Duodenojejunostomy in gastric operations for postbulbar duodenal ulcer

In two cases, two different techniques of duodenojejunostomy were employed as an alternative to an insecure closure of the "difficult duodenal stump." The arrangements are either duodenojejunostomy Roux-en-Y or isoperistaltic jejunal interposition. A single-layered suture line is employed. The ampulla of Vater is visualized during the construction of these anastomoses. In addition to obviating a tenuous stump closure, this technique has the theoretical advantage of providing internal drainage.

Dilation of esophageal strictures. A new technique controlled by fiberoptic endoscopy

Dilation of peptic esophageal strictures visually controlled by means of fiberoptic endoscopy was carried out in 16 patients. The dilation was performed by passing the woven silk bougies alongside the endoscope, so that the process could be observed in detail. The technique affords a better view of the procedure because of a wider visual angle and because the field of vision is not blocked by the bougie, as would be the case with the rigid endoscope. The size of the bougie employed is not limited by the size of the endoscope. All 16 patients, with and without subsequently undergoing Nissen fundoplication, were able to eat a normal diet after therapy.

New procedures. Improved technique for placement of intestinal feeding tube with the fibreoptic endoscope

A feeding tube can be rapidly introduced into the small intestine through a makeshift 'external channel' of the fibreoptic endoscope. To prevent dislodgement of the feeding tube upon withdrawal of the endoscope, the former may be stabilized by means of the biopsy forceps introduced through its regular channel.

Hydrogen ion transport in the rabbit esophagus

The lumen of the rabbit esophagus was perfused in vivo with solutions (one solution per esophagus) containing 0-160 mM HCl by a constant circulation technique for 5 h. During the 1st h, net H+ flux out of the lumen (efflux) was minimal at H+ concentrations of 80 mM or less, but increased linearly with increase in luminal H+ concentrations above 80 mM. After 3 h, the net H+ efflux increased proprtionately to increasing H+ concentrations above a threshold of 20 mM. At the 5th h a linear relationship between net H+ efflux and luminal concentration was seen at all concentrations. Histological damage accompanied increase in H+ efflux and correlated with luminal acid concentrations and duration of exposure. We conclude that the rabbit esophageal mucosa is essentially impermeable to H+ below a threshold concentration of 80 mM for up to 1 h of exposure. When exposure is prolonged, this threshold steadily decreases with time. The occurrence of passive H+ diffusion above threshold concentrations most probably results from an increase in mucosal permeability, possibly an initiating event in the genesis of esophagitis.