In three centres, 222 patients (Birmingham 70, London 87 and Rotterdam 65 patients) with chronic duodenal ulcer were treated by proximal gastrict vagotomy (PGV) (116 patients) or truncal vagotomy and antrectomy (TVA) (106 patients) in a prospective randomized trial. After 1 year 5 recurrent duodenal ulcers (4.3 per cent) have been recorded in the PGV group, compared with 1 (1 per cent) in the TVA group. The reoperation rate was high in both groups-6 after PGV, usually for recurrent ulcer, and 7 after TVA, mostly for gastric retention. PGV showed a marked superiority in the number of patients with a good clinical result Visick I or II) at 1 year after operation, i.e. 82 per cent compared with 56 per cent for TVA.

In a prospective, randomized study 145 patients with duodenal ulcer have been followed 5-7 years after proximal gastric vagotomy (PGV) or truncal vagotomy with antrectomy (TVA). Postoperative complications were significantly higher after TVA (P less than 0.0005). There was one death due to anastomotic leakage after TVA. The recurrence rate was significantly higher after PGV (9.9 per cent). Postoperative symptoms were less after PGV (P less than 0.01). Due to the recurrence rate after PGV there was no overall significant difference in the Visick grading, although perfect results (Visick I) were seen significantly more often (P less than 0.01). It is concluded that better results follow PGV.

One hundred and thirty insulin infusion tests (dose 0.05 u kg-1h-1) were carried out in 87 patients with peptic ulcer or after a vagotomy. During the test ECG tracings were taken and blood was sampled for blood glucose and serum potassium determination. In 31% of the tests electrocardiographic changes were seen. The cardiovascular effects were supraventricular and ventricular ectopic beats, ST-T changes and U waves. In 2 tests there were potentially dangerous arrhythmias. A significant relationship was seen between ECG abnormalities and the age of the patients. Such a relationship was not present between ECG changes and glucose and potassium values. It is concluded that the insulin infusion test is probably safer than the conventional Hollander test, but constant monitoring is still required.