A European state of the art in the treatment of gastric cancer is presented from the results of a questionnaire. Data were obtained from 62 centers, 60% of which were from abroad and 40% of which were from Germany, reporting a total of 16,594 patients. A feature was a low portion (8.8%) of early cancer. The operation preferred was total gastrectomy. Only in the case of antral carcinoma of the intestinal type, according to Laurén, would the majority perform subtotal gastrectomy. Staging of lymph nodes was performed by 84% of these centers; however, systematic radical dissection was carried out only by 27%. The preferred type of reconstruction after total gastrectomy was Roux‐en‐Y esophagojejunostomy; 16% of the European centers used some type of pouch in addition. Splenectomy was carried out depending on location of the tumor. The median in‐hospital mortality for early cancer was 0; for carcinoma of the antrum, 6.7%; corpus, 9.6%; and gastroesophageal junction, 11.7%. The median 5‐year survival rate in patients with early cancer was 82.5%; for advanced cancer of the antrum, 30.7%; corpus, 24%; and gastroesophageal junction, 15.5%. Ten‐year survival was 6–10% less. It is concluded that in Europe there is a high rate of advanced gastric cancer affecting the results. Improved results may be expected if gastric cancer can be detected earlier and if there is radical lymph node dissection. Generally, prospective randomized studies presented by standardized documentation and statistics are urgently needed.

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The influence of synthetic bradyklnin (BK) on disturbed protein and carbohydrate metabolism was studied in chemical and manifest maturity-onset diabetics, in surgical patients and in alloxan diabetic rats. BK, mixed with insulin and injected subcutaneously twice dally in alloxan diabetic rats lowered the morning blood glucose concentration in a dose-dependent way, whereas in a control group treated wlth insulin only no decrease was seen. Accelerated local blood flow or enhanced vascular permeability as a cause of increased glucose uptake eould be ruled out by control experiments using papaverlne and eledoisln. Better metabolic control in the BlfJinsulin-treated group was also indleated by lower arterial levels of free fatty acids and of flhydroxybutyrate, normalized hepatic glycogen content and better growth of body weight. In healthy man an intravenous infusion of BK (80 gg/h) did not influence normal fasting blood glucose concentrations, whereas elevated glucose levels in maturity-onset diabetics were continuously reduced within 100 min by 12.2 __ 1.4%. A comparable diabetic group receiving saline alone showed no spontaneous drop of blood glucose concentration. An improvement of pathological carbohydrate metabolism by infusion of BK i.v. could also be demonstrated using the intravenous glucose tolerance test in chemical and manifest maturlty-onset diabetics and in surgical patients: in all groups k values of the glucose tolerance test were significantly increased by BK. This effect was neither due to stimulated insulin release nor to changed glucose pool or to increased renal glucose loss, which was even reduced by BK. Interestingly, normal k values in healthy volunteers were not further improved by BK. A stimulated protein breakdown, which occurs after surgery due to peripheral insulin resistance, can also be restricted by intravenous infusion of BK: in surgical patients urinary nitrogen excretion was reduced by 50% during infusion of BK and was accelerated again after cessation of the infusion. These results indicate that BK can improve the efficacy of exogenous insulin in insulin-deficlent animals and depressed insulin sensitivity in maturity-onset diabetics and surgical patients.