The choice of operation in the surgical treatment of chronic duodenal ulcer remains a controversial subject. Partial gastrectomy is now performed less frequently, as surgeons are increasingly attracted to the advantages of vagotomy, which effects a substantial reduction of gastric-acid secretion in most cases. Recurrent ulceration appears to be more common after vagotomy than after partial gastrectomy, but this disadvantage of vagotomy is balanced and possibly outweighed by the higher post-operative mortality rate after partial gastrectomy. The major criticism of partial gastrectomy is that it leads to an unacceptably high incidence of late complications, which include alimentary symptoms such as postprandial abdominal discomfort, dumping, and vomiting, and also impaired nutrition manifested by loss of weight, anaemia, and more rarely osteomalacia. Although agreement is not complete, many publications support the contention that untoward alimentary symptoms are comparatively infrequent after vagotomy. However, there is remarkably little information in the literature to substantiate the view that impaired nutrition is rare after vagotomy. In order to provide data relevant to this latter problem, this paper reports the results of a study of patients after vagotomy and gastrojejunostomy for chronic duodenal ulcer.Vagotomy has been extensively used in Sheffield since 1958, and the interval between operation and the present review varied between 37 and 57 months in the patients studied; we have therefore considered the results as representing a post-operative investigation at approximately four years. A gastric drainage procedure must be performed simultaneously with vagotomy, which by itself causes a high proportion of symptoms due to delayed gastric emptying. Gastrojejunostomy was combined with vagotomy in the present series, and the patients having pyloroplasty in the period under consideration have not been included as they were too few to merit detailed investigation. The study was designed to give as much information as possible without requiring more co-operation than could reasonably be expected from our patients. The tests were therefore restricted to peripheral blood examination, estimation of serum-iron and serum-vitamin-B12 levels, and measurement of vitamin-B1, absorption and faecal fat excretion. In addition, the patients were asked about alimentary symptoms and weight changes before and after operation. Insulin tests to confirm completeness of vagotomy were not performed in all patients, but a recent study from this department suggests that vagal-nerve section was achieved in approximately 90% of patients (Ross and Kay, 1964 Clinical MaterialFrom a consecutive series of 120 patients with chronic duodenal ulcer treated by vagotomy and posterior gastrojejunostomy approximately four years previously, 25 were excluded because of death (5), reoperation (7), failure to attend (7), and distance from Sheffield (6). The 95 patients remaining for detailed investigation were 75 males and 20 females. Some were un...

SYNOPSIS A method for the routine determination of urinary pregnanediol by gas-liquid chromatography is presented. By applying the samples automatically to the chromatograph overnight, batches of up to 25 samples can be easily handled. The method described is compared with that of Klopper, Michie, and Brown (1955).The output of urinary pregnanediol in late pregnancy is being used increasingly as an index of placental activity. The method generally employed is that of Klopper, Michie, and Brown (1955); this is lengthy and includes two column chromatographic stages. The estimation of pregnanediol by gas chromatography after extraction of hydrolysed urine has been reported but this method has not lent itself to routine batch analysis in the past because of the need to apply specimens singly to the colunm at intervals. The development of a device for the automatic application of samples to the chromatogram now allows a batch of 25 samples and standards to be loaded into the apparatus and fed to the chromatograph automatically at pre-set intervals throughout the night (Podmore, 1965).For comparison results are presented on 108 urine specimens determined by the method of Klopper et al. (1955), and the gas-liquid chromatographic method described. METHODS AND MATERIALSAnalyses were performed by the gas-liquid chromatographic method described below on 24-hour samples of urine obtained chiefly from pregnant women. The pregnanediol output was also determined by the routine method of Klopper et al. (1955) GAS-LIQUID CHROMATOGRAPHIC METHOD To 5 ml. urine in a glass-stoppered test tube is added 0 75 ml. ION hydrochloric acid. After standing in a boiling water bath for 12 min. the mixture is cooled and 5 ml. toluene added, the tubs stoppered, mechanically shaken for 10 min. and the layers allowed to separate, centrifuging if necessary. Three ml. of the toluene layer is evaporated to dryness in a test tube by standing in a water-bath at 70 to 80°C. and directing a current of nitrogen or air onto the surface. The use of a manifold with multiple nitrogen jets allows a whole batch to be evaporated simultaneously. The residue is dissolved in 1 ml. warm benzene, 1 ml. of acetyl chloride is added, and the mixture is allowed to stand for one hour at 20 to 25°C. The tube is then replaced in the bath at 70'C. and evaporated once more as described above. The dry residue is dissolved in 1 ml. benzene.Fifty pl. of each of the extracts are pipetted into small tinplate cylinders (16 x 4 mm.) and the solvent allowed to evaporate. Standards containing pregnanediol in the range 1 to 5 pg. are provided by appropriate amounts of a pregnanediol diacetate solution in similar cylinders. A control standard, containing 4 pg. of pregnanediol, is run at intervals of 10 specimens so that a compensation can be made if any variation of response occurs over the run. The batch of sample cylinders is loaded into the automatic application device and argon connections are made. Electromagnetically, sample containers are fed to and removed from the flash heater...

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