One hundred and seventy-six patients scheduled for elective major abdominal surgery were randomized to two prophylactic regimens to prevent postoperative thromboembolism. All patients were screened with the 125I-labelled fibrinogen uptake test, and thromboembolism was verified by ascending phlebography and/or perfusion/ventilation lung scintigraphy. In the group of patients receiving low-dose heparin treatment (5000 units twice daily subcutaneously) 12 per cent developed thromboembolic complications. In the other group, where low-dose heparin treatment was supplemented with graded compression stockings only 2 per cent developed thromboembolism. It is concluded that the combination of low-dose heparin and the use of graded compression stockings is superior to heparin alone in preventing thromboembolism following major abdominal surgery.

Factors thought to be important in the development of recurrent ulcer after proximal gastric vagotomy were investigated 1-4 years after operation in 211 patients with duodenal ulcer and in 49 with pre-pyloric ulcer. Recurrent ulcer was found in 25 patients with duodenal ulcer (12 per cent) and in 6 with pre-pyloric ulcer (12 per cent). Recurrence was not related to age, sex, duration of dyspepsia, radiological findings or peak acid output before and 10 days after vagotomy. Fifty-six patients were operated upon by the method of Amdrup and Jensen (1970), including skeletonization of about 2 cm of the oesophagus. The remaining 204 patients were operated on by a technique in which the dissection of the lesser curve was begun at the 'crow's foot' and the oesophageal dissection was extended, in most cases, to more than 4 cm above the cardia. Recurrence was more frequent among the 56 patients in the first group than among the remaining patients with duodenal ulcer. Recurrence was positively related to basal acid output after vagotomy. An increase of peak acid output of 50 per cent was seen in a smaller group with recurrence and patients with dyspepsia within 18 months of vagotomy. It was concluded that the risk of recurrence is not related to the number of parietal cells, as expressed by peak acid output to histamine. The risk may probably be reduced by extension of the oesophageal skeletonization. A marked increase in peak acid output may be seen during the first year after proximal gastric vagotomy in patients with recurrence or dyspepsia.

No abstract

No abstract