Significance of early and late positive responses to insulin hypoglycaemia in patients with intact vagi

Acid secretion in relation to recurrence of duodenal ulcer after vagotomy and drainage

“…Furthermore, patients who have not developed a recurrent ulcer despite a positive Hollander response were also distributed equally between the two groups of responders. This finding is in accordance with that of Burns, Cheng, Cox, Payne, Spencer, and Welbourn (1969), who studied IOO patients with unoperated duodenal ulcer, found 37 per cent with a 'late positive' response, and concluded that the division into 'early' and 'late' responders was artificial. It must be emphasized, however, that the peak acid output to pentagastrin of early responders in the present study was greater than that of late responders, a finding which is in agreement with that of Giles, Mason.…”

“…Blood-glucose was determined by the Autoanalyzer method of Wincey and Marks, Statistical Methods.-Student's t-test for paired and unpaired data was used where appropriate. Data for males and females have been pooled because there were so few females, even though our previous study (Spencer, Burns, Cheng, Cox, and Welbourn, 1969) had shown significant differences between the sexes in their response to insulin. Patients who were Hollander positive at the first test but have not developed symptoms of a recurrent ulcer have not been tested again.…”

Propranolol and Serum Gastrin in Postvagotomy Insulin Tests

“…Certain observations suggest further that before vagotomy acid output is not only higher absolutely during insulin stimulation but also that an increment occurs within the first 90 min as opposed to the first 120 min [1,7]. Taken together with our studies, the observations suggest (1) that acid out put increments beyond 90 min have little relationship to vagus; (2) that acid output after 90 min may bear more relationship to circulating gastrin than that before 90 min; (3) that if any acid output increments, over fasting, during the insulin test heavily depend on vagal integrity, they must be confined to those in the first 90 min after insulin, and (4) that even those increments of acid output are partly dependent on ¡3-adrenergic factors.…”

Comparison of the Gastric Acid Responses to Pentagastrin and Insulin Hypoglycemia in Male and Female Ulcer Patients

“…In clinical research this test should in our opinion be carried out preoperatively also to evaluate quantitatively the effect of vagotomy on vagally (insulin) induced secretion. A preoperative insulin test is also essential since there are reports of absent [2,10,13,17] or 'late' [22] appearing responses in unoperated patients [2,10], In the present study, insulin hypoglycemia stimulated acid secretion in all patients according to our criterion [6], In 2 male patients (one with duodenal and one with pre pyloric gastric ulcer) the difference between the PAO30 to insulin and the highest 30-min basal acid output was small, or only 0.6 and 0.9 mEq, respec tively. According to the criteria of Hollander [12], insulin hypoglycemia produced no acid response in these 2 patients.…”