Congo Red Testing Research Articles

Evaluation of abdominal fat pad aspiration highlighting challenges to interpretation

Fine-needle aspiration (FNA) of abdominal fibroadipose tissue is a commonly utilized method for the detection of amyloidosis. While generally regarded as an accurate and specific detection method, the sensitivity is variable. The objective of this study was to investigate the performance of fat pad FNAs in detecting amyloidosis relative to other tissue biopsies. Fat pad FNA results from January 1, 2014, to December 31, 2022, were catalogued. Clinical data including FNA indication were ascertained for each case. The results of any subsequent tissue biopsy/biopsies evaluated for amyloidosis by Congo red staining were also assessed. Challenges to diagnostic interpretation were explored. A total of 334 fat pad FNAs were identified. The most common indications were peripheral neuropathy (29.3%), cardiomyopathy/heart failure (28.1%), monoclonal gammopathy (27.8%), and multiple myeloma/lymphoplasmacytic lymphoma (21.0%). Cytologic interpretations were: 7 (2.1%) nondiagnostic, 284 (85.0%) negative, 18 (5.4%) indeterminate, 16 (4.8%) suspicious, and 9 (2.7%) positive for amyloid deposition. In our sample, 103 (30.8%) patients had Congo red testing performed on a subsequent surgical specimen(s) including: 3 of 7 of nondiagnostic cases, none which were positive on the subsequent surgical; 70 of 284 negative cases, 27 which were positive on the subsequent surgical; 11 of 18 indeterminate cases, 7 which were positive on the subsequent surgical; 13 of 16 suspicious cases, 2 which were positive on the subsequent surgical; and 6 of 9 positive cases, 3 which were positive on the subsequent surgical. Challenges to FNA interpretation included scant cellularity, focal staining/birefringence, and overstaining. It is best to view fat pad aspiration versus other tissue biopsy results as complimentary diagnostic tests that should be interpreted in the context of the clinical setting and overall clinical suspicion for amyloidosis.

Structural properties and anti-inflammatory activity of purified polysaccharides from Hen-of-the-woods mushrooms (Grifola frondosa).

Grifola frondosa is an edible medicinal mushroom that has been proven to have a variety of health benefits. The main active ingredients of this mushroom are polysaccharides. In this study, ultrasonic-assisted extraction was used to obtain crude Grifola frondosa polysaccharides (GFPs). Then, purified GFP was obtained after purification. The optimum extraction conditions were an extraction time of 71 min, an extraction temperature of 90°C in a solid-to-liquid ratio of 1:37 g/mL, and an ultrasonic power of 500 W. GFP was purified using DEAE-52 and Sephadex G-100. The structural characterization of GFP was performed using Fourier transform infrared spectroscopy (FT-IR), X-ray diffraction (XRD), ion chromatography (IC), and ultraviolet (UV) visible photometry. The morphology of GFP was analyzed by scanning electron microscopy (SEM), thermogravimetric differential scanning calorimetry (TG-DSC), and Congo red testing. In addition, the administration of GFP in oxazolone (OXZ)-induced ulcerative colitis (UC) in mice was found to prevent weight loss. Different doses of GFP (80, 160, and 320 mg/kg body weight) were used, and sulfapyridine (SASP) was used as a positive control (370 mg/kg body weight) for the treatment of OXZ-induced UC. After treatment, the mice were killed, and blood and colon tissue samples were collected. GFP was found to prevent decreases in colon length and the levels of leukocytes, platelets, and neutrophils in UC mice. Moreover, GFP also decreased the expression of pro-inflammatory cytokines [tumor necrosis factor (TNF)-α and interleukin (IL)-1 β], increased IL-10, and reduced colon injury in UC mice. The results showed that Under these conditions, the predicted polysaccharide yield was 21.72%, and the actual extraction rate was 21.13%. The polysaccharide composition (molar ratio) was composed of fucose (0.025), glucosamine hydrochloride (0.004), galactose (0.063), glucose (0.869), and mannose (0.038). GFP was also found to have a typical absorption peak, and the GFP extracted using the ultrasound-assisted extraction protocol was mainly β-glucan. These results indicate that ultrasound-assisted extraction of GFP could reduce OXZ-induced intestinal inflammation as a promising candidate for the treatment of UC, with the potential for development as a food supplement to improve intestinal diseases.

Selective fermentation of Lactobacillus delbrueckii ssp. Bulgaricus SRFM-1 derived exopolysaccharide by Lactobacillus and Streptococcus strains revealed prebiotic properties

Abstract The prebiotic potential of exopolysaccharide (r-EPS) structures released from Lactobacillus delbrueckii ssp. bulgaricus SRFM-1 was assessed using in vitro fermentations. Fermentations with pure cultures of Lactobacillus (nine strains) and a Streptococcus strain as well as two food-borne pathogenic Escherichia coli were performed. Scanning electron microscopy and Congo red testing revealed that the three r-EPS fractions had different individual structures. All r-EPS fractions were found to stimulate the growth of the lactobacilli and the Streptococcus strain and inhibit the growth of the E. coli strains. Additionally, the primary structure including molecular weight, monosaccharide composition and glycosidic linkages and the individual structures of three r-EPS fractions were found to influence the μmax and cell density of these strains. The results strengthen previous studies on the r-EPS from L. delbrueckii ssp. bulgaricus SRFM-1 and provide additional validation of r-EPS as a potentially novel prebiotic for incorporation in functional foods.

Isolation and characterization of Soil Termites (Macrotermes gilvus) cellulolytic bacteria and activity determination of cellulase enzyme on newsprint substrates

The study aims to explore and identify cellulolytic bacteria of termites that have the potential to cellulose hydrolysis on newsprint into glucose. The cellulolytic bacteria are characterized by the formation of clear zones in the medium agar containing newsprint paper after 0.1% Congo red testing. The isolates that produce large clear zones are identified by the type of bacteria. Identification of bacteria morphologically in colonies, gram staining and biochemical tests. The activity of cellulose enzyme based on concentration of reducing sugar (glucose) produced from the cellulose hydrolysis on newsprint was tested by 3.5-dinitrosylicyl reagent using a UV-Vis spectrophotometer. The results showed that 6 cellulolytic bacterial isolates through the Congo red test, 2 isolates that have a large diameter of the clear zone are: Isolates C1 and D1 4.27 cm and 2.05 cm, respectively. Cellulase enzyme crudes of isolates C1 and D1 have an enzyme activity of 15.7 mU/mL and 2.33 mU/mL, protein concentration of 0.35 mg/mL and 1.18 mg/mL with specific activity of 45.17 mU/mg protein and 1.98 mU/mg protein. Based on the observation of the colony’s morphology in macroscopy, microscopy and biochemical test results, an isolate of C1 is the Provedencia sp and D1 isolate is the Bacillus sp.

Hyper-Productivity, Characterization, and Exploitation of a Cellulase Complex from a Novel Isolate of Aspergillus tubingenesis S2 using Lignocellulose-based Material

The hyper-production potential of a cellulase complex from a local strain of Aspergillus tubingensis S2, indigenously isolated from rotten tomato, was investigated. A total of nine fungal species of Aspergillus and Trichoderma were isolated and confirmed through triple-phase screening via 18S ribosomal DNA sequencing and construction of a phylogenetic tree. Congo red testing and the zone of clearance method were used to confirm the cellulase production from A. tubingenesis S2 isolate. A. tubingenesis S2 revealed maximum cellulase production (78 µg/mL/min) and was selected for further study. The optimum fermentative conditions, including the incubation period, pH, and temperature values, were determined to be 96 h, pH 4.8, and 40 °C, respectively, for obtaining the cellulase activity of 86.4±2.1 µg/mL/min. The cellulase was 5.14-fold purified by ammonium sulfate fractionation and gel permeation chromatography. Characterization revealed that maximum activity (130.5 µg/mL/min and 133.5 µg/mL/min) was achieved at 4.5 pH and 40 °C, respectively. A monomeric protein with an apparent molecular weight of 76 kDa was evident after sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Cellulase revealed maximal activity with 40-mesh size corn stover as compared with 20-mesh size corn stover and 80-mesh size corn stover after 36 h of incubation at 40 °C.

Insights into the use of zinc–mannitol alkoxide as a novel thermal stabilizer for rigid poly(vinyl chloride)

ABSTRACTZinc–mannitol alkoxide (Zn–Man) was synthesized through alcohol exchange reaction, and investigated by means of Fourier transform infrared spectroscopy and elemental analysis. The thermal stability of Zn–Man for rigid poly(vinyl chloride) (PVC) was evaluated by Congo red testing, conductivity measurements, thermal aging testing, thermogravimetric analysis (TGA), and ultraviolet–visible (UV–vis) spectroscopy test. The experimental results demonstrate that the addition of Zn–Man not only apparently prolonged the static thermal stability time to approximately 96.5 min but also evidently improved the initial color of PVC. More importantly, the color of the PVC sheets stabilized with Zn–Man did not change to black within 180 min; this showed that no zinc‐burning phenomenon occurred. In addition, the results of TGA reveal that Zn–Man raised the initial degradation temperature of PVC to about 273.4°C. UV–vis testing indicated that the presence of Zn–Man decreased the content and shortened the length of the conjugated double bonds of PVC. The possible thermal stability mechanism is discussed. © 2015 Wiley Periodicals, Inc. J. Appl. Polym. Sci. 2015, 132, 42038.

Influence of nano-CeO2as Co-stabilizer on the thermal stabilization efficiency of novel calcium/Zinc soap stabilizers for poly(vinyl chloride)

The novel organic calcium (Ca)/zinc (Zn) stabilizer of poly(vinyl chloride) (PVC) was synthesized from poly (zinc methylacrylate) and Ca adipate. The influences of Zn/Ca soap weight ratios and nano-CeO2 as co-stabilizer on the thermal stability of PVC were investigated. Congo red testing, thermogravimetric analysis, dynamic rheology, and dynamic mechanical analysis of the mixtures were performed. The results show that the novel stabilizer has good stabilization efficiency on PVC. When 5 phr (parts by weight per hundred parts of resin) of novel stabilizer (weight ratio of Zn/Ca soap is 6/4) in 100 phr of PVC is used as stabilizer, the Congo red time can reach 192 min, which is 131 min longer than 5 phr of the mixture of 3 phr of Zn stearate and 2 phr of Ca stearate as stabilizer. If 3 phr of mixture of Zn methylacrylate with Ca adipate (weight ratio of Zn/Ca soap is 4/6) and 2 phr of nano-CeO2 are used as co-stabilizers, the Congo red time is 205 min. The combination of nano-CeO2 with Ca/Zn soap stabilizer shows an obvious improvement for the thermal stability of the PVC. J. VINYL ADDIT. TECHNOL., 20:243–249, 2014. © 2014 Society of Plastics Engineers

Homozygosity for the V122I Mutation in Transthyretin Is Associated with Earlier Onset of Cardiac Amyloidosis in the African American Population in the Seventh Decade of Life

Individuals heterozygous for the V122I mutation in transthyretin (TTR) tend to develop cardiac amyloidosis, often after the seventh decade of life. Although homozygotes have been reported, these have typically been single case reports. We report a cohort of 13 V122I homozygotes. TTR gene sequencing results from the Mayo Clinic Molecular Genetics Laboratory between September 2004 and January 2013 were reviewed; 177 heterozygotes and 13 homozygotes for the V122I alteration were identified. Detailed clinical history was available for the 24 heterozygotes seen at Mayo Clinic. We compared age at onset of disease for this group to homozygotes, both alone and pooled with the 11 homozygotes from the literature. Individuals with homozygous V122I manifested symptoms a mean of 10 years earlier than heterozygotes (63.8 ± 5.7 versus 72 ± 8.1 yrs, P = 0.0002). Further, males were significantly overrepresented in both heterozygous and homozygous individuals. There was a trend for an even higher male bias in the homozygous group. All 24 homozygotes were African American, whereas four of the heterozygotes were reported as white. Two novel V122I compound heterozygotes were also identified, with clinical presentation in the late fifth or early sixth decade of life. This study is the largest homozygous V122I cohort reported and demonstrates association with earlier age at onset. It also highlights the uncertain penetrance, particularly with respect to sex.

Metal lanolin fatty acid as novel thermal stabilizers for rigid poly(vinyl chloride)

The synergistic stabilization effect of different metal lanolin fatty acids as natural-based thermal stabilizers for poly(vinyl chloride) (PVC) including calcium lanolin fatty acid (Calan 2), zinc lanolin fatty acid (Znlan 2) and lanthanum lanolin fatty acid (Lalan 3) were studied through Congo red testing, color measurements, FTIR analyses and thermal behavior in this paper. The results showed that Lalan 3/Calan 2/Znlan 2 stabilizers exhibited more excellent thermal stabilization efficiency to PVC than Calan 2/Znlan 2 thermal stabilizers, and the optimal mass ratio of Lalan 3/Calan 2/Znlan 2 was 8:9:3. At last, the effect of degradation mechanism on PVC and synergistic stabilization was also investigated by FTIR analyses and thermal behavior.

Laparoscopic adjustable gastric banding with truncal vagotomy: any increased weight loss?

Laparoscopic adjustable gastric banding (LAGB) causes weight loss primarily through a mechanical restrictive mechanism. The vagus nerve provides connections between the brain and the gut through afferent and hormonal signals that regulate fullness and satiety. Published studies demonstrate clinically significant weight loss by subjects undergoing open surgical truncal vagotomy for ulcer disease and morbid obesity. This study aimed primarily to evaluate the safety and efficacy of adding truncal vagotomy to LAGB and to compare the weight loss with that of LAGB alone. This open-label case-controlled study was conducted at Central Carolina Surgery, PA, a private bariatric surgery practice in Greensboro, North Carolina. Since May 2006, 49 subjects with classes 2 and 3 obesity have undergone LAGB with truncal vagotomy. The anterior and posterior nerves were divided and resected just below the diaphragm and sent to pathology. The primary safety variable was the number of procedure-related adverse events. The primary efficacy variable was the percentage of excess weight loss (%EWL). Completeness of vagotomy was assessed by direct inspection, microscopic confirmation, and endoscopic Congo red testing after intravenous Baclofen stimulation. For the ongoing comparison, 49 cohorts were matched for age, sex, and preoperative body mass index (BMI). At enrollment, the average BMI was 45 kg/m(2), and the average age was 46 years. No intraoperative or unanticipated adverse events occurred. All the subjects were discharged in 24 h less. One case of incomplete vagotomy was confirmed via pathologic evaluation. The LAGB plus vagotomy group had an average EWL of 38% at an mean of 34 months after surgery, and the cohort group had an average EWL of 36% at a mean of 36 months after surgery. All the vagotomy patients reported an absence of hunger. No diarrhea, no significant gastric outlet obstruction, and no dumping were seen. The study data do not support the hypothesis that vagotomy added to LAGB enhances weight loss.

Postoperative function following laparoscopic collis gastroplasty for shortened esophagus.

Collis gastroplasty is indicated when tension-free fundoplication is not possible. Few studies have described the physiological results of this procedure, and no studies have evaluated outcomes of the endoscopic approach. To assess the long-term outcomes of patients treated with laparoscopic Collis gastroplasty and fundoplication. Case series. Tertiary care teaching hospital and esophageal physiology laboratory. Fifteen consecutive patients with refractory esophageal shortening diagnosed at operation. Complicated gastroesophageal reflux disease or type III paraesophageal hernia (or both) was preoperatively diagnosed with esophagogastroduodenoscopy, 24-hour pH monitoring, esophageal motility, and barium esophagram. Fourteen (93%) of the 15 patients were available for long-term objective follow-up. Laparoscopic Collis gastroplasty with fundoplication and esophageal physiological testing. Preoperative and postoperative symptoms, operative times, and complications were prospectively recorded on standardized data forms. Late follow-up at 14 months included manometry, 24-hour pH monitoring, and esophagogastroduodenoscopy with endoscopic Congo red testing and biopsy. Presenting symptoms included heartburn (13 patients [87%]), dysphagia (11 patients [73%]), regurgitation (7 patients [47%]), and chest pain (7 patients). An endoscopic Collis gastroplasty was performed, followed by fundoplication (12 Nissen and 3 Toupet). There were no conversions to celiotomy and no deaths. Long-term follow-up occurred at 14 months. Esophagogastroduodenoscopy revealed that all wraps were intact with no mediastinal herniations. Manometry demonstrated an intact distal high-pressure zone with a 93% increase in resting pressure over the preoperative values. Two (14%) of these patients reported heartburn, and 7 (50%) patients had abnormal results on postoperative 24-hour pH studies (mean DeMeester score, 100). Biopsy of the neoesophagus revealed gastric oxyntic mucosa in all patients. Endoscopic Congo red testing showed acid secretion in only those patients with abnormal DeMeester scores. Of these 7 patients, 5 (36%) had persistent esophagitis and 6 (43%) had manometric evidence of distal esophageal body aperistalsis that was not present preoperatively. Collis gastroplasty allows a tension-free fundoplication to be performed to correct a shortened esophagus. It results in an effective antireflux mechanism but can be complicated by the presence of acid-secreting gastric mucosa proximal to the intact fundoplication and a loss of distal esophageal motility. These patients require close objective follow-up and maintenance acid-suppression therapy.

Evaluation of benzalkonium chloride chemoneurolytic proximal gastric vagotomy

Transmucosal chemoneurolytic injection of benzalkonium chloride (BAC) has previously been shown to duplicate operative proximal gastric vagotomy (PGV) in controlling gastric acid secretion. In this study, BAC was evaluated as to efficacious dose, methods of delivery, and systemic toxicities. Sham celiotomy, operative PGV controls, transmucosal injections through a gastrotomy, and transserosal injections of BAC (saline controls, 0. 625, 1.25, 2.5, 5.0, 10 mg BAC/kg body wt) were administered to Sprague-Dawley rats. After 3 months the rats underwent Congo red testing (CRT), horseradish peroxidase (HRP) neuronal staining, and necropsy. The color density change of the gastric mucosa from basic to acidic demonstrated by the CRT at the time of necropsy was used to calculate the residual anatomic acid-secreting area. Prior to necropsy, subserosal HRP injections into the anterior and posterior stomach walls assayed vagal neuronal viability via retrograde axonal flow. Results were compared by an ANOVA. The results demonstrated that 1.25-10 mg/kg transmucosal BAC replicated the results of operative PGV; 2.5 mg/kg was found to be the most effective dose. All injection groups including saline controls demonstrated similar diminished vagal retrograde axonal flow by HRP testing consistent with local BAC chemoneurolytic effects. No systemic toxic symptoms were observed after tail vein intravenous BAC 1.25, 2.5, and 5.0 mg/kg. These efficacy studies have demonstrated BAC's potential utility in the performance of endoscopic transmucosal chemoneurolytic PGV.

Proximal Gastric Vagotomy

The authors compared open and laparoscopic proximal gastric vagotomies for efficacy of acid reduction and preservation of gastric emptying. Laparoscopic methods have been used to perform vagotomy in patients with duodenal ulcer; however, no direct comparisons are available of laparoscopic and open surgical procedures regarding acid reduction and gastric emptying. Thirty-one consecutive dogs were randomized to open proximal gastric vagotomy (OPGV; n = 11), laparoscopic anterior seromyotomy and posterior truncal vagotomy (ASPTV; n = 10), or laparoscopic proximal gastric vagotomy (LPGV; n = 10). Intraoperative endoscopic Congo red testing assured complete vagotomy. Basal acid output (BAO) and maximal acid output (MAO) during pentagastrin and insulin-induced hypoglycemia were measured with marker dilution techniques, and gastric emptying was assessed with radionuclide-labelled solid and liquid markers before and 5 weeks after operation. Operative time (mean +/- standard error of the mean) for OPGV was shorter compared with ASPTV and LPGV (86 +/- 7 minutes vs. 124 +/- 7 minutes and 115 +/- 7 minutes; p < 0.002). Postoperative BAO did not decrease in any group. Open proximal gastric vagotomy and LPGV, but not ASPTV, decreased MAO (p < 0.05); (after pentagastrin, OPGV from 26.4 +/- 1.7 mEq/hour to 11.3 +/- 0.1 mEq/hour, LPGV from 21.4 +/- 1.0 mEq/hour to 6.4 +/- 0.5 mEq/hour; after insulin-induced hypoglycemia, OPGV from 9.9 +/- 0.5 mEq/hour to 2.2 +/- 0.3 mEq/hour, LPGV from 7.9 +/- 0.5 mEq/hour to 1.9 +/- 0.4 mEq/hour). Gastric emptying of liquids and solids, as quantitated by the time for one half of the marker to empty (T 1/2) and the shape of the emptying curve, were similar before and after all three surgical procedures. Laparoscopic proximal gastric vagotomy was comparable to OPGV in decreasing stimulated gastric acid production without significantly altering gastric emptying. Anterior seromyotomy and posterior truncal vagotomy was less effective in decreasing MAO and required more operative time. Laparoscopic proximal gastric vagotomy has the potential to become accepted therapy for patients with duodenal ulcer managed presently with OPGV.

POSTOPERATIVE RECURRENT ULCER

Figure 2 summarizes my evaluation of most patients with postoperative recurrent ulcers. First, serum gastrin and calcium levels should be determined in all patients. At the initial endoscopy, any silk sutures should be removed, and gastric ulcers biopsied. The presence of gastric ulcers or evidence of delayed gastric emptying should influence the surgical procedure. Ideally, a Congo red test should be performed at the initial endoscopy. The only caveat is that excessive sedation may invalidate the test results. If the initial diagnostic endoscopy does not include a Congo red test and serum gastrin and calcium levels are normal, it is reasonable to proceed with medical management without vagotomy testing. I believe that if medical management fails and operative treatment is planned, all patients should undergo vagotomy testing. If the Congo red test is definitively positive, sham feeding is not necessary. On the other hand, if the Congo red test suggests hyposecretion, I believe that sham feeding is mandatory prior to proceeding with operation. Conversely, sham feeding tests may be falsely negative in postoperative patients. Therefore, many of our patients undergo both Congo red testing and sham feeding prior to reoperation. Finally, if delayed gastric emptying is believed to be part of the clinical syndrome, a radionuclide scan should be performed to assess gastric emptying. It can be either a solid-meal study or an acetanilidoiminodiacetic acid scan, which measures bile reflux as well as determines emptying of bile from the fasted stomach (see introductory article in this issue).

Prospective comparison of Congo red and sham feeding testing to determine vagal innervation of the stomach

The purpose of this study was to validate Congo red (CR) testing as a means of determining the status of vagal innervation of the stomach after gastric surgery by comparing it with the sham feeding test (SF). Twenty-six patients with previous gastric operations were studied prospectively. The operations were vagotomy/antrectomy (n = 14), vagotomy/ antrectomy/Roux-en-Y anastomosis (n = 4), proximal gastric vagotomy (n = 3), vagotomy/pyloroplasty (n = 2), and antireflux (n = 3). In each case, the CR test was performed prior to the SF test so that the endoscopist was unbiased. The CR test solution was sprayed on the gastric mucosa through a wash catheter and immediately aspirated. A two-dimensional map of the endoscopist's conception of the red and black mucosa was drawn, and areas were calculated using a computerized scanner. The SF test was performed as described previously, with sham/peak ratios (sham feeding stimulated acid output [SAO]/peak acid output [PAO]) greater than 0.1 indicating a positive test, or incomplete vagotomy. The CR test was negative in 11 patients and positive in 15 patients. SF was negative in 16 patients (SAO/PAO of less than 0.1) and positive in 10 patients. The results correlated in 18 of 26 (69%) patients (p = not significant). Positive sham feeding tests and negative Congo red tests were more reliable, whereas negative sham feeding tests and positive Congo red tests were less reliable. Except patients with Roux-en-Y anastomosis, patients with negative or weakly positive CR tests did not have recurrent ulcers or other symptoms attributable to acid hypersecretion. The CR test was easier to perform and preferred by the patients. We conclude that both tests provide valuable clinical information and that both tests should be available in the evaluation of postgastrectomy patients.

Pros and cons of parietal cell versus truncal vagotomy

The reliability of parietal cell vagotomy as a primary procedure for duodenal ulcer is still questioned by many, and several surgeons advocate pyloroplasty in certain subgroups. Since the opening of our hospital in 1972, a randomized, prospective study has been under way. Sixty-seven patients were randomized into three groups: truncal vagotomy and Jaboulay pyloroplasty (Group 1), parietal cell vagotomy and Jaboulay pyloroplasty (Group 2), and parietal cell vagotomy without drainage (Group 3). The overall operative mortality was zero, with an 18 percent morbidity. Postoperative Congo red testing revealed truncal vagotomy to be a more reliable vagotomy, with 25 percent of Group 1 patients noted to have some degree of incomplete vagotomy compared with 36 percent of patients in Group 3 (p < 0.05). The ulcer recurrence in Group 1 was 4 percent, in Group 2 18 percent, and in Group 3 10 percent. No dumping or diarrhea was noted in Group 3 compared with Group 1 in which 4 percent of patients had dumping and 17 percent had diarrhea and Group 2 in which 14 percent of patients had dumping and 23 percent had diarrhea (p < 0.05). The higher incidences of recurrence and postoperative side effects obviously related to the pyloroplasty made parietal cell vagotomy with pyloroplasty the least desirable operative procedure. Parietal cell vagotomy is technically a more difficult procedure, but if performed satisfactorily, results in greater patient satisfaction, with 81 percent of the patients symptomfree compared with 63 percent of those who had truncal vagotomy and pyloroplasty.

The practicality of the Congo Red test, or is your vagotomy complete?

The use of Congo Red testing for adequacy of vagotomy in a variety of clinical situations is described. Its intraoperative use is presented for the first time, thus allowing the surgeon immediate documentation of the completeness of his vagotomy and hopefully averting incomplete vagotomy, the single most common cause of ulcer recurrence after vagotomy-pyloroplasty.