Ulcer In Man Research Articles

Influence of ascorbic acid on the healing of corneal ulcers in man.

Influence of ascorbic acid on the healing of corneal ulcers in man.

Question of the return of gastric secretion after complete vagotomy.

THE QUESTION of regeneration of the vagus nerves and return of gastric secretion after complete vagotomy has become of great clinical as well as scientific interest because of the widespread use of section of the vagus nerves as a method of treatment of various types of peptic ulcer in man. It seems highly probable that the beneficial effects of this operation are largely due to the marked reduction in the secretion of gastric juice both in the fasting stomach and as a result of the stimulation of food. Perhaps to a lesser extent some of the beneficial effects of vagotomy may be ascribed to a decrease in the hypertonicity and hypermotility of the stomach so frequently found in patients with duodenal ulcers. Accordingly, if vagotomy is to be of long-continued or permanent value in the treatment of peptic ulcer, the effects on secretion and motility ought to be long continued

Peptic ulcer in man. Part 3. Evaluation of ulcer therapy.

In order to evaluate properly a new antacid (Carmethose Ciba) developed in the laboratory at Michael Reese Hospital, criteria for such evaluation are presented: Any patient, after obtaining complete remission on hospital therapy, who had to be rehospitalized for perforation, hemorrhage, obstruction or intractable pain, was considered a recurrence. The mere presence of epigastric distress which could be relieved by antcid or strict diet, was not considered a recurrence, because it indicated that the patient was not following the diet, or that he was suffering from one of the possible disorders concurrent often with peptic ulcer.

Peptic ulcer in man. Part 2. The status of ulcer therapy

Peptic ulcer in man. Part 2. The status of ulcer therapy

Peptic ulcer in man; the ulcer problem.

A review of the more important theories on the cause of peptic ulcer in man is presented. The incidence of ulcer in the armed forces during peace and wartime is discussed, in view of evaluation of therapy with a new antacid in a group of veterans, to be reported in a subsequent paper.

Failure of vagotomy to prevent the formation of Mann Williamson ulcers in dogs.

THE MANN-WILLIAMSON procedure of internal duodenal drainage is recognized as a convenient and consistent method of producing experimental peptic ulcers. 1 In from 90 to 100 per cent of dogs so prepared chronic progressive ulcers resembling the spontaneous ulcers of the stomach and duodenum in man develop. The availability of an experimental procedure which leads to the development of a specific disease in such a high percentage of cases obviously provides a most useful test object for the therapeutic effectiveness of various types of treatment. While this method was not employed by Dragstedt and his associates 2 when they introduced complete gastric vagotomy for the treatment of peptic ulcer in man, it has since been employed almost simultaneously in a number of different laboratories as a check on results coming from the clinic. During the progress of the present study, several workers have published results from similar experiments. Harkins and

EFFECT OF GASTRECTOMY AND DIVERSION OF DUODENAL SECRETIONS INTO THE TERMINAL PORTION OF THE ILEUM ON DEVELOPMENT OF ULCER

THE FAILURE of bilateral supradiaphragmatic vagotomy to protect against the development of ulcer in the Mann-Williamson dog, as recently reported,1has been the stimulus for the work herein described. This investigation was conducted to determine (1) the effect of total gastrectomy with diversion of the duodenal secretions into the terminal portion of the ileum on the development of ulcer and (2) to determine the possible existence of another factor besides the role of acid in the formation of ulcer in man. The role of acid in the production of ulcer appears to be too definite2to be disputed, and it is also well known that vagotomy produces in the dog a definite decrease in the amount of acid and in the total volume of gastric secretion.3However, the failure of vagotomy to protect against the development of ulcer in the Mann-Williamson dog led my colleagues and me

Recurrence of Peptic Ulcer in Man as Affected by Treatment with an Enterogastrone Preparation

Summary 1.Forty-six patients who received a course of enterogastrone injections (in most instances 3 or 6 times per week for one year) and whose subsequent course after stopping the treatment has been followed for as long as 5 years are reported upon. 2.During the year of treatment 41 per cent of the patients were symptom free and an additional 46 per cent had fewer recurrences. At the end of the second year (after discontinuing treatment) 40 per cent had fewer recurrences. 3.The average of the longest symptom free period in these 46 patients was 0.3 year during the 2 year period prior to therapy and 0.9 year after the therapy. The difference between 0.3 and 0.9 year is statistically significant. 4.Our results are sufficiently clear to cause us to conclude that there is probably an antiulcer substance in the enterogastrone preparation which tends to prevent recurrences in man. The purification of this factor is the subject of continuing research.

Effect of Drugs on Gastric Motility Following Vagotomy

ConclusionsDeath of rabbits one or 2 days after cervical vagotomy occurred as reported by Short4 and others. During the first several hours after operation the animals seemed in good condition and stomach motility ceased. Levin5 has described this as “shock.” Motility recovered later and persisted as described by Opuls,6 Auer7 and others. Van Yzeren8 noted chronic gastric ulcers in rabbits after vagotomy and this has been confirmed by others and by us.In man gastric contractions were markedly depressed after vagotomy even though resting intragastric pressure increased slightly. These effects persisted. Ulcers healed or became quiescent. This difference in the effect of vagotomy, that is, healing of ulcer in man and development of ulcer in rabbits might be associated with decreased motility in man and increased or continued motility in rabbits.Of the drugs studied (Table I) most restored motility or tone during the first hours after vagotomy in rabbits. In patients Urecholine was the most effective. Starr ...

RELATION OF ACUTE MUCOSAL HEMORRHAGES AND ULCERS OF GASTROINTESTINAL TRACT TO INTRACRANIAL LESIONS

CUSHING, in his Balfour Lecture, 1 stated that erosions and ulcers in the gastrointestinal tract are not infrequently seen in association with various cerebral lesions and after intracranial operations. He reviewed the literature covering this subject up to 1932. The generally accepted opinion is that these ulcers follow certain intracranial processes which cause a state of parasympathetic irritation or sympathetic paralysis of autonomic centers in the hypothalamus. A number of experimental studies were dedicated to this problem. 2 Mechanical or chemical stimulation of the hypothalamic region was frequently followed by hemorrhages or erosions of the gastrointestinal tract. Since Cushing's paper, the coincidence of cerebral lesions and acute peptic ulcers in man has been reported only occasionally. 3 The purpose of the present paper is to elucidate as far as possible how frequently and under what conditions acute mucosal hemorrhages and erosions of the gastrointestinal tract may be observed with and

RELATION OF EMOTIONS TO INJURY AND DISEASE: A CALL FOR FORENSIC PSYCHOSOMATIC MEDICINE

Excerpt I. INTRODUCTION AND HISTORICAL REVIEW Few problems of scientific proof have been so perplexing to court and counsel, and to the expert witness, as those which arise in the "nervous shock" c...

The action of histidine on the gastro-lntestinal tract

The effect of intramuscular histidine on gastric secretion was studied in dogs with accessory stomachs and in gastrostomized preparations. In vitro experiments were performed to determine the action of this amino acid on intestinal tone and motility. Histidine did not decrease the volume or acidity of gastric secretory response to either food or histamine stimulation. In two of three pouch dogs and in one of two gastrostomized dogs there occurred a prolonged and increased secretory response coincident with histidine administration. In organ baths, histidine in physiological concentrations had no effect on the tone or motility of segments of small intestine. The data presented in the above experiments offer no support for the therapeutic claims made for histidine in the treatment of peptic ulcer in man.

CLINICAL CONSIDERATION OF THE ETIOLOGY OF PEPTIC ULCER

Benign duodenal, gastric and anastomotic ulcers are usually referred to as peptic ulcers because they are invariably to be found in regions subjected to the bathing influence of the acid chyme and because it is assumed that the eroding action of the gastric juice is of paramount significance in their development. There are still many factors regarding the etiology, course and chronicity of the lesions which remain imperfectly understood. Even a cursory review of the literature on the subject is convincing evidence of the complexity of the problem. It is my purpose here to review briefly a few of the more important hypotheses advanced to explain the genesis and the course of peptic ulcer. I shall attempt also to arrange the various hypotheses so as to make them apply in a practical manner to the problem of ulcer in man. HYPOTHESES CONCERNING THE CAUSE OF PEPTIC ULCER Circulatory Disturbances. —Virchow

PEPTIC ULCERS (GASTRIC, PYLORIC AND DUODENAL)

The etiology of peptic ulcer in man is unknown. Heredity, occupation, infections, tobacco, alcohol, worry and trauma of the mucous membrane from hot foods have been suggested as etiologic factors, but are inadequate explanations. The relation of vitamins to tuberculous ulceration of the intestine as demonstrated in our previous studies 1 suggested that peptic ulcer might be due to a deficiency of certain vitamins in the dietary. HISTORIC REVIEW The following data also suggest that peptic ulcer may be related to the dietary. The incidence of peptic ulcer varies in different countries: 0.8 per cent in Russia, 1.3 per cent in North America, 5 per cent in England and Germany and 16 per cent in Denmark. A marked increase in the incidence of peptic ulcer occurred in Russia and Germany during the period of partial starvation which followed the World War (from 1914 to 1918). 2 Hutter 3 stated that

INCIDENCE OF GASTRIC ULCER IN ALBINO RATS FED DIETS DEFICIENT IN VITAMIN B (B1)

73 per cent of a group of albino rats whose diet was deficient in vitamin B have been found to have ulcerations of the gastric mucosa. A control group was found to be free from gastric lesions. Of 74 observed lesions eight were chronic, indurated ulcers resembling chronic peptic ulcer in man. The chronicity of the ulcers seems to be related to the duration rather than the degree of the deficiency. The lesions were generally located along the lesser curvature of the stomach, as is true in man. The size of the lesions in rat and man are comparable if adjustment is made for differences in the sizes of the organs.

ELECTIVE LOCALIZATION OF STREPTOCOCCI ISOLATED FROM CASES OF PEPTIC ULCER

As yet there is no universal agreement concerning the pathogenesis of the peptic ulcer which occurs spontaneously in man. Voluminous articles have been devoted to the effort to establish some causative factors, but the various theories and experimental reports have generally led rather to divergence than to convergence of ideas as to the particular etiologic agent. It is true that ulcerations in the gastric and duodenal mucosa have been produced in various ways, but these experimental methods are usually so foreign to what could actually occur clinically that they can have little practical bearing on the etiology of the ulcer in man. REVIEW OF THE LITERATURE Ulcers of the stomach have been produced experimentally by interfering with nerve supply, 1 by section of the spinal cord 2 and by section or stimulation of the vagus or the sympathetic nerves. Durante 3 and Vedova 4 by such methods produced fairly well formed ulcers in a

The specificity of the streptococcus of gastroduodenal ulcer and certain factors determining its localization

In previous papers I have shown that ulcer of the stomach in man and in domestic animals often is associated with a streptococcus infection in the ulcerated area, that foci of infection, such as in tonsils and teeth, harbor the streptococcus and predispose to ulcer, and that the streptococcus isolated from the ulcer and from the distant focus has elective affinity for the stomach, producing hemorrhage and ulcer on intravenous injection.1 The character of the experimentally produced ulcers, and their location, especially with regard to nonhealing, resemble those noted in the spontaneous diseases. Among the difficulties encountered in my earlier work was the inability to maintain specific infecting power and specific immunologic properties in the streptococcus isolated. Specific infecting power disappeared on successive animal passage or aerobic cultivation. It has been found since that relatively anaerobic conditions, and keeping the organisms in latent life, tend to preserve this property. Some of the strains were put aside under these conditions in the hope that they would live and maintain specific characteristics for a long time. It is my purpose here to record the results of a study of the localizing power, the mechanism involved, and the immunologic condition of several of the strains isolated years ago, of a fresh strain from a recurrent ulcer in man, and of a series of similar strains from experimental ulcers in dogs.

THE PROBABLE ENDOCRINE ORIGIN OF PEPTIC ULCER

The consensus of opinion is that chronic ulcer in man develops from the acute ulcer, and that the acute ulcer must necessarily be preceded by an initial lesion. Once the initial lesion is formed, its further development through the various stages into the chronic ulcer is attributed to the corrosive action of the hydrochloric acid of the gastric juice. However, intrinsic causes, such as the mechanical irritation of food on the ulcerated area, and extrinsic causes, such as epigastric pressure from abnormal posture, are other agents helping to produce chronicity. The presence of hyperchlorhydria in conditions other than ulcer, and the absence of ulcer in true achylia gastrica, though occasionally lesions in the stomach may be present in the latter condition, are facts suggesting that hydrochloric acid is a secondary, though prominent, factor in effecting the beginning of an ulcer. It is not the main etiologic factor. Various theories have

THE RELATION OF GASTRIC AND DUODENAL ULCER TO VASCULAR LESIONS

The importance of local disturbances in circulation in the etiology of gastric and duodenal ulcer appeals to be a well established fact with the majority of those who have made a close anatomical study of this condition. Still this view seems to be far from generally accepted. Only a short time ago a special committee was organized in Germany for the collective investigation of the causation of ulcer of the stomach. In its circular this committee makes the following statement: "The nature of ulcer of the stomach has not yet been explained. Even if we have been successful in producing gastric ulcers experimentally, with all their characteristic signs, yet the etiology of gastric ulcer in man is practically unknown.'' Schütz¹says quite recently: We still have very incomplete and inaccurate ideas as to its etiology and its development and in this regard have to resort to hypotheses. Even

EXPERIMENTAL GASTRIC ULCER.

The importance of discovering a definite method by which can be produced experimentally ulcers in the stomach that in every way are analogous to genuine human gastric ulcer needs no emphasis. The prevention and the healing of human ulcers would thereby unquestionably be promoted in various ways. Recently reports have been made of results in this field of experimentation which indicate that noteworthy progress is being achieved. Thus Turck¹has shown that by feeding dogs for variable periods with large quantities of cultures of colon bacilli ulcers not unlike round or peptic ulcer in man may be produced in the stomach and duodenum. The exact mechanism whereby ulcers are produced under these conditions has not been worked out, but the indications point to a combination of local and general disturbances. It would seem that the method, if found by other investigators to give reliable and constant results, will prove