Postgastrectomy bone disease was a term devised to describe the metabolic disorders of bone which may follow a gastrectomy operation. Although the use of this operation has declined drastically in recent years, this metabolic bone disorder is still with us and may escape and confuse the unwary. These disorders may take the form of osteomalacia, osteoporosis in excess of normal ageing, or a combination of both. For screening purposes, regular estimations of plasma alkaline phosphatase levels identify patients who may be developing osteomalacia which can then be treated with calcium and vitamin D supplements. Numerically, osteoporosis in excess of ageing is a bigger problem and its prevention and treatment is at present unsatisfactory. Screening procedures for osteoporosis are reviewed, including the more recent methods of bone mineral density assessment. Osteopenia or demineralization occurs in both osteomalacia and osteoporosis therefore osteomalacia must be excluded before attributing any loss to osteoporosis. The present situation with regards to the prevention and treatment of osteoporosis is also reviewed.

Bone Density↗

PubMedDate not supplied

Integrating a medical database and advisory system.

A system is described which incorporates the use of a diagnostic and treatment advice expert system into the routine information-handling functions of a surgical breast clinic. The main focus of the system is on identification and management of non-malignant breast disease. The advisor is linked with a clinical database which is used to hold summary case notes, and from which reports forming the basis for audit of case-mix and resource utilization can be produced. The system uses backward chaining of extended production rules and a relational database, and runs on a desktop microcomputer.

Breast Neoplasms↗

PubMedDate not supplied

A technique for safe resection of extensive tumours associated with the extracranial internal carotid artery.

Resection of tumours associated with the extracranial internal carotid artery such as carotid body tumours and paraganglionomas carry a hazard of stroke which might occur from temporary clamping of the artery to obtain better control, or from inadvertent damage to the artery which requires ligation. Some extensive tumours have been deemed unresectable because of their extent. Intracranial extension is a further technical challenge. We describe a technique for safe resection of such tumours employing an outlying Pruitt Inihara shunt. During resection of the tumour the shunt allows safe dissection because the internal carotid artery is rendered relatively bloodless. Further, any damage to the artery can be safely repaired, and indeed if necessary the artery itself can be resected and grafted. We have employed this technique in 3 difficult case of paraganglionoma (1) and carotid body tumour (2) whilst at the same time resecting 8 other simple cases without the need for such a technique.

Carotid Artery, Internal↗

PubMedDate not supplied

Dragstedt, gastric acid and duodenal ulcer.

Dragstedt believed that basal hypersecretion of gastric acid was the root cause of duodenal ulcer, that the hypersecretion was due to an increased vagal stimulation, and that vagotomy would therefore cure duodenal ulcer. He introduced vagotomy and demonstrated that the operation was successful in curing most patients of their duodenal ulcers. This article reviews how further research in the succeeding half century has demonstrated that it is the effect of vagotomy on stimulated, rather than upon basal secretion that cures duodenal ulcer and that the apparent basal hypersecretion of patients with duodenal ulcer is due to an increased parietal cell mass. The article points out that there is no convincing explanation as yet of the mechanism whereby vagotomy reduces histamine-stimulated gastric secretion.

Duodenal Ulcer↗