Word: duodenum
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Dates: during 1960-1969
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...emotional -the stomach cells churn out digestive juices when there is no food for them to work on, they may start digesting a spot on the wall of the stomach itself. The result is a gastric ulcer. More often, the corrosive juices empty through the pylorus into the duodenum, the second chamber in man's digestive tract, and start eating through part of that. Though duodenal ulcers never lead to cancer, some types of stomach ulcers are associated with cancer...
...techniques. Physicians realized in the 1880s that man can get along, after a fashion, with only a remnant of his stomach. German-born Surgeon Theodor Billroth then decided it was possible to cut out the lower stomach and pylorus and join what was left of the stomach to the duodenum (see top diagram). After this "subtotal gastrectomy," or "Billroth I," came a still more daring invention, "hemigastrectomy," or "Billroth II": cutting out about half of the stomach and hitching up what was left to the small bowel, leaving the duodenum dead-ended and dangling (second diagram...
After 1930, these and variant operations were widely used for ulcers. It mattered not that the ulcer might be in the duodenum: the part to cut out, the doctors reasoned, was in the stomach, where the digestive juices were being overproduced. Over the years, doctors concluded that this part was high up in the stomach. Some surgeons went on cutting out not only 50% but 75% to 80% of the stomach. "This," complains Boston's famed Surgeon Francis D. Moore (TIME cover, May 3), "is not only crippling but wanting in elegance of rationale...
...latest advance in ulcer surgery is still simpler, less mutilating, and therefore "more elegant" by Dr. Moore's definition. This consists of "pyloroplasty," or widening the gate valve between stomach and duodenum by slitting its muscular ring, or "sphincter" (fourth diagram). The tissue is stretched, then the slit is closed at right angles. Such operations (there are several variants) had been around since 1886, but not until 1947 did Dr. Joseph Weinberg of the Long Beach (Calif.) VA Hospital try the promising combination of vagotomy and pyloroplasty. A vagotomy by itself tends to make the stomach flaccid so that...
...Madden reviewed the cases of 554 patients who have had various operations or combinations of them at St. Clare's Hospital, and reached a surprising conclusion: the best operation for most patients is "antrectomy" -removal of 35% to 40% of the stomach and hooking the remainder to the duodenum. Dr. Madden dismissed vagotomy alone as unsatisfactory, and gave the Weinberg operation a low rating because too often it fails to effect a cure...