Word: stomaching
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Dates: during 1960-1969
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Problem of Choice. Not until 1943 was a more elegant and rational attack on ulcers adopted. Since the stomach-wall cells are activated by the vagus nerves (which explains why stress or emotional upsets can trigger the ulcer process), Chicago's Dr. Lester R. Dragstedt figured that cutting the vagus nerves would cut down the acid output. His operation, "vagotomy," is not as simple as it sounds: surgeons often have difficulty finding and cutting all the nerve fibers in the bunch. And by itself, vagotomy is not consistently effective. So vagotomy has been combined with hemigastrectomy (second diagram...
...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...
...Bartlett pays more attention than many other experts to the antrum, the lower part of the stomach's rear wall, which partly controls the output of acids. But the antrum also seems to ex ert a balancing effect, and Dr. Bartlett's M.G.H. team has had good results from a vagotomy combined with removal of about half the stomach but leaving a small part of the antrum intact...
...Downstate Medical Center, Dr. John 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...
...reducing the risk of a later shutdown. Other surgeons are combining the Weinberg method with the tying-off of blood vessels, especially for bleeding ulcers. Minnesota's Surgeon Owen H. Wangensteen is trying to make fellow surgeons abandon the knife for nearly all ulcer patients and freeze the stomach instead, a procedure that is hotly debated (TIME...