A retrospective study of 100 proved cases of primary carcinoma of the gallbladder admitted to the... more A retrospective study of 100 proved cases of primary carcinoma of the gallbladder admitted to the University Surgical Unit, University of Hong Kong, over a 20-year period was undertaken. The female to male ratio was 1·4 to 1. The peak incidence was in the seventh decade for the females and the sixth decade for the males. Preoperative diagnosis was made in 10 patients. ‘Curative’ cholecystectomy was performed in 20 patients with a 5-year survival rate of 10 per cent. Palliative procedures were performed in 44 patients with a median survival of 8 weeks, which was notsignificantly different from that in the 30 patients who were not operated upon or had laparotomy and biopsy only. Radical resection was carried out in 6 patients, all of whom died in hospital. Gallstones were found in only 26 patients. The gallbladders of 3 patients had associated benign tumours, one of which had malignant transformation at multiple sites. One patient had chronic typhoid infection. The incidence of clonorchis infestation and primary pyogenic cholangitis in these 100 patients was not different from that of our general hospital population.
Purpose: Weight gain is common during the first year after breast cancer diagnosis. In this study... more Purpose: Weight gain is common during the first year after breast cancer diagnosis. In this study, we examined clinical factors associated with body size at diagnosis and weight gain during the subsequent year. Patients and Methods: An inception cohort of 535 women with newly diagnosed locoregional breast cancer underwent anthropometric measurements at baseline and 1 year. Information was collected on tumorand treatment-related variables, as well as diet and physical activity. Results: Mean age was 50.3 years; 57% of women were premenopausal. Mean baseline body mass index (weight [kg] divided by height [m] squared) was 25.5 kg/m2. Overall, 84.1% of the patients gained weight. Mean weight gain was 1.6 kg (95% confidence interval, 1.2 to 1.9 kg), 2.5 kg (95% confidence interval, 1.8 to 3.2 kg) in those receiving chemotherapy, 1.3 kg (95% confidence interval, 0.7 to 1.8 kg) in those receiving tamoxifen only, and 0.6 kg (95% confidence interval, 0.01 to 1.3 kg) in those receiving no adj...
testinal duplication in adults ranges from chronic nonspecific gastrointestinal discomfort to one... more testinal duplication in adults ranges from chronic nonspecific gastrointestinal discomfort to one of acute abdominal pain. Although several series of these lesions have been described in children, there have been few descriptions in adults. We present the cases of 3 adults who presented recently with duplication of the foregut, midgut and hindgut. These lesions are important because these duplications share patterns of presentation common to many nonspecific intra-abdominal diseases, yet are readily managed by a combined radiologic and surgical approach. The cases provide an opportunity to review the spectrum of presentations associated with enteric duplication in adults and the current literature on this topic.
Purpose: Diet has been postulated to influence breast cancer prognosis; however, existing evidenc... more Purpose: Diet has been postulated to influence breast cancer prognosis; however, existing evidence is weak and inconsistent. Previous studies have sought evidence of a linear relationship between diet and breast cancer outcomes. Because of a U-shaped association of body mass index (BMI) with survival in breast cancer, we hypothesized that a nonlinear association also existed for dietary variables. Patients and Methods: Four hundred seventy-seven women with surgically resected T1 to T3, N0/1, M0 breast cancer completed the Block Food Frequency Questionnaire 9.3 4.6 weeks (mean standard deviation) after diagnosis, reporting intake over the preceding 12 months. Data on tumor-related factors, treatment, and outcomes were obtained prospectively from medical records. A series of Cox models was performed, modeling the association of dietary factors with breast cancer survival linearly and quadratically, adjusting for total energy intake, tumor- and treatment-related variables, and BMI. Res...
We concur in Dr. Schuman's commentary but hasten to add that the circumstances which may promote ... more We concur in Dr. Schuman's commentary but hasten to add that the circumstances which may promote the tear should be recognized (inadequate sedation, over-distension of the stomach, prolonged endoscopy).
Sir: Colloidal bismuth promotes ulcer healing. I The healing efficacy of colloidal bismuth is com... more Sir: Colloidal bismuth promotes ulcer healing. I The healing efficacy of colloidal bismuth is comparable to that of cimetidine for gastric ulcers' and duodenal ulcers.' However, it is not known if colloidal bismuth is effective for recurrent ulcers following gastric surgery. Here we report our experience of treating 19such patients with tri-potassiumdi-eitrato bismuthate (De-Nol, Gist Brocades, Holland). Each pat ient took five mL four times a day for four weeks. Each dose was Patients with unhealed ulcers were treated with cimetidine, one gram daily for six weeks (200 mg three times a day before meals and 400 mg at bedtime). Three stomal ulcers and two duodenal ulcers healed. One stomal ulcer remained unhealed after five months of treatmentwith cimetidine although the patient was asymptomatic . One duodenal ulcer did not heal after six weeks of treatment with cimetidine, and the patient was severely symptomatic . Both patients agreed to surgery. At operat ion, both ulcers were found to be deeply penetrating . Cimetidine has been effective for recurrent ulcers following gastric surgery," 6 and long-termtreatmentwith cimetidine is also effective for preventing relapse once these ulcers have healed.' Our experience with colloidal bismuth indicates that it effectively healed postoperative gastric ulcers but seemed ineffective in treating stomal ulcers and recurrent duodenal ulcers. Colloidal bismuth acts locally . Histochemical studies demonstrate that it has a selective coating affinity for the ulcer base .' The optimal conditions for such coating activity are an empty stomach, a gastric pH of about three, presence of proteins at the ulcer site for chelation, and sufficient time ofcontactwith the ulcer.' These
During 1970-1980, admissions for peptic ulcers per 100,000 population to all government and gover... more During 1970-1980, admissions for peptic ulcers per 100,000 population to all government and government-assisted hospitals in Hong Kong increased by 21% from 152 to 185. At the same time, peptic ulcer perforations per 100,000 population increased by 71% from 9.3 to 15.9. The percentage of men >60 yr of age with ulcer perforation rose from 18.1 to 24.4, while that in the genera1 population rose from 2.9 to 3.9. However, the male/female ratio has remained stable at-6: 1. During the same period, mortality rate per 100,000 population due to peptic ulcer declined by 26% from 4.2 to 3.1. Thus, while the hospitalization and perforation rates for peptic ulcer appeared to be falling in the United States and the United Kingdom over the past decade, the opposite has occurred in Hong Kong. Recently accumulated data from the United States (1) and the United Kingdom (2) indicate that peptic ulcer disease is declining in both countries. It is not known whether or not this downward trend is observed in other parts of the world. So far, little or no data have been published from non-Western sources. This paper examines the data on hospital admission, perforation, and mortality of peptic ulcer in Hong Kong for the period 1970-1980.
511 Background: Vit D acts through a nuclear transcription factor to regulate many aspects of cel... more 511 Background: Vit D acts through a nuclear transcription factor to regulate many aspects of cellular growth and differentiation. Low levels have been associated with increased BC risk. We examined Vit D levels and prognostic effects in an existing BC cohort. Methods: 512 consecutive women with newly diagnosed BC were enrolled at 3 U of Toronto hospitals between 1989 and 1995. A blood specimen obtained at diagnosis was stored at −80°C. The Block questionnaire was used to measure diet intake. Clinical and pathology data were obtained from medical and pathology records. 25-OH Vit D was measured by radioimmunoassay. Women were followed prospectively to 2006. Results: Mean age was 50.4±9.7 yrs. 288 women had T1 tumors, 164 T2 and 24 T3/4. 356 tumors were N0. 342 were estrogen receptor (ER) positive. 73 tumors were grade 1, 202 grade 2 and 173 grade 3. 199 women received adjuvant chemotherapy (CXT) and 200 received tamoxifen. 116 women (22.7%) had distant recurrences and 106 (20.7%) died during a median follo...
PURPOSE: Weight gain is common during the first year after breast cancer diagnosis. In this study... more PURPOSE: Weight gain is common during the first year after breast cancer diagnosis. In this study, we examined clinical factors associated with body size at diagnosis and weight gain during the subsequent year. PATIENTS AND METHODS: An inception cohort of 535 women with newly diagnosed locoregional breast cancer underwent anthropometric measurements at baseline and 1 year. Information was collected on tumor- and treatment-related variables, as well as diet and physical activity. RESULTS: Mean age was 50.3 years; 57% of women were premenopausal. Mean baseline body mass index (weight [kg] divided by height [m] squared) was 25.5 kg/m2. Overall, 84.1% of the patients gained weight. Mean weight gain was 1.6 kg (95% confidence interval, 1.2 to 1.9 kg), 2.5 kg (95% confidence interval, 1.8 to 3.2 kg) in those receiving chemotherapy, 1.3 kg (95% confidence interval, 0.7 to 1.8 kg) in those receiving tamoxifen only, and 0.6 kg (95% confidence interval, 0.01 to 1.3 kg) in those receiving no a...
Two unselected series of 528 Chinese and 539 Scottish patients with duodenal ulcer were compared.... more Two unselected series of 528 Chinese and 539 Scottish patients with duodenal ulcer were compared. In both races, early-onset patients (symptoms began before age 30 years) in contrast to late-onset patients (symptoms began after age 30 years) constituted significantly more males, more patients with positive familial dyspepsia, more acid hypersecretors, and more gastrointestinal bleeding, but, unlike late-onset patients, there was no significant blood group O predominance, and their females did not have an older onset age than males. Among early-onset patients, Scottish patients developed symptoms at a significantly later age and had significantly more acid hypersecretors than Chinese, whereas among late-onset patients the Scots had significantly more patients with positive familial dyspepsia, in whom the frequency of acid hypersecretion was increased. These findings indicate that (i) early and late-onset duodenal ulcers are distinct subgroups, with many features common to both Chinese and Scots despite different ethnic backgrounds, suggesting the occurrence of similar pathophysiological mechanisms in the two races, (ii) for early-onset disease, these mechanisms appear to operate sooner in the Chinese, (iii) in the Scottish patients, familial late-onset duodenal ulcers with acid hypersecretion form a substantial and distinct subgroup.
The survival of 103 patients operated on for advanced carcinoma of the stomach other than the car... more The survival of 103 patients operated on for advanced carcinoma of the stomach other than the cardia was assessed. The median duration of survival for patients subjected to palliative partial gastrectomy, total gastrectomy, gastrojejunostomy, and biopsy only was 24, 22, 11, and 10 weeks, respectively. All of these patients had definite residual tumor. In the 27 patients with preoperative signs of incurable tumor, the high operative mortality rate (19 percent), the low rate of resectability (26 percent), and the short duration of survival in the patients who had resection (median 11 weeks) combined lead to the conclusion that exploration for the possibility of resection is not worthwhile.
Somatic cell hybridization (fusion) was carried out between cells of the murine lymphoma L‐5178Y(... more Somatic cell hybridization (fusion) was carried out between cells of the murine lymphoma L‐5178Y(r) and peripheral human lymphocytes. The L‐5178Y(r) line is deficient in hypoxanthine‐guanine phosphorybosyl transferase (HGPRT). Using a selective medium system, it was possible to isolate hybrid cell clones having the complete complement of murine chromosomes as well as the human X chromosome on which the gene for HGPRT is located. This model system may be used to study the effect of the human X chromosome on the phenotype of the murine lymphoma.
Pyloric function after Ramstedt's pyloromyotomy was assessed in seven patients aged five to eleve... more Pyloric function after Ramstedt's pyloromyotomy was assessed in seven patients aged five to eleven years and compared to that in sixteen normal children. Gastric emptying (T1/2) of liquid, as measured by the double sampling test, was faster in patients than in normal children. Duodenal reflux was calculated from the sodium content in gastric aspirates. At rest, it was greater in patients than in normal children. In the poststimulatory state, there was no difference. Gastric acid secretion was similar in both groups. Rapid gastric emptying might explain the high incidence of peptic ulcer reported in several series of long-term follow-up patients. Increased duodenal reflux at rest might account for a similar increased incidence in gastritis and dyspepsia.
ABSTRACT One hundred and twelve patients with 49 corpus and 35 prepyloric gastric ulcers and 28 d... more ABSTRACT One hundred and twelve patients with 49 corpus and 35 prepyloric gastric ulcers and 28 duodenal ulcers associated with gastric ulcers were entered into a stratified, controlled double-blind randomized study comparing the healing efficacy of colloidal bismuth suspension with placebo. Healing of corpus and prepyloric ulcers, but not duodenal-ulcer associated gastric ulcers, was significantly better with the bismuth compound than with placebo. The clinical, personal, ulcer and acid secretory data of these patients were prospectively collected and evaluated by stepwise discriminant analysis in two phases. In the first phase, the collected data of 91 consecutive patients were entered into computer analysis. The derived discriminant function classified patients into healed and unhealed categories with a sensitivity of 82%, specificity of 77%, positive diagnostic value of 73%, negative diagnostic value of 85% and diagnostic efficiency of 79%. In phase two, the discriminant function from phase 1 was applied prospectively to 21 patients to predict the outcome of treatment. Five out of five healed and 11/16 unhealed gastric ulcers were correctly predicted, giving a diagnostic efficiency of 76%. The present study shows that healing or non-healing of gastric ulcer can be predicted with reasonable accuracy by discriminant analysis. In addition, discriminant analysis identified, aside from the efficacious drug, ulcer size, young age, co-existing duodenal ulcer, and concomitant medical condition as adverse factors for gastric ulcer healing.
A retrospective study of 100 proved cases of primary carcinoma of the gallbladder admitted to the... more A retrospective study of 100 proved cases of primary carcinoma of the gallbladder admitted to the University Surgical Unit, University of Hong Kong, over a 20-year period was undertaken. The female to male ratio was 1·4 to 1. The peak incidence was in the seventh decade for the females and the sixth decade for the males. Preoperative diagnosis was made in 10 patients. ‘Curative’ cholecystectomy was performed in 20 patients with a 5-year survival rate of 10 per cent. Palliative procedures were performed in 44 patients with a median survival of 8 weeks, which was notsignificantly different from that in the 30 patients who were not operated upon or had laparotomy and biopsy only. Radical resection was carried out in 6 patients, all of whom died in hospital. Gallstones were found in only 26 patients. The gallbladders of 3 patients had associated benign tumours, one of which had malignant transformation at multiple sites. One patient had chronic typhoid infection. The incidence of clonorchis infestation and primary pyogenic cholangitis in these 100 patients was not different from that of our general hospital population.
Purpose: Weight gain is common during the first year after breast cancer diagnosis. In this study... more Purpose: Weight gain is common during the first year after breast cancer diagnosis. In this study, we examined clinical factors associated with body size at diagnosis and weight gain during the subsequent year. Patients and Methods: An inception cohort of 535 women with newly diagnosed locoregional breast cancer underwent anthropometric measurements at baseline and 1 year. Information was collected on tumorand treatment-related variables, as well as diet and physical activity. Results: Mean age was 50.3 years; 57% of women were premenopausal. Mean baseline body mass index (weight [kg] divided by height [m] squared) was 25.5 kg/m2. Overall, 84.1% of the patients gained weight. Mean weight gain was 1.6 kg (95% confidence interval, 1.2 to 1.9 kg), 2.5 kg (95% confidence interval, 1.8 to 3.2 kg) in those receiving chemotherapy, 1.3 kg (95% confidence interval, 0.7 to 1.8 kg) in those receiving tamoxifen only, and 0.6 kg (95% confidence interval, 0.01 to 1.3 kg) in those receiving no adj...
testinal duplication in adults ranges from chronic nonspecific gastrointestinal discomfort to one... more testinal duplication in adults ranges from chronic nonspecific gastrointestinal discomfort to one of acute abdominal pain. Although several series of these lesions have been described in children, there have been few descriptions in adults. We present the cases of 3 adults who presented recently with duplication of the foregut, midgut and hindgut. These lesions are important because these duplications share patterns of presentation common to many nonspecific intra-abdominal diseases, yet are readily managed by a combined radiologic and surgical approach. The cases provide an opportunity to review the spectrum of presentations associated with enteric duplication in adults and the current literature on this topic.
Purpose: Diet has been postulated to influence breast cancer prognosis; however, existing evidenc... more Purpose: Diet has been postulated to influence breast cancer prognosis; however, existing evidence is weak and inconsistent. Previous studies have sought evidence of a linear relationship between diet and breast cancer outcomes. Because of a U-shaped association of body mass index (BMI) with survival in breast cancer, we hypothesized that a nonlinear association also existed for dietary variables. Patients and Methods: Four hundred seventy-seven women with surgically resected T1 to T3, N0/1, M0 breast cancer completed the Block Food Frequency Questionnaire 9.3 4.6 weeks (mean standard deviation) after diagnosis, reporting intake over the preceding 12 months. Data on tumor-related factors, treatment, and outcomes were obtained prospectively from medical records. A series of Cox models was performed, modeling the association of dietary factors with breast cancer survival linearly and quadratically, adjusting for total energy intake, tumor- and treatment-related variables, and BMI. Res...
We concur in Dr. Schuman's commentary but hasten to add that the circumstances which may promote ... more We concur in Dr. Schuman's commentary but hasten to add that the circumstances which may promote the tear should be recognized (inadequate sedation, over-distension of the stomach, prolonged endoscopy).
Sir: Colloidal bismuth promotes ulcer healing. I The healing efficacy of colloidal bismuth is com... more Sir: Colloidal bismuth promotes ulcer healing. I The healing efficacy of colloidal bismuth is comparable to that of cimetidine for gastric ulcers' and duodenal ulcers.' However, it is not known if colloidal bismuth is effective for recurrent ulcers following gastric surgery. Here we report our experience of treating 19such patients with tri-potassiumdi-eitrato bismuthate (De-Nol, Gist Brocades, Holland). Each pat ient took five mL four times a day for four weeks. Each dose was Patients with unhealed ulcers were treated with cimetidine, one gram daily for six weeks (200 mg three times a day before meals and 400 mg at bedtime). Three stomal ulcers and two duodenal ulcers healed. One stomal ulcer remained unhealed after five months of treatmentwith cimetidine although the patient was asymptomatic . One duodenal ulcer did not heal after six weeks of treatment with cimetidine, and the patient was severely symptomatic . Both patients agreed to surgery. At operat ion, both ulcers were found to be deeply penetrating . Cimetidine has been effective for recurrent ulcers following gastric surgery," 6 and long-termtreatmentwith cimetidine is also effective for preventing relapse once these ulcers have healed.' Our experience with colloidal bismuth indicates that it effectively healed postoperative gastric ulcers but seemed ineffective in treating stomal ulcers and recurrent duodenal ulcers. Colloidal bismuth acts locally . Histochemical studies demonstrate that it has a selective coating affinity for the ulcer base .' The optimal conditions for such coating activity are an empty stomach, a gastric pH of about three, presence of proteins at the ulcer site for chelation, and sufficient time ofcontactwith the ulcer.' These
During 1970-1980, admissions for peptic ulcers per 100,000 population to all government and gover... more During 1970-1980, admissions for peptic ulcers per 100,000 population to all government and government-assisted hospitals in Hong Kong increased by 21% from 152 to 185. At the same time, peptic ulcer perforations per 100,000 population increased by 71% from 9.3 to 15.9. The percentage of men >60 yr of age with ulcer perforation rose from 18.1 to 24.4, while that in the genera1 population rose from 2.9 to 3.9. However, the male/female ratio has remained stable at-6: 1. During the same period, mortality rate per 100,000 population due to peptic ulcer declined by 26% from 4.2 to 3.1. Thus, while the hospitalization and perforation rates for peptic ulcer appeared to be falling in the United States and the United Kingdom over the past decade, the opposite has occurred in Hong Kong. Recently accumulated data from the United States (1) and the United Kingdom (2) indicate that peptic ulcer disease is declining in both countries. It is not known whether or not this downward trend is observed in other parts of the world. So far, little or no data have been published from non-Western sources. This paper examines the data on hospital admission, perforation, and mortality of peptic ulcer in Hong Kong for the period 1970-1980.
511 Background: Vit D acts through a nuclear transcription factor to regulate many aspects of cel... more 511 Background: Vit D acts through a nuclear transcription factor to regulate many aspects of cellular growth and differentiation. Low levels have been associated with increased BC risk. We examined Vit D levels and prognostic effects in an existing BC cohort. Methods: 512 consecutive women with newly diagnosed BC were enrolled at 3 U of Toronto hospitals between 1989 and 1995. A blood specimen obtained at diagnosis was stored at −80°C. The Block questionnaire was used to measure diet intake. Clinical and pathology data were obtained from medical and pathology records. 25-OH Vit D was measured by radioimmunoassay. Women were followed prospectively to 2006. Results: Mean age was 50.4±9.7 yrs. 288 women had T1 tumors, 164 T2 and 24 T3/4. 356 tumors were N0. 342 were estrogen receptor (ER) positive. 73 tumors were grade 1, 202 grade 2 and 173 grade 3. 199 women received adjuvant chemotherapy (CXT) and 200 received tamoxifen. 116 women (22.7%) had distant recurrences and 106 (20.7%) died during a median follo...
PURPOSE: Weight gain is common during the first year after breast cancer diagnosis. In this study... more PURPOSE: Weight gain is common during the first year after breast cancer diagnosis. In this study, we examined clinical factors associated with body size at diagnosis and weight gain during the subsequent year. PATIENTS AND METHODS: An inception cohort of 535 women with newly diagnosed locoregional breast cancer underwent anthropometric measurements at baseline and 1 year. Information was collected on tumor- and treatment-related variables, as well as diet and physical activity. RESULTS: Mean age was 50.3 years; 57% of women were premenopausal. Mean baseline body mass index (weight [kg] divided by height [m] squared) was 25.5 kg/m2. Overall, 84.1% of the patients gained weight. Mean weight gain was 1.6 kg (95% confidence interval, 1.2 to 1.9 kg), 2.5 kg (95% confidence interval, 1.8 to 3.2 kg) in those receiving chemotherapy, 1.3 kg (95% confidence interval, 0.7 to 1.8 kg) in those receiving tamoxifen only, and 0.6 kg (95% confidence interval, 0.01 to 1.3 kg) in those receiving no a...
Two unselected series of 528 Chinese and 539 Scottish patients with duodenal ulcer were compared.... more Two unselected series of 528 Chinese and 539 Scottish patients with duodenal ulcer were compared. In both races, early-onset patients (symptoms began before age 30 years) in contrast to late-onset patients (symptoms began after age 30 years) constituted significantly more males, more patients with positive familial dyspepsia, more acid hypersecretors, and more gastrointestinal bleeding, but, unlike late-onset patients, there was no significant blood group O predominance, and their females did not have an older onset age than males. Among early-onset patients, Scottish patients developed symptoms at a significantly later age and had significantly more acid hypersecretors than Chinese, whereas among late-onset patients the Scots had significantly more patients with positive familial dyspepsia, in whom the frequency of acid hypersecretion was increased. These findings indicate that (i) early and late-onset duodenal ulcers are distinct subgroups, with many features common to both Chinese and Scots despite different ethnic backgrounds, suggesting the occurrence of similar pathophysiological mechanisms in the two races, (ii) for early-onset disease, these mechanisms appear to operate sooner in the Chinese, (iii) in the Scottish patients, familial late-onset duodenal ulcers with acid hypersecretion form a substantial and distinct subgroup.
The survival of 103 patients operated on for advanced carcinoma of the stomach other than the car... more The survival of 103 patients operated on for advanced carcinoma of the stomach other than the cardia was assessed. The median duration of survival for patients subjected to palliative partial gastrectomy, total gastrectomy, gastrojejunostomy, and biopsy only was 24, 22, 11, and 10 weeks, respectively. All of these patients had definite residual tumor. In the 27 patients with preoperative signs of incurable tumor, the high operative mortality rate (19 percent), the low rate of resectability (26 percent), and the short duration of survival in the patients who had resection (median 11 weeks) combined lead to the conclusion that exploration for the possibility of resection is not worthwhile.
Somatic cell hybridization (fusion) was carried out between cells of the murine lymphoma L‐5178Y(... more Somatic cell hybridization (fusion) was carried out between cells of the murine lymphoma L‐5178Y(r) and peripheral human lymphocytes. The L‐5178Y(r) line is deficient in hypoxanthine‐guanine phosphorybosyl transferase (HGPRT). Using a selective medium system, it was possible to isolate hybrid cell clones having the complete complement of murine chromosomes as well as the human X chromosome on which the gene for HGPRT is located. This model system may be used to study the effect of the human X chromosome on the phenotype of the murine lymphoma.
Pyloric function after Ramstedt's pyloromyotomy was assessed in seven patients aged five to eleve... more Pyloric function after Ramstedt's pyloromyotomy was assessed in seven patients aged five to eleven years and compared to that in sixteen normal children. Gastric emptying (T1/2) of liquid, as measured by the double sampling test, was faster in patients than in normal children. Duodenal reflux was calculated from the sodium content in gastric aspirates. At rest, it was greater in patients than in normal children. In the poststimulatory state, there was no difference. Gastric acid secretion was similar in both groups. Rapid gastric emptying might explain the high incidence of peptic ulcer reported in several series of long-term follow-up patients. Increased duodenal reflux at rest might account for a similar increased incidence in gastritis and dyspepsia.
ABSTRACT One hundred and twelve patients with 49 corpus and 35 prepyloric gastric ulcers and 28 d... more ABSTRACT One hundred and twelve patients with 49 corpus and 35 prepyloric gastric ulcers and 28 duodenal ulcers associated with gastric ulcers were entered into a stratified, controlled double-blind randomized study comparing the healing efficacy of colloidal bismuth suspension with placebo. Healing of corpus and prepyloric ulcers, but not duodenal-ulcer associated gastric ulcers, was significantly better with the bismuth compound than with placebo. The clinical, personal, ulcer and acid secretory data of these patients were prospectively collected and evaluated by stepwise discriminant analysis in two phases. In the first phase, the collected data of 91 consecutive patients were entered into computer analysis. The derived discriminant function classified patients into healed and unhealed categories with a sensitivity of 82%, specificity of 77%, positive diagnostic value of 73%, negative diagnostic value of 85% and diagnostic efficiency of 79%. In phase two, the discriminant function from phase 1 was applied prospectively to 21 patients to predict the outcome of treatment. Five out of five healed and 11/16 unhealed gastric ulcers were correctly predicted, giving a diagnostic efficiency of 76%. The present study shows that healing or non-healing of gastric ulcer can be predicted with reasonable accuracy by discriminant analysis. In addition, discriminant analysis identified, aside from the efficacious drug, ulcer size, young age, co-existing duodenal ulcer, and concomitant medical condition as adverse factors for gastric ulcer healing.
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