Surgery: The Best Hope of All

• Share

(7 of 11)

restore full circulation to the brain when there is critical narrowing in an accessible artery in the neck. His colleague, Dr. Cooley, did the first operation to remove an aneurysm (a thin, ballooned-out section) from the left ventricle, the heart's main pumping chamber. He tried putting a patient on the heart-lung machine two years ago while he removed a "pulmonary embolism," a usually fatal blood clot in the pulmonary artery. Now. with three successes logged, Cooley believes the procedure should be made generally available, with disposable oxygen kits ready in all major hospitals.

Ironically, an old. familiar operation has stirred some of the sharpest surgical controversy. In the American Journal of Surgery, Dr. Moore recently inveighed against the various stomach-cutting operations that have been tried as "cures"' for duodenal ulcer. "The removal of a large segment of normal stomach for a disease in the duodenum," he wrote, "is not only crippling, but wanting in elegance of rationale." Dr. Moore, who drives himself hard and ignores any possible effects on his own digestion, insists that the basic cause of ulcers is still unknown. The dazzling variety of stomach operations devised between 1886 and the mid-1900s. says he, made many "digestive cripples." may have caused more ulcers than were ever cured, and killed too many patients. The first great advance in ulcer treatment, says Dr. Moore, came in 1943, when Chicago's Dr. Lester R. Dragstedt reported that cutting the vagus nerves (vagotomy) would keep the stomach from producing the excess acid that eats a hole in the wall of the duodenum. Dr. Moore's prescription for a duodenal ulcer severe enough to require surgery: Cut both vagus nerves, but cut out no part of the stomach —only enlarge its outlet.

But adventurous surgeons have devised still other ulcer treatments. From the fertile mind of Minnesota's Wangensteen came the idea that chilling the stomach, by running a coolant solution through a swallowed balloon, might stop bleeding from ulcers in the stomach itself. It did. Then with his surgeon son Stephen, Dr. Wangensteen reasoned that actually freezing the stomach wall might cripple the acid-producing cells and thus keep acid from spilling into the duodenum. It does, at least for several months. After that, says Dr. Wangensteen, the procedure can be repeated—though in any but expert hands, it may be dangerous.

Pressure Boosters. In another area of contention, surgeons still argue about the cause and treatment of "irreversible shock." a condition in which the blood pressure falls dangerously low. A whole generation of doctors has treated this kind of shock with adrenaline and noradrenaline because those drugs are blood-pressure boosters.

No wonder the results have been so bad, complains Minnesota's Dr. Richard C. Lillehei;* there never has been any evidence that pressure-boosting hormones relieve shock caused by blood loss or infection. The basic problem. Dr. Lillehei believes, is a drop in the amount of blood available for circulation. He recommends giving massive doses of hydrocortisone. or of phenoxybenzamine, a new drug not yet released for general use. Neither drug increases blood pressure, and they may even lower it, but both increase blood flow to the body's smaller blood vessels.

Singular