1. Skim through the text and determine the meaning of the words

from the context:

inflammation, peritoneal, perforation, fluid, anorexia, gangrene, fever, reduce, intestinal, stenosis, umbilical, exudate, locate, retroperi­toneal, rectal.

2. Find sentences in the text pertaining to:

   1. clinical manifestations of appendicitis;

   2. location of appendicitis.

3. Give as many facts as you can to prove the following

statements.

1. Obstruction usually leads to inflammation.

2. Acute appendicitis endangers the occurrence of peritonitis.

OPERATIVE TREATMENT IN GASTROINTESTINAL HEMORRHAGE Duodenal ulcer. A multiplicity of operations is available for the treat­ment of peptic ulcer disease. These operations include vagotomy and drainage procedure (pyloroplasties or gastrojejunostomy), subtotal gas­trectomy, vagotomy and antrectomy and, more recently, parietal cell vagectomy. In a patient with bleeding, duodenal ulcer the surgeon must strive to perform the most effective operation in terms of control of bleeding and prevention of recurrence of ulcer disease. This must be bal­anced against morbidity and mortality associated with the procedure. In the elective situation, parietal cell vagectomy without drainage will prob­ably have least morbidity and mortality, while vagotomy and antrectomy will probably have the least recurrence rate. Unfortunately, the former procedure is inadequate for control of bleeding unless the duodenum is opened and the ulcer suture ligated. Furthermore, this would be more time-consuming than truncal vagectomy- with drainage. Vagotomy and antrectomy, on the other hand, will afford greatest control of bleeding and protection from recurrence, but at the cost of increased morbidity from duodenal stump or anastomotic leakage. Subtotal gastrectomy has been shown to be associated with high mortality (as high as 30% in one series) when it is used in the emergency treatment for bleeding duodenal ulcer. Because of these considerations and on the basis of data from sev­eral studies, vagotomy and pyloroplasty with suture ligation of the bleed­ing ulcer appears to be the best procedure, even though the rebleeding rate in the immediate postoperative period may be higher than after either of the resective procedures.

Gastric ulcer. There is little doubt that bleeding from a chronic gas­tric ulcer, unassociated with duodenal ulcer, is best controlled by subto­tal gastric resection, especially when there is active bleeding. Such oper­ative treatment will also allow excision of an unrecognized malignancy in the ulcer. If the location of the ulcer is such that a local resection of the ulcer alone is feasible, then this should be preferred in the poor risk patient. Unfortunately, gastric ulcers are not infrequently located high in the stomach in relatively inaccessible areas for resectional therapy. Under these circumstances, suture ligation of the ulcer from inside the stomach, or ligation of the feeding vessel (frequently the left gastric artery) from outside the stomach, combined with vagectomy and a drainage procedure, or antrectomy should be considered.

I. Skim through the text and write out sentences expressing the main idea of it.