Excisional surgery with ileostomy for Crohn's colitis with particular reference to factors affecting recurrence.

This paper reports the indications for, and results of, excision of the large intestine with ileostomy in 73 patients with Crohn's colitis who have been followed for a mean of nine years since resection. Sixty-four of them are still alive and all but two of the survivors are now in good health.However, 23 (33%) have developed recurrent Crohn's disease since resection.

Abscess and fistulae in Crohn's disease.

In a series of 360 patients with Crohn's disease 18% have developed a complication of abscess and/or fistula. Both complications can be spontaneous but more commonly occur in patients who have had a previous operation. There is a high incidence of fistula after laparotomy without resection of diseased bowel.

Appointment of preregistration house officers.

A new programme to try and match the preferences of students and consultants in preregistration appointments has been designed after a survey of student opinion. It is based on five main principles: a standardized change-over date for posts; holding only one post in a teaching hospital; separate application for house physician and house surgeon appointments; application six months before the post becomes vacant; and two rounds for matching preferences.The programme has now been working successfully for a year and experience suggests that the ideal administrative size for it is that of a region or area health authority.

The effect of preserving antral innervation and of a pyloroplasty on gastric emptying after vagotomy in man.

A prospective randomized trial of 40 duodenal ulcer patients is reviewed. The patients had one of four operations (selective vagotomy, proximal gastric vagotomy, selective vagotomy plus pyloroplasty, or proximal gastric vagotomy plus pyloroplasty). The gastric emptying of a hypertonic fluid meal was assessed before and three to four months after operation.

Free perforation in Crohn's disease.

Free perforation is a rare complication of Crohn's disease. Seven cases were found in a total series of 360 in Birmingham. It occurs during an acute exacerbation of chronic disease, particularly in the presence of distal obstruction.

A comparison of results of excision and bypass for ileal Crohn's disease.

One hundred and ten patients presented with Crohn's disease confined to the terminal ileum, and indications for their surgical treatment are reviewed. Treatment was either by ileo-transverse side-to-side bypass (21 patients) or primary excision and end-to-end ileo-colic anastomosis (89 patients). In a long follow up (mean 13.

The effect of retaining antral innervation on the reductions of gastric acid and pepsin secretion after vagotomy.

The result of a prospective trial of 40 patients with duodenal ulcer treated either by proximal gastric vagotomy (antrum innervated) or by selective vagotomy (antrum denervated) shows that they are equally effective in reducing gastric acid and pepsin secretion. Preservation of antral innervation by proximal gastric vagotomy reduces gastric secretion as effectively as denervation of the entire stomach.