Percutaneous transhepatic drainage for malignant biliary obstruction.

Percutaneous transhepatic drainage ( PTHD ) is an adjunct in the management of malignant biliary obstruction. It can be used for two purposes: as a palliative measure alone or as part of the preoperative preparation. This study assesses the efficacy of this technique.

Efficacy of oral and systemic antibiotic prophylaxis in colorectal operations.

A cooperative Veterans Administration study of the septic complication rate during large-bowel surgery was undertaken in two groups of patients. The first group received oral neomycin and erythromycin base plus parenteral placebo; the second, the oral antibiotics plus parenteral cephalothin sodium. During a five-year period, 1,128 patients were studied.

Hypercalcaemia due to hyperparathyroidism in a patient with chronic renal failure and renal carcinoma.

A 65-year-old woman with a history of a left heminephrectomy for renal carcinoma developed hypercalcaemia 11 years after the operation. The same kidney was found to contain a recurrent renal carcinoma. After the radical nephrectomy of the left kidney, hypercalcaemia remitted but reappeared 11 months later.

Preoperative administration of fluids.

A study by questionnaire was sent to 134 Surgical Services at Veterans Administration Hospitals to ascertain the prevalence of the practice of preoperative hydration during the period of hydropenia preceding surgery. A 92.5 per cent response was noted and the following conclusions are drawn: (1) The majority of Veterans Administration Surgical Services do not routinely provide intravenous fluids during the immediate preoperative period.

Motility of gastric tubes.

In gastric tubes interposed between small bowel a clear wave pattern was found, differing markedly from the bowl above and below. The gastric tube appears to be not an inert conduit since it continues to exhibit automatic rhythmic contraction. The possibility of slowing intestinal transit by the interposition of an antiperistaltic gastric tube seems to be supported by the demonstration of regular contraction.