Prevention of postoperative renal dysfunction in patients with obstructive jaundice: a multicentre study of bile salts and lactulose.

The role of preoperative lactulose and bile salts in the prevention of postoperative renal failure in patients with obstructive jaundice has been evaluated in a prospective randomized trial. One hundred and two patients undergoing surgery for obstructive jaundice (bilirubin greater than 100 mumols/l) were randomized into three groups: those receiving preoperative oral lactulose (n = 35), those receiving oral sodium deoxycholate (n = 32) and a control group of patients receiving no specific treatment (n = 35). All patients received intravenous fluids commencing the night before surgery.

Staging of cancer of the pancreas.

Staging of cancer of the pancreas is relatively reliable when based on pathological material obtained from operative specimens or at autopsy. At operation, the assessment of disease stage, and therefore of operability, is more difficulty-particularly in relation to the extent of lymph node involvement and liver metastases. Preoperative staging, which, clinically, is the most essential, is difficult and unsatisfactory at the present time.

Management of chronic relapsing pancreatitis in adolescents.

Chronic relapsing pancreatitis in adolescence is a most uncommon clinical problem and has received minimal separate recognition in the literature. Adolescence is an age when the causes of the disease, which may operate from birth, overlap with the major etiological factors in the generality of pancreatitis in adult life. A personal series of 32 patients with pancreatitis, aged 11-20 years, is reported.

Intraoperative testing of the integrity of left-sided colorectal anastomoses: a technique of value to the surgeon in training.

Left-sided colorectal anastomoses sometimes leak despite the best efforts of the surgeon. The cause is thought to be multifactorial but imperfections in the technique of performing the anastomosis must play some part. A method for testing the integrity of left-sided colorectal anastomoses has been developed using intraluminal distension.

Fracture of the penis.

Two cases of fracture of the penis are reported and the literature is reviewed. Of the two alternative treatments--conservative and immediate exploration with suture closure of the defect--the authors recommend the surgical approach. This would appear to eliminate any possibility of late surgical deformity of the Peyronie type.

Chronic relapsing pancreatitis: a review of 64 cases.

A collected series of 64 cases of chronic relapsing pancreatitis is reported. Analysis of this material reveals several points of interest. There is a difference in the aetiological spectrum in Britain when compared with reports from France and the United States.

Immunostimulant therapy with levamisole for rheumatoid arthritis.

In a controlled study involving thirty-four patients levamisole was shown to be as effective as D-penicillamine and more effective than placebo in the treatment of rheumatoid arthritis. Its action was slow and was accompanied by a reduction in erythrocyte sedimentation-rate, rheumatoid factor, and technetium index. These properties indicate that it has a specific action like that of D-penicillamine.

Patterns of incidence in acute pancreatitis.

A review of acute pancreatitis occurring over a 20-year period in the Bristol clinical area is reported. A total of 590 cases were available for analysis. The yearly incidence was 53-8 per million population at risk, with a mortality of 9-0 per million.