Hugh Berchmans Devine: surgical visionary and great Australian.

It is now 75 years since a letter signed by Sir George Syme, Hamilton Russell and Hugh Devine was sent to leading surgeons in Australia and New Zealand inviting them to form an Australasian Association of Surgeons, a body dedicated to improving the standard of surgery as practised in the two countries. This letter proved to be the catalyst that led to the formation of what eventually became the Royal Australasian College of Surgeons, after a previous attempt to form such an Association in 1920 by Professor Louis Barnett had failed. It was Hugh Devine, returning from America in 1925, who played a leading role in the foundation of the College and it is not inappropriate in the year 2000, 75 years after the letter was drafted, to reappraise the life and achievements of this great Australian surgeon.

Extracorporeal shock wave lithotripsy combined with litholytic therapy in the treatment of patients with symptomatic gallstones--the Melbourne experience.

Objective: To investigate the role of extracorporeal shock wave lithotripsy using the Dornier MPL9000 lithotripter and adjuvant litholytic therapy in the treatment of symptomatic gallbladder stones.

Patients And Methods: Between August 1989 and March 1991, 399 patients had their one to three gallbladder stones fragmented by the Dornier MPL9000 lithotripter. Chenodeoxycholic acid alone was used as adjuvant litholytic therapy in the majority.

Retroperitoneal perforation of a peptic ulcer situated in the second part of the duodenum.

Retroperitoneal perforation of a peptic ulcer of the second part of the duodenum is an extremely uncommon complication producing both diagnostic and management difficulties. The tenth recorded case of this condition--the first managed successfully by the technique of primary closure and 'duodenal diverticulization'--is reported.

Phytobezoars--an overlooked cause of small bowel obstruction following vagotomy and drainage operations for duodenal ulcer.

Phytobezoar impaction is an important cause of small bowel obstruction in patients who have had previous vagotomy and drainage procedures for duodenal ulcer. Most cases present with typical symptoms and signs of small bowel obstruction, but in some there are no definite radiological signs of bowel obstruction on plain X-ray. In these the phytobezoar is often located by barium studies.

The Zollinger-Ellison syndrome: a review of the St Vincent's Hospital, Melbourne experience.

Eight cases of the Zollinger-Ellison syndrome were diagnosed at St Vincent's Hospital in the period 1966-84. Although a rare tumour, its true incidence is almost certainly greater than the number of cases represented in this series. The Zollinger-Ellison syndrome should be suspected in all cases of recurrent peptic ulceration, in cases of peptic oesophagitis not responding to medical treatment, in some cases of diarrhoea and in those cases of peptic ulceration associated with hypercalcaemia.

Traumatic retroperitoneal rupture of the duodenum.

A report of six cases of retroperitoneal rupture of the duodenum is presented. A high index of suspicion is necessary to enable early diagnosis to be made and appropriate treatment carried out. Early treatment will prevent the extremely rare, but at present uniformly fatal complication of gas gangrene.

Rupture of the bowel due to road trauma: the emergence of the "seat belt syndrome".

Seat belts have proved to be life saving for drivers and passengers involved in motor-car collisions. The number of severe head, face and trunk injuries has been significantly reduced. However, the wearing of belts has been responsible for an increased incidence of bowel rupture, in itself a potentially lethal injury if not diagnosed and treated early.