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Student oral and written surgical clerkship performances may be related to the clerkship structure and the time of year the students rotate through the clerkship. The influence of calendar block, hospital site (university hospital, affiliated private tertiary-care hospital, and rural preceptor experience), and the mix of general surgical versus subspeciality rotations on oral and written student surgery clerkship scores was analyzed. Multivariate analysis of variance revealed significant differences in score for calendar block (p = 0.02) only; this difference resided in the written examination. The various combinations of rotations were not different from one another in terms of measured outcome.

The pancreas was generally ignored in antiquity, both as an organ and as a seat of disease. The first description of the pancreas is attributed to Herophilus. It was in the 17th century that the main duct of the organ was described and its significance demonstrated. At that time, Brunner thought that the pancreas was not essential to digestion, and he failed to associate the pancreas with diabetes. Claude Bernard discovered the function of the pancreas in digestion. In 1922, Banting and Best obtained isletin and demonstrated the capacity of the substance to cause a dog to recover from diabetic coma. In 1889, Reginald Fitz firmly established pancreatitis as a disease entity. In 1927, the first case of hyperinsulinism due to a tumor of the islet cells was reported. Twenty-eight years later, Zollinger and Ellison described two patients with unusually severe peptic ulcer disease, both of whom had noninsulin-secreting tumors of the pancreatic islets. Subsequently, gastrin was isolated as the hormone responsible for this syndrome. In March 1940, Dr. O. Whipple performed the first recorded one-stage pancreaticoduodenectomy. Much progress has been made since then and today transplantation of isolated islets and portions of whole pancreas is a reality.

Major complications of operations that remove or transplant a portion of the pancreas appear related to the arterial blood supply. Hemorrhage is a result of inadequate control of the appropriate principal arteries, and ischemia and its consequences occur when the arterial blood supply to portions of preserved pancreas has been inadvertently interrupted. This radiographic study of the principal arteries of the pancreas demonstrates that these vessels may be visualized and their origin determined in the vast majority of cases. The application of data gained from preoperative arteriography can potentially decrease the incidence of major complications associated with removal or transplantation of portions of the pancreas.

In fifty cases of pancreatic pseudocyst the diagnosis was established by autopsy in five cases and operation in forty-five cases. Alcoholism was identified as the most common etiologic factor. The best physical or laboratory evidence of pseudocyst was displacement of the stomach or duodenum in 86 per cent of forty-four patients examined by barium studies. External drainage with a catheter, the most common method of surgical management, was associated with low morbidity. Delay in operation appeared responsible for a number of complications, some of which were fatal. Eight of the fifty patients died, with hemorrhage being the primary cause of death in seven.

The purpose of the distal splenorenal shunt is to provide decompression of gastroesophageal varices while avoiding insult to the diseased liver. However, the technical difficulty of the operation has prevented widespread application of the procedure. It is important, therefore, that the technical problems an hazards of the operation continue to undergo analysis. This report has described successful establishment of a Warren shunt in three patients with abnormalities of the left renal vein. Previous left nephrectomy or an anomaly of the left renal vein does not preclude the use of the distal splenorenal shunt in the treatment of variceal hemorrhage.

In male patients injuries to the ureter occur most frequently during surgical procedures performed on the abdominal aorta. A patient has been described in which ureteral obstruction resulted when the ureter was compressed between a common iliac artery and one limb of an aortofemoral bypass prosthesis. Although unusual, this complication may occur when an arterial prosthesis is positioned anterior to the ureter.