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Microscopic examination of 50 colon resection specimens from 46 patients with ulcerative colitis revealed 6 patients whose colons contained intranuclear inclusions characteristic for cytomegalovirus (CMV). All patients were male, 47 years of age or older, and all had marked severe and fulminating courses. Five of the 6 patients had toxic dilation of the colon. Three of our patients had received no steroid therapy before their toxic dilation, however, all received steroids during attempts at medical management. Two other patients were found to have toxic dilation of the colon among our 46 patients, however, no evidence of CMV could be found in these 2 cases. There were 6 patients without toxic dilation whose colon specimens showed destructive inflammation and granulation tissue extending into the muscularis propria or transmurally. None of the colons from these 6 patients contained CMV inclusions. In our patients, the finding of CMV may be coincidental, but it is suggested that in our group of patients with ulcerative colitis, the CMV may play a role in altering the clinical course of these patients.

In two patients, the value of percutaneous transhepatic decompression in the management of benign biliary strictures is illustrated. The procedure can help provide relief of jaundice, control of infection and improvement of nutritional status. Results of previous experience indicate that these factors play a major role in determining the over-all success rate in the surgical management of these patients.

We analyzed the records of 242 consecutive patients with adenocarcinoma of the stomach operated on for cure. We correlated survival with several factors, including the type of primary lesion, the operation performed, operative mortality, state of regional lymph nodes, margins of the resected specimens, and duration of preoperative symptoms. Overall survival at 5 years was only 18.6% and at 10 years was 7.1%. Patients with small malignant gastric ulcers, however, enjoyed increased survival at 5 years (53.8%) and at 10 years (15.0%). Overall operative mortality was 7.1%, but was 0% for patients with small malignant gastric ulcers. Even with large or high-lying lesions, radical operation can be accomplished with acceptable mortality and definite chance for cure. Thirteen of 45 five-year survivors had positive lymph nodes, and 7 of the 45 had positive margins of resection. Longer symptomatic preoperative periods, correlated positively with increased survival. Thirty patients with preoperative symptomatic periods exceeding 24 months had a 30.0% 5-year survival. Perhaps some of these lesions underwent malignant change in areas of symptomatic benign disease. We advocate early operation for gastric ulcers which do not heal promptly and stay healed.

A case report of a patient with severe nutritional deficiency and no adequate access to the central venous system for total parenteral nutrition is presented. Operative placement of a catheter directly into the right atrium allowed adequate nutritional support and led to a marked improvement in the clinical status of the patient and a gain of weight from 67 to 98 pounds. The technique of the procedure and its limited indications are discussed.

Kraske's methodology was classic: develop the operation in the laboratory, try it initially on patients as a last resort and, if it works, expand its use to patients with less severe disease. His operation immediately gained acceptance and was popular for the next quarter of a century. It was subsequently modified by Hochenagg, Billroth and Rydygier. These men merely altered the amount or manner of sacral removal. The operation was largely abandoned after Miles (3) showed that the lymphatic spread from carcinoma of the rectum is toward the liver. Kraske's procedure, however, stands as a landmark in preantibiotic operations on the colon. Combined with abdominal exploration, this type of procedure can be used to preserve the anus in certain instances of carcinoma of the rectum today.

A retrospective analysis was conducted on 74 patients with inflammatory bowel disease who were treated with intravenous hyperalimentation at the Hospital of the University of Pennsylvania between the years 1967-1976. Intravenous hyperalimentation can ameliorate the inevitable protein-calorie malnutrition present in patients with inflammatory bowel disease. Combined with complete bowel rest, intravenous hyperalimentation can effectively function as the primary treatment or as an adjunct to the surgical management of the complications of inflammatory bowel disease. Intravenous hyperalimentation can be safely administered to these severely ill patients, almost certainly improving survival rates in the patients treated.