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Evaluates the results of the Imanaga reconstruction following pylorus preserving pancreatoduodenectomy. Role of the gastrointestinal reconstruction; Use of the normal anatomical route for the jejunal loop; Restoration of the normal configuration of the upper gastrointestinal tract.

Presents correspondence related to medicine in Great Britain. Dangers of transporting sick children by air; Payments to doctors and the responsibilities of ethics committees; Head injuries in adult; Issues on medical defence societies.

, , 349-351. Lung hernias occur in the cervical position in about one third of cases. The remainder appear through the chest wall. Some lung hernias are congenital, but trauma is the most common cause. The indications for surgery depend upon the severity of symptoms. Repair by direct suture can be used for small tears in Sibson's (costovertebral) fascia while larger defects have been closed using prosthetic materials. Four patients with cervical lung hernia are described together with an account of their operations. [ABSTRACT FROM PUBLISHER]

Objectives: Chronic pancreatitis (CP) is common. It is associated with a substantial morbidity, including malnutrition, malabsorption, pseudocysts, metabolic disturbances, and intractable abdominal pain. Approximately 5% of patients with CP are refractory to nutritional support and opiate analgesia, making management challenging.Pancreatic rest can provide symptomatic relief. However, achieving simultaneous pancreatic rest and adequate nutritional support in these patients is difficult. We describe a technique for providing nutritional support and pancreatic rest in patients with intractable symptomatic CP., Methods: Three patients with symptomatic CP refractory to standard treatment were included in the study. All 3 patients had masses associated with the pancreas. Symptom relief and adequate nutritional support were achieved by inserting a long-term nasojejunal (NJ) tube (Flocare Bengmark, Nutricia Clinical Care, United Kingdom) under ambulatory endoscopic guidance. Data were recorded prospectively., Results: Long-term NJ tube feeding achieved pancreatic rest and significant symptomatic relief while delivering adequate nutritional support. Pseudocyst size decreased substantially in 2 patients. The third patient was found to have pancreatic carcinoma after pancreaticoduodenectomy., Conclusions: In patients with symptomatic CP refractory to standard nutritional support and opiate analgesia, long-term NJ tube feeding can be a cheap, well-tolerated, safe, and effective method of providing adequate nutritional support and substantially relieving intractable symptoms.

Pulsed radio-frequency electrical energy has been used for many years in the treatment of various soft tissue lesions, and this paper describes its use in stimulating repair in delayed and non-union, with a success rate in 16 cases equal to that of the other electrical stimulation techniques. The equipment is described and a theory proposed that the cell membrane has a diode effect in allowing the absorption of electrical charge, which, by its influence on the calcium ion, stimulates the cell into activity.

Using micropuncture techniques, pancreatic electrolyte secretion was studied in 50 female mongrel cats. During maximal secretin stimulation (GIH, 4 to 6 U per kg-hr), juice was collected from intralobular (10 to 50 mu diameter), and extralobular (25 to 300 mu diameter) ducts by micropuncture and compared with juice simultaneously collected from the main duct. The juice [Cl-] steadily decreased from intralobular ducts (112 +/- 9 mEq per liter) to the main duct (46 +/- 8 mEq per liter). During in vivo perfusion, secretion of H2O and HCO3- by the extralobular ducts (25 to 150 mu diameter) was sensitive to secretin. There was no evidence for secretion by the main duct. Pancreatic secretion of water and electrolytes appears to result from the admixture of a Cl-rich primary secretion originating from intralobular structures and a larger volume of HCO3- -rich fluid originating from the smaller extralobular ducts. HCO3- cl- exchange in these ducts accounts for the characteristic changes in concentrations of HCO3- and Cl- as the flow rate varies.

A new micropuncture technique of microcannulation has been developed and applied in cats to study exocrine secretion in the pancreatic ducts. Two micropipets of different diameters are assembled with the smaller pipet (10-20 mum) mounted inside the larger (25-50 mum). Using the combination, a larger pancreatic duct (less than 300 mum) is directly punctured and the inner pipet is advanced into the lumen of a small (20-50 mum) duct, which would otherwise be inaccessible. In anesthetized cats, during maximal stimulation with secretin (GIH 4-6 units/kg per h iv) the average chloride concentration of juice obtained from small ducts (25-50 mum) was 106 +/- 3 meq/1 and from large ducts (50-150 mum) was 75 +/- 5 meq/1. The results were confirmed by conventional micropuncture techniques which were technically more difficult. This method to collect fluid from small ducts is more physiological than direct micropuncture and thus the technique is a useful addition to micropuncture methodology.

Pancreatic biopsy in 171 patients produced complications in 4.7 per cent and death in 1.7 per cent. The biopsy diagnosis was confirmed in 86 per cent but was falsely negative in 14 per cent of pancreatic cancers. Frozen sections were interpreted correctly in all cases. Wedge biopsy resulted in fewer complications and fewer false-negative results than needle biopsy and is preferable except for periampullary lesions in which transduodenal needle biopsy is best. When the biopsy incision transected a pancreatic duct, suture ligation and drainage avoided complications. Open transduodenal biopsy of periampullary lesions was reliable, but the duodenotomy closure leaked in 10 per cent of the cases. Pancreatic biopsy with confirmation of malignancy should precede pancreaticoduodenectomy in most cases of suspected pancreatic cancer.