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We studied antipyrine clearance (APC1) in 19 healthy controls, 10 cirrhotic patients, 20 patients undergoing partial hepatectomy for liver tumors (14 with cirrhosis and 6 without cirrhosis). The aim of the study was to evaluate if the test represents a measure of the residual hepatic function and a useful index of surgical risk in cirrhotic patients following partial hepatectomy. The APC1 was significantly reduced in cirrhotic patients ws healthy controls. It is reduced following partial hepatectomy in cirrhotic patients (p less than 0.001) and in non cirrhotic patients (n.s.). The APC1 was found to be related with the plasma level of albumin and pseudocholinesterase; it also was related with the Pugh's score for hepatic function. The APC1 is a satisfactory index of residual hepatic function. On the other hand it does not provide more useful information than the Pugh's score for surgical risk in liver resection.

Encephalopathy is the most common complication after total portal by-pass operation. 5-15% of patients have severe and intractable encephalopathy. Many medical and surgical procedures were proposed to prevent and treat this complication but none of these were effective. Two cases of patients with severe encephalopathy after side to side portal by-pass are presented. They were treated with the procedure proposed by Bismuth; it consists of a gradual suppression of the anastomosis associated with esophagogastric devascularization. In the first case we obtained the regression of encephalopathy while the second patient died portal thrombosis (probably due to this procedure) two months after surgery. Validity and efficacy of this procedure must be evaluated with a higher number of patients. This surgical technique should lead to choose the type of portal by-pass: side to side portal by-pass operation allows according to Bismuth's procedure to reestablish an hepatopetal flow.

Indications for and results of bilio-digestive shunt are discussed and basic stages described. The data refer to non-cancerous pathology of the bile ways. It is concluded that the operation should always be carried out in the first instance (comparatively high intracholedochic pressure values, moderate dilatation of the main bile way, calculosis of the papilla) and not just at reoperation. This convinction is backed up by the very low operative mortality, the good long-term results and the operation's comparatively easy performance.

A case of Zollinger-Ellison syndrome with some peculiar aspects is described. The disease started with painless dyspepsia, watery diarrhea, relevant loss of body weight and absence of peptic ulcer. After a steroid treatment performed at home without any rationale, diarrhea stopped totally for 18 months and body weight returned to normal. Subsequently, the disease recurred with more typical clinical characters: juxtapyloric ulcer, increase in serum gastrin levels and positive secretin test, presence of gastrinomas at angiography. The monitoring of gastric pH showed a persistent hyperacidity during medical treatment with H2 and muscarinic antagonists. The localization of gastrinomas was extrapancreatic, at the root of jejunal mesentery. Excellent results were obtained by surgical treatment which consisted in resection of the principal neoplastic masses with total gastrectomy. The patient's general conditions after two years are good.

Le Veen's peritoneal-jugular shunt was employed in the treatment of irreducible ascites in 16 patients with cirrhosis of the liver. Intraoperative mortality was 18%. It was due to disseminated intravascular coagulopathy in 2/3 cases. Regression of ascites and renal failure was noted in all survivors. Follow-up over 6-28 months (mean 10 months) showed that 2 patients had died from sepsis and two from liver failure. Recurrence of ascites (3 cases) had been brought about by malposition or thrombosis of the venous catheter; in one subject, thrombosis extending to the vena cava superior necessitated a portal shunt. There were no instances of digestive haemorrhage attributable to rupture of oesophageal varices. Good results free from complications were noted in 7 patients (43%) and easily treatable complications in 9 (56%). There was an evident improvement over the results obtainable with conventional management. The fact that mortality is generally confined to patients in Child's group C with marked hypoprothrombinaemia suggests that such candidates should be carefully selected. This, together with technical improvements designed to reduce the incidence of intravascular coagulopathy and haemodynamic overload following the operation, would seem capable of permitting better results in the future.