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Background: Management of the pancreatic stump after pancreaticoduodenectomy (PD) is still a matter of debate. Pancreaticojejunostomy (PJ) is used commonly but is associated with a significant incidence of pancreatic leaks. Pancreaticogastrostomy (PG) is an alternative that has been reported to be safer., Methods: The study is a retrospective analysis of all patients having PD for ampullary carcinoma in one surgical unit at All India Institute of Medical Sciences over 18 years, with PG being the only drainage procedure for the pancreatic stump., Results: Among 125 patients having PD for ampullary carcinoma, overall morbidity rate was 28%, mortality rate was 4.8%, with no cases of leakage from the pancreaticogastrostomy., Conclusions: In world literature (including the current series), the leakage rate of PG is 2.5% (14 of 553) with only 2 deaths (2 of 14) due to leakage from PG. Our large experience and these data conclusively prove the safety of pancreaticogastrostomy, which should be the drainage procedure of choice for the pancreatic stump following pancreaticoduodenectomy.

The nutritional status of 24 patients of carcinoma oesophagus was assessed before and after central hyperalimentation with a liquid blenderized diet containing 3000-3500 cal and 100-120 g protein. The overall prevalence of malnutrition was found to be 70.8 per cent before the initiation of therapy. Of the various parameters used for assessment of nutritional status weight loss was the most common finding (91.6%) followed by alteration in midarm circumference, haemoglobin, triceps skin fold thickness, midarm muscle circumference and serum albumin. Enteral hyperalimentation for 10 days improved nutritional status by inducing significant gain in body weight (74.1%), triceps skin fold thickness (50%), midarm circumference (58%), midarm muscle circumference (62.5%) and serum albumin levels (91.6%). There was no significant change in haemoglobin levels.

Fifty-three patients with suspected gallbladder carcinoma underwent ultrasonography and laparoscopy. Laparoscopy correctly excluded malignancy in five patients when ultrasonography had suggested gallbladder neoplasia. Of 48 patients with gallbladder carcinoma, laparoscopy identified 46 (95.8%) as compared with 30 (62.5%) by ultrasonography (p less than 0.001). Distant metastases in the liver, parietal peritoneum, or omentum were present in 41 patients (85.4%) and were detected by laparoscopy in 39 (sensitivity 95%) and by ultrasonography in 21 (sensitivity 51.2%) (p less than 0.001). Combination of ultrasonography and laparoscopy improved the overall diagnostic accuracy to 100%. Laparoscopy provided histological diagnosis of the disease in 36 patients (75%) and circumvented unnecessary laparotomy in 40 (83.3%) patients by revealing advanced or associated disease. When laparoscopy suggested that the disease was localized, the diagnosis was correct in 83.3% (5 of 6) patients. Laparoscopy under local anesthesia is useful in the diagnosis and staging of gallbladder carcinoma, and therefore helpful in planning management.

Superior vena cava syndrome, an uncommon manifestation of carcinoma of the thyroid, is usually due to retrosternal extension of the growth. Rarely, however, there may be direct tumour extension into the great veins of the neck, which may cause sudden death. Only eight such cases have been reported in the English literature. The case reported by us is the first to be documented by computed tomography. Patients with carcinoma of the thyroid with the superior vena cava syndrome should undergo computed tomography to differentiate external compression due to goitre from intraluminal tumour.

Eighty patients with primary carcinoma of the gallbladder were studied by ultrasonography. Two broad groups were defined. In group I (72.5%), the gallbladder lumen was identified along with a mass lesion, and in group II (27.5%), a large mass totally replacing the gallbladder was seen. Group I was further categorized into three subtypes according to the morphology of the lesion: type 1--a mass almost filling the lumen; type 2--a polypoidal mass projecting into the lumen; and type 3--an infiltrating mass. Associated findings of infiltration of the liver, presence of calculi, biliary tree obstruction, liver metastasis, and lymphadenopathy further supported the diagnosis. Ultrasonography was found to be highly reliable in the diagnosis of carcinoma of the gallbladder. In addition, it provided guidance for biopsy/aspiration of nonpalpable tumors. Its shortcomings appear to be its inability to assess peritoneal and bowel involvement, as well as that of the omentum and posterior rectus sheath.

A case of primary malignant cyst of the parotid gland is described, and the possible origins of such cysts are discussed.