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A prospective study was carried out in 100 patients with carcinoma of the digestive tract, in whom a CT-scan and a radionuclide scan were made prior to operation. The CT-scan and the radionuclide scan had the same degree of diagnostic relaibility (about 80% correct diagnoses). Routine pre-operative CT or isotope scans do not in our experience alter the surgical management. From the in vitro investigation in which the liver is cut into the same slices as the computerized tomography, it appears that liver metastases larger than 3.5 cm diameter are always seen, while smaller metastases may be missed. The alkaline phosphatase and the gamma CT are no reliable estimations in establishing the diagnosis of liver metastases.

The results of operative treatment of unstable distal radial fractures were evaluated in 46 patients according to the criteria of Steinmann and Spier. The overall results were excellent or good in 35 patients (76.1%) and fair in 11 patients (23.9%). There were no poor results. Intra-articular fractures with volar dislocation (Smith type II) and fractures with severe comminution (Sarmiento type IV) are unstable and require surgery. Special attention must be paid to the Sarmiento type-II fracture with severe comminution of the dorsal cortex, severe radial shortening (greater than 10 mm) and dorsal tilt (greater than 25 degrees). Although not intra-articular, this fracture type may also prove to be unstable. The treatment of a Smith type-II fracture is a volar buttress plate unless extended comminution is present. Then, and in all other unstable fracture types, external fixation should be employed. In cases with severe loss of the dorsal cortex, bone grafting may be indicated.

86 Patients treated for first or second degree haemorrhoids by Lord's manual dilatation of the anus were followed up for a mean period of 7.2 years. The outcome in the 76 patients traced was satisfactory or good in 76.3%. In only 14.5% was the result unsatisfactory. Lord's anal dilatation is a relatively simple procedure; the results of this study show that it gives good long-lasting results.

All instrument and needle accidents, and mucosal exposure to blood involving surgical specialists and operating room personnel were recorded for a seven-month period in a middle-sized Amsterdam hospital, the St. Lucas. Fifty-four accidents were reported, of which 42 were percutaneous wounds and 12, blood splatters in the eyes. The frequency of percutaneous wounds per operation per person ranged from 0 to 0.013. In the same period 3098 patients who had to be operated on were asked to participate in an anonymous study for HIV antibody. One hundred and twenty patients refused participation (3.9%). Of the 2978 participating patients seven were seropositive for anti-HIV (0.23%). The observed percutaneous accident frequency and HIV prevalence were used in combination with reports from the literature on the risk of infection after a single exposure to HIV infected material, to calculate the HIV professional risk for operating room personnel in this hospital. For general surgeons the risk of infection (based on 500 operations per year) was calculated as 0.0012 for an occupational lifespan of 30 years. For the other specialists and functions the risk was the same or less. Considering the low risk our conclusion is that screening of preoperative patients is not necessary in this hospital. The observance of general protective measures provides sufficient protection for the professional group examined.

A patient with gastric volvulus after traumatic diaphragmatic rupture is reported. The trias of Borchardt (pain in epigastrio with gastric distension, hiccups with the inability to vomit, inability to secure the passage of a nasogastric tube) must raise the suspicion on acute gastric volvulus, especially if these abdominal complaints are associated with blunt abdominal trauma in the past. In these cases, lateral X-ray examinations of the chest and swallowing studies establish the diagnosis.

Five patients were treated for pseudo-obstruction of the colon. The symptoms, diagnostic procedures and treatment of Ogilvie's syndrome are discussed. A definitive diagnosis can be established only at laparotomy when no mechanical obstruction is found to be present. Progression of ileus and signs of peritonitis constitute an indication for laparotomy. Delay in operative therapy implies the risk of (coecal) perforation with increased mortality. Coecostomy is an adequate therapy that spares the patient a second procedure for closure of a colostomy.

We have developed an anastomosis technique for resection of the distal colon based on the principle of submucosal layer apposition. The anastomosis apparatus consists of two rings of Ertalyte (polyester-polyethyleneterephtalate) containing two magnetic rings of polymer bonded rare earth cobalt. For low anastomoses we developed a magnetic ring holder, protecting cap and hexagonal connecting rod. The working principle is based on progressive compression leading to necrosis of the intermediate mucosal and submucosal layers by increasing magnetic force while bowel healing takes place. After 7 to 17 days the magnets cut through and are propelled by peristalis out of the anastomotic region. From our initial series of five patients we performed three sigmoid resections and two low anterior resections. There were no postoperative complications. Sigmoidoscopic and radiological investigations two weeks postoperatively, showed no evidence of leakage or anastomotic narrowing. The technique and the special advantages of the apparatus are discussed.

Based upon experiments on animals, an anastomotic apparatus, consisting of two magnetic rings of polymer bonded, rare earth cobalt magnets embedded in polyester, was developed. There are three types of polyester device with diameters of 25, 28, and 30 millimeters, respectively. The force between the magnets varied between 2.5 Newtons at 4 centimer separation and 11.8 Newtons at union. For the low colorectal anastomosis, a magnet holder, connecting rod and spherical cap were developed. The aim of the technique is a quick restoration of the underbroken submucosal intestinal cylinder by optimal circular apposition of the submucosal layer. The working mechanism is based upon progressive compression, leading to necrosis of the intermediate mucosal and submucosal layers by increasing the magnetic force while intestinal healing takes place. After seven to 12 days, the magnets cut through the disappear from the anastomotic region by intestinal peristalsis. From the initial series of 21 patients, 11 resections of the sigmoid colon and nine low anterior resections were performed. Dehiscence of the suture line was noted in two instances. One patient required reoperation. The other patient had a small area of dehiscence at the suture line after evacuation of an infected hematoma with a further uncomplicated course. One patient died on the third postoperative day of recurrent myocardial infarction. In the other 18 patients, primary intestinal healing was demonstrated roentgenologically and sigmoidoscopically.