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Two hundred and eighty-four patients who underwent highly selective vagotomy for duodenal or prepyloric ulcer were followed up for at least 1 year, and 47.9% of them for at least 5 years (mean : 58 months). The actuarial recurrence rates were 4.7% at 3 years, 9.6% at 5 years and 13.1% at 7 years. These results do not agree with the recently published figure of 20%. The authors insist on the necessity to dissect the lower oesophagus on a length of at least 5 cm. In duodenal ulcers, this technical detail should result in a cure rate of about 90% at 5 years.

Iodized oil (lipiodol) injected into the hepatic artery is selectively retained by hepatocarcinomas, as demonstrated by computerized tomography (CT) performed one week after the injection. The value of this technique for the diagnosis of hepatocarcinoma was assessed in a retrospective study of 45 patients. In 39 per cent of the cases intrahepatic tumoral extension was determined by the iodized oil which showed tumoral nodules that had not been detected by conventional methods, such as ultrasonography and CT alone. The lesions revealed by the iodized oil were small nodules around the main tumour. The combined iodized oil-CT technique plays an important role in the choice of treatment, especially when surgical excision is contemplated. It might also contribute to an early diagnosis of hepatocarcinoma in patients at risk, as illustrated by four of our cases where conventional morphological examinations had been negative.

Vasopressin was infused intra-arterially or intravenously during 12 portal bypass operations. In comparison with a control group (without vasopressin), there was a very significant reduction in blood loss and portal pressure, and a moderate increase in arterial blood pressure.

We have attempted to establish a prognostic nutritional index prospectively in 633 patients with digestive carcinoma making it possible to predict tumor resectability and occurrence of postoperative complications. The following factors were studied prior to surgery: age, sex, weight loss index, triceps skinfold thickness, midarm circumference, lymphocyte count, plasma albumin, transferrin and prealbumin levels, delayed hypersensitivity as investigated by 8 skin tests. The prognostic nutritional index was calculated using Mullen's formula. Unidimensional and multidimensional studies (linear discriminant and logistic discriminant analyses with partial correlations) were used for the statistical analysis. Mortality was 6,7 p. 100 while 16,2 p. 100 of patients presented a postoperative complication. The following variables showed a significant correlation with the resectability of the tumour: weight loss (p less than 0.0001), triceps skinfold thickness (p less than 0.01), midarm circumference (p less than 0.01), total lymphocyte count (p less than 0.01), plasma transferrin (p less than 0.01), delayed hypersensitivity (p less than 0.05). In the occurrence of postoperative complications there was a statistically significant value only to weight loss (p less than 0.001) and delayed hypersensitivity (p less than 0.05). Logistic discriminant analysis gave a linear model predicting tumor resectability in 78 p. 100 of patients and postoperative complications in 86 p. 100 of patients in which weight loss and delayed hypersensitivity were statistically significant. No prognostic value of Mullen's index was found. This study shows that assessment of the preoperative nutritional status of patients with gastrointestinal cancer makes it possible to predict tumor resectability and postoperative complications.

The anastomotic clamp described may be used to perform end-to-end anastomoses in digestive surgery. After a description of the instrument and its mode of use in its most suitable application -- colo-rectal anastomosis -- the authors report the first results of their clinical experience in 13 anastomoses, which are highly satisfactory.

Two hundred hospital patients with gallstones who had been cholecystectomized on account of typical biliary colics were investigated for migraine, headache, malaise, vertigo, flatulence, diarrhoea or constipation 2, 6, 12 and 24 months after the operation. The study showed that these symptoms are common in patients with biliary lithiasis, particularly women, and that their frequency increases with the duration of the disease. The beneficial effects of cholecystectomy are uncertain and appear to decrease with time ; only 30% of the patients seemed to improve after surgery. It is concluded that these symptoms betray real functional disorders, that cholecystectomy is not the appropriate treatment for them and that any improvement observed may be credited to the placebo effects of the operation.

The authors report the results of the surgical removal of bilestones in 139 patients over 75 years of age, taken from a series of 1 179 cases. The low mortality (4.3%) and morbidity rates are due to a non-aggressive protocol, especially in the treatment of choledocholithiasis. They conclude that advanced age does not necessarily imply a need for systematic alteration of the therapeutic approach.

Selective hepatic artery ligation has traditionally been considered dangerous by some authors in the treatment of traumatic haemobilia. Having observed one case in which this technique was successful in controlling liver haemorrhage, the authors have reviewed the literature. Conditions in which selective hepatic artery ligation can be dangerous are discussed. The safety and effectiveness of this treatment of traumatic haemobilia in normovolemic patients is emphasized.