W. P. Small

Suture line ulcer after gastric surgery

Abstract 1. 1. Suture line ulcer as a postoperative complication of surgery for peptic ulcer has been recognised fifteen times in fourteen patients; a continuous nonabsorbable seromuscular suture had been used. 2. 2. Undiagnosed, it is a needless cause of pain, dyspepsia, and bleeding. 3. 3. Diagnosis is made by gastroscopy. Alternatively diagnosis is achieved by laparotomy which includes inspection of the suture line. Barium examination is seldom helpful. The acid output is low but not diagnostic. 4. 4. Treatment is by resection of the anastomosis and reconstitution using catgut. 5. 5. The exclusive use of absorbable suture material should abolish this form of recurrent ulcer.

SCINTILLOGRAPHY IN THE DIAGNOSIS OF PANCREATIC DISEASE

Abstract [ 75 Se]-methionine at doses of 3 μC per kg. intravenously has been used to scan the pancreas in eighty patients with known or suspected pancreatic disease, or in whom it was necessary to try to exclude a pancreatic lesion. Total-body radiation with this procedure will not exceed 1.3 r. The results were compared with surgical and other evidence. Of the 76 successful scans 37 were normal (including 3 falsenegatives) and 39 were abnormal (6 of them were falsepositives). In twenty patients hormone-stimulated tests of pancreatic function were done: the results were the same in sixteen comparisons. Scanning has proved a useful aid in the diagnosis of pancreatic disease and in the exclusion of the pancreas in the search for intra-abdominal lesions. In conjunction with clinical assessment and other laboratory and radiological techniques a high measure of accuracy of diagnosis in pancreatic diseases was obtained. By this means the number of exploratory laparotomies in patients without pancreatic disease should be reduced.

FAILURE OF SOMATOSTATIN TO ACCELERATE CLOSURE OF ENTEROCUTANEOUS FISTULAS IN PATIENTS RECEIVING TOTAL PARENTERAL NUTRITION

Sleep apnoea is a complication of untreated acromegaly. It can lead to fatigue and several adverse consequences, among them daytime sleepiness, pulmonary hypertension, right ventricular failure, and life-threatening arrhythmias.5 These apnoeas are probably secondary to the involvement of tongue and pharynx that can also be responsible for problems during intubation or anaesthesia.2,6 Long-term somatostatin has been reported to decrease soft-tissue swelling in acromegaly. Such improvement can be very acute, as suggested by the rapid amelioration of the sleep apnoea syndrome in our patient. Thus, in acromegaly SMS 201-995 may be useful for the treatment of severe sleep apnoea syndrome, thereby avoiding the need for tracheostomy. Moreover it might be of value in the preoperative preparation of acromegalic patients.