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We present two cases of patients with coincidental pancreatic disease and abdominal aortic aneurysm. Initial pancreaticoduodenectomy was followed by staged abdominal aortic aneurysm repair via a retroperitoneal approach in both cases. We recommend the retroperitoneal approach over the transperitoneal approach as an easier and safer method of aortic aneurysmorrhaphy after the Whipple procedure.

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In this trial of pentoxifylline, 15 patients with end-stage peripheral vascular disease had symptoms severe enough to warrant operation, but surgery was contraindicated because of anatomically noncorrectable disease, serious medical problems, or refusal. Their mean age was sixty-six years. Each patient received oral pentoxifylline, 400 mg tid, for twelve weeks. Pentoxifylline had no measurable clinical benefit in 14 of the patients. In addition, the authors noted an increased incidence of symptomatic coronary artery insufficiency during the trial period that may or may not have been drug related.

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Proximal ligation usually controls bleeding from a tumor-eroded carotid artery. When this maneuver failed, two intraluminal balloon catheters were passed distally into the vessel, after which they were inflated and left in place for six weeks. The patient had no neurologic sequelae or further bleeding before succumbing to tumor progression 10 months later.

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The experience of the University of Colorado Medical Center affiliated hospitals with leukemic reticuloendotheliosis, hairy cell leukemia, during the past two years has been reviewed. Eight instances were found. The majority of patients in this study presented with fatigue, pancytopenia and splenomegaly. Diagnosis was based upon finding characteristic hairy cells in the blood, bone marrow or spleen. Treatment, unlike other hematopoietic malignant conditions, was primarily surgical, with splenectomy being the treatment of choice, which may lead to prolonged remission in the majority of instances.

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One hundred high-risk newborns underwent a total of 115 temporal artery catheterizations using direct arterial exposure. Early catheter-related complications occurred in 10 patients: retrograde thrombosis of the posterior auricular artery (6), small area of skin slough at catheterization site (2), and positive blood cultures. (2). Twenty-five surviving infants were examined 6-10 mo after catheter removal: 5 patients showed scarring of minor cosmetic importance; 20 patients had barely perceptible incisional scars; and 21 patients had a return of pulsatile flow in the catheterized temporal artery.

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One hundred patients with suspected biliary tract disease underwent gray scale cholecystosonography (GSCS) and had diagnostic confirmation by oral cholecystogram (OCG) and/or operation. Ultrasonography demonstrated the gallbladder in 94 of the 100 patients; 2 patients had had previous cholecystectomy and 3 of the 4 remaining patients had documented stones with no confirmation of a nonvisualizing OCG in the other patient. Among the 88 patients with OCG, GSCS findings correlated in 91 per cent (2 per cent false-positive; 7 per cent false-negative). Among the 43 operative patients, GSCS was proven correct in 91 per cent (no false positive; 9 per cent false-negative). Of 12 patients with jaundice GSCS correlated with operative findings in 75 per cent (no false-positive; 25 per cent false-negative). Diagnostic errors occurred in patients with very small biliary calculi, particularly when a single stone was impacted in the cystic duct. Failure to identify the gallbladder with ultrasound signifies probable cholelithiasis in the patient without previous cholecystectomy. On the basis of this experience, we conclude that (1) GSCS is most useful when jaundice or acute illness precludes conventional studies; (2) GSCS provides an inexpensive, quick, accurate means of diagnosing cholelithiasis with a very high specificity (97 per cent) and moderate sensitivity (88 per cent); and (3) GSCS is the optimal diagnostic procedure for evaluating the biliary tract in the acutely ill, jaundiced, vomiting, allergic, and/or pregnant patient.

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The hazards of umbilical artery catheterization necessitate the adoption of an alternate arterial cannulation site for monitoring arterial pressure and oxygen tension in the critically ill newborn. A newly developed method of catheter placement in the temporal artery not only provided arterial access for substantially longer than that reported for radial artery cannulation, but more than 50% of the infants in which it was performed weighted less than 1500 grams. Close adherence to the technique of arterial cannulation and catheter fixation is essential for prolonged arterial access. The method involves (1) Doppler location of the temporal artery, (2) a 3 mm transverse incision directly over the vessel, (3) bevel-down insertion of a winged hub teflon catheter with inner needle stylet, (4) securing the catheter with suture and collodion, and (5) maintenance of catheter patency with a constant infusion of heparinized solution. Temporal artery cannulation using this technique has been performed thus far 115 times in 100 infants with severe respiratory distress. The patients weighed between 540 and 3900 grams. Catheters remained operational for an average of 6.5 days (8 hours to 23 days), with 62% of all catheters providing arterial samples for more than 5 days. The cannulas worked well for arterial pressure monitoring, and pulse contour matched that of the umbilical artery in infants with catheters in both vessels.

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A comparison of small bowel bypass performed at university centers and by private practitioners in a large metropolitan area demonstrates definite stmilarities in terms of patient selection, mortality and morbidity, and weight loss results. The only aspect of small bowel bypass in the private sector that could be criticized would be the adequacy of follow-up. An operation with as many known and probably other unknown long-term complications as jejunoileal bypass necessitates prolonged careful patient follow-up. We belive the person most qualified to provide such follow-up is the surgeon who performed by bypass procedure.

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Accounting for each wounding bullet represents an important part of the emergency room evaluation of gunshot victims. Physical examination must include a thorough search for exit wounds. Medical personnel must be aware of the possibility of intra-arterial passage of a wounding missile and routinely obtain appropriate roentgenagraphic studies so that patients with arterial bullet embolization will be identified preoperatively and can receive optimal surgical repair of their injuries.

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Peristomal herniation represents the second most common late complication of abdominal wall enterostomy. Early herniation results from the creation of too large of a fascial defect. Late herniation is caused by a gradual enlargement of the fascial defect because of a poor selection of the colostomy site or an intrinsic weakness of the fascia due to the patient's age or general condition. Once peristomal herniation occurs, operative repair should be considered in an otherwise healthy person. Previous reports advocate primary repair of the herniation. In the present series of nine patients, three patients developed recurrence of the hernia six to eight months after primary repair. Six patients had colostomy hernia repairs that involved moving the site of the original stoma. All of these repairs remain intact at an average of two years, nine months (range, four months to six years). We therefore believe that the solution to the problem of recurrent colostomy herniation lies in the transposition of the site of the original colostomy.

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