Ectopic Gallstone as a Cause of Gastric Outlet Obstruction

Callstone ileus is, of course, a well known cause of small bowel obstruction. A gallstone, however, is a very rare cause of gastric outlet obstruction. Three cases illustrating this phenomenon are exhibited. Radiographs were diagnostic in two of the studies. All three patients did well postoperatively.     

DRAINING PUS FROM THE CORNEA

Thirteen patients with varying grades of suppurative keratitis were studied with regard to their response to keratoplasty. In all patients there was a rapid improvement in symptoms and signs. In eight of the 13 there was restoration at least of previous function: one patient lost all vision due to secondary closed-angle glaucoma, because he refused further surgery. Corneal graft opacification occurred in three eyes; one other became partially opaque; whilst in a fourth, the lamellar graft remained clear while the original autograft failed. At last follow-up, all eyes were normotensive and free of symptoms. Keratoplasty should assume an important part of the management of suppurative keratitis, from both theoretical and practical considerations.     

Recovery from day-case anaesthesia

Sixty unpremedicated patients undergoing dilatation and curettage were allocated randomly to receive one of three inhalational agents (halothane, enflurane or isoflurane) to supplement 67% nitrous oxide in oxygen after induction of anaesthesia with methohexitone. Recovery was assessed by the time patients took to open their eyes, to give their correct date of birth, to regain their pre-operative level of manipulative skill with a children's postbox toy, and by comparing pre-operative and postoperative performance of a paper and pencil test (the p-deletion test). There was no difference in the time to open eyes or to regain their pre-operative score with the postbox whether the patients received halothane, enflurane or isoflurane. Patients in the isoflurane group took longer than patients in the enflurane group to give their correct date of birth, but they performed better in the p-deletion test postoperatively, completing more lines with the same number of errors. Patients receiving enflurane committed more errors postoperatively in the p-deletion test. The incidence of complications was low and was not influenced by the choice of inhalational agent.