Noncaseating Granulomas of the Pancreas

The patient presented with evidence of common bile duct obstruction and at surgery had narrowing of the distal common bile duct secondary to noncaseating granulomas of the pancreas, most probably sarcoidosis. Although pancreatic sarcoid is rare, this entity should be included in the differential diagnosis of pancreatic disease.     

THE USE OF MUSCLE RELAXANTS AT THE INDUCTION OF ANAESTHESIA OF PATIENTS WITH A FULL STOMACH

The use of a muscle relaxant after a rapid induction of anaesthesiawill facilitate intubation and prevent vomiting when the patientis paralyzed. After paralysis, fluid may flow passively fromthe stomach and oesophagus if the patient be horizontal or tiltedhead-down, and will make rapid endotracheal intubation difficult,thus putting the patient in hazard from hypoxia. Tracheal aspirationis, however, unlikely. The passive movement of fluid is preventedby a foot-down tilt during induction, but, if any other factorcause fluid to reach the oropharynx in this position, trachealaspiration is very likely, and has occurred in several instances.Possible factors are attempted vomiting before the onset ofparalysis, abnormalities of the gastro-oesophageal junction,perhaps associated with respiratory trouble during induction,and changes in intragastric pressure during induction. The dangersof methods dependent on a muscle relaxant in the hands of inexperienceddoctors are stressed, and the need to consider gastric decompressionand to practice pre-oxygenation of the patient prior to anaesthesiaare emphasized. It is concluded that insufficient evidence isavailable to favour one position more than another during induction.Cricoid pressure to occlude the oesophagus against the cervicalveretebrae should be used, if the supine horizontal positionbe chosen.