Future needs for ERCP: incidence of conditions leading to bile duct obstruction and requirements for diagnostic and therapeutic biliary procedures.

Although the development of endoscopic methods of treatment for biliary obstruction has proceeded rapidly in recent years, endoscopic retrograde cholangiopancreatographic (ERCP) services are patchily distributed. A recent survey by the British Society of Gastroenterology has shown that almost half the district general hospitals questioned did not have a sphincterotomy service available locally. To assess the level of provision required, two investigations have been undertaken. Firstly, an epidemiological study of bile duct obstruction has been carried out in the South Western Region. Secondly, the actual surgical and endoscopic workload in treating obstructive jaundice has been analysed in two health districts. Using present incidence and treatment rates at least 50 ERCPs per 100,000 of the population per year are estimated to be required in the future. Surgical treatment rates can be expected to fall as the number of therapeutic ERCPs increases. The implications of this estimate in equipment and staffing terms are discussed.     

胆通合成工艺改进

本文报道了胆通(4—甲基—7—羟基香豆素)合成新工艺,用强酸性阳离子交换树脂作为缩合反应的催化剂,它比原法简单,废水减少而收率接近原法,达74％。     

Medical admissions to Hillbrow Hospital, Johannesburg, by discharge diagnosis

Medical admissions to a Johannesburg hospital serving an urban black population were analysed for a 3-month period by discharge diagnosis. Current disease trends are noted and the possibility of collecting hospital discharge data on a larger scale is discussed.     

Botshabelo's vaccination survey.

This community-based survey evaluates vaccination coverage of small children and socio-economic status of their households in a randomly selected sample of a black South African township. It reveals a poverty-stricken community, where only 19% of the children surveyed were fully vaccinated. It is suggested that expansion of health infrastructures together with a co-ordinated strategy of immunisation would result in a spectacular increase in vaccination coverage.     

Involvement of guanylate cyclase and phosphodiesterases in the functional heterogeneity of human blood platelet subpopulations

Cyclic nucleotides are involved in the regulation of platelet activation, shape change, and aggregation. In this study we have investigated the role of guanylate cyclase and phosphodiesterase in three functional heterogeneous human blood platelet subpopulations separated according to density. In low-density platelets aggregation was enhanced and inhibited less when cyclic GMP was increased by sodium nitroprusside, compared to high-density platelets. Low-density platelets possessed a lower basal level of cyclic GMP and exhibited a smaller increase in cyclic GMP after stimulation with sodium nitroprusside. Cyclic GMP-dependent phosphodiesterase activity was similar in high, low, and intermediate-density platelets. In contrast, the activity of the cyclic AMP-dependent phosphodiesterase was higher in low-density compared to high and intermediate-density platelets. These results suggest that regulation of cyclic GMP and cyclic AMP levels plays an important role in the functional heterogeneity of human blood platelets.     

The results of Ramstedt's operation: room for complacency?

The results of 101 pyloromyotomies performed from 1972 to 1980 have been analysed; 34 operations were performed using local anaesthesia and 67 using general anaesthesia. The use of local anaesthesia was not associated with any advantage related to postoperative or other complications. A high postoperative complication rate of 20% was found (excluding postoperative vomiting), and there were 2 deaths; 11 patients suffered wound infection, with Staphylococcus aureus isolated from 5 of these wounds. The use of prophylactic antibiotics active against Staphylococcus aureus is suggested.     

Randomized prospective trial of Roux-en-Y duodenal diversion versus fundoplication for severe reflux oesophagitis

It is not widely recognized that duodenal contents are implicated in the causation of severe reflux oesophagitis and stricture formation in patients with hiatus hernia. In a randomized prospective trial, including only patients with severe oesophageal changes, standard Nissen fundoplication has been compared with antrectomy and Roux-en-Y reconstruction. Twenty-two patients were randomized to each group. The 42 surviving trial patients have been followed for an average period of over 5 years. Good results (Visick I or II) have been achieved in 91 per cent of 22 patients having antrectomy and Roux-en-Y anastomosis (Group B), compared with 65 per cent of 20 patients surviving after Nissen fundoplication (Group A). Poor results (Visick III or IV) seen in seven patients (35 per cent) in group A were almost all associated with failure of fundoplication to stop reflux. Two of these patients have subsequently had antrectomy and Roux-en-Y reconstruction with excellent results. Antrectomy with Roux-en-Y gastrojejunostomy appears to be superior to a standard anti-reflux procedure as primary surgical treatment in these patients. The technique is recommended: where the patient has a fixed irreducible hiatus hernia; where previous surgery at the hiatus has failed and rendered reoperation hazardous.     

Transformation of newborn hamster cells with simian adenovirus SA7

Newborn Syrian hamster skin cells can be transformed in vitro by simian adenovirus SA7. The transformation occurs within 6–8 days of treatment with virus and the transformed cells give rise to tumour development when they are re-inoculated into weanling hamsters.