Observations and surgical management of chronic pancreatitis in the British Isles: a review of the twentieth century.

Chronic pancreatitis was a recognized clinical entity in the British Isles at the beginning of the twentieth century, but until little more than 30 years ago, it was considered to be a rare condition and received scant attention from British surgeons. During the second half of the twentieth century, the incidence of the disease in the British Isles has increased significantly and alcohol abuse has become, by far, the most important etiological factor. Per capita consumption of alcohol in the British Isles has increased very markedly in the past 30 years and alcohol abuse is becoming a major social problem, but, although chronic pancreatitis is more common now than it was 30 years ago, the increase in its incidence is a good deal less than might be expected. British surgeons are agreed that intractable pain is the cardinal indication for surgical intervention in chronic pancreatitis and success depends on selection of the operative procedure most appropriate to the pathological state of the pancreas and, in particular, of its ductal system. In recent years, British surgeons in highly specialized units have become more radical in their approach to the treatment of chronic pancreatitis with total pancreatectomy in selected patients currently being advised more frequently than in previous decades.

Long term review of procedures for venous perforator insufficiency.

In a retrospective review of 108 patients treated for perforator insufficiency, we evaluated 99 limbs of 80 returning patients, 80 per cent of whom had had the operation at least five years before. In 64 of the patients reviewed, good to excellent results were achieved. These patients did not have a recurrence of the ulceration, eczema or prominent varices. Two instances of recurrent ulceration and one of incipient ulceration were discovered in the study. Wound complications were a problem because of the nature of the skin problems encountered. We concluded that division of incompetent perforating veins combined with excision of the superficial venous system yields good results.