Carcinoma of the prostate with rectal symptoms.

An unusual case of a carcinoma of the prostate where the patient presented with rectal symptoms is described. A good initial response to oestrogen therapy occurred, with loss of perineal pain and rectal bleeding an improvement in urinary stream.

Anal pressure studies in spinal patients.

Maximal and sphincter pressure was measured in 22 patients with spinal cord lesions and in a group of 10 controls, using perfused sleeve manometry. The mean resting pressure of the spinal patients was 63+/-8 (SEM) mm Hg, and of the control group 116+/-14 (SEM) mm Hg, P less than 0-01. When the rectum was distended by a balloon inflated with 100 ml of air a fall in anal sphincter pressure to 33+/-6 (SEM) mm Hg in the spinal group and to 78+/-10 (SEM) mm Hg in the control group was observed.

An evaluation of preoperative methods of preventing postoperative pulmonary complications.

The effectiveness of three current regimes of preoperative respiratory care in reducing postoperative respiratory complications following herniorrhaphy was studied prospectively. No smoking for five days plus intensive physiotherapy, five days no smoking, and routine hospital admission two days preoperatively were the regimes. Clinical, bacteriological, chest X-ray, blood gas and respiratory function test data were the criteria for assessment. The same surgical and anaesthetic team performed each operation. No statistical difference between the groups for pulmonary complications was noted. A significant correlation was found between the preoperative vital capacity and arterial pO2; also between the preoperative forced expiratory volume in one second-vital capacity ratio with the postoperative arterial pO2.

The lymph nodes of the porta hepatis.

The area under the liver was dissected in 27 human autopsy specimens to search for lymph nodes in the fissures. Nodes were present in all instances. They were in the transverse fissure, posterior to the portal vein, posterior to pars transversus of the left portal vein and associated with the left hepatic artery. The size varied from 2 millimeters to 2 centimeters. Each node was histologically confirmed. Nodes were infrequent and small on the right. Nodes were not found between the portal vein, hepatic artery and bile ducts in the fissures. Nodes were found outside the fissures in the fascia between the bile duct and hepatic artery. Occlusion of the portal vein and hepatic artery could be expected before occlusion of the bile duct. Node enlargement in the transverse fissure is anticipated as a rare cause of jaundice.

The effect of acute ethanol administration on the exocrine pancreatic secretion of the pig.

The acute effect of intravenous and intragastric alcohol on exocrine pancreatic secretion was studied in pigs with chronic pancreatic and gastric fistulas. A new H-type pancreatic cannula was designed for the study. With intravenous alcohol and the gastric fistula open, increased gastric acid secretion occurred but pancreatic enzyme output was inhibited. When acid was allowed to inter the duodenum by closing the gastric fistula, intravenous alcohol produced a secretin-like effect of increased pancreatic volume and bicarbonate secretion. Intragastric alcohol caused an increase in volume, bicarbonate and enzyme output. This was probably due initially to direct gastroduodenal stimulation as the same response occurred following intragastric mannitol of similar volume, pH and osmolality. The subsequently sustained increase in volume and bicarbonate was possibly a secondary secretin-like response following absorption of alcohol. It is concluded that the pig pancreas responds to alcohol as has been described in other animals. The use of a single model has allowed clarification of various phases of response invoking the effects of secretin, gastric and glucagon.

Anal dilatation and haemorrhoidectomy. A prospective study.

The results of haemorrhoidectomy alone and anal dilatation alone for the treatment of 20 patients with second or third degree haemorrhoids were assessed prospectively over a 12-month period. After haemorrhoidectomy the symptoms of bleeding, lump, pruritus and discharge disappeared, and anal continence was maintained. Proctoscopy showed the occasional development of secondary piles high in the anal canal. Of those patients having an anal dilation alone, nearly half had symptoms and one had a mucus leak. Anal continence was unalttered in the remainder. Proctoscopy indicated the loss of anal venous engorgement.