Between 1966 and 1980, 54 patients (40 men and 14 women) with a mean age of 38 years were operated on for a pancreatic pseudocyst at the Department of General Surgery, University of Göttingen. The aetiology of the cysts was alcohol abuse in 35 patients, biliary diseases in 8, blunt abdominal trauma in 4, virus-induced in 2 and unknown in 5. With the exception of those who had had trauma, all patients were suffering from chronic pancreatitis. Surgical therapy included in all cases a cystojejunostomy (52 with a Roux-Y-limb and 2 with an omega loop). The mean follow-up period was 13 years (range 6 to 20 years). The late mortality was 15 per cent (8 of 52 patients). Recurrent cysts occurred in two patients (5 per cent) and relapse of pancreatitis in one third of the patients. Deterioration of carbohydrate metabolism was observed in 20 per cent of the patients. After drainage operation stool fat content became normal in 20 per cent and deteriorated in 13 per cent. Persistence or cessation of alcohol intake influenced the long-term results. From these data we conclude that both alcohol withdrawal and sufficient drainage of the pseudocyst are important factors in the prognosis of pseudocyst.

1. For a precise analysis of angiotensin II (ANG) effects on human gastric muscle, we dissected longitudinal (lo) and circular (ci) strips from fundus (Fu), corpus (Co) and antrum (An), and circular muscle from the inner and outer part of the pyloric sphincter (Py-inn and Py-out) and from duodenum. The mechanical activity of these muscle strips was recorded simultaneously under auxotonic conditions. Preparations were taken from a total of 10 stomachs (from organ donors or gastrectomy preparations). 2. Excitatory effect after application of ANG (10(-9) to 10(-6) mol l-1) were regularly observed in all types of preparation (threshold: 10(-9) mol/l). 3. The quality of the responses depended on the general characteristics of the type of preparation. Tonic types of muscle showed predominantly tonic responses to ANG (Fu-lo, Fu-ci, Co-lo). Purely phasic muscles (An-ci) showed increases of the phasic activity (amplitude up to 33% delta 1). Intermediate types of muscle exhibited combined phasic/tonic responses (Co-ci, An-lo). Phasic responses were also seen in Py-out. Inner pyloric muscle (Py-inn) responded only to a small extent to ANG. Phasic/tonic activations were observed in the duodenal preparations, accompanied by slight increases in frequency. 4. The intensity of the ANG-induced responses often exceeded the maximum acetylcholine-induced activation. The qualitative pattern of ANG responses was similar to that of bombesin-induced activation.

The effects of motilin on gastrointestinal muscles show great variations in different organs and different species. For a precise regional differentiation, we recorded the mechanical activity of longitudinal and circular strips from fundus, corpus and antrum and of circular preparations from the inner and outer layer of the pyloric sphincter and from the duodenum (20 human stomachs). Motilin produced excitatory effects on the mechanical activity of the circular muscle strips from all regions of the human stomach including the pylorus. The effects on longitudinal preparations and on duodenal strips were weak. The most striking effect was an increase of phasic activity (amplitude) in circular antrum preparations, which exceeded the acetylcholine- and bombesin-induced activity. In pylorus preparations, a strong stimulation of phasic activity was observed with a transition to tonic activity in the inner layer of the pyloric ring at high motilin concentrations. The motilin-induced activity of the pyloric preparations was greater than the acetylcholine-induced contractions and even exceeded the bombesin-induced responses in the outer pylorus. The responses of the muscle strips of the proximal stomach (fundus and corpus) were weaker and did not exceed the acetylcholine-induced activity. All effects remained unaltered by atropine and tetrodotoxin application. The study confirms that motilin can interact directly with the smooth muscle of human stomach.

In the past three years five premature very low birth weight infants (VLBW, birth weight 720-1,300 g) developed spontaneous localized perforations of the small intestine during the second week after birth. There was no evidence of intestinal obstruction or necrotizing enterocolitis (NEC). The clinical presentation and laboratory values as well as the radiologic, intraoperative and histologic findings were different from those of NEC. In four cases the initial symptoms presented as a gray-green discoloration of the flank and inguinal region with an otherwise unremarkable general condition. All patients exhibited a leukocytosis (range 14,700-19,300) and increased neutrophil count (range 9,900-14,800). Additionally, a pronounced increase in the activity of alkaline phosphatase (> 2.000 U/l in 3 cases) and a renewed increase of serum bilirubin was observed. Four of the five infants survived following laparotomy with ileostomy (n = 2) or primary anastomosis (n = 3).

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