Although Trasylol has been available for the treatment of acute pancreatitis for 15 years a review of the lberature reveals that its effectiveness has never been eithef proved or disproved. A prospective double blind controlled trial was therefore started in 1967. The results are now reported. One hundred and five patients were studied. They provided a uniform clinical material and all were managed on an identical strict protocol except that patients received either Trasylol A or B, allotted in sequence using random numbers. At the conclusion of the acute episode the illness was assessed according to criteria which were not open to observer variation and each attack was categorized as mild, moderate, severe or fatal. The trial showed that there was a mortality o f 4 out of 53 cases (7.5 per cent) in group A and 13 out of 52 cases (25 per cent) in group B. Statistically this diflerence is signifcant (f = 4675, d.J = I , P = 0.05). The code was then broken and this revealed that group A had received the active Trasylol. Analysis of age patterns showed that in the Trasylol-treatedgroup the usual tendency for mortality to rise with advancing age was abolished. Trasylol must therefore be regarded as a drug which is beneficial in the treatment of acute pancreatitis.

It is understandable that more debate has been given to whether or not psychotropic drugs should be prescribed than to which psychotropic drugs should be prescribed. I Summary A review of acute pancreatitis occurring over a 20-year period in the Bristol clinical area is reported. A total of 590 cases were available for analysis. The yearly incidence was 53 8 per million population at risk, with a mortality of 9 0 per million. This compares favourably with 11 4 deaths per million for England and Wales as a whole during the same period but the difference is not statistically significant. When the deaths occurring in the Bristol clinical area were expressed in terms of case mortality rate the figure was 17%. In contrast the mortality for recurrent acute pancreatitis was only 1-5%, and the benign nature of this second condition is confirmed. Aetiological factors and age and sex distribution were also analysed in relation to each other and to mortality.

Chitty (1957), reporting on prostatic abscess from the Bristol Department of Urology, suggested that the treatment of choice was transurethral resection of the entire gland. Over the 10 years since this initial report our experience has amply confirmed this view and a further series of 67 patients is now analysed. It would appear that there is no absolute means of establishing the diagnosis, either from the history or the clinical findings, and that even when the diagnosis is suspected it may only be confirmed by resection of the gland. The abscesses are not infrequently multiple and thus a simple saucerization of one cavity may leave further significant foci undiscovered. A full transurethral prostatectomy is therefore the treatment of choice. This policy of radical treatment by the transurethral route has been followed by minimal postoperative complications or recurrence.IN 1957 Chitty reported to the BRITISH JOURNAL OF SURGERY 6 years' experience of prostatic abscess in the Urological Department in Bristol. His series consisted of 27 cases averaging rather more than 4 a year, and from these he outlined the mode of presentation and the various forms of treatment which had been employed. He also reviewed the literature and discussed various theories as to the aetiology of the condition. He concluded that conservative treatment carried the danger of either recurrent abscess or the establishment of chronic prostatitis. This appeared to be because drainage was incomplete and Chitty therefore advocated transurethral resection (TUR) of the prostate gland as the treatment of choice. This has since been the policy of this Department of Urology, and it was felt that our experience of this condition should now be reviewed. In particular, the results of this more radical form of treatment are reassessed with full follow-up.

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