Over a 14-year period 34 patients were referred for surgical treatment of insulinoma. The diagnosis was confirmed by demonstrating hypoglycaemia with inappropriate hyperinsulinaemia during prolonged fasting. Selective visceral angiography localized 30 solitary benign insulinomas and two carcinomas. In two patients with islet cell hyperplasia, angiography demonstrated a single lesion only. Ultrasonography had a sensitivity of 15 per cent and computed tomography a sensitivity of 24 per cent in the localization of tumours. All patients but one were treated by operation. Eighteen tumours were enucleated and 13 (including both patients with islet cell hyperplasia) were treated by distal pancreatectomy. Two patients underwent negative primary exploration; both had single adenomas removed at re-exploration. There were no operative deaths but nine patients (predominantly those undergoing pancreatic resection) had complications. Thirty-one patients were symptom-free following operation at a mean follow-up of 16 months.

Improved imaging of phaeochromocytoma obviates the need for transperitoneal exploration, allowing selected phaeochromocytomas to be successfully managed using an extraperitoneal approach.

A case of midgut volvulus forty eight hours following laparoscopic cholecystectomy is reported.

Previous reports suggest that up to 70% of patients undergoing surgery for Crohn's disease of the large bowel do not have gastrointestinal continuity restored and require a permanent ileostomy. In this study the experience with patients requiring surgical treatment of large bowel Crohn's disease is reviewed with particular reference to the management of the rectum. The records of 19 elective and 25 urgent colonic resections performed for large bowel Crohn's disease in 44 patients (16 males, 28 females; mean age 41 years, range 17-76) between 1983 and 1995 were reviewed. Staged proctectomy was performed in 5 of 12 patients who had colectomy for acute colitis and in one patient who had had an elective colectomy. Permanent ileostomy was required in 72% of patients with acute Crohn's colitis and 84% of patients who had elective surgery for large bowel Crohn's. Over 70% of patients having surgical treatment of Crohn's disease of the large bowel required permanent ileostomy. No cases of cancer developed in patients with retained rectal stumps.

Haemospermia is usually not associated with serious disease and is, therefore, frequently considered to be a symptom of limited significance. We present a case of Hodgkin's lymphoma in which haemospermia was one of the dominant presenting symptoms .Case Report S.A., a 29-year-old male, presented with a 4-month history of haemospermia which was recently associated with a vague lower abdominal ache and erectile failure. He also reported an 18-month history of night sweats and gradual weight loss. Physical examination was normal. Routine haematological assessment revealed an elevated ESR of 107 mmjs and a low haemoglobin of 10.3 8%. Coagulation studies were normal. Intravenous urography showed medial displacement of the left ureter and left wall of the bladder (Fig.). Ultrasonography and CT scan demonstrated that this was due to left iliac lymphadenopathy and that the para-aortic and peri-pancreatic nodes were similarly enlarged. There was no evidence of supradiaphragmatic involvement. Biopsy of a left iliac lymph node showed Hodgkin's lymphoma of mixed cellularity ; chemotherapy was commenced, with an early favourable response that included complete resolution of the haemospermia.