No abstract

Denied by relativc 5 Not requcstcd 3 1 (Chisholm GD. Time to end the softly softly approach on harvesting organs for transplantation.

ObjectiveThe authors determine if any aspects of the treatment of renal transplant patients with pancreatitis were of particular benefit with regard to graft and patient survival.

The results of 48 Roux-en-Y (RY) diversion procedures are reported: 41 were performed as secondary procedures and 7 as part of a primary operation for peptic ulcer. There was no operative mortality, but four patients developed temporary fistulae in the postoperative period and three patients required reoperation. Good clinical results were found when RY diversion was performed as a primary procedure or when the indication for operation was peptic ulceration. The overall results, however, were poor: 24 patients (50 per cent) felt that they had not benefited and 32 patients (67 per cent) remained in Visick grades III or IV. The main cause of failure was gastric stasis, especially of solid food. Gastric emptying studies were carried out after RY diversion in 22 patients, most of whom had symptoms of stasis. Emptying of liquids was found to be normal in most patients, but emptying of solids was delayed, the median t 1/2 for solids being 160 (75-370) min compared with 67 (50-85) min in DU patients. Bilious vomiting improved significantly after RY diversion, but 18 patients (38 per cent) complained of vomiting food and 32 patients (67 per cent) experienced postprandial distress or pain. Loss of the antral mill, vagotomy of the gastric remnant and, perhaps, resistance to gastric emptying by the Roux loop itself may together explain the delay in gastric emptying of solids after RY diversion.

The prevalence of urological symptoms in elderly males in the community is poorly documented. A series of 578 men, aged 60 to 85 years and registered with one inner city health centre, completed a self-administered questionnaire which inquired about current urological symptoms. Many symptoms were common, including a lengthening of the time to pass urine (26%), a deterioration in urinary flow (30%), dribbling (26%), urgency (31%), increased day-time frequency (32%) and nocturia (57%); 102 men (18%) gave 5 or more positive responses to the 13 questions relating to urological symptoms. In contrast, during a 2-year period, only 17 men, aged 60 to 85 years, were referred to a urology department from the same health centre. The implications of these findings are discussed.