resin while three remained untreated. Anticoagulation was achieved with heparin and blood flow maintained at 200 ml/min throughout haemoperfusion (two hours).Both forms of haemoperfusion significantly reduced plasma paraquat levels (P<0 05) compared with control values (see fig.), cation exchange resin being more effective than activated charcoal (P < 0.05). Plasma paraquat clearances remained consistently high using cation exchange but were lower and more variable with activated charcoal. After haemoperfusion plasma paraquat concentrations increased in both treated groups. Paraquat concentrations approached control values 30 minutes after charcoal haemoperfusion but took 90 minutes after cation exchange haemoperfusion. Conversion: SI to Traditional Units-Paraquat: 1 ,Lmol/ 0-26 mg/l. Activated charcoal reduced blood platelet concentrations by 40% and cation exchange resin reduced them by 50%. The cation exchange resin was equilibrated before haemoperfusion with electrolyte solutions, and subsequently plasma calcium, magnesium, sodium, and potassium remained normal. DiscussionProgressive lung fibrosis leading to respiratory failure remains the most important lethal complication of paraquat poisoning in man, though renal failure is also common. Early reports suggested that paraquat exerts its toxic effect in a "hit and run" fashion.3 Recently, however, paraquat has been shown in vivo to accumulate selectively in rat lung2 and in vitro in rat and human lung by similar mechanisms.After oral dosage of paraquat to rats sustained plasma paraquat concentrations of about 3-9 tmol/l (1 mg/l) resulted in paraquat accumulating in the lung and in death.2 Repeated oral doses of sorbents (bentonite, Fuller's earth) effectively reduce gastrointestinal absorption of paraquat resulting in reduced plasma paraquat concentrations and preventing lung damage and death.2In man paraquat removal has been attempted using forced diuresis,' peritoneal dialysis,4 and haemodialysis.5 The treatment we propose for rapid and efficient reduction of paraquat concentrations combines the haemoperfusion methods described here with forced diuresis and repeated administration of oral sorbents. The platelet falls we saw are acceptable.The rebound in plasma paraquat concentration after haemoperfusion may be partly due to the method of paraquat administration, but may indicate the necessity for prolonged haemoperfusion, especially when renal excretion is impaired by concomitant acute renal failure. Though proximal gastric vagotomy is generally regarded as a safe operation' occasional complications have occurred.2 Of particular importance is necrosis of the lesser curve of the stomach which may be accompanied by fatal peritonitis. We describe a patient who underwent routine proximal gastric vagotomy and developed a gastric fistulaa previously unrecorded complication of this procedure. Case ReportA previously fit 41-year-old man was admitted for elective surgery for a chronic duodenal ulcer. He had a 15-year history of recurrent dyspepsia. Barium meal exa...

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