A randomized, multicenter clinical trial was conducted in Western Norway to study the effectiveness of preoperative radiation therapy in operable rectal cancer, given at a dosage of 3150 cGy in 18 fractions, 2 to 3 weeks before radical surgery. Three hundred nine patients were entered into the trial between May 1976 and December 1985. After radiation no tumor was seen in 4.5% of the patients. There was no increased morbidity or mortality at surgery. The 5-year survival for evaluable patients was 57.5% in the control group and 56.7% in the radiotherapy group. For patients operated on for cure the 5-year survival was 60.9% and 64.2% in the control group and radiotherapy group, respectively. Radiation significantly delayed both local and distant recurrences in patients in the radiation group who had curative resection from 13.3 months in controls to 27.1 months. The local recurrence rate in the corresponding groups was 21.1% and 13.7%, respectively. We conclude that higher preoperative radiation doses should be used in new trials as a higher dosage may transform the observed positive effects into a survival benefit.

The effect of preoperative radiotherapy (31.5 Gy in 3.5 weeks) in operable rectal cancer was examined with respect to resectability and prognosis after two surgical procedures, abdominoperineal resection, or low anterior resection. Preoperative radiation did not influence the surgeon's selection of low anterior resection, which was similar (40 percent) in each group. Radiation improved five-year survival probability and decreased the incidence of local recurrence significantly after low anterior resection. In contrast, no improvement of treatment results was found in patients treated by abdominoperineal resection after radiotherapy.

The incidence of ulcerative colitis (UC) in the three counties that compose Western Norway was registered in a prospective study during the years 1984 and 1985. Both inpatients and outpatients were included. Five hundred and fifty general practitioners and 12 hospitals participated in the study. A total of 239 patients were diagnosed in this area with 807,000 inhabitants, giving a mean annual incidence of 14.8 per 100,000. For patients between 30 and 35 years of age the age-specific incidence rate was 31.2. The M/F sex ratio was 1.10. Familial occurrence of inflammatory bowel disease was found in 11% of the patients. Patients with rectal involvement only constituted 35% of the patients.

Using graded portal vein stenosis in rats, a well-defined limit between a high death rate and a high survival rate was found when the diameter of the stenosis was 1.1 mm. A 0.1-mm widening of this threshold stenosis increased the survival rate from 25 to 75%, which is statistically significant. Stenosis with a diameter of 1 mm or less was fatal in nearly 100% of rats weighing approximately 350 g. Total ligature of the portal veins 10 weeks after a 1.2-mm stenosis gave a 100-percent immediate survival.

SUMMARY Intestinal absorption and bacteriology of the ileal contents were compared in seven patients with continent ileostomy and seven patients with conventional ileostomy. The absorption of vitamin B12 was reduced in five patients with continent ileostomy and subnormal in two patients with conventional ileostomy. Steatorrhoea was present in four patients with continent and one patient with conventional ileostomy. Increased concentrations of total anaerobic bacteria and Bacteroides were found in the ileum of the patients with continent ileostomy. After an oral dose of [1-14C] glycocholic acid there was no difference in the faecal excretion of radioactivity, whereas the 14C02-expiration was increased in two patients with continent ileostomy. In four patients with continent ileostomy and malabsorption of B12 there was evidence of a stagnant loop syndrome, as oral lincomycin treatment resulted in increased absorption of B12, decreased excretion of faecal fat, and decreased concentrations of Bacteroides in the ileum.The continent ileostomy introduced by Kock (1969) is an alternative to the conventional ileostomy and makes use of an abdominal reservoir in which the intestinal contents are stored for several hours. Clinical studies have shown that the operation results in morphological changes in the reservoir with shortening of the villi as well as an increased number of microorganisms (Brandberg et al., 1972). It is, however, still uncertain whether the continent ileostomy leads to intestinal malabsorption. Jagenburg et al. (1971) found subnormal values of the Schilling test in six out of 10 patients with continent ileostomy, whereas the absorption of fat, d-xylose, and Lphenylalanine was the same as in patients with conventional ileostomy. In a subsequent study a low value in the Schilling test was found in only one patient of 34 with continent ileostomy , and it was shown that the mucous membrane of the reservoir retained its capacity to absorb d-xylose and phenylalanine .In this study we present evidence of malabsorption because of a stagnant loop syndrome in four out of seven patients with continent ileostomy.'Address for reprint requests: H. Schj0nsby, Medical Department A, 5016 Haukeland Hospital, Norway. Received for publication 23 March 1977 Methods PATIENTS Seven outpatients with a conventional ileostomy (four women and three men, age range 28-61 years) and seven outpatients with a continent ileostomy (one woman and six men, age range 20-51 years) were included in the study. The postoperative observation period in the patients with conventional ileostomy varied between one to 110 months (mean 36 months) and in the patients with continent ileostomy between six to 52 months (mean 36 months). The indication for proctocolectomy was ulcerative colitis. In one patient with a continent ileostomy 15 cm of the ileum had been resected. In all the other patients less than 10 cm of the ileum had been removed. All patients gave their informed consent to the study, and were on unrestricted diet.