This paper reviews the literature regarding the development of gastric cancer in the stomach remnant following gastric resection. Although there is as yet little supporting experimental evidence, clinical studies suggest that the risk of developing gastric cancer is increased, perhaps as much as 6-fold, following partial gastrectomy for benign lesions. It also appears that the risk of developing cancer is greatest if the lesion for which the gastrectomy was originally performed was a gastric ulcer rather than a duodenal ulcer. The type of gastrectomy does not seem to influence this increased risk. Hypotheses are reviewed concerning the role of changes in gastric morphology following partial gastrectomy in the development of cancer.

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in patients unfdergoing major open-heart surgery are reviewed. The indications and complications are classified, and the high incidence of secondary infection is discussed briefly. Tracheal stenosis or dilatation occurred in six patients (9 4%) and the contributory factors are discussed in greater detail.Tracheostomy is one of the oldest established procedures in surgical practice, but the indications for its use have undergone considerable changes, particularly in the last 25 years (Borman and Davidson, 1963). Its use is again under review (Lancet, 1967) and, as a result of the associated complications, many centres are using alternative methods, such as oro-tracheal and naso-tracheal intubation, even though they may have their own drawbacks (Tonkin and Harrison, 1966).It is therefore pertinent to review the use of tracheostomy in relation to one of the more recent indications-that is, after major open cardiac surgery. MATERIAL AND METHODSAll patients admitted to the intensive care unit at the Brompton Hospital from 1 September 1965 to 31 August 1966 were assessed. The minimum period of follow-up was four months to allow for the development of late complications. Of 179 patients submitted to cardiopulmonary bypass surgery 68 required a tracheostomy for intermittent positive pressure respiration.The case records of 64 of these patients were examined; four were untraced. They consisted of a mixed population whose ages ranged from 6 to 63 years (average 34 years). Two patients had a second tracheostomy, and these are included as separate entities, as they were separated by a sufficient period of time and were, in any case, performed for different indications. There were 41 survivors (65%).TECHNIQUE AND MANAGEMENT All tracheostomies in this series were performed by a member of the sur-1 Present address: West Herts Hospital, Hemel Hempstead, Herts gical team, and all followed a common technique. Under general anaesthesia the method of Bjork (1960), using a transverse skin incision and constructing an anterior tracheal wall flap stitched to the subcutaneous tissues, was used. A plastic (Portex) cuffed tracheostomy tube, of the standard pattern and appropriate size, was inserted and the cuff was inflated just sufficiently to make an airtight seal. A dry dressing only, or skin sutures, were used, and the tracheostomy tube was then connected to a sterile respirator of the intermittent positive pressure type.During the period under review the nursing staff observed the following instructions for the management of the tracheostomy:The cuff was not released for the first 12 hours, and was then released for one minute every four hours following pharyngeal suction. It was then inflated again with just sufficient air to make an airtight seal.Tracheal suction was applied hourly, or more frequently if necessary, via a sterile rubber catheter held by sterile forceps. A 'no-touch' technique was desirable but was not always possible.The wound was cleaned with chlorhexidine

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