This study suggests that, despite an evolution in the resolution of ultrasound imaging, there has not been a corresponding improvement in sensitivity. There is a false positive rate of 16% which remains unchanged since the early 1990s.

SUMMARY Altered bowel habit commonly occurs in thyroid disease. We measured orocaecal transit in healthy volunteers and in hyperthyroid and hypothyroid patients before and after treatment, using the lactulose hydrogen breath test incorporating a standard liquid meal to obtain a more physiological assessment. Mean transit time in 12 control subjects was 85 (8) minutes (mean (SE)) (mean coefficient of variation between replicate studies, 8-6% (3%)). In eighteen hyperthyroid patients transit was more rapid at 49 (4) minutes (p<0-01). Ten hypothyroid patients had a transit time similar to controls at 91 (9) minutes. Transit time returned to normal in thyrotoxic patients after treatment but in eight hypothyroid patients retested, it remained unchanged. Our findings suggest that (a) the inclusion of a liquid meal provides a reproducible method of measuring orocaecal transit using the lactulose hydrogen breath test, (b) rapid small bowel transit in thyrotoxicosis may be one factor in the diarrhoea which is a feature of the disease and (c) if altered gut transit is the cause of sluggish bowel habit in hypothyroidism, delay in the colon, and not small bowel, is likely to be responsible.

A consecutive series of 27 patients with gastric neoplasm (24 carcinoma, 3 lymphoma) have been staged at laparotomy using the Japanese criteria for macroscopic staging. In 20 patients the radical R2/3 resection was considered potentially curative as defined by the Japanese Society for Research in Gastric Cancer. The operative mortality in this subgroup was 1/20 (5 per cent) and 3/27 (11 per cent) in the entire series. Locoregional recurrence was not observed in the potentially curative group. Follow-up has varied from 6 months to 7 years. An overall survival of 12/27 (48 per cent) has been observed to date. Death from cancer dissemination is maximal in the first and second year after resection. The R2/3 resection was considered non-curative in seven patients. In this subgroup there were two postoperative deaths and four have died of metastatic disease within 12 months of the resection. The only 5 year survivor in this group had a gastric lymphoma.

T-tube placement into the common bile duct (CBD) is most commonly performed after CBD exploration for cholelithiasis or repair of an iatrogenic CBD injury. Bile peritonitis occurring after T-tube removal is generally considered an exceedingly rare complication, which on occurrence necessitates urgent intervention. No clear guidance exists on the timing of T-tube removal and its relationship to the development of bile peritonitis. This study aimed to determine the incidence of bile peritonitis after T-tube removal, its relationship to the timing of removal and how knowledge of this can help the general surgeon.