During the period from 1978 to 1986, 106 patients were diagnosed with carcinoma of the pancreas; 30 of these patients were excluded from this study. Of the remaining 76 patients, 40 did not receive intraoperative radiotherapy (IORT) and were used as the nonrandomized control group for the 36 patients who did receive IORT after histologic confirmation of carcinoma of the pancreas. The records of 35 patients were available for review. The group receiving IORT ranged in ages from 43 to 89 years (20 males and 15 females). Seventeen patients had distant metastatic disease. The primary was located in the head of the pancreas in 32 and the body in three. No patient in this group had a curative resection. All patients were treated by a combination of biliary and gastric bypass prior to or concurrent with IORT. IORT was begun only after obtaining a histologic diagnosis and prior to the completion of any anastomosis. Necrotizing pancreatitis occurred in the treated group. There was no statistically significant difference in the survival of the nonrandomized control and treated groups.

Patients with preservation of the transitional zone of the anal canal have less leakage and less need to wear pads than patients who have had mucosectomy. There is a significant difference in mean maximum resting pressure between patients that have had anal transitional zone preservation and mucosenomy. With preservation of the anal transitional zone, a mean maximum resting pressure of 57.6±3.8 mmHg was obtained compared with 47.3±4 mmHg in the mucosectomy group. Preservation of the resting pressure is dependent on preservation of internal anal sphincter integrity. The integrity of the sphincter is injured during mucosectomy due to anal dilation. Other factors affecting continence and stool frequency, such as diet, antidiarrheal medications, stool consistency and compliance, when examined were found to be unrelated factors.Can J Gastroenterol I 990;4(7):428,431Key Words: lleo-anal anastomosis, Pressure studies, Surgery Les 'ostomies' -Importance de la zone de transition RESUME: Les patients chez qui la zone de transition du canal anal a ete preservee souffrent d'un nombre moindre de fuites ct eprouvent moins le besoin

Numerous diagnostic and therapeutic practices are used in an attempt to reduce the morbidity of colostomy closures. Our principal aim was to evaluate the role of preoperative studies, specifically barium enemas and endoscopic examinations, performed before colostomy closures. Additionally, we wished to identify other practices involved in the perioperative management of patients undergoing colostomy closure that influenced morbidity. The records of 100 consecutive patients who underwent elective colostomy closure at University of Louisville Hospital between January 1989 and July 1995 were reviewed. Wound infection was the most common complication (12%). Various bowel preparations were equivalent in efficacy and did not influence the complication rate. Intermittent wound irrigation with antibiotics for 3 days postoperatively, via subcutaneous drains, was associated with a low incidence of incision infection. Preoperative barium enema or sigmoidoscopy were often performed but rarely useful. Performing these examinations merely increased hospital cost without a corresponding decline in morbidity.