Studies of the effect of elevated levels of serum calcium on gastric secretion in dogs 1 7 indicate that there is no significant stimulation of acid secretion and that some degree of inhibition may occur.' In order to investigate the possible role of the gastrin mechanism in the stimulation of gastric secretion by infusion of calcium, we have studied the effects of the intravenous administration of calcium on gastric acid secretion and on the serum concentration of gastrin in duodenal ulcer patients and in normal individuals. We further tested the effect of calcium infusion on

NCT01400412.

Bile peritonitis can occur when a T-tube is electively removed from the common bile duct, but this is regarded as a rare complication. Plastic T-tubes are known to increase the risk and should not be used. Latex rubber T-tubes are preferred but the complication can still occur. We present three patients with this complication despite the use of a latex T-tube. A questionnaire was sent to 107 surgeons in the South East Thames Region. The replies showed that the complication is far more common than generally realized. Based on these replies the risk of bile peritonitis each time a latex T-tube is electively removed from the common bile duct is calculated to be 0.84 per cent or 1 in every 119 explorations.

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The clinical and pathological features of 57 cases of primary carcinoma of the gall-bladder are described.Gall-stones were associated with the tumour in only 54 per cent of cases. The relationship between gall-stones and carcinoma is discussed.Preoperative diagnosis is rare, treatment is usually ineffective, and the prognosis is bad.

The clinical features of 38 patients with intestinal complications after radiotherapy are recorded. Intestinal complications are commonly progressive and in this series led to the death of 14 patients (37 per cent). Nine of these patients had no sign of recurrent tumour. ‘Spontaneous’ necrosis of the irradiated bowel and necrosis of intestinal anastomoses after surgical operation carried a particularly high mortality. Only 3 patients (8 per cent) became completely asymptomatic after treatment of their bowel disease. Apparently localized radiation lesions in the small bowel were sometimes associated with severe malabsorption. Radiographs showed distinctive radiological patterns in the small bowel. A combined radiotherapy/surgical follow‐up clinic is advocated.

BACKGROUND Antenatal cases of Bombay‐phenotype (Oh) individuals and hemolytic disease of the fetus and newborn (HDFN) are not well described in the literature. We present two case reports of high‐titer anti‐H in pregnant Oh individuals and their serologic investigation, clinical management, and subsequent outcomes. We describe current published cases detailing pregnancy in Oh individuals, to add to the evidence base for clinical decision making and management of pregnancy. STUDY DESIGN AND METHODS We describe two case reports of high‐titer anti‐H in pregnancy in Oh individuals. We summarize published cases to date, to inform clinical decision making and antenatal management in individuals with the Bombay phenotype. RESULTS Of the case reports described, neither were affected by HDFN due to anti‐H. Antibody titers were high in both cases (immunoglobulin G titer scores, 512 and 4000, respectively) and would be expected to cause some degree of HDFN, a surprising finding. Regular mean cerebral artery Doppler ultrasound was normal. Patient blood management (PBM) techniques ensured that the patient's hemoglobin (Hb) levels were monitored and maintained. Transfusion intervention was not required, with minimal blood loss recorded at birth in both cases. CONCLUSION High‐titer anti‐H in Oh pregnancies may, in rare cases, cause HDFN, but evidence suggests that this may not be the case in all pregnancies. We recommend a multidisciplinary approach, with prompt referral to a fetomaternal medicine unit, combined with PBM strategies, and a planned delivery with the provision of rare‐phenotype units (if available and if indicated) on standby.

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