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Clinical details ofpatient Urinary catecholamine concentrations (nmojday)* Findings of cawc Findnson computed 131-metaiodobenzyguanidine No Sex Age (years) Symptoms Adrenaline Norad line Dop tomnomphy Ocann n Outcome 1 F-81 Anoreia,nausea, labile 405 62 1862 Left sided adrenal mass Left sided adrenal m Normotensive, well hypertension, syncope, 10 cm in diameter palpitations 2 F 74 Persistent hypertension, 520 1175 332 Right sided adrenal Right sided adrenal mass Normotensive, well flushes and sweating, mass 2-8 cm in nausea, diarrhoea, diameter palpitations 3 F 75 Persistent hypertension, 433 350 11000 Left sided adrena mas Multiple skell Death nausea and vmiting, 5x7 cm metAT palpitations, sweating 4 F 72 Neurofibromatosis, 110 100 492 Left sided adrenal=ass Left sided adrenal mass. Refsedtohaveoperation, hypertension I Frischman WH, Silverman R. Clinical pharmacology of the new beta adrenergic blocking drugs. Part 2. Physiologic and metabolic effects. Am HeanJ 1979;97:797-807. 2 Otterstad J, Strom 0. Severe angina pectoris and beta blocker induced bradycardia treated with an artificial pacemaker. Acta Med Scaxd 1980;207:5034. 3 Warren V, Goldberg E. Intractable angina pectoris. Combined therapy with propranolol and permanent pervenous pacemaker. JAMA 1976j235:841-2. 4 Viersma JW, Van den Berg MP, Van Gilst WH, Lie KI. Intrnsic sympathomimetic activity (ISA) of pindolol in patients with sinus node dysfunction. EurHeart7 1986;7:42-6.

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Clindamycin (Dalacin C) was given to 22 patients undergoing surgery for chronic cholecystitis. Samples of bile were taken either directly from the gall-bladder and common duct or post- operatively from a T tube. Clindamycin was rapidly excreted in the bile, peak levels being found after 2 h. High concentrations were found in the bile of the common duct and in those patients with radiologically functioning gall-bladders. The gall-bladder bile of those patients with radiological non-function were all found to contain clindamycin but in a lower concentration than the functioning gall-bladders. The penetration of clindamycin into the bile in radiologically non-functioning gall-bladders in concentrations exceeding the minimum inhibitory concentrations for Salmonella suggests that a trial of its use in typhoid carriers would be justified.

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This unusual case is presented for two reasons. First, it illustrates the value of a long by‐pass graft from the common iliac artery to the popliteal artery passing through the obturator foramen when there are complications which forbid operation through the femoral triangle. Secondly, it provides clinical and histological evidence of the late effects upon neighbouring large arteries of radiotherapy—given in this instance for a fibrosarcoma in a thigh muscle.

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