The management of Meckel's diverticulum (MD) incidentally detected in adults remains controversial. To assess the risk involved in excision of such diverticula and the incidence of complications arising from MD in adult life, we analysed 260 cases of MD found at laparotomy in a baseline population during a 15-year period. There were 148 symptomless and 112 symptom-producing diverticula, with intestinal obstruction as the most common complication. Assuming a 2 per cent general incidence of MD, the complication rate in these adult patients was 0.03 per cent per year. The calculated lifetime risk of complication from MD was 3.7 per cent at age 16 years, falling to zero in old age. Excision of an incidentally detected MD entailed a 6 per cent rate of major complications. Twenty-eight symptomless diverticula were not excised, and follow-up revealed no complications in these cases. In adults an incidentally discovered, symptomless Meckel's diverticulum should be left in place.

To evaluate the contribution of blood cellular elements to inter-organ transport of amino acids, net exchange across the leg and splanchnic bed of 17 amino acids was determined in seven healthy postabsorptive subjects by use of both whole blood and plasma for analysis. Arterial-portal venous differences were measured in five additional subjects undergoing elective cholecystectomy. By use of whole blood, significant net release of amino acids was noted from the leg and gut, while a consistent uptake was observed by the splanchnic bed. The output of alanine from the leg and gut and the uptake of this amino acid by the splanchnic bed exceeded that of all other amino acids and accounted for 35-40% of total amino-acid exchange. Transport by way of plasma could not account for total tissue release or uptake of alanine, threonine, serine, glutamine, methionine, leucine, isoleucine, tyrosine, and citrulline. For each of these amino acids, significant tissue exchange was calculated to occur by way of the blood cellular elements, the direction of which generally paralleled the net shifts occurring in plasma. For alanine, 30% of its output from the leg and gut and 22% of its uptake by the splanchnic area occurred by way of blood cells. We conclude that the blood cellular elements, presumably erythrocytes, contribute substantially to the net flux of amino acids from muscle and gut to liver in normal postabsorptive humans. Alanine predominates in the inter-organ transfer of amino acids occurring by way of blood cells as well as plasma.It is generally believed that plasma rather than erythrocytes is the vehicle of amino-acid exchange between tissues (1). The slow equilibration time of amino-acid transport across erythrocyte membranes, as indicated by in vitro studies (2), has led to the widely held notion that erythrocytes are of little, if any, significance in the inter-organ transfer of amino acids. As a consequence, studies of amino-acid metabolism in physiologic as well as pathologic circumstances have generally been restricted to measurements of amino-acid concentrations in plasma rather than whole blood (1, 3). However, recent observations on glutamate flux in intact humans suggest a dynamic role for erythrocytes in the transport of this amino acid across muscle tissue (4). In addition, studies in dogs indicate that erythrocytes and plasma may play independent and occasionally opposing roles in the exchange of several amino acids across the liver and gut (5, 6). The present investigation was consequently undertaken to determine the contribution of blood cells, primarily erythrocytes, to inter-organ amino-acid transport in normal humans. This was done by examination of peripheral, splanchnic, and portal exchange of 17 individual amino acids in the postabsorptive state; whole blood as well as plasma was used for the determination of arterio-venous differences. In particular, we were interested in the contribution of the blood cellular elements to the tissue exchange of alanine. Plasma analyses have emphasized the ...

A B S T R A C T Arterial-venous concentration differences for individual free fatty acids (FFA) were measured across the deep tissues of the forearm, the splanchnic vascular bed, and the kidney in healthy, postabsorptive subjects. In addition, arterial-portal venous FFA differences were determined in five patients undergoing elective cholecystectomy.The differences in fractional uptake among the individual FFA across the forearm were small and not statistically significant. Splanchnic fractional uptake was high for FFA with short chain lengths and rose with increasing degree of unsaturation. Small, negative arterial-portal venous differences for individual FFA were observed, indicating that arterial-hepatic venous FFA differences mainly reflect hepatic uptake. When the arterial FFA concentration was reduced to approximately 25% of the control values by the administration of nicotinic acid, net uptake of total FFA ceased but there was release of stearic acid and uptake of lauric, myristic, and palmitoleic acid to the splanchnic region. Muscle and liver uptakes of individual FFA were both dependent on their arterial concentrations with the exception of the splanchnic uptake of stearic acid. There was no uptake of free arachidonic acid by either muscle or liver, nor was there significant uptake of any of the free fatty acids by the kidney. It is concluded (a) that there are important quantitative differences between the net exchanges of individual FFA across the splanchnic vascular bed, (b) that tracer studies of FFA metabolism require the determination of individual FFA specific activities, (c) that palmitic and oleic acid appear to be suitable tracers for the entire FFA fraction in most instances.

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Between 1980 and 1983, 373 patients with clinically resectable rectal adenocarcinoma entered a prospective randomized study aimed to evaluate the effect of short‐term preoperative radiotherapy. Protocol violations were identified in 21 instances. Of the remaining 352 patients, 182 were randomized to surgical treatment only (S‐group). Immediately, before surgery, 170 patients were irradiated to the pelvic region with 25 Gy (2500 rad) during a 5‐day period (RT‐group). Of these patients, 59% underwent abdominoperineal excision, 38% anterior resection, and 3% laparotomy only. At surgery distant metastases were discovered in 32 patients (9%). There were no significant differences between the groups in the distribution of age, sex, operative methods, and tumor stage according to the original Dukes' classification. During the follow‐up time, ranging between 6 months and 3 years, tumor recurrence occurred in 35 patients, 19 in the S‐group and 16 in the RT‐group. Fifteen patients in the S‐group had pelvic recurrence compared to 10 patients in the RT‐group. Distant metastases occurred in six and eight patients, respectively. Two patients in each group had both pelvic and distant recurrence. There was no correlation between tumor recurrence and type of operation. Median time interval from diagnosis to pelvic recurrence was 10 months in the S‐group and 16 months in the RT‐group. Postoperative complications in the form of wound sepsis were slightly more common in the RT‐group. In summary, the applied treatment regimen, is well‐tolerated and apparently does not affect the Dukes' stage of the tumor. Although there is no statistically significant difference, there is a trend of less pelvic recurrence in patients receiving preoperative radiotherapy. Cancer 55:1182‐1185, 1985.