Summary Carcinomas of the exocrine pancreas respond poorly to most chemotherapy regimens. Recently continuous infusional 5-fluorouracil (200 mg m2day') with 3 weekly cisplatin (60 mg m ) and epirubicin (50 mg m-2) (the ECF regimen) has proven to be an active regimen in gastric and breast cancer and consequently worthy of further study in pancreatic cancer. Thirty-five patients were treated with the ECF regimen as above, of whom 29 were evaluable for response and 32 were evaluable for toxicity.

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We have studied the effect of the preoperative administration of bile salts on postoperative renal function in jaundiced patients undergoing surgery. Nine patients did not receive bile salts and in this group there were 2 cases of acute renal failure in the postoperative period. Furthermore, creatinine clearance values fell in this group from a mean value of 85 ml/min preoperatively to a mean postoperative value of 55 ml/min. Nine patients received preoperative bile salts with no case of renal failure. Creatinine clearance values increased in all but 2 patients from a mean preoperative value for the group 79 ml/min to a mean postoperative value for the group of 99 ml/min. The difference between the changes in creatinine clearance in the two groups was statistically significant (P less than 0.01). The results of this study suggest that the oral administration of bile salts to jaundiced patients in the preoperative period prevents deterioration in renal function postoperatively and also reduces the incidence of postoperative renal failure.

We present the results of surgery in 53 patients with intractable pain due to chronic pancreatitis associated with pancreatic duct dilatation. Using a limited mucosal to mucosal anastomosis over a silastic T tube the main pancreatic duct was drained in 33 patients into a Roux-en-Y jejunal loop (pancreaticojejunostomy, PJ) and in 20 patients into the stomach (pancreaticogastrostomy, PG). There was one postoperative death in the PJ group and none in the PG group. All patients were followed up for a minimum of four years. There was significantly greater pain relief in the PG group both at 1 (P less than 0.01) and 4 years (P less than 0.05) after surgery. We argue that PG is the operation of choice to relieve intractable pain in most patients with chronic pancreatitis associated with duct dilatation.

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SYNOPSIS Using the method of Chong and Owen (1967), the normal range of methaemalbumin in plasma was 0 to 0*6 mg/100 ml, expressed as milligrams of haematin per cent. Previous results, using the method of Shinowara and Walters (1963), reported a normal range of 0 to 8-0 mg/100 ml, but it was expressed as milligrams of haemoglobin percent. The conversion factor from the Shinowara method is as follows: mg haematin % = mg haemoglobin % x 0-04.The level of plasma methaemalbumin is elevated after severe intravascular haemolysis (Fairley, 1941;Dacie, 1954) and in some patients with haemorrhagic pancreatitis (Northam, Rowe, and Winstone, 1963). It is formed by the breakdown of haemoglobin to haematin which combines with albumin to give methaemalbumin.After intravascular haemolysis, haemoglobin released into the plasma from red cells combines with an alpha2 globulin, haptoglobin, to form a complex which is then removed from the circulation (Laurell and Nyman, 1957). If the amount of haemolysis exceeds the capacity of haptoglobin to bind haemoglobin, the free haemoglobin circulates before its excretion by the kidney and some breaks down to haematin giving rise to methaemalbumin. In patients with haemorrhagic pancreatitis, plasma methaemalbumin levels are elevated probably as a result of pancreatic enzyme action on extravasated blood in the haemorrhagic gland (Northam, Winstone, and Banwell, 1965). Haemoglobin released from red cells breaks down locally to haematin which either diffuses into the circulation to form methaemalbumin or, more likely, combines with albumin in the extravascular fluid and passes thence into the circulation.Of the various quantitative methods available for the measurement of methaemalbumin, probably the most widely used is that of Shinowara and Walters (1963). A disadvantage of this method is that turbidity or background colour of the specimen can invalidate the spectroscopic data. To overcome this difficulty, Chong and Owen (1967) devised a method based on the ability of reducing agents such as sodium dithionite to change the absorption spectrum of methaemalbumin. The purpose of this paper is Received for publication 19 March 1973. to report the range of normal values for haematin using the method of Chong and Owen. Methods and ResultsStandard solutions were made by dissolving weighed amounts of haematin (BDH) in a minimum volume of 1 M NaOH and added immediately to a solution (4 % w/v) of human serum albumin. To 2 ml aliquots of plasma or standard solution was added 1 ml of phosphate buffer (1 M pH 7 4). The mixture was centrifuged for five minutes and the absorbance measured at 569 nm on a Unicam SP 500 spectrophotometer. The solution was then returned to a test tube and about 5 mg of solid sodium dithionite added. The tube was gently shaken to dissolve the dithionite and left for five minutes to allow complete reduction of methaemalbumin. The absorbance at 569 nm was again determined and the increase calculated.Calibration graphs were constructed on five separate occasions. Mean values (± ...