Reconstruction with a colonic J pouch was associated with a lower incidence of anastomotic leakage and better clinical bowel function when compared with the traditional straight anastomosis. Functional superiority was especially evident during the first 2 months.

The effect of 1-alpha-hydroxycholecalciferol (1-alpha-OH-D3) on the incidence of arterial calcifications, and the influence of parathyroidectomy on the effect of this vitamin D treatment, were studied in uraemic rats. Uraemia was induced by 3/4 kidney resection, and parathyroidectomy was achieved by electrocoagulation. 1-alpha-OH-D3 in a dose of 3, 10 or 125 ng/100 g body weight (b.w.) was given in the drinking water. The animals were killed after 12 or 16 weeks. Aorta and small arteries in the heart and in anterior tibial muscle were studied by light microscopy. Arterial lesions were frequently found in uraemic rats and were characterized by medial necrosis and calcifications. Following a 1-alpha-OH-D3 dose of 125 ng/100 g b.w. in uraemic rats both serum calcium and serum phosphate were increased and there was a high incidence of arterial calcifications both in the aorta and the small arteries. In uraemic rats receiving 10 ng/100 g b.w. of 1-alpha-OH-D3 serum calcium was only slightly elevated although the incidence of arterial calcifications (mainly in the aorta) was such higher than in uraemic rats without vitamin-D treatment. A dose of 3 ng/100 g b.w. of 1-alpha-OH-D3 given to uraemic rats did not result in any serum calcium increase, nor did it alter the incidence of arterial calcifications. Parathyroidectomy prevented arterial calcifications. Parathyroidectomy prevented arterial calcification in uraemic rats, but this effect was abolished by 1-alpha-OH-D3 in a dose of 10 ng/100 g b.w. which only raised the serum calcium to a subnormal value. In uraemia, treatment with 1-alpha-OH-D3 may increase the serum calcium X phosphate product, but this cannot fully explain the increased incidence of arterial calcifications. It is therefore suggested that vitamin D causes changes in the arterial wall which increase its susceptibility to the development of calcifications.

Three cases of pericardial tamponade caused by central venous catheters are reported. Two essential factors have been recognized. First, the catheter material should be extremely soft and remain soft. Today the best material available seems to be a silicone rubber elastomer. Polyvinylchloride or polyethylene, which is widely used, is too rigid. These materials also contain phthalate esters to soften the plastic, and these softeners are gradually washed out into the bloodstream, rendering the catheters even more rigid in time. Second, a central venous catheter should enter the venous system proximal to the shoulder. When the catheter is inserted through a vein in the arm, the tip of the catheter will be able to progress 6-10 cm farther down in the venous system by extreme movements of the arm. This occurs regularly when a patient is turned in bed and his or her arm is elevated 108 ~ at the shoulder. The internal jugular vein and the subclavian vein are the most suitable veins for catheterization. Veins in the arm should not be used.

A one-year prospective study to evaluate the use of central venous catheters in intensive treatment of patients with acute blood malignancies was performed. Forty-seven catheters in 29 patients were studied. In spite of thrombocytopenia in several patients, no severe bleeding episodes were observed. Five patients with agranulocytosis had episodes of bacterial growth in the blood. Four patients had a clinical infection in the subcutaneous tunnel of the catheter. Bacterial growths on the tips of the catheters were found in three cases. Six patients died during the observation period, none of these was in remission. One of these patients had a growth of coagulase negative staphylococci in the blood, and another on the tip of the catheter, without any other known source of infection. The use of central venous catheters facilitates patient care and minimizes discomfort. It is associated with acceptable complications, necessitating meticulous insertion techniques, and careful daily care on the ward or at home.

The recovery of cells arising from small intestinal mucosa alone was studied during continuous perfusion of a closed segment of jejunum. The