Twenty-five patients with traumatic diaphragmatic hernia discovered at least five months after injury are described, of whom 18 were male and seven female. All but one hernia occurred on the left side. Stab wounds were the etiological factor in 22 patients and blunt trauma in three. The diagnosis was most often made by a chest or abdominal radiograph, but barium ingestion confirmed the diagnosis in ten patients. Intercostal drainage of gastric contents provided the diagnosis in two patients. In all nine patients initially approached by a thoracotomy or a thoracoabdominal incision, the hernia was easily reduced and the defect repaired. Although reduction and repair were easily accomplished by the abdominal route in seven patients, this approach was unsatisfactory or inadequate in six others. The colon and stomach were usually in the chest, and strangulation occurred in five patients. The mortality was 20% but rose to 80% when gangrene was present.

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One hundred and eighty-one patients with carcinoma of the upper thoracic oesophagus were intubated perorally using a Procter-Livingstone tube. The mortality was 16-6 per cent but, in the patients who survived, the palliation achieved, as judged by improved swallowing, was considered satisfactory. Factors influencing the success of intubation are also considered.

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The pressure profile of the gastro-oesophageal junctional zone was studied at rest and during abdominal compression in 26 duodenal ulcer patients after subdiaphragmatic truncal vagotomy with a drainage procedure. An 'early' group of 9 patients was investigated 10-14 days after surgery and a 'late' group of 17 patients more than 1 year after operation. Comparisons were made with 25 control subjects. The resting lower oesophageal sphincter pressures after vagotomy in both the early and late groups were similar to the levels of sphincter pressure in the controls. However, the increase in sphincter pressure always observed during absominal compression in normal subjects was significantly decreased by complete vagotomy, and the normal increase in the gastrosphincteric pressure gradient was not produced. All 26 patients were tested for completeness of vagotomy using the insulin/pentagastrin test. In 19 patients the vagotomy was complete and in 7 patients it was judged to be incomplete. A decrease in the gastro-sphincteric pressure gradient on manometric study of the lower oesophageal sphincter was interpreted as indicating complete vagotomy. Accurate correlation between secretory response and compression response was achieved in all patients with complete vagotomy and in 5 of the 7 patients with incomplete vagotomy.