Eight patients with 15 symptomatic nonneoplastic congenital hepatic cysts underwent ultrasound-guided percutaneous aspiration and temporary injection of 99% ethanol into the cyst. All cysts were treated at least twice at the same sitting. The volume of alcohol injected varied from 20 to 100 ml, depending on the size of the cyst. A cure was usually achieved with one alcohol sclerotherapy treatment. Only minor side effects such as transient pain and temperature elevation occurred. No recurrences were found during a follow-up period of 12 to 32 months. The results indicate that aspiration and alcohol sclerotherapy is a feasible alternative to surgical intervention in patients with symptomatic nonneoplastic congenital hepatic cysts. We recommend it as the treatment of choice in cases with high surgical risk or polycystic liver disease.

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This study was undertaken to elucidate whether or not resection for cancer of the pancreas and the periampullary region can be performed with an acceptable survival rate in patients over 70 years of age (n = 21) as compared with patients under 70 years of age (n = 47), and whether resection provides an improvement in their prognosis and longevity. The operative mortality for patients over 70 years of age and under 70 years was 10 and 9 per cent respectively and the cumulative 5 years survival 12 +/- 11 and 20 +/- 9 per cent respectively. The median survival was 11 months in both groups. It was concluded that an age of 70 years or more is not an absolute contra-indication for pancreatic resection. Prognosis is related to tumour histology.

The efficacy of sucralfate and of an alginate/antacid compound was compared in a randomized, double-blind 6-week trial in patients with symptomatic, endoscopically confirmed macroscopic reflux esophagitis. Of the 68 patients who completed the study, 36 received sucralfate and 32 alginate/antacid. Significant symptomatic improvement occurred in both treatment groups: almost 70% of the patients became symptom-free or improved. Esophagitis healed completely in 53% of the patients receiving sucralfate and in 34% of the alginate/antacid patients, as measured with endoscopic criteria (p greater than 0.05). Our results indicate that sucralfate seems to be at least as effective as alginate/antacid in relieving symptoms and in healing macroscopic lesions. As a safe, locally active mucosal protecting agent, sucralfate is a promising new drug for the treatment of reflux esophagitis and deserves further trials over longer periods.

410 patients were treated for pancreatic and periampullary carcinoma in 1968–1987 of whom 89 (21.5%) underwent resection. Hospital mortality decreased from 33% in 1968–1972 to 0% in 1983–1987, but the morbidity rate remained unchanged. The trends were similar in patients ≥ 70 and < 70 years of age. The pylorus-saving technique did not increase mortality, morbidity, operative blood loss or the incidence of delayed gastric emptying, but it did reduce the operative time by one hour (p< 0.01). The real 5 year survival for periampullary cancer was 52%, but none of the patients with pancreatic carcinoma survived for 5 years. It is concluded that age as such is not a limiting factor for pancreatic resection. Resection can be performed with acceptable mortality and survival rates even in patients over 70 years of age if enough attention is paid to careful patient selection and proper preparation. The long-term prognosis is nevertheless related to tumour histology. The recent decline in operative mortality is mostly due to the resections being performed by the same group of surgeons. The best biopsy, and also palliation, is radical removal of the suspicious mass, provided that this can be performed with minimal risk.

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The effects of indomethacin administration on hemodynamics were investigated in canine acute hemorrhagic pancreatitis (AHP). Thirteen mongrel dogs were randomly divided into a fluid treatment group, an indomethacin prophylaxis group (IMP), and an indomethacin therapy (IM) group. Indomethacin (5 mg/kg) was administered as a bolus dosage 30 min before the induction of AHP in the IMP group. In the IM group, indomethacin was also given as a bolus (5 mg/kg) in 5 min starting 30 min after the induction of AHP. AHP was induced with a mixture of trypsin and sodium taurocholate infused into the pancreatic duct. Hemodynamics were monitored during the 4.5 h of surveillance time. Heart rate did not change significantly between the groups. Indomethacin prophylaxis maintained mean arterial pressure at a significantly higher level (P less than 0.05) and prevented the initial fall in blood pressure when compared to the fluid treatment or IM group. Indomethacin increased cardiac output (P less than 0.05) in the IM group, but did not differ significantly in the IMP group in comparison with the fluid treatment group. In conclusion, the inhibition of the initial fall in blood pressure by indomethacin in AHP suggests prostaglandins to play a role in hemodynamic changes and pancreatic shock to be "septic" as evaluated by hemodynamic changes.