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Pancreaticogastrostomy is a safe method for reconstruction of the pancreatic remnant after pancreatoduodenectomy for periampullary tumors. It results in an acceptable incidence of anastomotic leakage that is easily controlled by conservative measures.

Thyroid carcinoma usually presents as an asymptomatic thyroid nodule. Thyroid cancer may show microscopic vascular invasion; however, internal jugular vein tumor thrombus is a rare complication of thyroid cancer. A unique case of internal jugular vein tumor thrombus associated with thyroid carcinoma is presented and discussed.

A prospective, randomized trial was undertaken to compare the nutritional efficacy in surgical stress of a standard amino acid solution and two branched chain-enriched amino acid solutions: one enriched primarily with valine, the other with leucine. The study comprised 37 patients in the surgical intensive care unit who received isocaloric, isonitrogenous parenteral nutrition started within 24 hours of the onset of major operation, injury, or sepsis. Nitrogen retention was marginally but statistically significantly better on days 5, 7, and 10 in both groups of patients receiving the branched chain-enriched solutions, but differences in cumulative nitrogen balance were not statistically significant. Amino acid composition appeared to be important in that the group receiving the leucine-enriched solution appeared to maintain hepatic protein synthesis better (as manifest by higher short-turnover plasma protein concentrations) and required less exogenous insulin to maintain euglycemia. Improved outcome was not seen in the groups receiving the branched chain-enriched solutions.

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