SUMMARY1. The role of Ca ions in stimulus-secretion coupling has been analysed in the isolated and perfused rat pancreas.2. The omission of [Ca2+]. diminished but did not abolish the release of amylase in response to continuous stimulation with 5 m-u. pancreozymin (Pz)/ml. The addition of Mn2+ (1.0 mM) to this Ca-deficient environment abolished the residual release of amylase. This was followed by a complete recovery of amylase output when the control [Ca2+]o was reestablished.3. The addition of Mn2+ (1.0 mM) to the extracellular environment containing 2-5 mM-Ca2+ reversibly inhibited the Pz-induced release of amylase.4. A kinetic scheme based on competition of Ca and Mn at a carrier in the acinar cell membrane could quantitatively explain the effects of Ca and Mn upon the Pz-induced amylase release.5. These results support the view that the Ca2+ influx into the acinar cells is the major contributor to the rise in [Ca2+]i which, in turn, mediates the processes in the stimulus-secretion coupling in the exocrine pancreas, and suggest that the mode of Ca influx is a facilitated diffusion.

To assess the efficacy of proximal gastrectomy in the treatment of upper gastric carcinoma, we analyzed clinical data from patients with lesions confined to the upper third of the stomach (group 1) and from patients with lesions which, while primarily located in the upper portion of the stomach, showed spread to the body of the stomach (group 2). Patients in group 2 showed more metastatic lymph node involvement, particularly of the infrapyloric lymph nodes, which were not included in lymphadenectomy accompanying proximal gastrectomy. None of the group 1 patients demonstrated metastasis to the infrapyloric lymph nodes. The postoperative 5-year survival rate in curatively operated group 1 patients was not significantly different between those treated by proximal gastrectomy and those subjected to total gastrectomy. We conclude that proximal gastrectomy is indicated in patients with upper gastric carcinoma when it is confined to the upper third of the stomach.

To study post-gastrectomy metabolic bone disorders, we measured the radial bone mineral content (BMC), serum levels of calcium, inorganic phosphorus, alkaline phosphatase, and 25-hydroxyvitamin D(25-OH-D) in 59 patients with partial- and 39 patients with total gastrectomy. Total gastrectomy patients manifested a higher incidence of decreased BMC levels than did partial gastrectomy patients (56 per cent vs. 25 per cent). Patients subjected to the Billroth II procedure, especially females, manifested abnormally low BMC values. The decline in BMC was age-related; it was pronounced in females. At 10 years postoperatively, many of the partial gastrectomy patients manifested markedly low BMC levels; in totally gastrectomized patients this finding was made at less than 5 years postoperatively. Approximately 30 per cent of our patients showed abnormalities in serum minerals, alkaline phosphatase or 25-OH-D.

A case which presented with early cancer of the duodenal duplication in addition to a gallbladder defect is reported. This may be the first case of its kind reported in the literature.

In patients 70 years or older, pulmonary function tests were performed before and after abdominal surgery to correlate the results with the development of postoperative pulmonary complications which developed in 48% of these patients, compared to 15% in the control group. To predict the development ot PPC, preoperative analysis of the flow-volume curve is useful and 4 (V50-V25)/forced vital capacity is a valuable parameter for the analysis of the flow-volume curve. Postoperatively, pulmonary function was reduced and there was a delay in the restoration of pulmonary function in cases with postoperative pulmonary complications. The administration of appropriate analgesics may be useful to improve postoperative ventilatory disturbances.

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