The Allen test is a good and valid screening test for the circulation of the hand. If the Allen test is negative it is safe to harvest the radial artery. If it is positive further examinations are needed to ensure safe harvesting of the radial artery.

To evaluate the influence of antireflux surgery on gastric emptying.Design: Nonrandomized controlled trial 3 months before and after surgical intervention.Setting: Secondary and tertiary referral center.Patients and Control Subjects: Twenty consecutive patients (7 women, 13 men), mean age 49.2 years, with symptomatic, objectively confirmed gastroesophageal reflux disease and 10 healthy control subjects (3 women, 7 men), mean age 37.3 years. Intervention: Laparoscopic or open Nissen fundoplication (in 1 case Toupet 180°posterior hemifundoplication).Main Outcome Measures: Gastric emptying scintigraphy, using solid food, in control subjects and patients 3 months before and 3 months after the operation; time to halving of the maximal activity and the activity remaining at 60, 100, and 120 minutes.Results: Preoperative symptoms included pyrosis in 19 of 20 patients and regurgitation in 18. Three months postoperatively, 19 patients were symptom-free. The mean time to halving of the maximal activity decreased from 113 to 78 minutes (P = .001). Delayed gastric emptying was found postoperatively in 3 patients, compared with preoperative values, using activity at 60, 100, 120 minutes and the mean time to halving of the maximal activity as the variables. Compared with control subjects, gastric emptying was slower in patients preoperatively and faster postoperatively, but the difference was not statistically significant. Conclusion:Gastric emptying is enhanced after antireflux surgery, along with cessation of symptoms and healing of esophagitis.

The influence of pancreatic resection on early systemic complications of acute necrotizing pancreatitis was evaluated in 84 patients. The aetiology of pancreatitis was alcohol 71 per cent, gallstones 13 per cent, alcohol plus gallstones 2 per cent, trauma 1 per cent and idiopathic 12 per cent. A total of 26 of 81 patients (32 percent) had greater than 50 per cent pancreatic necrosis and 9 patients (11 per cent) considered to have parenchymal necrosis at operation had none shown histologically. The overall mortality was 38/84 (45 per cent) and mortality during the first postoperative week was 15/84 (18 per cent). The outcome after early and delayed operation did not differ significantly. Pancreatic resection had no beneficial effect on shock or respiratory or renal failure (respective pre-operative incidence 12 per cent, 11 per cent and 14 per cent).

The effect of lesser sac drainage with or without lavage on some early predictors and on outcome in acute necrotizing pancreatitis was analysed. The evaluation was made prospectively for 24 patients, in a single centre study. According to Ranson's criteria and laparotomy findings, the lavage and drainage groups were comparable and the pancreatitis was severe and necrotizing in both groups. In a longitudinal analysis of the first 4 postoperative days, lavage did not show any advantage over drainage, as measured by seven prognostic signs (serum creatinine, blood glucose, base excess, haematocrit, white blood cells, C-reactive protein and immunoreactive phospholipase A2 concentration). Furthermore, the study did not find that lavage had any positive effect on the incidence of mortality (36 versus 17 per cent in the drainage group) or on septic complications in acute necrotizing pancreatitis. In the total series the extent of pancreatic necrosis was an essential predictor of the outcome.

Since radial artery is preferably harvested from a non-dominant hand, our aim was to study whether there are contraindications for radial artery harvest in the dominant hand if the radial artery of the other hand is not suitable for harvesting. Thirty-three patients scheduled to coronary artery bypass grafting with contraindication for radial artery harvest in the non-dominant hand underwent Allen test, upper arm Doppler ultrasonography and digital pletysmography. In ultrasonography, both anatomical and circulatory measurements were performed. Both hands were then compared to each other. Furthermore, twelve control patients without contraindication for radial artery harvest in the non-dominant hand were examined. All 33 patients had contraindication for radial artery harvest in the non-dominant hand. Twenty-four (73%) had contraindication in the dominant hand as well. In terms of morphology, there was no statistically significant difference between the hands but circulatory parameters as a group suggested contraindication. Among controls, four patients (33%) had contraindication in the dominant hand. In the case of a non-harvestable radial artery in a hand there is clearly an increased risk for contraindication for radial artery harvest also in the other hand.