Acute pancreatitis in North-East Scotland from January 1983 to December 1985 was examined. The criteria for diagnosis were a serum amylase greater than 1000 units/l with a consistent clinical presentation, or acute pancreatitis confirmed at laparotomy or post mortem. All serum amylase assays were performed in one regional laboratory. The commonly used diagnostic coding search for pancreatitis yielded only half the cases found. We identified 378 episodes of acute pancreatitis (196 males and 182 females). The mean annual incidence for first attacks of acute pancreatitis was 242 per million of the population. The commonest aetiology was biliary tract disease (30 per cent of males and 53 per cent of females). Alcohol related pancreatitis occurred in 26.5 per cent of males but only 3 per cent of females. Complications included 26 pseudocysts, 11 pancreatic abscesses, 9 patients with respiratory failure, 11 patients with renal failure and 6 patients with disseminated intravascular coagulation.

In a consecutive series of 93 patients who required emergency surgery for distal colonic lesions, 61 had primary bowel resection with immediate anastomosis after intra-operative antegrade colonic irrigation. The operative mortality was 8 per cent, anastomotic leakage rate 7 per cent and superficial wound infection occurred in 3 per cent of patients. The mean hospital stay was 13 days. Of the remaining 32 patients, 3 did not have a resection and 29 had a primary resection and end colostomy without anastomosis: bowel continuity was later restored in 17 of 28 survivors (61 per cent) but 11 (39 per cent) were left with a permanent colostomy. The hospital mortality in this group was 6 per cent, superficial wound infection rate 14 per cent and the mean hospital stay 26 days. The results of this study suggest that intra-operative colonic irrigation is an effective method enabling the surgeon to perform a primary anastomosis with reasonable safety after emergency resection of selected distal colonic lesions.

Stapled anopexy offers a significantly less painful alternative to excisional haemorrhoidectomy and achieves a higher patient acceptability. Although the overall symptom control and safety are similar in the majority of the patients, the re-treatment rate for recurrent prolapse at 1 year is higher following SA when compared to CH.

The association of gynaecomastia and testicular tumours is well described in the literature. A testicular examination should be routine as part of the assessment of young males presenting with breast enlargement. We describe two cases where gynaecomastia preceded the appearance of testicular swelling by several months. Case reports Case 1 A 27 year old man was routinely referred to a general surgery department and assessed by a breast surgeon (RB) for bilateral gynaecomastia. On examination, the testes were normal. Six months later he was referred to the urology department with a history of persistent terminal haematuria. The patient mentioned during the examination that he had discovered a lump in a testicle since his attendance at the breast clinic. He had paid no attention to it and had not complained about it to his general practitioner. An abdominal examination showed an epigastric mass. An urgent ultrasound scan confirmed a testicular tumour measuring 2.4×2.0×1.6 cm and a retroperito-neal mass measuring 6.9×7.3 cm resulting from meta-static deposits in para-aortic lymph nodes. His fetoprotein was raised (639 700 IU/l (normal < 7000 IU/l)), as was his total human chorionic gonado-trophin (64.0 IU/l (reference range 0.1-3 IU/l)). The patient was admitted urgently for radical orchidectomy and endoscopic assessment. The cystos-copy showed venous congestion of the bladder neck as the likely source of haematuria. Histology testing of the orchidectomy specimen showed 80% classic seminoma and 20% mature teratoma. The staging computed tomogram confirmed the enlargement of para-aortic and inguinal lymph nodes consistent with metastatic disease. The patient was referred to the regional oncology service for further treatment in the form of chemoradiation. Case 2 A 20 year old man with unilateral breast enlargement was routinely referred to a general surgery department by his general practitioner. He was seen in a breast clinic six weeks later (by RB), where a testicular swelling was discovered on physical examination. An urgent ultrasound scan confirmed a testicular tumour. His testicular tumour markers were substantially raised (fetoprotein 3 290 000 IU/l and total human chorionic gonadotrophin 87.0 IU/l). The patient was admitted for urgent radical orchid-ectomy. The staging computed tomogram showed no evidence of metastatic disease. Histology testing of the orchidectomy specimen showed features of mixed germ cell tumour, with 50% of differentiated teratoma, 25% of embryonal carci-noma, and 25% of yolk sac tumour. The patient was referred to the regional oncology service for further management. Discussion The incidence of gynaecomastia in adult men is reported as being 35-65%, depending on the criteria for diagnosing gynaecomastia and the age group. 1 However, only 2% of men presenting with gynaeco-mastia are found to have testicular tumours. 2 Gynaeco-mastia is usually attributed to an imbalance of oestrogen and androgen but may be due, in part, to a more direct action of luteinising hormone or human chorionic gona...

Prolonged survival of vascularized organ allografts has been produced in unmodified inbred rats by transfer of thymocytes from enhanced, engrafted, syngeneic animals. For these thymocytes to increase significantly the survival of test allografts they must be harvested 6-9 d after transplantation. Thymectomy of the enhanced, engrafted animals during the same critical period causes acute rejection of othewise long surviving grafts. For optimal effect, the enhanced thymocyte donor must be actively and passively immunized and receive a cardiac allograft. The necessity for erythrocytes in the initial active immunization regimen is noted. Additionally, the antigenic specificity of the suppressor effect has been established with two histoincompatible donor rat strains. Cellular and humoral host responses mounted by test graft recipients after thymocyte transfer from enhanced, engrafted donors are different from those mounted either by unmodifed animals acutely rejecting their grafts or by enhanced rats bearing well-functioning grafts. Numbers of T lymphocytes are reduced in the grafted hearts and in the spleens of test graft recipients, a finding paralleled by the complete absence of specific direct lymphocyte-mediated cytotoxicity. In contrast, cytotoxic antibody production, although delayed, is increased in magnitude, peaking around the time of graft rejection. These studies provide evidence that different biological manipulations can modify separate pathways in the complex cellular and humoral responses towards organ allografts. They demonstrate that cellular immunity is critically involved in immunological enhancement of vascularized organ allografts, a phenomenon hitherto considered primarily humoral. It seems clear that cells with suppressor activity are present within the thymus during the early phases of immunological enhancement.