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A multivariate probit analysis was used to develop a prognostic scoring system known as the Prognostic Index (PI), which consisted of age, pulse rate, blood urea nitrogen, serum albumin, serum cholesterol and serum potassium. This PI accurately predicted the severity and mortality of 83 surgical patients with septic shock caused by gastrointestinal diseases, who were admitted to Tenri Hospital, Nara, Japan from 1975 to 1981 (internal check), and also that of 25 other patients, examined from 1982 to 1983 (external check). As the prognostic predictive model provides a prompt and easy prediction of how severe the patients' state is, it has proved to be very useful to our surgical staff for managing critically ill patients.

Three cases of obstruction of the afferent loop following a Billroth II type gastrectomy were preoperatively detected by ultrasonography. The obstructions in the 3 patients were caused by volvulus, internal herniation and recurrence of gastric cancer, respectively. The important US findings which helped diagnose this condition were a dilated intestinal loop without gas echo in the upper abdominal cavity and echo lucent swelling of the pancreas. Ultrasonography is very useful for the early and easy detection of this life-threatening condition which requires immediate surgery.

Total pancreatectomy was performed for carcinoma of the head of the pancreas associated with multiple anomalies in the peripancreatic region and of the pancreas. The anomalies were preduodenal portal vein, annular pancreas with agenesis of the dorsal pancreas, left-sided gallbladder, polysplenia and high mobile right colon. The surgical implications of pancreatectomy for such anatomical abnormalities, especially preduodenal portal vein, and the usefulness of ultrasonography for the preoperative evaluation are given attention.