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In the last ten years we have seen two cases from which we can prove that the cause of the acute abdomen was an intraperitoneal urinary bladder perforation. One had previously undergone radiation treatment of the abdomen and the other had a total abdominal hysterectomy.

In 17 totally gastrectomised patients the vitamin B12-serum level was analyzed by 57Co-marked vitamin B12 according to the principle of competitive protein-bounding. Pathological low B12-serum levels in 10 patients refer to the lack of this vitamin. This, however, was only clinically manifested in one case by a megalocytic anaemia. The control of B12-serum levels by running substitution is only useful at the end of the interval between two injections. It is only at this time that it is a help in evaluating the effect of substitution. The monthly or 2-monthly vitamin B12-substitution should be preferred. No optimal substitutional effect can be achieved by injecting 1000 micrograms of vitamin B12 every three months.

This study is based on 632 outpatient and 1948 inpatient repairs of inguinal hernias. Outpatient organisation, surgical technique, anaesthesia and after-care are described in detail. Complications, such as disturbed wound healing and recurrences also the time being out of work are dealt with. These data are compared with those patients who underwent the inguinal hernia operation as an in-hospital procedure. The authors postulate that outpatient surgery of inguinal hernia has many advantages over the inpatient operation.

The nutritional status of 18 patients after total gastrectomy was recorded by anthropometric measures, serum protein and immunological investigations. 15 patients underwent gastrectomy due to carcinoma, the others due to benign diseases. Those patients with carcinoma had been free of signs of malignancy for at least 6 months. According to the elected criteria no patient had a normal nutritional status, there were slight to moderate disturbances of the protein metabolism. By mass reduction the body of the gastrectomised patients had adapted to the decreased intake of protein and calories. In this way the body reaches a new balance and remains efficient. The quality of life of most gastroectomised patients is satisfactory. It depends on the incidence of alimentary complaints and the ability of intake of sufficient food. On the basis of these results there are no serious arguments against Graham's oesophagojejunostomy.

The principle of staged surgical approach to tumour-dependent colonic ileus is no longer justified in all situations. One single right-side hemicolectomy has proved to be superior to the staged approach in cases of colonic ileus on the right to transverse centre. Surgical treatment was applied to 22 patients with right colonic ileus, between 1983 and 1986. Seven of them died after surgery, including three of eight who had undergone palliative operations and four of 14 who had undergone radical surgery in one single session. Transversal colostomy as a first step of a staged approach has proved to be successful on patients with left colonic ileus, from transverse centre. It was found to be just as promising as one single approach. One single approach required intestinal evacuation, using a specific aseptic technique. Incontinence resection (Hartmann's operation) has proved to be an effective method. The majority of 31 patients with left colonic ileus underwent staged surgery. Hartmann's operation was performed on seven of them, and external defecation without resection was applied to 24. Twelve of them died after the first operation, including two after Hartmann's operation and ten of 23 after external defecation without tumour removal.

The nutritional status of 41 male patients with carcinoma of the stomach was recorded, right after admission to hospital, and was related to tumour-specific operability. The nutritional condition of most of the patients was moderately impaired. Significant differences between operable and non-operable patients were recorded from the following parameters: upper-arm circumference, haemoglobin concentration, serum albumin, pseudocholinesterase, intradermal testing, E-rosette count. The findings thus obtained provided some limited information on operability.