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Background: Treatment of biliary pancreatitis includes suppression of the biliary cause by cholecystectomy and common bile duct clearance. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy for eradication of biliary stones and laparoscopic cholecystectomy (L.C.) for residual gallbladder stones would be ideal but were once considered to be contraindicated by most surgeons. The timing of definitive biliary tract surgery and the role of ERCP have been the focus of discussion in recent years., Methods: During a two-year study period 51 patients with acute biliary pancreatitis were studied. Seven patients (14%) underwent emergency laparotomy, necrosectomy, cholecystectomy, exploration of the common bile duct and T-tube insertion, because unstable clinical conditions, with evidence of pancreatic and peripancreatic necrosis on CT-scan. Elective open cholecystectomy and CBD exploration were performed in 7 patients after the resolution of acute pancreatitis during the same hospital admission., Results: Early ERCP and L.C. were associated with favourable outcomes. 33 patients underwent ERCP preoperatively: 17 within 72 hours of admission and 16 after signs of clinical improvement. Laparoscopic cholecystectomy performed 3-25 days after admission was successful in 27 of 29 patients. Postsphincterectomy bleeding occurred in one patient and was treated successfully by endoscopic epinephrine injection. For median hospital stay and recurrence there were statistical differences between early and delayed ERCP., Conclusions: ERCP and sphincterectomy have a certain role in conjunction with laparoscopic cholecystectomy in the management of patients with acute biliary pancreatitis, particularly in institutions where there is easy access to expert interventional endoscopic techniques. This policy should reduce the risk of cholangitis and recurrent pancreatitis.

Therapeutic effectiveness of a new long-acting antiarrhythmic preparation was evaluated in 31 patients with sustained premature ventricular beats. After an observation period, a 24 hours Holter monitoring was performed. A group (21 patients) was treated with dihydrochinidine 250 mg twice a day; another group (11 patients) was treated with 500 mg twice a day. In the latter group was determined basal chinidinemia on the first and third day. A 24 hours Holter monitoring was repeated on the fourth day. In the first group we reached a 77.4% reduction of the arrhythmia: not enough, however, to agree with established statements. We reached a larger reduction (84.7%) with higher doses (1000 mg daily). This drug was well tolerated in both groups.

Epidermoid cysts of the central nervous system may show a wide variation of localization. It sometimes involves the diploe of the skull; in this case it may occasionally be detected by an X-ray as a small area of osteolysis. Surgical treatment is mandatory because of the tendency to grow. Incomplete excision is always followed by recurrence.

The results of a breast tumour prevention campaign conducted in 1977-78 by the Varese/3 Southern Outer Health Consortium are described. All women aged 30-65 yr were asked to come for a clinical examination of the breast by suitably trained midwives. Periodic self-examination was explained on this occasion and a card was prepared with historical data for evaluation of the risk factors. 4708 of the 8226 women approached came for examination (57%). Of those subjected to further diagnostic tests, 170 are still under out-patient control, while 34 have been hospitalised with a neoplastic incidence of the order of 1.28%, coupled with a pathological picture with various probabilities of degeneration. On the whole, it is felt that the most useful feature of the venture was its contribution towards the health education of the female population, and its bringing out of risk factors. A favourable judgement is passed on the campaign and its continuation is suggested.