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The Authors considering cholelithiasis as an heterogenic pathological entity report their experience of 25 surgical consecutive patients: 20 with cholesterol or combination gallstones and 5 with black pigmented gallstones. In this series the most frequent factors associated with cholesterol gallstones were LDL hypercholesterolemia and hypertriglyceridemia; while the most frequent factors associated with black pigmented gallstones were hepatopathies. The most frequent symptom was dyspepsia. Only the black pigmented and the mixed gallstones were associated with jaundice and pancreatitis. According to the Literature infection is associated to brown pigment gallstones in 95% of cases, in this series infection is rarely associated with other types of gallstones. Treatment with oral bile salts is useful only in pure cholesterol gallstones, so the distinction among different types of gallstones is useful not only for a better knowledge of their pathogenesis but also for a correct choice of the therapeutic options.

Histological material from 121 patients who underwent surgery for cancer of the left colon and rectum was reexamined by two pathologists according to criteria put forward in Jass' histopathological classification. A prevalence of Jass' grades II (36.4%) and III (47.9%) were observed in this series. There was no correlation between the site of neoplasia but there was a clearly increased incidence of advanced stages C and D according to Dukes-Kirklin's classification within Jass' grades II, III and IV (p less than 0.005) and growth pattern, but not for the configuration of tubules. The new histopathological model proved to be more reliable in prognostic terms in the case of cancer of the rectum compared to that of the left colon, but at present its clinical significance is limited to specifying the site and stage of the neoplasia. The latter was found to be the most reliable prognostic parameter.

Modern views concerning the surgical treatment of pseudocysts of the pancreas are presented. The patient's general condition, the presence of complications, the features and site of the pseudocysts, and the state of "maturation of the wall" will determine the steps to be taken in any given case. The different of operation employed are described, together with their indications and contraindications, possible complications and results.

Recent advances in the diagnosis and surgical management of cases involving the extrahepatic bile ducts are illustrated. Particular stress is laid on the universally recognised importance of preoperative cholangiography, the usefulness of the flexible choledochoscope, and the employment of cold light to visualise calculi undetected by cholangiography. The scope of and indications for direct surgery on the papilla, derivative operations, and reconstruction of the duct are discussed. Lastly, reference is made to the use of endoscopic sphincterotomy, and the suitability of continuous perfusion of the ducts in the destruction of calculi.

Initial results of research into pancreatic blood flow by the use of a gammaemitting radioisotope, Rubidium86 (Rb86) are reported. The experiments were carried out on normal dogs and on dogs with acute pancreatitis that had been brought on by various techniques. Some of the physiopathological aspects of the role of microcirculatory changes within the pancreas in the genesis of acute necrotico-haemorrhagic pancreatitis are discussed.