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Twenty-two patients were treated for 25 occurrences of pancreatic pseudocysts. The male to female ratio was 3:1, and the average age was 39 years. Alcoholism was the most common cause of the preceding episode of pancreatitis. The pseudocyst rarely developed from end-stage chronic pancreatitis. Our preferred treatment for the majority of pancreatic pseudocysts is external sump drainage, if there is no obstruction of the distal part of the pancreatic duct. This form of treatment was followed by a 100 per cent survival rate, and neither a pancreaticocutaneous fistula nor a pancreatic abscess occurred. The two instances of a recurrence were due to our treatment with a Penrose drain alone, and this practice is not recommended. Obstruction of the distal part of the pancreatic duct negates external sump drainage, and in such instances, a Roux-en-Y cystojejunostomy should be the treatment of choice and not transgastric cystogastrostomy, which does not offer dependent drainage. The treatment of a pancreatic pseudocyst should not be equated with that of chronic fibrotic pancreatitis, as the basic pathologic clinical features and response to surgical treatment are quite different.

The case is presented of a 48-year-old woman with esophageal granular cell myoblastoma who was treated by local excision. A review of the literature is also included. So far as we can determine, this is the thirteenth such case reported.

Gastric nonepithelial tumors of clinical significance are infrequently encountered. These tumors make up less than 3 percent of all gastric tumors and are predominantly composed of growths that derive from the gastric smooth muscle. The malignant nature of those leiomyomatous tumors encountered might be obvious by virtue of liver or peritoneal spread or organ invasion at the time of surgery. When this is not the case, a high frequency of mitotic figures and cell necrosis on histologic analysis, while not without exception, correlates best with malignant potential.Hemorrhage, acute or chronic, features prominently as a presenting symptom. The upper gastrointestinal series often suggests the correct diagnosis. The tumors, unlike carcinomas, exhibit little tendency to lateral mucosal and submucosal spread and to lymph node metastasis; consequently, appropriately conservative gastric resectional procedures generally suffice for treatment. Currently, surgery appears to be the only useful modality for the treatment of primary, as well as recurrent, disease.

During three years, from January 1975 through December 1977, the authors saw six cases of traumatic left diaphragmatic hernias, all of whom survived. All were males aged 17 to 56 years, with an average age of 30 years. Four (67 percent) of the cases resulted from blunt abdominal trauma while two (33 percent) were due to stab wounds of the left lower chest. Admitting chest x-ray findings were diagnostic for all acute hernias due to blunt trauma and for all hernias presenting with a delayed interval. Digital exploration of all penetrating lower chest wounds is recommended by some authors if exploratory laparotomy is not contemplated. Our preferred approach for the repair of the hernias includes (1) laparotomy for all acute cases, (2) thoracotomy for delayed cases, and (3) separate abdominal thoracic incisions whenever a combined approach is considered necessary. The repair should be carried out in two layers with nonabsorbable sutures.

Forty-three patients who underwent intraperitoneal closure of colostomy are reported on. Complication rates of 4.6 per cent for wound infection and 4.6 per cent for fecal fistulas appear significantly lower than the 10 to 21 per cent complication rates reported for colostomy closure using other technics.

Twelve cases of pancreatic abscess, managed at two hospitals in the District of Columbia, are analyzed. Forty-two percent of cases followed acute pancreatitis and infected pancreatic pseudocysts without previous surgical intervention. In 58 percent of the patients, pancreatic abscess was a complication of internal drainage of pancreatic pseudocysts. A discussion of management problems is presented.

Hidradenitis suppurativa is a suppurative inflammatory disease of the apocrine sweat glands. It affects the apocrine gland bearing regions, the axillae being the most common site. It causes considerable morbidity and has several complications. The etiology is unknown and there is no standard method of treatment. A comprehensive review of the literature is presented demonstrating a paucity of information about this disease. The authors' experience and the management of the axillary lesion is outlined. Radical excision of the apocrine gland bearing area with split thickness skin graft (STSG) after one week is the method of choice. A reinforced sling is used for arm immobilization after grafting. The predictability of this technique makes it the preferred method of treatment. Also, more effort is urged towards better understanding of this neglected but serious health problem.