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Although much as been written on the surgical treatment of pilonidal sinus, the subject remains unsettled. The literature abounds with a variety of statistics and opinions. Surgeons seem to fall into two groups: those who favor primary suture * and those who favor some type of open operation.† The former believe that recurrences should be no greater with primary closure than with the open operation. They add that, although the patient may require a longer period of hospitalization postoperatively, he does not require after-care following discharge from the hospital. Furthermore, the patient does not have the prolonged discomfort that accompanies an open wound. The latter believe, in general, that recurrence rates are lower, complications fewer, and hospitalization shorter than with the closed technique. They tend to minimize the inconvenience of an open wound.After reviewing the statistics it becomes obvious that differences of opinion transcend philosophical considerations. For instance, following primary

The postoperative course of 90 patients with duodenal ulcer was followed for at least a year in order to compare the results of two operations. Hemigastrectomy with vagotomy was done in 45 cases, and subtotal gastrectomy without vagotomy was done in the others. By some criteria the results of hemigastrectomy with vagotomy were found to be better, but the differences were not strikingly or consistently in favor of this operation. Hemigastrectomy with vagotomy was more frequently followed by the desired achlorhydria, however, and was less frequently followed by disabling sequelae or occurrence of the stomal ulcer. The authors believe that it is the better of the two operations.

It is the purpose of this exhibit to present the value of costal intraosseous venography in the diagnosis of portal hypertension. RATIONALE The injection of contrast medium directly into the medullary cavity of a lower rib demonstrates venous pathways not outlined by conventional means. Under normal conditions, the intrathoracic vascular pattern appears fairly constant. In portal hypertension, costal intraosseous venography demonstrates systemic venous collaterals in contradistinction to splenoportography, which visualizes portal venous collaterals. TECHNIQUE The patient is thoroughly informed about the procedure and is told to expect some mild discomfort at the site of bony puncture. Precautionary tests against possible idiosyncrasies to the contrast medium or local anesthetic agent must be carried out. Adequate sedation of the patient is achieved with meperidine hydrochloride (Demerol) 100 mg., and secobarbital (Seconal) sodium 100 mg., both drugs being administered one hour prior to the procedure.With the patient supine on the x-ray table,

Arteriovenous fistulae between abdominal aorta and inferior vena cava or between common iliac vessels are uncommon. These fistulae are formed (1) by rupture of an aortic aneurysm into the vena cava, (2) as a result of a stab or gunshot wound of the abdomen, or (3) following an operation for a herniated nucleus pulposus. Of the 19 fistulae collected and reported by DeBakey et al.,1 9 were the results of disc operations.The Neurosurgical Section at the Bronx Veterans Administration Hospital has made follow-up examinations on the patients who had disc operations at this institution2 since 1946. One hundred sixty patients who had this operation between 1951 and 1959 were contacted, and ninety-one reported for examination. None of the 91 patients showed evidence of an arteriovenous fistula. Because of the rarity of this condition, the following case is reported. REPORT OF CASE A 42-year-old male postal clerk was