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Eight patients at school-age, from 12 to 17 years old, were surgically treated for Crohn's disease at Tenri Hospital, Nara, Japan. The relationship between operative results and their school lives were evaluated. Primary symptomes of the small intestinal type (6 cases) included abdominal pain (5), melena (1), and abscess formation in Douglas' pouch (1), and that of the colonic type (2 cases) mucinous-bloody stool (2) and anal fistula (1). Mean preoperative duration from the onset of the disease, except for 2 emergent cases, was 21.8 (ranged 8-46) months with mean cumulative hospitalizing duration of 8.6 (1-21) months. Four patients had recurrence, and in all 13 operations of 8 cases intestinal resections limited to macroscipical lesions. Mean postoperative disease-free term was 40.7 (ranged 5-168) months, during which all patients have completely finished curricula in schools. As now there is no effective treatment of Crohn's disease, physician should take school-aged patients back to the schools in disease-free state obtained by operations. An early return to the school might be important for mental or psychiatric development of the patient of this age.

We report a case of biotin deficiency developed in a 25-yr-old man with Crohn's disease who had been on total parenteral nutrition for more than 9 months. His cutaneous, ophthalmic, and neurologic manifestations were characteristic of this disease entity described in literature. In particular, the appearance of his face deserves to be called "biotin deficiency facies." After administration of biotin the low plasma nonesterified fatty acid level promptly returned to normal. This phenomenon may prove to serve as a convenient means for the purpose of detecting biotin deficiency. (Journal of Parenteral and Enteral Nutrition9:760-763, 1985)

Three cases of obstruction of the afferent loop following a Billroth II type gastrectomy were preoperatively detected by ultrasonography. The obstructions in the 3 patients were caused by volvulus, internal herniation and recurrence of gastric cancer, respectively. The important US findings which helped diagnose this condition were a dilated intestinal loop without gas echo in the upper abdominal cavity and echo lucent swelling of the pancreas. Ultrasonography is very useful for the early and easy detection of this life-threatening condition which requires immediate surgery.

Total pancreatectomy was performed for carcinoma of the head of the pancreas associated with multiple anomalies in the peripancreatic region and of the pancreas. The anomalies were preduodenal portal vein, annular pancreas with agenesis of the dorsal pancreas, left-sided gallbladder, polysplenia and high mobile right colon. The surgical implications of pancreatectomy for such anatomical abnormalities, especially preduodenal portal vein, and the usefulness of ultrasonography for the preoperative evaluation are given attention.