Quantitative whole-body autoradiography in the pharmaceutical industry. Survey results on study design, methods, and regulatory compliance

INTRODUCTION

Quantitative whole-body autoradiography (QWBA) is a technique used to determine the tissue distribution of radiolabeled compounds in laboratory animals. This relatively new technique is quickly replacing wet-tissue dissection techniques, which, up to now, have been used by the pharmaceutical industry when performing tissue distribution studies to develop new drugs and to address regulatory compliance needs. In an effort to harmonize QWBA procedures across the pharmaceutical industry, the Society for Whole Body Autoradiography (SWBA) surveyed its membership to gain insight into the procedures and practices being used to perform tissue distribution studies conducted in support of drug development.

METHODS

The survey polled 29 respondents, who represent pharmaceutical companies in the United States, Europe, and Asia. Participants answered approximately 50 questions related to study design, applications, autoradiography methods, tissue quantitation, and regulatory compliance.

RESULTS

The survey revealed general consistencies and inconsistencies among the labs that responded. Consistencies were related to: isotope use and doses of radioactivity, number of animals per time point, exsanguination of animals, freezing methods, section thickness, tissue collection lists, section lyophilization, imaging technology, blood and calibration standards, tissues and sections sampled for quantitation, use of QWBA data for human dosimetry, and QWBA method validation. Inconsistencies were related to: number of time points used, euthanasia methods, carcass freezing time, microtome calibration, section thickness verification, sample collection, validation of commercial standards, use of background measurements during calibration, definition of limits of quantitation, reporting of extrapolated values, reexposure of section to determine low levels, computer system validation, definitions of raw data, audit trail documentation, studies performed under Good Laboratory Practices (GLP) vs. non-GLP conditions.

DISCUSSION

The survey indicated that most labs are now using QWBA to perform their tissue distribution studies and that these data have been submitted and accepted by regulatory authorities around the world. Procedures and practices involved in the design of these studies appear to vary somewhat. An important inconsistency found related to the number of time points used to determine the pharmacokinetic (PK) parameters for tissues, which may effect the reliability of these parameters for use in predicting human exposure to radioactivity during human radiolabeled studies. Survey results regarding QWBA methods indicated that there is a lot of consistency across surveyed labs; however, there are some inconsistent areas that raise regulatory compliance issues and these are related to the verification of section thickness, validation of commercial standards and their use in quantitation, definitions of limits of quantitation, and consideration of background measurements during quantitation. This survey provides autoradiographers, managers, and regulators with an important reference on the state-of-the art of QWBA and shows that the technique has gained wide acceptance across the pharmaceutical industry. However, it also shows that there are some key areas, such as inconsistencies in the procedures used for quantitation, that investigators may want to probe further to assure that the highest quality and most useful studies are performed.

Measuring alcohol consumption and alcohol-related problems: comparison of responses from self-administered questionnaires and telephone interviews

AIMS

Compared with surveys using self-administered questionnaires, telephone interviews generally yield higher coverage rates, have a lower proportion of missing values and result in fewer inconsistencies. Meta-analyses, however, show that responses to sensitive questions by telephone tend to be biased by social expectations. The aim of the study is to examine whether responses on alcohol consumption and alcohol-related problems differ with respect to mode of administration (self-administered vs. telephone). Design and participants. Data were analysed from the 1995 self-administered survey among 6427 subjects and from telephone surveys conducted annually between 1994 and 1996 yielding a pooled sample of 6193 subjects.

MEASUREMENTS

Alcohol consumption within the last 30 days was measured using a beverage-specific quantity-frequency index. For a summary measure responses were converted into pure alcohol (ethanol) per day and categorized into no alcohol consumption (0 g), non-hazardous consumption (< or = 20 g for female and < or = 40 g for males) and hazardous consumption (> 20 g for females and > 40 g for males). Alcohol-related problems were assessed using the CAGE questionnaire with a cut-off point of at least two positive responses.

FINDINGS

Using (cumulative) logistic regression, a significant mode effect was found for both alcohol consumption and alcohol-related problems. Lower beverage-specific prevalences in the telephone mode were found to be responsible for the difference in the distribution of the summary consumption measure.

CONCLUSIONS

Results indicate that patterns of drinking and alcohol-related problems are more easily reported in self-administration questionnaires compared to telephone interviews.

Prevalence of alcohol use and the association between onset of use and alcohol-related problems in a general population sample in Germany

AIMS

This paper examines the prevalence of alcohol use, alcohol-related problems and onset of regular alcohol use, including its association with the prevalence of CAGE symptoms.

DESIGN AND PARTICIPANTS

Data come from three nationally representative samples of the non-institutionalized German general population aged 18-59 years which were conducted annually between 1994 and 1996. Subjects (n = 7501) were surveyed through telephone interviews.

FINDINGS

Overall, men were more likely to drink alcohol, to be heavier drinkers and to experience more alcohol problems than women. Prevalence of 12-month use was constant across age among males, but decreased with age among women. Prevalence of heavier drinking, however, increased with age in both sexes. While for both sexes the median age of onset decreased towards younger cohorts, the prevalence of regular use at younger ages increased more strongly among females compared to males. In all cohorts of both sexes, an association between early age of onset and negative consequences measured by the CAGE questionnaire could be observed. Odds ratios were significantly lower for life-time experience of at least two CAGE symptoms among respondents if they had started regular alcohol use later than their peers.

CONCLUSIONS

The results indicate a narrowing of the gender gap due to an increasing prevalence of regular alcohol use for females across cohorts. Gender differences with regard to heavier drinking are still prominent. The findings confirm those of related studies in which early age of onset of regular alcohol use was found to be a significant predictor for life-time alcohol-related problems.

[Laparostomy in the treatment of severe hemorrhagic-necrotic pancreatitis]

The authors present their experience with the therapy of severe necrotic pancreatitis which was applied in the period from 1986 to 1993. Alcoholic etiology was stated in 52.56% patients. The authors analyse in detail the cases treated with "open packing" laparostomy. They emphasise its advantages and advocate to its more frequent application. Laparostomy in the frame of complex therapy of acute pancreatitis can contribute to mortality reduction. The mortality in the group of patients yielded 17.75%. Complications and multiorgan failure with a high mortality rate and severe forms of necrotic pancreatitis still represent a sad component of abdominal surgery. (Tab. 6, Ref. 13).

Molecular cloning and characterization of a cDNA encoding feline interleukin-6

With the discovery that the cat is susceptible to infection by a lentivirus quite similar to the virus that causes the human acquired immune deficiency syndrome, the cat has become an important animal model with which the interactions between host and immunodeficiency virus can be studied. To facilitate investigation of the feline immune response and the response of cytokine expression to infection by feline immunodeficiency virus, our laboratory has focused on the isolation and molecular cloning of cDNA representative of feline lymphokines, cytokines, and monokines. Herein, we describe the molecular cloning and characterization of a cDNA encoding feline interleukin (IL)-6. The nucleotide sequence of feline IL-6 was found to exhibit 81%, 76%, 63%, and 61% homology with pig, human, rat, and mouse IL-6, respectively, while the predicted amino acid sequence exhibits 66%, 53%, 37%, and 30% homology with pig, human, rat, and mouse IL-6, respectively.

Ultrasonic angioplasty in totally occluded peripheral arteries. Initial clinical, histological, and angiographic results

BACKGROUND

Ultrasonic angioplasty was recently shown to ablate thrombi and atherosclerotic plaques in vitro and to recanalize occluded arteries in experimental animal models. The goal of the present study was to examine the clinical feasibility of ultrasonic angioplasty.

METHODS AND RESULTS

Intraoperative ultrasonic angioplasty was performed in vivo on totally occluded peripheral arteries (n = 7). The ultrasonic angioplasty device consists of a 1.6-mm diameter flexible wire attached to a piezoelectric crystal generating ultrasound at 20 kHz. The controls, totally occluded human atherosclerotic femoral arterial segments (n = 6), were crossed mechanically with the ultrasound wire ex vivo but without application of ultrasonic energy. Ultrasonic angioplasty achieved successful recanalization without perforation in all vessels. Angiograms of the treated arteries showed an average lumen patency of 82.5%. Histological examination of the recanalized arteries revealed that the recanalization had taken place through intima diffusely involved with complicated plaque. The treated arteries, compared with the controls, had greater area of recanalized lumen (5.9 +/- 1.8 versus 1.7 +/- 0.4 mm2, p less than 0.05) and more flow (49.3 +/- 16.0 versus 11.8 +/- 4.9 ml/min, p less than 0.03). The damage in treated and control arteries was similar. Size-distribution analysis of the plaque debris from the treated arteries showed that 41 +/- 5% of the debris was 0.2-8 microns, 48 +/- 8% was 8-30 microns, and the remainder was 30-100 microns. In the mechanically crossed arteries, there was a shift in the distribution to larger size debris with 47 +/- 1% greater than 100 microns (p less than 0.001).

CONCLUSIONS

Ultrasonic angioplasty may be a useful clinical method for recanalization of total occlusions in patients with peripheral vascular disease. Ultrasonic energy appears to cause controlled injury to the atherosclerotic intima by selectively disrupting the ultrasound-sensitive occlusion.

[Vascular injuries in children]

Vascular trauma in children differs in some respects from that in adults. In infants and children the total blood volume is smaller, and despite effective compensatory mechanisms, critical blood loss is also smaller. Gentle and meticulous technical skill is needed to correct injuries of minute vessels and allow adequate blood flow. The use of synthetic tubes and materials is not recommended, as they do not lengthen as the child grows. Ischemia is a major factor influencing limb growth and function. 3 different types of vascular injuries operated on in the past year are presented.

Motivational syndromes associated with natural killer cell activity

This article reports three studies that taken together support two hypotheses: (a) that the stressed power motivation syndrome is associated with relatively low natural killer cell activity (NKCA) and (b) that the unstressed affiliation motivation syndrome is associated with higher NKCA. In Study 1, college students who were relatively high in stressed power motivation had significantly lower NKCA than did their peers. In addition, students high in unstressed affiliation motivation had significantly greater NKCA than did those showing less evidence of this syndrome. Study 2 replicated these findings on a sample of middle-class men. In Study 3, which tested the hypotheses among adult patients from a Health Maintenance Organization, results were in the same direction but less significant. Meta-analyses clearly indicate that the combined evidence from the three studies reliably supports both hypotheses.

[A pancreatic-pleural-pulmonary fistula as a complication of chronic pancreatitis]

The authors describe a rare case in a 40-year old patient of a pancreatic-pleural-pulmonary fistula. The patient had been treated six years previously on account of very painful relapsing chronic pancreatitis. After establishment of the diagnosis, confirmed by ERCP, the condition was successfully resolved by laterolateral derivation.

[Pancreato-pleural fistula as a complication of post-traumatic pancreatic mediastinal pseudocyst]

The authors describe a rare case of pancreatopleural fistula in a 42-year-old patient as a complication of a post-traumatic pseudocyst of the pancreas resistant to repeated conservative treatment. After establishment of a pancreatojejunal anastomosis side-to-side with an excluded jejunal loop and ligature of the fistula, regression of the pleural effusion and healing was recorded.

Glutathione status of rat thymocytes and splenocytes during the early events of their ConA proliferative responses

Glutathione plays an important role in the lymphocyte mitogenic response. We have demonstrated that 2-ME increases the ConA proliferative response of rat splenocytes and in parallel, causes an enhancement of glutathione synthesis in these cells. On the other hand, 2-ME had the same action on the glutathione level of thymocytes during the late phase of their mitogenic response, but it had no effect on the [3H]thymidine uptake of these cells. To clarify this discrepancy and the role of glutathione during the mitogenic response, we studied the glutathione status of thymus cells during the early phase of the ConA-induced proliferative response in the presence or the absence of 2-ME in parallel with that of whole spleen cells and the T cell fraction of splenocytes. During the early events of the mitogenic response, i.e., during the 24th h, we observed a normal 2 GSSG/GSH + 2 GSSG ratio in cultured cells, indicating a normal redox state, and that ConA involved an increased glutathione level in thymocytes but not in whole splenocytes and in splenic T cells. 2-ME had no effect on the glutathione level of stimulated thymocytes during the early phase of the mitogenic response. This phenomenon could be related to an absence of its effect on [3H]thymidine uptake. On the other hand, 2-ME induced an enhancement of the glutathione level and [3H]thymidine uptake in the two types of stimulated splenocytes. This study suggest that thymocytes do not have the same mechanism of glutathione synthesis induction as that which occurs in splenocytes during the ConA proliferative response. This mechanism could be related to the maturation state of the T cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Glutathione status during the mitogenic response of rat splenocytes. Effects of oxygen concentration: FO2 21% versus FO2 7%

Glutathione is known to be an important parameter for ConA proliferative response of murine splenocytes. We studied the glutathione status of ConA-stimulated rat splenocytes during the early and late phase of the mitogenic response under low (FO2 7%) and standard (FO2 21%) oxygen concentrations. We determined the intracellular total, oxidized and reduced glutathione levels after 6, 12, 24 and 48 h of culture with or without ConA and/or 2-ME, under FO2 7% and 21%. Our results showed that: The 2 GSSG/GSH + 2 GSSG ratio, which indicated the redox state of the cells, remained normal during the early period of culture (0-24 h), irrespective of culture conditions. After 48 h of culture, this ratio increased dramatically under FO2 21% and less under FO2 7%. The maintenance of the redox state seems to be an oxygen concentration-dependent phenomenon. ConA stimulation involved a glutathione consumption during the early stages of culture; under these conditions 2-ME increased the glutathione synthesis, which was higher under FO2 7% than under FO2 21%. On the other hand, the presence of 2-ME involved an increase of tritiated thymidine uptake in stimulated splenocytes, which was significantly higher under FO2 21% than under FO2 7%. Low oxygen tension (FO2 7%) can induce a higher increase of glutathione synthesis, whereas the respective ConA proliferative response is lower than that observed under standard O2 conditions.

Resistant hypertension associated with a renin-producing ovarian Sertoli cell tumor

A 17-year-old girl with refractory, but nonmalignant, hypertension and hypokalemia is presented. A state of primary hyperreninism and secondary hyperaldosteronism was found to exist, together with a renin-producing Sertoli cell ovarian tumor. Upon removal of the tumor, this patient attained both a normotensive and a normokalemic state. A brief review is given of renal and nonrenal renin-producing tumors.

Lymphocyte glutathione status in relation to their Con A proliferative response

We studied the intracellular total, oxidized and reduced glutathione levels in thymus and spleen rat lymphocytes cultured with or without Con A and 2-mercaptoethanol (2-ME). After 48 h culture, the total glutathione level decreased and the oxidized glutathione level increased in the two types of unstimulated and stimulated cells. In the presence of 2-ME, the tritiated thymidine incorporation increased in splenocytes but not in thymocytes; on the other hand, the two types of stimulated cells increased their total and oxidized glutathione content. The enhancement of the GSSG/GSH + GSSG ratio, irrespective of culture conditions, indicates a severely disturbed redox state of the cells. 2-ME acts on the glutathione synthesis of stimulated lymphocytes but is unable to maintain a normal redox state of these cells.

Depression of Con A proliferative response of immune cells by in vitro hyperoxic exposure--protective effects of thiol compounds

Time dependent response for hyperoxic exposure was determined in vitro on ConA proliferative response of rat splenocytes, peripheral blood mononuclear cells and thymocytes. The proliferative responses were evaluated after different lengths of hyperoxic exposure (12-72 h, FiO2 = 0.95). After 24 h oxygen exposure, the spleen cell viability assessed by dye exclusion was normal but DNA synthesis was markedly suppressed in the above three types of cells. Total or partial protection of the mitogenic response to ConA was obtained by 2-mercaptoethanol, reduced glutathione or L-cysteine addition in culture medium; only selenomethionine had no protective effect. Thymic cells showed a different response-curve: after 6 h exposure to normobaric oxygen DNA synthesis was decreased and was not restored by any of the thiol compounds tested. In this respect, these cells demonstrated different susceptibility to an oxidant injury, i.e. exposure to high oxygen concentration. From a pharmacological point of view O2 exposure and altered immune response could be proposed as a useful model for screening the antioxidant drug activity.

High concentrations of oxygen modulate in vitro Con A responses of rat lymphoid cells. Effect of 2-mercaptoethanol

The effects of different normobaric oxygen concentrations (40, 60 and 95%) on the survival and the proliferative response to Con A of rat lymphoid cells were studied. Spleen, thymus and peripheral blood mononuclear cells were tested. We found that oxygen concentrations modulated the proliferative response independently of cell survival. The addition of 2-mercaptoethanol (2-ME) partially prevented the toxic effects of hyperoxia but the population of thymocytes which responded to Con A stimulation appeared to be less sensitive to the protective action of 2-ME. The relationship between oxygen concentrations and the lymphoid proliferative response could be used as a model of oxidant immunodepression for evaluating pharmacological effects of antioxidant compounds.

Life change stress, psychiatric symptoms, and natural killer cell activity

Previous research has linked stress with adverse health change; however, the immunologic mechanisms mediating these changes remain poorly understood. To test whether "stress" was associated with alterations in cell-mediated immunity, we examined the correlations of self-reported life change stress (LCS) and psychiatric symptoms with natural killer cell activity (NKCA) among 114 healthy undergraduate volunteers. Although the bivariate correlation between LCS and NKCA was not significant, subjects reporting few psychologic symptoms in the face of large amounts of LCS ("good copers") had significantly higher NKCA than those experiencing high levels of both symptoms and LCS ("poor copers"). Furthermore, self-reported psychiatric symptoms were found to inversely correlate with NKCA, suggesting that symptoms such as anxiety and depression may negatively affect immunity.

HLA antigens in Guillain-Barré syndrome

We compared Guillain-Barré syndrome (GBS) cases reported from cities in the United States in 1976-1977 with spouse or associate controls to detect possible HLA associations. HLA-A11 was somewhat less common among 92 cases than among 100 controls (p = 0.04). The 38 patients and 42 controls vaccinated against A/NJ/76 differed slightly in overall distribution of B locus antigens (p = 0.06), but the individual HLA-B antigen associations were more easily explained by chance. The 54 unvaccinated cases showed no apparent relation to HLA type. These findings should encourage further immunogenetic study of etiologically related GBS cases.

Characterization of immunological depression in mice exposed to normobaric oxygen

Immunological cell functions were evaluated during 24, 48 and 96 h O2 exposure in C57Bl/6 mice. A normobaric O2 exposure resulted in depression of delayed type hypersensitivity (DTH) to oxazolone and Staphylococcus aureus antigens. This effect was proportional to the duration of O2 exposure. The antibody response of splenic cells was more rapidly (24 h O2 exposure) and markedly depressed using a T-dependent antigen (sheep red blood cell, SRBC) than with a T-independent antigen (trinitrophenylated lipopolysaccharide, TNP-LPS). While mitogen-induced proliferative responses of spleen cells to Con A and PHA were inhibited after 72 h of O2 exposure, proliferative responses to LPS were inhibited after 96 h. A dissociated antigen and mitogen responses was observed after a short time of O2 exposure (48 h): the antigen specific responses were impaired with a more pronounced effect on T lymphocytes, whereas the DNA synthesis in response to mitogen remained normal.

Successful parathyroid gland autotransplantation after total parathyroidectomy in dialysis patients

Secondary hyperparathyroidism is one of the major complications encountered in patients on maintenance dialysis. Medical management is frequently unsuccessful, and there is often a need to perform a parathyroidectomy. Recurrent clinical secondary hyperparathyroidism may occur as a sequela of subtotal parathyroidectomy and necessitate a reexploration of the neck. Total parathyroidectomy followed by autotransplantation of parathyroid tissue into the patient's forearm bypasses the need for a second operation, and it provides a simple ambulatory procedure, under local anesthesia, for the removal of hyperplastic parathyroid tissue. The results in six patients indicate that this new procedure should be considered the treatment of choice for this condition.

The watery diarrhea syndrome with hypercalcemia--a symptomatic response to phosphate buffer

Two patients with the watery diarrhea, hypokalemia, achlorhydria syndrome are described. Both had hypercalcemia, hypophosphatemia and suppressed parathyroid hormone activity. On repeated occasions the diarrhea was controlled by oral or intravenous phosphate buffer. An exhaustive search by sophisticated non-invasive methods and by celiac arteriography failed to demonstrate a pancreatic tumor. Yet, in both cases fairly large pancreatic non-beta-cell adenomas were found at laparotomy. The removal of these tumors was followed by complete recovery.

Altered protein synthesis and creatine kinase in breast muscle cell cultures from dystrophic chick embryos

The total protein synthesis (TPS), myosin synthesis (MS) and creatine kinase (CK) levels in muscle cell cultures obtained from 400 normal (strain 454) and 400 dystrophic chick embryos (strain 455) were investigated. The cultures were obtained from breast muscles of 12 day chick embryos by dissociation in 0.25% trypsin, preplating and plating of 5 x 10(5) floating cells on gelatin coated dishes in Minimal Essential Medium, 10% horse serum and 2% chick embryo extract. After 6 days, when electron-microscopic studies demonstrated good muscle differentiation, cell cultures were labeled with [3H]leucine. TPS and MS, respectively, showed 85% and 65% increases in breast muscle cell cultures from dystrophic chick embryos. The half-life times for total protein and myosin from dystrophics were 19 and 32 hr, respectively as compared with 36 and 48 hr from controls. Noncollagen protein content (NCP) showed 27% decrease in postfusion stage (12 days) of cell cultures from dystrophics. The CK level showed 30% lower values in the cells from dystrophics but 50% higher values in their culture medium. The addition of leupeptin plus pepstatin (50 microgram/ml) to these cultures resotred NCP content, total protein and myosin turnover to normal values and significantly increased TPS and MS. The addition of diphenylhydantoin (DPH) (20 microgram/ml) to cell cultures from dystrophics did not change the NCP content nor the turnover for total protein and myosin but significantly increased TPS, MS and CK while medium CK significantly decreased. The addition of leupeptin plus pepstatin or DPH to muscle cell cultures from normal chick embryos also significantly stimulated TPS and MS.

[Malignant melanoma, leukoderma and vitiligo]

We report about two patients with malignant melanoma, who developed vitiligo at a site distant from the primary melanoma after surgery and during consecutive immunotherapy. In two patients a leucoderma was observed within the area, where metastatic lymphnodes had been excised, as also reported in the literature. These depigmentations may be due to an immunologic defense mechanism, but there is no evidence, if they represent a favourable sign in the course of malignant melanoma.

Propagation in a weakly anisotropic waveguide

In this communication we have considered propagation in a weakly anisotropic dielectric waveguide. It is shown that for a positive anisotropy the fractional power carried by the guide core increases over the isotropic case and that the anisotropy has an increasing effect as cutoff is approached. For negative anisotropy the effect is reversed. The increase in the fractional power varies linearly with the value of anisotropy with slope increasing as cutoff is approached. The degeneracy between the HE(n+1,m) and EH(n+1,m) modes present in the isotropic weakly guiding approximation is broken, and it is physically significant to distinguish between EH and HE modes. The anisotropy in retinal receptors (considered as dielectric waveguides) increases the stability of modal power with variation of the wavelength, although the effect is too small to explain the observation.

Cholecystectomy without drainage, nasogastric suction, and intravenous fluids

A comparative study was made between 60 patients in whom drainage of subhepatic space was performed after uncomplicated cholecystectomy and 60 patients in whom no drainage was performed. In addition, 30 patients were treated without drainage, nasogastric suction, or intravenous fluids. After operation the patients were evaluated as to postoperative pyrexia, wound infection, lung atelectasis, thrombophlebitis, and postoperative stay in hospital. Fever and wound infection occurred in fewer patients without drainage than those with drainage, but omission of nasogastric suction and intravenous fluids did not influence the incidence of wound infection. Postoperative stay in hospital was shorter in the patients without drainage and shortest in those treated without drainage, nasogastric suction, and intravenous fluids. Nasogastric suction and intravenous fluids are not needed postoperatively, as the degree of the paralytic ileus is very slight and they may be harmful, causing lung atelectasis and thrombophlebitis. Uncomplicated cholecystectomy may be performed safely without drainage, postoperative nasogastric suction, and intravenous fluids.

Perforation of hydatid cyst into the common bile duct; report of four cases

Four cases of hydatid cysts which perforated into the common bile duct are presented. Jaundice was the presenting symptom in three cases. The operative treatment consisted of choledochotomy, evacuation of the daughter cysts and the membrane of the mother cyst and drainage through the T-tube. In one case, it was possible to open the mother cyst, evacuate its contents and drain it externally.

Axillary sympathectomy for upper extremities

Among the several various surgical approaches to the cervico-dorsal sympathetic system, the axillary approach seems to us the operation of choice. The operation is simple, gives excellent access to the required sympathetic ganglions, including the lower part of the stellate ganglion, down to the fifth thoracic ganglion. In all cases the sympathectomy was clinically complete. The postoperative course was mostly smooth, and the few cases of transient Horner's Syndrome, pneumothorax and hemothorax could have been avoided.

Transient obstruction of the common bile duct following its exploration

Failure of the contrast medium to enter the duodenum during the operative cholangiography following the common bile duct exploration and instrumentation may be caused by transient obstruction of the common bile duct. It is attributed to spasm and oedema of the sphincter choledochus of Boyden and not of the sphincter of Oddi. The knowledge of the possibility of the pseudo-obstruction of the common bile duct following its exploration may save the surgeon from unnecessary re-exploration and performing sphincterotomy or choledochoduodenostomy. The exploration is unnecessary if, during the common duct exploration, the dilators and the catheter passes easily into the duodenum and on the cholangiogram the obstructed area is smooth and there is no filling defect. A normal cholangiogram performed 8-10 days following the operation proves that the obstruction was transient and not caused by calculus stricture or tumour.

Selective massive amyloidosis of small intestine

A patient with intestinal amyloidosis with perforation was successfully treated by resection of almost the whole involved small intestine and is recuperating on hyperalimentation therapy. Because there were no signs of amyloiditic deposition in other parts of the body and no other cause of the amyloidosis, the case was considered to be selective localized intestinal amyloidosis. This is the third reported case of perforated amyloiditic intestine and apparently the first case of selective small intestinal amyloidosis involving such a complication.