BRAZIL

Pancreatoduodenectomy.  —Eight cases of pancreatoduodenectomy are reported by Dr. Eurico de Silva Bastos, professor at the Faculdade de Medicina de São Paulo. The technique used by him was the following: (a) removal en masse of the duodenum, the pancreas, and adjacent tissues; (b) implantation of the common bile duct into the jejunum; (c) anastomosis of the residual portion of the pancreas to the jejunum, distally to the bilidigestive anastomosis and proximally to the gastrojejunostomy; and (d) gastrojejunal anastomosis performed distally to the intestinal implantation of the common duct and the pancreatic duct. These operations were performed in either one or two stages. The failures of pancreatoduodenectomy are generally due to the difficulty of a preoperative diagnosis and even, sometimes, to the difficult and doubtful diagnosis on the surgical table. To obtain real effects from such a radical operation it has to be done early, sometimes even without the absolute