Abstract Background Pancreatoduodenectomy (PD) remains the treatment of choice for resectable cancers affecting the pancreatic head. It is the only curative-intent treatment option for pancreatic ductal adenocarcinoma (PDAC), the fourth leading cause of cancer-related death in Europe. Perioperative mortality following PD has fallen in recent years due to improvements to patient selection, operative technique and the centralisation of services. This is now less than 4.0% in high-volume centres. However, postoperative morbidity remains around 60% and relaparotomy is not uncommon. Not infrequently, a tissue diagnosis is not obtained preoperatively and radiologically distinguishing between benign, premalignant and malignant lesions can be challenging. Hence, a proportion of patients who are thought to have malignant disease preoperatively are ultimately found to have benign/premalignant histology postoperatively. It is unknown if this affects perioperative outcomes. This study aimed to compare the surgical outcomes of these patients with case-matched controls who had malignancy histologically confirmed postoperatively. Statistical analysis was designed to test the primary hypothesis that perioperative outcomes do not differ significantly between the two groups. Methods A retrospective, paired case matched-control study was undertaken using a prospectively maintained database (01/01/2006–31/12/2020). Patients with suspected malignancy on preoperative imaging and a final histological diagnosis of a benign or premalignant disease were included. Forty-five cases were matched to confirmed malignant controls using the following criteria: age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) grade, preoperative serum bilirubin, application of neoadjuvant therapy (NAT), preoperative endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary (PTC)-drainage, type of PD (standard Whipple's procedure or pylorus-preserving approach), absence of vascular resection or additional procedure, and type of pancreatic reconstruction (pancreatico-jejunostomy or pancreatico-gastrostomy). Matching was blinded to the measured outcomes, which included 30- and 90-day mortality and morbidity, quantified using the Clavien-Dindo system. Continuous variables both in preoperative matching and postoperative outcomes were analysed for distribution using the Shapiro-Wilk test. Fisher's exact test was used for categorical variables selected as part of the matching criteria. Significance was set at p<0.01. Continuous variables with non-normal distribution were analysed using the Mann-Whitney U test. Categorical variables from postoperative outcomes were analysed using either Fisher's exact test or the Chi-squared test. Results A total of 609 PDs were performed. Overall morbidity and 90-day mortality rates were 49.9% and 3.1%, respectively. Forty-five patients (7.4%) were found to have undergone PD for suspected malignancy but ultimately found to have benign/premalignant histology. These cases were compared to 45 controls where malignancy was confirmed postoperatively. Matched characteristics demonstrated no significant difference between the benign/premalignant and malignant groups. Histology did not significantly affect 30-day mortality (5 vs 2, p=0.238), median length of stay (both 11 days, p=0.711), number of patients admitted to intensive care (both 29, p=1.00), or the number of days spent in intensive care (both one day, p=0.984). Furthermore, unplanned return to theatre (benign: 6, malignant: 4, p=0.502) and 90-day readmission rates (benign: 6, malignant: 5, p=0.138) were similar. Final histological diagnosis did not affect overall morbidity (both 28, p=1.00) but major morbidity (Clavien-Dindo grade III-V) was significantly higher in the benign/premalignant group (18 vs 8, p=0.035). Independently, clinically relevant postoperative pancreatic fistula (CR-POPF) was also more common in the benign/premalignant group (10 vs 2, p=0.013). This was despite the fact that pancreatic consistency and main pancreatic duct size did not significantly differ between the two groups. Conclusions A not insignificant proportion of patients who undergo PD for suspected malignancy are ultimately found to have benign/premalignant histology. In our study, these patients had a significantly higher incidence of overall major morbidity when compared to those who had a malignant histological diagnosis confirmed. Patients with benign/premalignant disease were also found to have a higher incidence of pancreatic fistula, despite having similar pancreas texture and main pancreatic duct diameters compared with the malignant group. Future research should focus on developing methods that can accurately distinguish between malignant and non-malignant lesions preoperatively.

INTRODUCTION:The SARS-CoV-2 pandemic presented healthcare providers with an extreme challenge to provide cancer services. The impact upon the diagnostic and treatment capacity to treat pancreatic cancer is unclear. This study aimed to identify national variation in treatment pathways during the pandemic. METHODS:A survey was distributed to all United Kingdom pancreatic specialist centres, to assess diagnostic, therapeutic and interventional services availability, and alterations in treatment pathways. A repeating methodology enabled assessment over time as the pandemic evolved. RESULTS:Responses were received from all 29 centres. Over the first six weeks of the pandemic, less than a quarter of centres had normal availability of diagnostic pathways and a fifth of centres had no capacity whatsoever to undertake surgery. As the pandemic progressed services have gradually improved though most centres remain constrained to some degree. One third of centres changed their standard resectable pathway from surgery-first to neoadjuvant chemotherapy. Elderly patients, and those with COPD were less likely to be offered treatment during the pandemic. CONCLUSION:The COVID-19 pandemic has affected the capacity of the NHS to provide diagnostic and staging investigations for pancreatic cancer. The impact of revised treatment pathways has yet to be realised.

Introduction: There is a paucity of information on micronutrient status in patients with pancreatico-biliary malignancies referred for surgery. Deficiency states could impact recovery from surgery. The purpose of this study was to investigate the frequency of deficiency states in our specialist Hepato-Biliary and Pancreatic (HPB) unit. Methods: Patients with suspected pancreatico-biliary malignancies referred to our surgical team between October 2019 and July 2020, and seen by a dietitian were included in the study. Serum levels of vitamins A, D, E, B-12, and folate, and minerals zinc, selenium, copper and iron were obtained. Results: Forty-eight patients were eligible for inclusion, 28 males and 20 females with a median age of 68 years. Pancreatic cancer was suspected in 40 patients, bile duct cancer in four patients, and duodenal cancer in four patients. Zinc, vitamin D, selenium and iron were the most frequently occurring micronutrient deficiencies. Zinc deficiency was found in 83% patients and vitamin D insufficiency in 57%. Selenium deficiency was less frequent but found in 24% cases, while iron deficiency suggested by low transferrin saturation was found in 23% patients. Conclusions: Micronutrient deficiencies and borderline status may be more frequent in this patient group than generally acknowledged. Routine analysis of specific vitamins and minerals may be useful to identify deficiency/sub-clinical deficiency states. Further more extensive studies are needed to inform practice and enable guideline development. (C) 2021 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Chyle leak (CL) is an uncommon complication of pancreatico‐duodenectomy (PD). Its incidence, risk factors, and effect on prognosis are not well described and optimum management remains debated. This study aims to calculate incidence of CL following PD and identify risk factors. Following a literature review, we have proposed a management algorithm.

BACKGROUND:To ascertain if post-operative drain fluid lipase is superior to amylase in routinely detecting clinically significant post-operative pancreatic fistulae (POPF).METHOD:Between January 2015 and March 2016 data were collected on all patients undergoing pancreatic surgery at a regional referral centre. Routine drain fluid analysis was performed on post-operative patients as part of a locally defined enhanced recovery protocol. POPF was diagnosed in accordance with the recently updated International Study Group of Pancreatic Surgery guidance.RESULTS:During the study period, there were 68 pancreatic resections. The median age was 69.1 years. A total of 11 (15.9%) patients developed clinically significant POPF (nine type B and two type C). The median drain amylase result in patients with type B or C leak was 532 IU/L (interquartile range (IQR) 264-833). This was significantly higher than those without a clinical fistula (median 38, IQR 15-376, P = 0.012). The median drain lipase result was 1504 IU/L (IQR 746-2236). This was significantly higher than those without a clinical fistula (median 57, IQR 13-1277, P = 0.012). Fluid amylase had a sensitivity of 81.8% and specificity of 69.2%; fluid lipase had a sensitivity of 91% and specificity of 64.9%.CONCLUSION:Our experience suggests drain fluid amylase or lipase results are not sufficiently sensitive or specific to reassure clinicians and rule out clinically significant POPF. However, if biochemical tests are used to aid decision-making, then lipase is a more sensitive biochemical marker than amylase for the routine detection of clinically significant POPF.

The purpose of this study was to investigate the impact of post-mortem computed-tomography angiography (PMCTA) on the histology of the liver, kidneys and heart. Multiple tissue cores were collected from the liver, left and right kidneys and left ventricle utilizing CT-guided biopsy. Subsequent whole body PMCTA was performed using a solution of polyethylene glycol and iodinated radiographic contrast, and an embalming pump. Corresponding biopsy cores were collected at autopsy, and blinded histology analysis assessing for PMCTA-induced histology artefact was performed. The blinded analysis of pre-PMCTA and post-PMCTA biopsy samples demonstrated that whole body PMCTA had no effect on the histological analyses of the liver (0%, CI = 0–13.7%), left ventricle of the heart (0%, CI = 0–36.9%) and right kidney (0%, CI = 13.2%), however likely caused increased Bowman’s capsule spaces in the left kidney of one case (4%, CI = 0.01–20.4%). Other artefactual histological changes identified included eosinophilic material in the liver, whiter interstitium and dilated tubules in kidney samples, and autolysis-related changes, however these could not be categorically attributed to the PMCTA procedure. PMCTA causes zero or minimal effect to the histological examination of the liver, left kidney, right kidney and left ventricle, and as such performing PMCTA prior to autopsy is unlikely to impact autopsy histological results in these organs.

BACKGROUND:Differentiating hepatic mucinous cystic neoplasms (MCNs) from simple hepatic cysts (SCs) preoperatively is a challenging task. Our aim was to determine whether radiological features on ultrasound scan (USS), CT or MRI, cyst fluid tumour markers, or multidisciplinary team (MDT) outcomes could differentiate MCN from SC.METHODS:A retrospective review of radiological features, cyst fluid tumour marker levels and MDT outcomes in 52 patients was performed.RESULTS:There were 13 patients with MCN, 38 with SC and one ciliated foregut cyst. MCNs were more often solitary (p = 0.006). Although no other individual radiological characteristic on USS, CT or MRI was predictive of MCN, MDT outcomes stating that a cyst was complex in nature were highly predictive (p = 0.0007). Cyst fluid carbohydrate antigen 19-9, carcino-embryonic antigen and cancer antigen 125 were unable to differentiate MCN from SC (p = 0.45, p = 0.49, and p = 0.73, respectively).CONCLUSIONS:MDT outcomes are of greatest value when trying to differentiate MCN from SC, as well as having a solitary cyst on imaging. Conventional cyst fluid tumour markers are unhelpful. All suspicious cystic liver lesions should be discussed pre-operatively by a hepatobiliary MDT to determine the most appropriate surgical approach.

The vast necropolis at Samtavro, near Tbilisi, Georgia, is accorded primacy in the archaeology of the southern Caucasus for several reasons. Covering an area approximately 20 hectares, it is the largest burial ground in the Caucasus. Its longevity of use is also remarkable. First utilised as a cemetery in the third millennium BC, it peaked during the Late Bronze and Iron Ages, and again in the late Roman and late Antique periods. The cemetery was also intensely used, as is shown by the proximity of the burials, often packed closely together, and, in some cases, stratified. Finally, Samtavro was the main burial ground at Mtskheta during the Iberian Kingdom and witnessed the implantation of Christianity in the fourth century BC. Curiously, though, the burial traditions from the fourth and fifth centuries are not those usually associated with Christian burial practice elsewhere. This paper reports on the results of the first twoyears of renewed excavations carried out by the Georgian National Muse­ um and The University of Melbourne. ÖZET Tiflis'in 18 km kuzeyinde yer alan Samtavro, Kafkas İberya Krallığı'nın (MÖ 300 MS 580) başkentinin mezarlık alanıdır. 19. yüzyılın sonlarında Avusturyalılar ve Fransızlar tarafından kazılan mezarlık, Son Tunç ve Demir Çağı'nda (MÖ 1600-300) yoğun bir şekilde, daha sonra Roma döneminde ve Ortaçağ'ın başların¬ da (MS 100-500) kullanılmıştır. Gürcistan, antik zamanlardan beri doğu ve batı olmak üzere iki ayrı bölüm olarak algılanırdı. Klasik ve Ortaçağ yazarlarının da bu ayrımı belirttikleri bilinmektedir. Günümüzde hala doğu ve batı arasında etnik ve dilsel ayrım bulunmaktadır. İberya Krallığı Doğu Kafkasya'da, MÖ 300de başlayan ve MS 580yılın­ da Sassanilerle olan karşılaşmada yenilgiye uğrayarak son bulan zengin bir krallıktı. Bu zaman süreci kap­ samında 7 ayrı soydan 49 kralın, Roma ve Pers krallıklarıyla diplomatik ilişkileri sürdürdüğü bilinmekte­ dir. MS 337de krallık hristiyanlığı kabul etmiş, bundan sonra Bizans İmparatorluğu ile yakın ilişkilere girm313_338/D.18-Sagona:TUBA-AR 11/23/10 11:00 PM Sayfa314

Post-hepatectomy liver failure (PHLF) is a leading cause of morbidity and mortality following major liver resection. The development of PHLF is dependent on the volume of the remaining liver tissue and hepatocyte function. Without effective pre-operative assessment, patients with undiagnosed liver disease could be at increased risk of PHLF. We report a case of a 60-year-old male patient with PHLF secondary to undiagnosed alpha-1-antitrypsin deficiency (AATD) following major liver resection. He initially presented with acute large bowel obstruction secondary to a colorectal adenocarcinoma, which had metastasized to the liver. There was no significant past medical history apart from mild chronic obstructive pulmonary disease. After colonic surgery and liver directed neo-adjuvant chemotherapy, he underwent a laparoscopic partially extended right hepatectomy and radio-frequency ablation. Post-operatively he developed PHLF. The cause of PHLF remained unknown, prompting reanalysis of the histology, which showed evidence of AATD. He subsequently developed progressive liver dysfunction, portal hypertension, and eventually an extensive parastomal bleed, which led to his death; this was ultimately due to a combination of AATD and chemotherapy. This case highlights that formal testing for AATD in all patients with a known history of chronic obstructive pulmonary disease, heavy smoking, or strong family history could help prevent the development of PHLF in patients undergoing major liver resection.

Aim: To assess technical features of multiple biopsy devices for post-mortem CT-guided biopsy (PMCTB).Methods: Five different BARD clinical biopsy devices, including spring-loaded and vacuum-assisted, were used to perform percutaneous biopsy of the liver in a deceased person using the largest gauge needle size available in each. A standard co-axial biopsy technique was used for all devices except SenoRX (R). Specimens were placed on sponge in cassettes for initial fixation and then processed using routine histological techniques. The devices were assessed by a team consisting of a forensic technician, forensic radiologist and two forensic pathologists (one blinded to the type of device used). Assessment parameters included technical performance, cost of device, and specimen review under light microscopy.Results/discussion: The Max-core (R) and Magnum (R) devices were mechanically easy to load, fire and retrieve specimens. The Finesse (R) and Vacora (R) provided advanced technical features. On histological review the tissue sample from the Vacora (R) was judged to be of higher quality. Due to the permanent needle attachment to the vacuum machine, the SenoRX (R) was deemed impractical. Histological artefacts identified included stretch-crush cellular damage likely from the use of vacuum-assisted devices, and tissue breakage from the use of cassette sponges.Conclusion: The 2 spring-loaded biopsy devices are considered the most appropriate for PMCTB tissue sampling based on ease-of-use, lowest cost and provision of diagnosable biopsy specimens. (C) 2015 Elsevier Ltd. All rights reserved.

PURPOSE:Recognition of injury to the hyoid bone is intrinsic to post-mortem examination. Given its superficial location in the neck hyoid fractures are generally associated with some form of compressive neck force although they are well recognized in the peri-mortem period, in the context of manual handling and resuscitation. Hyoid fractures are variably reported to occur in manual strangulation and during hanging.METHODS:In this study Computer Tomography (CT) scans of the head and neck of 431 deceased persons (235 males and 196 females) between the ages of 1 day and 100 years of age (mean age 35.93 ± 24.15) and including 25 victims of hangings were examined to reveal the pattern of age-related change and the types of injury that occurred. Hyoid variants were also documented.RESULTS:The synchondroses between greater cornua and body were found to progressively fuse with age although in the current sample 20% non-fusion was observed beyond 65 years of age. Sex differences were evident in adult hyoid bones and discriminant function analysis correctly confirmed sex in 74.7% of cases.CONCLUSIONS:The greatest age-related changes occurred from puberty to post-adolescence and a linear regression equation successfully assessed age into three general categories in 87.7% of cases. Hyoid fractures were documented in 24% of victims of hangings and while previous reports indicate these are more likely in older age, when synchondroses are fused, in this study the average age of victims with fracture was 27 ± 10 years. In the majority of cases the site of ligature was below the hyoid bone and in only one on the hyoid body.

Recognition of injury to the hyoid bone and thyroid and cricoid cartilages is intrinsic to post-mortem examination. Due to its increasing brittleness with age the thyroid cartilage is particularly susceptible to injury following neck trauma, although there is inconsistency in the patterns of injury reported. In this study computed tomography scans of the head and neck of 431 deceased persons (235 males and 196 females) between the ages of 1 day and 100 years (mean age 35.93 ± 24.15), and including 25 victims of hangings, were examined to reveal the pattern of age-related change and the types of injury that occurred. Thyroid cartilage anomalies likely to cause confusion and be misinterpreted as trauma-related are documented. Angulation of the thyroid cartilage horns was found to change with age, and it is suggested this may be a significant factor in traumatic neck injury. Unlike in previous reports, the average age of hanging victims with fractures to the thyroid cartilage was 34 years. The base of the superior horn was the most common fracture site and in 50 % of hanging cases was associated with a ligature positioned on the thyrohyoid membrane or thyroid lamina. Although an age-related relationship exists it was not possible to establish narrow age-prediction ranges from calcification of the thyroid cartilage.

‘Eagle’s’ syndrome is a rare condition in which an ossified stylohyoid ligament may endanger neural and vascular structures in the neck (Eagle, 1949, 1962; Rechtweg et al., 1998; Rodriguez-Vazquez et al., 2006; Chuang et al., 2007). Compression of one or other of these structures may give rise to symptoms including unilateral neck pain, dysphagia, otalgia and tinnitus (Kaufman et al., 1970; Omnell et al., 1998; Basekim et al., 2005; Ramadan et al., 2007; Yagci et al., 2007; Ramadan et al., 2010. Computer Tomography (CT) scans of the head and neck of 431 deceased persons (235 males and 196 females) between the ages of 1 day and 100 years (mean age 35.93 ± 24.15) who were admitted for medico-legal death investigation to the Victorian Institute of Forensic Medicine (VIFM) in Melbourne, Australia were examined. Ossification of the ligament was observed to occur in parts, the superior part at its attachment to the styloid process of the temporal bone being the most common. Complete ossification was not seen. Ligament ossification increased with age although there were no sex differences. In some cases there appeared to be a pseudoarthrosis along the course of the ligament. While the study did not examine the anatomical relationship to neurovascular structures it is apparent that the stylohyoid ligament may undergo almost complete ossification and could compress vital neck structures.

This study was designed in order to assess the suitability of clavicular development in discriminating whether or not an individual has reached the age of 18 years. The development of the medial clavicular epiphysis was examined in an Australian population using computed tomography as the imaging modality. The sample consisted of individuals who were admitted to the Victorian Institute of Forensic Medicine, Melbourne, Australia, for the purposes of medico-legal death investigation. Comparisons were made with similar studies conducted on different populations in other countries, which revealed that the Australian population reaches maturity earlier, and the level of left/right asymmetry is higher than in other studies. The high degree of variation in fusion times is discussed, and the consequent effect upon the ability to use this epiphysis as a tool for determining if an individual has reached the age of 18 years is analysed. If an individual in this population has completely fused clavicles at stage 5, then for males they will be at least 18 years of age, with a 99% certainty of being at least 21, and for females they will be at least 20 years old. If at stage three then an individual of either sex will be at least 17 years of age.

A multi-factorial method for estimating age was devised based on the development of the 3rd molar tooth, the medial clavicular epiphysis, and the spheno-occipital synchondrosis, using multiple regression as the means to construct age estimation formulae and CT scanning as the imaging modality. The sample consisted of approximately 600 individuals from a contemporary Australian population, between the ages of 15 and 25 years, who were admitted to the Victorian Institute of Forensic Medicine, Melbourne, Australia, for the purposes of medico-legal death investigation. Results show that the spheno-occipital synchondrosis does not contribute to the age estimation model for this age cohort. The regression computation for the 3rd molar tooth and medial clavicle, when combined into a single multiple regression calculation, provides a robust model with tighter age ranges at the 95% confidence interval (CI) than when each age marker is used individually. This research provides a method to estimate age for unknown age Australian individuals in the problematic age group of 15–25 years with greater precision than previously possible.

PURPOSE:An accurate, complete understanding of the prostate neuroanatomy is required to optimize nerve sparing techniques during radical prostatectomy. However, the precise topography and function of the periprostatic nerves remain contentious and there is uncertainty about which nerve sparing technique is most optimal. We accurately quantified the distribution, precise localization and cross-sectional area of periprostatic neural tissue using cadaveric specimens.MATERIALS AND METHODS:We analyzed 13 cadaveric hemipelves using hematoxylin and eosin stained sections from the base, mid zone and apex of each prostate. Each section was digitized and divided into 6 sectors numbered clockwise. Analysis was performed using National Institutes of Health ImageJ software to calculate the total periprostatic neural cross-sectional area per sector.RESULTS:Calculating the total neural cross-sectional area highlighted a decrease from prostate base to mid zone to apex of 24.7, 19.7 and 13.7 mm(2), respectively. Most neural tissue was located in the posterolateral region. However, the proportion surrounding the anterior part of the prostate increased toward the apex with a median of 6.0% and 7.6% at the base and mid zone regions, respectively, increasing to 11.2% at the apex.CONCLUSIONS:Simple numerical nerve quantification may be insufficient to accurately describe the periprostatic neural distribution. Calculating nerve bundle cross-sectional area confirmed that most neural tissue is in the posterolateral region, although the proportion located anterior increases from base to apex. Thus, higher release of the periprostatic fascia may be indicated toward the apex.

The prevalence of developmental asymmetry between left and right sides of the body in the third molar tooth and medial clavicular epiphysis is examined in a contemporary Australian population (92% Caucasian). The contention that differences between left and right side developmental timing is statistically insignificant, and can therefore be ignored in forensic age estimation procedures, is questioned. It was found that of a population sample of 604 individuals, 177 displayed asymmetrical timing in development between antimeres of the third molar, the medial clavicle or both. There was no correlation found between the third molar tooth and medial clavicular epiphysis in terms of left/right synchronicity. For those individuals differing in development by two or more developmental stages in either age marker or one stage in both age markers, the effect upon the accuracy of forensic age estimations can be significant. Differences in age estimates for each side were as much as 3.1 years. Age estimations based on one side only may not provide the best estimate for an individual, and more accurate results can be achieved if both sides are taken into consideration. A protocol for dealing with asymmetrical development is discussed with reference to the multifactorial age estimation method proposed by the same authors in previous research.

Pancreatic surgery is still associated with a relatively high morbidity and mortality compared with other specialties. This is a result of the complex nature of the organ, the difficult access as a result of the retroperitoneal position and the number of technically challenging anastomoses required. Nevertheless, the past two decades have witnessed a steady improvement in morbidity and a decrease in mortality achieved through alterations of technique (particularly relating to the pancreatic anastomoses) together with hormonal manipulation to decrease pancreatic secretions.Recently minimally invasive pancreatic surgery has been attempted by several centres around the world which has stimulated considerable interest in this approach. The majority of the cases attempted have been distal pancreatectomies, because of the more straightforward nature of the resection and the lack of a pancreatic ductal anastomosis, but more recently reports of laparoscopic pancreaticoduodenectomy have started to appear.The reports of the series to date have been difficult to interpret and although the results are claimed to be equivalent or better than those associated with a traditional approach a careful examination of the literature and comparison with the best results previously reported does not presently support this. In the present review we examined all the reports of pancreatic procedures performed laparoscopically and compared the results with those previously achieved at open surgery.

The vast necropolis at Samtavro, near Tbilisi, Georgia, is accorded primacy in the archaeology of the southern Caucasus for several reasons. Covering an area approximately 20 hectares, it is the largest burial ground in the Caucasus. Its longevity of use is also remarkable. First utilised as a cemetery in the third millennium BC, it peaked during the Late Bronze and Iron Ages, and again in the late Roman and late Antique periods. The cemetery was also intensely used, as is shown by the proximity of the burials, often packed closely together, and, in some cases, stratified. Finally, Samtavro was the main burial ground at Mtskheta during the Iberian Kingdom and witnessed the implantation of Christianity in the fourth century BC. Curiously, though, the burial traditions from the fourth and fifth centuries are not those usually associated with Christian burial practice elsewhere. This paper reports on the results of the first twoyears of renewed excavations carried out by the Georgian National Muse­um and The University of Melbourne 1 .