[Nephrotic syndrome and microhematuria in a patient with nutcracker syndrome: Report of a case and review of the literature]. / Nephrotisches Syndrom und Mikrohämaturie bei einer Patientin mit Nussknacker-Syndrom: Ein Fallbericht mit Literaturübersicht.

We report about a 43-year-old woman with polyvalent drug addiction (i.e. alcohol, nicotine, methadone maintenance program with parallel consumption of heroin) who presented to the emergency department with peripheral edema, generalized weakness, and arthralgia. Laboratory findings revealed, among others, proteinuria, hyperlipoproteinemia and hypoproteinemia defining nephrotic syndrome. Computed tomography of the abdomen and iliocavography further revealed compression of left renal vein between aorta and superior mesenteric artery with distention of left ovarian vein as a possible cause of nephrotic syndrome (i. e. nutcracker syndrome). After excluding other possible causes of nephrotic syndrome, we decided against an interventional procedure due to poor compliance of the patient and potential risk of secondary stent dislocation. Instead, we opted for a surgical approach (i. e. veno-venous bypass, meaning transposition of left vena ovarica on vena cava inferior). The operative and postoperative course was uneventful. Postoperatively, proteinuria, microhematuria, arthralgia and edema receded.

Endoscopy in Barrett's oesophagus: adherence to standards and neoplasia detection in the community practice versus hospital setting.

OBJECTIVE: Potential process differences between hospital and community-based endoscopy for Barrett's oesophagus have not been examined. We aimed at comparing adherence to guidelines and neoplasia detection rates in medical centres (MC) and community practices (CP). DESIGN: Retrospective analysis. SETTING: All histologically confirmed Barrett cases seen over a 3-year period in six MC and 19 CP covering a third of all upper gastrointestinal endoscopies (n = 126,000) performed annually in Berlin, Germany. MAIN OUTCOME MEASURE: Rate of relevant neoplasia (high-grade intraepithelial neoplasia or more) in both settings in relation to adherence to standards. RESULTS: Of 1317 Barrett cases, 66% were seen in CP. CP patients had a shorter mean Barrett length (2.6 cm vs. 3.8 cm; P < 0.001) with fewer biopsies taken during an examination (2.5 vs. 4.1 for Barrett length

Effects of bombesin on pancreatic digestive enzyme gene expression.

We examined the effects of bombesin on rat pancreatic digestive enzyme gene expression using cloned complementary DNA probes for amylase, trypsinogen I, chymotrypsinogen B, and lysophospholipase. Rats were injected sc three times daily with 5 nmol/kg body wt bombesin. Pancreata were investigated after 6, 12, 24, 48, and 120 h of hormone treatment. Bombesin administration resulted in a time-dependent increase of pancreatic weight, as well as DNA and protein concentration. Cellular hypertrophy became evident after 48 h, and pancreatic hyperplasia occurred after 5 days of hormone treatment. Bombesin administration resulted in a time-dependent parallel decrease of amylase and lysophospholipase messenger RNA (mRNA) concentrations with maximal inhibition occurring after 120 h of bombesin treatment (13 +/- 1% and 14 +/- 3% of control, respectively, P less than 0.05, n = 6). In contrast, chymotrypsin and trypsin mRNA levels remained unaltered after bombesin treatment for up to 5 days. Amylase and chymotrypsin enzyme levels did not correlate with their respective mRNA concentrations. Both decreased to approximately 50% of control after 12 h and increased to 126 +/- 38% of control and 388 +/- 109% of control (P less than 0.05, n = 6), respectively, after 5 days of bombesin treatment. To test whether the bombesin regulation was mediated by the release of cholecystokinin (CCK), the specific CCK receptor antagonist L-364,718 (1 mg/kg body wt) was injected ip either alone, or 15 min before each bombesin injection for 5 days. Although the antagonist alone significantly reduced the mRNA concentrations for trypsin, chymotrypsin, and lysophospholipase to approximately 50%, it did not block the effects of bombesin on pancreatic digestive enzyme levels. These data therefore indicate that bombesin regulates pancreatic digestive enzyme mRNA and protein concentrations in a nonparallel manner; furthermore, CCK is not involved in mediating the bombesin effects on pancreatic gene expression.

Octreotide long term treatment of acromegaly: effect of drug withdrawal on serum growth hormone/insulin-like growth factor-I concentrations and on serum gastrin/24-hour intragastric pH values.

We studied a possible persistence of low GH concentrations after drug withdrawal in eight acromegalic patients who had been receiving octreotide treatment continuously for 42 months. Since octreotide induces chronic active gastritis, intragastric pH and serum gastrin were also determined before and during drug withdrawal. Results were compared to the respective pretreatment (pre-Tx) values. GH and insulin-like growth factor-I (IGF-I) increased after 4 weeks of octreotide withdrawal to pre-Tx values (GH, 12-h profile, 4.5 +/- 0.6, 2.6 +/- 0.7, and 5.6 +/- 1.1 micrograms/L; IGF-I, three samples, 3.4 +/- 0.4, 0.8 +/- 0.1, and 2.5 +/- 1.0 IU x 10(3)/L; means +/- SE, pre-Tx, on and off octreotide). A reduced insulin and augmented glucose response to oral glucose during therapy normalized after octreotide withdrawal (insulin, 527 +/- 84, 289 +/- 62, and 733 +/- 110 pmol/L; glucose, 6.2 +/- 0.3, 8.5 +/- 0.4, and 6.8 +/- 0.2 mmol/L; pre-Tx, on and off octreotide, means +/- SE). During octreotide treatment, the median 24-h intragastric pH value was 2.8 (pre-Tx pH not determined), and the median serum gastrin concentration (areas under the curve of 12-h profiles) was 1275 +/- 153 ng/L.12 h (n = 7). During octreotide withdrawal, pH decreased to 1.4, while serum gastrin increased to a median of 2937 +/- 472 ng/L.12 h. We conclude that GH and IGF-I suppression by long term octreotide therapy does not persist after drug withdrawal, indicating a need for life-long treatment. Octreotide-induced insulin suppression and glucose elevation are reversible. A high gastric pH during treatment may facilitate the development of octreotide-related gastritis. The gastrin increase during octreotide withdrawal probably reflects a response to chronic active gastritis after release from octreotide-induced gastrin inhibition.

Effect of the somatostatin analog octreotide on gastric mucosal function and histology during 3 months of preoperative treatment in patients with acromegaly.

OBJECTIVE: To study the effects of the somatostatin analog octreotide on gastric mucosal function and histology during short-term (3 months) preoperative treatment in patients with acromegaly. DESIGN: Open design clinical study. METHODS: 10 patients were studied before treatment with octreotide (pre-tx), on day 1 of 300 microg octreotide/day (d300), after 1 week on 300 (w300), 600 (w600) or 1500 (wl500) microg octreotide/day, and after an additional 2.5 months on 1500 microg octreotide/day (M3). An 8h gastrin profile was obtained and ambulatory intragastric 23h pH-metry carried out at the indicated time points. Gastroscopy was performed at pre-tx and M3 and multiple mucosal biopsy specimens taken. RESULTS: The mean serum gastrin concentration at first declined during octreotide therapy to a nadir at w1500, then recovered despite ongoing therapy (probably in response to reduced gastric acidity) and was similar to pre-tx values at M3 (mean+/-S.E.: 87+/-26, 50+/-11 and 98+/-46ng/l for pre-tx, w1500 and M3 respectively; P<0.05, pre-tx vs w1500). Gastric acidity had also declined at d300(P<0.05, d300 vs pre-tx), then recovered (despite the increase in the octreotide dose), but declined again at M3 (mean pH (95% confidence interval): 2.4 (1.7-3.2), 3.3 (2.4-4.3), 2.6 (1.8-:3.5, n=8) and 2.9 (1.6-4.2, n=7) at pre-tx, d300, w1500 and M3 respectively). The gastrin concentration at M3, although similar to pre-tx values, remained inadequately low for the reduced gastric acidity. The reduction in gastric acidity was marked during the daytime (0900-2200 h; P<0.01, d300 vs pre-tx and P=0.028, M3 vs pre-tx). However, while the stimulated postprandial gastric acid secretion was reduced at d300 (P<0.01, d300 vs pre-tx) and at M3 (n=7; P=0.027, M3 vs pre-tx), fasting and preprandial acidity was not affected. During the night, gastric acidity was reduced from 2200 to 0300 h, but the reduction was less marked than during the daytime. Paradoxically, the physiological intermittent late nocturnal reduction in acidity ('pH peaks' (0300-0800 h)) was abolished rather than enhanced. No patient acquired new Helicobacter pylori infection. The mean gastritis scores for antrum and body (n=8, Sidney classification) increased marginally from 1.7 to 1.9 (chronicity) and from 0.7 to 0.9 (atrophy), while the activity score was slightly reduced from 1.2 to 1.0. CONCLUSIONS: Three months of preoperative octreotide treatment profoundly and persistently altered gastric mucosal function (gastrin suppression, reduced acidity), but caused only minor variations in the pre-existing gastritis scores.

Endosonography of neuroendocrine tumors of the stomach, duodenum, and pancreas.

Neuroendocrine tumors (NETs) of the foregut type are frequently smaller than 2 cm in diameter and mainly located in the pancreas or the gastric and duodenal wall. Conventional cross-sectional imaging techniques, such as transabdominal ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) are limited by their inability to detect small tumors and especially those located within the gastrointestinal wall. Endoscopic ultrasonography (EUS) allows detailed visualization of the whole pancreas and almost all parts of the gastric and duodenal walls. Therefore, EUS is an important diagnostic tool for the preoperative localization of NETs of the foregut type. Several studies performed in a retrospective manner, as well as two studies performed in a prospective manner, indicate a clear superiority of EUS as compared to CT, US, MRI, and also angiography in detecting NETs of the foregut type. Somatostatin-receptor scintigraphy (SRS) also detects NETs of the foregut type in a very high percentage of cases, and the combination of EUS and SRS appears to increase the sensitivity even more. Thus EUS and also SRS should be employed early if NETs of the foregut type are suspected. Conventional imaging procedures such as US, CT, and MRI should be mainly used to exclude local and distant metastases.

Mechanism of bombesin-induced pancreatic secretion in unanesthetized rats.

It is unclear whether stimulation of pancreatic enzyme secretion by intravenously administered bombesin is a direct effect on acinar cells or is mediated by release of CCK; this distinction is important for defining the potential role of bombesin-like peptides as regulators of pancreatic secretion. The role of CCK in bombesin-induced pancreatic secretion was examined in rats using CCK radioimmunoassay and the CCK receptor antagonist L-364,718. A biphasic pancreatic response occurred to sequential doubling doses of bombesin (31 to 2000 pmol/kg/h, each for 30 min; n = 9 rats); amylase secretion increased to peak at 250 pmol/kg/h (11.5 +/- 1.7 kU/30 min; 4.2 +/- 0.6 kU/30 min, basal) and then declined to basal levels at 2000 pmol/kg/h. The ED50 dose of bombesin for stimulation was 31 pmol/kg/h, and the maximal response did not differ significantly from that to exogenous CCK-8 (10.6 +/- 1.5 kU/30 min) in the same rats. When single doses of bombesin were infused for 2 h (31, 62, 125, 250 pmol/kg/h; one dose per day; order randomized; n = 8), a similar dose-response relationship was seen, both for peak amylase response and cumulative output over basal. L-364,718 (0.5 mg/kg IV) had no effect on the pancreatic response to ED50 or maximal doses of bombesin. Neither dose of bombesin altered plasma CCK levels. In contrast, other stimulants of pancreatic secretion (food ingestion, soybean trypsin inhibitor) caused marked elevations in plasma CCK levels. These results indicate that the potent stimulation of pancreatic secretion by exogenous bombesin in rats is not mediated by CCK, similar to findings in humans.

Effects of potent bombesin antagonist on exocrine pancreatic secretion in rats.

Recent synthesis of specific, potent bombesin receptor antagonists allows examination of the role of bombesin-like peptides in physiological processes in vivo. We characterized effects of [D-Phe6]bombesin(6-13)-methyl-ester (BME) on pancreatic enzyme secretion stimulated by the C-terminal decapeptide of gastrin releasing peptide (GRP-10), food intake, and diversion of bile-pancreatic juice in rats. In isolated pancreatic acini, BME had no agonistic effects on amylase secretion but competitively inhibited responses to GRP-10, yielding a pA2 value of 8.89 +/- 0.19. In conscious rats with gastric, jugular vein, bile-pancreatic, and duodenal cannulas, basal enzyme secretion (bile-pancreatic juice recirculated) was not affected by the antagonist. Maximal amylase response to GRP-10 (0.5 nmol/kg/h) was inhibited dose dependently by BME, reaching 97% inhibition at a dose of 400 nmol/kg/h. The dose response curve of amylase secretion stimulated by GRP-10 was shifted to the right by 40 nmol/kg/h BME, but maximal amylase response was unaltered, suggesting competitive inhibition in vivo. Liquid food intake and bile-pancreatic juice diversion caused substantial increases in amylase secretion; neither response was altered during administration of 400 pmol/kg/h BME. These results demonstrate that BME is a potent, competitive antagonist of pancreatic responses to bombesin-like peptides in vitro and in vivo. Lack of effect of BME on basal pancreatic secretion or responses to liquid food intake or diversion of bile-pancreatic juice in rats suggests that endogenous bombesin-like peptides do not act either directly or indirectly to mediate these responses.

Dose-related involvement of CCK in bombesin-induced pancreatic growth.

We examined the role of CCK in bombesin-induced pancreatic growth in rats using the CCK receptor antagonist L-364,718. Rats (155 +/- 1 g, 8-10 per group) received subcutaneous injections every 8 h for 5 days with bombesin (0.6, 1.7 and 5 nmol/kg) or bombesin in combination with L-364,718 (1 mg/kg). After 5 days the pancreas was removed and pancreatic weight, protein content, DNA, amylase and chymotrypsin contents were determined. Bombesin produced a significant increase (48-475%) of pancreatic weight, tissue contents of protein, DNA, amylase and chymotrypsinogen (F = 82, P less than 0.001). When a large dose of bombesin (5 nmol/kg) was combined with L-364,718 a significant inhibition (up to 70%) of all tissue parameters was observed (P less than 0.001). L-364,718 did not affect the growth response to a small dose of bombesin (0.6 nmol/kg). Plasma CCK levels 15 min after a single injection of bombesin (0.6, 1.7 and 5 nmol/kg) were significantly increased in response to the 5 nmol/kg dose (2.0 +/- 0.7 to 3.4 +/- 0.8 pM, F = 6.9, P less than 0.01). No increases of CCK plasma levels were found in response to the 0.6 and 1.7 nmol/kg doses of bombesin, corresponding to the lack of effects of L-364,718 on growth parameters at these doses. Measuring the time-course of CCK plasma levels after a single injection of 5 nmol/kg bombesin revealed an increase from basal values of 1.4 +/- 0.3 pM to maximal levels of 3.5 +/- 0.5 pM after 15 min (F = 7.1, P less than 0.001). Values returned to basal after 60 min. These results suggest that low doses of bombesin act directly at the acinar cell or through release of non-CCK growth factors whereas high doses of bombesin act in part through CCK release.

Distinct receptors mediate gastrin-releasing peptide and neuromedin beta-induced delay of gastric of liquids in rats.

The present study was carried out to define which bombesin receptors are involved in the delay of gastric emptying induced by bombesin-like peptides. Adult male rats were fitted with gastric and jugular vein cannulas. Gastric emptying was determined 5 min after a 3-ml intragastric load of 0.9 M NaCl using phenol red as a marker. Mammalian bombesin-like peptides gastrin-releasing peptide-10 and neuromedin B both induced a delay of gastric emptying. When [Phe6]bombesin-(6-13)-methyl ester, a selective antagonist of the gastrin-releasing peptide-preferring subtype of bombesin receptors, was injected 5 min before the agonists, the effect of gastrin-releasing peptide-10 was competitively inhibited, whereas that of neuromedin B remained unaffected. Our results indicate that gastrin-releasing peptide-10 and neuromedin B delay gastric emptying by acting on distinct receptors in rats, in vivo.

Reduction of 24-hour gastric acidity by different dietary regimens: a randomized controlled study in healthy volunteers.

Evidence from animal experiments suggests that intraduodenal infusion of nutrients leads to an inhibition of gastric acid secretion via an enterogastric feedback mechanism. Detailed data are lacking, however, on the difference in circadian gastric acidity between gastric and intraduodenal alimentation in man. We conducted a randomized study in 10 healthy volunteers (5 men, 5 women, age 22-30 yr). From 8:00 am of the first study day until 4:00 pm of the next day, either a standardized normal meal or a liquid polymer diet (Fresubin) was given orally at 8:00 am, noon, and 6:00 pm. In a third experiment, a liquid hydrolysed diet (Survimed OPD) was continuously applied to the duodenum using a portable pump. Daily caloric intake and main nutrient components were comparable in all three diets. From 2:00 pm of the first day until 4:00 pm of the next day, an intragastric pH-metry was performed with a combined glass pH-electrode in the gastric corpus. Median pH-values from predefined time periods (whole day, prandial, interdigestive, nocturnal) were compared between the three groups. The orally applied liquid polymer diet led to a significantly stronger increase in 24-hr and prandial gastric pH than the normal diet. Twenty-four-hr, interdigestive, and nocturnal pH-median values were significantly higher during continuous intraduodenal application of the liquid hydrolysed diet than during the normal diet.

Subjective distress during continuous enteral alimentation: superiority of silicone rubber to polyurethane.

A small-bore feeding tube of silicone rubber was developed in order to improve the acceptance of enteral feeding. The insertion procedure was facilitated by providing a double guidewire which allows continuous adjustment of tip rigidity. The usefulness of this tube was tested in a short-term and a long-term volunteer study as well as in a prospective follow-up of patients receiving enteral nutrition. The volunteer study showed that the newly developed tube significantly reduced subjective distress (rank value 14) when compared to a conventional tube made of polyurethane (rank value 20). In the patient study, 131 silicone rubber tubes were used in 85 patients who received enteral nutrition for a total period of 2080 days and complained about foreign-body feeling and rhinorrhea in only 3.7% and 0.5% of the days, respectively. The rate of inadvertent removals was relatively low (32%), mainly due to restricted mental status of the patients.

[Neuroendocrine tumors of the stomach (gastric carcinoids) are on the rise: good prognosis with early detection]. / (Neuro-)Endokrine Tumoren des Magens sind auf dem Vormarsch: Gute Prognose bei frühem Nachweis.

Neuroendocrine tumors (NET) of the stomach are on the rise. In the United States they have increased about tenfold in the last 35 years. Prognosis has been much improved over the last three to four decades. Nowadays most of such NETs are diagnosed at an early stage. Quite often gastric NETs are found incidentally during a gastroscopy, performed for other reasons. Most of the asymptomatic, well differentiated gastric NETs are less than 2 cm in diameter. Conservative management and endoscopic surveillance is adequate for well differentiated, multifocal type 1 or type 2 gastric NETs (gastric carcinoids) of 10-20 mm , unless they are angio-invasive, have infiltrated into the muscularis propria or have metastasized. Endoscopic ultrasound is the method of choice to determine tumor size and depth of infiltration. Surgery is, however, indicated for all NETs larger than 20 mm. For optimal management tumor biology, type and stage of the neoplasm as well as the individual situation of the patient have to be taken into account. Most of the patients can be treated conservatively and be followed up with endoscopic surveillance.

[Tolerance of intraduodenal tube feeding. Prospective studies of the tolerance of a 10-day, continuous intraduodenal administration of a peptide diet and its effects on various serum parameters in healthy subjects]. / Die Verträglichkeit der intraduodenalen Sondenernährung. Eine prospektive Untersuchung zur Akzeptanz einer 10tägigen, kontinuierlichen, intraduodenalen Applikation einer Peptiddiät und ihrer Auswirkung auf einzelne Serumparameter bei gesunden Probanden.

Filiform nasoduodenal nutrition tubes in connection with portable infusion pumps are now available and by this way continuous enteral nutrition is given to a certain number of patients, thus avoiding expensive parenteral nutrition which demands a great deal of nursing care and bears a greater risk of complications. In order to study the acceptance and effects of this nutrition, 10 healthy persons were fed by the new system with a fiber-free, low molecular peptide diet. The probands had to write a daily protocol and, at the end of the test, had to answer a questionnaire regarding the effectivity and social consequences of the system and their subjective sensations. Before and after the enteral nutrition phase, different serum parameters were also determined. The results show that a continuous intraduodenal nutrition by tube can be achieved outside the clinic allowing to exercise the profession. The general well-being of the probands was moderately disturbed only by the tube whereas the other points from the questionnaire were less disturbing. Regarding the serum parameters only a reduction in the serum potassium was remarkable.

Growth effects of regulatory peptides on human pancreatic cancer lines PANC-1 and MIA PaCa-2.

Several studies have reported effects of gastrointestinal regulatory peptides on growth of experimentally induced pancreatic neoplasms and human cancer cell lines. The growth of human pancreatic cancer lines PANC-1 and MIA PaCa-2 was characterized in vitro, and the effects of cholecystokinin, bombesin, insulin, epidermal growth factor, secretin, vasoactive intestinal peptide, and somatostatin were determined. Fetal bovine serum was required for initiation of growth in both cell lines. Growth effects of peptides were determined by incubating cells with peptides in serum-free medium after a 72-h preincubation in 10% serum-supplemented medium alone. Epidermal growth factor (3.4 x 10(-9) M) and insulin (10(-6) M) significantly (p less than 0.001) increased growth of both cell lines as determined by increases in deoxyribonucleic acid and protein. Bombesin, secretin, vasoactive intestinal peptide, and somatostatin (all 10(-8) M) did not affect growth of either cell line. Neither cholecystokinin-8 nor [Thr4, Nle7] cholecystokinin-9 altered growth in concentrations from 10(-12)-10(-6) M. Anchorage-dependent clonogenic growth of both cell lines was also not altered by cholecystokinin-8. Cholecystokinin added to cultures was degraded by separate effects of serum and cells. Addition of cholecystokinin-8 to cultures every 8 h maintained cholecystokinin levels but did not alter cell growth. These data support roles for epidermal growth factor and insulin as growth factors for human pancreatic cancer cell lines.

High amount of dietary carbohydrate does not cause an adaptational increase of stimulated human pancreatic amylase secretion.

In order to investigate whether the human pancreas is capable of adapting to a diet with high-carbohydrate, low-fat, and normal protein content, 10 healthy volunteers were given a defined elemental diet (60% of calories as carbohydrates, 22% as fat, and 18% as protein) for 7 d. For the next 7 d they received an elemental diet with a further increased carbohydrate content (76% of calories) and a decreased fat content (10% of calories). A complete secretin-pancreozymin test was carried out at the end of the first wk and at d 14. The results show that an increase in dietary carbohydrate does not provoke an adaptational response of stimulated secretion rates of amylase, trypsin, and chymotrypsin in humans, as expected from animal experiments.

Lack of adaptive changes in human pancreatic amylase and lipase secretion in response to high-carbohydrate, low-fat diet applied by a 10-day continuous intraduodenal infusion.

In order to investigate whether the human exocrine pancreas is capable of adapting to a diet with a high-carbohydrate, low-fat, and normal protein content, 10 healthy subjects were given a continuous intraduodenal infusion of such a dietary composition (8760 kJ in 2400 ml/day) via a portable infusion pump over a period of 10 days. The diet consisted of 76% of calories as carbohydrates (80% oligosaccharides, 20% mono- and disaccharides), 10% as fat (more than 90% C18 fatty acids) and 14% as protein (oligo- and polypeptides; 11.8 g nitrogen per day). A complete pancreozymin-secretin test was carried out before and after the experimental period. The results show that the above dietary regimen leads to a significant (P less than 0.05) increase in the stimulated secretion rates of trypsin and chymotrypsin, whereas, in contrast to the findings in animal experiments, no change could be measured in the secretion rates of amylase and lipase.

Direct vs. indirect effects of bombesin on pancreatic growth.

Bombesin and its mammalian analogue gastrin-releasing peptide (GRP) have been reported to stimulate pancreatic growth. Whether this stimulatory effect is mediated through the release of regulatory peptides, in particular CCK, remains controversial. Since CCK is the most potent stimulant of pancreatic growth, it is a potential mediator of bombesin-induced pancreatic growth. On the other hand, there is evidence from in vitro studies, supporting a direct interaction of bombesin with receptors on acinar cells. A number of studies using potent and selective CCK antagonists have revealed controversial results. This may in part be due to considerable differences in their design and methods. The recent development of potent bombesin antagonists provides an important tool to further characterize the mechanism of bombesin-induced pancreatic growth and to determine the physiologic importance of bombesin.

[Endoscopic ultrasound of pathological mediastinal findings]. / Endoskopischer Ultraschall pathologischer Mediastinalbefunde.

INTRODUCTION: Mediastinal diseases are mostly diagnosed by CT and MRI. The applicability of ultrasound is limited by the surrounding air- and bone-containing thorax, which permits only restricted echo windows. Transesophageal endoscopic ultrasonography circumvents this problem and ensures visualization of parts of the mediastinum. PATIENTS AND METHODS: We report our results in 38 patients with pathological mediastinal findings who were examined by endoscopic ultrasound between 1988 and 1993. The diagnoses were established by imaging and/or histological procedures. RESULTS: The following mediastinal diseases were diagnosed in 38 patients: aberrant right subclavian artery (n = 3), right aortic arch (n = 1), aortic aneurysm (n = 6), cysts (n = 4), retrosternal struma (n = 3), mediastinal lymph node tuberculosis (n = 1), Hodgkin's/non-Hodgkin's lymphomas (n = 11), lymph node involvement in bronchogenic carcinoma (n = 8), mediastinal inflammatory fibrosarcoma (n = 1). Altogether, 37/38 pathological findings were demonstrated endosonographically. CONCLUSIONS: The results in this small group of patients with pathological mediastinal findings show that endoscopic ultrasound can give additional information to conventional imaging methods. A prospective comparative study is necessary to evaluate this procedure in comparison to the established imaging techniques.