[CT and ERCP as a combination research method in pancreatic diseases]. / CT und ERCP als Kombinationsuntersuchung bei Erkrankungen des Pankreas.

The value of combined CT and ERCP for studying the pancreas has been assessed in a retrospective study. CT and ERCP used singly provided a correct diagnosis in 74 and 63% respectively; the combination of these methods increased diagnostic accuracy to 86%. ERCP is employed after CT and is indicated if the pancreas appears normal, if there is suspicion of chronic pancreatitis or neoplasia, for elucidating focal masses or if there is obstructive jaundice, without its cause being visible on CT.

[CT and ERCP for the combined study of biliary tract diseases]. / CT und ERCP als Kombinationsuntersuchung bei Erkrankungen der Gallenwege.

The value of combined CT and ERCP for examining the bile ducts was studied retrospectively. CT on its own led to a correct diagnosis in 59% of cases. CT was valuable for estimating the calibre of the bile ducts, for localising the level of obstruction, for demonstrating calcified biliary concrements, and for showing peribiliary tumours. ERCP yielded a correct diagnosis in 67% of cases. The value of ERCP lies in the demonstration of poorly calcified and small concrements, strictures, tumours with ductal infiltration, and for investigating the post-cholecystectomy syndrome. Combining these two types of examination increases diagnostic accuracy to 82%.

[Experiences with endoscopic placed endoprosthesis in stenosing malignancies of the esophagus and cardia]. / Erfahrungen mit endoskopisch plazierten Endoprothesen bei stenosierenden Malignomen von Oesophagus und Kardia.

Seventy-five patients with obstructing esophagogastric malignancies were palliatively treated by fiberendoscopic insertion of prosthetic tubes. The indications for endoscopic intubation are discussed, the procedure is described. The mortality rate was 6.6%. Complications were obstructions due to food impaction (10), tumor overgrowth (5) or mucosa folds (3), reflux and aspiration (7), dislocation of the prosthesis (5), perforation (1) and desintegration of the tube (1). Normal swallowing was restored in 98% and in general, there was a marked improvement in the quality of life. In summary, we conclude palliative fiberendoscopic intubation as the best existing procedure in patients with an incurable obstructing esophagogastric neoplasm.

Simple gastroscopy technique in the rat.

We present a simple method for gastroscopy in the anesthetized rat using an implanted gastric cannula, a standard rigid arthroscope, and a newly designed valve system. The method allows high-quality endoscopy and photo documentation, large-size biopsies, electrocoagulation and fluid collection. Repeated gastroscopy in the same animal is easy and well tolerated.

Severe pseudomembranous and ulcerative colitis during gold therapy.

A case of severe pseudomembranous and ulcerative colitis is described in a 58-year-old patient with rheumatoid arthritis receiving sodium aurothiomalate. Watery diarrhea occurred after the fourth injection (total amount 130 mg). Several months elapsed prior to full recovery after discontinuation of gold administration.

Comparison of gastrointestinal loss of alpha-1-antitrypsin and chromium-51-albumin in Ménétrier's disease and the influence of ranitidine.

In a 37-year-old patient with Ménétrier's disease, 51Cr-albumin and alpha 1-antitrypsin (alpha 1-AT) output was measured simultaneously in gastric juice and feces. While the 51Cr-albumin studies demonstrated a threefold increase in gastrointestinal protein loss, alpha 1-AT was found in normal quantities in gastric juice and feces. The histamine H2 antagonist, ranitidine, led to a marked reduction in gastric protein loss, as evidenced by decreased 51Cr activity in the stomach. Studies of protein loss in the gastric juice during pentagastrin stimulation (6 micrograms/kg/h) showed that the 51Cr-albumin output paralleled the volume secreted, whereas alpha 1-AT decreased with lower pH values, not being detectable below pH 3. This probably results from peptic degradation of alpha 1-AT at low pH. We conclude that fecal alpha 1-AT determination cannot be used for the assessment of protein-losing gastropathy in patients who are not achlorhydric.

[Stomach cancer. Spontaneous course, therapy and prognosis]. / Das Magenkarzinom. Spontanverlauf, Behandlung und Prognose.

The incidence of gastric cancer in Switzerland has decreased remarkable in the last fifty years and now constitutes 4% of all newly diagnosed neoplasms. Nutrition plays an important role in the pathogenesis of this tumor. The pathology, natural history and the staging of stomach cancer are reviewed, with special emphasis on early gastric cancer. Radiological and gastroscopic diagnosis is correct in almost all cases. Surgery remains as it was 100 years ago when Billroth performed the first gastrectomy, the only curative treatment. In the last few years combination chemotherapy for gastric cancer has been markedly improved, and with modern cytostatic regimens objective tumor responses are achieved in one third to half of patients. The value of adjuvant chemotherapy in radically resected patients remains to be proven. The poor prognosis of gastric cancer can be improved by early diagnosis, better understanding of the pathogenesis of this tumor, elimination of carcinogens from our food and incorporation of effective systemic treatment in the primary treatment plan for stomach cancer.

Effect of immunization against angiotensin II on blood pressure and on plasma aldosterone in the rabbit.

1. Rabbits were actively immunized aganist angiotensin II (AII). 2. Basal plasma aldosterone concentration was 0-058 plus or minus 0-027 pmol/ml (20-7 plus or minus 9-6 pg/ml) (mean plus or minus SD) in immunized and 0-056 plus or minus 0-021 pmol/ml (20-2 plus or minus 7-5 pe. When the endogenous formation of AII was stimulated by frusemide, by haemorrhage or by feeding with low sodium diet, a significant increase of plasma aldosterone was observed with no difference between immunized and non-immunized animals. 3. In non-immune rabbits, the average mean arterial blood pressure rose 13 mmgHg during the infusion of AII (5 pmol min--1 kg-1) and 27 mmHg during the infusion of 50 pmol min-1 kg-1. In contrast, there was no clear increase in blood pressure in the immunized animals. The blood pressure rose in immune animals (15 mmHg) and in non-immune animals (36 mmHg) during the infusion of 200 pmol min-1 kg-1 ALL. Plasma aldosterone rose in all animals in response to each of the three infusions with no significant difference between the two groups. 4. It is concluded that the immunization against ALL blocked only the pressor effect of the peptide but had no clear influence on the response of plasma aldosterone to increased ALL. Differences between the affinities of the adrenal and vascular AII receptors may explain these findings.