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36 patients (18 males and 18 females, mean age 51 [21-76] years) were prepared for colonoscopy with acupuncture (points: Hegu, Neiguan, Zusanli and Gongsun bilaterally), without acupuncture or pretend acupuncture at points not expected to bring about pain relief. In the 12 acupuncture patients mean pain sensitivity, estimated during the examination by means of a visual analog scale, was significantly (P = 0.003) lower (1.4 +/- 0.4) than in the groups without acupuncture (n = 12; 2.7 +/- 0.3) or pretend acupuncture (n = 12; 3.0 +/- 0.3). In addition, analgesics and sedatives needed to be given significantly less to those with acupuncture (one patient each; P = 0.005) than those without (analgesics to five, sedatives to eight patients) or with pretend acupuncture (analgesics to four, sedatives to five patients). These data demonstrate that pain connected with colonoscopy can be reduced by preceding acupuncture.

Serial biopsies were taken over four to five years from 15 healthy hepatitis-Bs antigen-positive persons with normal biochemical findings ("healthy carriers"). The antigen persisted throughout, but the histological picture did not worsen in any way: there was certainly no sign of chronic progressive liver disease.

Somatostatin (200 mug/h) was administered to five healthy volunteers after submaximal stimulation of exocrine pancreatic secretion with 0.33 KU secretin or cholecystokinin-pancreozymin, given intravenously. In all instances there was a significant reduction in duodenal secretory volume after secretin, without any change in HCO3- concentration. Stimulation of enzyme secretion by cholecystokinin-pancreozymin was significantly inhibited and gallbladder contraction abolished.

The effect of somatostatin on pentagastrin-induced gastric-acid secretion was measured in three healthy volunteers and four patients with duodenal ulcer. Somatostatin (100, 200 and 400 mug/h) inhibited secretory volume and acid concentration simulated by pentagastrin infusion (2 mug/kg - h), the effect being dose-dependent. In the patients with duodenal ulcer somatostatin given as a bolus (50 mug) and by subsequent infusion (150 mug/h) reduced maximal acid output after subcutaneous injection of 2.0 mug/kg pentagastrin by 68-96%.

Intra-abdominal adhesions as the cause of severe abdominal pain were diagnosed in eight patients because (1) other abdominal diseases had been excluded, (2) certain movements, but only rarely meals, precipitated or increased the pain, (3) laparoscopy had confirmed adhesions and their manipulation had caused pain. After the adhesions had been removed at laparoscopy the pain either disappeared or was decisively reduced.

Intragastric instillation of coffee, decaffeinated coffee and pure caffeine in humans significantly stimulated gastric secretion. After intragastric caffeine, basal serum gastrin concentrations were not changed. However after instillation of coffee and decaffeinated coffee serum gastrin increased significantly. Thus acid secretion was significantly greater after coffee and decaffeinated coffee than after caffeine. Roasted products seem to be responsible for the gastrin-releasing effect of coffee.

Results of percutaneous transhepatic cholangiography (PTC) with the Chiba needle were compared with those obtained by endoscopic retrograde cholangiopancreatography (ERCP). PTC was used in 102 cases, most often after ERCP had been inconclusive or had failed. Overall success rate of PTC was 79%. Contrast medium could be injected in only 66% of cases with normal-sized bile passages, but in 98% of those with enlarged passages. The most frequent side effect was temporary pain in the right upper abdominal quadrant. One patient had transitory severe peritoneal irritation with shock. Emergency operation was never required. PTC is technically simpler, takes less time and causes less stress to the patient, but it is less informative than ERCP. If, therefore, both methods are mastered technically, ERCP should be employed first. If it fails to provide the diagnosis, PTC can be performed at once. Biliojejunal anastomoses and pancreatic pseudocysts are absolute indications for the primary use of PTC to investigate the cause of biliary stasis. On the other hand, allergies to iodine or contrast medium and disorders of coagulation are absolute indications for ERCP.

In an open, randomised cross-over trial nine patients with severe exocrine pancreatic insufficiency and considerable steatorrhea (greater than 25 g fecal fat excretion daily) received for five days, after a treatment-free period of three days, two new acid-protected enzyme preparations: Kreon, three times six capsules daily, pellets of 1-2 mm diameter; Panzytrat 20.000, three times three capsules daily, microtablets of 2 mm diameter. Both preparations significantly decreased fecal weight and fecal fat excretion. With equivalent lipase dosage there was no difference in effect between the two preparations.

Three cases of factitious (self-induced) hypoglycaemia, brought about by regular intake of sulphonylurea preparations, seen in the span of three years are reported. The clinical picture was similar to that caused by an insulinoma. One patient was a 31-year-old male nurse, another a 17-year-old girl whose mother was a diabetic, the third a 60-year-old female diabetic. The correct diagnosis of factitious hypoglycemia was made only after demonstrating glibenclamide in serum and urine. Factitious hypoglycemia can be differentiated from fasting hypoglycemia caused by hyperinsulinaemia by a lowered C-peptide level after injection of insulin. When sulphonylurea preparations are taken, the only way of distinguishing factitious hypoglycemia from insulinoma is by determining the drug in serum and urine. The cases reported in the literature are almost all in medical personnel, diabetics or members of their family.

For three months a 17-year-old boy had been suffering from laryngitis, pharyngitis and conjunctivitis, weight loss, nocturnal sweating and signs of changing cranial-nerve involvement (dizziness, nausea, nystagmus). The diagnosis of recurrent polychondritis was made only when, in addition to a definite inspiratory stridor there also developed a painful swelling of the left ear cartilage and a saddle nose due to loss of the cartilaginous portion of the nasal skeleton. Histological examination of the inflamed ear cartilage confirmed the diagnosis. After treatment with prednisone (100 mg daily, gradually reduced to 25 mg) and azathioprine (100 mg daily, increased to 150 mg after three weeks), there was clinical improvement, but the airway resistance (R = 6.2 cm H2O.s/l) rose further, requiring tracheostoma twelve months after onset of symptoms.

Studies were undertaken in 40 patients with chronic pancreatitis six months to seven and a half years (mean 25 months) after operation, results being compared with pre-operative findings. Measurements included: exercise capacity, absence of pain, body weight, endocrine (36) and exocrine (25) pancreatic function. Almost all patients returned to full or only slightly impaired activity, were free of pain or had less pain and weight increase. Exocrine pancreatic function (secretin-pancreozymin test and faecal fat) was noted in 11 of 25 patients. In another 11 pre-operative progression was arrested. But endocrine function improved in only three of 36 and worsened in 13 (manifestation of subclinical diabetes in eight, worse glucose tolerance in five). The results justify a more active surgical approach in the treatment of chronic pancreatitis in order to save the patients from an often long and painful "burning out" of the disease on purely conservative treatment. Furthermore, exocrine pancreatic function, at least, is maintained or improved.

Over the last seven years self-inflicted diarrhoea was diagnosed in seven patients with chronic diarrhoea which was deliberately induced by the secret intake of laxatives. Six of the patients were female, four of them in paramedical occupations. All also had loss of weight and hypokalaemia between 2.1 and 2.9 mmol/l. All had accepted extensive and interventional procedures during a mean of five hospital admissions, with minimal pathological findings and no aetiological diagnosis. They had undergone numerous therapeutic measures, in one instance even several operations and parenteral feedings. Making the correct diagnosis was decisively impeded and delayed by the patients' seeming cooperativeness. In four patients the diagnosis was finally made by demonstrating laxatives in the urine, in two others by finding hidden tablets in the room, in one by demonstrating melanosis of the colon. A factitious cause of chronic diarrhoea should be excluded if no other cause can be established.