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A gastrinoma was found in 12 of 23 patients with Zollinger-Ellison syndrome. Those with gastrinoma were not different from those without as regarded fasting gastrin level, increased gastrin secretion after secretin and calcium, acid secretion, or survival time. Five of the 23 patients have died, four immediately postoperatively, the fifth of the metastasizing tumour. Treatment with the H2-receptor antagonist cimetidine avoided emergency operation and thus decreased operative mortality, giving time for localization by ultrasound, computed tomography and selective arteriography. The rate of false-negative results was high. Transhepatic selective catheterization of the pancreatic veins with gastrin determination gives localization of the tumour and identification of the secreted hormone. In three patients tumour resection was possible under cover of H2-receptor antagonist administration which normalized gastrin and acid secretion. There is a change in the treatment of the Zollinger-Ellison syndrome, away from total gastrectomy to conservative treatment with H2-receptor antagonists and an attempt of curative treatment by removal of the tumour.

The signs of congenital erythropoietic porphyria (Günther) had their onset at the age of two in a male patient born in 1934: there were blisters and scars after exposure to sunlight, red urine, marked cutaneous pigmentation, acral mutilation, lanugo and erythrodontia. Porphyrin levels in red blood cells and urine confirmed the diagnosis. Splenectomy was performed in 1966 for hypersplenism and haemolysis. No transfusion has been necessary since and the haemolysis has completely disappeared, but signs of ineffective erythropoiesis have continued. Cholecystectomy with choledochal revision was performed because of right upper abdominal colics, fever and biliary stasis in 1977: five partly pigmented, partly mixed gall-stones were removed. The latter had a black, friable centre with high porphyrin content and a cholesterol coating. Thus, as in other chronic haemolyses, pigmented gall-stones may also occur in congenital erythropoetic porphyria.

In all affected members of a family with Gardner's syndrome the complete triad of skin tumours, osteomas and polyps of the colon has developed since 1968 when examination revealed an apparently bisymptomatic variant of Gardner's syndrome. In this family bony changes consisting of circumscript osteomas, diffuse sclerosing zones within certain bones, and ridge-like widening of the corticalis were noted, having developed during puberty but remaining constant thereafter. Similarly, no significant new skin tumours appeared after puberty. Most colonic polyps however, occurred in adolescence or thereafter, with malignant transformation after a variable interval of several years. The necessity of long-term observation of the colon, also in patients presenting with a bi- or monosymptomatic form, is stressed. Coloscopy has proven to be more useful diagnostically than radiological methods.

Impairment of social function was measured by questionnaire in 270 patients with Crohn's disease. In about half of them, the disease had had its onset below the age of 20 years. In 10%, schooling or job training was delayed or even had to be abandoned. Ten percent of the patients were forced to change their occupation because of the disease. 23.5% of the patients stated that their illness had prevented them from having whole-day jobs. Ten percent had temporary or permanent pensions; 3.8% were unemployed. 43.7% of patients stated that the relation to their family and (or) partner was impaired by the disease; in 36.4% the disease had interfered with leisure time activities. The results show that Crohn's disease has social effects which in the individual case can be very serious; they correlate with the duration and severity of the disease. Nonetheless, the majority of patients succeeds in mastering their chosen training and occupation and leading an active life.

A 73-year-old woman with a history of chronic hypochondria, depression and abdominal symptoms, such as colics, flatulence and changing fecal consistency, was diagnosed as having an "irritable colon" syndrome and "hypochondria". Over a period of ten years she had been taking regularly various psychoactive drugs, especially diazepins and amitryptiline. Three years ago she began to have wave-like movements of the abdominal wall, interpreted as intestinal hyperperistalsis with chronic subileus. Radiological and endoscopic examinations were normal, but wave-like contractions of the abdominal musculature were demonstrated on electromyography. The most likely cause is the chronic abuse of psychoactive drugs over many years. In case of abdominal symptoms attention should be paid to the abdominal wall, not only the gastrointestinal tract.