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In 383 patients, suffering from Crohn's disease, ileum was studied both endoscopically and histologically. In patients without surgical interventions (n = 207), endoscopic lesions were observed in 69%, histologic lesions in 74%. Most numerous endoscopic lesions were redness (51%), vulnerability (29%) and ulcer (27%), most frequent histologic lesions discontinuous infiltration (30%) and ulcer (30%). In patients, operated on, endoscopic and histologic lesions were found more often in the ileal region, near to anastomosis than in the more proximal ileum. Overall, the endoscopic and histologic appearance of the distal segment of the ileum widely corresponded to that of the terminal ileum in patients without surgery. Several endoscopic parameters were correlated to histologic variables, but overall the correlation was low (maximal correlation coefficient 0.34). Granulomas were present in 7.4% of the biopsies and 9.1% of the patients. The occurrence was significantly correlated to the endoscopic variables cobblestone appearance and ulcer as well as to the histologic variables density of infiltration, ulcer, and activity of inflammation. In conservatively treated patients, the incidence of mucosal vulnerability, and cobblestone appearance significantly declined in long standing disease, the incidence of stenosis increased. In patients operated on, aphthous lesions and ulcers increased in longstanding disease.

The study was performed in 64 post mortem ductograms of pancreata, missing any inflammatory and/or neoplastic alterations in extensive histological investigations by whole organ sections. The pancreatic duct was measured in the radiograms. From these measured values and by mean of a computer program of a cubic spline function the straightened pancreatic ducts were plotted. The number, the length and the amplitude of ductal deviations were measured in these plots. Luminal dilatations were found in all organs, ranging from 0.5 mm to 6 mm and more. Their frequency was significantly lowered in young people (11-30 years).

A ductographical and histological study was carried out in 70 human pancreata postmortem. The diameter, the thickness and the length of the major pancreatic duct were measured. The obtained data were evaluated statistically. The autopsy revealed in 7 cases an acute or a mild chronic pancreatitis, in 20 cases a disease of the bile duct system, in 4 both an acute pancreatitis and a bile duct disease, while the other patients showed no inflammatory or neoplastic diseases of the pancreas or the bile ducts. The relative wall thickness of the duct increases with growing distance from the papilla, while the real thickness of the wall decreases. The inner and outer diameter of the duct steadily rises with aging. The relative thickness decreases with aging, but in a considerable less degree. The length of the duct growths with aging. All these relations were expressed in mathematical equations. In acute pancreatitis, in mild chronic pancreatitis and in disease of the bile duct system no statistically significant differences of the outer and inner diameter, of the length and the relatative thickness of the wall were found in comparison to normal pancreata.

The incidence of cholelithiasis and rate of cholecystectomy has been studied in three differently selected groups: first, in 3842 autopsies during the years 1969-1977, second, in 6564 patients who underwent to x-ray examination during 1970-1974 for various reasons; third in 163 patients aged over 50 years referred for reasons other than abdominal discomfort. The incidence of dyspeptic symptoms was registered in the patients of the last group. The rate of cholelithiasis and cholecystectomy in the first group corresponds well to that in the second group. In men and women over 60 years, who had been referred to the outpatients clinic for reasons not related to abdominal pain, the rate of cholelithiasis was 33% and 42% respectively. This finding corresponds to that of the first and second group. There was no difference in the incidence of dyspeptic symptoms among the patients of the last group with and without cholelithiasis. The results suggests that in the old patients the incidence of silent gallstones increases, but that the rate of cholecystectomy did not.

The report is the first on intestinal pseudoobstruction in german literature. The most impressive clinical signs and symptoms in our case were uncharacteristic abdominal discomfort, flatulence, and relapsing diarrhoe over a period of two decades. Finally we observed periods of inappetence, occasional vomiting a few hours after food intake and kachexia developing in 8 months. A localized dilatation of the duodenum and upper jejunum associated with complete atonia was found by laparatomy. The dilated segment of the intestine was largely resected. An impressive decrease in the thickness of the muscularis propria with splitting of muscle fibres and intact neural plexus was found by histology. After treatment with antibiotics it came to a satisfying restitution of the patient. The hitherto very rare clinical syndrome of localized dilatation of intestine with severe disturbance of motility and the published cases of the world literature are discussed.

12% of the rectal biopsies (19% of the patients) showed epitheloid cell granulomas in clinically definite Crohn's disease. In colonic biopsies such granulomata were visible in 14% (22% of the patients). Granulomata were scarcely seen in normal or slightly inflamed mucosa. They were mostly found together with crypt abscesses and/or erosions and ulcers. The combination of local inflammation around crypts and crypt abscesses is rather characteristic for Crohn's disease. The inflammatory colonic alterations, visible in crohon's disease, may have the following pathogenetic sequence: Local colitis-crypt abscess--destruction of the crypt with proliferation of enlarged histiocytes--transformation histiocytes to epitheloid cells and Langhans cells--epitheloid cell granuloma.