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To better understand the putative association between insulin and atherosclerosis many experimental studies have explored the metabolic effects of insulin upon the arterial intima-media (which is essentially made up of smooth muscle cells). This tissue appears to be insulin-sensitive in vivo but not in vitro, suggesting that the actions of insulin on arterial metabolism are probably indirect. Yet, cultured arterial smooth muscle cells do increase their anabolism when physiological concentrations of insulin (10-250 microU/ml) are added to the medium. To account for these discrepancies we have proposed a haemodynamic explanation : hydrostatic forces present in vivo but absent in vitro, would be necessary for insulin to reach the cells of the media and act upon them. We demonstrated such an effect using an isolated rat aorta perfused under variable pressure. But only highly unphysiological concentrations of insulin (0.1 mU/ml) could stimulate the metabolism of intima-media significantly. The insulin-sensitivity of the target tissue for atherosclerosis remains an enigma. We speculate that the variable phenotype of arterial smooth muscle cells (either contractile or synthetic) might be an interesting clue to this problem.

In patients with arteriosclerosis obliterans of the lower limbs immediate (operative risk) and long term prognosis depend on the diffusion of the atheroma to other arterial beds (coronary and carotid). Basic investigations were completed by doppler ultrasonography of the cervical arteries, exercise electrocardiogram and lateral aortogram. Doppler ultrasonography revealed significant degrees of stenosis of the cervical arteries in 67 out of 402 patients (16.6 p. 100). The stenosis were totally latent clinically in 13 patients. Valid results were obtained in 72 p. 100 of 140 after an exercise electrocardiogram. It was positive in 19 p. 100 of patients without clinical or electric sign of coronary heart disease. Lateral aortogram in 125 patients showed atheromatous lesions in 39 cases (31 p.cent). These were often multiple and involved the coeliac and superior mesenteric arteries in 13 cases. These investigations are of great importance in making the therapeutic decision, indications related with risk and resulting priorities. Alarming coronary or carotid lesions may indeed require treatment before arterial disease of the lower limbs.

Capillary abnormalities were found by electron microscopy in labial salivary gland biopsies obtained from 20 patients with progressive systemic sclerosis (PSS). They consisted of marked thickening and multilayering of basal lamina, degenerative and adaptative endothelial cell changes, alterations of pericytes and perivascular mononuclear cell infiltration. There was no correlationship between the intensity of the capillary abnormalities and the duration of the disease. In 12 patients with Raynaud's disease (RD) such changes were not found. Thus capillaries displayed normal-looking ultrastructural appearances. Mean capillary basal lamina width was consistently thicker in the PSS group than in the RD group (p less than 0.001). These observations are consistent with the hypothesis that the primary event in PSS occurs in the microvessels. It is suggested that labial salivary gland biopsy may be helpful for early recognition of PSS among subjects with Raynaud's syndrome.

A polarographic electrode was used for non-invasive transcutaneous measurement of partial oxygen pressure (PO2, oxygen tension) in healthy subjects (controls) and in patients with arteritis. The mean oxygen tension value on the dorsum of the foot in controls (n = 32) was 67.9 +/- 8.1 mmHg; individual values were inversely correlated with age and were distributed along a gaussian curve; mean differences on repeated measurements were 4 mmHg at 3 hours and 7.3 mmHg at 24 hours, which is extremely good. Patients with arteritis (n = 43) had a mean oxygen tension value of 41.5 +/- 20.7 mmHg; after adjustment for age the difference was significant (p less than 0.001). Oxygen tension values in patients with intermittent claudication were not different from those found in controls, but they were lower in patients with gangrene and with pain on decubitus. In the diagnosis of cutaneous ischaemia, the sensitivity of the test was 96%, its specificity 82%, its positive predictive value 79%, its negative predictive value 96% and its reliability 89%. These results suggest that the method will be increasingly used in vascular pathology.

The authors report six new cases of necrosis of the fingers occurring during the course of a malignant condition. None of the patient was suffering from any other disease which could explain the digital necrosis. They discuss the mechanism of the relationship between the two conditions : blood hyperviscosity, thrombocytosis, polycythaemia, cryoglobulin and the production of immune complexes. The particular role of bleomycin is mentioned. The possibility of a true paraneoplastic syndrome is suggested.

To assess the relationship between a nailfold scleroderma pattern and histopathological data, we compared the results of nailfold capillaroscopy with capillary basement membrane width of labial salivary glands in 25 patients with either a Raynaud's disease (RD: 12 patients) or a progressive systemic sclerosis (PSS: 13 patients). The sensitivity of a capillaroscopic scleroderma pattern for capillary basement membrane thickness is of 75%. These results confirm the usefulness of in vivo capillary examination for the early diagnosis of PSS.

Changes in blood coagulation following the action of intermittent treatment with streptokinase are studied : 1) Fibrinogenemia remains at a concentration slightly higher than that obtained after the first 16 hour perfusion. 2) The thrombin time becomes considerably longer on the first day, then becomes shorter and remains slightly long throughout treatment. The theoretical interest of the rise in plasminogen levels during interruption of perfusions of streptokinase is discussed.

The authors report the results of a study of 3 565 consecutive patients over 30 years of age, of French nationality living in the Paris region, hospitalised over a 5 year period in a Department of internal medicine and vascular pathology. The incidence of gastroduodenal ulcer was compared in each sex in 10 year age groups in 764 patients with arterial disease and 2 801 patients without arterial disease. The incidence of ulcers was higher in patients with occlusive arterial disease in men in the 50 to 59 year age group (20,4 p. 100 compared to 9 p. 100, p less than 0,01), and in the 60 to 69 year age group (20,3 p. 100 compared to 9,8 p. 100, p less than 0,001), and after 70 years of age in females (12,8 p. 100 compared to 4 p. 100, p less than 0,01). The overall incidence in all patients with arterial disease (16,7 p. 100 of all 591 males, and 12,1 p. 100 of all females) was higher than in a corresponding control group (9,7 p. 100, p less than 0,0001, and 4,8 p. 100, p less than 0,001 respectively). These results only concern chronic ulcers. There was no difference in the incidence of acute ulcers.

This paper describes a case of disseminated gonococcal infection, a rare disease in France. A 41 year-old woman was hospitalised with acute polyarthritis and characteristics skin lesions. Jaundice and liver function abnormalities are difficult to interpret due to a preexisting alcoholic cirrhosis. The possibility of an endocarditis is raised because of a systolic murmur heard at the base of the heart. Bacteriological identification of N. Gonorrhoeae is carried out in blood culture; it has also been recovered by scrapings of a cutaneous bullae by staining only. Therapy was instituted by daily intravenous penicillin G sodium 50 000 000 u. and intramuscular gentamicin 160 mg for 45 days. There resulted good clinical and bacteriological response. The elements of clinical and bacteriological diagnosis, as well as the therapy are discussed.

Nailfold capillary microscopy patterns in 22 patients with mixed connective tissue disease (MCTD) were compared with those of 21 patients with systemic lupus erythematosus (SLE) and 30 patients with systemic sclerosis (scleroderma [SD]). Microvascular data were classified blindly as follows: normal, nonspecific abnormalities, SD pattern, and SLE pattern, with special attention to the presence of dystrophic, branched "bushy" capillary formations. Of the 22 patients with MCTD, 63.6% had an SD pattern, 22.7% had an SLE pattern, 13.6% had nonspecific abnormalities, and 72.7% had bushy capillary formations. Compared with SLE microangiopathy, MCTD microangiopathy exhibited significantly greater capillary loss (P less than 0.05), more frequent SD patterns (P less than 0.001), and more frequent bushy capillaries (P less than 0.001). Compared with SD patients, MCTD patients displayed less frequent SD patterns (P less than 0.02) and more frequent bushy capillary formations (P less than 0.01). The presence of bushy capillaries was suggestive of MCTD. For diagnostic purposes, bushy capillaries displayed 72% sensitivity, 80% specificity, and 87.2% negative predictive value. The quantitative and qualitative expressions of microangiopathy were different in MCTD and SLE, respectively. This supports the hypothesis that each disease is a distinct entity. Nevertheless, there were many resemblances between MCTD and SD, which implies that MCTD is possibly a clinical form of SD.

We have studied the effect of insulin upon the accumulation of glucose carbon into the intima-media and the adventitia of rat aorta following in vitro exposure by adding insulin to the incubation medium, and in vivo exposure by producing relative hyperinsulinemia during life and subsequently incubating excised tissue in a medium containing no insulin. Hyperinsulinemia in vivo was either (1) endogenous--following 1.5-2 hr of refeeding after a 48-hr fast--or (2) exogenous--following an i.v. injection of insulin. For adventitia, a significant stimulation was found after both in vitro (+ 53%, p < 0.001) and in vivo exposure to insulin (+ 96%, p < 0.01 with endogenous insulin; + 75%, p < 0.05 with a dosage of 2 U/kg of exogenous insulin). For intima-media, the stimulation was weak and insignificant after in vitro exposure (+ 11%, p > 0.30), but became important and significant after in vivo exposure to insulin (+ 100%, p < 0.001 with endogenous insulin; + 50%, p < 0.05 with a dosage of 0.5 U/kg and + 49%, p < 0.05 with a dosage of 2 U/kg of exogenous insulin). For the in vivo exposure experiments, we found a significant linear correlation (r = 0.611, p < 0.005) between plasma insulin concentrations and glucose carbon accumulations into intima-medias of control and refed rats. These results establish the insulin sensitivity of the adventitia and show a sensitivity of intima-media only to in vivo insulin exposure. These different behaviors of intima-media in vivo and in vitro may have a hemodynamic basis.

When added in vitro, insulin exerts little or no effect on the metabolism of arterial media. However, indirect evidence suggests that an in vivo exposure of arterial tissue to insulin stimulates its metabolism. To evaluate the possibility that hemodynamic forces existing only in vivo may account for this difference, we studied the effect of brief (9-minute) exposures to insulin of isolated rat thoracic aorta perfused in situ at low (34 mm Hg = 4.6 kPa) and high (70 mm Hg = 9.4 kPa) static pressures. After perfusion, incorporation of glucose-derived 14C into CO2 and lipids, and production of lactate by incubated aortic tissue, were measured. At low perfusion pressure, insulin did not affect the metabolism of the media but strongly stimulated all aspects of the glucose metabolism of the adventitia. At high pressure, insulin again stimulated the adventitia but now also significantly stimulated (+66%) the synthesis of glucose-derived lipids by the media; production of CO2 and lactate by the media did not increase significantly. These results indicate that insulin directly stimulates at least one pathway of glucose metabolism by the media; and that hemodynamic forces are an important factor in determining the response of aortic media to insulin.

The action of trimethylcolchicinic acid on the synthesis and excretion of proteoglycans has been studied on the L cell strain. The incorporation of precursors has been measured, and proteoglycans produced in the culture medium have been extracted and their concentration determined. The mucopolysaccharide components have been studied by electrophoresis. Control cultures produce hyaluronic acid, dermatan sulfate and very low concentrations of chondroitin 4-sulphate or 6-sulphate. Cultures treated with trimethycolchicinic acid (4 mu g/ml) produce hyaluronic acid, very high concentrations of chondroitin 4-sulphate or 6-sulphate and only traces of dermatan sulphate. So, trimethylcolchicinic acid does not modify the synthesis of hyaluronic acid: it considerably increases the production of chondroitin 4-sulphate or 6-sulphate and inhibits the production of dermatan sulphate. Protein fraction of the proteoglycans is proportionally increased in treated cultures, but there is no marked difference between amino acid concentrations of proteoglycans extracted from control and treated cultures. A slight fall in the cystine concentrations was the only change in the amino acid content of proteoglycans extracted from treated cultures. A hypothesis to explain these results is discussed.

The results of nailfold capillary microscopy were compared in 107 lumberers who had been using a chain saw for more than 3 years and 115 manual workers who had never used vibrating tools. The prevalence of Raynaud's phenomenon was 61.7% in lumberers and 5.2% in the control group. The mean time of exposure to risk before the condition developed was 7.86 years. The syndrome was usually mild, but the patients had an abnormally high incidence of accidents at work, including wounds and cut off fingers. The number of capillary loops was significantly reduced. The lumberers affected showed an abnormal spasm of the digital artery in response to cold; the predictive value of this test was 88%. It is suggested that nailfold capillary microscopy should be systematically used in industrial medicine for monitoring workers using a vibrating tool.

Arterial lesions are thought to be rare in neurofibromatosis. In the case reported here full vascular exploration demonstrated diffuse lesions of the aorta, splenic artery, renal arteries, left internal carotid artery, right common iliac artery and arteries of the legs. This underlines the usefulness of thorough angiographic exploration when arterioplasty is envisaged in a patient with neurofibromatosis. Microscopic examination of an arterial biopsy specimen showed fibrodysplasia of the media associated with hyperplasia of the periarterial nerves, thus confirming that the lesions involved tissues of both mesodermal and neuroectodermal origins.

Chromosome studies were performed on 54 apparently healthy relatives of 29 scleroderma patients and on 40 controls. Increased chromosomal breakage is observed in 86 per cent of brothers and sisters and in 68 per cent of children of patients. If the findings in relatives are compared to those obtained in the 29 scleroderma patients of these families, the percentage of abnormal cells does not differ significantly between the two groups (25.8 per cent and 29.1 per cent respectively), and there is no difference for the frequencies of gaps and open breaks. However acentric fragments, "minutes" and morphologically abnormal chromosomes are significantly increased in patients as compared to their asymptomatic relatives with increased breakage. The distribution of breaks is found to be random. The presence of structural chromosome aberrations in relatives of scleroderma patients may have a special importance with regard to the concept of familial autoimmune disease.

The authors report the case of a 10-year-old child with a cutaneous lesion of the thigh present since birth and made up of small translucid raised areas grouped in clumps. The association with these pseudo-vesicles of erysipelatous exacerbations 3 or 4 times a year and the discharge of clear fluid indicative of lymphorrhoea led to a clinical diagnosis of complicated cutaneous lymphangioma. CT scan of the thigh showed absence of spread to deeper layers. This case serves as a basis for discussion of the pathogenic hypothesis of Whimster suggesting that the superficial vesicles are connected to larger lymphatic chambers in the subcutaneous tissue and that the course depends upon pressure variations within these chambers. If this were the case, surgical excision of these lymphatic chambers would be a logical alternative to symptomatic medical treatment of inflammatory episodes.

Lipids, apolipoproteins A1 and B and lipoproteins were studied in 49 patients with peripheral arterial disease and in 26 control patients. The observed hypertriglyceridemia was related to the elevation of the VLDL lipid mass; no alteration in their structure could be shown. The origin of this VLDL excess was discussed especially the role of tobacco and genetic.

To assess the value of nailfold capillary microscopy (N.C.M.) for measuring finger systolic pressure (F.S.P.), 25 patients were studied by N.C.M. and plethysmography. Twelve of them presented Raynaud's phenomenon. The results revealed that N.C.M. can be correlated with plethysmography for measuring F.S.P. Therefore, N.C.M. with F.S.P. measurement is a practical, inexpensive method, and provides an additional microvascular diagnostic evaluation.

Persistence of the primitive axial limb artery is an uncommon developemental anomaly. This artery is called sciatic in account of its connections with the nerve. Usually gluteal aneurysms develop and the anomaly is disclosed by a complication : pain, pulsatile buttock mass, thrombosis or release of emboli. Prophylactic surgical repair of such aneurysms seems reasonable.

The blood pressure of 106 men who had undergone amputation of one limb on account of war injury was compared with that of 184 male controls of the same ages. All subjects with a diastolic pressure above 90 mmHg were excluded from the study. The diastolic pressure was statistically equivalent in both groups, but the amputees had a significantly higher systolic pressure. Changes in the visco-elastic properties of the arterial system related to amputation might be responsible for this rise in systolic pressure.

Two patients are presented as new cases of secondary syphilitic hepatitis. The closely resemble descriptions in the literature with the same clinical and laboratory "profile" and the same course spectaculary influenced by anti-syphilitic penicillin therapy. The presence of treponemes in the liver, which would definitely confirm the diagnosis, was not demonstrated. This is a particularly important diagnosis, which should not be missed since it leads to treatment of fundamental importance to the patient's future.

Hemodynamic parameters and systemic arterial compliance were measured in patients with arteriosclerosis obliterans of the lower limbs before and after acute administration of propranolol. Arterial compliance was evaluated from a simple viscoelastic model, enabling the calculation of diastolic drainage and diastolic blood flow as indices of the reservoir role of the larger arteries in overall circulation. In comparing basal conditions with normal subjects of the same age, patients with arteriosclerosis obliterans exhibited a significant decrease in arterial compliance (p less than 0.01) and heart rate (p less than 0.02) with a significant increase in systolic pressure (p less than 0.001). Diastolic drainage was increased (p less than 0.01) and was positively correlated with diastolic time (r = 0.73, p less than 0.001). Diastolic blood flow remained within normal ranges (52 +/- 2 vs 49 +/- 3 ml/m2/sec). After acute propranolol intravenous administration, heart rate and stroke volume decreased (p less than 0.001), while total peripheral resistance increased (p less than 0.001). Systemic arterial compliance and diastolic blood flow significantly decreased (p less than 0.01). The study provided evidence that in patients with arteriosclerosis obliterans, the diastolic blood flow was maintained in basal conditions despite the observed reduction in arterial compliance, and that intravenous propranolol administration decreased systemic arterial compliance and diastolic blood flow.

A case of severe limb ischaemia predominating in the legs in a young female drug addict is reported. Arteriography revealed diffuse spasm of all arteries of the lower limbs associated with localised spasm along the profunda artery in particular. These appearances regressed on control angiography performed 10 days later. The treatment which associated volume expanders and intravenous vasodilatation agents (magnesium sulphate) led to rapid improvement in the clinical condition in 3 days. There were no long-term complications. The causative role of LSD was suggested by the history of greatly increased intake in the period before the onset of symptoms. LSD is a derivative of lysergic acid, the common nucleus of the derivative of the ergot of rye. Analysis of a sample dose taken by the patient showed a very large quantity of LSD and of lysergic acid and a very small amount of other ergot alkaloids known for their peripheral vasoconstrictor effects. The circumstances following peripheral ischaemia are discussed; the association of haschich - LSD does not seem to be a factor. The increased doses and a predisposed vascular system, in common with ergot containing drugs, seem to be the major factors.

The authors study the biological variations which accompany an oral, thrombolytic treatment in which urokinase and lysyl-plasminogen are combined. Fibrinogen, the products of degradation of fibrinogen or fibrin, plasminogen and rapid alpha 2 antiplasmin are studied as a function of time. Two dimensional electrophoreses were carried out at precisely determined times. The combination of the two therapeutic agents causes the appearance of plasmin in the circulation, but it is neutralised by its rapid inhibitor. This therapeutic protocol entails moderate circulating fibrinolysis and may easily be monitored by determination of the circulating fibrinogen.

The case of an 18 year old Algerian girl with acrocyanosis of the four extremities since childhood and presenting a with 6 months history of oedema of the left hand resulting in severe functional handicap, is reported. Clinically, the oedema suggested a lymphatic origin. However, its localised, strictly unilateral distribution, the normality of vascular investigations, the absence of pain and regression of the oedema during the period of hospitalisation suggested autoaggression. The discovery of tourniquet marks on the skin of the thigh confirmed the diagnosis of Charcot's blue oedema. The patient has a hysterical personality, was of higher than normal intelligence but immature, and could only express herself through her functional handicap, a cry for affection in a rigid family environment only concerned by her scholastic achievements. To our knowledge, there have been 27 other reports of this condition since Charcot's first description in 1890. The majority concerned young intelligent women. Diagnosis is difficult and can only be confirmed by the finding of tourniquet marks on the skin. Psychotherapy is often useful as an underlying neurotic or psychotic personality is commonly found.

Takayasu's disease is a syndrome of inflammatory arteritis involving the aorta and its branches due to varying etiologies. The diagnosis is usually made after clinical, radiological and biological investigations, but the pathognomonic sign of the disease is inflammatory sclerosis of the adventitial media. There appear to be five prognostic factors: hypertension, arterial aneurysm, aortic regurgitation, coronary insufficiency, and retinopathy.

The electrophoretic mobility of several forms of antithrombin III in an agarose gel has been compared with the mobility in a gel containing heparin. When a serum was studied, three different compounds were observed. The inactige antithrombin III with higher molecular size, separated by gel filtration, was found to be homogenous even if there was heparin in the gel. A purified antithrombin III, prepared by affinity chromatography, contained an immunoreactive material of higher molecular size which has no activity and a higher mobility in agarose gel. When heparin is incorporated in the agarose plate, the electrophoretic mobility of this polymerized antithrombin III is not modified.

We studied the glucose oxidation to CO2 and the incorporation of glucose into lipids by thoracic aorta from streptozotocin-diabetic rats in two circumstances: 9 minutes exposure of the isolated aorta to insulin, perfused in situ; and one-week treatment with either low--4 units (U)--or high--12 U--daily doses of insulin. Diabetes inhibited the glucose metabolism of media and adventitia. Perfusion with insulin did not influence the depressed metabolism of media but increased that of adventitia. Four units insulin treatment normalized the synthesis of glucose-derived lipids by the media, whereas 12-U treatment brought it to levels significantly higher (+23%) than those found in nondiabetic rats. We conclude that: (a) a haemodynamic explanation cannot account for the in vitro insulin resistance of media found in diabetes; (b) insulin treatment exerts a dose-dependent lipogenic effect upon the media, which might favour an atherogenic role for therapeutic hyperinsulinaemia in insulin-dependent diabetics.

A study of salivary immunoglobulins revealed the presence of IgM in 11 out of 17 patients suffering from progressive systemic sclerosis. The presence of IgM was frequently accompanied by an increase in IgA and less often by IgG. Immunofluorescence examination of labial biopsies showed comparable modifications in the immunocyte populations; the presence of IgM cells, sometimes in large numbers, and an increase in IgA and IgG cells. All patients with a nodular lymphoplasmocyte infiltration of the minor salivary gland of the lip have salivary IgM. The presence of IgM in the saliva is a diagnostic criteria of Sjögren's syndrome. The absence of a correlation between immunoglobulin concentrations in the saliva and the serum and correlation between the salivary IgM concentration and the number of IgM immunocytes, demonstrate that the presence of IgM is related to the glandular synthesis of this enzyme.

Hemodynamic parameters were measured in 24 patients with arteriosclerosis obliterans of the lower limbs (AOLL) in comparison with 16 normal subjects of same age. Systemic artérial compliance was estimated from a simple visco-elastic model. In patients with (AOLL), systolic pressure was significantly increased (P less than 0.001) while diastolic pressure remained within normal ranges. Arterial compliance was reduced (P less than 0.01) and was negatively correlated with systolic pressure (r = - 0.72). Intravenous administration of nitroglycerin significantly decreased systolic pressure (P less than 0.05) and increased arterial compliance (P less than 0.01) without any change in mean arterial pressure. The study provided evidence that, in patients with AOLL the reduced systemic arterial compliance contributes in the increase in systolic pressure largely.

The finger systolic pressure of 25 healthy subjects and 23 hypertensives was studied by plethysmography at 30 degrees, 15 degrees and 10 degrees centigrade. The hypertensive group was given equipotent doses of either Metoprolol or Propranolol in accordance with a double-blind cross-over protocol including a washout period. The fall in systolic pressure between the brachial artery in the upper arm and the digital artery was significantly increased in the hypertensive group as compared to healthy controls; the rise persisted under hot and hyperemic conditions and remained constant during both betablocker treatments. In the hypertensive group digital arterial tone increased under cold conditions before any treatment; this abnormality did not vary under Metoprolol but intensified significantly under Propranolol. Finger plethysmography made it possible to show and quantify the peripheral vascular repercussions of hypertension on the digital artery and evaluate the changes induced by treatments. It also helps to clarify the physiopathology of certain side effects caused by betablockers and might to some extent help in the choice and the survey of treatment and in the subsequent follow-up.

Biopsies of the lips were performed on 27 patients (7 male and 20 female; mean age, 58 years) with diffuse scleroderma and on 10 healthy subjects serving as controls. The degree of intralobular sclerosis in labial salivary glands was measured on tissue sections by an automated morphometric analysis technique. Collagenous compared with controls. It was independent from the type of cell infiltrating the gland and from the evolution potential of the disease, but it correlated with its duration and seemed to be specific to scleroderma.

The esophagus was examined radiologically and endoscopically in 33 patients with generalized scleroderma. 13 patients complained of difficulties which suggested implication of the esophagus, scleroderma was found in the esophagus in 26. Radiological demarcation of location of the scleroderma required investigation of the esophageal peristalsis. Endoscopic examination permits an equally reliable assessment through the identification of characteristic signs: the lack of peristaltic contractions in the lower half of the esophagus, and the persistence of water in the esophagus for more than 30 seconds after injection of a few milliliters in the recumbent patient. Further, a peptic esophagitis can often be recognised endoscopically when it is not detectable radiologically (10 cases) and in cases of peptic stenosis (4 patients) exact location of the lesion is possible.