Initial experience with the new electronic endoscope

With the introduction of an electronic sensor attached to the tip of a flexible endoscope, which functions in the manner of a television camera, new dimensions have been opened up for endoscopy. First reports on the clinical application of this new method have been presented at congresses held recently. We, too, were given the opportunity of trying out the prototype of an electronic colonoscope in four patients. This is a brief report of our findings.

Serum concentrations of metronidazole and its main metabolite in patients with active Crohn's disease: correlation with disease activity and therapeutic efficacy?

Serum concentrations of metronidazole and its main metabolite [1-(2-hydroxyethyl)-2-hydroxymethyl-5-nitroimidazole] have been determined by high performance liquid chromatography in sera of 10 patients with histologically confirmed ileocolitis Crohn, 7 presenting with highly active disease and pathologically increased Crohn's disease activity index (CDAI) and 3 with secreting fistulas but normal CDAI. Metronidazole serum concentrations showed dose-dependent peak characteristics and ranged between 10.62 +/- 0.95 and 24.88 +/- 3.63 micrograms/ml for a metronidazole intake of 1,000 mg/day and between 5.04 +/- 1.13 and 9.21 +/- 1.00 micrograms/ml for a daily intake of 400 mg, whereas its metabolite leveled at constant serum concentrations up to 24 h after onset of therapy, with 7.50 +/- 1.40 micrograms/ml for a metronidazole intake of 1,000 mg/day and 3.20 +/- 0.60 microgram/ml for an intake of 400 mg/day. Considering the known minimum inhibitory concentration of metronidazole for anaerobic bacteria involved in Crohn's disease, this work has shown 400 mg metronidazole to be the minimum daily dosage. Correlation analysis, although limited by the small number of patients investigated so far, indicated a possible positive correlation between metronidazole serum concentrations and disease activity (CDAI, r = 0.480) and therapeutic efficacy (delta CDAI, r = 0.430) in Crohn's disease.

[Interdisciplinary diagnosis of choledochus cysts]

Cystic dilatations of the biliary tract are rare anomalies. In the individual case, diagnosis may pose great problems. The relevance of the various methods was assessed in eight patients investigated with different diagnostic methods. In all patients the predominant symptom was uncharacteristic upper abdominal complaints. Two patients showed intermittent jaundice. Among non-invasive methods sonography is preeminent and permits precise demonstration of intra- and extrahepatic biliary duct dilatations. It can be complemented by CAT-scanning. Whereas intravenous cholegraphy does not permit sufficient ascertainment of the diagnosis, ERCP and PTC allow precise demonstration of the anomaly. Functional hepatobiliary scanning is indicated where endoscopic methods are not available. Among the eight patients sonography was decisively relevant in five cases and ERCP in all cases. The remaining functional assessments furnished important additional informations.

Morphology of the pancreatic ductal epithelium after traumatization of the papilla of Vater or endoscopic retrograde pancreatography with various contrast media in cats

The epithelium of the pancreatic duct in cats was examined histologically, in the scanning electron and in the transmission electron microscope, after traumatization of the papilla of Vater or after pancreatography (ERP) with various contrast media. Ten minutes after traumatizing the papilla by repeated cannulation, we found lesions of the surface membrane of the epithelial cells. After ERP with the contrast media metrizamide and sodium meglumine ioxaglate, in the acute experiments, the least damage was observed when the low-osmolar, non-ionic metrizamide was used. In our chronic experiments the epithelial changes did not correlate with the contrast medium used. The degree of papillary stenoses and, probably, the initial injection pressure are more important. A mixture of the antiseptic polyvinyl pyrrolidone iodine to the contrast medium, which would prevent a bacterial contamination of the pancreatic duct after ERP, is morphologically justifiable but entails a risk of latent hyperthyroidism. Parenchymography with this mixture damaged the epithelium more than pancreatography.

Mechanical lithotripsy through the intact papilla of vater

The indications for endoscopic papillotomy are clearly defined. When only the normal risk presents, our working group favours an age limit of 50 years, below which the papilla should, as far as possible, be preserved. In the present case report, a possibility is described for effecting an endoscopic extraction of bile duct concrements through a completely intact papilla. It is thus apparent that, in certain cases, mechanical lithotripsy can also be employed to smash ductal stones through the intact papilla.

On the ultrastructure of the gastric "borderline lesion"

The "borderline lesion" of the stomach (severe dysplasia of the protruded type) is nowadays considered to be a true precancerous lesion. Histologically, this lesion is characterized by a proliferation in the area of the glandular neck, combined with severe cellular atypia. Investigation by means of transmission electron microscopy reveals the structure of these cells to be very similar to the structure of cells of an intestinal-cell-type carcinoma of the stomach. In addition to signs for a loss of differentiation of the cells, such as the absence of rough-surfaced endoplasmatic reticulum, mucin granules, and of the polarity of the cells, remarkably frequently luminal bulges and "blebs" developed to various extents can be detected. Morphometric analysis is delineating the tendency of structural features of the borderline lesion to develop toward the gastric cancer cell. These irregularities might be expressions of the beginning of expansive growth and signs pointing to differentiation into malignant neoplasia.

[Mechanical destruction of common bile duct calculi]

After endoscopic papillotomy freedom from stone in the choledochal duct can be achieved in about 90% of cases. Either there is a spontaneous passage of concrements or they can be extracted with a basket. But in 10% the stones are so large or are so disproportionate to the size of the distal choledochal duct, that they cannot be removed by conventional means. Mechanical lithotripsy is an easy and simply learned alternative to electro-hydraulic lithotripsy or intraductal gall-stone dissolution for non-surgical removal of large concrements. So far the method has been successful in 18 of 20 patients. Average size of the bile-duct concrements was 27.3 mm with a mean distal choledochal diameter of 10.4 mm. In four patients the stone fragments were passed spontaneously, in 14 they were removed either with the lithotripter itself or the basket. Mechanical lithotripsy is thus an important addition to the non-surgical treatment of gall-stones.

The importance of ERCP for the surgical tactic in haemorrhagic necrotizing pancreatitis (preliminary report)

In patients with haemorrhagic necrotizing pancreatitis who are scheduled for surgery, we have been carrying out a preoperative retrograde investigation of the pancreatic duct system for the past 3 months. The results in, to date, ten patients, all of whom survived their severe illness, revealed four different morphological findings of importance for the surgical tactic. 1. A normal pancreatic duct system with no signs of fistulae: only peripancreatic necrosectomy is required. 2. Contrast medium leaks via a ductal fistula: left resection, including the removal of the fistulous area, must be done. 3. Normal duct system with complete segmental parenchymal staining, representing total necrosis in this region: left resection of the pancreas. 4. Duodenoscopically demonstrable perforation into the duodenum of a necrotic cavity in the head of the pancreas: conservative management only, no surgery, since this lesions, resulting in drainage of the necrotic cavity into the bowel, permits self-healing, while the site of the perforation within the necrotic wall cannot be dealt with by surgery. The experience gained so far indicates that the surgical tactic can be determined with greater selectivity by the use of ERCP.

[Gastrointestinal manifestation of malignant systemic diseases]

Malignant diseases of the lymphoreticular system can become manifest within the gastrointestinal tract, either isolated, involving solitary organs, in generalized form, or as diffuse polyposis. The ratio of primary to secondary lymphomas is quoted as being 1:2 to 1:3. The clinical picture is characterized by their spread. Abdominal pain, loss of weight, anorexia, nausea and vomiting, including even gastrointestinal hemorrhage, are the most frequently observed symptoms. The involvement of the gastrointestinal tract in Hodgkin's and non-Hodgkin lymphomas of, on average, some 10%, is confirmed in our own material over the past 7 years. From a total of 580 malignant lymphomas, 47 cases were confirmed, endoscopically and bioptically, to have gastrointestinal involvement, primary lymphomas accounting for 1/3, secondary for 2/3. Gastric lymphomas accounted for 59.6%, small-bowel lymphomas for 25.5%, a large-bowel involvement was seen in 14.9%. The centrocytic-centroblastic and lymphoblastic lymphomas predominate.

Endoscopic-radiological findings in metastatic obstructive jaundice

Metastatic obstructive jaundice usually results from an occlusion of the common hepatic or bile duct. More rarely, the underlying cause is a disseminated intrahepatic infiltration that has led to the occlusion of the bile canaliculi. The endoscopic-radiological examination techniques usually permit a reliable differentiation between neoplasms originating primarily in the biliary tract, and ductal occlusions caused by metastatic disease. In addition to this, both ERC and PTC permit the placement of an internal or external biliary drain during one and the same procedure. ERC represents a highly suitable method for the follow-up monitoring or documentation of the therapeutic effect of biliary drainage, radiotherapy and/or polychemotherapy. With the aid of regular follow-up examinations, recurrent disease can be detected early on, and appropriately treated.

DNA flow cytometric measurements in inflammatory and malignant human gastric lesions

102 gastroscopically taken biopsy specimens which were normal (n = 28) or showed superficial gastritis (n = 18), chronic atrophic gastritis (n = 18), gastric ulcers (n = 19) and gastric carcinomas (n = 19) were submitted to FCM analysis. Carcinomatous specimens were readily recognized by either ploidy abnormality or significantly raised S- and G2 + M values. Intestinal-type and diffuse carcinomas could not be distinguished by proliferation kinetics, however, diffuse carcinomas showed a higher rate of aneuploidy. Chronic atrophic gastritis and gastric ulcers, though significantly differing from both normal tissue and superficial gastritis, exhibited similar proliferation characteristics. In gastric ulcers, an S-phase proportion of more than 12% was correlated with histological detection of cellular atypias and a proliferative tendency.

[Clinical aspects, diagnosis and therapy of acrodermatitis enteropathica]

Acrodermatitis enteropathica is a very rare disease, usually occurring during child age, but also in grown-ups. Symptoms are skin lesions localized periorally and acrally, alopecia, diarrhea and psychic alterations. The disease is caused by zinc deficiency due to malabsorption. The diagnosis can be established by decreased plasma levels of zinc; typical changes of the Paneth cells may be demonstrated by electron microscopy. Substitution by supplying zinc will lead to complete clinical healing.

Clinical application of a new mechanical lithotripter for smashing common bile duct stones

After endoscopic papillotomy, the extraction of large stones is often very difficult. In numerous cases, it proves impossible to remove large concretions using conventional methods. On account of technical problems, electro-hydraulic lithotripsy was unable to fulfill all the hopes placed in it. A possible alternative method is that of mechanical lithotripsy. Initial clinical experience gained in 8 patients with large stones in the common bile duct, has shown that, with the aid of the technically simple procedure, it is possible to extract such large concretions, too.

Experimental evidence for an "internal leak" of cat gastric mucosa after stimulation with histamine and carbachol

Numerous factors are involved in the pathogenesis of gastric ulcer. Possibilities under discussion are acid back diffusion, a reduction in the quality of the gastric mucus, and vascular factors that give rise to local ischemia. One hypothetical model presented for consideration, is based on the notion of an "internal leak", as a result of which acid escapes out of the parietal cells directly into the interstitium. Using the cationic dye acridine orange in cats, it has been possible to show, in particular after prior stimulation with stimulation with histamine and carbachol, but not with pentagastrin, that a microfocal accumulation of the dye in the interstitium can indeed be found. Under conditions of hypoxia, this phenomenon was not observed. In view of the specific properties of the dye, it may be concluded that, under certain conditions, acid substances can indeed diffuse out of the parietal cells into the interstitium. this animal model offers distinct findings compatible with the pathogenetic concept of an "internal leak".

[Treatment of chronic constipation with swelling substances]

In 20 patients with chronic constipation and, in many cases, years of laxative abuse, in a prospective and randomized study, treatment with new, specially prepared swelling substances administered at the recommended doses, was carried out after first stopping the use of laxatives. After only one week of this treatment, a marked increase in the weight of the stools, and a reduction in stool transit time (p less than 0.05 in each case) were observed.

Splenic abscess-clinical symptoms and diagnostic possibilities

A 71-yr-old female patient was admitted for investigation of a massive leukocytosis and loss of weight. Physical examination revealed a reduction in the respiratory excursion of the left lung, a left pleural friction rub located ventrobasally and tension of the upper abdominal wall. Additional diagnostic procedure excluded extrasplenic disease. Ultrasound-guided puncture demonstrated the presence of pus in the splenic bed, and splenic abscess was diagnosed. Subsequent surgery confirmed this diagnosis. Histological findings revealed extensive splenic infarction. Since bacteriological investigation revealed the identical pathogens in the pus obtained with the puncture needle, in the intraoperative swab and in the midstream urine, the splenic abscess was most likely caused by hematogenous spread of a urinary tract infection into the splenic infarction. The postoperative course was uneventful, and the patient was discharged on the 11th postoperative day, free of symptoms. The clinical picture, radiological diagnosis, origin, therapy and course of splenic abscess are discussed with reference to the literature.

[Treatment of Crohn's disease with metronidazole (author's transl)]

The therapeutic effect of metronidazole, alone or in combination with the basic treatment schedule of corticosteroids, salazosulphapyridine or dietary formula was analysed retrospectively for 34 patients with active Crohn's disease who had previously been treated without success on the basic schedule. Clinical remission was achieved in all ten patients with highly florid Crohn's disease but no fistulae, regardless of whether metronidazole was given alone or in combination with the basic treatment regimen. Complete closure of the fistulae was achieved in 12 or 24 patients with fistulae, while marked regression of fistulae secretion occurred in a further five. It is concluded that metronidazole is of value particularly in cases resistant to basic treatment or with fistulae.

[Chronic pancreatitis and the neighboring organs]

The close topographic relationship between pancreas and the functional entity of the upper abdominal organs causes in about 20 percent of the patients with chronic pancreatitis alterations of the surroundings. In 531 patients compression of the common bile duct was found in 18.1%, duodenal stenosis in 17.7%, pleural thickening in 6.6%, splenic vein thrombosis in 5.1%, gastric outlet obstruction in 3.2% and colonic stenosis in 0.4%. In primary asymptomatic chronic pancreatitis these local complications may be the first hint to pancreatic disorders. Occasionally these changes demand operative interventions or alleviate the decision for resectional therapy.

[The ultrastructure of intestinal amyloidosis]

Amyloidosis nearly always goes along with manifestations of the gastrointestinal tract. It can mimic a variety of different clinical syndromes. Pathogenetically amyloidosis leads to an organ insufficiency due to local infiltration of amyloid or to replacement of tissue with amyloid fibrils. Characteristic ultrastructure is composed of an irregular network of fibrils without any periodicity. The topographic position gives an explanation for the intestinal symptoms. Involvement of the intramural nerve system is responsible for motility disorders like diarrhoea or constipation. In case of perivasal infiltration hemorrhage and inflammatory changes can be found, as well as malabsorption syndromes, when subepithelial amyloid layers are present. Electron microscopy therefore may contribute to the pathogenetic understanding of morphological findings in regard to clinical symptoms.

[Early diagnosis of primary biliary cirrhosis (author's transl)]

Electron microscopic investigations of liver biopsy specimens in 16 patients with a clinically suspected diagnosis of chronic obstructive non-purulent cholangitis as the early stage of primary biliary cirrhosis showed characteristic changes of the intrahepatic biliary canaliculi. These consist of a coarsening and reduction of microvilli, thickening of pericanalicular ectoplasm and intercellular gaps as well as increasing obliteration of the canalicular lumen. Typical primary biliary cirrhosis developed in 6 patients over an observation period of 3 years. The ultrastructural findings may contribute towards identification of morphogenesis of this disease. They are possibly pathognomonic for the early stage of the disease. However, the precipitating factor remains unknown.

Tuberculosis of the pancreas

In a case report, the rate condition of tuberculosis of the pancreas is described. There are two conceivable ways in which the pancreas may become diseased: 1. toxic-allergic reaction of the pancreas in response to generalized tuberculosis (so-called concomitant pancreatis) 2. Invasion of the pancreas by tubercle bacteria disseminated via the blood, or through penetration of the organ by adjacent caseating abdominal lymph nodes. Histologically, epithelioid cells and Langhans' giant cells are only rarely found; caseation usually develops, with subsequent calcification, which can lead to stenosis of the pancreatic duct. In patients with generalized tuberculosis and abdominal complaints, the diagnosis is most reliably established on the basis of ERCP and CAT. In the presence of pain, resection of the affected portion of the pancreas may be considered as means of treatment.

Long-term follow-up after endoscopic sphincterotomy

Endoscopic sphincterotomy has become a well-accepted procedure in choledocholithiasis and papillary stenosis. Long-term follow-up data covering an observation period of 7 years disclose that about 90% of the patients are either completely relieved of symptoms, or show marked improvement. Re-stenosis or recurrent concrements seem are events; in primary papillary stenosis, however, long-term results are less favorable.

Non-surgical biliary drainage - technique, indications and results

Nonsurgical biliary drainage offers a therapeutic alternative in the palliation of malignant obstructive jaundice. Two basic approaches are available. The percutaneous transhepatic method can be employed either for external drainage or for the placement of an internal endoprosthesis. In the case of the transduodenal, transpapillary approach, either a pigtail catheter can be placed, after prior papillotomy, or - with or without the need to split the papillar - a nasobiliary drainage tube can be introduced. Successful drainage was achieved in 67 patients. In the majority of cases, external drainage was performed as a palliative measure in inoperable carcinoma of the biliodigestive system. In addition, however, pre-operative temporary drainage was also carried out to reduce the risks of surgery in patients with severe obstructive jaundice. The complication rate was low. Apart from biliary peritonitis, cholangitis and minor bleeds were observed. The rate of failure for technical reasons was a relatively low 10%.

Mucosal suggillation in the colon in secondary amyloidosis

Amyloidosis of the gastrointestinal tract can mimic a variety of different conditions. The symptoms and findings depend upon the localization and extent of the amyloid deposits. This report concerns a 53-year-old female patient with secondary amyloidosis in the presence of a plasmocytoma, in whom, at endoscopy, petechial mucosal suggillation were observed in the distal colon. The cause of the mucosal petechiae were probably vascular changes induced by deposits of amyloid.

[Effects of uric acid on the B cell in the isolated perfused rat pancreas (author's transl)]

Methylxanthines, such as caffeine and theophylline, show effects increasing the secretion of insulin. Perfusion experiments were intended to find out whether insulin secretion is influenced by uric acid, which is chemically closely related. Besides, it was to be demonstrated that uric acid causes no damages to islet cell structures for it is well established that alloxan, which is chemically related to uric acid, produces necroses in B cells. Isolated rat pancreata were stimulated by glucose at concentrations of 100 mg/100 ml and 300 mg/100 ml. In part of the experiments uric acid was added to the perfusion medium at a concentration of 12 mg/100 ml. We found that uric acid has no influence on insulin secretion if it is stimulated by glucose at a concentration of 100 mg/100 ml. However, if B cells are stimulated by glucose at a concentration of 300 mg/100 ml insulin secretion is enhanced by the addition of uric acid by more than 100%. This indicates that this substance exhibits a glucose-potentiating effect. The characteristic dynamics of insulin secretion demonstrate together with light- and electron-microscopic investigations that uric acid causes a real additional secretion and no leaking of intracellular insulin as a result of destruction of islet cell structures by an effect of uric acid similar to that of alloxan.

The "Internal Leak" as a possible cause in the pathogenesis of peptic ulcer

In cat gastric mucosa stimulated with histamine and damaged by direct application of acetylsalicylic acid, the fluorescent dye acridine orange may be found outside the parietal cell. Normally it is distributed throughout, or bound to the limiting membrane of, the vesicles in the parietal cell. The special properties of this cationic dye in an acid environment, support the hypothesis that a so-called "internal leak" may possibly play an important role in the pathogenesis of peptic ulcer.

[Amyloidosis of the intestinal tract (author's transl)]

Amyloidosis may afflict different organs of the body and thus cause a variety of clinical symptoms. Amyloidosis of the gastro-intestinal tract can mimic several gastric and intestinal disorders, as for instance disturbances of motility, vascular processes and tumors. The amyloid infiltrates the tissue affected, replaces it and thus cause insufficient organ function. The disease usually progresses slowly, in some cases however, acutely life threatening situations may occur. Biopsy of the rectal mucosa will allow to establish the diagnosis; generalized amyloidosis was present in about 80% of the cases analysed. A medical management has to be done.

[Internist therapy of cholelithiasis]

Medical treatment of gallstones as an alternative to cholecystectomy has been established in recent years. Considering certain conditions--i.e. radiolucent cholesterol gallstones, functioning gallbladder, stone size, patients' cooperation--it is possible in up to 70% to dissolve gallstones completely or partially, using a therapeutic regimen of chenodeoxycholic or ursodeoxycholic acid at a dosage of 10 mg or 15 mg/kg body weight respectively. Side effects as diarrhoea or slight increase of serum transaminase levels are harmless and occur only with chenodeoxycholic acid. Therapeutic success may be controlled either by ultrasound or by cholecystography. Recurrence rate after dissolution is about 20%. Stones of the common bile duct can be treated easily by endoscopic papillotomy (EPT). In many cases the stone has to be removed with a basket; however, it may pass spontaneously. Certain indications for this procedure are obligatory. In the first place there is the patient over 50 years of age with the gallbladder already removed.

[In-vitro experiments to study the role of contrast medium in pancreatitis due to ERCP (author's transl)]

The causes of hyperamylasaemia or pancreatitis, occasionally observed after the endoscopic retrograde cholangio-pancreatographie (ERCP), have been unequivocally identified as pressure, volume and the duration of contrast medium instillation. In a completely pressure free experimental model involving the perifusion of lobes of the pancreas of guinea pigs, a study has now been carried out to investigate the extent to which, in addition to these known causes, the contrast medium itself contributes to the development of enzymatic disorders. It was found that, merely as a result of stimulation through Ceruletid (Takus), the secretion of amylase was increased by more than 400%. Following the addition of 50% contrast medium to the perifusion medium, however, amylase secretion was completely suppressed. The electron-microscopic examination of the perifused pancreatic cells revealed that the contrast medium had a synthesis-enhancing effect on the production of zymogen granules in the cells of the acini, but that, however, throughout the duration of contrast medium perifusion, the extrusion of granules was suppressed. Only after the contrast medium had been washed out, an excessive secretion of amylase was observed. The findings show that, in addition to the increase of intraductal pressure, the contrast medium itself may also be possible causal factor in the development of hyperamylasaemia or pancreatitis.

Synopsis of endoscopic and other morphological findings in intestinal lymphangiectasia

Intestinal lymphangiectasia may present as a primary congenital disorder as well as a secondary form due to numerous underlying diseases. Endoscopically, whitish swollen tips of the villi are fairly characteristic; histologically, dilatation of the lymphatics can be demonstrated. By means of electron microscopy dilated intercellular spaces with aggregation of protein precipitations as well as ectatic lymph vessels with abnormal structure are found. Possible relations to the pathomechanism are discussed.

[Differentiated therapy in Crohn's disease]

Causal therapy of Crohn's disease up to now cannot be achieved due to the unknown etiology. However, randomized multicenter cooperative trials have demonstrated that adrenocorticoids and sulfasalazine are the most efficient basic therapeutics. In the acute attack additional supportive measures like hyperalimentation, transfusions or substitution of vitamins may become necessary. In contrast to former times a maintenance treatment is no longer justified. About 60% of all patients with Crohn's disease have to be operated because of complications of their disease. The knowledge of absolute and relative indications for surgery in Crohn's disease facilitates the decision. Therapy in Crohn's disease has to be differentiated in relation to severity of the disease and disease location.

Treatment of choledocholithiasis using the transpapillary perfusion technique

In 5 patients with common bile duct stones a dissolution therapy with the octanoate mixture Capmul 8210 was performed using the transpapillary perfusion technique. In 3 out of the 5 cases a passage of the stones without further endoscopic operative procedures could be achieved. Complaints were endurable except in one case. Further studies to dissolve common bile duct stones with a modified Capmul solution via a transpapillary tube seem justified.

New methods in gastroenterology

Major advances in gastroenterology are due in part to the rapid development of fiberendoscopes. Originally intended to improve gastroenterological diagnostics, the field of application was broadened by a variety of therapeutic procedures which now concur with the corresponding surgical approach. Endoscopic electro- and photocoagulation has considerably improved the outcome of acute gastrointestinal hemorrhage: endoscopic polypectomy is the procedure of choice today in benign and occasionally in malignant bowel tumors. Biliary tract surgery was revolutionized by endoscopic sphincterotomy, offering a low-risk procedure in high-risk patients with common bile duct stones. Endoscopic treatment of chronic pancreatitis by duct occlusion is just the beginning, and the old dream of dissolving gallstones rapidly by perfusing the biliary system with litholytic agents is now reality. Finally, the transhepatic or internal drainage in obstructive jaundice leads to transitory preoperative or permanent relief in malignant blockade of bile flow.

[Irrigation treatment of concrements in the common bile duct with octanoate (Capmul 8210) (author's transl)]

An irrigation treatment using the octanoate mixture Capmul 8210 of a maximum duration of 10 days was performed in 11 patients with concrements in the common bile duct using either a T-drain (n = 6) or a permanent naso-biliary tube (n = 5). In 6 out of the 11 cases total or partial dissolution led to voiding of concrements without further operative or invasive procedures. The treatment was tolerated in all but two cases. There was no evidence of systemic toxic side effects. Local inflammatory mucous membrane damage due to the instillation was observed in two cases.

Further evidence of gastric back diffusion. Autoradiographic and mass spectrographic studies

In further studies of the phenomenon of back diffusion (acid, hydrogen (H+) ions), two different experimental approaches were used. 1. Autoradiographic studies with tritium-labelled water instilled in the stomach of fasted rats, revealed the activity to be overwhelmingly concentrated in the mucus layer. In contrast, following aspirin-induced gastric mucosal barrier disruption, radioactivity was prevalent in the mucosal membrane, diffusely scattered. 2. To answer the question as to whether tritium has moved in the gastric mucosa as an ion or as a water molecule, mass spectrographic studies were performed. Using the same experimental approach, comparison of tritium-labelled water with water containing another isotope (O18-water) demonstrated that after damage to the gastric mucosa, a change in the mass spectra of the gastric tissue occurred with tritium-labelled water, but not with O18-water. The results indicate that, indeed, it is not water molecules, but ionic particles represented by tritium that back diffuse, thus giving reason to believe that this mechanism also applies in the case of hydrogen ions.