[On the syndrome of childhood-hypoglycemia. I. Definition of hypoglycemia in different age-groups and problems of neonatal hypoglycemia (author's transl)]

Hypoglycemia was diagnosed in 118 patients admitted to the University Children's Hospital Basel over 13 years, altogether 137 times. A definition of infantile and childhood hypoglycemia is discussed. Hypoglycemia was accepted as the correct diagnosis in 72 cases (group I), where 2 or more blood sugar values or at least one blood sugar value and one glucose value in the cerebrospinal fluid were below the limit for the age-group. In 46 cases only one abnormal blood sugar value vas documented (group II). In 19 cases no value was found to be definitely below the normal range. 58 patients were newborns up to 10 days of age. 34 patients (43 hospital admissions) were children in the agegroup after the newborn period. 65% of the newborns in group I and 58% of them in group II showed clinical symptoms concomitant with hypoglycemia. Convulsions (62%) were the most frequent feature. In more of the 76 patients was hypoglycemia documented as an isolated symptom. 75% of newborns were premature and/or of low birth weight. 50% had hypoglycemia and 20% verified central nervous system disease. 4 patients (5%) died in the hospital for reasons other than hypoglycemia. 15% (11 patients) had definite neurological symptoms when discharged from hospital. 30 of the 72 surviving neonates could be reexamined at a mean age of 26,5 months. 18% (13 patients) showed evidence of neurological disorders. 4 patients were readmitted with hypoglycemia at a later age, 3 were diagnosed as idiopathic and one as a ketotic hypoglycemia. One child developed diabetes mellitus at the age of 8 years.

[On the syndrome of childhood-hypoglycemia. II. Hypoglycemia in the postneonatal period (author's transl)]

Hypoglycemia (h.) in the postneonatal period was predominantly observed in male infants and children. The incidence was 0,51/1000 hospitalizations. The majority of cases was found in the agegroup around 2 years. Concomitant diseases (mostly infections of the upper respiratory tract or gastrointestinal tract) were found in 30 out of 43 hospitalizations. Convulsions and coma were the most frequent symptoms which were found in 43%. In 30% some degree of somnolence was obvious. Hypoglycemia was not considered in the differential diagnosis in any case by the physician treating first. Only 7 out of 34 cases a complicated biochemical work up resulted in an etiological diagnosis: one leucininduced h.; one ketotic h,; one h. in dystrophy and bronchopneumonia with septicemia; one h. in meningococcic septicemia; one h. in adrenal insufficiency; one h. in isolated ACTH-deficiency; one ethyl-induced h.; one h. in polynesy of pancreas; one h. in insulinoma; one h. in diabetes mellitus under insulintherapy.

[Endoscopic diagnosis of oesophagitis: problems of differentiation from normal (author's transl)]

The diagnostic significance of endoscopically early signs of oesophagitis in the absence of macroscopic evidence of epithelial abnormalities has been studied prospectively. Changes from the usually observed shininess, pale-pink colour, smooth texture, regular capillaries, sharp Z-line and a decreased mechanical resistance of the mucosa to mechanical damage do not indicate oesophagitis. Nor should one infer gastro-oesophageal reflux from these endoscopic findings. They are presumably ageing changes in the oesophagus.

[The role of the duodenum in the regulation of the lower esophagus sphincter]

Instillation of a 20% peptone solution into the isolated duodenum causes a significant increase of LES-pressure in the dog. No comparable increase of LES-pressure after instillation of a 0.9% saline solution into the duodenum or of 20% peptone solution into the stomach is observed. As shown in this investigation, it is possible that the duodenum regulates the LES-pressure in the dog.

[Motility determinations on the esophagus and its sphincter system]

The most important tests in esophageal disease are endoscopy and standard X-ray examination. The tests yield valuable information on the structure but little information on the function of the esophagus. Many disorders, however, such as oropharyngeal dyskinesia, diffuse esophageal spasm, achalasia and gastroesophageal reflux are defined by an abnormal esophageal function. In these cases tests such as cinéradiography, manometry, pH-metry and scintigraphy which quantitatively assess esophageal function are necessary. The interpretation of these tests is difficult for the following reasons. 1. Insufficient technical equipment favours false positive and false negative results. 2. Some disorders of esophageal motility exist only temporarily and may be absent at the time of examination. 3. Some disorders such as gastroesophageal reflux are quantiatively defined. Minor or transient disturbancies of esophageal motility may also be found in healthy individuals. The normal range of esophageal function is not sufficiently known in most instancies. Because of these difficulties it is advisable to perform several function tests in each individual patient and to assess the results of these tests together with the slinical symptoms, standard radiology and endoscopy.

Human calcitonin stimulates salivary amylase output in man

Salivary amylase output in man increases after injection of synthetic human calcitonin. This effect is dose dependent.

[Oesophageal function in patiensts with angina (author's transl)]

Oesophageal functions were measured in 18 patients with angina, 13 healthy volunteers and 29 age-matched patients with reflux disease. Acid clearance was as abnormal in angina patients (88 +/- 46 swallows) as in those with reflux disease (97 +/- 45). The pressure in the lower oesophageal sphincter was low in patients with angina (13 +/- 8 mm Hg). The incidence of hiatal hernia, subjective symptoms during acidification of the oesophagus and results of the reflux provocation test were similar in patients with angina pectoris and healthy controls.

[Liver metastases: diagnostic value of blood tests, scintiscanning, and laparoscopy (author's transl)]

In 90 patients with known extra-hepatic malignancy the liver was examined for metastases. The diagnostic value of clinical information, blood examinations, 99mTc scintiscan, and laparoscopy for the diagnosis of the liver metastases was evaluated. Clinical data (age, sex, time since onset of symptoms and localisation of primary tumor) are of no diagnostic value. The most reliable blood tests are alkaline phosphatase (AP) and GOT. The probability of liver metastastases rises with increasingly abnormal values of AP and GOT. However, the probability is not much greater in cases with highly abnormal values than in cases with only moderate elevation of AP and GOT. Diagnostic accuracy of AP is optimal by using a cutoff point of 76 U/l (sensitivity 79%, specificity 64%). Bilirubin, prothrombin time, haemoglobin and blood sedimentation rate are of very little value. Combinations of AP with these blood tests does not improve diagnostic accuracy. Therefore, it is not useful to determine more blood tests than AP alone. Informed reading of liver scans has a specificity of 75% and a sensitivity of 91%. Blind reading of scans has a sensitivity of 94% and a specificity of 95%. This diagnostic accuracy cannot be improved by additional blood tests. Laparscopy has a sensitivity of 85% and a specificity of 95%. Scanning and laparoscopy are complementary methods. When optimal diagnostic accuracy is required both methods should be used.

[Calcitonin and salivary gland amylase secretion in vivo and in vitro. Preliminary report]

Synthetic human calcitonin stimulates amylase secretion of salivary glands in man. The same effect has been demonstrated in isolated cells of rat salivary glands. In vitro experiments suggest that the stimulatory effect is a direct action of calcitonin on salivary cells. Salivary secretion is not affected by pancreozymin or secretin. Our findings afford another example of the difference in secretory behaviour between salivary glands and pancreas.