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A logistic regression model was applied to assess risk factors and diagnostic predictors in duodenal and gastric ulcer, as well as in unspecific changes of gastric mucosa. In the latter group smoking, epigastric distress, and pain were associated with elevated relative risks. In the gastric ulcer model, increased odds were found for age, German nationality, smoking, and low and high urease activity of antral mucosa. This holds for duodenal ulcer, too; however interactions between complaints, urease activity, and nationality must be considered. In each case odds depend from the composition of the control group. Therapeutic implications have been considered.

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A 32-year-old woman without preceding illness or significant cardiovascular risk factors was admitted to hospital because of a syncope after physical exertion. Transoesophageal echocardiography, performed to exclude aortic dissection, showed as an incidental finding a cystic space-occupying mass, 5 x 6 cm in diameter, dorsal to the aortic root and main pulmonary artery. Exercise ECG had S-T segment depressions of about 0.3 mV, associated with anginal symptoms, so that inadequate coronary artery flow on exertion was suspected. Subsequent coronary angiography demonstrated a funnel-shaped 80% stenosis at the origin of the main left coronary artery, while all other coronary arteries were normal and smooth-walled. A causal connection between the two findings was assumed and quickly undertaken surgical intervention revealed an intrapericardial bronchogenic cyst which, presumably as a result of its size and location, had pressed on the main stem of the left coronary artery and caused the stenosis of its ostium. The cyst was completely resected and angioplasty of the coronary artery ostium was performed to ensure its patency. 3 months postoperatively the patient underwent an exercise test of up to 125 Watt without signs of ischaemia. This case presents a previously unreported complication of a bronchogenic cyst.

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CLO-tests: A statistical analysis for the evaluation of the presence of Campylobacter pylori in antral mucosal biopsies. Antral biopsies taken in a sample of 475 endoscopy patients were positive for CLO on 21% of 77 controls, compared with 39% of non-ulcer dyspepsia (NUD) patients without and 69% with a history of former peptic ulcer. Epigastric pain was associated with a positive CLO-test more frequently than belching or heart burn. Patients with NUD of Turkish or Yugoslavian nationality had a significantly higher rate of positive CLO-reactions compared with Germans or Italians with the same diagnosis. In 96 patients with peptic ulcer, the percentage of positive CLO-test decreased significantly in old persons.

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Ultrasonographic findings in gastric cancer are essential for assessment of operability. In surveillance programs, endoscopy is important in detecting secondary gastric carcinomas, whereas ultrasonographic examination has no clinical value. Preoperative ultrasonography in colorectal carcinoma focuses on detection of liver metastases and, if metastases are detected, on assessment of resectability. Sonographic surveillance at short intervals in thus important for possible therapeutic interventions.

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The absolute bioavailability (f) of pirenzepine was determined in 27 intensive care patients receiving the drug for prophylaxis and therapy of upper gastrointestinal tract bleeding. A multiple oral and intravenous dosage regimen and the times of blood sampling were adapted to individual conditions and treatment. Mean f in the patients was 0.28, which was significantly higher than in 12 normal subjects (0.14). It showed no dependence on age (range 20-82 y), nor on the risk factors cardiac insufficiency, renal and hepatic dysfunction, gastrectomy (Billroth II) and bleeding gastrointestinal ulcers, nor on concomitant administration of metoclopramide or antacids. Due to the wide therapeutic index of pirenzepine, it is concluded that individualization of therapy is not necessary for patients in intensive care.

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Results of sonographic investigations from 435 patients with blunt abdominal trauma or polytrauma admitted to a traumatology service are given. Complete evaluation of the abdominal organs was impeded in 94 cases by meteorism or other factors like immobility or hyperactivity of inebriated patients. Evaluation of the pancreas was inhibited in most of these cases. In 33 cases lesions of an organ could be verified during surgery. In one case the false positive diagnosis of "spleen rupture" led to operation. Suspicion of free fluid in the abdominal cavity (5 cases) could not be verified in any of the cases during a second investigation and was deemed to be negligible. Rupture of the spleen was diagnosed in 12 out of 14 cases, renal contusion in 7 out of 7 cases. Liver-, bowel- and mesenteric lesions were occasionally diagnosed indirectly (evidence for free fluid). Quality assessment did not reveal a difference between day time or nocturnal work shifts provided the investigators were experienced in sonography.

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16 cases with abdominal venous thrombosis proven by sonographic exploration, have been collected. The efficiency of present ultrasonographic techniques to venous system has been demonstrated and the importance of routine abdominal ultrasonography for lesions of great abdominal vessels has been stressed.

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A retrospective study was performed on 1091 acute duodenal ulcers found by endoscopy from 1973-1983. The chi 2-test verified statistically a maximum of ulcers in autumn. The vectorial analysis by means of the Rayleigh-Test showed a maximum of observed ulcers in November for all of the patients as well as for subjects with a duodenal ulcer seen only once, or with one relapse found endoscopically. Patients with three or more successive duodenal ulcers showed an individual pattern with or without seasonal periodicity. In chronic duodenal ulcer disease the individual long-time follow-up might be useful in prophylactic anti-ulcer therapy.

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Case report of a 24 years old woman with esophageal ulceration in relation to ingestion of oral anticoncipiens without fluid just before going to bed. Clinical symptoms were typically consisting of odynophagia and retrosternal burning. Endoscopy revealed rapidly healing of the lesion in the otherwise normal esophagus after short therapy with antacids. Symptoms are abolished definitively since flushing down the dragees with adequate quantities of water. This side-effect of the "pill" has not previously been reported.

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35 out of 57 patients with gastric carcinoma presented with a so called "target" pattern. In cases with distal cancer the more advanced cases with endoscopic types Borrmann III/IV showed this sign more frequently than less advanced forms, i.e. suspected early cancer, Borrmann I or Borrmann II. On the other hand in endoscopically advanced cancers Borrmann III/IV a thickening of the gastric wall was more frequent in distal than in proximal localization of carcinoma. The presence of target sign in abdominal ultrasound did, statistically, not influence gastric resection. Other findings, which were observed exclusively in gastric cancer type Borrmann III/IV, like infiltration to the surrounding (pancreas, liver), liver metastasis, and/or ascites, were decisive. Additional sonography of the abdomen is, therefore, a valuable preoperative diagnostic procedure in gastric cancer beside upper GI endoscopy and biopsy.

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It is reported about a female patient with two lipomas of the liver. The special diagnosis and the differentiation against metastases and other malignant tumors of the liver are only possible by means of computertomography. Scintigraphy and sonography do not allow a differential diagnosis. On the one hand lipoma of the liver is a very rare and benign disease but on the other hand a correct diagnosis may be - like in this case - very important because of therapy and prognosis.

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An unusual complication of a peptic esophageal ulcer is presented. Developing near the cardiac border, its origin from dystopic gastric mucosa is under discussion. The literature on aorto-esophageal fistulas has been discussed.

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