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Stimulation of the immune response could be obtained in outpatients with inoperable locally advanced or metastasizing gastrointestinal tumors (n = 56), who were palliatively treated with cyclophosphamide (cy), 350 mg/m2 i.v., thymostimulin, echinacin i.m. and in part additionally with epirubicin, 15 mg/m2 i.v. At present, outpatients with pancreatic (n = 7) or colon carcinomas (n = 1) receive interleukin 2 (IL-2) intralesionally, 2 x 10(5) Cetus units (CU), days 3, 5 and 7 after cy, and by portable continuous infusion systems i.v., 3 x 10(5) CU/day, days 3-8 after cy. Subsets of lymphocytes slightly decreased in the patients' peripheral blood, recall antigen reactivity slightly increased. Patients' mean survival time was 5.7 +/- 1.7 months.

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Endoscopic ultrasound (EUS), conventional ultrasound (US), computed tomography (CT) and angiography were compared in their assessment of local resectability in 35 consecutive patients (19 men, 16 women; mean age 49.8 [42-821] years) with non-metastatic carcinoma of the pancreas. The findings were made prospectively and independently of each other. EUS proved to be superior to transabdominal US and to CT in the diagnosis of tumour infiltration of the portal and splenic veins. For the portal vein the sensitivity was 93% by EUS, 14% by US and 36% by CT. Corresponding figures for the splenic vein were 92%, 39% and 69%. EUS was markedly superior to angiography in the diagnosis of portal vein involvement (sensitivity of 93% and 36%, respectively), but the two methods had similar sensitivity regarding splenic vein infiltration (92 and 100%). Tumour involvement of the coeliac trunk was diagnosed with higher sensitivity angiographically (86%) than by EUS (57%), CT (71%) or US (29%). Regarding T and N staging, EUS was superior to both US and CT. These data indicate that EUS is the most accurate method for local tumour staging of potentially resectable pancreatic carcinoma. It can replace angiography in the diagnosis of portal vein infiltration.

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In a prospective study, endoscopic ultrasonography was compared with transabdominal ultrasonography, computed tomography, and angiography in 60 consecutive patients with pancreatic (n = 46) and ampullary (n = 14) cancer considered to be candidates for surgery. The diagnostic value of these imaging procedures in determining local resectability was assessed. The diagnosis of ampullopancreatic malignancy was made by operation (n = 40) or puncture/biopsy (n = 20). In the 40 patients who underwent surgery, endoscopic ultrasonography was significantly superior to abdominal ultrasonography and computed tomography in determining tumor size and extent and lymph node metastases of pancreatic and ampullary cancer. Furthermore, involvement of the portal venous system as judged by histopathology or surgical exploration was correctly assessed by endoscopic ultrasonography in 95%, whereas angiography (85%), computed tomography (75%) and abdominal ultrasonography (55%) were less sensitive. Of 11 cases of portal venous infiltration found at surgery, endoscopic ultrasonography correctly predicted 10, abdominal ultrasonography only 1, computed tomography 4, and angiography 5 (P less than 0.05 for all three comparisons). Twenty patients did not undergo surgery for different reasons: of those, 9 patients were excluded from operation because of portal venous involvement as shown by angiography. Endoscopic ultrasonography detected portal venous invasion in all these cases. In contrast to the venous system, arterial encasement was less reliably detected by endoscopic ultrasonography. In conclusion, endoscopic ultrasonography is the most effective single imaging procedure for local tumor staging in pancreatic and ampullary cancer. Thus, endoscopic ultrasonography will improve the assessment of tumor resectability and further decrease the need for explorative laparotomy.

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A case is reported of a 56-year-old woman of Libyan origin presenting with dysphagia, retrosternal pain and weight loss. Oesophago-gastroduodenoscopy revealed an ulcerated tumor in the upper oesophagus strongly suggesting a malignancy. A positive Mendel-Mantoux test along with histological evidence of epitheloid cell granulomas and clinical findings consistent with pulmonary and lymph node tuberculosis led to the presumptive diagnosis of oesophageal tuberculosis. The diagnosis was later confirmed by positive bacteriological cultures of oesophageal biopsies and gastric washings. It is very unusual for dysphagia to be the presenting symptom of active adult tuberculosis. Oesophageal tuberculosis is extremely rare and must be distinguished predominantly from oesophageal carcinoma.

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Three patients with ulcerative colitis in the active stage demonstrated reduced levels of F XIII activity and F XIII subunit A (61 and 80.3%, respectively). Because of the lack of clinical improvement during conservative therapy, the patients were treated additionally with F XIII concentrate (Fibrogammin HS, Behring, FRG) for 10 days. The substitution resulted in an increase in F XIII activity (144.3%) and F XIII subunit A (238%) as well as in a marked improvement in symptoms.

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Ultrasound is the preceding method for evaluation of fragmentation and subsequent fragment clearance from the gallbladder. Considering the methodological shortcomings of ultrasonography, this study was therefore designed to investigate the degree of conformity between two independent ultrasound units. In our protocol patients were evaluated for fragments two weeks and three, six, nine and twelve months after ESWL. A restricted number of experienced sonographers in two independent ultrasound units examined the patient without knowledge of the other unit's findings. A total of 62 examinations have been carried out so far. Complete or sufficient conformity with a difference in size of 0-3mm was achieved in 24 examinations. Seven examinations revealed differences of 4-13 mm. In 31 cases the diagnosis of a stone-free gallbladder has been made, but only in 25 cases this could be confirmed by the other ultrasound unit. In six examinations a small fragment of less than 5mm was found by the respective other sonographer. We conclude that the diagnoses of a stone-free gallbladder after ESWL should be reconsidered by a second independent and experienced sonographer.

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13 patients with pyogenic liver abscess and five patients with amoebic abscess underwent percutaneous drainage of the abscesses using the Seldinger (n = 8) or trocar technique (n = 11). The results showed that the trocar method was easier and faster to perform and well tolerated by the patients. No complications were observed despite of one case of transient peritonitis caused by a dislocated catheter. One patient with pyogenic liver abscess died of septic shock. All other patients were successfully treated, using local drainage and systemic antibiotic therapy.

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A 33-year-old woman suffering from anal erosions developed severe illness with fever, diarrhea, ischalgia, hypotension, acute abdominal pain, dyspnea, renal and hepatic impairment, myalgia, desquamation of the skin, leukocytosis, anemia, hypocalcemia, decreased serum albumin, and cholesterol levels. Exploratory laparotomy did not reveal pathologic findings. Hemolytic group A streptococci were grown from peritoneal swabs and pleural exudate in bacteriologic cultures. The patient slowly recovered after intense penicillin and tobramycin therapy.

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Totally implantable portal systems are widely used for long-term central venous access. A new venous portal system inserted via the brachial veins (P.A.S. Port system, Pharmacia Deltec Inc, U.S.A.) was studied in five centres. From January 1988 through May 1989 61 systems were implanted. Fifty-two patients had malignant diseases. Nine cases had non-malignant disorders. The portals were implanted subcutaneously in the fore-arm and catheterization was done percutaneously (46) or by cutdown-technique (15) under local anesthesia. Catheter tip position was controlled by fluoroscopy or x-ray. The basilic vein (49) and the cephalic vein (12) were used. The total follow-up time for all systems was 323 months. Forty-five systems were still in use at the end of the observation period, six were explanted electively at the end of infusion therapy and six systems were still functioning at the time of the patient's death (at a maximum of 14 months after implantation). Temporary armphlebitis was noticed on the first postoperative week in five patients. Two P.A.S. Port systems were explanted due to infection and one because of skin rupture at the wound. One intact system was removed as it was thought to be leaking because of needle displacement. The P.A.S. Port system is easy and safe to implant with a high success rate and a low complication rate. It is well accepted by patients and nurses. The device should be advantageous in patients unsuitable for standard venous portal systems and offers an excellent alternative system for venous access.

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One case of a malignant peripheral neuroectodermal tumor of the thoracopulmonary region (Askin-Tumor) is reported. The tumor represents a distinct pathologic entity of neuroectodermal origin. The patient developed a metastasis in the upper jaw and in a lumbar vertebra. Morphologic and immunocytochemical findings of this extremely rare tumor were described and differential diagnosis from other soft-tissue round-cell sarcomas, such as Ewing's sarcoma and neuroblastoma are discussed. Problems associated with the clinical behavior and treatment are outlined. The prognosis in most cases of Askin-tumor is poor. The recommended therapy is radical resection, irradiation and combination chemotherapy containing anthracyclines and a high dose of alkylating agents.

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In recent years, newer techniques have become available to the clinician for the diagnosis and treatment of biliary and pancreatic disease. This article emphasizes interventional procedures through the liver, such as percutaneous transhepatic cholangiography, percutaneous transhepatic biliary drainage, and ancillary techniques. Also discussed are the nonsurgical management of bile duct calculi and the diagnosis and treatment of pancreatic tumors, abscesses, and pseudocysts.

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The effect of the antifibrinolytic agents, epsilon-aminocaproic acid (EACA) and tranexamic acid (t-AMCHA), on acute gastric ulcers induced by cold restraint stress in rats was studied. Intravenous administration of 500 mg/Kg of EACA and t-AMCHA before exposure to stress significantly reduced the severity of gastric bleeding and ulcer formation (P less than 0.01). These agents did not affect gastric acid secretion in pylorus-ligated rats. The results indicate that antifibrinolytic agents may be beneficial in the prevention of stress ulcers in man and support the concept that local gastric fibrinolysis may play a role in the pathogenesis of stress ulcers.

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The effect of heparin on acute gastric hemorrhagic lesions in rats induced by cold restraint stress was examined in relation to dose responsiveness. Prestress heparin with intravenous injection of either 50 or 500 U/Kg significantly reduced gastric bleeding (P less than 0.01). Treatment with the former dose inhibited the formation of gastric ulceration (P less than 0.01). Heparin poststress with both doses did not significantly affect either gastric bleeding or ulceration. In contrast, both heparin prestress and poststress at 5000 U/Kg intravenously markedly enhanced gastric bleeding (P less than 0.05 and P less than 0.01, respectively). The results encourage the use of low-heparin prophylaxis for stress ulcers in patients at high risk, and support the concept of a thrombotic etiology for this disease.

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The retrospective study of 38 male patients undergoing aorto-iliac reconstructive and abdominal aortic aneurysm surgery was carried out. The study demonstrates the deficiency in the pre-operative, intra-operative, and post-operative evaluation of these patients regarding the factors affecting impotence. Recommendations are made, and a flow sheet is compiled to assist the vascular surgeon in the evaluation and management of these patients.

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