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Purpose: To correlate the functional changes of the esophagus determined by manometry and radiography using bread and barium with the severity of esophageal symptoms. Material and Methods: Fifty-seven patients, mean age 44.4 years, suspected of primary esophageal motility disorders underwent simultaneous video-radiography and manometry. Based on interviews the patients were divided into subgroups according to predominant symptom − gastro-esophageal reflux symptoms, dysphagia, or chest pain – and to severity of symptoms, i.e., symptoms with negative or no influence on daily life. The manometric diagnosis and esophageal emptying were based on both liquid and solid swallows. Results: There was significant difference in the incidence of esophageal dysmotility disorders both globally and in the subgroup of patients with dysphagia between patients with and those without severe symptoms, but only after solid swallows. Conclusion: We suggest employment of bread in esophageal function tests to improve the...

Purpose: To evaluate whether location of the gastro-esophageal junction (GEJ) could be determined with the same accuracy on radiography as by manometry with special reference to pH probe positioning. Material and Methods: Ninety patients with suspected esophageal motility disorders underwent simultaneous manometry and video-radiography. The lower esophageal sphincter pressure (LESP) and location was determined, and pressure recordings were made in the body of the esophagus. The GEJ and any structural changes were diagnosed on radiography during single-barium swallows and continuous barium drinking. Simultaneous radiographic and manometric investigations were performed with the pressure-catheter placed 5 cm proximal to the superior border of the GEJ located by manometry, and the distance to the radiographically determined superior border could be measured directly on the videotapes using a radiopaque metric ruler placed under the patient. Results: On radiography, the GEJ proved to be situated < 2 ...

Purpose: Gastro-oesophageal reflux (GOR) is demonstrated by radiography as a supplement to 24-h pH monitoring. Material and Methods: Forty-two patients (mean age 44 years) with suspicion of GOR disease were assessed according to a standard questionnaire. GOR was investigated by 24-h pH-monitoring and by radiography. Oesophageal emptying and the presence of rings or strictures were registered as well. Mucosal biopsies, classified as normal, light oesophagitis, severe oesophagitis, or Barrett's oesophagus, were correlated to age, gender, symptomatology, pH monitoring, and oesophageal emptying. GOR and morphological changes demonstrated by radiography were correlated to pH monitoring and mucosa biopsies. Results: Based on pH monitoring, patients with severe oesophagitis and Barrett's oesophagus had a significantly higher acid exposure compared to patients with normal mucosa and light oesophagitis, with no difference concerning age, gender, and symptoms. Severe oesophagitis, including Barrett's oesophagus, was found only in patients with a positive test for radiologic GOR. Eleven patients had rings or strictures independent of oesophageal mucosal changes. Conclusion: GOR demonstrated by radiography identified patients where complications could be expected, which was not possible by pH monitoring alone.

Purpose: Gastro-oesophageal reflux (GOR) is demonstrated by radiography as a supplement to 24-h pH monitoring.Material and Methods: Forty-two patients (mean age 44 years) with suspicion of GOR disease were assessed according to a standard questionnaire. GOR was investigated by 24-h pH-monitoring and by radiography. Oesophageal emptying and the presence of rings or strictures were registered as well. Mucosal biopsies, classified as normal, light oesophagitis, severe oesophagitis, or Barrett's oesophagus, were correlated to age, gender, symptomatology, pH monitoring, and oesophageal emptying. GOR and morphological changes demonstrated by radiography were correlated to pH monitoring and mucosa biopsies.Results: Based on pH monitoring, patients with severe oesophagitis and Barrett's oesophagus had a significantly higher acid exposure compared to patients with normal mucosa and light oesophagitis, with no difference concerning age, gender, and symptoms. Severe oesophagitis, including Barrett's oesophag...

Manometry and gastroesophageal reflux (GER) monitoring are important tests in evaluation of patients suspected of having motility disorders and/or gastroesophageal reflux disease (GERD), but we do not recommend these as first choice investigations. If a functional, benign esophageal disease is suspected, a video-radiologic investigation based on physiological principles using bread-and-barium could often separate patients with normal manometry from patients with severe motility disorders, i.e., diffuse esophageal spasms (DES) and achalasia (Nellemann et al. 2000). Furthermore, this radiologic method could demonstrate GER in adults with a sensitivity of 52 % and a specificity of 100 %, thus reducing the number of patients referred to manometry and GER monitoring (Aksglaede et al. 1999).

Sphincter of Oddi activity and the common bile duct (CBD) and pancreatic duct (PD) pressures were measured by means of endoscopic manometry in 15 patients (11 men and 4 women aged 18-77 (median, 40) years) with various degrees of chronic pancreatitis. Eleven of the 15 patients studied had an abnormal manometric pattern: elevated base-line pressures were seen in 8 patients, elevated duct pressures in 6 patients, abnormal peristalsis in 6 patients, and discoordination in 4 patients. There was no relation between the severity of chronic pancreatitis as shown by endoscopic retrograde pancreatography and the pancreatic function test and the manometric findings. However, a positive correlation between the sphincter of Oddi base-line pressure and the pancreatic duct pressure was found. It is concluded that manometric abnormalities are common findings in patients with chronic pancreatitis. Whether this is primary or secondary to the inflammatory process is still uncertain.

To correlate gastro-esophageal reflux (GER) demonstrated on radiography, with reflux determined on 24-h pH monitoring among infants of less than 1 year of age.Twenty-one infants with suspected GER were examined. In the supine position the infants drank 20-60 ml of barium contrast, and the presence or absence of hiatal hernia, gastric outlet obstruction, or intestinal malrotation was evaluated. The infant was placed in the 25 degrees right oblique supine position and fed 2-3 swallows of milk by a feeding bottle. GER was scored as positive on radiography when the contrast column reached a level of at least 3 vertebral segments above the gastro-esophageal junction (GEJ). An antimony intraluminal esophageal pH probe was positioned 2 vertebral segments above the GEJ as identified by the barium swallow, confirmed on radiography after positioning and prior to probe removal. A total time of esophageal pH4 exceeding 5% was assigned as pathological.The radiological method of GER evaluation showed a specificity of 50% and a sensitivity of 29%, as compared to 24-h pH monitoring.The radiological method was of no value among infants of less than 1 year when demonstrating GER.

To correlate the functional changes of the esophagus determined by manometry and radiography using bread and barium with the severity of esophageal symptoms.Fifty-seven patients, mean age 44.4 years, suspected of primary esophageal motility disorders underwent simultaneous video-radiography and manometry. Based on interviews the patients were divided into subgroups according to predominant symptom - gastro-esophageal reflux symptoms, dysphagia, or chest pain - and to severity of symptoms, i.e., symptoms with negative or no influence on daily life. The manometric diagnosis and esophageal emptying were based on both liquid and solid swallows.There was significant difference in the incidence of esophageal dysmotility disorders both globally and in the subgroup of patients with dysphagia between patients with and those without severe symptoms, but only after solid swallows.We suggest employment of bread in esophageal function tests to improve the correlation between symptomatology and positive diagnostics findings.

To evaluate whether location of the gastro-esophageal junction (GEJ) could be determined with the same accuracy on radiography as by manometry with special reference to pH probe positioning.Ninety patients with suspected esophageal motility disorders underwent simultaneous manometry and video-radiography. The lower esophageal sphincter pressure (LESP) and location was determined, and pressure recordings were made in the body of the esophagus. The GEJ and any structural changes were diagnosed on radiography during single-barium swallows and continuous barium drinking. Simultaneous radiographic and manometric investigations were performed with the pressure-catheter placed 5 cm proximal to the superior border of the GEJ located by manometry, and the distance to the radiographically determined superior border could be measured directly on the videotapes using a radiopaque metric ruler placed under the patient.On radiography, the GEJ proved to be situated2 cm distally as compared to its location determined by manometry in 95.6% of the patients, and the maximal difference was 2.5 cm. The LESP or structural changes had no significant influence on the results.The variation of location of GEJ on radiography as compared with manometric findings was sufficiently small to accept both methods as valid in the positioning of the pH probe properly.

Purpose: To correlate gastro-esophageal reflux (GER) demonstrated on radiography, with reflux determined on 24-h pH monitoring among infants of less than 1 year of age. Material and Methods: Twenty-one infants with suspected GER were examined. In the supine position the infants drank 20–60 ml of barium contrast, and the presence or absence of hiatal hernia, gastric outlet obstruction, or intestinal malrotation was evaluated. The infant was placed in the 25° right oblique supine position and fed 2–3 swallows of milk by a feeding bottle. GER was scored as positive on radiography when the contrast column reached a level of at least 3 vertebral segments above the gastro-esophageal junction (GEJ). An antimony intraluminal esophageal pH probe was positioned 2 vertebral segments above the GEJ as identified by the barium swallow, confirmed on radiography after positioning and prior to probe removal. A total time of esophageal pH

Purpose: To registrate the oscillations of the pH probe in the esophagus during phonation and swallowing in the erect and supine positions. Material and Method: Sixty-seven patients with suspicion of gastroesophageal reflux disease underwent manometry, 24-h pH monitoring, and videoradiography. In 43 patients the effect of dry, wet, and solid swallows in the erect and supine positions was determined, making a total of 258 swallows. In another 24 patients the effect of pH probe movement during phonation was studied. Results: During every swallow the probe moved in the proximal direction from 0.5 to 2.0 cm, returned to baseline, and in 48 swallows an additional descendent movement of up to 2.0 cm was seen, the last mentioned more pronounced during solid swallows. In the erect position, no significant difference was observed for the different swallowing types, whereas in the supine position, movements were significantly more pronounced during solid food swallows. During phonation the pH probe only ascended and returned to the baseline, with no descending part. Conclusion: The pH probe movements are dependent on body position, bolus size, bolus composition, and talking. The ascending movements can only partially compensate for the esophageal shortening during swallow because of the time difference, and could perhaps explain the variation in results and reproducibility of 24-h pH monitoring.

Gastro-oesophageal reflux (GOR) is demonstrated by radiography as a supplement to 24-h pH monitoring.Forty-two patients (mean age 44 years) with suspicion of GOR disease were assessed according to a standard questionnaire. GOR was investigated by 24-h pH-monitoring and by radiography. Oesophageal emptying and the presence of rings or strictures were registered as well. Mucosal biopsies, classified as normal, light oesophagitis, severe oesophagitis, or Barrett's oesophagus, were correlated to age, gender, symptomatology, pH monitoring, and oesophageal emptying. GOR and morphological changes demonstrated by radiography were correlated to pH monitoring and mucosa biopsies.Based on pH monitoring, patients with severe oesophagitis and Barrett's oesophagus had a significantly higher acid exposure compared to patients with normal mucosa and light oesophagitis, with no difference concerning age, gender, and symptoms. Severe oesophagitis, including Barrett's oesophagus, was found only in patients with a positive test for radiologic GOR. Eleven patients had rings or strictures independent of oesophageal mucosal changes.GOR demonstrated by radiography identified patients where complications could be expected, which was not possible by pH monitoring alone.

The aim of this retrospective study was to evaluate the initial video-radiology and manometry in 40 consecutive patients with systemic sclerosis (n=21) or suspected systemic sclerosis (n = 19) in relation to oesophageal symptoms; and, furthermore, to evaluate the consequence of radiographic or manometric findings in the oesophagus on diagnosis and treatment. Evaluating oesophageal abnormalities in relation to diagnosis and treatment has, to our knowledge, not been reported before. Video-radiology together with manometry demonstrated oesophageal dysfunction in 80% of patients. Thirteen patients (33%) were asymptomatic in spite of identified motility abnormalities. Following the radiographic and manometric investigation, 9 patients (23%) had a change of diagnosis and, in 20 patients (50%), systemic treatment was instituted or intensified. The study confirms that both manometry and video-radiology are important for the identification of oesophageal motility abnormalities in patients with systemic sclerosis. Oesophageal symptom profiles alone do not predict abnormal findings.

Background: In patients with early stages of achalasia manometry is of significant diagnostic value. Technically, however, measurement of lower esophageal sphincter (LES) relaxation is not always easy. Accordingly, we looked for a simpler way of measuring incomplete LES relaxation. Methods: In 186 consecutive patients referred to esophageal motility testing the esophageal body base-line pressure was measured during continuous swilling of 180 ml fluid within 20 sec. Results: Seventeen of the 186 patients had achalasia. Fourteen of these patients were compliant for the swill test, and all had a positive test, characterized by a steady increase in base-line pressure with negative deflections on deglutition. All non-achalasia patients could complete the test, which was negative in all except one patient, who had a severe peptic stricture. Conclusions: The swill test is diagnostic for incomplete lower esophageal relaxation in achalasia in compliant patients without organic stenosis.

Purpose: The purpose was to investigate the manometric characteristics in patients with lower esophageal rings or strictures with special reference to food impaction. Material and Methods: The material comprised 344 patients (158 female and 186 male). Lower esophageal rings or strictures were diagnosed radiologically by the full column technique. Manometry was performed with triple lumen catheters connected to a hydraulic capillary system and external transducers. Results: Forty patients had rings, and 21 patients strictures. The reference group comprised 283 patients. Dysphagia was seen most frequently in patients with rings. Food impaction was seen only in patients with rings or strictures, whereas chest pain and heartburn appeared with the same incidence in all 3 groups. Non-specific motor disorders were seen most frequently in patients with strictures, but as delayed esophageal emptying with no influence on the tendency to food impaction. Only ring diameter, but not stricture diameter, was of any significance with a higher incidence of food impaction in patients with narrow rings. Conclusion: Radiology rather than manometry should be the first diagnostic step in patients with benign dysphagia suffering from food impaction.

Purpose: To correlate gastroesophageal reflux (GER), demonstrated by a radiological method using food, with the reflux events, as determined by 24-h pH monitoring. Material and Methods: One hundred and seventeen patients with a median age of 47 years (86 male and 31 female) were examinated. In the supine left position, the patient consumed 360 ml of barium contrast. Fluoroscopy was performed with the patient in the supine right oblique position during mastication and swallowing a piece of rye bread with liver paté and barium. the test was positive if barium was observed ≥5 cm proximal to the gastroesophageal junction. An antimony pH-probe was placed 5 cm above the lower esophageal sphincter, previously determined by manometry. the position was controlled by radiography after positioning and before removal. the total time of esophageal pH Results: the radiological method had a specificity of 100% and a sensitivity of 52% compared to 24-h pH monitoring. Conclusion: the high specificity of this radiological method justify direct therapeutic consequence of a positive test. However, a negative test still renders the problem unsolved.

Continuous 24-hour esophageal pH-monitoring was performed in 89 infants. Of 38 patients with respiratory symptoms 74% were found to have a pathological 24-h pH monitoring. The same number of pathological monitorings (71%) were found in 38 patients with clinical symptoms of gastro-oesophageal reflux. We found pathological monitorings in only 25% of eight patients with unusual posturing and five healthy children all had normal monitorings. Gastrooesophageal reflux is common in children with clinical gastrointestinal symptoms as well as in children with respiratory symptoms.

Retrospective studies of duodenal polyps have shown a prevalence of 0.3%-1.5% in patients referred to upper endoscopy, and histopathologic classifications have been inconsistent.A prospective consecutive study was carried out in 584 patients referred to diagnostic upper endoscopy. Symptoms were registered on a questionnaire, endoscopic and histopathologic findings on standard forms. The same pathologist evaluated all biopsy specimens.Twenty-seven patients had polyps in the first and/or second part of the duodenum, for a prevalence 4.6%. Sixteen polyps were either inflammatory (nine polyps) or ectopic gastric mucosa (seven polyps). Both of these polyp types were practically always non-solitary, sessile, small, and located in the duodenal bulb. Seven polyps were covered by normal mucosa, three being endoscopically typical lipomas. Two polyps were adenomas (0.4% of all the patients and 7% of the polyps), and both were found in the descending part. One hyperplastic polyp of the gastric type and one case of fibrosis were found.1) Duodenal polyps are found in 4.6% of patients referred to upper endoscopy and should therefore be looked for. 2) Multiple, small polyps in the duodenal bulb are always benign and need neither biopsy nor treatment (in patients with familial polyposis biopsy is recommended). 3) In the descending duodenum polyps are rare, but a substantial number of them are adenomas. Biopsy is therefore mandatory in this localization.

Using a radiological method to demonstrate food-stimulated gastroesophageal reflux (GER), a comparative study was carried out employing a solid, already validated bolus versus a liquid one. One hundred and four consecutive patients received both a solid and a liquid bolus in randomized order. GER was observed in 37 (35.6%) patients receiving the solid bolus versus 28 (26.9%) with the liquid one. This means that the solid bolus provokes significantly more reflux (P less than 0.02). GER, grade II (reflux above the level of the carina), occurred equally often as a result of both types of bolus, however. The study suggests that significant, food-stimulated GER is independent of the consistency of the foodstuffs and may be detected employing a liquid bolus. This result might be used in the examination of infants for GER, using milk as a food stimulus.

An investigation to detect food-stimulated gastro-oesophageal (GE) reflux was carried out in 54 consecutive fasting patients, 35 of whom experienced reflux while 19 did not. All patients then received a standard meal (566 kcal), and the investigation was repeated 1 h later. Out of the 35 with GE reflux in the fasting state, 33 also had GE reflux in the postprandial state, and 17 of the 19 patients with no GE reflux while fasting also had none in the postprandial state. It is concluded that the radiological method can identify most patients in whom food-stimulated GE reflux could be of clinical significance.

The sphincter of Oddi (SO) motility before and after an artificial elevation of the common bile duct pressure was studied by means of endoscopic manometry in nine female subjects, seven of whom had undergone previous cholecystectomy. An increase in the hydrostatic common bile duct pressure resulted in total inhibition of the phasic SO contractions in the two patients with gallbladders in situ, as well as in four of the cholecystectomized patients. The results thus indicate that the inhibitory effect of hydrostatic common bile duct pressure on the SO motility previously demonstrated in the cat is also present in man. On the other hand, as the inhibition of the phasic contractions failed to occur in three of the postcholecystectomy patients, the findings also suggest that cholecystectomy may result in altered regulation of SO motility in some patients. This mechanism could then contribute to development of pain in susceptible subjects postcholecystectomy. Finally, the results also showed that pain experienced by some patients upon contrast injection during ERCP bears no relationship to SO motility, but is due to an interindividually variable sensitivity of the bile duct wall to the intraluminal pressure variation.

Cholescintigraphy after food stimulation was carried out in 40 patients (13 patients with biliary enteric bypass, 14 patients with bile duct stenosis, demonstrated by ERC, 5 patients with endoprothesis and 8 patients with clinically suspected post-cholecystectomy syndrome. Biliary-bowel transit time of one hour or less was considered to be normal. In patients with biliary enteric bypass 11 had a normal transit time; however, one with a concomitant anastomotic leakage, and 2 patients had prolonged transit time and a significant obstruction by the anastomosis. All 14 patients with demonstrated biliary stricture had normal transit time. In 5 patients with endoprothesis, 2 had prolonged transit time in spite of patent endoprothesis. Finally, in the 8 patients with suspected post-cholecystectomy syndrome, 4 had normal sphincter of Oddi manometry and normal transit time, and 4 had abnormal sphincter of Oddi manometry, but only one with prolonged transit time. It is concluded that in patients with biliary enteric bypass (hepatico-jejunostomia) or biliary strictures a biliary-bowel transit time of one hour will be discriminatory between normal and abnormal conditions. This is in contrast to patients with endoprothesis and suspected sphincter of Oddi dysmotility, where a transit time of one hour only will have limited predictive value.

The influence of Cisapride on food-stimulated gastro-oesophageal reflux mechanisms was studied in a double-blind cross-over investigation in 24 consecutive patients selected by endoscopy, 12 with microscopical evidence of gastro-oesophageal reflux and 12 with additional macroscopic oesophagitis. 63% had food-stimulated gastro-oesophageal reflux, and Cisapride significantly reduced the tendency to gastro-oesophageal reflux and mucosal contact time between gastric content and the oesophageal mucosa in 73% of these patients. It is concluded that Cisapride could be valuable in the treatment of gastro-oesophageal reflux.

In ten healthy subjects final gastric emptying of solid food was measured by a new scintigraphic method, employing 99mTc labelled pellets, and compared to a radiologic method, employing food with incorporated barium suspension. Final gastric emptying of solid food, measured by the scintigraphic technique, was 5.2 hours and with the radiographic technique 5.5 hours, with no significant difference. It is concluded that significant information concerning gastric emptying of solid food can be obtained by the radiological method.

In a series of 48 patients with dyspepsia but without gastric ulcer it is shown that pyloric regurgitation occurred significantly more often in patients with distal and combined anomalies of the duodenum or a short loop than in patients with a normal duodenal loop. No difference existed between patients with proximal duodenal anomalies and the normal group. When pyloric regurgitation occurred in the erect position it could be prevented in the supine position and also to some extent by intravenous by intravenous administration of 20 mg metochlopramide.

Of 29 patients with hernia Bochdaleck there were 11 in the non surgical group and 18 in the surgical group. 14 were operated in the first 24 hours of life, and 4 patients after that time. No patients in the non-surgical group survived. In patients who were operated upon in the first 24 hours of life, 5 survived, and after that time 3. In all cases the transthoracic approach was used. The investigation did not permit any safe judgement of the preoperative treatment. On these conditions multiple anomalies combined with prematurity and intrauterine asphyxia had some influence on, whether a patient lived so long, that an operation could take place. Gastro-intestinal anomalies had a certain prognostic significance in the postoperative period. In cured patients the severity of a complicating cardiac failure could be of some importance.

Ten children with histiocytosis X and recurrent otitis media as a presenting symptom were compared to children with otitis media complicating cholesteatoma. When radiography and biopsy findings were not diagnostic a low age (less than 3 years) and a remaining elevated ESR were characters that most effectively separated the histiocytosis X group from the cholesteatoma group.

The radiological findings in ERCP in 49 patients (ERP 49 patients and ERC 24 patients) with pancreatic diseases were evaluated blindly (24 patients with chronic pancreatitis and 25 patients with pancreatic cancer as a final diagnosis). Obstructions of the main pancreatic duct were found in 16 out of 24 patients with chronic pancreatitis and in 24 out of 25 patients with pancreatic cancer. Irregularity of obstructions was seen significantly more often in patients with cancer. Cholangiography demonstrated obstructions of the distal part of the common bile duct in both groups of patients, but irregularity of obstructions was exclusively seen in the cancer group. Though characteristic radiological features were demonstrated, a safe diagnosis must probably still rely on biopsy.

In a study, partly retrospective and partly prospective, there were 29 infants who had sliding hiatal hernia: their principal clinical features, the diagnostic criteria, treatment and cure rate were similar to those of other series. The study highlights associated duodenal anomalies which seem to influence the radiological but not the clinical cure rate. The findings can be contrasted with those in adults who have duodenal abnormalities with sliding hiatal hernias in that 21 out of 29 infants with sliding hiatal hernia had a normal duodenal loop. Severe dyspepsia, with malnutrition initially, did not have any influence on physical development in 27 out of 29 patients.

Basal and food-stimulated motility patterns were studied in seven patients with distal duodenal anomalies (DDA) and in seven controls. A discordant pressure pattern and a significantly higher frequency of pressure waves was observed in DDA both in the basal state and after food intake in comparison to controls. It is concluded that the shape of the duodenal loop can influence basal and food-stimulated motility patterns in the duodenum, and thereby probably also the transport mechanism through the duodenal loop.

The clinical value of fine-needle aspiration biopsy of mediastinal lesions was evaluated in 132 patients. The method was of conclusive clinical value in 88 cases, in 53 of which the further management was based only on the needle biopsy findings, radiographic observations and clinical status. Fine-needle aspiration biopsy of mediastinal lesions is therefore recommended as an early step in diagnostic procedures.

The activity of the endothelial and macrophage derived angiotensin-converting enzyme in blood was within normal range in 12 patients with histiocytosis X, independent of extent and activity of the disease. In contrast to sarcoidosis and Gaucher's disease, histiocytosis X is not associated with elevated levels of angiotensin-converting enzyme.

The clinical value of percutaneous pulmonary aspiration biopsy was assessed in 500 patients. Conclusive information was obtained in 53.6% (i.e. with decisive value in 27.4 and supportive value in 26.2%). Inconclusive results were reported in 44.8% of the cases and in 1.6% the cytologic report was misleading. Pneumothorax occurred in 25% of the series and required intubation in 4.4%. Percutaneous transthoracic fine-needle aspiration biopsy provides a simple means of obtaining positive diagnostic information of pulmonary lesions suspected to be malignant.

The findings in 9 patients with histiocytosis X localized to the spine and 7 patients with tuberculous spondylitis were compared. It was not always possible to differentiate between these two conditions without a supplementary fine needle aspiration biopsy. This is therefore recommended in patients with possible histiocytosis X or spondylitis and a divergent clinical course.

In a prospective study a barium examination combined with food stimulation was compared with the acid reflux test in 30 consecutive patients with symptoms of gastro-oesophageal reflux. Both methods were further compared with endoscopy and histology. Gastro-oesophageal reflux could be demonstrated by the radiologic examination in 22 patients and by the acid reflux test in 23 patients. By combining the two methods gastro-oesophageal reflux could be demonstrated in 27 patients. Comparing the two methods with symptoms, endoscopy, and histology they seemed to be of equal value. Accordingly, a food-stimulated barium examination is recommended as the first method for demonstrating gastro-oesophageal reflux because it is simple and well-tolerated by the patient. References

The significance of bone lesions in the skull as a possible prognostic factor in patients with histiocytosis X was examined in 64 patients, of whom 29 had such lesions. Lesions localized to the skull cap or facial bones were associated with a good prognosis whereas those in the base of the skull had a prolonged course or even a fatal outcome.

Conventional radiography of bone lesions in children and adolescents gives limited information on the nature of the process. Before treatment a morphologic diagnosis is always necessary. The value of open surgical biopsy is clear, but surgical exploration may be an elaborate procedure. Needle biopsy under fluoroscopic control offers an adequate alternative (SCHAJOWICZ 1955, FRANZBN & STENKV~ST 1968). The present report constitutes a review of the experiences with the aspiration biopsy method in cases of histiocytosis X, Ewing’s sarcoma and metastatic bone lesions of neuroblastoma.

Gastric emptying time of a solid meal was estimated on X-ray in 7 patients with a normal duodenal loop, 7 patients with a proximal duodenal anomaly, and 12 patients with a distal duodenal anomaly. A determination coefficient between gastric emptying time and duration of serum gastrin increase was calculated. The food-stimulated serum gastrin secretory pattern was studied in 9 patients with a normal duodenal loop, 6 with a proximal duodenal anomaly, and 13 with a distal duodenal anomaly. The various groups presented significantly different gastric emptying times; thus patients with normal duodenal loop had a mean gastric emptying time of 6 h, patients with proximal duodenal anomalies ahd a mean gastric emptying time of 4.5 h, and patients with distal duodenal anomalies had a mean gastric emptying time of 9 h. Gastric emptying time and duration of increased serum gastrin secretion was positively correlated (R2 = 0.89). The food-stimulated serum gastric secretory pattern was equal in patients with proximal duodenal anomalies and those with distal duodenal anomalies and furthermore, reached significantly higher serum gastrin concentrations than in patients with a normal duodenal loop.

The clinical value of cytological aspiration biopsy in 85 patients with lytic bone lesions was studied. In 71 cases cytology was of diagnostic value, but in 14 cases it was inconclusive or misleading. The method is considered a simple primary diagnostic procedure especially in lytic bone lesions of uncertain nature.

ERP was analyzed in 87 patients with chronic pancreatitis with special reference to its clinical value in management of pain, the dominating symptom in uncomplicated chronic pancreatitis. A significant correlation was found between ductal changes due to pancreatitis and decrease in pancreatic function. However, no association was found between severe pancreatic pain and pancreatic function or pancreatic morphology. The significance of ERP in management of patients with persistent severe pancreatic pain is discussed.

The lymphoscintigraphic pattern in the head and neck lymphatics was studied in 45 healthy subjects. After submucous injection of Lymphoscint-solco in the oral cavity there was visualization of regional lymph nodes immediately after food intake. There was an extreme variation in the number of visualized lymph nodes and a lack symmetry between right and left side of the neck. The accumulated radioactivity in subsequent lymph nodes showed an extreme variation. Accordingly no characteristics of diagnostic value could be evaluated from this study.

Antroduodenal motility was studied before, during, and after food intake in patients with X-ray-negative dyspepsia and abnormal duodenal loop and in normals. No differences were observed between X-ray-negative dyspepsia and a proximally located abnormal duodenal loop. Patients with a distal duodenal anomaly had significantly higher food-stimulated duodenal activity than any of the other groups studied, whereas no differences were observed in antral motility.

Simultaneous measurement of food-stimulated serum pancreatic polypeptide and serum gastrin was carried out in 18 patients with functional dyspepsia and correlated to the shape of the duodenal loop. Significantly higher serum concentrations of pancreatic polypeptide and gastrin were encountered in patients with an abnormal shape of the duodenal loop compared to patients with a normal shape. Although no cause could be given to the phenomenon it may be taken into account when evaluating hormone profiles in patients with functional dyspepsia.