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Nonsteroidal anti-inflammatory drugs have become increasingly popular, with more than 90 million prescriptions being written annually. These drugs inhibit the intracellular cyclooxygenase enzyme system, thus blocking the production of various prostaglandin compounds. This, in turn, interferes with normal mucosal protective mechanisms, leading to local injury. Gastrointestinal complications of nonsteroidal anti-inflammatory drug use include ulcerations, hemorrhage, perforation, stricture formation, and the exacerbation of inflammatory bowel disease. Treatment involves stopping the drug if at all possible and then instituting more specific therapy depending on the anatomic area that has been injured.

There are currently four needle biopsy methods for obtaining tissue from patients with possible diffuse liver disease or cancer. These include percutaneous blind needle biopsy, a visually guided needle biopsy at laparoscopy, guided fine-needle biopsies with ultrasonography or computed tomography, and the transvenous liver biopsy. We and others have found the guided fine-needle biopsy technique to be safe, relatively cheap, and highly accurate in the diagnosis of liver cancer. Blind percutaneous biopsy should be reserved for patients with possible diffuse, noncancerous, liver disease. Guided biopsies at laparoscopy can be done if the other two methods fail to give a tissue diagnosis. The transvenous approach is useful in patients with a coagulation disorder.

During a one-year period 420 middle-aged patients were examined as part of the executive health program at the Palo Alto Clinic. Of these, 30 percent were found to have at least one disease and 20 percent to have at least one laboratory abnormality. It is concluded that such examinations are worthwhile, especially in identifying self-destructive habits and serious emotional illnesses in busy, highly motivated executives.

The parasite Blastocystis hominis has been found in 10% to 18% of stool specimens submitted to microbiology laboratories. Controversy exists as to whether this organism can cause illness in humans. We have reviewed the records of 65 symptomatic patients with B hominis in their stool. We conclude that B hominis is a potential pathogen that may or may not require drug therapy depending on the overall clinical circumstances, the severity of symptoms, and the presence of other pathogenic organisms.