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Non-traumatic duodenocaval fistulae are rare, but may be the source of massive gastrointestional bleeding with associated fever and sepsis. These fistulae result from penetrating duodenal peptic ulcers or right nephrectomy and subsequent radiation to the upper abdomen. The outcome depends on early diagnosis and surgery before a potentially fatal hemorrhage occurs. The therapy of choice includes closure of the fistula and repair of the duodenum and inferior vena cava. We describe the seventh case with radiogenic duodenal ulcer. Gastrointestinal bleeding occurred 10 years after radical nephrectomy and radiation (60 Gy). The patient survived following partial pancreatoduodenectomy (Whipple).

In the present study the influence of O-(beta-hydroxyethyl)-rutoside (HR) on the intestinal cells of irradiated mice was investigated. The mitotic activity in the duodenum after irradiation of the abdomen with 800 and 1200 R was shown to be significantly increased during the recovery phase after application of HR. The number of irradiation induced stem cell pycnoses was markedly reduced by HR in the case of both radiation doses. The initially decreased incorporation rate of H3-thymidine was found to increase more rapidly during the first few hours after irradiation in animals pretreated with HR than in those untreated. Cytogenesis of goblet cells, in the duodenum proved to be favourably influenced by HR. During the recovery phase the values were found to be above those observed in the control group and in the untreated animals. The mitosis free interval in the rectal cells immediately after irradiation proved to be shortened in the pretreated animals and the re-increase of the mitotic activity was found to be accelerated. The number of cell pycnoses was also markedly reduced after application of HR, while the incorporation rate of H3-thymidine was accelerated. The radiosensitivity of the goblet cells was not influenced by HR. Disorders in differentiation of the muciferous cells were observed in both test groups.

On the basis of a case of life-threatening haemorrhage from a postbulbar duodenal ulcer two and a half year after radiotherapy carried out on a non-Hodgkin-lymphoma, cases of the genesis and the diagnostics of this late complication are discussed.

A new type of endoscope combines the advantages of the narrow-calibre paediatric endoscopes and the stable-shaft regular endoscopes. This is achieved by reduction of the distal diameter from 13 mm to 9,5 mm with a conical transition between both parts. These characteristics make the instrument particularly suitable for the diagnosis of gastrointestinal stenoses (stenosis endoscope). At the same time the stenosis endoscope dilates as well as a metal olive or a rubber bougie. Thus dilatation of gastrointestinal stenoses is now possible beyond the reach of instruments used as bougie or for dilatation until now. The stenosis endoscope opens new possibilities of therapeutic endoscopy.

Esophago-gastro-duodenoscopies with multiple mucosa biopsies were performed before and after irradiation of the mantle field or the spleen pedicle in 13 patients with Hodgkin's disease in stage I and II. For the irradiation the photons of a 4 MeV linear accelerator were applied with focal doses of 40 to 44 Gy. Contrast simulator radiographs were made in order to verify the position within the irradiation field of the organs from which biopsies were taken. In 0/10 patients examined before the irradiation, 0/5 patients examined less than 15 weeks after the irradiation, and 0/12 patients examined 15 weeks or later after the irradiation, histomorphologic investigation of the mucosa of the esophagus showed no pathologic findings. With the same intervals of examination related to irradiation, the gastric mucosa showed a pathologic histomorphology in 1/13, 7/9, and 5/9 patients, respectively, and the duodenal mucosa in 0/13, 5/9, and 2/9 patients, respectively. With the exception of one ulcer in the duodenal bulb the histopathologic findings as well as the macroscopic findings were neither significant nor characteristic, i.e. not radiospecific. Most of these findings were inflammatory alterations of the mucosa, erosions, and capillarectasies.