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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.

The value of interrupting the migrating motor-complex (MMC) and computer-assisted technique in HIDA cholescintigraphy was studied in 10 healthy subjects. Sequential scintigrams were sufficient for evaluating biliary-bowel transit time, visualization of the gall bladder and liver wash-out. However, the point of dynamic equilibrium between net uptake and emptying of the tracer of the gall bladder and hepatic areas, required computer assisted technique. Finally, interruption of the MMC resulted in biliary-bowel transit within one hour in all, but only gall bladder visualization in 8, whereas in the fasting state the gall bladder was visualized in all, but with prolonged biliary-bowel transit in one subject.

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 24 patients with duodenal diverticula, demonstrated by ERCP, food-stimulated gastrooesophageal reflux was demonstrated in 33% of the patients and biliary tract calculi in 81%. This is in contrast to a previous study in patients with duodenal diverticula demonstrated by barium examination where gastroesophageal reflux occurred in 81% and biliary tract calculi in 38% of the patients. Differences in clinical selection are believed to be the underlying cause to these varying results.

In a series comprising 122 patients with a lesion localized to the thoracic cage or pleura the value of fine needle aspiration biopsy has been analyzed. In 53 patients the cytological reports were decisive for further clinical evaluation and management. Two false negative reports were recorded. No complications occurred. Fine needle aspiration biopsy is recommended as first diagnostic step since it is well tolerated by the patients, without complication and has a fair diagnostic safety.

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 clinical value of the benign cytological report was evaluated in 65 patients with a peripheral solitary pulmonary nodule. The cytological report suggesting a specific benign diagnosis (hamartoma, tuberculoma, carcinoid) was of decisive clinical value in 47 patients. In 18 patients the cytological report only suggested the presence of benign cellular elements and was of limited or even misleading clinical value and comprising two false negative reports. It is concluded, that the benign cytological report suggesting a specific lesion is of decisive clinical value, whereas a cytological report only suggesting benign cellular elements should prompt repuncture or surgical biopsy.

The diagnostic value of 100 mm-spotfilm-technique for investigations of the colon has been evaluated and compared to the conventional screen film technique. No difference has been found between the diagnostic value of the two methods, but the total number of exposures in the spotfilm technique has to be increased compared to the conventional method. There is a reduction of the x-ray dose, though not as big as expected.

Fine-needle aspiration biopsy was performed in 92 patients with back pain and a lesion confirmed via x-ray of the spine. In 31 patients in whom x-ray findings had suggested spondylitis, fine-needle aspiration biopsy showed the presence of a tumour in three patients. Of 61 patients with radiographic findings suggestive of malignancy, 26 had benign unspecific lesions, and 35 patients had neoplastic lesions. There were four false negative cytological reports and one false positive report. Additional ESR determination was of no clinical value. There were no complications. Fine-needle aspiration biopsy of bone lesions is recommended as an easy, safe and very often a valuable diagnostic complement.

In diagnosing a Meckel's diverticulum besides the conventional plain films of the abdomen with and without contrast and the angiographic special attention is called to the scanning with technetium. This examination can be very helpful in cases of children with gastrointestinal bleeding episodes in the diagnosis of a Meckel's diverticulum, if it contains ectopic gastric mucosa.

The incidence, reproducibility, and mechanisms of food-stimulated gastrooesophageal reflux demonstrated by radiography were investigated in 100 subjects: 30 normaldeletes, 52 dyspeptics, and 18 patients with oesophagitis. The average incidence and reproducibility were in normals: 17%-76% respectively, in dyspeptics: 40%-86% respectively, and in oesophagitis: 83%-81% respectively. In normals only active gastrooesophageal reflux was noticed whereas in dyspeptics and patients with oesophagitis free as well as active gastrooesophageal reflux occurred.

The influence of different foodstuffs, solid meal, semi-solid meal and solid bolus, was investigated in 21 patients with food-stimulated gastro-oesophageal reflux. All 21 had GE reflux following solid meal, 9 after semi-solid and 11 after solid bolus. The result could not be explained by difference in fat content or reproducibility. It is concluded that information concerning test meals could be of importance when comparing different GE reflux populations.

24 asthmatic children and 15 children without any respiratory or gastrointestinal signs of symptoms were investigated for gastro-oesophageal reflux (GER) by a new radiological test in which the child swallowed a piece of rye bread with liver paté after intake of a glass of Mixobar (600 mg/ml barium sulphate). The asthmatic children were divided into an exogenic and an endogenic group. 62.5% of the endogenically asthmatic children had GER (p less than 0.01) and 19% in the exogenic group. In normal children only one child had GER (7%). Furthermore, GER was more frequent in asthmatic children with nightly cough compared to asthmatic children without nightly cough (p less than 0.02). It is concluded that GER reflux occurred significantly more often in patients with endogenic asthma and/or nightly cough when compared to normal children.