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The effectiveness of cimetidine or antacid in healing recurrent jejunal peptic ulcers after Billroth II gastric resection without vagotomy was tested in a randomized study of 18 in-patients. Mean stimulated acid secretion of the cimetidine group was 11.2 +/- 4.3 mmol/h, in the antacid group 12.6 +/- 5.6 mmol/h. Serum gastrin levels were within the normal range in all patients. Within four weeks the ulcers had healed completely in eight of the nine patients on cimetidine (1,000 mg/d), but in only three of the nine patients on antacids (magnesium-aluminiumhydroxide, neutralization capacity 564 mmol/d). The difference is statistically significant (P less than 0.025). All 11 patients with healed ulcers were given prophylactically either 800 mg cimetidine daily or magnesium-aluminiumhydroxide (neutralization capacity 564 mmol/d). During a follow-up period of one year recurrences occurred in two of the five patients on antacids, but in none of the six treated with cimetidine. The results indicate that cimetidine also accelerates the healing of recurrent jejunal peptic ulcers. But further studies are required to elucidate whether long-term treatment with histamine-H2-receptor antagonists is as good as surgery in the long-term prevention of ulcer recurrences.

A new technique for lumbar sympathectomy is described. It consists of CT-guided trans-abdominal fine needle puncture and injection of alcohol. The technique is simple and well tolerated by the patient, and it permits accurate application of the alcohol. Complications have so far not been observed.

Seventy-three patients with vascular occlusions in the pelvis or lower limbs and three patients with upper limb lesions were treated by local low dose fibrinolysin, with strict control of any possible bleeding tendencies. Adequate recanalisation was obtained in 56 patients (73.6%). In ten patients, the occlusion recurred while the patient was still in hospital. After four to six months, 37 of the 56 (67%) of the vessels were still patent. In 18 patients, peripheral emboli resulted in some deterioration, but in 15 of these cases this could be treated successfully by operation. The methods and indications of local fibrinolysis therapy and the problems associated with it are discussed.

Focal nodular hyperplasia was diagnosed angiographically in 14 patients and confirmed histologically. Differentiation of this benign lesion from other space-occupying diseases of the liver can be very difficult, since focal nodular hyperplasia produces a variable angiographic appearance. The typical angiogram showing radial vessels in the arterial phase and sharply demarcated foci in the parenchyma phase is found in only one third of patients. Angiographic differential diagnosis includes adenomas and carcinomas of the liver. Resection of the tumours in case of malignant tumours is not indicated. Foci at the margin of the liver, or if they are pedunculated, should be removed in case of spontaneous perforation. Tumours in the centre of the liver should be observed (computer tomography). Oral contraceptives stimulate the growth of these foci. They may diminish in size after stopping these drugs. 70% of cases of focal nodular hyperplasia remain clinically silent and were discovered accidentally or at autopsy.

Fifty-one patients, on whom a total of 64 carotid thromboendarterectomies had been performed, were followed up by duplex sonography. Five asymptomatic occlusions of the internal carotid artery (8%) and one occlusion of the common carotid artery were found. Two patients (3%) developed a restenosis of more than 50% and another two patients a restenosis of less than 50%. Changes in the vessel wall not producing significant luminal change were observed in another 18 cases (28%). Thirty-six of the operated vessels (56%) showed no change.