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A reference group (252 males, 436 females) and a group of patients with primary hyperparathyroidism (34 males, 67 females) and cirrhosis of the liver (33 males) were subjected to a multivariate data assessment; the analyses were performed on the Technicon autoanalyzer SMA 12/60 (sodium, potassium, chloride, total protein, albumin, inorganic phosphorus, cholesterol, urea nitrogen, calcium, creatinine, bilirubin, uric acid) and the SMA 6 plus (iron, copper, magnesium, alkaline phosphatase, acid phosphatase, glucose). A multivariate test statistic containing age as a regressor variable was used, thus correcting for age. Derivation of the test statistic required multivariate normality of the distributions of the clinical-chemical values, a condition which is generally not fulfilled in the data of patients. In order to arrive at the multivariate normality of the distributions, we applied the X-transformation of van der Waerden [1965) Mathematische Statistik, Springer Verlag, Berlin--Göttingen-Heidelberg) to the marginal values. We introduced the concept of group-conformity behaviour of the patient data. According to our definition, a patient behaves in conformity with a given group of patients with respect to a clinical-chemical value, if the patients' value deviates from the estimated age-specific expected value of the reference group and the deviation lies in the same direction as that of the mean value of the respective group of patients. Using this procedure, disease-specific deviation patterns were determined from the data, thus enabling us to make clear separations of the patient groups from the reference group and from each other. Furthermore, the computed deviation patterns throw light upon the pathobiochemical modifications of the parameters in the examined diseases.

Gastric anisakiasis was an incidental finding on gastroscopy of a 48-year-old man known to have AIDS. At that time the patient had been symptom-free, the test having been performed to check on an ulcerative Candida oesophagitis. The Anisakis larva was extracted through the gastroscope and there has been no recurrence. The history suggested a chronic course. The unusual absence of symptoms suggests that the immunodeficiency had influenced the pathogenesis of the parasitic disease.

A 40-year-old female patient was admitted with bleeding from esophageal varices. The histology of liver and spleen showed granulomatous infiltrations that had developed without symptoms so far. The portal hypertension and a thrombopenic bleeding diathesis gave rise to the establishment of a splenorenal shunt with exstirpation of the spleen. By this the patient could be cured symptomatically, as three years after the acute episode liver functions are still normal. In the light of this case, pathogenesis, the variety of etiologies and the clinical courses of granulomatous liver diseases are discussed in detail with regard to the differential diagnosis.

Techniques of hepatic vein catheterization, hepatic venous pressure measurement, and occlusion phlebography using a balloon catheter are described. Hepatic venous pressure measurements (n=95) and hepatic occlusion phlebography were combined in 32 cases. In patients with liver cirrhosis (n=63) a significant elevation of hepatic venous pressure gradients was found. A decrease of the pressure gradient was seen after portacaval and splenorenal shunt operations. Hepatic occlusion phlebography showed alterations of hepatic veins only in patients with cirrhosis. A rough correlation between pressure gradients and the extent of changes in the liver veins was found. Hepatic occlusion phlebography, in patients who had undergone shunt procedure, demonstrated various collaterals. Combined hepatic vein pressure measurements and hepatic occlusion phlebography using a balloon catheter are proposed as a very suitable method for the evaluation of chronic liver disease and portal hypertension.

The symptoms of the zinc depletion syndrome are demonstrated in two males and two females. The four patients, 23 to 39 years old, were suffering from ileocolitis Crohn. After three to eight weeks of total parenteral nutrition they showed signs of acrodermatitis. Serum zinc was found considerably below normal levels (0,21--0,68 microgram/ml). After oral nutrition was re-initiated the dermatitis healed within four weeks without zinc oxid or zinc sulphate administration. Serum zinc increased to normal levels.

The association of Campylobacter pyloridis with antrum gastritis and peptic ulcers was described. We investigated antral biopsies from 180 patients who underwent gastroscopy. By culture or Gram stain or both, we found overall 98 (54%) of them to be positive for C. pyloridis. In the various groups the following percentages were found to be positive: normal antral mucosa 3% (n = 30); moderate superficial antrum gastritis, 49% (n = 83); severe superficial antrum gastritis, 86% (n = 44); duodenal ulcer, 83% (n = 54); and gastric ulcer, 72% (n = 18). A serological screening that used a complement fixation test yielded the following results: highest rates of positive complement fixation titers were seen in patients with severe gastritis and those with duodenal ulcers, both with 79%; the lowest incidence was in a group of 20 blood donors, with 5%. Positive complement fixation titers in gastritis patients also correlated well with characteristic patterns on immunoglobulin G and A immunoblots, while there was no specific reactivity observed on immunoglobulin M immunoblots.

Involvement of visceral organs is a recognized condition of Reiter's Syndrome. To our knowledge, however, involvement of the colon, as it is seen in other rheumatoid-like processes mostly caused by vasculitis, has not been described before. We present the case of a patient with incomplete Reiter's Syndrome with arthritis, circinate balanitis and psoriasilike lesions of skin and nails who developed ischemic colitis. Angiographic features point to vasculitis as a potential cause, although this could not be proved. It is possible but, as we believe, unlikely that simultaneously administered steroid treatment may have contributed to the development of the lesions.

In a controlled trial, the effect of the beta 1-selective blocking agent metoprolol on cirrhotic portal hypertension was investigated. A sustained reduction of portal pressure was observed in 60% of the treated patients after 1 and 2 months. No correlation between changes of portal pressure and cardiac output was established. This may indicate a direct action of beta-blocking substances on the splanchnic vascular system. The results suggest that treatment with metoprolol may be of value in patients with portal hypertension secondary to cirrhosis of the liver. However, to eliminate non-responders the pressure has to be measured repeatedly.

In order to assess the role of bile secretion in the serum cholestrol lowering effect of a portacaval anastomosis in rats, bile flow rate, bile salt and cholesterol secretion in bile were determined. The study comprised five groups of animals: (1) rats with protacaval shunt cholesterol free food ad libitum. (2) sham-operated and pair-fed controls; (3) unoperated, pair-fed controls; (4) unoperated controls on cholesterol free diet ad libitum; and (5) unoperated controls on normal laboratory rat chow ad libitum. Bile flow rate showed no difference in any of the groups on cholesterol free diet. Bile salt secretion was significantly elevated in shunted animals (87.1 +/- 7.0 nmol/min) as compared with pair-fed sham-operated (64.7 +/- 20.0 nmol/min) and unoperated controls (56.0 +/- 22.3 nmol/min). Biliary cholesterol output tended to be higher in shunted animals but this was not statistically significant. The data indicate that the atrophied rat liver in shunted animals is able to maintain a normal bile flow and to increase bile salt secretion. Thus, the serum cholesterol lowering action of a portocaval anastomosis may be partly due to an increased cholesterol catabolism to bile salts.

We are reporting our 2 years experience in the fiberscopic sclerotherapy of esophageal varices. 170 patients from 15-83 years of age were treated (61 females and 109 males), the majority being around 50 years of age. In 162 cases, the cause of the portal hypertension was cirrhosis of the liver and in 8 cases thrombosis of the splenic or portal vein. 47 patients were treated during acute bleeding, 101 in the interval, and 22 prophylactically. Using the modified intravascular technique, most varices could be sclerosed after a maximum of three treatments. In 83%, acute hemorrhages were stopped. The hospital mortality amounted to 30%, while in the interval group only it was 5%. None of the prophylactically treated patients died during their stay in hospital. The mortality after an average of 11.2 months amounted to 11.8%: The main cause was liver failure. Bleeding reoccurred in 11.2% and resulted in death in every fifth case. The most common complication, namely stenosis, arose in 16 cases and 4 of these necessitated dilation therapy. Esophagothoracic fistulae occurred in 2 cases and could be cured by siphon drainage. The rate of complication amounted to 10.6%, without any lethal outcome.

Five cases representing four different venous anomalies involving the portal system are described. The clinical importance of these anomalies, especially in patients with portal hypertension, is stressed.

Fifty hepatic occlusive venograms with the Swan-Ganz balloon catheter were obtained in 20 patients with portal hypertension. The venographic patterns of hepatic veins were divided into four categories: (a) hepatic venous system without visible alterations; (b) slight loss of branching and tapering, no major wall irregularities; (c) considerable loss of branching and tapering and/or marked wall irregularities; and (d) severe reduction of venous tree with severe wall irregularities ("defoliated tree"). These correlated with severity of the disease. The portal venous system was simultaneously opacified in 10 patients. Intrahepatic and extrahepatic collaterals were found in 8. Hepatic occlusion venography is a suitable method for evaluating alterations of the liver outflow tract in portal hypertension.

With respect to their diagnostic utility CA 19-9, CEA, AFP and POA were determined in pancreatic secretions and serum of patients suffering from pancreatic cancer (n = 76/55) or chronic pancreatitis (n = 79/45) and of controls (n = 81/42), respectively. While the determination of AFP and POA both in pancreatic secretions and serum does not permit a differential diagnosis, serum CEA (greater than 10 ng/ml) and CA 19-9 (greater than 50 U/ml) levels were indicative of pancreatic cancer in 30% and 83%, respectively, with a rate of false positive results of 5% and 8.5% confined to the chronic pancreatitis patients. A combination of tumor marker analyses, that is, serum CA 19-9 (greater than 50 U/ml) and pancreatic secretion CEA (greater than 70 ng/ml), proved to be positive in 92.9% of tumor patients with a maximum of 10.5% false positives. Likewise, values of serum CA 19-9 (greater than 50 U/ml) and serum CEA (greater than 10 ng/ml) were found in 85.8% of the pancreatic cancer patients with only 8.8% false positives, which were confined to the chronic pancreatitis patients. These results indicate the superiority of multiparametric tumor marker analyses for the diagnosis of pancreatic cancer, especially when including new monoclonal antibody defined tumor markers.

The catabolism of lipoproteins was measured in rats with a portacaval anastomosis and in intact control rats. Radioiodinated rat high density lipoproteins or human low density lipoproteins, the major cholesterol-bearing lipoproteins in rat or man respectively, were injected intravenously into rats. More than 90% of trace amounts of these lipoproteins were removed from plasma of rats with portacaval anastomosis and controls on standard chow at closely similar rates within 24 h. Also, [125I]high density lipoproteins left the plasma at comparable rates in controls and rats with portacaval anastomosis, whether fed with a cholesterol-free chow or a carbohydrate-rich lard chow. These dietary regimens were employed to avoid artifacts through a different development of the body weight in operated and control rats. A standard laboratory chow ad libitum led to weight loss in rats with portacaval anastomosis. Pair-fed with a cholesterol-free chow both groups of rats kept the same weight, but only with a carbohydrate-rich lard chow could the natural weight gain be achieved. In all rats with portacaval anastomosis liver weights were reduced and serum cholesterol decreased by 21-31% with the major change in high density lipoproteins. The findings suggest that cholesterol concentrations are not likely to be lowered in rats with portacaval anastomosis by enhanced lipoprotein catabolism.

The technique and use of occlusion phlebography is described. The method is based on temporary occlusion of blood flow by means of a balloon catheter. Various balloon catheter systems were used and their technical properties were evaluated. The distal veins can be demonstrated by using double lumen catheters, distal and proximal veins by using a catheter with three lumina. Occlusion phlebography is a suitable method for demonstrating hepatic and renal veins; it improves the demonstration of the azygos vein, the suprarenal vein and of visceral pelvic veins, including the iliolumbar veins. It also permits demonstration of the inferior vena cava and parietal veins in the pelvis in separate stages. Occlusion phlebography is the method of choice for the direct demonstration of splenorenal shunts.