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An isotope scan using sucralphate labelled with technetium-99m has been compared with barium meal in the detection of peptic ulceration in 18 patients with endoscopically proven upper gastrointestinal lesions and eight controls. Gastric (75%) and duodenal (67%) ulcers were detected with identical frequency by isotope scan and barium meal but both were inferior to endoscopy. Structural, non-ulcerated lesions, were not identified by isotope scanning. The scan has potential value in duodenal ulcer disease, the serial assessment of ulcer healing and in paediatric gastroenterology.

The distribution of radioactivity after the oral administration of sucralfate labelled with technetium-99m was studied in 33 patients with Crohn's disease (13 adults, 20 children), 10 with ulcerative colitis (four adults), and 29 controls (23 with upper intestinal disease, four irritable bowel, one hypolactasia, and one malrotation of the gut). Positive scans were obtained in all patients with ulcerative colitis and 29 of 31 with active Crohn's disease. The scans of two patients with inactive Crohn's disease were negative. There were two false negative scans in patients with Crohn's colitis and one false positive scan. Overall, sensitivity was 95% and specificity 97%. Comparison with radiology in 39 patients showed similar distribution of disease in 24 and more extensive disease in 12. The scan was inexpensive, simple to perform, well tolerated, allowed small and large bowel to be visualised simultaneously, and used a lower dose of radiation than barium studies. It may prove useful as a screening test for inflammatory bowel disease and in the serial assessment of disease activity.

Two cases of Crohn's disease with unusual manifestations of fistulae involving joints are reported. One case with a fistula from the rectum through the pelvis presented with an abscess adjacent to the left hip joint. The second presented acutely with inflammation and swelling of the right thigh suggesting thrombophlebitis. This patient died from septicaemia and was found at postmortem to have ileal Crohn's disease with fistulae into the thigh, producing septic arthritis of the knee. The possibility of underlying Crohn's disease should be considered in patients who develop abscesses adjacent to the pelvis, or physical signs suggesting thrombophlebitis of the thigh.

Summary In a prospective, randomized trial, 76 patients with duodenal ulceration treated by truncal vagotomy and pyloroplasty were compared with 77 patients who underwent highly selective vagotomy. A total of 149 patients was followed up for from 1 to 4 years, the average follow-up period being 2.6 years. There was no operative mortality and no significant difference in postoperative morbidity between the two groups. The incidence of recurrent ulceration was greater after highly selective vagotomy, but this difference was not statistically significant. The clinical results were comparable in each group, and although the incidence of diarrhoea and dumping was greater after vagotomy and pyloroplasty, this difference was not statistically significant.

Une observation: un athlete pratiquant la course souffre depuis 3 ans de troubles de defecation: urgence et frequence (toutes les 30 mn lors de competitions). Les examens revelent que la cause peut etre une hypertrophie du psoas comprimant le colon; lors d'efforts continus ce «massage» peut provoquer une diarrhee