Bile acid concentrations were estimated enzymatically in fasting and postprandial (two-hour) serum samples from 18 normal subjects and 30 patients with histologically proven hepatobiliary disease. The serum bile acid concentration was less than 15 mumol/1 in normal subjects and did not increase postprandially. The fasting serum bile acid concentration was raised in 27 of the patients with hepatobiliary disease, and following a meal was outside the normal range in all 30 patients. Other liver function tests were abnormal less frequently. These results suggest that the estimation of serum bile acids in the postprandial state is a sensitive screening test of hepatobiliary disease. They should be of particular value in patients in whom liver disease is suspected but not proven, and in those recovering from liver disease, especially following therapy.

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In a prospective dosage response study of 84 patients with radiolucent gall bladder stones treated with ursodeoxycholic acid (UDCA), a dose of 500 mg daily was as effective as 1,000 mg daily. Complete dissolution of stones was achieved in 9 of 31 patients (29 %) treated for at least 6 months with the lower dose, and in 7 of 33 patients (21 %) on the higher dose. 4 patients in each group continue on treatment having shown partial gall-stone dissolution. When the two dosage groups were considered together, small stones dissolved more readily than larger ones and, after allowance for stone size, success rates were equal in obese and non-obese patients. Treatment with UDCA was well tolerated and significant adverse effects were not encountered.

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SummaryWe describe a case of hydronephrosis as a result of retroperitoneal fibrosis in a patient who had previous sclerosing lobulitis of the breast. To the best of our knowledge this is the first reported association between these two conditions in the english literature. We presume these conditions are linked and unify them under the general heading of systemic multifocal fibrosclerosis.