Healthy adults who had not been exposed to antimicrobial agents for the preceding 4 weeks were examined for intestinal carriage of Clostridium dif®cile. The 1234 individuals examined were composed of seven groups: three classes of university students, hospital workers at two hospitals, employees of a company and self-defence force personnel at a local station. Overall, 94 (7.6%) individuals were positive for C. dif®cile by faecal culture but carriage rates among the study groups ranged from 4.2% to 15.3%. Typing by PCR ribotyping and pulsed-®eld gel electrophoresis demonstrated clusters of carriers colonised by a single type in each of three groups, indicating that cross-transmission of C. dif®cile can occur in community settings. Follow-up culture was performed on 38 C. dif®cile-positive individuals and C. dif®cile was isolated again from 12 (32%) of them 5± 7 months after the initial culture; six (50%) of these 12 individuals had a new strain on repeat culture. Two or more family members were C. dif®cile-positive in ®ve of 22 families examined. C. dif®cile with an identical type was isolated from persons within a family in only one family. These results suggest that intestinal carriage by healthy adults may play a role as a reservoir for community-acquired C. dif®cile-associated diarrhoea, but that cross-transmission of C. dif®cile does not occur frequently among family members at home.

Endoscopic placement of an inside stent is useful for treating biliary strictures in patients who have undergone right-lobe LDLT with duct-to-duct reconstruction.

Total colonoscopy with a transparent cap allows inspection of the blind area of the colonic mucosa behind the semilunar folds, with good visual fields. This method is potentially useful for both screening and diagnostic purposes.

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Autoimmune mechanism may be involved in some patients with idiopathic pancreatitis associated with hypergammaglobulinemia.

Epinephrine sprayed on the papilla tended to prevent post-ERCP pancreatitis, although it was not statistically significant because of the low incidence of pancreatitis. Further studies on the efficacy of this technique in patients at high risk for pancreatitis, and on other volumes and/or concentrations of epinephrine, are warranted.