The clinical and histopathologic characteristics of gastric carcinoma in young patients (less than 40 years old) were studied retrospectively. The carcinoma was of the diffuse type in 94% of the young patients, and typical features were poor prognosis, an equal sex ratio, and a strong association with blood group A. The family histories of the young patients were studied. There was a highly significant (p less than 0.001) overrepresentation of gastric cancer in the parents of the index cases. In four instances (13%) the findings were compatible with hereditary cancer. One of the patients belonged to a cancer family syndrome (CFS) kindred. The CFS is an autosomal, dominantly inherited trait for adenocarcinomas is well documented. It seems, on the basis of the present study, that CFS should also be added to the list of genetic risk factors for gastric carcinoma. The high incidence of familial cases indicates the importance of studying the family history of every patient with abdominal symptoms.

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Summary We determined the concentrations of immunoreactive epidermal growth factor in the urine (U-irEGF) of 97 adult patients with various malignancies, including carcinomas of the urinary bladder, kidney, stomach, colon, rectum, breast, endometrium, uterine cervix, ovary, vagina, prostate, pancreas and thyroid, liposarcoma and skin melanoma. The relative U-irEGF concentrations (ng m-1 creatinine) were higher (P=0.002) for the whole series of female patients than for healthy controls matched for sex and age. Such difference did not appear for male patients. The only specific group with a statistically supranormal U-irEGF concentration (P=0.0005) comprised women with endometrial carcinoma of the uterus.Epidermal growth factor (EGF) appears to be involved in the regulation of proliferation, differentiation and differentiated functions of a multitude of cell types (Gospodarowicz, 1981;Carpenter & Zendegui, 1986). In certain normal cells in vitro EGF elicits transformation-associated responses (Stoscheck et al., 1986). There is also a considerable body of evidence associating EGF receptor with oncogenesis. The EGF receptor is the product of the c-erbB proto-oncogene, which is closely related to the v-erb B (Downward et al., 1984). The receptor is present in enormous numbers on the cells of many human epidermoid and glial malignancies (Lin et al., 1984;Merlino et al., 1984;Libermann et al., 1984). Many malignant cells produce another EGF receptor agonist, transforming growth factor alpha (TGF-a) Roberts et al., 1980). TGF-cx is excreted in urine by patients with various malignancies (Sherwin et al., 1983), but not by healthy subjects (Twardzik et al., 1985). Uchihashi et al. (1983) and Kurobe et al. (1985) found urinary excretion of EGF to be higher in patients with cancer than in healthy persons. This has not been generally accepted. We have now measured urinary immunoreactive EGF (U-irEGF) levels in patients with a variety of malignancies before and after tumour removal. Materials and methodsSubjects and samples Spot urine samples were collected from 97 patients (49 men and 48 women, aged 28-88 years) with various malignancies before surgical removal (or any other treatment) of the tumour. In addition to those shown in Figure 1, six patients had carcinomas, I of the vagina, 2 of the pancreas, and 3 of the thyroid, and 1 patient had liposarcoma and 1 skin melanoma. The malignancies included both metastasized and in situ tumours. We also measured U-irEGF concentration in 24 patients daily during the first week after removal of the tumour, and in a further 7 patients on the sixth postoperative day. For comparison, urine samples were collected from age-and sex-matched healthy subjects (56 men and 62 women, aged 28-86 years).Assay procedures Human EGF, used both as standard and labelled tracer, and a rabbit antiserum against it (8C-217,3129) were donated by AMGen (Thousand Oaks, California). U-irEGF was measured by a specific homologous radioimmunoassay (Mattila et al., 1985) and creatinine by the kinetic method of Ja...

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A series of patients showing a previously unrecognized type of sliding hiatus hernia is presented and analyzed. This type of hernia is characterized by reflux of the mucous membrane of the Hiss angle into the lumen of the esophagus. The occurrence of mucosal prolapse is a secondary phase of gastroesophageal reflux. The mucous plug prevents further reflux of the acid contents of the stomach into the esophagus and mouth. After the appearance of mucosal prolapse, the symptoms and signs of esophagitis disappear. The most characteristic complaint of the patients is retrosternal pain on lying and bending down. Endoscopy with provocative tests reveals the mucosal prolapse. Tooth erosions due to previous acid reflux into the mouth are diagnostic. The symptoms of this new subtype of sliding hiatus hernia were cured by the Nissen fundoplication.

Forty paid healthy male students participated in two subacute experiments of 6 weeks each. In the first trial 20 of them received bromazepam, thioridazine, and placebo double blind cross over for 2 weeks each, and in the second trial the active agents administered to the other 20 participants were chlorpromazine and sulpiride. The tests used were paired associate learning with nonsense syllables and digit memory span. Before testing the subjects took either an alcoholic or a nonalcoholic bitter drink. As in the previous study from this laboratory, alcohol was found to impair learning capacity. Of the drugs used only bromazepam impaired learning significantly, and the combined effect of alcohol and bromazepam on learning capacity was very deleterious. The adrenolytic effect of drugs did not correlate with their effect on learning. Caution is necessary when prescribing bromazepam for active outpatients at least in doses used in this study.

1Forty-five out-patients with clinically manifested anxiety were tested in order to study the effects of 2 weeks' treatment with placebo, diazepam (5-10 mg three times daily) or thioridazine (25-50 mg three times daily) on their psychomotor skills related to driving. 2 When compared with placebo, diazepam increased the number of mistakes in reaction and co-ordination tests and also decreased.ability to discriminate the fusion of flickering light.3 When compared to other groups, reactive and co-ordinative skills were more impaired in patients treated with thioridazine which also impaired divided attention. 4 Subjectively thioridazine was not experienced as effective an anxiolytic as diazepam.