Ten cases of the rare solid and cystic pancreatic tumors are presented. All except one occurred in young women (mean age, 25 +/- 9.2 years). The large neoplasms were evenly distributed across the pancreas; in one case, metastasis occurred; all other cases were free from disease after complete resection. Histologic hallmarks of solid and cystic neoplasms were papillary growth, large intracytoplasmic granules, and immunoreactivity with alpha 1-antitrypsin, alpha 1-antichymotrypsin, phospholipase A2, and neuroendocrine markers (neuron-specific enolase [NSE], synaptophysin). This suggests both endocrine as well as exocrine differentiation.

Ultrasound examination of the gallbladder was performed in a prospective study (from 1985 to 1988) of 14,841 consecutive patients. Polypoid changes were found in 224 (129 men, 95 women; mean age 54 [18-88] years), sonographically classified as cholesterol polyps in 212, as polypoid lesions of uncertain benignity in 12. Mean observation time of 92 patients with cholesterol polyps was 9 (3-48) months. In six the polyp diameter increased by up to 5 mm: only two of them were operated upon and the diagnosis was confirmed in both. A total of 21 patients suspected of having cholesterol polyps were operated upon, the diagnosis confirmed in 17, chronic cholecystitis in two and, in one case each, thickened wall-adherent bile or wall-adherent concrements as cause of the ultrasound changes. Six of the 12 patients with polypoid lesions of uncertain benignity were operated upon: two had an adenoma, one each had tissue heterotopy, malignant melanoma metastasis, gall-bladder carcinoma and adenomyomatosis.

From 1961 to 1978, 113 patients with early gastric cancer were treated surgically at Erlangen University. The lesions were located in the lower 1/3 of the stomach in 47% of the patients, in the corpus and fundus in 46%, and in the gastric stump after resection in 7%. Surgical techniques included subtotal distal resection, proximal resection, total gastrectomy, local excision and polypectomy, and their use depended on the circumstances. The tumors were classified as intestinal type carcinoma in 71% of patients and diffuse type carcinoma in 29%. The 5-year survival rates calculated by the actuarial method were 74% (observed) and 87% (age corrected). Tumors in the lower 1/3 of the stomach had a better prognosis than tumors of other regions. Tumors limited to the mucosa had a higher 5-year survival rate than those with invasion of the submucosa. In Europe, as in Japan, early gastric cancer has a much better prognosis than all other forms of gastric cancer.

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The purpose of this study was to reevaluate the significance of serum PHI in gastrointestinal cancer at histopathologically defined stages prior to primary treatment. A total of 248 patients with malignant tumors of the gastrointestinal tract and a collective of 42 patients with noncancerous diseases were studied. The results are compared with those obtained with the established markers tissue polypeptide antigen (TPA) and carcinoembryonic antigen (CEA). Phosphohexose isomerase (PHI) revealed an overall diagnostic sensitivity of 69%, combined with a specificity of 74%. The corresponding data for TPA were found to be 73 and 47% while for CEA 26 and 95% respectively were determined. Even in the early stages of colorectal and esophageal carcinoma, PHI showed a sensitivity of about 60%. A continuous rise of PHI serum levels, correlating well with the extent of the tumor disease, could be detected. In contrast to TPA and CEA, PHI assay can be carried out with a minimum of laboratory efforts, in a short time and at low costs. These findings suggest that serum PHI assay is a useful aid for screening of gastrointestinal cancer, especially esophageal and gastric carcinoma, and a reliable marker for treatment control and follow-up.

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Using a flashlamp pulsed Nd: YAG laser it is possible to destroy gallstones within a few seconds (median: 4 sec for stones less than 1.5 cc; 9.5 sec greater than 1.5 cc). In in vitro and animal studies it was shown that the median energy needed for stone destruction varies between 32 Joule for stones less than 1.5 cc and 80 Joules for stones greater than 1.5 cc. A 0.2 mm thick, flexible glass fibre makes possible retrograde laser lithotripsy by conventional endoscopes. Using a suitable technique the danger of thermal damage to tissue is small.

SUMMARYThe tissue reactions that occurred during piezoelectric shockwaves for the fragmentation of biliary calculi were investigated in 10 surgically removed stone containing human gall bladders and in acute (six dogs) and chronic (six dogs) animal experiments. Before and after shockwave (500, 1500 or 3000) in the anaesthetised dogs, computed tomography (CT), magnetic imaging (MRI) and laboratory tests were done; treatment was carried out under continuous ultrasonographic control. Shockwave application to the human gall bladders resulted in disintegration of the stones with no macroscopically or microscopically detectable tissue changes. In acute animal experiments, small haematomas were observed in all six animals at surfaces, but also inside the liver and gall bladder (max diameter 25 mm). Perforation or intra-abdominal or pleural bleeding did not occur. In chronic experiments, no macroscopic, and only slight microscopic residual lesions (haemosiderin deposits) were seen three weeks after shockwave. In almost all instances, the lesions were detected by CT, MRI, and ultrasonography, while laboratory tests were negative.Non-surgical procedures for the treatment of cholecystolithiasis must be measured against the effectiveness of cholecystectomy and its low morbidity (7%) and mortality (0.4%) rates.' In contrast with oral chemolitholysis alone, extracorporeal shockwave lithotripsy in combination with chemolitholytic post-treatment, appears to be a promising alternative to cholecystectomy in selected patients.2 Sauerbruch et al adapted a kidney stone lithotripter that worked on the basis of the high voltage spark gap discharge principle to the requirements of the biliary system, and reported a 78% stone free rate in patients with solitary stones (up to 20 mm) after four to eight months.3Using a new type of lithotripter that generates shockwaves using the piezoelectric principle, we have been able to show that gall stones can be disintegrated reliably and reproducibly.45 The