The diagnositc value of ultrasonic tomography of the upper abdominal organs is sometimes limited by bones and gas. Endoscopic ultrasonography (EUST) combines the advantages of the direct visualization of the upper GI tube and the ultrasonic imaging of adjacent organs. The ultrasonic probe consists of a 5 MHz array that generates a good resolution at the acustical focus, the endoscope is a conventional Olympus gastroscope type GFB3. The ultrasonic transducer is firmly attached to the distal end of the endoscope. Combined examinations are performed in 18 patients with biliary, pancreatic and hepatic disorders or postoperative changes. EUST may be of value not only for gastrointestinal but also for retroperitoneal, cardiac, and mediastinal diseases.

Background and Aims: Malfunctions of enteric neurons are believed to play an important role in the pathophysiology of irritable bowel syndrome (IBS). Our aim was to investigate whether neuronal activity in biopsies from IBS patients is altered in comparison to healthy controls (HC).Methods: Activity of human submucous neurons in response to electrical nerve stimulation and local application of nicotine or a mixture of histamine, serotonin, tryptase, and TNF-α (IBS-cocktail) was recorded in biopsies from 17 HC and 35 IBS patients with the calcium-sensitive-dye Fluo-4 AM. The concentrations of the mediators resembeled those found in biopsy supernatants or blood. Neuronal activity in guinea-pig submucous neurons was studied with the voltage-sensitive-dye di-8-ANEPPS.Results: Activity in submucous ganglia in response to nicotine or electrical nerve stimulation was not different between HC and IBS patients (P = 0.097 or P = 0.448). However, the neuronal response after application of the IBS-cocktail was significantly decreased (P = 0.039) independent of whether diarrhea (n = 12), constipation (n = 5) or bloating (n = 5) was the predominant symptom. In agreement with this we found that responses of submucous ganglia conditioned by overnight incubation with IBS mucosal biopsy supernatant to spritz application of this supernatant was significantly reduced (P = 0.019) when compared to incubation with HC supernatant.Conclusion: We demonstrated for the first time reduced neuronal responses in mucosal IBS biopsies to an IBS mediator cocktail. While excitability to classical stimuli of enteric neurons was comparable to HC, the activation by the IBS-cocktail was decreased. This was very likely due to desensitization to mediators constantly released by mucosal and immune cells in the gut wall of IBS patients.

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Specially designed longstanding nasobiliary tubes allow to reflect upon some well established therapeutic rules. The safe, decompressing effect of the tube leads to prompt relief of obstructive suppurative cholangitis. Therefore emergency of laparotomy can be avoided in high risk patients. Large common bile duct stones until now have required a large papillotomy with increased frequency of complications. The attempt to dissolve those stones with Capmul is justified on an account of a 50% success rate. Either a very small EPT or even non is necessary in order to insert the tube.

In an evaluation of endoscopic-radiological cholangiopancreaticographies (ERCP), in addition to variations in the form of the papilla of Vater, peripapillary diverticula were found on 34 and papillae with several orifices on 19 occasions. The most frequently found pancreatic anomaly at 2.70/o (18 cases) was the non-fusion of the original double "anlage" of the pancreatic duct systems. Accessory pancreatic duct, annular pancreas, ancillary pancreas, cystic fibrosis, choledochus cyst, accessory bile duct, deep hepatic bifurcation and anomalies of the gallbladder are demonstrated. Knowledge of the atypical forms and the anomalies involving papilla, pancreas and common bile duct system, is important, even though they occur in only small percentage of cases, in order to avoid misinterpretations. Key-Words: Anomalies of biliary ducts, anomalies of pancreas, ERCP, retrograde cholangiography, retrograde pancreaticography. Variationen und Anomalien von Papilla Vateri, Pankreas und Gallengangsystem Bei Auswertung von 911 endoskopisch-radiologischen Cholangiopankreatikographien (ERCP) fanden sich neben Formvarianten der Papilla Vateri 34mal peripapilläre Divertikel und 19 Papillen mit mehreren Orifizien. Die häufigste Pankreasatypie stellt mit insgesamt 2,7°/o (18 Fälle) die Nichtvereinigung der urspriinglich doppelt angelegten Pankreasgangsysteme dar. Akzessorischer Pankreasgang, Pancreas annulare, Nebenpankreas, Mukoviszidose, Choledochuszyste, akzessorischer Gallengang, tiefe Hepatikusgabel und Anomalien der Gallenblase werden demonstriert. Die Kenntnis von Atypien und Anomalien an Papille, Pankreas und Gallenwegssystem ist wichtig, auch wenn sie nur in einem geringen Prozentsatz vorkommen, um Fehldeutungen zu vermeiden. Downloaded by: University of British Columbia. Copyrighted material.