tion not only relieves jaundice and pruritus in these patients but also improves other symptoms and quality of life. The considerable improvement in appetite after stenting was of particular benefit.

Splenomegaly size and abnormal HVP are useful predictors of chronic liver disease and cirrhosis, and both can be measured reliably and reproducibly. However, Doppler measurements of PVV, PVD and HARI are not useful in distinguishing patients with chronic liver disease from normal controls.

The commonly reported gastrointestinal side effects-that occur with erythromycin are related to its prokinetic action on the gut, mediated, at least in part, by its motilin receptor stimulating activity. This action may be of clinical use in conditions associated with gastrointestinal hypomotility such as diabetic gastroparesis and intestinal pseudo-obstruction, although further work needs to be done to establish the long term therapeutic uses of erythromycin in these disorders. Macrolide compounds with no antibacterial properties but which have a pronounced prokinetic action on the gut have already been synthesised and are currently being developed for future use in man. These 'motilides' should provide a useful addition to our rather limited armamentarium of effective gastrointestinal prokinetic agents.

No abstract

Octreotide therapy in acromegaly is associated with an increased prevalence of gall stones, which may be the result of an inhibition of gall bladder motility. Gail stone prevalence in untreated acromegalic patients relative to the general population is unknown, however, and the presence of gail stones and gail bladder motility in these patients and in acromegalic patients receiving octreotide was therefore examined. Thirteen patients with gall stone disease were also studied. Six aged 43-56 years (one woman) had undergone percutaneous cholecystolithotomy and were free of stones at the time of this study, and seven patients aged 28-78 years (four women) had gall stones in the gall bladder. Ultrasound of the gall bladder after percutaneous cholecystolithotomy showed no evidence of thickening or tethering of the gall bladder wall.