Endoscopic clipping of esophageal perforation after pneumatic dilation for achalasia.

A 67-year-old man with a long history of achalasia underwent pneumatic dilation of the lower esophageal sphincter due to increasing dysphagia. During the procedure, a small perforation of the thoracic part of the distal esophagus occurred. Since the rupture was small, well-confined, and detected immediately, the lesion was closed using endoscopically applied metallic clips.

[Nicotine and the gastrointestinal tract].

Reflux esophagitis occurs much more often in smokers because of reduction of saliva production and lessened tonus of the LES (lower esophageal sphincter). Duodenal ulcers heal during H2-blocking agents in smokers slower than during placebo-therapy in non smokers. Mortality of duodenal ulcer in smokers is 2 to 7 times increased.

[Accuracy of sonography in the diagnosis of diffuse liver parenchymal diseases--comparison of sonography and liver histology].

A prospective study has been carried out on 127 patients to test the accuracy of sonography in the diagnosis of diffuse liver diseases compared with histology based on percutaneous liver biopsy. Using sonographic criteria - size, margin, surface, elasticity, echo structure and sonic conductivity of the liver, hepatic veins and portal vein - and measuring the size of the gallbladder and the spleen, the following sonographic diagnoses were made: normal liver, fatty liver, fatty liver fibrosis, alcoholic hepatitis, chronic active hepatitis, cirrhosis. Sonographic diagnosis predicted histological diagnosis in case of normal liver in 56%, fatty liver 70%, alcoholic hepatitis 92%, chronic active hepatitis 63%, cirrhosis 79%.