[Primary sclerosing cholangitis].

In a 40-year-old patient unexplained recurrent attacks of epigastric colic with transient cholestatic icterus occurred over a 9-year period. When the patient was again hospitalised because of progressive pain-free icterus associated with mild pruritus (alkaline phosphatase 900 U/l, direct bilirubin 305 mumol/l, GOT 187 U/l, GPT 103 U/l) sonography revealed liver enlargement to 17 cm, extended intrahepatic bile ducts and an echodense area of about 1 cm size in the region of the bifurcation of the common hepatic duct. Fine-needle puncture did not yield clear cytological findings.

[Eosinophilic fasciitis (Shulman's syndrome)].

A 36-year-old man had noted a firm and painful swelling of the upper and lower limb, increasing over the previous few weeks. He had no fever, but the erythrocyte sedimentation rate was slightly increased (20 mm in the first hour). In addition there was a mild normochromic, normocytic anaemia (13 g/dl) and thrombocytosis (517,000/microliters).

[Paroxysmal non-hereditary angioedema].

Recurrent hypovolaemic shock had been occurring over the last five and four years, respectively, in a 53-year-old woman and a 46-year-old man who had previously been healthy. The attacks were characterized by a tension feeling and sometimes oedema in the limbs, as well as increased thirst. Within a few hours sweating, tachycardia, orthostatic complaints and shock would occur.

[Intestinal drug smuggling--a new diagnostic and therapeutic problem].

Since spring 1985 81 persons were examined because of suspected intestinal drug-smuggling (body-packing). 46 patients (57%) had drug-packages in the gastro-intestinal tract, in 35 persons (43%) the suspicion was not confirmed. 26 patients had swallowed the drugs (mostly cocaine) whereas in 20 cases drugs were found in the rectum (mostly heroine).

[Idiopathic cold agglutinin disease. Clinical aspects, therapy and course in 6 patients].

Clinical features, diagnostic procedure, therapy, course of the disease and prognosis in 6 patients with severe idiopathic chronic cold agglutinin disease are described. In 5 patients the main complaint was cold mediated acrocyanosis. The cold agglutinin in all patients was of anti-I type and belonged to IgM immunoglobulin.

[Principles of modern antibiotic therapy in general practice and the clinic].

It is reported on the principles of modern therapy with antibiotics and here above all is referred to the differences in the antibiotic treatment in practice and clinic. Issuing from the infections usually occurring in practice with the spectre of causative agents known in many cases the therapeutic possibilities are discussed also taking into consideration economic points of view. In contrast to this in infections in the clinic, so-called nosocomial diseases, changing situations are present, which need a therapy on the basis of the antibiogramme.

[Which uric acid value is in need of treatment?].

Asymptomatic hyperuricemia should be treated only if the plasma uric acid levels are around 10 mg/100 ml or more on several determinations. In addition, patients on a purine-free diet who excrete more than 600 mg uric acid per 24 h should be treated. In both cases, treatment is intended to be prophylactic against gouty nephropathy.