G A S T R O E N T E R O L O G Y Volume 97, July-December 1989

Editor

Raj K. Goyal Beth Israel Hospital ( L Y 3 3 0 )

3 3 0 Brookline Avenue Boston, Massachusetts 0 2 2 1 5

FAX: ( 6 1 7 ) 7 3 1 - 5 7 2 8

Consulting Editor

William Silen Beth Israel Hospital Boston, Massachusetts 0 2 2 1 5

Associate Editors

Jules L. Dienstag Massachusetts General Hospital Boston, Massachusetts 0 2 1 1 4

John L. Gollan Brigham and Women's Hospital Boston, Massachusetts 0 2 1 1 5

James L. Madara Brigham and Women's Hospital Boston, Massachusetts 0 2 1 1 5

Satish Rattan Beth Israel Hospital Boston, Massachusetts 0 2 2 1 5

Allan Walker Massachusetts General Hospital Children's Hospital Boston, Massachusetts 0 2 1 1 4

Selected Summaries Editor Mark Feldman Dallas, Texas

Book Review Editor Howard Spiro New Haven, Connecticut

Chairman of Editorial Board

Jerry S. Trier Boston, Massachusetts

Editorial Board

Thomas Brasitus, Chicago, Illinois Raymond F. Burk, Nashville, Tennessee Donald L. Castell, Winston-Salem, North Carolina Helen J. Cooke, Columbus, Ohio Robert M. Donaldson, Jr., New Haven, Connecticut William C. Duane, Minneapolis, Minnesota Charles O. Elson III, Birmingham, Alabama Ralph Giannella, Cincinnati, Ohio Roberto Groszmann, New Haven, Connecticut W. Gary Hardison, San Diego, California Walter J. Hogan, Milwaukee, Wisconsin Albert L. Jones, San Francisco, California Mary Jeanne Kreek, New York, New York Nicholas F. LaRusso, Rochester, Minnesota Robert K. Ockner, San Francisco, California Jay A. Perman, Baltimore, Maryland David F. Ransohoff, New Haven, Connecticut Charles T. Richardson, Dallas, Texas George Scheele, New York, New York Francis Simon, Denver, Colorado William J. Snape, Jr., Torrance, California Michael Steer, Boston, Massachusetts David H. Van Thiel, Pittsburgh, Pennsylvania Tädataka Yamada, Ann Arbor, Michigan

Officers of the American Gastroenterological Association

President Eugene D. Jacobson Denver, Colorado

President Elect David H. Alpers St. Louis, Missouri

Vice-President Sidney Cohen Philadelphia, Pennsylvania

Secretary * Gregory L. Eastwood Worcester, Massachusetts

Treasurer Martin Brotman San Francisco, California

C O N T E N T S O F V O L U M E 9 7

NO. 1, JULY 1989

A L I M E N T A R Y T R A C T

1 In tes t ina l I m m u n e React ivi ty to I n t e r l e u k i n 2 Differs A m o n g Crohn's Disease, Ulcerat ive Col i t i s , a n d Controls ' K . K U S U G A M I , K . R . Y O U N G M A N , G . A . W E S T , A N D C . FlOCCHI

10 Persistent Complement A c t i v a t i o n i n Submucosal Blood Vessels of A c t i v e I n f l a m m a t o r y B o w e l Disease: I m m u n o h i s t o c h e m i c a l Evidence T . S . HALSTENSEN, T . E . M O L L N E S , A N D P . BRANDTZAEG

20 Increased N e u t r o p h i l Receptors f o r . a n d Response to the P r o i n f l a m m a t o r y Bacter ia l Peptide F o r m y l - M e t h i o n y l -Leucyl-Phenylalanine i n Crohn's Disease P . A . A N T O N , S .R . Τ ARG A N , A N D F. S H A N A H A N

29 Studies of In tes t ina l L y m p h o i d Tissue. X I I . Ep i the l ia l Lymphocyte a n d Mucosa l Responses to Rectal Gluten Challenge i n Celiac Sprue D . E . L O F T , M . N . M A R S H , G . I . SANDLE, P . T . CROWE,

V . GARNER, D . GORDON, A N D R . BAKER

38 Colonic ΛΓ-Acetylation of 5 -Aminosa l i cy l i c A c i d i n I n f l a m m a t o r y B o w e l Disease H . ALLGAYER, N . O . A H N F E L T , W . KRUIS , U . K L O T Z ,

Κ . FRANK-HOLMBERG, Η . Ν . Α . SÖDERBERG, A N D

G . PAUMGARTNER

42 Regional Differences i n the Vascular Response of the Canine Esophagus to Vasodilators I . PROKOPIW, P . K . D I N D A , A N D I . T . BECK

48 Developmental Profi le o f C h r o m o g r a n i n , H o r m o n a l Peptides, a n d 5 - H y d r o x y t r y p t a m i n e i n Gastrointest inal Endocr ine Cells P . FACER, Α . Ε . BISHOP, G . A . COLE, M . A I T C H I S O N ,

C . H . K E N D A L L , G . V A N ASWEGEN, R . J . A . PENKETH,

C . H . RODEK, P . MCKEEVER, A N D J . M . POLAK

58 Enteroclysis i n the Eva luat ion of Suspected S m a l l Intes t ina l Bleeding D . K . REX, J .C . LAPPAS, D . D . T . M A G L I N T E , M . C . M A L C Z E W S K I ,

K . A . KOPECKY, A N D E . M . COCKERILL

61 Bacter ia l Chemotactic Oligopeptides a n d the Intes t inal Mucosa l B a r r i e r D . M . FERRY, T . J . B U T T , M F . B R O O M , J . H U N T E R , A N D

V . S . C H A D W I C K

68 Effects o f Streptozotocin-Diabetes o n Rät Intes t ina l M u c i n a n d Goblet Cells M . M A N T L E , E . T H A K O R E , E . A T K I N S , R . M A T H I S O N , A N D

J.S. D A V I S O N

76 A u t o r a d i o g r a p h i c Loca l iza t ion o f Sigma O p i o i d Receptors i n d i e Gastrointest inal Tract o f the Guinea Pig F. R O M A N , X . PASCAUD, G . CHOMETTE, L . B U E N O , A N D

J . L . JUNIEN

. 83 Pylor ic M o t o r Response to I n t r a d u o d e n a l Dextrose Involves M u s c a r i n i c Mechanisms D . R . F O N E , M . H O R O W I T Z , J. D E N T , N . W . R E A D , A N D

R . HEDDLE

91 A n a t o m i c , M o t o r , a n d C l i n i c a l Assessment o f Ver t i ca l Banded Gastroplasty K . E . BEHRNS, N . J . SOPER, M . G . SARR, K . A . K E L L Y , A N D R . W . HUGHES

98 A r b a p r o s t i l [15(R)-15-Methyl Prostaglandin E 2 ] i n a Single N i g h t t i m e Dose of Either 50 or 100 μ% i n Acute Duodenal Ulcer A . R . EULER, R.J . BAILEY, M . A . Z I N N Y , M . L . B R A N D O N , Β . ROUSSEAU, J .P. FERGUSON, D . R . W O O D , A N D V . H . L E

104 Measurement of the Surface H y d r o p h o b i c i t y o f H u m a n Gastrointest inal Mucosa R . T . SPYCHAL, J . M . MARRERO, S . H . SAVERYMUTTU, A N D T . C . NORTHFIELD

112 Importance of an A l k a l i n e M i c r o e n v i r o n m e n t for R a p i d Rest i tut ion o f the Rabbit Duodenal Mucosa I n V i t r o W . FEIL, S . KLIMESCH, P . KARNER, E . W E N Z L , M . STARLINGER, E . R . L A C Y , A N D R . SCHIESSEL

123 Effect o f Sialoadenectomy o n A d a p t i v e Cytoprotect ion i n the Rat B . L . TEPPERMAN, B . D . SOPER, A N D G . P . M O R R I S

130 I m p a i r e d I n t e r n a l A n a l Sphincter i n a Subgroup o f Patients W i t h I d i o p a t h i c Fecal Incontinence W . M . S U N , N . W . READ, A N D T . C . D O N N E L L Y

L I V E R , P A N C R E A S , A N D B I L I A R Y T R A C T 136 Hepatocel lular Carc inoma W i t h a n d W i t h o u t Cirrhosis .

A Comparison i n Southern A f r i c a n Blacks M . C K E W

140 Hepatocel lular Carc inoma W i t h o u t Cirrhosis i n Japanese Patients K . O K U D A , T . N A K A S H I M A , M . KOJIRO, Y . K O N D O , A N D K . W A D A

147 Exocrine Pancreatic F u n c t i o n A f t e r Gastrectomy. Specif ici ty o f Indi rec t Tests G . HEPTNER, S. DOMSCHKE, A N D W . DOMSCHKE

154 Associat ion of Focal N o d u l a r H y p e r p l a s i a a n d Hepatic Hemangioma D . M A T H I E U , E . S . Z A F R A N I , M - C . A N G L A D E , A N D D . D H U M E A U X

158 Effect o f Diuresis Versus Therapeut ic Paracentesis o n Asci t ic F l u i d Opsonic A c t i v i t y a n d Serum Complement Β . Α . R U N Y O N , M . R . A N T I L L O N , A N D A . A . M O N T A N O

163 Fat-Storing (Ito) Cells o f Rat L i v e r Synthesize a n d Secrete A p o l i p o p r o t e i n s : Compar ison W i t h Hepatocytes G . R A M A D O R I , H . RIEDER, F . THEISS, A N D K - Η . M E Y E R Z U M BÜSCHENFELDE

173 Effect o f Ursodeoxychol ic A c i d A d m i n i s t r a t i o n o n Nuc lea t ion T i m e i n H u m a n Gal lb ladder Bi le S. T A Z U M A , H . S A S A K I , S . M I Z U N O , H . S A G A W A , S. H A S H I B A , I . H O R I U C H I , A N D G . K A J I Y A M A

179 Subunit Interact ions a n d Physical Properties o f Bovine Gal lb ladder M u c i n B . F . S M I T H , J . A . PEETERMANS, T . T A N A K A , A N D J . T . L A M O N T

C A S E R E P O R T S 188 L ive iLTransplanta t ion i n a Patient W i t h P r o t o p o r p h y r i a

J .R. B L Ö O M E R , £ M . K . WEIMER, I . C . BOSSENMAIER, D . C . SNOVER, W.D*. P A Y N E ^ N D N . L . ASCHER

195 Gastric S m a l l L y m p h o c y t i c Pro l i fe ra t ion W i t h I m m u n o g l o b u l i n Gene Rearrangement i n Pseudolymphome Versus L y m p h o m a S . H . S IGAL, S . H . S A U L , H . E . A U E R B A C H , Ε . RAFFENSPERGER, J . A . K A N T , A N D J.J. BROOKS

202 Removal o f C o m m o n Bi le Duct Stones by the C o m b i n a t i o n of Percutaneous Ba l loon D i l a t a t i o n a n d Extracorporeal Shock-Wave L i t h o t r i p s y J . N . GROEN, M . T . W . T . LOCK, J.S. LAMERIS, M . V A N BLANKENSTEIN, A N D O . T . TERPSTRA

207 Neuroendocr ine Cel l Prol i ferat ions i n Gastric A n t r a l Vascular Ectasia J .R. LOWES A N D J. RODE

i v CONTENTS GASTROENTEROLOGY V o l . 97, N o . 6

B R I E F R E P O R T S 213 Spontaneous Rupture of Nonparas i t ic Cyst of the L iver

E . A . AKRIVIADIS , H . STEINDEL, P . RALLS, A N D A . G . REDEKER

216 N e u r o h u m o r a l Pathways M e d i a t i n g Stress-Induced Changes i n Rat Gastrointest inal Trans i t H J . L E N Z

219 S t i m u l a t i o n of G 2 -Arres ted Rat L i v e r and Pancreas Cells by Fasting R. D A O U S T

E D I T O R I A L 222 L y m p h o k i n e - A c t i v a t e d K i l l e r - C e l l Cytotoxic i ty i n the

Intes t inal I m m u n e System M . E . K A N O F A N D W . STROBER

S E L E C T E D S U M M A R I E S 225 ^ - A n t i t r y p s i n Deficiency: T w o Wrongs Call M a k e a

Right

226 M i c r o v a s c u l a r A n g i n a of the Esophagus?

228 Psychoneuroimmunology: Interact ions o f the Central Nervous System a n d the Intes t inal I m m u n e System

230 Is Low-Dose Pulse Methotrexate Hepatotoxic i n Rheumatoid A r t h r i t i s ?

231 A d d i t i o n a l Evidence That Celiac Disease Is a Genetically Determined, I m m u n o a l l e r g i c Disease

233 Pro-Choice—Sulfasalazine or 5 -Aminosa l i cy l i c A c i d i n Ulcerat ive Col i t is

234 A l l That Flushes Is Not C a r c i n o i d

236 BOOK R E V I E W S

C O R R E S P O N D E N C E 240 Corticotropin-Releasing Factor a n d Stress-Induced

Gastrointestinal Al te ra t ions

240 M i t o c h o n d r i a l Aspartate Aminotransferase i n Nonalcohol ic Cirrhosis

241 Diagnosis of Sphincter o f O d d i Dysfunct ion

241 Ethanol-Induced Intes t ina l Mucosa l I n j u r y

242 Mechanisms of Carrageenan I n j u r y o f Cel l Monolayers

243 Dysplasia i n Ulcerat ive Col i t is : A n e u p l o i d y Versus Morphology

245 The M a n p o w e r Posi t ion: Is the Expense Too Immense to M a k e Sense?

246 Posttransfusion Hepat i t i s i n Buenos A i r e s , A r g e n t i n a

246 The D-Xylose Test i n Pediatr ics : Is I t Useful?

247 Fine Needle L iver Biopsy of Hepatoce l lu lar Carc inoma: Is Sampl ing Simple?

248 Fecal L i p i d Excretion i n Pancreatic Insuff ic iency

249 Technet ium 99m Phagocyte Scanning i n I n f l a m m a t o r y Bowel Disease

251 N O T I C E S

252 C L A S S I F I E D A D S

NO. 2, A U G U S T 1989

A 3 T h i s M o n t h i n GASTROENTEROLOGY 304 Lipoxygenase Metaboli tes i n the Rat Gastric Microvascular Response to Intragastr ic Ethanol Y . Y O N E I A N D P . H . G U T H

A L I M E N T A R Y T R A C T 255 Effect o f Folate Supplementat ion o n the Incidence of

Dysplasia and Cancer i n Chronic Ulcerat ive Coli t is Β A . LASHNER, P . A . HEIDENREICH, G L . Su, S . V . K A N E , A N D

S . B . H A N A U E R

260 I n h i b i t o r y Effect o f G a l a n i n o n Postprandia l Gastrointest inal M o t i l i t y and Gut H o r m o n e Release i n Humans F.E. BAUER, A . Z I N T E L , M . J . K E N N Y , D . CALDER, M . A . G H A T E I , A N D S.R. B L O O M

265 M o r t a l i t y i n Celiac Disease R.F .A. L O G A N , E . A . RIFKIND, I . D . TURNER. A N D X FERGUSON

272 Endoscopic Laser Treatment for Rectosigmoid V i l l o u s Adenoma: Factors Affect ing the Results J . M . BRUNETAUD, V . M A U N O U R Y , D . COCHELARD, B . BONIFACE,

A . CORTOT, A N D J . C PARIS

278 Role of A r a c h i d o n i c A c i d Metabolites i n Acid-Pepsin I n j u r y to Rabbit Esophagus B . E . STEIN, M . L . S C H W A R T Z M A N , M . A . CARROLL, R . E . S T A H L ,

A N D W . S . ROSENTHAL

284 Bi la tera l Adrenalec tomy Worsens Gastric Mucosal Lesions Induced by I n d o m e t h a c i n i n the Rat K . T A K E U C H I , H . N I S H I W A K I , M . O K A D A , H . N H D A , A N D

S. O K A B E

294 Surfactant A p p r o a c h to the Gastric Mucosa l Barr ier : Protection of Rats by Banana Even W h e n A c i d i f i e d Β . Α . H I L L S A N D C . A . KIRWOOD

313 Electr ical A c t i v i t y Recorded F r o m A b d o m i n a l Surface A f t e r Gastrectomy or Colectomy i n H u m a n s F . PEZZOLLA, G . RIEZZO, M . A . M A S E L L I , A N D I . GIORGIO

321 C l i n i c a l T r i a l o f C l o n i d i n e H y d r o c h l o r i d e as an Antisecretory Agent i n Cholera G . H . R A B B A N I , Τ . BUTLER, D . P A T T E , A N D R . L . A B U D

326 I n f l a m m a t o r y M e d i a t o r s o f Exper imenta l Col i t i s i n Rats D . RACHMILEWITZ, P . L . S I M O N , L . W . SCHWARTZ,

D . E . GRISWOLD, J . D . FONDACARO, A N D M . A . W A S S E R M A N

338 S t ruc tura l and Enzymatic Changes D u r i n g Colonic M a t u r a t i o n i n the Fetal and S u c k l i n g Rat P . C . COLONY, J . M . K O I S , A N D L . P . PEIFFER

348 Expression of Substance P / N e u r o k i n i n A-Encoding P r e p r o t a c h y k i n i n Messenger Ribonucleic A c i d s i n the Rat Enteric Nervous System C . STERNINI, Κ . ANDERSON, G . F R A N T Z , J .E. KRAUSE, A N D

N . BRECHA

357 Ascorbic A c i d i n the H u m a n Stomach G . M . SOBALA, C.J . ScHORAH, M . SANDERSON, M . F . D I X O N ,

D . S. TOMPKINS, P . G O D W I N , A N D A . T . R . A X O N

364 Parietal Cell Äutoantigens I n v o l v e d i n Neonata l Thymectomy-Induced M u r i n e A u t o i m m u n e Gastr i t is Y. M O R I , K . F U K U M A , Y . A D A C H I , K . SHIGETA, R . K A N N A G I ,

Η . ΤΑΝΑΚΑ, M . S A K A I , K . K U R I B A Y A S H I , H . U C H I N O , A N D

f . M A S U D A

376 Blocked and N o n b l o c k e d A c i d Secretion a n d Reported Pain i n Ulcer , N o n u l c e r Dyspepsia, a n d N o r m a l Subjects S. BATES, P - O . SJODF;N, J. FELLENIUS, A N D O . N Y R £ N

December 1989 CONTENTS ν

384 Quant i ta t ion of the Rabbit Intes t inal G l y c o l i p i d Receptor for Shiga T o x i n M . MOBASSALEH, S . K . GROSS, R.H. M C C L U E R , A . DONOHUE-ROLFE, A N D G . T . KEUSCH

392 Cell Lineage M a r k e r s i n Premalignant a n d M a l i g n a n t Colonic Mucosa S . B . H o , S . H . ITZKOWITZ, A . M . FRIERA, S - H . JIANG, A N D Y . S . K I M

405 Central Nervous System A c t i o n o f Thyrotropin-Releas ing Hormone to Increase Gastric Mucosal B lood F l o w i n the Rat G . T H I E F I N , Y . TACHE", F . W . LEUNG, A N D P.H. G U T H

412 S t i m u l a t i o n of Duodenal Mucosa l Bicarbonate Secretion i n the Rat by B r a i n Peptides G . FLEMSTRÖM A N D G . JEDSTEDT

L I V E R , P A N C R E A S , AND B I L I A R Y T R A C T 421 Development of Large Spleno-Adreno-Renal Shunt A f t e r

Endoscopic Sclerotherapy J .B . D I L A W A R I , G . S . RAJU, A N D Y . K . C H A W L A

427 Benign Recurrent Intrahepat ic Cholestasis: A l t e r e d Bi le A c i d Metabol ism C . M . A . BIJLEVELD, R.J . V O N K , F . KUIPERS, R . H A V I N G A , R . BOVERHOF, B.J . K O O P M A N , B . G . WOLTHERS, A N D J. FERNANDES

433 Patterns of Leukocyte Chemotaxis to Bi le A f t e r L i v e r Transplanta t ion D . H . A D A M S , D . BURNETT, R . A . STOCKLEY, A N D E . ELIAS

439 Early Indicators o f Prognosis i n F u l m i n a n t Hepatic Fa i lure J .G . O ' G R A D Y , G . J . M . ALEXANDER, K . M . H A Y L L A R , A N D R . W I L L I A M S

446 Effect of A g i n g o n I n V i v o a n d I n V i t r o Ethanol Metabol ism and Its T o x i c i t y i n F344 Rats H . K . SEITZ, M . M E Y D A N I , I . FERSCHKE, U . A . S IMANOWSKI , J. BOESCHE, M . BOGUSZ, W - W . HOEPKER, J .B . BLUMBERG, A N D R . M . RUSSELL

457 Gallstone Disappearance A f t e r Extracorporeal L i t h o t r i p s y and O r a l Bi le A c i d Dissolut ion T . PONCHON, A . N . B A R K U N , Β . PUJOL, J . L . M E S T A S , A N D R. LAMBERT

C A S E R E P O R T S 464 Gastr in-Producing O v a r i a n Cystadenocarcinoma:

Sensit ivity to Secretin and SMS 201-995 J. H E Y D , N . L I V N I , D . HERBET, S. M O R - Y O S E F , A N D Β . GLASER

468 O v a r i a n Carc inoma as a Cause of Z o l l i n g e r - E l l i s o n Syndrome P . N . M A T O N , S . M . M A C K E M , J . A . N O R T O N , J . D . GARDNER, T . M . O 'DORISIO, A N D R . T . JENSEN

B R I E F R E P O R T S 472 Shock-Wave T h e r a p y of Gastric Outlet Syndrome Caused

by a Gallstone J. H O L L , Μ . S A C K M A N N , R . H O F F M A N N , P . SCHÜSSLER, Τ . SAUERBRUCH, D . JÜNGST, A N D G . PAUMGARTNER

475 Cerebral Responses Evoked by Electr ical S t i m u l a t i o n of the Esophagus i n N o r m a l Subjects T . FRIELING, P . ENCK, A N D M . WIENBECK

479 H L Α Ä l , B8, DR3 Extended Haplotypes i n A u t o i m m u n e Chronic Hepat i t i s B . T A I T , L R . M A C K A Y , P . BOARD, M . COGGAN, P . EMERY, A N D G . ECKARDT

S P E C I A L R E P O R T S AND R E V I E W S 482 G r o w t h o f Digestive Diseases Research Funds and

Investigators Supported by the N a t i o n a l Insti tutes of H e a l t h S . C . KALSER A N D V . L . W . G O

488 Hemostasis i n L i v e r T r a n s p l a n t a t i o n R.J. PORTE, E . A . R . K N O T , A N D F . A . BONTEMPO

E D I T O R I A L S 502 Folate, Dysplasia , and Cancer

I . H . ROSENBERG A N D J .B . M A S O N

504 Federal Suppor t for Digestive Diseases Research J.S. TRIER

S E L E C T E D S U M M A R I E S 506 Ant i -endoplasmic Ret i cu lum A n t i b o d y i n A u t o i m m u n e

Chronic A c t i v e H e p a t i t i s — A n A n t i b o d y Comes of Age

507 U n r a v e l i n g the Mystery of H D V and Its M o d e o f Repl icat ion : One Step F o r w a r d

508 A n t i m i c r o b i a l Therapy of Duodenal Ulcer? H o l d Off for N o w !

510 Management of Necrot iz ing Pancreatitis

512 The A , B, C of D-Xylose A b s o r p t i o n

513 Hirschsprung's Disease: Matters o f M a t r i x and M i g r a t i o n

515 BOOK REVIEWS

T R A I N I N G AND E D U C A T I O N I N G A S T R O E N T E R O L O G Y

518 List of A v a i l a b l e T r a i n i n g Programs

C O R R E S P O N D E N C E 550 Dietary Fat In take , 72-Hour Excret ion, a n d Sudan Stain

for Fecal Fat

551 Extrapancreatic Lipases

552 O l d Insight I n t o a N e w Insight I n t o an O l d Test

553 ΜΚ-329 Has N o Direct Effect o n the Pancreas

554 Prostaglandins i n the M e d i a t i o n o f Secret in-Induced I n h i b i t i o n of Gastric Secretion a n d S t i m u l a t i o n of Pancreatic Secretion

556 I m m u n o p r o l i f e r a t i v e S m a l l B o w e l Disease

558 N O T I C E S

559 C L A S S I F I E D A D S

NO. 3, SEPTEMBER 1989 A 3 This M o n t h i n GASTROENTEROLOGY

A L I M E N T A R Y T R A C T 561 I n h i b i t i o n of A c i d Secretion by Bombesin Is Par t ly

Media ted by Release of Fundic Somatostatin M . L . SCHUBERT A N D J. HIGHTOWER

568 Placebo-Controlled T r i a l W i t h the Somatostatin Analogue SMS 201-995 i n Peptic Ulcer Bleeding J. CHRISTIANSEN, R . OTTENJANN, F . V O N A R X , A N D THE STUDY GROUP

575 Mast Cells A r e Closely Apposed to Nerves i n the H u m a n Gastrointest inal Mucosa R . H . STEAD, M . F . D I X O N , N . H . B R A M W E L L , R . H . RIDDELL, A N D J. BIENENSTOCK

v i C O N T E N T S GASTROENTEROLOGY V o l . 97, N o . 6

586 C i r c u l a t i n g Gastr in , Endocrine Cells, His tamine Content, and H i s t i d i n e Decarboxylase A c t i v i t y i n A t r o p h i c Gastrit is D . C A T T A N , A - M . ROUCAYROL, J - M . L A U N A Y , J. CALLEBERT, Ν . CHARASZ, Y . N U R I T , J. BELAICHE, A N D R. K A L I F A T

597 Sensit ivi ty, Specif icity, a n d Positive Predic t iv i ty of the Hemoccult Test i n Screening for Colorectal Cancers J.S. M A N D E L , J . H . B O N D , M . BRADLEY, D . C . SNOVER, T . R . CHURCH, S. W I L L I A M S , G . W A T T , L . M . S C H U M A N , F . EDERER, A N D V . GlLBERTSEN

601 Dietary Caloric Density a n d Osmola l i ty Influence Gastroesophageal Reflux i n Infants J . L . SUTPHEN A N D V . L . DlLLARD

605 N e u t r o p h i l i c Proteases: Mediators of F o r m y l - M e t h i o n y l -Leucyl -Phenylalanine- Induced I le i t i s i n Rats C . V O N RITTER, R . B E , A N D D . N . GRANGER

610 Exper imenta l Studies o f In ject ion Therapy for Severe Nonvar i cea l Bleeding i n Dogs P. RUTGEERTS, K . GEBOES, A N D G . VANTRAPPEN

622 Isolated Colonocyte Metabol ism of Glucose, Glutamine , n-Butyrate , a n d /3-Hydroxybutyrate i n M a l n u t r i t i o n A . FlRMANSYAH, D . P E N N , A N D E. LEBENTHAL

630 Ul t rasonography i n the Diagnosis of Acute A p p e n d i c i t i s : A Prospective Study W . B . SCHWERK, B . WICHTRUP, M . R O T H M U N D , A N D J. RÜSCHOFF

640 I n V i v o A l k a l i n e Secretion by M a m m a l i a n Esophagus B . H . H A M I L T O N A N D R . C . O R L A N D O

649 Prostaglandin Prevents A s p i r i n I n j u r y i n the Canine Stomach U n d e r I n V i v o But Not I n V i t r o Condit ions J . M . H E N A G A N , K . L . SCHMIDT, A N D T . A . M I L L E R

660 Cigarettes and A l c o h o l as Independent Risk Factors for Colonic Adenomas J . W . KlKENDALL, P.E. B O W E N , M . B . BURGESS, C . M A G N E T T I , J. W O O D A R D , A N D P. LANGENBERG

665 Electr ical Correlates o f Peristaltic and Nonperis ta l t ic Contract ions i n the Opossum Smooth Muscle Esophagus W . G . PATERSÖN

676 M i c r o w a v e Energy Compared W i t h Heater Probe and BICAP i n Canine Models o f Peptic Ulcer Hemorrhage P.A. MlCHALETZ A N D D . JUDGE

685 R a p i d Epi the l ia l Rest i tut ion of H u m a n a n d Rabbit Colonic Mucosa W . FEIL, E.R. L A C Y , Y - M . M . W O N G , D . BURGER, E. W E N Z L , M . STARLINGER, A N D R . SCHIESSEL

702 Ingestion of Corrosive A c i d s . Spectrum of I n j u r y to U p p e r Gastrointest inal Trac t a n d N a t u r a l H i s t o r y S . A . ZARGAR, R . KOCHHAR, B . N A G I , S . M E H T A , A N D S . K . M E H T A

L I V E R , P A N C R E A S , AND B I L I A R Y T R A C T 708 Influence of L i v e r Disease o n Hepatic A l c o h o l and

A l d e h y d e Dehydrogenases J. PANES, X . SOLER, A . PARE*S, J. CABALLERiA, J. FARR^S, J. RODE'S, A N D X . Ρ ARE'S

715 Evidence for Disease Recurrence A f t e r L i v e r Transplanta t ion for P r i m a r y B i l i a r y Cirrhosis R.J. POLSON, B . P O R T M A N N , J. NEÜBERGER, R . Y . C A L N E , A N D R. W I L L I A M S

726 Gallstone Recurrence A f t e r Successful O r a l B i le A c i d Treatment N . V I L L A N O V A , F . B A Z Z O L I , F . T A R O N I , R . FRABBONI, G . M A Z Z E L L A , D . FESTI, L . BARBARA, A N D E . R O D A

732 Effect o f Somatostatin o n Plasma A m i n o A c i d Uptake by H u m a n Pancreas L . G U L L O , R . PEZZILLI , A N D L . BARBARA

737 Evaluat ion of Computed Tomography i n the Assessment of L iver I r o n Over load D . GUYADER, Y . G A N D O N , Y . DEUGNIER, H . JOUANOLLE, O . LOREAL, M . S I M O N , Μ . BOUREL, Μ . CARSIN, A N D P . BRISSOT

744 Effects of the Benzodiazepine Receptor Antagonist F lumazeni l i n Hepatic Encephalopathy i n H u m a n s G . BANSKY, P.J. MEIER, E . RIEDERER, H . WALSER, W . H . ZlEGLER, A N D M . SCHMID

C A S E R E P O R T S 751 Legionella In fec t ion of the Colon Presenting as Acute

A t t a c k of Ulcerat ive Col i t i s T . SCHMIDT, A . PFEIFFER, W . EHRET, Ε . KEIDITSCH, G . RUCKDESCHEL, A N D H . KAESS

756 Heal ing of Severe Perineal and Cutaneous Crohn's Disease W i t h Hyperbar i c Oxygen C . E . BRADY I I I , B . J . COOLEY, A N D J .C. D A V I S

761 Dietary M o d i f i c a t i o n o f Chyle Composi t ion i n Chylothorax G L . JENSEN, E . A . M A S C I O L I , L . P . MEYER, S . M . LOPES, S.J. BELL, V . K . B A B A Y A N , G . L . B L A C K B U R N , A N D B . R . BISTRIAN

766 Hepatic Peroxisomal A b n o r m a l i t i e s i n Abeta l ipoprote inemia j . C . COLLINS, L H . SCHEINBERG, D . R . G I B L I N , A N D I. STERNLIEB

771 Postbulbar Duodenal Ulcer i n a Patient W i t h Pentagastrin-Fast A c h l o r h y d r i a M . GOLDSCHMIEDT, W . L . PETERSON, F . V U I T C H , A N D M . F E L D M A N

B R I E F R E P O R T S 775 Effect o f Cyc l i ca l U n i p o l a r Depression on U p p e r

Gastrointest inal M o t i l i t y a n d Sleep N . J . T A L L E Y , M . C A M I L L E R I , B . A . O R K I N , A N D K . G . KRAMLINGER

778 N e u t r o p h i l - D e r i v e d Oxidants Mediate F o r m y l - M e t h i o n y l -Leucyl -Phenyla lanine- Induced Increases i n Mucosa l Permeabi l i ty i n Rats C . V O N RITTER, M . B . G R I S H A M , Μ . H O L L W A R T H , W . I N A U E N , A N D D . N . GRANGER

S P E C I A L R E P O R T S AND R E V I E W S 781 A r a c h i d o n i c A c i d Metabol i tes i n H e p a t o b i l i a r y

Physiology a n d Disease D . L . K A M I N S K I

E D I T O R I A L S 793 W h y Does the Gastric O x y n t i c G l a n d Mucosa Conta in

Gastrin-Releasii ig Peptide Nerve Fibers? J . H . W A L S H

796 Pharmacotherapy o f Bleeding Peptic Ulcer—Is I t T i m e to Give U p the Search? W . L . PETERSON

S E L E C T E D S U M M A R I E S 798 Gut Proteins a n d Hemochromatosis

799 Losing Weight , But G a i n i n g Gallstones (But Maybe Not)

800 Raf-1 Protein: A Cytoplasmic Signal T r a n s d u c i n g Agen for Prol i ferat ive S t i m u l i

802 Regulation of T ight Junct ion Permeabi l i ty i n the Intes t inal E p i t h e l i u m

803 Gastric Ulcer Management: Is Long-Term Maintenance Therapy Necessary?

804 C a l c i u m and Colon Cancer

805 The L i v e r Is Man ' s Carburetor

December 1989 CONTENTS v i i

807 B O O K R E V I E W S

C O R R E S P O N D E N C E

810 Hepatic I n j u r y Related to E n a l a p r i l

810 Hepatic E p i t h e l i o i d Hemangioendothel ioma i n P r i m a r y B i l i a r y Cirrhosis

811 Formyl -Methionyl -Leucyl -Phenyla lan ine- Induced Intest inal I n f l a m m a t i o n

813 NOTICES

813 CORRECTION

814 CLASSIFIED ADS

NO. 4 ,

A 3 This M o n t h i n GASTROENTEROLOGY

A L I M E N T A R Y T R A C T

815 Discordance Between F l o w Cytometric Abnormal i t i e s and Dysplasia i n Barrett 's Esophagus M . B FENNERTY, R . E . SAMPLINER, D . W A Y , R. RIDDELL, K . STEINBRONN, A N D H . S . GAREWAL

821 Clearance of Spontaneous Gastroesophageal Reflux i n A w a k e and Sleeping Infants J . M . SONDHEIMER

827 Long-Term Efficacy and Safety of Omeprazole i n Patients W i t h Z o l l i n g e r - E l l i s o n Syndrome: A Prospective Study P . N . M A T O N , R . V I N A Y E K , H . FRUCHT, K . A . M C A R T H U R , L . S . M I L L E R , Z . A . SAEED, J . D . GARDNER, A N D R . T . JENSEN

837 Effect of Acute Suppression of A c i d Secretion by Omeprazole o n Postprandial Gastr in Release i n Conscious Dogs C . SIMOENS, M C . WOUSSEN-COLLE, A N D J. D E GRAEF

846 Enprost i l Reduces the Increase of Gastric Corpus Mucosal Mass Induced by the Hydrogen-Potassium-Stimulated Adenosine Triphosphatase I n h i b i t o r BY 831-78 i n the Rat W . I N A U E N , C . ROHNER, H . R . KOELZ, J. H E R D M A N N , C - C . SCHÜRER-MALY, L . V A R G A , A N D F . HALTER

853 I n h i b i t i o n of Stress-Induced Gastric I n j u r y i n the Rat by Glutathione M . HlROTA, M . INOUE, Y . A N D O , K . H I R A Y A M A , Y . M O R I N O , K . S A K A M O T O , K . M O R I , A N D M . A K A G I

860 Suppression of N o c t u r n a l A c i d Secretion W i t h Famotidine Accelerates Gastric Ulcer Heal ing A . J . M C C U L L O U G H , D . Y . G R A H A M , T . E . K N U F F , F . L . L A N Z A , H . L . LEVENSON, D . T . L Y O N , W . P . M U N S E L L , J. PEROZZA, W M . ROUFAIL, D . R . SINAR, J. LACEY S M I T H , R . S . B E R MAN, J .K . ROOT, W . E . WORLEY, A N D T. J . HUMPHRIES

867 Relat ionship Between Gastric A c i d and Elevated Plasma Somatostat inl ike I m m u n o r e a c t i v i t y Af ter a M i x e d Meal M . R . LUCEY, J . A . H . W A S S , L . H . REES, A . M . D A W S O N , A N D P . D . FAIRCLOUGH

873 Cell-Free Synthesis of Rat and Rabbit Gastric Proton Pump A . S M O L K A , G. SACHS, A N D P . LORENTZON

882 N a + / H + Exchange i n Isolated Hamster Enterocytes. Its M a j o r Role i n In t race l lu lar p H Regulation J. GORg A N D C . H O I N A R D

888 O r n i t h i n e Decarboxylase and Diamine Oxidase i n H u m a n Colon Carcinoma Cell L ine CaCo-2 i n Cul ture L . D ' A G O S T I N O , B . DANIELE, S. P IGNATA, R. GENTILE, P . TAGLIAFERRI, A . CONTEGIACOMO, G. SILVESTRO, C . POLISTINA, A . R . B I A N C O , A N D G. M A Z Z A C C A

895 Assessment of Lactose Absorpt ion by Measurement of U r i n a r y Galactose J . D . G R A N T , J . A . BEZERRA, S . H . THOMPSON, R.J. L E M E N , O . KOLDOVSKY, A N D J . N . ÜDALL, JR.

900 Geographic Origins of Jewish Patients W i t h I n f l a m m a t o r y Bowel Disease M - P . R O T H , G . M . PETERSEN, C . MCELREE, E . F E L D M A N , A N D J . I . ROTTER

ER 1989 905 Home N o c t u r n a l Supplemental Nasogastric Feedings i n

Growth-Retarded Adolescents W i t h Crohn's Disease H . AIGES, J. M A R K O W I T Z , J. ROSA, AND F . D A U M

911 Intest inal M o t o r A c t i v i t y i n Exper imenta l H y p e r t h y r o i d i s m i n Conscious Dogs M . K A R A U S , M . WIENBECK, Μ . GRUSSENDORF, J .F. ERCKENBRECHT, A N D G . STROHMEYER

920 Mucosal I n j u r y Induced by Ischemia and Reperfusion i n the Piglet Intestine: Influences of Age a n d Feeding K . D . CRISSINGER A N D D . N . GRANGER

927 Intest inal Permeabil i ty i n Patients W i t h Crohn's Disease and Thei r Heal thy Relatives K . D . K A T Z , D . HOLLANDER, C M . V A D H E I M , C . MCELREE, T . DELAHUNTY, V . D . D A D U F A L Z A , P . KRUGLIAK, A N D J . I . ROTTER

932 Psychological and Physiological Characteristics of Patients W i t h Severe I d i o p a t h i c Const ipat ion A . W A L D , J.P. H I N D S , A N D B.J . C A R U A N A

938 Influence of Infusate Viscosity on Intest inal A b s o r p t i o n i n the Rat B . W . ANDERSON, J . M . KNEIP, A . S . LEVINE, A N D M . D . LEVITT

944 Use of Microbleeding and an U l t r a t h i n Endoscope to Assess Gastric Mucosal Protection by Famot idine T . K . DANESHMEND, P.J. PRICHARD, N . K . BHASKAR, P.J. M I L L N S , A N D C.J. H A W K E Y

L I V E R , P A N C R E A S , AND B I L I A R Y T R A C T 950 Effect of Secretin o n Bi le F o r m a t i o n i n Rats W i t h

Cirrhosis of the L iver : S t ructure-Funct ion Relat ionship J. KNUCHEL, S. KRÄHENBÜHL, Α . Z I M M E R M A N N , A N D J. REICHEN

958 Effect of Roux-en-Y B i l i a r y Divers ion o n Campylobacter pylori H . J . O ' C O N N O R , K . M . NEWBOLD, J. A L E X A N D E R - W I L L I A M S , H . THOMPSON, J. D R U M M , A N D I . A . D O N O V A N

965 Treatment of Hepatocel lular Carc inoma by Transcatheter A r t e r i a l Embol izat ion Combined W i t h I n t r a a r t e r i a l In fus ion of a M i x t u r e of C isp la t in and Ethiodized O i l H . K A S U G A I , J. KOJIMA, M . T A T S U T A , S. O K U D A , Y . S A S A K I , S. I M A O K A , M . FUJITA, A N D S. ISHIGURO

972 H L A - L i n k e d Hemochromatosis Al le les i n Sporadic P o r p h y r i a Cutanea Tarda C . Q . EDWARDS, L . M . GRIFFEN, D . E . GOLDGAR, M . H . SKOLNICK, A N D J.P. KUSHNER

982 Immunocytochemica l Loca l izat ion of M y o s i n i n N o r m a l a n d Phal loidin-Treated Rat Hepatocytes S. Y A S U U R A , T . U E N O , S. W A T A N A B E , M . HIROSE, A N D T . N A M I H I S A

990 Detection of Hepatitis Β Virus X Gene Protein and Antibody in Type Β Chronic Liver Disease K . K A T A Y A M A , N . H A Y A S H I , Y. S A S A K I , A . K A S A H A R A , K . U E D A , Η. F U S A M O T O , N . S A T O , O. C H I S A K A , K . M A T S U B A R A , A N D T. K A M A D A

999 Rat But Not Human Interferons Suppress Hepatic Oxidative Drug Metabolism in Rats P.I . C R A I G , S.J. W I L L I A M S , E. C A N T R I L L , A N D G.C. FARRELL

v i i i CONTENTS GASTROENTEROLOGY V o l . 97, N o . 6

1005 Pancreatic K a l l i k r e i n Gene Expression: Effects o f Glucocort icoids I n V i v o a n d I n V i t r o S. ROSEWICZ A N D C D . LOGSDON

1011 Effects o f I r o n Loading o n Free Radica l Scavenging Enzymes a n d L i p i d Peroxidat ion i n Rat L i v e r L . M . FLETCHER, F . D . ROBERTS, M . G . IRVING, L . W . POWELL, A N D J . W . H A L L I D A Y

C A S E R E P O R T 1019 Membranous Obstruct ion o f the I n f e r i o r Vena Cava

Associated W i t h a M y e l o p r o l i f e r a t i v e Disorder F . SEVENET, H . D E R A M O N D , A . HADENGUE, N . CASADEVALL, J. DELAMARRE, A N D J-P. CAPRON

B R I E F R E P O R T S 1022 Steatohepatitis Associated W i t h L i m b L i p o d y s t r o p h y

E . E . POWELL, J. SEARLE, A N D R . MORTIMER

1025 Pancreatic Duct-Porta l V e i n F is tula S . M . W I L L I S A N D T . G . BREWER

1028 Suppurat ive Pylethrombosis : A Changing C l i n i c a l Picture D . C . KNOCKAERT, G . K . ROBAEYS, E.J. Cox, A N D G.J . M A R C H A L

1031 Prevalence of Acute Enteric V i r a l Pathogens i n A c q u i r e d Immunodef i c iency Syndrome Patients W i t h Diarrhea K . T . KALJOT, J .P. L I N G , J . W . M . G O L D , B . E . L A U G H O N , J . G . BARTLETT, D . P . KOTLER, L . S . OSHIRO, A N D H . B . GREENBERG

S P E C I A L R E P O R T S A N D R E V I E W S 1033 Parenteral N u t r i t i o n W i t h Branched-Chain A m i n o A c i d s

i n Hepatic Encephalopathy. A Meta-Analys is C D . N A Y L O R , K . O ' R O U R K E , A . S . DETSKY, A N D J .P. BAKER

E D I T O R I A L S 1043 Meta-Analysis o f Branched-Chain A m i n o Ac ids i n

Hepatic Encephalopathy J . A . BERLIN A N D T . C . CHALMERS

1045 I n h i b i t i o n of Hydrogen-Potassium-Stimulated Adenosine Triphosphatase: Effects o n A c i d Secretion, Plasma Gastr in , a n d the Gastric Mucosa J .E. M C G U I G A N

1049 N u t r i t i o n i n L i v e r Fa i lure G . L . BLACKBURN A N D S . J .D. O ' K E E F E

S E L E C T E D S U M M A R I E S 1052 N o n - A , Non-B Hepat i t i s : F i n a l l y the B ig Breakthrough

1053 Misopros to l Prevents Nonstero ida l A n t i i n f l a m m a t o r y Drug- Induced Gastric Ulcers—Has Pandora's Box Been Opened?

1055 Salmonella Bacterial Adherence and Penetrat ion of Mucosal Cells: I n d u c i n g Role o f the E p i t h e l i u m

1056 T u m o r Necrosis Factor i n A l c o h o l i c Hepat i t i s

1057 Does M e t h y l Ter f -Buty l Ether Result i n an E m p t y Gallbladder?

1059 BOOK R E V I E W S

C O R R E S P O N D E N C E 1063 Aerobic Exercise and Mouth- to-Cecum Trans i t T i m e

1064 Dysplasia a n d Adenocarc inoma i n Barrett 's Esophagus

1064 K e r c k r i n g Duodenal Folds i n Celiac Disease

1065 Embolotherapy for Severe Iatrogenic Hepatic I n j u r y

1066 Cimet idine and A l c o h o l A b s o r p t i o n

1068 Presence of H B V D N A and HBeAg i n Serum o f an A n t i -HBs-Positive I n d i v i d u a l

1069 Serum I m m u n o g l o b u l i n G A n t i b o d y Levels f o r Campylobacter pylori Diagnosis

1071 N O T I C E S

1072 C O R R E C T I O N

1073 C L A S S I F I E D A D S

NO. 5, NOVEMBER 1989

A 3 T h i s M o n t h i n GASTROENTEROLOGY

A L I M E N T A R Y T R A C T 1075 Expression of I m m u n e Sensit ization to Epi the l ia l Cel l -

Associated Components i n the Cotton-Top T a m a r i n H . S . W I N T E R , P . M . C R U M , JR., N . W . K I N G , P . K . SEHGAL, A N D J . K . ROCHE

1083 Role o f Peptide H i s t i d i n e Isoleucine i n Relaxation of Cat L o w e r Esophageal Sphincter P . B I A N C A N I , M . C . BEINFELD, C . HILLEMEIER, A N D J. BEHAR

1090 Short -Chain Fatty A c i d s i n B o w e l Contents A f t e r Intes t ina l Surgery P . BR0BECH MORTENSEN, J. HEGNH0J, T . R A N N E M , H . SANDVAD RASMUSSEN, A N D K . H O L T U G

1097 Seroreactivity of Patients W i t h Crohn's Disease W i t h L y m p h Nodes o f P r i m e d Nude M i c e Is Independent o f the Tissue Used for P r i m i n g H C . W A L V O O R T , G . E . F A Z Z I , A N D A . S . P E N A

1101 Stress-Induced Changes i n Gastric E m p t y i n g , Postprandial M o t i l i t y , and Plasma G u t Hormone Levels i n Dogs ' M . G U E , T . PEETERS, I . DEPGORTERE, G . VANTRAPPEN, A N D L . B U E N O

1108 A u t o r a d i o g r a p h i c Study of the Regional D i s t r i b u t i o n of Gastric B lood F l o w i n Porta l Hypertensive Rats J . G . GERAGHTY, W . J . ANGERSON, A N D D . C . CARTER

1115 Lack o f an Associat ion Between Po lymorphisms o f the T-Cell Receptor α-Chain a n d Ulcerat ive Col i t i s L . M . R A N D O L P H , H . T O Y O D A , C . K . MCELREE, F . S H A N A H A N , S .R. T A R G A N , A N D J . I . ROTTER

1121 Ulcers Produced by L i g a t i o n of I n d i v i d u a l Gastric Mucosa l Arter ies i n the Guinea Pig C . PIASECKI, C . THRASIVOULOU, A N D " A . R A H I M

1130 Central Neurotensin I n h i b i t s Gastric A c i d Secretion: A n Adrenergic M e c h a n i s m i n Rats L . Z H A N G , L . X I N G , L . DEMERS, J. W A S H I N G T O N , A N D G . L . K A U F F M A N , JR.

1135 M i g r a t i o n of the Myoelec t r i c Complex A f t e r I n t e r r u p t i o n o f the Myenter ic Plexus J.J. G A L L I G A N , J .B . FURNESS, A N D M . COSTA

1147 Potentiat ion o f A s p i r i n - I n d u c e d Gastric Lesions by Exposure to C o l d i n Rats A . ROBERT, F . W . L E U N G , D . G . KAISER, A N D P . H . G U T H

1159 Glycine-Extended Processing Intermediates o f Gastr in and Cholecys tok in in i n H u m a n Plasma J. D E L V A L L E , K . S U G A N O , A N D Τ . Y A M A D A

December 1989 CONTENTS i x

1164 Mechanisms o f Polyethylene G l y c o l 400 Permeabi l i ty o f Perfused Rat Intestine P . K R U G L I A K , D . HOLLANDER, T . Y . M A , D . T R A N , V . D . D A D U F A L Z A , K . D . K A T Z , A N D K . L E

1171 I m m u n o h i s t o c h e m i c a l Survey o f Cobalamin-Binding Proteins E.Y . LEE, B . SEETHARAM, D . H . ALPERS, A N D K . D E S C H R Y V E R - K E C S K E M E T I

1181 M a n o m e t r i c Responses to Ba l loon Dis tent ion i n Patients W i t h Nonobstruct ive Dysphagia W . K . DESCHNER, K . A . M Ä H E R , E .L . C A T T A U , JR., A N D

S . B . BENJAMIN

1186 Comparat ive Study of Clostridium difficile T o x i n A a n d Cholera T o x i n i n Rabbit I l e u m G . TRIADAFILOPOULOS, C . POTHOULAKIS, R . WEISS , C . GlAMPAOLO, A N D J . T . L A M O N T

1193 Repair o f M i c r o v i l l i i n the Rat S m a l l Intest ine A f t e r Damage W i t h Lectins Contained i n the Red K i d n e y Bean M . D . W E I N M A N , C . H . A L L A N , J.S. TRIER, A N D S.J. H Ä G E N

1205 Gastric O r i g i n o f the First-Pass M e t a b o l i s m of Ethanol i n Humans : Effect of Gastrectomy J. CABALLERIA, M . FREZZA, R . H E R N A N D E Z - M U N O Z , C . D I P A D O V A , M . A . KORSTEN, E. B A R A O N A , A N D C S . LIEBER

1210 Thrombogenic i ty o f T o t a l Parenteral N u t r i t i o n Solut ions: I . Effect o n i n d u c t i o n of Monocyte/Macrophage Procoagulant A c t i v i t y A . WAKEFIELD, Z . C O H E N , M . CRAIG, P . CONNOLLEY,

K . N . JEEJEEBHOY, R . S ILVERMAN, A N D G . A . L E V Y

1220 Thrombogenic i ty o f T o t a l Parenteral N u t r i t i o n Solut ions: I I . Effect o n I n d u c t i o n of Endothe l ia l Cel l Procoagulant A c t i v i t y A . WAKEFIELD, Z . C O H E N , A . ROSENTHAL, M . CRAIG,

K . N . JEEJEEBHOY, A . GOTTLIEB, A N D G . A . L E V Y

L I V E R , P A N C R E A S , AND B I L I A R Y T R A C T 1229 Extracorporeal Shock-Wave L i t h o t r i p s y a n d M e t h y l tert-

B u t y l Ether for P a r t i a l l y Calci f ied Gallstones C. J. PEINE, B . T . PETERSEN, H . J . W I L L I A M S , C.E. BENDER,

D . E. PATTERSON, J . W . SEGURA, D . M . NAGORNEY,

M . A . W A R N E R , A N D J . L . THISTLE

1236 Iso la t ion a n d M o r p h o l o g i c Character izat ion of B i le Ducf Epi the l ia l Cells F r o m N o r m a l Rat L i v e r M . ISHI I , B . V R O M A N , A N D N . F . L A R U S S O

1248 Iso la t ion of a N o n p a r e n c h y m a l L i v e r Cel l Frac t ion Enr iched i n Cells W i t h B i l i a r y E p i t h e l i a l Phenotypes G . A L P I N I , R . L E N Z I , W - R . Z H A I , M . H . L I U , P . A . SLOTT,

F . PARONETTO, A N D N . T A V O L O N I

1261 Effect o f Die tary Cholesterol o n Phosphat idylchol ines and Phosphatidylethanolamines i n B i le a n d Gal lb ladder Mucosa i n the Pra i r ie Dog

. M . L . BOOKER, Τ . Ε . SCOTT, A N D W . W . L A M O R T E

1268 Ursodeoxycholic A c i d i n P r i m a r y B i l i a r y Cirrhosis : Results o f a Contro l led Double -B l ind T r i a l U . LEUSCHNER, H . FISCHER, W . K U R T Z , S. G Ü L D Ü T U N A , Κ . HUBNER, Α . HELLSTERN, Μ . G A T Z E N , A N D Μ . LEUSCHNER

1275 I n h i b i t i o n o f D u c k Hepat i t is Β V i r u s Repl ica t ion by 2',3'-Dideoxycyt id ine . A Potent I n h i b i t o r o f Reverse Transcriptase C. KASSIANIDES, J . H . HOOFNAGLE, R . H . M I L L E R , E. D O O ,

H . FORD, S. BRODER, A N D H . M I T S U Y A

11281 A n a t o x i n Bt F o r m a m i d o p y r i m i d i n e A d d u c t s i n H u m a n Hepatocarcinogenesis: A P r e l i m i n a r y Report H - S . LEE, I . SAROSI, A N D G . N . V Y A S

1288 Prognosis o f Cort icosteroid-Treated Hepat i t i s Β Surface Antigen-Negat ive Chronic A c t i v e Hepat i t i s i n Postmenopausal W o m e n : A Retrospective Ana lys i s K . K . W A N G A N D A . J . C Z A J A

1294 Blockade of the Hydroosmot ic Effect o f Vasopressin Normal izes Water Excret ion i n C i r r h o t i c Rats J. C L A R I A , W . JIMENEZ, V . A R R O Y O , F . GUARNER, C . LOPEZ, G . L A V I L L A , M . ASBERT, F . RIVERA, A N D J. RODES

1300 Misonidazo le B i n d i n g i n M u r i n e L i v e r Tissue: A M a r k e r f o r Ce l lu lar H y p o x i a I n V i v o A . P . M A X W E L L , M . P . M A C M A N U S , A N D T . A . GARDINER

1304 Systemic a n d Regional Hemodynamics i n Patients W i t h L i v e r Cirrhos is a n d Ascites W i t h a n d W i t h o u t F u n c t i o n a l Renal F a i l u r e J. FERNANDEZ-SEARA, J. PRIETO, J, QUIROGA, J . M . Z O Z A Y A , M . A . COBOS, J . L . RODRIGUEZ-EIRE, A . G A R C I A - P L A Z A , A N D J. L E A L

C A S E R E P O R T 1313 H i g h Plasma Pancreastat inl ike I m m u n o r e a c t i v i t y i n a

Patient W i t h M a l i g n a n t I n s u l i n o m a K . T A T E I S H I , A . F U N A K O S H I , A . J I M I , S. F U N A K O S H I , H . T A M A M U R A , H . Y A J I M A , A N D Y . M A T S U O K A

B R I E F R E P O R T S 1319 Jaundice as a Paraneoplastic Phenomenon i n a T-Cel l

L y m p h o m a J. W A T T E R S O N A N D J.R. PRIEST

1323 Acute A i r w a y Obstruct ion i n Achalas ia . Possible Role of Defective Belch Reflex D . J . BECKER A N D D . O . CASTELL

1327 Resolut ion o f In tes t ina l Cryptospor idios is A f t e r Treatment o f A I D S W i t h A Z T R . E . GREENBERG, R . M I R , S . B A N K , A N D F ; P . SIEGAL

1331 Effects o f L o x i g l u m i d e o n G a l l b l a d d e r E m p t y i n g i n Hea l thy Volunteers C . NIEDERAU, Τ . HEINTGES, L . R O V A T I , A N D G . STROHMEYER

E D I T O R I A L 1337 I so la t ion o f In t rahepat ic B i le Duct E p i t h e l i a l Cells: Clues

f o r F u n c t i o n A . L . JONES A N D D . L . SCHMUCKER

S E L E C T E D S U M M A R I E S

1340 Surgery o r Pneumatic D i l a t a t i o n f o r Achalas ia : A Head-to-Head Comparison. N o w A r e A l l the Questions Answered?

1341 Special ized Receptors f o r Ant igens o n G u t E p i t h e l i a l Τ Cells

1342 Sporadic Chronic N o n - A , Non-Β V i r a l Hepat i t i s : A M o r e Ominous Diagnosis T h a n First Surmised?

1344 Somatostatin a n d Postgastrectomy D u m p i n g

1344 N S A I D S m a l l B o w e l I n j u r y a n d Cytoprotec t ion

1345 Synergism Between Vasoactive In tes t ina l Polypept ide a n d Carbachol-Mediated Responses i n a H u m a n M u c u s -Secreting Colonic E p i t h e l i a l Cel l L i n e

1347 B O O K R E V I E W S

χ C O N T E N T S f GASTROENTEROLOGY V o l . 97, No. 6

C O R R E S P O N D E N C E

1353 Radiology and Endoscopy Complementary i n Ear ly Gastric Cancer

1354 Release of Gastr in by Secretin

1354 Mycobacteria as the Cause of Crohn's Disease

1356 Effect o f Prostaglandin E 2 i n Exper imenta l Col i t i s

1358 N O T I C E S

1359 C L A S S I F I E D A D S

A53 C A L L F O R A B S T R A C T S

NO. 6, DECEMBER 1989

A 3 T h i s M o n t h i n GASTROENTEROLOGY

1361 Reorganizing the A G A : W h y , H o w , a n d W h e n . The Presidential Address R . M . G L I C K M A N

1368 Presentation o f the Julius F r i e d e n w a l d M e d a l to M a r v i n H . Sleisenger, M . D . R . K . OCKNER

A L I M E N T A R Y T R A C T 1372 Prol i ferat ive Responses of H u m a n I n t r a e p i t h e l i a l

Lymphocytes to Var ious T-Cell S t i m u l i E . C . EBERT

1382 I m m u n o c y t o c h e m i c a l Study of Peptidergic Structures i n Brunner ' s Glands A . BOSSHARD, S. CHERY-CROZE, J .C. CUBER, M . A . DECHELETTE, F . BERGER, A N D J . A . C H A Y V I A L L E

1389 Effect o f Exercise and Physical Fitness o n Large Intes t ina l F u n c t i o n S . A . B I N G H A M A N D J . H . C U M M I N G S

1400 Regulat ion of Eicosanoid Product ion i n Rabbit Colon by I n t e r l e u k i n - 1 F . C O M I N E L L I , C . C . N A S T , C . A . DINARELLO, P . G E N T I U M , A N D R . D . ZIPSER

1406 Gastr in Is a M a j o r M e d i a t o r o f the Gastric Phase of A c i d Secretion i n Dogs T . O . G . KOVACS, J . H . W A L S H , V . M A X W E L L , H . C . W O N G , T . A Z U M A , A N D E . K A T T

1414 Ident i f i ca t ion of Neurotransmit ters Regulating Intest inal Peristalt ic Reflex i n H u m a n s J .R. GRIDER

1420 Leukotrienes C 4 and D 4 Potentiate A c i d Product ion by Isolated Rat Parietal Cells W . SCHEPP, D . K A T H , C . T A T G E , B . Z I M M E R H A C K L , V . SCHUSDZIARRA, A N D Μ . CLASSEN

1430 A c t i v a t i o n of the Complement System i n P r i m a r y Sclerosing Cholangit is G . SENALDI , P . T . D O N A L D S O N , S. M A G R I N , J . M . FARRANT, G . J . M . ALEXANDER, D . V E R G A N I , A N D R . W I L L I A M S

1435 A b i l i t y o f H u m a n Colonic E p i t h e l i u m to Express the 4F2 A n t i g e n , the C o m m o n Acute Lymphoblas t ic Leukemia A n t i g e n , a n d the T r a n s f e r r i n Receptor S. P A I S A N D F . P A L L O N E

1442 Lack of Associat ion Between O r a l Contraceptive Use and Crohn's Disease B . A . LASHNER, S . V . K A N E , A N D S . B . H A N A U E R

1448 R a p i d Decrease i n Electr ical Conductance of M a m m a l i a n Duodenal Mucosa I n V i t r o H . J. MACHEREY A N D K - U . PETERSEN

1461 Long-Term Influence o f Enteric In fec t ion o n Jejunal Propuls ion i n Guinea Pigs H . A L I Z A D E H , W . A . W E E M S , A N D G . A . CASTRO

1469 Upper Esophageal Sphincter Opening a n d M o d u l a t i o n D u r i n g S w a l l o w i n g P . JACOB, P.J. K A H R I L A S , J . A . L O G E M A N N , V . S H A H , A N D T . H A

L I V E R , P A N C R E A S , AND B I L I A R Y T R A C T 1479 Gal lb ladder Contrac t ion i n Patients W i t h Pigment a n d

Cholesterol Stones J. BEHAR, K.Y. LEE, W . R . THOMPSON, A N D P . B I A N C A N I

1485 Changes i n B i le Duct Diameter A f t e r Cholecystectomy: A 5-Year Prospective Study D . R. H U N T A N D A . J . SCOTT

1489 Ultrasonic Doppler Studies o f Hepatoce l lu lar Carc inoma and Comparison W i t h Other Hepatic Focal Lesions K . O H N I S H I A N D F . N O M U R A

1498 Bile A c i d Synthesis i n Humans : Regulat ion o f Hepatic Microsomal Cholesterol 7α-Hydroxylase A c t i v i t y E. REIHNER, I . BJÖRKHEM, B . A N G E L I N , S. EWERTH, A N D K . ElNARSSON

1506 Reduced Central B l o o d V o l u m e i n Cirrhosis J . H . HENRIKSEN, F . BENDTSEN, T . I . A . SORENSEN, C . STADEAGER, A N D H . RING-LARSEN

1514 Chol ine M a y Be an Essential N u t r i e n t i n M a l n o u r i s h e d Patients W i t h Cirrhosis R . K . C H A W L A , D . C . W O L F , M . H . KUTNER, A N D H . L . BONKOVSKY

1521 Role of Phospholipase A 2 i n H u m a n Acute Pancreatit is M . BÜCHLER, P . MALFERTHEINER, H . SCHÄDLICH-T. J . N E V A L A I N E N , Η . FRIESS, A N D H . G . BEGER

1527 Dietary In take and the Prevalence of Ga l lb ladder Disease i n Mexican A m e r i c a n s A . K . D I E H L , S . M . HAFFNER, J . A . K N A P P , H . P . H A Z U D A , A N D M . P . STERN

1534 Effects of S t i m u l a t i o n of the H y p o t h a l a m i c A r e a o n Pancreatic Exocrine Secretion i n Dogs N . FURUKAWA A N D H . Ö K A D A

1544 Pancreatobi l iary Responses to an Intragastr ic A m i n o A c i d M e a l , M . FRIED, J .B . JANSEN, Τ : HARPOLE, I . L . T A Y L O R , C . B . LAMERS, Τ . REEDY, J. ELASHOFF, A N D J . H . M E Y E R

B R I E F R E P O R T S 1550 Gastrointest inal Bleeding Due to Pancreatic

Schwannoma Compl i ca t ing V o n Recklinghausen's Disease M . M . W A L S H A N D K . BRANDSPIGEL

1552 Collagenous Gastr i t is R . B . COLLETTI A N D T . D . TRAINER

1556 Gastrointest inal Dupl i ca t ions Causing Relapsing Pancreatitis i n C h i l d r e n J .E. L A VINE, M . HARRISON, A N D M . B . H E Y M A N

December 1989 C O N T E N T S x i

1559 R a p i d l y Progressive N o n - A , Non-B Hepat i t is i n Patients W i t h H u m a n Immunodef i c iency V i r u s In fec t ion P. M A R T I N , A . M . D i BISCEGLIE, C. KASSIANIDES, Μ. LISKER-M E L M A N , A N D J . H . HOOFNAGLE

S P E C I A L R E P O R T S A N D R E V I E W S

1562 I m m u n o b i o l o g y a n d I m m u n o p a t h o l o g y o f H u m a n Gut Mucosa : H u m o r a l I m m u n i t y a n d I n t r a e p i t h e l i a l Lymphocytes P. BRANDTZAEG, T . S . HALSTENSEN, K . K E T T , P. KRAJCI, D . K V A L E , T .O. R O G N U M , H . SCOTT, A N D L . M . SOLLID

E D I T O R I A L

1585 A n i m a l Research a n d the Pract ic ing Gastroenterologist R . M . D O N A L D S O N , JR.

S E L E C T E D S U M M A R I E S

1587 T r a n s f o r m i n g G r o w t h Factors a n d Intes t ina l Epi the l ia : M o r e Questions T h a n Answers

1588 M o r e Bang for the B u c k i n Bangkok: Us ing Hepat i t is Β V i r u s Vaccine W i t h o u t Hepat i t i s Β I m m u n e G l o b u l i n

1589 Detection o f Colorectal L i v e r Metastases: W h i c h Imaging Technique Is Best?

1591 A r e A l l Gallstones " S i l e n t " U n t i l Acute Cholecystit is Occurs?

1592 Endoscopy for Gallstone Pancreatit is

1593 Effect o f Cholecystectomy o n Bi le A c i d Kinet ics

1594 Prote in Kinase C Subspecies

1596 B O O K R E V I E W S

C O R R E S P O N D E N C E

1600 Effect o f FOY-305 (Camostate) o n Severe A c u t e Pancreatit is i n T w o Exper imenta l A n i m a l Models

1601 N O T I C E S

1602 C O R R E C T I O N

1603 C L A S S I F I E D A D S

1605 S P E C I A L N O T I C E

1611 A U T H O R INDEX T O V O L U M E 9 7

1623 S U B J E C T INDEX T O V O L U M E 9 7

GASTROENTEROLOGY 1989;97:472-4

B R I E F R E P O R T S

Shock-Wave Therapy of Gastric Outlet Syndrome Caused by a Gallstone

JOSEPH H O L L , MICHAEL SACKMANN, ROBERT HOFFMANN, PETER SCHÜSSLER, T I L M A N SAUERBRUCH, DIETER JÜNGST, and G U S T A V PAUMGARTNER Department of M e d i c i n e I I , K l i n i k u m Grosshadern, Univers i ty of M u n i c h , and Distr ic t Hospi ta l of Garmisch-Partenkirchen, Federal Republic of Germany

A patient with gastric outlet syndrome (Bouveret's syndrome) caused by a large gallstone impacted in the duodenal bulb was successfully treated by ex­tracorporeal shock-wave lithotripsy. Thus, open abdominal surgery could be avoided. For disinte­gration of the stone, three consecutive lithotripsy procedures were necessary. Thereafter, stone frag­ments could be extracted endoscopically. Extracor­poreal shock-wave lithotripsy could become a non­surgical alternative in patients with obstruction of the duodenum caused by a gallstone.

Cholelithiasis is complicated by gallstone ileus in a very small percentage of patients (1,2). Gastric

outlet syndrome (Bouveret's syndrome) caused by a gallstone obstructing the duodenal bulb is a rare but nevertheless life-threatening event that occurs in about 3% of the patients with gallstone ileus (3). Until recently, enterolithotomy has been the only treatment choice (4).

Successful disintegration of gallstones using extra-corporeally generated, focused shock waves has re­cently been introduced as a nonsurgical alternative therapy for gallbladder calculi as well as for stones in the bile duct (5,6). A severely il l patient presented with obstruction of the duodenum caused by a large gallstone. The stone was clearly identified by ultra­sonography. Therefore, we attempted to treat this patient by means of an ultrasound-guided gallstone lithotripter to avoid open abdominal surgery.

Materials and Methods

Patient's History

A 6 7 - y r - o l d m a l e p a t i e n t w a s a d m i t t e d t o t h e h o s ­p i t a l as a n e m e r g e n c y case ( r e s p i r a t o r y f a i l u r e because o f a s p i r a t i o n , w e i g h t loss , h y p o g l y c e m i c c o m a ) . S u c t i o n v i a a n a s o g a s t r i c t u b e y i e l d e d 3 L o f gas t r i c j u i c e . E n d o s c o p y r e v e a l e d a la rge s t o n e o b s t r u c t i n g t h e d u o d e n a l b u l b .

Repeated a t t e m p t s t o r e m o v e t h e s t o n e e n d o s c o p i c a l l y f a i l e d . A p l a i n f i l m of t h e a b d o m e n r e v e a l e d gas i n t h e b i l e d u c t s . U l t r a s o n o g r a p h y d i s c l o s e d a e r o b i l i a , a s tone- f ree g a l l b l a d d e r , a n d a large s t o n e (4.5 c m i n d i a m e t e r ) i n t h e d u o d e n u m , w i t h n o i n t e s t i n a l gas b e t w e e n t h e a b d o m i n a l w a l l a n d t h e s t o n e . T h e s tone w a s r a d i o l u c e n t o n x - r a y ( F i g u r e 1). T h e p a t i e n t r e c e i v e d p a r e n t e r a l n u t r i t i o n . A f t e r t h e g e n e r a l c o n d i t i o n o f t h e p a t i e n t h a d i m p r o v e d , e x t r a ­c o r p o r e a l s h o c k - w a v e l i t h o t r i p s y b y m e a n s o f a b i l i a r y l i t h o t r i p t e r g u i d e d b y u l t r a s o u n d w a s c o n s i d e r e d , a n d t h e p a t i e n t ' s w r i t t e n i n f o r m e d c o n s e n t w a s o b t a i n e d .

Shock-Wave Treatment of the Gallstone Obstructing the Duodenum

T h e p a t i e n t w a s t r e a t e d t h r e e t i m e s b y e x t r a c o r p o ­r e a l s h o c k - w a v e l i t h o t r i p s y u s i n g a n a d v a n c e d g a l l s t o n e l i t h o t r i p t e r ( M P L 9000 ; D o r n i e r M e d i z i n t e c h n i k , G e r m e r ­i n g , F .R.G.) . T h i s l i t h o t r i p t e r e m p l o y s u l t r a s o u n d f o r s tone l o c a t i o n a n d t a r g e t i n g . T h e p a t i e n t w a s t r e a t e d i n a p r o n e p o s i t i o n . T h e s h o c k - w a v e t r e a t m e n t s w e r e p e r f o r m e d w i t h o u t a n y ana lges ic agent o r s e d a t i v e . T h e first l i t h o t r i p ­sy w a s p e r f o r m e d w i t h 1 7 0 0 d i s c h a r g e s at 22 k V w i t h i n 4 8 m i n a n d d i d n o t r e s u l t i n changes o f s t o n e s i z e . T h e s e c o n d t r e a t m e n t w a s p e r f o r m e d 1 d a y l a t e r w i t h 1 4 0 0 d i s c h a r g e s at 2 1 k V w i t h i n 4 0 m i n a n d r e s u l t e d i n d i m i n u t i o n o f s tone d i a m e t e r b y ~ 1 c m . A t repea t e n d o s c o p y , t h e s t o n e c o u l d n o t be r e m o v e d . T h e r e f o r e , a t h i r d t r e a t m e n t w a s p e r ­f o r m e d 10 d a y s l a t e r w i t h 1500 d i s c h a r g e s at 23 k V w i t h i n 40 r h i n .

T h e r e a f t e r , m u l t i p l e s m a l l s t o n e f r a g m e n t s c o u l d be e x t r a c t e d e n d o s c o p i c a l l y , t h e d u o d e n a l o b s t r u c t i o n w a s r e l i e v e d , a n d t h e p a t i e n t ' s c o n d i t i o n i m p r o v e d . R e g u l a r f o o d a n d beverages w e r e t o l e r a t e d w e l l , a n d a w e i g h t g a i n of > 5 k g w i t h i n 1 m o w a s o b s e r v e d . R a d i o l o g i c a l l y , f ree passage of c o n t r a s t m e d i u m w a s d e m o n s t r a t e d ( F i g u r e 1) . A b i l i a r y e n t e r i c fistula w a s n o l o n g e r d e t e c t a b l e , r a d i o l o g ­i c a l l y o r e n d o s c o p i c a l l y .

© 1989 b y the A m e r i c a n Gastroenterological Associat ion 0016-5085/89/$3.50

August 1989 S H O C K - W A V E T H E R A P Y F O R G A L L S T O N E I L E U S 473

Figure 1. Upper gastrointestinal tract series demonstrating obstruction of the duodenal bulb caused by a large gallstone (arrows, left). After fragmentation of the stone by extracorporeal shock-wave lithotripsy and endoscopic extraction of the fragments, free passage of contrast material is observed (right).

Discussion

Obstruction of the duodenum by a gallstone causing gastric outlet syndrome (Bouveret's syn­drome) is a rare but severe complication of gallstone disease (7-9). The treatment of choice of gallstone ileus is surgical removal of the obstructing stone (4,10). As most patients with gallstone ileus are elderly and often present in critical condition, the mortality is as high as 25% (11,12). To our knowl­edge, nonsurgical alternatives have not been de­scribed previously.

Gallstones that cause intestinal obstruction usu­ally enter the intestinal tract via a cholecystenteric fistula (13,14). In most patients, no history of previ­ous acute cholecystitis is obtained, and the diagnosis often is delayed (2). The stones enter either the stomach, the small intestine, or the large bowel. In the small bowel, the stones rarely remain in the duodenum but usually travel for varying length aborally before causing symptoms of obstruction (12). In our patient, the stone probably had entered the duodenum via a biliary enteric fistula. However, at the time of extraction of stone fragments a fistula could no longer be detected. Different opinions exist regarding removal of a stone-free gallbladder after treatment of gallstone ileus (4,10,13).

Most stones causing obstruction at various sites in the intestinal tract wil l be hidden by intestinal gas, and ultrasonography wil l often fail to localize such

stones. However, in our patient ultrasound clearly detected the stone in the duodenum. Successful sonographic identification of stones in the duodenal bulb recently has also been reported by other inves­tigators (15). As shock waves are attenuated by gas-filled structures, only stones not hidden by gas can be treated safely and successfully by extracorpo­real shock-wave lithotripsy. Such a favorable situa­tion can be found in Bouveret's syndrome but prob­ably not in most other cases of gallstone ileus. In our patient, shock-wave lithotripsy was used success­fully for the treatment of obstruction of the duode­num by a gallstone clearly detected by ultrasound. No adverse effects of this nonsurgical therapy were observed.

According to our experience, extracorporeal shock-wave lithotripsy combined with endoscopic extraction of fragments could become an alternative, nonsurgical therapy for gastric outlet syndrome caused by a gallstone.

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Received November 9, 1988. Accepted February 14, 1989. Address requests for reprints to: Dr. Joseph Holl , Department of

Medicine II, Klinikum Grosshadern, University of Munich, 8000 Munich 70, Federal Republic of Germany.