Carcinoid tumors may develop in any part of the gastrointestinal tract. They constitute 1.5% of all gastrointestinal tumors (1). The duodenum is one of the least common sites of this tumor, with a reported incidence varying between 0.2% and 8.9% (2, 3). We report on a case of a bleeding duodenal carcinoid in a patient who underwent bilateral nephrectomy for malignant hypertension.

There are two reasons for treating renovascular hypertension: first, to normalize blood pressure; and secondly, to prevent or improve renal failure due to renal artery stenosis, especially in patients with a solitary kidney, bilateral renal artery stenoses, or damaged contralateral kidney. There is no established way of distinguishing patients with progressive from those with stable disease.

Percutaneous transluminal renal dilatation (PTRD) as a useful clinical method could be more strongly advocated after development of the coaxial double-lumen balloon catheters by Grüntzig for iliac and coronary artery dilatation [2, 3, 4, 5, 6, 7, 8, 9, 10, 11]. Only a safe technique of passing the stenosis and dilatation with balloon could be an alternative to vascular surgery.

Wegen des Verdachtes auf eine Nierenarterien- oder Transplantatarterienstenose wurden 17 Patienten im Alter von 27–67 Jahren angiografiert und beim Vorliegen einer Stenose nach Möglichkeit dilatiert. Die Indikation zur Angiografie ergab sich in zwei von vier Fällen durch das Frühurogramm, in fünf von sechs Fällen durch das Nephrogramm und wurde in den übrigen Fällen allein durch den klinischen Untersuchungsbefund bestimmt. Der seitengetrennte Reninquotient war lediglich bei zwei von sechs Patienten mit unilateraler Nierenarterienstenose erhöht.

Bei vier Patienten mit maligner renaler Hypertonie wurde die Nierenarterienembolisation (Spiralembolisation nach Gianturco) als Alternative zur bilateralen Nephrektomie durchgeführt: drei Patienten mit funktionierendem Nierentransplantat und medikamentös nicht einstellbarer Hypertonie ohne Nachweis von Gefäßstenosen am Transplantat. Ein Dialysepatient mit maligner Hypertonie (Volumenunabhängig, therapieresistent). Der Hochdruck konnte in allen Fällen gebessert und die Antihypertensiva reduziert werden.

14 patients with severe hypertension showed unilateral (7) or bilateral (6) stenoses of renal artery due to arteriosclerosis (12) or fibromuscular hyperplasia (7); one stenosis appeared after renal transplantation. Successful application of percutaneous transluminal angioplasty of renal artery was performed in 14 stenoses. 4 of 10 patients showed normal values of blood-pressure, in 4 patients blood-pressure was improved, in 2 patients hypertension remained unchanged. The patients were observed 1 to 23 months after dilatation; antihypertensive drugs were necessary in all cases, but could be reduced. The effectiveness of the procedure was demonstrated by renal arteriogram and determination of pre- and poststenotic blood-pressure values.

: Embolization of renal arteries (coil embolization by Gianturco) was performed in four patients with malignant renal hypertension as an alternative to bilateral nephrectomy. Three patients with successful renal transplantation developed intractable hypertension without arterial stenosis of the transplant. One patient treated with hemodialysis showed malignant hypertension refractory to volume depletion and antihypertensive therapy. In all cases hypertension could be improved and thus medical therapy be reduced.

Intragastric titration can be used not only for the quantiative assessment of gastric secretion in healthy subjects and patients with peptic ulcer, but also for differentiating disorders in the regulation of HCI secretion. It is useful foe evaluating the effect of antacids after stimulation of acid secretion with a test meal. The duration of action of an antacid taken about one hour after a meal was much greater than when taken on an empty stomach. Results in 12 healthy subjects indicate that frequent small meals (6 to 8 daily) and antacids between meals greatly reduce gastric acidity. Whether these findings hold true for patients with peptic ulcer remains to be determined.

Der die Magensekretion des Menschen stimulierende Effekt einer akuten Hypercalcämie ist schon lange bekannt und durch zahlreiche Untersuchungen belegt [1, 2, 4, 5, 6, 8]. Hingegen wurde der ubiquitäre Antagonismus von Magnesium bisher kaum untersucht. Es liegen in vitro und tierexperimentelle Untersuchungen an der motorischen Endplatte, im Säugerhirn, an peripheren Ganglien, an der Speicheldrüse und am Nebennierenmark vor, die einen calciumantagonistischen Effekt aufzeigen. Bisher wurde die Wirkung akuter Hypermagnesiämie auf die durch Calcium, Pentagastrin und Histamin stimulierte Magensekretion geprüft [6, 7]. Während durch akute Hypermagnesiämie die calcium- und pentagastrinstimulierte gastrale Säuresekretion signifikant inhibiert wird, war bei der durch Histamin submaximal angeregten HCL-Sekretion ein inhibitorischer Effekt nur auf die gastrale Volumensekretion nachweisbar.

Laparoscopic pancreoscopy offers the possibility of carrying out endoscopic pancreatic biopsy. Previously, the removal of tissue specimens from the pancreas was possible only at surgery and was associated with a mortality rate of 3.8% and a complication rate of up to 20%. The percentage of false negative results was between 12% and 54% with a mean figure of 35%. With the introduction of fine needle biopsy (Kifa-Franzen instrumentarium), pancreatic biopsy seems to have become a low-risk and diagnostically useful method which should also be utilized endoscopically.