Hepatic flow scintigraphy has been used to evaluate 150 patients with gastrointestinal carcinoma. A normal range has been obtained on a group of 23 healthy volunteers. The flow scintigraphic findings have been correlated with the presence of metastases at the time of primary surgical therapy. The group of patients with livers ostensibly clear of metastases have been followed up over a one-year period. At one year the specificity of the investigation is 72 per cent with a sensitivity of 96 per cent. We conclude that flow scintigraphy is capable of not only detecting established hepatic metastases, but will also identify patients harbouring occult metastatic disease.

Of 507 consecutive recipients of renal allografts, 45 developed a urological complication. In 39 patients (7.7%) ureteric problems were implicated and these comprised 30 cases of obstruction and 9 cases of ureteric necrosis presenting as urinary leakage. In 7 patients ureteric obstruction resolved following a period of nephrostomy decompression; 10 patients were reconstructed surgically and this was successful in 8, with 2 patients requiring further surgical procedures. Ten patients were successfully treated by percutaneous stenting after dilatation of the stricture. Stenting failed in 4 patients and in 1 patient caused rupture of a calix. All 10 stents have now been removed and there is no recurrence of stricture (follow-up 32.0 +/- 8.6 months). Of the remaining 3 grafts, 2 were removed and the other graft had percutaneous removal of a ureteric calculus. The 1-year survival rate of allografts in the ureteric complication group was 84.6%; in the recipients without a urological complication it was 81%. It was concluded that an active approach to ureteric problems following renal transplantation results in the rescue of the majority of allografts.

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suMMARY Both hog gastrin and synthetic gastrin stimulate the cardiac sphincter to increase tone and augment the resistance to reflux. Endogenous gastrin has a similar effect, and gastrin also stimulates the secretion of acid which has also been found to increase the resistance of the sphincter, but the effect of gastrin appears to be independent of the secretory stimulus.Now that the role of gastrin in the control of gastric acid secretion has become clearer, attention has turned to the subsidiary action of this hormone on the smooth muscle of the gastrointestinal tract. Early studies by Blair, Harper, Lake, Reed, and Scratcherd (1961) showed that an extract of antral mucosa produced a marked pressor response in the stomach and upper small intestine of anaesthetized cats. Similar results were later reported by Gregory and Tracy (1964) using an extract of hog antral mucosa to produce stimulation of intestinal motility in dogs.In an earlier study (Giles, Humphries, Mason, and Clark, 1968) we found that the intraluminal pressure of the cardiac sphincter increased when the gastric aspect of the sphincter mucosa was perfused with acid. This suggested a physiological response to gastric secretion such as after eating, and perhaps designed to increase the barrier pressure preventing gastrooesophageal reflux. Following this hypothesis it seemed reasonable to examine whether circulating gastrin, induced during eating, might have a similar effect.In the experiments to be described, the pressures exerted by the lower oesophageal sphincter have been measured before and after the injection of hog gastrins I and II in varying doses, and also after injection of synthetic gastrin (ICI 50,123). The effect of release of endogenous gastrin can be studied in man using the technique of meat extract stimulation (Giles and Clark, 1967; Giles, Buchan, and Clark, 1967). This technique has been adopted to study the effect on the cardiac sphincter in an attempt to ascertain the events likely to occur during digestion. MATERIALS AND METHODSThe methods used to measure the sphincteric pressures in these experiments were similar to those used previously (Giles et al, 1968) and measurements were made of the mean gastric pressure, maximum sphincteric pressure, and the oesophageal pressures, all calculated from the end expiratory measurements. After the sphincteric profile had been determined under resting control conditions, an injection of gastrin was given slowly intravenously and the sphincter profile was repeated after 15 minutes. The gastrin (Leo Labs) was given in a bodyweight dose which carried from 0.005 units to 1.0 units/kg.In five subjects a continuous infusion of pentagastrin (ICI 50,123) was given at a rate of 0-06 tg/kg/hr and sphincter profiles were obtained in the usual way after five and again after 25 minutes of infusion. In a further three subjects, pressure tracings were made before and 15

An ll-year-old boy with terminal ummary hepatic failure due to Wilson's disease was treated 18 months ago with orthotopic liver transplantation. Postoperatively, there has been evidence of clearance of body copper stores but without accumulation of copper in biopsy specimens of the transplanted liver after 6 and 17 months. Further follow-up will be necessary before deciding whether the disorder has been cured by liver replacement and in turn whether this constitutes proof that Wilson's disease is an inborn error of hepatic metabolism. The observations so far are consistent with these conclusions.