No abstract

Since several data refer to the role of immune processes in the pathogenesis of dia. betes mellitus, this study was performed to compare aspecific and specific immune reactions in type Iand in type II diabetic patients over a six month period. The percentage and the absolute number of SRBC-rosette forming active E(A), of theophylline-resistant E(Thr) and of ORCB-rosette forming T(M)-cell subsets proved to be elevated in newly diagnosed type I but reduced in type II diabetic patients. Also an elevated percentage of HLA-DR positive, activated T cells was found in the majo--rity of recent-onset type I diabetics. In the presence of human pancreas extract, a significant inhibition of leucocyte migration, a pronounced and specific cytotoxic capacity of all lymphocyte subsets (especially of the T(G)-cells), and elevated antibody titers (passive haeniagglutination, indirect immunofluorescence) were observed in almost all type I diabetics, but only in a few cases of type II patients. After six months, the frequency both of the aspecific and of the specific immune parameters was decreased in type I diabetics, but no changeß were observed in the type II diabetics with a previously positive test. The latter patients required insulin therapy at the time of the, second investigation. The leucocyte migration inhibition test and the lymphocyte-mediated cytotoxicity are suitable for studying in-vitro-sensitization against pancreatic tissue and they might predict later insulin-dependency in type II diabetic patients.

No abstract

We read with interest the paper by Kim et al. [1], presenting an ingenious idea for using a metallic clip to close a colocutaneous fistula after placement of a percutaneous endoscopic gastrostomy (PEG) tube. We would query whether it was really necessary to close the fistula interventionally. In the case reported, early dislodgment of the PEG tube occurred at 2 weeks. The time at which the colonoscopy was carried out is not clear from the paper. Evidently, a 10-day period with total parenteral nutrition and systemic antibiotic treatment elapsed after the patient had vomited the feculent material. It can be assumed that endoscopic removal of the PEG tube and endoscopic closure of the fistula were carried out after that period. Was it really necessary to use a sophisticated endoscopic technique after a 10-day delay, instead of the familiar conservative solution?Last year, a 47-year-old man with an inoperable mesopharyngeal tumor was referred to us for PEG placement due to a locally advanced neoplasm causing swallowing difficulty. The PEG tube was placed by a relatively inexperienced team. After 6 weeks, the swallowing disturbances disappeared due to successful radiotherapy, and removal of the PEG tube was planned. A brown, malodorous fluid was observed flowing from the side of the PEG. Gastroscopy did not reveal the internal bumper in the stomach, but the former site of the gastrostomy was identified. Omnipaque was then administered via the PEG tube. The contrast material initially appeared in the transverse colon ( Figure 1), after which the gastric folds began to appear under fluoroscopy ( Figure 2). The outer part of the tube was then pulled gently and cut at the level of the skin. Mild finger pressure was placed on the former PEG site to push the inner part of the tube into the lumen. Passage of the bumper was not observed by the patient, but a subsequent barium examination did not detect it 4 days la-

No abstract