managerial accounting The case study method aims, through real life examples, to generate open discussion among participants by providing a realistic illustration from the business world. The method requires intellectual rigour and discipline. It reverses the classic learning mechanisms taught at schools and universities. Whereas the latter approach relies on theory to derive practical applications, case studies require students to analyse and interpret the available data in order to decide which actions to implement. At a later point, the results may be generalized so as to apply to other situations; then links with theory, or new theories, may emerge. This learning method should be used by teachers and lecturers as it enables students to capture better, and to analyse faster and more effectively, the problems involved in managing a business. IX Foreword Dunod - Toute reproduction non autorise est un dlit. This method has two major advantages. First, active research and analysis by students enables them to acquire knowledge more easily and in greater detail than teaching methods based purely on theory; in the latter case students remain completely passive in the learning environment. Secondly, the analytical skills acquired and developed in the context of a real life business situation are far more important for making decisions than purely theoretical knowledge.

31 It is stated that nitric oxide (NO) inhibits the relaxation of the lower oesophageal sphincter (LOS) and that sildenafil is given for treating achalasia. As far as I know, sildenafil acts to increase the guanine monophosphate (GMP), just as NO uses the same mechanism to relax the LOS. Could you explain this paradox?

32 In Kumar and Clark Clinical Medicine you mention that auscultation is not important in cases of gastrointestinal disorders, but Harrison's Principles of Internal Medicine gives this as being of equal importance because succussion splash and bowel sounds can help in presumptive diagnosis. Succussion splash indicates gastric obstruction (e.g. gastroparesis) and likewise bowel sounds can help determine the status of developing ileus. Would you agree that this is therefore a diagnostic tool?

33 Is it hazardous to give aspirin in the antiplatelet doses (75-325 mg/day) to a patient with a past history of haematemesis proved to be from a peptic ulcer?

34 How can upper gastrointestinal (GI) bleeding be distinguished from lower GI bleeding by using faecal analysis?

35 In upper gastrointestinal bleeding, without knowing the cause or source of bleeding, why do we give proton pump inhibitors (PPIs, e.g. omeprazole)? What is the role of these, if the source of bleeding is not peptic or duodenal ulcer?

36 Why is the incidence of coeliac disease increasing in many countries?

37 Are small amounts of gluten harmful to a patient with coeliac disease?

38 I refer to the treatment of complications related to diverticular disease. Under 'bleeding' you mention that 'Persistent bleeding can often be arrested by undertaking an "instant" barium enema, which acts to plug the offending diverticulum'. When I mentioned this to my consultant he said he had never heard of this. Could you clarify how this would work and where I could obtain more information?

39 In children with abdominal pain and fever, does a white cell count help establish a diagnosis of appendicitis?

40 I have always been taught that ulcerative colitis only affects the large bowel with some associated proctitis. I read in your chapter on gastrointestinal disease that it can cause mouth ulcers and am now confused.