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In India, dengue endemic areas overlap with chikungunya-affected areas and both the viruses are transmitted by same vector, Aedes aegypti — thereby increasing opportunity of co-infection by both viruses. Present study was carried out to understand the DENV–CHIKV infection dynamics during recent outbreaks in eastern India (West Bengal state) and its implication on disease manifestations. Blood was collected from 326 symptomatic febrile patients. Patients’ serum was subjected to serological diagnosis for presence of anti-dengue-IgM, anti-chikungunya-IgM antibodies and dengue-NS1 antigen by ELISA. Viral RNA was extracted, and presence of dengue virus (DENV) and chikungunya virus (CHIKV) genome, their viral load (VL), and serotype among infected patients’ plasma was determined by real-time qRT-PCR. Statistical analysis was performed by using EPI INFO software. DENV and CHIKV were detected in 54% and 33% of symptomatic patients respectively, among whom 23% were harboring both viruses. WHO classified warning signs were detected among 64% DENV patients and 61% DENV–CHIKV double-infected patients. Patients with warning signs always had much higher DEN VL than those without warning signs. Hemorrhagic manifestation and abdominal pain was found in significantly higher frequency among patients with high dengue VL (>10,000 copies/ml). DENV2 was the most predominant serotype among monotypic dengue patients, whereas DENV2–DENV4 combination was most prevalent among patients infected with dual dengue serotypes. This study indicated that DENV–CHIKV double infection and high dengue VL contributed towards severe disease manifestations among infected patients. DENV2 and DENV2-DENV4 combination were the most prevalent serotype(s) found in current outbreak.

Impressive advances have been made in imaging the biliary tree by various modalities in the last few decades. However, the histological diagnosis of stenosing lesions in the biliary ductal system has remained difficult and unreliable. Application of Simpson atherectomy catheter biopsy in obtaining accurate histological diagnosis of bile duct lesions appears promising. The purpose of our study was to determine the clinical accuracy of the Simpson atherectomy catheter biopsy in the evaluation of bile duct strictures.A retrospective study of medical records of patients who underwent bile duct biopsy by atherectomy catheter was conducted between 1991 and 1999. During this period, 53 patients underwent 56 endoluminal bile duct biopsies with an atherectomy catheter as part of an obstructive jaundice workup. Histological diagnosis on biopsy was confirmed by subsequent surgical biopsy and/or clinical follow-up.Fifty-four (96%) bile duct biopsies were technically successful in terms of yielding a histological diagnosis. Thirty-one of the 56 (55%) biopsy specimens were positive for malignancy (27 adenocarcinoma, two islet cell-carcinoids, one small cell carcinoma, and one malignant lymphoma). Four (7%) were read by the pathologist as highly suspicious for malignancy, and 19 (34%) specimens were considered negative for malignancy. Sensitivity of atherectomy catheter endoluminal biliary biopsy in this study was 97% with a specificity of 100%. In addition, the positive predictive and negative predictive values of this modality were 100% and 93%, respectively.Endoluminal bile duct biopsy by Simpson atherectomy catheter appears to be a highly sensitive and specific method for establishing histological diagnosis of stenosing lesions in the biliary ductal system.

In the present study we used 125I-labeled insulin-like growth factor I (125I-IGF-I) to identify and characterize IGF-I receptors in the well-characterized and propagable human esophageal epithelial (HEE) cell line and to characterize their role in cell growth. Binding of 125I-IGF-I was saturable, time and temperature dependent, reversible, and specific for IGF-I and related peptides. Scatchard analysis of binding data demonstrated that HEE cells possess two classes of IGF-I receptors: high affinity [dissociation constant (Kd) = 0.058 nM] and low capacity (13,870 receptors/cell), and low affinity (Kd = 2.2 nM) and high capacity (39,000 receptors/cell). Binding of 125I-IGF-I was inhibited with the following relative potencies (half-maximal inhibition): IGF-I (3.0 pM) > IGF-II (1.2 mM) >> insulin (1.0 microM). Affinity cross-linking of cell membranes using disuccinimidyl suberate as a cross-linking agent under reducing conditions revealed a single polypeptide band (relative mol wt 133,000) representing the alpha-subunit of the IGF-I receptor. IGF-I stimulated [3H]thymidine incorporation and cell proliferation in a dose-dependent manner with detectable effect observed with 0.5 nM IGF-I and maximal effect at 50 nM IGF-I. IGF-I occupation of low-affinity IGF-I receptors appears to mediate cell growth. The present results demonstrate that HEE cells possess two classes of IGF-I receptors: one class has a high affinity and low capacity and the other has a low affinity and high capacity for IGF-I. Occupation of low-affinity IGF-I receptors by IGF-I appears to mediate cell growth.

We evaluated vitamin A absorption in 50 healthy adults and 26 gastrointestinal-disease patients by measuring the postabsorptive response in plasma retinyl esters after oral doses of the vitamin. On 3 consecutive days, two physiologic-dose tests of 2000-2400 retinol equivalents (RE) and one pharmacologic-dose test (84,000 RE) were administered. The physiologic doses were given as an oil-soluble or a water-miscible preparation. In gastrointestinal-disease patients the physiologic-dose test was highly correlated with the pharmacologic-dose test for the oil-soluble preparation as determined by peak rise (r = 0.50, P less than 0.05) and area under the curve (r = 0.56, P less than 0.01), suggesting that the physiologic dose is valid for investigating vitamin A absorption. Intestinal-disease or resection patients absorbed preparations poorly. Pancreatic-disease patients absorbed the oil-soluble preparation poorly. Physiologic rather than pharmacologic doses of vitamin A can be used to study vitamin A absorption.

The close and constant association of allergic rhinitis (AR) and asthma, both in children and adults, is hardly mentioned in medical textbooks. Proper treatment is delayed, as these patients are often seen in rotation by chest physicians, allergy experts, otolaryngologists, general physicians and paediatricians. Even then treatment is directed mainly towards asthma with little attention being paid to associated rhinitis, often lying unrecognised in adults. The clinical pattern of asthma in children and adults differs in our country. Unless AR is treated simultaneously with asthma, recurrent AR will result likely in suboptimal control of asthma. Proof and arguement is brougnt forward to recognise the unified concept of nasobronchial allergy or rhinobronchitis for proper management.

GIPC is highly expressed in human pancreatic adenocarcinoma and is a central protein for the stability of IGF-1R in pancreatic adenocarcinoma cell lines (15). The goal of this study was to prove the importance of GIPC in vivo and to evaluate possible therapeutic strategies that target this protein and its PDZ domain. In vivo effects of GIPC knockout were studied after lentiviral transduction of luciferase-expressing MiaPaCa2 pancreatic cancer cells with shRNA against GIPC; growth characteristics were monitored with bioluminiscence. Knockdown of GIPC led to a significant inhibition of pancreatic tumor cell growth in vivo in different mouse models. To test a possible therapeutic approach, the PDZ domain of GIPC was targeted by a short peptide composed of the amino acid sequence PSQSSSEA. This octapeptide was designed based on the C-terminal binding motif of GAIP. Targeting GIPC with this peptide inhibited the association between IGF-1R and GIPC. The subsequent downregulation of IGF-1R decreased proliferation in vitro and in vivo. In conclusion, our findings suggest that targeting GIPC and its PDZ domain-mediated interaction with the tyrosine kinase receptor IGF-1R could be a promising new treatment option for pancreatic cancer.

Prolonged exposure to arsenic contaminated water produces various clinical features, cutaneous features e.g. melanosis, keratosis and cancers being very common. Evaluation of such lesions by proliferative markers can provide useful information in regards to the biological behaviour of the lesions. Thus, cases with high proliferative status can be ominous sign for development of cancers. We studied skin biopsy of 42 cases. These were evaluated with AgNOR score and PCNA stain, in addition to HE examination. Here, invasive cancer cases had mean AgNOR score of 3.56, those with severe dysplasia had 3.0, moderate and mild dysplasia scored 1.73, benign changes had mean score of 1.35 while normal control cases had 1.08. PCNA index in cancers was above 50, that of severe dysplasia 25-30, mild to moderate dysplasia 1.0-5.0, those with benign changes 0.5 -1.0 and normal control had LI of less than 0.5%. PCNA has the advantage of less chance of observer error over AgNOR stain.

Twenty-five cases of Ductal carcinoma in situ(DCIS), of breast with an associated invasive component were selected for this study. The aim was to identify the percentage of malignant cases having DCIS component, to analyse the distribution of DCIS according to architecture and cytonuclear grading and evaluate the correlation between grade of DCIS with that of associated invasive component. The DCIS component was classified according to traditional architectural classification and Van-Nuys cytonuclear classification. The grading of the invasive component was done according to Nottingham's modification of Bloom-Richardson system. Architecturally 72% of DCIS components were of pure form, 28% were of mixed pattern. According to cytonuclear grading 24% cases had grade-I, 28% grade-II and 48% grade-III DCIS. The invasive component showed 16% cases in grade-III. After correlating the grade of DCIS and invasive component 91% positive correlation was found in grade-III cases followed by 66.6% in grade-I and 57.1% in grade-II cases.

Fifty-one breast lumps were studied by fine needle aspiration cytology (FNAC) and scrape imprint cytology. Of the 51 cases, 28 were malignant and included infiltrating duct carcinoma (22), well differentiated adenocarcinoma (2), mucinous, papillary and lobular carcinoma (one each) and malignant lymphoma (one). Benign lesions were mastitis, fibroadenoma and fibrocystic disease. The diagnostic accuracy of FNAC was 90.2% and that of imprint 94.1% with no false negatives. Two imprint smears and one aspirate designated suspicious were proved to be benign. The combination of FNAC and imprint cytodiagnosis gave a diagnostic accuracy of 96% thus proving their value in the rapid diagnosis of breast lesions.

A pilot study of 29 patients for research on clinical depression employed the framework of cultural epidemiology to examine illness-related experience, meaning, behaviour with a Bengali version of the explanatory Model Interview Catalogue (EMIC). This report examined patterns of distress and stigma with reference to the most troubling patient-specified symptom. All subjects were psychiatric outpatients in the Institute of Psychiatry, Calcutta, and met Diagnostic and Statistical Manual (DSM)-IV criteria for a major depressive episode. Only 5 patients (17.2%) identified sadness as the most troubling problem, and 48.3% specified pains and other somatic symptoms instead. An internally consistent stigma scale with Cronbach's alpha of .67, comprised 13 items, was used to assess stigma. In addition to the scale score for each subject, the contribution of each item was reported and compared. A suggestive, though not significantly lower value of the stigma score for patients reporting somatic symptoms as most troubling, compared with sadness, was consistent with findings from prior studies showing a positive relationship between the magnitude of depression and stigma. These findings are discussed with reference to their impact on recognition and help seeking among patients, and recognition and management of depression by general practitioner. Culturally distinctive presentations and social contexts of depression and other mental illnesses should be addressed in professional training and public health communications.

125 formalin fixed human tissues from different organs and 50 fresh animal tissues were taken. Each tissue piece was divided into two. Fresh animal tissues were fixed and processed in a domestic microwave oven and formalin fixed tissue were only processed in microwave oven. Simultaneous conventional processing was also carried out. Among the fresh tissues, 34 pieces were fixed in 10% formalin and 16 were stabilized in normal saline, with microwave irradiation. For histoprocessing graded ethanol (70% and absolute) for 150 tissues and graded isopropanol (70% and absolute) for 25 tissues were used for dehydration in microwave technique. Chloroform for 95 tissues, xylene for 15 tissues and isopropanol for 65 tissues were used as clearing agent in microwave technique. Liquid paraffin was impregnating agent in all 175 cases. The oven was operated at 50% power for 10 cases and 40% power for 165 cases. Recording of temperature could not be done. Regarding fixation with formalin 80% cases gave satisfactory result, while with normal saline, only 30% cases were satisfactory. Regarding dehydration with ethanol 80% were satisfactory and with isopropanol 60% were satisfactory. Regarding clearing--both chloroform and isopropyl alcohol gave satisfactory results in 80% cases but with, xylene tissues were fragmented and brittle.

Chronic arsenic toxicity (CAT) manifests predominantly as cutaneous lesions in the form of melanosis, keratosis and neoplastic changes. We have studied skin biopsies from 42 patients of CAT. Histological study of H/E stained sections showed--hyperkeratosis in 13, parakeratosis in 13, acanthosis in 12, papillomatosis in 24, elongation of reteridges in 21, increased basal pigmentation in 27 and dysplastic changes in 8 cases. Squamous cell carcinoma was present in 2, basisquamous in 1 and basal cell carcinoma in 1 case. Changes of skin lesions after drug DMSA and DMPS therapy compared to placebo were studied. The result was inconclusive. Proliferative activity of skin lesions in CAT were studied by AgNOR stain to assess the biological behaviour of the lesions. AgNOR score showed--normal control 1.08, benign changes (e.g. Hyperkeratosis, parakeratosis, acanthosis, papillomatosis etc.) without dysplasia--1.35, mild to moderate dysplasia--1.735, severe dysplasia--3.0 and carcinoma--3.56. Thus, AgNOR score gives some idea on the biological behaviour of CAT lesions. It is suggested that AgNOR staining should be done regularly along with HE staining for proper assessment of the cases.

In sarcoidosis, diagnosis rests on positive tissue biopsy in association with suggestive clinical features. In absence of guidelines in India, multiple biopsies (494 in total) were undertaken from 170 suspected and later proven cases of sarcoidosis. Involved tissues, Kveim test site, right scalene node, palpable peripheral lymph nodes and open pulmonary biopsy gave 80-100% positive result. (Perbronchial lung biopsy proved positive in India by other workers.) Mantoux test site, a rather unusual tissue, even if negative at 72 hours, may show positive granuloma in 64.5% cases with active sarcoidosis. Positive liver biopsy has only corroborative importance.

In a study of 847 cases of bronchial asthma and nasal allergy frequent association with raised serum IgE was noticed. Degree of atopy (as judged by skin allergy tests), age, sex and duration of disease tended to influence IgE levels in asthmatics. Both extrinsic and intrinsic varieties of asthma showed similar raised serum IgE levels. In subjects with nasal allergy alone, the values were considerably lower but still much higher than found in control patients.

Exposure of pNGE7, a recombinant clone containing the coding and regulatory sequences for the expression of neuron specific enolase gene, cells to electromagnetic radiations (915 MHz, 16 Hz AM, SAR 0.05 mW/kg) resulted in the elevation of neuron specific enolase (NSE), a diagnostic marker for neuron and lung cancer. Using ion-exchange chromatography we separated the neuron specific enolase activity from the non-neuronal enolase (NNE) activity and observed an alteration in the expression of neuron specific enolase and non-neuronal enolase. The clinical applications of the present studies have been discussed.

Oncogenes, along with the autocrine secretion growth factors, emerged as a unifying theme in the search for the molecular and cellular basis of malignant transformation. To investigate whether some of the oncogene coding sequences are phylogenetically conserved, we performed hybridization experiments using well characterized c-myc, c-fos and c-ras oncogene probes to establish the sequence divergence in the genomes of different organisms. Our results indicate the c-myc, c-fos, and c-ras coding sequences exist in human, cow, monkey, rabbit, chicken, and yeast genomes. To the best of our knowledge this is the first report wherein a correlation among species in the oncogenes coding region has been established. The evolutionary implication of the present studies is discussed.

Qualitative analysis of semen samples have been compared between 79 different types of tobacco addicts (smokers, chewers, and multiple addicts) with 21 nonaddicts (never consumed any form of tobacco). The percentage of motile sperm and total sperm count of the tobacco chewers are significantly low (p < .05). The frequency of abnormal sperm is also significantly high (p < .001) for smoking and multiple addict groups. Differential effects of smoking and chewing tobacco on sperm characteristics are discussed.

Activity of adenosine deaminase (ADA) in serum and peritoneal fluid was studied prospectively in 24 aetiologically proved cases of ascites and 10 age-matched controls. Patients were divided into 3 groups according to causes of ascites, viz. malignant ascites (11), tubercular peritonitis (7) and cirrhosis of liver (6). Serum ADA values and peritoneal: serum ADA ratio did not show any consistent pattern in any group. But in patients with tubercular peritonitis ADA activity in ascitic fluid was significantly higher (P.001) than in the other groups. An ascitic ADA level of 30 units/L had a sensitivity of 100% and specificity of 94.1% for tubercular peritonitis. These findings suggest that the ascitic fluid ADA activity is useful for the diagnosis of tubercular peritonitis; this method is simple and least invasive.

Parotid saliva samples from 24 alcoholic subjects without evidence of cirrhosis were analyzed for changes in flow rate, composition, and epidermal growth factor (EGF) secretion. Mean (+/- SE) stimulated parotid saliva flow rate (ml/min/gland) was significantly (p less than 0.01) lower in alcoholic subjects than in matched control subjects. Reduction in parotid saliva flow rate was associated with significant (p less than 0.05) decrease in total protein and amylase secretion in this group of patients. In addition, secretion of immunoreactive EGF, a specific salivary protein, was also markedly reduced (p less than 0.05) in alcoholic patients. None of the parotid saliva samples from the alcoholic subjects had detectable bioactivity of EGF in saliva. These data suggest that chronic alcohol ingestion is associated with significant changes in parotid saliva secretion and its composition, which may perpetuate and compound ethanol-induced injury to the upper gastrointestinal tract.

A total of 171 cases of wounds of various aetiology were examined and screened bacteriologically for evidence of infection by surface swab culture and quantitative full thickness wound biopsy culture techniques. Staphylococcus pyogenes was the most frequently isolated (39.9%) single organism. Other organisms being Escherichia coli (26.1%), Pseudomonas aeruginosa (15.4%), klebsiella species (5.8%), Streptococcus pyogenes (4.9%), proteus species (4.8%) and coliform organism (3.1%). Collectively the Gram-negative organisms were the majority among the isolated organisms. As indicator of wound infection, surface swab culture was found to be reliable in 72% cases when correlated with wound biopsy culture. The latter technique was found to be more consistently valuable (in 95% cases) both for regular assessment of the wounds as well as to judge the response to treatment.

Genomic amplification by the polymerase chain reaction (PCR) was used to identify a unique genomic sequence of Ehrlichia risticii directly in DNA isolated from peripheral-blood buffy coat cells of E. risticii-infected horses (Potomac horse fever) and from infected cell cultures. A specific primer pair, selected from a cloned, species-specific, 1-kb DNA fragment of the E. risticii genome as a template, was used for the amplification of the target DNA of 247 bp. The optimal number of 40 PCR cycles, determined by analyzing an amplification profile obtained with a constant Taq polymerase concentration, was used to achieve maximum amplification of the E. risticii DNA segment. Efficient amplification of target DNA was achieved with specimens processed by either the phenol extraction or rapid lysis method. The specificity of the amplified DNA product was confirmed by the proper size (247 bp) and appropriate restriction enzyme cleavage pattern of the amplified target DNA, as well as by the specific hybridization signal obtained by using a PCR-amplified 185-bp internal DNA probe. A 10(5)- to 10(6)-fold amplification of target DNA, which allowed detection of E. risticii from as few as two to three infected cells in culture and from a very small volume of buffy coat cells from infected horses, was achieved. This PCR amplification procedure was found to be highly specific and sensitive for the detection of E. risticii for the study of Potomac horse fever.

Forty patients with uncomplicated acute myocardial infarction were studied within 6-18 hours after the infarction. Serum myoglobin was elevated in all the cases and was markedly high in cases studied 18 hours after the acute infarction, though the level did not show any relation with the severity of the attack. Myoglobin level showed no correlation with SGOT level, which did not rise appreciably within 6 hours. Serum sodium and potassium levels did not show any change, even in the most severe cases. Serum myoglobin estimation is thus a good diagnostic test in the early hours of acute myocardial infarction.

The cell mediated immune status (CMI) of twenty three patients with chronic tonsillitis was studied with a view to ascertain any possible role of CMI deficiency in causation of the disease. No evidence of significant CMI deficiency was detected in these cases.

The effect of high fiber diet on fat malabsorption was evaluated in twelve patients with exocrine pancreatic insufficiency secondary to chronic alcoholic pancreatitis. Additionally, the effect of dietary fiber on pancreatic enzymes was examined in vitro, employing different concentrations of cellulose, pectin, and wheat bran incubated with amylase, lipase, and trypsin. Ingestion of a high fiber diet was associated with a small but significant (p less than 0.01) increase in fecal weight and fecal fat excretion. All patients complained of increased abdominal flatulence with high fiber diet, however, no significant increase in frequency of bowel movements was noted. In vitro studies demonstrated reduction in pancreatic enzyme activity by increasing concentration of dietary fiber and its components. These data suggest that steatorrhea may be enhanced with the ingestion of high fiber diet in patients with exocrine pancreatic insufficiency on oral pancreatic enzyme therapy. Increase in fecal fat excretion may, in part, be related to reduction in the activity of pancreatic enzymes by the dietary fiber.

A case of multiple centrally umbilicated gastric polyps is presented. Several endoscopic biopsies of the various polyps rapidly established the histological diagnosis of amelantoic melanoma. The significance and differential diagnosis of this endoscopic lesion is discussed.

Forty subjects each were rapidly inducted by road to altitudes of 3200 and 3771 meters (m). Half of subjects at each altitude were maintained on digoxin and the other half received placebos. The digoxin group showed higher serum potassium at both altitudes. Serum sodium remained unaltered. When compared to control groups, urinary volume changes were less marked in the digoxin group. Similarly, the alterations in calcium and magnesium in serum and urine at 3771 m were less pronounced. However, none of these changes in the digoxin groups were statistically significant when compared with control groups.

The antibody response and the antibody reactivity to component antigens of Ehrlichia risticii were studied in horses with induced Potomac horse fever. These horses had no detectable antibodies to E. risticii in their preinoculation (PrI) sera by indirect fluorescent-antibody assay and enzyme-linked immunosorbent assay (ELISA). All the horses exhibited typical disease features following experimental infection and responded with specific antibodies, as measured by ELISA and indirect fluorescent-antibody assay. A primary antibody response was detected in 70% of the horses, while a secondary-type antibody response was detected in 30% of the horses by ELISA. In the primary antibody response, a distinct titer was observed at 2 weeks postinoculation (PI), when the immunoglobulin M (IgM)/IgG ratio was 2 to 5, and the overall antibody titer peaked at 6 to 8 weeks PI. The secondary-type antibody response exhibited a characteristic titer at 1 week PI, the IgM and IgG titers were about equal at 2 weeks PI, and the overall antibody titer peaked at 6 weeks PI. A transient depression in the IgG response at 4 weeks PI was observed in both response types. The antibody was maintained at a high titer for over a year in all horses. Western immunoblot reactivity showed that the antisera collected from these infected horses at 4 to 5 weeks PI recognized some or all of the six major E. risticii component antigens (70, 55, 51, 44, 33, and 28 kilodaltons), all of which were apparent surface components. The 6- to 8-week PI antisera recognized up to 16 component antigens, including 9 major antigens (110, 86, 70, 55, 51, 49, 44, 33, and 28 kilodaltons). However, the PrI sera of these horses showed reactivity at various intensities with one to seven of the component antigens. There was no apparent correlation between this reactivity pattern and the subsequent antibody response types.

Immunological studies in 3 patients with acute pseudomembranous esophageal candidiasis are presented. None of the patients had history or clinical signs of chronic mucocutaneous candidiasis. All 3 patients had an intact humoral response as measured by the presence of elevated candida agglutinating antibody titers. However, further investigations revealed a cell-mediated immune defect characterized by in vivo and in vitro anergy to candida antigen in these patients. Response to the other antigens was found to be intact in 2 of 3 patients. Successful medical therapy was associated with return of skin and lymphocyte reactivity to candida antigen in two cases.

The therapeutic efficacy of a pH-sensitive enteric coated pancreatic enzyme preparation was compared with conventional pancreatic enzyme preparations in 6 adult patients with exocrine pancreatic insufficiency. Fecal fat excretion and postprandial duodenal recovery of orally ingested pancreatic enzymes were evaluated after ingestion of each preparation. Fecal fat excretion decreased significantly (p less than 0.005) on treatment with pH-sensitive and conventional pancreatic enzyme preparations. Postprandial concentration and delivery of trypsin and lipase in samples aspirated from duodenojejunal junction were higher after ingestion of conventional pancreatic enzyme preparation as compared to the pH-sensitive enteric coated preparation. The difference, however, did not reach statistical significance. Our observations suggest that the pH-sensitive enteric coated pancreatic enzyme preparation is only as effective as conventional pancreatic enzyme preparations in controlling fat malabsorption in patients with exocrine pancreatic insufficiency. Failure of pH-sensitive enteric coated preparation to deliver greater quantities of pancreatic enzymes at duodenojejunal junction is most likely related to the impaired release of enzymes from microspheres due to low intraluminal pH in the upper small intestine in pancreatic insufficiency.

We have measured the level of lingual lipase activity in gastric and duodenal aspirates of five patients with cystic fibrosis (CF) and pancreatic insufficiency. Lingual lipase activity (measured in vitro by the hydrolysis of long-chain triglyceride, tri-[3H]olein, at pH 4.2 and expressed in nanomoles FFA released per milliliter aspirate per minute) and pH in gastric and duodenal aspirates were measured at 10-min intervals during a a 30-min basal period and at 15-min intervals during a 2-h period after the ingestion of a test meal. In gastric aspirates, lingual lipase activity decreased from basal levels of 200 +/- 34 nmol FFA released per milliliter per minute (similar to values reported previously in normal subjects (Hamosh M., H. L. Klaeveman, R. O. Wolf, and R. O. Scow, 1975, J. Clin. Invest., 55:908-913) to 79 +/- 15 nmol FFA/ml per min during the first postprandial hour and returned to basal levels during the second postprandial hour, (206 +/- 39 nmol FFA/ml per min). Duodenal aspirates, obtained during basal conditions, had lingual lipase activity similar to that in the stomach, 178 +/- 63 nmol FFA/ml per min. Enzyme activity levels were 56 +/- 14 and 113 +/- 29 during the first and second postprandial hours. Measurements of total lipase activity delivered to the ligament of Treitz showed that lingual lipase amounted to 91.22 +/- 4.06% of the total lipase activity in the upper small intestine during the 150-min study period. The basal and postprandial gastric pH levels in the five CF patients studied (3.2 +/- 0.44, 4.0 +/- 0.16, and 4.4 +/- 0.4 for basal and first and second postprandial hours, respectively) did not differ from previously reported values for normal subjects. The pH of duodenal aspirates was however significantly lower (P less than 0.001) in CF patients, both under basal conditions (5.0 +/- 0.26) and during the first and second postprandial hours (4.9 +/- 0.13 and 4.4 +/- 0.36, respectively), than in normal subjects. The low postprandial duodenal pH enables lingual lipase to act not only in the stomach but to continue the hydrolysis of dietary fat in the upper small intestine of CF patients. The data presented show that lingual lipase remains fully active in CF and accounts for greater than 90% of total lipase activity in the upper small intestine. We suggest that, because of low intestinal pH in CF, enzyme replacement therapy containing lingual lipase could improve fat absorption in CF patients to a greater extent than the pancreatic preparations now in use.