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Hepatitis B virus (HBV) has been demonstrated in bile duct epithelial cells (BDEC) during chronic infection. The persistence of virus in BDEC may play an important role in disease pathogenesis, and may be at least partly responsible for the relapse phenomenon observed in antiviral treatments using nucleoside analogues. The aims of this study were to examine the morphological changes within the liver in the duck hepatitis B model following bile duct ligation (BDL), and to assess the effect of biliary hyperplasia upon viral DNA and proteins. Seven-day-old ducklings, congenitally infected with the duck hepatitis B virus (DHBV), were subject to BDL. The pathological and virological changes were then followed at 5, 10, 15, and 20 days after ligation. All results were compared with age-matched unligated control birds congenitally infected with DHBV. To assess the early morphological changes, additional animals were sacrificed at 1, 2, 3, and 4 days post-BDL. The proportion of DHBV-infected BDEC, was examined by immunohistochemistry and in situ hybridization. BDL induced rapid biliary hyperplasia, with a doubling time for BDEC of 1.3 days. The proliferated BDEC displayed immunohistochemical features identical to resting BDEC. More than 50% of BDEC in unligated controls, and more than 46% of proliferated BDEC in ligated animals were positive for DHBV DNA and structural proteins. The intensity of immunohistochemical staining and in situ hybridization signal in the BDEC was consistently greater than that of the hepatocytes, both before and after BDL. BDL induces biliary hyperplasia in the duck model, and BDEC division does not reduce the viral burden in infected cells.

Previous studies of the effect of albumin on initial uptake of ligands by isolated cell suspensions or cultures found that the apparent uptake for unbound ligand appeared larger in the presence of binding to the albumin than when albumin was absent. Furthermore, when ligand and albumin were increased in a fixed molar ratio, uptake appeared to be competitively inhibited by the excess albumin. We examined the kinetics underlying this apparent facilitation phenomenon by incorporating unbound fraction of ligand in the medium (fu1) into the general model for diffusion between two compartments. The analysis showed that even in the absence of facilitation by albumin, the apparent rate constant for uptake of unbound ligand (k/fu1) increases as albumin concentration increases but the uptake clearance of unbound ligand remains constant. This theoretical analysis was verified experimentally by measuring the effect of albumin on uptake rates of 14C-taurocholate (12, 24, 48, 60, and 96 microM, with and without 0.87 mM albumin) in a nonphysiological system consisting of two solutions separated by a cellulose membrane. Moreover, when the taurocholate and albumin concentrations were increased in a fixed molar ratio of 0.06 (taurocholate 12-96 microM, albumin 0.2-1.6 mM), the initial uptake rate exhibited the same nonlinear pattern as the previous studies that used living cells. This pattern was due not to saturation of a putative albumin receptor but simply to the concomitant decrease in fu1 which tended to offset the increase in uptake rate due to the increasing total taurocholate concentration. The model was also used to evaluate published data describing the effect of albumin on the uptake of iopanoic acid by cultured hepatocytes. In accordance with the model, k1/fu1 increased as albumin concentration increased, but uptake clearance was independent of albumin concentration. Therefore, the kinetic pattern found in this and other studies with isolated cell suspensions or cultures argues against a special role for albumin in facilitating cellular ligand uptake.

The bidirectional placental transfer of sodium [11,12-di-3H]chenodeoxycholate and sodium [14C]deoxycholate was studied in conscious pregnant sheep near term. In fetal-to-maternal studies, radiolabeled bile salt was injected into the fetal portal vein, and the daily excretion of radiolabel in maternal hepatic bile was measured over 3-4 days. In maternal-to-fetal studies, the mother received daily injections of radiolabeled bile salt, and the accumulation of label in the fetal pool was measured after 6-9 days. Bile salts were transferred predominantly as the taurine conjugate. Transfer rates were 1) fetus to mother; chenodeoxycholate, 6.7 mumol/24 h and deoxycholate, less than 0.5 mumol/24 h and deoxycholate, 1.4 mumol/24 h. We conclude that, in sheep near term, deoxycholate derived from the mother slowly accumulates in the fetus, while the placenta acts as an excretory route for fetal chenodeoxycholate.

Vasoactive intestinal polypeptide (VIP) is released into the portal circulation by a meal stimulus, but is rapidly cleared from plasma. Although it is known to bind to receptors on liver cells, the role of the liver in the clearance of VIP is not clearly defined. We therefore studied the disappearance of VIP in recirculating and in single pass isolated perfused rat liver (IPRL) preparations. Disappearance of added VIP was rapid in recirculating IPRL experiments with a half life of ca. 30 min. In single-pass steady-state studies in which livers were perfused at 16 ml/min for 30 min, clearance of VIP was complete (16 ml/min) at concentrations of 500 fmol/ml, but clearance fell to 3 and 1 ml/min at perfusate concentrations of 8 and 40 pmol/ml respectively. Further experiments to evaluate whether VIP was disappearing in perfusate itself demonstrated substantial metabolism of VIP in perfusate which had previously been circulated through a liver for 90 min. The products of metabolism were identical to those found in the IPRL. We conclude that VIP is rapidly cleared as it passes through the isolated perfused rat liver model with a significant proportion of clearance attributable to release of a peptidase from the liver into the perfusate.

The use of cimetidine administered by bolus intravenous injection to critically ill patients has been associated with serious cardiac arrhythmias, due presumably to high initial plasma concentrations. The aim of this study was to determine the range of infusion times of a single 200 mg dose of cimetidine which would avoid high initial drug concentrations while maintaining a duration of effective concentrations no less than that resulting from bolus injection. Computer simulations of both maximum plasma cimetidine concentrations and duration of effective plasma cimetidine concentrations versus duration of infusion were based on mean pharmacokinetic date from 6 peptic ulcer patients who had received cimetidine 200 mg i.v. over 5 min. The simulations indicated that to reduce maximum plasma cimetidine concentrations by at least 50%, while maintaining the duration of effective plasma concentrations, the infusion time should be at least 30 min and no longer than 4.5 h. The validity of the simulations was subsequently tested in 4 of the patients, who received cimetidine 200 mg i.v. over 30 min. The mean maximum plasma concentration for the 30 min infusion (4.57±0.53 µg/ml) was, as predicted, approximately half that corresponding to bolus administration in these patients (8.97±1.96 µg/ml). Moreover, the duration of effective concentrations for the infusion (1.43±0.28 h) was significantly greater than that for the 5 min infusion (1.21±0.31 h). We suggest that where an acute intravenous dose of cimetidine (200 mg) is indicated, it should be administered over at least 30 min rather than as a bolus.

Omeprazole, a substituted benzimidazole which suppresses gastric acid secretion, and its sulphone and sulphide metabolites were simultaneously measured in human plasma and urine using a selective, reversed-phase, high-performance liquid chromatographic method with a sensitivity of 5 ng/ml for omeprazole, 30 ng/ml for omeprazole sulphone, and 50 ng/ml for omeprazole sulphide. The coefficients of variation for within-day assays were 4.4, 7.5, and 17.5%, respectively. In a pilot pharmacokinetic study, 40 mg of omeprazole (encapsulated enteric-coated granules) were administered to two healthy volunteers. Peak plasma concentrations for omeprazole of 240 and 520 ng/ml, and for omeprazole sulphone of 320 and 400 ng/ml, were reached between 3 and 4 h post-dose. Omeprazole concentrations fell rapidly with apparent half-lives of about 40 min, and concentrations of both omeprazole and the sulphone metabolite were below the minimal detectable level by 6–8 h. Omeprazole sulphide could not be detected in this study.

The Report of the Royal College of Physicians on Physical Disability in 1986 and Beyond gives details of a Medical Disability Service to redress the present imbalance in the provisions for the physically disabled. An integral part of this service should be the provision of adequate scientific and technical resources, which could be established by making four or five new Medical Physics and Clinical Engineering appointments annually in each Region for the next ten years.

For substances eliminated from blood by the liver, the effect of a change in unbound fraction of drug (fu(b)) on steady state total (Cb) and unbound (Cu(b)) blood concentrations has hitherto only been considered for the two limiting cases, i.e., at the upper and lower extremes of hepatic intrinsic clearance (CL(int)). For a substance of very low CL(int), if fu(b) changes, Cb will change and Cub will remain constant, whereas if CL(int) is very high, Cub will change and Cb will remain constant. The present study defines the effects of a change in fu(b) on Cb and Cub over the whole CL(int) range. Computer simulations were undertaken which predicted that, for a given change in fu(b), absolute and relative changes in Cb would decrease nonlinearly with increasing CL(int), while the relative change in Cub would increase with CL(int). The absolute change in Cub would be independent of CL(int). Significant changes in Cb and Cub would be observed at intermediate values of CL(int) not just at the high and low extremes. These theoretical predictions were investigated experimentally in the isolated perfused rat liver by examining the effects of a change in fu(b) of sodium taurocholate a substance with intermediate CL(int) (such that at fu(b) = 0.27, hepatic extraction ratio = 0.71) induced by concurrent administration of sodium oleate. Sodium 24-14 C-taurocholate (specific activity 52 microCi/mmol) was infused into the reservoir in a recycling system at 30 mumol/hr for 105 min (n = 6). At 45 min a bolus dose of sodium oleate (50 mmol) was administered to the reservoir, followed by a constant infusion of 143 mmol/hr for 1 hr. Following the administration of oleate, taurocholate fu(b) fell promptly by 55% (0.27-0.12). There was a relative increase of taurocholate Cb of 22.7% and a relative decrease in Cub of 45.4%, in accordance with the simulations (p less than 0.05). We conclude that important changes in unbound steady-state concentration, the pharmacologically active moiety, can occur upon changes in unbound fraction with compounds of intermediate hepatic intrinsic clearance.

1. A chronic fetal bile fistula model was developed in sheep which allowed observations on fetal bile for periods of up to 10 days. A comparison of fetal, lamb and adult bile acids was made in bile fistula animals. 2. Bile was analysed by thin layer chromatography, gas liquid chromatography, and high pressure liquid chromatography. Fetal bile contained a much greater proportion of chenodeoxycholic acid (42.0 +/- 1. S.E. of mean 3.0% of total bile acids by high pressure liquid chromatography) than lamb bile (8.1 +/- 1.9%) or adult bile (5.4 +/- 0.6%). The corresponding figures for cholic acid were fetal: 45.8 +/- 2.9%, lamb: 89.1 +/- 2.9%, and adult: 75.2 +/- 2.6%. Deoxycholic acid, a secondary bile acid, was present in fetal bile (12.2 +/- 4.9%). In the lamb, deoxycholic acid comprised only 2.8 +/- 1.1% of total bile acids, compared with 19.3 +/- 2.9% in adult sheep. Taurine conjugates predominated in sheep bile, but this predominance was least marked in lamb bile. 3. The fetal bile acid pool (101 +/- 13 mu mole/kg) was significantly smaller than the neonatal pool (214 +/- 26 mu mole/kg, P < 0.01). This increase in pool size, together with the increased proportion of cholic acid, suggests a rapid rise in cholic acid synthesis soon after birth. 4. Bile acid synthetic rates were estimated from bile acid secretion rates at the nadir of the washout curves. The values obtained were 0.71 +/- 0.18 mu mole/kg.hour (adult), 0.47 +/- 0.16 mu mole/kg.hour (lamb), and 0.35 +/- 0.08 mu mole.hour (fetus). 5. In the fetus and in pregnant adult sheep, the normal increase in bile acid synthesis in response to depletion of the bile acid pool was much less marked. 6. In the fetus, biliary secretion of cholesterol and phospholipid ran parallel with bile acid secretion. Bile lipid composition was similar to that in the adult. 7. Fetal bile water production was higher, relative to bile acid secretion, than lamb or adult bile water secretion.

The intestinal absorption of sodium taurocholate was studied in the near-term fetal and neonatal dog. Absorption rates were measured in vivo in isolated loops of fetal jejunum and ileum. Absorption was also measured in vitro in everted sacs and rings of fetal and neonatal jejunum and ileum. The maximal rates of taurocholate absorption observed after instillation of 1 micronmol taurocholate into closed segments of fetal jejunum and ileum with intact blood supply were not significantly different (P less than 0.2), and equalled 0.282+/-0.026 (mean+/-SEM) and 0.347+/-0.051 micronmol/h per 10-cm segment length jejunum and ileum, respectively. Similarly, the rates of absorption from open segments of jejunum and ileum perfused with 0.4 and 1.0 mM taurocholate were nearly identical (0.232+/-0.040 and 0.255+/-0.039, respectively at 0.4 mM, and 0.470+/-0.065 and 0.431+/-0.013, respectively at 1.0 mm) (P greater than 0.2). At perfusate concentrations of 4.0 mM, moreoever, jejunal absorption exceeded ileal absorption (1.490+/-0.140 and 0.922+/-0.200, respectively (P less than 0.05). As expected, concentration of taurocholate by the mucosa was readily demonstrated in adult ileal, but not in adult jejunal everted rings. In contrast, there were no significant differences in mucosal uptake of taurocholate by fetal jejunal and ileal rings. Fetal ileal mucosal concentrations were not significantly above those in the incubation medium after 1-h exposure of the mucosa to 0.003, 0.03, and 0.3 mM taurocholate. Uptake was proportional to incubation medium concentration over the full range of values. This was also true of tissues from 1-wk-old neonates. However, by 2 wk of age, ileal mucosal concentration of taurocholate was evident and adult levels were attained by 5 wk of age. It is concluded that taurocholate is absorbed by the fetal gut and that ileal absorption is no more efficient than jejunal absorption. Although active glucose transport was demonstrable in both jejunum and ileum, it was not possible to demonstrate an ileal mechanism for active transport of taurocholate in the fetus. Active ileal transport was not demonstrable in the newborn until at least 2 wk after birth.

The effect of a low dose of omeprazole on intragastric acidity and fasting plasma gastrin concentration was measured in eight subjects with duodenal ulcer in remission. Intragastric acidity was measured during a baseline 24 h period. This was then repeated after 14 days of dosage with 10 mg of omeprazole administered daily, either in the morning or the evening, using a randomized, double-blind cross-over design. The median 24 h pH level rose significantly from a baseline of 1.6, to 3.1 and 3.5 during morning and evening dosages, respectively. However, variability in the response to this dose was substantial: three subjects exhibited no discernible change in 24 h median acidity on two occasions, while in others it was reduced by greater than 99%. Fasting plasma gastrin concentrations were not significantly altered by the administration of 10 mg of omeprazole daily for 2 weeks.

Bile salt metabolism was studied in fetal dogs 1 wk before term. The size and distribution of the fetal bile salt pool were measured, and individual bile salts were identified. The hepatic excretion of endogenous bile salts was studied in bile fistula fetuses, and the capacity of this excretory mechanism was investigated by the i.v. infusion of a load of sodium taurocholate-14C up to 20 times the endogenous pool size. The total fetal bile salt pool was 30.9±2.7 μmoles, of which two-thirds was in the fetal gallbladder. Expressed on a body weight basis, this was equal to approximately one-half the estimated pool size in the adult dog (119.2±11.3 vs. 247.5±33.1 μmoles/kg body wt). Measurable quantities of bile salt were found in small bowel (6.0±1.8 μmoles), large bowel (1.1±0.3 μmoles), liver (1.2±0.5 μmoles), and plasma (0.1±0.03 μmoles). Plasma bile salt levels were significantly greater in fetal than in maternal plasma (1.01±0.24 μg/ml vs. 0.36±0.06 μg/ml; P < 0.05). Fetal hepatic bile salt excretion showed a fall over the period of study from 2.04±0.34 to 0.30±0.07 μmoles/hr. The maximal endogenous bile salt concentration in fetal hepatic bile was 18.7±1.5 μmoles/ml. The concentration in fetal gallbladder bile was 73.9±8.6 μmoles/ml; and, in those studies in which hepatic and gallbladder bile could be compared directly, the gallbladder appeared to concentrate bile four- to fivefold. Taurocholate, taurochenodeoxycholate, and taurodeoxycholate were present in fetal bile, but no free bile salts were identified. The presence of deoxycholate was confirmed by thin-layer chromatography and gas liquid chromatography, and the absence of microorganisms in fetal gut suggests that it was probably transferred from the maternal circulation. After infusion of a taurocholate load, fetal hepatic bile salt excretion increased 30-fold, so that 85-95% of the dose was excreted by the fetal liver during the period of observation. Placental transfer accounted for less than 5% of the dose. Fetal bile volume increased 15-fold on average, while bile salt concentrations increased two- to threefold. It is concluded that bile salt is taken up, conjugated, and excreted by the fetal liver with remarkable efficiency. The excreted material is either stored and concentrated in the fetal gallbladder or released into the intestine and reabsorbed to be reexcreted in bile.

Gall bladder and hepatic bile was sampled from 66 patients undergoing elective operations on the biliary tract. Fifty-one patients had cholesterol gall stones but only 59% of these were found to have bile which was supersaturated with cholesterol. Repeated sampling of hepatic bile from patients with T-tubes showed that the secretion of supersaturated bile was intermittent.These results indicate that it is impossible to separate patients with cholesterol stones from controls simply by examination of the lipid composition of their bile, since an appreciable number of bile samples from patients with cholesterol stones were unsaturated.The fact that cholesterol gall stones form when the bile is supersaturated with cholesterol only intermittently suggests that the gall bladder may also have a part in their formation.

The effect of low (50 μg) and high (1 mg) doses of the histamine H2-receptor antagonists cimetidine and ranitidine on the first pass extraction of propranolol was studied in the rat isolated perfused liver. Both low and high dose cimetidine increased the area under the perfusate propranolol concentration time curve (AUC) 4 to 5−fold. Although low dose ranitidine did not alter propranolol AUC, high dose ranitidine increased it to the same extent as cimetidine. These results indicate that ranitidine has a clear propensity for microsomal inhibition, but one which is unlikely to be manifest at therapeutic dosage.

The substituted benzimidazole, omeprazole, is a potent inhibitor of the ATP-dependent proton pump of the parietal cell. Since there is accumulating evidence that hepatic lysosomes also possess an ATP-dependent proton pump system to maintain internal acidification, and since antibodies to the putative lysosomal proton pump protein are immunologically similar to the parietal cell (H+ + K+) ATPase, we studied the effects in rats of six days of omeprazole treatment on hepatic lysosomal function. Omeprazole, 5 mg kg−1, a dose five times the ED50 for gastric acid secretion inhibition in rats, did not alter the activity of three representative lysosomal enzymes in liver (acid phosphatase, β-galactosidase and N-acetyl-β-glucosaminidase) nor did it alter lysosomal enzyme latency, a measure of the integrity of the lysosomal membrane. Furthermore, bile flow and the secretion of lysosomal enzymes into bile were also unaffected by omeprazole. These data indicate that in rats short-term treatment with omeprazole, in doses that markedly inhibit gastric acid secretion, has no major biological effect on liver lysosomal integrity and lysosomal enzyme activity.

Interdigestive migrating myoelectrical complexes, caudad moving bands of action potentials, were first described in the canine small intestine by Szurszewski in 19691. The presence of similar complexes has since been demonstrated in the small intestine of a variety of animals2,3,4. These complexes are initiated in the stomach and then propagated along the small intestine. In fasting human duodenal motility studies each period of motor activity terminates in a burst of regular waves with a frequency identical to the duodenal slow wave frequency of 11–12 cpm5,6, and these bursts of contractions have been shown to pass distally along the bowel7. However, studies of migrating myoelectrical complexes in the human small intestine have not been reported.

Previous studies of the hepatic uptake of several albumin-bound ligands, using constant and variable albumin concentrations, were interpreted as being inconsistent with the traditional mechanism of uptake, defined as an uptake rate directly proportional to unbound ligand concentration, and led to the formulation of the albumin receptor theory of hepatic uptake. Because other experimental designs have failed to confirm the albumin receptor theory, we reexamined, using the isolated perfused rat liver preparation, the traditional uptake mechanism under the conditions used in the original studies, of constant and variable albumin concentration. Livers (n = 6) were perfused in randomized sequence with 10 different solutions containing 24-14C-taurocholate in a single-pass design. Five solutions contained fixed albumin (0.1 mM) and variable taurocholate (3-48 microM) concentrations, and five maintained the taurocholate-albumin ratio fixed at 0.06; absolute concentrations of taurocholate varied from 3-48 microM, and of albumin from 0.05-0.08 mM. At constant albumin concentration in hepatic inflow, elimination rate of taurocholate was linearly related to both total (Cin) and unbound (Cin,u) taurocholate concentration in hepatic inflow, indicating first-order elimination kinetics. When taurocholate and albumin were increased in hepatic inflow in a fixed molar ratio, taurocholate uptake rate was not linearly related to Cin,u but was still consistent with the traditional uptake mechanism. Moreover, the apparent saturation of taurocholate uptake by added albumin was consistent with the reduction in unbound fraction (fu) in accordance with the traditional uptake mechanism. This study shows that although the traditional uptake mechanism dictates that ligand uptake rate is linearly related to unbound ligand concentration within the liver, uptake rate need not necessarily be linearly related to Cin,u. Therefore, experiments in which lack of a linear relationship between uptake rate and Cin,u is found do not necessarily imply receptor-mediated uptake.

Bidirectional placental transfer of taurocholate was studied in conscious, pregnant sheep near term. In studies of maternal-to-fetal transfer sodium, [14C]cholate was injected intravenously daily into the mother to label the endogenous cholate pool. Ninety-five percent of the radiolabel was present in the maternal pool as [14C]taurocholate. No radiolabel was detected in the fetal bile over 6-9 days, indicating minimal placental transfer of taurocholate to the fetus. In contrast, mean fetal-to-maternal transfer of taurocholate, studied over 3-4 days, was 2.6 mumol/24 h, representing approximately 2%/day of the fetal taurocholate pool. We conclude that in the sheep placental transfer from the mother, at term, contributes little if any taurocholate to the fetal pool. However, the placenta may be an important excretory organ for fetal bile salts, thus playing a key role in fetal steriol homeostasis.

Summary: The association of chronic active hepatitis with pyoderma gangrenosum. A. W. Marshall, J. M. Slonim, R. A. Smallwood and K. J. Fraser, Aust. N.Z. J. Med., 1978, 8, pp. 656–658. This report deals with a 25-year-old man with chronic active hepatitis and cirrhosis who developed the rare complication of pyoderma gangrenosum which improved rapidly following the commencement of prednisolone.

Summary: Twenty young narcotic addicts who had been using drugs intravenously for at least two years were examined for the presence of liver disease. Eleven (55%) had abnormal liver function tests, and 19 (95%) had abnormal liver biopsies. Fourteen showed the changes of chronic persistent hepatitis. The remaining five showed in addition greatly expanded portal tracts with dense lymphoid aggregates and poorly formed histiocytic granulomas. Foreign material was identified in five biopsies. No patient had HB Ag in the serum, but four had detectable levels of HB Ab. It is concluded that the liver lesion is associated with the repeated intravenous injection of contaminated drug preparations, but no single causal agent, infective or chemical, has been clearly identified. Despite little biopsy evidence of progression, florid changes persist long after drug taking has stopped, so that a benign prognosis cannot be assured.

Summary 1. The biliary excretion of a tracer pulse of sodium [14C] taurocholate injected into the portal vein was compared in adult and near-term foetal sheep. 2. Biliary excretion was virtually complete in both adult and foetus, although appreciably faster in the adult. 3. These results indicate that at birth the mechanisms for bile salt uptake and excretion in the sheep liver are well established.

Summary: The plasma disappearance of an intravenously injected tracer dose of glycocholic acid (glycine-1-14Cy was compared in patients with and without diffuse hepatocellular disease. No difference was found between the two groups of patients. We conclude that this test is not a sensitive index of the presence of significant liver disease.

The effect of four H2-receptor antagonists (cimetidine, burimamide, oxmetidine, and ranitidine) on antipyrine elimination was studied in the isolated perfused rat liver. The first three drugs are substituted imidazoles, whereas ranitidine contains a furanyl nucleus. Isolated livers were perfused using a 100-ml, recycling, constant flow circuit for 4 hr. Antipyrine elimination was studied with or without an H2-receptor antagonist present. In all experiments, antipyrine concentrations declined monoexponentially. In control experiments (no other drug present), antipyrine clearance was 32.5 +/- 0.9 ml per hr. This was greatly reduced in the presence of cimetidine (clearance = 10.1 +/- 0.8 and 5.8 +/- 1.5 ml per hr after 1 and 5 mg doses, p less than 0.01) and burimamide (4.5 +/- 0.6 and 3.0 +/- 1.7 ml per hr, p less than 0.001). By contrast, neither oxmetidine nor ranitidine significantly altered antipyrine pharmacokinetics. These results indicate that the inhibitory effect on hepatic mixed-function oxidases is rapid in onset, independent of H2-receptor antagonist activity, and is not an inevitable consequence of the presence of an imidazole nucleus.

The effect of four bile acids, taurocholic (TC), taurochenodeoxycholic (TCDC), tauro-3 alpha,7 alpha-dihydroxy-12-keto-5 beta-cholanoic (T12K), and cholic (C), on bile lipid and water secretion was studied in the bile fistula cat over a 20-fold range of bile acid secretion rates. The critical micellar concentration (CMC) and lecithin-solubilizing capacity of TC, TCDC, and T12K were measured in vitro. T12K and C produced a greater choleresis than TC or TCDC; phospholipid secretion was strikingly reduced with T12K; and cholesterol secretion strikingly increased with TCDC, with a high cholesterol-phospholipid ratio. The estimated CMCs of TC, TCDC, and T12K were 3.3, 0.7, and 6.2 mM respectively; the relative lecithin-solubilizing capacities were 4.4:2.6:1. We conclude that the micellar characteristics of the bile acids studied do not explain the differences in water and lipid secretion observed, and that effects within the hepatocyte may be equally important.

Summary: Giardiasis following gastric surgery. A patient is presented who developed acute life-threatening diarrhoea due to infestation with Giardia lamblia. We propose that the severity of the illness may have been related to hypochlorhydria following gastric surgery.

SUMMARY 1. The effect of pretreatment with phenobarbitone on the hepatic transport of sodium 14C-taurocholate was studied in the Sprague Dawley rat. Taurocholate solutions were injected into the portal vein in a volume of 0.2 ml in 2 s. 2. Biliary secretion of taurocholate injected into the portal vein in a concentration of 25 μM was not altered by pretreatment with phenobarbitone. This concentration of taurocholate corresponds to that occurring normally in portal venous blood. 3. When taurocholate was injected in a much larger concentration (13 mM), biliary secretion of taurocholate was significantly slower in phenobarbitone-pretreated rats than in control rats. 4. Changes in hepatic bile salt transport do not appear to contribute to the choleresis that occurs with phenobarbitone.

The effect of five bile acids on biliary lipid secretion was studied in the pentobarbital-anesthetized cat. The dihydroxy acid, taurohyodeoxycholic acid, was indistinguishable from another dihydroxy acid, taurochenodeoxycholic acid, but secretion of both phospholipid and cholesterol was considerably reduced with two mono-keto dihydroxy acids, tauro-3alpha,12alpha-dihydroxy-7-keto-5beta-cholanoic acid and tauro-3alpha,7alpha-dihydroxy-12-keto-5beta-cholanoic acid. The effect of a trihydroxy bile acid, taurocholic acid was as previously described. The effect of the keto bile acids may be explained by the ability of these bile acids to solubilize lipid, but such an explanation is inadequate for the difference between di- and trihydroxy bile acids. An intracellular effect of bile acid is postulated.

The plasma clearance and the liver uptake of intravenously administered (64)Cu were significantly impaired in four patients with Wilson's disease. These defects were unlikely to be simply expressions of the high liver copper concentration as the plasma clearance and hepatic uptake of (64)Cu were normal in four patients with primary biliary cirrhosis, in whom the liver copper concentration was raised to a degree comparable to that in Wilson's disease. The normal liver uptake and plasma clearance of (64)Cu in three patients with other forms of hepatocellular disease suggest that impaired liver cell function does not have a significant effect. The precise nature of the defect in copper transport in Wilson's disease remains to be elucidated; it is possible that delayed uptake of copper by the hepatic lysosomes may account for the toxic effects of the metal.

1. [14C]Cholesterol was administered intravenously via the umbilical vein to foetal sheep in the latter half of gestation, and the incorporation of radioactive label into foetal bile acids was assessed. 2. After 4 days, 0·5–2% of the radioactive label was found in foetal bile. Seventy to eighty per cent of the radioactive label in foetal bile was present as [14C]taurocholic acid and [14C]taurochenodeoxycholic acid. The remainder was [14C]cholesterol. No radioactive label was found in taurodeoxycholic acid, or in any of the glycine-conjugated bile acids. 3. It is concluded that the foetal sheep liver in the second half of gestation synthesizes taurocholic acid and taurochenodeoxycholic acid. However, the secondary bile acid taurodeoxycholic acid and the glycine-conjugated bile acids, present in foetal bile, have been acquired by placental transfer from the mother.

The optimal dose schedule for omeprazole in the treatment of peptic ulcers has not been established. Two recent comparative dose studies in small groups of patients showed rapid healing of duodenal ulcers treated with 20, 40 or 60 mg/day for 4 weeks (1, 2). We report a double-blind study comparing a lower dose of omeprazole than has previously been studied (10 mg/day) with an intermediate dose (30 mg/day).

Previous studies with omeprazole have demonstrated that a daily dose of 30 or 40 mg reduces the acidity of gastric contents throughout the 24-hour period (1, 2). The influence of dosing time has been examined with 40 mg given either in the morning or in the evening (1). A dose at 0900 hours produced a slightly greater overall elevation in 24-hour pH than did dosing at 2100 hours. Inhibition of gastric acidity was nearly complete with either regimen, so that the difference between them was of doubtful therapeutic significance. At a lower dose, which may be considered for maintenance therapy, the time of administration may be more important. Therefore, 24-hour gastric pH profiles were examined in duodenal ulcer patients given omeprazole, 10 mg, in the morning or the evening.

To examine whether changes in inhibition of gastric acid secretion occur during chronic ranitidine therapy, duodenal ulcer patients in remission were studied before and after 9 months of maintenance ranitidine therapy (150 mg nocte). At each time, the effect of a bolus i.v. dose of ranitidine (50 mg) on pentagastrin-stimulated maximal acid output was measured. Oral and intravenous pharmacokinetic studies were also performed to examine whether changes in absorption or disposition occur during long-term dosage. After 9 months' therapy, ranitidine inhibited pentagastrin-stimulated secretion by a median of 62%, substantially less than the median inhibition of 95% pre-treatment. Median acid output in the period 60-120 min post-ranitidine was six times the pretreatment value. Since pharmacokinetic parameters were unaltered, this reduced ability to inhibit acid output appears to indicate reduced sensitivity of acid secreting mechanisms to ranitidine after prolonged dosage.