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The effect of oral 1 alpha-hydroxyvitamin D3 (1 alpha (OH)D3) was studied in six patients with calcium malabsorption and steatorrhoea due to small-intestinal resection or small-bowel disease. After 3 months of treatment with 1 alpha (OH)D3 a significant increase in calcium absorption, but not in bone mineral content (BMC), was observed. During treatment urinary calcium increased significantly. We conclude that comparative long-term studies should be carried out to determine the effect and side effects of 1 alpha (OH)D3 and conventional vitamin D in calcium malabsorption after small-intestinal resections.

13 patients with chronic inflammatory bowel disease were treated with an elemental diet (Vivasorb). Intestinal protein exudation was studied during the treatment by means of of 131I-albumin. 131I-albumin studies showed no significant change of albumin degradation and, by inference, of intestinal protein loss in the group as a whole. A high initial albumin degradation rate augured treatment with elemental diet and prednisone to be unsuccessful. It is concluded that measurement of intestinal protein leakage is of no predictive value as regards the effect of treatment of chronic inflammatory bowel disease with elemental diet. Apparently, diminishing protein exudation is a late phenomenon during a course of clinical remission.

Bile acid metabolism was studied in 26 patients with a continent ileostomy (Kock's reservoir) and 32 patients with conventional ileostomy. All had been colectomized for ulcerative colitis. In patients with a continent ileostomy the 14C-glycocholic acid breath test showed increased pulmonary 14CO2 excretion as evidence of abnormal bacterial deconjugation of bile acids and increased faecal 14C excretion as evidence of bile acid malabsorption. Faecal bile acid excretion, determined chemically, and, by inference, bile acid synthesis were only moderately increased (median, 1.8 mmol/day). The disturbance of bile acid metabolism was similar to that found in 32 patients with conventional ileostomy, but more pronounced with higher faecal 14C. A significant difference was that no abnormal bacterial deconjugation took place in patients with conventional ileostomy, since their pulmonary 14CO2 excretion was subnormal. Stool mass was almost identical in the two groups, with median values of 665 and 663 g/day, respectively. Faecal fat excretion was normal in most in both groups. Thus bile acid metabolism is slightly more disturbed in patients with a continent ileostomy than in patients with conventional ileostomy. The resulting malabsorption was modest in both groups.

In 12 patients comparative studies were carried out, to assess the therapeutic effect of synthetic diets containing either oligopeptides (Oligopep) or pure amino acids (Viva-sorb). Owing to side effects and failing therapeutic success it was possible to carry through nitrogen balance studies in only 7 patients. No difference could be shown between the two preparations with respect to nitrogen balance, stool mass and clinical effect. Four of the 7 patients had ulcerative colitis.

Thirty-four patients with chronic inflammatory bowel disease, 23 with ulcerative colitis, and 11 with crohn's disease, weretreated with elemental diet. thirty-one patients had been on high dose prednisonetherapy one to four weeks prior to the diet with no or insufficient response. Fifteen patients (44%) went into remission when elemental diet was introduced as the only change of treatment. Furthermore six patients (18%) went into remission when the dietary treatment was supplemented with high dose prednisone treatment (2 cases) or an increase of prednisone dose (4 cases). Remission occurred in 16 of 21 patients with disease of moderate activity, but in only 5 of 13 cases with severe disease. Remission rate was higher in patients with a limited extent of the lesion, but 8 patients with extensive colitis responded to treatment. There was no significant change of haemoglobin serum iron, transferrin, albumin, orosomucoid, or renal excretion of creatinine. However, significant decreases were observed of sedimentation rate, renal urea excretion, faecal volume and daily number of bowel movements. Colectomy was performed in 8 patients whose condition remained unchanged or aggravated during treatment. Follow-up studies of non-operated patients who went into remission showed that 6 of 13 patients with ulcerative colitis were perfectly well 7-28 months after the study, 3 patients suffered a mild recurrence after 4-24 months, and 4 patients were colectomized 5-10 months later due to severe attack. Of 8 patients with Crohn's disease 4 remained unoperated and free of symptoms 22-35 months after the study.

A retrospective analysis is presented is presented of 205 major operations performed over a 10-year period on 95 previously steroid-treated patients with Crohn's disease (C.D.) or ulcerative colitis (U.C.). All patients had been treated both in the medical and in the surgical gastroenterological department. The incidence of early postoperative complications was high, but there was nothing to suggest a relationship between the complications and the intensity of the preoperative steroid therapy. However, mortality rate, duration of hospital convalescence as well as incidence of complications were found to be significantly lower in those patients who had undergone elective in preference to emergency surgery. The fear of an increased complication rate following intensive steroid treatment of patients with acute C.D. or U.C. is, in our opinion, unfounded.

In a selected material of 228 patients with chronic inflammatory bowel disease (CIBD) the incidence of urolithiasis was 15% (95% confidence limit 11-21). The tendency to urolithiasis is significantly correlated to small-bowel resection and its extent and to obstruction in the urinary tract. On the other hand, there is no definite correlation to the duration or extent of the bowel disease. The significant correlation between urolithiasis and ileal resection is in agreement with the hyperabsorption of oxalate as an important cause of stone formation demonstrated by others. That local factors too play an essential role in the formation of urinary calculi is apparent from the increased incidence of urolithiasis in obstruction of the urinary tract. The incidence of urolithiasis was particularly high (22-25%) among patients with ileostomies. The few and negligible symptoms of and sequelae to, urolithiasis in CIBD encourage a conservative attitude.

On the basis of intravenous pyelography the frequency of ureteral obstruction was elucidated in retrospect in 140 patients with Crohn's disease and 88 patients with ulcerative colitis. The findings were related to X-ray examination of the gastrointestinal tract and to the clinical condition at the time of examination. 19% of the Crohn patients had ureteral obstruction, typically affecting the right ureter on a level with the linea terminalis. There was a close topographic relationship between radiologically demonstrated intestinal changes and a mass in the homolateral iliac fossa. There was no relation to duration or activity of the disease, urinary tract infections, surgery, or steroid medication. 14% of the patients with ulcerative colitis had ureteral obstruction of varying localization and nearly always arising after colectomy. Renal calculi were found in 13% of the patients with Crohn's disease and in 18% of those with ulcerative colitis. I.v. pyelography is recommended before and after intestinal resection in chronic inflammatory bowel disease to demonstrate the relatively common and often fairly silent urinary tract complications.

We report three cases of severe chronic intestinal pseudo-obstruction after extensive bowel resection for Crohn's disease. The patients retained less than or equal to 150 cm jejunum in continuity with the left half of the colon and had no evidence of inflammatory activity in the remaining bowel. Total parenteral nutrition was required, since even very small meals caused abdominal distention, pain, and vomiting. Two patients had a sigmoidostomy constructed, which alleviated the symptoms and enabled a normal oral intake, but only temporarily in one of the patients. Even with a sigmoidostomy the patients needed supplementary parenteral nutrition because of severe malabsorption with high stomal output.

Seven cases of Crohn's disease of the duodenum are presented. They made up 2% of 350 cases of Crohn's disease seen over a period of 15 years. Mean age at onset of Crohn's disease was 22 years (range, 13--47). All patients had other, and most patients severe, lesions elsewhere in the alimentary tract. In three patients the duodenal lesion appeared simultaneously with or within a year of lesions elsewhere, in four cases not until 4 to 15 years later. The period of observation after detection of regional duodenitis was 2 to 14 years; mean, 8 years. The commonest complaint due to duodenitis was epigastric pain. It was present in everyone. Gastrointestinal bleeding rarely occurred. Complicating pancreatitis was not seen. Pathophysiologic abnormalities (decreased vitamin B12 and iron absorption, abnormal protein loss) depended more on the extraduodenal extension of Crohn's disease than on the duodenal lesion. In three patients duodenal obstruction required a bypass operation (gastrojejunostomy or duodenojejunostomy). The same three patients and three other of the series were subjected to other surgical treatment, including ileal resection and, in four cases, subtotal colectomy. Two patients died, one of pneumonia in his home and one in her home town of, probably, acute gastroenteritis complicating a severe short-bowel syndrome. The prognosis in this series seemed to be worse than in Crohn's disease in general, not because of the duodenal lesion but because of its association with severe lesions elsewhere in the gastrointestinal tract.

Study of immunoglobulin levels in 16 Indian control subjects showed that, compared with a Danish control series, they had a significantly higher mean level of IgG, but not of IgA or IgM. By contrast, the IgG levels in eight patients with tropical sprue were decreased or low normal in six cases and raised in only one case. Two patients with tropical sprue had agamma-A-globulinaemia.Turnover studies with (125)I-labelled IgG showed a high rate of synthesis in three Indian controls and an appreciably reduced or low rate in seven of the eight cases of tropical sprue.

In a population study on the western coast of Greenland the incidence of sucrose malabsorption was estimated by means of sucrose tolerance tests in 190 persons. Small-intestinal disaccharidase activity was estimated in 19 patients. Sucrose malabsorption was present in 10.5% of the cases studied-a surprisingly high figure and much higher than the incidence reported elsewhere in the world. This incidence is, however, lower than that of lactose malabsorption in Greenland Eskimos (54%). In contrast to lactose malabsorption, sucrose malabsorption is present from birth; this may have important clinical implications since chronic diarrhoea and malnutrition are fairly common during infancy in Greenland.

In rabbits hyperimmunized with pneumococcal vaccine high concentrations of gamma globulin are produced. In such rabbits, plasma volume was determined with (131)I-labelled rabbit albumin and red cell volume with (51)-Cr-labelled autologous red cells. It was found that the plasma volume increased with increasing gamma globulin concentration, the highest values observed being about 10 gm. per cent gamma globulin and about 70 ml. plasma per kg as against normal values of 0.6 to 0.7 gm. per cent gamma globulin and 30 ml. plasma per kg. The red cell volume was the same in immunized and in normal rabbits and consequently hemoglobin concentration fell with increasing gamma globulin.