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Salivary secretions on mechanical stimulation with forced spitting method and on chemical simulation with 10% citric acid and gastric acid secretions on maximal histamine stimulation were studied in 20 adults with tropical sprue and 20 adult control subjects. It was observed that the chemical method provided a better stimulus than the mechanical one in both groups. The salivary flow rates as well as salivary amylase, pH, sodium and potassium were similar in both groups. Tropical sprue patients, however, had significantly lower maximal acid output as compared to normals. It was concluded that, although tropical sprue patients are known to have widespread damage to alimentary tract mucosa, salivary glands do not seem to be involved.

Dose-response curves for the effect of continuous infusion of histamine on gastric acid secretion were obtained in 10 patients with iron deficiency anemia due to hookworm infection. Each patient was studied with 4 doses (40, 60, 80 and 100 mug/kg/h) of histamine acid phosphate administered for 3 h, on separate days, in random fashion. The acid output increased with the dose of histamine, the maximal acid output was reached in all patients at the dose of 100 mug/kg/h. The dose of histamine when calculated according to body weight correlated well with the maximal acid output; the absolute dose of histamine had no correlation with the maximal acid response. The dose-response curve of stimulated acid output in anemia patients was much flatter than in control patients.

Salivary flow rates on mechanical stimulation by forced spitting method and by chemical stimulation with 10% citric acid and gastric acidity using an augmented histamine test were determined in 20 adult patients suffering from duodenal ulcer and in 20 adult control subjects matched with respect to age, sex, and body weight. Salivary flow rates were found to be much higher in response to chemical than to mechanical stimulus in both the groups. Duodenal ulcer patients exhibited an unexplained exaggerated response to chemical stimulation. Salivary pH, amylase, sodium, and potassium levels showed no significant differences between the two groups. The flow rates by either method generally showed a positive correlation with body weight in both the groups. Histamine stimulated gastric acid secretion was higher in duodenal ulcer patients than in controls. Acid secretion did not appear to be related to weight and also showed no consistent correlation with the salivary flow rates. It was concluded that (1) the salivary flow was dependent on body weight in duodenal ulcer patients as well as in controls, and (2) although salivary gland hyperplasia could be postulated in duodenal ulcer patients on the basis of increased salivary flow, the latter was poorly related to maximal acid secretion and therefore, if a combination of parietal cell and salivary gland hyperplasia did exist, it should be considered as incidental.

Gastric secretory studies were carried out in the following groups of patients: group A, 30 Salmonella typhi positive enteric patients, group B, 15 non-enteric fever patients and group C, 20 healthy controls. Patients with typhoid were divided into two subgroups on the basis of the severity of the disease: group A1 (17) consisted of uncomplicated cases of enteric fever and group A2 (13) comprised of those who had associated complications. During convalescence both groups of typhoid patients showed significantly lower basal acid output (BAO) and maximal acid output (MAO) levels compared with controls and patients with non-enteric fever. Patients in group A2 had significantly lower MAO levels compared with group A1 but the BAO levels showed no such difference. In contrast BAO and MAO levels during convalescence in patients with non-enteric fever were similar to those in the control group. After two months, there was a significant increase in both the BAO and MAO levels in groups A1 and A2. The levels in group A2, however, remained significantly lower compared with group A1, controls and patients with non-enteric fever. Histologically, the gastric mucosa did not show any significant abnormality in either group of typhoid patients. The results suggest that depressed gastric secretion is the result of enteric infection and is related to the severity of the disease process.

A fatal case of meningo-encephalitis due to Amoeba naegleria is discussed. It was a problem for diagnosis because of its unusual presentation. The patient, a young pregnant female presented with pyrexia, severe headache, and photophobia. Anti-biotic therapy was started after a provisional diagnosis of acute pyogenic meningitis had been made. There was no response to antibiotic therapy. Facial nerve palsy and abnormal activity in the left centro-temporal region in the EEG was observed and suspicion of an intra-cranial space occupying lesion was entertained. Carotid angiography and ventriculography, however, showed no abnormality. Repeat cerebrospinal fluid examination revealed motile amoebae. The patient, however, died shortly afterwards. This case is documented for its atypical clinical presentation and therapeutic problems.

The efficacy of pyrantel embonate (1,4,5,6-tetrahydro-1-methyl-2-(trans-2-(2-thienyl)-vinyl)-pyrimidine embonic acid salt; Combantrin) was evaluated in 60 cases of hookworm infestation. They were divided into six groups of 10 cases. Pyrantel embonate was administered orally, in dosage schedules (randomized) of 100, 75, 50, 20, 15, and 10 mg/kg of body weight. The stool examination for hookworm ova and coproculture were positive in each case. The predominant species was Ancylostoma duodenale (in 58 patients). After treatment with pyrantel embonate the stool examination for hookworm ova and coproculture were negative on the 10th and 15th days in each group. The blood levels of the drug were significantly higher in patients receiving 100 and 75 mg/kg body weight. In groups A and B one patient experienced nausea and vomiting on the day of administration of drug. There were no abnormal changes in liver function tests or blood urea levels in any of the groups. Hence the optimum single dose of the drug effective against hookworm infestation is 10 mg/kg body weight, and further studies are required to evaluate the minimum effective dose of pyrantel embonate.

Twenty-eight patients with typhoid fever and one patient with paratyphoid fever were subjected to intestinal function tests (faecal fat and D-xylose) and jejunal biopsy soon after recovery from the acute phase of the disease in order to assess the residual functional and morphological status of the small bowel. The results indicate that almost 50% (14/29) initially had defective D-xylose absorption which recovered rapidly. No patient had steatorrhoea. Jejunal biopsies of eight patients out of 22 showed increased chronic cell infiltration; there was, however, no specific lesion. It appears that intestinal injury following salmonellosis results only in mild functional derangement of the bowel which recovers rapidly.