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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.

Summary Liver function study was carried out on 26 cases of symptomless carriers, and 28 cases of intestinal amebiasis with symptoms. High serum globulin values were the only evidence of hepatic dysfunction in 9 cases (34.6 per cent) of symptomless carriers; other liver function tests were normal. High serum globulin, abnormal cephalin cholesterol flocculation and thymol flocculation tests were observed in 15 cases (53.6 per cent), 6 cases (21.4 per cent) and 3 cases (10.7 per cent) respectively, in cases having symptoms.

A double-blind trial with tolbutamide has been instituted in 50 patients with cirrhosis of the liver. The results of the trial, statistically analyzed, showed the only significant improvement with tolbutamide to have been increased appetite and a rise in serum albumin fraction. The drug was not very well tolerated by some of the patients and transient episodes of hypoglycemia were observed in 20% of the patients.

An account of the clinical and pathological features of 70 cases of tropical sprue occurring in the Delhi area is presented. The syndrome is characterised by chronic diarrhoea, steatorrhoea, barium meal abnormalities and histological alterations in the mucosa of the small intestine.Although the syndrome is generally similar to the coeliac disease and idiopathic steatorrhoea of the West, it differs from it in some respects. It has a short and self-limiting course; the steatorrhoea is generally mild as also are the histological changes. It improves on a good hospital diet and is not specifically influenced by a gluten-free diet.The aetiology and pathogenesis are obscure.The roles of infection and malnutrition are discussed.

A total of 164 patients from Australia, Ceylon, India, Singapore, and Thailand were studied for the prevalence of autoantibodies associated with "idiopathic" chronic liver disease-namely, antinuclear antibody, smooth muscle antibody, and mitochondrial antibody. The prevalence of these autoantibodies was high among patients from Australia (55%), but was low among patients from Ceylon (14%), India (11%), Singapore (0%), and Thailand (8%). There are variations in types of hepatitis and cirrhosis between races, and this applies particularly to the type associated with autoimmune markers. This may be related to genetic differences that have evolved between peoples of European and Asian descent.

Intestinal dipeptidase activities were studied in 20 normal control subjects and in 9 patients with primary protein malnutrition. The normal control subjects had low dipeptidase levels as compared with American and European controls. Although the dipeptidase levels of our patients were significantly lower (P < 0.001) than those of the control subjects, no gross damage to their intestinal mucosa was observed. It is possible that early, minor morphological changes in the brush border were missed by the light microscope but were severe enough to affect the enzyme levels. It is postulated that the effects of protein deficiency are increased because the enzymes, present in insufficient amounts (due initially to protein malnutrition), are unable to act on the low levels of protein available in the gastrointestinal tract, thus creating a vicious cycle. Am. J. Clin. Nutr. 27 760-763, 1974.

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.

Summary Dimethyloctadecylamine hydrochloride was shown to be a safe drug that is fairly effective in the treatment of hookworm infections with a single dose of 50 mg per kg of body weight. The rate of cure was 64% of 50 patients studied, and there was a significant reduction of worm load in another 30% of the cases. The side-effects were mild and usually due to gastrointestinal irritation. They could be avoided by giving the drug with milk, food, or antacid agents, and were usually amenable to symptomatic treatment.

In order to study the effects of protein deficiency on functional and structural derangements of small intestine, 18 cases of primary malnutrition, 10 cases of cirrhosis of the liver, 17 cases of nephrotic syndrome and 20 normal control subjects were investigated.Total serum proteins were less than 6 g% in all patients, or significantly lower than normal levels of 7.3 ± 0.4g%.Clinical manifestations suggesting nutritional failure were present in all the patients with primary malnutrition. Patients with cirrhosis of the liver and nephrotic syndrome did not present features suggesting malabsorption.In 4 patients with primary malnutrition and 2 patients with cirrhosis of the liver mild steatorrhea was found. Normal control subjects on a 100 g fat diet were found to excrete 3.7 ± 1.15 g of fecal fat per 24 hours. D-xylose test was found to be abnormal in 9 patients with primary malnutrition and in 6 patients with cirrhosis of the liver.Jejunal biopsies were studied in 38 patients and in all the 20 normal cont...

Gastrointestinal function, chiefly acid secretion by the stomach, was studied in 30 children with iron deficiency anemia and in 13 healthy children of comparable age. Sixteen of the anemic patients had an associated hookworm infection and in 14 the anemia was due to dietary iron deficiency. Gastric acidity was reduced in all of the anemic patients regardless of etiology and of whether observations were made under basal conditions or following stimulation with histamine. A direct effect of hookworm infestation could not be demonstrated either in terms of acid secretion or by biopsy of the small bowel. In these children anemia seemed vastly more important than damage wrought by hookworms in reducing acid secretion by the stomach. Additional observations on fecal fat and urinary xylose excretion did not yield definitive conclusions.