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This study was done to determine the severity and extent of abnormalities of duodenal mucosal architecture in non-specific (non-ulcerative) and ulcer-associated duodenitis. The effect of successful treatment with cimetidine on these changes has also been assessed. A method of microdissection and measurement of villus height, crypt depth, and mitotic figure count per crypt was applied to endoscopic biopsies from the duodenum. Five groups of patients were studied: untreated ulcer-associated duodenitis, untreated non-specific duodenitis, healed ulcer-associated and non-specific duodenitis after cimetidine treatment, and controls. Significant reduction in villus height, increase in crypt length, and increase in mitotic figure count per crypt were all found in both ulcer-associated and severe non-specific duodenitis as compared with controls. These changes were localised to visually inflamed areas and regressed after healing of these lesions with cimetidine. This is the first quantitative comparison of the architectural features between diseased states in the duodenum and control in the same study. Identical morphological changes in the form of crypt hyperplasia and villus atrophy were demonstrated in areas of non-specific and ulcer-associated duodenitis. No evidence could be found from this study that non-specific duodenitis constitutes a different disease from ulcer-associated duodenitis. [ABSTRACT FROM PUBLISHER]

Presents several correspondence on medicine related to clinical trials. Discussions on the management of acute illness among infants; Evaluations on the use of benzodiazepines and other drugs; Descriptions on the Volkmann's ischemic contracture.

Comments on various topics related to medicine. Complication of influenza by fulminating bacterial pneumonia; Views of media on dried milk; Investigation on the effect of metronidazole in appendicitis.

A patient is described, the subject of a previous report (Ross et al., 1971), who subsequently developed gross peripheral mosaic warts and a malignant small bowel lymphoma in association with marked lymphocyte depletion. [ABSTRACT FROM PUBLISHER]

Counts of lamina propria and intraepithelial cells, lymphoid and polymorphonuclear, have been performed on semithin sections of endoscopic biopsies from the duodenum of patients with ulcer-associated duodenitis, with non-specific duodenitis, and from controls. In both types of duodenitis there were significant increases in lamina propria counts of plasma cells, lymphocytes and eosinophils, and in intraepithelial lymphocyte counts, when compared with controls. In control specimens, neutrophil polymorphs were very infrequent but a substantial neutrophil polymorph infiltration of the epithelium and lamina propria was present in both types of duodenitis. In biopsies from areas of duodenitis scanning electron microscopy showed the presence of cells, which are probably neutrophil polymorphs, on the luminal surface of the mucosa. Abnormalities in cell counts were present only in biopsies taken from visually inflamed areas of the duodenal bulb. These values returned to normal after healing of duodenitis with cimetidine. This study highlights the complex nature of the mucosal cellular infiltrate in in duodenitis, particularly the striking increase in polymorphonuclear leucocytes. Histopathological features of ulcer-associated and non-specific duodenitis are identical. [ABSTRACT FROM PUBLISHER]

Maximal acid output (MAO) after pentagastrin stimulation and gastrin response to a standard meal was studied in 100 control and 200 duodenal ulcer subjects from each of two ethnic groups, Scots and Chinese. The acid output was significantly higher in the Scots than in the Chinese for both controls and duodenal ulcer patients. Despite correction for differences in body stature by expressing MAO as a function of the body weight, these differences persisted. In 45 pairs of closely matched patients with duodenal ulcer, the differences between the two ethnic groups remained significant, irrespective of whether MAO was expressed in absolute or weight corrected values. This indicates that differences in age, sex, family history, or duration of illness did not account for differences in acid output. In 20 pairs of normal control and 45 pairs of duodenal ulcer patients the fasting and post-prandial serum gastrin levels did not differ, significantly between the two ethnic groups. The proportion of acid normosecretors was significantly higher in the Chinese duodenal ulcer patients than in the Scottish. The reason for these differences in the gastric acid output between the two ethnic groups is not known and needs to be studied further. [ABSTRACT FROM PUBLISHER]

Pneumatosis cystoides intestinalis (PCI) is an uncommon condition of unknown aetiology. Bacterial gas production may be an important aetiological factor, but experimental evidence in humans has been lacking. We have studied breath hydrogen excretion as an index of bacterial gas production in 12 patients with PCI and have shown that four out of five with demonstrable cysts produced unusually high levels of hydrogen while fasting. This abnormality has not been previously reported. One patient showed resolution of PCI after antibiotic treatment. These findings confirm the importance of bacterial gas production in the pathogenesis of PCI. [ABSTRACT FROM PUBLISHER]

In this investigation, the measurement of trypsin levels in duodenal juice following a standard test meal (Lundh test) was evaluated as a test of pancreatic function, and a study was made of diseases and other factors which may influence its diagnostic efficiency. The method of trypsin assay, which required only basic laboratory equipment, gave a linear concentration-activity curve, with a threshold at 50 μg of crystalline trypsin per ml. Intestinal juice could be frozen and stored for up to six weeks with no detectable loss of tryptic activity. The normal control values were very similar to those found by other workers and were unaffected by the sex or age of the subject. When used to assess 32 patients in whom the presence or absence of pancreatic disease had been clearly established, the test had a diagnostic success rate of 94%. Retrospective analysis of results from 98 patients showed that trypsin levels were generally grossly reduced in patients with chronic pancreatitis or carcinoma of the head of the pancreas. Trypsin levels were normal in most patients with steatorrhoea not of pancreatic origin. Levels were generally depressed to intermediate levels in patients with a diabetic glucose tolerance, with or without steatorrhoea, but no other sign of pancreatic insufficiency. Some lowering of trypsin levels was also noted in patients having an obstruction of the common bile duct. A small but significant depression of tryptic activity was noted in patients with villous atrophy and no pancreatic disease. [ABSTRACT FROM PUBLISHER]

A patient is described who presented with pleural effusions, asymmetrical oedema of the face and limbs, and numerous warts of the hands and feet. He was shown to have vitamin B malabsorption, steatorrhoea, and a protein-losing enteropathy. Lymphography showed asymmetrical lymphatic hypoplasia. Jejunal biopsy showed intestinal lymphangiectasia. The hypoproteinaemia responded well to a low-fat, high-protein diet. Corticosteroids at first appeared to speed resolution of the pleural effusion but had only a limited effect. The effusion was attributed to infections injuring a lymphatic system already impaired. [ABSTRACT FROM PUBLISHER]

The metabolism of salicylazosulphapyridine was studied in 16 patients with ulcerative colitis admitted to hospital. The acetylator phenotype was determined on admission. The mean serum concentration (μg/ml) (at steady state eight ± two days in patients responding to treatment) of SASP, total SP, and 5-ASA were 18·7 ± 12·8; 53·7 ± 23·1; and 1 ± 0·9 for slow acetylators and 17·6 ± 7·1; 31 ± 9·0 and 1 ± 0·9 for fast acetylators respectively. Twenty-four hour urinary excretion of SASP, total SP, and 5-ASA were 4·6% ± 3·1; 52% ± 9·6 and 22·3 ± 6·7% of the administered dose respectively. Serum total SP concentration of 20 to 50 μg/ml appeared to coincide with clinical improvement in the absence of any side effects related to salicylazosulphapyridine. No such relationship could be shown with serum SASP, individual metabolites, or 5-aminosalicyclic acid. [ABSTRACT FROM PUBLISHER]

In a retrospective study of 399 patients with ulcerative colitis, 27 patients had colitic arthritis, 17 had ankylosing spondylitis, and 20 had clubbing of the fingers. Colitic arthritis and ankylosing spondylitis were not related to severity, extent of involvement, or duration of colitis. A significant association between colitic arthropathy and other complications of ulcerative colitis, such as pseudopolyposis, perianal disease, eye lesions, skin eruptions, aphthous ulceration, and liver disease has been demonstrated. The outcome of the first referred attack of colitis in the presence of colitic arthritis and ankylosing spondylitis remained uninfluenced. Clubbing of fingers was related to severity, extent of involvement, and length of the history of colitis. A significant association between clubbing of the fingers and carcinoma of the colon, pseudopolyposis, toxic dilatation, and arthropathy has been shown. The frequency of surgical intervention in patients with clubbing was higher but the overall mortality was not significantly different from the patients without clubbing. [ABSTRACT FROM PUBLISHER]

The incidence of faecal stasis and of diverticular disease has been studied in a group of 399 patients with ulcerative colitis. Sixty-one patients had faecal stasis and 23 patients had diverticular disease. Pathological studies demonstrated an increase in the thickness of the inner spiral muscle in colitis patients with faecal stasis. The thickening was not as great as that seen in diverticular disease. Preliminary studies on the motility patterns in patients with faecal stasis show a higher mean activity in the pelvic colon than in normals but not as great as that seen in diverticular disease. Pressure studies in patients with faecal stasis have shown hypotonia in the proximal colon associated with dilatation. The possible significance of these results is discussed. It is suggested that ulcerative colitis may initiate a motility disturbance which leads to muscle thickening similar to that in diverticular disease. Diverticula associated with ulcerative colitis are usually not involved in the mucosal inflammatory process. [ABSTRACT FROM PUBLISHER]

Reported here are the assay results, using the anaesthetized rat preparation of Lai (1964), of plasma from patients known or suspected to have peptide-secreting adenomata and these are compared with assays carried out on plasma from patients whose clinical history excluded such pathology. It is suggested that these demonstrate that this technique is of diagnostic value in this condition and that it has practical advantages over other bio-assay methods currently available and physiological advantages over immunological methods. It may well be that identification of the presence of tumour in these patients may first be made by immunological techniques to be followed by functional identification using a bioassay procedure such as is described here. [ABSTRACT FROM PUBLISHER]

Methods for bio-assay of secretin-like humoral agents in both cat and dog are described. Bio-assay of tumour extracts and of plasma from patients with the pancreatic choleraic syndrome are described. The first patient was found to have choleretic and secretinlike activity in an extract of her pancreatic islet cell tumour and gastrin-like activity in her plasma. The second patient was found to have both secretin and gastrin-like activity in her plasma, as well as choleretic activity. It is concluded that at least part of the profuse, watery electrolyte diarrhoea of the `pancreatic cholera' syndrome associated with peptide-secreting adenoma of the pancreas is likely to be a reflection of the excessive production of secretin, as well as of gastrin, and possibly also of a choleretic agent. [ABSTRACT FROM PUBLISHER]

The clinical data are presented of two women with profound metabolic upset from exceptional water and electrolyte losses in diarrhoea. One had an islet-cell adenoma of the pancreas and the other abnormal islets. Gastric and pancreatic function were abnormal in both, consistent with the subsequent demonstration of a pancreatic and choleretic secretagogue in the tumour tissue and pancreatic and gastric secretagogues in circulating blood (Cleator, Thomson, Sircus, and Coombes, 1970). [ABSTRACT FROM PUBLISHER]

Two groups of patients with chronic peptic ulcer were studied to determine the influence of duration of symptoms and age at operation on the result of surgical treatment. Independent physical and psychiatric assessments were made. Statistical analysis of the findings indicates that selection for operation by `earning' is unreliable in that it fails to identify that group of patients liable to do badly. In its place, a combined physical and psychiatric preoperative assessment of the peptic ulcer patient is recommended. [ABSTRACT FROM PUBLISHER]