Showing papers in "Gut in 1969"
TL;DR: A normal range has been established by studying 25 normal subjects and all passed the first marker within three days and most passed 80% of the markers within five days.
Abstract: A simple technique for measuring gastrointestinal transit times using radioopaque pellets of barium-impregnated polythene has been developed and validated. A normal range has been established by studying 25 normal subjects; all passed the first marker within three days and most passed 80% of the markers within five days.
739 citations
TL;DR: The bacterial flora of the faeces from people in England, an area with a high incidence of cancer of the large bowel, with that of people in Uganda, where the incidence is low are compared.
Abstract: Cancer of the large bowel shows marked variations in geographical distribution (Doll, 1967; Doll, Payne, and Waterhouse, 1966; Davis, Knowelden, and Wilson, 1965) and, with the exception of Japan, the disease is more prevalent in developed than in underdeveloped countries. The reason for this variation is not known but epidemiological evidence suggests that environmental factors may be involved. It is claimed that immigrants from areas with a low incidence of cancer of the large bowel tend to show the same high incidence of this cancer as the local population (Haenszel and Dawson, 1965; Buell and Dunn, 1965). Changes in dietary habit may be especially important (Wynder and Shigematsu, 1967; Buell and Dunn, 1965) and diet is known to affect the nature and distribution of bacteria in the faeces (Hoffmann, 1964; Dubos, 1965). Among the important metabolic activities of intestinal bacteria is the degradation of bile salts (Hill and Drasar, 1968). It seems possible that some of the bacteria in the bowel could convert bile salts, or steroids in the diet, into carcinogens; Haddow (1958) has reviewed the ways in which it is possible, in the laboratory, to convert deoxycholate into 20-methylcholanthrene, a potent carcinogen. We have, therefore, compared the bacterial flora of the faeces from people in England, an area with a high incidence of cancer of the large bowel, with that from people in Uganda, where the incidence is low. We have also compared the abilities of English and Ugandan strains of faecal bacteria to degrade bile salts and have examined the products of bile degradation in English and Ugandan faeces.
379 citations
TL;DR: This work has been carried out to determine the incidence of Diverticula and associated pathology in Queensland, to attempt to assess the relationship of diverticula to symptoms, and to seek any evidence which may throw light on the aetiology of this condition.
Abstract: Diverticular disease of the colon is a common cause of morbidity among many western races, and, being especially a disease of the elderly, is becoming a problem of increasing magnitude. Abdominal symptoms are common in this age group, and in the absence of evidence of other disease, the finding of diverticula on x-ray examination is prone to lead to a diagnosis of 'diverticulitis'. The frequency with which such an association is a chance one, without causal relationship, would depend on the incidence of diverticulosis in the normal population. It is probable that the present safety of colonic surgery is the major reason for a tendency to treat diverticular disease by resection at an early stage, for there has been little work reported on the natural history of the disease when treated conservatively to prove that routine surgical excision is justified. The work which has been reported suggests that the disease is not as inexorable in its progress to serious complications as much surgical literature implies (Bolt and Hughes, 1966; Horner, 1958). Detailed studies of the pathology of diverticular disease are also surprisingly few, considering its importance as a cause of morbidity, while very little indeed is known of its aetiology. Deficiences in knowledge of aetiology and basic pathology make rational treatment difficult. This, together with the tendency to frequent diagnosis and radical therapy, may readily lead to overtreatment. This work has been carried out to determine the incidence of diverticula and associated pathology in Queensland, to attempt to assess the relationship of diverticula to symptoms, and to seek any evidence which may throw light on the aetiology of this condition.
351 citations
TL;DR: The cause of solitary ulcer is unknown, the condition is essentially benign and may persist for many years unchanged, and different views on the pathogenesis are discussed.
Abstract: Solitary ulcer of the rectum is usually a disease of young adults of either sex which has a characteristic appearance on sigmoidoscopy. Distinctive changes may also be seen in biopsies taken from mucosa adjacent to the ulcer. The name ;solitary ulcer' is misleading because more than one ulcer may be present. Moreover, there is a preulcerative phase which is clinically and histologically recognizable. The condition is essentially benign and may persist for many years unchanged. It has not responded satisfactorily to medical or surgical methods of treatment. The cause of solitary ulcer is unknown. Different views on the pathogenesis are discussed.
331 citations
TL;DR: No one type of cirrhosis was more liable to be associated with gallstones at necropsy and in contrast to the general population bilirubin stones were more frequent in cirrhotics.
Abstract: The frequency of gallstones in cirrhotic and non-cirrhotic patients at necropsy has been determined from a retrospective survey of postmortem records over 15 years. The frequency of gallstones was found to be 29·4% in the cirrhotic group and 12·8% in the non-cirrhotic population. Whereas gallstones were twice as frequent in females than males in the general population the sex difference disappeared in cirrhotic patients. Gallstones increased in frequency with age in the general population but this phenomenon was not seen in the cirrhotic group. No one type of cirrhosis was more liable to be associated with gallstones at necropsy. In contrast to the general population bilirubin stones were more frequent in cirrhotics.
190 citations
TL;DR: Advances in identifying different classes of mucosubstances give more tools which can usefully be applied to solve some of the diagnostic difficulties of the histopathologist.
Abstract: The histopathologist quite often faces diagnostic problems such as the recognition of early stages of disease, borderline cases, and morphologically atypical pictures which are not always solved by the usual laboratory techniques. Recent histochemical advances in identifying different classes of mucosubstances give more tools which can usefully be applied to solve some of these diagnostic difficulties. Other authors working in this field have already shown the value of these techniques not only for diagnostic purposes but also for the understanding of the physiological processes in human secretory epithelia and their variations in disease (Lev, 1966; Tellem, Nedwich, Amenta, and Imbriglia, 1966; Greco, Lauro, Fabbrini, and Torsoli, 1967; Hukill and Vidone, 1967; Esterly and Spicer, 1968). By applying a variety of histochemical techniques to some pathological conditions of the colon and rectum an attempt has been made to draw a map of the mucosubstances present in different diseases and to find a 'trait' which could be an aid to morphological diagnosis.
181 citations
TL;DR: The effect of antibiotics on intestinal function and bacteriology was studied in three patients and Vitamin B12 malabsorption appeared to be related to the total number of bacteria colonizing the small bowel rather than to any specific type of microorganisms.
Abstract: Microbial populations of the small bowel and bile salt metabolism were studied in 15 patients with lesions of the stomach and small intestine. These types of microorganism could be correlated with the site and extent of stasis in the small bowel and the presence of a normally functioning stomach. The presence of obligate anaerobes (bacteroides) and free bile acids could be correlated with areas of stagnation. When these abnormalities were detected throughout the small bowel, steatorrhoea was also noted. However, bacteroides and free bile acids in localized regions of either proximal or distal small bowel were generally associated with normal faecal fat excretion. Vitamin B 12 malabsorption appeared to be related to the total number of bacteria colonizing the small bowel rather than to any specific type of microorganisms. The effect of antibiotics on intestinal function and bacteriology was studied in three patients. In one patient, the broad-spectrum antibiotic tetracycline was effective in eradicating an abnormal bacterial flora. In the other two, lincomycin, which is specifically effective in eradicating the anaerobic flora, restored intestinal function to normal.
168 citations
TL;DR: The anatomy, pathology and some clinical features of diverticulitis of the colon with special reference to the action of certain drugs on the behaviour ofthe colon are described.
Abstract: Bumm, R. (1933). Die Divertikel des Dickdarms und ihre Komplikationem. Langenbecks Arch. klin. Chir., 174, 14. Dearlove, T. P. (1954). Diverticulitis and diverticulosis, with a report on a rare complication. Med. J. Aust., 1, 470-475. Drummond, H. (1917). Sacculi of the large intestine, with special reference to their relations to the blood vessels of the bowel wall. Brit. J. Surg., 4,407-413. Edwards, H. C. (1954). Intestinal diverticulosis and diverticulitis. Ann. roy. Coll. Surg., 14, 371-388. Fleischner, F. G., Ming, S. C., and Henken, E. M. (1964). Revised concepts on diverticular disease of the colon. I. Diverticulosis. Radiolugy, 83, 859-872. Homer, J. L. (1958). The natural history of diverticulosis of the colon. Amer. J. dig. Dis., 3, 343-350. Hughes (1969b). The relationship of bowel symptoms to diverticular disease. To be published. (1969c). The muscle abnormality of diverticular disease of the sigmoid colon. A functional study using the polysiloxane foam enema. To be published. Keith, A. (1910). A demonstration on diverticula of the alimentary tract of congenital or ofobscure origin. Brit. med. J., 1, 376-380. Kohler, (1963). R. The incidence of colonic diverticulosis in Finland and Sweden. Acta chir. scand., 126, 148-155. Manousos, 0. N., Truelove, S. C., and Lumsden, K. (1967). Prevalence of colonic diverticulosis in the general population of Oxford area. Brit. med. J., 3, 762-763. Mourgues, P. de (1913). Des Diverticules acquis du gros intestin. Thesis, Lyons. Ochsner, H. C., and Bargen, J. A. (1935). Diverticulosis of the large intestine. Ann. intern. Med., 9, 282-296. Painter, N. S. (1964). The aetiology of diverticulosis of the colon with special reference to the action of certain drugs on the behaviour ofthe colon. Ann. roy. Coil. Surg., 34,98-119. Slack, W. W. (1960). Diverticula of the colon and their relation to the muscle layers and blood vessels. Gastroenterology, 39, 708-712. ,(1962). The anatomy, pathology and some clinical features of diverticulitis ofthe colon. Brit. J. Surg., 50, 185-190. Spriggs, E. I., and Marxer, 0. A. (1925). Intestinal diverticula. Quart. J. med., 19, 1.34. Watt, J., and Marcus, R. (1964). The pathology of diverticulosis of the anti-mesenteric intertaenial area of the pelvic colon. J. Path. Bact., 88, 97-105. Williams, K. L. (1960). Acute solitary ulcers and acute diverticulitis of the caecum and ascending colon. Brit. J. Surg., 47, 351-358.
153 citations
TL;DR: The gastrointestinal abnormalities encountered in 125 patients with the Ehlers-Danlos syndrome have been described and abdominal surgery in affected patients may be made difficult by fragility of tissues and a bleeding tendency.
Abstract: The gastrointestinal abnormalities encountered in 125 patients with the Ehlers-Danlos syndrome have been described. Spontaneous perforation of the intestine and massive gastrointestinal haemorrhage are uncommon but potentially lethal complications of the Ehlers-Danlos syndrome. Less dangerous abnormalities, such ;as external hernia, hiatus hernia, eventration of the diaphragm, intestinal diverticula, and rectal prolapse were all encountered in patients in the series. Abdominal surgery in affected patients may be made difficult by fragility of tissues and a bleeding tendency. In the postoperative period, tearing out of sutures and wound dehiscence may occur.
140 citations
TL;DR: The present study was initiated to study systematically the site of amyloid deposition in the digestive tract in a large number of cases, finding the deposition appeared to be quite haphazard and unpredictable.
Abstract: Amyloid may cause widespread damage to the gastrointestinal tract. Affection of blood vessels may lead to infarction and perforation of the bowel (Brody, Wertlake, and Laster, 1964; Akbarian and Fenton, 1964) as well as to bleeding or loss of protein into the lumen of the gut (Jarnum, 1965); damage to the musculature or nervous elements may cause marked alterations in motility (Gilat and Spiro, to be published); and mucosal destruction may lead to impaired absorption (Beddow and Tilden, 1960). The presence of amyloid in a tissue does not evoke an inflammatory response and damage is apparently caused by local replacement of tissue. Knowledge of the anatomo-histological site of amyloid deposition may, therefore, help in understanding and anticipating the clinical manifestations. Perusal of reported cases of amyloidosis with gastrointestinal manifestations failed to reveal any pattern or trend: the deposition of amyloid appeared to be quite haphazard and unpredictable. The present study was, therefore, initiated to study systematically the site of amyloid deposition in the digestive tract in a large number of cases. Amyloid is an extracellular scleroprotein with a characteristic fibrillar structure as seen by electron microscopy (Cohen and Calkins, 1959; Gafni, Merker, Shibolet, Sohar, and Heller, 1966). The weight of recent evidence favours the thesis of local production (Cchen, Gross, and Shirahama, 1965; Gafni et al, 1966) apparently by reticuloendothelial cells (Cohen, 1967). The detection and localization of amyloid in histological sections has been much facilitated by the use of polarized light. When Congo red-stained sections are viewed with the polarizing microscope amyloid exhibits a typical green birefringence which allows of the detection of even minute amounts of amyloid as well as its exact localization in various histological structures (Ravid, Gafni, Sohar, and Missmahl, 1967).
130 citations
TL;DR: In this study extraluminal force transducers were used to monitor gastric and duodenal smooth muscle contractions in intact unaesthetized dogs and the gastric emptying rate of trisodium citrate and glucose and that of the fat substance test meals and their influence on smooth Muscle contractions were evaluated.
Abstract: Studies of gastric emptying in dogs, rats, and man have demonstrated that solutions of various substances empty in a characteristic manner. This topic has been reviewed by Hunt (1963). The rate of emptying of test meals from the stomach is influenced by many factors, including volume (Hunt and Macdonald, 1954), osmotic pressure (Hunt, 1956), titratable acidity (Hunt and Knox, 1962), and chemical composition (Elias, Gibson, Greenwood, Hunt, and Tripp, 1968; Hunt and Knox, 1968). Thomas (1957) has reviewed motor patterns of the gastroduodenal area which have been characterized when various substances are placed in the stomach. These studies were usually done with balloons or open-tip catheters. Such devices are obstructive to the normal flow of gastric contents and may initiate reflexes that can alter gastric emptying time. Radiological methods have also been used but the data obtained by these methods are subjective and difficult to quantify. Louckes, Quigley, and Kersey (1960) utilized the inductograph, an extraluminal recording device, to study the contractile pattern of the 'pyloric region' but did not quantify their results. Another type of extraluminal device has been developed (Jacoby, Bass, and Bennett, 1963). This unit avoids mucosal contact and the data obtained may be quantified. In this study extraluminal force transducers were used to monitor gastric and duodenal smooth muscle contractions in intact unaesthetized dogs. The gastric emptying rate of trisodium citrate and glucose and that of the fat substance test meals and their influence on smooth muscle contractions were evaluated.
TL;DR: The type and distribution of bacteria in the jejunal juice of patients with a variety of gastrointestinal conditions that might affect the small intestinal flora were examined and no simple correlation between the patient's fat excretion and bacterial colonization of the jejunum could be demonstrated.
Abstract: The type and distribution of bacteria in the jejunal juice of patients with a variety of gastrointestinal conditions that might affect the small intestinal flora were examined. Bacterial colonization of the jejunum defined, in this context, as the occurrence of a bile salttolerant flora consisting of both aerobic and anaerobic bacteria qualitatively resembling that of faeces, was observed only in patients with some form of blind loop. Prominent among the bacteria isolated from these colonized juices were non-sporing anaerobic bacteria, most usually Bacteroides, able to hydrolyse bile salts. No simple correlation between the patient's fat excretion and bacterial colonization of the jejunum could be demonstrated.
TL;DR: It cannot therefore be said that food intake has a direct effect on the development of gastrointestinal cancer, and no time lag has been proved between food intake and the mortality rate for intestinal cancer.
Abstract: The hypothesis upon which this study was based is that there is a relationship between mortality from gastrointestinal cancer and living standards. On this basis we found significant correlations between the intake of animal proteins and the mortality rates for gastric and intestinal cancer. The negative correlation coefficient (r = − 0·85) is an expression of the inverse relationship between gastric and intestinal cancer mortality rates. This inverse relationship is also expressed as the correlation between the food intake, expressed by the intake of animal protein, and the respective mortality rates. The higher the food intake, the lower the gastric cancer mortality rate but the higher the intestinal cancer mortality rate. We do not claim that this relationship discovered by correlation analysis is a causal one. On the basis of this study it cannot therefore be said that food intake has a direct effect on the development of gastrointestinal cancer. In this respect our findings can only be a signal for further studies. Secondly no time lag has been proved between food intake and the mortality rate for intestinal cancer. The findings relating to gastric cancer do not contradict the hypothesis of a time lag.
TL;DR: Both hog gastrin and synthetic gastrin stimulate the cardiac sphincter to increase tone and augment the resistance to reflux.
Abstract: Both hog gastrin and synthetic gastrin stimulate the cardiac sphincter to increase tone and augment the resistance to reflux. Endogenous gastrin has a similar effect, and gastrin also stimulates the secretion of acid which has also been found to increase the resistance of the sphincter, but the effect of gastrin appears to be independent of the secretory stimulus.
TL;DR: The motility not only under resting conditions but also the response to the physiological stimulus of eating is considered, as any hypothesis about the aetiology of diverticular disease must be related to a repetitive physiological stimulus such as eating rather than pharmacological stimuli which occur only rarely in the life of the individual.
Abstract: Arfwidsson (1964) showed that the activity of the sigmoid colon in diverticular disease was greater than normal under resting conditions, following a meal, and after an injection of prostigmine, and he postulated that the muscle in diverticular disease was generally overactive. In the same year Painter and Truelove (1964) found that patients with diverticular disease did not differ from normal under resting conditions but that segments of the colon containing diverticula reacted in an excessive way to pharmacological stimuli such as prostigmine and morphine. They wondered if naturally occurring stimuli also evoke an exaggerated response causing herniation of colonic mucosa. While these authors reach a similar hypothesis about the aetiology of diverticular disease, their reports differ materially and so, using the open tube technique, we have studied intraluminal pressures in the sigmoid colon and rectum in patients with diverticular disease. We have considered the motility not only under resting conditions but also the response to the physiological stimulus of eating, as any hypothesis about the aetiology of diverticular disease must be related to a repetitive physiological stimulus such as eating rather than pharmacological stimuli which occur only rarely in the life of the individual. In addition, observations were made on another group of patients and controls, using miniature balloons, to assess whether differences detected by the open tube could be confirmed by an alternative method of pressure recording.
TL;DR: Manometric studies in nine patients suffering from attacks of severe abdominal pain for which no cause was found after thorough investigation, including laparotomy in some cases seemed to be related to changes in intraluminal pressures in either small or large intestine.
Abstract: Abdominal pain is one of the commonest presenting symptoms in gastroenterology. In some patients an organic lesion is responsible but in many others the cause of pain remains obscure, despite thorough investigation. There is some evidence, however, that the motor activity of the colon may be abnormal in patients with various alimentary disorders (Connell, 1959, 1962; Chaudhary and Truelove, 1961; Wangel and Deller, 1965; Misiewicz, Connell, and Pontes, 1966), but very little is known about the relationship between pain and changes of intraluminal pressure in individual patients (Connell, Jones, and Rowlands, 1965). In this paper we present the results of manometric studies in nine patients suffering from attacks of severe abdominal pain for which no cause was found after thorough investigation, including laparotomy in some cases. The attacks seemed to be related to changes in intraluminal pressures in either small or large intestine.
TL;DR: It is confirmed that gastric hypersecretion can occur in man and dogs after massive intestine resection and the rationale of performing vagotomy and pyloroplasty at the same time as the intestinal resection is questioned.
Abstract: This paper confirms that gastric hypersecretion can occur in man and dogs after massive intestinal resection. The assumption, made by others, that hypersecretion in the clinical situation is similar to that observed in dogs is challenged. An acute hypersecretory state occurred in eight of 19 patients after massive intestinal resection. This was apparent as an increased rate of basal secretion. It was usually transient and unrelated to the length of intestine resected. A correlation was noticed between hypersecretion and jaundice in the immediate postoperative period. Histamine release after acute hepatic injury was postulated as the cause of the hypersecretion. By contrast a chronic gastric hypersecretory state was demonstrated in dogs after massive intestinal resection. The rate of basal secretion was not significantly altered. The increased daily acid output was shown to be due to prolonged and enhanced response to food. The cause was thought to be loss of inhibitory agents, such as enterogastrone, normally released by the small intestine when in contact with food. The rationale of performing vagotomy and pyloroplasty at the same time as the intestinal resection is questioned.
TL;DR: The staining, ultrastructural, and distributive patterns of endocrine cells in the antropyloric mucosa of man and some mammals have been carefully reinvestigated with the aim of a better understanding of their morphological and functional significance.
Abstract: Previous histological and histochemical studies on pancreatic tumours associated with the ZollingerEllison syndrome have shown that they are mainly composed of endocrine cells which, under proper conditions, display argyrophilia, toluidine blue metachromasia, and pseudoisocyanin fluorescence (Cavallero and Solcia, 1965; Potet, Martin, Thiery, Bader, Bonfils, and Lambling, 1966; Cavallero and Solcia, 1968). Since islet D cells of the normal human pancreas display the same staining properties (Solcia and Sampietro, 1965a; Epple, 1967; Fujita, 1968; Solcia, Vassallo, and Capella, 1968), it was postulated that these tumours originate from the neoplastic growth ofD cells (Cavallero, Solcia, and Sampietro, 1967). It has been well established that Zollinger-Ellison tumours produce and release a substance displaying all the chemical and physiological properties of gastrin, the polypeptide hormone identified in the antropyloric mucosa (Gregory, Tracy, French, and Sircus, 1960; Gregory and Tracy, 1964b; Gregory, Grossman, Tracy, and Bentley, 1967). Therefore, we considered the possibility that normal D cells may also secrete gastrin, and that endocrine cells staining exactly as the islet D cells or the cells of ZollingerEllison tumours may be present in the antropyloric mucosa and may be the site of gastrin secretion. In fact, in the antropyloric mucosa a type of endocrine cell has been found (the G cell), which was darkened by silver, stained metachromatically by toluidine blue, and showed white fluorescence with pseudoisocyanin (Solcia and Sampietro, 1965b; Solcia et al, 1968). The histochemical and ultrastructural features of this cell were in keeping with an internal secretion akin to a protein or peptide (Solcia, Vassallo, and Sampietro, 1967). In the present paper the staining, ultrastructural, and distributive patterns of endocrine cells in the antropyloric mucosa of man and some mammals have been carefully reinvestigated with the aim of a better understanding of their morphological and functional significance. Comparative observations have been made on the pancreatic islets, with special reference to islet D cells, as well as on the endocrine cells of the fundic and duodenal mucosa. MATERIAL AND METHODS
TL;DR: The features of small intestinal structure in normal control subjects using the scanning electron microscope are described and the importance of maintaining normal gut motility is described.
Abstract: In this paper we describe the features of small intestinal structure in normal control subjects using the scanning electron microscope.
TL;DR: An attempt has been made to define the width of the normal colon in statistical terms and the validity of these definitions has been tested by comparison with the diameter of the colon in patients with severe idiopathic proctocolitis complicated by megacolon and by patients with total colitis without this complication.
Abstract: Statements that the colon is dilated as judged by radiographic appearances have an element of uncertainty because the range of normality is unknown. In this paper an attempt has been made to define the width of the normal colon in statistical terms and the validity of these definitions has been tested by comparison with the diameter of the colon in patients with severe idiopathic proctocolitis complicated by megacolon and in patients with total colitis without this complication.
TL;DR: A number of standardized controlled vascular occlusions are produced in the experimental animal and studied to study their general and local effects in the hope of increasing the knowledge of what may be expected in the clinical situation.
Abstract: Recent clinical experience (Boley, Schwartz, Lash, and Sternhill, 1963; McGovern and Goulston, 1965; Marston, Pheils, Thomas, and Morson, 1966; Miller and Knox, 1966; Sturdy, 1968) has suggested that many cases of hitherto obscure colonic disease may in fact originate from vascular insufficiency. Some of these cases are directly attributable to blockage of a major vessel by thrombosis or embolism (Marston et al, 1966; Miller and Knox, 1966) whilst in others the ischaemia originates from occlusion or spasm of the smaller intramural vessels (Boley, Krieger, Schultz, Robinson, Siew, Allen, and Schwartz, 1965). The diagnosis of colonic infarction is not always easy and the clinical features, x-ray appearances, and pathology are still not completely defined. The purpose of the present work has been to produce a number of standardized controlled vascular occlusions in the experimental animal and to study their general and local effects in the hope of increasing our knowledge of what may be expected in the clinical situation. Dogs were selected for the investigation for reasons of availability and ease of handling, and also because there is considerable laboratory experience in the behaviour of the ischaemic intestine in this species (Marston, 1962). The pattern of arterial supply to the dog's colon is shown in Figure 1. Blood arrives through the common colic artery, a branch of the superior mesenteric trunk, and the caudal (inferior) mesenteric artery. The common colic artery divides into the middle colic artery, which is distributed much as in the human colon, and the ileo-caeco-colic artery, which runs down the ascending colon and divides into two vessels which finally inosculate with the termination of the superior mesenteric. The caudal mesenteric artery runs straight to the colon and forms a 'T-junction', which above connects with the left branch of the middle colic, and below continues to form the superior rectal artery. In this way a continuous vessel, running along the inner side of the colonic loop, is formed: the marginal artery of the colon. FIG. 1. Anatomy of the blood supply to the dog's colon, showing points of ligature.
TL;DR: The significance of an increase in Paneth cells is discussed and it is suggested that in ulcerative colitis it may produce a self-perpetuating and destructive state.
Abstract: A systematic study of the distribution of Paneth cells in disease of the small and large intestine is described. In disease of the small intestine and appendix there is usually a fall in the number of Paneth cells normally present. Occasionally, as in Crohn's disease, there may be proliferation. In disease of the colon the number of Paneth cells is unaltered in functional and developmental disorders and increased in the inflammatory and neoplastic diseases. It is suggested that the Paneth cell proliferation originates from stem cells in the colon. The significance of an increase in Paneth cells is discussed and it is suggested that in ulcerative colitis it may produce a self-perpetuating and destructive state.
TL;DR: Two peptides which are potent stimulants of gastric acid secretion are isolated from Zollinger-Ellison tumour tissue and evidence is presented in respect of the one isolated in greater amount that its aminoacid sequence is probably identical with that of human gastrin type I.
Abstract: Two peptides which are potent stimulants of gastric acid secretion are isolated from Zollinger-Ellison tumour tissue. They have aminoacid constitutions identical with those of human gastrin types I and II as isolated from human antral mucosa, and they are present in similar proportions. Their electrophoretic and chromatographic behaviour corresponds to that of human gastrins. Evidence is presented in respect of the one isolated in greater amount that its aminoacid sequence is probably identical with that of human gastrin type I.
TL;DR: A significant order of spatial correlation is shown between the geographical pattern of the disease and the drinking of sugar-based alcoholic spirit in central Africa and a simple means of excluding carcinogenic compounds from illicit spirits should be ascertained and widely promulgated at village level.
Abstract: A geographical pathology survey of a large area in central Africa is described and a contrast is recognized between neighbouring areas with apparently many and apparently few cases of oesophageal cancer. This distribution is compared first with other known areas of high and low incidence in sub-Saharan Africa and then with the drinking of indigenous types of distilled spirits. A significant order of spatial correlation is shown between the geographical pattern of the disease and the drinking of sugar-based alcoholic spirit in central Africa. Samples of spirits from eastern Zambia, central Kenya, and the Transkei, although prepared in apparently dissimilar utensils, were all shown to be contaminated in varying degree with zinc. Nitrosamine-like compounds in native spirits were also reported in all these areas. The need for a geographical survey of indigenous drinking habits in Africa is illustrated. Since legislation against distilling is ineffective, a simple means of excluding carcinogenic compounds from illicit spirits should be ascertained and widely promulgated at village level.
TL;DR: The incidence, clinical and investigative features, treatment, and course of severe oesophagitis in 200 patients seen and followed up in the Thoracic Surgical Department for north east Scotland from 1951 to 1967 are reviewed.
Abstract: The incidence, clinical and investigative features, treatment, and course of severe oesophagitis in 200 patients seen and followed up in the Thoracic Surgical Department for north east Scotland from 1951 to 1967 are reviewed. The male/female ratio was 1/1·9. The incidence of severe oesophagitis (grades III and IV) approximated to 4·5 per 100,000; there was a dramatic increase from the age of 50 years onwards. Reflux, with or without hiatal hernia, precedes oesophagitis and has an incidence in excess of 86 per 100,000. It is difficult to assess the extent to which reflux produces mild oesophagitis, but it is clear that it only infrequently leads to the severe grades. Severe oesophagitis does not always need operative treatment. A conservative regime, supplemented by bouginage as required, enables the poorer-risk older patient to live a near-normal life span, in very reasonable comfort. Fifty-three patients of the whole series were operated upon, half primarily and half after previous conservative treatment. The problems of operative treatment are discussed. Newer procedures designed to prevent reflux now allow operation to be more freely advised. Perhaps, rather surprisingly, severe oesophagitis had very little effect on the expectation of life, whether treatment was conservative or operative.
TL;DR: Several reports have now appeared of an increased incidence of disorders of the lymphoreticular system in coeliac disease, ranging from splenic atrophy to more generalizedymphoreticular atrophy and an increased occurrence of malignant reticulosis, involving the gastrointestinal.
Abstract: Several reports have now appeared of an increased incidence of disorders of the lymphoreticular system in coeliac disease. These disorders have ranged from splenic atrophy (Engel, 1939) to more generalized lymphoreticular atrophy (McCarthy, Fraser, Evans, and Read, 1966), and an increased incidence of malignant reticulosis, particularly involving the gastrointestinal tract (Gough, Read, and Naish, 1962; Austad, Cornes, Gough, McCarthy, and Read, 1967; Harris, Cooke, Thompson, and Waterhouse, 1967). Furthermore an association with hypogammoglobulinaemia (Huizenga, Wollaeger, Green, and McKenzie, 1961) and more recently with specific deficiencies of the immunoglobulins IgA (Crabbe and Heremans, 1967) or IgM (Hobbs and Hepner, 1968) have been found in patients with this disease. Phytohaemagglutinin (PHA)-induced lymphocyte transformation has been found to be defective in some malignant disorders of the lymphoreticular system such as Hodgkin's disease (Hersh and Oppenheim, 1965), giant follicular lymphoblastoma, and reticulosarcoma (Hirschhorn, Schreibman, Bach, and Siltzbach, 1964). In view of these findings, and the association already mentioned of disorders of this group with coeliac disease, we have studied the serum immunoglobulin levels in 30 patients with coeliac disease not on gluten-free diets, and in order to examine any relationship between the immunoglobulin pattern and PHA-induced transformation of circulating lymphocytes, we have also studied the latter parameter in 10 of the patients selected at random. Transformation and DNA synthesis (on autoradiography) were assessed by two culture techniques using wholeleucocyte-rich plasma or washed leucocytes, respectively. On each occasion lymphocytes from two normal individuals were also cultured and reciprocal serum-exchange cultures between patients and controls were performed to determine whether any abnormalities which might occur in cultures of the patients' blood would be imposed on the control lymphocytes by the patients' sera, or conversely,
TL;DR: Findings show that the administration of cholestyramine causes a reduction in the absorption of vitamin D 3 - 3 H but not of radiocalcium.
Abstract: The absorption of 10 mug doses of vitamin D(3)-(3)H in rats was found to be decreased by the addition of cholestyramine to the diet in an amount sufficient to cause steatorrhoea. Studies in vitro suggested that the effect of cholestyramine was due to its known ability to bind bile salts and thus disrupt micelles containing vitamin D. The absorption of 1 mg (47)calcium chloride was similar in both control and cholestyramine-fed rats, whether estimated by the whole body counting or the faecal excretion technique. These findings show that the administration of cholestyramine causes a reduction in the absorption of vitamin D(3)-(3)H but not of radiocalcium.
TL;DR: The quantitative effect of mistakes made during the plateau of secretion evoked by intravenous histamine diphosphate was minimal at high secretion rates but important at low rates.
Abstract: Gastric secretion from 24 subjects was collected by continuous nasogastric aspiration during the plateau of secretion evoked by intravenous histamine diphosphate, 0·01 mg/kg/hr. Simultaneously, phenol red was instilled at a constant rate into the proximal part of the stomach. Concentrations of phenol red in 15-minute aspirates were measured, and used to deduce pyloric losses and the reasons for random variation in the volumes aspirated. The average coefficient of variation in the volume was 26%, irrespective of the nature of the nasogastric tube. Correction by phenol red reduced this value to 21%. The coefficient of variation of volume diminished as secretion rate increased. Pyloric losses amounted to 7 ml/15 min, and were independent of the secretion rate. The quantitative effect of these errors upon the assessment of gastric secretion was minimal at high secretion rates but important at low rates.
TL;DR: Evidence will be presented of an association between uncomplicated gastric ulcer in younger women, and the consumption of large quantities of aspirincontaining preparations, usually proprietary powders containing aspirin, phenacetin, and caffeine, taken for the relief of headache.
Abstract: Evidence will be presented of an association between uncomplicated gastric ulcer in younger women, and the consumption of large quantities of aspirincontaining preparations, usually proprietary powders containing aspirin, phenacetin, and caffeine (APC), taken for the relief of headache. Billington (1960a, 1960b, 1963, 1964a, 1965a, 1965b) has demonstrated a rising incidence and mortality rate for gastric ulcers in young women. This change is confined to New South Wales and Queensland, and began about 1943. It has not occurred in any other part of the world, where the rates for ulcers at all sites for both men and women are falling (Susser and Stein, 1962; Susser, 1967). The rates for men in New South Wales and Queensland are similar to those elsewhere. Billington postulated that an exogenous, ulcerogenic factor was responsible, and that this was 'dependent on some aspect of [the women's] behaviour'. Douglas and Johnston (1961) suggested that this factor was aspirin, taken for chronic headache. Duggan demonstrated an association between perforation (1965, 1967) and bleeding (1968) of gastric ulcers in young women on the one hand, and the taking of excess aspirin on the other.