Showing papers in "Journal of Gastroenterology and Hepatology in 1989"

Motor mechanisms associated with slowing of the gastric emptying of a solid meal by an intraduodenal lipid infusion.

Abstract: The aim of this study was to define better the motor phenomena associated with the slowing of gastric emptying by a duodenal lipid infusion. Antral, pyloric and duodenal motility were recorded in 10 healthy subjects with a manometric assembly which incorporated multiple perfused side-holes and a sleeve sensor positioned astride the pylorus. The gastric emptying of a standard solid meal and the distribution of the ingesta between the proximal and distal stomach were monitored with a radionuclide technique. A triglyceride emulsion was infused into the duodenum for 45 min once 25% of the meal had emptied. The infusion caused significant slowing in the rate of gastric emptying (P less than 0.01). This slowing in gastric emptying was associated with the suppression of pressure waves in the distal antrum (P less than 0.01) and proximal duodenum (P less than 0.01), the induction of pressure waves isolated to a narrow pyloric segment (P less than 0.01), and a redistribution of ingesta from the distal to proximal stomach. These findings suggest that pressure waves isolated to the pylorus, changes in the intragastric distribution of ingested food, and changes in proximal duodenal motility may all act in concert with changes in antral motility to regulate the gastric emptying of solids.

Corrosive oesophageal strictures following acid ingestion: clinical profile and results of endoscopic dilatation.

Abstract: There are several reports on oesophageal strictures caused by alkali ingestion, but information on oesophageal strictures due to acid ingestion is scarce. Endoscopic dilatation, which has been found to be quite safe and effective in the treatment of benign oesophageal strictures of other aetiology, has also not been evaluated adequately in the treatment of these strictures. Over a period of 2 years, of 47 patients treated at this centre of benign oesophageal strictures, 17 (36.2%) patients had strictures following ingestion of corrosive agents. Thirteen patients had ingested acids and only four gave a history of alkali ingestion. The age range of these 13 patients was 14-50 years (mean = 25.5 years, s.d. = 2.6). The amount of acid ingested varied from 10 to 100 ml (median = 50 ml). The interval between acid ingestion and presentation to hospital ranged from 1 to 60 months (median = 2 months). Ten patients had multiple strictures, and the most common site of involvement was the upper third followed by the lower third of the oesophagus. Only five of these 13 patients had evidence of gastric involvement in the form of antral stricture (four) and hour glass deformity (one). Strictures were dilated using Eder-Puestow metal olives passed over a guide wire. The total number of sittings required to achieve adequate dilatation in this group ranged from 1 to 30 (median = 14). Most patients were managed successfully with dilatation (good response 63.6%, satisfactory response 18.2%). On follow-up, recurrence of dysphagia was seen in a high number of patients (66%), but this could be managed easily with repeat dilatation.(ABSTRACT TRUNCATED AT 250 WORDS)

Aetiology and outcome of acute viral hepatitis in pregnancy

Abstract: The aetiologic types of sporadic acute viral hepatitis in 169 pregnant women were compared with those of 70 non-pregnant women and 287 adult men. The majority of pregnant women (87.6%) came with acute hepatitis in the last trimester of pregnancy. Non-A, non-B (NANB) hepatitis accounted for 81.6% of hepatitis during pregnancy in comparison with 48.6% in non-pregnant women and 57.1% in adult men. Hepatitis A was extremely uncommon during pregnancy. Hepatitis B infection accounted for 17% of all cases in pregnant women compared with 45% in controls. Acute viral hepatitis in pregnancy had a poor outcome as assessed by maternal and/or fetal mortality (28.5%). The outcome was equally bad in hepatitis NANB and hepatitis B. Pregnant women generally had significantly lower immunoglobulin levels in comparison with non-pregnant women. In acute NANB hepatitis during pregnancy, serum IgG and IgM levels were lower and higher, respectively, compared with those in non-pregnant women and pregnant women with acute hepatitis B. It is suggested that an immune suppression during pregnancy might be responsible for increased susceptibility to acute NANB viral hepatitis, which, by itself, seems to induce only a transient acute phase IgM response.

Endoscopic sclerotherapy in children.

Abstract: Thirty-eight children, aged 1-15 years, with portal hypertension and recent variceal bleeding, were treated with repeated endoscopic sclerotherapy. Thirty-six of them had extrahepatic portal venous obstruction. Obliteration of varices was achieved in 35 (92%) patients requiring an average of 5.3 sessions per patient. Major complications occurred in seven patients, three of whom had oesophageal perforations and four had oesophageal stricture. Sclerotherapy significantly reduced the rate of rebleeding after the start of sclerotherapy and more so after variceal obliteration.

Haem in the gut. I. Fate of haemoproteins and the absorption of haem.

Abstract: Haem (FeII-protoporphyrin-IX) is presented to the gut lumen as haemoproteins derived from exogenous dietary) and endogenous (mucosal cell desquamation and bleeding) sources. Haemoproteins such as haemoglobin, myoglobin and catalase undergo hydrolysis by luminal proteases to release the haem. Released haem is maintained in a soluble form in the gut lumen by the products of haemoprotein digestion. Chelators of elemental iron do not bind haem-iron and so haem-iron is better absorbed than elemental iron. Haem-iron does not exchange with luminal elemental iron. Mucosal uptake of haem is limited. Less than 10% binds to the brush border of the villus cell. Although the mechanisms by which haem binds to the brush border and is transported to the intracellular environment are poorly understood, it is known that some haem is transferred to secondary lysosomes where the porphyrin ring is split to release iron and form bilirubin. Depending upon the composition of the diet, the iron released from haem within the villus cell can be the major physiological source of iron. In iron-deficiency in humans, absorption of haem-iron can increase threefold whereas absorption of elemental-iron can increase tenfold. These observations indicate that haem-iron and elemental-iron are absorbed via different mechanisms which are subject to different regulation. For haem-iron to be absorbed, the haem itself must be taken up by the mucosa.

Choledochal cyst: Anomalous arrangement of the pancreaticobiliary ductal system and biliary malignancy

Abstract: Congenital biliary dilatation (CBD) or choledochal cyst has previously been considered a rarity; however, the number of cases reported in the literature has been increasing. It is generally accepted that there is a predominance in Japanese, as more than one-third of the cases are from Japanese literature.

Combined hepatocellular-cholangiocarcinoma associated with dermatomyositis.

Abstract: A 56 year old female developed combined hepatocellular cholangiocarcinoma associated with dermatomyositis. Serum tumour markers except for carbohydrate antigen (CA 19-9; 6400 ng/ml) were within normal range. Despite extensive chemotherapy, no clinical response was obtained and the patient's course deteriorated after 4 months. Macroscopically, the liver was mainly occupied by hepatocellular carcinoma but cholangiocarcinoma was found in the hilum. This is the first case of a rare association of combined hepatocellular-cholangiocarcinoma and dermatomyositis.

Omeprazole and ranitidine in duodenal ulcer healing and subsequent relapse: a randomized double-blind study with weekly endoscopic assessment.

Abstract: To investigate the efficacy of standard and low dosage of omeprazole in the healing of duodenal ulcer, 270 patients with endoscopically active duodenal ulcer were randomized to receive omeprazole, 10 mg or 20 mg every morning, or ranitidine, 150 mg twice daily, using the double-dummy technique. Forty-six potential prognostic factors for healing including clinical, acid-secretory, and endoscopic characteristics were prospectively obtained and healing was assessed by endoscopy at weekly intervals for up to 4 weeks. The cumulative healing rates in the 4 weeks were 43%, 77%, 94% and 95% for omeprazole, 10 mg (n = 83); 49%, 86%, 93%, and 96% for omeprazole, 20 mg (n = 87); and 29%, 63%, 83% and 93% for ranitidine (n = 84), respectively. Life-table analysis showed P less than 0.03 for omeprazole, 10 mg versus ranitidine and P less than 0.002 for omeprazole, 20 mg versus ranitidine. Life-table analysis also showed that in the omeprazole groups, healing rates were lower in smokers than in non-smokers (P less than 0.001), in late- than in early-onset patients (symptoms starting after or before the age of 30 years, respectively, P less than 0.02), in those with less than 5 months than in those with more than 5 months of remission (P less than 0.05), and in those with increased maximal acid output than in those with normal output (P less than 0.05). Patients with healed ulcer were interviewed at 2-month intervals and endoscoped at 4-month intervals or whenever symptoms recurred. The cumulative ulcer relapse rates in 1 year were not significantly different between omeprazole and ranitidine groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of posture on transient lower oesophageal sphincter relaxation and gastro-oesophageal reflux in the dog.

Abstract: Abstrat The hypothesis that suppression of transient lower oesophageal sphincter relaxation (TLOSR) in recumbent postures in the dog is dependent upon the sensing of a gastric pool of liquid in proximity to the lower oesophageal sphincter was examined. Constant gastric insufflation with air (80 ml/min) was used to evoke TLOSR in unsedated, fasting animals. Oesophageal motility was monitored with a perfused manometric sleeve catheter assembly. Gastro-oesophageal flow was recognized manometrically and by oesophageal pH recording. TLOSR occurred significantly less frequently in three recumbent positions (right lateral, left lateral and supine) than when the dog stood on four legs, but was more likely to be associated with acid reflux when they occurred in recumbent positions. Aspiration of the gastric pool was found to have no effect on triggering of TLOSR although it reduced the frequency with which acid reflux was associated with TLOSR. It is concluded that the low rate of occurrence of TLOSR in recumbent positions is unlikely to be explained by the presence of a gastric pool of liquid in proximity to the lower oesophageal sphincter.

Chylous ascites in cirrhosis: a case report and review of the literature.

Abstract: Chylous ascites is an uncommon clinical entity which results from the accumulation of fat, predominantly chylomicrons, in the ascitic fluid. Conventional treatment methods are unsatisfactory. A patient is reported with chylous ascites associated with cirrhosis and portal hypertension in whom the ascites, the renal insufficiency and the fluid and electrolyte disturbances were corrected by the insertion of a Denver peritoneovenous shunt.

Tumour markers of hepatocellular carcinoma

Abstract: Hepatocellular carcinoma (HCC) produces no pathognomonic symptoms or signs, is not associated with a distinctive pattern of disturbed hepatic function, and does not give a specific picture with any of the several modalities used in imaging of the liver. As a result, the diagnosis of HCC is often made only late in the course of the disease when the tumour is seldom resectable, the results of chemotherapy are poor, and the prognosis is correspondingly grave. The availability of a definitive serum marker of HCC would allow earlier recognition of the tumour and offer the prospect of an improved prognosis. Such a marker could also be used, in conjunction with a sensitive imaging modality, in both population-screening and long-term surveillance programmes designed to detect presymptomatic, resectable tumours in individuals at high risk of developing HCC. For a tumour marker to be ideal, it should be present in the serum of all patients with HCC, that is, it should have a sensitivity of 100%. Furthermore, such a marker should not be detectable in patients with any other tumour, particularly those that metastasize to the liver, or with benign hepatic diseases which may be mistaken clinically for the tumour, that is, there should be no ‘false positive’ results, giving a specificity of 100%. In addition, the serum concentration of the marker should accurately reflect the viable tumour-burden, enabling the marker to be used in monitoring response to treatment, in assessing completeness of surgical resection, and in the early recognition of recurrences. Finally, it should be possible to assay an ideal tumour marker readily (and relatively inexpensively) in serum or plasma. Although an ideal serum marker for HCC (or, indeed, for any other tumour) has thus far not been identified, at least two mechanisms exist in the transformed cell which could produce such a marker. Mature hepatocytes retain the potential to synthesize those substances that they normally produce during

Morphological and immunohistochemical assessment of intrahepatic bile duct development in the rat.

Abstract: The hypotheses that intrahepatic bile ducts are derived either by a transformation of periportal liver cells or by dichotomous branching of the extrahepatic bile ducts were investigated in fetal and postnatal rat livers by histological and immunohistochemical methods using an antiserum to prekeratin which, in the liver, binds to biliary epithelial cells (BEC). In conventionally stained sections, bile duct development was observed to begin in the 19 day fetus around the larger branches of the portal vein, with the formation of lumina surrounded by cuboidal or elongated hepatoblast-like cells on the portal aspect and readily distinguished hepatoblasts on the lobular aspect. At 21 days, these structures had developed into canals of Hering lined jointly by recognizable liver cells and BEC. The number of canals of Hering per portal tract peaked at 22 days’ gestation and diminished in number at birth and over the ensuing 56 h, with a concomitant increase in fully formed ducts. Bile ducts lined completely by BEC were first found at 20 days. Immunohistochemically, prekeratin antigens were first detected at 20 days in duct-like structures not only in phenotypic BEC but also in adjacent cells with an hepatoblast phenotype. Such intermediate cells were present until birth. These findings support the view that intrahepatic bile ducts develop by a reorganization and modulation of the periportal hepatoblasts to BEC.

A comparison between des‐γ‐carboxy prothrombin and α‐fetoprotein as markers of hepatocellular carcinoma in southern African Blacks

Abstract: Abstrat Des-γ-carboxy prothrombin (DCP), a precursor of prothrombin, has been reported recently to be as good a marker, or even better, of hepatocellular carcinoma than α-fetoprotein (α-FP). The sensitivity, specificity and predictive values of the two markers have been compared in 98 southern African Blacks with hepatocellular carcinoma and in 120 Black controls with various diseases which might be mistaken clinically for this tumour: 32 with hepatic metastases, 33 with amoebic hepatic abscesses, and 55 with chronic hepatic parenchymal disease. DCP levels were measured using a chromogenic assay with Dispholidus typus venom and staphylocoagulase. The agreement between the two methods was excellent (r= 0.995). α-FP concentrations were measured by radioimmunoassay. DCP levels were raised in 66 of 98 patients (67.3%) and α-FP levels in 82 of 98 patients (83.7%) with hepatocellular carcinoma (P= 0.006). The specificity of DCP was also less than that of α-FP, although the difference just failed to reach statistical significance (P= 0.085). The predictive values of both a positive and a negative test for DCP were significantly less than those for α-FP (P= 0.047 and 0.048, respectively). When, in an attempt to eliminate false positive results, the diagnostic cut-off level for DCP was increased from 1.5 to 5.0 mu/ml and that of α-FP from 20 to 400 ng/ml, the differences between the two markers remained the same. If the two tests were used together, the number of false negative α-FP results was reduced from 16.3% to 7.1% and the number of equivocal α-FP results was reduced from 11.2% to 5.1%. It is concluded that DCP is less useful than α-FP as a single marker of hepatocellular carcinoma in southern African Blacks. However, the two markers can be used together profitably.

Measurement of activity in Crohn's disease.

Abstract: Crohn's disease is a chronic inflammatory disorder of unknown aetiology affecting any part of the gastrointestinal tract. Recurrent exacerbations are common but some patients feel mildly unwell even when in remission which makes it difficult to confirm reactivation of the inflammation and to assess disease activity objectively. Yet this assessment is important if appropriate therapy is to be instituted and monitored. This paper reviews the clinical, laboratory and imaging methods used to measure the degree of activity in Crohn's disease.

Omeprazole compared with ranitidine once daily in the treatment of duodenal ulcer.

Abstract: A double-blind randomized study in 230 Malaysian patients with duodenal ulcer was conducted to compare the proton-pump inhibitor, omeprazole 20 mg, given once daily in the morning, with ranitidine 300 mg, administered once daily at night. After 2 and 4 weeks of treatment, 222 and 220 patients, respectively, were evaluable according to the study protocol. Omeprazole produced significantly higher healing rates than ranitidine at both 2 weeks (75% versus 46%, respectively, P less than 0.0001) and 4 weeks (97% versus 83%, respectively, P = 0.001). Ulcer symptoms were relieved more rapidly by omeprazole than ranitidine. After 2 weeks, daytime epigastric pain was reported by 30% of ranitidine-treated patients but only by 15% of omeprazole-treated patients, which is a statistically significant difference (P = 0.004). No major clinical or biochemical side effects were recorded for either omeprazole or ranitidine. In conclusion, omeprazole 20 mg was found to be superior to ranitidine 300 mg administered once daily for the treatment of duodenal ulcer as measured by ulcer healing and pain relief.

Synergism of chronic alcoholism and hepatitis B infection in liver disease.

Abstract: One hundred and fifty-seven patients with alcoholic liver disease were studied. Hepatitis B surface antigen (HBsAg) was positive in 20.4% of the patients. Those who were positive for the HBsAg presented at an earlier age, had a lower albumin level, a higher globulin level, a more prolonged prothrombin time, were more likely to have features of cirrhosis in the liver biopsy, and were probably more likely to suffer from hepatic encephalopathy in the follow-up compared with those negative for HBsAg. The mortality of subjects was low both on admission and during follow-up. It is concluded that chronic alcoholism and hepatitis B virus infection act synergistically in producing more severe liver damage and causing cirrhosis at a younger age compared with chronic alcoholism alone. One possible reason for the low mortality of the patients might have been their relatively good nutritional status.

AIDS and the gastroenterologist.

Abstract: The acquired immunodeficiency syndrome (AIDS) epidemic has spread during the last decade to virtually every country.”’ By the end of the 1980s the total number of cases reported to the World Health Organization (WHO) had reached 200 000, which almost certainly represented a substantial under-reporting of the disease.2 The WHO estimates the true cumulative incidence of AIDS to be > 500000.’ Table 1 shows the cumulative incidence of AIDS in countries with the highest case loads. It is apparent that no region of the world remains unscathed, although in Asia and the Pacific, with the possible exception of Australia, the spread of AIDS appears to have lagged behind that in other continents. Three major patterns of spread of human immunodeficiency virus (HIV) infection have been defined.’ Pattern I resulted from extensive spread in the 1970s and early 1980s amongst homosexual/ bisexual males, so that the male : female ratio is 10 : 1. Paediatric cases are therefore unusual in this group, although there is increasing spread among populations of intravenous drug users. Overall prevalence of HIV infection is less than 1%. This pattern prevails in North America, Western Europe and Australia. Pattern 11, where spread was also extensive in the 1970s and early 1980s, resulted mainly from heterosexual activity. The male : female ratio is 1 : 1, and paediatric cases of AIDS are common. Here, the overall prevalence of HIV infection is greater than 1%. This pattern is typified by sub-Saharan Africa. Pattern I11 is seen in many countries in which HIV infection did not occur until the mid 1980s. Few AIDS cases have been reported, mostly in people who have been to Table 1 highest case burden*

Parietal cells in duodenal ulcer disease: a histochemical study of the effects of omeprazole and ranitidine on mitochondrial activities.

Abstract: H2-Receptor antagonists and omeprazole, a H-K ATPase inhibitor, inhibit acid secretion from the parietal cells. The ultrastructural changes of the parietal cells after treatment have been described, but the changes in the mitochondrial activity which reflect the energetic metabolism were not well defined. To study the effect of omeprazole and H2-receptor antagonists on the mitochondrial activity of the parietal cells, endoscopic biopsies were taken from nine patients with duodenal ulcer before and after treatment with either 10 mg or 20 mg omeprazole each morning, or 150 mg ranitidine twice daily for 2 weeks, given in a double-blind randomized manner. Three patients with healed duodenal ulcer who were on maintainence treatment with 150 mg ranitidine nightly for 1 year had an endoscopy performed after 4 and 12 months and two non-ulcer dyspeptic patients were recruited as controls. Three biopsies were taken during each endoscopy from the body of the stomach. The mitochondrial activity was assessed by the reaction of succinic dehydrogenase with nitroblue tetrazolium and of cytochrome oxidase with naphthoic acid mixed with N-phenyl-p-phenylenediamine, according to the intensity of the staining reaction. After treatment with omeprazole or ranitidine, the mitochondrial activity decreased appreciably and returned to the pretreatment level on cessation of treatment. Patients on maintainence ranitidine showed decreased mitochondrial activities after 4 months, which, however, returned to pretreatment levels in two patients. It is concluded that short-term treatment with omeprazole or ranitidine resulted in reversible suppression of mitochondrial activity while long-term treatment with ranitidine resulted in an initial suppression followed by a tendency to return to pretreatment level despite continued treatment.

Biological basis of omeprazole therapy.

Abstract: There are two means of reducing acid secretion The best studied is inhibition of stimulation of the parietal cell There are three major types of receptors that activate secretion by this cell and two classes of receptor antagonists, as well as at least two intracellular messenger pathways The receptors are for histamine (H2 subtype), acetyl choline (M2 subtype) and gastrin Antagonists of these receptors include the H2-antagonist class (Tagamet, Zantac and Pepcid), the M1 muscarinic antagonists (pirenzepine, telenzepine) and the gastrin antagonist, proglumide The major pathway for stimulation appears to be the H2-receptor, since this is the only receptor that stimulates adenylate cyclase, and both acetyl choline and gastrin release histamine locally within the gastric mucosa However, these agonists elevate intracellular calcium, which has a partially independent action on acid secretion Accordingly, the most efficacious type of receptor antagonist will be of the H2 class, which is borne out by clinical experience Prostaglandins of the E type prevent adenylate cyclase stimulation by histamine and are also effective antisecretory agents It will be difficult to abolish acid secretion entirely by a single receptor antagonist, although longer-acting H2-antagonists should show clinical superiority to short-acting antagonists of this type An alternative approach to acid suppression is to block the terminal step of acid secretion, the gastric proton pump (H+, K(+)-ATPase) This enzyme is virtually unique to the parietal cell and, when active, forms a very acidic space within the parietal cell called the secretory canaliculus Activation of acid secretion involves several steps The enzyme is present in cytosolic membranes when the cell is at rest and moves to the membrane of the secretory canaliculus when stimulated Simultaneously, there is an increased permeability of potassium chloride (KCl), which allows presentation of K+ to the luminal surface of the pump and H+ for K+ exchange The result is the secretion of HCl into the canaliculus, and hence into the gland lumen and then the stomach There are two classes of pump inhibitors One class is K+ competitive and relatively selective for the H+, K(+)-ATPase, as exemplified by SCH28080 This class has not yet been used in man The other class is specific to the functioning H+, K(+)-ATPase in the stomach It is exemplified by omeprazole (Losec) This compound is a weak base with a pKa of 4 In the unprotonated, uncharged form it will penetrate cell membranes and, at pH less than 4, it becomes protonated and therefore charged(ABSTRACT TRUNCATED AT 400 WORDS)

Relationship between morphine responses and sphincter of Oddi motility in undefined biliary pain after cholecystectomy.

Abstract: In 150 patients with undefined biliary pain after cholecystectomy, responses to morphine were compared with responses to morphine combined with neostigmine. The relationship between rises in plasma levels of aspartate aminotransferase (AST) after morphine or morphine-neostigmine and sphincter of Oddi motility as assessed by endoscopic manometry was also examined. When compared with morphine-neostigmine, patients given morphine alone showed a similar frequency (30% versus 33%) of increases in plasma levels of AST (greater than twice the upper limit of the reference range) but had less abdominal pain and a lower frequency of similar increases in plasma levels of amylase (4% versus 25%). Of 92 patients who consented to endoscopic manometry of the sphincter of Oddi, satisfactory manometric records were obtained in 84, 31 with and 53 without increases in AST after morphine or morphine-neostigmine. Those showing rises in AST had a higher frequency of abnormal manometric records (81% versus 57%, P = 0.025), higher basal pressures in the sphincter of Oddi (P = 0.0001) and higher pressures within ducts (P = 0.02). There was a significant correlation between sphincter basal pressures and intraduct pressures (r = 0.51, P less than 0.001). Rises in plasma AST after morphine are similar to those after morphine-neostigmine and are influenced by, or linked to, factors which determine sphincter basal pressures and intraduct pressures.

Gall-bladder and sphincter of Oddi response to cholecystokinin in the Australian possum.

Abstract: The effects of cholecystokinin octapeptide (CCK-OP) on the gall-bladder (GB) and sphincter of Oddi (SO) of the Australian brush tailed possum were examined in 45 anaesthetized animals. CCK-OP (20-640 ng/kg) consistently caused the GB to contract in a dose-dependent manner (Kruskal Wallis P less than 0.05). In 20 animals, the same dose range of CCK-OP produced an excitatory response in the SO, increasing the SO motility index (MI = frequency of contractions x mean peak amplitude) dose-dependently (Kruskal Wallis P less than 0.05). In five animals, an inhibitory response, that is, a decrease in MI, was recorded, with 640 ng/kg of CCK-OP producing a 50% decrease in MI. In the remaining 20 animals, variable responses of both excitation and inhibition were elicited within the same animal. The action of CCK-OP on the SO and GB was not modified by atropine, phentolamine or propranolol. Tetrodotoxin (TTX) reversed the inhibitory responses of the SO to CCK-OP such that responses were excitatory (sign test P less than 0.05). TTX did not alter the response of the GB to CCK-OP. It is concluded that CCK-OP acts directly on smooth muscle receptors of the GB. In the SO, its action is mediated via non-cholinergic, non-noradrenergic inhibitory neurons and also by a direct excitatory action on the smooth muscle of the SO.

Ulcerative colitis in Karachi

Abstract: Experience of 189 patients with non-specific ulcerative colitis has been reviewed. The majority of patients was in the 21–30 year age group, and neither sex predominated. Seventy-two percent had mild to moderate disease. The disease was mainly confined to the left colon (60%) and 13% had total colitis.

Serum and urinary zinc in fulminant hepatic failure.

Abstract: Patients with chronic hepatic encephalopathy have been shown to have low serum zinc levels. Moreover, in a controlled study, significant improvement was seen in these patients on oral zinc supplementation. Information on zinc status in fulminant hepatic failure is insufficient. Serum and urinary zinc abnormalities were studied in 22 patients with fulminant hepatic failure (FHF) and they were compared with age- and sex-matched controls. The mean serum zinc values were significantly less in patients with FHF (72.7 +/- 3.7 micrograms/100 mL versus 107.9 +/- 6.2 micrograms/mL) while the urinary zinc values were significantly higher compared with controls (603.5 +/- 9.3 micrograms/24 h versus 334.4 +/- 10 micrograms/24 h). The serum zinc levels significantly and progressively decreased, while urinary zinc significantly increased after admission in patients with FHF. The serum zinc values in the group that survived were significantly higher than those in the group of patients who died. Correspondingly, urinary zinc was lower in survivors than in the group that expired. This study indicates that serum and urinary zinc levels could be used as a prognostic indicator in FHF. A therapeutic trial with zinc supplementation is justified in this group of patients.

Lymphangioma of the pancreas.

Abstract: Lymphangiomas of the pancreas are rare Only six cases have been reported An additional case of lymphangioma of the pancreas in a 20 year old male which was demonstrated by computerized tomography and treated with complete surgical excision is reported

Clinical experience with omeprazole: assessment of efficacy and safety.

Abstract: After pharmacological studies showed that omeprazole had a marked and longlasting inhibitory effect on acid secretion, many clinical studies commenced. In duodenal ulcer, omeprazole in doses of 20-40 mg/day has been shown to give significantly higher healing rates than ranitidine or cimetidine. Omeprazole has given healing rates of 58-83% after treatment for 2 weeks and 84-100% after 4 weeks. A more pronounced effect on the relief of ulcer symptoms has also been observed. Similarly, in gastric ulcer several studies have been performed, all of which have shown higher healing rates with omeprazole both at 4 and 8 weeks. Symptom relief has also been faster and more pronounced with omeprazole. In patients with reflux oesophagitis, omeprazole has been shown to decrease the time with an acid milieu in the oesophagus. In several studies omeprazole in doses of 20-60 mg/day has consistently given healing rates approximately twice those of ranitidine in doses of 150 mg twice daily at 4 and 8 weeks. In addition, there has been a rapid improvement in the symptoms of oesophagitis. Omeprazole has been found to be very effective in the Zollinger-Ellison syndrome, with a prompt effect on acid secretion and symptoms. The accumulated experience exceeds 300 patients. More than 13,000 patients have taken part in the clinical investigations with omeprazole. Neither serious side-effects nor other side-effects which could be ascribed to treatment have been observed. There have not been any clinically significant changes in laboratory variables apart from those which are caused by the decrease in acid secretion.(ABSTRACT TRUNCATED AT 250 WORDS)