Human interdigestive and postprandial gastrointestinal motor and gastrointestinal hormone patterns

Fasting gastrointestinal motor and hormone patterns were studied in 11 healthy volunteers. Cyclic motor activity was present in all subjects during fasting, but the duration and site of onset of each cycle were variable, even in the same subject. Fasting gastrin, GIP, and glucagon levels remained low and constant during the 8-hr study, while plasma motilin levels exhibited cyclic variation in 7 of the 11 subjects. Achlorhydria (induced with cimetidine in 5 of the 11 subjects) did not alter the pattern of fasting motor activity or plasma motilin. In the remaining six subjects, the effect of liquid nutrient meals was examined. Ingestion of a sodium chloride bolus failed to disrupt fasting cyclic activity, while all nutrient-containing solutions inhibited gastric phase-2 motor activity, the duration of inhibition being longest for the mixed and lipid meals. All nutrient meals released GIP, while only protein and mixed meals released gastrin, and the lipid meal released motilin. Our study confirms the rhythmicity of interdigestive motor cycles in man and demonstrates their lack of dependence on gastric acid secretion and some relationship to motilin cycles in certain individuals as determined by radioimmunoassay. Transition from fasting to fed pattern (after liquid meals) is characterized by the inhibition of phasic gastric pressure changes in the antrum and the development of irregular activity in the intestine, similar in pattern to fasting phase 2. Because the duration of interruption of the gastric interdigestive pattern by meals depends on their nutrient content, we conclude that dietary composition may be a major determinant of the fasting-fed motor balance in man.

Luteinizing hormone-releasing hormone involvement in the reproductive behavior of a male amphibian

The present study demonstrates that an intracerebroventricular injection of luteinizing hormone-releasing hormone (LHRH) activates sexual behaviors and elevates the plasma androgen concentrations in rough-skinned newts (Taricha granulosa). The stimulatory effect of LHRH on male behavior may be a seasonal phenomenon, because LHRH stimulation of sexual behavior was only observed during the early part of the breeding season (November and December). When an active LHRH antagonist was injected into male newts, sexual behavior was suppressed. These studies indicate that endogenous LHRH is involved in regulating sexual behavior in this amphibian.

Intestinal control of human postprandial gastric function: the role of components of jejunoileal chyme in regulating gastric secretion and gastric emptying

Intestinal control of gastric secretion and emptying were studied in healthy humans by using intubation-marker-perfusion techniques. An occluding balloon was used to separate the jejunoileal test segment from the more proximal gut. Mixed-nutrient, semielemental meals (300 and 600 calories) were administered while varying the jejunal perfusate: normal saline, jejunal chyme or its protein (casein hydrolysate), lipid (oleic acid), or carbohydrate (maltose) components. The meal in contact with the stomach and duodenum increased gastric secretion above fasting levels. This was partially inhibited by whole chyme in contact with the jejunum, the lipid and carbohydrate components of chyme mediating this inhibition. Jejunoileal chyme inhibited gastric emptying, with all three nutrient components acting as inhibitors. Effects on gastric secretion and emptying were dose-dependent, being greater after the larger meal and most prominent in the early postprandial period; these effects on gastric emptying were more prominent than those on gastric secretion. These results suggest that the intestinal phase of gastric function is directed mainly toward regulation of the reservoir function of the stomach: to adapt the gastric delivery of nutrients and fluid to the capability for efficient digestion and absorption.

Dysfunctions of the stomach with gastric ulceration

Factors implicated in the pathogenesis of gastric ulcer were studied simultaneously in seven patients with strictly defined type 1 gastric ulcer (single benign ulcer above the incisura of the stomach) and in six healthy controls. After ingestion of an ordinary solid-liquid meal, patients with gastric ulcer demonstrated gastric hyposecretion of acid, pepsin, and water; delayed gastric emptying of solids with normal emptying of liquids; and increased intragastric concentrations of bile acids. These functional abnormalities appear to be interrelated. Metoclopramide, administered orally in a double-blind fashion, ameliorated the defect in the emptying of solids and the high concentrations of bile acid in the gastric contents. The ability of this drug to break this interdependent cycle suggests the need for further clinical investigation.

Gastric, pancreatic, and biliary responses to meals in hyperthyroidism

Upper gastrointestinal function in response to a mixed nutrient meal was evaluated in hyperthyroid patients, both before and after therapy, and in healthy controls. Gastric secretion, gastric emptying, and pancreatic secretion were all normal and normally integrated postprandially in the hyperthyroid patients. Bile acid output was reduced (P less than 0.05) in this group of patients relative to healthy controls. Duodenal bile acid concentrations, however, were above the critical micellar concentration in most of the hyperthyroid patients, and the bile acid output and concentration remained unchanged in all patients three months after treatment. After radioactive iodine therapy, when gastrointestinal symptoms were returning toward normal, a small but statistically significant increase in gastric secretion was observed. However, gastric emptying and pancreatic secretion, like biliary secretion, remained unchanged. Abnormalities responsible for the diarrhoea and steatorrhoea in hyperthyroidism appear to reside primarily distal to the duodenum. However, reduced bile acid output may be a contributory factor in some patients.

Application of recategorized WISC-R scores for adjudicated adolescents

Bannatyne's recategorization of WISC-R scores was applied to 97 juveniles who had been adjudicated by the juvenile court system to a diagnostic and evaluation unit in Eastern Alabama. Mean ranks werre analyzed using the Friedman test for repeated-measures analysis of variance. The total sample exhibited a significant mean rank pattern of scores in the following descending order: Spatial, Conceptual, Sequential, and Acquired Knowledge. Subgroup patterns varied for those youths with IQs 90 and above (Conceptual, Spatial, Sequential, and Acquired Knowledge) and IQs below 90 (Spatial, Sequential, Conceptual, and Acquired Knowledge). Pairwise comparisons using the Scheffé procedure indicated significant differences between the Spatial score and Acquired Knowledge score for the total group and those youths with IQs below 90. The study extended the application of recategorized scores for adjudicated youth suggested by Bannatyne (1968, 1971, 1974). This investigation affirms the need for further studies of the differential effect of IQ on the patterns of WISC-R scaled scores.

Cholecystectomy and gastric ulcer--an etiologic relationship?

To determine whether cholecystectomy might be a factor predisposing to gastric ulceration, we evaluated the frequency of prior cholecystectomy in the 181 residents of Rochester, Minnesota, who had gastric ulcer diagnosed at the Mayo Clinic during the 10-year-period from 1966 to 1975. This frequency was similar to that in a control population from the same city, matched for age, sex, and time of registration at the Mayo Clinic. This was also true for subgroups of benign gastric ulcer. However, the frequency of prior cholecystectomy was higher in patients with type 1 ulcer than in those with type 2 or 3 ulcer, probably as a result of the relative predominance of older women in the type 1 ulcer group. These data do not support the hypothesis that cholecystectomy may be harmful in predisposing to gastric ulceration.

Dyspepsia, antral motor dysfunction, and gastric stasis of solids

Extensive gastric manometric and emptying studies were performed in a patient with postprandial dyspeptic symptoms which, for many years, had been diagnosed as functional complaints. After ingestion of a mixed, solid-liquid meal we observed marked gastric stasis of solids associated with a weak antral pressure response, whereas gastric emptying of fluids was normal. Fundic pressure activity, recorded separately, was also normal. This case may represent a pathophysiologic expression of the specific roles of the antrum in the emptying of solids (abnormal) and of the fundus in the emptying of liquids (normal) and shows that pathophysiologic abnormalities can sometimes be demonstrated in patients lumped under a "functional" category.

In the absence of nutrients, pancreatic-biliary secretions in the jejunum do not exert feedback control of human pancreatic or gastric function

Feedback inhibition of basal pancreatic enzyme secretion by luminal pancreatic enzymes appears to be an important regulator of pancreatic secretion in some laboratory animals. To determine whether pancreatic enzymes in the jejunum influence pancreatic or gastric functions in healthy man, we intubated six subjects with a gastric sump tube and a four-lumen duodenal tube which provided (1) a duodenal perfusion site, (2) a duodenal aspiration site, (3) an inflatable balloon immediately distal to the aspiration site, and (4) a jejunal perfusion site immediately beyond the balloon. In this way, the gastroduodenal segment could be functionally separated from the remainder of the intestine. The jejunum was exposed to normal saline, active pancreatic-biliary secretions, or pancreatic-biliary secretions in which the enzymes had been inactivated by heat. Ten minutes after initiation of each jejunal perfusion, normal saline was instilled into the stomach. No differences in trypsin secretion, gastric acid secretion, or gastric emptying occurred with the different jejunal perfusates. We therefore conclude that normal man, in the absence of intraluminal nutrients, does not exhibit a jejunal pancreatic enzyme-dependent feedback control mechanism for pancreatic enzyme or gastric secretion. However, our study does not exclude the possibility of a duodenal feedback regulatory mechanism.

Gastrointestinal hormone profile in renal insufficiency

Fasting serum gastrin, cholecystokinin, glucagon, and gastric inhibitory polypeptide concentrations were simultaneously measured in normal subjects and in patients with different degrees of renal failure. Values of gastrin, cholecystokinin, gastric inhibitory polypeptide, and glucagon were significantly higher in all patients with serum creatinine concentrations greater than 3 mg/dl than in controls (P less than 0.01). The degree of renal insufficiency was significantly correlated (P less than 0.05) with serum concentrations of each hormone, but no significant linear correlation existed among the serum concentrations of different gastrointestinal hormones in individuals. Hemodialysis did not significantly alter predialysis serum gastrin, cholecystokinin, or glucagon concentration, but the serum gastric inhibitory polypeptide concentration decreased by 30% (P less than 0.01) after hemodialysis. The disproportionate increases of hormones with antagonistic actions may alter gastrointestinal function in renal insufficiency.

Analytical characteristics of late-eluting halogenated flame retardants

The analytical characteristics of halogenated flame retardants were studied. Suitable electron capture gas-liquid chromatographic conditions were developed, and retention times and sensitivity responses were obtained. The behavior of these industrial chemicals through the AOAC multiresidue method for nonfatty foods was studied using fish as the test substrate. Of the 24 flame retardants investigated, 23 were recovered (85-110%) using the AOAC method.

Takayasu's arteritis in Crohn's disease

This report describes a patient with coexistent Crohn's colitis and Takayasu's arteritis involving the thoracic aorta, superior mesenteric artery, and left hepatic artery. Unlike most previously reported cases of this association, characteristic histopathology is demonstrated. This case is also unusual in that the Takayasu's arteritis presented as aneurysmal disease instead of occlusive disease. We believe that Takayasu's arteritis may represent another of the many extra-intestinal manifestations of inflammatory bowel disease.

Control of human postprandial pancreatic exocrine secretion: a function of the gastroduodenal region

Regulation of the exocrine pancreatic secretion elicited by a meal in man is incompletely understood. In this study, we attempted to localize in the gastrointestinal tract areas that control postprandial trypsin secretion and to determine the effects of individual components of jejunal chyme on the meal-stimulated trypsin secretion. Trypsin outputs elicited by ingesting a mixed-nutrient meal and diverting it at the ligament of Treitz proximal to an occlusive balloon were compared with those occurring when the same meal was ingested, diverted at the ligament of Treitz, and immediately reinfused distal to the balloon, a procedure that exposed the entire gastrointestinal tract to chyme. Two different meals, one of semielemental and one of complex nutrients, were used with similar results. Trypsin outputs were similar whether or not jejunal chyme was diverted. In addition, no component--exogenous nutrients or endogenous secretions--of chyme reaching the jejunum after a meal further modified the trypsin secretion elicited by the gastroduodenal segment. This finding suggests that the gastroduodenal segment is sufficient to elicit the entire postprandial trypsin output and is the physiologic determinant of meal-stimulated trypsin secretion.

Intestinal nutrient influence on the enteroinsular axis

The gastrointestinal contribution to carbohydrate metabolism includes carbohydrate absorption and the release of gastrointestinal hormones that interact with the endocrine pancreas. To learn the contributions to the enteroinsular axis from different levels of the gastrointestinal tract and different nutrients in chyme, we determined serum concentrations of glucose, gastric inhibitory peptide (GIP), insulin, and glucagon postprandially in six normal subjects who underwent diversion of chyme just proximal to an occlusive balloon at the ligament of Treitz and jejunal infusion of saline or chyme carbohydrate, protein, and lipid, separately or in combination. Postprandial elevations of serum glucose, GIP, and insulin and decrease of serum glucagon were elicited predominantly from the bowel and its contents distal to the ligament of Treitz. In this segment, each chyme nutrient (but especially carbohydrate) significantly stimulated factors affecting carbohydrate metabolism. Protein and lipid were able to block carbohydrate-induced glucagon inhibition. The gastroduodenal segment, although containing several proposed insulinotropic hormones (gastrin, secretin, and cholecystokinin), had no effect on serum glucose of glucagon and stimulated only small insulin and GIP responses.

Postprandial duodenal function in man

Duodenal function was studied in 11 healthy volunteers after intragastric instillation of a mixed semi-elemental meal. The duodenum accepted chyme of varying pH, osmolality, and nutrient concentration; and, as a result of biliary, pancreatic, and enteric secretion as well as absorption, it delivered chyme with nearly constant pH, osmolality, and nutrient concentration to the jejunum. The flow rate and nutrient load of jejunal chyme varied. The duodenum absorbed more carbohydrate than lipid and less protein, taking up each nutrient at a constant rate during most of the postprandial period. The percentage of nutrient load absorbed was greatest in the late postprandial period, when flow rate, nutrient load, and concentrations were low.

Interrelationships of psychopathology and adience-abience on the HABGT

Using two distinctively different populations, 40 hospitalized schizophrenics and 100 outpatient therapy cases, the interrelationships of two measures based on the HABGT, one of psychopathology and the other of perceptual adience-abience, were investigated. The relationships of each of these measures with sex, age, and educational level were examined. Both measures significantly differentiate the psychotic from the non-psychotic population. Although there is a statistically significant correlation between the two measures in each population, it is shown that the commonality between them varies from a considerable degree of commonality in the schizophrenic group to only a limited degree in the outpatient group. Both measures are uncorrelated with sex, age, and level of educational attainment. The study offers additional evidence of the values of these two measures.

Abnormal intestinal bile acid distribution in azotaemic man: a possible role in the pathogenesis of uraemic diarrhoea

Proximal intestinal bile acids have been studied in 14 ambulatory patients with varying degrees of azotaemia. When compared with normal subjects, the azotaemic patients showed a significant decrease in deoxycholic acid. Analysis of faecal bile acids of a patient with low intestinal deoxycholic acid also showed low deoxycholic acid with a preponderance of primary bile acids, and contrast with faecal bile acids of a normal subject and a patient with normal intestinal deoxycholic acid. It is suggested that impairment of deconjugation or 7alpha-dehydroxylation might be contributing to the low deoxycholic acid observed in azotaemic patients. Unusual bile acids: ursodeoxycholic acid, 3-hydroxy-7-keto-cholanic acid, and 3,12-dihydroxy-7-keto-cholanic acid were also noted in intestinal aspirates of azotaemic patients. The presence of these bile acids in conjunction with low deoxycholic acid correlates with the symptom of diarrhoea in azotaemic patients, and may contribute to the pathogenesis of diarrhoea in these patients.

Further studies of a measure of adience-abience: reliability

Previous studies have suggested adequate reliability for a measure of perceptual adience-abience based on the HABGT in view of significant evidence concerning its construct and predictive validity. The present study explored the test-retest reliability of this scale with 40 process schizophrenics over a two-week interval. Reliability was found to be adequate for both males and females (rho equals .84) for the total scale. The four components of the scale were similarly found to be reliable. No subject changed on retest with respect to adient or abient orientation. Interjudge reliability was very high (rho = .912).

Psychopathology scale of the Hutt adaptation of the Bender-Gestalt Test: reliability

The test-retest reliability of the Hutt Adaptation of the Bender-Gestalt test was explored with a population of 40 process schizophrenics over a two-week interval. The total Psychopathology Scale Score was found to have high retest reliability for both male and female patients (rho = .87 for males and .83 for females). Moreover the three major components for the Scale were found to have high reliability, and fairly high reliabilities were obtained for patients scoring high as well as low on the Scale. Interjudge reliability was also found to be very high (rho = .895), confirming previous studies in this respect. On these grounds, the Scale offers promise both for clinical and research purposes.

Pepsin secretion in man after Histalog stimulation

Human gastric juice shows three separable pepsin fractions on chromatography on DEAE-cellulose. The response of these fractions to stimulation with beta-aminoethylpyrazole hydrochloride (Histalog) was studied. After a single intramuscular injection of Histalog (1.7 mg/kg body weight) there was an increase in the output of all three chromatographically distinguishable pepsin fractions. Little change was observed in the relative proportions of these three fractions and there was no evidence of selective stimulation of any individual fraction.

Febrile convulsions in families: findings in an epidemiologic survey

In a well-studied community of 3,953 individuals under 20 years of age, 142 or 3.6 per cent had a history of one or more proven febrile seizures. Certain families are more FC-prone. An unexpectedly strong relationship was found between children with febrile convulsions and sibs with mental retardation.