Basal, sham feed and pentagastrin stimulated gastric acid, pepsin and electrolytes after omeprazole 20 mg and 40 mg daily

Gastric secretion was measured in nine patients with duodenal ulcer before, and after treatment for four weeks with omeprazole 20 mg or 40 mg daily. Basal acidity and acid output were affected variably by 20 mg, but inhibited totally by 40 mg daily. Sham feed stimulated acid output was reduced by 20 mg daily and completely inhibited by 40 mg daily. Maximal pentagastrin stimulated acid output was halved by 20 mg omeprazole daily and 84% inhibited by 40 mg daily. The reduction in acidity was always greater than the reduction of volume. Pepsin output after pentagastrin was little altered but with the reduced secretory volume pepsin concentrations were increased by both doses. The major cause of reduced aspirate acid output after omeprazole is decreased secretion of the primary acid component of the parietal cell by the proton pump H+K+ ATPase. Duodenogastric alkaline reflux is, however, markedly increased after omeprazole and is an additional factor in the resultant hypoacidity or even anacidity after this drug.

Focal liver lesions: a plan for management

A management plan for patients with suspected focal liver lesions which avoids early biopsy includes routine laboratory investigations, ultrasound scanning, and assessment for evidence of extrahepatic metastases and non-hepatic primary tumours. Angiography and computed tomography may also be indicated, and laparotomy or laparoscopy is undertaken to assess any potentially resectable focal liver lesions. The plan requires modification to suit individual circumstances.

Metastasis to pampiniform plexus from left renal adenocarcinoma presenting with acute varicocele

A case of metastatic adenocarcinoma from the left kidney to the veins of the pampiniform plexus is described following initial presentation with an acute varicocele. It provides further evidence to support the retrograde venous route for intrascrotal secondary malignancy and also for low ligation of the left testicular vein at radical nephrectomy.

CONDITIONAL POLYGENIC EFFECTS IN THE STERNOPLEURAL BRISTLE SYSTEM OF DROSOPHILA MELANOGASTER

The chromosomal architecture of genotype × environment interactions was investigated in lines of Drosophila melanogaster selected for increased or decreased sternopleural bristle number at 18°, 25° and 29°. In general, interactions were found to have a stabilizing effect upon the bristle phenotype, in the sense that the genotype × environment interaction tended to increase bristle number under conditions in which temperature alone reduced bristle number and vice versa. The polygenic modifiers of mean bristle number were often separable from modifiers of the response to temperature both at the chromosomal level and intrachromosomally. In one of the low selection lines, a temperature-dependent polygenic locus was mapped on chromosome 3. It is suggested that genotype × environment interactions be thought of in terms of conditional polygenic expression. Such conditionality may be one of the ways in which polygenic variation is maintained in a population in the face of selection for an optimum phenotype.

Surgical approaches to malignant tumors of the nasal septum

Malignant tumors of the nasal septum are rare, probably not more than 300 having been reported. Most of these tumors are epidermoid carcinomas; the second most common histologic type is melanoma. Unless diagnosed and treated early, these tumors are lethal. We report five cases, four carcinomas and one melanoma. We recommend a combined approach with early, wide surgical excision and postoperative irradiation therapy. Surgical considerations must include functional and cosmetic restoration as well as adequate excision of the tumor. Prosthetic appliances can be quite helpful in patients with large resections.

Obscure gastrointestinal haemorrhage of small-bowel origin

The records of 37 patients investigated for obscure gastrointestinal haemorrhage originating from the small bowel were reviewed retrospectively. Bleeding was caused by Meckel's diverticula in eight cases, smooth muscle tumours in seven cases, vascular anomalies in 14 cases, and other single lesions in eight cases. The lesions were identified by angiography in 18 patients, operation in 17, and barium follow through examination in two. Only one patient under 50 years of age had a lesion that would not have been found by careful laparotomy. Early laparotomy is advisable in patients aged under 50 with obscure gastrointestinal bleeding; expert selective angiography is recommended before operation in patients aged over 50 and those who have already undergone a laparotomy yielding negative results.

Penetrating injuries of the larynx

Patients with penetrating laryngeal trauma can present a wide spectrum of signs and symptoms. Severe trauma frequently leads to life-threatening airway compromise, whereas lesser injuries are often overlooked because of the subtlety of physical and roentgenographic findings or the severity of vascular and neurologic injuries. Increased suspicion should accompany the examination of patients who have sustained a penetrating neck injury, and such injuries demand examination by an experienced laryngoscopist. Early surgical repair is mandatory to avoid delayed complications, which can permanently impair airway, speech, and deglutition. In a series of 19 patients presented here, diagnosis was delayed in seven (37%). The most relevant factor determining return to normal voice appeared to be the presence or absence of vocal cord paralysis.

Effect of large oral and intravenous doses of vitamins D2 and D3 on vitamin D in milk

Vitamins D2 and D3 were measured in milk after high performance liquid chromatography of unsaponifiable lipids first on a silica column and then on a reverse-phase column. Milk from cows kept indoors contained barely detectable vitamin (less than 2 IU/100 ml) predominantly in the form of vitamin D3. When cows were given 5 or 10 million IU vitamin D3, maximums were in milk 3 to 7 days after oral doses and up to 10 days after intravenous injections. Maximums ranged from 7 to 90 IU/100 ml. Two cows were given given a mixture of 1 million IU vitamin D2 and 1 million IU vitamin D3 orally, and of the vitamins were maximum 2 to 3 days after the dose in blood plasma and a day later in milk. Equal amounts of the two forms of the vitamins were in milk, but vitamin D3 in plasma was double vitamin D2. Different mechanisms control concentrations of vitamins D2 and D3 in blood and milk after large doses.

New oligosaccharides from heparin and heparan sulfate and their use as substrates for heparin-degrading enzymes

Oligosaccharides were isolated from heparin and heparan sulfate by a procedure consisting of three major steps: (a) acid hydrolysis; (b) gel chromatography; and (c) cation exchange chromatography on an amino acid analyzer. To date, six new oligosaccharides have been isolated by this procedure and have been sequenced by a combination of NaB3H4-labeling and deaminative cleavage with nitrous acid. The structures of these oligosaccharides were as follows: 1. GlcN-GlcUA-GlcN 2. GlcN-IdUA-GlcN 3. GlcN-GlcUA-GlcN-GlcUA-GlcN 4. GlcN-IdUA-GlcN-GlcUA-GlcN 5. GlcN-GlcUA-GlcN-IdUA-GlcN 6. GlcN-IdUA-GlcN-IdUA-GlcN The linkage positions and anomeric configurations were assumed to be the same as in the polysaccharides from which the oligosaccharides originated. The usefulness of some of these oligosaccharides as enzyme substrates was tested after appropriate modifications and radioactive labeling. Oligosaccharides 2 and 3 were N-[35S]sulfated and were found to serve as substrates for heparan N-sulfate sulfatase (heparin sulfamidase), with a homogenate of cultured skin fibroblasts as enzyme source. Similarly, reduction of oligosaccharide 2 with NaB3H4 yielded a substrate for acetyl-CoA:alpha-D-glucosaminide N-acetyltransferase. Finally, the previously known disaccharide, 4-O-alpha-D-glucosaminyl-L-iduronic acid, which was isolated in the course of this work, was N-acetylated with [3H] acetic anhydride and was shown to be a substrate for N-acetyl-alpha-D-glucosaminidase.