[Detection of excessive chronic alcoholic consumption and control of withdrawal. Comparative study of respective values of the mean red-cell volume and serum gamma-glutamyl-transferase activity]

The routine detection of chronic alcoholism is necessary during any medical examination whether private or in hospital, or in occupational medicine. The practitionner now has available a simple reliable and cheap test. It consists of the serum estimation of gamma-glutamyl-transferase (gammaGT) and interpretation of the average red cell volume supplied by automatic counting of the red cell. Out of 120 chronic alcoholic subjects ; 67% has a gammaGT increased and 44% had macrocytosis. Under the influence of weaning, there was a rapid fall in gammaGT and a slower reduction in average red cell volume. gammaGT estimation was thus a more sensitive test than M.C.V. for the detection of chronic alcoholics and the control of withdrawal. Its association with the rise in immunoglobulin A-transferrin ratio which we have suggested permits the detection of almost all chronic alcoholics in the population studied.

[The secretin test with the standard dose and high dose in chronic pancreatitis]

Sequential standard (1.0 U/kg) and augmented (4.0-5.0 U/kg) secretin response of the pancreas has been briefly compared in normal subjects and in pathologic series. The results of sequential testing led to the conclusion that, for clinical purposes, the standard test is sufficient for the diagnosis of well established pancreatic pathologies causing gross destruction of the parenchyma, while the augmented test is of particular value when the response to 1 U/kg produces equivocal results, since a higher stimulation enhances the masked secretory deficiency. The application of the augmented stimulus in alcoholic patients suggested the hypothesis that the post-secretin response pattern of minimal pancreatic inflammatory pathology is hypersecretion. Repeated observations in alcoholic hypersecretors will provide physiologic data elucidating the evolution of pancreatic pathology towards the end stages of chronic pancreatitis.

[Isolation of 6 subunits of scorpion, Androctonus australis garzonii, hemocyanin]

A method for the purification of the 5 sub-units 5 S and of a 7 S sub-unit of the haemocyanin of the Scorpion Androctonus australis garzonii is reported. It includes preparation of crude haemocyanin, dissociation in 1 M urea in the absence of divalent cations, starch gel electrophoresis and A 50 DEAE "Sephadex" separation. All the sub-units are homogeneous with regard to ultracentrifugation and polyacrylamide gel electrophoresis. The yield variers from 7 to 20 per cent according to each fraction.

[Compared efficiency of mean corpuscular volume (MCV) and serum gamma-glutamyltransferase (gamma-GT) as screening tests for excess-ethanol drinkers (author's transl)]

53 percent of ethanol drinkers had, before detoxication, a gamma-GT higher than the upper limit of the reference interval at the 2.5 percent risk level (36 mU/ml). 44 percent had a mean corpuscular volume (MCV) higher than the limit (99.2 mum3). In alcoholics not previously "weaned" during a rest cure or in a hospital the proportion becomes 67 percent for gamma-GT but remains at 44 percent for MCV. gamma-GT thus seems a better test for the screening of an excessive ethanol intake than MCV, especially when the subject has not been previously weaned.

[Standard and Augmented Secretin Tests in Chronic Pancreatitis]

The response of the pancreas to standard (1.0 U/kg) and augmented (4.0-5.0 U/kg) doses of secretin was compared in normal subjects and patients. The results of the investigation showed that for clinical purposes the standard test is sufficient for the diagnosis of pancreatic diseases causing gross destruction of the parenchyma. The augmented test is of particular value when the response to 1 U/kg produces equivocal results, since greater stimulation enhances the masked secretory deficiency. The effect of the augmented stimulus in alcoholic patients suggests the hypothesis that the post-secretin response pattern of minimal pancreatic inflammatory disease is hypersecretion. Repeated observation is alcoholic hypersecretors has provided data which can explain the evolution of pancreatic pathology in the terminal stages of chronic pancreatitis.

[Spontaneous perforation of the hepatic duct during biliary lithiasis complicated by acute pancreatitis]

The association of perforation of the common bile duct, cholecystitis and acute pancreatitis, should be emphasized. Physiopathology of perforation of the bile duct may be compared with that of pancreatitis. Repair of the bile duct may be delicate requiring hepatico-jejunostomy on an isolated loop.

Standard and augmented secretin testing in chronic pancreatic alcoholic disease

Sequential standard (1.0 U./kg.) and augmented (4.0-5.0 U./kg.) secretin response to the pancreas has been briefly compared in normal subjects and in patients with combinations of alcoholism, cirrhosis and alcoholic pancreatitis. The results of sequential testing led to the conclusion that, for clinical purposes, the standard test is adequate for the diagnosis of well established pancreatic pathologies causing gross destruction of the parenchyma. The augmented test is of particular value when the response to 1 U./kg. produced equivocal results, inasmuch as augmented stimulation enhances the masked secretory deficiency. The administration of the augmented stimulus to alcoholic patients yielded data which suggest a new hypothesis of pathogenesis for alcoholic pancreatitis, e.g., the postsecretin response pattern of minimal pancreatic inflammatory pathology is hypersecretion. Alcohol is thought to induce fatty degeneration of the pancreatic cell initially. Continued injury leads to necrosis and fibrosis.

[Surgical problems. (Apropos of reoperations in abdominal surgery)]

Out of 1,500 laparotomies carried out between january 1970 and december 1973, 49 patients, i.e. 3.2 p. 100 underwent 61 reinterventions: one out of three patients died. Almost 60 p. 100 of these patients who had undergone operations had essentially parietal complications. The authors analyze the different syndromes which had led to the reintervention while making a special place for parietal problems.

[Decrease in serum gamma-glutamyltranspeptidase following abstention from alcohol in cirrhotics (author transl)]

Gamma-Glutamyltranspeptidase activity of patients having an ascitic cirrhosis due to ethanol consumption is high (139 mU/ml) when the patient is still drinking at the time of the assay; it is lower when the patient had stopped drinking at least two months before the assay (49 mU/ml). On the other hand, in 10 patients out of the 11 who submitted to a second assay gamma-glutamyltranspeptidase decreases as soon as the patient abstains from alcohol. In 4 abstinent patients re-examined one year after the first measurement, the gamma-glutamyltranspeptidase activity had decreased to the reference values of Szasz. The half time of the return to normal has been estimated by extrapolation from the ethylic model at between 11 and 54 days. We conclude that the hyper gamma-glutamyltranspeptidase in cirrhotics is due to the ethanol impregnation and that repeated assays of the enzyme show whether the patient abstains from alcohol or not.

[Use of the measurement of gamma-glutamyltranspeptidase activity in serum to determine the success of cures for alcohol detoxification (author's transl)]

44 patients were studied during a 2-year period following a cure for alcohol detoxification. 29 patients (group A) did not start drinking again while 15 relapsed less than one year after their cure (group R). The average gamma GT activity (m) in mU per ml serum was, in group A, 148 (standard deviation, S.D. 184) at the beginning of the cure, 21 (S.D. 14) after one year and 19 (S.D. 13) after 2 years. During the same period there was no significant decrease in group R (cure: m 140, S.D. 161: 1 year: m 166, S.D. 164; 2 years: m 162, S.D. 163). On the other hand, all the subjects of group A who had a high gamma GT activity (greater than 29 mU/ml) at the start of the cure showed a decrease after one year.

[Serum gamma-glutamyl-transpeptidase and alcoholism. Diagnosis and control of withdrawal]

The gammaGT of a generally healthy population is abnormally high due to the presence of ethanol in the diet. We confirm Rosalki's finding that a high proportion of alchoholics show an increased gammaGT activity. After alcohol deprivation, the gammaGT of alcoholics decreases in the first few days according to an exponential law with a half-time of return to normal of 5-17 days. Among past alcoholics, those who stopped drinking for a year have a lower GT activity (mean: 21 mU/ml) than a generally healthy population and in the range of Szasz's reference values. Alcoholics who did not stop drinking have a higher gammaGT activity (mean: 172). Ascitic cirrhotics who drink at least 1 liter of wine per day have also a high activity (mean: 139) while those who stopped drinking for at least 2 months have a much lower activity (mean: 49) and those who stopped for a year a normal activity. In 10 out of 11 alcoholic cirrhotics who stopped drinking, the gammaGT decreased (half-time: 11-54 days). These results show that the determination of gammaGT activity is a good test for the detection of ethanol impregnation.