Outcome of biliary tract surgery in unknown cirrhotics: a case-control study

The substantial risk of biliary surgery in patients with liver cirrhosis may be reduced by preoperative preparation but the problem of the unknown cirrhotic remains. We studied 18 patients found incidentally to have cirrhosis at surgery. The perioperative complications and the outcome in these patients was compared with 18 non-cirrhotic patients, computer matched for age and sex, undergoing the same operations. Mean blood loss at operation was 324 ml (SD 218.1 ml) in the cirrhotic group and 105 ml (SD 74.7 ml) in the control group (P < 0.01). The postoperative complication rate was 38% in cirrhotics, but zero in controls (P < 0.01). The length of hospital stay was significantly increased in the cirrhotic group (P < 0.01). There was no mortality in either group. The incidental finding of cirrhosis at biliary surgery is associated with increased peroperative bleeding and increased morbidity. There is no increase in mortality in such patients.

Microscopic colitis: a diagnosis to consider

Microscopic colitis is a syndrome of chronic watery diarrhoea for which no cause can be identified other than the presence of diffuse, chronic inflammation in the lamina propria on colonic biopsy. Endoscopically and radiologically the colon appears normal. We studied case records of 215 patients presenting to our institution over a three year period with chronic diarrhoea. Nineteen patients were included in the study where two pathologists agreed on the presence of chronic inflammation on colonic biopsies. All patients had watery diarrhoea with urgency. Stool examination, laboratory indices, radiology of the large and small bowel and colonoscopy were normal in all patients. Patients did not respond to a variety of drugs. A significant improvement was noted in one patient given salazopyrin. In developing countries chronic diarrhoea is most often attributed to infection and treated with antibiotics. Microscopic colitis should be considered in the diagnosis of such patients.

Identification of reentry circuit sites during catheter mapping and radiofrequency ablation of ventricular tachycardia late after myocardial infarction

BACKGROUND

Ventricular tachycardia reentry circuits in chronic infarct scars can contain slow conduction zones, which are difficult to distinguish from bystander areas adjacent to the circuit during catheter mapping. This study developed criteria for identifying reentry circuit sites using computer simulations. These criteria then were tested during catheter mapping in humans to predict sites at which radiofrequency current application terminated ventricular tachycardia.

METHODS AND RESULTS

In computer simulations, effects of single stimuli and stimulus trains at sites in and adjacent to reentry circuits were analyzed. Entrainment with concealed fusion, defined as ventricular tachycardia entrainment with no change in QRS morphology, could occur during stimulation in reentry circuit common pathways and adjacent bystander sites. Pacing at reentry circuit common pathway sites, the stimulus to QRS (S-QRS) interval equals the electrogram to QRS interval (EG-QRS) during tachycardia. The postpacing interval from the last stimulus to the following electrogram equals the tachycardia cycle length. Pacing at bystander sites the S-QRS exceeds the EG-QRS interval when the conduction time from the bystander site to the circuit is short but may be less than or equal to the EG-QRS interval when the conduction time to the circuit is long. The postpacing interval, however, always exceeds the tachycardia cycle length. When conduction in the circuit slows during pacing, the S-QRS and postpacing intervals increase and the slowest stimulus train most closely reflects conduction times during tachycardia. Endocardial catheter mapping and radiofrequency ablation were performed during 31 monomorphic ventricular tachycardias in 15 patients with drug refractory ventricular tachycardia late after myocardial infarction. During ventricular tachycardia, trains of electrical stimuli or scanning single stimuli were evaluated before application of radiofrequency current at the same site. Radiofrequency current terminated ventricular tachycardia at 24 of 241 sites (10%) in 12 of 15 patients (80%). Ventricular tachycardia termination occurred more frequently at sites with entrainment with concealed fusion (odds ratio, 3.4; 95% confidence interval [CI], 1.4 to 8.3), a postpacing interval approximating the ventricular tachycardia cycle length (odds ratio, 4.6; 95% CI, 1.6 to 12.9) and an S-QRS interval during entrainment of more than 60 milliseconds and less than 70% of the ventricular tachycardia cycle length (odds ratio, 4.9; 95% CI, 1.4 to 17.1). Ventricular tachycardia termination was also predicted by the presence of isolated diastolic potentials or continuous electrical activity (odds ratio, 5.2; 95% CI, 1.8 to 15.5), but these electrograms were infrequent (8% of all sites). Combinations of entrainment with concealed fusion, postpacing interval, S-QRS intervals, and isolated diastolic potentials or continuous electrical activity predicted a more than 35% incidence of ventricular tachycardia termination during radiofrequency current application versus a 4% incidence when none suggested that the site was in the reentry circuit. Analysis of the postpacing interval and S-QRS interval suggested that 25% of the sites with entrainment with concealed fusion were in bystander areas not within the reentry circuit. At restudy 5 to 7 days later, 6 patients had no monomorphic ventricular tachycardia inducible, and inducible ventricular tachycardias were modified in 4 patients. None of these 10 patients have suffered arrhythmia recurrences during a follow-up of 316 +/- 199 days, although 4 continue to receive previously ineffective medications.

CONCLUSIONS

Regions giving rise to reentry after myocardial infarction are complex and can include bystander areas, slow conduction zones, and isthmuses for impulse propagation at which radiofrequency current lesions can interrupt reentry.

Molecular cloning and expression of the ovine testicular follicle stimulating hormone receptor

A sheep testicular cDNA library constructed in pcDNA1 vector was screened with a probe generated by polymerase chain reaction (PCR) and corresponding to a 1.6 kb fragment of the rat luteinizing hormone receptor cDNA. Several clones hybridizing to the rat probe at low stringency were sequenced to obtain 95% of the putative full-length ovine follicle-stimulating hormone receptor (oFSH-R) cDNA. The missing 5' region was obtained by PCR amplification of the cDNA library. Sequencing revealed a 2085 nucleotide open reading frame encoding a mature protein of 678 amino acids (74,580 daltons). The oFSH-R is remarkably similar (> 90%) to the human and rat FSH receptors, has a structural motif like the G protein-coupled family of receptors and contains 3 potential sites for N-linked glycosylation. RNA blot analysis revealed two major transcripts of 2.6 kb and 6.7 kb in size and a smaller transcript of about 1 kb in the sheep testis. A 53 residue segment in the extracellular domain unique to the receptor contains more than 50% of residues bearing functional side chains that could participate in ligand (FSH) interaction and/or signal transduction. Transfection of human fetal kidney cell line (293) with the cloned oFSH receptor cDNA based in pcDNA1/Neo vector revealed functional expression. Labeled oFSH bound to receptor expressed on the membrane with high affinity and specificity. In stably transfected 293 cells, purified oFSH and hFSH but not oLH stimulated cyclic AMP accumulation. Chemically deglycosylated oFSH (DG-oFSH) was inactive in these cells but it effectively blocked the action of native hormone.(ABSTRACT TRUNCATED AT 250 WORDS)

Cloning of alternately spliced mRNA transcripts coding for variants of ovine testicular follitropin receptor lacking the G protein coupling domains

We report the cloning and characterization of two alternately spliced forms of ovine testicular follitropin receptor mRNA. A smaller receptor cDNA (151 A1) of 727 bp codes for a possible soluble receptor protein of 134 amino acids arising from exons 1-4 of the full length receptor. The 1.1 Kb cDNA clone (HK 18) extending up to the 8th exon codes for a mature protein of 259 amino acids with a single membrane spanning domain predicted by hydropathy analysis. As these structures account for 34% and 61% respectively of the extracellular domain of the full length receptor, we suggest that their putative protein products are likely to possess moderate or high affinity binding sites of physiological significance.

A case report of painful oral ulcerations associated with the use of alpha interferon in a patient with chronic hepatitis due to non-A non-B non-C virus

The following case report is of a patient who received alpha interferon for non-A, non-B, non-C chronic hepatitis and developed severe painful oral ulcerations associated with inanition and weight loss. The association of painful oral ulcerations with interferon therapy has not been reported before.

The patterns and treatment of recurrence following radiotherapy for carcinoma of the oral cavity

In many centres carcinoma of the oral cavity, if relatively early, is treated by irradiation. The present study includes 186 patients treated in this manner. The primary recurrence rate for previously untreated patients was 34% and was not significantly affected by host or tumour factors. The 5-year survival for the 144 previously untreated patients was 65%, and salvage surgery offered a 35% chance of cure. Survival was reduced in patients aged 60 years and over (P < 0.02). The recurrence rate in cervical lymph nodes following radiotherapy was 38% and was more likely to occur for primary sites in the tongue and floor of mouth (P < 0.01). The five-year survival rate after nodal recurrences was 31% and was predicted only by the presence of extracapsular rupture (P < 0.01). One-third of patients had died of causes other than the primary tumour at 5 years and one-third had died of the original tumour. The rest of the patients are alive and well, only 7% having had a major resection. We feel that the present policy has optimum cure rate whilst saving most patients from major surgery.

Cholestatic jaundice associated with danazol therapy

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Interleukin-1 beta stimulates decidual stromal cell cyclo-oxygenase enzyme and prostaglandin production

The cytokine interleukin-1 (IL-1 beta) increased prostaglandin production by decidual stromal cells in culture in a time and dose dependent manner. Optimum conditions for stimulation were found to be for 24 hours at a concentration of 100 pg IL-1 beta/ml. An apparent increase in cyclo-oxygenase enzyme synthesis accompanied the increase in prostaglandin production, and both changes were inhibited by the protein synthesis inhibitor cycloheximide. This implicates protein synthesis in the stimulatory effects of IL-1 beta, which may be mediated through the increase in cyclo-oxygenase enzyme. A pre-incubation period of 72 hours was found to be necessary to observe the stimulatory effect of IL-1 beta on prostaglandin production, but this did not seem to be due to any change in the sensitivity of the cells to IL-1 beta; the increase in the number of cyclo-oxygenase positive cells was the same if IL-1 beta was added on day 1, day 2 or day 3 of culture, even though prostaglandin production was not stimulated on day 1 or day 2. Cycloheximide increased prostaglandin production on the first two days of culture and had no effect on the third day of culture. This was interpreted as indicating that a factor inhibiting cyclo-oxygenase activity was synthesised during the initial period of culture, which prevented any increase in prostaglandin production following the increase in enzyme synthesis.

Effects of platelet-activating factor on prostaglandin E2 production by intact fetal membranes

OBJECTIVE

The hypothesis tested in this study is that platelet-activating factor increases prostaglandin E2 synthesis from fetal membranes.

STUDY DESIGN

Fetal membrane disks obtained before or after labor were incubated with or without platelet-activating factor for time periods of up to 24 hours. The production of prostaglandin E2 and its inactive metabolites was determined by specific radioimmunoassays.

RESULTS

Platelet-activating factor (1 to 10 mumol/L) stimulated the production of prostaglandin E2 and its metabolites by intact fetal membranes and chorion-decidua threefold to fourfold after 24 hours of incubation. Platelet-activating factor had far greater effects on the production of prostaglandin E2 by intact fetal membranes obtained after the onset of labor, such that prostaglandin E2 production was increased by tenfold to 100-fold.

CONCLUSION

These results suggest that platelet-activating factor mainly stimulates prostaglandin E2 production by the chorion-decidua before labor and that it may act in synergism with other stimulatory factors present in the fetal membranes during labor.

Changes in decidual stromal cell function associated with labour

OBJECTIVE

To determine whether decidual cells produce altered levels of prostaglandins after labour.

DESIGN

Decidual stromal cells and macrophages were isolated before and after labour, and the production of prostaglandins E2 and F2 alpha measured. Changes in the numbers of cyclooxygenase enzyme positive cells were assessed by immunocytochemistry.

RESULTS

Decidual stromal cells obtained after labour produced 30 times more prostaglandins E2 and F2 alpha in culture than cells obtained before labour. The increased production persisted for up to 72 h of culture, and was associated with an increase in the numbers of cyclooxygenase-positive cells from less than 5% to greater than 95%. No changes in macrophage function were observed.

CONCLUSION

Increased levels of prostaglandins E2 and F2 alpha were released from decidual stromal cells after labour, suggesting that these cells may be an important source of prostaglandins in labour.

Calcitonin gene-related peptide and substance P decrease in the rabbit colon during colitis. A time study

The sensory neuropeptides, substance P and calcitonin gene-related peptide, have been implicated in inflammatory reactions in several tissues. An immune-complex model of colitis was used in rabbits to determine the colonic content (nmol/g protein) of immunoreactive substance P and calcitonin gene-related peptide at various times after induction of inflammation to assess changes in these neuropeptides during the inflammatory response. Calcitonin gene-related peptide content was decreased by 66% 4 hours after induction of inflammation and reached a maximum of 80% at 48 hours. The substance P content was decreased at 8 hours, with a maximum decrease of 64% at 48 hours. Substance P decrease was detected in the muscle layer. The amounts of substance P in the mucosal/submucosal layer extracts were too low to allow accurate measurements. Calcitonin gene-related peptide decreased both in the muscle and the mucosal-submucosal layers. Immunohistochemical analysis showed that calcitonin gene-related peptide and substance P innervation patterns were comparable in normal and inflamed colon, even though there appeared to be a decrease in density and intensity of the staining, particularly for calcitonin gene-related peptide at 48 hours. The early decrease of calcitonin gene-related peptide and substance P during the time course of colitis might be due to release from nerve terminals of the gut during the inflammatory response. The profound changes in colonic calcitonin gene-related peptide and substance P content during colitis may have important implications during inflammation and subsequent tissue repair and may also lead to disturbances in gut motility.

Quantitative production of prostaglandin E2 and its metabolites by human fetal membranes

Cultured amnion, choriodecidua and intact fetal membrane produced similar quantities of prostaglandin E2 (PGE2) (1-5 ng/ml). Choriodecidua and intact fetal membrane also produced very high levels of PGE2 metabolites (100-1000 ng/ml). The total production of PGE (PGE2 + PGE2 metabolites) was similar in intact fetal membrane and in choriodecidua, suggesting that the amnion, although a source of PGE2, contributes little to the overall PGE production by fetal membranes.

A comparison of two populations of decidual cells by immunocytochemistry and prostaglandin production

The decidua has been implicated in the control of human labour, particularly through changes in prostaglandin production, but this tissue contains a number of different cell types. A density gradient system was used to obtain two populations of cells from term human decidua, and these populations were characterised. The more dense cells (population B) was a mixed population, predominantly macrophages (80%), but small numbers of T- and B-lymphocytes were also present, as identified by immunocytochemistry. Most of these cell types also contained detectable levels of cyclooxygenase enzyme. The less-dense cell population (population A) did not contain significant numbers of the above cell types and released prolactin, suggesting that they were decidual stromal cells. This preparation of decidual stromal cells may be of use in defining the functions of these cells in labour.

Limited transfer of prostaglandin E2 across the fetal membrane before and after labor

The transfer of prostaglandin E2 (PGE2) across intact fetal membranes (amnion-chorion-decidua) obtained before and after the onset of labor was investigated using a novel system for in vitro fetal membrane culture. Studies using physiological concentrations of PGE2 showed that very little PGE2 will cross the membranes without being metabolised, before or after the onset of labor. It was only when pharmacological concentrations of PGE2 were used that the enzyme activity of the chorion was no longer able to prevent transfer of PGE2 without conversion to inactive metabolites. These results suggest that only small amounts of PGE2 from amnion are normally transferred across the chorio-decidua before or after the onset of labor, but the metabolism of PGE2 subsequent to transfer across the fetal membranes requires further assessment.

Comparative study of sensitivity and specificity of beta monoclonal agglutination inhibition and sandwich immunometric assay tests in the diagnosis of pregnancy

Urine of 30 pregnant females was tested for gravidex test. Both concentration and agglutination inhibition (Beta monoclonal) tests were performed on the same urine specimens. Results showed that the sensitivity and specificity of the concentration (colour) test was much higher than that of the B monoclonal test.

Identification of two groups of leghemoglobin genes in alfalfa (Medicago sativa) and a study of their expression during root nodule development

Differential screening of an alfalfa root nodule cDNA library with either root or nodule mRNA resulted in the isolation of two groups of leghemoglobin cDNA which differ significantly in sequence. Analysis of one member of each group revealed a divergence within the coding region of 15% at the nucleotide level and 14% at the amino acid level. The 3' non-coding sequences are 25% divergent but are highly conserved over a stretch of 54 nucleotides which contains two sequence motifs common to leghemoglobin genes from other plant species. Southern blotting analysis with exon-specific probes has shown that there are approximately twice as many leghemoglobin gene copies in the alfalfa genome corresponding to one type of cDNA as compared with the other. Using the same criterium of DNA sequence relatedness these two distinct groups of leghemoglobin genes have also been identified in the genomes of the diploid annual Medicago truncatula and the closely related genus, Melilotus. Transcripts corresponding to both groups of leghemoglobin genes are first detected in alfalfa nodules 9-10 days after Rhizobium inoculation. Thereafter, mRNA levels increase rapidly and synchronously, reaching a maximum approximately 2 days later. There is a 2-3 fold difference in the steady-state levels of the two mRNA populations and this is maintained throughout the subsequent two weeks of nodule growth. The absence of any detectable transcription during the early stages of nodule development and the apparent co-ordinate expression of leghemoglobin genes in alfalfa contrasts with the situation in soybean and suggests that important differences in leghemoglobin gene regulation exist between these two distantly related legume species.

Giant neurilemoma: unusual scrotal mass

General physical examination of the male at whatever age is incomplete unless the scrotum and its contents are assessed. Since the scrotum consists of skin, fibrous connective tissue, smooth muscle, vessels, nerves, and a lining of simple squamous epithelium, a variety of tumors may arise in it. Scrotal tumors, however, are infrequent. Rare tumors are solitary neurilemomas. The English literature does not describe a giant neurilemoma of the scrotum.

Income inequality, poverty and socioeconomic development in Bangladesh: an empirical investigation

By analyzing the data for 1963-1964 through 1976-1977, this paper studies the pattern of income distribution and poverty in Bangladesh, and it also compares the socioeconomic status of the country in the mid-1970s with other developing countries of Asia, Africa, and Latin America. There has been a drastic increase in inequality and poverty in recent years, and this disturbing finding is reinforced by the fact that Bangladesh occupies the lowest position in the Third World in terms of a composite social index. The very poor within the poverty population suffered most, and the increase in the extent of poverty was most noticeable in the rural sector. The broad policy recommendation is that relatively more attention should be given to the social sectors white allocating resources for the country's future development.

Deletion loop mutagenesis of the nifL promoter from Klebsiella pneumoniae: role of the -26 to -12 region in promoter function

Nine single C-to-T transitions were introduced into the -26 to -12 region of the Klebsiella pneumoniae nifL promoter by bisulphite mutagenesis of M13 heteroduplexes containing a 15 nucleotide single-stranded loop. Mutant promoter fragments were inserted into translational lac fusion vectors to utilise beta-galactosidase activity as a measure of promoter efficiency. Mutations in invariant nucleotides found in the consensus sequence for nif promoters gave a strong 'down' promoter phenotype with respect to transcriptional activation. Mutations in semi-conserved residues had a much weaker down phenotype, whereas a mutation which increased homology to the consensus sequence enhanced promoter strength. One mutant showed increased activation by ntrC and decreased activation by nifA.

Site-directed mutagenesis of the Klebsiella pneumoniae nifL and nifH promoters and in vivo analysis of promoter activity

The role of conserved nucleotides in nitrogen-fixation promoter function has been examined using both oligonucleotide and chemical mutagenesis to introduce base changes in the Klebsiella pneumoniae nifL and nifH promoters. Among ten mutations analysed, including six spontaneous mutations, base changes at -12, -13, -14, and -26, located in previously identified conserved sequences, perturbed the activity of the promoters, demonstrating that these sequences are required for transcription. Not all base changes produced similar strong promoter down phenotypes when the nifL and nifH promoters were compared: activation of the nifH promoter by the nifA gene product was less sensitive to base changes in conserved nucleotides than was activation of the equivalently altered nifL promoter by the nifA or ntrC products. We have found that the nifH promoter can be weakly activated by the ntrC product; this activation shows the same down response to base changes seen with ntrC activation of the nifL promoter. We present evidence that the efficient activation of the nifH promoter by nifA (but not ntrC) can be attributed to specific upstream sequences present in the nifH promoter.

Skin barrier properties in the newborn. Transepidermal water loss and carbon dioxide emission rates

Relative permeabilities of newborn and adult skin to small molecules were determined by measuring emission of carbon dioxide and water vapor through skin. Transepidermal water loss (TEWL) measured on the forearm of 22 term infants was lower than that observed in 30 control adults (0.31 +/- 0.09 vs. 0.39 +/- 0.15 mg/cm2/h). There was no significant difference between newborn carbon dioxide emission rates (CDER) and adults CDER. When environmental temperature was raised from 74 to 80 derees F, large dramatic increases in adult TEWL were observed in contrast to small increases in newborns. This phenomenon suggests diminished eccrine activity in the newborn. No correlation of TEWL or CDER with respect to birth weight, sex, age or gestational age was observed. Similar permeability to carbon dioxide in neonates and adults and a decreased TEWL in neonates compared to adults suggest that even at birth the skin functions as an efficient barrier to these molecules, penetration rates, in adults, of other polar compounds should be similar to those in neonates.

Risk factors for hepatitis C disease in Tando Allahyar, Pakistan: a case-control study

Objective: Present study was undertaken to explore the epidemiological and dietary risk factors for hepatitis C disease in Tando Allahyar during June to December 2007. Materials and methods: 140 Hepatitis C patients and 149 controls (age, sex and locality matched with no personal or family history of hepatitis C) were randomly selected from the Tando Allahyar population during June 2007 to December 2007. A standard questionnaire specially developed for that purpose, was distributed among patients and controls. Accurate rapid card test was performed to confirm Hepatitis C virus (HCV) positive or negative patients and controls. O.R with 95% confidence interval was computed and p values were calculated by chi square test. Results: Over all findings showed that among 140 HCV patients 64% were females and 36% males (mean age range was 20-48 years). Our results showed strong positive association of sedentary life style (OR=4, 95% CI, 1.48-10.6, p=0.005), marital status, +ve family history, B+ve blood group, piercing, syringe use (70%), multiple pregnancies (OR=4.72, 95% CI, 1.47-15.15, p=0.008), blood transfusion (OR=4.4, 95% CI, 1.2-14.95, p=0.017), take out food debris by office pins (NS), shave at barber’s shop (NS), dental procedures (NS), medicines used in past (OR=3.08, 95% CI, 1.2-7.71, P=0.016), G.I.T diseases (OR =8.66, 95% CI, 1.28-55.58, p=0.023), stones of kidney or gallbladder, jaundice, Tuberculosis and psychological problems (OR =2.5, 95% CI, 1.04-6.13, P=0.04) with hepatitis C disease. We did not find any association of surgery, BMI, ENT, diseases, meat consumption and smoking with the disease. Vegetables OR =0.842, 95% CI, 0.361-1.964, P=0.694), pulses, tomatoes (OR =0.31, 95% CI, 0.041-2.53, P=0.31), and tea (OR =0.598, 95% CI, 0.251-1.431, P=0.25) were found to be the protective factors for Hepatitis C disease. Conclusion: Sedentary life style, multiple pregnancies, blood transfusion, medicines used in past, G.I.T diseases, and psychological problems are significantly positively associated with Hepatitis C disease. Key words: Hepatitis C disease, HCV infection, epidemiological risk factors, Diet, blood transfusion, G.I.T diseases, and psychological problems. DOI: http://dx.doi.org/ 10.3329/bjms.v10i3.8359 BJMS 2011; 10(3): 163-169

Determining Genetic Diversity of Some Jute Varieties and Accessions Using RAPD Markers

The genetic diversity of 18 jute genotypes of the two cultivated species Corchorus capsularis L. and C. olitorius L. which include released varieties and collected races, referred to as accessions was evaluated. DNA profiling was generated using sequence independent RAPD markers. A total of 140 scorable loci were observed and a dendrogram was constructed with these markers. The relationship that is portrayed by this clustering also agreed with the available pedigree information on jute. Two major clusters representing the two species were resolved among the genotypes that were examined in the study. This genetic distance information could be useful in breeding programs in order to introduce agronomically important traits such as short field duration, low temperature tolerance, snow white fibre, higher harvest index etc. From the study one C. olitorius and two C. capsularis varieties were found more suitable for their selection as seed parent against different accessions for improvement because of their higher genetic distant relationship within species. However, more extensive molecular data are needed in order to reach a general conclusion about the relationship between jute genotypes.  Key words: Jute, Polymorphism, Genetic diversity, RAPD D.O.I. 10.3329/ptcb.v17i2.3239 Plant Tissue Cult. & Biotech. 17(2): 183-191, 2007 (December)

Effect of histalog, insulin and reserpine on gastric emptying and secretion in man

Four different groups of subjects were given Histalog, insulin or reserpine or acted as controls. Changes were noted in gastric emptying, acid, chloride, parietal and non-parietal secretions and neutral chloride. Gastric emptying and secretion were measured by the Hunt and Spurrell test meal as modified by us for drug testing.Histalog stimulated gastric secretion but not emptying. Insulin stimulated both secretion and emptying. Reserpine stimulated secretion but it stimulated emptying only in one-half of the subjects.After Histalog and reserpine the rise in hydrogen and chloride secretion was equal, so the neutral chloride did not increase. After insulin the rise of chloride was proportionately greater than the rise of hydrogen, so that neutral chloride was increased.