Evidence of lymphocyte alveolitis in Crohn's disease

Cellular characteristics of bronchoalveolar lavage (BAL) were investigated in 18 consecutive patients with Crohn's disease, who were free of clinical pulmonary symptoms and had normal findings on chest roentgenograms. Total BAL cell count and cellular viability of alveolar macrophages did not differ significantly between patients and control subjects. Percentage of alveolar lymphocytes was increased in 11 of 18 patients (from 18 percent to 79 percent). There was no apparent correlation between BAL differential cell count and abnormal pulmonary function tests noted in 11 patients, drug treatment or Crohn's disease site, and activity. These results demonstrate a high proportion of latent lymphocyte alveolitis as assessed by BAL, suggesting a latent involvement of the lung in Crohn's disease.

Investigation of drug absorption from the gastrointestinal tract of man. I. Metoprolol in the stomach, duodenum and jejunum

Gastrointestinal (GI) absorption of the beta-adrenoceptor blocker metoprolol was investigated in five healthy subjects by means of an intubation method, employing a triple-lumen tube introduced into the intestine, and a twin-lumen tube in the stomach. Metoprolol was introduced into the stomach with a homogenized meal containing a nonabsorbable marker, [14C]-PEG 4000, and another marker, PEG 4000, was perfused continuously into the duodenum just below the pylorus. Samples of GI contents were collected at regular intervals over 4 h in the stomach and at two different levels in the upper small intestine. Metoprolol was not absorbed from the stomach. Approximately 60% of the amount of drug emptied from the stomach was absorbed from the duodenum; about 50% of that leaving the duodenum was absorbed from the first part of the jejunum. The delivery process was the rate-limiting factor of metoprolol absorption in these segments of the gut. Plasma concentrations reflected drug loss from the lumen and were higher in subjects exhibiting faster gastric emptying and higher absorption rates in the duodenum and jejunum. The intubation technique appeared to be a suitable method for investigating drug absorption from the GI tract in man.

Investigation of drug absorption from the gastrointestinal tract of man. V. Effect of the beta-adrenoceptor antagonist, metoprolol, on postprandial gastric function

The role of the adrenergic system in normal gastric function was assessed in five healthy volunteers by measuring gastric secretion and emptying after a mixed meal containing a non-absorbable marker, [14C]-PEG 4000, with and without 100 mg of metoprolol, a beta 1-adrenoceptor antagonist. Intraduodenal perfusion of PEG 4000, and gastric and jejunal sampling was achieved by means of a gastrointestinal intubation technique. Gastric function was assessed from the degree of dilution of the duodenal marker. Analysis of acid content by titration allowed the gastric acid secretory rate to be determined. Gastric emptying of a meal over 4 h was similar with and without metoprolol, the time to 50% emptying being 100 min. In the presence of metoprolol, gastric acid content was significantly increased during the late postprandial period producing a corresponding increase in acid load delivered to the duodenum. beta 1-adrenoceptor blockade appears to prolong the gastric secretory response to food without altering gastric emptying.

[Gastric metastasis of a malignant melanoma of the choroid]

Gastric metastases of choroid malignant melanoma seem to be exceptional since less than 10 cases have been previously published. We report the case of a 71 year old patient with a gastric melanosarcoma secondary to a choroid malignant melanoma. Gastric metastasis was revealed by digestive bleeding occurring 18 years after right eye enucleation. Gastroscopy showed black ulcerated tumors. Histology confirmed the diagnosis portraying typical melanic pigments within the gastric mucosa. Laser photocoagulation of the gastric lesion was used for the first time in this indication. As a result, hemorrhage decreased and the patient's comfort was improved.

Serotonin-secreting and insulin-secreting ileal carcinoid tumor and the use of in vitro culture of tumoral cells

The authors report the case of a patient with a typical carcinoid syndrome and a severe hypoglycemia due to hyperinsulinism. He was found to have an ileal carcinoid tumor with hepatic metastasis and no evidence of pancreatic insulinoma at surgery and autopsy. By assaying serotonin and insulin in the tumor and in the supernatants of the culture derived from hepatic metastasis, the authors have been able to show that both hormones were produced by the carcinoid tissue. Cultured cells also synthesized minute amounts of gastrin and thyrocalcitonin.

Parallel gastric emptying of nonhydrolyzable fat and water after a solid-liquid meal in humans

Our aim was to examine the control of gastric emptying of the oil phase of a mixed solid and liquid meal. Previous studies had shown that liquid dietary fats normally leave the stomach at a slower rate than does water. We wished to determine whether the slower emptying of fats was due to the physical characteristics of food (lower density and greater viscosity than water), to retardation by duodenal feedback mechanisms, or whether both factors contributed. Thus, we quantified the emptying rates of water and sucrose polyester (a nonabsorbable analog of dietary fat) ingested by healthy volunteers as a mixed solid and liquid meal. Gastric emptying was quantified by an intubation-perfusion method incorporating an occlusive jejunal balloon to facilitate recovery. Four phase-specific, nonabsorbable markers were used. [14C[Sucrose octaoleate and polyethylene glycol were incorporated in the meal and traced the lipid and water phases, respectively; [3H]glycerol triether and phenolsulfonphthalein were used as duodenal recovery markers. Sucrose polyester (substituting for dietary fat) was emptied very rapidly, and at about the same rate as was water, in contrast to natural fat, which empties very slowly. Emptying of water was rapid and comparable to that observed after mixed meals containing natural fat. These results imply that gastric emptying of the oil phase is controlled by receptors sensitive to the hydrolytic products of fat digestion and that the slow emptying of dietary fat is not simply due to its lower density.

Gastric emptying of lipids after ingestion of a solid-liquid meal in humans

We measured gastric emptying of fat and water from a mixed meal in 6 healthy volunteers using a technique of duodenal perfusion that included phase-specific, nonabsorbable markers. Pairs of water-soluble markers (polyethylene glycol 4000 and phenolsulfonphthalein) and (equivalent) lipid-soluble ([14C]sucrose octaoleate and [3H]glycerol triether) markers were used. For each pair, one marker was used to label the corresponding component of the meal (water of fat), and the other was perfused into the duodenum as a recovery marker. The perfusion method was validated by comparing the amount of marker emptied, as estimated by marker dilution, with the amount obtained by complete aspiration of intestinal contents proximal to an occlusive balloon. Throughout the postprandial period, ratios of lipid marker to total fatty acids in the stomach remained constant, indicating a stable relationship of meal marker to total lipids. Water always emptied faster than did lipids, substantial amounts of which were still in the stomach after 6 h. There was close agreement between recovery of fat proximal to the balloon and calculations of lipid emptying from duodenal perfusion, supporting the validity of the marker dilution technique for the gastric emptying of lipids. This study demonstrates that when ingested as part of an ordinary mixed meal, water and fat have different patterns of emptying, water leaving the stomach first.

H2-receptor antagonists in perspective

Cimetidine, like its predecessors burinamide and metiamide, has been shown in vitro to be a specific competitive histamine H2-receptor antagonist. In vivo, it is a potent inhibitor of histamine-stimulated gastric acid secretion in animals and man after both intravenous and oral administration. Doses sufficient to inhibit gastric secretions are without measureable effects on other physiologic systems. The main indication for cimetidine is in the treatment of duodenal ulcer and of the Zollinger-Ellison syndrome. Useful indications are treatment of gastric ulcer and pnacreatic insufficiency. Possible indications are prevention of gastrointestinal bleeding and treatment of peptic esophagitis. The neutrophil toxicity seen with metiamide has so far not been demonstrated with cimetidine; side effects with cimetidine have generally been trivial. In the future, H2-receptor antagonists are likely to become key therapeutic agents in diseases in which gastric acid-pepsin secretion plays a pathogenetic role.