Clinical characteristics of Crohn's disease in 72 families

BACKGROUND & AIMS

Familial aggregation argues for genetic susceptibility to Crohn's disease. The aim of this study was to compare the age of onset and the clinical features of Crohn's disease between patients with familial disease and those with sporadic disease and investigate the concordance for disease location and type among relatives with Crohn's disease.

METHODS

Seventy-two families with 2 (n = 55), 3 (n = 8), 4 (n = 6), and 5 or more (n = 3) affected first-degree relatives were selected for the study. A population of 1377 patients with sporadic nonfamilial Crohn's disease was used for comparison.

RESULTS

Clinical data were obtained from 176 patients with familial Crohn's disease (79 men and 97 women). Median age at onset was younger in familial Crohn's disease than in sporadic cases: 22 vs. 26.5 years (P < 0.01). In familial cases, fewer patients had exclusively colonic involvement and more patients had both small bowel and colonic involvement. Among relatives of families with 2 affected members, 56% were concordant for disease location and 49% for disease type. These percentages reached 83% and 76%, respectively, within families with more than 2 affected members.

CONCLUSIONS

Patients with familial Crohn's disease are characterized by an early age at onset with more extensive disease and may represent a homogeneous clinical subgroup with a particularly strong genetic influence.

Brain noradrenergic systems modulate the ceco-colonic myoelectric activity in rats

The role of the brain noradrenergic systems in the control of the ceco-colonic myoelectric activity was investigated in rats following lesions with intracerebroventricular (icv) or intracisternal (ic) injection of 6-hydroxydopamine (6-OHDA). Controls received the vehicle alone. The ceco-colonic myoelectric activity was recorded 3 weeks later in conscious rats chronically fitted with electrodes. After icv injection of 6-OHDA, lesions of rostral and caudal (spinal) noradrenergic systems were observed whereas only spinal noradrenergic systems were lesioned after ic injection. This differential pattern of lesions was followed by a differential pattern of ceco-colonic myoelectric activity. In fasted animals, a significant increase of the long spike burst (LSB) frequency (nb min-1) was observed after icv injection of 6-OHDA whereas no modification was observed after ic injection of the neurotoxic. After a 6-g pelleted rat diet, a significant increase of the LSB frequency was also observed in the icv lesioned group when compared to controls. No modification of the ceco-colonic noradrenergic innervation was observed, thus confirming the central selectivity of these lesions. Lesions of central noradrenergic systems modify the LSB frequency in rats; the rostral noradrenergic systems seem to play the major role.

[Can early recurrent hemorrhage in gastroduodenal ulcer be predicted?]

OBJECTIVE

To evaluate clinical, biological and endoscopic predictive factors of early recurrent bleeding from gastric or duodenal ulcers.

PATIENTS AND METHODS

Seventy six patients (26 females and 50 males) with a mean age of 65.9 years (SD = 17.2) were included in a prospective study. Among the 76 patients, there were 39 NSAIDs users (51.3%). An endoscopy was performed systematically until 12 hours after admission. Treatment modalities were identical for all patients. The predictive value of 11 factors was evaluated through an univariate and multivariate analysis.

RESULTS

Three factors had independent significant predictive value: a) the number of blood units used to treat a shock and to increase the haemoglobin level up to 100 g/L (P < 0.05); b) "high endoscopic risk" of recurrent bleeding including Forrest Ia, IIa and IIb ulcers (P < 0.05); c) a non steroidal anti-inflammatory treatment was associated with no recurrent bleeding contrary to the other factors (P < 0.05). Based on a second multivariate analysis including clinical factors only, a predictive score was calculated: 5 + number of blood units -5 x (NSAID = 0/1). The cut off point with maximum discrimination was 6 (specificity = 79.6%; sensitivity = 77.2%).

CONCLUSION

A combination of clinical and endoscopic factors is useful to predict ulcer recurrent bleeding. Our clinical predictive score is interesting because of its simplicity. Its predictive value is of interest but have to be evaluated in another sample of patients.

Role of upper esophageal reflex and belch reflex dysfunctions in noncardiac chest pain

Fifty-four patients examined for noncardiac chest pain (NCCP), showing no esophageal motor disorder or gastroesophageal reflux disease compatible with NCCP, were subjected to an intraesophageal balloon distension test and a study of the belching reflex provoked by intraesophageal air injection. Thirty-three control subjects were also studied, allowing us to define high-threshold belchers (group I) as those who belched during two of three 40-ml distensions and low-threshold belchers (group II) as those who did not. The balloon distension test induced NCCP in 64% of the patients in group I, and in 14% of the patients in group II (P < 0.01). High-threshold belching was a factor favoring the positivity of the balloon distension test. This result supports the hypothesis that esophageal distension by air due to a belching disorder may be the mechanism responsible for NCCP in some patients with an abnormal sensitivity to balloon distension.

Locus ceruleus modulates migrating myoelectric complex in rats

The role of the locus ceruleus (LC) in the control of migrating myoelectric complex (MMC) was investigated in rats with lesions induced by injections of 6-hydroxydopamine (6-OHDA). Control animals received the vehicle alone. MMC was recorded in conscious rats chronically fitted with electrodes. After 6-OHDA was injected into the LC, lesions of the LC were total, partial (mostly rostral), or ineffective. The MMC period was significantly longer in animals with a total or partial lesion but was unchanged in animals with an ineffective lesion. No lesion of other brain noradrenergic nuclei was observed. The longer MMC period is comparable to that obtained after intracerebroventricular injection of 6-OHDA, which is responsible for a more diffuse destruction of brain noradrenergic systems, including LC itself. Bilateral lesions of the central tegmental tract, which carries ascending noradrenergic axons from the medullary and pontine cell groups outside the LC, do not alter the MMC cycle. Consequently, the LC is most likely the major brain noradrenergic candidate for modulating the MMC pattern in rats.

Involvement of hypothalamic noradrenergic systems in the modulation of intestinal motility in rats

Selective lesions of the noradrenergic systems of the paraventricular nucleus (PVN) of the hypothalamus with 6-hydroxydopamine (6-OHDA) lengthen the periodicity of the migrating myoelectric complex (MMC), an index of intestinal motility, in rats. These lengthening effects resemble those obtained after lesions of the locus coeruleus (LC), thus suggesting that noradrenergic terminals from LC to the PVN are involved in this modulation.

Chronic intestinal pseudoobstruction with myopathy and ophthalmoplegia. A muscular biochemical study of a mitochondrial disorder

The association of chronic intestinal pseudoobstruction with ophthalmoplegia has been reported previously in visceral myopathies. We report a case of this association in which muscle mitochondria had a crystalline appearance, a dense core, and decreased cytochrome c oxidase and succinate cytochrome c reductase activities. The absence of evident mitochondrial DNA deletion in the skeletal muscle of this patient does not exclude the possibility of localized deletion or mutation of mitochondrial DNA in digestive muscle.

Modulation of the migrating myoelectric complex by brain noradrenergic systems in rats

The respective role of central and peripheral noradrenergic systems in the control of migrating myoelectric complex (MMC) was investigated in rats following lesions with 6-hydroxydopamine (6-OHDA). 6-OHDA was injected via intraperitoneal (ip), intracisternal (icis), and intracerebroventricular (icv) routes in rats. Control animals received the vehicle alone. One month later, MMC was recorded in conscious rats chronically fitted with electrodes. The MMC period was significantly lengthened after 6-OHDA ip or icv injection, and slightly shortened after 6-OHDA icis injection. No disruption of central noradrenergic systems was detected after ip lesions. Norepinephrine content was reduced in the digestive tract after ip lesions, in the spinal cord after icis lesions, and in the cortex, the hypothalamus, pons-medulla, and the spinal cord after icv lesions. After icis lesions, noradrenergic perikarya were spared in pons-medulla, whereas only pons noradrenergic perikarya were lesioned after icv lesions. We conclude that lesions of brain noradrenergic systems modify MMC periodicity in rats. The rostral noradrenergic systems may play the major modulatory role.

Is there an abnormal fasting duodenogastric reflux in nonulcer dyspepsia?

A quantitatively and/or qualitatively abnormal duodenogastric reflux (DGR) could be involved in the pathogenesis of nonulcer dyspepsia (NUD). The aims of this prospective study were to look for (1) a pathological DGR profile during fasting and (2) an eventual correlation between DGR profile and clinical symptoms. Twenty-six NUD patients were investigated. Seven other operated patients with a surgical procedure facilitating DGR episodes and 27 healthy volunteers served as control groups. A clinical score was determined for each patient from a standardized questionnaire. Gastric aspiration was performed for 6 hr in fasting subjects. The aspirates were pooled into 17 samples. In each sample the concentration and the output of total bile acids was determined. If the concentration was larger than 30 mumol/liter in pooled samples, the concentrations of free bile acids and the distribution of the conjugated bile acids was determined. The percentage of aliquots with a total bile acid concentration larger than 50 mumol/liter (without upper limit), and the percentage with a concentration larger than 2500 mumol/liter was also obtained. No significant difference was demonstrated between the healthy volunteers and NUD patients, whatever the parameter considered. However, there was a significant increase in each of the quantitative parameters for the group of operated patients in comparison with the NUD patient group. No significant correlation was found between the clinical score and the DGR profile in NUD patients. Apparently, DGR episodes do not play a primary role in the pathogenesis of NUD.

Scintigraphic study of gallbladder emptying and duodenogastric reflux during non-ulcerous dyspepsia

Cholescintigraphy with technetium 99m hydroxy imino diacetic acid (99mTc-HIDA) was used to study gallbladder emptying (GE) and duodenogastric reflux (DGR) simultaneously during the postprandial period in humans. Two groups of subjects were examined prospectively; one was a group of healthy volunteers (n = 14) and the other a group of patients with non-ulcerous dyspepsia (NUD) (n = 22). Symptoms were quantified using a clinical score (CS). GE kinetics was quantified according to two indices. DGR episodes were detected by an image-subtraction method and quantified. The group of patients with NUD showed significant early acceleration of GE (P less than 0.01). One DGR episode equivalent to 1% of the injected dose was observed in 1 of the 14 control subjects, and greater than 1% in 3 of the 22 NUD patients. However, there was no correlation between the CS, GE kinetics and DGR episodes. The physiopathological mechanism and clinical significance of these digestive motility anomalies remain to be demonstrated.

[Duodenogastric reflux: diagnostic approach and incidence in dyspeptic disorders]

Duodeno-gastric reflux might be responsible for a number of acute and/or chronic diseases of the oesophagus and stomach. However, no consensus has emerged from published clinical or experimental studies concerning the relationship between duodeno-gastric reflux and digestive tract disease. This inconsistency could be partly linked to the difficulties in detection and quantification of duodeno-gastric reflux episodes and, consequently, in differentiation between physiological and pathological reflux. A critical review of the different diagnostic methods is therefore submitted here. An application of duodeno-gastric reflux evaluation to the inter-digestive period in non-ulcerous dyspepsia was carried out. The preliminary results of this prospective study do not favor an immediate responsibility of a quantitatively abnormal fasting reflux in non-ulcerous dyspepsia. However, other applications of duodeno-gastric reflux analysis taking into account not only the quantitative aspect but also the composition of the reflux material, (selective bile acids, phospholipids, etc.) are necessary.

[Campylobacter pylori: diagnostic value of the urease test during endoscopy]

The aims of this prospective study were a) to evaluate the diagnostic value of the urease test for the detection of C. pylori in gastric biopsy specimens, b) to specify the prevalence of C. pylori in a sample of 74 patients from the Grenoble area undergoing upper gastrointestinal endoscopy, c) to analyze the density of bacteria according to the biopsy site (antrum, body, edges of ulcer), d) to demonstrate any possible correlation between the histologic state of the antral and body mucosa and the presence of C. pylori. An antral biopsy was taken for the urease test during endoscopy. Biopsies were also taken from the body, the antrum and the edges of gastric or duodenal ulcers for bacterial and histologic studies, and urease test in the bacterial laboratory. The sensitivity and the specificity of the urease test during endoscopy varied according to the delay in observation of the color change. They were 0.81 and 0.84, respectively, at 2 h 30. The sensitivity and specificity of the urease test in the bacterial laboratory were 0.67 and 0.95, respectively, for the same delay. The global prevalence of C. pylori was 51 p. 100: it was 42 p. 100 in the absence of ulcer, 67 p. 100 in the presence of gastric ulcer, and 71 p. 100 in the presence of duodenal ulcer (p less than 0.05 compared to the group without ulcer).(ABSTRACT TRUNCATED AT 250 WORDS)

Scintigraphic study of duodenogastric reflux. Value of a computerized image-subtraction method

Duodenogastric reflux (DGR) could be implicated in several esophageal and gastric diseases. Establishing its pathophysiological role however is difficult because of the problems in the demonstration and quantification of DGR episodes. The aim of this study was to improve a scintigraphic method of detection and quantification of DGR episodes during the postprandial period in man. The study was carried out in 14 control subjects (7 males and 7 females, median age = 25 years, range: 22-35 years). As scintigraphic recording was continuous during 150 min, all DGR episodes were revealed. In order to improve visual detection of DGR episodes, images were treated by a computerized image subtraction method. The visual detection limit of DGR episodes determined by comparison to test images was 0.6 p. 100 of the dose injected intravenously or 17 microCi. A DGR episode was demonstrated in one of the 14 control subjects. The quantity of refluxed liquid was estimated, in this case, at 30 microCi, and the duration of the reflux greater than 2 min. Continuous scintigraphic recording in association with a computer based technique of image subtraction seems to improve scintigraphic performance in the study of DGR episodes under pathological conditions.

[Reduction of postprandial gastroesophageal reflux with sodium alginate in suspension. Multicenter pH study in 21 patients]

The purpose of this study was to ascertain the pharmacological effectiveness of sodium alginate liquid in the treatment of gastroesophageal acid reflux. The pharmacological test selected was 3 hours postprandial oesophageal pH, because of the physico-chemical properties of this drug. Twenty-one patients of both sexes were included in this study. The initial pH measurement served both as inclusion criteria, by confirming the presence of gastric acid reflux, and as reference for the evaluation of the effect of sodium alginate liquid by a second pH determination after treatment. After treatment with sodium alginate liquid, the number and mean duration of episodes of reflux, as well as the time spent at each pH level, had significantly decreased as compared to the initial value. The gastroesophageal reflux score was significantly reduced during the second hour in recumbent posture, but none of the different parameters studied separately (number and mean duration of episodes of reflux and time spent at each pH level) was significantly decreased. This study demonstrates the pharmacological effectiveness of the drug during the post prandial period and indicates that it is more effective in upright than in supine position.

Local nerve blockade by tetrodotoxin induces ectopic phase 3 of the migrating myoelectric complex in dogs

The effect on the migrating myoelectric complex (MMC) of local nerve blockade in the jejunum was studied in five unanesthetized dogs. A silastic catheter was implanted in a terminal branch of a jejunal artery, perfusing a 5- to 10-cm segment, 45 cm below the ligament of Treitz. Small-bowel motor activity was studied electromyographically with implanted electrodes. Three different doses of tetrodotoxin (166, 333, 500 ng/kg/h) were administered intra-arterially for 5 h. During the 333- and 500-ng but not during the 166-ng/kg/h perfusions ectopic activity fronts started just below the perfused segment. At this time no phase-3 activity was observed in the proximal bowel. In addition to ectopic fronts normal MMCs were observed during the perfusions. These observations show that local nerve blockade induces phase-3 activity, probably by inhibiting an inhibitory nerve action.

[Diagnostic value of gastric pHmetry in duodenogastric reflux]

Several studies have been performed to examine the problem of diagnosing gastroduodenal reflux (GDR). No single method is widely accepted. The aim of this work was to evaluate the diagnostic value of gastric pHmetry in this regard. A gastric aspiration probe attached to a combined glass electrode was placed in the stomach of 24 patients, with its distal tip located between 9 and 12 cm below the cardia. One ml samples of gastric juice were taken from 8 of the patients every 30 min for 15 h and as well as, every time a spontaneous alkalinization (SA) (defined by a pH greater than or equal to 4 for at least 1 min) was observed. The pH of each sample was measured by colorimetry whereas the concentration of total biliary acids (CTBA) was evaluated by the fluorimetric method (Kit Sterognost 3 alpha Flu); pH value measured via the intragastric electrode during aspiration was also recorded (protocol A). Continuous gastric aspiration was carried out in the remaining 16 patients for the entire duration of the test (6 h) which was divided into periods of 20 min. Apart from the parameters evaluated during protocol A, the percentage of time during which the stomach had a pH greater than or equal to 4 was recorded, as well as the quantity of total biliary acids collected over the 20 min periods (protocol B). Correlation studies were carried out using the Kendall tau and Spearman tests. Percentages were compared using the chi 2 test.(ABSTRACT TRUNCATED AT 250 WORDS)

[Ambulatory recording of esophageal pH over a 24-hour period in a population of 27 control subjects: analysis of technical and methodological factors influencing results]

Twenty-four hour pH monitoring is used increasingly as a technique for diagnosis of gastro-esophageal reflux (GER). The Synectics recording apparatus (Stockholm, Sweden) was used in 27 ambulatory control subjects in order to: identify the variations of the data-dependent factors (electrodes, buffer solutions, calibration, placement of esophageal electrode). The consequences of these variations were evaluated by studying the measurement deflection after 24 h, baseline variations, and a comparative double pH esophageal recording with reference equipment for 3 h postprandial; to provide normal values for several parameters of GER measurement under the conditions of this study (total number of reflux, number of reflux episodes longer than 5 min, duration of the longest reflux, percentage of time during which pH was less than 4.0). Important interindividual variations were observed. When interpreting the results provided by this type of apparatus, one should take into account these large variations due, first, to the technique used and second, to the conditions of ambulatory recording.

[Gastric emptying of a solid-liquid meal in gastroesophageal reflux in adults]

Several studies concerning the relationships between gastroesophageal reflux (GOR), gastric emptying and esophageal motility are available. So far, results have been contradictory. The purpose of this work was to study gastric emptying in patients with GOR; to search for simultaneous esophageal motility disorders and to specify their type and frequency; to establish a potential relationship between motor disorders of the esophagus and the stomach in these patients. Thirty-two consecutive patients were selected according to clinical criteria, i.e. presence of at least two of the three characteristic symptoms of GOR, and the data of a three-hour post-prandial pH-metry. Gastric stasis related clinical manifestations (nausea, post-prandial vomiting, sensation of abdominal distension or of post-prandial epigastric fullness) were also searched for in all patients. A gastroscopy allowed to score esophagitis in each case. All patients, including adult controls underwent an esophageal manometry as well as a radionuclide determination of gastric emptying, after isotopic labelling of the solid (S) and liquid (L) phases of a test meal. The results showed that there was no significant modification of gastric emptying of the S and L phases of the meal in the group of patients with GOR whatever the intensity of the reflux, judged on the pH-metry results and the endoscopic data. Thus the average time of gastric half-emptying of S and L was respectively 115 and 52 min for the patients vs 111 and 51 min for the control group. As well, no correlation was found between the gastric emptying parameters and the presence or absence of clinical signs of gastric stasis or the amplitude of esophageal contraction waves. On an individual basis, two patients showed a significant decrease in gastric emptying of either the S or L phases without any attendant modification in the kinetics of the other. These results suggest that, in the adult, gastric emptying cannot be considered to be a determining factor of GOR and there are no diffuse motility disorders of the upper digestive tract during this illness.

[Esophageal motility in Raynaud's disease, systemic scleroderma and presclerodermal Raynaud's syndrome]

Fifty-five consecutive subjects with Raynaud's phenomenon were submitted to esophageal manometry. According to the results of clinical examination and periungual capillaroscopy, they were divided into three groups: sixteen patients presented presclerodermal Raynaud's phenomenon, and nineteen, systemic sclerosis; twenty others had Raynaud's disease. Twenty volunteers formed the control group. Esophageal motor disorders were observed in the group with presclerodermal Raynaud's phenomenon, affecting the esophageal lower sphincter and the peristalsis of the body of the esophagus. In the group with systemic sclerosis, these motor disorders were associated with alterations in the amplitude and the duration of contractions. Esophageal motility was normal in subjects with Raynaud's disease. We can conclude that: 1) esophageal motor disorders can be seen in presclerodermal Raynaud's phenomenon. The kind of abnormalities observed at this stage of the disease are in favor of an early alteration of the neurogenic component of esophageal motility; 2) there is no relationship between esophageal motor disorders and Raynaud's phenomenon in scleroderma.

Somatostatin induces ectopic activity fronts of the migrating motor complex via a local intestinal mechanism

To study the peripheral effect of somatostatin in dogs a tiny Silastic catheter was implanted in an almost terminal branch of the mesenteric artery, providing blood supply to a jejunal segment of 5-10 cm. In 4 dogs one catheter was implanted, perfusing a small bowel segment about 60 cm below the angle of Treitz; in 3 dogs two catheters were implanted, perfusing two small bowel segments about 30 and 60 cm below the angle of Treitz. The catheter was kept open by continuous perfusion with a diluted heparin solution by means of a portable insulin infusion pump fixed to the animal's protection jacket. Small bowel motility was recorded electromyographically. Experiments were started 2 wk after surgery and were performed in conscious fasted animals. Control experiments using intraarterial saline perfusion showed normal migrating motor complexes in the perfused segment. Intraarterial perfusion of somatostatin (50-200 ng/kg X h) induced ectopic activity fronts, which always started just distal to the perfused segment and progressed down the small bowel at a normal propagation velocity. During the occurrence of ectopic fronts no activity fronts were observed in the small bowel proximal to the perfusion site. Apart from ectopic fronts, normal activity fronts, starting in the duodenum and passing the perfused segment, were also observed. The most proximal part of the jejunum was more sensitive to intraarterial somatostatin than the more distal jejunum. Intravenous infusion of the same doses of somatostatin had no effect. Somatostatin, therefore, seems to induce ectopic fronts via a local mechanism. We propose that somatostatin is able to relieve the intestine locally from an inhibitory mechanism that prevents the development of activity fronts.

[Effects of propantheline on the motor activity of the normal human esophagus]

The aim of this study was to examine the action of orally administrated propantheline bromide, an anticholinergic agent, on esophageal motor function. To evaluate these effects a double blind randomized study was carried out in ten normal volunteers. An optimal effective dose for each subject was determined according to the Sun and Shay method. Esophageal motor activity following dry and wet swallow was markedly altered by propantheline. This drug: a) dramatically lowered the peristaltic wave amplitude in the smooth muscle part of the esophagus (P less than 0.001); b) decreased the wave velocity in the proximal part of the smooth muscle (P less than 0.05), and c) increased the frequency of both the non peristaltic and repetitive waves (P less than 0.001). On the other hand propantheline weakly but significantly diminished the lower esophageal sphincter resting pressure (P less than 0.05). These results suggest that: a) the peristaltic function of the human esophageal smooth muscle is greatly dependent on muscarinic neurotransmission, and b) in patients with gastroesophageal reflux, orally as well as parenterally administrated anticholinergic agents are contraindicated.

Assessment of the accuracy of segmental perfusion under an occluding balloon for measuring the intrajejunal secretion of albumin and immunoglobulin A

The suitability was investigated of the segmental perfusion technique under an occluding balloon (which prevents the contamination of the test segment by upper digestive secretions and pancreatic proteolytic enzymes) for measuring immunoglobulin A (IgA) and serum albumin outputs into the jejunal lumen. The influence of the perfusion rate and of the transintestinal water movements in the 40 cm long test segment was studied in 11 healthy subjects. IgA and serum albumin outputs did not differ significantly when the same isotonic solution was perfused at rates of 5 or 10 ml/min, nor when water absorption was stimulated by the presence of glucose. A possible artefact linked to intestinal wall distension by the occluding balloon was evaluated in eight subjects with complete exocrine pancreas insufficiency. IgA and serum albumin outputs obtained under the occluding balloon were compared with those found with the triple non-occlusive method. Care was taken to achieve a similar flow rate and solute composition of the fluid entering the test segments with both techniques in each subject. Under these conditions, IgA and serum albumin outputs measured with both methods did not differ significantly. These findings validate the use of the segmental perfusion technique under an occluding balloon to measure IgA and serum albumin outputs into the human small intestine.

Colonic inhibition of gastric secretion in man

The effect of colonic infusion of various solutions on submaximal pentagastrin-stimulated gastric secretion was determined in healthy volunteers. Hypertonic (823 mOsm/kg) glucose, mannitol, and saline, and also isotonic glucose significantly induced a marked and sustained inhibition of gastric acid secretion of 74%, 66%, 79%, and 54%, respectively. A similar degree of inhibition was obtained for pepsin secretion with hypertonic glucose and mannitol. Isotonic triglycerides and isotonic saline solutions had no significant effect on gastric acid secretion. Hypertonic glucose, mannitol, and saline infusions significantly increased plasma concentrations of enteroglucagon, whereas other solutions had no effect. No correlation, however, was found between the percentage rise of enteroglucagon and the percentage inhibition of gastric secretion obtained from any of the three hypertonic solutions. The physiological significance of these findings remains to be established.

Action of norepinephrine on the serum gastrin level

The authors have studied the influence of endogenous norepinephrine released during exercise on the level of serum gastrin. After a period of absolute rest, 10 volunteers in good health underwent a prolonged graded exercise corresponding to 60, then 80% of the maximum theoretical heart-beat frequency. Only norepinephrine was significantly high during the course of the second phase of muscular activity. No significant change in serum gastrin was observed during the entire test.

Increase in amylase clearance in relation to creatinin clearance during acute pancreatitis

Renal amylase clearance in relation to creatinin clearance (Cam/Ccr) was determined for 20 patients suffering from acute pancreatitis (AP). For each of them, the diagnosis rested upon operative or laparoscopic observation of characteristic anatomical or histological lesions. The average clearance relationship in these patients reached 16 +/- SEM 3.8%. These results were significantly higher than those obtained from 132 patients who had been hospitalized for other medical or surgical diseases, as well as from 51 test patients (p less than 0.001). The authors stressed the diagnostic importance of this test, in particular in the presence of a normal amylasemia level.