The decay of endogenously labelled 75Se-selenomethionine labelled proteins in duodenal juice: evidence for recirculation in man.

The decay of the specific radioactivity of duodenal juice proteins, endogenously labelled with 75Se-selenomethionine has been studied in man. Duodenal juice was collected against a background infusion of cholecystokinin-pancreozymin (1 unit/kg/hr) and secretin (1 unit/Kg/hr). In 4 subjects, duodenal juice was aspirated continuously and pooled in 30 min. aliquots. In 3 other subjects approximately 5-10 ml of juice was removed at 15 min, intervals. The rate of decay of protein specific radioactivity was significantly more rapid in the drainage group (p less than 0.01). A similar trend was also observed for trypsin. The data suggests that endogenous duodenal juice proteins might be recirculated as intact proteins in man.

Methylmercury in populations eating large quantities of marine fish.

A Peruvian population was identified that was chronically exposed to methylmercury from the long-term consumption of ocean fish. The weekly fish intake averaged 10.1 kg per average family of 6.2 persons. Blood methylmercury concentrations ranged from 11 to 275 ng/ml, with a mean of 82 ng/ml. Paresthesias were reported by 29.5% of the population. In contrast, a nearby control population had a mean weekly fish consumption of 1.9 kg per average family of 6.4 persons. Their blood methylmercury levels were 3.3-25.1 ng/ml, with a mean of 9.9 ng/ml. Paresthesias were reported by 49.5% of this control group. No individual was identified with symptoms or signs that could be attributed to methylmercury intoxication.

Unplanned splenectomy--harbinger of complications.

Splenectomy alone or in combination with other major operative procedures has been implicated as the cause of excessive morbidity and mortality. We retrospectively studied 151 consecutive patients with splenectomy performed between 1985 and 1992. Subsets of patients according to indication for splenectomy were compared with a cohort of patients having elective open cholecystectomy. Morbidity with elective splenectomy (11.5%) was not significantly increased over that with elective open cholecystectomy (6.8%). Morbidity with nonelective splenectomy (40.4%) was increased when compared with that of elective splenectomy (11.5%) or with elective open cholecystectomy (6.8%). Mortality was significantly worse for nonelective (10.6%) than for elective splenectomy (1%). Nonelective splenectomy should be recognized as one event in a cascade of events leading to excessive morbidity and mortality. Splenectomy should not be implicated as the sole or primary cause of such excesses.

Idiopathic hemochromatosis: a study in a large Puerto Rican family.

We studied 13 first-degree relatives in a large family with an index case of idiopathic hemochromatosis to detect the relatives with evidence of iron overloading. Serum iron, total iron binding capacity (TIBC), and serum ferritin levels were measured in all family members. We also performed HLA typing to identify the relatives who are homozygous with the proband and genetically predisposed to develop the disease. The family was composed of the parents and 12 siblings including the index case. The mean age of the siblings was 25 years. None presented with evidence of iron overload by the iron biochemical tests. HLA typing demonstrated six homozygous siblings with the proband. In separate analysis these siblings did not present abnormalities in any of the iron biochemical tests. These homozygous relatives were followed for one year after initial evaluation and none presented abnormalities in the iron studies during this period. These results are contradictory to other previous studies done in families with idiopathic hemochromatosis. The most feasible explanations for these findings are the young age of these siblings and the predominance of females among them. We consider that these homozygous relatives must be followed for their life-times with iron studies to detect a possible increase in iron stores as expected in later ages.

Hepatitis C viral RNA amplification by the polymerase chain reaction allows detection of false positive HCV ELISAs among patients with non-A, non-B hepatitis.

Serum from patients which tested positive for hepatitis C virus (HCV) by Enzyme Linked Immunosorbent Assay (ELISA) were analyzed for the presence of HCV RNA by nested Polymerase Chain Reaction (PCR) and for anti-HCV antibodies by Recombinant Immunoblot Assay (RIBA II). Total RNA was extracted from whole blood by a new procedure and subjected to reverse transcription of HCV RNA employing primers to the conserved 5' non-coding region of the HCV genome. PCR performed on these samples uncovered several false positive ELISAs. Reciprocal confirmation between PCR and RIBA II results was observed. These results substantiate this variation of the HCV PCR assay as a reliable alternative for routine confirmation of HCV serological tests.

Prevention of recurrent esophageal bleeding and survival in patients with alcoholic cirrhosis: a randomized study.

OBJECTIVES: To compare endoscopic sclerotherapy, propranolol and distal splenorenal shunt in the prevention of rebleeding esophageal varices and mortality in alcoholic cirrhotics. METHODS: Forty-three alcoholic cirrhotics that had bled from esophageal varices were randomized to sclerotherapy (13), shunt (15) or propranolol(15). Outcomes measured were rebleeding from varices and death. RESULTS: There was no significant difference between the three treatment groups in relation to rebleeding rate or death. Continued alcohol consumption did not influence outcome. CONCLUSIONS: All three therapies were equally effective in preventing rebleeding from varices.

Phenytoin induced fatal hepatic injury.

A 61 year old female developed fatal hepatic failure after phenytoin administration. A typical multisystem clinical pattern precedes the manifestations of hepatic injury. The hematologic, biochemical and pathologic features indicate a mixed hepatocellular damage due to drug hypersensitivity. In a patient receiving phenytoin who presents a viral-like illness, early recognition and discontinuation of the drug are mandatory.

[Inflammatory disease of the gastrointestinal tract at the University Hospital, Medical Center, Puerto Rico. 1980-87]. / Enfermedad inflamatoria del tracto gastrointestinal en el Hospital Universitario, Centro Médico, Puerto Rico. 1980-87.

Although ulcerative colitis and Crohn's disease have been known for a long time, the etiology is still unknown, and at times it is difficult to distinguish one from the other. In addition, the characteristics of the disease make their epidemiologic study difficult. We have reviewed 70 cases with the diagnosis of Crohn's disease or ulcerative colitis, and compared our results with those published from other parts of the world. We found a high proportion of ulcerative colitis to Crohn's disease, 5.36:1. There was no difference in affected age groups or most frequent symptoms; but we found Crohn's disease to be more frequent in the colon. We also found a very low incidence of extraintestinal manifestations. We believe an adequate standard protocol should be followed for the evaluation of patients with inflammatory bowel disease, including complementary studies to assess disease patterns and complications.

Idiopathic hemochromatosis in a young man presenting with palpitations.

A 32-year-old male presented with palpitations and an elevated serum iron. Further evaluation revealed elevated serum ferritin, and a liver biopsy confirmed the diagnosis of hemochromatosis. Cardiovascular workup was normal except for sinus bradycardia alternating with sinus tachycardia in the 24-hour Holter study. Treatment with weekly phlebotomies was started and the family is being studied for early diagnosis of any other case of hemochromatosis. The manifestations, diagnostic workup, and the importance of early diagnosis of hemochromatosis is stressed.

Electrophoretic studies of human upper gastrointestinal mucosal acid proteinases.

The pattern of acid proteinase zymogens, seven pepsinogens (Pg) and slow moving protease (SMP), in normal human gastric mucosa has been reported. No significant differences were found in appearance of individual pepsinogens in oxyntic mucosa in the two sexes, but in pyloric mucosa, Pg 3 occurred significantly more often in men. Rapidly migrating pepsinogens (constituents of Group I pepsinogens) were seen in pyloric mucosa as well as in oxyntic mucosa. The duodenal mucosa contained small amounts of proteinases, the activity being largely confined to the slower moving proteinases (constituents of Group II pepsinogens).

Measurement of trypsin in duodenal juice by radioimmunoassay.

Trypsin in duodenal aspirate and pure pancreatic juice samples has been measured by both radioimmunoassay and enzymatic mathods. The radioimmunossay has been shown to be specific and to detect trypsin in the presence of aprotinin (Trasylol). In duodenal juice samples from control subjects and from patients with primary biliary cirrhosis a good correlation was obtained between both immunoreactive trypsin concentration and trypsin activity. The immunoreactive trypsinogen concentration in pure pancreatic juice also correlated well with activated trypsin activity. The mean immunoreactive trypsin concentration and the concentration of enzymatically inert immunoreactive trypsin in duodenal juice samples from patients with primary biliary cirrhosis were significantly lower than controls, suggesting pancreatic hyposecretion in this disease. After five duodenal juice samples had been stored for three months at -70 degrees C, immunoreactive trypsin concentration in samples stored without Trasylol were reduced by 12 . 0 +/- 4 . 2 (mean +/- SD) times the concentration of samples stored in Trasylol. Trypsin autodegradation continues even at -70 degrees C; Trasylol protects against this. Radioimmunoassay is a reliable method of trypsin estimation in duodenal juice and has advantages over conventional enzymatic analysis.

Metabolism of 125I-labelled trypsin in man: evidence of recirculation.

125I-labelled human trypsin metabolism has been investigated in man. Three subjects received 125I-trypsin and 131I-albumin intravenously. Against a background secretin infusion (1 U/kg/h), trypsin decayed biexponentially from the serum with half-lives of 17.5, 21, and 24 minutes for the rapid disappearance phase and 520, 540, and 560 minutes for the slow phase. Between 13% and 38% of the 125I injected was recovered from duodenal juice aspirated continously over 300 minutes. In contrast, less than 1% of the 131I-albumin injected was recovered. When bile and pure pancreatic juice were collected at endoscopic retrograde cholangiopancreatography after intravenous 125I-trypsin in a fourth subject 125I radioactivity was found to be secreted via both these routes. After 125I-trypsin infusion into the duodenum 11% of the total dose was found to be present in the circulation after 75 minutes. These results support the concept that recirculation of trypsin exists in man.

Prevention of recurrent esophageal bleeding and survival in patients with alcoholic cirrhosis: a randomized study

OBJECTIVES: To compare endoscopic sclerotherapy, propranolol and distal splenorenal shunt in the prevention of rebleeding esophageal varices and mortality in alcoholic cirrhotics. METHODS: Forty-three alcoholic cirrhotics that had bled from esophageal varices were randomized to sclerotherapy (13), shunt (15) or propranolol(15). Outcomes measured were rebleeding from varices and death. RESULTS: There was no significant difference between the three treatment groups in relation to rebleeding rate or death. Continued alcohol consumption did not influence outcome. CONCLUSIONS: All three therapies were equally effective in preventing rebleeding from varices