EuCd_{2}As_{2}: A Magnetic Semiconductor.

EuCd_{2}As_{2} is now widely accepted as a topological semimetal in which a Weyl phase is induced by an external magnetic field. We challenge this view through firm experimental evidence using a combination of electronic transport, optical spectroscopy, and excited-state photoemission spectroscopy. We show that the EuCd_{2}As_{2} is in fact a semiconductor with a gap of 0.77 eV. We show that the externally applied magnetic field has a profound impact on the electronic band structure of this system. This is manifested by a huge decrease of the observed band gap, as large as 125 meV at 2 T, and, consequently, by a giant redshift of the interband absorption edge. However, the semiconductor nature of the material remains preserved. EuCd_{2}As_{2} is therefore a magnetic semiconductor rather than a Dirac or Weyl semimetal, as suggested by ab initio computations carried out within the local spin-density approximation.

Lactose intolerance in the Lebanese population and in "Mediterranean lymphoma".

Lactose tolerance tests were performed on 75 healthy Lebanese volunteers, 12 patients with "Mediterranean lymphoma" and 15 American and West European Caucasians. Small intestinal biopsies were done on 10 intolerant and five tolerant subjects for histological evaluation and lactase assay. Lactose malabsorption was present in 78% of the Lebanese subjects, in all patients with Mediterranean lymphoma and in five of the 15 Caucasians. Two of the five intolerant Caucasians had giardiasis. There was no difference in the prevalence rate among the various Lebanese groups nor among males and females. Symptoms occurred in 91% of the 58 intolerant Lebanese subjects: diarrhea in 71%, abdominal distension in 67%, and cramps in 48%. The increased prevalence of lactose intolerance with Mediterranean lymphoma is probably secondary to the pathological changes in the intestinal mucosa and protein depletion.

Comparative effects of Criticare HN and Vivonex HN in the treatment of malnutrition due to pancreatic insufficiency.

The effect of high nitrogen Criticare and Vivonex on nutritional repletion was evaluated in 12 patients with malnutrition secondary to pancreatic insufficiency. The patients were randomized to receive either Criticare HN or Vivonex HN for a total period of 9 days. Each patient received 3000 kcal/day of either preparation, in addition to 1000 kcal of solid food. A significant weight gain was encountered in the group of patients receiving Criticare HN. Increased blood urea nitrogen was encountered in both groups of patients. All patients tolerated both diets well without evidence of relapse of their pancreatitis. No significant complications were encountered. Our results indicate that Criticare HN is of superior nutritional value, but both preparations resulted in increased blood urea nitrogen retention.

Fat absorption after longitudinal pancreaticojejunostomy.

This study was undertaken to determine whether fat absorption is improved following longitudinal pancreaticojejunostomy. Ten consecutive patients with chronic pancreatitis underwent measurement of fat absorption (fecal fat, 14C-labeled phenylacetic dipalmitate oil absorption test) before and after operation. Fecal fat increased in 8 of 10 patients following side-to-side pancreaticojejunostomy. However, the average postoperative fecal fat increase of 4.3 gm was of no clinical significance. The observed mild postoperative decline in fat absorption was confirmed by the 14C-labeled phenylacetic dipalmitate test. An improvement in postoperative fat absorption following side-to-side pancreaticojejunostomy Roux-en-Y should not be expected. The primary indication for this procedure for patients with chronic pancreatitis continues to be intractable pain.

Diflunisal and ibuprofen: effects on gastric and duodenal mucosa in patients with osteoarthritis.

Patients with osteoarthritis make up the largest group of users of nonsteroidal anti-inflammatory drugs (NSAIDs), but the effects of these agents on the gastrointestinal mucosa of such patients have not been well studied. This article describes a short-term comparison of two widely used NSAIDs, diflunisal and ibuprofen, in patients requiring these medications for their osteoarthritis. Efficacy, tolerability, and endoscopically documented effects of these drugs on the gastric and duodenal mucosa were assessed. Consenting, eligible patients were randomly assigned to one of the two study drugs for a two-week course. Clinical assessments were made after each week of treatment. Fiberoptic endoscopy and laboratory tests were performed before and after the treatment period. Thirty patients completed the study: 16 received diflunisal and 14 received ibuprofen. Similar improvements in pain, joint mobility, functional capacity, and joint swelling and tenderness were observed in both treatment groups. Transient, mild abdominal cramping was reported by two patients in each group; one patient receiving ibuprofen complained of transient dizziness. No patient withdrew from the study because of side effects. Follow-up endoscopy revealed slight (grade 1) changes in the gastric mucosa of two patients in each treatment group. An additional patient in the ibuprofen group had gastric erosions (grade 2) at the end of the study. Endoscopic changes were not correlated with symptoms. Diflunisal and ibuprofen were found to be similarly effective and well tolerated in the treatment of osteoarthritis. Their use may be associated with some gastrointestinal side effects even during short-term use.

The value of [14C]phenyl acetic dipalmitate (PADP) as a test for maldigestion.

[14C]phenyl acetic dipalmitate (PADP) was prepared and evaluated in vitro and in vivo. Upon incubation with lipase it was hydrolyzed into phenyl acetic acid and monoglycerides. Phenyl acetic acid is not metabolized by the body and is quantitatively excreted in urine. When tested in rats there was no tissue deposition of the 14C label in any of the organs studied. There was also no evidence of absorption from the colon. The newly prepared compound was evaluated in 15 human volunteers and 24 patients with chronic pancreatitis and compared to fecal fat and D-xylose. Normal volunteers had a urinary excretion of 34.5 +/- 6.4% of the administered 14C label in 5 h. Both fecal fat and PADP were abnormal in 16 of 20 patients with chronic pancreatitis. They were both normal in two, while in two other patients fecal fat was normal and PADP abnormal. Both of the latter patients had clinical evidence of steatorrhea but reduced oral intake due to pain. D-xylose was abnormal in five patients presumably due to bacterial overgrowth. Our findings indicate that PADP is a simple, accurate and rapid test for pancreatic function; is not dependent on fat intake and may be run concomitantly with D-xylose.

Phenylacetic oil: a possible simple test for fat absorption.

The preparation of a phenyl[1-14C]acetic acid oil is described. The absorption pattern of the phenylacetate in this oil is similar to that of oleic acid in triolein when examined in rats under conditions that may interfere with digestion and/or absorption. The safety of this compound, which is a normal metabolite, was established by the absence of the 14C label in various tissues five days after its administration to rats. When tested in 18 normal human volunteers 66.6 +/- 16.0 (S.D.) percent of the phenylacetate was recovered in a five hour urine collection. In two patients with malabsorption, less than 30% of the label was recovered in the urine over the same period. The half-life of the phenylacetate was determined to be 1-1.5 h. Our preliminary results indicate that phenylacetic oil may serve as a useful simple clinical test for fat absorption.

Importance of terminal hepatic venule thickening.

Thickening around the terminal hepatic venule (THV) in alcoholics has been implicated as a marker for fibrosis and cirrhosis. To test this hypothesis, we evaluated 107 liver biopsy specimens from patients with normal liver histologic features (12), fatty livers (30), mild alcoholic hepatitis (15), and florid alcoholic hepatitis (29). Twenty-one follow-up liver biopsy specimens from patients with fatty liver and alcoholic hapatitis were also available for this study. Two observers (S.M.N., V.H.N.) graded 18 histologic features on a scale of 0 to 3. There was no significant difference in the prevalence of THV thickening in normal biopsy specimens and in various forms for alcoholic liver injury. There was also no correlation between the degree of THV thickening and steatosis, necrosis, or inflammation. Thickening of the THV was most common in the presence of lobular and subsinusoidal fibrosis. Cirrhosis developed in nine of ten alcoholic patients who had subsinusoidal and lobular fibrosis. These findings illustrate that the marker for progressive fibrosis and development of cirrhosis is lobular and subsinusoidal fibrosis and not the isolated thickening of the THV.

Clinical characteristics of patients with a second primary tumor in the endometrium or ovary.

The clinical characteristics of patients with second primary tumors in the ovary and endometrium were compared to those with single primary tumors treated at our Center during the same period of time. Despite the fact that the patients were under medical surveillance for the first primary tumor, most second tumors were diagnosed following patient symptoms and complaints, and not at a routine follow-up appointment. Patients with a second primary endometrial cancer had a more advanced stage of disease at diagnosis as compared to those with single endometrial cancer. This was not found to be true for patients with second ovarian cancer. Patients with primary breast cancer and colon cancer, lymphoma or melanoma were found to be at higher risk for developing a second primary tumor in the endometrium or ovary as compared to those with a primary tumor at other sites. Although there are no proven means for the early detection of these gynecologic malignancies, it seems prudent to draw the attention of medical practitioners to the need for a better gynecologic evaluation for women with cancer at other sites during their follow-up visits. Studies on the efficacy of currently available diagnostic techniques should be carried out to evaluate their yield in this high risk group.

Evaporation-driven growth of large crystallized salt structures in a porous medium.

Subflorescence refers to crystallized salt structures that form inside a porous medium. We report a drying experiment revealing major development of subflorescence in the dry region of the porous medium away from the liquid zone. Using a combination of image analyses and numerical computations, we show that the growth is directly correlated to the evaporation flux distribution along the boundary of the growing salt structure. This indicates that the salt is transported into the domain occupied by the salt structure in the porous medium up to the structure periphery, where salt deposition takes place. This is confirmed when a growing salt structure encounters dry subflorescence formed earlier during the drying process. The dry subflorescence is reimbibed and resumes its growth. The analysis also suggests that the solution within the growing subflorescence is in equilibrium with the crystallized salt wall. These results shed light on the growth mechanisms of subflorescence, a phenomenon that can play a fundamental role in several important issues such as carbon dioxide sequestration or salt weathering.

Comparison of hypertonic glucose to other provocative tests in patients with noncardiac chest pain.

The effect of hypertonic glucose as a provocative test was studied in 51 patients with noncardiac chest pain, 15 patients with esophagitis, and 16 asymptomatic controls. It was compared to esophageal perfusion with 0.1 N HCl and saline and intravenous administration of 10 mg edrophonium. Continuous esophageal manometric recordings were performed at the time of testing. The patients' symptoms were monitored every minute. The effect of these solutions and edrophonium on lower esophageal sphincter (LES) pressure and amplitude of esophageal contractions was also evaluated. Esophageal perfusion with hypertonic glucose, saline, or acid had no significant effect on LES pressure or amplitude of esophageal contractions in most patients. Edrophonium, however, resulted in a significant rise in the amplitude of esophageal contractions and the LES pressure in all groups studied. Hypertonic glucose resulted in chest pain in 13.6% of patients with noncardiac chest pain and 20% of those with esophagitis, whereas edrophonium reproduced the pain in 38.7 and 37%, respectively. Our results indicate that hypertonic glucose is not effective as a provocative test for noncardiac chest pain nor does it contribute to the chest pain in esophagitis. They also had no significant effect on the amplitude of esophageal contractions or LES pressure. Edrophonium continues to be a relatively sensitive test for noncardiac chest pain.

The effect of topical pharyngeal anesthesia on esophageal motility.

A strong gag reflex may be a limiting factor to perform esophageal motility in some patients. Even though local anesthetics could alleviate such a problem, they are not used for fear of interfering with various manometric parameters. In this study, we evaluated the effect of topical pharyngeal local anesthesia on lower esophageal sphincter pressure, amplitude, duration, and velocity of esophageal contractions. We also studied its effects on the patient's tolerance. Esophageal motility was performed before and after topical anesthesia with 20% benzocaine. The baseline tracing and the tracing obtained after topical anesthesia were number coded and separated. They were evaluated blindly as to the pressure in the lower esophageal sphincter, amplitude, duration, and velocity of esophageal contractions. An average of 10 wet swallows was used to determine the above values. There was no significant change in the lower esophageal sphincter pressure or the amplitude of esophageal contractions after benzocaine. Similarly, there was no change in the duration or velocity of peristaltic activity. The patient's tolerance to the tube was unchanged or improved in 12 of 14 patients. Six patients had some difficulty in swallowing, but were able to compensate by sucking on the syringe. Our results indicate that topical pharyngeal anesthesia does not affect the usually measured manometric parameters; and while it may improve the patient's tolerance to the manometric catheter, it interferes with the ability to swallow.

Serum isoamylase as a test for pancreatic insufficiency.

Total and pancreatic serum isoamylases were performed on 38 control subjects (21 non-smokers and 17 smokers) and 21 consecutive patients with pancreatic insufficiency before and after meal stimulation. There was no difference in the fasting or stimulated levels of total amylase (T), pancreatic isoamylase (P), or % P/T between smokers and non-smokers. The P/T ratio was significantly reduced in patients with pancreatic insufficiency when compared with each of the control groups (p less than 0.0005). Eleven of 21 patients with pancreatic insufficiency had raised total serum amylase, but none had a rise in the pancreatic fraction or P/T ratio. Our findings indicate that the T, P, and P/T ratio of serum amylase are not influenced by smoking or meal stimulation. A reduced P/T ratio in a patient with steatorrhoea suggests pancreatic insufficiency as the cause. Hyperamylasaemia in patients with pancreatic insufficiency does not necessarily imply a relapse.

Aminoacid therapy of alcoholic hepatitis.

35 consecutive patients with alcoholic hepatitis were randomly allocated to control (18 patients) and study (17 patients) groups. All patients were offered a 3000 kcal 100 g protein diet and were studied for 28 days. The study group received 70-85 g of intravenous aminoacids daily in the form of 'Aminosyn' or 'Travasol'. Both groups had similar clinical and biochemical features at the time of randomisation. Ascites and encephalopathy tended to improve more in the study group. Serum concentrations of bilirubin (p < 0.01) and albumin (p < 0.025) improved in the study but not in the control group. 4 patients died in the control group, but none died in the study group. Intravenous therapy with aminoacid for 4 weeks seemed to be associated with lower mortality rate (p < 0.02) and improved serum bilirubin and albumin concentrations in patients with alcoholic hepatitis.

Enteric fever: a clinicopathologic study of 104 cases.

The records of 104 patients with culture-proven enteric fever were reviewed and evaluated as to the clinical signs, laboratory findings, pathologic features and complications of the disease. One patient with fatal disseminated intravascular coagulation and enteric fever is also presented. Fever and bradycardia were the leading clinical signs followed by splenomegaly, hepatomegaly and rose spots. The principal complications of enteric fever included anemia, typhoid hepatitis, relapse and bleeding. Evidence of typhoid hepatitis was present in 30% of the patients tested. The pathology consisted of typhoid nodules of variable frequency and size depending upon the severity of the condition. The relationship of typhoid hepatitis to relapse seems to be more than coincidental as four out of seven patients who had relapse had abnormal liver tests. The occurrence of disseminated intravascular coagulation in enteric fever is rare; however, awareness of such a potential complication may be life-saving to the patient.

Radionuclide esophageal emptying and manometric studies in diabetes mellitus.

Esophageal function was prospectively studied in 50 consecutive insulin-requiring diabetes mellitus patients. The patients were stratified in three groups: A) 18 without peripheral neuropathy (PN); B) 20 with PN but no autonomic neuropathy; C) 12 with PN and autonomic neuropathy. Twelve patients (four B, eight C) had gastrointestinal symptoms including six with dysphagia. Radionuclide esophageal emptying was abnormal in 55, 70, and 83% of patients in groups A, B, and C, respectively. Eleven of the 12 (92%) symptomatic and 23 of the 38 (60%) asymptomatic diabetes mellitus patients had abnormal emptying. Five of six patients with dysphagia had abnormal emptying. Esophageal manometry was also performed in 15 patients. Twelve patients had abnormal manometry. These included nutcracker esophagus in two, achalasia in one, and increased percentage of multipeaked and simultaneous contractions in nine. There were no significant correlations between radionuclide esophageal emptying, manometric changes and symptoms. Gastrointestinal symptoms were more common in the presence of autonomic neuropathy. Delayed esophageal emptying was more profound in the presence of PN, but abnormal esophageal emptying was present in patients with neuropathy as commonly as patients without. Furthermore, the presence of diabetic retinopathy, duration or control of diabetics, and fasting blood sugar did not influence the frequency of abnormal esophageal emptying. Our data indicate that esophageal dysfunction is common in male diabetics even in the absence of clinical PN and retinopathy, suggesting that diabetic gastroenteropathy can occur in the absence of significant diabetic complications. Commonly observed abnormal esophageal manometry in diabetics is not necessarily accompanied by significant functional disturbances or symptoms.