Chronic vomiting in a case of citrullinaemia detected after treatment by total parenteral nutrition.

We report a case of a 56 year old woman who presented with a long history of chronic attacks of vomiting. On admission to hospital she was cachectic, and attempted parenteral nutrition induced coma. The illness was found to be due to citrullinaemia, a metabolic disorder of the urea cycle. Our patient is the oldest with this disorder so far described in the literature. The main points of the case and its investigation are outlined: hyperammonaemia, amino acid chromatogram, measurement of enzyme activity in skin and liver biopsy material. The therapeutic measures which led to cure are of particular interest.

A cooperative study on the detection of colorectal cancer and polyps in France.

Systematic investigations testing for the presence of polyps and cancers of the large bowel were conducted in a population of 1,369 inpatients and outpatients, aged 45-70 years, in eight university departments of gastroenterology or abdominal surgery (Toulouse, Dijon, Paris, Marseille, and Strasbourg). Double-contrast barium enema and proctosigmoidoscopy examinations were carried out in all cases, whereas total coloscopy was performed only in the case of detected tumors. A questionnaire including 233 parameters (age, sex, family, and personal history and symptoms) was completed for each patient. A total of 414 lesions were detected in 252 patients, including 245 adenomatous or villous polyps, 8 transformed polyps, and 30 carcinomas; 3 of 4 lesions were located in the rectum or sigmoid. Cancer or adenomatous or villous polyps were found in 13% of the patients. The prevalence of these lesions in the population studied was increased in patients with rectorrhagia (19%) or with a personal history of surgery for colorectal cancer or polyp (23%). In the patients without rectorrhagia or a history of intestinal tumor, the incidence was 9.7%. It was significantly increased in males and patients more than 50 year old. The efficacy of proctosigmoidoscopy and double-contrast barium enema was compared in 909 patients. Sensitivity and specificity were, respectively, 35% and 99% for endoscopy, 96% and 94% for radiology.

Screening for colorectal tumors - results of two years experience.

The experience after two years of systematic colorectal tumors screening of 603 subjects, aged between 40 and 70, is reported. All subjects were submitted to proctoscopy (P) and air filled barium enema (AFBE). Total frequency of screened tumors: 15.25%. More than 85% of the tumors were found in the recto-sigmoid. Two subgroups were identified in this population. In subgroup A, 125 subjects were submitted to P, AFBE and flexible pansigmoidoscopy (FP). Percentage of screened tumors is 19.2%. Sensitivity rate of radiology for exploration of the recto-sigmoid area, as compared to FP is rather low: 0.41. In subgroup B, 165 subjects were submitted to hemoccult, P, AFBE and colonoscopy when an abnormal or dubious image was shown by AFBE. The comparative study of these different means of investigation shows a very low rate of sensitivity of hemoccult: 0.16. In addition, the percentage of screened colorectal tumors is significantly higher (p less than 0.01) in subjects with personal or family history of polyp or carcinoma: 22%, compared to the incidence in the remaining population of 13%. Flexible pansigmoidoscopy is recommended for systematic screening of colorectal tumors in subjects older than 40.

General and lysin specific control of saccharopine dehydrogenase levels in the yeast Saccharomycopsis lipolytica.

Lysine supplementation of the growth medium of a wild type strain of the yeast Saccharomycopsis lipolytica specifically results in saccharopine dehydrogenase repression. Starvation of the strain for histidine triggers a general depression of various histidine, leucine, arginine and lysine biosynthetic enzymes, including saccharopine dehydrogenase. These two types of control, specific and general, act independently on saccharopine dehydrogenase expression, since mutants which fail to respond to the specific control still are sensitive to the general one. These mutants were first selected as unable to catabolize lysine, suggesting that a link may exist between saccharopine dehydrogenase specific regulation and activity of the catabolic pathway.

[Problem posed by the prevention and detection of colorectal cancers]. / Problèmes posés par la prévention et le dépistage des cancers colo-rectaux.

The incidence of colonic and rectal carcinoma is in constant progression. The detection and destruction of polyps is the only effective means of reducing the number of adenocarcinomas. The technical means of detection are well known and fully proved: rectosigmoidoscopy, thin layer double contrast enema, colonoscopy. The true problem is that of the cost of this prevention. It is important to define high risk groups in which these tests should be carried out as a routine. Furthermore it is necessary to know whether blood tests or examination of the stools may be considered as a means of detection of polyp or at least certain types of potentially malignant polyp. without suggesting a considerable increase in the number of medical investigations, one may hope for better use of sigmoidoscopy and double contrast barium enema. These two examinations represent undoubtedly the essential factor in the diagnosis of colonic and rectal tumours.

Role of cholinergic mechanisms in the response to secretin of isolated canine pancreas.

The effects of carbamylcholine (CCH, 100 mug per hr) and of atropine (0.25, 1.0, and 10.0 mg per hr) on the response of the exocrine pancreas to secretin (0.1, 0.5, and 5.0 clinic units per hr) were studied using the isolated canine pancreas perfused with whole heparin-treated blood. CCH induced a sharp decrease in D50 (dose of secretin which elicits half the calculated maximal response) but no increase in maximal response to secretin. Experiments performed under different haemodynamic conditions show that this potentiating effect (synergism) is partly due to vasomotor modifications and chiefly to the action of CCH on the receptor of secretin. Although this work indicates that cholinergic tone is not necessary for secretin-induced hydrelatic response to occur, it evidences that this cholinergic tone plays a major role in modulating the pancreatic response to submaximal doses of secretin. It has also been found that large doses of atropine (10 mg per hr) were necessary to achieve a complete inhibition of enzymatic response to CCH. Even at these high doses, however, enzymatic response to secretin and cholecystokinin-pancreozymin were not significantly inhibited.