Dermopathic changes in hypozincemia.

In seven patients with chronic debilitating gastrointestinal disease who were being given total parenteral nutrition using L-amino acids and concentrated dextrose solution, severe hypozincemia (less than 60 micrograms/dL) developed with characteristic skin lesions and alopecia. The lesions were similar to seborrheic dermatitis, and they occurred in areas of high sebaceous gland concentration. Hyperkeratotic lesions were also seen on the extensor surfaces of large joints. The skin lesions and alopecia disappeared when serum zinc values were raised to levels above 60 micrograms/dL, with appropriate zinc sulfate replacement. A hypothesis on the etiology and clinical manifestations is presented.

Obstructive, pseudo-obstructive and enteropathic syndromes after jejunoileal bypass.

We have encountered two patients with volvulus of the small intestine at the ileocolic anastomosis, occurring after jejunoileal bypass. This uncommon complication is generally seen many months after bypass and may be difficult to diagnose. Barium enema examination was helpful in one patient. If there are acute, severe abdominal symptoms, mechanical obstruction and early operation should be considered. Attention has been called to other intestinal syndromes with obstructive features developing after jejunoileal bypass, and these have been compared.

Extrahepatic biliary steering-wheel trauma simulating pancreatic carcinoma--a dilemma in management.

A case report of extrahepatic common bile duct injury manifesting 3 weeks after a car accident, which resulted in a submucosal hematoma simulating bile duct carcinoma. Following operative placement of a T-tube the hematoma in the common bile duct resolved. The case presented supports the theory that the injury is caused by the effect of a shearing force on the inelastic common bile duct (5).

Poor prognosis of patients with intra-abdominal sepsis and hypouricemia.

With uric acid levels of 0.4 to 3.0 milligrams per cent, hypouricemia was noted in 17 patients with intra-abdominal sepsis. This was associated with a fivefold to sixteenfold increase in the urate clearance and uric acid to creatinine clearance ratios. The number of deaths in the 17 patients with hypouricemia is 14 versus 20 for the overall group of 111 patients studied. Two patients had a reversal of the serum uric acid, 24 hour urine uric acid output and uric acid to creatinine clearance ratio, with drainage of the intra-abdominal sepsis. Hypouricemia seems to indicate a poor prognosis in patients with intra-abdominal sepsis.

Short-term and long-term ethanol administration inhibits the placental uptake and transport of valine in rats.

Ethanol ingestion during pregnancy causes a pattern of fetal/neonatal dysfunction called the FAS. The effects of short- and long-term ethanol ingestion on the placental uptake and maternal-fetal transfer of valine were studied in rats. The in vivo placental uptake and fetal uptake were estimated after injection of 0.04 micromol of 14C-valine intravenously on day 20 of gestation in Sprague-Dawley rats. Short-term ethanol ingestion (4 gm/kg) caused a significant reduction in the placental uptake of 14C-valine by 33%, 60%, and 30%, and 31% at 2.5, 5, 10, and 15 min after valine administration, respectively (p less than 0.01), and a similar significant reduction occurred in the fetal uptake of 14C-valine (p less than 0.01). Long-term ethanol ingestion prior to and throughout gestation resulted in a 47% reduction in placental valine uptake (p less than 0.01) and a 46% reduction in fetal valine uptake (p less than 0.01). Long-term ethanol feeding from day 4 to day 20 of gestation caused a 32% reduction in placental valine uptake (p less than 0.01) and a 26% reduction in fetal valine uptake (p less than 0.01). We conclude that both short- and long-term ingestion of ethanol inhibit the placental uptake and maternal-fetal transfer of an essential amino acid--valine. An alteration of placental function may contribute to the pathogenesis of the FAS.