Julian M. Ruffin

Scleroderma Presenting as the Malabsorption Syndrome: A Case Report

Summary A patient with scleroderma whose presenting problem was diarrhea and malnutrition and whose disease seemed to be confined to the small intestine is reported.

The Evaluation of Pancreatic Function by Use of I131 Labeled Fat

Summary A study using an I 131 labeled fat meal has been carried out on 30 patients with proven pancreatic disease. Measurements were made of the per cent of blood radioactivity at four, five, and six hours following the test meal, and on a subsequent 48-hour collection of feces. The test yielded information of diagnostic value in 10 of 12 patients found to have chronic relapsing pancreatitis, in 17 of 18 patients with pancreatic carcinoma. In the absence of small bowel disease, pyloric obstruction, or gastric surgery, an impairment of fat absorption using this technique is strongly suggestive of pancreatic disease. The method can further be used as a laboratory aid in evaluating substitution therapy in patients with pancreatic insufficiency.

I131 blood levels correlated with gastric emptying determined radiographically. I. Protein test meal.

Conclusions 1. A characteristic and reproducible curve of radioisotope blood levels was obtained in normal humans and normal dogs following an I131 labeled protein test meal. 2. Radiographic determination of gastric emptying is necessary for the proper interpretation of data. 3. Delayed gastric emptying significantly altered the radioisotope blood levels. 4. Fainting and change in position may alter radioisotope blood levels.

Coexistent Carcinoma Of The Stomach And Hypertrophic Gastritis: Report of a Case with Review of the Literature

Summary The differential diagnosis between giant hypertrophic gastritis, gastric carcinoma and lymphosarcoma 29 is difficult. There are no diagnostic clinical or laboratory findings in the patients who developed gastric carcinoma to distinguish them from the larger group with uncomplicated hypertrophic gastritis. Giant hypertrophic gastritis alters the gastric mucosal pattern to such an extent that further alteration by superimposed carcinoma is difficult to detect roentgenologically. Gastroscopy is of value 30, 31 but even with gastroscopy it is frequently impossible to differentiate hypertrophic gastritis from carcinoma32. The early recognition of the development of carcinoma in hypertrophic gastritis must still depend on a high index of clinical suspicion, combined with repeated gastroscopic and roentgenologic observation.

Use of I131 Labeled Oleic Acid in Study of Gastrointestinal Function.

Summary and Conclusion 1. Constant and reproducible curves of blood radioactivity levels are found in normal humans and dogs after an oleic acid test. 2. Following pancreatectomy and induced pancreatitis in dogs, the curves obtained with oleic acid test were within normal range while those obtained with triolein were depressed.

Effect of antibiotic therapy on gluten-sensitive enteropathy

SummaryIn 2 cases of gluten-sensitive enteropathy, clinical recovery, partial in one and complete in the other, followed the administration of a gluten-free diet. When challenged with gluten both patients had a pronounced relapse. After the prolonged administration of tetracycline both patients have resumed a normal diet and show no effect when challenged with gluten. If these results can be confirmed in other patients, there must be a factor other than gluten in the so-called gluten-sensitive enteropathy.

EFFECT OF DEPEPSEN IN THE TREATMENT OF PEPTIC ULCER

The essential features of conventional medical management of peptic ulcer are a bland diet with frequent feedings, antacids and drugs that inhibit gastric secretory or motor activity. Although such therapy is highly effective in most patients with ulcers, recurrences are common in spite of strict adherence to a prescribed routine and many patients require surgery because of complications or severe recurrences. In seeking a more effective form of medical therapy, most investigators have been concerned with the neutralization or suppression of hydrochloric acid. It has been shown that certain sulfated polysaccharides inhibit the proteolytk action of pepsin and prevent the development of peptic ulceration in the Shay rat.* The following is a report of our experience using such a compound (SN-263) in an attempt to promote healing, to prevent a recurrence of ulcer, and to study its effect upon the clinical course of peptic ulcer disease in patients.

Effect of Pre-Feeding of Fat on I131 Triolein Absorption in Subtotal Gastrectomy Patients

Summary The I131 tagged triolein test was performed in 12 patients with subtotal gastrectomy (Billroth II) in the fasting state and 30 minutes after oral ingestion of a fat meal. In the fasting state, increased fecal radioactivity was observed in 10 patients. When lipid was pre-fed, there was a significant decrease in radioactive content of stool and increase in blood radioactivity. The data support the concept that the defect exhibited by these patients is primarily digestive and suggest that the major disturbance is one of inadequate mixing of labeled triglyceride with the upper intestinal contents necessary for proper lipid digestion.

The effect of inflation of the stomach upon the gastroscopic picture

1. Inflation of the stomach effects marked alterations in the gastroscopic picture. 2. Hypertrophic folds can be effaced by inflation. 3. In the dog, the typical picture of “atrophic gastritis” can be produced at will by inflation. 4. In some instances in man, apparently normal folds will disappear under pressure and blood vessels will be seen. 5. The diagnosis of chronic gastritis by means of the gastroscopic picture should be the subject of further critical studies.

The occurrence of gastritis as diagnosed by gastroscopy in gastric neuroses

1. Chronic gastritis, as diagnosed by gastroscopy, is not common in North Carolina. 2. The symptoms of most patients usually classified as having gastric neuroses cannot be explained on the basis of a chronic gastritis. 3. Hemorrhagic, or pigment spots, are common (25%), but their significance has not been determined.