Robert H. Resnick

A Controlled Trial of Colon Bypass in Chronic Hepatic Encephalopathy

Summary Ninety-two cirrhotic patients with chronic portal-systemic encephalopathy were considered for entry into a prospective controlled trial of colonic exclusion. Of this number 38 subjects were operable and subsequently randomized into surgical and medical groups. Selection for the study favorably influenced survival because of the rejection of patients with advanced liver failure. Long term mortality experience was similar for the operated and medically treated series in spite of an immediate 26% surgical fatality rate. Preliminary observations of living randomized patients show that colonic exclusion substantially reduces the need for conventional medical treatment of hepatic encephalopathy, but surgery has provided no advantage in terms of over-all rehabilitation. The late occurrence of hemorrhage from bleeding stomal varices renders the operation hazardous in patients who have not received a prior portacaval shunt.

Chemical and histologic demonstration of hydrochloric acid-induced release of serotonin from intestinal mucosa.

Summary Reduction of the serotonin content of the upper small intestine of the rat and degranulation of argentaflin cells were produced by perfusion with 0.1 N hydrochloric acid in physiologic amounts. A small fraction of intestinal 5-hydroxytryptamine was recovered intraluminally, which indicated a release phenomenon. It is suggested that acid-induced serotonin release may occur under physiologic circumstances.

Stimulation of Gastric Secretion in Man by a Serotonin Antagonist

Summary The administration of the serotonin antagonist, 1-methyl- d -lysergic acid butanolamide bimaleate (UML-491), to peptic ulcer patients produced striking elevations in gastric secretion of hydrochloric acid, both during the basal state and during stimulation with histamine. The prior infusion of the serotonin precursor, 5-hydroxytryptophan, inhibited the stimulatory effect during the basal state. The possibility that endogenous serotonin may have an inhibitory influence on gastric secretory function is considered.

Serotonin Metabolism in Paralysis Agitans.

Summary Urinary excretion of 5-hydroxyindole compounds before and after 5-hy-droxytryptophan infusion was studied in paralysis agitans and a control group of other neurological disorders. The findings appear to rule out a systemic defect of serotonin metabolism associated with basal ganglia dysfunction in these patients. However, a localized biochemical or physiological lesion within the central nervous system involving 5-hydroxyindoles remains a speculative possibility.

Severe alcoholic hepatitis in a hypothyroid patient

A treated hypothyroid patient with chronic alcoholism stopped replacement therapy with the onset of heavy drinking. The resulting hypothyroid state did not protect against an eventually fatal termination of acute alcoholic liver disease. Unlike the controlled trials of anti-thyroid therapy for alcoholic hepatitis, this experience simulates the animal experiments suggesting a hypermetabolic mechanism in alcohol hepatotoxicity. The outcome in this instance, however, is not supportive of this hypothesis.