Simmy Bank

Chronic pancreatitis in the Western Cape.

A review of 1,006 patients studied over a 12-year period underlines the importance of alcohol in calcific, chronic and, to a lesser extent, acute pancreatitis. The racial incidence, natural history an

Gastric emptying after vagotomy and pyloroplasty: Relation to some postoperative sequelae

Emptying of liquids from the stomach was studied in 19 patients who had had a vagotomy and pyloroplasty and the results compared with 12 patients with duodenal ulcers and 9 patients with normal upper gastrointestinal tracts. The patterns of gastric emptying after vagotomy and pyloroplasty was found to consist of a very rapid initial emptying phase followed by emptying at a rate rather faster than in the other two groups. There was no difference in the gastric emptying of patients with duodenal ulcer and those with a normal gastrointestinal tract. Patients who complained of postprandial fullness and dumping after vagotomy and pyloroplasty had extremely rapid initial gastric emptying, more than half the test solution leaving the stomach almost immediately. Three patients who had postoperative gastric ulcers, 2 patients with vomiting since operation and 1 with postvagotomy persistent diarrhea showed a starting index and half-life similar to those of asymptomatic postoperative patients and only minor differences in the emptying time. Serial tests at varying intervals during the weeks after operation showed the gastric emptying of liquids was faster than normal from the earliest postoperative test. Over the succeeding weeks, emptying became still faster and probably reached a static state in 2 or 3 months.Emptying of liquids from the stomach was studied in 19 patients who had had a vagotomy and pyloroplasty and the results compared with 12 patients with duodenal ulcers and 9 patients with normal upper gastrointestinal tracts. The patterns of gastric emptying after vagotomy and pyloroplasty was found to consist of a very rapid initial emptying phase followed by emptying at a rate rather faster than in the other two groups. There was no difference in the gastric emptying of patients with duodenal ulcer and those with a normal gastrointestinal tract. Patients who complained of postprandial fullness and dumping after vagotomy and pyloroplasty had extremely rapid initial gastric emptying, more than half the test solution leaving the stomach almost immediately. Three patients who had postoperative gastric ulcers, 2 patients with vomiting since operation and 1 with postvagotomy persistent diarrhea showed a starting index and half-life similar to those of asymptomatic postoperative patients and only minor differences in the emptying time.Serial tests at varying intervals during the weeks after operation showed the gastric emptying of liquids was faster than normal from the earliest postoperative test. Over the succeeding weeks, emptying became still faster and probably reached a static state in 2 or 3 months.

Alpha-chain disease in subsaharan Africa

The first 2 cases of alpha-chain disease in subSaharan Africa are reported in 2 young mulatto patients with malabsorption, a prominent plasma cell infiltrate of the lamina propria of the small bowel, and abdominal lymphoma. The reticulum cell lymphoma had involved mesenteric nodes in both patients as well as the small bowel in one of them. Abnormal alpha-chian disease protein was demonstrated in their sera; this disappeared after radiotherapy and steroid therapy and was associated with a clinical remission. The histogenic relation of the plasmacytic infiltrate and the malignant lymphoma are discussed.The first 2 cases of alpha-chain disease in subSaharan Africa are reported in 2 young mulatto patients with malabsorption, a prominent plasma cell infiltrate of the lamina propria of the small bowel, and abdominal lymphoma. The reticulum cell lymphoma had involved mesenteric nodes in both patients as well as the small bowel in one of them. Abnormal alpha-chian disease protein was demonstrated in their sera; this disappeared after radiotherapy and steroid therapy and was associated with a clinical remission. The histogenic relation of the plasmacytic infiltrate and the malignant lymphoma are discussed.

Pancreatic exocrine responses to test meals of varying compositions in man.

The effect of test meals containing different proportions of fat, protein, carbohydrate, water, or sodium chloride on exocrine pancreatic secretion was investigated in 9 control subjects. A total of 34 test meals were studied. Volume measurements were of no significance in the different test meals as there were marked fluctuations. The pH of duodenal aspirate remained fairly constant throughout the test. With very few exceptions there were no statistically significant differences between the pancreatic amylase, trypsin, and lipase concentrations following the various test meals. This study shows that different types of food given orally stimulate exocrine pancreatic secretion in a similar way. The results confirm previous reports, that there is no adaptive response of pancreatic enzymes to a single administration of different types of food.

Dissecting microscopy of the rectal mucosa in health and disease

SummaryThe dissecting-microscopic appearance of the human rectal mucosa was studied in 147 biopsy specimens. The normal mucosa is divided into mucosal units by a “honeycomb” pattern of the rectal microvasculature, the center of each unit containing a refractile “pit” which may represent the mouth of the rectal crypt. The changes occurring in ulcerative colitis were graded according to severity of disturbance of the vascular channels, ranging from dilatation, neoformation and tortuosity of the individual vessels to complete disorganization of the “honeycomb” pattern. The vascular and “pit” changes in ulcerative colitis and other diseases of the rectum are described. The pathogenesis of the dissecting-microscopic changes is discussed in relation to the normal vascular pattern of the human colonic mucosa.

The lymphatics of the intestinal mucosa. A clinical and experimental study.

SummaryJejunal biopsy specimens from 77 control subjects and 232 patients with intra- and extra-abdominal disease were reviewed with regard to the frequency with which mucosal lymphatic channels were visualized on routine microscopy. An attempt was made to measure their approximate size. The difficulties in differentiating lymphatics from empty blood vessels and villous edema is discussed.It was concluded that to be certain of abnormal mucosal lymphatic dilatation, the lymphatics should be greater than normal size and should be present in several villi. Only 3 patients in this series exceeded the range found in the normal control; the lymphatic block appeared to be at a lymph-land level in 2 and at a level of the muscle layer of the bowel wall in 1. It is suggested that electron microscopy and multiple biopsy specimens are necessary to be certain of lesser degrees of lymphatic dilatation, particularly those less than 10 µ in diameter.The possible reasons for the occurrence of protein-losing enteropathy without lymphangiectasia are presented, and the difficulty in producing lymphangiectasia experimentally in the dog is demonstrated.Jejunal biopsy specimens from 77 control subjects and 232 patients with intra- and extra-abdominal disease were reviewed with regard to the frequency with which mucosal lymphatic channels were visualized on routine microscopy. An attempt was made to measure their approximate size. The difficulties in differentiating lymphatics from empty blood vessels and villous edema is discussed. It was concluded that to be certain of abnormal mucosal lymphatic dilatation, the lymphatics should be greater than normal size and should be present in several villi. Only 3 patients in this series exceeded the range found in the normal control; the lymphatic block appeared to be at a lymph-land level in 2 and at a level of the muscle layer of the bowel wall in 1. It is suggested that electron microscopy and multiple biopsy specimens are necessary to be certain of lesser degrees of lymphatic dilatation, particularly those less than 10 µ in diameter. The possible reasons for the occurrence of protein-losing enteropathy without lymphangiectasia are presented, and the difficulty in producing lymphangiectasia experimentally in the dog is demonstrated.