W. Sircus

Breath hydrogen in pneumatosis cystoides intestinalis.

Pneumatosis cystoides intestinalis (PCI) is an uncommon condition of unknown aetiology. Bacterial gas production may be an important aetiological factor, but experimental evidence in humans has been lacking. We have studied breath hydrogen excretion as an index of bacterial gas production in 12 patients with PCI and have shown that four out of five with demonstrable cysts produced unusually high levels of hydrogen while fasting. This abnormality has not been previously reported. One patient showed resolution of PCI after antibiotic treatment. These findings confirm the importance of bacterial gas production in the pathogenesis of PCI.

PSEUDOPOLYPOSIS IN ULCERATIVE COLITIS

Abstract In a retrospective analysis of 399 patients with ulcerative colitis the clinical significance of pseudopolyposis has been examined. 75 patients had pseudopolyposis. Pseudopolyposis was more likely to occur in patients with severe and extensive disease. The outcome of severe attacks of ulcerative colitis in the presence of pseudopolyps was found to be more favourable.

Suture line ulcer after gastric surgery

Abstract 1. 1. Suture line ulcer as a postoperative complication of surgery for peptic ulcer has been recognised fifteen times in fourteen patients; a continuous nonabsorbable seromuscular suture had been used. 2. 2. Undiagnosed, it is a needless cause of pain, dyspepsia, and bleeding. 3. 3. Diagnosis is made by gastroscopy. Alternatively diagnosis is achieved by laparotomy which includes inspection of the suture line. Barium examination is seldom helpful. The acid output is low but not diagnostic. 4. 4. Treatment is by resection of the anastomosis and reconstitution using catgut. 5. 5. The exclusive use of absorbable suture material should abolish this form of recurrent ulcer.

Faecal stasis and diverticular disease in ulcerative colitis.

The incidence of faecal stasis and of diverticular disease has been studied in a group of 399 patients with ulcerative colitis. Sixty-one patients had faecal stasis and 23 patients had diverticular disease. Pathological studies demonstrated an increase in the thickness of the inner spiral muscle in colitis patients with faecal stasis. The thickening was not as great as that seen in diverticular disease. Preliminary studies on the motility patterns in patients with faecal stasis show a higher mean activity in the pelvic colon than in normals but not as great as that seen in diverticular disease. Pressure studies in patients with faecal stasis have shown hypotonia in the proximal colon associated with dilatation. The possible significance of these results is discussed. It is suggested that ulcerative colitis may initiate a motility disturbance which leads to muscle thickening similar to that in diverticular disease. Diverticula associated with ulcerative colitis are usually not involved in the mucosal inflammatory process.

Arthropathy, ankylosing spondylitis, and clubbing of fingers in ulcerative colitis

In a retrospective study of 399 patients with ulcerative colitis, 27 patients had colitic arthritis, 17 had ankylosing spondylitis, and 20 had clubbing of the fingers. Colitic arthritis and ankylosing spondylitis were not related to severity, extent of involvement, or duration of colitis. A significant association between colitic arthropathy and other complications of ulcerative colitis, such as pseudopolyposis, perianal disease, eye lesions, skin eruptions, aphthous ulceration, and liver disease has been demonstrated. The outcome of the first referred attack of colitis in the presence of colitic arthritis and ankylosing spondylitis remained uninfluenced. Clubbing of fingers was related to severity, extent of involvement, and length of the history of colitis. A significant association between clubbing of the fingers and carcinoma of the colon, pseudopolyposis, toxic dilatation, and arthropathy has been shown. The frequency of surgical intervention in patients with clubbing was higher but the overall mortality was not significantly different from the patients without clubbing.

SCINTILLOGRAPHY IN THE DIAGNOSIS OF PANCREATIC DISEASE

Abstract [ 75 Se]-methionine at doses of 3 μC per kg. intravenously has been used to scan the pancreas in eighty patients with known or suspected pancreatic disease, or in whom it was necessary to try to exclude a pancreatic lesion. Total-body radiation with this procedure will not exceed 1.3 r. The results were compared with surgical and other evidence. Of the 76 successful scans 37 were normal (including 3 falsenegatives) and 39 were abnormal (6 of them were falsepositives). In twenty patients hormone-stimulated tests of pancreatic function were done: the results were the same in sixteen comparisons. Scanning has proved a useful aid in the diagnosis of pancreatic disease and in the exclusion of the pancreas in the search for intra-abdominal lesions. In conjunction with clinical assessment and other laboratory and radiological techniques a high measure of accuracy of diagnosis in pancreatic diseases was obtained. By this means the number of exploratory laparotomies in patients without pancreatic disease should be reduced.