Walter R. Thayer

Possible role of Mycobacteria in inflammatory bowel disease: II. Mycobacterial antibodies in Crohn's disease

An unclassifiedMycobacterium species has been isolated from two patients with Crohns disease (CD). Antibodies to the unclassified mycobacteria cross-reacted withMycobacterium paratuberculosis. Because of this cross-reactivity, an enzyme-linked immunosorbent assay (ELISA) was used to examine the sera of inflammatory bowel disease (IBD) patients, both CD (N=56), and ulcerative colitis (UC) (N=34), for antibodies toM. paratuberculosis, Mycobacterium kansasii, andMycobacterium tuberculosis. Controls consisted of healthy, PPD-negative individuals (N=67), and from PPD-positive patients (N=41). Eighteen resected CD patients were also examined. CD patients had a statistically significant increase in antibody titer (P=0.0003) toM. paratuberculosis compared to healthy controls. Although patients with positive PPD had elevated titers to this organism, the positive response of CD patients was not related to PPD responsiveness, area of involvement in the gut, nor to activity of the disease process.

Computed normal values for peak acid output based on age, sex and body weight

The value of gastric analysis in the clinical management of patients with duodenal ulcer disease has been limited by lack of information on the expected normal gastric acid production following maximal stimulation. A table of peak acid outputs utilizing the augmented histamine test and based on age, sex and body weight of the individual was devised using the method of least squares.Results of the peak acid output in 64 patients with proven duodenal ulcer and in 38 normal controls, when compared to the computed normal values based on age, sex and body weight, revealed that 90% of patients with duodenal ulcer fell outside the expected normal range, and 92% of the normal subjects fell within the computed normal range. It is felt that these tables are helpful in recognizing individuals with duodenal ulcer or its diathesis.

The use of “medical by-pass” in the therapy of Crohn's disease: Report of a case

The treatment of Crohns disease complicated by perianal fistulas, abscesses, and ulcerations can be one of the most difficult tasks to confront a physician. Medical management, including the use of steroids and sulfa drugs, is often unsuccessful (1). Surgery also has been relatively unsuccessful because of the high incidence of recurrence (2) and frequent postoperative complications (3, 4). Recently, however, several reports have suggested surgical bypass of the diseased bowel (5, 6, 7). These surgically bypassed loops of large intestine have shown evidence of healing, and reanastomosis has occasionally been successful (7). We recently had the opportunity to use a medical bypass, utilizing an oral liquid elemental diet in a young boy with Crohns disease of the ileum and colon complicated by a large perianal ulceration. The dramatic results obtained in this case prompted this brief report.

Skin test reactivity in inflammatory bowel disease in the United States and Czechoslovakia.

Inflammatory bowel disease (IBD) patients in the United States of America (USA) and Czechoslovakia (CSSR) were categorized by clinical, pathological, and radiological criteria as having Crohns disease (CD) or ulcerative colitis (UC) and were tested with five skin test antigens [Candida, mumps, purified protein derivative (PPD), streptokinase-streptodornase (SK-SD), and trichophytin] at two different dilutions in an attempt to elicit some evidence of anergy. No significant differences were encountered between the USA and CSSR populations or between any patient group and its controls.

A negative search for four infectious agents in inflammatory bowel disease.

Diseased resected portions of intestine from patients with inflammatory bowel disease were examined by chicken embryo inoculation for the presence of chlamydia and histologically for the presence of chlamydia, intracellular campylobacters, Tyzzers bacilli, and cryptosporidia. Chlamydia were not isolated from any of the seven colon specimens tested and chlamydia, intracellular campylobacters, Tyzzers bacilli, and cryptosporidia were not demonstrated in 39 sections of colon and ileum from 16 IBD patients.: Diseased resected portions of intestine from patients with inflammatory bowel disease were examined by chicken embryo inoculation for the presence of chlamydia and histologically for the presence of chlamydia, intracellular campylobacters, Tyzzers bacilli, and cryptosporidia. Chlamydia were not isolated from any of the seven colon specimens tested and chlamydia, intracellular campylobacters, Tyzzers bacilli, and cryptosporidia were not demonstrated in 39 sections of colon and ileum from 16 IBD patients.

Inhibition of glutethimide absorption

Three dogs with Thiry-Vella fistulas were perfused with 0.6–1.2 g of glutethimide at pH 6 and pH 9 in an attempt to devise a more effective means of removing glutethimide from the body. The higher pH increased the hydrolysis of glutethimide to 4-ethyl-4-phenyl glutaramic acid (EPG), a non-absorbable hydrolysate. However, even when allowances were made for this effect, decreased absorption was apparent. No significant functional or histological changes were noted in the intestine perfused with the higher pH solutions. These results suggest that intestinal perfusion or gastric lavage with a high pH solution would be an alternative means to treat glutethimide overdose.ZusammenfassungZur Auffindung einer wirksameren Methode zur Entfernung von Glutethimid aus dem Körper werden Thiry-Vella-Fisteln an drei Hunden mit 0,6–1,2 g Glutethimid bei pH 6 und pH 9 durchströmt. Der höhere pH beschleunigte die Hydrolyse von Glutethimid zu 4-Äthyl-4-phenylglutarsäure, einem nicht-resorbierbaren Hydrolyseprodukt. Selbst unter Berücksichtigung dieses Effektes war die Resorption vermindert. Bei der Perfusion mit Lösungen des höheren pH traten keine wesentlichen funktioneilen oder histologischen Veränderungen im Darm auf. Die Ergebnisse deuten darauf hin, daß Intestinalspülung oder Magenspülung mit Lösungen von hohem pH eine Alternativmethode zur Behandlung der Glutethimid-Vergiftung darstellen.

Hemochromatosis associated with chronic cimetidine therapy

We report a patient in whom hemochromatosis with high transferrin saturation developed during long-term cimetidine administration. Prior reports have noted impaired iron absorption to be associated with short-term cimetidine use. The effect of chronic cimetidine administration on iron absorption and metabolism has not been studied. We believe this to be the first, and so far the only report of increased iron absorption with long-term cimetidine use.

Interference with glutethimide (doriden) absorption by altering intraluminal pH of the small bowel in dogs

consisted of three rats, weighing 200 Gm, and 6 cm of jejunal loop was perfused for different time intervals, taking utmost care to keep an intact blood supply to the segment. In the control groups, the loops were perfused with 2 ml of isotonic saline solution containing 5 mg of glucose. About 60~ ofperfused glucose was absorbed from the loop in 5 min., and linear increase in absorption was observed during the 20 minutes perfusion. Elimination of sodium from the perfusate was followed by almost total inhibition of the absorption. Six consecutive 15 rain. perfusions in the same loop did not show any decrease in the absorption activity of the loop. The deduction of sodium content of the perfusates to a half of the control did not change the rate of glucose absorption. When a 150 mos/L of saline was replaced with the same osmole of lactulose about 40% deduction in glucose absorption was seen in 20 min. perfusion. 7 mos of an amino acid mixture, with amino acid composition resembling to mothers milk, was perfused with 2 ml of isotonic saline. About 50 to 90% of the acids were absorbed in 10 min. and more in subsequent 20and 30 min. perfusions. When a half of NaC1 was replaced with lactulose, about 10% deduction in the amino acid absorption wsa seen in 20 minutes perfusion. No histological change was observed in the loops after the perfusions of lactulose. It was concluded that lactulose has some inhibiting activity on the absorption of glucose and amino acids from the jejunal loop.