William T. Foulk

A Study of the Motility Patterns and the Basic Rhythm in the Duodenum and Upper Part of the Jejunum of Human Beings

Summary 1. Balloon-photokymographic recordings of duodenal and upper jejunal motility have been made in 21 normal persons, 5 patients who had duodenal ulcer and 5 who had chronic ulcerative colitis. 2. The waves seen in the records were classified in two types designated I and III. Measurements of the dimensions of these waves and their frequency of occurrence were made and the percentage of the observation time during which activity was present was also determined in each record. 3. In all of the records, periods of activity alternated with periods of quiescence. When the normal persons and the patients fasted overnight, motility was present 60 to 70 per cent of the time. This percentage was reduced in normal persons to 34 by a fast of 24 to 36 hours. During the active periods, type I waves occurred almost continuously and type III waves were seen about half of the time. 4. Bursts of type I waves in rhythmic sequence occupied about 2 per cent of the tracings from normal persons and from patients who had duodenal ulcer. In the patients who had ulcerative colitis the incidence exceeded 6 per cent. In all of the persons studied, the mean rate of the type I waves when in rhythmic sequence was 11 per minute and the variations around this mean were less than 1 per minute. This rate of rhythmic type I waves has been presented as representing the basic rhythm of the small intestine.

Studies of Sulfobromophthalein Sodium (BSP) Metabolism in Man. III. Demonstration of a Transport Maximum (Tm) for Biliary Excretion of BSP

Convincing direct evidence that in dogs the secretion of BSP into bile is limited by a maximal rate, similar to the transport maximum (Tm) for certain substances secreted by the renal tubules, has been provided by Wheeler and co-workers (1, 2). They also showed that the Tm for BSP may be estimated from observations on peripheral plasma concentrations during different rates of constant infusion without resort to bile collections, hepatic venous sampling, or measurement of hepatic blood flow. The colorimetrically determined maximal output of BSP in dog bile was equal, on the average, to 87.57o% of the estimated Tm. The existence of a rate-limited BSP transport mechanism in man was inferred from the achievement of a state in which the hepatic removal rate was independent of the absolute plasma concentration and related only to the rate of change of plasma concentration. Utilizing the constant-infusion technic, estimations of Tm in man, analogous to those in the dog, have been reported by Wheeler and his group and by workers in other laboratories as well (3, 4). The experiments reported herein were performed on a person with complete obstruction of the distal common bile duct due to cancer of the pancreas; a T-tube had been placed in his bile duct without an attempt to remove the obstructing lesion. This circumstance provided an opportunity to obtain evidence supporting the concept of a transport maximum for biliary excretion of BSP in man, even though there was mild (presumably secondary) hepatic damage.

Identification of extrahepatic bilirubin monoglucuronide and its conversion to pigment 2 by isolated liver.

Summary and Conclusions The pigment obtained by reversed-phase partition chromatography from the plasma of the hepatectomized dog has been shown to be bilirubin monoglucuronide (pigment 1). In the experiments performed, pigment 1 was of extrahepatic origin. The isolated perfused rat liver converts bilirubin monoglucuronide to bilirubin diglucuronide and excretes the diconjugate in the bile.

COLUMN CHROMATOGRAPHY OF BILE, SERUM, AND URINE AFTER INTRAVENOUS ADMINISTRATION OF SULFOBROMOPHTHALEIN

Summary The chromatographic fractionation of sulf obromophthalein (Bromsulphalein) exereted in rat bile, reported by Krebs and Brauer, together with alterations in the excretion pattern in experimental liver injury are confirmed. The dye when injected intravenously was excreted in the bile as at least three compounds, of which two (compounds II and III) are chromatographically distinct from Bromsulphalein. The chromatographic fractionation of Bromsulphalein excreted in the bile of Gunnstrain rats is closely similar to that occurring in normal animals. This is indirect supporting evidence against a glucuronide structure for compounds II and III. Distinctive chromatographic patterns of Bromsulphalein may be observed in the serums of normal rats, rats with bile ducts ligated, rats with livers damaged by breathing of carbon tetrachloride. Little metabolic transformation of Bromsulphalein is found in the serum of hepatectomized rats. Three principal components of Bromsulphalein, which may be shown by chromatographic fractionation and which have independent rates of excretion, are present in human bile. In the bile of a patient with severe liver cell failure, the modification of the excreted Bromsulphalein was less than in the others. Chromatography of dye extracted from the serum and urine of jaundiced patients has yielded suggestive results which warrant further investigation.

Cholecystitis in the Elderly Patient

Chronic cholecystitis, with cholelithiasis and choledocholithiasis, and acute cholecystitis occur more frequently in elderly persons than in younger ones. Because of the serious and often fatal complications which these conditions cause, cholecystectomy should be advised for chronic cholecystitis with stones whenever the condition exists. Elderly patients for whom operation is not strongly contraindicated tolerate simple cholecystectomy well.Acute cholecystitis usually is best managed by early surgical treatment.The most common condition requiring abdominal surgical treatment in the aged is disease of the biliary tract.