William W. Faloon

An experimental malabsorption syndrome induced by neomycin.

Abstract In an attempt to characterize the effect of neomycin upon intestinal absorption, six absorptive parameters have been employed: plasma carotene, urinary d-xylose excretion, serum cholesterol, plasma iron-59 curves, glucose tolerance and urinary excretion of Co 60 -labelled vitamin B 12 . In six patients receiving supplementary carotene, the oral administration of neomycin for six to eight days produced a marked decrease in plasma carotene concentration. Following withdrawal of the neomycin the carotene concentration again rose. Comparison studies with magnesium sulfate catharsis were carried out in three subjects and revealed no fall in carotene levels. One subject receiving castor oil and magnesium sulfate showed a decrease in carotene levels which was less than that observed with neomycin. Iron-59 absorption curves during the administration of neomycin showed decreased absorption, in comparison to control studies, in four of six subjects. The urinary excretion of Co 60 -labelled vitamin B 12 was reduced by 20 to 60 per cent of control figures in four of six subjects. The urinary excretion of d-xylose after the oral ingestion of a test load decreased 35 per cent or more from control values in six of eight subjects during the period of neomycin administration. In four of six subjects so studied, lowered glucose tolerance curves were observed; in three of these the curves became flat during the administration of neomycin. The serum cholesterol concentration fell 19 per cent or more from control levels in six of nine subjects after five to eight days of neomycin therapy. These findings indicate that neomycin is capable of producing a broad spectrum of malabsorptive errors resembling those observed in idiopathic steatorrhea.

Mechanism of Vitamin B12 Malabsorption in Patients Receiving Colchicine

Abstract Intermittent Schilling tests and daily 57Co-labeled vitamin B12 administration and analyses of urinary and fecal radioactivity revealed that colchicine given by mouth decreased vitamin B12 absorption in all except one normal subject, and this effect was greatest when colchicine was delivered by tube into the ileum. Gastric mucosa was histologically unchanged, and gastric-juice intrinsic-factor activity was undiminished as shown by bioassay in subjects with pernicious anemia and by in vitro assay. Colchicine in vitro did not prevent vitamin B12 binding to intrinsic factor or binding of this combination to guinea-pig ileal mucosa. Intestinal hypermotility induced by cascara for comparison with colchicine did not alter 57Co-labeled vitamin B12 urinary excretion, but did yield increased fecal excretion. Colchicine appears to induce reversible vitamin B12 malabsorption by altering the function of ileal mucosa.

McArdle's disease: Metabolic studies in a patient and review of the syndrome

A twenty-two year old man with recurrent stiffness following exercise was found to have chemical and histologic changes consistent with partial deficiency of myopnosphorylase. Muscle biopsy showed increased glycogen and a decrease in glycogen phosphorylase. Ischemic muscle exercise yielded a subnormal increase in venous lactate which was returned toward normal by prior administration of oral fructose or parenteral glucagon but not by oral glucose. Oral alcohol also increased blood lactate but did not enhance potassium uptake. A review of twenty-four reported cases of McArdles disease revealed previously unrecognized major characteristics of this abnormality, including the predominance of exercise intolerance as an early symptom, the occurrence of muscle cramps before age eighteen in the majority of patients and the occurrence of myoglobinuria in approximately half the patients before the age of eighteen. These observations indicate that McArdles disease is probably more common than suspected and exists in mild and unrecognized forms. Confirmation of the diagnosis is achieved by analyzing blood lactate levels after ischemic exercise and determining myophosphorylase content in muscle biopsy specimens.

The hemostatic defect in thrombocytopenia as studied by the use of ACTH and cortisone

Abstract 1.1. Four patients with idiopathic thrombocytopenic purpura and three with purpura and thrombocytopenia associated with leukemia have been studied during ACTH or cortisone therapy. 2.2. The results indicate that these agents induce improvement in vascular resistance which is not necessarily accompanied with increased platelet production. Although complete remission with normal platelet counts, prothrombin utilization and clot retraction occurred in two patients, this was preceded by improvement in vascular resistance in both. In all other patients vascular resistance increased without platelet count changes. 3.3. Administration of adrenocorticotropic hormone or cortisone interferes with neither the occurrence of a spontaneous remission nor remission induced by splenectomy. 4.4. The hematologic changes occurring during ACTH induced remission do not appear to differ from those found during a spontaneous remission. 5.5. The use of adrenocorticotropin or cortisone in thrombocytopenic states has been found to control the hemorrhagic phenomena before splenectomy and may be of use in the acute phase until spontaneous remission occurs. Likewise, patients undergoing relapse after splenectomy may undergo improvement during ACTH or cortisone therapy. These agents also appear to be of value in the symptomatic relief of leukemia patients with thrombocytopenia and hemorrhagic diatheses.

THE EFFECT OF HUMAN SERUM ALBUMIN, MERCURIAL DIURETICS, AND A LOW SODIUM DIET ON SODIUM EXCRETION IN PATIENTS WITH CIRRHOSIS OF THE LIVER.

The relative importance of the serum albumin concentration, portal hypertension, and antidiuretic substances in the formation of ascites and edema in patients with cirrhosis of the liver has not been clarified. There is evidence, however, that each of these factors is important (1-3). In an effort to eliminate the factor of hypoalbuminemia, salt-poor concentrated human serum albumin has been given intravenously. Although the serum albumin concentration may by this means be raised to normal, the edema and ascites have not been consistently relieved (4-7). Moreover, improvement in ascites and edema is observed in some instances with mercurial diuretics or simply by furnishing a nutritious diet alone (8, 9). In an attempt to find an abnormality common to these patients and consistently altered by the apparently unrelated therapeutic agents, the studies of sodium excretion and balance reported here were undertaken.

Malabsorption Syndrome Associated with Intestinal Diverticulosis: Report of a Case with Jejunal Biopsy

Summary A patient is reported in whom defective absorption was observed associated with intestinal diverticulosis. The histologic appearance of the jejunal biopsy was similar to that found in other malabsorptive states. The malabsorption was shown to be reversible by oral tetracycline.

Needle biopsy of the liver: Comparison of initial clinical and histological diagnoses, with a note on postbiopsy mortality in patients with metastatic neoplasm

Abstract 1.1. The admission clinical diagnosis has been compared with the histologic diagnosis in 341 patients undergoing needle biopsy of the liver. 2.2. The initial clinical diagnosis was in error in 30.2 per cent of the cases. 3.3. The histologic diagnosis as established by needle biopsy was proved by laparotomy or autopsy to be in error in eight cases. Errors in diagnosis probably occurred in three additional cases, as demonstrated by cytologic study of ascitic fluid and sputum. 4.4. Five deaths occurred following biopsy. Intraperitoneal hemorrhage was proved in four of these patients. Four deaths occurred in patients with metastatic malignancy, for a biopsy mortality of 12 per cent under these circumstances. 5.5. Needle biopsy of the liver in the presence of suspected malignant disease is hazardous and surgical biopsy under local anesthesia may be a preferable procedure in this situation.

Assessment of jejunoileostomy for obesity— some observations since 1976

In this review, which only partially covers the data available, it is pointed out that the evaluation of the results of jejunoileostomy may depend upon the criteria used by the observers, and disclosure of the true effects of the operation may depend upon the long-term follow-up of the patients. With increasing length of observation, it has become apparent that problems such as vitamin D deficiency, renal stone formation, continued steatorrhea, gallstones, zinc and copper deficiency, and even renal failure may be seen with disturbing frequency. Some of these may be preventable, others may be correctable and, indeed, the overall incidence of genuinely severe problems may, in the long run, be sufficiently low so as to make the benefits of jejunoileostomy outweigh the hazards. The rate of patient satisfaction is high, quality of life is generally improved and psychosocial and economic benefits of jejunoileostomy are apparent. The operation may also be a better alternative than the physical hazards of continuing obesity. Whether or not gastric bypass represents a true improvement over jejunoileostomy will depend upon the conclusions reached after applying to it the same searching scrutiny that is being used to examine the long-term results of jejunoileostomy.

An Evaluation of Risks — Bypass versus Obesity

One of the early lessons that a thoughtful physician learns is that all therapy is an evaluation of risks. In other words, does the treatment, although associated with risks, have a better result t...