In 150 patients with undefined biliary pain after cholecystectomy, responses to morphine were compared with responses to morphine combined with neostigmine. The relationship between rises in plasma levels of aspartate aminotransferase (AST) after morphine or morphine-neostigmine and sphincter of Oddi motility as assessed by endoscopic manometry was also examined. When compared with morphine-neostigmine, patients given morphine alone showed a similar frequency (30% versus 33%) of increases in plasma levels of AST (greater than twice the upper limit of the reference range) but had less abdominal pain and a lower frequency of similar increases in plasma levels of amylase (4% versus 25%). Of 92 patients who consented to endoscopic manometry of the sphincter of Oddi, satisfactory manometric records were obtained in 84, 31 with and 53 without increases in AST after morphine or morphine-neostigmine. Those showing rises in AST had a higher frequency of abnormal manometric records (81% versus 57%, P = 0.025), higher basal pressures in the sphincter of Oddi (P = 0.0001) and higher pressures within ducts (P = 0.02). There was a significant correlation between sphincter basal pressures and intraduct pressures (r = 0.51, P less than 0.001). Rises in plasma AST after morphine are similar to those after morphine-neostigmine and are influenced by, or linked to, factors which determine sphincter basal pressures and intraduct pressures.

Abdominal Pain↗

PubMedDate not supplied

Oesophageal and ileal ulceration in Behçet's disease.

Over a six-year period a Caucasian girl with chronic neutropaenia developed recurrent mouth ulceration, genital ulceration, ileitis and deep ulcers involving the upper oesophagus. These features constitute an incomplete form of Behçet's disease with the rare manifestation of oesophageal ulceration and the previously unreported association with chronic neutropaenia.

Behcet Syndrome↗

PubMedDate not supplied

Metabolic phenotypes and colorectal neoplasia.

It now appears likely that the development of colonic adenomas and carcinomas involves a series of steps in which environmental or endogenous carcinogens induce or promote neoplasia through the accumulation of multiple, specific genetic mutations. Genetic predisposition to this process may take the form of inherited defects in control of cellular proliferation as in familial polyposis coli, or genetically determined polymorphism which affects enzyme activities relevant to the production or detoxication of carcinogens. Genetic effects may also influence levels of hormones and/or their target cell receptors which regulate the metabolic and proliferative activity of colonocytes. This review highlights data suggesting a role for polymorphism associated with xenobiotic acetylation, hydroxylation, and conjugation with glutathione in the metabolism of potential carcinogens, as well as for dehydroepiandrosterone in the metabolic control of cell proliferation. The study of genetically determined polymorphism in colorectal cancer may provide new insights into the epidemiology of cancer and result in new methods for the detection of higher risk groups.

Acetylation↗

PubMedDate not supplied

Responses to cholecystokinin octapeptide in patients with functional abdominal pain syndromes.

Clues to the pathogenesis of functional pain syndromes may be derived from the study of stimuli that precipitate or aggravate symptoms. In this study, cholecystokinin octapeptide (CCK-8, 0.06 microgram/kg) and placebo were given by intravenous infusion (5 min) in random order to control subjects and four groups of patients with unexplained abdominal pain. Induction of pain and nausea were assessed by linear analogue scales while sympathoadrenomedullary responses were assessed by serial changes in plasma concentrations of noradrenaline, adrenaline and dopamine. Scores for pain and nausea were low after infusion of placebo. After infusion of CCK-8, pain scores were significantly higher in patients with spontaneous pain than in control subjects, but significant increases in nausea were restricted to patients with irritable bowel syndrome and a subgroup of patients with pain after cholecystectomy. Although some groups showed increases in plasma concentrations of catecholamines after the infusion of CCK-8, the size of these increases was neither consistent among patients within each group nor predictive of scores of pain and nausea in individual subjects. Pain during the infusion of CCK-8 was a feature common to patients with diverse functional pain syndromes, and did not appear to be attributable to activation of the sympathetic nervous system.

Abdominal Pain↗

PubMedDate not supplied

Intestinal pseudo-obstruction, type 1 anti-neuronal nuclear antibodies and small-cell carcinoma of the lung.

Intestinal pseudo-obstruction is a rare paraneoplastic manifestation of small-cell carcinoma of the lung. This report documents a further case associated with neuronal degeneration of enteric neural plexuses and a high serum titre of immunoglobulin G (IgG) type 1 anti-neuronal nuclear antibodies (ANNA-1).

Aged↗

PubMedDate not supplied

Glutathione concentrations and glutathione S-transferase activity in human colonic neoplasms.

Tissue concentrations of glutathione (GSH) and the activity of glutathione S-transferases (GST) are relevant to the inactivation of a variety of xenobiotics including carcinogens and anti-neoplastic drugs. In this study, GSH concentrations and GST activity were determined in 25 adenomatous polyps removed at colonoscopy, and in cancer and uninvolved 'normal' mucosa from 58 operative specimens containing colon cancer. We also examined the relationship between GSH concentrations, GST activity and rates of cell proliferation as assessed by flow cytometry. Concentrations of GSH were significantly higher in adenomas (P = 0.001) and cancer (P = 0.001) than in uninvolved mucosa while GST activity was significantly higher in cancer (P = 0.007). There was a positive relationship between GSH concentrations and GST activity in adenomas (P = 0.001) but not in uninvolved mucosa (P = 0.06) or cancer (P = 0.4). Concentrations of GSH and GST activity were independent of results from flow cytometry. The higher concentrations of GSH in colonic neoplasms and the raised activity of GST in cancer may contribute to their resistance to anti-neoplastic drugs.

Adenoma↗

PubMedDate not supplied

How safe is endoscopic sphincter of Oddi manometry?

The safety of endoscopic manometry of the sphincter of Oddi was evaluated in a prospective survey of 158 consecutive procedures in 126 patients with either unexplained pain after cholecystectomy or idiopathic recurrent pancreatitis. The only complication was that of pancreatitis which was defined as the development of abdominal pain in association with a plasma amylase above the reference range. This occurred in 13 patients (8%) and was more frequent (P = 0.001) when the indication for the procedure was idiopathic recurrent pancreatitis (29%) than unexplained pain (6%). Pancreatitis was also more frequent (P = 0.02) in patients with abnormal manometry (14%) than in those with normal manometry (3%) and occurred at highest frequency (50%) in a subgroup of patients with idiopathic recurrent pancreatitis and sphincter stenosis (high sphincter basal pressure). All episodes of pancreatitis were mild with a median increase in hospital stay of 2 days; no patients died. The risk of pancreatitis after endoscopic manometry is relatively low but increases in patients with abnormal sphincter manometry, particularly those with idiopathic recurrent pancreatitis.

Abdominal Pain↗