Cholecystokinin and secretin prevent the intestinal mucosal hypoplasia of total parenteral nutrition in the dog.

Because the pancreas undergoes involutional changes during total parenteral nutrition (TPN) and because pancreatico-biliary secretions are trophic to the intestine, we studied jejunal and ileal structure and function and exocrine pancreatic function before and after 6 weeks of TPN in two groups of beagle dogs, one of which had TPN alone, the other having TPN plus daily stimulation of pancreatico-biliary secretions with intravenous infusions of cholecystokinin (CCK) and secretin. The injections of 1 U each per kg of body weight per day of CCK and secretin completely prevented the proximal and distal small bowel mucosal hypoplasia which developed in the TPN alone group. They also resulted in significant increases in in vivo galactose absorption (64 mM) per unit length of jejunum and ileum.

Resistance to chenodeoxycholic acid (CDCA) treatment in obese patients with gall stones.

In most patients with radiolucent gall stones who were given chenodeoxycholic acid (CDCA) in doses of 13-15 mg/kg body weight/day the bile became unsaturated in cholesterol, and their gall stones dissolved. The patients whose stones did not dissolve were significantly heavier and fatter than the responders, which suggested that obese patients might be "resistant" to the effects of CDCA. To test this hypothesis, 32 consecutive patients presenting for medical treatment of gall stones had their ideal body weight (IBW) and estimated body fat mass calculated.

Effect of ioglycamide (Biligram) on bile flow and biliary lipid secretion in man.

Twenty-one anicteric patients with a t-tube in situ were studied between the ninth and 11th postoperative days. Eleven patients were given an intravenous infusion of the biliary contrast agent ioglycamide (Biligram), while the other 10 acted as controls. Bile flow was recorded and the biliary concentrations of ioglycamide, bile salt, phospholipid, and cholesterol estimated in the two groups.

Physiological factors influencing serum bile acid levels.

This study defines the effects of fasting (prolongation of an overnight fast for a further four hours), feeding (the response to eating the three main ;solid' meals of the day), and cholecystokinin-induced gallbladder contraction (75-100 units of CCK given as a bolus intravenous injection) on serum individual bile acids in five to eight healthy control subjects. The serum conjugates of the two primary bile acids, cholic and chenodeoxycholic, were measured using sensitive specific radio-immunoassays. During fasting, there was no significant change in the levels of the serum individual bile acids (conjugates of cholate, 1.

Ursodeoxycholic acid treatment of gallstones. Dose-response study and possible mechanism of action.

To determine the optimum dose for the medical treatment of gallstones with ursodeoxycholic acid (U.D.C.

Speed of change in biliary lipids and bile acids with chenodeoxycholic acid--is intermittent therapy feasible?

To see whehter intermittent chenodeoxycholic acid (CDCA) therapy is a potential alternative to continous treatment for gallstone dissolution, the speed of change in bile lipid composition was studied after starting and stopping CDCA therapy. In addition, the relationship between bile lipid composition and the proportions of the bile acids was examined. Bile-rich duodenal fluid was collected twice in the first week and then at approximately weekly intervals for four to six weeks, from six gallstone patients starting 13-15 mg CDCA.

Vitamin C and post-suxamethonium pains.

A double-blind trial of the effects of vitamin C on the frequency, severity and duration of post-suxamethonium pains was performed. Fifty-three patients undergone bronchoscopy received either a placebo or 10 g of vitamin C. No beneficial effect was demonstrated.

The mechanism for small-bowel adaptation in lactating rats.

1. To study the relative contributions of luminal nutrition, bile and pancreatic secretions and hormonal factors in intestinal adaptation, lactation hyperphagia was chosen as a model for increased luminal nutrition, either alone (intestinal transection control group) or in combination with (i) exclusion of bile and pancreatic secretions from the jejunum (by transposition of the jejunum above the Ampulla of Vater) or (ii) exclusion of bile, pancreatic secretions and exogenous luminal nutrition from the jejunum (proximal Thiry-Vella by-pass group). 2.

Effects of oral versus intravenous nutrition on intestinal adaptation after small bowel resection in the dog.

To study the influence of luminal nutrition on the structural and functional adaptive changes which are seen in the residual intestine after partial small bowel resection, quantitative histology, in vitro uptake of 14C l-leucine, mucosal enzyme activities, and in vivo absorption of glucose were studied before and 6 weeks after 50% proximal small bowel resection in 10 greyhound dogs, 5 of which were nourished exclusively by the intravenous route while 5 were pair-fed by mouth. In the orally fed jejunectomized dogs, the ileum became dialed with mucosal hyperplasia, the villus height increased from 796 +/- SEM 26 mum to 1102 +/- 28 mum (P less than 0.001), and there was a corresponding increase in glucose absorption in vivo (milligrams -centimeter of intestine -1min-1) from 5.

Adaptive changes in vitamin B12 absorption in celiac disease and after proximal small-bowel resection in man.

Resection of the proximal small bowel is known to cause mucosal hyperplasia and enhanced absorption in the ileum of experimental animals, but similar adaptive changes had not previously been studied in man. Since intrinsic-factor-bound vitamin B12 (IF-B12) absorption is confined to the ileum, as an index of ileal adaptation, we measured whole-body IF-58 Co B12 absorption in 24 control subjects, in 4 patients after proximal small-bowel resection, and in 9 patients with adult celiac disease (where mucosal damage is often limited to the proximal intestine and spares the ileum). Control subjects absorbed 20.

The value of radiology in predicting gallstone type when selecting patients for medical treatment.

Since medical treatment of gallstones is confined to cholesterol-rich stones, the ability of clinical radiographs to predict gallstone type was tested prospectively by comparing the preoperative radiological appearance of gallstones from 57 unselected patients with cholelithiasis coming to cholecystectomy with the subsequent analysis of the stones both by X-ray diffraction and by chemical techniques. Fifty-two per cent of the patients had 'non-functioning' gallbladders which failed to opacify after at least two contrast examinations and 25 out of 50 had radioopaque stones. Of the 25 patients with radiolucent stones, the stones in 20 ((80%) were predominantly cholesterol in type but radiology was misleading in five; three contained 40-55% calcium salts but were still radiolucent while two were amorphous and contained less than 10% cholesterol by weight on chemical analysis.

Effect of pentagastrin on small bowel structure and function in the rat.

Since chronic pentagastrin stimulates pancreatic and proximal duodenal growth (15), we studied jejunal structure and function following subcutaneous pentagastrin (2 mg-100 g-1 day-1). After 15 days, macroscopic enlargement was confined to the proximal duodenum with a significant increase in wet weight (from 231 +/- SEM 6 to 308 +/- 13 mg) but there was no significant difference in wet and defatted dry intestinal weights, histological measurements of villous height and mucosal thickness or in glucose absorption per unit length of distal duodenum and proximal jejunum. Since chronic pentagastrin causes parietal cell hyperplasia and hypersecretion of gastric acid, the results suggest that the adaptive changes seen in the jejunum after ileectomy are neither mediated by gastrin nor by factors present in gastric secretions.

The control of bile acid pool size: effect of jejunal resection and phenobarbitone on bile acid metabolism in the rat.

In patients with cholesterol gallstones, there is a diminished bile acid pool and the bile becomes supersaturated with cholesterol. Medical treatment has been aimed at re-expanding the pool to improve cholesterol solubility in bile but as yet the factors controlling the size of the bile acid pool' are unknown. Therefore the role of the liver and intestine in controlling bile acid pool size in the rat was studied and the effect of experimental expansion of the pool on bile acid metabolism and bile lipid composition examined.

Liver structure and function in cholelithiasis: effect of chenodeoxycholic acid.

Although, in suitable patients, oral chenodeoxycholic acid (CDCA) dissolves gallstones, the results of recent animal studies suggest that it might be hepatotoxic. Liver function was therefore studied in patients with gallstones before and during treatment with CDCA and liver biopsies were carried out both in patients with cholelithiasis given bile acid therapy and in those who had been given no medical treatment. In 25 patients treated with 0.