Acute pseudo-obstruction of the colon (Ogilvie's syndrome) resulting from combination tocolytic therapy.

We describe a case of colonic pseudo-obstruction occurring in a pregnant patient whose preterm labor was being treated with intravenous magnesium and nifedipine. Sequential colonoscopies were required to manage the recurrent colonic dilations prior to delivery of healthy twins. There was no recurrence after delivery and discontinuation of the tocolytics.

A comparison of omeprazole and ranitidine for duodenal ulcer in South African patients. A multiracial study.

The study was a multicenter double-blind parallel-group comparison of omeprazole, a proton-pump inhibitor, with the H2-receptor antagonist, ranitidine, in 206 patients with duodenal ulcer. There were 145 men and 62 women of mixed racial origin with an average age of 40 years (range 19-76); 63 of them were white, 7 black, 135 coloured and 1 Asian. Each drug was given for four weeks and ulcer healing rate, symptom relief, and adverse events were recorded and compared between treatment groups. Patients received either 20 mg omeprazole once daily in the morning (N = 104) or ranitidine 300 mg once daily at night (N = 106). Healing rates were significantly higher in the omeprazole group than in the ranitidine group at both two weeks (80% vs 52%, P less than 0.001) and four weeks (95% vs 85%, P less than 0.05), using the "per protocol" approach, and these results were confirmed using the "intention to treat" approach. Omeprazole-treated patients reported significantly less daytime epigastric pain (P = 0.02) and heartburn (P = 0.04) after two weeks than ranitidine-treated patients. By four weeks, there were no significant differences in symptom reporting between groups. Both treatments were well tolerated, and there were no serious adverse events.

The value of routine pancreatic iso-amylase measurements in the diagnosis of pancreatitis.

The value of serum pancreatic iso-amylase (Pi) measurements in the clinica diagnosis of pancreatitiss was assessed using a wheat inhibitor kit (Phadebas) and cellulose acetate membrane (CAM) electrophoresis. Wheat inhibition totally suppressed Pi activity in the sera of 3 healthy subjects with substantial Pi bands on electrophoresis. Reference intervals for Pi, salivary iso-amylase (Si) and total alpha-amylase were established from the sera of 61 healthy subjects using CAM electrophoresis. Sera from 47 patients were assayed. Twenty-three had proven acute pancreatitis (AP) and 24 had established chronic pancreatitis (CP). All patients with AP had elevated serum Pi levels. Fifteen of these patients had a low P3 index, which ranged between 55.8% and 82.6% with a mean of 67.1%. An index of less than 100% indicates the presence of P3 isoamylase. P3 iso-amylase only occurred in patients with AP. Thirteen of these 15 patients did not have Si in their serum. In 20 of 24 patients with CP, serum Pi was reduced and in 4 it was at the lower limit of the reference interval. Ten of these patients had raised Si levels. In 13 of these patients the total amylase level was normal; in 4 it was increased and in 7 it was reduced. It is concluded that raised Pi and the P3 index are useful in the diagnosis and monitoring of AP; reduced Pi is highly suggestive of CP, and the use of total alpha-amylase levels alone can be misleading.

Early postoperative endoscopic sphincterotomy for retained common bile duct stones.

Endoscopic sphincterotomy was performed within 28 days after cholecystectomy in 20 patients with retained common bile duct stones, of whom 15 (75%) underwent endoscopic sphincterotomy within the first week of surgery. Stone extraction was successful in all patients and no immediate complications were noted. Early endoscopic sphincterotomy for retained common bile duct stones was safe and effective in the early postoperative period.

Radioisotopic flow scanning for portal blood flow and portal hypertension.

The use of a simple, noninvasive, isotope scanning technique for the determination of relative portal blood flow and detection of portal hypertension is described. Using this technique the presence of portal hypertension was demonstrated in seven of nine patients known to have elevated portal venous pressure. By contrast, esophageal varices were demonstrated in only five of these patients, illustrating the potential value of the method. Furthermore, this technique has been adapted to the study of portal blood flow in patients with myeloproliferative disorders with splenomegaly but without disturbances in hepatic architecture. Results demonstrate that the high relative splenic flow resulting from the presence of splenomegaly may in turn be associated with elevated relative portal blood flow and portal hypertension. The theoretic reasons for the development of flow-related portal hypertension and its relationship to splenic blood flow are discussed.

Curry powder as a vehicle for iron fortification: effects on iron absorption.

Curry powder was investigated as a vehicle for targeted iron (Fe) fortification, and especially for NaFeEDTA, by assessing its acceptability to consumers and its effects on Fe absorption. A random survey in an Indian community in the Republic of South Africa, indicated that fortified premixed curry powder was acceptable in terms of color, palatability, and stability. The effect of curry powder on Fe absorption from a potato meal was assessed in 64 Indian housewives. Curry powder caused a significant though modest rise in Fe absorption in two of the studies (t = 2.716, p less than 0.05 and t = 3.126, p less than 0.025) but, in the third, the effect was noted only in the more Fe-depleted subjects. There was no enhancement of Fe absorption from a dhal soup of low-Fe bioavailability (t = 0.224, p greater than 0.1). The results of both the human and animal studies suggested that curry powder's overall mild enhancing effect on Fe absorption was due to its capacity to stimulate gastric acid secretion.

Diagnostic and therapeutic use of endoscopic retrograde cholangiopancreatography.

Endoscopic retrograde cholangiopancreatography (ERCP) is an important investigative technique in the diagnosis of biliary tract and pancreatic disease. It can also be employed as a therapeutic tool in the management of these disorders. The indications, results and complications of 500 ERCPs performed in the Medical Gastro-enterology Unit, Johannesburg Hospital, over 30 months are reported. In addition, endoscopic therapeutic procedures including sphincterotomy, nasobiliary drainage, placement of bilioduodenal endoprostheses and balloon dilatation of bile duct strictures are highlighted.

Endoscopic retrograde sphincterotomy in the management of common bile duct stones.

Endoscopic retrograde sphincterotomy (ERS) was performed in 53 patients with choledocholithiasis, 26 of whom had an intact gallbladder. An adequate sphincterotomy was achieved in every patient, and all stones were removed in 90%. There was 9% morbidity but no mortality. ERS is a major advance in the management of common bile duct stones with significantly lower morbidity and mortality than those associated with conventional surgery. In particular, the role of ERS in pre-cholecystectomy patients is discussed.

Autonomous cholesterol biosynthesis in murine hepatoma. A receptor defect with normal coated pits.

These studies indicate that autonomous cholesterol biosynthesis by hepatocellular carcinoma may result from absent or defective receptors for chylomicron remnants on the surface of the malignant hepatocytes. In vivo, DAB2 hepatoma or liver were perfused with chylomicron remnants labeled with tritiated palmitic acid. Normal liver had chylomicron remnant uptake/gm tissue that was ten times that of hepatoma. In vitro studies using isolated hepatocytes and cultured DAB2 hepatoma cells showed similar results. Uptake of chylomicron remnants labeled with 3H-palmitic acid by normal hepatocytes during a 4-hour period was ten times that of hepatoma cells. Both in vivo and in vitro differences were statistically highly significant (P less than 0.005). Since many surface receptors are related to the coated pits, the cellular membranes of both neoplastic and normal liver cells were examined by electron microscopy. Coated pits were present in both the hepatoma and normal liver cells and occupied 2.61% and 2.65% of the cell surface, respectively. The defective uptake of chylomicron remnants by DAB2 hepatoma appears to be related to the chylomicron remnant receptor and not to the coated pit-internalization mechanism.

Thyroxine binding globulin and thyroid function tests in patients with hepatocellular carcinoma.

To determine the prevalence of elevated serum concentrations of thyroxine binding globulin (TBG) in patients with hepatocellular carcinoma (HCC) and the influence of the associated cirrhosis, TBG was measured in 39 patients with HCC, 22 with and 17 without cirrhosis, in 20 patients with cryptogenic macronodular cirrhosis but without HCC, and in 40 matched controls. The mean serum TBG concentration in the patients was 34.5 +/- 17.7 microgram per ml, compared to 21.4 +/- 6.8 microgram pr ml in controls and 20.5 +/- 6.3 microgram per ml in cirrhosis without HCC (p less than 0.01). The presence or absence of cirrhosis in the HCC patients did not significantly influence the frequency with which elevated TBG levels were found; levels were normal in every subject with cirrhosis and no HCC. The mean thyroxine (T4): TBG ratio was 5.58 +/- 1.78 in controls and was reduced in HCC patients with both elevated (3.33 +/- 0.80, p less than 0.001) and normal TBG values (4.39 +/- 1.90, p less than 0.05), and in cirrhotics without HCC (4.29 +/- 1.01, p less than 0.01). T4 and TBG concentrations correlated significantly in controls, in HCC patients with elevated TBG, and in the cirrhotics without HCC. It is concluded that in patients with HCC (i) TBG levels may be elevated both in the presence or absence of cirrhosis; (ii) there is reduced binding of T4 TBG, and (iii) a low T4:TBG ratio excludes the diagnosis of hyperthyroidism in the presence of high T4 levels. TBG levels are normal in patients with cryptogenic macronodular cirrhosis without HCC.

Acute hepatitis following enflurane anaesthesia.

A patient developed fever and acute hepatitis shortly after enflurane anaesthesia. Other causes of postoperative hepatitis were excluded. Cross-sensitization with halothane may have occurred, and the enflurane hepatitis may have been aggravated by halothane hepatitis.

Myxoedema presenting with ascites: a case report.

A 61-year-old woman who presented with gross ascites is described. She had many of the clinical features of hypothyroidism, including a pericardial effusion and a normocytic normochromic anaemia. The ascitic fluid was exudative in type. The diagnosis of primary hypothyroidism was confirmed by the finding of low serum thyroxine and tri-iodothyronine levels, low 131I uptake, and high serum thyroid-stimulating hormone levels. The patient responded well to carefully graded thyroxine therapy.