Hepatobiliary disease that precedes ulcerative colitis.

There is a variable temporal relationship between the presenting symptoms of inflammatory bowel disease and associated hepatic disease: hepatobiliary disease may precede, occur with, or occur many years after the onset of the bowel disease. We describe six patients in whom hepatobiliary disease of initially obscure origin preceded the development of inflammatory bowel disease. The colitis which subsequently developed in these patients was symptomatically mild. In our series, there was a high prevalence of sclerosing cholangitis. We conclude that in patients with chronic hepatobiliary disease of obscure origin, evaluation should include detailed questioning about bowel symptoms and routine sigmoidoscopy to screen for subclinical colitis. If a diagnosis of colitis is made in such a patient, endoscopic retrograde cholangiography may be indicated to evaluate the biliary tree for sclerosing cholangitis.

Major gastrointestinal hemorrhage from peripancreatic blood vessels in pancreatitis. Treatment by embolotherapy.

Seven cases of gastrointestinal bleeding originating from peripancreatic blood vessels seen between 1977 and 1982 are presented. The bleeding originated either from true aneurysms, formed when the pancreatic inflammatory processes weaken the walls of peripancreatic blood vessels, from pseudoaneurysms which occurred after vascular leakage into pancreatic pseudocyst, or from veins. Gastrointestinal bleeding occurs when these entities rupture into gastrointestinal viscera. Hemorrhage of this nature must be considered in the clinical setting of patients who have a history of alcoholism, chronic relapsing pancreatitis, and known pseudocysts. Endoscopy, bleeding scans, and barium contrast studies are only occasionally helpful in diagnosis. Selective visceral angiography during acute hemorrhage is often diagnostic and concomitant arterial embolization techniques may offer a temporizing or permanent modality for hemostasis. This technique may be especially useful in the unstable, acutely ill patient with alcoholic hepatitis, sepsis, or an immature pseudocyst who poses a poor operative risk.

Comparison of exogenous energy sources for in vitro maintenance of follicle cell-free Xenopus laevis oocytes.

The purpose of these experiments was to determine which exogenous energy sources are suitable for isolated follicle cell-free oocytes from the frog, Xenopus laevis. In order to compare prospective energy sources, follicle cell-free oocytes from 0.4 to 1.3 mm in diameter were incubated in a 1 mM concentration of each of a variety of energy sources and scored daily for the maintenance of morphological characteristics. Vitellogenic oocytes placed in succinate or fumarate deteriorated at the same time as those in saline alone. Oocytes incubated in oxaloacetate (OAA) appeared to remain in the best morphological condition, followed by oocytes maintained in pyruvate or glucose. Fully grown oocytes were tested at various times of incubation for their ability to respond to progesterone by undergoing germinal vesicle breakdown. These experiments showed that oocytes placed in OAA or pyruvate retained the ability to respond to progesterone longer than those in the other energy sources. Increased respiratory rates were stimulated in isolated oocyte mitochondria by succinate as well as pyruvate and OAA. However, oocytes incubated in labelled pyruvate evolved 80 to 140 times as much labelled CO2 as oocytes incubated in labelled glucose or succinate. In addition, it was found that the rate of uptake of pyruvate is 20 to 25 times greater than the rate of uptake of glucose or succinate. It is concluded from these experiments that OAA and pyruvate are the most effective exogenous energy source for the in vitro maintenance of Xenopus oocytes. On possible explanation for the ineffectiveness of glucose or succinate as exogenous energy sources is a restriction in their uptake into the oocytes.