The differing effects of acute and chronic alcohol on gastric and intestinal permeability.

OBJECTIVE: Acute and chronic alcohol intake cause GI symptoms because of either alcohol-induced structural or functional abnormalities. In theory, the disruption of the integrity of the gut mucosa should be reflected by changes in the absorption of molecular probes, such as lactulose, mannitol, and sucrose. Accordingly, we investigated the effects of acute and chronic ethanol on the permeability of the gastric and small intestinal mucosa. METHODS: We measured the absorption of sucrose, mannitol, and lactulose in 20 controls and 18 alcoholics within 3 days after their last drink. We evaluated the reversibility of the abnormalities in alcoholics by repeat testing after 7 to 14 days of sobriety. The acute effects of ethanol in normal controls and abstinent alcoholics were also studied after the administration of ethanol by both the oral and IV routes. RESULTS: The absorptions of lactulose and sucrose in chronic alcoholics were normal. However, the alcoholics demonstrated a significant decrease in mannitol absorption and a corresponding increase in the lactulose/mannitol ratio. Both parameters returned to normal after a period of sobriety. Acute ethanol did not significantly affect mannitol or lactulose absorption, whereas oral ethanol significantly increased sucrose absorption. CONCLUSIONS: Chronic ethanol reversibly affects the integrity of small intestinal villi without significantly affecting gastrointestinal permeability. In contrast, a single oral dose of ethanol increases gastroduodenal permeability but has no effect on the lactulose or mannitol permeability of the small intestine. These regional changes in gut permeabilities may contribute to alcohol-induced GI symptoms.

Attention deficits disorder and drug abuse.

Recent research studies have attempted to explore various aspects of attention deficit disorder and substance abuser subtypes. The purpose of the present study is to evaluate the effect of drug abuse on MMPI scale score profiles of alcoholics with or without attention deficit disorder symptoms. For the alcoholic group with ADDRT versus the alcoholic group with ADDRT and drug abuse there were no significant differences between the groups. The hypothesis that the factor of drug abuse would account for MMPI score differences between alcoholics with or without ADDRT failed to be supported. Regardless of whether or not the subject groups contained drug abusers or not, the ADDRT-diagnosed groups demonstrated clinically significant levels of psychopathology on the MMPI profiles. These results would suggest that the variable of ADDRT diagnosis is probably an important factor to consider in substance abuser populations.

The perineal field in the external irradiation of cancer of the prostate: a modified Regato technique. First Annual del Regato Distinguished Lecture.

(1) 50 consecutive patients with cancer of the prostate, stages A2 through C2 received external irradiation. The whole pelvis was treated using 4-MV photons, and a prostate boost was given through the perineum using a cesium-137 teletherapy unit. (2) The treatment technique was easily duplicated daily and was well tolerated. There were no grade 2, 3 or 4 complications. (3) Local control was excellent: 96% of all cases. (4) Disease-free survival was high. (5) Potency was maintained in the majority of this elderly population. Considering that American males have an increasing longevity and thus a greater likelihood of developing cancer of the prostate, external-beam radiation therapy should be utilized in the future even more so than today. We must continue to refine radiation therapy techniques in order to further increase disease-free survival and reduce radiation morbidity.

Modulation of salivary secretion by acid infusion in the distal esophagus in humans.

To examine the relationship between esophageal acid exposure and development of salivation and heartburn, 15 healthy subjects underwent perfusion of the distal esophagus with varying concentrations of hydrochloric acid, different-osmolality saline solutions, and deionized water. In five study subjects, hydrochloric acid was infused in the body of the stomach only. During the study, timed samples of whole and parotid saliva were collected and analyzed for flow rate and bicarbonate concentration. Only hydrochloric acid concentrations of 20 mmol/L or greater (pH 1.8 or lower) induced a rapid (within 2 minutes) and significant (P < 0.05) increase in salivation. The hydrochloric acid-induced salivation was associated with significant (P < 0.05) increase in bicarbonate secretion in both parotid and whole saliva samples. Intravenous atropine administration completely inhibited hydrochloric acid-induced salivary secretion in all six subjects. Changes in osmolality of saline solution infused in the esophagus and hydrochloric acid infused in the stomach did not significantly alter parotid and whole saliva flow rates. These data suggest that in humans, rapid salivation in response to esophageal mucosal exposure to intraluminal hydrochloric acid is a pH-dependent and osmolality-independent phenomenon that is most likely mediated by pH-sensitive chemoreceptors located in the esophageal mucosa.

Attention deficit disorder, alcoholism, and drug abuse: MMPI correlates.

Earlier research had demonstrated that alcoholics with attention deficit disorder residual type (ADDRT) differ from other alcoholics on the Minnesota Multiphasic Personality Inventory (MMPI). The purpose of this study was to explore the influence of drug abuse on the relationship of ADDRT and alcoholism as reflected on the MMPI. Groups of 48 male alcoholics, 28 ADDRT alcoholics, 25 ADDRT alcohol and drug abusers and 18 alcohol and drug abusers were all administered the MMPI. Significant differences were found between the alcoholic and ADDRT alcoholic groups on scales Pd, Sc, Si, F, and K. For the ADDRT alcohol and drug abusers versus the alcohol and drug abuser groups, they differed on scales K, Hs, D, Pd, Pa, Pt, Sc, Si, F, K, and L.

Computerized interpretation of the Luria-Nebraska Neuropsychological Battery: a pilot study.

Programs for the computer analysis and interpretation of neuropsychological test data have been developed in recent years. In this paper, a new computer program, with initial validation data, is presented. Diagnostic hit rate for brain damage was 80% (52 of 65). For the extent of brain damage the hit rate was 60% (12 of 20). When laterality was considered, the hit rate was 71% (10 of 14). These results are comparable with computer programs for data from the Halstead-Reitan Neuropsychology Test Battery.

Dietary fiber supplementation: effect on exocrine pancreatic secretion in man.

The effect of a dietary fiber supplementation program (20 g/d) on exocrine pancreatic gland secretion was evaluated in six healthy male subjects who underwent quantitative assessment of pancreatic enzyme secretion both before and after 4 wk of dietary fiber supplementation. A duodenal perfusion technique was used to quantify the concentrations and output of pancreatic enzymes after ingestion of a standard test meal. Samples were aspirated from the ligament of Trietz and analyzed for pH, total protein, amylase, trypsin, and lipase activity. No significant changes were observed in duodenal flow rate pH, total protein, amylase, or trypsin concentrations and outputs after fiber supplementation. A marked increase in mean (+/- SEM) lipase concentration (U/mL) and output (kU/min) in both the resting and postprandial states was seen, reaching statistical significance (p less than 0.05) at 120 min postprandial. These data suggest that in man, a 4-wk dietary fiber supplementation program can modulate pancreatic lipase secretion.

Subtle/obvious MMPI scales identify attention deficit disorder alcoholics.

Earlier research has demonstrated that alcoholics with or without attention deficit disorders, residual type (ADDRT) can be differentiated by Minnesota Multiphasic Personality Inventory (MMPI) Clinical Scale Profiles. This study addressed the question of whether that differentiation was made by virtue of subtle or obvious aspects of the MMPI item pool. Groups of 30 of male alcoholics with or without ADDRT were individually matched on age and education variables. Statistically significant differences were found for the D-O, HY-O, HY-S, PD-O, PA-O, PA-S, MA-O, MA-S, ES and A scales.

Alcoholism and attention deficit disorder: MMPI correlates.

Previous research suggests that the alcoholic population can be meaningfully divided into subtypes, one of which is attention deficit disorder, residual type (ADDRT). The purpose of this study was to identify differences in personality profiles, as measured by the Minnesota Multiphasic Personality Inventory (MMPI), between ADDRT alcoholics and other alcoholics. Groups of 50 male ADDRT alcoholics and 50 male nonADDRT alcoholics were administered the MMPI. Statistically significant differences were found for the D, PD, Pa, Pt. Sc. MA, Si, F and K scales: the ADDRT alcoholics scored significantly higher than the nonADDRT alcoholics on most of the scales, but significantly lower on the K scale.

External radiation therapy of stage I cancer of the endometrium: a need for reappraisal of this adjunctive modality.

One hundred and eighty-five patients with Stage I cancer of the endometrium were irradiated preoperatively. All were irradiated to the whole pelvis by external beam only using supermegavoltage apparati. The total mid-pelvis dose ranged from 4500 cGy/5 weeks to 5500 cGy/6 1/2 weeks. Surgery followed usually in 6 weeks. Complications were minimal. Disease-free survival at Stage IA was 92.4% 5-year, 87.7% 10-year; Stage IB was 83.5% 5-year, 74.6% 10-year. Prognosis was related to stage, grade, depth of myometrial penetration, the presence of "residual" tumor at hysterectomy. External beam preoperative irradiation is recommended for all Stage I patients; Stage IB with higher grade pathology should have intracavitary irradiation supplemental to the external irradiation.

Prostatic carcinoma: limited field irradiation.

This is a retrospective study of 251 patients with histologically proven adenocarcinoma treated primarily with limited field radiotherapy techniques, under the principle direction of authors JMV and JPG, between 1968 and 1981 in San Francisco, California. All patients are followed for a minimum of 3 years; mean follow-up is 7.3 years. Routine clinical staging procedures included: H&P, digital prostate exam, cystoscopy, biopsy, blood studies including serum acid phosphatase, and imaging studies including chest X ray, IVP, bone survey or radionucleotide bone scan, and in recent years, pelvic CT scans. Twelve patients are Stage A1, 37-Stage A2, 50-Stage B, 140-Stage C1 and 12-Stage C2. Ninety percent of all cases and 85% of Stage C patients were treated with limited fields to the prostate and periprostatic volume only. Total doses were prescribed at midplane or isocenter and were generally 6500-7000 cGy, daily doses of 180-200 cGy, 5 days per week. Actuarial 5- and 10-year survival rates are: entire population-69% and 47%; Stage A1-74% and 50%; Stage A2-81% and 67%; Stage B-84% and 53%; Stage C1-63% and 42%; Stage C2-32% and 11%. The 5- and 10-year disease-free actuarial survivals are: entire population-71% and 50%; Stage A1-89% and 74%; Stage A2-82% and 69%; Stage B-71% and 52%; Stage C1-67% and 44%; Stage C2-0%. Sites of recurrence, alone or as a component of the failure pattern are: 37 (15%) local, 11 (4%) symptomatic regional recurrence (lower extremity edema, pelvic pain/sciatica, hydroureteronephrosis), and 87 (35%) distant metastasis. Seven (3%) had unknown sites of failure. Local-regional failure occurred in 42% of Stage C2 patients. Concomitant hormonal therapy has no survival impact on Stage C1 patients and poorly differentiated histology is associated with decreased determinate and disease-free survival rate of 5 years. Complications correlate with treatment technique, being more frequent with single field per day treatment plans. In patients treated with multiple fields per day or rotational plans, complications occur in less than 8% of patients and major complications have not occurred.

Gastric emptying in patients with insulin-requiring diabetes mellitus.

Gastric emptying of technetium labeled liquid and solid meals were studied in a group of long-standing, insulin-requiring male diabetics to evaluate the relationship of gastroparesis to symptoms, diabetic control, and diabetic complications. Control subjects and three groups of diabetics were studied: A) no neuropathy; B) peripheral neuropathy; and C) peripheral and autonomic neuropathy. Nine diabetics had gastrointestinal symptoms. Gastric t1/2 liquid emptying was similar in all groups and in controls, but liquid gastric emptying in the first 15 min was significantly more rapid in the diabetics than controls. Solid emptying was prolonged in group C patients. There was a significant correlation between t1/2 solid emptying and the severity of neuropathy. The eight patients with slow solid emptying had more neuropathy and gastrointestinal symptoms than the remaining 22 patients. The type and duration of diabetes, diabetic control, and frequency of retinopathy are independent of gastroparesis. These data indicate that delayed emptying of solids is common (27%) in patients with clinically detectable neuropathy and may often be asymptomatic. Visceral autonomic neuropathy seems the most important underlying factor in diabetic gastroparesis.

The influence of field size, treatment modality, commissure involvement and histology in the treatment of early vocal cord cancer with irradiation.

One hundred and thirty-seven patients with TNM staged T1 glottic cancer were treated from 1966 to 1980. The patient characteristics were no different from those noted in previous studies. Patients were treated either with 60Co teletherapy units or 4 MeV linear accelerators with different daily (180-225) and weekly (4 times vs. 5 times) fractionation schemes. A recurrent-free survival was attained in 80% of the patients 2 years after primary treatment with radiation therapy. There were 27 local recurrences, of which 82% were salvaged with surgery for an overall adjusted survival of 95%. Patients treated on 60Co units with field sizes less than or equal to 30 sq. cm had a 15% increase in local recurrence compared with field size greater than 30 sq. cm, which could not be attributed to lower doses. Poorly differentiated tumors and those involving the anterior commissure were more likely to develop a local recurrence. Doses above 1900 ret were associated with a decrease in local recurrence in patients having anterior commissure involvement. Salvage with limited surgery for failure was effective in selected cases.