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G A S T R O E N T E R O L O G Y Volume 91, July-December 1986
Editor Editorial Board
Raj K. Goyal Beth Israel Hospital 330 Brookline Avenue Boston, Massachusetts 02215
Consulting Editor
William Silen Beth Israel Hospital Boston, Massachusetts 02215
Associate Editors Jules L. Dienstag Massachusetts General Hospital Boston, Massachusetts 02114
John L. Gollan Brigham and Women's Hospital Boston, Massachusetts 02115
James L. Madara Brigham and Women's Hospital Boston, Massachusetts 02115
Satish Rattan Beth Israel Hospital Boston, Massachusetts 02215
Allan Walker Children's Hospital Boston, Massachusetts 02115
Selected Summaries Editor Robert M. Glickman New York, New York
Book Review Editor Howard Spiro New Haven, Connecticut
Chairman of Editorial Board
Robert M. Donaldson, Jr. New Haven, Connecticut
David H. Alpers, St. Louis, Missouri Thomas Brasitus, Chicago, Illinois Raymond F. Burk, San Antonio, Texas Martin Carey, Boston, Massachusetts Donald L. Castell, Winston-Salem, North Carolina Wylie J. Dodds, Milwaukee, Wisconsin Robert M . Donaldson, Jr., New Haven, Connecticut Mark Donowitz, Boston, Massachusetts Charles O. Elson III , Richmond, Virginia Jerry D. Gardner, Bethesda, Maryland Peter B. Gregory, Stanford, California Roberto Groszmann, New Haven, Connecticut W. Gary Hardison, San Diego, California R. Thomas Holzbach, Cleveland, Ohio Albert L. Jones, San Francisco, California Keith A. Kelly, Rochester, Minnesota Mary Jeanne Kreek, New York, New York Nicholas F. LaRusso, Rochester, Minnesota Willis C. Maddrey, Philadelphia, Pennsylvania Robert K. Ockner, San Francisco, California Jay A. Perman, Baltimore, Maryland Charles T. Richardson, Dallas, Texas Jack A. Vennes, Minneapolis, Minnesota Tadataka Yamada, Ann Arbor, Michigan
Officers of the American Gastroenterological Association
President Douglas B. McGill Rochester, Minnesota
President Elect John M. Dietschy Dallas, Texas
Vice-President Robert M . Glickman New York, New York
Secretary Paul D. Webster III Augusta, Georgia
Treasurer Martin Brotman San Francisco, California
C O N T E N T S O F V O L U M E 91
NO. 1 , JULY 1986
A L I M E N T A R Y TRACT
Use of 23-Selena-25-Homocholyltaurine to Detect Bile A c i d Malabsorption i n Patients W i t h Ileal Dysfunction or Diarrhea Carnitine Transport i n Human Intestinal Biopsy Specimens. Demonstration of an Act ive Transport System
Reversibility of Exocrine Pancreatic Failure i n Chronic Pancreatitis
Patients W i t h a High Jejunostomy Do Not Need a Special Diet
Preparation of Subcellular Membranes From Rat Intestinal Scrapings or Isolated Cells. Different C a 2 + B inding , Nonesterified Fatty A c i d Levels, and L ipo ly t i c A c t i v i t y Effects of Decreasing Intra luminal Amylase A c t i v i ty on Starch Digestion and Postprandial Gastrointestinal Funct ion i n Humans
Nonspecific Adaptat ion of Jejunal A m i n o A c i d Uptake i n the Rat
Healing of Benign Gastric Ulcer W i t h Low-Dose Antacids and Fiber Diet Chronic Intestinal Pseudoobstruction i n Young Chi ldren
Lack of Specific B inding of Prostaglandin E 2 , Prostaglandin F 2 a , and 6-Keto Prostaglandin F l a to Ser u m i n Patients W i t h Peptic Ulcer Disease and i n Healthy Subjects
Estimated Versus Measured Basal Energy Requirements i n Patients W i t h Crohn's Disease
Comparison of an Intravenous Selective Mesenteric Vasodilator W i t h Intraarterial Papaverine i n Experimental Nonocclusive Mesenteric Ischemia Interaction of Tripotassium Dicitrato Bismuthate W i t h Macrophages i n the Rat and I n Vitro Relationship Between Impaired Gastric Emptying and Abnormal Gastrointestinal M o t i l i t y Decreased F l u i d Tolerance, Accelerated Transit, and Abnormal M o t i l i t y of the Human Colon I n duced by Oleic A c i d
Trophic Effects of Pentagastrin on Gastrointestinal Tract i n Fed and Fasted Rats
Mechanical Characteristics of Phase I I and Phase I I I of the Interdigestive Migrat ing Motor Complex i n Dogs
Evidence for Abnormal Cholinergic Neuromuscular Transmission i n Diabetic Rat Small Intestine
Upper Esophageal Sphincter Function During Belching
G. S C I A R R E T T A , G. VICINI , G. F A G I O L I , 1
A. V E R R I , A. G I N E V R A , A N D P. M A L A G U T I
J.W. H A M I L T O N , Β U.K. LI , A . L . S H U G , A N D 10
W.A. O L S E N
A . M . G A R C I A - P U G E S , S. N A V A R R O , 17
E . R O S , M. E L E N A , A. B A L L E S T A ,
R. A U S E D , A N D J. V I L A R - B O N E T
P.B. M c I N T Y R E , M. F I T C H E W , A N D 25
J.E. L E N N A R D - J O N E S
J.R.F. W A L T E R S , P.J. H O R V A T H , A N D 34
M.M. W E I S E R
P. L A Y E R , A.R. Z I N S M E I S T E R , A N D 41
E.P. D i M A G N O
G . M . L E V I N E 49
A. R Y D N I N G , R. W E B E R G , O. L A N G E , A N D 56
A. B E R S T A D
S. A N U R A S , F . A . M I T R O S , R.T. S O P E R , 62
K . C P R I N G L E , B.V. M A V E S , M.K. Y O U N O S Z A I ,
E . A . F R A N K E N , Jr.. A N D P. W H I T I N G T O N
J.S. R E D F E R N A N D M. F E L D M A N 71
Α.Τ.Η. C H A N . C R . F L E M I N G , W.M. O ' F A L L O N , 75
A N D K . A . H U I Z E N G A
K . L . M a c C A N N E L L 79
R . L . S O U T A R A N D S.B. C O G H I L L
T . E . S O L O M O N
M. S C H E M A N N A N D H-J. E H R L E I N
T . V . N O W A K , Β. H A R R I N G T O N ,
J.Η. K A L B F L E I S C H , A N D J.M. A M A T R U D A
P.J. K A H R I L A S , W.J. D O D D S . J. D E N T ,
J . B . W Y M A N . W.J. H O G A N , A N D
R . C A R N D O R F E R
84
94 Μ. C A M I L L E R I , M.L. B R O W N , A N D
J-R. M A L A G E L A D A
R . C . S P I L L E R , M . L . B R O W N , A N D S.F . P H I L L I P S 100
108
117
124
133
iv C O N T E N T S G A S T R O E N T E R O L O G Y Vol. 91, N>. 6
Gastric M o t i l i t y Is Stimulated but Overall Blood Flow Is Unaffected During Cold Restraint i n the Rat Randomized, Double-Blind, Placebo-Controlled Crossover Tria l of Cimetidine and Pirenzepine i n Nonulcer Dyspepsia
LIVER A N D BILIARY TRACT Factors Associated W i t h Postoperative Complications i n Diabetics After Bi l iary Tract Surgery
Effect of Portacaval Shunt on Drug Disposition i n Patients W i t h Cirrhosis Cl inical Significance of Low Molecular Weight (7-8S) Immunoglobul in Μ Ant ibody to Hepatitis Β Core Antigen i n Chronic Hepatitis Β Virus Infections
Corynebacterium parvum-Elici ted Hepatic Macrophages Demonstrate Enhanced Respiratory Burst A c t i v i t y Compared W i t h Resident Kupffer Cells i n the Rat
Circadian Rhythm of Hepatic Cytosolic and Nuclear Estrogen and Androgen Receptors
Differing Effects of Nor-ursodeoxycholic or Ursodeoxycholic A c i d on Hepatic Histology and Bile A c i d Metabolism i n the Rabbit
CASE REPORTS Emergence of Malignant Lesions W i t h i n an Adenomatous Hyperplastic Nodule in a Cirrhotic Liver. Observations i n Five Cases
Neurologic Syndrome Associated W i t h Low Levels of V i t a m i n Ε i n Primary Bi l iary Cirrhosis
Rupture of the Stomach After Hemorrhage From a Gastric Ulcer Primary Malignant Melanoma of the Gallbladder, Metastatic to the Common Bile Duct
Transformation of Inferior Vena Caval Thrombosis to Membranous Obstruction i n a Patient W i t h the Lupus Anticoagulant
PROGRESS ARTICLE Countercurrent Mechanisms i n the Mammalian Gastrointestinal Tract
EDITORIALS
Technology Il luminates a Shadowy Syndrome Asymptomatic Gallstones. Does Diabetes Mell i tus Make a Difference?
Selective Mesenteric Vasodilators. A Future Role i n Acute Mesenteric Ischemia?
T. G A R R I C K , F.W. L E U N G , S. B U A C K , 141
K. H I R A B A Y A S H I , A N D P.H. G U T H
N.J. T A L L E Y . D. M c N E I L . A. H A Y D E N . A N D 149
D.W. PIPER
R.S. S A N D L E R . W.F. M A U L E . A N D M.E. B A L T U S 157
G. P O M I E R - L A Y R A R G U E S , P-M. H U E T , 163
J-P. V I L L E N E U V E , AND D. M A R L E A U
M.H. SJOGREN, W . H . B A N C R O F T , 168
J.H. H O O F N A G L E , J.L. S O S E B E E . A N D
S.M. L E M O N
M.J.P. A R T H U R , P. K O W A L S K I - S A U N D E R S . 174
AND R. W R I G H T
A. F R A N C A V I L L A . P.K. E A G O N . A. D i L E O , 182
D.H. V A N T H I E L . C P A N E L L A , L. P O L I M E N O .
C. A M O R U S O . M. I N G R O S S O . A . M . A Q U I L I N O .
A N D T . E . S T A R Z L
B. I. C O H E N . A . F . H O F M A N N . E . H . M O S B A C H , 189
R.J. S T E N G E R . M.A. R O T H S C H I L D . L.R. H A G E Y .
A N D Y.B. Y O O N
M. A R A K A W A , M. K A G E , S. S U G I H A R A , 198
T. N A K A S H I M A . M. S U E N A G A . A N D K. O K U D A
R.E. K N I G H T . A.J. B O U R N E . M. N E W T O N . 209
A. B L A C K . P. W I L S O N . AND M.J. L A W S O N
D.P. O ' D O H E R T Y , A.R. B A K E R , AND 212
W.W. B A R R I E
J.J. V E R B A N C K , L.J. R U T G E E R T S . 214
F.J. V A N A E L S T , J.H. T Y T G A T . J.M. D E C O S T E R .
D.N. N O Y E Z . P.J. T H E U N Y N C K , A N D
K.J. G E B O E S
Η. T E R A B A Y A S H I . Κ. O K U D A . 219
F. N O M U R A . Κ. OHNISHI. A N D P. W O N G
M. JODAL A N D O. L U N D G R E N 225
W.G.M. H A R D I S O N 242
C A . P E L L E G R I N I 245
S.J. B O L E Y A N D L.J. B R A N D T 247
SELECTED SUMMARIES
A Hormonal Basis for Cachexia?
Gut Mucosa, Adaptive Growth, and Enteroglucagon 250
251
December 1986 C O N T E N T S ν
Determinants of Bi l iary Cholesterol Secretion 252 The Influence of Chronic Ethanol Adminis trat ion 253 on the F l u i d i t y of Liver Plasma Membranes Colon Cancer, Colon Polyps, and Cholesterol 254 What to Do W i t h the Adenoma-Carcinoma 256 Intermezzo
BOOK REVIEWS 258 CORRESPONDENCE 265 NOTICES 270 CORRECTION 272
N O . 2, AUGUST 1986
AMERICAN GASTROENTEROLOGICAL ASSOCIATION Our New President—Douglas B. M c G i l l , M.D.
LIVER A N D BILIARY TRACT Ontogenic and Phylogenic Studies of Intestinal, Hepatic, and Placental Alkal ine Phosphatases. Evidence That Intestinal Alkal ine Phosphatase Is a Late Evolutionary Development
Regulation of B i l i r u b i n Glucuronide Synthesis i n Primate [Macaca fascicularis) Liver. Kinetic Analysis of Microsomal B i l i r u b i n U r i d i n e Diphosphate Glucuronyltransferase Effect of Dietary Cholesterol on Bi l iary Cholesterol Content and Bile Flow i n the Hypothyro id Rat
Short-Term Adminis t ra t ion of Parenteral Glucose-L i p i d Mixtures Improves Protein Kinetics i n Portacaval Shunted Rats
Ultrasonographic Study of Gallbladder M o t i l i t y During Total Parenteral N u t r i t i o n
A L I M E N T A R Y TRACT
Development of Gastric Mucosal Protection Against A c i d i n the Rat. Role of Corticosteroids and Prostaglandins
Isolation and Characterization of Crohn's Disease Tissue-Specific Glycoproteins
Influence of the St imulation State of the Parietal Cells on the Inhibi tory Effect of Omeprazole on Gastric A c i d Secretion i n Dogs
Linear Gastric Erosion. A Lesion Associated W i t h Large Diaphragmatic Hernia and Chronic Blood Loss Anemia
Intestinal Hydrolysis of Pyridoxal 5'-Phosphate I n Vi tro and I n Vivo i n the Rat. Effect of Protein B inding and p H
Effects of A s p i r i n on Tight Junction Structure of the Canine Gastric Mucosa I n h i b i t i o n of Gastrointestinal Transit Due to Surgical Trauma or Peritoneal Irr i tat ion Is Reduced i n Capsaicin-Treated Rats
Esophageal Motor Abnormalities i n Gastroesophageal Reflux and the Effects of Fun duplicat ion
H.N. H O F F M A N 273
T . K O M O D A . I. K O Y A M A , Α. Ν A G A T A . 277
Y . S A K A G I S H I , K. D e S C H R Y V E R - K E C S K E M E T I ,
A N D D.H. A L P E R S
S . C H A U S E R , J.C. Z I U R Y S , A N D J.L. G O L L A N 287
F.J. F I E L D , E . A L B R I G H T . A N D S.N. M A T H U R 297
J.J. P O M P O S E L L I . L . L . M O L D A W E R , 305
J.D. P A L O M B O . V . K . B A B A Y A N , B.R. B I S T R I A N ,
A N D G.L. B L A C K B U R N
N. C A N O , F. C I C E R O , F. RANIERI , J. M A R T I N , 313
A N D J. di C O S T A N Z O
E.J. D I A L A N D L . M . L I C H T E N B E R G E R
S. B A G C H I , B. B A R A L , A N D K . M . D A S
318
326
J. D E G R A E F A N D M-C. W O U S S E N - C O L L E 333
A.J. C A M E R O N A N D J.A. HIGGINS
H . M . M I D D L E T O N , III
338
343
R.A. M E Y E R , D. M c G I N L E Y , A N D Z. P O S A L A K Y 351
P. H O L Z E R , l .Th. LIPPE, A N D 360
U . H O L Z E R - P E T S C H E
R . C . G I L L . K . L . B O W E S . P.D. M U R P H Y , A N D 364
Y.J . K I N G M A
vi C O N T E N T S G A S T R O E N T E R O L O G Y Vol . 91, No. 6
Human Duodenal Mucosal Bicarbonate Secretion. Evidence for Basal Secretion and Stimulation by Hydrochloric A c i d and a Synthetic Prostaglandin Ei Analogue Altered Patterns of Secretion of Monomeric IgA and IgA Subclass 1 by Intestinal Mononuclear Cells i n Inflammatory Bowel Disease
Human Interdigestive M o t i l i t y : Variations i n Patterns From Esophagus to Colon
Sulfapyridine Appearance i n Plasma After Sali-cylazosulfapyridine. Another Simple Measure of Intestinal Transit
Endoscopic Ultrasonography of Non-Hodgkin L y m phoma of the Stomach Endoscopic Measurement of Papillary Sphincter Zone and Pancreatic M a i n Ductal Pressure i n Patients W i t h Chronic Pancreatitis When Is Endoscopic Polypectomy Adequate Therapy for Colonic Polyps Containing Invasive Carcinoma? Dermatoglyphic (Fingerprint) Evidence for a Congenital Syndrome of Early-Onset Constipation and Abdomina l Pain
Bacterial Contamination of Pancreatic Necrosis. A Prospective Clinical Study Effect of Ethanol on A c i d Secretion by Isolated Gastric Glands From Rabbit
Use of a 3T3 Cell Growth Factor Assay for the Delineation and Characterization of Humoral Trophic Factors Involved i n Intestinal Adaptation i n the Rat
CASE REPORTS
Resolution of Diffuse Granulomatous Fibrosis of the Liver W i t h Antituberculous Chemotherapy
Tularemic Hepatitis Presenting as Obstructive Jaundice Primary Sclerosing Cholangitis Associated W i t h Hyper immunoglobul in Μ Immunodeficiency (Dys-gammaglobulinemia)
Gastrointestinal Involvement Complicating Stevens-Johnson Syndrome
Treatment of Acute Mesenteric Ischemia by Percutaneous Transluminal Angioplasty
EDITORIALS Surgical Intervention i n Necrotizing Pancreatitis
You See What You Look For
SELECTED SUMMARIES
What Are Transgenic Mice and How W i l l They Affect Medicine? Man Is What He Eats (Der Mensch ist was er isst)
Neuropeptide Modulat ion of Mucosal Immuni ty
Current Concepts of Pancreas and Liver Trauma Management
J.I. I S E N B E R G . D.L. H O G A N , M.A. K O S S . AND 370
J.A. S E L L I N G
R.P. M a c D E R M O T T . G.S. N A S H . M.J. B E R T O V I C H , 379
R.F. M O H R M A N , I.J. K O D N E R . D.L. D E L A C R O I X .
AND J-P. V A E R M A N
J.E. K E L L O W , T.J. B O R O D Y . S.F. P H I L L I P S .
R.L . T U C K E R , A N D A . C . H A D D A D
J.E. K E L L O W . T.J. B O R O D Y . S.F. P H I L L I P S .
A . C . H A D D A D . A N D M.L. B R O W N
T . L . T I O , F .C .A. den H A R T O G JAGER. A N D
G.N.J. T I J T G A T
Κ. ΟΚΑΖΑΚΙ, Υ. Y A M A M O T O , A N D Κ. I T O
J.P. C R A N L E Y . R.E. P E T R A S , W.D. C A R E Y ,
K. P A R A D I S , A N D M.V. S I V A K
S.H. G O T T L I E B A N D M.M. S C H U S T E R
H.G. B E G E R , R. B I T T N E R . S. B L O C K . A N D
M. BÜCHLER
386
396
401
409
419
428
433
B.J. R E I C H S T E I N . C. O K A M O T O . AND J.G. F O R T E 439
J.A. B I L L E R . R.K. M O N T G O M E R Y . R.J. G R A N D , 448
M. K L A G S B R U N . A N D A. R O S E N T H A L
K. O K U D A . K. K I M U R A . K. T A K A R A , Μ. O H T O . 456
Μ. O M A T A . A N D L. L E S M A N A
T.J. O R T E G O , L . F . H U T C H I N S , J. R I C E , A N D 461
G.R. D A V I S
J.A. D i P A L M A . C T . S T R O B E L , A N D
J.G. F A R R O W
B. Z W E I B A N , H. C O H E N . A N D
P. C H A N D R A S O M A
W.H. V a n D E I N S E . J.K. Z A W A C K I . A N D
D. P H I L L I P S
H.A. R E B E R
J.F. M O R R I S S E Y
464
469
475
479
481
483
484
485
486
December 1986 C O N T E N T S vii
Salicylates and Reye's Syndrome 487 The B i l i r u b i n Controversy: Settled? 488 Flexible Sigmoidoscopy Training—Is Some 489 Enough?
Reply to Selected Summary: Is Delayed Gastric 490 Emptying a Contributing Factor i n the Failure of Fundoplications for Reflux? (GASTROENTEROLOGY 1986;90:1299-1300)
BOOK REVIEWS 491
TRAINING A N D EDUCATION I N GASTROENTEROLOGY List of Available Training Programs 495
CORRESPONDENCE 522 NOTICES 528 CLASSIFIED ADS 532
NO. 3, SEPTEMBER 1986
A L I M E N T A R Y TRACT
D A a Receptor Mediates Dopamine-Induced Relaxation of Opossum Lower Esophageal Sphincter In Vitro
Evidence for a Midgastric Transverse Band i n Humans Comparison of Methodologies for the Measurement of Antroduodenal Motor Act iv i ty i n the Dog Induct ion of Duodenal Ulcers in Rats Under Water-Immersion Stress Conditions. Influence of Stress on Gastric A c i d and Duodenal Alkal ine Secretion
Experimental Diabetic Diarrhea i n Rats. Intestinal Mucosal Denervation Hypersensitivity and Treatment W i t h Clonidine
Substrate Dependence and Oxygen Sensitivity of Tone and of Spontaneous and Evoked Contractions of the Distal Colonic Muscularis Mucosae of Opossum
Immunohistochemical Study of Neuron-Specific Enolase and CA 19-9 i n Pancreatic Disorders. The Value of Neuron-Specific Enolase as a Marker for Islet Cell and Nerve Tissue
Cancer Family Syndrome: Marker Studies
Venti latory Function i n Chronic Peptic Ulcer. A Controlled Study of Ventilatory Function i n Patients W i t h Gastric and Duodenal Ulcer
Effects of Differing Concentrations of Sodium Bu-tyrate on 1,2-Dimethylhydrazine-Induced Rat Intest ina l Neoplasia
Role of Mucus i n the Repair of Gastric Epithel ial Damage i n the Rat. Inhib i t ion of Epithel ial Recovery by Mucolyt ic Agents
D.M. L O M B A R D I , M. G R O U S , C F . FINE, 533
F .C . B A R O N E , P.}. F O W L E R , W.B. PHY A L L ,
I .A. R U S H . A N D H.S. O R M S B E E , III
J.G. M O O R E , A. D U B O I S , P.E. C H R I S T I A N , 540
D. E L G I N , A N D N. A L A Z R A K I
R.M. V A L O R I , S.M. C O L L I N S , E . E . D A N I E L , 546
S.N. R E D D Y . S . S H A N N O N , A N D J. JURY
K. T A K E U C H I, O. F U R U K A W A , A N D S. O K A B E 554
E.B. C H A N G , R.N. F E D O R A K . A N D M. F I E L D 564
W.H. P E R C Y , R.L. R O B E R T S , J.B. M A S O N . A N D 570
J. C H R I S T E N S E N
Κ. I W A S E , Κ. K A T O , A. N A G A S A K A , K. M I U R A , 576
K. K A W A S E , S. M I Y A K A W A , Τ. T E I , S. O H T A N I ,
M. I N A G A K I , S. S H I N O D A . A. N A K A I ,
Τ. O H Y A M A . Y. H O R I G U C H I , Η. N A K A N O , A N D
Μ. I T O H
J.F. M A R K O W I T Z , H.W. A I G E S , 581
S. C U N N I N G H A M - R U N D L E S , Ε. K A H N ,
S. T E I C H B E R G , S.E. F I S H E R , A N D F. D A U M
J.E. K E L L O W , Ζ. T A O . A N D D.W. PIPER 590
H.J. F R E E M A N 596
J.L. W A L L A C E A N D B.J.R. W H I T T L E 603
viii C O N T E N T S G A S T R O E N T E R O L O G Y Vol. 91, No. 6
Serotonin Release Into Blood After Food and Pen-tagastrin. Studies i n Healthy Subjects and i n Patients W i t h Metastatic Carcinoid Tumors Impaired Transit of Chyme i n Chronic Intestinal Pseudoobstruction. Correction by Cisapride Release and Characterization of Cholecystokinin From Isolated Canine Jejunal Cells Trypsin Suppression of Pancreatic Enzyme Secret ion. Differential Effect on Cholecystokinin Release and the Enteropancreatic Reflex
Intracolonic WR 2721 Protection of the Rat Colon From Acute Radiation Injury
Spectrum of Rectal Biopsy Abnormalities i n Homosexual Men W i t h Intestinal Symptoms
Gastric Protection by Sucralfate. Role of Mucus and Prostaglandins
Ontogeny of Gastric Secretion i n the Rat. Ultra-structural Changes i n Relation to Secretory Changes
Translocation of Indigenous Bacteria From the Gastrointestinal Tract of Mice After Oral Ricinole-ic A c i d Treatment
LIVER A N D BILIARY TRACT
Chronobiological Study of Factors Affecting Plasma Aldosterone Concentration i n Cirrhosis
Levamisole Therapy i n Chronic Type Β Hepatitis. Results of a Double-Blind Randomized Trial
Distr ibution of Bi l iary Cholesterol Between Mixed Micelles and Nonmicelles i n Relation to Fasting and Feeding i n Humans
U t i l i t y of Bi l iary Microscopy for the Prediction of the Chemical Composition of Gallstones and the Outcome of Dissolution Therapy W i t h Ursodeoxycholic A c i d
Chemical and Morphologic Characteristics of Cholesterol Gallstones That Failed to Dissolve on Chenodiol. The National Cooperative Gallstone Study
CASE REPORTS
Pathological Findings of Lymphangiectasia of the Large Intestine i n a Patient W i t h Protein-Losing Enteropathy
U t i l i t y of Specimen Angiography i n Angiodyspla-sia of the Colon
Bil iary Ascariasis: Ultrasonography, Endoscopic Retrograde Cholangiopancreatography, and Bil iary Drainage
Diffuse Somatostatin-Immunoreactive D-Cell Hyperplasia i n the Stomach and Duodenum
G. R I C H T E R . F. STÖCKMANN, J.M. C O N L O N , 612
A N D W. C R E U T Z F E L D T
M . C A M I L L E R I , M . L . B R O W N , A N D 619
J-R. M A L A G E L A D A
D.L. B A R B E R , J.H. W A L S H . A N D A . H . S O L L 627
C. O W Y A N G , D. M A Y , A N D D.S. L O U I E 637
H.G. F R A N C E . Jr., R.L. J IRTLE, A N D 644
C M . M A N S B A C H . II
C M . S U R A W I C Z , S.E. G O O D E L L . T . C . Q U I N N . 651
P.L. R O B E R T S , L. C O R E Y , K.K. H O L M E S ,
M.D. S C H U F F L E R . A N D W.E. S T A M M
Τ. S H E A - D O N O H U E , L. S T E E L , E. M O N T C A L M , 660
A N D A. D U B O I S
D . M . J A C O B S , S .H. A C K E R M A N . A N D 667
R.D. S H I N D L E D E C K E R
J.L. M O R E H O U S E . R.D. S P E C I A N . J.J. S T E W A R T , 673
AND R.D. B E R G
M. B E R N A R D I , R. De P A L M A , F. T R E V I S A N I , 683
C. SANTINI , F. C A P A N I , M. B A R A L D I N I , A N D
G. G A S B A R R I N I
G. F A T T O V I C H , L. B R O L L O , P. P O N T I S S O , 692
E. P O R N A R O . M. R U G G E . A. A L B E R T I . A N D
G. R E A L D I
N.R. P A T T I N S O N A N D B.A. C H A P M A N 697
E. R O S . S. N A V A R R O , I. F E R N A N D E Z , 703
M. R E I X A C H , J.M. RIBO, AND J. R O D E S
H.S. F R E I L I C H , P.F. M A L E T , J.S. S C H W A R T Z , 713
R.D. S O L O W A Y , A N D T H E N A T I O N A L
C O O P E R A T I V E G A L L S T O N E S T U D Y G R O U P
H. A S A K U R A , M. T S U C H I Y A , S. K A T O H , 719
K. K O B A Y A S H I , Y. Y O N E I , T . Y O S H I D A ,
Y. H A M A D A , S. M I U R A , A. M O R I T A ,
S. K U R A M O C H I , A N D T. T E R A M O T O
S.M. A L D A B A G H , Y.P. T R U J I L L O , A N D 725
J.B. ΤΑΧΥ
P.S. K A M A T H , D.C. JOSEPH, R. C H A N D R A N , 730
S. R A M A R A O , M.L. SRI P R A K A S H , A N D
A.J. D ' C R U Z
G.E. H O L L E , W. S P A N N , W. E I S E N M E N G E R , 733
J. R I E D E L , A N D L. P R A D A Y R O L
December 1986 C O N T E N T S ix
Celiac Sprue Complicated by Lymphoma Presenting W i t h M u l t i p l e Gastric Ulcers
PROGRESS ARTICLE Intestinal I m m u n i t y and Inflammation: Recent Progress
EDITORIALS
a 2 -Adrenergic Agonists: A Newer Class of A n t i -diarrheal Drug Role of Biopsy i n Diagnosis of Rectal Infections Changing Concepts of Cholesterol Solubil i ty i n Bile
SELECTED SUMMARIES Cryptosporidium: A Growing Clinical Spectrum Malignant Histiocytosis or T-Cell Lymphoma? Direct Visualization of Lymphocytes Entering Peyer's Patches Alternative Strategies i n Crohn's Disease T i m i n g of Surgery for Gallstone Pancreatitis Shock Waves: Waves of the Future for Gallstone Treatment? Reply to Selected Summary: Flexible Sigmoidoscopy Training—Is Some Enough? (GASTROENTEROLOGY 1986;91:489-90)
BOOK REVIEWS CORRESPONDENCE NOTICES CLASSIFIED ADS
R.L. R O E H R K A S S E , I .M. R O B E R T S , A. W A L D ,
T . S . T A L A M O , A N D H. M E N D E L O W
C O . E L S O N , M.F. K A G N O F F , C. F I O C C H I ,
A.D. B E F U S , A N D S. T A R G A N
K. D H A R M S A T H A P H O R N
R.L. O W E N
G.J. SÖMJEN A N D T. G I L A T
740
746
769
770 772
776
777
778
779 780 781
782
784 787 793 796
NO. 4, OCTOBER 1986
AMERICAN GASTROENTEROLOGICAL ASSOCIATION
The Future of Digestive Diseases Research: Is There Cause for Concern? The Presidential Address
LIVER A N D BILIARY TRACT
Results of a Randomized Trial of End-to-Side Portacaval Shunt and Distal Splenorenal Shunt i n A l coholic Liver Disease and Variceal Bleeding
T-Lymphocyte Sensitization to Hepatocyte A n t i gens i n Auto immune Chronic Active Hepatitis and Primary Bi l iary Cirrhosis. Evidence for Different Underlying Mechanisms and Different Antigenic Determinants as Targets
Foscarnet Decreases Serum and Liver Duck Hepatit is Β Virus D N A i n Chronically Infected Ducks Serum Bile A c i d Concentrations During Pregnancy and Their Relationship to Obstetric Cholestasis
A L I M E N T A R Y TRACT
Somatomedin-C Levels i n Growth-Impaired Chi l dren and Adolescents W i t h Chronic Inflammatory Bowel Disease
|.S. T R I E R 797
H. A.J. H A R L E Y , T . M O R G A N , A . G . R E D E K E R , 802
T.B. R E Y N O L D S , F. V I L L A M I L , J.M. WEINER,
A N D A. Y E L L I N
S. V E N T O . C.J. O ' B R I E N , B.M. M c F A R L A N E , 810
I. G. M c F A R L A N E , A . L . W . F . E D D L E S T O N , A N D
R. W I L L I A M S
A . H . S H E R K E R , K. H I R O T A , Μ. O M A T A , A N D 818
K. O K U D A
M. L U N Z E R , P. B A R N E S . Κ. B Y T H , AND 825
M. O ' H A L L O R A N
B.S. K I R S C H N E R A N D M.M. S U T T O N 830
C O N T E N T S G A S T R O E N T E R O L O G Y Vol . 91, No
Effects of Topical 5-Aminosalicylic A c i d and Prednisolone on Prostaglandin E 2 and Leukotriene B 4
Levels Determined by E q u i l i b r i u m In Vivo Dialysis of Rectum i n Relapsing Ulcerative Colitis
Abnormal Sensory Perception i n Patients W i t h Esophageal Chest Pain Influence of the Oropharyngeal Microflora on the Measurement of Exhaled Breath Hydrogen
Transferrin Receptors in the Human Gastrointestinal Tract. Relationship to Body Iron Stores Effect of Ethanol on Intestinal Calcium Transport i n Chicks Distr ibut ion and Molecular Heterogeneity of Ga-lanin i n Human, Pig, Guinea Pig, and Rat Gastrointestinal Tracts
Effects of Corticotropin-Releasing Factor on Plasma M o t i l i n and Somatostatin Levels and Gastrointestinal M o t i l i t y i n Dogs A b o l i t i o n of Gas Reflux and Transient Lower Esophageal Sphincter Relaxation by Vagal Blockade i n the Dog
Esophageal Peristaltic Dysfunction i n Peptic Esophagitis I n h i b i t i o n of Gastric A c i d Secretion by Brain Peptides i n the Dog. Role of the Autonomic Nervous System and Gastrin Role of the Unstirred Layer i n Protecting the M u rine Gastric Mucosa From Bile Salt
Kinetic Assay of Human Gastric Lipase on Short-and Long-Chain Triacylglycerol Emulsions
Circadian Variation i n the Propagation Velocity of the Migrating Motor Complex
Intestinal Hydrolysis of Aspartylphenylalanine— The Metabolic Product of Aspartame
Arctic Trichinosis Presenting as Prolonged Diarrhea
Three-Dimensional Organization of the Lymphatics i n the Rabbit Appendix . A Scanning Electron and Light Microscopic Study
Electron Microscopic Study of Neuropeptide Y-Containing Nerve Elements of the Guinea Pig Small Intestine
Protection by Metals Against Ethanol-Induced Gastric Mucosal In jury i n the Rat. Comparative Biochemical and Pharmacologic Studies Implicate Protein Sulfhydryls
Gastric Mucosal Protection Against Ulcerogenic Factors i n the Rat Mediated by Capsaicin-Sensitive Afferent Neurons
Nature and Course of Pancreatitis Caused by 6-Mercaptopurine i n the Treatment of Inflammatory Bowel Disease
K. L A U R I T S E N , L .S . L A U R S E N . K. B U K H A V E ,
A N D J. R A S K - M A D S E N
J.E. R I C H T E R , C F . B A R I S H . A N D D.O. C A S T E L L
D.G. T H O M P S O N . J.D. O ' B R I E N . A N D
J.M. H A R D I E
D. B A N E R J E E . P.R. F L A N A G A N , J. C L U E T T . A N D
L S . V A L B E R G
D.D. B I K L E , E . A . G E E , A N D S.J. M U N S O N
F.E . B A U E R . T . E . A D R I A N , N.D. C H R I S T O F I D E S ,
G-L. F E R R I , N. Y A N A I H A R A . J.M. P O L A K . A N D
S.R. B L O O M
L. B U E N O . M.J. F A R G E A S . M. G U E ,
T . L . P E E T E R S . V. B O R M A N S , AND
J .FIORAMONTI
C.J. M A R T I N , J. P A T R I K I O S , A N D J. D E N T
P.J. K A H R I L A S , W.J. DODDS, W.J. H O G A N ,
M. K E R N . R.C. A R N D O R F E R . A N D A. R E E C E
H.J. L E N Z , R. K L A P D O R , S.E. H E S T E R ,
V.J. W E B B . R.F. G A L Y E A N , J.E. RIVIER, A N D
M.R. B R O W N
W.C. D U A N E , M.D. L E V I T T , N.A. S T A L E Y ,
A.P. M c H A L E , D.M. W I E G A N D . A N D
C A . F E T Z E R
Y. G A R G O U R I , G. PIERONI, C. R I V I E R E ,
J-F. S A U N I E R E . P.A. L O W E , L . S A R D A , A N D
R. B E R G E R
D. K U M A R , D. W I N G A T E , A N D Y. R U C K E B U S C H
N.A. T O B E Y A N D W.D. H E I Z E R
J. V I A L L E T , J.D. M a c L E A N , C A . G O R E S K Y ,
M. S T A U D T , G. R O U T H I E R , A N D C. L A W
Ο. O H T A N I , A. O H T S U K A , A N D R.L . O W E N
E. F E H E R A N D G. B U R N S T O C K
D. D U P U Y AND S. S Z A B O
P. H O L Z E R A N D W. S A M E T Z
C.J. H A B E R . S.J. M E L T Z E R , D.H. P R E S E N T , A N D
B.I. K O R E L I T Z
December 1986 C O N T E N T S xi
CASE REPORTS Liver Abscess i n Crohn's Disease. Report of Four Cases and Review of the Literature Radiation-Induced Intestinal Pseudoobstruction
Fragile Papilloma (Papillary Adenoma) of the Gallbladder. A Cause of Recurrent Biliary Colic
CLINICAL TRENDS A N D TOPICS Gastrointestinal Hormones and Gastrointestinal and Pancreatic Carcinomas
PROGRESS ARTICLE Effect of Ursodeoxycholic A c i d and Chenodeoxy-cholic A c i d on Cholesterol and Bile A c i d Metabolism
EDITORIALS Growth Retardation i n Chronic Inflammatory Bow- D M . M O C K
el Disease Variceal Bleeding: W h i c h Shunt? J.M. HENDERSON
SELECTED SUMMARIES Interaction of the Vagus and Enterogastrone to Inhib i t A c i d How D O Solids and Liquids Empty From the Stomach? Dietary-Induced Alterations i n Intestinal Transport—Or You Are What You Eat Diagnosis of Inflammatory Bowel Disease W i t h Sucralfate
HBV Vaccines Without HBsAg: Immune M i m i c r y Via Ant i id io type Antibodies Nuclear Bomb Explosions and the Age of Gallstones
Resection of Colorectal Metastases to Liver
BOOK REVIEWS CORRESPONDENCE NOTICES CLASSIFIED ADS PROGRAM OF THE MEETING OF THE AMERICAN MOTILITY SOCIETY
S . H . M I R - M A D J L E S S I . M.C. M c H E N R Y , A N D
R . G . F A R M E R
L . E . PERINO, M.D. S C H U F F L E R , S.). M E H T A ,
A N D G.T. E V E R S O N
Y. NIV, K. K O S A K O V . A N D B. S H C O L N I K
C M . T O W N S E N D , JR., P. S I N G H , A N D
I . C T H O M P S O N
G . S . T I N T , G. S A L E N , A N D S. S H E F E R
987
994
999
1002
1007
1019
1021
1024
1025
1026
1027
1027
1028
1029
1031 1035 1037 1040 1041
NO. 5, NOVEMBER 1986
A L I M E N T A R Y TRACT Gastrointestinal Lesions i n Hereditary Hemorrhagic Telangiectasia
Autoradiographic Localization of μ- and δ-Type Opio id Receptors i n the Gastrointestinal Tract of the Rat and Guinea Pig
Chronic Antra l Gastritis i n Duodenal Ulcer. Natural History and Treatment W i t h Prostaglandin E a
P. V A S E A N D O. G R O V E 1079
E. N I S H I M U R A , A.M.J. B U C H A N , A N D 1084
C . H . S . M c I N T O S H
W - M . HUI, S-K. L A M , J. HO, M.M-T. NG, I. L U I , 1095
C - L . L A I , A . S - F . L O K , W-Y. L A U , G-P. POON,
S. CHOI, A N D T - K . C H O I
xii C O N T E N T S G A S T R O E N T E R O L O G Y Vol. 91, No. 6
Colonic Transit Scintigraphy. A Physiologic A p proach to the Quantitative Measurement of Colonic Transit i n Humans
Variations of Gastric Transmucosal Potential Difference and Lesion Formation During Hemorrhagic Shock i n the Rat
Anorectal Ergotism: Another Cause of Solitary Rectal Ulcers
Porosity of the Basement Membrane Overlying Peyer's Patches i n Rats and Monkeys Effects of Intra luminal Epidermal Growth Factor on Mucosal Proliferation i n the Small Intestine of A d u l t Rats
Bethanechol Increases the Diagnostic Y ie ld i n Patients W i t h Esophageal Chest Pain Clostr idium difficile Cytotoxin Inhibits Protein Synthesis i n Fibroblasts and Intestinal Mucosa Cholecystokinetic and Pancreozymic Effect of O-Sulfated Gastrin Compared W i t h Nonsulfated Gast r i n and Cholecystokinin
Colonic Dysfunction Dur ing Cholera Infection
Mechanism of Increased Exocrine Pancreatic Secret ion i n Pancreatic Juice-Diverted Rats Bone Metastases i n Malignant Gastrinoma
Delayed Rectal Sensation W i t h Fecal Incontinence. Successful Treatment Using Anorectal Manometry Circadian Variation of Susceptibility to Gastric Mucosal In jury by Ac id i f i ed A s p i r i n or Absolute Ethanol i n the Rat
Healing and Relapse of Reflux Esophagitis D u r i n g Treatment W i t h Ranitidine
Increased HLA-DR Expression by Enterocytes i n Children W i t h Celiac Disease
Scintigraphic Measurements of Canine Ileocolonic Transit. Direct and Indirect Effects of Eating
Cholinergic Mediat ion of γ-Aminobutyric A c i d - I n duced Gastrin and Somatostatin Release From Rat A n t r u m
Role of Aldosterone i n the Regulation of Sodium and Chloride Transport i n the Distal Colon of Sodium-Depleted Rats Identification and Characterization of Brush-Border Membrane-Bound Neutral Metalloendopeptidases From Rat Small Intestine
Bile Salt Malabsorption i n Pancreatic Insufficiency Secondary to Alcohol ic Pancreatitis
B. K R E V S K Y , L . S . M A L M U D , F. D ' E R C O L E , 1102
A . H . M A U R E R , A N D R.S. F I S H E R
K. T A K E U C H I , Τ. O H N O , A N D S. O K A B E 1113
V . F . E C K A R D T , G. K A N Z L E R , A N D 1123
W. R E M M E L E
S.G. M c C L U G A G E , F .N. L O W , A N D M.L. Z I M N Y 1128
M.H. U L S H E N , L . E . L Y N - C O O K , AND 1134
R.H. R A A S C H
T . T . N O S T R A N T , J. S A M S , A N D T. H U B E R 1141
C. P O T H O U L A K I S , G. T R I A D A F I L O P O U L O S , 1147
M. C L A R K , C. F R A N Z B L A U , A N D J.T. L a M O N T
P. C A N T O R , L. P E T R O N I J E V I C , J.F. P E D E R S E N , 1154
A N D H. W O R N I N G
P. S P E E L M A N , T . B U T L E R , I. K A B I R , A. A L I . 1164
A N D J. B A N W E L L
K. S H I R A T O R I , Y . F . C H E N , W.Y. C H E Y , 1171
K . Y . L E E , A N D T - M . C H A N G
J.C. B A R T O N , B.I. H I R S C H O W I T Z , P.N. M A T O N . 1179
A N D R.T. J E N S E N
W.D. B U S E R A N D P.B. MINER, JR. 1186
C . E . O L S O N , A . H . S O L L , AND P.H. G U T H 1192
H.R. K O E L Z , R. B I R C H L E R , A. B R E T H O L Z , 1198
B. BRON, Y. C A P I T A I N E , G. D E L M O R E .
H.F . F E H R , I. F U M A G A L L I , J. G E H R I G ,
J.J. G O N V E R S , F. H A L T E R , B. H A M M E R ,
L. K A Y A S S E H , E . K O B L E R , G. M I L L E R ,
G. MÜNST, S. P E L L O N I , S. R E A L I N I ,
P. SCHMID, M. V O I R O L , A N D A . L . B L U M
F. A R N A U D - B A T T A N D I E R , 1206
N. C E R F - B E N S U S S A N , R. A M S E L L E M , A N D
J. S C H M I T Z
R.C. S P I L L E R , M.L. B R O W N . S.F. P H I L L I P S . 1213
A N D F. A Z P I R O Z
R.F. H A R T Y A N D P.A. F R A N K L I N 1221
J. H A L E V Y , M.E. BUDINGER, J.P. H A Y S L E T T , 1227
A N D H.J. BINDER
I-S. S O N G , M. Y O S H I O K A , R.H. E R I C K S O N , 1234
S. M I U R A , D. G U A N , A N D Y . S . K I M
S.K. D U T T A , K. A N A N D , A N D T.R. G A D A C Z 1243
December 1986 C O N T E N T S xiii
Cholinergic Modula t ion of the Release of Seroton i n i n the Gastric Interstitial F l u i d . A n I n Vivo Study i n Rabbits
LIVER A N D BILIARY TRACT A New Method to Assay Des-y-Carboxyprothrom-b i n . Results Obtained i n 75 Cases of Hepatocellular Carcinoma Sex Hormone-Related Functions i n Regenerating Male Rat Liver
Effect of Glucagon on Alcohol Dehydrogenase Act i v i t y i n Rat Hepatocyte Culture
Demonstration of a Transcellular Vesicle Pathway for Bi l iary Excretion of I n u l i n i n Rat Liver
CASE REPORTS Magnetic Resonance Imaging Diagnosis of B u d d -Chiari Syndrome
M e t h y l tert-Butyl Ether Fails to Dissolve Retained Radiolucent Common Bile Duct Stones
Esophageal Cryptosporidiosis i n a C h i l d W i t h Acquired Immune Deficiency Syndrome
EDITORIALS Asiatic Cholera: Nature's Experiment?
Diagnosis of Primary Hepatocellular Carcinoma SELECTED SUMMARIES
Preoperative Chemotherapy i n Esophageal Cancer Differing Incidence and Long Latency of Malignancy After Gastric Surgery Effect of Cholecystokinin on Gastric Emptying
Pigment i n the Center of Cholesterol Gallstones— Colorful , but Pathogenically not Important? Feeding and Epidermal Growth Factor Insul in and the Colon Heterogeneity of Goblet Cells i n the H u m a n Colon
Reply to Selected Summary: Resection of Colorectal Metastases to Liver (GASTROENTEROLOGY 1986;91:1029-30)
BOOK REVIEWS CORRESPONDENCE CORRECTION NOTICES CLASSIFIED ADS
NO. 6, DECEMBER 1986
LIVER A N D BILIARY TRACT Randomized Tria l of Chlorambucil for Primary B i l iary Cirrhosis
M . P A I R E T , O. M E I R I E U , T . B A R D O N , A N D
Y . R U C K E B U S C H
J-P. S O U L I E R , D. G O Z I N , A N D
J-J. L e F R E R E
A. F R A N C A V I L L A , P.K. E A G O N , A. D i L E O ,
L . P O L I M E N O , C. P A N E L L A , A . M . A Q U I L I N O ,
M . I N G R O S S O , D . H . V A N T H I E L , A N D
T . E . S T A R Z L
Ε. M E Z E Y , J.J. P O T T E R , A N D D.L . R H O D E S
I. L O R E N Z I N I , S. S A K I S A K A , P.J. M E I E R , A N D
J.L. B O Y E R
A . C . F R I E D M A N , P. R A M C H A N D A N I ,
M. B L A C K , D.F . C A R O L I N E , P.D. R A D E C K I ,
A N D P. H E E G E R
C . Di P A D O V A , F . Di P A D O V A , W. M O N T O R S I ,
A N D R. T R I T A P E P E
P .G. K A Z L O W , K. S H A H , K.J. B E N K O V ,
R. D I S C H E , A N D N.S. L e L E I K O
S.F . P H I L L I P S
M.J. T O N G
J.H. H O O F N A G L E , G . L . D A V I S , D.F . SCHÄFER,
Μ. P E T E R S , M.I. A V I G A N , S . C P A P P A S ,
R.G. H A N S O N , G.Y. MINUK, G.M. D U S H E I K O ,
G. C A M P B E L L , R.N.M. M a c S W E E N , A N D
E . A . JONES
1250
1258
1263
1271
1278
1289
1296
1301
1304
1306
1308
1309
1310
1311
1312 1313 1314 1315
1316 1320 1321 1322 1326
1327
xiv C O N T E N T S G A S T R O E N T E R O L O G Y Vol. 91, No. 6
Dynamics of Hepatic Glycosaminoglycan Accumulation in Murine Schistosoma japonicum Infection Low-Protein-Concentration Ascitic Fluid Is Predisposed to Spontaneous Bacterial Peritonitis Brain Edema in Rabbits With Galactosamine-Induced Fulminant Hepatitis. Regional Differences and Effects on Intracranial Pressure Detection of Hepatitis Β Virus Infection in Hepatitis Β Surface Antigen-Negative Hemodialysis Patients by Monoclonal Radioimmunoassays Reflex Regulation of Flow Resistance in the Feline Sphincter of Oddi by Hydrostatic Pressure in the Biliary Tract
A L I M E N T A R Y T R A C T
Life Events Stress and Psychosocial Factors in Men With Peptic Ulcer Disease. A Multidimensional Case-Controlled Study Effect of Transection and Pacing on Human Jejunal Pacesetter Potentials Peptide Y Y Release by Fatty Acids Is Sufficient to Inhibit Gastric Emptying in Dogs
Effect of Intragastric Infusions of Ethanol and Wine on Serum Gastrin Concentration and Gastric Acid Secretion
Prevalence and Incidence of Inflammatory Bowel Disease in Family Members Structural Features of Absorptive Cell and Microvillus Membrane Preparations From Rat Small Intestine Early Microcirculatory Stasis in Acute Gastric Mucosal Injury in the Rat and Prevention by 16,16-Dimethyl Prostaglandin E 2 or Sodium Thiosulfate
Central Nervous System Influence of Prostaglandin E 2 on Jejunal Water and Electrolyte Transport in Conscious Dogs
Rat Pancreatic Zymogen Granules. A n Actively Acidified Compartment
Charge Selectivity of Rat Intestinal Capillaries. Influence of Polycations Comparison of the 1-Gram [ 1 4C]Xylose, 10-Gram Lactulose-H 2, and 80-Gram Glucose-H 2 Breath Tests in Patients With Small Intestine Bacterial Overgrowth
Influence of Food and Marker Length on Gastric Emptying of Indigestible Radiopaque Markers in Healthy Humans
Superficially Invasive Squamous Cell Carcinoma of the Esophagus. A Study of Seven Cases in Memphis, Tennessee
Altered Calcium-Handling Properties of Jejunal Smooth Muscle From the Nematode-Infected Rat Central a:2-Adrenergic Control of the Pattern of Small Intestinal Motility in Rats
G.R. O L D S , C. F I N E G A N , A N D T . F . K R E S I N A 1335
B.A. R U N Y O N 1343
P.G. T R A B E R , D.R. G A N G E R , A N D A . T . B L E I 1347
Y . K . FUJITA, Κ. K A M A T A , Η. K A M E D A , 1357
K.J. I S S E L B A C H E R , AND J.R. W A N D S
A. T H U N E , Ε. T H O R N E L L , A N D J. S V A N V I K 1364
M. F E L D M A N , P. W A L K E R , J.L. G R E E N , A N D 1370
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T . N . P A P P A S , H.T. D E B A S , A . M . C H A N G , AND 1386
I .L . T A Y L O R
W.L. P E T E R S O N , C. B A R N E T T , A N D 1390
J.H. W A L S H
B. A. L A S H N E R , A .A. E V A N S , J.B. K I R S N E R , 1396
A N D S.B. H A N A U E R
D.J. BJORKMAN, C . H . A L L A N , S.J. HÄGEN. 1401
A N D J.S. T R I E R
G. P I H A N , D. MAJZOUBI, C. H A U D E N S C H I L D , 1415
J.S. T R I E R , A N D S. S Z A B O
M.P. PRIMI AND L. B U E N O 1427
C. N I E D E R A U , R.W. Van D Y K E , 1433
B. F. S C H A R S C H M I D T , A N D J.H. G R E N D E L L
D. N. G R A N G E R , P.R. K V I E T Y S , M A . P E R R Y , 1443
A N D A . E . T A Y L O R
C. E. K I N G AND P.P. T O S K E S 1447
H. J. S M I T H AND M. F E L D M A N 1452
L.W. S C H M I D T , P.J. D E A N , AND R.T. W I L S O N 1456
A . E . F O X - R O B I C H A U D A N D S.M. C O L L I N S 1462
M.J. F A R G E A S , J. F I O R A M O N T I , A N D 1470
L. B U E N O
D e c e m b e r 1986 C O N T E N T S xv
Folic A c i d Malabsorption i n Atrophic Gastritis. Possible Compensation by Bacterial Folate Synthesis
Phenotypic Analysis of Lamina Propria Lymphocytes. Predominance of Helper-Inducer and Cytolyt ic T-Cell Phenotypes and Deficiency of Sup-pressor-Inducer Phenotypes i n Crohn's Disease and Control Patients
A Laboratory Index for Predicting Relapse i n Asymptomatic Patients W i t h Crohn's Disease
Production of Secretory Immunoglobul in A in Rat Self-Fil l ing B l i n d Loops. Local Secretory Immunoglobul in A Immune Response to Luminal Bacterial Flora
Oncogene Alterations i n Primary Human Colon Tumors Growth Characteristics of Autochthonous Experimental Colonic Tumors as Assessed by Serial Colonoscopic Measurement i n Rats
Intestinal Adaptation. Different Growth Responses to Disaccharides Compared W i t h Monosaccharides i n Rat Small Bowel
Famil ial Visceral Neuropathy W i t h Autosomal Dominant Transmission
Effect of Cigarette Smoke on Esophageal Epitheliu m of the Rabbit
CASE REPORTS Colonic Varices. Report of an Unusual Case Diagnosed by Radionuclide Scanning, W i t h Review of the Literature Chronic Mesenteric Vascular Insufficiency W i t h Gastric Ulceration Monozygotic Triplets W i t h Crohn's Disease of the Colon
CLINICAL TRENDS A N D TOPICS Gallstone Dissolution Therapy. Current Status and Future Prospects
SELECTED SUMMARIES Intrinsic Reflexes Between the Esophagus and Stomach To Treat or not to Treat
Hepatic Vi tamin A Metabolism
Move Over Acetaldehyde, Here Come the Fatty A c i d Ethyl Esters!
Fibrosis and Granulomas i n the Liver Due to Bacterial Cell Wal l Components Risks and Benefits of Percutaneous Transhepatic Bil iary Drainage Reply to Selected Summary: How Do Solids and Liquids Empty From the Stomach? (GASTROENTEROLOGY 1986;91:1025-6)
R.M. R U S S E L L , S.D. K R A S I N S K I ,
I .M. S A M L O F F , R.A. JACOB, S C . H A R T Z , A N D
S.R. B R O V E N D E R
S.P. JAMES, C. F I O C C H I . A . S . G R A E F F , AND
W. S T R O B E R
C. B R I G N O L A , M. C A M P I E R I , G. B A Z Z O C C H I .
P. F A R R U G G I A , A. T R A G N O N E , A N D
G.A. L A N F R A N C H I
S. L I C H T M A N , P. S H E R M A N , A N D
G. F O R S T N E R
R.J. A L E X A N D E R , J.N. B U X B A U M , A N D
R.F . R A I C H T
S.R. H A M I L T O N , S-Z. Z H A N G ,
D. O ' C E A L L A I G H , A N D D. M c A V I N C H E Y
E. WESER, J. B A B B I T T . Μ. H O B A N , AND
A. V A N D E V E N T E R
E . A . M A Y E R , M.D. S C H U F F L E R , J.I. R O T T E R .
P. H A N N A , AND M. M O G A R D
R.C. O R L A N D O . J.C. B R Y S O N . A N D
D.W. P O W E L L
H. GUDJONSSON. D. Z E I L E R , R.L . G A M E L L I .
AND M.D. ΚΛΥΕ
R.D. C H E R R Y . M. JABBARI. C A . G O R E S Κ Y,
M. H E R B A , D. R E I C H . A N D P.E. B L U N D E L L
J. P U R R M A N N . J. B E R T R A M S , F. B O R C H A R D ,
B . M I L L E R , S . C L E V E L A N D , T . S T O L Z E , AND
G. S T R O H M E Y E R
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H . F R O M M
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G A S T R O E N T E R O L O G Y 1986;91:733-9
Diffuse Somatostatin-Immunoreactive D-Cell Hyperplasia in the Stomach and Duodenum
G. E. H O L L E , W. SPANN, W. EISENMENGER, J. RIEDEL, and L. PRADAYROL Surgical University Clinic and Policlinic, Munich-Center, Munich; University Institute of Forensic Medicine, Munich, Federal Republic of Germany; and I N S E R M U 151, CHU-Ranguil, Toi'lou^e France
This paper presents the first case of extensive, diffuse, somatostatin-immunoreactive D-cell hyperplasia in the human stomach and duodenum. It occurred in a 37-yr-oId woman, who showed clinical signs of dwarfism, obesity, dryness of the mouth, and goiter. The density of the distribution of Ό cells was increased 39-fold in the stomach fundus, 23-fold in the proximal antrum, 25-/oJd in the distal antrum, and 31 -fold in the upper duodenum in comparison with normal values. At the same time, the gastrin-immunoreactive cells were increased 2.3-fold in the antrum. Although the range in size of the D cells was within normal limits in all regions examined, the G cells showed pronounced hypertrophy of up to 127%. A possible relationship between the immuno-histochemicaJ findings and the clinical picture is discussed.
Somatostatin is widely distributed in neurons and fibers in the central nervous system, especially in the hypothalamic region (1) and throughout the nervous
Received October 2, 1985. Accepted March 13, 1986. Address requests for reprints to: G. E . Holle, M.D., Lecturer in
Pathophysiology, Ludw. Max. University, Munich; Surgical University Clinic and Policlinic, Munich-Center, Gastroenterology Research Laboratory, Pettenkoferstrasse 8a, 8000 Munich 2, Federal Republic of Germany.
This work was supported by the Deutsche Forschungsgemeinschaft, Bad Godesberg, F .R.G. , Ho 936/1-2.
A n extract of this paper was presented at the 18th meeting of the European Association of Gastroenterology and Endoscopy and was awarded the first prize for the best presentation, March 14, 1986.
The authors thank Professor E . Wünsch of the Max-Planck Institute for Biochemistry, Martinsried, F .R .G. for the somatostatin 28 and gastrin 17 and 34; Professor W. G. Forssmann, of the Anatomy Institute at the University of Heidelberg, F .R.G. for the gastrin-antibody serum; Mrs. A. Ruhfus for skillful technical assistance; and Mrs. Jennifer Grüner for translation assistance.
© 1986 by the American Gastroenterological Association 0016-5085/86/$3.50
system of the digestive tract. It is also produced and stored in considerable amounts in the D cells in the intestinal mucosa and in the pancreas (2,3). Here, it may act (in part) in a paracrine, mainly inhibitory manner (4), but stimulated somatostatin also enters the circulation (5). Somatostatin controls hormones of the gastrointestinal tract and the pancreas (6), the endocrine function of the anterior pituitary (7), the thyroid gland (8), the salivary gland (9), and the urinary excretory system. It achieves homeostasis of nutrients in a wide range (10,11) and influences functional maturation, growth, and behavior (12-14).
Taking into account some deviations in different laboratories, somatostatin blood levels are highest in the portal vein at 100 pg/ml. This is a clear indication of the extensive production of somatostatin in the upper gastrointestinal tract. In the general circulation, physiologic levels in the fasting state are —29 ± 5 pg/ml, and in the postprandial state after carbohydrate, protein, and fat they are 48 ± 7, 74 ± 8, and 80 ± 9 pg/ml, respectively (15). The level is highest after a mixed meal (16). At these levels somatostatin influences insulin and glucagon release, indicating its endocrine function (17). The somatostatin present in the cerebrospinal fluid ranges —35.4 pg/ml (18).
Since 1979, pathological increased levels of circulating somatostatin have been described in sporadic cases of solid somatostatin tumors and in somatostatinomas containing subpopulations of other endocrine cells (19,20). Like gastrinomas, the tumors were mostly malignant and with few exceptions were predominantly located in the pancreas: two tumors in the duodenum (21,22) and one in the jejunum (23). The clinical symptoms were heterogeneous and depended on the serum somatostatin levels and probably on the composition of the different molecular weight forms of the circulating
734 H O L L E E T A L . G A S T R O E N T E R O L O G Y Vol. 91, No. 3
hormones (24,25), the hormonal heterogeneity of some somatostatinomas, and probably on the varying degrees of target organ resistance to the increased hormone levels (26).
Case Report A 37-yr-old woman died suddenly exhibiting nau
sea and dyspnea. A n autopsy was performed within 6 h. The fresh, macroscopically inconspicuous stomach was prepared for the purpose of studying the normal distribution of special cell populations, including the peptide hormone cells in the stomach mucosa.
Retrospective inquiry into the case history revealed the following. From early infancy on, the woman showed retarded growth, but she was slender until puberty. Later, she became obese. She was hypokinetic and except for an appendectomy, a tonsillectomy, and a motoring accident 7 mo before death, she never felt i l l . She sometimes used contraceptives and had irregular menstrual cycles. On the whole, she displayed retarded sexual behavior and became increasingly lethargic and sleepy. Weight, and especially thirst, increased continuously until they reached pathological levels (>3L/day of liquids, some of which was cola-flavored soda). At death she was 146 cm tall and weighed 97 kg-
During the time when she was hospitalized for her accident, the following was observed: extreme dryness of the oral cavity and an unstable blood pressure reading between 120/80 mmHg and 180/110 mmHg. Some abnormal laboratory results were available from the 4-6-mo period before death (numbers in parentheses are normal values): a 2-globulin, 12.30 relative % (4.7-9.5 relative %) ; serum cholesterol, 243 mg/dl (<220 mg/dl); γ-glutamyl-transpeptidase, 27.4 U/L (4-18 U/L); potassium level, 3.29 mmol/L (3.5-5.0 mmol/L). Urinalysis and creatinine clearance, as well as fasting glucose levels (82.0 and 95.0 mg/dl, normal = 50-120 mg/dl), were normal. She had very fragile bones with very thin corticalis. A slight trauma resulted in a humerus fracture followed by a very prolonged healing process.
Autopsy showed bilateral pulmonary embolism as the cause of death. The weights of various organs were as follows: brain, 1394 g; heart, 394 g; lungs, 660 g; liver, 2115 g; and spleen, 256 g. The enlargements were between 7% and 46%. The pancreas was of normal size and weight, she had a nodular goiter of considerable size, and abscess cavities were found at the upper pole of the left kidney.
Materials and Methods
After removal of its contents, the stomach was opened at the greater curvature, washed in ice water, prepared in 10 longitudinal strips, fixed in Bouin's fluid for 24 h, dehydrated, and embedded in paraffin. From the total material (including corpus-fundus, the total antrum, and the upper duodenum), complete sagittal sections from the surface to the muscle layers were prepared alternately as follows for differential cell counts: (a) hematoxylin and eosin dye for the total gland cells; (b) modified Zimmermann dye for the parietal cells and mucous neck cells;
(c) Masson-Fontana for the enterochromaffin cells; and (d) the peroxidase-antiperoxidase method after Sternberger (27) for gastrin-immunoreactive cells and somatostatin-immunoreactive cells.
The antisera came from rabbits after immunization with (a) synthetic human gastrin 17 and 34 from E. Wünsch (prepared and tested by W. G. Forssmann) and (b) synthetic somatostatin 28 (octacosapeptide) from E. Wünsch. L. Pradayrol prepared and tested the somatostatin 28 antibody serum by radioimmunoassay to exclude cross-reactivity against 18 gastrointestinal hormones at the 100-ng level. A l l antisera were used in a dilution of 1:1000, with an incubation time of 72 h. Sections incubated with antiserum inactivated by addition of an excess of the respective antigen (50 μg of synthetic somatostatin 28 per milliliter of diluted antiserum) were used as controls.
Cell counts were carried out according to the method jointly developed with A. Schauer (28). In an area of 5000-8000 nuclei-containing gland cells, the specific cells were identified on a drawing microscope, outlined, counted, and determined by percentage of the total number of gland cells. The count method gives as a result the density of the cell population in the tissue. Each counted tissue block (~2 cm in length) was subdivided into an oral and aboral measuring area. The total antrum was exam-
MAC MAC
AW Anterior Wall PW Posterior Wall
A Antrum Py Pylorus
MIC minor curvature side MAC major curvature side
I II III IV
Fundus prox. Antrum dist. Antrum Duodenum
-10 tissue blocks
Figure 1. Diagram of the measuring fields in the stomach fundus-corpus, the proximal and distal antrum, and the proximal duodenum. Every numbered tissue block is subdivided into an oral and aboral measuring area.
September 1986 D - C E L L H Y P E R P L A S I A IN D W A R F I S M A N D O B E S I T Y 735
Size of Somatostatin u D-CeUs in the stomach Fundus, prox. Antrum, dist. Antrum and Duodenum
Figure 2. Evaluation of somatostatin-immuno-reactive U cells in the upper gastrointestinal tract of patient D.R. in comparison with normal values (N). Top panel: size of D cells ascertained as an average of 100-150 cells . Bottom panel: percentage of D-cell population of each in an area of 500-8000 total mucosal gland cells.
80-
70
60
50 PA d A
Number 7< 20η
F Fundus pA prox. Antrum dA dist. Antrum D Duodenum
SD 10 tissue blocks so n=12
F p A d A D
Number % of Somatostatin i.r. D-Cett Population in the
Stomach Fundus, Antrum and Duodenum
ined completely. Counting results for our patient were given from four representative circular strips: (a) the distal fundus, (b) the proximal antrum, (c) the distal antrum, and (d) the proximal duodenum (Figure 1). The data express the mean values of the results of all measured areas of the 10 and 8 tissue blocks from each total circumference.
G cells and D cells were surface analyzed using the semicomputerized Leitz ASM analytical system. The mean values of 100-150 nucleus-containing cells were determined for each examination. The mucosal thickness and the length of the histologic antrum were determined with the same equipment. The control values for comparison were taken from a separate study on the normal distribution of gastrin- and somatostatin-immunoreactive cells in the human stomach from 12 healthy subjects of different age and sex who died in accidents (G. E. Holle et al., in preparation). Bioptic material was also compared from peptic ulcer patients preoperatively and postoperatively (29,30).
Results I n the present case, the stomach was of normal
size and shape. The length of the histologic antrum ranged f rom 4.5 cm at the lesser curvature to 6.2 cm at the major curvature. The mucosal thickness was 1066 ± 118 μτη i n the stomach fundus, 869 ± 73 μτη i n the proximal antrum, and 833 ± 63 μτη i n the distal antrum. The tubular-shaped course of the fundus glands showed high parietal cell numbers w h i c h were between 20% and 30% of the total number of fundus gland cells. The anatomic arrangement of the pyloric glands was regular. Likewise, scattered islets w i t h inflammatory inf i l t ra t ion i n the gastric antrum were w i t h i n the normal range. The density of the somatostatin-immunoreactive D-cell populat ion was 2.38% ± 1.78% i n the fundus-corpus, 14.46% ± 2.89% i n the proximal antrum,
736 H O L L E E T A L . G A S T R O E N T E R O L O G Y Vol. 91, No 3
Size of Gastrin i.r Cells in the Stomach Fundus, Antrum and Duodenum
no
100
80
70
LO
20-
pA d A
# p<0,01
- Γ -Ο
* p<0.01 * * p<0.05
Figure 3. Evaluation of gastrin immunoreactive cells in the upper gastrointestinal tract of patient D.R. in comparison with normal values (N). Top panel: size of G cells ascertained as an average of 150 cells. Bottom panel: percentage of G-cell population of each in an area of 5000-8000 total mucosal gland cells.
F Fundus pA prox. Antrum dA dist. Antrum D Duodenum
OR. patient Ν Normal
so 10tissue blocks SD η = 12
F pA dA D
Number % of Gastrin i.r. Cell Population in the Stomach Fundus, Antrum and Duodenum
15.58% ± 3.59% in the distal antrum, and 1.53% ± 0.57% in the proximal duodenum. In comparison with the density of the somatostatin-immunorea-ctive cells in normal stomachs (0.06% in the fundus, 0.62% in the antrum, and 0.07% in the upper duodenum), this means a 39-fold increase in the density of the somatostatin-immunoreactive cells in the stomach fundus, a 23-fold increase in the proximal antrum, a 25-fold increase in the distal antrum, and a 21-fold increase in the upper duodenum (Figure 2).
In all regions, the size of the somatostatin-immunoreactive D cells was normal, with 77 ± 9 μπι2 in the fundus, 74 ± 7 μπι2 in the proximal antrum, 65 ± 9 μ,πι2 in the distal antrum, and 73 ± 5 / im 2 in the upper duodenum. In the antrum, somatostatin-immunoreactive D-cell sizes had a tendency to become smaller from the oral to the aboral area, but the differences are not significant.
In comparison to D-cell distribution, the fundus-
corpus showed only a few scattered G cells. The G cells in the proximal antrum amounted to 10.51% ± 2.58%, in the distal antrum 12.51% ± 3.34%, and in the proximal duodenum 1.95% ± 0.99%. This means a 2.3-fold increase in the number of G cells over the normal values. In addition, the G-cell sizes were increased by —127% compared with normals, with mean values of 106 ± 4.8 μπι2 in the stomach fundus, 108 ± 7.6 μπι2 in the proximal antrum, 102 ± 7.33 μπι2 in the distal antrum, and 94 ± 13 μπι2 in the upper duodenum (Figure 3). The somatostatin/gastrin quotient, which is normally —0.12, was far above 1 in all test regions.
Discussion The present study gives the first description of
an excessive, diffuse somatostatin-immunoreactive D-cell hyperplasia in the stomach and duodenum,
Figure 4. D cells in the stomach fundus-corpus approximate to parietal and chief cells. Stain: PAP, 1 χ 1000.
Fgure 5. D-cell hyperplasia in the stomach antrum. Stain: PAP, 1 x 250.
738 H O L L E E T A L . G A S T R O E N T E R O L O G Y Vol . 91, No. 3
w i t h values between 20 and 40 times above normal . The diagnosis was ascertained postmortem i n a w o m a n w i t h m u l t i p l e c l in ica l features, e.g., dwarfism (the height of an 11-yr-old female ch i ld) , obesity, dryness of the m o u t h , and goiter. There was no evidence available as to whether a possible retarded splanchnic c i rcula t ion result ing f r o m an i n creased serum somatostatin level was responsible for the thrombosis.
The cytochemistry showed strong reactivity w i t h somatostatin 28 ant ibody serum (Figures 4 and 5). L. Pradayrol detected, extracted, and described the structure of somatostatin 28 f r o m the intestine (31), as we recognize somatostatin 28 as the m a i n biologically active molecular f o r m i n the intestine (32). Hypothalamus and pancreas have been found to contain equimolar amounts of somatostatin 14 and somatostatin 28 (33). However , somatostatin 28 binds w i t h 3.2 times greater aff inity to receptors involved i n the control of g r o w t h hormone secretion, and it acts there w i t h o u t pr ior cleavage to the smaller molecule (34). We should assume that i n our case, somatostatin 28 predominated i n the mucosa of the stomach and d u o d e n u m as w e l l as i n the general c irculat ion.
Analogous to the elevated serum-gastrin levels i n Z o l l i n g e r - E l l i s o n s y n d r o m e a n d a n t r a l G-cel l hyperplasia, we conclude f r o m the extensive somatostatin cell hyperplasia i n the upper gastrointestinal tract of our patient, that elevated serum somatostatin levels may have been present. As our patient underwent continuous s t imula t ion through polyphagia, we are even more convinced. Pathological increases of somatostatin serum levels of between 40-fold and 100-fold greater than normal values are k n o w n f r o m somatostatinomas (9000-1300 pg/ml) . These were accompanied by very l o w basal serum growth hormone levels (0.8 ng/ml) , w i t h o u t any response to st imulat ion i n hypothalamic and pi tu i tary functional tests (20,21).
I n considering the retarded g r o w t h of our patient i n relation to a possible hypersomatostatinemia, we conclude that the endocrine abnormali ty i n the upper gastrointestinal tract must have existed since early infancy, possibly as a developmental defect (35). It is k n o w n that c i rculat ing hormones have the abil i ty to interfere w i t h certain centers i n the central nervous system (36). E s p e c i a l l y i n the paraventricular region of the t h i r d ventricle , h ighly permeable fenestrated capillaries pierce the blood-brain barrier (37) and permit a t h r o t t l i n g of the growth hormone release and t h y r o t r o p i n release (possibly also growth hormone releasing hormone) through chronica l ly increased somatostatin b lood levels (38,39). A parallel mechanism is k n o w n f r o m ectopic growth hormone releasing hormone-producing t u
mors accompanied by acromegaly (40,41). The latter can be influenced by somatostatin administration into the general c irculation.
Further research, especially concerning circulating somatostatin serum levels [for example, i n idiopathic growth hormone deficiency patients (42) or in disorders of the thyrot ropin releasing hormone-thyrotropin system], could probably help to clarify syndromes like the one under discussion. By this connection, the mucosa of the gastrointestinal tract should be recognized as an integral endocrine organ, and a gut-brain axis can be assumed.
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