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The aim of our study was to explore the effect of clonidine on the mouth to caecum transit time in healthy man. Hydrogen-breath test, using lactulose 10 g, was carried out in 10 healthy male volunteers, in double-blind conditions and in random sequences of medications, placebo or clonidine (0.3 mg per os). Clonidine increased the mouth to caecum transit time significantly (p = 0.013): from 85 +/- 12 min. (with placebo) to 139 +/- 16 min. (mean +/- SE). This study suggests that the antidiarrheal action of clonidine is due, at least in part, to effect on motility of the proximal gut.

Twenty-five cases of non-infectious, macroscopic colitis, observed consecutively in patients over 70, were studied. The final diagnosis was, in 12 instances, ischemic colitis, in 10 instances cryptogenetic colitis (6 ulcerative colitis and 4 Crohn's diseases), and in 3 instances, non-classified colitis. The clinical manifestations consisted of rectal bleeding (92%), abdominal pain (76%) and diarrhea (56%). In 3 cases, the ano-perineal lesions observed in Crohn's diseases were noted and, in one case, a pyoderma gangrenosum was present. Endoscopy and/or barium enema showed a lesion of the left colon in 92% of the cases and of the sigmoid colon in 80% of the cases. The prognosis was severe, requiring surgery in 32% of the cases (5 ischemic colitis, 3 cryptogenetic colitis), and a 24% mortality (3 ischemic colitis, 3 ulcerative colitis), secondary to the condition and the extent of the colic involvement. The best factors of the etiological diagnosis of colitis were: the type of onset of the symptoms, the presence of anal or cutaneous lesions, the information provided by endoscopy and histology, which were specific in 11 out of 20 cases. In 5 cases, the diagnosis was only made by examination of the surgical specimen; in 3 cases, the diagnosis remained uncertain. These results suggest that the clinical data combined with an early, minimally traumatizing left endoscopy in elderly patients, should allow a quick, positive and etiological diagnosis of colitis, in order to initiate a suitable treatment in most cases.

Intestinal absorption after extensive small bowel resections, for diseases other than Crohn's disease, was studied in 17 patients. When the ileocecal valve and the right colon were preserved, malabsorption was transient and moderate and had no prejudicial nutritional effect (fecal fat: 8.8 +/- 1.8 g/24 h in resections sparing the 2 distal bowel loops, and 16.2 +/- 4.8 g/24 h in resections including the distal ileum; mean +/- SEM). When colectomy was associated, malabsorption was severe and persistent (fecal fat: 47.4 +/- 12.2 g/24 h; mean +/- SEM). These findings suggest that the most important prognostic factor in extensive small bowel resection is the site of the resection, and particularly the presence or absence of the right colon and ileocecal valve.

This paper reports a rare case of a patient with biclonal gammopathy IGM kappa and IgG lambda corresponding to the simultaneous occurrence of the clinical manifestations of Waldenström's macroglobulinemia and multiple myeloma. Two cellular populations derived from the B lymphocyte cell line can be observed in this patient. Bone marrow aspiration revealed abnormal plasma cells with inclusions and lymph node aspiration showed immature lymphoid cells containing mu heavy chains.

21 patients with alcoholic cirrhosis were worked up for malabsorption. In three patients, the fecal weight was over 200 g/24 h; three had a steatorrhea over 6 g/24 h and in four the creatorrhea was over 2 g/24 h. The D-xylose test was abnormal 4 times out of 18, but these 4 patients presented an ascites. Alpha-1-antitrypsin clearance was increased in 1 out of 9 patients. The Lundh test demonstrated in 5 out of 8 cases an external pancreatic insufficiency, but without any relation with the fecal losses. The 4 patients with malabsorption showed signs of malnutrition (anthropometric criteria). In the course of an alcoholic cirrhosis, malabsorption seems therefore infrequent, dissociated, and only observed in patients with signs of malnutrition.

Rectocolitis remains, at the present time, in spite of the large amount of work carried out, a condition of which the cause and the physiopathological mechanism are unknown: none of the theories proposed has been confirmed by the facts; none has made it possible to propose an effective therapeutic regimen. The diagnosis of haemorrhagic rectocolitis rests solely on an assembly of clinical, radiological, and anatomological findings, together with findings on progress of the disease; none of these findings taken separately being pathognomonic. Because of this it is essential in cases of inflammatory colic disorders to analyse critically these different elements before affirming the diagnosis that is often arrived at too easily. Different affections, even apart from Crohn's disease (parasitic, microbial, and iatrogenic affections, etc) may, in fact, give rise to radiological and clinical pictures close to those of haemorrhagic rectocolitis.

We studied 54 patients who, after small intestinal resection, developed a massive protracted diarrhea with a daily fecal loss greater than 2 kg, status we defined as the "overwhelmed intestine syndrome" (OIS). Median length of residual small bowel was 120 cm, 19 patients had a definitive stoma (jejunostomy, n = 9; colostomy, n = 10), 26 patients had a provisional jejunostomy. Fecal weight greater than 2 kg was related to enteral hyperalimentation (greater than 3,500 Kcal) in 19 patients (induced OIS) and was clearly independent in 16 others who had fecal weight over 3 kg while receiving approximately 2,000 Kcal (obligatory OIS); the last 19 patients had fecal weight between 2 and 3 kg during normoalimentation. Hypocalcemia and hypomagnesemia were common in the three groups. The other complications were seen mostly in patients with obligatory OIS: in those patients, parenteral nutrition was maintained in 9 cases out of 16 (vs. 0 in other groups), nutritional gain was scanty, sodium equilibrium was difficult to obtain in spite of a large sodium intake (380 mmol/day), hospitalization lasted several months and autonomy via the enteral route could not be achieved in 7 out of the 9 patients with definitive short bowel (vs. 0 in other groups). This study shows that the OIS is an unique functional entity. Complications and prognosis are dependent on the obligatory or induced pattern of the syndrome. Only patients with obligatory OIS require definitive home parenteral nutrition.

The aim of this study was to investigate the value of elemental diet in steroid-resistant and steroid-dependent Crohn's disease. Elemental diet (Vivonex HN, 39.4 +/- 9.2 kcal/kg/d) was delivered through a nasogastric tube at a constant rate. Twenty therapeutic periods lasting from 20 to 74 days (median, 32 days) were undertaken in 18 patients. Elemental diet was well tolerated. Mean values of hemoglobin, serum albumin, and serum transferrin increased significantly through the therapeutic period; body weight and anthropometric data did not change significantly. The short-term response to elemental diet was excellent in 11 cases, demonstrated by achievement of clinical remission and steroid withdrawal; six patients had an incomplete remission and remained slightly active or had to be maintained under low dose steroids; three patients did not respond to therapy and had to be operated upon. During the follow-up (6-30 months), 8 patients out of 17 had a relapse. Relapse was controlled by medical therapy in 5 cases and led to surgery in the 3 other cases. We conclude that elemental diet, as total parenteral nutrition, is an effective therapy of steroid-resistant and steroid-dependent Crohn's disease. However, elemental diet does not prevent relapse.