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Fifty patients who had recently had a transient ischaemic attack took part in a double-blind cross-over trial of sulphinpyrazone 200 mg 4 times daily against placebo. Each treatment was given for 4 months. The incidence of recurrences was much greater in the initial 4 months but there was no difference between the 2 treatments. A follow-up of 39 of the patients showed that 2 years later 90% of those who had not had a recurrence during the 8 months had suffered no further neurological events whereas of those who did have a recurrence during the study only 47% had no further neurological events. [ABSTRACT FROM PUBLISHER]

Tests of intestinal permeability are used as a reflection of upper-small-intestinal mucosal damage. Thirty-two elderly in-patients aged 75–96 years, and 64 hospital volunteers aged 22–64 years with no overt gastro-intestinal disease were studied to determine whether permeability changes with increasing age. Intestinal permeability was assessed by measuring the 5-h urinary excretion of a monosaccharide, L-rhamnose, and a disaccharide, cellobiose, for 5 h after their oral administration in a hypertonic solution. While in the elderly, excretion of both mono- and di-saccharides was significantly reduced by a half to two-thirds, the ratio of the two sugars in the urine was similar in both age groups. We conclude that permeability was unimpaired in the elderly patients whom we studied. Because the test depends on a ratio of excretion rates rather than an absolute rate, accuracy of urine collection and abnormal renal function do not invalidate the results. It is therefore useful as a screening test of upper-small-intestinal mucosal damage in the elderly. [ABSTRACT FROM PUBLISHER]

Fibronectin is a glycoprotein of high molecular weight present in tissues, plasma, and tissue fluids. Its distribution in the rectal mucosa was studied by immunofluorescent and immunoperoxidase techniques using a monospecific antiserum. Immunofluorescent reactivity for fibronectin was present in the normal rectal mucosa of control subjects in epithelial cells, on basement membranes, and as a loose cribriform network of extracellular reactivity in the lamina propria that codistributed with histochemically demonstrable reticulin. Fibronectin was demonstrated immunoelectromicroscopically on collagen fibres, on smooth muscle cells and within and between columnar epithelial cells. In the rectal mucosa of patients with colitis with marked inflammatory changes, fibronectin appeared thickened and more prominent when present on basement membranes and as sparse strands between inflammatory cells infiltrating the lamina propria. In patients with longstanding colitis and less inflammatory cell infiltration there was a diffuse increase in fibronectin which was densely and uniformly present throughout the lamina propria. Fibronectin is a structural component of the rectal mucosa and changes in its distribution may form an important part of the local reaction to inflammatory bowel disease. [ABSTRACT FROM PUBLISHER]

The size and composition of the bile salt pool has been measured in patients with untreated coeliac disease and in control subjects. The total bile salt pool was markedly increased in coeliac patients, the average being 9·2 grams compared with 3·1 grams in controls. Taurocholate synthesis was normal, consistent with its enlarged pool and prolonged half-life. Half-life and pool size were significantly correlated. The composition of the bile salt pool was virtually identical in the two groups. Our findings suggest that as the enterohepatic circulation is slowed by gallbladder inertia, so hepatic surveillance of pool size is diminished. [ABSTRACT FROM PUBLISHER]

Thirty-six patients with rheumatoid arthritis were allocated at random to one of 3 groups prescribed 4 different non-steroidal anti-inflammatory drugs (NSAID). Each drug was given for one week over 4 consecutive weeks in a balanced order. The patients were then asked to select one NSAID for continuation therapy and were followed-up 6 months later. The success of the patient selection method was compared with that of physician selection by retrospectively surveying NSAID prescribing in 164 patients attending 2 other rheumatology units over a 5-year period. Only 72% of patients in the prospective study felt able to choose one of the NSAIDs and 31% of these had discontinued the chosen drug within 6 months. In the retrospective study, 40% changed their NSAID within 6 months. [ABSTRACT FROM PUBLISHER]

In order to assess the value of the after fatty meal films, 232 oral cholecystograms were reviewed. Gallbladder opacification, duct visualisation, separation of gallbladder from overlying bowel gas shadows, and the demonstration of abnormalities were assessed from the pre-fatty meal films, and then again in conjunction with those taken after fat, when contraction was also assessed. Of the 200 examinations given the fatty meal, 132 were adjudged normal, 63 had gallstones, four had adenomyomatosis (one with stones), and two cholesterolosis. The post-fatty meal films, were found to be essential for the diagnosis of adenomyomatosis and cholesterolosis, and considered to be occasionally helpful in diagnosing small stones. They were of little value in assessing the biliary ducts, or separating the gallbladder from overlying bowel gas, and of no value in the diagnosis of functional biliary tract disorders.

The relation between colonic bacterial metabolites in bile and saturation of bile with cholesterol was investigated. Eleven healthy men ingested metronidazole (2 g daily) for 10 days to inhibit anaerobic bacterial activity. Bile composition was determined in fasting samples aspirated from the duodenum before metronidazole was given, at the end of 10 days on metronidazole, and a month after the drug was discontinued. Bile cholesterol saturation fell in ten of the eleven subjects from a mean of 1.00 to 0.83 and rose in all eleven after the drug was stopped. At the same time the proportion of deoxycholate in bile acid decreased from a mean of 24% to 7%, returning to 22% of the total a month after metronidazole had been stopped, and the proportion of chenodeoxycholate changed significantly from 33% to 46% and back to 33%. There was little change in cholate concentrations. Deoxycholate is formed exclusively by bacterial action in the colon. Its administration increases cholesterol saturation of bile, while chenodeoxycholate reduces it. These results suggest that colonic function is important in regulating bile composition. Dietary measures which reduce the return of newly formed deoxycholate from the colon to the bile reduce cholesterol saturation and so are likely to reduce the risk of gallstones.

Sixteen patients with practolol peritonitis are described. Dense peritoneal thickening and adhesions caused small bowel stasis and obstruction with characteristic radiology and histology. The disease was best treated by surgery though complications were frequent and three of 16 patients died. Ocular and skin involvement were common. Fifty four asymptomatic patients who had taken a beta adrenoceptor blocking drug for more than 12 months were studied. Seven were found to have radiological abnormalities of the small bowel. These changes were associated with propranolol, oxprenolol and practolol therapy. It is not known whether they are related to practolol peritonitis.