Rapid Transit Time Research Articles

Gut-hormone profile in totally pancreatectomised patients.

In eight totally pancreatectomised patients the release of the relevant gut hormones was determined after a standard test meal. Plasma levels of pancreatic glucagon were not significantly different from zero in our series of pancreatectomised patients. Pancreatic polypeptide was undetectable. These findings imply the absence of a significant number of normally functioning alpha cells and pancreatic polypeptide cells in extrapancreatic sites in man. Consistent with the antrectomy, duodenectomy, and resection of the upper jejunum that are performed in conjunction with a total pancreatectomy the gastrin release was significantly impaired. In contrast there was a striking post-prandial rise in enteroglucagon probably induced by the rapid intestinal transit time often seen after partial gastrectomy. In contrast plasma motilin and GIP levels were normal. Pancreatectomised man thus presents an interesting model of total deficiency of endogenous insulin, pancreatic polypeptide, and pancreatic glucagon and, in addition, greatly diminished gastrin. The considerable derangement of metabolic and intestinal function that follows total pancreatectomy may, in part, be explained by this gross disturbance of the normal physiology of gut hormone.

Dynamic isotope aortoiliac assessment. Clinical, doppler, and arteriographic correlation.

In the presence of multiple tandem arteriosclerotic stenoses of the distal aorta, iliac, and lower extremity arteries, it may be difficult to ascertain which lesions are clinically and surgically important. Usually the history, physical examination, and arteriogram will resolve this issue. However, a recent report has stated that the rapid transit time of isotope from the distal aorta to the femoral arteries may be helpful. The relevance of this technique in surgical candidates with different clinical stages of vascular disease has yet to be demonstrated. We compared the use of this technique in surgical candidates with their clinical state and assessment of vascular disease by standard angiographic and directional transcutaneous Doppler techniques. Only modest benefit from the isotope transit was found, particularly when compared with the patient's clinical status of asymptomatic, claudicating, or limb salvage categories. We conclude that isotope transit times as currently measured are not as clinically important as previously reported. With further development, some trends may prove to be useful.

How and when to use barium for diagnosis of small bowel obstruction.

The diagnosis of intestinal obstruction is readily made when a patient presents with typical history and signs, and when plain films of the abdomen display characteristic findings. Some patients, however, constitute diagnostic problems because abdominal roentgenograms are still equivocal, even after repetition in four hours. In the unclear case, use of a barium meal will safely, promptly, and routinely prove or disprove small bowel obstruction. Intestinal obstruction in which the initial abdominal films tend to be either unrevealing or equivocal include high obstructions, including the superior mesenteric artery syndrome; presence of strangulation; partial small bowel obstruction; and fluid-filled proximal bowel. In intestinal obstruction, characteristic roentgenographic findings with use of barium meal are normal to rather rapid transit time to the point of obstruction; homogenous dilution of barium in dilated proximal loops; and inhomogenous, scattered, and fragmented collections of barium in the distal, collapsed loops.

Vitamin A Deficiency Following Small-Bowel Bypass Surgery for Obesity

Side effects are common in individuals who have undergone small-bowel bypass surgery for morbid obesity. Most of these side effects subside after a few months. More serious complications may require reestablishment of the bypassed loop. Rarely have vitamin deficiencies been observed. Development of vitamin A deficiency in a patient was characterized by phrynoderma and night blindness. This was promptly reversed by oral treatment with vitamin A. There was no improvement in low to subnormal serum levels of fat-soluble vitamins after a course of tetracycline hydrochloride. Studies suggested presence of a malabsorption state probably due to rapid transit time through the small bowel and reduced absorptive surface.

Cell Proliferation Kinetics of Epidermis in the Essential Fatty Acid Deficient Rat

Rats fed diets deficient in essential fatty acids (EFA) develop severe scaling in the skin, histologically characterized by acanthosis of the epidermis and hyperkeratosis. Epidermal cell proliferation kinetics in the EFA- deficient rat were studied as a potential animal model for human diseases of epidermal hyperplasia. EFA deficient rats were injected IP with tritiated thymidine ( 3 H-TdR). Serial punch biopsies from dorsal skin were obtained 1-30hr after 3 H-TdR administration and processed by standard autoradiographic techniques. A composite percent labeled mitoses (PLM) curve was obtained by plotting the mean ratio of labeled mitoses/total mitoses at each time interval. The mitotic index was 1.0%. The labeling index determined 1hr after 3 H-TdR injection was 11.2%. From these data the total germinative cell cycle was calculated to be 67hr with the duration of the cell cycle phases: S, 7.5 hr; G 2 , 4.5 hr; M, 0.7 hr; and G 1 , 54.3hr. The transit time for labeled basal cells to proceed from the basal layer to the uppermost stratum granulosum was 2 days. In normal control rats the labeling index was 2.2% and the transit time 6 days, reflecting much slower epidermal proliferation than in the EFA deficient rat. The similar kinetic characteristics of enhanced epidermal proliferative activity, rapid cell cycle and transit time, suggest that the EFA-deficient rat model may be suitable for examination of various problems relating to the chemotherapy of psoriasis and other hyperproliferative skin conditions.

Letter: raw diet and diabetes mellitus.

Comments and Correction1 May 1975Raw Diet and Diabetes MellitusGARFIELD C. PICKELL, M.D.GARFIELD C. PICKELL, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-82-5-723 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: Dr. Douglass (Ann Intern Med82:61-62, 1975) suggests that the salutary effect of a raw diet on diabetic control may be due to "non-inactivated enzymes that are present in raw items or with the fast transit time that is inherent in a raw diet." It is unlikely that enzymes not absorbed in active form have any notable effect during their brief enteric lives, particularly in view of their being active during a relatively long shelf life, shared with foods that are ultimately cooked. The implication of a rapid transit time seems to be that caloric absorption is...

Diarrhea Associated With Medullary Carcinoma of the Thyroid: Studies of intestinal function in a patient

An investigation of small intestinal function in a patient with diarrhea associated with a medullary carcinoma of the thyroid indicated that jejunal transport of electrolytes, mucosal permeability, and intestinal transit were all normal. The ileum, however, was unable to absorb Na+ and Cl− against a concentration gradient, had an abnormal mucosal permeability, and had an abnormally rapid mean transit time. It is postulated that these three abnormalities of ileal function may be collectively responsible for the diarrhea. Although it is uncertain as to which of the several humoral substances liberated by the tumor is responsible for the intestinal abnormalities, it is unlikely to be a prostaglandin since plasma levels were normal on three occasions and slightly elevated on one. Indomethacin, a known inhibitor of prostaglandin synthesis, failed to influence the diarrhea in this patient.

Why are small bowel tumours rare? An experimental model.

It is a well known clinical observation that small bowel tumours are rarer than tumours of the stomach or colon. The fluidity and relative sterility of small bowel contents, and rapid transit time and of the relative sterility of the small bowel itself have been suggested as possible factors contributing to this relatively low incidence. A further mechanism, that of a local immune response against malignant cells, has also been suggested and this investigation is the subject of this paper. A transplantable tumour (Gardner lymphosarcoma) was injected either into the stomach or small bowel of CBA mice, and the incidence of subsequent tumour growth was studied when the immune status of the host mouse was altered. Normal mice, mice ;deprived' by thymectomy and irradiation (T-cell-deficient mice), and ;reconstituted mice' (prepared as the ;deprived' animals but given a thymus graft) were used. The results showed that in normal and reconstituted mice more tumours arise in the stomach than in the small bowel but that in deprived mice the incidence of tumours was the same in both sites. This could be taken to suggest that local immune responses can suppress the development of tumours of the small bowel.

Factors Influencing the Microbiological Degradation of Choline and Tryptophan in Man

SummaryAntibacterial compounds, including penicillin G and phthalylsulfathiazole or a combination of these drugs produced variable suppression of urinary trimethylamine (TTMA) and indican output in normal male subjects. Three men with rapid intestinal transit time and low initial indican values exhibited markedly reduced TTMA and indican excretion in response to either drug alone and prolonged depression with combined drug treatment; while four men with prolonged intestinal transit time and high initial indican values showed less suppression of TTMA and indican excretion with sulfa or penicillin G alone and only transient suppression of indican and TTMA with combined treatment. It has been concluded that intestinal stasis is a major determinant of the escape of intestinal microflora from the action of these drugs.

THE RADIOLOGIC ASPECTS OF MEDULLARY (SOLID) THYROID CARCINOMA

Medullary carcinoma of the thyroid probably originates from parafollicular cells of the thyroid and characteristically contains amyloid. Clinically it is an intermediate grade malignancy with early cervical and mediastinal lymph node involvement. Diarrhea occurs in approximately 30 per cent of all patients with MTC. MTC may be associated with pheochromocytoma, parathyroid adenoma, and mucocutaneous neuromata. The radiologic finding of calcifications in the neck, either in the thyroid or lymph nodes should suggest MTC. Rapid transit time of a barium meal through the gastrointestinal tract occurs in both the patients with MTC and their families. The significance of peptic ulcerations in these cases still must be determined. Radiologic investigation for pheochromocytoma should be done in all cases of medullary carcinoma of the thyroid, especially in the familial variety.

99mTc-labelled E.D.T.A. for renal scanning.

A simple labelling procedure using 99pertechnetate and Versene, a readily obtained chelate, has been shown to have a rapid transit time in the kidneys of the rabbit. Its application to humans must be considered due to the better count rate statistics obtained and the lower radiation dose that would be received by the kidneys.

Neutrophil kinetics in acute infection.

Neutrophil kinetics of acute experimental infection were studied with diisopropylfluorophosphate-(32)P labeling in 31 dogs inoculated intrabronchially with pneumococci. In vitro neutrophil labeling indicated a rapid transit time through the blood in early infections, with an elevated marginal granulocyte pool sometimes preceding an elevation of the circulating granulocyte pool. 13 hr after infection, the circulating and total blood granulocyte pools were increased but the rate of neutrophil transit through the blood was normal. During the recovery from infection there was a marked prolongation of neutrophil blood transit time, suggesting virtually complete cessation of bone marrow release of neutrophils into the blood. Labeling of neutrophils in vivo indicated an increased rate of emptying of the bone marrow storage pool proportional to the severity of infection as measured by the fever index. The change in the blood ratio of nonsegmented to segmented neutrophils was a much more accurate index of the severity of infection than the blood granulocyte concentration, correlating significantly with the fever index.

Gastric Arterio-venous Shunts

The function of gastric submucosal A-V shunts has been investigated in dogs by the injection of a bolus of dye into the arterial side of the gastric circulation and its subsequent collection from the veins so that a dilution curve is obtained of its passage across the gastric vascular bed. Evidence of shunt activity has to be taken as a rapid transit time or double peak curves. Results suggest that under basal conditions evidence of functional A-V shunts has been found in some animals. Histamine appears to close shunts if they are open and divert blood through other slower channels. Adrenaline, vagal stimulation, vagotomy, and hepatic anoxia have not been found to have any effect on shunt activity. No evidence has been found to support the view that shunts respond in a uniform manner to control mucosal blood flow.

The role of bicarbonate pathophysiology and therapy in Asiatic cholera

Metabolic acidosis in Asiatic cholera was due to fecal loss of bicarbonate, with stool clearances of bicarbonate ranging up to 41 ml. per minute. The carbon dioxide content of stool (up to 75.6 mEq. per L.) consistently exceeded that of arterial plasma. Such a carbon dioxide content was within the physiologic limits normally present in the lower parts of the small bowel and cecum, and could be explained by a deficient reabsorption of bicarbonate associated with the rapid intestinal transit time observed in cholera. Acidosis should be treated after the initial correction of shock and dehydration. An average of 0.43 mEq. per kg. of bicarbonate administered intravenously was required to raise the carbon dioxide content of plasma 1 mEq. per L. A similar amount was required in control patients with diarrhea from other causes. Although acute renal tubular necrosis may be a complication in Asiatic cholera, patients included in this report showed at least qualitatively appropriate renal tubular functions in concentrating the urine and adjusting hydrogen ion concentration to meet a changing systemic acid-base balance. Glomerular filtration was depressed early after correction of shock and acidosis in these subjects but improved later.

The Site of Absorption of Orally Administered CO60-Labeled Vitamin B12 in Dogs: The Effect of Dose

Summary Data on the site of absorption of oral Co 60 -labeled vitamin B 12 in 25 dogs are presented. Our findings indicate that the lower small bowel of the dog is the primary site of vitamin B 12 absorption over a dose range of 0.05 μg. per kg. to 1000 μg. per kg. of body weight. Jejunal absorption of vitamin B 12 was more frequently observed when very large doses of the vitamin were used. Duodenal absorption of vitamin B 12 was not observed over the entire dose range. This failure to participate in vitamin B 12 absorption is most probably due to the duodenal segment's rapid transit time in conjunction with an inefficient trapping mechanism.

Positive stool guaiac test after meat ingestion in patients who have undergone gastrectomy.

TESTS for blood in the stool vary in sensitivity; it is generally agreed that the unmodified benzidine test gives a positive reaction if the patient has eaten meat, but the guaiac test is not considered sufficiently sensitive to react in this way. Recently, however, we saw a patient with a subtotal gastrectomy of some years' duration who had persistently + + + + positive guaiac tests while taking a regular diet. The test became negative when the patient stopped eating meat. Accordingly, this note reports a few simple studies demonstrating that after subtotal gastrectomy a rapid transit time or poor . . .

Use of Radioactive Iodine as a Tracer in Water-Flooding Operations

Abstract The accurate evaluation of reservoir-performance characteristics in the secondary recovery of petroleum by water flooding requires use of a water tracer that may be injected into water-input wells and detected at oil-production wells to supplement data obtained from core analyses, wellhead tests, and subsurface measurements. Radioactive iodine has been used successfully as a water tracer in field tests to determine:relative rates and patterns of flow of injected water between water-input and oil-production wells andzones of excessive water entry into oil-production wells. Laboratory evaluations of potential water tracers, previous tracer studies, the value of using a radioactive tracer, general field procedures, and the use of surface and subsurface instruments for the detection of the emitted gamma radiation, are summarized. Data from the field tests are presented graphically and discussed in detail. It is concluded that the radioactive-tracer method, using radioactive iodine, may be used successfully to measure either the relative rates and patterns of flow or zones of excessive water entry into wells under conditions of comparatively rapid transit time between wells. Introduction Extensive use is made of data obtained from core analyses, wellhead tests, fluid characteristics, and subsurface measurements in evaluating the sweep efficiency of water injected into oil sands for the recovery of oil. Theoretical flow rates and patterns may be calculated from those data using radial-flow formulas, if it is assumed that the physical conditions in the productive formation are homogeneous. Unfortunately, homogeneous conditions rarely, if ever, exist in oil-productive formations. The use of a tracer that may be injected into an oil sand and detected quantitatively, or even qualitatively, at offsetting oil-production wells provides basic data that may be used in determining more accurately the subsurface rates and patterns of flow of injected water between wells than is possible by theoretical calculations based on assumed conditions. Consideration of the data obtained by using a water tracer assists in the application of remedial measures to water-input wells, such as plugging of channels, or selective plugging of highly permeable zones, thereby effecting a more uniform flood and a greater ultimate oil recovery.

Examination of small intestine with carboxymethylcellulose.

Most of us have experienced difficulty at times in deciding whether a small intestine is normal or abnormal by roentgen examination, and further, if abnormal, what name to give to the condition. Different workers use different procedures, administer the barium in different mixtures, and use different terms to describe the resulting radiographic appearances. There is a widespread desire for reliable criteria for the limits of normal and for the best possible examination procedure. We find that suspensions in water of barium sulfate and the sodium salt of methylcarboxycellulose4 are stable and inert physiologically, have a rapid small-intestine transit time, and produce a good mucosal pattern in patients without small-intestine disease. Zimmer (1) made extensive studies of the settling of barium (in vitro and in vivo) in distilled water, in hard tap water, in artificial gastric juice, and in artificial intestinal juice. He found that pure barium produces a coarsened mucous membrane pattern and segmentation. He says that when “protective colloids” are added a “gracefully barbed” mucosa shows up. The preparation he recommends activates peristalsis so that the entire small intestine can be visualized in an hour. Frazer, French, and Thompson (2) showed how the “segmentation pattern” could be induced in normal subjects. They gave, at different times, a long list of substances with barium by mouth and by duodenal tube. The following produced segmentation: hypertonic saline, sodium bicarbonate, and glucose; also sodium oleate, hydrolyzed olive oil, sprue fecal fat, and olive oil. They also found that an abnormal small bowel pattern was induced in a healthy individual by the ingestion of a fatty meal the evening before the examination. Experiments in vitro showed that when mucus was added, fluocculation resulted. There was the same picture when barium mixed with mucus was placed in a loop of intestine removed from a cadaver. Frazer and his associates believed that the segmentation pattern they induced in normal people was indistinguishable from the “deficiency pattern.” It would seem that altered neuromuscular activity, as suggested by Golden, is not the correct explanation for this phenomenon for it could not account for the changes observed in the normal small bowel examined postmortem. That the segmentation pattern is associated most often with defective fat absorption was shown not only by these authors, but also by Snell and Camp (3), Gambill (4), and Kantor (5). The conditions which may produce it are: tropical and non-tropical sprue, celiac disease, obstructive jaundice, pancreatic fibrosis of infants, pancreatogenous diarrhea (Kirklin), mesenteric lymphatic obstruction, and Whipple's disease. Gambill, in a study of patients with pancreatic calcification, found steatorrhea in 32 per cent of those giving a history of pancreatitis.

A roentgen study of the effect of exclusion of pancreatic juice from the intestine on gastrointestinal motor activity in the dog.

In a previous study the effects of the loss of both intrinsic and extrinsic secretions of the pancreas upon the roentgenologic appearance of the gastrointestinal tract of dogs were evaluated (11). Hyperglycemia in the depancreatized animals was associated with a marked delay in gastrointestinal motility. During insulin-induced hypoglycemia, normal, and at times rapid, gastric emptying and small-intestinal transit times were noted. In these experiments it was not possible to ascribe any of the effects observed to a loss of the external secretion of the pancreas because, if any were present, they could have been masked by the influence of the abnormal blood sugar levels. In order to study this problem further, the roentgen procedures were repeated with non-diabetic dogs in which the external pancreatic secretion was prevented from entering the intestine by ligation of the pancreatic ducts. Material and Methods The gastrointestinal tracts of three young adult dogs were examined roentgeno-graphically by the method previously described (11). Subsequently the animals were subjected to laparotomy3 under intravenous Nembutal anesthesia. The pancreas and duodenal loop were exposed; the common duct and both pancreatic ducts were identified. The pancreatic ducts were ligated and the pancreas was separated from the duodenum throughout its length, its blood supply being left intact at each end. Omentum was interposed between the pancreas and the duo-denum. The denuded areas of the gland were thus covered in an attempt to provide a barrier to fistula formation between the pancreas and bowel. The abdomen was then closed. Following a one-week recovery period the roentgen examinations of the gastrointestinal tract were repeated. Throughout the experiment the dogs were maintained on a routine kennel diet. Immediately following the last roentgen examination each dog was again subjected to laparotomy under intravenous Nembutal anesthesia. The pylorus and the duodenum distal to the pancreas were ligated. From the distal end of the closed duodenal loop the content was aspirated and analyzed for pancreatic enzymes. The pylorus, duodenum, and pancreas were then removed, and the animal was exsanguinated. The roentgen appearance of the gastrointestinal tract was subjected to analysis, with special attention to gastric emptying time, tone, and motility, and to small-intestinal transit time, tone, and continuity of pattern. Results Stomach (Table I; Fig. 1): The median value for gastric emptying in the three of the transit time was 130 minutes, with extremes at 80 and 200 minutes. The small-intestinal transit time for individual dogs was also in the general range of those found preoperatively. Tone, as indicated by the width of the barium column, and its continuity, were unchanged following ligation of the ducts. Colon: The width of the proximal colon was measured, on first filling when possible.