The result of a prospective trial of 40 patients with duodenal ulcer treated either by proximal gastric vagotomy (antrum innervated) or by selective vagotomy (antrum denervated) shows that they are equally effective in reducing gastric acid and pepsin secretion. Preservation of antral innervation by proximal gastric vagotomy reduces gastric secretion as effectively as denervation of the entire stomach.

The effects of a new carbenoxolone analogue (BX24), zinc sulphate, and vitamin A on the healing of gastric ulcer have been assessed in a multifactorial clinical trial conducted in out-patients treated for four weeks.Forty-eight patients completed the trial. Three groups of eight patients were given respectively 300, 600, and 1 200 mg of BX24 daily and were compared with 24 patients who were given 300 mg of carbenoxolone sodium daily. The size of the ulcer niche was reduced on average by 14.6% in the eight patients given BX24 300 mg daily, by 47.6% in the patients given 600 mg daily, and by 51.0% in the patients given 1 200 mg daily. In the patients given carbenoxolone the size of the niche was reduced by 68.9%. These results were compared with those obtained previously with carbenoxolone and inert tablets and it was concluded that BX24 is without clinically useful effect in the doses used. Eleven of the 24 patients (46%) treated with carbenoxolone sodium developed side effects due to fluid retention and electrolyte disturbances. None of the patients given BX24 experienced such effects. In addition to carbenoxolone or BX24, 24 patients were given zinc sulphate, 660 mg daily, and in 24 patients these tablets were withheld. Among the patients given carbenoxolone the reduction in the size of the niche was much the same irrespective of whether or not the patients received zinc sulphate. Among the 12 patients given BX24 with zinc sulphate the ulcer healed completely in four and, on average, the size of the niche was reduced by 53.5%, compared with 21.9% in the 12 patients given BX24 alone. This difference is not statistically significant but the possibility of a beneficial effect from zinc is not excluded. No side effects attributable to zinc were observed.Twenty-four patients were also given vitamin A, 50 000 units daily, and in 24 patients the vitamin was withheld. No evidence was obtained to suggest that vitamin A had any beneficial effect on the healing of gastric ulcer.

The gastric secretory response to insulin is mediated predominantly by the vagus. The associated hypoglycaemia stress response is mediated by the sympathetic nervous system. Inhibition of the sympathetic response by simultaneous alpha and beta receptor blockade was studied in five healthy young adults. No appreciable modification of gastric secretory output resulted.

The absorption of synthetic pteroyltriglutamate has been measured in nine normal students with and without the anticonvulsant drug phenytoin. It has been shown that phenytoin has no effect on the absorption of this folate polyglutamate. The reasons are discussed for the disparity between this result and those reported in the literature when folate polyglutamates derived from yeast were used.

The possible existence of kinetic interactions between rifampicin and isoniazid and the effect of the concomitant presence of an impaired liver function were investigated in man. In a first study normal healthy subjects and patients with chronic liver disease received, on three different occasions, a single dose of 600 mg rifampicin or isoniazid and of rifampicin and isoniazid associated in randomized sequences. The results have shown that in both groups the serum levels, half-life values, and urinary excretion of each drug given alone are not significantly different from those observed when the other drug is associated. Serum levels and half-life of rifampicin and isoniazid were significantly higher in patients with chronically impaired liver. In a second study, rifampicin and isoniazid were given in combination at the same doses as in the first study over a period of one week. The results have shown a trend to decrease in the serum levels of rifampicin of the healthy subjects and a trend to increase in the patients with chronic liver disease on day 7 of treatment. In both groups a reduction in the half-life of rifampicin was also observed. No changes in serum isoniazid concentrations were observed between day 1 and day 7 in the healthy subjects, whereas a significant increase was observed in the patients. No significant changes in the half-life of isoniazid were observed.

Ten flatulent but otherwise healthy subjects were studied while consuming two or three different diets. Flatus collections showed that a bean-containing, high crude-fibre diet produced more flatus (mean 49.4 ml/hr) than either a diet with a restricted crude-fibre content (mean 26.7 ml/hr) or a liquid chemically defined diet (mean 10.9 ml/hr). There was a close correlation between the crude-fibre content of the diet and the production of flatus. The results are consistent with the conclusion that flatus is not the result of swallowing air, but arises mainly from bacterial fermentation of indigestible carbohydrate, eg, cellulose, passing into the colon.

A double blind comparison of conventional premedication (pethidine, promethazine, and atropine) and neuroleptanalgesia (droperidol and phenoperidine) failed to demonstrate any difference in either the comfort of the patient or ease of instrumentation in 70 upper gastrointestinal tract endoscopies. Further trials are needed before conventional premedication is abandoned.

A double-blind trial of deglycyrrhizinated liquorice was performed in 47 patients with active duodenal ulcer. Twenty-four patients received a placebo and 23 the trial medication (Caved-S) for one month. Both groups were clinically similar. No advantage of deglycyrrhizinated liquorice over placebo was found.

The effects on biliary pressure of pentazocine, morphine, pethidine, and phenazocine were compared by direct measurement through a ;T' tube after choledochotomy. In two within-patient comparisons, the mean increases in biliary pressure following intramuscular morphine were significantly greater than those following pentazocine. When pethidine and phenazocine were compared with pentazocine, the mean increases were lower following pentazocine but not to a statistically significant extent. Pentazocine appears to be the most appropriate strong analgesic in biliary and pancreatic disease.

No significant difference could be detected either by clinical impression or statistical analysis in the relief of pain afforded by 2.5 mg phenazocine hydrobromide (Narphen) and 10 mg morphine sulphate when given by intramuscular injection to patients with acute abdominal pain. Phenazocine does not cause spasm of the sphincter of Oddi and so is recommended for treating biliary or pancreatic pain.

Electrolyte solutions containing glucose, glycine, or a combination of the two were absorbed sufficiently well from the intestine to supply maintenance fluid and the electrolytes required by cholera patients. Data on net absorption and duration and volume of diarrhoea show that a solution containing both glucose and glycine provides more effective therapy than solutions containing either glucose or glycine alone.

A controlled single-blind trial has been carried out to determine the value of long-term anticholinergic therapy in duodenal ulcer. Of 106 male patients with symptomatic and radiologically proven duodenal ulcer admitted to the trial, 91 completed the study. Patients were divided randomly into three groups. They received either glycopyrronium, or 1-hyoscyamine in a sustained-release form, or inert tablets for one year. Progress was judged on the basis of frequency and severity of symptoms, monthly assessments by patients, antacid consumption, and radiology. By all criteria, glycopyrronium and 1-hyoscyamine were not significantly superior to placebo. Symptomatic improvement, both subjective and objective, occurred in approximately 80% of all patients during the year of observation; there was no significant difference between the groups.

Six normal subjects were tested with various doses of histamine acid phosphate (1, 10, 40, and 80 mug/kg/hr) and pentagastrin (0.15, 1.5, 6.0, and 12.0 mug/kg/hr), the different doses of the stimulants being administered by separate continuous intravenous infusions. In each sample of gastric juice, which was collected at 15-minute intervals, we estimated the concentrations of the H(+), Na(+), K(+), and Cl(-) and the concentration of pepsin. The drugs elicited equal maximal outputs of acid and pepsin. Pentagastrin was more potent than histamine in stimulating acid and pepsin secretion, and the rate of the responses was faster with pentagastrin than with histamine. Apart from this, however, the patterns of secretion of the various constituents of the gastric juice and the interrelationships between the concentrations of the electrolytes were identical with the two drugs. We therefore concluded that the actions of histamine acid phosphate and pentagastrin on human gastric secretion were identical.

The effects of continuous intravenous infusions of ;maximal' and ;supramaximal' doses of histamine acid phosphate and pentagastrin were assessed in a normal human volunteer. The secretory patterns in respect of the two drugs were indistinguishable over two and a quarter hours. During the steady states of acid secretion, outputs of pepsin and of electrolytes were also constant. The output of acid during the first hour of the steady state is a valid measurement of the maximal secretory capacity. The constant output of pepsin during the steady state of acid secretion suggests that both drugs are true stimulants of pepsin secretion.

The inhibitory effect of intravenous secretin and intrajejunal acid infusion on basal and pentagastrin-induced gastric acid secretion as well as the stimulatory influence of both infusions on pancreatic flow rate and bicarbonate output were compared in two groups of healthy subjects. Secretin strongly inhibited basal acid output and slightly decreased pentagastrin induced gastric secretion. Intrajejunal acid infusion did not affect the gastric secretion but resulted in an increase in pancreatic volume flow and bicarbonate output reaching about 40% of the pancreatic response to secretin(1) infused intravenously in a dose of 2 units per kilogram per hour. It is concluded that this provides evidence that secretin is a strong inhibitor of spontaneous gastric acid secretion and that acid in the jejunum causes the release of secretin in man.