William H J Summerskill

Interactions between bile acids (taurocholate, TC; taurochenodeoxycholate, TCDC; or taurodeoxycholate, TDC) and digestive products (essential amino acids, EAA or monoolein, MO) in the lumen of the proximal small bowel, affecting pancreatic enzyme secretion and gallbladder contraction, were studied in 77 healthy volunteers by a perfusion method. Perfusion of EAA or MO caused significant increases in pancreatic enzyme output together with gallbladder contraction; MO was more potent and ...

The ability of products of digestion to stimulate pancreozymin secretion in man was investigated using a bioassay procedure, based on duodenal perfusion, which quantified the total outputs of pancreatic enzymes evoked by intraduodenal stimuli under steady-state conditions. Patterns of response resulting from physiologic intraduodenal concentrations of test material were basal output (with isotonic saline), washout of enzymes (with dextrose, micellar fatty acid, and amino acids), and ...

Histologic study of serial biopsy specimens in a prospective, controlled, double blind, randomized trial of treatment involving 63 patients with predefined clinical and biochemical criteria of severe chronic active liver disease revealed five different histologic patterns of hepatic injury on initial biopsy: chronic persistent hepatitis, chronic aggressive hepatitis, subacute hepatitis with bridging, subacute hepatitis with multilobular necrosis, and cirrhosis. The initial biopsies in ...

A method is described for determining the cytotoxicity of normal and autologous lymphocytes for 51Cr-labeled isolated parenchymal liver cells in a low aggressor to target cell ratio. Results were compared from patients with chronic active liver disease (CALD), chronic persistent hepatitis (CPH), miscellaneous liver diseases, or primary biliary cirrhosis (PBC). In 53% of CALD patients, lymphocytes showed greater cytotoxicity for hepatic cells than did normal allogenic lymphocytes, but in ...

We have compared responses to an ordinary solid-liquid (S) meal and to a homogenized (H) meal of identical composition (sirloin steak, bread, butter, ice cream with chocolate syrup, and water) by measuring simultaneously postprandial gastric, pancreatic, and biliary functions by marker-perfusion techniques. Responses to each (S or H) meals differed strikingly both in magnitude and pattern. S meals elicited a stronger early gastric secretory response (acid, pepsin, and volume) which ...

Disappearance of symptoms, resolution of most biochemical abnormalities, and histologic improvement to mild chronic inflammation were accomplished in 69 of 123 patients (56%) with severe chronic active liver disease treated with corticosteroids for up to 6.5 yr. Remission of at least 6 mo duration was possible in 35 of the 69 (51%) after discontinuation of therapy while others relapsed promptly and required retreatment. The likelihood of sustained remission was not predicted by initial ...

Perfusion of the cleansed human colon was used to quantify movement of urea between the circulation and lumen, together with the amount of urea hydrolysed to ammonia in the colon. Only 2% of urea delivered to the colon by the circulation was recovered from the lumen at normal or elevated blood-urea concentrations, and only 5% of urea perfused through the colon was absorbed. Urea was not hydrolysed to recoverable ammonia when perfused through the colonic lumen, and only 0·2% of urea ...

A prospective, controlled, double blind, randomized trial of treatments for severe chronic active liver disease, involving 63 consecutive patients chosen by predefined criteria, showed that 20 mg of prednisone daily or a combination of 10 mg of prednisone and 50 mg of azathioprine daily was superior to 100 mg of azathioprine daily or placebo. Prednisone or a combination of 10 mg of prednisone and 50 mg of azathioprine daily significantly improved (1) life expectancy; (2) resolution to ...

Serum conjugates of cholic acid were determined by radioimmunoassay and compared with conventional tests in 38 patients during the course of chronic active liver disease that responded to treatment; 16 patients subsequently relapsed when treatment was discontinued. At the time of diagnosis, values for these bile acids were always significantly elevated. At biochemical resolution of conventional liver tests, the values were still elevated in 33 of 38 patients, and this finding correlated ...

A method, featuring perfusion of both gastric and duodenal markers with collections from the stomach and duodenum, was developed and validated for simultaneous measurements of total duodenal and gastric secretory outputs in man. Calculations of duodenal reflux into the stomach, of contamination of duodenal contents by gastric contents, and of the amounts -recycled between the two organs were made. The values so obtained were used to establish application of duodenal perfusion (with ...

Sera from thirty-one patients with chronic active liver disease were examined for the presence of Australia antigen, Au(1). Patients were selected using criteria which include fivefold or greater elevations of serum-glutamic-oxaloacetic-transaminase, hypergammaglobulinæmia, histological changes on biopsy (hepatitis with or without cirrhosis), and liver disease documented for at least 10 weeks. Au(1) was detected in the sera of three of the thirty-one patients. These three patients did ...

In 50 patients with chronic active liver disease, observer and sampling error in histologically evaluating hepatitis and cirrhosis after blind-needle biopsy of the liver was assessed from coded tissue. This was done by repeated readings of the same specimens by the same pathologist, by sequential biopsies from the same patients with cirrhosis, and by multiple simultaneous biopsies from adjacent areas of the liver. Observer error was small. The consistency of grading the individual ...

The purpose of this investigation was to determine whether the contrasting transmucosal potentials of the stomach and the esophagus can be used to identify the gastroesophageal mucosal junction. To relate changes in the potential difference (PD) to other characteristics of the junctional zone, pressure and pH determinations were made simultaneously with those of PD. Observations were made during fasting on 18 healthy persons, 5 dogs, and 12 patients with hiatal hernia. A zone of elevated ...

In 14 healthy volunteers, studied by colonic perfusion technics, colonic ammonia output during steady-state conditions was 1782 ± 233 μg per hour (S.E.). Colonic outputs and concentrations of ammonia in four patients with cirrhosis and encephalopathy were similar. In these patients, blood ammonia concentrations fell during cleansing by perfusion. Treatment with neomycin reduced colonic ammonia concentration and outputs; the urease inhibitor acetohydroxamic acid reduced colonic ammonia ...

Changes in pancreatic enzyme secretion and gallbladder contraction occurring after vagotomy and pyloroplasty were investigated and compared with findings from healthy volunteers and patients with duodenal ulcer. Total lipase and bile acid outputs were quantified, using duodenal perfusion, under basal conditions and in response to both endogenous cholecystokinin-pancreozymin (CCK-PZ) (released by intraduodenal perfusion of essential amino acids) and to exogenous (porcine) CCK-PZ given by ...