Controlled trial comparing prednisolone with an elemental diet plus non-absorbable antibiotics in active Crohn's disease.

In a randomised clinical trial, patients with moderately active Crohn's disease received either prednisolone 0.5 mg/kg/day plus a normal diet, or an elemental diet plus oral framycetin, colistin and nystatin. Patients were assessed using the Crohn's disease activity index (CDAI), ESR, and faecal granulocyte excretion quantified by 111In-autologous leucocytes. Five patients were intolerant of the elemental diet plus antibiotics and were withdrawn from the trial within 72 hours. Sixteen patients completed 10 days treatment on each regime. Fifteen of 16 patients on elemental diet plus antibiotics and all 16 patients on prednisolone improved with marked, but statistically indistinguishable falls in CDAI, ESR, and faecal granulocyte excretion between the two groups. Thus a regime decreasing the intraluminal concentration of bacteria and complex food molecules, was associated with rapid improvement in activity of Crohn's disease. This suggests that these intraluminal factors play a role in maintaining inflammation and that their removal or alteration offers an approach to management.     

Use of gas liquid chromatography in the clinical diagnosis of anaerobic pleuropulmonary infection

Evidence of anaerobic infection was sought in 83 patients with pulmonary disease with anaerobic culture and gas liquid chromatography (GLC) of mucopurulent sputum, or pleural fluid where appropriate. Saliva samples from nine healthy controls and 14 patients with cystic fibrosis were examined by the same methods to assess anaerobic content. Clinically significant anaerobic pleuropulmonary infection was not found in our patients with bronchitis, bronchiectasis and cystic fibrosis and occurred in only some of our patients with empyema and lung abscess. GLC of pleural fluid (empyema) or sputum (lung abscess) was helpful in identifying these cases, when a strongly positive reading was obtained. The gas liquid chromatogram was negative or only weakly positive in those patients where the presence of anaerobes was clinically insignificant, most probably resulting from contamination of the sputum samples by saliva. Results were rapidly available and the need for transtracheal aspiration to obtain specimens of bronchial secretion uncontaminated by mouth flora was avoided. The semiquantitative GLC would therefore appear to be a useful method for investigating specimens from patients with suspected anaerobic pleuropulmonary infection.     

Effect of intravenous bovine growth hormone or human pancreatic growth hormone-releasing factor on milk production and plasma hormones and metabolites in sheep

Although it is well known that exogenous bovine GH (bGH) increases milk yield in ruminants it has not been possible to determine whether an increase in endogenous GH secretion has the same effect. The recent isolation of human pancreatic GH-releasing factor (hpGRF-44) has enabled this comparison of the effects of bGH and hpGRF-44 on milk production in sheep. Three pairs of Dorset ewes underwent three 4-day treatments according to a Latin square design. Treatment 1 involved: 2-hourly i.v. injections (approximately 3.0 ml) of bGH (15 micrograms/kg; 1.8 units/mg); treatment 2: 2-hourly i.v. injections (approximately 3.0 ml) of hpGRF-44 (0.6 microgram/kg); treatment 3: 2-hourly i.v. injections (3.0 ml) of the vehicle. Treatment periods were separated by 10 days. Sheep were milked twice daily and the milk was analysed for fat, protein and lactose. Blood samples (5.0 ml) were taken before and at 15, 45, 75 and 100 min after every third injection throughout the 4 days. Plasma was analysed for insulin, glucose, urea and non-esterified fatty acids (NEFA). The changes in plasma GH stimulated by hpGRF-44 were consistent and repeatable throughout the 4 days of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)     

Increased serum levels of eotaxin in patients with inflammatory bowel disease

BACKGROUND: The CC-chemokines eotaxin and eotaxin-2, produced by epithelial and phagocytic cells, are potent and selective chemoattractants for eosinophils and basophils. The eosinophil is a potent inflammatory cell thought to play an important role in the pathogenesis of inflammatory bowel disease (IBD). In this study we investigated the serum concentrations of eotaxin and eotaxin-2 in patients with Crohn disease and ulcerative colitis. METHODS: Thirty-one patients with Crohn disease, 35 patients with ulcerative colitis and 41 control patients were studied. Eotaxin and eotaxin-2 serum levels were measured with solid phase sandwich enzyme-linked immunosorbent assays. RESULTS: Significantly increased serum eotaxin levels were observed in both patients with Crohn disease (289.4+/-591.5 pg/ml) and ulcerative colitis (207.0+/-243.4 pg/ml) when compared with controls (138.0+/-107.8 pg/ml) (P < 0.01). Moreover, patients with active Crohn disease and ulcerative colitis showed significantly higher serum eotaxin levels than patients with quiescent disease (434.0+/-776.8 pg/ml versus 113.8+/-65.4 pg/ml in Crohn disease and 295.7+/-337.1 versus 121.2+/-91.9 pg/ml in ulcerative colitis, P < 0.05). In contrast, there was no significant difference in eotaxin-2 serum levels among patients with Crohn disease (863.5+/-448.2 pg/ml), ulcerative colitis (1028.3+/-431.4 pg/ml) and controls (981.4+/-539.4 pg/ml). CONCLUSIONS: Eotaxin is significantly increased in serum of patients with active Crohn disease and ulcerative colitis, suggesting that this cytokine may play a role in the pathogenesis of IBD.     

Effect of different growth hormone-releasing factors on the concentrations of growth hormone, insulin and metabolites in the plasma of sheep maintained in positive and negative energy balance

Three experiments were conducted to compare the ability of different preparations of growth hormone-releasing factor (GRF) to stimulate GH secretion in sheep maintained in positive and negative energy balance. In experiment 1 five sheep were injected (i.v.) with three preparations of human pancreatic GRF (hpGRF-44, hpGRF-40, hpGRF-29-NH2) and one preparation of rat hypothalamic GRF (rhGRF-29-NH2) all at 98.0 pmol/kg, or control vehicle, in a Latin square design when the animals either had free access to food or were fed half their maintenance requirements. Analysis of plasma samples, obtained before and for 150 min after injection, revealed that the reduced food intake resulted in the expected changes in body weight and circulating GH, insulin, glucose, urea and non-esterified fatty acids. The maximum post-injection concentrations of GH did not differ between either the two levels of feeding or the four GRF preparations but the mean post-injection concentration of GH was significantly higher for all GRF treatments on the restricted ration (P less than 0.001). The mean post-injection response to rhGRF-29-NH2 was less than that obtained with hpGRF-44 for sheep with food available ad libitum (P less than 0.05) and was clearly more persistent for all GRF treatments in animals fed the reduced diet (P less than 0.001). In experiment 2 the same five sheep were injected i.v. with rhGRF-29-NH2 (98.0 pmol/kg) when they had free access to food and after food had been withdrawn for 3 days.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of acute angiotensin converting enzyme inhibition on renal blood flow in patients with stable congestive heart failure

Renal blood flow was serially measured as the left renal vein blood flow using the continuous thermodilution technique during acute angiotensin converting enzyme inhibition in 20 patients with stable congestive heart failure. Eleven patients received captopril orally, and the remaining nine patients received enalaprilat intravenously. During the control period, left renal vein blood flow and cardiac output did not correlate closely (r = 0.57). Following administration of captopril or enalaprilat, stroke volume index increased from 20 +/- 7 to 25 +/- 8 ml/M2 (p less than 0.001), while pulmonary capillary wedge pressure decreased from 26 +/- 8 to 19 +/- 8 mm Hg (p less than 0.001). Left renal vein blood flow increased in all patients despite a consistent reduction in systemic arterial pressure. At peak effect, left renal vein blood flow increased from 295 +/- 86 to 443 +/- 122 ml/min (p less than 0.001), while mean systemic arterial pressure fell from 81 +/- 13 to 71 +/- 14 mm Hg (p less than 0.001). Thus, in patients with stable congestive heart failure, acute angiotensin converting enzyme inhibition, although decreasing substantially systemic arterial pressure, consistently enhances renal blood flow.