SUMMARY The process of iron absorption has been studied in 23 patients with idiopathic haemochromatosis, in eight with iron-deficiency anaemia, and in 20 control subjects. The initial uptake of iron by the intestinal mucosa was estimated by administering 59Fe-ferric citrate during a standard meal together with a non-absorbable marker, 51Cr-chromic chloride. Body iron absorption (iron retained at 14 days) was measured by whole body counting with discriminant analysis to separate the two isotopes. Thus, the fraction of the initial mucosal uptake finally retained in the body was calculated (the mucosal transport index of iron).In control subjects the mean values for mucosal uptake of iron and body iron absorption were 12-0 ± SD 4.9 % and 3.6 ± SD 2.4%, with a mean mucosal transport index of 031 i SD 0.21. Mucosal iron uptake and body absorption were both considerably increased in the patients with iron-deficiency anaemia (33.5 ± 15.6 and 29.8 ± 17-0% respectively) and in the eight patients with idiopathic haemochromatosis treated by venesection therapy until the excess iron stores were removed (27-2 + 12-0 and 26.6 ± 14.6% respectively). The mucosal transport index in all these subjects approached 1.0. Eight patients with haemochromatosis were studied before venesection therapy. The mucosal uptake of iron was within the normal range in all (mean 14-0 ± 2.8 %) but body iron absorptiorn was increased in five (mean 9.1 ± 4-8 %). The mean mucosal transport index of iron was significantly increased in this group (0.62 + 0.28; p <0.01).The findings suggest that the increased iron absorption in subjects with idiopathic haemochromatosis results from an abnormality of the intestinal mucosa and not from altered intraluminal factors. However, whether the aberrant mucosal cell function is a primary defect in the cell or an acquired change, dependent on humoral or corporeal factors, is unknown.While there is evidence that the absorption of iron in some patients with idiopathic haemochromatosis is increased, particularly in the early stages of the disease (Charlton

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Summary: An experimental model, originally designed to study the effects of controlled interruption of the enterohepatic circulation (EHC), has been extensively modified and adapted to study the applied physiology of an “intact” EHC of bile in Rhesus monkeys. Basically, the model consists of a surgically exteriorised extrahepatic biliary circuit in which an electronic stream splitter is interposed. This diverts every twentieth drop of bile which provides a representative sample for analysis while returning the remaining 95% of bile to the upper intestine. During these studies, the monkeys were comfortably restrained in specially designed chairs whose construction is described in detail. Animal maintenance and the design of the electronic stream splitter are also described. Analysis of the glycine: taurine and the dihydroxy: trihydroxy bile salt ratios both in gallbladder bile and in bile obtained with an “intact” EHC (by using the stream splitter), showed that the Rhesus monkey secretes a bile similar in composition to that of man. The bile salt: cholesterol: phospholipid ratios in monkey gallbladder bile (81:6:13) were also similar to those found in human bile, indicating that this animal is suitable for studies of cholesterol solubility in bile – a factor of major importance in gallstone pathogenesis. The model has been used to measure bile volume, bile salt secretion, pool size and the frequency of circulation of the bile salt pool. The diurnal variation in these variables has also been studied.

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SummaryThe leucocyte adherence inhibition test provides a rapid, reliable, and specific technique for the immunodiagnosis of primary hepatocellular carcinoma (malignant hepatoma). The patient's blood leucocytes are tested in vitro for cell-mediated immunity against tumour-associated antigens and the serum is tested for blocking factor which interferes with the immunological reaction. Specific reactivity of both leucocytes and serum was consistently detected in patients with malignant hepatoma, and negative reactions were obtained in other liver diseases including secondary tumours of the liver. The test has provided positive evidence for the presence of hepatoma when more conventional methods gave doubtful or negative results. A positive result preceded the clinical appearance of tumour by up to three years in two patients. IntroductionThe early diagnosis of primary hepatocellular carcinoma (malignant hepatoma) poses several difficulties for the clinician. Hepatomas are often preceded by other pathological conditions of the liver, such as cirrhosis and haemochromatosis (Finch and Finch, 1955), so that a change in symptoms due to the tumour may escape recognition. A small tumour may not be detected by hepatic scanning, biopsy, or angiography. Moreover, currently available serological tests lack specificity and sensitivity.