In an analysis of data from the CESAME cohort in France, patients with anal and/or perianal Crohn's disease have a high risk of anal cancer, including perianal fistula-related cancer, and a high risk of rectal cancer.

This work describes a new preparation of dog pancreatic acini which were used to study amylase release in response to various secretagogues. Neither secretin nor vasoactive intestinal peptide stimulated amylase release from acini. Caerulein, carbachol and human synthetic gastrin G17 stimulated amylase release with the same efficacy, but with different potencies. Bombesin nonapeptide did not show any evidence of a direct stimulatory effect on amylase release. These species-related peculiarities stress the necessity of using the same species when comparing pancreatic cell behaviour in vivo and in vitro.

SUMMARY We report a case of a 56 year old woman who presented with a long history of chronic attacks of vomiting. On admission to hospital she was cachectic, and attempted parenteral nutrition induced coma. The illness was found to be due to citrullinaemia, a metabolic disorder of the urea cycle. Our patient is the oldest with this disorder so far described in the literature. The main points of the case and its investigation are outlined: hyperammonaemia, amino acid chromatogram, measurement of enzyme activity in skin and liver biopsy material. The therapeutic measures which led to cure are of particular interest.Chronic vomiting in an adult patient without evidence of organic lesions of the gastrointestinal tract or the central nervous system is often considered to be psychogenic.' In children, chronic vomiting is a well known symptom of a metabolic disorder, especially one of urea synthesis leading to hyperammonaemia. Citrullinaemia, a result of an hereditary deficiency of argininosuccinate synthetase, is one of these metabolic diseases. Many cases have been reported in neonates and children, but adult cases are very rare in white people.2 ' We report here the case of an adult female (aged 56 years) with a long history of chronic vomiting traced to citrullinaemia with concomitant bouts of hyperammonaemia. This is the oldest patient so far described. Case reportA 56 year old white woman was referred to our department in October 1980 with cachexia and a long history of chronic cyclic vomiting which had begun in her infancy. There was no past record of such vomiting in her parents and relatives, but her two brothers died shortly after birth of an undetermined cause. The patient's pregnancy and delivery

Les études concernant la régulation de la sécrétion enzymatique du pancréas réalisées in vivo chez le chien n'ont pas permis de Les peptides agissant par l'intermédiaire de l'AMP cyclique, selon le schéma de Gardner (1979) tels la sécrétine et le VIP, quelle que soit la dose utilisée (de 10-11 M à 10-6 M), n'entraînent pas de sécrétion enzymatique lorsqu'ils sont administrés seuls.Associés à des sécrétagogues tels que la caeruléine ou le carbachol, ils ne modifient pas la réponse sécrétoire de ces peptides. Les peptides « CCK-like », caeruléine, gastrine et le carbachol stimulent la sécrétion enzymatique des acini pancréatiques ; leur D max étant respectivement de 3 x 10-9 M, 10-5 M et 10-5 M. Par contre, le nonapeptide de la bombésine n'a pas d'effet stimulant direct sur la sécrétion enzymatique (de 10-11 M à 10-5 M) alors que la bombésine 14 présente un effet faiblement stimulant à la dose de 10-5 M. Le niveau d'AMP cyclique intracellulaire n'est pas affecté par la caeruléine et le carbachol. Seuls le VIP et la sécrétine entraînent une accumulation intracellulaire d'AMP cyclique. Cette accumulation croît avec la dose de sécrétine utilisée pour atteindre un maximum à 10-a M, alors que la Dn, ax du VIP est de 10-s M.En conclusion, ni la sécrétine, ni le VIP n'exercent d'effet sécrétoire isolément ou en association avec la caeruléine. La potentialisation observée in vivo entre la sécrétine et la caeruléine n'est pas le résultat d'un effet direct intracellulaire. L'effet sécrétagogue de la bombésine dépend étroitement de la longueur de la chaîne peptidique. Enfin, la sécrétine et le VIP provoquent l'accumulation d'AMP cyclique, cette accumulation semblant indé-pendante de la sécrétion enzymatique.

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