symptoms continued after dilatation; 13 others had occasional symptoms only. Though health gradually deteriorates even if symptoms are controlled by dilatation and drugs, 41 patients had a satisfactory quality of life after surgery (groups SA, B, and C)There was no appreciable difference in either postoperative mortality or recurrence of symptoms in the two groups having conservative or radical surgery. The 30 day mortality was similar to that reported for younger patients" and might be reduced with better selection of patients. The five year survival in our patients was 68%. More elderly patients should be considered for surgery for oesophageal stricture. Peak secretion of acid stimulated by pentagastrin was 45 2 (SEM 3 0) mmol/h in the patients who were positive for H pylon compared with 29-7 (4 0) mmol/h in those who were negative (p<0 05). Basal gastrin concentrations were significantly higher in the patients who were positive for H pylori (13 1 (2 0) v 6-3 (2-6) pmol/l, p<005). Integrated plasma gastrin responses to the standard meal were 1564 (267) pmol.min/l in the patients positive for H pylon' and 965 (248) pmol.min/l in those negative for H pylorn (p
We studied the distribution of pancreatic secretory trypsin inhibitor (PSTI) in the epithelia of the gastrointestinal tract and determined whether PSTI is secreted into gastric juice. PSTI was measured by a specific radioimmunoassay in biopsy specimens taken from the upper (n=8) and lower (n=7) gastrointestinal tract of patients with normal endoscopies. PSTI was present in the stomach, small intestine, and colon. Concentrations (1ig/g protein) were highest in the stomach, and significantly higher in the antrum (1240, 670-1700, median and range) than in the gastric body (370, 350-570) (p<001). Concentrations were similar in the duodenum (180, and colon (160, Pancreatic secretory trypsin inhibitor (PSTI) is a small protein containing 56 amino acid residues which was originally isolated from bovine pancreas,' and human PSTI has now been purified24 and cloned.5 PSTI is thought to protect the pancreas from prematurely activated proteases but the recent demonstration of PSTI-like immunoreactivity (PSTI-LI) in other regions of the gut"8 and its isolation from the human stomach,9 suggests that PSTI may protect the whole gastrointestinal tract.The present study was undertaken to determine epithelial concentrations of PSTI using biopsy specimens obtained from the stomach, small intestine, and colon and to study the cellular distribution of PSTI-LI. We also analysed gastric juice to determine whether PSTI is secreted into the lumen. MethodsThe local ethics committee approved the protocol and all patients gave informed consent.All chemicals were purchased from BDH (Poole, Dorset) unless otherwise stated. PURIFICATION AND RADIOIMMUNOASSAY OF PSTIPancreatic juice from postoperative pancreatic drains was stored at -20°C until extraction. Purification of PSTI was based on the method of Iwai et al.'0 Briefly, pooled juice was mixed with an equal volume of 0' 1 M sodium citrate, and the pH adjusted to 2'5. Sodium chloride was then added to a final concentration of 1 M and the mixture maintained at 80°C for 40 minutes, centrifuged at 3500 g for 45 minutes at 4°C, and the supernatant concentrated on a C-18 Sep-Pak cartridge (Waters Associates, Milford MA) equilibrated with 0'05% v/v trifluoroacetic acid in water. The cartridge was then eluted with 80% acetonitrile in 0-05% trifluoroacetic acid, and the eluent lyophilised. The eluent was reconstituted in 0'05 M sodium bicarbonate and applied to a 1'5 x 100 cm column packed with Sephadex G-50 superfine (Pharmacia, Uppsala, Sweden) and eluted with the same buffer. Fractions containing trypsin inhibitor activity were pooled, lyophilised, and further purified by reverse phase high pressure liquid chromatography on a lOx 100 mm Dynamax C-8 column (12 [tm, 300 A, Rainin, Woburn MA), eluted with a gradient of 16-30% acetonitrile in 0'1% trifluoroacetic acid. PSTI eluted in a number of fractions as several poorly resolved peaks and a mixture of these fractions was used for immunisation of rabbits. A sample was also applied to a Mono S column (Pharmacia) equilibrated with ammonium...
Gastrin is trophic to colon cancers that possess gastrin receptors. Whether fasting serum gastrin concentrations are high in patients with colon cancer is controversial. We therefore studied the effect of food on serum gastrin concentrations in patients with colon cancer and control subjects. Fasting serum gastrin was greater, though not significantly so, in patients with colon cancer before surgery (mean (SD) 17*4 (3.6) pmoVI, n=16) compared with control subjects (12.6 (1.9) pmol/l, n=14). Postprandial increases in serum gastrin were significantly and persistently higher than normal in the cancer patients. Blood samples were taken while fasting and then at 10, 20, 40, 60, 90, and 120 minutes after a standardised hospital meal. In the patients with cancer, these studies were performed on the day of admission before bowel preparation, and were repeated 10 days after surgery, immediately before hospital discharge. The blood was drawn into EDTA bottles containing 10 units of Trasylol (Bayer UK, Reading) and immediately placed on ice. Plasma was separated by centrifugation (3000 rpm for five minutes) within 30 minutes of collection and was stored at -70°C before gastrin assay.At surgery, samples (1 g) of tumour and healthy colonic mucosa from the distant resection margin were collected and stored dry at -70°C. These specimens were then extracted by mincing and boiling in distilled water for 30 minutes at a volume of 5 ml water/g tissue (1:5 dilution). The supernatant was separated by centrifugation and stored again at -70°C for subsequent analysis. As a positive control for our extraction procedure, samples of normal gastric antrum taken at gastric surgery were also examined for gastrin concentration.Determination of the gastrin concentration in both serum and tissue extracts was by radioimmunoassay using antibody G179 (a gift of Professor S R Bloom) which recognises the large C terminal fragments of gastrin -that is, G-34 and G-17 -with less than 2% cross reactivity to .'3 The data were analysed using a two way analysis of variance (ANOVA), and where the ANOVA showed a significant difference, the groups at each time point were compared using a Student's t test (p<005 considered significant). ResultsThe results of the effect of feeding on serum gastrin are summarised in Figure 1. Fasting serum gastrin values were higher in the colon cancer patients before surgery (mean (SD)
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