Gastritis with veno-capillary ectasia as a source of massive gastric hemorrhage.

The rapidity with which unaltered protein is absorbed following its oral administration is directly influenced by the degree of gastric acidity. In patients with hyperacidity the absorption of unaltered protein is definitely retarded. In the presence of hypoacidity the absorption is accelerated.

Studies in absorption of undigested proteins in human beings

Blood plasma pepsinogen. II. The activity of the plasma from normal subjects, patients with duodenal ulcer, and patients with pernicious anemia.

Medical problems in mineral metabolism

This chapter highlights facets of a broad range of topics that collectively encompass the “nitrate-nitrite problem.” The overview portrays the current status of an area with potentially important ramifications in regard to aspects of mutagenesis/carcinogenesis and, thus, in regard to public health. The reader will encounter citation of some older literature that appears neglected but merits reconsideration in the light of modern knowledge. The reader will also encounter mention of numerous gaps in current knowledge that seem to hinder critical evaluation of the nitrate-nitrite problem. Many of these gaps can be readily filled by further research. In no case is it intended that the final word has been said or that all pertinent and important documentation has been exhaustively reviewed and discussed. Many unsettled issues remain, and in fact differences of opinion prevail more often than not. It is hoped that some balance has been achieved in presentation of the most controversial points. Certainly, the reader is referred to the original literature that contains the data and theses on which the segments of this review were built. Nothing really new is presented in this review— just a way of looking at things that, in itself, may suggest new critical experimentation and analysis.

Nitrates and Nitrites: Ingestion, Pharmacodynamics, and Toxicology

The clinical, pathologic and biochemical changes resulting from obstruction in the upper intestinal tract have been carefully studied by a number of investigators. It is known that a marked or complete pyloric or duodenal obstruction results in severe toxemia or death. The associated increased nerve irritability and the development of a syndrome usually designated gastric tetany have long been recognized. Experimental work along these lines has been concerned chiefly with the nature of the toxic agent, with the changes in blood chemistry, and with the mechanism involved in the production of gastric tetany. The cause of death in this group of cases also has received much attention. Various hypotheses have been advanced, based on experimental studies and on theoretic considerations, but we believe that the associated renal lesion has not yet received sufficient recognition or consideration. Clinically it has been observed that the body reacts differently to intestinal obstruction, depending

Toxic nephritis in pyloric and duodenal obstruction: renal insufficiency complicating gastric tetany

For fifty years the study of gastric acidity in disease has been hampered, first, by the absence of detailed standards of normal for persons of varying age and sex and, second, by a cumbersome method of classifying acidity, a method that tends to obscure any but large differences between two sets of data. We recently published standards of normal based on the records of 3,746 persons. The reader is referred to that paper 1 for many details in regard to technic and other matters. Our standards for free and total acidity and for the incidence of achlorhydria in adults will be found in table 1. So far as children and young persons aged less than 20 years are concerned (table 2), we can provide standards only for free acidity because our data were meager and unsatisfactory in regard to total acidity and the incidence of achlorhydria. In our previous article

Changes in gastric acidity in peptic ulcer, cholecystitis and other diseases: analyzed with the help of a new and accurate technic

Pellagra as a complication of a lesion or of dysfunction of the digestive tract is assuming greater significance in view of the increasing number of cases reported. Rolph1first called attention to the possibility of pellagra originating under these circumstances in 1916, when he reported a case of carcinoma of the upper third of the stomach, involving the cardiac orifice and associated with pellagra. Other instances of benign and malignant lesions with secondary pellagra have been reported by Bryan,2Bender,3Nuzum,4Joyce and Seabrook,5Barnes,6Elliott,7Klauder and Winkelman,8Cabot9and one of us (P. A. O'L.).10One of the most recent contributions from the pellagrous belt is that of Turner,11in which he reported sixteen cases of the disease associated with diverse lesions of the gastro-intestinal tract, eight of which were strictures of the rectum. One of the purposes of this report is to bring up to date the

Pellagra secondary to benign and carcinomatous lesions and dysfunction of the gastro-intestinal tract: report of thirteen cases

7. Jordan, S. M.: Calcium, Chloride and Carbon Dioxide Content of Venous Blood in Cases of Gastro-nuodenal Ulcer Trea tment with Alkalis. J . A. M. A., 87:1906. Dec., 1926. 8. Crohn, B. B.: Effects of Antacid Medication on Gastric Acidity and Secretion. Am. J. Med. Sc., 155:801, 1918. 9. Bakaltschuk, M. : Berl. klln. Wschr., 7:1551, 1928. 10. Szilard, Z.: Die Wirkung des Natr iumhydrokarbonat auf den Magen. Deutsh. Arch. fiir Klin. Meal., 168:368, Sept., 1980. 11. Apperly, F. L. and Semmens, K. M. : Variations in Normal Gastric Functions and Their Causes. Med. J. Australia, 2:226, Aug. 25, 1928. 12. Browne, J . S. L. and Vineburg, A. M.: The Interdependence of Gastric Secretion and the CO, Content of the Blood. J. Physiol., 75:345, July, 1932. 13. Apperly, F. L. and Crabtree, M. G.: The Relation of Gastric Function to the Chemical Composition of the Blood. Jour. of Physiol., '/8:381, 1931. Apperiy, F. L. : Gastric Acidity and its Significance. Lancet, 230:5, Jan. 4, 1936. 14. Bloomfield, A. L. and Keefer, C. S.: A Method for the Quantitat ive Estimation of Gastric Secretion and Discharge in Man. Arch. Int. Med., 37:819, June. 1926. 15. Van Slyke, D. D., Hiller, A. and Berthelsen, K. C.: A Gasometric Method for Determination of Iodates and Sulphates and its Application to the Estimation of Total Base in Blood Serum. J. Biol. Chem.. 74:659, 1927. 16. Van Slyke, D. D. and Neill. J. M.: The Determination of Gases in Blood and other Solutions by Vacuum Extraction and Manometric Measurement. J. Biol. Chem., 61:523, Sept., 1924. 17. Wilson. D. W. and Ball, E. G.: A Study of the Estimation of Chloride in Blood and Serum. J. Biol. Chem.. 79:221, 1928. 18. Cullen, G. E . : The Colorimetric Determination of the Hydrogen Ion Concentration of Blood Plasma. J. Biol. Chem., 52:501, 1922.

Observations on gastric acidity before and after development of carcinoma of the stomach

H EMATENIESIS or melena, or both, are reliable evidence of gross hemorrhage from the upper portion of the gastro-intestinal tract, which may be due to a variety of causes. When such hemorrhage is associated with a history of upper abdominal pain or discomfort related to the digestive cycle and with other digestive disturbances, one logically assumes the presence of some type of intrinsic lesion of the stomach or duodenum until proved otherwise. Every now and then one sees patients whose sole complaint is the vomiting of blood and the passing of t a r ry stools, singly or repeatedly, and of varying degrees of severity. Such patients have never experienced pain, discomfort or indigestion. What are the circumstances that give rise to such a state of affairs, and to what extent do gastro-duodenal lesions, so-called silent, concealed or asymptomatic lesions, play a role?

Gastro-Intestinal hemorrhage from otherwise symptomless lesions, with special reference to duodenal ulcer

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