BACKGROUND: Nitric oxide (NO) production is increased in inflammatory bowel disease (IBD), and measurement of NO metabolites may be useful for monitoring disease activity. AIMS AND OBJECTIVES: To characterise urinary nitrite levels, a stable metabolite of NO, in IBD and to evaluate its potential as a marker of disease activity. METHODS: Twelve-hour urinary nitrites were measured by the microplate assay method in 46 patients with IBD (active; n = 32). Urinary samples from 16 healthy individuals served as controls. RESULTS: Increased levels of urinary nitrites were found in patients with active IBD compared with those with inactive IBD. Twenty-eight out of 32 patients (87.5%) with active IBD had detectable levels of nitrite in their urine as compared with 2/14 (14.3%) patients with inactive IBD. None of the 16 healthy controls had detectable urinary nitrite. Twelve-hour urinary nitrite in active compared with inactive IBD: 5 0.7 versus 0.1+/-0.04 micromol (P < 0.05). There was good correlation between urinary nitrite and some markers of disease activity in IBD such as C-reactive protein and microalbuminuria but not with erythrocyte sedimentation rate. Conclusions: Increased levels of nitrite were detected in urine of patients with active IBD, consistent with increased NO synthesis. This simple assay may be exploited as a potential marker of disease activity in IBD.

Extrapulmonary anaplastic small cell tumours (EPSCC) of the gastrointestinal tract are generally aggressive neoplasms with a poor prognosis. Recent work has demonstrated that EPSCC may be sensitive to the chemotherapeutic regimens employed to treat small cell lung cancer.In this report we present the case of a patient with a primary anaplastic small cell gastric carcinoma treated with combination chemotherapy. Plasma calcitonin, somatostatin, gastrin releasing peptide, total enolase and non-muscle creatine kinase levels were measured before and, if elevated, after completion of induction chemotherapy. Doxorubicin, cyclophosphamide and etoposide treatment resulted in a complete remission which lasted for 11 months. Calcitonin levels, elevated prior to treatment, fell to within the normal range following completion of induction therapy. Extrapulmonary gastric small cell cancer is sensitive to cytotoxic chemotherapy. Like small cell lung cancer, these tumours may produce plasma/serum markers which may be useful in monitoring response to therapy.Case report. A 54-year-old man presented with a 3-month history of severe epigastric pain in October 1992. The pain was waking the patient from his sleep, was aggravated by moving and eased by vomiting. The symptoms were associated with a weight loss of 16 kg. There was no history of dysphagia. He had stopped smoking cigarettes 14 years earlier. Physical examination revealed exquisite tenderness in the epigastrium. On the day following admission to hospital he had an episode of haematemesis.At oesophago-gastroscopy examination a protruberant ulcerating lesion was noted in the gastric cardia below the oesophagogastric junction. The oesophegus appeared normal. Biopsies of the gastric mass (Figs la and b) revealed an infiltrating neoplasm composed of mitotically active small cells with hyperchromatic nuclei, inconspicuous nucleoli and scanty cytoplasm resembling small cell carcinoma of the lung. The cells were uniformly negative for common leukocyte antigen and weakly positive for keratin and neuron-specific enolase. Further biopsies were taken of the gastric antrum which revealed helicobacter pylori positive antral gastritis.A full blood count, renal, liver and bone biochemistry were within normal limits. Bone marrow aspirate and bone biopsy showed no evidence of malignant infiltration. Radiology included a CXR and CT scan of the thorax, a CT brain scan and isotope bone scan all of which were normal. A CT examination of the abdomen revealed evidence of a tumour at the cardia of the stomach with suhmucosal extension to involve the lower oesophagus. A subsequent barium swallow confirmed these findings. A radiolabelled somatostatin analogue scan, using "'In-[DTPA-DPhe'l-octreotide as the radioligand, failed to localise either the primary tumour or show evidence of metastases.Plasma and serum samples were obtained for analysis for the presence of a number of markers. Gastrin releasing peptide, somatostatin, total enolase and non-muscle creatine kinase levels were within normal lim...

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