Jejunal suction biopsies of 18 chronic alcoholics (alcohol intake of more than 100 g of ethanol per day for several years) and 10 nonalcoholic control subjects were analyzed quantitatively using the microdissection technique described by Clarke. Both groups were comparable concerning age, body weight and sex. The duration of alcohol withdrawal in the alcoholics before the biopsy was taken ranged from 2 to 7 days. The mean number of villi and surface per villus was slightly lower in the jejunum of the alcoholics. The mucosal surface per mm² was significantly lower in the latter group when compared to the controls (p < 0.005). The ratio of the number of crypts per villi was increased in the alcoholics (p < 0.05). Histological evaluation revealed a more than twofold increase in the number of interepithelial mononuclear cells (p < 0.005), while the number of epithelial cells/100 μm of villous mucosa and the mean height of the epithelial cells were comparable in both groups.

Fecal chymotrypsin (CT) activities were determined in 149 randomly collected fecal specimens of 80 patients in whom the pancreatic function had been tested by a secretin-cholecystokinin test. There was a significant correlation between fecal CT activities and outputs of trypsin (r = 0.3451, p < 0.01) and amylase (r = 0.3285, p < 0.01) in duodenal juice. Fecal CT activities were normal in all patients who – based upon enzyme outputs in duodenal juice after stimulation with secretin and CCK/PZ – were classified as ‘borderline cases’, in most patients with ‘Ιow-normal’ pancreatic function, and in a significant number of patients with established insufficiency of exocrine pancreas. On the other hand, fecal CT activities were abnormal in patients with severely impaired output of trypsin in duodenal juice, and only 7% of the fecal specimens from patients with established normal function of exocrine pancreas had abnormal low CT activities. It is concluded that the sensitivity of the fecal enzyme method is rather low as compared to the secretin-cholecystokinin test, but that fecal CT determinations give valuable diagnostic information in patients with more pronounced insufficiency of the exocrine pancreas.

SUMMARY The results of a double-blind trial of glucagon in 69 patients with acute pancreatitis are reported. In a subgroup of 59 patients statistical analysis showed no significant differences between the glucagon-treated (n = 29; 2 x 5 mg protamine-zinc glucagon intramuscularly per day) and the placebo-treated (n = 30) subjects for the following data: duration of pain felt spontaneously and induced by palpation, amounts of analgesics and antispasmodics required by the patients, duration of hospital stay, amylase activities in serum and 24 hour urine collections. Mortality rates did not differ significantly between the glucagon-treated and the placebo-treated subjects in the total group of 69 patients and in the two subgroups of patients who were treated conservatively (n = 59) and those who underwent laparotomy because of severe peritonitis (n = 10). From the results of this study it is concluded that favourable effects of glucagon upon the course of acute pancreatitis-if they do exist-are not significant. (Condon et al., 1973;Mercadier et al., 1973;Fleischer and Kaspar, 1974;Holub and Om, 1974;Stremmel, 1974). Relief of pain and clinical improvement were observed together with a decline in enzyme activities in these studies. In order to assess the value of this treatment we started a double-blind trial, the results of which are reported in this paper. MethodsPatients entering the trial had to fulfil the following criteria: (1) a history and clinical signs typical of acute pancreatitis, (2) a rise in amylase activities in serum and urine to at least twice the upper normal limit. The patients were divided into two groups: group I comprised nine patients (five treated with placebo and four treated with glucagon) who were operated on during the acute phase of their illness 'Preliminary results of this study were reported at the 8th

Macroamylasaemia was produced in vitro by incubation of hydroxyethylstarch with serum, and in vivo by intravenous infusion of hydroxyethylstarch. Gel filtration on Sephadex G-100 revealed distinct differences in molecular size distribution between such hydroxyethylstarch-induced macroamylase and the usual form of naturally occurring macroamylase which was observed in a few patients from our hospital. Further studies demonstrated that the gel filtration elution pattern of amylase activity in serum containing hydroxyethylstarch-induced macroamylase is significantly altered with time in vitro and in vivo, probably because of an enzymatic degradation of the hydroxyethylstarch components of the macromolecular complexes. In a healthy volunteer the serum amylase activity was elevated to a maximum of 797 u/l and the renal clearance rate of amylase was diminished to a minimum of 0.3 ml/min after infusion of 500 ml of a 6% solution of hydroxyethylstarch, as compared to 300 u/l, and 0.95 ml/min, respectively, during the pre-infusion period.

A Lineweaver-Burk plot demonstrated that the apparent Michaelis constants are identical for chymotrypsin (CT) in duodenal juice and in feces of the same patient. CT in fecal homogenates exhibits a remarkable stability and is bound to particles to a considerable but variable extent. The pH optimum of CT in human feces is somewhat higher as compared to pure bovine pancreatic CT. All measurements of fecal CT activity should, therefore, be performed at pH 9.0. The distribution of CT among the fecal mass has been investigated. There were considerable differences between CT activities in random fecal specimens and in the corresponding stool collections. However, if the results were expressed in terms of ‘normal’ and ‘abnormal’, 113 out of 120 random fecal specimens gave the same results as the corresponding stool collections. It is concluded that the risk of ‘false-normal’ values cannot be effectively reduced by determination of CT outputs in stool collections (or by using continuous markers) instead of CT activities in random stool specimens.