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1974. The enhancement of maximal bilirubin excretion with taurocholate-induced increments in bile flow. Can. J. Physiol. Pharmacol. 52,[389][390][391][392][393][394][395][396][397][398][399][400][401][402][403] Of the processes involved in the handling of a bilirubin load, the biliary secretory maximum or T,,, for bilirubin has been regarded as rate limiting, and as a characteristic of liver function. In the present study, bile flow was varied by use of bile acid infusions, in order to determine whether the T,,, is indeed constant or whether it varies with flow. Anesthetized dogs, with bile flow stabilized by cholinergic blockade, were studied during taurocholate infusions. In these animals the ductular conlponent of flow is relatively inhibited and the bile flow rate increases approximately in proportion to the rate of excretion of taurocholate. The maximal biliary excretion rate of bilirubin was found to increase linearly with flow and taurocholate excretion, in a significant fashion, but, in contrast to the relation between taurocholate excretion and flow, a significantly large intercept remained on linear extrapolation towards zero flow. The basis for the large intercept is a great increase in the bilirubin concentration in bile as the flow is decreased. This results in a simultaneous sharp increase in the molar ratio (bilirubin/taurocholate) at very low flow rates.

Three patients with Crohn's disease primarily involving the large intestine had unusual abscesses of the vulvar area. At biopsy, the abscesses had classic features of the primary disease and were clearly separated from the intestinal tract. There was no fistula in the anal canal, and the perineum between the vulvar abscess and the anus was normal. One of the patients also had an early lesion of Crohn's disease in the sigmoid. The lesion appeared as a small erythematous spot without ulceration. Biopsy revealed a typical granuloma under an intact mucosa. It is concluded that Crohn's disease is not confined to the gastrointestinal tract, and that early lesions of the disease within the gastrointestinal tract are submucosal rather than mucosal.