I Ten consecutive patients with hypertriglyceridaemia who adhered to a low carbohydrate diet without complete control of serum triglycerides were started on chenodeoxycholic acid 750 mg daily and followed monthly for 6 months. Nine of these patients were then followed for a further month on placebo capsules and thereafter monthly for a further 6 months on clofibrate 2 g daily. 2 The mean serum triglyceride level fell by 36% after dietary treatment alone (P <0.05) and by 47% from initial values on diet plus chenodeoxycholic acid (P < 0.01). In the nine patients who proceeded to clofibrate therapy there was a rise in triglyceride levels on placebo capsules to the level achieved by diet alone, and a further fall on diet plus clofibrate of 47% of initial values (P < 0.05). 3 Chenodeoxycholic acid therapy is effective in the management of hypertriglyceridaemia not completely cured by dietary measures, and may be as efficacious as clofibrate.

One hundred consecutive referrals to a general medical out-patient clinic were evaluated psychiatrically under blind conditions in order to investigate the nature and occurrence of non-organic disease presenting as gastrointestinal illness. Twenty-eight patients had marked psychiatric illness with or without physical illness, and there was an association between psychiatric illness and the absence of organic disease, as determined by outcome at follow-up of 4-11 months. Patients with obsessional traits were more at risk of non-organic illness. Historical items indicating a likelihood of non-organic gastrointestinal illness included "nerves", "depression", unhappy childhood, early parental loss and early separations from parents during childhood. Psychiatric illness often persisted after treatment for physical symptoms. Some of the techniques used in this study to identify psychiatric illness could be usefully employed in everyday practice.

SUMMARY A patient with nodular lymphoid hyperplasia, who manifested defects in cellular immunity, is presented. The clinical course is discussed and a review included of the 23 patients thus far reported with nodular lymphoid hyperplasia and hypogammaglobulinaemia.Acquired idiopathic hypogammaglobulinaemia can be associated with a sprue-like syndrome in about 20% of patients (Gitlin, Gross, and Janeway, 1959). Hermans, Huizenga, Hoffman, Brown, and Markowitz (1966) described the association of hypogammaglobulinaemia with nodular lymphoid hyperplasia of the small intestine, recurrent upper respiratory infections, the malabsorption syndrome with steatorrhoea, and infestation with Giardi lamblia. Nodular lymphoid hyperplasia is relatively rare and is not found in the vast majority of patients with acquired idiopathic hypogammaglobulinaemia. Our purpose is to report a patient with this disorder and to review the literature relating to this subject. Case HistoryThe patient, a male aged 62, presented in November 1969 complaining of loss of appetite and vomiting for two weeks and weight loss of 20 kg over one month. His previous health had been good apart from the symptoms of chronic bronchitis for 30 years. Examination showed evident weight loss and pallor. Haemoglobin was 9.5 g per 100 ml with macrocytosis of the peripheral blood film. Megaloblasts were present in the sternal marrow biopsy. An augmented histamine test revealed achlorhydria. After a standard Schilling test no radioactive vitamin B12 was excreted in the urine and the addition of intrinsic factor improved the 24-hour urinary excretion to only 7 % of the administered dose (normal > 12 %). Total serum protein was 4.6 g per 100 ml (albumin 2-9 g, total globulin 1-7 g). A barium meal showed an atrophic mucosal pattern and poor peristalsis suggestive of linitis plastica.After transfusion with 4 pints of blood a laparotomy revealed no abnormality except for a few enlarged mesenteric nodes, one of which was

SummaryThe 1-0'C)-glycine-glycocholic-acid breath test has been performed on 104 subjects and a normal range established. Abnormal results due to bacterial deconjugation of bile salts were found not only in patients with the "conmnated bowerl syndrome and in those with ileal resection but also in a third group, patients with cholangitis. Abnormal results were also found in patients with gastrocolic fistula and staphylococcal enterocolitis, while mildly abnormal results were also found in some patients with liver disease.