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Summary and conclusionsTo determine the prevalence of alcohol use in casualty patients breath-alcohol analysis was performed on 702 patients attending the accident and emergency department of a large teaching hospital during the evening.

SUMMARY The influence of the type and size of solid particles on their emptying from the stomach was studied using isotopically labelled chicken liver and inert particles in normal subjects and in patients who had undergone gastric surgery. In normal subjects, initial emptying of the liver was slower than that of inert particles both for large liver cubes (1 cm) and small cubes (0.3 cm). Liver emptying subsequently accelerated to be faster than emptying of the inert particles. Overall emptying of the liver given as small cubes was faster than large cubes; 50% emptied in 50 minutes and 70 minutes respectively. In the postoperative subjects, emptying of the liver and of the inert particles was identical. The findings are consistent with the hypothesis that solid foods such as liver are ground down and 'liquefied' by the action of gastric peristalsis before being discharged to the duodenum. Ingested particle size appears to influence the rapidity of this process, which should be distinguished from the propulsive function of the stomach where small solid particles are concerned.After the ingestion of a mixed liquid and solid meal, the liquid component empties from the stomach more rapidly than the solid. Although there is still debate about the relative importance of the proximal stomach' and of gastric peristalsis2 in controlling the emptying of liquids, it is generally agreed that the emptying of solids is controlled by the distal stomach,3 where peristaltic activity also serves to grind and mix the gastric contents before their delivery to the duodenum. Recent interest in the gastric emptying of solids has led to the development of several radioisotopically labelled solid foods suitable for study by scintigraphic methods. Liver labelled with technetium 99m has been particularly favoured46 but emptying studies using bread7 and egg white,8 cellulose fibre,9 and bran'0 have also been described.We have previously reported studies of gastric emptying in man using small inert particles labelled with technetium 99m, which are added to a normal meal.11 These particles are emptied from the stomach in an approximately linear manner with time, corresponding to the pattern observed for solids which are normal dietary constituents. How-* Present address:

SUMMARY The use of real-time ultrasonic imaging of the stomach for the study of gastric contractions in response to a liquid test meal is described. Gastric contractions in the pyloric antrum and distal body of the stomach were observed on closed circuit television, recorded on to cassette tape and also imaged on polaroid and cine film. Gastric contractions were recorded from the pyloric antrum by longitudinal scanning in the lower epigastrium and reproducible motility tracings were obtained on a fibreoptic chart recorder. Intravenous metoclopramide enhanced the magnitude and frequency of antral movement, which was abolished by intravenous propantheline. Real-time ultrasonic imaging permits the non-invasive study of gastric contractions. It is safe, may be repeated as required, and provides a method for the study of the effect of drugs and disease states on gastric motility.Most current techniques for the study of gastric motility require intubation of the stomach or exposure of the subject to ionising radiation.1-3 Gastric intubation is often disliked by volunteers and patients and may itself induce anxiety or nausea which may be sufficient to disturb normal gastric motility. Contrast radiography or scintigraphic scanning techniques, used to determine gastric emptying rate, are unsuitable for repeated studies on the same individual because of radiation hazards and are best avoided in the premenopausal female.To overcome these disadvantages of existing methods for the study of gastric motility, we have used real-time ultrasonic scanning4 to obtain dynamic images of the stomach. Abdominal ultrasound has hitherto been used mainly to study organs other than the stomach or intestines, principally because gas in the gastrointestinal lumen disrupts the ultrasonic beam. An abnormally thickened or food-filled stomach produces a recognisable echographic image.5-8 Gastric intercontraction times have been recorded using a B-scan plus time-motion (T-M) scan technique.9 Real-time ultrasonic imaging has a number of advantages resulting from visualisation of the motion of the selected section while the time-motion record is being produced.

The gastric emptying rate was measured in 10 female patients with primary anorexia nervosa and 12 healthy volunteers, using a scinti-scanning technique for the simultaneous study of the liquid and solid components of a test meal. The emptying rate of both the liquid and the solid phase components of the meal was significantly slower in patients with anorexia nervosa. The aetiological and therapeutic implications of this finding are discussed.

SUMMARY Pneumatosis cystoides intestinalis (PCI) is an uncommon condition of unknown aetiology. Bacterial gas production may be an important aetiological factor, but experimental evidence in humans has been lacking. We have studied breath hydrogen excretion as an index of bacterial gas production in 12 patients with PCI and have shown that four out of five with demonstrable cysts produced unusually high levels of hydrogen while fasting. This abnormality has not been previously reported. One patient showed resolution of PCI after antibiotic treatment. These findings confirm the importance of bacterial gas production in the pathogenesis of PCI.There has been much speculation about the aetiology of pneumatosis cystoides intestinalis (PCI), an uncommon condition characterised by the presence of gas-filled cysts within the walls and mesentery of the intestine. The most widely accepted theories have proposed a mechanical origin for the cysts (Koss 1952;Keyting et al., 1961), but mechanical theories alone fail to account for the finding that hydrogen, a gas never produced by mammalian cells, may comprise up to 50 % of the gas content of the cysts (Forgacs et al., 1973).Measurement of breath hydrogen is now an established method of studying bacterial activity in the intestine (Hepner, 1974) and we have therefore studied breath hydrogen excretion in our patients with PCI.

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