Eating and corticosteroid levels.

Correspondence MBDICToSH 313 discolorations were observed. On the anterior stomach wall an irregular rupture measuring 8 cm. by 2 cm. in diameter was found and closed. The large hernial defect of the diaphragm was found between the centrum tend-ineum and the muscular pars costalis, and was sutured after the herniated stomach and transverse colon had been replaced into the abdomen without difficulty. Convalescence was uneventful , and the patient left hospital on 9 May in excellent condition. A few weeks later vomiting returned, and the patient had to be reoperated on on 12 June. This time adhesions were found around the stomach, which were divided. A retrocolic posterior gastroenterostomy was performed. The patient has remained well, and has had no further gastrointestinal complaints since the second operation. Rupture of the stomach incarcerated in the thoracic cavity appears to be rare. In the literature available to us we could find only a few published cases.` Of the reported cases four had a fatal termination. The cause of the rupture was rising intragastric tension, impaired blood supply, and/or local factors in the wall of the stomach. In our case traumatic diaphragmatic hernia developed after a thoracic gunshot wound, and had led to rupture of the stomach one year later.-We are, etc., SIR,-I have read with distress the letter by Dr. G. Nuki and others (1 March, p. 574) who say that they have not found the same effect of lunch on plasma corticosteroid levels (11-OHCS) as myself (28 December, 1968, p. 833). I postulated that in normal people lunch may quickly increase the 11-OHCS level to an extent which is greatest when the pre-lunch level is low, and which may be nil or reversed at higher levels. May I say, first, that out of their nine comparisons of 1l-OHCS levels made before and one hour after lunch, five were higher after lunch, agreeing with nine out of eleven in my experiments. Three of theirs, which before lunch were more than 16 ug./100 ml., fell after lunch, like the remaining two of mine. Their remaining one had a pre-lunch concentration of 14 lAg./100 ml., a level near which eating seemed to have little effect in my experiments-or in this one of theirs. A Scottish lunch is nae sae different fra' an English one. The accompanying Figure, which I have drawn from our results, shows how cannily their data fit with mine; especially considering …