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Coeliac disease, an immune inflammatory disorder of the gastrointestinal tract characterized by diarrhea, malnutrition, gastrointestinal bleeding, and low blood calcium levels, is frequently treated by prescribing a special diet free from gluten (a vegetable protein found in wheat). Often, adherence to this diet must be maintained throughout a patient's entire life. Owing to the somewhat unpalatable nature of the gluten-free diet, appreciable problems with patient compliance have been reported. Non-compliance among teenagers has been documented to be as high as 50 percent; actual non-compliance rates may be even higher if microscopic abnormalities in intestinal anatomy are accurate markers for surreptitious dietary intake of gluten. To further document the rate of compliance and the effect of non-compliance to a gluten-free diet in adolescents, a study was carried out involving 123 patients diagnosed as having celiac disease within the first three years of life who could be followed-up for at least 10 years. Biopsy specimens were obtained from 36 of the patients. Dietary analysis indicated that 65 percent of the study population was adhering strictly to the diet as prescribed; 11.4 percent occasionally went off the diet, and 23.6 percent did not restrict gluten intake. Clinical symptoms, such as bleeding and diarrhea, were more common among patients who did not restrict gluten intake, but there were no differences between strict adherents to the diet and those who allowed occasional lapses. Patients who did not regulate gluten intake had higher levels of antigliadin antibodies (antibodies against a common wheat protein) than either of the two restricted-gluten groups; and both unrestricted and partially restricted patients had pathological microscopic changes in intestinal structure. (Consumer Summary produced by Reliance Medical Information, Inc.)

Adhesive interactions between endothelium and circulating cells, such as monocytes, neutrophils and lymphocytes, are crucial for localizing the inflammatory response. We investigated the inflammatory response of rectal mucosa to local gluten challenge as a dynamic model of antigen-induced tissue injury, during which the expression of adhesion molecules on leucocytes and endothelial cells could be sequentially observed. Expression of ELAM-I, lCAM-1 and VCAM-l was monitored in 10 treated and eight untreated patients with gluten sensitivity (coeliac disease), and in five disease controls for up to 4 h (short challenge), while a further seven treated coeliaes were monitored for up to 24 h(long challenge) following rectal gluten challenge. In the former, the expression of VCAM-l and ELAM-I was significantly raised 4 h after gluten challenge compared with controls. VCAM-l and ELAM-l expression was also increased in mucosa of treated patients. but to a lesser extent. VCAM-1 expression continued to increase for up to 24 h after gluten, while ELAM-l had begun lo wane by 4 h, reaching basal levels by 24 h. In contrast, the expression of ICAM-I did not change in any of the disease groups studied. These findings relate to significant increases in lymphocytes (CD3+ cells) after 8 h, and neutrophils (CD15+ cells) after 4 h in the lamina propria. This approach has permitted novel studies of the inflammatory response to a defined antigen in sensitized (gluten-sensitive) human patients. [ABSTRACT FROM AUTHOR]

Faecal alpha-1-antitrypsin and 51Cr-albumin losses in 42 patients with either gastrointestinal or hepatic disease were compared. The reference range was derived from measurements in 20 controls without gastrointestinal disease. Alpha-1-antitrypsin excretion was increased in patients with excessive 51Cr-albumin loss, and correlations were found between alpha-1-antitrypsin clearance and 51Cr-albumin excretion. Because of the considerable overlap of faecal alpha-1-antitrypsin excretion between controls and patients, sensitivity and specificity of the test were only 58% and 80%, respectively. This poor reliability could not be explained by sampling error or temporal variations in alpha-1-antitrypsin excretion. These results show that although faecal alpha-1-antitrypsin excretion correlates with 51Cr-albumin excretion when whole groups of patients are studied, its poor sensitivity makes it an unreliable measure of enteric protein loss. [ABSTRACT FROM PUBLISHER]

Several diseases of the small intestine, including gluten-sensitivity, present with malabsorption and a "flat" mucosa. Determination of the mitotic index of epithelial lymphocytes provides a simple, objective method of assessing, and thus of predicting, whether a flat mucosa is due to gluten-sensitivity (index greater than 0.2%), or not (index less than 0.2%). The use of this index in circumstances especially likely to cause diagnostic confusion--for example, intestinal lymphoma; Crohn's jejunitis of immunodeficiency--is illustrated in this paper. Of seven cases, five (two primary lymphoma, three immunodeficiency) had been treated with a gluten-free diet without benefit; a mitotic index performed on the initial biopsy in each of these patients could have predicted from the outset that none was gluten-sensitive. Of the remaining two cases, determination of the mitotic index on the biopsy initially obtained from a man with severe hypogammaglobulinaemia would have indicated that he was also gluten-sensitive. Empirical use of a gluten-free diet was avoided in the other patient (with flat small intestinal mucosa and low mitotic index) in whom the diagnosis was ultimately shown to be due to Crohn's disease of jejunum. [ABSTRACT FROM PUBLISHER]

It has been established that considerable blast-transformation and mitotic activity occurs among epithelial lymphocytes of untreated coeliac mucosa. This paper is concerned solely with the proliferative activity of epithelial lymphocytes (expressed as percentage "mitotic index") in the prospective diagnosis of coeliac disease, in comparison with other conditions such as lymphoma. Crohn's disease and immunodeficiency which are often associated with malabsorption and flattening of jejunal mucosa. The results demonstrate that a high mitotic index (greater than 0.2%) clearly distinguishes, and hence predicts, gluten-associated enteropathies (including dermatitis herpetiformis and malignant histiocytosis) from others in which gluten plays no aetiological role and where the mitotic index differs insignificantly from normal control mucosae (much less than 0.2%). Furthermore, it has been demonstrated that the mitotic index is raised in so-called "non-responsive coeliacs," thus suggesting that such patients may also be gluten-sensitive despite their subsequent failure to respond morphologically to dietary gluten restriction. [ABSTRACT FROM PUBLISHER]

In 1964 Samman and White described 13 patients with lymphoedema of the lower extremities associated with an unusual dystrophy of the finger and toe nails: this they termed the 'yellow-nail' syndrome. Affected nails were thickened, excessively curved along both axes, very slow growing and of yellowish-grey hue; cuticle and lunula were usually absent and onycholysis was frequently evident. Lower limb lymphangiography in most individuals revealed hypoplasia, or aplasia of the lymphatics, similar to that occurring in primary lymphoedema: other patients also developed pleural effusions of high protein content or ascites suggestive of a more generalised disorder of the lymphatic system. Here we describe a patient in whom the classical 'yellow-nail' syndrome was associated with intestinal and chylous ascites. [ABSTRACT FROM PUBLISHER]

Intestinal permeability was investigated in patients with coeliac disease and dermatitis herpetiformis by a 51Chromium-labelled ethylenediaminetetraacetate (51Cr-EDTA) absorption test and the results correlated with histomorphometric analysis and intraepithelial lymphocyte counts of jejunal biopsies. The mean (+/- SD) 24 hour urine excretion of 51Cr-EDTA in 34 healthy volunteers was 1.9 +/- 0.5% of the orally administered test dose. Patients with untreated coeliac disease (19) or untreated dermatitis herpetiformis (five) excreted significantly more 51Cr-EDTA than controls (5.9 +/- 2.7% and 4.6 +/- 2.1%, respectively, p less than 0.001) and all were outside the normal range of 1.0-2.6%. Patients with coeliac disease (42) treated for 6 months-23 years (mean 5 years) and patients with dermatitis herpetiformis (11) treated for 6 months-8 years (mean 3 years) excreted significantly more 51Cr-EDTA than controls, 4.2 +/- 2.4% p less than 0.0001 and 3.0 +/- 0.9% p less than 0.003 respectively. Eleven of 14 (79%) treated patients with coeliac disease with an entirely normal jejunal mucosae demonstrated abnormal intestinal permeability. Intestinal permeability did not correlate significantly with either the mucosal height/crypt depth ratio or intraepithelial lymphocyte counts in jejunal biopsies from patients with untreated or treated coeliac disease. The demonstration of a persistent increase in intestinal permeability in patients with both coeliac disease and dermatitis herpetiformis may suggest a common pathogenetic mechanism in both disorders. It is postulated that altered permeability may facilitate the entry of gluten or a fraction thereof into the lamina propria where it causes a cascade of immunological events. [ABSTRACT FROM PUBLISHER]

Computed tomography detected the presence of dilated ducts in 15 of 18 cases with extrahepatic obstructive jaundice and demonstrated the obstructing lesion in 18 out of 25. The cause of the obstruction was detected in the absence of duct dilatation, and calculi which were radiolucent on conventional radiographs were demonstrated. Ulstrasound detected dilated ducts in eight of 10 cases, but demonstrated the cause of the obstruction in only one of 13 cases. Both techniques are capable of demonstrating dilated ducts in the majority of cases, but computed tomography is better at detecting the cause of the obstruction. [ABSTRACT FROM PUBLISHER]

Mice were given either intraperitoneal tritiated thymidine (3H-Tdr) or colchicine to study proliferation and migration of intestinal epithelial lymphocytes. Both labelled medium and large lymphocytes ('immunoblasts') were observed throughout the epithelium, crossing the basement membrane and within villous lymphatics for at least seven days after 3H-Tdr administration. Epithelial lymphocytes are predominantly young cells, actively dividing at the rate of 1% per hour. They do not migrate along the villi, unlike epithelial cells, but circulate rapidly through the epithelium, returning to the lamina propria at the rate of approximately 3 epithelial lymphocytes/1000 epithelial cell nuclei/hour. The labelling pattern of epithelial lymphocytes and intralymphatic cells with time was very similar suggesting that epithelial lymphocytes therefore may directly enter adjacent lymphatics and hence gain access to thoracic duct lymph. [ABSTRACT FROM PUBLISHER]

The morphology of epithelial lymphocytes in osmium-fixed, Epon-embedded jejunum of adult mice was studied by light and electron microscopy. Toluidine blue-stained 1 mum 'thick' plastic sections were compared with adjacent thin sections, thereby permitting precise ultrastructural identification and description of selected epithelial lymphocytes. Their size and appearances varied considerably, ranging from typical small lymphocytes through medium-sized lymphocytes to large immunoblasts. A high proportion of medium-sized epithelial lymphocytes (mean diameter 6-9 +/- 1-1 mum) contained several lysosomes, extensive Golgi complexes, prominent centrioles and abundant ribosomes. Their appearances, therefore, corresponded directly to mitogen-stimulated lymphocytes. In contrast, immunoblasts were big cells (mean diameter 11-0 +/- 0-8 mum) with large, euchromatic nuclei and prominent nucleoli. The majority had pale-staining, ribosome-studded cytoplasm and thus resembled type I, or T blasts. Very rarely, densely staining blasts containing ribosomes and well developed rough endoplasmic reticulum were observed; these corresponded to type II or B blasts. These observations indicate that transformation of lymphocytes occurs within the interepithelial cell spaces of the small intestinal mucosa, suggesting that epithelial lymphocytes are immunocompetent cells which may be responsive to local antigenic stimulation. [ABSTRACT FROM PUBLISHER]

Isolated epithelial cells and their subcellular organelles were examined both by transmission and by scanning electron microscopy. It was shown that scanning electron microscopy is particularly useful for displaying the three-dimensional structure of the brush border. Furthermore, it has been possible to observe the basal aspect of separated epithelium for the first time. Studies on the scanning electron microscopic appearance of isolated nuclei, mitochondria, and lysosomes did not reveal any evidence of surface structure. [ABSTRACT FROM PUBLISHER]

In this paper we describe the features of small intestinal structure in normal control subjects using the scanning electron microscope. [ABSTRACT FROM PUBLISHER]

A 72-year-old man with severe megaloblastic anaemia due to a benign duodeno-colic fistula originating from an antimesenteric duodenal diverticulum is described. Previous reports of fistulae from duodenal diverticula are reviewed. [ABSTRACT FROM PUBLISHER]

A women with beta-thalassemia intermedia, and iron overload following many years' treatment with oral iron, was treated with subcutaneous desferrioxamine. During the course of this treatment she developed tinnitus, which was considered to be a rare complication of the use of this chelating agent. The mechanism of this effect is not understood. [ABSTRACT FROM PUBLISHER]