Brian McNicholl

Jejunal Biopsy in Celiac Disease

When symptoms suggestive of celiac dis case have been present for over three months, irrespective of tests of absorptive function, a jejunal biopsy is indicated, but this should be preceded by at least a week of a gluten-containing diet. If severe mucosal damage is found, a gluten-free diet should be prescribed for several years, and in many cases must be continued until growth has ceased. Equivocal findings, which are most likely in the early months of the disease, call for further assessment including repeat biopsy when symptoms persist on a gluten-contain ing diet.

Organ culture of coeliac and non-coeliac small intestinal mucosa

SummaryOrgan culture of small intestinal mucosa from coeliac and non-coeliac patients is described. Morphological preservation of structure was observed and an increase in the levels of alkaline phosphatase and a decrease in the lactic dehydrogenase from coeliac mucosa was noted. Similar trend in non-coeliac mucosa were not statistically significant. The initial elevted lactic dehydrogenase activity in coeliac mucosa has not previously been reported.

Survival of rabbit foetus in maternal hypoxia

SummarySeven pregnant rabbits were subjected to hypoxia for 24 hours between the 27th and 28th days of gestation : the critical level for foetal survival appeared to be around 9 per cent oxygen. Three of the 7 litters were born alive, the animals surviving from some minutes to 48 hours; all had marked resorbtion atelectasis.These hypoxic animals had lower birth weights than other animals born at the same stage of gestation but without artificial hypoxia.

Alcohol-related presentations to emergency departments in Ireland: a descriptive prevalence study.

Objectives To determine the prevalence of alcohol-related presentations in all 29 emergency departments (EDs) in Ireland and compare with non-alcohol-related presentations in order to identify opportunities for improvements in the quality of patient care and related data collection. Design and setting Descriptive prevalence study reviewing all records in the same four 6-hour periods in every 24-hour ED in the country. Participants 3194 persons who attended EDs over four specified 6-hour periods. Primary outcome measures The prevalence of alcohol-related presentations, comparison with non-alcohol-related presentations and the categorisation of these presentations according to WHO International Statistical Classification of Diseases and Related Health Problems 10th Revision codes. Results The total number of presentations was 3194 in the four 6-hour periods, of whom 189 (5.9%) were alcohol related, varying from 29.0% in the early hours of Sunday morning to 1.2% on Monday morning (p>0.0001). The alcohol-related presentations were more likely to be men, attend on early hours of Sunday morning, arrive by ambulance, leave before being seen by a doctor or leave against medical advice; and they were less likely to be admitted to hospital. Conclusions Alcohol-related presentations are a significant burden on EDs and ambulance services, especially in the early hours of Sunday mornings. Addressing the alcohol-related burden on EDs requires improvements in data collection and information systems, the development of appropriate interventions and related referral services and better preventive actions for alcohol-related harm.

Coeliac disease and congenital pernicious anaemia

SummaryThe concurrence of coeliac disease (CD.) and congenital pernicious anaemia (C.P.A.) in an Irish boy, whose sister also had C.P.A. is described. The sister with C.P.A. has shown no evidence of having coeliac disease. The proband and his sister are concordant for C.P.A. and have identical H.L.A. types, supporting the generally accepted view that inheritance of C.P.A. is recessive. The discordance for CD. suggests that a genetic factor other than that in the H.L.A. system may be needed for its expression, assuming shared environmental factors.

7. Celiac disease sans diarrhea

Three infants presented around I year of age with failure to thrive, comiting, and anorexia and were shown to have severe jejunal mucosal lesions characteristic of celiac disease before or at the time of onset of mild diarrhea. Two infants had fecal retention, none had steatorrhea, and all have thrived on glutenfree, milk-containing diets. Other investigations were confirmatory, including some sugar tolerance tests, and assays of mucosal lactase, glutamyl-tyrosine, γ-glutamyl-β-napthylamide, and glycylleucine; the dipeptidase assays were by a zymographic technique. Immunoglobulins were measured by single radial diffusion and showed high IgA in each child, low IgM in one, and variable IgG levels. The mucosal lesion of gluten-induced celiac disease can be demonstrated before diarrhea or steatorrhea occur.

Experimental respiratory distress in newborn rabbits

SummaryAttempts at production of pulmonary hyaline membranes in full term and prematurely born rabbits were unsuccessful; methods included intratracheal injection of human and rabbit liquor amnii, rabbit blood and serum; oxygen poisoning; bilateral cervical vagotomy with and without subsequent oxygen poisoning; hypoxia in the intact amniotic sac during Caesarean section, and hypoxia in utero by means of maternal hypoxia.