Clifford Hawkins

GLUTEN SUBFRACTIONS IN CŒLIAC DISEASE

Abstract Gluten, which contains the substance toxic to patients with cœliac disease, has been broken down into twelve subfractions by ion-exchange chromatography. Toxicity testing using an oral-xylose technique was used to demonstrate that the toxin or toxins are present in only one of these subfractions.

Xylose Test: Effect of Aspirin and Indomethacin

The xylose test was used to assess the effect of drugs on intestinal absorption. Both aspirin and indomethacin reduced the urinary output of xylose. By giving xylose intravenously as well as orally it was found that aspirin had a parenteral effect, probably impairing renal function, whereas indomethacin depressed intestinal absorption.

Medicolegal audit in the West Midlands region: analysis of 100 cases.

One hundred medicolegal cases were analysed to obtain quantitative data about diagnoses and the causes of litigation that affect hospital doctors in the National Health Service. Sixteen actions concerned minor problems that are an unavoidable risk of treatment, and 39 were due to natural causes. In other cases it was debatable whether a medical accident or negligence was responsible. At the end of three years 73 actions had been withdrawn, 12 settled out of court, and one lost in court by the plaintiff, and 14 were pending. Of these 14, nine were likely to reach court on charges of negligence. Contributory causes were failure of communication in 27 and matters connected with the patients attitude or personality in 20. Because much time and money are spent on cases that should never have started a doctor should sit on the legal aid panel to give advice for medical cases. Also, solicitors should obtain an independent medical opinion when a complaint is first received from a patient. Consent forms should be more informative and give details of what can reasonably be expected from treatment and its possible risks.

ORAL GLUCOSE IN REDUCTION OF JEJUNOSTOMY EFFLUENT

Abstract A 65-year-old man had a jejunostomy and colectomy for ulcerative colitis complicated by infarction of the ileum. Oral glucose therapy, as used in cholera, reduced intestinal fluid losses by 1000 ml. per 24 hours.

TESTING GLUTEN SENSITIVITY BY THE XYLOSE TEST

Abstract The 5 g. oral-xylose test, particularly the initial 2-hour result, is used to demonstrate improvement in patients with adult coeliac disease put on a gluten-free diet. The decrease in xylose excretion occurring within 48 hours of ingesting a single dose of gluten proves sensitivity to gluten and confirms the diagnosis.

5-NUCLEOTIDASE IN THE SERUM AND SYNOVIAL FLUID OF PATIENTS WITH RHEUMATOID DISEASE

Abstract Increased serum 5-nucleotidase, usually indicative of liver disease, occurred in 30% of 66 rheumatoid patients. The same enzyme was found in the synovial fluid of 58% of 24 patients with rheumatoid arthritis, but in much higher concentration than in the serum. Estimation of serum 5-nucleotidase in synovial fluid is of diagnostic value, as it is low in non-inflammatory forms of arthritis.

The investigation of malabsorption

Malabsorption can seldom be investigated by one test alone, for the small intestine has a myriad of functions: digestive, absorptive, synthetic, and excretory. Multiple tests-small-intestinal function testsare needed like liver function tests. Each new diagnostic test has a similar career. Hailed as the answer to the physicians prayer, the first report shows distinct separation between normal and abnormal (Fig. la). As later papers appear, the two groups merge and records appear of similar findings in other conditions (Fig. lb); then occurs a disappointing overlap between abnormals and normals (Fig. ic). This is the story of jejunal biopsy and also of various tests of absorption where numerous substances have been tried but abandoned because of lack of specificity. The discriminant index of a single test may not be great, but when two or more tests are combined a higher statistical significance is more likely. Sometimes a normal result may provide stronger evidence in excluding a disorder than an abnormal one which is common to other conditions. No test for malabsorption carries the stamp of certainty. Steatorrhoea itself may be absent not only

Problem Oriented Medical Record

Problem Oriented Medical Record P. H. M. Carson, M.R.C.P.; C. F. Hawkins, F.R.C.P ................................. 713 Dangers of Corn Starch Powder L. Michaels, F.R.C.P.(C)., and N. S. Shah, F.R.C.S ....... 714 Contraindications to Smallpox Vaccinadon A. B. Christie, F.R.C.P ..... 714 Psychiatric Symptoms in Typhoid Fever G. Edsall, M.D.; R. A. Billings, M.R.C.P. 714 Infection with E.B. Virus J. E. Parker, F.R.C.P.(C)., and R. A. Rockerbie, PH.D .715 Duration of Action of Beta-blocking Drugs C. R. Kumana, M.B., and T. R. D. Shaw, M.B.; S. E. Smith, PH.D., B.M 715 Outpatient Maintenance of Chronic Schizophrenics with Long-acting Fluphenazine S. R. Hirsch, M.D., and others ............ 715