Quantitation of intraepithelial lymphocytes in human jejunum

An estimate of the number of intraepithelial lymphocytes in jejunal villous epithelium can be obtained by differential counting of nuclei in the epithelium. From counts carried out in 160 jejunal biopsies from patients who did not have coeliac disease the normal range has been established as 6-40 intraepithelial lymphocytes per 100 villous epithelial cells. In some biopsies there was a moderate increase in the intraepithelial lymphocyte count; this was probably an objective measurement of ;increased chronic inflammatory cell infiltrate'. Intraepithelial lymphocyte counts were high in untreated coeliac disease; counts were lower, but rarely within the normal range, in coeliac patients on a gluten-free diet. Counts were normal in most autoimmune diseases, ulcerative colitis, and Crohn's disease. There were abnormal intraepithelial lymphocyte counts in four patients, with otherwise normal jejunal histology, in whom no cause had been found to explain prolonged and incapacitating gastrointestinal symptoms.

Plasma insulin response to oral carbohydrate in patients with glucose and lactose malabsorption

Plasma insulin levels were determined following oral glucose in 12 patients with adult coeliac disease, after oral lactose in four patients with alactasia, and in age-matched control subjects. In coeliac patients the insulin response was greater than expected from the small rise in blood sugar, and no correlation was found between plasma insulin and sugar levels at any period during the test. The separation of the plasma insulin curve from the blood sugar curve after glucose is in keeping with the concept that a factor responsible for stimulating insulin secretion is released from the gut during or after absorption of glucose. In patients with selective lactose malabsorption (alactasia) administration of lactose by mouth failed to elicit any insulin response, indicating that the insulin-releasing effect of the bowel is not activated merely by the presence of intraluminal carbohydrate.

Scanning and transmission electron microscopic studies of human intestinal mucosa

The scanning electron microscope is capable of 25 mmu resolution combined with a great depth of focus, features which make the technique of value in the study of the intestinal mucosa. Surgical biopsies and postmortem specimens of small intestine have been examined using scanning and transmission electron microscopy. In biopsies, at low magnification, the villous pattern is seen while at higher magnification details of cell surfaces may be observed. Some features are best observed using scanning microscopy to examine dewaxed thick histological sections. In necropsy specimens villous architecture can still be satisfactorily assessed and details of the villous cores are seen, their collagen skeletons apparently less robust than the villi of the fresh biopsy. Scanning microscopy can extend the three-dimensional study of the small intestinal mucosa beyond the limits imposed by the resolution of the dissecting microscope.

Dermatitis herpetiformis in two patients with idiopathic steatorrhoea (adult coeliac disease)

Two patients who had had idiopathic steatorrhoea for several years developed typical eruptions of dermatitis herpetiformis. In each case the rash responded to treatment with dapsone.It is more usual for the rash to precede the enteropathy when the two occur together, but the association between coeliac disease and dermatitis herpetiformis is not yet clear.

Ascaris lumbricoides infectation associated with jejunal mucosal abnormalities

A patient with ascaris lumbricoides infestation associated with small bowel mucosal abnormalities is reported. The importance of careful radiological examination of the small intestine and examination of the faeces is stressed. Morphological changes and disturbed function of small bowel are discussed in relation to infestation with certain worms.

Gastrointestinal amyloidosis in psoriatic arthritis

Images

The incidence of thyroglobulin antibodies and thyroid enlargement in a general practice in north-east England

Antibodies to thyroglobulin in a titre of 1:25 or more were found in 16·2% of women and 4·3% of men between the ages of 21 and 80 years in a random sample of the population from a general practice in the north-east of England. The incidence of antibodies was highest in the seventh decade in both sexes. High antibody titres (1:78125 or more) were found in 4·6% of women and 1·6% of men and it is suggested that this may represent the incidence of diffuse thyroiditis in the population.

Significant thyroid enlargement was found in 12% of women and 0·9% of men, the corrected incidence of goitre obtained by averaging the frequency of goitres in each decade between 21 and 80 years was 8·9% and 0·9% respectively.