Symposium on pathology of the gastrointestinal tract-Part II. Small intestinal biopsy

A practical approach to the interpretation of peroral small intestinal biopsy specimens is presented. Biopsy technique and tissure handling are described. Interpretation of normal and abnormal biopsy specimens is discussed. A practical classification of abnormal small intestinal biopsies is presented and illustrated.

Hardness of finger nails in well-nourished and malnourished populations

1. The Knoop test of hardness applied to samples of finger nails from 334 healthy and 147 malnourished individuals showed statistically significant differences in the mean hardness of the nails of the two groups.

2. The hardest nails were those of Filipino infants and children suffering from protein-energy deficiency. The softest nails were those of children in Guatemala recovering from protein-energy deficiency. Ranking of hardness appeared to be related to the severity and duration of protein-energy depletion.

3. In children up to 12 years of age, hardness did not appear to be influenced by the age, sex, and racial origins of individuals or the environmental conditions to which nail specimens were exposed.

4. Further studies are required to correlate hardness with clinical, biochemical and anthropometric measurements of nutritional status during protein-energy deprivation and during recovery. The causes of the differences in hardness need to be explored.

Neonatal hair as a record of intra-uterine nutrition

Scalp hair samples were studied from 10 term infants of normal weight for dates, 10 infants born very early of normal weight for dates and 10 infants born near term who were small-for-dates. The samples were examined morphologically and the diameters measured precisely using a scanning electron microscope. The control term-normal weight for dates infants had hairs which tapered gradually to the tip. Infants born very early had narrower hairs: these could be superimposed on the distal segments of the term infants hairs. Small-for-dates infants had hairs which where shorter and of narrower diameter for gestational age than the equivalent hair segments from normally grown infants, implying growth constraint from about 20 weeks of gestation. Amino acid analysis of the hairs from the three groups of infants showed no differences in concentration. These data suggest that no specific disturbance of any one or any groups of amino acids is the growth-limiting factor on the fetus as a whole in intra-uterine growth retardation.

Experimental protein-energy malnutrition in baby baboons. 2. Liver pathology

1. Liver biopsies were performed through laparotomy wounds in six baby baboons during the development of a kwashiorkor-like illness induced by low-protein, high-carbohydrate diets similar to those consumed by many East African children. Up to six biopsies have been performed successfully in one animal within a period of 1 year. This material has been studied by light and electron microscopy.

2. A similar study was carried out in two healthy animals fed on an adequate diet. A description is given of liver ultrastructure in normal baby baboons, based on examination of these biopsies.

3. The hepatocytes of the malnourished animals contained excessive amounts of glycogen and showed a reduction in rough and smooth endoplasmic reticulum. Even at the height of an illness indistinguishable clinically from marasmic kwashiorkor, there was no excess of liver fat except in those animals whose diet contained sucrose. This may have been the result of stimulation of hepatic triglyceride synthesis by fructose.

4. In no specimen from the experimental group were there signs of serious progressive and irreversible liver cell damage which might have been expected if liver dysfunction were an important component of kwashiorkor.

5. Biopsies performed in one malnourished animal during recovery showed a return of liver ultrastructure to normal.

Conducting tissue of the heart in kwashiorkor

Images