[Nutritional problems in diseases of the small and large intestine]

18 patients with inflammatory bowel disease, among them ten with ulcerative colitis and 5 with Crohn's disease, were treated with the combined enteral-parenteral synthetic hypercaloric nutrition. By use of Vivasorb the clinical results were rather good. However, it was impossible to normalize the serumalbumin until the application of the formula diet BSD, enriched in amino acids. These experiences with BSD reveal much better results. All patients recovered nearly completely from their complaints and the clinical parameters went back to normal. Furthermore, it is easier to improve the flavour. The typical mode therapy is demonstrated on one patient with ulcerative colitis and one with Crohn's disease.

Dermatitis herpetiformis and bullous pemphigoid. Intermediate and mixed forms

Nine patients had clinical and histological features suggestive of both dermatitis herpetiformis (DH) and bullous pemphigold (BP). Five patients responded to treatment with sulfapyridine or sulfones: in two the response was inconsistent, and the disease was controlled by combined treatment with prednisone; in one patient, there was no response to sulfapyridine or sulfones. Immunofluorescence studies showed IgA deposits in a linear homogeneous pattern at the basement membrane zone in all patients, and IgG was present in five. No circulating anti-basement membrane antibodies were detected by repeated immunofluorescence examinations. The authors conclude that the occasional overlapping of BP and DH should not lead to dropping the distinction between the two entities. For overlap cases that cannot be classified as BP or DH, the term "intermediate or mixed form of DH and BP" seems to be most suitable.

Juvenile dermatitis herpetiformis versus "benign chronic bullous dermatosis of childhood." Are these immunologic diseases?

Seven cases of juvenile dermatitis herpetiformis have been investigated. Immunofluorescence and histologic studies were made in all and jejunal biopsies in three. Immunopathologic results were positive in all cases including one that had previously been reported to be negative. Two groups could be distinguished according to clinical and histologic criteria, response to sulfapyridine, and character of the immunoglobulin deposits. The first corresponded to dermatitis herpetiformis (DH) of adults, with characteristic lesions of the jejunal mucosa; the second corresponded either to bullous pemphigoid (BP), although in the majority of the cases without circulating antibasement-membrane antibodies, or to a mixed type with the combined features of DH and BP. Repeated biopsies with serial sections are essential for demonstrating immune deposits. The question arises whether any immunologically negative cases of "benign chronic bullous dermatosis of childhood" actually exist.

Diagnostic significance of the immunofluorescent pattern in dermatitis herpetiformis

Despite significant clinical, histologic, immunopathologic and other differences between typical cases of dermatitis herpetiformis (DH) and bullous pemphigoid (BP), the differential diagnosis may be difficult. Our direct immunofluorescent studies in 59 cases of DH and 134 cases of BP indicate the diagnostic value of immunopathologic studies.