Breast milk zinc and copper concentrations in Bangladesh

Breast-fed infants in Bangladeshi villages were weighed at 1, 2, 6, 9 and 12 months. The concentrations of zinc and copper in the breast milk were measured and the daily intake of these elements calculated. Breast milk Zn concentration decreased over the year but was comparable with that found in developed countries. The calculated daily intake decreased from 17.7 to 8.0 mumol (10-30% of recommended dietary allowances (RDA); National Academy of Sciences, 1980). Breast milk Cu concentration also fell over the year and was lower than that reported from developed countries. Calculated daily Cu intake was 1.95-2.63 mumol (RDA 7.81-15.63 mumol). Deficiencies of trace elements may therefore be a problem in poorly nourished communities where breast feeding is continued for several years with only small amounts of additional food. Breast milk may not be adequate as the only source of infant nutrition after the first few months of life in Bangladesh.

Trophic effect of Efamol on the rat small-intestinal mucosa

1. The hypothesis that triacylglycerols are trophic to the small-intestinal mucosa of the rat was tested by comparing the action of the essential fatty acid-rich oil Efamol with that of glucose. 2. Two groups of nine female Wistar rats were pair-fed Vivonex HN with 50% calorie substitution by glucose or Efamol for 21 days. 3. Body weight gain was greater with glucose than with Efamol, but, despite this, whole gut weight, mucosal weight and mucosal protein were increased by Efamol in all small-intestinal segments. Total mucosal DNA was also increased with a significant change in the middle small-intestinal segment. These changes were associated with an increased crypt cell production rate. 4. Fasting plasma levels of peptidyltyrosyltyrosine ('peptide YY'), but not of enteroglucagon, were significantly elevated in the Efamol-fed group. 5. The data show a trophic effect of Efamol on the rat small-intestinal mucosa. Possible mechanisms are discussed.

Small-intestinal function during enteral feeding and starvation in man

1. Small-intestinal absorption and permeability were measured in nine patients with malnutrition who were receiving liquid enteral nutrition after different periods of starvation, in five patients receiving enteral nutrition without starvation, in six healthy subjects after starvation for 36 h and in two obese subjects starved for 11 days. 2. Absorption, expressed by the plasma 60 min D-xylose level and the plasma 60 min D-xylose/3-O-methyl-D-glucose ratio, was greatly decreased (P less than 0.001) in the nine patients receiving enteral feeding after starvation, whereas permeability, denoted by the 5 h urinary lactulose/rhamnose ratio, was increased (P less than 0.05). 3. The five patients receiving enteral feeds without prior starvation had normal intestinal absorption and permeability. 4. Starvation of the healthy subjects reduced absorption (P less than 0.05) and this was detectable at 36 h. Permeability, however, was not increased by 36 h starvation. Starvation of the obese subjects also progressively reduced absorption, and this was reversed with refeeding. 5. Changes in intestinal function during enteral feeding are similar to those seen in intestinal diseases. They develop rapidly and are not caused or reversed by liquid enteral feeds. Starvation, before beginning feeding, may explain some of the changes found.

Effect of dietary fat on the small intestinal mucosa

The presence of food within the small intestinal lumen promotes mucosal cell proliferation. To define the trophic role of triglycerides, three groups of eight female Wistar rats were isocalorically fed for four weeks with either Vivonex, or Vivonex with 50% calorie substitution with an essential fatty acid mixture, or Vivonex with 50% calorie substitution with a saturated fatty acid mixture. Although Vivonex caused greater body weight gain, both essential fatty acids and saturated fatty acids increased small intestinal weight, mucosal weight, protein and DNA overall, and in each of three intestinal segments (proximal, middle and distal), compared with Vivonex. Mucosal indices were similar for essential fatty acids and saturated fatty acids. These results show that triglycerides, regardless of essential fatty acid content, are trophic to the rat small intestinal mucosa.

Thrombotic cutaneous nodules and hepatic vein thrombosis in the anticardiolipin syndrome

A patient with the anticardiolipin syndrome presented with hepatic vein thrombosis (Budd-Chiari syndrome) and non-ulcerating, thrombotic, cutaneous nodules. This cutaneous manifestation of the anticardiolipin syndrome has not been described before, though its histological appearances resemble those of previously reported cutaneous complications, such as chronic ulceration, livedo reticularis and distal cutaneous ischaemia. Recognition of the skin lesion could allow the prevention of major systemic complications.

Active chronic hepatitis and febrile panniculitis

Two patients with autoimmune hepatitis B negative chronic hepatitis and febrile panniculitis are described. On each occasion the panniculitis responded to increasing the doses of prednisolone.

Reduced hepatic blood flow and intestinal malabsorption in severe falciparum malaria

We have studied intestinal function and liver blood flow in Thai adults with complicated and uncomplicated falciparum malaria. The absorption of 3 orally administered test sugars, D-xylose, 3-O-methyl-D-glucose, and L-rhamnose, was greatly reduced in complicated malaria, while the lactulose/rhamnose absorption ratio was significantly increased. Hepatic blood flow was concomitantly reduced in severe malaria. These deviations reverted to normal in convalescence. Neither sugar absorption nor liver blood flow was reduced in uncomplicated falciparum malaria.

Lectin histochemistry of the embryonic heart: expression of terminal and penultimate galactose residues in developing rats and chicks

Rat embryos at days 10-18 of gestation and chicken embryos at days 3-6 of incubation were fixed and processed for lectin histochemistry. The distribution of binding sites for a lectin from the peanut Arachis hypogaea (PNA) conjugated to horseradish peroxidase (HRP) was determined on tissue sections both before and after enzymatic cleavage of sialic acid with neuraminidase (sialidase). Endocardial cushion tissue in the rat, but not in the chick, reacted with PNA-HRP prior to digestion with sialidase. Endocardium of both species (12 and 13 days in rat, 5 and 6 days in chick), particularly at the level of endocardial cushions, reacted strongly with the sialidase-PNA sequence; this staining decreased markedly after day 14 of gestation in the rat. PNA binding sites capped by sialic acid were most abundant in the developing rat heart during the critical period of endocardial cushion formation and decreased as development proceeded. The marked changes in the appearance and distribution of cardiac cell and tissue glycoconjugates during cardiogenesis support the concept that rapid changes occur in the structure of complex carbohydrates during embryonic and fetal development. The findings also suggest that such glycosylation-related events may be species specific.

Lectin histochemistry of the embryonic heart: fucose-specific lectin binding sites in developing rats and chicks

Glycoconjugates, particularly their sugar side chains, play important roles in embryonic development. Changes in cell-surface-associated glycoconjugates are known to affect cell differentiation, cellular interactions, and other developmental phenomena during embryogenesis. The embryonic heart goes through a series of complicated morphologic events during development. Of particular interest is morphogenesis of the outflow tract. This region of the embryonic heart originates from more than one cell population and undergoes a complex process of septation during formation of the great vessels. Histochemical analysis with a series of fucose-specific lectins conjugated to horseradish peroxidase has revealed the presence of a fucosylated glycoconjugate in the outflow tract of the developing heart. The results reveal further that the expression of the fucosylated glycoconjugate is stage-dependent and thus probably genetically regulated. The timing and distribution of staining with the lectin OFA suggest that this fucosylated glycoconjugate may play a role in directing the migration of neural crest cells into the heart and subsequent formation of the conus septum.

Cytoplasmic stress fibers in the developing heart

Rhodamine-conjugated phalloidin staining was used to study the distribution of filamentous actin in the developing heart of embryonic chicks and rats during the morphogenetic period of cardiac septation. In the chick, intense fluorescence indicative of abundant filamentous actin was observed along the myocardium and in the mesenchymal condensations that formed within the aorticopulmonary septum at day 5. Such cellular condensations and concentration of filamentous actin were not seen in the atrioventricular cushions nor in the preseptation outflow tract. Similar results were found in the 14-day rat embryo. In electron micrographs, microfilament bundles with irregular dense bodies were seen in elongated mesenchymal cells between the valve sites of both species. Cell-cell contacts were observed between such elongated cells and myocyte processes protruding from the nearby myocardial sheath. These histochemical and ultrastructural observations suggest that such mesenchymal condensations serve a specialized mechanical tensile role during embryonic septation of cardiac outflow channels.

Zinc in the elderly

Zinc levels in plasma and leucocytes of elderly patients with and without cutaneous ulcers and in hospital were compared with those of a group of healthy elderly living at home and of a younger group. The groups in hospital had lower levels of plasma and leucocyte zinc than the control groups, but these were not associated with cutaneous ulcers. The zinc intake of the patients in hospital was well below the recommended daily allowance. Tissue zinc levels were found to be low in elderly patients in hospital, probably due to poor intake, but their contribution to the formation of skin ulcers was unproven.

Intestinal mucosal mast cells: enumeration in urticaria pigmentosa and systemic mastocytosis

Endoscopic gastrointestinal mucosal biopsy specimens from one patient with systemic mastocytosis and five with urticaria pigmentosa (UP) were fixed with Carnoy's reagent and then stained for chloracetate esterase. The mast cell population densities were enumerated in the mucosa using cursor planimetry. Compared with controls, mast cell counts were increased in gastric and duodenal but not sigmoid mucosae. On a histological basis, systemic involvement would appear commoner in urticaria pigmentosa than is generally expected. Gastrointestinal symptoms did not relate to elevated mucosal mast cell counts.

Zinc status in inflammatory bowel disease

1. The zinc contents of plasma, erythrocytes, polymorphonuclear leucocytes and mononuclear leucocytes from 18 normal control subjects, 31 patients with Crohn's disease and 15 patients with ulcerative colitis were measured. 2. Plasma zinc levels were low in Crohn's disease, particularly in malnourished patients, and related to plasma albumin concentrations, but were normal in ulcerative colitis. 3. Erythrocyte zinc levels were normal in both Crohn's disease and ulcerative colitis. 4. Mean polymorphonuclear leucocyte zinc levels were normal in Crohn's disease and ulcerative colitis. Ten per cent of Crohn's disease patients had subnormal levels, which were associated with inactive disease, while 10% had elevated levels, which were associated with active disease. Seven per cent of ulcerative colitis patients had subnormal levels. Mononuclear leucocyte zinc levels were normal in Crohn's disease and in ulcerative colitis. 5. Tissue zinc depletion occurs in only a few patients with Crohn's disease and ulcerative colitis.

Is alcohol hepatotoxic in the baboon?

The baboon is the only animal in which alcoholic fibrosis and cirrhosis of the liver has been produced with a nutritionally adequate diet. Zinc deficiency is associated with alcoholic liver disease and may contribute to liver damage. We have therefore investigated whether zinc supplementation would reduce liver damage in ten baboons receiving ethanol and an adequate diet. Eight received ethanol at up to 25 g/kg/day (70% of calories) for up to 60 months (four were supplemented with 50 mg zinc/day). All animals gained weight, and blood concentrations of ethanol were 63-342 mg/dl. Changes in liver blood tests were slight. Liver histology only showed fatty change in six animals, severe in two, and minor inflammatory changes but no significant fibrosis or cirrhosis. In one of the animals with severe fatty change there were also degenerative changes in parenchymal cells. There was thus no significant hepatic fibrosis or cirrhosis in baboons given large amounts of ethanol and an adequate diet for up to 5 years.

Nutritional rehabilitation in Bangladesh--the importance of zinc

Our aim was to investigate whether zinc deficiency becomes apparent during nutritional rehabilitation and limits the rate of weight gain. Twenty-five severely malnourished children, who were admitted to the Children's Nutrition Unit in Bangladesh, were alternately allocated to two groups. Their mean dietary Zn intake was 3.7 mg/d and mean caloric intake greater than 150 kcal.kg-1.d-1; one group received a daily Zn supplement of 50 mg for 2 wk. During the first week, weight gain was similar in the two groups, but during the second week, weight gain was 73% more in the Zn-supplemented group (8.83 +/- 1.56 vs 5.09 +/- 1.62 g.kg-1.d-1). The 95% confidence limits were 0.88 less to 8.36 g.kg-1.d-1 more gain in children receiving Zn supplements. The results strongly suggest that Zn supplements are beneficial to severely malnourished children during nutritional rehabilitation. Polymorphonuclear (PMN) cell Zn increased in the group receiving Zn supplements (p less than 0.001), confirming that the Zn content of PMN cells reflects available Zn.

Zinc concentrations in leucocytes of patients receiving antiepileptic drugs

To determine whether some of the side effects of antiepileptic drugs could be due to zinc depletion within tissues, zinc concentrations in the polymorphonuclear leucocytes in 26 epileptic patients receiving valproate or carbamazepine and 14 controls were assessed. There was no difference in zinc concentration in leucocytes among the three groups and no evidence of zinc depletion. Valproate and carbamazepine may affect the intracellular distribution of zinc.

Polymorphonuclear leucocytes in Crohn's disease and ulcerative proctocolitis: association between enhanced adherence to nylon fibre and disease variables

The adherence of polymorphonuclear leucocytes (PMN) to nylon fibre was investigated in patients with Crohn's disease, ulcerative proctocolitis, and anorexia nervosa, and compared with changes of circulating PMNs, C reactive protein concentrations, erythrocyte sedimentation rates, and clinical assessment of disease activity. PMN adherence was in excess of the maximum value detected for healthy subjects in 14 of 25 patients with Crohn's disease and two of 10 with proctocolitis, but it was within the normal range for all eight with anorexia nervosa. High adherence in Crohn's disease, however, was not associated with quantitative or qualitative changes of PMN populations, absolute concentrations of C reactive protein, erythrocyte sedimentation rates, disease severity, drug regimens, malnutrition, or zinc deficiency. High PMN adherence in Crohn's disease may therefore reflect the activation in vivo of normal PMN by humoral factors.

Pseudotumour cerebri in a patient with Castleman's disease

A patient with systemic Castleman's disease (angiofollicular lymph node hyperplasia) including bone changes and peripheral neuropathy, is described. She also had pseudotumour cerebri, and, as this association has been reported previously, it is unlikely to be due to chance.

Cardiomyopathy with arrhythmias and ectodermal dysplasia: a previously unreported association

Hidrotic ectodermal dysplasia represents a group of congenital or hereditary disorders that involve ectodermal derivatives. It is characterized by partial or complete alopecia, dystrophic nails, and dental abnormalities. Dilated cardiomyopathy has not previously been reported in association with this illness. We report the cases of three children with fatal dilated cardiomyopathy with associated cardiac arrhythmias and ectodermal dysplasia. Laboratory investigations revealed no specific cause for the cardiomyopathy. It is speculated that this association is not simply coincidental.

Effects of cimetidine and ranitidine on plasma high-density lipoprotein subclasses in humans

The effects of cimetidine (400 mg b.d.) and ranitidine (150 mg b.d.) on high-density lipoprotein (HDL) subclasses and other plasma lipoproteins were studied in 18 men and 15 women with reflux oesophagitis and/or duodenitis. Serum testosterone and sex hormone binding globulin (SHBG) concentrations were also measured. Treatment with either drug was continued for 12 weeks. Ranitidine had no significant effect on any measured variable in either men or women. Cimetidine had no effect in men, but in women it raised the cholesterol concentration in the HDL2 subclass by 15% after 8 weeks, and by 48% after 12 weeks. In females, cimetidine also reduced the concentrations of SHBG (by 24% at 12 weeks) and of total testosterone (by 25% at 12 weeks). The significance of these latter changes is uncertain, however, as estimates of the biologically active free testosterone concentration were unchanged.