Egg-protein-induced villous atrophy

The effect of egg protein on the small bowel mucosa of a 9-month-old infant with a history of intolerance to egg protein was studied. Within 24 h of ingestion of egg protein marked villous atrophy, depletion of mucosal oligosaccharidases, impaired absorption of xylose, and depressed serum complement levels were observed. The study demonstrates that egg protein is yet another cause of flat mucosa of the small intestine in infants.

Elevated IgG and decreased complement component C3 and factor B in B-thalassaemia major

Serum immunoglobulins, complements C3 and C4 and factor B were assayed in the sera of children with B-thalassaemia major, siblings and matched controls in an attempt to resolve the controversy surrounding the conflicting results reported in the literature. Significantly elevated IgG and decreased C3 and factor B levels were observed in thalassaemic patients who also had a high incidence of HBS hepatitis and other infections. The controversial results probably reflect differences in the incidence of infection, and the presence of circulating immune complexes due to blood transfusions, in the various communities. The alterations in immunoglobulin and complement levels represent a secondary rather than a primary immune disorder.

In vitro diagnosis of cow's milk protein sensitive enteropathy by organ culture method

The criteria that are used at present to diagnose cow's milk protein sensitive enteropathy (CMPSE) are based on an in vivo milk challenge which can be hazardous and life threatening. We have used an organ culture model to determine the usefulness of this technique in establishing the diagnosis of CMPSE on the basis of a single biopsy with in vitro milk challenge. Fourteen infants with diarrhoea clinically suspected to have CMPSE were studied prospectively. On the basis of milk challenge studies seven infants had CMPSE. They had clinical reaction to cow's milk with associated histological changes and depression of alkaline phosphatase levels in the jejunal mucosa. In all seven cases parallel changes in alkaline phosphatase levels were noted in the organ culture specimens of initial biopsy subjected to in vitro challenge. The seven control infants tolerated cow's milk and did not have histological changes. The alkaline phosphatase levels were moderately increased in the jejunal mucosa in five of the seven infants. The alkaline phosphatase levels in the organ culture specimens of initial biopsy were increased after in vitro challenge in all seven infants. This study suggests that organ culture methods may be useful in the vitro diagnosis of CMPSE, and also obviate the need for in vivo oral milk challenges and repeated biopsies.

Immunological studies in cows' milk protein-sensitive enteropathy

55 infants, aged between 1 and 13 months, who presented with persistent diarrhoea were placed on a diet free of cows' milk protein. The clinical condition of the infants improved and 6-8 weeks later each was challenged with low-lactose cows' milk. The following investigations were performed before and 24 hours after provocation: jejunal biopsy, serum and duodenal juice levels of complement C3 and C4, C3-activator, and immunoglobulins A, G, M, and D. Three groups were recognised on postchallenge clinical symptoms together with histological changes in the jejunal mucosa: group 1 (n=10 infants) with no clinical or mucosal abnormality, group 2 (n=18 infants) with mucosal abnormalities but lacking clinical symptoms, and group 3 (n=27 infants) with mucosal abnormalities and clinical symptoms; but in group 3 symptoms were delayed for over 24 hours in 7 infants, and in the remaining 20 infants symptoms appeared within 24 hours. After provocation the serum IgG levels were decreased in 3 infants in group 1, 12 in group 2, and 17 in group 3. The mean serum IgA and IgM levels were higher in group 1 compared with group 2 or 3; pre- and postchallenge mean serum immunoglobulin levels, complement, and complement activator levels were of equal magnitude in all three groups. A depletion of serum complement C3 level was observed in 4 (group 1), 4 (group 2), and 13 (group 3) infants 24 hours after provocation with cows' milk; the fall in serum IgG was often associated with depletion of complement in serum. This suggests the involvement in some infants of IgG-mediated complement-consuming immune reactions in the development of the damage in the intestinal mucosa. After challenge, exudation of IgG and IgA occurred irrespective of the presence or absence of mucosal damage and was not always associated with the decrease in serum IgG concentration. Because of the variable conditions present in the intestinal lumen it is suggested that the level of immunoglobulins in duodenal juice is not a reliable measure of the local immune response. Levels of complement and immunoglobulin in serum or duodenal juice fail to provide help in the diagnosis of cows' milk protein-sensitive enteropathy.

The pineal gland of equatorial mammals. I. The pinealocytes of the Malaysian Rat (Rattus sabanus)

The ultrastructure of the pinealocytes of the Malaysian rat (Rattus sabanus), a mammal inhabiting a zone near the equator where the annual variations of daylength are inconspicuous, was examined and compared with that of pinealocytes of other mammals. On the basis of the presence of granular vesicles, only one population of pinealocytes was found. A large number of granular vesicles and vesicle-crowned rodlets is characteristic of the pinealocytes of this equatorial species. Vesicle-crowned rodlets are especially numerous in the endings of the pinealocyte processes and; they most often found in direct topographical connection with the perivascular spaces. The physiological significance of the presence of such large amounts of vesicle-crowned rodlets and of the secretory process characterized by the formation of granular vesicles is discussed.

Acquired carbohydrate intolerance and cow milk protein-sensitive enteropathy in young infants

Sixty infants with acquired carbohydrate intolerance, 19 with protracted diarrhea, and 41 with features indistinguishable from acute infectious enteritis, were maintained on a lactose-free and cow milk protein-free formula for about eight weeks, after which jejunal biopsies were performed before and after oral provocation with cow milk protein. Following provocation, 43 infants showed mucocal abnormalities associated with marked reduction in the levels of all three disaccharidases. In one infant, mucosal change was unaccompanied by enzyme depletion. Six infants had enzyme depletion without visible mucosal changes. In ten infants the intestinal mucosa remained normal and there was no consistent pattern of change in the enzyme levels. The findings suggest that cow milk protein has a deleterious effect on the small bowel mucosa of young infants recovering from enteritis and may be an important contributing cause of acquired carbohydrate intolerance in these infants. In the management of young infants with acquired carbohydrate intolerance both the offending sugar and protein should be excluded.

Cows' milk protein-sensitive enteropathy: an important contributing cause of secondary sugar intolerance in young infants with acute infective enteritis

The effect of cows' milk protein (CMP) on the mucosal disaccharidases was investigated in 23 infants with acute infective enteritis. Jejunal biopsies performed before and after cows' milk provocation were subjected to histological examination and to mucosal disaccharidase enzyme (lactase, sucrase, and maltase) analyses. After milk challenge, changes in mucosal histology were observed in 18 infants, in 17 of them the levels of all 3 mucosal disaccharidases were much reduced. 10 of these infants developed diarrhoea and, in 6, the stools were positive for reducing sugar. It is concluded that CMP has a deleterious effect on the jejunal mucosa of young infants recovering from infective enteritis, so that in the management of young infants with sugar intolerance secondary to infective enteritis, CMP and lactose should be excluded from the diet.

Serum immunoglobulin levels in the Malaysian Orang Asli

Serum immunoglobulin G, A, M, D and E levels were determined in the forest-dwelling Orang Asli of age group 8 to 64 years. The levels are higher than observed for urban Malaysians and comparable to levels reported for populations residing in the tropics. There was no significant difference in serum levels of all the immunoglobulins studied in both sexes. The elevated serum immunoglobulins levels are discussed in terms of the nature of the immune defence developed in the Orang Asli to contend with the many parasites prevalent in their environment.

Cows' milk protein-sensitive enteropathy. An important factor in prolonging diarrhoea of acute infective enteritis in early infancy

The possible role of cows' milk protein in prolonging diarrhoea in very young infants with acute infective enteritis was studied in 14 infants, 9 under the age of 2 months and 5 older than 6 months. Bacterial pathogens were isolated from the stools of 4 infants from the younger age group. After appropriate initial treatment the infants were maintained on a cows' milk protein-free formula. 6 weeks later jejunal biopsies were performed before and 24 hours after challenge with a low lactose cows' milk protein formula. The immunoglobulin and complement levels in the serum and duodenal juice were also estimated at these times. Attempts to isolate bacterial and viral pathogens in stools were again made in all patients. The 5 older infants clinically tolerated cows' milk protein and their pre- and postchallenge jejunal biopsies were within normal limits. However, significant histological changes were observed in the postchallenge jejunal biopsies of all 9 infants under 2 months of age. In addition, 5 of these infants developed diarrhoea. This suggests that the jejunal mucosa of very young infants previously fed a cows' milk protein-based formula and who contract infective enteritis suffers damage when rechallenged with cows' milk protein.

Cows' milk protein-sensitive enteropathy. Combined clinical and histological criteria for diagnosis

Cows' milk protein enteropathy is recognised as a significant cause of persistent diarrhoea and malabsorption in young infants, but there are as yet no generally accepted diagnostic criteria. A combined clinical and histological approach to the diagnosis of cows' milk protein-sensitive enteropathy has been used in 15 patients, and the following set of criteria are proposed. (1) Clinical disease (diarrhoea with or without vomiting) while receiving cows' milk protein. (2) Clinical improvement on a diet free of cows' milk protein. (3) Normal or mildly abnormal histology of jejunal mucosa when taken 6-8 weeks after symptoms subside. (4) Histological relapse, with or without clinical relapse, after re-exposure to cows' milk protein.

Serum immunoglobin A. G and M levels in blood donors of four racial groups in Malaysia

Serum levels were determined in urban Chinese, Malays and Indians and in the forest-residing Orang Asli of age group 11 to 50. There was no difference in the IgM levels in the Chinese, Indians and Malays, but the serum IgG was elevated (p less than 0.05) in the Malays and the serum IgA level (p less than 0.01) in the Indians, when compared to the other two races. In contrast to the three other races there was a significant elevation of all three immunoglobulins in the Orang Asli. The mean immunoglobulin levels of the urban Malaysians are comparable to those reported for Caucasians residing in temperate countries. However, in the Orang Asli, the immunoglobulin levels were higher than observed for populations of the temperate regions but are comparable to the levels reported for several other populations of the tropical regions. Females had higher IgM levels than males in the Chinese, Indian and Malays but in the Orang Asli there was no sex difference in the immunoglobulin levels.

The presence of teh cervical and thoracic thymus lobes in marsupials

Thymus lobes, in 93 marsupial species studied, were found in two different topographical locations: the thoracic cavity (thoracic thymus), the ventral cervical region, superficial to hyoid, sternomastoid, and depressor neck muscles and just beneath the skin (superficial cervical thymus), or in both places. All polyprotodont species examined (42 examples from Didelphidae, Dasyuridae, Thylacinidae, Notoryctidae, Peramelidae, and Caenolestidae) had two to four lobed thoracic thymus and no superficial cervical thymus. Species examined from the diprotodont Burramyidae, Petauridae, Phalangeridae, Phascolarctidae, and Tarsipedidae (17 species) and Macropodidae (32 species) had both a thoracic thymus with two to four lobes, and a pair of superficial cervical thymus lobes. Both of the two genera in the diprotodont Vombatidae, Lasiovhinus and Vombatus, had a cervical thymus; no thoracic thymus was seen in the latter but the former had specimens with and without it. The presence of superficial cervical thymus lobes in only the superfamily Phalangeroidea is discussed with particular reference to herbivorous diet, small litter size, and immunological development of pouch young.

Passage of maternal immunoglobulins to the pouch young of a marsupial. Setonix brachyurus

Prenatal and precolostral newborn quokkas, S. brachyurus, had no immunoglobulins in their serum. Immunoglobulins were not detected in the yolk-sac fluid, the amniotic fluid, or the allantoic fluid, but were present in the uterine fluid, the colostrum, and milk whey. Immunoglobulins were present in the serum of neonatal quokkas that had suckled for at least 24 hr. Initial immunization of a female with Salmonella adelaide flagella and bacteriophage 0 x 174 antigen resulted in high titres of antibodies in her blood 1 week later, but there was a lag of less than 1 week before anti-S. adelaide agglutinins and a lag of 2 weeks before antiphage antibodies were detectable in the serum of the suckling pouch young. A further delay of 2 weeks occurred before serum antibody titres were as high in pouch young as they were in the mother. At no time in development did antibody titres in the sera of pouch young exceed those of the mother. The ability to absorb antibody in the gut ceased 2-3 weeks after the 6-month-old young left the pouch.