Celiac sprue after surgery of the upper gastrointestinal tract. Report of 10 patients with special attention to diagnosis, clinical behavior, and follow-up

The clinical onset of celiac sprue (CS) may be precipitated by upper digestive tract surgery. We report a series of 10 patients who developed CS after diverse types of peptic ulcer surgery. Six were male and 4 female. Gastrectomy with Billroth II anastomosis was performed in 5 patients, truncal vagotomy and pyloroplasty in 2, parietal cell vagotomy and pyloroplasty in 1, and vagotomy with gastrojejunal anastomosis in 2. We found that eight patients had had previous symptoms that suggested CS. Symptoms occurred early in the postoperative period. Severe diarrhea and striking weight loss were the most prominent clinical findings. The response to gluten-free diet was independent of the type of surgical procedure performed and was similar to that observed in the general celiac population.

Keshan disease-an endemic cardiomyopathy in China

Keshan disease, an endemic cardiomyopathy in China, was prevalent in rural areas located in a long belt region where the selenium content was low in foods. Intervention studies with well controlled subjects revealed a prophylactic effect of sodium selenite. Multifocal necrosis and fibrous replacement of the myocardium characterized the histopathological features and myocytolysis was present in most cases. Ultrastructural observations on twelve postmortem cases revealed remarkable changes in many organelles of which mitochondria appeared to be most important in the development of myocardial lesions. Three kinds of specific granules, which have not been found in other reports on cardiomyopathies, were represented and other factors which might also contribute to the aetiology are discussed.

Pregnancy complicated by heroin addiction

During a 5-year time span, 118 addicted women gave birth to viable infants. These patients were subject to an increased incidence of complicating medical problems as well as many obstetric problems leading to maternal or fetal risk. The obstetrician should be aware of the possibility of addiction and its effects on pregnancy, and when possible, appropriate management should be initiated. Intensive care of the neonate must be begun as soon as possible.