Biomedical subjects
Publications and source records attributed to G D Iliffe.
A patient with generalised cutaneous and gastrointestinal scleroderma subsequently died from respiratory failure secondary to hyperventilation. At necropsy changes consistent with scleroderma of the diaphragm were found; these were thought to have contributed appreciably to the terminal respiratory failure.This case indicates that diaphragmatic changes should be added to the list of respiratory complications of scleroderma.
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Rectal biopsies from a series of 35 patients with radiologic evidence of Crohn's disease were assessed histologically and classified according to the type of lesions identified. These were then correlated with the sigmoidoscopic findings and site of radiologic involvement. Overall, 40% of the biopsies were abnormal, and in 28% the changes were highly suggestive of Crohn's disease. Granulomas were identified in 15%. Differences between sigmoidoscopic interpretation and histologic diagnosis were present in 11% of cases. This yield of positive biopsies is similar to earlier reports but is approximately double the numbers recorded by the National Cooperative Crohn's Disease Survey. It is concluded that rectal biopsy may confirm the diagnosis in unselected cases of Crohn's disease and provide useful information in patients where the diagnosis was not previously established. In our hands rectal biopsy was an extremely safe diagnostic procedure.
A 76-year-old female presented with malabsorption and was subsequently shown to have jejunal villous atrophy. There was only partial clinical and histologic recovery with gluten withdrawal, but this was thought to be due to poor adherence to the diet. The findings were considered to be consistent with adult celiac disease. During the course of investigations, she was also found to have primary biliary cirrhosis. This is the fifth recorded instance of this association and the first from North America. Because these are uncommon conditions, it is postulated that this is unlikely to be a chance association. The recognition of this coexistence is of practical importance in the investigation and treatment of patients with primary biliary cirrhosis and celiac disease.