TREATMENT OF ELECTROLYTIC DISTURBANCE ASSOCIATED WITH MALABSORPTION.
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Biomedical subjects
Publications and source records attributed to W T COOKE.
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A study of 33 patients with jejunal diverticula showed that all except four had symptoms or metabolic upsets attributable to the presence of the diverticula. A disturbance of vitamin B12 metabolism or absorption was found in 16 patients and neuropathy was found in 12 patients. It is considered that abnormal bacterial activity in the small intestine is an important factor in these patients.
A clinical, biochemical, and pathological study is recorded of 50 patients in whom a diagnosis of idiopathic steatorrhea had been made and who had ;flat' jejunal biopsies. It is suggested that there is an underlying constitutional defect, not yet clearly defined, and that possibly secondary intestinal infection allows the intestinal mucosa to become sensitized to substances in the diet. Of these gluten is the commonest; milk adversely affects others; and there may be other factors.
The 20 patients described could be included in the group of patients diagnosed as ;idiopathic steatorrhoea'. However, their histories were short and diarrhoea was not a major feature. Since megaloblastic anaemia due to folic acid deficiency was a common feature it is suggested that these patients may form a homogeneous group and the diagnostic label of temperate sprue is suggested.
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This paper demonstrates that the hepatic surface counting technique is a reliable and satisfactory method of estimating the absorption of radioactive vitamin B(12). It does not require the collection of faeces or urine and is therefore particularly useful in studying out-patients.
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This paper assesses the use of d.xylose as a test of function of the small intestine. In general d.xylose excretion is associated with disturbance of the intestinal wall of the upper jejunum. Low readings are found with adult coeliac disease but rarely with regional enteritis.
The case history of a 40-year-old woman with a fatal haemorrhage from a duodenal ulcer, jejunitis, renal lithiasis, hypertrophy of the adrenal glands, multiple adenomas of the pancreas, and three adenomas of both the parathyroid and pituitary glands is reported. Though there was histological evidence, in the bones, of hyperparathyroidism, the serum levels of calcium, phosphorus, and phosphatase and the urinary excretion of calcium were normal. The significance of low calcium and high phosphorus excretion in the urine as an indication of parathyroid disorder is discussed."Multiple endocrine adenoma syndrome" is suggested as the appropriate designation for the clinical disorders in which adenomas of one or more endocrine glands are associated with disorders of the alimentary tract when patients present with recurrent peptic ulceration, pancreatic dysfunction, or watery diarrhoea.
Urinary amino-acid chromatograms from 23 patients with megaloblastic anaemia have been studied before and after therapy. The most consistent abnormality was an increased taurine or increased taurine/glycine ratio. This was not related directly to deficiency of vitamin B(12) or folic acid or to the degree of anaemia.