Diagnosis of dermatitis herpetiformis.
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Dermatitis Herpetiformis↗
Biomedical subjects
W T Cooke
Publications and source records attributed to W T Cooke.
Serum concentrations of 25-hydroxy vitamin D in Europeans and Asians after oral vitamin D3.
Serum concentrations of 25-hydroxy vitamin D (25-OHD3) were measured in seven Asians of Indian extraction and eight Europeans before and at intervals after taking 1 mg vitamin D3 by mouth. In all subjects the concentrations rose in the 24 hours after ingestion. There was little change over the next nine days in the concentrations in the Europeans but those in the Asians continued to rise until about day 10. Subsequent rates of fall in 25-OHD3 were similar in the two groups. Our observations suggest that the low serum concentrations of 25-OHD3 found in Asians are not caused by either impaired intestinal absorption of vitamin D or rapid clearance of 25-ODH3 from the plasma.
Administration, Oral↗
Coeliac disease and immunological disorders.
Out of 314 patients with coeliac disease, 63 had associated disorders of known or suspected immunological cause (excluding aphthous stomatitis and dermatitis herpetiformis). Autoimmune diseases appeared to occur more often in patients with coeliac disease than in the normal population, 52 such diseases being found in 45 patients. Of individual disorders, diabetes mellitus, thyroid diseases, and ulcerative colitis seemed to be more common than expected. Atopy (asthma and eczema) occurred in 7% of the patients. Most of these immunological disorders developed when the patients were on normal diet. A gluten-free diet and virtually normal jejunum did not prevent their development, and the diet had little ameliorating effect on their course apart from an occasional dramatic improvement in atopic patients.
Autoimmune Diseases↗
Intestinal lymphoma associated with malabsorption.
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Adolescent↗
Acid microclimate in coeliac and Crohn's disease: a model for folate malabsorption.
The surface pH of human proximal jejunum was measured in biopsy samples and found to be more acid than the phosphate buffer in which they were incubated. The in vitro jejunal surface pH was 5.93 +/- 0.05 in control subjects and 6.19 +/- 0.09 in treated coeliac patients. A group of untreated coeliac patients with a surface pH of 6.56 +/- 0.14 had a significantly less acid surface pH compared to controls, as did a group of Crohn's patients with a surface pH of 6.21 +/- 0.04. These two groups with a significantly raised surface pH were subdivisible into 'high' and 'low'groups. Surface pH was found to remain low in the treated coeliac and control groups but became more acid over the incubation period reaching almost normal values in the Crohn's group and the untreated coelic initial surface pH. The raised surface pH in untreated coeliac disease and Crohn's disease would alter the amount of a weak acid available for non-ionic diffusion. Therefore the present results may help to explain the folate malabsorption known to occur in untreated coeliac disease and the frequently seen low serum folate levels in Crohn's disease.
Adolescent↗
Response of the skin in dermatitis herpetiformis to a gluten free diet, with reference to jejunal morphology.
Twenty-one patients with dermatitis herpetiformis have been on a gluten free diet regularly followed up for at least one year (mean four years). Eighteen patients had a 'flat' mucosal appearance (grade III), one patient had moderately severe mucosal abnormality (grade II), one patient had mild mucosal abnormality (grade I), and one patient had a normal mucosal appearance (grade O). On the diet, 10 patients had no skin rash and took no dapsone, seven patients controlled the skin rash on a lower dose of dapsone, and four noticed no improvement. There was no correlation between pre-diet jejunal morphology and response of the skin. A repeat jejunal biopsy, on the gluten free diet, was possible in 15 patients. While all those with skin improvement showed some improvement in jejunal morphology, there was no association between the degree of skin improvement and the degree of recovery of the jejunal mucosa.
Adolescent↗
The neurological manifestations of malabsorption.
The clinical and pathological findings in patients with neurological disorders in association with disordered function of the small intestine, in particular coeliac disease, are outlined. The possible significance of the abnormalities of pyridoxine, tyrosine and tryptophan metabolism are considered in relation to biopterin derivatives and their relevance to neurological dysfunction.
Biopterins↗
Accuracy of placental localization by ultrasound.
In a retrospective study, ultrasound diagnoses were correct in 93% of 164 patients referred for examination because of suspected placenta praevia. There was one false-negative finding in 13 cases of proven placenta praevia, and ten false-positive errors in 151 true-negative cases. False-positive results represented the largest number of errors. Examination of the patient with an empty bladder, in addition to the routine technique, is suggested to reduce the number of false-positive results.
Diagnostic Errors↗
Diabetes mellitus and coeliac disease: a clinical study.
Fourteen adults in whom diabetes mellitus and coeliac disease coexist, are described. In no patient was coeliac disease diagnosed (biopsy proven) before the age of 28 years. Diabetes was recognized before coeliac disease in all except one. Diabetic control was very unstable and hypoglycaemia particularly troublesome before treatment with a gluten free diet. Following gluten restriction, insulin requirement increased in six patients, and diabetic control became more stable. Diarrhoea due to coeliac disease in a patient with coexisting diabetes, may be mistakenly diagnosed as 'diabetic diarrhoea'. However, certain clinical and laboratory features should arouse suspicion that the diarrhoea is not of diabetic origin. These included a history of gastrointestinal symptoms preceding the diagnosis of diabetes, the occurrence of repeated hypoglycaemia, absence of neuropathy, anaemia, low serum folate, low serum albumin and a malabsorption pattern on small bowel radiography. A definitive diagnosis of coeliac disease can be made only jejunal biopsy. The opportunity to diagnose coeliac disease in adult diabetics will usually fall to the diabetologist and wider use of jejunal biopsy in diabetics with chronic or recurrent diarrhoea is suggested.
Adult↗
"Non-responsive" coeliac disease.
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Celiac Disease↗
Serum-25-hydroxyvitamin-D concentrations in adolescent boys.
In March, 1976, vitamin-D status was investigated in 256 thirteen-year-old school boys of Asian, West Indian, andEuropean origin in Birmingham. Serum-25-hydroxyvitamin-D3 (25-OHD3) concentrations in 78% of the 124 Asian boys resembled those found in rickets and osteomalacia. Serum-25-OHD3 concentrations were also low in a few West Indian and European children. Dietary intake of vitamin D and exposure to sunlight were similar in each group. Serum-parathormone concentrations were increased in many children with low serum-25-OHD3. Reinvestigation in October, 1976, of a group of children whose serum-25-OHD, concentration had been less than 8 microng/l in March, 1976, showed pronounced improvement in all, but some still had concentrations which indicated a possible deficiency. It is suggested that the high frequency of vitamin-D deficiency in Asian adolescents would be much reduced if 1 mg of vitamin D3 was given orally each school term during adolescence.
Adolescent↗
Enzymatic and morphometric evidence for Crohn's disease as a diffuse lesion of the gastrointestinal tract.
Intestinal disaccharidase and dipeptidase activities were measured in mucosal biopsies from the proximal jejunum in 20 patients with Crohn's disease apparently confined to the distal ileum or large bowel, 14 patients with ulcerative colitis, and 14 healthy volunteers who acted as controls. The dissecting microscopy and histological appearance of the biopsies were normal (Gd 0-1) except for two which showed grade 2 changes. tbiopsy morphometry showed a reduction of jejunal mucosal surface area and an increase in mucosal volume in patients with Chron's disease when compared with the other two groups. The mucosal enzymes studies demonstrated that patients with Crohn's disease had a significant reduction in brush-border enzymes (disaccharidase) but no change in cytoplasmic enzyme activity (dipeptidases). The enzyme levels in patients with ulcerative colitis did not differ from the healthy controls. The reduction of brush-border enzymes with normal cytoplasmic enzymes in the presence of abnormal morphometry is further evidence of the concept of Crohn's disease as a diffuse lesion of the gastrointestinal tract. It also suggests that there is either specific damage to the microvilli or some other abnormality such as impairment of enzyme synthesis.
Adolescent↗
IgA class reticulin antibodies in relatives of patients with coeliac disease.
IgA class reticulin antibodies were not found in patients with Crohn's disease, ulcerative colitis, and hiatus hernia despite a significant incidence of IgG class reticulin antibodies. None of 56 normal healthy subjects was positive. In contrast, 13 (76%) of the sera from 17 patients with coeliac disease on normal diet were positive for IgA class antibodies as were 19 (20%) of 93 first degree relatives. Seventy-three relatives underwent jejunal biopsy. Grade III (flat) histology was found in 13 and, of these patients, 10 (77%) showed IgA class reticulin antibody in their serum. It is suggested that determination of IgA class reticulin antibodies was a useful test to determine which relative must be biopsied.
Adolescent↗
Serum folates in man.
In an aseptic microbiological assay of folate compounds and their breakdown compounds, using Lactobacillus casei, Streptococcus faecalis, and Pediococcus cerevisiae, 4a-hydroxy-5methyl-4,5,6,7-tetrahydrofolate and 5-methyl-5,8-dihydrofolate were inactive under all conditions to all three organisms and 5-methyl-5,6-dihydrofolate was inactive unless ascorbate was present in the incubation medium, and then only to L. casei. 5-Methyltetrahydrofolate was active only for L. casei, and activity in purified samples to S. faecalis was due to trace amounts of folic acid. Analysis of S. faecalis values in the serum in normal subjects and in patients with various disorders showed that levels of 10-formyltetrahydrofolate are raised in coeliac disease, leukaemia, rheumatoid arthritis, and schizophrenia. 5-Methyltetrahydrofolate is readily absorbed by normal human subjects and by patients with pernicious anaemia but poorly absorbed by patients with coeliac disease or leukaemia. 5-Methyl-5,6-dihydrofolate was quickly absorbed by normal human subjects, being reflected by a considerably raised level of 5-methyltetrahydrofolate in serum when sodium bicarbonate was given by mouth before the 5-methyl-5,6-dihydrofolate. These higher levels were comparable to those in patients with pernicious anaemia after oral administration of 5-methyl-5,6-dihydrofolate. Oral 5-methyl-5,8-dihydrofolate and 4a-hydroxy-5-methyl-tetrahydrofolate did not appear as microbiologically active folates in the serum. The findings of this study suggest that the availability for biological utilisation of the major dietary folate compounds will depend on the amount of gastric acidity and of ascorbate in the intestinal chyme. Many may be unavailable for metabolic utilization in the body.
Anemia, Pernicious↗
Crohn's disease involving the colon: an audit of clinical management.
This paper describes the clinical management of 204 patients with Crohn's disease involving the colon who have been reviewed regularly for many years. The results have been analyzed to define the morbidity, mortality, and long term prognosis of the disorder. Despite a high morbidity, the long term prognosis is good. Although the mean interval since the onset of symptoms is more than 13 years, 77% of the patients are symptom-free and 60% have normal laboratory indices. This analysis suggests that until the etiology of Crohn's disease is established and a specific therapy is developed, good results can be obtained with regular medical review and appropriate surgical treatment with the limited use of immunosuppressive agents or total parenteral nutrition.
Adolescent↗
DNA-synthesizing cells in the blood in coeliac disease and inflammatory bowel disease.
The level of 3H-labelled thymidine ([3H]TdR) incorporation of blood cells of patients with coeliac disease was shown in two separate studies to be significantly lower than that of a normal control group. In the first study the 'background' DNA synthesis in unstimulated cultures containing a standard number of blood lymphocytes was measured on days 4, 5 and 6. In the second study a standard volume of freshly drawn whole blood was added to culture medium and the [3H]TdR incorporation measured over the first 24 hr and from 48 to 72 hr. In all cases the [3H]TdR incorporation of cells of coeliac patients on a normal or a gluten-free diet was lower than that of the control group. It is suggested that sequestration of DNA-synthesizing cells in the mucosa of the small bowel may partly explain these results. In whole-blood cultures from patients with inflammatory bowel disease in remission [3H]TdR incorporation over the first 24 hr was raised in Crohn's disease but normal in ulcerative colitis.
Blood Cell Count↗
Bowel mucosa in Crohn's disease.
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Crohn Disease↗
Prophylaxis against anaerobic sepsis in bowel surgery.
Sixty-two patients were admitted to a prospective randomized controlled trial to investigate the influence of a prophylactic antibiotic, lincomycin, on anaerobic sepsis following bowel surgery. The incidence of postoperative sepsis was reduced from 45 to 18 per cent (P less than 0-025). Wound infections were reduced from 38 to 12 percent (P less than 0-05). Intra-abdominal or pelvic abscess occurred in 1 of the treated group compared with 3 controls. Septicaemia occurred after operation in 1 patient receiving lincomycin and in 3 of the controls; in 2 of the latter, pure growths of bacteroides were isolated from the blood cultures and 1 of these patients died. Although lincomycin had no influence on the number of patients who developed aerobic postoperative infections, there was a significant reduction in the incidence of sepsis due to bacteroides, which occurred in 10 of the control group compared with 1 in the lincomycin group (P less than 0-005). No patients developed complications attributable to lincomycin, such as pseudomembranous colitis. These data indicate that the genus Bacteroides are important pathogenic organisms and are responsible for postoperative morbidity. Furthermore, anaerobic sepsis can be reduced by appropriate prophylactic antibiotics.
Aged↗