Chronic dietary administration of prednisolone to the adult rat caused alteration in morphology and enzyme activity of the small intestinal mucosa. Reduction of villous height, crypt depth, and surface epithelial cell height was accompanied by a significant increase in the specific activity of several jejunal peptidases.
Three cases of haematemesis associated with alcohol abuse are described. Early fibreoptic endoscopical examination in each showed a focal, well demarcated area of gastric mucosal haemorrhage, close to the oesophagogastric junction. Two patients showed prolapse of the lesion into the lower part of the oesophagus, and the third had coexistent Mallory-Weiss tears. Our observations suggest that forceful vomiting is responsible for this lesion, by causing abrupt retrograde gastrooesophageal prolapse. The prognosis of the lesion appears good.
A review of 84 patients treated by limited gastrectomy and moderate doses (about 2000 r) of irradiation to the stomach revealed 31 with evidence of renal disease 8–19 years later: seven died of uraemia and two of malignant hypertension. The latent interval between gastric irradiation and discovery of renal disease was one to 14 years. The 31 patients with presumed radiation-induced renal disease were grouped as follows: chronic renal failure, 5 patients; malignant hypertension, 4 patients; benign hypertension, 11 patients; biochemical evidence of renal disease, 11 patients. Measurement of renal length radiologically and renal weight at necropsy showed significant shrinkage of the left kidney as compared with the right, and the degree of shrinkage was somewhat proportional to the dose of radiation. The basic pathological lesions as determined from seven necropsy and six biopsy specimens were interstitial nephritis with degenerative changes of the small and medium sized arteries, indicating that the primary radiation effect was damage to the renal blood vessels.
Summary: Factors influencing small bowel changes in dermatitis herpetiformis. I. C. Roberts-Thomson, D. P. Stevens, B. Michel, W. E. Braun, P. J. Morris, A. J. Wall, D. J. Fone and H. J. Dworken, Aust. N.Z. J. Med., 1977, 7. pp. 356–362. Factors influencing small bowel morphology in dermatitis herpetiformis (DH) were investigated by comparing patients with DH and normal small bowel biopsies to patients with DH and abnormal small bowel biopsies. The mean age of 18 patients with morphological changes in small bowel (38 years) was significantly lower (P < 0 001) than the mean age of nine patients with normal bowel mucosa (60 years). HLA typing confirmed the high frequency of HLA-B8 in DH (64%) but HLA-B8 was unrelated to the presence or severity of small bowel lesions. Four patients had diarrhoea with progressive weight loss or abdominal cramps subsequently responsive to gluten withdrawal. In this subgroup serum levels of IgG and IgM were significantly lower than in patients with normal small bowel mucosa. Small bowel involvement appeared to be independent of the duration and severity of skin disease, and the deposition of immunoglobulin and complement (C3) in the dermal papillae of skin adjacent to skin lesions.
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