Polymorphonuclear leucocytes in Crohn's disease and ulcerative proctocolitis: association between enhanced adherence to nylon fibre and disease variables.

The adherence of polymorphonuclear leucocytes (PMN) to nylon fibre was investigated in patients with Crohn's disease, ulcerative proctocolitis, and anorexia nervosa, and compared with changes of circulating PMNs, C reactive protein concentrations, erythrocyte sedimentation rates, and clinical assessment of disease activity. PMN adherence was in excess of the maximum value detected for healthy subjects in 14 of 25 patients with Crohn's disease and two of 10 with proctocolitis, but it was within the normal range for all eight with anorexia nervosa. High adherence in Crohn's disease, however, was not associated with quantitative or qualitative changes of PMN populations, absolute concentrations of C reactive protein, erythrocyte sedimentation rates, disease severity, drug regimens, malnutrition, or zinc deficiency. High PMN adherence in Crohn's disease may therefore reflect the activation in vivo of normal PMN by humoral factors.

Confocal microscopy of thick sections from acrylamide gel embedded embryos.

The preparation of optically clear, thick sections of fragile embryonic tissues greatly aids the power of confocal scanning laser microscopy in imaging three-dimensional structures. We report here conditions for embedding, sectioning, and staining embryos in polyacrylamide gels for a variety of confocal imaging techniques. Infiltration of tissues in standard mixtures of 10-15% acrylamide monomer yields, upon polymerization, blocks that cut easily by vibratome between 50 and 1,000 microns. These conditions worked well for tissues previously stained or for staining gel sections with low molecular weight water-soluble fluorochromes (MW < 5 kD [e.g., propidium iodide, phalloidin]). For immunostaining of tissue after embedding and sectioning, the acrylamide concentration was reduced to 2-3% acrylamide to allow access of immunoglobulins to antigenic sites; such gels were supplemented with 1% agarose to facilitate sectioning and handling. Either method yielded abundant, optically clear, and easily handled sections for mounting and examination in water-miscible media.

Lead, copper, and cadmium in teeth of normal and mentally retarded children.

Whole teeth obtained from handicapped children and from controls have been analysed for lead by anodic stripping voltammetry. No significant differences were found between the two groups. Teeth originating from the same patient showed systematic variations in lead content that are dependant on anatomical tooth type. The nature of this association is discussed. Analyses of sectioned teeth revealed, for cadmium and copper, unexpectedly large variations. High concentrations of cadmium found in the tips of deciduous incisor teeth indicate a probable contribution from maternal blood.

Rapid non-equilibrium aluminium-ligand interactions: studies on the precipitation of aluminium by laser light scattering, ultrafiltration and centrifugation.

The study aimed to develop simple assays to study aluminium-ligand interactions in natural/biological systems where equilibrium is rarely reached and thus where the initial seconds or hours of interactions are important. The immediate and non-equilibrium precipitation of aluminium hydroxide, in aqueous solution at neutral pH, was therefore studied by laser light scattering (diffraction), ultrafiltration and centrifugation. The interaction of weak ligands, present in the gastrointestinal lumen, on the precipitation of aluminium hydroxide was also investigated. The initial kinetics and particle sizes of precipitated aluminium hydroxide were sensitive to a number of external factors, including the presence of weak ligand (bicarbonate), sheer force (stirring), electrolyte concentration and initial (i.e. added) aluminium concentration. However, after a few seconds (no weak ligand), or several hundred seconds (with weak ligand), the subsequent observed changes to the solid phase were of small magnitude and occurred slowly. Thus, a 25-min window, within 5 and 30 min of pH adjustment, can be used to study the interactions of aluminium-ligand. This may approximate better to most natural systems where unperturbed aluminium-ligand equilibrium must rarely exist.

Gastro-intestinal availability of aluminium from tea.

The in vitro speciation of aluminium (Al) in black tea infusion (pH 4.8) was assessed using 3000, 10,000 and 30,000 Da cut-off ultrafilters, and the effect of adding human gastric juice (pH 2.3) and then raising the pH to 6.5 were also studied. 78% Al in the tea infusion passed through the 3000-Da ultrafilter; this percentage increased to more than 90% with the addition of gastric juice at pH 2.3, but then reduced to approximately 5% when the incubate was adjusted to pH 6.5. The breakdown of tea-derived polyphenols to low molecular weight phenols in vivo was measured using high-resolution 1H nuclear magnetic resonance spectroscopic analysis of ileostomy effluent, but there was no evidence of low molecular weight breakdown products from the polyphenols of ingested tea in this effluent. These results suggest that only a small proportion of Al in tea is potentially available for absorption throughout the small bowel. It may be misleading to estimate systemic Al absorption from tea drinking simply from total urinary aluminium excretion as has been done previously.

Intestinal absorption of 25-hydroxyvitamin D and osteomalacia in primary biliary cirrhosis.

Bone histology and intestinal absorption of 25-hydroxyvitamin D3 (25-OHD) were investigated in 11 patients with primary biliary cirrhosis (P.B.C.). 4 patients had osteomalacia, and all these had received long-term cholestyramine. Plasma-25-hydroxyvitamin-D (25-OHD) concentrations after an oral dose of 25-OHD3 were significantly lower in the patients with P.B.C. (especially those with osteomalacia) than in normal controls. Serum calcium and urinary calcium excretion were lower, and serum-alkaline-phosphatase higher, in patients with osteomalacia. It is suggested that absorption of 25-OHD undergoing enterohepatic circulation and of dietary vitamin D is reduced in patients with P.B.C. Absorption of 25-OHD is further decreased by cholestyramine and the development of osteomalacia is thus hastened.

The role of removable orthodontic appliances in the investigation and management of patients with hypernasal speech.

The hospital-based orthodontist is involved with the management of cleft palate patients. Removable orthodontic appliance therapy as an adjunct to speech problems is described and discussed. The literature is reviewed and the investigation and management of speech problems related to palate-pharyngeal incompetence and hypernasal speech is outlined.

Transvenous cryoablation of the bundle of His.

Cardiac dysrhythmias are a prominent cause of morbidity and mortality. Pharmacological treatment is ineffective in a large number of patients and is associated with many serious side effects. Thus, direct treatment of cardiac arrhythmias has been used with increasing frequency. Each form of direct treatment, such as surgical ablation, DC catheter ablation, radiofrequency catheter ablation, laser catheter ablation suffer serious drawbacks. Thus, we investigated the utility of transvenous catheter cryoablation of the bundle of His in five miniature swine, 40-60 lbs. in weight. Complete atrioventricular block was produced in each animal during cryothermia and persisted for 1 hour of observation in four out of five swine. In the fifth animal, 2:1 atrioventricular block within the atrioventricular node persisted for 1 hour of observation. Morphological and histologic examination revealed no dysfunction of capillaries and myofibriles in the atrioventricular node and proximal bundle of His. This potential mode of transcatheter therapy deserves further investigation.

Reduction of absorption of paracetamol by activated charcoal and cholestyramine: a possible therapeutic measure.

The absorption of an oral 2-g dose of paracetamol was markedly reduced by the simultaneous oral administration of either activated charcoal or cholestyramine but was only slightly reduced when the adsorbents were given 60 minutes after the paracetamol. Since the absorption of a larger dose of the drug will probably be slow, the administration of adsorbents may be of value even when delayed several hours.

Cardiomyopathy with arrhythmias and ectodermal dysplasia: a previously unreported association.

Hidrotic ectodermal dysplasia represents a group of congenital or hereditary disorders that involve ectodermal derivatives. It is characterized by partial or complete alopecia, dystrophic nails, and dental abnormalities. Dilated cardiomyopathy has not previously been reported in association with this illness. We report the cases of three children with fatal dilated cardiomyopathy with associated cardiac arrhythmias and ectodermal dysplasia. Laboratory investigations revealed no specific cause for the cardiomyopathy. It is speculated that this association is not simply coincidental.

Teeth and benign oesophageal stricture.

In patients undergoing upper gastrointestinal endoscopy, benign oesophageal strictures were significantly more frequent (p less than 0.01) in those with severe tooth loss than in controls of the same age. This may be because of edentulous patients eating less solid and more liquid food, which would otherwise dilate the lower oesophagus, or poor salivary flow leading to both tooth loss and impaired neutralisation of refluxed gastric acid, or malnutrition. No association was found, however, between either oesophagitis or hiatus hernia and dentition.

Omeprazole and dry mouth.

BACKGROUND: Omeprazole causes irreversible inhibition of the hydrogen/potassium adenosine triphosphatase enzyme, leading to a marked reduction in both acid secretion and volume of gastric juice. Reported side-effects include nausea, vomiting, diarrhoea, constipation, and headache. We report the development of dry mouth during omeprazole therapy. METHODS: We have identified six patients taking omeprazole for more than 6 weeks who complained of a dry mouth. Salivary production was measured as whole salivary flow produced over a 10-min period spat into a collecting vessel and as 5% citric acid-stimulated parotid salivary flow collected with a Lashley cup device placed over the parotid duct. Flow rates were evaluated both during and after cessation of treatment. Saliva produced was then cultured for microbes. RESULTS: Four of the six had subnormal parotid or whole salivary flow rates on treatment that recovered after stopping treatment. The increase after treatment was marked in four. Significant amounts of Candida albicans grew from the saliva of the three patients with the lowest salivary flows; one saliva also grew Staphylococcus aureus. CONCLUSION: Salivary flow is reduced in some patients treated with omeprazole, returning to normal after cessation of treatment. This reduction may predispose to opportunistic infection, particularly in the edentulous.

Oral and gastrointestinal manifestations of epidermolysis bullosa.

The mouth, oesophagus, and anus are often involved in dystrophic and junctional epidermolysis bullosa, but the frequency is unknown. Among 246 patients with epidermolysis bullosa, dysphagia developed in 76% of those with recessive dystrophic, in 20% of those with dominant dystrophic, in 15% of those with junctional, and in 2% of those with simplex forms. Lingual adhesions or microstomia occurred in dystrophic epidermolysis bullosa only, but were eight times more common in recessive than in dominant subtypes. These lesions are provoked by the trauma of eating and further reduce food intake, which exacerbates constipation caused by anal blisters and results in malnutrition. Management requires specialised multidisciplinary care.