Catatonia following biparietal infarction with spontaneous recovery.

We describe a case of catatonic stupor following simultaneous biparietal infarction. The patient recovered, a result not previously described in catatonia caused by this pattern of cerebral infarct.

Urinary infection may invalidate the double-sugar test of intestinal permeability.

To assess the effect of urinary infection on a typical double-sugar test of intestinal permeability, rhamnose and cellobiose were added to 12 infected urine samples to give sugar concentrations generally present in the 5-h urine samples of patients undergoing the test. Rhamnose concentration fell by approximately 20% in two of the specimens after incubation at 37 degrees C for 5 h. Eight of the 12 samples showed a fall in cellobiose concentration at 2.5 h, and 11 at 5 h. On five occasions more than 90% of the cellobiose was destroyed within 5 h. Yet only eight of these urine samples contained organisms that were able to metabolize cellobiose. This apparent anomaly may have resulted from bacteria surviving in spite of the thiomersal preservative, and then consuming the glucose to which the cellobiose was hydrolysed to enable calculation of cellobiose concentration. We conclude that bacteriuria may invalidate the result of the double-sugar test of intestinal function.

The double sugar test of intestinal permeability in the elderly.

Tests of intestinal permeability are used as a reflection of upper-small-intestinal mucosal damage. Thirty-two elderly in-patients aged 75-96 years, and 64 hospital volunteers aged 22-64 years with no overt gastro-intestinal disease were studied to determine whether permeability changes with increasing age. Intestinal permeability was assessed by measuring the 5-h urinary excretion of a monosaccharide, L-rhamnose, and a disaccharide, cellobiose, for 5 h after their oral administration in a hypertonic solution. While in the elderly, excretion of both mono- and di-saccharides was significantly reduced by a half to two-thirds, the ratio of the two sugars in the urine was similar in both age groups. We conclude that permeability was unimpaired in the elderly patients whom we studied. Because the test depends on a ratio of excretion rates rather than an absolute rate, accuracy of urine collection and abnormal renal function do not invalidate the results. It is therefore useful as a screening test of upper-small-intestinal mucosal damage in the elderly.

Distribution of fibronectin in the rectal mucosa.

Fibronectin is a glycoprotein of high molecular weight present in tissues, plasma, and tissue fluids. Its distribution in the rectal mucosa was studied by immunofluorescent and immunoperoxidase techniques using a monospecific antiserum. Immunofluorescent reactivity for fibronectin was present in the normal rectal mucosa of control subjects in epithelial cells, on basement membranes, and as a loose cribriform network of extracellular reactivity in the lamina propria that codistributed with histochemically demonstrable reticulin. Fibronectin was demonstrated immunoelectromicroscopically on collagen fibres, on smooth muscle cells and within and between columnar epithelial cells. In the rectal mucosa of patients with colitis with marked inflammatory changes, fibronectin appeared thickened and more prominent when present on basement membranes and as sparse strands between inflammatory cells infiltrating the lamina propria. In patients with longstanding colitis and less inflammatory cell infiltration there was a diffuse increase in fibronectin which was densely and uniformly present throughout the lamina propria. Fibronectin is a structural component of the rectal mucosa and changes in its distribution may form an important part of the local reaction to inflammatory bowel disease.

Pyoderma gangrenosum and ulcerative colitis.

The relationship of pyoderma gangrenosum and ulcerative colitis remains uncertain. We investigating 14 patients with pyoderma gangrenosum by colonoscopy with multiple biopsies. Six patients had ulcerative colitis and all of these had disease affecting the whole colon. There were no correlations between exacerbations of the colitis and the onset or course of pyoderma gangrenosum. The remaining eight patients with pyoderma gangrenosum had no other disease and they were found to be significantly older than those patients with coexisting colitis (P less than 0.002).