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Lymphocyte transformation in the mesenteric lymph nodes of patients with Crohn's disease
264
what elongated colon showing some sort of right colonic flexure.--G. Brandesky Regional Enteritis and Growth Retardation Without Intestinal Symptoms. J. W. Donald and J. G. Donald. South. Med. J. 66:90% 912 (August), 1973. Severe growth failure associated with regional enteritis can occur even in the absence of intestinal s y m p t o m s . The authors report such a situation in a 16-yr-old boy. This association is more likely when the disease is present in the j e j u n u m or proximal ileum. Accordingly, roentgenographic barium study of the small bowel is essential in the diagnosis of this condition. In the investigation of growth retardation, even in the absence of intestinal s y m p t o m s , a careful search for regional enteritis should be made. Resection of the involved 91cm segment o f mid small bowel was accomplished. Microscopic appearance was typical of regional enteritis. In the first 5 m o following the operation he gained 9.1 kg, and his height increased 3.7 cm. His good health continued until 9 m o later when he developed a b d o m i n a l cramps and diarrhea. Barium studies revealed mild recurrence of the regional enteritis. This responded to a medical program of bland diet and Azulfidine. Since then he has had no intestinal s y m p t o m s with a weight gain of 13.6 kg and height increase of 10.2 cm. The a u t h o r s propose growth retardation as another indication for resection in patients with this d i s e a s e . George Holcomb Lymphocyte T r a n s f o r m a t i o n in the Mesenteric L y m p h Nodes of Patients With C r o h n ' s Disease. P. J. Guillou, T. G. Brennan, and G. R. Giles. Gut:14:20 24, 1973. T h e response, in vitro, of peripheral l y m p h o cytes to phytohemagglutinin (PHA) is compared with the responses obtained in l y m p h o cytes from mesenteric lymph nodes of a group of eight patients with C r o h n ' s disease and another group of seven patients undergoing laparotomy for n o n i n f l a m m a t o r y and n o n m a lignant conditions of the gastrointestinal tract. Following incubation of each culture the n u m ber of lymphocytes demonstrating uptake of radioactive thymidine was determined a n d expressed as a percentage of the total n u m b e r of cells in the culture to give "lymphocyte transformation rate" (L.T.R.~o). In the patients with C r o h n ' s disease the L.T.R. for peripheral lymphocytes was 35.8~o
ABSTRACTS
as against 48.3~,,, in normal subjects. The L.T.R, for " l y m p h node lymphocytes" in C r o h n ' s disease was 22.8'Yo, as against 42.6'~o in controls. It appears that the cause of this depressed response lay within the lymphocyte itself. Attempts to correlate L.T.R. with the histologic appearances of the lymph nodes were not entirely satisfactory, Despite the observed results an i m m u n o l o g i cal basis for C r o h n ' s disease c a n n o t be excluded by this study. It could be that in C r o h n ' s disease most of the lymphocytes in the lymph nodes and peripheral blood are bone m a r r o w derived and therefore do not respond to p h y t o h e m a g glutinin. Techniques which d e m o n s t r a t e imm u n o g l o b u l i n s on the surface of bone marrow derived lymphocytes m a y be able to help clarify the situation f u r t h e r . - - J . J. Corkery Pathology of Ulcerative Colitis in Childhood. B. C. Morson. Proc. Roy Soc Med. 66:1036 (October), 1973. This paper emphasizes that ulcerative colitis can affect persons at any age and the a u t h o r has examined specimens from babies and very y o u n g children; the histology is exactly the same as in adults. The risk of the development of colon carcinoma in children with ulcerative colitis is emphasized.--John E. S. Scott Medical Aspects of Ulcerative Colitis in Childhood. S. C. Truelove. Proc. Roy. Soc. Med. 66:1032 (October), 1973. The present m e t h o d s of medical t r e a t m e n t are outlined indicating the variations required for disease of differing severity, it is pointed o u t that corticosteroids are of no value as m a i n t e n a n c e treatment because they do not prevent recurrence of the disease, whereas sulphasalazine does reduce the risk of recurrence and has become the basis of long term medical treatment and m a y be required for several years. The a u t h o r describes a series o f 57 children with ulcerative colitis collected over a period of 10 yr; children with the more benign h e m o r rhagic proctitis are excluded, 5 6 ~ of the series having evidence of total colitis. There was one death following proctocoleetomy, one child was found to have a c a r c i n o m a in a proctocolectomy specimen, a further eight were subjected to excisional surgery, Thirtyseven patients did not require surgery and all were living n o r m a l lives, t h o u g h s o m e were on m a i n t e n a n c e therapy.--John E. S, Scott
what elongated colon showing some sort of right colonic flexure.--G. Brandesky Regional Enteritis and Growth Retardation Without Intestinal Symptoms. J. W. Donald and J. G. Donald. South. Med. J. 66:90% 912 (August), 1973. Severe growth failure associated with regional enteritis can occur even in the absence of intestinal s y m p t o m s . The authors report such a situation in a 16-yr-old boy. This association is more likely when the disease is present in the j e j u n u m or proximal ileum. Accordingly, roentgenographic barium study of the small bowel is essential in the diagnosis of this condition. In the investigation of growth retardation, even in the absence of intestinal s y m p t o m s , a careful search for regional enteritis should be made. Resection of the involved 91cm segment o f mid small bowel was accomplished. Microscopic appearance was typical of regional enteritis. In the first 5 m o following the operation he gained 9.1 kg, and his height increased 3.7 cm. His good health continued until 9 m o later when he developed a b d o m i n a l cramps and diarrhea. Barium studies revealed mild recurrence of the regional enteritis. This responded to a medical program of bland diet and Azulfidine. Since then he has had no intestinal s y m p t o m s with a weight gain of 13.6 kg and height increase of 10.2 cm. The a u t h o r s propose growth retardation as another indication for resection in patients with this d i s e a s e . George Holcomb Lymphocyte T r a n s f o r m a t i o n in the Mesenteric L y m p h Nodes of Patients With C r o h n ' s Disease. P. J. Guillou, T. G. Brennan, and G. R. Giles. Gut:14:20 24, 1973. T h e response, in vitro, of peripheral l y m p h o cytes to phytohemagglutinin (PHA) is compared with the responses obtained in l y m p h o cytes from mesenteric lymph nodes of a group of eight patients with C r o h n ' s disease and another group of seven patients undergoing laparotomy for n o n i n f l a m m a t o r y and n o n m a lignant conditions of the gastrointestinal tract. Following incubation of each culture the n u m ber of lymphocytes demonstrating uptake of radioactive thymidine was determined a n d expressed as a percentage of the total n u m b e r of cells in the culture to give "lymphocyte transformation rate" (L.T.R.~o). In the patients with C r o h n ' s disease the L.T.R. for peripheral lymphocytes was 35.8~o
ABSTRACTS
as against 48.3~,,, in normal subjects. The L.T.R, for " l y m p h node lymphocytes" in C r o h n ' s disease was 22.8'Yo, as against 42.6'~o in controls. It appears that the cause of this depressed response lay within the lymphocyte itself. Attempts to correlate L.T.R. with the histologic appearances of the lymph nodes were not entirely satisfactory, Despite the observed results an i m m u n o l o g i cal basis for C r o h n ' s disease c a n n o t be excluded by this study. It could be that in C r o h n ' s disease most of the lymphocytes in the lymph nodes and peripheral blood are bone m a r r o w derived and therefore do not respond to p h y t o h e m a g glutinin. Techniques which d e m o n s t r a t e imm u n o g l o b u l i n s on the surface of bone marrow derived lymphocytes m a y be able to help clarify the situation f u r t h e r . - - J . J. Corkery Pathology of Ulcerative Colitis in Childhood. B. C. Morson. Proc. Roy Soc Med. 66:1036 (October), 1973. This paper emphasizes that ulcerative colitis can affect persons at any age and the a u t h o r has examined specimens from babies and very y o u n g children; the histology is exactly the same as in adults. The risk of the development of colon carcinoma in children with ulcerative colitis is emphasized.--John E. S. Scott Medical Aspects of Ulcerative Colitis in Childhood. S. C. Truelove. Proc. Roy. Soc. Med. 66:1032 (October), 1973. The present m e t h o d s of medical t r e a t m e n t are outlined indicating the variations required for disease of differing severity, it is pointed o u t that corticosteroids are of no value as m a i n t e n a n c e treatment because they do not prevent recurrence of the disease, whereas sulphasalazine does reduce the risk of recurrence and has become the basis of long term medical treatment and m a y be required for several years. The a u t h o r describes a series o f 57 children with ulcerative colitis collected over a period of 10 yr; children with the more benign h e m o r rhagic proctitis are excluded, 5 6 ~ of the series having evidence of total colitis. There was one death following proctocoleetomy, one child was found to have a c a r c i n o m a in a proctocolectomy specimen, a further eight were subjected to excisional surgery, Thirtyseven patients did not require surgery and all were living n o r m a l lives, t h o u g h s o m e were on m a i n t e n a n c e therapy.--John E. S, Scott