Association between anti-endomysial antibody and total intestinal villous atrophy in children with coeliac disease.

BACKGROUND: There is growing evidence to suggest that detection of anti-gliadin antibody (AGA) and anti-endomysial antibody (EmA) can serve as sensitive markers of the degree of histological abnormalities in patients with coeliac disease. AIM: To evaluate the association between the presence of AGA and EmA and villous atrophy in intestinal biopsies of children with suspected coeliac disease. SETTINGS AND DESIGN: Intestinal samples of 46 children with failure to thrive, chronic diarrhoea, malabsorption and short stature with either AGA and/or EmA positivity were evaluated, retrospectively. The diagnosis of coeliac disease was based on ESPGHAN criteria. METHODS AND MATERIAL: Patients with total villous atrophy who fulfilled the ESPGHAN criteria for the diagnosis of coeliac disease were diagnosed to have coeliac disease. Nine patients without villous atrophy were taken as negative controls for this study. AGA-IgA was measured both by immunoflourescence (IF) and ELISA and EmA-IgA by IF while patients were on normal diet. Relationship between autoantibody positivity and intestinal total villous atrophy was evaluated. RESULTS: Overall positivity for AGA IgA was 85% (39/46) by IF+ELISA and EmA positivity was 85% (39/46) by IF within the study group. Histological examination revealed total villous atrophy with lymphocyte infiltration and crypt hyperplasia in 37 (80%) patients. AGA IgA was positive in 14 (38%) and 31 (84%) of these children by ELISA and IF, respectively. EmA positivity was detected in 35/37 (95%) cases with atrophy and 4/9 (44%) without atrophy (p=0.002). Thirty out of 37 (81%) patients with villous atrophy had both AGA IgA (IF) and EmA positivity (p=0.186). All of the sixteen patients that had both positive AGA IgA (ELISA+IF) and EmA had total villous atrophy (p=0.037). CONCLUSION: A significant association between total villous atrophy and EmA positivity has been documented in this study.

Effect of polyethylene glycol 4000 on adhesion formation following thyroid surgery in rats.

BACKGROUND & OBJECTIVES: Difficulties in dissection encountered during reoperative thyroid surgery could be minimised by preventing formation of adhesions in the operative field. We studied the prevention of adhesion formation in rats after thyroid surgery by using polyethylene glycol 4000 (PEG 4000). METHODS: Twenty two rats in two equal groups were studied. Right hemithyroidectomy was performed in both groups with 0.9 per cent saline being instilled in the operative field in the control group and PEG 4000 solution in the study group. After 10 days, all rats were re-explored and the remaining thyroid tissue of the right lobe was excised. The specimens were scored according to the thickness of the connective tissue over the remainder of the thyroid gland. RESULTS: The connective tissue thickness over the remaining tissue of the thyroid gland in the control and study groups was 272.04 +/- 77.10 and 172.90 +/- 48.92 microns respectively. The decrease of the connective tissue thickness over the remainder of thyroid gland in the study group was significant (P < 0.05). INTERPRETATION & CONCLUSION: In this animal model although application of PEG 4000 did not completely prevent adhesion formation, a significantly decreased amount of adhesions was found.