SUMMARY Fifty two children in whom coeliac disease was confirmed by persistent enteropathy while they were taking gluten were monitored to assess the effects of compliance with a gluten free diet (GFD). Between the ages of 17-8 and 18-5 years height (in 45 patients followed up for a mean of 14*9 years) and weight (in 43 followed up for a mean of 15-2 years) were significantly lower in those complying poorly with a GFD compared with those complying well. Of the 37 patients still attending the clinic after a mean of 25 years, having been followed up for a mean of 18-4 years, 16 who had complied well with the diet had normal or only slightly abnormal mucosal morphology whereas all 10 who had not complied had abnormal morphology. In these 10 lactase, sucrase, and alkaline phosphatase activities were significantly less than values in those who complied well. Mucosal sucrase and alkaline phosphatase activities in those who complied well were no different from those in a control population, whereas lactase activity was significantly lower. It is concluded that failure to comply with a GFD during childhood results in decreased adult stature and in persisting active enteropathy with depressed brush border enzyme activity.Sheldon reviewed 57 young adults who had been diagnosed as having coeliac disease in childhood and found that six were stunted'; there had, however, been a delay of at least seven years before diagnosis. Of the 57, 13 had had a clinical relapse, and 19 had low serum folate and 11 low serum iron concentrations. The initial diagnosis had been made without intestinal biopsy. Young and Pringle from a series of 110 children regarded as having coeliac disease, followed up 44 for between eight and 19 years2; 11 out of 20 receiving a strict gluten free diet (GFD), six out of 16 receiving a partial GFD, and only one out of eight receiving a normal diet were above the 50th height centile, and five receiving a normal diet were below the 3rd centile. No initial biopsy was done in 13 of the 110, and in the 44 followed up for some years repeat biopsies were not done, progress being assessed by anthropometric and clinical criteria.We followed up a group of 52 children for a mean of 18-4 years to see if there was an association between their growth, general health, mucosal morphology, and enzymology and their compliance with a GFD. We believe that this is the first study in which the initial diagnosis was confirmed in all cases by the finding of persisting gluten enteropathy and in which serial biopsies were performed. Patients and methodsWe studied 52 children, 47 of whom had taken part in a previous study;3 the mean age at diagnosis was 3-3 years (range 6 months to 12 years). The children comprised 32 girls and 20 boys; because there was no difference between the sexes in either compliance with diet or outcome the results were combined. In 42 children persisting gluten intolerance was confirmed by mucosal relapse on return to a normal diet; 10, whose dietary compliance was poor, were regarded as having persisting glut...

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management of spinal cord or cauda equina compression from recurrent primary or secondary malignancies was not discussed. (6) The critical role of dexamethasone in emergency treatment was not mentioned. (7) Chemotherapy now has a central role in the management of intraspinal malignancy,S yet receives no mention whatever. If a specific diagnosis can be made by biopsy (of the cord compressing lesion itself or of a separate site of tumour spread-for example, lymph node, bone marrow or, in the case of neuroblastoma, by a combination of biochemical and radiological criteria), laminectomy can be avoided. This is important because multisegment laminectomy can cause major morbidity. Besides the acute deterioration of neurological function, mentioned by Dr Cole, major cosmetic and functional consequences of laminectomy are also common. When radiotherapy and laminectomy are combined, these 'late effects' are particularly severe.4 (8) The role of 'lamina replacement' after laminectomy also deserves mention. The morbidity of the operation (especially in young children) will almost certainly be reduced by the general introduction of this technique.

Myocarditis is defined as inflammation of the myocardium. The clinical manifestations of myocarditis vary from flu-like symptoms to fatal fulminant forms. We report the case of a 39-year-old woman with a diagnosis of cardiogenic shock caused by fulminant myocarditis. Extracorporeal membrane oxygenation was used as a bridge to recovery. Etiological study revealed Legionella pneumophila serogroup 1 infection. Recovery of biventricular function was seen after treatment with azithromycin.