No abstract

SUMMARY A dual sugar (mannitol, lactulose) absorption test was evaluated using an iso-osmolar oral dose in two groups of children: a study group of 43 children divided into five subgroups, based on severity of mucosal damage, and a control group of 53 children with histologically normal jejunal biopsy specimens. After an oral dose, the three hour urinary mannitol:lactulose ratios in the control group showed a highly significant positive correlation with body surface area. After correction for the body surface area relationship, a control lower limit was defined by the mean -2SD of the log1o transformed control mannitol:lactulose ratios.Specificity and sensitivity for severe villous atrophy was 98% and 95% respectively but the sensitivity declined rapidly with decreasing degrees of mucosal damage, and the test would not therefore be an adequate screening procedure for all enteropathies. In sequential studies in 18 children, the changes in the mannitol:lactulose ratio were consistent with the changes in mucosal structure induced by gluten challenge or gluten withdrawal. The test may therefore have a role in any sequential study of lesions of the mucosa of the small intestine.

The concept of an enteromammary link in secretory IgA (SIgA) antibody production was tested by hypothesising that specific SIgA

x-fetoprotein can more easily reach the maternal circulation. Another possibility is absorption of fetal blood after tubal abortion. Our findings support the use of Rho (D) immune globulin in Rhnegative women with ectopic pregnancy. Determination of the xfetoprotein concentration may also prove useful as an adjunct in the diagnosis of ectopic pregnancy. UK Collaborative Study on Alpha-fetoprotein in Relation to Neural Tube Defects. Second report. Amniotic fluid alpha-fetoprotein measurement in antenatal diagnosis of anencephaly and open spina bifida in early pregnancy. Lancet 1979;ii:651-61. 2 Cederqvist LL. The use of alpha-fetoprotein in the evaluation of the fetus. In: Lauersen NH, ed. Principles of clinical fetal monitoring. New York: Plenum Publishing Corp (in press). 3 Saxena BB, Landesman R. Diagnosis and management of pregnancy by the radioreceptor assay of human chorionic gonadotropin. Am J Obstet Gynecol 1978;131:87-107. Los FJ, DeWolf BTHM, Hvisjes HJ. Raised maternal serum alphafetoprotein levels and spontaneous fetomaternal transfusion. Lancet 1979 ;ii :1210-2.

Two male siblings from a consanguinous Pakistani family had fatal diarrhoea with an onset at 24 and 48 hours after birth. A diagnosis of microvillous inclusion disease (MVID) was established by showing characteristic light and electron microscopic features in the small intestinal biopsy specimen on day 6 of life in case 1. The typical abnormalities ofMVID were also demonstrated retrospectively in case 2 by examining archival appendicular tissue from 10 years previously.These cases are consistent with an autosomal recessive inheritance for MVID. Retrospective diagnosis of MVID is possible by examining appropriate archival material, which may aid genetic counselling and future research.