SUMMARY The toxicity of three fractions (A, B, and C) obtained by ultrafiltration of a peptic: tryptic digest of gluten has been assessed by serial feeding experiments in patients with treated coeliac disease.The first fraction (A), which contains amino acids and oligopeptides, produced no damage to the jejunal mucosa.The other two fractions (B and C) both caused mucosal damage. Fraction B, which contains the products of digestion of smaller molecular weight, consists of polypeptides which are concentrated in the region of 8000 molecular weight. It contains no gliadin (molecular weight 50 000) or gluten.Ultrastructural evidence of damage was visible six hours after challenge with fraction B and by 10 hours histological abnormalities were also present.Ultrastructural abnormalities occurred early in the epithelial cells and preceded changes in the basement membrane and capillaries.The disaccharidases showed a pronounced depression in all three subjects by 24 hours. The rapid onset of damage after challenge, coupled with the evidence of recovery as soon as 72 hours later, is more in keeping with a direct action on the surface epithelial cells rather than an immune mechanism.

The renal biopsy findings in a 76 yr-old woman suffering grom anuria due to acute tubular necrosis are described. The glomeruli were normal on light- and electron microscopy. Immunofluorescent studies failed to reveal any fibrin or immunoglobulins in the glomerular capillaries. Extensive focal areas of necrosis were seen in the tubular epithelium often exposing the lumen of the tubule directly to the tubular basement-membrane. In some areas necrotic cells lay adjacent to normal or near normal cells. The proximity of the necrotic tubular epithelium to the oedematous interstitial tissue and the peritubular capillaries, together with the finding of normal glomeruli is compatible with the theory of back diffusion as a mechanism for the oliguria.

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Three cases of carcinoma of the breast are described, in which similar tumour cells were found in pleural or peritoneal fluid. The cells were characterized by the frequent presence of 'bull's-eye' vacuoles, in which a central spot was deeply stained by Giemsa, eosin or periodic acid-Schiff (PAS). In one of these it was shown by electron microscopy that the vacuoles are lined by microvilli, and that their mucinous content is condensed in the central area, presumably as a result of failure to discharge the secretion.