ALTHOUGH formation of metastases via the cerebrospinal fluid (CSF) is well recognised with medulloblastomas, this mode of spread is rare amongst other intracranial tumours. Metastasis outside the central nervous system was, for many years, thought never to occur (Bailey and Cushing, 1926). Several cases have now been described and were reviewed by Glasauer and Yuan (1963); we are presenting a further series of five gliomas spreading through the cerebrospinal fluid, with distant metastases in two instances, in an attempt to define their histological features and other circumstances that favour this mode of spread.
Endoscopic duodenal biopsies were taken from 27 patients with suspected coeliac disease and compared with intubation capsule jejunal biopsies. The specimens were reported without knowledge of the patients' names or symptoms. In 24 patients (89%), coeliac disease could either be diagnosed or excluded with 100% accuracy, despite the inability to orientate the biopsies correctly. Six biopsies were considered technically unsatisfactory, but only in three (11%) was it impossible to exclude coeliac disease. Duodenal biopsies were also taken from 118 consecutive patients attending for routine upper gastrointestinal endoscopy, and 1 patient with coeliac disease was discovered. We conclude that endoscopic duodenal biopsies are a reliable and worthwhile screening test for coeliac disease in certain patients attending for routine upper gastrointestinal endoscopy.
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