Chemokines, together with key cytokines that promote their release are elevated in mucosal tissues from patients with IBD. It is likely that these chemokines play an important role in the perpetuation of tissue destructive inflammatory processes.
These are not, of course, grounds for condemning epidural anaesthesia. It should not, in Reynold's terms, be "classed with other forms of obstetric intervention as undesirable interference by the medical profession in what would otherwise be a trouble free and satisfying natural event."7 In addition to providing the only really effective form of pain relief during labour,89 an epidural offers a number of positive clinical benefits for both the mother'0" and the baby.'2-'4 Moreover, the backache is not solely a consequence of epidural anaesthesia but is probably due to a combination of muscular relaxation and postural stresses in labour. The problem now is to determine in precise detail the mechanisms that result in backache and to refine the management of epidural anaesthesia in labour.Thanks are due to all women who took part in the study.
SUMMARY Because of the possible clinical association between coeliac disease and sarcoidosis, the incidence of humoral sensitivity to dietary proteins was examined in patients with sarcoidosis. Raised concentrations of circulating IgG antibodies to alpha gliadin were found in 41/99 sarcoid patients whereas antibody levels to casein, beta lactaglobulin and ovalbumen were similar to normal controls. Subsequently, a group of 26 sarcoid patients were selected for small intestinal biopsy; 11 had raised and 15 normal alpha gliadin antibody (AGA) levels. One AGA positive patient had villous atrophy consistent with coeliac disease. Intraepithelial lymphocyte (IEL) counts were raised in AGA positive (median 30; 95% confidence limits 22-46) and AGA negative (median 24; 95% confidence limits 19-32) sarcoid patients when compared with a control group (median 13.5; 95% confidence limits 10-18) p<001. Serum IgG concentrations were raised in 11/52 patients tested but there was no correlation between IgG levels and the presence ofIgG antigliadin antibodies. HLA Dr typing was done in 21 of the 26 biopsied patients. The coeliac disease associated antigen Dr3 was present in eight of 21 (38%) which is very similar to the prevalence in unselected blood donors (34%). There was no significant difference in IEL counts between Dr3 positive and Dr3 negative sarcoid patients. These findings suggest that in patients with sarcoidosis, there is an altered gastrointestinal mucosal immune response, accompanied in about 40% of patients by specific sensitisation to wheat protein.
Cholangiocarcinoma is a serious but common complication of primary sclerosing cholangitis (PSC) that is often difficult to diagnose. The aim of this study was to conduct an evidence based radiology review of the diagnostic modalities used to identify cholangiocarcinoma in patients with PSC. A systematic review of the current best evidence was carried out and a diagnostic algorithm for cholangiocarcinoma in PSC is proposed.
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