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PubMed1995

Epithelial barrier and ion transport in coeliac sprue: electrical measurements on intestinal aspiration biopsy specimens.

Epithelial barrier function and ion transport was studied in coeliac sprue using a miniaturised Ussing device for measurements on diagnostic aspiration biopsy specimens from the jejunum of untreated or gluten free nourished sprue patients, or from healthy controls. Pure epithelial resistance (Re) indicating epithelial barrier function was determined by transmural alternating current impedance analysis. It was reduced by 56% in acute sprue mean (SEM) (9 (1) omega.cm2) compared with controls (20(2) omega.cm2). In gluten free nourished sprue patients Re was only partly recovered (15 (1) omega.cm2). Subepithelial resistance (Rsub) was also changed from 28 (1) omega.cm2- in control to 17 (1) omega.cm2 in acute sprue because of the change in mucosal architecture, but was unchanged in gluten free nourished sprue patients (29 (4) omega.cm2). In acute sprue, unidirectional Na+ and Cl- fluxes were increased in both directions as a consequence of the decreased resistance. However, short circuit current (ISC) as well as Na+ and Cl- net fluxes were not significantly different from control. Subsequently, the electrogenic Cl- secretory system was investigated. After maximal stimulation with theophylline and prostaglandin E1, a Cl(-)-dependent increase in ISC was obtained in the sprue mucosa and control jejunum. It showed saturation characteristics and was blockable by serosal bumetanide. When compared with control, neither Km nor Vmax of this electrogenic Cl- secretion was significantly changed in coeliac sprue. In conclusion, a miniaturised Ussing device was used for transport measurements on intestinal biopsy specimens. In acute coeliac disease, the epithelial barrier of the jejunum was seriously disturbed. The active electrogenic Cl- secretory transport system was present in the sprue mucosa, but was not activated in the Ussing chamber in vitro when compared with control jejunum.

Acute Disease↗
PubMed1985

The kinetics of D3-3H metabolism in tropical sprue.

The metabolism of vitamin D3-3H was studied in a small group of controls and subjects with tropical sprue after the oral or intravenous administration of 8 to 10 microCi of D3-3H. The biological half life of D3-3H upon the administration of the isotope by the intravenous route was normal in 2 controls, very low in a subject with tropical sprue who had steatorrhea, and decreased in a subject with tropical sprue who did not present steatorrhea. After the administration of the isotope by the oral route, the biological half life was 35 hours in the control and no radioactivity could be detected in the plasma of the subject with tropical sprue who had steatorrhea. Twenty four hours after the intravenous dose the percentage of radioactivity in the plasma as HCC-3H was two times higher in the tropical sprue subjects than in the controls. When the dose was given orally the net absorption was 50.5% in the subject with tropical sprue and steatorrhea and 86.8% in the subject with tropical sprue who was partially treated. These results showed rapid clearance of the D3-3H in the subject with tropical sprue and steatorrhea indicating depletion of vitamin D stores in the tissues and decrease in the net absorption of the dose when given orally. The presence of a higher percentage of the dose in the plasma as HCC-3H after the intravenous and oral administrations in the tropical sprue subjects when compared to controls indicates that the diseased state does not alter vitamin D3 metabolism.

Administration, Oral↗
PubMed1997

The effects of sprue design on the roughness and porosity of titanium castings.

PURPOSE: This study measured the effects of the sprue number and position on the roughness and porosity of cast titanium crowns. MATERIAL AND METHODS: Twenty-four complete veneer crown wax patterns were fabricated on a stainless steel die with a 30-degree bevel finish line. Twelve wax patterns were sprued with one 8-gauge wax sprue and the remaining 12 were double sprued. All patterns were invested with a phosphate bonded investment. Castings were made with a titanium casting, according to the manufacturer's instructions, with commercially pure titanium (> 99.5%) ingots. The castings were carefully cleaned and the surface roughness was measured with a profilometer. The specimens were then embedded and sectioned. Internal porosities were quantified with photographs by computerized image analysis. Data were analyzed with an ANOVA and the Student's t test with a confidence level of 95%. RESULTS: The roughness value of the occlusal third of the crowns for the single sprue group (Ra = 3.0 +/- 0.9 microns) was significantly higher than other measurements (p < 0.05). There were statistically significant differences in values of porosity areas between the single sprue group (1.5 +/- 0.7 mm2) and the double sprue group (0.2 +/- 0.2 mm2) (p < 0.01). The double sprue design resulted in a relatively smoother casting surface and less internal porosity than the single sprue design. CONCLUSIONS: Improvements in the degree of roughness and porosity of titanium crown castings were the result of the double sprue design.

Analysis of Variance↗
PubMed1999

Celiac sprue among US military veterans: associated disorders and clinical manifestations.

The present study aimed to describe the clinical manifestations of celiac sprue related to malnutrition and to analyze the associations between celiac sprue and other diagnoses. A case-control study compared the occurrence of comorbid diagnoses in case and control subjects with and without celiac sprue, respectively. All patients with a primary or secondary diagnosis of celiac sprue (ICD-579.0) who were discharged from hospitals of the Department of Veterans Affairs between 1986 and 1995 were selected as case subjects. In a multivariate logistic regression analysis, the occurrence of celiac disease served as outcome variable, while age, gender, ethnicity, and the comorbid occurrences of other diagnoses served as predictor variables. A total of 458 individual patients with celiac sprue were identified. The data confirmed the known associations of celiac sprue with dermatitis herpetiformis, lactase deficiency, enlargement of lymph nodes, and lymphoma. Celiac sprue was also found to be statistically significantly associated with pancreatic insufficiency, Crohn's disease, functional bowel symptoms, chronic nonalcoholic hepatitis, and pulmonary eosinophilia. The nutritional manifestations associated with celiac disease included nutritional marasmus, cachexia, weight loss, hypocalcemia, osteoporosis, vitamin B-complex deficiency, and various types of iron- and vitamin-deficiency anemias. The large variety of complex associations clearly indicates that celiac sprue is a systemic disease that involves multiple organs and exceeds an isolated nutritional intolerance to gluten.

Aged↗
PubMed2000

Distinction between coeliac disease and refractory sprue: a simple immunohistochemical method.

AIMS: We recently showed that refractory sprue is distinct from coeliac disease, the former being characterized by abnormal intraepithelial T-lymphocytes expressing a cytoplasmic CD3 chain (CD3c), lacking CD3 and CD8 surface expression, and showing TCRgamma gene rearrangements. To take advantage of the abnormal phenotype of CD3c + CD8 - intraepithelial lymphocytes (IEL) in refractory sprue we developed a simple method to distinguish coeliac disease from refractory sprue. METHODS AND RESULTS: Comparative immunohistochemical studies using anti-CD3 and anti-CD8 antibodies were applied on paraffin-embedded and frozen biopsy specimens in refractory sprue (n = 6), coeliac disease (n = 10), healthy controls (n = 5) and suspected refractory sprue (n = 6). Comparable results were obtained on fixed and frozen biopsy specimens. In four of the six patients with suspected refractory sprue, abnormal CD3c + CD8 - IEL and TCRgamma gene rearrangements were found, as in refractory sprue; the remaining two patients had normal (CD3 + CD8 +) IEL and no TCRgamma gene rearrangements. Both patients had coeliac disease, as one failed to comply with a gluten-free diet, while the other was a slow responder. CONCLUSION: This simplified immunostaining method using anti-CD3 and anti-CD8 antibodies on paraffin sections can distinguish active coeliac disease from refractory sprue and should prove useful in clinical practice.

Adult↗
PubMed1990

Colonic volvulus as a complication of celiac sprue.

Colonic volvulus has been a rarely reported complication of celiac sprue. We describe two patients with long-standing celiac sprue, one in whom a recurrent sigmoid volvulus developed, and in the other, a cecal volvulus. Following surgery, both are now asymptomatic on a gluten-free diet. The association between celiac sprue and colonic volvulus was first reported in 1953. There have been only a few isolated cases documented, surprisingly so because the two major predisposing conditions for colonic volvulus are often seen in patients with celiac sprue. Colonic bacterial fermentation of malabsorbed carbohydrate (in celiac sprue) leads to excess gas production. Flaccid bowel loops with sigmoid redundancy, a long mesentery, or cecal hypermobility are not uncommon. A motility disorder in celiac sprue has also been proposed. Thus these factors together would suggest that the likelihood of development of colonic volvulus in celiac sprue would be relatively great. The possibility of underlying celiac sprue should be considered in patients with colonic volvulus who have a background history of recurrent abdominal distention or malabsorptive symptoms.

Adult↗
PubMed2006

[Changing clinical image of celiac sprue in childhood].

BACKGROUND: Celiac sprue is considered to be the second most common chronic disease in childhood after allergic diseases. At present, the prevalence of this disease is stated as high as approximately 1% in inhabitants of the North America and Western Europe. Aetiology of celiac sprue is multifactorial as it is in other chronic diseases. Pathogenetically, it is an autoimmune disease whose main autoantigene is the tissue transglutaminase. It affects those individuals carrying HLA-DO2 or HLA-DO8 gene and those who were exposed to wheat gliadine or similar amino acids (prolamines) in rye and barley. The purpose of the present study was to find out whether clinical manifestation of celiac sprue changed in our group of patients in course of 23 years. METHODS AND RESULTS: In forty-eight children celiac sprue was diagnosed according to histopathological and histochemical findings in the small intestine mucosa. In the children examined within 5 years in 1982-1987, main clinical symptom of celiac sprue was diarrhoea. In the control group of children examined within 7 months in 2004-2005, intestinal and extraintestinal symptoms in celiac sprue were equally distributed; the so-called sleeping forms occurred too. CONCLUSIONS: It is discussed what are the trigger mechanisms and the possible danger of celiac sprue manifestations and why celiac sprue is diagnosed in the older children at present time compared with the past years.

Age Factors↗
PubMed1978

[Flow of molten metal in denture base in horizontal centrifugal casting procedure. (Part 2) Flow, inflow volume and casting time of molten metal passing through several sprues into model denture plate mold (author's transl)].

Two types of spruing methods were used in the casting of the denture type model pattern (thickness, 0.43 mm). Flow of molten metal in the mold was filmed by the improved system of Part 1. When three sprues were attached to the pattern vertically, molten metal passed through each sprue gate flowed being affected by the direction of gravity and revolution of casting machine, and gathered at the lower part of the mold. Next molten metal filled the mold from the lower part to the upper part. In this spruing type, molten metal turned its direction of flow several times. At the middle stage of casting, the inflow volume per unit time (inflow rate), v (mm3/10-2)s)was evaluated as v = 12.36 + 5.16A-0.16 A2 (A: total cross-sectional areas of sprues). The inflow rate increased with increase of the area of the sprues, but it saturated. When the main sprue and the subsprues were attached at the posterior border, the molten metal filled the mold from the lower part to the upper part quietly. In this spruing type, the casting mold was set facing its sprue gates downwards. The inflow rate at the middle stage of casting was evaluated as v = 21.05 + 1.79 C (C: the cross-sectional area of the main sprue). The inflow rate increased linearly with increase of the area of the main sprue.

Dental Casting Technique↗
PubMed1967

Water and solute movement in the small intestine of patients with sprue.

Water and electrolyte movement in the jejunum of normal subjects and patients with sprue was measured during perfusion with isotonic electrolyte solutions. Normal subjects absorbed water, sodium, and potassium. By contrast, in patients with sprue (seven with adult celiac sprue and one with tropical sprue) who had diarrhea and steatorrhea, these substances were secreted into the intestinal lumen. This indicates that the jejunal mucosa of these patients was in a secretory state with respect to water and electrolytes.A method is presented for detecting abnormalities in the effective pore size in disease states. The method is based on the principle of restrictive diffusion and involves measuring the simultaneous diffusion rates of solutes of different molecular size. Since the method does not depend on measurement of water flow in response to osmotic pressure gradients, it can be used in disease states in which absorption and secretory processes involving water may be abnormal.The ratio of urea to tritiated water diffusion in the jejunum of normal subjects averaged 0.8, compared to 0.2 in patients with sprue. This indicates a marked decrease in the effective pore size of the jejunal mucosa in sprue. This conclusion was strengthened by the finding that erythritol and L-xylose, which are somewhat larger solutes than urea, are essentially non-absorbable in small bowel involved with sprue.

Adult↗
PubMed1990

Comparison of the effects of three sprue designs on the internal porosity in crowns cast with a silver-free high-palladium alloy.

This study tested the effect of bsprue design on internal porosity of a silver-frees high-palladium alloy. The designs evaluated consisted of: (1) a cylindrical sprue, (2) a cylindrical sprue with a reservoir, and (3) cylindrical sprue with a constriction at the point of attachment with the pattern. Ten identical complete crowns were made with each sprue design. The cast crowns were embedded in epoxy resin, sectioned, and polished. A total of six sites for each sample were analyzing computer. The mean amount of internal porosity from all analyzed sites for each sprue design was calculated as a percent site porosity per total site and differences between the experimental sites and groups tested. The analysis of variance found no significant differences among the sprues and no significant interaction, but determined a significant difference (p less than 0.05) among the sites analyzed. Tukey's studentized range test showed that the sprue contained a significantly greater percentage of porosity than any of the other sites analyzed.

Analysis of Variance↗
PubMed1990

Colonic lymphocytosis in patients with celiac sprue.

We examined colonic biopsies from 39 patients with clinical and small bowel biopsy changes of celiac sprue. In 12 of 39 patients (31%), striking lymphocytic infiltration of the superficial colonic epithelium and chronic inflammation of the lamina propria were identified. These 12 cases had a mean of 30.4 lymphocytes per 100 superficial colonic epithelial cells, compared with means of 8.4 in sprue cases without colonic epithelial lymphocytosis, 4.8 in normal controls, and 32.4 in nine cases of lymphocytic colitis without concurrent celiac sprue. No case showed subepithelial collagen layer thickening. Four patients with celiac sprue and colonic lymphocytosis also had gastric biopsies; two showed gastric lymphocytosis. Intraepithelial lymphocytes at all sites were positive for the T-cell marker MT-1. These findings indicate that sprue-associated colonic lymphocytosis and lymphocytic colitis are histologically, quantitatively, and immunohistochemically indistinguishable, that the epithelial T-cell infiltration of celiac sprue occurs in glandular mucosa at all levels of the gastrointestinal tract, and that colonic subepithelial collagen deposition in patients with celiac sprue is an infrequent occurrence. These findings also suggest that gastrointestinal epithelial T-cell infiltration may be an immunologic response that is common in individuals sensitized to absorbed lumenal antigens, and that colonic lymphocytosis may occur as a response to a number of antigens, including gluten.

Celiac Disease↗
PubMed2003

Recurrent partial trisomy 1q22-q44 in clonal intraepithelial lymphocytes in refractory celiac sprue.

BACKGROUND & AIMS: Refractory celiac sprue, a low-grade intraepithelial lymphoma characterized by expansion of clonal intraepithelial lymphocytes with intracellular CD3 epsilon but no surface CD3-T-cell receptor complexes, can be an intermediary step between celiac disease and overt T-cell lymphoma. To gain insight into the mechanisms of lymphomagenesis in celiac disease, we have performed the first cytogenetic study in refractory celiac sprue. METHODS: Karyotypes were performed on: (1) 7 cell lines derived from clonal intraepithelial lymphocytes of patients with refractory celiac sprue; (2) 14 control T-cell lines, either from 4 of 7 patients with refractory celiac sprue or from 10 patients with uncomplicated celiac disease; and (3) bone marrow and peripheral blood lymphocytes in 1 of 7 patients with refractory celiac sprue. Rearrangements were confirmed by in situ hybridization using whole-chromosome painting probes and by comparative genomic hybridization in one patient. RESULTS: A recurrent structural chromosomal aberration leading to partial trisomy of the long arm of chromosome 1 was found in 6 of 7 cell lines from patients with refractory celiac sprue but in none of the control T-cell lines. In one patient with circulating abnormal intraepithelial lymphocytes, the partial trisomy 1q was confirmed on cells freshly isolated from bone marrow and blood. CONCLUSIONS: Refractory celiac sprue is strongly associated with partial trisomy of the 1q region. Gain of chromosome 1q, recently found in 16% of enteropathy-type T-cell lymphoma, may be an early event in lymphomagenesis related to celiac disease and provides a key to investigating molecular mechanisms of lymphoid transformation in this disease.

Adult↗
PubMed1978

Impairment of secretin release in celiac sprue.

Plasma secretin concentrations and pH in the second portion of duodenum were measured in the fasting state and during duodenal infusion of HCl in five patients with untreated celiac sprue, five celiac sprue patients after gluten-free diets, and five normal subjects. Mean fasting plasma secretin concentrations were insignificantly lower in untreated sprue patients (4.1 +/- 1.4 pg/ml) than in normal subjects (5.7 +/- 0.59 pg/ml). During 30-min intraduodenal infusions of 0.1 N HCl at 0.20 mEqH+/min, mean plasma secretin concentrations were significantly lower in untreated sprue patients (5.8 +/- 1.8 pg/ml) than in normal subjects (25.4 +/- 1.60 pg/ml, P less than 0.01). The increases in mean secretin concentrations over fasting were 2.1 +/- 0.82 pg/ml in untreated sprue patients compared to 19.7 +/- 1.47 pg/ml in normal subjects (P less than 0.01), a ninefold difference. The results indicate that endogenous release of secretin in response to duodenal acidification is impaired in patients with celiac sprue.

Adult↗
PubMed1989

The effect of sprue attachment design on castability and porosity.

Sprue attachment design is an important and controversial variable that can affect casting characteristics of castability and porosity. Four sprue attachment designs--straight, flared, abrupt constriction, and gradual constriction--were investigated. Standardized wax copings simulating complete veneer metal ceramic crowns with knife-edge margins were sculpted on refractory investment dies, sprued, invested, and cast with Olympia alloy. The specimens were embedded, sectioned, and polished. Castability was analyzed by measuring the width of the cast meniscus of the margins. The margin widths of the flared and the straight sprue attachment groups were significantly less than the abrupt or gradual constriction attachment group (p less than 0.05). Photomicrographs revealed discernible differences in the relative quantity and location of porosity in the sprue-coping junctions. The straight and flared sprue attachment groups were less porous than the abrupt or gradual constriction groups (p less than 0.01). Flared and straight sprue attachments optimized castability and minimized porosity.

Chemical Phenomena↗
PubMed1999

Investigation of the effect of three sprue designs on the porosity and the completeness of titanium cast removable partial denture frameworks.

STATEMENT OF PROBLEM: Although titanium has been used to cast removable partial denture frameworks, the casting process is arduous and requires specialized equipment. PURPOSE: This study evaluated the ability of 3 sprue designs (tree, ball, and circular) to produce complete, void-free castings of removable partial denture frameworks made from commercially pure titanium. METHODS AND MATERIAL: A cast with a Kennedy class III, modification 1, partially edentulous arch was used. The blocked-out cast was modified to facilitate assessment of the completeness of the casting of the clasp arms. Thirty refractory casts were made, and 10 wax patterns for each sprue design were fabricated and invested with ethyl silicate investment. Castings were made with an arc-type automatic casting machine in an argon atmosphere. Castings were examined with radiographic equipment to detect the presence of voids in the castings, and the completeness to each casting was visually verified. Data on porosities were tabulated and statistically analyzed with 1-way ANOVA followed by Student Newman-Keuls test. Chi-square analysis was used to identify statistically significant differences in casting defects among the 3 sprue designs. RESULTS: No statistically significant differences in the total number of porosities were found between the 3 sprue designs (P =.51). Results of completeness of castings evaluated by using chi-square test revealed a statistically significant deference among the 3 sprue designs (P =.008). CONCLUSION: The ball-sprue design produced the most complete castings for the removable partial denture titanium frameworks.

Analysis of Variance↗
PubMed1998

The effect of sprue design on the marginal accuracy of titanium castings.

The purpose of this study was to measure the effects of sprue number and position on cast titanium crown margins. Twenty-four complete veneer crown wax patterns were fabricated on a stainless steel die with a 30 degrees bevel finish line. Twelve wax patterns were sprued with one 8-gauge wax sprue and the remaining 12-gauge double sprued. All patterns were invested with a phosphate bonded investment. Castings were made with a titanium casting machine following the manufacturer's instructions and using commercially pure titanium (> 99.5%) ingots. The castings were than carefully cleansed and the margins were examined with indirect impression technique. Data were analysed with an ANOVA and the Student's t-test with confidence level at 95%. The results revealed that the marginal discrepancy for the double sprueing group (32.1 +/- 12.8 microm) has significantly less discrepancy (P < 0.001) than the single sprueing group (49.8 +/- 16.4 microm). There was no statistically significant differences in marginal discrepancy between locations within the sprueing techniques (P > 0.05). An improvement in the degree of casting accuracy of titanium crown was indicated by the double sprue design used in this investigation.

Analysis of Variance↗
PubMed2002

Internal porosity of cast titanium removable partial dentures: Influence of sprue direction on porosity in circumferential clasps of a clinical framework design.

STATEMENT OF PROBLEM: Although internal porosity is a potential risk factor for clasp fracture, little is known about its frequency in the clasps of titanium removable partial dentures. PURPOSE: This study investigated the influence of the direction of auxiliary sprues on porosity in the circumferential clasps of a pressure-cast titanium removable partial denture. MATERIAL AND METHODS: Wax patterns of a removable partial denture framework were made on 10 identical refractory casts of a Kennedy class II, modification 1, mandibular partially edentulous arch. For the auxiliary sprues directed to the circumferential clasps, 2 designs were used: straight and curved. Casting was performed in a 1-chamber pressure casting machine. Pore number and size were assessed on radiographs of the castings. The data were analyzed with the 2-tailed Student t test (P <.05). Randomly selected specimens were sectioned for morphologic observation of the internal surface of the pores. RESULTS: The number of pores >or=0.5 mm diameter and the total number of pores were significantly lower in the molar lingual arms of the curved sprue group than in the corresponding clasp arms of the straight sprue group (P =.03 and P =.009, respectively). No significant differences between the 2 groups were found for pores of any size in other locations. The pores had smooth internal surfaces. CONCLUSION: Within the limitations of this study, the curved sprue design produced significantly less porosity in the circumferential clasp arms of a cast titanium removable partial denture than the conventional straight design. The results suggest that internal porosity in titanium castings can be controlled through sprue design.

Dental Casting Technique↗
PubMed1996

How many hospital visits does it take before celiac sprue is diagnosed?

We studied the hospital records of patients with celiac sprue in order to determine how frequently hospital specialists failed to make the diagnosis. Over a 7 1/2-year period, 39 patients were diagnosed, 49% within the last 18 months of the study period. Fourteen patients (39%) had been referred to the hospital a total of 30 times with features suggestive of celiac sprue, yet without being successfully diagnosed: the delay between initial referral and diagnosis was > 6 years in nine of these patients. The diagnosis was made by gastroenterologists or other internists in 38 (97%) patients. Gastroenterologists had an 85% (33 of 39) diagnostic success rate, other internists 63% (five of eight), and surgeons 7% (one of 14). None of eight referrals to other specialists led to diagnosis. While a history of diarrhea was morel likely to lead to diagnosis, it was reported by only 59% (23 of 39) of patients at the time of diagnosis and at only 46% (32 of 69) of referrals; furthermore, it did not prompt correct diagnosis in 28% (nine of 32). Anemia was the sole manifestation of celiac sprue at 17 referrals, and correct diagnosis was made in only seven (41%), all by gastroenterologists. The perceived rarity of celiac sprue reflects its underdiagnosis. Diagnosis is still delayed even in patients with classic diarrhea, and there is still a failure to appreciate the possible manifestations of sprue, including anemia without gastrointestinal symptoms. Because patients may be referred to specialists other than gastroenterologists with symptoms arising from celiac sprue, a wider knowledge of its manifestations is called for.

Anemia↗