522 CHRONIC ASTHMA AND GROWTH FAILURE IN CHILDREN

SIR,—I

was

interested in Dr

Murray

and his

colleagues’

findings (July 24, p. 197). During the pasfeight years

we

have

studying growth patterns of asthmatic children in one English town. There are now about 600 children. The measurements throughout have been performed by two observers using a stadiometer. Although we have not completed our work the following patterns have emerged: (1) In the "non-steroid" child height growths for boys and girls are normal but a high proportion of children are retarded in their corresponding weight growths. It is unusual to see an asthmatic child below the third centile for height but not for weight as it is uncommon to find very tall asthmatic children. (2) Small doses of oral corticosteroids (5 mg or more per day) adversely affect growth-i.e., the child grows but his growth velocity is below what it should be if he had not been

been

steroids. This pattern may be observed for two or three years withdrawal before catch-up growth occurs and continues for up to three years. (3) We have not analysed our findings so far in relation to sodium cromoglycate or steroid aerosols and their effects, if any, on growth patterns of these children. (4) Many children even with moderate asthma have delayed puberty. The remarks apply to both boys and girls. on

This

study

has been

supported by

a

grant from the East

Anglian

Regional Health Authority. Department of Pædiatrics, Peterborough District Hospital,

Peterborough PE3 6DA

J. A. KUZEMKO

SIR,—With much interest

we read the report of Dr Touand his gaard colleagues (May 15, p. 1044) describing a controlled trial of lahydroxycholecalciferol in renal osteodystrophy. Although it is not one of the main issues of the paper, it was also gratifying to see that the authors now make use of the phosphorus/hydroxyproline ratio in bone, which we introduced some ten years ago as probably the best chemical measure of the average degree of mineralisation of bone-biopsy material. Taking into consideration the work of Strandh and Norlén,1 who studied calcium, phosphorus, and nitrogen content of normal bone, we could recognise, by means of the phosphorus/hydroxyproline ratio obtained in pure cancellous bone from the iliac crest, states of hypomineralisation of bone, such as primary hyperparathyroidism,2 3 renal osteodystrophy,3 and vitamin-D-resistant osteomalacia,3as well as (more surprisingly) states of apparent hypermineralisation-namely, osteoporosis in Cushing’s syndrome2-4 and idiopathic osteoporosis of elderly people.3 5 In later years one of us (D. H. B.-F.) also made use of this ratio in longitudinal studies.6

Rotterdam

Department of Internal Medicine III, University Hospital "Dijkzigt", Erasmus University, Rotterdam, Netherlands

D. H. BIRKENHÄGER-FRENKEL

J. C. BIRKENHÄGER

Strandh, J., Norlén, H. Acta orthop. scand. 1965, 35, 257. Birkenhäger, J. C., van der Sluys Veer, J., van der Heul, R. O., Smeenk, D. in Proceedings of Third Symposium on Calcified Tissues (edited by H. Fleisch, H. J. J. Blackwood, and M. Owen); p. 73. Berlin, 1966. 3. Birkenhäger, J. C., Birkenhäger-Frenkel, D. H. Neth.J. Med. 1968, 11, 155. 4. Blrkenhäger, J. C., van der Heul, R. O., Smeenk, D., van der Sluys Veer, J., van Seters, A. P. Proc. R. Soc. Med. 1967, 60, 1134. 5. Birkenhäger-Frenkel, D. H. in Proceedings of Fourth Symposium on Calcified Tissues (edited by P. J. Gaillard, A. van der Hooff, and R. Steendijk); p. 8. Amsterdam, 1966. 6. Birkenhäger-Frenkel, D. H., Dey, K., Putto-Bol, G. J., Rademaker-Hillenbrink, Th. A., Strackée, J.Neth.J. Med. 1973, 16, 141. 1. 2.

SIR Raised levels of 5-hydroxytryptamine (5-H.T.) m blood and of its urinary metabolite 5-hydroxyindoleacetic acid (5-H.I.A.A.) have been reported in adults and children with untreated coeliac disease.1-6 Clinical recovery after the introduction of a gluten-free diet is accompanied by a fall in blood 5-H.T. and urinary 5-H.I.A.A.2 5S-H.T. is synthesised by enterochromaffin cells in the small intestine, and hyperplasia of these cells occurs in patients with coeliac disease.’ Increased quantities of 5-H.T. may, therefore, be released into the circulation in patients with coeliac disease by increased numbers of enterochromaffin cells in the small intestine. We have measured tissue levels of 5-H.T. in the duodenal mucosa of patients with cceliac disease and compared the results with those from a control group. Peroral biopsies of the small intestine were done on eleven patients with untreated coeliac disease (seven children, four adults) and on nine controls (six children, three adults) who were being investigated for suspected malabsorption or for shortness of stature. The appearances of the duodenal mucosa in the controls were normal on light microscopy, In all patients, tissue was obtained from a site between the third and fourth part of the duodenum, using a Watson adult intestinal biopsy capsule. 5-H.T. was extracted from duodenal tissues 9 and determined fluorimetrically by its reaction with o-phthalaldehyde.10 Results of tissue concentrations of 5-H.T. in the two groups of patients studied are as follows: Weight of tissue

1&agr;-HYDROXYCHOLECALCIFEROL IN CHRONIC RENAL FAILURE

Department of Pathology I, Erasmus University,

DUODENAL TISSUE CONCENTRATIONS OF 5-HYDROXYTRYPTAMIE IN CŒLIAC DISEASE

Patients (9) Cœliacs

Controls (11) (9)

Tissue protein

5-H.T.

(qlmg of Protein) 12.6±6.8

76.4±24.0

144.3±39.6

Differences between arithmetic means were examined using Student’s t test. Neither the weight of duodenal tissue (P>0.1) were signifinor the concentration of tissue protein (P>0.8) cantly different in the two groups. Tissue concentrations of 5-H.T. were significantly higher in patients with coeliac disease This finding suggests that inthan in the controls (P