675 EOSINOPHIL-COUNTS IN DUODENAL TISSUE IN COW’S MILK ALLERGY
SiR,—The appearances light microscopy of sections of the upper small-intestinal mucosa from children with cow’s milk allergy vary from complete flattening of the villi to minor abnormalities of the superficial epithelial cells. Increased cellular infiltration of the lamina propria with lymphocytes, plasma cells, and eosinophils is also common, and a cell-counting technique has therefore been used to determine whether eosinophil counting assists in the identification of duodenal material from patients with cow’s milk allergy. Peroral biopsies from the 3rd-4th part of the duodenum were done under fluoroscopic control with a Watson pEediatric biopsy capsule, on ten children with persistent diarrhoea and a clinical history suggestive of cow’s milk allergy. The serum radioallergosorbent test for IgE milk-specific antibodies, (’Phadebas’) was positive in all patients, and withdrawal of cow’s milk and all cow’s milk containing foods from the diet led to clinical recovery. The biopsy specimens, fixed in 10% formal saline, were processed conventionally, embedded in paraffin on
DUODENAL EOSINOPHIL-COUNTS IN
COW’S
MILK ALLERGY
NOW LET ME SEE was surprised to see the statements made by ProfesWeale (March 10, p. 542) that the Japanese are still myopic and that there are only anecdotal reports from central East Africa. In 1965 Sato’ reported a decrease in the incidence of myopia of 50-70% in Japan, most probably a result of much-improved nutrition in the Japanese. In 1963 I cited a number of studies from developing countries,2 including our own from Tanzania. Since then there have been four other such studies,3-6 including a further investigation of refraction in Tanzania in which examination of 3590 eyes in six areas of the country revealed, for a former famine area, the highest rates of high myopia and anisometropia ever
SIR,-I
sor
reported. Department of Physiology, University Medical School, Edinburgh EH8 9AG
D. S. MCLAREN
MEGALOBLASTIC ANÆMIA WITH NORMAL MEAN CELL VOLUME
SIR,-We agree with Dr Prentice and Dr Evans (March 17, p.
606)
tosis is
that
389) imply. wax, and sectioned at a thickness of 5 um. Eosinophils were demonstrated by staining with haematoxylin and eosin. The appearances of the villi in four patients were normal, and in six patients varying degrees of villous flattening were present. Peroral duodenal biopsies were also done on ten children who were failing to thrive, and stained sections of biopsy specimens were prepared in an identical manner. The appearance of the duodenal mucosa on light microscopy in these children was considered to be normal. The cell-counting method described has been previously used to count other specific types of cells in the small intestinal mucosa,I,2 A 1 cm square grid (Graticules Ltd) was inserted into a xlO eyepiece of a Wild M20 light microscope, and each duodenal section was viewed with a x50 oil-immersion objective, giving a final image magnification of x 625. The grid contained 81 uniformly distributed points where both horizontal and vertical grid lines crossed. In each field the grid points or hits, falling on the epithelium and lamina propria were counted, as were eosinophils within the whole 1 cm square grid. With the muscularis mucosa as a baseline, by systematic movement of the microscope stage, one randomly selected section from each specimen was completely scanned. The whole section was counted to avoid errors arising from an uneven distribution of eosinophils and care was also taken to avoid recounting eosinophils. The number of hits falling on each section is proportional to the area of tissue, and eosinophil counts were randomly expressed as the ratio of the number of eosinophils to 1000 hits. Eosinophil-counts/1000 hits in the patients with cow’s milk allergy were higher than values from controls (see table); there was no overlap, and the difference between
the groups was significant (p
SiR,—The appearances light microscopy of sections of the upper small-intestinal mucosa from children with cow’s milk allergy vary from complete flattening of the villi to minor abnormalities of the superficial epithelial cells. Increased cellular infiltration of the lamina propria with lymphocytes, plasma cells, and eosinophils is also common, and a cell-counting technique has therefore been used to determine whether eosinophil counting assists in the identification of duodenal material from patients with cow’s milk allergy. Peroral biopsies from the 3rd-4th part of the duodenum were done under fluoroscopic control with a Watson pEediatric biopsy capsule, on ten children with persistent diarrhoea and a clinical history suggestive of cow’s milk allergy. The serum radioallergosorbent test for IgE milk-specific antibodies, (’Phadebas’) was positive in all patients, and withdrawal of cow’s milk and all cow’s milk containing foods from the diet led to clinical recovery. The biopsy specimens, fixed in 10% formal saline, were processed conventionally, embedded in paraffin on
DUODENAL EOSINOPHIL-COUNTS IN
COW’S
MILK ALLERGY
NOW LET ME SEE was surprised to see the statements made by ProfesWeale (March 10, p. 542) that the Japanese are still myopic and that there are only anecdotal reports from central East Africa. In 1965 Sato’ reported a decrease in the incidence of myopia of 50-70% in Japan, most probably a result of much-improved nutrition in the Japanese. In 1963 I cited a number of studies from developing countries,2 including our own from Tanzania. Since then there have been four other such studies,3-6 including a further investigation of refraction in Tanzania in which examination of 3590 eyes in six areas of the country revealed, for a former famine area, the highest rates of high myopia and anisometropia ever
SIR,-I
sor
reported. Department of Physiology, University Medical School, Edinburgh EH8 9AG
D. S. MCLAREN
MEGALOBLASTIC ANÆMIA WITH NORMAL MEAN CELL VOLUME
SIR,-We agree with Dr Prentice and Dr Evans (March 17, p.
606)
tosis is
that
389) imply. wax, and sectioned at a thickness of 5 um. Eosinophils were demonstrated by staining with haematoxylin and eosin. The appearances of the villi in four patients were normal, and in six patients varying degrees of villous flattening were present. Peroral duodenal biopsies were also done on ten children who were failing to thrive, and stained sections of biopsy specimens were prepared in an identical manner. The appearance of the duodenal mucosa on light microscopy in these children was considered to be normal. The cell-counting method described has been previously used to count other specific types of cells in the small intestinal mucosa,I,2 A 1 cm square grid (Graticules Ltd) was inserted into a xlO eyepiece of a Wild M20 light microscope, and each duodenal section was viewed with a x50 oil-immersion objective, giving a final image magnification of x 625. The grid contained 81 uniformly distributed points where both horizontal and vertical grid lines crossed. In each field the grid points or hits, falling on the epithelium and lamina propria were counted, as were eosinophils within the whole 1 cm square grid. With the muscularis mucosa as a baseline, by systematic movement of the microscope stage, one randomly selected section from each specimen was completely scanned. The whole section was counted to avoid errors arising from an uneven distribution of eosinophils and care was also taken to avoid recounting eosinophils. The number of hits falling on each section is proportional to the area of tissue, and eosinophil counts were randomly expressed as the ratio of the number of eosinophils to 1000 hits. Eosinophil-counts/1000 hits in the patients with cow’s milk allergy were higher than values from controls (see table); there was no overlap, and the difference between
the groups was significant (p
