Lipomatosis and true lipomas of the ileocecal valve.

Two patients with lipomatosis and two patients with true lipoma of the ileocecal valve are described. The symptomatology, radiological appearances, pathological findings and treatment are discussed. True lipomas of the ileocecal valve should be differentiated from the more commonly occurring lipomatosis or lipohyperplasia. The rare true lipomas have a demarcating capsule around the fatty tissue and are confined to only one of the ileocecal lips. The lipomatosis, on the other hand, is characterized by a diffus fatty deposition in the submucosa of the valve with no encapsulation. Lipomatosis as well as true lipomas may appear as rounded, smoothly outlined and sharply demarcated masses on barium enema examination. Occasionally, these filling defects may present problems of differential diagnosis with respect to malignant involvement of the ileocecal region. A correct preoperative diagnosis, however, is important to prevent unnecessary or too radical surgical treatment.

Plasma fibronectin is sequestered into tissue damaged by inflammation and trauma.

Mechanical trauma or inflammatory reaction induced in striated muscle tissue of rats was followed by a flux of fibronectin from plasma into the damaged tissue, as determined by measurement of radioactivity, autoradiography and immunofluorescence. When homogenized muscle tissue was incubated with labelled fibronectin prior to separation of its subcellular components by ultracentrifugation, fibronectin bound to all fractions, but with strongest affinity for the microsomal and plasma membrane fraction. When trauma occurs, fibronectin from plasma binds to exposed structures on cell membranes and to components of connective tissue such as collagen and proteoglycans. Because of its ability to mediate cellular adhesion to tissue components, fibronectin probably exerts important functions in normal wound healing.

Plasma fibronectin contributes to fibronectin in tissues.

Fibronectin is produced by several cell types, with hepatocytes currently recognized as the main source of plasma fibronectin. Mesenchymal cells produce fibronectin in vitro and probably do so even in vivo. But it is not clear if these cells represent the sole source of tissue fibronectin. In the present study, using direct and indirect immunofluorescence, fibronectin was found to occur ubiquitously in connective tissue in the rat. When 125I-labelled fibronectin was intravenously injected in rat, there was significant uptake of fibronectin in the tissues. The half-time for removal of labelled fibronectin in circulation was c. 15 hours. The authors conclude that flux of fibronectin occurs from plasma into the tissues and that in normal circumstances plasma fibronectin contributes to fibronectin in tissues.

Fibronectin promotes binding but not ingestion of agarose beads by mouse macrophages adn human monocytes.

We have examined to what extent human fibronectin associated with agarose beads with a 5- to 10-micron diameter mediates binding and uptake of the beads by mouse macrophages and human monocytes. Native agarose beads preincubated with 125I-fibronectin were neither associated with nor taken up by mouse macrophages after 30 min of incubation under serum-free conditions. When fibronectin was cross-linked to cyanogen bromide-activated agarose beads or incubated with gelatinized beads, this resulted in a significant increase in particle binding by macrophages and monocytes as compared with gelatinized beads, whereas the fraction of cells with ingested particles remained unaltered. Native agarose beads activated by cyanogen bromide and treated with ethanolamine were to a greater extent associated with and taken up by phagocytes than fibronectin- or gelatin-coated beads. Our results indicate that fibronectin acts as an adhesive glycoprotein and not as an opsonin. Since agarose beads are activators of the alternative pathway of complement, and fibronectin is reported to bind to factor C3, we speculate that cell-derived C3b is bound to the beads and fibronectin-coated beads are ingested by the phagocytes via complement C3b receptors on the cells.

Renal endometriosis. A case report.

In a 23-year-old woman with lumbar pain, an expansive process in the right kidney was demonstrated by I.V.P., retrograde pyelography and renal angiography. The histological examination subsequent to nephrectomy showed endometriosis in association with localized xanthogranulomatous pyelonephritis. Renal endometriosis has been described only eight times previously in the literature. The current case is discussed and compared with previous reports.

Fibronectin binds to complement-coated agarose beads and increases their association to mouse macrophages.

We have studied the binding of fibronectin to complement (C3b, C3bi, C3d)-coated agarose beads and its effect on cell association of such beads to mouse macrophages. Fibronectin bound to agarose beads preincubated in human serum, whereas no binding occurred after preincubation of the beads with complement-inactivated (50 degrees C for 20 min or ethylenediaminetetraacetic acid) sera. The binding of iodine-labelled fibronectin to beads preincubated in fibronectin-depleted serum (HS-FIB) was about twice that of beads preincubated in normal serum. Unlabelled fibronectin inhibited the following binding of labelled fibronectin to beads pretreated in HS-FIB. A similar amount of fibronectin bound to agarose beads coated with equimolar amounts of C3b, C3bi, or C3d, suggesting that the common domain C3d carries the main binding site(s) for fibronectin. Preincubation of serum-treated and trypsinized agarose beads with fibronectin led to an increased association (22%) of such beads to mouse macrophages. The results indicate that fibronectin promotes binding of complement-coated agarose beads to mouse macrophages, whereas the ingestion of the beads is mediated via complement C3 receptors.

Routine double contrast barium enema and fiberoptic colonoscopy in the diagnosis of colorectal carcinoma.

The diagnostic efficacy of routine double-contrast barium enema and fiberoptic coloscopy for detection of cancer was retrospectively studied in 303 patients consecutively operated for colorectal adenocarcinoma in a 52-month period from January 1980. Double-contrast barium enema was performed in 180 patients with 184 carcinomas, 157 (85%) of which were revealed by this examination. The detection rate of carcinoma according to site was 89% between cecum and descending colon, 92% in sigmoid colon and 71% in rectum. Fiberoptic colonoscopy was done in 176 patients with 181 carcinomas, 163 (90%) of which were detected by the endoscopical examination. The detection rate of carcinoma according to site was 86% between cecum and descending colon, 90% in sigmoid colon and 95% in rectum. The two methods were equally effective in detecting carcinoma of the colon. Colonoscopy was superior to barium enema in detection of rectal carcinoma.

[Laparoscopic hernia repair. A useful method for surgical treatment of inguinal hernia?]. / Laparoskopisk brokkreparasjon. Brukbar metode i kirurgisk behandling av lyskebrokk?

Between September 1992 and May 1993 14 groin hernias in 13 patients were treated with laparoscopic transabdominal preperitoneal repair using a polypropylene mesh to reinforce the abdominal wall. There were two indirect and 12 direct hernias. Five hernias were recurrent. There were no perioperative complications. In the follow up period 14-24 months after the operations, two patients developed recurrent hernias after four and ten months respectively, one patient presented with a new hernia on the contralateral side, and one patient died from cardiac disease. Laparoscopic hernia repair is technically demanding and in our setting is more time- and resource consuming than an open, tension-free repair. Thus it is questionable whether this method should be used in primary hernia repair. It may, however, have a place in the treatment of recurrent hernias and bilateral hernias.

The effect of alpha- and beta-receptor blocking agents on gastric acid secretion in guinea-pigs.

The effects of alpha- and beta-receptor blocking agents on gastric acid secretion were tested on 95 female guinea-pigs. Alpha blockade insignificantly inhibited the gastric acid secretion in the unstimulated animals, whereas in those stimulated with histamine, significant reduction was seen. Beta blockade had no influence on gastric secretion in the unstimulated animals but significantly enhanced the histamine-stimulated secretion of acid.

In vitro interactions of murine peritoneal macrophages and sarcoma cells. II. Induction of DNA synthesis in macrophages.

Unstimulated peritoneal macrophages grown in vitro for 5 days do not incorporate thymidine. Sarcoma (AA) cells introduced to the culture on the fifth day die and disintegrate whereas the macrophages become markedly stimulated and autoradiography shows that they are triggered to synthesize DNA. In syngeneic cocultures up to 28% of the macrophages incorporate thymidine after 5 days of coculture.

Fibronectin, complement and immunoglobulins in serum after surgery.

In recent years it has been suggested that fibronectin is a non-specific opsonic protein of significance in host resistance against septic complications following trauma and surgery. The aim of the present study was to investigate the fluctuations in serum levels of fibronectin, immunoglobulins IgG and IgM, and complement factors C3 and C4 postoperatively. Serum samples were obtained pre-operatively and at different intervals postoperatively in 72 patients admitted for elective surgical procedures on the alimentary tract, the heart and the hip joint. The mean pre-operative fibronectin values were 257 +/- 79 micrograms/ml. The lowest values (166 +/- 65 micrograms/ml) were found immediately after the operation, followed by an increase which did not reach pre-operative levels within 120 h. Five patients who developed postoperative complications and 14 patients with malignant disease did not differ significantly either in their pre- or postoperative fibronectin levels, compared with the whole group. The lowest fibronectin levels seen were also significantly above the concentrations necessary to promote binding of gelatinized test particles to macrophages and monocytes in vitro. There was a significant decrease in C3, C4 and IgG levels postoperatively whereas IgM levels were unaltered. The observed reduction did not extend below the lower normal levels for these proteins. The probable mechanism behind the reduction in serum levels seems to be a sequestration at the site of tissue injury. The postoperative reduction in circulating fibronectin levels has probably no implications for host resistance against septic complications. When sequestered into the site of injury, it may, however, be of significance for normal wound healing, due to its cell-matrix interactions.

An audit of the treatment of cancer of the oesophagus.

The treatment of cancer of the oesophagus in The General Infirmary at Leeds between the years 1975 and 1988 was reviewed. All cases with histologically proved cancer of the oesophagus were included, data being obtained from case notes, theatre operation books, endoscopy records, pathology records, and the Yorkshire Cancer Registry. Three hundred and sixteen patients were identified. Demographic details, mode of presentation, preoperative investigations, surgical management, methods of palliation, and survival data were entered into a database. The male to female ratio was 3:2 and the median age at presentation was 69 years (range 35-96). Surgical exploration was carried out in 134 of 316 patients (42%). Resection of the tumour, whether curative or palliative, was possible in 106 of 134 patients (79%). Operative (30 day) mortality was 27%. In 22 of 134 patients (16%), only intubation of the tumour was possible, while six patients (5%) had a thoracotomy or laparotomy alone. Median survival of the 106 patients after surgical resection was 292 days (range 0-14.2 years) and seven of them (7%) were still alive five years later. Of the remaining 182 patients (58%) who were not operated upon, 36 patients (11%) had a radical course of radiotherapy with a median survival of 175 days (range 80-453) and 146 patients (46%) either had endoscopic intubation (n = 64) or received no specific treatment (n = 82) with a median survival of 106 days (1-725) and 91 days (1-358) respectively. None of the 182 patients who did not have surgical treatment was alive at five years.