Large colorectal adenomas. An approach to pathologic evaluation.

Adenomatous polyps are common neoplastic lesions of the large intestine. The risk of carcinoma increases with polyp size. Small polyps are typically totally embedded for histologic examination, but no standard method for sampling large, grossly benign polyps has been established. We reviewed grossly noninvasive adenomas 2.5 cm or larger to determine the percentage that contained high-grade dysplasia (HGD) and invasive cancer (IC). Based on these findings, we suggest an approach to evaluating large adenomas. Forty-three colon resections met the inclusion criteria (no previous diagnosis of cancer, no gross evidence of invasion, and totally embedded polyp). Twelve (28%) had HGD with 3% (1 of 33 slides) to 100% (4 of 4 slides) containing HGD. Five (12%) had IC with 4% (3 of 72 slides) to 42% (5 of 12 slides) containing IC. All cases with IC had HGD in other slides. Probability studies showed that in the majority of cases, polyps would need to be entirely embedded to have an estimated probability of 95% or more of detecting either HGD or IC. Therefore, grossly noninvasive adenomas should be routinely entirely embedded.

Immediate prediction of recovery of consciousness after cardiac arrest.

OBJECTIVE: Short-latency somatosensory evoked potential (SSEP) monitoring has been reported to be useful in predicting neurological outcome in patients with cardiac arrest and hypoxic-ischemic encephalopathy. To obtain the immediate data of SSEP and evaluate the relationship between the presence of cortical activity and the recovery of consciousness, SSEP was recorded immediately after return of spontaneous circulation. DESIGN AND SETTING: Prospective observational study in an intensive care unit of a university general hospital. PATIENTS: The study included 30 patients resuscitated from out-of-hospital cardiac arrest. INTERVENTIONS: Basic and advanced cardiac life support, and intensive care. MEASUREMENTS AND RESULTS: SSEP were recorded between 40 and 170 min (median 65) after spontaneous circulation returned. In the initial study all 30 patients showed the Erb's point potential and the N11-13 component, while only 12 (40%) showed cortical activity. Patients were assessed neurologically for recovery of consciousness until 1 month after cardiac arrest. Of 12 these patients 8 recovered consciousness within 10 days, while all patients without cortical activity died without opening their eyes. CONCLUSION: Even immediately following resuscitation, absence of cortical activity in SSEP indicates unlikelihood of recovering consciousness, while the preservation of such activity suggests that consciousness is improved. The result promises further accumulation of patients to validate the predictive ability of SSEP in managing postresuscitated patients.

Production of monoclonal antibody against Aeromonas hydrophila haemolysin.

Two hybridoma cell lines that produce monoclonal antibodies against Aeromonas hydrophila haemolysin were established by fusion of myeloma and spleen cells obtained from a mouse immunised with haemolysin detoxified with tetranitromethane. Enzyme-linked immunosorbent assay (ELISA) showed that the two purified monoclonal antibodies, B7 and B11, recognised the same epitope on the haemolysin molecule. Antibody B7 neutralised the haemolytic and enterotoxic activities of the haemolysin. It is concluded that the same site on the haemolysin molecule is responsible for both haemolytic and enterotoxic activities.

Cytologic study of the tissue repair cells of the uterine cervix. With special reference to their origin.

In order to characterize tissue repair cells (TR) of the uterine cervix and clarify their origin, exfoliated cells obtained after laser conization for early cervical lesions were examined. One specimen was first examined by Papanicolaou staining and then examined for epithelial membrane antigen (EMA) and vimentin by immunocytochemical staining, using a restaining method. The other specimen was observed by phosphotungstic acid-hematoxylin (PTAH) staining. Morphologic findings on TR were investigated together with the histologic findings on the wound healing process. TR were classified morphologically into three groups: stromal (STR), epithelial (ETR) and of unknown origin (UTR). Validity of this classification was confirmed by the findings of immunocytochemical staining with EMA and vimentin. These cells appeared one to eight weeks after laser conization. TR with relatively large nuclei, or atypical TR (ATR), appeared when each type of TR was most plentiful, at two to five weeks. Regarding the origins of each TR, cytologic and histologic findings could be considered to offer evidence that ETR originated with hyperplasia of immature cells of the squamous epithelium or reserve cells below the columnar epithelium. The presence of myofibrils in cytoplasm, demonstrated by PTAH staining for STR and some UTR, strongly suggested the possibility that these cells were myofibroblasts in granulation tissue.

Transcatheter arterial embolization for postpartum massive hemorrhage: a case report.

A 29-year-old woman suffered uncontrollable massive hemorrhage from a deep vaginal laceration following spontaneous vaginal delivery. Pelvic angiography revealed extravasation from a branch of the right pudendal artery. Transcatheter arterial embolization was successfully performed and quickly achieved hemostasis. When postpartum hemorrhage cannot be controlled with conservative treatment, transcatheter arterial embolization should be considered in order to avoid major surgery in an unstable patient and to maintain reproductive potential.

Strangulation of small bowel due to Meckel diverticulum: CT findings.

We report an unusual case of small bowel strangulation due to long Meckel diverticulum. CT demonstration of the bundle-like segment contiguous with the distended fluid-filled loops of bowel contributed to the prompt preoperative diagnosis.

[A case of occult testicular tumor].

A 43-year-old male presented with a left supraclavicular mass as well as an upper abdominal mass. Biopsy of the supraclavicular mass revealed seminoma with components of both embryonal carcinoma and choriocarcinoma. Right orchiectomy was performed because physical examination showed that the left testis was normal but the right testis was slightly atrophic. The primary tumor which was approximately 1 cm in diameter was found in the right testis and histological examination revealed seminoma. When germ cell tumor is found in a region other than the gonads, either primary extragonadal germ cell tumor or occult testicular tumor is considered. To differentiate between the two, it is imperative to make careful histological exploration of the testes.

[Effects of bronchial artery infusion (B-AI) with single use of MMC after intravenous peplomycin (PEP) administration in lung cancer].

Effects of BAI therapy on 86 cases of lung cancer were evaluated in three groups: single-use of MMC group after intravenous PEP administration (PEP (iv).MMC group), PEP and MMC combination use group (PEP + MMC group) and single use of MMC group. Tumor regression rate determined by chest X-ray film 2 or 3 weeks after BAI was highest in the PEP (iv).MMC group followed by the PEP + MMC and MMC group. Cavity formation was more typical in the group treated with PEP + MMC. Histopathological effects were best for the PEP + MMC group followed by those of the PEP (iv).MMC and MMC group. As for side effects, pulmonary fibrosis and necrotizing bronchitis were noted in 8% of the PEP + MMC group, but side effects in the other two groups were mild. In conclusion single use of MMC after intravenous PEP administration was found to be the best way to give BAI in these three groups.

[Effects of the bronchial artery infusion of peplomycin (PEP) and mitomycin C (MMC) in lung cancer--comparison with single administration of PEP or MMC].

Effects of BAI with PEP 30 mg+MMC 10 mg on 26 patients with lung cancer were evaluated in comparison with 34 cases treated with single PEP or MMC. Histopathological findings of the cases treated with PEP+MMC and PEP alone showed more effective results than that of MMC alone. The tumor decreased rate on the chest X-ray film of the cases treated with PEP+MMC was highest and the cavity formation was also typical in the cases with PEP+MMC and PEP alone. The side effects of the cases with PEP+MMC were able to reduce markedly to about 50% compared with single administration of PEP or MMC; however pulmonary fibrosis and necrotizing bronchitis were noted in 8%.