Intestine-associated antigens in ovarian tumours: an immunohistological study.

The presence of 3 intestine-associated antigens, small intestine mucin antigen (SIMA), large intestine mucin antigen (LIMA) and carcinoembryonic antigen (CEA) was studied in the female genital tract and ovarian tumours by immunofluorescence. These antigens could not be detected in normal ovary, benign cysts of ovary, fallopian tube or endometrium, but both LIMA and CEA were present in endocervical glandular tissue. The antigenic cross-reactivity of endocervical and large bowel mucin may indicate a close embryological relationship between these organs during the cloacogenic stage. The 3 antigens could be demonstrated in mucinous tumours of the ovary but were absent in serous or mesonephroid tumours. In one of the 2 endometroid tumours CEA was the only detectable antigen. These observations confirm the presence of intestinal type of epithelium in cystic mucinous tumours of the ovary and explain the cross-reactivity of mucin of benign tumours of the ovary and mucin from colonic cancer, normal colonic mucosa and gastric mucosa as reported by earlier workers. In the process of malignant transformation the columnar epithelium of ovarian cystadenoma seems to behave in the same way as superficial gastric and gall bladder epithelium by forming inappropriate intestine-associated mucin substances. Our technique may provide a specific means for studies on the histogenesis of female genital tract tumours, particularly ovarian tumours. It can also be used in differentiating between benign and malignant variants of these tumours.

Measurement and control of postoperative pain.

Continuous intravenous infusion of morphine in a dosage varied according to the changing needs of the patient is proposed as an ideal method of controlling postoperative pain and reducing postoperative respiratory complications. An original technique for the measurement of pain is described which, when used in conjunction with measurement of serum levels of free morphine, has demonstrated the superiority of this method of pain control. Preoperative psychological tests are considered as possible predictors of pain experienced after operation, and extra counselling is suggested for patients indicated to be at risk.

Mass single layer closure of abdominal wounds.

A prospective study to evaluate the technique of mass single layer closure of abdominal wounds is presented. This consists of 616 cases operated upon in one hospital, and includes a large variety of procedures performed in a diverse group of patients, the majority of whom were elderly. Complete wound breakdown occurred in two patients (0.3%) and partial wound breakdown occurred in two patients (0.3%)--a total incidence of 0.6%.

Inappropriate mucin production in endodermal carcinoma--one point of view.

The mucosal lining cells in the gastrointestinal tract respond to a threatening situation by secreting mucins manufactured during foetal life and this secretion is considered to be an early manifestation of cytogenetic instability and which may be the first step in the process of malignant transformation. Using immunohistological techniques and specific antisera against SIMA (small intestinal mucin antigen), LIMA (large intestinal mucin antigen) and CEA (carcinoembryonic antigen) the presence of these mucin antigens was studied in resected specimens from colonic, gastric and gall bladder carcinomas as well as in mucinous tumours of the ovary. Inappropriate or oncofoetal mucins were present in the majority of endodermal carcinomas, in associated metaplastic epithelium and premalignant lesions such as polyps. These antigens were also demonstrated in normal histological epithelium at some distance from the tumour. These findings lead to a better understanding of the biological behaviour of preneoplastic lesions of endodermal tissues and will aid in developing sensitive diagnostic tests for the presence of these substances.

Suppurative pyephlebitis and multiple hepatic abscesses with silent colonic diverticulitis.

This report records the first known case in the literature of suppurative pylephlebitis associated with multiple intrahepatic and extrahepatic abscesses and gross hypoalbuminaemia, as a consequence of colonic diverticulitis.

Intestinal mucinous substances in gastric intestinal metaplasia and carcinoma studied by immunofluorescence.

Immunofluorescent studies using specific antisera against intestinal mucins revealed small intestinal mucin antigen (SIMA) and large intestinal mucin antigen (LIMA) in areas of intestinal metaplasia of the stomach. In 25 gastric carcinomas studied, both these antigens were detected in seven carcinomas, SIMA only was present in four and LIMA in only four cases; the antigens could not be detected in ten of the carcinomas. In 21 of the 25 gastric operation specimens, including the 15 carcinomas positive for intestinal mucin antigens, there was evidence of chronic gastritis and intestinal metaplasia. These immunohistologic observations confirm the results of recent histochemical studies that both small and large intestinal type mucins are present in intestinal metaplasia and gastric carcinomas. Our findings provide further evidence that at least a proportion of gastric carcinomas may supervene on intestinal metaplasia. The absence of one or both antigens in gastric carcinomas may indicate stages of dedifferentiation or alternatively differences in histogenesis.

The presence of oncofoetal antigens in large bowel carcinoma.

This paper is an immunohistological study of the occurrence of the oncofoetal antigens, (carcinoembryonic antigen (CEA), small intestine mucin antigen (SIMA), and normal large bowel mucin antigen (LIMA) in 60 surgically resected colons: 10 non-malignant specimens and 50 colorectal carcinomas. SIMA is a new oncofoetal antigen found in mucinous carcinoma of the large bowel. In the adult it is normally present only in the duodenum and jejunum. Of the 50 carcinoma specimens, 13 were mucinous, 17 non-mucinous and 20 mixed mucinous and non-mucinous. LIMA was the only antigen detected in the mucosa of non-malignant specimens. In mucinous carcinomas only SIMA was present, whilst in the non-mucinous specimens CEA was always found and to a lesser extent LIMA. The same relationship was observed in mixed tumours: SIMA in mucinous and CEA-LIMA in the non-mucinous parts. In the mucosa adjacent to the cancer in all 50 cases there was evidence of an increase or decrease in LIMA. In 42 cases (84%) both oncofoetal antigens (CEA and SIMA) could also be detected in this transitional or perineoplastic epithelium at varying distances from the tumour. These results provide evidence to suggest that the majority of large bowel carcinomas occur in areas of metaplastic change.

The effect of EMG biofeedback on postoperative pain following abdominal surgery.

To investigate the effects of electromyography (EMG)-biofeedback on pain experienced during the immediate post-operative period following abdominal surgery, twelve patients were randomly assigned to either (1) EMG-biofeedback from abdominal muscles; (2) EMG-biofeedback from the frontalis muscles; or (3) were given no EMG treatment. EMG training consisted on one pre-operative 30 minute session, and three 30 minute postoperative sessions. All patients were able to reduce EMG activity. A within-sessions analysis of pain reports (on a 0-10 pain intensity scale) indicated that EMG biofeedback is an effective method of pain relief only when feedback is given to the muscle site involved in the operation.

Primary "brown pigment" bile duct stones.

Bile duct stones from 42 patients were morphologically and chemically analysed. The calculi from 27 patients had important primary bile duct stone (PBDS) features, consisting of a general ovoid shape and fragile structure, with alternating light and dark brown pigmented layers on cross-section. Chemically these stones contained low levels of cholesterol, with high levels of bilirubin and calcium. Subsequent infrared spectroscopy analysis showed that calcium bilirubinate and calcium palmitate were the only calcium salts present. Calcium palmitate was prominent in the light brown layers. A morphological and chemical comparison with gallbladder stones showed that bile duct "stasis stones" were similar in morphological and chemical composition to the brown pigment gallbladder calculi. However, they were distinct from most gallbladder stones, indicating that primary bile duct calculi have an aetiology that is different to 90% of gallbladder calculi. Primary bile duct calculi were observed to occur with or without the presence of a gallbladder, and more interestingly, in the bile duct of two patients with cholesterol gallbladder stones. Bile duct bile of patients with primary choledocholithiasis were always moderately to profusely infected and with abundant calcium bilirubinate precipitation. Moreover, this study has shown that PBDS chemical analyses profiles were consistent and correlated well with their defined morphology. Consequently, PBDS may be accurately identified at the time of operation by morphology. An important aetiological factor would appear to be infection, which would seem to promote bile duct bile stasis and eventual stone growth.

Inappropriate mucin production in gall bladder metaplasia and neoplasia--an immunohistological study.

This study demonstrates the presence of three antigens in glandular metaplasia occurring in patients with cholecystitis and cholelithiasis: specifically carcinoembryonic antigen (CEA), large intestinal mucin antigen (LIMA) and small intestinal mucin antigen (SIMA). These antigens could not be detected in normal gall bladder mucosa or in squamous metaplasia of the gall bladder. The occurrence of the three intestine-associated antigens in three carcinomas was irregular. In one mucinous carcinoma, only SIMA could be demonstrated. In one adenocarcinoma, SIMA was present in small areas of mucinous change, whilst CEA was present in the non-mucinous malignant tissue. In a mixed mucinous and non-mucinous adenocarcinoma with widespread dissemination, the three antigens were present both in the primary tumour and the metastases. These observations suggest that all forms of glandular metaplasia of the gall bladder are intestinal in nature and at least a proportion of gall bladder carcinomas are of an intestinal type. Finally they provide further immunological evidence that glandular metaplasia of the gall bladder should be considered a pre-malignant condition.