A pilot study of DNA aneuploidy in colorectal adenomas and risk of adenoma recurrence.

This case-control study examined whether DNA aneuploidy in colorectal adenomas is a risk factor for subsequent adenoma recurrence. Cases (recurrent polyp formers) were defined as persons with diagnoses of new adenomas at 2 colonoscopies following the index (first) adenoma diagnosis; controls were persons with no new adenomas at a follow-up at least 1 year after the index diagnosis. Cases (n = 22) and up to 3 controls (n = 29) were matched for factors known to be associated with polyp recurrence or aneuploidy: (a) age; (b) histology; (c) number of index polyps; and (d) size of largest index polyp. The largest adenoma from the index colonoscopy was removed from the paraffin block and analyzed for DNA content abnormalities by flow cytometry. On the basis of the observed distribution of aneuploidy in case-control sets, the point estimate for the relative odds of recurrence given aneuploidy in the index polyp was infinity (P < 0.035), and the lower bound for the 95% confidence interval was 2.02. We conclude that in this convenience sample, DNA aneuploidy increased the risk of recurrent colorectal adenomas. Larger, preferably prospective studies are needed before DNA content flow cytometric analysis of colorectal adenomas can be recommended as a routine clinical practice, but these results do suggest that polyp ploidy should be assessed in research studies using adenomas as end points or intermediate end point markers.

Mesenteric inflammatory veno-occlusive disease. A seldom recognized cause of intestinal ischemia.

We describe seven patients (three men, four women; ages 27-78) who presented with signs of intestinal ischemia requiring surgical intervention. In each case, the resected colon, small bowel, or both showed striking phlebitis and venulitis affecting veins of the bowel and mesentery and resulting in ischemic injury of the bowel. In each case, this vasculopathy was the only demonstrable cause of ischemia. Arteritis involving the bowel or the mesentery was not found in any patient, and none had clinical evidence or a history of extraintestinal vasculitis. The composition of the inflammatory infiltrate was variable; in four patients, it was predominantly lymphocytic, in two necrotizing and in one lymphocytic/granulomatous. In addition, three patients also had myointimal hyperplasia of the affected mesenteric veins. Six of seven patients recovered uneventfully after surgery, suggesting a self-limited or indolent process, and the seventh died of an unknown cause. We propose the name mesenteric inflammatory veno-occlusive disease (MIVOD) to describe this unusual and previously unrecognized cause of intestinal ischemia. Its etiology is unknown, and MIVOD may represent a precursor of the recently described idiopathic myointimal hyperplasia of mesenteric veins.

Multicystic pancreatic hamartoma: a distinctive lesion with immunohistochemical and ultrastructural study.

A multicystic pancreatic hamartoma is reported in a 20-month-old female who presented with abdominal pain and distention. This appears to be a distinctive lesion not previously characterized in the English language literature. The 9-cm mass consisted of large, irregular lobules of well-formed pancreatic acini admixed with fibrous tissue and fat. Cystically dilated ducts of variable caliber lined by benign epithelium were present. Endocrine cell islets were not evident. Immunohistochemistry and ultrastructural examination illustrated insulin-producing cells diffusely throughout the exocrine tissue as single cells or in small groups. Cells producing other pancreatic hormones were markedly decreased when compared with an age-matched control pancreas and were similarly dispersed. The patient was alive and well without tumor 9 months later. This entity may provide an unusual opportunity for insight into pancreatic organogenesis and pancreatic cellular differentiation.

NG-methyl-L-arginine, an inhibitor of nitric oxide formation, reverses IL-2-mediated hypotension in dogs.

The effects of NG-methyl-L-arginine (L-NMA), an inhibitor of nitric oxide formation, were studied in dogs treated with interleukin-2 (IL-2). The administration of IL-2 to dogs resulted in hypotension within 3 days of treatment. The development of hypotension correlated with accumulation in the serum of nitrate, which is a stable breakdown product of nitric oxide. Administration of L-NMA decreased serum nitrate levels and increased the mean arterial pressure. The antihypotensive effect was dose dependent with a maximum effect observed at a dose of 20 mg/kg. Administration of a continuous infusion of L-NMA (5 mg.kg-1.h-1) maintained the mean arterial pressure for 48 h with concurrent administration of IL-2. Evaluation of IL-2-induced lymphokine-activated killer cell proliferation and tumoricidal activity toward a canine glioblastoma target cell line was unaffected by L-NMA. These studies imply that L-NMA may effectively ameliorate the dose-limiting hypotension associated with administration of IL-2 without adversely affecting the antitumor effects.

A 10-year survey of eye injuries in Northern Ireland, 1967-76.

Ocular injuries of sufficient severity to necessitate admission to the Eye and Ear Clinic, Royal Victoria Hospital, Belfast, were sustained by 1707 male patients and 325 female patients. Blunt injury occurred in 1063 eyes (49.2%), perforating injury in 1037 (48%), and intraocular or intraorbital foreign bodies in 181 eyes (8.4%). More than three-quarters of the patients (77.4%) were less than 36 years of age and 84% of all injuries occurred in males. Normal visual acuity (6/6 or better) was regained by 41.2% of the patients in whom the final visual outcome was known. The benefit of wearing seat belts in road vehicles and protective goggles in industry and sport should receive more publicity on radio and television and via poster campaigns. Compulsory fitting of laminated windscreens in all road vehicles is recommended. The vulnerability of children to ocular injury should be highlighted through the mass media, schools, and health centres.

Helping ostomy patients back to independence.

Because elderly ostomy patients must deal with numerous challenges, be sure to identify their strengths and enhance their self-esteem. When teaching the older adult, remember factors that may affect learning, such as sensory changes, slowed reaction time, decreased short-term memory, and motivation. Consider the effects of other chronic illnesses and medications when developing a routine for ostomy care, and be sure to discuss dietary considerations with the patient.