Gallstones and risk of gallbladder cancer.

The relationship between gallstones and gallbladder cancer was investigated in a case-control study in 131 subjects with gallbladder cancer and 2,399 subjects without gallbladder cancer. Included in the study were male and female subjects from 3 racial groups: white, black, and Southwestern American Indian. For the non-Indian group there was a significant relationship between gallstones and gallbladder cancer, with an overall estimated relative risk (RR) of 4.4 (95% confidence interval, 2.6-7.3). For the Indian population the overall estimated RR was much higher: RR = 20.9; 95% confidence interval = 8.1-54. By the combination of the RR, the prevalence of gallstones, and the overall incidence of gallbladder cancer, the risk of gallbladder cancer was calculated in each population for subjects with untreated gallstones. In older subjects with gallstones the estimated 20-year cumulative risk for gallbladder cancer ranged from 0.13% in black males to 1.5% in Indian females. It was concluded that the risk of gallbladder cancer in untreated subjects with gallstones is heterogeneous, depending on race and sex as well as the period of exposure to gallstones.

An experimental study of gastric stump carcinoma in Wistar rats.

The risk of gastric stump carcinoma is increased 15-20 years after gastric resection for benign disease. Reflux of duodenal juice, bacterial overgrowth and formation of N-nitroso compounds are possible etiological factors. There is a geographical variation in the incidence of gastric cancer, possibly explained by differences in food intake. Experimentally it is possible to induce gastric stump carcinoma in rats without the addition of exogenous carcinogens. The aim of this study was: 1) to find the incidence of gastric carcinoma in rats subjected to BII resection and followed for 10 months, and 2) to examine if acetic acid, a common dietary factor, could influence the development of gastric carcinoma. Amongst BII-operated male Wistar rats, infiltrating carcinoma was found in 5/20 on a normal diet and in 5/24 exposed to acetic acid (NS). Benign mucosal changes were seen in 12/20 and 16/24 respectively (NS). With the exception of a profound inflammation in one sham-operated animal, no mucosal pathological changes were found in 24 sham-operated and 24 control animals where no operation was performed.

Varying occurrence of gastroduodenal immunoreactive pancreatic secretory trypsin inhibitor.

Operative specimens from various parts of gastroduodenal mucosa were analysed for immunoreactive pancreatic secretory trypsin inhibitor (PSTI) using a peroxidase-antiperoxidase method. Normal gastric mucosa exhibited a varying degree of PSTI immunoreactivity, which was more pronounced in the foveolar cells of gastric mucosa of fundus type than in the non-pepsinogen producing antrum-pyloric mucosa. With the exception of metaplastic Paneth cells and some goblet cells, the intracellular content of PSTI was low in gastric mucosa with intestinal metaplasia. These findings may indicate that a PSTI immunoreactive substance has a role in the normal defence of the gastric mucosa.

Olfactory neuroblastoma.

A case of olfactory neuroblastoma, type 1 (olfactory neurocytoma), in a 44-year-old man is described. The tumour grew extensively in the right nasal cavity with involvement of the maxillary sinus and ethmoidal region, but was radically removed at operation. The prognosis and treatment are discussed in the light of earlier literature.

[Collagenous colitis]. / Kollagene Kolitis.

Collagenous colitis is now regarded by an overwhelming majority of authors as a clinicopathological entity and has been taken up as a such in many text-books and diagnostic atlases (Morson & Dawson, 1990, Fenoglio-Preiser et al., 1989, Whitehead 1985, Whitehead 1989). A good, detailed review of cases of collagenous colitis published up to 1988 was performed by Perri et al. Collagenous colitis was also presented to a wider medical public through a clinicopathological conference case at Massachusetts General Hospital (Case 29-1988). Finally it may be added that collagenous colitis has been included in the new fourth edition of Robbins Pathologic Basis of Disease (Cotran, Kumar, Robbins, 1989), where the possibility of an autoimmune disease is stressed.

Gastric and duodenal peptic ulcer disease in a well-defined population. A prospective necropsy study in Malmö, Sweden.

In a necropsy series from Malmö of 2,218 subjects above 20 years of age, and composing 88.2% of all Malmö residents above 20 who died during the period of investigation, the frequency of gastric and duodenal peptic ulcer disease (ulcer, scar or surgically treated peptic ulcer) was studied. The total frequency of peptic ulcer disease was 17.9% (20.9% in men and 14.7% in women). The condition was most common (25.4%) in men in the 50-59 year age group, after which the frequency declined. In women a constant high frequency (15-16%) was seen in all age groups above 60 years. Gastric ulcer (ulcer or scar) was found in 10.7% and duodenal ulcer in 5.5%. 16.1% of subjects with peptic ulcer disease had been subjected to surgical treatment, 22.8% of the men and 5.8% of the women.

'Collagenous colitis' with watery diarrhoea--a new entity?

A case of chronic watery diarrhoea showed in rectal biopsy a thick subepithelial collagenous deposit in the colorectal mucosa. This deposit was of the same type as that described in the jejunal mucosa in collagenous sprue, and seems to have been the cause of the diarrhoea.

Frequency of gallstone disease in a well-defined Swedish population. A prospective necropsy study in Malmö.

In a necropsy series from Malmö of 2,218 subjects above 20 years of age, and composing 88.2% of all persons above 20 who died that year in Malmö, the frequency of diseases of the gallbladder and bile ducts was studied. The frequency of gallstone disease (gallstone at necropsy or postoperative state) was 44%; 32% for males and 57% for females, with a maximum frequency for males of 57% in the 90-99 year age group and for women-about 63%-in all age groups above 70. Of subjects with cholecystolithiasis 27% had 1 stone, 36% 2-10 stones, and 8% had more than 100 stones. The same proportion-about one-fifth--of both men and women with gallstone disease had been operated upon, and in 11% of the operated cases stones were found in the remaining bile ducts. Chronic cholecystitis was noted in 17% of the cases. Cancer of the gallbladder was observed in 20 subjects with marked female preponderance. Cancer of the bile duct was noted in 12 cases. In 3.2% of the cases with gallstone disease this disease had been the cause of death (chief or contributory).

Lack of relationship between cholecystectomy and colorectal cancer. A case control autopsy study in a defined population.

To study the postulated relationship between prior cholecystectomy and occurrence of subsequent colorectal cancer, we examined the prevalence of cholecystectomy in all patients with histologically confirmed colorectal cancer registered during 1966-75 in the city of Malmö. In addition, we studied the frequency of colon cancer in all females autopsied in 1978-79 with a previous cholecystectomy. Of all 1061 cases of colon cancer diagnosed during the 1966-75 period, 94 (8.9%) had undergone cholecystectomy, as compared with 106 (10.0%) in the age-matched controls. In the female subgroup (n = 503) the corresponding figure for cholecystectomy was 58 (11.5%), as compared with 70 (13.9%) in the controls. The incidence of right-sided colon cancer among the 58 females with previous cholecystectomy did not differ from that of age-matched controls (28.6 and 28.1%, respectively). The incidence of colon cancer among 305 females with a prior cholecystectomy autopsied during 1978-79 was 24 (7 right-sided), as compared with 22 (8 right-sided) in age-matched controls without gallbladder disease. Gastric cancer was more frequent (p less than 0.01) in cholecystectomized women than in controls. These results refute the suggested relationship between cholecystectomy and development of colon cancer in any location.

Experimental colonic tumours in the rat. II. Double contrast examination and microscopy.

Experimentally induced tumours in the colon of the rats were examined with a double contrast method. Carcinogenic agents were administered to 114 rats. The development of the colonic tumors was recorded by repeated examinations. In the dead rats a thorough necropsy was performed. The radiographic and microscopic results were correlated and the radiographic appearances of colonic tumours were evaluated. The diagnostic accuracy of the radiographic method in distinguishing between benign and malignant lesions was 92 per cent.

Liver abnormalities in penicillamine treated rheumatoid arthritis.

Liver enzymes were followed in 99 patients treated with D-penicillamine for rheumatoid arthritis. In six abnormalities were found which consisted of elevated levels of lactic dehydrogenase. ALAT/ASAT, alkaline phosphatases or combinations of these. The changes were reversible on stopping the drug with one possible exception. No evidence of biliary cirrhosis, chronic active hepatitis or HBag-associated hepatitis was found. Liver biopsy was performed in 4 cases--one was taken 2 months after the treatment was discontinued, and was normal. One biopsy showed mild inflammatory changes, whereas in two histologic evidence of toxic liver necrosis was present. Liver damage should be included among possible complications of D-PA treatment.

Recurrence risk after stapled anastomosis for rectal carcinoma.

Forty patients operated upon for cure of carcinoma of the rectum with anterior resection using the EEA stapling device have been analyzed in an uncontrolled series. The recurrence rate during a mean follow-up of 39 months was 35%. The recurrence rate in all 62 patients with carcinomas operated upon with other techniques during the same period was 34%. The recurrence risk seemed to vary with stage and grade of the tumor growth, but the series is too small for valid conclusions. Preoperative selection of patients at high risk for local recurrence is difficult when only preoperative biopsies and peroperative findings are used as information.

Eosinophilic fasciitis complicated by carpal tunnel syndrome.

A case of eosinophilic fasciitis in a 64-year-old woman had all the characteristics of severe fascial involvement and was complicated by bilateral carpal tunnel syndrome requiring surgical decompression. The course was followed with repeat biopsies and biochemical analyses. No medication was given except for occasional nonsteroidal antiinflammatory agents. The patient recovered completely and remains well at an age of 69 years.

Variants of pancreatic duct system of importance in endoscopic retrograde cholangiopancreatography. Observations on autopsy specimens.

A postmortem radiographic investigation of 330 pancreas specimens showed a total frequency of 10 per cent for the 3 variants of the pancreatic duct system, in which the main pancreatic duct drained to the minor duodenal papilla (type III). In no instance did the main duct drain into the duodenum distal to the major papilla, onto which the common bile duct drained as usual. In the most common variant, type III-B, a separate accessory duct drained part of the pancreatic head onto the major papilla. In the remaining cases either an analogous accessory duct existed, communicating with the main duct (type III-A) or no accessory duct at all (type III-C). The different features of the accessory and main duct systems of type III in the pancreatic head varied widely. In types III-A and III-B, the corresponding ventral and dorsal pancreatic primordia formed more or less of mainly the posterior and anterior parts of the pancreatic head, respectively.

Colon of the rat. An anatomic, histologic and radiographic investigation.

The anatomy and radiologic appearance of the colon in rats are described on the basis of 300 animals treated with carcinogenic agents and 40 normal rats. The macroscopic and microscopic appearance of the mucosa varies in the different parts of the colon. Lymphoid plaques are normal structures. The results justify a new anatomic nomenclature.

Experimental colonic tumours in the rat. III. Induction time, distribution and appearance of induced tumours.

In 189 rats N-methyl-N'-nitro-N-nitrosoguanidine or 1,2-dimethylhydrazine (DMH) was given in order to induce colonic tumours. The tumour induction was followed by double contrast examination. At 894 examinations 196 adenomatous tumours were revealed. Autopsy and microscopy revealed 214 macroscopic and 53 microscopic benign or malignant adenomatous tumours. Metastases were found in 17 per cent in the DMH group. The relationship between adenomas and carcinomas is also evaluated.

Angiography in colonic carcinoma.

Angiography of the mesenteric arteries was performed in 17 patients with adenocarcinoma of the colon and rectum. At angiography, the marginal artery was encased in 13 patients and 10 of these were surgically unresectable while three could be resected radically. Encasement of the mesenteric arterial branches was found in seven of 11 unresectable tumors and in two of five resectable tumors. The resectability of colonic carcinoma cannot be established by means of angiography but in two patients with recurrent colonic carcinoma, barium-enema examinations were negative, while infiltrated vessels were demonstrated by angiography and the carcinomas were verified at surgery. Four patients received intra-arterial chemotherapy with mitomycin C. In one of these, a slight decrease in tumor size was noted, while in the others no change was noted.

Gastroduodenal erosions in Crohn's disease.

Gastroduodenal erosions were observed endoscopically and shown by double-contrast radiology in nine of 38 patients who had established Crohn's disease elsewhere in the intestinal tract. One of the nine patients was known to have duodenal involvement by Crohn's disease, but in the other eight there was no clinical suspicion of upper gastrointestinal disease. The possible significance of this finding is discussed.

Cholelithiasis, cholecystectomy, and cancer: a case-control study in Sweden.

To study the relationship between gallstone disease (cholelithiasis and cholecystectomy) and cancer, a case-control study was performed in two Swedish hospitals comparing the prevalence of gallstone disease discovered at necropsy in 1422 subjects who died of cancer and 1205 subjects who did not die of cancer. Gallstone disease was more prevalent in the group of 131 women less than 50 yr of age who died of various cancers: odds ratio = 2.2, p less than 0.01. When the analysis was restricted to 89 younger women who died of cancers that have been suggested to be related to diet (breast, reproductive system, gastrointestinal), the results became more significant: odds ratio = 3.3, p less than 0.001. No such relationship was detected in older women or in men of any age. It seems likely that gallstone disease and several common cancers in younger Swedish women share similar epidemiologic and perhaps metabolic features.