Specific cytogenetic abnormalities in two new human colorectal adenoma-derived epithelial cell lines.

Two new epithelial cell lines from sporadic human colorectal adenomas designated S/AN and S/RG are reported. S/AN was from a villous adenoma and S/RG from a tubular adenoma. Both cell lines have extended growth capacities in vitro reaching passages 18 and 15, respectively, so far and show no signs of senescence. S/AN and S/RG have retained in vitro the ability to form mucin-producing goblet-like cells. Every cell of S/AN has a deletion on the short arm of chromosome 1 and one normal copy of chromosome 1. S/AN is also monosomic for chromosome 18. The majority of cells of S/RG only have one normal copy of chromosomes 6, 7, 14, 17, 18, and 22. S/RG also has several marker chromosomes. Although aneuploid S/AN and S/RG are nontumorigenic in athymic nude mice, these cytogenetic abnormalities are insufficient for the fully tumorigenic phenotype. The common abnormality for S/AN and S/RG is monosomy for chromosome 18, indicating that this is a central and important step in colorectal carcinogenesis. Our cytogenetic analysis of the adenoma cell lines suggests at least two possible routes by which premalignant colonic cells can develop and progress to malignancy. S/RG, unlike most other adenoma cell lines, is clonogenic. Aneuploidy, clonogenicity, and extended in vitro growth capacity may therefore be useful in vitro markers for adenoma cell lines with a relatively high malignant potential.

Doppler ultrasound examination of pathologically enlarged lymph nodes.

Pathologically enlarged lymph nodes have been examined with a commercially available 10 MHz continuous-wave Doppler flowmeter. Many enlarged lymph nodes gave rise to significant Doppler-shift signals indicating increased blood flow. The signals have been spectrum analysed and the large diastolic flow components suggest that there is considerable arterio-venous shunting within lymph glands involved in leukemia, lymphoma and carcinoma. It also seems that the signals tend to diminish in response to treatment. The Doppler signals have been used in an imaging system to produce a vascular map of the region of the enlarged gland. It is suggested that these findings might be applicable to the detection of neoplastic tissues in less accessible sites.

Dysphagia in the elderly: what does it mean to the endoscopist?

The role of fibreoptic endoscopy in the investigation of dysphagia in an elderly population was investigated. Three hundred and sixty-five subjects were studied. Two hundred and sixty subjects had abnormalities with extra oesophageal disease accounting for symptoms in a substantial minority. Endoscopy was safe, offered the advantage of immediate therapy and was well tolerated. Sub-group analysis showed it to be preferable to radiological investigation in diagnosing both benign and malignant mucosal lesions.

Surgical management of intestinal radiation injury.

The management of 14 cases of radiation injury to the intestinal tract over a 4-year period is evaluated. The longest latent interval between radiation treatment and symptoms was 30 years. Eight patients were treated surgically; six were treated conservatively by laser therapy or application of formalin to the affected mucosa. The indications for surgery were rectovaginal fistula (four), rectal stricture (one), radiation proctitis (eight), and small bowel obstruction (one). Seven patients underwent large bowel resection. These consisted of four anastomoses with coloanal J-reservoirs, two low anterior resections, and one coloanal anastomosis without reservoir. There was no perioperative mortality. Morbidity occurred in one of the eight surgical cases. Radical resection of the radiation-damaged rectum has been shown to be a safe and reliable treatment for rectovaginal fistulas, rectal strictures, and proctitis unresponsive to medical measures. Coloanal J-reservoir is the procedure of choice to avoid urgency and frequency symptoms associated with coloanal sleeve anastomosis. Laser therapy for hemorrhagic proctitis can achieve an important place in the management of this problem without recourse to surgery.

Twice-daily cimetidine does not increase gastric bacterial flora.

Thirty patients with peptic ulcer (20 duodenal, 10 gastric) underwent glucose-hydrogen (H2) breath tests before and after 6 weeks treatment with cimetidine, 400 mg twice daily. For the group as a whole, basal breath H2 and integrated H2 output over a 2.5 hr test period was unchanged by cimetidine treatment. We conclude that there was no evidence of significant gastric bacterial colonization following twice daily cimetidine treatment.

Prevalence of Helicobacter pylori in respiratory physicians performing bronchoscopy: a comparison with gastroenterologists using the carbon 13 urea breath test.

BACKGROUND: The mode of transmission of Helicobacter pylori is unclear, but it has been shown that gastroenterologists are at a greater risk of acquiring the infection when performing endoscopy. The current study was designed to assess the risk H. pylori infection in respiratory physicians performing bronchoscopy compared to an at-risk group of gastroenterologists. We were interested in identifying whether the oral cavity is important in the transmission of H. pylori. MATERIALS AND METHODS: Respiratory physicians and gastroenterologists in southern England and Wales were invited to participate in the study. Medical, personal, and professional details were recorded, and H. pylori status was established using a carbon 13 urea breath test. RESULTS: The study included 30 gastroenterologists and 30 respiratory physicians. The groups were similar for age (mean age, 46.2 years [SD 8.7] and 43.9 years [SD 8.5], respectively), number of years in practice (mean, 16.1 [6.8] and 13.2 [5.5], respectively), amount of Third-World travel, and glove and drug use (antacids, H2 antagonists, proton pump inhibitors, promotility agents, and bismuth). The prevalence of upper gastrointestinal symptoms (indigestion, heartburn, abdominal pain) and history of previous peptic ulcer or hiatus hernia were similar for both groups. Fifteen of thirty gastroenterologists and three of thirty respiratory physicians had positive breath tests (chi square, p < .001, 1 df). There was no relation between age and H. pylori status. Within the group of gastroenterologists, performance of endoscopy without gloves for longer than 7 years was associated with an increased prevalence of infection (> 7 years, 11 of 15 breath-test-positive; < 7 years, 4 of 15 breath-test-positive [chi square, p = .01, 1 df]). CONCLUSIONS: Gastroenterologists in this study appeared to be at risk of infection, whereas respiratory physicians are not. Gastroenterologists who wear gloves during endoscopy appear to be at lower risk of H. pylori infection.

Splanchnic blood flow in patients with cirrhosis and portal hypertension: investigation with duplex Doppler US.

PURPOSE: To investigate splanchnic blood flow changes in patients with hepatic cirrhosis and portal hypertension. MATERIALS AND METHODS: Duplex Doppler ultrasound (US) was used to measure blood flow in the superior mesenteric artery (SMA) and splenic artery in 20 patients with biopsy-proved cirrhosis and clinical evidence of portal hypertension, and in 20 healthy volunteers who were matched for age and sex. RESULTS: Mean SMA and splenic artery blood flow was significantly greater in the patients than in healthy subjects. Neither SMA nor splenic artery blood flow was increased in patients with normal-sized spleens; however, blood flow was significantly elevated in patients with splenomegaly. Total splanchnic blood flow in patients was also significantly elevated compared with healthy subjects. Total splanchnic blood flow in patients with normal-sized spleens was not significantly elevated compared with healthy subjects, but splanchnic flow was significantly increased in patients with splenomegaly. CONCLUSION: Blood flow is increased in the SMAs and splenic arteries of patients with cirrhosis and portal hypertension. Increased splanchnic blood flow associated with cirrhosis may occur exclusively in patients with splenomegaly.

Spontaneous bile reflux in the elderly.

Duodenogastric bile reflux is common in postoperative stomach but has been reported in intact stomachs. Spontaneous bile reflux in the elderly has not been studied before. This has been assessed in dyspeptic elderly and young patients. Total bile acid (TBA) levels and pH were measured in the samples of fasting gastric juice. Antral biopsies were taken for histological examination including Helicobacter pylori identification. TBA levels were significantly higher in elderly patients with gastritis in comparison to elderly and young normal groups. Only 10% of elderly patients with gastritis and 7% with gastric ulcer has abnormal TBA (> 1 mmol/l). There was some correlation between the pH and TBA but a significant proportion of elderly patients has pH > 4 with a normal TBA. TBA levels were not significantly different in H. pylori +ve and H. pylori -ve patients. Nineteen elderly patients had evidence of reactive gastritis. Five of these patients had raised TBA levels with severe H. pylori infection. The remaining 15 patients had normal TBA. These patients were on NSAIDs and 4 of them had H. pylori infection. We conclude that spontaneous bile reflux in the elderly is uncommon. Hypochlorhydria which is observed in the elderly is not caused by alkaline bile reflux. The main cause of reactive gastritis in the elderly is NSAIDs ingestion.

Dieulafoy's disease: a distinctive arteriovenous malformation causing massive gastric haemorrhage.

Dieulafoy's disease is a distinctive arteriovenous malformation of the gastric fundus, which presents with massive or recurrent gastrointestinal bleeding. The lesion is very small and easily overlooked even at laparotomy, and can only be correctly diagnosed by endoscopy or arteriography if the patient is actively bleeding. A wedge resection will stop bleeding and give histological confirmation of the characteristic submucosal vessels.

Direct vision brush cytology with colonoscopy: an aid to the accurate diagnosis of colonic strictures.

The accuracy of direct vision brush cytology at colonoscopy was compared with colonoscopic biopsies, colonoscopy alone and radiology in the diagnosis of colonic strictures. There were 82 brushings in 79 patients; 55 had malignant and 24 had benign lesions. Cytology was correct in 66 (81 per cent), and biopsy was less accurate with 53 (68 per cent) correct reports. The combined accuracy of cytology and biopsy was 88 per cent. Whilst an endoscopic diagnosis was usually correct (96 per cent), direct vision brush cytology had an important place in the accurate tissue diagnosis of colonic strictures, particularly those in the rectosigmoid.