Nuclear size and nuclear binding of tritiated actinomycin D into epithelial cells of colon cancer patients with apparently normal colorectal mucosa.

The nuclear binding of tritiated actinomycin ([3H]AM) is clearly linked to the structural organization of the chromatin. [3H]AM decreases in cells which differentiate and becomes very low in fully differentiated cells. [3H]AM nuclear binding and nuclear size were concomitantly measured in normal-appearing flat mucosa of 10 patients bearing a colorectal cancer and compared with the colon mucosa of 10 normal individuals. In the colon of these normal subjects, there is a decreasing gradient of labeling in the upper third of the gland, with heavy labeling in the lower two-thirds and light labeling in surface epithelial cells. The ratio (R) of grain count in cells in the bottom of the glands to grain count in the surface epithelial cell varies in normal subjects from 4 to 14. There is no correlation between nuclear size and [3H]AM binding. In normal-appearing flat mucosa of cancerous patients, there is no decrease of labeling [3H]AM in the upper third of the glands; superficial cells are as labeled as those at the bottom (R = 1). There is a correlation between nuclear size and [3H]AM in these cells. Normal-appearing cells of colorectal cancer patients are probably not involved in a normal process of differentiation.

Cardiac tamponade as first manifestation of colonic cancer.

Metastatic cardiac tamponade was the presenting manifestation of a colonic carcinoma. The patient's condition improved after surgical treatment and shows no sign of recurrence of pericardial effusion after more than eight months of systemic chemotherapy. Metastatic pericardial effusions and their treatment are discussed.

Comparative study of ultrasound and ERCP in the diagnosis of hepatic, biliary and pancreatic diseases: a prospective study based on a continuous series of 424 patients.

A prospective study of the diagnostic yield of ultrasound (US) and ERCP was made on a continuous series of 424 patients. Technical failures were slightly more frequent with US (11%) than with ERCP (8%), while US proved more accurate than ERCP in the diagnosis of focal hepatic disease--94% of correct diagnosis versus 41% (n = 17). In diffuse hepatic disease (n = 63) the accuracy of both methods was the same--87% of correct diagnosis with US, 83% with ERCP. US had better performances (91%), while ERCP was more accurate in the diagnosis of common duct lithiasis or tumour (98% for ERCP, 36% for US). Although ERCP has a better diagnostic yield for pancreatic diseases (92% to 100% of correct diagnosis according to the lesions) associate complications, such as pseudo-cysts, abscess formation and extravasations are better demonstrated by US (95% of correct diagnosis versus 73%). The two methods thus prove to be complementary.

An unusual cause of subocclusion in Crohn's disease.

Enteroliths as a cause of intermittent small bowel obstruction is a uncommon clinical entity. We present the case of a patient with Crohn's disease in whom a false primary enterolith--an apricot seed--was responsible for numerous episodes of subobstruction. The association of Crohn's disease with different types of enterolith is discussed.

[Anorectal localization of chronic inflammatory diseases of the intestines]. / Localisation ano-rectale des maladies inflammatoires chroniques de l'intestin.

In Ulcerative Colitis (UC), the rectum is always involved, but the disease may be extended to the left colon (distal colitis) or the entire organ (pancolitis). Secondary perineal lesions (erythema, fissures, hemorrhoids) are limited to local irritation related to the diarrheic syndrome; specific ano-rectal lesions are related to the mucosal inflammatory process, but others pathological situations may be observed and are due to the postoperative status (stenotic ileo-anal anastomosis, pouch inflammation). Ano-rectal localisation of Crohn's Disease (CD), sometimes underestimated, is clinically more complex (abscess, fistula, ulcer, etc) and requires precise classical (endoscopy, conventional radiology) or more modern (echo-endoscopy, nuclear magnetic resonance) investigations. The treatment is more difficult (medical conservative, "a minima" or more extended surgery). Differential diagnosis, symptoms, methods of investigation and appropriated therapeutical choices are successively developed.

Nuclear binding of tritiated actinomycin in surface epithelial cells from normal stomach and atrophic gastritis.

Triated actinomycin binding to DNA is closely linked to the degree of repression in chromatin. 3H-AM binding to DNA is the most pronounced in nuclei of cells committed into cycle. Inversely, in cells in the last steps of their differentiation or (and) in the resting state (non-dividing cells), 3H-AM binding for DNA is diminished down to a baseline since it is limited by the deoxynucleoproteins. Epithelial cells of stomach mucosa and duodenum demonstrate an increased cell uptake of tritiated actinomycin from the surface to the bottom of the pits. In severe gastritis and in intestinalysed metaplasia this was abolished: with a uniform enhancement of 3H-AM binding. These findings seem to indicate that these cells are derepressed.

Cell differentiation in human gastric gland as revealed by nuclear binding of tritiated actinomycin.

The nuclear binding of H3 actinomycin, which is closely linked to the differentiation phenomenon, was studied in human normal gastric mucosa. Actinomycin binding decreases in cells which differentiate and becomes very low in fully differentiated cells. In the gastric pits, there is a decreasing gradient of labelling from the deeper stem cells to the well-differentiated superficial cells. This indicates that migration and renewal of the surface epithelium occurs following a 'pipe-line' system. All the undifferentiated stem cells are labelled. Where the parietal cells are concerned all degrees of labelling are observed at various levels with a decreasing proportion of labelling from the surface to the bottom of the gland. With mucous cells and chief cells in the upper part of the gland a great number of poorly labelled mucous neck cells is observed. In the middle and lower part of the gland there is a new growth of heavily labelled cells. This means that in the normal human stomach chief cells probably do not originate from mucous cells.

Campylobacter pylori-associated gastritis: a double-blind placebo-controlled trial with amoxycillin.

We randomly assigned 45 adult patients with Campylobacter pylori-confirmed antral gastritis to 8 days of treatment with 1 g amoxycillin suspension twice a day, or placebo, according to a double-blind study design. At the end of therapy, 91% of patients treated with amoxycillin demonstrated clearance of the organism from the antrum, compared with 16% in the placebo group (p less than 0.001). Active antral gastritis resolved in 68% of patients in the amoxycillin group versus only 9% in the placebo group (p less than 0.001). No significant difference was observed when looking at the evolution of chronic only gastritis. No significant improvement was observed in the assessment of clinical symptoms and endoscopic appearance. Reappearance of C. pylori and significant worsening of the histological score of active gastritis was observed after 2 wk in all patients. In a second study phase, 18 patients initially not cleared of their bacteria received amoxycillin single blind for 14 days. Clearance of bacteria associated with improvement or resolution of active gastritis was observed in 72% of the cases. In this subgroup, all patients investigated after 1 month were recolonized with C. pylori and, again, had histological active gastritis. We conclude that amoxycillin is effective in treating active antral gastritis associated with C. pylori, but not in preventing relapses, which occur in all cases within 1 month after therapy.

[Endoscopic findings compared with clinical findings in diverticular disease of the colon]. / Données endoscopiques confrontées aux données cliniques dans la maladie diverticulaire du côlon.

In a retrospective study of 702 consecutive colonoscopies, the authors observed 185 cases of diverticulosis or moderate diverticulitis. They studied the colonic diseases associated with the presence of diverticula (78 cases) and discussed the role of endoscope in the approach of colonic diverticulosis.

Epidemiology of inflammatory bowel disease in Brussels' area (1992-1993).

A prospective epidemiological study on inflammatory bowel diseases (IBD) patients was performed in Brussels' area from April 1st, 1992 to 30th March, 1993. The mean annual incidence for Crohn's diseases (CD) was 4.1/10(5) inhabitants/year among native Belgian people and 6.4/10(5) inhabitants/year for subjects issued from Moroccan families. For ulcerative colitis, the incidence was 3.7/10(5) inhabitants/year for native Belgian people and only 1.2/10(5) inhabitants/year for Moroccan subjects. The male/female sex ratio was 0.4 for CD and 1.9 for UC. At the time of diagnosis, the mean age was 34 years for CD and 38 years for UC. For both diseases, the age peak was between 20 and 29 years. Cigarette smoking was significantly higher in CD (48%) than in UC patients (12%). Family history was about 10% for both diseases.

Juxtapapillary duodenal diverticula: association with biliary stone disease.

In order to explore the relationship between duodenal diverticula and biliary stone disease, we reviewed 2231 endoscopic retrograde cholangio-pancreatography procedures. We found at least one juxtapapillary diverticulum per 239 patients (10.8%). The occurrence of duodenal diverticula increases with age. Patients with duodenal diverticula were older, had more gallbladder stones, more common bile duct stones, had undergone cholecystectomy more frequently, and experienced more frequently common bile duct stone recurrence after cholecystectomy. We thus confirm an association between the presence of diverticula of the second part of the duodenum, and biliary stone pathology, including gallbladder stones, common bile duct stones, and recurrent stones after cholecystectomy. We discuss the aetiopathogeny of this affection.

A randomized, multi-observer, comparative evaluation of conventional fiberendoscopy and videoendoscopy in the upper GI tract.

In a comparative, histologically controlled study, no significant difference was found in the accuracy of conventional fiberendoscopy and videoendoscopy in the diagnosis of upper gastrointestinal tract lesions. Both techniques permitted accurate description of focal and/or ulcerative lesions, but videoendoscopy did not provide better sensitivity than fiberendoscopy in the diagnosis of superficial, non-ulcerative, inflammatory changes. The same results were obtained on checking the reproducibility of the macroscopic diagnosis by a delayed review of recorded videotapes.

Acute lower gastrointestinal bleeding in Crohn's disease: characteristics of a unique series of 34 patients. Belgian IBD Research Group.

OBJECTIVE: Acute lower gastrointestinal bleeding is a rare complication of Crohn's disease, which represents a diagnostic and therapeutic challenge. The aim of this study was to define epidemiological characteristics and therapeutic options of hemorrhagic forms of Crohn's disease. METHODS: Thirty-four cases of hemorrhagic forms of Crohn's disease were studied retrospectively. Acute lower gastrointestinal hemorrhage was defined as acute rectal bleeding originating in diseased bowel and requiring a transfusion of at least 2 units of red blood cells within 24 h. Upper gastrointestinal tract hemorrhage or anal lesions and postoperative bleeding were excluded. RESULTS: Mean age at time of hemorrhage was 34.2 +/- 14 yr. Mean duration of disease before the hemorrhage was 5.6 +/- 6 yr. The hemorrhage occurred during a flare up of the disease in 35% of cases. The hemorrhage revealed Crohn's disease in 23.5% of cases. The hemorrhage was more frequent in colonic disease (85%) than in isolated small bowel disease (15%) (p < 0.0001). The origin of bleeding was identified in 65% of cases, by colonoscopy (60%), by angiography (3 patients), or at surgery (1 patient). The bleeding lesion was an ulcer in 95% of cases, most often in the left colon. The treatment was surgical in 20.5% (colectomy in 36%), endoscopical (7 patients, including 5 successes), or medical. Hemorrhage recurred in 12 patients (35%) within a mean time of 3 yr (4 days-8 yr), requiring surgery in 3 cases. No death was observed. CONCLUSIONS: This study performed in a series characterized by a nonsurgical recruitment, the largest to date, shows that hemorrhagic forms of Crohn's disease may reveal disease in 23.5%, occurs in quiescent Crohn's disease in two-thirds of cases. Given the potential efficacy of endoscopical or medical treatment, as well as the absence of mortality, a conservative approach may be suggested as first-line therapy in the majority of patients.