Intestinal pseudo-obstruction, myasthenia gravis, and thymoma.

Two patients presented with abdominal pain, recurrent vomiting, weight loss, and constipation secondary to intestinal pseudo-obstruction. Both patients had symptoms and signs of myasthenia gravis, acetylcholine receptor antibodies, and thymoma. In one patient inflammatory cell infiltrates and occasional degenerate neurons were found in the myenteric plexus. The gastrointestinal symptoms resolved during treatment with pyridostigmine. The close temporal relationship between the onset of the gastrointestinal symptoms and the detection of myasthenia gravis and thymoma suggests that intestinal pseudo-obstruction can be a paraneoplastic syndrome associated with thymoma.

Assessment of invasive growth pattern and lymphocytic infiltration in colorectal cancer.

A total of 122 specimens of colorectal cancer were re-assessed in relation to the reporting of invasive growth pattern (expanding vs. infiltrating) and presence or absence of peritumoral lymphocytic infiltrate as used in the Jass prognostic classification. Jass agreed with 69% of cases reported as infiltrating and 90% of reported as expanding. This parameter was distributed similarly amongst Dukes B and C cases in the original assessment (P = 0.27), whereas in the reviewed data infiltrating cases were more likely to be staged as Dukes C (P = 0.04). Jass agreed with 44% of lymphocyte present and 94% of lymphocyte absent assessments. The original lymphocyte assessments showed no significant differences in distribution between Dukes A and B cases (P = 0.12) or B and C cases (P = 0.75), whereas the reviewed data showed significant differences for A vs. B (P = 0.015) and B vs. C cases (P = 0.0025). Criteria for assessment were circulated to eight observers who revisited 20 of the cases in which there was disagreement. Consensus agreement with Jass was achieved in nine of 10 cases for invasive growth pattern and seven of 10 cases for lymphocyte infiltration (with two being evenly split). Most observers showed at least fair levels of agreement with Jass and some achieved excellent levels of agreement. This study indicates that assessment of criteria used in the Jass prognostic system for colorectal cancer is less than optimal in routine practice, but is improved through the provision of simple guidelines.

Ducts of esophageal glands proper and paneth cells in Barrett's esophagus: frequency in biopsy specimens.

The frequency of ducts of esophageal glands proper and Paneth cells was studied in endoscopic biopsy specimens obtained from 49 patients diagnosed as having Barrett's esophagus. Esophageal gland ducts were found in 5 (10%) of the subjects. Paneth cells were observed in 15 (31%) of the 49 patients, being located mainly among mucous cells of intestinalized crypts although a few were also noted in the surface epithelium. Since the presence of esophageal gland ducts in the columnar epithelium-lined mucosa is a pathognomonic feature of Barrett's esophagus, 10% of the patients reviewed were considered to have an unequivocal diagnosis of Barrett's esophagus. Barrett's mucosa showed histological features similar to incomplete-type intestinal metaplasia of gastric mucosa, except for the presence of Paneth cells.

Malassezia furfur folliculitis of the vulva: olive oil solves the mystery.

BACKGROUND: In treating women with chronic fungal infections, it is important to know which organism is responsible for the infection. In the past, organisms thought to cause vaginitis and vulvitis could all be cultured on modified Sabouraud agar. CASE: We describe a case of a woman whose chronic fungal vulvar folliculitis masqueraded as squamous epithelial hyperplasia. The 46-year-old woman, taking immunosuppressive therapy for rheumatoid arthritis, was referred with an 8-month history of vulvar vesicles, itching, and burning. Her examination revealed a vulvar folliculitis. When fungal cultures were initially negative, a vulvar biopsy revealed a squamous epithelial hyperplasia. However, a fungal culture covered with sterile olive oil eventually grew Malassezia furfur, a yeast with peculiar growth requirements. She was cured with a 2-week course of fluconazole. CONCLUSION: Malassezia furfur, an organism rarely described in the vaginitis literature, can cause vulvar folliculitis in a patient on immunosuppressive therapy.

Spinal subarachnoid haemorrhage from an "ancient" schwannoma of the cervical spine.

A case of spinal subarachnoid haemorrhage secondary to degenerative changes in a cervical schwannoma is presented. The problems associated with diagnosis as well as the possible mechanisms resulting in haemorrhage from spinal tumours are reviewed.

Birth defects surveillance. A pilot system in the Cape Peninsula.

A pilot birth defects surveillance system was established in 1982 as part of an epidemiological baseline study pertaining to potential changes in water quality in the Cape Peninsula. The methodology used for reporting birth defects for two information systems, one hospital-based and the other population-based, utilizing statutory notifications of births, is described. Preliminary birth defect rates by cause are presented for a hospital-based system and are consistent with rates reported internationally. The system based on statutory notifications showed gross under-reporting.

Online searching for human nutrition: an evaluation of databases.

This study compares six databases which contain information on applied and clinical human nutrition: AGRICOLA, BIOSIS, CAB ABSTRACTS, EMBASE, MEDLINE, and SCI-SEARCH. Five research questions were searched, and the results were compared to identify the database of first choice and to determine the degree of overlap among the databases. Results indicate that for most of the human nutrition questions searched, MEDLINE was the most productive database. However, MEDLINE alone only uncovered 24% to 69% of the citations available. A combination of MEDLINE and at least one other database is recommended. The results of this study suggest that for most human nutrition questions, AGRICOLA is the best file to complement MEDLINE.

The concept of a 'case' in psychiatric population surveys.

A series of in-patients, a series of out-patients and a series of women from a general population sample, all aged under 65, and all living in the same area of south-east London, were examined using the ninth edition of the Present State Examination (PSE). An 'index of definition' (ID), based on number, type and severity of PSE symptoms, was constructed in order to define a threshold point above which sufficient information was available to allow classification into one of the functional psychoses or neuroses. The index specified 8 levels of definition of disorder; the threshold point for a 'case' lying between levels 4 and 5. The identification of 'cases' by this means in the general population series was highly concordant with global clinical judgement. When the 3 series were compared, the in-patient series contained the most definite cases, the outpatient series was intermediate, and the general population series was characterized mainly by below-threshold conditions. Disorders above the threshold point were classified using the CATEGO program. The clinical severity of the depressive disorders and anxiety states identified in this way in the 3 series was compared on the basis of symptom and syndrome profiles and PSE scores. As expected, the inpatients had the most severe, and the general population 'cases' the least severe disorders. It is suggested that the PSE-ID-CATEGO techniques can be used to help standardize certain aspects of case-finding and case-description in both referred and non-referred populations and thereby make the results of surveys more comparable.

Reliability of the PSE (ninth edition) used in a population study.

A random sample of 237 women in a south-east London area were seen by non-medical interviewers, trained to use a standard technique (the Present State Examination) to elicit and record psychiatric symptoms. Ninety-five were interviewed a second time by psychiatrists, who also rated audiotape recordings. The reproducibility of the techniques is adequate though not as high, in some respects, as that obtained from out-patient or in-patient samples. This is true at the level of symptom, syndrome, total score, and index of definition of psychiatric disorder. It is concluded that non-medical interviewers can obtain as high reproducibility as psychiatrists on most of the non-psychotic sections of the PSE if they have appropriate training. Repeatability is lower than reproducibility, partly due to fluctuations in clinical condition, partly to environmental changes between interviews, and partly to differential responses to medical and non-medical interviews. Over a short period of time, such as a week, repeatability is satisfactory.