Giant colonic mucocele following palliative surgery for metastatic adenocarcinoma.

We report an unusual case of a giant colonic mucocele following ileo-sigmoid bypass surgery in a patient with advanced adenocarcinoma of the splenic flexure. The formation of a giant colonic mucocele resulted from distal splenic flexure obstruction due to tumour relapse and proximal caecal obstruction due to peritoneal disease with subsequent accumulation of mucus in the closed loop.

Magnetic endoscope imaging: a new technique for localizing colonic lesions.

BACKGROUND AND STUDY AIMS: The precise localization of advanced colorectal lesions preoperatively directs the appropriate surgical management. The use of internal landmarks at colonoscopy can be inaccurate, and other methods are therefore necessary to localize lesions precisely. Magnetic endoscope imaging (MEI), a real-time, nonradiographic technique for imaging of the colonoscope, may assist in determining the location of lesions found at colonoscopy. PATIENTS AND METHODS: A prospective study was carried out to determine the accuracy of MEI for localizing the colonoscope tip anatomically. The MEI system was used to identify one of four predetermined locations within the colon. Once identified, two endoscopic marking clips were attached to the colonic mucosa, and 400 - 500 ml of Urografin radiographic contrast medium was injected to produce an air-contrast "enema." The clips were subsequently localized using plain abdominal radiography, assessed by a single experienced radiologist who was blinded to the colonoscopic findings. RESULTS: Twenty-nine consecutive patients were enrolled in the study. The overall accuracy of MEI in comparison with the air-contrast "enema" was 90 % (26 of 29 cases). There were three slight errors of localization - clips localized to the descending rather than the sigmoid-descending colon junction (n = 1), or to either side of the mid-transverse (n = 1) and hepatic flexure (n = 1) - but these were not considered to be of surgical or clinical importance. CONCLUSIONS: MEI is a reliable and accurate method for determining the anatomical position of the endoscope tip during colonoscopy. When it becomes commercially available, we believe the use of MEI will avoid the need for unnecessary barium enemas for localization of lesions prior to definitive surgery.

Colonic metastasis from bronchogenic carcinoma presenting as pancolitis.

The colonic metastases from bronchogenic carcinoma are rare. We present a 73-year-old man presented with features suggestive of pan colitis after metastasis from undifferentiated large cell carcinoma of the lung. The plain radiograph and computed tomography scan of the chest had revealed a mass lesion in the right lower lobe of lung. He had no evidence of significant lesions elsewhere. Considering the advanced stage and poor differentiation of the tumour, no active therapy was undertaken and he survived for three months.

TGF-beta is not the principal immunosuppressive component in coagulation factor concentrates.

Coagulation factor concentrates are known to inhibit a variety of immune reactions when assessed in vitro. This study assessed the immunomodulatory activity of a wide range of coagulation factor concentrates by measuring their inhibition of PHA-stimulated lymphocyte proliferation and reduction in IL-2 secretion. The hypothesis that TGF-beta is responsible for most of these effects was tested by measuring biologically active TGF-beta and immunoreactive TGF-beta1 in the concentrates and comparing the levels recorded with immunosuppressive activity. In addition, the coagulation factors were compared directly with a standard preparation of TGF-beta in a TGF-beta-specific bioassay and in lymphocyte proliferation assays. Although there was a broad correlation between levels of total or active TGF-beta and immunosuppressive activity across all of the coagulation factors tested, individual data sets showed clear discrepancies. Implying that TGF-beta probably serves as a surrogate marker for other immunomodulatory contaminants and that neither TGF-beta nor any other single substance could account for all of the immunosuppressive activity observed. Furthermore, there was a difference of more than 100-fold in the relative potencies of coagulation factors and pure TGF-beta, when compared in immunosuppression assays, indicating that the different assays did not measure the same substance. Whereas anti-TGF-beta antibody almost completely blocked the activity of coagulation factor concentrates (TGF-beta-specific bioassay) and abrogated the effect of authentic TGF-beta (immunosuppression assays) at high concentrations it achieved <50% reversal of the immunosuppressive effects of coagulation factors in immunosuppression assays. These findings indicated that TGF-beta accounted for only a minor proportion of the immunosuppressive activity in most coagulation factor concentrates.

Recurrent acute renal failure due to a rectal villous adenoma.

A case is reported in which a rectal villous adenoma was complicated by severe fluid and electrolyte depletion producing recurrent renal failure. The pathophysiology of the depletion syndrome and its complications are discussed. Successful management by acute haemodialysis and early surgical resection of the tumour is described.

Ingrowing toenails: is there a nail abnormality? A prospective study.

Ingrowing of the nail of the hallux has been ascribed to an abnormality of the shape of the nail; our prospective study was planned to test this association. Twenty-three consecutive patients and 23 age-matched controls were assessed by caliper measurement and standard photographs, before a first operation for ingrowing toenail. We found no differences in shape between the toenails of the patients and those of the controls, both groups showing great variation. Our results suggest that the ingrowth is not commonly associated with an abnormal shape of the nail.

Successful treatment of an infected vascular graft with gentamicin beads.

This short report describes the successful healing of an infected axillo-bifemoral graft by the insertion of Gentamicin beads, this technique cannot be recommended for all infected grafts the majority of which will have to be removed and replaced.

The effect of Kupffer cell stimulation or depression on the development of liver metastases in the rat.

Tumour cells from a squamous carcinoma (approximately 2.5 X 10(5)) were injected intraportally into a syngeneic strain of rats to produce liver metastases 14 days later. Kupffer cells were stimulated by Corynebacterium parvum (7 mg or 1 mg i.v.) and zymosan (10 mg intraportally). Kupffer cell activity was depressed by the administration of silica, gadolinium chloride or human red cells. The animals in each group were sacrificed at 14 days, the livers removed and the number of visible surface metastases counted and compared. (Mann-Whitney U-test). Kupffer cell stimulation significantly reduced the number of surface liver metastases in all animals (P 0.0048). In contrast depression of Kupffer cell activity significantly increased the number of metastases in all animals (P 0.0045), suggesting that the activity of these cells has an important effect on the development of liver metastases.

Can technetium-labelled millimicrospheres be used to measure Kupffer-cell function? An experimental study.

It has been suggested that sodium pertechnetate 99mTc millimicrospheres can be used to measure Kupffer-cell function. We studied animals and humans to show whether the clearance and catabolism of 99mTc-labelled millimicrospheres can be used as a measure of Kupffer-cell function. Comparison with albumin 125I-microaggregates clearance of human serum albumin failed to demonstrate that they can be used for this purpose. We suggest that their blood clearance is mainly an expression of liver blood flow.

Agglutination of intralipid by sera of acutely ill patients.

The serum of over half of a group of acutely ill patients agglutinated "Intralipid' a fat emulsion based on soya bean oil designed for intravenous infusion. This reaction is probably precipitated by C-reactive protein in the presence of calcium ions. Post-mortem examinations of patients who had received intralipid showed evidence of microembolism which could have been caused by agglutination of intralipid. If this is the case then intralipid should perhaps not be given to these acutely ill patients.

Phlebography in the salage of dialysis fistulae.

Provision of long-term satisfactory vascular access for haemodialysis is an increasing problem. The functional life of an arteriovenous fistula can be greatly extended by an active salvage policy to which radiology makes an invaluable contribution. Forty-seven consecutive patients with vascular access problems were studied, 11 undergoing forearm phlebography and 36 phlebography of a malfunctioning fistula. Of the 11 patients with forearm phlebograms, only one patient had a fistula constructed that was not used for dialysis, despite demonstration of a patent forearm venous system; and in three patients operation was avoided after demonstration of inadequate veins. Only three of the 36 fistulograms failed to give useful information, whereas in seven patients operation was avoided by demonstration of a normal fistulogram.