Increased lymph node harvest from colorectal cancer resections using GEWF solution: a randomised study.

BACKGROUND: The lymph node harvest from colorectal specimens is pivotal for patients with colorectal cancer (CRC), independent of N stage. AIMS: To determine whether the use of GEWF solution (glacial acetic acid, ethanol, distilled water and formaldehyde) could improve the lymph node harvest in CRC specimens. METHODS: Consecutive fresh colonic (n = 60) and rectal (n = 60) specimens from patients with primary CRC resected at Aarhus University Hospital THG between March 2006 and July 2007 were randomised to either conventional preparation or GEWF preparation and examined in a standard manner. RESULTS: For colonic as well as rectal specimens, the GEWF solution increased the mean lymph node harvest from 9 and 10 to 16 and 17 lymph nodes per specimen compared to conventional prepared specimens (p<0.001). Using the recommended threshold of 12 lymph nodes to ensure adequacy of nodal harvest, the adequacy increased from less than half to almost three quarters independent of tumour origin (p<0.037). The proportion of node-negative specimens was not significantly different between the two preparation groups. CONCLUSION: The use of GEWF solution in patients with CRC significantly increases the lymph node harvest of resected specimens.

[Partial re-screening of all negative smears. A method of quality control of pathology department concerning smear screening against cervix cancer]. / Partiel rescreening af alle negative "smears". En metode til patologiafdelingens kvalitetskontrol af "smear"-screening mod livmoderhalskraeft.

Partial rescreening of all negative smears is recommended as the most cost-effective method of internal quality control. The method was tested by eight cytotechnologists and the average diagnostic sensitivity, assessed upon their answering of 200 test-smears (150 negative and 50 positive) was 80%, while specificity vas calculated to 95%. Partial rescreening has here-upon been used in daily routine. After one year 21,000 smears have been re-screened. Twenty-nine cases of false negatives, 16 with atypia, eight with koilocytosis, and five cases with dysplasia have been detected, which corresponds to an overall false negative rate on 3%. In five of the 29 false negative cases with dysplasia histological follow-up has shown three cases of CIN III (two carcinoma in situ, one severe dysplasia), one case with CIN II (moderate dysplasia) and one case with CIN I (mild dysplasia). Conclusively, partial rescreening of all negative smears implies an improved quality with reduction of the number of false negative specimens.

[Merkel cell carcinoma]. / Merkel-cellekarcinom.

Eight patients with Merkel cell carcinoma are reported to document their response to surgery and/or radiotherapy. Four patients who initially underwent surgery without postoperative radiation therapy all had local recurrence. Two patients were treated with postoperative radiation therapy and two were treated with radiation therapy without excision of the tumour. None of these four patients had local recurrence. Five patients developed regional recurrence. Recurrence was seen in one patient in the irradiated field. Metastatic disease was not seen in any case. These results combined with a review of the literature suggest that radiation therapy postoperatively to both the surgical bed and the draining lymph nodes may improve local regional tumour control.

Thymic epithelial abnormalities in patients with congenital heart disease and Down's syndrome.

Among 85 children (< 5 years) operated on for congenital heart disease, we found 15 with structural changes of the thymus consisting of epithelial ducts and cysts. Nine of the children had Down's syndrome. In only two of these did we find epithelial abnormalities. In conclusion, these changes were not more frequent in children with Down's syndrome than in other patients with congenital heart disease.

Mediastinal tumours. A report of 129 cases.

Primary mediastinal tumour or cyst was surgically treated in 129 patients (including 19 younger than 12 years) during a 16-year period. All histologic specimens and smears from fine-needle aspiration biopsy were reviewed. Intrathoracic goitre, neurogenic lesions and thymomas comprised 62% of all the tumours. Fifty lesions (39%) were found at routine radiographic examination and were asymptomatic. Eight of these 50 lesions were malignant. Chest pain, fatigue, weight loss and fever were significantly more common in malignant than in benign disease. Despite extensive investigations, the diagnosis was not established preoperatively in 32% of the cases. Chest radiography, CT-scanning and fine-needle aspiration biopsy usually provide satisfactory diagnostic information, thereby substantially reducing the need for other preoperative procedures. Early operative intervention is mandatory in these cases.

[Significance of the demonstration of Actinomyces in cervical cytological smears]. / Betydningen af Actinomyces-påvisning i vaginalcytologiske skrab.

PIP: In recent years there has been well documented evidence of a connection between adnexitis and the use of IUDs. It has also been reported that Actinomyces-caused adnexitis is often a serious precursor of tubo-ovarian abscesses which require surgical attention. The investigation included a total of 17,734 routine Pap smears taken in the pathology department over a 4-month period. The smears were screened for the presence of Actinomyces and information on type of IUD and gynecological symptoms was gathered from women testing positive for Actinomyces. Comparable information was gathered from 2 age-matched control groups. 1 group consisted of women with an IUD but without Actinomyces; the other group consisted of women without an IUD and without Actinomyces. Of the 180 patients with Actinomyces, 175 were IUD users and only 5 were nonusers. The incidence of gynecological symptoms among the patients showed increased frequency for women with Actinomyces only with regard to cervical discharge. The Nova-T IUD was found to be significantly less frequently associated with Actinomyces than the other IUDs.^ieng

Extracellular deposit of the cationic proteins ECP and EPX in tissue infiltrations of eosinophils related to tissue damage.

In a series of eosinophil inflammatory states affecting various organs (heart, gut, bladder and skin) we performed an immunohistochemical study of the eosinophil cationic proteins ECP and EPX. A strong correlation was noted between the liberation of ECP and EPX and tissue necrosis in all organs. In most cases ECP and EPX were found on the same location. However, one case indicated a possible differential release. Extracellular ECP and EPX were revealed concurrently with the two polyclonal antibodies and the monoclonal EG2 antibody. The latter binds to both ECP and EPX, but only during secretion. Since EG2 does not differentiate between ECP and EPX, but only during secretion. Since EG2 does not differentiate between EXP and EPX, it is for the first time demonstrated that both cationic proteins are correlated to tissue damage. The chymotrypsin-like cationic protein (CCP), related to neutrophils, showed a low correlation with the eosinophil cationic proteins in cases of tissue damage. The hypothesis is put forward that the release of eosinophil granule proteins and especially ECP results in a non-specific tissue damage.

Diabetic macroangiopathy. Quantitative histopathological studies of the extramural coronary arteries from type 2 (non-insulin-dependent) diabetic patients.

A morphometric study was performed on histological sections of the extramural coronary arteries from 10 Type 2 (non-insulin-dependent) diabetic patients and 10 non-diabetic subjects, matched for age and sex. Standardised samples were taken from the two coronary arteries and the fractional contents of Periodic Acid-Schiff-positive material, acid mucopolysaccharides and connective tissue was determined in the arterial tunica media from the two groups using a point-counting technique. The thickness of tunica intima and tunica media was obtained by micrometric measurements. There was no difference in the thickness of tunica intima with and without atherosclerotic plaque between the vessels from diabetic and nondiabetic hearts. However, the thickness of tunica media was significantly reduced in arteries from the diabetic patients (2p less than 0.01). In tunica media of the diabetic patients there was a significant increase (50%) in the amount of Periodic Acid-Schiff-positive material (2p less than 0.01), whereas the content of acid mucopolysaccharides (alcian-blue positive) was significantly reduced (2p less than 0.02). These changes in tunica media were similar in areas below and outside the intimal atherosclerotic plaques. The content of connective tissue was found to be significantly increased in the arteries from the diabetic patients, but only in areas outside atherosclerotic plaques (2p less than 0.025). There was no correlation between the observed changes in tunica media and the known duration of diabetes. The results obtained in the present study may be ascribed to the presence of a non-atherosclerotic diabetic macroangiopathy.

Effect of endoscopic sclerotherapy of esophageal varices on liver blood flow and liver function. An experimental study.

In 10 Göttingen mini-pigs esophageal varices developed after banding of the portal vein. In five pigs the varices were treated by paravariceal injection of polidocanol, and the rest served as controls. As judged from endoscopy and portography, the varices disappeared after four sclerotherapy sessions within 4 weeks, and at the same time portal venous pressure rose from 19 to 38 mm Hg. No changes were seen in the control group. After 24 weeks of observation the hepatic blood flow in the untreated group was 10 ml/kg/min, and portal angiography showed that nearly all the portal blood bypassed the liver. In the pigs treated with sclerotherapy the hepatic blood flow increased to 28 ml/kg/min, angiography showed a normal hepatogram, and no filling of the collaterals was seen. Sclerotherapy induced only a few changes in liver function, and these may be related to the concomitant increase in liver blood flow.

Chronic portal venous hypertension. The effect on liver blood flow and liver function and the development of esophageal varices.

Portal venous hypertension was induced in Göttingen minipigs by banding the portal vein. The pigs were checked repeatedly during the following 24 weeks. Portal pressure increased immediately on banding, from 8.4 +/- 0.7 mm Hg to 19.4 +/- 0.7 mm Hg, and remained constant throughout the observation period. Within 5 weeks all pigs developed esophageal varices, as demonstrated by portal angiography and endoscopy. The experimentally induced portal hypertension was accompanied by a 65% decrease in hepatic blood flow, most probably caused by almost complete shunting of portal venous blood. The hepatic arterial flow appeared to be within normal limits and sufficient to cover the oxygen demand of the liver; to judge from the splanchnic elimination rate of galactose, the hemodynamic changes did not affect the functional capacity of the liver.

Endoscopic sclerotherapy of esophageal varices in an experimental animal model. A histomorphologic study.

Endoscopic sclerotherapy with Aethoxysclerol 2% was carried out in rabbits with esophageal varices. Nineteen animals were injected paravenously, and 17 were injected intravenously. The animals were killed between 1 h and 4 weeks after injection for histologic examination of the esophagus. None of the animals showed an acute total occlusive thrombosis of the large vessels, whereas edema and later fibrosis compressed the varices in the paravenously injected animals. After 4 weeks an almost complete repair with patent varices was observed in the intravenously treated group, whereas the varices in the paravenously injected group either had shrunk totally or were surrounded by a dense envelope of connective tissue. The study suggests that paravenous treatment of esophageal varices provides a higher degree of efficacy.

Experimental prehepatic portal hypertension and esophageal varices in the rabbit.

Prehepatic portal hypertension was induced in rabbits by constricting the vein, creating a pressure approximately 100% higher than the preoperative value. Angiographic, endoscopic, and pressure studies confirmed the portal hypertension to be decompressed, with shunting of blood through esophageal varices. Small periportal collaterals were insufficient to prevent the esophageal shunting. The esophageal varices developed within 4 weeks and were a consistent finding throughout the observation period. No relation between the extent of portal hypertension and the size of the varices was found.

The thymus in congenital heart disease.

Some cases of thymus developmental defects (DiGeorge's syndrome) are associated with the development of defects of the heart and great vessels. To see if anomalies of the heart are also associated with anomalies of the thymus, a material of thymus tissue removed during operation for congenital heart disease was compared with thymus tissue from a forensic autopsy material representing the same age group, but without cardiac lesions. Among 27 cases of congenital heart disease, occurrence in the thymus of solid epithelial cords were seen in 6 and cyst- or duct-like structures were found in 7. Among 47 forensic cases, 1 showed cords and another showed duct-like structures. Of these, one had congenital anomalies in the form of hepatic hamartomas and nesidioblastosis, whereas the other had died from morbilli, raising the possibility of congenital immune deficiency. Anyhow, a striking occurrence of minor morphological deviations in the structure of the thymus was found in children with congenital heart disease. Such material therefore may be less suitable for studying the morphology and biology of the normal thymus gland.