[Gastrointestinal hemorrhage of obscure origin].

Gastrointestinal bleeding of obscure origin consists of recurrent bouts of acute or chronic bleeding for which no definite source is discovered in routine endoscopic and barium contrast studies of the upper and lower gastrointestinal tracts. Usually its cause is angiodysplasia of the intestine, but many cases are due to tumors, mostly of the small bowel, which may be malignant. In patients under the age of 50, the proportion with malignancy is relatively high (up to 14%) as compared to older patients. We describe a 45-year-old woman who suffered from gastrointestinal bleeding for 3 years. The cause of bleeding was not found despite extensive work-up. In her last admission for acute gastrointestinal hemorrhage she was given a total of 30 units of blood. A tumor of the small intestine found by angiography was excised and found to be a stromal tumor of uncertain malignant potential. 1 year after operation she is asymptomatic without bleeding and her hemoglobin is stable without treatment.

[Screening for colorectal neoplasms].

We screened groups at high risk for colorectal neoplasms, determining the efficacy of the leukocyte adherence inhibition test (LAI) for early detection, in comparison with that of the fecal occult blood (Hemoccult) test and sigmoidoscopy or colonoscopy. Those screened included 549 first-degree relatives of patients with colorectal cancer, 190 patients with a past history of colorectal adenoma or carcinoma and 67 with a past history of breast or gynecological cancer or inflammatory bowel disease. 146 normal volunteers served as controls. In 782 of those fully screened during a 3-year period, 121 had adenomas (15.5%) and 5 had invasive cancer (0.6%). The LAI test was positive in 21% of those at high risk and in 7.5% of the controls. The hemoccult test was positive in only 4.8%, but in 1/3 of them neoplasms were found. This predictive value of 33% compares with only 16% for the LAI test. That most of the neoplasms found were adenomas and not invasive cancer may be due to the relative youth of most of those screened. We conclude that the groups studied were indeed at high risk. The LAI test is not sensitive enough to identify benign adenomas but might serve as another risk-market for colorectal neoplasms. Long-term follow-up of those at high-risk with positive LAI tests may prove that we have identified a subgroup truly at risk.

Antitumor immune response to colorectal cancer antigen detected by the leukocyte adherence inhibition test (LAI) in groups at high risk for colorectal cancer.

Colorectal cancer is the second leading cause of cancer death in western populations. As treatment outcome is highly correlated with stage at diagnosis, early detection is a very important task. Three high-risk groups for colorectal cancer (first-degree relatives of colorectal cancer patients; individuals with past history of colorectal neoplasms, polyps, or carcinoma; and patients with ulcerative colitis) were screened for colonic neoplasms. The study program included the leukocyte adherence inhibition test (LAI), a specific immune response test for colorectal cancer antigen; fiberoptic sigmoidoscopy or colonoscopy; and guaiac impregnated slide test. The main finding was the detection of 92 positive LAI tests out of 451 high-risk individuals tested (20%), compared to eight positive tests out of 194 (4.1%) in a control group. Fifty-six colonic neoplasms were found out of 344 (16%) colonoscopies performed, most of them adenomatous polyps and a few carcinomas. Our findings, compared with the expected 2-3% neoplasms in low-risk groups, would prove that the screenees were indeed at high risk. However, only 11/56 (19%) of the polyps identified were LAI positive. The number of polyps found among LAI positive individuals were, so far, 11/92 (11%). The guaiac impregnated slide test for occult blood in the stool was performed in 221 screenees. Of these only 10 were positive (4.5%) compared with the average of 1% positive tests in low-risk groups.

Systemic alteration in blood glucose levels following localized deep microwave hyperthermia.

Blood glucose levels were temporarily elevated in normal rabbits subjected to one localized microwave hyperthermia treatment in the rectum. A major peak of blood glucose level was observed 8 hours after treatment, and a second minor peak was measured 14-17 hours after treatment. These findings indicate that localized microwave hyperthermia affects the host systemically.

Normal tissue response to localized deep microwave hyperthermia in the rabbit's prostate: a preclinical study.

Experiments were performed to determine the response of normal tissues of the rectal cavity and the prostate to localized 2.45 GHz microwave deep hyperthermia. Hyperthermia at 43 degrees C was delivered by means of a coaxial probe in the rectal cavity for 30 min. once or twice at an interval of 2 days. Normal tissues of the rectum, urinary bladder, and prostate were histologically examined up to three months after treatments. In almost all of the treated animals no tissue and organ injury resulted from localized deep hyperthermia at 43 degrees C. This treatment appears to be safe for the treatment of carcinoma of the prostate.

99mTc-HIDA cholescintigraphy in Dubin-Johnson and Rotor syndromes.

99mTc-HIDA cholescintigraphy was performed in 6 patients with Dubin-Johnson syndrome and 1 patient with Rotor syndrome. In the patients with Dubin-Johnson syndrome, the cholescintigrams had a characteristic pattern of delayed visualization or nonvisualization of the gallbladder and bile ducts in the presence of intense, homogeneous, and prolonged visualization of the liver. In the patient with Rotor syndrome, the hepatobiliary system was not visualized at all. It is concluded that 99mTc-HIDA cholescintigraphy may be helpful in the diagnosis of Dubin-Johnson syndrome and Rotor syndrome and in the differential diagnosis between these two conditions.

[Ischemic colitis in a woman on contraceptive pills].

PIP: This is the first published report in Israel of ischemic colitis in a woman using the contraceptive pill; 20 such cases have been reported in other parts of the world. The patient was a 46 year old married woman with 3 children; she had been in good health except for obesity and chronic hypertension. Her medications included an oral contraceptive for a period of 3 years, and methyldopa for treatment of her hypertension. She presented with abdominal pain and diarrhea of 5 weeks duration. She underwent surgical reanastamosis of the bowel and was doing well at follow-up 1 year after surgery. The presence of ischemic colitis was definitively diagnosed by histological examination; the differential diagnosis included cancer, ulcerative colitis, Crohn's disease, and infectious disease. The authors note that although there is possible association between taking oral contraceptives and the appearance of ischemic colitis, there is not yet any statistical evidence for such a relationship. Similar cases have been reported among young women who were not using oral contraceptives.^ieng