Incidence of oesophageal necrosis in an autopsy material.

The incidence of oesophageal necrosis was studied in 310 consecutive autopsies of patients more than 2 years old. The oesophagus and upper part of the stomach were excised and formalin-fixed in all cases suspicious of necrosis. Suspicious areas were taken out for microscopy. The necroses presented as dark coloured or black, punctate, striped or confluent areas, most frequently located in the lower third of the organ and usually stopping abruptly at the cardia. They were distinguished from autolytic changes by the presence of a vital reaction (i.e. fibrin exudation and presence of neutrophils). Necroses were observed in 32 of the 310 patients. In nine patients the necrosis extended into or through the muscularis propria. In 13 patients there was only mucosal necrosis. In the remaining cases the necroses extended into the submucosa. In one patient the necrosis caused fatal bleeding. We believe that oesophageal necrosis is a change which is often overlooked - whether presenting at endoscopy or at autopsy - and that the condition should be taken seriously as a cause of possible bleeding, perforation or septicemia. The cause is not firmly established, but the present as well as earlier works point to acid reflux combined with hypoperfusion as important pathogenetic factors.

Gastro-oesophageal reflux demonstrated by radiography. A supplement to 24-h pH monitoring.

PURPOSE: Gastro-oesophageal reflux (GOR) is demonstrated by radiography as a supplement to 24-h pH monitoring. MATERIAL AND METHODS: Forty-two patients (mean age 44 years) with suspicion of GOR disease were assessed according to a standard questionnaire. GOR was investigated by 24-h pH-monitoring and by radiography. Oesophageal emptying and the presence of rings or strictures were registered as well. Mucosal biopsies, classified as normal, light oesophagitis, severe oesophagitis, or Barrett's oesophagus, were correlated to age, gender, symptomatology, pH monitoring, and oesophageal emptying. GOR and morphological changes demonstrated by radiography were correlated to pH monitoring and mucosa biopsies. RESULTS: Based on pH monitoring, patients with severe oesophagitis and Barrett's oesophagus had a significantly higher acid exposure compared to patients with normal mucosa and light oesophagitis, with no difference concerning age, gender, and symptoms. Severe oesophagitis, including Barrett's oesophagus, was found only in patients with a positive test for radiologic GOR. Eleven patients had rings or strictures independent of oesophageal mucosal changes. CONCLUSION: GOR demonstrated by radiography identified patients where complications could be expected, which was not possible by pH monitoring alone.

Total pancreatectomy in six patients with intraductal papillary mucinous tumour of the pancreas: the treatment of choice.

BACKGROUND: Intraductal papillary mucinous tumours (IPMT) were described as a distinct entity in 1982.The extent of surgical resection remains controversial. METHODS: Six patients with a diffuse dilatation of the main pancreatic duct were treated with total pancreatectomy for cure of IPMT. RESULTS: Histological examination showed one IPM adenoma, four IPM non-invasive carcinomas and one IPM invasive carcinoma. In all but one case multifocal extensive intraductal changes were found, affecting either most of the pancreas or the whole organ. All patients survived the operation and remain alive 5-56 months later. Post-pancreatectomy diabetes has been moderately well controlled. DISCUSSION: IPMTs represent a subgroup of pancreatic neoplasms with a favourable prognosis, and the resection should aim at removing all dysplastic foci. In cases with diffuse dilatation of the main pancreatic duct, widespread tumour involvement of the duct system can be expected, so total pancreatectomy should be the operation of choice.

Beneficial effects of hydrocortisone in a model of experimental acute pancreatitis.

BACKGROUND: Proinflammatory cytokines like TNF-alpha and IL-8 have been thought to play a pivotal role in the propagation of severe acute pancreatitis (AP) and the development of its systemic complications, particularly acute lung injury. OBJECTIVE: To investigate the effects of pretreatment with hydrocortisone on the production of cytokines and the occurrence of acute lung injury in rabbits with AP. METHODS: AP was induced in 17 rabbits by infusion of 5% chenodeoxycholic acid into the pancreatic duct, followed by ductal ligation. The rabbits were allocated to pretreatment with subcutaneous and intravenous hydrocortisone (25 mg/kg, respectively; n = 7) or 0.9% saline (n = 10) 30 min before induction of AP. Rabbits were observed for 12 h. Serum amylase, lipase, TNF-alpha, IL-8, glucose, calcium and leukocyte count were measured every 3 h. At the end of the experimental period, ascitic fluid was collected and tissue specimens from the pancreas, lungs and kidney were obtained. RESULTS: Hydrocortisone pretreatment improved survival from 40 to 100%. Serum TNF-alpha and IL-8 were lower in the hydrocortisone group than in the control group at 6 h (p = 0.006 and p < 0.001, respectively). Hydrocortisone abolished leukopenia (p < 0. 001), hyperamylasemia (p = 0.05), the occurrence of acute lung injury and reduced the volume of ascites. CONCLUSIONS: Our findings suggest a role for TNF-alpha and IL-8 in mediating the progress of AP from a local disease into a systemic illness. Hydrocortisone should be tested experimentally after the induction of AP and clinically as a prophylactic measure to avoid severe AP induced by endoscopic retrograde cholangiopancreaticography.

Excessive nodular hyperplasia of Brunner glands associated with gastric hypersecretion and lipomatous atrophy of the pancreas.

The case of a 34-year-old woman complaining of diarrhoea and abdominal pain is presented. Contrast radiography and endoscopy showed multiple polypoid tumours in the second part of the duodenum. Moreover, a severe fatty infiltration of the pancreas was shown by magnetic resonance and computed tomography scans. Due to pain, pancreatoduodenectomy (Whipple operation) was performed, and subsequent histopathologic examinations showed excessive Brunner gland hyperplasia of the duodenum and severe lipomatous atrophy of the pancreas. The occurrence of these two rare conditions in one patient has not been described previously, and it is conceivable that the lipomatous atrophy and exocrine insufficiency of the pancreas may have caused a compensatory stimulation of the submucosal structures of the duodenum.

Protein C activation during the initial phase of experimental acute pancreatitis in the rabbit.

BACKGROUND: Disturbances of coagulation and fibrinolysis are well-known systemic effects of acute necrotising pancreatitis (ANP). The purpose of this experimental study was to evaluate the initial events in the haemostatic activation during ANP in an animal model with relevance to the human situation. METHODS: ANP was introduced in 7 rabbits by infusion of chenodeoxycholic acid in the pancreatic duct. Seven rabbits served as sham-operated controls. Serial measurements of coagulation variables (prothrombin time, activated partial thromboplastin time, FVII activity, fibrinogen, tissue factor activity), anticoagulant proteins (protein C, antithrombin) and fibrinolytic factors (tissue plasminogen activator, plasminogen activator inhibitor-1) were performed for 5 h. RESULTS: ANP was confirmed by elevated serum amylase, development of ascites, and histological changes of the pancreas. A moderate activation of the coagulation system was found in both study groups. A significant decrease in protein C concentration from 1 h after the induction of ANP was found, whereas the response of antithrombin and the inhibition of the fibrinolytic system were similar in the 2 study groups. Microthrombosis of the lungs or kidneys was found in 2 rabbits with ANP. CONCLUSION: An immediate activation of protein C is a specific characteristic of the haemostatic activation in ANP in rabbits. This activation has not been described previously and the possible therapeutic implications ought to be studied.

Sodium fusidate and the cytokine response in an experimental model of acute pancreatitis.

BACKGROUND: New therapies designed to downregulate the aberrant immune response associated with severe acute necrotizing pancreatitis (ANP) are being increasingly investigated in different experimental models of ANP. The aim of this study was to test the potential effects of sodium fusidate on the course of severe ANP in rabbits. METHODS: ANP was induced in 20 rabbits by retrograde injection of 5 per cent chenodeoxycholic acid into the pancreatic duct followed by duct ligation. The rabbits were allocated to pretreatment with intravenous physiological saline or sodium fusidate 80 mg/kg 30 min before the induction of ANP. Levels of serum amylase, lipase, tumour necrosis factor (TNF) alpha, interleukin (IL) 8, glucose and calcium, and leucocyte count were measured every 3 h for a total of 12 h. At the end of the experiment, ascitic fluid was collected and the pancreatic, lung and kidney tissues were obtained for histological examination. RESULTS: Pretreatment with sodium fusidate reduced the mortality rate from six of ten to three of ten (P < 005) and reduced the output of ascitic fluid from 5 2 to 2.0 ml/h (P < 0001). Serum levels of TNF-alpha and IL-8 were reduced significantly in the treated group from 5 min up to 9 h after induction of ANP. The leucopenia observed after 3 h in the untreated group was not significantly improved in the group treated with sodium fusidate (P = 0.055). By contrast, both treated and untreated rabbits had similar biochemical changes including levels of amylase, lipase, glucose and calcium as well as similar histological changes in the pancreas and lungs. CONCLUSION: Pretreatment with sodium fusidate resulted in a considerable reduction in mortality rate and ascitic fluid output in rabbits with bile-induced ANP, probably by lowering the TNF-alpha and IL-8 blood levels. However, pretreatment with sodium fusidate did not alter the local or systemic manifestations of ANP. Thus, cytokines other than TNF-alpha and IL-8 are likely to mediate the local and systemic symptoms of ANP.

Aseptic laparoscopic colon resection with intraabdominal anastomosis. An experimental study in pigs.

BACKGROUND: We evaluated a new aseptic method for laparoscopic left colon resection in terms of technical feasibility and outcome. METHODS: Ten pigs were operated on under general anesthesia. Pre- and postoperative body weight, stools, behavior, and need for analgesics were recorded. Fourteen days later, the animals were killed. At autopsy, the degree of intraabdominal adhesions was noted. The anastomoses were sent for histological examination. The entire procedure was performed intracorporeally, and no antibiotics were given. After division of the mesocolon, the segment to be resected was invaginated down through the colon. This was facilitated by a custom-made instrument that was introduced into the bowel via the anus; it consisted of a pull-out device and a modified diathermy wire. The anastomosis was completed at the invagination fold by a row of hernia staples that were covered by an interrupted suture. Then the invaginated bowel was transected by the diathermy wire and delivered through the anus. RESULTS: One animal was killed before completion of the operation because of a colonic perforation. The remaining nine animals had an uneventful and rapid recovery. They ate from the 1st postoperative day and gained weight rapidly. Stools were normal after 2 days (median), and normal behaviour was noted in all animals from the 1st postoperative day. At the postmortem examination, intraabdominal adhesions were observed in two animals. In one case, the adhesions extended from a hematoma in the mesentery to the abdominal wall. There were no adhesions to the anastomosis or the colon. In the other case, the anastomosis adhered to the right uterine tube and a loop of small intestines. CONCLUSIONS: The method is technically feasible, but a modification is suggested for cases where the invagination is impossible. Recovery after the operation is rapid.

IT 9302, a synthetic interleukin-10 agonist, diminishes acute lung injury in rabbits with acute necrotizing pancreatitis.

BACKGROUND: Proinflammatory cytokines (eg, tumor necrosis factor [TNF]-alpha, interleukin [IL]-1 and Il- 8) are believed to play an important role in the pathogenesis of acute necrotizing pancreatitis (ANP) and its systemic complications. Recently, IL-10 has emerged as a major anti-inflammatory cytokine, inhibiting the secretion and activities of inflammatory cytokines. Further, a protective effect of IL-10 has recently been shown in experimental acute pancreatitis. The purpose of this study was to test the potential role of a newly developed IL-10 agonist, IT 9302, in a model of ANP in rabbits. METHODS: ANP was induced in 18 rabbits by retrograde injection of 5% chenodeoxycholic acid in the pancreatic duct, followed by duct ligation. The rabbits were allocated to pretreatment with intravenous physiologic saline solution or IT 9302 (200 micrograms/kg) 30 minutes before the induction of ANP. RESULTS: Injection of IT 9302 resulted in a significant reduction in the blood levels of TNF-alpha and IL-8 from 3 to 6 hours. IT 9302 also reduced the amount of ascitic fluid and significantly inhibited neutrophil infiltration and margination, as well as the number of CD11b- and CD18-positive cells in the lung tissues. By contrast, the local pancreatic necrosis, as well as the biochemical changes such as serum amylase, lipase, and calcium, was sever and similar in both groups. Survival was improved significantly after treatment with IT 9302. CONCLUSIONS: As expected, IT 9302 cannot change the degree of ANP induced by 5% bile acid but does reduce mortality rates and the development of acute lung injury, probably through the inhibition of circulating levels of TNF-alpha, IL-8, and the expression of the adhesion molecule complex CD11b/CD18.

Whipple's operation for carcinoma of the pancreatic head and the ampullary region. Short-and long-term results.

BACKGROUND AND METHODS: In this retrospective review short- and long-term perspectives have been evaluated for 108 patients who, during 1982 through 1992, had Whipple's operation performed for carcinoma of the pancreatic head (PC, n=63) or the ampullary region (AC, n=45). In 24 patients the operation was not radical (21 with PC and 3 with AC). RESULTS: Total perioperative morbidity was 60%, and 13 patients (12%) died within 30 days of operation. This decreased from 15.2% in the first half of the study period to 8.2% in the second half. Recurrence occurred in 56.2% of the remaining 73 patients, with no significant differences between PC and AC. Recurrence was related to regional lymph node metastases and poor tumour differentiation. Overall 5-year survival was 7.4% for PC and 24.8% for AC. For patients with radically excised tumours surviving 30 days the 5-year survival rates were 13.1% for PC and 30% for AC. CONCLUSION: Careful preoperative evaluation is still of great importance.

A monoclonal anti-interleukin 8 antibody (WS-4) inhibits cytokine response and acute lung injury in experimental severe acute necrotising pancreatitis in rabbits.

BACKGROUND: Interleukin 8 (IL-8) has recently been proposed to have an important role in mediating the development of the systemic sequelae associated with severe acute pancreatitis. AIMS: To define the role of IL-8 in acute pancreatitis by neutralising its effects with a monoclonal anti-IL-8 antibody (WS-4), in a rabbit model of severe acute pancreatitis. METHODS: Acute pancreatitis was induced by retrograde injection of 5% chenodeoxycholic acid into the pancreatic duct and duct ligation. Twenty rabbits were divided equally into two groups: acute pancreatitis controls received physiological saline and the treated group received WS-4, 30 minutes before induction of acute pancreatitis. RESULTS: Pretreatment of animals with WS-4 resulted in significant down regulation of serum IL-8 and tumour necrosis factor alpha (TNF-alpha) from three to six hours after induction of acute pancreatitis (p = 0.011 and 0.047 for IL-8 and 0.033 and 0.022 for TNF-alpha, respectively). In addition, a significant reduction in the CD11b and CD18 positive cells and the amount of interstitial neutrophil infiltration in the lungs from WS-4 treated animals was seen. In contrast, WS-4 did not alter the amount of pancreatic necrosis and the serum concentrations of amylase, lipase, calcium, and glucose. CONCLUSION: WS-4 cannot change the amount of pancreatic necrosis induced by injection of 5% bile acid, but does reduce the acute lung injury, presumably through inhibition of circulating IL-8 and TNF-alpha, and CD11b/CD18 in lung tissue. Therefore, a role of IL-8 in the progression of acute pancreatitis and the development of its systemic complications is suggested.

[Esophagoscopy in patients with angina pectoris and normal coronary arteriography]. / Ovre endoskopi hos patienter med angina pectoris og normal koronararteriografi.

The clinical value of oesophago-gastro-duodenoscopy and distal oesophageal biopsies was investigated in 49 patients with angina pectoris and normal coronary angiograms. The results were compared to 24 hour oesophageal pH-monitoring of the patients and of a control group of 22 healthy sons. Macroscopic esophagitis--mainly grade I was found in 31% of the patients and microscopic oesophagitis in 25%. The only major abnormalities were the identification of three peptic ulcers (6%). Median (range) reflux index was 1.3 (0.0-13.4) in the patient group and 2.1 (0.0-9.9) in the controls (p = 0.49). There were no differences with respect to endoscopical findings or reflux index between patients with a positive and patients with a normal exercise electrocardiogram. At a median 36 months post study 38% of the patients had undergone acid secretion inhibitor treatment with an effect on symptoms in only 4%. The study provides evidence that routine oesophago-gastro-duodenoscopy is of limited value in this patient group.

Upper endoscopy in patients with angina and normal coronary angiograms.

BACKGROUND AND STUDY AIMS: It has been recommended that patients with angina, a normal coronary angiogram, and no other signs of heart disease, should be evaluated using esophagogastroduodenoscopy before referral to dynamic esophageal investigations. The aim of the present study was to investigate the clinical value of upper endoscopy in this patient group. PATIENTS AND METHODS: Forty-nine consecutive patients (28 women aged 18-70 years, mean 51.6 years) with angina-like chest pain and a normal coronary angiogram, who were referred to a tertiary cardiologic center, were included in a prospective study. Upper endoscopy with distal esophageal biopsies was performed. The results were compared with 24-hour pH monitoring. At a median of 36 months after discharge, the patients were asked to complete a follow-up questionnaire. RESULTS: Macroscopic esophagitis was found in 15 patients (31%), and microscopic esophagitis in 11 (25% of the patients who underwent esophageal biopsy). One patient had macroscopic grade II esophagitis, and the rest had grade I esophagitis. The only major abnormalities were three peptic ulcers (6%). Five patients had symptoms of gastroesophageal reflux, but the 24-hour pH monitoring revealed an abnormal reflux index in only one. The median reflux index was 1.3 (range 0.0-13.4) in the patient group and 2.1 (range 0.0-9.9) in a control group (n = 22; p = 0.49). Patients with positive and normal exercise electrocardiography did not differ in terms of the endoscopic findings or reflux index. At the post-study follow-up, 38% of the patients had undergone acid secretion inhibitor treatment, with an effect on symptoms in only 4%. CONCLUSIONS: The study provides evidence that routine esophagogastroduodenoscopy is of limited value in this group of patients.

Tamm-Horsfall glycoprotein in streptozotocin diabetic rats: a study of kidney in situ hybridization, immunohistochemistry, and urinary excretion.

Tamm-Horsfall glycoprotein, present only in the kidney thick ascending limb of Henle's loop, was studied here in streptozotocin diabetic rats. Tamm-Horsfall glycoprotein mRNA in situ hybridization was performed on snap-frozen left kidneys; the right kidneys were perfusion-fixed with 4% paraformaldehyde and embedded either in paraffin, for Tamm-Horsfall glycoprotein immunohistochemistry, or in Epon for stereologic measurements. The length of the thick ascending limb of Henle's loop and the amount of glycogen were measured and the ultrastructure of the cells was evaluated. Urinary excretion of Tamm-Horsfall glycoprotein, calcium, magnesium and albumin was measured. After 10 and 50 days' duration of diabetes, kidney weight increased 20 and 41%, respectively and the length of the thick ascending limb of Henle's loop increased 28 and 56%, respectively, compared with controls. Substantial glycogen accumulations were present in the thick ascending limb of Henle's loop, and electron microscopy revealed a significant decrease in organelles and basolateral membranes. After 10 and 50 days' duration of diabetes, in situ hybridization of Tamm-Horsfall glycoprotein mRNA revealed a fourfold decrease, and the immunostaining for Tamm-Horsfall glycoprotein showed a threefold decrease as measured by densitometry. However, urinary Tamm-Horsfall glycoprotein excretion rate was increased fivefold and urinary concentration about twofold. Urinary calcium excretion increased three-fold and magnesium twofold, but urinary albumin excretion was not significantly increased. The increased amount of Tamm-Horsfall glycoprotein, calcium and magnesium in the urine in diabetes occurs here concomitant with severe cellular damage in the thick ascending limb of Henle's loop.

The effect of treadmill exercise on azoxymethane-induced intestinal neoplasia in the male Fischer rat on two different high-fat diets.

A total of 120 eight-week-old male rats were exposed to azoxymethane (15 mg/kg body wt in saline s.c.) on Days 1, 4, and 8. Two days after the last injection of carcinogen, the rats were randomized into four experimental groups: two groups were given a chow high in corn oil (23% corn oil) and two groups a chow high in coconut oil (21% coconut oil and 2% corn oil). One group on each chow was kept sedentary, and one group was exposed to moderate exercise, running 2 km/day on weekdays for 38 weeks. At the end of the experiment, the exercising and sedentary rats fed coconut oil were significantly heavier than those fed corn oil. Among the rats fed the high-fat corn oil diet, exercise reduced the number of animals developing carcinomas in the colon (sedentary, 10; exercise, 0) and in the small intestine (sedentary, 5; exercise, 0). The same tendency was observed in the rats fed the coconut oil diet: colon (sedentary, 6; exercise, 3) and small intestine (sedentary, 3; exercise, 2). In the sedentary rats fed the high corn oil diet, 16 intestinal carcinomas were recorded; none were found in the exercised group. In the rats fed the high coconut oil diet, nine carcinomas were recorded in the sedentary groups as opposed to five in the exercised rats. Rats fed the high-fat coconut oil developed significantly fewer neoplasms than the rats fed the equally high-fat corn oil diet.

Effect of exercise on intestinal tumour development in the male Fischer rat after exposure to azoxymethane.

Thirty-two male Fischer rats were exercised in a treadmill, 2 km daily on weekdays for 38 weeks, after three subcutaneous injections of azoxymethane, 15 mg/kg body weight. Randomly selected control animals were housed in regular 38 x 22 cm cages in groups of no more than three rats per cage. All rats were allowed free access to food and water. The exercising rats ate about 20% more than the sedentary rats, but gained less weight. Fat stores were considerably smaller in the exercised rats whereas the lean body mass and ash content were similar. After 38 weeks significantly fewer rats in the exercise group had developed neoplasia of the colon mucosa.

The progression of cisplatin-induced tubulointerstitial nephropathy in rats.

We have previously shown that administration of cisplatin to rats leads to chronic nephropathy with many atubular glomeruli. Using unbiased stereological and histochemical methods our purpose was to investigate the progression of renal structural changes, specifically the events preceding and following the formation of atubular glomeruli in rats after increasing total doses of cisplatin. After administration of cisplatin (2 mg/kg body weight i.p. once weekly) the animals were sacrificed 10 days, three, six, 10 and 20 weeks later. After 4 mg/kg the distal part of most proximal S3 segments appeared necrotic with a negative reaction for enzymes characteristic of brush border and mitochondria. After larger doses, atrophy (and possibly necrosis) was observed in clusters of cortical proximal and distal nephron segments corresponding to an increasing amount of non-functioning nephrons. Hypertrophy/hyperplasia of remaining uninjured nephrons and collecting ducts was observed. The stereological investigations showed an increasing number of atubular glomeruli with open capillaries or glomeruli connected to atrophic tubules with the total dose of cisplatin (30% and 40%, respectively, after 20 mg/kg). The percentage of glomeruli with damaged tubules was significantly higher in the juxtamedullary cortex compared with the superficial cortex. Sclerotic glomeruli were not observed. The findings suggest that a toxic destruction of most S3 segments leads to atrophy or disappearance of the corresponding nephrons with formation of atubular glomeruli, and that the remaining hypertrophic nephrons are connected to the few surviving or regenerated S3 segments.

Time to loco-regional recurrence after resection of Dukes' B and C colorectal cancer with or without adjuvant postoperative radiotherapy. A multivariate regression analysis.

Factors influencing time to loco-regional recurrence were identified in a multivariate regression analysis of data from a series of 468 radically operated patients (260 Dukes' B and 208 Dukes' C) with carcinoma of the rectum and the rectosigmoid. A number of clinical and pathological characteristics were prospectively collected and recorded. In addition, carcinoembryonic antigen (CEA) was measured within 1 week before surgery. The endpoint used was recurrence below the level of the umbilicus. All patients were followed for at least 5 years or until time of death. The two Dukes' stages B and C were analysed in two separate analyses using the Cox proportional hazards model. In patients with Dukes' B tumours, an increased risk of loco-regional recurrence was associated with perineural invasion, tumour located less than 10 cm from the anal verge, patient aged above 70 years, and small tumour size. In patients with Dukes' C tumours, the necessity to resect neighbour organs, perineural and venous invasion, tumour located less than 10 cm from the anal verge, and large tumour size were all associated with a poor loco-regional outcome. Postoperative radiotherapy was not a significant prognosticator for loco-regional control. An update of the 5-year results of the randomised study of post-operative radiotherapy (50 Gy with 2 Gy per fraction in an overall treatment time of 7 weeks) showed no survival benefit from adjuvant radiotherapy in either Dukes' category and no statistically significant improvement in the 5-year loco-regional control rate. However, when the comparison was restricted to a group of high-risk patients there was a statistically significant benefit from radiotherapy with respect to loco-regional control (P = 0.03) but not with respect to survival (P = 0.23). The potential advantage, in terms of the required number of patients, of restricting clinical trials of intensified loco-regional therapies to the high-risk patients, is illustrated.

The presence of HPV types 6/11, 13, 16 and 33 in bowenoid papulosis in an HIV-positive male, demonstrated by DNA in situ hybridization.

A perianal bowenoid papulosis was examined for the presence of HPV types 2, 6, 11, 13, 16, 18, 32 and 33 by DNA in situ hybridization. Positive signals were seen for HPV types 6/11, 13, 16 and 33. HPV type 13 is strongly related to oral focal epithelial hyperplasia and has not been reported outside the oral cavity before.