Gastric ulcers and risk for cancer. Is follow-up necessary for all gastric ulcers?

The aim of this study was to determine the accuracy of initial endoscopy combined with histology and to define whether there is a point in following-up all gastric ulcers until complete healing. We have studied all patients with gastric ulcers documented at endoscopy during a 6-year period. Ulcers were macroscopically characterised as benign or suspicious for malignancy, and biopsies were taken. A follow-up endoscopy and histology was performed 4-6 weeks and 3 months after an anti-ulcer treatment. Resistant ulcers were treated surgically. All patients were followed-up clinically and endoscopically for a year after complete ulcer healing. 802 patients with gastric ulcers were enrolled. At initial endoscopy, 732 ulcers (91.3%) were macroscopically characterised as benign and 70 ulcers (8.7%) as suspicious for malignancy. In the group of endoscopically benign ulcers, only one (0.1%) had malignancy detected by biopsy in the first examination. None of these ulcers turned out to be malignant on subsequent examinations. From the suspicious for malignancy ulcers, 20 (28.6%) were proven to be malignant. Endoscopy may recognise with great accuracy benign ulcers, but it overestimates the malignant ones. The cost-benefit of serial follow-up endoscopies should be re-evaluated in ulcers that appear benign, and biopsies are negative at the initial examination.

Corneal complications following abuse of topical anesthetics.

PURPOSE: To describe corneal complications in three patients following abuse of topical anesthetics. MATERIALS AND METHODS: We describe one case with bilateral corneal perforation, another with unilateral corneal perforation and a third case of chronic keratitis following excessive use of topical anesthetics. RESULTS: Two patients continued to instill topical anesthetic drops despite all recommendations to stop. The result was a bilateral corneal perforation in the first case and a large unilateral descemetocele in the second. The third patient who had chronic toxic keratitis discontinued the anesthetic drops and after the appropriate treatment the cornea returned to normal. Corneal grafting and conjunctival flaps were used to seal the corneal perforation but the long-term anatomical and functional results were very poor. CONCLUSIONS: The initial presentation of this rare clinical entity creates difficulties in reaching a correct diagnosis. A presumed acanthamoeba keratitis is the first choice among many similar conditions. Thus abuse of topical ocular anesthetic drops should be included in the differential diagnosis of cases of chronic keratitis as it may masquerade as acanthamoeba keratitis. A current or past history of psychiatric and mental disorders or psychoactive substance abuse is important in the diagnosis. Functional and anatomical results after appropriate treatment are usually poor. Psychiatric counselling is extremely helpful and is in fact mandatory in the management of these patients.

Nonfunctional adrenal cortical carcinoma. Report of a case and review of the literature.

Nonfunctional carcinomas of the adrenal gland are quite rare. By presenting a 47-year-old woman with such a tumour, a review of the literature is made, with special emphasis on the epidemiology and histologic criteria in predicting malignant behaviour. In addition, the clinical, pathological and radiographic findings, as well as the treatment modalities of this neoplasm are discussed.