Diagnosis and prognosis in colon cancer based on a profile in immune reactivity.

An immunologic profile consisting of measurements of circulating carcinoembryonic antigen (CEA), tumor antigen-induced inhibition of monomuclear cell migration (IMM) and skin reactivity to purified protein derivative, streptokinase-streptodornase, and mumps was assessed as a diagnostic and prognostic tool in 16 patients with colon cancer. Preoperatively, 10 of 14 patients tested had elevated CEA, 12 of 12 showed tumor antigen-induced IMM, and 10 of 11 failed to react to 2 or more recall antigens. Potential surgical cure (7 patients) was accompanied by normal CEA in 4, absent tumor antigen-induced IMM in all 7, and increased skin-test reactivity in 6. Disseminated cancer (9 patients) was associated with elevated CEA in all 9, with absent IMM in all 7 and with suppressed skin-test reactivity in 6 of 9.

An observational study of direct oral anticoagulant awareness indicating inadequate recognition with potential for patient harm.

UNLABELLED: Essentials Ignorance of direct oral anticoagulants' effects on coagulation tests may be a safety issue. An electronic questionnaire was sent to prescribers in NHS Grampian with 143 respondents. We found widespread evidence of inappropriate interpretation of the clinical scenarios given. The study suggests potential for patient harm due to lack of knowledge and education is required. SUMMARY: Background Lack of awareness of the nature of the direct oral anticoagulants (DOACs) combined with the poor correlation between routine coagulation test prolongation and the activity of these drugs represents a potential for patient harm. Objectives To establish the level of awareness of the different DOACs, and to assess whether prescribers were able to recognize the state of anticoagulation in a hypothetical patient. Methods and results An electronic questionnaire was sent by email to prescribers in our health board. Among 143 respondents, we found significant differences in awareness of the currently licensed drugs. Of the respondents, 88%, 80% and 50%, respectively, recognized rivaroxaban, dabigatran, and apixaban. When provided with a routine clinical situation, only 13.5%, 17.5% and 16.8%, respectively, recognized that the hypothetical patient was anticoagulated, and only 55-58% recognized that it was unsafe to proceed with an invasive procedure. Conclusion These results indicate a significant risk for patient harm related to lack of knowledge about this new group of frequently used drugs, and indicate that additional education and training on this subject are required.

Prognostic factors in colon carcinoma: correlation of serum carcinoembryonic antigen level and tumor histopathology.

The results of histopathologic study and the preoperative circulating carcinoembryonic antigen levels were correlated with each other and with the postoperative clinical course in 45 surgically treated patients with cancer of the colon. Histopathologic evaluation of the tumor included the depth of bowel wall involvement according to the Dukes classification, the histologic differentiation of cells on the basis of Broders' grades of malignancy, evidence of lymphocyte and plasma cell infiltration within and surrounding the primary tumor, and evidence of blood vessel, lymphatic, and perineural invasion. All these parameters, including the serum carcinoembryonic antigen level, had prognostic value. Low serum carcinoembryonic antigen levels in patients with colonic cancer suggested tumor localized within the bowel wall; the highest values were found in patients with tumors that had spread beyond the bowel wall. An inverse correlation was noted between the degree of tumor differentiation and carcinoembryonic antigen levels in the same patient. Carcinoembryonic antigen levels tended to be elevated when blood vessel, lymphatic, and perineural invasion was present. An inverse correlation was also noted between the preoperative carcinoembryonic antigen level and the degree of lymphocyte and plasma cell infiltration in the primary tumor. Round cell infiltration was interpreted as an indication of the host's immune response against the tumor. Thus, on the basis of clinical follow-up of the patients it is concluded that all morphologic parameters evaluated have prognostic value, that preoperative serum carcinoembryonic antigen levels have prognostic value, that all prognostic parameters correlate with each other appropriately, and that the combined parameters are more reliable than any single one alone.

Massively bleeding gastric pouch ulcer after silastic ring vertical gastroplasty successfully treated endoscopically: a report of two cases.

Two patients who developed massive bleeding from a gastric pouch ulcer are described. This rare complication occurred during the early postoperative course after silicone ring vertical gastroplasty (SRVG). In both cases the bleeding stopped after the ulcers were injected with epinephrine and alcohol. Both ulcers healed after 1 month of treatment with omeprazole (Losec). The probable etiology of this rare complication is discussed.

Malabsorption due to a ventral hernia.

A case of malabsorption due to a stagnant loop which occurred in a huge ventral hernia is presented. The clinical course was relatively indolent with symptoms of malabsorption and occasional abdominal pain. Although rare, abdominal hernia can lead to malabsorption due to bacterial overgrowth as a result of stagnant loop.

Bleeding esophageal varices in pregnancy. A report of two cases.

Hemorrhage from esophageal varices during pregnancy in women with cirrhosis is a rare occurrence with a high mortality rate. Two such women, previously treated surgically for bleeding varices, one with additional sclerotherapy, had massive hemorrhages at 35 weeks necessitating cesarean section for fetal distress. Both neonates were healthy. One woman died one week postpartum. Pregnancy does not appear detrimental to the maternal prognosis despite the theoretical probability of raised portal pressure. About 70% of those with demonstrable varices will bleed during pregnancy; the overall mortality rate is 20%. Endoscopy and sclerotherapy before and in early pregnancy may help reduce the mortality rate. An awareness of the possibility of unpredictable bleeding and of the available treatments in a pregnant woman with esophageal varices is essential.

Coagulation studies for severe liver disease detection in a gastroenterologic department.

15 patients with clinical, histological and laboratory findings of cirrhosis were investigated. When the results of routine hemostasis tests--thrombin time, reptilase time and fibrinogen quantitation by clotting methods--were prolonged, further immunological determinations were done. Normal results in the immunological determinations together with prolonged ones obtained by clotting methods are suggestive of dysfibrinogenemic states. A possible survey of the treatment with the help of these determinations is proposed.

Chromosome sensitivity to bleomycin-induced mutagenesis in lymphocytes from colorectal cancer patients under 40 years of age.

PURPOSE: The incidence of colorectal cancer in young adults (under 40 years of age) is rare. The reason for the occurrence in these patients may lie in their genetic background. METHODS: We studied chromosomal fragility in peripheral blood lymphocytes of patients under the age of 40 with large bowel cancer. Lymphocytes from 24 subjects were examined: 10 untreated large bowel cancer patients under the age of 40 and 14 age-matched and sex-matched controls. RESULTS: The mean number of spontaneous chromosomal breaks per cells (b/c) was significantly higher in the right-sided large bowel cancer patients (0.23 +/- 0.12 b/c) compared with the control group (0.09 +/- 0.04 b/c; P < 0.01), but with no significant difference between the left-sided colorectal cancer patients and the control group. Lymphocytes exposed to the radiomimetic agent, bleomycin, were arrested in methaphase and analyzed for chromosome fragility. Mean chromosome breaks per cell in the left-sided colorectal cancer patients (1.60 +/- 0.49 b/c) were significantly higher than in either the controls (0.72 +/- 0.31 b/c; P < 0.001) or the right-sided, large bowel cancer patients (0.91 +/- 0.24 b/c; P < 0.05). CONCLUSIONS: The increased spontaneous chromosomal breaks in the right colon, as opposed to the increased mutagen-induced chromosomal breaks in the left colon, might indicate that in young colon cancer patients the occurrence of right-sided colon cancer is more likely to be genetically determined, whereas in left-sided colon cancer, environmental carcinogens might play a greater role.

Amputation neuroma after cholecystectomy. A cause of intermittent obstructive jaundice.

A 43-year-old woman developed recurrent attacks of intermittent obstructive jaundice 5 years after cholecystectomy. After 6 years of recurrent attacks, an obstructive lesion was finally demonstrated, and was diagnosed at surgery as an amputation (traumatic) neuroma of the midcommon bile duct (CBD). Symptoms disappeared following surgical removal of the lesion. We review the clinical picture of this relatively rare problem, along with its diagnosis, pathogenesis, and treatment.

The value of tissue mucin changes and CEA content in evaluation of benign colonic adenomas.

A combined histopathologic, histochemical, and immunohistochemical study of benign colorectal adenomas is presented. Specimens of 39 adenomas were studied by hematoxylin and eosin (HE) stain, alcian blue-periodic acid Schiff (AB-PAS), and high-iron-diamine-alcian blue (HID-AB). Carcinoembryonic antigen (CEA) was demonstrated by peroxidase-antiperoxidase (PAP) technique. Variable amounts of neutral mucin and decreased sulfated acid mucin content, as well as increased CEA content, were found in the dysplastic epithelium of benign colonic adenomas. These changes were not seen in normal colonic mucosa. It is suggested that the above-mentioned methods may represent an aid in the evaluation of malignant potential of benign polyps.

Budd-Chiari-like syndrome in Caroli's disease.

Caroli's disease was complicated by a Budd-Chiari-like syndrome as a result of enlarged lymph nodes that compressed the vena cava. Histologically the picture was compatible with "sinus histiocytosis with massive lymphadenopathy." We discuss the combination of these two rare disorders.

Elevated carcinoembryonic antigen levels and biliary tract obstruction.

Circulating carcinoembryonic antigen (CEA) levels and their relation to liver function test values were studied in 29 jaundiced patients with benign extrahepatic biliary tract obstruction and inflammation. During the obstructive and inflammatory phase, 15 (52%) of the patients had CEA levels greater than 2.5 ng/ml. Elevated CEA levels were associated more frequently with common bile duct stones (and cholangitis) than with gallbladder stones (and cholecystitis) alone, although this difference was not statistically significant. The former often had values greater than 5.0 ng/ml. The highest values were found in two patients with liver abscesses. T'HE CEA levels returned to normal following relief of obstruction in seven of ten patients and increased in two patients who had progressive inflammation. Serum alkaline phosphatase and bilirubin levels were significantly higher in the patients with elevated CEA levels (p smaller than .05). Serum alkaline phosphatase levels showed a significant positive correlation with CEA levels (p smaller than .02). Patients with obstructive jaundice and elevated CEA levels do not necessarily have cancer.

X-ray microanalysis of the fingernails in cirrhotic patients.

The element content of clipped nails of 13 patients with liver cirrhosis was examined by X-ray microanalysis, and compared with that of 50 healthy subjects. The results showed a statistically significant increase in the percentage of Na, Mg and P and a slight, but statistically significant decrease in S and Cl. The percentage of K, Ca, Fe, Cu and Zn did not show any difference from that of the controls. The findings indicate that X-ray microanalysis may be a valuable tool for the simultaneous examination of a large number of elements in the fingernails.

The diagnostic significance of sulfated acid mucin content in gastric intestinal metaplasia with early gastric cancer.

Specimens of fifteen surgically resected stomachs with early gastric cancer were histologically and histochemically examined using Alcian blue-periodic acid-Schiff and high iron diamine--Alcian blue stains. Samples were taken from the tumor, from the gastric mucosa 3 cm from the edge, and from the resected margins. In all 15 stomachs colonic intestinal metaplastic changes were present in the tumor tissue, as well as in the adjacent 3 cm mucosa and in the distant resected margins. In all cases neutral mucin content was reduced, whereas acid nonsulfated mucin was increased as demonstrated by Alcian blue-periodic-acid Schiff staining. Furthermore, acid sulfated mucin was demonstrated by high iron diamine-Alcian blue staining in the superficial layer of the metaplastic mucosa adjacent to the cancerous lesion and in the tumor itself. Sparse foci were also found in the surgical margins. We suggest that the increased content of acid sulfated mucin and its distribution might serve as an early indicator of malignant potential of the metaplastic gastric mucosa.

Interferon-alpha and dexamethasone effect on AF10 myeloma cell line sialytransferase activity.

Interferon-alpha and the synthetic glucocorticoid dexamethasone are used in the treatment of multiple myeloma. The effect of 48 h exposure to recombinant interferon-alpha 2b (100 to 10,000 U/ml) and dexamethasone (1 microM to 1 mM) was studied in AF10, and IgE-secreting myeloma cell line. Interferon-alpha and dexamethasone at 10,000 U/ml and 1 mM respectively had a synergistic inhibitory effect on IgE concentration. Interferon-alpha and dexamethasone had an additive inhibitory effect on myeloma cell concentration. Interferon-alpha at 10,000 U/ml caused a twofold increase in sialyltransferase activity. Dexamethasone decreased sialytransferase activity and attenuated the stimulatory effect of interferon-alpha. These data suggest that combined interferon-alpha and dexamethasone therapy might have a synergistic effect on monoclonal protein production and a diverse effect on sialytransferase activity.