Iron tablets cause histopathologically distinctive lesions in mucosal biopsies of the stomach and esophagus.

Iron tablets are widely used in the community. Severe, sometimes lethal, damage to the gastrointestinal tract following overdose is well known, but there is less appreciation of the damage that can be caused by therapeutic dosage. In this histological study of three esophageal lesions and six gastric lesions (including one autopsy case), heavy iron accumulation was demonstrated within ulcer granulation tissue, in connective tissue and blood vessels of the mucosal lamina propria, and within glandular and squamous epithelium. The appearance was distinctive and was similar to that seen following overdosage, although more localized. Five of the patients studied had evidence of delayed esophageal or gastric emptying which could have contributed to the damaging effect of the iron tablets. In most of the patients ulceration appeared to have preceded the commencement of iron therapy, so that the iron probably exacerbated rather than initiated ulceration and stricture formation. Histopathological reporting of iron-induced changes in endoscopic biopsies will alert clinicians to a correctable pathological process.

Brain-invasive meningioma in a 16-month-old boy.

A previously well 16-month-old boy presented to Sydney Children's Hospital with generalised seizures. There was no history of neurofibromatosis and no family history. Imaging revealed a well-demarcated, frontal intracranial mass at the grey-white matter junction with surrounding oedema. At operation, the tumour was adherent to the underlying brain on its deep aspect but superficially connected to the dura. There was an associated peritumoural cyst. The tumour was biopsied for intra-operative frozen section opinion and excised in its entirety. The specimen consisted of a 25 x 25 x 17 mm nodule of firm cream tissue and separate fragments. Histologically, the tumour was a meningioma with frequent mitoses, necrosis and brain invasion. Optimal treatment, in view of the recurrence risk, includes complete excision and postoperative irradiation. The latter was deferred because of the young age. At follow-up at 26 months, the child was well and free of disease on MRI scan. Paediatric meningiomas are rare, with very few brain-invasive examples in reported series. In infants and young children, few meningiomas have been reported. There are several notable differences between meningiomas in children and adults. This report illustrates these differences.

Improving the predictability of performance by prerace detection of dorsal metacarpal disease in thoroughbred racehorses.

OBJECTIVE: To determine the prevalence of dorsal metacarpal disease in 2-year-old Thoroughbred horses by prerace inspection and to evaluate the effectiveness of a dorsal metacarpal disease detection program on the predictability of race performance (finishing in the order predicted by punters) and the distance between the first- and last-placed horse in a field. DESIGN: A retrospective study using client-owned horses. METHODS: A program of prerace detection of dorsal metacarpal disease using digital palpation of the dorsal aspect of the third metacarpal bone of both forelimbs of 2-year-old Thoroughbreds racing at Ascot racecourse was instituted by the Western Australian Turf Club in December 1995. Horses that had significant pain reaction to digital palpation were considered to have pain due to dorsal metacarpal disease, withdrawn from that day's race and not permitted to race for 6 weeks. The race records of all 2-year-old Thoroughbreds racing at Ascot racecourse from December 1993 until December 1995 were compared with the race results from December 1995 until March 1997, after initiation of the dorsal metacarpal disease detection program. RESULTS: After initiation of the program, horses were racing more predictably over 1100 m (P = 2.09) and 1200 m (P = 3.48). These horses finished closer to the winner over 1100 m (P = 3.39) and over 1200 m (P = 3.13). In 1000 m races, the trend for horses to race more predictably (P = 1.07) and for there to be less distance between first and last (P = 1.72) was not statistically significant. CONCLUSIONS: The program of prerace digital palpation for dorsal metacarpal disease was considered to be beneficial in 2-year-old Thoroughbreds racing over 1100 m and 1200 m, in that they raced more predictably.

Prevalence and predictors of adolescent dating violence.

This study of 561 rural North Carolina adolescents examined relationships among race, parental educational level, family structure, parental discipline, family violence exposure, and dating violence experiences. The sample was predominantly female (77%), with 40% black and 58% white. The subjects ranged in age from 15 to 20 years; 80% of the adolescents were 16-18. Dating violence experiences were assessed by a researcher-constructed instrument measuring warning signs of potential violence and actual violent experiences. The results suggested that recognition of abusive relationships is difficult, with many adolescents denying such a relationship but actually reporting numerous abusive events. Sixty percent had experienced violent acts during dating relationships; 24% reported extreme violence (episodes of rape, use of weapons). More than 20% of the adolescents reported family violence and 2.2% reported family sexual abuse. The study suggests new avenues for research in adolescent date violence, and for interventions with high risk groups.

Symptom provocation in irritable bowel syndrome. Effects of differing doses of fructose-sorbitol.

The role of fructose and sorbitol, when ingested together, in the aetiology of irritable bowel syndrome (IBS) is controversial. The aims of this study in IBS patients, therefore, were to compare differences in symptom provocation with various doses of fructose-sorbitol and to relate differences in the extent of colonic hydrogen production after each dose to such symptom provocation. Two different mixtures of fructose and sorbitol--20 g fructose plus 3.5 g sorbitol ('lower' dose) and 25 g fructose plus 5 g sorbitol ('higher' dose)--were administered to 15 patients with IBS and to 24 healthy controls. Breath hydrogen concentrations were determined at 10-min intervals for 3 h after ingestion of each mixture, and the presence and severity of a range of gastrointestinal symptoms were recorded on a standard form before, during, and after the study. Total symptom score in IBS patients, but not controls, was greater (p < 0.05) after the higher than after the lower dose of fructose-sorbitol mixture, and, for the higher dose, symptoms were significantly greater in IBS patients than in controls (p < 0.05). Moreover, the increase in total symptom score between the higher and lower dose mixtures was of a greater magnitude (p = 0.01) in IBS patients than in controls. No significant correlation was observed between the increase in symptom score and the increase in peak hydrogen concentration or the increase in integrated hydrogen response between lower and higher dose mixtures, although these latter increases were at times substantial.(ABSTRACT TRUNCATED AT 250 WORDS)

Extraction of myosin light chains and actin from bovine cardiac muscle acetone powder.

A joint preparation of the two myosin light chains and actin from bovine cardiac muscle acetone powder is described. There is a significant improvement in the ease of purification, while the yield of the myosin light chains equals the best yields obtained from the use of established techniques. The actin yield greatly exceeds that obtained in an earlier published report.

Genetic analysis of multiple sporadic colon carcinomas from a single patient.

At least two separate genetic pathways of carcinogenesis in sporadic colon cancer involving the accumulation of mutations at various genetic loci have been described. About 15% of sporadic colorectal carcinomas arise via a mechanism associated with microsatellite instability (MSI) and mutations in transforming growth factor beta receptor II (TGFbetaRII), insulin-like growth factor II receptor (IGFIIR) and BAX, whilst the remaining 85% are associated with aneuploidy and gross chromosomal rearrangements. An 81-year-old woman had a sigmoid colon carcinoma resected and 18 months later developed two additional carcinomas of the caecum and transverse colon. To investigate whether there was a common genetic mechanism of carcinogenesis for the three lesions, MSI status was assessed, TGFbetaRII, IGFIIR and BAX were analysed for mutations and protein expression of transforming growth factor beta1 (TGFbeta1) and p53 were studied using immunohistochemistry. The caecal and transverse colonic carcinomas were both MSI positive but different mutations were identified in each lesion. No genetic abnormalities were identified in the sigmoid colonic carcinoma. This suggests that each carcinoma arose via a separate genetic mechanism of carcinogenesis.

Surfactant protein B deficiency: clinical, histological and molecular evaluation.

Congenital alveolar proteinosis due to surfactant protein B deficiency is an inherited disease which results in severe respiratory failure in term infants soon after birth. The pathophysiologic basis of this disease is now known to be an inability to synthesise adequate quantities of normally functioning surfactant protein B. We report a male infant with fatal respiratory failure of neonatal onset, and histopathological features typical of those seen in congenital alveolar proteinosis. Molecular analysis of genomic DNA revealed two mutations, the 'common' 121ins2 mutation in exon 4, and a novel 2bp frameshift mutation in exon 5. We believe this is the first Australian case of surfactant protein B deficiency confirmed by molecular analysis.