Clas Lindström

Destructive lesions of the mandibular condyle following diskectomy with temporary silicone implant

Dacron-reinforced silicone is widely used as disk-replacement implant material in the temporomandibular joint. A retrospective radiographic analysis was undertaken in a series of thirty-two patients on whom diskectomy had been performed. Twenty patients had received temporary silicone implants, whereas twelve patients had surgery without disk-replacement implants. Six of the patients with implants had destructive lesions of the mandibular condyles at follow-up examinations, but no such lesions were seen in any of the patients who had surgery without implants. Histologic analysis of material removed from one patient who had a second operation showed multiple particles of foreign material surrounded by focally marked inflammatory reaction with foreign body granulomas. The underlying cartilage and bone showed focal resorption and bone destruction. Electron microscopy combined with energy-dispersive x-ray microanalysis showed that the foreign material contained silicone. It was concluded that the radiographically observed destructive lesions of the mandibular condyle may be a sign of a reactive synovitis induced by silicone particles abraded from the silicone implant.

Molecular cloning of a small prostate protein, known as beta-microsemenoprotein, PSP94 or beta-inhibin, and demonstration of transcripts in non-genital tissues

In order to study the gene expression of the seminal plasma protein beta-microseminoprotein, also known as PSP94 and beta-inhibin, clones encoding this protein were isolated from a cDNA library constructed in lambda gt11. Nucleotide sequencing confirmed the structure of a previously cloned cDNA. By northern blot analysis identical sized transcripts were demonstrated in the prostate, the respiratory (tracheal, bronchial and lung) tissues and the antrum part of the gastric mucosa. Thus, the protein is not primarily associated with male reproductive function. Although probably of no physiological significance, a slight structural similarity to the ovarian inhibin beta-chains was identified in the C-terminal half of the molecule.

Silicone Carpal Implants: Risk or Benefit?

The present report is based on assessment of 48 patients who underwent carpal Silastic H.P. implant arthroplasty (trapezium, condylar, scaphoid, lunate and scapholunate implants). Mean follow-up period was 29 months (range 6-82). Recurrent pain and/or evidence of wrist synovitis and lytic lesions made early subsequent surgery necessary in 10 patients. In the remaining 38 patients the post-operative course was followed for an average period of 33 months (range 8-82). Severe giant-cell silicone synovitis combined with isolated or disseminated osteolytic lesions were found in 17/30 (56%) patients with scaphoid or lunate implants and in 2/18 (11%) with other types of Silastic carpal implants. Well-defined cysts were observed within 8 months of insertion of the implant. Morphologically, an erosive giant-cell synovitis was regularly seen, with large quantities of intra- and extracellular silicone debris. Abraded material was also observed in central parts of normal bone and in lymph node tissue distant from the implant. The ultimate tissue response to this propagation of silicone particles is unknown. The situation is of great concern and the continued use of proximal carpal Silastic H.P. implants should at present be seriously questioned.

Crohn's disease confined to the appendix

Crohns disease confined to the appendix is a rare entity, less than 50 cases having been reported. The present study reports on another 12 cases representing 6 per cent of all 194 patients operated upon for Crohns disease in a total, unselected series. The indications for surgery were appendicitis in eight patients, appendiceal abscess in two, suspected pyosalpinx in one, and an ovarian cyst in one. The appendices were in all cases strikingly enlarged. Giant-cell granulomas, without microabscesses, were detected in all but one patient. Two patients had early septic postoperative complications. Fistulization from the cecum did not occur. The median observation time after operation was 13.8 years. Since none of the patients had further manifestations of the disease, it is concluded that patients with Crohns disease confined to the appendix have a favorable prognosis.

Prevalence and Clinical Significance of Gliadin Antibodies in Healthy Children and Adults

Coeliac disease (CD) is associated with the presence of gliadin antibodies (GA) (IgG and IgA), often used as a screening test for CD. Using a modified micro-enzyme-linked immunosorbent assay for GA, we studied the prevalence of GA in three healthy groups: children (mean age, 12 years), adult blood donors (mean age, 38 years), and healthy women (mean age, 57 years). We also studied the clinical characteristics of the blood donors. On the basis of findings in 27 untreated CD patients, cut-off levels of IgG and IgA antibody titres were chosen to yield a test with relatively low sensitivity (56%) but high specificity (100%). Analysis of IgM antibodies did not improve the sensitivity. Of the 384 12-year-old children, both IgG and IgA GA positivity was found in 15 (3.91%), a rate significantly greater than that in the blood donors (22 of 1537, 1.43%; p < 0.001) or in the middle-aged women (11 of 944, 1.17%; p < 0.0001). Of the 22 GA-positive healthy blood donors, 13 underwent small-bowel biopsy, but only 1 of the specimens manifested histologic changes compatible with CD. The other 12 had normal specimens, including a normal intraepithelial lymphocyte count. The estimated frequency of CD among the blood donors was thus 1 of 1500, a figure consistent with those previously published. We conclude that GA occur frequently in the Swedish population but that their prevalence decreases with increasing age. As a screening test for CD in healthy individuals, the GA titre is of poor predictive value.

Lack of relationship between cholecystectomy and colorectal cancer. A case control autopsy study in a defined population.

To study the postulated relationship between prior cholecystectomy and occurrence of subsequent colorectal cancer, we examined the prevalence of cholecystectomy in all patients with histologically confirmed colorectal cancer registered during 1966-75 in the city of Malmö. In addition, we studied the frequency of colon cancer in all females autopsied in 1978-79 with a previous cholecystectomy. Of all 1061 cases of colon cancer diagnosed during the 1966-75 period, 94 (8.9%) had undergone cholecystectomy, as compared with 106 (10.0%) in the age-matched controls. In the female subgroup (n = 503) the corresponding figure for cholecystectomy was 58 (11.5%), as compared with 70 (13.9%) in the controls. The incidence of right-sided colon cancer among the 58 females with previous cholecystectomy did not differ from that of age-matched controls (28.6 and 28.1%, respectively). The incidence of colon cancer among 305 females with a prior cholecystectomy autopsied during 1978-79 was 24 (7 right-sided), as compared with 22 (8 right-sided) in age-matched controls without gallbladder disease. Gastric cancer was more frequent (p less than 0.01) in cholecystectomized women than in controls. These results refute the suggested relationship between cholecystectomy and development of colon cancer in any location.

Pre- and Post-Operative Complications in Crohn's Disease with Special Reference to Duration of Preoperative Disease History

In an analysis of a consecutive series of 133 patients with a diagnosis of Crohns disease established preoperatively and in which early surgical intervention was the prevailing policy, the median time between diagnosis and operation was short. For patients with predominantly small-bowel disease it was 4 months and for patients with predominantly colonic involvement 8 months. The frequencies of preoperative and early postoperative complications were low compared with those in other reports. Local complications, such as intra-abdominal fistulae and abscesses, were preoperatively seen in only 4% of the patients. Arthritis, iritis, or erythema nodosum was not seen in patients with predominantly small-bowel disease. The early postoperative death rate was 1.5%, the late mortality rate related to Crohns disease 2.3%. In conclusion, early resectional surgery seems to be justified as one form of treatment for Crohns disease in that it diminishes the rate of serious complications. The risk of recurrence is, however, not influenced by early surgical intervention.

Evaluation of possibilities for mass screening for colorectal cancer with Hemoccult fecal blood test.

Data from a health survey including the Hemoccult® fecal blood test, together with official cause-specific death rates, were used to assess the magnitude of a controlled trial that would be required to prove a 25 percent reduction of the mortality from colorectal cancer associated with screening. All men in three age groups in the city of malmö, Sweden, were invited, but 46 percent did not participate in, the Hemoccult screening. One carcinoma and 89 adenomas were detected in 56 of the 2422 who did. With the risk function used in our calculation and a complicance rate of 60 percent, a study population among 45- to 69-year-olds of 605,000 is required to prove an expected 25 percent reduction of the mortality with 90 percent power. Considering the size of such a trial, we question whether a controlled trial is feasible. With known risk functions for death from all causes and death from colorectal cancer, the study population was calculated using variable statistical power, participation rate, and risk reduction. Statistical methods and computer programs are given. In addition, alternative study models to assess the benefits associated with screening are discussed.

Immunohistochemical Demonstration of Pancreatic Secretory Proteins in Human Paneth Cells

Gastro-intestinal mucosa obtained at surgical resection was studied by light microscopy using the unlabelled antibody enzyme method for immunohistochemical staining of lysozyme, anionic trypsin, cationic trypsin and pancreatic trypsin inhibitor (PSTI). Paneth cells, identified by their content of lysozyme, contained anionic trypsin, cationic trypsin and PSTI-like immunoreactivity. The demonstration of immunoreactive trypsin and immunoreactive PSTI is a further indication of the resemblance between Paneth cells and the pancreatic acinar cells.

Reliability of routine double-contrast examination (DCE) of the large bowel in polyp detection: a prospective clinical study.

A total of 2,118 consecutive patients, examined with double-contrast examination of the large bowel (DCE), were evaluated radiographically, clinically, and endoscopically for up to 48 months.A total of 402 polyps were diagnosed during the follow-up period. Of these, 307 were revealed at the first DCE and 95 at subsequent endoscopy or autopsy.The accuracy of the DCE for demonstrating or excluding patients with polypoid lesions of the colon was 97%, whereas the predictive value of a positive DCE report was 96% and a negative one, 97%. However, the ability to demonstrate every known polyp at DCE was only 63%, although the probability of a polypoid lesion demonstrated at DCE being a true polyp was 92%.