Mimi Baratz

Increased serum iron and iron saturation without liver iron accumulation distinguish chronic hepatitis C from other chronic liver diseases

One hundred twenty-three patients with chronic liver diseases of various etiologies were evaluated for their iron status. The patients were divided into four distinct groups: chronic hepatitis C (63), chronic hepatitis B (14), B + C (3) and nonviral chronic liver diseases (43). In 107 patients (87%) the chronic liver disease was confirmed by biopsy. Mean serum iron (±sd) levels in the above four groups were: 166 ± 62, 103 ± 52, 142 ± 48, and 115 µg/dl; iron-binding capacity was 346 ± 80, 325 ± 72, 297 ± 27, and 374 ± 75 µg/dl, and iron saturation 50 ± 18, 32 ± 16, 48 ± 16, and 28 ± 10%, respectively. Serum ferritin, increased in all four groups, was highest in HCV; however, no evidence of hepatic iron accumulation could be found in any of the patients. There were no significant differences in liver function parameters measured in the four groups. We conclude that serum iron, iron saturation, and ferritin are increased in patients with hepatitis C in comparison to hepatitis B or other nonviral, nonhemochromatotic liver diseases. The increased iron status in hepatitis C patients is not manifested by increased liver iron. Awareness of these distinct features of chronic hepatitis C is essential in the diagnosis and treatment of chronic liver diseases.

Endometriosis of the umbilicus.

Endometriosis is a common phenomenon. Most cases reported are pelvic endometriosis which cause typical symptoms. Cutaneous endometriosis is rare, usually appearing in surgical scars or following surgical procedures. Umbilical endometriosis can occur after surgery but is generally spontaneous. Six cases of spontaneous umbilical endometriosis are presented.

Familial juvenile colonic polyposis with associated colon cancer

A mother and son were found to have multiple juvenile polyps of the colon; later a metastatic adenocarcinoma of the large bowel developed in the mother. In both patients, histologic examination of the polyps did not reveal adenomas, but some of the juvenile polyps contained adenomatous‐like elements. Because of the mothers history of colon cancer and the adenomatous features in some of the sons juvenile polyps, he underwent an elective subtotal colectomy. This family may represent a phenotype variation with features of both the juvenile and adenomatous polyposis syndromes and the presence of dysplasia of the glandular epithelium could be a marker of potential malignancy in patients with juvenile polyposis coli.

Endoscope-induced colitis: Description, probable cause by glutaraldehyde, and prevention

Six cases of acute, self-limited colitis that occurred after screening flexible sigmoidoscopy were deduced to be iatrogenic, probably caused by glutaraldehyde residues in the endoscopes after disinfection in an automatic disinfecting machine. The concentration of these residues was indirectly estimated by conductivity measurements of electrolyte concentration in the rinse-water tank of the disinfecting machine during and after five cycles and also in fluid remaining on the surface of the endoscopes and in the endoscope channels. After five cycles, residues in both the rinse water and fluid in the endoscope channels contained the equivalent of 0.2% glutaraldehyde. This was the result of a combination of technical and human errors. It can be prevented by changing the rinse water after each cycle, using forced air to dry the instruments, and washing the endoscopes before use. Users of the automatic disinfecting machine should be aware of the potential accumulation of toxic levels of residues that remain in endoscopes after disinfection.

The relative value of fecal occult blood tests and flexible sigmoidoscopy in screening for large bowel neoplasia

The secondary prevention of colorectal cancer is based on the early detection of noninvasive cancer and removal of adenomatous polyps. The two commonly used screening tests are flexible sigmoidoscopy and guaiac fecal occult blood testing. Both were performed simultaneously and independently on 1176 asymptomatic volunteers followed by colonoscopic examination if either occult blood or a neoplasm was detected. Neoplasia (adenomatous polyps or cancer) were found in 48 screenees. Only ten had positive stool occult blood while 45 were detected by sigmoidoscopy. Analysis of sensitivity for neoplasia was 93.8% for sigmoidoscopy but only 20.8% for the occult blood tests, while the positive predictive values for neoplasia were 100% and 23.8% respectively. The fecal occult blood test detected only 18% of screenees with adenomas and 60% with invasive cancer. Flexible sigmoidoscopy detected 95% and 80% respectively. Analysis (kappa statistic) demonstrated little agreement between the two tests (P > 0.05), indicating that they are diagnosing different neoplasia. Evaluation of expected gain in diagnosing neoplasia, by combining both tests, gave 18% for the fecal blood test and 94% for the endoscopic test. These results confirm the complementary value of performing both tests, but especially the high sensitivity and predictive value positive of flexible sigmoidoscopy for adenomas, including those with severe dysplasia, and the converse for the fecal occult blood test. This latter test must be recommended and used within a screening program with caution and full understanding of its limitations.

Primary inflammatory malignant fibrous histiocytoma of the colon

A unique case of inflammatory malignant fibrous histiocytoma of the large bowel is presented. This lesion occurred in the colon of an elderly man suffering from weakness, anemia, anorexia, and weight loss. A right hemicolectomy was performed, and six months later, on follow-up, he was found to be well. The literature on visceral involvement by malignant fibrohistiocytic tumors is reviewed.

Irradiation-induced colonic stricture and colitis cystica profunda: Report of a case

SummaryA 57-year-old patient was operated upon for a colonic stricture that appeared 18 years after removal of a clear-cell carcinoma of the kidney, followed by irradiation therapy. In addition to typical irradiation-induced changes and fibrotic stricture, colitis cystica profunda was discovered. Review of the literature showed no similar case.

Leiomyosarcoma of the colon and rectum

Leiomyosarcoma of the colon is an uncommon lesion and may appear throughout the colon. Early diagnosis is seldom accomplished before complications such as bleeding or obstruction appear. Sometimes it is histologically difficult to distinguish between a benign and a malignant leiomyoma. Some leiomyomas have biologic evidence of malignancy. Five cases of leiomyosarcoma are described, one of which was histologically diagnosed as a leiomyoma, but two years later, at laparotomy, metastases were found.

Rectal bleeding due to amebic colitis diagnosed by multiple endoscopic biopsies: report of two cases.

Recurrent rectal bleeding over a period of seven and 12 months, respectively, was the main and unusual manifestation of amebic colitis in two patients. The difficulty in establishing the diagnosis led to one patients receiving potentially dangerous steroid therapy. Only by taking multiple colonoscopic biopsies was the amebic colitis recognized. This and serologic tests, should be routine in all cases of inflammatory bowel disease before initiating therapy.

Acute induction of joint inflammation in the rat by poly I . poly C.

Intraarticular injection of interferon inducer, double-stranded polyinosinate-polycytidylate (Poly I · C) caused acute synovitis in rats. This acute inflammatory response was accompanied by an increased concentration of prostaglandin E (PGE) in the synovial tissue. Double-stranded polyadenylate-polyuridylate (Poly A · Poly U) was less potent than Poly I · Poly C in inducing synovitis and increasing PGE concentration, while single-stranded polyinosinate (Poly I) or polycytidylate (Poly C) were inactive in these respects. Intraarticular injection of partially purified mouse fibroblast interferon also induced synovial inflammation. The present results suggest that interferon may be a mediator of viral inflammatory responses.