R. Rowland

Endometriosis of the large bowel: A report of 11 cases

&NA; The clinical and pathological features of 11 cases of large bowel endometriosis are reported, one of which also had lesions in the small intestine. All of the cases had rectal or rectosigmoid involvement. Altered bowel habit and pain were common symptoms but were rarely associated with the menstrual cycle. Sigmoidoscopy was generally unhelpful. Rectal or vaginal examination and barium enema often revealed a mass which was usually diagnosed preoperatively as a malignancy. A correct diagnosis was made preoperatively in only two cases; carcinoma was suspected in four and carcinoid in one case. Histological evidence of recent hemorrhage was confined to those cases where endometriosis seemed to be the major cause of intestinal symptoms. The colonic mucosa overlying the endometriotic deposits was commonly histologically abnormal. It showed a range of changes resembling colitis, solitary ulcer, prolapse or even neoplasm. An appreciation of these mucosal alterations is important to those reporting colonic and rectal biopsies; when observed to be focal in a female patient they should arouse a suspicion of endometriosis.

Effects of Fractionated Abdominal Irradiation on Small Intestinal Motility Studies in a Novel In Vitro Animal Model

Disordered small intestinal motility occurs frequently during acute radiation enteritis. However, the characteristics and time course of the motor dysfunction are poorly defined. These parameters were assessed in a novel animal model of radiation enteritis. Ileal pressures were recorded in vitro with perfused micromanometric catheter using an arterially perfused ileal loop in 22 ferrets following fractionated abdominal irradiation (9 doses 2.50 Gy thrice weekly for 3 weeks). Tissue damage was graded histologically. Studies were performed 3 to 29 days after irradiation. Tissue from 7 control animals was also studied. All treated animals developed diarrhoea. Histology showed changes consistent with mild to moderate radiation enteritis. Following irradiation, there was an initial increase in frequency followed by a non-significant reduction in the frequency, but not the amplitude of ileal pressure waves. The frequency of pressure waves showed an inverse relationship with time after radiation (r = -0.634, p < 0.002). There was no relationship between motility and histology. We conclude that abdominal irradiation is associated with a time-dependent reduction in ileal motility which does not correlate with light microscopic changes.

Early Gastric Cancer: 52 Cases of Combined Experience of Two South Australian Teaching Hospitals

&NA; Fifty‐two patients with early gastric cancer are described. At presentation, the average age was 60 years and the male: female ratio was 3:2. The patients had presenting symptoms indistinguishable from those due to benign peptic ulcer disease. Endoscopic examination with multiple biopsies was the most accurate means of diagnosis, with an overall 93% detection rate. The tumours were located predominantly along the lesser curve (75%) and in the antrum (64%), with ulcerated or depressed lesions most common and flat lesions least common. Approximately 58% of lesions were of intestinal type, submucosal invasion was seen in 45% and lymph node metastases had occurred in 7% of cases. Lesser curve and antral lesions were more likely to be ulcerated. Ulcerated lesions were on average, the same size as non‐ulcerated lesions. Body lesions were larger than antral lesions and lesions which had spread to the submucosa were larger than mucosal lesions. Diffuse‐type lesions were more likley to be ulcerated than intestinal‐type lesions and dysplasia was more commonly associated with intestinal‐type lesions than with diffuse or mixed‐type lesions. The crude 5‐year survival rate was 80%, but only one death was associated with a recurrence of gastric cancer.

Hepatitis C: histopathology of liver biopsy in blood donors

Reported are the results obtained from screening 70,299 blood donations from 55,500 donors for Hepatitis C antibody over an eight month period using Abbott HCV EIA. Three hundred and fifty-seven were found to be positive for hepatitis C and 70 of them had elevated serum alanine-amino-transferase levels and were offered further evaluation. A liver biopsy was carried out in 24 of these patients only two of whom were woman. The patterns of disease observed were: Chronic active hepatitis without steatosis eight cases. Chronic active hepatitis with steatosis four cases. Chronic persistent hepatitis 10 cases. Chronic persistent hepatitis with steatosis one case. Fibrosis with steatosis one case. All cases also showed low grade lobular inflammation; 18 cases showed fibrosis, one with steatosis. No case of cirrhosis was diagnosed. The histology findings of each case was also scored according to Knodell’s numerical system and all showed disease activity of 10 or less out of a possible 22.