Robert S. Nelson

Endoscopic Evaluation of the Effects of Aspirin, Buffered Aspirin, and Enteric-Coated Aspirin on Gastric and Duodenal Mucosa

THE damaging effect of aspirin on the gastric mucosa has been well documented by endoscopy1 2 3 4 5 6 and by studies of fecal blood loss.7 , 8 Because of the unquestioned value of aspirin in the th...

Stages IE and IIE non-Hodgkin's lymphomas of the stomach: Comparison of treatment modalities

Seventy‐nine patients with Stages IE and IIE non‐Hodgkins lymphomas of the stomach were treated between 1953 and 1980. The histopathologic classification was as follows: diffuse large cell, 61 (of which 23 were immunoblastic sarcomas [plasmacytoid]); diffuse well‐differentiated lymphocytic, 6; diffuse mixed, 1; undifferentiated non‐Burkitts, 1; nodular, 9; and unclassifiable, 1. Thirty‐five patients had Stage IE disease and 44 had Stage IIE. Treatment modalities included surgery, radiotherapy, chemotherapy, and combinations thereof. Sixty‐six patients had a laparotomy for diagnosis and/or management. Of these, only 42 had a gastrectomy. The stomach was considered to be unresectable in the other 24 patients. There were 5 postoperative deaths among 31 patients who had a laparotomy or gastrectomy at our institution. The overall 5‐year actuarial survival was 56%; the disease‐free survival was 54%. For patients with Stage IE disease the survival was 76%, and for those with Stage IIE, 42%. Promising results were obtained in 13 patients who were treated on a multimodality program consisting of four cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus bleomycin (Bleo), which was alternated with involved field radiotherapy. All 13 patients had no evidence of disease as of this report. Only one patient had a relapse (Waldeyers ring), and he was salvaged with radiotherapy. Six of these 13 were diagnosed by endoscopic biopsy and did not have a laparotomy, 3 were found to have unresectable disease at laparotomy, and 4 had a resection. Biopsy with the flexible fiberscope and treatment with CHOP‐Bleo and radiotherapy can avoid the morbidity and mortality of gastrectomy.

Effects of fenbufen, indomethacin, naproxen, and placebo on gastric mucosa of normal volunteers: A comparative endoscopic and photographic evaluation

The effects of fenbufen (1,000 mg a day), indomethacin (150 mg a day), naproxen (750 mg a day), and placebo on gastric mucosa were determined by endoscopy and recorded photographically. One hundred normal subjects, randomly divided into equal, parallel-treatment groups, were given the drugs in divided daily doses for seven consecutive days. The results revealed that the effects of fenbufen on gastric mucosa were significantly (p less than or equal to 0.05) less than those of either naproxen or indomethacin and not statistically different from those observed with placebo.

Acute Granulomatous Hepatitis Due to Histoplasmosis

A 54-year-old man presenting with fever, hepatomegaly, and weight loss was found to have acute histoplasmosis, apparently involving only the liver. The diagnosis was established by culture of liver biopsy material and elevated complement fixation titers which declined in the convalescent phase of the patients illness. Histological examination showed only granulomatous hepatitis. The patient recovered uneventfully without the use of systemic antifungal drugs. He did receive corticosteroids for a brief period. The patient now has been followed for 3 years and remains well. A recent liver biopsy showed only minimal periportal lymphocytic infiltration. A review of the literature fails to reveal a similar case. An analogy is drawn between this case and the acute self-limited pulmonary form of histoplasmosis. Culture of liver biopsy material showing granulomatous hepatitis is recommended in all cases where the etiology is not clear from other evidence.

Small intestinal function in malignant neoplasia

Of 20 patients with malignant neoplasia arising outside the small bowel, who were investigated for evidences of malabsorption, 13 had impaired D‐xylose absorption, and four had slightly elevated fecal fat excretion. Jejunal biopsy showed only slight blunting of the villi in one patient. A rapid plasma clearance of 3H‐folic acid was seen in all of the eight patients in whom this test was done. Serum folic acid was low in 11 of 18 patients. The findings suggest that the impairment of small intestinal function seen in patients with malignant neoplasia is mostly confined to the proximal small bowel, and it is probably related to folic acid deficiency. The finding of a selective elevation of serum IgA in patients with lung cancer is explained on the basis of a local stimulatory effect of the neoplasia on the immunoglobulin production.

Primary gastric candidiasis in uncompromised subjects

The authors share unique observations in 2 otherwise well patients of focal infection of gastric mucosa by Candida albicans

BLOOD AMMONIA LEVELS IN PRIMARY AND METASTATIC CANCER OF THE LIVER.

Abstract Venous blood ammonia was measured in patients with carcinoma of the liver and in controls. The fasting blood ammonia levels in patients with cancer of the liver were not different from those in the controls. In patients with cancer of the liver, there was a significant increase in the blood ammonia levels 30 to 60 min after feeding a meal containing 40–50 g of proteins, with a return towards pre-meal levels within 90 min. There was no elevation of blood ammonia following meal feeding in the controls. These findings are consistent with the possibility that pathologically, developed intrahepatic portosystemic shunts may exist in patients with carcinoma of the liver, although other undetermined mechanisms may play a part. The liberation of ammonia in vitro during its estimation appeared to be greater than normal in patients with cancer of the liver.

The swizzle stick syndrome, acute and chronic

Swizzle sticks may be hazardous to ones health. Two extraordinary cases of swizzle sticks impaled in stomachs rather than in olives are described. In the first, the reaction was acute and promptly remedied by gastrotomy. In the second, the presentation was after protracted symptoms, and subtotal gastrectomy revealed chronic foreign body reaction previously thought to be neoplasm. This newly described source of gastric injury, although rare, must be considered in any patient who freely imbibes and presents with gastrointestinal symptoms, acute or chronic.

Fatty metamorphosis of the liver in malignant neoplasia. Special reference to carcinoma of the breast.

Fatty metamorphosis of the liver was found in an unusually large number of percutaneous needle liver biopsies in patients having mammary carcinoma with suspected metastases; this prompted a study of this abnormality in patients with cancer in general. The autopsy records of 1744 patients and percutaneous liver biopsy reports of 489 patients with malignant neoplasia were reviewed. Fatty metamorphosis was found in 66 (2.8%) of autopsies and 36 (7.3%) of liver biopsies. In cancer of the breast the incidence of fatty metamorphosis on biopsy (21.0%) exceeded that for all other cancers combined or for any other single tumor type, while at autopsy the frequency (5.9%) exceeded that of all other cancers (3.5%). In both autopsy and biopsy series there was a fatty metamorphosis ratio of 2:1 female to male patients.

General Principles Involved in the Use of Radioactive Phosphorus (P32) in Cancer Diagnosis and its Employment Outside the Gastrointestinal Tract

The use of radioactive phosphorus (P32) for the diagnosis of malignant neoplasia was initially suggested by basic research on phospholipid turnover in normal and neoplastic tissues. The work of Jones et al. (1940) demonstrated that the phospholipid turnover of tumors bears a greater resemblance to the more active tissue, such as liver, kidney and intestine, as well as the fact that each type of tumor displays a characteristic type of activity, the rate of turnover differing among different groups. These workers also noted P32 was retained in greater concentration and for longer periods in tumors than in other tissues of the host, in this particular instance the laboratory mouse. The tumor uptake was high and rapid in the early intervals after administration of P32, and there was a pronounced capacity for retention of the isotope for long periods. It was felt that this characteristic served to distinguish tumor from normal tissue. Marshak (1940) similarly found that while the fraction of P32 bound by mice liver nuclei remained constant, the relative concentration in tumor nuclei of the same animal rose to more than twice that of the tumor tissue. At 48 hours, the specific activity of tumor nuclei was found to be more than four times that of liver nuclei. Erf and Lawrence (1941) after studying mice carrying various neoplasms and concluding that wherever there was leukemic or neoplastic infiltration, there was a higher uptake of P32 than in uninvolved tissue, injected radioactive phosphorus into humans dying of various malignant tumors and measured tissue content after death.