Subject(s)
Esophageal Diseases/etiology , Gastroscopy/adverse effects , Female , Humans , Middle Aged , Rupture, SpontaneousABSTRACT
The treatment of 8 patients who sustained endoscopic perforation of the large bowel at this hospital in the past 5 years is described. Two had signs of general peritonitis and were operated on. One had a laparotomy under the same general anaesthetic as that during which perforation occurred. Of the remainder, 4 were treated conservatively, while no perforation was found at operation in the other case. All recovered. We conclude that when signs of general peritonism are absent and the patient's condition is good, expectant management with nasogastric suction, intravenous fluids and broad spectrum antibiotics should be adopted. Free gas on X-ray is not per se an indication for laparotomy. A defunctioning colostomy is often unnecessary in those patients treated operatively.
Subject(s)
Colonoscopy/adverse effects , Intestinal Perforation/therapy , Intestine, Large/injuries , Sigmoidoscopy/adverse effects , Adult , Aged , Female , Humans , Intestinal Perforation/etiology , Male , Middle AgedABSTRACT
A case of squamous cell carcinoma arising in a cystic duplication within the small bowel mesentery of a 65-yr-old man is described. The cyst wall had a double layered smooth muscle coat with intervening ganglionic plexus; part of the cyst was lined by ciliated columnar epithelium. Twelve previously reported cases of carcinoma arising in duplications are reviewed together with present case. In all but one case, the onset of symptoms was probably related to malignant change; the age at presentation ranged from 26 to 65 yrs. Pre-operative diagnosis proved difficult, and led to a delay in the appropriate treatment of some of the five cases involving duplications of the rectum. Duplications of the alimentary tract are encountered only occasionally in adults; malignant change, although rare, should be recognised as a possible complication.
Subject(s)
Carcinoma, Squamous Cell/complications , Intestinal Neoplasms/complications , Intestine, Small/abnormalities , Aged , Carcinoma, Squamous Cell/pathology , Humans , Intestinal Neoplasms/pathology , Male , Mesenteric Cyst/complications , Mesenteric Cyst/pathologyABSTRACT
The process of ulcer healing is still incompletely understood and the cause of delayed healing in chronic ulcers is unknown. The work described here is concerned with certain aspects of epithelial repair in experimental ulcers--that is, mitotic activity, cell migration, and cell re-establishment with differentiation, using light and electron microscopy. The findings have been compared with similar observations on human gastric and venous ulcers. The results have shown that increased mitotic activity and attempted cell migration are able to persist throughout epithelialisation of experimental lesions and that the chronicity of human ulcers cannot be explained by a lack of new epthelial cell production or failure of these cells to assume a migratory form. Some other basic defect in the healing process must therefore be present.
Subject(s)
Stomach Ulcer/pathology , Wound Healing , Acute Disease , Animals , Cell Movement , Chronic Disease , Epithelium/ultrastructure , Humans , Male , Microscopy, Electron , Mitosis , RatsABSTRACT
Features of epithelial repair, namely mitotic activity, cell migration, and cell differentiation have been investigated in 17 mucosal biopsy samples from the edges of chronic gastric ulcers in 16 patients, using light and electron microscopy. Results have shown that mitosis persists at the margins of these lesions and that mitotic figures are significantly more numerous in the region of chronic ulcers than in normal mucosa. Cells with the ultrastructural features of migratory cells are present but adjacent epithelium shows abnormalities of differentiation. Lack of cell production does not appear to be the limiting factor in epithelialization and some other cause such as an abnormality of cell or re-establishment must be sought.
Subject(s)
Gastric Mucosa/pathology , Stomach Ulcer/pathology , Adult , Aged , Cell Differentiation , Cell Movement , Chronic Disease , Epithelium/ultrastructure , Female , Humans , Male , Microscopy, Electron , Middle Aged , MitosisABSTRACT
Excision wounds were made in the pyloric epithelium of the rat's stomach and the mitotic response studied at intervals from 1 day to 12 weeks afterwards. Increased mitotic activity followed wounding with peaks at 2 and 7 days, and with a subsequent high level of activity which was maintained in all the later stages of healing, even in the presence of long-delayed epithelialization. Most mitoses initially occurred some distance from the wound edge, but subsequently the highest counts were found in glands immediately adjacent to the edge, and this distribution persisted. Mitotic counts for deep ulcers (including mucous membrane and muscularis externa) were higher than those for superficial ulcers (involving mucous membrane only) at any one time.
Subject(s)
Mitosis , Stomach Rupture/pathology , Animals , Epithelium/pathology , Male , Mitotic Index , Rats , Stomach Ulcer/pathologyABSTRACT
Certain features of epidermal repair, namely increased mitotic activity, cell migration and cell differentiation, have been investigated in fresh biopsies from 17 patients with chronic venous ulcers, using light and electron microscopy. Increased mitotic activity was present at the edges of most of these lesions whether they were in a grossly recognizable healing or non-healing phase, and some cells with ultrastructural features of migratory cells were invariably seen. The results are discussed in relation to other chronic epithelial lesions and suggest that failure of epithelialization is not due to any lack of epithelial cell production and that some other fundamental defect must be sought.
