Pneumobilia associated with small-bowel obstruction.

We present a patient who was admitted complaining of nausea, vomiting, and abdominal distention. A roentgenogram of the abdomen revealed a dilated stomach and pneumobilia. At surgery, he was found to have proximal small-bowel obstruction. To our knowledge, this is the first case of pneumobilia associated with proximal small-bowel obstruction not associated with a gallstone.

Sucralfate therapy for lye-induced esophagitis.

Sucralfate is a recently introduced drug that has received acceptance as a nonsystemic, locally active antiulcer agent used in the treatment of duodenal ulcer disease. In addition, sucralfate has been used for the treatment of gastric ulcer and a variety of other gastrointestinal diseases. However, the use of sucralfate to treat caustic esophagitis has not been clinically investigated, and a review of the literature yielded scant information (1). Herein, we report our experience with sucralfate in the treatment of a case of lye-induced esophagitis.

Duodenal mucosal T cell subpopulation and bacterial cultures in acquired immune deficiency syndrome.

Enteric infections, chronic diarrhea frequently with no obvious etiology, and weight loss cause major morbidity and mortality in acquired immune deficiency syndrome (AIDS). Alterations in mucosal immunity may explain the increased incidence of enteric infections, and contamination of the upper small intestine with bacteria may be the cause of weight loss observed in these patients. To test this hypothesis we studied the mucosal T lymphocyte subset in duodenal mucosal biopsies in 14 AIDS and seven control patients. Duodenal fluid was also cultured for aerobic and anaerobic bacteria. There was a significant decrease among leu-3a T cells (helper/inducer) subset in AIDS. The proportion of mucosal T cells reacting with leu-2a (cytotoxic/suppressor) was significantly increased in AIDS patients. These patients also had a significant reversal of the normal mucosal helper/suppressor T cell ratio. There was no change in the number of leu-7 cells (cells mediate natural killer and antibody-dependent cellular cytotoxicity) as compared to controls. All patients with diarrhea and three of five patients without diarrhea had bacteria in their duodenal fluid. Mean number of organisms was 4.5 X 10(4)/ml. Cultures were negative in all control subjects. The results reveal that the abnormalities of T cell subpopulation in the blood of AIDS patients also occur in their duodenal mucosa. This immunological abnormality is associated with the bacterial colonization of upper gastrointestinal tract which may explain the diarrhea and weight loss observed in majority of our patients. The results also indicate that increased incidence of enteric infections in AIDS may be explained on the basis of altered mucosal immunity.

Histopathologic prognostic factors in stage II and III squamous cell carcinoma of the uterine cervix. An evaluation of 91 patients treated primarily with radiation therapy.

Pretreatment biopsies in 54 patients with Stage II and 37 patients with Stage III squamous cell carcinoma of the uterine cervix were reviewed. The patients were all diagnosed, staged, and treated in a uniform manner in a single radiation therapy unit. The biopsies were scored for degree of keratinization, nuclear pleomorphism, frequency of mitoses, cell size, inflammation, desmoplastic pattern of invasion, and presence or absence of vascular infiltration by tumor. Regression analysis and comparative survivals were analyzed to identify histologic parameters of prognostic value. The 5-year survivals were 60 and 32% for Stage II and III tumors, respectively. None of the histologic parameters evaluated was found to predict patient survival. Subclassification of the tumors by World Health Organization grading criteria also failed to predict patient survival. Stage of disease was the only factor that correlated with patient outcome.

Control of overt maternal diabetes during pregnancy in a county hospital.

Tight metabolic control of manifest diabetes during pregnancy was attempted in 51 clinic referrals to a county hospital. Starting before the 28th week of gestation, a good control of diabetes was achieved with the help of initial hospitalization, regular home blood glucose monitoring, and frequent clinic visits. Mean preprandial plasma glucose level was 96.4 +/- 22.6 mg/dL. A mean preprandial plasma glucose level of less than 110 mg/dL was achieved in 42 (82%) of the 51 patients. Total perinatal mortality was 7.7% (4/52). When we excluded major maternal morbidity unrelated to diabetes that accounted for fetal loss, the corrected perinatal loss was 3.8%. Significant maternal hypoglycemia was uncommon. Major congenital malformations in the fetus, neonatal hyperbilirubinemia, and neonatal hypoglycemia each occurred in fewer than 5%. These results suggest that good metabolic control of diabetes is achievable in patients in a general hospital and it may lower fetal loss and morbidity associated with overt maternal diabetes.

Histopathologic grading of squamous cell carcinoma of the uterine cervix. An evaluation of 70 stage Ib patients.

Multiple histopathologic parameters were evaluated to determine which were of prognostic value in predicting patient outcome. Seventy patients with clinical stage Ib squamous cell carcinoma constituted the study population. The patients were primarily treated by surgery, with actuarial survival rates of 76%, 68%, and 57% at 5-, 10-, and 15-year intervals. Eight of 57 patients (14%) with lymph node material available for review had pelvic lymph node metastases and a decreased survival rate (P less than 0.001). Thirty-six patients had 5 mm or less depth of tumor invasion in their hysterectomy specimen and a 5-year survival rate of 94%. Thirty patients had greater than 5 mm of invasion in resected uteri and a 5-year survival rate of 58% (P = 0.007). None of the patients with less than 5 mm of invasion died of their disease. Evaluation of nine histologic parameters in the initial biopsy specimens demonstrated that only vascular invasion (lymphatic and/or capillary) predicted a poor outcome (P = 0.046). Cell size, inflammatory response, degree of keratinization, or any of the other histologic parameters tested failed to demonstrate significant prognostic value in this study.