Obstructive colitis: an analysis of 50 cases and a review of the literature.

Obstructive colitis is an ulcero-inflammatory and necrotizing condition that occurs in the colon proximal to benign or malignant stenosing lesions. it is the result of ischemia due to impairment of blood supply secondary to elevation of the endoluminal pressure, distension of the colonic wall and other factors which impair adequate perfusion. The incidence among patients with colonic obstruction is reported at between 1 and 7%. Of 50 patients with this condition in this series, 30 female and 20 male, 2/3rds were well over 70 yrs of age. Obstruction was most common in the rectosigmoid. In half the patients this was due to adenocarcinoma, 24 were due to benign obstruction and 15 were caused by diverticular disease. Type, extent and depth of ischemic lesions were highly variable and comprised early mucosal hemorrhage and edema, ulcero-hemorrhagic lesions and transmural necrosis. There was always an abrupt transition between affected and normal bowel. A segment of preserved mucosa was usually present on the proximal side of the stenosis. In 16 patients massive dilatation with stretching and thinning of the bowel wall, associated with a blow-out type of perforation or with transmural necrosis, was observed and was considered to have resulted from a rapid rise of endoluminal pressure to high levels. The microscopic and macroscopic features are described in detail and histological factors discussed in relation to the pathological lesions encountered. Emphasis is placed upon the range of appearances and similarities are shared with other inflammatory colonic diseases, particularly idiopathic inflammatory bowel disease. The importance of recognition of this disease entity, not only by pathologists but by surgeons dealing with the disease at operation, is stressed.

Distribution of systemic blood flow in lambs with an aortopulmonary shunt during strenuous exercise.

We studied regional blood flows with radioactive-labeled microspheres in 12 7-wk-old lambs with an aortopulmonary left-to-right shunt [59 +/- 3% (SE) of left ventricular (LV) output] and in 11 control lambs, at rest and during exercise at 80% of predetermined peak O2 consumption. At rest, systemic blood flow was similar in the two groups. Blood flow to the heart and diaphragm was substantially higher in the shunt than in the control lambs. Blood flow to the other organs was not significantly different between the two groups. During exercise, systemic blood flow increased substantially but less in shunt (81%) than in control lambs (134%). Blood flow to the heart and diaphragm increased, that to the heart still being higher in shunt than in control lambs. Blood flow to the brain did not change, whereas that to the kidneys and splanchnic organs decreased to the same extent (25%) in shunt and control lambs. Intrahepatic and intrarenal blood flow redistribution in the shunt lambs persisted during exercise. In conclusion, myocardial blood flow is not increased at the expense of one particular organ, nor is it associated with an essential change in exercise-induced redistribution in shunt lambs.

Low-grade immature teratomas with peritoneal gliomatosis; a case report.

Immature teratomas with peritoneal gliomatosis are rare. Eight cases have been registered by the Dutch Ovarian Tumor Committee and one patient, presented in this paper, was treated recently. The follow-up in these cases indicates a good prognosis, even in grade 2 teratomas. Peritoneal implants do not influence adversely the prognosis when they are composed of mature glial tissue. A conservative approach seems to be justified.

Neuroendocrine carcinoid tumours of the breast: a variant of carcinoma with neuroendocrine differentiation.

Carcinoid tumours most frequently develop in the gastrointestinal tract but have been described in many organs of the body. In 1977 the first cases were reported in the mamma, followed by descriptions of argyrophilic carcinoid-like, neuroendocrine mammary tumours by many investigators who performed immunohistochemical and ultrastructural examinations. The existence of true carcinoids in the mamma is still a controversial issue. Eight mammary neoplasms with monomorphous cytonuclear features, five of the small cell carcinoid-like variety and three composed of larger cells, were examined by immunohistochemical and ultrastructural examination. We believe this kind of tumours are ductal or lobular carcinomas with focal or more extensive neuroendocrine features and are the result of a dual differentiation of neoplastic precursor stem cells along epithelial and endocrine lines. Consequently, we consider that treatment of such cases should not be different from that of the ordinary type of mammary carcinomas.

Proliferative and malignant Brenner tumours (BT) and their differentiation from metastatic transitional cell carcinoma of the bladder: a case report and review of the literature.

Up to now 110 cases of malignant Brenner tumour (BT) and 45 cases of proliferative BT have been reported in the accessible literature. To delineate the diagnostic criteria and to determine the differences between these tumours and metastatic tumours of the urinary tract, 94 cases of malignant BT and 37 cases of proliferative BT were reviewed. The difficulties encountered in determining these differences are illustrated by means of a case history.

Failure of anterior cruciate-ligament reconstruction using tendon xenograft.

From January 1981 to September 1983 forty knees had replacement of a torn anterior cruciate ligament with a tendon xenograft. In six of the first thirty knees that were operated on severe synovitis developed within eight months after the operation, and total synovectomy and removal of the graft was required. Because of this complication we changed the recommended rinsing procedure for the graft in the last ten knees, and no synovitis occurred in these. Approximately half of all of the grafts ruptured between twelve and twenty months after the operation.

Primary ganglioneuroblastoma of the anterior mediastinum in a 61-year-old woman.

A case of primary ganglioneuroblastoma located in the anterior mediastinum is described. The tumour was found incidentally at autopsy in a 61-year-old woman who died of coronary artery thrombosis. There was no evidence of metastases. Histologically the tumour was a ganglioneuroblastoma of the diffuse type. There was no pure neuroblastomatous tissue present and maturation to ganglioneuroma was not observed. Regressive changes like fibrosis and calcification were present. Review of the literature failed to reveal any recorded cases of ganglioneuroblastoma occurring in the anterior mediastinum. Although ganglioneuroblastoma occurs predominantly in children, 24 cases occurring in adults have been reported in the literature.

Leiomyomatosis peritonealis disseminata.

In the course of a cesarean section on a 38-yr-old negroid patient the peritoneum was found to be studded with small greyish white nodules resembling carcinomatosis peritonei. On microscopical examination these appeared to be composed of decidualized cells and smooth-muscle cells. No evidence of malignancy was observed. Another 18 cases of leiomyomatosis peritonealis disseminata have been reported previously in the literature. It seems likely that these small tumors originate from subcelomic mesenchymal cells which, through a process of metaplasia, differentiate into myofibroblasts under the influence of hormonal factors. At laparoscopy, performed several years before the patient's pregnancy, the peritoneum was observed to be entirely normal. Regression of the nodules was evident at laparoscopy 12 wk post partum.

Oxalosis in chronic renal failure.

The incidence and severity of oxalate deposition as a complication of chronic renal failure in a retrospective study of 73 patients is presented. The reason for this study was the occurrence of a syndrome characterised by multiple shunt-complications, muscle weakness and peripheral ulceration in three haemodialysis patients. This syndrome seems to be caused by an obliterative vasculitis due to oxalate deposition in the media of peripheral vessels (Figure 1).

Two cases of multiple gastric polyps.

Two cases of multiple gastric polyps are described. In both cases a large number of hyperplastic polyps were found in the antrum and body of the stomach. A total gastrectomy was performed in these two patients. Histologically the polyps were benign; in one case gastritis with metaplasia was present. The pathological and clinical aspects of multiple gastric polyps are discussed with reference to the literature.

Primary carcinoid tumor of the testis: case report, ultrastructure and review of the literature.

A case of primary pure carcinoid tumor of the testis which occurred in a 71-year-old male is reported. The patient was treated by radical orchiectomy and remains well and symptom free 10 months after operation. Histologically as well as ultrastructurally the tumor showed typical appearances of carcinoid tumor of midgut derivation. 23 cases of carcinoid tumors of the testis were discovered in the literature. Of these 17 were primary testicular carcinoids, and 6 were metastatic to the testis. Of the 17 cases of primary carcinoid tumors, 14 were pure carcinoids and only 3 were associated with teratoma. None of the primary testicular carcinoids were associated with metastases and the prognosis after orchiectomy was excellent, thus indicating that no further therapy is necessary. The prognosis of patients with carcinoid metastatic to the testis is poor. In view of this it is very important to determine whether the tumor is primary or metastatic.