Detection of cecal adenocarcinoma by Tc-99m pertechnetate scintigram.

A 23-year-old male presented with occult gastrointestinal bleeding and iron deficiency anemia. A Tc-99m pertechnetate abdominal scan was positive and surgery revealed an adenocarcinoma of the cecum. No Meckel's diverticulum was identified. This is the first reported association of an abnormal Tc-99m pertechnetate scan in adenocarcinoma. Carcinoma of the right colon should be considered in any patient with a positive pertechnetate scan for Meckel's diverticulum and suggestive clinical features.

Serial carcinoembryonic antigen (CEA) blood levels in patients with ulcerative colitis.

Fifty-seven patients with ulcerative colitis were folloued 1-49 months (mean, 18 months) with serial CEA determinations during periods of remission, mild relapses, and severe relapses. Elevated CEA titers correlated with activity and possibly extent of disease: 12% of patients with proctitis, 47% of patients with left-sided colitis, and 60% of patients with transverse or universal colitis had elevated CEA titers during a flare. Moreover, 24% of patients with mild flares and 86% of patients with severe flares had elevated CEA titers. Ninety-two percent of patients with extensive disease and severe flares had elevated CEA titers. Elevated CEA titers were correlated with histologic findings in three patients. Inflammation of mucosa was demonstrated by colonoscopy and confirmed by biopsy in one patient with persistently elevated CEA titers during clinical remission. In two other patients with active disease whose CEA titers fell prior to colectomy, marked denudation of colonic mucosa was noted. In this study, a transiently elevated CEA titer indicated either clinically active ulcerative colitis or active inflammation of colonic mucosa.

Does lower esophageal sphincter incompetency contribute to esophageal bleeding?

The purpose of this study is to determine whether lower esophageal sphincter (LES) incompetency is a common occurrence in patients with liver cirrhosis and contributes to the development of variceal bleeding. Resting LES pressure (17.8 +/- 1.1 mm Hg) in 35 patients with cirrhosis was similar to that of our control population (17.3 +/- 2.0 mm Hg). No differences were found among patients with ascites, variceal hemorrhage, or with different degrees of hepatic decompensation. In both patients and control subjects the LES responded with a significant pressure increase to gastric alkalinization. Symptoms and radiological evidence of gastroesophageal reflux were extremely uncommon in patients with liver cirrhosis. Based on these data it is unlikely that acid-pepsin regurgitation is a significant factor in the development of variceal hemorrhage.

Strong MJ, Hendrix TR: Response of the human oesophagus to d-tubocurarine and atropine.

Intraluminal manometric studies of normal swallowing activity fail to distinguish between the peristaltic response of striated and smooth muscle. Studies were performed to determine if the two types of musculature differ in their response to pharmacological stimulation. After the administration of d-tubocurarine, peristaltic amplitude in the striated muscle segment decreased by 26 to 51%, while amplitude in the smooth muscle portion was not significantly affected. The administration of atropine, on the other hand, abolished or diminished smooth muscle peristalsis without altering striated muscle activity. The injection of neostigmine restored peristaltic amplitude toward normal in both striated and smooth muscle portions. These studies demonstrate that although the striated and smooth muscle segments are indistinguishable during normal oesophageal peristalsis, they do differ markedly in their pharmacological response. Pharmacologically, oesophageal striated muscle responds like other striated muscle and oesophageal smooth muscle responds like smooth muscle elsewhere.

Successful treatment of chronic esophageal moniliasis with a viscous suspension of nystatin.

A 35-year-old man with idiopathic hypoparathyroidism and moniliasis developed progressive dysphagia and weight loss. Diagnostic studies established the presence of esophageal moniliasis. Therapy with a viscous suspension of nystatin resulted in rapid clinical improvement; prolonged administration of the drug was associated with progressive widening of a narrowed segment of esophagus and complete disappearance of dysphagia. The chemotherapy of esophageal moniliasis is discussed in the light of current knowledge of the pharmacological action of nystatin.