Topographical variation in the mucosal surface of oesophageal biopsies.

There have been comparatively few scanning electron microscopic (SEM) studies of mucosal biopsies of the human upper gastrointestinal tract. This study reviews the use of SEM in human oesophageal research and deals with the results of a SEM study of thirty two biopsies of human oesophagus, taken from eighteen patients during endoscopy for upper gastrointestinal symptoms. For each biopsy, three areas of the mucosal surface chosen at random were examined using standard magnifications. The SEM showed three mucosal patterns, which were designated typical squamous, atypical squamous and nonsquamous, each displaying common features in relation to desquamation, cell boundaries and microridges. The two squamous epithelial groups showed surface microridges. The typical group displayed clear cut cell boundaries and well developed microridges arranged in rows. The atypical squamous group showed desquamation, less well developed cell boundaries and variation in microridge patterns. Many nonsquamous specimens displayed simple columnar epithelium, similar to mucosa of gastric type. Care was taken to correlate the surface structure of the oesophagus with the endoscopic appearance. The two assessments were done independently and the material was coded throughout. The broad subdivision of the biopsies into groups using these qualitative topographical criteria gave good correspondence with the endoscopic appearance.

Radiation induced carcinoma of the anus.

The frequent use of radiation in the treatment of malignancy has resulted in an increased incidence of radiation induced tumours. The distal large bowel appears to be most vulnerable to this complication following radiation treatment to the pelvis. The anal canal is notably spared and radiation induced malignancy is very rare indeed. Only one such case appears in the world literature. We report a patient who developed such a tumour seven years following curative radiotherapy for a cervical carcinoma and succumbed to her anal tumour seven years later.

A simple method of assessing intracranial pressure in hydrocephalic patients with shunts.

A simple method is described for assessing intracranial pressure in patients with Holter valves when the function is questionable. The method entails measuring intravalvular pressure by puncturing the valve belly with a fine needle connected to a manometer. High pressure suggests a distal occlusion; very low pressure coupled with difficulty in aspirating CSF suggests a proximal occlusion. All pressures have to be corrected by the addition of a factor equal to half the pressure specification of the valve. The results of a pilot study support these conclusions.

Anaphylactic reaction to aprotinin despite negative ocular sensitivity tests.

A man with a history of pancreatitis was given aprotinin intravenously just before endoscopic retrograde pancreatography. Despite negative sensitivity tests with aprotinin eye drops he developed a profound anaphylactic reaction on intravenous administration of the drug. Ocular sensitivity tests may not predict severe anaphylactic reactions to intravenous aprotinin.