Primary lymphoma of the thyroid, the association with Hashimoto's thyroiditis.

This paper reviews the cases of thyroid lymphoma seen at one centre to assess the relationship between autoimmune thyroiditis and the subsequent development of thyroid lymphoma. Twenty two cases of thyroid lymphoma were seen over a 10 year period; 5/22 (23%) had previously been diagnosed as having Hashimoto's thyroiditis. The series comprised 18 women and four men; mean (range) age at presentation was 64 (26-85) years. All patients presented with a rapidly enlarging goitre and 13/22 (59%) underwent surgical excision prior to diagnosis of lymphoma. Nineteen of 22 (86%) patients underwent radiotherapy. The 5-year mortality for stage IE disease was 43%, survival appeared to be unrelated to previous Hashimoto's thyroiditis or to surgical resectability. The histological differentiation between pre-existing thyroiditis and thyroid lymphoma is often difficult and may lead to an underestimate in the reporting of the association. A prospective study of serial autoantibody assays in patients with Hashimoto's thyroiditis may be useful in predicting the onset of lymphomatous change in this condition.

The association between thyroid neoplasia and intestinal polyps.

Recent reports have suggested an association between familial adenomatous polyposis and papillary carcinoma of the thyroid. This report describes four patients, each with intestinal polyps and thyroid or thyroglossal cyst carcinoma. One patient had a medullary rather than papillary carcinoma of the thyroid and in another the intestinal polyps were due to Peutz-Jeghers syndrome. This may indicate a wider association between thyroid carcinoma and intestinal polyps than has previously been recognised.

Long term parenteral nutrition in the management of severe Crohn's disease.

Twelve patients with active severe Crohn's disease, who failed to respond to medical treatment, received total parenteral nutrition (T.P.N.) via a Broviac long term feeding catheter for periods of 35-190 days prior to surgery. The 10 patients who were non-oedematous increased their mean weight by 3.3 Kg (p<0.01) and their mean plasma albumin by 5.80 g/l (p<0.025) after 28 days T.P.N. There were two episodes of catheter-related sepsis. Although the mean Crohn's disease activity index was significantly reduced from 364.50 (+/-91.51) to 236.75 (+/-121.29) (p<0.005) after 28 days T.P.N., all 12 patients were found to have active disease at operation. There was no post-operative mortality and the only major post-operative morbidity was a pelvic abscess following a panproctocolectomy. It is concluded that long term T.P.N. does not eliminate the need for surgery, but it may improve the nutritional status and reduce the post operative morbidity of malnourished patients with severe Crohn's disease.

Treatment of oesophageal perforation by intubation.

The mortality following oesophageal perforation ranges from 25% to 100% depending on the delay in diagnosis and treatment. Although the treatment recommended for thoracic perforations is emergency thoracotomy and suture of the perforation, the avoidance of this approach in elderly patients is desirable. We therefore describe 6 cases of oesophageal perforation which were treated by insertion of a Celestin tube at laparotomy.

Cystadenoma of the pancreas--an unusual presentation.

Cystadenoma is a rare lesion of the pancreas. A case is reported in which the tumour was initially misdiagnosed as a pseudocyst and inappropriate surgery performed. The patient subsequently presented with gastro-intestinal haemorrhage and the tumour was resected. The diagnosis and management of cystic lesions of the pancreas are discussed, stressing the need for complete pre-operative investigation in order that incorrect treatment is avoided.

Jejunal perforation secondary to metastatic bronchogenic carcinoma.

A case of peritonitis secondary to the perforation of a bronchogenic small bowel metastasis is reported. To our knowledge this is only the fourth case in which peritonitis was the presenting feature of a squamous cell carcinoma of the bronchus. The publications to date are reviewed and the need to biopsy every small bowel perforation found at laparotomy is stressed.

A simple computer model for insulin-receptor interactions and insulin dependent glucose uptake by adipocytes.

A simple computer model is described for the simulation of insulin binding to cell surface receptors on adipocytes and the subsequent stimulation of glucose uptake. The model is based on the currently accepted physiology and biochemistry of insulin action. The model successfully simulated changes in sensitivity to insulin with changes in receptor numbers seen with in vitro experiments; it is also consistent with the proposal that an increased rate of insulin-receptor complex internalisation should lead to an insulin-resistant state. The model also suggests that such an insulin-resistant state should not be affected by a subsequent increase in the rate of return of internalised receptors to the outer cell surface.

Priapism--a complication of home parenteral nutrition?

A case of priapism in a patient receiving home parenteral nutrition is reported. To our knowledge this is the first such case to occur in a patient receiving home parenteral nutrition. The literature is reviewed and the possible aetiology discussed.