Ulcerative colitis and indeterminate colitis in the city of Malmö, Sweden. A 25-year incidence study.

BACKGROUND: This study was designed to assess time trends in the incidence of ulcerative colitis and indeterminate colitis in an urban population. METHODS: Medical records of in- and out-patients with inflammatory bowel disease were reviewed by a panel to establish the diagnosis. All histopathologic specimens and almost all radiographs were re-examined. RESULTS: During the time period 1958 to 1982 there were 354 new cases of definite ulcerative colitis, 117 of probable ulcerative colitis, and 100 of indeterminate colitis. This corresponds to an average annual incidence per 100,000 of 5.5, 1.8, and 1.6, respectively. The incidence was higher in men than in women. Peak incidence was between 20 and 29 years, but indeterminate colitis was most common in 10- to 19-year-old males. The incidence was stable from 1958 to 1972 but then increased in almost all age groups in both sexes. The increase in annual incidence of definite ulcerative colitis from 4.2 to 9.4/10(5) corresponds to an average annual increase of about 5% (p < 0.001). The increase in the incidence of definite ulcerative colitis was due to an increased proportion of patients with proctitis. CONCLUSIONS: This study has shown an increased incidence of ulcerative colitis and indeterminate colitis, and we have found no reason to believe that this is a spurious finding.

Angiography in colonic carcinoma.

Angiography of the mesenteric arteries was performed in 17 patients with adenocarcinoma of the colon and rectum. At angiography, the marginal artery was encased in 13 patients and 10 of these were surgically unresectable while three could be resected radically. Encasement of the mesenteric arterial branches was found in seven of 11 unresectable tumors and in two of five resectable tumors. The resectability of colonic carcinoma cannot be established by means of angiography but in two patients with recurrent colonic carcinoma, barium-enema examinations were negative, while infiltrated vessels were demonstrated by angiography and the carcinomas were verified at surgery. Four patients received intra-arterial chemotherapy with mitomycin C. In one of these, a slight decrease in tumor size was noted, while in the others no change was noted.

[Roentgen diagnosis of mucosal cysts of the maxillary sinus]. / Uber die Röntgendiagnose der Schleimhautzyste der Kieferhöhle.

The most common cystic lesion of the maxillary sinuses is the mucosal cyst. In reviewing a 5-years material of 5026 pathological X-ray examinations of the sinuses 12.2% of these were found to have mucosal cysts. These cysts usually do not give rise to symptoms and require no treatment, but are often erroneously diagnosed as polyps, compact maxillary sinuses, hypertrophy of the lining mucosa or tumors. As radiologic examination of the sinuses is a common procedure and the diagnosis of a mucosal cyst is possible other diagnoses may not be given in most cases.

Angiography in angiomatous lesions of the gastrointestinal tract.

Twenty patients with various angiomatous lesions of the gastrointestinal tract, such as right-colon angiodysplasia and manifestations of Rendu-Osler-Weber disease and Klippel-Trenaunay syndrome are reported. During the past 15 years an increasing number of such lesions have been reported, diagnosed mainly by angiography. The major complication from these vascular lesions is bleeding. Angiography is the primary method for their detection because of their often small size and is a prerequisite before surgery when reason exists for anticipating an angiomatous lesion as the source of bleeding. However, in certain cases angiography will fail to demonstrate the vascular abnormality or its full extent.

Radiographic features of olfactory neuroblastoma.

Olfactory neuroblastomas are malignant, slowly growing neurogenic tumors originating from the olfactory mucosa of the nasal cavity. Fourteen patients with this tumor were evaluated and showed variable extension into adjacent structures such as the ethmoid and sphenoid sinuses, orbit, and anterior cranial cavity.

Lymphangiography in staging of carcinoma of the prostate: the potential value of percutaneous lymph node biopsy.

Bilateral pedal lymphangiography was performed in the staging of 208 patients with prostatic carcinoma. Forty-seven (23%) were found to have lymph node involvement, and 40 of these 47 had Stage C disease. Nine per cent of the Stage C1 patients (moderately advanced disease) and 37% of Stage C2 (massive carcinoma) had lymph node metastases. The distribution of the abnormal nodes was in continuity with the lymph node drainage from the prostate. The external iliac nodes were the most frequent site of metastases. Histological confirmation was obtained in 20 of the 40 positive Stage C2 cases. More recently, percutaneous aspiration biopsy of the opacified nodes was used to document the presence of metastic disease, thereby extending the value of lymphangiography.

Colon of the rat. An anatomic, histologic and radiographic investigation.

The anatomy and radiologic appearance of the colon in rats are described on the basis of 300 animals treated with carcinogenic agents and 40 normal rats. The macroscopic and microscopic appearance of the mucosa varies in the different parts of the colon. Lymphoid plaques are normal structures. The results justify a new anatomic nomenclature.

Osteogenic sarcoma after the age of 50: a radiographic evaluation.

Twenty-four cases of primary osteosarcoma in individuals over the age of 50 are described. This represents 6% of all osteosarcomas and 80% of osteosarcomas occurring over the age of 50 at this institution. Radiographically, features were similar to osteosarcoma in younger individuals. Females were more frequently affected than males (2.4:1). The radiographic features are discussed in detail, and the differential diagnosis outlined.

Radiologic demonstration of multiple foci of malignancy in the esophagus.

Three patients, each with two synchronous esophageal carcinomas demonstrated radiologically, are presented. The importance of complete esophageal evaluation in patients with one obvious tumor of the esophagus is emphasized. Assessment of the full extent of disease in such cases directly affects treatment planning.

Experimental colonic tumours in the rat. I. Preparation and technique of examination.

A method is described for demonstrating the mucosal appearance of the colon of the rat with double contrast and magnification radiography. The rats were examined at regular intervals. Double contrast examinations were performed 1 570 times in 418 rats. The animals were prepared by cleansing the colon with enemas. The mortality rate for different forms of anesthesia was recorded. An anesthesia with intraperitoneal administration of chloralhydrate and atropine-sulfate was the most appropriate.

Experimental colonic tumours in the rat. II. Double contrast examination and microscopy.

Experimentally induced tumours in the colon of the rats were examined with a double contrast method. Carcinogenic agents were administered to 114 rats. The development of the colonic tumors was recorded by repeated examinations. In the dead rats a thorough necropsy was performed. The radiographic and microscopic results were correlated and the radiographic appearances of colonic tumours were evaluated. The diagnostic accuracy of the radiographic method in distinguishing between benign and malignant lesions was 92 per cent.

Experimental colonic tumours in the rat. III. Induction time, distribution and appearance of induced tumours.

In 189 rats N-methyl-N'-nitro-N-nitrosoguanidine or 1,2-dimethylhydrazine (DMH) was given in order to induce colonic tumours. The tumour induction was followed by double contrast examination. At 894 examinations 196 adenomatous tumours were revealed. Autopsy and microscopy revealed 214 macroscopic and 53 microscopic benign or malignant adenomatous tumours. Metastases were found in 17 per cent in the DMH group. The relationship between adenomas and carcinomas is also evaluated.

Detection of antibodies to embryonic antigens in sera of multiparous or colon tumor-bearing rats by a new indirect immunofluorescence assay.

An indirect immunofluorescence assay using antigen coupled to agarose beads detected high titers of antibody to embryonic antigens in sera from multiparous rats and rats bearing colon carcinomas. Sera from pregnant rats had antibody titers greater than 10(3) and some rats still had titers greater than 10(2) 30 weeks after the end of pregnancy. Rats which developed colon carcinomas after treatment with 1,2-dimethylhydrazine were bled monthly between the end of treatment and detection of carcinoma. Antibody to embryonic antigens appeared in their sera at least 2 months before roentgenologic diagnosis of tumor.

Cleansing of the colon without enemas.

Several methods have been used to cleanse the large bowel prior to roentgen examination and rectoscopy for more than ten years. A method with administration of a salt solution (SALAX) in combination with different oral laxatives (Cascara sagrada, Dantron, Bisacodyl) without cleansing enemas is described. Hospitalized patients should have an individual preparation while ambulatory patients are almost completely cleansed if they carefully follow the given instructions.

Double contrast examination in disease of the anorectal region.

Patients with symptoms from the anorectal region will not always be rectoscopically examined and sometimes lesions of the ano-rectal region are overlooked by the rectoscopist. In order to increase the overall diagnostic accuracy and make possible an early diagnosis of pathological changes in the ano-rectal region, the radiologist should take responsibility also for this part of the bowel. Minor lesions are often difficult to demonstrate by the conventional barium enema, but they are readily seen on an adequately performed double contrast examination. Of special importance is the diagnosis of small polypoid tumors which may become malignant. An early diagnosis and subsequent surgical removal of these tumors prevent spread and minimizes the surgical procedure.

Sequential studies of serum blocking activity in rats bearing chemically induced primary bowel tumors.

Colon and small-bowel tumors were induced in WF rats by treatment with one of three chemical carcinogens. Tumor occurrence and growth were monitored by multiple double-contrast examinations. Roentgenologic diagnoses and histologic examination of tumors were verified at tumor resection or autopsy. Serial serum samples from each of 11 rats were tested in microcytotoxicity assays for their ability to block the cytotoxicity of lymph node cells from rats with isografts of colon carcinoma NG-W1 against NG-W1 target cells. Sera from all tumor-bearing rats demonstrated specific blocking activity. With two exceptions, serum blocking activity preceded roentgenologic evidence of tumor. Sera of the 2 exceptional rats lacked blocking 2 and 8 weeks before tumor detection, respectively. The sera of only one animal specifically inhibited lymphocyte cytotoxicity despite consistently negative double-contrast examinations. At autopsy this rat was found to have an adenocarcinoma of the distal rectum, impossible to visualize by the roentgenologic technique used. In serum samples obtained from animals after successful tumor excision and with no radiologic evidence of recurrence, blocking activity could no longer be demonstrated. Rats that had received carcinogen but developed no tumor and had no abnormalities on double-contrast examination demonstrated no serum blocking activity.