[Cancer incidence in persons with a mental handicap; possibly increased risk of esophageal cancer]. / Incidentie van kanker bij mensen met een verstandelijke handicap; mogelijk verhoogd risico op slokdarmkanker.

OBJECTIVE: Prompted by a British study which revealed a raised frequency of oesophageal cancer as the cause of death among the mentally handicapped, a study was made of the cancer incidence among an institutionalized population with a mental handicap, which incidence was compared with that among the population in general. DESIGN: Retrospective follow-up study. METHODS: An inventory was made of the cytologically or histologically confirmed cancer diagnoses among persons living in an institute for the mentally handicapped during 1 January 1974 through 1 January 1994 (n = 1020). The incidence figures were compared with those for the general population (Netherlands Cancer Registration 1989) after indirect standardization. RESULTS: The total cancer risk among the population with a mental handicap was the same as that among the general population where women, and lower where men were concerned. This study brought to light a decreased risk of lung cancer (standardized morbidity rate (SMR): 0.33; 95% confidence interval: 0.33-0.97), while the SMR of oesophageal cancer showed no statistically significant increase. CONCLUSIONS: Cancer is not more frequent among the mentally handicapped than among the general population. Nevertheless, increased attention for occurrence of oesophageal cancer appears to be still indicated.

[Fatal course of acute appendicitis associated with infectious mononucleosis]. / Een fataal verlopende combinatie van appendicitis acuta en mononucleosis infectiosa.

The case history is presented of a 10-year-old boy with a fatal combination of acute appendicitis and infectious mononucleosis, in the literature a particularly rare combination. The boy died of a perforative peritonitis. His appendicitis appeared not to be a complication of the infectious mononucleosis.

Abdominal wall defect associated with persistent cloaca. The embryologic clues in autopsy.

Three stillborn fetuses are reported in which an abdominal wall defect was associated with defects in the urogenital and anal region. Autopsy of these fetuses provided clues indicative of how and where the embryonic development went wrong. The malformation involved a disturbance of the cell deposition process, occurring in the caudal part of the embryo. During the cell deposition process, which takes place in the neural crest and the body wall placode, ectodermal cells are added to the mesodermal compartment of the embryo, thus contributing to the anlagen of several structures, including the ventral body wall. In addition, a change in the shape of the embryo is generated. The sequence of events resulting from a disturbance of the cell deposition process is explained.

[Ebstein's anomaly of the tricuspid valve following prenatal exposure to lithium]. / Anomalie van Ebstein van de tricuspidalisklep na expositie aan lithium voor de geboorte.

An 18-year-old man visited the outpatient cardiology clinic because of a cardiac murmur found at a medical examination for military service. An Ebstein's anomaly was diagnosed, with tricuspid valve insufficiency. Exposure to lithium in utero was established. Literature reports indicate an association between exposure to lithium in utero and cardiac anomalies, notably Ebstein's anomaly.

[Epidemiologic study of the estimated number of older patients with Down's syndrome in 1990-2025]. / Epidemiologisch onderzoek naar de te verwachten aantallen oudere patiënten met syndroom van Down in de jaren 1990-2025.

Since a population-based registry of the mentally retarded is lacking in The Netherlands, data concerning incidence and life expectancy patients with Down's syndrome (DS) are not available. Based on birth statistics, in combination with risk factors for DS in relation to maternal age on the one hand and on studies on life expectancy in DS from Denmark, British Columbia and Western Australia on the other, the numbers of these patients older than 40 years were estimated for The Netherlands for the period 1990-2025. After a considerable increase of the number of institutionalized DS patients of 40 years and older between 1958 and 1985, the present estimates indicate a further rise. It is expected that the level of aged DS patients will be highest between 2005 and 2020, and will increase at least to numbers 50% above those expected for 1990. These findings have to have an impact on the capacity planning for institutes for the mentally retarded.

Microwave irradiation of human brain tissue: production of microscopic slides within one day.

A three step method using microwave irradiation enabled microscopic slides of human brain tissue to be obtained within one working day: steps 1 and 2 hardened and solidified brain tissue; step 3 completed formalin fixation. The efficacy and precision of the method was compared with slides of conventionally processed brain tissue that had been fixed in formalin for six weeks. The microscopic quality of the sections was excellent with good presentation of brain tissue and equalled that of conventionally processed slides.

Malignant granular cell tumor. Report of a case with special reference to carcinoembryonic antigen.

A case of malignant granular cell tumor and its histochemical and electron-microscopic characteristics are reported. This case showed, in addition to the well-known distribution of this type of tumor in subcutaneous fat, mediastinum, retroperitoneum and lungs, multiple foci in the myocardium. Contrary to recent studies reporting the presence of carcinoembryonic antigen (CEA) in benign and malignant granular cell tumors, this case is CEA-negative. We suggest that the reported CEA-reactivity in this type of tumor is probably due to cross-reacting antibodies against antigens, presumably associated with lysosomes.