Retroperitoneal perforation in ulcerative colitis with mediastinal and subcutaneous emphysema.

Retroperitoneal colonic perforation in patients with ulcerative colitis is rare. We report such a case in a patient with severe ulcerative colitis without toxic dilatation in whom mediastinal and subcutaneous emphysema also developed. Unlike previously reported cases, our patient was treated conservatively with intravenous fluids, parenteral nutrition, intravenous hydrocortisone, and antibiotics. After 2 weeks, the mediastinal and subcutaneous emphysema and the retroperitoneal air completely disappeared.

DNA flow cytometry of colorectal carcinoma: correlation of DNA stemlines with other prognostic indices.

DNA flow cytometry (FCM) was performed on paraffin-embedded tissue blocks of 38 surgically resected colorectal carcinomas (CRC). Forty-seven percent of tumors exhibited aneuploidy and 53% were diploid. Seventy-two percent of patients in the aneuploid but only 35% in the diploid group were alive after a mean follow-up of 30.7 and 28.8 months (p = 0.01), and 5-yr survival of 56.7% and 11.7%, respectively (p less than 0.05). The site of tumor location, Dukes' stage, and serum CEA level did not predict a certain DNA stemline. However, irrespective of the ploidy pattern, a serum CEA level greater than 5.0 was associated with a higher mortality and poor 5-yr survival (p less than 0.005). Similarly, advanced Dukes' stage was associated with higher mortality (p less than 0.05). Forty-six percent of the patients with lesions that were Dukes' B2 or advanced stage received adjuvant therapy. Eighty-five percent of this subgroup of patients died; 18% of these patients had aneuploid tumors. The role of FCM in the assessment of prognosis of CRC deserves further clinical evaluation in a randomized control trial.

Epidemiology and prevention of low birth weight babies in a developing country.

PIP: The factors contributing toward the high incidence of low weight births in developing countries were described and suggestions for reducing the number of low weight births were made. Low birth weight infants were defined as those babies who weighed 2500 g or less at birth. Socioeconomic, cultural, biological, maternal, obstetric, and fetal factors, identified in previous studies as contributory factors, were summarized. In regard to social, economic, and cultural factors, low birth weight is positively correlated with 1) low socioeconomic status; 2) poor maternal diet; 3) short birth intervals; 4) illegitimacy; 5) the performance of strenuous work during the last 6 weeks of pregnancy; 6) low maternal education; and 7) smoking. Biological factors positively associated with low birth weight include 1) early and late maternal age; 2) 1st births; 3) low maternal weight and short maternal stature; 4) the birth of females; 5) slow maternal growth patterns; and 6) high altitude pregnancies. Maternal factors positively associated with low birth weight include 1) the presence of maternal tuberculosis, heart disease, renal failure, and hypertension; 2) low maternal caloric and protein intake; 3) maternal anemia; 4) obstetric complications; 5) a history of previous low weight births, abortions, stillbirths, or premature births; 6) various uterine and placental factors; 7) multiple pregnancies; and 8) inadequate prenatal care. Fetal factors associated with low weight births include fetal infection and congenital abnormalities. The cause of low weight births varies in different populations and the 1st step in any preventive program is to determine the major causes of low weight births in the target population. Preventive measures include 1) improving secioeconomic and public health conditions; 2) upgrading maternal diets and maternal and prenatal health care; 3) expanding health education programs; and 4) preventing premature births.^ieng