DNA content in Barrett's esophagus and esophageal malignancy.

Barrett's esophagus is a premalignant condition; endoscopic surveillance is often performed to search for early adenocarcinoma of the esophagus. In an attempt to detect early changes of malignancy, we have added the use of flow cytometry to routine endoscopic surveillance procedures. DNA histograms were generated from biopsy samples by utilizing a specific DNA fluorochrome (4',6-diamidino-2-phenylindole) and flow cytometry. Sixty-three samples from patients with esophagitis, Barrett's esophagus, and esophageal malignancy were analyzed. An abnormal DNA histogram (aneuploidy) was detected in 79% of esophageal malignancies. In addition, aneuploidy was detected in seven patients with Barrett's esophagus, two of whom had dysplasia. DNA quantification with flow cytometry may be a useful adjunct in screening patients with Barrett's esophagus for early malignant change.

Flow cytometry. A new technique in the diagnosis of malignant ascites.

The diagnosis of peritoneal carcinomatosis is often dependent on the finding of malignant cells in ascitic fluid analysis by a trained cytologist. Other methods are needed to increase the current diagnostic yield of 60-90%. Abnormal DNA content is characteristic of most malignancies. In an attempt to detect aneuploidy, we used high-resolution DNA histogram analysis with fluorescent DNA-specific stains and flow cytometry to evaluate 33 ascitic fluid samples. Of 13 patients with malignant ascites, aneuploidy was demonstrated in 10. Six patients with proven peritoneal carcinomatosis and normal cytologic examination had abnormal DNA histograms. DNA quantitation and cytologic examination agreed in 24 of 33 cases. These findings suggest that flow cytometry is a rapid and useful technique in the diagnosis of malignant ascites. The presence of aneuploidy in cells from ascitic fluid is highly suspicious for peritoneal carcinomatosis and suggests the need for further evaluation for malignancy.

Ogilvie's syndrome associated with herpes zoster infection.

Acute colonic pseudo-obstruction that occurs in the setting of an underlying medical condition is known as Ogilvie's syndrome. The etiology of Ogilvie's syndrome is unknown, and associated medical illnesses are varied and often extra-abdominal. While herpes zoster infection has been reported to cause constipation and hypomotility, the association with massive colonic distention has not so far been described. We present a patient with Ogilvie's syndrome in the setting of herpes zoster infection. There was no evidence of other active illnesses, and the patient has continued to do well since the resolution of the zoster. We believe that this is the first reported association of Ogilvie's syndrome and herpes zoster infection.

Sclerosing cholangitis, chronic pancreatitis, and Sjogren's syndrome: a syndrome complex.

The disease complex of chronic pancreatitis, sclerosing cholangitis, and Sjogren's syndrome seems to be a well-defined entity with an autoimmune cause similar to that which occurs in primary biliary cirrhosis. Treatment depends on the component of primary sclerosing cholangitis and, more particularly, on the degree of extrahepatic involvement.

Does spontaneous bacterial peritonitis occur in malignant ascites?

Spontaneous bacterial peritonitis is a well-described entity estimated to occur in 8% of patients with cirrhotic ascites. Characteristic clinical findings may often be absent and the only manifestation may be decompensation of liver function. Ascites at Memorial Hospital is most commonly related to malignancy. We reviewed the records of 101 patients with ascitic fluid cytology positive for malignancy during the calendar year 1979. The most common malignant cytological diagnosis was adenocarcinoma, seen in 76 patients. Of the 101 patients with positive ascitic fluid cytology, 65 fluid specimens had microbiological studies performed which included aerobic, anerobic, fungal, and acid fast bacterial cultures. Only three patients had positive ascitic fluid cultures. We believe that these three patients had other reasons for peritonitis and do not represent true spontaneous bacterial peritonitis. Ascites alone, without liver disease, seem to predispose to spontaneous bacterial peritonitis. Perhaps, the presence of liver disease with less than normally effective hepatic reticuloendothelial function and portasystemic shunting is needed for the development of spontaneous bacterial peritonitis.