Giant pseudopolyposis in granulomatous colitis.

A case is described of an unusual combination of polypois and inflammatory bowel disease of a granulomatous type. A striking feature is the complexity of the polypoidal lesions. The relationship between these lesions and the granulomatous colitis which is probably a variant of Crohn's disease is discussed.

Pathology of five Scottish deaths from pneumonic illnesses acquired in Spain due to Legionnaires' disease agent.

The pathology and histology are reported of five Scots who died of severe pneumonic illnesses after holidays in Spain, three in 1973 and two in 1977. There is strong evidence in favour of all the deaths having been due to the newly discovered Legionnaires' disease (LD) agent. The agent (or its soluble antigen) has been visualised in sections of lung tissue by fluorescent-antibody tests in all cases, and the agent has been identified by the Dieterle silver staining method in small numbers in all cases. Serological testing was possible in three of the patients, and two had very high antibody titres against the LD agent. Apart from the extensive and severe nature of the pathological process there is no feature to distinguish pulmonary infection by this agent from that due to more commonly known bacteria capable of causing lobar pneumonia. The severity and extensive nature of the process is partly a reflection of neglect in seeking treatment until late in the infection, and partly a reflection, as revealed in retrospect, on the use of the wrong antibiotic combination during treatment. Erythromycin has been recommended by other workers as the drug of choice against the LD agent. Infection by this organism is not confined to the USA or to Spain and is indigenous also in the United Kingdom.

Hepatocellular carcinoma and hepatic cirrhosis in the west of Scotland: a 25-year necropsy review.

A two-fold increase in the incidence of hepatocellular carcinoma in the west of Scotland is reported on the basis of a 25-year retrospective necropsy review (313 cases). This increase is not accompanied by a corresponding increase in the incidence of hepatic cirrhosis. The relationship between hepatocellular carcinoma and hepatic cirrhosis is discussed in the light of these findings.

Incidence in South-west Scotland of hepatitis B surface antigen in the liver of patients with hepatocellular carcinoma.

A retrospective examination in South-west Scotland of formalin-fixed paraffin-embedded liver tissue by an immunoperoxidase technique revealed hepatitis B surface antigen (HBsAg) in eight out of 81 cases (10%) of primary hepatocellular carcinoma (PHC) and in four out of 82 cases (5%) of cirrhosis. No positive staining was found in 112 controls without overt liver disease matched for age and sex. Unlike most previous studies showing an association between HBsAg and PHC, the present investigation was carried out in an area where HBs antigenaemia is infrequent and PHC is an uncommon tumour. While possibly hepatitis infection is an important cause of PHC, the association between HBsAg and PHC could be due merely to activation by the tumour of latent virus B in a previously infected person.

The significance of folic acid, tissue iron stores, and tissue viability in determining iron uptake from serum by thyroid tissue slices.

This paper describes an attempt to measure in vitro iron uptake from serum by human thyroid slices and to relate the uptake to tissue iron stores, folic acid status, and tissue viability. It is an extension of work previously reported (Buchanan, 1969). Thyroids were obtained from patients undergoing partial thyroidectomy for colloid goitre and serum from clinically normal healthy adults. The haemoglobin, serum iron, and folic acid levels of both thyroid and serum donors were measured and thyroids examined histologically for the presence of stainable iron. Viable and non-viable tissue slices were incubated in sera treated with radioactive iron so as to produce high and normal levels of transferrin saturation. Iron was taken up both from sera with normal and high transferrin saturation but the amount was, in almost all cases, greater from the more highly saturated. The uptake by non-viable tissue was appreciable but did not vary to any great extent from one serum to the next, and was attributed to simple diffusion of ionic iron into the tissue. There was, however, marked variation in uptake from different sera by viable tissue. It was concluded therefore that viability is a factor affecting the uptake. As the variation in uptake by viable tissue incubated in a single serum was significantly less than tissue incubated in a number of different sera it was further concluded that there was also a factor in the serum itself affecting iron uptake. The nature of the factor was not elucidated but neither folic acid nor levels of iron stores appeared to influence uptake because no correlation was found between iron uptake and iron stores or folic acid.