[Submucosal lipoma of the colon: abdominal cramps with rectal bleeding and weight loss]. / Submucosaal lipoom in het colon: buikkrampen met rectaal bloedverlies en gewichtsverlies.

An 81-year-old woman had abdominal cramps, rectal bleeding since 2 weeks and weight loss. Colonoscopy showed an ulcerating tumour of about 4 cm in the transverse colon. Pathological examination of biopsies taken during colonoscopy indicated moderately active chronic colitis. Based on the colonoscopy findings, the tumour appeared to be malignant and laparotomy was performed and the transverse colon was resected. Pathological examination of the resected lesion revealed a submucosal lipoma. The patient recovered fully. Lipomas account for 4% of benign gastrointestinal tumours and 90% of lipomas are submucosal. Their presentation is often similar to malignant tumours. The naked fat sign after biopsy and the elasticity of the lesion are typical features encountered during colonoscopy. Given the high fat content of these lesions, they are easily discernible with CT and MRI. Lipomas with a diameter < 2 cm can be safely removed endoscopically. Larger lesions should be removed by segment resection.

A national burden of disease calculation: Dutch disability-adjusted life-years. Dutch Burden of Disease Group.

OBJECTIVES: This study estimated the burden of disease due to 48 major causes in the Netherlands in 1994 in disability-adjusted life-years (DALYs), using national epidemiologic data and disability weights, and explored associated problems and uncertainties. METHODS: We combined data from Dutch vital statistics, registrations, and surveys with Dutch disability weights to calculate disease-specific health loss in DALYs, which are the sum of years of life lost (YLLs) and years lived with disability (YLDs) weighted for severity. RESULTS: YLLs were primarily lost by cardiovascular diseases and cancers, while YLDs were mostly lost by mental disorders and a range of chronic somatic disorders (such as chronic nonspecific lung disease and diabetes). These 4 diagnostic groups caused approximately equal numbers of DALYs. Sensitivity analysis calls for improving the accuracy of the epidemiologic data in connection with disability weights, especially for mild and frequent diseases. CONCLUSIONS: The DALY approach appeared to be feasible at a national Western European level and produced interpretable results, comparable to results from the Global Burden of Disease Study for the Established Market Economies. Suggestions for improving the methodology and its applicability are presented.

An aggregate public health indicator to represent the impact of multiple environmental exposures.

We present a framework to aggregate divergent health impacts associated with different types of environmental exposures, such as air pollution, residential noise, and large technologic risks. From the policy maker's point of view, there are at least three good reasons for this type of aggregation: comparative risk evaluation (for example, setting priorities), evaluation of the efficiency of environmental policies in terms of health gain, and characterizing health risk associated with geographical accumulation of multiple environmental exposures. The proposed impact measure integrates three important dimensions of public health: life expectancy, quality of life, and number of people affected. Time is the unit of measurement. "Healthy life years" are either lost by premature death or by loss of quality of life, measured as discounted life years within a population. Severity weights (0 for perfect health, 1 for death) are assigned to discount the time spent with conditions associated with environmental exposures. We combined information on population exposure distribution, exposure response relations, incidence, and prevalence rates to estimate annual numbers of people affected and the duration of the condition, including premature death. Using data from the fourth Dutch National Environmental Outlook, we estimated that the long-term effects of particulate air pollution account for almost 60% of the total environment-related health loss in the Netherlands as modeled here. Environmental noise accounts for 24%, indoor air pollution (environmental tobacco smoke, radon, and dampness, as well as lead in drinking water) for around 6%, and food poisoning (or infection) for more than 3%. The contribution of this set of environmental exposures to the total annual burden of disease in the Netherlands is less than 5%.

Do antioxidants and polyunsaturated fatty acids have a combined association with coronary atherosclerosis?

To evaluate the antioxidant hypothesis with regard to atherosclerosis, we compared plasma selenium, serum alpha-tocopherol, serum polyunsaturated fatty acids (PUFA), and the ratios of selenium and alpha-tocopherol to PUFAs in subjects with varying degrees of coronary atherosclerosis. Cases had more than 85% stenosis in at least one coronary vessel and controls had less than 50% stenosis in all three vessels. Plasma selenium was significantly lower in cases than controls (95.1 +/- 21.0 micrograms/l and 108.8 +/- 29.3 micrograms/l, respectively). Though alpha-tocopherol and PUFA levels were similar in both groups, the ratios Se/linoleic acid, Se/total PUFA and Se/total n-6 acids were significantly lower in cases. In particular, these differences were observed in subjects with low serum alpha-tocopherol level (below the median; 1452 micrograms/dl). Moreover, in this subgroup the ratio Se/PUFA was significantly lower in cases than in controls for all PUFAs except eicosapentaenoic and docosahexaenoic acid. Though definitive conclusions cannot be drawn from our data, it is hypothesized that high PUFA levels, when insufficiently protected by antioxidants against peroxidation, may indicate a higher risk of atherosclerosis.

Autoantibodies to brain specific proteins in human serum from normal and several pathological conditions.

Autoantibodies to three nervous tissue specific proteins [alpha Albumin (GFA, Eng et al., 1971), S100 (Moore et al., 1968) and MBP (Eylar et al., 1969)] were determined in sera from 270 neurological patients. Control values were established in sera from 21 blood donors. Differences between the control group and several pathological conditions were found, positive results were obtained in sera of patients affected with MS, polyneuropathy and astroglial tumors.