Adenocarcinoma of the appendiceal stump.

We have reported the case of a 58-year-old woman with nonspecific abdominal complaints in whom barium enema and subsequent colonoscopy showed a 3 cm lobulated adenocarcinoma within a villous adenoma arising from the appendiceal stump. Because such appendiceal malignancies have no specific clinical signs, symptoms, or radiologic features, preoperative diagnosis is extremely difficult, and colonoscopy may be required to clarify radiologically demonstrated irregularities.

Identification of Campylobacter pylori by endoscopic brush cytology.

To investigate the value of Papanicolaou-stained endoscopic brush samples in the diagnosis of Campylobacter pylori infection of the upper gastrointestinal tract, 138 brush and biopsy samples from the esophagus, stomach, and duodenum, taken concomitantly, were reviewed retrospectively. In 35 cases, Campylobacter-like organisms (CLOs) were found in both cytology and biopsy samples. In 15 cases, CLOs were seen in biopsy material only, and in 8 cases, CLOs were found in cytology material only. CLOs were found in 49% of the gastric specimens and 33% of the Barrett's esophagus specimens by histologic or cytologic examination or by both methods. CLOs were found by at least one method in 64% of the gastric samples with active gastritis 40% with borderline gastritis, 15% without gastritis, and in 64% with adenocarcinoma. Cytologic examination of endoscopic brush samples is a valuable technique for the diagnosis of gastric Campylobacter infections and can be performed easily in cytopathology laboratories.

A new subtype of a natural viral inhibitor (CVI) that is stable in the gastrointestinal tract.

A virus inhibitor found in gastric secretions and in extracts from gastrointestinal tissues is described. The inhibitor shares a number of characteristics with the recently described contact-blocking virus inhibitor (CVI), which is produced by unstimulated cells in culture, and occurs naturally in some body fluids. The new inhibitor, which we have designated gastrointestinal-CVI (GI-CVI) is similar to the originally described CVI in its resistance to denaturation by acid and alkali, stability at 100 degrees C, and broad antiviral action. GI-CVI can be distinguished from the previously described material by its resistance to proteolytic inactivation and enhanced heat stability, however. This new virus inhibitor has been found in significant titers in gastrointestinal secretions and tissue extracts from three mammalian species.

Chlamydia trachomatis in the ascitic fluid of patients with chronic liver disease.

Several recent reports suggest that Chlamydia trachomatis causes peritonitis and perihepatitis in young women. We studied nine patients with chronic liver disease and ascites to determine a possible role for C. trachomatis in the bacterial peritonitis of cirrhotic patients. C. trachomatis was isolated and identified from the peritoneal fluid in three of these patients. In these patients, the peritoneal fluid was a transudate that contained fewer than 250 white blood cells/mm3, with fewer than 10% neutrophils, except when a bacterial organism other than C. trachomatis was also present. Two of these patients developed peritonitis that was associated with other bacterial organisms. Unless specific tests for C. trachomatis was performed, its presence will not be detected, and the peritoneal fluid cell count will not suggest bacterial infection.

Endoscopic prognosis in gastric cancer.

Sixty-eight patients with gastric adenocarcinoma underwent upper gastrointestinal endoscopy from 1968 to 1975. Tumors were divided into two categories according to their gross characteristics at endoscopy (mass-ulcer or infiltrative), to try to correlate gross morphology and stage at presentation with survival. The median survival in the mass-ulcer group was 31 months, in the infiltrative group, 4.7 months. Mucosal biopsies were positive in 88% of the mass-ulcer group and in 64% of the infiltrative group. Ninety-four percent of patients with infiltrative lesions had stage III or IV disease (regional lymphatic or distant metastasis) at the time of diagnosis, compared to only 55% of the mass-ulcer patients. Endoscopic features consistent with an infiltrating tumor suggest an advanced stage of tumor with a poor prognosis.

Serologic testing for amoebiasis.

The diagnosis of amoebiasis presents problems, particularly if one relies on finding the organism. Thus, serologic tests are expedient. A gel diffusion precipitin test (GDP), commercially available, simple to perform, and inexpensive, was compared with the indirect hemagglutination test (IHA). 257 Patients' sera were tested; 14 had amoebic colitis, 21 had amoebic liver abscess, 63 had suspected amoebic liver abscess, and 46 had inflammatory bowel disease. GDP tests were positive in 85% of amoebic colitis and 95% of amoebic liver abscess patients; IHA was positive in 91% of amoebic colitis and 94% of abscess patients. Within 6 mo, GDP tests became negative in 66% of patients. IHA tests were observed positive up to 20 yr. The performance characteristics of diagnostic methods in amoebiasis, fecal examination, IHA and GDP, show serologic tests have superior sensitivity and predictive value in recognizing invasive disease.

Viral hepatitis in pregnancy with disseminated intravascular coagulation and hypoglycemia.

A case of a 26-year-old woman who presented at 38 weeks of gestation with severe hepatitis B complicated by disseminated intravascular coagulation (DIC) and hypoglycemia is reported. The clinical features of the illness suggested acute fatty liver of pregnancy. Cesarean section was followed by resolution of the coagulopathy and the hypoglycemia. Both mother and infant survived and remain well. The diagnosis of hepatitis B was confirmed by a transiently positive hepatitis B surface antigen and percutaneous liver biopsy. This case emphasizes the difficulty in distinguishing acute viral hepatitis from acute fatty liver of pregnancy. In addition, the predominant features of DIC and hypoglycemia in our case are reported.

Amebic liver abscess: 1966-1976.

A 10-year retrospective analysis of 15 patients with amebic liver abscess is reviewed and represents a continuation of the previous 2-decade experience at our institution (37 patients). Records were studied to determine the population affected, presenting symptoms, physical and laboratory findings, type and response to therapy. Most patients were rural males of lower socioeconomic status in the third to fifth decade of life. They presened as a febrile illness with abdominal pain for an average of 2 1/2 months duration. Significanct physical abnormalities were tender hepatomegaly (93%), right-sided pulmonary changes (40%), and fever (66%). All patients had abnormal liver scan, positive amebic serology, and hypoalbuminemia. All patients promptly responded to amebicidal therapy except one whose therapy was delayed. Clinical suspicion, liver scanning, serologic testing, and response to therapy are the keys to diagnosis.

Hepatitis-associated lipid storage myopathy.

We report the case of a 23-year-old woman who developed severe myalgias in association with mild hepatitis B surface antigen-positive hepatitis. Muscle biopsy showed myriads of microvacuoles filled with neutral lipid. Prednisone therapy was associated with complete clearing of all clinical and laboratory abnormalities. Since muscle carnitine levels were normal before treatment, we conclude that infection with hepatitis virus may induce non-carnitine-deficient lipid storage myopathy in man.