Preoperative short-term radiotherapy in rectal carcinoma. A preliminary report of a prospective randomized study

Between 1980 and 1983, 373 patients with clinically resectable rectal adenocarcinoma entered a prospective randomized study aimed to evaluate the effect of short-term preoperative radiotherapy. Protocol violations were identified in 21 instances. Of the remaining 352 patients, 182 were randomized to surgical treatment only (S-group). Immediately, before surgery, 170 patients were irradiated to the pelvic region with 25 Gy (2500 rad) during a 5-day period (RT-group). Of these patients, 59% underwent abdominoperineal excision, 38% anterior resection, and 3% laparotomy only. At surgery distant metastases were discovered in 32 patients (9%). There were no significant differences between the groups in the distribution of age, sex, operative methods, and tumor stage according to the original Dukes' classification. During the follow-up time, ranging between 6 months and 3 years, tumor recurrence occurred in 35 patients, 19 in the S-group and 16 in the RT-group. Fifteen patients in the S-group had pelvic recurrence compared to 10 patients in the RT-group. Distant metastases occurred in six and eight patients, respectively. Two patients in each group had both pelvic and distant recurrence. There was no correlation between tumor recurrence and type of operation. Median time interval from diagnosis to pelvic recurrence was 10 months in the S-group and 16 months in the RT-group. Postoperative complications in the form of wound sepsis were slightly more common in the RT-group. In summary, the applied treatment regimen, is well-tolerated and apparently does not affect the Dukes' stage of the tumor. Although there is no statistically significant difference, there is a trend of less pelvic recurrence in patients receiving preoperative radiotherapy.

Flow-cytometric DNA analysis as a means for early detection of malignancy in patients with chronic ulcerative colitis

A new approach to the problem of monitoring patients with chronic ulcerative colitis is presented and discussed in connection with a case report. When annual colonoscopies are performed, biopsies are taken for histopathological examination and DNA measurements are made using flow-cytometric techniques (FCM). Using the latter approach, gross chromosomal aberrations indicating malignant transformation in a cell population may be detected. In a 46 year old man with a long history of ulcerative colitis, an area with slight mucosal dysplasia at light microscopy was accompanied by two aneuploid cells lines - that is, colonic mucosa cells with an abnormal amount of DNA in the nuclei. An operation one year later revealed a 5 X 2 mm large adenocarcinoma in the corresponding area of the colon. We suggest that flow-cytometric techniques can be used as a complement to already practised methods for monitoring the colorectal mucosa in colitic patients for the early detection of malignancy.

Effects of 16,16 dimethyl prostaglandin E2 on irradiation damage of the small intestine

The effects of oral 16,16 dimethyl prostaglandin E2 on irradiation induced damage of the small intestine was examined in the rat. Groups of Sprague-Dawley rats received graded doses of the analogue or placebo at 24, 8 and 0.5 hours before and at 16 and 24 hours following whole abdominal exposure to 10 Gy. Rats were killed 72 hours after irradiation. Pretreatment within the lower dose range had a moderate protective effect with better preserved crypts and crypts to villus ratio. Larger doses seemed to increase the intestinal damage. The prostaglandin treated sham irradiated rats had higher villous height and larger epithelial surface compared with controls.

Ploidy and proliferation patterns in colo-rectal adenocarcinomas related to Dukes' classification and to histopathological differentiation. A flow-cytometric DNA study

The cellular DNA pattern in 66 colo-rectal adenocarcinomas was studied by means of flow-cytometric DNA analysis. The degree of ploidy and the proportion of cells in S-phase were related to the clinical stage according to Dukes' classification and to the histological differentiation. Multiple cell populations were found in about 60 per cent of the tumours but more frequently in advanced clinical stages. According to the DNA index the cell populations were bimodally distributed with one peak in the diploid-peridiploid region and one peak in the tri- to tetraploid region. In the second group there was a higher frequency of more advanced tumours as compared to the first. The proportion of cells in S-phase was higher in pure diploid tumour cell populations of all clinical stages as compared to normal mucosa but lower as compared to peridiploid and aneuploid cell populations with high DNA index. High as well as low S-phase values may occur in all clinical stages, but a significant higher mean value was found for Dukes' C compared to Dukes' B tumours. Distant metastases occur at all DNA indices and with various S-phase values. In conclusion, tumours of different clinical stages and histological differentiation may be subdivided according to DNA index, to the existence of single or multiple cell populations and to the proportion of cells in S-phase. The biological significance of this subdivision can only be evaluated by means of clinical follow-up.

Comparative studies on the histogenesis of squamous carcinoma of esophagus in mice and in human subjects

Histological changes occurring in the esophageal mucosa of 110 C57b1 mice, after protracted topical treatment with diethylnitrosamine, were compared to those present in human esophagus in three patients operated for early esophageal cancer. Both in mice and in human material, the histological changes were classified into slight, moderate or severe dysplasia, carcinoma in situ, questionable invasive carcinoma and invasive carcinoma. Starting from moderate dysplasia, the epithelial-stroma border became irregular with bud formation bulging into the stroma. The findings strongly suggest an association between the degree of cellular atypia, the formation of epithelial buds, and progression towards invasive carcinoma.

A semiquantitative histological method to estimate acute and chronic radiation injury in the small intestine of the cat

To study the radiation injury in the small bowel of the cat after doses close to and above the threshold for chronic radiation injury (15 Gy), an attempt was made to quantify these changes. For this purpose a semiquantitative method was developed by using 13 different histological alterations that were considered to mirror the acute and chronic radiation changes in the mucosa. Fibrosis was difficult to quantify; micrometric measurements of the bowel wall and its different layers were therefore carried out. The histological alterations were tabulated in increasing degree of severity. The sum of points of registered alterations in the specimen yielded scores that together with the micrometric measurements made it possible to differentiate specimens irradiated with high doses from those irradiated with low doses. The method may be valuable in estimating radiation injury in surgical specimens and in experimental studies of radiation injury.

Occurrence of an insulin-like peptide in extracts of peripheral nerves of th cat and in extracts of human vagal nerves

Biopsies from various peripheral nerves were collected from living cats. The biopsies were extracted with acid ethanol and the insulin-like immunoreactivity (ILI) content of the extracts determined with radioimmunoassay. The vagal, sciatic and radial nerves contained on the average 90, 3 and 28 ng of ILI per gram nerve tissue (wet weight), respectively. In the sympathetic trunc no ILI was found. In order to partly purify and characterize the nerve ILI extracts these were run on an HPLC system. the ILI coeluted with standard bovine insulin. The same amounts of ILI were found in the nerve extracts whether run on the HPLC system or not. It can be concluded that all of the immunoreactive material of the nerve extracts corresponds to insulin or to a peptide very similar to insulin. In two cats the radial and sciatic nerves were ligated for 24 h. Two to ten times more ILI occurred in biopsies taken proximal to the site of ligation than in those from corresponding distal biopsies, indicating that the insulin-like material is transported distally within the nerves. ILI was found in extracts from vagal nerves taken from 3 days old human autopsy material. Also this human ILI coeluted with the bovine insulin standard in the HPLC system.

Acetazolamide interferes with the protective effect of prostaglandin E2 in the rat gastric mucosa

Oral prostaglandin E2 protected the gastric mucosa against the damage induced by intraperitoneal indomethacin in the rat. Blocking of the gastric alkaline secretion by subcutaneous acetazolamide potentiated the ulcerogenic action of indomethacin and reduced or abolished the protective effect of a submaximal dose prostaglandin E2. The results are compatible with the hypothesis that stimulation of the alkaline secretion is one of the mechanisms by which prostaglandin E2 protects the gastric mucosa.

Relation between early and advanced gastric cancer

Of 75 consecutive inpatients with gastric carcinoma during a 3.5 year period, 40 underwent operation with the intention of cure, 5 had palliative gastric resection and 30 had exploratory celiotomy only. Early gastric cancer was found in 11 cases, that is, 15 percent of patients with gastric carcinoma or 24 percent of patients subjected to gastrectomy. The patients with early gastric cancer were operated on with the intention of cure. Comparison with a previous series from the same geographic area shows that the ratio between early gastric cancer and all gastric cancer increased significantly. This improvement in the management of patients with gastric carcinoma can be ascribed to the use of gastroscopy and biopsy. The survival rates in patients with early gastric cancer are excellent. The prognosis in patients with advanced gastric cancer, on the other hand, is poor and has remained so for the last 30 to 40 years. Twelve of the 75 patients had gastric stump carcinoma; 2 of these were early gastric cancer. Screening of asymptomatic patients for gastric cancer is at present an impossible task in most Western countries, but the risk of cancer after partial gastrectomy for benign lesions makes screening desirable in this selected group of patients.

[Meckel syndrome (author's transl)]

Authors study four cases, two siblings in two different families, with several anomalies allowing to consider them as examples of the Meckel-Grüber syndrome. A review of the recent literature about this entity is made, as well as a comparative study of the anomalie present in the published cases.

[Malnutrition in congenital deficiency of enterokynase (author's transl)]

A case of Congenital deficiency of Enterokynase is presented. The main clinical findings are: Chronic diarrhea, malnutrition and edema. Diagnosis was made by determination of tripsine activity in duodenal juice before and later to confront it to Enterokynase. The patient was treated with pancreatic supplements and protein hidrolysate with favourable results.

Induratio penis plastica Peyronie's disease. Clinical features and etiology

The clinical and laboratory findings in 106 patients with Peyronie's disease as well as histopathological examinations of biopsies from the plaques were studied. The clinical symptoms and signs were in general similar to those found in previous studies, but bone marrow smears showed an increased number of plasma cells and lymphocytes in 18 of 24 examined. Biopsy of the plaque in cases of long-term symptomatology disclosed a fibrosis poor in cellular components. In patients with a short history of the disease and a tender induration, an inflammatory component of the specimens with perivascular accumulation of lymphocytes and balooning of endothelial cells in the small vessels was seen. Characteristic cells with "cross-banded" nuclei, described earlier only in Dupuytren's contracture and experimental fibrosis, was observed for the first time in Peyronie's disease. Based on these findings a combined traumatic-immunological etiology is suggested.