7,12-dimethylbenz[a]anthracene-induced 'early' squamous cell carcinoma in the Golden Syrian hamster: evaluation of an animal model and comparison with 'early' forms of human squamous cell carcinoma in the upper aero-digestive tract

To test and optimize photodynamic therapy of early cancers in the upper aero-digestive tract and oesophagus, we sought an appropriate animal model, which was found in the 7,12-dimethylbenz[a]anthracene-induced early squamous cell carcinoma in the Golden Syrian hamster. This chemically induced neoplasm is shown, by histology and immunohistochemistry, to pass through similar stages of early cancer development as its human counterpart. Its time sequence is highly reproducible, leading to a well differentiated carcinoma in situ and microinvasive carcinoma in the hamster cheek pouch over a period of 10 weeks.

[Magnetic resonance imaging and x-ray computed tomography in advanced cancer of the oral cavity. A comparative clinical, radiological and morphological study]

The objective of this prospective study is to assess the impact of magnetic resonance imaging (MRI) and computed tomography (CT) as compared to physical examination in the choice of type of surgery for advanced intraoral cancers (with or without resection of the mandibula). From 1990 to 1993, we operated on 21 intraoral malignant tumors with segmental resection of the mandibula followed by a histological examination. The preoperative evaluation consisted of an MRI (n = 8), a CT (n = 8) or both (n = 5). MRI suspected an infiltration of the bone in 9 cases, CT in 4 and physical examination in 16. This was histologically confirmed in 6 of the 21 patients only. MRI and CT both have a high sensitivity, as does physical examination, but neither have a good specificity (physical examination: 5 true positive, 4 true negative, 11 false positive, 1 false negative; MRI: 4 true positive, 4 true negative, 5 false positive, 0 false negative; CT: 3 true positive, 7 true negative, 3 false positive, 0 false negative). In conclusion, the decision of a mandibular resection can only be taken after a careful physical examination, including palpation under general anesthesia in a fully relaxed patient. This is best accomplished during the pretherapy bronchoesophagoscopy, routinely performed for the detection of synchronous second primary tumors using toluidin blue as a vital staining method. If this initial evaluation gives a suspicion of a massive infiltration of the mandible, an MRI, rather than a CT, should be performed to determine the extent of the resection because of a high rate of artefacts with CT.

[Association of a giant Meckel's diverticulum and Crohn disease of the neighboring intestinal segments]

We report the case of a 51-year old patient presenting a giant Meckel's diverticulum associated with Crohn's disease in the proximal and the distal segments. The voluminous diverticulum had already been demonstrated by radiographies at the age of 28 years. Late symptoms were signs of partial obstruction and malabsorption.

[Liver transplantation. Initial Lausanne experiences]

This paper presents the results of the first 7 orthotopic liver transplants performed in Lausanne between December 1988 and September 1990. 6 patients are surviving; their rehabilitation is excellent.

[Is papilloma of the esophagus a preneoplastic lesion? Study of 33 cases]

The etiology of esophagus papilloma is much debated: some authors attach greater importance to irritation factors, while others give preference to the viral hypothesis and suggest that this disease could eventually lead to squamous cell carcinoma of the esophagus. To verify the viral hypothesis, we reviewed the histological slides of the 33 cases of esophageal papilloma diagnosed in our Institute of Pathology between 1973 and 1988. We evaluated the histological diagnosis using Winckler's criteria. HPV typing was done using probes of HPV DNA types 6-11, 16-18, 31-33-35 applied to paraffin sections according to the in-situ hybridization method. Clinical and endoscopic data of 15 cases (from the CHUV) are reviewed. Oncological data was provided by the Vaud Cantonal Tumor Register. No patient in our series fulfilled all the histological criteria set by Winckler to diagnose an HPV condition. Viral DNA 31-33-35 was found in a small minority of the papillomas. The clinical impact of esophageal papilloma on epidermoid carcinogenesis is nil.

[Does Barrett's esophagus regress after effective treatment of gastro-esophageal reflux?]

Regression and disappearance of Barrett's esophagus are a rare event of which there are only three well documented cases in the literature. Two cases are described in this study.

[Histology of the endobrachyesophagus: its value in the monitoring of patients]

Two histological classifications of Barrett's esophagus are posited in the literature: (1) a layered disposition (Paull); (2) a mosaic pattern (Thompson). Only specialized epithelia are potentially neoplastic. Our experience, based on two histological studies, confirms the heterogeneity of Barrett's esophagus. These studies show that the mosaic pattern is more frequent than the layered disposition. Therefore we consider it extremely important to perform multiple biopsies (centimeter by centimeter on the four faces of the esophagus) to allow histological diagnosis of the specialized form of columnar epithelium and/or of dysplasia.

[Drug-induced esophagitis and its complications. Retrospective study of 30 case reports and review of 650 published cases (1970-1987)]

Prevalence and incidence of drug-related esophagitis are probably underestimated. The condition can often be diagnosed on the basis of history alone. Tetracyclines and emepronium bromide were implicated in most published cases. Endoscopy usually shows erosions in the upper two thirds of the esophagus. These esophageal lesions generally heal after the medication has been stopped. Complications such as stricture, hemorrhage or perforation are very rare.

[Herpetic esophagitis following renal transplantation]

We report the case of a patient who developed herpes simplex oesophagitis less than one month after renal transplantation. Graft rejection treatment may have induced this infection. Diagnosis was suspected at endoscopy and was confirmed by biopsy. The patient was cured by intravenous acyclovir and temporary discontinuation of immunosuppressive medication.

[Y-loop gastrojejunostomy in postoperative gastritis caused by reflux]

This prospective study involving 24 patients operated for postoperative reflux gastritis spanned over the period between 1974 and 1987. Diagnosis by exclusion was based on clinical, endoscopic and histological findings collected a few months to 16 years following surgery, the outcome of which was either alteration or destruction of the antropyloric sphincteral mechanism. All patients had Y-loop gastrojejunostomy performed according to Roux's procedure (at 50 cm). The clinical results as assessed on the basis of Visick's score and by gastroscopy were good. Anatomopathological examination of pre- and postoperative bioptic specimens blind-collected by a single operator indicated that foveolar hyperplasia is a good indicator of enterogastric reflux.

[Pathogenic heterogeneity of Barrett's ulcers. Apropos of 38 case reports]

Barrett's ulcer is thought to develop in the columnar epithelium of Barrett's esophagus. In our series there is evidence that at least some Barrett's ulcers develop in squamous epithelium which may correspond to islets within Barrett's esophagus; in other cases Barrett's mucosa may surround a preexisting reflux-induced ulcer and thus transform it into Barrett's ulcer. In some individual cases of Barrett's ulcer development of the ulcer primarily in the columnar epithelium could not be ruled out. These ulcers may be produced by local acid secretion, by acid or alkaline gastroesophageal reflux in patients with reduced resistance of the columnar epithelium. Exceptionally, Barrett's ulcer may result from local irritation by medication (pill-induced ulcer) or by nasogastric intubation.

[Value of anti-Ro antibodies in 2 cases of Sjögren's disease with multisystem involvement]

In 2 patients the finding of anti-Ro antibodies led to the diagnosis of Sjögren syndrome, which explained a succession of various autoimmune diseases, viz. glomerulonephritis, orbital lymphoma and hemolytic anemia in case 1; primary biliary cirrhosis, subacute cutaneous lupus erythematosus and subclinical autoimmune thyroiditis in case 2.

[Surgical treatment of Barrett esophagus. Apropos of 110 cases]

One hundred and ten patients with Barrett's esophagus were operated on between 1963 and 1986. Preoperative endoscopy showed active peptic disease in 94% of the cases and a stenosis or ulcer in 61%. An anti-reflux operation was performed in 102 cases and a resection in 8 cases. Operative mortality was 3.6% and the morbidity was 9%. After an average follow-up of 6.9 years, 83% of the patients were satisfied with their operation. Postoperative endoscopy was performed in 39 patients after an average of 5.4 years. No progression or regression of the columnar epithelium was found. Two patients developed an adenocarcinoma in spite of adequate reflux control.

[Savary's ulcer: a new complication of gastroesophageal reflux? Apropos of 32 endoscopically observed cases]

Savary's ulcer is a rare and little known peptic ulcer situated just above Barrett's esophagus. It is predominant in elderly women, bleeds less than Barrett's ulcer and is almost always associated with peptic stenosis. It is, like Barrett's and Wolf's ulcers, a complication of gastroesophageal reflux and not of Barrett's esophagus.

[Current role of biopsy in the diagnosis of hepatic disease]

The criteria for the use of liver biopsy as a diagnostic tool were retrospectively analyzed over a ten-year period in 390 consecutive patients. The four principal conditions in which this procedure was employed were alcoholism (33%), hepatitis (18%), abnormal hepatic tests (16%) and tumors (10%). The development of new, "non-invasive", investigative methods such as echography and tomodensitometry has led to an decrease in the number of liver biopsies performed annually, but no change in the relative frequency of the various indications. In this paper, evidence is presented which demonstrates that hepatic biopsy confirmed the clinical diagnosis in 62.4% of the cases reviewed and fundamentally modified the diagnosis in 20.2%. Based upon these findings, it can be concluded that liver biopsy remains an indispensable diagnostic procedure in the field of hepatology, since it can result in modification of the clinician's diagnosis in one out of five cases.