[Automatic contour search and segmentation of sonographic transverse sectional pictures of the uterus with regard to optimization of individual isodose planning in uterine cancer]

Intrauterine ultrasonography has proved to be an adequate method to represent the normal myometrium as well as its pathologic modifications, especially for the assessment of localization and extent of malignant processes. So for the first time, intracavitary radiotherapy of the carcinoma of the body, especially the afterloading technique, can work by means of the produced crossections with a precisely defined target volume, because the sonographic probe and the afterloading probe have identical geometric configurations. A method is presented which allows a computer-assisted determination of the tumor volume by means of the segmentation of organ sections and a pseudo-threedimensional projection in combination with the energy dose distribution of the radioactive source.

Clostridium difficile colitis

We reviewed all rectal biopsies performed on patients with proven C. difficile infection between 1977 and 1982 (36 patients). All patients were symptomatic and all had received antibiotic treatment recently, the commonest antibiotic treatment being ampicillin or amoxycillin. There was poor correlation between the histological appearances and the severity of symptoms. A range of histological appearances was observed: normal (8%), congestion and edema (8%), nonspecific colitis (3%), infective colitis (28%) and pseudomembranous colitis (53%) (PMC). Most cases of PMC showed 'early' features, involving predominantly the surface epithelium, where attenuation and inflammation, intraepithelial microabscesses, and small eruptive lesions were seen. Recognition of these features, in the context of an acute infective-type colitis, may lead to early diagnosis of C. difficile colitis.

The influence of smoking on the healing of duodenal ulcer treated with oxmetidine or cimetidine

The influence of smoking on duodenal ulcer healing was examined during a double blind study of 83 patients randomly allocated to oxmetidine or cimetidine treatment. Smoking habits were recorded but patients were not advised to change these. Smokers and nonsmokers were similar clinically and did not differ in compliance with medication. Both H2-receptor antagonists were equally effective and after four weeks of treatment ulcers were healed in 76% of patients. Ulcer healing occurred significantly less frequently in smokers (69%) than nonsmokers (89%). Smokers with healed ulcers consumed fewer cigarettes per day (mean +/- SE: 15.8 +/- 1.4) than those whose ulcers did not heal (22.2 +/- 2.7). When smokers were grouped according to daily cigarette consumption, a direct relationship was found between increasing cigarette consumption and decreasing frequency of ulcer healing. No reduction in ulcer healing was apparent in patients who smoked nine cigarettes a day, or less.

Chronic radiation injury to the intestine: a clinico-pathological study

This paper draws attention to the continuing problem of chronic radiation injury to bowel. Fifty-seven symptomatic patients with this disorder were studied, 31 with predominantly small bowel injury and 26 with colonic disease. The mean latent interval following irradiation was 4.7 years. Small bowel disease presented initially as intestinal obstruction (19 cases) or malabsorption (11 cases) and the radiation related mortality in small bowel disease was 32%, while that for colonic disease was 4%. There was a high incidence of prior pelvic surgery and of adjunctive chemotherapy in patients developing small bowel disease. Analysis of the radiotherapy techniques used highlighted that an unsatisfactory distribution of radiation dosage occurred when parallel opposed fields were used particularly where one field only was treated daily. Difficulty in matching external beams with intracavity sources may also have contributed to radiation injury.

Ultrastructure and electron-probe x-ray analysis of the pigment in melanosis duodeni

A patient with peptic ulceration developed melanosis duodeni, which was studied by light microscopy, histochemistry, electron microscopy and electron-probe x-ray analysis. Our studies show that the pigment in melanosis duodeni resides in the lysosomes of macrophages in the lamina propria. The pigment is not melanin or a melanin-like compound as has been claimed by previous workers. On the basis of electron-probe x-ray analytical findings we have concluded that the pigment is essentially FeS. On the basis of the history of this patient and cases reported in the literature we think that the Fe in this pigment is derived from haemorrhage in the gastrointestinal tract. We also found small amounts of Ca, K, Al, Mg, Si, and Ag. It would appear that Al, Mg and Si were probably derived from the biological milieu and/or other drugs and/or food and/or specimen contamination.

Collagenous colitis: a distinctive and potentially reversible disorder

A case of collagenous colitis is reported. The patient's symptoms cleared up after a course of mepacrine hydrochloride. Biopsies taken after clinical recovery still showed some increase in the number of reticulin fibres present in the upper layers of the lamina propria but the subsequent six years.

Medical manpower in South Australia with special reference to general practitioners

A survey of general-practitioner and total medical manpower in South Australia has been made through the AMA local associations. This reveals that a sizeable increase in medical manpower, particularly for general practitioners, is likely in the coming decade. Immediate attention is warranted to find solutions to problems which can be expected to arise from a possible oversupply of doctors. The solutions will need to be acceptable to universities, governments, the AMA and the Australian people.

Albright's syndrome involving the facial bone

A case of ALbright's syndrome involving the facial bone is presented. A satisfactory result was obtained by surgically recontouring the patient's facial asymmetry.

Long-term treatment of duodenal ulcer with cimetidine. Intermittent or continuous therapy?

Forty-eight patients with chronic duodenal ulcers which were healed with cimetidine were allocated at random into two equal groups to assess different ways of using cimetidine during one year of treatment. Twenty-four patients received intermittent six-week courses of cimetidine for each relapse, and 24 patients were treated with maintenance administration of cimetidine (400 mg twice a day) continuously. Only one patient in the group receiving continuous therapy suffered clinical recurrence, but asymptomatic ulceration was found in four others. The group of patients who were receiving intermittent therapy suffered a total of 36 clinical recurrences. Three of these patients required prolonged treatment to heal their ulcers, and seven developed asymptomatic ulcer. The number of relapses varied from none to five. No way of predicting the individual prognosis was found. Intermittent treatment was an acceptable alternative in approximately half of the patients treated in this way, and was a failure in one-quarter of the group.

Double-blind trial of trimipramine in the treatment of duodenal ulcer

Twenty-three patients with chronic duodenal ulcer were allocated randomly to receive either trimipramine 25 mg or placebo, as a single night-time dose, for six weeks. Ulcer healing was determined by endoscopy. The ulcer healed in two of 10 patients receiving trimipramine and in seven of 13 patients receiving placebo. Trimipramine in this dosage does not assist ulcer healing.

Carcinoma of the stomach--prognostic factors and current treatment

Two-hundred-and-six cases of gastric carcinoma were analysed for survival on the basis of their clinical, endoscopic and operative findings. An attempt has been made to identify prognostic factors and the role of edoscopy. It is concluded that too much radical surgery is being performed in patients who can be recognised preoperatively as having obviously advanced disease.

Prevention of duodenal ulcer relapse by cimetidine: a one-year double-blind trial

Fifty-one patients with duodenal ulcer which was healed by a six-week course of cimetidine completed a one-year double-blind study to compare the effects of cimetidine and placebo on the prevention of ulcer relapse. Patients were allocated at random to receive either 400 mg of cimetidine twice daily or placebo. Ulcer relapse was assessed by regular clinical follow up and endoscopy. A total of six of the 24 cimetidine-treated patients (25%) suffered a relapse compared to 25 of the 27 of placebo-treated patients (92.6%). Out of this total number of relapses, asymptomatic relapse with ulceration discovered by routine endoscopy at six months or one year, occurred in three patients receiving cimetidine and eight patients receiving placebo. Cimetidine prevents recurrence in patients with duodenal ulcer disease.

Arteriovenous fistula of the upper lip: report of case

A case of arteriovenous malformation is presented. Complete excision is important to avoid recurrence and formation of a new fistula. The pathophysiology and treatment of the lesion are discussed.

Hodgkin's disease as a complication of Crohn's disease

A case of a patient with Crohn's disease who was treated with azathioprine, and developed intestinal Hodgkin's disease as a complication is described.

Cimetidine treatment of duodenal ulceration: short term clinical trial and maintenance study

Eighty-five patients with endospcopically confirmed duodenal or pyloric canal ulcers entered a double blind trial with 1200 mg of cimetidine per day or placebo for 6 weeks. Eighty-four per cent of patients treated with cimetidine and 38 percent of those receiving placebo healed their ulcers (P less than 0.001). Measurement of basal acid output and maximal acid output before and after treatment showed no significant change but patients who failed to heal their ulcers had a higher basal acid output and maximal acid output than those who healed. Patients who smoked or drank alcohol had the same healing rate as abstainers. Sity-seven patients with duodenal ulceration healed by a 6-week course of cimetidine were randomly allocated to 400 mg of cimetidine twice daily or placebo in the maintenance trial. Actuarial analysis of the number of relapses in each group demonstrates that cimetidine is highly effective in preventing relapse.

C bodies and R bodies in the epithelial cells of normal and diseased human rectum

Small spherical, extracellular bodies (C bodies) measuring 20 to 80 nm in diameter and enclosed by a trilaminar membrane 7 nm wide surrounded the microvilli of human rectal epithelial cells. Similar bodies were observed within membrane-bound vesicles (R bodies) in the apical cytoplasm. The C bodies associated with the mature epithelial cells of the luminal surface were more numerous than those associated with the immature cells of the crypts, where the R bodies predominated. A decreased number of C bodies was observed in ulcerative colitis. We concluded that the membrane-bound C bodies surrounding the microvilli were cellular in origin and arose from R bodies within the cytoplasm of the rectal epithelial cells.

Cimetidine in the treatment of duodenal ulcer

In a double-blind trial performed in two centres, 67 outpatients with endoscopically confirmed duodenal (55) or pyloric canal (12) ulcers received cimetidine (34 patients) or placebo (33 patients) for six weeks. At 6 weeks complete healing of ulcers was significantly increased in patients receiving cimetidine (82%) compared with those receiving placebo (39%) (chi2=11-27; P less than 0-0008). Patients receiving cimetidine had significantly less daytime pain and required less antacid than those receiving placebo. Gastric acid secretion measured one week after cessation of treatment demonstrated that there was no rebound hypersecretion of acid in patients who had received cimetidine. The pretrial basal acid output of those patients whose ulcers failed to heal during cimetidine therapy was significantly greater than that of those whose ulcers healed during treatment with the drug (P less than 0-001). No side effects were encountered.

The significance of lowered jejunal disaccharidase levels

Disaccharidase estimations on 115 consecutive jejunal biopsies are reported. The patients were divided into four groups: 1. Normal jejunal biopsy light microscopy, not milk intolerant, 82 cases. 2. Normal jejunal biopsy light microscopy, milk intolerant, eight cases. 3. Patients with giardiasis, 11 cases. 4. Coeliac disease patients, 14 cases. The lowest disaccharidase levels were found in coeliac disease, with giardiasis cases showing intermediate levels. Poor correlation of lactase levels with milk intolerance was found. Three cases in Group 1 showing lowered lactase levels were given metronidazole and showed remission of clinical symptoms, raising the possibility that they had undiagnosed infections with Giardia lamblia.

The diagnosis of giardiasis

Four methods of diagnosing giardiasis are compared. Examination of smear preparations made from the jeunal biopsy specimen showed positive results in all of the 20 consecutive cases of giardiasis reported. The test was more reliable than examination of histological sections of the jejunal biopsy, wet preparations of jejunal aspirate, or faecal smears.

Solitary ulcer of the rectum, A report of fiteen cases

Fifteen cases of solitary ulcer of the rectum are described. The patients complained mainly of rectal bleeding, discomfort and passage per rectum of mucus. The lesion is most commonly situated on the anterior wall of the rectum and can be red and granular, nodular or ulcerating. Peolapse was found in nine cases. The histological lesion is similar to that seen in rectal prolapse. The condition can be mistaken for colitis, adenomatous polyp or carcinoma. Reassurance, defaecation reeducation and dealing with the patients'emotional problems alleviated the condition in some cases. Surgery to remove a prolapsing segment was performed in one case only.

Early gastric carcinoma

Seven cases of early gastric carcinoma are reported. This condition by definition refers to a carcinoma confined to the mucosa and submucosa only. The definition depends upon the depth of spread and not the surface area covered by tumour or the period over which it is believed to have been present. Each patient had a history indistinguishable from one of benign ulceration. All seven patients had barium meal studies, and in only two was the possibility of malignancy raised. In the other five patients the ulcers demonstrated radiologically were considered benign. Fibreoptic endoscopy was done in six cases; in three the appearances were suspicious of malignancy, and in the remaining three the lesions appeared benign. Biopsy specimens taken at endoscopy contained carcinomatous tissue in all six cases. The patients all had partial gastrectomy, and no recurrence has yet been found. The longest follow-up period is 36 months.

Symptomatic osteoarthritis of the temporomandibular joint: report of a case

A case of osteoarthritis in the TMJ which manifested clinical symptoms, radiographic changes, and the classic microscopic alterations has been presented. Whether the condition was a primary or secondary form of the disease could not be unequivocally ascertained, as the symptoms preceded the injection of a sclerosing solution and a mandibular fracture, both of which could be significant contributing factors to a trauma-induced secondary osteoarthritic change. Nevertherless, a lack of symptoms in other joints would tend to exclude a generalized (primary) form of osteoarthropathy. In this regard, symptoms referable to the TMJ (to the exclusion of other joints) are more consistent with findings of secondary osteoarthritic change. Whether osteoarthritic changes were discernible by radiography in the TMJ before the traumatic episodes recorded in the history is unknown. Indeed, a developmental anatomic anomaly could not be ruled out. Regardless of whether the changes were the result of primary degenerative disease or chronic trauma, the symptoms were adequately resolved by surgical intervention.

The value of endoscopy and biopsy in the diagnosis of gastric carcinoma

The value of endoscopy and biopsy in the diagnosis of gastric carcinoma has been examined. Out of a total of 550 patients, gastric carcinoma was suspected in 101. Endoscopy and biopsy provided a firm diagnosis in 43 of the 44 cases of gastric carcinoma present, and effectively excluded gastric carcinoma in 48 cases. We recommend endoscopy and biopsy as valuable diagnostic procedures in the investigation of patients suspected of having gastric carcinoma. Used together they can eliminate the necessity for diagnostic laparotomy.

Diarrhoea and colitis associated with antibiotic treatment

Sixteen cases of colitis developing within twenty-one days of antibiotic therapy are reported. There was a wide range of disease severity. Lincomycin and Clindamycin were implicated in twelve. The colitis was of two pathological patterns pseudomembranous colitis and "non-specific" colitis. There is a relative sparing of the rectum in some cases making the diagnosis more difficult on sigmoidoscopy.

The effect of carbenoxolone sodium on the plasma 11 hydroxycorticoid levels in chronic gastric ulceration

The mineralcorticoid effects of carbenoxolone sodium are well established and seem related to the ulcer healing of the drug. In the present study the plasma 11 hydroxycorticoid responses were assessed in 12 patients undergoing treatment with carbenoxolone for chronic gastric ulceration. After treatment with carbenoxolone for one month the plasma 11 hydroxycoticoid levels rose significantly, suppression by dexamethosone was less marked and the normal diurnal periodicity was abolished. Carbenoxolone therapy influences the results of tests designed to assess the function of the pituitaryadrenal axis and may lead to sub-clinical adrenocortical hyperfunction.