Histological evolution of chronic hepatitis C. Factors related to progression

We have evaluated the histological progression of liver disease in 29 untreated patients with chronic hepatitis C. All patients were positive to antibodies to hepatitis C virus by ELISA2 and RIBA2. Two liver biopsies were carried out for each patient, with an interval ranging between 12 and 126 months (mean 50.2 +/- 30.7). In all cases the usual histological classification was applied and the histological activity index scoring system according to Knodell et al. was determined. Fifteen cases worsened (51.7%), 12 cases showed no histological changes (41.4%) and two patients improved (6.9%). Cirrhosis was found in five patients (18.5%) in the second liver biopsy. Epidemiological, clinical, biochemical and histological progression and the group with impairment in liver histology. Factors related to histological worsening were: more advanced age (p = 0.002), high levels of aspartate aminotransferase (p = 0.04), high global histological activity index (p = 0.03) and piecemeal necrosis and bridging necrosis scores (p = 0.02) at first biopsy. The histological activity index can be applied to assess the natural history of chronic viral hepatitis, and is a good tool to evaluate the prognosis. Thus chronic hepatitis C virus infection is a histologically progressive disease in at least half the cases.

Blood transfusion has no effect on colorectal cancer survival. A population-based study

This study was conducted to evaluate the impact on survival of perioperative blood transfusion in a series of 698 colorectal cancer patients undergoing radical surgery. Patients were identified, and follow-up was carried out by the local population-based cancer registry. Data on blood transfusion was obtained by record linkage with the files of the blood banks operating in the area covered by the registry. Prognostic factors were age, Dukes stage and topography of the primary tumour. Relative risk (RR) for Dukes B patients was 1.53 [95% confidence interval (CI) 0.94-2.50] and for Dukes C, 3.57 (95% CI 2.22-5.75) when compared with Dukes A patients. For the left colon, RR was 0.96 (0.61-1.52) and for the rectum 1.87 (1.22-2.86) when compared with the right colon. When adjusting for these factors and excluding operative mortality, RR for transfused patients was 1.16 (95% CI 0.87-1.55). It is concluded that blood transfusion does not adversely affect survival in colorectal cancer patients.

Diet and colorectal adenomas: a case-control study in Majorca

A case-control study on dietary factors and colorectal adenomas was conducted in the island of Majorca, Spain, from April 1987 to February 1990. Subjects were interviewed using a food frequency questionnaire. Nutrient and caloric intake was estimated using local food composition tables. The risk of colorectal adenomas was related to the consumption of sugar and pastries. Consumption of vegetables was highly protective, irrespective of the cooking procedures. Analyses by nutrients identified as protective factors fiber from fruits and vegetables, magnesium and zinc, and vitamins C, B6 and folic acid. No excess risk was found for alcohol drinking, intake of saturated fats or animal protein. Of the non-dietary factors, sedentariness in the work-place and urban residence were the only risk factors identified.

Occurrence of Ki-ras and p53 mutations in primary colorectal tumors

Twenty-four colorectal tumors and their paired mucosa were examined for allele loss on chromosomes 5 and 17, using polymerase chain reaction-amplified DNA, and for mutations in the Ki-ras and p53 genes. In addition, 19 benign polyps were analysed for mutations in the p53 gene. RFLP analysis of the long arm of chromosome 5 indicated an allele loss frequency of 47% for malignant tumors, a value somewhat higher than previously observed. Examination of the short arm of chromosome 17 indicated an allele loss of 60%. Sequence analysis of the p53 gene in colorectal tumors indicated that 64% contained a mutation. All tumors showing allele loss on chromosome 17 were mutant for p53, suggesting that mutation of one p53 allele precedes the hemizygotic loss of the wild-type allele. Sequence analysis of the p53 gene in 19 benign polyps, devoid of severe dysplasia, did not reveal any mutants, suggesting that the mutation of one p53 allele is an event that takes place after polyp formation. Ki-ras mutations were observed in 48% of the tumors examined. All tumors which were mutant for Ki-ras, except for one, were also mutant for p53.

Nutritional factors in colorectal cancer risk: a case-control study in Majorca

The relationship between energy intake, selected nutrients and colorectal cancer was investigated in the population of Majorca, a Spanish island in the Mediterranean basin. A population-based case-control study using food frequency questionnaires was conducted during the period 1984-1988 and included 286 cases of colorectal cancer, 295 population controls and 203 hospital controls. Food composition tables and ad-hoc estimates of portion sizes were used to derive intake estimates of 29 nutrients and of total calories. Relative risks were calculated for quartiles of consumption of each specific nutrient after adjustment for total calorie intake. Colorectal cancer was found associated with dietary intake of total calories (RRs = 1.0, 1.6, 1.6, 2.6) and cholesterol (RRs = 1.0, 0.9, 1.7, 1.7) and a protective effect was associated with the intake of fibre from legumes (pulses) and folic acid. The associations and the trends were statistically significant. Among the main energy-supplying nutrients, after adjustment for calories from other sources, increased risks were found for protein (RRs = 1.0, 1.1, 1.7, 2.5), notably animal protein, and carbohydrates (RRs = 1.0, 1.5, 1.4, 2.2), whereas no effects were found for increased consumption of lipids or saturated fats.

[A prospective study of the functioning of 2 types of enteral nutrition catheters]

The problems of disintubation and obstruction of nutritional catheters are common during treatment with enteral nutrition. This prospective study has been designed to evaluate the differences in the frequency of obstruction between two different types of enteral nutrition catheter. Catheter A (Silk, Ibys) with one single lateral outlet, wide, long and with a curved edge, and Catheter B (Nutrisoft M, Kabi-Pfrimmer), with several smaller lateral holes, 46 nutritional periods were studied, divided into two groups: first group, n = 32 (catheter A) and second group n = 14 (catheter B, Nutrisoft M, Kabi-Pfrimmer). There were no significant differences between both groups for the type of diet administered, osmolarity, speed, volume administered, number and duration of interruptions, external fixation, washing of the catheter and duration of the nutritional period. The catheter slipped out in 21 periods (46%). Obstruction of the catheter was the cause of disintubation of the catheter in eight cases, five of the cases with catheter A (15%) and three cases with catheter B (21%); there were no significant differences between the values for both. These results indicate that the frequency of obstruction is similar with both catheters; however, the Silk catheter may have a better tolerance and be easier to intubate, due to its smaller external diameter.

Ascites increases the resting energy expenditure in liver cirrhosis

The purpose of this study was to investigate the effect of ascites on the energy metabolism of patients with liver cirrhosis. The resting energy expenditure was determined in 10 patients with liver cirrhosis and ascites of moderate or large volume. The resting energy expenditure measurement was performed using indirect calorimetry and the resting energy expenditure predictive value was calculated with the Harris-Benedict equation, both before and after removal of ascitic fluid by paracentesis. Metabolic stress factors were absent in all cases. After an interval of 11.2 +/- 7.7 days between measurements, a weight loss of 16.6 +/- 10.3 kg was observed with paracentesis. The resting energy expenditure measured by indirect calorimetry showed a statistically significant decrease from 1682 +/- 291 to 1523 +/- 240 kcal/day (P less than 0.005) after removal of ascites. The repeatability of our indirect calorimetry method only allowed for the analysis of the results in 4 of 10 patients in whom ascites removal produced a consistent decrease in resting energy expenditure. There were no statistically significant differences between the measurements obtained by indirect calorimetry and those provided by the Harris-Benedict equation, but the latter had a moderate reliability in predicting the real resting energy expenditure of every patient. Our results suggest that, far from being an inert volume, ascites may be associated, at least in some patients, with an increased resting energy expenditure and therefore accelerate the appearance of protein energy malnutrition with corresponding complications.

[Spontaneous bacterial peritonitis in the cirrhotic patient. A study by discriminant analysis]

Infection of peritoneal fluid in cirrhotic patients requires an early diagnosis and treatment. Different parameters have been used for the diagnosis of this complication, however, the statistical study has not used multivariable analysis techniques. We have therefore designed this work performing a discriminating analysis in order to find the best variable combination. Twenty-six cirrhotic patients who were consecutively admitted to our hospital have been studied. Total adn polymorphonuclear leukocytes, glucose, LDH, and lactic acid were determined in peritoneal fluid. Eighteen peritoneal fluids were classified as non infected and the rest as infected. The criteria obtained from the discriminating function which combines total leukocytes, LDH, and glucose has been chosen as optimal. The utility of discriminating analysis is discussed and we conclude with the need to verify in a later study the value of the calculated function.

A population-based case-control study of colorectal cancer in Majorca. I. Dietary factors

A population-based case-control study was conducted between July 1984 and February 1988 in the Spanish island of Majorca; 286 incident colorectal cancer cases, 295 population controls and 203 hospital controls were interviewed using a food frequency questionnaire. In a multivariate analysis, an increased risk of colon cancer was found for high consumption of fresh meats (RR = 2.87) while a high consumption of cruciferous vegetables afforded protection (RR = 0.48). For rectal cancer an increased risk was associated with dairy products (RR = 3.08) while a protection was afforded by consumption of cruciferae (RR = 0.50). For colorectal cancer, the cereal food group also showed an increase in risk (RR = 1.92). When cases were compared to hospital controls, the effects of cruciferae in colon and rectum and those of dairy products in rectal cancer remained. The magnitude of the RR estimates was decreased for most comparisons, although in general terms the direction of the associations was the same. In addition, univariate analyses of food groups also suggested significant increases in risk of colorectal cancer for increasing consumption of cereals, potatoes, pastry, eggs and number of meals per day. An indication was found of a reduction in risk for consumers of coffee. An analysis based on risk scores was also conducted and a 4-fold increase in the risk of colorectal cancer and a highly significant statistical trend was found for high consumption of fresh meat, dairy products and cereals combined with low consumption of cruciferae.

Endoscopic diagnosis of the excluded gastric antrum

A 69-year-old woman was admitted to our hospital with GI haemorrhage. Twenty-two years previously, she had had a Billroth II operation to treat a duodenal ulcer. A gastroscopy performed on admission showed two ulcers on the anastomotic crest. We were able to visualize all of the blind duodenal pouch and how in the proximal end the mucosa was prominent and different in colour. Excluded gastric antrum was confirmed by endoscopic biopsy. We discuss the different approaches to the diagnosis of excluded gastric antrum, and we conclude that endoscopy must play important role in the diagnosis of this pathology.

Use of the urologic resectoscope in rectal pathology

We have resected five sessile polyps and treated rectal hemorrhage using the urologic resectoscope that operates in an aqueous solution. It is our belief that working in an aqueous environment can avoid some of the drawbacks of the standard technique in an air environment. We think that this is a useful technique in digestive endoscopy with precise indications and promising future development.