Papillary thyroid carcinoma in Danish patients with familial adenomatous polyposis

All patients from the nationwide Danish Polyposis Register have been followed up with regard to thyroid carcinoma. During the period 1943-1985, 2/107 Danish women and 0/138 men developed papillary thyroid carcinoma after the diagnosis of familial adenomatous polyposis. The expected number among females was 0.02 resulting in a observed/expected ratio of 100 (95% confidence limits 12-361). Consequently, thyroid carcinoma should be included among the extracolonic lesions, which may develop in any female polyposis patient. However, regular thyroid examination is not indicated, as thyroid carcinoma is uncommon and as the prognosis is excellent.

Ileal pouch-anal anastomosis after failure of straight ileoanal anastomosis. Case report

The technique for creating an ileoanal anastomosis and an ileal reservoir with stapling technique is described. It was used in two patients in whom severe complications after colectomy and straight ileoanal anastomosis had necessitated ileostomy. The functional result was satisfactory.

Tubocutaneous fistula. Case report

A 40-year-old woman with Crohn's disease had a cutaneous fistula discharging only during menstruation. Surgical exploration showed a tubocutaneous fistula. Such fistula is extremely rare without prior surgery of the reproductive organs. Discharge during menstruation was the salient feature in most reported tubocutaneous fistulas. Resection of the fistula and salpingectomy is the treatment of choice.

In vitro tetraploidy in patients with ulcerative colitis

One hundred and seven patients (57 patients with ulcerative colitis and 50 controls) were investigated for in vitro tetraploidy (IVT) in dermal fibroblast monolayer cultures. There was no difference in incidence of IVT between patients with ulcerative colitis and controls. We advance the hypothesis that the genetic background of the colorectal cancer type found in ulcerative colitis differs from that found in the colon cancer syndromes and in non-hereditary colorectal cancers. Colorectal cancer in ulcerative colitis is probably only dependent on the degree of inflammatory lesions of the colonic mucosa.

Dental anomalies in familial adenomatous polyposis coli

Forty-seven Danish and 50 Finnish patients with familial adenomatous polyposis coli (FPC) were studied by panoramic tomography (PTG) of the mandible, which showed dental abnormalities in 17% of the cases. Eleven patients (11%) had supernumerary teeth and/or compound osteomas, and nine patients (9%) had impacted permanent teeth. The frequency of the dental anomalies was statistically significantly higher in FPC patients than in the normal population; it is therefore concluded that this dental abnormality should be included in the list of extracolonic manifestations that may occur in any FPC patient. The frequency of dental anomalies was higher in Finnish than in Danish patients, probably owing to a higher frequency of extracolonic manifestations in the Finnish series.

In vitro tetraploidy in patients with non-hereditary colorectal adenoma and carcinoma. Support for a genetic influence on the pathogenesis of colorectal carcinoma

One hundred and seventy-two patients (76 patients with colorectal cancer, 46 with adenoma of the colon or rectum, and 50 controls) were investigated for in vitro tetraploidy in dermal fibroblast monolayer cultures. The incidence of increased in vitro tetraploidy (IVT) among patients with adenoma or carcinoma was significantly different from that of controls. There was no difference in the incidence of IVT between the adenoma patients and those with colorectal cancer. IVT was investigated among different subgroups of adenoma and colorectal cancer patients and was only found to be related to an inherited tendency to colorectal cancer.

Incidence of associated diseases in familial polyposis coli

In this review we present diseases associated with hereditary polyposis syndromes. In addition to the known extracolonic manifestations of the so-called Gardner's syndrome, other important diseases are carcinomas of the thyroid and of the small bowel and bile duct adenoma. The incidence of these diseases is discussed.

Mandibular osteomas in unaffected sibs and children of patients with familial polyposis coli

Orthopantomography of the mandible (OTM) showed osteomas in 3 of 34 non-affected sibs and children of the probands in 14 families with polyposis coli. The observed to expected ratio with osteomas was 0.35, which is not significantly lower than 1.0 and in accordance with the frequency in the normal population. Although the result does not enable a definite evaluation of the diagnostic value of OTM, the finding suggests that this method may be used as a supplement to regular proctosigmoidoscopic screening of first-degree relatives of polyposis patients.

Mandibular osteomas in colorectal adenomas

Orthopantomography of the mandible was carried out on 50 patients with colorectal adenoma(s) without carcinoma or any known familial disposition. Four patients (8%) had osteomas, and we advance the hypothesis that individuals with both osteomas and adenomas represent a separate type of adenoma patient. Further studies are needed to evaluate the prognostic value of the association of adenomas and mandibular osteomas.

IgG heavy-chain (Gm) allotypes in familial polyposis coli

Serum samples from 40 Danish patients with familial polyposis coli and 105 normal blood donors were typed for eight Gm and one Km markers. The distribution of all Gm phenotypes as a group was significantly different in the patient population as compared to the controls. Examination of individual Gm phenotypes showed an increased frequency of Gm3;5,13 in the patients.

The incidence and prevalence of familial polyposis coli in Denmark

Based on the Danish Polyposis Register, the frequency of familial polyposis coli was estimated at the end of 1982. The mean annual incidence rate of polyposis coli has remained rather constant at approximately 1 X 10(-6) X yr-1 since the forties. The life-time risk of developing polyposis coli is about 1 X 10(-4). The point prevalence rate was 26 X 10(-6) at the end of 1982. The number of cases found in sibs and children of probands made it probable that a nation-wide prophylactic examination of first degree relatives resulted in a complete identification of affected family members. The completeness of the Danish Polyposis Register in the period 1976-82 was estimated to be 90% and the validity of the diagnosis is considered to be 100%.

Clinical features in familial polyposis coli. Results of the Danish Polyposis Register

Three hundred nineteen affected members of 94 Danish families with familial polyposis coli had been registered in the Danish Polyposis Register by the end of 1982. Of the 247 histologically verified cases, 168 were propositi and 79 were call-up patients. The frequency of colorectal cancer at the time of diagnosis of polyposis was 69 percent in propositi vs. 3 percent in call-up patients. The cumulative survival rate after ten years was 97 percent in call-up patients, as compared to 42 percent in propositi. The prognosis of polyposis patients has improved significantly since the establishment of the Danish Polyposis Register in 1971.

Increased in vitro tetraploidy: a possible biomarker of non-heritable colorectal cancer?

In vitro tetraploidy (IVT+) in dermal fibroblast monolayer cultures has been studied in a series of patients with non-syndrome colon cancer and a control group to determine its value in identification of genetic predisposition for all colon cancers and its relevance to colon cancer occurrence on the basis of clinical history and pedigree data. Among 41 patients with colon cancer 18 (44%) had IVT+. In the control group 3 of 34 individuals (9%) showed IVT+. The difference is statistically significant (p less than 0.001). There was no correlation between a positive family cancer history, sex, age, or the presence of IVT+. Further studies using this possible in vitro biomarker may clarify the role of genetics in non-syndrome colorectal cancer.

Indomethacin treatment of acute pancreatitis. A controlled double-blind trial

Thirty patients with acute pancreatitis were allocated to indomethacin suppositories, 50 mg twice daily, or identical-looking placebo suppositories for 7 days in a controlled double-blind trial. The groups of patients were not different with regard to age, sex, etiology, or number of Ranson criteria. The number of days with pain and number of opiate injections were significantly less in patients treated with indomethacin. The median values of serum amylase and serum calcium were not different before or at any day during treatment. Bleeding from the gastrointestinal tract was not seen.

Chromosomal studies in familial polyposis coli

A study of five patients with familial polyposis coli did not demonstrate any structural abnormalities of prometaphase chromosomes from methotrexate synchronized peripheral blood lymphocytes. No chromosomal heritable fragile sites were observed, nor was sister chromatid exchange increased.

Mandibular osteomas in colorectal cancer

Orthopantomography of the mandible was carried out on 50 patients with colorectal cancer without known familial disposition. Twelve patients (24%) had osteomas, as against 5% in the control group (P less than 0.001). Since an increased occurrence of mandibular osteomas has earlier been demonstrated in cases of familial polyposis coli and the family cancer syndrome, we must conclude that genetic factors are presumably of more importance in the development of colorectal cancer than previously assumed.

Gastroduodenal polyps in familial polyposis coli

A total of 26 patients with familial polyposis coli without extracolonic manifestations were examined by gastroduodenoscopy. Histologically verified polyps were found in 18 patients (69 percent, 95 percent confidence limits 48-86). Gastric adenoma was diagnosed in one patient, fundic gland polyposis in six patients, and duodenal adenomas in 12 patients. It is concluded that the incidence of gastroduodenal polyps is independent of the clinical presence of other extracolonic manifestations. It is advisable that polyposis patients should be followed with gastroduodenoscopy and biopsy of polyps.