The significance of antinuclear antibodies in juvenile rheumatoid arthritis associated with chronic bilateral iridocyclitis

Serum samples from 8 children with juvenile rheumatoid arthritis (JRA) and chronic bilateral iridocyclitis were significantly distinguished from 5 children with JRA and no eye symptoms by the presence of large immune complexes (IC) greater than 22S, IgM antinuclear antibodies (ANA), IgG granulocyte-specific (GS-) ANA, C3 fixing ANA, and IgM anti-IgG. One serum with and two sera without IC greater than 22S, all from patients with iridocyclitis, were fractionated by rate zonal ultracentrifugation. Each fraction relevant for the study was separately concentrated and reexamined. In one of the sera without IC greater than 22S this technique exposed the presence of IgA GS-ANA not detectable in the corresponding whole serum. IgG ANA were precipitated in an area with higher molecular weight than the one for IgG indicating the presence of aggregated IgG ANA. Fractionation of the serum with IC greater than 22S demonstrated IgM GS-ANA not present in whole serum. The results support previous suggestions that ANA may be involved in the pathogenesis of chronic iridocyclitis and may explain why ANA (in particular C3 fixing ANA) negative patients with JRA rarely develop chronic iridocyclitis.

Malignant non-Hodgkin lymphoma of the gastrointestinal tract. A histopathological review of 34 cases

Thirty-four cases of malignant non-Hodgkin lymphomas of gastro-intestinal origin were histopathologically reviewed employing Rapaport's (18) classification. The majority of the tumours, 25, were localized to the stomach. The rest of the lesions occurred with decreasing frequency throughout the gastro-intestinal tract, with the exception of 3 rectal cases. Thirty lymphomas displayed a purely diffuse pattern, 1 was purely nodular, and 3 were nodular with diffuse components. "Histiocytic" lymphoma was the commonest type, including 16 cases; poorly differentiated lymphocytic type next, with 10 cases. The histopathology of this series does not differ from those of comparable studies.

A comparison of the effects of HP 549 (Isoxepac), indomethacin and acetylsalicylic acid (Aspirin) on gastric mucosa in man

To determine the reaction of the gastric mucosa to HP 549 (isoxepac) an oxo-dibenz-oxepine derivative of acetic acid and new non-steroidal antiphlogistic agent in comparison with standard drugs, 12 healthy volunteers received 3 g of Aspirin, 150 mg of indomethacin, or 600 mg of HP 549 (isoxepac) in a double-blind cross-over trial. Before and after each treatment period, all subjects underwent gastroscopy with biopsy of gastric mucosa. The subjects recorded complaints (side effects) before and after each treatment period. Aspirin produced significantly more gross mucosal changes at endoscopy. There was no significant difference between isoxepac and indomethacin. Both produced very few gastric mucosal changes and there were few subjective complaints.

Precancerous conditions and epithelial dysplasia in the stomach

A distinction can be made between a precancerous condition and a precancerous lesion. The former is a clinical state associated with a significantly increased risk of cancer, whereas a precancerous lesion is a histopathological abnormality in which cancer is more likely to occur than in its apparently normal counterpart. Up to the present time atrophic gastritis, gastric ulcer, pernicious anaemia, gastric stumps, gastric polyps, and Ménétrier's disease have all been considered as precancerous conditions and lesions of the stomach. Of these, only atrophic gastritis, pernicious anaemia, gastric stumps, and certain types of gastric polyp can now be regarded as having any really significant malignant potential. The precancerous lesion common to these is epithelial dysplasia which can occur in ordinary (foveolar) gastric epithelium as well as in intestinal metaplasia. The criteria for grading dysplasia in gastric epithelium into mild, moderate, and severe grades are given, and attention is drawn to the problems of differentiating inflammatory or regenerative change from mild dysplasia and intramucosal carcinoma from severe dysplasia. The clinical and epidemiological implications of gastric dysplasia are discussed with suggestions for further research.

Cell proliferation in normal and diseased gastric mucosa. Autoradiography after in vitro continuous labelling with tritiated thymidine

The rate of gastric epithelial cell proliferation was studied in healthy volunteers and in patients with different degrees of gastritis. Endoscopic biopsies from the antral and fundic part of the stomach were incubated in vitro with 3H-thymidine for 30, 120, and 210 minutes respectively. Autoradiographs were prepared, and the percentage of DNA-synthesizing cells (labeling index) in the progenitor cell region was estimated. From the successive labeling indices the rate of entry of cells into DNA-synthetic phase (S-phase) and the duration of the S-phase could be estimated. All the biopsies were classified according to the degree of gastritis. The mean (+/-SEM) length of the S-phase was found to be 7.4 +/- 0.3 hours in antral mucosa and 7.2 +/- 0.4 hours in fundic mucosa. There was no significant difference between the S-phase duration in normal mucosa, superficial gastritis, mild atrophic gastritis and severe atrophic gastritis. This observation suggests that the labeling index can be used as an expression for the rate of cell proliferation in human gastric mucosa. A significant correlation between the labelling indices and the degree of gastritis was found in both antral and fundic mucosa. In six cases, labelling indices estimated by cell counts performed on longitudinal or cross sections of foveolae were compared. Ther was no significant difference between the results obtained by the two different counting techniques.

Lung function in an Australian population: 2. Spirometric performance and cigarette-smoking habits

The FEV1, FVC and FEV1/FVC% in 12016 females and 18 359 males were related to cigarette-smoking habits. Over all, non-smokers had significantly better lung function than cigarette smokers. Ex-smokers of either sex had significantly higher FEV1 and FEV1/FVC% than cigarette smokers, but the FVC values were higher only in females. With consumption in excess of 10 cigarettes per day, deterioration in lung function was manifest in both sexes, but was greater in males than females. The mean chronological age of males who smoked from 30 to 50 cigarettes per day was 12.9 years and 9.6 years less than would have been predicted on the basis of their FEV1 and FVC values respectively. The corresponding values in women were 9.3 years and 7.9 years respectively. Additionally, the deterioration in lung function with increasing age was greater in cigarette smokers than in non-smokers.

Lung function in an Australian population: 1. Spirometric standards for non-smoking adults

Relationships between age, height, weight and spirometry with FEV0.5, FEV1, FVC and FEV1/FVC are described for a sample of 6275 female and 6511 male non-smoking adults living in New South Wales. Prediction equations for ventilatory function tests are derived from non-smokers and compared with other standards that are available in a population sample of 31172 subjects. It is concluded that the standards described in this paper are more appropriate for use in Australian populations. Nomograms for predicting FEV1 and FVC in females and males are provided.

Elevated early gastric carcinoma. Differential diagnosis as regards adenomatous polyps

Differential diagnostic problems between gastric carcinomas and precancerous lesions with severe dysplasia have become more perceptible with the increasing number of resected early carcinomas. Although such problems come up for all macroscopic and histologic types of gastric cancer they are particularly marked between early carcinomas of the elevated type and adenomatous polyps. Elevated early carcinomas are usually highly differentiated adenocarcinomas with a morphology which often reminds of of adenomas. But sometimes the carcinomas also demonstrate convincing signs of being developed from adenomas. The criterion of distinction between intramucosal carcinomas and adenomas is invasion through the basal membrane, often difficult to evaluate. The morphological relation between elevated early gastric carcinomas and adenomas and the criterion of distinction between them were studied in 20 early gastric carcinomas of the Japanese types I and IIa, 6 intramucosal and 14 submucosal all highly differentiated adenocarcinomas, and in 42 polyps, of which 5 were of the adenomatous type. All lesions were taken from resection specimens. Among the carcinomas 5 demonstrated convincing signs of being malignant transformed adenomas. In addition, 6 carcinomas had a morphology which more or less reminded of adenomas, but their genetic origin was more uncertain. Nine carcinomas revealed no sign of an adenomatous origin. Among the 5 polyps diagnosed as adenomas 2 revealed an extraordinary degree of severe dysplasia which caused uncertainty on the benign diagnosis. The rest of the polyps were without dysplasia. The significance of invasion through the basal membrane as an indispensable factor of distinction between adenoma and carcinoma in the stomach is discussed. It is concluded that the degree of dysplasia can be so severe and the invasion so difficult to evaluate that the classification of some few tumours depends on the subjectivity of the single pathologist. Four of the tumours, 2 adenomas and 2 intramucosal carcinomas, having a remarkable macroscopic appearance like a large mucosal fold are especially mentioned. Their relation to gastric mucosal prolaps is discussed. Furthermore, a tumour apparently demonstrating only a moderate degree of dysplasia, but even so setting up metastases is mentioned in detail.

Drinking, smoking and drug-taking patterns in a predominantly lower socioeconomic status sample: comparison with Medicheck sample

The drinking, smoking, and drug-taking patterns of 9829 adult members of the Australian Workers Union in Sydney are compared with data collected through the Medicheck Referral Centre. Overall, the two sets of data are very similar, but the results of this survey point to the high prevalence of heavy alcohol consumption, and of regular drug-taking in young people.

Relationship between gastric acid secretion, histopathology, and cell proliferation kinetics in human gastric mucosa

Cell proliferation of gastric antral and fundic mucosa was studied in a series of patients with different gastric diseases. After in vitro incubation of endoscopic biopsies with tritiated thymidine, radioautographs were prepared by the dipping technique. The labeling indices were estimated, and the biopsies were classified according to the degree of gastritis. The peak acid output after "maximal" stimulation with histamine was also determined. A highly significant inverse correlation between peak acid output and the labeling indices in both antral and fundic mucosa was demonstrated. The correlation between the degree of gastritis and the labeling indices in antral and fundic mucosa was also statistically significant. The results indicate that a significant inverse relationship exists between the acid secretory capacity of the gastric mucosa and the rate of cell proliferation in both antral and fundic mucosa. Furthermore, the data suggest that an increasing degree of gastritis in human gastric mucosa is followed by an increased rate of epithelial cell proliferation.

The diagnostic significance of intestinal metaplasia in endoscopic gastric biopsies

The incidences of intestinal metaplasia in two groups of benign endoscopic biopsies taken from stomachs with malignant and benign lesions respectively were compared. 315 single biopsies were taken from stomachs with proven carcinoma, but outside the carcinomatous area. They were compared to 786 single biopsies taken from stomachs with proven benign lesions. Each single biopsy was placed in one of three groups: intestinal metaplasia absent, or making up less or more than 50 per cent of the epithelium in the biopsy. The results showed that single biopsies with intestinal metaplasia regardless of the extension of the metaplasia in the biopsy were found more often in stomachs with carcinoma than in stomachs with benign lesions but without any significant difference. If more than half of the benign biopsies taken during an examination demonstrated extensive grades of intestinal metaplasia a sligtly significant difference in favour of carcinomas was found.

The diagnostic significance of Russell bodies in endoscopic gastric biopsies

The incidence of cells containing so-called Russell bodies in 315 benign single gastric biopsies taken from stomachs with proven carcinoma, but outside the carcinomatous area and 786 biopsies taken from stomachs without carcinoma were compared. The Russell body containing cells were counted in a fixed area and on the basis of the counting each biopsy was classified in one of four groups: Russell body containing cells absent or present in a number of 1-5, 6-10 or more than 10 in the area. The results showed that endoscopic biopsy examinations containing one single benign biopsy with more than 5 Russell body containing cells in the carcinoma. If half or more than half of the biopsies in the examination contained 1-5 Russell body containing cells significant differences were also found. The sensitivity of such examinations was low but their predictive values (PVpos) varied from 46 per cent to 95 per cent, meaning that such examinations may be of importance for the diagnosis of gastric cancer.

Yersinia enterocolitica infection in patients with acute surgical abdominal disease. A prospective study

The rate of yersiniosis in patients with acute abdominal disease was studied in a 16-month prospective investigation in 1972-1973 of 205 acutely ill patients referred to a surgical clinic of a Copenhagen City hospital with complaints of abdominal pain suggestive of appendicitis. Yersinia enterocolitica, biotype 4, was isolated from 11 patients (5.4%), 8 of whom were children. Yersinia was grown from faeces in 8 cases and from appendix of all 9 patients operated upon. Rising or falling agglutinin titres larger than or equal to 100, indicative of yersiniosis, were found in 22 patients (10.7%) including all bacteriologically verified cases. Eight additional patients (3.9%) had less significant titres larger than or equal to 100, suggestive of recent or present infection. 28 patients (13.7%) had insignificant titres, including 3 with antibodies against serotype 9. In all cases except these 3, antibodies were against Y. enterocolitica, serotype 3. A differential diagnosis between Y. enterocolitica infection and other types of appendicitis could not be made within this highly selected group of patients using available clinical data. All cases were rather mild and self-limiting. It is suggested that in future epidemiological and other studies of yersiniosis, early bacteriological and serological examinations be carried out.

Antral gastrin cells. A correlation between the number of gastrin cells and the total concentration of gastrin in serum and in antral mucosa. A pilot investigation

Correlation between the gastrin cell number of delineated by immunohistological staining and the gastrin content in blood and antral mucosa has been studied in biopsies from the antral region of the human stomach. With a semiquantitative score system of the antral gastrin cells, we found correlation between the number of cells and the gastrin content in mucosa and serum and the grade of atrophic pyloric gastritis in 52 patients with different gastric diseases. It is concluded that further studies will be necessary before it is possible to estimate the total mass of gastrin cells and thereby compare different clinical groups.

Variation in distribution of antral gastrin cells

Using immunoperoxidase technique a considerable variation in the number of antral gastrin cells was demonstrated in patients with atrophic gastritis. This variation must be taken in consideration when the number of gastrin cells is to be estimated on the basis of gastric biopsies.

Gastroscopic biopsy: reliability of histological diagnosis with special reference to the single biopsy

For three years (1970-72) endoscopic gastric biopsies from 883 lesions in 862 patients were histologically examined, every single biopsy (4088) separately. In 38% of the cases, namely 142 malignant and 194 benign lesions, the diagnoses could be verified. If the criterion for a positive examination was that one of the biopsies showed unambigous carcinoma, the sensitivity of the examination was 76%, the specificity 99%, the PVpos 98%, and the PVneg 85% for the first examination, using the terms of Vecchio. If the biopsy diagnoses carcinoma with some uncertaincy and precancerous biopsies were considered positive too, and if all examinations prior to verification were included, the corresponding figures were 88%, 98%, 97%, and 91%. The most common number of biopsies used in an examination for diagnosing carcinoma was 4 (range 1-11). Fewer biopsies were used if the carcinomas were localized to the whole stomach, were protruded or had a largest diameter of more than 7 cm. The characteristic 'protruded' was the only tumour criterion which significantly was found most common among positive examinations. Ulcer-like carcinomas were common among the false negative. On the basis of pathoanatomy no special number of biopsies to be taken per examination could be recommended.