MicroRNA-15b is induced with E2F-controlled genes in HPV-related cancer

Background:

MicroRNAs (miRNAs) are important regulators of cellular processes and are found to be deregulated in many cancers. We here analysed the miRNA expression in anal carcinomas. In a previous study, we found that our anal carcinoma tumours were divided into two groups based on the expression of E2F-regulated genes. Therefore, we searched for miRNAs that could reproduce this grouping.

Methods:

A global screen of the miRNA population was performed using real-time quantitative PCR (RT–qPCR) array methods and differentially expressed miRNAs were identified. Real-time–qPCR was used to verify the expression levels of selected miRNAs and genes in a larger collection of biopsies. A siRNA-mediated knockdown of human papilloma virus (HPV)16 E7 in a cervical cell line was performed to assess the effect of E7 on miR-15b.

Results:

The grouping of tumours into two groups based on the expression of E2F-controlled genes was confirmed in a larger collection of anal carcinoma tumours. The expression of miR-15b was shown to be highly correlated with that of five selected E2F-induced genes (CCNA2, CCNB1, CCNB2, MSH6 and MCM7). A knockdown of HPV16 E7 resulted in decreased levels of miR-15b in Ca Ski cells.

Conclusion:

MiR-15b expression correlates with E2F-regulated genes in anal carcinoma and appears to be part of the E2F-regulatory network.

Rectal cancer with macroscopic peritoneal involvement--clinical challenges and consequences

OBJECTIVE

In gastrointestinal cancer, serosal involvement indicates advanced disease. We looked at the possible role of clinical peritoneal involvement (CPI) in local recurrences (LRs) and the overall survival of patients with rectal cancer (RC).

METHOD

Between 1993 and 2002, 6404 patients were diagnosed with RC. Based on macroscopic findings at surgery and corresponding histological findings, 166 patients (3%) had CPI. Surgery was stratified according to type and extent of operation: as resective or nonresective surgery and as curative (R0) or noncurative (R1 or R2) resection.

RESULTS

The presence of CPI was a negative factor for survival with a median of 15 months (95% CI, 12-19) in the presence of CPI compared with 65 months (95% CI, 61-70) without it (P < 0.001). In R0 resections, the median survival was 97 months (95% CI, 90-102) in patients without CPI compared with 48 months (95% CI, 22-74) in patients with CPI (P < 0.001). In R1 or R2 resections, the median survival was 16 months (95% CI, 15-17) in the absence of CPI and 9 months (95% CI, 8-10) in the presence of CPI. The LR rate in patients without CPI was 10.2% compared with 15.7% in patients with CPI (P = 0.022).

CONCLUSIONS

Clinical peritoneal involvement is a significant detrimental prognostic factor for the LR of RC and survival in the absence of metastases. Observations from this large national cohort add to what is known about peritoneal involvement. Diagnosed CPI should be taken into consideration when adjuvant treatment strategies are addressed.

Palliative surgery for rectal cancer in a national cohort

OBJECTIVE

Whether resection of the primary tumour is of benefit to patients with incurable rectal cancer (RC) remains a matter of debate. In this study we analyse prospectively recorded data from a national cohort.

METHOD

Among 4831 patients diagnosed with RC between 1997 and 2001, 838 (17%) patients were treated with palliative surgery. Patients were stratified according to disease stage, age and type of surgery.

RESULTS

A significantly longer median survival, 12 (range 10-13) months, was observed in patients treated with resection of the primary tumour compared with 5 (range 4-6) months in patients treated with nonresective procedures (P < 0.001). Median survival in months was significantly (P < 0.001) related to age (13; < 60 years of age, 10; 60 to 69 years, 7; 70 to 79 years, 6; >/= 80 years of age). In patients over 80 years, survival was similar regardless of the treatment. Thirty-day mortality varied from 2.5% to 20%, according to age groups.

CONCLUSION

The longer survival observed in patients with resection of the primary tumour may partly be explained by patient selection. Elderly patients (>/= 80 years) had a similar survival, irrespective of resection of the primary tumour or not. Careful consideration of the individual patient, extent of disease and treatment-related factors are important in decision-taking for palliative treatment for patients with advanced RC.

Local resection of rectal tumors by transanal endoscopic microsurgery: experience with the first 70 cases

BACKGROUND

Transanal endoscopic microsurgery (TEM) can access the whole rectum up to 20 cm from the anal verge. Due to its excellent view and accurate dissection, TEM is useful for the removal of adenoma and selected low risk cancers of the rectum. We report our experience with the first 70 patients presenting.

METHODS

A prospective descriptive study of 70 patients treated for rectal tumor with TEM from December 99 until October 2002 at Haukeland University Hospital.

RESULTS

TEM was performed in 37 men and 33 women, median age 70.5 (19-90) years, for anticipated adenoma (n = 64), adenocarcinoma (n = 3), rectal ulcer (n = 1), and re-resection after snare resection of rectal polyp with adenocarcinoma (n = 1) and carcinoid tumor (n = 1). The median observation time was 12 (1-33) months. The distance from the anal verge to the lower tumor border was 5.5 (2.5-14) cm. The median resected area was 15.4 (1.5-132) cm(2). 56 of the 64 anticipated adenomas were true adenoma, resected without recurrences; 8 (12.5%) were unexpected adenocarcinoma. Three of these underwent a secondary rectal resection and 5 patients have been observed without recurrence. Of the 3 patients with known adenocarcinoma, there was one recurrence which was treated with a secondary curative rectal resection.

CONCLUSIONS

TEM can access tumors in the whole rectum. Large tumors may be removed with low frequency of per- and postoperative complications and short hospital stay. TEM is highly useful for removal of rectal adenoma. A role for primary treatment of selected low-risk rectal cancers may emerge.

Dieulafoy's vascular malformation: role of endoscopic ultrasonography in therapeutic decision-making

BACKGROUND

Dieulafoy's vascular malformation may cause severe, potentially life-threatening gastrointestinal bleeding. Endoscopic diagnosis may be difficult because of minute mucosal lesions, and additional intramural abnormalities are usually not encountered. Endoluminal high-frequency ultrasonography is a new modality for imaging intramural and perivisceral structures.

METHODS

We report two cases of recurrent severe gastric bleeding in which different endosonographic modalities were used in the diagnosis of Dieulafoy's malformation, and the impact of endosonography on therapeutic strategy is discussed. In the first case a radial-scanning 7.5/12-MHz echoendoscope and a linear 20-MHz miniature probe were applied for B-mode imaging in a stable-state patient who had undergone previous endoscopic sclerotherapy, and arterial flow signals from the small intramural lesion were recorded using a 10-MHz transendoscopic pulsed Doppler probe. In the other case urgent endosonography was performed shortly after a bleeding episode, disclosing an aberrant large-calibre artery entering the gastric wall with a long submucosal branch.

RESULTS

Both patients were successfully operated on with a transabdominal approach.

CONCLUSION

Endosonography is a quick and safe diagnostic method and should be considered when vascular malformations are suspected as the cause of gastric bleeding.

Smoking and ulcer perforation

BACKGROUND

The use of ulcerogenic drugs is the only well documented risk factor for peptic ulcer perforation, but accounts for only a quarter of the events. Smoking is a well known risk factor for uncomplicated ulcer disease, and patients with ulcer bleeding have increased death rates from smoking related disorders.

AIM

To assess the role of smoking in ulcer perforation.

SUBJECTS

A total of 168 consecutive patients with gastroduodenal ulcer perforation and 4469 control subjects from a population based health survey.

METHODS

The association between ulcer perforation and smoking habits was analysed by logistic regression while adjusting for age and sex.

RESULTS

Current smoking increased the risk for ulcer perforation 10-fold in the age group 15-74 years (OR 9.7, 95% CI 5.9 to 15.8) and there was a highly significant dose-response relationship (p < 0.001). The results were similar in men (OR 9.3, 95% CI 4.9 to 17) and women (OR 11.6, 95% CI 5.3 to 25), and for gastric (OR 10.5, 95% CI 4.5 to 25) and duodenal (OR 8.6, 95% CI 4.9 to 15.4) ulcer perforation. No increase in risk was found in previous smokers (OR 0.8, 95% CI 0.2 to 2.2).

CONCLUSION

Our findings suggest that smoking is a causal factor for ulcer perforation and accounts for a major part of ulcer perforations in the population aged less than 75 years.

[High frequency ultrasonography of the gastrointestinal wall]

If an ultrasound probe comes close to the area of interest, high ultrasound frequencies can be applied. Endoscopic ultrasonography is performed by means of echoendoscopes or miniature probes using ultrasound frequencies between 7 and 30 MHz. A high frequency ultrasound image of the normal gastrointestinal wall usually shows five layers corresponding closely to the histological layers of the wall. Corrections have to be made, however, for interface echoes between layers with different acoustic impedances. We describe studies performed with the aim of correlating ultrasound images of the normal and diseased gastrointestinal wall with the histology. Ultrasound images of the normal gastrointestinal wall and pathological changes like ischemia, ulcers, tumours and inflammation are presented.

Adjuvant tamoxifen for pre- and postmenopausal women with estrogen receptor positive, node positive breast cancer: a randomized study

370 patients with operable, axillary node positive breast cancer, were randomized to receive tamoxifen (TAM) 20 mg/day for 2 years or no adjuvant hormone therapy. All patients had estrogen receptor (ER) positive (ER > 10 pmol/g) primary tumours. 350 patients, 93 younger than 50 years of age and 257 patients 50 years or older, were evaluable for the study. After a median follow up of 76 months, significantly (p = 0.0001) fewer loco-regional, but not distant (systemic), relapses have been recorded in the TAM group. Overall survival was also improved, but even though the study was designed to give maximum benefit from TAM statistically significant effect of TAM seemed to be limited to patients 50 years of age and older.

[Colonoscopy. In investigation, treatment and control of gastrointestinal diseases]

Colonoscopy is the initial examination for patients with manifest or occult rectal bleeding, inflammatory bowel disease and colorectal polyps. In addition to polypectomy, colonoscopy is useful in decompression of adynamic colonileus and laser palliation of intractable tumours. In adenoma patients controls should be limited to high risk patients, i.e. those with large and multiple tubular adenomas, villous adenomas, multiple hyperplastic polyps (> 30), and first degree relatives of patients with colorectal carcinomas. Control after radical surgical treatment of colorectal cancer is offered during the first two years after the operation and to persons younger than 40 years. The efficacy of control programmes for hereditary nonpolyposis colorectal cancer families have to be evaluated in controlled series. Rectosigmoidoscopies could probably replace some total colonoscopies to examine ulcerative colitis patients for cancer, since cancer usually occurs in the distal colon. Complications are rare after diagnostic and therapeutic colonoscopies, but perforation, bleeding and injury to surrounding organs can be experienced.

Progesterone binding cyst protein in hormone receptor positive breast cancer; a predictive factor for effect of adjuvant tamoxifen treatment

Progesterone binding cyst protein (PBCP) was measured in breast cancer cytosols from 128 pre- and post-menopausal women with operable node positive (pN+) breast cancer Stage II. All patients were included in a national multicenter study on the effect of adjuvant tamoxifen treatment in hormone sensitive breast cancer, i.e. estrogen receptor content of at least 10 pmol/g cytosol protein. Patients were randomised to receive adjuvant tamoxifen 20 mg once daily for two years or no endocrine treatment. At a median follow-up of 60 months, we found PBCP content in the primary tumor to be an important factor with regard to the effect of adjuvant tamoxifen treatment. The benefit of adjuvant tamoxifen treatment on relapse-free survival and overall survival was confined to the subpopulation of patients with PBCP negative tumors. PBCP should be further evaluated as a predictive factor for the effect of tamoxifen treatment.

Androgen receptors in operable breast cancer: relation to other steroid hormone receptors, correlations to prognostic factors and predictive value for effect of adjuvant tamoxifen treatment

Steroid hormone receptors have been evaluated as independent prognostic factors as well as predictive factors for endocrine manipulation in the clinical management of breast cancer. The contribution of each receptor or combinations of different receptors remains controversial. In cytosols from 224 patients with operable breast cancer (stages I & II), estrogen receptor (ER), progesterone receptor (PgR) and androgen receptor (AR) content have been measured. An improved AR-assay has been used in order to circumvent some of the problems inherent in other methods. In this study, 91.1% of the patients were classified as AR 'positive' (i.e. greater than or equal to 10 pmol/g). The steroid hormone receptors were significantly correlated (P less than 0.001). Taking the median value of AR as cut-off (50.5 pmol/g), a significantly higher incidence (P = 0.004) of node negative patients was found in the group with a lower AR content. In a multivariate analysis the AR category (median value used as cut-off) was shown to be an independent predictor of the likelihood of axillary metastases (P = 0.001). AR category, however, did not reveal any significant prognostic information concerning relapse free survival. A subpopulation of node positive patients with ER positive tumors, have been included in a randomized trial on the role of tamoxifen as an adjuvant treatment compared with no endocrine treatment. In a multivariate analysis, PgR status was shown to be a single independent prognostic factor (P = 0.016) for relapse free survival in patients with a lower AR content (less than median value). The improved AR assay used in the present study may provide a basis for more correct estimation of the AR content in an individual tumor. The present study suggests that AR analysis and the use of a well-chosen cut-off level may add information about tumor biology to increase our understanding of breast cancer biology and treatment.

Progesterone-binding cyst protein (PBCP) in operable breast cancer: correlations with prognostic factors and predictive value for effect of adjuvant tamoxifen treatment

Progesterone-binding cyst protein (PBCP) is a secretory protein which has been found in varying concentrations and incidence in cytosols from benign breast tumors, primary breast cancer and metastasis. In order to evaluate its correlation to other prognostic factors, PBCP was analysed in tumor cytosols from 386 women with stage I and stage II breast cancer. The incidence of PBCP negative (i.e. PBCP = 0) tumors was significantly decreased in node negative patients as compared to node positive (p = 0.012). An inverse correlation between estrogen receptor content and PBCP was found (p = 0.001). In a multivariate analysis PBCP category was found to be an independent predictor of the likelihood of axillary nodal involvement (p = 0.015). In spite of this association, PBCP did not reach statistical significance as an independent prognostic factor with regard to relapse-free survival. To evaluate PBCP category as a possible predictive factor for response to adjuvant endocrine treatment, a subpopulation of node positive patients with ER positive tumors was analysed; in patients with PBCP negative tumors, adjuvant treatment with tamoxifen proved to increase the relapse-free survival significantly (p = 0.011). We suggest that PBCP may have a place among other biochemical parameters in breast cancer, to provide an extended basis for understanding of tumor biology and a better selection of patients for endocrine treatment.

Palpation of the axillary nodes in breast cancer: what does the surgeon feel?

The findings on routine pre-operative palpation of the axilla in patients with infiltrative breast carcinoma are compared to the results of histological quantitation of the nodal lymphoid tissue and its tumour deposits in 91 consecutive cases in which a standardized axillary dissection had been carried out. The study demonstrates that lymphoid tissue, even when present in large amounts (up to 6 cm2 on histology), is seldom palpable. What the clinician identifies in favourable cases is the tumour deposit itself. When little lymphoid tissue is present very small tumour deposits (0.2 cm2) may be found on palpation, but large deposits (1 cm2) may be missed when surrounded by sufficient lymphoid tissue. These findings go far to explain the well documented unreliability of the nodal findings on axillary palpation in breast cancer.

Risk of carcinoma following gastric operations for benign disease. A historical cohort study of 3470 patients

The risk of stomach cancer was analysed in a cohort of 3470 patients who had had gastric surgery for benign disease between 1900 and 1969. In 87 patients (2.2%) stomach-stump cancer was diagnosed in the follow-up period 1970-84. By comparison with the total incidence of stomach cancer in the same region during the same time period, the observed versus expected ratio in the post-surgery group was 2.1 (p less than 0.001) and did not differ between men and women. At 5-10 years postoperative the risk of cancer was no different from that in the total population, whereas after 40-45 years it was 7.3-fold higher. The risk was unrelated to primary diagnosis or type of operation.

Duodenal duplication--a case with special features

A duodenal duplication almost as large as the stomach proper was found along the greater curvature of the stomach in a 6-month-old Caucasian girl. There was a wide communication with the proximal part of the duodenum, from which the duplication blood supply originated. The duplication and the stomach shared the serosal lining, but had individual, full thickness walls. The duplication was removed in toto, and the communication with the duodenum was closed by transverse suture. The luminal lining of the duplication consisted of corpus type of gastric mucosa. There was a 1 X 1 cm mucosal ulceration in the region of which respiratory tract elements were found. The condition is interpreted as a duodenal duplication with ectopic gastric mucosa and respiratory tract elements. To our knowledge, the occurrence of respiratory tract elements in an intestinal duplication BELOW the diaphragm is being reported for the first time. It offers a challenging explanation for the ulceration found within this duplication.

Temporary ischaemia of a large bowel segment induced by degradable starch microspheres in man

Degradable starch microspheres were used to induce temporary ischaemia measured by electromagnetic flowmetry in colon segments during bowel resection. Severe reversible ischaemia free from unwanted side effects was induced in eight of nine patients. In one of the five patients where the tumour was included in the microsphere-embolised tissue volume no reduction in blood flow was seen. Segmental enteric ischaemia induced by degradable starch microspheres in man seems safe and may be useful for radioprotective purposes in clinical radiation therapy.

Influence of gastric banding on stomach blood supply with or without concurrent splenectomy

A lethal gastric perforation occurred after a gastric banding procedure, which was complicated with splenectomy. Prompted by this incident, an experimental study was undertaken in which regional blood flow in the stomach was measured in anesthetized cats after gastric banding or splenectomy or both. A fatal course with an extensive ischemic lesion of the stomach near the banding area was seen in all the cats with the combined procedure after 5 to 12 days. Banding alone reduced gastric blood flow within 24 hours, particularly on the greater curvature. Splenectomy also reduced blood flow along the greater curvature within 2 weeks. The combined procedure showed similar flow changes within 24 hours. The implication of these experimental results is that, if the spleen must be removed, the performance of gastric partitioning for morbid obesity should be reconsidered.

Changes in gastric mucosal morphology, capillary permeability and blood flow during the first 3 days of acute gastritis in cats

In the present investigation gastric morphology, blood flow, vascular permeability and water content were studied in cat stomachs with acetic acid-induced gastritis at different time intervals up to 3 days after induction of gastritis. The morphological changes including mucosal erosions, edema and hemorrhage showed normalization within 3 days. The mucosa and muscularis blood flow remained essentially unchanged compared with pre-gastritis values and with the control group. Gastritis was associated with leakage of circulating albumin into the stomach wall most pronounced 4 h after the induction of gastritis. The water content was high at 4 and 24 h after induction of gastritis with almost normalization at 3 days. The morphologaical characteristics of our model are very similar to those observed in man. Leakage of circulating albumin into the gastric wall seems to be the best parameter for quantifaication of the inflammatory changes found in acute gastritis, while blood flow seems to be a less important parameter.

Effect of partial gastric devascularization on mucosal blood flow and acid secretion in cats

Partial devascularization of the stomach was performed in cats anesthetized with pentobarbital. The devascularization included all blood vessels along the greater curvature and two of the main branches of the left gastric artery. Gastric mucosal blood flow and cardiac output were determined by means of the microsphere distribution technique. The acid (H+) output from the 30th to the 60th min of pentagastrin stimulation was used as the 'acid response value'. Blood flow and acid secretion were determined before and approximately 2 h after devascularization or sham operation. A marked decrease in acid secretion and mucosal blood flow of the corpus/fundus occurred after devascularization. A high degree of correlation was found between the decrease in acid secretion and the decrease in mucosal blood flow caused by the devascularization. The regression coefficient of acid secretion on mucosal blood flow did not change significantly after devascularization.

Effect of indomethacin on blood flow distribution in the stomach of cats with acute gastric ulcer

An ulcer was induced in the anterior wall of the antrum of cats by local injection of acetic acid solution. Carbonized microspheres, 15 +/- microns in diameter, labelled with 141Ce, 46Sc, and 85Sr, were used to measure blood flow in different regions and layers of the stomach wall. The radioactivity of a blood reference sample and of tissue samples was determined, and the blood flow was calculated for each tissue sample. The blood flow distribution was determined before, 1/2 h, and 1 h after an intravenous infusion of indomethacin in a dose of 3 mg/kg. Two groups of anaesthetized animals were used: animals with a 24-h gastric ulcer and control animals 24 h after laparotomy. In the control animals indomethacin caused a mean reduction in gastric mucosal blood flow of approximately 50%. The flow reduction was about the same in different regions of the stomach. In the muscularis there was no change in blood flow after indomethacin. The blood flow was reduced in the duodenum and jejunum but not in the other intestinal organs studied. The blood pressure and cardiac output remained unchanged. In the ulcer group indomethacin caused about the same reduction in mucosal blood flow. However, the blood flow was reduced less in the ulcer region and tended to increase in the mucosa around the ulcer 1 h after indomethacin infusion.

Blood flow distribution in the stomach of cats with acute gastric ulcer

An ulcer was induced in the anterior wall of the antrum of cats by local injection of acetic acid solution. Carbonized microspheres, 15 +/- 5 microns in diameter, labelled with 141Ce, were used to measure blood flow in different regions and layers of the stomach wall. The radioactivity of a blod reference sample and of tissue samples was determined, and the blood flow was calculated for each tissue sample. The gastric tissue samples were examined microscopically, and the level of gastrin in serum was determined. Two groups of anaesthetized animals were used: in one group of animals blood flow was determined 24 h after ulcer induction and in a group of control animals 24 h after laparotomy. In the ulcer animals the gastric blood flow as increased both in the mucosa and in the muscularis in a zone around the ulcer. Microscopic examination revealed tissue necrosis corresponding to the floor of the ulcer and acute inflammatory changes in the gastric wall around the necrotic area. The serum gastrin concentration tended to increase after ulcer induction.

Effect of vasopressin on blood flow distribution in the stomach of cats with gastric ulcer

An ulcer was induced in the anterior wall of the antrum by local injection of acetic acid solution. Carbonized microspheres 15 +/- 5 micrometer in diameter, labeled with 85Sr and 141Ce, were used to measure blood flow in different regions and layers of the stomach wall, and in each sample the mucosa was separated from the muscularis. The radioactivity of a blood reference sample and the tissue sample was determined, and the blood flow was calculated for each tissue sample. Two groups of anesthetized animals were used: animals with normal stomachs given vasopressin and animals with a 1-week ulcer given vasopressin. The vasopressin was administered intravenously over a 20-min period. In animals with normal stomachs and in animals with a gastric ulcer vasopressin was found to decrease the blood flow to the stomach in all areas examined. The presence of a 1-week ulcer in the cat did not seem to influence the effect of vasopressin.

Distribution of microspheres with different diameters in the small bowel wall of the cat

The purpose of the present study was to investigate the distribution in the small bowel wall of intracardially injected microspheres with different diameters, and to find a sphere size that could be used for determination of blood flow to the different layers of the bowel wall. Microspheres were injected into the left ventricle of the hearts of cats in the following order of succession, 8--10, 15 +/- 5, 25 +/- 5 and 50 +/- 5 micrometer. Samples of the proximal part of the jejunum and the distal part of the ileum were examined microscopically, and the size and the location of the spheres recorded. The following distribution of the microspheres was found: villi 6--16 micrometer, crypt layer 6--20 micrometer, propria below the crypts and the muscularis mucosa 11--24 micrometer, submucosa 9--66 micrometer and muscularis 6--30 micrometer. Spheres between 8 and 13 micrometer appeared to be fairly uniformly distributed in the different layers of the intestinal wall.

Effect of pentagastrin on blood flow distribution in the stomach of cats with gastric ulcer

Ulcer was induced in the anterior wall of the antrum by injection of acetic acid solution. Carbonized microspheres 15 +/- 5 mj in diameter and labelled with 85Sr and 141Ce were used to measure blood flow in different regions and layers of the stomach. The radioactivity of the blood and tissue samples was determined, and the blood flow was calculated for each tissue sample. Three groups of anaesthetized animals were used: 1) animals, with normal stomachs, 2) animals with normal stomachs given pentagastrin, 3)animals with a one-week ulcer given pentagastrin. In animals with normal stomachs given pentagastrin during 20 minutes, the mucosal blood flow increased in all areas of the stomach apart from the antrum. In animals with a gastric ulcer pentagastrin was not found to influence the mucosal blood flow significantly. Pentagastrin was not found to change the muscularis flow in animals with normal stomachs, or in animals with a gastric ulcer.

Effect of partial devascularization on the blood flow distribution in the cat stomach

Partial devascularization of the stomach was performed in cats anesthetized with pentobarbital. Gastric blood flow distribution and cardiac output were determined by means of the microsphere distribution technique. Blood flow was determined before and 30 min after the partial devascularization. Devascularization of the lesser curvature caused a significant decrease in the mucosal and muscularis blood flow at the lesser curvature. After devascularization of the greater curvature, localized reduction in mucosal and muscularis blood flow occurred at the greater curvature. In the sham-operated animals the muscularis blood flow was significantly higher than in the nonoperated animals.

Perforated peptic ulcer: a comparison of long term results following partial gastric resection or simple closure

The results of simple closure were compared with those of partial resection in the treatment of perforated peptic ulcer. The investigation was carried out 7-13 years after the primary operation on 126 patients who had been allotted to one of the two treatment methods on the basis of an almost randomized schedule. Better late results were obtained with partial resection than with simple closure in patients in the age range 50-59 years at operation, with short duration of perforation and with a long history of symptoms before perforation. None of the patients treated with partial resection later underwent surgical treatment for recurrence of symptoms. In the simple closure group 27.3 per cent needed further surgery at 3 months to 10 years after perforation.

Blood flow distribution in the stomach of cats with gastric ulcer

Ulcer was induced in the anterior wall of the antrum by a subserous injection of 0.3 ml of a 20% acetic acid solution. Carbonized microspheres 15 plus or minus 5 mu in diameter and labelled with 169Yb were used to measure blood flow in different regions and layers of the stomach. Approximately 2-3 million microspheres were injected into the left ventricle of the heart. Simultaneously a blood sample was drawn from the distal aorta at a flow of 1 ml/min. Standardized tissue samples were punched from the lesser curvature and the anterior and posterior walls of the antrum, corpus, and fundus. In each sample the mucosa was separated from the muscularis. The radioactivity of the blood and tissue samples was determined, and the blood flow was calculated for each tissue sample. Three groups of animals were examined: 1) anaesthetized control animals, 2) animals laparotomized one week before examination, 3) animals with a one-week ulcer. In the control animals the blood flow was found to be the same in corresponding regions of the anterior and posterior walls of the stomach. The flow was slightly lower in the antrum than the fundus. The flow was similar in the different regions of the muscularis. The muscularis flow was markedly lower than the mucosa flow. In the laparotomized animals the blood flow was found to be increased in the muscularis of the corpus. In the ulcer animals the mucosa flow was increased in the anterior wall of the antrum, and the muscularis flow was increased in the antrum and the anterior wall of the corpus.