Angioedema of the small bowel due to an angiotensin-converting enzyme inhibitor

We describe a case of a 72-year-old woman who presented with two episodes of abdominal pain, vomiting, and diarrhea. Abdominal computed tomographic scans done during each episode demonstrated edema of the small bowel. Review of the patient's history revealed that she had been started on a treatment of lisinopril for hypertension 1 month before the first episode and had her prescribed dose increased 24 hours before each presentation. Angiotensin-converting enzyme (ACE) inhibitor-associated angioedema was suspected and the medication was discontinued. The patient has remained symptom-free while not taking the ACE inhibitor for 1 year. Review of the literature reveals only nine similar cases. All cases, including ours, occurred in women. Angioedema of the small bowel associated with ACE inhibitors is rare and often is not recognized before surgical exploration. Angioedema of the gastrointestinal tract should be considered in symptomatic patients taking ACE inhibitors.

Differences in laser-induced autofluorescence between adenomatous and hyperplastic polyps and normal colonic mucosa by confocal microscopy

Laser-induced autofluorescence has been used to discriminate normal from adenomatous colonic mucosa. However, few studies to date have studied the origin of colonic autofluorescence. Using confocal microscopy (excitation wavelength 488 nm), we have shown that autofluorescence at this wavelength is present predominantly in the lamina propria of normal mucosa but in the epithelium in adenomatous and hyperplastic polyps. The intensity ratio of epithelial cell to lamina propria fluorescence was significantly lower (P < 0.0001) in normal mucosa (0.52 +/- 0.01) compared with either adenomatous (1.6 +/- 0.2) or hyperplastic polyps (1.7 +/- 0.15). However, the ratios were not significantly different between hyperplastic and adenomatous polyps. Thus, confocal microscopy enables the detection of the sites of autofluorescence within colonic mucosa and the quantitation of differences in fluorescence between different tissue types.

Effect of physician characteristics on the cesarean birth rate

The rising cesarean birth rate has become of increasing concern to the obstetric profession and the public. There is a general consensus that the major obstetric indications responsible for the rising rate are dystocia, fetal distress, breech presentation, and previous cesarean delivery. However, the role of sociologic or nonmedical factors has not been established. This retrospective study examines the effect of the physician's age, experience, gender, and practice setting (solo versus group practice) on the cesarean birth rate. The analysis is based on 6327 private deliveries performed by 48 attending obstetrician/gynecologists at a New York City Hospital from January 1983 through December 1985. Although no significant differences were found according to the gender or practice setting of the physicians, older, more experienced physicians performed significantly fewer cesarean sections for dystocia and a higher percentage of forceps deliveries and breech extractions. These results suggest that physician characteristics may affect the type of delivery that is performed.