Short chain fatty acid rectal irrigation for left-sided ulcerative colitis: a randomised, placebo controlled trial

BACKGROUND

Short chain fatty acid (SCFA) deficiency is associated with colitis in animals and humans, and the mucosal metabolism of these compounds is decreased in ulcerative colitis.

AIMS

To assess the efficacy of topical SCFA treatment in ulcerative colitis.

PATIENTS AND METHODS

103 patients with distal ulcerative colitis were entered into a six week, double-blind, placebo controlled trial of rectal SCFA twice daily; patients who were unchanged on placebo were offered SCFA in an open-label extension trial.

RESULTS

Of the 91 patients completing the trial, more patients in the SCFA treated than in the placebo treated group improved (33% v 20%, p = 0.14, NS). Those on SCFA also had larger, but statistically non-significant, reductions in every component of their clinical and histological activity scores. In patients with a relatively short current episode of colitis (< 6 months, n = 42), more responded to SCFA than to placebo (48% v 18%, p = 0.03). These patients also had larger, but statistically non-significant, decreases in their clinical activity index (p = 0.08 v placebo). Every patient who improved used at least five of six of the prescribed rectal SCFA irrigations, whereas only 37% who did not improve were as compliant. In the open-label extension trial, 65% improved on SCFA; these patients also had significant reductions (p < 0.02) in their clinical and histological activity scores.

CONCLUSIONS

Although SCFA enemas were not of therapeutic value in this controlled trial, the results suggest efficacy in subsets of patients with distal ulcerative colitis including those with short active episodes. Prolonged contact with rectal mucosa seems to be necessary for therapeutic benefit.

Extragonadal seminoma involving urinary bladder and arising in the prostate

The authors report the first instance of a patient with seminoma probably arising from the prostate but also involving the bladder. A 58-year-old man presented with symptoms and signs of prostatic enlargement. Cystoscopy revealed a fungating neoplasm, probably arising from the prostate and surrounding the bladder neck. The biopsy was consistent with the diagnosis of seminoma. The patient experienced complete remission after chemotherapy with bleomycin, cisplatin, and etoposide.

Appendices epiploicae of the colon: radiologic and pathologic features

Appendices epiploicae are adipose structures protruding from the serosal surface of the colon. They can be seen with abdominal radiography and cross-sectional imaging if the colonic wall is surrounded by intraperitoneal contrast material, ascites, or blood. Normal appendices epiploicae appear as lobulated masses of pericolic fat, usually 2-5 cm long and 1-2 cm thick. Their enlargement, deformity, or altered radiopacity may result from various pathologic processes that can originate locally or extend from adjacent viscera. In a series of 22 cases, appendices epiploicae were affected by spontaneous torsion and hemorrhagic infarct, calcification due to aseptic fat necrosis, primary or secondary inflammation, enlargement by lipomas or metastases, and incarceration in hernias. Disorders of appendices epiploicae are often manifested by nonspecific clinical signs and symptoms (eg, torsion is often mistaken for appendicitis or diverticulitis). These entities should be included in the differential diagnosis of any unexplained abdominal pain or pericolic lesions in adults.

Uterine leiomyoma with skeletal muscle differentiation. Report of a case

Skeletal muscle differentiation is reported in a uterine leiomyoma from a 54-year-old woman. Evidence of rhabdomyoblastic features included a typical light microscopic appearance, immunoreactivity with antimyoglobin antibodies by immunoperoxidase studies, and the presence of myofibrils by electron microscopic examination. The patient is well more than two years after surgery.

Rectal irrigation with short-chain fatty acids for distal ulcerative colitis. Preliminary report

Colon cells from patients with ulcerative colitis utilize short-chain fatty acids inefficiently and may be exposed to decreased concentrations of these compounds. To test whether irrigation of the inflamed mucosa with short-chain fatty acids is useful, we conducted a six-week preliminary trial in 12 patients with distal colitis. Each patient used twice daily rectal irrigations with 100 ml of a solution containing acetate (80 mM), propionate (30 mM), and butyrate (40 mM). Two patients stopped at three weeks, one because of no improvement and the other because of complete resolution of symptoms. Of the 10 who completed the trial, nine were judged to be at least much improved and showed a change in a mean disease activity index score from 7.9 +/- 0.3 (SE) to 1.8 +/- 0.6 (SE) (P less than or equal to 0.002) and in a mucosal histology score from 7.7 +/- 0.7 (SE) to 2.6 +/- 0.7 (SE) (P less than or equal to 0.002). Thus, ulcerative colitis patients appear to benefit from increased contact with or higher than usual levels of these critical energy substrates.

Prostatic aspiration biopsy: an assessment of accuracy based on long-term observations

We present the results of transrectal thin needle aspiration biopsy of the prostate in 133 patients. Test specificity was 94 per cent and sensitivity also appeared to be high initially. However, with repeated rectal examinations and biopsies during an 11-year period a number of additional false negatives became apparent, which resulted in an apparent test sensitivity of 82 per cent, lower than most previously published reports. Our data suggest that aspiration biopsy has specificity and sensitivity similar to core biopsy, it is important to re-test patients who have a palpable abnormality and an initially benign biopsy, and aspiration biopsy simplicity allows for a low threshold of suspicion of subtle abnormalities and for repeating biopsies after negative findings.

Necrotizing sarcoid-like granulomatosis: radiologic-pathologic correlation

Necrotizing sarcoid-like granulomatosis is one of five forms of pulmonary disease characterized histologically by angiitis and granulomata formation. Although there have been several reports of the clinical and pathological characteristics of the disease, there has been little reported radiographic correlation. We present two patients with necrotizing sarcoid-like granulomatosis with radiographic and pathologic correlation. The radiographic finding of diffuse lesions, either bilateral nodules or nodular densities with or without cavitation, should prompt definitive diagnostic evaluation. Tissue diagnosis is imperative as necrotizing sarcoid-like granulomatosis has a relatively good prognosis when compared with other similar granulomatous diseases.

Fine needle aspiration cytology of toxoplasmic lymphadenitis

A retrospective study of four cases of toxoplasmic lymphadenitis diagnosed by fine needle aspiration and confirmed by serology or biopsy is reported. The cytopathologic features of this disease, not previously described in the American literature, were found to be highly characteristic and are described in this report. Toxoplasmic lymphadenitis is a fairly common cause of lymphadenopathy, and surgical biopsy is frequently performed because of a suspicion of lymphoma. Since the disease is generally self-limited, no treatment is necessary, and fine needle aspiration can spare the patient unnecessary hospitalization and surgery.

Angiogenic nature of the "intravascular bronchioloalveolar tumor" of the lung: an electron microscopic study

An intravascular bronchioloalveolar tumor of lung (IVBAT) was studied with electron microscopy. Based on ultrastructural evidence and information obtained from the literature, we propose the following: (1) IVBAT is a true pulmonary neoplasm with distinctive morphologic features; (2) it consists of cells with endothelial characteristics and is probably derived from multipotential mesenchymal reserve cells; (3) it is not related to the typical bronchioloalveolar tumor of lung; (4) a more appropriate designation for this unusual pulmonary neoplasm is "sclerosing angiogenic tumor."

Intraoperative fine needle aspiration biopsy of thoracic lesions

Forty-one intraoperative fine needle aspiration biopsies were performed on 35 patients during exploratory thoracotomy (33 patients) or mediastinoscopy (2 patients). Each biopsy was done with a 22 gauge needle. Smears were prepared at the operating table, air-dried, sent directly to the laboratory, stained, and interpreted immediately by the pathologist. Preparation and reporting time averaged ten minutes. Surgical decisions were made on the basis of the pathologist's reports. Intraoperative fine needle aspiration biopsy was 100% accurate in differentiating inflammatory from neoplastic lesions. Ninety-five percent diagnostic accuracy for malignancy (39 out of 41 specimens) was obtained. It permitted quick biopsy of lesions deep within the lung parenchyma without the need to cut across uninvolved tissue, thus permitting appropriate resection in each patient. There were no deaths related to the procedure.

Intranuclear cytoplasmic inclusions (invaginations) in thyroid aspirations. Frequency and specificity

In order to determine the frequency and specificity of intranuclear cytoplasmic inclusions (invaginations), described by some as an important criterion for the cytologic diagnosis of thyroid carcinoma, 258 consecutive thyroid aspirates were reviewed. Intranuclear cytoplasmic inclusions were present in 91% of the papillary adenocarcinomas but were not seen in any of the benign thyroid lesions or in any of the few nonpapillary adenocarcinomas in the study. It is concluded that the presence of intranuclear cytoplasmic inclusions in thyroid aspirates is probably specific to thyroid carcinoma but is not necessarily restricted to the papillary variant.

Maxillofacial synovial sarcoma. Light- and electron-microscopic study of two cases

The light microscopy and ultrastructural features of two maxillofacial synovial sarcomas are presented. By light microscopy, one of the tumors revealed the typical biphasic pattern while the other was predominantly fibrosarcomatous. Ultrastructurally, both cases revealed a biphasic pattern. Epithelial-like cells displayed abundant mitochondria, Golgi profiles, electron-dense bodies, cytolysosomes, and thin filaments. Stromal cells were spindle-shaped and provided with smaller cytoplasm and scant organelles, mainly consisting of profiles of rough endoplasmic retuculum, mitochondria, and free ribosomes. Pseudoglandular spaces lined by cuboidal to flattened epithelial-like cells with apical microvilli were numerous. Basal lamina and intercellular junctions were prominent in one case, but sparse in the other. The most undifferentiated tumor revealed many intercellular clefts containing filopodia among the epithelial-like cells; occasional intracyltoplasmic lumina were also present. These findings are somewhat similar to those reported in normal and nonneoplastic diseases of the synovium. However, the location of the tumors in areas normally devoid of synovium suggests one more that they might arise from nonspecialized primitive mesenchyme.

Cytologic changes associated with vaginal pessary use. With special reference to the presence of Actinomyces

The cytopathology of Papanicolaou smears from 23 postmenopausal women with vaginal pessaries is described. The following alterations, when seen in the smear of an elderly postmenopausal woman, were found to be strongly suggestive of pessary use: cytologic atypia in the form of severe inflammatory changes in squamous cells, atypical metaplasia, and reparative changes with a background pattern of acute inflammation and prominent superficial maturation of the squamous cells. A notable additional finding in 13 of the 23 patients was the presence of filamentous organisms resembling Actinomyces and morphologically similar to organisms recently described and specifically identified as Actinomyces in patients with intrauterine devices.