A survey is given of colorectal polyps detected in a prospective randomized screening study with the fecal occult blood test. It is demonstrated that colonoscopy in persons with positive Hemoccult-II tests results in detection of and removal of a higher number of adenomas than among controls. The strategy may, therefore, possibly be followed by a reduction of the incidence of colorectal cancer. Screen-detected adenomas were most often in males and were larger than among controls; they were most often in the sigmoid colon, whereas the rectum was the most frequent location for adenomas in controls. Eight percent of persons with screen-detected adenomas had some symptoms, which could be referred to adenomas, in contrast to 50% among controls. Hyperplastic polyps served as markers for adenomas in persons with positive Hemoccult-II as well as in controls with adenomas detected by colonoscopy; however, most persons with adenomas had no hyperplastic polyps. Endoscopic polypectomy did not result in any severe complications, but surgical removal in 2 of 22 patients proved fatal. The results presented are compared with those of other prospective randomized trials. The optimistic view--that the incidence of cancer may be reduced by polypectomy in persons with positive Hemoccult-II tests--stresses the importance of securing optimal colonoscopy service.

Adenoma↗

PubMedDate not supplied

The value of the hospital autopsy. A study of causes and modes of death estimated before and after autopsy.

Among 312 consecutive deaths in a Danish Central Hospital autopsy was performed in the pathology department on 266 cases, i.e. 85%. Retrospectively, the underlying causes of death were estimated from the clinical information alone by an experienced clinician and subsequently compared with the autopsy report. The definite cause of death was determined jointly by the clinician and the pathologist. The clinician's diagnosis was thereby confirmed as incorrect in 18% of the cases if small differences in site and type of malignant tumours were not considered. This is less than in many other investigations, but it is stressed that this could partly be because formal errors in completing the death certificate were avoided. The main causes of death were ischaemic heart disease and neoplasia. Clinical diagnosis of malignant diseases was never found to be erroneous. There was a slight tendency to clinically overestimate ischaemic heart disease, but in general the different errors outweighed each other, so that the total number of different causes of death before and after autopsy was nearly the same. The original death certificate was investigated in 12 accidental cases. Hereby it was found that the mode of death was originally stated erroneously as natural in 7 cases, i.e. 4.5%. It is concluded that hospital autopsy is still needed for the control and correction of causes of death, and it is stressed that clinicians as well as pathologists should be more aware of cases with a trauma in the history to avoid errors in the mode of death. Such errors can imply legal as well as insurance problems.

Accidents, Home↗

PubMedDate not supplied

A three-day doxycycline regimen for treatment of gonorrhea.

Patients with uncomplicated gonorrhea were given three 300-mg capsules of doxycycline, one of which was to be taken after the heaviest meal of the day, on each of three consecutive days. A total of 560 men and women were treated by this method. Of the 355 patients who returned for tests of cure within seven to ten days, all but seven (2%) responded favorably to the treatment. The effectiveness of the regimen was similar to that of other accepted treatments. Adverse effects were inconsequential or absent, providing that the medication was taken after meals. This treatment option simplifies considerably the directions to be followed by the patient and minimizes the risk of noncompliance in the treatment of gonorrhea with tetracyclines.

Doxycycline↗

PubMedDate not supplied

The anal transitional zone: a scanning and transmission electron microscopic investigation of the surface epithelium.

The ultrastructure of the anal transitional zone (ATZ) is described by means of scanning and transmission electron microscopy. The technique used permits histologic reexamination of the scanning electron microscopic biopsies. The surface of the ATZ shows, in addition to areas of normal colorectal mucosa and squamous epithelium, a characteristic picture: there are cells of varying size, arranged in a cobblestone pattern, and a surface covered with short microvilli that tend to form rows, indicating beginning microridge formation. This corresponds histologically to the so-called ATZ epithelium, and it is suggested that this might be metaplastic squamous epithelium rather than urothelium. The deepest part of the epithelium contains endocrinelike cells with granules of at least two types.

Anal Canal↗

PubMedDate not supplied

Immunisation of colorectal cancer patients with autologous tumour cells.

Patients with colorectal cancer were entered into a clinical phase I trial of immunotherapy with an autologous tumour cell/bacillus Calmette-Guerin (BCG) vaccine. We attempted to describe the possible effects and side effects of the immunisation, and further to investigate whether expression of immune-response-related surface molecules on the tumour cells in the vaccine correlated with survival. The first and second vaccine comprised of 107 irradiated tumour cells mixed with BCG, the third of irradiated tumour cells only. Thirty-nine patients were considered, but only 6 patients fulfilled the criteria for inclusion. No serious side effects were observed. With three years of observation time, two patients are healthy, while the rest have had recurrence, and two of them have died. In all vaccines, all tumour cells expressed HLA class I, some expressed HLA class II and none expressed CD80. There was an inverse relation between survival and HLA class II expression. This highlights an essential problem, in the absence of CD80 expression the expression of HLA class II may induce anergy. In future attempts to develop improved vaccines this problem should be addressed.

Adenocarcinoma↗

PubMedDate not supplied

Can hairspray be used as a smear fixative? A comparison between two types of coating fixatives.

Pairs of smears from 25 consecutive women undergoing routine screening and 30 consecutive colposcopy patients suspected of having cervical intraepithelial neoplasia were randomized and fixed with either Merckofix or a hairspray to compare their use as coating fixatives. Vacuolated cells from the cervical transformation zone were present in 9 of 25 and 24 of 30 smears fixed with hairspray against 2 of 25 and 2 of 30 of smears fixed with Merckofix in the two series, respectively. These findings indicate that the fixative effect of commercial hairsprays always should be tested before such hairsprays are introduced into routine procedures.

False Negative Reactions↗