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Many types of advanced liver disease are now treated by liver transplant. However, the role of liver transplant in the treatment of hepatocellular cancer has not yet been defined. Hepatocellular carcinoma, a malignant tumor of the liver, occurs most often in Africa and the Far East, and has a poor prognosis. Surgical excision of the tumor has been the only treatment found to be effective. Previous studies have reported a high rate of recurrence for hepatocellular cancer patients treated by transplant. However, a small number of patients have been cured by transplant. A study was undertaken to compare the 10-year outcome of patients who received a liver transplant (105 subjects) and those who underwent subtotal liver resection (76 subjects). The overall survival rate at one year was 71.1 percent for resection, and 65.7 percent for transplant; at two years, 55.0 percent, and 49 percent; at three years, 47.2 percent, and 39.2 percent; at four years 37.2 percent, and 35.6 percent; and, at five years 32.9 percent, and 35.6 percent. In both treatment groups survival correlated with tumor staging, a system for describing the extent of the spread of cancer. If the patient had liver cirrhosis (degenerative disease of the liver), survival after transplant was significantly better than after resection. Cancer recurrence rate was high in both groups; at 50 after resection, and 43 percent after transplant. A better than five year survival rate was achieved by 12 patients who underwent resection, and by 13 patients who received a liver transplant. Improvements in survival will probably come from advances in nonsurgical anti-cancer therapy given before and/or after surgical removal of the tumor. (Consumer Summary produced by Reliance Medical Information, Inc.)

Radiation therapy directed at the abdomen may damage the digestive tract, the type and extent of injury depending on the dose of the radiation and the radiation sensitivity of the gut. Characteristic early changes are manifest in the mucosa of the gut: for later ulceration, changes in the collagen tissues and particularly in the vascular channels occur. This paper describes and characterizes injuries to the esophagus, stomach, small intestine and colon. It emphasizes the importance of recognizing radiation-induced damage to the gut which may occur early or late after radiation.

A 62-year-old man with carcinoma of the tongue had two separate asymptomatic carcinomas of the esophagus, one squamous and the other adenocarcinoma arising from Barrett's mucosa. We review the multicentric origin and synchronous occurrence of tumors in the oropharyngoesophageal area with and without Barrett's mucosa to emphasize the importance of complete evaluation of the esophagus in patients with oropharyngeal malignancy.

Groups of male Fischer 344 rats were chronically fed semipurified choline-devoid or choline-supplemented diets, high in fat (15%), and containing or not containing 0.06% phenobarbital. Atypical acinar cell nodules were observed in the pancreas of the rats, irrespective of the diet fed, with incidences varying from 38% to 100% in the various groups. No consistent differential effects of the dietary treatments on the incidence and growth of the nodules were evident, even though the diameter of the nodules tended to be greater in some of the groups fed the basal choline-devoid diet. The vast majority of the nodules were of the acidophilic type. More advanced pancreatic acinar cell lesions were observed in a few of the rats. Since the rats were not exposed to a chemical carcinogen(s), development of the nodules and of the more advanced lesions, even in rats fed the control diets, was most likely due to evolution of endogenous (spontaneous) initiated pancreatic cells, promoted primarily by the feeding of semipurified diets with a high fat content.

Abstract: To evaluate the relationship between duodenal ulcer disease and duodenitis, duodenal epithelial cell renewal was measured in mucosal biopsies by the incorporation of [3H]thymidine. When 14 patients with duodenal ulcer were compared to 13 control subjects or 7 with endoscopic duodenitis alone, the crypt size was the same in all groups. Similar to other inflammatory processes of the gastrointestinal tract, patients with endoscopic duodenitis showed increased proliferative indices including a greater number of cells incorporating [3H]thymidine. In contrast, the proliferative indices from the duodenal mucosa of patients with duodenal ulcers did not differ from a control group. In a group of 6 patients with both endoscopic duodenitis and duodenal ulcer, the [3H]thymidine incorporation was intermediate between control subjects or patients with duodenal ulcer alone and those with endoscopic duodenitis alone. When subjects were divided according to the histologic appearance of the duodenal mucosa, those having chronic duodenitis demonstrated enhanced [3H]thymidine incorporation in comparison to a control group or patients with chronic active duodenitis (polymorphonuclear leukocytes present). Although there are many possible explanations of these findings, one may speculate that duodenal ulceration does not stimulate duodenal epithelial proliferation.

The problem is to offer surgery only for thyroid nodules known to be malignant; the suggested solution is based on 8years’ experience with a large group of patients treated by a team of endocrinologists, surgeons, and pathologists.

A, B and H isoantigens, demonstrable in human gastric and small intestinal mucosae, using the mixed cell agglutination reaction, were diminished or absent in eight of nine gastric epithelial malignancies. In all metastases, there was complete absence of isoantigenic activity, even though in three of the corresponding primary gastric tumors, there was some residual activity. The loss of isoantigenicity noted in tumors paralleled that seen in the intestinalized metaplastic epithelium accompanying such tumors. In 2 patients with pernicious anemia, there was partial retention of such isoantigenicity in tumor tissue. Although it is not known whether they cause or result from malignant change, these findings suggest that an alteration of blood-group substance synthesis occurs in malignant epithelium. It is conceivable that such alterations may contribute to the potential of malignant cells to metastasize.

• Ganglioneuromas are neuroectodermal tumors that are found in diverse anatomic sites, but they are very uncommon in the colon. We observed a patient with partial colonic obstruction whose roentgenogram had a napkin-ring construction that was thought to be carcinoma. On resection, pathologic examination showed a ganglioneuroma. Mesenchymal neoplasms of various histologic types occur throughout the gastrointestinal tract. Neurogenic tumors are not uncommon in Von Recklinghausen's neurofibromatosis and multiple mucosal neuroma syndrome, but solitary lesions unassociated with these conditions are rare. To our knowledge, this complication in the colon is only the second such reported case. We believe that this case is noteworthy because of its clinical and roentgenographic resemblance to carcinoma.(Arch Surg 115:75-77, 1980)

The article presents the author's views on several challenges encountered by local government in dealing with its workforce management in Australia. The author discusses the complexities encountered by employers and human resource (HR) managers in complying workplace standards, particularly the occupational health and safety (OHS) requirements. The author also notes the critical areas faced by HR managers including attendance data, award interpretation, and employee leave management.

Clinical and histological effects of Cromolyn (DSCG) were studied in 12 patients with inflammatory bowel disease (IFBD) (5 Crohn's and 7 UC). Patients had refractory disease for at least 1 year. Treatment varied from 6-18 months and was not associated with adverse effects. Granulated mast cells were estimated in the lamina propria of normal control specimens (22) and others with IFBD. Biopsies were classified as normal, healed or chronic active. Index of disease activity was recorded for each patient. Results were in mast cells/mm2: Normal-343; UC-323 and Crohn's-304. During DSCG treatment: in Crohn's disease 3 of 5 (60%) improved clinically and 2 had progressive disease. Those who improved showed a mean increase of 105 mast cells/mm2(from 267 to 372). In UC, 6 of 7 improved clinically (85%). Four of these showed a mean increase of 148 mast cells/mm2(from 239 to 387/mm2). Two who improved clinically but had no increase in mast cells had active histologic disease pre and post-treatment. Overall, those who responded best to drug both by clinical and histologic criteria showed an increase in mast cells. DSCG is of value in the therapy of IFBD, and its effects may be directly related to its action on mast cells.