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Relatively little is known about differences in English-administered, clinical neuropsychological test performance between native versus non-native English speakers, with prior literature yielding mixed findings. The purpose of this study was to examine the performance of native and non-native English speakers with similar age and educational backgrounds on a variety of cognitive tests. Participants were 153 university students (115 native and 38 non-native English speakers) who completed a neuropsychological battery during two testing sessions. Multiple regression analyses examined relations of native language to cognitive performance after adjustment for age, education, sex, and depressive symptomatology. Results showed that native English speakers outperformed non-native English speakers on several language-mediated tasks-Letter and Category Fluency and the Cognitive Estimation Test-as well as Trails A (p's < .05). The two groups performed similarly on tests of executive functions, perceptuo-motor speed, verbal memory, and visuospatial abilities. These results suggest that non-native English language may have a negative influence predominantly on language-dependent tasks.

Mild traumatic brain injury (mTBI) affects a significant number of combat veterans returning from Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF). Although resolution of mTBI symptoms is expected over time, some individuals continue to report lingering cognitive difficulties. This study examined the contributions of self-reported mTBI injury characteristics (e.g., loss of consciousness, post-traumatic amnesia) and psychiatric symptoms to both subjective and objective cognitive functioning in a sample of 167 OEF/OIF veterans seen in a TBI clinic. Injury characteristics were not associated with performance on neuropsychological tests but were variably related to subjective ratings of cognitive functioning. Psychiatric symptoms were highly prevalent and fully mediated most of the relationships between injury characteristics and cognitive ratings. This indicates that mTBI characteristics such as longer time since injury and loss of consciousness or post-traumatic amnesia can lead to increased perceived cognitive deficits despite having no objective effects on cognitive performance. Psychiatric symptoms were associated with both cognitive ratings and neuropsychological performance, illustrating the important role that psychiatric treatment can potentially play in optimizing functioning. Finally, subjective cognitive ratings were not predictive of neuropsychological performance once psychiatric functioning was statistically controlled, suggesting that neuropsychological assessment provides valuable information that cannot be gleaned from self-report alone. (JINS, 2012, 18, 576–584)

To examine relations of blood pressure (BP) with single photon emission computed tomography (SPECT)-derived estimates of cerebral blood flow in older men and women.Seventy-four stroke and dementia-free, community-dwelling older adults (ages 54-83 years; 68% men; 91% white) free of major medical, neurological, or psychiatric disease, engaged in clinical assessment of resting SBP and DBP, MRI rated for brain atrophy, and brain single photon emission computed tomography (SPECT) studies with computerized coding of cortical and select subcortical regions of interest.Given significant interactions of BP and sex with respect to multiple SPECT outcomes, sex-stratified multiple regression models were computed. Models were adjusted for age, fasting glucose levels, antihypertensive medication, BMI, and MRI ratings of brain atrophy. In men (n = 50), higher levels of SBP and/or DBP were associated significantly with lower estimates of cerebral perfusion in the right and left frontal, temporal, parietal, and occipital cortex, thalamus, head of caudate, and cingulate cortex accounting for up to 28% of the variance in these measures (P0.05). In women (n = 24), higher DBP was related marginally to higher levels of perfusion in the right temporal cortex (P = 0.05).Higher resting SBP or DBP was associated with lower levels of cerebral perfusion in otherwise healthy older men, but not women, in the present sample. Reduced cerebral blood flow may play a pathogenic role in increasing risk for stroke, dementia, and/or cognitive decline, particularly among older men with high BP.

Osteochondromas found within the soft tissue without osseous or intra-articular involvement are better described as extraskeletal osteochondromas. They are slow-growing, benign, osseous tumors, and are often misdiagnosed as conventional osteochondromas. Though extraskeletal osteochondromas are rare, they typically affect the digits of the hands or feet. We present a patient with a giant symptomatic extraskeletal osteochondroma that developed in the plantar medial longitudinal arch of the foot. To the authors' knowledge, this is the largest isolated extraskeletal osteochondroma in the arch of the foot identified in the literature. The diagnosis of an extraskeletal osteochondroma should be considered when a well-defined osseous mass occurs in the soft tissue. Level of Clinical Evidence: 4.

Laughter “punctuates” speech, occurring during pauses, at phrase boundaries, and before and after statements and questions—the places where punctuation would be placed in a transcript of a conversation. Such punctuation indicates that language is dominant over laughter in competition for the vocal tract because laughter seldom interrupts spoken phrases. The punctuation effect is shown here to extend to emoticon placement in website text messages, a nonvocal linguistic medium. As in earlier studies of speaking and manual signing, the phrase structure of language was preserved, indicating the regulation of emotional expression by a common, higher-order linguistic process.

This study explored using the FIT as a measure of performance validity among veterans undergoing neuropsychological evaluation for mild traumatic brain injury (mTBI).The Rey Fifteen-Item Memory Test (FIT) is a performance validity measure criticized for poor sensitivity.Two hundred and fifty-seven veterans completed the FIT and Wechsler Adult Intelligence Scale, Fourth Edition, Digit Span (DS); 109 of whom completed the Test of Memory Malingering (TOMM). FIT cut-offs of9,8 and stricter cut-offs were examined using DS and/or TOMM as criterion performance validity measures.Only four participants scored below the standard cut score of 9 on the FIT. Among the 13 veterans failing both criterion tests, only two scored below 9 on the FIT. Regardless of which FIT cut-off was used, the FIT had poor diagnostic accuracy.Despite its popularity, the FIT is not supported as an appropriate measure of performance validity in veterans undergoing evaluation for possible mTBI. Therefore, inferences regarding neuropsychological data reliability with adequate statistical certainty require use of other measures of performance validity with greater sensitivity.

In the last 50 years, multiauthored publications have become more prevalent, given the increasing number of collaborative, interdisciplinary, multicenter research studies. The determination of authorship credit and order is a difficult process, especially for graduate students, whose disadvantaged power position in research settings increases their vulnerability to exploitation. The American Psychological Association has published ethical standards for determining authorship credit, but the power difference inherent in the student–faculty relationship may complicate this ethical dilemma. The authors reviewed a number of previously recommended strategies and proposed that determining authorship credit is most effectively facilitated through professional development.

Activation of delta-opioid receptors in NG108-15 cells induces the release of calcium from an inositol 1,4,5-trisphosphate- sensitive intracellular store. We used fura-2-based digital imaging to study the effects of prolonged exposure to agonist on opioid-induced increases in [Ca2+]i. Exposure to D-Ala2-E-Leu5 enkephalin (DADLE) (1 microM) for 30 min completely desensitized NG108-15 cells to a second DADLE-induced response. The cells recovered gradually over 25 min following washout of DADLE. The desensitization was not due to depletion of intracellular calcium stores and bradykinin failed to cross-desensitize the DADLE-evoked response, although both agonists mobilized the same Ca2+ store. Desensitization induced by 100 nM DADLE was overcome by a higher concentration of DADLE (100 microM). Treatment with 8-cpt-cAMP (0.1 mM) for 30 min did not influence the DADLE-induced increases in [CA2+]i. Phorbol dibutyrate (PdBu) (1 microM) blocked the response completely. Treatment with the inhibitor of cyclic nucleotide-dependent kinases H8 (1 microM) for 45 min did not prevent DADLE-induced desensitization. Treatment with the protein kinase C (PKC) inhibitors staurosporin (10 nM) and GF-109203X (200 nM) for 45 min reduced desensitization. However, down-regulation of PKC by 24 h exposure to PdBu (1 microM) failed to prevent the DADLE-induced desensitization in NG108-15 cells. Thus, we conclude that multiple pathways participated in desensitization of delta-receptor-mediated Ca2+ mobilization, one of which includes PKC.

In neuronal cell lines, activation of opioid receptors has been shown to mobilize intracellular Ca2+ stores. In this report, we describe the excitatory actions of opioid agonists on murine neuroblastoma neuro2a cells stably expressing either delta, mu, or kappa opioid receptors. Fura-2-based digital imaging was used to record opioid-induced increases in intracellular Ca2+ concentration ([Ca2+]i). Repeated challenges of delta, mu, or kappa opioid receptor expressing cells with 100 nM [D-Ala2,D-Leu5]-enkephalin (DADLE), [D-Ala2,N-Me-Phe4,Gly-ol]-enkephalin (DAMGO), or trans-(+/-)-3,4-dichloro N-methyl-N-(2-[1-pyrollidinyl] cyclohexyl) benzene acetamide (U-50488H), respectively, elicited reproducible Ca2+ responses. Non-transfected neuro2a cells did not respond to opioid agonists. Removal of extracellular Ca2+ from the bath prior to and during agonist challenge did not affect significantly the agonist-evoked increase in [Ca2+]i, indicating that the response resulted from the release of Ca2+ from intracellular stores. Naloxone reversibly inhibited responses in all three cell lines, confirming that they were mediated by opioid receptors. Expression of cloned opioid receptors in neuro2a cells, coupled with digital [Ca2+]i imaging, provides a model system for the study of opioid receptors and opioid-activated signaling processes. The fact that all three receptors coupled to the same intracellular signaling mechanism suggests that the primary functional difference between opioid responses in vivo results from their selective localization.

Reliable Digit Span (RDS) is a measure of effort derived from the Digit Span subtest of the Wechsler intelligence scales. Some authors have suggested that the age-corrected scaled score provides a more accurate measure of effort than RDS. This study examined the relative diagnostic accuracy of the traditional RDS, an extended RDS including the new Sequencing task from the Wechsler Adult Intelligence Scale-IV, and the age-corrected scaled score, relative to performance validity as determined by the Test of Memory Malingering. Data were collected from 138 Veterans seen in a traumatic brain injury clinic. The traditional RDS (≤ 7), revised RDS (≤ 11), and Digit Span age-corrected scaled score ( ≤ 6) had respective sensitivities of 39%, 39%, and 33%, and respective specificities of 82%, 89%, and 91%. Of these indices, revised RDS and the Digit Span age-corrected scaled score provide the most accurate measure of performance validity among the three measures.

Servicemembers returning from recent conflicts frequently report symptoms associated with traumatic brain injury (TBI) and are subsequently assessed within the Depart- ment of Veterans Affairs (VA) medical system. Information on potential cognitive and behavioral correlates of TBI is avail- able from multiple sources. A Veteran's symptom presentation may be significantly influenced by the information he or she has received. Despite knowledge of the relationship between information source and symptom presentation, little work has focused on a characterization of where Veterans receive their information. The present study aims to fill this gap in the litera- ture. We asked 152 Veterans who screened positive for possible TBI within the VA healthcare system about the sources of infor- mation they have encountered regarding TBI and its sequelae. "Friends in the military" was the most frequently cited source of information, followed by the Internet, medical professionals, and informational pamphlets. The results of this survey indi- cate that Veterans are being exposed to information about TBI prior to a formal evaluation and that this information comes from multiple sources of varying reliability. Future research should focus on evaluating and ultimately improving the reli- ability of this information in order to positively influence the treatment of Veterans.

The assessment of mild traumatic brain injury (mTBI) among combat veterans of the Iraq and Afghanistan wars is a major challenge. Recently, clinicians within the United States Veterans Administration Health System have expressed concern for potential iatrogenic disability related to outreach efforts to identify veterans with possible mTBI. We describe a veteran with a history of mTBI sustained during combat who underwent repeated examination for cognitive symptoms reportedly due to mTBI, and with variable descriptions of severe peri-trauma characteristics attributed to blast exposure over multiple assessments. Repeat neuropsychological (NP) testing indicated, in general, minimal cognitive impairment and probable invalid performance on testing (e.g., poor effort). The consensus conclusion of several NP examinations attributed his cognitive complaints to psychiatric disturbance, including posttraumatic stress disorder, rather than brain dysfunction. Despite this, the veteran’s treating medical practitioners continued to infer mTBI as a source for his cognitive complaints and self-reported disability. The repeated reassessment of cognitive function purportedly attributable to mTBI appeared to reinforce for the veteran an erroneous self-perception of permanent and severe brain damage, a process fostered by practitioner misunderstandings regarding the nature and trajectory of expected positive outcome from a single concussion. This case illustrates potential iatrogenic risk in encouraging an erroneous perception of being brain damaged among combat veterans with cognitive complaints. Common pitfalls in the misdirected clinical management of these veterans are explored.

Veterans undergoing evaluation for mild traumatic brain injury commonly report insomnia, psychiatric symptoms, and cognitive dysfunction. This study examines the effects of self-reported amount of sleep and subjective sleep quality on neuropsychological test performance.262 veterans were seen for neuropsychological assessment in a Veterans Affairs traumatic brain injury clinic. All participants completed measures of depression, anxiety, and sleep satisfaction, and also estimated the number of hours they slept the night before the assessment. Factor scores of attention/concentration and memory were created using factor analyses. Data were analyzed with linear regression.Depression and anxiety were significantly correlated with sleep satisfaction and predictive of cognitive ability. Both sleep satisfaction and hours slept were significantly correlated with memory, but not attention. After controlling for the effects of depression and anxiety, hours slept but not sleep satisfaction was predictive of memory test performance.Perceived sleep quality is heavily influenced by psychiatric symptoms; therefore, veterans' report of sleep satisfaction may merely reflect their overall level of distress. Sleep quantity, however, appears to uniquely contribute to memory performance. Thus, assessment of sleep is important and provides clinicians with useful information, especially among individuals with psychiatric comorbidities.

Mild traumatic brain injury (mTBI) is not uncommon among Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans, and many individuals within this group report lingering cognitive difficulties following their injury. For Department of Veterans Affairs clinicians, an accurate assessment of cognitive symptoms is important in providing appropriate clinical care. Although self-assessment is commonly employed to screen for difficulties in cognitive functioning, little is known about the accuracy of self-report in this population. This study collected cognitive, psychiatric, and self-report data from 105 OIF/OEF veterans with mTBI to examine the relationship between self-reported cognitive functioning and objective neuropsychological test performance. Additionally, clinicians who frequently work with OIF/OEF veterans were asked to predict the magnitude of these associations. Self-reported cognitive functioning was not significantly correlated with objective cognitive abilities, suggesting that objective neuropsychological testing should be used when cognitive weakness is suspected. Perceived cognitive deficits were associated with depression, anxiety, and posttraumatic stress disorder, illustrating the additional importance of adequate assessment and treatment of psychiatric symptoms. Clinicians tended to overestimate the association between self-report and test performance.

The Cognitive Estimation Test (CET), which purportedly assesses aspects of executive functioning, consists of answering questions that require deductive reasoning. This paper explored the CET's psychometric properties in neurorehabilitation samples, including its reliability and strength of association with tests involving varying levels of executive skill. Among 112 patients (age = 65.3 years, SD = 12.5) with various neurological impairments, CET performance had limited reliability and was moderately correlated with nearly all cognitive tests examined, regardless of their executive demands. These findings highlight the poor divergent validity of the CET and raise questions of its utility in cognitive assessment.

Recent reports of increasing incidence, especially in men, led us to update through 1989 an earlier study of colorectal cancer incidence in Rochester that covered the period 1940 through 1979. The combined data reflected cancer trends in the community over half a century. Data resources of the Rochester Epidemiology Project were used to identify new cases of colon and rectal cancer among Rochester residents. Incidence rates were estimated using decennial census data, and 95% confidence intervals were based on the Poisson distribution. The GLIM statistical package was used to evaluate trends over time. Age-adjusted (US white 1970) incidence rates of colorectal cancer for men were 53.7, 61.3, 53.7, 54.2, and 52.5 per 100,000 person-years, respectively, for the decades 1940 to 1949, 1950 to 1959, 1960 to 1969, 1970 to 1979, and 1980 to 1989. Comparable rates for women were 42.7, 49.3, 42.9, 40.7, and 40.9 per 100,000 person-years. No statistically significant changes were seen in the incidence of colon and rectum cancer for men or women. There was no consistent trend in tumor stage at diagnosis and the mean size of the initial lesion did not change with time. The incidence of colorectal cancer has not changed over the past 50 years in this community where case ascertainment has been consistent and complete.

PURPOSE: The aim of our study was to evaluate the risks of multiple hemorrhoidal bandings in a single session. METHODS: We retrospectively examined all of the patients who had hemorrhoidal bandings from July 1989 to August 1992. RESULTS: Patients with multiple hemorrhoidal banding in a single session when compared with patients with single banding had greater discomfort and pain (29 percentvs.4.5 percent), but this discomfort was usually manageable with oral analgesia of limited duration. There were also more vasovagal symptoms (5.2 percentvs.0 percent), local swelling and edema (2.6 percentvs.0 percent), and urinary hesitancy and frequency (12.3 percentvs.0 percent) in the multiple-banded patients. No major complication such as massive delayed bleeding and perineal or pelvic sepsis was noted. CONCLUSION: Most patients tolerated multiple hemorrhoidal banding in a single session with acceptably low complications. Multiple banding in a single session is a safe and cost-effective alternative.

Peripheral blood mononuclear cells from patients with either Crohn's disease or ulcerative colitis (collectively referred to as inflammatory bowel disease) are cytotoxic in vitro for isologous or allogeneic colonic epithelial cells. Utilizing the ability of thymusderived (T) lymphocytes to bind sheep red blood cells to their surface and the property of bone marrow-derived (B) lymphocytes to display easily detectable surface immunoglobulin determinants, the cytoxicity of these lymphocyte subpopulations was tested. The results indicate that the mononuclear cell required for the lysis of colonic epithelium was not included within the bulk of T or B lymphocytes. Indeed, enrichment for cytotoxicity correlated best with enrichment for a mononuclear cell population lacking classical T or B markers. Additionally, mononuclear cells specifically adhering to plastic petri dishes coated with heat-aggregated immunoglobulin, and thus presumably bearing a surface Fc receptor, were enriched in their cytotoxicity. Alternatively, cells not adhering to aggregated Ig-coated petri dishes were relatively depleted of cytotoxicity. The implications of these findings as they relate to possible interactions between cellular and humoral immune mechanisms as a pathogenic mechanism for the colonic inflammatory process noted in patients with inflammatory bowel disease are discussed.

One hundred twenty patients with primary retrorectal tumors (79 congenital, 14 neurogenic, 13 osseous, and 14 miscellaneous) had their initial treatment at the Mayo Clinic from 1960 to 1979. The mean age was 43 years (100 patients were adults). Female predominance was associated with congenital cysts (15:1) and male predominance with chordomas (5:1). Forty-three percent of the patients had malignant lesions. No dermoid cysts were found in this series. Diagnosis was made by digital examination or sacral radiographs in all patients. Computed tomography scan was the most important diagnostic method; the rate of positive findings was 100 percent in 20 patients. Approach to the tumor was posterior in 79 of 102 patients in whom resection was possible. Ten of 66 patients with benign tumors had recurrence. The five-year survival rate for patients with chordomas was 75 percent and for patients with other malignant lesions was 17 percent. Because preoperative biopsy can cause tumor spread, abscess, fecal fistula, or meningitis, it should not be performed if tumors are potentially resectable. Whenever possible, total resection should be done.

Among 188 patients presenting with carcinoma of the anal canal the predominant cell types were squamous cell (56%) and nonkeratinizing basaloid (35%). Thirteen patients who had predominantly small (less than or equal to 2 cm) and only superficially invasive squamous cell lesions were treated with local excision, and although one required later abdominal perineal (AP) resection for local recurrence, all were apparently cured. Local excision should be preferred as initial treatment for such lesions. One hundred eighteen patients with squamous cell and nonkeratinizing basaloid carcinomas were primarily treated with AP resection. The operative mortality rate was 2.5%. Among 114 patients who survived surgery and had adequate follow-up, 40% developed recurrent disease, and 71% have survived 5 or more years. Pathologic staging based on depth of tumor invasion and regional nodal involvement was strongly predictive of survival as was tumor histology with progressively poorer survival rates from low-grade squamous cell to high-grade squamous cell to nonkeratinizing basaloid types. Tumor size was inversely related to prognosis and was strongly associated with stage. Squamous cell anal carcinoma was dominantly a local disease with approximately 70% of patients presenting with tumor apparently limited to the bowel wall, only 20% with regional node involvement and only 2% with distant metastasis. Even among those patients who recurred after AP resection approximately 80% had all known disease still limited to the pelvic area. Corresponding figures for nonkeratinizing basaloid tumors were 50 percent presenting limited to the bowel wall, 30% with regional nodes, 20% with distant metastasis, and 60% with initial recurrence limited to the pelvis. Among the 13 patients studied with small cell anal carcinoma, the authors found the disease to be very virulent either initially presenting with or rapidly evolving into diffuse dissemination. Only one of the seven patients who could be treated surgically survived 5 years. As is true for small cell carcinomas primary to other sites, this neoplasm should be regarded as a systemic disease. With these findings as a foundation, possible future strategies for management of anal carcinoma are discussed.

The issue of whether patients who have invasive carcinoma in an otherwise benign polyp should undergo surgical resection of that bowel segment is controversial. We examined the records of 83 patients with such polyps that were removed endoscopically between 1978 and 1981. After exclusion of 18 patients from the study for various reasons, our study group consisted of 65 patients who had undergone complete endoscopic removal of 69 polyps that contained a malignant process. Carcinoma in situ was found in 34 polyps, and 3 patients with such polyps had a recurrent malignant lesion of the same degree. These recurrent tumors were treated successfully by aggressive endoscopic removal. Seventeen polyps that contained invasive carcinoma were treated endoscopically without resection, and two patients in this group subsequently had recurrent carcinoma at the site of the original polyp. These recurrent lesions were resected, and neither patient had evidence of nodal metastasis. Of the 18 patients who underwent immediate resection of invasive carcinoma, 2 had residual carcinoma at the time of the resection, although no lymph node metastasis was found. We conclude that colonic polyps with carcinoma in situ can be treated safely with complete endoscopic removal. Invasive carcinoma in a polyp can be treated safely with complete polypectomy, and immediate resection may not be necessary. This group of patients, however, should undergo thorough follow-up studies and periodic endoscopic reexamination.

A prospective study was done on 34 patients using magnetic resonance imaging (MRI) and computed tomography (CT) preoperatively to stage patients with known rectal carcinoma. The study was done to determine the accuracy and clinical usefulness of CT and MRI. The Thoeni staging method was used. Twenty-four of 30 cases were staged correctly by CT. Sixteen of 27 were staged correctly by MRI. CT detected lymph node metastases in six of 15 cases with one false-positive. MRI detected lymph node metastases in two of 15 patients with one false-positive. CT was the preferred examination, and was useful in some cases. These cases included patients with small tumors who were considered for local excision and patients with extensive disease who were candidates for preoperative or intraoperative radiation treatment. MRI demonstrated extensive disease, as did CT in our later cases.

Ln a series of 14 tests using lymphocytes from the peripheral blood of normal healthy adults, we were successful in inducing cytotoxicity for allogeneic colonic epithelial cells by preliminary incubation of the lymphocytes with a lipopolysaccharide extract from Escherichia coli O119:B14, but not by the use of phytohemagglutinin or by incubation alone. The cytotoxicity was unrelated to the incidence of blast transformation in the lymphocytes per se and could not be attributed to allogeneic inhibition. In three tests no cytotoxicity of lymphocytes for ileal epithelial cells could be induced, although the lymphocytes treated with the extract of E. coli became cytotoxic for colonic cells. When lymphocytes were used from 2 patients with dys- gammaglobulinemia, no cytotoxicity for colonic cells was induced by treatment of the lymphocytes with the extract of E. coli O119:B14 or phytohemagglutinin.

Summary This study reports the cytotoxic effects in vitro of lymphocytes from the peripheral blood of patients with granulomatous or ulcerative colitis on suspensions of allogeneic colonic epithelial cells after 4 hr of incubation at 37 C. It has shown also that this effect can be inhibited by preliminary incubation of the lymphocytes in the presence of 10% horse anti-human thymus serum but not normal horse serum. Preliminary incubation of the colonic epithelial cells with either serum did not produce any similar inhibitory effect. If the hypothesis is accepted that the cytotoxic effects of lymphocytes on colonic epithelial cells may have a role in the pathogenesis of granulomatous or ulcerative colitis, then it is suggested that a clinical trial of horse anti-human thymus serum, possibly in association with other immunosuppressives, might prove valuable.

Further studies have been made of the cytotoxicity in vitro of lymphocytes from the peripheral blood of patients with ulcerative colitis, granulomatous colitis, or regional enteritis for allogeneic colonic epithelial cells when incubated at 37 C for 4 hr in the presence of complement. It has been shown that this cytotoxic effect was eliminated by total colectomy or, in one instance, by hemicolectomy with removal of the diseased segment, and the possible significance of these observations is discussed. In 2 patients, despite the cytotoxic effects of the lymphocytes for colonic epithelial cells, no cytotoxicity was found for gastric or ileal epithelial cells. Lymphocytes from healthy subjects and patients with diseases other than ulcerative colitis or granulomatous enterocolitis also were tested for cytotoxic effects in vitro on allogeneic colonic epithelial cells. So far this cytotoxic property has been found to be specific to lymphocytes from patients with ulcerative colitis or granulomatous enterocolitis.

Experiments were carried out to assess the effect of preliminary incubation of normal lymphocytes or lymphocytes from subjects with active chronic ulcerative colitis (CUC) or granulomatous colitis (GC) with their own sera, pooled normal human serum, or sera from other patients with CUC or GC, including sera obtained 10 days following colectomy, on their cytotoxicity for human colonic epithelial cells in vitro, Sera from a small number of patients with some gastrointestinal diseases other than inflammatory bowel diseases also were included in the study. It was shown that preliminary treatment for 4 days of lymphocytes from normal individuals with CUC or GC sera led to their demonstration of cytotoxic properties for colonic epithelium, but that this was not found if 10-day postoperative CUC sera, fetal calf serum, pooled normal human serum, or sera from patients with other diseases were used. The cytotoxicity of lymphocytes from patients with CUC or GC for colonic cells in vitro was decreased markedly by pretreatment with CUC or GC sera from other patients with these diseases, but not by similar treatment with their own serum or with 10-day postoperative CUC sera, fetal calf serum, pooled normal human serum, or sera from patients with diseases ther than CUC or GC.

It has been shown that preliminary incubation of the lymphocytes from patients with chronic ulcerative colitis or granulomatous colitis with a lipopolysaccharide extract of Escherichia coli O119:1314 resulted in considerable diminution of their cytotoxic effects in vitro for allogenic colonic epithelial cells, but that this did not occur when the lymphocytes were incubated with phytohemagglutinin-P or the tuberculin preparation purified protein derivative. It is speculated that the E. coli extract could be a specific antigen and that its preincubation with sensitized lymphocytes resulted in their desensitization. If this view were correct, then the phenomenon of cytotoxicity for colonic cells might be a final expression of delayed hypersensitivity in vitro, but the arguments against this are reviewed and presently it remains highly theoretical.

This report has described a series of 22 patients who underwent colonoscopic decompression for acute pseudoobstruction of the colon and summarizes those cases previously reported in the literature. Twenty of the 22 patients (91 percent) were successfully treated by decompression initially. Fifteen patients (68 percent) were cured with the initial procedure, and 4 patients (18 percent) experienced recurrence. Overall, in 17 patients (77 percent), the pseudoobstruction resolved completely with colonoscopic decompression. Three patients (14 percent) underwent operation because of cecal dilatation refractory to colonoscopic decompression, and in one patient (4.5 percent), the colonic dilatation resolved spontaneously after a failed colonoscopy. Complications resulted in the death of one patient (4.5 percent). Our data are similar to those in the literature and indicate that colonoscopic decompression is a safe and efficacious first line of treatment for acute pseudoobstruction of the colon.

A technique to measure the pH on the surface of rectal mucosa of humans and dogs is described.

We conducted a retrospective cohort study of 751 residents of Rochester, Minnesota, whose small (1 cm or less) colorectal polyps had been treated without biopsy. Eighteen colorectal carcinomas were found in this group in the course of more than 10,000 person-years of follow-up, whereas 15.27 cases were expected (relative risk, 1.2). The overall rate for the development of cancer and the relative risks for various subgroups of the cohort were not significantly elevated, and survival in this cohort was not impaired. We conclude that fulguration of selected small colorectal polyps without prior biopsy does not subject patients to an unusual risk for development of colorectal carcinoma. Customary periodic medical examination should suffice for patients with these lesions.

A series of 1007 patients was randomly divided into two groups, one a group of 499 patients who underwent rigid sigmoidoscopy and the other a group of 508 patients who had flexible sigmoidoscopy. Contrast barium enema studies were subsequently performed in all patients. Eighteen per cent of the patients had a neoplasm. We concluded that, given the amount of colon surveyed by rigid and flexible sigmoidoscopy in conjunction with contrast barium enema, there was no difference in the rate of detection between the two endoscopic techniques.

Of 323 patients with colorectal polyps that either were larger than 1 cm in diameter or were 1 cm or smaller but had been subjected to biopsy or excision, 20 (6%) had subsequent development of a colorectal carcinoma, an incidence rate of 4.6 per 1,000 person-years of follow-up. These 20 cases of cancer compared with 7.38 cases expected; thus, the risk of colorectal carcinoma in these patients was 2.7 times that in the general population (P less than 0.001). Although risks were greater for certain subgroups of patients, the differences detected were usually modest. We conclude that patients with large colorectal polyps (more than 1 cm in diameter) should be closely followed up after treatment of the initial polyp, regardless of the size, site, or histologic type of the polyp, the age or sex of the patient, or the type of initial treatment (excision or fulguration). Those patients with more than one polyp, especially if more than one segment of the colon is involved, need special attention. Examination of the entire colon is important because the site of development of carcinoma may be distant from the site of the initial polyp.

Twenty-two patients with leiomyosarcoma of the rectum (n = 19) or the anus (n = 3) were treated surgically at the Mayo Clinic from 1950 through 1985. The majority of tumors occurred in men (1.4:1.0) during the sixth and seventh decades of life. Fifty-nine percent of the patients had symptoms including, most commonly, change in bowel habit, bleeding, and pain. Wide local excision was performed in 10 patients, whereas a more radical surgical procedure, including abdominoperineal resection (n = 8), pelvic exenteration (n = 2), and low anterior resection (n = 1), were performed in 11 patients. One tumor was unresectable. The overall survival until death from disease was 90% at 1 year, 74% at 5 years, and 51% at 10 years postoperatively. The percentage of patients free of disease at 1, 5, and 10 years postoperatively was 85, 62, and 40, respectively. Wide local resection was not superior to a more radical surgical approach in preventing tumor recurrence or improving survival. Lesions less than 2.5 cm and confined to the bowel wall can be treated by wide local excision, whereas larger or more extensive tumors should be treated by a more radical surgical approach.

Thirty adenomas of the large bowel, removed from 15 females and 15 males, were examined for the presence of estrogen receptor protein. The finding of positive binding capacity in two of the 30 adenomas supports the hypothesis that hormonal dependency does not play a major role in the development and growth of colorectal adenomas.

Manometric studies of internal sphincter responses were carried out on 15 patients--14 with rectal prolapse and one with mucosal prolapse with proctitis cystica profunda. In all 12 patients studied preoperatively, the internal sphincter reflexes (inhibitory reflex) were absent or markedly obtunded. Anterior resection was performed on three of the patients in whom preoperative and postoperative manometric studies could be carried out. In one, the inhibitory reflex returned to normal after successful corrective surgery and in one, absence of the reflex persisted after anterior resection and this patient eventually had recurrent rectal prolapse.

A series of 121 patients with chronic fissure-in-ano who underwent fissurectomy with superficial midline sphincterotomy was studied. The mean follow-up was 8.1 years. Minor problems with anal competence occurred after the operation in 30 patients (25 per cent). Within two months, this problem had resolved in all patients. One patient (0.8 per cent) had a true recurrence. Five patients (4.1 per cent) had recurrent acute anal abrasions as the result of passage of a hard stool. These healed spontaneously. Twelve patients (9.9 per cent) had fragile scars, but this was a significant problem in only five (4.1 per cent). No patient had significant stricture formation, keyhole deformities, or major persistent problems with anal competence. The patients graded their operations with regard to satisfaction: 118 (97.5 per cent) reported satisfactory results and three (2.5 per cent) reported unsatisfactory results. This study shows that fissurectomy with superficial midline sphincterotomy is a viable approach to the surgical management of chronic fissure-in-ano.

Forty patients with fecal incontinence underwent sphincter repair between 1975 and 1984. Divided sphincter musculature resulted from obstetrical injury in 23 and previous anorectal surgery in 17. Eighteen had undergone a previous attempt at repair. Fifteen patients experienced seepage of stool and 25 had gross incontinence. In nine patients, reconstruction of the external sphincter was by overlap of the muscle ends. Twenty-four others underwent accurate approximation of the external sphincter muscle and anterior plication of the levator muscles, and in seven the anal canal was made smaller by narrowing the anal orifice. Follow-up was an average of 67 months after operation (range, 2.4 to 166 months). Continence was objectively improved in 62 percent (P less than .01) when performance criteria were analyzed by Wilcoxon signed-rank test, although 85 percent of the patients reported subjective improvement. Requirements for protective pads were reduced in 57 percent (P less than .01) and fewer social limitations were experienced in 52 percent (P less than .01). There was no significant correlation between outcome and type of operation.