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Juvenile polyposis is an uncommon condition characterized by the development of multiple juvenile polyps, predominantly in the colon but also in the rest of the gastrointestinal tract. The condition usually presents in childhood; only 15 per cent of patients present as adults. The rarer and often fatal form, namely, juvenile polyposis of infancy, is typified by diarrhoea, protein-losing enteropathy, bleeding and rectal prolapse. The more common form of juvenile polyposis (affecting the colon, stomach and small bowel) occurs in the first or second decade with rectal bleeding and anaemia. A family history of the condition is found in 20-50 per cent of patients with apparently an autosomal dominant trait. The gene for juvenile polyposis has not yet been identified. Epithelial dysplasia is common and the cumulative risk of colorectal cancer is > 50 per cent. Various extracolonic abnormalities may also occur. Most patients are treated surgically for colonic polyps, although endoscopic polypectomy is also an option. The rest of the gastrointestinal tract should be screened as should asymptomatic first-degree relatives.

In this study, a double-blind, placebo-controlled approach was used in assessing the effectiveness of hydration treatments in the clinical management of selected voice disorders. Six adult female patients with laryngeal nodules or polyps each received 5 consecutive days of hydration treatment and 5 consecutive days of placebo/control treatment. The combined results indicated improvements in voice and in laryngeal appearance following both placebo/control and hydration treatments as compared with baseline. However, the greatest improvements were obtained following the hydration treatment. Although caution about generalization of the effects to the typical clinical situation is emphasized, the study provides preliminary evidence of a therapeutic benefit from hydration treatments in patients with nodules or polyps. Based on previous theoretical work, hydration effects may be related to reductions in the viscosity of vocal fold tissue, although other explanations are also possible.

The case of a 13 year old boy with an inflammatory esophagogastric polyp and ulcerative colitis is described. Endoscopy revealed a typical polyp and gastric fold complex at the esophagogastric junction and a hiatal hernia. Histology of a biopsy specimen confirmed an inflammatory polyp covered by hyperplastic squamous and gastric foveolar epithelium. Continuous 24 hour esophageal manometry suggested gastroesophageal reflux, which may be related to the pathogenesis of the lesion. Follow-up endoscopy showed marked regression of the polyp with medication for reflux esophagitis. This clinical entity is rare in childhood and adolescence, and the manifestations may not be readily recognized. Therefore, endoscopic biopsy is important in children with esophageal polyps. However, polypectomy is unnecessary except when malignancy is suspected or when symptoms persist.

In 1982 four Japanese authors Okaba, Honda, Toshiba and Asami reported at the International Symposium in Tokyo on successful transendoscopic sclerosification of bleeding ulcer, around which a sclerosifying agent or absolute alcohol was injected with or without epinephrine. Alcohol suppresses bleeding, causing local dehydration, coagulation and sclerosis of the bleeding tissue, thus producing hemostasis. For the last two years the authors have gained some experience in the application of periulcer and peritumor sclerosification with the sclerosifying agent etoxysclerol (3 per cent solution) and pure 96 per cent ethanol + 1 ampoule epinephrine. As regards the bleeding site, patients with the following nosologic entities were treated: gastric ulcer--24 patients; duodenal ulcer--13; gastric cancer--6; anastomotic ulcer--2; acute ulcer--7; Mallory-Weiss syndrome--10 patients. The results may be summarized as follows: temporary hemostasis was achieved in 21 patients, bleeding recurred in 8 and 9 patients required emergency surgery. Complete and ultimate hemostasis was attained in 29 patients (46.7 per cent). Nine patients died of hemorrhage.

The authors present seven cases of benign oesophageal tumours treated in hospital in the years 1972-1990. Among the treated patients were six men and one woman, aged from 30 to 70 years. In four patients the tumour was situated in the middle part of the thoracic segment, and in three cases in the lower part of the supradiaphragmatic segment of the oesophagus. The diagnosis od benign oesophageal tumour was made on the basis of X-ray examination, oesophagoscopy, and histopathological examination. Five patients were treated surgically. In two patients the access to the tumour was from the right pleural cavity, and in three other cases--from the abdominal cavity. The result of histopathological examination of the removed tumours was as follows: in two patients--benign polyps, in one patient--mature teratoma, in one female patient--myxofibroma, and in one case--fibromyoma. In all patients operated on complete cure was achieved.

This study describes a new technique for excision of small colorectal polyps in a series of 210 consecutive patients, who had total colonoscopy, and in whom any clotting problems had been excluded. A total of 288 small polyps of 5 mm or less in diameter were transected by mechanical strangulation with a polypectomy snare, but without applying any electrical energy. All polyps were recovered whole and sent for histologic examination. No case of perforation, serious bleeding, or mortality was recorded, nor was there any need for blood transfusion because of sudden or delayed bleeding. Of the small polyps, 56% were adenomas, 43% hyperplastic, and 1% were other types. No invasive cancer was found, but in seven small adenomas severe dysplasia was observed. No correlation between the macroscopic appearance of small polyps at endoscopy and their nature at histology was found. Our data confirm that all visible polypoid lesions of the colon should be removed, and that cold snare excision of small polyps is a safe and effective alternative method of treatment in patients without clotting problems.

Aural polyps or granulation tissue, though usually due to infection, may represent a neoplasm, the most frequent malignant tumour in childhood being rhabdomyosarcoma. We report a 9-year-old boy from whom an aural polyp was removed 4 years ago, with the histological diagnosis of a botryoid (alveolar type) rhabdomyosarcoma. Surgery and chemotherapy with cyclophosphamide, vincristine, adriamycin and actinomycin D were followed by a local recurrence 2 years later. This was treated by chemotherapy and irradiation with 50 Gy; the child has now been free of disease for 2 years. Rhabdomyosarcoma of the ear has a considerably improved cure rate with newer treatments if the diagnosis is made early by biopsy.

The authors report a series of 350 patients referred for clinical investigation of nasal polyps between 1980 and 1990. 93 patients were followed for more than 5 years. Allergy to inhalants was rarely found (2.8%). Detailed study of past rhinosinusal and bronchial symptoms often revealed a history of vasomotor rhinitis (nasal hyperreactivity HRN) preceding the nasal polyposis by a mean interval of 8 years. The ratio non-allergic vasomotor rhinitis/nasal polyps was 4.31 in women (41.4% of the patients) and 1.74 in men (58.6% of the patients). Treatment is usually based on the use of local corticosteroids. However, because of the variable clinical pattern of nasal polyposis treatment may be medical alone or both medical and surgical, and always requires a long clinical follow-up. Intolerance to aspirin is a factor of poor prognosis. A 15% failure rate was noted among patients intolerant to aspirin.

Gastric and duodenal polypoid lesions are almost always diagnosed incidentally and constitute a clinical problem for treatment and follow-up. The histologic types of polypoid lesions in stomach and duodenum are described, as well as the clinical setting in which they are found. Endoscopy and directed biopsies, but particularly diathermic snare polypectomy, are essential to establish a certain histologic diagnosis. Guidelines are given for treatment and follow-up.

The study included 96 women with combined benign hyperplastic uterine conditions. Half of them underwent a radical uterine resection and were examined at 3.1 +/- 0.2 years following the operation. The rest were randomly selected as matched pairs and were evaluated at 4.3 +/- 0.13 years following multicomponent treatment including hormones (n-26) and cryohormonal treatment (n-22). Analysis of results revealed a complex pathogenesis of this disease of the reproductive tract, presenting as severe postoperative vegetoneurotic disorders. Potential of an adequate conservative treatment in preserving specific female functions was determined.

The efficacy of ultrasonic ethmoidectomy combined with magnetic therapy was investigated in 90 patients. Ultrasonic ethmoidectomy was applied with the help of a LORA system consisting of a generator and an acoustic unit connected to a waveguide with a spoon-shaped end (44 Hz frequency and 35-40 microns amplitude). Under visual control the ultrasonic spoon was inserted into the meatus nasi medius, and the injured medial, superior and some anterior cells of the ethmoidal bone were opened. Bone trabecules of the cells were removed together with the polypous mucous membrane and polyps, by moving the concave surface forwards and keeping the long axis of the bent portion of the spoon in the vertical position. Follow-up of the treated patients during 6 months to 4 years revealed the absence of polyps in 79.7%. Repeated application of this treatment in the case of severe recurrent forms of polypous ethmoiditis improved the therapeutic efficacy.

Gastric and duodenal epithelial polyps are almost always diagnosed incidentally and constitute a clinical problem for treatment and follow-up. All histologic types of these polyps are described, as are the clinical settings in which they are found. Endoscopy, often with snare polypectomy, is essential to obtain a certain histologic diagnosis. Guidelines are given for treatment and follow-up.

Since 1981, we have been conducting research on percutaneous transhepatic cholecystoscopy through the sinus tract of percutaneous cholecystostomy and this method has been employed in 72 patients with gallbladder diseases. We have already reported on percutaneous transhepatic cholecystoscopy and its usefulness for the diagnosis of early gallbladder carcinoma. Histological diagnosis was possible on the basis of cholecystoscopic biopsies in all 21 patients with gallbladder carcinoma, including eight patients with early carcinoma. Percutaneous cholecystoscopy is a reliable method for making the differential diagnosis between carcinoma and polypoid lesions of the gallbladder, and the diagnosis of cancer extension on the mucosa to the cystic duct. This method is recommended as a further and final step for the early diagnosis of gallbladder carcinoma. We performed endoscopic lithotripsy with the Nd:YAG laser or electrohydraulic lithotripter, and treated 21 patients with cholecystolithiasis. We report here on the results and features of this method as a nonsurgical treatment for cholecystolithiasis.

After underlining the frequency of organic lesions observed in functional diseases of vocal cords, emphasis is placed on the importance of the phonetogram in their evaluation and video-laryngo-stroboscopic investigation in their diagnosis. When surgery is necessary, stainless steel instruments are preferred to the laser. Respective isolated or associated vocal reeducational and surgical indications are discussed, and the establishment of a team including laryngologist, phoniatrist and orthophonist recommended to ensure most effective results.

We investigated the clinical records of 784 patients with vocal fold polyps and 372 patients with vocal fold nodules who were seen in our clinic during the 10 years from 1971 to 1980. Polyps were frequent in middle ages in both sexes whereas nodules were common in boys and middle-aged women. Vocal abuse was the most important etiologic factor. No regular voice therapy was available for lack of voice therapists. Surgical removal yielded the best result, but not in all the patients operated.

The paper presents the results of the 10-year follow-up of 1,237 patients at high risk for stomach cancer. Among them, 669 patients suffered from chronic gastric ulcer, 78--polyps, 382--chronic gastritis and 108 underwent resection of the stomach more than 10 years ago. Repeated gastroscopic examinations, including biopsy, carried out within the last two years, revealed malignancies in 405 cases (32,7%): chronic ulcers--10.8, polyps--11.1 and chronic gastritis--0,6%. Malignancy of the gastric stump was observed in 5.0%. In chronic gastritis patients, cancer development was registered in cases of hyperplasia only (4.5%). No malignancy was found in cases of reorganization gastritis and atrophic gastritis.

CO2 hysteroscopy for diagnosis of cervical polyps was performed in 36 patients. The polyps could be located under direct vision and their attachments were found to be deeper than what is seen in regular inspection. A relatively high number of endometrial polyps were found. It is advised that the polyps be surgically removed by cutting the stem at its attachment followed by a curettage.

A benign prostatic urethral polyp is considered as an unusual lesion of the urethra. It attracts the patient or doctor's attention only when hematuria or hemospermia is noted. From August 1987 to June 1988, the authors found four cases of posterior urethral polyps in the Taitung Branch of Mackay Memorial Hospital. Hematuria was found in all of the 4 patients and hemospermia was found in one. Three patients presented gross hematuria, and one microscopic hematuria. Of the four, two had suprapubic soreness; one had perineal discomfort; and only one manifested no symptoms at all. All of the patients underwent a cystoscopic biopsy, and their specimens were stained and studied by the immunoperoxidase method. All of the specimens were PSA positive, and presented a picture of adenomatous polyp. Only one patient received transurethral electrocoagulation because of continued hematuria and perineal discomfort that persisted even after a two week medical course that appeared to be more effective to the previous one. In conclusion, the authors believe that more of such lesions will be discovered when more attention is paid to the posterior urethra; when adenomatous polyps are suspected in patients who have the above symptoms; and when polyps are considered as a possibility in the differential diagnosis.

The clinical applications of peroral and percutaneous cholangioscopies are discussed, and the indications, advantages, disadvantages and therapeutic results compared. Peroral cholangioscopy (PCS) performed between January 1986 and April 1989 with the most advanced mother and baby 'scope system was compared with percutaneous cholangioscopic procedures such as PTCS, POCS and PTCCS done in the same period. PCS was done to remove common bile duct stones using electrohydraulic lithotripsy and to diagnose bile duct tumors with effective biopsy studies. Removal of intrahepatic bile duct stones was successfully performed with percutaneous cholangioscopy compared with the PCS procedure. For direct visualization of common bile duct tumors, PCS was the preferred approach for tumors located in the middle CBD to the liver hilus. On the other hand, percutaneous approaches had a good indication for the lesions in the distal CBD. Thus, the best approach for each lesion should be selected for effective diagnosis and treatment.

The authors analyse the pathophysiology of pseudo-tumours of the female urethra and present the clinical signs and diagnostic traps associated with these lesions. Treatment is essentially medical by means of a combination of anti-infectious and anti-inflammatory agents and local oestrogens.

A case of SLE with the unique association of gastric polyps and vasculitis is reported. Gastrointestinal symptoms, surgical indications, and complications of SLE with gastrointestinal involvement are reviewed. The unusual patterns of ileus or lupus peritonitis secondary to mesenteric vasculitis must be differentiated from a true surgical emergency. Corticosteroids may be expected to produce rapid clinical improvement in the two former instances. Surgical exploration is reserved for those cases with clinical or radiologic evidence of uncontrollable hemorrhage, bowel perforation, or mesenteric infarction.

In spite of many recent advances in basic science, the etiology and pathogenesis of nasal and paranasal polyps have still not been clarified. Well defined causal factors are hereditary diseases such as cystic fibrosis and primary ciliary dyskinesia. Allergic and non-allergic processes of the airways, particularly intrinsic asthma and intolerance to non-steroidal antiinflammatory drugs (NSAID), are implicated in the development of nasal polyposis. Histopathological studies of polyp tissue do not allow etiologic or prognostic conclusions, but are indispensable for the classification of structures involving clinical signs similar to nasal polyps. Causal antiallergic therapy is confined to the rare cases with an evident clinically relevant nasal allergy. Topical corticosteroids are effective in the treatment of nasal polyposis, but in extensive and obstructive polyps surgery is required. In severe polyposis of the ethmoid sinus endoscopically controlled endonasal ethmoidectomy is the surgical treatment of choice.