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Examinations of 83 patients and 13 healthy subjects with the augmented histamine test and gastric biopsy show that a maximal acid secretion lower than 10 mEq HCl/hour signifies a diffuse gastritic lesion, the type of which can be verified by a single gastric biopsy. Detailed investigations of the nature and clinical course of gastritis, however, require repeated tests of gastric function and multiple gastric biopsies.

Thirty-four cases of malignant non-Hodgkin lymphomas of gastro-intestinal origin were histopathologically reviewed employing Rapaport's (18) classification. The majority of the tumours, 25, were localized to the stomach. The rest of the lesions occurred with decreasing frequency throughout the gastro-intestinal tract, with the exception of 3 rectal cases. Thirty lymphomas displayed a purely diffuse pattern, 1 was purely nodular, and 3 were nodular with diffuse components. "Histiocytic" lymphoma was the commonest type, including 16 cases; poorly differentiated lymphocytic type next, with 10 cases. The histopathology of this series does not differ from those of comparable studies.

The incidences of intestinal metaplasia in two groups of benign endoscopic biopsies taken from stomachs with malignant and benign lesions respectively were compared. 315 single biopsies were taken from stomachs with proven carcinoma, but outside the carcinomatous area. They were compared to 786 single biopsies taken from stomachs with proven benign lesions. Each single biopsy was placed in one of three groups: intestinal metaplasia absent, or making up less or more than 50 per cent of the epithelium in the biopsy. The results showed that single biopsies with intestinal metaplasia regardless of the extension of the metaplasia in the biopsy were found more often in stomachs with carcinoma than in stomachs with benign lesions but without any significant difference. If more than half of the benign biopsies taken during an examination demonstrated extensive grades of intestinal metaplasia a sligtly significant difference in favour of carcinomas was found.

PURPOSE: The aim of this study was to establish the intraobserver and interobserver variability in the assessment of histologic type (tubular, villous, and tubulovillous) and grade of cytologic dysplasia (mild, moderate, and severe) in colorectal adenomas. METHODS: One hundred eighty-seven slides of adenomas were assessed twice by three experienced pathologists, with an interval of two months. Results were analyzed using kappa statistics. RESULTS: For agreement between first and second assessment (both type and grade of dysplasia), kappa values for the three specialists were 0.5345, 0.9022, and 0.4100, respectively. Agreement was better for type than for dysplasia. The strength of agreement was moderate for Observers A and C and almost perfect for Observer B. Agreement between all three observers was seen in 35.2 percent for both type and dysplasia in 61 percent for type and in 47.8 percent for dysplasia. The kappa values for Observer Avs.B and Observer Cvs.B were 0.3480 and 0.3770, respectively (both type and dysplasia). Values for type were better than for dysplasia, but agreement was only fair to moderate. CONCLUSION: The interobserver agreement was moderate to almost perfect, but the intraobserver agreement was only fair to moderate. A simpler classification system or a centralization of assessments would probably increase kappa values.

Epidemiologic studies have shown an association between seafood consumption and risk of thyroid cancer. Fish meals increase the serum concentrations of the longchain fatty acids, eicosapentaenoic acid (20∶5,n-3) (EPA) and docosahexaenoic acid (22∶6,n-3) (DHA), for days. The hypothesis that serum concentrations of fatty acids may be associated with thyroid cancer risk therefore was tested in a population-based case-control study with 74 cases and 221 matched controls. Seventy-three cases with sera in the Norwegian serum bank (JANUS) were identified in the Norwegian Cancer Registry and matched with three controls, also in JANUS, on age, gender, place of residence, and time of blood sampling. Each case was matched with two controls. Serum concentrations of 11 longchain fatty acids were determined blindly by gas chromatography for all subjects. Controls were divided into three groups with increasing serum fatty acid concentrations, and odds ratios between cases and controls were estimated relative to the group with lowest serum level by univariate and multivariate analyses. The main finding was a significant inverse relation between the sum of arachidonic acid (20∶4,n-6) (AA) and DHA serum concentrations and thyroid cancer risk. The significance of this association was weakened when the analyses were restricted to the papillary type of thyroid carcinoma. It was of the same order of magnitude whether the period between blood sampling and diagnosis was greater than eight years, or eight or less years. High EPA/AA ratio, indicating consumption of fish fat, was not associated significantly with increased thyroid-cancer risk. These data indicate that the association between seafood ingestion and increased thyroid-cancer risk may not be caused by the marine fatty acids.

Using immunoperoxidase technique a considerable variation in the number of antral gastrin cells was demonstrated in patients with atrophic gastritis. This variation must be taken in consideration when the number of gastrin cells is to be estimated on the basis of gastric biopsies.

Increasing incidence and changing stage distribution of testicular carcinoma in Norway 1970–1987

The rate of yersiniosis in patients with acute abdominal disease was studied in a 16-month prospective investigation in 1972-1973 of 205 acutely ill patients referred to a surgical clinic of a Copenhagen City hospital with complaints of abdominal pain suggestive of appendicitis. Yersinia enterocolitica, biotype 4, was isolated from 11 patients (5.4%), 8 of whom were children. Yersinia was grown from faeces in 8 cases and from appendix of all 9 patients operated upon. Rising or falling agglutinin titres larger than or equal to 100, indicative of yersiniosis, were found in 22 patients (10.7%) including all bacteriologically verified cases. Eight additional patients (3.9%) had less significant titres larger than or equal to 100, suggestive of recent or present infection. 28 patients (13.7%) had insignificant titres, including 3 with antibodies against serotype 9. In all cases except these 3, antibodies were against Y. enterocolitica, serotype 3. A differential diagnosis between Y. enterocolitica infection and other types of appendicitis could not be made within this highly selected group of patients using available clinical data. All cases were rather mild and self-limiting. It is suggested that in future epidemiological and other studies of yersiniosis, early bacteriological and serological examinations be carried out.

Ten healthy volunteers received the prostaglandin E1 analogue Rioprostil 300 µg b.i.d. for 1 week. Endoscopically obtained biopsies were investigated with tritiated thymidine and autoradiog

Seven duodenal ulcer patients were treated for 3 months with cimetidine. Before and after treatment endoscopic biopsy specimens were taken for autoradiographic estimation of cell proliferation in the gastric mucosa in the antral and fundic part of the stomach and from the duodenum. In all three areas the estimated labeling index was increased during medication with cimetidine. The increase in epithelial cell renewal may participate in the ulcer healing effect of cimetidine.

Cell proliferation of gastric antral and fundic mucosa was studied in a series of patients with different gastric diseases. After in vitro incubation of endoscopic biopsies with tritiated thymidine, radioautographs were prepared by the dipping technique. The labeling indices were estimated, and the biopsies were classified according to the degree of gastritis. The peak acid output after "maximal" stimulation with histamine was also determined. A highly significant inverse correlation between peak acid output and the labeling indices in both antral and fundic mucosa was demonstrated. The correlation between the degree of gastritis and the labeling indices in antral and fundic mucosa was also statistically significant. The results indicate that a significant inverse relationship exists between the acid secretory capacity of the gastric mucosa and the rate of cell proliferation in both antral and fundic mucosa. Furthermore, the data suggest that an increasing degree of gastritis in human gastric mucosa is followed by an increased rate of epithelial cell proliferation.

The histopathologic and clinical findings in 682 patients with carcinoma of the rectum have been analyzed. Invasion of veins and nerves by primary growth was found in 38.9 and 34.9 per cent, respectively. The five-year survival rate for patients with resectable tumors was 49 per cent. The age, Dukes' staging, and presence and/or absence of liver metastases, of venous invasion, and of nerve invasion were found to be of statistically significant importance for the prognosis. Sex was found to be on the borderline of significance and Broders' grading was even less significant. Invasion of veins was found statistically significant more frequently than nerve invasion, but the present investigation revealed the importance of the invasion of veins as well as of nerves. When venous invasion was observed, liver metastases developed over three times as frequently in these patients as when metastases were not demonstrated. In contrast to Dukes' staging. Broders' grading can be applied to tumor biopsies preoperatively. The importance of venous and nerve invasion for the selection of patients for adjuvant therapy after termination of surgical treatment is discussed.

To determine the effect of acetyl salicylic acid and Indomethacin on the rate of cell proliferation in the human gastric stomach, 6 healthy volunteers received daily 3 g of acetyl salicylic acid or 150 mg of indomethacin for one week in a double-blind crossover trial. Cell proliferation was assessed by means of tritiated thymidine and autoradiography. The labelling index did not change, indicating that cell proliferation to compensate for the exfoliation caused by ASA and indomethacin does not increase.

A total of 26 patients with familial polyposis coli without extracolonic manifestations were examined by gastroduodenoscopy. Histologically verified polyps were found in 18 patients (69 percent, 95 percent confidence limits 48–86). Gastric adenoma was diagnosed in one patient, fundic gland polyposis in six patients, and duodenal adenomas in 12 patients. It is concluded that the incidence of gastroduodenal polyps is independent of the clinical presence of other extracolonic manifestations. It is advisable that polyposis patients should be followed with gastroduodenoscopy and biopsy of polyps.

The brown bowel syndrome (BBS) is a rare disease characterized by malabsorption and accumulation of lipofuscin in the smooth muscle cells of the muscularis externa of the small intestine. Recently, we incidentally observed a case of BBS in a colon operated on because of a neoplasm. Our ultrastructural investigation, which demonstrated changes in the mitochondria, further supports the significance of mitochondrial damage in BBS.

The incidence of cells containing so-called Russell bodies in 315 benign single gastric biopsies taken from stomachs with proven carcinoma, but outside the carcinomatous area and 786 biopsies taken from stomachs without carcinoma were compared. The Russell body containing cells were counted in a fixed area and on the basis of the counting each biopsy was classified in one of four groups: Russell body containing cells absent or present in a number of 1–5, 6–10 or more than 10 in the area. The results showed that endoscopic biopsy examinations containing one single benign biopsy with more than 5 Russell body containing cells in the counted area were significantly most common among examinations taken from stomachs with carcinoma. If half or more than half of the biopsies in an examination contained 1–5 Russell body containing cells significant differences were also found. The sensitivity of such examinations was low but their predictive values (PVpos) varied from 46 per cent to 95 per cent, meaning that such examinations may be of importance for the diagnosis of gastric cancer.

For three years (1970-72) endoscopic gastric biopsies from 883 lesions in 862 patients were histologically examined, every single biopsy (4088) separately. In 38% of the cases, namely 142 malignant and 194 benign lesions, the diagnoses could be verified. If the criterion for a positive examination was that one of the biopsies showed unambigous carcinoma, the sensitivity of the examination was 76%, the specificity 99%, the PVpos 98%, and the PVneg 85% for the first examination, using the terms of Vecchio. If the biopsy diagnoses carcinoma with some uncertaincy and precancerous biopsies were considered positive too, and if all examinations prior to verification were included, the corresponding figures were 88%, 98%, 97%, and 91%. The most common number of biopsies used in an examination for diagnosing carcinoma was 4 (range 1-11). Fewer biopsies were used if the carcinomas were localized to the whole stomach, were protruded or had a largest diameter of more than 7 cm. The characteristic 'protruded' was the only tumour criterion which significantly was found most common among positive examinations. Ulcer-like carcinomas were common among the false negative. On the basis of pathoanatomy no special number of biopsies to be taken per examination could be recommended.

Heterotopic gastric epithelium in the duodenum was investigated by the following enzyme histochemical reactions: NADH-tetrazolium reductase, lactic acid dehydrogenase, succinic acid dehydrogenase, glucose-6-phosphate-dehydrogenase, alkaline phosphatase, acid phosphatase, aminopeptidase and non-specific esterase. The enzyme activities were compared with that of normal fundic mucosa. No differences could be disclosed.

Augmented histamine, gastric biopsy, and barium meal studies were made of 44 patients with respiratory insufficiency. Despite the fact that 80% evidenced atrophic gastritis, 27% had peptic ulcers and high acid secretion. More comprehensive studies of total acid production and of multiple gastric biopsies arc desirable.