Abnormal blood vessels in the gastric antrum

Three patients who bled from curious vascular lesions of the gastric antrum are described. Each presented with an iron-deficiency anemia. Histological examination in two of the patients demonstrated numerous ectatic submucosal vessels in the antrum, the appearances being somewhat similar to angiodysplasia of the colon. The gastric lesions were not shown by barium meal examination or angiography but gave characteristic appearances on endoscopy. We believe that Billroth I partial gastrectomy is the treatment of choice for this condition.     

BASAL CELL CARCINOMA IN QATAR

Background. There is an increasing incidence of basal cell carcinoma (BCC) and skin cancer in general among various countries, where the sun is implicated as an important causative factor. Methods. Results of clinical and histopathologic examination and the incidence rate of BCCS were recorded over a period of 5 years at Hamad Medical Corporation, Doha, Qatar. Results. Basal cell carcinoma is the commonest skin cancer in Qatar. The average annual incidence per 100,000 residents of working manpower, standardized to the 1986 census, is 9.9 for both sexes and at all ages. Expatriates formed the highest proportion and of these, Europeans were predominant. The tumor was more frequent in men, on sun-exposed areas, was mostly of the nodular and infiltrative type, and occurred in the 3rd, 4th, and 5th decades. As a whole, persons with relatively heavily pigmented skin constituted 66.7% of the patients. Conclusions. Intense sunlight exposure during outdoor work and leisure activities in Qatar puts residents at increased risk for nonmelanoma skin cancer, even in persons with relatively pigmented skin.     

The prevalence and antibiotic sensitivity of oral Viridans streptococci in healthy children and children with disabilities in Kuwait

The purpose of this study was to compare the antibiotic susceptibility profiles of Viridans streptococci (VS) isolated from the oral cavity of healthy children and children with disabilities in Kuwait. Plaque samples were collected from the tooth and tongue surfaces of 102 healthy children and 102 children who were intellectually disabled and institutionalized. The resistance to seven antibiotics (amoxicillin, cephalothin, clindamycin, erythromycin, penicillin G, tetracycline, and vancomycin) was tested.
A total of 330 (44.5%) VS were isolated from the children who were healthy and 411 (55.5%) from children with disabilities. The most common isolates were S. salivarias (27.3%) in healthy children; S. sanguis (22.6%) was predominant among children who were disabled. S. mutans was found in 12.1% of the healthy children and in 16.5% of the children who were disabled. The combined percentage of resistant strains (healthy and disabled) was found to be highest with amoxicillin (43%) and lowest with vancomycin (12%). S. sanguis, S. mitis and S. oralis were more resistant in healthy children (45%, 56%, and 55% respectively) than in children with disabilities (40%, 47% and 47% respectively). S. mutans was the least resistant species to all antibiotics in both groups of children. About 56% of ali streptococci isolated from both groups were resistant to at least one of the antibiotics tested.
The data showed that there was a diference in the level of resistance of oral VS isolated from healthy children and children with disabilities to some antibiotics commonly used in dentistry.     

Goals of statin therapy: Three viewpoints

The “lipid hypothesis” is now universally recognized as a law. Few issues in medicine are as completely resolved as the question of whether reducing serum cholesterol increases longevity. However, there are a few questions that remain, and the most important uncertainty is to what extent cholesterol should be reduced. The medical community, in partnership with government and industry, has contributed many excellent trials demonstrating the effects in patients with elevated cholesterol (above the mean). Where should our goal of therapy be? Until data is available from several large, ongoing trials, we do not have a final answer. We asked three investigators, Drs. Gilbert Thompson, Christopher Packard, and Neil Stone, who have all been integrally involved in the accumulation of our present database, to argue three different possible answers.     

Detecting poor design, erroneous analysis and misinterpretation of studies

To detect bad research in published articles, it is necessary to know what to look for. Some examples of the types of poor study design, inappropriate analyses and pitfalls of interpretation which can occur are presented.     

Effects of blood glucose levels on aspirin-induced gastric mucosal damage

In female rats aspirin-induced gastric mucosal damage was increased and glycoprotein synthesis decreased by fasting and by insulin administration. Glucose added to the drinking water during the fasting period reduced mucosal damage and increased glycoprotein synthesis to control levels. Alloxan diabetes did not affect mucosal damage or glycoprotein synthesis. Alloxan diabetes plus insulin restored blood glucose levels to normal, and susceptibility to aspirin damage and glycoprotein synthesis were also normal. Alloxan diabetes plus fasting restored blood glucose levels to normal but increased aspirin-induced mucosal damage and reduced glycoprotein synthesis.In vitro incubation of gastric mucosal homogenates showed that dibutyryl cyclic AMP and theophylline inhibited glycoprotein synthesis but dibutyryl cyclic GMP had no significant effects. The importance of an adequate supply of glucose to the gastric mucosa and the effects of cyclic nucleotides on glycoprotein synthesis are discussed.     

Chondrosarcoma of the bones of the feet

Twelve chondrosarcomas of the bones of the feet from 11 patients in the Scottish Bone Tumor Registry were reviewed. One patient with diaphyseal aclasis (osteochondromatosis) developed 2 chondrosarcomas. The mean age of patients was 52.3 years (range, 17 to 83 years). Men were predominantly affected. Four tumors affected the tarsal bones; the rest involved the short tubular bones. The usual clinical presentation was a painful, progressively enlarging swelling. Radiologically, most showed some bone expansion, cortical destruction with indistinct margins, and soft-tissue extension. Histologically, the majority were middle-grade tumors. Treatment included curettage or local excision for 4 tumors and amputation or ray resection for 8 tumors. Follow-up varied from 6 months to 18 years (average, 5.8 years). Local recurrence after surgery was seen in 3 patients. All 3 died because of metastases to the lungs or brain.