Underdiagnosis of carcinoma of the stomach in the elderly: a 25-year autopsy study

Gastric carcinoma may present atypically in the elderly. Between 1955 and 1979, 571 autopsies on gastric carcinoma cases were carried out at the Gade Institute, Bergen. In 165 of them the diagnosis had not been made clinically. The latter patients were, on average, 10 years older at death than those in whom the diagnosis was made premortem, and their tumours were smaller. In 45 the tumour was considered an incidental autopsy finding, while 58 were diagnosed clinically as advanced cancer of unknown origin. In the remaining 62 cases the cancer was the underlying cause of death. Recognition of an elderly sub-group of patients whose gastric carcinomas presented atypically brings with it an increasing diagnostic challenge in our ageing population.     

Metal allergy in north Norwegian schoolchildren and its relationship with ear piercing and atopy

In 424 schoolchildren (223 boys and 201 girls) aged 7–12 years undergoing routine patch tests, 21.0% (89 children), 38.8% (78/201) of girls and 4.9% (11/223) of boys, had had their ears pierced. 18.6% (79 children, 55 girls and 24 boys) gave a history of cutaneous reactions to metallic jewellery, and in 17.2% (73 children, 49 girls and 24 boys), sensitivity to one or more metals was confirmed. Metal allergy was confirmed by patch testing in only 34.2% of the children with a history of metal dermatitis, and 13.3% of those without a history of metal reactions had, in fact, positive patch tests to 1 or more metals. The low sensitivity (37.0%) and low positive predictive value (34.2%), together with high specificity (85.2%) and high negative predictive value (86.7%), seem to justify dermatological examination of individuals with a positive symptom-based diagnosis only. Nickel sensitivity was found in 14.9% (63 children, 44 girls and 19 boys). There is clearly a relationship between ear piercing and induction of nickel allergy in girls, as nickel sensitivity in girls with pierced ears was 2 × (30.8%) that found in those without (16.3%) pierced ears. In boys, nickel sensitivity was much less frequent and few cases were related to ear piercing. Atopy appeared to influence the propensity for developing metal sensitivity in girls, as atopic girls showed positive metal tests 2xas frequently (30.8%) as non-atopic (17.0%). No such differences were found in boys. Girls with a combination of atopy and ear piercing showed the highest frequency of positive metal tests (45.5%). The frequency of metal allergy increased with increasing number of holes in the ear lobes. Symptoms of nickel allergy were reported in 30.2% (19/63) of mothers whose children had nickel allergy, compared to 16.3% (59/361) of mothers whose children had negative nickel tests. Only 4 children reported symptoms of nickel allergy in their father. The high frequency of nickel sensitivity in all children tested may indicate an influence of sources other than ear piercing.     

Fallopian tube sperm perfusion (FSP) versus intra-uterine insemination (IUI) in the treatment of unexplained infertility: a prospective randomized study

Prospective randomization of 60 couples with unexplained infertilitywas performed for treatment either with intrauterine insemination(IUI), using a volume of 0.5 ml of the inseminate, or Fallopiantube sperm perfusion (FSP), using a volume of 4 ml of inseminate.The protocols for ovarian stimulation and induction of ovulationwere the same in the two groups. The two groups were similarconcerning age of the female at the start of treatment and thenumber of follicles > 15 mm diameter, the serum oestradiolconcentrations and the endometrial thickness on the day of humanchorionic gonadotrophin (HCG) administration. The mean (±SD)number of motile spermatozoa inseminated was significantly higherin the FSP group than in the IUI group (52 ± 5 x 10⁶and 28 ± 3 x 10⁶ respectively). In the FSP group, 30women were given a total of 52 treatment cycles; 14 clinicalpregnancies occurred in this group, giving a pregnancy rateof 26.9% per cycle and 46.7% per woman. In the IUI group, 28women were given a total of 51 treatment cycles; five clinicalpregnancies occurred, giving a pregnancy rate of 9.8% per cycleand 17.9% per woman. The pregnancy rates per cycle and per womanin the FSP group were significantly higher than in the IUI group(P < 0.05, chi-square test). This study indicates that inthe treatment of couples with unexplained infertility, Fallopiantube sperm perfusion (FSP) is more successful than intra-uterineinsemination (IUI).     

Mast cell changes and tumour dissemination in human breast carcinoma

In breast carcinoma metachromasia on staining the primary tumour with toluidine blue is related to mast cell changes and an infiltrative as opposed to an expansive growth form. In 73 patients the presence of metachromasia in the zone of host-tumour interaction, just beyond the edge of the tumour cells, was associated with poor short-term survival, giving greater discrimination than, for example, axillary nodal status or histological grade. 12 of 19 patients with metachromasia in this zone died within 5 years of operation. This indicates that the reaction is not only related to local infiltrative growth, but may also reflect the tumour potential for metastatic spread. In the absence of metachromasia in this zone death occurred mainly in patients with poorly differentiated tumours. The possible mechanisms involved are discussed. It is stressed that stromal metachromasia is not tumour specific, but that in certain areas, under defined circumstances, it may give information of both prognostic and biological interest.     

Genetics of the low density lipoprotein receptor:

Six indices of low density lipoprotein (LDL) receptor activity were assayed in cultured fibroblasts from seven subjects with familial hypercholesterolemia (HC) and six subjects without HC (non-HCs). Four non-HCs, three HC heterozygotes and one HC homozygous proband belonged to one kindred (kindred A). The proband's fibroblast 125I-LDL processing values fell within or were slightly above the range defined by fibroblasts from three "receptor-negative" HC homozygotes. Thus, the plasma membrane receptor defect in this kindred is probably of the "receptor-negative" category. LDL receptor-dependent 125I-LDL processing was about twice as high in fibroblasts from non-HCs as in those from HC heterozygotes belonging to kindred A. The segregation pattern of LDL receptor activity in this kindred was compatible with control by a single gene locus. 125I-LDL processing values from non-HCs, HC heterozygotes and HC homozygotes differed significantly from one another, but non-HCs and HC heterozygotes showed some overlap. LDL receptor-dependent 125I-LDL association (plasma membrane binding plus intracellular accumulation) data for 6 HC heterozygous and 13 non-HC fibroblast strains clustered into two and into three groups, respectively. Median 125I-LDL association levels in these groups appeared to be in agreement with hypothesis that two different geno-types in HC heterozygotes and three in non-HCs determined LDL receptor activity. These findings suggest the possibility that 125I-LDL processing studies may reveal "normal" alleles at the LDL receptor locus.     

Low density lipoprotein receptor activity in cultured fibroblasts from subjects with or without ischemic heart disease (in the absence of familial hypercholesterolemia)

Fibroblast strains from six subjects with ischemic heart disease (IHDs) were compared to strains from 43 subjects without a history of IHD (non-IHDs), with respect to association (plasma membrane binding plus intracellular accumulation) and degradation of radioiodinated LDL (125I-LDL). The subjects (25 females and 24 males) were selected on the criteria that they were twins (one from each pair), 58-61 years old, and living within 200 km of Oslo. None of them suffered from autosomal, dominant hypercholesterolemia, which is associated with reduced cell surface LDL receptor activity and increased susceptibility to IHD. There was a trend towards lower 125I-LDL association values in strains from IHDs than in strains from non-IHDs (P=0.009). There was a significant negative correlation between, on one hand, serum total cholesterol level and on the other fibroblast association (P=0.03) or degradation (P=0.04) of 125I-LDL. We have previously presented data indicating that fibroblast association of LDL may be determined by alternate genes at one single locus. Together with the present limited data, this raises the possibility that normal genes at the LDL receptor locus may render subjects more or less susceptible to ischemic heart disease.     

Who gets a second primary cancer after gastric cancer surgery?

Eleven patients presented with a second primary cancer during follow-up after surgery for gastric carcinoma. In these patients the serum concentrations of C1-INH and IgG prior to gastric cancer surgery were similar to those of 53 patients with recurrence of gastric cancer. In these two groups, the preoperative C1-INH concentrations were higher and IgG lower (P less than 0.001 and P less than 0.05) when compared to 36 patients alive and disease-free 5 years after surgery. The median time between surgery and signs of recurrence was 11 months, whereas the median time until signs of the second primary cancer was 4 years. A patient with gastric carcinoma who pre-operatively has high C1-INH and low IgG is liable either to have recurrence or to develop a second primary cancer. Our data indicate that these variables represent a cancer susceptibility feature appropriate to the host.     

Distribution of taste buds on fungiform and circumvallate papillae of bovine tongue

The distribution of taste buds on the fungiform and circumvallate papillae of the cow tongue has been determined. The two tongues studied were from Holstein-Friesian cows four to six years of age; they contained 14,765 and 21,691 taste buds, respectively. The tip of the tongue is well supplied with fungiform papillae, and the posterior portion contains the circumvallate papillae. The midportion of the tongue contains relatively few taste papillae. The fungiform papillae contained 1,580 and 1,838 taste buds on the two tongues, respectively, and the circumvallate papillae were estimated to contain 13,185 and 19,853 taste buds. The highest concentration of taste buds therefore occurs in the circumvallate papillae; these relatively few papillae contain approximately 90% of the taste buds. On a circumvallate papilla, taste buds are found only on the papillary sidewall, with none either on the apical surface of the papilla or on the outer wall of the moat.     

Is Lauren's histopathological classification of importance in patients with stomach cancer? A national experience. Norwegian Stomach Cancer Trial.

This study was performed to investigate the association between Lauren's histopathological classification system and different clinico-pathological characteristics in patients with gastric carcinoma. We revealed that the percentage of intestinal type tumour (ITT) increased with advancing age (52% in patients less than 60 years compared to 73% of octogenarians (P less than 0.001)). The male:female ratio was 1.7 for ITT versus 1.3 for diffuse type tumour (DTT (P = 0.12)). ITT was more common in proximally (fundus) localized tumours than in distal lesions (77% vs 65%; P less than 0.05). The proportion of patients with ITT decreased with advancing stages of the disease (70% in stage I and II vs 52% in stage IV (P less than 0.0001)). More patients with DTT had tumour infiltration in the resection margin (21% vs 9%; P less than 0.001). Intestinal metaplasia was found in 48% of those with ITT compared with 28% of those with DTT (P less than 0.001). No association was found between Lauren's classification and the ABO blood group or between the tumour types and infiltration in lymphatic or blood vessels. We conclude that gastric adenocarcinoma occurs in at least two different biological forms and that differentiation between the two is of relevance for treatment.     

Adverse health events associated with antimicrobial drug resistance in Campylobacter species: a registry-based cohort study

BACKGROUND: Resistance to clinically important antimicrobial agents, particularly fluoroquinolones and macrolides, is increasing among Campylobacter isolates, but few studies have explored the human health consequences of such resistance. METHODS: In a registry-based cohort study, we determined the risk of invasive illness and death associated with infection with quinolone- and erythromycin-resistant Campylobacter strains, while adjusting for comorbidity. We linked data from the Danish Surveillance Registry for Enteric Pathogens with data from the Civil Registration System and National Health Registries. RESULTS: Of 3471 patients with Campylobacter infection, 22 (0.63%) had an adverse event, defined as invasive illness or death, within 90 days of the date of receipt of samples. Patients infected with quinolone-resistant Campylobacter strains had a 6-fold increased risk of an adverse event within 30 days of the date of receipt of samples, compared with patients infected with quinolone- and erythromycin-susceptible Campylobacter strains (adjusted odds ratio [AOR], 6.17 [95% confidence interval {CI}, 1.62-23.47]). However, infection with erythromycin-resistant strains was associated with a >5-fold risk of an adverse event within 90 days of the date of receipt of samples (AOR, 5.51 [95% CI, 1.19-25.50]). CONCLUSIONS: The present study provides evidence of the human health consequences of resistance to clinically important agents among Campylobacter infections and the need for increased efforts to mitigate such resistance.