Mixed adenocarcinoma and carcinoid tumour of the colon. A report of 4 cases with postulates on histogenesis

Gastro-intestinal tumours which contain both mucinous and endocrine cells have been reported with increasing frequency recently. Four such mixed neoplasms of the colon are described. Macroscopically, the tumours caused muscular hypertrophy resulting in thickening of the wall of the bowel and annular stenosis of the lumen. Microscopic examination showed them to be poorly differentiated adenocarcinomas with a distinct carcinoid component. Both the mucinous and endocrine elements were demonstrated in metastatic deposits of the tumour, so confirming the malignant nature of each component. The neoplasms appear to represent a distinct clinico-pathological entity associated with a poor prognosis. The histogenesis is postulated to be a range of neoplasms from pure adenocarcinoma through mixed tumours to pure carcinoids and small-cell undifferentiated carcinoma. Such mixed tumours could arise from neoplastic change of crypt-base stem cells.     

Deliberate termination of life of newborns with spina bifida,a critical reappraisal

Objects Deliberate termination of life of newborns (involuntary euthanasia) with meningomyelocele (MMC) is practiced openly only in the Netherlands. ‘Unbearable and hopeless suffering’ is the single most cited criterion for this termination, together with the notion that ‘there are no other proper medical means to alleviate this suffering’. In this paper, both (and other) statements are questioned, also by putting them in a broader perspective. Methods First, a historical overview of the treatment of newborns with MMC is presented, concentrating on the question of selection for treatment. Second, a thorough analysis is made of the criteria used for life termination. Third, a case of a newborn with a very severe MMC is presented as a ‘reference case’. Conclusion ‘Unbearable and hopeless suffering’ cannot be applied to newborns with MMC. They are not ‘terminally ill’ and do have ‘prospects of a future’. In these end-of-life decisions, ‘quality of life judgments’ should not be applied. When such a newborn is not treated, modern palliative care always will suffice in eliminating possible discomfort. There is no reason whatsoever for active life-termination of these newborns. Commentaries on this paper are available at doi:, doi:, doi:, doi:, doi:, doi:, doi:, doi:, doi:, doi:, doi:, and doi:.     

Autoantibodies to acetylcholine receptor in myasthenia gravis: light chains

We studied the light chain type of autoantibodies to acetylcholine receptor (AChR) by affinity chromatography with monoclonal anti-kappa and anti-lambda antibodies. The autoantibodies in four of eight myasthenic patients were of a single light chain type; the others comprised both types. In Graves' disease and cold-reactive hemolytic anemia, the pathogenic autoantibodies are confined to a single light chain type in individual patients, and in other diseases, doubtfully pathogenic autoantibodies are invariably mixtures of both light chain types. AChR antibodies may comprise both pathogenic and nonpathogenic types of autoantibody.     

Size distribution of airborne dust in Labrador iron mines

The size distribution of the total airborne dust and its components approximates a straight line on a plot of log mass undersize against log aerodynamic size. The quartz component distribution has a reasonably constant slope, is close to the distributions found in other mines and mills, and follows the normal breakage laws. The results for the iron component suggest that the top size present is similar to that of quartz and that the slope is also similar. The slopes for total dust by weight are not as steep as for quartz and suggest a bimodal distribution consisting of a coarser mineral fraction mixed with a finer fraction from other sources, such as combustion products, that are often found. The slopes for manganese are sometimes much less than for iron or quartz and suggest that manganese is associated with a more crushable rock. The one finding of chromium suggests that it is associated mostly with very fine particles and, therefore, may have been dispersed as fume from an operation such as welding.     

Chronic cerebral intracellular alkalosis following forebrain ischemic insult in rats

We measured cerebral intracellular pH using in vivo phosphorus-31 nuclear magnetic resonance spectroscopy during 1 week after forebrain ischemia or sham operation in eight and seven rats, respectively. Mean maximum pH was significantly higher (p less than 0.003) in the ischemic group than in the sham-operated group (7.34 +/- 0.03 and 7.19 +/- 0.02, respectively). The difference between mean maximum pH and baseline pH (7.08 +/- 0.01 in each group) was significantly greater (p less than 0.02) in the ischemic group than in the sham-operated group. In the ischemic group, alkalosis occurred primarily after 48-72 hours of recirculation. We speculate that brain tissue alkalosis occurring chronically after ischemia is associated with delayed ischemic neuronal death.     

A case of recurrent congenital fetal anomalies associated with a familial subtelomeric translocation.

The potential of a new fluorescent in situ hybridization technique is discussed, which uses a complete set of telomeric probes to reveal cryptic chromosome rearrangements that remain undetected by standard cytogenetic analysis. We report the obstetric history of a patient who had a termination of pregnancy at 20 weeks for a fetus with multiple congenital anomalies but a normal male karyotype using conventional G-banding analysis on a mid-trimester placental biopsy. In a subsequent pregnancy, a diaphragmatic hernia and intra-uterine growth restriction were detected at 34 weeks' gestation and a fetal blood sample showed a normal female karotype. However, her child was born with dysmorphic features and additional severe abnormalities including microcephaly, anophthalmos and left fixed talipes. The child has shown marked developmental delay. In view of a strong family history of congenital abnormalities and recurrent miscarriage suggestive of a familial translocation, a fluorescent in situ hybridization technique using specific telomeric probes was performed on blood from the affected child and her parents. An unbalanced subtelomeric translocation was detected involving the long arms of chromosomes 2 and 7 in the child and a balanced translocation was detected in her father. Accurate genetic counselling and the opportunity for early prenatal diagnosis can now be offered to this family.