Concurrent collagenous colitis and multiple heal carcinoids

Summary A case of collagenous colitis in a patient with ileal carcinoid is described. Considerable fibrofatty thickening of the small bowel mesentery was present. The association of these findings appears to be unprecedented. Further observations are required to ascertain that collagenous colitis is one of the protean manifestations of carcinoid tumor.     

Management of obstructive carcinoma of the left colon. Comparative study of staged and primary resection

Of 82 patients who had obstructing cancer of the left colon, 22% had incurable disease and 36.5% had advanced cancer at presentation. All methods of treatment carried a high morbidity and mortality. The mean survival rate with palliative operations was 8.7 months. Twenty-four poor-risk patients treated with staged operations had a 25% operative mortality and a 20.8% five-year survival rate. Forty primary resections, with or without anastomosis, were followed by a 27.5% operative mortality and by more than a twofold five-year survival rate (47.5%) compared with that of staged resection. These results suggest that delay of cure may reduce the late survival rate and justify primary resection as the operation of choice in selected good-risk patients.     

Mutations in TAX1BP3 Cause Dilated Cardiomyopathy with Septo‐Optic Dysplasia

We describe a Bedouin family with a novel autosomal recessive syndrome characterized by dilated cardiomyopathy and septo‐optic dysplasia. Genetic analysis revealed a homozygous missense mutation in TAX1BP3, which encodes a small PDZ domain containing protein implicated in regulation of the Wnt/β‐catenin signaling pathway, as the causative mutation. The mutation affects a conserved residue located at the core of TAX1BP3 binding pocket and is predicted to impair the nature of a crucial hydrophobic patch, thereby interrupting the structure and stability of the protein, and its ability to interact with other proteins. TAX1BP3 is highly expressed in heart and brain and consistent with the clinical findings observed in our patients; a knockdown of TAX1BP3 causes elongation defects, enlarged pericard, and enlarged head structures in zebrafish embryos. Thus, we describe a new genetic disorder that expands the monogenic cardiomyopathy disease spectrum and suggests that TAX1BP3 is essential for heart and brain development.     

Prognostic significance of platelet count changes during hospitalization for community-acquired pneumonia

The prognostic significance of platelet count (PC) changes during hospitalization for community-acquired pneumonia (CAP) has not been investigated. For 976 adults, clinical data during hospitalization for CAP and all-cause mortality following discharge were compared according to ΔPC (PC on discharge minus PC on admission): groups A (declining PC, ΔPC < ?50 × 10⁹/l), B (stable PC, ΔPC ± 50 × 10⁹/l), and C (rising PC, ΔPC >50 × 10⁹/l), and according to the presence of thrombocytopenia, normal PC, and thrombocytosis on admission/discharge. Groups A, B, and C comprised 7.9%, 46.5%, and 45.6% of patients, respectively. On hospital admission/discharge, thrombocytopenia, normal PC, and thrombocytosis were observed in 12.8%/6.4%, 84.1%/84.4%, and 3.1%/9.2% of patients, respectively. The respective 90-day, 3-year, and total (median follow-up of 54 months) mortality rates were significantly higher: in group A (40.3%, 63.6%, and 72.7%), compared to groups B (12.3%, 31.5%, and 39.0%) and C (4.9%, 17.3%, and 25.4%), p < 0.001; and in patients with thrombocytopenia at discharge (27.4%, 48.4%, and 51.6%), compared to those with normal PC (10.2%, 26.9%, and 35.4%) and thrombocytosis (8.9%, 17.8%, and 24.4%) at discharge (p < 0.001). Mortality rates were comparable among groups with thrombocytopenia, normal PC, and thrombocytosis at admission (p = 0.6). In the entire sample, each 100 × 10⁹/l increment of ΔPC strongly predicted lower mortality (p < 0.001, relative risk 0.73, 95% confidence interval 0.64?0.83). In conclusion, PC changes are common among CAP inpatients. Rising PC throughout hospitalization is a powerful predictor of better survival, while declining PC predicts poor outcome. Evaluation of PC changes during hospitalization for CAP may provide useful prognostic information.     

Country of origin,age at migration and risk of cutaneous melanoma: A migrant cohort study of 1,100,000 Israeli men

Cutaneous melanoma (CM) is a common cancer with increasing incidence in many parts of the world where light‐skinned populations live. We conducted a large‐scale nationally representative migrant cohort study to assess country of origin and age at migration as predictors of CM, controlling for possible confounders. Data on 1,086,569 Israeli Jewish males, who underwent a general health examination before compulsory military service at ages 16–19 between the years 1967–2005, were linked to Israel National Cancer Registry to obtain incident CM up to 2006. Cox proportional hazards was used to model time to event. Overall, 1562 incident cases were detected during 19.3 million person‐years of follow‐up. Origin was a strong independent predictor of CM. Incidence was higher for European (hazard ratio [HR] = 4.08, 95% confidence interval [CI]: 3.55–4.67) and Israeli origin (HR = 2.92, 95% CI: 2.25–3.79) compared to N. African/Asian origin, adjusted for year of birth, years of education, residential socio‐economic position, rural residence and body surface area (or height). Among those of European origin, the adjusted risk was significantly lower for those who immigrated after the age of 10 years (HR = 0.58, 95% CI: 0.45–0.73) but not for younger ages (HR = 1.02, 95% CI 0.84–1.23) compared to Israeli born. The high rates of CM among men of European origin and the almost twofold lower risk among those immigrating after age 10 provide solid support for the deleterious role of childhood sun exposure as a risk factor for melanoma. These findings will serve in directing public health and research efforts.     

Adipose reduction by beta,beta'-tetramethyl-substituted hexadecanedioic acid (MEDICA 16)

Treatment of normal rats kept on a balanced laboratory chow diet with beta,beta'-tetramethyl-substituted hexadecanedioic acid (MEDICA 16) (Bar-Tana et al., 1985, J. Biol. Chem, 260, 8404-8410) resulted in an acute reduction in adiposity, which was already established during the first week of treatment and was sustained as long as the drug was administered. Adipose reduction consisted of 30-80 percent decrease in the perirenal, omental, epididymal, parametrial and subcutaneous fat with a concomitant 50 percent decrease in total body neutral lipid mass. The reduction in adiposity was accounted for by a respective decrease in the lipid content of individual adipocytes together with a transient or sustained decrease in the number of adipocytes of selected adipose tissues. The decrease in the lipid content resulted from (a) an extensive hypotriglyceridemia in MEDICA 16-treated rats; (b) inhibition of adipose lipogenesis by MEDICA 16; (c) increased sensitivity to catecholamines-. ACTH- and forskolin-induced lipolysis in MEDICA 16 adipocytes. Adipose reduction by MEDICA 16 was not compromised by a decrease in overall net caloric intake but was accompanied by a 40 percent increase in resting metabolic rate.