Enterocutaneous fistulization due toActinomyces odontolyticus

A case of abdominal actinomycosis originating from the sigmoid colon is presented.Actinomyces odontolyticus was isolated; it is a rarity, but should be suspected in the case of a palpable mass and several fistulas developing after a latent period of weeks to months following surgical or inflammatory trauma. The diagnosis is made by anaerobic cultivation. Primary treatment with large doses of penicillin for several weeks may be supplemented by surgery. The strain isolated in the present case was only moderately sensitive to penicillin and was successfully treated with erythromycin.     

Risk of Myocardial Infarction in Parents of HIV-infected Individuals:a population-based Cohort Study

Background  

Previous studies have indicated an increased risk of myocardial infarction (MI) in HIV infected individuals especially after start of highly active antiretroviral therapy (HAART). It is however controversial whether the increased risk of atherosclerotic disease is exclusively associated with the HIV disease and HAART or whether life-style related or genetic factors also increase the risk in this population. To establish whether the increased risk of myocardial infarction in HIV patients partly reflects an increased risk of MI in their families, we estimated the relative risk of MI in parents of HIV-infected individuals.     

Effect of Small Intestinal Bacteria on Intrinsic Factor and the Vitamin B12-Intrinsic Factor Complex

The effect of bacteria isolated from small intestinal contents of blind loop patients on human intrinsic factor (IF) and the vitamin B₁₂-IF complex was studied in vitro. After incubation of human gastric juice (HGJ) with bacterial cultures, there was a moderate reduction in IF-concentration, while the ability of HGJ to enhance the uptake of ⁵⁷CoB₁₂ by guinea-pig small intestinal brush borders was unaffected. Following incubation of HGJ-bound ⁵⁷CoB₁₂ with enterobacteria and bacteroides, the brush border uptake of ⁵⁷CoB₁₂ was not significantly different from control uptake, whereas the uptake after incubation with bifidobacteria was 79% of control uptake (p < 0.01). Significant release of unbound ⁵⁷CoB₁₂ could not be detected when HGJ-bound ⁵⁷CoB₁₂ was dialysed with bacterial cultures. Bacterial cell extracts from these cultures contained ⁵⁷CoB₁₂ partially bound, possibly to IF.     

Three randomized long-term surveillance trials in patients with sporadic colorectal adenomas

Objective. Guidelines for surveillance of patients with previous sporadic colorectal adenomas are based on retrospective long-term follow-up and prospective short-term studies. The aim of the present studies was to compare relative risk (RR) of new neoplasia as well as complications, using different intervals between examinations in long-term surveillance. Material and methods. Between l98l and l991, patients with pedunculated and small, flat and sessile adenomas were allocated at random to a 24 months (group A) or 48 months (group B) interval between surveillance colonoscopies (n=671). Patients with flat and sessile adenomas greater than 5 mm in diameter were randomized to intervals of 6 months (group C) or 12 months (group D) between l981 and 1987 (n=73). Finally, 200 patients with similar adenomas as in groups C and D were randomized to 12 months (group E) or 24 months (group F) from 1988 to 2000. The study ended in 2002. Results. Advanced adenomas were equally as frequent in group A and group B, but colorectal cancer (CRC) was found significantly more often in group B (RR?=?6.2 (1.0–117.4)). Severe complications occurred in 4 patients in group A and 2 patients in group B. Advanced new adenomas tended to be more frequent in group D than in C (p=0.08), but only one CRC was detected and this was in group C. There was no significant difference in the risk of CRC between the E and F groups, but the two cancers in group E were both early stage, in contrast to those in group F. Severe complications were seen in one patient in group E and also in group F. Conclusions. The results suggest that 2-year intervals should be used between colonoscopies in patients with previous pedunculated adenomas and small, flat and sessile adenomas, whereas larger, flat and sessile adenomas may need intervals of 1 year.     

Prevalence,awareness, and control of arterial hypertension in Denmark

Hypertension is an important modifiable risk factor for cardiovascular disease. Risk is reduced by reduction of blood pressure (BP). The present survey estimated the prevalence of hypertension, awareness, treatment, and BP control in Denmark. BP was measured three times on one occasion in a representative sample (n = 7,767) of the Danish population ages 20 to 89 years. Persons with screening BP ≥140/90 mm Hg also measured BP at home. Participants with home BP ≥135/85 mm Hg in general and ≥125/75 mm Hg for patients with diabetes or renal disease were categorized as hypertensive together with those already on antihypertensive treatment. Awareness was registered by questionnaire. Treated patients with BP below relevant limits were categorized as controlled. Age-adjusted prevalence of hypertension was on the basis of screening BP 25.7% and by home BP 22.3%. Seventy-two percent of patients found hypertensive by home BP were aware of it, 64% were treated, and 57% of those treated were controlled by office BP and 68% by home BP. One-fifth of the adult Danish population was found to be hypertensive, Awareness and control of hypertension was better than in most previous reports. Control rates similar to those of clinical trials are achievable in clinical practice.     

The expression of p53, Ki-67 and urokinase plasminogen activator receptor in colorectal adenomas with true invasion and pseudoinvasion.

The recognition of pseudoinvasion is important in the differential diagnosis of adenocarcinoma in patients with adenomas. This distinction might occasionally be difficult, particularly when the dysplasia is pronounced. The present study was undertaken in order to investigate whether the immunohistochemical expression of p53, Ki-67 and the urokinase plasminogen activator receptor (uPAR) was different in adenomas with true invasion and pseudoinvasion. We studied 26 formalin-fixed, paraffin-embedded tumor samples, consisting of 10 cases of adenomas with pseudoinvasion and 16 cases of adenocarcinomas in adenomas. In this series of selected histologically typical cases a constant moderate or strong reaction for uPAR was present at the invasive front in all of the 16 adenomas with adenocarcinoma, but only focally in one of 10 adenomas with pseudoinvasion. The reactions for p53 and Ki-67 showed only minor differences. In conclusion, the immunohistochemical reaction for uPAR seems to be a useful supplement in cases without typical histology or with severe dysplasia.     

Serum level of YKL-40 is elevated in patients with Streptococcus pneumoniae bacteremia and is associated with the outcome of the disease

YKL40 is secreted by activated macrophages and neutrophils. Elevated serum concentrations of YKL40 are found in patients with diseases characterized by inflammation or ongoing fibrosis. The aim of this study was to evaluate serum YKL-40 levels in patients with Streptococcus pneumoniae bacteremia and to correlate these levels with clinical findings and outcomes. YKL40 was determined by ELISA and 89 patients were included in the study. Serum YKL-40 levels were significantly higher in patients with S. pneumoniae bacteremia (median 342 microg/l; range 20-20,400 microg/l) than in age-matched healthy subjects (44 microg/l; 20-184; p < 0.001). Serum YKL-40 levels were related to the severity of the infection, with significantly higher serum YKL-40 levels being observed in patients who needed hemodialysis (p < 0.001), pharmacological treatment of hypotension (p < 0.001) and mechanical ventilation (p = 0.003) compared to those in patients who did not need this supportive treatment. Nineteen patients died and these patients had significantly higher serum YKL-40 levels (980 microg/l; 88-20,400 microg/l) than those of survivors (256 microg/l; 20-9,100 microg/l; p < 0.001). Serum YKL40 level was an independent prognostic factor of survival in logistic multivariate regression analysis (p = 0.002). In conclusion, high serum levels of YKL40 indicated a poorer prognosis for patients with S. pneumoniae bacteremia.     

Acute viral hepatitis: morphologic and functional correlations in human livers

The usual histologic pattern in acute viral hepatitis (AVH) includes cellular abnormalities predominantly in the perivenular (zone 3) hepatocytes and changes interpreted as representing regenerative activity in the periportal (zone 1) hepatocytes. Enzyme histochemical and ultrastructural studies of livers of 12 patients with AVH were undertaken to see whether these features support the concept of regeneration of hepatocytes in zone 1. The swollen hepatocytes in the perivenular areas were hydropic, with dilated or eccentric rough endoplasmic reticulum and decreased or vesicular smooth endoplasmic reticulum; correspondingly, the glucose-6-phosphatase activity (reflecting, when present, intact and functional endoplasmic reticulum) was markedly decreased. Succinic dehydrogenase and diphosphopyridine nucleotide diaphorase activities, representing mitochondrial enzymes, were limited to the perinuclear or pericanalicular cytoplasm of swollen hepatocytes. gamma-Glutamyl transpeptidase activity was increased. The periportal hydropic hepatocytes were small and arranged in clusters displacing sinusoids. Ultrastructurally, these hepatocytes had nearly normal organelles but scanty smooth endoplasmic reticulum. Activities of the enzymes glucose-6-phosphatase, succinic dehydrogenase, and diphosphopyridine nucleotide diaphorase were weak, although glycogen was abundant. gamma-Glutamyl transpeptidase activity was scanty in these hepatocytes. These findings from enzyme histochemical and electron microscopic studies could be interpreted as evidence of functional deterioration of perivenular swollen hepatocytes and relative functional immaturity of periportal hydropic clustered hepatocytes, suggesting regeneration of zone 1 hepatocytes.