HYPERPLASTIC POLYPS

A colonoscopy and colonoscopic polypectomy service was established at Wellington Hospital, New Zealand in April 1975. Between April 1975 and March 1990 1157 polyps were either removed or biopsied and examined histologically. Twenty-five polyps were lost. Patient-age seemed to increase through the spectrum hyperplastic, tubular, tubulovillous, villous and polypoid carcinoma. Sessile < 6 mm in diameter hyperplastic polyps were more numerous than small adenomatous polyps. Pedunculated tumours were most commonly adenomata in all sizes, whereas sessile tumours in the rectum and sigmoid colon were usually hyperplastic. As polyp size increased the numbers of hyperplastic polyps decreased relative to the numbers of adenomatous polyps. The majority of hyperplastic polyps were found in the distal colorectum. Site distribution for hyperplastic polyps corresponded to the site distribution for colorectal carcinomata. One of five patients with hyperplastic index polyps was found to have an adenomatous polyp at follow-up. Strong evidence for a sequential relationship between hyperplastic and adenomatous polyps was not found in this study. It is unlikely that an aggressive attitude to the investigation and removal of hyperplastic polyps will have a significant effect on the later development of colorectal cancer.     

A Safety Study of Albumex®5, a Human Albumin Solution Produced by Ion Exchange Chromatography

Human serum albumin solutions have been used as plasma replacement fluids for many years and adverse events associated with their use are rare. Albumex®5 is a new albumin solution manufactured by a combination of the Cohn fractionation process and a chromatographic technique. A multicentre, randomised study was conducted to compare the safety of Albumex®5 and 5% normal serum albumin (5% NSA) in patients undergoing large volume therapeutic plasmapheresis for a variety of disorders. Up to six exchanges were performed on each patient. A total of 208 evaluable exchanges were performed on 40 patients, 109 5% NSA and 99 Albumex®5. There were 9 adverse events (reaction rate of 8.3%) in 6 patients with 5% NSA and 12 events (reaction rate 12.1%) in 8 patients with Albumex®5. The difference is not statistically significant (p = 0.37, Fisher's exact test). None of the adverse events were considered serious. Only six reactions were thought to be possibly related to the product and three exchanges were modified as a result of an adverse event; one with Albumex®5 was interrupted and two with 5% NSA were slowed. Albumex®5 can be considered to be a safe product with a low adverse event rate.     

PERITONEAL NEUTROPHILIA: A POTENTIAL INDICATOR OF THE SURGICAL ACUTE ABDOMEN

The percentage of neutrophils in a peritoneal cell sample (PNP), obtained at operation, was measured in 250 patients who underwent urgent laparotomy because ‘the surgical acute abdomen’ (SAA) was suspected. The PNP was substantially higher in patients with confirmed SAA than in others and is potentially a very sensitive and very specific test of SAA. If the PNP was available as a diagnostic test for patients with acute abdominal pain, there might be a significant reduction in unnecessary and delayed laparotomies.     

Neurotoxic marine poisoning

Marine poisoning results from the ingestion of marine animals that contain toxic substances and causes substantial illness in coastal regions. Three main clinical syndromes of marine poisoning have important neurological symptoms-ciguatera, tetrodotoxin poisoning, and paralytic shellfish poisoning. Ciguatera is the commonest syndrome of marine poisoning and is characterised by moderate to severe gastrointestinal effects (vomiting, diarrhoea, and abdominal cramps) and neurological effects (myalgia, paraesthesia, cold allodynia, and ataxia), but is rarely lethal. Tetrodotoxin poisoning and paralytic shellfish poisoning are less common but have a higher fatality rate than ciguatera. Mild gastrointestinal effects and a descending paralysis are characteristic of these types of poisoning. In severe poisoning, paralysis rapidly progresses to respiratory failure. Diagnosis of all types of marine poisoning is made from the circumstances of ingestion (type of fish and location) and the clinical effects. Because there are no antidotes, supportive care, including mechanical ventilation in patients with severe paralysis, is the mainstay of treatment.     

Clinical effects of exposure to the White-stemmed gum moth (Chelepteryx collesi)

Background: The White‐stemmed gum moth (Chelepteryx collesi) can be found in eastern Australia. The clinical effects of injuries caused by its many spine‐like hairs are poorly defined and concern about the numerous hairs that remain embedded following contact with the cocoon have led to heroic means of removal. Objective: To examine the clinical effects of injuries by the caterpillar or cocoon of the White‐stemmed gum moth. Methods: Prospective observational study of caterpillar injuries from calls to the New South Wales Poisons Information Centre. Cases resulting from C. collesi exposure were included for analysis. Caterpillars and cocoons were expertly identified where available and a follow‐up consultation of all patients was conducted. Information was collected on the circumstances of exposure, local and systemic effects and treatment. Results: From the 26 included cases, seven had confirmed caterpillar contact (all children aged 1–11), six had confirmed cocoon contact and 13 had exposures consistent with C. collesi, but no caterpillar was caught. All cases occurred in summer. Of 13 confirmed exposures there was no difference between caterpillars and cocoons, and these were considered together. Affected areas were hands, feet, or both, following C. collesi being handled or trodden on. Pain was reported in all 13 cases, one with severe pain. In 10 cases pain duration was < 60 min. Six subjects had more than 100 hairs embedded (small black dots). In three cases, the hairs were surrounded by swelling and yellow discolouration. Despite the attempted removal of multiple hairs, they remained embedded for prolonged periods but caused no sequelae. Conclusion: The clinical effects of the White‐stemmed gum moth were minor with local pain. Although hairs remained in all cases, they caused no problems. Complete removal of hairs is neither possible nor necessary, and painful and invasive methods should be avoided.     

Acute conjunctival inflammation following contact with squashed spider contents

PURPOSE: To report the effects to the eye following contact with spider contents. DESIGN: Observational case report. METHODS: A 46-year-old man presented with a painful and inflamed eye after contents of a spider got into his right eye when he squashed the spider with a newspaper. He suffered immediate severe pain in the eye, which rapidly became red and swollen. He had conjunctival edema and periorbital swelling of the eye and severe photophobia, but his vision was normal. RESULTS: Topical local anesthetic was applied to the right eye, which was then flushed with normal saline for an hour. The redness and swelling began to resolve over 2 hours. CONCLUSIONS: Ocular exposure to the contents of a spider can cause severe pain, swelling, and redness associated with photophobia. The effects are short term, so reassurance, irrigation, and symptomatic treatment are sufficient.