Endoscopic Diagnosis of a Giant Esophageal Leiomyosarcoma

A giant polypoid lesion of the cervical esophagus was discovered on barium swallow in a patient with minimal dysphagia. Endoscopy revealed a whitish, polypoid intraluminal mass with superficial ulcerations and mucosal biopsies, necrotic epithelium plus spindle cells consistent with leiomyoma. At exploration, a leiomyosarcoma with microvascular invasion was excised. The clinical features and value of endoscopic biopsies are reviewed for this and other cases reported in the literature.     

Oral tobacco: prevalence, health risks, dependence potential and public policy

This paper discusses public health policy with regard to oral tobacco use. It notes that in the UK, oral tobacco use is extremely rare. Concern that it might become prevalent among schoolchildren has proved unfounded. Smokeless tobacco almost certainly carries health risks but these risks are probably less than from smoking. What little evidence exists suggests that smokeless tobacco may be less dependence-inducing than cigarettes. In the light of this, the UK Government's decision to ban oral tobacco products is hard to reconcile with their continuing to permit the sale and advertising of cigarettes. A cynic would view the Government's ban as a‘no cost’ measure to placate the public health lobby and ease the pressure for more restrictions on cigarette promotion. The inconsistency in the Government's approach to Skoal Bandits and cigarettes may be used as a focus for pressure to change in the laws governing promotion of cigarettes.     

Immunological properties of recombinant proteins of the transmission blocking vaccine candidate, Pfs48/45, of the human malaria parasite Plasmodium falciparum produced in Escherichia coli

A precondition for the development of a transmission blocking vaccine based on the sexual stage-specific surface antigen Pfs48/45 of Plasmodium falciparum is its heterologous synthesis in a native state. Here we describe the production of recombinant Pfs48/45 in Escherichia coli . Two recombinant proteins, of which one is a glutathione-S-transferase fusion protein, were produced. Enzyme-linked immunosorbent assays showed that at least a subfraction of the recombinant proteins had a conformation capable of binding transmission blocking monoclonal antibodies. However, despite the fact that both proteins were very immunogenic, they did not induce transmission blocking immunity in mice or rabbits. Immunological studies with congenic mouse strains demonstrated that immune responses could be boosted with gametocyte extracts and were not restricted to a particular class II major histocompatibility complex haplotype .     

"Ulcerative Appendicitis" Occurring as a Skip Lesion in Chronic Ulcerative Colitis

A 39-year old white female with a 19-year history of chronic ulcerative colitis was admitted to the hospital with fulminating disease and toxic megacolon requiring total colectomy.
The appendicial changes were most unusual. The pathological changes were typical of those seen in ulcerative colitis, namely, mucosal ulceration and crypt abscess formation ("ulcerative appendicitis"). Furthermore, these changes occurred as a skip lesion since the cecum and ascending colon were both free of disease.     

T Lymphocyte Subsets in Parenteral and Non-parenteral Heroin Abusers in Britain

Parenteral drug abusers comprise the second largest group of patients with the acquired immune deficiency syndrome (AIDS). To determine whether heroin abusers in Britain had immunologic abnormalities similar to those seen in AIDS, we determined T lymphocyte subsets in 14 parenteral heroin abusers and 10 non-parenteral heroin abusers. No significant differences were found in T4/T8 ratios or in the absolute numbers of T3, T4, or T8-positive cells. These results suggest that neither narcotic drugs nor repeated exposure to unsterile injectable substances are responsible for low T4/T8 ratios in parenteral drug abusers with AIDS.     

Evaluation of a Flexible Endoscope for Laparoscopy

Thirty patients underwent diagnostic laparoscopy using an unmodified Olympus GIF-P2 fiberendoscope. Both feasibility and safety of the fiberoptic instrument were evaluated. Compared to conventional laparoscopy, a greater area of the peritoneal cavity was visualized, and biopsies and photographs were successfully obtained. There were neither mechanical nor infectious complications. As has occurred in other areas of endoscopy, use a flexible instrument for laparoscopy appears to offer advantages over conventional rigid laparoscopes.     

Quantitative Hemagglutination Studies in the Rh Blood Group System. II. A Study of the D (Rho) Agglutinogen

The reactivity of Rh positive red cells with saline anti-D sera has beeninvestigated by means of quantitative hemagglutination methods. The inhibitory effect of C on the D antigen has been confirmed and the possibility ofinhibition by this antigen in the cis position suggested. It is also suggested thatthe e antigen has suppressive effect on D. The presence of companion antigensresults in a -D-> R₂ > R_o > R₁ progression of decreasing agglutinability.Within families differences in the agglutination behavior between homozygousand heterozygous D positive cells were found. The heterogeneity of thisantigen was confirmed.

Accepted on November 20, 1960     

A New Variant of Hereditary Hemolytic Anemia With Stomatocytosis and Erythrocyte Cation Abnormality

A new variant of congenital hemolyticanemia associated with stomatocytosis,reticulocytosis, decreased osmotic fragility, type I autohemolysis and shortened erythrocyte survival without specific splenic sequestration was discoveredin three siblings of Swiss-German ancestry. Increased intracellular sodium(two to three times normal) and slightlydecreased intracellular potassium weredetected. Total sodium efflux was eight-fold greater than normal but total potassium influx was normal and ouabain-sensitive potassium influx was decreased.The ouabain-sensitive sodium efflux:potassium influx ratio was 26:1 ratherthan the 3:2 ratio noted in normal cells.The consanguineous parents, four othersiblings, and 44 other family membershad mild stomatocytosis, reticulocytosis,and, when studied, decreased osmoticfragility, increased autohemolysis, intermediate abnormalities of cation content,cation flux, and moderate shortening oferythrocyte survival. Autosomal dominant inheritance was suggested. Noabnormalities of RBC enzymes, hemoglobin or lipids were observed. No abnormalities of membrane protein weredetected on acrylamide gel. Substratedepletion of these hypermetabolic cellsresulted in intracellular dehydrationwith potassium loss in excess of sodiumgain and decreased deformability. Although the exact nature of the defectresponsible for hemolysis is unknown,this syndrome differs from other hereditary hemolytic anemias associated withstomatocytosis.

Submitted on December 21, 1970 Revised on March 16, 1971 Accepted on March 29, 1971     

The influence of HLA-matched sibling donor availability on treatment outcome for patients with AML: an analysis of the AML 8A study of the EORTC Leukaemia Cooperative Group and GIMEMA

To determine whether patients with a HLA-identical sibling donor have a better outcome than patients without a donor, an analysis on the basis of intention-to-treat principles was performed within the framework of the EORTC-GIMEMA randomized phase III AML 8A trial. Patients in complete remission (CR) received one intensive consolidation course. Patients with a histocompatible sibling donor were then allocated allogeneic bone marrow transplantation (alloBMT), the patients without a donor were randomized between autologous BMT (ABMT) and a second intensive consolidation (IC2). 831 patients <46 years old and alive >8 weeks from diagnosis were included. HLA typing was performed in 672 patients. AlloBMT was performed during CR1 in 180 (61%) out of 295 patients with a donor. Another 38 patients were allografted: five in resistant disease, 14 during relapse and 19 in CR2. ABMT was performed in 130 (34%) out of 377 patients without a donor in CR1, in six (2%) patients during relapse and in 38 (10%) patients during CR2. The disease-free survival (DFS) from CR for patients with a donor was significantly longer than for patients without a donor (46% v 33% at 6 years; P = 0.01, RR 0.78, 95% confidence interval 0.63–0.96). The overall survival from diagnosis for patients with a donor was longer, but not statistically significant, than for patients without a donor (48% v 40% at 6 years; logrank P = 0.24). When patients were stratified according to prognostic risk groups, the same trend in favour of patients with a donor was seen for survival duration and the DFS remained significantly longer for this group of patients.     

Implementation of a Multidisciplinary Inpatient Cardiology Service to Improve Heart Failure Outcomes in Guyana

Background

Guyana is a small developing country with a high burden of cardiovascular disease and extensive barriers to optimal care delivery. We investigated the effectiveness of a newly established multidisciplinary inpatient cardiology service in this setting.