Endoscopic Nd-YAG laser treatment of colorectal neoplasms. A four-year longitudinal study

In order to gain a longitudinal perspective of the benefits, complications, and role of the neodymium yttrium aluminum garnet (Nd-YAG) laser in the treatment of colorectal neoplasms, we performed a review of endoscopies using the laser during a 53-month period ending in January 1989. We reviewed the records of 100 patients for details of the endoscopic procedure and demographic data. Performance status and survival were critically assessed. We performed 275 procedures on 57 men and 43 women with an average age of 76.5 years. An average of 2.75 procedures, each lasting an average of 45 minutes, were performed per patient. Half of the patients had fulgurations of rectal tumors with the common indication being bleeding. Thirteen morbid events and no deaths occurred. Ninety-six per cent of the procedures were performed with the patient under intravenous sedation. The Karnofsky performance scale applied to surviving patients revealed that 90 per cent were able to care for themselves and scored greater than 70. Average survival was 5.58 months. Our results indicate that the Nd-YAG is a safe and effective tool in the treatment of colorectal neoplasms offering palliation as well as maintenance of quality of life.     

Fine-needle aspiration of dermoid cyst of the pancreas: A case report

A 53-yr-old woman presented with a left upper quadrant abdominal mass attached to the body of the pancreas. Fine-needle aspiration (FNA) yielded cyst fluid containing numerous benign, mature squamous cells, keratin debris, and inflammatory cells. The diagnosis of dermoid cyst was subsequently rendered on the resected specimen. The cytologic and histologic features are presented. FNA cytology proves to be a valuable diagnostic adjunct in the preoperative evaluation of a patient with dermoid cyst of the pancreas.     

CMV colitis mimicking Crohn's disease in a patient with acquired immune deficiency syndrome (AIDS)

The spectrum of gastrointestinal tract infections observed in patients with acquired immune deficiency syndrome (AIDS) has been widening rapidly. Patients with cytomegaloviral (CMV infection of the colon have been described predominantly as having cecal disease or a superficial colitis. We report a patient with scattered deep colonic ulcerations, mimicking Crohn's disease and representing another appearance of CMV colitis.     

What to do when results of a western blot test are indeterminate

The role of primary care physicians in diagnosis of human immunodeficiency virus (HIV) infection is becoming increasingly important. Given the development of antiretroviral therapy, which can delay the clinical progression of asymptomatic HIV infection, early and accurate identification is invaluable to these patients. Screening begins with the enzyme immunoassay, which, although highly sensitive, lacks specificity. Therefore, the Western blot test should always be used for confirmation. When results of the Western blot test are indeterminate, reassessment for risk factors for HIV infection should be followed by serial Western blot testing and HIV culture or polymerase chain reaction testing.     

Neodymium-YAG laser. A new palliative tool in the treatment of colorectal cancer

Twenty-four patients with colorectal carcinoma and one patient with a recurrent, transitional-cell, vesical tumor invading the rectum but not amenable to surgical resection underwent neodymium-YAG laser therapy. There were 16 men and nine women with an average age of 75.6 years (range, 35 to 93 years). There were 14, 6, 1, 1, and 3 tumors found in the rectum, rectosigmoid colon, transverse colon, descending colon, and ascending colon, respectively. Symptoms consisted of bleeding or partial obstruction. Twelve patients were high-risk surgical candidates, 11 patients had widespread disease, and two patients had another primary tumor not controlled by a previous surgical procedure. The tumor was eradicated in two patients. There were two complications, namely, a perforation and a rectovaginal fistula. Thirteen patients died from their disease. The remaining patients have been kept free from obstruction and bleeding.     

Enzymatic labeling of gamma-globulin and insulin with iodine-125.

The parameters of enzymatic labeling of proteins with iodine 125 were examined. The manner and sequence of reagent addition, the effects of reagent concentration, reaction time and total Na125I activity on the labeling yield were determined.     

Effect of tacrine on cytosolic Ca2+ level and calmodulin in gastric muscle tissues of rat

INTRODUCTION: Tacrine is an acetylcholinesterase inhibitor. It has an indirect cholinomimetic effect inducing contractions of the gastric smooth muscles. The contractions are related to the effect of the accumulated acetylcholine in tissues on the respective choline receptors. There is a well defined direct correlation between tacrine concentrations and the inhibition of cholinesterase activity. That suggest simultaneous increase of the strength of tacrine-induced contractions. Instead, at concentrations above 1 x 10(-5) mol/l, tacrine causes permanent relaxation with yet unknown causing mechanism. AIM: The aim of this study was to investigate if tacrine induces reduction of calcium ions through chelation and/or inhibits directly calmodulin's participation in the contractile processes, thus causing smooth muscle relaxation which is not characteristic of a typical acetylcholinesterase blocker. METHODS: The contractile activity of smooth muscle preparations was measured isometrically with a Microtechna (Czech Republic) amplifier and recorded by a Linseis (Germany) recorder. The absorption electron spectrum of tacrine (1 x 10(-4) mol/l) was determined with a Cary 1 (Varian, Australia) spectrophotometer. The concentration of ionized CaCa2+ was measured with the ISE-block of a clinical-chemical analyzer Konelab 60 (Finland). RESULTS: The presence of Ca2+ (10(-2) mol/l) does not alter tacrine characteristic absorption spectrum at pH values corresponding to the SM cell cytosolic pH. The presence of 1 x 10(-4) mol/l tacrine does not affect Ca2+ concentration in the Krebs solution (pH = 7.4). In the presence of trifluoperazine (a calmodulin blocker) 1 x 10(-4) mol/l tacrine causes relaxation which is commensurable with that in the controls. CONCLUSIONS: Tacrine-induced smooth muscle relaxation is not a result of the reduction of the effective Ca2+ concentrations as a result of chelation between tacrine and Ca2+ and it is not related to the tacrine effects on calmodulin.