Lymphoid follicular hyperplasia–a distinctive feature of diversion colitis

Diversion colitis refers to the inflammatory changes that occur in the defunctioned segment of the large intesting following diversion of the faecal stream. We report the histological features in the defunctioned rectums from seven patients: one each with severe constipation and Behcet's disease, two with Crohn's disease with rectal sparing and three with ulcerative colitis. The appearances of diversion colitis in a previously normal rectum are compared with diversion colitis with superimposed inflammatory bowel disease. Lymphoid follicular hyperplasia was found in all cases. This was marked in patients with inflammatory bowel disease. with or without initial rectal involvement. Other changes comprised surface epithelial degeneration and ulceration, mucosal inflammation including crypt abscesses, and crypt branching. Inflammatory and crypt changes were mild, except in ulcerative colitis where changes were marked and resembled those of the proximal colon. Lymphoid hyperplasia is a distinctive feature in diversion colitis. The term follicular proctitis, previously used to indicate chronic ulcerative colitis exclusively, should be re-examined.     

The relationship between blood pressure and left ventricular mass in essential hypertension is observed only in the presence of the angiotensin-converting enzyme gene deletion allele

An insertion/deletion polymorphism in the angiotensin-convertingenzyme (ACE) gene accounts for approximately 50% of the variancein plasma ACE concentration: deletion homozygotes (DD) havethe highest, and insertion homozygotes (II) the lowest ACE concentrations.ACE is responsible for the generation of angiotensin II, whichis implicated in the development of left ventricular hypertrophy,an independent risk factor for morbidity and mortality in hypertension.The aim of this study was to investigate the contribution ofACE genotype to the development of left ventricular hypertrophyin patients with essential hypertension. Eighty-five patientswith essential hypertension underwent echocardiographic assessmentof left ventricular mass index (LVMI) and determination of ACEgenotype from leukocyte DNA by polymerase chain reaction. Therewas no significant difference in LVMI among the genotypes (II,ID, DD). Analysis of covariance modelled for LVMI showed a significantinteraction with systolic blood pressure (p = 0.036). but notdiastolic blood pressure (p = 0.453). The relationship betweenLVMI and systolic blood pressure was strongest in the deletionhomozygotes (p = 0.002, R² = 0.47), and also present in theheterozygotes (p = 0.013, R² = 0.40). No relationship was seenin the insertion homozygotes (p = 0.914, R² = 0.23) These findingssuggest that the effect of blood pressure on LVMI in essentialhypertension is expressed only in the presence of the ACE genedeletion allele.     

Preoperative embolization of a large vaginal leiomyoma: Report of a case and review of the literature

Leiomyoma of the vagina is a very rare tumour of the lower urogenital tract. These slow‐growing masses may be asymptomatic or present with pain, dyspareunia or urinary symptoms. Rarely, these tumours may present with life‐threatening haemorrhage. These hypervascular tumours are treated by surgical excision. Preoperative embolization therefore may aid in devascularization of these tumours before surgical excision. We present the MRI features of a case of vaginal leiomyoma, which was managed by preoperative embolization and was then excised in toto. To the best of our knowledge, this is the first report where preoperative embolization was performed before excision of a vaginal leiomyoma with minimal peroperative blood loss.     

Carcinoma of Müllerian Vestigial Origin: Report of a Case

Benign tumours of the epididymis, which are very rare, are variously regarded as adenomas, mesotheliomas and lymphangiomas, but an alternative opinion considers them to be of Müllerian vestigial origin. Their malignant counterparts are extremely rare, and this case is probably the second authentic instance to be reported in the English literature. Complete excision of the mass with wide resection of the cord followed by prophylactic local deep X-ray therapy has provided total relief to the patient over the year which has elapsed since these measures were undertaken.     

d· Ala5 analog of the elastin polypentapeptide. Physical characterization

The d ° Ala₅ analog, (l · Val₁-l · Pro₂-Gly3-l · Val₄-d · Ala₅)_n, of the polypentapeptide (PPP) of elastin is synthesized and characterized by a series of physical methods. Carbon-13 and proton nuclear magnetic resonance spectroscopies are used to verify purity and, by means of solvent dependence of peptide C -O chemical shift and of temperature dependence of peptide NH chemical shift, to establish by comparison with the PPP of elastin the presence and increased stability of the Type II Pro₂-Gly₃ β-turn. The temperature dependence of aggregation in water to form a viscoelastic phase called the coacervate is reported for several concentrations. Comparison of carbon-13 nuclear magnetic resonance spectra obtained under identical conditions for the coacervate states of the PPP of elastin and the d · Ala₅ analog shows the effect of replacing the Gly₅ residue by a d · Ala_s residue to be one of greatly restricting mobility of the polypeptide chain. Scanning electron micrographs, of the coacervate alone and of the coacervate cross-linked and compounded to a Dacron fabric before and after stress-strain studies, are reported which show the d · Ala₅ PPP matrix to rupture during the stresses of drying and of stretching while wet. Thus, the effect of adding a methyl moiety to the Gly₅ residue of the PPP of elastin is to decrease markedly the mobility of the polypeptide chain and to destroy elasticity. The results are presented as a test of the proposed librational entropy mechanism of elasticity of the PPP of elastin.     

Utilization of 1-hydroxybenzotriazole in mixed anhydride coupling reactions

The coupling of Boc-Val-OH to either H-Pro-OBzl or H-Pro-Gly-Val-Gly-OBzl by the mixed anhydride method leads to the formation of a urethane by-product in yields of 40–60%. This side reaction can be suppressed by the addition of HOBt to the reaction mixture before the amino component is added. This results in a substantially increased yield of the desired peptide.