Systemic arteriovenous malformations: a feature of advanced liver disease.

Arterial and arteriovenous abnormalities are reported in association with advanced liver disease, those most commonly recognised are spider naevi, pulmonary arteriovenous shunts, and generalised vasodilatation. The first two cases of peripheral systemic arteriovenous malformations in association with cirrhosis are reported. After liver transplantation in one of these patients the vascular malformation regressed.

Long-term survival associated with metastatic small cell carcinoma of the esophagus treated by chemotherapy, autologous bone marrow transplantation, and adjuvant radiation therapy.

A 44-year-old woman had small cell carcinoma of the esophagus complicated by liver and lymph node metastases. She was treated with aggressive combination chemotherapy, followed by autologous bone marrow transplantation and adjuvant radiation therapy. (The authors believe this to be the first use of autologous bone marrow transplantation for treatment of this condition.

Mycotic aneurysm of left subclavian artery.

Bacterial endarteritis is rare and usually affects the abdominal aorta. A case of bacterial left subclavian arteritis complicated by mycotic aneurysm is presented. An early diagnosis of infective arteritis was made based on a history of fever, sweats, rigors, and a progressive macular rash, polyarthralgia splinter haemorrhage (limited to the left arm), and a loud left subclavian bruit on admission.

Toxic megacolon with late perforation in Campylobacter colitis--a cautionary tale.

We report a case of Campylobacter-induced colitis complicated by toxic megacolon which led to colonic perforation requiring a total colectomy and ileostomy.

Thrombotic thrombocytopenic purpura mimicking acute small bowel Crohn's disease.

A 39 year old woman presented with a short history of bloody diarrhoea. She subsequently developed microangiopathic haemolysis, platelet consumption, and renal impairment. Initial investigations suggested underlying Crohn's disease of the terminal ileum complicated by sepsis and disseminated intravascular coagulation.

Hepatic metastases due to choriocarcinoma.

A 34 year old female presented with weight loss and hepatomegaly. Liver biopsy revealed clinically unsuspected metastatic choriocarcinoma. Severe haemorrhage occurred, and the patient died following complications after laparotomy.

Lobar pneumonia caused by Haemophilus influenzae type B.

Haemophilus influenzae type b is a rare cause of adult lobar pneumonia and we are unaware of any reported British cases. However in the United States this condition is well described and the incidence is increasing (Levin et al. 1977).

Scoring system to improve cost effectiveness of open access endoscopy.

The introduction of an open access general practitioner endoscopy service may result in many unnecessary examinations being performed. In an attempt to prevent this, 235 patients attending for endoscopy were interviewed and the results analysed to determine which factors best discriminated between those with major disease (ulcers, cancers, oesophageal strictures; n = 48) and those without (n = 187). The six characteristics which best discriminated between the two groups were increasing age, history of vomiting, male sex, smoking, and a past history of peptic ulcer or hiatus hernia.

A double-blind controlled trial of the effect of sodium cromoglycate in preventing relapse in ulcerative colitis.

A double-blind controlled trial of the effect of sodium cromoglycate (SCG) in preventing relapse in ulcerative colitis has been completed in 100 subjects. In patients already taking sulphasalazine, SCG did not prove to be of any additional benefit. However, in patients not on any other maintenance therapy, the relapse rate was 40% for SCG as compared with 75% for placebo.

Open-access endoscopy service for general practitioners.

An open-access general-practitioner referral service for endoscopy of the upper gastrointestinal tract was established in a district general hospital, and the impact of the service over three years was assessed. The reason for referral, duration of symptoms, and amount of disease detected were the same in patients referred by general practitioners and those attending from hospital outpatient departments. Despite a steady increase in the number of patients referred for endoscopy, the number of barium-meal examinations performed did not correspondingly decrease.

Plasmapheresis in Crohn's disease.

6 patients with Crohn's disease for 1-14 years have been treated with plasmapheresis for periods of up to 6 months. The symptoms of the one newly diagnosed patient were controlled by plasmapheresis alone, and 5 steroid-dependent patients were able to reduce their steroid requirements. During the study period, 13 clinical relapses were managed without increasing steroid dosage.

Autoradiographic study of the permeability characteristics of the small intestine.

This autoradiographic study demonstrates the distribution of a range of small solutes and macromolecules in the mucosa of the guinea-pig small intestine after intracardiac injection. The substances investigated were: 14C-urea, 3H-mannose, 3H-inulin, and 125I polyvinylpyrrolidone (PVP). Small bowel biopsies were taken at intervals from one to 60 minutes after injection and the tissues processed for autoradiography.

Selectivity of small intestinal exudate in celiac disease and Crohn's disease.

The small intestinal exudates of patients with protein-losing enteropathies produced by celiac disease or proximal jejunal Crohn's disease were compared with controls. The exudates in control subjects were highly selective, whereas those of the celiac and Crohn's disease subjects were relatively nonselective. It is believed that this loss of selectivity is secondary to basement membrane damage.

Upper gastrointestinal endoscopy--a GP service.

Since 1974 there has been an open endoscopy service available to general practitioners in the Bournemouth and Christchurch area. Patients are referred directly with a standard form. A retrospective comparison of requests for barium-meal examinations and for endoscopy by general practitioners showed that the reasons for referral were similar.

Permeability of the small intestine after intra-arterial injection of histamine-type mediators and irradiation.

Permeability and selectivity of rabbit small intestine were estimated by a perfusion technique after intra-arterial injection of histamine-type mediators and intestinal irradiation. It was shown that the histamine-type mediators caused an increase in capillary permeability which produced an overall moderate increase in transmucosal permeability with a moderate loss of selectivity. Local intestinal irradiation caused a very marked increase in permeability and a profound loss of selectivity.

Small intestinal permeability. 1. Effects of ischaemia and exposure to acetyl salicylate.

Permeability of the small intestinal mucosa was estimated using a perfusion technique after either a period of ischaemia or exposure to acetyl salicylate. It was shown that these procedures increased the passive permeability of the mucosa to macromolecules while maintaining normal mucosal selectivity. Histologically, there was derangment of the epithelial cell layer of the villous tips without damage to the epithelial basement membrane or subepithelial structures.

Watery diarrhoea and hypokalaemia associated with a phaeochromocytoma.

The syndrome of water diarrhoea, hypokalaemia and achlorhydria (WDHA) is well described in association with a non-beta islet cell tumour of the pancreas. The following case report is of a 28-year-old woman with a WDHA syndrome that was cured by the removal of a phaeochromocytoma.

The dynamic structure of a flat small intestinal mucosa studied on the explanted rat jejunum.

Small pieces of jejunum with an intact blood supply were explanted to the anterior abdominal wall in rats. Six weeks after explantation the mucosa appeared totally flat in many areas, both histologically and under the dissecting microscope. The structure of the flattened mucosa was shown to be identical to that in coeliac disease with hypertrophied intervillous ridges.

The permeability of the small intestinal mucosa: a study using iron.

Various substances containing iron were injected into the lumen of the small intestine in rabbits and into the mesenteric arterial supply. Sections of the mucosa were stained for ferric ions by immersing for 30 minutes into equal parts of 2% HCl and 2% potassium ferrocyanide (Prussian Blue reaction). The ferric ion is bound to various cell structures and its passage through the mucosa could therefore be demonstrated.

Small intestinal permeability in animals and man.

The permeability of the human small intestine has been studied by measuring the clearance from the plasma into the intestinal lumen of substances with molecular weights ranging from 60 to 80 000. A direct relationship has been demonstrated between intestinal loss and plasma concentration and an inverse one between clearance and molecular size.The permeability of the rabbit small intestine has been studied at various levels by measuring the blood-to-lumen clearance of substances of different molecular size ranging from 60 to 40 000.

Permeability of the small intestine to substances of different molecular weight.

The permeability of the rabbit small intestine has been studied by measuring the plasma clearances of water-soluble molecules over the molecular weight range 60-33,000. An inverse relationship has been demonstrated between permeability and molecular weight. The significance of these findings in relation to current concepts of the ;pore hypotheses' is discussed, and the possible physiological and pathological implications are considered.