Long pedunculated colonic polyp composed of mucosa and submucosa: proposal of a new entity, colonic muco-submucosal elongated polyp

We encountered 15 patients with colonic polyps showing histologic features that did not belong to any of the known categories. All polyps were elongated and drumstick-shaped, with lengths of 12 to 160 (mean, 29 mm) mm. Histologically, the polyps were covered with normal mucosa and consisted of edematous, loose, fibrous, connective tissues and dense, fibrous submucosal layers, often showing dilation of blood vessels and lymphatics. Although the mechanism of generation of such polyps remains unknown, their elongation may be caused by intestinal motion. Because this kind of polyp has not been described previously outside Japan, we here introduce a new type of polyp, which we have proposed calling the colonic muco-submucosal elongated polyp.     

The epidemiology of stroke: a focus on Rhode Island

Effects were studied of vincamin and tanakan in 68 patients with stage I, II and III discirculatory encephalopathy (as per WHO classification 1981). In 52% of the patients atherosclerosis of brain vessels was associated with arterial hypertension (group I), in 48 per cent venous discirculatory encephalopathy was diagnosable against the background of arterial hypertension (group IIA-20%) and arterial hypotension (group IIB-26%). Both tanakan and vincamin were found to be effective in group I patients; however, in stage III condition their effectiveness was no better than 42 and 15% respectively, which fact might be due to organic changes in the vascular wall. Tanakan appeared to be more beneficial in group II patients since venous dystonia is considered to be the main pathogenetic link in this context, and tanakan is known to improve the venous outflow from the cranial cavity. Almost in one-third of group IIB patients vincamin worsened general health status, especially so in stage III discirculatory encephalopathy, which fact may be related to peculiar effect of the drug on the arterial link of brain blood supply.     

Health care quality improvements in Rhode Island diabetes mellitus

In the vicinity of the river Aquidabán in Eastern Paraguay occurred in the last years an endemic disease within cattle herds which killed thousands of heads (Mal de Aquidabán [MdA]). The disease was seen in form of an afebrile, paralytic condition characterized by muscle tremors, swaying of the hind quarters, recumbence and sudden death of the animals. Therefore it was described as "Bovine Paraplegic Syndrome". Comparable symptoms in adult cattle have also being seen in Eastern and Central Venezuela. After we found in the peritoneal fluid of 2 animals, which died under typical symptoms, toxins of C. perfringens toxovar D, we started to investigate the occurrence of C. perfringens in the feces of clinical healthy animals on farms, where MdA was diagnosed before. There we found 73% of the isolated strains belonging to toxovar D. In herds with no case of the disease toxovar A was isolated up to 90%. The next step was the production of a vaccine (anaculture) with a high toxin producing strain of C. perfringens toxovar D. 2000 cattle were vaccinated for 3 years twice a year. None of the vaccinated animals diseased. In 2 control-herds some cases of MdA occurred. But we became quite sure that MdA was an infectious disease, when we started to vaccinate cattle of unvaccinated herds where MdA suddenly occurred. One or two animals died in the next 2 days and after this period the endemic disease was immediately stopped.     

Establishment of a hereditary nonpolyposis colorectal cancer registry

INTRODUCTION: Hereditary nonpolyposis colorectal cancer (HNPCC) is an autosomal dominant condition characterized by early age of onset colorectal cancer, right-sided predominance, excess of synchronous and metachronous colonic neoplasms, and extracolonic cancers. The purpose of this study is to report clinical characteristics of HNPCC families in our registry. METHODS: This is a retrospective review of medical records of patients with a significant history of colorectal cancer and interviews with their families. RESULTS: Three hundred one people with cancer in 40 HNPCC families were identified. In 284 of 301 (94 percent) people, 363 cancers were identified. Colorectal cancer only was identified in 182 people (64 percent) and, in conjunction with extracolonic tumors, in another 31 people (11 percent). Extracolonic cancer alone was noted in 71 people (25 percent). Median age at diagnosis of colorectal cancer was 48 (range, 17-92) years. In patients with documented pathology, right-sided tumors predominated (55 percent), synchronous and metachronous tumors were noted in 53 percent, and synchronous of metachronous adenomas were documented in 51 percent of people. Generational anticipation was also noted. CONCLUSION: This study demonstrates and confirms characteristics that have been described in HNPCC. Namely, early age of onset of colorectal cancer, right-sided predominance, multiple synchronous and metachronous neoplasms, increased extracolonic cancers, and generational anticipation.     

Serologic and molecular detection of granulocytic ehrlichiosis in Rhode Island

A new indirect fluorescent-antibody (IFA) assay with antigen produced in vitro in the human promyelocytic leukemia cell line HL60 was used to identify the first recognized case of human granulocytic ehrlichiosis in Rhode Island. This IFA assay was used to detect granulocytic ehrlichiae in white-footed mice and in a dog inhabiting the area surrounding the patient's residence. Host-seeking Ixodes scapularis ticks found in the same habitat also were infected. I. scapularis ticks collected from other locations were fed on dogs and New Zealand White rabbits to assess the competency of these species as hosts of granulocytotropic Ehrlichia. Tick-induced infections of dogs were confirmed by serologic testing, tissue culture isolation, and PCR amplification, whereas several rabbits seroconverted but were PCR and culture negative. PCR amplification of the 16S rRNA gene and DNA sequencing of the PCR products or culture isolation was used to confirm granulocytic Ehrlichia infections in humans, dogs, white-footed mice, and ticks.     

Rectal cancer after sulindac therapy for a sporadic adenomatous colonic polyp

Correlation of the clinical manifestations of a patient with fibroblastic rheumatism with sequential skin biopsy findings revealed an early inflammatory stage with cutaneous nodules, patchy erythematous skin lesions, polyarthritis, dermal lymphomonocytic infiltrates, and fibroblastic and myofibroblastic proliferation, followed by a chronic stage with sclerodactyly, joint ankylosis, deformities and dense dermal fibrosis. Treatment of this rare disorder in its early active stages may prevent the development of incapacitating joint sequelae.