BACKGROUND AND AIMS Controversy surrounds the risk of colorectal cancer (CRC) in ulcerative colitis (UC). Many studies have investigated this risk and reported widely varying rates. METHODS A literature search using Medline with the explosion of references identified 194 studies. Of these, 116 met our inclusion criteria from which the number of patients and cancers detected could be extracted. Overall pooled estimates, with 95% confidence intervals (CI), of cancer prevalence and incidence were obtained using a random effects model on either the log odds or log incidence scale, as appropriate. RESULTS The overall prevalence of CRC in any UC patient, based on 116 studies, was estimated to be 3.7% (95% CI 3.2–4.2%). Of the 116 studies, 41 reported colitis duration. From these the overall incidence rate was 3/1000 person years duration (pyd), (95% CI 2/1000 to 4/1000). The overall incidence rate for any child was 6/1000 pyd (95% CI 3/1000 to 13/1000). Of the 41 studies, 19 reported results stratified into 10 year intervals of disease duration. For the first 10 years the incidence rate was 2/1000 pyd (95% CI 1/1000 to 2/1000), for the second decade the incidence rate was estimated to be 7/1000 pyd (95% CI 4/1000 to 12/1000), and in the third decade the incidence rate was 12/1000 pyd (95% CI 7/1000 to 19/1000). These incidence rates corresponded to cumulative probabilities of 2% by 10 years, 8% by 20 years, and 18% by 30 years. The worldwide cancer incidence rates varied geographically, being 5/1000 pyd in the USA, 4/1000 pyd in the UK, and 2/1000 pyd in Scandinavia and other countries. Over time the cancer risk has increased since 1955 but this finding was not significant (p=0.8). CONCLUSIONS Using new meta-analysis techniques we determined the risk of CRC in UC by decade of disease and defined the risk in pancolitics and children. We found a non-significant increase in risk over time and estimated how risk varies with geography.

https://gut.bmj.com/content/gutjnl/48/4/526.full.pdf

The risk of colorectal cancer in ulcerative colitis: a meta-analysis

At first sight, it is puzzling to find that cirrhosis of the liver apparently develops only in a minor proportion of heavy drinkers and alcoholics, which seems to contradict the well-established association’ between alcoholism and cirrhosis. A statistic based on IOseries of autopsy records (TABLE 1) shows that the incidence of cirrhosis in alcoholics ranged from as low as 2.4% to a maximum figure of about 28%. This statistic is a partly corrected extension of original data from Jolliffe and Jellinek,54 who calculated an average incidence of only 8% as against an estimated 1.2% in the general nonalcoholic population. Varying diagnostic standards in a number of these older autopsy series may have contributed to an underrepresentation. The modified statistic presented here yields a higher average incidence, of 18%, which is largely due to the inclusion of Wilen’s selected sample. This sample is outstanding in that it takes account of the potential length of drinking history and of minimum levels of daily alcohol intake. In more recent series where liver biopsies were performed during life (TABLE 2), the incidence of cirrhosis among defined alcoholics, though definitely, higher, still reaches only 30%, which is close to Wilen’s percentage. According to crosssectional studies of this kind, it can be safely assumed that cirrhosis will develop only in roughly 4 to # of those who heavily indulge in alcohol abuse during a lengthy period of their lives. In my own series of 320 biopsy cases, wellestablished cirrhosis was seen in 12%. This proportion, however, seems to contrast strikingly with the high incidence of alcoholism in cirrhosis of the liver in all those regions of the world where the sale and consumption of alcoholic beverages is an integral part of social and economic life (TABLE 3). For North and South America the average incidence of alcoholism in cirrhosis is now 66%, for Europe 42%. A small number of series from Asia, where alcohol consumption is low or nonexistent, shows an average incidence of only 1 1 % (TABLE 4). A calculation based on 80 clinical and autopsy series comprising a total of 20,000 cases shows that in the Western World an alcohol etiology in cirrhosis of the liver is found in 50% of the cases (TABLE 5). Even in the United Kingdom, where, owing to high taxes imposed on alcoholic beverages since 1 914,128*133 an alcohol etiology had previously played a laudably minor role, alcohol is now of about equal importance with other causeslZ6 or in some areas even the predominant one.’J2*53 If one endeavors to resolve this apparent discrepancy and to study the association between alcohol abuse and cirrhosis, 3 essential points should be kept in mind : (1) Ethanol is an ambivalent molecule that possesses a metabolic and a pharmacologic side. An intake per time unit up to a certain magnitude can effectively be dealt with by several metabolic degradation systems. However, an intake that exceeds the capacity of these systems will result in an elevation of the blood alcohol level, bringing out the pharmacologic or toxic properties of this central nervous

Cirrhosis in the alcoholic and its relation to the volume of alcohol abuse

Electrolyte and circulatory changes in terminal liver failure.

THE pathogenicity of salmonellae was first pointed out by Gartner1 in 1888 in an epidemic of gastroenteritis. Since that time, many reports dealing with the bacteriology, clinical aspects, epidemio...

Salmonellosis--a review of some unusual aspects.

Defects in T-cell function have been seen in patients with the acquired immunodeficiency syndrome. Although the cellular immune system plays a key role in host defense against Salmonella, there have been no detailed reports of salmonellosis in patients with this syndrome. We report our experience with salmonella infections in six patients. Salmonellosis in these patients was unusually severe, characterized by widespread infection, bacteremia, and relapse, despite standard antibiotic treatment. Because of the difficulty in eradicating salmonella infection in patients with the acquired immunodeficiency syndrome, long-term suppressive treatment with antibiotics seems warranted.

Salmonella Infections in Patients with the Acquired Immunodeficiency Syndrome

The literature pertaining to nonspecific ulcerative colitis continues to emphasize the widely varying concepts of its pathogenesis and treatment.1Although considerable attention has been directed in the past decade to the effects of antibiotics2and to the results of surgical therapy,3observations on the natural history of this disease have been comparatively infrequent.4It seemed of interest, therefore, to review the clinical features and course of nonspecific ulcerative colitis in an illustrative series of 100 patients. The cases were chosen from a group of approximately 250 by the following criteria: completeness of data, length of the period of observation and accurate information as to their present status. There were 14 deaths. Sixty-five of the 86 surviving patients have been reexamined since Jan. 1, 1947; the remainder were restudied in 1946. Because of the method of selection of material to be used in this report, the number of patients

Clinical course of chronic nonspecific ulcerative colitis.

CARRION'S disease is caused by Bartonella bacilliformis, a polymorphous organism classified as a bacterium in 1927 by Noguchi, 1 transmitted by sandflies of the genus Phlebotomus. The disease is limited geographically to certain areas of the Andean regions in Peru, Colombia and Ecuador. The disease is extremely polymorphic in symptoms. The confusion existing in the literature arose in part from reports prior to the discovery of B. bacilliformis, when intercurrent infections were not recognized and many symptoms were erroneously assigned to Carrion's disease. The present report is based on a study made on several hundred cases in Lima, Peru, during the period 1938 to 1943. HISTORY AND NOMENCLATURE Archeologic findings indicate that the disease was known in Peru in the pre-Incaic era. Surprisingly accurate representations of the cutaneous nodules, or verrugas, are found in the Peruvian ceramic pots called huacos , especially in the Chimu civilization. 2 The first medical publication

Clinical Manifestations of Carrion's Disease.

The abnormal electrophoretic patterns of the serum proteins in the acute stage of virus hepatitis were first described by Gray and Barron in 1943 (1) and have since been confirmed by several investigators (2-5). In the last few years there has been considerable interest (6-13) in cases of hepatitis progressing to chronic liver disease, or developing post-necrotic cirrhosis. Except for the study by Martin (4), however, little information has been presented on the serum proteins after the acute stage of the disease. The present investigation was undertaken to observe the alterations of the serum proteins during the course of virus hepatitis, including its later stages.

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Electrophoretic studies of the serum proteins in virus hepatitis

Electrophoretic runs were performed with standard apparatus and technique, the experimental details having been reported previously (4). The buffer was sodium diethylbarbiturate (veronal) of pH 8.6 and ionic strength 0.1. In the estimation of the fractions as per cent of the serum proteins both ascending and descending patterns were used, the areas being divided by ordinates from the nadirs between peaks to the base line. The quantities of the fractions as grams per cent represent the products (4, 5) of the percentages and the total proteins from the conventional Kjeldahl method, using a nitrogen factor of 6.25. Such a method of computation involves the assumptions that the specific refractive increments and the nitrogen contents of the various protein fractions are identical. These assumptions which have been generally employed as first approximations must be modified somewhat in view of the quantitative studies of Armstrong and colleagues (6, 7). In practice the errors thus introduced appear ordinarily no greater than others inherent in the electrophoretic method. However, where there is considerable increase in the lipids associated with the beta-globulin complex, the nitrogen content of this fraction is low in comparison with its refractive increment which determines the size of the peak in the electrophoretic diagram. In such a circumstance, which occurred in some of the cases of the present series, the errors in computing the absolute concentrations of the protein fractions may become appreciable. On the other hand, the accuracy of the values for the relative proportions of the fractions (as per cent of the serum proteins) should not be seriously affected... The tests of hepatic function were performed by the usual methods as previously described (4), alkaline phosphatase being reported in Bodansky units. Cholesterol

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Electrophoretic studies of the serum proteins in biliary cirrhosis.

/pdf/the-serum-proteins-in-portal-cirrhosis-under-medical-2nk5ikujae.pdf

William E. Ricketts

Papers

Clinical course of chronic nonspecific ulcerative colitis.

Clinical Manifestations of Carrion's Disease.

Electrophoretic studies of the serum proteins in virus hepatitis

Electrophoretic studies of the serum proteins in biliary cirrhosis.

The serum proteins in portal cirrhosis under medical management; electrophoretic studies