Naidu, Claudia

English

AJOL - African Journals Online

.'South African Medical Journal Suid-Afrikoanse TydskrifEDITORIALRECTAL BIOPSY IN ULCERATIVE COLITISVir Geneeskunde.In the typical case the diagnosis of ulcerative colitis posesno problems. The clinical history of chronic diarrhoea withblood omd mucus in the stools is suggestive, and the sigmoido·scopic appearances are usually characteristic. In mild oratypical cases, however, difficulties may arise. Recentreports by workers from Oxfordl and London! indicatethat help may be obtained from rectal biopsies taken atsigmoidoscopy; these are said to show specific histologicalchanges. Specimens of mucosa are removed 11-20 cm.from the anal verge; anaesthesia is not required and themethod is quite safe, neither infection nor significant bleedinghaving been reported.The dynamic nature of the disease is clearly shown bythese studies. According to Lumb and Protheroe! theprimary lesion consists of small erosions at the bases ofcrypts, with subsequent formation of crypt abscesses. Similarchanges are seen in colectomy specimens at the margin ofthe diseased area. 3 The ulceration may become more wide-spread, but there is usually also evidence of attempted healing.If the colitis is clinically quiescent, the mucosa is usuallyintact.An interesting and important result of this work hasbeen the demonstration that 'granular proctitis' shows theame histological changes as ulcerative colitis;! and there isno justification for considering it as other than a localizedexpression of the disease.Exfoliative cytology has also been employed in the studyof ulcerative coliti ;C,5 balloon-like cells are encountered,resembling those found in the stomach in pernicious anaemia.However, this method is of les value than formal biopsy,except in the detection of malignant change.Serial biopsies are of great use in the follow-up of patientsand in the assessment of the results of treatment; localtissue changes may precede clinical exacerbation,1 and theresponse to such measures as the local application of hydro-cortisone can be studied. In addition, more precise correla-tion of symptomatology with pathological activity is possible.As yet rectal biopsy has not been of much help in elucidatingthe aetiology of the disorder.Rectal biopsy is an easy and safe technique deservingof greater use in patients with ulcerative colitis. Any diag-nostic aid that will help sufferers from this uncommon yetpotentially disabling malady is to be welcomed.J. Truelove, S. C. and Richards, W. C. D. (1956): Brit. Med. l., I, 1315.2. Lumb, G. and Protheroe, R. H. B. (1955): Lancet, 2, 1208.3. Idem (J957): Gastroenterology, 33, 457.4. Galambos, J. T., Massey, B. W., KJayman, M. 1. and Kirsner, J. B. (1956):Cana:r, 9, 152.5. Truelove. S. C. and Richards, W. C. D. (1956): Brit. Med. J., 2, 1318.VAN DIE REDAKSIEPLEURALE EFFUSIE EN PLEURALE BIOPSIEPleurale vogversameling is dikwels 'n vroee verskynsel vanernstige long- of hartsiektes en dikwels is dit die eerste tekenvan 'n uiters belangrike gestelsiekte. Pleuritis met effusieis nooit 'n geringe bevinding nie. SeIfs as dit minimalekliniese verskynsels lewer, moet dit nog as 'n onheilspellendeteken van 'n lewensbedreigende toestand beskou word. lOnder die oorsake van die toestand is daar infeksie soosbakteriele, virus-, skimniel- en protosoale infeksies, asookonbekende nie-spesifieke inflammatoriese toestande. Malig-niteit (intratorakaal of metastases van elders), hartversakingen longembolisme, asook limfatiese obstruksie as gevolgvan tumore, is bekende oorsake van die toestand. Enigetoestand wat 'n hipoproteinemie veroorsaak, rnag aanwesigwees, en ook ander diverse, meer seldsame oorsake, soosMeig se sindroom, poliserositis, ens. Die belangrikste isseer seker die tuberkuleuse en maligne toestande van diepleura.Die onvermoe van geneeshere om 'n spoedige etiologiesediagnose in hierdie siekte te maak, is welbekend, en dieomvang van hierdie tergende diagnostiese probleem hetgelei tot sekere aksiomatiese stellings en kliniese stelreelswat in 70-80% van gevalle korrek mag wees. In die orige20-30% mag hulle lei tot 'n toename in die morbiditeit enmortali~it van die toestand.!Voorbeelde van hierdie kIiniese stelreels is dat 'n effusie19 J~ 1958in 'n jong persoon meer waarskynlik tuberkuleus van aardis, terwyl dit in 'n ouer persoon op maligniteit sou dui.Die aard van die vog sou dan ook, indien strooikleurig,n:eer ten gunste van 'n tuberkuleuse etiologie wees, terwyl 'nbloederige effusie maligniteit op die voorgrond bring.Hierdie oorwegings het gelei tot die ontwikkeling vantegnieke vir pleurale biopsies. Hoewel torakoskopie op dieVasteland van Europa reeds lank bekend is, het dit, sedertpneumotoraks by die behandeling van tuberkulose uit diemode geraak het, 'n minder gebruikte diagnostiese metodegeword.Donohue, Katz en Matthews gee in 'n onlangse artikel,'n oorsig van die literatuur insake pleurale biopsies.! Ditwas die gebruik om vroeer 'n biopsie van die pleura teneem tydens torakotomie vir terapeutiese doeleindes, maardit is maar onlangs dat dit suiwer vir diagnostiese doeleindesonderneem is.Die bevindings in gevalle waar 'n chirurgiese biopsiegeneem is, omrede die kliniese beeld nie heeltemal voldoenhet aan die vereistes van 'n tuberkuleuse effusie nie, toondat die prosedure geregverdig is, want in 9 uit 24 gevallewas daar geen teken van tuberkuleuse aantasting te vindnie. 3Die jongste ontwikkeling op hierdie gebied is die beskry-wing van de Francis, KIosk en Albanoc wat histologiese719720 S.A. MEDICAL JOURNAL 19 July 1958bevindings rapporteer ocr pleura wat deur naaldbiopsieverkry is. Hulle het 'n Vim-Silverman-naald gebruik'enbeskryf die tegniek in besonderhede. Hiema is verskeiesulke bevindings deur verskillende werkers gerapporteer. ~,'Die tegniek is eenvoudig en die gevare, komplikasies enmorbiditeit is dieselfde as vir gewone pleurale aspirasie,en die term aspirasie-biopsie word dus in die Amerikaanseliteratuur gebruik, omdat biopsie gedoen word saam metgewone aspirasie van die vog. Die eenvoud en minimalegevare van die tegniek maak dit 'n prosedure wat so dikwelsherhaal kan word as wat die aspirasie herhaal word. Indie meer as 100 gevalle in die literatuur, is geen mortaliteitaangemeld rue.' In 'n persentasie gevalle kon egter rue 'nduidelike antwoord verkry word rue, of 'n onvoldoende hoe-veelheid pleura is verkry. In sulke gevalle het Donohue et al.chirurgiese biopsie laat doen op 54 van hulle 132 gevalle, metvolledige eksplorasie, en se1fs daar was 'n geval waar on-voldoende pleura verkry is. Uit 14 wat 'n rue-spesifiek-inflammatoriese beeld getoon het, is in 6 gevalle die be-vinding weer by chirurgiese biopsie gevind. Van die orige8 het 5 tuberkulose en 3 maligniteit gehad.Hierdie skrywers2 meen dan dat die naaldbiopsie van diepleura 'n waardevolle diagnostiese prosedure is, en tensterkste aanbeveel kan word as 'n roetine prosedure ingevalle met 'n idiopatiese pleurale effusie.Die voordele van die naaldbiopsie is eenvoudigheid enherhaalbaarheid, sonder eDige oormatige ongerief vir diepasient. As dit by die eerste torakosentese gedoen word,kan die histologie e verslag na 48 tot 72 uur bekend wees.Die akkuraatheid kan Die dogmaties gestel word rue, maarwaarskynlik is dit volgens Donohue et al. net so akkuraatas chirurgiese biopsie sonder voUedige torakotomie eneksplorasie.Die chirUrgiese rnetode daarenteen. vereis 'n narkotiseur,chirurg en teater, en is klaarblyklik Die in alle gevalle vroegin hierdie toestand toepaslik Die. Die gevaar van empieem,as komplikasie, hoewel gering, is waarskynlik groter as metdie naaldbiopsie. . -Op grond van die bevindings van Donohue en sy mede-werkers, meen hulle'dat 'n entiteit van Die-spesifieke pleuritisbestaan wat na verwant is aan die bekende idiopatiese beDigne'perikarditis.Die nuwe tegniek vervang nie die gebruik van sito10gieseondersoeke van die vog en marmotinspuitings vir tuber-kulose, ens., Die, en natuurlik allermins 'n volledige, eksten-siewe kliniese ondersoek, maar dit mag tog- blyk die waarde-volste enkele ondersoelapetode in geval van pleurale effusiete word.Die eenvoudigheid van die tegniek beteken nie dat 'nmate van ondervinding Die nodig is Die, aangesien misluk-kings om pleura te verkry meer voorkom onder die eerstepogings as later. Ons voel egter dat elke intemis die tegnieksekerlik moet bemeester vir roetine gebruik in gevalle met'n idiopatiese pleurale effusie. Algemene praktisyns watpleurale effusies self aspireer, kan die tegniek oak gebruik,aangesien die formalienfikseerde monster Die kan bederfDie en na die naaste laboratorium versend kan word. Hierdienuwe metode en die huidige groot belangstelling in pleuraleeffusies, hou groot beloftes in vir hierdie, so dikwels, ter-gende diagnostiese probleem.I. Hinsbaw, H. C. en Garland, L. H. (1956): Diseaus of the Chest. Londen:W. B. Saunders.2. Donobue, R. F., Katz, S. en Maltbews, M. J. (1958): Ann. Intern. Med.,48, 344.3. Stead. W. W., Eicbenboltz, A. en Stauss, H. K. (1955): Amet. Rev. Tuberc.,71, 473. .4. De Francis, .,Klosk, E. en Albano, E. (1955): New Engl. J. Med., 252,948.5. Douglas, B. E., Cart, D. T. en Bernatz, P. E. (1956): Amet. Rev. Tuberc.,74, 954.6. Donohue, R. F. et 0/. (1957): Amet. J. Med., 22, 883.EDITORIALTOXOID IMMUNIZATION AGAINST TETANUSOne of the advantages that should accrue from the wideruse of toxoid prophylaxis against tetanus is the avoidanceof the dangers of the use of antitetanic serum. Many hospitalsare no less afraid of the possible allergic reactions to serumthan to the danger of tetanus, and in putting the case fortoxoid prophylaxis to the public the additional argumentis used that it is important to avoid repeated injections ofhorse serum.More and more people are being immunized againsttetanus with toxoid, and when these people sustain openwounds they should be getting booster doses of toxojd;but if they come to the hospital casualty department orreceive treatment from doctors who do not know theirimmunization history it is ~.T.S. they get. In other words,they lose the important advantage we have just mentioned.It is clear that what is needed is a.system whereby (a) theperson concerned carries on his persOl} an indication thathe has been immunized with toxoid, and (b) the doctorlooks for that evidence. The question arises what form thatindication might take-a locket carried like a soldier'sidentity disc and containing the necessary information?This is a matter that might usefully be made the subject ofdebate at medical meetings. An analagous problem ariseswith certain other people, for instance a person who is ableeder or a porphyric.A CASE OF ENDEMIC FLUOROSIS OF BONE IN THE CAPE PROVINCEL. WERBELOFF, M.B., D.M.R.E. AND B. SENDER, M.B., ER.CS.Departments 0/ Diagnostic Radiology and Surgery, Groote Schuur Hospital, and Uni~'ersity 0/ Cape TownFluorosis of bone is recognized as occurring in South Africafrom the consumption of drinking water containing a highlevel of sodium or calcium fluoride. In other countries such asthe United States of America and India it has also been re-corded in areas where the drinking water was similarly affec-ted. Industrial poisoning due to the inhalation of dust con-taining fluoride has not been recorded in South Africa, but inother. countries where cryolite, a fluoride of sodium and alu-minium, "is used in the production of aluminium it is wellknown. Similflrly, workers with rock phosphate are apt tosuffer from fluoride poisoning.Ockerse, l in a dental survey among the population of the

Editorial: Rectal biopsy in ulcerative colitis

https://www.ajol.info/index.php/samj/article/download/173937/163364

Editorial: Rectal biopsy in ulcerative colitis

Abstract

Similar works

Full text

Available Versions

AJOL - African Journals Online