Journal of the Royal Society of Medicine Volume 85 August 1992
'It seemed rather bad luck - I was then but nineteen So I went and consulted a quack, Who took a firm grip on my dominant gene And promptly mutated it back.'
'This,' said the surgeon, 'is something quite new And before we ascribe any merit We must see if the claims of this fellow are true, And observe what your children inherit!' H G PENMAN
Crawley Hospital West Green Drive West Green, Crawley, Susex RIWl1 7DH
Reference 1 Dukes CE. Familial intestinal polyposis. Ann R Coll Surg 1952;10:293-304
To our knowledge this is the first case of the deposition of such pigment in the oesophageal smooth muleAnd-in para-oesophageal lymph nodes in a patient suff9ring from longstanding chronic oesophagitis with hageal stricture. A strong association has been reported between marked smooth muscle proliferation and increased vascularity within the hilum of lymph nodes, which suggest that the smooth muscle proliferation may be of vascular origin'. We would suggest that patients with severe oesophagitis leading to oesophageal stricture, and poor intake of food may be susceptible to vitamin E deficiency with consequent deposition of lipofuscin pigment in the smooth muscle cells. Department of Histopathology D AL-OKATI N B N IBRAHIM
J D DAVIES
Brown bowel syndrome associated with chronic oesophagitis and oesophageal stricture We read with interest the case report by Hurley et aL (July 1991 JRSM, p 437) on massive lower gastrointestinal bleeding in association with the brown bowel syndrome. The authors postulate that haemorrhage may have been caused by a defect in the smooth muscle of blood vessels due to the deposition of lipofuscin pigment. We would like to report a case where similar lipofuscin pigment deposition occurred not only in the blood vessel walls, but also in smooth muscle fibres in the paraoesophageal lymph node tissue in a patient who suffered from long standing chronic oesophagitis associated with oesophageal stricture. Our patient (a 53-year-old man) had a long standing history of benign lower oesophageal stricture, associated with hiatus hernia and reflux oesophagitis. Gastroplasty and partial fundoplication were carried out. Biopsies from the oesophageal wall showed the deposition of lipofuscin pigment within oesophageal smooth muscle fibres. Para-oesophageal lymph nodes showed reactive hyperplasia with nodular proliferation of smooth muscle fibres in the perinodal tissue and the adventitia of adjacent small veins, with accumulation of lipofuscin pigment in the smooth muscle of paraoesophageal lymph nodes and blood vessels (Figure 1).
Frenchay Hospital
Bristol BS16 1LE Breast Pathology Unit Southmead Hospital Bristol BS10 5NB
Reference 1 Channer JL, Davies JD. Smooth muscle proliferation in the hilum of superficial lymph nodes. Virchows Arch [A] 1985;406:261-70
Inferior turbinates I read with interest the recent report by Padgham and Vaughan-Jones (December 1991 JRSM, p 728), which described the arterial supply ofthe inferior turbinates. It is unfortunate and discomforting that the authors chose to reintroduce the term 'turbinate' in place of 'concha' when describing the inferior bone of the nasal cavity. Since at least 1966, in the third edition of the Nomina Anatomica, concha has been the anatomically correct term. While we older practitioners will certainly recognize the word 'turbinate', young faculty and students, be they medical, dental or graduate, especially those in North America, will in all likelihood never have heard turbinate used when describing the nasal' bones. In attempting to standardize terminology, might it, be prudent for the Editorial Board of the Journal to ask that articles dealing primarily with anatomical structures use the terminology currently in vogue as endorsed by the sixth edition of the Nomina Anatomica? I trust that the above suggestions are taken as constructive by anyone preparing articles dealing primarily with anatomical structures. A H MARTIN
Professor of Anatomy Faculty of Medicine The University of Western Ontario
The authors reply below: In our paper we used the term inferior turbinate, as, to our knowledge, this is the term used currently by all nasal surgeons in both the UK and North America (including the younger trainees!). It was to this audience that the paper was primarily addressed. We hope that preclinical teachers will take note. Figure 1. There is deposition of lipofuscin pigment in smooth muscle fibres in the lymph node capsule and adventitia of adjacent veins. Masson Fontana x21.6
University Department of Otolaryngology N PADGHAM Ninewells Hospital and R VAUGHAN-JONES Medical School Ninewells Avenue, Dundee
511
'It seemed rather bad luck - I was then but nineteen So I went and consulted a quack, Who took a firm grip on my dominant gene And promptly mutated it back.'
'This,' said the surgeon, 'is something quite new And before we ascribe any merit We must see if the claims of this fellow are true, And observe what your children inherit!' H G PENMAN
Crawley Hospital West Green Drive West Green, Crawley, Susex RIWl1 7DH
Reference 1 Dukes CE. Familial intestinal polyposis. Ann R Coll Surg 1952;10:293-304
To our knowledge this is the first case of the deposition of such pigment in the oesophageal smooth muleAnd-in para-oesophageal lymph nodes in a patient suff9ring from longstanding chronic oesophagitis with hageal stricture. A strong association has been reported between marked smooth muscle proliferation and increased vascularity within the hilum of lymph nodes, which suggest that the smooth muscle proliferation may be of vascular origin'. We would suggest that patients with severe oesophagitis leading to oesophageal stricture, and poor intake of food may be susceptible to vitamin E deficiency with consequent deposition of lipofuscin pigment in the smooth muscle cells. Department of Histopathology D AL-OKATI N B N IBRAHIM
J D DAVIES
Brown bowel syndrome associated with chronic oesophagitis and oesophageal stricture We read with interest the case report by Hurley et aL (July 1991 JRSM, p 437) on massive lower gastrointestinal bleeding in association with the brown bowel syndrome. The authors postulate that haemorrhage may have been caused by a defect in the smooth muscle of blood vessels due to the deposition of lipofuscin pigment. We would like to report a case where similar lipofuscin pigment deposition occurred not only in the blood vessel walls, but also in smooth muscle fibres in the paraoesophageal lymph node tissue in a patient who suffered from long standing chronic oesophagitis associated with oesophageal stricture. Our patient (a 53-year-old man) had a long standing history of benign lower oesophageal stricture, associated with hiatus hernia and reflux oesophagitis. Gastroplasty and partial fundoplication were carried out. Biopsies from the oesophageal wall showed the deposition of lipofuscin pigment within oesophageal smooth muscle fibres. Para-oesophageal lymph nodes showed reactive hyperplasia with nodular proliferation of smooth muscle fibres in the perinodal tissue and the adventitia of adjacent small veins, with accumulation of lipofuscin pigment in the smooth muscle of paraoesophageal lymph nodes and blood vessels (Figure 1).
Frenchay Hospital
Bristol BS16 1LE Breast Pathology Unit Southmead Hospital Bristol BS10 5NB
Reference 1 Channer JL, Davies JD. Smooth muscle proliferation in the hilum of superficial lymph nodes. Virchows Arch [A] 1985;406:261-70
Inferior turbinates I read with interest the recent report by Padgham and Vaughan-Jones (December 1991 JRSM, p 728), which described the arterial supply ofthe inferior turbinates. It is unfortunate and discomforting that the authors chose to reintroduce the term 'turbinate' in place of 'concha' when describing the inferior bone of the nasal cavity. Since at least 1966, in the third edition of the Nomina Anatomica, concha has been the anatomically correct term. While we older practitioners will certainly recognize the word 'turbinate', young faculty and students, be they medical, dental or graduate, especially those in North America, will in all likelihood never have heard turbinate used when describing the nasal' bones. In attempting to standardize terminology, might it, be prudent for the Editorial Board of the Journal to ask that articles dealing primarily with anatomical structures use the terminology currently in vogue as endorsed by the sixth edition of the Nomina Anatomica? I trust that the above suggestions are taken as constructive by anyone preparing articles dealing primarily with anatomical structures. A H MARTIN
Professor of Anatomy Faculty of Medicine The University of Western Ontario
The authors reply below: In our paper we used the term inferior turbinate, as, to our knowledge, this is the term used currently by all nasal surgeons in both the UK and North America (including the younger trainees!). It was to this audience that the paper was primarily addressed. We hope that preclinical teachers will take note. Figure 1. There is deposition of lipofuscin pigment in smooth muscle fibres in the lymph node capsule and adventitia of adjacent veins. Masson Fontana x21.6
University Department of Otolaryngology N PADGHAM Ninewells Hospital and R VAUGHAN-JONES Medical School Ninewells Avenue, Dundee
511
