Accepted for publication 9 February 1989. tumour. These findings were then analysed in relation to operative and eventual outcome. MethodsAll endoscopically removed neoplastic colorectal polyps greater than 1 cm diameter were retrieved from three hospitals in the West Midlands for the five year period 1981 to 1985. A total of 367 neoplastic polyps were examined. All slides and reports were reviewed by two pathologists (SM and JN). The majority of polyps, 297, were completely removed small adenomas showing only mild or moderate dysplasia. A further 36 showed severe dysplasia, and the remaining 34 showed invasive carcinoma.The 34 polyps with invasive carcinoma were subjected to further study. Excluded from this study were polyps arising in patients with a known colorectal carcinoma (past or synchronous), familial adenomatous polyposis, and cases without full follow up details.The adenomatous element was classified as either tubular, tubulovillous, or villous according to standard histopathologic criteria. Other factors noted were the degree of epithelial dysplasia, the degree of differentiation of the carcinoma (well, moderately, 1385 on 10 May 2018 by guest. Protected by copyright.

From 5 centres 154 patients with ulcerative colitis and a history of smoking completed a questionnaire about the temporal relationship between diagnosis of colitis and cessation of smoking. One hundred and thirty-eight of these were ex-smokers and 107 (69.5%) had stopped smoking before the diagnosis of colitis was made. Fifty-six patients (52%) developed colitis within 3 years of stopping smoking. The findings suggest that smoking exerts protective effect against the development of ulcerative colitis.

Anorexia nervosa (AN) is an eating disorder predominantly affecting young women. Abnormal liver function tests (LFT's) resulting from AN is well-described but to date few cases of dramatic rises in liver enzymes have been described. We report a 32-year-old women with severe anorexia having dramatic rise in LFT's with liver failure during extremely poor nutritional status. Acute rise in liver enzymes observed on several occasions in this patient resulted from ischaemic hepatitis secondary to liver hypoperfusion. Clinicians caring for patients with severe AN should monitor haemodynamic parameters with the knowledge that acute liver failure can be a consequence of sudden liver hypoperfusion. Therapeutic intervention comprising volume support with gradual nutritional support results in normalization of LFT's.

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The indications for percutaneous endoscopic gastrostomy (PEG) and patient outcome, were examined prospectively in the setting of a general hospital. In the course of 26 months, 76 patients underwent PEG (median age 62 years (range 18-99)) and were followed up for 6887 patient days. The median (range) duration of PEG feeding was 93 (3-785) days. The procedure was carried out for neurological indications in 76% of cases (stroke 51%) and 53% of patients were severely malnourished (body mass index <17 kg/M2) at the time of referral. In 12 (16%) patients swallowing recovered and the PEG was removed after a median (range) of 55 days