SUMMARY We studied 14 large bowel resections from patients with a provisional clinical diagnosis of a bleeding vascular lesion of the colon. For the purpose of this study we developed a barium-gelatine vascular injection technique. Six of the 14 cases were proven to be angiodysplasias with an identifiable mucosal vascular ectasia. The pathological findings in these six cases are described. We conclude that angiodysplasias represent a significant cause of lower gastrointestinal haemorrhage in the elderly. It is our opinion that only the mucosal vascular ectasia seen in these cases is histologically diagnostic and that sub-mucosal venous ectasia, while characteristic of angiodysplasia, is non-specific. The differential diagnostic features which will allow the histological distinction of angiodysplasia from other vascular lesions of the colon are discussed. Six of the cases were proven to be angiodysplasias Accepted for publication 16 December 1981 with an identifiable mucosal vascular ectasia. When viewed under the dissecting microscope, the mucosal aspect of the lesion in these cases had a characteristic "coral-reef' like appearance (Fig. 1). In a further two cases the histological findings were suggestive of angiodysplasia but not diagnostic in that ectatic submucosal veins were present but no mucosal lesion was identified. All the angiodysplasias were located in the caecum, their diameter varying from 3 to 10 mm. All were flat and showed varying degrees of attenuation of the mucosa, but none was ulcerated. The angiodysplasias were multiple in three cases.The dominant histological feature in all six proven cases of angiodysplasia was the presence of dilated thin-walled vascular channels in the lamina propria of the mucosa (Fig. 2)
the control centre was recorded as the arrival time. Moreover, the centres using automatic time-stamps (the centre quoted above did not) were prevented from entering times retrospectively. Despite these qualifications, the findings show that the resources of some deputising services, medical manpower or telecommunications or both, appeared to be stretched at bank holiday periods. Generalisations about the quality of deputising services as a whole have in the past been misleading. It is to be hoped that the introduction of standard procedures for monitoring the operation of deputising services (DHSS Health Circular HC(FP)(78)1) will serve to diminish differences in quality among them.
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