All 68,308 inhabitants of Göteborg born between 1918 and 1931 were randomly divided into a test and a control group. The subjects in the test group were invited to perform Hemoccult II fecal occult blood testing on 3 days and to repeat the test after 16 to 24 months. In the prevalence screening 21,347 (63%) performed the test, and in the rescreening 19,991 (60%). Investigation of the 942 (4.4%) with positive tests in the prevalence screening showed 47 cancers and 129 subjects with adenomas > or = 1.0 cm. In the rescreening 5.1% had a positive test, and 34 cancers and 122 subjects with adenomas (> or = 1.0 cm) were found among those. Cancer had also been diagnosed in 19 subjects in the interval between the two screening occasions and in 15 subjects among the non-responders. Forty-four cancers had been diagnosed in the control group during the same period. Cancers detected by screening were at a less advanced stage than in the control group. It is too early to show any effect of screening on mortality from colorectal cancer.

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SUMMARY Characteristic mucosal lesions in resected small intestinal segments from seven patients are reported. Preoperatively, four patients were in shock and general hypotension while the three remaining cases showed signs of local intestinal hypotension. The microscopic appearance of the mucosal lesions was in all patients identical with that previously observed in the feline and canine small intestine after haemorrhage or local intestinal hypotension. It is proposed that an extravascular short-circuiting of oxygen in the mucosal countercurrent exchanger and an intravascular aggregation of blood cells might produce tissue hypoxia which makes the mucosa vulnerable to enzymatic degradation.Haemorrhagic lesions in the small intestinal mucosa have regularly been reported from experimental shock studies on dogs (Wiggers, 1950;Lillehei et al., 1964;Chiu et al., 1970) and cats (Ahren and Haglund, 1973;Haglund, 1973). A characteristic feature is that these lesions appear first at the tips of the villi, and in cases where the entire villus is destroyed the deeper layers of the intestinal wall are still free from inflammatory changes (Chiu et al., 1970;Ahr6n and Haglund, 1973). Similar mucosal lesions have also been reported in patients dying in shock (see, for example, Penner and Bernheim, 1939;Marston, 1962;Bounous, 1969). Most of these studies were, however, 'based on necropsies where postmortem autolysis could not be excluded. There exist in the literature only a few exceptional cases where intestinal mucosal lesions have been reported in patients in shock based on microscopic studies of intestinal segments removed ante-mortem-for example, at operation (Carey et al., 1967;S0rensen and Vetner, 1969;Hugon and Bounous, 1971). This comparatively rare occurrence ofreports on intestinal mucosal lesions in association with clinical shock has led to the suggestion that these lesions may be a peculiarity of the dog and, therefore, it has even been proposed that only primates can be used in experimental studies of shock as it appears in clinical medicine (Brobmann et al., 1970;Swan et al., 1972).This study reports seven patients exhibiting haemorrhagic lesions in the small intestinal mucosa. The microscopic appearance is described and posReceived for publication 24 September 1975. sible pathophysiological mechanisms responsible for the development of such lesions are discussed. Methods CASE HISTORIESThis report is based on seven patients operated upon for different gastrointestinal disorders. During the preoperative period four patients exhibited obvious signs of clinical shock and, in the remaining three, the small intestine had evidently been subjected to a period of local hypotension. The detailed histories are given below.Case 1 A 52 year old man had 14 years earlier had a partial gastrectomy and a gastrojejunal anastomosis for bleeding ulcer. The patient was readmitted with clinical signs of gastric bleeding and signs of shock. Blood transfusions could not restore haemoglobin concentration above 8 g/dl and for two h...

We examined causes and hematological consequences of low serum cobalamin (vitamin B12) concentration in two representative population samples of 70-year-old (N = 293) and 75-year-old subjects (N = 486). Subjects with values below 130 pmol/liter (4.8% and 5.6%, respectively) were investigated with Schilling test, upper gastrointestinal endoscopy, determination of serum gastrin and group I pepsinogens, and bone marrow examination. Gastrointestinal abnormalities of etiologic significance were found in 26 of the 32 examined subjects: atrophy of the gastric body mucosa (N = 16, with pernicious anemia in six), partial gastrectomy (N = 6), and intestinal malabsorption (N = 4). Megaloblastic hematopoiesis was found in 10 individuals, four of whom had macrocytic anemia. Our results indicate that low serum cobalamin concentration in the elderly is usually a consequence of disease rather than of high age per se and that gastric mucosal atrophy is a major etiologic factor.

Six patients with coeliac disease and inflammatory bowel disease are described. Of special interest were two patients with coeliac disease and dermatitis herpetiformis and ulcerative colitis, one of whom also had sclerosing cholangitis. Three patients had both coeliac disease and ulcerative colitis, and one of them also had sclerosing cholangitis. In one patient with coeliac disease Crohn's disease of the small bowel was diagnosed. There seems to be association between coeliac disease without dermatitis herpetiformis, and ulcerative colitis. The possible combination of coeliac disease and inflammatory bowel disease deserves more attention than it has hitherto received.