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Biomedical subjects

F Mitros

Publications and source records attributed to F Mitros.

10 recordsLinked to original sources

Morphology and pathology of radiation-induced esophagitis. Double-blind study of naproxen vs placebo for prevention of radiation injury.

Radiation-induced esophagitis can cause substantial morbidity. Experiments in lab animals have shown that pretreatment with indomethacin protects the esophagus from radiation damage. We conducted a prospective, double-blind, randomized trial of naproxen vs placebo in patients undergoing thoracic radiation therapy for lung cancer. Twenty-eight patients were enrolled, of which 26 completed the study. Sixteen patients were given a short course of radiation (30 Gy/10 fractions/2 weeks), and 10 patients were given a longer course and a larger dose (40-50 Gy/25 fractions/5 weeks). Half of the irradiated patients were treated with naproxen, 375 mg, taken orally twice a day, and half were given an identical placebo. All patients were given ranitidine 300 mg, taken orally once a day. Study drugs were taken throughout the course of radiation. Endoscopy with esophageal biopsies and brushings was performed before and on the last day of treatment. Patients kept a daily diary for symptom scoring. Symptoms such as chest pain, dysphagia, odynophagia, and/or heartburn were reported in 15 patients from both subgroups, resulting in diet restriction to liquids only in eight patients and requiring temporary discontinuation of radiation therapy in one of them. Approximately half the patients in each subgroup developed esophagitis, usually mild and usually limited to the proximal esophagus. Severity of symptoms was not proportional to the severity of esophagitis. Candidiasis was documented in eight patients, but only four had symptoms that were severe in one. We conclude that acute radiation injury to the esophagus is observed in approximately half the patients receiving radiation therapy and can result in substantial morbidity.(ABSTRACT TRUNCATED AT 250 WORDS)

Double-Blind Method

Pneumococcal colitis: report of a case with radiologic and endoscopic findings.

Gastrointestinal symptoms and signs have been reported in association with pneumococcal infection for many years. Only rarely has Streptococcus pneumoniae been reported as a bowel pathogen. We report the clinical, radiographic, colonoscopic, and pathologic features of a case of pneumococcal colitis in an otherwise healthy 3.5-year-old female.

Child, Preschool

Adenovirus type-2 in a patient with lethal hemorrhagic colonic ulcers and chronic active Epstein-Barr virus infection.

An adenovirus type-2 was isolated from peripheral blood lymphocytes and throat washings from a patient with severe chronic active Epstein-Barr virus infection. Despite the Epstein-Barr virus reactivation, attempts to establish spontaneous lymphoblastoid cell lines from peripheral blood lymphocytes and to immortalize cord lymphocytes with throat washings were unsuccessful due to a marked cytopathic effect. The supernatants from the cultures induced cytopathic effect in cultured cord lymphocytes, MRC-5 cells, A-549 cells, or Vero cells. Virus particles with adenovirus morphology were seen by electron microscopy. Using type-specific antisera, the isolate was identified as adenovirus type-2. In addition, both Epstein-Barr virus and adenovirus type-2 genomes were seen in the colonic tissues and spleen. These results suggest that the combination of Epstein-Barr virus and adenovirus type-2 may be etiologic agents in the development of chronic active Epstein-Barr virus infection in this patient.

Adenoviridae Infections

Pseudo-Zollinger--Ellison syndrome in a child presenting with anemia.

Pseudo-Zollinger--Ellison syndrome appears to very rarely afflict young children. Hypergastrinemia, regardless of the etiology, presents with signs and symptoms of nonhealing or multiple gastric or duodenal ulcers, or both. We present a 7-yr-old boy with fasting hypergastrinemia (serum gastrin 200-500 pg/ml) who had mild to moderate iron deficiency anemia, but was asymptomatic. Stool guaiac was positive and gastric acid secretion was almost 40-fold above normal. Endoscopy showed multiple small gastric fundal ulcerations and severe gastritis. Workup for Zollinger--Ellison syndrome was negative. Changes in serum gastrin levels after secretin injection and after ingestion of a protein meal were compatible with those noted in adults with pseudo-Zollinger--Ellison syndrome. This child may be the first case of pseudo-Zollinger--Ellison syndrome under the age of 17 yr.

Anemia, Hypochromic

Epitheliotropic lymphoma of the small bowel. Report of a fatal case with cytotoxic/suppressor T-cell immunotype.

The authors report the clinical, pathologic, and immunologic features of a case of jejunal cytotoxic/suppressor T-cell lymphoma associated with intractable malabsorption. Histologically, the tumor exhibited striking involvement of small bowel surface and glandular epithelium, and of epithelium in sites of disease dissemination. This epitheliotropism consisted of both cell clusters resembling Pautrier 's microabscesses and single cells within epithelium. Grossly, the jejunal mucosal fold pattern was completely obliterated by lymphoma which formed miliary nodules and multiple distinct tumor masses. Despite aggressive chemotherapy the patient developed widespread disease, and died 11 months after presentation. At autopsy, in addition to disseminated lymphoma, there was a notable activation of hematopoiesis evidenced by extensive extramedullary hematopoiesis and bone marrow hypercellularity. Many lymph nodes spared by the lymphoma showed a polyclonal proliferation of plasma cells and immunoblasts. In view of recent immunologic evidence that normal cytotoxic/suppressor T-cells selectively home to the gut surface epithelium, striking tumor cell epitheliotropism may be a morphologic marker for visceral lymphomas of cytotoxic/suppressor T-cell origin. This unique case broadens the clinical and morphologic spectrum of T-cell disorders.

Epithelium

Inherited ophthalmoplegia with intestinal pseudo-obstruction.

A new inherited neuromuscular disease was identified in 4 patients (1 male, 3 females), offspring of consanguineous marriages, belonging to the same kindred. The proband was a 24-year-old female with history of ptosis and ophthalmoplegia since childhood and progressive intestinal pseudo-obstruction for the last 4 years of her life. A sural nerve biopsy showed axonal and demyelinating neuropathy. Muscle biopsies of pectoral and gastrocnemius revealed myopathic alterations with marked variation in muscle fiber size, atrophy of both fiber types and normal mitochondria. An upper gastrointestinal study showed barium in the stomach after 8 h and jejunal diverticula. Tests for absorption of fat, protein, carbohydrate, folic acid and vitamin B12 were normal. Serum levels of vitamin A and lipoproteins were also normal. The patient underwent partial gastrectomy and gastrojejunostomy. Postoperatively, she developed severe pancreatitis, sepsis, peritonitis and expired. Tissue samples from the proband and from her brother, revealed normal mucosa, but degeneration of smooth muscle of the stomach and small intestine. The myenteric plexus and vagus nerves were normal. The biochemical studies of contractile proteins (myosin, actin, tropomyosin) in the fresh and cultured smooth muscle cells of the proband obtained at the time of gastrectomy showed a 50-75% decrease in the synthesis of different contractile proteins. Turnover of contractile proteins and synthesis and turnover of collagen showed normal values. The reduction in synthesis of contractile proteins may account for the weak peristalsis and be a factor in the pathogenesis of the intestinal pseudo-obstruction.

Adult

Secretory diarrhea in ulcerative colitis.

Severe secretory diarrhea developed in a 15-year-old girl with ulcerative colitis restricted to the distal 30 cm of the colon. No known hormonal or pathologic cause for the secretory diarrhea was discovered. Since the diarrhea subsided after colectomy, it appeared to be secondary to a factor(s) in the inflamed bowel. We believe this is the first report of secretory diarrhea secondary to ulcerative colitis restricted to the distal portion of the large bowel.

Adolescent

Rectosigmoidal colitis in common variable immunodeficiency disease.

A patient with common variable immunodeficiency disease is described with severe colitis confined to the rectosigmoid region. Inflammation was extensive in the regions involved and exhibited a character that we believe is most unusual. Inflammation was transmural in the regions involved. Macrophages were the major inflammatory cells, and no granulomas or giant cells were seen. Although the disorder seemed distinct from either ulcerative colitis or Crohn's disease, the colitis responded favorably to oral azulfidine, prednisone, and to steroid enemas.

Adolescent

Multiple adenocarcinomas and premalignant changes in "backwash" ileitis.

In a patient with long-staning ulcerative colitis and "backwash" ileitis, multiple carcinomas developed in the colon and ileum. In both locations premalignant mucosal changes of the basal cell proliferation type were seen adjacent to and remote from sites of carcinoma. Although the frequency of such premalignant and malignant changes in "backwash" ileitis is unknown, their concurrence in this case suggests that ulcerative colitis involving the terminal ileum increases the risk of small bowel carcinoma.

Adenocarcinoma