[Diagnostic and therapeutic strategy in severe acute colitis in adults].
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Acute Disease↗
Biomedical subjects
J C Rambaud
Publications and source records attributed to J C Rambaud.
Extensive small intestinal T-cell lymphoma of low-grade malignancy associated with a new chromosomal translocation.
BACKGROUND: Primary T-cell lymphoma of the small intestine is rare, and most cases have proved rapidly fatal. METHODS: We describe a case of lymphoma involving the small intestine uniformly and extensively in a 28-year-old man on initial examination seen with long-standing diarrhea, malabsorption, and recurrent episodes of intestinal obstruction. Clinical remission was obtained with pentostatin (2'-deoxycoformycin, supplied by Professor Catovsky, London UK) after the patient had failed to improve under conventional chemotherapy. Tumor specimens as well as mesenteric lymph node, liver, and bone marrow specimens were studied with conventional pathology and immunochemistry. Additionally, mesenteric lymph nodes and peripheral blood cells were studied for T-cell receptor (TCR) gene rearrangement and karyotype. RESULTS: Lymphoma cells were small T-lymphocytes with irregular pleomorphic nuclei, bearing the CD3, CD4 and TCR alpha-beta phenotype. Peripheral-blood cytology and bone marrow biopsy were normal. Southern blot analysis of the TCR beta-chain gene revealed the same monoclonal rearrangement in the mesenteric lymph nodes and peripheral blood lymphocytes. An as yet undescribed t(4;16)(q26;p13) translocation, involving the region where the interleukin-2 (IL-2) gene has been mapped, was present in the mesenteric lymph nodes and peripheral blood lymphocytes. CONCLUSION: We believe this is the first description of an extensive, small intestinal lymphoma of low-grade malignancy made up of monoclonal T-cells with a TCR alpha-beta and helper/inducer phenotype, associated with a novel chromosomal translocation.
Adult↗
Colonoscopy of acute colitis. A safe and reliable tool for assessment of severity.
Complications that might lead to surgery in severe attacks of ulcerative colitis have been found to be correlated with the depth of colonic ulcerations as measured by pathological examination of colectomy specimens. In order to evaluate the value of colonoscopy for the assessment of colonic ulcerations, we have reviewed the clinical, biological, colonoscopic, and anatomical findings in 85 consecutive patients with attacks of ulcerative colitis involving at least the rectosigmoid and part of the descending colon, seen in our center between 1981 and 1989. All had colonoscopy performed by a senior endoscopist at entry. Extensive deep colonic ulcerations were diagnosed in 46 of them, and moderate endoscopic colitis in 39. No complication related to colonoscopy occurred except for one colonic dilatation. Forty-three of the 46 patients with severe endoscopic colitis were operated upon; 38 of them failed to improve with high-dose corticosteroids and five had a toxic megacolon. Extensive ulcerations reaching at least the circular muscle layer were found at pathological examination of colectomy specimen in 42 of the 43 patients. Conversely, 30 of 39 patients with moderate endoscopic colitis went into clinical remission with medical treatment, and only nine patients needed further surgery because of medical treatment failure. Six of these nine patients underwent another colonoscopy prior to colectomy, and all six showed features of severe endoscopic colitis. Deep ulcerations reaching the circular muscle layer were found at pathological examination in five of these six patients and in one additional patient whose colonoscopy had been performed 21 days before colectomy.(ABSTRACT TRUNCATED AT 250 WORDS)
Acute Disease↗
Enterocolitis cystica profunda lesions in a patient with unclassified ulcerative enterocolitis.
Enteritis cystica profunda and diffuse colitis cystica profunda are exceedingly rare conditions. We report here the first case in which these two entities are associated in one patient. This 48-year-old woman presented initially with a solitary ulcer of the rectum and developed later deep ileal and colonic ulcerations with intervening normal mucosa, polypoid masses, and a dense fibrosis of the bowel wall. Colon and ileum specimens demonstrated submucosal mucous cysts and occasionally herniation of mucosal epithelium into the submucosa, which led to the diagnosis of enteritis and colitis cystica profunda. The exact nature of the underlying ileocolonic disease, which necessitated colectomy and extensive ileal resection, remained undetermined although an aggravating role of iterative surgical procedures is possible. Enteritis cystica profunda and diffuse colitis cystica profunda therefore seem to share a common pathogeny and have to be considered as lesions complicating an underlying disease rather than specific and autonomic diseases.
Cysts↗
Association of hepatic vein obstruction and coeliac disease in North African subjects.
This study describes three adults with coeliac disease and hepatic vein obstruction, an association which has not been reported so far. Similarities were found with the cases of five children with Budd-Chiari syndrome and intestinal villous atrophy recently reported in the literature. All subjects had North African origin. Coeliac disease and Budd-Chiari syndrome are uncommon conditions, and it is postulated that this is probably not a chance association, although no link between these diseases and the ethnic origin of the subjects could be elucidated.
Adolescent↗
Gastrointestinal effects and energy value of polydextrose in healthy nonobese men.
We studied seven healthy volunteers before and during acute (PD1) and chronic (PD2) ingestion of 30 g polydextrose (PD)/d. The energy value of PD was assessed after [U-14C]PD was added to the 10-g morning dose of PD during PD1 and at the end of PD2. Thirty-one +/- five percent (mean +/- SD) (PD1) and 29 +/- 4% (PD2) of the dose appeared in breath within 48 h. A small fraction of the ingested radioactivity was recovered in urine (4 +/- 1%) and excreted in flatus (< or = 1%) and in feces as volatile fatty acids (VFAs) (< 1%) and bacteria (3-4%); the remaining radioactivity in stools, 33 +/- 3% (PD1) and 32 +/- 4% (PD2), was assumed to be intact PD. Breath excretion of the label was 49 +/- 5% after intracolonic infusion of [U-14C] acetate. The energy value of PD, calculated by means of Miller and Wolin's stoichiometric equation of colonic fermentation, was similar during PD1 and PD2: 4.0 and 6.1 kJ/g, respectively, when breath 14CO2 and VFA production from PD were used for calculation.
Adult↗
Effect of the energy density of a solid-liquid meal on gastric emptying and satiety.
The effect of the energy density of a meal on gastric emptying and satiety was assessed in nine volunteers. They ingested, in randomized order, a diluted (2671 kJ/L, 950 mL) and a concentrated (7452 kJ/L, 350 mL) test meal of 2500 kJ each (80% as solids). Half-emptying times of solids and liquids were not significantly different for the diluted and concentrated meal (solids: 145 +/- 18 and 156 +/- 16 min, respectively; liquids: 76 +/- 10 and 84 +/- 10 min, respectively), and consequently, pyloric outputs of energy were identical. Neither the intensity and duration of satiety, nor the amount of energy ingested, ad libitum, 6 h after the test meal, were significantly affected by energy density of the food ingested. Both the intensity and duration of satiety correlated significantly with the gastric emptying time for solids (r = 0.60 and 0.67, respectively, P < 0.01). These results show that satiety depends on gastric emptying of energy and is not affected by the energy density of food intake.
Adolescent↗
Tolerance and absorption of lactose from milk and yogurt during short-bowel syndrome in humans.
This study aimed to compare the absorption and tolerance of 20-g lactose loads as milk and yogurt in 17 patients with short-bowel syndrome with either a terminal jejunostomy (group A, n = 6) or a jejunocolic anastomosis (group B, n = 11). Records and measurements during the 8 h after the meals included fecal weight, symptoms, lactose and hexose flow rates in stomal effluents (group A), and breath-hydrogen excretion (group B). In group A lactose was better absorbed in the form of yogurt than in the form of milk (mean +/- SE: 76 +/- 6% vs 50 +/- 9%, P < 0.05), whereas no significant difference could be detected by using the breath-hydrogen test in group B. The excellent tolerance to 20 g lactose from milk and yogurt suggests that lactose should not be excluded from the diet of these subjects.
Adult↗
Short report: treatment of gastric ulcer with lansoprazole or ranitidine: a multicentre clinical trial.
We studied the effectiveness of lansoprazole and ranitidine in promoting gastric ulcer healing in a multicentre double-blind trial, by comparing the proportion of healed ulcers after 4 and 8 weeks of treatment. One hundred and fifty-eight patients were randomly given either ranitidine (150 mg each morning and at bedtime) or lansoprazole (30 mg each morning and placebo at bedtime). One hundred and twenty-eight patients completed the trial (62 taking lansoprazole, 66 taking ranitidine). Fifty-one (80%) of those treated with lansoprazole and forty-two (62%) of those treated with ranitidine had healed ulcers at 4 weeks (P < 0.05). Sixty-one (98%) patients who received lansoprazole and 57 (86%) who received ranitidine had healed ulcers at 8 weeks (P < 0.05). The observed differences were not significant in the intention-to-treat analysis. No serious adverse event was reported with lansoprazole.
2-Pyridinylmethylsulfinylbenzimidazoles↗
Digestibility and bulking effect of ispaghula husks in healthy humans.
The digestibility of ispaghula, a mucilage from Plantago ovata composed mainly of arabinoxylans, and its faecal bulking effect were studied in seven healthy volunteers who ingested a low fibre controlled diet plus either placebo or 18 g/day of ispaghula for two 15 day periods. Whole gut transit time and gas excretion in breath and flatus were not different during the periods of ispaghula and placebo ingestion. Faecal wet and dry weights rose significantly, however, during ispaghula ingestion. Faecal short chain fatty acid concentrations and the molar proportions of propionic and acetic acids also increased. Most of the ispaghula had reached the caecum four hours after ingestion in an intact highly polymerised form. During ispaghula ingestion, the increase in the faecal output of neutral sugars was accounted for by the faecal excretion of arabinose and xylose in an intact highly polymerised form; the apparent digestibilities of these sugars were 24 (11) and 53% (6) respectively (mean (SEM)). In conclusion, ispaghula is more resistant to fermentation than previously reported in humans, and its bulking effect largely results from intact material.
Acetates↗
Ileal tone in humans: effects of locoregional distensions and eating.
Using an electronic barostat in the human terminal ileum, we studied ileal tone in response to various stimuli in 10 healthy volunteers. Phasic activity was also measured by manometry. Graded orad (ileal) and caudad (cecal) balloon distensions did not produce any significant changes in ileal tone at all levels tested, even when a sensation of discomfort was felt. A linear relationship between pressure and volume was observed during in situ isobaric ileal distensions. Meal induced a biphasic tonic response with a brief (20 min) and immediate decrease in intrabag volume (64 +/- 7% of preprandial value, P < 0.05), followed by a prolonged increase in intrabag volume (158 +/- 10% of preprandial value, P < 0.05). A significant correlation was found between volume variations and phasic activities during the first phase (r = 0.88, P < 0.05), whereas no correlation was found during the second phase (r = 0.55, NS). The administration of glucagon induced a significant increase in intrabag volume from 45 +/- 5 to 70 +/- 8 ml (P < 0.05). We conclude that 1) regional distensions do not influence ileal tone and phasic motility, 2) the ileum does not show accommodation to distensions, and 3) meal produces an immediate increase in phasic and tonic activity followed by a prolonged relaxation.
Adult↗
[Mucoviscidosis discovered after the age of 25 years. Review and follow-up of cases of the literature].
We report a case of cystic fibrosis diagnosed in a 27-year-old man complaining of diarrhoea which was present for 2 years. The diagnosis was suspected upon the association of exocrine pancreatic insufficiency, massive hepatic steatosis, pulmonary infiltrates on chest radiograph, and moderate alterations of pulmonary function tests. It was confirmed by positive sweat tests. Study of the cystic fibrosis gene demonstrated a compound heterozygosity for delta F508 deletion and for mutation W1282X. Diagnosis of cystic fibrosis after the age of 25 is a rare event and the 25 hitherto published case reports are analysed after obtention of more detailed information for the authors. The existence of cases of late diagnosis might be explained by genetic heterogeneity.
Adult↗
[Pseudotumoral aspects of the ileocecal valve in post-antibiotic colitis].
The authors report a case of acute hemorrhagic colitis following amoxicillin therapy, characterized by a tumor-like lesion of the ileo-cecal valve. Clinical symptomatology and endoscopic lesions disappeared within a few days after withdrawal of the antibiotic.
Amoxicillin↗
Is the surgically reversed small bowel loop an alternative to intestinal transplantation?
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Adult↗
Absolute bioavailability of an aqueous solution of 1-deamino-8-D-arginine vasopressin from different regions of the gastrointestinal tract in man.
The absolute bioavailability of an aqueous solution of 1-deamino-8-D-arginine vasopressin (dDAVP) from different regions of the gastrointestinal (GI) tract (stomach, duodenum, jejunum, ileum, colon, rectum) has been studied in 6 healthy, male volunteers aged 24 to 35 years, followed for 12 h after each drug administration. For i.v. administration the subjects received 4 micrograms dDAVP. For intestinal administration 400 micrograms dDAVP was directly applied to six distinct sites in the GI tract via two or four channel tubes with or without a distal occlusive balloon. Biological effects were assessed and plasma and urinary levels of dDAVP were measured using a specific, sensitive RIA. Urine osmolality remained elevated and diuresis decreased for 12 h following dDAVP administration irrespective of the site of application. After i.v. administration, the half-life of elimination of dDAVP was 60.0 min, plasma clearance 1.7 ml.min-1.kg-1, amount excreted in urine 2.0 micrograms and renal clearance was 0.8 ml.min-1.kg-1. The mean bioavailability (f) after gastric application was 0.19% (range 0.02-0.35%). f was 0.24% after duodenal application (range 0.04-0.62%), 0.19% after jejunal (range 0.01-0.41%), 0.03% after distal ileal (range 0.01-0.08%), 0.04% after proximal colonic (range 0.01-0.12%) and 0.04% after rectal (0.01-0.10%) application. The bioavailability was significantly higher in the three upper GI regions in comparison to the three lower regions. The bioavailability of dDAVP after gastric, duodenal and jejunal application was similar to that after swallowing a tablet in a previous study. Absorption from the ileum was lower than expected and no preferential site of absorption was found.
Adult↗
Pyxigraphic sampling to enumerate methanogens and anaerobes in the right colon of healthy humans.
BACKGROUND: A major limitation in studying the proximal human colonic flora is the lack of suitable sampling methods. The aim of this study was (1) to describe a prototype technique, pyxigraphy, which uses swallowed capsules containing a mechanism allowing the remote control of sampling the gastrointestinal tract contents, and (2) to use this sampling method to examine the distribution of methanogens in the colon of methane (CH4) excretors and non-CH4 excretors. METHODS: In six CH4 excretors and four non-CH4 excretors, samples of the right colonic contents were obtained by means of the pyxigraphic sampling method. Methanogens and total anaerobes were enumerated in both the right colonic and fecal contents. RESULTS: In CH4 excretors, the concentration of methanogens was higher in the feces than in the right colonic contents, representing 12% and 0.003%, respectively, of the total anacrobes (P < 0.02). In non-CH4 excretors, no difference was observed, methanogens representing < 0.003% of the total anaerobes in both the right colonic and fecal contents. CONCLUSIONS: Pyxigraphy is a noninvasive, simple, and safe sampling method that allows to study the microbial populations of the proximal colon. The results obtained showed that methanogens preferentially colonize the distal part of the colon in CH4 excretors.
Adult↗
Alpha-chain disease: analysis of alpha-chain protein and secretory component in jejunal fluid.
BACKGROUND: It is unclear why different forms of alpha-chain disease protein appear in intestinal fluid. This was studied in a 23-year-old Mauritanian man in whom alpha-chain disease was diagnosed localized to the duodenum and jejunum, nasopharynx, and bone marrow. METHODS: The duodenal infiltrate was studied by immunohistochemistry. Forms of alpha chain-containing proteins in serum and jejunal fluid were analyzed by ultracentrifugation and radioimmunoassays. RESULTS: The infiltrating cells contained alpha-1 chain but no light chains, and approximately 66% showed variable expression of J chain. Serum contained a large fraction of monomeric alpha-chain disease protein, whereas both monomeric and heavier forms appeared in jejunal fluid. Some of the latter were bound to secretory component, and the fluid contained virtually no free component. CONCLUSIONS: Linkage of polymeric alpha-chain disease protein to secretory component depends on balanced synthesis of alpha chains and J chain in the proliferating B cells, giving rise to polymers with binding site for secretory component expressed as an epithelial receptor. Insufficient receptor-mediated transport capacity (either relative and/or because of intestinal crypt reduction) results in passive external transfer of polymers without bound secretory component along with leakage of serum-derived or locally produced monomeric alpha-chain disease protein, the latter presumably originating from immunocytes with little or no J-chain synthesis.
Adult↗
Primary digestive tract lymphoma: a prospective multicentric study of 91 patients. Groupe d'Etude des Lymphomes Digestifs.
BACKGROUND: The optimal management of primary gastrointestinal lymphoma including the use of surgery remains unsettled. This prospective study aimed to determine the prognostic factors of primary gastrointestinal lymphoma and to evaluate a therapeutic strategy based on surgical tumor reduction, followed by chemotherapy adapted to the histological type of tumor and tumor removal or nonremoval. METHODS: Ninety-one patients were included (mean age, 50.4 years) with mainly gastric (61%) or several digestive tract organ (18%) involved sites in clinical stages IE (43%), IIE (27%), and IV (30%). Three therapeutic groups were defined: group I, patients with low-grade lymphoma (n = 28); group II, patients with high-grade lymphoma who had complete tumor removal (n = 24); and group III, patients with high-grade lymphoma who had only partial or no tumor removal (n = 39). Each group underwent adapted chemotherapy. RESULTS: The respective overall 5-year survival rates for groups I, II, and III were 81% +/- 6%, 100%, and 56% +/- 8%, respectively (P < 0.0001). By Cox multivariate analysis, the prognostic factors of survival were age under 65 (P < 0.05), gastric localization (P < 0.05), stage IE (P < 0.001), and radical or incomplete surgery (P < 0.01). CONCLUSIONS: Combined radical surgery and chemotherapy according to histological grading is associated with prolonged remission in patients with primary digestive tract lymphoma. Moreover, compared with chemotherapy alone, incomplete resection of tumor is associated with increased survival of high-grade lymphomas.
Adolescent↗