Diradylglycerol formation is altered by n-3 highly unsaturated fatty acids, with differences between eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids.
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Animals↗
Biomedical subjects
P Marignani
Publications and source records attributed to P Marignani.
Diarrhea, constipation, and hypothyroidism.
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Adult↗
Diarrhea, constipation, and hypothyroidism.
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Adult↗
Acute necrotizing esophagitis.
Esophagitis of varying degrees and significance is caused by reflux, infections, radiation, and ingestion of chemical agents. A case of necrotizing esophagitis, seen as a black esophagus on endoscopy in a postoperative patient and resulting in long tubular stricture which ultimately required esophagectomy, is reported. Although the course of necrotizing esophagitis may parallel that associated with ischemia, severe caustic injury, or overwhelming infection, its etiology is uncertain. Diminished mucosal defenses, microbial implantation by a nasogastric tube placed perioperatively or sepsis, and transient ischemia with oxyradical formation and resultant reperfusion injury are hypothesized as important causative factors in the pathogenesis of acute necrotizing esophagitis.
Aged↗
Necrotizing duodenitis--a stress-associated lesion?
We report three cases of stress ulceration exhibiting primarily mucosal abnormalities of the duodenum with duodenal ulceration and linear ulcerations on the duodenal folds which is unique in our experience. We hypothesize that vascular insufficiency during low flow states decreases the ability of mucosa to buffer back-diffused hydrogen ion, leading to mucosal injury and ulceration. The duodenal folds receive an end-arteriole supply and are thus affected before other areas of the duodenum. Given the degree of necrosis associated with these lesions on pathological examination, we have chosen the term necrotizing duodenitis to describe the lesions observed.
Aged↗
Endoscopic treatment of Dieulafoy's lesion of the duodenum.
Dieulafoy's lesion is an often unrecognized cause of catastrophic upper gastrointestinal hemorrhage, typically seen in otherwise asymptomatic patients. Although the lesion is most often found in the stomach, it has rarely been reported to occur in the jejunum and duodenum. Endoscopic treatment has recently been attempted to arrest the bleeding from these lesions, when found in the stomach, with satisfactory results. We report a patient with a bleeding duodenal Dieulafoy lesion who was successfully treated with endoscopic injection of epinephrine (1:10,000) and electrocoagulation. Endoscopic treatment of Dieulafoy's lesion should be attempted before surgery and, as in other causes of acute nonvariceal hemorrhage, be considered the treatment of choice.
Aged↗
Splenic rupture at colonoscopy.
We report splenic rupture a few hours after a colonoscopy. Even though the patient had no previous history of splenic injury or symptoms attributable to splenocolonic adhesions, exploration revealed adhesions between the spleen and the colon at the level of the splenic flexure. Pathological examination revealed capsular thickening and fibrosis. Splenocolonic adhesions may lead to potentially lethal rupture of the spleen. A careful history prior to endoscopy should rule out pathological conditions that may lead to formation of adhesions between the spleen and the colon. In addition, the endoscopist should consider splenic rupture after colonoscopy in the patient who develops abdominal pain and acute anemia without evidence of intestinal perforation or external bleeding.
Colonoscopy↗
Flexible sigmoidoscopy: diagnostic yield in 1015 patients.
The purposes of our study were to 1) identify the number of neoplastic lesions (adenomatous polyps and cancer) diagnosable by flexible sigmoidoscopy (FS) in patients with symptoms of colorectal disease and 2) determine the age distribution of patients in whom neoplastic lesions are detected by FS. A total of 1015 patients, ages 20-89 years, underwent FS because of the following indications: rectal bleeding, occult blood loss, anemia, change in bowel habit, weight loss, and abdominal pain. FS examined a mean distance of 49 +/- 2 cm (SEM) in an average time of 11.5 min. A bowel preparation of 2 Fleet enemas was adequate in 95% of patients and the examination was well tolerated by all age groups. There were no complications encountered. Eight-five neoplastic lesions were identified in 78 patients. Fifty-four percent of all adenomatous polyps and 61% of the cancers were detected beyond 20 cm. Neoplastic lesions were identified in all adult decades studied, ranging from 3.2% of patients aged 20-40 years, 8.0% for patients between 40 and 60, and 10.1% from 60 to 80; with a peak yield of 11.2% in the 7th decade. Cancer was diagnosed only in patients more than 40 years; 3.3% of patients over 60 had carcinoma compared to 0.8% in patients less than 60. These data provide evidence for the value of FS as a safe initial diagnostic procedure to detect neoplastic lesions in symptomatic patients of all adult age groups.
Adult↗
Salmonella colitis presenting as a segmental colitis resembling Crohn's disease.
Salmonella species have recently been shown to involve the colon in a diffuse fashion resembling ulcerative colitis by radiographic and endoscopic appearance. We describe a case of Salmonella colitis in which the radiographic and colonoscopic features were focal ulcerations, mucosal edema, friability, and a loss of normal vascularity, an appearance resembling Crohn's disease. This is the first well-documented example of this clinical presentation.
Colitis↗
Duodenal epithelial thymidine uptake in patients with duodenal ulcer or endoscopic duodenitis.
To evaluate the relationship between duodenal ulcer disease and duodenitis, duodenal epithelial cell renewal was measured in mucosal biopsies by the incorporation of [3H]thymidine. When 14 patients with duodenal ulcer were compared to 13 control subjects or 7 with endoscopic duodenitis alone, the crypt size was the same in all groups. Similar to other inflammatory processes of the gastrointestinal tract, patients with endoscopic duodenitis showed increased proliferative indices including a greater number of cells incorporating [3H]thymidine. In contrast, the proliferative indices from the duodenal mucosa of patients with duodenal ulcers did not differ from a control group. In a group of 6 patients with both endoscopic duodenitis and duodenal ulcer, the [3H]thymidine incorporation was intermediate between control subjects or patients with duodenal ulcer alone and those with endoscopic duodenitis alone. When subjects were divided according to the histologic appearance of the duodenal mucosa, those having chronic duodenitis demonstrated enhanced [3H]thymidine incorporation in comparison to a control group or patients with chronic active duodenitis (polymorphonuclear leukocytes present). Although there are many possible explanations of these findings, one may speculate that duodenal ulceration does not stimulate duodenal epithelial proliferation.
Adolescent↗
Is gastroduodenitis part of the spectrum of peptic ulcer disease?
Gastroduodenitis should be included with duodenal ulcer and gastric ulcer in the spectrum of clinical disorders that have different pathogenetic mechanisms but a similar clinical picture. Published results of a clinical, endoscopic, radiologic, and histologic study of 100 patients presenting with gastrointestinal symptoms revealed that 61% had classic and 39% had atypical manifestations of peptic ulcer disease. We could not clinically distinguish the 24 patients with ulcer crater (40% of the classic group) from the 25 patients with acute gastroduodenitis without crater (41% of the classic group). Preliminary data of a prospective study compared the treatment responses of 19 patients with gastroduodenitis and 39 patients with peptic ulcer disease. These patients were diagnosed endoscopically and restudied after treatment with a bland diet and antacids seven times per day for 8 weeks. The responses to therapy in gastroduodenitis and peptic ulcer were as follows: endoscopically, 63 and 80%, respectively; histologically, 74 and 65%, respectively; symptomatically, 47 and 65%, respectively. Preliminary data on the duodenal epithelial thymidine uptake revealed an increased proliferative index in duodenitis patients but not in patients with peptic ulcer or control subjects.
Adult↗
The endoscopic diagnosis of colonic enterobiasis.
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Animals↗
Clinical experience with flexible sigmoidoscopy in asymptomatic and symptomatic patients.
The purpose of this study was to evaluate the diagnostic yield of flexible sigmoidoscopy when performed as a routine procedure in asymptomatic patients over the age of 40 being referred for a complete physical examination. The preliminary results of this ongoing program are presented together with the diagnostic yield in 408 patients with symptoms and signs suggestive of colorectal disease who were of similar age (56.6 vs. 56.5 years) and sex distribution (79 percent male) to the asymptomatic population, and who underwent flexible sigmoidoscopy as an indicated part of their evaluation. In the 122 asymptomatic patients, the mean distance examined by the procedure was 50.8 cm with the instrument being advanced beyond the optimal rigid sigmoidoscopy distance of 20 cm in 100 percent of patients. Adenomatous and hyperplastic polyps were identified in 16 patients, 13.1 percent, in the asymptomatic group, a similar percentage to the symptomatic population, 15.4 percent. Adenomatous polyps were diagnosed in 7.4 percent of the asymptomatic subjects and 9.1 percent of the symptomatic group. Colonic cancer was diagnosed in 0.8 percent of asymptomatic patients vs. 3.2 percent of the symptomatic group (p < 0.05). Seventy-seven percent of the neoplastic polyps detected in the asymptomatic patients and 60 percent in the symptomatic group were beyond 20 cm from the anus. Diverticulosis was diagnosed in a similar percentage of patients, 13.1 percent in the asymptomatic and 10.0 percent in the symptomatic group. No complications were encountered and the procedure was well tolerated without analgesia. It is concluded that: (1) in an asymptomatic population over the age of 40, flexible sigmoidoscopy, as a routine examination, results in a diagnostic yield not possible with rigid proctosigmoidoscopy and which approaches that observed in a symptomatic population of similar age; (2) for the internist trained in this procedure, flexible sigmoidoscopy has a future role in the detection of colorectal lesions and as an interval screening examination for premalignant lesions and colorectal cancer in asymptomatic and symptomatic patients.
Adenoma↗