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PubMed1984

Results and toxicity of the treatment of anal canal carcinoma by radiation therapy or radiation therapy and chemotherapy.

The results of treating anal canal carcinoma by radical external beam radiation alone (RT) or by combined 5-fluorouracil, mitomycin C and radiation (FUMIR), were compared in nonrandomized groups of patients treated in a single center. In each treatment regimen, surgery was reserved for those patients with residual carcinoma. The uncorrected 5-year survival rate in each group was approximately 70%, but primary tumor control was achieved in 93% (28/30) with FUMIR compared to 60% (15/25) treated with RT. Acute hematologic and enterocolic toxicity with uninterrupted external beam radiation courses of 5000 cGy in 4 weeks plus chemotherapy led to the adoption of split-course treatment. Serious late toxicity requiring surgical intervention occurred in 3 of 25 following RT, and in 5 of 30 following FUMIR. Colostomies were needed as part of treatment for residual carcinoma or for the management of treatment-related toxicity in 11 of 25 treated by RT and have been required to date in 4 of 30 treated by FUMIR. The improvement in the primary tumor control rate and the reduction in the number of patients requiring colostomy when compared with the results of RT favor combined chemotherapy and radiation as the initial treatment for anal canal carcinoma.

Actuarial Analysis↗
PubMed1997

Cholera and myocarditis--a case report.

The authors describe the case of a fifty-nine-year-old white man, previously in good health, who initiated his present illness with acute episode of enterocolitis characterized by mild fever and, in the next eight hours, twenty-four episodes of watery diarrhea, nausea and vomiting, as well as generalized sweating and severe weakness secondary to hypovolemia and electrolyte disorder. These complications were corrected in seventy-two hours in the intensive care unit. Two days later, when the patient was stable hemodynamically, under cardiac monitoring and with normal laboratory studies including serum electrolytes, he developed electrocardiographic changes characterized by trifascicular block (prolonged P-R interval, complete right bundle branch block [CRBBB] and left posterior hemiblock [LPH]) with a cardiac rate of thirty beats per minute, for which a temporary pacemaker was inserted. Endomyocardial biopsy showed histopathologic signs of myocarditis and the immunologic study of the cardiac tissue revealed positive polymerize chain reaction (PCR+) with the presence of antitoxine choleric antibodies (AcTCA). After three weeks, the same conduction disturbances remained, for which a permanent pacemaker was inserted. On top of intravenous fluid replacement and electrolyte supplements, the patient was managed with tetracycline 2 g a day for one week and sulfamethoxazole-trimethoprim 800/160 mg a day for two weeks. The purpose of this study is to present a rare and very well-documented myocarditis by cholera in a patient with enteric disease, in whom several cardiac complications occurred.

Anti-Bacterial Agents↗
PubMed1978

Fatal strongyloidiasis in gibbons (Hylobates lar).

A 6-year retrospective study of necropsy material from a colony of 200 gibbons showed strongyloidiasis to be the most frequent cause of death (24 cases). Clinical signs included diarrhea, constipation, weight loss, paralytic ileus and dyspnea. Lesions were most frequent in the gastrointestinal tract and lungs. In the gut there were erosive and ulcerative enteritis associated with adult female parasites and rhabditiform larvae and acute and granulomatous enterocolitis associated with invading filariform larvae. There was severe multifocal or diffuse hemorrhage associated with migrating larvae in the lungs of 23 gibbons. Filariform larvae and the lesions they caused also occurred in various tissues; this was commensurate with the wide distribution of these larvae when hyperinfection occurred.

Animals↗
PubMed1999

[Differential diagnosis of ulcerative colitis].

Important points during differential diagnosis of ulcerative colitis from other inflammatory disorders are endoscopic examination and microbial studies of stools. In acute phase of enterocolitis in which waterly diarrhea with bloody stool and abdominal pain appeared, infectious enterocolitis by Shigella, Salmonella, Campylobacter and Yersinia, which sometimes causes mucosal edema, hyperemia, erosions and ulceration should be distinguished carefully. Microbial studies of stool would bring helpful information in such situation. In chronic phase of inflammatory diseases of bowel, they often showed chronic diarrhea associated with mucobloody stools and abdominal pain. They often revealed mucosal inflammation mimicking ulcerative colitis during endoscopic evaluation. Among them, most important diseases are amebic colitis, ischemic colitis, radiation colitis and antibiotics associated hemorrhagic colitis.

Bacterial Infections↗
PubMed1992

Spondylarthropathy and gut inflammation: immunopathogenetic mechanisms.

In 62% of patients with spondylarthropathy (SpA) we found clinically unsuspected gut inflammation to feature acute or chronic enterocolitis on ileocolonoscopy. A proportion of patients of the latter group had subclinical Crohn's disease as demonstrated clinically, endoscopically, genetically, histologically and immunopathologically. There is a relation between the activity of the gut inflammation and clinical rheumatic symptoms. A pathogenetic mechanism is increased handling of luminal (bacterial or nutritional) antigen, hence inducing T-cell activation and intestinal inflammation. In ileal mucosal biopsies we showed two different cellular events: increased enterocytic expression of class II molecules in active inflammation and an increase of membranous (M) cells overlying lymphocytes in inflamed mucosa. Although the number of intraepithelial lymphocytes was not increased in inflammation, intraepithelial T lymphocytes had protruding processes in close apposition to the tips of epithelial plasma membranes. Lymphocytes crossing the basement membrane were a frequent finding. These features indicate that the intestinal immune response caused by increased antigen processing in the terminal ileum induces an inflammatory immunocascade responsible for the clinical picture of SpA.

Adolescent↗
PubMedDate not supplied

[High molecular weight kininogen in inflammation and angiogenesis: a review of its properties and therapeutic applications].

The plasma kallikrein-kinin system (KKS) participates in the pathogenesis of inflammatory reactions involved in cellular injury, coagulation, fibrinolysis, kinin formation, complement activation, cytokine secretion and release of proteases. It has been shown that KKS activation in the systemic inflammatory response syndrome results in decrease of its component plasma proteins. Similar changes have been documented in diabetes, sepsis, children with vasculitis, allograft rejection, disseminated intravascular coagulation, patients with recurrent pregnancy losses, hereditary angioedema, adult respiratory distress syndrome and coronary artery disease. Direct involvement of the KKS in the pathogenesis of experimental acute arthritis and acute and chronic enterocolitis has been documented by previous studies from our laboratory using experimental animal models. It has been found that in HK deficient Lewis rats, experimental IBD was much less severe. We showed a genetic difference in kininogen structure between resistant Buffalo and susceptible Lewis rats, which results in accelerated cleavage of HK and it is responsible for the susceptibility to the inflammatory process in the Lewis rats. It has been demostrated that therapy with a specific plasma kallikrein inhibitor (P8720) modulated the experimental enterocolitis, arthritis and systemic inflammation. Furthermore, it has been shown that a bradykinin 2 receptor (B2R) antagonist attenuates the inflammatory changes in the same animal model. We have showed that a monoclonal antibody targeting HK decreases angiogenesis and arrests tumor growth in a syngeneic animal model. In summary, these results indicate that the plasma KKS plays a central role in the pathogenesis of chronic intestinal inflammation, arthritis and angiogenesis.

Amino Acid Sequence↗
PubMedDate not supplied

[Isolation of rotavirus from the feces of subjects (children and adults) from various hospitals in Rome].

Enteric infections in childhood are estimated to be a primary cause of illness and death in the third world and Rotaviruses play a very important role in acute nonbacterial diarrheal enterocolitis. The Authors analyse the latest results of the direct investigation of the virus in the feces by ELISA method. The improvements in diagnostic techniques and the new knowledges about Rotaviruses and their pathogenic power acquired during the last decade have made it easier to know the consequences of Rotavirus infections particularly in the poorest countries, with very bad sanitary conditions. Much attention has therefore been paid to the study of dietetics and immunoprophylaxis in order to find the most suitable cure. At present only some vaccines of animal origin are available that many Authors consider to be harmless, and that, might hopefully be employed in the third world countries.

Adult↗
PubMedDate not supplied

[An episode of hospital infection due to Klebsiella pneumoniae in a neonatal department].

Enterotoxin-producing Klebsiella pneumoniae was implicated in the induction of intrahospital infections in new-born babies. A total of 46 children and 4 adults (hospital personnel) were involved. Most of the subjects (82.6%) had median and light forms of gastroenterocolitis, and recovered following biological re-equilibration. In 17.39% of the cases the evolution was more severe due to advanced dehydration and secondary dissemination of the infection. Two children (approximately 4%) died. Factors that favored the dissemination of the infection were hygiene deficiencies and ignorance of functioning rules of materno-infantile units, and these included: admission to the hospital of working personnel with acute phenomena of enterocolitis; administration of sweetened solutions that were prepared without control and stored at room temperature; the "critical" point represented by the special room for "the accommodation" of the newborns, a "key-point" where infection was disseminated to other wards following dispersion of "adapted babies".

Air Microbiology↗
PubMed2001

Ogilvie's syndrome in acute myeloid leukemia: pharmacological approach with neostigmine.

Acute colonic pseudo-obstruction, the so-called Ogilvie's syndrome, is a rare and life-threatening digestive complication usually observed in critically ill patients. It is characterized by signs of large-bowel obstruction, without a mechanical cause, and has been reported in various settings, including acute leukemias as a complication of neutropenic enterocolitis after intensive chemotherapy. We describe the case of a young woman who, during the neutropenic phase following autologous bone marrow transplantation for relapsed acute myeloid leukemia, developed neutropenic enterocolitis complicated by an acute pseudo-obstruction of descendent colon and sigma. This process was associated with sepsis and resolved with conservative therapy of the underlying condition, using granulocyte colony-stimulating factor and intravenous neostigmine. We discuss the management of this rare syndrome.

Adult↗
PubMed1997

Activation of the kallikrein-kinin system in arthritis and enterocolitis in genetically susceptible rats: modulation by a selective plasma kallikrein inhibitor.

We have developed models of acute and chronic inflammatory arthritis and enterocolitis using peptidoglycan-polysaccharide injected intraperitoneally or subserosally (intramurally) into the distal ileum and cecum. Acute inflammation occurs in both Buffalo and Lewis rats, characterized by inflammation of the injected areas of the intestine. However, only the genetically susceptible Lewis rat develops chronic synovitis and joint erosion or adhesions and granulomatous enterocolitis. In the Lewis rat but not the Buffalo rat, these changes are accompanied by a decrease in plasma prekallikrein and high-molecular-weight kininogen, reflecting activation of the kallikrein-kinin system. Pretreatment with a specific plasma kallikrein inhibitor modulates the acute and chronic arthritis. The same inhibitor partially abrogates the acute changes characteristic of enterocolitis, and preliminary data suggest similar results in the chronic model. The results of these studies indicate that the kallikrein-kinin system plays an important role in arthritis and enterocolitis induced by bacterial products and that kallikrein inhibitors are potential therapeutic agents for inflammatory arthritis and inflammatory bowel disease.

Acute-Phase Proteins↗
PubMed1988

Post-necrotizing enterocolitis strictures presenting with sepsis or perforation: risk of clinical observation.

Intestinal stenosis or stricture occurs in approximately one third of medically treated infants surviving the acute phase of necrotizing enterocolitis (NEC). Identification of these lesions by the use of routine contrast enemas has been advocated as a means of decreasing potential morbidity from delayed diagnosis. However, the significant incidence of spontaneous resolution and reluctance to submit asymptomatic infants to contrast enema have led recent researchers to reserve these studies for patients developing symptoms of obstruction during a period of close observation. From July 1984 to July 1986, symptomatic strictures developed in five infants (15%) responding to medical management at our institution. Contrast enemas were not routinely performed and four (80%) of these patients presented with life-threatening sepsis or perforation associated with intestinal obstruction. Two infants developed complete colonic obstruction 4 and 6 weeks after discharge from the Intensive Care Nursery, having initially tolerated oral feedings. Both infants were critically ill due to perforation or sepsis and underwent emergency colostomy at community hospitals. Two other infants developed abdominal distension with sepsis and cardiopulmonary decompensation while remaining hospitalized for prematurity and pulmonary insufficiency. These patients became symptomatic 5 and 7 weeks after cautious refeeding while closely monitored in the Intensive Care Nursery. The occurrence of such life-threatening complications suggests that clinical observation alone is not adequate in the management of many of these infants. Contrast enemas should be performed to identify those patients at risk of such potential morbidity or mortality, especially those infants not residing near pediatric surgical facilities.

Abdomen↗
PubMed1987

[Morphologic manifestations of intestinal lesions of bacterial and mycotic etiology developing in association with acute respiratory infections].

By means of light and immunofluorescent microscopy the intestines of 34 children were studied, whose bacterial or mycotic enterocolitis most often combined with acute respiratory infections. Intestinal lesions were caused either by virus (sometimes by Mycoplasma), or by bacteria and fungi. Such changes developed in the debilitated children and their course was more severe, than in monoinfections because of the impaired systemic and local immunity, and probably due to formation of viral-bacterial complexes. Viral intestinal lesions were most often caused by a single virus, but not by multiple ones, as in pulmonary infections, which is explained by interferon production and the intensive therapy used. The alternative component in a viral lesion is enhanced due to the presence of lactic acid in the intestine and therefore it is inhibited when acute viral respiratory infection develops against the background of bacterial or mycotic enterocolitis due to dysbacteriosis. Changes in mucosal stroma and intestinal lymphatic system in different infections depend on the duration of the intestinal lesion.

Acute Disease↗
PubMed2003

Surgical necrotizing enterocolitis: are intestinal lesions more severe in infants with low birth weight?

PURPOSE: This study examines whether the intestinal lesions of necrotizing enterocolitis (NEC) in infants undergoing surgery are more severe in patients with extremely low birth weight (BW). METHODS: Between 1980 and 2000, 128 infants underwent laparotomy for NEC: 90 in the acute phase, and 38 for secondary stenosis. Resections were limited to areas of transparietal bowel necrosis and to secondary stenoses. The authors studied the extent of initial bowel lesions at initial laparotomy, and, in the survivors, the extent of bowel resections and the existence of digestive sequelae, with a median follow-up of 24 (range, 1 to 247) months. Children with BW < or =1,000 g (group 1, 22 patients) and greater than 1,000 g (group 2, 103 patients) were compared by using chi(2) and t test. RESULTS: Patients' survival rate was 87%: 68% and 91% in the groups 1 and 2, respectively (P =.01). No significant difference between the 2 groups was seen: (1) for the rate of patients with panintestinal lesions at initial surgery (12%); (2) in the survivors, the ratio of remaining to total length of jejuno-ileum (mean 88%), the number of colonic segments resected (mean 1.2), the rate of survivors without distal ileum (34%), ileo-caecal valve (39%), or right colon (29%); and (3) for the existence of digestive symptoms, even minor, at last follow-up (25%). CONCLUSIONS: Although the prognosis of surgical NEC was worse in infants with extremely low birth weight, the intestinal lesions were not found more severe in these patients.

Acute Disease↗
PubMed1981

Proctoscopy in infancy with reference to its use in necrotising enterocolitis.

Experience with the fairly simple and safe technique of proctoscopy in an infant using an ordinary auroscope is reported. The use of the auroscope showed the presence of a frank colitis in 13 of 14 consecutive cases of necrotising enterocolitis. A prospective study was made during a 6-month period of 51 infants with diarrhoea referred to a gastroenterology isolation unit; proctoscopic findings that suggested colitis were found in 10. Of these, 3 appeared to have necrotising enterocolitis; 3 had salmonella or shigella dysentery; in 3 of the remaining 4 the findings were localised to the anus, with normal mucosa above. This was attributed to a mild rectal prolapse on straining. There was no correlation between the severity of the diarrhoea and the presence of colitis. Proctoscopy is safe and valuable in the early diagnosis of necrotising enterocolitis. It is also helped in assessing the progress of the disease.

Acute Disease↗
PubMedDate not supplied

[Post-necrotizing enterocolitis stenosis of the colon associated with cytomegalovirus infection. Description of a clinical case].

We report a case of an infant with a post-necrotizing enterocolitis stenosis, resolved with operative measures. The histologic finding of Cytomegalovirus in the resected sigmoid colon rise the question if the intestinal stricture was the proper consequence of a primary enteric viral infection or a superinfection in a transitory immunodeficiency after the acute phase of necrotizing enterocolitis.

Colonic Diseases↗
PubMed1981

[Abdominal complications of heart surgery].

Abdominal complications after cardiac surgery (excluding "medical" jaundice) are rare. Twenty six cases were observed out of a total of 7 847 operations (0.33%) performed between 1973 and 1980. The causes were very diverse; the most common being gastroduodenal ulceration, usually acute (9 cases). Other cases included intestinal (3 cases of postoperative ileus, 4 cases of mesenteric infarction, 2 cases of necrosing enterocolitis), biliary (2 cases of acute cholecystitis) and splenic pathology (2 cases of splenic infarction, one associated with necrosing enterocolitis). Anticoagulant therapy was implicated in 3 cases. Diagnosis is difficult in the immediate postoperative period, some complications only being recognised at autopsy. The clinical signs may be misleading and the interpretation of complementary investigations difficult. Therefore, the possibility of abdominal complications must be kept in mind, especially in patients with one or more predisposing factors. Excluding accidents due to anticoagulant therapy the following factors were associated with an increased risk of abdominal complications: previous history of gastro intestinal pathology (ulcer, gall stone, alcoholism) the nature of the underlying cardiac disease (coronary artery and aortic valve disease), cardiopulmonary bypass, and, above all, per- and postoperative incidents: hypovolaemia, low output syndrome (half the patients in this series) respiratory and infectious complications. The inappropriate use of vasoconstricting agents may also play a role. The majority of abdominal complications seemed to be related to ischaemia and anoxia in the splanchnic territory, which explains the important role of the preceding factors. The prognosis of abdominal complications after cardiac surgery was poor, mortality reaching 50 to 100% in some causes: in this series, 12 of the patients died. This justifies certain prophylactic measures: strict selection of patients, diagnosis and treatment of associated abdominal pathology before operation, prevention of low output states, respiratory and infectious complications ... and careful examination of the abdomen after operation to ensure the early diagnosis and treatment of complications, should they develop.

Acute Disease↗
PubMed1999

The radiology of necrotizing enterocolitis.

This article reviews the radiology of necrotizing entercolitis (NEC), with an emphasis on the sensitivity and specificity of the typical plain film findings. An approach to radiologic diagnosis is suggested. The more recently described entity of perforation without NEC also is described.

Acute Disease↗