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PubMed1984

Descriptive statistics for the larval stages of Onchocerca volvulus in host-seeking Simulium ochraceum.

In four localities of Guatemala with dissimilar intensities of onchocerciasis, filarial larvae were recovered by dissection from host-seeking Simulium ochraceum. Measurements made on over 600 Onchocerca volvulus larvae were used to characterize the early first, late first, second, and third developmental stages. The numerical attributes used to characterize the third larval stage and the associated means were body length (657.3 microns); anterior body width (18.9 microns); posterior body width (20.2 microns); distance from anterior end to nerve ring (87.9 microns), to junction of muscular and glandular esophagus (137.6 microns), and to junction of esophagus and intestine (419.6 microns); and distance from anus to tip of tail (36.8 microns). Ratios to total body length were as follows: distance from anterior end to nerve ring, mean = 0.133, to junction of esophagus and intestine, mean = 0.634, and to anus, mean = 0.945. Differences between these phenotypic features and those reported for African O. volvulus appeared to be insufficient to distinguish the two forms. With very few exceptions, the filarial larvae found in host-seeking S. ochraceum were considered to be O. volvulus.

Anal Canal↗

PubMed1989

Neonatal intestinal obstruction.

Our experience in the management of 138 infants with various causes of intestinal obstruction has provided us with important principles of diagnosis and treatments that we adhere to in the course of our practice. 1. The overall mortality of neonates suffering from intestinal obstruction should be fewer than 5 per cent. The high survival rate is accounted for by improved care these patients receive in specialized units. 2. Prematurity did not appear to play a significant factor in the outcome of these infants with intestinal obstruction. Our experience shows that premature infants tolerate operative procedures well, even in those instances in which an associated surgically correctable lesion is simultaneously repaired. 3. The major risk factor in any neonate with intestinal obstruction is the delay in diagnosis and operative intervention, especially in infants diagnosed to have midgut volvulus. The additional second risk factor is the association of chromosome abnormality. 4. Traditional diagnostic studies such as plain films of the abdomen supplemented by either an upper GI or lower GI contrast study for specific indications have been very effective in obtaining an accurate diagnosis of intestinal bowel obstruction. 5. Hirschsprung's disease can be diagnosed in the neonatal period if the index of suspicion for this is high. 6. Special surgical techniques as described should be used whenever indicated to minimize morbidity. 7. The traditional Wangensteen-Rice evaluation of a patient with imperforate anus is accurate, and specialized studies should be deferred for the postoperative period. Collaborative care provided by the neonatologist, pediatric anesthesiologist, and pediatric surgeon for these patients is the key to a favorable outcome.

Abnormalities, Multiple↗

PubMed1995

[Percutaneous endoscopic colopexy--a new treatment possibility for volvulus of the sigmoid].

An 83-year-old woman, largely bedridden since a stroke 2 years before, was hospitalized because of upper abdominal pain, nausea and obstipation. She had regularly been taking laxatives of the anthraquinone type. She had a fever of 38.6 degrees C and leukocytosis (14,900/microliters). Radiological examination revealed volvulus of the sigmoid colon with ileus. As she vehemently refused an operation, it was attempted to reduce the volvulus endoscopically. At the first coloscopy the volvulus was untwisted. At that time there were already areas of necrosis in the rectosigmoid and descending sigmoid portions. As the volvulus recurred three days later, another coloscopic derotation was performed, this time with fixation of the sigmoid by three gastrostomy tubes for 20 days. The further course was uncomplicated, the patient had regular bowel movements and became free of fever and symptoms. The white cell count returned to normal and the intestinal mucosa healed histologically without scarring. There has been no recurrence for 10 months. The conventional treatment of volvulus of the sigmoid is decompression followed by sigmoid resection. This case describes for the first time the nonoperative treatment by percutaneous endoscopic colopexy.

Aged↗

PubMed1985

[Extensive resection of the small intestine in children].

Thirteen children aged 2 to 16 years have had a subtotal resection of small bowel, following a mid-gut volvulus in 10 cases. All children are still alive, and their growth was normal; 36 cumulative patient-years of parenteral nutrition and 11 years of constant rate enteral nutrition were performed. In 7 cases, where residual small bowel varied between 30 to 120 cm, termination of all artificial nutritional support was possible at a mean of 30 months after intestinal resection. On the other hand if resection was near total with less than 20 cm remaining, life long dependence on parenteral nutrition is unavoidable unless intestinal transplantation becomes feasible; with cyclic parental nutrition at home, their quality of life is near normal.

Adolescent↗

PubMed1990

Putrescine N-acetyltransferase in Onchocerca volvulus and Ascaris suum, an enzyme which is involved in polyamine degradation and release of N-acetylputrescine.

A novel type of N-acetyltransferase, clearly different from the nuclear and cytosolic polyamine N-acetyltransferases of mammals, was recently found in the intestinal nematode Ascaris suum. The occurrence of this putrescine N-acetylating enzyme has also been noted in the filarial parasite Onchocerca volvulus. The enzyme was partially purified from adults of O. volvulus and A. suum by chromatography on DEAE-cellulose and cadaverine-Sepharose. Substrate specificities of the filarial enzyme resemble those of the N-acetyltransferase from A. suum, with respect to its preference for putrescine and other diamines above polyamines and histones. Additionally, both nematode enzymes acetylated histamine, whereas dopamine and serotonin were not accepted as substrates. The activities of the N-acetyltransferase from O. volvulus and A. suum were potently inhibited by the drug berenil; the type of inhibition was competitive with respect to putrescine. The inhibition constants for berenil were determined as 4.2 and 1.2 microM for the enzymes of O. volvulus and A. suum, the Km values for putrescine were found to be 330 microM and 250 microM, respectively. Putrescine N-acetyltransferase is discussed as a regulatory step in the degradation of excessive polyamines via polyamine oxidase to putrescine. At this branching point, putrescine is retained in the cell for de novo synthesis of spermidine and spermine, catabolized via diamine oxidase or acetylated to a suitable transport product for excretion.

Acetyltransferases↗

PubMed1997

Ultrastructure of infective larvae (L3) of Onchocerca volvulus (Nematoda: Filarioidea) developed in Simulium yahense in Liberia.

Third-stage infective larvae of Onchocerca volvulus were examined to elucidate the ultrastructure and the interrelations of the stoma, esophagus, intestine, and nervous system. The alimentary canal involves a cuticularized stoma with a triradiate lumen that is continuous with a similar triradiate lumen in the muscular region of the esophagus. The lumen wall may be laterally appressed or opened into a stellate form in the glandular region. Posteriad from the esophagointestinal valve, the cylindroid lumen becomes partially occluded with microvilli formed by the evaginations of the apical membranes of the intestinal epithelium. Cross sections, through this region reveal that groups of 5 radiating epithelial cells are joined near the lumen surface by junctional complexes. The alimentary canal terminates via a rectal valve and channel supported by somatic and neural cells. The central nervous system consists of a nerve ring that surrounds the muscular region of the esophagus. Related neurons support chemoreceptors and tactoreceptors of sensilla and the extensive coelomyarian and meromyarian somatic muscles. Extensive accumulations of glycogen rosettes are present in many of the muscle and hypodermal cells.

Animals↗

PubMed2006

Acute small intestinal obstruction associated with Parascaris equorum infection in young horses: 25 cases (1985-2004).

AIMS: To retrospectively evaluate the medical and surgical records of horses with acute small intestinal obstructions associated with Parascaris equorum infection; to describe the gastrointestinal lesions; and to determine the outcome of cases with such lesions. METHODS: Records of 25 horses with acute small intestinal obstruction associated with P. equorum between 1985 and 2004 were reviewed to determine signalment, history, physical examination, surgical or post-mortem findings, and outcome. RESULTS: All horses except one were less than 12 months old. Standardbreds were over-represented in the population studied. Sixteen horses (72%) had been administered anthelmintics, including pyrantel (n=8), ivermectin (n=7), and trichlorphon (n=1), within 24 h prior to the onset of colic. Of the 25 cases reviewed, 16 had simple obstructive ascarid impactions (SOAIs), and nine had complicated obstructive ascarid impaction (COAI) including volvulus (n=6) or intussusception (n=3), both concurrent with ascarid impaction of the small intestine. Short-term survival (discharge from hospital) occurred in 79% of horses treated for SOAI, and was 64% for all horses. Long-term survival (>1 year) occurred in 33% of horses with SOAI, and the overall long-term survival was 27% for all horses. Formation of adhesions was the most frequent finding associated with death for horses that did not survive long-term. CONCLUSIONS AND CLINICAL RELEVANCE: The incidence of anthelmintic treatment within 24 h of the onset of colic in this study population (72%) was higher than that previously reported. Resistance of P. equorum to ivermectin recently reported in Ontario may be associated with increased ascarid burdens, predisposing horses to ascarid impaction. The long-term survival of these horses was better than that reported previously.

Animals↗

PubMed1984

Cecal volvulus. Low mortality at a city hospital.

The case records of 12 patients with cecal volvulus over a 20-year period were reviewed. The patients averaged 46.7 years old; 75 per cent were white and 67 per cent were male. Patients presented with signs and symptoms of intestinal obstruction. Pain and distention were present in more than half of the patients. X-rays assisted in making the diagnosis of cecal volvulus in only five of the patients. Diagnosis was made in the remainder at the time of surgical exploration. At operation, one cecum was necrotic and required resection. Five patients underwent cecostomy, two cecopexy, and four simple detorsion. Post-operatively, one patient developed a wound infection. There were no deaths. Follow-up for seven patients averaged 75 months each. One patient who had undergone simple detorsion developed another cecal volvulus. All who were contacted were alive and well. At St. Luke's Hospital, cecal volvulus generally occurs in middle-aged white males. Cecostomy or cecopexy adequately treats cecal volvulus when the cecum remains viable. This study demonstrates that prompt surgical intervention, before strangulation of the colon occurs, results in low mortality even in city hospital patients.

Adult↗

PubMed1988

Proposed form to evaluate some histological aspects of macrofilarial morphology, its age dependent alterations and drug related changes in nodules of Onchocerca volvulus and O. gibsoni.

Histological assessment of drug-related pathomorphological changes in macrofilariae of the two nodule forming species Onchocerca gibsoni and O. volvulus is hampered by the variability of age-dependent signs of natural degeneration and the virtual inexistence of clinically established reference medicaments. A specific form was designed to record systematically all characteristics observed in the various organs, tissues, cell types and developmental stages inside normal and drug-affected macrofilariae. Its tabular format permits the synoptic presentation of the findings in all female and male macrofilariae from a particular treated or untreated individual. The proposed form enumerates thirty eight morphological characteristics subdivided into the six subunits cuticle, hypodermis, longitudinal muscle, genital tract, pseudocoelomic cavity and intestinal tract (gut). The normal morphology of sexually mature and productive male and female O. volvulus is described and illustrated by photomicrographs. The cuticle of the male is wrinkled and forms regular striations strictly transverse to the body's longitudinal axis. The longitudinal muscles are well developed and cover almost 100% of the circumference at the anterior and posterior end. Towards the mid-body region the muscular portion diminishes to 50-60% and is replaced there by the very voluminous lateral hypodermic chords. The male genital tract originates with its distal end of the testis close to the anterior end and runs through almost the entire body very close to the posterior end. Spermatogenesis is clearly synchronized and the various development stages are arranged in strict sequential order inside the genital tract. Each type of gonosomal cell may thus serve as a marker of the respective region of the body. The same applies for females where the paired genital tubes run through almost the entire length of the body until the two uteri unite to form a short unpaired vagina. Each of the two reproductive tracts originates at different levels in the posterior part of the female. Because of this, two distinct stages of the sexual products are normally present in sections of the two uteri in the various parts of the female macrofilariae. Towards the anterior end identical stages of embryos may be found. The wide uteri narrow shortly before the vaginal junction to less than 40 microns in the very anterior part of the body. This part is characterized by the voluminous lateral chords of hypodermis and the well developed longitudinal muscles covering greater than 50% of the circumference. Drug-related changes come to light first in this part of the female's body.(ABSTRACT TRUNCATED AT 400 WORDS)

Aging↗

PubMed1998

Colonic volvulus and ulcerative jejunoileitis due to occult celiac sprue.

Colonic volvulus is a rare complication of celiac disease. A case is reported of a 46-year-old man with a long-standing history of diarrhea and abdominal distention with a diagnosis of irritable bowel syndrome. After an elective inguinal hernia repair, a cecal volvulus and an ulcerative jejunoileitis developed in the patient that required an extensive intestinal resection. Short bowel syndrome developed and was treated with total parenteral and enteral nutrition. The patient had a poor course after reinitiation of oral diet. Subsequently, celiac sprue was diagnosed and the patient improved with a gluten-free diet.

Celiac Disease↗

PubMed1995

Coecal volvulus following caesarean section.

A case of coecal volvulus following caesarean section is reported. The importance of knowing the possibility of intestinal obstruction during pregnancy and puerperium is underlined.

Adult↗

PubMed1990

Pathology mimicking distal intestinal obstruction syndrome in cystic fibrosis.

Eight patients with cystic fibrosis had chronic abdominal pain and the other features of distal intestinal obstruction syndrome. Coexistent abdominal pathology was shown in six patients. Two had a small bowel volvulus, and the others had Crohn's disease, a small bowel fistula, appendix abscess, and an ovarian dermoid. Opiate abuse exacerbated symptoms in two other patients.

Abdominal Pain↗

PubMed1996

Gastrointestinal manifestations in cystic fibrosis.

CFTR, or cystic fibrosis transmembrane conductance regulator, the gene product that is defective in cystic fibrosis, is present in the apical membrane of the epithelial cells from the stomach to the colon. In the foregut, the clinical manifestations are not directly related to the primary defect of the CFTR chloride channel. The most troublesome complaints and symptoms originate from the oesophagus as peptic oesophagitis or oesophageal varices. In the small intestinal wall, the clinical expression of CF depends largely on the decreased secretion of fluid and chloride ions, the increased permeability of the paracellular space between adjacent enterocytes and the sticky mucous cover over the enterocytes. As a rule, the brush border enzyme activities are normal and there is some enhanced active transport as shown for glucose and alanine. The results of continuous enteral feeding of CF patients clearly show that the small intestinal mucosa, in the daily situation, is not functioning at maximal capacity. Although CFTR expression in the colon is lower, the large intestine may be the site of several serious complications such as rectal prolapse, meconium ileus equivalent, intussusception, volvulus and silent appendicitis. In recent years colonic strictures, after the use of high-dose pancreatic enzymes, are being increasingly reported; the condition has recently been called CF fibrosing colonopathy. The CF gastrointestinal content itself differs mainly from the normal condition by the lower acidity in the foregut and the accretion of mucins and proteins, eventually resulting in intestinal obstruction, in the ileum and colon. Better understanding of the CF gastrointestinal phenotype may contribute to improvement of the overall wellbeing of these patients.

Colonic Diseases↗

PubMed1979