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[Extraintestinal manifestations of chronic inflammatory intestinal disease].

Intestinal Inflammatory Chronic Disease includes a series of pathological entities of unknown etiology, basically characterized by inflammatory lesions in the digestive tube. Importance of this disease, which frequency has grown in the last few years, lies in the fact that not only affects the intestine but also other organs, originating systemic manifestations which, occasionally, modify the evolution and therapy of these patients. Because of this fact, we try, in this work, to provide a general overview of the extra-intestinal pathology associated with Crohn's disease and ulcerative colitis.

Biliary Tract Diseases

[Articular manifestations of intestinal diseases].

The articular manifestations of the intestinal diseases can be quite variable affecting primarily either the pripheral joints, or sacroiliac areas and the spine. The presence of the haplotype HLA-B27 is associated in the majority of cases with the presence of spinal involvement. The treatment of the arthritis does not usually follow the natural history of the inflammatory bowel disease.

Arthritis

Intestinal disease and the urban environment.

Factors in the urban environments of highly industralized societies are important causes of disease. This review examines urban diseases of small and large intestine. The urban environment is pervaded by chemicals including drugs, food additives, pesticides, industrial products, etc., which are potential causes of disease. Examples of typical urban, as contrasted with rural, intestinal disease are considered in terms of differing etiological factors. Urban intestinal disease is examined from the following standpoints: the population at risk; the chemical agents to which the population is exposed; a model for the physiology of distribution and metabolism of chemicals in relation to the alimentary tract; the application of this model to treatment of an industrial disease; a major urban disease of the alimentary tract, carcinoma of the colon, considered in terms of this model; approaches to characterizing, identifying, and controlling urban intestinal disease.

Bacterial Infections

[The use of parietal pH-metry in the diagnosis of intestinal diseases].

Parietal measurements of pH values in patients with various intestinal diseases and in normal subjects have revealed that alkaline medium with gradual elevation of the values in the caudal direction is characteristics of the normal large intestine; acid pH values were registered in patients with lactase insufficiency, nonspecific ulcerative colitis, in contrast to those with post-dysentery colitis and tumors of the large intestine. Lactulose and sodium sulfate were found the factors that significantly influence the large intestine parietal pH values, the effects of wheat bran were lower; magnesium sulfate and sodium hydrocarbonate mineral water with medium mineral content had no effect on parietal pH values.

Colitis, Ulcerative

[Data on the biological characteristics of serological group O4 Escherichia isolated in acute intestinal diseases].

A study was made of 155 strains of E. coli of the O4 serological group isolated from sick children and adults during group and sporadic acute intestinal diseases), from persons who came in contact with them, and also from healthy persons during prophylactic examination; three standard cultures were examined as well. Along with strains with a typical enzymatic activity there were strains which produced retarded lactose fermentation and also gas-free, immobile and lysin-negative strains resembling Shigellae. Eight biochemical types were determined among E. coli 04. A study of the antigenic structure by cross agglutinin adsorption indicated identicity of the strains by O-antigen and their difference by the K- and H-antigens. Circulation of E. coli of serological types O4: K12(L): H1,O4: K3(L): H5,O4: K3(L): H12,04: K12(L): H40,04: K52(L): H4, and O4: K12(L) HII was revealed; the first two serological types prevailed. Serological types of O4: K3(L):H12, O4: K12(L): HI and O4: K12(L): H40, isolated in cases of group and sporadic acute intestinal diseases were described for the first time.

Acute Disease

[Study of the role of conditionally pathogenic enterobacteria in acute intestinal diseases].

Conditionally pathogenic enterobacteria were isolated in 34.2% of the patients with acute intestinal diseases (1559 cases examined in all). Such representatives of enterobacteria as Klebsiella, Hafnia, Citrobacter of 4, 8, and 22 serological groups. Proteus mirabilis of 6, 10, 13, 26, and 28 serological groups, and Proteus morganii mostly played the etiological role. In some of the patients conditionally pathogenic microbes only aggravated the main disease, taking part in the development of dysbacteriosis. In healthy individuals these microbes were much more rare and were encountered inconstantly.

Acute Disease

[Identification of conditionally pathogenic enterobacteria in laboratory practice in the diagnosis of acute intestinal diseases].

Identification of 361 cultures isolated from patients suffering from various acute intestinal diseasesand from persons who had sustained them, as well as from contacts and persons examined prophylactically with the use of various biochemical tests showed that ty their taxonomic properties the cultures were referred to conditionally-pathogenic representatives of Enterobacteriaceae of the corresponding genera:Citrobacter, Hafnia, Klebsiella, Proteus, Providencia. Serological typing of the strains of bacteria of the Citrobacter pointed to the most frequent circulation of the strains of the serological groups 04, 01, 03, 013, 05, 022, 08; among these groups 04, encountered among all the categories under study, prevailed. At the current stage of identification of conditionally pathogenic enterobacteria in practical laboratories it is of expedience to use in the diagnosis of intestinal diseases the serological typing along with a complex from several additional biochemical tests.

Citrobacter

HLA AW19, B12 in immunoproliferative small intestinal disease.

A group of 21 patients with immunoproliferative small intestinal disease (IPSID), 10 with alpha heavy chain paraproteinaemia and 11 without it, were HLA typed. The results were compared with 35 disease controls and 120 normal controls. A significant increase of Aw19 and B12 antigens was noted among the patients compared with the control subjects. The high rate of association of both AW19 and B12 antigens in patients as compared with controls suggests a possible haplotype (Aw19, B12) association with IPSID.

Adolescent

Hyperoxaluria and intestinal disease. The role of steatorrhea and dietary calcium in regulating intestinal oxalate absorption.

Hyperoxaluria was documented in patients with pancreatic insufficiency, adult celiac disease, regional enteritis after ileectomy and partial colectomy, and jejunoileal bypass. The degree of hyperoxaluria correlated directly with the severity of the steatorrhea and inversely with the dietary calcium content. High-calcium diets suppressed oxalate excretion to normal when fecal fat excretion was approximately 30 g/day or less. In patients with more severe steatorrhea, decreasing dietary fat and oxalate content further reduced urinary oxalate excretion. These data suggest that, while steatorrhea is the most important determinant for enhanced absorption of dietary oxalate, variations in dietary calcium content modulate the amount of oxalate absorbed.

Adult

Epidemiology of chronic intestinal disease in middle Africa.

Gastrointestinal disease in middle Africa is changing. The traditional patterns were high frequencies of parasitic and infectious diseases and sigmoid volvulus, and low incidences of colonic polyps, carcinoma of the colon, appendicitis, diverticulosis, ulcerative colitis and Crohn's disease. The current disease patterns are compared with those for gastrointestinal disease in developed countries and etiological factors are discussed.

Africa, Central

[Influence of a diet enriched with polyunsaturated fatty acids on some indices of the metabolism and course of acute gastro-intestinal diseases in children in the 1st year of life].

The influence of new products "Vitalakt" and "Malysh", enriched with polyunsaturated fatty acids, on the evolution of acute gastro-intestinal diseases and the lipids metabolism characteristics (total lipids, cholesterol and its ethers, phospholipids, nonetherified fatty acids in the blood serum), as well as on blood serum, protein fractions was studied. A total of 137 children were examined and the diet of 87 of them included the new dairy products "Vitalakt" and Malysh". These new dairy mixtures have been found to exert a beneficial effect on the course of the disease, tended to normalize the blood serum lipids characteristics and to reduce dysproteinemia. All this warrants recommending the mixtures "Vitalakt" and "Malysh" to be included in the diet of infants in the first year of life, suffering from acute gastro-intestinal diseases.

Cholesterol

[Role of E. coli 06 in the epidemiology of acute intestinal diseases].

The authors demonstrated the etiological role of E. coli 06 in group acute intestinal diseases with the clinical picture of food poisoning. The leading role of the food factor in the spread of this infection was established. A study was made of 64 E. coli 06 cultures isolated from the patients in group infection and from the carriers examined by various indications. The cultures produced no keratoconjunctivitis in guinea pigs. The capacity to produce enterotoxin was revealed in 2 of 5 cultures tested in experiments with the intranasal infection of albino mice.

Acute Disease

[Study of the antibiotic sensitivity of the Shigellae, pathogenic Escherichia, Proteus and Staphylococcus isolated from young children in Tbilisi with acute intestinal diseases].

Sensitivity of Shigella, pathogenic Escherichia, Proteus and Staphylococcus isolated from children with acute intestinal diseases was studied with respect to antibiotics widely used in medical practice: streptomycin, levomycetin, tetracycline, chlortetracycline, oxytetracycline and neomycin. The antibiotic sensitivity was determined with the method of indicator discs. It was found that sensitivity of shigella was: 44 percent to streptomycin, 69.5 per cent to levomycetin, 18.5 per cent to tetracycline, 18.5 per cent to chlortetracycline, 23 per cent to oxytetracycline and 94 per cent to neomycin. Sensitivity of pathogenic Eschericia was 28, 33, 14, 14, 25 and 74 per cent, sensitivity of staphylococci was 46, 56.5, 21, 21, 31.5 and 89.5 per cent, sensitivity of Proteus was 15, 31.5, 3.5, 3.5, 7.5 and 52.5 per cent respectively. Cross resistance with respect to tetracyclines was found in all the microbes studie. Intragenera differences in the antibiotic sensitivity were observed among Shigella and pathogenic Escherichia.

Acute Disease

[Etiologic interpretation of acute intestinal diseases].

The authors suggest a scheme for the detection of the etiologic factor of an acute intestinal condition; this scheme permits detecting dysbiotic changes in the microbiocenosis, finding pathogenic or opportunistic microorganisms in fecal culture. Classification of acute intestinal diseases into those induced by pathogenic and opportunistic microorganisms, as well as those resultant from acute imbalance of the normal ratio of intestinal bacteria helps carry out differential therapy of patients. The results of such bacteriologic studies may be useful for epidemiologists.

Acute Disease

"Mediterranean abdominal lymphoma" or immunoproliferative small intestinal disease. Part II: pathological aspects.

The pathology of 25 cases of Mediterranean abdominal lymphoma, better designated as immunoproliferative small intestinal disease (IPSID), are reported from the American University of Beirut Hospital. The series includes nine cases with documented alpha heavy chain disease (alpha-HCD). The disease is characterized by the presence of a diffuse and compact bandlike lymphoplasmacytic infiltration of the proximal small intestinal mucosa. The presence of a concomitant malignant lymphoma in the intestine and/or mesenteric lymph nodes, and of alpha-heavy protein in the serum is commonly encountered. Two histopathologic variants of IPSID are present. The first is characterized by the diffuse infiltration of the mucosa, at sites away from tumoral masses, by either pure plasmacytic infiltration, or mixed lymphoplasmacytic infiltration. This variety is associated with the immunoblastic sarcoma type of malignant lymphoma, and with alpha chain disease (alpha-HCD). The second variant is characterized by a diffuse follicular lymphoid hyperplasia pattern in the small intestinal mucosa. The associated malignant lymphoma is diffuse and undifferentiated often having a starry-sky pattern. This variety is not associated with alpha-HCD. Both histologic variants share the same clinical antecedents. In five patients, mesenteric lymph nodes harbored immunoblastic sarcoma while the intestinal mucosae of the same patients were involved with a benign appearing lymphoplasmacytic infiltration. This finding stresses the need for staging laparatomy. Three patients, with alpha-HCD, had peripheral lymph node involvement with immunoblastic sarcoma. The disease apparently evolves in two stages: an immunoproliferative phase, probably reversible, and a later development of malignant lymphoma. The term immunoproliferative small intestinal disease accurately describes the nature of the entity.

Female

[Bacteria of the citrobacter genus as one of the possible indeices of dysbacteriosis in intestinal diseases].

A study of the incidence of detection of bacteria of the Citrobacter genus in chronic intestinal diseases with the clinical and bacteriological manifestations of dysbacteriosis indicated that the mentioned conditioned pathogenic bacteria were revealed with the same frequency as bacteria of the Proteus genus which served as the commonly accepted index of intestinal dysbacteriosis. Comparative analysis of the intestinal microbial flora of the patients led to a supposition that bacteria of the Citrobacter genus could be found not only in the associations with other microbes, but also as a definite individual group of bacteria during the infectious disease and antibiotic therapy in case of disturbance of normal intestinal biocenosis; this could occur even in the absence in these patients of the known bacteriological indices of dysbacteriosis, thus becoming one of its manifestations.

Anti-Bacterial Agents