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Biomedical subjects

K Geboes

Publications and source records attributed to K Geboes.

At least 145 records · Page 8Linked to original sources
PubMed1995

Controlled trial of metronidazole treatment for prevention of Crohn's recurrence after ileal resection.

BACKGROUND/AIMS: New lesions recur within weeks to months after ileal resection and ileocolonic anastomosis for Crohn's ileitis. A double-blind controlled trial was performed using metronidazole to prevent recurrence after ileal resection. METHODS: Sixty patients who underwent curative ileal resection and primary anastomosis were included within 1 week after surgery. Thirty patients received metronidazole (20 mg/kg body wt) daily for 3 months, and 30 patients received placebo. Treatment was then discontinued. Nine patients dropped out during treatment, 7 in the metronidazole group and 2 in the placebo arm. RESULTS: At 12 weeks, 21 of 28 patients (75%) in the placebo group had recurrent lesions in the neoterminal ileum as compared with 12 of 23 patients (52%) in the metronidazole group (P = 0.09). The incidence of severe endoscopic recurrence was significantly reduced by metronidazole (3 of 23; 13%) as compared with placebo (12 of 28; 43%; P = 0.02). Patients in the metronidazole arm had more frequent side effects. Metronidazole therapy statistically reduced the clinical recurrence rates at 1 year (4% vs. 25%). Reductions at 2 years (26% vs. 43%) and 3 years (30% vs. 50%) were not significant. CONCLUSIONS: Metronidazole therapy for 3 months decreases the severity of early recurrence of Crohn's disease in the neoterminal ileum after resection and seems to delay symptomatic recurrence.

Adult↗
PubMed1995

Anti-Leu-19 is a marker for nervous tissue in the mucosa of the human rectum.

Despite numerous investigations on the enteric nervous system, the knowledge about the mucosal innervation of the human rectum and colon is very shallow and mainly based on ultrastructural studies. We performed an enzyme (NADH-Ach) and immunohistochemical (NF, synaptophysin, anti-Leu-19) study on cryostat sections of the human rectal mucosa in order to study the possible additional characteristics of the mucosal innervation in depth. Enzyme histochemistry reveals positively staining fibers in the muscularis mucosae. Staining with antibodies against neurofilaments and synaptophysin reveals positively staining fibers in the lamina propria and muscularis mucosae. The latter staining is comparable with the findings obtained with anti-Leu-19. The monoclonal antibody anti-Leu-19 is characterized by a nerve-like staining in the mucosa revealed by nerve-like fibers from the plexus submucosus internus (Meissner) penetrating the muscularis mucosae, and creating a real plexus of fine twisted fibers in the lamina propria, around the crypts and underneath the epithelium. The distribution of the mucosal nerve-like pattern in the areas with mucosa-associated lymphoid follicles differs from the pattern observed in the lamina propria in between. Since the monoclonal antibody anti-Leu-19 and the monoclonal antibody NKH1a show a great similarity, we were interested also in the possible relation between the nerve like mucosal staining pattern and the lymphocytic population. Comparing the distribution pattern of anti-Leu-19 with other lymphocytic markers, there was an apparent similarity with the distribution of the T-helper subgroup. Our data indicate that the monoclonal antibody anti-Leu-19 shows a nerve-like staining pattern in the mucosa.

Adult↗
PubMed1995

Laxatives and intestinal epithelial cells: a morphological study of epithelial cell damage and proliferation.

Experimental studies indicate that anthranoid laxatives may induce epithelial damage. In addition they induce the release of prostaglandins. Epithelial cell damage and release of prostaglandins are two pathways by which epithelial cell proliferation could be influenced. Other laxatives including fermentable laxatives like lactulose may also influence large intestine cell proliferation by the trophic effect of the fermentation products such as short chain fatty acids. For these reasons an in vitro study was performed on human intestinal epithelial cells in culture to investigate the direct damaging effect of rhein anthrone. Ultrastructural examination showed a dose dependent direct damage. In addition an in vivo study in rats was performed to compare the short and long term effect of sennosides, bisacodyl, sodium picosulphate and lactulose on epithelial cell proliferation in the ileum and large intestine. Cell proliferation was examined by the BrdUrd labeling technique after 2, 6 and 12 weeks of continuous treatment. Studies in control animals show that the Labeling Index (LI) is higher in the caecum compared with other segments of the colon, and higher in the ileum than in the colon. Treatment with sennosides, bisacodyl and sodium picosulphate does not influence the LI in the ileum and induces no statistically significant increase of the LI when the treated groups are compared with the control group at the end of the study. The proliferative pattern along the crypts remains unchanged with all the laxatives throughout the study. It appears therefore that 'contact' laxatives have no major influence on ileal and colonic epithelial cell proliferation.

Animals↗
PubMed1995

Intermittent subobstruction and cholestasis as complications of duodenal amyloid tumours.

Amyloidosis confined to the duodenum is uncommon. In the present report the history of an 83-year old patient, admitted for vomiting and heavy epigastric pain, is described. Radiographic and endoscopic investigation revealed two polypoid lesions in the duodenum (D2). Biopsies showed diffuse amyloid deposition in the lamina propria, muscularis mucosae and submucosa of the duodenum as well as vascular deposits. No other localisations were documented. Amyloid tumours of the gastrointestinal tract are rare but may lead to serious symptoms.

Aged↗
PubMed1994

Surgical treatment of Barrett's carcinoma. Correlations between morphologic findings and prognosis.

Barrett's carcinoma occurred in 66 of 331 patients with adenocarcinomas of the esophagus or gastroesophageal junction. Only 32 (46%) of these patients had a history of gastroesophageal reflux. A history of alcohol and tobacco abuse was absent in 50% and 47.5%, respectively. The mean length of Barrett's metaplasia was 7.37 cm. Operability was 98.5% and resectability 95.5%. No postoperative or hospital deaths occurred. Pathologic staging was as follows: stage 0 and I, 38.3%; stage II, 20.6%; stage III, 22.2%; and stage IV, 19%. Overall survivals were 80.5% at 1 year, 62.7% at 2 years, and 58.2% at 5 years. Five-year survival for patients with stage I disease was 100%; for stage II, 87.5%; for stage III, 22.2%; and for stage IV, 0%. Thirty-four (51.5%) patients were under surveillance for a related or unrelated condition before diagnosis of their carcinoma; only nine (26.5%) had diseased lymph nodes. In 32 the diagnosis was made at their first medical contact, and 78% of them had diseased lymph nodes. Five-year survival without nodal metastasis was 85.3% and significantly better than for patients with metastasis, 38.3% (p = 0.0033). Of the 66 patients, 19 (28.7%) had a biopsy-proved history of Barrett's metaplasia before malignancy developed. Mean time interval between diagnosis of metaplasia and degeneration was 3.8 years (89.5% > 1 year). Over the surveillance period, the length of metaplastic Barrett's esophagus remained unchanged in all patients. Barrett's ulceration was present from the beginning in 14 patients, and three patients never had an ulcer. Intestinal metaplasia was seen in 18 patients. Resected specimens revealed severe dysplasia in 16 patients. Of the 19 patients, 73.7% had stage I disease. Our data suggest that close endoscopic monitoring and systematic biopsies of the smallest irregularities in the metaplastic mucosa may result in early detection of carcinoma. In this respect, patients with an ulcer within a zone of intestinal metaplasia seem to be at risk. Early detection increases substantially the chances for cure by diminishing the risks of lymph node involvement. Resection remains the treatment of choice in Barrett's adenocarcinoma including high-grade dysplasia, because mortality can be kept low with excellent to very good functional results in the majority of the patients provided the intervention is performed by experienced teams.

Adenocarcinoma↗
PubMed1994

Increased permeability of macroscopically normal small bowel in Crohn's disease.

To investigate permeability alterations of the macroscopically normal jejunum in Crohn's disease, the permeation of two probes was measured during perfusion of an isolated jejunal segment. The data were compared with the results obtained by the standard per oral test in the same patients. Test probes were PEG-400 and [51Cr]EDTA. Ten normal individuals, 12 patients with Crohn's ileitis or ileocolitis, and seven patients with isolated Crohn's colitis all with normal jejunum on x-ray series were studied. Upon perfusion of the proximal small bowel, the 3-hr [51Cr]EDTA excretion was significantly increased in ileitis patients (P = 0.023) as compared to normals. The excretion exceeded the highest value of normals in eight of 12 ileitis patients. The excretion in Crohn's colitis patients was not significantly increased (P = 0.24) and abnormal excretion was found only in one of the Crohn's colitis patients. PEG-400 permeation during perfusion did not differentiate between the groups, but five of the seven patients with isolated Crohn's colitis had PEG-400 excretion exceeding the highest value in normals. Overall, 13 of the 19 patients had increased permeation of one of the two probes through jejunal mucosa during perfusion. These data suggest that the permeability is increased in the majority of patients even in segments that seem normal on x-ray.

Adult↗
PubMed1994

Appendectomy protects against ulcerative colitis.

BACKGROUND/AIMS: Defining risk factors for ulcerative colitis (UC) is important to better understand the pathogenesis of this idiopathic disease. One factor modulating the disease is smoking. A pilot study showed the absence of appendectomy in the medical history of patients with ulcerative colitis. The aim of the present case control study was to compare the relative risk of developing UC after appendectomy with the relative risk of developing UC with an intact appendix. METHODS: One hundred seventy-four (84 females and 90 males, mean age 34.9 years) consecutive UC patients examined at our inflammatory bowel disease clinic or hospital ward, were included. Fifty-six had pancolitis (32%) and 118 (68%) suffered from left-sided colitis. The control group consisted of 161 consecutive patients examined at the orthopedic clinic (86 females and 75 males, mean age 40.9 years). RESULTS: Two parameters, absence of appendectomy and smoking, were closely related to the development of UC. Before the onset of UC, only 1 of the 174 patients (0.6%) had undergone an appendectomy. Of the 161 controls, 41 (25.4%) had undergone an appendectomy. The difference between the two groups was highly significant with an odds ratio of 59.1 (95% CI, 18-189; P < 0.001). The relative risk of getting the disease associated with nonsmoking was 2.95 (95% CI, 1.69-5.17). CONCLUSIONS: Appendectomy is a protective factor against UC.

Adolescent↗
PubMed1994

In vivo cell kinetic measurements in human oesophageal cancer: what can be learned from multiple biopsies?

The importance of intratumour variability of cell kinetics was studied in 60 patients with cancer of the oesophagus. Five biopsies per tumour were taken. The labelling index, S-phase duration and potential doubling time (Tpot) were measured using flow cytometry. The mean Tpot value was 5.56 +/- 4.43 days (+/- 1S.D.) for adenocarcinomas and 4.40 +/- 2.45 days (+/- 1S.D.) for squamous cell carcinomas. These values were statistically significantly different. Although intratumour variation in Tpot measurements occurred, the intertumour variability was more important (P < 0.00001). This feature permits classification of tumours into slow and fast proliferating groups, leaving an intermediate group of tumours that could not be unequivocally categorised. The relative distribution of tumours into these three categories depends on the intratumour and intertumour variability of Tpot, and on the cut-off values used. Increasing the number of biopsies from one to five reduces the number of non-classifiable tumours.

Adenocarcinoma↗
PubMed1994

Three cases of non-tumoural tight stenosis of the bifurcation of the hilar bile ducts.

Stenosis of the bifurcation of the hepatic bile duct is usually caused by malignant lesion. We report on three different causes of benign stenosis of the hepatic confluence with a similar radiological pattern on direct cholangiography. The first case is considered a spontaneous neuroma, the second a periductal abscess, and the third case a postoperative stricture Bismuth type 4.

Adult↗
PubMed1994

Test conditions greatly influence permeation of water soluble molecules through the intestinal mucosa: need for standardisation.

Permeability tests are widely used to investigate the pathogenesis of various gastrointestinal diseases including coeliac disease, infectious diarrhoea, and inflammatory bowel disease. In Crohn's disease they are used as activity parameters by some investigators. Lack of standardisation, however, makes it very difficult to compare data reported in different studies. The aim of this study was to gather permeation data in well controlled test conditions to standardise the methods. Nine healthy volunteers each received five consecutive permeability tests by mouth using polyethylene glycol-400 (PEG-400) and 51Cr-EDTA as probe molecules. The probes were dissolved in water, a glucose solution, a starch solution, a hyperosmolar lactulose-mannitol solution, and a liquid meal. A significantly decreased permeation for both probes was found when given with the hyperosmolar solution. The 51Cr-EDTA permeation was also decreased with water. The permeability index, 51Cr-EDTA/PEG-400, corrected for influencing factors, confirmed that the lactulose-mannitol solution and plain water yield lower values of macro-molecule permeation than starch, glucose or liquid meal. Hyperosmolarity was clearly accompanied by a decrease in permeability probably caused by reversed solvent drag. Interindividual variability of probe permeation and permeability index is very low with a standard liquid meal. It is proposed that for permeability studies a standard liquid meal is always used.

Adult↗
PubMed1994

Depressed T cell reactivity to recall antigens in Crohn's disease before and after surgical resection.

Earlier studies regarding possible primary immune disturbances participating in the pathogenesis of Crohn's disease yielded conflicting results. Peripheral blood lymphocyte subsets and lymphocyte proliferative responses to five soluble recall antigens and to the polyclonal stimulator phythaemagglutinin were therefore measured in 17 patients with active Crohn's disease, before and six months after surgical resection of the inflamed intestine and in 16 healthy controls. Lymphocyte proliferation in response to all five recall antigens was significantly lower in patients than in controls. No significant differences with controls were detected after surgery. Addition of indomethacin to phythaemagglutinin stimulated lymphocyte cultures had a stronger proliferation enhancing effect in patients than in controls, resulting in comparable proliferative responses in both groups. When both indomethacin and prostaglandin E2 were added, inhibition of reactivity by prostaglandin E2 was stronger in patients' cultures. This suggests a higher sensitivity to inflammatory prostaglandins in Crohn's disease. The degree of lymphocyte stimulation by antigens correlated positively with the percentage of circulating memory T cells (CD 45 RA-). The percentage of activated (HLA-DR+) CD8 cells was higher in patients than in controls. The CD4/CD8 ratio, which was not significantly different between patients and controls, correlated significantly with disease activity and characteristics, even in the postoperative phase. These findings suggest that immune abnormalities in Crohn's disease fluctuate with and are probably secondary to inflammatory activity.

Adult↗
PubMed1994

Collagenous and microscopic colitis: clinical importance.

Minimal-change colitis and microscopic colitis are clinicopathological terms for diarrhoea with normal endoscopic or barium enema findings. Some controversy about the exact definitions and terminology still exists. Some forms of minimal-change colitis may overlap with "self-limited" colitis (infectious colitis) or may be due to (surreptitious) use of laxatives or other drugs. In recent years it has become clear however that some genuine forms of chronic colitis can be diagnosed only by microscopic examination of multiple colonic biopsies while macroscopy is negative and hence can be called "microscopic colitis". Collagenous colitis and lymphocytic colitis are at present two forms of this type of colitis which are more or less well defined both clinically and pathologically. Chronic watery diarrhoea is the main symptom for both. The symptoms of collagenous colitis appear most commonly in the sixth decade. Women are affected about 4 times more frequently than men. The major microscopic characteristic is a thickened collagen layer underneath the intercryptal surface epithelium. The major characteristic of lymphocytic colitis is an increase in number of interepithelial lymphocytes. Both conditions are characterized by signs of mucosal inflammation. Clinically, collagenous colitis is characterized by long-lasting diarrhoea. In patients with lymphocytic colitis the period of chronic diarrhoea is usually shorter and female predominance is less apparent. Although the natural history of these forms of colitis is not precisely known, it appears from the data thus far published that the long-term consequences are unlikely to be dire. The true incidence, aetiology and pathogenesis are unknown for both conditions and treatment is unclear.(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy↗
PubMed1994

Imaging of polypoid endoluminal growing bile duct tumors.

We reviewed the radiological documents and protocols of 196 cases of bile duct tumors examined over a period of 12 years: 20 of them (10.2%) presented with a polypoid endoluminal growth. The aim of this study was to provide a better knowledge about the radiological features of this less frequent kind of tumor. In these 20 cases, the correct diagnosis of bile duct lesion was provided in 100% by E.R.C.P., P.T.C., U.S. as well as C.T., and in 42% by arteriography. The correct diagnosis of tumor was made by E.R.C.P. in 86%, by P.T.C. in 88%, by U.S. in 61%, by C.T. in 63%, and by arteriography in 25%. A correct diagnosis of tumor could be reached in all cases by combination of several examination techniques. The anatomopathological diagnosis was: bile duct adenocarcinoma (7 cases), adenocarcinoma of the ampulla of Vater (4), villous adenoma of Vater's ampulla (2), cystadenoma (1), cystadenocarcinoma (1), hepatocellular carcinoma (1), apudoma (1), and metastases (3).

Adenocarcinoma↗
PubMed1994

Adenocarcinoma of the rectum with a solitary metastasis to the urethra in a female.

Adenocarcinoma of the urethra is extremely rare, constituting 10 to 20% of all primary urethral malignancies in women. As in men, the squamous carcinoma accounts for 70% of all urethral tumours. Adenocarcinomas are mostly primary lesions, originating from the paraurethral glands. A case is reported about a female patient, presenting with a mucinous urethral adenocarcinoma, presumably secondary to a primary rectal adenocarcinoma.

Adenocarcinoma, Mucinous↗
PubMed1993

Conventionalization of germ-free rats reverses the disability of rhein anthrone to induce laxation.

This study shows that rhein anthrone has no laxative potency in germ-free rats because after intracaecal administration of a dose of 50 mg/kg the large intestine transit exceeded 240 min. The time course of the laxative potency of rhein anthrone injected intracaecally was evaluated after peroral inoculation of germ-free rats with the caecal contents of conventional rats. Large intestine transit was measured at consecutive periods, on days 0, 1, 2, 3 and 5 after peroral inoculation. It appeared that 1 day after peroral inoculation the laxative potency of rhein anthrone was already established (large intestinal transit < 10 min) and laxation remained on the following days (days 2, 3 and 5). We concluded that rhein anthrone is inactive in germ-free rats and acquires laxative potency after peroral inoculation of germ-free rats with caecal contents of conventional rats.

Animals↗