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Necrotic enteritis and regional ileitis are recognised causes of sporadic death in pigs. In both conditions, the intestinal mucosa harbours the bacterium, Campylobacter sputorum subsp mucosalis, which was first associated with procine intestinal adenomatosis.
One hundred seventy consecutive patients with clinical suggestion of acute appendicitis were studied by ultrasound (US) with the examiner using the graded compression technique. In 14 patients, the only US findings consisted of enlarged mesenteric lymph nodes in combination with mural thickening of the terminal ileum. This was consistent with the findings at surgery in four patients and with the results of barium studies in seven patients. In nine of 14 patients, stool cultures were performed, eight of which were positive for Yersinia enterocolitica. None of these 14 patients finally proved to have appendicitis. In a patient with acute pain in the right lower quadrant whose appendix cannot be visualized sonographically and whose US findings consist of enlarged mesenteric lymph nodes and mural thickening of the terminal ileum, the diagnosis is probably mesenteric adenitis and acute terminal ileitis. Appendectomy should be avoided in this condition.
Pregnancy-specific beta 1-glycoprotein (SP1) was assayed by particle-counting immunoassay (PACIA) with a sensitivity of 1 microgram/L. In serum from 50 men, the SP1 concentration was less than 1 microgram/L, whereas three of the specimens from 46 nonpregnant women had values exceeding 1 microgram/L. In 29% of 950 consecutive patients' sera, SP1 concentrations exceeded 1 microgram/L--in sarcoma (six of six), in malignant hemopathies (101/127, 80%) such as myeloma (20/26, 92%) and acute myeloblastic leukemia (23/27, 90%), and in various other types of cancer (11/19, 58%) except for bronchial epithelioma, which did not lead to any significant increase of SP1 in the five patients examined. The concentration of SP1 was also frequently increased in patients with Crohn's ileitis (28/43, 65%) but not in patients with other inflammatory disorders.
Starting with one case of acute granulomatous appendicitis of their own observation, the authors review the scant literature on the subject (only 23 published cases to date) and advocate systematic appendicectomy in all isolated appendicular localizations of Crohn's disease. On the grounds that no post-appendicectomy fistulization has ever been reported in such patients, the authors recommend prophylactic appendicectomy also in the far more frequent cases of acute ileitis, to forestall the possibility of evolution into chronic Crohn's disease and the risk of missing a nongranulomatous acute appendicitis appearing with the same clinical symptoms.
A case if ileorectal internal fistula during the course of regional ileitis is described. The clinical course and main forms of surgical managent are illustrated. The clinical, morphological and experimental pathological data indicated that this case should be classed as example of delayed hypersensitivity.
Morphological and histological changes were described in regional ileitis of pigs, which constitutes one of the forms of the complex of diseases referred to as intestinal adenomatosis of pigs. The most pronounced changes were concentrated on the ileum and were characterized, from the morphological point of view, by a distention of the intestinal wall and from the histological point of view, by proliferation of the epithelial cells of ileum, proliferation of the lymphatic tissue of tunica mucosae and submucosae, and hypertrophy of tunica muscularis. This disease has not been described in Czechoslovakia up to now.
A case of acute segmental inflammation of the terminal ileum in a female patient, who presented with signs and symptoms of acute appendicitis is reported. She had an associated bilateral pulmonary tuberculosis. The role of Mycobacterium tuberculosis in the etiology of the segmental ileal disease, and the relationship of the acute disease of the ileum to Crohn's disease is discussed. Henoch's purpura whose intestinal manifestations may mimic acute regional ileitis is discussed in the differential diagnosis.
The discussion on the differentiation of colitis ulcerosa and ileitis terminalis (M. Crohn) respectively has not as yet been settled in regard to their psychosomatic aspects. This study attempts to examine differences in the psychic manifestation occasionally discussed in the literature and in the clinical environment with the aid of psychological tests and data won by means of semi-standardized interviews. The results support the hypothesis that there are differences in the psychic structures of the patients from the two samples. Patients suffering from colitis ulcerosa show a closer resemblance to one another than the M. Crohn patients. The general impression is that they area "more normal" and better adjusted. Among the M. Crohn patients a difference must be made between an older, depressive part of the sample, and a younger, more active group with pronounced dependency conflicts. The connections with psychodynamic interpretations are discussed.
The differential diagnosis of diarrhea in patients infected with HIV is broad, and includes a variety of bacterial, viral, and parasitic pathogens, as well as malignancies including lymphoma and Kaposi's sarcoma. Idiopathic non-specific inflammatory bowel disease rarely occurs in association with HIV infection. A recent case report described a patient with longstanding Crohn's disease who experienced remission of his bowel disease upon infection with HIV (6). The authors inferred that the remission was secondary to a depressed CD4 (T helper) lymphocyte count. We report the first case of Crohn's ileitis developing in a patient with established HIV infection, depressed CD4 lymphocyte count, and no prior history of inflammatory bowel disease. This case raises questions about the role of CD4 cells in the pathogenesis of Crohn's disease.
Not all Crohn's ileitis perforations occur in the peritoneal cavity; a proportion of them, which may be theoretically calculated as about 8%, occurs between the two leaves of the mesentery. These mesenteric perforations (which perhaps may be called more properly "penetrations") produce their pathological consequences in three consecutive anatomical compartments: 1) between the two leaves of the mesentery, causing mesenteric abscesses which are very dangerous, especially because of their embolisation into portal vessels (pylephlebitis, hepatic abscesses); 2) in the lower right quadrant of the retroperitoneum, causing what we call "Mesenteric Insertion Retroperitoneal Syndrome" (MIRS), consisting of a collection producing genito-femoral neuralgia, psoitis, obstructive uropathy and iliofemoral thrombophlebitis; 3) out from the pelvis, causing collections which in their spreading recall the cold abscesses of Pott's disease and which, diffusing along muscles and nerves, reach Scarpa's triangle, or the buttock and popliteal space.
Pseudotumor of the urinary bladder and intestino-vesical fistula caused by regional ileitis (Crohn's disease) and diverticulitis require radical en bloc resection. The authors present their own procedure.
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