[Intestinal diseases. Everyday gastrointestinal problems in general practice].
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Behçet's disease (BD), when first described in 1937, consisted of three symptoms: recurrent oral and genital ulcerations and iridocyclitis. Today, it is known that BD is a multisystemic chronic vasculitic disorder which may involve both arteries and veins of all sizes, as well as the central nervous and gastrointestinal systems. The rate of gastrointestinal involvement of BD varies in different populations, being more common in Japan (50%-60%) and less common in the Mediterranean basin, including Turkey (0%-5%). We present a 34-year-old Turkish woman with BD who had ileal and colonic ulcerations complicated by perforation and gastrointestinal bleeding. Special emphasis was placed on the differential diagnosis between Crohn's disease (CD) and BD with gastrointestinal involvement.
Lysozyme levels were determined in the mucosa of gut in 80 children with chronic inflammatory bowel disease, malabsorption and acrodermatitis enteropathica.l Levels of lysozyme in the mucosa of colon were found to be significantly higher in cases with chronic inflammatory bowel disease, whereas in children with malabsorption (celiac disease) concentration of lysozyme in the mucosa of small intestine were significantly lower compared to a control group. In a 4 months old boy with acrodermatitis enteropathica there was a low level of lysozyme in the mucosa of the small intestine. After therapy with zinc for one year concentration of lysozyme was normalized.
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The levels of unsulfated, free or conjugated cholic, deoxycholic and chenodeoxycholic acids were measured using gas chromatography in 39 humans free of hepatic or intestinal diseases before and 10, 60, 120 and 180 min after ingestion of a standard meal. The probable maximal levels were determined with an error risk lower than 0.05. In fasting subjects, the observed values are comparable with those obtained by other authors working with gas chromatography or radioimmunoassay. Meal ingestion does not influence in the same way the serum levels of the various bile acids: the chemodeoxycholic serum level rose significantly in all cases whereas cholic and deoxycholic serum levels rose only in two-thirds of observed subjects; 60 and 120 min after the meal for chenodeoxycholic acid, and only 60 min after the meal for cholic acid, the mean values are significantly higher than the fasting ones; 120 min after the meal, the chenodeoxycholic and total bile acid probable maximal levels (respectively 7.4 and 10.3 micrometer) are twice the fasting ones. The cholic to chenodeoxycholic serum level ratio is nearly always lower than 1 but may reach 3. On the basis of these results, the validity and efficacy of the exploration tests based on serum bile acid level determinations are discussed.
Intestinal disorders in infants are determined in 96.9% of cases by the opportunistic flora with the predominance of Pr. mirabilis (25.5%), E. coli (19.1%), Enterobacter aerogenes (12.6%) and with the less frequent occurrence of Klebsiella (4.1%) and pathogenic staphylococci (5.8%). As a result of the unbased use of antibiotics, the majority of children demonstrate dysbacteriosis and the growth of the number of resistant hospital strains. It is suggested that in children with ARVI, the drugs containing lactic acid bacteria and lactose should be used on a wider basis to prevent dysbacteriosis and reduction of resistant strains.
The three most common inflammatory diseases of the bowel, colonic diverticulitis, regional enteritis and ulcerative colitis, involve the bladder or ureter in the advanced stage in about 10%. The colovesical fistula is found more frequently with diverticulitis and less often with regional enteritis, which penetrates predominantly from the ileum into the bladder. On the other hand, if an ureteric stenosis develops, it will be caused on the right side mainly by regional enteritis and on the other side by ulcerative colitis. The vesicointestinal fistulae will close without sequelae after resection of the involved bowel segment. However, the ureteric stenosis will often be followed by nephrectomy despite bowel resection and ureterolysis, if the operation is not undertaken early enough. Frequent rechecks with infusion urography should help to prevent this. Nephrolithiasis, amyloidosis, and a contracted bladder are futher, yet less common complications of chronic inflammatory disease of the bowel.
Twenty-two cases of immunoproliferative small intestinal disease (IPSID) were studied with an immunoperoxidase technique. Sixteen of these had serologic evidence of alpha heavy chain disease (AHCD) and have a characteristic immunochemical pattern that allows a diagnosis on jejunal biopsy. kappa-light chain was found in a case of AHCD in the benign appearing plasma cell proliferation and in the associated malignant lymphoma suggesting that failure of light chains is not constant in AHCD. Four cases of IPSID showed secretion of polyclonal IgA in the plasma cell infiltrate providing evidence that some cases may be associated with secretion of complete IgA molecules. This polyclonal pattern is suggestive of a reactive process. Two cases of IPSID without evidence of AHCD showed an immunohistochemical pattern characteristic of AHCD and may represent nonsecreting forms of the disease. Alternatively they may be secreting nondetectable amounts of AHCD protein or an abnormal protein not recognized by standard antisera.
PURPOSE: To review the recent progress in the understanding of clinical and laboratory characterization as well as management of immunoproliferative small intestinal disease (IPSID). DATA IDENTIFICATION: A literature search was conducted using Index Medicus, MEDLINE (1962 to 1989), and bibliographies of identified relevant articles. STUDY SELECTION: All international comprehensive reviews, reported epidemiologic or immunologic studies, and prospective clinical trials published or abstracted in English were selected. RESULTS OF DATA SYNTHESIS: A high incidence of lymphoma primarily in the gastro-intestinal tract in Third World countries has stimulated enormous epidemiologic and pathogenetic interests globally. IPSID, with a distinctive biologic marker (alpha heavy chain para-protein), affects the young underprivileged population of those countries. The initially benign-appearing antibiotic-responsive immunoproliferative lesions often evolve to fatal high-grade lymphomas. Roles of environmental and host factors in this evolutionary course are emerging. Recently demonstrated malignant potentials form the early onset of pathogenesis have given a new dimension to the traditional management strategy of IPSID. CONCLUSIONS: Epidemiologic, immunologic, and pathogenetic data that have emerged over the last 25-year study of IPSID have improved our understanding about the complexity of infection-immunity-cancer interrelationships, comparable to those that have arisen from the study of the acquired immunodeficiency syndrome. Early detection and institution of antimicrobial-based treatment regimens with judicious and consistent follow-up can save the lives of many young patients whose manpower is badly needed in Third World countries.
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Theophylline pharmacokinetics was investigated upon introduction of euphylline (0.15 g) at four levels of gastrointestinal tract: orally (20 patients), into the jejunum (15 patients) at enterogastroduodenoscopy, in the ileocecal area (8 patients) at colonoscopy and rectally (9 patients). Absorption speed depended on the variant of the gastrointestinal introduction rather than on the variant of chronic nonspecific intestinal disease, and appeared maximal in the drug introduction into the jejunum. Concentration and area under curve became maximal in minor participation of the liver in primary capture and biotransformation of theophylline. Reduced theophylline doses are recommended in lower hepatic metabolism of the drug, in hepatic hypofunction, in rectal route of administration.
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