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PubMed1989

[Clinico-pathological re-examination on the first diagnosis as enterocolitis unclassified].

Sixteen surgical resected cases of "enterocolitis unclassified" diagnosed on the first pathological examination were re-examined. Their incidence was 3.0% of non-neoplastic bowel diseases registered in our department. On the re-examination including additional microscopic sections, histological reconstruction, special stainings and precise clinical data of each lesion, the 16 lesions were macroscopically divided to nine types and re-diagnosed as follows: (1) definite diseases: ulcerative colitis and phlegmonous enterocolitis, (2) probable diseases: intestinal tuberculosis and infective enterocolitis, (3) possible diseases: healed ischemic colitis, healed ischemic enteritis, healed infective colitis, and healed Crohn's disease or healed ulcerative colitis, (4) enterocolitis unclassified in a narrow sense. In conclusion, patho-morphologically the 16 lesions of enterocolitis unclassified might be subdivided into 13 lesions with the similarity to the already known inflammatory bowel diseases and three lesions with enterocolitis unclassified in a narrow sense.

Adult↗
PubMed1994

A case of radiation-induced rectal cancer developing after a long-term follow-up.

A case of radiation-induced rectal cancer is presented. In November, 1971, a 58-year-old woman had a stage II squamous cell carcinoma in the uterine cervix. She underwent a hysterectomy and postoperative radiotherapy. External pelvic irradiation of 10 MV x-ray was carried out in 15 fractions of 2 Gy daily, with a total dose of 30 Gy, and intracavitary radium insertion with a total dose of 960 mg hours (20 mg x 48 hours). She had been followed-up in our department since 1972, when rectal bleeding occurred. Proctoscopy and periodical biopsies were performed when the patient visited our hospital. There was no evidence of malignant tumor cells nor of recurrent cervical cancer from 1973 to 1989. In August, 1990, a biopsy specimen taken from a rectal ulcer revealed a malignant mucinous adenocarcinoma. The time interval between the radiotherapy and the development of the rectal cancer was 19 years. Microscopically, the main lesion was situated in the granulation tissue covered with the regenerating mucosal epithelium, and histologically was found to be a mucinous adenocarcinoma. Other radiation damage was additionally found including colitis, endarteritis and intestinal wall fibrosis. The evidence strongly suggested the present case to be one of radiation-induced rectal cancer.

Adenocarcinoma, Mucinous↗
PubMedDate not supplied

Antibiotic associated colitis.

It is a prospective study based on 100 consecutive cases of diarrhea following antibiotic therapy admitted to the pediatric services of J.N. Medical College, A.M.U., Aligarh between January to December 1987. They had C. penicillin (50), chloramphenicol (34), ampicillin (34), gentamicin (34), cephalosporin (4) and cotrimoxazole (4) for 3 days to 3 weeks prior to the onset of diarrhea. Apart from routine and special investigations, naked eye and microscopic examination of stool, its culture for pathogens including Cl. difficile were carried out in all cases. Presence of Cl. difficile cytotoxin was demonstrated by observing the cytopathic. Effect on veru cell culture, 18 grew Cl. difficile (14 cyto toxin positive). Frequency of fever, vomiting, abdominal distension, dehydration and duration of diarrhea was not different (p > 0.05) in the two groups. Purge rate and presence of mucus and blood in Cl. difficile positive patients was significantly higher (p < 0.05). Eight Cl. difficile positive (7 cytotoxin+ve) were subjected to endoscopy. Three of them showed P.M. colitis and 2 non specific colitis. Chloromycetin, gentamicin and penicillin were the main culprits responsible for AAC. None of the patients given ampicillin alone suffered from AAC. The mortality was 5%.

Anti-Bacterial Agents↗
PubMed1983

Neutropenic colitis and aplastic anemia: a new association.

Colitis is a life-threatening complication of aplastic anemia which occurs during periods of profound neutropenia. Four cases of this previously unreported association are described here. A syndrome of fever, watery diarrhea, and generalized abdominal pain and tenderness occurred in close temporal relationship to development of severe neutropenia (less than 50 neutrophils per cu mm). None of the patients had received antibiotics, nor had a history of previous episodes of colitis. Three had cultures positive for colonic organisms during the episodes. In only one instance was the correct diagnosis made without operation. Gross evidence of disease was found in the cecum, the transverse colon, and rectosigmoid in three patients, but the true extent of disease was underestimated. Microscopic examination of the two resected specimens showed extensive mucosal and variable submucosal necrosis with invasion of the colonic wall by bacteria. Acute inflammatory changes were absent. With profound neutropenia, the colon wall lacks resistance to invasion by the resident microflora. The condition is probably best treated without operation. If first recognized at laparotomy, resection should be avoided.

Adolescent↗
PubMed1990

Axonal damage in Crohn's disease is frequent, but non-specific.

We have attempted to confirm the claim by Dvorak and Silen that 'Crohn's disease is accompanied by a severe and extensive necrosis of gut axons...[which] may serve to differentiate Crohn's disease from other inflammatory conditions'. In this electron microscope study the diagnoses were withheld until the assessment of axonal damage was completed. We assessed the axonal damage in ileostomy biopsies in 13 cases of Crohn's disease, four cases of ulcerative colitis, and two 'controls'. In Crohn's disease we found a mean per cent of abnormal axons of 29.85, in ulcerative colitis of 21.25 per cent, and in the two 'controls' of 12.11 and 10.63 per cent, respectively. The difference between the 13 cases of Crohn's disease and the six cases of non-Crohn's disease is not significant. We found considerable numbers of abnormal, very small axons of uncertain nature but probably related to regeneration following surgery. Including or excluding such axons did not significantly alter the incidence of abnormal axons. We conclude that axonal damage is common in chronic inflammatory bowel disease and is not specifically related to Crohn's disease.

Axons↗
PubMed1996

Anti-lactoferrin autoantibodies: relation between epitopes and iron-binding domain.

Anti-neutrophil cytoplasm antibodies (ANCA) have been found in the sera of patients presenting systemic necrotizing microscopic vasculitis, i.e. Wegener's granulomatosis and microscopic polyangiitis. Lactoferrin (LF) is one of the antigens rarely recognized by ANCA, and anti-LF autoantibodies are found in several autoimmune conditions, including rheumatoid vasculitis, rheumatoid arthritis, systemic lupus erythematosus, ulcerative colitis, primary sclerosing cholangitis and Crohn's disease. We analysed the epitopes recognized by human anti-LF antibodies to test whether the heterogeneity of clinical presentation might be due to a different epitope recognition profile. Several monoclonal antibodies were raised and used in competition studies with six human sera. Four distinct epitopes were identified on LF, and LF binding of only one of six sera was inhibited by one of the monoclonals. Thus, anti-LF autoreactivity appears to be polyclonal and not restricted to an immunodominant epitope. Specific epitope profiles cannot be determined in these autoimmune conditions. We hypothesized that the interaction of anti-LF antibodies with the LF iron binding domain might contribute to pathogenesis by inhibiting iron chelation after neutrophil activation, thereby providing increased iron availability for endothelial cell damage. The relation of anti-LF mouse monoclonals or polyclonal human or rabbit antibodies to the LF iron-binding domain was studied in competition assays between 59Fe and these antibodies. Preincubation of LF with monoclonals or anti-LF human sera did not affect the binding of 59Fe on LF. 59Fe-binding kinetic studies showed that rabbit anti-LF polyclonal, but not mouse monoclonals or human anti-LF positive sera, was capable of inhibiting iron binding on LF. Therefore, anti-LF autoantibodies did not appear to modulate LF iron-binding activity. We conclude that LF is a rare antigen specificity for ANCA and that the clinical and pathophysiological relevance of anti-LF autoreactivity remains uncertain.

Antibodies, Monoclonal↗
PubMed1998

Is ileoscopy with biopsy worthwhile in patients presenting with symptoms of inflammatory bowel disease?

OBJECTIVE: To assess the value of adding ileoscopy with biopsy to colonoscopy, hence increasing the indications for ileoscopy in patients presenting with symptoms of inflammatory bowel disease. METHODS: Two hundred fifty-seven patients with persistent diarrhea and 43 patients with sporadic colonic polyps were studied prospectively. The final diagnosis based on clinical and follow-up data, the histology of multiple ileal biopsies, and endoscopic findings were analyzed. RESULTS: Endoscopic lesions of the terminal ileum were found in 123 of 300 patients. In the 43 patients with colonic polyps, no ileal lesions were seen. Ileal disease without colonic involvement was present in 44 of 123 patients. Microscopic lesions of the ileum were present in 125 of 300, or in 125 of 257 (49%) with symptoms of diarrhea. Two of these had a normal endoscopy. Thirteen patients had a diffuse colitis and 11 had a predominantly left-sided colitis, both originally suggestive of ulcerative colitis. Crohn's disease was diagnosed in 88 patients and infectious disease in 17. Ileal biopsies were essential for the diagnosis in 15 patients and were contributive in 53. Granulomas, solitary giant cells, pseudopyloric gland metaplasia, eosinophils, and a disturbed villous architecture were the most important lesions observed in Crohn's disease and were contributive for this diagnosis. CONCLUSIONS: Ileoscopy with biopsy is useful in carefully selected patients presenting with symptoms of inflammatory bowel disease. The main indications are diagnosis of isolated ileal disease in the presence of a normal colon and differential diagnosis in patients with pancolitis and predominantly left-sided colitis. Multiple biopsy specimens show definite pathology in almost half of the patients.

Adolescent↗
PubMed1997

Involvement of the appendix in pseudomembranous colitis.

Pseudomembranous colitis (PMC) is an inflammatory disorder usually limited to the large intestine and is the consequence of antibiotic associated Clostridium difficile overgrowth with production of its toxin. It has a characteristic gross and microscopic appearance. PMC-like changes, usually associated with peri-operative hypotension and with more extensive gastrointestinal tract involvement, have also been described. In neither clinical setting has pseudomembranous appendicitis been recorded. A case of pseudomembranous appendicitis in a 76 year old woman is described.

Aged↗
PubMed1996

Intestinal spirochetosis and giardiasis in a beagle pup with diarrhea.

This report describes the light microscopic and ultrastructural changes in a 3-month-old dog with naturally acquired intestinal spirochetosis and giardiasis. It was concluded that the pathogenetic characteristics of weakly beta-hemolytic spirochetes associated with colitis in this pup were similar to those associated with human and porcine spirochetal diarrhea.

Animals↗
PubMed2006

Neoadjuvant capecitabine and oxaliplatin followed by synchronous chemoradiation and total mesorectal excision in magnetic resonance imaging-defined poor-risk rectal cancer.

PURPOSE: To evaluate neoadjuvant capecitabine/oxaliplatin before chemoradiotherapy (CRT) and total mesorectal excision (TME) in newly diagnosed patients with magnetic resonance imaging (MRI) -defined poor-risk rectal cancer. PATIENTS AND METHODS: MRI criteria for poor-risk rectal cancer were tumors within 1 mm of mesorectal fascia (ie, circumferential resection margin threatened), T3 tumors at or below levators, tumors extending > or = 5 mm into perirectal fat, T4 tumors, and T1-4N2 tumors. Patients received 12 weeks of neoadjuvant capecitabine/oxaliplatin followed by concomitant capecitabine and radiotherapy. TME was planned 6 weeks after CRT. Postoperatively, patients received another 12 weeks of capecitabine. RESULTS: Between November 2001 and August 2004, 77 eligible patients were recruited. After neoadjuvant capecitabine/oxaliplatin, the radiologic response rate was 88%. In addition, 86% of patients had symptomatic responses in a median of 32 days (ie, just over one cycle of capecitabine/oxaliplatin). After CRT, the tumor response rate was increased to 97%. Three patients remained inoperable. Sixty-seven patients proceeded to TME, and all but one patient had R0 resection. Pathologic complete response was observed in 16 patients (24%; 95% CI, 14% to 36%), and in an additional 32 patients (48%), only microscopic tumor foci were found on surgical specimens. Four deaths occurred during neoadjuvant capecitabine/oxaliplatin therapy as a result of pulmonary embolism, ischemic heart disease, sudden death with history of chest pain, and neutropenic colitis. CONCLUSION: Capecitabine/oxaliplatin before synchronous CRT and TME results in substantial tumor regression, rapid symptomatic response, and achievement of R0 resection.

Adult↗
PubMedDate not supplied

[Acute pancreatitis complicating biliary distomatosis caused by Fasciola hepatica in a patient with a choledochal diverticulum].

A 43 years old man presented with acute pancreatitis following 13 years of mild grade hepatic colitis and angiocholitis. The absence of visible gall stone evocated the possibility of millithiasis. The operation discovered a big and hard head of the pancreas and an hypertrophied choledocal mucous membrane and the microscopic analysis of bladder's bile, ova of Fasciola hepatica. A control opacification on the 7th day revealed an adult fluke and a small diverticulum which were not visible on the roentgenogram at the time of the operation. Seven infusions of 60 mg de dehydroemetin permitted to eliminate the fluke with only a peak of fever. The diagnostic, pathophysiologic and therapeutic implications are discussed.

Acute Disease↗
PubMed1988

Reproducibility of counting immunoglobulin-containing cells in colonic mucosal biopsies.

Counting immunoglobulin (Ig)-containing cells in colonic mucosal biopsies can help to objectively support the differential diagnosis of ulcerative colitis and Crohn's disease. Before a method for counting Ig-containing cells can be applied in a clinical setting, however, its reproducibility must be determined. This study investigated the reproducibility of two different methods for counting such cells. The use of a light microscope with an ocular grid resulted in a slightly better reproducibility than did the use of a projection microscope with a graphics tablet. Moreover, the ocular grid method had a higher efficiency. The counting of IgM- and IgG-containing cells had a considerably higher reproducibility than did the counting of IgA-containing cells. To determine the minimal number of cells to be counted in order to ascertain a stabilized mean number of Ig-containing cells, the running means of counts of Ig-containing cells were calculated for two observers. When at least 600 Ig-containing cells (i.e., two to four fields) were counted, the interobserver variation of the running means was less than 10% for IgA and IgG counts and less than 5% for IgM counts. Since earlier studies showed differences in the counts of IgA-, IgG- and IgM-containing cells between ulcerative colitis and Crohn's disease to be, respectively, 3%, 25% and 28%, the results of the present study suggest that the proposed counting method can be useful in the differentiation between these entities.

Cell Count↗
PubMed2001

Lycopene supplementation attenuates the inflammatory status of colitis in a rat model.

The aim of this study was to examine the influence of lycopene and beta-carotene on the inflammatory status in a rat model of induced-colitis. Using the 2,4,6-trinitrobenzenesulfonic acid (TNBS) model, colitis was induced in thirty-two male Wistar rats divided into four groups. Each group received a different diet regime in parallel with the induction of colitis and was sacrificed after seven days. The groups were divided as follows: Group A: without colitis and fed a normal chow diet; Group B: induced with colitis and fed a diet supplemented with lycopene (300 micrograms/rat/day); Group C: induced with colitis and fed a diet supplemented with beta-carotene (300 micrograms/rat/day); Group D: induced with colitis and fed a normal chow diet. Colonic inflammation following TNBS induction was characterized by hemorrhagic necrosis and fibrosis of the mucosa, increased colonic wall thickness, infiltration of inflammatory cells, and increased myeloperoxidase (MPO) activity. Supplementation of lycopene in the diet had a beneficial effect on the various macroscopic parameters examined including: colonic thickness, colon weight, and total area of inflammation. Furthermore, the level of myeloperoxidase (MPO) was significantly lower in the lycopene-treated group compared to the control group. In terms of microscopic changes, a more attenuated inflammatory reaction was observed in the group fed a diet supplemented with lycopene. No significant effect was noted in the beta-carotene-supplemented group. Therefore, we propose that the dietary supplementation of lycopene may be an effective approach for reducing the level of oxidative stress and improving the inflammatory status of colitis.

Analysis of Variance↗
PubMed2000

Enhanced gastrointestinal diagnosis: light-scattering spectroscopy and optical coherence tomography.

Detection of microscopic and biochemical changes within the mucosa and submucosa are beyond the realm of routine endoscopy. Distinguishing hyperplastic from neoplastic polyps, differentiating malignant from benign ulcers, and detecting mucosal dysplasia in patients with ulcerative colitis or Barrett's esophagus remain within the purview of the gastrointestinal pathologist. Recent developments in tissue spectroscopy and endoscopic optical coherence tomography have the potential to expand significantly our ability to diagnose gastrointestinal disease beyond the capabilities of visible light endoscopy.

Barrett Esophagus↗
PubMed1999

Enhanced mucosal re-epithelialization induced by short chain fatty acids in experimental colitis.

The short chain fatty acids (SCFA) are the best nutrients for the colonocytes. Glucose is poorly used as a fuel but may be transformed into SCFA by colonic bacteria. The aim of this study was to investigate the effect of SCFA or glucose on experimental colitis. Colitis was induced in 30 Wistar rats by colonic instillation of 4% acetic acid. Five days later they were randomized to receive twice a day colonic lavage containing saline (controls, N = 10), 10% hypertonic glucose (N = 10) or SCFA (N = 10) until day 8 when they were killed. At autopsy, the colon was removed and weighed and the mucosa was evaluated macro- and microscopically and stripped out for DNA assay. Data are reported as mean +/- SD or median [range] as appropriate. All animals lost weight but there was no difference between groups. Colon weight was significantly lower in the SCFA group (3.8 +/- 0.5 g) than in the control (5.3 +/- 2.1 g) and glucose (5.2 +/- 1.3 g) groups (P<0.05). Macroscopically, the severity of inflammation was less in SCFA (grade 2 [1-5]) than in control (grade 9 [4-10]) and glucose-treated (grade 9 [2-10]) animals (P<0.01). Microscopically, ulceration of the mucosa was more severe in the glucose and control groups than in the SCFA group. The DNA content of the mucosa of SCFA-treated animals (8.2 [5.0-20.2] mg/g of tissue) was higher than in glucose-treated (5.1 [4.2-8.5] mg/g of tissue; P<0.01) and control (6.2 [4.5-8.9] mg/g of tissue; P<0.05) animals. We conclude that SCFA may enhance mucosal re-epithelialization in experimental colitis, whereas hypertonic glucose is of no benefit.

Acetic Acid↗
PubMed1996

[Current diagnosis, clinical course and treatment of acute colitis infection with Clostridium difficile].

Detection rate of G. intestionalis in feces with direct microscopy has been compared with the immuno-enzymatic technique detecting protein GSA 65 with Alexon Inc., ProSpec T/Giardia reagents kit. The results obtained with both methods have further been compared with those obtained by microscopic examination of the duodenal content. Detectability of Giardia intestinalis with EIA technique with the use of ready-made kit has been assessed. Feces have been collected from 371 patients. Protein GSA 65 has been present in 170 samples, 45.8%, examined with the use of ProSpec T/Gardia kit. Giardia intestinalis cysts have been detected microscopically in the feces of 37 patients, i.e. in 22.3%. Microscopic examinations carried out by three independent examiners have shown marked diversity in the rate of positive results, being 0.1% (examiner A), 28.6% (B), and 45.2% (C). Comparison of G. intestinale detectability of all 3 techniques used have shown absence of protein GSA 65 in 2 out of 9 examined patients. However, trophozoits have been present in the duodenal content. Test performed with kits made by Alexon Inc. and DIALAB have given 45.8% and 60.7% of the positive results, respectively.

Adult↗
PubMed1994

Morphological analysis of acute ulcerative colitis experimentally induced by dextran sulfate sodium in the guinea pig: some possible mechanisms of cecal ulceration.

This study in the guinea pig demonstrated that ulcerative colitis-like lesions were induced more rapidly and effectively than in other laboratory animals by the oral administration of dextran sulfate sodium (DSS). In all guinea pigs receiving 3% DSS solution, diarrhea was noted within 48h, and bleeding at 48-72h. Light microscopically, hemorrhagic and ulcerative lesions were observed in the cecum and proximal colon as early as 72h after administration. Lamina propria macrophages, gather in the subepithelial region under normal conditions, were markedly increased in number after DSS administration; by 96 h, they were approximately three times as many as in the control specimens. The cecal mucosa was also characterized, in earlier stages, by the obliteration of virtually all cryptal lumina because of the accumulation of mucous secretions, leading to the subsequent disappearance of the crypts. The obliteration of crypts, which preceded the increase of macrophages, is suggested to play a leading part in this ulceration.

Acute Disease↗