Antihypertensive effects of nifedipine gastrointestinal therapeutic system on clinic and ambulatory blood pressure in essential hypertensives. Italian GITS Study Group.
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Blood Pressure↗
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Results for “GASTROINTESTINAL SYSTEM”
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[Occurrence of sexual abuse of children referred to a pediatric department over a 5-year period].
The study concerns 287 children, who were referred to and examined by the paediatric department's clinical psychologist. Evidence of sexual abuse was observed in 29 of the children (23 girls and 6 boys). Sexual abuse was initially suspected in 15 children; the suspicion was confirmed in 11 cases and rejected in four cases. The remaining 18 patients had been admitted because of somatic complaints and sexual abuse was later uncovered in the psychological examination. The somatic problems originated in different organ systems: Five from the gastrointestinal system, five from the urogenitary system, three from the endocrinological system, two from the locomotor system, two enuresis/encopresis and one from the central nervous system. Sexual intercourse was completed in seven cases, four with vaginal abuse and three with anal abuse. Four children were subjected to oral abuse. Sexual abuse through touching was cited in 14 cases. In all cases the children were abused on more than one occasion. In 65% the perpetrator was a family member. The perpetrator in five cases were 15 year old boys. Sex, age, nature of abuse, and frequency is described. Sexual abuse within the family is described. It is concluded that sexual abuse was found in 10% of 287 children referred to the psychologist in a paediatric department during the period from 1988-1992. Sexual abuse as a diagnosis must be considered in situations with uncertain pathological pictures, behavioral changes and problems in learning. It is important to know the different types of sexual abuse and their expression in children. Maternal abuse was often seen.
Adolescent↗
[Changes in the locomotor system in gastrointestinal diseases].
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Adult↗
[The immune system and gastrointestinal diseases].
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Bone Marrow↗
Systemic mastocytosis mimicking inflammatory bowel disease: A case report and discussion of gastrointestinal pathology in systemic mastocytosis.
Gastrointestinal (GI) symptoms are present in up to 80% of patients with systemic mastocytosis (SM). GI symptoms include mainly abdominal pain, diarrhea, nausea, and vomiting. It is believed that most of the GI symptoms are due to the secondary effect of mast cell mediators on the GI tract. Direct involvement of the GI tract by neoplastic mast cell infiltration has not been well documented. We report a case of SM that initially mimicked inflammatory bowel disease based on clinical, radiographic, endoscopic, and histopathologic findings. On routine histologic sections of small bowel and colonic mucosal biopsies, there was expansion of the lamina propria by mononuclear inflammatory cells, foci of erosions with associated acute inflammation, and evidence of chronic mucosal injury with architectural distortion and gland foreshortening. Only on repeat biopsies and with ancillary tests for mast cells was a diagnosis of SM made, with extensive involvement of the GI tract. This is the first reported case of SM presenting as and mimicking inflammatory bowel disease. It is critical that clinicians and pathologists are aware that neoplastic mast cells in patients with SM can infiltrate the mucosa throughout the GI tract and that this infiltration can lead to symptoms and findings that can mimic inflammatory bowel disease.
Colonoscopy↗
Histochemical characterization of carbohydrate residues during the morphogenesis of gastrointestinal and respiratory systems of Caretta caretta.
The distribution of carbohydrates in the gastrointestinal and respiratory tract of Caretta caretta during embryogenesis and postnatal development was investigated by histological and histochemical techniques and using fluorescein-labelled lectins. The results indicate that the compartmentalised expression of glycoconjugates found in the juvenile Caretta caretta is acquired during development. The occurrence of neutral carbohydrates in cells and extracellular matrix was dependent on the developmental stage of the animal. In general, periodic acid Schiff positive glycoconjugates of the respiratory tract occurred at an earlier stage of development than those from the gastrointestinal system. The lectin binding pattern of both organ systems revealed a more refined pattern of the types of carbohydrates present during development. Wheat germ agglutinin showed the broadest binding pattern, whereas Soy bean agglutinin and phythaemagglutinin were more limited in their binding to tissue structures. The terminal carbohydrates detected in the gastrointestinal and respiratory tract of Caretta caretta were similar to those observed in mammals; this finding emphasises the suitability of Caretta caretta as a model system for amniote development.
Animals↗
Eosinophilic gastroenteritis: a problem of the mucosal immune system?
The gastrointestinal immune system is a major component of the mucosal barrier, which provides an appropriate immunologic homeostasis between host and numerous foreign antigens, including microbial and dietary antigens. However, under certain pathological circumstances created by disturbance of the immunologic balance, allergic responses associated with the gastrointestinal tract can be triggered by abnormal immune responses against selected food protein antigens. Among the several types of immune competent cells, eosinophils are generally considered to play a central role for the development of allergic diseases in gastrointestinal tissue. Although most research has been focused on the molecular and cellular understanding of eosinophils in the peripheral tissues and lung, recent studies elucidate the unique trafficking and regulation mechanisms of eosinophils in the gastrointestinal tissues. In this review, we summarize current findings in the regulatory mechanism of gastrointestinal eosinophils. Furthermore, several unique murine models for eosinophilic gastroenteritis, which can be applied for the elucidation of underlying mechanisms of eosinophil-mediated gastrointestinal allergy, and the development of new mucosal immune therapy for the control of food allergy are reviewed.
Animals↗
Chronic intestinal pseudo-obstruction in systemic lupus erythematosus.
BACKGROUND/AIMS: Chronic intestinal pseudo-obstruction (CIPO) reflects a dysfunction of the visceral smooth muscle or the enteric nervous system. Gastrointestinal manifestations are common in systemic lupus erythematosus (SLE) but CIPO has not been reported. Features of CIPO are reported in five patients with SLE. METHODS: From 1988 to 1993, five patients with SLE or SLE-like syndrome were hospitalised for gastrointestinal manometric studies. CIPO was the onset feature in two cases. Antroduodenal manometry (three hours fasting, two hours fed) was performed in all patients, and oesophageal manometry in four. RESULTS: Intestinal hypomotility associated with reduced bladder capacity and bilateral ureteral distension was found in four patients and aperistalsis of the oesophagus in three. Treatment, which consisted of high dose corticosteroids, parenteral nutrition, promotility agents, and antibiotics, led to remission of both CIPO and urinary abnormalities in all cases. Antroduodenal manometry performed in two patients after remission showed increased intestinal motility. One patient died, and postmortem examination showed intestinal vasculitis. CONCLUSIONS: CIPO in SLE is a life threatening situation that can be reversed by treatment. It may be: (a) a complication or onset feature of the disease; (b) secondary to smooth muscle involvement; (c) associated with ureteral and vesical involvement; (d) the result of intestinal vasculitis.
Adult↗
Special features of the intestinal lymphocytic system.
The gastrointestinal lymphocytic system can be divided in two functional compartments, the organized lymphoid tissue, for example, the Peyer's patches, and the lymphocytes located diffusely in the mucosa, the lamina propria lymphocytes (LPL), and the intra-epithelial lymphocytes (IEL). Antigens enter the Peyer's patches as the afferent part of the GALT via specialized epithelial cells called M cells. After the initiation of the immune response by antigen processing and presentation to B and T cells in Peyer's patches, primed lymphocytes leave the mucosa via the thoracic duct. Finally they migrate back to the mucosa where they exert effector functions. Adhesion molecules, including integrins, especially alpha 4 beta 7 and alpha E beta 7 (HML-1) are involved in these homing and adhesion processes. LPL and LEL differ from peripheral blood lymphocytes in their expression of adhesion molecules and other surface and activation markers. Additionally, they exhibit functional features different from those of other lymphocyte compartments. In the mucosal immune system, plasma cells mainly secrete IgA, which is part of the specialized humoral defence in the gut.
Animals↗
Hypomelanosis of Ito.
We report two patients with hypomelanosis of Ito, one whose afflictions were limited to the pigmentary skin abnormalities and another with systemic involvement of the neurological and gastrointestinal system. These case reports give support to the importance of establishing hypomelanosis of Ito as occurring with or without systemic involvement.
Adult↗
Antidepressants for treating depression in dementia.
BACKGROUND: The use of antidepressants for patients with dementia accompanied by depressive symptoms is widespread, but their clinical efficacy is uncertain. Many of the individual trials of antidepressants have been too small to provide precise estimates of the moderate benefits that might realistically be expected. Combining the information from all appropriate trials may provide a better estimate of the likely effects of treatment.Objectives To determine whether antidepressants are clinically effective and acceptable for the treatment of patients with depression and also dementia.Search methods The CDCIG Specialized Register was last searched on 27 April 2005. This register contains records from major health care databases and many ongoing trials databases and is updated regularly.Medical information departments of pharmaceutical companies were asked to search their databases for any relevant clinical trials. Where necessary authors of trials were approached with requests for additional information.Selection criteria All relevant unconfounded, double-blind, randomized trials comparing any antidepressant drug with placebo, for patients diagnosed as having dementia and depression, according to established criteria.Data collection and analysis Two reviewers extracted data independently and settled any differences by agreement.Main results There were seven included studies with a total of 1140 subjects of which 769 met inclusion criteria. Four included studies reported sufficiently detailed results to enter into meta-analyses, with a total of 137 subjects. Two of these studies investigated the properties of drugs not commonly used in this population with only two studies (Petracca 2001 and Lyketsos 2003) using the more common selective serotonin reuptake inhibitors (SSRIs). Lyketsos 2003 produced two significant differences in favour of treatment in the Cornell Scale for Depression in Dementia (CSDD) at 12 weeks and in the psychiatrists' global rating. However, the CSDD was not used in any of the other studies and no statistical differences were found with the other measures used in the meta-analysis. The meta-analysis of the number of patients suffering at least one adverse event, one event of the nervous system, one event of the gastrointestinal system and one event of dry mouth at 6 to 12 weeks showed a significant difference in favour of placebo. There were no other significant results.Authors' conclusions Available evidence offers weak support to the contention that antidepressants are effective for patients with depression and dementia.However, only four studies are included in the meta-analysis relating to efficacy, and sample sizes are small.Moreover, only two included studies investigated the properties of the more commonly used SSRIs and no studies investigated the properties of newer classes of antidepressants (e.g. selective noradrenergic reuptake inhibitors). This review draws attention to the paucity of research and evidence in this area.
Antidepressive Agents↗
Epididymoorchitis mimicking testicular torsion in Henoch-Schönlein purpura.
Henoch-Schönlein purpura, although being a systemic vasculitis, mostly involves skin, gastrointestinal system, joints, and kidneys. Testicular involvement is a rare occurrence. A 7-year-old boy with Henoch-Schönlein purpura developed acute scrotum and was referred to rule out testicular torsion. On gray-scale ultrasonography, the testes and epididymis were slightly enlarged, and had heterogeneous and hypoechoic echotexture. The scrotal wall was thickened as well. Color and power Doppler ultrasonography revealed increased vascularity in scrotal contents. Testicular torsion was excluded and the diagnosis of testicular involvement of Henoch-Schönlein purpura was established. Color Doppler US, together with gray-scale findings, can be useful in the evaluation of Henoch-Schönlein purpura with acute scrotum, excluding testicular torsion and preventing unnecessary surgery.
Child↗
Intermedin: a skin peptide that is downregulated in atopic dermatitis.
Intermedin (IMD), also called adrenomedullin-2, is a peptide that belongs to the calcitonin/calcitonin gene-related peptide/amylin peptide family. IMD exerts many effects on the cardiovascular system, gastrointestinal tract, and central nervous system. Here, we analyzed the expression of the IMD peptide in human skin of healthy controls, in biopsies from lesional and non-lesional areas of atopic dermatitis (AD) skin, in cultured human keratinocytes, and in the HaCaT keratinocyte cell line at the transcriptional (quantitative reverse transcription-PCR) and translational (immunohistochemistry) level. IMD messenger RNA (mRNA) and protein could be detected in keratinocytes and human skin. Keratinocytes, nerve fibers, periglandular cells, arterial/arteriolar smooth muscle cells, and pericytes of dermal microvessels were intensely IMD-immunoreactive. The IMD mRNA was, compared to healthy skin, significantly reduced in lesional and non-lesional areas of AD skin. This was accompanied by a reduction of IMD immunoreactivity in pericytes of the upper dermis indicating that skin from AD patients is generally affected, and downregulation of IMD in AD skin is not a secondary phenomenon caused by acute inflammation but is a general characteristic of AD skin. These data further point to a role of IMD expressed by pericytes in conferring higher susceptibility of the skin of AD patients to inflammatory stimuli.
Adult↗
Characterization of multiple organ dysfunction syndrome in very low birthweight infants: a new sequential scoring system.
To define multiple organ dysfunction in newborns, we established a sequential scoring system NEOMOD (Neonatal Multiple Organ Dysfunction Score). It was developed to describe the process of increasing physiologic derangement in critically ill newborns. It provides, during the first 28 days of life, information concerning function of organ systems having a primary influence on mortality in very low birth weight (VLBW) infants. Our scoring system has been used in 142 VLBW infants. It evaluates moderate (1 point) or severe dysfunction (2 points) in 7 organ systems (central nervous system, cardiovascular, renal, respiratory, and gastrointestinal systems, and hemocoagulation and acid-base balance) in 24-h intervals from day 1 to 28 of life. Maximum possible value of NEOMOD was 14 points. Receiver operating characteristic curve was used for assessing predictive accuracy of maximum NEOMOD score obtained by daily scoring for mortality rate. AUC (area under curve) attained by NEOMOD was 0.95 for mortality within the first 28 days and 0.91 for hospital mortality, respectively. In the study group, NEOMOD score of > or = 9 was associated with 100% mortality. An analysis of specific organ dysfunctions in the non-survivors group (n = 16) disclosed, in all patients, dysfunction of more than two organ systems 24 h before death. Similar to critically ill adults, secondary multiple organ dysfunction can be described also in a majority of critically ill VLBW infants. NEOMOD scores may help to evaluate daily the severity of the syndrome and risk of death.
Female↗
Polyhydramnios and associated maternal and fetal complications in singleton pregnancies.
During the 10-year period 1 January 1979 to 31 December 1988, polyhydramnios occurred in 537 patients with singleton pregnancies delivered at the Mercy Maternity Hospital. Associated maternal and fetal complications and the perinatal outcome of these pregnancies with polyhydramnios were analysed. In 248 of the 537 pregnancies (46%) in this group there were no maternal complications or fetal malformations and the perinatal mortality (PNM) rate was 2.4%. The PNM rate increased significantly to 13.1% when there was associated pre-eclampsia, 10% with gestational diabetes, and to 7.6% with miscellaneous complications. When polyhydramnios was associated with a fetal or placental malformation the PNM rate was 61.4%. The commonest malformations were central nervous system (31%), musculoskeletal (12%) and gastrointestinal system anomalies (10%). Placental chorioangioma occurred in two patients (0.4%) and both babies died. In women with low oestriol excretion (18% of the 455 tested) the PNM rate increased five times to 22.7%.
Congenital Abnormalities↗
Metabolic acidosis of chronically hemodialyzed patients.
Metabolic acidosis is a condition that is commonly encountered in both chronic renal failure and in end-stage renal disease. Metabolic acidosis is associated with many adverse effects: negative nitrogen balance, increased protein decomposition, anorexia, fatigue, bone lesions, impaired function of the cardiovascular system, impaired function of the gastrointestinal system, hormonal disturbances, insulin resistance, hyperkalemia, altered gluconeogenesis and triglyceride metabolism, increased progression of chronic renal failure, and growth retardation in children. Even 'minor' degrees of metabolic acidosis are deleterious. Metabolic acidosis of end-stage renal patients could be successfully corrected with bicarbonate hemodialysis and with peroral bicarbonate-containing phosphate binders, i.e. calcium carbonate. Bicarbonate powder compared with bicarbonate solutions has some advantages and enables a stabile composition of electrolytes. 'High' dialysate bicarbonate (40- 42 mmol/l) is a safe, well-tolerated and useful tool for better correction of the metabolic acidosis and must become a standard of hemodialysis treatment. Measured postdialysis blood bicarbonate concentration should be obtained at least every month and correction of metabolic acidosis by maintaining serum bicarbonate >or=22 mmol/l should be a goal of the management of patients undergoing chronic hemodialysis.
Acidosis↗
Behçet's disease in southern Chinese patients.
OBJECTIVE: To describe the clinical characteristics of Behçet's disease (BD) in a southern Chinese population and compare them with those reported in other ethnic groups. METHODS: Patients with BD from 4 large regional hospitals in Hong Kong were identified from the hospital information retrieval system. Their records were retrospectively reviewed and the diagnosis was verified by at least 2 rheumatologists using the International Study Group (ISG) criteria. Demographic data and various clinical features of our patients were collected and analyzed. RESULTS: Between 1978 and 2000, 37 adult patients with definite BD according to the ISG criteria were identified. All patients were ethnic southern Chinese. There were 19 women and 18 men (F:M = 1.1:1). The mean age at diagnosis was 36.2 +/- 10 (18-74) years. Presenting features at diagnosis, in decreasing order of frequency, were oral ulceration (100%), genital ulceration (81%), skin lesions (73%), arthritis/arthralgia (54%), and ocular lesions (35%). Among skin lesions, the commonest manifestations were erythema nodosum (74%), folliculitis (44%), and acneiform nodules (30%). Arthritis was usually polyarticular (75%) and symmetrical, and involved the upper limb joints. Anterior uveitis was the most common ocular complication (77%) and was often bilateral. Involvement of other systems such as the central nervous system, gastrointestinal (GI) tract, and cardiopulmonary system was uncommon. Vascular complications were rare. Only 2 (6%) patients had a positive pathergy test. Our patients were followed for a mean of 59.9 +/- 52 months. Apart from recurrent attacks of orogenital ulceration and uveitis, new systemic features were unusual. One patient died of bowel perforation as a result of active GI disease. Compared with other reported series, our patients had fewer ocular and systemic manifestations, and a significantly lower incidence of the pathergy reaction. CONCLUSIONS: BD is rare among southern Chinese in Hong Kong and tends to run a more benign course with less systemic involvement and fewer serious ocular complications. Whether the observed difference in clinical manifestations of the disease is related to a different HLA association or environmental factors warrants further studies.
Adolescent↗
[Churg-Strauss syndrome. Personal caseload and review of the literature].
Churg-Strauss syndrome (CSS) is a disease characterised by hypereosinophilia and systemic vasculitis occurring in patients with asthma and allergic rhinitis. In the course of CSS three phases may be distinguished. The prodromal phase, which may persist for many years, consists of allergic disease. The second phase is characterised by peripheral blood eosinophilia and eosinophilic tissue infiltrates that produce a clinical picture diagnosed as Loeffler's syndrome, chronic eosinophilic pneumonia or eosinophilic gastroenteritis. The third phase is dominated by systemic vasculitis in which skin, cardiovascular system, gastrointestinal tract and peripheral nervous system are frequently involved. Renal disease in CSS is less common and generally less severe than that classical polyarteritis nodosa and Wegener's granulomatosis. Genitourinary tract may be involved, too. In the postvaculitic phase, allergic rhinitis and asthma usually persist and clinical picture is characterised by the consequences of the vasculitic illness, most commonly in form of neuropathy and hypertension. The pathogenesis of CSS is unknown but its association with asthma and allergic rhinitis may indicate an abnormal immune reactivity. The recently reported association with antineutrophil cytoplasmic antibodies with antimyeloperoxidase specificity may suggest a their role in the pathogenesis of the disease. An important role may be played by eosinophils, too. The main therapy is that with corticosteroids, possibly in association with immunosuppressive drugs.
Adult↗