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PubMed1986

Computed tomography of gastrointestinal inflammation after bone marrow transplantation.

Overwhelming secretory diarrhea can be a major complication after bone marrow transplantation, associated usually with acute graft-versus-host disease (AGVHD). Radiographic evaluation may be hampered by nausea, vomiting, or debilitation. Computed tomography (CT) in seven such patients demonstrated diffuse wall thickening in the small intestine, colon, and/or mesentery. In two cases, prolonged adherence of oral contrast material to the luminal surface resulted in bizarre patterns of coating. In two others, a layer of low attenuation within the thickened wall produced a target appearance consistent with submucosal edema or hemorrhage. Small bowel dilatation and fold enlargement was the only finding in one patient. The role that superinfection of the gastrointestinal tract with opportunistic organisms can play in this immunocompromised group of patients is less well established. In this group of patients, the findings were due to AGVHD in two, AGVHD and viral enteritis in two, and viral enteritis alone in three. CT may be an alternative to routine contrast studies in assessing the extent of gastrointestinal tract involvement after bone marrow transplantation. Neither contrast studies nor CT were able to differentiate between AGVHD and viral enteritis.

Adolescent↗
PubMed1988

Increased plasma levels of peptide YY in coeliac disease.

Peptide YY (PYY) is exclusively localized in endocrine cells in the gut, and these cells are most numerous in the distal small intestine, colon, and rectum. We have earlier shown that PYY coexists with enteroglucagon in the gut endocrine cells. High basal and postprandial plasma enteroglucagon concentrations have earlier been found in patients with untreated coeliac disease. PYY circulates in human plasma and is detectable in most healthy adults. We have therefore studied the basal PYY levels in patients with coeliac disease. Marked elevated basal plasma PYY levels were found in patients with coeliac disease compared with an age- and sex-matched control group. The PYY levels were inversely correlated to the concentration of folate acid in serum. The PYY levels were studied in four patients with newly diagnosed disease and had normalized within 8 months on a gluten-free diet.

Adolescent↗
PubMed1989

Pathogenicity of Campylobacter pylori--a causative factor in gastritis?

There is now much worldwide evidence that Campylobacter pylori plays a pathogenic role in the aetiology of gastritis rather than colonizing an already inflamed gastric mucosa. 1) There is a very close association between the presence of C. pylori on the gastric mucosa and histologically confirmed Type B chronic active gastritis. Ninety percent of patients with C. pylori infection have gastritis whereas less than 5% of patients with normal mucosa are colonized. 2) C. pylori only colonizes gastric type mucosa; it is not found colonizing intestinal type mucosa in the stomach. 3) Two volunteer studies have confirmed Koch's third and fourth postulates. Ingestion of C. pylori led to the development of histologically proven gastritis. 4) Outbreaks of hypochlorhydric C. pylori gastritis have occurred. In one such epidemic 17 of 37 volunteers developed C. pylori hypochlorhydric gastritis after acid secretion studies were undertaken with an unsterilized pH electrode. 5) Susceptible animal models (gnotobiotic piglets and the macacus monkey) inoculated with a suspension of C. pylori have developed histologically proven gastritis. 6) Clearance of C. pylori with antimicrobial agents (amoxicillin or nitrofurantoin) or bismuth salts (colloidal bismuth subcitrate or bismuth salicylate), alone or in combination, leads to rapid resolution of the histologically confirmed gastritis. If relapse occurs the gastritis returns.

Animals↗
PubMed1986

Experimental whole gut irrigation in the rat.

An animal model of whole gut irrigation (WGI) in the rat was developed to study the effects of the irrigation procedure on the gastrointestinal microflora. Irrigation was performed with as well as without neomycin (1,000 mg/l) in the irrigation fluid. At the end of the irrigation procedure the animals were intragastrically contaminated with 2 neomycin-resistant Enterobacteriaceae strains (i.e. an Escherichia coli and a Klebsiella pneumoniae) to study the intestinal colonization by these strains. Although both contaminating strains persisted longer in the animals treated with irrigation fluid with neomycin than in those treated with mere irrigation fluid, persistence was only significantly longer with the E. coli strain (p less than 0.025). It seems likely that the condition of the--mainly anaerobic--mucosa-associated microflora after WGI was responsible for this difference in duration of colonization by the contaminating E. coli strain.

Animals↗
PubMed1991

The risk of gastrointestinal and other primary malignant diseases following gastric cancer.

The risk of developing a second primary cancer was studied among 34,506 gastric cancer patients identified through the Swedish Cancer Registry. A second cancer was reported in 962 patients compared to an expected number of 826 (relative risk = 1.16, 95% confidence limits = 1.09-1.24). The slightly but significantly elevated risk was largely confined to the first year after the gastric cancer diagnosis, and to patients under 70 years old at the time of diagnosis. The risk was significantly increased for cancer in the small intestine, colon, rectum, kidney, breast and prostate. A closer look at the data, however, revealed that a substantial proportion of the second cancers were diagnosed within one month after the gastric cancer diagnosis, or at autopsy. We recalculated the relative risk estimates under the assumption that only 75% of the cancers incidentally detected in connection with diagnosis/treatment of the gastric cancer would have become clinically manifest during the relatively short observation time. and that 20% of the cancers revealed at autopsy in the gastric cancer patients would have been detected if the death and autopsy rates in this group had been equal to those in the general population (matched for age and gender). Under those assumptions the risk of having a second primary cancer among gastric cancer patients was close to what would be expected. The increased risk reported in some previous studies could be the result of closer patient surveillance.

Adult↗
PubMed1996

Cancer of the digestive system in Circumpolar Inuit.

Cancer of the oesophagus, stomach, small intestine, colon, rectum, liver, gallbladder, biliary tract and pancreas was studied in the Inuit populations of Alaska, Canada and Greenland. Indirect standardization to the populations in Canada, Connecticut (USA) and Denmark was used. High risk of oesophageal cancer was observed in both sexes with standardized incidence ratios (SIRs) of up to 7. An increased risk of colon and rectum cancer occurred among Alaskan Inuit compared with the Inuit populations in Canada and Greenland, which had lower rates. Liver and gallbladder cancer rates were high, with SIRs of 1.5 to 4.1, whereas there were no differences in pancreatic cancer in the populations compared. Dietary habits, alcohol and tobacco consumption are believed to play an important role in most of the observed cancer patterns, but for liver cancer hepatitis B virus infection is also believed to have a causal role.

Alaska↗
PubMed1989

Parasitic conjoined twins with omphalocele and tetralogy of Fallot.

Human parasitic twins are very rare. Here we report a unique case of a partial twin attached to the host in the midline at the forehead, chin, chest, and epigastrium. The parasite lacked thoracic organs and major neural tube derivatives. However, it had small peripheral nerves and ganglia within perirenal and pericolonic connective tissue. Also present were a well-developed small intestine, colon, and appendix with normal submucosal and myenteric plexuses. These findings may represent either the initial presence of a neural tube that later regressed or migration of autosite neural crest cells. The parasite had a mature, functioning kidney with its ureter opening to skin and complete absence of urinary bladder or genital organs. This raises questions about the embryological development of the ureteric bud, which is an outgrowth of the mesonephric duct. The host had tetralogy of Fallot and omphalocele containing the parasitic kidney and bowel. Parasitic twinning occurs at 3 weeks of gestation, tetralogy of Fallot at 3-7 weeks, and omphalocele at 6-10 weeks. A single noxa acting at 3 weeks could have caused sequential malformations that initially seem unrelated.

Abnormalities, Multiple↗
PubMed1993

Summary of work to control pathogens in poultry processing.

The National Broiler Council and Southeastern Poultry and Egg Association sponsored a study to determine whether various processing modifications would significantly alter the microflora of processed broilers. The results of this study were presented as part of the symposium and have been published in the Journal of Applied Poultry Research. Other current research topics covered include water recycling, scald and chill water treatments, and the effects of dietary manipulation on intestinal colonization and carcass contamination.

Animals↗
PubMed1995

Effect of type of defeathering system on Salmonella cross-contamination during commercial processing.

The cross-contamination effects of three commercial defeathering systems were compared using turkeys from a single Salmonella-positive flock (< or = 15% cloacal-positive). Single or "common" flocks were used to control flock-to-flock variability. Thirty birds were mechanically defeathered in each system as the first flock of the day and compared with 30 hand-defeathered (control) birds. Three trials, each using a different common flock, were completed. In Trial 1, the incidence of Salmonella-positive birds decreased following mechanical defeathering at all three processors. The incidence of Salmonella-positive carcasses in test flocks increased following steam-spray (approximately 100%) and kosher (approximately 50%) defeathering in Trials 2 and 3, whereas no increase in Salmonella-positive carcasses resulted from conventional defeathering. The decrease in the number of Salmonella-positive birds as a result of defeathering observed in Trial 1, as compared to increases observed in Trials 2 and 3, may be related to the selection of feather-contaminated (Trial 1) vs intestinal-colonized (Trials 2 and 3) turkeys. Surface temperature of the carcasses and length of time required to defeather were monitored within each system. It is hypothesized that the increases in the number of Salmonella-positive birds following steam-spray and kosher defeathering in Trials 2 and 3 were a result of skin surface changes occurring during the defeathering process, which allowed increased adherence or entrapment of Salmonella spp. on or within remaining skin layers.

Animals↗
PubMed2003

Suppression of NF-kappa B activation and proinflammatory cytokine expression by Shiga toxin-producing Escherichia coli.

The NF-kappaB family of transcription factors forms one of the first lines of defense against infectious disease by inducing the expression of genes involved in inflammatory and immune responses. In this study, we analyzed the impact of Shiga toxin-producing Escherichia coli (STEC) on the NF-kappaB DNA-binding activity in HeLa cells. After a period of weak initial activation, DNA binding of NF-kappaB was actively suppressed by viable, E. coli secreted protein B (EspB)-secreting STEC. Sustained NF-kappaB activity was observed either using an isogenic mutant lacking EspB or after gentamicin-based killing of STEC after allowing bacterial attachment. These observations indicate that the ability of STEC to cause NF-kappaB activation is suppressed by a translocated bacterial effector protein, which is either EspB itself or requires EspB for delivery into the host cell. We found that STEC, enterohemorrhagic E. coli, and enteropathogenic E. coli all interfere with NF-kappaB activation initiated by TNF-alpha, indicating that suppression of signal-induced NF-kappaB activity is a property common to several attaching and effacing bacteria. As a consequence of NF-kappaB suppression, wild-type STEC induces significantly lower mRNA levels of IL-8, IL-6, and IL-1alpha upon prolonged infection periods compared with bacteria lacking EspB. For IL-8 and IL-6, the suppressive effect was also reflected at the level of cytokine secretion. Suppression of both basal and signal-induced NF-kappaB DNA binding by attaching and effacing-inducing bacteria appears to be an active strategy to counteract host defense responses, thus favoring intestinal colonization by these pathogens.

Bacterial Outer Membrane Proteins↗
PubMed1999

Defining patients at risk of non-steroidal anti-inflammatory drug gastropathy.

Non-steroidal anti-inflammatory drugs have long been known to cause gastro-duodenal damage. However, all parts of the gastrointestinal tract may be affected, including the small intestine, colon and oesophagus. Non-steroidal anti-inflammatory drugs can cause dyspeptic symptoms, erosions, ulceration, which may lead to haemorrhage or perforation, and a requirement for surgery. The purpose of this report is to assess risk factors which may lead to gastrointestinal damage and, thus, to identify those patients at greatest risk of non-steroidal anti-inflammatory drug damage. Possible risk factors include age, sex, previous ulcer history, the presence of Helicobacter pylori, the type and severity of arthritis, individual non-steroidal anti-inflammatory drugs (dose, duration of treatment, route of administration), other debilitating diseases, smoking, alcohol, and the use of concomitant drugs. Risk of non-steroidal anti-inflammatory drug damage is higher in older patients (RR > 60 5.52; < 60 1.65), but there is no convincing sex difference. There is increased risk in patients with a previous history of peptic ulceration (RR first gastrointestinal event 2.39; subsequent gastrointestinal event 4.76), and in the first three months of treatment. Debate continues about the relevance of Helicobacter pylori, and this will be discussed in a later report. There is no strong evidence that patients with rheumatoid arthritis are more likely to have more trouble than those with osteoarthritis, but the former are more likely to require higher doses of non-steroidal anti-inflammatory drugs. Highest risk non-steroidal anti-inflammatory drugs include azapropazone, ketoprofen and piroxicam, and those with least risk include ibuprofen, diclofenac and etodolac. There is an increased risk of gastrointestinal complications with relatively small-dose prophylactic aspirin. Other factors increasing the risk are smoking and the presence of chronic underlying respiratory and cardiovascular disease. Risk of gastrointestinal problems is increased with concomitant drugs, especially corticosteroids (RR 14.6 if given with non-steroidal anti-inflammatory drugs), but also with anticoagulants and some other drugs. The clinical importance of identifying possible risk factors lies in being aware of likely problem patients and in the use of safer non-steroidal anti-inflammatory drugs or combination therapy with protective drugs in these patients.

Adult↗
PubMed1999

Dieulafoy's lesion: an obscure cause of GI bleeding.

Dieulafoy's lesion is an uncommon cause of major gastrointestinal bleeding and may be difficult to recognise. It consists of an arteriole that protrudes through a tiny mucosal defect, usually within 6 cm of the gastroesophageal junction on the lesser curve of the stomach. Similar lesions have also been described in the distal oesophagus, small intestine, colon, and rectum. Awareness of the condition and experience in endoscopy are the mainstay of diagnosis. Therapeutic endoscopy is the first line of treatment. It is safe, effective and has very good long term results.

Arteriovenous Malformations↗
PubMed1999

Validation of the lactose-[13C]ureide breath test for determination of orocecal transit time by scintigraphy.

UNLABELLED: The breath test using oral administration of a 13C-labeled substrate, lactose-ureide (LU), to measure orocecal transit time (OCTT) was validated against 99mTc-scintigraphy. Although LU is not absorbed in the human small intestine, colonic bacteria readily metabolize LU, producing 13C-labeled CO2. The time at which 13CO2 appears in breath corresponds to the OCTT. METHODS: Twenty-two healthy volunteers ingested a meal labeled with 99mTc and 13C-LU. Scintigraphy was performed over 8 h at time intervals of 10 or 15 min. OCTT with scintigraphy was defined as the time at which at least 10% of the label had entered the colon. Breath samples were obtained every 10-15 min for 10 h and measured by isotope ratio mass spectrometry. OCTT was defined as the time of first significant increase above baseline. The results were compared using correlation and Altman-Bland statistics. RESULTS: OCTT results from scintigraphy (mean OCTT = 283+/-53 min) and breath test (mean OCTT = 292+/-58 min) correlated well (r = 0.94). Altman-Bland statistics showed close agreement between scintigraphy and breath test. No significant difference between male and female subjects was observed. CONCLUSION: The breath test using 13C-LU is a valid alternative to scintigraphy techniques for measuring OCTT.

Adult↗
PubMedDate not supplied

High mortality and growth depression experimentally produced in young turkeys by dual infection with enteropathogenic Escherichia coli and turkey coronavirus.

Six-day-old turkeys were inoculated with turkey coronavirus (TCV) and an enteropathogenic Escherichia coli (EPEC) (isolate R98/5) that were isolated from poult enteritis and mortality syndrome (PEMS)-affected turkeys. Turkeys inoculated with only R98/5 did not develop clinically apparent disease, and only mild disease and moderate growth depression were observed in turkeys inoculated with only TCV. Turkeys dually inoculated with TCV and R98/5 developed severe enteritis with high mortality (38/48, 79%) and marked growth depression. R98/5 infection resulted in attaching/effacing (AE) intestinal lesions characteristic of EPEC: adherence of bacterial microcolonies to intestinal epithelium with degeneration and necrosis of epithelium at sites of bacterial attachment. AE lesions were more extensive and were detected for a prolonged duration in dually inoculated turkeys compared with turkeys inoculated with only R98/5. An apparent synergistic effect in dually inoculated turkeys was indicated by increased mortality, enhanced growth depression, and enhanced AE lesion development. The results suggest that TCV promoted intestinal colonization by R98/5; however, R98/5 did not appear to alter TCV infection. The present study provides a possible etiologic explanation for PEMS.

Animals↗
PubMed1999

Diarrhoea and malnutrition interaction.

Epidemiological studies have demonstrated a marked negative relationship between diarrhoea and physical growth and development of a child. Each day of illness due to diarrhoea produces a weight deficit of 20-40 gms. Poor nutrition is associated with more serious prolonged diarrhoea. 'Catch-up growth' often does not occur in malnourished children. Malnutrition, particularly wasting, is a strong predictor of diarrhoeal duration and the prolonged illness could exacerbate nutritional faltering, thereby increasing the subsequent risk of death. Poor appetite, vomiting, deliberate withholding of food resulting in poor intake; malabsorption of macro and micronutrients; hastening of intestinal transit time; disturbance of metabolic and endocrine functions; and direct loss of protein and other nutrients in gastrointestinal tract are some of the known mechanisms which have an impact on the nutrition during an episode of diarrhea. In addition diarrhoea of infectious origin causes cytokine induced malnutrition which results from the actions of proinflammatory cytokines like tumour necrosis factor and interleukin 1, 6 and 8. Preexisting malnutrition is associated with decreased turnover of epithelial cells resulting in delayed recovery which may prolong an episode of infectious diarrhoea by itself as well as by promoting tissue invasion by other enteropathogens. Malnutrition may also alter protective host factors and thereby favour intestinal colonization by the pathogenic microbes. Mucosal damage varying from moderately severe changes to flat lesions indistinguishable from those of celiac disease may occur in kwashiorkar. Diarrhoea malnutrition interaction represents a dangerous web which can be distangled by prevention of disease transmission by promoting exclusive breast feeding, hygienic weaning practices, safe drinking water and handwashing, improved host defences by breast feeding, improved nutrition, measles vaccine and other vaccines against enteropathogens in the offing; and promotion of standard case management with special emphasis on nutritional support and rehabilitation.

Age Distribution↗
PubMed2001

Enterobacter sakazakii infection in the newborn.

UNLABELLED: Enterobacter sakazakii, a Gram-negative bacillus, previously known as "yellow pigmented Enterobacter cloacae", is a rare cause of neonatal infection. We describe the detailed clinical presentation of two cases in whom E. sakazakii was isolated in our neonatal service during the course of 1 mo. These include one case of sepsis and meningitis complicated by cerebral infarction, and one case of sepsis. In addition, three cases of intestinal colonization were identified. The source of the organism was thoroughly sought and was found to be a blender in the milk kitchen that was used for preparation of the reconstituted powdered milk formula. CONCLUSION: Our paper adds clinical and laboratory information about the disease spectrum caused by this relatively rare organism and emphasizes the importance of a thorough search for the source of the infection.

Central Nervous System Infections↗
PubMedDate not supplied

Role of diagnostic imaging in abdominal lymphadenopathy.

Abdominal lymph node chains and route of lymph drainage of various organs (stomach, duodenum, liver, gallbladder, pancreas, small intestine, appendix, blind intestine, colon rectum) are analyzed according to their location. The role of conventional radiology and diagnostic imaging is evaluated in the study of abdominal lymphatic system with particular reference to lymphangiography and the new procedures of sonography, CT and MRI. Present methods used in inflammatory abdominal lymphadenopathy with special attention to tuberculous lymphadenitis, liver cirrhosis, neoplastic abdominal lymphadenopathy, colorectal and pancreatic cancer, are illustrated. Combined modality imaging is considered in gastric cancer based on the evolution of the classification of gastric lymph nodes. The role of sonography, endoscopic ultrasonography, spiral CT and MRI is assessed in gastric cancer N staging. A retrospective study is analyzed and perspectives for the application of a new CT protocol are proposed. PET potentialities in the study of abdominal lymph nodes are examined.

Abdomen↗
PubMed2001

Cloning a novel mouse Gabarapl2 cDNA and its characterization.

AIM: To clone a novel mouse GABAA-receptor-associated protein like 2 (Gabarapl2) gene, and to analysis its primary function. METHODS: With the aid of computer, the human GABARAPL2 cDNA was used as information probe to search mouse EST database of GenBank for mouse homolog. A series of overlapping EST were found and assembled into an EST contig using Genetics Computer Group (GCG) ASSEMBLY program. The existence of the gene was then identified by experiment. Northern blotting was performed to hybridize [alpha-32P]dATP labeled probe with mRNA of 11 different mouse tissues that had been transferred to the nylon membrane. RESULTS: The novel gene was deposited in GenBank under Accession No AF190644. Its cDNA contained an intact open reading frame and a canonical polyadenylation signal AATAAA followed by polyA. The deduced protein was completely identical to that of human GABARAPL2, and was termed Gabarapl2 by Mouse Gene Nomenclature Committee. The putative protein of Gabarapl2 has a calculated molecular weight of 13 700 and an isoelectric point of 8.56. It was also predicted to contain two protein kinase C phosphorylation sites and one tyrosine kinase phosphorylation site. Northern hybridization showed that Gabarapl2 was expressed as a single 1.35 kb transcript, with high levels in brain, thymus, lung, heart, kidney, and liver, and low in pancreas, testis, small intestine, colon, and stomach. CONCLUSION: A novel mouse Gabarapl2 gene was cloned and identified.

Adaptor Proteins, Signal Transducing↗