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PubMed1988

The histological appearance of large intestinal biopsies in dogs with clinical signs of large bowel disease.

Colonic and rectal forceps and excision biopsies of 355 dogs with clinical signs of large bowel disease were investigated. Five percent of the forceps biopsies were unsuitable for examination; all excision biopsies were of good quality. Forceps biopsies were obtained from one to eight sites, up to 60 cm cranial from the anus, while excision biopsies, mostly from tumors, were from the rectoanal region. Slight to severe colitis and/or proctitis was found in 192 dogs (54%). A single type of colitis was seen in 160 dogs; in 53 cases the lesions were local, in 107 cases multiple. A combination of different types of colitis was found in 32 dogs. Atrophic colitis, diffuse colitis and canine histiocytic ulcerative colitis were the most prominent findings, followed by ulcerative, superficial and eosinophilic colitis. Follicular, hypertrophic and aspecific granulomatous colitis were found in only a few cases. Tumors were diagnosed in 57 dogs (16%). Of these tumors 50 were of epithelial and seven were of mesenchymal origin. A high percentage (61%) of the epithelial tumors consisted of adenomas of the rectoanal region. In ten other dogs (3%) a differential diagnosis of lymphosarcoma or colitis had to be made. Colitis and colorectal tumors were more prevalent in Boxers, German Shepherds, Poodles, Great Danes and Spaniels. In the Boxers simple chronic colitis, as well as canine histiocytic ulcerative colitis were more frequently found, the latter especially in females. Other biopsy findings were edema, crypt cysts, hemorrhages, an increased number of intraepithelial lymphocytes and an increased or decreased number of goblet cells.

Animals↗
PubMed1988

The role of rectal biopsy in infectious colitis.

Rectal biopsy has a dual role in the diagnosis of infectious colitis. It can usually differentiate acute self-limited colitis (ASLC) from idiopathic inflammatory bowel disease (IBD), and it can also sometimes diagnose the specific infection in ASLC. Seven histologic features reliably differentiate IBD from ASLC: crypt distortion, crypt atrophy, a villous appearance of the surface epithelium, epithelioid granulomas, basally located isolated giant cells, basal lymphoid aggregates, and a lamina propria infiltrate of both acute and chronic inflammatory cells. One or more of these findings is frequent in rectal biopsies from patients with IBD, but rare in ASLC. Thus, the diagnosis of ASLC is made by the absence of the findings that characterize IBD. The usual histopathological picture of ASLC is nonspecific: normal architecture and increased numbers of acute inflammatory cells in the lamina propria. Certain findings may suggest a specific diagnosis. Granulomas may be present in specimens from homosexual men with proctitis due to C. trachomatis or T. pallidium. Granulomas are also present in schistosomiasis, tuberculosis, histoplasmosis, and yersinia enterocolitica infection. Typical viral inclusions can be seen in herpes simplex virus type II and cytomegalovirus infections. Specific parasites may be seen in biopsies from patients with amebiasis, schistosomiasis, and cryptosporidiosis. Intestinal spirochetosis is frequent in male homosexuals.

Acute Disease↗
PubMed1988

[Colorectal carcinoma--clinical and radiologic problems of aftercare].

Aftercare following surgery of colorectal tumours aims mainly at early detection of a relapse for the purpose of curative re-intervention. Improvement of diagnostic possibilities, especially by means of tumour markers, flexible endoscopy, computed tomography, magnetic resonance and ultrasound, increased the efficacy of aftercare; however, diagnosis of tumour recurrence has always been too late to perform repeated surgery with the expected measure of success. In relation to all cases of failure of therapy, the proportion of potentially curative re-interventions was about 10%. Whereas operations at the frame of the colon are practically free from a specific therapeutic co-morbidity, problems of continence may be expected in deep rectal surgery; especially after extirpation of the rectum, we can expect stoma problems and urogenital complaints as well as difficulties with the rectal excision wound. In case of adjuvant radiotherapy there may be irradiation sequels such as adhesion difficulties or radiogenic proctitis. The occurrence of metachronous secondary tumours is a special aspect of colorectal carcinomas, so that aftercare always includes prevention as well. Further aftercare measures follow from the context of psychosocial rehabilitation. Principally it is possible to achieve the ideal goal of complete reinstatement in the family, in society and in professional life after colorectal cancer surgery.

Colonic Neoplasms↗
PubMed1987

Experimental infection of weanling pigs with Salmonella typhisuis: effect of feeding low concentrations of chlortetracycline, penicillin, and sulfamethazine.

Clinical and pathologic variables of Salmonella typhisuis infections were studied in weanling pigs. The influence of daily feeding of low concentrations of chlortetracycline, penicillin, and sulfamethazine on S typhisuis infection also was determined. Ten pigs (group 1) given feed containing low concentrations of chlortetracycline, penicillin, and sulfamethazine when orally inoculated with S typhisuis became pyretic, developed a mild neutrophilia, and had increased serum agglutinating antibody titers, but were clinically normal. Lesions were not present, and S typhisuis was not isolated from 2 group-1 pigs that were killed and necropsied on postinoculation day 8. Then, the antimicrobial agents were withdrawn from the feed of the remaining 8 pigs for 6 days. The pigs were reinoculated with S typhisuis on postinoculation day 16 and developed mild clinical disease with sustained high rectal temperatures. Severe necrotizing typhlocolitis and ulcerative proctitis were found at necropsy in all 8 of the pigs. Similar findings were induced in 7 additional pigs (group 2) that were concurrently inoculated with S typhisuis, but that had no previous exposure to S typhisuis. Successful isolation of S typhisuis required special care and media.

Administration, Oral↗
PubMed1986

Ulcerative colitis in Stockholm County--a study of epidemiology, prognosis, mortality and cancer risk with special reference to a surveillance program.

The epidemiology of ulcerative colitis (UC) in Stockholm County 1955-79 was investigated. There were 1274 cases. The proportion of patients with proctitis, left-sided and total extent of disease remained constant over the study period. The incidence increased over the first 20 years followed by a plateau. The peak incidence in relation to age increased slightly but remained in the third and fourth decade through the study period. The incidence in men over 40 years of age increased markedly towards the end of the study. There were 109 deaths at follow-up (Dec. 1981) among those having the UC diagnosis between 1955-1979. Twentysix out of 41 patients who died due to UC did so postoperatively. The mortality pattern among those 68 patients who had causes of death unrelated to UC was similar to the expected. There was a decrease in cumulative survival probability compared with the expected, in particular in those with total colitis. This was also seen when only deaths unrelated to UC were included suggesting an increased sensitivity to the ordinary disease spectrum in UC patients. Between 1945-1979 there were 1339 patients who had UC diagnosed. Twentyfive of those had developed colon cancer (24 with total colitis) at follow-up (Dec. 1981). Eighteen were dead at follow-up, the survival time being in direct relation to the Dukes' grading at cancer diagnosis irrespective of age. The cumulative cancer risk at 25 years duration (total colitis patients only) was 13% (SD 4%) compared to the expected 1,9%. In a selected group of 71 patients followed for cancer surveillance during the period 1974-82 nine patients developed at least low grade dysplasia including one Dukes' A carcinoma. The dysplasia or cancer leading to operation was found above the rectum in four of five operated patients, all having total colitis with a duration ranging between 25-44 years.

Adolescent↗
PubMed1986

[Incidence of severe local complications in ulcerative colitis and Crohn disease].

At the example of the severe and foudroyant courses of the ulcerous colitis in patients who died or underwent a resection (n = 93) the severe local complications are demonstrated. 70 patients with resection of the intestine, 21 patients with diagnostic laparotomy as well as 32 deceased patients with Crohn's disease were compared with them. Transmigration peritonitides (3.3% of 458 patients with ulcerous colitis except haemorrhagic proctitis), perforation peritonitides (2.0%) as well as the toxic megacolon (3.3%) alone or in combination are the most frequent severe complications. Therapy-resistant intestinal haemorrhages (1.1%) are infrequent. In 0.9% of the cases colorectal carcinomata appear. The acute or chronic mechanical ileus is the most frequent complication in Crohn's disease (21.1% of 171 patients altogether). Intraabdominal abscesses are found in 11.7%. In participation of the colon fistulae are nearly twice as frequent as in localisation of the small intestine. Free perforations of the small intestine (3.8%) are more frequently observed than perforations of the colon (2.2%).

Adult↗
PubMed1987

[Epidemiology, clinical aspects and therapy of infections with Chlamydia trachomatis serotype D-K].

Chlamydia trachomatis serotype D-K is one of the most important pathogens of communicable diseases. 3 to 5 million new infections are observed annually in the USA. 10% to 30% of young sexually active persons in the age group 15 to 20 years are affected. The organism was isolated from 20% to 30% of patients attending dispensaries for sexually transmitted diseases, 5% to 10% of gynaecological outpatients, 1% to 8% of pregnant women and 0% to 5% of asymptomatic control persons. In men, C. trachomatis was found in 30% to 70% of patients with urethritis (15% to 25% simultaneously with gonorrhoea), in 30% to 60% of persons suffering from nongonoccocal urethritis and in 65% to 70% with postgonoccocal urethritis. 20% of newborns from mothers with positive cultures develop pneumonia and 37% conjunctivitis. Complications such as endometritis, salpingitis, periappendicitis, perihepatitis, ectopic pregnancy, premature birth, proctitis, cystitis, deferenitis, epididymitis, reactive arthritis, morbus Reiter, conjunctivitis, pneumonia (in infants and adults) may cause long lasting disease and may leave behind irreversible sequelae. Treatment with tetracyclines or erythromycin is always effective.

Adult↗
PubMed1986

[Surgical therapy of late radiation sequelae of the gastrointestinal tract].

Fifty-six operations for intestinal complications of radiation therapy were performed in 48 patients at the Second Surgical Clinic, University of Vienna between 1971 and 1985. The lesions were located in the small bowel (n = 32), the colon and rectum (n = 27) and the duodenum (n = 2). The incidence of the operations increased during the fifteen-years-period, 48.2% being performed in the last five years. 96% of the patients were females, the most frequent cause for irradiation was ovarian cancer (39.6%), followed by cervical (27%) and endometrial cancer (16.7%). 20 Patients (39.6%) had also been treated by chemotherapy. Ovarian cancer as underlying disease (56%) and chemotherapy (56%) were more frequent in small bowel lesions, than in other locations. The radiation damage presented as stenoses (n = 38), fistulas (n = 13), perforations (n = 3), one rectal ulcer and one hemorrhagic proctitis. Resection with end-to-end-anastomosis (n = 15) and bypass (n = 14) were the operations most frequently performed on the small bowel, whereas most colonic and rectal lesions were treated by colostomy alone (n = 14). The postoperative course was complicated by fistulas in 7 patients, by peritonitis in 5, by pulmonary embolism in one and duodenal ulcer perforation in another case. Six patients died postoperatively (10.7%), 5 because of peritonitis. After small bowel resection complications occurred in 4 cases, and two (13%) of the patients died. Bypass in small bowel lesions performed as well as resection: 5 complications and one death (7%) occurred. Single layer suture technique performed better than two layer anastomoses. Eighteen operations with single layer anastomoses resulted in 16.7% complications and no death.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Recognition and treatment of chlamydial infections.

The microbiology, laboratory diagnosis, clinical features, and treatment of infectious diseases caused by Chlamydia trachomatis and Chlamydia psittaci are reviewed. Chlamydial genital infection is the most common sexually transmitted disease in the United States. C. trachomatis plays an important role in nongonococcal urethritis, postgonococcal urethritis, cervicitis, pelvic inflammatory disease, and possibly proctitis. Proper treatment of genital infections caused by C. trachomatis is important to prevent severe sequelae such as epididymitis and pelvic inflammatory disease, both of which may lead to sterility. Infected pregnant women should be treated to prevent transmission of chlamydial infections to their infants. Chlamydial conjunctivitis is the most common eye infection in the first month of life. C. trachomatis also causes pneumonia in infants. Lymphogranuloma venereum and trachoma are important diseases in developing countries. C. psittaci, transmitted by birds, causes psittacosis in humans; this disease is rare in the United States. Diagnosis is a problem because chlamydial genital infection can be asymptomatic and because the organism is difficult to isolate. Culture remains the diagnostic method of choice, but recently marketed direct-detection assays provide qualitative results within hours after specimen collection. Tetracyclines and erythromycin are the drugs of choice for treating chlamydial infections in adults. An antimicrobial with activity against both C. trachomatis and Neisseria gonorrhoeae is preferred because both organisms are often present concurrently in patients with sexually transmitted disease. Chlamydial infections in pediatric patients often respond to systemic erythromycin therapy; tetracyclines are equally effective but are contraindicated for children less than nine years of age. Adequate diagnosis and treatment of sexually transmitted chlamydial infections in patients and their contacts is important to limit the spread of disease.

Chlamydia Infections↗
PubMed1986

The epidemiology of inflammatory bowel disease in Cape Town 1980-1984.

Patients with inflammatory bowel disease diagnosed in the greater Cape Town area between the years 1980 and 1984 inclusive were studied to establish the incidence and presenting features of these diseases. Case details were obtained from the records of the Groote Schuur Hospital group and Tygerberg Hospital as well as from questionnaires completed by 97% of 731 medical practitioners in the area. There were 134 patients with Crohn's disease, 197 with ulcerative colitis and 16 with indeterminate colitis. The incidences of Crohn's disease in the coloured, white and black population groups were calculated to be 1.8, 2.6 and 0.3/100 000 per year respectively and those for ulcerative colitis 1.9, 5.0 and 0.6/100 000 respectively. Among Jews the incidence was higher for both Crohn's disease (10.4/100 000) and ulcerative colitis (17.0/100 000). Of patients with ulcerative colitis 35% had limited proctitis, 26% proctosigmoiditis, 12% left-sided disease and 27% total colitis. Of patients with Crohn's disease 27% had colonic involvement alone, 37% ileocolitis and 36% small-bowel involvement alone. The incidence of inflammatory bowel disease has increased in the greater Cape Town area over the last 10 years, while the pattern of disease has remained similar to that previously reported for this geographical area.

Adolescent↗
PubMed1986

[Results of abdominal x-ray computed tomography in 25 patients with the acquired immunodeficiency syndrome or the lymphadenopathy syndrome].

An abdominal computed tomographic examination was performed to 20 patients with Acquired Immunodeficiency Syndrome (AIDS) and to 5 patients with Lymphadenopathy Syndrome (LAS). Intraabdominal lymph nodes were seen in 18 out of 20 cases of AIDS and in 5 cases of LAS. Lymph nodes have a normal size or are slightly enlarged but they are too numerous. Splenomegaly was found in 17 patients. Rectal modifications secondary to a proctitis were seen in the homosexual patients.

Acquired Immunodeficiency Syndrome↗
PubMed1979

Ischemic diseases of the large intestine.

The blood flow within the walls of the digestive tract must be sufficient to maintain its structural and functional integrity. All episodes of vascular insufficiency cause ischemic damage to the organ and carry the threat of diffuse or focal necrosis. Certain forms of ischemic colitis or proctitis arise from episodes of reduced peripheric or splanchnic blood flow; indeed, those that do not culminate in necorsis of the colonic wall are more frequently caused by hemodynamic disorders than by vascular occlusions. The crisis is often mitigated by the development of collateral circulation, which is nevertheless of rather meager quality, such that the patients are very vulnerable to subsequent slight changes in cardiac output. Necrotic, gangrenous ischemic colitis arises from a combination of occlusive damage to the arteries and general hemodynamic disturbances. The vascular insufficiency might be slight or severe, temporary or long-lasting, localized or diffuse. In addition, the attack occurs in a septic medium in the presence of an abundant microbial flora that may be highly pathogenic. Thus infection complicates and aggravates the ischemic damage, with the result that the gangrenous aspect of the lesions tends to hide their ischemic origin. Indeed, the variability of the manifestations of the disease represents one of its primary characteristics and is a function of the different causative factors. A knowledge of the anatomy and pathophysiology of the splanchnic circulation and its hemodynamics is essential for a full appreciation of the diagnosis and treatment of the disorders and for the adoption of the aggressive approach necessary to improve the poor prognosis of ischemic diseases of the colon and rectum. The salient points have been stressed in the present chapter. The features of the different forms of the disease have been described, together with the necessary medical treatment and the indications for surgical for surgical intervention. In the relatively rare cases where operation is necessary, the tactics and techniques have been described. All treatment should be based on (a) constant, prolonged intensive care; (b) precise monitoring of any change in status; and (c) rapid excision of any necrotic (often gangrenous) tissue. Ischemic colitis is most likely to occur in elderly patients with a history of cardiovascular disease, but it is not excluded in younger individuals. It is a frequent entity and is potentially lethal. Although its clinical, radiological, and anatomical characteristics permit its classification as a separate disease, it is often confused with other disorders of the colon. Although the abdominal surgeon is most likely to be concerned with this disease, the vascular surgeon who attacks the lower aorta should always be on the lookout for possible occurrences of segmentary ischemia of the distal colon as a result of his intervention.

Animals↗
PubMed1985

[Cronkhite-Canada disease. Discussion apropos of a case and study of the pigmentation].

In 1955, Cronkhite and Canada described two patients presenting abnormal skin pigmentation, alopecia, onychodystrophy and gastrointestinal polyposis. In the first French case reported here, the skin pigmentation has been the object of a special electron microscope study. M. E..., 48-year old, developed, in 1968, pigmented maculae with a metallic gloss around his pelvic girdle. The melanoderma rapidly expanded, associated with fall of hair, body hairs and eyebrows. Onyxis and perionyxis of the right thumb, milium-like epidermal cysts, tumoral lesions of the keratoacanthoma type on the nose and scrotum and, chiefly, generalized cockade-like bullous erythema associated with buccal erosions soon completed the clinical picture. The bullae were subepidermal, and direct and indirect immunofluorescence tests revealed the presence of antibodies directed against the basal membrane area. A few years later, a gastrointestinal syndrome developed progressively, consisting of liquid diarrhoea (8-10 stools per day) with deterioration of the patient's general condition and loss of weight leading to cachexia and, ultimately, death. During periods when the gastrointestinal symptoms regressed the general condition improved, hair and hairs started growing again and pigmentation was less pronounced. Examinations of the digestive tract discarded a malabsorption syndrome. Endoscopy revealed the presence of false polyps with paved appearance of the colonic and rectal mucosae. The mucosa was congested, inflamed and strewn with ulcerations. Histology showed signs of acute proctitis. The abnormal skin pigmentation was the object of histological and ultrastructural analysis. Under the light microscope the epidermis was thicker than normally with increased melanin content. There was marked pigment leakage with numerous melanophages. At electron microscopy the melanocytes, more numerous, showed increased melanogenic activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Alopecia↗
PubMed1986

[Side effects of postoperative irradiation of uterine cancer with high dose rate iridium and low dose rate radium].

A report is given about reversible and irreversible complications following postoperative irradiation in cases of endometrial carcinoma. Intravaginal brachytherapy was performed. In advanced cases or in cases with poor prognosis (tumor grading) percutaneous irradiation was added (Co60). In 156 cases low-dose-rate irradiation (Ra226) and in 143 cases high-dose-rate irradiation (Ir192) was applied intravaginally. Reversible complications (cystitis, proctitis) could be observed following Radium in 7%, following Iridium in 14%. Irreversible complications (fistulas, stenoses): 1.9% following Radium and 3.5% following Iridium. When high-dose-rate irradiation was combined with percutaneous Co60 therapy, reversible complications occurred in 22.8%. After changing the Iridium-therapy scheme (reduction of dose from 10 to 7 Gy and irradiation only of the upper two thirds of the vagina) complications only could be observed in the same level as in Radium-therapy. High-dose-rate irradiation does not need hospitalization of the patients.

Brachytherapy↗
PubMedDate not supplied

Pseudomembranous colitis in a preterm neonate.

This preterm female infant abruptly developed diarrhea and bowel distention at 25 days of age and died within 60 h with fulminating pseudomembranous colitis and proctitis. Toxin-producing C. difficile was recovered from the stool. The pseudomembranous colitis developed 12 days after the last dose of ampicillin was given to the baby. Necrotizing enterocolitis, a condition pathologically distinct from pseudomembranous colitis, was also present.

Ampicillin↗
PubMed1985

[Effect of an enema on the macroscopic and microscopic appearance of the rectal mucosa].

In flexible fiberoptic sigmoidoscopy the application of an enema is mandatory. By contrast, rigid sigmoidoscopy can be performed without preparation. In 16 patients we tested the influence of a hypertonic enema on the macroscopic and microscopic appearance of the rectal mucosa. As a first step in the unprepared patient the mucosa was assessed and a rectal biopsy obtained. After enema this procedure was repeated. Development of mucosal edema was observed, although the histopathologist was not always able to decide whether or not the biopsy was taken before or after the enema. Histological assessment of edema requires histometric measurements which cannot be obtained from biopsy specimens. A knowledge of these changes is particularly important in assessment of inflammatory bowel disease, where edema of the unprepared mucosa means slight proctitis, and we recommend that the histopathologist be informed if enemas are used for bowel preparation.

Adult↗
PubMed1985

[Digestive manifestations of the acquired immunodeficiency syndrome (AIDS): study in 26 patients].

We studied the gastrointestinal manifestations in 26 cases of AIDS. The patients belonged to two different epidemiological groups: the first group included thirteen french homosexual men, the second group included 6 Haitians, 6 Africans and a Pakistanian, none of them admit homosexual activity. The clinical manifestations were: chronic watery diarrhea in 17 cases, bloody diarrhea in 2 cases; loss of weight in the 26 cases; dysphagia in five cases; jaundice in one patient (due to Kaposi sarcoma of the ampulla of Vater). The digestive lesions found, alone or associated, were necrotizing enteritis (2), ulcerative colitis (1), pseudomembranous colitis (1), Candida esophagitis (10), erythematous duodenitis (6), proctitis (4), Kaposi sarcoma (3), diffuse (2) or localized (1). Thirteen patients out of the 26 presented opportunistic digestive infections due to one or several germs. These were 10 cases of esophageal infection (due to Candida albicans) and 8 cases of enterocolonic infection due to Cytomegalovirus (3 cases), Cryptosporidium (3 cases), Mycobacterium avium intracellulare (1 case), Cryptococcus neoformans (1 case). The other digestive infections cases were due to non-opportunistic pathogens: Entamoeba histolytica (3 cases); Giardia lamblia (3 cases); Strongyloides stercoralis (2 cases); Salmonella typhi (2 cases); Shigella (1 case); Herpes simplex virus (1 case). No difference was noticed between the homosexual and the heterosexual groups with respect to the nature and the frequency of the digestive infections.

Acquired Immunodeficiency Syndrome↗
PubMed1985

[Cancer of the prostate: intolerability and morbidity of external radiotherapy].

The pertherapeutic intolerance and morbidity are analyzed in a group of 597 patients with localized prostatic carcinoma treated by definitive radiotherapy between 1975 and 1982. Minimum follow-up is 2 years, median is 46 months. The results are compared to following parameters: associated diseases, associated surgical treatments, doses and irradiated target volumes. Pertherapeutic intolerance manifestations were found in 73% of patients and lead to complications. Urinary incontinence and chronic cystitis were more frequent after transurethral resection or prostatic surgery. Proctitis was the most disabling and can be reduced by a better estimation of prostatic target volume and by split course irradiation. Chronic diarrhea was more frequent when using large target volume. Leg edema was closely associated with pelvic lymphadenectomy. The control of pertherapeutic manifestations and the prevention of complications should improve survival in patients treated by external radiotherapy.

Follow-Up Studies↗