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PubMed1985

[Gastrointestinal manifestations of AIDS].

We studied 26 cases of digestive manifestation in AIDS. The 26 patients were divided into two different epidemiological groups: 13 homosexual men, constituted the first group; no homosexual patient was in the second group which included 6 haitians, 6 africans and a pakistanian. The clinical manifestation were: a watery chronical diarrhea in 17 cases a bloody diarrhea in 2 cases; a loss of weight in the 26 cases; a dysphagia in five cases; a 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 oesophagitis (10), erythematous duodenitis (6), proctitis (4), Kaposi sarcoma (3) diffuse (2) or localized (1). 13 patients out of the 26 presented opportunistic digestive infections due to one or several germs. The were 10 cases of oesophageal infection (due to (Candida albicans) and 8 cases of enterocolic 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). Neither the nature nor the frequency of the digestive infections was different from the first epidemiological group to the second one.

Acquired Immunodeficiency Syndrome↗
PubMed1985

[Fecal incontinence: methods of exploration].

Faecal incontinence is defined as the involuntary and sometimes unconscious release of liquid and/or solid faecal matter by the anus. The clinical history and examination and complementary investigations are able to direct the aetiological diagnosis: in particular, one should look for chronic constipation ("spurious diarrhoea"). After elimination of an organic cause (tumour, proctitis...), the most appropriate therapeutic procedure will be based on the results of further investigations, such as: defaecography, electromyography of the anal sphincter, ano-rectal manometry, measurement of the rectal capacity, measurement of the coefficient of elasticity of the rectal wall and tests of the rectal continence of fluids. Following this survey, the cause of the faecal incontinence can be determined: anal sphincter deficiency, anomaly of discriminative sensation (mucosal or neurological lesion), reduction of the rectal distensibility or abnormal rectal contractile activity. Some patients, selected on the basis of precise manometric criteria, may be suitable for reeducation by means of "bio-feedback". Faecal incontinence is a condition which is sometimes associated with social disinsertion. Hopefully, as a result of the new methods of investigation of ano-rectal function, it will now be possible to determine the aetiological mechanisms responsible for the incontinence, resulting in more effective treatment.

Biofeedback, Psychology↗
PubMed1979

[Coloportal fistula in ulcerative colitis (massive penetration, through the splenic vein, of barium and air into the portal system during barium enema)].

The authors describe one case of massive penetration of barium and air through the splenic vein into the portal system during administration of a radiopaque enema to a woman suffering from hemorrhagic proctitis in the florid phase. They provide a detailed description of this rare clinical case and discuss the possible etiology and pathophysiology of the observed event.

Barium Sulfate↗
PubMed1979

[Rectal prolapse. Clinical studies on rectal prolapse].

A series of 164 patients with procidentia recti has been studied. Symptoms are sensation of obstruction, difficulties in emptying the bowel, proctitis, incontinence, reduced tonus of anal sphincters, and complete rectal prolapse. During I the rectum prolapses only under increased intraabdominal pressure and retracts spontaneously. Massive prolapse (stage II) often occurs without increased intraabdominal pressure and has to be reposited manually. Best results are obtained by fixing the mobilised rectum in the hollow of the sacrum as described by Wells in 1959 or by Ripstein in 1969. In bad risk patients a sublevatoric wire can be used. Most patients have satisfactory continence postoperatively without a corresponding physiological tonus of anal sphincters.

Adult↗
PubMed1980

[Ulcerative colitis and Crohn's colitis. Medical or surgical treatment].

Colectomy with ileorectal anastomosis was performed in 47 patients affected by ulcerative colitis and Crohn's colitis. These two forms of "aggressive idiopathic colitis" present the same problems of therapy from both the pharmacological and the surgical point of view. The topical employment of antiphlogistic steroids and sulphasalazine by daily retention enemas caused a regression of proctitis and allowed a safe ileorectal anastomosis. After the surgical procedure a protective treatment of the rectal mucosa was prosecuted with minimal dosages of the same antiphlogistic drug by daily minienemas. Betametasone in aqueous solution have proved, among the antiphlogistic steroids, to be very suitable for a topical action without side-effects in the long time. The association of topical treatment and surgery is particularly indicated for those patients who cannot recover with medical therapy alone, as it enables them to recover and return to a normal life. The opportunity for colectomy is so much greater as it is possible, as a rule, to spare the rectum and protect the ileorectal anastomosis by means of a topical therapy without limitations of time. Therefore the surgical indication should not be delayed whenever the medical treatment by systemic administration of steroids, sulphasalazine and immunosuppressors is unable to prevent the evolution of aggressive idiopathic colitis to a chronic and seriously invalidating disease.

Anti-Inflammatory Agents↗
PubMed1977

Colo-rectal biopsy in inflammatory bowel disease.

The term inflammatory bowel disease (IBD) is viewed as all-inclusive, covering the full panoply of intestinal disorders in which inflammatory changes are a prominent feature, including those of infectious, toxic, and intrinsic origin as well as the idiopathic entities ulcerative colitis and Crohn's disease. This chapter describes and discusses those aspects of colo-rectal biopsy in IBD which can help pathologists make optimal interpretations. The areas covered are: 1) methods used to prepare biopsy specimens for study, 2) normal histologic findings and common artefacts, 3) basic pathologic changes occurring in IBD, 4) a general approach to differential diagnosis in IBD, and 5) discussion of the various individual forms of IBD. The importance of full and reliable information exchange between the endoscopist and pathologist is stressed. Special attention is given to features in biopsy specimens which help in differentiating between ulcerative colitis and Crohn's disease. Other entities discussed are bacterial dysenteries; gonococcal proctitis; tuberculosis; Whipple's disease; amebiasis; balantidiasis; schistosomiasis; cryptosporidiosis; lymphopathia venereum; cytomegalovirus infection; histoplasmosis; antibiotic colitis; IBD due to cytotoxic drugs (5-FU), heavy metals, and foodstuffs; irradiation colitis; ischemic colitis; solitary ulcer syndrome; diverticulitis; and colitis secondary to obstruction. The term pseudomembranous enterocolitis is also considered.

Biopsy↗
PubMed1983

Virus-associated colitis in homosexual men: two case reports.

Two homosexual men with colitis are described. In each case there was evidence of viral infection of the colon. One patient developed toxic megacolon that responded to conservative therapy. The other patient had proctosigmoiditis and opportunistic infections that eventually led to his death. An intensive search for viruses should be made in all homosexual men with proctitis and/or colitis.

Adult↗
PubMed1984

Intersphincteric proctectomy.

Conventional proctectomy for inflammatory bowel disease is followed by delayed perineal wound healing in 20% to 63% of patients and sexual dysfunction in up to 17%. Although described several times since 1967, intersphincteric proctectomy is a technique used by very few surgeons in the United States. Accurate and safe rectal mobilization is easily accomplished by dissection within the intersphincteric plane, resulting in minimal damage to the pelvic floor and pelvic nerves and a much smaller perineal wound. The records of 58 patients who underwent rectal excision were examined. Proctectomy was performed in a conventional fashion for 30 patients and an intersphincteric proctectomy was performed for 28 patients. Of the 30 conventional procedures, 20 were for ulcerative colitis and 10 were for Crohn's disease. There was complete healing of the perineal wound in 70% of the patients at 6 months and in 73% at 1 year. There were four residual deep sinus tracts. Of the 15 men, three developed impotence, one permanently. Of the 28 patients who underwent intersphincteric proctectomy, 17 had ulcerative colitis, eight had Crohn's disease, two had incapacitating proctitis, and one had cancer of the midrectum. There was complete healing of the perineal wound in 84% of the patients at 6 months and in 84% at 1 year. There were no residual deep sinus tracts. Of the 15 men, one developed impotence that resolved after 1 year. Only one patient complained of persistent anal discomfort. The morbidity rate from intersphincteric proctectomy is low and we recommend more widespread use of this technique.

Aged↗
PubMed1978

[Experiences in gastrointestinal cytology in Steiermark country (author's transl)].

In Steiermark out of 150 000 smears per annum 1 percent concern gastrointestinal cytology. The material consists in brush smears of stomach and rectum, aspiration biopsy of pancreas and secretions from ERCP. In 80% of gastric brush smears a histologic diagnosis was available for comparison. 17% of gastric smears could not be evaluated, 3.5% were false positive and 4% false negative. Percentage of carcinomas amounted 25%. Age of cancer patients was 30--88 years with a peak between 60 and 65 years. 55% of cancers were inoperable. Only 4% were early cancers. 10% of brush biopsies from rectum and colon were normal, 25% were chronic ulcerative nonspecific proctitis, 15% papillous polyps and 35% carcinoma. Fine needle biopsies of pancreas were performed during operation and evaluated as urgent intraoperative diagnostic. 7 of 25 cases were carcinoma. ERCP is performed mainly in cholostatic icterus. Proportion of carcinoma was 9.1%.

Adult↗
PubMed1983

Treatment of locally advanced cancer of the cervix with transperineal interstitial irradiation. Report on 106 cases.

The survival of patients with locally advanced cancer of the cervix (stage IIB, IIIB, and IVA) treated with conventional intracavitary radium remains unsatisfactory. Over 50% of these patients are local failures and die with uncontrolled tumor in the pelvis. In 1978, we began performing transperineal interstitial implants to the parametria in patients with advanced disease. One hundred six evaluable patients (34 IIB, 67 IIIB, and five IVA) received one (99) or two interstitial implants (7) following 40-50 Gy of external supervoltage external irradiation. In addition, seven patients underwent exploratory staging laparotomies concurrently with the first implant procedure. Mean follow-up is 23 months and range is 12-60 months. Control of the pelvic tumor has been documented in 85%, 75%, and 40% of stage IIB, IIIB and IVA patients, respectively. Seven patients developed distant metastases and three died of intercurrent disease with no evidence of pelvic relapse. Nineteen patients (18%) developed radiation-related complications: proctitis or cystitis (six), rectal stenosis (six), ulceration and necrosis of the vaginal wall (one), and recto- or vesicovaginal fistula (six). It is noteworthy that 7/11 patients (64%) who had radioactive sources placed on the surface of the vaginal obturator as a substitute for an intrauterine tandem developed severe complications. We conclude that transperineal interstitial irradiation is both safe and an effective modality in the treatment of advanced cancer of the cervix.

Brachytherapy↗
PubMed1983

Ileorectal anastomosis for inflammatory bowel disease in children and adolescents.

As in any operation for IBD, colectomy and ileorectal anastomosis should be performed only after every effort has been made to control the disease medically. Only in uncontrolled disease should early proctectomy be advised on the grounds of lack of normal physical development and sexual immaturity. Ileorectal anastomosis should not be performed upon every patient requiring surgical treatment any more than proctocolectomy and ileostomy should be performed upon every patient. Unless there is severe persistent disease of the rectum or destruction of the anal sphincter, the rectum should be preserved because severe ulcerative proctitis may heal or improve postoperatively with further medical treatment. If further surgical treatment is necessary, conversion to an ileostomy can be undertaken, and there are now other alternatives, such as the continent ileostomy and the ileoanal anastomosis, with or without a pelvic pouch.

Adolescent↗
PubMed1984

Secondary syphilis: uncommon manifestations of a common disease.

Reports of cases of primary and secondary syphilis are increasing in the United States, particularly in urban areas and among homosexual men. While primary syphilis poses little diagnostic difficulty, many physicians are unfamiliar with the multisystem nature of secondary lues. Patients who have secondary syphilis commonly present with systemic signs, skin rash, mucous membrane lesions and generalized adenopathy. Less commonly, secondary syphilis may occur as acute meningitis, sensorineural hearing loss, iritis, anterior uveitis, optic neuritis, Bell's palsy, gastropathy, proctitis, hepatitis, pulmonary infiltration, nephrotic syndrome, glomerulonephritis, periostitis, tenosynovitis and polyarthritis. The diagnosis of secondary syphilis is easily confirmed. Its various manifestations are readily treated with penicillin and, if treated early, are entirely reversible. Two recent cases of secondary syphilis, one presenting as nephrotic syndrome and one as chorioretinitis and ptosis, illustrate the usual and unusual features of this common infection.

Adult↗
PubMed1984

Jejunal infection with Campylobacter.

A patient had common variable immunodeficiency, chronic malabsorption, and Campylobacter jejuni infection. Infection was diagnosed by jejunal aspiration. A follow-up jejunal aspirate was culture positive at the same time that a stool culture was negative. Infection resulted in worsening of chronic diarrhea, but it was not associated with clinical features of colitis or proctitis. The duration of infection was prolonged and initial antimicrobial therapy was ineffective. Single drug therapy with erythromycin ethylsuccinate and then chloramphenicol led to the emergence of resistant organisms. After five months of bacterial excretion, combination therapy with metronidazole and neomycin sulfate eliminated the organism. This case emphasizes that the clinical manifestations and response to therapy of C jejuni infection can be altered in immunodeficient patients.

Adult↗
PubMed1984

[Effect of brachytherapy and teletherapy on treatment results in primary vaginal cancer].

From 1971 to 1977 99 cases of primary carcinoma of the vagina were treated at the Radiotherapy Department of the I. University Clinic for Gynecology and Obstetrics in Vienna. Radiotherapy was adapted individually as far as possible due to the different localisations and extensions of this tumor and to the vicinity of bladder and rectum, two very radiation-sensitive organs. Basically a three-phased scheme of treatment was intended: primarily a focal irradiation of the tumor by plaque-application, then combined intra-uterine and intra-vaginal radium insertion, followed by a vaginal cylinder. Thus the vaginal tissue is charged with about 32 Gy in a depth of 0,5 cm, the tumor itself with about 100 Gy. Percutaneous telecobalt irradiation was applied additionally following the method prescribed for carcinoma of the cervix uteri. A vulvo-perineal irradiation field was applied supplementarily , if the tumor was localised in the lower third of the vagina. 5-year overall remission rate amounted to 32% for the years 1971 to 1977; hence it was somewhat lower than for the total time observed (1950 to 1977), which was 39,8%. This could be explained by the sharp increase of very old patients and of progressed stages. For separate stages, the following 5-year healing rates were observed: stage I: 78%; stage II: 48%; stage III: 24% and stage IV: 19%. Recto-vaginal or vesico-vaginal fistulas occurred in 8% of the cases; less severe complications, such as cystitis or proctitis, were found in 41 and 43%, respectively. The effect of percutaneous telecobalt irradiation on the healing rate was marked in progressed cases, especially. Only 1 patient of 15 (7%), who were not treated by teletherapy, reached 5-year remission , as compared to 14 of 52 (27%), who received teletherapy. Stages I and II did not show a comparable difference. Intrauterine brachytherapy was of more importance for remission rate in early stages: 11 of 16 (69%) patients with stages I and II, who were treated with intrauterine curietherapy, survived 5 years or more; of those who did not have intrauterine insertion, only 6 of 15 (40%) reached 5-year remission . For stages III and IV, intrauterine curietherapy did not markedly change the healing rate.

Adult↗
PubMed1982

Lymphogranuloma venereum: review of clinical manifestations, epidemiology, diagnosis, and treatment.

Lymphogranuloma venereum (LGV) continues to be a rare disease in the Scandinavian countries; cases are, with rare exceptions, contracted elsewhere. The clinical manifestations of LGV include extragenital infections such as pharyngitis, with cervical lymphadenopathy, and proctitis. Delayed diagnosis can lead to late complications, with disabling anatomic defects as an end result. Diagnosis usually is based on clinical grounds, with serological confirmation. Other chlamydial infections besides LGV can cause seroconversion, particularly in tests for complement-fixation antibodies. Treatment with tetracyclines is effective to eradicate the causative agent, provided that the treatment course is of adequate length. Only rarely is surgical intervention needed, and then primarily to correct anatomic abnormalities in far-advanced cases.

Anti-Bacterial Agents↗
PubMed1980

Campylobacter jejuni enterocolitis. A clinicopathologic study.

Sixteen patients with diarrhea due to Campylobacter jejuni seen within a one-year period at a general hospital were studied to review the clinical and pathological features of this illness. Campylobacter jejuni causes an acute diarrheal illness often associated with fever, delayed-onset hematochezia, and severe abdominal pain. Roentgenographically, one may see colonic and ileal ulceration. Sigmoidoscopically, the rectal appearance is similar to that from acute idiopathic ulcerative colitis, while rectal biopsy specimens show preservation of glandular architecture and a range of focal inflammatory changes. These changes are most severe in patients with a history of frank blood in stool, provided the specimens are taken within the first week of illness. No correlation between stool frequency, abdominal pain, or fever and the severity of proctitis in rectal biopsy specimens can be drawn, which suggests that the pathogenic determinants for thesse clinical manifestations may not be in the rectum, but higher in the colon or in the small intestine.

Campylobacter↗
PubMed1982

[Severe intoxication after combined chemotherapy of a sigma-adenocarcinoma with peptichemio and 5-fluorouracil (author's transl)].

After perioperative adjuvant chemotherapy of a sigma-adenocarcinoma with 400 mg peptichemio and 500 mg 5-fluorouracil a 61-year-old woman developed a severe intoxication: myelosuppression with pancytopenia, gastroenteritis and ulcerative proctitis, toxic hepato- and myocardiopathy, impaired renal function and alopecia. As a result of reduced resistance pneumonias, urinary tract infection, sepsis, cytomegaly infection and candidiasis of the oral mucosa occurred. The toxic effects are attributed mainly to the high dose of peptichemio.

Adenocarcinoma↗
PubMed1982

Colonoscopic retroflexion in the evaluation of rectal disease.

Although previously described and advocated, rectal retroflexion has not been well studied as a diagnostic maneuver. We report 75 cases in which the maneuver was performed during colonoscopy or fibersigmoidoscopy. The technique was both easily performed by the examiner and well tolerated by patients. Rectal retroflexion increased diagnostic yield in six of 75 patients. It proved a useful adjunct to the standard forward-view of the rectum in the evaluation of internal hemorrhoids and in the detection of small perirectal polyps and rectal inflammatory bowel disease. Excluding patients with severe proctitis or a contracted rectal vault, rectal retroflexion is a valuable technique for the evaluation of suspected rectal disease.

Colonoscopy↗