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PubMed2006

[Ileus disease].

Intestinal obstruction may be mechanical or non-mechanical (adynamic ileus). Adhesions and external hernias are the most common causes of obstruction in small intestine, whereas carcinoma, sigmoid diverticulitis, and volvulus are the most common causes in large intestine obstruction. Distension of the intestine caused by gas and fluid accumulation in the obstructed segment is the key pathophysiological mechanism initiating ileus with subsequent multiorgan failure and death. Surgery should always be undertaken if complete obstruction or strangulation is suggested and ileus is established. Before operation, the fluid and electrolyte balance should be restored and decompression instituted by means of a nasogastric tube. Delaying the operation because of improvement in patient well-being during resuscitation is only justified in those suffering from large intestine obstruction due to colorectal carcinoma. Purely nonoperative treatment is safe only in the presence of incomplete obstruction and best utilized in patients with postoperative adynamic ileus or repeated episodes of partial obstruction.

Diagnosis, Differential↗
PubMed1979

Eosinophilic gastroenteritis in extreme allergy. Immunopathological comparison with nonallergic gastrointestinal disease.

Intestinal mucosal biopsy immunoglobulin content in a patient with eosinophilia, allergic gastroenteropathy (atopy, food sensitivities, protein-losing enteropathy, iron deficiency anemia, and growth retardation), and hyperimmunoglobulinemia E (68,000 units) was compared with that of a control group and a group with eosinophilic gastroenteritis who had no atopic features. The patient had no evidence of cellular or humoral immunodeficiency but was severely hypersensitive to multiple inhalant and dietary allergens. In contrast to the findings in patients with nonallergic eosinophilic gastroenteritis, whose intestinal immunoglobulin content was similar to that of controls, tissue immunoglobulin IgE and IgG was markedly increased in the allergic patient. These results support an intestinal reaginic mechanism in the etiology of the allergic form of eosinophilic gastroenteritis.

Adolescent↗
PubMed2004

Graft versus host disease in intestinal transplantation.

Our aim was to analyze the clinical course and outcome of patients with graft vs. host disease (GVHD) after intestinal transplantation (ITx). All patients receiving ITx between May, 1990 and December, 2003 were retrospectively reviewed for evidence of GVHD. Two hundred and fifty patients underwent ITx during the study period. Graft vs. host disease was suspected clinically in 23 patients on the clinical basis of presentation such as skin rash, ulceration of oral mucosa, diarrhea, lymphadenopathy, or native liver dysfunction. Fourteen (eight children and six adults) patients (5.6% of total patient population) had GVHD confirmed by histopathological criteria including keratinocyte necrosis (n = 9), epithelial apoptosis of the native gastrointestinal tract (n = 4), and epithelial cell necrosis of oral mucosa (n = 1). Donor-cell tissue infiltration or extensive peripheral blood donor-cell chimerism was documented on seven occasions. The majority of cases of GVHD resolved with steroid administration and optimization of tacrolimus immunosuppression. The incidence of histologically proven GVHD after clinical intestinal transplantation is 6.5% (8/122) in children and 4.7% (6/128) in adults. Successful clinical management requires a high index of suspicion to minimize morbidity and mortality. Diagnostic and treatment strategies based on this experience are proposed.

Adolescent↗
PubMed2004

Human norovirus infection and the lessons from animal caliciviruses.

PURPOSE OF REVIEW: Human noroviruses are a major cause of infectious intestinal disease, particularly in the health sector, with considerable knock-on effects on care provision through ward closures and staff sickness. This review will describe recent advances in our understanding of human noroviruses. In addition, we will consider related nonhuman caliciviruses to highlight some potential difficulties in the control of caliciviral disease. RECENT FINDINGS: Using more sensitive reverse transcriptase polymerase chain reaction based assays, noroviruses are now recognized as the most common cause of infectious intestinal disease in the community, as well as outbreaks of the infectious intestinal disease. After recovery from acute disease, some individuals continue shedding norovirus, particularly if immunosuppressed. The noroviruses are extremely variable, which has important implications for protection following challenge, and for future vaccination. From amongst this variability, new strains have emerged with the potential to spread widely. Recently a mouse norovirus has been identified which will afford new insights into the biology of these important viruses. Studies on human susceptibility have identified some resistant individuals in the population and a potential virus receptor, which may lead to the development of novel antiviral therapies. SUMMARY: Lack of cell culture systems for the human noroviruses is being overcome by molecular technologies. Such studies have provided new insight into the significance and epidemiology of these viruses and opened the possibility of disease control through vaccination. Work on nonhuman caliciviruses has interesting parallels with human noroviruses, and provides new insights into the understanding of these important human pathogens.

Animals↗
PubMedDate not supplied

[Diffusion of intestinal parasitic diseases in some Milanese kindergartens].

During the months of October and November 1977, 560 children aged between three and five attending some kindergartens of Milan were studied to evaluate the diffusion of intestinal parasitic infections. Among a first group of 274 children, examination of the stool only with Ritchie's method was positive in 14.96% of subjects. When Scotch tape swab test for enterobiasis was also carried out, the diffusion of parasitic infections resulted higher (54.54% in a second group of 286 cases). These data were correlated to the same parameters (age and sex, place of origin and social status of the family, density of inhabitants, hygienic situation), obtaining almost corresponding values in the two groups. In particular, an increase of the incidence of parasitic infections with advancing age and a higher diffusion among members of immigrated italian families (especially if living in overcrowded houses at low hygienic conditions) were observed.

Age Factors↗