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PubMed1989

A prospective survey of necrotising enterocolitis in very low birthweight infants.

Necrotising enterocolitis is the most common gastrointestinal complication of pre-term infants. In order to determine the strength of the association of hypoxia/ischaemia and infection as causative factors in necrotising enterocolitis, we evaluated all liveborn pre-term infants with a birthweight less than 1500 g and/or gestational age less than 32 weeks in The Netherlands in 1983. The factors related to hypoxia/ischaemia included: asphyxia, respiratory distress syndrome, ventilatory assistance, persistent fetal circulation, persistent ductus arteriosus, apnoea, bradycardia, exchange transfusion and peri/intraventricular haemorrhage; those related to infection were: congenital infections, pneumonia, sepsis and meningitis. Of the 1338 infants enrolled, 1187 survived for more than 24 hours and had complete data. Mean (+/- s.d.) birthweight was 1278 (+/- 297) g and mean (+/- s.d.) gestational age 30.7 (+/- 2.6) weeks. Seventy-three (6.1%) infants developed necrotising enterocolitis: 46 (63.0%) stage I disease (clinically very suspect), 11 (15.1%) stage II (pneumatosis intestinalis) and 16 (21.9%) stage III (intestinal perforation). Mean +/- s.d. birthweight of the infants with necrotising enterocolitis (1197 +/- 284 g) was lower (P less than 0.02) than in those without necrotising enterocolitis (1283 +/- 297 g). Gestational ages were comparable. Mortality in the group with necrotising enterocolitis was 21.9% versus 15.8% in the non-necrotising enterocolitis group (NS). Stepwise logistic regression analysis indicated that among those factors studied, only sepsis and birthweight were truly associated with the occurrence of necrotising enterocolitis.

Enterocolitis, Pseudomembranous↗
PubMed2005

Ascites after orthotopic liver transplantation in children.

Ascites is a poorly understood postoperative complication of orthotopic liver transplantation (OLT). It is associated with additional morbidity and can prolong hospitalization considerably. The incidence, the factors predictive of occurrence and the etiology of this complication are not known. The charts of 118 patients with 138 OLT were analyzed according to the following criteria: ascites lasting longer than the first 10 postoperative days, assessed by loss of ascitic fluid through drainage tubes, surgical wounds or paracentesis, with a peak volume of > or =10 mL/kg/day. Patients were divided into three groups: Group 1, no ascites; Group 2, ascites associated with postoperative complications, including chylus ascites; and Group 3, ascites not associated with postoperative complications. Postoperative ascites occurred in 43 of 138 OLT (31.2%). Patients with biliary atresia, preoperative portal hypertension, postoperative pleural effusion or at retransplantation had ascites significantly more often. In 32 of 138 (23.2%) OLT, ascites was associated with postoperative complications, including thrombosis, abdominal infections, intestinal perforation, biliary leak, pancreatitis, and chylus ascites. In 11 of 138 (7.9%) OLT, ascites was the only postoperative complication (group 3). Group three patients were significantly older, and had lower preoperative platelet counts and preoperative ascites more often than group 1 patients. The primary liver diseases were mainly cystic fibrosis of the pancreas, congenital hepatic fibrosis, and North American Indian childhood cirrhosis. The serum-ascites albumin gradient suggested a hepatic origin of ascites. Postoperative ascites is associated with the duration and degree of preoperative portal hypertension. We speculate that the mechanism involved includes a disproportion between venous blood volume and liver uptake capacity of the donor organ.

Ascites↗
PubMed1986

Duodenal ulceration: a complication of tolazoline therapy.

Tolazoline Hydrochloride is a pulmonary vasodilator that is used for the treatment of pulmonary hypertension of the newborn. Two patients who were receiving Tolazoline by infusion developed duodenal ulceration and subsequent intestinal perforation. This undesirable side effect of Tolazoline may be prevented by the concomitant use of antacids to maintain gastric pH greater than 5.

Duodenal Ulcer↗
PubMed1996

Intermediate lymphocytic lymphoma massively involving the gastrointestinal tract.

A case is presented of intermediate lymphocytic lymphoma seen in a 53 year old male, which extensively infiltrated systemic organs, including the entire digestive tract from the esophagus to the rectum. Peyer's patch invasion was evident. Multiple intestinal perforations caused death 5 months later. Surface marker studies suggested the marginal zone origin for this CD20+ B cell malignancy.

Antigens, CD↗
PubMed2005

Tuberculous peritonitis developing during chemotherapy for pulmonary and intestinal tuberculosis: a case report.

This report is of a case of tuberculous peritonitis that developed during antituberculous chemotherapy. A 54-year-old man had been diagnosed as all-drug susceptible pulmonary and intestinal tuberculosis, and treatment with isoniazid, ethambutol and rifampicin had been initiated. About 5 months later, while still undergoing therapy, a large amount of ascites developed. A diagnostic laparoscopy was performed but due to the adhesion between the greater omentum and the parietal peritoneum, intestinal perforation occurred. An emergency operation was performed and the diagnosis of tuberculous peritonitis was confirmed. There are few reports of abdominal tuberculosis developing during antituberculous chemotherapy. In this case a paradoxical response may have been involved in the pathogenesis.

Antibiotics, Antitubercular↗
PubMed1989

Small bowel obstructions: the case for investigation for occult large bowel carcinoma.

Over the last century, the incidence of adhesive small bowel obstructions has increased as the rate of operative management of abdominal conditions has risen. Concurrently, the rate of colonic cancer has also increased. One of the ways in which colonic cancer may present is as an isolated small bowel obstruction. Three cases of resolving small bowel obstruction secondary to occult carcinoma are presented and a survey of the literature is made. The conclusion is that all patients who present with a small bowel obstruction, which resolves, and who are in the cancer age group should be investigated for colonic cancer, especially when the putative causative operation was carried out some years previously; otherwise, large bowel tumours presenting as an isolated small bowel obstruction may pass undiagnosed.

Adenocarcinoma↗
PubMed1994

Childhood intussusception in a regional hospital.

This study reviews all childhood intussusceptions treated over a 6 year period in a regional centre with six visiting general surgeons and two paediatricians. Clinical presentation, management, complications and outcomes were noted and an attempt was made to follow up all cases. There were 20 patients, with a median age of 6 months (range 10 weeks to 17 months). Only one patient had all four classical features of intussusception (pain, vomiting, 'red currant jelly' stools and abdominal mass). Seven patients were managed successfully by barium enema reduction, but 14 required operation, four following failed radiological reduction. There was one intestinal perforation due to attempted barium enema reduction and one patient required a reoperation for ileal gangrene following operative reduction. There were no deaths and there have been no subsequent recurrent intussusceptions although three cases were lost to follow up. There was a delay in diagnosis in some cases (average duration from onset to diagnosis was 34 h). Although delay was incurred by parents in some cases and in peripheral hospitals in others, there is a need for greater awareness by surgeons of the significance of subtle features such as pallor and lethargy in a child with persistent vomiting. Delay in diagnosis is likely to lead to an increased need for primary surgical intervention. Adverse features (age > 3 months or < 2 years; symptoms > 24 h; small bowel obstruction; dehydration > 5%) were predictive of an increased likelihood of surgical resection, and may help avoid inappropriate attempts at radiological reduction.(ABSTRACT TRUNCATED AT 250 WORDS)

Barium Sulfate↗
PubMed1982

Chronic radiation injury to the intestine: a clinico-pathological study.

This paper draws attention to the continuing problem of chronic radiation injury to bowel. Fifty-seven symptomatic patients with this disorder were studied, 31 with predominantly small bowel injury and 26 with colonic disease. The mean latent interval following irradiation was 4.7 years. Small bowel disease presented initially as intestinal obstruction (19 cases) or malabsorption (11 cases) and the radiation related mortality in small bowel disease was 32%, while that for colonic disease was 4%. There was a high incidence of prior pelvic surgery and of adjunctive chemotherapy in patients developing small bowel disease. Analysis of the radiotherapy techniques used highlighted that an unsatisfactory distribution of radiation dosage occurred when parallel opposed fields were used particularly where one field only was treated daily. Difficulty in matching external beams with intracavity sources may also have contributed to radiation injury.

Female↗
PubMed2006

Long-term outcome of adult-to-adult living donor liver transplantation for post-Kasai biliary atresia.

Our objective was to analyze problems in the perioperative management and long-term outcome of living donor liver transplantation (LDLT) for biliary atresia (BA). Many reports have described the effectiveness of liver transplantation (LT) for BA, particularly in pediatric cases, but little information is available regarding LT in adults (> or =16 years old). Between June 1990 and December 2004, 464 patients with BA underwent LDLT at Kyoto University Hospital, of whom 47 (10.1%) were older than 16 years. In this study, we compared the outcomes between adult (> or =16 years old) and pediatric (<16 years old) patients. The incidence of post-transplant intestinal perforation, intra-abdominal bleeding necessitating repeat laparotomy and biliary leakage was significantly higher (p < 0.0001, <0.001 and <0.001, respectively) in adults. Overall cumulative 1-, 5- and 10-year survival rates in pediatric patients were significantly higher (p < 0.005) than in adults. Two independent prognostic determinants of survival were identified: a MELD score over 20 and post-transplant complications requiring repeat laparotomy. Outcome of LDLT in adult BA patients was poorer than in pediatric patients. It seems likely that LT will be the radical treatment of choice for BA and that LDLT should be considered proactively at the earliest possible stage.

Adolescent↗
PubMedDate not supplied

Survey of the use of radiography vs. ultrasonography in the investigation of gastrointestinal foreign bodies in small animals.

A question frequently asked by clinicians who are treating small animals suspected of having gastrointestinal foreign bodies is whether one imaging test such as survey radiography or ultrasonography is sufficient to make the diagnosis. A study was undertaken to try and answer this question. Survey abdominal radiography and ultrasonography was performed on 16 small animals (11 dogs, five cats) with clinical signs of an obstruction because of a confirmed gastrointestinal foreign body. The majority of the foreign bodies (14/16) were confirmed by surgical removal and were located in the small intestine. A gastric foreign body was retrieved endoscopically and a colonic foreign body was passed in the feces. Radiographically identifiable foreign bodies were evident in nine animals. Small intestinal overdistension was present radiographically in seven animals. Ultrasonography detected a foreign body in all 16 animals. The foreign bodies were identified by their distal acoustic shadowing and variable degrees of surface reflection. An intestinal perforation was detected sonographically but not radiographically. The value of additional sonographic findings including thickening of the gastrointestinal wall and loss of layering, free peritoneal fluid, and lymphadenopathy in these animals is discussed. The findings in this series suggest that in a small animal with a gastrointestinal foreign body, ultrasonography alone could be used to make the diagnosis and may be a more appropriate choice than survey radiography.

Animals↗
PubMed1990

[Typhoid fever with intestinal hemorrhage, drug-induced fever, DIC, ARDS and psychiatric disorder (a case report)].

A 40-year-old poor nutritional Japanese male was admitted to our hospital on June 5, 1989, with a 31-day history of fever. He had been working as a crew member of a ship in South East Asia. Salmonella typhi was isolated from his blood culture. In the course of the disease, intestinal hemorrhage, drug-induced fever and liver dysfunction, DIC, ARDS, and psychiatric disorder were identified. Intestinal hemorrhage occurred after the coagulation test became normal, so it was thought that the intestinal hemorrhage did not correlate with DIC. The patient was treated with CP, ABPC and supportive therapy. He became well, and ARDS and psychiatric disorder were disappeared. He was discharged on the 118th day of illness. Drug-induced fever was thought as one of the allergic reaction and the causative drug was not identified by LST. It was suspected that psychiatric disorder correlated with poor nutrition. Supportive therapy such as mandatory bed rest, intravenous hyperalimentation and low-volume blood transfusions, as well as an antimicrobial treatment were important for the inhibition of shock and/or intestinal perforation.

Adult↗
PubMed1991

[Clinical research on patients with typhoid and paratyphoid fever (1984-1987). Research Group for Infectious Enteric Diseases, Japan].

Patients with typhoid or paratyphoid fever, admitted to 14 hospitals for infectious diseases during 1984-1987, were epidemically and clinically studied. Of the total number of 183 typhoid, 49 paratyphoid fever patients, those infected overseas was 44.3% and 71.4% respectively, giving an overall annual decrease, yet marking an increased ratio of overseas infection. Patients aged 20s-30s and males were dominant. One hundred and seventy six cases (96.2%) of typhoid and all the paratyphoid fever cases were bacteriologically diagnosed. The period from the onset to the diagnosis was around 14 days in most cases, but beyond 29 days in over 10% of the cases. We would like to emphasize that enteric fever, focusing on high fever, bradycardia, roseola, hepatosplenomegaly, leukopenia, elevated serum-GOT GPT and LDH, can be easily diagnosed by blood/stool culture before beginning chemotherapy. Intestinal bleeding was recognized in 24 cases (13.1%) of typhoid and 4 (8.2%) of paratyphoid fever, intestinal perforation in 2 (1.1%) and death in 1 (0.5%) of typhoid fever. CP was most commonly used in chemotherapy. Bacteriological relapse was recognized in 7/127 cases (5.5%) of typhoid, 6/48 (13.0%) of paratyphoid fever those followed beyond 3 weeks, though eradication was attained by retreatment. One strain of S. typhi resistant to CP.ABPC.KM.SM was isolated in 1986 from a patient infected overseas. New quinolones seem reliable in our preliminary studies.

Adolescent↗
PubMed1997

Synergistic effect of mutations in invA and lpfC on the ability of Salmonella typhimurium to cause murine typhoid.

Penetration of the intestinal mucosa at areas of Peyer's patches is an important first step for Salmonella typhimurium to produce lethal systemic disease in mice. However, mutations in genes that are important for intestinal invasion result in only moderately decreased virulence of S. typhimurium for mice. Here we report that combining mutations in invA and lpfC, two genes necessary for entry into Peyer's patches, results in a much stronger attenuation of S. typhimurium than inactivation of either of these genes alone. An S. typhimurium invA lpfC mutant was 150-fold attenuated by the oral route of infection but was fully virulent when the intestine was bypassed by intraperitoneal challenge of mice. During mixed-infection experiments, the S. typhimurium invA lpfC mutant showed a strong defect in colonizing Peyer's patches and mesenteric lymph nodes. These data suggest that mutations in invA and lpfC deactivate distinct pathways for intestinal penetration and colonization of Peyer's patches. While the inv-mediated pathway is widely distributed, the lpf operon is absent from many phylogenetic groups within the genus Salmonella. To investigate how acquisition of the lpf-mediated pathway for mucosal penetration contributed to evolution of virulence, we studied the relationship between the presence of the lpf operon and the pathogenicity for mice of 18 isolates representing 14 Salmonella serotypes. Only strains possessing the lpf operon were able to cause lethal infection in mice. These data show that both the invA- and lpfC-mediated pathways of intestinal perforation are conserved in mouse virulent Salmonella serotypes.

Animals↗