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PubMed1977

[Determination of isoenzymes of alkaline phosphatase and alpha-amylase in feces].

Investigations for the proof of isoenzymes of the alkaline phosphatase and the alpha-amylase in stool were carried out. The measurements of the faecal enzyme activities were performed in 96 patients with intestinal diseases. The disc electrophoresis in the polyacrylamide gel served for the separation of isoenzymes. The separated enzyme bands of the extracts of stool were compared with those ones of serum duodenal juice and extracts of the mucous membrane of the duodenum, the jujunum, the ileum as well as of the colon. Hereby up to 4 very much anodically wandering bands were present, which might be subunits or fission products of the alkaline phosphatase. In the alpha-amylase up to 5 bands could be proved, which were compared with those ones of the serum, the duodenal juice and the urine. A coordination of these isoenzymes concerning their origin is not possible. The faecal activities of enzymes correlate with the weights of stool. In exocrine pancreatic insufficiency and ulcerous colitis increased faecal activities of enzymes are found, the genesis of which is discussed.

Alkaline Phosphatase↗
PubMed1994

Prevalence of intestinal microsporidiosis in HIV-infected individuals referred for gastroenterological evaluation.

OBJECTIVES: The reported prevalence of enteric pathogens, especially microsporidiosis, in HIV infection varies greatly. In this study, the prevalence rates for microsporidiosis and other enteric pathogens in HIV-infected individuals referred for gastrointestinal symptoms were compared. METHODS: This prospective study included 250 HIV-infected individuals (179 with AIDS) who were referred for GI evaluation (diarrhea in 194). The prevalence rates of symptomatic intestinal disease due to microsporidiosis and other intestinal pathogens were determined by clinical evaluation, and their epidemiological, clinical, and immunological characteristics were compared. RESULTS: Enteric pathogens were identified in 83% of 141 AIDS patients with diarrhea, 2% of 53 AIDS patients without diarrhea, and 3% of 56 non-AIDS patients. Microsporidia was the most common pathogen found (39% of AIDS patients with diarrhea). Two or more coexisting infections were found in 28% of AIDS patients with diarrhea. The prevalence rates for coexisting infections were similar to those predicted from the individual prevalence rates, with the exception of cryptosporidiosis and microsporidiosis, which were lower than predicted. Patients with microsporidiosis had severely depressed CD4 lymphocyte counts in peripheral blood. All patients with microsporidiosis, except one, had diarrhea, and D xylose malabsorption was universal in patients with microsporidiosis. CONCLUSION: Microsporidiosis is a common cause of chronic diarrhea, malabsorption, and weight loss in AIDS patients.

AIDS-Related Opportunistic Infections↗
PubMed1993

[A case report of atypical Fabry's disease with colon cancer].

An atypical case of Fabry's disease, a rare congenital disorder of glyco-lipid metabolism, associated with sigmoid cancer was reported. A 50-year-old man who had been diagnosed as having atypical form of Fabry's disease complained of lower abdominal pain and difficult defection. A barium enema and an endoscopic examination disclosed sigmoid colon cancer. The cancer was curatively resected. Fabry's disease is often associated with intestinal disease, but the patient with Fabry's disease associated with intestinal malignancy has not been reported.

Adenocarcinoma↗
PubMed1979

Primary intestinal lymphoma in South Africa.

All adult cases of primary intestinal lymphoma seen during the years 1953--77 at Groote Schuur Hospital, South Africa, were reviewed. Seventy percent of patients with solitary lymphoma and 80% with immunoproliferative small intestinal disease were mulatto. Patients in the latter group presented with malabsorption and those with a solitary lymphoma presented with intestinal obstruction. Four of 15 patients tested for the presence of alpha-heavy-chains were found to have alpha-heavy-chain disease. Family studies of potential genetic and immunologic factors showed some significant differences in IgA and IgG levels in the families of two patients with alpha-heavy-chain disease. Elevated alkaline phosphatase of intestinal origin was found in four of six patients with immunoproliferative small intestinal disease and in a high proportion of relatives. Fifty percent of the six patients were of blood group B. Minor blood groups, ABH secretor state and Pi phenotype distribution were similar to those of the control subjects. HLA gene frequency was particularly increased in the HLA-A9 antigen. These studies suggest that genetic factors may be relevant to the pathogenesis of immunoproliferative small intestinal disease.

Adult↗
PubMed1986

Stool chymotrypsin activity measured by a spectrophotometric procedure to identify pancreatic disease in infants.

The aim of this study was to assess the analytical performance of the BMC stool chymotrypsin test and its accuracy in diagnosing pancreatic disease in infants. The test utilizes a detergent which solubilizes chymotrypsin bound to stool residues, and a tetrapeptide coupled to p-nitroaniline which is specifically cleaved by chymotrypsin. We employed the IL Multistat at 30 degrees C to monitor enzyme activity as an increase in absorbance at 405 nm. The reaction was linear to 600 U/g stool. Recovery of exogenous chymotrypsin with a single detergent extraction was 98-105%, and of endogenous chymotrypsin (as determined by multiple extractions) 80-97%. Imprecision (CV) was 2.2% within-day and 2.4% between-day for the BMC control, and 2.4-5.2% for stool chymotrypsin in the range 8.3-14.4 U/g. Since the test utilises only 100 mg of stool, inhomogeneity of enzyme distribution was assessed by multiple assays on a single stool, which revealed a range of activity from 4.2-150%. We therefore recommend sampling of each stool in triplicate. With this procedure, chymotrypsin was measured in 220 consecutive stool samples submitted for fat determination from children. Applying the manufacturer's lower reference limit of 4.1 U/g, the following results were obtained (number abnormal/total number): suspected intestinal disease with normal stool fat (5/127); proven intestinal disease and increased stool fat (1/26); untreated cystic fibrosis (CF) with (19/22), and without (0/3) steatorrhea; CF with pancreatic insufficiency on replacement therapy (4/42).(ABSTRACT TRUNCATED AT 250 WORDS)

Chymotrypsin↗
PubMed1995

Incidence and risk factors associated with the development of cytomegalovirus disease after intestinal transplantation.

From May 1990 to March 1993, 38 patients (21 adults and 17 children) received 40 allografts that included the small bowel (14 isolated small bowel, 21 small bowel and liver, and 5 multivisceral transplantations). Fifteen patients (39%) had 26 episodes of CMV disease: 7 with one episode, 6 with two, and 1 each with three and four. CMV enteritis accounted for 21 (81%) of the episodes, hepatitis and pneumonitis for 2 each, and a viral syndrome for 1. Cox's proportional hazards univariate and multivariate analyses showed that significant first-episode risk factors were: CMV seropositive donors for negative recipients (relative risk [RR], 3.86; P = 0.02), the average daily plasma trough level of tacrolimus (RR, 2.15; P = 0.04), and total amount of steroid boluses (RR, 2.90; P = 0.02). CMV disease recurrence factors were: CMV seronegative recipients (RR, 8.60; P = 0.02) and total amount of steroid bolus pulses (RR, 12.39; P = 0.004). Because long courses of ganciclovir prophylaxis could not prevent the development of CMV disease, avoidance of CMV seropositive grafts in seronegative recipients and new strategies to prevent heavy immunosuppression without the penalty of rejection will be necessary to ameliorate this problem in intestinal transplant recipients.

Adolescent↗
PubMed1993

Interleukin-2- and interferon-gamma-secreting T cells in normal and diseased human intestinal mucosa.

A sensitive reverse haemolytic plaque assay to detect lymphokine-secreting T cells, and Northern blot analysis to detect expression of lymphokine messenger RNA (mRNA) were used to study interferon-gamma (IFN-gamma) and interleukin-2 (IL-2) production in the mucosa of children with Crohn's disease or ulcerative colitis (UC), and in histologically normal mucosa from patients without inflammatory bowel disease. In the mucosa of most patients with UC and control patients, IL-2- and IFN-gamma-secreting cells were absent or were present at only low levels. In contrast, in mucosa from patients with Crohn's disease, lymphokine-secreting cells were readily detectable (3-18%). IFN-gamma mRNA was detected by Northern blot analysis in 5/6 Crohn's tissues, but only in 1/5 UC samples and none of nine samples of control mucosa. These studies reveal an ongoing cell-mediated immune response in the mucosa in Crohn's disease.

Adolescent↗
PubMed1975

The sialic acid and carbohydrate content and the synthesis of glycoprotein from radioactive precursors by tissues of the normal and diseases upper intestinal tract.

The sialic acid and total hexose content of perorally obtained mucosal biopsies have been determined. Gastric mucosa has a higher content of sialic acid/mg protein and a lower content of total hexoses/mg protein than does jejunal mucosa. There were no differences chemically between gastric biopsies from subjects with or without peptic ulcers. Neither were there any differences between normal jejunal mucosa and jejunal mucosa from patients with untreated or treated coeliac disease. The studies of the incorporation of radioactive glucose into glycoprotein using all these tissues indicate that bacteria make a major in vitro contribution. This method is not suitable for study of de novo synthesis in either gastric or jejunal mucosa. Results are presented which suggest that bacteria may normally be present within the mucous layer of the stomach.

Adult↗
PubMed2005

Crohn's disease: a comparative prospective study of transabdominal ultrasonography, small intestine contrast ultrasonography, and small bowel enema.

BACKGROUND: Small intestine contrast ultrasonography (SICUS), when performed after distention of the small bowel lumen with an iso-osmolar polyethylene glycol electrolyte-balanced solution, shows high sensitivity (100%) and specificity (97%) in detecting small bowel abnormalities in patients who have not received a diagnosis but in whom there is a suspicion of intestinal diseases. The diagnostic yield of SICUS remains to be established in detecting small bowel lesions in patients with proven Crohn's disease (CD) in comparison with transabdominal ultrasonography (TUS), and in relationship to the experience of the operator, using small bowel enema (SBE) as the "gold standard." AIM: The aim of this study was to evaluate the diagnostic value of SICUS, when performed by a sonologist with 1 year of experience, and TUS, when performed by a sonologist with 10 years of experience, compared to SBE in the assessment of the site, extension, and stenosis of small intestinal lesions in CD patients. PATIENTS AND METHODS: A total of 28 consecutive patients (men, 16; women, 12; age range, 21 to 60 yr) with a diagnosis of CD underwent TUS and SICUS, which were performed by 2 sonologists who were unaware of the radiologic findings, on the same day. SICUS was performed after the ingestion of 375 mL of a polyethylene glycol contrast solution. A standard SBE was performed on a different day by an expert radiologist who was unaware of the sonographic findings. RESULTS: Sensitivities in the detection of small bowel lesions were 96% for TUS and 100% for SICUS. Compared with SBE, SICUS detected the presence of 4 lesions in the jejunum that had been missed by TUS. The mean (+/-SD) extent of the ileal disease was 22 +/- 12.5 cm when measured during SBE, 14.5 +/- 8.6 cm when measured during TUS, and 19.5 +/- 12.5 cm when measured during SICUS [P = 0.05 (SICUS versus SBE)]. The correlation of the extension of the lesions between SICUS and SBE (r = 0.88) was better than that between TUS and SBE (r = 0.64). The sensitivities of TUS and SICUS in the detection of at least 1 stricture were 76% and 94%, respectively. Sensitivity and specificity in assessing prestenotic dilatation were 50% and 100%, respectively, at TUS, and 100% and 90%, respectively, at SICUS. CONCLUSION: In inexperienced hands, SICUS is a more accurate technique for assessing CD lesions, and the accuracy is better than that of TUS performed by an expert sonologist. The use of SICUS, instead of SBE, could be indicated for the follow-up of patients with CD.

Abdomen↗
PubMed1994

Intestinal vessels express a high density of somatostatin receptors in human inflammatory bowel disease.

BACKGROUND/AIMS: The neuropeptide somatostatin exerts multiple functions in the gastrointestinal tract and may also play a regulatory role in inflammatory bowel disease, as several other neuropeptides do, e.g., substance P or calcitonin gene-related peptide. Therefore, the expression of somatostatin receptors was evaluated in tissue sections of diseased intestines and compared with controls. METHODS: Somatostatin receptors were measured in intestinal samples of 6 patients with Crohn's disease, 3 with ulcerative colitis, and 7 controls using somatostatin receptor autoradiography with 125I-[Tyr3]-octreotide or 125I-[Leu8,D-Trp22,Tyr25]-somatostatin-28 as radioligands. Substance P receptors were measured similarly on adjacent sections. RESULTS: Somatostatin receptors are present in high density in most intramural veins, but not in arteries, of intestines in florid Crohn's disease or ulcerative colitis. The receptors are specific and of high affinity for somatostatin-14 and -28, as well as for octreotide. Somatostatin receptors remain undetectable in the veins of noninflamed control intestine. Substance P receptors are identified in the somatostatin receptor-positive veins and also in arteries. CONCLUSIONS: The expression of receptors for somatostatin in veins of inflamed intestines suggests an active involvement of this peptide in the pathophysiology of inflammatory bowel disease and perhaps of inflammation in general.

Adult↗
PubMed1988

Anal fissure in Crohn's disease.

There is little information on the natural history of anal fissure in Crohn's disease. The case notes of all new patients with Crohn's disease attending one hospital between 1977 and 1983 were reviewed: there were 61 patients with this diagnosis and an unhealed anal fissure as the only anal lesion. Of these 61 patients the fissure healed in 42 (69 per cent) during medical treatment of the intestinal disease. Ten patients (16 per cent) developed other anal lesions and in the remaining nine patients the fissure remained unhealed at the time of rectal excision (six) or last out-patient attendance (three). Activity of the fissure did not reflect disease activity elsewhere in 11 cases in whom healing of the fissure occurred despite progressive intestinal disease subsequently requiring resection. This study validates the policy of conservative management of anal fissure in Crohn's disease with anal surgery (required in 9.8 per cent of patients in this series) being reserved for the development of other anal disease.

Adolescent↗
PubMed1996

[Waldman's disease. Primary intestinal lymphangiectasis].

INTRODUCTION: Primary intestinal lymphangiectasias are often associated with lymphoedema. OBSERVATION: The diagnosis was performed at 4 months when Maxime presented with lymphoedema, diarrhea, hypoprotidemia and hypolipemia. Duodenum biopsies revealed intestinal lymphangiectasias. An hyperprotidic and low fat diet, medium chain triglyceride-supplemented and an elastic contention allowed a decline of the oedemas. DISCUSSION: We report one case of Waldman's disease. It shows very well the typical circumstances of diagnosis in this disease and the two types of oedema (lymphoedema and hypoprotidic oedema).

Dietary Proteins↗
PubMed2004

Tropheryma whipplei Infection of an acellular porcine heart valve bioprosthesis in a patient who did not have intestinal Whipple's disease.

Rare cases of culture-negative infective endocarditis are caused by Tropheryma whipplei, the uncommon bacterium of Whipple's disease. We evaluated an 80-year-old woman with valvular heart disease but without intestinal Whipple's disease. The diagnosis of aortic valve xenograft culture-negative infection with T. whipplei was established by multiple molecular assays and by electron microscopy. First, a PCR with broad-range primers identified the complete 16S ribosomal DNA of T. whipplei in bioprosthesis tissue. Novel real-time reverse transcription-PCR assays were developed to detect mRNAs encoding recently identified proteins determined from the T. whipplei genome, specifically Whipplei surface protein (TW113) and a DNA polymerase III subunit (TW727). The positive detection of mRNAs indicated the presence of metabolically active bacteria and suggested the viability of T. whipplei. The quantification of T. whipplei genome equivalents by real-time PCR indicated a high-density bacterial colonization of the valve tissue. Additionally, an ultrastructural examination revealed numerous rod-shaped bacteria consistent in size with T. whipplei in the extracellular collagen matrix of the bioprosthesis. We conclude that extracellular growth of T. whipplei can occur in the microenvironment of biological prosthetic valve tissue and that T. whipplei endocarditis can occur in the absence of intestinal Whipple's disease.

Actinomycetales↗
PubMedDate not supplied

[Effectiveness of the use of nutrient media in isolation of Yersinia].

Three liquid nutrient media (phosphate buffer medium, 1% buffered peptone water pH 7.6-7.7, buffer casein yeast medium) and live solid media (Endo's, Serov's, and differential diagnostic medium with bromothymol blue, made in this country, and two foreign ones, agar deoxycholate and McConkie's) are compared in examinations of the material from 213 patients with acute intestinal diseases and from 460 small mammals. The results demonstrate a higher efficacy of bacteriologic investigations carried out in the new buffer casein yeast medium or 1% buffered peptone water, pH 7.6-7.8. The data are also indicative of the essential advantages of the differential diagnostic medium with bromothymol blue and prompt its wide practical use.

Acute Disease↗