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Oxalate stone disease after intestinal resection.

There have been 543 jejuno-ileal bypass patients screened for the presence of urinary calculi 1 to 6 years postoperatively. Of these patients 9 per cent have had 1 to 2 calculi during the followup and 3 per cent have had multiple calculi. Ninety-four per cent of the recovered calculi consisted entirely of calcium oxalate. Seven patients had a history of stones before the bypass, 6 of whom have had additional stones postoperatively. To define the conditions associated with stone formation in these patients measurements of serum and urinary oxalate concentration, urinary calcium oxalate saturation, urinary crystal size distribution, and the rates of intestinal oxalate absorption and urinary crystallization have been performed on patients who did and did not have stones postoperatively. On the basis of these studies it appears that the patients in whom stones formed differ from those in whom they did not form only in the rate of urinary crystallization and in the number of large crystal particles present in the urine. Evaluation of current therapeutic modalities in terms of the capability to correct these stone-forming characteristics and to reduce actual calculus formation reveals that the only successful regimen is that which includes an extreme reduction of oxalate ingestion.

Follow-Up Studies↗

Assessment of a breath collection technique and portable breath hydrogen monitor for use in cats and dogs.

Until now the use of breath hydrogen testing in companion animal gastroenterology has been limited to academic institutions because of the expense of the equipment. Recently portable breath hydrogen monitors, designed for use in paediatric gastroenterology, have been developed. They may be suitable for use in veterinary medicine as an ancillary diagnostic aid but, before widespread use can be recommended, thorough validation is required. Hydrogen breath tests were conducted in five dogs and four cats, undergoing investigations for small intestinal disease. Breath samples were taken using a closed-flow collection system and concurrently analysed with a commercially available portable breath hydrogen monitor and a previously validated breath hydrogen monitor. In cats, sample collection was troublesome and complete studies could only be performed in two individuals. Good correlation was demonstrated between the readings of both monitors (rs=0.902 and 0.935 for dogs and cats respectively; P<0.002) but agreement was poor with significant under-read from the portable monitor. Our results demonstrate that more studies on validation and the generation of a reference range would be required before the use of this portable hydrogen monitor could be recommended.

Animals↗

COLOSTOMY.

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Colostomy↗

Recurrent Escherichia coli bacteraemia--clinical characteristics and bacterial properties.

The aim of the present study was to determine if recurrent bacteraemia due to Escherichia coli might be caused by the same strain in spite of apparently adequate antimicrobial therapy. Eleven patients who, altogether, experienced 24 episodes of E. coli bacteraemia were studied. All had underlying diseases; five biliary-intestinal disease, four were severely immunocompromised and two had urinary tract disorders. During the first bacteraemic episode, nine patients were treated with various combinations of drugs which included gentamicin and two with co-trimoxazole alone. Antibiotic treatment was continued for at least 12 days in each case and all patients were clinically cured. All isolates of E. coli were characterized by biochemical fingerprinting, O and K serotyping, the presence of cell-surface hydrophobicity and production of aerobactin. In two patients, the recurrent infections were due to strains different from those causing the previous episodes. In nine patients who, altogether, had 19 episodes of bacteraemia, the strain of E. coli isolated during the first and all later episodes were identical, according to all tests performed. We suggest that in such circumstances, the infecting strain may remain in the patients' environment and after recolonising the faecal flora may give rise to further infections. It may be, however, that if necessary steps are not taken, the original bacterial focus remains within the same patient so leading to emergence of the infecting strain which may then cause further episodes of bacteraemia.

Adult↗

[Alveolar hemorrhage associated with intestinal inflammatory disease and Hashimoto thyroiditis].

Diffuse alveolar hemorrhage (DAH) is characterized by diffuse bleeding into alveolar spaces. Three histopathological patterns may be seen: 1) pulmonary capillaritis due to immunological aggression to the membrane, 2) diffuse alveolar damage within the context of acute respiratory distress syndrome, and 3) and "bland" DAH without alveolar or capillary damage. In the first two groups, pulmonary damage usually occurs within the context of a systemic disease. In the last, injury is usually found only in the lung, an entity called pulmonary hemosiderosis. We present a case of DAH with neither capillaritis nor diffuse alveolar damage in association with inflammatory bowel disease and Hashimoto thyroiditis. The case is interesting both because the association has not yet been described in the literature and because the presence of alveolar bleeding without evident tissue damage within the context of known autoimmune diseases may extend the field to include a new pathophysiological mechanism of pulmonary hemorrhage.

Adult↗

Immunoepidemiology of the equine tapeworm Anoplocephala perfoliata: age-intensity profile and age-dependency of antibody subtype responses.

The equine intestinal cestode Anoplocephala perfoliata has been the subject of recent epidemiological and immunological studies because of its suspected association with intestinal disease in the horse. We have previously shown that the IgG(T) subtype antibody response to the 12/13 kDa component of the parasite excretory/secretory (E/S) antigen is positively correlated with parasite intensity. In this study, we utilize that correlation to examine the changes in natural infection intensity with age. Infection intensity based on IgG(T) responses showed a triphasic age-dependency pattern with peak mean worm burden in the 6 months-2 years age group, falling to a lower plateau level from 3 to 15 years, and rising again in older age groups. Anti-E/S total IgG was found to have a convex age-dependency curve, with maximal response in the 6 months-2 years old age group. IgG(a) showed a triphasic response similar to the age-intensity profile of IgG(T); IgG(c) showed steadily increasing levels of antibody with age. The IgG(b) age-dependency profile was intermediate between IgG(a) and IgG(c). Age-specific correlation coefficients between anti-12/13 kDa IgG(T) (as a measure of infection intensity) and IgG(a) and IgG(b) revealed statistically significant values for many age groups. The relative importance of exposure to infection and the development of acquired immunity as determinants of the observed age-intensity pattern is considered.

Age Factors↗