Gastrointestinal complications of renal transplantation. 1. The upper gastrointestinal tract.

In 95 consecutive cases of cavaderic renal transplantation followed up for 1 to 83 months (mean 23.1 months) 17 complications developed in the upper gastrointestinal tract of 15 patients; these included duodenal ulcer in 12 and gastric ulcer, esophagitis, hemorrhagic gastritis, small-bowel obstruction and small-bowel perforation in 1 each. The occurrence of a complication was not related to the patient''s age, sex, blood group or use of cigarettes or alcohol, the duration of hemodialysis before transplantation, the tissue match or the number of infusions of immunosuppressive medication. One patient died of the complication. The peptic ulcers that developed after transplantation were successfully managed conservatively in 69% of cases. Since surgical treatment in patients whose immune response has been suppressed is associated with an increased frequency of complications such as disruption of suture lines, it is preferable to reserve it for those in whom complications develop that are unresponsive to conservative measures.     

An incidental case of human Heterophyes nocens infection diagnosed by sectional morphology in a biopsy specimen of the small intestine.

A case of human infection with Heterophyes nocens (Heterophyidae) was incidentally found in a biopsy specimen of the Meckel's diverticulum at the upper part of the small intestine. The patient was a 58-year-old man living in a rural area of Talsonggun, Kyongsangbuk-do. He had gastrointestinal symptoms such as epigastric pain, indigestion, and abdominal discomfort for 3 months, and severe diarrhea, abdominal pain, and vomiting for about 1 month before hospitalization. Endoscopy of the upper part of the small intestine revealed a Meckel's diverticulum, and it was excised and histopathologically examined. Three adult flukes were incidentally found sectioned in the mucosa, and they were identified as H. nocens. The patient had a history of eating raw mullets at a fish market in Pusan 6 months ago, and the mullets were presumed to be the source of infection. This case brings a considerable interest in that specific diagnosis of heterophyid infections could be done by sectional morphology of the worms.     

Tuberculous Enteritis

Tuberculous enteritis occurs in about 2 percent of patients with pulmonary tuberculosis. Although it is uncommon in the United States, tuberculous enteritis should be considered in any patient with active pulmonary tuberculosis and abdominal complaints.Eight cases of T. enteritis have been treated at Harbor General Hospital in the last 25 years. Associated pulmonary disease was shown radiologically to be present in seven of eight patients. Findings on contrast studies of the gastrointestinal tract showed disease in six of six patients examined.In five patients, surgical operation was required for diagnosis or complications. Resection of diseased bowel with primary anastomosis was done in five patients. Although medical therapy is the mainstay in the treatment of both pulmonary and intestinal tuberculosis, one staged resection of diseased bowel with primary anastomosis is the procedure of choice for complications such as obstruction, hemorrhage or perforation.     

Abdominal wall and labial edema presenting in a girl with Henoch-Schönlein purpura: a case report

Introduction

We report a rare case of gastrointestinal perforation following dacarbazine infusion for metastatic melanoma. The condition is attributed to a responding malignant melanoma in the gastrointestinal tract.

Case presentation

A 52-year-old Caucasian man presented with abdominal pain and distension, malaise, night sweats, dysphagia and early satiety. A computed tomography scan showed massive ascites, lymphadenopathy and liver lesions suspect for metastases. An upper gastrointestinal endoscopy was performed and revealed multiple dark lesions of 5 mm to 10 mm in his stomach and duodenum. When his skin was re-examined, an irregular pigmented lesion over the left clavicle measuring 15 mm × 8 mm with partial depigmentation was found. Histological examination of a duodenal lesion was consistent with a diagnosis of metastatic melanoma. The patient deteriorated and his level of lactate dehydrogenase rapidly increased. The patient was started on systemic treatment with dacarbazine 800 mg/m² every three weeks and he was discharged one day after the first dose. On the sixth day he was readmitted with severe abdominal pain. A chest X-ray showed the presence of free intraperitoneal air that was consistent with gastrointestinal perforation. His lactate dehydrogenase level had fallen from 6969U/L to 1827U/L, supporting the conclusion that the response of gastrointestinal metastases to dacarbazine had resulted in the perforation of the patient's bowel wall. A laparotomy was discussed with the patient and his family but he decided to go home with symptomatic treatment. He died 11 days later.

Conclusion

Melanoma can originate in, as well as metastasize to, the gastrointestinal tract. Gastrointestinal perforations due to responding tumors are a well-known complication of systemic treatment of gastrointestinal lymphomas. However, as the response rate of metastatic melanoma to dacarbazine is only 10% to 20%, and responses are usually only partial, perforation due to treatment response in metastatic melanoma is rare. Medical oncologists should be aware of the risk of bowel perforation after starting cytotoxic chemotherapy on patients with gastrointestinal metastases.     

Primary Tumours of the Small Bowel and its Mesentery

Twenty-seven primary small bowel tumours encountered at the University of Alberta Hospital in a 10-year period have been reviewed. Seventeen symptomatic growths were treated by resection and 10 asymptomatic tumours were discovered incidentally. During this same period, three intramesenteric lipomas were found. Small bowel tumours were malignant in 15 of the 17 symptomatic cases and benign in seven of the nine asymptomatic cases. Carcinoid tumours, malignant lymphomas, non-lymphoid sarcomas and carcinomas were the common malignant neoplasms while adenomas, lipomas, myomas, fibromas and angiomas comprised the majority of benign growths reported. Symptoms of anorexia, anemia, abdominal pain, obstruction and hemorrhage suggest small bowel tumour if commoner pathology has been ruled out.     

Secondary extramedullary plasmacytoma of sigmoid colon in a patient with multiple myeloma: a case report

Background

Extramedullary plasmacytoma is an uncommon tumor that most often involves the nasopharynx or upper respiratory tract. Extramedullary plasmacytoma is a type of plasma cell neoplasm that can present as a primary tumor or secondary to another plasma cell neoplasm, such as multiple myeloma. Secondary extramedullary plasmacytoma is usually noted in the advanced stages of the disease. Involvement of the gastrointestinal tract occurs in approximately 10% of cases.

Case presentation

A 71-year-old Caucasian woman with known diverticular disease of the colon and multiple myeloma diagnosed 3 years previously, with monoclonal bands of immunoglobulin A, lambda light chains, and multiple osteolytic lesions, presented to our hospital with abdominal pain, abdominal discomfort, and pneumoperitoneum. She underwent left colectomy for diverticulitis with perforation, and an extramedullary secondary colonic plasmacytoma was found in histopathological examination of the sigmoid colon.

Conclusions

Plasmacytoma is known to occur in extraosseous sites. The stomach and small intestine are the most commonly involved sites in the gastrointestinal tract. Secondary extramedullary plasmacytoma of the colon is rare. Colonic plasmacytoma may have varying clinical presentations, such as inflammatory bowel disease and multiple colonic strictures. Although these cases are rare, treating physicians as well as radiologists, pathologists, and surgeons should be aware of this entity.

     

尼龙绳与钛夹在预防内镜下切除大肠宽蒂息肉术后出血的疗效 和安全性的比较

目的:比较尼龙绳和钛夹在预防大肠宽蒂息肉切除后出血的疗效和安全性的比较.方法:从2005年1月至2011年9月连续选择155例患大肠宽蒂息肉和有蒂且顶部直径大于10mm息内的患者.随机分为3组.A组(53例),将尼龙绳套扎息肉的基底部,然后使用常规的套圈器进行息肉电切术.B组(52例),使用常规的套圈器进行息肉电切术,然后残端使用钛夹缝合.C组(50例),使用常规的套圈器进行息肉电切术.结果:所有息肉均成功摘除.A组和B组1例出血;C组5例出血,其中1例需要手术干预.结论:大肠宽蒂息肉常规圈套器进行息肉电切术具有较大的出血风险;尼龙绳和钛夹对内镜下切除大肠宽蒂息肉术后出血具有良好的预防作用.     

In vivo imaging of intestinal helminths by capsule endoscopy

This review examines the use of digestive endoscopy to visualize intestinal helminths. The infections caused by these parasites are responsible for high levels of morbidity and mortality. These helminths can be visualized using gastroduodenal endoscopy, endoscopic retrograde cholangiopancreatography, and colonoscopy. Endoscopic examination of the small bowel is limited by its considerable length and its distance from the mouth and anus. Since capsule endoscopy (CE) was first reported in 2000, it has been established as a noninvasive modality for the investigation of the gastrointestinal tract. CE is used as a first-line tool for imaging various small-bowel diseases, mainly obscure gastrointestinal bleeding and Crohn's disease. Since the Food and Drug Administration (FDA) approved CE in 2001, the indications for its use have expanded widely. For example, CE can be used to visualize the in vivo kinetics of intestinal helminths. If the current trends in technological development continue, CE will become more widely used to facilitate the diagnosis and treatment of helminth infections in the near future.     

Isolated jejunal metastasis in a patient with cervical cancer: A case report

Background

In approximately 8% of cervical carcinoma patients, gastrointestinal tract is involved, most commonly the rectosigmoid portion, because of local extension. Isolated metastases to small bowel are exceedingly rare.

Case report

We present a case of a 63-year-old woman with cervical cancer who developed isolated jejunal metastasis 8 months after postoperative chemoradiotherapy. The patient was alive with no evidence of disease 6 months after resection of metastasis. Very few cases have been reported concerning squamous cell carcinoma of the cervix with documented metastases to the small bowel. There is only one published case report of cervical cancer with multiple metastases to the small intestine and jejunum. To our knowledge, this is the first case of cervical cancer with isolated jejunal metastasis, which was initially demonstrated with positron emission tomography and confirmed histopathologically.

Conclusion

Although the exact mechanism underlying the isolated metastasis is unknown, hematogenous spread or tumor seeding during surgery may play a role.     

POU-domain gene expression in the gastrointestinal tract

The process of self-renewal which occurs in the gastrointestinal epithelium is greatly amplified and accelerated during the intestinal adaptation which occurs in the residual ileum after massive small bowel resection (MSBR). As with growth and development, these processes must involve the coordinated regulation of many genes. Several families of nuclear proteins are known to be involved in the control of gene expression during development including the POU-domain genes; their expression has not been characterized in the gastrointestinal tract during normal cellular renewal or adaptation, and POU-domain encoding cDNAs were cloned from ileal RNA. Three known genes were cloned: Oct-1, Brn-1 and Tst-1 but no novel members of this gene family were identified. The encoded sequence for rat Oct-1 differs from that previously reported. Oct-1 is relatively ubiquitously expressed with increased expression during both development and adaptation. Minimal expression of Tst-1 was observed. Brn-1 exhibits limited expression in the adult gastrointestinal tract. but may play a role in the fetal gastrointestinal tract.     

Obscure gastrointestinal haemorrhage of small-bowel origin.

The records of 37 patients investigated for obscure gastrointestinal haemorrhage originating from the small bowel were reviewed retrospectively. Bleeding was caused by Meckel''s diverticula in eight cases, smooth muscle tumours in seven cases, vascular anomalies in 14 cases, and other single lesions in eight cases. The lesions were identified by angiography in 18 patients, operation in 17, and barium follow through examination in two. Only one patient under 50 years of age had a lesion that would not have been found by careful laparotomy. Early laparotomy is advisable in patients aged under 50 with obscure gastrointestinal bleeding; expert selective angiography is recommended before operation in patients aged over 50 and those who have already undergone a laparotomy yielding negative results.     

The effect on gastrointestinal motility after ingestion of raw bile of grass carp (Ctenopharyngodon idellus) in the conscious rats

The influence of raw grass carp bile on gastrointestinal motility was studied in conscious rats. It was found that the toxic bile prolonged the gastric emptying time, increased a marker substance traversed along the small intestine and accelerated the transit time along the colon. These findings might be explained by a very efficient protective response of the digestive system, and/or poisoning effect of the invading toxic substance in rats. Accumulation of fluid was found in the stomach, 20 min after ingestion of 0.3 ml of the toxic bile. Besides, ingestion of the raw bile also increased the urea nitrogen in blood, which may result from a loss of fluid volume through the gastrointestinal tract and (or) a direct action of the bile on the kidneys.     

Effect of organic acid on gastrointertinal motility of rat invitro

The quantity of organic acids ( lactic acid, acetic acid, propionic acid and butyric acid ) in the content of the gastrointestinal tract of germ-free and conventional rats and the $\text{in}$$\text{vitro}$ effects of the organic acid on the motility of the gastrointestinal tract of rats were investigated.Organic acids were detected only in the gastrointestinal contents of conventional rats but not in those of germ-free rats.Lactic acid detected in the stomach of rats stimulated the motility of both small and large bowel while acetic acid, propionic acid and butyric acid found in the cecum stimulated the motility of the large bowel but not of small bowel.     

Descriptive epidemiology of small-bowel atresia in metropolitan Atlanta.

The epidemiological characteristics are presented of 46 children with small-bowel atresia, ascertained over a 6-year period by an active, population-based birth defect surveillance program in Atlanta, Georgia. The malformation occurred at a rate of 2.7/10,000 livebirths. The previously reported association of duodenal atresia and Down syndrome was confirmed was confirmed. No instances of familial association were noted, nor was any excessive prenatal exposure to drugs found. Thirty-two instances of isolated small-bowel atresia were analyzed in detail. The frequency of the isolated defect for blacks was twice that for whites because of a higher rate for black females. The isolated defect was commonest in the winter months. The relation between isolated small-bowel atresia, birth weight, and mortality was discussed. This small series cannot readily be subdivided into distinct epidemiological groups on the basis of the location of the atretic lesions along the length of the small bowel.     

Selected immunohistochemical markers in stromal neoplasms of the gastrointestinal tract.

We studied immunohistochemical reactions to vimentin, desmin and protein S-100 in 43 cases of stromal tumors of the gastrointestinal tract. The material studied included: 1 esophageal tumor, 18 gastric tumors, 19 small intestinal tumors and 5 colonic tumors, classified in 13 cases as benign and in 30 cases as malignant neoplasms of various degree of malignancy. Mean age of the patients was 58.9 years. A positive reaction to vimentin was found in 37 cases, a negative reaction concerned an esophageal tumor, two benign tumors (gastric and small intestinal) and three malignant tumors (gastric and two small intestinal). A positive reaction to desmin was detected in an esophageal tumor and in nine gastric tumors. Only one benign small intestinal tumor and three benign colonic tumors showed a positive reaction to desmin. Protein S-100 was found in an esophageal tumor and in 7 out of 18 gastric tumors and in 12 out of 24 intestinal tumors. Coexpression of vimentin and desmin was found in 8 gastric tumors, only in one small intestinal tumor and in three colonic tumors. Three gastric tumors showing both these reactions were all benign. Coexpression of desmin and protein S-100 was found in 7 out of 43 tumors of the alimentary tract. In six cases these tumors were benign. Basing on the results we may say that the presence of these antigens reflects the degree of differentiation of gastrointestinal stromal tumors of the gastrointestinal tract, though it does not allow to choose unequivocally conclusions as to their histogenesis.     

Small intestinal presentation of nodular lymphocyte-predominant Hodgkin lymphoma with T cell/histiocyte-rich B cell lymphoma-like areas-with review of literature on extranodal presentation of this disease

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), accounts for ～5% of all cases of Hodgkin lymphoma and is characterized by involvement of the peripheral lymph nodes. NLPHL occurs in young adults and is associated with frequent relapses. In 3% to 7% of cases, NLPHL progresses to a diffuse large B cell lymphoma. Furthermore, a proportion of NLPHL also have areas with features of T cell/histiocyte-rich large B cell lymphoma (THRLBCL), either at presentation or on follow-up. Here, we describe a 32-year-old man who presented to the emergency department with small bowel perforation. The resected small bowel showed full-thickness mural ulceration and involvement by a lymphoma with features of NLPHL that also had areas resembling THRLBCL. The patient had axillary lymphadenopathy, biopsy of which showed NLPHL with focal THRLBCL-like areas. Such a lymphoma presenting as small intestinal lesion/perforation has not been reported in the literature before. We take this opportunity to review the literature on extranodal presentations of NLPHL and discuss the natural history of this disease.     

Computer phonoenterography in the assessment of the motor-evacuatory function of the gastrointestinal tract in healthy children

A new computer phonoenterography (CPEG) method allowing an objective assessment of the motor-evacuatory function of the gastrointestinal tract was developed. To study the age-related characteristics of bowel motility, the CPEG data were analyzed in healthy children aged 6–15 years on an empty stomach and after a test breakfast. The fasting CPEG indices were significantly higher in children aged 6–9 years. After a test breakfast, a significant weakening of bowel motility and a decrease in the motor-evacuatory function of the gastrointestinal tract occurred in all age groups. The weakening after a test breakfast was greatest at the ages of 13–15. No significant changes in CPEG indices were found when the age groups were divided by sex.     

Proliferative activity of well differentiated neuroendocrine tumours of the gut

Neuroendocrine tumours of the gastrointestinal tract are relatively uncommon neoplasms with, in spite of their characteristic morphology, relatively unpredictable biological behaviour. In some sites, notably the appendix, these tumours are largely benign whereas at other localisations, such as the small bowel, metastases occur and the outcome is less favourable. Given the lack of discriminative power of histological parameters, immunohistochemical parameters have been proposed. Of these the Ki-67 index, as an indicator of proliferative activity, has shown some promise. In order to assess their proliferative activity and the potential contribution of this parameter to defining biological behaviour, we performed Ki-67 immunostaining of a series of 64 well differentiated neuroendocrine tumours of the gut (stomach, small bowel, appendix, colon and rectum). Ki-67 labeling index, based upon counting of up to 5000 cells, ranged between 0 and 6.1%. No difference was found according to age, gender, size, location or TNM classification. Ki-67 labeling index of midgut endocrine tumours of long term surviving patients did not differ from patients that died. We conclude that Ki-67 labeling index as an indicator of proliferative activity of well differentiated neuroendocrine tumours of the digestive tract does not correlate with size nor site nor stage. Even though only small numbers of tumours could be analysed, which hampered appropriate statistical analysis, it seems unlikely that proliferative activity has potential as an independent prognostic parameter for this type of tumour.     

Radiation Enteropathy of the Small Bowel

The features of radiation injury of the small bowel are reviewed to focus attention on this uncommon but persistent problem which usually arises in women undergoing treatment for gynecological malignancy and which may be confused with recurrence of the malignant growth. Intestinal perforation, bleeding, obstruction and fistulas have all been observed in patients with radiation enteropathy. Three cases in which these complications occurred are reported. Early excisional surgery is considered to be the preferred treatment, although conservative surgical procedures have been used for patients who are very ill or for those with diffuse bowel changes. Medical measures alone have not been successful but have been utilized in preoperative preparation.     

Cellular prion protein is expressed in a subset of neuroendocrine cells of the rat gastrointestinal tract.

Prion diseases are believed to develop from the conformational change of normal cellular prion protein (PrPc) to a pathogenic isoform (PrPsc). PrPc is present in both the central nervous system and many peripheral tissues, although protein concentration is significantly lower in non-neuronal tissues. PrPc expression is essential for internalization and replication of the infectious agent. Several works have pointed to the gastrointestinal (GI) tract as the principal site of entry of PrPsc, but how passage through the GI mucosa occurs is not yet known. Here we studied PrPc expression using Western blot, RT-PCR, and immunohistochemistry in rat GI tract. PrPc mRNA and protein were detected in corpus, antrum, duodenum, and colon. Immunoreactivity was found in scattered cells of the GI epithelium. With double immunofluorescence, these cells have been identified as neuroendocrine cells. PrPc immunostaining was found in subsets of histamine, somatostatin (Som), ghrelin, gastrin (G), and serotonin (5HT) cells in stomach. In small and large bowel, PrPc cells co-localized with subpopulations of 5HT-, Som-, G-, and peptide YY-immunolabeled cells. Our results provide evidence for a possible and important role of endocrine cells in the internalization of PrPsc from gut lumen.