1/183. brain-gut axis and mucosal immunity: a perspective on mucosal psychoneuroimmunology.The role of the brain-gut axis has traditionally been investigated in relation to intestinal motility, secretion, and vascularity. More recently, the concept of brain-gut dialogue has extended to the relationship between the nervous system and mucosal immune function. There is compelling evidence for a reciprocal or bi-directional communication between the immune system and the neuroendocrine system. This is mediated, in part, by shared ligands (chemical messengers) and receptors that are common to the immune and nervous systems. Although the concept of psychoneuroimmunology and neuroimmune cross-talk has been studied primarily in the context of the systemic immune system, it is likely to have special significance in the gut. The mucosal immune system is anatomically, functionally, and operationally distinct from the systemic immune system and is subject to independent regulatory signals. Furthermore, the intestinal mucosal immune system operates in a local milieu that depends on a dense innervation for its integrity, with juxtaposition of neuroendocrine cells and mucosal immune cells. An overview of evidence for the biologic plausibility of a brain-gut-immune axis is presented and its potential relevance to mucosal inflammatory disorders is discussed.- - - - - - - - - - ranking = 1keywords = gut (Clic here for more details about this article) |
2/183. The radiology corner: Longitudinal fistulous tract of the colon and a perianal fistula in diverticulitis.Diverticular disease may mimic many of the symptoms and signs of Crohn's disease. The presence, however, of perirectal involvement and a longitudinal fistula greater than 10 cm. in the wall of the colon are two unusual features of diverticular disease. Discussed herein is a patient who presented with both of these complications.- - - - - - - - - - ranking = 0.5305049976116keywords = tract (Clic here for more details about this article) |
3/183. Enterovesical fistula complicating pregnancy. A case report.BACKGROUND: Enterovesical fistula is a rare cause of recurrent urinary tract infections. This condition is unusual in young people as common etiologies include diverticular disease and cancer. When an enterovesical fistula occurs in women of childbearing age, Crohn's disease is a likely cause. To our knowledge, enterovesical fistula complicating pregnancy has not been reported before. CASE: A pregnant woman with recurrent urinary tract infections was evaluated. cystoscopy was suggestive of an enterovesical fistula, which was confirmed by charcoaluria following oral charcoal administration. The prenatal course was complicated by two episodes of hemorrhagic cystitis despite antibiotic prophylaxis. The patient had an uncomplicated term spontaneous vaginal delivery. An upper gastrointestinal series performed postpartum was suggestive of Crohn's disease and confirmed an enterovesical fistula. Surgical repair was successfully performed three months following delivery, revealing Crohn's disease. CONCLUSION: Enterovesical fistula may be an unusual cause of recurrent urinary tract infections in pregnancy. In this case, enterovesical fistula was the presenting symptom of Crohn's disease.- - - - - - - - - - ranking = 0.3978787482087keywords = tract (Clic here for more details about this article) |
4/183. Oral crohn disease: clinical characteristics and long-term follow-up of 9 cases.BACKGROUND: Oral localization of crohn disease is uncommon and must be differentiated from nonspecific lesions. Its natural course and its long-term prognosis are unknown. OBSERVATIONS: We studied 9 patients (8 male, 1 female; age range, 7-52 years; median age, 16 years) with crohn disease and specific oral lesions, including deep linear ulcers, pseudopolyps, and/or labial or buccal swelling and induration. The prevalence of such lesions was 0.5%. The median follow-up was 11 years. Oral localization developed before (n = 2), at the same time as (n = 2), or after (n = 5) the onset of the digestive disease. Noticeable associated localizations were observed in the anoperineum (n = 8) and the esophagus (n = 3). The median duration of the oral lesions was 4 years (range, 1-13 years), without necessary parallelism with the digestive localization. Five patients had complete healing after a median delay of 2 years. CONCLUSIONS: Oral localization of crohn disease is characterized by a marked male predominance, a young age at onset of crohn disease, and a very protracted course. The high prevalence of associated anal and esophageal involvement suggests that Crohn lesions have a particular trophicity for squamous cell epithelium.- - - - - - - - - - ranking = 0.9041023935822keywords = digestive, tract (Clic here for more details about this article) |
5/183. Psoas abscesses complicating colonic disease: imaging and therapy.Most surgeons think of psoas abscesses as a very rare condition related to tuberculosis of the spine, but in contemporary surgical practice they are more usually a complication of gastrointestinal disease. A case note study was undertaken on all patients treated for psoas abscess at two large hospitals in the mid-Trent region over a 2-year period. All seven patients presented with pyrexia, psoas spasm, a tender mass and leucocytosis. The diagnosis was made on abdominal radiographs in one patient, CT scan in three, MRI in two, and ultrasound in one. Aetiological factors included Crohn's disease in three, appendicitis in two, and sigmoid diverticulitis and metastatic colorectal carcinoma in one each. Six patients underwent transabdominal resection of the diseased bowel, retroperitoneal debridement and external drainage of the abscess cavity. Percutaneous drainage was performed in one. Two patients had more than one surgical exploration for complications. There were no deaths and the hospital stay ranged from 8-152 days. psoas abscess can be a difficult and protracted problem. Bowel resection, thorough debridement, external drainage and concomitant antibiotics are essential for psoas abscesses complicating gastrointestinal disease. Defunctioning stomas may be necessary. However, in some cases a multidisciplinary approach may be required, as psoas abscesses can involve bone and joints.- - - - - - - - - - ranking = 0.1326262494029keywords = tract (Clic here for more details about this article) |
6/183. Successful management of Crohn's disease of the ileoanal pouch with infliximab.This study reports the clinical benefit and safety of the murine chimeric anti-tumor necrosis factor (TNF)-alpha monoclonal antibody, infliximab, in the treatment of patients who developed findings compatible with Crohn's disease after undergoing colectomy with ileal-pouch anal anastomosis (IPAA) for an original diagnosis of ulcerative colitis. medical records of 7 patients with Crohn's disease and an IPAA treated with infliximab were reviewed. Clinical response was classified as complete response, partial response, and no response. Concurrent treatment with immune modifier agents and/or antibiotics was recorded. Seven patients with active inflammatory or fistulizing Crohn's disease and an IPAA performed for diagnosis of ulcerative colitis were treated with infliximab after they had no response to conventional therapies. patients received 1-4 infliximab infusions at a dose of 5 mg/kg. All patients improved clinically. Six patients had a complete response, and 1 had a partial response. Four of the 5 patients with complex perianal and fistulizing disease had closure of all fistula tracts, and 1 patient improved temporarily. Six of the 7 patients underwent concurrent treatment with immune modifier drugs. One patient had myalgias and malaise after the first infliximab infusion and flu-like symptoms after the second one. No other adverse effects were observed. This case series demonstrates that the murine chimeric anti-TNF-alpha monoclonal antibody, infliximab, can be used successfully to treat patients with Crohn's disease involving an IPAA who are refractory to conventional therapies.- - - - - - - - - - ranking = 0.1326262494029keywords = tract (Clic here for more details about this article) |
7/183. Ectopic pregnancy after transmyometrial embryo transfer: case report.OBJECTIVE: To report a case of ectopic pregnancy after transvaginal transmyometrial ET. DESIGN: Case report. SETTING: University-based IVF program. PATIENT(S): A woman with tubal subfertility and a history of difficult ETs. INTERVENTION(S): Transvaginal transmyometrial ET performed to avoid a difficult transcervical ET. MAIN OUTCOME MEASURE(S): Expected improvement in the pregnancy rate in a selected group of patients. RESULT(S): Tubal pregnancy. CONCLUSION(S): Transmyometrial ET is an attractive alternative to difficult transcervical ET but is not free of complications.- - - - - - - - - - ranking = 0.1326262494029keywords = tract (Clic here for more details about this article) |
8/183. Liquid pancreatic enzyme therapy for a patient with short bowel syndrome and chronic pancreatitis in a complicated case of Crohn's disease.The case of a 45 year old female with multiple complications of Crohn's disease is reported. After multiple resections in the gastrointestinal tract she had been suffering from short bowel syndrome and severe malnutrition. With a special continuous gastric tube feeding system, she was able to maintain her weight for years. In the beginning of 1997 the enteral nutrition was not longer tolerated for an exacerbation of chronic pancreatitis. There was a weight loss, permanent pain and total parenteral nutrition had to be performed. In this situation a new liquid preparation of pancreatic enzymes which had been tested in the laboratory before, was used for continuous enzyme replacement via gastric tube. In combination with this enzyme preparation, enteral nutrition could successfully be started again.- - - - - - - - - - ranking = 3.527119250303keywords = gastrointestinal tract, tract (Clic here for more details about this article) |
9/183. Crohn's disease.Crohn's disease is manifested by fissure ulcers, transmural inflammation with lymphocytes, and granulomata affecting any part of the gastrointestinal tract. There seems to be a genetic predisposition, conditioned perhaps by environmental factors and possibly a virus. The disease is characterized by spontaneous fistulae, internal and external, anal lesions, stricture formation, and healing by fibrosis. The presenting symptoms are intestinal and systemic (Table 2). Systemic manifestations, such as arthritis, skin lesions, episcleritis and uveitis, pericholangitis, hydronephrosis, renal stones, amyloidosis, arrested maturation, fever, and anemia occur as complications of the intestinal disease. Medical treatment is empirical and supportive. Surgical treatment is reserved for complications. The incidence of Crohn's disease seems to be increasing because our diagnostic techniques are improving, but our treatment is unsatisfactory.- - - - - - - - - - ranking = 3.527119250303keywords = gastrointestinal tract, tract (Clic here for more details about this article) |
10/183. Oral changes in Crohn's disease.Oral lesions in patients with Crohn's disease may be characteristic granulomatous lesions, secondary results of deficiency conditions, or coincidental lesions. Thorough investigations are necessary to rule out involvement of the gut in the disease process. If results fail to substantiate a diagnosis of Crohn's disease, regular follow-up examinations are necessary to detect possible later development of the disorder.- - - - - - - - - - ranking = 0.125keywords = gut (Clic here for more details about this article) |
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