1/114. polymerase chain reaction based human leucocyte antigen genotyping for the investigation of suspected gastrointestinal biopsy contamination.BACKGROUND: Mislabelling or contamination of surgical specimens may lead to diagnostic inaccuracy, particularly within gastrointestinal pathology when multiple small mucosal biopsy specimens are commonly taken, and where a tiny fragment of foreign tissue may be indistinguishable from true biopsy material using histological assessment alone. AIMS: To assess the utility of polymerase chain reaction (PCR) based human leucocyte antigen (HLA) genotyping techniques for the investigation of potentially mislabelled or contaminated gastrointestinal biopsy specimens. patients: Ten cases (28 samples) in which mislabelling or contamination was suspected, comprising four upper gastrointestinal tract biopsies and six colonoscopic biopsy series. methods: Direct and nested PCR-sequence specific primer (SSP) based HLA class II genotyping was performed on dna extracted from formalin fixed and paraffin wax embedded tissue (23 samples) or peripheral blood leucocytes (five samples). RESULTS: A full HLA-DRB1 genotype was determined in all 28 samples. In seven cases the HLA-DRB1 genotype of the putative contaminant was different to that of the corresponding reference tissue, confirming different individual origins for the contaminant and reference material. In one case the contaminant tissue was shown to possess the same HLA-DRB1 alleles as a second patient (probable source). In the remaining three cases the same HLA-DRB1 alleles were detected within the potential contaminant and reference tissues. CONCLUSIONS: PCR based HLA class II genotyping is a valuable tool for investigating potential contamination or mislabelling within gastrointestinal biopsy specimens and this report has confirmed contamination in seven of ten cases studied.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
2/114. Gastrointestinal and hepatic manifestations of human ehrlichiosis: 8 cases and a review of the literature.BACKGROUND: ehrlichiosis has emerged as an increasingly recognized tick-borne rickettsial disease. It can affect multiple organs including the gastrointestinal tract and liver. signs and symptoms include abdominal pain, nausea, vomiting, diarrhea, jaundice, and hepatosplenomegaly. patients commonly have elevated liver transaminases early in the course of illness as well as leukopenia and thrombocytopenia. If not diagnosed and treated in a timely fashion, ehrlichiosis can progress to multiorgan failure. methods: Between 1992 and 1998, 8 patients meeting the CDC criteria for ehrlichiosis were diagnosed and treated at the John L. McClellan Memorial veterans Hospital and University Hospital in Little Rock, Ark. These cases and English-language articles relating to gastrointestinal and hepatic manifestations of ehrlichiosis, identified by searching medline and manually reviewing bibliographies of retrieved articles, are reviewed. RESULTS: Seven of the eight patients had elevated transaminases on presentation which increased rapidly initially and slowly returned to normal. Three of our patients had hyperbilirubinemia. One of the eight patients presented with hepatomegaly. Three had hyperbilirubinemia with a peak bilirubin of 13.8 mg/dl. Two patients (25%) had a rash on presentation. All 8 patients were treated with and responded to doxycycline. One developed multiorgan failure but eventually recovered with intensive medical care and doxycycline. CONCLUSION: To avoid treatment delay and serious complications, in the appropriate clinical setting ehrlichiosis should be considered as a cause of elevated liver transaminases.- - - - - - - - - - ranking = 56.369163225336keywords = abdominal pain, pain (Clic here for more details about this article) |
3/114. endoscopy as a tool for diagnosing and treating gastrointestinal angiodysplasia in haemodialysis patients.Gastroenteric angiodysplasia is an important cause of haemorrhage in chronic renal failure patients. This paper reports on 2 patients on maintenance haemodialysis with upper gastrointestinal bleeding due to different manifestations of angiodysplasic lesions (sudden appearance of haematemesis and melaena in one case, progressive anaemia with apparent resistance to erythropoietin in the other case). Exploratory endoscope examination of the first digestive tract showed in both cases the presence of bleeding angiodysplasic lesions. Both patients were there and then submitted to surgical endoscopy, during which the bleeding angiodysplasic lesion was sclerosed with physiological salt solution plus adrenaline 1/10000 and 1% polydocanol. In one patient, bleeding occurred again ten days later, making renewed surgical endoscopy necessary. In the course of this an elastic ligature was made to the superangular angiodysplasia. A year later in both cases there were no direct or indirect signs of further bleeding; an endoscopic check-up showed the treated lesions to be sclerosed. endoscopy offers the unique possibility of being used for both diagnostic and therapeutic purposes in a single session. In expert hands, endoscope therapy is effective and markedly reduces the risk of side effects.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
4/114. Gastrointestinal lesions in an adult patient with Henoch-Schonlein purpura.A 28 year-old man was admitted because drug toxication, due to a high dose of antipsychotic drugs, presented purpuric rash on both legs, lower abdominal pain, arthralgia, and fresh-bloody stool. colonoscopy observed numerous small ring-like petechiae in the rectum and in the sigmoid colon. Upper gastrointestinal endoscopy found a few petechiae in the antrum of the stomach and in the duodenal second portion. He was treated with coagulation factor x III after admission. After 38 days, there was no abnormal mucosa in the colorectum, the duodenal second portion, or the antrum of the stomach. The disappearance of gastrointestinal lesions correlated with the course of the illness. Gastrointestinal tracts should be thoroughly observed in patients with Henoch-Schonlein purpura.- - - - - - - - - - ranking = 56.369163225336keywords = abdominal pain, pain (Clic here for more details about this article) |
5/114. A systematic history for the patient with chronic pelvic pain.Chronic pelvic pain is a source of frustration to both the physician and the patient. physicians have been ill equipped by their training to confront the multifaceted nature of the complaints of patients with chronic pelvic pain. patients have experienced a repetitive dismissal of their complaints by physicians too busy in their practices to address their problems comprehensively. The approach to the patient with chronic pelvic pain must take into account six major sources of the origin of this pain: 1) gynecological, 2) psychological, 3) myofascial, 4) musculoskeletal, 5) urological, and 6) gastrointestinal. Only by addressing and evaluating each of these components by a very careful history and physical examination and by approaching the patient in a comprehensive manner can the source of the pain be determined and appropriate therapy be administered. This article was developed to provide the clinician with a set of tools and a methodology by which the patient with this complaint can be approached.- - - - - - - - - - ranking = 33.835693612849keywords = pain (Clic here for more details about this article) |
6/114. Gastrointestinal manifestations of Behcet's disease.Behcet's disease (BD) is a multisystem, chronic, relapsing vasculitis of unknown origin that affects nearly all organs and systems. While recurrent oral ulcerations are a "sine qua non" of BD, the frequency of extra-oral parts of the gastrointestinal involvement varies widely in different countries. The most frequent extra-oral sites of gastrointestinal involvement are the ileocecal region and the colon. The liver (except with budd-chiari syndrome), pancreas, and spleen are rarely involved. The symptoms associated with these extra-oral manifestations of BD are abdominal pain, nausea, vomiting, diarrhea with or without blood, and constipation. The lesions typically are resistant to medical treatment and frequently recur with surgical treatment. We review the literature regarding the gastrointestinal and hepatobiliary systems in BD. Also, we present a patient who had BD complicated with radiologically-proven hepatic veins involvement (budd-chiari syndrome) and complete occlusion of hepatic portion of inferior vena cava and who had a good response to colchicine and penicillin treatment.- - - - - - - - - - ranking = 56.369163225336keywords = abdominal pain, pain (Clic here for more details about this article) |
7/114. barium impaction as a complication of gastrointestinal scleroderma.Two patients with scleroderma of the bowel experienced life-threatening barium impaction after upper intestinal x-ray studies. Although the frequency of this complication is unknown, the difficulty of managing it when it occurs makes prevention imperative. X-ray studies should be performed only after careful consideration of the risks and benefits. When x-ray studies are performed, the patient should be vigorously purged soon thereafter, and a follow-up roentgenogram should be obtained to confirm adequate removal of barium.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
8/114. Acute meningococcaemia complicated by late onset gastrointestinal vasculitis.Extra-meningeal and non-cutaneous manifestations of meningococcal infection are well recognized but rare. Herein we report a little recognized complication of meningococcaemia, namely late-onset gastrointestinal vasculitis. In the case presented, the prostacycline analogue iloprost was used in an attempt to minimize incipient digital gangrene ina patient with evidence of protracted immunological phenomena. In addition, diclofenac was used to treat severe arthralgia. Withdrawal of iloprost on day 19 was associated with abdominal pain and peritonism. laparotomy demonstrated ischaemia and ulceration in the caecum, and histology revealed full thickness mucosal ulceration with a prominent vasculitic process. It is postulated that these findings were immunologically mediated, with possible rebound vasoconstriction following withdrawal of iloprost. It is also possible that NSAID use contributed to the findings via cyto-toxicity to mucosal cells.- - - - - - - - - - ranking = 56.369163225336keywords = abdominal pain, pain (Clic here for more details about this article) |
9/114. Acute gastrointestinal manifestations associated with use of crack.Crack, the free-base form of cocaine, causes pulmonary, cardiac, obstetric, neurologic, musculoskeletal, and gastrointestinal complications. As the popularity for crack use increases, it follows that the number of cocaine-related emergency department (ED) visits, hospitalizations, and deaths should increase. We report 3 cases of patients arriving to the ED with acute onset of abdominal pain after smoking crack. These patients required surgical correction of their intestinal perforations. Although the exact pathophysiology of intestinal ischemia is not known, cocaine blocks the reuptake of norepinephrine, which leads to mesenteric vasoconstriction and focal tissue ischemia that may lead to perforation. The chronologic relationship of crack consumption to gastrointestinal perforation leads us to surmise that a possible crack-related ischemic event is the cause of perforation in these patients. physicians examining patients with abdominal pain should be aware of the potential gastrointestinal complications of crack and consider bowel ischemia whenever a cocaine abuser presents with abdominal pain.- - - - - - - - - - ranking = 169.10748967601keywords = abdominal pain, pain (Clic here for more details about this article) |
10/114. Inflammatory pseudotumor of the alimentary tract: clinical and surgical experience.BACKGROUND/PURPOSE: Initially described in 1937, inflammatory pseudotumor (IPT) inflammatory myofibroblastic tumor (IMT) or plasma cell granulomas are synonymous for an inflammatory solid tumor that contains spindle cells, myofibroblasts, plasma cells, and histocytes. Common sites of presentation include lung, mesentary, liver, and spleen; intestinal presentations are rare, and the etiology remains obscure. This report details the clinical and surgical experiences in 4 children with alimentary tract IPT at a single institution. methods: A retrospective chart review was conducted of pediatric patients with the pathologic diagnosis of IPT. RESULTS: Between 1990 and 1999, 4 patients (4 girls, ages 5 to 15 years) were identified with gastrointestinal tract origins of IPT. Symptoms at presentation included anemia (n = 4), intermittent abdominal pain (n = 3), fever (n = 3), weight loss (n = 2), diarrhea (n = 2), dysphagia (n = 1). Two patients had comorbid conditions of juvenile rheumatoid arthritis and mature B cell lymphoma. Three of 4 patients had elevated sedimentation rates. The sites of origin were the gastroesophageal junction, the colon, the rectum, and the appendix, with the referral diagnosis achalasia, perforated appendix, inflammatory bowel disease, and recurrent lymphoma, respectively. All were treated with aggressive surgical resection, and 3 girls have had no recurrences since the initial surgery. One patient had 3 recurrences within 8 months of presentation; she remains disease free 8 years later. CONCLUSIONS: IPT, although rare in the gastrointestinal tract, mimics more common problems. Successful surgical management is possible even in cases of multiple recurrences.- - - - - - - - - - ranking = 56.369163225336keywords = abdominal pain, pain (Clic here for more details about this article) |
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