1/10. Successful conservative treatment of neutropenic enterocolitis complicating taxane-based chemotherapy: a report of five cases.Five cases of acute neutropenic enterocolitis complicating taxane-based chemotherapy are described. During a 34-month period, our department administered 4,600 courses of taxane-based (paclitaxel and docetaxel) chemotherapy to 800 cancer patients. Seven to 10 days postchemotherapy in five patients (0.1% of the given courses), neutropenic fever, abdominal pain, rebound tenderness, and grade II-IV diarrhea (bloody in two cases) developed. Two patients had oral candidiasis, and in two others septic shock developed. Computed tomography scans of the abdomen revealed in all patients thickening of the colon wall and pericolic edema, and a pericolic abscess was revealed in three of them. Both clinical and radiologic findings supported the diagnosis of acute neutropenic enterocolitis. All patients were successfully treated with broad-spectrum antibiotics and recombinant human granulocyte colony-stimulating factor. In conclusion, acute neutropenic enterocolitis is a severe complication of taxane-based chemotherapy. early diagnosis and appropriate conservative treatment leads to complete recovery. Although rare, this infection is less often associated with other chemotherapeutic regimens.- - - - - - - - - - ranking = 1keywords = propria (Clic here for more details about this article) |
2/10. Intestinal bleeding and occlusion associated with shiga toxin-producing escherichia coli O127:H21.We report a case of a nine-year old boy with vomiting, abdominal pain and fever, who underwent surgery with a diagnosis of appendicitis in Mendoza and from whom a shiga toxin-producing escherichia coli (STEC) O127:H21 strain was recovered. Forty-eight hours after surgery he presented bilious vomiting and two episodes of intestinal bleeding. Laboratory findings included: hematocrit, 35%; blood urea nitrogen, 0.22 g/L. The urinary output was normal. The following day physical examination showed an alert mildly hydrated child, without fever but with distended and painful abdomen. The patient was again submitted to surgery with a diagnosis of intestinal occlusion. Bleeding and multiple adhesions in jejunum and ileum were found. The patient still had tense and painful abdomen and presented two bowel movements with blood; hematocrit fell to 29% and blood urea nitrogen rose to 0.32 g/L. STEC O127:H21 eae(-)/Stx2/Stx2vh-b( )/E-Hly( ) was isolated from a stool sample. He was discharged after 10 days of hospitalization and no long-term complications such as HUS or TTP were observed. This is the first report, to our knowledge, on the isolation of E. coli O127:H21, carrying the virulence factors that characterize STEC strains, associated to an enterohemorrhagic colitis case. This serotype was previously characterized as a non-classic enteropathogenic E. coli (EPEC). STEC infections can mimic infectious or noninfectious pathologies. Therefore an important aspect of clinical management is making the diagnosis using different criteria thereby avoiding misdiagnoses which have occasionally led to invasive diagnostic and therapeutic procedures or the inappropriate use of antibiotics.- - - - - - - - - - ranking = 1keywords = propria (Clic here for more details about this article) |
3/10. Extensive enteric leiomyolysis due to cytomegalovirus enterocolitis in vertically acquired human immunodeficiency virus infection in infants.We report two infants with the acquired immunodeficiency syndrome (AIDS) and rectal bleeding due to cytomegalovirus (CMV) ileitis and colitis with minimal focal mucosal ulceration but with extensive leiomyolysis of the muscularis propria. Immunostaining and in situ hybridization for CMV showed numerous viral inclusions in the myocytes of the muscularis propria and vascular endothelium/smooth muscle with only occasional inclusions present in the muscularis mucosae. colectomy was curative in one patient; in the other the bowel was only examined at postmortem.- - - - - - - - - - ranking = 2keywords = propria (Clic here for more details about this article) |
4/10. Nongranulomatous chronic idiopathic enterocolitis: a primary histologically defined disease.Nongranulomatous chronic idiopathic enterocolitis is characterized by sudden onset of severe watery diarrhea, malabsorption, exudative enteropathy, frequent appearance of shallow ulcerations, and variable degrees of villus atrophy. In the absence of infectious and pharmacologic causes, the presence of a predominantly acute inflammatory infiltrate limited to the lamina propria establishes the diagnosis. No underlying disease appears during prolonged follow-up. The etiology remains unknown. The disease is generally corticosteroid-responsive; low-dose maintenance therapy is frequently required. The long-term prognosis is guarded. Three of 11 patients died of opportunistic infections or resistance to therapy.- - - - - - - - - - ranking = 9.63559767556keywords = lamina propria, propria, lamina (Clic here for more details about this article) |
5/10. Collagenous enterocolitis: a manifestation of gluten-sensitive enteropathy.We report coexistent collagenous colitis and collagenous sprue in a 62-year-old woman with diarrhea. Investigations suggested malabsorption, and small intestinal biopsies demonstrated a flattened mucosa with subepithelial collagen deposition. Colonic biopsies also showed a thickened subepithelial collagen band as well as a striking lamina propria inflammatory cell infiltrate. Symptomatic remission was induced with a gluten/lactose-free diet, oral prednisone, and sulfasalazine and has been maintained with gluten restriction alone. Repeat biopsies after 2 months demonstrated restoration of normal small intestinal and colonic collagen bands; only a chronic inflammatory cell infiltrate (consistent with microscopic/lymphocytic colitis) persisted in colonic biopsies. We propose that, in this instance, collagenous enterocolitis represented a diffuse manifestation of gluten sensitivity.- - - - - - - - - - ranking = 9.63559767556keywords = lamina propria, propria, lamina (Clic here for more details about this article) |
6/10. campylobacter jejuni enterocolitis causing peritonitis, ileitis and intestinal obstruction.patients with Campylobacter enterocolitis may come to laparotomy due to the severity of abdominal symptoms and signs, although only two patients with intestinal inflammation have been described and in neither was the histopathology documented. A case of a 52-year-old male who had a typical diarrhoeal illness of Campylobacter enterocolitis diagnosed on stool culture is reported. Despite appropriate treatment he developed signs and symptoms consistent with small intestinal obstruction. laparotomy revealed peritonitis and thickened distal ileum with transmural inflammatory changes on histopathology. These changes were shown to have completely resolved at a second laparotomy, required for persistent obstruction due to adhesions. Recurrent adhesions culminated in a third laparotomy. The clinical, operative and histopathological findings may be confused with Crohn's disease.- - - - - - - - - - ranking = 1keywords = propria (Clic here for more details about this article) |
7/10. Successful surgical management of neutropenic enterocolitis in two patients with severe aplastic anemia. case reports and review of the literature.We describe two patients with severe aplastic anemia in whom neutropenic enterocolitis developed while they were undergoing treatment at the National Institutes of health. Both patients had progressive symptoms while receiving optimal medical management and both underwent and survived surgical intervention despite continued prolonged neutropenia in the perioperative period. This experience contrasts with six cases reported in the literature and suggests that surgery can be employed even in patients with profound neutropenia. Thus, in patients who remain persistently septic or who develop clinical deterioration despite medical management or who have other indications for surgical intervention, neutropenia should not be a contraindication to the appropriate or necessary procedure.- - - - - - - - - - ranking = 1keywords = propria (Clic here for more details about this article) |
8/10. Nongranulomatous chronic idiopathic enterocolitis: clinicopathologic profile and response to corticosteroids.BACKGROUND & AIMS: Nongranulomatous ulcerative enterocolitis has been reported in association with celiac sprue, lymphoma, and hypogammaglobulinemia. The objective of this study is to present evidence that this disorder exists as a primary entity. methods: The medical records and histological material of 9 patients (mean age, 45.7 /- 5.9 years) who presented with severe chronic diarrhea without specific diagnosis after extensive investigations were reviewed. RESULTS: Endoscopically, the duodenum and proximal jejunum were inflamed in 6 of 7 patients, with superficial ulcerations in 5 patients. On histology, the lamina propria was infiltrated by polymorphonuclear and chronic inflammatory cells, with varying degrees of villous atrophy. There were no significant cellular abnormalities of the epithelial enterocytes. A similar inflammatory infiltrate was present in the colon in 4 or 5 patients. Eight of 9 patients responded to corticosteroids with clinical and variable histological improvement. Four patients developed bleeding from ulcerations in the small or large intestine. Three patients died: 1 patient who did not respond to treatment with corticosteroids and 2 patients with systemic infection. Four of the 6 surviving patients required maintenance low-dose corticosteroid therapy. No underlying disease was discovered during prolonged follow-up. CONCLUSIONS: Idiopathic nongranulomatous enterocolitis may present as a primary, frequently fatal disease. Corticosteroid therapy provides immediate benefit and may be required indefinitely.- - - - - - - - - - ranking = 9.63559767556keywords = lamina propria, propria, lamina (Clic here for more details about this article) |
9/10. Mucosal biopsy findings and venous abnormalities in idiopathic myointimal hyperplasia of the mesenteric veins.Idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) is a rare cause of intestinal ischemia secondary to venous compromise. A patient with this condition who presented with crampy abdominal pain, diarrhea, and rectal bleeding initially attributed to inflammatory bowel disease had several colonoscopies and ultimately a sigmoid colectomy. The colonic mucosa in biopsies performed at initial presentation and subsequently and in the resection specimen contained numerous hyperplastic, thick-walled, hyalinized vessels in the lamina propria, which have not been described in this entity previously. Examination of the mucosa in 27 resection specimens of ischemic enterocolitis of various etiologies, in five resections of prolapsed rectum, and in seven colostomy specimens revealed no instance in which there were similar histologic abnormalities. When seen on biopsy, therefore, these features should lead to inclusion of IMHMV in the differential diagnosis. Furthermore, the characteristic lesions of the submucosal and extramural veins in IMHMV were compared with those of 14 examples, from several organs, of veins subjected to arterial pressure and 21 cases of venous hypertension. The marked similarity of the arterialized veins to the mural veins of IMHMV suggests a role for arteriovenous fistulization in the pathogenesis of IMHMV, and a mechanism by which this might occur is proposed.- - - - - - - - - - ranking = 9.63559767556keywords = lamina propria, propria, lamina (Clic here for more details about this article) |
10/10. clostridium septicum sepsis and neutropenic enterocolitis in a patient treated with intensive chemotherapy for acute myeloid leukemia.We report a case of neutropenic enterocolitis complicated by clostridium septicum sepsis following intensive chemotherapy to induce remission of acute myeloid leukemia. With the trend towards more intensive chemotherapy, particularly using regimens that induce gastrointestinal toxicity, it is important to recognize the circumstances under which sepsis due to C. septicum is likely to occur, so that appropriate treatment can be instituted promptly.- - - - - - - - - - ranking = 1keywords = propria (Clic here for more details about this article) |
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