Radiologic evaluation of gastrointestinal leiomyosarcomatosis

A 68-year-old woman who had previously undergone small intestinal resection because of leiomyosarcoma was referred to our clinic with epigastric pain. A double-contrast barium study and the subsequent abdominopelvic CT and abdominal MRI examinations demonstrated multiple extraluminal growing tumors arising from the walls of stomach, small bowel, and colon. A CT-guided aspiration biopsy revealed malignant mesenchymal tumor. The presence of disseminated intra-abdominal masses without concomitant ascites and invasion of tissue planes on CT in a patient operated on prior because of a leiomyosarcoma led to the diagnosis of gastrointestinal leiomyosarcomatosis. In this report we discuss the radiological approach to this rare entity.     

The eosinophilic response of the rat to infection with Taenia taeniaeformis

Rats were dosed with eggs of Taenia taeniaeformis and hematologic parameters were measured throughout the course of primary infection. There was no evidence of anemia but differential leukocyte counts revealed distinct and reproducible patterns of white blood cell changes. A lymphocytosis developed at the end of the 1st and 5th weeks postinfection (p.i.). Neutrophil counts peaked 8 days p.i., although at that time there was no marked neutrophilic infiltration of the tissues. Eosinophil counts began to rise during the 2nd week p.i., and reached a peak during the 3rd week, followed by a decline and then another peak during the 5th week p.i. Eosinophilic infiltration of the tissues was remarkable during the period of peripheral eosinophilia. A wide zone of eosinophils surrounded the developing larvae at 22 days p.i. and persisted in some cases for a further 2 weeks. Eosinophils remained in lesser numbers in the connective tissue capsule throughout the infection, often in association with plasma cells. After oral challenge with 1,000 eggs infected rats showed brisk secondary eosinophilic responses 3 to 7 days later but other hematologic parameters were unaffected. Average peripheral eosinophil counts at 3 and 4 days post-challenge were significantly higher than those in unchallenged controls (P less than 0.05 and P less than 0.01, respectively). There was no detectable increase in eosinophilic infiltration of small intestinal tissues in challenged rats. These results are discussed in relation to current understanding of the mechanisms of eosinophil chemotaxis in vitro and the possible causes of local eosinophil accumulation in parasitic infections in vivo.     

Antibody-mediated secondary eosinophilic response to Taenia taeniaeformis in the rat

An experimental model for neoplastic pleural effusion was made using a transplantable pleural fibrosarcoma MC-106 in ddO mice, and a local immunotherapy of neoplastic pleural effusion with oil-attached BCG cell-wall skeleton was attempted. Viable cells (3 X 10(5)) of MC-106 were injected into the right pleural cavity of the mice on day 0 with a tuberculin syringe which was joined to a two-way tap attached to a capillary manometer. All of the mice in the control group, which received intrapleurally saline solution 24 hr after the injection of tumor cells, died within 24 days and the mean survival time was 16.9 +/- 3.4 (SD) days. Macroscopically massive blooded pleural effusion in both pleural cavities and multiple tumor nodules on the surface of parietal and visceral pleura were observed. On the other hand, the mice which received intrapleurally 100 mug of oil-attached BCG cell-wall skeleton 24 hr after the injection of tumor cells survived much longer. About 50% of the mice remained alive and were killed on day 95. They revealed histologically no malignant lesion of the pleura except for residual changes of inflammatory reactions.     

The effects of vasculitis on the gastrointestinal tract and liver

Vasculitis can affect every organ of the digestive system. In many cases, it may first present with gastrointestinal symptoms. In several forms of vasculitis, including Churg Strauss syndrome, Henoch-Sch?nlein purpura, and lupus, the majority of patients have gastrointestinal involvement. The astute gastroenterologist should consider vasculitic causes of the symptoms seen in many patients. Making the correct diagnosis requires a thorough understanding of the potential role of vasculitis in causing these symptoms and the appropriate path to making a diagnosis. This article reviews the variety of manifestations of vasculitis on the digestive system, and emphasizes diagnosis and clinical manifestations.     

Prospective evaluation of the gastrointestinal tract in patients with iron deficiency and no systemic or gastrointestinal symptoms or signs

BACKGROUND: Although endoscopic evaluation of the gastrointestinal tract is commonly performed to evaluate iron deficiency, little data is available regarding the underlying causes, yield of evaluation, and long-term outcome for those in whom gastrointestinal and systemic symptoms and signs are absent. METHODS: In- or out-patients seen by the gastroenterology consultative service at a large inner-city hospital over a 56-month period were considered eligible for the study when iron deficiency (serum ferritin <50 ng/mL) was documented. Exclusion criteria included: any gastrointestinal or systemic symptoms/signs, radiographic or endoscopic examinations of the gastrointestinal tract within 3 and 5 years, respectively, or obvious source of blood loss. Patients underwent colonoscopy and if no lesions other than carcinoma were found, upper endoscopy was then performed with a pediatric colonoscope. RESULTS: Fifty-two patients were evaluated (mean age, 66 +/- 13 years; range, 20 to 89 years; 32 men/20 women). At the time of evaluation, the mean (+/-SD) hematocrit was 25% +/- 7% (range, 14% to 42%). Overall, 23 patients (44%; 95% CI 30% to 59%) had an identifiable gastrointestinal lesion considered the cause of iron deficiency, including: colonic carcinoma, 11 (21%); colonic and/or esophagogastric/duodenal vascular ectasias, 9 (17%); and gastric carcinoma, colonic polyposis, and colonic ulcers in 1 patient each. Long-term follow-up (median 24 months, range 2 to 63 months) identified only 1 patient with a cause found (colonic carcinoma), and in this patient, complete colonoscopy was not technically possible at the time of initial evaluation. There were no clinical or laboratory features that distinguished patients with an etiology for iron deficiency to the idiopathic group. CONCLUSIONS: Approximately half of patients with iron deficiency in whom gastrointestinal or systemic signs or symptoms are absent have an underlying gastrointestinal lesion. Nevertheless, despite a thorough endoscopic evaluation, some patients will have no etiology found; the prognosis for these patients is excellent.     

Healing in the gastrointestinal tract

Healing in the GI tract is rapid when free of complications: Unlike cutaneous healing, in which progress can be observed on a daily basis and intervention instituted early if necessary, healing of the intestinal anastomosis is anatomically obscured from inspection, allowing the surgeon only the patient's parameters of general well-being to judge the success of the operation. For the same reason, complications usually require re-operation, with the associated morbidity of a laparotomy and additional general anesthetic. This places a great responsibility on the surgeon to be cognizant of all the preoperative, intraoperative, and postoperative factors relating to anastomotic healing that might compromise the healing process. Bearing these in mind, along with attention to technical detail, should limit complications to an acceptable level. Patients most at risk are (1) those who perioperatively develop physiologic problems that lead to shock, hypoxia, and resultant anastomotic ischemia, (2) those with radiation-induced tissue injury, (3) those with sepsis, and (4) those with preoperative bowel obstruction. Malnourishment, malignancy, diabetes, steroids, and age also influence outcome to varying degrees. Future advancement in the field of GI healing lies in our ability to manipulate the early struggle between collagen synthesis and collagen breakdown. A profound understanding of the molecular and biochemical pathways and the factors that control them will bring us closer to this goal. Clinically, this may be accomplished by the introduction of wound healing enhancers into the anastomotic site, possibly by incorporating them into suture materials, biofragmentable anastomotic rings, or staple materials. Already much is known about the influence of different cytokines and growth factors on collagen regulation, knowledge that will help resolve many of the long-standing problems associated with GI surgery.     

AIDS and the gastrointestinal tract

Gastrointestinal disease in AIDS most often affects three major areas: the bowel, the esophagus, and the liver. Investigation should be tailored to identify treatable causes of disease, bearing in mind that multiple infections, superinfection, and untreatable diseases are common. Clinical decisions must be made regarding both the level of investigation necessary and the best testing procedures to use. Treatment is often only symptomatic, but in some cases a specific pathogen can be targeted.     

Diabetes and the gastrointestinal tract

Gastrointestinal motility disorders are common in patients with diabetes. The entire gastrointestinal tract may be involved from the esophagus to the anal sphincter. Before instituting therapy, people with diabetes first require a careful diagnostic evaluation. Treatment includes tight glucose control and the use of antiemetics and prokinetic agents.     

Feeding manipulation elicits different proliferative responses in the gastrointestinal tract of suckling and weanling rats

It was found out, that immunomodulative action of low frequency acoustic oscillations (LFAO) is mediated in mice by enhancement or decreasing of distinct stages of immunogenesis. Exposure to this factor at intensity of 80 dB varied number of cells in lymphoid organs, enhanced cell proliferation, improved cooperative interaction of thymocytes and bone marrow cells in immune response, caused increase of allogenic stem cells inactivation. On the contrary, exposure to LFAO at the acoustic pressure of 130 dB caused alternative effects, as inhibition of immunocompetent cells in interaction.     

Brief report: evaluation of the upper gastrointestinal tract in uraemic patients undergoing haemodialysis

PURPOSE OF THE STUDY: This study was performed to determine the gastrointestinal symptoms, and endoscopic and histopathological findings in patients on maintenance haemodialysis. STUDY DESIGN: Nintey-two patients on haemodialysis were enrolled in this study and 100 consecutive dyspeptic patients referred for endoscopy served as controls. They were interviewed to obtain information regarding GI symptoms and endoscopy was performed and biopsies were taken from antral mucosa for histopathological evaluation and helicobacter identification. RESULTS: Prevalence of GI symptoms in the dialysis group was extremely common (77%); with more cases in those with periods of dialysis longer than 6 months. Endoscopically observed of hiatus hernia was present in 27 patients in the dialysis group versus 14 in the control group (P<0.02). Duodenal ulcers were present in three patients of the dialysis group compared with 16 in the control group (P<0.01). Histologically, chronic superficial gastritis and mucosal atrophy tended to be more common in the dialysed patients, but this difference was not statistically significant. Helicobacter pylori were present in 45 patients in the dialysis group versus 73 in the control group (P<0.01).     

Biomechanics of the gastrointestinal tract

As the function of the gastrointestinal tract is to a large degree mechanical, it has become increasingly popular to acquire distensibility data in motility research based on various parameters. Hence it is important to know on which geometrical and mechanical assumptions the various parameters are based. Currently, compliance and tone derived from pressure-volume curves are by far the most often used parameters. However, pressure-volume relations obtained in tubular organs must be carefully interpreted as they provide no direct measure of luminal cross-sectional area and other variables useful in plane stress and strain analysis. Thus, erroneous conclusions concerning tissue distensibility may be deduced. Other parameters, such as wall tension, stress and strain, give more useful information about mechanical behaviour. Distensibility data procure significance in fluid mechanics and in the study of tone, peristaltic reflexes, and mechanoreceptor kinematics. Such data are needed for the determination of the interaction between stimulus, electrical responses in neurons and the mechanical behaviour of the gut. Furthermore, from a clinical perspective, investigation of visco-elastic properties is important because GI diseases are associated with growth and remodelling. For example, prestenotic dilatation, increased collagen synthesis, dysmotility and altered distensibility are common features of obstructive diseases. The purpose of this review is to discuss the physiological and clinical importance of acquiring biomechanical data, distensibility parameters and interpretation of these results and their associated errors. We will also discuss some aspects of the relationship between morphology, growth and biomechanics. Finally, we will outline a number of techniques to study the mechanical properties of the GI tract.     

Duplications of the gastrointestinal tract

The pathology and clinical presentation of intestinal duplications are discussed. 8 assorted cases are presented. Spherical lesions of the small intestine were resected together with the stenosed segment of bowel while the cysts of the ileo-caecal region were dissected out. The rare tubular duplication of the rectum was managed with an anastomosis at the most distal end of the duplication to the original bowel.     

MRI of the gastrointestinal tract

To test whether the effects of marital status on health differ between never married women and divorced and separated women, this study utilizes prospective panel data for a large national sample of non-institutionalized young women in the U.S. (the National Longitudinal Surveys of Young Women). The women were aged 24-34 at the beginning of two successive five-year follow-up intervals (1978-1983 and 1983-1988). The health effects of marital status were evaluated in regressions which assessed the relationships between initial marital status and subsequent health trends in each follow-up interval. In the first follow-up interval, never married women tended to have worse health trends than divorced and separated women for physical impairments and for overall health problems. However, there were no differences between never married women and divorced and separated women in health trends for psychosomatic symptoms in either follow-up interval or for any health measure in the second follow-up interval. Our analyses of cross-sectional data showed few significant differences in health between never married women and divorced and separated women. Taken together, the evidence from our study and previous studies suggests that differences between never married women and divorced and separated women may vary by age and/or cohort. Evidence for the 1970s and 1980s suggests that, among older women, divorced and separated women may have experienced more harmful health effects than never married women; however, among younger women, this difference may have been absent or possibly reversed.     

Systemic amyloidosis and the gastrointestinal tract

Systemic amyloidosis is caused by a variety of different diseases and frequently involves the gastrointestinal tract. Each type of amyloid affects the gastrointestinal tract differently. This article reviews the unique pathogenesis, pattern of gastrointestinal disposition, diagnosis, and treatment of the five systemic amyloidoses, and discusses the gastrointestinal diseases that cause systemic amyloidosis: inflammatory bowel disease and familial Mediterranean fever.     

Growth factors and the gastrointestinal tract

This paper reviews areas of interest in gut mucosal growth factor physiology. Several epidermal growth factor (EGF)-like peptides (EGF, transforming growth factor [TGF]-alpha, heparin-binding EGF-like peptide, amphiregulin, and betacellulin) have been identified in the gut, EGF is produced by the salivary glands and is present in milk. It may act on the mucosa from the lumen as a surveillance peptide promoting mucosal repair. A stem-cell-derived "ulcer-associated cell lineage" develops adjacent to ulcers and produces EGF, which may play a role in ulcer healing. TGF-alpha is expressed by villus enterocytes and may have an important role in mucosal healing. The Trefoil peptides (pS2, spasmolytic polypeptide, intestinal trefoil factor) are protease resistant molecules secreted by mucin cells throughout the gut, with a role in mucosal healing. The TGF-beta family inhibit cell proliferation, and promote cell differentiation. TGF-beta has a gradient of expression along the crypt villus axis, with maximum production at the villus tip. It is suspected that it may prevent cell proliferation and support differentiation of villus enterocytes. Hepatocyte growth factor is a multifunctional growth factor expressed in many tissues, including the gastrointestinal tract. It has a role in organogenesis. Intestinal adaptation is highly dependent on enteral nutrition, and it is likely that growth factors are involved in adaptation. Little is known, however, about interactions between nutrients and growth factors. Milk contains a range of potentially important growth factors. Their biological significance is uncertain, and this is an area of active research.     

Endoscopic ultrasonography in the gastrointestinal tract

Endoscopic ultrasonography is a combination of endoscopy and ultrasonography. This method facilitates an accurate evaluation of singular layers of the gut-walls and adjacent structures. Great gain is represented by the possibility to analyze submucosal tumors, to diagnose vascular anomalies and especially the staging of both gastrointestinal malignancies and tumors in the pancreato-biliary area. The method is also suitable for the monitoring of treatment of these malignancies (chemotherapy, radiotherapy and laser therapy) as well as for an early diagnosis of tumor recurrences. The paper enumerates the possibilities, limits, some differential-diagnostic problems, complications, as well as perspectives of this modern method.