Etiological mechanism and treatment of Guillain-Barre syndrome-- Campylobacter jejuni enteritis and the development of anti-ganglioside antibody preceding the syndrome

An ulnar dislocation of the trapeziometacarpal joint is reported. On the posteroanterior radiograph of the wrist, the boney alignment appeared normal, and the only sign indicating a dislocation was a slight widening of the joint. By contrast, a true posteroanterior view of the trapezium clearly demonstrated the metacarpal ulnarly displaced. A late tendon reconstruction of the damaged palmar and medial ligaments produced a satisfactory result.     

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.     

Stress symposium in Johannesburg: plants versus humans

To explore the involvement of serotonin transporter (5HTT) in mood disorder, we studied two polymorphisms of the 5HTT gene (a variable number of tandem repeats in the second intron (VNTR) and a 44 bp insertion/deletion in the 5HTT linked polymorphic region (5-HTTLPR)) in a sample of unipolar and bipolar patients and controls. Homozygosity for the short variant of the 5-HTTLPR was significantly more frequent in bipolar patients than in controls (chi2 = 4.68, d.f. = 1, P = 0.03) whereas there was no difference between bipolar patients and controls for allele distribution, suggesting a recessive effect. The interaction between the two markers suggests that the two polymorphisms probably have independent effects to determine the susceptibility to affective disorder. Further studies are required to identify the precise phenotype associated with 5HTT polymorphisms in depressed patients.     

A survey of snakebit in the Johannesburg area

Case records of persons with snakebite treated at the Johannesburg General Hospital and the Transvaal Memorial Children's Hospital during the 10-year period 1963-1972 were investigated. It was concluded that (i) snakebites were rare, since only 39 cases were recorded, none of which ended fatally; (ii) 86% of patients were men (mean age was 24 years); (iii) 80% of bites were on the hand and arm; (iv) 28% of patients had had previous snakebites; and (v) 60% of bites were 'illegitimate', i.e. they occurred in snake handlers. Apart from occasional bites by exotic snakes in collections, the venomous snakes responsible for the majority of bites were, in order; ringhals, puff adder, and burrowing adder. The first two snakes are common in the region, while amateur herpetologists are at particular risk of being bitten by burrowing adders because of the snake's ability to bite even when held by the back of the neck. Ringhals bites, although the most common, caused virtually no morbidity. Bites by other venomous snakes showed considerable variation in morbidity, suggesting that many different factors must be taken into account when the nature and effects of snakebite are assessed. Eighty-five per cent of snakes were positively identified, mostly by the snake fanciers they had bitten. This permitted specific treatment.     

Guillain-Barré and Fisher's syndromes subsequent to Campylobacter jejuni enteritis are associated with HLA-B54 and Cw1 independent of anti-ganglioside antibodies

The frequencies of human leukocyte antigens (HLA)-class I (A, B and Cw) were determined serologically and those of HLA-class II (DRB1 and DQB1) at the genomic level in 35 Japanese patients with Guillain-Barré syndrome (GBS), 58 with Fisher's syndrome (FS), and 112 healthy controls. HLA-B54 and -Cw1 antigens were found in GBS and FS patients from whom Campylobacter jejuni had been isolated more often than found in the healthy controls. No HLA types were related to GBS or FS as a whole, except for the B54 antigen which often was significant in the entire GBS group. This relation, however, may depend on the high population of C. jejuni-isolate patients in our GBS group. There were no relationships between the frequencies of HLA types and the presence of serum IgG antibodies to GM1, GQ1b, GD1a, or GalNAc-GD1a. Our findings suggest that HLA types are associated with the onset of GBS and FS after C. jejuni enteritis and that the HLA types in distinct GBS and FS subgroups of a single etiological origin need to be examined.     

Corynebacterium equi enteritis in foals

The limiting laws for polyelectrolyte solutions developed in previous papers of this series have been amply confirmed by measurement. A surprising result of the accumulated data is that the limiting polyelectrolyte charge fraction (fraction of fixed charges uncompensated by condensed counterions in the limit of zero concentration), persists up to concentrations of 0.1 M or even higher. Here the theory is extended in a simple manner to finite concentrations, and the stability of the charge fraction is found to be firmly based on consequences of the long-range polyelectrolyte field. The associated counterions are assumed to translate freely in a region centered on the contour axis of the polyion. The numerical value of the free volume is determined self-consistently from the axial charge density of the polyelectrolyte and is used as the general framework within which specific binding effects are treated.     

Granulomatous enteritis in nine horses

Granulomatous enteritis was diagnosed in 9 horses between 1 and 11 years of age. The complaint in all cases was persistent weight loss. Four of the horses had chronic diarrhea. Two consistent diagnostic features were hypoalbuminemia and decreased phagocytic activity of mesothelial cells in the peritoneal fluid. In 2 cases the diagnosis was confirmed by biopsy of the rectal mucosa. Remaining cases were definitively diagnosed by exploratory laparotomy and biopsy or at necropsy.     

Bleeding infectious enteritis

A recent trend on bleeding intestinal infections in Japan was described. Salmonella Enteritidis infection occupied over 42% of food-borne diseases in 1996. Salmonella Enteritidis is the most popular infectious agent for food-borne outbreak in Japan. Salmonella Typhimurium DT104 which is widely spread in Europe and in U.S.A. is not common in Japan. We experienced large outbreak of foodbore EHEC/VTEC O157: H7 infections in 1996. Since then, diagnostic and therapeutic studies on EHEC/VTEC infection and haemolytic uremic syndrome are promoted by the Government. HACCP may take an important roll for the prevention of large outbreaks of foodbore EHEC/VTEC infections.     

Acute regional enteritis

Severe melena is a rare complication of acute regional enteritis. The hemorrhage is more severe when the large intestine is also involved. The difference betwee "real" acute regional enteritis and exacerbations of regional enteritis lies in their pathological appearance, development and complications.     

Drug-associated hemorrhagic enteritis

Drug-associated hemorrhagic colitis are divided into antibiotic associated hemorrhagic colitis (AAHC) and other drug associated hemorrhagic colitis. AAHC are mainly caused by oral usage of Ampicillin and its derivatives (85%). Initially AAHC are believed to be caused by Klebsiella oxytoca overgrowth. However, these organisum has no exotoxin like Clostridium difficile and pathogenesis of AAHC are still unresolved. Typical AAHC are diagnosed by colonoscopy with diffuse hemorrhage and edema mainly found in descending colon and transverse colon. NSAIDs are also the cause of hemorrhagic colitis like AAHC. Mephenamic acid are famous for this complication. Diarrhea is one of the main complication of oral 5-fluorouracil administration and even causes hemorrhagic colitis. Its histology are characteristic in gland atrophy. Gold colitis are reported 36 cases in rheumatoid arthritis patients. Exact mechanism of bleeding are not understood. NSAIDs may cause collagenous colitis and or lymphocytic colitis in RA patients. Other rare hemorrhagic colitis are associated with azathioprine, methyl dopa, interferon alfa etc. NSAIDs and anticoagulants are well known drugs for complication of GI bleeding making hemorrhagic enteritis.     

Clinical characteristics and outcome of hyperglycaemic emergencies in Johannesburg Africans

In this prospective analysis we investigated the clinical characteristics of black South African diabetic patients admitted to hospital with hyperglycaemic emergencies. The study cases were selected from the medical admissions to an urbanized, Johannesburg academic hospital over a period of 12 months. Only patients with severe diabetic ketoacidosis (DKA) or hyperosmolar non-ketotic hyperglycaemia (HNKH) as defined in the text were included. Over the study period, we identified 58 patients with severe DKA (M: 32, F: 26) and 24 with HNKH (M: 14, F:10). Thirty-two of the patients with DKA (55.2%) were classified as having non-insulin dependent (Type 2) diabetes mellitus (NIDDM). Compared to the 26 subjects with insulin-dependent (Type 1) diabetes mellitus (IDDM), the NIDDM patients were older (51.7 vs 27.7 years) and had a significantly higher body mass index (BMI) (29.4 vs 23.5 kg m(-2), p = 0.002), and glucose levels 47.5 vs 34 mmol l(-1) p = 0.004). Mortality from DKA was 6.8 % and from HNKH 16.6%. Infection was the leading precipitating factor for both DKA and HNKH, followed by first presentation and noncompliance. We conclude that the majority of urban African patients admitted to hospital with DKA have NIDDM. Mortality from DKA among the black Africans in Johannesburg is low and comparable to the mortality in western Europe.     

Diagnosis of enteritis virus

Weanling rats were fed either a semisynthetic diet with no fat, with 28% by wt partially hydrogenated fish oil, or with 28% by wt arachis oil(control diet) for 6 or 7 1/2 months. The in vitro conversion of arachidonic acid to prostaglandin E2 by homogenates of the rat kidney medulla was measured by gaschromatography with electron capture detection. The kidney medulla of essential fatty acid deficient animals showed increased activity for the in vitro conversion of exogenous arachidonic acid to prostaglandin E2 when compared to the controls. The change of the enzymatic activity in the essential fatty acid deficient animals was reversible, as shown by refeeding. Inhibition of the prostaglandin synthetase was found at exogenous substrate concentrations higher than 50-100 muM.     

Antibiotic therapy for infectious enteritis in childhood

A brief review of the actual knowledge on the infantile enteritis caused by infectious agents is given. The antibiotic therapy of bacterial enteritis is still acute, but the range of indications is limited. This kind of therapy aims at the curative effect, but not at the sanitation of the stools, for which no reliable method exists. Any kind of infantile enteritis needs dietetic treatment.     

Parvovirus enteritis in vaccinated juvenile bush dogs

Parvovirus enteritis developed in 10 of 17 vaccinated juvenile bush dogs (Speothos venaticus) from 4 litters in a 5-month period. Nine dogs died. The first outbreak involved 6 of 9 bush dogs from 2 litters. Each had been vaccinated with a killed feline-origin parvovirus vaccine at 11 and 14 weeks of age. The 6 affected dogs became ill at 29 weeks of age and died. The second outbreak involved a litter of 6 bush dogs. Each had been vaccinated every 2 weeks starting at 5 weeks of age. Two were isolated from the colony at 16 weeks of age for treatment of foot sores. Three of the 4 nonisolated dogs developed parvovirus enteritis at 20 weeks of age; 2 died at 6 and 8 days, respectively, after onset of signs. The 3rd outbreak involved a litter of 2 bush dogs. Both had been vaccinated every 2 to 3 weeks, starting at 6 weeks of age. One of these dogs became ill at 17 weeks and died 13 days later. A litter of 6 maned wolves (Chrysocyon brachyurus) and a litter of 3 bush dogs were isolated from their parent colonies at 13 and 15 weeks of age, respectively. Each animal had been vaccinated weekly, beginning at 8 weeks of age, using an inactivated canine-origin parvovirus vaccine. None of the isolated animals developed the disease. Serologic testing during isolation did not reveal protective titers (greater than or equal to 1:80) against canine parvovirus in the bush dogs until they were 23 weeks old, whereas protective titers developed in the maned wolves when they were 14 to 18 weeks old. One hand-raised bush dog was vaccinated weekly, beginning at 8 weeks of age, and a protective titer developed by 21 weeks of age. It was concluded that the juvenile bush dogs went through a period during which maternal antibodies interfered with immunization, yet did not protect against the disease. When the pups were isolated from the colony during this period, then vaccinated repeatedly until protective titers developed, the disease was prevented.