Intestinal endometriosis

Pelvic endometriosis affects 5 to 10% of all menstruating women, and of these 3% to 34% have intestinal involvement. Commonly, intestinal endometrial lesion affects only the serosa. Although the invading endometrial tissue may extend into the intestinal wall, it does not usually reach the mucosa. The majority of the patients are asymptomatic. The most common symptom is lower recurrent abdominal pain. It has been estimated that 0,9% of women with intestinal endometriosis have obstructive symptoms. Occasionally deeper and more extensive intestinal wall involvement results in cyclic menstrual rectal bleeding. The authors describe a case with obstructive symptoms associated to rectal bleeding. This is an uncommon finding. Histological confirmation of deep muscular and mucosal involvement was obtained. This case led us to some considerations about the diagnostic difficulties and therapeutic possibilities in the present.     

Intestinal amebiasis

Infection produced by Entamoeba histolytica constitutes a clinical problem of great importance due to its frequence and serious complications. Age, diagnosis and clinical manifestations, phisic exploration, lab. procedures, proctosigmoidoscopy, radiology, complications, pathologic anatomy, statistical reports from the Ministry of Health and Social Asistence in addition we emphasize on the importance of an accurate and precocious diagnosis. We expose an effective terapeutic regimen for the different amibiasis states.     

Intestinal tuberculosis

Since the symptoms and clinical presentation of intestinal tuberculosis is nonspecific, the diagnosis is frequently delayed and may be achieved at autopsy only. Intestinal tuberculosis is very rare in Denmark, but may now be seen more often because of increasing numbers of immigrants from countries of the third world with a high prevalence of tuberculosis. A case of intestinal tuberculosis in a 28 year old Somalian female is reported. Methods of diagnosing intestinal tuberculosis are commented, and the frequent necessity of starting medical treatment before a bacteriological diagnosis is reached is emphasized.     

Intestinal pseudo-obstruction

The report is the first on intestinal pseudoobstruction in german literature. The most impressive clinical signs and symptoms in our case were uncharacteristic abdominal discomfort, flatulence, and relapsing diarrhoe over a period of two decades. Finally we observed periods of inappetence, occasional vomiting a few hours after food intake and kachexia developing in 8 months. A localized dilatation of the duodenum and upper jejunum associated with complete atonia was found by laparatomy. The dilated segment of the intestine was largely resected. An impressive decrease in the thickness of the muscularis propria with splitting of muscle fibres and intact neural plexus was found by histology. After treatment with antibiotics it came to a satisfying restitution of the patient. The hitherto very rare clinical syndrome of localized dilatation of intestine with severe disturbance of motility and the published cases of the world literature are discussed.     

Intestinal neuronal dysplasia

CONCLUSION: Based on these data we suggest that regional intra-arterial chemotherapy for advanced pancreatic cancer seems not to be superior to common treatment modalities, such as combined radiochemotherapy. BACKGROUND: The prognosis for advanced pancreatic cancer is very poor. No standard treatment is available. Recently, better survival and quality of life was reported from regional cancer treatment via celiac axis infusion. In an attempt to confirm these results we conducted a phase II study of intra-arterial chemotherapy for nonresectable pancreatic cancer. METHODS: From May 1994 to February 1995, 12 consecutive patients with biopsy-proven advanced ductal carcinoma of the exocrine pancreas were given intra-arterial infusions consisting of Mitoxantrone, 5-FU + folinic acid, and Cisplatin via a transfemorally placed catheter in the celiac axis. Six patients were classified as UICC stage III and six as stage IV with the liver as the sole site of distant metastasis. Nine patients had primary and three had recurrent pancreatic carcinoma after a Whipple procedure. Nonresectability of primary tumors was assessed in all patients by laparotomy or laparoscopy. RESULTS: A total of 31 cycles of chemotherapy (mean 2.6 cycles/patient) was administered. Catheter placement was technically feasible in all cycles. A groin hematoma was the only catheter complication. The follow-up by CT scans at 2-mo intervals revealed partial remission in 1 patient (8%), temporary stable disease in 4 patients (33%), and disease progression in 7 patients (58%). The same response was obtained after analyzing the CA 19-9 course. Median survival in stage III patients was 8.5 mo (3-12 mo) and in stage IV patients 5 mo (2-11 mo). Toxicity according to WHO criteria consisted of grade III (4 events), grade II (10 events), and grade I (17 events), mainly resulting from leucopenia and diarrhea/vomiting. Nine of 11 patients experienced temporary relief of pain immediately after regional treatment.     

Intestinal metabolism of estrogens

Estrogen metabolism in the human intestine was studied in two ways. Firstly, by measuring the excretion of 12 estrogens in pooled human late pregnancy feces before and during the administration of ampicillin (2 g/day). Secondly, by administering 5.4 and 20 mg of 16alpha-hydroxyestrone orally to two postmenopausal women and analyzing the estrogens in simultaneously drawn portal and peripheral venous blood samples at time intervals from 0 to 150 min after steroid administration. The majority of the estrogens in normal pregnancy feces were unconjugated. The amounts of estradiol, estreon and 16-epiestriol excreted, relative to the principal estrogen estriol, were greater than in pregnancy bile or urine and 16alpha-hydroxyestrone, an important biliary estrogen, was only present in trace amounts. Considerable quantities of 15alpha-hydroxyestradiol-17beta were also found. Ampicillin administration, which decreases intestinal bacterial steroid metabolism, caused a huge increase in the fecal excretion of conjugated estrogens. In particular it caused very striking increases in the excretion of both unconjugated and conjugated, estriol, 15alpha-hydroxyestrone, 15alpha-hydroxyestradiol and 2-methoxyestrone. These findings emphasize the active role played by the intestinal microflora in estrogen metabolism under normal conditions. Administration of 16alpha-hydroxyestrone resulted in increases in portal venous unconjugated and conjugated 16alpha-hydroxyestrone, 16-oxoestradiol-17beta, 15alpha-hydroxyestrone, 16-epiestriol and conjugated estriol levels. The most significant finding in both subjects was the large increase in portal venous unconjugated 15alpha-hydroxyestrone. This would suggest that the human intestine (or intestinal contents) has the ability to carry out the transformation, 16alpha-hydroxyestrone leads to 15alpha-hydroxyestrone. Increases in the same estrogens were found in peripheral plasma, with the increase in conjugated estriol occurring in peripheral blood before it was seen in portal blood. The largest elevations in peripheral plasma values were seen in unconjugated estriol and conjugated 16alpha-hydroxyestrone in the subject who received the 20 mg dose and in unconjugated 16alpha-hydroxyestrone and 16-oxoestradiol-17beta in the subject who had the 5.4 mg dose. The intestinal and enterohepatic metabolism of estrogens is discussed in relation to these findings.     

Intestinal microflora and antibiotic therapy

Antibiotic therapy is one of the major factors leading to disturbances in the intestinal flora. This can lead to chronic diarrhea and life threatening pseudomembranous colitis. Much attention had recently been focused on so-called translocation of endotoxins and bacteria through the intestinal wall which lead to systemic infection, shock and multiorgan failure. Prevention is based on the proper choice of antibiotic and administration of lactic-acid bacteria.     

Intestinal invagination in the adult

Idiopathic intestinal invagination is a relatively frequent process in children in comparison with cases of intestinal obstruction/subocclusion by invagination secondary to a tumor in adults which is unusual and more often observed in patients over the age of 60 years. Two clinical cases of intestinal obstruction in young adult males due to intestinal invagination by a tumor of the small intestine are presented. One case was due to a submucosal lipoma which lead to ileo-ileal intussusception and an ileo-cecal invagination by a terminal ileum lymphoma. The clinical and diagnostic aspects of this infrequent disease are discussed.     

Intestinal transplantation: living related

The use of live donors in intestinal transplantation could potentially both reduce the severity of rejection responses against this highly immunogenic organ by better tissue matching and also reduce cold ischaemia times. These two advantages over cadaveric grafts could preserve mucosal integrity and reduce the risk of systemic sepsis from bacterial translocation. The disadvantages of live donation are the inherent risk to the donor and the compromise of using a shorter graft. Although only a handful of such cases have been performed, the success rate has been high and this is a therapeutic modality which should be explored further.