Jejunoileal diverticula.

Jejunoileal diverticula are estimated to occur in 1-5% of the population. The incidence increases with age, peaking at the sixth and seventh decades. The pathogenesis is believed to involve an acquired defect of the intestinal smooth muscle or myenteric plexus. Eighty percent of jejunoileal diverticula are localized to the jejunum, 15% to the ileum, and 5% to both. Diverticula in the jejunum tend to be large and multiple, whereas those in the ileum are small and solitary. Symptoms of intermittent abdominal pain, flatulence, diarrhea, and constipation are reported in 10-30% of patients with jejunoileal diverticula. The radiographic diagnosis of these diverticula is difficult to establish. Enteroclysis should be reserved for patients who have persistent abdominal pain despite nonrevealing endoscopic and contrast enhanced studies of the upper and lower gastrointestinal tracts. Asymptomatic jejunoileal diverticula should be managed conservatively. Complications occur in 6-10% of patients and include obstruction, diverticulitis, hemorrhage, perforation, malabsorption, and chronic debilitating abdominal pain. When surgical therapy is indicated, intestinal resection with primary anastomosis is the preferred treatment.

Cytodiagnosis of Campylobacter pylori in Papanicolaou-stained imprints of gastric biopsy specimens.

The use of Papanicolaou-stained touch preparations of gastric antral biopsies for the identification of Campylobacter pylori was examined using specimens obtained from 63 consecutive patients with endoscopic evidence of antral gastritis, with the results compared to routine histologic examination and Warthin-Starry silver staining. Organisms were readily identifiable in the Papanicolaou-stained imprints of the gastric mucus. The sensitivity in detecting organisms was 92.5% for the Warthin-Starry-stained sections, 71.4% for the Papanicolaou-stained imprints and 100% for both techniques combined. False-negative imprints were attributed to poor smears and/or the submission of duodenal tissue rather than antral biopsies. Properly performed touch preparations stained by the Papanicolaou method are a cost-effective adjunct to Warthin-Starry-stained section for improving the sensitivity of gastric biopsies for the diagnosis of C pylori.

Nonsteroidal anti-inflammatory drugs activate quiescent inflammatory bowel disease.

Four patients with quiescent inflammatory bowel disease had prompt exacerbations when given nonsteroidal anti-inflammatory drugs. Nonsteroidal anti-inflammatory drugs can have noxious effects on the distal intestine as well as on the proximal gut. Eight previous cases of exacerbation of ulcerative colitis have been reported, as have instances of de-novo colitis and ileitis in persons treated with nonsteroidal anti-inflammatory drugs who did not have preexisting inflammatory bowel disease. Nonsteroidal anti-inflammatory drug ingestion should be considered in the differential diagnosis of inflammatory bowel disease. These drugs should be administered to patients with inflammatory bowel disease only after consideration of their possible harmful effects.

Liver abscess. A complication of regional enteritis.

A patient with liver abscess in association with regional enteritis is reported. Liver abscess should be suspected in patients with regional enteritis who present with fever, elevated serum alkaline phosphatase, liver tenderness, right upper quadrant pain or hepatomegaly.

Lymphangiomyomatosis with chylous ascites: treatment with dietary fat restriction and medium chain triglycerides.

Lymphangiomyomyoma is a tumor of lymphatic channels and lymph nodes, clinically manifested by recurrent chylous pleural effusions and ascites. The disease is usually progressive and unresponsive to surgery, chemotherapy, or irradiation. A case of lymphangiomyomatosis in a 24-year-old woman who presented with chylous ascites is described. The patient was treated with dietary fat restriction supplemented with medium chain triglycerides and has remained free of recurrent effusions for 2 years.

An unusual clinical presentation of pancreatic carcinoma: Duodenal obstruction in the absence of jaundice.

A case of pancreatic carcinoma, presenting with the uncommon initial manifestation of vomiting secondary to duodenal obstruction without jaundice, is reported. A review of 72 consecutive biopsy-proven cases of pancreatic carcinoma admitted to our institution in the past five years revealed an 8.3% incidence of this unusual primary complaint. Although infrequently reported previously, pancreatic carcinoma should be considered in the differential diagnosis of gastric outlet obstruction in the absence of jaundice. The classic triad of progressive jaundice, weight loss and abdominal pain suggests carcinoma of the head of the pancreas. Emesis, secondary to high grade duodenal obstruction in the absence of jaundice, is an infrequent clinical presentation. The case described is illustrative of widespread pancreatic carcinoma that remained silent until obstruction developed.

Noradrenaline concentration and turnover in different regions of the gastrointestinal tract of the rat: an approach to the evaluation of sympathetic activity in the gut.

The endogenous noradrenaline concentration, fractional turnover, half-life, and turnover rate of tritiated ((3)H) noradrenaline were determined in the oesophagus, non-glandular and glandular portions of the stomach, duodenum, jejunum, ileum, and colon of the rat. The highest concentration of endogenous noradrenaline was present in the duodenum and colon. The (3)H-noradrenaline fractional turnover rates and half-lives were significantly greater in the small and large intestines as compared with the oesophagus and stomach. The noradrenaline turnover rate, which is an estimate of the level of sympathetic activity, was greatest in the colon and duodenum. This method of assessing sympathetic activity in various tissues by direct measurement of the noradrenaline turnover rate may be applied to the study of the adrenergic nervous system in the physiology and pathophysiology of the gastrointestinal tract.