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Query: UMLS:C0021831 (enteropathy)
 4,403 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Despite improvement in early outcome, rejection particularly chronic allograft enteropathy continues to be a major barrier to long-term visceral engraftment. The potential role of donor specific antibodies (DSA) was examined in 194 primary adult recipients. All underwent complement-dependent lymphocytotoxic crossmatch (CDC-XM) with pre- and posttransplant solid phase HLA-DSA assay in 156 (80%). Grafts were ABO-identical with random HLA-match. Liver was included in 71 (37%) allografts. Immunosuppression was tacrolimus-based with antilymphocyte recipient pretreatment in 150 (77%). CDC-XM was positive in 55 (28%). HLA-DSA was detectable before transplant in 49 (31%) recipients with 19 continuing to have circulating antibodies. Another 19 (18%) developed de novo DSA. Ninety percent of patients with preformed DSA harbored HLA Class-I whereas 74% of recipients with de novo antibodies had Class-II. Gender, age, ABO blood-type, cold ischemia, splenectomy and allograft type were significant DSA predictors. Preformed DSA significantly (p < 0.05) increased risk of acute rejection. Persistent and de novo HLA-DSA significantly (p < 0.001) increased risk of chronic rejection and associated graft loss. Inclusion of the liver was a significant predictor of better outcome (p = 0.004, HR = 0.347) with significant clearance of preformed antibodies (p = 0.04, OR = 56) and lower induction of de novo DSA (p = 0.07, OR = 24). Innovative multifaceted anti-DSA strategies are required to further improve long-term survival particularly of liver-free allografts.
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PMID:Preformed and de novo donor specific antibodies in visceral transplantation: long-term outcome with special reference to the liver. 2294 59

Ischemic bowel disease results from an acute or chronic drop in the blood supply to the bowel and may have various clinical presentations, such as intestinal angina, ischemic colitis or intestinal infarction. Elderly patients with systemic atherosclerosis who are symptomatic for the disease in two or more vascular beds have multiple comorbidities and are particularly at risk. The clinical evolution and outcome of this disease are difficult to predict because of its pleomorphic aspects and the general lack of statistical data. In this paper, we present the case of a patient who was monitored in our unit for six years. For this patient, we encountered iterative changes in the clinical pattern, beginning with chronic "intestinal angina" and finishing with signs of acute mesenteric ischemia after an episode of ischemic colitis. This evolution is particularly rare in clinical practice, and the case is instructive because it raises discussions about the natural history of the condition and the therapeutic decisions that should be made at every stage of the disease. An important lesson is that ischemic bowel disease should always be considered in patients who have multiple risk factors for atherosclerosis and have experienced recurrent "indistinct" abdominal symptoms. In these cases, aggressive investigation and therapeutic decisions must be taken whenever possible. Despite an absence of standardized protocols, angiographic evaluation and revascularization procedures have beneficial outcomes. Current advances in endovascular therapy, such as percutaneous transluminal angioplasty with stenting, should be increasingly used in patients with chronic mesenteric ischemia. Such therapy can avoid the risks that are associated with open repair. However, technical difficulties, especially in severe stenotic lesions, frequently occur.
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PMID:Ischemic colitis and large bowel infarction: a case report. 2311 60

Atherosclerotic vascular disease involving the mesenteric arteries occurs frequently in the elderly population. Although the prevalence of ischemic bowel disease is difficult to determine, acute mesenteric ischemia (AMI) has been reported to cause in 1 in 1000 hospital admissions, whereas chronic mesenteric ischemia (CMI) is estimated to affect 1 in 100,000 individuals. Mesenteric ischemia generally manifests in its chronic form as postprandial abdominal pain resulting in significant weight loss, and in its acute form as an abrupt development of abdominal pain, lower gastrointestinal bleeding, and subsequent intestinal necrosis. This article discusses the cause, clinical manifestations, diagnosis, and management of AMI and CMI.
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PMID:Ischemic bowel syndromes. 2340 66

Hepatic portal venous gas (HPVG) has been considered a rare entity associated with a poor prognosis. Portal vein gas is most commonly caused by mesenteric ischemia but may have a variety other causes. HPVG can be associated with ischemic bowel disease, inflammatory bowel disease, intra-abdominal abscess, small bowel obstruction, acute pancreatitis, and gastric ulcer. Because of high mortality rate, most HPVG requires emergent surgical interventions and intensive medical management. We experienced a case of hepatic portal venous gas caused by acute pancreatitis and successfully treated with medical management.
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PMID:[A case of successful treatment of portal venous gas caused by acute pancreatitis]. 2357 37

While the clinical findings of cocaine-induced enteropathy from mesenteric ischemia are fairly well understood, there is a paucity of imaging description and detail in the literature that describes these findings. Imaging characteristics of cocaine-induced mesenteric ischemia on CT examination include bowel edema, mucosal enhancement, venous engorgement, mesenteric free fluid, and dilatation of the small bowel lumen. A thorough history, physical examination, and laboratory testing are critical for the diagnosis and prompt surgical intervention may be necessary. We present a case of cocaine-induced mesenteric ischemia in a 49 year old male which resolved within 24 hours of supportive therapy.
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PMID:Ischemic bowel: uncommon imaging findings in a case of cocaine enteropathy. 2370 38

Ileitis, or inflammation of the ileum, is often caused by Crohn's disease. However, ileitis may be caused by a wide variety of other diseases. These include infectious diseases, spondyloarthropathies, vasculitides, ischemia, neoplasms, medication-induced, eosinophilic enteritis, and others. Eosinophilic enteritis can present as abdominal pain, protein loosing enteropathy, ulcers, intestinal obstruction, intussusception and perforation.Bowel perforation is an uncommon presentation of eosinophilic enteritis. We report a rare case of ileal perforation due to eosinophilic enteritis in a 57 years old female.
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PMID:Rare case of ileal perforation. 2399 95

Portal venous gas or hepatic portal venous gas (HPVG) found on imaging portends grave outcomes for patients suffering from ischemic bowel disease or mesenteric ischemia. HPVG is more rarely seen with severe but treatable abdominal infection as well as multiple benign conditions, and therefore must be aggressively evaluated. We report a 70-year old female who developed extensive intra- and extra-hepatic portal venous gas, pneumatosis intestinalis and free air associated with a perforation of the jejunojejunostomy after a gastrectomy for gastric carcinoma.
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PMID:Extensive portal venous gas: Unlikely etiology and outcome. 2568 12

Vasculopathies are the least publicized but most important manifestation of neurofibromatosis type 1 (NF1, or, von Recklinghausen disease) as the cause of morbidity and mortality in children and young adults afflicted with the disease. Occlusive or aneurysmal disease of arteries of all sizes may occur almost anywhere in the body. Coarctation or segmental hypoplasia of the abdominal aorta with or without renal artery ostial stenosis is a common cause of renovascular hypertension. Although rare, occlusive coronary artery disease in NF1 may result in myocardial infarction and sudden unexpected death. Visceral vasculopathy causes ischemic bowel disease; and catastrophic retroperitoneal or abdominal hemorrhage has been attributed to spontaneously ruptured arterial aneurysms. Peripheral vascular disease in NF1 with limb ischemia requiring an amputation is described for the first time here. Scanty information exists in the current pathology literature on NF1 vasculopathies, hence the presentation of this review.
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PMID:Vasculopathies of Neurofibromatosis Type 1 (von Recklinghausen Disease). 2599 68

Although radiotherapy is effective in managing abdominal and pelvic malignant tumors, radiation enteropathy is still unavoidable. This disease severely affects the quality of life of cancer patients due to some refractory lesions, such as intestinal ischemia, mucositis, ulcer, necrosis or even perforation. Current drugs or prevailing therapies are committed to alleviating the symptoms induced by above lesions. But the efficacies achieved by these interventions are still not satisfactory, because the milieus for tissue regeneration are not distinctly improved. In recent years, regenerative therapy for radiation enteropathy by using mesenchymal stem cells is of public interests. Relevant results of preclinical and clinical studies suggest that this regenerative therapy will become an attractive tool in managing radiation enteropathy, because mesenchymal stem cells exhibit their pro-regenerative potentials for healing the injuries in both epithelium and endothelium, minimizing inflammation and protecting irradiated intestine against fibrogenesis through activating intrinsic repair actions. In spite of these encouraging results, whether mesenchymal stem cells promote tumor growth is still an issue of debate. On this basis, we will discuss the advances in anticancer therapy by using mesenchymal stem cells in this review after analyzing the pathogenesis of radiation enteropathy, introducing the advances in managing radiation enteropathy using regenerative therapy and exploring the putative actions by which mesenchymal stem cells repair intestinal injuries. At last, insights gained from the potential risks of mesenchymal stem cell-based therapy for radiation enteropathy patients may provide clinicians with an improved awareness in carrying out their studies.
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PMID:The potential of mesenchymal stem cells in the management of radiation enteropathy. 2624 25

Dual-energy computed tomography (CT) relies on material-dependent x-ray absorption behavior from concurrently acquired high- and low-kilovolt peak data and has a range of imaging applications. This article focuses on use of dual-energy CT in assessment of bowel disease. After a summary of relevant dual-energy CT image acquisition and postprocessing principles, the authors describe dual-energy techniques of greatest utility in evaluation of benign and malignant pathologic conditions in the bowel, including neoplastic, vascular, infectious, and inflammatory disorders, as well as in assessment of abdominopelvic trauma. The dual-energy postprocessing techniques of iodine-selective imaging and virtual monochromatic imaging have the broadest applicability in bowel imaging. They may be used for improved visualization of subtle differences in bowel wall enhancement or for quantitative assessment of altered enhancement for evaluation of a neoplasm or bowel ischemia. Iodine images and virtual monochromatic low-kiloelectron volt images are particularly helpful for assessment of a neoplasm, ischemia, infection, or inflammation, while iodine maps paired with virtual nonenhanced images are most helpful to differentiate iodine from other dense materials, as in gastrointestinal bleeding or trauma. In most applications, radiation doses at dual-energy CT are comparable to those at traditional CT. However, dual-energy CT may allow reduction in radiation dose by using virtual nonenhanced images that obviate an additional nonenhanced CT acquisition. Limitations of dual-energy CT are discussed, including potential challenges in acquisition, postprocessing, and interpretation.
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PMID:Use of Dual-Energy CT and Iodine Maps in Evaluation of Bowel Disease. 2696 52


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