Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0021933 (intussusception)
 3,822 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Abdominal pain and gastrointestinal symptoms such as vomiting or diarrhea are common chief complaints in young children who present in emergency departments. It is the emergency physician's role to differentiate between a self-limited process such as viral gastroenteritis or constipation and more life-threatening surgical emergencies. Considering the difficulties inherent in the pediatric examination, it is not surprising that appendicitis, intussusception, and malrotation with volvulus continue to be among the most elusive diagnoses. This article reviews both the self-limited and more life-threatening gastrointestinal conditions that may present in the emergency department.
 ...
PMID:Abdominal pain in children. 1648 87

Intussusception is much more common in children than in adults. Unlike in children, intussusception in adults is associated with an identifiable etiology in 90 per cent of cases. Lipomas are the second most common benign tumors of the colon. Small lipomas are usually asymptomatic and are found incidentally during colonoscopy. Giant lipomas are uncommon causes for colonic intussusception. This usually presents as abdominal pain and vomiting and less commonly as diarrhea. Computed tomography is an excellent method to diagnose giant colonic lipomas, by showing a well demarcated, round, low-attenuated lesion in the lumen of the colon. The definitive treatment for symptomatic lipomas is surgical resection. Both laparoscopic and open resections have been described. Endoscopic resection of colonic lipomas is associated with a high complication rate. In this report, we present a patient with a giant colonic lipoma causing colocolonic intussusception.
 ...
PMID:Giant lipoma causing a colo-colonic intussusception. 1743 43

Acute rotavirus gastroenteritis can be successfully managed with oral and intravenous rehydration solutions; however, it is still a major cause of childhood mortality and morbidity in developing countries and is responsible for significant morbidity and health-care costs in developed countries. Pentavalent human-bovine rotavirus vaccine (HBRV) is an oral vaccine containing five live attenuated human-bovine reassortant strains containing the human serotypes responsible for the majority of rotavirus cases worldwide. Approximately three-quarters of all acute rotavirus gastroenteritis cases and almost all cases of severe gastroenteritis were prevented by pentavalent HBRV in a phase III clinical trial. Pentavalent HBRV has a favorable safety profile, with fever, irritability, vomiting and diarrhea generally reported in similar proportions of infants who received either vaccine or placebo. Results from a large phase III study indicate that there was no excess risk of intussusception among those vaccinated compared with placebo recipients. This review summarizes the current data on the clinical efficacy and safety of HBRV in healthy infants.
 ...
PMID:Pentavalent human-bovine reassortant rotavirus vaccine: a review of its efficacy and safety in preventing acute rotavirus gastroenteritis in healthy infants. 1680 94

Rotavirus is the most common cause of severe diarrhoea in children worldwide and diarrhoeal deaths in children in developing countries. Accelerated development and introduction of rotavirus vaccines into global immunisation programmes has been a high priority for many international agencies, including WHO and the Global Alliance for Vaccines and Immunizations. Vaccines have been developed that could prevent the enormous morbidity and mortality from rotavirus and their effect should be measurable within 2-3 years. Two live oral rotavirus vaccines have been licensed in many countries; one is derived from an attenuated human strain of rotavirus and the other combines five bovine-human reassortant strains. Each vaccine has proven highly effective in preventing severe rotavirus diarrhoea in children and safe from the possible complication of intussusception. In developed countries, these vaccines could substantially reduce the number and associated costs of child hospitalisations and clinical visits for acute diarrhoea. In developing countries, they could reduce deaths from diarrhoea and improve child survival through programmes for childhood immunisations and diarrhoeal disease control. Although many scientific, programmatic, and financial challenges face the global use of rotavirus vaccines, these vaccines-and new candidates in the pipeline-hold promise to make an immediate and measurable effect to improve child health and survival from this common burden affecting all children.
 ...
PMID:Rotavirus vaccines: current prospects and future challenges. 1686 Jul 2

Hemolytic uremic syndrome is caused primarily by Shiga toxin-producing Escherichia coli O157:H7. The most common cause of acute renal failure in children, hemolytic uremic syndrome also can occur in adults. Characteristic features of the syndrome are microangiopathic anemia, thrombotic thrombocytopenia, and renal failure. Although the presentation of this syndrome is diverse, the classic prodromal illness is bloody diarrhea following ingestion of hamburger meat contaminated with E. coli O157:H7, the most common mode of infection in the United States. Children with hemolytic uremic syndrome generally present with gastroenteritis complaints (e.g., abdominal pain or tenderness, nausea or vomiting, fever, anemia); affected adults may be asymptomatic. Complications from hemolytic uremic syndrome can include intussusception, chronic renal failure, and seizures in severe cases. Because an incubation period of approximately one week occurs between the start of diarrhea and the onset of hemolytic uremic syndrome, physicians should maintain a high index of suspicion; early laboratory testing is important to diagnose and manage this syndrome. Obtaining a complete blood count and stool culture and performing Shiga toxin testing are the first of a series of tests that may help diagnose hemolytic uremic syndrome.
 ...
PMID:Hemolytic uremic syndrome: an emerging health risk. 1700 34

Treatment of gastrointestinal infections continues to be complicated by expanding resistance to antibiotics. This has led to both new antibiotic treatments and to research on alternative therapies. In the case of Clostridium difficile colitis, interesting preliminary results have been obtained with both probiotic therapy and passive immunization strategies. The newer macrolides were found to be effective for multidrug-resistant Salmonella typhi and safe in the pediatric population. The efficacy of rifaximin, a nonabsorbed antimicrobial agent, was demonstrated in the treatment of travelers diarrhea in Mexico. The benefit of the proteolytic agent bromelain, which degrades enterocyte receptors for enterotoxigenic Escherichia coli, was shown in an experimental model of piglets challenged with this infection after bromelain prophylaxis. The potential value of zinc supplementation in infant diarrhea was shown in a study in India. The recently approved rotavirus vaccine is being withheld because of multiple reported cases of intussusception. Cryptosporidiosis continues to challenge old and new chemotherapeutic agents. The usefulness of paromomycin in Cryptosporidium infection was shown in both murine and piglet models. The cost effectiveness of prophylaxis for parasitosis in immigrants has been an area of investigation.
 ...
PMID:Treatment of gastrointestinal infections. 1702 16

Rotavirus, the most common cause of severe diarrhea and a leading cause of mortality in children, has been a priority target for vaccine development for the past several years. The first rotavirus vaccine licensed in the United States was withdrawn because of an association of the vaccine with intussusception. However, the need for a vaccine is greatest in the developing world, because the benefits of preventing deaths due to rotavirus disease are substantially greater than the risk of intussusception. Early vaccines were based on animal strains. More recently developed and licensed vaccines are either animal-human re-assortants or are based on human strains. In India, two candidate vaccines are in the development process, but have not yet reached efficacy trials. Many challenges regarding vaccine efficacy and safety remain. In addition to completing clinical evaluations of vaccines in development in settings with the highest disease burden and virus diversity, there is also a need to consider alternative vaccine development strategies.
 ...
PMID:Rotavirus vaccines. 1718 42

Multiple cases with various types of pediatric malabsorption syndromes were evaluated. The clinical manifestations, laboratory findings, pathophysiology, and histopathological descriptions of each patient were analyzed in an effort to clear the pathogenesis of the malabsorption syndromes and the treatments were undertaken. The cases studied, included one patient with cystic fibrosis, two with lactose intolerance with lactosuria (Durand type), one with primary intestinal lymphangiectasia, two with familial hypobetalipoproteinemia, one with Hartnup disease, one with congenital chroride diarrhea, one with acrodermatitis enteropathica, one with intestinal nodular lymphoid hyperplasia (NLH), five with intractable diarrhea of early infancy and four with glycogenosis type Ia. Each case description and outcome is described below: 1. A 15-year-old Japanese boy with cystic fibrosis presented with severe symptoms, including pancreatic insufficiency, bronchiectasis, pneumothorax and hemoptysis. His prognosis was poor. Analysis of the CFTR genes of this patient revealed a homozygous large deletion from intron 16 to 17b. 2. In the sibling case of Durand type lactose intolerance, the subjects'disaccaridase activity of the small bowel, including lactase, were within normal limits. The results of per oral and per intraduodenal lactose tolerance tests confirmed lactosuria in both. These observations suggested, not only an abnormal gastric condition, but also duodenal and intestinal mucosal abnormal permeability of lactose. 3. In the case of primary intestinal lymphangiectasia, the subject had a lymphedematous right arm and hand, a grossly coarsened mucosal pattern of the upper gastrointestinal tract (identified via radiologic examination) and the presence of lymphangiectasia (confirmed via duodenal mucosal biopsy). The major laboratory findings were hypoalbuminemia, decreased immunoglobulin levels and lymphopenia resulting from loss of lymph fluid and protein into the gastro-intestinal tract. 4. In two cases of heterozygous familial hypobetalipoproteinemia, serum total cholesterol and betalipoprotein levels were very low. The subjects presented with symptoms and signs of acanthocytosis and fat malabsorption. Further, one subject had neurological abnormalities such as mental retardation and severe convulsions. Treatment with MCT formula diet corrected the lipid malabsorption. 5. A 5-year-old girl presented with pellagra-like rashes, mental retardation and cerebellar ataxia. An oral tryptophan (Trp) and dipeptide (Trp-Phe) loading test were conducted and the renal clearance of amino acids was also evaluated in this patient and in controls. Following the oral Trp loading test, plasma levels of Trp indicated a lower peak in the case, reaching a maximum at 60 minutes. On the other hand, the oral dipeptide (Trp-Phe) loading test in the Hartnup patient showed the peak Trp plasma level was the same as the control subjects. The renal clearance of neutral amino acids in this case increased to levels 5 to 35 times normal. 6. In the case of congenital chloride diarrhea, the subject had secondary lactose intolerance, dehydration, hyponatremia, hypokalemia, hypochloremia, hyperreninemia and metabolic alkalosis. The chloride content of her fecal fluid was very high. The concentrations were 89-103 mEq/l. In contrast, her urine was chloride-free. The subject's growth and development improved after treatment with lactose free formura and oral replacement of the fecal loses of water, NaCl and KCl. Unfortunately, the patient died of a small bowel intussusception. The kidney histopathological finding was juxtaglomerular hyperplasia by a necropsy. 7. In the case of acrodermatitis enteropathica, the subject had characteristic skin lesions, low serum zinc levels and ALPase activity. An oral ZnSO4 loading test and intestinal mucosal histology by a peroral biopsy were conducted. The serum zinc peak level was 2 hours after the oral ZnSO4 loading test. Infant formula alone could not maintain normal serum zinc ranges. Light microscopic studies of the intestinal villous architecture showed a normal pattern. However, ultrastructual examination of several epithelial cells revealed numerous intracellular vesicles. After zinc therapy, these changes were decreased. The lesions were postulated as the secondary result of zinc deficiency. 8. A 12-year-old girl presented with hypogammaglobulinemia, recurrent infections, chronic diarrhea and intestinal NLH. A barium meal and follow-through examination showed multiple nodules throughout the stomach and intestine. The nodules, all uniform in size, were 2 mm diameter. The barium enema did not show NLH in the colon. Mucosal biopsy of the stomach and jejunum revealed the typical histology of NLH in the lamina propria. Also, achlorhydria was present in this patient and her serum gastrin levels were very high; 315-775 pg/ml. 9. In 4 cases of intractable diarrhea in early infancy (by Avery G B), a jejunal biopsy showed shortening villi and nonspecific enterocolitis. Some patients were found with only low lactase or low lactase and sucrase levels. An electron microscope analysis of the small bowel in 2 cases showed alterations: increased pinocytosis in microvillus membranes and lysosomes by endocytosis of undigested macromolecular substances. I postulated that the stated evidence was causative of this clinical profile. 10. I frequently observed diarrhea as a clinical manifestation in glycogenosis type Ia and lipid malabsorption in one case. The light and electron photomicrographs showed intestinal absorption cells with the glycogen deposits in the inferior devision of nuclei.
 ...
PMID:[Clinical studies of pediatric malabsorption syndromes]. 1722 86

(1) Each year in France, diarrhoea caused by rotavirus kills about 10 infants under three years of age and leads to about 210 hospitalisations per 100 000 children under 5 years of age. (2) Two new oral rotavirus vaccines designed for immunisation during infancy are marketed or shortly to be marketed in France for the first time; one is based on a human strain and the other on both bovine and human strains. (3) The vaccine based on a human strain has been tested in a double-blind placebo-controlled trial involving about 63 000 infants. It had no statistically significant impact on mortality but prevented about 10 cases of severe diarrhoea per 1000 vaccinated infants during the following year. Other, smaller trials provided similar results. (4) In two double-blind placebo-controlled trials involving a total of about 70 000 infants, the human-bovine vaccine prevented about 16 cases of severe diarrhoea per 1000 vaccinated infants during the year following vaccination. As with the human vaccine, there was no impact on mortality. (5) An analysis of data on 60 000 to 70 000 infants immunised with each vaccine showed no increase in the risk of acute intestinal intussusception, a severe adverse effect observed with another rotavirus vaccine that was marketed in the 1990s in the United States (but not in France). This product has since been withdrawn from the market. (6) The two new rotavirus vaccines do not appear to have more adverse effects than placebo. (7) Rotavirus vaccination does not seem to reduce the efficacy of other vaccines. (8) Vaccination is simpler with Rotarix than with Rotateq, requiring two oral doses instead of three. However, Rotarix is sold in kits containing a vial of powder, a prefilled solvent syringe, and a syringe-bottle adaptor, creating a risk that this vaccine might be accidentally injected instead of being given orally. (9) In practice, rotavirus vaccination during infancy is not a public health priority in western countries. Vaccination of individual infants may be useful, especially when access to healthcare may be difficult.
 ...
PMID:Rotavirus vaccines: new drug. Rotavirus infection: one case of severe diarrhoea prevented per 100 vaccinated infants. 1732 13

Bloody diarrhoea is a common presenting symptom in acute surgery, medicine and also in out-patient clinics. Intussusception, although a common cause of small bowel obstruction and rectal bleeding in infants, is rare in adults. In contrast to paediatric cases, where the majority can be treated by pneumatic or hydrostatic reduction, the vast majority of adult cases of intussusception are due to a tumour of some kind and will require operation and resection. Diagnostically plain radiology, CT, ultrasound and endoscopy are useful since the clinical picture is often unclear. We present a case of a young man who presented with acute bloody diarrhoea. The diagnosis was made colonoscopically and he was treated surgically. The case underlines the need for surgeon to maintain an open mind when investigating unexceptional symptoms.
 ...
PMID:Intussusception in a young adult with bloody diarrhoea. 1746 41


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>