Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0085693 (acute appendicitis)
 3,606 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A patient over 40 years of age who complains of lower abdominal pain, constipation or diarrhea or both, and increased flatulence should be suspected of having diverticulosis. When pain becomes more severe and persistent, diverticulitis must be considered. Diagnosis depends on roentgen demonstration of the presence of diverticula. Sigmoidoscopy and barium enema study are essential to exclude coexisting disease but in diverticulitis may need to be postponed until severe local and systemic signs of inflammation have subsided. A number of diseases can simulate diverticulitis, and differential diagnosis may present considerable difficulty. Irritable colon syndrome and acute appendicitis may be indistinguishable clinically from diverticulitis. Differentiation from carcinoma is usually not difficult, but exclusion of coexistent carcinoma may be impossible except by resection. Ulcerative colitis is also easily distinguished except when, rarely, it coexists. Crohn's disease of the colon is less easily differentiated, especially in patients over 40, in whom the two diseases often coexist. Other colonic diseases, such as ischemic colitis, and pelvic inflammatory diseases usually show characteristic features which make them readily distinguishable from diverticulitis.
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PMID:Diagnosis and differential diagnosis of colonic diverticulitis. 103 35

Hemolytic uremic syndrome is seen occasionally by the surgeon in adult patients with colorectal manifestations. Two cases of hemolytic uremic syndrome are presented here, one misdiagnosed clinically as acute appendicitis and the other as acute ulcerative colitis. In each case the diagnosis was only established postoperatively and both patients died of this disease. These cases serve to remind colorectal surgeons that this potentially lethal disease may occur with symptoms and signs suggestive of more common colorectal pathology.
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PMID:Beware of hemolytic uremic syndrome presenting as colorectal disease in adults. Report of two cases. 271 35

Complications after ineffective medical management are indications for surgical treatment in Crohn's disease and ulcerative colitis. Immediate intervention is necessary in perforation, bleeding and intestinal obstruction, but abscess, fistulation, chronic bowel obstruction and an inflammatory tumor need also surgery without longer delay. Acute ileitis terminalis imitating acute appendicitis is an exceptional case of Crohn's disease. Local recurrence, severe abdominal pain, diarrhoea, retardation of growth and development, and risk of malignant change may be reasons for elective surgery. As development of recurrence after operation is frequent and the results of colectomy and proctocolectomy with ileostomy are not always satisfactory some caution to surgery in ulcerative colitis and Crohn's disease in childhood is advisable.
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PMID:[Surgical indications in Crohn's disease and ulcerative colitis in childhood]. 660 Dec 4

Due to controversial evaluation of the contribution of clinical signs for the diagnosing of non-specific inflammatory bowel disease, as well as due to the lack of similar data, we tried to find our own answer to the question as to whether the clinical signs of ulcerative colitis (UC) and Crohn's disease (MC) are helpful, unhelpful, or even confusing for the diagnosis. A group of patients with MC and UC was analyzed from this aspect. Individuals in their twenties and thirties prevailed in the sample, mostly intellectual workers, the number of males and females was equal. Our attempt to analyze all the available diagnostic methods originated in an observation that a long period of health problems precedes the diagnosis of MC, namely 1.5 y in males and as long as 4 y in females. Other striking information was that surgery represented the initial treatment in 66% of cases and the correct diagnosis was made peroperatively only in 56% of cases. We compared our results with those of the OMGE study, one of the largest projects which evaluated positively the contribution of clinical signs to the diagnosing of MC and UC. We found that the main signs of CU have not changed in the last century, and some additional signs occur rather due to complications than due to the disease per se. Frequency of pain increased by 25% in our patients, and approximately 1/3 of it represented intermittent pain caused by tenesms. Pain in MC must be properly analyzed in order to discriminate acute appendicitis. Other indicators did not differ from the OMGE study. In accordance with its results, we confirmed the importance of correct evaluation of clinical signs for the diagnosis and differential diagnosis of UC and MC. The number of diagnostic methods still increases. Their validity must be continuously re-evaluated, however the clinical examination in the dynamic process stays to be of crucial value.
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PMID:[What is the value of clinical symptoms in the diagnosis of nonspecific inflammatory bowel disease?]. 763 12

Interleukin-8 (IL-8) is a potent cytokine for recruitment and activation of neutrophils. To visualize its distribution in the intestinal mucosa and to understand better its possible role in the induction and promotion of inflammatory bowel disease, expression of the IL-8 gene was analyzed in resected bowel segments of 14 patients with active Crohn's disease or ulcerative colitis. In situ hybridization with IL-8 anti-sense RNA probes revealed strong and specific signals in the histologically affected mucosa. The number of cells expressing IL-8 gene correlated with the histological grade of active inflammation. In accordance with the characteristic histological signs of active disease, IL-8-expressing cells were diffusely distributed over the entire affected mucosa in patients with ulcerative colitis, whereas in patients with Crohn's disease, IL-8-expressing cells showed a focal distribution pattern. Cells expressing IL-8 were mainly located at the base of ulcers, in inflammatory exudates on mucosal surfaces, in crypt abscesses, and at the border of fistulae. Analysis of semi-serial sections pointed to macrophages, neutrophils, and epithelial cells as possible sources of this cytokine in active inflammatory bowel disease. We consistently failed to detect IL-8 messenger RNA in the mucosa of uninvolved bowel segments and in normal-appearing control mucosa of patients with colon cancer. In contrast, tissue specimens from two patients with acute appendicitis displayed IL-8-expressing cells in the mucosa. These results support the notion that IL-8 plays and important but nonspecific role in the pathogenesis of inflammatory bowel disease and that the production of IL-8 messenger RNA is restricted to areas with histological signs of inflammatory activity and mucosal destruction.
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PMID:Expression of interleukin-8 gene in inflammatory bowel disease is related to the histological grade of active inflammation. 817 48

At the end of the eighties, Doppler equipment added to conventional ultrasonography a new dynamic dimension. On the basis of radiological (US, CT, barium studies), clinical, biological, surgical and/or pathological correlations in 30 cases, the following considerations were emphasized. In case of intestinal obstruction, viability of the obstructed segment is compromised when Doppler parietal flow remains undetectable. In Crohn's disease or ulcerative colitis, as well as in acute appendicitis, presence of Doppler parietal flow throughout the affected thickened segment indicates an acute condition; similarly, abnormally high mean portal velocity (30-48 cm/sec; normal: 15 +/- 7 cm/sec), and abnormally low resistive index in the superior mesenteric artery (0.58-0.78; normal: 0.908 = 0.026) are detected. In colonic diverticulitis, similar characteristics can be observed, but are subtle and usually predominant at the mesenteric side of the affected segment in moderate diverticulitis. These abnormal Doppler findings disappear with successful therapy.
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PMID:[Contribution of Doppler sonography in inflammatory pathology of the large bowels]. 864 80

We present an immunohistochemical study of accessory cells in acute appendicitis and ulcerative colitis (UC). By comparing these two diseases, it is possible to distinguish between changes associated with inflammatory bowel disease and those resulting from nonspecific intestinal inflammation. Nine total colectomy specimens from patients with UC, in which the appendix was also involved, were compared with nine cases of acute appendicitis. Accessory cells were stained for CD68 (PGMI), ACPI (acid cysteine proteinase inhibitor), S100 protein, MAC387 (calgranulin), CD1a, factor XIIIa, and WR18 (HLA class II). In ulcerative colitis, but not acute appendicitis, there was extension of a network of S100 positive dendritic cells into the crptal mucosa, and these S100-positive dendritic cells were closely aligned with the epithelium. The epithelium in UC, but not in acute appendicitis, showed intense upregulation of HLA class II, and this was particularly marked at the crypt bases. Dendritic, MAC387-positive cells were seen only in UC. In both diseases there were abundant ACPI-positive accessory cells in the cryptal areas, a population normally restricted to the dome areas. Factor XIIIa- and PGM1-positive cells, although abundant in both conditions, had distributions similar to those that we had previously shown in normal controls. No CD1a-positive cells were identified in either UC or acute appendicitis. We hypothesize that S100 identifies a subpopulation of activated macrophages. The concentration of this subpopulation, in close contact with the epithelium, which also shows altered expression of HLA class II antigens, suggests that a component of the immune response is targeting this area in UC. In addition, we also suggest that the identification of MAC387-positive dendritic cells in UC reflects increased macrophage turnover in inflammatory bowel disease.
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PMID:The accessory cell populations in ulcerative colitis: a comparison between the colon and appendix in colitis and acute appendicitis. 904 93

Epithelial neutrophil-activating protein 78 (ENA-78) is a member of the CXC chemokines and acts as a potent chemoattractant and activator of neutrophil function. On stimulation in vitro, ENA-78 is highly expressed in many cell types. ENA-78 protein levels are strongly elevated in synovial fluid and blood of patients with rheumatoid arthritis. By in situ hybridization and immunofluorescence staining, ENA-78 has been recognized as a major CXC chemokine expressed in epithelial cells of the intestinal mucosa of patients with Crohn's disease, ulcerative colitis, and acute appendicitis. A high expression of ENA-78 and interleukin-8 (IL-8) was also observed in the exocrine tissue of patients with chronic pancreatitis (CP). It is interesting to note that expression of IP-10, MIP-1alpha, and MCP-1 is high in healthy pancreatic tissue but low in tissue of patients with CP, suggesting a mutually exclusive expression of the ELR-CXC vs. non-ELR-CXC/CC chemokines. High-resolution studies of intracellular chemokines has revealed specific immunoreactivity for ENA-78 associated with the endoplasmic reticulum of many cell types. In contrast, GROalpha immunoreactivity was exclusively localized in the nucleus. Despite their common effects on neutrophil functions, the differential intracellular localization of ENA-78 and GROalpha suggests additional roles for these two chemokines in normal cell biology.
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PMID:Regulation and function of the CXC chemokine ENA-78 in monocytes and its role in disease. 936 15

Autoantibodies specific to the cytoplasmic components of neutrophils and monocytes are associated with vasculitis and other idiopathic inflammatory disorders. In this study, using enzyme-linked immunosorbent assay (ELISA) and immunofluorescence assays, sera from patients with acute and chronic infection were examined for the presence of anti-neutrophil and anti-monocyte antibodies: cystic fibrosis (n = 23), acute appendicitis (n = 22), tuberculosis (n = 26), acute gastroenteritis (n = 38), bronchiectasis (n = 9) and chronic granulomatous disease (n = 6). Sera from patients with Wegener's granulomatosis (n = 14), rheumatoid factor positive (n = 15) and healthy volunteers (n = 20) were used as positive and negative controls. In patients with chronic infection, using an ELISA assay, antibodies reactive with neutrophil or monocyte components (% reacting with monocyte components in parenthesis) were found in: 70% (39%) of patients with cystic fibrosis, 4% (38%) of patients with tuberculosis, 0% (33%) of patients with bronchiectasis and 0% (17%) of patients with chronic granulomatous disease. When these sera were examined using an immunofluorescence assay, all of the positive samples were found to react with the cytoplasmic component of neutrophils or monocytes. In patients with acute infection no antibodies (either IgG or IgM) were detected against neutrophils or monocytes. These findings imply that antibodies directed against neutrophil cytoplasmic components are predominantly associated with chronic pyogenic infection and antibodies specific to monocyte cytoplasmic components are predominantly associated with chronic granulomatous infection. This mirrors the findings in idiopathic inflammatory disease where anti-monocyte antibodies are associated with granulomatous disorders such as sarcoidosis, and anti-neutrophil antibodies are associated with neutrophilic disorders such as ulcerative colitis. These results suggest that chronic stimulation of phagocytes by infectious agents may result in the generation of a humoral response against phagocyte cytoplasmic components. This furthers our understanding of humoral immune responses against phagocytic cell components during infection.
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PMID:Anti-phagocyte antibodies and infection. 975 9

A 20-year-old African female was hospitalized several times for diffuse chronic abdominal pain. The following exclusions were made: Acute adnexitis (by laparoscopy), acute appendicitis (by appendectomy), gastric ulcerations (by esophagogastroduodenoscopy) as well as Crohn's disease and ulcerative colitis. However, once taking a closer microscopical look at the mucosa, that otherwise appeared colonoscopically to be normal, multiple eggs of schistosomiasis mansoni (S. mansoni) were found in the colon as well as the rectum. Thus, the diagnosis of an intestinal bilharziosis was finely established. In retrospect even the sample taken for the appendix could have indicated this diagnosis already earlier on. Both the antibodies (ELISA/IFAT) and the specific immunoglobulins (IgE) for S. mansoni proved significantly positive. Therapy of choice was a single oral dosage of praziquantel. Migration and tourism have considerably increased the range of tropical and infectious diseases that need to be included into differential diagnosis. This case report focuses on intestinal bilharziosis as a potential underlying cause of chronic abdominal pain in immigrants of endemically affected areas. Direct diagnosis is the most important diagnostic method. The adult worms are usually inaccessible, so the method of choice to assess both diagnosis and the degree of activity of a chronic infection is evidence of living eggs in the stool. Alternatively, in case of lack of direct evidence diagnosis can be established by endoscopy and rectal biopsy.
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PMID:[Chronic abdominal pain and eosinophilia in a young African patient]. 1107 77


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