BACKGROUND: Most patients with Crohn's disease (CD) require one or more operations during their lifetime. Repeated resections and surgical complications may result in short gut in a subset of patients, typically those with extensive small bowel disease or a penetrating CD phenotype. The effects of short bowel syndrome (SBS) can range in seriousness from mild to life-threatening advanced intestinal failure. Worldwide, CD is the second leading indication for intestinal transplantation (ITx) in SBS, but the overall incidence of ITx is quite low. Key Messages: Currently, total parenteral nutrition (TPN) is the preferred treatment option for patients with SBS because of its superior survival outcome. However, TPN can fail from loss of venous access due to catheter-associated thromboses, recurrent catheter-related blood stream infections, or intestinal-failure-associated liver dysfunction. Three types of transplantations are available for CD patients - small bowel alone, liver plus small bowel and multivisceral, which includes other intra-abdominal organs. An abdominal wall transplant is required in case of abdominal wall defects or lack of free intra-abdominal space. The current 5-year survival rate of 54% following ITx of the isolated small bowel appears worse than that associated with TPN. However, outcomes are substantially improving because of surgical and technical advances and progress in medical therapy. On the other hand, ITx carries the risk of both complications (e.g., rejection, infections, and post transplant lymphoproliferative disorders) and adverse events associated with immunosuppression. CD recurrence has been reported in a few patients, but this primarily histologic recurrence might not be of great clinical importance. CONCLUSIONS: ITx has become a well-established treatment for those who fail on TPN and who have life-threatening complications. Fortunately, it concerns only a small proportion of CD patients, but it does offer reasonable survival and quality of life. Primary management of patients with small bowel failure should be provided by a center experienced in medical intestinal rehabilitation, nutrition, and transplantation of other solid organs.
- MeSH
- Crohnova nemoc komplikace chirurgie MeSH
- dospělí MeSH
- imunosupresivní léčba škodlivé účinky MeSH
- kvalita života MeSH
- lidé MeSH
- míra přežití MeSH
- mladý dospělý MeSH
- nemoci střev etiologie chirurgie MeSH
- parenterální výživa úplná MeSH
- syndrom krátkého střeva etiologie chirurgie MeSH
- tenké střevo transplantace MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- Publikační typ
- časopisecké články MeSH
Patients with implanted mechanical cardiac support are exposed to the risk of various complications in the early postoperative period. Although thromboembolic and bleeding events occur most frequently in these patients, we cannot disregard other complications that can have a significant impact on the further development of the implanted patients condition. These include abdominal complications. Literature data show clearly that mortality in implanted patients who developed an abdominal complication is significantly higher than that in patients without postoperative abdominal complications.
Biodegradable stents, which are made of various synthetic polymers, such as polylactide or polyglycolide, or co-polymers, such as polydioxanone, can be used for the treatment of benign refractory stenoses of the gastrointestinal tract. Here we report 11 patients (median age 41) with stenosing Crohn's disease of the small and/or large intestine. Endoscopic insertion of a biodegradable stent was successful at the first attempt in all patients except one. Subsequent follow-up was for a mean of 16 months, median 17 months, range 12-29 months. Early stent migration (between 2 days and 8 weeks) was seen in three patients. Mucosal overgrowth (epithelial hyperplasia) was not observed in any of the patients during the follow-up period. The high rate of early stent migration might be solved by appropriate tailoring and further improvements in the design of the biodegradable stents. Proof of long-term efficacy and safety requires further studies.
- MeSH
- Crohnova nemoc komplikace MeSH
- dospělí MeSH
- kolon patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- nemoci střev etiologie terapie MeSH
- prospektivní studie MeSH
- selhání protézy MeSH
- stenóza etiologie terapie MeSH
- stenty * MeSH
- tenké střevo patologie MeSH
- vstřebatelné implantáty * MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
A characteristic feature of human intestinal spirochetosis (IS) is the colonization of the mucosa of the large intestine with intestinal spirochetes of the genus Brachyspira. The joining of the brachyspirae with the apical cellular membrane of enterocytes resembles in histological slides a false brush border of the intestinal mucosa. Various symptoms related to the involvement of the large gut were found with invasive IS. From the cultures of these cases were isolated Brachyspira aalborgii and B. pilosicoli. The frequency of the incidence of brachyspirae depended on the socio-economic living conditions of people. Colonization of the mucosa of the large gut was found more often in human populations in the developing countries; it was fairly rare in countries with high hygienic standards. An exception were men of homosexual orienation and patients presenting with a HIV infection. Isolation of brachyspirae from the faeces and biopsy of the mucosa of the large gut are fairly demanding jobs, especially with B. aalborgii. Most documented IS cases of this aetiology were diagnosed using immunohistochemical methods and amplification of the genus-specific region of the gene 16S rRNA. Isolation of B. pilosicoli tends to be simpler, it requires anaerobic incubation on selective blood agars for a period of 3-6 days at 37 degrees C. When manual haemoculture systems were used, patients in a critical state presented a translocation of brachyspirae into blood circulation, while automatic systems don't necessarily diagnose spirochetaemia. In the management of described cases of invasive IS particularly successful proved metronidazole and beta-lactam antibiotics. In isolated B. pilosicoli, in vitro tests confirmed sensitivity to metronidazole, ceftriaxone, meropenem, tetracycline, moxifloxacine and chloramphenicol. A varying frequency of resistance was found with clindamycin and amoxicillin, which how ever was efficacious in combination with clavulanic acid.
- MeSH
- feces mikrobiologie MeSH
- lidé MeSH
- mikrobiální testy citlivosti MeSH
- nemoci střev * diagnóza etiologie mikrobiologie MeSH
- Spirochaetaceae účinky léků izolace a purifikace MeSH
- spirochetové infekce * diagnóza mikrobiologie přenos MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- přehledy MeSH
A 45-year old patient admitted with confirmed calculous pancreatitis underwent the laparoscopic cholecystectomy at the 14th day of the hospitalization. 4 days after the operation he had to be reoperated due to small-bowel-obstruction caused by the herniation of the loop through the supraumbilical port. The small bowel was reduced and plasty of the operative wound was done. Postoperative course was uncomplicated and the patient was discharged from the hospital 6 days after the operation.
- MeSH
- cholecystektomie laparoskopická škodlivé účinky MeSH
- hernie etiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nemoci střev etiologie MeSH
- střevní obstrukce etiologie MeSH
- tenké střevo MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
A 37-year-old woman with brown bowel syndrome had yellowish-brown pigment in muscularis propria cells of removed intestine. The pigment occurred here and there in muscularis mucosae, in some arterial walls and in macrophages of submucosa. Its tinctorial characteristics were those of low oxidized lipofuscin. Its probably lysosomal localization was shown by electron microscopy.
- MeSH
- dospělí MeSH
- lidé MeSH
- lipofuscin analýza MeSH
- nemoci střev etiologie metabolismus patologie MeSH
- poruchy pigmentace etiologie metabolismus patologie MeSH
- střeva chemie MeSH
- syndrom MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
- Názvy látek
- lipofuscin MeSH
The effect of abdominal compression on acute intestinal radiation syndrome in rats was studied morphologically using light microscopic and histochemical methods. It was confirmed that the method of abdominal compression introduced by Svoboda et al. does not induce either acute or later changes (until 11 months) of the structure of abdominal cavity organs. The structure of intestinal mucosa of rats exposed to local irradiation of the abdomen with 14 Gy of gamma radiation from a Co60 source with or without abdominal compression was quite different with respect to acute changes. Ischemia of the intestine wall protects stem cells of intestine epithelium and subsequently allows a rapid and pronounced regeneration of radiation injury.
- MeSH
- břicho * MeSH
- enzymy analýza MeSH
- experimentální radiační poranění patologie patofyziologie MeSH
- ileum patologie účinky záření MeSH
- jejunum patologie účinky záření MeSH
- kolon patologie účinky záření MeSH
- krysa rodu Rattus MeSH
- kyselá fosfatasa metabolismus účinky záření MeSH
- mitóza MeSH
- nemoci střev etiologie patologie patofyziologie MeSH
- střevní sliznice enzymologie patologie účinky záření MeSH
- tlak MeSH
- zvířata MeSH
- Check Tag
- krysa rodu Rattus MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- enzymy MeSH
- kyselá fosfatasa MeSH
The radioprotective effect of abdominal compression introduced by Svoboda et al. on rats exposed to local irradiation of the abdomen with 30 Gy was studied using light microscopic and histochemical methods. Irradiation combined with abdominal compression does not lead to the development of typical radiation alterations of intestinal mucosa. The protected animals retained normal structure of intestinal and colon mucosa, and unchanged epithelium with typical enzymatic equipment. Local differences in protective effect may be due to various degree of ischemization of intestinal tract.
- MeSH
- břicho * MeSH
- enzymy analýza MeSH
- experimentální radiační poranění patologie patofyziologie MeSH
- ileum enzymologie patologie účinky záření MeSH
- jejunum enzymologie patologie účinky záření MeSH
- kolon enzymologie patologie účinky záření MeSH
- krysa rodu Rattus MeSH
- nemoci střev etiologie patologie patofyziologie MeSH
- střevní sliznice enzymologie patologie účinky záření MeSH
- tlak MeSH
- zvířata MeSH
- Check Tag
- krysa rodu Rattus MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- enzymy MeSH
Faecal samples were investigated from 948 children hospitalized with the diagnose of acute intestinal infection. The authors studied the isolation and properties of a broad spectrum of microorganisms from children's faeces: Salmonella, Shigella, E. coli, S. aureus, rotaviruses, Klebsiella, Morganella, Proteus. As a result, laboratory criteria were formulated of diagnosing in children intestinal infection of staphylococcal etiology.
- MeSH
- akutní nemoc MeSH
- Bacteria izolace a purifikace MeSH
- bakteriologické techniky normy MeSH
- feces mikrobiologie MeSH
- kojenec MeSH
- lidé MeSH
- náhodné rozdělení MeSH
- nemoci střev diagnóza etiologie MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- stafylokokové infekce diagnóza MeSH
- Staphylococcus aureus izolace a purifikace MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- ileum abnormality patologie MeSH
- lidé MeSH
- nemoci střev etiologie patologie MeSH
- novorozenec MeSH
- perforace střeva etiologie patologie MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
