Résumé
Background: Gangrene of stomach or intestines owing to non-occlusive bowel infarction (NOBI) is a rare event with unknown etiolology. Since B19 may cause vasculitis, arteritis, angiopathy and more importantly, localized microvascular thrombi formation hence patients with bowel gangrene were investigated for B19 infection. Methods: Twelve patients (8 male and 4 females; median age 40 yr) of ischemic unexplained gangrene of bowel underwent emergency laparotomy. Eight cases had NOBI while four had occlusive bowel infarction (OBI). Anti-B19 antibodies in sera by ELISA and Western-blot and B19 DNA by PCR in sera and resected tissues were analysed. Results: All patients underwent resection of gangrenous bowel; with exteriorization followed by restoration wherever appropriate. Histopathology showed loss of bowel mucosa and crypts with inflammatory cell infiltration besides fibrin thrombus in gastric vessels. Sera of all 8 patents of NOBI had B19 genome by nested-PCR (VP1 unique) and in 6 by PCR (VP1-VP2). In three patients resected bowel tissues also had B19 DNA besides anti-B19 IgM and IgG antibodies. NOBI patients were reticulocytopenic and anaemic while one had necrotizing vasculitis of skin a year ago. No IgM antibodies to agents causing vasculitis (HTLV-I, HIV-1+2, CMV, HSV1+2, mumps virus and Mycobacterium tuberculosis) nor any abnormality in coagulation profiles were detected. In four OBI cases’s sera and resected bowel tissues and in control bowel tissues (n=36) no anti-B19 IgM antibodies or B19 DNA were detected. Conclusion: Novel finding of active B19 infection in non-occlusive gangrene of the bowel may be causal rather than casual.
Sujets)
Adolescent , Adulte , Sujet âgé , Technique de Western , Maladies du côlon/génétique , Maladies du côlon/immunologie , Test ELISA , Femelle , Gangrène/immunologie , Humains , Immunoglobuline M/immunologie , Mâle , Adulte d'âge moyen , Parvovirus humain B19/génétique , Parvovirus humain B19/immunologie , Maladies de l'estomac/génétique , Maladies de l'estomac/immunologie , Jeune adulteRésumé
Bartter's syndrome (BS) is an inherited renal tubular disorder characterized by hypokalemia, hypochloremic metabolic alkalosis, and hyperaldosteronism with normal blood pressure. A 22-year-old woman was referred at 23 week of gestation. Polyhydramnios was detected and the chloride level of the amniotic fluid was high. The mother was treated with indomethacin from 26 to 31 week of gestation. The newborn was delivered at 34 week of gestation. At 8th day of life, indomethacin was also started for the baby. After three days, a colonic perforation developed. Indomethacin-induced colon perforation is uncommon in antenatal Bartter's syndrome. This patient indicates that administration of indomethacin in both antenatal and/or early postnatal period may be associated with colonic perforation.
Sujets)
Adulte , Liquide amniotique/composition chimique , Anti-inflammatoires non stéroïdiens/effets indésirables , Syndrome de Bartter/complications , Syndrome de Bartter/diagnostic , Syndrome de Bartter/traitement médicamenteux , Syndrome de Bartter/génétique , Maladies du côlon/complications , Maladies du côlon/génétique , Femelle , Âge gestationnel , Humains , Indométacine/effets indésirables , Nouveau-né , Perforation intestinale/induit chimiquement , Perforation intestinale/complications , Perforation intestinale/génétique , Mutation , Polyhydramnios/traitement médicamenteux , Polyhydramnios/génétique , Grossesse , Complications de la grossesse/génétiqueRésumé
Congenital chloride diarrhea CLD is a rare autosomal recessive disorder caused by a defect in the chloride/ bicarbonate exchange in the ileum and colon. It is characterized by watery diarrhea, abdominal distension, hypochloremic hypokalemic metabolic alkalosis with high fecal content of chloride >90 mmol/l. We report 3 patients with CLD associated with various renal abnormalities including chronic renal failure secondary to renal hypoplasia, nephrocalcinosis and congenital nephrotic syndrome