Endoscopic study of scalloped folds and grooves in the mucosa of the duodenum as signs of villous atrophy

This prospective study was designed to discover how commonly duodenal mucosal scallops and grooves occurred and delineate their relationship to villous atrophy. All patients undergoing upper gastrointestinal endoscopy were examined, especially inspection and examination of the duodenal mucosa. Biopsy samples were taken from those in whom the mucosa was abnormal [n = 30] and from those in whom it was not. The results showed that none of the 85 endoscopically normal controls had subtotal villous atrophy; 76 had normal histology, 2 had non- atrophic change and 7 had partial villous atrophy [PVA]. Moreover, 19 of the 30 individuals with abnormal duodenum had subtotal villous atrophy; 10 had both scallops and grooves, 5 had scallops alone and 4 had grooves only. All patients with both scallops and grooves had subtotal villous atrophy. Scallops and grooves together indicated that subtotal villous atrophy is very likely histologically even when that diagnosis has not been suspected. A normal duodenum excludes it

Significance of changes of serum bile a cid level after glucagon injection in patients with liver cirrhosis

In this study, the fasting serum total bile acid level and 15, 60 and 120 minutes levels after intravenous administration of 1 mg glucagon were measured in 34 cirrhotic patients [divided into grades A, B and C according to child's classification] and 10 apparently healthy individuals as a control group. The fasting total bile acid [TBA] level was significantly high in all patients as compared with the control group [p <0.001]. From the results it was found that glucagon induced reduction in serum TBA level mostly in the cases with relatively low grade severity of liver cirrhosis, whereas the majority of severe cases showed an increase. This reduction of serum TBA is due to enhancement of Na +/- coupled membrane transport of bile acids in hepatocytes under effect of glucagon. Lack of this response may be indicative of cell membrane dysfunction in the liver. So, glucagon- induced alteration of serum TBA level is non invasive technique which could be a useful liver function test that is correlated with the severity of liver cirrhosis

Frequency and spectrum of microorganisms isolated from cases of chronic colitis

Forty patients, 24 males and 16 females aged 17-65 years, diagnosed clinically, sigmoidoscopically and histopathologically as chronic colitis cases [14 [35%] ulcerative colitis, 4 [10%] Crohn's disease and 22[55%] non specific colitis] were investigated by stool analysis, stool culture and biopsy culture. Chlamydia antigen was detected in biopsy specimens by direct immunofluorescence technique. Ten healthy subjects we included as controls. Hundred percent of cases of inflammatory bowel disease [IBD] were positive for bacterial infections compared to 73% in cases of nonspecific colitis [P<0.05] and infection rate was prominant in bilharzial cases 85%. Salmonella paratyphi [A] and Shigella dysentriae were isolated from both rectal biopsy and stool culture each in 2 cases only. The potentially pathogenic bacteria isolated from biopsy culture only were chlamydia trachomatis, Aeromonas hydrophlla, Pseudomonas aeruginosa, Staph. aureus and Diphtheroid. E. coli were isolated from 40 cases by stool culture and from 14 cases by biopsy culture compared to 4 and 20 cases for Klebsiella sp. In cases that were positive by both biopsy and stool cultures the organisms isolated were identical. There were 4 cases that were diagnosed macroscopically as suspecious ulcerative colitis and microscopically as non specific colitis, while by bacterial cultures each of the following organisms were isolated from one case; Klebsiella sp., E. coli, Chlamydia trachomatis and Pseudomonas aeruginosa. The results of the present work revealed that an appropriate diagnostic program of chronic colitis must include endoscopic, histopathologic and bioptic microbiological examinations in addition to stool culture and analysis to avoid inevitable misdiagnosis of IBD and there is a necessity for the cooperation between the endoscopists, histopathologists and microbiologists to reach a proper diagnosis and proper management