Isquemia mesentérica masiva en paciente puerperal por shock tóxico estreptocócico / Massive mesenteric ischemia in a puerperal woman due to streptococcal toxic shock

El estreptococo B hemolítico del grupo A es una bacteria aerobia Gram +, que puede producir una gran variedad de síndromes infecciosos en el puerperio. Hasta un tercio de las infecciones se complicará con un shock tóxico estafilocócico, caracterizado por shock y disfunción multiorgánica. Cultivos, diagnóstico y tratamiento precoces son vitales para el buen pronóstico. Presentamos el caso de una paciente puerperal con un síndrome de shock tóxico estreptocócico, complicado con una isquemia mesentérica masiva, donde tratamiento antibiótico y cirugía precoz fueron claves para la evolución

B hemolytic group A streptococcus is an aerobic Gram-positive bacteria that can produce a wide variety of infectious syndromes in the puerperium. Up to one-third of infections will be complicated by streptococcal toxic shock, characterized by shock and multiorgan dysfunction. Early cultures, diagnosis and treatment are vital to good prognosis. We present the case of a puerperal patient with streptococcal toxic shock, complicated by massive mesenteric ischemia, in whom antibiotic treatment and early surgery were the key to outcome

Increased activity and expression of gelatinases in ischemic colitis.

Ischemic colitis results from insufficient blood supply but its pathogenesis is poorly understood. The aim of this study was to determine whether the activity and expression of gelatinases (MMP-9 and MMP-2) are increased in the colonic mucosa of patients with ischemic colitis. MMP-9 and MMP-2 activity and expression were assessed in colonic mucosal specimens from 8 patients with acute ischemic colitis and in 12 controls with a normal colonoscopy. The activity and expression of MMP-9 and MMP-2 were quantified in tissue samples by zymography and western blot, respectively. Colonoscopy was repeated 12 weeks after discharge in two patients and MMP activity was assessed in the slight residual mucosal changes of ischemic colitis. In patients with ischemic colitis, a significant increase in total MMP-9 and MMP-2 activity and expression was found in ulcerated areas compared with noninvolved sites of mucosa. Following resolution of ischemic ulcers the proteolytic activity returned to baseline levels. In addition, the colonic mucosa of controls showed MMP-2 activity, whereas the MMP-9 activity was negligible or not detected. We conclude that ischemic colitis induces increased activity and expression of MMP-9 and MMP-2 in the involved colonic mucosa. These changes may contribute to tissue degradation and remodeling of the colonic mucosa in ischemic colitis.

[Expression of heme oxygenase-1 in ischemic colitis].

BACKGROUND/AIMS: Ischemic colitis is a vascular condition of inadequate blood flow in the colon which leads to colonic inflammation and can cause significant morbidity and mortality. Oxidative stress is an early initiating event in ischemia and reperfusion injury. Heme oxygenase (HO) is considered to be an antioxidant enzyme that catabolizes heme to carbon monoxide, free iron and biliverdin. The aim of this study was to evaluate the expression patterns of HO-1, inducible form of HO, in ischemic colitis. METHODS: We analyzed the twelve cases of clinically and pathologically diagnosed ischemic colitis without surgical intervention compared with normal colon (n=10) and psedomembranous colitis (n=5). Immunohistochemical stainings for HO-1 were performed in paraffin-embedded tissues. RESULTS: The age of the patients ranged from 56 to 84 years (mean: 67 years) in ischemic colitis. Eight patients (66.7%) were female. The most common presenting symptom was bloody stool (66.7%) and rectosigmoid area (91.7%) of the large intestine was the most common ischemic site. Expression of HO-1 in ischemic colitis was high in contrast to normal colonic mucosa or psedomembranous colitis. CONCLUSIONS: Ischemic colitis usually involves the rectosigmoid area in elderly female patients with a history of bloody stool. High expression of HO-1 in ischemic colitis may be responsible for a protective mechanism to ischemia or heme injury.

Expression of Heme Oxygenase-1 in Ischemic Colitis / 대한소화기학회지

BACKGROUND/AIMS: Ischemic colitis is a vascular condition of inadequate blood flow in the colon which leads to colonic inflammation and can cause significant morbidity and mortality. Oxidative stress is an early initiating event in ischemia and reperfusion injury. Heme oxygenase (HO) is considered to be an antioxidant enzyme that catabolizes heme to carbon monoxide, free iron and biliverdin. The aim of this study was to evaluate the expression patterns of HO-1, inducible form of HO, in ischemic colitis. METHODS: We analyzed the twelve cases of clinically and pathologically diagnosed ischemic colitis without surgical intervention compared with normal colon (n=10) and psedomembranous colitis (n=5). Immunohistochemical stainings for HO-1 were performed in paraffin-embedded tissues. RESULTS: The age of the patients ranged from 56 to 84 years (mean: 67 years) in ischemic colitis. Eight patients (66.7%) were female. The most common presenting symptom was bloody stool (66.7%) and rectosigmoid area (91.7%) of the large intestine was the most common ischemic site. Expression of HO-1 in ischemic colitis was high in contrast to normal colonic mucosa or psedomembranous colitis. CONCLUSIONS: Ischemic colitis usually involves the rectosigmoid area in elderly female patients with a history of bloody stool. High expression of HO-1 in ischemic colitis may be responsible for a protective mechanism to ischemia or heme injury.

Collagenase-1 (MMP-1), matrilysin-1 (MMP-7), and stromelysin-2 (MMP-10) are expressed by migrating enterocytes during intestinal wound healing.

BACKGROUND: Matrix metalloproteinases (MMPs) play a crucial role in wound healing of the skin, airways, and cornea, but data on MMPs in normal intestinal wound healing is limited. The aim of this study was to clarify the role of collagenase-1 (MMP-1), matrilysin-1 (MMP-7), and stromelysin-2 (MMP-10) in intestinal wound repair and to determine the effect of cytokines on the expression of these MMPs in intestinal epithelial cell lines. METHODS: Surgical specimens from patients with ischemic colitis (n = 5) were used as an in vivo model of intestinal re-epithelialization. Fetal ileal explants were used as an ex vivo model. In situ hybridization for MMPs -1, -3, -7, and -10 was performed and immunohistochemical stainings were used to localize MMP-7 and -9 expressing cells. Stainings for cytokeratin and laminin-5 were performed to identify epithelial cells and migrating enterocytes, respectively. Caco-2, HT-29, and WiDr cell lines were treated for 6-48 h with different cytokines (e.g. EGF, KGF, IL-1 beta, TGF-alpha, TNF-alpha, and TGF-beta1) and Taqman real-time quantitative RT-PCR was used to investigate their effect on the expression of MMPs-1, -7, and -10. RESULTS: MMP-7, MMP-10, and MMP-1 were expressed by migrating enterocytes bordering intestinal ulcers in 5/5, 3/5, and 3/5 samples, respectively. In the fetal gut model, MMP-1 and MMP-10 were expressed by migrating enterocytes, but matrilysin-1 expression was not detected. Matrilysin-1 was up-regulated by TNF-alpha and IL-1 beta, and stromelysin-2 by TNF-alpha and EGF in Caco-2 and WiDr cell cultures. MMP-1 was up-regulated in Caco-2 cells by TGF-beta, EGF, and IL-1 beta, but only by EGF in WiDR cells. CONCLUSIONS: It is concluded that collagenase-1, stromelysin-2, and matrilysin-1 are involved in intestinal re-epithelialization in vivo and that they are up-regulated by cytokines relevant in wound repair.

Prognosis of ischemic colitis: comparison of color doppler sonography with early clinical and laboratory findings.

OBJECTIVE: The objective of this study was to compare the value of color Doppler sonography with early clinical and laboratory findings in determining the prognosis of patients with ischemic colitis. SUBJECTS AND METHODS: We reviewed the early clinical, laboratory, and color Doppler sonographic data of 24 patients with ischemic colitis. The patients were divided into two groups on the basis of their outcome. The first group comprised the patients with transient ischemia who recovered uneventfully, and the second group included the patients who needed surgery because of symptomatic transmural colic gangrene or colic stricture. Clinical data and laboratory values were compared with color Doppler sonographic findings including colic wall thickness, presence of stratification, and arterial flow in the bowel wall. RESULTS: At univariate analysis, increased age (p = 0.007), leukocyte count (p = 0.030), lactate dehydrogenase level (p = 0.030), blood lactate level (p = 0.041), and absence of vascular flow in the colic wall (p<0.001) were significantly related to complicated ischemic colitis. At multivariate analysis, absence of arterial flow was the only significant predictor of complicated ischemic colitis (p = 0.002), with a sensitivity of 82%, a specificity of 92%, a positive predictive value of 90%, and a negative predictive value of 86%. CONCLUSION: Absence of arterial flow in the wall of the ischemic colon on initial color Doppler sonography is suggestive of an unfavorable outcome and is more closely associated with outcome than early clinical and laboratory findings.