Volume 72 - 2009 - Fasc.2 - Letters
Giardia lamblia infection as a possible cause of eosinophilic ascites and enterocolitis
Eosinophilic ascites is rarely observed in clinical practice and uncommonly related to parasitic infections. It may also be associated with subserosal type of eosinophilic gastroenteritis, peritoneal dialysis, lymphomas, and hypereosinophilic syndrome. A 45-year-old, previously healthy, male was admitted to the hospital complaining of abdominal pain, watery diarrhea with mucus (4-5 times per day) and fever lasting for 20 days. The patient denied taking any drugs or herbal medicine. He had no history of atopy or food allergy. His body temperature was 37.5 °C. Physical examination revealed mild abdominal distention with shifting dullness. The laboratory evaluation was significant for a white blood cell count of 26,700/mm3 , with 67% eosinophils, and normal serum chemistries. The sedimentation rate was 10 mm/h and CRP 1.5 mg/dL. The titres of auto-antibodies were negative as well as serology for Toxocara canis, Toxoplasmosis, Fasciolasis, Leishmaniasis, and Echinococcus granulosus. Total IgE value was normal. FIP1L1-PDGFRA gene mutation (which is often associated with idiopathic hypereosinophilic syndrome) was negative.
Asymptomatic eosinophilic colitis in a patient with previous allogeneic bone marrow transplantation for chronic myeloid leukaemia : letter to editor.
We report the case of a 63-year-old woman with a pre- vious history of allogeneic bone marrow transplantation (BMT) for chronic myeloid leukaemia (CML) at the age of 45. The diagnosis of CML was been made in 1988, one year before BMT. At that time, she received a course of chemotherapy prior to bone marrow transplantation from her HLA-compatible sister. Bone marrow grafting was performed with a traditional regimen of chemother- apy, total body irradiation and graft versus host disease (GVHD) prophylaxis. Three years later, CML relapsed and remission was again obtained after a short course of Hydroxyurea, interferon and transfusion of white blood cells from the bone marrow donor.
Fecal transplantation for recurrent Clostridium difficile colitis, an underused treatment modality
Recently we successfully treated a patient who suf- fered from recurrent Clostridium difficile colitis with a fecal transplant (fecal bacteriotherapy) from a first degree relative. To our knowledge this is the first case of a successful transplant of this kind in Belgium. Also of interest is the fact that in our patient a cure was obtained using the supernatant after centrifugation of the fecal material.
The patient was a 59-year-old woman with lithium induced chronic renal failure who presented with four episodes of clinically and endoscopically severe Clostridium difficile colitis. No typing of the strain was done. The first episode occurred after treatment of an infected wound on one of her toes with amoxicillin- clavulanic acid. She was not receiving proton pump inhibitors nor was she immunocompromised.
The first attack was treated with five days of metronidazole 3 ?? 500 mg/day and because of persisting symptoms an additional ten days of oral vancomycin 4 ?? 500 mg/day. The second and third episodes were treated with two weeks of oral vancomycin 4 ?? 500 mg/day and a tapered/pulsed scheme of vancomycin (1, 2). However, each time only a few days after stopping treatment the patient relapsed.
Inflammatory bowel disease and African Americans
I read with interest Fiasse & Latinne 's published arti- cle on "Intestinal helminths : a clue explaining the low incidence of inflammatory bowel diseases in Subsaharan Africa ? Potential benefits and hazards of helminth ther- apy" (1). In their review, the authors demonstrated that the very low incidence and prevalence of Inflammatory Bowel Diseases (IBD) in sub-Saharan Africa cannot be explained by genetic factors since in Black populations of the U.S.A. and U.K., the incidence of these diseases is approaching that of the white populations.
Inflammatory bowel disease and African Americans (Reply)
We thank Dr El-Tawil for his interest in our article. He quoted the extensive study of Mahid et al. (1), conclud- ing that in the USA there is no racial difference between African American populations and Caucasian American populations in inflammatory bowel disease (IBD) pre- sentations, as well as in incidence and prevalence of Crohn's disease (CD) and ulcerative colitis (UC). The hypothesis of Dr El-Tawil is that genetic alleles to IBD from Europeans have been transmitted to African Americans since their arrival as slaves in America in the 17th century.
The probiotic Saccharomyces boulardii upgrades intestinal digestive functions by several mechanisms
Saccharomyces boulardii (S. boulardii) is a probiotic yeast largely prescribed in many countries over the world. This probiotic has shown to exhibit therapeutic properties in acute and chronic enterocolopathies, irrita- ble bowel syndrome, antibiotic - associated - diarrhoea and enterotoxigenic Clostridium difficile infections (1) However, the mechanisms of its effects remain largely unknown. The aim of this letter is to propose three com- plementary mechanisms explaining its trophic effects. In human volunteers (2) and growing rats (2), oral adminis- tration of lyophilized preparations of S. boulardii pro- duces trophic intestinal effects including increases in the specific and total activities of sucrase and maltase-glu- coamylase in epithelial cells and in endoluminal fluid, enhanced secretion of s-IgA in intestinal fluid (3) and enhanced synthesis of the secretory component (receptor for polymeric immunoglobulins) in crypt cells (3).
The three mechanisms of action of th eprobiotic Saccharomyces boulardi
In response to 1000 nanomoles of spermine, enzyme stimulation was proportionally greater with increases in sucrase ( 4,6) and maltase (+ 70%) activities. Similarly, weaned rats treated with either S. boulardii or equivalent quantities of spermine (500 nanomoles) presented parallel, significant increases in specific sucrase (157%) and maltase (+ 47,5%) activities. Therefore, oral administration of 100 mg lyophilised S. boulardii containing 679 nanomoles of polyamines to breast fed sucklings reproduced similar changes in microvillous enzymes than the administration of 500 nanomoles of spermine. Regarding the stimulation of microvillous enzymes, the oral administration of spermine is a dose - dependent phenomenon. It is more sensitive for sucrase than for other microvillous enzymes (lactase, aminopeptidase, maltase-glucoamylase) and becomes detectable at doses of spermine as low as 250 nanomoles/day. After absorption, polyamines act at the level of DNA synthesis, mRNA expression and protein production. Lastly, recent experiments indicate that S. boulardii inhibits the signal transduction triggered by E. coli on in vitro intestinal cell lines, essentially interleukin 8 ad NF-kB (13).
Vanishing bile duct syndrome in a patient with Hodgkin's lymphoma and asymptomatic hepatitis B virus infection
45-years-old male patient presented with jaundice, dark urine and white stool. He has presented with lumps in the right groin, fever, drenching night sweats and weight loss 3 years agO. been diagnosed as Hodgkin's lymphoma (HL), nodular sclerosing type. He has received 8 courses of adriamycin, bleomycin, vinblas- tine, dacarbazine (ABVD) chemotherapy and 24 sessions of radiotherapy and has been followed up as in remission for 6 months.
Pons hepatis : Report of two cases
The pons hepatis is defined as a prolongation of the hepatic substance bridged over the umbilical fissure between the quadrate and left lobes of the liver. The reported incidence of the pons hepatis is quite differ- ent (1-3). Although some anatomy textbooks neglect to define the pons hepatis, others (1, 4, 5) well document it.
During routine dissection studies we encountered two unusual structures in the visceral surface of the liver (Fig. 1). Histological examination of these structures by hematoxylin-eosin staining and cytokeratin-19 immuno- histochemistry revealed that there were numerous ves- sels and bile ducts as seen in normal liver tissue contents. According to its direction and content, they were consid- ered as pons hepatis. In Case 1 (52-year-old male cadav- er), it was a string-like structure (1.8 cm in length and 0.35 cm in width). Additionally, a superficially located intrahepatic vessel and its branches were laid in the gall bladder's fossa (Fig. 1A). In Case 2 (47-year-old female cadaver), it was a bulky structure and divided by a single fissure into two parts (Fig. 1B). The quadrate and left lobes were appearing as united lobes covering the umbil- ical vein.
