Minnie M. Mathan

Colonoscopic study of 50 patients with colonic tuberculosis.

Fifty patients with colonic tuberculosis are reported in whom a colonoscopic diagnosis confirmed by histological examination was possible in 40. Bacteriological studies did not increase the diagnostic yield. Abdominal pain was the most common symptom (90%) and an abdominal mass the most common abnormal physical finding (58%). A nodular mucosa with areas of ulceration was the usual colonoscopic finding. Ileocaecal disease was found in 16, ileocaecal and contiguous ascending colon disease in 14, segmental colonic tuberculosis in 13, ileocaecal disease and non-confluent involvement of another part of the colon in five, and pancolitis in two patients. This report emphasises that colonoscopy is a useful procedure for diagnosing colonic tuberculosis and that segmental colonic tuberculosis is not uncommon.

Endoscopic mucosal biopsies are useful in distinguishing granulomatous colitis due to Crohn's disease from tuberculosis

BACKGROUND Intestinal tuberculosis and Crohn’s disease are chronic granulomatous disorders that are difficult to differentiate histologically. AIMS To characterise distinctive diagnostic features of tuberculosis and Crohn’s disease in mucosal biopsy specimens obtained at colonoscopy. METHODS Selected histological parameters were evaluated retrospectively in a total of 61 biopsy sites from 20 patients with tuberculosis and 112 biopsy sites from 20 patients with Crohn’s disease. The patients were chosen on the basis of clinical history, colonoscopic findings, diagnostic histology, and response to treatment. RESULTS The histological parameters characteristic of tuberculosis were multiple (mean number of granulomas per section: 5.35), large (mean widest diameter: 193 μm), confluent granulomas often with caseating necrosis. Other features were ulcers lined by conglomerate epithelioid histiocytes and disproportionate submucosal inflammation. The features characteristic of Crohn’s disease were infrequent (mean number of granulomas per section: 0.75), small (mean widest diameter: 95 μm) granulomas, microgranulomas (defined as poorly organised collections of epithelioid histiocytes), focally enhanced colitis, and a high prevalence of chronic inflammation, even in endoscopically normal appearing areas. CONCLUSIONS The type and frequency of granulomas, presence or absence of ulcers lined by epithelioid histiocytes and microgranulomas, and the distribution of chronic inflammation have been identified as histological parameters that can be used to differentiate tuberculosis and Crohn’s disease in mucosal biopsy specimens obtained at colonoscopy.

Prevalence of intestinal parasites in rural Southern Indians

objective    To determine the prevalence of intestinal protozoal and helminthic infection in a rural population.method  Seventy‐eight members of 15 families from a village were studied. Stool samples from all subjects were examined on alternate days for one month.results  The overall prevalence rate of various parasitic infections was 97.4%, with only 2 of 78 subjects not excreting parasites in any of their 15 samples. Eighteen (23.1%) persons had only one type of parasite, while 58 (74.3%) excreted multiple parasites. Giardia and Cryptosporidium were the commonest protozoan infections, affecting 42/78 (53.8%) and 31/78 (39.7%), respectively. Hookworm infestations were the commonest helminthic infections, seen in 48/78 (61.5%). Based on excretion patterns, the asymptomatic individuals could be divided into 2 groups of infrequent and frequent excretors, indicating that the host response may determine the level of parasite replication in the gut.

Medical therapy of rhinosporidiosis with dapsone

Clinical, histopathological and ultrastructural studies in three cases of rhinosporidiosis show complete remission of infection within one year of therapy with dapsone. Light and electron microscope studies confirmed arrest of the maturation of the spores and accentuated granulomatous response with fibrosis following dapsone therapy.

Ultrastructural changes in the upper small intestinal mucosa in patients with cholera

BACKGROUND & AIMS Small intestinal mucosal ultrastructural abnormalities were reported in a limited number of patients with cholera in the 1970s. This study extends these observations by examining distal duodenal biopsy samples from 19 patients with cholera and 10 controls. METHODS Endoscopic biopsy samples obtained, usually during the first 24 hours of illness, were processed for electron microscopy. RESULTS Widening of intercellular spaces and alteration of apical junctional complexes were prominent in the villus epithelium, whereas blebbing of microvillus border and mitochondrial changes were more prominent in the crypt epithelium. The apical junctional and intercellular space changes were not altered by oral rehydration. Degranulation of argentaffin cells, mucosal mast cells, and eosinophils; increase in neutrophil polymorphs; and changes in the enteric nerve fibers and microvasculature were also present. The extent of the changes correlated with clinical severity. CONCLUSIONS The differential involvement of the villus and crypt suggests that factors responsible for secretion may act differentially on surface and crypt epithelium and that both regions may contribute to secretion. The contribution of the enteric nervous system, vasculature, argentaffin cells, mucosal mast cells, eosinophils, and neutrophils in the secretory process and in determining the severity of the clinical illness must be determined by further clinical studies.

Cytomegalovirus infection of the human gastrointestinal tract

Background : Current interest in cytomegalovirus (CMV) is largely due to an increase in the number of cases of acquired immunodeficiency syndrome and organ transplantation in recent years. The proper recognition of CMV‐infected cells in gastrointestinal mucosal biopsies is critical for effective treatment of this condition.

Collagenous gastritis and collagenous colitis: a report with sequential histological and ultrastructural findings

The case is reported of a young adult man with collagenous gastritis, an extremely rare disorder with only three case reports in the English literature, who subsequently presented with collagenous colitis. Sequential gastric biopsies showed a notable increase in thickness of the subepithelial collagen band. Ultrastructural study of gastric and rectal mucosa showed the characteristic subepithelial band composed of haphazardly arranged collagen fibres, prominent degranulating eosinophils, and activated pericryptal fibroblasts.

Risk of colorectal cancer in ulcerative colitis in India

Background:  The risk for colorectal cancer (CRC) in ulcerative colitis (UC) in India is not known.

Quantitative and Ultrastructural Analysis of Rectal Mucosal Mast Cells in Acute Infectious Diarrhea

The role of mast cells, potential mediators ofmucosal immunity and inflammation, was studiedmorphologically in the rectal mucosa in two acutediarrheal diseases, cholera and shigellosis.Quantitation of mucosal mast cells showed that they weresignificantly higher in the deeper lamina propria whereblood vessels and nerves were more abundant. There wasno difference in mast cell counts or degranulation in the mucosa in both groups of patients andcontrols. Intraepithelial mast cells were decreased inthe patients. The prevalence of lipid bodies wassignificantly higher in mast cells from patients with cholera and shigellosis (P < 0.01). Thesefindings suggest that mast cell populations are moredense around blood vessels and nerves and thatinflammatory mediators derived from arachidonic acidmetabolites, as indicated by the lipid bodies, are theresponse of mast cells to the alterations in diarrhea,despite differences in the etiology ofdiarrhea.

Prevalence of Helicobacter pylori in southern Indian controls and patients with gastroduodenal disease

Abstract The spiral organism Helicobacter pylori has been casually implicated in the genesis of various gastroduodenal diseases. Since these diseases are common in southern India, this study was undertaken to determine the prevalence of H. pylori in the gastric mucosa of asymptomatic adults and patients with various gastroduodenal diseases. H. pylori was detected in the gastric mucosa of 25 of 30 (83.3%) normal volunteers. Prevalence rates in the disease groups were also high, and included 38 of 41 patients with duodenal ulcer (92.6%), 13/16 with gastric ulcer (81.3%), and 85/119 subjects (71.4%) with non‐ulcer dyspepsia. Light microscopic examination of the gastric mucosa provided the best method of detecting H. pylori. H. pylori colonization was significantly associated with histological abnormalities, mainly chronic atrophic gastritis (147) and superficial gastritis (11), while only three of 161 H. pylori positive patients had histologically normal antral mucosa. Ultrastructural examination revealed changes in the apical complex of the gastric mucosal cells in response to bacterial adhesion, with mucus depletion and cellular damage. Bacteria were also noted disrupting the tight junctions and entering the intercellular spaces. The high prevalence of H. pylori infection may explain the high incidence of gastritis, duodenal ulceration and gastric carcinoma in this population. However, in this population, the prevalence of infection in asymptomatic individuals was nearly as high as that in duodenal ulcer, underlining the need for further study to identify the differences in host response or bacterial pathogenicity that lead to the development of ulcer in only some individuals.