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Intraepithelial giardia intestinalis: a case report and literature review.
Martínez-Gordillo, MN, González-Maciel, A, Reynoso-Robles, R, Montijo-Barrios, E, Ponce-Macotela, M
Medicine. 2014;(29):e277
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Abstract
The giardiasis is a neglected parasitic disease. The WHO has estimated more than 280 million of human infections each year; however, intraepithelial giardiasis is a rare entity, there are only 5 reports showing invasive giardiasis. A pediatric female patient with chronic abdominal pain, diarrhea, or pasty stools, without fever, was seen in the Gastroenterology and Nutrition Service. The stool studies were negative for pathogens and lactose hydrogen breath test was positive. The presumptive clinical diagnosis was giardiasis and the patient was empirically treated with nitazoxanide. But, the patient persisted with abdominal pain and pasty stools. Endoscopy was indicated to search for Helicobacter and Giardia. Guardian and patient gave written informed consent. Hematological profile was normal. The endoscopy was performed under general anesthesia and the biopsies and duodenal aspirate were obtained. The microscopic analyses of duodenal fluid showed Giardia trophozoites. Electron microscopic analysis was negative for Helicobacter pylori, but Giardia trophozoites with a typical crescent shape within the tissue were found. The patient was treated with tinidazole, subsequent tests showed that lactose absorption was normal, stool examinations were negative for Giardia and abdominal pain had stopped. This case suggest that intraepithelial giardiasis could be a common entity but unseen because the giardiasis diagnosis is usually made on fecal samples. Future studies are necessary to determine the role of intraepithelial trophozoites in giardiasis pathogenic mechanisms.
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[A case of anorectal melanoma localized in mucosa].
Ito, T, Kondo, A, Tanaka, M, Naganuma, T, Hashimoto, A, Kawamata, H, Isaji, S
Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology. 2012;(3):435-41
Abstract
The patient was a 67-year-old woman. An elevated rectal lesion had been identified at a local clinic, and colonoscopy revealed a 7-mm black elevated lesion with blackening of the surrounding mucosa. Malignant melanoma was diagnosed by biopsy, and the patient was referred to our department. An invasion depth of M was diagnosed on the basis of preoperative imaging. Local excision was considered, but abdominoperineal resection was performed in light of its nature, to perform curative resection. Pathological findings showed abnormal cells staining positive for HMB-45 in the tumor and surrounding mucosa, but these were localized within the mucosa. As of 1 year and 6 months after surgery, the patient has survived without recurrence.
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Digestive smooth muscle mitochondrial myopathy in patients with mitochondrial-neuro-gastro-intestinal encephalomyopathy (MNGIE).
Blondon, H, Polivka, M, Joly, F, Flourie, B, Mikol, J, Messing, B
Gastroenterologie clinique et biologique. 2005;(8-9):773-8
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Abstract
We report 3 new cases of Mitochondrial-Neuro-Gastro-Intestinal Encephalomyopathy (MNGIE) (or Pseudo-Obstruction-Leukoencephalopathy-Intestinal-Pseudoobstruction Syndrome [POLIP]), a rare disease that associates chronic intestinal pseudo-obstruction (CIPO) and neurological symptoms. A review of the 72 reported cases together with these 3 cases revealed that this condition was associated with (a) a specific cluster of neurological symptoms including leukoencephalopathy (96%), polyneuropathy (96%), ophthalmoplegia (91%) and hearing loss (55%); (b) a CIPO syndrome with the presence of small bowel diverticulae (53%); and (c) mitochondrial cytopathy in 36 of the 37 tested patients (2 of our 3 cases), and thymidine phosphorylase gene mutations in all the 37 tested patients (2 of our cases). The etiology of POLIP/MNGIE syndrome appears therefore to be due to a mitochondrial cytopathy secondary to thymidine phosphorylase gene mutation(s). In 3 cases, including 2 of our 3 patients, mitochondrial abnormalities were evidenced at the ultrastructural level in digestive smooth muscle demonstrating that the pathogenesis of gastrointestinal involvement was directly related to mitochondrial alterations in digestive smooth muscle cells.
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A milligram of gluten a day keeps the mucosal recovery away: a case report.
Biagi, F, Campanella, J, Martucci, S, Pezzimenti, D, Ciclitira, PJ, Ellis, HJ, Corazza, GR
Nutrition reviews. 2004;(9):360-3
Abstract
In recent years it has been suggested that patients with celiac disease can be adequately followed up on the basis of merely clinical and serological response to a gluten-free diet. Thus, a duodenal biopsy some months after commencement of a gluten-free diet would no longer be necessary. We report here the case of a celiac patient in whom the ingestion of a milligram of gluten every day for 2 years prevented histological recovery in spite of satisfactory clinical and serological response. The literature regarding the minimal amount of gluten that could be harmless to celiac patients is reviewed.