Types of colorectal cancer and dysplasia associated with inflammatory bowel disease

Ulcerative colitis (UC) and Crohn’s disease (CD) are two major inflammatory disorders of the intestinal wall collectively known as inflammatory bowel disease (IBD). Colorectal carcinoma (CRC) is the most significant and grave consequence of IBD and is preceded by dysplasia in majority of the cases. In this review we aim to discuss the various types of dysplasia found in patients with CRC due to IBD. A thorough literature search was conducted in online databases such as PubMed, Google Scholar, from which all studies published in the last ten years were included in this review. The major development in diagnostic procedures and visualization modalities have aided our understanding of dysplasia, which is now known to be the strongest predictor and marker for CRC development. However, the unpredictable behavior and progression of dysplasia still warrants vigilant surveillance. Dysplasia has been classified on histological characteristics using grades of dysplasia from ‘negative for dysplasia’ to ‘high grade dysplasia’. On visibility via an endoscope from ‘visible dysplasia’ to ‘invisible dysplasia’ and macroscopic features of ‘conventional dysplasia’ and ‘non-conventional dysplasia’. No single classification can be utilized to define the stage of dysplasia and more importantly predict its progression and outcome of CRC. Using evidence-based medicine an integrated classification expanding on a management algorithm must be formulated by a panel of experts to steer management of the disease. A multidisciplinary, tailored approach with a strong emphasis on regular and timely surveillance to ensure early detection of CRC can enhance quality of life and patient outcomes.

Role of gut microbiota in the pathogenesis of type 2 diabetes mellitus (literature review)

Type 2 diabetes mellitus is an extremely common disease that leads to the development of life-threatening complications but its pathogenesis remains poorly understood. One of the promising directions in this area is the study of disorders of gut microbiota. Literature data indicate that a number of quantitative and qualitative changes in the composition of the gut microbiota are the most important factors in the pathogenesis of type 2 diabetes mellitus. Bacteria of the genera Ruminococcus, Fusobacterium and Blautia are most involved in the pathogenesis of this disease. The participation of the gut microbiota in the pathogenesis of type 2 diabetes mellitus is due to its metabolites, which play an important role in the regulation of the permeability and integrity of the intestinal wall, the expression of specific intestinal receptors, incretin secretion, gluconeogenesis activity, chronic subclinical inflammation, and even in adipose tissue remodeling. Further in-depth study of gut microbiota disorders is promising in order to develop fundamentally new approaches to the treatment and prevention of type 2 diabetes mellitus.

Role of damage to intestinal barrier in development of psoriasis

Disorders of interstitial barrier permeability as one of the promising mechanisms of psoriasis formation and development is a trend of the last decades. In the analysis of modern works devoted to the evaluation of the role of intestinal barrier damage in the development of psoriasis, several ways of assessing intestinal permeability have been noted (including measurement of transepithelial electrical responses using a Ussing chamber, measurement of excretion of orally injected molecules, determination of dynamics and kinetics of LPS intestinal bacteria, immunohistochemical confocal analysis of uniform Z-sections perpendicular to the epithelial cell surface, etc.). However, most authors emphasize the diagnostic significance and availability of biomarker detection. Among the described biomarkers, claudin-3, fecal zonulin, α1-antitrypsin, calprotectin and intestinal fatty acid binding protein (I-FABP) are the most valuable. Through these methods of assessing intestinal permeability and the results of their studies, a number of authors practically prove the correlation between the violation of the intestinal microbiota, intestinal barrier permeability and the development of psoriasis, as well as its severity. This aspect is promising to the therapy of patients with psoriasis, which includes correction of intestinal microbiota and intestinal wall permeability.

Structural Features of Glands in the Sphincter Zones of the Large Intestine of an Adult

The aim is to study macro- and microscopic structure, as well as the cellular composition of the glands of the sphincter zones of large intestine of adults of different age groups.Material and methods. On autopsy material obtained from 30 people, without signs of pathology of the digestive tract of three age groups: 20–29 years, 50–59 years, 90–99 years, the structure of the glandular apparatus of the sphincter zones was studied. The areas of the Gerlach flap, Girsch sphincters, Payr–Strauss, Bally, O'bern–Pirogov–Moutier were considered. Quantitative morphometry was performed on histological preparations stained with methylene blue, followed by fixation in a saturated solution of ammonium molybdenum (picric acid), hematoxylin-eosin, picrofuchsin according to Van Gieson. Methods of parametric statistics based on the Statistica 6.0 program were used for statistical data processing.Results. The analysis of the number, size and cellular composition of the glands of the sphincter zones of the large intestine revealed an increase in both the number of glands and their size in all age groups compared to the proximally adjacent areas of the intestine, on average by 1.3–1.5 times. In a similar range, individual indicators of the number of epithelial cells in the glands of the sphincter zones of the colon increased. At the same time, the cellular composition of the glands of the sphincter zones and adjacent areas of the intestinal wall was similar to neighboring areas, with predominant goblet-shaped epithelial cells (52.9–54.2% of cells on the longitudinal section of the gland) and the presence of absorption cells (29.9–31.2%), undifferentiated – 11.9–13.2% and argyrophilic endocrinocytes – 1.4–5.3%.Conclusion. Against the background of narrowing of the lumen of the large intestine in the area of the sphincters and changes in the nature of the mucous membrane, there is an increase in the size and density of the localization of glands in all age groups. This confirms the thesis about the formation of a protective barrier that provides a local adaptive potential of this area of the intestinal wall, against the background of increased mechanical effects of intestinal masses.

DIAGNOSTIC CRITERIA FOR VISCEROABDOMINAL DISPROPORTION SYNDROME IN GASTROSCHISIS

The objectives of this study were to determine the frequency and search for additional criteria for the diagnosis of visceroabdominal disproportion syndrome (VADS) in newborns with gastroschisis. Materials and methods of research: prospective controlled observational cross-sectional analytical study was carried out in 61 newborns with gastroschisis, admitted from June 2009 to July 2021. To search for the most significant factors indicating the presence of VADS, the following parameters were recorded in the studied patients: the size of the defect in the anterior abdominal wall, the composition of eventrated organs, the presence of a conglomerate of intestinal loops, the diameter of the intestinal tube, the thickness of the intestinal wall, the degree of visceroabdominal disproportion (VAD). Results: VAD was detected in 50 (82%) newborns with gastroschisis. In 10 (17%) cases, VAD was mild, in 27 (44%) – moderate, and in 13 (21%) patients – severe. A moderate direct relationship was found between the size of the anterior abdominal wall defect (r=0.29, p=0.022), intestinal tube diameter (r=0.56; p=0.001) and the severity of VAD. There was a strong direct correlation between the thickness of the intestinal wall, and the frequency and severity of VAD (r=0.93, p=0.001). A direct association was found between the presence of a conglomerate of intestinal loops in the eventrated organs and the frequency of VAD (p=0.002). There was no statistically significant relationship between the number of eventrated anatomical structures with the frequency and degree of VAD (p=0.36). Conclusion: to determine VADS, it is advisable to diagnose the following pathological conditions in patients with gastroschisis: thickening of the intestinal wall, dilatation of the intestinal tube, the presence of a conglomerate of tightly welded eventrated organs, the severity of which is directly proportional to the degree of disproportion.

CONSEQUENCES OF CHILDREN SWALLOWING FOREIGN BODIES IN THE FORM OF MAGNETIC BALLS

The authors draw attention to dangerous children's toys – magnetic balls (MB). When MB is swallowed in the gastrointestinal tract (GIT), they can connect with each other in chains or are attracted to each other through the intestinal wall, forming necrosis and perforation of hollow organs at the junction. The authors cite four clinical cases of patients aged 2 to 8 years with varying degrees of severity of pathology caused by magnetic foreign bodies in GIT, from spontaneous discharge of foreign bodies during vomiting to multiple perforations of GIT.

The Zoonotic Helminth Parasite Fasciola hepatica: Virulence-Associated Cathepsin B and Cathepsin L Cysteine Peptidases Secreted by Infective Newly Excysted Juveniles (NEJ)

Fasciolosis caused by Fasciola hepatica is a major global disease of livestock and an important neglected helminthiasis of humans. Infection arises when encysted metacercariae are ingested by the mammalian host. Within the intestine, the parasite excysts as a newly excysted juvenile (NEJ) that penetrates the intestinal wall and migrates to the liver. NEJ excystment and tissue penetration are facilitated by the secretion of cysteine peptidases, namely, cathepsin B1 (FhCB1), cathepsin B2 (FhCB2), cathepsin B3 (FhCB3) and cathepsin L3 (FhCL3). While our knowledge of these peptidases is growing, we have yet to understand why multiple enzymes are required for parasite invasion. Here, we produced functional recombinant forms of these four peptidases and compared their physio-biochemical characteristics. Our studies show great variation of their pH optima for activity, substrate specificity and inhibitory profile. Carboxy-dipeptidase activity was exhibited exclusively by FhCB1. Our studies suggest that, combined, these peptidases create a powerful hydrolytic cocktail capable of digesting the various host tissues, cells and macromolecules. Although we found several inhibitors of these enzymes, they did not show potent inhibition of metacercarial excystment or NEJ viability in vitro. However, this does not exclude these peptidases as targets for future drug or vaccine development.

Olgular Işığında İleusun Güncel Cerrahi Tedavisi

More than 200 million operations are performed worldwide each year. Most of these patients have comorbid features such as advanced age (1). Postoperative ileus is an annoying condition that usually develops after abdominal surgeries. The incidence of postoperative ileus after colorectal surgery is more common than other surgeries. Incidence rtes vary between 10% and 30% of the incidence of postoperative ileus have been reported (2,3). Various risk factors have been identified for the development of ileus. These risk factors are; It can be summarized as advanced age, open surgical approaches, the difficulty of the operation, operation time intestines, decrease in hematocrit or need for blood transfusion /crystalloid and late mobilization. In most cases, more than one of these risk factors is observed. Ileus pathophysiology; it was defined by Vater et al as impared motility and intestinal wall edema (4). Although some publications argue that mechanical ileus can be treated conservatively within 12 hours by rejecting the rule of thumb (5), what we have experienced in these two cases is that the conservative approach is not sufficient in the treatment of such cases. And perhaps to insistence on conservative treatment may cause irreversible damage to the general condition of the patient. We aimed in this study to examine current surgical treatments in two ileus cases with a complex picture. Keywords: Ileus, abdominal surgery, treatment of ileus

Chronic Enteropathy Associated with SLCO2A1-Associated Primary Hypertrophic Osteoarthropathy in Female Patients: A Case Report and Literature Review

This paper reports a case of chronic enteropathy associated with the SLCO2A1 gene (CEAS) combined with primary hypertrophic osteoarthropathy (PHO). The patient was a 25-year-old woman with a normal onset of puberty who was admitted to our hospital four times due to intractable oedema and anaemia. She had a history of hyperhidrosis since childhood, and her parents were close relatives (cousins). Enteroscopy revealed stenotic ulcers on the ileocecal valve and the terminal ileum. Computed tomography enterography (CTE) and magnetic resonance enterography (MRE) showed segmental thickening of the ileum and terminal intestinal wall and centripetal narrowing of some intestinal cavities. MRE also showed a marked "comb sign" in the adjacent mesentery, and X-rays of both lower limbs showed thickening of the tibiofibular cortex. The CEAS pathogenic genes were screened by whole exome sequencing, and a homozygous missense mutation of p. Gly222Asp (c.664G>A) was found in the fifth exon of the SLCO2A1 gene, which was verified by Sanger sequencing. In conclusion, the patient was identified as CEAS with PHO associated with a SLCO2A1 gene mutation, but the patient is a young woman, which has rarely been reported in previous studies. In addition to reporting her case, the relevant literature was reviewed to improve clinicians' understanding of diseases associated with the SLCO2A1 gene.