Excessive loss of plasma protein into the gastrointestinal tract associated with primary myocardial disease

Primary intestinal lymphangiectasia: Minireview

Primary idiopathic intestinal lymphangiectasia is an unusual disease featured by the presence of dilated lymphatic channels which are located in the mucosa, submucosa or subserosa leading to protein loosing enteropathy.Most often affected were children and generally diagnosed before third year of life but may be rarely seen in adults too. Bilateral pitting oedema of lower limb is the main clinical manifestation mimicking the systemic disease and posing a real diagnostic dilemma to the clinicians to differentiate it from other common systemic diseases like Congestive cardiac failure, Nephrotic Syndrome, Protein Energy Malnutrition, etc. Diagnosis can be made on capsule endoscopy which can localise the lesion but unable to take biopsy samples. Thus, recently double-balloon enteroscopy and biopsy in combination can be used as an effective diagnostic tool to hit the correct diagnosis. Patients respond dramatically to diet constituting low long chain triglycerides and high protein content with supplements of medium chain triglyceride. So early diagnosis is important to prevent untoward complications related to disease or treatment for the sake of accurate pathological diagnosis.

Acquired combined immunodeficiency associated with protein losing enteropathy complicating Fontan operation

It is vitally important that the immunological aspect of protein losing enteropathy following Fontan procedures is highlighted, in order to decrease significant morbidity and mortality

Reversal of protein-losing enteropathy with heparin therapy in three patients with univentricular hearts and Fontan palliation

We studied three pediatric patients with protein-losing enteropathy in conjunction with univentricular hearts and right atrial to pulmonary artery anastomosis (Fontan operation) before and during heparin therapy. Each patient showed dramatic improvements in symptoms, marked elevations in serum albumin levels, and quantitative reversal of enteric protein loss within a few weeks of beginning therapy. These findings suggest that heparin may be an important treatment for this poorly understood condition.

Skeletal muscle involvement in tropical endomyocardial fibrosis

Evidence for neuromuscular dysfunction was sought in 20 consecutive, angiographically proven cases of tropical endomyocardial fibrosis (Group I). Statistical comparison was made with equal number of age, sex and weight-matched normal healthy volunteers (Group II), as well as similarly matched cases of consecutive heart failure (Group III). A myopathic pattern in the EMG was found in 85% of Group I and 65% of Group III patients. However, the severity and global extent of the EMG changes was much more marked in Group I than in Group III. The summed motor unit potential duration was reduced by 20.1% in Group I and by 9.5% in Group III. Corresponding figures for summed motor unit potential amplitude were 27.9% and 15.4%. the summed frequency of polyphasic potentials was significant in Group I and in Group III. Involvement of 3 or 4 muscles in the same patient was found in 80% of Group I, n 10% of Group III. The upper limb muscles were affected in 80% of Group I and 50% of Group III. The motor nerve conduction velocity and distal latency time were normal in all the patients. It is suggested therefore that the myopathic EMG changes in Group I patients may be related to the disease process itself, rather than a reflection of long standing CHF alone. Light-microscopic study of the quadriceps muscles in 8 patients of Group I did not reveal any abnormality.

Symposium on pathology of the gastrointestinal tract-Part II. Small intestinal biopsy

A practical approach to the interpretation of peroral small intestinal biopsy specimens is presented. Biopsy technique and tissure handling are described. Interpretation of normal and abnormal biopsy specimens is discussed. A practical classification of abnormal small intestinal biopsies is presented and illustrated.

Folic acid deficiency in congestive heart failure

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Use of 125-I- and 51-Cr-labeled albumin for the measurement of gastrointestinal and total albumin catabolism

A method for the simultaneous measurement of gastrointestinal protein loss and total albumin turnover entailing the use of a combination of (125)iodine- and (51)chromium-labeled albumin is described. Albumin turnover was calculated by the measurement of albumin-(125)I plasma decay and cumulative urinary excretion, and the results obtained agreed closely with previous studies utilizing albumin-(131)I. Gastrointestinal catabolism was calculated from the rate of fecal excretion of (51)Cr and the specific activity of plasma albumin-(51)Cr, and these data were related to the calculated albumin turnover results. During the period of 6-14 days after administration, the ratio of specific activties of albumin-(125)I and -(51)Cr in plasma and in extravascular spaces or gastric and biliary secretions remained almost identical. Fecal excretion of (51)Cr was also quite stable at this time. In six normal subjects gastrointestinal catabolism accounted for less than 10% of total albumin catabolism. Excessive gastrointestinal protein losses did not contribute to the low serum albumin in three patients with cirrhosis or in two adults with the nephrotic syndrome. Multiple mechanisms leading to hypoalbuminemia were demonstrated in other subjects with a variety of gastrointestinal disorders.