Small Bowel Enema and Diagnosis of Chronic Nonischemic Disturbance of Superior Mesenteric Venous Blood Flow

Chronic nonischemic disturbance of mesenteric venous blood flow is reported in 11 patients with a mean age of 19 years. This entity, rarely discussed in the literature, is different from acute thrombosis and chronic thrombotic forms with portal hypertension or hypercoagulopathy. In eight patients this syndrome was secondary to organic lesions of different origin: mesenteric vein squeezed by fibrous bands or an abnormal jejunal artery (four cases), lymphoma involving the distal superior mesenteric veins (three cases), hemangioma causing microthrombi (one case). In three patients no etiology or predisposing factor was found. All patients presented with rectal hemorrhage. Small bowel enema showed a constant pattern in 11 patients: small nodules, modified by compression or peristalsis, involving the mesenteric border of the jejunoileal segment, and associated with thick, straight but regular folds. Mesenteric varices were suspected and led to angiographic studies which were normal in three cases, confirmed varices in eight cases, and thrombosis in four cases. Laparotomy was normal in three cases and established the etiological diagnosis in eight cases. Varices were shown in six cases. Arteriography and laparotomy were unable to reach a complete diagnosis

Bacterial vaginosis - Transmission, role in genital tract infection and pregnancy outcome: An enigma

Larsson PG, Bergstrom M. Forsum U, Jacobsson B, Strand A, Wolner-Hanssen P Bacterial vaginosis. Transmission, role in genital tract infection and pregnancy outcome: an enigma. APMIS 2005; 113:233-45. Whether bacterial vaginosis (BV) is acquired from an endogenous or an exogenous source is subject to controversy Despite findings of an association between sexual behaviour and BV some data indicate that BV is not a sexually transmitted infection in the traditional sense, while other data indicate Thai BV is an exogenous infection. A third aspect of BV is its tendency to go unnoticed by affected women. All of this will have a strong impact on how physicians view the risks of asymptomatic BV This review focuses on whether or not BV should be regarded as a sexually transmitted infection (STI), its role in postoperative infections and pelvic inflammatory disease (PID), and on whether or not treatment of BV during pregnancy to reduce preterm delivery should be recommended. The reviewed studies do not lend unequivocal support to an endogenous or exogenous transmission of the bacteria present in BV. For women undergoing gynaecological surgery such as therapeutic abortion, the relative risk of postoperative infection is clearly elevated (approx. 2.3-2.8). A weaker association exists between BV and pelvic inflammatory disease. Data on treatment of BV as a way of reducing preterm delivery are inconclusive and do not support recommendations for general treatment of BV during pregnancy. The discrepant associations between BV and preterm birth found in recent studies may be explained by variations in immunological response to BV Genetic polymorphism in the cytokine response - both regarding the TNF alleles and in interleukin production - could make women more or less susceptible to BV, causing different risks of preterm birth. Thus, studies on the vaginal inflammatory response to microbial colonization should be given priority