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Summary Background Intestinal transplantation is used in patients with short-bowel syndrome after repeated resections for Crohn's disease. We report the apparent clinical recurrence of Crohn's disease in a transplanted intestine. Methods and findings The patient, a 33-year-old Hispanic woman, underwent small-bowel transplantation in December, 1994. Immunosuppression with tacrolimus, methylprednisolone, bone-marrow infusions, and OKT3 was given. In July, 1995, the patient had recurrent abdominal symptoms. The histological diagnosis of Crohn's disease was established by the independent interpretations of four experienced gastrointestinal histopathologists. Interpretation The prompt appearance of this autoimmune disorder (within 6 months of transplantation), despite massive immunosuppression may provide important insights into the nature of Crohn's disease and of the recurrence of autoimmune disease during immuno-suppression.

Source Citation Camilleri M, Northcutt AR, Kong S, et al. Efficacy and safety of alosetron in women with irritable bowel syndrome: a randomised, placebo-controlled trial. Lancet. 2000 Mar 25;355:10...

(2000) Ann Intern Med 133, 136. Jailwala J, Imperiale TF, Kroenke K. . Pharmacologic treatment of the irritable bowel syndrome: a systematic review of randomized, controlled trials. . Jul 18; . : . –47. . [OpenUrl][1][PubMed][2][Web of Science][3] QUESTION: What is the effectiveness of pharmacological agents for the treatment of irritable bowel syndrome (IBS)? Studies were identified by searching Medline (1966–99), EMBASE/Excerpta Medica (1980–99), PsycINFO (1967–99), and the Cochrane Controlled Trials Registry with terms that included colonic diseases, functional, irritable, spastic, bowel, and colon and by manually searching bibliographies of relevant studies. Published studies in the English language were selected if they examined use of a pharmacological treatment for IBS on >10 adult patients for ≥2 weeks; included a placebo group; reported an outcome measure of global status or individual symptoms, or both, of IBS; and used a randomised, double blind, parallel group or crossover design. Data were extracted on the diagnostic criteria for IBS, participant characteristics, interventions, study design, methodological quality (scored between 1 and 5 with a higher score representing higher quality; studies with a score ≥4 were classified as “high quality”), and outcomes. Pharmacological agents were classified as having “positive” effectiveness if the study reported significant improvement in global status or individual IBS symptoms; otherwise, they were classified as having “negative” effectiveness. 70 studies (4836 patients, median age … [1]: {openurl}?query=rft.jtitle%253DAnnals%2Bof%2BInternal%2BMedicine%26rft.stitle%253DANN%2BINTERN%2BMED%26rft.issn%253D0003-4819%26rft.aulast%253DJailwala%26rft.auinit1%253DJ.%26rft.volume%253D133%26rft.issue%253D2%26rft.spage%253D136%26rft.epage%253D147%26rft.atitle%253DPharmacologic%2BTreatment%2Bof%2Bthe%2BIrritable%2BBowel%2BSyndrome%253A%2BA%2BSystematic%2BReview%2Bof%2BRandomized%252C%2BControlled%2BTrials%26rft_id%253Dinfo%253Apmid%252F10896640%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10896640&link_type=MED&atom=%2Febmed%2F6%2F1%2F20.atom [3]: /lookup/external-ref?access_num=000088258500007&link_type=ISI

Summary A case of agenesis of the gall bladder and cystic duct with associated choledocholithiasis and suppurative cholangitis has been presented. Incidence of the congenital disorder, its symptomatology and associated pathology have been reviewed. Mechanisms responsible for common duct dilatation in the absence of calculi as well as for the formation of calculi in the absence of the gall bladder are discussed. A rational therapeutic approach is outlined.

Two patients developed local gangrene after subcutaneous infiltration of vasopressin (Pitressin, Parke, Davis & Company, Detroit, Mich.) utilized for the control of bleeding from esophageal varices. In the 1st patient, ischemic gangrene resulted in transmetatarsal amputation and also necessitated skin grafts on the forearm. The 2nd patient developed gangrene and clostridial sepsis and expired. The effects of systemically administered Pitressin are reviewed and suggestions to prevent local necrosis are presented.

The potential of non-01 Vibrio cholerae as human pathogens is assuming greater clinical importance. They are also capable of producing a spectrum of illness that is not confined to the gastrointestinal or biliary tracts. We report a case of fatal non-01 Vibrio cholerae septicemia in a patient with chronic lymphocytic leukemia.