Small Stool Research Articles

Mahabarata

Mahabarata

S1615 Primary Rectal Lymphoma: A Rare Entity of Lower Gastrointestinal Bleeding

INTRODUCTION: Primary rectal lymphoma is an extremely rare gastrointestinal neoplasm. The diagnosis can be delayed with varied presentations depending on the site of the colonic involvement. We present a case of acute onset of hematochezia from primary diffuse large B-cell lymphoma at the rectum. CASE DESCRIPTION/METHODS: A 54-year-old Caucasian man who has sex with men presented with constipation for 3 weeks and rectal bleeding for one week. He reported rectal pain associated with having bowel movements and tenesmus. He denied fever, chills, night sweats, or weight loss. Physical examination was unremarkable. Laboratory showed WBC 11.1 K/MM3, Hb 14.6 g/dL, platelet count 325 K/MM3, and negative serum HIV screening. CT scan of the abdomen and pelvis revealed circumferential rectal wall thickening with mesorectal fat stranding and enlarged mesorectal lymph nodes (Figure 1). The patient underwent flexible sigmoidoscopy which demonstrated circumferential deep ulcerations, linear erosions, and loss of vascularity of mucosa from the anus to the recto-sigmoid colon up to 20 cm and hypertrophied anal papillae (Figure 2). Biopsy of the rectum up to 20 cm revealed diffused large B-cell lymphoma with germinal center origin. A whole-body PET-CT scan showed disease activity localized in the rectum. Bone marrow biopsy showed slightly hypocellular bone marrow but negative for lymphoma. He underwent R-CHOP chemotherapy and radiation with a good response. Repeat colonoscopy at 3 months after treatment did not show evidence of recurrence. Follow-up PET-CT and CT chest/abdomen/pelvis were without recurrence of the disease. He remains in remission for 15 months since the diagnosis. DISCUSSION: Gastrointestinal (GI) non-Hodgkin lymphoma accounts for 1-4% of primary GI neoplasms. The stomach is the most commonly involved site followed by the small intestine and colon. Primary colorectal lymphoma only accounts for 6-12% of GI non-Hodgkin lymphomas. Diffuse large B-cell lymphoma (DLBCL) is the most common histopathology. Symptoms are varied depending on the location of the disease. Rectal lymphoma can present with rectal bleeding and obstructive symptoms, for example, constipation, small stool caliber, or tenesmus, as in this case. DLBCL is sensitive to chemoradiation. The estimated median survival of patients with localized disease is approximately 23 months. A high index of suspicion is required to prevent delays in diagnosis.Figure 1.: CT scan of abdomen and pelvis showed circumferential wall thickening at the rectum (arrows).Figure 2.: Flexible sigmoidoscopy showed circumferential deep ulcerations, linear erosions, and loss of vascularity of mucosa at the rectum (A) and hypertrophied anal papillae in retroflection view (B).

Dignity and Futility: Art and Labour in a Post-Industrial World

On May Day in 2018, artist Ceri Hann sat on a small stool in a large domed room at the Mission to Seafarers, a community building on the docks of Melbourne that provides support to visiting ship-wo...

An 11-year-old boy with chronic diarrhea and weight loss

This article has no abstract. The first 100 words appear below: An 11-year-old boy presented with 15 months history of diarrhea with up to 10-20 times small volume stool daily with mucus. It was associated with a feeling of incomplete defecation and excessive straining. The frequency of diarrhea increased to 20-30 times per day over the last 8 months. Subsequently, he developed fecal incontinence, for which he couldn't attend his school. He also had a history of significant weight loss in the last 7 months. According to his mother's statement, his body weight was reduced to 64 kg from 77 kg during this illness.

Joy

Joy Na Ye (bio) Translated by Ming Di (bio) How trustworthy this ancient flame,these potatoes with fresh mud, these cabbages,the steam from the hot bread,the frost on the radishes. Now, I'm no longer a strangerto myself,nor is life elsewhere. I'm tasting what the Buddhist Scripture says: joy. The sunflower on my apron twists my body like love.How are you, my old sun? As good as you were in the Agrarian Age?These wisps of smoke came from whose eyes? I don't like the brisk new age, sun.And this room keeping pace with the world. . . A gusting echo in the morning dew and my sweat—I lovemy old kitchen that smelled like a farmwith an empty bottle at dusk—I love the me that sat still on a small stool. [End Page 83] Na Ye Na Ye 娜夜 is an ethnic Manchu poet. Her family was from Niaoning province, northeast China, but she grew up in western China. After graduating from Nanjing University, she became a journalist in Lanzhou city, Gansu province. Ming Di Ming Di 明迪 is a Chinese poet based in the U.S. She attended Boston College and Boston University, where she taught Chinese. She has published six books of poetry in Chinese along with a collaborative translation, River Merchant's Wife (2012). She co-translated The Book of Cranes by Zang Di (2015) with Neil Aitken, and Empty Chairs: Selected Poems by Liu Xia (2015) with Jennifer Stern, which was a finalist for the 2016 Best Translation Book Award. She edited and co-translated New Cathay: Contemporary Chinese Poetry (2013) and New Poetry from China 1917–2017 (2019). In 2013 and 2014, she received Henry Luce Foundation fellowships. A co-founder of Poetry East West journal, she serves as the China editor for Poetry International Rotterdam. She has also translates from English into Chinese, most recently Observations by Marianne Moore (2018). Copyright © 2019 University of Hawaiʿi Press

Work System Improvement for A Sugarcane Block Enterprise using 10 Physical Ergonomic Principles

Nagari Bukik Batabuah is located in Agam, West Sumatra is one of the most significant regions, which produces sugarcane block named saka . Since the taste is lovely and delicious, the demand for it is high. Unfortunately, the processing of saka sugarcane was not supported by excellent facilities and infrastructure. This study analyses the saka workstations in Agam, West Sumatra and recommends some improvement to the working system. Ten physical ergonomic principles were applied in sugar mill workstation, boiling workstation, and saka molding workstation for improvement. It was found that all the workstations need to have more working facilities. In mining workstation, ergonomic chairs and stacks cane container was designed. Furthermore, an ergonomic cane-grinding machine was also proposed in the milling workstation. Meanwhile in the boiling workstation; cane stirrer, a small stool, and windows were designed. Gloves, lights, tools for changing the working facilities were also proposed to be used. A laying cane, a small stool, and saka pouring were designed for molding workstation.

Design, development, and initial operation of BabyScan: An in-vivo counter for children around Fukushima

The Fukushima Dai-ichi accident has released large quantities of radionuclides, including 131I, 134Cs, and 137Cs. These radionuclides, when inhaled or ingested, cause internal dose to the individual. Whole Body Counting [WBC], also known as in-vivo counting is a common method to assess internal radioactivity as a tool to evaluate internal dose. The FastScan WBC system was widely used following the Chernobyl and the Fukushima accidents for in-vivo measurements of the population. Although the FastScan was designed for adults, it was successfully used for children by having them stand on a small stool. However small children and infants cannot stand, and have a much lower quantity of radioactive cesium. That required the development of a much more sensitive WBC system, called the BabyScan. A very important element of the project was to make the unit look esthetically pleasing, while not compromising performance. The steel shield was enclosed in a molded fiberglass exterior skin, whereas a carbon-fiber liner was used on the interior, to keep the background low. The system was calibrated using MCNP; on-site testing with phantoms confirmed the adequacy of the mathematical efficiency calibrations. The system has a Minimum Detectable Activity with a 4-min measurement of approximately 20Bq for infants approximately 10kg in weight, and ~40Bq for children approximately 30kg in weight. The 40K that is naturally present is also reliably detected at the appropriate quantity for infants as small as 6kg. Data from the first 365 subjects counted showed that 40K was detected in all of them, and that there was no 134Cs or 137Cs above the MDA levels.

A Consuming Conundrum

Woman Made Gallery Chicago May 4-June 21, 2012 saw Consumer Culture at Woman Made Gallery in Chicago on an eerily hot day in mid-June, a reminder that global warming has robbed us of the loveliness of an early summer day. The urgent question is how, in the face of such a huge crisis, can we continue to drown ourselves in big-box store consumer goods so clearly responsible for much of the problem? Curator M. E. Ware explored this issue from a variety of conceptual and material angles stemming from her own deep artistic commitment to the issue surrounding consumption, particularly as it relate to women. The show was full of wonderful pieces, ranging from Mary Ellen Croteau's Endless columns 2011 12, an assemblage of plastic that looked like a twisted child's LEGO tower of pill bottles and Tide detergent tops, to Ifeoma Anyaeji's wonderful Mkpu Mkpu Oche (Small Stool) 2012 made from plastic bags and crates, an exploration of alternative visions of beauty and utility. A selection of media works made some of the strongest statements. Lauri Burrier's video 5 Days Plastic 2011 pairs a visual catalog of five days of her plastic refuse the volume is surprising with collected images of its devastating impact on the environment and its inhabitants. A soundtrack reminiscent of a dance club adds another layer to the mindless consumer aspect, creating an ambiance of trance-like devotion,. The video is posted on You Tube: watching it there is a bit like participating in an instant symposium, with other hits for important works on the same topic. Further online research revealed a wealth of information about the artists and works thematic exhibitions benefit tremendously from descriptive texts: some at the gallery were more helpful than others). Katie Kapuza's animated video ID Don't Want to be Wholesome (2011) features images of women's consumer goods from junk mail overlaid with strange, but powerful, spoken word excerpts like, I was not of a brilliant mind, nor of beautiful face. It turns out the audio is Gertrude Behanna, a bizarre religious zealot and supposed former heroin addict who made vinyl recordings about her ways and coming to Christ. The work presents an interesting twist on religion as a different kind of consumerism. [ILLUSTRATION OMITTED] [ILLUSTRATION OMITTED] In an ongoing video and performance project. Homing 2011, Michelle Acuff walks through both natural and urban landscapes such as the Art Institute of Chicago museum campus with a life-sized plastic duet lawn ornament on her back and dressed like a lumberjack. It has a nice taste of hunting lodge hipster irony, in which the embrace of nature is nothing more than a consumer costume in flannel and Timberlands. …

“Make Us Whole”: Environmental Justice and the Politics of Skepticism

Just after 6 p.m. on a mid-summer evening, I balanced on a small orange stool attached to a yellow Formica table, along with some 60 residents of Augusta, Georgia's Hyde Park neighborhood. As the d...

Colitis ulcerosa

Ulcerative colitis is a chronic inflammatory disease of the colon mucosa which always starts in the rectum; depending on how far the disease extends proximally, it is classified as proctitis, proctosigmoiditis, left-sided, subtotal or total pancolitis (sometimes with backwash ileitis). The cardinal symptoms are peranal hemorrhage, diarrhea and evacuations of small stool quantities with tenesmus. Ulcerative colitis is an intermittent disease with a high risk of recurrence, and remission can take from weeks to years. The diagnosis is based on the clinical picture and the endoscopic findings; additional microbiological examinations are indicated for the differential diagnosis in acute diarrhea. Medical therapy includes 5-ASA and SASP preparations, beclomethasone, budesonide and prednisone. Immunosuppressive therapy is indicated in steroid-refractory and chronic active disease; therapy options for severe episodes are corticosteroids, cyclosporine A, azathioprine, tacrolimus, infliximab and adalimumab. Potential complications include toxic megacolon, colon perforation, hemorrhage, thromboembolic complications, osteoporosis, CMV superinfection, intestinal scarring, colon carcinoma and primary sclerosing cholangitis. Surgical therapy is indicated for severe treatment-resistant episodes, megacolon, perforation, refractory bleeding, dysplasia of the colon mucosa or chronic active disease. Under adequate therapy, the mortality nowadays amounts to <1–2%.

“Low Caliber Stool” and “Pencil Thin Stool” are Not Signs of Colo-Rectal Cancer

Over the past several years, primary care providers have been referring a large number of their patients to gastroenterologists for colonoscopy because of "low caliber stool" or "pencil thin stool." Most textbooks of internal medicine and gastroenterology consider "small caliber stool" as one of the presenting signs of colorectal cancer (CRC). A review of the literature reveals that this rather lay misconception-i.e. presence of tumor results in narrowing of the colon, which in turn decreases the caliber of the stool-was conceived late in the nineteenth century. In the absence of reliable data to support this concept, the authors of gastroenterology textbooks in the mid-twentieth century practically dismissed the concept. Nevertheless, this misconception somehow permeated the standard textbooks of medicine and even the newer editions of text-books of gastroenterology. Our own everyday experience shows that low caliber stool is noticed whenever we have loose stool. Since diarrheal states are much more common than CRC, in the absence of authentic symptomatology of CRC, such as rectal bleeding, change in the bowel habit, tenesmus, left-sided abdominal cramps, anemia, etc., the referral of these patients for colonoscopy based solely on "decreased stool caliber" is unwarranted. Such unwarranted referrals expose the patients to unnecessary risks and discomforts and put a strain on an already over-stretched healthcare resources.

Emerging Health Properties of Whey Proteins and Their Clinical Implications

The nursery rhyme “Little Miss Muffet sat on a tuffet (small stool) eating her curds and whey. …” is recognition of the fact that over the centuries “curds and whey”, the two major components of cow's milk, have been widely accepted as part of a healthy diet. Milk provides complete nourishment for the neonate for six months from birth, containing factors that help develop various organ systems including the brain, immune system, and the intestine. Importantly it provides immune protection at a time when the neonates own immune system, though fully developed, is albeit immature. Many adult consumers include cow's milk as part of a healthy diet as it provides protein and essential nutrients, vitamins, and minerals, in particular calcium for strong bones. There is a growing appreciation that milk, and in particular whey, contains components that not only provide nutrition, but can also prevent and attenuate disease, or augment conventional therapies, when delivered in amounts that exceed normal dietary intakes. This paper reviews the emerging health properties of whey proteins and their clinical implications.

The Hot Air and Cold Facts of Dietary Fibre

Division of Gastroenterology, Faculty of Medicine, University of Calgary, Calgary, Alberta Correspondence: Dr Eldon A Shaffer, Division of Gastroenterology, Faculty of Medicine, University of Calgary, 3330 Hospital Drive South West, Calgary, Alberta T2N 4N1. Telephone 403-210-9363, fax 403-210-9358, e-mail shaffer@ucalgary.ca Received for publication July 28, 2005. Accepted August 2, 2005 America is a constipated nation.... If you pass small stools, you have to have large hospitals – Denis Burkitt

Clinical characteristics of collagenous and lymphocytic colitis

Background: Microscopic colitides (MC), collagenous colitis (CC) and lymphocytic colitis (LC) share clinical features, but their mutual relationship is unclear, and clinical comparative studies are rare. We aimed to examine the clinical features in CC and LC by focusing on concomitant diseases. Methods: Patients with MC (30 with CC, 54 with LC) were identified in the pathology databases and by reviewing biopsies. Controls included 84 age‐ and sex‐matched persons. The clinical data collected from patient records were prospectively completed by interviews. Results: The female:male ratio was 2:1 in CC and 5.75:1 in LC. Mean age at diagnosis was 53 in CC and 55.4 years in LC. There were no differences in the pattern of symptoms. Concomitant autoimmune diseases were more common in CC (53.3%) than in LC (25.9%; P = 0.017). Celiac disease was common in both CC (20%) and LC (14.8%). Bronchial asthma was associated with LC (25.9%), but not with CC (6.7%; P = 0.042). Colon diverticulosis was rare in MC (16%) compared with the controls (39%; P = 0.001). Hypolactasia was common in MC (45%; 76% in CC, 54% in LC) compared to its prevalence in the Finnish general population (17%). Conclusions: CC and LC are largely similar clinically, but the differences in the occurrence of autoimmune conditions and bronchial asthma suggest that they differ in immunopathogenesis. MC is associated with reduced lactose tolerance and shows a negative association with diverticular disease, possibly related to the small intestinal pathology and abnormal stool consistency.

Eficácia da confecção de válvulas colônicas após ressecção retoanal em ratos

OBJETIVO: Testar a eficácia da construção de válvulas colônicas após a ressecção retoanal em ratos, para se obter retardo do fluxo intestinal. MÉTODO: Análise clínico-evolutiva, radiológica e anatomopatológica de 31 ratos submetidos a duas seromiotomias circunferenciais transversais no cólon com invaginação sero-serosa e ressecção retoanal, com colostomia perineal. RESULTADOS: Sete ratos morreram no pós-operatório e, necropsiados, apresentavam impactação fecal. Houve redução do peso corporal e fecal no pós-operatório imediato (estatisticamente não significante), seguida de aparente normalização dos valores. Fecalitos aderidos uns aos outros foram freqüentes. Dos 24 animais radiografados, em oito, ao menos uma das válvulas estava visível. Após a necropsia de 21 ratos, constatou-se o predomínio absoluto de fezes a montante das válvulas. Macroscopicamente, nem sempre as válvulas foram identificadas. Na microscopia, encontrou-se hipertrofia das fibras musculares e interrupção da camada muscular com alteração na disposição das fibras e fibrose nos locais da seromiotomia. CONCLUSÕES: A operação foi tecnicamente viável. A presença das fezes a montante das válvulas, a eliminação de fezes aderidas, a hipertrofia e a interrupção da camada muscular reforçam a hipótese de que a seromiotomia age como mecanismo frenador, retardando o trânsito intestinal. O modelo experimental não permite aferir sobre continência fecal.

Correlation between Faecal Excretion of Indium-111-Labelled Granulocytes and Calprotectin, a Granulocyte Marker Protein, in Patients with Inflammatory Bowel Disease

Background: Several studies have suggested that clinical indices of disease activity in inflammatory bowel disease (IBD) do not adequately reflect the degree of inflammation in most such patients. Faecal excretion of indium-111-labelled neutrophilic granulocytes has been suggested as the gold standard of disease activity, but its complexity and high cost and the exposure of patients to ionizing irradiation have limited the use of this technique. The aim of this study was to investigate the correlation between the faecal excretion of the granulocyte marker protein calprotectin and that of 111In-labelled granulocytes. Methods: Calprotectin in stool extracts from 19 patients with Crohn's disease (CD), 10 with ulcerative colitis (UC), and 9 presumably healthy controls was assessed with a simple enzyme-linked immunosorbent assay. Simultaneously, the faecal excretion of autologous 111In-labelled granulocytes was measured. Results: There was a strong correlation between the average daily excretion of calprotectin and that of the total 3-day excretion of 111In-labelled granulocytes (r = 0.87, P < 0.0001). Furthermore, the concentration of calprotectin, assessed in a small stool sample on day 1, also correlated well with the excretion 111In-labelled granulocytes (r = 0.80, P < 0.0001). Conclusion: The results suggest that faecal calprotectin reflects the granulocyte migration through the gut wall in patients with IBD and hence might serve as a simple, inexpensive alternative to the indium-111 technique.

Constipation and encopresis in childhood.

1. Adel Abi-Hanna, MD 2. Alan M. Lake, MD* 1. 2. *Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD. 1. Constipation is a symptom, not a diagnosis, that has multiple etiologies and multiple alternative treatments. 2. Encopresis or fecal soiling has many etiologies, not all of which are associated with fecal retention or responsive to laxatives. 3. Children who have Hirschsprung disease almost never have encopresis because the aganglionic segment maintains tonic contraction due to the absence of inhibitory neurons containing nitric acid and vasoactive intestinal polypeptide. 4. Functional retentive constipation is associated with loss of lower colonic muscle tone and will not resolve until complete repetitive evacuation of the lower colon allows muscle tone to be restored. 5. Successful treatment of constipation and encopresis requires a combination of patient and parent education, medical therapy, nutritional intervention, behavioral modification, and long-term monitoring of compliance. Constipation is a very common frustration for children, parents, and physicians. It is reported to account for nearly 5% of all outpatient visits to pediatric clinics and more than 25% of all referrals to pediatric gastroenterologists. Painful defecation and encopresis (involuntary passage of stool from the anus) usually are the first manifestations noted. Constipation generally is defined by the hard nature of the stool, the pain associated with its passage, or the failure to pass three stools per week. It would be preferable to define constipation as the failure to evacuate the lower colon completely with a bowel movement. This allows the parents and physician to realize that a child who has three small stools daily may not yet have evacuated the colon, while a child who has two large soft stools a week may not be constipated. The frequency of stools in most children decreases from a mean of four per day in the first week of life to 1.7 per day by the age of 2 years. Over this interval, stool volume increases more than tenfold while maintaining …

Constipation and Encopresis in Childhood

Constipation and Encopresis in Childhood

Diarrhoea

Diarrhoea is defined as the passage of more than 3 loose stools a day, due to an increase in stool water content (Watson, 1993). It should be differentiated from frequent passage of small volume stools and from faecal incontinence. There is a wide variation in normal bowel habit, which makes a more precise definition impossible.

Primary Health Care at the Village Level

The room was bare but for a mound of brown rice in the corner, a small wooden stool missing a leg, and two ceramic pots. The tiny infant lay snugly bundled on a straw mat beside its mother. For the woman, at age 24, this was her third baby. She smiled broadly as she spoke of the baby, who had been delivered at home the evening before, after she had gone into premature labor at 36 weeks. We examined the infant to make sure that there were no signs of umbilical sepsis—the cord had been cut by the grandmother with an unclean knife. The child looked healthy, although small for gestational age. We briefly reviewed with the mother proper breast-feeding technique. Then, touching our palms together in a farewell "namaste," we left the hut. I was accompanying two nurses in Tamil Nadu, South India, as they made their daily "home