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Biomedical subjects

A Cortot

Publications and source records attributed to A Cortot.

At least 73 records · Page 4Linked to original sources
PubMed1996

Chronic pancreatitis: a complication of sarcoidosis?

Gastrointestinal localizations of sarcoidosis are rare. A total of 14 cases of pancreatic involvement in sarcoidosis has been reported previously. We report here a case of late onset idiopathic chronic pancreatitis diagnosed at the same time as sarcoidosis with liver, colonic, renal, mediastinal and neurologic involvement in a 56-year-old man. This case further suggests a possible relationship between idiopathic chronic pancreatitis and multisystem diseases.

Age of Onset↗
PubMed1996

Specific antibody response to oligomannosidic epitopes in Crohn's disease.

Elevated antibody levels against the yeast Saccharomyces cerevisiae have been reported in sera from patients with Crohn's disease and not with ulcerative colitis. The aim of the study was to identify the nature of the epitopes supporting this antibody response. Whole cells from different S. cerevisiae strains were selected in immunofluorescence assay for their ability to differentiate the antibody responses of patients with Crohn's disease and ulcerative colitis. Their cell wall phosphopeptidomannans were then tested as antigen in enzyme-linked immunosorbent assay (ELISA) against sera from 42 patients with Crohn's disease, 20 patients with ulcerative colitis, and 34 healthy controls. Graded chemical degradations were performed on the most reactive strain phosphopeptidomannan. The discriminating epitope was determined through gas-liquid chromatography-mass spectrometry. The greatest discrimination among patients with Crohn's disease, ulcerative colitis, and controls was obtained with Su1, a S. cerevisiae strain used in brewing of beer. ELISA directed against phosphopeptidomannan of this strain was 64% sensitive and 77% specific for discriminating Crohn's disease versus ulcerative colitis and 71% sensitive and 89% specific for Crohn's disease versus controls. Periodate oxidation and selective degradation demonstrated that the most important polysaccharide epitope was shared by both the acid-stable and the alkali-labile domains of the phosphopeptidomannan. The determination of oligomannose sequences of S. cerevisiae Su1 phosphopeptidomannans suggested that a mannotetraose, Man (1 --> 3)Man(1 --> 2)Man(1 --> 2)Man, supported the serological response seen in Crohn's disease. Further identification of the immunogen eliciting this antibody response as a marker of the disease may help to understand its etiology.

Adult↗
PubMed1996

["Metastatic" Crohn's disease of the penis].

Inflammatory genital cutaneous involvement of Crohn's disease is a rare complication. In a 23 year old man, who had colonic Crohn's disease treated by colectomy 3 years earlier, a phimosis revealed a penile localisation of Crohn's disease. "Metastatic" locations of Crohn's disease are defined by granulomas sitting at a distance from the injured bowel. Their clinical manifestations are misleading and their course is independent of the digestive disease. In our patient, after failure of classical therapy, cyclosporin A permitted a slow regression.

Adult↗
PubMed1995

Hyperbaric oxygenation in severe perineal Crohn's disease.

PURPOSE: Perineal involvement in Crohn's disease is a common and distressing condition, often refractory to medical or surgical treatments. Recent reports suggest the efficacy of hyperbaric oxygenation (HBO) in the healing of perineal lesions. We evaluated HBO in severe patients with perineal Crohn's disease. METHODS: Ten consecutive patients (8 women, 2 men; mean age, 30 years) were studied. There were four superficial fissures, four cavitating ulcers, six low or superficial fistulas, two high fistulas, and one irreversible anal stenosis. All patients had received one or more medical treatments without healing the perineal lesions, and all had had previous surgery for perineal lesions. RESULTS: Two patients discontinued HBO after a few sessions and did not complete treatment. Eight patients completed at least 30 HBO sessions and were evaluable. At the end of the procedure, six of eight patients treated were healed, three completely and three partially. All patients who healed completely received HBO as an additional treatment to local perineal surgery. CONCLUSION: HBO might be useful as a last resort treatment of chronic perineal Crohn's disease, resistant to other treatments or as a complement to surgery.

Adult↗
PubMed1995

Biofeedback for the treatment of fecal incontinence. Long-term clinical results.

UNLABELLED: Biofeedback therapy has been proposed as a treatment for fecal incontinence with good, short-term results. PURPOSE: This study was designed to assess long-term clinical results of biofeedback therapy compared with medical therapy alone and to assess manometric results in patients treated with biofeedback. METHODS: Two groups of incontinent patients were studied. Group 1 consisted of 16 patients (3 males and 13 females; mean age, 59.9 years). Etiologies treated by biofeedback included descending perineum syndrome (7), postfistula or hemorroidectomy (4), and miscellaneous (5). Group 2 consisted of eight patients (two males, six females; mean age, 62.2 years). Etiologies treated with medical treatment alone (including enema and antidiarrheal therapy) included descending perineum syndrome (3), postfistula or hemorroidectomy (2), and miscellaneous (3). The incontinence score was initially 17.81 +/- 3.27 (standard deviation) in Group 1 and 17.0 +/- 2.77 in Group 2. Resting pressure of the upper and lower anal sphincter, maximum squeezing pressure, and duration of contraction were not initially different in Groups 1 and 2 but were significantly lower than in the control group of patients without incontinence (n = 12; 8 males, 4 females; mean age, 66.4 years) (P < 0.05). Follow-up duration was 30 months, with intermediate clinical score at 6 months for Group 1. RESULTS: After biofeedback therapy, the incontinence score at 30 months was lower in Group 1 (14.43 +/- 6.35 vs. 17.81 +/- 3.27; P < 0.035) and unchanged in Group 2 (18.0 +/- 2.72 vs. 17.0 +/- 2.77). However, in Group 1 the score at 6 months was much lower than at 30 months (6.31 +/- 7.81 vs. 14.43 +/- 6.35; P < 0.001). Only the amplitude of voluntary contraction and upper anal pressure (51.1 (range, 27-90) vs 36.7 (range, 20-80) mmHg) were significantly increased (81.5 (range, 55-120) vs. 62.1 (range, 30-90) mmHg; P < 0.05). CONCLUSION: Biofeedback improved continence at 6 months and at 30 months. However, the score at 6 months was much better, suggesting that the initial good results may deteriorate over a long time. These data suggest that it could be useful to reinitiate biofeedback therapy in some patients.

Adult↗
PubMed1995

Bacterial enzymes used for colon-specific drug delivery are decreased in active Crohn's disease.

Enzymes produced by colonic microflora have been proposed for triggering local delivery of antiinflammatory azo-bond drugs and prodrugs to the colon. This approach could be advantageous in steroid treatment of inflammatory bowel diseases, thus sparing steroids' side effects. We recently demonstrated that the metabolic activity of digestive flora, assessed on the activity of fecal glycosidases, was decreased in patients with active Crohn's disease. In the present study, the azoreductase activity in feces of 14 patients with active Crohn's disease was decreased (11.39 +/- 7.93 mU/g F) as compared with 12 healthy subjects (51.13 +/- 21.39 mU/g F). beta-D-Glucosidase and beta-D-glucuronidase activities in fecal homogenates incubated under anaerobic conditions were also decreased in patients. These data bring into question the therapeutic usefulness for those patients of azo-bond drugs and glycoside prodrugs. They could explain the therapeutic failure of some of those drugs in active ileocolic and colic Crohn's disease.

Adult↗
PubMed1995

Immunocytochemical evidence of Listeria, Escherichia coli, and Streptococcus antigens in Crohn's disease.

BACKGROUND/AIMS: Infectious agents have long been suspected of playing a role in the initiation of Crohn's disease. The objective of this study was to search for likely microbial agents in diseased tissues using immunocytochemical techniques. METHODS: Intestines and mesenteric lymph node specimens of 21 patients from two French families with a high frequency of Crohn's disease and from Connecticut were studied. The microbial agents searched for included Bacteroides vulgatus, Borrelia burgdorferi, Escherichia coli, Listeria monocytogenes, Streptococcus spp., bovine viral diarrhea virus, influenza A virus, measles virus, parainfluenza virus, and respiratory syncytial virus. RESULTS: Seventy-five percent of the patients with Crohn's disease (12 of 16) were positively labeled with the antibody to Listeria. Macrophages and giant cells immunolabeled for this antigen were distributed underneath ulcers, along fissures, around abscesses, within the lamina propria, in granulomas, and in the germinal centers of mesenteric lymph nodes. In addition, 57% (12 of 21) of the cases contained the E. coli antigen, and 44% (7 of 16) contained the streptococcal antigen. The immunolabeling for the latter two agents also occurred within macrophages and giant cells, distributed in a pattern similar to that of Listeria antigen. CONCLUSIONS: The results suggest that Listeria spp., E. coli, and streptococci, but not measles virus, play a role in the pathogenesis of Crohn's disease.

Antigens, Bacterial↗
PubMed1995

Comparison of budesonide and 5-aminosalicylic acid enemas in active distal ulcerative colitis.

BACKGROUND: Budesonide is a new corticosteroid with high topical anti-inflammatory activity but little systemic effect. The aim of the present study was to compare the efficacy and safety of budesonide enema (2 mg/100 mL) and 5-ASA enema (mesalazine 1 g/100 mL) given for 4 weeks in the treatment of active distal ulcerative colitis and proctitis. METHODS: Ninety-seven patients were studied in a multicentre single-blind randomized group-comparative trial. The primary efficacy variables were endoscopy and histopathology scores obtained at 0, 2 and 4 weeks. Clinical symptoms were the secondary efficacy variables. Haematology, chemistry and adverse events were the safety variables. RESULTS: Budesonide and 5-ASA enemas both resulted in a significant improvement in endoscopy and histopathology scores but no difference could be demonstrated between the two treatment groups. There was also a significant improvement of symptoms (number of bowel movements per day, quality of stools, presence of blood and mucus, and state of well-being) within both groups but no difference between the two treatment groups. The clinical remission rate at 4 weeks was, however, 38% for patients treated with budesonide enema but 60% for those treated with 5-ASA enema (P = 0.03). No adverse events attributed to the study drugs were recorded in either of the groups. CONCLUSIONS: Budesonide enema 2 mg/100 mL appears to be as efficient and well-tolerated as 5-ASA enema in the treatment of active distal ulcerative colitis and proctitis.

Adult↗
PubMed1995

Parallel interleukin 5 synthesis by eosinophils in duodenal and skin lesions of a patient with dermatitis herpetiformis.

A 59 year old man is presented with a diagnosis of dermatitis herpetiformis. Duodenal and skin biopsy specimens from blisters of both recent and late onset were collected before treatment. Electron microscopy, immunohistochemistry, and in situ hybridisation were performed to analyse the presence of activated eosinophils and the local synthesis of interleukin 5 (IL5). Parallel state of eosinophil activation and IL5 synthesis was found in the duodenal mucosa with total flat mucosa and in skin vesicles of recent onset. It is suggested that duodenal and cutaneous eosinophils can synthesise IL5 and then participate in small bowel and skin lesions.

Dermatitis Herpetiformis↗
PubMed1995

Activated eosinophils and interleukin 5 expression in early recurrence of Crohn's disease.

Endoscopic recurrences after radical surgery for Crohn's disease are useful for studying the pathogenesis of initial lesions of Crohn's disease. Factors predisposing to recurrence are poorly understood, but it has been shown that eosinophilic infiltration of the neoileum may occur within a few weeks of resection. The aim of this study was to compare, in nine patients having an ileocolectomy, the infiltration of eosinophils and their activation state in normal and diseased areas of the neoileum, three months after surgery. Tissue eosinophils were studied by histochemical methods and electron microscopy. Mucosal expression of interleukin 5 (IL 5), an important eosinophil activating factor was studied using in situ hybridisation. Sixty per cent of patients had endoscopic recurrence at three months. Eosinophil infiltration was more pronounced in diseased than in endoscopically normal areas and was associated with a high expression of IL 5 mRNA. Ultrastructural analysis showed features of eosinophil activation, but no cytotoxic lesions of surrounding inflammatory or epithelial cells. This study suggests that local synthesis of IL 5 associated with eosinophil activation in the tissues could participate in early mucosal damage in Crohn's disease.

Adult↗
PubMed1995

Remaining small bowel endoscopic lesions at surgery have no influence on early anastomotic recurrences in Crohn's disease.

OBJECTIVES: We recently demonstrated that 65% of patients operated on for Crohn's disease (CD) had lesions of the small bowel at perioperative endoscopy (POE). These lesions were unrecognized before surgery in more than half of the patients. The aim of this study was to assess the prognostic value of endoscopic small bowel lesions let in place at time of surgery on further anastomotic endoscopic relapse. METHODS: Twenty one patients (10 women, 11 men, mean age 34 yr) had an enteroscopy from the terminal ileum to the ligament of Treitz during an ileocolectomy performed for CD. All patients were subsequently enrolled in a placebo-controlled trial of mesalazine for the prevention of early endoscopic relapse; 10 patients received placebo, and 11 received mesalazine (1.5 g/day) for 12 wk after surgery. At the end of this trial, they all had a colonoscopy with inspection of the anastomosis and the neoterminal ileum. RESULTS: POE was completed up to the angle of Treitz in all 21 patients. In 10/21 cases (47%), mild lesions were found distributed at random along the small intestine 30 cm beyond the resection margin. At colonoscopy performed 12 wk later, lesions were found in 11/21 cases (52%) between section margin and were estimated to be 25 cm over the anastomosis. Endoscopic recurrence occurred in 5/10 patients who received placebo and 6/11 patients who received mesalazine. Endoscopic recurrence occurred in 5/10 patients having lesions at POE and in 6/11 patients who had no lesions. There was no relationship between endoscopic recurrence at 12 wk and presence of lesions at initial POE, whatever the postoperative treatment. CONCLUSION: Endoscopic lesions let in place after "curative" surgery have no influence on early endoscopic anastomotic recurrences in CD.

Adult↗
PubMed1995

Idiopathic acute pancreatitis and sarcoidosis.

Pancreatic involvement is rare in sarcoidosis. We describe a 30-year-old man who had two episodes of acute pancreatitis within one month with no current aetiology. Diagnosis of sarcoidosis was based on the presence of bilateral mediastinal adenopathies, alveolar lymphocytosis on bronchoalveolar lavage and biopsy of an enlarged lymph node showing multiple granulomas. This case and five others previously reported in the literature suggest the diagnosis of sarcoidosis should be considered in apparently acute idiopathic pancreatitis.

Acute Disease↗
PubMed1995

The relationship of granulomas to blood vessels in intestinal Crohn's disease.

It has been suggested that granulomatous vasculitis is a primary mechanism in the production of pathologic changes seen in Crohn's disease. We set out to investigate the relationship of granulomas to blood vessels and to confirm or refute previous reports of granulomatous vasculitis in Crohn's disease. Thirty paraffin embedded tissues from 11 patients with Crohn's disease were selected after examination of H&E stained sections for the presence of granulomas. Using an immunohistochemical method, various monoclonal antibodies were applied to sequential sections from each tissue to demonstrate vascular structures and granulomas. In three patients none of the granulomas occurred in association with blood vessels, in five a small proportion of the granulomas affected blood vessels, and in three granulomatous vasculitis appeared occlusive and significant. A total of 232 granulomas were identified, 22% of which were closely associated with blood vessels, which included both arteries and veins; 16% were perivascular, while 6% were intravascular. Perivascular granulomas did not surround blood vessels or invade the medial layers. They were asymmetric, suggesting that they originated by encroachment of nearby lymphatic or connective tissue granulomas. These results indicate that the granulomas of Crohn's disease are usually not associated with blood vessels; however, there is a minority of patients in whom vascular granulomatous inflammation may be important, although probably as a secondary phenomenon.

Adult↗