Biomedical subjects
Publications and source records attributed to R R Babb.
The diagnosis of colonic varices, a rare cause of gastrointestinal hemorrhage, may be exceedingly difficult. If this entity is not considered, a rectal or colonic biopsy may lead to brisk and dangerous bleeding, as in our patient on two separate occasions. Once the diagnosis is made, appropriate surgery will prevent future bleeding episodes.
Charcot-Leyden crystals are associated with the active proliferation of eosinophils and are nonspecific.
Acute fulminating amoebic colitis is a very uncommon complication of amoebiasis. Most patients die, with or without surgery. We report such a patient who survived after total colectomy. If an excision of diseased colon is done, an exteriorising procedure should be added and primary anastomosis avoided.
Patients with chronic diarrhea should be carefully questioned about their diet. A correlation may be found between gastrointestinal symptoms and the ingestion of coffee, milk, or sugars such as sorbitol and fructose. If the offending agent can be identified and withdrawn from the diet, the diarrhea will stop and further evaluation can be avoided.
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There are clinical and laboratory associations between thyroid and liver disease. Patients with chronic liver disease may have thyroiditis, hyperthyroidism, or hypothyroidism. Occasionally, alcoholics with active cirrhosis will show eye signs or laboratory evidence of hyperthyroidism, and yet be euthyroid on further testing. Patients with subacute thyroiditis or hyperthyroidism may have abnormalities in liver function tests which return to normal as the thyroid condition improves. In similar fashion, patients with acute or chronic liver disease may have changes in thyroid function tests which improves as the liver inflammation resolves. These interrelationships must be remembered if errors in patient care are to be avoided.
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Acute proctitis is a nonspecific disease secondary to many specific causes. These include ulcerative colitis, Crohn's disease, enteric infections, venereal disease, antibiotics, ischemia, and radiation therapy. Clinicians should avoid making a diagnosis until appropriate tests such as sigmoidoscopy, rectal biopsy, and stool analysis have been done.
Cimetidine has now been on the market for over three years and appears to be safe and effective. Its beneficial effect in the short-term treatment of peptic ulcer disease in the duodenum is well documented, and it appears to be helpful in preventing ulcer relapse. It may also be therapeutic in other diseases associated with gastric acid abnormalities. Cimetidine may cause mental confusion and should be used with caution and in reduced dosage in the presence of hepatic or renal disease, or both, and in elderly patients. Other potential problems include neutropenia, reduced sperm count, and potentiation of warfarin.
An immediate hypersensitivity reaction with mast cell degranulation may be of importance in the pathogenesis of ulcerative colitis. Cromolyn sodium stabilizes the mast cell membrane, and thus could have potential benefit in the treatment of this disease. The few clinical studies published to date are difficult to interpret, and have not established the therapeutic benefit of cromolyn sodium in ulcerative colitis.
During a one-year period 420 middle-aged patients were examined as part of the executive health program at the Palo Alto Clinic. Of these, 30 percent were found to have at least one disease and 20 percent to have at least one laboratory abnormality. It is concluded that such examinations are worthwhile, especially in identifying self-destructive habits and serious emotional illnesses in busy, highly motivated executives.
Because of the form of sexual contact and the number of such contacts among homosexual men, physicians should be watchful for sexually transmitted infections in the homosexual community. Hepatitis B, anorectal gonorrhea, shigellosis, amebiasis, and giardiasis are now known to be among these infections. For treatment to be effective and epidemics avoided, physicians should question affected male patients about their sexual habits and advise abstinence from sexual contact until treatment is finished and cultures or smears are negative.
Abdominal paracentesis is a useful and safe technique in the evaluation of ascites. The withdrawn ascitic fluid should be routinely analyzed for appearance, blood cell count, and amylase and total protein concentrations; examined cytologically; and cultured. Results should either substantiate the clinical diagnosis or alert the clinician to the presence of previously unsuspected disease.
Indications for the use of total parenteral nutrition (TPN) in the treatment of inflammatory bowel disease include improvement of nutrition in the pre- and postoperative periods, management of gastrointestinal fistulas and as an adjunct to medical therapy. In general, patients with Crohn's disease respond better than those with ulcerative colitis. TPN is supportive and does not lead to a long-lasting cure in most cases.
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