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PubMed1992

Ulcerative colitis complicated by Wenckebach atrioventricular block.

Extracolonic manifestations of inflammatory bowel disease are common and diverse. Cardiac complications, however, are rare and of these pericarditis is the most frequently described association. A 57 year old man with a 20 year history of ulcerative colitis presented with a four day history of retrosternal chest pain and exertional dyspnoea. Electrocardiogram showed Wenckebach atrioventricular block. Three days later he developed bloody diarrhoea and sigmoidoscopy showed active proctocolitis. He was treated with oral prednisolone after which the chest pain and diarrhoea settled within 48 hours. At outpatient review two weeks later he was completely well and the electrocardiogram had returned to normal.

Colitis, Ulcerative↗
PubMed1983

Isolation of Chlamydia trachomatis from prostatic fluid in association with inflammatory joint or eye disease.

We describe two patients, one with peripheral arthritis, sacro-iliitis, positive HLA B27, and autoantibodies to smooth muscle and gastric parietal cell; the other with aphthoid ulcers, geographical tongue, conjunctivitis, anterior uveitis, peripheral arthralgia, and diarrhoea with distal proctocolitis. Neither patient would have been diagnosed as having urethritis on the basis of accepted microscopic criteria. In both patients, however, Chlamydia trachomatis was isolated from the prostatic fluid, but not the urethra.

Adult↗
PubMed1999

Radiation-associated rectal cancer: report of four cases.

BACKGROUND/AIMS: Radiation-associated rectal cancer is a remarkable clinical entity. We demonstrate 4 patients (mean age 68 years, range 63-74) who had undergone pelvic radiotherapy for cervical cancer. We indicate some characteristics of radiation-associated rectal cancer. RESULTS: Two patients had received intracavitary and external pelvic radiotherapy, while the remaining 2 had external pelvic radiotherapy following hysterectomy. The mean total radiation dose was 63 Gy, though radiation dose information was not available for 1 patient. Colorectal cancer developed at a mean time of 20.7 years (range 11-30) after radiation therapy. All patients presented with chronic radiation colitis, and 3 demonstrated abnormal tumor markers. Colonoscopy revealed an ulcerative, localized well-differentiated adenocarcinoma of the rectosigmoid colon in 1 patient, and diffusely infiltrating cancers of the lower rectum, one signet-ring cell carcinoma and two mucinous carcinomas in the remaining 3. One case was stage I, 2 were stage IIIa, and the remaining case was stage IV. Three patients underwent abdominoperineal resection. The remaining patient was felt to be inoperable. The colorectal wall demonstrated the changes of chronic radiation injury. Two patients died within a short time because of their advanced cancers. CONCLUSION: Radiation-associated rectal cancer has a tendency to be diagnosed in the advanced stage and to have a poor prognosis. A literature review and our case report suggest that since there are no reliable clinical or laboratory indicators of the presence of a curable colorectal cancer in the setting of chronic radiation proctocolitis, surveillance with a colonoscope should be done 10 years after irradiation in patients with previous pelvic radiotherapy.

Aged↗
PubMed1987

Inflammatory bowel disease: one condition or two?

Demographic data obtained from epidemiological studies of Crohn's disease and ulcerative proctocolitis in Regio Leiden (Leiden health care region) were compared. Ulcerative colitis (6.8 cases/10(5) population/year) had an incidence almost twice that of Crohn's disease (3.9/10(5)/year; p less than 0.001). Each disease occurred with equal frequency in both sexes and diagnosis of the diseases occurred at similar ages (Spearman's correlation coefficient = 0.84; p less than 0.01). Where ulcerative colitis was common in the various municipalities so was Crohn's disease (Spearman's correlation coefficient = 0.88; p less than 0.001). No cases of Crohn's disease were identified amongst migrants, but 6 cases of ulcerative colitis (prevalence = 85/10(5); 95% confidence interval = 35-195) were found. This difference was significance (p less than 0.05). It seems likely that the two diseases may simply represent the opposite ends of a continuous spectrum of inflammatory bowel disease.

Colitis, Ulcerative↗
PubMed1987

Fulminant ulcerative colitis in late pregnancy and the puerperium.

Four patients underwent emergency colectomy during pregnancy or the puerperium for complications of ulcerative proctocolitis. Three had inactive colitis at conception, while in the fourth the disease started during pregnancy. Three patients required subtotal colectomy and ileostomy for toxic dilatation during the third trimester or within 5 days of delivery, and the fourth underwent proctocolectomy postpartum for intractable colitis. There were no maternal deaths but 2 of 4 infants died. One child weighing 1.4 kg survived vaginal delivery during the 33rd week of pregnancy, 2 weeks after his mother had undergone emergency colectomy.

Acute Disease↗
PubMed1979

Clinical and morphological characteristics of colitis carcinoma and colorectal carcinoma in young people.

Two series of young patients (less than 40 years of age) with colorectal carcinoma (22 idiopathic carcinomas and 25 carcinomas complicating ulcerative proctocolitis), well matched for age and sex, were compared with regard to clinical features, tumour morphology and stage, and ultimate outcome after surgery. The cure rate in both series was low. Although a failure to diagnose colitis carcinoma accurately at an early stage might have contributed to the poor results, such a delay could hardly be responsible for the bad prognosis in patients with idiopathic carcinoma. The vast majority of the patients in both groups studied had highly malignant and/or mucoid adenocarcinoma, and surgery was palliative in about 40% of the patients in both series, owing to widespread dissemination. The general impression gained from this study of factors of histologic grade of malignancy, extent of spread, and survival rate was that colorectal carcinomas in the young, irrespective of being idiopathic or complicating ulcerative colitis, run a rapid course and have a gloomy prognosis. The outloook depends largely on the biologic characteristics of the tumours concerned. The results support previous statements that prophylactic surgery is justified in patients with long-standing ulcerative colitis with total involvement of the colon, particularly in the young. Regrettably, patients with idiopathic carcinoma will not have this chance.

Adenocarcinoma, Mucinous↗
PubMed1990

Role of rectal formulations: suppositories.

Mesalazine (5-aminosalicylic acid) suppositories are safe, effective, well tolerated, and well retained in patients with active distal proctitis. The best results are seen in patients with idiopathic ulcerative proctitis. Approximately 85% of these patients are healed within 4 weeks and virtually 100% by 10 weeks, with mucosal healing and complete loss of symptoms. Suppositories cover the last 20 cm of the rectum, as shown by technetium labelling. Maintenance therapy using suppositories alone--in doses varying from 500 mg every second bedtime to 1000 mg per day in divided doses--is at least as effective as oral sulphasalazine. Mesalazine suppositories are also useful in treating patients with Crohn's disease affecting the rectum, although the response rate is slower and healing is incomplete in half the patients treated. In the rare solitary rectal ulcer syndrome, mesalazine suppositories may be as efficacious as mesalazine enemas. Patient compliance and dramatic response even when conventional therapy has failed make an excellent case for mesalazine suppositories being the treatment of choice for distal ulcerative proctocolitis.

Administration, Rectal↗
PubMed1993

Incidence and characteristics of pouchitis in the Kock continent ileostomy and the pelvic pouch.

The incidence, the median time to first appearance, and the clinical pattern of pouchitis were prospectively studied in 180 patients operated on for ulcerative proctocolitis with a continent ileostomy (CI; 84 patients) and a pelvic pouch (PP; 96 patients). Median follow-up for CI patients was 8.5 years (range, 2-15 years) and for PP patients, 5 years (range, 1-8 years). Pouchitis, with symptoms severe enough to require treatment, developed in 33% (28 of 84) of CI and 47% (45 of 96) of PP patients. The cumulative risk of developing one or more episodes of pouchitis over a 5-year follow-up was 34% in CI patients and 51% in PP patients. The median time to first appearance of pouchitis was 5 and 12 months, respectively. Eighty-six per cent of CI patients with pouchitis (24 of 28) and 71% of PP patients (32 of 45) experienced their initial episode within the first 2 years. Sixty-four per cent (18 of 28) of the CI patients and 76% (34 of 45) of PP patients had one single or a few short-lasting episodes of pouchitis with various symptom-free intervals, whereas 18% of patients in each group (5 of 28 CI patients, 8 of 45 PP patients) had frequent relapses. Most of these patients responded promptly to metronidazole treatment. Eighteen per cent (5 of 28) of CI patients and 6% (3 of 45) of PP patients had long-lasting episodes with a poor response to treatment. In this long-term study the pouch inflammation proved eventually to be Crohn's disease in four patients (2.2%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Laser Doppler assessment of human colonic blood flow.

We have used laser Doppler flowmetry to assess human colonic blood flow in patients with healthy mucosa and in those with active proctitis. We report a significant correlation between colonic serosal laser Doppler flux readings and serosal tissue oxygen tension (n = 45: r = 0.671: p = 0.001). Mucosal blood flow was measured using the PF309 probe of a Perimed Pf2b set on 12 kHz frequency shift. There was no significant difference throughout the colon in healthy patients. The flow in rectal mucosa was significantly higher in patients with proctocolitis than in normal mucosa.

Colon↗
PubMed1992

Chronic colitis associated with human immunodeficiency virus infection.

OBJECTIVE: A clinical and pathological description of chronic colitis associated with human immunodeficiency virus (HIV) infection. DESIGN: A retrospective case review. SETTING: Tertiary referral institution and specialist gastroenterology practice. PATIENTS: A series of six patients with human immunodeficiency virus infection and chronic colitis observed for up to four years. RESULTS: The six patients had chronic diarrhoea for longer than six months, rectal bleeding, abdominal pain and stool leukocytosis. The mucosal pattern on colonoscopy showed diffuse proctocolitis, consisting of contact bleeding, superficial ulcerations, exudates, and/or loss of vascular pattern. Colonic biopsies showed a persisting diffuse colitis characterised principally by a mixed inflammatory cell infiltrate (mononuclear cells and neutrophils) and essentially preserved crypt architecture after six to 39 months of histological follow-up. The histopathology over this time frame was not typical of ulcerative colitis or Crohn's disease, nor of the conventionally described forms of infective colitis. HIV nucleic acid was identified by insitu hybridisation in colonic biopsies from four patients. In two of three patients tested, the presence of HIV DNA was confirmed by Southern blot analysis. No other microbial agent could be demonstrated as the cause of diarrhoea. At presentation all patients had CD4+ lymphocyte counts greater than 265 x 10(6)/L and none had the acquired immunodeficiency syndrome. Four patients have gone into remission, the other two patients were not in remission at four and a half to five years after onset. CONCLUSION: We suggest that chronic colitis may represent a new entity related to infection of the colon with human immunodeficiency virus.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Infections with Campylobacter jejuni and Campylobacter-like organisms in homosexual men.

In studies of the cause of gastrointestinal symptoms in homosexual men, Campylobacter jejuni was recovered from 10 of 158 men with, and 2 of 75 men without, intestinal symptoms. In addition, a heterogeneous group of Campylobacter-like organisms was identified in 26 symptomatic and 6 asymptomatic homosexual men, but in none of 150 heterosexual men and women. Infections with Campylobacter-like organisms, like infections with C. jejuni, were significantly associated with the sexual practice of anilinctus and were usually associated with diarrhea, abdominal cramps, and hematochezia; proctocolitis seen at sigmoidoscopy; increased numbers of leukocytes seen on rectal smears; acute inflammatory changes seen on rectal biopsy specimens; and a serum antibody response to the infecting organism.

Adult↗
PubMed1984

Bacteremia caused by Campylobacter-like organisms in two male homosexuals.

Bacteremia caused by newly described Campylobacter-like organisms occurred in two immunosuppressed homosexual patients with tuberculosis. Although these organisms grow well in aerobic bottles using a radiometric blood culture system, they are not readily seen in gram-stained smears and are easily missed if routine subculture methods are used. Microscopic examination of wet preparations and subculture to brucella agar base supplemented with 10% sheep blood and incubated in microaerophilic conditions are useful for identification and isolation. The recovery of Campylobacter-like organisms from the blood suggests that these organisms, formerly known only to be associated with proctocolitis or asymptomatic rectal infection in homosexual men, can also cause systemic infection in these patients.

Adult↗
PubMed1999

Pericardial abscess--a rare complication of sepsis.

Pericardial abscess is a very rare complication of sepsis. Authors describe the case of a 69-year-old woman. In her case staphylococcus sepsis led to pericardial abscess. During the course positive blood cultures (3x) indicated the sepsis and pus was obtained from the left pleural cavity (pleuropneumonia). Concomitant purulent process in the left shoulder also was noted. Decline immunity due to long-standing corticoid therapy (prednisone) for proctocolitis idiopathica was observed. Following antibiotic treatment successful surgical evacuation of the pericardial abscess was performed.

Abscess↗
PubMed1998

Colonoscopic findings in Kenyan African patients.

OBJECTIVE: To determine the types and prevalence of colonic diseases in Kenyan African patients referred for colonoscopy with lower gastrointestinal tract symptoms. DESIGN: A cross sectional survey conducted over a two year period. SETTING: Major private hospitals in Nairobi. PATIENTS: Two hundred forty seven consecutive patients of both sexes and all ages referred for colonoscopy between January 1996 and December 1997. Only Kenyans of African origin were included. Patients were referred from all over the country though the majority of cases were from Nairobi and its surrounding districts. RESULTS: The major indications for colonoscopy were lower abdominal pain (35.6%), non-bloody diarrhoea (22.3%), constipation (21.4%) and rectal bleeding (19.8%). Nearly 53% of patients colonoscoped had abnormal mucosal findings, with the main abnormalities being: proctocolitis (20.2%), colorectal cancers (12.1%), haemorrhoids (7.3%), colorectal polyps (6.5%) and diverticulosis (5.3%). The main histological diagnosis among patients whose colonic biopsy were done included normal colonic mucosa (29%), non-specific colitis (28.5%), adenocarcinoma (18.2%), benign colonic polyp (9.7%) and ulcerative colitis (7.3%). There was one case of Crohn's colitis and five cases (3%) of infective colitis. CONCLUSION: The study shows that the African colon has a number of pathological lesions contrary to previous reported literature.

Adolescent↗
PubMed1999

Drug treatment of common STDs: Part II. Vaginal infections, pelvic inflammatory disease and genital warts.

The Centers for Disease Control and Prevention (CDC) released new guidelines for the treatment of sexually transmitted diseases (STDs) in 1998. Several treatment advances have been made since the previous guidelines were published. Part II of this two-part series on STDs describes recommendations for the treatment of diseases characterized by vaginal discharge, pelvic inflammatory disease, epididymitis, human papillomavirus infection, proctitis, proctocolitis, enteritis and ectoparasitic diseases. Single-dose therapies are recommended for the treatment of several of these diseases. A single 1-g dose of oral azithromycin is as effective as a seven-day course of oral doxycycline, 100 mg twice a day, for the treatment of chlamydial infection. Erythromycin and ofloxacin are alternative agents. Four single-dose therapies are now recommended for the management of uncomplicated gonococcal infections, including 400 mg of cefixime, 500 mg of ciprofloxacin, 125 mg of ceftriaxone or 400 mg of ofloxacin. Advances in the treatment of bacterial vaginosis also have been made. A seven-day course of oral metronidazole is still recommended for the treatment of bacterial vaginosis in pregnant women, but intravaginal clindamycin cream and metronidazole gel are now recommended in nonpregnant women. Single-dose therapy with 150 mg of oral fluconazole is a recommended treatment for vulvovaginal candidiasis. Two new topical treatments, podofilox and imiquimod, are available for patient self-administration to treat human papillomavirus infection. Permethrin cream is now the preferred agent for the treatment of pediculosis pubis and scabies.

Anti-Infective Agents↗
PubMed1999

[The concept, criteria for diagnosis, and disease classification of ulcerative colitis].

The concept of ulcerative colitis(UC) in Japan has been defined based on the definition of idiopathic proctocolitis by CIOMS. UC is an idiopathic, non-specific inflammatory disorder involving primarily the mucosa and submucosa of the colon, especially the rectum, often with mucosal erosions and ulcers. Criteria for diagnosis of UC consist of the following three conditions; one is continuous or repeated findings of hematochezia or mucous and bloody stools, second is colonoscopic and/or X ray findings characteristic of UC, and third is histopathological findings consistent with UC pathology. Disease classifications of UC are divided in many clinical aspects such as disease extents, disease activity, disease severity, clinical courses, endoscopic grades, and disease conditions for obtaining financial supports by Japanese government.

Colitis, Ulcerative↗
PubMed2000

[Rectal cancer associated with irradiation--case report].

The authors report one patient with rectal cancer after pelvic irradiation for gynaecological malignancy. The interval between irradiation and the diagnosis of rectal cancer was 31 years. Histological findings of radiation proctocolitis adjacent to the cancer were observed.

Adenocarcinoma↗
PubMedDate not supplied

[Diclofenac-induced colitis complicated by Klebsiella oxytoca infection].

A 25-year-old man presented with abdominal pain and bloody diarrhea. Colonoscopy showed hemorrhagic proctocolitis with superficial erosions. Histology was consistent with the diagnosis of ulcerative colitis and biopsy cultures were negative. Despite treatment with prednisolone (40 mg/day), his clinical condition deteriorated and he was referred to our institution. On repeated questioning, the patient reported self-medication with diclofenac (200 mg/day) for 6 weeks to treat tendinitis prior to the beginning of digestive symptoms. Rectosigmoidoscopy confirmed bleeding colitis and repeated biopsy cultures showed Klebsiella oxytoca. Corticosteroids were stopped and ofloxacin (400 mg/day) was prescribed for 14 days. Diarrhea quickly resolved. Colonoscopy 8 weeks later showed only patchy erythematous mucosa without bleeding or erosions. Two years later, the patient remains asymptomatic with normal total colonoscopy. The definitive diagnosis was de novo NSAID-induced colitis subsequently complicated by Klebsiella oxytoca infection.

Adult↗