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[Treatment of hemorrhagic rectocolitis].

Ulcerative colitis (UC) is a chronic inflammatory disease usually localized to the mucosa of the rectum and colon. Its cause remains unknown. A few fundamental notions underlie the therapeutic approach: (1) UC generally evolves by acute episodes separated by remissions, and the therapeutic indications depend on the severity and periodicity of these acute episodes; (2) although UC is a usually benign disease it may kill in two circumstances: when a severe (or complicated) acute episode is operated belatedly, or when cancer of the colon develops; (3) the present medical treatment only has a suspensive effect on the disease; the maintenance treatment must be taken for life; (4) only total proctocolectomy can provide complete cure, and until recently this procedure required permanent ileostomy. The recently introduced ileo-anal anastomosis (after total colectomy and rectal mucosectomy) gives the same results and enable the natural anus to be spared.

Colectomy↗

[Relevance and therapeutic implications of dysplasia in the follow-up of ulcerative rectocolitis].

Long standing ulcerative colitis (UC) is a condition capable of malignant transformation. Even if the rate of occurrence of carcinoma differs considerably among the various series, there is general agreement that it can be detectable in advance through the finding of glandular dysplasia. The Authors examine such a problem in a series of 27 patients submitted to clinical and endoscopic follow-up from 1984 to 1989. During this study a total of 237 rectosigmoidoscopies, 83 colonoscopies and 71 histologic exams were performed. At the outset mild or moderate dysplasia was found in 5 cases (18%). However, in the follow-up no evidence of dysplasia was detectable in 4 of the 5 cases. In the remaining case dysplasia was present only in one control. It was not found in the subsequent two histologic examinations. In our limited experience the incidence of dysplasia was not significant enough to require a prophylactic proctocolectomy. Instead a frequent and thorough endoscopic follow-up is recommended.

Adolescent↗

[Respiratory manifestations of hemorrhagic rectocolitis].

Several respiratory complications have been described in patients with ulcerative colitis (UC), and are the subject of this review. Involvement of the bronchial tree is the most frequent of them. Chronic bronchitis (16 patients) and bilateral bronchiectasis (16 patients) are responsible for chronic disabling bronchial suppuration. Symptoms related to the bronchial disease most often develop in patients in whom the diagnosis of ulcerative colitis is already established (88% of cases). Occurrence before the diagnosis of UC is possible, but unusual. Bronchial involvement can develop in patients whose UC is in complete remission, or who have undergone coloproctectomy up to several years earlier. Impressive improvement of cough and sputum production commonly occur following inhaled steroids. This is of great diagnostic and therapeutic significance. Other complications include subacute asphyxiating tracheal obstruction due to intralumenal inflammatory overgrowth (1 patient), small airways disease and panbronchiolitis (2 patients), BOOP (4 patients), pulmonary angiitis (6 patients), desquamative interstitial pneumonitis and granulomatosis (2 and 3 patients respectively), biapical pulmonary infiltrates (2 patients) and serositis. In addition, UC patients can develop less specific pulmonary problems such as pulmonary edema, pulmonary embolism and sulfasalazopyridine-induced pneumonitis and fibrosis.

Bronchial Diseases↗

[Ileo-anal pouch anastomosis: results in ulcero-hemorrhagic rectocolitis and in familial adenomatous polyposis].

Two hundred twenty-four ileal pouch-anal anastomoses have been made, 122 for ulcerative colitis and 102 for familial adenomatous polyposis. All the patients had a J pouch and a diverting temporary ileostomy. Mortality was 0.5%. Twenty-eight % of the patients with ulcerative colitis and 24% of the patients with familial adenomatous polyposis had various postoperative complications. Seventy-two patients with ulcerative colitis had a follow-up of more than one year. They had a mean of 4.6 stools per 24 hours; 84% had a normal day-time continence and 70% a normal nocturnal continence. Sixty-nine patients with familial adenomatous polyposis had a follow-up of more than one year. They had a mean of 4.1 stools per 24 hours; 93% had a normal daytime continence and 91% a normal nocturnal continence. In conclusion, ileal pouch-anal anastomosis can be made safely, with good functional results.

Adenomatous Polyposis Coli↗

[Efficacy and tolerability of 5-aminosalicylic acid in the short-term treatment of ulcerative rectocolitis during the mild or moderate stage].

The aim of the study was to compare the efficacy and side-effects of 5-ASA and SASP in the treatment of active ulcerative colitis. An improvement was seen in 71.4% (5-ASA) and 70.3% (SASP) but there were no complete remissions. The incidence of improvements was only 36.3% (5-ASA) and 37.5% (SASP) in pancolitis. The side-effects appeared in 14.2% (5-ASA) and 21% (SASP).

Adult↗

[Ileal pouch in the treatment of ulcerative rectocolitis and familial polyposis. Analysis of morbidity in a series of 30 cases].

Between 1984 and 1989, 30 patients underwent total coloproctectomy with J ileal pouch and ileo-anal anastomosis. They corresponded to 29 cases of ulcerative colitis and one case of familial polyposis. The authors report their own experience and the related morbidity and functional results. There were 23% fistulae, 6.6% pouchitis, 10% stenoses, 8.7% pelvic abscesses, 10% bowel obstructions, 6.6% fistulae after ileostomy closure. Only one pouch had to be removed for severe pouchitis. Functional results were partly related to post-operative complications: 50% of patients had normal continence, 57% at least 6 stools per day, 81% had one stool per night, 15% had soiling. Morbidity is discussed for the various types of complications.

Adenomatous Polyposis Coli↗

[Cytomegalovirus and herpes simplex virus antibodies in patients with idiopathic ulcerative rectocolitis].

The total and fractioned titres of circulating anticytomegalovirus (CMV) and antiherpesvirus (HSV) antibodies were evaluated in 63 idiopathic ulcerative proctocolitis patients in follow-up. The population was disaggregated applying criteria related to the stage of the disease: duration, extension, number of observed relapses over the follow-up. It was noted that just the anti-HSV antibodies were correlated in a statistically significant way to the extension (p less than 0.025) and duration (p less than 0.025) of the disease. We believe that this behaviour is a manifestation of the disease and that the antiHSV titration may be included in a score of evaluation during the follow-up.

Adult↗