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Colonic complication of acute lymphoblastic leukaemia.

We present four unusual colonic complications of acute lymphoblastic leukaemia which occurred during the early induction period of chemotherapy. These included a transverse colitis, a haemorrhagic proctitis, a caeco-colic intussusception and an ileo-colic intussusception complicating typhlitis. Although complications are rare, they should be considered in the differential diagnosis of abdominal pain in children undergoing chemotherapy.

Antineoplastic Combined Chemotherapy Protocols↗

Incidence of ulcerative colitis in Stockholm County 1955-1979.

The epidemiology of ulcerative colitis in Stockholm County over a 25-year period, 1955-79, was investigated. Only definite cases in accordance with specified acceptance criteria were included. There were 1274 cases--681 males and 593 females. The proportion of patients with proctitis, left-sided, and total extent of disease of diagnosis remained constant over the study period, as did the time interval between onset of symptoms and definite diagnosis. The peak incidence in relation to age increased slightly but remained in the 3rd and 4th decade through the study period. The incidence in men over 40 years old increased markedly towards the end of the study.

Adolescent↗

Olsalazine in the treatment of active ulcerative colitis: a placebo controlled clinical trial and assessment of drug disposition.

The efficacy, safety and disposition of olsalazine was assessed in patients with left-sided ulcerative colitis or proctitis in a double-blind placebo controlled trial. Thirty patients with a mild-to-moderate attack of ulcerative colitis were randomly allocated to olsalazine capsules, 1 g b.d., or placebo for 6 weeks. Good clinical response was found in six patients receiving olsalazine and in two receiving placebo. Improvement in sigmoidoscopic findings and histological appearance of rectal biopsies was also seen more often in olsalazine-treated patients. Plasma concentrations of olsalazine were significantly higher in patients who improved. Olsalazine showed an advantage over placebo which needs to be confirmed by further studies; it was safe in sulphasalazine-sensitive patients but appeared to cause watery diarrhoea in two patients.

Aminosalicylic Acids↗

Treatment of ulcerative colitis with olsalazine and sulphasalazine: efficacy and side-effects.

The effects of olsalazine were studied mainly in patients with ulcerative colitis who were intolerant to sulphasalazine, and for relapse prevention. A crossover design with sulphasalazine, 3 g/day, and olsalazine, 1.5 g/day, was applied to compare the side-effects of each drug and to evaluate their therapeutic efficacy. A total of 41 patients with mild or moderately severe left-sided colitis or proctitis were assigned to a randomized treatment schedule. Olsalazine and sulphasalazine were similar in their therapeutic efficacy. Twelve patients complained of adverse effects while on sulphasalazine and 4 patients during olsalazine treatment (p less than 0.05). It is concluded that olsalazine is a safe and effective drug for the treatment of mild or moderately severe ulcerative colitis, and is comparable to sulphasalazine, though with reduced side-effects.

Adult↗

Ulcerative proctocolitis in Orebro, Sweden. A retrospective epidemiologic study, 1963-1987.

In a retrospective epidemiologic study of the period 1963 to 1987 the annual incidence of definite ulcerative proctocolitis increased from 3.3 to 14.9/10(5), and during the last 10 years the mean incidence was 13.1/10(5) population. The incidence of extensive and total colitis was fairly stable, whereas an increase of ulcerative proctitis and distal colitis was seen. The increase in incidence is probably an artefact caused by better retrieval of cases in the latter part of the study. The prevalence on 31 December 1987 was 234/10(5) inhabitants. The male to female ratio was 1.59:1, compared with 0.96:1 in the general population. The median age at diagnosis was 33 years and increased almost 7 years by the end of the study, probably caused by an increased proportion of ex-smokers, who at diagnosis were, on average, 9 years older than lifetime non-smokers. The highest age- and sex-specific incidence was found in middle-aged men, who were ex-smokers to a significantly higher extent than women. No specific birth cohort was at an increased risk, and no second incidence peak in older age groups was seen.

Adolescent↗

Functional alterations of the microflora in patients with ulcerative colitis.

The aim of the study was to examine microflora-associated characteristics in patients with inactive ulcerative colitis, receiving sulphasalazine, in relation to the spread of the disease. The conversion of cholesterol to coprostanol, the production of urobilinogen, and the degradation of tryptic activity (FTA) and beta-aspartylglycine were measured in faecal samples from patients with proctitis or left-sided or total ulcerative colitis and in age- and sex-matched controls. No significant differences in the results were observed in patients with various degrees of extension of inflammatory bowel disease. However, the coprostanol ratio and the urobilinogen level were lower and the FTA was higher in patients with colitis than in the controls (p < 0.05). Beta-aspartylglycine was not found in any faecal sample. The results indicate that patients with ulcerative colitis taking sulphasalazine have a microflora with abnormal metabolic characteristics.

Adult↗

Incidence of ulcerative colitis and indeterminate colitis in four counties of southeastern Norway, 1990-93. A prospective population-based study. The Inflammatory Bowel South-Eastern Norway (IBSEN) Study Group of Gastroenterologists.

BACKGROUND: The incidence of ulcerative colitis (UC) has been difficult to interpret because prospective studies have only been performed during the past 3 decades. Geographic variations may therefore be due to differences in study design. METHOD: From 1 January 1990 to 31 December 1993 all new cases of UC in four counties in southeastern Norway were prospectively registered. Cases diagnosed as indeterminate colitis (IND) when endoscopy and histopathology were inconclusive or diverged with regard to diagnosis of UC or Crohn's disease (CD) were also included in the study. RESULTS: A total of 525 cases of UC and 93 cases of IND yielded an mean annual incidence of 13.6/10(5) and 2.4/10(5), respectively. There were differences in incidence between counties, and a peak of 21.5/10(5) in the annual incidence was found for the age group 25 to 34 years in UC. The distribution was about equal for each of the groups proctitis and left-sided and extensive colitis. The time interval from onset of symptoms to diagnosis was 4 months. CONCLUSION: In this study one of the highest incidences of UC in the world has been found. The classification 'indeterminate colitis' seems reasonable to use in some of the cases to prevent misclassification at the initial stage of diagnosis.

Adolescent↗

Complications from irradiation of carcinoma of the uterine cervix.

The types and frequency of complications in 2248 patients irradiated for carcinoma of the cervix using different techniques are reported. Proctitis was the most frequent complication. Severe complications, such as fistulas, ureteral stenosis with hydronephrosis, enterocolitis, sigmoiditis, intestinal obstruction and skin necrosis occurred in 81 patients (3.6%). Only 36 patients (1.6%) developed fistulas.

Brachytherapy↗

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↗

Solitary rectal ulcer syndrome.

We report three cases of solitary rectal ulcer syndrome (SRUS). The diagnosis was established according to histopathologic criteria. But, the initial clinical diagnosis was carcinoma, non-specific ulcer and localized proctitis respectively. SRUS is considered as one of functional disorder in pelvic floor which might go underdiagnosed due to unfamiliar concept in Korea. So we should consider SRUS to be one of the differential diagnosis in cases of complaining anorectal symptoms.

Diagnosis, Differential↗

Neisseria gonorrhoeae in children.

By culturing for N gonorrhoeae in cases of neonates and children with conjunctivitis, vaginitis, urethritis, proctitis, sepsis, and arthritis, gonococcal infections can be identified easily. They are then treated with ceftriaxone. In neonates, the mother and her sexual contacts also should be treated. In children, a full evaluation for sexual contacts, with the assistance of other professionals, if necessary, will almost always identify a sexual contact. Appropriate action then can be taken to protect the child from further sexual contact. .

Abscess↗

[Cost of early management of chronic inflammatory intestinal disease].

OBJECTIVES: The aim of this study was to assess the cost of the first management of inflammatory bowel disease (IBD) from the onset of first symptoms until 6 weeks after the diagnosis. This cost was calculated in French francs (FF) for all IBD and namely for Crohn's disease (CD), ulcerative colitis (UC), and ulcerative proctitis (UP). MATERIAL AND METHODS: Data concerning 258 patients were collected by the mean of a standardized questionnaire from 3 different sources: the patient, his general practitioner, and his gastroenterologist. RESULTS: Two hundred and fifty eight patients were included: 144 CD (55.8%), 76 UC (29.5%), 30 UP (11.6%), and 8 chronic unclassifiable colitis (CUC) (3.1%). The mean direct costs of the diagnosis (m +/- SD) were 23,116 +/- 40,820 FF for CD, 10,628 +/- 17,316 FF for UC and 3,451 +/- 2,743 FF for UP. Although unplanned hospitalizations occurred in only 38% of the patients (98/258), they represented the 3/4 of the mean costs: 78.2% for CD and 64% for UC. Indirect costs generated by days off work were 4,719 +/- 6,610 FF for CD, 2,996 +/- 6,897 FF for UC and 1,230 +/- 3,622 FF for UP. CONCLUSION: The first management of a patient with CD was twice more expensive than the one with UC and 6.5 times than the one with UP.

Adolescent↗

[Incidence of inflammatory bowel disease in Aragon: outcome of a prospective population-based study].

OBJECTIVE: To identify every new case of ulcerative colitis (UC) (including ulcerative proctitis), Crohn's disease (CD) and indeterminate colitis (IC) in Aragon, in Spain (population: 1,189,000, area: 47,719 km2) and to compare the incidence in this region with that in the rest of Spain and Europe. PATIENTS AND METHODS: We designed a prospective, population-based study based on inception cohorts. During a 3-year predetermined period (1st February 1992-31st January 1995) we identified every new case of inflammatory bowel disease in Aragon by checking the records in all the hospitals, outpatient clinics and private practices in this region. RESULTS: The overall adjusted incidence rate per 100,000 inhabitants/year was 7.2 for UC (a figure lower than the average for Europe) and 3.9 for Crohn's disease (a rate similar to that of Southern Europe). These rates are much higher than those previously described in Spanish studies, probably due to the design and methods used as well as to a real increase in the incidence of CD in Spain. The age and sex pattern was similar to those other studies. CONCLUSIONS: The incidence rates for inflammatory bowel disease in Aragon are higher than those previously described, the incidence of UC being inferior to that of Europe. Nevertheless, the incidence of CD is similar the average for southern Europe, which suggests that there has been a recent increase in the incidence of this disease in Aragon.

Adolescent↗

[Mesalamine-induced hypersensitivity pneumonitis].

A 23-year-old woman was admitted with a history of 2 weeks of cough, fever and bilateral lung infiltrates. She had been diagnosed 2 months before as having ulcerative proctitis and was treated with mesalamine, which induced a full remission, but 3 antibiotic regimens failed to improve her lung disease. Since computerized tomography revealed bilateral peripheral lung infiltrates and her eosinophile count was elevated, the diagnosis of drug-induced eosinophilic pneumonia was suggested. Mesalamine and antibiotics were stopped and oral corticosteroids begun. She became almost asymptomatic a week after mesalamine withdrawal, and the x-ray became normal.

Adrenal Cortex Hormones↗

Rectal strictures following abdominal aortic aneurysm surgery.

Rectal stricture formation is a rare complication of aortic aneurysm repair. Two case are described here. A combination of hypotension, a compromised internal iliac circulation and poor collateral supply following inferior mesenteric artery ligation can result in acute ischaemic proctitis--an infrequently described clinical entity. Ulceration and necrosis are the sequelae of prolonged ischaemia and fibrous stricture formation may result. One patient responded to dilatation and posterior mid-rectal myotomy; the other failed to respond to conservative measures and eventually had an end colostomy fashioned following intractable symptoms.

Aged↗

[The systemic manifestations of ulcerative colitis].

OBJECTIVE: To probe the relationship between location and extent of ulcerative colitis (UC) by analyzing its extra-intestinal manifestations. METHODS: 392 UC cases in Peking Union Medical College Hospital from 1976 to 2000 were reviewed retrospectively. Chi-square test was used to test the difference between groups. RESULTS: 82 of 392 patients (20.9%) with UC had extra-intestinal manifestations, 34 (8.7%) of these patients had more than one extra-colonic organ involvement; It shows that the extensive colitis has highest incidence of extra-intestinal manifestations with UC than that of the left-sided colitis did, while the proctitis had the lowest incidence. There were no significant difference (P > 0.05) between the group of extensive colitis and that of left-side colitis; The incidence of extra-intestinal manifestations in severe cases was significantly greater than that in mild cases. There was a trend of increasing incidence from severe to moderate to mild type (P < 0.05); Most of the extra-intestinal manifestations were associated with active UC, except for AS, PSC, healed during SASP and/or steroid treatment. CONCLUSIONS: Extra-intestinal manifestations had a high incidence in UC. The most frequently involved organs were joints, hepatobiliary system, skin, mouth and eyes. The majority of them were associated with the active UC. The incidence of extra-intestinal manifestations with UC was closely related with the extent and severity of the lesions, and the most of the extra-intestinal manifestations occurred in the active phase of UC. But the incidence of extra-intestinal manifestations was not related to prognosis.

Adolescent↗

Laparoscopic sigmoid colostomy for perianal Crohn's disease.

Fecal stream diversion is not an uncommonly used procedure in the treatment of symptomatic Crohn's disease of the rectum. We present a case report of a patient with documented Crohn's proctitis with multiple rectovaginal and perianal fistulas; an end sigmoid colostomy was performed as part of the management of her disease.

Adult↗

Evaluation of colon dysfunction.

There being no new or advanced technical aids to help the clinician in evaluating colon dysfunction, he must still depend on a careful history, knowledge of the patient, physical examination, which includes sigmoidoscopy, and a few appropriate diagnostic laboratory procedures to arrive at the proper diagnosis. With these means, it is possible to make a positive diagnosis of irritable bowel syndrome, and differentiate it from diverticulitis, ulcerative proctitis and polypoid disease.

Colitis, Ulcerative↗