[Hemorrhagic rectocolitis in a cardiac transplant recipient under long-term cyclosporine].
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We performed a retrospective analysis of morbidity and mortality in 100 cases of ulcerative colitis treated at the surgical care unit of the Ibn Sina hospital over a 10 year period from 1984 to 1994. One major complication, usually infection, was observed in 40% of the cases. Overall mortality was 22%, a rate higher than the larger published series. The main factor incriminated in our study ; besides surgical circumstances, was the delay in care, including in the intensive care unit. It must be concluded that medical and surgical management must be initiated as soon as a flare up is diagnosed.
We reported here a case of unexplained chronic pancreatitis diagnosed 4 years before the onset of ulcerative colitis. The diagnosis of chronic pancreatitis was confirmed by recurrent pancreatitis and irregularities of the main pancreatic duct on retrograde pancreatography. None of the classical etiologies for chronic pancreatitis was found. Chronic pancreatitis associated with ulcerative colitis has already been reported in 5 cases. Our case reinforces the hypothesis of a non fortuitous association between both diseases.
OBJECTIVES: The aim of the study was to assess in vitro the production of interleukin 8 in Crohn's disease and ulcerative colitis. PATIENTS AND METHODS: Interleukin 8 concentrations (measured by ELISA) were evaluated in the culture supernatants of: a) peripheral blood mononuclear cells from 13 patients with Crohn's disease, 7 patients with ulcerative colitis and 7 controls, b) organ cultures of inflamed (22 Crohn's disease, 15 ulcerative colitis) and uninflamed (21 Crohn's disease, 9 ulcerative colitis, 15 controls) intestinal mucosal biopsies. RESULTS: In patients with Crohn's disease and ulcerative colitis, the production of interleukin 8 by peripheral blood mononuclear cells and inflamed mucosa was higher than in controls (P < 0.01) without statistical difference between Crohn's disease and ulcerative colitis. Interleukin 8 production by normal mucosa was not different between the 3 groups. Interleukin 8 concentrations in the supernatants of organ culture were positively correlated to an endoscopical and a histological inflammatory index as well as to tumor necrosis factor, interleukin 1 and 6 concentrations. CONCLUSION: These results support the notion that interleukin 8 plays an important role in the pathogenesis of inflammatory bowel disease.
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The authors report their experience of 23 patients with ulcerative colitis treated with surgery from 1991 to 1994. At admission 8 patients had a high-grade illness, 10 patients had a middle-grade illness, 5 patients had a toxic megacolon. All the patients were treated with systemic medical management (mesalazine + methylprednisolone) and topical medical management with rectal steroid (methylprednisolone) and rectal mesalazine by enema, and with nutritional support (Total Parenteral Nutrition). The 5 patients with toxic megacolon, after 48 hours of unsuccessful medical management, underwent surgery with deferred urgency; the other 18 patients underwent surgery after one-four months. The authors prefer the ileorectal anastomosis (IRA), since the rectal lesions are more susceptible to topical therapy. A single-stage IRA was performed in 17 patients. A sigmoid resection has been employed in the first stage in the 18th patient with a local development of the disease in the sigma; a following relapse of the lesions required a total colectomy with a low ileorectal anastomosis. A first-stage subtotal colectomy with ileostomy and Hartmann closure of the rectum with low ileorectal anastomosis at a later date was performed in the 5 patients with toxic megacolon. One of these, 18 years old, died after a heart failure. After surgery, as soon as the patients start moving their bowels all of these had again a systemic therapy with mesalazine for a short period and after they had a topical therapy with mesalazine + methylprednisolone by enema, for a long period. The average postoperative period of admission was 16.3 days. The functional results have been encouraging with an average of 1.6 bowel movements daily and an average of 0.4 nocturnal bowel movements. All the patients had a normal anal sphincter function with an acceptable stool frequency. In male patients there no urinary or sexual defects. In one case of these, there was a low grade of dysplasia, revealed by endoscopic biopsy. The authors conclude that today surgical treatment of ulcerative colitis is not well established.
The authors report 21 cases of pulmonary metastases from operated cases of rectal and colonic carcinoma. Half the patients were aged between 60 and 70 years. In all cases except one the primary tumour was known and treated surgically before the metastasis occurred. The authors emphasize the necessity of radiological supervision of the chest after operation and recall that neither chemotherapy nor radiotherapy should be undertaken without prior histological confirmation. It is possible to remove the metastases by surgery but a high percentage require pneumonectomy i.e. it is necessary to take the same precautions before operation as for primary carcinoma of the bronchus. The operative mortality was nil, and the five year survival rate 18 p. 100.
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Cyclosporin has been suggested as an alternative treatment in severe acute ulcerative colitis. In a retrospective study, the outcome of seven ulcerative colitis patients treated by intravenous cyclosporin (mean dose 3.6 mg/kg/day) has been evaluated. Short-term results indicated full remission in 3/7 (43%) patients. At long term follow-up (one year), only 2/7 patients could avoid ileal pouch-anal anastomosis. Two complications (one colonic perforation and one septicemia) were observed. Our results suggest that intravenous cyclosporin should not be recommended as a standard therapy in severe acute ulcerative colitis. Its use has to be limited in patients presenting a major contraindication for surgery and has to be performed by those experienced in both immunosuppressive treatment and inflammatory bowel disease.
Aseptic osteonecrosis is a rare extraintestinal manifestation in patients with inflammatory bowel disease; its true prevalence is not precisely known. Steroid treatment undoubtedly participates in the pathophysiology of avascular osteonecrosis, however, other factors like hypercoagulability may be involved. Two cases of bilateral osteonecrosis of the knees--the first occurring during the course of ulcerative colitis, the second in a patient presenting with Crohn's disease--are described. Specific location of the lesions and regression of symptoms, as well as the importance of magnetic resonance imaging for early recognition of osteonecrosis, are noteworthy.
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Subtotal and total colectomy was the choice therapeutic solution for multiple colonic cancer, diffuse rectocolonic polyposis, multiple colonic polyposis, ulcerohaemorrhagic rectocolitis, and for two rare diseases; megacolon with extensive atrophy of lymph nodes, and acute ischaemia of the colon. A total of 35 cases are reported. Ileorectal anastomosis was the method used for this type of intervention. The opportunity of rectal conservation is discussed, in cases of rectocolonic polyposis and ulcerative haemorrhagic rectocolitis. The difficulty of making an optimal choice in complicated forms of ulcerohaemorrhagic rectocolitis is exemplified with the aid of clinical observations.