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At least 793 records · Page 44Linked to original sources
PubMed1964

ULCERATIVE COLITIS: DISEASE PATTERNS AND MEDICAL MANAGEMENT.

The extent of anatomical involvement (rectosigmoid, left colon, entire colon, segmental, and enterocolon) and clinical behaviour (acute fulminating, recurrent colitis, and chronic continuous colitis) must be considered in assessing the prognosis and management of patients with ulcerative colitis. The severity of symptoms and signs is highly variable. It ranges from the virtually asymptomatic patient with mild proctitis to the patient with acute fulminating colitis with arthritis, skin lesions and "toxic megacolon" who constitutes a medical emergency. Consequently, there is no single therapeutic formula to be applied in this disease. Treatment is reviewed with reference to the recent literature.

Adrenal Cortex Hormones↗
PubMed1992

Treatment of the mucosa with local anaesthetics in ulcerative colitis.

A new paradigm for the treatment of ulcerative colitis has recently been presented: Treatment of the mucosa with lidocaine (2%) enemas for prolonged periods. This therapy was introduced based on the hypothesis that hyperreactive autonomic nerves may play a pathogenetic role in the disease. One hundred consecutive patients have now been treated and the results presented. The proctitis patients all responded to the treatment, despite previous therapeutic failures in more than two-thirds of the cases. They were treated for 3-12 weeks, but 68% had a relapse (observation period 20 months). Of the 49 patients with proctosigmoiditis, two-thirds had chronic symptoms resistant to previous therapy. One of these patients did not respond to lidocaine, but developed fulminant total colitis. The other patient had therapeutic failure with lidocaine but responded well to subsequent cortisone enemas. The patients were treated until the subsets of T-lymphocytes (OKT4+ and OKT8+) disappeared from the mucosa. This occurred in parallel with symptomatic relief and eventual healing in 83% of the patients after treatment for 6-34 weeks. Of all the patients with proctosigmoiditis, 42% presented with recurrent symptoms (observation period 16 months). Of the 17 patients with left-sided colitis, all went primarily into remission within 2-4 months, but 23% had a relapse (observation period 13 months). The 6 patients with total colitis had symptomatic relief and improvement of histology when treated over 3-8 months. One patient had recurrence after 12 months. Treatment with a local anaesthetic in ulcerative colitis is a new approach to mucosal inflammation. The beneficial effects may be due to blockade of certain neural effects, such as epithelial proliferation and shedding and congestion of the mucosal vasculature, with actions on cells of the immune system.

Adult↗
PubMedDate not supplied

[Bipolar electrocoagulation in patients with persistent hemorrhage secondary to second degree postradiation proctopathy].

OBJECTIVE: Our objective was to evaluate response to bipolar electrocoagulation (BICAP) in patients with persistent rectorragia (PR) secondary to PRP (post-radiation proctitis) degree II (telangiectasias). MATERIAL AND METHODS: We had 64 cases prospective and conducted study cohort of 257 patients, with cervicouterine cancer, radiated, PRP degree II, and PR. DESIGN: We conducted prospective, cross-sectional and descriptive study. Patients were divided in three groups: (group 1), with hemodynamical instability; (group 2) with chronic anemia, and (group 3), without data of chronic anemia (Table 1). Clinical evaluation was carried out before and after the intervention (BICAP). BICAP of radial way at level of telangiectasias was applied, of sigmoides up to 2 cm of anal margin. Three sessions were average. RESULTS: A total of 55 patients had PR radiation dose average, with 49.85 Gy. Time average of appearance of rectorragia was 9 months. GROUP 1: A total of 21 patients, age 51.2 years average). Previous to BICAP, week by frequency of rectorragia was 2.23 (average). With hemoglobin (Hb) and hematocrit (Ht) of 7.1 g (average) and 24.4%, respectively (average). A total of 18 patients (85.7%) required hemotransfusion. Average hospital stay was 1.3 days. Cardiac frequency, arterial, blood and hemoglobin pressure, and hematocrit obtained later improvement to intervention with BICAP was statistically significant (p > 0.0001). Patients did not require additional blood transfusions. GROUP 2: A total of 18 patients with age average 56 years (average). Previous to BICAP they had weekly rectorragia of 2.16 (average). Hb was 11.4 g and Ht of 35.5% (average). Subsequent to BICAP, 100% patients had controlled hemostasis. The improvement observed with regard to cardiac frequency and blood pressure after application of BICAP did not have statistical significance despite the fact that it was demonstrated to laboratory parameters as well as diminution of weekly episodes of rectorragia if they were statistically significant (p > 0.0001). No blood transfusion was required. GROUP 3: There were 16 patients with average of 57.1 years of age (average). Previous to BICAP they had weekly 1 rectorragia of 2.06, Hb of 13.5 g and Ht of 41.2% (average). Subsequent to BICAP, there was 100% controlled haemostasis. In this group, diminution of weekly episodes of rectorragia, cardiac frequency, and blood pressure did not have statistically significant changes; nevertheless, hemoglobin and hematocrit had a statistically significant increase (p > 0.0001). No blood transfusion was required. CONCLUSIONS: Electrocoagulation (BICAP) is effective in hemostasis of bleeding telangiectasias, stabilizing to the patient, and diminishing recurrence, hospital stay, and blood requirements.

Cross-Sectional Studies↗
PubMed1992

Treatment of common anorectal disorders.

Family physicians can manage most common anorectal disorders seen in office practice. Proctitis is usually caused by sexually transmitted infections that can be treated with antibiotics. Pruritus ani, anal fissures, fungal infections and hygiene problems are all amenable to simple treatments. Thrombosed external hemorrhoids can be opened and drained. Bleeding or symptomatic internal hemorrhoids can be treated with rubber-band ligation. Perirectal or ischiorectal abscesses require incision and drainage, sometimes under general anesthesia. Serious disorders such as inflammatory bowel disease and cutaneous malignancies should always be considered in the differential diagnosis of common anorectal disorders.

Abscess↗
PubMed2004

[Sexual transmission of hepatitis C in homosexual men].

An acute hepatitis C infection was diagnosed in three HIV-positive gay men, aged 43, 48 and 30 years, respectively. In all three, unprotected sexual intercourse and fisting was a universal risk factor for the infection. They all denied having used drugs intravenously, which is the most common risk factor. The third man had a documented proctitis (lymphogranuloma venereum) at the time when the HCV transmission must have taken place. No serious complications occurred during the acute HCV infection. Because the infection did not resolve spontaneously after a few months, all three men were treated with pegylated interferon and ribavirin. Recently, the number of cases of acute HCV infection has been seen to increase in The Netherlands. This may be due primarily to an increase in unprotected sexual intercourse and fisting. This hypothesis is supported by a documented increased prevalence of sexually transmissible diseases among gay men in The Netherlands. As acute infections may turn into chronic infections, treatment of an acute infection should be considered in order to prevent the chronic disease.

Acute Disease↗
PubMed1992

Air enema revisited in assessment of colitis.

Plain radiographs and air enema were performed in 37 patients with ulcerative colitis, 7 patients with proctitis, and 8 patients with Crohn's disease. The air enema was superior to plain radiographs for diagnosing colitis, and for delineating the extent of disease and the degree of mucosal involvement. The air enema is simple to perform and easy to evaluate as shown by an almost complete agreement between 2 observers.

Acute Disease↗
PubMed2006

Argon plasma coagulation and the future applications for dual-mode endoscopic probes.

Argon plasma coagulation (APC) is a thermoablative technique increasingly being used in endoscopy. Since its introduction, the flexible APC probe has been employed by endoscopists throughout the world. APC has helped change the endoscopic management of many gastrointestinal (GI) diseases, including hemorrhagic proctitis, watermelon stomach, bleeding peptic ulcer, and colonic varices. Endoscopists and surgeons are creatively combining standard and new electrosurgical techniques with APC. For instance, APC used in combination with piecemeal polypectomy, endoscopic mucosal resection, balloon dilatation for strictures, and plasma welding of bleeding vessels after sclerotherapy injection are among the recent innovative techniques reported. Other emerging innovations using APC that are being considered include endoscopic en bloc resection of mucosal and submucosal tumors of the GI tract, endoscopic mucosal resection supplemented with APC for high-grade dysplasia and early GI cancers, endoscopic repair of anastomotic strictures, and welding GI fistula tracts. As such, endoscopists require more efficient and cost-effective multifunctional thermoablative probes. This review discusses the development and the potential application of dual-mode plasma endoscopic probes in fulfilling these emerging needs.

Argon↗
PubMed2006

[Severe (RTOG grades 3 or 4) long-term complications of adjuvant radiotherapy after total prostatectomy].

OBJECTIVE: Study of the incidence of severe long-term gastrointestinal (GI) and genitourinary (GU) complications of conformal radiotherapy after total prostatectomy for localized prostatic adenocarcinoma. MATERIAL AND METHOD: From 1991 to 2000, 114 patients with a mean age of 62 years (range: 45-82 years) were treated by total prostatectomy followed by adjuvant radiotherapy. The mean dose of radiotherapy was 65 Gy (range: 58-72 Gy). The mean interval between prostatectomy and radiotherapy was 10 months (range: 2-28 months). Patients were reviewed every 6 months. We studied severe complications (RTOG grade 3 or 4) occurring after treatment. The mean follow-up was 74 months (range: 32-132 months). RESULTS: Eight patients (7%) treated by adjuvant radiotherapy with a mean dose of 65.5 Gy (range: 59-70 Gy) developed long-term severe complications. The mean time to onset of complications was 25 months (range: 5-72 months). Three patients developed gastrointestinal complications (2 cases of radiation proctitis and 1 anal stricture). Five patients developed genitourinary complications (4 cases of radiation cystitis and 1 urethral stricture). These eight patients received multiple transfusions and required surgical or endoscopic procedures. Most patients were hospitalized on several occasions for periods ranging between 3 days and 1 month. CONCLUSION: Adjuvant radiotherapy after total prostatectomy is associated with severe long-term complications in 7% of cases. When they occur, these complications generally require repeated major urological and gastrointestinal surgery.

Aged↗
PubMed1991

[Incidence of inflammatory bowel diseases in children in the Nord-Pas-de-Calais region].

The incidence of inflammatory bowel disease (IBD) in French children is not known. Therefore we conducted a prospective epidemiologic study of IBD in the region Nord-Pas-de-Calais (3.9 millions inhabitants). During the first 17 months of the study each new suspected case was reported by all (private and public) gastroenterologists in the region (n = 104) and a questionnaire was filled up at the gastroenterologist office by an epidemiologist. The final diagnosis of Crohn's disease (CD), ulcerative colitis (UC) or proctitis was made in a blind manner by two expert gastroenterologists. During the period under study, 47 new cases of IBD were registered in children (less than 17 years of age); 31 (66%) had CD, 7 (15%) had UC, and 9 (19%) had unclassified colitis. The incidence was 2.07/100,000 children/year for CD and 0.46/100,000 children/year for UC. These preliminary data suggest that the incidence of CD is high in Northern France.

Adolescent↗
PubMed1990

Sexually transmitted diseases and enteric infections in the male homosexual population.

There are certain special considerations in the management of sexually transmitted diseases (STDs) in homosexual men, with the impact of human immunodeficiency virus (HIV) infection on the presentation, diagnosis, and management of certain STDs just becoming apparent recently. Rectal and pharyngeal gonorrhea are usually asymptomatic and also more difficult to treat. The serological diagnosis of syphillis may be unreliable in acquired immunodeficiency syndrome (AIDS) patients, and HIV-seropositive homosexual men may be at risk of accelerated progression to neurosyphilis, despite treatment with benzathine penicillin. Chlamydia trachomatis is infrequently detected in patients with proctitis so therapy should be directed only at culture-positive cases. Herpes simplex is usually severe and persistent in immunosuppressed patients and may be further complicated by the development of acyclovir-resistance. Concurrent HIV infection may be associated with increased infectivity of homosexual chronic hepatitis B carriers, but milder hepatic injury and reduced efficacy of hepatitis B vaccines and immodulatory or antiviral agents. Although there is some concern regarding the possibility of increased risk of anal cancer in homosexual men, conservative management of human papilloma-virus-associated conditions is advised. The carriage of Entamoeba histolytica in this group is rarely associated with any deleterious effects and treatment should be directed only at symptomatic patients in whom other enteric pathogens have been excluded.

Homosexuality↗
PubMedDate not supplied

Treatment of resistant herpes simplex virus with continuous-infusion acyclovir.

Two patients with acquired immunodeficiency syndrome who developed severe ulcerative proctitis caused by herpes simplex virus type 2 that was resistant to acyclovir were successfully treated with 6 weeks of high-dose, continuous-infusion acyclovir sodium (1.5 to 2.0 mg/kg per hour). Viruses cultured from the lesions were resistant to acyclovir in vitro after the patients had received prolonged therapy with oral and intravenous acyclovir in traditional divided doses. Investigation into the mechanism of the acyclovir resistance revealed changes in the thymidine-kinase activity of both isolates. This viral enzyme phosphorylates acyclovir and is necessary for drug activation. The first patient's isolate was deficient of all thymidine-kinase activity, while the second patient's isolate had a thymidine kinase with altered substrate specificity for acyclovir. The continuous infusion was safe, well tolerated, and done in an outpatient setting with weekly clinic visits and monitoring of creatinine and acyclovir levels.

Acquired Immunodeficiency Syndrome↗
PubMed1990

[The course of illness in ulcerative colitis].

The data of 301 ulcerative proctitis/colitis patients, with a mean follow-up of 10 (1/2-26) years were analysed retrospectively. In 84 patients (28%) the diagnosis was made in this hospital (non-selected group), the other 217 patients were referred from other hospitals with an established diagnosis of ulcerative colitis. At any time after the fifth year of illness approximately 55% of the non-selected patients were free of symptoms, for the referred patients this proportion was 30%. In one half of the cases the inflammation started as a proctitis, almost 60% of these progressed to colitis later. Fourteen patients (5%) had a toxic megacolon, and a colon carcinoma developed in 9 patients (3%) on average 13 years after the first symptoms of colitis. We recorded 9 colitis-related deaths. Fifty patients (17%) underwent a colectomy, mostly because of failure of conservative therapy.

Colitis, Ulcerative↗
PubMed1989

[Herpes simplex type 2 pneumonitis in an AIDS patient].

We report the case of a patient with AIDS, Kaposi's sarcoma and persistent herpes simplex type 2 proctitis who died of herpes simplex 2 pneumonitis following an episode of nonspecific interstitial pneumonitis. This rare complication of persistent herpes simplex mucosal infection must be considered in patients with AIDS suffering from severe pneumonitis with negative bronchoalveolar lavage.

Acquired Immunodeficiency Syndrome↗
PubMed1988

[Effectiveness of combined radiotherapy of patients with stage IB cervical cancer using gamma therapy with an AGAT-B catheter device].

The results of combined radiation therapy of 134 patients with cervical cancer, stage IB, using intracavitary gamma-beam therapy on the Agat-B unit were analyzed. The frequency of late radiation complications after treatment in the period of 1-5 yrs. was analyzed. The most common complications were necroepithelitis (9.7 +/- 2.6%), cystitis was less common (7.5 +/- 1.8%) as well as proctitis (1.5 +/- 1.0%). Therapeutic efficacy was assessed by primary tumor resorption, the presence of recurrences and metastases, and patients' survival. The cure rate of a primary focus was attained in 100%. Four patients died of the main disease. By the time of recurrence either osseous, organ or lymphogenic metastases were noted in them. Locoregional recurrences were undetectable in either of the patients. Radiation-induced tumors were not detected in them, either. The 5-year survival rate was 96.8%. A conclusion was made that the above method was very effective for therapy of patients with cervical cancer, stage IB and as such, should be a method of choice for them.

Adult↗
PubMed1987

[Inflammatory periproctal and anorectal conditions in HIV infections].

Twenty-nine homosexual patients with anorectal symptoms were investigated by sigmoidoscopy. Nineteen patients were anti-HIV antibody positive; in this group severe haemorrhagic proctitis was diagnosed in seven cases and purulent cryptitis with abscess formation and fistulation in three cases. All patients showed a reduced OKT 4/OKT 8 ratio (below 1.0). It is concluded that the immunodeficient condition of HIV patients is the essential pathogenic factor for the occurrence of the anorectal inflammations observed.

Acquired Immunodeficiency Syndrome↗
PubMed1986

The pattern of colonic diseases in the Eastern Province of Saudi Arabia.

The purpose of this paper is to highlight the incidence and scope of lower gastrointestinal tract (GIT) diseases in the Eastern Province of the Kingdom of Saudi Arabia. Between August 1981 and April 1984, 288 patients with significant complaints and physical signs attributable to the lower GIT were prospectively evaluated. A complete patient history was taken in each case followed by physical examination, routine laboratory studies and a sigmoidoscopic examination. In 128 patients (44.5%), sigmoidoscopy and rectal and/or colonic biopsies did not reveal any pathological abnormalities. These patients were considered to have various disorders such as irritable bowel syndrome or parasitic infestation. Eighty-one patients (28%) were found to have mild to moderate non-specific colitis or proctitis. In another 49 patients (17%) the diagnosis of schistosomiasis mansoni was made. Ulcerative colitis and colorectal carcinoma were detected in only 11 (4%) and 4 (1.5%) patients respectively. In the remaining 15 patients (5%), other lower GIT diseases were found. Comparative analysis of the disease pattern in our series has demonstrated some differences from other series from within the Kingdom and also from other countries.

Adolescent↗