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PubMed1981

Intravasation of barium sulphate during roentgenography of the Colon. Case Report.

This review presents the case history of a 67-year-old man, referred to hospital with severe ulcerative colitis. Treatment at home with prednisolone enemas had had very poor results. Coloscopy revealed large proctitis ulcerations with two polyps. Pathological anatomical examination: severe colitis, probably ulcerations. Intravasation of barium sulphate into the venous system occurred during roentgenography of the colon. Cardiac arrest occurred, and irreversible brain lesions developed.

Aged↗
PubMed1981

[Ambulant coloscopy in colitis ulcerosa and colorectal cancer].

In the first year after establishing a gastroenterological center in a vineyard and industrial district with 220.000 inhabitants we examined 1.171 patients. In 36.53% we had diseases in the lower gastrointestinal tract excluding proctological disturbances. We could find out 37 cases of colitis ulcerosa and 42 colorectal cancers. Excluding two cancers in colon transversum and ascendens all the tumors were found by coloscopy. Previously 4 cases of colitis ulcerosa were identified by other methods, clinically or by rectoscopy. In 48.6% of the colitis ulcerosa the transfer was done by reason of blood in the feces. The melaena lingers between 1 month and 10 years. Other presumed diagnoses for transfer to our Institute were gastroenteritis, proctitis, hemorrhoids, fissure or ileitis terminalis Crohn. In some rare cases the supposed diagnosis was salmonellosis or mycosis of the intestinum. In colorectal cancers the main reason for special gastroenterological investigation was the addition of blood to stool, whether microscopically or visible. Abdominal pain or ileus were following in frequency. Clinical symptoms were to be reconstructed in 30.9% for six weeks, in 59% for six months and in 9.5% up to one year. Most of the colorectal tumors (85.7%) were localized distal from splenic colonflexur, mostly in the rectosigmoid and colon descendens (see figure 1). Ambulant coloscopy is a method for quickly and definitive clarification, if the practitioner will refer swiftly.

Ambulatory Care↗
PubMedDate not supplied

Ischemic diseases of the large intestine.

The blood flow within the walls of the digestive tract must be sufficient to maintain its structural and functional integrity. All episodes of vascular insufficiency cause ischemic damage to the organ and carry the threat of diffuse or focal necrosis. Certain forms of ischemic colitis or proctitis arise from episodes of reduced peripheric or splanchnic blood flow; indeed, those which do not culminate in necrosis of the colonic wall are more frequently caused by hemodynamic disorders than by vascular occlusions. The crisis is often mitigated by the development of collateral circulation; this is, however, of rather poor quality so patients become very vulnerable to subsequent slight changes in cardiac output. Necrotic, gangrenous ischemic colitis arises from a combination of occlusive damage to the arteries and general hemodynamic disturbances. The vascular insufficiency may be slight or severe, temporary or long-lasting, localized or diffuse. In addition, the attack occurs in a septic medium in the presence of abundant microbial flora which may be highly pathologic. Thus infection complicates and aggravates the ischemic damage, resulting in the gangrenous aspect of the lesion tending to hide its ischemic origin. Indeed, the variability of the manifestations of the disease in one of its primary characteristics, and is a function of the different causative factors. A knowledge of the anatomy and pathophysiology of the splanchnic circulation and its hemodynamics is essential for a full appreciation of the diagnosis and treatment of the disorders, and for the adoption of the aggressive approach necessary to improve the poor prognosis of ischemic diseases of the colon and rectum. All treatment should be based on 1) constant, prolonged intensive care; 2) precise monitoring of any change in status; 3) rapid excision of any necrotic (often gangrenous) tissue. Ischemic colitis is most likely to occur in elderly patients with a history of cardiovascular disease, but can also affect younger individuals. It is a frequent, potentially lethal, entity. Although it can be classified as a separate disease on the basis of its clinical, radiological and anatomical characteristics, it is often confused with other disorders of the colon. Although the abdominal surgeon is most likely to be concerned with this disease, the vascular surgeon incising the lower aorta should always be on the look-out for segmentary ischemia of the distal colon which may occur following operation.

Aged↗
PubMed1980

Pyoderma gangrenosum: clinical and laboratory findings in 15 patients with special reference to polyarthritis.

Fifteen consecutive patients with PG have been studied during the period 1971-78. Systemic disease was found in 13 of the patients and preceded the skin disease in 10 patients by 1-25 years. Only two patients had ulcerative colitis. One patient had paroxysmal nocturnal hemoglobinuria and three patients had an IgA myeloma. Eight patients had polyarthritis; this was classical seropositive rheumatoid arthritis in two patients, and a seronegative inflammatory polyarthritis in six patients. Four patients had an unusual progressive erosive seronegative polyarthritis without evidence of granulomatous bowel disease, psoriasis, genital, urinary tract or eye disease. In three of these four patients the arthritis preceded the PG. Synovial fluid analysis showed depressed complement levels and in one patient deposits of immunoglobulins and complement were demonstrated in the synovial membrane. The course of the arthritis was progressive with development of disabling joint deformities and erosive destruction of joints, despite treatment with penicillamine, corticosteroids and nonsteroidal anti-inflammatory drugs. One other patient had severe degenerative joint disease and chondrocalcinosis in association with a seronegative inflammatory polyarthritis, and another patient had ulcerative proctitis and severe degenerative joint disease secondary to chronic seronegative inflammatory polyarthritis. None of the patients had colitic arthritis, but in view of the association between PG and ulcerative colitis, some patients previously reported with PG and joint disease may have been suffering from the arthritis of ulcerative colitis. PG developed at the site of skin trauma in six patients. The natural history of the skin disease ran one of two courses: an acute, progressive course in which the ulcers rapidly enlarged until arrested by treatment; and a chronic course in which the lesions extended slowly and which after a period of weeks began to show signs of spontaneous healing. In only the patients with ulcerative colitis was there any correlation between the activity of the associated disease and the onset and progression of the skin disease. Serum complement levels were normal and no circulating cryoprecipitable immune complexes were found. Skin histology showed no evidence of vasculitis and direct immunofluorescence examination of involved skin was negative for IgG, IgM, IgA and C3. No consistent abnormality of cell-mediated immunity or neutrophil function was found and no significantly increased prevalence of any HLA antigen type was noted. Twelve patients have been treated with systemic corticosteroids. Six of these patients developed serious steroid complications and four patients have died, all from complications of steroid therapy.

Adolescent↗
PubMed1980

[The possibilities of optimal therapy of corpus uteri cancer (author's transl)].

During the years 1960-1974 out of 1002 patients with endometrial carcinoma 256 underwent primary surgery and 846 primary irradiation. The evaluation of the results of 4 different surgical methods showed despite a different distribution of the stages of the cancer that Werthein's operation and abdominal hysterectomy and adnexectomy with simultaneous lymphnodectomy had statistically significant better results than abdominal hysterectomy without lymphonodectomy. By surgery a 5 years survival time was achieved in 83.6% (214 cases) with a primary mortality rate of 0.39% and an incidence of histologically proved lymphnode-metastases of 6.78%. Out of the 846 patients with generally or locally inoperable endometrial carcinomas, who underwent primary intracavitary irradiation 411 (48.6%) achieved a 5 years survival time. After irradiation in 9.9% reversible reactions (severe proctitis and cystitis) and in 2% irreversible complications (fistulas) were observed. After an observation period of 5 years 625 of the total of 1002 treated patients (62.4%) were alive and free of symptoms.

Evaluation Studies as Topic↗
PubMed1995

Laparoscopic pelvic lymph node dissection combined with real-time interactive transrectal ultrasound guided transperineal radioactive seed implantation of the prostate.

Laparoscopic pelvic lymph node dissection with real-time interactive transrectal ultrasound guided transperineal radioactive seed implantation is a new method of treatment for localized carcinoma of the prostate. A total of 58 patients with clinically confined prostate cancer and negative seminal vesicle biopsies underwent staging laparoscopic pelvic lymph node dissection immediately followed by prostate implantation: 50 had 125iodine and 8 had 103palladium implants. Mean operating time was 226 minutes (range 120 to 475), mean blood loss was 57 cc (range 5 to 400) and average hospital stay was 2.2 days (range 0.5 to 8). At a mean followup of 12 months (range 6 to 24), complications included proctitis in 1.7% of the cases, dysuria in 24%, nocturia in 21% and outlet obstruction in 17%. Erectile function remained unchanged. Prostate volume decreased to 58.9% of the pretreatment value by 12 months and to 44.3% by 24 months. Mean prostate specific antigen level was 18.4 +/- 26.3 ng./ml. before treatment, 3.4 +/- 3.9 ng./ml. at 6 months, 2.3 +/- 2.3 ng./ml. at 12 months and 4.9 +/- 6.0 ng./ml. at 24 months (1.2 +/- 1.0 ng./ml. for patients with no evidence of disease). Of the patients 15.8% had local failure at 18 to 24 months as determined by positive transrectal ultrasound guided biopsy. Five of 58 patients (8.6%) had persistently elevated prostate specific antigen levels, only 1 of whom had a positive biopsy. Laparoscopic pelvic lymph node dissection with transrectal ultrasound guided implantation is a safe and promising mode of therapy for patients with localized prostate cancer.

Aged↗
PubMedDate not supplied

Supporting the patient with inflammatory bowel disease.

Inflammatory bowel disease is a term that describes Crohn's disease, colitis and proctitis. This paper considers the nurse's role in patient education, information and support for people with these conditions.

Humans↗
PubMed1994

[Role of peroperative radiotherapy in the treatment of uterine cancers. Preliminary experience in Lyon].

AIM: Retrospective analysis of Intra operative Radiotherapy (IORT) in recurrent uterine carcinoma (RUC) and prospective pilot study of IORT in advanced cervix cancer (ACC) with high risk of local failure. PATIENTS-TREATMENTS: 1) RUC: from 1988 to 1991, 34 patients with RUC have been treated. Primary cancer was: cervix uterus: 28, endometrium: six. Site of recurrence: centro pelvis: four, latero pelvis: 25, lombo aortic: five. Total gross resection was only possible in 12 patients. A dose of 15 to 22 Gy was given by IORT according to the residual tumour size. External beam irradiation was added in 16 patients; 2) ACC: January 1991 to November 1992, 20 patients were included in this pilot study, stage IIB: seven, stage III: 12, stage IV: 1. Preoperative retroperitoneal pelviscopy showed 13 pN1 patients and NMR imaging ten tumours of 6 cm or larger in diameter. Treatment started with concommitant pelvic irradiation (44 Gy) and one conommitant cycle of 5 Fu-CDDP, followed by a short course of high dose rate upper vagina brachytherapy (4 Gy). Four weeks later a radical Wertheim operation was performed together with IORT on the lateral pelvis. RESULTS: 1) RUC: overall survival (Kaplan Meier) at 4 years is 32% (+/- 8). Local relapse in the fiedl of IORT was observed in six patients. Grade 2-3 complications: six patients (radiation proctitis, neuritis, vertebral collapse, ureteral stenosis); 2) ACC: the median follow up is hort (18 months). Four cases of pelvic relapse, no postoperative death. The first line radio chemotherapy was associated with two G3 early complications. Postoperative radiation complication was less than 10% G3. DISCUSSION: promising results of IORT in RUC have been observed especially if no irradiation is given during the primary treatment. Good feasibility of the pilot study of IORT in ACC was also observed. It could be followed by a multicentric feasibility trial.

Adult↗
PubMed1995

Allergic gastroenteropathy in children.

OBJECTIVE: To review the pathogenesis, symptoms, and treatment of gastrointestinal disorders linked to immunopathologic reactions associated with the ingestion of food antigens in infancy and childhood. DATA SOURCES: A computerized MEDLINE search was performed for the following topics: allergic colitis, allergic proctitis, eosinophilic gastroenteritis, eosinophilic colitis, cow milk intolerance, protein losing enteropathy, and malabsorption. This search was restricted to the English language and human subjects. Articles published between 1960 and 1993 were included as references. The textbooks which were used as references include: (1) Walker WA, et al, eds. Pediatric gastrointestinal disease; pathophysiology, diagnosis, management, Philadelphia: BC Decker, 1991; (2) Wyllie R, et al, eds. Pediatric gastrointestinal disease; pathophysiology, diagnosis, management, Philadelphia: WB Saunders, 1993; (3) Targan SR, et al, eds. Immunology & immunopathology of liver and gastrointestinal tract. Igaku-Shoin, 1991; (4) Goldman H, et al, eds. Pathology of the gastrointestinal tract. Philadelphia: WB Saunders, 1992. CONCLUSION: The symptoms of allergic gastroenteropathy may be those of classic allergic reactions or present as symptom complexes that may include diarrhea, malabsorption, and protein-losing enteropathy. The immunopathogenesis of allergic gastroenteropathy is complex and is still not clearly understood. As our understanding of the gastrointestinal mucosal system evolves, we should be able to manage and care for the infants and children who suffer from this group of disorders better.

Allergens↗
PubMed1995

Alleviation of cytotoxic therapy-induced normal tissue damage.

Cytotoxic chemotherapy and radiation therapy damage normal body tissues, resulting in stomatitis, conjunctivitis, esophagitis, proctitis, and dermatitis. Pursuant to this, the North Central Cancer Treatment Group has developed a series of clinical trials designed to study antidotes for these pathologic processes. These trials have demonstrated clinically helpful therapies (eg, oral cryotherapy for decreasing mucositis induced by 5-fluorouracil) and also have demonstrated lack of benefit for other proposed treatments. Results from several ongoing clinical trials should become available in the near future.

Chlorhexidine↗
PubMed1995

[Diagnosis of colitis caused by cytomegalovirus infection in AIDS. Comparative value of total colonoscopy and rectosigmoidoscopy (apropos of 24 cases). AIDS GIT].

OBJECTIVES: To evaluate the respective diagnostic value of flexible rectosigmoidoscopy and colonoscopy in the cytomegalovirus colitis. METHODS: Twenty-four patients with AIDS were studied retrospectively. The entry criteria were: flexible rectosigmoidoscopy or colonoscopy, with 2 rectal and 2 caecal biopsies, presenting cytomegalovirus inclusions bodies linked to an inflammation at least on one colonic biopsy. RESULTS: Twenty-four patients had 29 colonoscopies. In 16 cases colonoscopy was performed to the caecum. The endoscopic findings of the 16 full colonoscopies were: 7 right colitis, 5 diffuse colitis, 2 bisegmentary colitis, 1 proctitis and 1 non endoscopic lesion. The histologic findings of the 16 full colonoscopies were: 5 cytomegalovirus inclusions on rectal biopsies and 16 on caecal biopsies. For the 13 incomplete colonoscopies, 11 had inclusions on rectal biopsies. So the flexible rectosigmoidoscopy was not sufficient to find inclusions 13 times out of 29. CONCLUSION: Our study indicates that in the cytomegalovirus colitis, inclusions predominate in the caecum, isolated right colitis exists and extra-colonic cytomegalovirus disease is not always found. For these reasons full colonoscopy is necessary for diagnosis in patients with normal flexible rectosigmoidoscopy.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

[Influence of ano-perineal lesions on the outcome of the rectum in colonic and rectal Crohn disease].

Between 1960 and 1988, 83 patients (38 men, 43 women) underwent colectomy and ileorectal anastomosis (IRA) for severe colonic or rectal Crohn's disease. The mean age at IRA was 28.5 years. The mean interval from diagnosis was 4 years. There were two post-operative deaths. Among the 81 survivors 5 patients who had a covering ileostomy have never had their stomas closed and 24 patients required exclusion or excision of their IRA and rectum. (= 10 defunctioning IRA, 14 proctectomies with definitive ileostomy). The mean interval between IRA and the creation of a permanent ileostomy was 4.1 years. The mean interval between the onset of problems following IRA and permanent ileostomy was 2 years. 25 patients had perianal lesions prior to IRA. 5 of these patients had unhealed perianal disease at IRA and 7 required defunctioning ileostomy (28%). The need for rectal excision or exclusion following IRA was not related to the presence of perianal disease prior to IRA but functional results were worse. 33 patients developed perianal lesions following their IRA, among whom 19 required exclusion or excision of the rectum. Failure of IRA was then significantly higher amongst those who developed lesions following IRA. Rectal preservation after IRA may be proposed with success to patients with a healthy rectum or with minimal or moderate proctitis, even if there is perianal disease that could be safely treated before IRA. In this last setting the patient has to be informed of the risk of rectal preservation and the possible risk of requiring ulterior protectomy.

Adult↗
PubMed1994

Perianal streptococcal dermatitis: two familial cases.

Two familial cases of perianal streptococcal dermatitis in a 3-year-old girl and her 5-1/2-year-old brother are reported. The clinical features of well-demarcated perianal erythema variably associated with itching, painful defecation with subsequent constipation, rectal bleeding, and proctitis are reviewed, together with suggestions for the best therapy.

Anus Diseases↗
PubMed1995

Olsalazine versus sulphasalazine for relapse prevention in ulcerative colitis: a multicenter study.

OBJECTIVE: To compare the relapse-preventing effect and the frequency of adverse events of olsalazine and sulphasalazine in sulphasalazine-tolerant patients with ulcerative colitis. METHODS: Patients in remission, with at least two episodes of active disease during the last 5 yr, were randomized to 2 g of sulphasalazine or 1 g of olsalazine daily and were followed for 6-18 months. Relapse rates in the two groups were compared using frequency and life-table analysis. Sixty-nine patients with proctitis, 140 with left-sided colitis, and 113 with subtotal or total colitis were evaluated. RESULTS: In the intention-to-treat analysis, the failure rate (relapses plus withdrawals) was 54.7% in the olsalazine and 47.2% in the sulphasalazine group. In the per-protocol analysis excluding withdrawals, 44.7% relapsed in the olsalazine and 39.3% in the sulphasalazine group. Remission curves did not differ significantly, although at all time intervals the frequency of remission was slightly higher in the sulphasalazine group (p = 0.19 in the intention-to-treat analysis and p = 0.42 in the per-protocol analysis estimated by the log-rank test). Twelve patients (of whom five had diarrhea) in the olsalazine group versus eight patients in the sulphasalazine group discontinued the study because of side effects. CONCLUSION: The relapse-preventing effect of olsalazine and sulphasalazine in sulphasalazine-tolerant patients did not differ. Furthermore, the tolerability of olsalazine, particularly concerning diarrhea, appears to be better than previously reported.

Adult↗
PubMed1994

Distinct relationship between HLA-DR genes and intractability of ulcerative colitis.

OBJECTIVE: To explain the correlation between HLA class II genes and the intractability of ulcerative colitis (UC), DR genotyping and clinical analysis were performed for patients with UC. METHODS: HLA-DRB types and HLA-DR2 subtypes of 45 patients with UC in our hospital were determined using molecular genotyping in combination with sequence-specific oligonucleotide hybridization by polymerase chain reactions. The extent of involvement, clinical course, and treatment were studied to evaluate the intractability of UC. RESULTS: The gene frequency of DRB1*1502 in 18 patients with total colitis (0.444) was significantly higher than the group with left-sided colitis and proctitis (0.148; p < 0.05). In addition, DRw11 and DR2 increased significantly in the group including 18 cases with total colitis. In the 11 patients with total colectomy there were no cases with DRB1*1501, whereas 34 patients without operation included 12 genes of DRB1*1501 (p < 0.05). In addition, DRw11 increased significantly in the group with total colectomy compared to the group without operation (p < 0.05). When comparing between patients with and without intractability (defined based on the Japanese definition), DRB1*1502 and DRw11 were found more frequently in intractable UC patients (p < 0.01), whereas DRB1*1501 increased significantly in cases without intractability (p < 0.05). CONCLUSIONS: DRB1*1502 or DRw11 have a probability of being closely related to the intractability of UC. In addition, patients with UC possessing DRB1*1501 have a lower probability of their cases leading to intractable UC. Thus, we believe there are unknown genes present that encode the intractability of UC.

Adult↗
PubMedDate not supplied

[Usefulness of fiber-sigmoidoscopy in diagnosis of bleeding from the lower part of the digestive tract].

Out of 1000 consecutive fiber-sigmoidoscopic examinations performed using the CF-P 10 S flexible recto-sigmoidoscope, 350 examinations carried out in patients with overt rectal bleeding were subjected to analysis. Among other, 132 cases of haemorrhoids, 47 cases of proctitis, 64 cases of ulcerative colitis, 39 cases of cancer and 37 cases of adenomatous polyps were diagnosed. Only in nearly 3% of cases the examination failed to provide diagnostic conclusions. In 13.4% of cases fiber-sigmoidoscopy failed to show any lesion which led to further diagnostic management (coloscopy and/or large intestine X-ray examination). The usefulness is stressed of fiber-sigmoidoscopy in the diagnosis of bleeding from the lower part of the digestive tract as well as the need for its possibly early performance as the first examination in each case of rectal bleeding.

Adult↗
PubMed1975

Comparison of trimethoprim-sulfamethoxazole with penicillin and tetracycline in the treatment of uncomplicated gonorrhea in women.

In a collaborative prospective study 327 women with uncomplicated gonococcal cervicitis or proctitis were randomly assigned to one of four treatment groups: (1) aqueous procaine penicillin G, 4.8 million units IM in one session plus 1.0 g probenecide; (2) tetracycline HCI, 9 g over 4 days; (3) trimethoprim, 80 mg-sulfamethoxazole, 400 mg (TMP-SMX) six tablets once daily for 3 days; (4) TMP-SMX, six tablets wtice on 1 dat at a 6-hour interval. They were re-examined 4 to 8 days and 10 to 15 days after completion of therapy. There was no significant difference between the results of the four regimens in the 4- to 8-day period (P greater than 0.36). However, at the 2-week point the results of TMP-SMX given for 3 days were less effective (P smaller than 0.05) than those obtained by penicillin plus probenecid. There was no significant difference between the results of the other regimens at this latter period.

Administration, Oral↗
PubMed1993

[Local or systemic treatment of inflammatory bowel diseases?].

Standard therapy of inflammatory bowel disease is based on the treatment with corticosteroids, sulfasalazine and 5-aminosalicylic acid. Depending on localization, extent and activity of the bowel inflammation, these drugs are administered topically, systemically or in combination. The advantage of the topical therapy is the lack of non allergic side effects. Ulcerative proctitis and left-sided colitis should, in the first approach, be treated topically with suppositories or enemas. In severe colitis, a combined systemic and topical therapy is useful. In Crohn's disease topical agents are of minor importance. 5-aminosalicylic acid is efficient in mildly active Crohn's disease and prevents relapse for some patients in remission. In severely active Crohn's disease, systemic corticosteroids have to be administered. Azathioprine, cyclosporin A and metronidazole are considered to be reserve drugs because of significant side effects. The clinical usefulness of new topical corticosteroids showing both high antiinflammatory effect and no systemic side effects is presently investigated.

Administration, Oral↗