Mucous colitis; a case presentation.
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Mucous cell depletion is an important histological discriminator in favour of ulcerative colitis. The mechanism of this change was investigated in guinea pigs with experimental colitis induced by intrarectal instillation of acetic acid or dinitrochlorobenzene (DNCB) in sensitized animals. Both models showed mucous cell depletion. Increased numbers of mucous cells were flash-labelled with tritiated thymidine (3HTdR), indicating an increased pool of proliferating (oligo-) mucous cells; mucous cell production was in fact increased absolutely compared with control animals, and there was a marked increase in the rate of turnover of mucous cells. The results indicate that in colitis there is (i) increased mucous cell production and (ii) an increased rate of mucous cell turnover due to increased loss of older mucous cells. It is concluded that the disease process in experimental colitis leads to premature discharge of mucin, so that mucous cells are no longer recognizable by light microscopy. This explains the increase in mucin production in ulcerative colitis, which occurs even in the presence of significant mucous cell depletion.
When the endoscopic lesion typical anorectocolonic candidiasis is absent, the author demonstrates that mild cases of colonopathy due to Candida albicans do not always present the commonly described classic symptoms of anomarginal, copperhued, running lesions... The proctosigmoidoscope reveals that in half of the cases with concurrent ordinary digestive troubles and Candida albicans present in the stools, the mucosa is congestive and, very often, the rectal cytology disturbed. A good correlation exists between modifications of the rectosigmoid mucosa and the number of Candida albicans colonies isolated from the feces of these patients. In addition, anal pruritus, a rare clinical event by itself, can be attributed to candidiasis using the proctosigmoidoscope and coproculture. Mild anorectocolonic candidiasis can exist as a secondary infection with chronic inflammatory colitis (ulcerative colitis, etc.) or acute mucous colitis. These infections can also be primary and, in these cases, sometimes appear consequent to recent antibiotic therapy.
Numerous case reports suggest that diversion of the fecal stream results in nonspecific colitis, with abnormalities ranging from minimal friability to gross ulceration. Published reports consist largely of patients with symptomatic colitis, and there are scant data suggesting at what frequency diversion colitis actually occurs. In an attempt to identify the frequency of diversion colitis and any associated etiologic factors, 20 patients scheduled for colostomy closure at Grady Memorial Hospital between 8/1/88 and 6/15/89 underwent colonoscopy, including the excluded segment, to evaluate for diversion colitis. Colostomies were performed for the management of diverticulitis, trauma, cancer, protection of an anastomosis, and diversion of fecal fistula. Patients with ulcerative colitis or Crohn's disease were excluded. The colon was classified grossly as normal or colitis (including easy friability, edema, inflammation, and ulceration as colitis). Fourteen of the 20 patients (70%) had findings of diversion colitis (DC), while six had a normal exam (NL). Nine biopsies were performed in the DC group and all revealed microscopic abnormalities. One of the normal patients was also biopsied, revealing mild, nonspecific changes. There was no difference in mean age (DC 49.3, NL 48.2), interval from formation of colostomy (DC 9.21 +/- 7.27 months, NL 2.83 +/- 1.94 months), type of colostomy, or reason for colostomy in the two groups. None of the DC patients had symptoms of colitis (mucous or bloody discharge, tenesmus, or pain), and one of the DC patients manifested symptoms of colitis after colostomy closure. We conclude that diversion colitis is a common subclinical problem in patients with a diverting colostomy.(ABSTRACT TRUNCATED AT 250 WORDS)
A 10-year survey is presented of male cases of homosexually acquired infection seen between 1962 and 1971 at Charing Cross Hospital (West London Branch). Tables showing the number of cases of syphilis, gonorrhea, and other conditions in homosexual and heterosexual males and in females are considered. Tables of other relevant data are also presented. The reasons underlying the changes illustrated, including the Act legalizing homosexual practices between consenting adult males, which became effective in 1968, are discussed. Certain pathological conditions apparently connected with homosexual practices, such as serum hepatitis, local rectal disease, and mucous colitis, are included and also some relevant manifestations of herpes genitalis and genitral warts. Homosexually acquired infection in prisoners is described. Some of the psychiatric effects of homosexuality on clinic patients and also their fears of treatment at clinics are considered, as well as the behavioral differences in response to infection between exclusively homosexuals, bi-sexuals, and married homosexuals.
AP isoenzymes were estimated in 292 patients with locomotor diseases and in 124 healthy controls. The diagnostic usefulness of AP determination is increased by estimation of isoenzymes. Investigations were made to study the biological profile of organ specific AP activities: 1. Rheumatoid arthritis and Reiter's syndrome - the total AP and L-AP activities were increased. 2. Ankylosing spondylitis treated by physiotherapy - the total AP, B-AP and I-AP activities were increased. After drug therapy an increase occurred also in L-AP activity while I-AP activity showed no significant change. 3. Progressive OA of hip and knee showed increased levels of total AP and B-AP activities. 4. Degenerative diseases of the spine, chiefly cases of discopathy, showed significantly reduced levels of AP and B-AP activities. 5. In osteoporosis there was an increase in total AP, L-AP, B-AP and I-AP activities. 6. In the active generalised form of Paget's disease, increased levels were found of total AP, B-AP, I-AP and L-AP activities. 7. In neoplastic diseases the isoenzymes can help to reveal metastatic dissemination and thus aid preoperative evaluation. 8. In gout and hyperuricemic syndromes there was a relative increase of B-AP activity and non-significant fall of L-AP activity. Increased levels of L-AP occured in patients with gallbladder disease, after immunosuppressive therapy or after infectious hepatitis. A fall of L-AP levels was found after Corticotrophin and after intraarticular administration of Kenalog. Increased B-AP activities occurred after total hip replacement, in acute or chronic pyelonephritis and in active osteonecrosis and osteoporosis. Anabolic therapy caused a significant fale of B-AP activity to fall significantly. Reduced B-AP levels were also found after antibiotic therapy. Increased I-AP activity was found in cases of osteoporosis, and in secondary amyloidosis; reduced I-AP activity was seen in mucous colitis. The activity of I-AP is assumed to increase as a result of the changed intestinal calcium and phosphorus regulation occurring in association with the enhanced bone tissue metabolism. From this point of view an order of significance is given for the activity of bone pathology in the separate diagnostic groups of locomotor diseases.
This article discusses the symptoms, treatments and nursing management of patients who have irritable bowel syndrome. It has been recognised as the most common outpatient disorder in the U.K. Various terms have been used to describe the syndrome, including irritated colon, irritable colon syndrome, mucous colitis or spastic colon.
Irritable colon, spastic colon syndrome, mucous colitis, splenic flexure syndrome and functional diarrhoea were included with irritable bowel syndrome (IBS), however these related conditions accounted for only 3% of total IBS problems managed.
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Colonic mucus appears to consist of two glycoprotein fractions, one of which contains mannose, whereas the other is mannose-free. The mannose-containing fraction is significantly increased in ulcerative colitis.
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