Toxic megacolon of ulcerative colitis in infancy

A 12-week-old white male infant with ulcerative colitis and toxic megacolon is described. His diarrhea and rectal bleeding responded to prednisone. He subsequently developed toxic dilatation of the transverse colon while on salicylazosulfapyridine and one week after discontinuation of prednisone. His toxic megacolon disappeared during close medical observation, readministration of prednisone, and avoidance of repeated abdominal examinations. One year later sigmoidoscopy showed only friable mucosa and the barium enema showed the presence of ulcerative colitis but with improvement from the initial study. Currently he is taking 375 mg of salicylazosulfapyridine daily. Growth and development are normal and he is asymptomatic.     

Pseudomembranous colitis complicated with toxic megacolon. Report of a case

We present a patient who developed pseudomembranous colitis a few days after suffering serious multiple traumas and after receiving a variety of antibiotic treatments. The patient, whose condition was further complicated by toxic megacolon, underwent subtotal colectomy and ileostomy. Toxic megacolon is a rare complication of enterocolitis due to C. difficile and is associated with a high rate of mortality. We review the cases published to date, describe the pathogenesis of the condition, and discuss the diagnostic criteria for pseudomembranous colitis, emphasizing treatment and possible complications.     

'Sticky' neutrophils, pathergic arthritis, and response to heparin in pyoderma gangrenosum complicating ulcerative colitis

Pyoderma gangrenosum is strongly associated with inflammatory bowel disease and exhibits pathergy, occurring at sites of previous minor trauma. A patient is presented with a 21 year history of extensive ulcerative colitis, who developed pyoderma gangrenosum and arthralgia while receiving high dose corticosteroids for active ulcerative colitis. The arthralgia exhibited pathergy affecting particularly the left temporomandibular joint, which was stressed by an asymmetric bite, and the left elbow, which had been fractured many years previously. This prompted the hypothesis that neutrophils in this condition may be marginated, as a result of increased stickiness of either the neutrophil or the vascular endothelium. The introduction of heparin therapy was associated with rapid resolution of the arthralgia, pyoderma gangrenosum, and ulcerative colitis.     

Appendiceal inflammation in ulcerative colitis

The epoxyalkanoyl derivatives were designed and synthesized as ACE inhibitors. Coupling of unsaturated carboxylic acids with amino acids and following epoxidation with dimethyldioxirane gave the epoxyalkanoyls with high yield. The inhibitory activity of synthesized compounds on angiotensin converting enzyme was IC50 values of 0.06-5.5 microM.     

X-ray symptoms in ulcerative colitis

Barium enema studies in 200 patients with ulcerative colitis were analyzed according to radiological symptoms. The results of the radiological examination were compared with those of rectoscopy and biopsy. In about 75 per cent of patients good agreement was achieved.     

Nephrotic syndrome in ulcerative colitis

Complicating disorders in various organs outside the intestinal tract are common in ulcerative colitis. This report deals with the occurrence of nephrotic syndrome in two patients with long-standing ulcerative colitis. In the patient studied in most detail, 2 episodes have taken place, the first developing into uremia. After colectomy had been performed, rapid improvement of renal function took place. The morphological changes in kidney biopsies were compatible with the presence of focal glomerular sclerosis. Activity in the complement system and a favorable response to steroid treatment indicate that humoral immune mechanisms are of pathogenetic importance with regard to the renal disease in these two patients. To our knowledge nephrotic syndrome has not previously been described as a complication to ulcerative colitis.     

Risk factors in ulcerative colitis

In 504 Jewish patients with ulcerative colitis the following risk factors were evaluated: sex, age at onset of disease, community group, extent of disease, and duration of disease. The disease was more severe in females. Severe attacks, weight loss, iron deficiency, liver disease and arthritis were significantly more frequent in females than in mles. Mortality was higher in patients who contracted the disease above age 50. The disease appeared to be more severe in patiets of Ashkenazi origin as compared to Orientals. The difference failed to reach statistical signifcance except for mortality. We confirmed the well-known adverse effect of extensive colonic involvement. Severe attacks, a severe course of the disease and extensive colonic involvement are more frequent with increasing duration of the disease.     

Rifampicin for ulcerative colitis

The public health approach to injury control is now widely accepted. Since the development of this approach, there has been a shift in the perspective of public health programs to include broader definitions of health. There have also been increasing efforts to evaluate public health interventions in terms of health outcomes at the population level. In this context, it might be appropriate to broaden the focus of injury prevention to target more specifically injuries that are not life-threatening. Although they are not responsible for major morbidity at an individual level, they probably account for the greatest decrement in the health of the population as a whole.     

p-ANCA target antigens in ulcerative colitis

Isolated hearts from two strains of rats bred for sensitivity or resistance to amygdala kindling that also exhibit, in vivo, differential sensitivity to the cardiotoxicity of cocaine were studied. The goal was to determine if the differential cardiotoxic sensitivity was due, at least in part, to intrinsic strain-dependent differences in the heart. The Langendorff preparation was used (n=8 per strain). Hearts were perfused with increasing concentrations of cocaine (5 x 10(-6), 1 x 10(-5), 5 x 10(-5), 1 x 10(-4), and 5 x 10(-4) M) for 5 min with a 5 min washout between exposure to successive concentrations. Consistent with in vivo observations, hearts from genetically slow amygdala kindling rats (Slow) required lower cocaine doses to develop cardiac arrhythmias and arrest as compared to the hearts from genetically fast amygdala kindling rats (Fast). At 5 x 10(-5) M cocaine arrhythmias occurred in 38% (3/8) Slow and 0% Fast hearts. Five of 8 Slow hearts and none of 8 Fast hearts were arrested by 10(-4) M cocaine. Arrest in Fast hearts occurred only with 5 x 10(-4) M cocaine. Cocaine constricted coronary arteries (no significant difference between strains). On the other hand, coronary arteries of Slow but not Fast hearts dilated during cocaine washout after perfusion with all but the highest concentration of cocaine. We conclude that factors intrinsic to the heart and coronary artery influence the sensitivity or response of these structures to cocaine.     

Auto-immune haemolytic anaemia in ulcerative colitis

Most research regarding the health effects of smoking has focussed on mortality and on relatively young populations. Less is known about the consequences of smoking and the benefits of cessation among older adults. Improvements in quality of life are likely to represent more salient reasons to motivate older adults to stop smoking. Multivariate results from the Campbell's Survey on Well-Being indicate that long-term cessation among older adults yielded odds ratios comparable to never smokers in eight of 13 quality of life outcomes. Conversely, current smokers had elevated risks in 11 of 13 areas. Short-term benefits of smoking cessation were less clear in this subsample, and a number of possible explanations for this finding are explored.     

Cyclosporin for severe ulcerative colitis

In recent years there have been numerous reports of successful treatment of resistant ulcerative colitis with cyclosporin. A series of 9 patients with moderate to severe active ulcerative colitis was treated with cyclosporin between September 1993 and October 1994. All 9 had failed to respond to conventional therapy, including salazopyrine and intravenous corticosteroids. They underwent colonoscopy and after contraindications to therapy were ruled out, received intravenous cyclosporin, 4 mg/kg/day for 7-10 days. They were discharged on oral cyclosporin with average serum levels maintained at 200 ng/ml. Response was assessed using the clinical score system of Schroeder et al. 2 out of 9 patients (22%) responded with full clinical remissions lasting more than 6 months. 6 patients had partial responses to the intravenous therapy, but symptoms resumed shortly after its cessation. Factors predicting favorable response to cyclosporin therapy were a shorter duration of disease with a fulminant clinical course. The success rate was less than that reported in the literature, possibly because of comparatively low serum cyclosporin levels. Potential complications of therapy and high cost preclude the routine use of cyclosporin in ulcerative colitis. Larger controlled studies are required to assess its efficacy and safety. Until such studies are available, cyclosporin may be tried in poor surgical risks or those not yet ready psychologically for total colectomy.