Recurrent polychondritis associated with ulcerative colitis

Relapsing polychondritis and Ulcerative Colitis is an uncommon association that has been described only ten times in medical literature. We report a new case of this association in which it was necessary to treat with azathriopine to stop disease progression. Relapsing Polichondritis is a disorder to be considered in patients with Ulcerative Colitis and inflammation of the cartilagenous structures.     

Unusual cerebral complication associated with ulcerative colitis

A case of ulcerative colitis complicated with convulsive seizure is reported. Magnetic resonance imaging studies strongly suggested cerebral vasculitis was the main cause of this episode.     

Bile duct cancer associated with extramammary Paget's disease

We report a case of bile duct cancer associated with anogenital Paget's disease. The patient was a 80-yr-old Japanese woman whose chief complaint was exanthema from the left vulva to the anus for the previous 4 yr. Histological examination of the skin biopsy of the vulva showed numerous Paget's cells. Resection of the lesion and the rectum were performed, and a permanent colostomy was created. More than 1 month after the operation, the patient suddenly developed obstructive jaundice. Percutaneous transhepatic cholangiography performed simultaneously with endoscopic retrograde cholangiography showed complete obstruction of the middle part of the bile duct. Bile cytology was class V. On the basis of these results, bile duct cancer associated with extramammary Paget's disease (EMPD) was diagnosed. About 5 months after the operation, the patient died of liver failure. Microscopically the tumor in the bile duct was poorly differentiated adenocarcinoma. Although EMPD has a tendency to be associated with underlying internal malignancies, this is the first reported case, to our knowledge, of bile duct cancer associated with EMPD.     

Cytomegalovirus infection associated with ulcerative colitis in immunocompetent individuals

Gastrointestinal infection with cytomegalovirus (CMV) is usually found in immunocompromised patients and rarely affects immunocompetent subjects. We describe two immunocompetent patients who had primary CMV infection, and in both the disease was associated with ulcerative colitis. Both patients recovered from the CMV infection spontaneously.     

Clostridium difficile colitis associated with chronic renal failure

BACKGROUND: Clostridium difficile-associated diarrhoea (CDAD) is a potentially life-threatening illness which has been shown to be more common and more severe in patients with chronic renal failure (CRF) than in other groups. A review of CDAD in our nephrology unit was carried out. METHODS: A review of microbiology and histology records identified 32 cases of CDAD in the nephrology unit over a 24-month period. Patient notes were reviewed to identify risk factors, clinical features and outcome. Available isolates of C. difficile underwent 16S ribosomal RNA typing. RESULTS: The incidence of CDAD in the nephrology unit was 10.7 per 1000 admissions, compared to 2.7 per 1000 in other areas of the hospital (P<0.0001). CDAD was considered the sole or principal cause of death in six (19%) and was considered a contributing factor in a further seven (22%). Mortality was significantly higher among patients with established CRF (P=0.04). Seven cases occurred as a cluster, over a 1-month period. Isolates from this cluster, along with comparative strains from other areas of the hospital, were found to be PCR type 1. Diarrhoea occurred in 28 (89%) of cases, pyrexia in 17 (53%) and ileus or abdominal pain in 14 (44%). Six patients responded to discontinuation of antibiotics alone and 22 required metronidazole and/or vancomycin. Three patients had colectomy and one caecostomy because of toxic megacolon. Four patients died before specific therapy could be given and in two of these cases the diagnosis was made at autopsy. Twenty-six patients had a record of recent antibiotic therapy. Of these, 15 had at least one agent considered to be inappropriate (excessively broad spectrum agent in 11, excessive duration of therapy in four). Nine patients had only received antibiotics prior to admission. CONCLUSIONS: CDAD carries a high mortality in nephrology patients, especially those with established CRF. The diagnosis may be missed if a careful antibiotic history is not taken, including agents received prior to admission. Rational antibiotic prescribing and adherence to infection control measures are vital to reduce the incidence of this serious condition.     

Antibody coated red cells with and without hemolysis in chronic ulcerative colitis

A young female with ulcerative colitis associated with positive direct and indirect Coombs reaction and severe autoimmune hemolytic anemia is reported. Cortisone was beneficial and total colectomy was promptly followed by subsidence of the hematologic defects. Review of the literature suggests that this complication of ulcerative colitis is uncommon. It basis is unclear. It seems to be expressed through the presence of a "warm" auto-antibody. Colectomy should be strongly considered when severe hemolysis is present but not when the Coombs test is positive alone without significant hemolysis.     

Alterations in classical cadherins associated with progression in ulcerative and Crohn's colitis

Human colitis is a condition associated with a spectrum of altered morphologic changes and cellular adhesion. The role of cadherins, which are powerful morphoregulatory cell adhesion molecules, in colitis is provocative and as yet unknown. Herein, we present results that suggest a strong correlation between the deregulation of two cadherin molecules, E- and P-cadherins, and the progression of human colitis. We examined the expression and structural integrity of E- and P-cadherins in inflamed, dysplastic, or neoplastic human ulcerative colitis (UC) (n=58), human Crohn's colitis (n = 30), and normal tissue (n = 20) to assess cadherin function in normal and abnormal epithelium. E-cadherin is strongly expressed in normal colorectal epithelium, whereas in left-sided UC it is either down-regulated or has a single-base pair mutation in exon 4 resulting in an amino acid alteration (6 of 58 UC cases). By contrast, P-cadherin is dramatically up-regulated in both Crohn's disease and ulcerative colitis and especially in dysplastic ulcerative tissue. In vitro transfected SW-480 colorectal cells containing E-cadherin mutations identical to those in vivo were associated with increased spontaneous disaggregation compared with cells transfected with wild-type E-cadherin. Based on this evidence, we hypothesize that a small subset of colorectal cells expressing mutant E-cadherin are associated with widespread ulceration, whereas those expressing P-cadherin are associated with a rapidly dividing immature phenotype that includes dysplasia. The differential expression of mutated and wild-type cadherins examined herein are associated with a broad spectrum of abnormal epithelial phenotypes, lymphocyte integrin binding, and resistance to denudation, as is seen in the colitis adenocarcinoma sequence.     

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.     

Bile duct cysts in adults

INTRODUCTION: Bile duct cysts are rare, congenital dilations of the intrahepatic and/or extrahepatic biliary tract. Most of them present during childhood. The classical triad right upper quadrant pain, jaundice and abdominal mass is present only in a few instances. We report here the bile duct cysts which were diagnosed at our institution from 1989 to 1996. METHODS: 3245 consecutive endoscopic retrograde cholangiopancreatograms (ERCP) were evaluated retrospectively. Diagnosis was made when localized cystic dilations of the intrahepatic and/or extrahepatic biliary tract were present. Diffuse dilations of the intrahepatic and extrahepatic biliary tract were excluded. RESULTS: Bile duct cysts were found in 20 patients (17 females, 3 males) among 3245 ERCPs. Their mean age was 56 +/- 20 (median 64, range 10 to 83) years. The cyst types (according to the Alonso-Lej classification with the Todani modification) were type I in 11 (55%), type II, III and IV in two instances each (10%), and type V (or Caroli's disease) in 3 patients (15%). Leading symptoms were cholestasis in 14 patients, 10 of whom had abdominal pain, jaundice in 4 patients, and single cases of pancreatitis, cholangitis, and abdominal mass. In 2 patients the diagnosis was made incidentally. 10 patients had bile duct stones. We performed endoscopic sphincterotomy in 15 patients with concretions or persistent symptoms, 3 patients had cyst resection. One of these, with a type I cyst, already had a disseminated cholangiocarcinoma. 10 of 17 patients without cyst resection are currently symptom-free after complete removal of all gallstones. One male patient with cholecystolithiasis, who is not operable due to advanced liver disease, has recurrent cholangitis, 4 patients have died from causes unrelated to the bile duct cysts, and 2 patients are lost to follow up. CONCLUSION: Bile duct cysts in adults are rare. There is a preponderance in the female gender, and the most common type is the extrahepatic (choledochal) cyst. The leading symptoms are cholestasis and right upper quadrant pain. There is an increased risk of cholangiocarcinoma. In young patients the cysts should be entirely removed to prevent malignancy. Older persons are usually symptomless after complete removal of gallstones.     

Hepatic changes in patients with nonspecific ulcerative colitis

The presence of hepatic changes in ulcerative colitis ranges from 4.7% to 90% and the mechanisms are not clear. This study had the purpose to verify their frequency, observe the relation between clinical forms and hepatic lesions and identify the possible histological changes in the liver. We studied 21 patients with ulcerative colitis (Group 1, subdivided in Group 1A non-alcoholic and 1B alcoholic) and compared with 10 patients with irritable bowel syndrome (Group 2). The study involved clinical evaluation, ultrasonography liver function tests and needle biopsy of the liver, performed by laparoscopy, when necessary. Clinical alterations were present in three patients. The ultra-sonographic study was altered in 14.3% in Group 1A and in 57.1% in Group 1B. The albumin and cholinesterase levels were the most frequent abnormality in ulcerative colitis. In irritable bowel syndrome (Group 2), these exams were normal. Liver biopsy was performed in 15 patients and variable degrees of histologic changes were present in all.     

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.     

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.