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B I Korelitz

Publications and source records attributed to B I Korelitz.

At least 37 records · Page 2Linked to original sources
PubMed1998

Carcinoma arising in anorectal fistulas of Crohn's disease.

PURPOSE: Anorectal fistulas are commonly associated with Crohn's disease. Carcinoma arising in an anal fistula in the absence of Crohn's disease occurs rarely. Carcinoma arising in an anorectal fistula of Crohn's disease is likewise rare and is the subject of this article. METHODS: We have seen eight cases in seven patients. Four of these were squamous carcinoma and three were adenocarcinoma. Details of these seven patients are presented. RESULTS: Two deaths in the four patients with squamous carcinoma and one in the two patients with adenocarcinoma with adequate follow-up suggest a poorer prognosis in both types of malignancy than when these lesions occur without Crohn's disease. CONCLUSION: Carcinoma does arise in the midst of the anorectal fistulas and abscesses of Crohn's disease. Carcinoma arising in a Crohn's disease fistula can be very difficult to diagnose. Examination may be limited by pain, stricture, or induration of the perianal and perineal tissues. Examination under anesthesia can also overlook the lesion. Diagnostic examination under anesthesia yields increases with biopsies or curettage of the fistulous tracts.

Adenocarcinoma↗
PubMed1998

Inflammatory bowel disease and pregnancy.

Despite the lack of prospective studies on the relationship between inflammatory bowel disease (IBD) and pregnancy, the evidence strongly supports the conclusions that fertility is compromised in active Crohn's disease; heredity plays an important role in type and location of disease; fetal outcome is essentially no different than in the general population, except in the presence of active Crohn's disease during pregnancy; and the course of IBD during pregnancy is influenced by disease activity or lack of it before pregnancy. The major influence on outcome of pregnancy, fetal outcome, and course of IBD is the favorable effect of drug therapy on the disease. Most drugs, including sulfasalazine, 5ASA products, corticosteroids, and immunosuppressives, are safe, certainly safer than permitting the disease to be active and allowing for the possibility of surgical intervention during pregnancy. Episiotomy is contraindicated in women with Crohn's disease and perirectal complications. Cesarean section probably is indicated in most patients with Crohn's disease with colonic involvement.

Colitis, Ulcerative↗
PubMed1998

Intravenous corticotrophin vs. hydrocortisone in the treatment of hospitalized patients with Crohn's disease: a randomized double-blind study and follow-up.

Adrenocorticotrophic hormone (ACTH) and corticosteroids have no maintenance values for inflammatory bowel disease but serve to reduce the severity of disease. The effectiveness of intravenous corticotrophin versus hydrocortisone in ulcerative colitis has been determined including whether previous steroid therapy influenced the better response to one rather than the other, but no such studies have ever been done in Crohn's disease. Eighty-eight patients hospitalized with moderate-to-severe Crohn's disease (Present-Korelitz [P-K] Index -3 to -2 and the International Organisation for the Study of Inflammatory Bowel Disease-Crohn's & Colitis Foundation of America [IOIBD-CCFA] Index, mean 14, range 5-23) were treated in a prospective, randomized, double-blind clinical trial to receive either continuous intravenous infusion of 120 U/day of ACTH (44 patients) or hydrocortisone 300 mg/day (44 patients). Patients were also subdivided into those who received oral steroids during the 30 days prior to intravenous therapy and those who had not. Response was followed on a daily basis and tabulated at 3, 5, and 10 days. Patients were followed from 1-3 years to determine the later status. After 10 days of intravenous therapy 36 of 44 patients (82%) who received ACTH and 41 of 44 patients (93%) who received hydrocortisone fully responded (P-K index +3 and IOIBD-CCFA Index mean of 3). At the end of the study, response to intravenous ACTH and hydrocortisone was not statistically different whether or not patients received oral steroids during the 30 days prior to admission, although the response to IV ACTH tended to be faster at 3 days in those who had received previous steroid therapy. Intravenous ACTH and hydrocortisone are equally effective in achieving therapeutic goals in patients with Crohn's disease who have not achieved results with oral medications. Moreover the response rate was high (mean 88%), serving to buy time for establishment of successful maintenance programs of treatment with oral 5-ASA and immunosuppressive drugs for 69% of patients at 1-3 years.

Administration, Oral↗
PubMed1997

Inflammatory bowel disease and immune thrombocytopenic purpura: is there a correlation?

Different hematologic abnormalities are often encountered in patients with inflammatory bowel disease. Among them anemia, leukocytosis, and thrombocytosis are commonly seen. Leukopenia and thrombocytopenia are observed mostly as a side effect of therapy, particularly with use of immunosuppressive drugs. Immune thrombocytopenic purpura is rarely reported in association with inflammatory bowel disease. We present two cases with combination of these entities along with a literature review and treatment options. Immune thrombocytopenic purpura in these patients presented as an extraintestinal manifestation of inflammatory bowel disease mediated by a disturbance of the immune system.

Adolescent↗
PubMed1996

Crohn's disease and acute leukocytoclastic vasculitis of skin.

A 39-yr-old white male with a prolonged history of Crohn's disease presented with worsening diarrhea associated with an increasingly painful rash of both lower extremities as well as left ankle swelling. A skin biopsy revealed an acute leukocytoclastic vasculitis. Intravenous hydrocortisone followed by oral prednisone achieved a rapid remission of the both cutaneous and gastrointestinal manifestations. Long-term remission has been maintained with 6-mercaptopurine and mesalamine. The rare association between cutaneous vasculitis and Crohn's disease is discussed and earlier reported cases reviewed.

Adult↗
PubMed1995

Death from Crohn's disease. Lessons from a personal experience.

We traced 1,000 patients with Crohn's disease hospitalized at Lenox Hill Hospital in New York City during 1972-1987 to identify those who died, the events preceding death, and their relationship to Crohn's disease. We considered any management early in the disease that might have influenced outcome. We introduce the term "virulent" Crohn's disease to describe those patients with most or all of the following: young age at onset, multiple surgical procedures, short bowel/malabsorption, chronic steroid therapy, narcotic addiction, and sepsis. Twenty-five patients (2.6%) had died. Major events preceding 18 deaths related to Crohn's disease were virulent Crohn's disease (six), gastrointestinal neoplasms (six), complications in the elderly (five), and complications of drug therapy (one). Those seven deaths probably unrelated to Crohn's disease were attributed to extraintestinal neoplasms (four) and myocardial infarction (three). Death was related to Crohn's disease or its treatment in 72% and perhaps in all. Ten of the 25 died at age 46 or younger (mean 36 years, range 25-46 years). Twenty-two (88%) who died had undergone surgery for Crohn's disease (mean 3.3 procedures) including eight who died postoperatively (six elderly), attributable to sepsis in seven and pulmonary embolism in one. The events preceding death suggest that early aggressive nonoperative therapy for severe Crohn's disease warrants a careful controlled evaluation.

Adolescent↗
PubMed1995

Immunosuppressive therapy of inflammatory bowel disease: a historical perspective.

I present the progressive development of treatment with immunosuppressive drugs for Crohn's disease and ulcerative colitis, starting with rationale, failure of corticosteroids for maintenance, early observations, controlled trials, collaborations, toxicity (including fear of neoplasms), and considerations in pregnancy. Emphasis is on 6-mercaptopurine and azathioprine. Observations on methotrexate and cyclosporine are included, as well as advice on when to initiate immunosuppressive therapy, what is occurring currently, and what is expected to occur in the near future.

Azathioprine↗
PubMed1994

The role of leukopenia in the 6-mercaptopurine-induced remission of refractory Crohn's disease.

OBJECTIVES: 1) to determine the frequency of induced leukopenia in patients with refractory Crohn's disease treated with 6-Mercaptopurine (6-MP). 2) to determine the influence of 6-MP-induced leukopenia on achieving remission [including the three major specific goals of therapy: (a) elimination or reduction of steroids, (b) healing of abscesses and fistulas, and (c) elimination of recurrent intestinal obstruction] and the effect on the rate and percentage of improvement in the CCFA-IOIBD index of Crohn's disease activity after 3 months of 6-MP therapy. 3) to determine whether an improvement of leukopenia was accomplished by an increased risk of clinical bone marrow depression. METHODS: We reviewed the course of 98 consecutive patients with refractory Crohn's disease treated with 6-MP and compared the 51 who developed leukopenia and the 47 who did not, in regard to achievement of remission, length of time until remission, rate of recurrence, and time until recurrence. RESULTS: 1) The mean time to remission was 8.8 wk for patients with leukopenia versus 14.3 wk for those without leukopenia. 2) A strong positive correlation exists between 6-MP induced leukopenia and the achievement and maintenance of remission in refractory Crohn's disease. This was evident in the analysis of response in specific goals and in the activity index. 3) There was no clinical evidence of bone marrow suppression in the 51 patients who developed 6-MP induced leukopenia. CONCLUSIONS: 1) Increasing the dose of 6-MP in patients with refractory Crohn's disease who have not yet responded and who have not achieved leukopenia will very likely increase the efficacy of this drug. 2) Influenced by the results of this study, we have launched a double-blind prospective study to evaluate the relationship between the induction of leukopenia with 6-MP and the achievement of remission.

Adult↗
PubMed1993

Experience with Eudragit-S-coated mesalamine (Asacol) in inflammatory bowel disease. An open study.

We reviewed the courses of 63 patients with inflammatory bowel disease (IBD) treated in a private gastroenterology practice. All were allergic, unresponsive, or in some way intolerant of sulfasalazine and therefore were treated with Eudragit-S-coated mesalamine (Asacol). Thirty-eight patients had ulcerative colitis (UC) and 25 had Crohn's disease. In 22 and 14, respectively, mesalamine was used to treat active disease; in 16 and 11, respectively, it was introduced to maintain remission. In some patients, mesalamine was used along with other medications. Symptomatic and endoscopic response was seen in seven of nine (77%) with active UC treated with measalamine alone; remission was maintained in seven of eight (94%) when mesalamine was used alone. Therapeutic success was noted in eight of 10 (80%) with active Crohn's disease, and remission was maintained in seven of nine (78%) when mesalamine was used alone. Adverse reactions of varying severity occurred in 21 of 63 (33%), but the drug had to be terminated in only 9 of 63 (14%). Eudragit-S-coated mesalamine appears to be effective in the treatment and maintenance of remission of UC in 82% of those patients allergic or intolerant to the parent drug, sulfasalazine. Furthermore, contrary to what was expected, we found it effective in a much larger percentage of patients with Crohn's disease (79%) than the parent drug.

Acrylic Resins↗
PubMed1993

Long-term experience with 6-mercaptopurine in the treatment of Crohn's disease.

We report our observations after 20 yr of clinical experience with 6-mercaptopurine (6-MP) in 148 patients with Crohn's disease who had not satisfactorily responded to steroids and other drugs. Specific therapeutic goals were established for each patient, and the NFIC (now CCFA)-IOIBD index of Crohn's disease activity was calculated pre- and post-therapy. Defined therapeutic goals were achieved in 68%. Major successes include 1) elimination of steroids (66% p < 0.001); 2) healing of internal fistulas and abscesses or improvement by elimination of discharge and tenderness (64% p < 0.05); and 3) healing or improvement by elimination of pain, tenderness and discharge of perirectal fistulas and abscesses (87%, p < 0.05). Other therapeutic goals which achieved 100% success were 1) healing or marked improvement of Crohn's disease of the stomach and duodenum; 2) permitting surgery to be performed electively after 6-MP allowed margins for surgical resection to be delineated. 6-MP was less effective in achieving the therapeutic goals of preventing recurrent small bowel obstruction (43%) and elimination of abdominal masses (55%). Seventy-eight percent of patients showed a reduction in the activity index with a mean of 43% (95% C.I. 36-51%). 6-MP was once again demonstrated to be effective in achieving major therapeutic goals in two of three patients with severe Crohn's disease. Accordingly, the need for surgical resection and subsequent extension of the disease is often postponed or eliminated.

Crohn Disease↗
PubMed1993

Crohn's disease presenting as isolated jejunitis years after childhood colitis.

We present a case of a patient who had documented ulcerative colitis as a child and later presented with isolated Crohn's jejunitis. Although rare, Crohn's disease must be considered in those patients with segmental inflammation of the small bowel and a prior history of inflammatory bowel disease involving the colon. Patients with colitis that do not show specific criteria for either ulcerative colitis or Crohn's disease should be classified as indeterminant colitis, and a small bowel series is indicated. It may be indicated to obtain a small bowel series in patients with any form of colonic inflammatory bowel disease, periodically, after diagnosis.

Child, Preschool↗
PubMed1992

Surveillance in the routine management of ulcerative colitis: the predictive value of low-grade dysplasia.

Biopsies obtained at colonoscopy from 121 patients with ulcerative colitis (UC) for greater than 7 years were reviewed. Dysplasia or neoplasia was found in 27 patients (22%) after a mean of 16 years; 22 (18%) had dysplasia (all low grade), 2 had polyps, and 3 had carcinoma without prior dysplasia. Seven had dysplasia (or neoplasia) on the next examination, and another 4 after multiple negative examinations. Dysplasia preceded carcinoma in 4 (18%) of the 22 patients, and carcinoma occurred in 7 (6%) of 121 patients. The average time from the first encounter of dysplasia to the finding of carcinoma was 6.3 years, and 3 of 4 patients with negative second colonoscopies then had unremarkable examinations for 2-5 years. Dysplasia without cancer was found later in another 3. Dysplasia was found in 12 of 13 colectomy specimens, including the 3 from patients with cancer in whom no dysplasia had been found at surveillance colonoscopy. Active disease did not eliminate the capability to detect dysplasia or negate the value of surveillance for cancer when colonoscopy was conducted for routine clinical indications. Most dysplasia was detected in the rectum and sigmoid, supporting the value of interim sigmoidoscopies and biopsies during routine management of UC. Compliance for surveillance was diminished when the patient was asymptomatic, thereby increasing the risk of cancer. Low-grade dysplasia, like high-grade dysplasia, is predictive of future carcinoma and warrants careful follow-up. A "negative" second examination is no basis for a sense of security or relaxation of vigilance.

Adolescent↗