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Biomedical subjects

B I Korelitz

Publications and source records attributed to B I Korelitz.

At least 73 records · Page 4Linked to original sources
PubMed1987

Kaposi's sarcoma occurring in association with ulcerative colitis.

Kaposi's sarcoma is a well-known manifestation of the acquired immune deficiency syndrome. Involvement of the gastrointestinal tract, including the colon, by this tumor usually causes no gastrointestinal symptoms. However, Kaposi's sarcoma has never been reported in association with ulcerative colitis in patients with acquired immune deficiency syndrome. Herein, the second reported case of colonic Kaposi's sarcoma associated with ulcerative colitis in a non-acquired immune deficiency syndrome patient is presented. Alimentary tract lesions typical of Kaposi's sarcoma are reviewed.

Aged↗
PubMed1986

Nature and course of pancreatitis caused by 6-mercaptopurine in the treatment of inflammatory bowel disease.

6-Mercaptopurine (6-MP) has an important role in the treatment of inflammatory bowel disease. Its most frequent short-term complication has proven to be pancreatitis, which we have now seen in 13 of 400 (3.25%) patients (12 Crohn's disease, 1 ulcerative colitis) and which we here describe. The timing of the pancreatitis was such that it could not be attributed to sulfasalazine, which was also being taken by 9 patients, or corticosteroids, which were being taken by 7 patients. The dosage of 6-MP ranged from 50 to 100 mg daily, and the pancreatitis, which was uncomplicated in all cases, occurred within 8-32 days with one exception (6.5 mo). Symptoms included epigastric pain, back pain, fever, and nausea. The serum amylase was elevated in 12 patients. The average elevation was 5.9 times normal. In all cases, the 6-MP was discontinued and symptoms and signs returned to normal over a period of 1-11 days. No other complications of 6-MP occurred; there was no leukopenia. Of 7 patients rechallenged with 6-MP, all developed recurrent pancreatitis, including 4 in less than 24 h. In 3 patients, desensitization attempted by a gradual increase in dose from 1/8 tablet (approximately 6 mg) daily also led to recurrence. The timing of the initial pancreatitis and the recurrence at rechallenge are best explained by an allergic reaction. 6-Mercaptopurine should not be reinstituted once it has caused pancreatitis.

Amylases↗
PubMed1986

Sigmoidoscopy and biopsy in surveillance for cancer in ulcerative colitis.

Surveillance has become an established concept to find dysplasia as a premalignant lesion in ulcerative colitis. Since the advent of colonoscopy and the access of the entire colon to biopsy, utilization of the rigid sigmoidoscope and rectal biopsies has been markedly reduced. We have reviewed 940 rectal biopsies obtained from 360 patients with ulcerative colitis of various extent and duration to determine the yield of dysplasia and assess the value of this procedure. The rectal biopsies had been performed for a variety of reasons in the course of clinical management of ulcerative colitis in addition to surveillance. Dysplasia was found in 10.8% of the patients--higher than has been demonstrated by colonoscopy. In four of the 39 patients with dysplasia a carcinoma coexisted (2) or developed subsequently (2). In no instance did dysplasia serve to warrant the colectomy that disclosed the carcinoma, but earlier discovery of the dysplasia or more intense surveillance once it had been found might have led to earlier discovery of the carcinoma. The yield of dysplasia was greater in those with onset of ulcerative colitis in childhood. In more than half, including 71% of patients with onset in childhood, the dysplasia was found before they had the disease for 9 years. Surveillance, therefore, should begin earlier in young patients with ulcerative colitis. Sigmoidoscopic biopsies do not substitute for colonoscopic biopsies in a surveillance program. Nevertheless, the ease of obtaining rectal biopsies, the relatively large yield of dysplasia, and the need for frequent sigmoidoscopy in the clinical management of ulcerative colitis all warrant a high priority role for rectal biopsies to supplement that of colonoscopic biopsies.

Adolescent↗
PubMed1986

Mycobacterial aetiology of Crohn's disease: serologic study using common mycobacterial antigens and a species-specific glycolipid antigen from Mycobacterium paratuberculosis.

Crohn's disease is a granulomatous form of enteritis superficially similar to Johne's disease (paratuberculosis) of ruminants. Recently, a Mycobacterium sp closely related to Mycobacterium paratuberculosis was cultured from tissues of patients with Crohn's disease suggesting that M paratuberculosis may be the aetiologic agent in some cases. In addition, greater seroreactivity to M paratuberculosis has been reported in patients with Crohn's disease. In the present study, we have evaluated the serum antibody response to disrupted M paratuberculosis using ELISA and serum specimens from 33 people with Crohn's disease, 21 with ulcerative colitis, and 12 non-inflammatory bowel disease controls. We failed to find a consistent IgG, IgM, or IgA antibody response to Mycobacterium paratuberculosis. The results indicate that, as in bovine paratuberculosis, serum seroreactivity is not a reliable tool for examining the relationship between human intestinal disease and mycobacteria.

Antibody Formation↗
PubMed1985

Favorable effect of 6-mercaptopurine on fistulae of Crohn's disease.

Fistulae are distressing chronic complications of Crohn's disease which have served as one of the most common indications for surgical resection. While steroids and sulfasalazine have not been successful in closing fistulae, in a previous double-blind study 6-mercaptopurine (6-MP) was more effective than placebo in accomplishing this goal (31% vs 6%). Thirty-four patients with Crohn's disease fistulae were treated with 6-MP for a minimum period of 6 months. In 13 patients (39%) the fistulae closed completely, and in another 9 (26%) there was obvious improvement. All types of fistulae responded to 6-MP with the most impressive closures occurring in patients with fistulae of the abdominal wall and enteroenteric fistulae. The mean time to respond was 3.1 months, with 23% of patients taking longer than 4 months to show any response. Response was not related to other drugs (steroids, sulfasalazine) used in conjunction with the 6-MP. The site of intestinal involvement with Crohn's disease did not appear to play a significant role in the frequency or degree of response to 6-MP, but patients without prior resection and fistulae did better than those with fistulae occurring after surgery. The long-term response to fistulae was good if 6-MP was maintained, whereas exacerbation eventually followed discontinuation of 6-MP. 6-Mercaptopurine is an effective and useful drug in the treatment of fistulae, as it is in other manifestations of chronic unrelenting Crohn's disease.

Abdominal Muscles↗
PubMed1985

The fate of the rectal segment after diversion of the fecal stream in Crohn's disease: its implications for surgical management.

Diverting the fecal stream has been considered to benefit the course of Crohn's disease. Clinical signs and symptoms have not, however, been distinguished previously from the objective inflammatory changes in the distal segment. We reviewed the course of 16 consecutive patients with Crohn's disease in whom sigmoidoscopy showed normal mucosa at the time of diversion and who underwent an ileostomy or colostomy, the rectal segment being left in place. As early as 3 months after diversion, all 16 patients showed progressive friability, ulceration, and exudation in the retained rectum. Stricture occurred in four and lead to abdominoperineal resection in three. Four of eight patients with only moderate inflammation on sigmoidoscopy underwent reanastomosis which was followed by a return to a normal-appearing rectal mucosa. The rectal segment inflammed after diversion rarely shows the histological characteristics of Crohn's disease when resected. This leads us to suspect that the disorder of nonspecific "diversion colitis" might account for this phenomenon entirely, or at least it may accelerate the Crohn's disease process. Continuity of the intestinal tract should be maintained in the course of Crohn's disease surgery if feasible. If a diversion is clinically warranted, reanastomosis should be considered as early as possible despite progressive inflammation of the rectal mucosa.

Adult↗
PubMed1984

Uveitis occurring after colectomy and ileal-rectal sleeve anastomosis for ulcerative colitis.

Uveitis is an extraintestinal complication of ulcerative colitis and Crohn's disease. In most cases, its course parallels that of the underlying bowel disease and improves with its therapy. Occasionally, the two processes are not synchronous. In either case, the uveitis has usually been considered to be dependent on the presence of the colon. This report describes a patient who developed uveitis shortly after colectomy and ileal-rectal sleeve anastomosis for ulcerative colitis, indicating that the continuing presence of the colonic mucosa is not necessary for development of the associated ocular inflammation.

Adult↗
PubMed1984

Response to drug therapy in Crohn's disease: evaluation by rectal biopsy and mucosal cell counts.

Improvement in Crohn's disease after drug therapy was evaluated in 38 patients with evidence of rectal disease at sigmoidoscopy in whom the rectum later appeared normal. Rectal biopsies taken before and after therapy were examined histopathologically. Cell counts of the lamina propria connective tissue cells were used to evaluate mucosal changes. The drugs apparently responsible for conversion of the rectal mocosal appearance to normal were sulfasalazine, prednisone, and 6-mercaptopurine. There was complete healing histologically in 24 patients (63%). In the other 14, healing was incomplete as evidenced by microscopic chronic inflammation, microgranulomas, or occasional lymphangiectasia. There were both complete and incomplete responses to all three drugs, but the total numbers were too small to identify significant therapeutic differences. Cell counts confirmed the elimination of acute inflammation. Despite drug therapy, histological evidence of activity persisted in one-third of the patients in whom the appearance of the rectum became normal.

Biopsy↗
PubMed1984

Desensitization to sulfasalazine after hypersensitivity reactions in patients with inflammatory bowel disease.

Desensitization to sulfasalazine was successful in 40/47 (85%) patients with IBD who previously had hypersensitivity reactions. The desensitization with sulfasalazine was well-tolerated with no serious complications in short- or long-term follow-up. The course of IBD was subsequently favorable in 35/40 (87%) for extended periods including 17/17 (100%) with ulcerative colitis. Desensitization should be attempted in patients who have had typical hypersensitivity reactions to sulfasalazine.

Clinical Trials as Topic↗
PubMed1984

The influence of inflammatory bowel disease and its treatment on pregnancy and fetal outcome.

The influence of inflammatory bowel disease (IBD) and its therapy upon pregnancy is a frequent consideration before and after conception. We looked at the influence of disease activity and drug therapy during pregnancy on fetal outcome in 147 pregnancies in 124 women. Patients were divided into two groups; 46 (28 ulcerative colitis, 18 Crohn's disease) who received drug treatment during pregnancy, and 101 (42 ulcerative colitis, 59 Crohn's disease) who received no treatment. The frequency of fetal complications was higher than in the general population in the "treated" patients, but was not higher than in patients with IBD who received no drug treatment. Active IBD was present in 43% of the treated patients whose pregnancies resulted in fetal complications. Of patients with Crohn's disease whose pregnancies resulted in fetal complications, active IBD was present in 62.5%. Thus, our experience suggests that patients with IBD who receive therapy during pregnancy are at greater risk of fetal complications than the average population, but that disease activity is more likely to be responsible for this risk than drug treatment. This risk is much more evident in active Crohn's disease than in ulcerative colitis.

Abortion, Spontaneous↗
PubMed1984

Complications of Crohn's disease predisposing to dysplasia and cancer of the intestinal tract: considerations of a surveillance program.

Carcinomas of the ileum and colon in patients with Crohn's disease are being reported with such increasing frequency as to raise the question of a surveillance program to find dysplasia or the carcinoma itself at the earliest possible time. Accordingly, we consider the overall risk with emphasis on specific manifestations of Crohn's disease which predispose to malignancy so that the surveillance might be given special direction. Two more cases of carcinoma in Crohn's disease are reported, one in association with a long-standing fistula, the other with synchronous, metachronous, and multifocal lesions, and both with dysplasia.

Adenocarcinoma↗
PubMed1984

Proctitis after fecal diversion in Crohn's disease and its elimination with reanastomosis: implications for surgical management. Report of four cases.

Diverting the fecal stream has been considered to affect the course of Crohn's disease favorably. Adverse effects on the distal segment have not previously been distinguished from clinical signs and symptoms. The course of four patients with Crohn's disease who underwent fecal diversion with an in situ rectum were observed in whom sigmoidoscopy was initially normal at the time of the diversion, became distinctly abnormal during the year after the diversion, and then returned to normal within 3 mo following reestablishment of intestinal continuity. The entity of nonspecific diversion proctitis might account for this phenomenon independently or by accelerating the Crohn's disease process. The inflammation present was nonspecific and did not show the stigmata of Crohn's disease. Continuity of the intestinal tract should be maintained in the course of Crohn's disease surgery if feasible. If a diversion is clinically warranted, reanastomosis should be considered as early as possible despite evidence of inflammation in the rectal mucosa.

Adult↗
PubMed1983

Prognosis for nonoperative management of small-bowel obstruction in Crohn's disease.

Small-bowel obstruction has been the most common indication for surgical intervention in Crohn's disease. If, however, obstruction relents without surgery, new programs of management may reduce or eliminate the need for resection. Over 7 years, 25 of 26 patients were relieved of an index episode of ileal obstruction--in most cases aided by a small-bowel tube and intravenous ACTH. They were then maintained on medical therapy, sulfasalazine (SASZ) alone in seven, SASZ and intermittent prednisone in 18, and then 6-mercaptopurine with or without SASZ in 14 of those 18. Seven patients have had no recurrence of obstruction after an average follow-up of 52 months. Recurrent obstruction occurred 52 times in 18 patients over the next 16-106 months; in all the obstruction was again relieved nonoperatively. Twelve patients underwent elective surgery, for recurrent obstruction in nine. Eight months seemed to offer a useful cutoff criterion for the likelihood of recurrence. When recurrence of obstruction took place within 8 months, surgery was ultimately required in six of seven patients. In contrast, patients who weathered the first 8 months without obstruction did well; only three of 11 ultimately required resection. Of 18 patients without recurrent obstruction for 8 months, only five were eventually operated upon, two for other indications; in 11 of the 13 patients who underwent no operation, the quality of life was excellent or good. We conclude that if the initial episode of small-bowel obstruction can be reversed, subsequent maintenance therapy including SASZ, and/or 6-mercaptopurine with an intermittent liquid diet in some patients eliminates or postpones the need for resection without compromise of the quality of life.

Adrenocorticotropic Hormone↗
PubMed1983

Sulfasalazine pneumonitis.

A man with alleged Crohn's disease of the terminal ileum was started on sulfasalazine. Five weeks later he developed progressive cough, shortness of breath, and fever associated with peripheral eosinophilia and bilateral pulmonary infiltrates. After withdrawal of sulfasalazine all abnormalities returned to normal. This case supports the conviction that there is an entity of sulfasalazine-induced lung disease.

Adult↗