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Biomedical subjects

B I Korelitz

Publications and source records attributed to B I Korelitz.

At least 91 records · Page 5Linked to original sources
PubMed1981

Pregnancy in inflammatory bowel disease: effect of sulfasalazine and corticosteroids on fetal outcome.

To determine the safety of corticosteroids and sulfasalazine in pregnancy associated with inflammatory bowel disease, we reviewed the outcome of 531 such pregnancies in a national survey. Two hundred eighty-seven pregnancies (172 ulcerative colitis and 115 Crohn's disease) were treated with either or both drugs, whereas 244 (137 ulcerative colitis and 107 Crohn's disease) received neither. The frequency of fetal complications was significantly lower in both "treated" and "untreated" groups, as compared with the reported rates in the general pregnant population. We conclude: 1. Inflammatory bowel disease, except for severe active Crohn's disease, does not seem to affect the outcome of concurrent pregnancy adversely. 2. The use of corticosteroid and sulfasalazine in pregnancy associated with ulcerative colitis is unlikely to increase the fetal morbidity or mortality. 3. Patients with severe Crohn's disease requiring corticosteroid and/or both drugs experience more complications than the "untreated" ones, but still fewer than the prevailing rates in the general pregnant population. The higher complication rate seems to be associated more with disease-related factors than the use of these drugs. 4. In the management of inflammatory bowel disease associated with pregnancy, either or both drugs may be used just as in the nonpregnant patients.

Adrenal Cortex Hormones↗
PubMed1981

The course of inflammatory bowel disease during pregnancy and postpartum.

To determine whether pregnancy influences the course of inflammatory bowel disease, a survey of 324 patients, 178 with ulcerative colitis and 146 with Crohn's disease was carried out. During pregnancy, 70% of the patients remained unchanged or improved, whereas 30% developed exacerbations. The course of the disease was significantly milder in patients who became pregnant while in remission, as compared to those with moderate to severe disease (P less than 0.001). Postpartum, only 13% of patients, with quiescent to mild disease at term, experienced moderate to severe disease in contrast to 53% of those with active disease (P less than 0.001). We conclude that: 1. The course of inflammatory bowel disease is not adversely affected by concurrent pregnancy or postpartum 2. Exacerbations during or after pregnancy are more frequent in patients with active or uncontrolled disease. 3. Since the risk of relapse during pregnancy and postpartum is significantly lower in patients with inactive disease, treatment designed to induce and maintain remission in the course of pregnancy should minimize such exacerbations.

Colitis, Ulcerative↗
PubMed1981

Crohn's disease in endoscopic biopsies of the gastric antrum and duodenum.

Forty-five patients with Crohn's disease in whom the upper gastrointestinal tract was normal by x-ray were examined by gastroduodenoscopy. Biopsies were analyzed histologically from the lower esophagus, body of the stomach, gastric antrum and duodenal bulb. Cell counts were made of 500 connective tissue cells of the duodenal mucosa. Histological examinations and cell counts of the duodenal mucosa were also performed on 50 healthy volunteers used as controls. Histological lesions were found in 19 Crohn's disease cases; 11 (24%) were considered pathologically diagnostic and all these were found in the antrum or duodenum. In 11 the mucosa was endoscopically normal. Granulomas were present in three cases (7%), all from normal appearing mucosa. Microscopic alterations of the antrum and duodenum, similar to findings in the normal appearing rectal mucosa, support the concept that Crohn's disease involves the entire alimentary canal and that lesions are seen grossly only where the disease is most advanced.

Biopsy↗
PubMed1980

Treatment of Crohn's disease with 6-mercaptopurine. A long-term, randomized, double-blind study.

To test the effectiveness of 6-mercaptopurine (6-MP) in the treatment of Crohn's disease, we entered 83 chronically ill patients into a two-year double-blind study comparing 6-MP with placebo. Crossover data showed that improvement occurred in 26 of 39 courses of 6-MP (67%) as compared with three of 39 courses of placebo (8%) (P less than 0.001). Non-crossover data likewise confirmed the superiority of 6-MP. The drug was more effective than placebo in closing fistulas (31 vs 6%) and in permitting discontinuation or reduction of steroid dosage (75 vs. 36%) (P less than 0.001). The onset of response to 6-MP was often delayed, with 32% of patients taking longer than three months to respond, and 19% taking longer than four months. Adverse side effects to 6-MP occurred in 10% of patients and were uniformly reversible. We conclude that 6-MP is an effective and useful agent in the management of Crohn's disease.

Adolescent↗
PubMed1980

Anorectal Crohn's disease: definitive surgery for fistulas and recurrent abscesses.

Twenty patients with anorectal Crohn's disease manifested by anal fistulas or recurrent perirectal abscesses underwent attempted definitive surgical eradication of that pathologic process. The role of Parks' partial internal anal sphincterectomy is discussed. The results are presented and correlated with the activity of the underlying Crohn's disease. The excellent results recommend this approach for recurrent perirectal abscess and intersphincteric abscess, even when occurring for the first time.

Abscess↗
PubMed1977

Rectal biopsy in patients with Crohn's disease. Normal mucosa on sigmoidoscopic examination.

Of 99 patients with Crohn's disease whose rectal segment appeared normal on sigmoidoscopy, there was histologic inflammation in 45% and features characteristic of Crohn's disease in 30% of rectal biopsy specimens. Granulomas were found in 18% of patients, including 13% of those with ileitis, 13% of those with ileocolitis, and 37% of those with colitis. Eleven of the 17 granulomas were small undermarcated microgranulomas. Rectal biopsy specimens are of value to confirm the diagnosis in Crohn's disease and to determine the state of clinical activity even when the sigmoidoscopic appearance is normal.

Biopsy↗
PubMed1977

Colonic-duodenal fistula in Crohn's disease.

A fistula between the ascending colon and the duodenum occurs not uncommonly as a complication of Crohn's disease with primarily colonic involvement. Clinical and radiological findings in four cases are presented. In three instances the fistula served as an indication for surgical intervention; after ileosigmoidostomy, ileorectal anastomosis, and ileostomy alone, the patients improved clinically but x-ray evidence of patency of the fistula persisted. Recurrent activity of the Crohn's disease in two responded to medical treatment as it did in one patient without surgery at all. The internal fistula need not be a seriuos complication of Crohn's disease and should not serve as an indication for surgical correction for its own sake.

Adolescent↗
PubMed1977

Perforation of the colon in unsuspected amebic colitis: report of two cases.

Two cases of amebic colitis that resulted in perforation of the colon, an ominous complication, are presented. The first was diagnosed preoperatively as acute ulcerative colitis with toxic megacolon, and the second as peritonitis complicating acute cholecystitis. In both instances the correct diagnosis was made after operation. The first patient recovered after colectomy and antiamebic therapy, but the second patient died in the early postoperative period, in septic shock. Amebic colitis occurs infrequently in the United States, and the diagnosis is rarely considered. In most cases an initial diagnosis of ulcerative or granulomatous colitis is made and the true diagnosis is recognized only after operation for colonic perforation or hepatic abscess. It is suggested that amebic colitis should be considered more frequently in cases of patients who have diarrhea. Stool examination for ova and parasites is often negative in amebic colitis. The IHA is usually positive in emebiasis, and should be performed early in casesof patients who have bloody diarrhea or other clinical symptons when amebiasis is suspected. Rectal biopsy is also a useful diagnostic approach, but failed to reveal amebae in one of our cases. Finally, it is suggested that operation be performed urgently when fulminating amebic colitis is not reversed by antiamebic therapy, when peritonitis occurs even with antiamebic treatment in progess, and for colonic perforation or toxic megacolon even when antiamebic therapy has not been indicated.

Adult↗
PubMed1977

Microgranulomas in grossly normal rectal mucosa in Crohn's disease.

Rectal biopsies of sigmoidoscopically normal mucosa from 99 patients with Crohn's disease of the ileum, colon, or both were studied histologically, with particular reference to the presence of granulomas. Among the 14 cases of granulomas, some were of the usual sarcoid type and could easily be detected. Other microgranulomas were less well defined and were found only by mid- or high-power microscopic screening of serial sections. The morphologic characteristics, the relationship to ordinary Crohn's-disease granulomas and the possible significance of microgranulomas are discussed.

Biopsy↗