CHRONIC GRANULOCYTIC LEUKEMIA COMPLICATED BY ULCERATIVE COLITIS: ELEVATED LEUKOCYTE ALKALINE PHOSPHATASE AND POSSIBLE MODIFIER GENE DELETION.
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Adolescent↗
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THE TREATMENT OF ULCERATIVE COLITIS.
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Adrenal Cortex Hormones↗
THE COURSE AND PROGNOSIS OF ULCERATIVE COLITIS. III. COMPLICATIONS.
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Anemia↗
Surgical management of ulcerative colitis.
As long as our understanding of ulcerative colitis is too limited to allow a more specific, disease-targeted treatment, surgery will play an important role in the management of these patients. Careful interdisciplinary evaluation and counselling of patients with ulcerative colitis will permit to achieve the goals on an individual basis with maximum safety. Restorative proctocolectomy with an IPAA has evolved as the procedure of choice among four basic surgical options because it appears to be safe and carries a low mortality. Although the associated morbidity is not negligible, functional results are generally good and patient satisfaction is high.
Colitis, Ulcerative↗
[Experimental study on action of acupoint embedding thread on ANCA in the rat of ulcerative colitis].
OBJECTIVE: To observe therapeutic effect of acupoint embedding thread therapy on ulcerative colitis and to study the mechanism. METHODS: The rat model of ulcerative colitis was developed with 2,4-dinitrochlorobenzene method. The 20th day after the end of model development, they were randomly divided into a model group, a salicylazosulfapyridine (SASP) treatment group and an acupoint embedding thread therapy group. The SASP treatment group were treated with intragastrical perfusion of 4.5% SASP suspension, and the acupoint embedding thread therapy group were treated with embedding thread at "Zusanli" (ST 36) and "Shangjuxu" (ST 37). Anti-neutrophil cytoplasmic antibody (ANCA) was detected with indirect immunofluorescence, and the pathological changes were investigated with pathological tissue section technique. RESULTS: The positive rate of ANCA reached to 62.5% in the rat with ulcerative colitis with significant differences among the 3 groups. After treatment, the positive rate of ANCA was decreased in the two treatment groups (P < 0.05, P < 0.01). CONCLUSION: Acupoint embedding thread therapy has definite therapeutic effect on ulcerative colitis and the mechanism is possibly related with the decrease of ANCA.
Acupuncture Points↗
Large bullous eruption in patients with ulcerative colitis.
Oligocentric large bullous eruptions in two patients with ulcerative colitis were reported. Such bullae were similar to those seen in drug-induced coma, and those described as drug eruption due to high dose frusemide. However, neither narcotic drugs nor frusemide had been given in either case. The bullae were cured after the administration of corticosteroid and/or salazosulfapyridine with a course paralleling that of the ulcerative colitis. Thus the bullae seem to be a cutaneous manifestation of ulcerative colitis.
Adult↗
Takayasu's arteritis associated with ulcerative colitis; genetic factors in this association.
Both ulcerative colitis and Takayasu's arteritis are though to be organ-specific immune-mediated inflammatory diseases. We present the rare case of a 23-year-old woman with a 4-year history of ulcerative colitis who developed Takayasu's arteritis one month after giving birth. She was found to carry the human leukocyte antigens (HLA)-B52 and DR2, which were previously noted to be associated with these inflammatory conditions in the Japanese population. The pathogenic relevance of this haplotype to the concomitant development of these two conditions is discussed.
Adult↗
Autonomic response to standardized stress predicts subsequent disease activity in ulcerative colitis.
OBJECTIVES: Prospective studies of the role of psychological stress in ulcerative colitis are inconsistent or show a modest relationship. We tested the hypothesis that individual differences in autonomic function are associated with differences in the disease course of ulcerative colitis. METHODS: The spectral power of heart rate variability, an indirect marker of autonomic function, was measured during a standardized stress protocol in 93 ulcerative colitis patients. Patients were categorized as typical or atypical by an increase or decrease, respectively, in the high frequency band of heart rate variability from a period of acute stress to recovery 5 min later. Disease activity was measured at baseline (time 1) and a second time point (time 2) 7-37 months later. RESULTS: An atypical pattern of heart rate variability at time 1, present in 29% of patients, was associated with lower mean disease activity at time 2 (atypical, 0.56+/-0.93; typical, 2.27+/-2.56, P=0.001). The contribution of heart rate variability pattern to explaining time 2 disease activity was independent of the contributions of other factors that differed between groups, including time 1 disease activity and lifetime corticosteroid use. DISCUSSION: An atypical pattern of autonomic reactivity may be a marker of individual differences in stress regulation that has prognostic significance in ulcerative colitis.
Adult↗
Autoimmune hemolytic anemia and positive Coombs test associated with ulcerative colitis.
OBJECTIVES: To estimate the frequency of autoimmune hemolytic anemia and Coombs positivity without overt hemolysis in ulcerative colitis, to determine possible subsets of patients with ulcerative colitis susceptible to this complication, and to assess the efficacy of the applied therapeutic modalities. METHODS: Three hundred and two patients with ulcerative colitis treated at the University Hospital of Heraklion, Crete, over a 6-yr period were included. Within this group, a subgroup of 152 patients were studied prospectively for the presence of a positive direct Coombs test. RESULTS: Autoimmune hemolytic anemia was diagnosed in five of 302 patients with ulcerative colitis (1.7%). One more patient developed Coombs-positive hemolytic anemia, attributed to sulfasalazine. A positive Coombs test without evidence of hemolysis was found in three of 152 patients (2%). The mean age of all Coombs-positive patients was 50.5 yr, and there was a definitive male preponderance (male: female, 2:1). Autoimmune hemolytic anemia occurred during active colitis in all cases. The mean time between the onset of colitis and the diagnosis of autoimmune hemolytic anemia was 17 months. Three of five patients with autoimmune hemolytic anemia (60%) and seven of nine of all Coombs-positive patients (77.7%) had total colitis. All patients with autoimmune hemolytic anemia were treated initially with large doses of corticosteroids. Three of five (60%) had good hematological responses. One patient responded to the addition of azathioprine, and one underwent splenectomy and proctocolectomy. CONCLUSIONS: In this study, the frequency with which autoimmune hemolytic anemia was associated with ulcerative colitis was higher than in previous reports. The complication occurred early in the course of colitis and was related to activity and extent of the disease. In contrast to others studies, we found a preponderance of males. Although corticosteroids and/or immunosuppressive therapy was successful in most of our cases, one patient required surgery.
Adolescent↗
Acute CMV-colitis in a patient with a history of ulcerative colitis.
A symptomatic cytomegalovirus (CMV) infection usually occurs in patients with debilitating diseases, immunosuppression, transplantations and acquired immunodeficiency syndrome (AIDS). Gastrointestinal infections with CMV, especially colitis, are usually found in immunocompromised patients and rarely affect immunocompetent subjects. Here we report the case of a young female patient with a history of ulcerative colitis (UC) who presented with an acute attack of colitis caused by CMV infection. This was documented by the presence of CMV early antigen, antibodies and evidence of CMV in the colonic mucosa. After combined anti-inflammatory and antiviral treatment the patient recovered completely. As most attention is given to CMV-pathogeneity in immunocompromised patients, here we discuss the relationship to inflammatory bowel diseases.
Acute Disease↗
Clinical and diagnostic features of Crohn's disease and ulcerative colitis in childhood.
Crohn's disease and ulcerative colitis are important disorders in childhood which may present in a similar way to adult life, but the major paediatric dimension is impairment of growth and development which may occur in both disorders. Whilst the diagnosis of ulcerative colitis is usually quite quick by virtue of the pressing nature of the chief symptoms, bloody diarrhoea, the diagnosis of Crohn's disease may be significantly delayed in children as the symptoms are frequently less obvious and may not, at first, be gastrointestinal. Modern diagnosis is based upon a combination of endoscopy and radiology. Of particular importance is endoscopic biopsy which enables a definite histological diagnosis to be made. Early referral to diagnostic centres is particularly important in childhood.
Child↗
[Dietary habits of patients with ulcerative colitis (author's transl)].
The nutritional habits of 114 patients with ulcerative colitis were investigated by means of questionnaires and compared with a control group of 114 persons matched to age, sex and social status. The differences between both groups can be explained by an adaptation of dietary habits of patients with chronic inflammatory bowel disease (ulcerative colitis). Patients with ulcerative colitis consumed significantly more cereal products and potatoes but significantly less milk products, coffee, tea, fruit-juice, lemonade, vegetables, fruit and alcohol than the control group.
Adult↗
Ulcerative colitis in Olmsted County, Minnesota, 1940-1993: incidence, prevalence, and survival.
BACKGROUND: There is significant geographic variation in the reported incidence of ulcerative colitis. AIMS: To update the incidence and prevalence of ulcerative colitis in Olmsted County, Minnesota, examine temporal trends, and determine overall survival. PATIENTS: All Olmsted County residents diagnosed with ulcerative colitis between 1940 and 1993 (incidence cases), and all residents with ulcerative colitis alive on 1 January 1991 (prevalence cases). METHODS: Incidence and prevalence rates were adjusted using 1990 US census figures for whites. The effects of age, sex, and calendar year on incidence rates were evaluated using Poisson regression. Survival from diagnosis was compared with that expected for US north-central whites. RESULTS: Between 1940 and 1993, 278 incidence cases were identified, for an adjusted incidence rate of 7.6 cases per 100 000 person years (95% confidence interval (CI), 6.7 to 8.5). On 1 January 1991, there were 218 residents with definite or probable ulcerative colitis, for an adjusted prevalence rate of 229 cases per 100 000 (95% CI, 198 to 260). Increased incidence rates were associated with later calendar years (p<0.002), younger age (p<0.0001), urban residence (p<0.0001), and male sex (p<0.003). Overall survival was similar to that expected (p>0.2). CONCLUSIONS: The overall incidence rate of ulcerative colitis in Olmsted County increased until the 1970s, and remained stable thereafter. Incidence rates among men and urban residents were significantly higher. The prevalence rate in Rochester in 1991 was 19% higher than that in 1980. Overall survival was similar to that of the general population.
Adolescent↗
Ulcerative colitis and the skin.
The association between ulcerative colitis and various abnormalities of the skin, especially pyoderma gangrenosum, has been accepted for many years. The underlying aberrations in either of the organ systems, as well as the basis of their association, however, remain obscure. Several large series of ulcerative colitis patients are reviewed to emphasize the important concomitant cutaneous findings, and investigations into the pathogenesis of pyoderma gangrenosum are discussed.
Adult↗
Coffee and alcohol use and the risk of ulcerative colitis.
We performed a population-based, case-control study of the risk of ulcerative colitis associated with coffee and alcohol use among the 304,000 members of a prepaid health plan. We compared coffee and alcohol use histories before ulcerative colitis onset in 209 cases and an equal number of age- and sex-matched controls selected from the enrollment file of the prepaid health plan. Neither coffee use, amount of coffee consumed daily, or cumulative coffee consumption before disease onset altered the risk of developing ulcerative colitis. A decreased risk of ulcerative colitis was associated with alcohol consumption before disease onset among never-smokers only. This risk declined as daily alcohol consumption increased. These results suggest that alcohol consumption may lower ulcerative colitis incidence.
Coffee↗
Circulating antibodies against human colonic extract enriched with a 40 kDa protein in patients with ulcerative colitis.
We have previously described a 40 kDa colonic protein(s) which is specifically recognised by tissue-bound immunoglobulin G obtained from the colon of patients with ulcerative colitis. We now report the presence of circulating antibodies against this antigen using an enzyme-linked immunosorbent assay with a highly enriched preparation of the 40 kDa protein from normal colon extracts. Serum was collected from 79 patients with ulcerative colitis, 36 with Crohn's disease, 16 with specific diarrhoeal syndromes, and from 19 normal subjects. Twenty nine of 79 patients with ulcerative colitis, 21 of 36 with Crohn's disease, and all patients with diarrhoea were symptomatic during the collection of sera. The difference in optical density values between patients with symptomatic ulcerative colitis and each of the other groups, including patients with ulcerative colitis in remission, was highly significant (p less than 0.01). Seventy nine per cent of patients with symptomatic ulcerative colitis had optical density values above the means for all other groups. Fifty five per cent of sera from patients with symptomatic ulcerative colitis had optical densities beyond two SDs of the values for all other groups and only two of 71 sera from non-ulcerative colitis patients (one Crohn's disease and one normal subject) had values in this range. These results show the presence of anti-colon antibodies against the 40 kDa protein(s) in the sera of many patients with symptomatic ulcerative colitis.
Adolescent↗
[Cerebral vein thrombosis as a complication of a florid ulcerative colitis].
BACKGROUND: Thromboembolic episode, especially cerebral vein thrombosis, is a rare extraintestinal complication of ulcerative colitis. In world literature less than 100 cases are reported. Although the existence of coagulation alterations and fibrinolysis have been suggested, the exact mechanism of hypercoagulability in patients with ulcerative colitis is still unknown. CASE REPORT: The authors report of a 35-year-old female patient with ulcerative colitis, that has existed for several years. She developed strong cephalgias without further neurologic symptoms in an acute attack of her disease. Magnetic resonance imaging led to the diagnosis of an extensive acute cerebral vein thrombosis. Other possible reasons for a coagulopathy were excluded. CONCLUSION: Cerebral vein thrombosis is a rare, but severe complication of ulcerative colitis. Thus, the presence of neurologic symptoms in a patient with known ulcerative colitis should lead to immediate diagnosis and treatment.
Adult↗
Diagnostic value of DNA image cytometry in ulcerative colitis.
The increased risk of colorectal cancer in patients with extensive, long-standing ulcerative colitis is well established. The interpretation of dysplasia as the common precursor lesion of colorectal cancer in ulcerative colitis is, however, subject to inter- and intraobserver variation. The histologic diagnosis is particularly difficult in the presence of acute inflammation. Therefore, the analysis of ploidy patterns might be a more objective diagnostic tool. In the present study, the correlation of ploidy and dysplasia of the colonic mucosa was evaluated in the absence and presence of inflammation. Image cytometry was performed on 561 fixed, paraffin-embedded tissue specimens from 67 patients with ulcerative colitis. Twenty patients had long-standing and extensive disease, including eight patients in whom the colitis was associated with colorectal cancer. Dysplasia was only found in patients with long-standing colitis or with colorectal cancer and was significantly more often diagnosed in the case of concomitant inflammation. On the other hand, aneuploid patterns were shown to occur independent of inflammatory activity. Aneuploidy was present in all colorectal carcinomas associated with ulcerative colitis and in 46.2% of specimens with dysplasia. Moreover, aneuploidy was detectable in four of 12 samples with low-grade dysplasia as well as in one case devoid of any dysplastic alteration. Ulcerative colitis patients with low-grade dysplasia plus aneuploidy probably represent a subgroup that might be at higher risk of developing colorectal cancer than patients with low-grade dysplasia alone. All in all, image cytometry analysis might be instrumental in identifying neoplastic lesions even in cases of increased inflammatory activity or regenerative change.
Adolescent↗