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12/31/1969 03:59 PM
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Chronic Ulcerative Colitis
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CHRONIC ULCERATIVE COLITIS. Riely, Lea April 1935 Oklahoma City, Oklahoma uvh 0404522 English ARTICLE: PDF Only 370-375 Clinical Medicine 468 28 4 Success Turn on more accessible mode Skip to main 0
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12/31/1969 03:59 PM
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Chronic Ulcerative Colitis
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CHRONIC ULCERATIVE COLITIS. From the Department of Medicine, University of Tennessee, Memphis, Tennessee
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12/31/1969 03:59 PM
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Chronic Ulcerative Colitis
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CHRONIC ULCERATIVE COLITIS. From the Roosevelt Hospital, West Fifty-Ninth Street and Ninth Avenue, New York, New York
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12/31/1969 03:59 PM
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Chronic Ulcerative Colitis: Etiology
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CHRONIC ULCERATIVE COLITIS: ETIOLOGY. From the Department of Bacteriology, School of Medicine, Emory University, Emory University, Georgia
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12/31/1969 03:59 PM
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Chronic Ulcerative Colitis: Case Report
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CHRONIC ULCERATIVE COLITIS: CASE REPORT. Garon, Max December 1937 Louisville, Kentucky uvh 0404522 English Original Article: PDF Only 1181-1184 Clinical Medicine 295 30 12 Success Turn on more Skip 0
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12/31/1969 03:59 PM
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Toxic Megacolon Complicating Chronic Ulcerative Colitis*
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The authors describe the pathologic lesion and consider the pathogenesis of this extremely serious complication of ulcerative colitis. Their results of treatment have been excellent.
(C) 1965 Southern Medical Association
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12/31/1969 03:59 PM
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Surgical Management of Anorectal Complications of Chronic Ulcerative Colitis
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Several complications of ulcerative colitis may show themselves during the course of disease. They must be recognized and be thoroughly considered from the standpoint of surgical management.
(C) 1961 Southern Medical Association
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12/31/1969 03:59 PM
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Surgical Management of Chronic Ulcerative Colitis
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SURGICAL MANAGEMENT OF CHRONIC ULCERATIVE COLITIS.
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12/31/1969 03:59 PM
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Medical Management of Chronic Ulcerative Colitis
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MEDICAL MANAGEMENT OF CHRONIC ULCERATIVE COLITIS.
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12/31/1969 03:59 PM
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The Role of the Surgeon in Chronic Ulcerative Colitis
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THE ROLE OF THE SURGEON IN CHRONIC ULCERATIVE COLITIS.
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12/31/1969 03:59 PM
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Chronic Ulcerative Colitis: Vaccine Therapy in Sixty-Six Cases
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CHRONIC ULCERATIVE COLITIS: VACCINE THERAPY IN SIXTY-SIX CASES. Department of Gastro-Enterology, Baylor University College of Medicine, Dallas, Tex.
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12/31/1969 03:59 PM
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The Surgical Treatment of Chronic Ulcerative Colitis
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THE SURGICAL TREATMENT OF CHRONIC ULCERATIVE COLITIS.
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12/31/1969 03:59 PM
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Role of the Surgeon in the Treatment of Chronic Ulcerative Colitis
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The management of chronic ulcerative colitis, though successful by a medical regimen in many instances, often requires surgical intervention for permanent control or to save life. The author outlines the indications for surgical attack and the technics most appropriate.
(C) 1963 Southern Medical Association
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12/31/1969 03:59 PM
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Current Status of Sphincter-Saving Operations for Chronic Ulcerative Colitis
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When surgery is demanded by the course of a patient with ulcerative colitis, the sphincter mechanism can be spared. The straight ileoanal anastomosis without a reservoir has not been satisfactory for adults because of frequent diarrheal stools. The ileorectal anastomosis has the advantage of minimal morbidity, but the patient is not totally cured, because the diseased rectum is still in place. The pouch pull-through procedure has an increased morbidity, but the patient is cured of ulcerative colitis. The anastomotic stricture rate is 7% to 15% and the failure rate, 2% to 6%. Inflammation of the pouch or reservoir occurs in 5% to 19%. There have been no deaths in the reviewed series. As the details of the pouch pull-through procedure are refined, this operation will become the choice for treatment of ulcerative colitis.
(C) 1985 Southern Medical Association
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12/31/1969 03:59 PM
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Banthine(R) in Reptic Ulcer and Chronic Ulcerative Colitis: Clinical and Experimental Observations
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BANTHINE(R) IN REPTIC ULCER AND CHRONIC ULCERATIVE COLITIS: CLINICAL AND EXPERIMENTAL OBSERVATIONS. Medical Service, McGuite Veterans Administration Hospital, and the Department of Medicine, Medical
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12/31/1969 03:59 PM
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Airway Obstruction in Ulcerative Colitis
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colon; We present a case of fulminant ulcerative colitis with associated extraintestinal manifestations, including upper airway obstruction from acute laryngotracheitis. Review of the literature shows few other cases of airway obstruction in chronic inflammatory bowel disease. Aggressive medical management of the underlying inflammatory bowel disease may facilitate a conservative approach to airway management, as in this case.
(C) 1997 Southern Medical Association
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12/31/1969 03:59 PM
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Comparison of the Possible Risk Factors of Bone Mineral Density in Subjects with Ulcerative Colitis and Healthy Subjects
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Objective: Inflammatory bowel disease (IBD) is a gastrointestinal system disorder with a variety of causes. The prevalence of reduced bone mineral density (BMD) is greater in people with IBD as compared with healthy individuals. In this study, we aimed to investigate the possible risk factors for low BMD in subjects with ulcerative colitis (UC) and in healthy control subjects.
Subjects and Methods: A total of 40 subjects with UC and 29 healthy subjects were enrolled in the study. Age; sex; body mass index; location and duration of disease; current corticosteroid, azathioprine, or other immunosuppressive medications; smoking; consumption of alcohol, milk, and milk products; menstrual pattern in women; and use of vitamin D, calcium, folic acid, multivitamins, and iron preparations were recorded. BMD was measured by dual-energy x-ray absorptiometry at L2-L4 of the spine and the femoral neck.
Results: The BMD of patients was found to be lower than that in the control group. The T and z scores of the lumbar vertebra and femoral neck were normal in 21 subjects (52.5%). A total of 17 (42.5%) subjects had osteopenia, and 2 (5%) subjects had osteoporosis. Parathyroid hormone, 1,25(OH)2 vitamin D3, osteocalcin, and urinary markers were found to be similar in both groups. There were no significant differences between subjects with UC and subjects in the control group according to age, sex, and conventional risk factors.
Conclusions: The BMD of subjects with UC was found to be lower than that in subjects of similar age and sex in the control group. Our findings suggest that that the disease itself is the most important pathogenic factor contributing to low BMD.
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12/31/1969 03:59 PM
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Problem of Cancer in Ulcerative Colitis
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There are differences of opinion in regard to "prophylactic colectomy" against cancer in instances of chronic ulcerative colitis. The authors consider the prognosis in regard to possible cancer and suggest a conservative attitude if follow-up care can be adequate.
(C) 1968 Southern Medical Association
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12/31/1969 03:59 PM
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Ulceratiye Colitis: Surgical Indications and Alternatives
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colon; Ulcerative colitis is a surgically curable mucosal disease of the colon and rectum. Optimal management of this chronic condition requires close coordination between the patient, surgeon, and primary care provider or gastroenterologist. Knowledge of surgical indications and the operative alternatives available helps to individualize therapy. Acute and chronic indications for surgery and the five surgical methods currently in use are described.
(C) 1994 Southern Medical Association
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12/31/1969 03:59 PM
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Pyoderma Gangrenosum
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This progressive necrotizing and ulcerative disease of the skin presents serious problems in management. Its association with chronic ulcerative colitis in many instances offers opportunities for speculation as to its etiology, which is far from clear. Fortunately treatment is successful in most instances with reliance upon sulfonamides, and steroids for the more fulminant manifestations.
(C) 1969 Southern Medical Association
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12/31/1969 03:59 PM
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Special Considerations of Its Treatment
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SPECIAL CONSIDERATIONS OF ITS TREATMENT. Rankin, Fred Johnston, Coleman May 1941 Lexington, Kentucky uvh 0404522 English CHRONIC ULCERATIVE COLITIS: PDF Only 464-470 Miscellaneous Clinical 460 34 5
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12/31/1969 03:59 PM
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Duodenal Obstruction: Unusual Types
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From the Department of Medicine and the Mallinckrodt Institute of Radiology, Washington University School of Medicise. CHRONIC ULCERATIVE COLITIS: PDF Only
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12/31/1969 03:59 PM
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Radical Operation for Severe Varicose Veins and Varicose Ulcer
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RADICAL OPERATION FOR SEVERE VARICOSE VEINS AND VARICOSE ULCER. From the Department of Surgery. Tulane University School of Medicine. CHRONIC ULCERATIVE COLITIS: PDF Only
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12/31/1969 03:59 PM
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Inflammatory Bowel Disease-Related Thoracic Aortic Thrombosis
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Arterial and venous thromboembolisms have long been associated with inflammatory bowel disease (IBD) and can cause significant morbidity and mortality. We present a patient with aortic arch thrombosis embolizing to the left lower extremity during hospitalization for active ulcerative colitis (UC). The limb was preserved following emergent embolectomy. Thrombophilia was attributed to UC, as hypercoagulable testing was negative. IBD is certainly a hypercoagulable state, and aggressive thromboembolism prevention should be considered for hospitalized patients with active disease.
(C) 2010 Southern Medical Association
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12/31/1969 03:59 PM
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Technical Complications of Ileostomy
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A review of 45 patients with ileostomy revealed a complication rate of 24%. A higher incidence of complications was seen in those patients who were obese (80%), who had chronic ulcerative colitis (45%), or who had an emergency ileostomy because of a surgical complication (50%). Strict attention to technic should prevent the majority of these complications.
(C) 1980 Southern Medical Association
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12/31/1969 03:59 PM
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Current Surgical Management of Inflammatory Bowel Disease
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colon; When surgery is required for complications of inflammatory bowel disease (IBD) or for failure of medical management, numerous options exist. This review focuses on surgical alternatives, technical considerations, and complications for both routine and unusual problems associated with IBD. Restorative proctocolectomy for chronic ulcerative colitis, intestine-sparing procedures for Crohn's disease, and the management of Crohn's disease in difficult anatomic sites or with unusual complications are discussed.
(C) 1994 Southern Medical Association
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12/31/1969 03:59 PM
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Current Medical Therapy for Inflammatory Bowel Disease
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Traditional medical therapy for inflammatory bowel disease (IBD) includes corticosteroids and sulfasalazine. In recent years, several mesalamine derivatives of sulfasalazine have become available. These allow delivery of increased dosages of active medication with minimal side effects. Newer steroid preparations, all investigational at this point, likely will offer efficacy similar to that of prednisone but with an improved side effect profile. Immunosuppressive agents, including 6-mercaptopurine, azathioprine, and likely also methotrexate, are beneficial in treating refractory IBD, particularly in patients with chronic steroid dependence. Cyclosporine has been shown to be remarkably effective in delaying colectomy for severe ulcerative colitis, but its long-term role remains uncertain.
(C) 1996 Southern Medical Association
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12/31/1969 03:59 PM
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The Problem of Carcinoma in Inflammatory Disease of the Bowel: Selective Case Experiences
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The authors consider the difficulties in the differentiation of Crohn's disease of the colon from chronic ulcerative colitis. Furthermore, this problem is complicated by the tendency to develop malignancy of the colon in long-standing inflammatory disease. This paper evaluates the relative merits of the several means at hand to aid in definitive diagnosis.
(C) 1972 Southern Medical Association
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12/31/1969 03:59 PM
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An Unexpected Cause of Elevated Prostate Specific Antigen
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An Unexpected Cause of Elevated Prostate Specific Antigen. at this time was consistent with ulcerative colitis with goblet cell depletion, chronic inflammatory infiltration and crypt abscesses. He was
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12/31/1969 03:59 PM
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Asacol®-induced Neutropenia Resolution Without the Use of Granulocyte Colony-stimulating Factor
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We report a case of neutropenia and gram-negative septicemia in a 73-year-old male with ulcerative colitis. During the hospital course, medications were adjusted according to rare accounts of drug-induced neutropenia. While the substitution of propafenone for another antiarrhythmic brought about no change in the patient's absolute neutrophil count, the cessation of Asacol® (Warner Chilcott, Rockaway, NJ) was followed by a significant improvement in the neutropenic state. In fact, this neutrophil count continued to trend upward for months following. We thereby conclude that Asacol® carries the potential to induce neutropenia and that this reaction may be reversed in some patients solely by discontinuing the medication and without the aid of stimulating factors such as filgrastim.
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12/31/1969 03:59 PM
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MEFV Gene Mutations in a Patient with Eosinophilic Gastroenteritis
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Eosinophilic gastroenteritis (EG) is an uncommon gastrointestinal disease affecting both children and adults. The underlying molecular mechanism predisposing to the clinical manifestation of eosinophilic gastroenteritis is unknown. A 39-year-old man who was followed up with the diagnosis of familial Mediterranean fever (FMF) was admitted to our clinic with diarrhea, abdominal pain, and weight loss. After endoscopic and colonoscopic examinations EG was diagnosed by histopathological examination. Symptoms were resolved with the treatment of budesonide. To our knowledge, this is the first reported case of EG with the MEFV gene mutations in the literature.
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12/31/1969 03:59 PM
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Black Strap Molasses for the Treatment of Inflammatory Bowel Disease-associated Anemia
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Black Strap Molasses for the Treatment of Inflammatory Bowel Disease-associated Anemia. supplements. However, most patients with ulcerative colitis-associated anemia improve on intravenous iron alone
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12/31/1969 03:59 PM
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Cytomegalovirus Enteritis in Common Variable Immunodeficiency
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A woman with previously undiagnosed common variable immunodeficiency presented with diarrhea and volume depletion. Biopsies from upper and lower endoscopy revealed atrophic gastritis, villous atrophy, and an inflammatory bowel disease-like chronic colitis, with absence of plasma cells in all sites. Cytomegalovirus inclusions were demonstrated in the colon and small bowel mucosa. Despite therapy with intravenous immunoglobulin and ganciclovir, the patient deteriorated rapidly and subsequently died. This case report highlights the potential for cytomegalovirus to cause extensive disease in patients with common variable immunodeficiency and, thus, the importance of considering it in the initial differential diagnosis so that further morbidity and mortality might be prevented.
(C) 2004 Southern Medical Association
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12/31/1969 03:59 PM
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Relationship of the Intensity of Helicobacter pylori and Severity of Inflammation with Beta-2 Microglobulin Levels in Serum According to the Updated Sydney System
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Objective:
(HP) is a cause of chronic gastritis. Beta-2 microglobulin has been used as a simple inflammatory indicator in some diseases. We investigate the usability of beta-2 microglobulin as a simple marker that may reflect the severity of inflammation and intensity of HP in gastric mucosa.
Materials and Methods: A total of 114 patients was included in the study, who applied to an outpatient gastroenterology clinic with complaint of dyspepsia. Serum beta-2 microglobulin levels were evaluated in 109 patients. Esophagogastroduodenoscopy was performed on patients included in the study, and histological analysis was performed by obtaining two specimens from each of antrum, corpus, and incisura angularis. All specimens were evaluated according to the updated Sydney System.
Results: No statistically significant result was found between serum beta-2 microglobulin levels and the intensity of HP and the severity of inflammation of gastric mucosa. However, it was observed that the serum beta-2 microglobulin level in specimens taken from corpus was found to be higher in patients with moderate-severe HP intensities compared to those with lower HP intensities.
Conclusions: Although HP is the cause of the chronic active gastritis characterized with the infiltration of lymphocytes, plasma cells, and neutrophils, it is accompanied by local involvement apart from diseases with a course of systemic involvement. We suggest that the serum beta-2 microglobulin level cannot be used as a simple marker of HP intensity and severity of inflammation in gastric endoscopic biopsies.
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12/31/1969 03:59 PM
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Colonic Pseudo-obstruction in Sickle Cell Disease
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A young Arab woman with sickle cell-[beta]0-thalassemia disease developed acute colonic pseudo-obstruction that became chronic but showed some response to hydroxyurea. There was no evidence of microvascular or macrovascular occlusion. We also report the case of an Arab man with sickle cell anemia who presented with acute colonic pseudo-obstruction from which he recovered completely within a few days. Although the development of pseudo-obstruction in these two cases seems to have been a complication of sickle cell anemia, its pathogenesis remains unclear. There are several reports of ischemic and inflammatory disorders of the colon complicating sickle cell disease; however, these two cases represent the first descriptions of large-bowel pseudo-obstruction in this hemoglobinopathy.
(C) 2003 Southern Medical Association
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12/31/1969 03:59 PM
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Helicobacter pylori and Beta-2 Microglobulin Levels
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Helicobacter pylori and Beta-2 Microglobulin Levels Department of Pathology, Cankiri State Hospital, Cankiri, Turkey (Dincer) Departments of Gastrointestinal Surgery and Gastroenterology, Turkiye
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12/31/1969 03:59 PM
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To Pick a 'Bone' with the Gallbladder
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To Pick a 'Bone' with the Gallbladder. Medical Corps, United States Navy; Naval Medical Center San Diego; San Diego, CA (Lin) Special Sections: Letters to the Editor 1. Nelson JJ, Khan AG. A case of
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12/31/1969 03:59 PM
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Physical Activity Benefits and Risks on the Gastrointestinal System
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Abstract: This review evaluates the current understanding of the benefits and risks of physical activity and exercise on the gastrointestinal system. A significant portion of endurance athletes are affected by gastrointestinal symptoms, but most symptoms are transient and do not have long-term consequences. Conversely, physical activity may have a protective effect on the gastrointestinal system. There is convincing evidence that physical activity reduces the risk of colon cancer. The evidence is less convincing for gastric and pancreatic cancers, gastroesophageal reflux disease, peptic ulcer disease, nonalcoholic fatty liver disease, cholelithiasis, diverticular disease, irritable bowel syndrome, and constipation. Physical activity may reduce the risk of gastrointestinal bleeding and inflammatory bowel disease, although this has not been proven unequivocally. This article provides a critical review of the evidence-based literature concerning exercise and physical activity effects on the gastrointestinal system and provides physicians with a better understanding of the evidence behind exercise prescriptions for patients with gastrointestinal disorders. Well-designed prospective randomized trials evaluating the risks and benefits of exercise and physical activity on gastrointestinal disorders are recommended for future research.
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12/31/1969 03:59 PM
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Intestinal Necrosis due to Sodium Polystyrene Sulfonate (Kayexalate) in Sorbitol
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Background: Sodium polystyrene sulfonate (SPS, Kayexalate) has been implicated in the development of intestinal necrosis. Sorbitol, added as a cathartic agent, may be primarily responsible. Previous studies have documented bowel necrosis primarily in postoperative, dialysis, and transplant patients. We sought to identify additional clinical characteristics among patients with probable SPS-induced intestinal necrosis.
Methods: Rhode Island Hospital surgical pathology records were reviewed to identify all gastrointestinal specimens reported as containing SPS crystals from December 1998 to June 2007. Patient demographics, medical comorbidities, and hospital courses of histologically verified cases of intestinal necrosis were extracted from the medical records.
Results: Twenty-nine patients with reports of SPS crystals were identified. Nine cases were excluded as incidental findings with normal mucosa. Nine patients were excluded as their symptoms began before SPS administration or because an alternate etiology for bowel ischemia was identified. Eleven patients had confirmed intestinal necrosis and a temporal relationship with SPS administration suggestive of SPS-induced necrosis. Only 2 patients were postoperative, and only 4 had end-stage renal disease (ESRD). All patients had documented hyperkalemia, received oral SPS, and developed symptoms of intestinal injury between 3 hours and 11 days after SPS administration. Four patients died.
Conclusion: Intestinal ischemia is a recognized risk of SPS in sorbitol. Our series highlights that patients may be susceptible even in the absence of ESRD, surgical intervention, or significant comorbidity.
(C) 2009 Southern Medical Association
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12/31/1969 03:59 PM
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Diagnosing Irritable Bowel Syndrome: A Changing Clinical Paradigm
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Rather than being a diagnosis of exclusion, irritable bowel syndrome (IBS) is a diagnosis that can be identified by symptom-based criteria. The collection of these criteria by a meticulous history can be enhanced by using various tools. Once a positive diagnosis is made, using clinical criteria for diagnosis, one should look for alarm or warning symptoms or signs, and should characterize the type of bowel habit. Determining whether the condition is a diarrhea-predominant or a constipation-predominant IBS will direct further diagnostic evaluation and management.
Key Points
* IBS is diagnosed by symptom-based clinical criteria.
* A positive diagnosis using clinical criteria can avoid exhaustive diagnostic testing.
* Characterizing the bowel habit as diarrhea- or constipation-predominant will direct further diagnostic evaluation and management.
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12/31/1969 03:59 PM
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Colorectal Cancer Screening: Today and Tomorrow
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Colorectal cancer remains a disease with significant morbidity and mortality. However, the prognosis can be greatly improved with early detection. Here, we review the current screening modalities and guidelines for patients at average, moderate, and high risk for colorectal cancer. New experimental modalities are also introduced.
(C) 2006 Southern Medical Association
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12/31/1969 03:59 PM
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Emphysematous Cystitis in the Absence of Known Risk Factors: An Unusual Clinical Entity
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Emphysematous cystitis is a rare disorder that is usually associated with immunosuppression, poorly controlled diabetes mellitus, and other risk factors such as previous urinary tract infection and/or recent instrumentation of the urinary tract. The case of an 89-year-old woman with emphysematous cystitis who had no evidence of immunodeficiency or other risk factors except for advanced age is reported. A review of the literature on emphysematous cystitis in immunocompetent, nondiabetic individuals is presented.
(C) 2009 Southern Medical Association
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12/31/1969 03:59 PM
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Small Bowel Capsule Endoscopy: A Systematic Review
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Wireless capsule endoscopy offers a revolutionary diagnostic tool for small bowel diseases. Since its formal introduction, it has become an integral part of the diagnostic evaluation for obscure gastrointestinal bleeding. This relatively noninvasive imaging modality offered by small bowel capsule endoscopy is appealing to both patients and providers and consequently, the desire to expand its diagnostic role continues to grow. The use of CE in the diagnosis of Crohn disease and chronic diarrhea is being further investigated, as is the potential of employing this technique as a cancer surveillance mechanism in patients with hereditary polyposis syndromes which may involve the small bowel. This review article discusses the current indications for small bowel capsule endoscopy, the results of capsule endoscopy in patients with obscure gastrointestinal bleeding and small bowel diseases, and patient outcomes following capsule endoscopy. Capsule endoscopy is compared with traditional diagnostic modalities, including small bowel series, enteroclysis, CT, and push enteroscopy. Small bowel capsule endoscopy is the procedure of choice to evaluate obscure gastrointestinal bleeding, and is superior to radiographic procedures in detecting Crohn disease of the small bowel.
(C) 2007 Southern Medical Association
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12/31/1969 03:59 PM
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Diagnostic Tests for Rheumatic Disease: Clinical Utility Revisited
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Establishing a diagnosis of systemic rheumatic disease requires an integration of a patient's symptoms, physical examination findings, and the results of diagnostic testing. There is often a temptation by clinicians to rely heavily on objective measures such as the presence or absence of an autoantibody. Medical textbooks and the medical literature may overestimate the diagnostic utility of many commonly ordered tests for rheumatic disease because the tests are usually analyzed among patients with established rheumatic disease rather than among patients with an uncertain cause of symptoms as is common in practice. Few diagnostic tests are highly sensitive, though the antinuclear antibody in systemic lupus erythematosus (SLE) and the erythrocyte sedimentation rate in temporal arteritis are notable exceptions. Conversely, few diagnostic tests are highly specific; anti-proteinase-3 and antimyeloperoxidase antibodies (types of antineutrophilic cytoplasmic antibodies) among patients with Wegener granulomatosis (and related vasculitides) and anti-double-stranded and anti-Smith antibodies among patients with SLE may be particularly helpful in the proper clinical settings due to their high specificity. Anticitrullinated cyclic protein (anti-CCP), a newly described autoantibody that may be highly specific for rheumatoid arthritis, requires additional study as its utility in clinical practice is uncertain.
(C) 2005 Southern Medical Association
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12/31/1969 03:59 PM
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Irritable Bowel Syndrome: A Practical Review
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The epidemiology and current understanding of the pathophysiology of irritable bowel syndrome is reviewed, beginning with a historical perspective. The roles of genetics, environment, allergy, infection and inflammation, bacterial overgrowth, hormones and motility abnormalities are discussed. Using the current evidence-based literature, the practical approach of diagnosis and treatment is outlined, including traditional modalities and newer therapeutic agents such as serotonin modulators.
(C) 2006 Southern Medical Association
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12/31/1969 03:59 PM
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Kounis Syndrome
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The association between acute coronary events and acute allergic reactions has been recognized for several years. The first reported case occurred in 1950, during an allergic reaction to penicillin. In 1991, Kounis and Zavras described the syndrome of allergic angina and allergic myocardial infarction, currently known as Kounis syndrome. Two subtypes have been described: type I, which occurs in patients without predisposing factors for coronary artery disease and is caused by coronary artery spasm, and type II, which occurs in patients with angiographic evidence of coronary disease when the allergic events induce plaque erosion or rupture. This syndrome has been reported in association with a variety of medical conditions, environmental exposures, and medication exposures. Entities such as Takotsubo cardiomyopathy, drug-eluted stent thrombosis, and coronary allograft vasculopathy appear to be associated with this syndrome. In this review, we discuss the pathobiology, clinical features, associated entities, and management of Kounis syndrome.
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12/31/1969 03:59 PM
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Serum Leptin Levels in Rheumatoid Arthritis and Relationship with Disease Activity
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Objectives: This study was performed to evaluate serum leptin levels in rheumatoid arthritis (RA) patients and investigate the correlation with serum tumor necrosis factor alpha (TNF-[alpha]) levels and clinical and laboratory parameters of disease activity.
Methods: Fifty patients with RA and 34 control subjects were included. Disease activity score 28 (DAS28) was calculated for each patient. Laboratory activity was assessed by examining erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Immunoradiometric assay was used for measuring serum leptin levels (ng/mL). Serum TNF-[alpha] levels (pg/mL) were measured by sandwich enzyme-linked immunosorbent assay method in 41 of 50 RA patients and in 24 control subjects.
Results: Age, sex and body mass index (BMI) did not show a statistically significant difference between RA and control subjects (P > 0.05). Serum leptin levels were higher in RA (P = 0.000). In RA patients, there were no correlations between serum leptin levels and disease duration, swollen and tender joint counts, DAS28, CRP, ESR, serum TNF-[alpha] levels, oral glucocorticoid and methotrexate usage (P > 0.05). There was no statistically significant serum leptin level difference between patients with high disease activity and mild and low disease activity (P = 0.892). Serum leptin levels positively correlated with BMI in both patient and control groups (P < 0.05). In both groups, mean serum leptin levels were higher in women than men.
Conclusions: Even though serum leptin levels were found to be significantly higher in RA patients than in control subjects in this study, there was no correlation between serum leptin levels and TNF-[alpha] levels, clinical and laboratory parameters of disease activity. However serum leptin levels positively correlated with BMI in both patient and control groups. In RA, circulating leptin levels do not seem to reflect disease activity.
(C) 2006 Southern Medical Association
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12/31/1969 03:59 PM
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Wegener Granulomatosis: A Case Report and Update
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Wegener granulomatosis (WG) is a systemic disease of unknown etiology characterized by necrotizing granulomatous inflammation, tissue necrosis, and variable degrees of vasculitis in small and medium-sized blood vessels. The classic clinical pattern is a triad involving the upper airways, lungs and kidneys. Ninety percent of patients present with symptoms involving the upper and/or lower airways, and 80% will eventually develop renal disease. WG should be suspected in any patient with progressive or unresponsive sinus disease, glomerulonephritis, pulmonary hemorrhage, mononeuritis multiplex or unexplained multisystem disease. Before the routine use of glucocorticoids and cyclophosphamide, the one year mortality was 82%. However in 1973, Fauci and Wolf discovered that daily prednisone and cyclophosphamide induced complete remission in 75% of patients. The continued use of prednisone and cyclophosphamide for 1 year past remission leads to marked improvement in more than 90% of patients; however, is also associated with serious toxicities. Depending on the disease severity, current treatments employ induction with short-term cyclophosphamide followed by less toxic agents such as methotrexate to maintain disease remission. Although it is a rare disorder, it is pertinent to internists because it is a multisystem disease that presents in a variety of ways. We describe a 63-year-old white male with WG who presented with progressively worsening headaches, bilateral eye redness, epistaxis, hemoptysis and an unintentional 20 pound weight loss, and review the current treatment recommendations.
(C) 2006 Southern Medical Association
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12/31/1969 03:59 PM
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Factitious Diarrhea Masquerading as Refractory Celiac Disease
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A 23-year-old female with a history of a histologically confirmed diagnosis of celiac disease was referred to our institution for refractory celiac disease for consideration of immunosuppressive therapy. Full workup revealed an elevated fecal magnesium level, and a concurrent diagnosis of laxative abuse was confirmed after discussion with the family. This case highlights the importance of considering factitious diarrhea in all patients admitted for refractory diarrhea, even those with documented underlying conditions.
(C) 2006 Southern Medical Association
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