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12/31/1969 03:59 PM
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Idiopathic Dilation of the Colon in Fulminant Ulcerative Colitis
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These case reports call attention to a serious complication of ulcerative colitis.
(C) 1965 Southern Medical Association
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12/31/1969 03:59 PM
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The Significance of Granulomatous Changes in the Colon in Ulcerative Colitis
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This paper differentiates between ulcerative colitis with and without granulomatous lesions. Not only are the pathologic findings different, but clinical studies and information point to probable differing disease entities. What the implications are in the matter of treatment are not clear as yet.
(C) 1963 Southern Medical Association
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12/31/1969 03:59 PM
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The Use of the Duodenal Tube in Extreme Cases of Ulcerative Colitis-Some Forms of Parasitic Infection of the Colon, and Post-Operative Ileus
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OF THE DUODENAL TUBE IN EXTREME CASES OF ULCERATIVE COLITIS-SOME FORMS OF PARASITIC INFECTION OF THE COLON, AND POST-OPERATIVE ILEUS. Professor of Gastroenterology, New York Polyclinic Medical School
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12/31/1969 03:59 PM
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Ulcerative Colitis in Children
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Ulcerative colitis occurs more often in infants than is suspected. It may be attended by serious retardation in growth and development. Surgical treatment is generally successful.
(C) 1968 Southern Medical Association
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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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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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Adenoacanthoma and Ulcerative Colitis: Case Report and Review of the Literature
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Squamous cell carcinoma and adenoacanthoma of the colon and rectum above the anal verge are uncommon lesions. A total of 48 cases have been reported since 1907: 23 squamous and 25 adenoacanthomas, including the present case. Five of these cases occurred in patients with ulcerative colitis: the present case, one of adenoacanthoma with predominantly keratinizing metastatic lesions and psammoma bodies, and 4 squamous cell carcinomas reported earlier. In addition, 4 of the remaining 43 cases occurred in patients with preceding or concomitant colon disease: one squamous cell lesion and one adenoacanthoma occurred in the cecum of 2 patients at the site of draining sinuses which had developed some years after appendectomies were performed; one squamous cell carcinoma occurred at the site of tuberculomas, and one at the site of schistosomiasis.
(C) 1973 Southern Medical Association
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12/31/1969 03:59 PM
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Primary Small Cell Undifferentiated Carcinoma of the Rectum Associated With Ulcerative Colitis
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Primary small cell undifferentiated carcinomas (SCUCs) are unusual tumors of the colon and rectum. Histologically, these lesions represent a spectrum of neuroendocrine differentiation, with oat cell carcinoma being the most primitive subtype and carcinoid tumors being the most differentiated. This observation is supported by immunohistochemical and ultrastructural findings. We report a case of SCUC of the rectum in a patient with ulcerative colitis. To date, there have been only two reported cases of primary SCUC associated with ulcerative colitis. Recent theories of tumorigenesis attribute most colorectal cancers to a single, pluripotential mucosal stem cell, regardless of the tumor's histologic type.
(C) 1996 Southern Medical Association
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12/31/1969 03:59 PM
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Indications for Surgery in Ulcerative Colitis
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INDICATIONS FOR SURGERY IN ULCERATIVE COLITIS. E. Beck, Maj David USAF, MC JOINT MEETING OF THE SECTIONS ON GASTROENTEROLOGY AND COLON & RECTAL SURGERY: PDF Only
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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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Ulcerative Proctitis
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Ulcerative proctitis, a nonspecific inflammatory process involving the rectal mucosa but not the mucosa of the sigmoid or more proximal colon, is often diagnosed mistakenly as ulcerative colitis because of similarity in gross and microscopic appearances. Ulcerative proctitis, however, is more benign, symptoms are limited to the rectum (bleeding), extracolonic complications are rare, and there is little if any malignant potential, Prognosis is excellent. Review of 50 cases of ulcerative practitis showed a relationship to emotional tension in over one third of the cases. Effective treatment includes hydrocortisone enemas, salicylazosulfapyridine, and especially reassurance of the limited and benign nature of the disease.
(C) 1974 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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Topical Steroids in Diseases of the Colon
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The use of steroids in the form of a rectal instillation may offer a valuable adjunct in the treatment of acute exacerbations of ulcerative colitis.
(C) 1959 Southern Medical Association
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12/31/1969 03:59 PM
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Postcholecystectomy Colon Cancer: An Unanswered Question
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From the Division of Gastroenterology, Department of and cholesterol metabolites of patients with ulcerative colitis, a high-risk group for development of colon cancer. Cancer Res 1977;37:1697-1701
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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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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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Current Controversies in Pouch Surgery
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Restorative proctocolectomy with ileal pouch anal anastomosis has become the most commonly used procedure for elective treatment of patients with mucosal ulcerative colitis and familial adenomatous polyposis. Since its original description, the procedure has been modified in an attempt to obtain optimal functional results with low morbidity and mortality, and yet provide a cure for the disease. These modifications of the technique are discussed in this review, limited to the current points of controversy. We reviewed the current literature describing restorative proctocolectomy with ileal pouch anal anastomosis. The current "hot topics" for debate are transanal mucosectomy with hand-sewn anastomosis versus the double-stapled technique, the use of diverting ileostomy, indeterminate colitis, the role of laparoscopy, and indications for pouch surgery in the elderly. Longer follow-up of patients and increased knowledge and experience with pouch surgery, coupled with active prospective evaluation of the procedure are required to settle these issues. Patients must be fully informed to understand inherent risks of each choice.
(C) 2003 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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Restorative Proctocolectomy: Ochsner Clinic Experience
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Background. Restorative proctocolectomy, a standard operation for ulcerative colitis and familial adenomatous polyposis has significant complications, even in experienced hands.
Methods. We studied surgical outcome by retrospectively reviewing cases of restorative proctocolectomy done at Ochsner Foundation Hospital from 1982 to 1995. Demographic and clinical data from two periods (1982 to 1989 and 1989 to 1995) were compared to determine factors associated with improved outcome.
Results. We performed 145 ileal pouch-anal procedures. In 56 patients, 104 complications occurred. The more recent group had a greater incidence of inflammatory bowel disease, steroid use, and staged operations; reduced operative times and hospital stays; more general but fewer pouch-related complications. Pouch failures were similar for both groups.
Conclusions. Perioperative outcome appeared to be associated with technical experience, improved perioperative care, exclusion of patients with Crohn's disease, judicious surgical reoperation for pouch complications, and use of a 3-stage procedure in malnourished patients or those with acute or toxic colitis.
(C) 2001 Southern Medical Association
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12/31/1969 03:59 PM
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Loop IleoStomy: A Reliable Method of Diversion
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colon; Between September 1983 and March 1989, 36 loop ileostomies were performed on 34 patients (16 male and 18 female, mean age 36 years, range 11 to 68). Thirty-two patients had ileoanal pouch procedures (30 for ulcerative colitis and two for familial polyposis). One patient had a low anterior resection and another had a coloanal procedure. By the time of this review, 31 of the loop ileostomies were closed. The average time before closure was 5 months and the average length of follow-up was 37 months. All stomas were brought out through the rectus muscle in the right side of the abdomen, without ileal rotation, mesenteric fixation, or parastomal fascial sutures. A support rod was left in place for 3 to 4 weeks postoperatively. There were no major difficulties with skin irritation or appliance management and no instance of parastomal abscess and stoma retraction. Although no complications related to the ostomy or its closure were encountered in these patients, small bowel obstruction before closure (8 patients) or after takedown (5 patients) of the loop ileostomy required operative correction in one patient in each group.
(C) 1994 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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1. Perkins GL, Slater ED, Sanders GK This showed progression to involve the sigmoid colon. Biopsy at this time was consistent with ulcerative colitis with goblet cell depletion, chronic inflammatory
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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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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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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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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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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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Anterior Uveitis, Inflammatory Bowel Disease, and Ankylosing Spondylitis in a HLA-B27-positive Woman
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A woman developed anterior uveitis at age 24, inflammatory bowel disease at age 29, and ankylosing spondylitis at age 45 by history. There were frequent recurrences. An HLA-B27 test was positive at age 53. The literature indicates that all of these conditions together in a HLA-B27-positive woman are uncommon. Physicians should be alert to the possibility that a patient might develop another of these associated diseases years after presentation of the first condition and educate their patients accordingly.
(C) 2006 Southern Medical Association
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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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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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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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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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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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