|
12/31/1969 03:59 PM
|
|
Treatment of Ulcerative Colitis
|
TREATMENT OF ULCERATIVE COLITIS. Soper, Horace September 1936 St. Louis, Missouri uvh 0404522 English Original Article: PDF Only 901-904 Clinical Medicine 227 29 9 Success Turn on more accessible 0
|
|
12/31/1969 03:59 PM
|
|
The Surgical Treatment of Chronic Ulcerative Colitis
|
THE SURGICAL TREATMENT OF CHRONIC ULCERATIVE COLITIS.
|
|
12/31/1969 03:59 PM
|
|
Role of the Surgeon in the Treatment of Chronic Ulcerative Colitis
|
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
|
|
12/31/1969 03:59 PM
|
|
Adverse Reactions to Salicylazosulfapyridine (Azulfidine) in the Treatment of Ulcerative Colitis
|
Though sulfonamides have a place in the management of ulcerative colitis, their use is not without hazard as has been documented in this report.
(C) 1968 Southern Medical Association
|
|
12/31/1969 03:59 PM
|
|
Ulcerative Colitis in Children
|
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
|
|
12/31/1969 03:59 PM
|
|
Surgical Treatment of Ulcerative Colitis: Problems of the Ileostomy
|
In many patients having ulcerative colitis there comes a time when surgical interference must be considered. The indications and methods of attack are presented by the authors. It appears much is to be said for a one-stage ileostomy and colectomy for acute exacerbation of ulcerative colitis
(C) 1957 Southern Medical Association
|
|
12/31/1969 03:59 PM
|
|
A Different Therapeutic Approach in Patients with Severe Ulcerative Colitis: Hyperbaric Oxygen Treatment
|
Therapeutic Approach in Patients with Severe Ulcerative Colitis: Hyperbaric Oxygen Treatment. care or may contain comments on recent contents of the Journal. They will be published, if found
|
|
12/31/1969 03:59 PM
|
|
The Significance of Granulomatous Changes in the Colon in Ulcerative Colitis
|
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
|
|
12/31/1969 03:59 PM
|
|
Toxic Megacolon Complicating Chronic Ulcerative Colitis*
|
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
|
|
12/31/1969 03:59 PM
|
|
Vogt-Koyanagi-Harada Syndrome and Ulcerative Colitis
|
The Vogt-Koyanagi-Harada (VKH) syndrome is an uncommon disorder characterized by uveitis and neurologic and cutaneous abnormalities, including tinnitus, vertigo, headache, meningoencephalitis, vitiligo, alopecia, and poliosis. The VKH syndrome has been reported to occur in association with other autoimmune disorders. We report a case of a patient with severe ulcerative colitis who developed VKH syndrome. We postulate that the patient's history of a traumatic brain injury might have been responsible for an abnormal "immunologic milieu" and the occurrence of ulcerative colitis, VKH syndrome, and severe reactive arthritis.
(C) 2004 Southern Medical Association
|
|
12/31/1969 03:59 PM
|
|
Ileorectal Anastomosis for Intractable Ulcerative Colitis
|
Though this procedure has had limited acceptance in the surgical treatment of ulcerative colitis, the authors believe with the proper selection of cases and by use of proper technics it can be a valuable approach in the management of this baffling disease.
(C) 1965 Southern Medical Association
|
|
12/31/1969 03:59 PM
|
|
Current Status of Sphincter-Saving Operations for Chronic Ulcerative Colitis
|
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
|
|
12/31/1969 03:59 PM
|
|
Ulcerative Proctitis
|
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
|
|
12/31/1969 03:59 PM
|
|
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 SPECIAL CONSIDERATIONS OF ITS TREATMENT.
|
|
12/31/1969 03:59 PM
|
|
Pyoderma Gangrenosum
|
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
|
|
12/31/1969 03:59 PM
|
|
Topical Steroids in Diseases of the Colon
|
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
|
|
12/31/1969 03:59 PM
|
|
Black Strap Molasses for the Treatment of Inflammatory Bowel Disease-associated Anemia
|
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
|
|
12/31/1969 03:59 PM
|
|
Inflammatory Bowel Disease-Related Thoracic Aortic Thrombosis
|
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
|
|
12/31/1969 03:59 PM
|
|
An Unexpected Cause of Elevated Prostate Specific Antigen
|
at this time was consistent with ulcerative colitis with goblet cell depletion, chronic inflammatory abnormal prostate cells, there was no evidence of malignancy or any other pathology that may account
|
|
12/31/1969 03:59 PM
|
|
Transient Marked Elevation of Serum CA 19-9 Levels in a Patient with Acute Cholangitis and Biliary Stent
|
Special Sections: Letters to the Editor white male with a medical history of ulcerative colitis, sclerosing cholangitis, and multiple episodes of acute cholangitis, status post cholecystectomy, and
|
|
12/31/1969 03:59 PM
|
|
To Pick a 'Bone' with the Gallbladder
|
To Pick a 'Bone' with the Gallbladder. Medical Corps, United States Navy; Naval Medical 1. Nelson JJ, Khan AG. A case of bone metaplasia of the gallbladder epithelium. South Med J 2009;102:322-324
|
|
12/31/1969 03:59 PM
|
|
Imiquimod
|
α and interleukin-12. Interestingly, the effectiveness of imiquimod as an antiviral agent in the treatment of genital and perianal warts does not result from
|
|
12/31/1969 03:59 PM
|
|
MEFV Gene Mutations in a Patient with Eosinophilic Gastroenteritis
|
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.
|
|
12/31/1969 03:59 PM
|
|
Serum Leptin Levels in Rheumatoid Arthritis and Relationship with Disease Activity
|
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
|
|
12/31/1969 03:59 PM
|
|
Small Bowel Capsule Endoscopy: A Systematic Review
|
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
|
|
12/31/1969 03:59 PM
|
|
Physical Activity Benefits and Risks on the Gastrointestinal System
|
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.
|
|
12/31/1969 03:59 PM
|
|
Pneumocystis carinii jiroveci Pneumonia Following Infliximab Infusion for Crohn Disease: Emphasis on Prophylaxis
|
text>A 36-year-old white female with a history of Crohn disease presented to the emergency room with complaints of fever and shortness of breath for one day. She was diagnosed with
|
|
12/31/1969 03:59 PM
|
|
Gastrointestinal Kaposi Sarcoma with Appendiceal Involvement
|
Kaposi sarcoma is a vascular tumor manifesting as nodular lesions on skin, mucous membranes, or internal organs. This is a case of a 42-year-old human immunodeficiency virus- (HIV) positive bisexual male, not on highly active antiretroviral therapy (HAART) since diagnosis four years ago. He presented with a three-day history of abdominal pains, fever, vomiting, and a one-week history of melena stools. Endoscopy revealed Kaposi sarcoma in the stomach and duodenum. Postendoscopy, he developed acute abdomen. Exploratory laparotomy revealed extensive Kaposi sarcoma of the gastrointestinal tract with appendiceal involvement. The patient underwent appendectomy and had an uneventful recovery. A review of the literature discusses appendiceal Kaposi sarcoma with appendicitis, a rare but critical manifestation of gastrointestinal Kaposi sarcoma.
|
|
12/31/1969 03:59 PM
|
|
Intestinal Necrosis due to Sodium Polystyrene Sulfonate (Kayexalate) in Sorbitol
|
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
|
|
12/31/1969 03:59 PM
|
|
Acute Profound Thrombocytopenia Following Eptifibatide Administration
|
ED, et al. Acute thrombocytopenia after treatment with tirofiban or eptifibatide is associated with An 84-year-old female with a history of diabetes mellitus, hypertension, ulcerative colitis, and
|
|
12/31/1969 03:59 PM
|
|
Emphysematous Cystitis in the Absence of Known Risk Factors: An Unusual Clinical Entity
|
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
|
|
12/31/1969 03:59 PM
|
|
Wegener Granulomatosis: A Case Report and Update
|
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
|
|
12/31/1969 03:59 PM
|
|
Microscopic Polyangiitis Presenting with Liver Dysfunction Preceding Rapidly Progressive Necrotizing Glomerulonephritis
|
The authors describe a 52-year-old woman diagnosed with microscopic polyangiitis. She presented with abnormal liver function tests accompanied by fever, headache, and fatigue. Two months later, rapidly progressive necrotizing glomerulonephritis developed together with seropositivity for perinuclear antineutrophil cytoplasmic antibody. Although liver dysfunction from microscopic polyangiitis is very rare, especially at presentation, this diagnostic possibility should be kept in mind to permit prompt consideration of steroid therapy.
(C) 2004 Southern Medical Association
|
|
12/31/1969 03:59 PM
|
|
Relationship of the Intensity of Helicobacter pylori and Severity of Inflammation with Beta-2 Microglobulin Levels in Serum According to the Updated Sydney System
|
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.
|
|
12/31/1969 03:59 PM
|
|
Cytomegalovirus Enteritis in Common Variable Immunodeficiency
|
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
|
|
12/31/1969 03:59 PM
|
|
Diagnosing Irritable Bowel Syndrome: A Changing Clinical Paradigm
|
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.
|
|
12/31/1969 03:59 PM
|
|
Factitious Diarrhea Masquerading as Refractory Celiac Disease
|
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
|
|
12/31/1969 03:59 PM
|
|
Colorectal Cancer Screening: Today and Tomorrow
|
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
|
|
12/31/1969 03:59 PM
|
|
Irritable Bowel Syndrome: A Practical Review
|
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
|
|
12/31/1969 03:59 PM
|
|
Diagnostic Tests for Rheumatic Disease: Clinical Utility Revisited
|
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
|
|
12/31/1969 03:59 PM
|
|
Kounis Syndrome
|
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.
|
|
12/31/1969 03:59 PM
|
|
Asacol®-induced Neutropenia Resolution Without the Use of Granulocyte Colony-stimulating Factor
|
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.
|
|
12/31/1969 03:59 PM
|
|
Anterior Uveitis, Inflammatory Bowel Disease, and Ankylosing Spondylitis in a HLA-B27-positive Woman
|
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
|
|
12/31/1969 03:59 PM
|
|
Colonic Pseudo-obstruction in Sickle Cell Disease
|
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
|
|
12/31/1969 03:59 PM
|
|
Current Controversies in Pouch Surgery
|
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
|
|
12/31/1969 03:59 PM
|
|
Disseminated Nocardia nova Infection
|
We report the case of a 61-year-old female with ulcerative colitis on therapy with prednisone and azathioprine. The patient presented with fever, dry cough, a swollen lower extremity, and nodules on the right wrist and the scalp. Computed tomography scans of the head, chest, abdomen, and pelvis revealed multiple lesions. Aspirates and biopsies of the lower extremity cystic lesion, the wrist nodule, and the scalp nodule all grew out
. The patient was treated with high-dose trimethoprim and sulfamethoxazole therapy for one year and made a complete recovery.
|
