Metachronous colonic lymphomas complicating chronic ulcerative colitis

The gastrointestinal tract is the most common extranodal site of primary non-Hodgkin's lymphoma. Of these, 10–15% occur in the large bowel. Colonic lymphoma is a recognized complication of inflammatory bowel disease, particularly ulcerative colitis and, less commonly, Crohn's disease. We describe a unique case of two metachronous primary lymphomas of the large bowel in a patient with chronic ulcerative colitis.     

粪菌移植在溃疡性结肠炎治疗中的临床应用

粪菌移植最早起源于2700年前春秋战国时期,但用于溃疡性结肠炎的治疗目前仍处于起步阶段。其移植流程主要包括供体的选择、菌液制备及粪菌液的导入等。该治疗方式无严重不良反应,相对安全。关于其有效性各研究结论不一,可能与适应证的选择、供体的选择、移植流程等缺乏统一的标准有关。     

Granulocyte migration in ulcerative colitis

Although histologically relapses in ulcerative colitis are characterized by an intense granulocyte infiltrate, there is evidence both from in vitro function tests and skin window migration studies in vivo that there is defective granulocyte function in ulcerative colitis. We have recently developed a method for non invasively monitoring granulocyte migration to sites of inflammation using indium-111-labelled granulocytes, and have used this technique in fifteen patients with ulcerative colitis. In all fifteen cases there was rapid migration of indium-111-labelled granulocytes to inflamed bowel within 10 min of return of the labelled cells. This study provides no support for a significant granulocyte migration defect in ulcerative colitis.     

Radiographic demonstration of longitudinal ulcers in patients with ulcerative colitis

During the past 10 years, 122 patients with ulcerative colitis were diagnosed by double-contrast barium enema and colonofiberscopy with endoscopic biopsy. Among them, five patients (4%) had longitudinal ulcers and eccentric deformities in the colon. Other radiologic findings included thumbprinting (two cases), sacculations (two cases), and inflammatory polyps (four cases). The possibility of the concomitance of ischemic colitis in cases of ulcerative colitis is discussed, due to their radiographic similarities.     

30例溃疡性结肠炎患者的护理

目的探讨溃疡性结肠炎的护理方法。方法对30例溃疡性结肠炎患者的临床资料进行回顾性总结,分析其临床特点与诱因,有针对性地做好心理护理,提高患者的依从性,加强营养支持,必要时静脉营养,做好用药指导,确保患者长期、正确用药,在溃疡性结肠炎活动期加强病情观察,及时发现各种并发症。结果 24例患者均好转出院,门诊长期随访,目前有6例反复发作。结论溃疡性结肠炎病程漫长,常反复发作,督促患者长期、准确用药,定期复查,能维持长期缓解,减少并发症的发生。     

改良灌肠法治疗溃疡性结肠炎的疗效观察

目的 :探讨药物保留灌肠前先行清洁灌肠治疗溃疡性结肠炎的疗效与护理要点。方法 :将 6 2例溃疡性结肠炎患者随机分为观察组 32例与对照组30例。观察组于每晚药物保留灌肠前先行清洁灌肠 ,对照组按传统保留灌肠法治疗 ,两组所用药物相同。观察两组的大便性状、次数、颜色、腹痛缓解时间及大便常规及用电子结肠镜检查判断临床疗效。结果 :观察组和对照组有效率分别为 93 75 %和 80 %(P <0 0 5 )。结论 :溃疡性结肠炎患者药物保留灌肠治疗前先行清洁灌肠 ,能缩短疗程 ,提高临床疗效。     

Ulcerative colitis: value of MR imaging

Recent technologic advances have greatly improved the quality of abdominal magnetic resonance imaging (MRI) by allowing the identification of abnormalities in inflammatory bowel disease. Thus far, the role of MRI has been extensively investigated in Crohn disease (CD) and, to a minor extent, in ulcerative colitis (UC), likely due to intrinsic differences between these two diseases. In UC the inflammatory lesions, unlike CD, are confined to the colon, have a predictable spreading, and affect only the inner wall layer; thus endoscopy alone can assess the extent and severity of disease in most cases. However, preliminary studies have demonstrated that MRI also can be a reliable diagnostic tool for UC because it is useful for integrating clinical and endoscopic data. MRI can be valuable in distinguishing CD from UC in uncertain cases by assessing the sparing of the distal ileum and the continuity of colonic involvement. Moreover, MRI can provide important information if endoscopy is incomplete, e.g., due to tight strictures, or contraindicated, e.g., in severely acute disease, due to a high risk of perforation. MRI can detect most of the typical findings of the diseases, such as wall thickening, mural stratification, loss of haustrations, and several complications including fibrotic or neoplastic strictures. In addition, MRI can be extremely valuable in assessing disease activity by monitoring the degree of wall gadolinium enhancement and T2 signal at the level of the affected bowel segments, thus influencing pharmacologic and surgical planning. In the next few years, MRI will likely become the imaging modality of choice in the clinical management of this disease.     

溃疡性结肠炎的肠外表现特点分析

目的 分析溃疡性结肠炎(UC)患者肠外表现的临床特点.方法 对我院2002年1月至2007年2月的205例UC患者的临床资料进行回顾性分析.结果 肠外表现特征中骨关节病变和口腔病变发生率最高(均为6.83%,14/205).<40岁的患者肠外表现发生率(41.30%,38/92)明显高于40岁以上(21.24%,24/113)的患者(均为P<0.01);男(28/62)女(34/62)患者肠外表现发生率无明显差异(P>0.05);全结肠型肠外表现发生率(55.0%,44/80)明显高于左半结肠型(16.3%,8/49)、直乙状结肠型(13.2%,10/76),差异有统计学意义(P<0.05);活动期肠外表现发生率(32.6%,59/181)明显高于缓解期(12.5%,3/24),差异有统计学意义(P<0.05);轻(9.5%,7/74)、中(27.0%,17/63)、重度(55.9%,38/68)患者肠外表现发生率差异有统计学意义(P<0.05),从轻度、中度至重度呈递增趋势;病程5年以上组肠外表现发生率(39.3%,35/89)明显高于病程小于5年组(23.3%,27/116),差异有统计学意义(P<0.05).结论 溃疡性结肠炎患者肠外表现发生率较高,累及的部位依次是口腔、关节、肝胆、皮肤、眼睛.肠外表现的发生随年龄、病变范围、活动性、严重程度、病程增加有增多的趋势.     

糖皮质激素在溃疡性结肠炎治疗中的合理应用

糖皮质激素能有效诱导活动性溃疡性结肠炎缓解,同时伴有诸多的不良反应。由于大规模随机对照临床研究的缺乏,糖皮质激素在溃疡性结肠炎治疗中的应用标准模式尚不清晰。降低糖皮质激素使用风险,最大化其疗效需要选择适合人群,在适当时机给予恰当药物。本文结合近年发表的专家共识意见,探讨溃疡性结肠炎治疗中糖皮质激素的合理应用。     

溃疡性结肠炎的CT表现（附10例报道）

目的：探讨溃疡性结肠炎的CT表现。材料与方法：10例经双对比造影和内镜检查证实的病例,实时螺旋扫描,工作站三维重建。结果：CT表现：肠壁轻度增厚10例,粘膜面呈锯齿状7例,肠壁分层3例,肠系膜密度增高2例,系膜淋巴结增大2例,肠管变细、缩短,肠袋变浅或消失7例,结论：CT能提供传统双对比造影检查方法以外的影像学信息;溃疡性结肠炎的CT表现包括粘膜面、肠壁、肠管形态、肠系膜等改变。     

Golimumab for the treatment of ulcerative colitis

Introduction: Tumor necrosis factor antagonists have revolutionized the therapeutic management of inflammatory bowel disease. Infliximab and adalimumab were the first biological agents used to induce and maintain remission in ulcerative colitis. More recently, a third tumor necrosis factor antagonist, golimumab, was approved, extending the therapeutic approach for moderate-to-severe ulcerative colitis.

Areas covered: In this review, the authors review the literature on the efficacy and safety of golimumab in the context of other anti-TNF agents used in the treatment of this disease. The role of therapeutic drug monitoring in the case of loss of response to an anti-TNF agent is also discussed.

Expert opinion: Golimumab is currently effective to induce and maintain remission in patients with ulcerative colitis, especially those patients who are naive for an anti-TNF agent. No large studies have evaluated the efficacy of golimumab after failure of a first-line TNF antagonist therapy. In the case of loss of response to a first anti-TNF agent, therapeutic drug monitoring is essential to determine the most suitable therapeutic option.     

Application of color Doppler ultrasonography to ulcerative colitis

We used color Doppler ultrasonography (US) to evaluate bowel wall thickening in ulcerative colitis and to determine the value of this modality in this application. Twelve patients (6 men and 6 women) with ulcerative colitis underwent both gray-scale and color Doppler US. Bowel wall thickness and wall echotexture were recorded by gray-scale US, and the presence of intramural color Doppler flow and arterial signal were evaluated by color Doppler US. Color Doppler flow was graded as ‘weak’ or ‘abundant’, and resistive index was calculated; clinical severity of disease activity was also graded, and serum CRP level was measured. Variation in serum CRP levels and intramural color Doppler flow according to clinical severity, and the correlations between serum CRP levels and the number of blood flow signals were statistically significant. In 10 of the 12 patients, analysis of the Doppler waveform showed an arterial blood flow signal, and mean resistive index value was determined to be 0.550. We thus conclude that information provided by gray-scale and color Doppler US is useful in evaluating bowel wall thickening in ulcerative colitis.     

益生菌对溃疡性结肠炎疗效的影响

目的评价益生菌对溃疡性结肠炎的临床疗效。方法选择60例轻中度溃疡性结肠炎患者,随机分成治疗组和对照组,治疗组应用嗜酸乳杆菌颗粒制剂(乐托尔)联合美沙拉嗪,对照组单用美沙拉嗪,治疗8周,8周后统计临床疗效并对比血清C反应蛋白变化。结果治疗组总有效率(93.3%)高于对照组(83.3%),差异有统计学意义(P<0.05);治疗组8周后血清C-反应蛋白下降幅度(7.46±3.51 mg/L)明显高于对照组(4.62±2.09 mg/L),差异有统计学意义(P<0.05)。结论在轻中度溃疡性结肠炎治疗中,联合应用乐托尔比单用美沙拉嗪治疗临床疗效好。     

前列腺素E1治疗溃疡性结肠炎疗效观察

目的观察前列腺素E1对溃疡性结肠炎患者的治疗效果。方法反复发作的活动期轻、中度溃疡性结肠炎患者35例，随机分为2组：治疗组口服柳氮磺吡啶1g，3次／d；并应用前列腺素E1 100μg／d静脉滴注，疗程2周。对照组仅服柳氮磺吡啶1g，3次／d。观察患者疾病活动指数（DAI）及血沉（ESR）、C-反应蛋白（CLIP）、血小板计数（BPC）等的变化。结果治疗组72．2％（13／18）临床病情缓解，对照组29．4％（5／17）缓解（P〈0．05）。治疗组DAI、ESR、CPR、BPC等的改善程度与对照组比较差异均有显著性（均为P〈0．05）。两组均未发现明显不良反应。结论溃疡性结肠炎患者应用前列腺素E1治疗可取得满意的效果。     

Expression of nitric oxide synthase in ulcerative colitis

Abstract. Nitric oxide (NO) is generated from L-arginine by a family of enzymes called the NO synthases. Previous investigators have proposed that the expression of this inducible enzyme (iNOS) may account for the characteristic vasodilatation, oedema and impairment of gut motility seen in active ulcerative colitis. Using a specific antibody to iNOS, we have investigated the distribution of this enzyme in colonic tissue from patients with histologically proven ulcerative colitis. Eight patients with ulcerative colitis expressed calcium-independent citrulline activity (9.96±2.34 pmol citrulline mg^-1 protein min^-1) and showed immunoreactivity to the iNOS antibody within the inflammatory infiltrate of the lamina propria, and also within the cytoplasm of the epithelial cells lining the colon. Five age-matched controls showed no calcium-independent citrulline activity (0.2 ±0.08 pmol citrulline mg^-1 protein min^-1) and no immunoreaction to the antibody. We conclude that this enzyme is present in colonic tissue including the epithelium from patients with active colitis. Inhibition of this enzyme may provide a novel therapeutic option for patients with active ulcerative colitis.     

E-钙粘附蛋白在溃疡性结肠炎发病中的作用

通过研究Ｅ－钙粘附蛋白（Ｅ－ＣＤ）在溃疡性结肠炎（ＵＣ）中的表达,探讨Ｅ－ＣＤ在ＵＣ发病中的作用。方法应用免疫组织化学方法,研究正常结肠和ＵＣ标本中的Ｅ－ＣＤ表达。结果正常组和ＵＣ组中Ｅ－ＣＤ水平无显著性差异（Ｐ＞０．０５）：ＵＣ组中Ｅ－ＣＤ表达与病情程度不相关（Ｐ＞０．０５）。结论Ｅ－ＣＤ在ＵＣ进展阶段不起主要作用,Ｅ－ＣＤ在ＵＣ触发阶段的作用尚须进一步研究。     

弥散加权成像在活动期溃疡性结肠炎定量评估中的应用

目的  探究弥散加权成像（DWI）对活动期溃疡性结肠炎（UC）的诊断价值。方法  回顾性分析2018年至今于本院就诊治疗的80例UC患者的临床资料及影像学资料,以肠内镜诊断结果为“金标准”,将患者分为活动组（活动期UC,n=73）和非活动组（非活动期UC,n=7）。所有患者均接受CT、MRI检查,分析两组CT和MRI图像特征、表观弥散系数（ADC）值,采用ROC曲线评估ADC值对活动期UC的诊断价值。结果  MRI检查显示,UC患者以结直肠粘膜及粘膜下层T1WI高信号或稍高信号、T2WI高信或等信号为主要MRI特征,所有病变肠段在DWI上信号不同程度增高。活动组ADC值小于非活动组（P < 0.05）;ROC曲线分析结果显示,ADC值诊断活动期UC的AUC值为0.795（95% CI：0.691~0.878,P < 0.05）,具有较高的诊断效能。以肠内镜诊断结果为“金标准”,DWI诊断活动期UC的敏感度、准确率和阴性预测值均高于CT（P < 0.05）。结论  UC的CT、MRI图像具有一定特征,DWI在活动期UC的鉴别诊断中具有良好的应用价值,可作为诊断UC病变时期的有效方法。     

Acute ulcerative colitis in a Meckel's diverticulum

This report describes the case of a patient with acute ulcerative colitis who underwent an emergency colectomy and removal of an incidental Meckel's diverticulum which appeared inflamed. Histology showed acute inflammation of colonic epithelium within the Meckel's diverticulum, justifying its removal and confirming that this was indeed a 'skip lesion'.     

Smad3磷酸化促进溃疡性结肠炎的黏膜修复

目的：研究小鼠溃疡性结肠炎黏膜损伤与修复过程及转化生长因子-β（TGF-β）信号转导过程中关键分子Smad3对黏膜修复的作用。方法给予小鼠3％葡聚糖硫酸钠（DSS）饮用5天诱导急性溃疡性结肠炎,再停用DSS 改为正常饮水修复。实验小鼠分为6组,分别为正常对照组,3％DSS 5天损伤期组,饮水修复1、2、3、4周组,其中正常对照组小鼠仅饮用蒸馏水。观察小鼠结肠炎修复情况及行结肠组织学检查,检测结肠黏膜凋亡与增殖相关指标及TGF-β信号通路中Smad3及相关蛋白的表达,观察其在损伤与修复中的变化。结果小鼠疾病活动指数在饮用DSS 后上升,修复2周后恢复正常。结肠组织学评分于饮用DSS 5天损伤期时明显升高,修复2周后下降。结肠黏膜凋亡指数于损伤期升至最高,至修复3周后降至正常水平。增殖指数于损伤期降至最低,至修复3周时升至峰值。结肠黏膜TGF-β表达量在各实验组均升高,而p-Smad3表达量于损伤期降低,修复1周后开始上升。结论TGF-β转导过程中关键分子Smad3的磷酸化促进小鼠结肠炎黏膜的修复。