Corticosteroids Modulate Angiogenic Soluble Factors in Ulcerative Colitis Patients

Aims  

The aim of this study was to compare angiogenic factors in serum levels of active ulcerative colitis (UC) patients and in healthy controls, and to analyze these angiogenic levels depending on the achievement of remission after oral corticosteroid treatment throughout treatment, and according to the Truelove–Witts activity index.     

Pneumocystis carinii Pneumonia in HIV-negative patients with haematologic disease

Summary Since 1990,Pneumocystis carinii pneumonia (PCP) was diagnosed in 15 adult HIV-negative haematologic patients in our hospital. None of them had received PCP prophylaxis. All except one had been treated with prednisone. Symptoms usually started after stopping or tapering. In six patients the diagnosis of PCP was delayed because of confounding bacterial isolates from blood, sputum or urine leading to unsuccessful antibiotic treatment. PCP was diagnosed by demonstrating pneumocysts in bronchoalveolar lavage fluid. In four patients additional fungal or viral pathogens were identified. The infections were not clustered. The patients were treated with co-trimoxazole and, in case of a pO₂<60 mmHg, with prednisone. Three patients died (20%); they all had a coinfection with cytomegalovirus and/or aspergillus. The others recovered completely. There were no relapses. Primary PCP prophylaxis should be considered in patients with lympho-proliferative disease and exposure to prednisone.     

A Rare Case of Ulcerative Colitis with Severe Pneumocystis jirovecii Pneumonia and Cytomegalovirus Colitis: A Case Report and Literature Review

Pneumocystis jirovecii pneumonia (PJP) and cytomegalovirus (CMV) colitis are opportunistic infections that occur during immunosuppressive treatments for ulcerative colitis (UC). The prognosis of PJP and CMV colitis is very poor. We herein report a rare case of a 74-year-old UC patient with PJP and CMV colitis that was successfully treated with intensive therapy. PJP progresses rapidly, so the timing and choice of treatment are critical. Furthermore, a literature review of similar cases suggested that prophylactic therapy for opportunistic infections might be important, especially in the elderly. This case will serve as a reference for successful treatment in future cases.     

Pneumocystis carinii Pneumonia in an Immunocompetent Infant with Congenital Cytomegalovirus Infection

Summary The case of a term infant with congenital cytomegalovirus (CMV) infection who developed Pneumocystis carinii pneumonia (PCP) at 4 months of age is reported. Our patient suffered from severe malnutrition and zinc deficiency secondary to necrotizing enterocolitis since the age of 2 months. There was no evidence of human immunodeficiency virus infection. Qualitative and quantitative in vitro leukocyte functions were also normal. This case highlights the fact that PCP can occur in apparently immunocompetent term infants. Malnourished infants with zinc deficiency or congenital CMV infection are at increased risk of developing PCP. Received: November 23, 1999 · Revision accepted: January 21, 2000     

Appendiceal Involvement in Patients with Ulcerative Colitis

Abstract: There have been few case reports of ulcerative colitis with appendiceal involvement because the appendix has generally received little attention in ulcerative colitis patients. We encountered an inflammatory appendiceal lesion in a patient with ulcerative colitis, which piqued our interest in endoscopic findings of the appendix in these patients. Subsequently, we carefully observed the appendiceal orifice during colonoscopy in patients with ulcerative colitis. From December 1994 to December 1996, 44 patients with ulcerative colitis underwent colonoscopy in Nagaoka Red Cross Hospital. Among these 44, there were three in whom it had not been possible to observe the cecum. During this period, we encountered inflammatory appendiceal lesions in eight cases. Therefore, 20% (8/41) of patients with ulcerative colitis undergoing colonoscopy had appendiceal involvement. Five of these eight patients showed a colonoscopically normal cecum, such that appendiceal involvement thought to be a colonoscopic skip lesion was seen in five (12%: 5/41). There was only one case who had an appendiceal lesion without a microscopically diseased cecum. Appendiceal involvement may be frequent in ulcerative colitis. We thus recommend that endoscopists meticulously examine the appendiceal orifice during colonoscopy in patients with ulcerative colitis.     

Acute Pancreatitis in Patients with Ulcerative Colitis

Twenty-two patients (13 men and 9 women; median age, 34 years; range, 15–64 years) with ulcerative colitis (UC) were evaluated to determine the incidence of acute pancreatitis with UC at the First Department of Internal Medicine, Mie University School of Medicine, during 1989–2001. Among these, three patients (14%) were diagnosed as having had episodes of acute pancreatitis during the mean follow-up period of 6 years. One patient presented with acute pancreatitis and UC simultaneously. Two patients had drug-induced pancreatitis (one due to azathioprine and the other due to 5-ASA). In conclusion, acute pancreatitis is not a frequent, but an occasional extraintestinal manifestation of UC.     

Elevation of Serum KL-6 Levels in Patients with Hematological Malignancies Associated with Cytomegalovirus or Pneumocystis carinii Pneumonia

The level of serum KL-6 antigen has been reported to be a sensitive indicator of various interstitial pneumonitis, but in patients with hematological malignancies who were accompanied by infective interstitial pneumonitis like Pneumocystis carinii or cytomegalovirus (CMV) pneumonia, it is still unknown whether serum KL-6 level is useful as a good marker for the diagnosis or disease activity. In this study, the serum levels of KL-6 and soluble intercellular adhesion molecule 1 (sICAM-1) were evaluated in five patients with malignant lymphoma or adult T-cell leukemia. Serum KL-6 and sICAM-1 levels at the time of diagnosis of P. carinii or CMV pneumonia were 1220±323 U/ml (mean±SD) and 1246±485 ng/ml, respectively. These levels were apparently high, when compared with standard value of serum KL-6 (<520 U/ml) and that of sICAM-1 (115-306 ng/ml). In patients without P. carinii or CMV pneumonia, who had hematological malignancies or AIDS, serum level of KL-6 was not high (299±122 U/ml), but sICAM-1 was high (651±495 ng/ml) because of the elevation of sICAM-1 in four of five cases. These findings suggest that, in patients with hematological malignancies, serum level of KL-6 antigen rather than sICAM-1 may be useful in the evaluation of CMV or P. carinii pneumonia.     

结肠康灌肠治疗慢性非特异性结肠炎性病临床疗效观察

分析研究153例以远端溃疡性结肠炎为主的慢性非特异性结肠炎保留灌肠的治疗情况。结果：中药结肠康治疗组97例近期治愈率80．4％，总有效率95．8％；对照组56例，近期治愈率23．2％，总有效率60．7％，两组疗效比较有显著性差异（P＜0．05），说明治疗组有较好的疗效。     

Primary Sclerosing Cholangitis in Patients with Ulcerative Colitis

The prevalence of primary sclerosing cholangitis (PSC) in patients with ulcerative colitis (UC) attending the Depts. of Medical and Surgical Gastroenterology, Aalborg Hospital, during a 12-year period, was determined. All patients with an alkaline phosphatase (ALP) value above the normal range were investigated. Of 305 patients with UC, 24 patients had elevated ALP values, and 11 of these (3.6% of the study population), 4 males and 7 females, were found to have PSC by direct cholangiography. In five patients the disease worsened (two patients died of cholangiocarcinoma), in four it was stationary, and in two patients the disease improved during a mean observation period of 6 years. No differences in location of disease, disease activity, or duration of disease were found between patients with UC and PSC and patients with UC without PSC. The ALP values were raised to a mean of 3.7 times the upper normal limit (observed range, 1.5-5.5 times the upper normal limit). Aspartate aminotransferase was moderately elevated in most patients, but no other abnormal biochemical liver test results were observed at onset. The results of our study indicate that PSC is the major cause of raised ALP values in patients with UC; thus cholangiography should be performed in UC patients with unexplained elevated ALP levels. A prognostic indicator is needed to predict the individual prognosis and to determine the optimal timing of liver transplantation.     

Pneumocystis carinii Pneumonia as a Complication of Immunosuppressive Therapy

Summary Background: Patients receiving immunosuppressive therapy with corticosteroids and cytotoxic agents may develop opportunistic infections such as Pneumocystis carinii pneumonia (PCP). This indicates a severe T-cell defect, but so far there are no established criteria for identifying patients at risk. Patients and Methods: CD4+ and CD8+ T-lymphocyte counts were determined by flow cytometry in seven HIV-negative patients who developed PCP as a complication of immunosuppressive treatment. Results: CD4+ T-lymphocyte counts (T-helper phenotype) were less than 200/μl in all seven patients (mean 90.6/μl). The markedly reduced CD4 counts measured in these patients are similar to those observed in organ transplant recipients who developed PCP during immunosuppressive therapy for prevention of graft rejection and in HIV-positive patients with PCP as an AIDS-defining illness. Conclusion: Measuring CD4+ T-lymphocyte counts may be helpful in determining the risk of PCP not only in HIV-positive patients, but also in patients receiving immunosuppressive therapy. The risk of acqiring PCP seems to increase when CD4+ lymphocyte counts drop below 200/μl, regardless of the underlying disease. Received: March 13, 2000 · Revision accepted: June 16, 2000     

Fatal Pneumonia in an AIDS Patient Coinfected with Adenovirus and Pneumocystis carinii

Summary Background: Adenovirus infections are common in immunocomproised hosts. However, pulmonary adenovirus infections rarely cause significant morbidity in HIV-infected patients. Patient: Here we described a 27-year-old man with AIDS who presented with tachypnea, hypoxemia and an infiltrate in the upper left lobe on chest X-ray. Bronchoscopy was performed and Pneumocystis carinii was detected in brochoalveolar lavage (BAL) fluid. Treatment with cotrimoxazole and prednisone intially resulted in improvement, but after 10 days the patient's clinical condition deteriorated rapidly and he died after 23 days due to respiratory failure. Results: On autopsy histopathologic examination showed abundant “smudge cells,” suggestive of adenoviral infection. Electron microscopy revealed adenovirus-like particles arrayed in a paracrystalline manner. Subsequent immunohistochemistry confirmed the extensive presence of adenovirus in addition to P. carinii. Conclusion: This case demonstrates a pathogenetic role for adenovirus coinfection i P. carinii pneumonia (PCP). Earlier diagnosis, e. g. by PCR analysis of the BAL fluid or transbronchial biopsy, might have led to the consideration of ribavirin treatment. Received: September 24, 1999 · Revision accepted: July 5, 2000     

Corticosteroids for Pneumocystis carinii pneumonia with acute respiratory failure. Experience with rescue therapy.

Corticosteroids have proven effective as adjunctive therapy for the treatment of PCP in patients with AIDS, when begun within 72 h of conventional anti-Pneumocystis therapy. Their efficacy as rescue (or salvage) therapy in patients who have failed conventional therapy, however, remains unproven. Ths report presents our experience with 16 patients admitted to our MICU for acute respiratory failure (PaO2/FIO2 ratio less than or equal to 150) due to PCP. Five of six patients (83 percent) who received "primary" CS rescue (initial CS use prompted by acute respiratory failure after 72 h of conventional anti-Pneumocystis therapy) survived hospitalization. Our experience suggests that CSs may be effective even when started after 72 h of conventional therapy. Additional studies are needed to clarify the role of CS rescue therapy.     

Lower Prevalence of Diverticulosis in Patients with Ulcerative Colitis

Purpose Colonic diverticulosis is characterized by abnormal thickening of the bowel wall, associated with luminal overpressure and increase of sigmoid contractility. However, patients with ulcerative colitis show chronic inflammatory alterations determining a reduction of both bowel wall muscle tone and contractility. Thus, we could presume ulcerative colitis and colonic diverticulosis as two pathophysiologically and mutually excluding diseases. This study was designed to evaluate the prevalence of colonic diverticulosis in patients with ulcerative colitis compared with a control endoscopic population. Methods We prospectively analyzed the prevalence of colonic diverticulosis in 85 patients, older than aged 45 years, with known ulcerative colitis compared with that in 85 age/gender-matched patients without colitis. All patients underwent pancolonoscopy with ulcerative colitis and colonic diverticulosis diagnosis made by endoscopy and histopathology. The patients with ulcerative colitis also were divided in three subgroups according to the age at diagnosis (<30 years, 30–45 years, >45 years) and extension of disease (sigmoiditis, left colitis, extensive colitis). Results Colonic diverticulosis was present in 7 of 85 patients with and in 24 patients without ulcerative colitis (8.2 vs. 28.2 percent; P < 0.001; relative risk, 3.4; 95 percent confidence interval, 1.56–7.52). All seven patients with both diseases were diagnosed with ulcerative colitis when older than age 45 years. No differences were found between the two groups in terms of extension of diverticula. Conclusions Patients with ulcerative colitis show a significantly lower prevalence of colonic diverticulosis, with this finding probably reflecting the motor alterations caused by chronic bowel wall inflammation. In the patients affected by ulcerative colitis with late onset of the disease, the reduced prevalence of colonic diverticulosis is not evident.     

卡氏肺孢子菌肺炎大鼠超氧化物歧化酶和过氧化脂质变化的研究

24只SD大鼠分为卡氏肺孢子菌肺炎感染组(18只)和健康对照组(6只)。感染组以地塞米松磷酸钠3.5mg/(只.次),每周2次,连续8周腹股沟皮下注射SD大鼠,建立卡氏肺孢子菌肺炎动物模型。肺组织印片六亚甲基四胺银染色和肺组织病理切片伊红-苏木素(HE)染色观察实验大鼠肺组织的病理学变化。分光光度法检测肺组织匀浆超氧化物歧化酶(SOD)活力和过氧化脂质(LPO)含量。结果显示,感染组大鼠可见卡氏肺孢子菌包囊并发现典型病理改变;感染组SOD值[(31.49±7.18)U/mgprot]与健康对照组[(54.41±8.97)U/mgprot]相比,差异有统计学意义(P<0.01);感染组LPO值[(2.26±0.21)nmol/mgprott]与健康对照组[(1.63±0.01)nmol/mgprot]相比,差异有统计学意义(P<0.01)。