Lymphocytic and collagenous colitis: the emerging entity of microscopic colitis. An update on pathophysiology, diagnosis and management.

Microscopic colitis (MC) encompasses the two morphologically distinct entities of collagenous colitis (CC) and lymphocytic colitis (LC). MC was first described less than 30 years ago but is presently recognized as a relatively common cause of chronic diarrhea in the adult population. Remarkably, up to 10% of adults who have a colonoscopy for the investigation of chronic diarrhea, and have endoscopically normal appearing mucosa, may have MC. Patients with MC generally present with chronic diarrhea, which can be associated with cramping and bloating. Endoscopic and radiological examinations are usually normal. Histological assessment reveals inflammation consisting predominantly of lymphocytic infiltration, and a thickened subepithelial collagen band is diagnostic of CC. Both LC and CC can be associated with autoimmune diseases such as celiac disease, diabetes, arthritis and thyroiditis, yet the mechanisms involved in the pathogenesis remain unclear. Emerging studies suggest that a stepwise approach be taken in the medical management of MC. This approach includes antidiarrheal agents and stopping of any offending agents; budesonide or bismuth subsalicylate; and cholestyramine or 5-acetylsalicylic acid agents. In resistant cases, oral corticosteroids and other immune modulatory therapy have been used.     

Urinary 5-Hydroxytryptophol: A Possible Marker of Recent Alcohol Consumption

Urinary 5-hydroxytryptophol (5-HTOL) is currently being evaluated as a marker of recent alcohol consumption. To compensate for urinary dilution, the molar ratio between 5-HTOL and 5-hydroxyindole-3-acetic acid (5-HIAA) is used. The 5-HTOL/5-HIAA ratio showed a satisfactory degree of individual stability when it was followed in a group of teetotallers for 1 month. The mean value of 5-HTOL/5-HIAA in a group of 69 persons abstaining from alcohol was 7.6 (pmoles 5-HTOL/nmoles 5-HIAA). Ninety-seven percent had values ranging from 4 to 17, with no value exceeding 20. A group of healthy volunteers were tested 12 hr after alcohol consumption and showed a dose-dependent and statistically significant elevation in the 5-HTOL/5-HIAA ratio. Four regular alcohol consumers who were followed during a period of 3 months of drinking had elevated values of the 5-HTOL/5-HIAA ratio in 60% of their urine samples. The present study indicates that urinary 5-HTOL/5-HIAA is a sensitive and reliable marker of recent alcohol consumption. We propose that a 5-HTOL/5-HIAA ratio greater than 20 (pmoles/nmoles) can be used to indicate recent alcohol consumption. This limit gives a low frequency of false positives; the statistical probability of having a value greater than 20 during abstinence from alcohol was calculated to be less than 0.001.     

Dose-escalation study of intravenous nicardipine in patients with aneurysmal subarachnoid hemorrhage

A dose-escalation study of the calcium ion entry blocking drug nicardipine was performed using large dose infusions in 67 patients with recent aneurysmal subarachnoid hemorrhage (SAH). A safe, potentially therapeutic dose of the drug was determined. Patients admitted within 7 days of SAH from a documented cerebral aneurysm were entered into the study if no spasm was present on the initial angiogram. Nicardipine was administered as a continuous intravenous infusion throughout the 14-day period after SAH, regardless of the timing of surgery. To determine the safest possible dose, nicardipine was administered at seven dose levels from 0.01 to 0.15 mg/kg/hr. The total daily doses ranged from 27.7 mg to 375.0 mg. A follow-up angiogram was carried out on all 67 patients 7 to 10 days after SAH. Computerized tomography and neurological examinations were used to determine the presence of cerebral infarction. No major adverse effects, unexpected reactions, or permanent sequelae could be attributed to nicardipine. A decline in blood pressure was noted following administration of the drug. This occurred more frequently among patients given the largest dose but did not produce clinical problems or require discontinuation of the drug. Favorable outcomes were noted in 52 patients (78%). Vasospasm was found by arteriography in 31 patients (46%). A dose-related trend was noted: only eight (24%) of 33 patients treated at the highest dose level (approximately 10 mg/hr) developed arteriographic evidence of vasospasm. Symptomatic vasospasm was diagnosed in only two (6%) of 33 patients treated with this dose. Of the 34 patients receiving the lower dose levels, angiographic spasm was observed in 68% and symptomatic vasospasm in 27%. No deaths due to vasospasm occurred. Nicardipine appears to prevent both vasospasm and cerebral ischemia after SAH. A multicenter randomized double-blind trial to test this hypothesis is planned.     

Self-concept dimensions of clinically depressed and anxious outpatients.

Principal components analyses of the Beck Self-Concept Test (BST) were conducted independently for 288 women with primary mood disorders, 230 women with anxiety disorders, 236 men with mood disorders, and 161 men with anxiety disorders. Four self-concept dimensions that reflected (1) Intellectual Ability; (2) Work Efficacy; (3) Physical Attractiveness; and (4) Virtues/Vices occurred within the four samples. For 5-item subscales that represent these four dimensions, a two-way MANOVA found significant effects for sex and type of disorder. Women described themselves as having less intellectual ability than men did. Outpatients with mood disorders considered their physical appearance, work efficacy, and virtues/vices to be less acceptable than did those with anxiety disorders. Findings were discussed with respect to the cognitive content-specificity theory of psychopathology.     

Versicherungsrechtliche Medizin. Gewerbepathologie. (Gewerbliche Vergiftungen)

International Journal of Legal Medicine -     

Vitamin K administered to the mother during labor as a prophylaxis against hemorrhage in the newborn infant

This investigation has been conducted as two separate studies. Part I consisted of the determination of the prothrombin activity in normal newborn infants together with observations on the alterations in this activity which result from the administration of vitamin K to the mother. Part II was concerned with the practical application of the knowledge gained from the first study. It aimed to show the value of intra-partum vitamin K administration in reducing the incidence of hemorrhage in newborn infants.     

Endangitis obliterans — Periphlebitis tuberculosa retinae

Ohne Zusammenfassung     

Intraoperative Awareness in a Regional Medical System: A Review of 3 Years' Data

Background: Intraoperative awareness in patients undergoing general anesthesia is an infrequent but well-described adverse outcome. The reported incidence of this phenomenon is between 0.1% and 0.9%.

Methods: With institutional review board approval, the authors reviewed continuous quality improvement data from 3 yr (2002-2004) at the locations where the physician group provided anesthesia. Board-certified anesthesiologists supervising certified registered nurse anesthetists in the anesthesia care team model of practice delivered all anesthetics. Brain function monitors were not used in the operating room setting. Patients were interviewed twice during a 48-h postoperative period and, as part of that process, underwent a modified Brice interview to determine intraoperative awareness. All cases that met the criteria for awareness were examined by the continuous quality improvement committee to modify anesthetic practice and were included in this study.

Results: Data from 211,842 patients undergoing anesthesia were considered. Of these, the continuous quality improvement process followed up 177,468 (83.1%). Cases were not included in the study if the patient was younger than 18 yr, did not have a general anesthetic, or had a terminal event during the hospital course. By these criteria, a total of 87,361 patients followed by the continuous quality improvement process were at risk for awareness. Six patients reported instances of recall.