Colitis Cystica Profunda Simulating Rectal Carcinoma

Localized colitis cystica profunda is a rare, benign disease of the lower gastro-intestinal tract, usually presenting as a rectal mass and characterized microscopically by the presence of mucus-filled cysts in the submucosa. Knowledge of this particular pathological entity is important as it can mimic a well differentiated adenocarcinoma of the rectum and therefore could lead to unnecessary surgical resection. We present a case of colitis cystica profunda misdiagnosed as adenocarcinoma based on their similar clinical picture and histological features.     

Infliximab trough levels and persistent vs transient antibodies measured early after induction predict long-term clinical remission in patients with inflammatory bowel disease

BackgroundThe use of therapeutic drug monitoring has been proposed as a useful tool in the management of patients with loss of response to biological therapy in patients with inflammatory bowel disease.AimsTo evaluate whether early, post-induction anti-tumor necrosis factor trough levels and the presence of different types of anti-drug antibodies may impact long-term clinical remission in patients with inflammatory bowel disease.MethodsWe prospectively assessed anti-tumor necrosis factor trough levels and both persistent and transient anti-drug antibodies. The Harvey–Bradshaw Index and the partial Mayo score were evaluated at each visit or in case of relapse.ResultsAt week 14, median infliximab trough levels were significantly lower in patients who experienced loss of response at week 48 as compared to patients in stable remission (1.3 mcg/mL [range 0–10.2 mcg/mL] vs. 10.1 mcg/mL[range 0–42.8 mcg/mL], P < 0.0004). ROC curve identified an infliximab trough levels of 6.2 mcg/mL as the cut-off value with the highest accuracy (c-index = 0.864) for loss of response at week 48. At week 14 we observed a correlation between anti-drug antibodies concentration and infliximab trough levels (r_s = −0.513, P = 0.04).ConclusionsThe results highlight the usefulness of assessing early biological TL in order to predict patients’ long-term outcome.     

56例缺血性结肠炎临床回顾分析

目的 探讨缺血性结肠炎的临床特点、内镜特征及诊断和治疗方法.方法 对56例缺血性结肠炎患者的临床资料进行回顾性分析.结果 缺血性结肠炎多发生于老年患者,男女比例为1∶1.8.多伴有糖尿病（53.6％,30/56）、高血压（39.3％,22/56）、冠心病（32.1％,18/56）等基础疾病.腹痛（100.0％,56/56）及便血（89.3％,50/56）为主要临床表现.结肠镜检查以黏膜充血、水肿、糜烂、溃疡等非特异性表现为主,病变主要见于左半结肠,呈节段性分布.多数患者预后良好.结论 老年患者出现急性腹痛和便血时应警惕缺血性结肠炎可能,早期结肠镜检查可及时明确诊断和指导治疗.     

Comparison of Flow Cytometry and Histology with Mutational Screening for p53 and Ki-ras Mutations in Surveillance of Patients with Long-standing Ulcerative Colitis

Background: We evaluate the usefulness of screening for p53 and Ki-ras mutations in comparison with histological and flow cytometric findings. Methods: We analyzed 1486 biopsy samples from 769 locations of 83 patients with long-standing ulcerative colitis enrolled in a surveillance program by means of histology, flow cytometry and SSCP analysis. As a control we used 66 biopsy samples of 16 patients with irritable bowel disease. Results: With respect to all biopsy samples analyzed, DNA aneuploidy was found in 32.5% (27/83) of patients, dysplasia in 22.9% (15/83), p53 in 21.7% (18/83) and Ki-ras mutations in 18.1% (15/83) of patients. None of these markers was found in our control group. In 7 out of 10 patients who displayed dysplastic findings during endoscopic surveillance p53 and / or Ki-ras mutations were present in at least one colonoscopy. Statistically significant associations were observed between dysplasia and DNA aneuploidy ( P < 0.001), between dysplasia and p53 mutations ( P = 0.05) and between dysplasia and p53 and/or Ki-ras mutations ( P = 0.002). No significant associations were found between dysplasia and Ki-ras mutations alone. The results for the SSCP analysis showed a much broader variation than those for the flow cytometric analysis. Conclusions: These results show that screening for p53 and Ki-ras mutations can be a useful adjunct in surveillance of patients with longstanding ulcerative colitis.     

Surgery for Crohn Colitis Over a Twenty-Eight-Year Period: Fewer Stomas and the Replacement of Total Colectomy by Segmental Resection

Background: This study describes how surgery for Crohn colitis developed between 1970 and 1997, towards the end of which period limited resection and medical maintenance treatment was introduced. Methods: A cohort of 211 patients with Crohn colitis (115 population-based), of which 84 had a primary colonic resection (42 population-based), was investigated regarding indication for surgery, the time from diagnosis to operation, type of primary colonic resection, risk for permanent stoma and medication over four 7-year periods. Results: Comparison of the periods 1970-90 and 1991-97 revealed that active disease as an indication for surgery decreased from 64% to 25% ( P < 0.01) while stricture as an indication increased from 9% to 50% ( P < 0.001). Median time from diagnosis to operation increased from 3.5 to 11.5 years ( P < 0.01). Proctocolectomy or colectomy fell from 68.8% to 10% of the primary resections, whereas segmental resection increased from 31.2% to 90%. At the end of the first 7-year period, 26% had medical maintenance treatment, steroids or azathioprine taken by 7%. Corresponding figures for the last period were 70% and 49%. Patients diagnosed during the last two time-periods had less risk for surgery ( P = 0.017), permanent stoma ( P < 0.01) and total colectomy ( P < 0.01). Findings were similar in the population-based cohort. Conclusions: Current management of Crohn colitis implies a longer period between diagnosis and surgery, a reduced risk for surgery and permanent stoma, and the replacement of total colectomy by segmental resection.     

Changes in Distribution of Three Isoforms of Nitric Oxide Synthase in Ulcerative Colitis

Background: Nitric oxide (NO) has an important role both in normal physiology and pathological events of the colon. Our aim was to study possible changes of the three nitric oxide synthases in ulcerative colitis (UC). Methods: Tissue samples from normal colon and least and moderately affected regions of ulcerative colitis colon were obtained at surgery and immunostained for NOS-1, NOS-2, NOS-3, and GAP-43, a marker of nerve fibers. Quantitative analysis of NOS-1 immunoreactivity was performed on the circular muscle layer. Results: NOS-1-immunoreactive fibers in the muscularis mucosae disappeared in least affected and moderately affected UC colon. Quantitative analysis of NOS-1-immunoreactive nerve fibers in the circular muscle showed no differences between normal and diseased colon. NOS-2 immunoreactivity appeared apically in the epithelial cells. In normal colon some specimens showed immunoreactivity in lower parts of crypts. NOS-2 immunoreactivity increased according to the severity of UC. NOS-3 immunoreactivity was exclusively localized in the vascular endothelium. The difference in NOS-3 staining intensity between the lamina propria and submucosa observed in normal tissue disappeared in moderately affected UC colon. The number of NOS-3-immunoreactive vascular profiles increased in the lamina propria of UC colon. Conclusions: All three NOS isoforms show specific changes in UC colon.     

Contamination and Crossinfection with Clostridium difficile in an Intensive Care Unit*

Abstract: Contamination and crossinfection with Clostridium difficile in an intensive care unit. B.A.J. Walters, R. Stafford, R. K. Roberts and E. Seneviratne, Aust. N.Z. J. Med., 1982, 12, pp. 255–258. An outbreak of pseudomembranous colitis in an intensive care unit is described. This resulted in environmental contamination by Clostridium difficile. The outbreak could be traced to one patient who received several antibiotics over the preceding three months. A search was conducted for asymptomatic carriers among patient and staff but none were found. Aquisition of C. difficile from inanimate environmental sources was the most probable means of transmission of the organism. Its persistence in the hospital environment for several weeks, most likely as spores, suggests that patients who develop pseudomembranous colitis should be isolated, especially in areas of high antibiotic usage.