Increased rectal wall thickness may predict relapse in ulcerative colitis: a pilot follow-up study by ultrasonographic colonoscopy.

BACKGROUND AND STUDY AIMS: Ulcerative colitis is a chronic inflammatory bowel disease with repeated remission and relapse, although the occurrence of relapse is difficult to predict. We performed a prospective study to determine whether there is a relationship in ulcerative colitis between the inflammatory changes identified by endoscopic ultrasonography (EUS) and relapse. PATIENTS AND METHODS: Participants were 23 ulcerative colitis patients who had not suffered a relapse for 1 month, with a Seo activity index less-than-or-equal 150 and Baron grade 1 at colonoscopy. The thickness of the first to the third layer of the rectal wall in these patients was measured by EUS at the start of the study. They were subsequently followed up for 1 year to record any relapses, defined as having a Seo activity index > 150 and Baron grade greater-than-or-equal 2 at colonoscopy. RESULTS: Relapse occurred in eight patients. The mean activity index of the relapsed patients was 187.3 (95 % confidence interval (CI), 166.4 - 208.2) at the end of the study. The thickness of the first to the third layer of the rectal wall, as evaluated by EUS at the beginning of the study, was significantly larger in the relapse group (mean 2.73 mm, 95 % CI 2.13 - 3.33 mm) than in the non-relapse group (1.79 mm; 1.56 - 1.99 mm; P = 0.0001). CONCLUSIONS: Catheter probe-assisted endoluminal ultrasonography may predict the occurrence of relapse of ulcerative colitis.

Bleeding Meckel's diverticulum in an adult.

Bleeding Meckel's diverticulum tends to be a complication of ectopic gastric mucosa. It has been known that the gastric acid and digestive fluid produced from the ectopic gastric mucosa cause peptic ulcer, which leads to bleeding. When the ectopic gastric mucosa is entirely formed by the pyloric gland, however, ulcer formation may result from factors other than gastric acid and digestive fluid. This is a report of an adult case of bleeding Meckel's diverticulum with ectopic gastric mucosa in whom mechanical stimulation was suggested as a cause of the erosion and ulceration, resulting in bleeding.

Metaplastic polyp of the colon develops in response to inflammation.

BACKGROUND: The metaplastic polyp of the colon is a non-neoplastic lesion that is generally identified as white, flat and having a smooth surface. In general, this polyp is small, is less than 5 mm in diameter but is occasionally larger than 5 mm in diameter, and forms a swelling. The aims of the present study were to clarify the factors that determine the morphology of protruding metaplastic polyps. More specifically, we investigated whether the metaplastic polyp forms as a result of an abnormality in cell proliferation or inflammation of the region. METHODS: We examined 15 endoscopically resected metaplastic polyps of the colon having a longitudinal diameter of more than 5 mm. To study aspects of cell proliferation, we used proliferating-cell nuclear antigen (PCNA) staining. For examination of histological changes caused by inflammation, we used alpha-smooth muscle actin (alphaSMA) staining, in which myofibroblasts are specifically stained. RESULTS: Metaplastic polyps showed significantly higher expression of PCNA, not only in the deep layer, but also in the intermediate and superficial layers, compared with the normal mucosa of the colon. In the protruding metaplastic polyps, anti-alphaSMA staining revealed bundle-like myofibroblasts in the interstitium. CONCLUSIONS: The factors responsible for the formation of non-neoplastic metaplastic polyps larger than 5 mm with a protruding morphology are: an increased number of epithelial cells due to the movement of these cells toward the ductal epithelium in the proliferating zone; and expansion of interstitial tissues due to infiltration of myofibroblasts and other inflammatory cells in response to inflammation.

Antidiuretic hormone in acute asthma in children: effects of medication on serum levels and clinical course.

This study of seventeen patients presenting to the emergency room with acute severe asthma determined levels of antidiuretic hormone in serum as well as serum electrolytes and arterial blood gases serially. There was a progressive increase in plasma ADH concentration with severe asthma and ADH levels were substantially higher in those patients with PaCO2's higher than 45 Torr. Patients treated with intravenous aminophylline had a fall in ADH levels while those treated with injectable epinephrine showed an elevation of these levels. As the asthma improved, ADH levels decreased in all patients. In this series of children, sick for not more than 24 hours, serum sodium levels were normal. However, children who have been ill for longer periods than this or who are on prolonged intravenous fluid therapy need close monitoring of serum electrolyte concentrations.

How to prevent allergic disease. I. Study of specific IgE, IgG, and IgG4 antibodies in serum of pregnant mothers, cord blood, and infants.

We have investigated methods for decreasing the number of allergic patients and have produced the following data. We compared mothers' total IgE levels and allergen-specific IgG and IgG4 levels in 72 paired cases. In mothers with high total IgE, the cord blood levels of IgG and IgG4 specific for egg, milk, and mite allergens were significantly higher than in mothers with low IgE levels. Mothers who took over 200 ml of milk per day showed a statistically higher level of milk-specific IgG antibody. From our studies of IgE, IgG, and IgG4 antibody levels in atopic dermatitis patients, we conclude that specific IgG and IgG4 levels should be considered when eliminating offending foods. Infants with high egg-specific IgG antibody levels in cord blood were statistically more prone to develop allergic disease.

Role of chemical mediators after antigen and exercise challenge in children with asthma.

Changes in chemical mediators after antigen challenge and exercise challenge tests were studied in children with asthma. Chemical mediators studied after antigen challenge and exercise challenge included histamine, leukotrienes (LTB4, LTC4, and LTD4), and neutrophil chemotactic factor of anaphylaxis (NCA). The pharmacologic modification of immediate and late-phase reactions was evaluated for procaterol (beta 2-agonist), cromolyn sodium, and prednisolone. Histamine levels were noted to rise in patients who had a dual response of a mild to moderate nature, but did not change in patients who had severe asthma. During exercise challenge cromolyn sodium inhibited both immediate and late-phase reactions but also inhibited plasma generation of NCA. Prednisolone, on the other hand, did not affect immediate reactions, but blocked late-phase reactions to exercise and also decreased NCA generation. Procaterol inhibited the generation of LTD4 and also inhibited NCA when compared with placebo. Exercise challenge did not alter levels of plasma histamine or of LTB4 or LTC4.