Atypical, cytoplasmic and perinuclear anti-neutrophil cytoplasmic antibodies in patients with inflammatory bowel disease.

Atypical, cytoplasmic and perinuclear anti-neutrophil cytoplasmic antibodies (x-, c- and pANCA, respectively) are associated with a variety of inflammatory diseases, including inflammatory bowel disease (IBD). Anti-neutrophil cytoplasmic antibodies are more common in patients with ulcerative colitis (UC) than in patients with Crohn's disease (CD). Most publications only refer to p- and cANCA in relation to IBD. We have prospectively evaluated the reactivity of sera from 58 patients with IBD and 10 healthy controls against human neutrophils with emphasis on the distinction of the ANCA types. The sera were incubated with ethanol- and formaldehyde-fixed granulocytes to differentiate between c-, p- and xANCA. The results showed that 10 of 24 patients with UC were positive for ANCA, whereas only one of 34 patients with CD was ANCA positive. These results correspond to a sensitivity of 42%, a specificity of 97%, a negative predictive value of 91% and a positive predictive value of 75% in UC. Of the 11 ANCA-positive sera, two showed a cytoplasmic staining pattern, three showed a perinuclear and six an atypical staining pattern. The disease activity was not correlated to either the ANCA titre or to the presence of ANCA in the serum. In conclusion, ANCA are of limited value in differentiating between UC and CD. Because the majority of ANCA in patients with IBD are xANCA, these ANCA should be explored by not only incubating on ethanol-fixed granulocytes, but also on formaldehyde-fixed granulocytes.

[Physician-patient relations and stress caused by coloscopy in patients with chronic inflammatory bowel disease]. / Arzt-Patienten-Beziehung und Belastung durch Koloskopien bei Patienten mit chronisch entzündlicher Darmerkrankung.

The relationship between doctors and patients with inflammatory bowel disease is usually considered complex and difficult. We analyzed the quality of this relationship and the stress inflicted on the patients by endoscopy. 76 patients with Crohn's disease or ulcerative colitis answered a questionnaire. More than three quarters considered their relationship to their doctors good or very good. The patients expressed a wish for more information on the pathophysiology and treatment options of their disease. The stress placed on the patients by endoscopy was considered severe or very severe by 57%. We conclude that the relationship between doctor and patients with inflammatory bowel disease is generally considered good or very good. Endoscopies are highly stressful for most patients and we recommend appropriate sedation.

[Social consequences and quality of life in patients with chronic inflammatory bowel disease]. / Soziale Folgen und Lebensqualität bei Patienten mit chronisch entzündlicher Darmerkrankung.

We conducted a survey on the quality of life and social consequences for patients with inflammatory bowel disease. Questionnaires of 41 patients with Crohn's disease, 28 patients with ulcerative colitis and 7 patients with overlap colitis were evaluated. All the patients had been hospitalized in the past. 15 patients (20%) were unable to work due to inflammatory bowel disease. 9 (12%) of these 15 patients received a disability pension. 11 patients (15%) had to change a place of work and 16 (21%) had had financial problems due to inflammatory bowel disease. 4 patients (5%) had had to give up a partnership due to the disease. For 16% of the patients their perceived quality of life during the past 4 weeks was poor or very poor, while 35% of the patients perceived their overall quality of life as poor or very poor since the beginning of the disease. We conclude that inflammatory bowel disease affects job and financial matters rather than partnerships. The quality of life is judged by many patients as considerably diminished.

Disappearance of a large mediastinal pseudocyst in a patient with chronic alcoholic pancreatitis after total parenteral nutrition.

OBJECTIVE: To report the unusual case of a mediastinal pseudocyst in a patient with chronic pancreatitis, which resolved after conservative treatment. PATIENT: A 59-year-old patient with alcohol-induced chronic pancreatitis and a large mediastinal pseudocyst. INTERVENTIONS: Bowel rest and total parenteral nutrition for 4 weeks. MAIN OUTCOME MEASURES: The pseudocyst resolved completely. CONCLUSION: Conservative treatment is a valuable option in patients with chronic pancreatitis presenting with a mediastinal pseudocyst, but close supervision is mandatory.

[Triplet pregnancy with HELLP syndrome and transient diabetes insipidus]. / Drillingsschwangerschaft mit HELLP-Syndrom und transientem Diabetes insipidus.

A 35 year old primigravida with a triplet pregnancy developed polyuria and epigastric pain in the 31st week of pregnancy. During that week, emergency cesarean section was performed due to evidence of liver disease and imminent fetal hypoxia. Three girls were delivered who were healthy apart from transient neonatal respiration distress syndrome. Following surgery, the mother developed HELLP syndrome with hemolysis, increased transaminases and thrombocytopenia. She also developed diabetes insipidus with daily urine outputs of up to 7000 ml and poor response to desmopressin. Both the HELLP syndrome and the diabetes insipidus resolved spontaneously within ten days. In pregnant patients with right upper quadrant pain, HELLP syndrome or acute fatty liver of pregnancy should be considered. The association of diabetes insipidus with acute fatty liver of pregnancy is an established, but rare phenomenon. As far as is known, this is the first report of a patient presenting with a combination of HELLP syndrome and diabetes insipidus. Patients with HELLP syndrome have a good prognosis, if the diagnosis is early and the pregnancy terminated at the right time. With close supervision further pregnancies are possible.