Acute suppurative obstructive cholangitis due to stones: treatment by urgent endoscopic sphincterotomy.

Endoscopic sphincterotomy is an accepted treatment for retained common bile duct stones, but there is little specific information available regarding its application in acute suppurative obstructive cholangitis with sepsis due to choledocholithiasis. Thirteen patients with this condition were referred to the authors for consideration of urgent endoscopic common bile duct decompression. All had been judged to be poor surgical candidates. Pus was released from the common bile duct by sphincterotomy within 24 hours of admission in all 13. Stones were removed endoscopically in 10 patients (77%) without complications. After endoscopic stone removal, symptoms, signs, and abnormal laboratory values returned to normal rapidly; follow-up endoscopic retrograde cholangiography did not show retained stones. Three patients whose large stones precluded endoscopic removal underwent operative choledocholithotomy. Urgent endoscopic sphincterotomy offers an important alternative in the treatment of acute suppurative obstructive cholangitis secondary to choledocholithiasis.

Primary amyloidosis presenting as Sjögren's syndrome.

A patient had severe sicca complex. Histopathologic and immunologic examination of the salivary glands showed amyloid fibril infiltration, type A lambda VI. To our knowledge, this is the first documentation of immunologically characterized primary amyloidosis causing the sicca complex. The sicca complex is usually associated with Sjögren's syndrome and the presence of autoantibodies to SSA and SSB. These antibodies were absent in our patient, despite the severity of the sicca syndrome. The clinician should consider more unusual causes of the sicca complex, eg, amyloidosis, particularly if the serologic markers of antibodies to SSA and SSB are absent. Tissue typing the amyloid protein diagnosed primary amyloidosis, obviating the need to search for underlying disease.

Endoscopic recanalization of a portoenterostomy.

Sudden cessation of bile flow occurred in an infant with biliary atresia following successful portoenterostomy. Bile flow was re-established by an endoscopic recanalization procedure, and has been sustained during 1 yr of follow-up.

Estrogen- and progesterone-associated colitis: a disorder with clinical and endoscopic features mimicking Crohn's colitis.

Five women presented with episodes of abdominal pain and bloody diarrhea. Their colonic endoscopic features included (1) rectal sparing, (2) segmental involvement of the colon, and (3) discrete ulcers with normal adjacent mucosa that mimicked Crohn's colitis. All patients were taking estrogen or progesterone or both, and their symptoms and endoscopic findings resolved with cessation of therapy.

Antibodies to synthetic polyribonucleotides in spouses of patients with inflammatory bowel disease.

Serum from patients with inflammatory bowel disease (I.B.D.) and their unaffected spouses bound significantly more synthetic single-stranded (poly.rA) and double-stranded (poly.rA.poly.rU) R.N.A. but not KB cell D.N.A. than did serum from age-matched controls and their spouses. Binding activity resided in Ig fractions and was predominantly of IgM class. A significant corelation was observed between the amount of double-stranded but not single-stranded R.N.A. bound by serum from patients and from their respective spouses. These findings provide indirect support for the presence of R.N.A. viruses in patients with I.B.D. and the transmission of such agents to their close personal contacts.

Endoscopic electrocoagulation: an alternative to operative therapy in bleeding peptic ulcer disease.

Twelve patients with severely bleeding peptic ulcers (six duodenal, five gastric, and one esophageal) who were considered to be at high operative risk were treated instead by endoscopic electrocoagulation of the bleeding point. Arrest of the bleeding was permanent in ten, one bled again two days later, and one patient died of nonulcer disease one day later. Although this method to control bleeding from peptic ulceration is new, it seems to offer promise especially when treating desperately ill people.

Lymphocytotoxic antibodies in patients with inflammatory bowel disease and their spouses--evidence for a transmissible agent.

Serum lymphocytotoxic antibodies (LCA) were detected in twenty-seven out of fifty-three (51%) patients with inflammatory bowel disease (IBD) and in twenty-three out of their fifty-three (43%) unaffected spouses. The prevalence of LCA in both groups was significantly increased (P less than 0.001) compared to that in age- and sex-matched controls (11%) or in control spouses (6%). Concordant expression of LCA occurred in sixteen out of the fifty-three (30%) patient-spouse pairs compared to only one out of the fifty-three (2%) control-spouse pairs (P less than 0.001). In contrast to the LCA results, heterophile antibody titres were similarly distributed in all four study groups. It is suggested that LCA may represent markers of infectious agents in IBD and that their occurrence in unaffected close contacts of patients may indicate transmission of such agents to these subjects.

The association of heartburn with gastritis.

Esophageal, fundal, antral, and duodenal mucosal biopsies from 10 patients with heartburn were compared with biopsies from 18 patients with dyspepsia but without heartburn or radiographic or endoscopic evidence of peptic ulcer disease, gastric retention, or esophageal stricture. There was a highly significnt correlation between heartburn and antral gastritis and duodentitis (P less than 0.01). It is suggested that histologic reflux changes are determined by the severity of reflux and reparative potential of the esophageal mucosa. Heartburn, on the other hand, is more related to the nature of the refluxed fluid. The fluid most likely to induce heartburn is one containing duodenal fluid, which is also believed to be an important cause of antral gastritis.

The endoscopic appearance of the duodenum in Whipple's disease.

Duodenoscopic examination of a patient with Whipple's disease revealed that the duodenal mucosa appeared to be partially covered with a yellow-white material. On closer inspection, however, this was found to consist of enlarged villi interspersed with normal-looking mucosa. Histologically these enlarged white villi were shown to contain a heavy accumulation of lipid and typical PAS positive macrophages. The duodenal mucosa was endoscopically normal and histologically showed only a few PAS positive macrophages one year after instituting antibiotic therapy.