Aged Budd-Chiari syndrome attributed to chronic deep venous thrombosis with alcoholic liver cirrhosis.

Budd-Chiari syndrome is a rare disease, but there are many known causes. Recent studies showed that it can be an acquired lesion resulting from thrombosis in some elderly patients. We report a 74-year-old man with Budd-Chiari syndrome attributed to chronic deep venous thrombosis and alcoholic liver cirrhosis. When he was aged 45 years, stasis ulcers of the lower extremities appeared. Cerebral infarction and left hemiparesis occurred at age 71. Ultrasonography, venacavography, and three-dimensional-magnetic resonance imaging on admission demonstrated total obstruction of the inferior vena cava with several massive thrombi and developed collateral vessels. Although the etiology of the thrombosis remained obscure, we made some speculative assumptions that chronic disseminated intravascular coagulation (which is frequently observed in cirrhosis) or hereditary coagulopathy could be involved, from his familial history of thrombotic phenomena and a severe deficiency of clotting inhibitors. Despite the high mortality of untreated Budd-Chiari syndrome reported in previous studies, this patient had been alive for about 30 years from the suspected onset.

Significance of serum iron and ferritin in patients with colorectal adenomas.

BACKGROUND: Colorectal adenomas are often detected on mass screening, although detection rates with fecal occult blood tests are low. The relationship between colorectal adenomas and the resulting blood loss was examined indirectly, using serum iron and ferritin levels. METHODS: Serum iron and ferritin concentrations were measured in 184 men with colorectal adenomas (> or = 1 cm in 92; < 1 cm in 92) and in 92 healthy male controls. Values in the three groups were compared. In the patients with adenomas > or = 1 cm, serum iron and ferritin levels were compared on the basis of the site, number, histology, and degree of dysplasia of the adenoma. RESULTS: The mean serum iron level was significantly lower in patients with adenomas > or = 1 cm than in controls (P < 0.05), although this level did not differ significantly between those with adenomas < 1 cm and controls. The mean serum ferritin level also was significantly lower in patients with adenomas > or = 1 cm than in those with adenomas < 1 cm and controls (P < 0.05, P < 0.01, respectively), although this level did not differ between those with adenomas < 1 cm and controls. There was no difference in mean serum iron or ferritin levels on the basis of the site, number, histology, or degree of dysplasia of the adenoma. CONCLUSIONS: We conclude that decreased serum iron and ferritin levels are related only to adenoma size and that adenomas > or = 1 cm may bleed steadily, resulting in iron deficiency. However, low dietary intake of iron and fiber may be one of the causes of low serum iron and ferritin.

Changes in urinary nitrate and nitrite during treatment of ulcerative colitis.

The urinary excretion rates of nitrate (NO3) and nitrite (NO2) were monitored in 14 patients with active ulcerative colitis during treatment using hydrocortisone and sulfasalazine. During the active phase of the disease, the NO3 excretion was significantly higher in the patients than in healthy controls (n = 6, p < 0.05), although it varied considerably among the patients. During the healing phase, the NO3 excretion decreased concurrently with improvement of symptoms and colorectal ulceration, but the NO2 excretion increased. During the inactive phase of the disease, the NO3 and NO2 excretions were significantly lower than during the active phase, and the NO2/NO3 ratio resembled that in the healthy controls. In contrast, a patient who failed to respond to treatment showed continuously high NO3 and NO2 excretion rates. These results indicate that urinary NO3 and NO2 excretions vary with the disease state in ulcerative colitis.

Portal hypertensive colopathy: endoscopic findings and the relation to portal pressure.

Portal hypertensive colopathy (PHC) is a new clinical entity in patients with liver cirrhosis. In this study, colonoscopic findings and clinical features including upper gastrointestinal endoscopy and hepatic hemodynamics were prospectively investigated among 35 PH patients with a hepatic venous pressure gradient (HVPG) of greater than 12 mmHg due to chronic liver diseases. Colonoscopy was also performed in 100 patients without liver disease as non-PH controls. The colonoscopy revealed vascular ectasias, vascular irregularity, vascular dilatation, solitary red spots, diffuse red spots, and hemorrhoids in 26, 32, 30, 25, 10 and 25, respectively, of 35 PH patients compared to 3, 7, 3, 11, 0 and 19, respectively, in controls. PHC was endoscopically diagnosed in 27 of 35 PH patients according to our criteria. These patients with PHC were more frequently associated with esophageal varices and portal hypertensive gastropathy, and had higher HVPG than PH patients without PHC. Portal hypertension is an important factor in the etiology of PHC.

Clinical significance of serum iron and ferritin in patients with colorectal cancer.

To clarify the significance of serum iron and ferritin as indicators of iron loss caused by continuous bleeding, and, thus, to determine their value as markers of colorectal cancer, values for the two were compared in male patients with early and advanced colorectal cancer and age-matched male controls. The mean value of serum iron levels in patients with advanced colorectal cancer was significantly decreased compared with values in patients with early colorectal cancer and controls, 50.5 +/- 38.6 micrograms/dl vs 93.0 +/- 32.1 micrograms/dl and 107.1 +/- 32.9 micrograms/dl, respectively (p < 0.001). The mean value of serum ferritin levels in patients with early and advanced colorectal cancer was also significantly decreased compared with controls, 80.5 +/- 35.0 ng/ml (p < 0.01) and 48.8 +/- 72.8 ng/ml (p < 0.001), respectively, vs 117.1 +/- 46.8 ng/ml. However, there was no significant difference between mean serum iron levels in patients with early colorectal cancer and controls. Eighteen (78.3%) of the 23 patients with advanced colorectal cancer and 3 (16.7%) of the 18 patients with early colorectal cancer had serum iron levels below 85 micrograms/dl and serum ferritin levels below 60 ng/ml. Levels of both serum iron and ferritin, without clinically evident anemia, are useful indicators of advanced colorectal cancer.

An endoscopic study of antibiotic-associated hemorrhagic colitis.

Colonoscopy was performed on acute stage within 72 hours from onset in 48 patients with antibiotic-associated hemorrhagic colitis (AAHC). From our observations we have developed a new endoscopic classification of AAHC and investigated the incidence of each finding in further detail. We have classified in principle the endoscopic findings of the 48 subjects into two groups: major and minor ones respectively. Category of major findings were: 1) diffuse mucosal hemorrhage (100%); 2) spotty mucosal hemorrhage (100%), and 3) linear mucosal hemorrhage (22.9%), while minor findings were: 1) irregular ulcers in 10.4%; 2) aphthoid ulcers in 6.3%, and 3) linear erosions or ulcers in 4%. Minor findings were ulcers or erosions present over the hemorrhagic mucosa associated with the moderate degree of inflammation. A histopathologic study of colon biopsy specimens from 24 patients with AAHC showed hemorrhage and inflammatory cell infiltration in the lamina propria mucosae varying from mild to moderate in extent. It was concluded that AAHC was a colonic mucosal hemorrhagic disease caused by the destruction of mucosal vessels from unknown causes and in this disease mild to moderate inflammation was partially followed by ulceration over the edematous and hemorrhagic mucosa of the colon.

Pulmonary infiltration and eosinophilia associated with sulfasalazine therapy for ulcerative colitis: a case report and review of literature.

We report a 52-yr-old man with ulcerative colitis who developed sulfasalazine-induced pulmonary infiltration with eosinophilia (PIE syndrome), which resolved completely after withdrawal of this drug. Desensitization to sulfasalazine was successful, and allowed the patient to receive this drug without recurrence of the pulmonary toxicity. This is the first case of the sulfasalazine-induced PIE syndrome in Japan; a review of the world literature found no previous cases of successful desensitization following sulfasalazine-induced PIE syndrome.