Esophageal and gastric endoscopy in critically ill patients. How can it help you?

Bleeding from the upper gastrointestinal tract in a critically ill patient is a tough diagnostic situation. Endoscopy can help physicians determine the cause of bleeding and can also provide several therapeutic options. The authors discuss these applications of the current technology.

Colonoscopy in critically ill patients. What conditions call for it?

Indications for colonoscopy in the intensive care unit include acute lower intestinal bleeding, sigmoid volvulus, pseudo-obstruction of the colon, and suspicion of pseudomembranous colitis. Although the incidence of cardiorespiratory complications may be higher in these critically ill patients, the procedure can be done safely with proper attention to detail. Because of colonic dilatation, endoscopy can often be done without bowel preparation.

Cell-wall defective bacteria and Crohn's disease: studies using athymic nude mice.

Indirect immunofluorescence studies were performed to determine whether the antigenic recognition by Crohn's disease (CD) sera of lymphoid tissue from nude (nu/nu) mice injected with CD filtrate is related to cell wall defective pseudomonas-like bacterial revertant forms (CWD-RF). Antisera raised in rabbits against two CWD-RF isolates from CD tissues did not stain lymphomas or hyperplastic lymph nodes produced by CD filtrates, although these tissues demonstrated positive immunofluorescence with CD sera. Pre-absorption of reactive CD sera with CWD-RF did not block this immunofluorescence. Formalinized suspensions of CWD-RF were injected into 36 nu/nu, 12 nu/+, and 31 conventional mice. Thirty other mice were fed suspensions of bacteria. Several nu/nu injected with CWD-RF developed lymphoma (n = 2) and plasma cell hyperplasia (n = 5), none of which reacted with CD sera. Mice fed bacteria did not show intestinal pathology. These studies demonstrate that CWD-RF are not directly related to lymphomagenesis in nu/nu induced by CD filtrates and that different CD serum antibodies are involved in recognition of CWD-RF and lymphoid tissues from nu/nu previously injected with CD filtrates.

Ornithine carbamoyltransferase deficiency in an adult male patient: significance of hepatic ultrastructure in clinical diagnosis.

Ornithine carbamoyltransferase (OCT) activity was deficient (8% of control) in the liver of a 21-year-old man who died after suddenly becoming comatose. Activities of other enzymes of the urea cycle in the liver were normal. There was no known prior illness or injury; the patient, however, had been taking liquid protein supplements to his diet. Hyperammonemia and orotic aciduria were present, and the concentration of lysine in the plasma was elevated. Survey of earlier reports indicates that neither the specific deficiency of hepatic OCT nor the urine and plasma findings provide a basis for definitive diagnosis of the patient's illness as primary OCT deficiency or as Reye's syndrome. Indeed, the age of the patient at onset of symptoms and the absence of any prodromal infection argue against the OCT deficiency being either primary or a sequel to Reye's syndrome. We suggest that it was secondary to mitochondrial injury caused by an unknown agent. Electron microscopic study of hepatocyte ultrastructure lends support to this view; abnormalities of the patient's mitochondria (bizarre, elongated shapes) do not resemble those seen in Reye's syndrome, nor have abnormalities been found in primary OCT deficiency.

Desensitization of patients with inflammatory bowel disease to sulfasalazine.

Seventeen patients with ulcerative colitis and three patients with Crohn's disease exhibited different side effects during sulfasalazine therapy. Eighty percent of these patients belonged to slow acetylator phenotypes. All side effects except skin rash were associated with a mean serum total sulfapyridine concentration of 62.9 +/- 17.4 micrograms/ml and free sulfapyridine concentration of 42 +/- 9.5 micrograms/ml. All patients were successfully desensitized, which allowed them the benefit of continued sulfasalazine therapy for prevention of relapses.