G. Watkinson

Local complications of ulcerative colitis: stricture, pseudopolyposis, and carcinoma of colon and rectum.

because of disordered function of the temporal lobe, which may be related to disorder of structure when morphological study is available. It follows that even though the lesion may be a small one the patient is brain-damaged, to use a topical phrase. As the part of the brain damaged is responsible for the integration of all sensation into total experience, and as that experience is primarily responsible for behaviour, it would not be surprising if the epilepsy was associated with psychological disorders reflected in disturbance of mood or attitude, or evidenL in disturbed social behaviour. That of course is the case, tor so many people with aggressive psychopathic behaviour also have disturbance of this part of the brain either reflected in the electroencephalogram or in morbid anatomical studies. If the clinician will keep clearly before him the distinction between what happens in the attack itself (the ictus) and what results from the post-ictal confusional state, and will then divorce these events from the total behaviour of the patient, he will be doing just what the neurologist does when he is faced with the much simpler situation in a patient who has a parietal lobe lesion. In this case there may be a hemiplegia with disturbance of feeling which will affect the patients behaviour at a lower level of functional integration, and this disturbance of movement or behaviour may well be associated with attacks of a parietal lobe kind-that is to say, a focal fit affecting arm or leg,. In this simple situation there is no difficulty in distinguishing between the intermittent epileptic event and the continued life handicap. Although the distinction is much less obvious with temporal lobe lesions, it exists, and in practice it can in most cases be made. To know that it exists will prevent serious mistakes. Lastly, a point which has been made before must be re-emphasized-that in any epileptic patient the impact of the attacks upon the subjects life is apt to lead to psychological difficulties the effects of which are to increase the frequency of attacks and severity of epilepsy ; when the epilepsy includes in its experiences psychic disturbances it is particularly prone to be aggravated by psychological distress.

Early course of ulcerative colitis.

EDITORIAL SYNOPSIS The major factors influencing the prognosis in either the first or subsequent attacks of colitis have been found to be the age at onset of symptoms and the severity of disease and extent of involvement of the colon at the time of each attack. The mortality of this disease under present-day forms of treatment has been found to be low, except in patients with total involvement of the colon and rectum, and in patients over the age of 60 years. Specific recommendations are made for the treatment of patients in these high-risk groups.

Long-term Prognosis of Ulcerative Colitis

Brooke, B. N. (1961). Dis. Colon Rect., 4, 393. Brown, M. L., Kasich, A. M., and Weingarten, B. (1951). Amer. 7. dig. Dis., 18, 52. Carleson, R., Fristedt, B., and Philipson, J. (1963). Acta chir. scand., 125, 486. Castleman, B., and Krickstein, H. I. (1962). New Engl. 7. Med., 267, 469. Counsell, P. B., and Dukes, C. E. (1952). Brit. 7. Surg., 39, 485. Crohn, B. B., and Rosenberg, H. (1925). Amer. 7. med. Sci., 170, 220. Dawson, I. M. P., and Pryse-Davies, J. (1959). Brit. 7. Surg., 47, 113. de Dombal, F. T., Watts, J. M., Watkinson, G., and Goligher, J. C. (1966). Awaiting publication. --(1965). Proc. roy. Soc. Med., 58, 713. Dennis, C., and Karlson, K. E. (1961). Surgery, 50, 568. Dukes, C. E. (1954). Ann. roy. Coll. Surg. Engl., 14, 389. Edwards, F. C., and Truelove, S. C. (1964). Gut, 5, 1. Goldgraber, M. B., Humphreys, E. M., Kirsner, J. B., and Palmer, W. L. (1958). Gastroenterology, 34, 809. Jackman, R. J. (1954). Arch. intern. Med., 94, 420. MacDougall, I. P. M. (1954). Brit. med. 7., 1, 852. (1964). Lancet, 2, 655. Michener, W. M., Gage, R. P., Sauer, W. G., and Stickler, G. B. (1961). New Engl. 7. Med., 265, 1075. Nefzger, M. D., and Acheson, E. D. (1963). Gut, 4, 183. Registrar-General (1962). Statistical Review of England and Wales, 1962. Part 1, Tables, Medical. H.M.S.O., London. Rosenqvist, H., Ohrling, H., Lagercrantz, R., and Edling, N. (1959). Lancet, 1, 906. Russell, I. S., and Hughes, E. S. R. (1961). Aust. N.Z. 7. Surg., 30, 306. Slaney, Q., and Brooke, B. N. (1959). Lancet, 2, 694. Sloan, W. P., Bargen, J. A., and Baggenstoss, A. H. (1950). Proc. Mayo Clin., 25, 240, Svartz, N., and Ernberg, T. (1949). Acta med. scand., 135, 444. Texter, E. C. (1957) 7. chron. Dis., 5, 347 Truelove, S. C., and Witts, L. J. (1955). Brit. med. 7., 2, 1041. Van Prohaska, J., and Siderius, N. J. (1962). Surg. Clin. N. Amer., 42, 1245. Watts, J. McK., de Dombal, F. T., Watkinson, G., and Goligher, J. C. (1966). Brit. med. 7., 1, 1447.

Ocular complications of ulcerative colitis

Ocular disease arising in association with ulcerative colitis is rare. It was first described by Crohn (1925) who recorded the occurrence of corneal inflammation with conjunctivitis in two patients with ulcerative colitis. Since then, most reports have been confined to a few isolated cases (Bargen, 1929; Hurst, 1935; Rice-Oxley and Truelove, 1950; Cullinan and MacDougall, 1957; Hightower, Broders, Haines, McKenney, and Sommer, 1958; Ellis and Gentry, 1964; Thorpe, 1966); although Edwards and Truelove (1964), and Wright, Lumsden, Luntz, Sevel, and Truelove (1965) have recently described patients with colitis and eye complaints in more detail. The present paper describes in detail the eye lesions which were found among a group of465 patients with ulcerative colitis. An analysis is presented of the types of eye lesion found among the patients, and an attempt is made to relate the development of eye lesions to the clinical course of colitis.

Radiological signs of ulcerative colitis: assessment of their reliability by means of observer variation studies.

Since the radiological appearances of ulcerative colitis were described in 1912 by Stierlin, these appearances have evoked much investigation and speculation. Many and varied radiological signs are described as typical of ulcerative colitis and yet very few workers have attempted to analyse these signs in any detail in order to determine their reliability, usefulness, and prognostic significance to the patient. It therefore seems to us particularly relevant to examine our own experience in this field in a highly critical manner. Our investigations have been divided into three parts. We have carried out preliminary observer variation studies in order to determine the reliability of each individual radiological sign. Next we have subjected those of the signs which were found to be reliable to further analysis by a correlation with the clinical state and prognosis of the patient. And finally we have investigated the change in the extent of colitis which has talken place in our patients over a period of years. In this report we shall describe the results of our initial studies, namely, those involving observer variation.

Aetiology of ulcerative colitis. II. A new hypothesis.

trial of various diets in ulcerative colitis. Brit. med. J., 2, 138-141. (1965b). Circulating antibodies to dietary proteins in ulcerative colitis. Brit. med. J., 2, 141-144. -, (1966). Auto-immune reactions in ulcerative colitis. Gut, 7, 32-40. Yeomans, F. C. (1921). Chronic ulcerative colitis. J. Amer. med. Ass., 77, 2043-2048. Young, J. R., Humphries, A. W., De Wolfe, V. G., and Lefevre, F. A. (1963). Complications of abdominal aortic surgery. IT. Intestinal ischaemia. Arch. Surg., 86, 51-59.

Radiological appearances of ulcerative colitis: an evaluation of their clinical significance.

Many groups of workers have investigated the radiological changes of ulcerative colitis, and yet considerable difficulty still remains in the interpretation of these changes. Perhaps this is due to the fact that most studies have concentrated upon a detailed description of the radiological findings, whilst only a few have attempted to assess their significance in terms of the subsequent fate of the patient. Indeed, what is the clinical significance of the various radiological appearances of ulcerative colitis? The present paper attempts to evaluate this problem by comparing the findings on each of 340 barium enemas with the clinical pattern of colitis in each case. We have previously shown that many radiological signs described as being typical of colitis are open to wide variation in individual interpretation (Geffen, Darnborough, de Dombal, Watkinson, and Goligher, 1968). In this paper we shall attempt to answer three further questions. Do the radiological findings accurately reflect the clinical pattern of colitis? Is it possible to give an accurate short or long term prognosis on the basis of the x-ray appearances? And, finally, what are the radiological signs upon which such a prognosis may be based?

Intraperitoneal Perforation of the Colon in Ulcerative Colitis [Abridged]

1) The outcome of any attack of colitis depends on the severity of the attack, the extent of disease and the age of the patient at the time. (2) If surgery is to be used in a severe attack, it should be in the early stages. (3) Total involvement of the colon implies such a poor prognosis that prophylactic proctocolectomy may be justified in these patients. It may also be justified in patients over 60 even if the large bowel is not totally involved.

The Early Course and Prognosis of Ulcerative Colitis [Abridged]

The mucocutaneous junction at the pectinate line in man is often represented by a zone of gradual transition (Walls 1958, Parks 1958) which may extend for over a centimetre of epithelium. In most of the mammals studied, however, there was an abrupt change at the mucocutaneous junction from stratified squamous epithelium to rectal mucosa. In the baboon, however, the change was more like that ofman.