Joseph B. Kirsner

THE GASTROINTESTINAL LESIONS AND COMPLICATIONS OF THE LEUKEMIAS.

Excerpt In spite of their recognition Since the nineteenth century (5, 20, 48, 66, 144), the gastrointestinal lesions developing in the course of the leukemias have attracted attention only recentl...

A controlled trial of azathioprine in Crohn's disease

To determine the efficacy of azathioprine in the treatment of Crohns disease, a 26-week double-blind trial was performed. 20 patients with Crohns disease, requiring at least 10 mg of prednisone/day over the 3 months prior to entering the study were randomized into placebo (10 patients) and azathioprine (10 patients) treatment groups. Reduction of steroids was the major criterion of success in the trial. There were 7 relapses in the placebo group (5 patients) and 2 relapses in the azathioprine group (2 patients). Complications including fistulae were not affected by the medications. The mean reduction in steroid dosage in the azathioprine group at the end of the trial (−15.5 mg) was greater than in the placebo group (−6.1 mg). These results suggest that azathioprine may permit reduction or discontinuation of steroids without the worsening of symptoms in some patients who appear to require steroids for control of their symptoms. The clinical features of this “AZA-responsive subgroup” remain to be defined.

Thrombocytosis in Chronic Inflammatory Bowel Disease

Abstract Six patients with either ulcerative or granulomatous intestinal disease were noted to have markedly elevated concentrations of circulating blood platelets during a period of increased clin...

Nephrolithiasis in inflammatory bowel disease

In a series of 885 patients with inflammatory bowel disease, 64 (7.2%) also had nephrolithiasis. Forty-three patients (6.4%) had ulcerative colitis, and 21 (10.1%) had “granulomatous” inflammatory bowel disease. The majority of patients were young men with ulcerative colitis. The average duration of the bowel disease prior to the clinical diagnosis of renal calculi was 10 years. Calcium radiopaque stones were identified by chemical analysis or X-ray appearance in 46 patients. Uric acid radiolucent calculi similarly were identified in 12 patients. In 6 patients the stones could not be classified. Increased concentration and excretion of urinary crystalloids, possibly related to the administration of adrenal corticosteroids, persistent excretion of an acid urine, and intestinal surgery, may be important factors in the pathogenesis of nephrolithiasis in inflammatory bowel disease; but further metabolic studies are necessary to clarify this problem.

Cytomegalic inclusion disease and ulcerative colitis: Report of a case in a young adult

Abstract Cytomegalic inclusion disease in the colon of a young man with a clinical picture simulating non-specific ulcerative colitis is described. The patient has survived to date. Etiologic and contributing factors are discussed. The occurrence of the disease appears to be related to a combination of circumstances, perhaps including latent viral infection, reduced immunity incident to debility, disease of the reticuloendothelial system, and administration of certain drugs. The affinity of the salivary gland virus for the vascular endothelium of the colon and the role of endothelial involvement in the pathogenesis of the ulceration are emphasized.

Gastritis with veno-capillary ectasia as a source of massive gastric hemorrhage.

Summary In a patient with massive gastrointestinal bleeding, the hemorrhage arose in an unusual type of gastritis characterized by veno-capillary ectasia. The lesion was demonstrated at gastroscopy after all other clinical procedures including abdominal exploration had failed. Histologic examination of the resected stomach revealed gastritis with markedly dilated, thin-walled vessels at the most superficial levels of the mucosa.

Family Occurrences of Ulcerative Colitis, Regional Enteritis, and Ileocolitis

Excerpt Despite the genetic heterogeneity of man, surveys of disease among population groups and families are important in the search for possible etiologic mechanisms in obscure diseases. Whereas ...

Prevalence and incidence of inflammatory bowel disease in family members

To determine the risk of having or developing inflammatory bowel disease (IBD) in a family member of an IBD patient, a population of 245 IBD probands was randomly selected from the University of Chicago IBD Registry and their family history was elucidated by questionnaire and follow-up telephone call. One hundred seventy-nine (73%) probands responded to the questionnaire. There were no demographic distinctions between those eligible for the study, those who were complete responders, those who were nonresponders, and those with a positive family history of IBD. Fifty-four family members from 40 proband families (22%) had confirmed IBD. Prevalence of IBD in family members at the time of diagnosis of the proband was highest for parents (4.6%), siblings (2.6%), and children (1.9%). Grandparents, aunts and uncles, and first cousins had prevalence of IBD of less than 1%. Incident case frequency was determined by dividing the number of cases incident after the diagnosis of the proband by all those ever at risk. The incident case frequency was highest for siblings (1.9%), parents (1.0%), and children (1.0%). There was concordance noted for type of disease in the proband and the relative. No association could be discerned between the familial risk of IBD and gender, race, or religion of the proband. Despite a high occurrence rate of proband families with IBD, the specific risk to first, second, or third degree family members is low.

D-xylose and its use in the diagnosis of malabsorptive states

MONG the numerous procedures employed in A the diagnosis of malabsorptive states [7], only a few have been technically simple, widely applicable, inexpensive, and yet informative of the absorptive ability of the small intestine; these include plasma turbidity [2-51, carotene C&71, and the urinary excretion of d-xylose after oral administration [ 7-3,8-751. The present study was undertaken to evaluate the oral d-xylose test and to compare it with other indices of absorption in patients with malabsorption of varying etiology. Physiologic Comiderations. Substances employed to measure absorptive functions are subject to the same physiologic processes of intestinal absorption as foodstuffs, i.e., digestion, translocation and transportation, In addition, various metabolic processes referable to the specific test substance itself and the type of measurement often require special consideration. To facilitate an understanding of the biologic significance of the xylose test and its validity in evaluating intestinal absorption (especially carbohydrate absorption), a review of the metabolism of xylose seems appropriate. Xylose is a five-carbon monosaccharide (pentose) with a molecular weight of 150. Foodstuffs such as fruits and grains are especially rich in pentoses and can produce an alimentary pentosuria [76]. As with most simple carbohydrates given alone or after digestion of a balanced meal, xylose is absorbed (translocated) primarily in the duodenum and proximal jejunum [77]. In healthy individuals an average of 65 per cent

Ileostomy in ulcerative colitis: A questionnaire study of 1,803 patients

of xylose is absorbed. After feeding the pentose, Fourman [77] could not recover any