Kiyotaka Okawa

Ulcerative colitis with skip lesions at the mouth of the appendix: a clinical study

Objective: We examined the clinical characteristics of ulcerative colitis patients who demonstrated endoscopically discontinuous lesions at the mouth of the appendix. Methods: Of patients with initial or recurrent active ulcerative colitis who underwent total colonoscopy during the past 3 yr at Osaka City General Hospital, we selected those who had skip lesions in the mouth of the appendix before treatment, and examined their gender, age, disease type, sites of lesions, inflammatory reaction, severity of disease, effects of treatment, and posttreatment course. Results: Discontinuous lesions at the mouth of the appendix were found in 10 patients, who had the following common clinical features: the major lesion was usually present in the lower part of the large bowel including the rectum, many of the patients had suffered an initial attack only, all patients had mild disease, and many of the patients responded quite satisfactorily to treatment with salicylazosulfapyridine. Conclusion: Numerous patients with ulcerative colitis with discontinuous lesions at the mouth of the appendix were observed and their clinical characteristics were examined. Determination of the clinical significance of skip lesions in the appendix will contribute to elucidation of the pathogenesis of ulcerative colitis.

Cap polyposis cured by Helicobacter pylori eradication therapy.

Helicobacter pylori eradication. A 63-year-old man was diagnosed as having cap polyposis with mucoid stool, diarrhea, and bleeding on defecation. Following 5 weeks of total parenteral nutrition, his symptoms and hypoproteinemia improved and he was discharged, although follow-up colonoscopic findings revealed no improvement. Subsequent gastroscopy revealed diffusely erosive polyps with cap-like “fur” from the angle to the antrum of the stomach, similar to the lesions observed in the colon. Because H. pylori infection was demonstrated in the stomach, eradication therapy was administered. After this treatment, his symptoms immediately disappeared, and the polypoid lesions in the colon and stomach had completely disappeared 8 months later. Because there have been no previous reports of a relationship between H. pylori and cap polyposis, this case is of great interest.

New treatment of ulcerative colitis with K-76

The complement inhibitor K-76 (Otsuka Pharmaceutical Co., Osaka, Japan) was clinically evaluated as a new drug for treatment of active stage ulcerative colitis (UC). As monotherapy, K-76 proved effective in four of five cases. Furthermore, in patients with active stage UC that continued despite administration of corticosteroid hormone and salicylazosulphapyridine (so-called refractory UC), concomitant administration of K-76 was effective in seven of 21 cases. Thus, we believe that the multifunctional agent K-76 will provide clinicians with a new therapeutic approach to inflammatory bowel diseases, including UC and Crohns disease.

Multivariate Analysis for Factors Predicting Rapid Response of Leukocytapheresis in Patients With Steroid-resistant Ulcerative Colitis: A Multicenter Prospective Open-label Study

Leukocytapheresis (LCAP) has been advocated as a treatment for moderate to severe active ulcerative colitis (UC) in Japan. To clarify the predictive factors for a rapid response to LCAP treatment, we conducted a multicenter prospective open‐label study. A total of 105 patients with UC were analyzed. LCAP was performed using a Cellsorba EX column once a week for 5–10 sessions. The response was evaluated by the clinical activity index (CAI). When the CAI score decreased to less than half the pretreatment value or to less than 5 points within 3 weeks, the patient was considered to be a rapid responder. The average CAI significantly decreased from 11.7 to 4.2 (P < 0.01). Seventy‐four percent of the patients responded to the therapy, and 53% of these patients were rapid responders. The following significant factors correlated with the rapid LCAP response: (i) steroid resistance (P < 0.05), (ii) severe disease indicated by a CAI score greater than 11 (P = 0.05), (iii) disease duration of less than 1 year (P < 0.05), and (iv) C‐reactive protein levels before treatment (P < 0.01). These results suggest that the early initiation of LCAP is beneficial in patients with steroid‐resistant UC.

Clinical and prognostic features of rectal sparing in ulcerative colitis

Thirty patients with ulcerative colitis who had been followed clinically for more than 5 years were studied. Patients with total or left-sided colitis were investigated to evaluate the significance of rectal sparing in the prognosis of the disease. Patients were divided into two groups, one with complete or relative sparing of the rectum and the other with homogeneous lesions ranging from the rectum to the proximal colon based on endoscopic findings. The administration of topical corticosteroids seemed to have little effect on rectal sparing. However, the relapse index was significantly higher in patients with rectal sparing. The intractability index, representing the ratio of the duration of the active stage to the investigation period, was also higher, though not significantly so, in this group. The results suggest that rectal sparing may give information about intractability or a tendency to relapse.

Immunoglobulin-containing cells in the colonic mucosa of rabbits with carrageenan-induced colitis

Immunohistochemical analysis of immunocompetent cells in the colonic mucosa was performed with carrageenan-induced experimental colitis in rabbits. Colitis was induced by seven months of oral administration of λ-degraded carrageenan following immunization with the same substances containing Freunds complete adjuvant. In the colonic mucosa with colitis, IgG- and IgM-containing cells were significantly increased in number (IgG: 540±94/mm2 in experimental group,vs. 120±54/mm2 in control,P<.05, IgM: 55.0±19.7/mm2 in experimental group,vs. 6.7±2.4/mm2 in control,P<.05). There was no significant increase of IgA-containing cells either in number or in proportion to the total mononuclear cells. These changes, induced by carrageenan in rabbits, had resembled those in human ulcerative colitis well. These observations suggested an impairment of the IgA-regualted local immune system and an abnormality in the differentiation process of immunoglobulin-secreting cells.

A Study on Atypical Endoscopic Findings of Ulcerative Colitis: Longitudinal Ulcers, Mucosal Bridges and Red Spots

Abstract: One hundred and twenty‐one ulcerative colitis patients diagnosed during the period of 1984 to 1988 were examined endoscopically on repeated occasions. Forty‐six patients had total colitis, 56 had left‐sided colitis, 15 had proctitis, and 4 were postoperative patients. When classified according to their macroscopic findings, 28 of the patients had the polyposis type of this disease, 88 had the atrophic type, and 5 had the mixed type. Longitudinal ulcers were found in 9 patients, occuring usually in the sigmoid colon. There was no pathological evidence of ischemic changes in these 9 patients. Mucosal bridges were found in 13 of the patients with total colitis, occurring somewhere from the cecum to the rectum. The mucosal bridges tended to be present during the mildly active stage of the disease. Red spots, which sometimes looked like vascular spiders, were found in 10 patients. The spots tended to appear before the disease went into the inactive stage. Histological observation showed regenerating vessels, sometimes with intramucosal bleeding; therefore the spots seemed to be intractable changes.

A Case of Endometriosis of the Transverse Colon

症例は43歳女性．17年前に前置胎盤で帝王切開術を受けている．某年7月から下痢と血便があり，前医を受診した．翌月に大腸内視鏡検査（CS）を施行し，直腸に隆起性病変をみとめたため，精査目的で当科を受診した．CSでは，横行結腸中央部に狭窄を伴う表面顆粒状隆起性病変，S状結腸に粘膜下腫瘍様隆起，下部直腸に表面顆粒状の隆起性病変がみられた．腹部造影CT検査では，横行結腸に壁肥厚と壁内部に低吸収域がみられた．子宮は肥大し内部に低吸収域が多発し，子宮背側周囲に多胞性嚢胞がみられたため，子宮内膜症が疑われた．注腸検査では，横行結腸中央部に約6cmにわたる狭窄と鋸歯状の陰影欠損，S状結腸に壁の伸展不良，直腸に壁のひきつれと隆起を認めた．2ヵ月後CSを行い，横行結腸中央部，下部直腸からの生検で腸管子宮内膜症と診断した．横行結腸に病変をみとめた腸管子宮内膜症は，本邦では2例目で非常に稀であり，文献的考察を加えて報告する．

Sexually Transmitted Disease of the Anus and Rectum in the Department of Gastroenterology-Amebic Colitis and Chlamidia trachomatis Proctitis

消化器内科でみる直腸肛門のSTDの代表的疾患としてアメーバ性大腸炎とクラミジア直腸炎について述べた.アメーバ性大腸炎では大多数が男性同性愛者のSTDであるとの認識が必要である.そのため他のSTDの合併とくにHIV合併の有無を検索することが重要である.内視鏡像に習熟すれば1まとんどが診断可能であるが,確定診断にに生検のみでなく,血清抗体,白苔の鏡検便検査などの他の方法も併用することが重要である.クラミジア直腸炎は男性同性愛者と女性異性愛者に発隼するSTDであるが本邦では若年女性に多い.現在は非常にまれとされているが,診断されていない症例も多いと考えられ今後の増加が予想される.内視鏡像の特徴は直腸下部のイクラ状の隆起病変であり,病理組織学的にはリンパ濾胞の増生と炎症性細胞浸潤である.確定診断には直腸擦過診によるChlamidia trachomatis抗原やDNAの検出が必要である.

The leading cord method of colonofiberscopy

Although the colonofiberscope has undergone various modifications and improvements, the insertion principle remains unchanged; that is pushing and rotation and the elasticity of the scope itself are inevitable. It often is difficult to maintain proper balance among these dynamic factors; imbalance prevents deep insertion. Over-elongation of the scope leads to insertion failure, particularly if there are adhesions of the sigmoid colon, overextension of the colon, or transverse colon ptosis. Our “leading cord” method is an excellent aid to colonofiberscopy. It can be inserted from the clamp hole of a conventional fiberscope and hardened to straighten the scope, thereby permitting deep insertion. With this technique the region from the rectum to the descending colon, as well as a ptosed transverse colon, can be straightened. Our clinical experience indicates that the rate of successful insertions in colonofiberscopy will be increased considerably with this complementary device.