Walter L. Palmer

CORTICOTROPIN (ACTH) AND THE ADRENAL STEROIDS IN THE MANAGEMENT OF ULCERATIVE COLITIS: OBSERVATIONS IN 240 PATIENTS

Excerpt INTRODUCTION The ultimate role of corticotropin (ACTH), the adrenal steroids (cortisone, hydrocortisone) and related compounds (prednisone and prednisolone) in the management of ulcerative ...

The effect of various antacids on the hydrogen-ion concentration of the gastric contents

The neutralizing influence of various commonly used antacids was investigated in a total of 290 experiments performed on 25 patients with healing duodenal ulcer. The hydrogen-ion concentration of the gastric contents removed hourly was determined by the glass electrode method. Control studies were made with a general diet and with hourly feedings of a three-ounce mixture of milk and cream. The alkalies were administered hourly; they included calcium carbonate and sodium bicarbonate in varying amounts, calcium carbonate alone, aluminum hydroxide, tricalsate, tribasic calcium phosphate, and magnesium trisilicate The effect of atropine on gastric acidity when given alone and in conjunction with various antacids, was also studied. Some of the results were compared with the results of 329 experiments in which the free HCl was determined by the usual titration method. Pertinent clinical and experimental reports are reviewed.

The use of ACTH, cortisone, hydrocortisone and related compounds in the management of ulcerative colitis; experience in 180 patients.

Abstract Since January, 1950, 180 patients with ulcerative colitis have been treated with ACTH, cortisone, hydrocortisone and the newer analogues. In most instances these agents were prescribed as adjuncts to a comprehensive medical program. The disease was classified clinically as severe or moderately severe in 92 per cent of the patients. Steroid therapy was initiated with corticotropin in 134 patients, with hydrocortisone in twenty-nine cases and in the remaining seventeen with either cortisone, prednisone or prednisolone. An immediate beneficial effect was observed in 85 per cent of the patients. The response to corticotropin was more dramatic and more uniform than to the other agents; the beneficial effects included subsidence of fever, tachycardia, abdominal distress, and blood in the feces, together with increase in appetite and a pronounced sense of well being. The bowel movements decreased in frequency and the discharges improved in consistency, although somewhat more slowly. Proctoscopic improvement occurred in the majority of patients but less rapidly than the clinical response. Symptoms recurred in 70 per cent of the patients. The recurrence rate in those with a relatively brief history was lower than the overall figure. Repeated courses of corticotherapy induced favorable responses in the majority of ninety-one patients. However, the results were not as striking as in the first course. At present, 113 patients are considered to be in complete or partial remission; forty-four continue on steroid therapy. Thirty-nine patients have been in remission since the first course; the remainder have received multiple courses. Thirty-five patients are unimproved. Seventeen patients have undergone surgery, twelve have died (including one of the surgical group), and four have been lost to follow-up. The most common side effects were Cushinglike changes in 137 patients, alkalosis in ninety-five, hypokalemia in forty-five and hyperglycemia or glycosuria in twenty-six; these untoward effects seldom were severe enough to discontinue therapy. The more serious but less frequent complications included temporary psychosis in ten, two suicides, allergy to ACTH in nine, and severe infections in five. Peptic ulcer developed in only one patient; nine individuals with peptic ulcer received large doses of steroids without untoward effects. ACTH produced more frequent and the most profound side effects but, in general, was the most effective compound. Hydrocortisone, prednisone and prednisolone were less effective but often produced comparable clinical results with fewer side effects. Cortisone did not compare favorably with the other corticoids.

Blood carotene in steatorrhea and the malabsorptive syndromes

Abstract 1.1. The determination of plasma carotene is a simple, valuable screening test for steatorrhea. 2.2. Disorders other than steatorrhea presenting a low plasma carotene include high fever, poor dietary intake and liver disease. 3.3. The response of the plasma carotene is a useful guide to therapy in various malabsorptive disorders. 4.4. In patients with low plasma carotene levels a daily oral dose of 20,000 units of carotene-inoil for seven days raised to normal the level of plasma carotene depleted by poor diet; in patients with absorptive defects normal levels were not achieved. This differing response may serve to distinguish further a borderline from a truly abnormal test.

Reversibility in ulcerative colitis; clinical and roentgenologic observations.

Ulcerative colitis is recognized as a chronic disease, varying in clinical severity and characterized by remissions and exacerbations (1). In some patients the illness is relatively mild; the process seems limited to the rectum and rectosigmoid, as judged proctoscopically, and the roentgenologic examination is normal. In others the clinical symptoms are severe; the proctoscopic changes are more pronounced; varying involvement of the colon is demonstrable by x-ray. In still other patients the bowel appears roentgenologically to be extensively and irreversibly diseased; yet clinically the manifestations may be minimal. The clinical features have been thoroughly described by Bargen (2). The tendency of ulcerative colitis to progress and the high incidence of complications have been stressed repeatedly. The potential reversibility of the disease, on the other hand, has received little emphasis. The purpose of this paper is to direct attention to the pronounced improvement and complete healing of ulcerative co...

Gastric antacid and anti-secretory drugs: a survey based primarily on their effects upon gastric secretion in man.

Excerpt The medical management of peptic ulcer in large part comprises the use of compounds which either neutralize or inhibit temporarily the output of hydrochloric acid.1The rationale of this tre...

Exfoliative cytology in diagnosis of cancer of the colon

THE GREAT ?~IAJORITY Of adenocarcinomas of the colon can be identified and diagnosed by exfoliative cytology. The diagnostic accuracy of this method when appl ied to the colon is equivalent to that of the esophagus and stomach. One wonders why it has not been used as frequently by the cytopathologist in diagnosing cancer of the colon as he has cancer of other areas of the gastro-intestinal tract where the curabil i ty rate is decidedly lower. Probably the answer is that no one has found a way to uniformly and reliably cleanse the entire colon. Considerable progress, nevertheless, has been made and the future of colonic cytology is bright. Historically, as far back as the 1860s body ejecta were examined for exfoliated mal ignant cells. 13 T h e difficulties encountered in collecting, staining and interpreting the material were overwhelming. Taking courage from the success of cytologic studies in other areas, a few proctologists, surgeons and cytologists began cytologic studies anew, and by 1952 a few reports 1, s, 9, 10 were published. When the lesion was not visible, malignant cells were obtained from the exudate pooled distal to sigmoidal lesions in five of 19 cases of WissemanlS and associates and in one of 19 cancers studied by Blank

Disease of the liver in chronic ulcerative colitis

Abstract Parenchymal jaundice ranging in duration from fifteen to sixty days was observed during the evolution of ulcerative colitis in twenty-one of 720 patients (3 per cent). Chronic symptomatic hepatic disease occurred in eighteen of the 720 patients. In fifty autopsies of seventy fatal cases, fatty change was the most frequent hepatic lesion, being found in 50 per cent. Cirrhosis of the liver was found in 12 per cent of the necropsy cases of colitis as compared with 1 per cent each in two control groups. The types of cirrhosis noted were biliary (both obstructive and nonobstructive), portal and postnecrotic. There were two instances of carcinoma of the biliary ducts. It is concluded that the hepatic disease of patients with ulcerative colitis is basically similar to that found in other patients. The true incidence of chronic viral hepatitis probably will not be known until adequate diagnostic methods are available. Biliary cirrhosis was surprisingly frequent.

ULCERATIVE COLITIS: THERAPEUTIC EFFECTS OF CORTICOTROPIN (ACTH) AND CORTISONE IN 120 PATIENTS

Excerpt INTRODUCTION The effects of corticotropin (ACTH) and cortisone in ulcerative colitis have been characterized as beneficial,1-5indifferent6-8and unfavorable.9-14Numerous studies also have em...

The Histopathology of Chronic Ulcerative Colitis and its Pathogenic Implications

Summary A group of 124 patients with ulcerative colitis, who had colon surgery, an autopsy, or both, was studied. Review of clinical data and of proctoscopic, roentgenologic, and histopathologic findings revealed frequent lack -of correlation between them. A segment of bowel, although normal grossly by inspection or x-ray examination, may reveal disease when examined microscopically. Ulceration and pseudopolyp formation were the most constant histologic features. Cryptitis could not account for the mechanism of the ulcerative process. Other features observed in a large proportion of cases were granuloma formation, giant cells, and tissue eosinophilia. Their possible relation to the presence of a hyperimmune mechanism in the bowel wall is discussed. Vascular thrombosis, lymphatic dilation, and perivascular infiltrates were present frequently. Similar features are associated with hypersensitive states in the experimental animal. Acute vasculitis was present in only 1 case; it does not seem to play a role in the mechanism of ulceration in ulcerative colitis. Endothelial desquamation, observed in 3 cases, could not account for either thrombosis or ulceration. No information was obtained concerning the role of changes of the homogenous ground substance or of the number and activity of mast cells—both requiring special techniques and special studies. No suggestion could be found in our material of defective cellular regeneration. Adenomas and carcinomas were present in 26 and 19 per cent of the cases, respectively.