Lege Artis Medicinae

[Clinical and laboratory parameters in ulcerative colitis]

NAGY Ferenc1, PAPÓS Miklós2, CSERNAY László2

DECEMBER 28, 1994

Lege Artis Medicinae - 1994;4(12)

[The clinical and laboratory parameters which correlate with the intensity of the inflammatory process in ulcerative colitis patients were analyzed in this study. The severity of the inflammatory process was assessed with leukocytescinti graphy by colorectal segments using a scoring method in 36 patients (group A). The sum of the segmental scores were considered to represent the intensity of the inflammatory process and were compared with clinical and laboratory parameters. From among the 36 patients, acute ulcerative colitis was established with biopsy in 30 cases. Two toxic patients were not tested and four patients had inactive disease. In 20 (16 acute, 4 inactive) of 36 patients, the intensity of the inflammatory process was assessed by segments with score values of biopsy samples and leukocyte scintigraphy (group B). The sum of the score values was used to determine the correlation of the two methods. The intensity of the inflammatory process assessed by scintigraphy showed a good correlation (r = 0.6564, p = 0.0016) with histological findings (group B), as well as with the ESR (r = 0.6398), serum fibrinogen (r = 0.5424), alfa2 globulin level (r = 0.4721), number of bloody stools (r = 0.4605), and the thrombocyte count (r = 0,4594) in group A. Five clinical and laboratory parameters proved to be suitable to assess the actual severity of the inflammatory process in ulcerative colitis. The values of the parameters may help to choose the right examination in new cases and to evaluate the efficacy of the therapy. ]

AFFILIATIONS

  1. Szeged Megyei Jogú Város Önkormányzat Kórház-Rendelőintézet Belgyógyászati Osztály
  2. Szent-Györgyi Albert Orvostudományi Egyetem Központi Izotópdiagnosztikai Laboratórium Szeged

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[The first 15 years of the AIDS epidemic ]

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[The role of transesophageal echocardiography in the investigation of stroke]

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[Ischaemic infarction accounts for 85% of stroke aetiology (1). Approximately 60-70% of these are of cerebrovascular, i.e. carotid arteriosclerosis, origin (2). The proportion of cardiogenic embolism was previously estimated at 15% (1), but autopsy data suggest that embolism is the cause of half of fatal strokes (3). There are two reasons for this large discrepancy: 1) the intracardiac source is difficult to identify in vivo; 2) cardiogenic embolism has a more severe outcome than stroke of other origin. Probably both are true, but there is no doubt that before the introduction of transesophageal echocardiography (TE), the detection of intracardiac sources was rare and uncertain.]

Lege Artis Medicinae

[A multicentre, randomised, crossover, double-necked trial of contamination of conventional and bow-tie dressings in routine obstetric and gynaecological practice]

MARINKO M Biljan, CHARLES A Hart, DEBORAH Sunderland, PAUL R Manasse, CHARLES R Kingsland

[In the 19th century, the usual dress of doctors was a small bow tie tied in a flat knot "once round" in addition to a stiff standing collar (1). As fashions have changed, the wearing of bow ties has become less common and is now worn almost exclusively by a small minority of obstetricians, who often claim that they are more hygienic than the traditional tie in the delivery room, which is contaminated with blood and amniotic fluid. There is currently no evidence for this. We therefore examined the contamination of traditional and bow ties worn by obstetricians during a typical working week. ]

Lege Artis Medicinae

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[The authors report two cases of prenatally diagnosed endocardial fibroelastosis with echocardiography for the first time in Hungary. This disease is rare and usually fatal. Diagnoses were confirmed by autopsy and in one case by postnatal echocardiography as well. Principles for the diagnosis of endocardial fibroelastosis are discussed. Echocardiography makes possible the prenatal diagnosis of endocardial fibroelastosis and is recommended from the 18th week of pregnancy in high risk individuals.]

Lege Artis Medicinae

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[After reviewing our department's employment statistics a few weeks ago, I was not surprised to see that we have performed almost twice as many radiology examinations in the past year as the Royal College of Radiologists' recommended number of examinations. Since 1990, the number of outpatient examinations in our department has increased by 48%, the number of inpatient examinations by 13% and the number of accident and emergency examinations by 6%. Most other specialists could report similar figures.]

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Clinical Neuroscience

[Tension-type headache in ulcerative colitis]

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[Background and purpose - Tension-type headache is a very common disease with a high socio-economic impact as its lifetime prevalence is 30-78% in the general population. The incidence of inflammatory bowel diseases is continuously rising. Limited data are accessible on quality of life in patients with surgically treated ulcerative colitis. The aim of our study is to examine quality of life, concerning headache, among patients who had undergone surgery due to ulcerative colitis. Methods - Between 1 January 2005 and 1 March 2016, surgery was performed due to ulcerative colitis in 75 patients. During this retrospective analysis the average duration of the follow-up was 46 (1-124) months. The pre-sence of headache was evaluated by the use of Brief Illness Perception and Headache Questionnaires. Results - Among the primary headache disorders (n=27), tension-type headache occurred in 19 (70.4%) cases, and 8 (29.6%) patients had migraine (without aura). Among tension-type headache cases 17 (89.5%) patients experienced episodic form and 2 (10.5%) suffered from chronic form. Patients with headache had obtained a significantly higher score on Brief Illness Perception Questionnaire. Conclusions - According to our study tension-type headache is common among patients with ulcerative colitis. This observation raises the question whether stress plays role in the pathogenesis of both diseases, which influences and worsens considerably quality of life. Neurological examination, psychological and psychiatric guidance are worth considering in patients with ulcerative colitis.]

Lege Artis Medicinae

[THE GENETICS OF INFLAMMATORY BOWEL DISEASE]

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[The pathogenesis of inflammatory bowel disease is only partly understood; various environmental and host factors (e.g., genetic, epithelial, immune and non-immune) are involved. It is a multifactorial polygenic disease probably with genetic heterogeneity; some genes confer susceptibility to IBD in general, while others specifically increase the risk of ulcerative colitis or Crohn's disease or affect location (localized or extensive) and/or behaviour (e.g., mild, severe, aggressive). This review presents recent advances in the genetics of inflammatory bowel disease including chromosome segments newly recognized to be involved in inflammatory bowel disease as well as the role of NOD2/CARD15, SLC22A4/A5 and DLG5. The increasing genetic information provides, for the time being, a better understanding of the pathogenesis of the disease thus setting a basis for potential targets for therapeutic intervention. In the future, however, genetics may also help in refining the diagnosis or predicting disease course.]

Lege Artis Medicinae

[Extraintestinal manifestations in inflammatory bowel diseases]

LAKATOS László

[Inflammatory bowel diseases (IBD) are systemic disorders. Bowel symptoms are the predominant manifestations, however during the course of the disease a lot of intestinal and extraintestinal complications may occur. Systemic complications are responsible for substantial co-morbidity and they have negative influence on the quality of life. A part of the extraintestinal symptoms seem to have common pathogenetic background with IBD, while others are the consequences of subsequent metabolic and endocrine abnormalities or may relate to local complications and adverse effects of treatment. Growing evidence is available on the role of genetic and immunologic factors in the pathogenesis of extraintestinal manifestations. Most important systemic complications are: peripheral and axial arthritides, osteoporosis, uveitis, erythema nodosum, pyoderma gangraenosum, primary sclerosing cholangitis, nonalcoholic steatohepatitis, different types of anaemia, thromboembolism, kidney stones and urinary complications. Cooperation with the specialists is very important in the diagnosis and treatment of these comlications. During followup of IBD patients special attention is needed to monitor possible extraintestinal manifestations.]

Lege Artis Medicinae

[Correlation between clinical data and histologycal findings assessing the severity of ulcerative colitis]

NAGY Ferenc, KARÁCSONY Gizella

[ A knowledge of the current activity of ulcerative colitis is essential in planning appropiate follow-up. Histological findings obtained from 209 colonoscopies were compared with the values of 22 clinical variables. One way analysis of variance was carried out. Of the 22 variables 11 proved to be significantly different between the groups of the clinically valuable classification (inactive, chronic, acute). Each of the three groups differed in the number of bloody stools. The acute inflammatory process was characterized by the high numbers of bowel movements, mucus and bloody mucus defecation, bowel movements at night, and haematocrit values suggesting anaemia. The serum iron levels in the inactive group differed significantly from the levels of both the acute and the chronic groups. The count of thrombocyte and the general well being were found to be valuable only in the differentiation between the acute and the inactive inflammatory processes. The computed haematocrit value proved to be useful in distinguishing the acute stage from the inactive and the chronic process. Out of the 22 variables only 11 had clinical importance in the evaluation of the activity of ulcerative colitis. ]

Lege Artis Medicinae

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NAGY György, ÚJSZÁSZI László, JUHÁSZ László, MINIK Károly

[The epidemiologic data of inflammatory bowel diseases and the clinical aspects of ulcerative colitis and Crohn's disease were evaluated among the 800 000 inhabitants of Borsod County during three decades. Inflammatory bowel disease cases were continuously gathered from all the hospitals in the county. Patients were examined by standard diagnostic criteria. Consultative endoscopic advice, follow-up, and drugs prescription were provided on the wards. Patients' data were systematically registered and summarized. The following data were recorded: the patients' age, sex, ethnic group, urbanization; family prevalence, anatomical extension, type of course, severity of disease, and the occurance of malignant transformation. The authors registered 913 patients with inflammatory bowel disease, in the 10 hospitals of Borsod County between 1963 and 1992. 488 cases of ulcerative colitis were detected during the first twenty years, which is an incidence rate of 3.1/ 100,000 per year. The incidence during the third decade was 3.6/100,000 per year. 69 patients with Crohn's disease were examined during the first 20 years, and 78 in the third decade. The incidence of ileocolonal Crohn's disease increased from 0.43 to 1.00/100,000 per year. The authors didn't find a significant change in anatomical extension, severity or the clinical course of ulcerative colitis during the three decades. The increase of Crohn's diseases, and especially of isolated colonic types, may reflect improved diagnostic techniques. The incidence of inflammatory bowel disease increased among gypsies, but the incidence in that population was still only half of what was expected in the region. The authors found familial inflammatory bowel disease occurrence in 15 patients. Eight carcinomas were observed in the 766 ulcerative colitis patients, and 2 in the 147 Crohn's disease patients. ]