Cat scratch colon.

BACKGROUND: Bright red linear marks in the right colon are occasionally seen but have never been described in the medical literature. We have termed this finding "cat scratch" colon. METHODS: This was a prospective examination of 8277 colonoscopies at a single endoscopy center in a private practice setting. All cases of cat scratch colon were biopsied, and the results read by two pathologists. RESULTS: A total of 21 cases of cat scratch colon were identified, all in the ascending colon and cecum, with a prevalence of 0.25%. The majority of cases were in women. Although the colon was histologically normal in most cases, there was a significantly higher proportion of collagenous colitis in patients with cat scratch colon compared with the total cohort (14% vs. 0.15%). CONCLUSIONS: The prevalence of bright red linear markings (cat scratch colon) in the cecum and ascending colon is 0.25%. These markings appear to be superficial breaks in the mucosa possibly secondary to barotrauma. Patients tend to be older women with higher proportion of collagenous colitis.

Human leukocyte antigen class II alleles in Caucasian women with primary biliary cirrhosis.

In the current study, we investigated human leukocyte antigen (HLA) class II alleles in Caucasian women with primary biliary cirrhosis (PBC), a disease that preferentially affects women. Alleles of DRB1, DQA1, and DQB1 were determined by DNA-based HLA typing for women with PBC (n = 72) and healthy women (n = 381). All study subjects were Caucasian. HLA DRB1*08 was significantly increased in women with PBC compared to healthy women. The increase was primarily due to the DRB1*0801 allele, also the most common DRB1*08 allele among controls. DQB1*04 and DQA1*0401 were significantly increased. DRB1*1501, DQA1*0102, and DQB1*0602 were associated with decreased risk. Analyses conducted comparing parous women with PBC to parous healthy women (n = 68 and n = 282, respectively) yielded similar significant results. Although the DRB1*08-DQA1*0401-DQB1*04 haplotype was significantly associated with PBC, consistent with other studies, this haplotype nevertheless represented only 19% (14/72) of all PBC patients and can account for only a minority of the risk of PBC.

A randomized, controlled trial to assess a novel colorectal cancer screening strategy: the conversion strategy--a comparison of sequential sigmoidoscopy and colonoscopy with immediate conversion from sigmoidoscopy to colonoscopy in patients with an abnormal screening sigmoidoscopy.

OBJECTIVE: Our study was a randomized, controlled trial to assess a novel strategy that provides comprehensive colorectal cancer screening in a single visit versus traditional sigmoidoscopy and, where appropriate, colonoscopy on a subsequent day. METHODS: Consecutive patients referred for screening were randomized to control or so-called "conversion" groups. Patients in the control group were prepared for sigmoidoscopy with oral phospho-soda. Those with an abnormal sigmoidoscopy were scheduled for colonoscopy on a future day after oral polyethylene glycol preparation. In the conversion group, patients were prepared with oral phosphosoda. Patients with a polyp >5 mm or multiple diminutive polyps were converted from sigmoidoscopy to colonoscopy, allowing comprehensive screening in a single visit. Clinical outcomes were assessed by postprocedure physician and patient questionnaires. RESULTS: Two hundred thirty-five patients were randomized (control = 121, conversion = 114). In the control group, 28% had an indication for colonoscopy. Three of 33 (9%) with an abnormal sigmoidoscopy did not return for colonoscopy. At colonoscopy, 27% had a proximal adenoma. In the conversion group, 28% had an abnormal sigmoidoscopy and underwent conversion to colonoscopy. Forty-one percent undergoing colonoscopy in the conversion group had a proximal adenoma. Physicians reported no differences in preparation or procedure difficulty, whereas patients reported no differences in the level of comfort or overall satisfaction between groups. When queried regarding preferences for future screening, 96% chose the conversion strategy. CONCLUSIONS: The conversion strategy led to similar outcomes compared to traditional screening while improving compliance with colonoscopy in patients with an abnormal sigmoidoscopy.

Immunization.

Immunization is undergoing important changes, with improved vaccines replacing less immunogenic or less safe vaccines, new vaccines for common diseases such as chickenpox and hepatitis A infection, and improved immunization schedules. Immunization is also being transformed by basic work in molecular medicine. Vaccines made of DNA are being developed as a form of gene therapy that use the patient's own cellular machinery to make foreign proteins that stimulate an immune response. Currently immunization is used to protect patients prior to exposure to an infectious agent or during the incubation phase after exposure, but before disease has occurred. New technologies are being investigated to induce the immune system to fight infections that have already produced chronic disease such as acquired immunodeficiency syndrome and chronic hepatitis B virus infection.

Massive secretory diarrhea and pseudo-obstruction as the initial presentation of Crohn's disease.

We report large-volume secretory diarrhea and intestinal pseudo-obstruction in a man whom ultimately proved to have Crohn's disease that responded to sulfasalazine and steroids with resolution of all his symptoms. Although this is an unusual presentation, Crohn's disease should be included in the differential diagnosis in patients whose initial symptoms are intestinal pseudo-obstruction and secretory diarrhea.

Identification of bilirubin UDP-GTs in the human alimentary tract in accordance with the gut as a putative metabolic organ.

The initial identification of traditionally hepatic enzymes expressed in the gut has led to the hypothesis that the gut may function as a metabolic organ. The UDP glucuronosyltransferases (UDP-GTs) play an important role as phase II metabolizing enzymes. Previously members of this family have been identified in the gut by non-isoform specific immunoreactivity, and a small amount of bilirubin glucuronosyltransferase activity was detected in the colon. Recent reports of gut transplantation to reverse the metabolic defect in Gunn rats raised further interest in the expression and distribution of human bilirubin (UDP-GTs (HUG Br 1 and HUG Br 2) in the human alimentary tract. The availability of molecular genetic probes for HUG Br 1 and HUG Br 2 permits the screening of the alimentary tract for the presence of isoform specific message. RNA samples extracted from pinch biopsy specimens of buccal mucosa, esophagus, stomach body, antrum, duodenum, and colon were analyzed for expression of HUG Br 1 and HUG Br 2. HUG Br 1 hybridization was detected in duodenum > colon, whereas HUG Br2 hybridization was detected in duodenum > esophagus > colon. Immunoreactivity data confirmed the presence of HUG Br 1 protein at low levels in the duodenum, whereas the less abundant HUG Br 2 protein was below the limits of detection of isoform specific anti-peptide antibodies. Bilirubin specific reactivity was demonstrated in duodenal samples but not antrum samples, consistent with the molecular genetic data. The presence of functional bilirubin UDP-GT isoforms in human alimentary tract supports the notion that the gut may function as a metabolic organ and may have diagnostic and therapeutic implications for disorders of bilirubin metabolism.

Nicotine effects on prostaglandin-dependent gastric slow wave rhythmicity and antral motility in nonsmokers and smokers.

BACKGROUND & AIMS: Mechanisms of antral hypomotility with smoking are unknown. Slow wave disruption, which may be prostaglandin dependent, inhibits gastric motility. This study tested if nicotine reproduces motor effects of smoking and assessed the role of slow wave disruption in inducing hypomotility and the prostaglandin dependence of dysrhythmic responses. METHODS: Electrogastrography and antroduodenal manometry were performed in 9 nonsmokers and 9 smokers during transdermal nicotine treatment (14 mg). Studies were repeated after administration of 150 mg indomethacin daily for 3 days to test prostaglandin requirements of nicotine responses. RESULTS: Antral migrating motor complex periodicity and fasting and fed motility indices, not different in the groups under control conditions, decreased similarly in nonsmokers and smokers with nicotine. Tachygastria (> 4.5 cycle/min) increased from 2% +/- 2% to 16% +/- 3% of recording time, and arrhythmias (frequency instability index) increased from 0.5 +/- 0.1 to 1.1 +/- 0.2 cycle/min with nicotine in nonsmokers (P < 0.05), which normalized with indomethacin. Electrogastrography results were unchanged in smokers. CONCLUSIONS: Nicotine evokes antral hypomotility in nonsmokers and smokers but evokes prostaglandin-dependent gastric dysrhythmias only in nonsmokers. Smokes show desensitization to nicotine-stimulated dysrhythmias. Thus, slow wave disruption is not essential to inhibit motor activity. This provides a model for the motor and myoelectric effects of smoking.

Effects of smoking on interdigestive gastrointestinal motility.

The effect of smoking on interdigestive gastrointestinal motility is little studied but may play a role in gastrointestinal morbidity. We studied gastroduodenal motility in 10 volunteers (five smokers and five nonsmokers) using a water-perfused pressure catheter. A pH probe was placed in the duodenal bulb. Baseline motility was recorded until phase III of the migrating-motor complex had occurred in the stomach three times in order to record two complete cycles of MMC activity. Subjects then began smoking until phase III activity occurred again (mean duration of smoking 117 min). During the control period, all subjects had normal MMC cycles and there were no differences between smokers and nonsmokers. While smoking, no gastric phase III was observed in any subject and gastric motility was markedly reduced. In seven of 10 subjects, smoking did not prevent the occurrence of normal duodenal phase III activity. Three subjects had no duodenal phase III activity during smoking. The duodenal pH profile did not change during smoking and motilin levels continued to fluctuate in conjunction with phase III activity. In conclusion, smoking abolished phase III activity in the stomach without affecting the plasma motilin cyclic fluctuations or duodenal bulb pH. In contrast, smoking has little effect on duodenal motility.

Misuse of veterinary phenylbutazone.

Phenylbutazone is a nonsteroidal anti-inflammatory drug that was commonly prescribed for the treatment of arthritic conditions; it is no longer available for use in humans because of its numerous side effects, including aplastic anemia. We describe a horse trainer who developed gastric ulcers and renal insufficiency as a result of taking veterinary phenylbutazone. A review of the literature reveals a pattern of abuse by those who work with and around animals. When appropriate, patients who work around animals should be questioned about illicit phenylbutazone consumption.