Changes In Ulcerative Colitis Research Articles

The value of electron microscope studies in diagnosing malignant change in ulcerative colitis.

Ultrastructural and histological appearances were studied in normal rectal and colonic mucosa, in the mucosa immediately adjacent to neoplasms (transitional mucosa), in neoplasms themselves, and in ulcerative colitis to try to determine whether any changes found in colitis might be recognized as premalignant. Two of the ulcerative colitis specimens showed histological evidence of premalignant change and these changes were reflected at the ultrastructural level. No electron microscopical premalignant changes were found which could not more easily be detected by simple histology, and it is concluded that attempts to detect premalignant changes in ulcerative colitis using electron microscopical techniques are likely to be unrewarding.

Early roentgen manifestations of mild ulcerative colitis and proctitis.

Proctocolitis has been defined as an inflammatory condition of the rectal mucosa in which there are: a clear upper limit beyond which the mucosa is normal, failure to identify a specific cause for the inflammation, and a normal colon on x-ray examination (12). The concept that roentgen examination of the colon is of little assistance in the diagnosis of early changes in ulcerative colitis is well established. In a series reported by Ricketts, Kirsner, and Palmer (15), for example, the barium-enema examination was reported as normal in 60 of 150 patients. The purpose of this report is to indicate that careful study of an apparently normal, routine colon examination in most cases would reveal minor but definite variations from normal, indicative of inflammatory changes in the mucosa. Selection of Patients The method of selection of cases for this investigation has been described in detail (18) and will be mentioned only briefly. The records of 1,181 patients with unequivocal symptoms and proctoscopic evidence of ulcerative colitis were reviewed. The cases in which colon examinations were reported as either normal or with involvement of the rectosigmoid region only were selected for further study, the films of 292 patients being available for such a review. On the basis of combined roentgen and proctoscopic findings, 45 of these patients were considered to have ulcerative proctitis. This report is based on the findings, radiographic and proctoscopic, in these 45 patients. Technic of Colon Examination At the University of Chicago Medica Center, the patient is prepared for roentgen examination of the colon in the following manner. On the day prior to examination, 60 cc of castor oil is administered at noon and no solid food is permitted subsequently. The patient also is instructed to take nothing by mouth after midnight on the evening before the examination. Thorough cleansing of the bowel is essential, and in our experience the administration of castor oil to patients with mild ulcerative colitis and ulcerative proctitis has not produced an exacerbation of the disease. Most patients are examined with a conventional filling and evacuation technic. Prior to 1958, lateral films of the rectum were not obtained routinely. Since that time, this projection has been considered an essential part of the examination and always has been included. Films made on the filming fluoroscope of the sigmoid, splenic and hepatic flexures, and the ileocecal region are also obtained. After this, a prone film of the filled colon and, later, a post-evacuation film are taken. Occasionally, a double-contrast examination is performed, usually following the routine examination. The stock barium solution contains barium sulfate 46 per cent by weight, sodium earboxymethylcellulose 0.75 per cent, methylparaben 0.05 per cent as preservative, and one part per million anti-foam. Tannic acid has never been used.

Hepatic Histological Changes in Ulcerative Colitis.

Operative liver biopsy was performed on 58 consecutive patients coming to radical excisional surgery for ulcerative colitis. The histological changes seen in the liver were: increased cellularity of the portal tracts (83 per cent); fatty infiltration (83 per cent); areas of focal necrosis (47 per cent); and early cirrhosis (2 per cent). Severe liver damage was shown to he associated with severe active colitis, and with a poor subsequent post-operative prognosis. The mechanisms responsible for liver damage in patients with colitis are discussed.

Immunological Changes in Ulcerative Colitis

Immunological Changes in Ulcerative Colitis

Early pathologic changes in ulcerative colitis. Their relation to surgical complications

Early pathologic changes in ulcerative colitis. Their relation to surgical complications

Early histological changes in ulcerative colitis

Summary Degeneration of the reticulin fibers of the colonic mucosa and dilation of the subepithelial capillaries are constant and early findings in chronic ulcerative colitis. Later in the course of the disease there is a progressive infiltration of the lamina propria with plasma cells and lymphocytes and, in some cases, with eosinophils and polymorphonuclear cells. Ulceration of the mucosa appears to be directly related to occlusion of the small vessels of the mucosa by platelet agglutination. Anemia in colitis patients may occur in the absence of ulceration by the passage of extravasated red cells through the intact epithelium into the colonic lumen. A possible mechanism for the depletion of reticular collagen in ulcerative colitis is discussed. Steroids do not prevent the changes in collagen which have been observed.

Altered Inflammatory Reaction in Nonspecific Ulcerative Colitis

NONSPECIFIC lONSPECIFIC chronic ulcerative colitis is generally regarded as both a clinical and pathologic entity. However, to define this entity precisely in terms acceptable to most gastroenterologists is quite difficult. So long as the etiology remains unknown and the pathogenesis unclear, observations by experienced physicians of the clincial and pathological changes in ulcerative colitis probably provide the most serviceable guide to its recognition. The present study has involved a histopathologic and cytologic analysis of sigmoidoscopic biopsies taken from individuals with colonic inflammations of varying type and duration, as well as from control cases without inflammation. Among these were a number of patients with ulcerative colitis in different stages of activity or quiescence, similar to those reported by others.^1-7The pathologic data indicate that in the persistent inflammatory reaction of ulcerative colitis the leukocytic sequences ordinarily observed in acute and chronic inflammation are altered. <h3>Materials and Methods</h3> Biopsy specimens were

Early pathologic changes in ulcerative colitis: Their relation to surgical complications

Study of colonic biopsy specimens in early ulcerative colitis has revealed a constant pattern of change in the involved mucosa. Degeneration occurs in the thickened layer of collagen fibrils which lies under the surface epithelium and often progresses to involve the entire pericellular collagen stroma of the lamina propria. The fibroblasts are granular and vacuolated. The small vessels of the mucosa contain reduced numbers of red blood cells, and signs of cellular anoxia appear in the surface epithelium. Early stromal edema gives way to round cell infiltration of the lamina propria. Later in the course of the disease, platelet agglutination occurs in the small mucosal vessels, and the surface capillaries are obliterated. The resulting mucosal infarctions are associated with the accumulation of polymorphonuclear leukocytes, apparently in response to ordinary bacterial invasion of the devitalized mucosa. The agglutination of the intact platelets is usually reversible, but occasionally the platelets break down, with the release of thromboactive materials. This may lead lead to true thrombosis, with enlargement of the areas of mucosal ulceration and the occurrence of pulmonary emboli from areas of pelvic venous thrombosis. The significance of these observations in the surgical management of ulcerative colitis is discussed.

IRREVERSIBLE CHANGES OF ULCERATIVE COLITIS.

IRREVERSIBLE CHANGES OF ULCERATIVE COLITIS.

SMALL-INTESTINAL AND GASTRIC CHANGES IN ULCERATIVE COLITIS: A BIOPSY STUDY.

We decided to make an objective study of the state of the stomach and small intestine in this disease, with special reference to the histological picture as judged by peroral biopsy specimens. In addition to obtaining gastric and small-intestinal specimens, it was our intention to make some studies of small-intestinal function. The full range of tests available for the study of this function takes a considerable time. In dealing with an attack of ulcerative colitis it is essential that treatment be given without undue delay, and, in addition, the patient is often not fit to withstand any disturbing investigation. It has therefore been necessary for us to restrict the tests to one or two which can be carried out in the course of a few days and which do not cause any upset. In the event it has proved possible to estimate the faecal fat excretion and the absorption of vitamin B12 without inconveniencing the patient. Some patients were already on corticosteroid treatment at the time of our studies, but others with first attacks of the disease or with a recent relapse were studied before specific treatment was instituted. The object of this paper is to present the results obtained in a pilot study along the lines just discussed and to consider future possibilities.

Serotonin Content and Argentaffin and Paneth Cell Changes in Ulcerative Colitis

Serotonin Content and Argentaffin and Paneth Cell Changes in Ulcerative Colitis

Malignant change in ulcerative colitis.

1Birmingham, England Read at the meeting of the American Proctologic Society, Pittsburgh, Pennsylvania, June 21 to 24, 1961.

The pathological basis of the radiological changes in ulcerative colitis: a study of cases treated by colectomy.

In ten cases of ulcerative colitis treated by colectomy, the pathological findings in the excised colon have been compared with the findings on barium enema immediately before colectomy, and with the appearance of the barium-filled excised colons. The absence of mucosal haustra was associated with fairly severe submucosal damage. The presence of narrowing was associated with fairly severe submucosal fibrosis, although the converse was not true. A smooth contour may be associated with a normal or abnormal mucosa. The presence of abnormality is indicated by an abnormal after-evacuation surface pattern or, in the presence of more severe damage, absence of mucosal haustra and alteration in calibre. The presence of indentations, particularly when associated with a reticular surface pattern, usually indicated areas of mucosal denudation, between remaining islands of inflamed mucosa, with or without small pseudopolyps. The same appearance may be associated with deeper ulcers into the muscular coat. Large pseudop...