Hemorrhagic Rectocolitis Research Articles

ASSOCIATION DE GRANULOMATOSE EOSINOPHILIQUE AVEC POLYANGEITEAVEC RECTOCOLITE HEMORRAGIQUE: A PROPOS DUN CAS

Eosinophilic granulomatosis with polyangiitis (EGPA) is a necrotizing vasculitis of small vessels, which is part of the anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitides. It evolves through a prodromal phase characterized by allergic manifestations, followed by blood and tissue hypereosinophilia contributing to visceral infiltration. Finally, the necrotizing vasculitis phase explains the systemic manifestations occurring several years after the prodromal phase. Hemorrhagic rectocolitis (UC) belongs to the chronic inflammatory bowel diseases (IBD).the inflammation typically begins in the rectum and spreads proximally and continuously to affect a variable extent of the colon. It most often evolves in flare-ups interspersed with remissions.The coexistence of ANCA-associated vasculitis and IBD is a rare condition that is rarely described in the literature. We report a new case of association of IBD and GEPA.

Acquired hemophilia associated with vedolizumab in a patient with hemorrhagic rectocolitis.

Acquired hemophilia associated with vedolizumab in a patient with hemorrhagic rectocolitis.

Coexistence of Small Bowel Adenocarcinoma and Chronic Inflammatory Bowel Disease (IBD): Case Report and Review of the Literature

Small bowel tumors are rare, rating between 1% and 6% of all gastrointestinal tumors [1]. The association of small bowel tumor is reported in Crohn's disease (CD) [2]. We report a case of a 40-year-old female patient with a history of Hemorrhagic Recto-colitis admitted for an occlusive small bowel tumor, treated by a carcinologic resection.

STRANGE CARDIAC COMPLICATION AFTER MEDIAN EVENTRATION SURGERY

A 51-year old patient comes to the hospital complaining of 20-30 bowel movements every day andabdominal pain following the introduction of a new medication for his cardiological problems(notable aspirin). His relevant medical history shows antecedents of hemorrhagic recto-colitis,non-stented coronaropathy, and a colectomy performed more than 10 years before. The diagnosiswas simple to make following laboratory, imagistic and clinical investigations – pouchitis andmedian eventrations following the prior surgery. The real problem appeared the next day followinghis eventration cure – cardiac tamponade in the context of antiplatelet medication. The patient wassuccessfully managed by the cardiothoracic surgeons. An intracardiac foreign body was found andeliminated during the intervention. Taking into consideration the fact that the patient had beentaking antiplatelet medication for almost a month, it is very likely that the foreign body hadmigrated there during or after the corrective surgical procedure for the eventration and created thehemopericardium in this particular context.

Association of Chronic Inflammatory Bowel Diseases and Celiac Disease

The association of celiac disease with inflammatory bowel diseases is rare. It was basically described as clinical cases. This is usually a hemorrhagic recto colitis. The purpose of our study is to assess the prevalence of CD in patients with IBD and to describe the topographic and phenotypic and progressive features of IBD in patients with CD. We report a new observation.

Therapy Side Effects in Systemic Lupus Erythematosus.

Glucosteroids (GS) are widely used drugs for various inflammatory pathologies (Nephrotic syndrome, Proliferative glomerulonephritis, Extramembrane glomerulonephritis, Nephropathy of the Nodous Poliarterita (PAN), Nephropathy from purple Henoch-Schonlein, lupus nephropathy (LN), Acute adrenal insufficiency Waterhouse-Friederichsen, Chronic adrenal insufficiency Addison, Systemic Lupus Erythematosus (SLE), Polymyositis and dermatomyositis, Chronic granulomatosis, Crohn's disease, Hemorrhagic rectocolitis, Hemolytic anemias, Acute leukemias and chronic lymphocytic leukemia, Hodgkin's lymphoma). Although they are prescribed for their anti-inflammatory and immunosuppressive properties, they also have many side effects, hyperglycemia being one of the most common and representative, which is why these drugs need careful monitoring when administered over the long term. This paper presents the case of a 39 year old patient diagnosed with systemic lupus erythematosus (SLE) with class IV lupus nephropathy (LN) who developed numerous complications due to the pathogenic side effects: diabetes, amenorrhea, recurrent infections, and depression.

Robotic Laparoscopic Pyeloplasty

We aimed to assess the feasibility and outcomes of complex ureteropelvic junction obstruction cases submitted to robotic-assisted laparoscopic pyeloplasty. The records of 131 consecutive patients who underwent robotic-assisted laparoscopic pyeloplasty were reviewed. Of this initial population of cases, 17 were considered complex, consisting of either atypical anatomy (horseshoe kidneys in 3 patients) or previous ureteropelvic junction obstruction management (14 patients). The patients were divided into 2 groups: primary pyeloplasty (group 1) and complex cases (group 2). The mean operative time was 117.3 ± 33.5 minutes in group 1 and 153.5 ± 31.1 minutes in group 2 (P = .002). The median hospital stay was 5.19 ± 1.66 days in group 1 and 5.90 ± 2.33 days in group 2 (P = .326). The surgical findings included 53 crossing vessels in group 1 and 5 in group 2. One patient in group 1 required conversion to open surgery because of technical difficulties. One patient in group 2, with a history of hemorrhagic rectocolitis, presented with peritonitis postoperatively due to a small colonic injury. A secondary procedure was performed after the patient had an uneventful recovery. At 3 months, significant improvement (clinical and radiologic) was present in 93% of cases in group 1 and 88.2% in group 2. At 1 year, all patients in group 2 showed satisfactory results. At a late follow-up visit, 1 patient in group 1 presented with a recurrent obstruction. Robotic pyeloplasty appear to be feasible and effective, showing a consistent success rate even in complex situations. Particular care should be observed during the colon dissection in patients with previous colonic pathology.

Étude pharmacologique et pharmacogénétique de deux immunomodulateurs : l’azathioprine et la 6-mercaptopurine. Stratégies de prévention des complications

Thiopurines are frequently used in gastroenterology for Crohn's disease or hemorrhagic rectocolitis. Their metabolism is regulated by a particular enzyme, thiopurine S-methyltransferase or TPMT. There are three ways to evaluate the effectiveness and the risk of side effects associated with this treatment. TPMT activity measurement or genotyping are recommended to decide for treatment, while metabolites determination is a used as marker of monitoring. Phenotypic approach (TPMT activity measurement or metabolites determination) requires delicate techniques and interindividual variations make the interpretation difficult. Genotyping is easier to interpret but cannot exclude some risk of side effects.

Quels sont les risques à ne pas traiter intensivement une maladie inflammatoire chronique ?

With more than 10 years of experience in rheumatology and thousands of patients treated, the infectious and oncological risks of TNF-alpha blocking agents are well known. The efficacy of biotherapies in rheumatismal diseases has been largely demonstrated. The recent review of publications and communications shows that biotherapies benefit the comorbidities associated with inflammatory rheumatisms (uveitis, Crohn disease, hemorrhagic rectocolitis, stroke, myocardial infarction). They can even reduce the excess mortality of chronic rheumatoid inflammatory diseases.

Traitement des maladies inflammatoires chroniques de l’intestin

The same drugs are used to treat hemorrhagic rectocolitis (HRC) and Crohn's disease (CD), although the aims are very different. Aminosalicylates are highly beneficial in HRC but virtually ineffective in CD, a disease in which immunosuppressants are more useful. Aminosalicylates exert their antiinflammatory effect directly on the lesions. Various oral and rectal preparations have been developed in order to deliver the active molecule to the intestinal target segment. These drugs are now known to act by stimulating the nuclear receptor PPAR-gamma, and this knowledge should help with the development of new agents. Chronic aminosalicylate treatment appears to diminish the risk of malignant transformation. Systemic steroids are still the mainstay of treatment for exacerbations of HRC and CD, yielding remissions in 60 to 90% of cases. In contrast, systemic steroids should not be used for maintenance therapy. Budesonide is a preparation that selectively releases steroids in the ileocolonic region, thereby reducing systemic adverse effects. Immunosuppressants such as azathioprine and 6-mercaptopurine, and also methotrexate in some cases, are used for maintenance therapy of steroid-dependent and highly recurrent forms. These drugs stabilize the disease in about half the patients who receive them. Treatment typically lasts several years and necessitates regular monitoring, especially of hematological status. Cyclosporine is used intravenously in severe HRC. Infliximab (RemicadeR), a chimeric monoclonal antibody targeting TNF is effective in acute forms and as maintenance therapy for CD. It was also recently shown to be effective in HRC. Infliximab is indicated in steroid-resistant forms and contraindicated in patients with latent systemic infections (tuberculosis, hepatitis B) and heart failure. Artificial nutrition is now only used in children with acute forms, in order to avoid the need for steroids. Probiotics might have a place in maintenance treatment of HRC. Surgical treatment of HRC consists of colectomy or, more radically, ileoprotectomy followed by ileoanal anastomosis with resection: however, the likely benefits and potential complications (especially nocturnal diarrhea) must be carefully weighed up. Surgical treatment of CD consists of resecting the worst-affected segments. As available medical and surgical treatments can only control these diseases, without curing them, patient management must be planned on a long-term basis. Control of exacerbations is judged on the basis of clinical parameters and biological markers of inflammation, rather than on lesion healing. The choice of maintenance therapy depends on the nature of the disease (HRC or CD) and its progressive nature. Surgery is reserved for patients with complicated and drug-resistant forms.

Kaposi's sarcoma confined to the colorectum: A case report

Reported is a new case of a Kaposi's sarcoma involving only the colorectal area in an HIV-negative patient presenting with hemorrhagic rectocolitis. The colonoscopic examination and the radiological imaging showed the presence of multiple nodular pseudopolypoid formations in the rectum, which suggested, in the differential diagnosis, primarily a malignant non-Hodgkin lymphoma.

Hidden damage revealed.

Nonsteroidal anti-inflammatory drug (NSAID)-induced gastrointestinal lesions should be suspected when a patient receiving NSAID therapy has pain or signs of hemorrhage that are severe enough to warrant an emergency endoscopy. However, with endoscopy, patients receiving NSAID therapy with no particular gastrointestinal symptoms may also be found to have lesions. These lesions are polymorphic in character and lack clear anatomic and clinical parallels with spontaneous lesions. Endoscopically, they are of three types: (1) Advanced focal or diffuse lesions, uncommon and not usually seen in ambulatory patients; (2) large or diffuse, ulcerated or hemorrhagic lesions, that can be differentiated from those seen in typical digestive system pathology; and (3) microlesions, often responsible for false-negative examinations and now detectable through advances in electronic endoscopy. Lower bowel or ileocolonic damage is also a common finding but has only recently come to clinical attention. The endoscopic appearance of these intestinal lesions suggests a superficial inflammatory bowel disease such as hemorrhagic rectocolitis or Crohn's disease.

Favorable effect of trimethoprim-sulfonamide (Eusaprim) in a case of hemorrhagic rectocolitis

SummaryA 36 years-old man, suffering since more than ten years from a severe hemorrhagic recto-colitis (ulcerative colitis) experienced a bad relapse at the beginning of 1972. Treatment with Salazopyrin (Azulfidin) and ACTH proved of no avail. Because of a white cell count of 14,200 it was decided to resort to an anti-infectious therapy : Trimethoprim-sulfamide (Eusaprim) was given in daily amounts of 4 tablets for one week ; afterwards the daily dose was reduced to 2 tablets. Results were spectacular : within three days the diarrhea ceased ant there occurred only a minimal passage of blood after bowel movements. The left colon was no longer tender. Within the next five months the body-weight increased with 6 Kg.

Cryptogenetic Recto-colitis (Hemorrhagic and Purulent Recto-colitis and Ulcerous Colitis)

Cryptogenetic Recto-colitis (Hemorrhagic and Purulent Recto-colitis and Ulcerous Colitis)

Contribution to the Study of Uremic Hemorrhagic Rectocolitis

Contribution to the Study of Uremic Hemorrhagic Rectocolitis