Pulse cyclophosphamide therapy for inflammatory bowel disease

AIM:To assess the efficacy of intravenous cyclophos-phamide pulse therapy for refractory inflammatory boweldisease(IBD).METHODS:We included in our cohort eight patientswith(moderate/severe)steroid refractory IBD(4 withulcerative colitis and 4 with Crohn's disease).They allreceived 6 cycles of intravenous cyclophosphamide(800mg)per month.RESULTS:Patients entered into remission after the sec-ond/third cyclophosphamide pulse.Disease activity de-creased.There were no side effects and toxicity.All thepatients went into long lasting remission.All Crohn's diseasepatients and 3 of 4 ulcerative colitis patients achievedcomplete remission.One patient with ulcerative colitisshowed an impressive clinical response but did not enterinto remission.For the maintenance,patients with Crohn'sdisease were treated with methotrexate(15 mg/wk)andpatients with ulcerative colitis were treated with azathio-prine(2.5 mg/kg body weight/d).CONCLUSION:Remission was maintained in all pa-tients for 6 mo on the average.The drug was well toler-ated.These findings suggest that aggressive immuno-suppressive therapy may be useful in some refractorypatients and further controlled study should be consid-ered in order to fully evaluate this type of treatment as apotential therapy for IBD.

Catheter-directed thrombolysis in inflammatory bowel diseases:Report of a case

In patients with inflammatory bowel diseases (IBD) the prevalence of thrombosis is 6.2%, the average incidence of thromboembolism (TE) is 3.6 times higher compared to normal population. The TE is a common extraintestinal complication of IBD, squarely associated with the IBD activity. The application of antico-agulant and thrombolytic therapy in severe IBD is an unresolved issue. Herein we report the first case in literature of an active IBD patient with an upper limb acute arterial occlusion and successful catheter-directed thrombolysis (CDT). A 46-year-old male patient is reported who had Crohn's disease for 10 years. His right hand suddenly became cold and painful. Angiography proved acute occlusion of the brachial and radial artery. Vascular surgery intervention was not applicable. Endoscopy showed extended, severe inflammation of the colon. Despite the severe endoscopic findings, frequent bloody stools and moderate anaemia, CDT with recombinant tissue plasminogen activator was performed. The control angiography proved improvement, the radial artery pulse appeared. No bleeding complication was observed. This case supports that CDT-after careful estimation of the bleeding risk-can be effective and safe in patients with severe or life-threatening TE and active IBD.

Microscopic colitis: A retrospective study of clinical presentation in 53 patients

AIM: To evaluate the relationship between symptoms and microscopic colitis (MC) subtypes: to test whether collagenous colitis (CC) and/or lymphocytic colitis (LC)might be related to both constipation and diarrhea.METHODS: A cohort of patients with independently confirmed typical histopathological changes was investigated. Fifty-three patients with histologically proved MC (46 with CC, 7 with LC) were included. The existence of diarrhea or constipation and the co-existence of autoimmune diseases were also investigated and all data were retrospectively analyzed.RESULTS: Twenty-three (43.39%) of MC patients had chronic constipation (20 in CC, 3 in LC patients). Twentyfour(45.28%) of MC patients had autoimmune disease and the diagnosis of autoimmune disease was always prior to MC. Sjogren's syndrome was associated only with the constipation subgroup.CONCLUSION: The Janus face of MC resembles the subgroups of irritable bowel syndrome. The co-existence of autoimmune diseases and MC is confirmed in both the constipation and diarrhea subgroups.

Pedigree and genetic analysis of a novel mutation carrier patient suffering from hereditary nonpolyposis colorectal cancer

瞄准：屏蔽一个怀疑的匈牙利 HNPCC 家庭发现特定的变化并且在疾病的演讲上评估他们的效果。方法：家庭被使用阿姆斯特丹和 Bethesda 标准识别。Immunohistochemistry 被执行，并且从肿瘤织物孤立的 DNA 样品为微卫星不稳定性被评估。可能的变化的鉴定被定序 hMLH1 和 hMSH2 基因执行。结果：二个不同变化在索引病人并且在他的家庭成员被观察。第一个变化在 7 上位于前， 422 hMSH2 上的鳕鱼，并且上从 Glu 引起了一个变化到站鳕鱼。没有其它这报导一个变化被出版了，根据我们能在国际数据库发现。第二个变化在 127 hMSH2 基因上在 3 鳕鱼上在前被发现，导致毒蛇 --】Ser 替换。第二个变化已经被出版，作为一个非病原的突变而产生之遗传的变化。结论：家谱分析建议在 7 hMSH2 基因上的前的最新检测的胡说八道变化可能为结肠癌的发展负责。没在 7 变化上的前的家庭成员结合这个错误感觉变化，结肠癌出现在 40 岁以后。这二个变化的协会似乎是疾病的表明的年龄到减少进早三十。