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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A case report of subacute, reversible ischemic colitis associated with use of oral contraceptives (OCs) is reported. A 19-year-old woman was admitted to the hospital with chief complaints of abdominal cramps, nausea, vomiting, diarrhea, and rectal bleeding of 2 days' duration. Past medical history and family history were noncontributory. The patient was receiving no medication other than Norinyl 2 (2 mg of norethindrone and .1 mg of mestranol), which she had been taking for 6 months. 2 days before admission the patient had taken 100 mg of dimenhydrinate and 2 ExLax tablets (90 mg of phenolphthalein) for constipation. Colonic roentgenograms revealed impaired mesenteric circulation and bowel ischemia; OC-induced ischemic bowel disease was diagnosed. Patient symptoms subsided within 96 hours of discontinuing the OC and initiating supportive therapy (including intravenous fluid infusion, nasogastric suction, analgesics, and antiemetics). When a repeat barium enema was performed, it showed resolution of the ischemia. In a short review following the case report, these drugs were indicted in causation of colitis-like syndrome: amoxicillin, ampicillin, cephazolin, chloramphenicol, chlorpropamide, clindamycin, cloxacillin, cotrimoxasole, cyclophosphamide, digitalis, ergotamine tartrate, flucytosine, fluorouracil, gold salts, laxative and cathartic abuse, mercurous chloride, methyldopa, penicillin V, and tetracycline. Ischemic bowel disease secondary to OC use is a rare but important complication because of its significant morbidity and potential mortality, and because of the widespread use of the drugs. The case report emphasizes the need to consider the differential diagnosis of acute vascular insult with bowel ischemia when acute abdominal pain progressing to bloody diarrhea occurs in young women taking OCs.
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PMID:Oral contraceptive-induced ischemic bowel disease. 48 72

Myxedema megacolon is rare; usually, it manifests with abdominal distention, flatulence, and constipation. Herein we describe a 72-year-old man who had intermittent diarrhea, bloating, and abdominal pain for more than a year. Cultures of stool specimens for Clostridium difficile enterotoxin were variably positive and negative. Colonoscopic biopsy specimens were thought to be consistent with chronic ischemia. Thyroid function tests showed severe hypothyroidism; the patient's symptoms resolved with thyroid hormone replacement. We hypothesize that gross dilatation of the colon, attributed to myxedema, was followed by intestinal ischemia and complicated by recurrent episodes of pseudomembranous colitis. A review of the relevant literature is provided. This unusual manifestation of myxedema should be considered in the differential diagnosis when a patient has diarrhea, bloating, and abdominal pain.
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PMID:An unusual case of myxedema megacolon with features of ischemic and pseudomembranous colitis. 154 53

Analysis of 14 cases of stercoral ulcer showed that they tended to occur in patients over 70 years of age and associated diseases included heart failure under hemodialysis, cerebral hemorrhage, and postoperative states requiring bet rest for long duration. Constipation is always preceded the occurrence of the disease, and the initial symptoms was generally massive hematochezia of sudden onset. Massive blood transfusion was often required, however, heater probe hemostasis was effective. The most common site of involvement was the rectum, and the shape of ulcer was irregular or round. Measurement of the mucosal blood flow in the rectum revealed that blood perfusion was markedly reduced immediately after the occurrence, and that it recovered with healing of ulcer. Ischemia was considered to participate in the pathogenesis of the disease.
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PMID:[Clinical investigation of stercoral ulcer]. 207 57

Stenosis of the rectum after surgery is a rare complication of low anastomosis. Infection, ischemia, foreign body reaction, technical faults or recurrence of neoplasms are the most important causes. Dilatation is attempted either manually or by instrument, if the stenosis causes discomfort and in particular if diarrhea results. Rarely resection of the stenosed segment is necessary. Stenosis in conjunction with incontinence is the most feared complication of anorectal surgery. It develops exceptionally after scarring of a large mucocutaneous defect after hemorrhoidectomy, correction of an anal fistula, a mucosal prolapse, electro-resection, infection or trauma. Anal stenosis leads to increasing constipation, a reduction of stool volume, abdominal cramps and rectal bleeding.
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PMID:[Postoperative anorectal stenosis]. 236 80

Recombinant gamma interferon (r-GIFN) demonstrates in vitro and in vivo characteristics that contrast with those of alpha and beta interferons. It has relatively weak antiviral properties, yet relatively potent immunomodulatory effects. A phase I trial was performed with r-GIFN (specific activity 2.6 X 10(6) IU/mg protein), administered as a continuous intravenous (IV) infusion over 24 hours for five days (Cl X 5) and repeated every 28 days. This schedule was chosen based on the short half-life of r-GIFN in animal systems and the in vitro augmentation of biologic effects with continuous exposure to interferons. Twenty-one patients with refractory solid tumors received 46 evaluable courses of therapy. The dose-limiting toxicities included fever, flu-like symptoms, cardiovascular toxicity, and neurotoxicity. The cardiovascular toxicity included hypotension and one episode of cardiac ischemia with chest pain. Neurotoxicity consisted of lethargy and confusion. These toxicities were reversible, and although dose-limiting, occurred sporadically throughout all dosage levels. Mild to moderately severe non-dose-limiting toxicities included nausea and vomiting, leukopenia, and liver function abnormalities. Other infrequent toxicities included hypocalcemia, diarrhea, constipation, and alopecia. The maximally tolerated dose of r-GIFN on this schedule is 0.5 X 10(6) IU/m2/d. Partial responses were seen in one patient with metastatic melanoma and in one patient with renal cell carcinoma. Toxicity and antitumor activity were seen at doses where interferon serum levels could not be detected by radioimmunoassay. In addition, the toxicity and antitumor activity seen were at much lower doses than previously described for shorter infusion schedules of other recombinant gamma interferon preparations. Differences in biologic activity of interferon preparations and/or differences in scheduling may account for this variability. Although this study defines a recommended phase II dose of r-GIFN based on the maximally tolerated dose, the optimal therapeutic index may exist at a lower dosage level.
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PMID:A phase I clinical trial of recombinant DNA gamma interferon. 310 84

Necrosis of the cecum occurs in various settings, including low-flow states. Cecal necrosis in two dialysis patients with documented, sustained hypotension is presented. Spontaneous left colon perforations, which have been previously reported in renal failure patients, were considered secondary to distention from constipation. The cecum may be more susceptible to ischemia than the remainder of the colon. Maximal distention develops at this point. With an associated low-flow state, in a possible watershed area, necrosis can occur. The diagnosis of cecal necrosis and perforation should be entertained in any dialysis patient with an acute abdomen. Early exploration may be necessary.
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PMID:Cecal necrosis in the dialysis-dependent patient. 406 55

Besides classical necrotizing enterocolitis (in neonates), which is seen in India as elsewhere in the world, we observe sporadic cases of tropical enterocolitis, i.e. segmental jejunitis, ileitis or colitis and rarely duodenitis. This is a distinct clinico-pathological entity presenting as "acute abdomen", with pain, bilious vomiting, constipation or bloody diarrhoea. The clinical course is not as fulminating as neonatal necrotizing enterocolitis. Most cases are salvaged by conservative treatment especially after the confidence brought by laparoscopic vision of the abdomen, thus excluding perforation or gangrene of the bowel involved. Without laparoscopy, most of the cases end up in laparotomy. The pathology appears to be a kind of local hyperimmune reaction in the segment of bowel involved, ranging from punctate haemorrhages in the seromuscular layer of the bowel to a generalized red fiery look or perforation due to mucosal ulceration. Whatever the causative agent, the pathogenesis is of local vasculitis leading to ischemia and various patterns of disease.
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PMID:Tropical enterocolitis in children. 808 96

A segmental necrosis of the ascending colon sometimes affecting the terminal ileum was observed 13 times in 12 end-stage renal disease patients over a 5400 patient-years observation period. In all but three cases the patient was operated within 24 h of onset of the abdominal pain. Three patients had a bowel perforation; nine had a limited intestinal necrosis. All underwent a partial resection or colectomy. Two died within 1 month. In all cases the mucosa was necrotic, the submucosa small vessels were congested and the mesenteric vessels were normal. Ischaemic bowel disease has been previously reported in uraemic patients, but our cases do not fit with the usual reported features of this complication. The absence of typical mesenteric infarction, vascular thrombosis, stenosis or major atherosclerotic lesions is surprising. The ascending colon topography of the lesions is very unusual. Ischaemia, constipation and other factors may play a role.
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PMID:Segmental necrosis of ascending colon in haemodialysis patients. 891 53

The following article contains a short review on gastrointestinal problems of the elderly. The diseases of the esophagus occurring in the elderly are not much different from those in younger patients. Clinically relevant in the stomach are above all bleeding ulcerations and the gastric carcinoma occurring more frequently in advanced age. The pyogenic liver abscess is diagnosed primarily in the elderly and is at a rule the consequence of an infection of the gall bladder and other abdominal sites. The hepatocellular carcinoma does not grow rapidly in the elderly, but its accompanying unfavourable survival rate at five years is also approximately 5 per cent. In the case of symptomatic cholelithiasis, older high risk patients do especially profit from minimally invasive laparoscopic surgical procedures. Today, bile duct calculi are preferably treated by endoscopic papillotomy and following extraction of the calculi. The pancreas is subjected to atrophy, lipomatosis and fibrosis at the advanced age. However, these changes are rarely of clinical relevance. A frequent problem in clinical practice is that of constipation, from which 35% of patients suffer above the age of 65 years. Another typical symptom of the elderly is the incontinence, the different causes are being discussed. In advanced age, gastrointestinal hemorrhages are mostly occurring above the Treitz's ligament. Hemorrhages of the lower gastrointestinal tract occur mostly in the form of diverticle bleedings and those of angiodysplasias in the elderly. The diverticulosis is also a disease observed in over 50 per cent of patients above 70 years, but it is symptomatic in only part of the patients. When suspecting an inflammatory bowel disease in the elderly, the possibility of a mesenterial ischemia must always be considered as differential diagnosis. The classical chronic inflammatory bowel diseases can, however, also occur at advanced age. The colon carcinoma is one of the most frequent lethal causes in the Western countries 90 per cent of the cases of colon carcinoma are found in patients older than 50 years of age. Intensive attention is therefore required in this age group.
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PMID:[Gastrointestinal problems in elderly patients]. 933 52

The term "obstructive colitis" is defined by the presence of ulcero-inflammatory lesions in a colonic area proximal to a potentially obstructive lesion. Seven cases retrospectively identified during a 5-year period are here reported. They illustrate the clinico-pathological spectrum of this entity. Most patients were women, with a mean age of 66 years and with history of chronic underlying disease (diabetes mellitus and arterial hypertension). Abdominal distension and pain, as well as acute constipation were the main clinical symptoms. An adenocarcinoma predominantly located at the rectosigmoidal region accounted for the obstructive nature in 100% of cases. Macroscopically the colitis area was moderately dilated and there were single or confluent ulcers in the luminal surface. Characteristically, there was always a transitional preserved area between the obstruction and the colitis area. Microscopically, the mucosa was totally replaced by a granulation tissue with a relevant inflammatory infiltrate involving up to the muscularis propria. The cytometric study revealed and increase in the cell cycle (S-phase) and proliferation index, at the level of the obstructive lesion, with marked aneuploidy in cases with advanced neoplastic invasion. The role of mural hypoperfusion with localized ischemia in the pathogenesis is discussed. The similarities with other colonic inflammatory diseases are emphasized.
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PMID:[Obstructive colitis: analysis of 7 patients]. 958 36


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