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Alimentary Pharmacology & Therapeutics Dec 1997Mesalazine suppositories at 500 mg b.d. are a safe and effective treatment for patients with ulcerative proctitis or distal proctosigmoiditis. Recently a mesalazine 1 g... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
BACKGROUND
Mesalazine suppositories at 500 mg b.d. are a safe and effective treatment for patients with ulcerative proctitis or distal proctosigmoiditis. Recently a mesalazine 1 g suppository (Pentasa) has been developed.
METHODS
Fifty patients with active ulcerative colitis extending not beyond 20 cm from the anus on sigmoidoscopy, participated in a randomized single-blind study comparing the efficacy, tolerance and acceptance of the new Pentasa mesalazine 1 g suppository, given once daily versus Claversal mesalazine 500 mg suppository b.d.
RESULTS
After 2 weeks, clinical remission was observed in 16 of 25 (64%) in the Pentasa group and in 7 of 25 (28%) in the Claversal 500 mg b.d. treated group; sigmoidoscopic remission occurred in 13 of 25 (52%) in the Pentasa group and in six of 25 (24%) in the Claversal group (P < 0.01). After 4 weeks, clinical and sigmoidoscopic remission were observed, respectively, in 84 and 76% of patients treated with Pentasa suppositories, and in 80 and 72% of patients treated with Claversal suppositories 500 mg b.d. (P = N.S.). The patients' evaluation for tolerability and practicality showed that the Pentasa suppository was significantly superior to the Claversal suppository.
CONCLUSIONS
Pentasa 1 g suppository once daily induces a quicker clinical and sigmoidoscopic remission, and was better tolerated, than the Claversal 500 mg suppository b.d., and it may represent an advance for the topical treatment of distal proctosigmoiditis.
Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Drug Administration Schedule; Female; Humans; Male; Mesalamine; Middle Aged; Patient Satisfaction; Proctitis; Proctocolitis; Single-Blind Method; Suppositories
PubMed: 9663829
DOI: 10.1046/j.1365-2036.1997.00259.x -
Gut Mar 1988Fifty male patients with proctitis were examined and the clinical, microbiological, serological and proctological features compared with 51 known male homosexuals...
Fifty male patients with proctitis were examined and the clinical, microbiological, serological and proctological features compared with 51 known male homosexuals attending the genitourinary (GU) clinic at the same hospital. The homosexuals had a short history of bowel symptoms, minor sigmoidoscopic and histological changes on rectal biopsy and many positive serological markers of sexually transmitted infection. There was some evidence of sexually transmitted disease in the IBD patients and three were homosexuals. IgG antibodies were positive for chlamydia trachomatis (n = 10) and hepatitis A (n = 7). One had a positive screening test for syphilis. Stool examination and rectal swab cultures were positive in two patients for cryptosporidium and cytomegalovirus respectively. Gastroenterologists must be aware of the possibility of specific infection in IBD patients and a clinical history should include sexual preferences and practices. If homosexuality is admitted, specific infection must be sought and excluded.
Topics: Adolescent; Adult; Aged; Antibodies, Anti-Idiotypic; England; Homosexuality; Humans; Immunoglobulin G; Male; Middle Aged; Proctitis; Rectum; Sexually Transmitted Diseases; Sigmoidoscopy
PubMed: 3258576
DOI: 10.1136/gut.29.3.332 -
World Journal of Gastroenterology Aug 2005To investigate the prevalence of advanced polyps in asymptomatic Chinese and to determine the risk of proximal advanced colonic polyps in subjects with and without...
AIM
To investigate the prevalence of advanced polyps in asymptomatic Chinese and to determine the risk of proximal advanced colonic polyps in subjects with and without polyps in the distal colon.
METHODS
Data were collected prospectively during colonoscopic examinations performed in 5 973 subjects as part of health evaluation at our unit from December 1997 to December 2003. Polyps were considered advanced, if they were larger than 10 mm or were tubovillous, villous or malignant. Proximal colon was defined as the splenic flexure and more proximal portions of the colon.
RESULTS
Colon polyps were detected in 971 (16.3%) subjects (613 males and 358 females) with their mean age being 56.6+/-10.7 years. Advanced polyps were noted in 199 (3.3%) individuals. Subjects were sub-classified according to the location of polyps into three groups: distal (569, 58.6%), proximal (284, 29.2%), and combined proximal and distal (118, 12.2%) groups. Subjects with advanced polyps in these three groups were 95 (9.8%), 56 (5.8%), and 48 (4.9%) respectively. In the 48 subjects with advanced combined polyps, 13 advanced polyps were distributed at the distal colon, 17 at the proximal colon, and 18 at both. Eighteen colon cancers including 12 at sigmoid and 6 at ascending colon were confirmed by final pathology. The relative risk for advanced proximal polyp according to distal findings was 3.1 (95%CI: 1.3-7.4) for hyperplastic polyp, 2.7 (95%CI: 1.4-5.3) for tubular polyp and 13.5 (95%CI: 5.1-35.4) for advanced polyp as compared to that for no polyp. However, 56 (28.2%) of 199 subjects with advanced polyps had no index polyps at the distal colon and might go undetected under sigmoidoscopic screening.
CONCLUSION
Although distal lesions can predict the risk of advanced proximal polyps, a substantial portion of Chinese with advanced proximal polyps is not associated with any distal sentinel lesions. These data have implications for screening policy of colon cancers in Taiwanese Chinese.
Topics: Adult; Aged; China; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Female; Humans; Male; Mass Screening; Middle Aged; Risk Factors
PubMed: 16094719
DOI: 10.3748/wjg.v11.i30.4731 -
Case Reports in Women's Health Jun 2023Genital tract trauma and obstetric anal sphincter injuries are known complications of normal vaginal and assisted vaginal delivery. Cervical tears are an uncommon...
Genital tract trauma and obstetric anal sphincter injuries are known complications of normal vaginal and assisted vaginal delivery. Cervical tears are an uncommon complication that can lead to significant postpartum haemorrhage and may have implications for future pregnancies. Careful evaluation of the genital tract, including the cervix, along with adequate resuscitation are essential to reduce maternal morbidity and mortality. This is a case report of a 36-year-old primigravida woman at 41 + 6 weeks of gestation with delay in the second stage requiring Neville Barnes forceps delivery. She then went on to have a major postpartum haemorrhage, initially thought to be a result of uterine atony. However, inadequate response to uterotonics led to identification of a cervical buttonhole tear with an intact external os. She required repair under general anaesthesia. A rigid sigmoidoscope was utilised to ensure cervical canal patency during the repair. Previous reports have described annular cervical tears, thought to occur from the extension of a cervical buttonhole tear, but to the best of our knowledge the latter has not previously been reported. The case demonstrates the importance of awareness of such tears and proposes a novel technique for repair with the use of a rigid sigmoidoscope.
PubMed: 37275570
DOI: 10.1016/j.crwh.2023.e00516 -
Annals of the Royal College of Surgeons... May 2003This study describes the first full year of independent practice by a newly appointed nurse endoscopist in a district general hospital.
INTRODUCTION
This study describes the first full year of independent practice by a newly appointed nurse endoscopist in a district general hospital.
PATIENTS AND METHODS
Patients underwent either 'one stop' flexible sigmoidoscopy and barium enema or flexible sigmoidoscopy alone. Barium enema results, video photography, clinical follow-up, and histology were used to validate the results of the flexible sigmoidoscopy. One stop clinic: 161 endoscopies were performed, with 104 female patients (65%), and a mean age of 64 years. There was one failed endoscopy due to poor bowel preparation. Abnormalities were identified in 84% of endoscopies. Flexible sigmoidoscopy detected abnormalities not seen on the barium enema in 28 cases, all of which were polyps (18%). Barium enema identified one abnormality within reach of the flexible sigmoidoscope not identified at endoscopy (small polyp in sigmoid; 1%). Elective flexible sigmoidoscopy list: 121 endoscopies were performed, with 65 female patients (54%), and a mean age of 59 years. There were two failed endoscopy procedures, both attributed to poor bowel preparation. Two-thirds of patients had an abnormality on investigation. There were no complications in either group of patients.
CONCLUSIONS
The nurse-led endoscopy service has been successfully initiated with a high completion rate for flexible sigmoidoscopies. All significant conditions were identified with 99% sensitivity. Nurse endoscopy is a safe, useful and practical procedure in the setting of this district general hospital.
Topics: Adult; Aged; Aged, 80 and over; Ambulatory Care; Barium Sulfate; Colonic Polyps; Contrast Media; Diverticulum, Colon; Endoscopy, Gastrointestinal; Enema; Female; Follow-Up Studies; Hospitals, District; Humans; Male; Middle Aged; Nurse Practitioners; Prospective Studies; Sigmoid Diseases; Sigmoidoscopy
PubMed: 12831491
DOI: 10.1308/003588403321661343 -
British Journal of Cancer Nov 2001Cancer incidence in the Falkland Islands, 1989-2000, was compared with rates in England and Wales, from which most Islanders originate. Colon and rectum cancer incidence... (Comparative Study)
Comparative Study
Cancer incidence in the Falkland Islands, 1989-2000, was compared with rates in England and Wales, from which most Islanders originate. Colon and rectum cancer incidence was significantly raised 1989-93 but greatly reduced after 1994, when colonoscopic screening in high-risk families and sigmoidoscopic screening in the general population were introduced.
Topics: Colonic Neoplasms; Colonoscopy; England; Epidemiologic Studies; Falkland Islands; Incidence; Mass Screening; Rectal Neoplasms; Risk Factors; Sigmoidoscopy; Wales
PubMed: 11720470
DOI: 10.1054/bjoc.2001.2099 -
BMC Infectious Diseases May 2012Treatment of shigellosis in rabbits with butyrate reduces clinical severity and counteracts the downregulation of cathelicidin (CAP-18) in the large intestinal... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Treatment of shigellosis in rabbits with butyrate reduces clinical severity and counteracts the downregulation of cathelicidin (CAP-18) in the large intestinal epithelia. Here, we aimed to evaluate whether butyrate can be used as an adjunct to antibiotics in the treatment of shigellosis in patients.
METHODS
A randomized, double-blind, placebo-controlled, parallel-group designed clinical trial was conducted. Eighty adult patients with shigellosis were randomized to either the Intervention group (butyrate, n = 40) or the Placebo group (normal saline, n = 40). The Intervention group was given an enema containing sodium butyrate (80 mM), twice daily for 3 days, while the Placebo group received the same dose of normal saline. The primary endpoint of the trial was to assess the efficacy of butyrate in improving clinical, endoscopic and histological features of shigellosis. The secondary endpoint was to study the effect of butyrate on the induction of antimicrobial peptides in the rectum. Clinical outcomes were assessed and concentrations of antimicrobial peptides (LL-37, human beta defensin1 [HBD-1] and human beta defensin 3 [HBD-3]) and pro-inflammatory cytokines (interleukin-1β [IL-1β] and interleukin-8 [IL-8]) were measured in the stool. Sigmoidoscopic and histopathological analyses, and immunostaining of LL-37 in the rectal mucosa were performed in a subgroup of patients.
RESULTS
Compared with placebo, butyrate therapy led to the early reduction of macrophages, pus cells, IL-8 and IL-1β in the stool and improvement in rectal histopathology. Butyrate treatment induced LL-37 expression in the rectal epithelia. Stool concentration of LL-37 remained significantly higher in the Intervention group on days 4 and 7.
CONCLUSION
Adjunct therapy with butyrate during shigellosis led to early reduction of inflammation and enhanced LL-37 expression in the rectal epithelia with prolonged release of LL-37 in the stool.
TRIAL REGISTRATION
ClinicalTrials.gov, NCT00800930.
Topics: Adolescent; Adult; Animals; Anti-Bacterial Agents; Anti-Inflammatory Agents; Butyrates; Clinical Medicine; Double-Blind Method; Drug Therapy, Combination; Dysentery, Bacillary; Endoscopy; Feces; Female; Histocytochemistry; Humans; Male; Middle Aged; Placebos; Rabbits; Treatment Outcome; Young Adult
PubMed: 22574737
DOI: 10.1186/1471-2334-12-111 -
British Medical Journal (Clinical... Nov 1985Olsalazine (azodisalicylate) is a new drug in which two molecules of 5-aminosalicylic acid are linked by an azo bond. Its role in the treatment of mildly active, distal... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
Olsalazine (azodisalicylate) is a new drug in which two molecules of 5-aminosalicylic acid are linked by an azo bond. Its role in the treatment of mildly active, distal ulcerative colitis was investigated. Sixty patients were randomly allocated to receive olsalazine 1 g or a placebo as a retention enema nightly for two weeks. Clinical improvement was seen in 19 (66%) and sigmoidoscopic improvement in 17 (59%) of the 29 patients receiving olsalazine compared with 12 (43%) and 11 (39%), respectively, of the 28 in the control group. These differences were not significant. In a second trial 40 patients were randomised to receive oral olsalazine 2 g daily or a placebo capsule for two weeks. Significant clinical and sigmoidoscopic improvement was seen in the patients receiving oral olsalazine compared with the patients receiving placebo capsules. Oral olsalazine may be valuable in the treatment of mildly active ulcerative colitis. Its role in maintaining remission is yet to be determined.
Topics: Administration, Oral; Adolescent; Adult; Aged; Aminosalicylic Acids; Clinical Trials as Topic; Colitis, Ulcerative; Enema; Female; Humans; Male; Middle Aged; Random Allocation
PubMed: 3933675
DOI: 10.1136/bmj.291.6506.1373 -
Alimentary Pharmacology & Therapeutics Oct 1997Since transdermal nicotine is of value in the treatment of active ulcerative colitis but is often associated with side-effects, an alternative in the form of topical... (Clinical Trial)
Clinical Trial Comparative Study
BACKGROUND
Since transdermal nicotine is of value in the treatment of active ulcerative colitis but is often associated with side-effects, an alternative in the form of topical therapy with nicotine enemas has been developed.
METHODS
In an open study, 22 patients with active colitis, all non-smokers, were asked to take a 100 mL enema containing 6 mg of nicotine every night for 4 weeks. Pre-trial treatment using mesalazine (n = 16), oral prednisolone (8), cyclosporin (1) and azathioprine (1) was kept constant for the month prior to assessment and during the study period. Symptoms, with stool frequency, were recorded on a diary card and an endoscopy was performed with rectal biopsy at the beginning of the study and after 4 weeks.
RESULTS
Seventeen of the 22 patients completed 1 month of treatment. Mean duration of relapse was 29 weeks, range 3-94. Sixteen of 17 improved their St Mark's score. Urgency and stool frequency improved in 12 patients, sigmoidoscopic and histological scores in 10. Three patients had a full remission of symptoms with normal sigmoidoscopy. Six of 10 with a partial response continued with the enemas for a second month and five showed further improvement with full remission in two. The enema appeared effective when added to conventional treatment and produced few side-effects.
CONCLUSION
Topical nicotine therapy for ulcerative colitis may have a place in future management, but controlled studies are needed.
Topics: Adult; Aged; Colitis, Ulcerative; Enema; Female; Humans; Male; Middle Aged; Nicotine; Nicotinic Agonists; Sigmoidoscopy
PubMed: 9354193
DOI: 10.1046/j.1365-2036.1997.00220.x -
BMJ Case Reports May 2019Ileosigmoid knotting (ISK) is a rare cause of intestinal obstruction rapidly progressing to bowel gangrene. It is characterised by the wrapping of loops of ileum and...
Ileosigmoid knotting (ISK) is a rare cause of intestinal obstruction rapidly progressing to bowel gangrene. It is characterised by the wrapping of loops of ileum and sigmoid colon around each other. The condition often remains undiagnosed preoperatively; however, it can be suspected by the triad of small bowel obstruction, radiographic features suggestive of predominately large bowel obstruction and inability to deflate the intestine by a sigmoidoscope. We are reporting a case of 56-year-old man who presented with features of acute intestinal obstruction and compensated shock within 24 hours of onset of symptoms. Exploratory laparotomy revealed ISK resulting in gangrene of ileum and sigmoid colon. In view of haemodynamic instability, end ileostomy was done after excising gangrenous segments. The patient improved and stoma closure and ileocolic anastomosis were done after 3 months in follow-up.
Topics: Acute Disease; Gangrene; Humans; Ileal Diseases; Intestinal Obstruction; Intestinal Volvulus; Male; Middle Aged; Rare Diseases; Shock; Sigmoid Diseases; Treatment Outcome
PubMed: 31151967
DOI: 10.1136/bcr-2018-226663