No abstract

No abstract

The successful use of topical steroid therapy for diseases of the skin. eye. and joints has led us to evaluate the effect of cortisol by rectum in iodiopathic ulcerative colitis. Truelove ( 1 ) and Allodi and lluratori ( 2 ) almost simultaneously reported good clinical results with cortisol enemas. but whether this was the result of systemic absorption of the steroid or a purely local effect was undetermined. Our experience with the clinical efficacy of this form of treatment will be reported in detail elsewhere: the present study is concerned with the absorption of rectally administered cortisol in ulcerative colitis.Jlcthods. A. Mode of -4dininistration: Patients with ulcerative colitis of one to 4 years' duration, proven by sigmoidoscopy and x-ray. received daily enemas at about 1O:OO a.m. of 100 cc. of normal saline for a period of 7 to 10 days prior to the administration of cortisol by rectum. After this control period. 200 mg of cortisol (hemisuccinate-sodium ) dissolved in 100 cc of normal saline was administered as a rectal enema for a 20-minute period, at the rate of 3-5 ml per minute from an infusion bottle. Daily therapy with the steroid was continued for 2 weeks. Three patients received cortisol-4-CI4 in a dose of 4!400,000 counts per minute (494 pg) as a tracer dose added to the 200 mg carrier cortisol.B. Blood samples were obtained a t 0, %, 1 , 2 , 4, 6, and 24 hours after the administration of saline and cortisol enemas. The levels of plasma cortisol were measured quantitatively in duplicate on the initial day of therapy by the method of Bondy, et a L ( 3 ) and the presence of conjugated steroids was determined by the method of Cohn and Bondy (in preparation). In these experiments where cortisol-4-C14 was employed conjugated steroids were initially separated by paper electrophoresis of a butanol extract of plasma. The conjugated steroids were eluted with 70% methanol taken to dryness in vacuo and counted as the total conjugated glucuronide fraction in a gas flow windowless counter, shielded by steel, with a background of 1.8-2 .O counts/minute. Unconjugatd cortisol-4-C" was counted in a liquid phosphor scintillation counter (TMC Model LP-2).Results. Table 1 illustrates the plasma TA\T:T,E I. Pl:imn 1,cvels of Cortisol.