The high rates of both acute hemostasis and recurrent bleeding suggest that Hemospray may be used in high-risk cases as a temporary measure or a bridge toward more definitive therapy.

Our results revealed a 41% positive yield from brushing cytology. The sensitivity of biliary brushing cytology in our center was 61% and the specificity was 98%. Predictors of positive yield include older age, mass size>1 cm, and stricture length of >1 cm.

New crypts are added continuously to the adult mouse intestinal epithelium by a process of crypt replication. Branching crypts found in the epithelium represent a stage in the process of crypt replication. In "normal" human colonic epithelium we found a small but definite percentage of branching crypts, 0.44 +/- 0.16, indicating that new crypts are being produced at a low rate in this epithelium. Significantly higher (P less than .001) percentages of branching crypts, 30.4 +/- 5.75, 15.1 +/- 1.08, and 13.2 +/- 1.05, were found in diseased colonic epithelium from patients with ulcerative colitis, Crohn's disease, and multiple polyposis, respectively. These results may be interpreted as suggesting that the rate of crypt production in human colonic epithelium is increased in a number of disease states. We concluded that, as in the mouse intestinal epithelium, the rate of the crypt replication process in human colonic epithelium is plastic and may respond to a variety of conditions.

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The objective of this study was to determine the effect of human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) on inflammatory bowel disease (IBD). A retrospective survey of the medical records of St. Paul's Hospital and its AIDS-care physicians/gastroenterologists searching for patients with both HIV/AIDS and IBD was conducted. Of 1,839 hospitalized patients (4,459 hospital admissions) from 1989 to 1993, two patients with AIDS/HIV and IBD were found. The physician survey revealed four patients for a total of six patients. Four patients developed de novo IBD--two ulcerative colitis (UC), one Crohn's disease (CrD), and one indeterminate colitis (IC)--after HIV infection. Two patients had UC predating HIV seroconversion. The absolute CD4 count of patients with de novo IBD was 210-700 cells/ml at the time of IBD. The patient with IC maintained quiescent IBD from a CD4 count of 190-30 cells/ml. The other had many relapses before HIV seropositivity. With CD4 count depletion, disease activity improved. IBD medications were discontinued at a CD4 count of 130 cells/ml. Diarrhea returned at a CD4 count of 20 cells/ml; however, sigmoidoscopy was unremarkable, and mucosal biopsy revealed cryptosporidiosis without active UC. No patient had an AIDS-related illness during active IBD. Two patients followed to CD4 counts of < 30 cells/ml suffered AIDS-related infections with quiescent IBD. With a progressive decline in CD4 count, IBD disease activity may improve and remit. The CD4 count at which remission occurs may reflect severe immunodeficiency such that risk for AIDS-related infection is high. Active IBD may occur with lesser degrees of immunodeficiency.