It has been widely assumed that the activity of ulcerative colitis is related to differences in mucosal appearances seen at sigmoidoscopic examination. We have tested this assumption by making comparisons of the symptoms and clinical signs associated with three reproducible appearances of the rectal mucosa. By cross-tabulating 222 observations of each of 10 symptoms and signs with these sigmoidoscopic appearances it has been shown that the subdivision of hemorrhagic mucosae into those which bleed spontaneously and those which bleed only on light touching or scraping is meaningful clinically. Sigmoidoscopic appearances seemed to correlate better with clinical disease activity than histological assessment, even when quantitative, of mucosal biopsies. On the basis of this study, four variables have been suggested which, in addition to the sigmoidoscopic appearances, could form the basis of regular clinical assessment or scoring.
SUMMARY Serial measurements of 11 serum proteins have been made throughout 39 admissions of 36 patients to hospital for the treatment of acute attacks of ulcerative colitis. There was a striking correlation between rapid changes in C-reactive protein and pre-albumin concentrations and the clinical response to medical treatment. Measurements of the a,-acid glycoprotein, albumin, and total serum protein concentrations at the time of admission were found to correlate with the outcome of the attack. Measurement of these proteins provides a useful guide to the management of patients with attacks of ulcerative colitis.
A randomized controlled trial has been made of corticotropin (ACTH) 80 units given intramuscularly daily and hydrocortisone 400 mg infused intravenously over 24 hours, in the treatment of in-patients with severe proctocolitis. Seven patients were treated with ACTH and nine with hydrocortisone over an initial seven days. Three patients in the ACTH group and six in the hydrocortisone group improved and were discharged on medical treatment. Four patients treated with ACTH and two with hydrocortisone required urgent colectomy during this admission. Plasma cortisol levels were measured, but there was no correlation between these and the observed therapeutic response. Sideeffects were troublesome in both groups but were more marked in those treated with hydrocortisone. It is concluded that ACTH is not intrinsically superior to hydrocortisone in these doses, in the treatment of severe proctocolitis.
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