Rectal Cortisol in the Therapy of Ulcerative Colitis

Schwartz, R. D.

doi:10.1001/archinte.1959.00270080086011

Cited by 14 publications

(2 citation statements)

References 3 publications

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“…Truelove (1956,1958). Schwartz et al (1959), and others achieved a rapid clinical remission by local-that is, rectal-hydrocortisone. According to Truelove (1960) a better result is to be expected in moderate and mild cases from local treatment than from systemic prednisolone therapy.…”

Section: Discussionmentioning

confidence: 99%

Phenylbutazone Suppositories in Treatment of Non-specific Proctitis

Hankiss¹

1961

BMJ

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JOBRfNAL manifest. The problem of the appearance of hypercalciuria at relatively low serum-calcium levels while on treatment with dihydrotachysterol (Litvak et al., 1958) has complicated his management. The second patient, critically ill with parathyroid poisoning, was cured by operation.Possibly this association between parathyroid disorder and steroid-treated ulcerative colitis is purely fortuitous. Against this possibility is a previous report of the appearance of tetany in a patient with ulcerative colitis receiving steroid therapy (Moehlig and Steinbach, 1954). While the hypoparathyroidism might be explained by parathyroid involvenaent in a multisystem disease known to affect the skin, joints, eyes, liver, and kidneys as well as the bowel, the cause of the adenoma formation would remain obscure. Furthermore, one might expect that the steroid therapy which lessens the other manifestations of the disease might prevent parathyroid involvement, but in fact the opposite appeared to be the case.A possible explanation for the association is that in severe long-standing ulcerative colitis calcium stores are reduced either through poor absorption or excessive excretion via the bowel. The use of steroids with their " anti-vitamin D " effect (Anderson et al., 1954) might cause further embarrassment to the already depleted calcium stores. The effect of this might be a need for increased quantities of "para-thor-mone" resulting in either exhaustion, hypoparathyroidism, or adenoma formation. SummaryTwo patients with long-standing ulcerative colitis treated with steroids developed hypoparathyroidism and hyperparathyroidism respectively.Both have fairly active arthritis, even though the first case has had a complete colectomy.The tetany and cramps in the first case became more pronounced after colectomy and have persisted for four years. These symptoms respond to dihydrotachysterol, but he has a low renal threshold for calcium and a persistently positive Sulkowitch reaction in his urine. Furthermore, he has hyperthyroidism controlled by methylthiouracil.The second case, one of hyperparathyroidism, presented with generalized weakness and a phlebothrombosis of his calf veins. He had had an episode of urolithiasis three months prior to admission. His condition deteriorated so rapidly after admission that he had to be subjected to an emergency operation for removal of a parathyroid adenoma, of chief-cell histology, with cure of his hyperparathyroidism.The possible mechanism for this association of parathyroid dysfunction and ulcerative colitis is discussed. Keszthelyi, 1960; Hankiss, 1961). We tried this drug because of its excellent anti-inflammatory effect, and practical experience has supported our theoretical supposition. A rapid remission occurred in the responsive cases. This was similar to the results achieved by local hydrocortisone. The only essential difference was that, in contrast to Truelove's observations, the extent of involvement proved to be of decisive significance in the case of local phenylbutazone tre...

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Section: Discussionmentioning

confidence: 99%

Phenylbutazone Suppositories in Treatment of Non-specific Proctitis

Hankiss¹

1961

BMJ

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“…Sixteen responded with sym ptom atic and proctoscopic im provem ent, two responded sym ptom atically but were considered treatm ent failures because there was no change in the proctoscopic appearance. Three did not respond sym ptom atically or proctoscopically.Encouraged by these results and the reports of others [12,16,17,19], we extended the use of this method of therapy to almost all patients with ulcerative colitis coming under our care.This report details the results of our efforts over a 10-year-period (1953)(1954)(1955)(1956)(1957)(1958)(1959)(1960)(1961)(1962)(1963) w ith 73 patients. …”

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confidence: 85%