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Introduction: Despite decades of clinical experience in optimizing the induction and maintenance of remission in patients with ulcerative colitis (UC), some patients remain refractory to conventional medical treatment while, in others, the effectiveness of drugs is limited by side-effects. We investigated factors predictive of the efficacy of cyclosporine and leukocyte removal therapy in patients with intractable UC. Methods: Forty-five patients with moderate to severe UC who were refractory to corticosteroid therapy were enrolled. Twenty-six patients were treated with cyclosporine and 19 by leukocyte removal therapy. Disease activity index (DAI) score assessment, and colonoscopic and histological examinations were done before and at 10, 20 and 40 days after the initiation of treatment. A clinical response to treatment was defined as a decrease in DAI score of 3 points or more at 40 days. Results: Responder ratio did not significantly differ between the cyclosporine (65.6%) and leukocyte removal therapy (63.2%) groups. Factors predictive of a response to cyclosporine therapy were fever (≥ 38.0°C), anemia and large mucosal ulceration. In contrast, mucosal bleeding and poor extensibility of the intestinal lumen were predictive of a poor response to cyclosporine. No significant differences in any clinical or endoscopic parameter predictive of a response to leukocyte removal therapy were identified. Conclusions: Intravenous cyclosporine may be effective in patients who have severe steroid-refractory UC, and leukocyte removal therapy may be useful in patients with moderate active UC predicted to be refractive to cyclosporine.

A 13-year old male with acute lymphocytic leukemia was admitted to our hospital for bone marrow transplantation (BMT). Lower abdominal pain and bloody diarrhea developed during the fourth post-BMT week. Colonoscopy revealed edematous mucosa, erosions and multiple irregular ulcers in the rectum and sigmoid colon. Histologically, multiple apoptotic lesions were recognizable in the crypt basement membrane. Most infiltrating lymphoid cells were mature memory T lymphocytes bearing LFA-la-, CD43 and CD45RO antigens. HLA-DR and ICAM-1 immunostaining was seen on the vascular endothelium and the epithelium stained positively for HLA-DR antigens.

We reviewed 18 cases of large intestinal lipohyperplasia (LPH) to clarify the clinical and endoscopic features of this lesion. LPH was found in the ileocecal valve in 16 patients (88.9%). On colonoscopic examination, LPH showed a submucosal tumor-like lesion with a smooth surface. The color was slightly yellowish or the same as that of the surrounding mucosa and the cushion sign was positive in all cases. According to endoscopic features, LPH in the ileocecal valve was classified into three types. The diffuse type showed a symmetrically swollen ileocecal valve. In contrast, the localized type displayed polypoid protrusion from the ileocecal valve. The intermediate type showed partial protrusion with asymmetrical swelling of the valve. Four patients had the diffuse type, three the intermediate type and nine the localized type. The upper lip of the ileocecal valve was more frequently involved in the localized and intermediate types. On rare occasion, LPH was recognized as hemispherical mucosal elevation in the ascending colon and rectum. Histological examination revealed infiltration of mature adipose tissue in the submucosal layer. It was noted that five of the 18 patients had associated malignancies of the gastrointestinal tract. As to therapy, six patients received endoscopic polypectomy and one underwent right hemicolectomy for associated advanced cancer in the cecum. In summary, this review shows that LPH is recognized primarily as focal or diffuse swelling of the ileocecal valve. On colonoscopic examination the possibility of such a lesion in the ileocecal valve should be kept in mind.

Two patients with pneumatosis cystoides intestinalis (PCI) successfully treated with hyperbaric oxygen are described, The first patient was a 52-year-old male who presented with bloody stools and was diagnosed as having primary PCI. The second was a 61-year-old male whose occupation entailed prolonged exposure to trichloroethylene. Following hyperbaric oxygen therapy, the colonic gas cysts completely disappeared in both patients, and there has been no evidence of recurrence. The relevant literature from 1980 to 1992 is reviewed, and hyperbaric oxygen therapy for PCI is discussed in detail. The data accumulated thus far suggest that hyperbaric oxygen is superior to high-flow oxygen breathing in PCI therapy.

Three cases of peptic ulcer in children under two years of age are reported, and 33 cases of infants with peptic ulcer reported in Japan between 1955 and March, 1989 are reviewed. Case 1 was an 8-month-old male complaining of melena, and endoscopic examination showed a gastric ulcer on the lesser curvature of the antrum. Cases 2 and 3 were a 15-month-old mule and an 18-month-old male, respectively, with complaints of melena and hematemesis. Endoscopic examination revealed an active duodenal ulcer in both cases. All 3 infants were successfully treated with H2 blocker and/or antacid. In these 3 cases, infection or drugs were speculated to be predisposing factors, and the fathers of these three infants all had histories of duodenal ulcer. Among 33 cases of infants under 2 years old with peptic ulcer in Japan, 9 had a gastric ulcer and 24 had a duodenal ulcer. Seventeen were treated with conservative therapy and 16 were operated on because of perforation or bleeding. We should always keep in mind that peptic ulcer does occur in infancy, and that endoscopic examination should be promptly performed when peptic ulcer is suspected.