pituitrin and Colitis--Ulcerative

We report a case of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) after total proctocolectomy followed with ileal pouch-anal anastomosis (TPC-IPAA) for ulcerative colitis (UC). The patient was a 46-year-old woman. She was diagnosed with UC of pancolitis in 2000. High grade dysplasia was detected in the transverse colon after a surveillance colonoscopy in 2021. She underwent laparoscopy-assisted TPC-IPAA. On the sixth postoperative day, she had a decreased level of consciousness that worsened on the following day. Her laboratory data showed a serum sodium level of 108 mEq/L and the plasma osmolality was 234 mOsm/kg. We did not find any other abnormalities in the laboratory examination that could cause hyponatremia. Computed tomography scan showed no central nervous system disturbances such as a pituitary tumor, antidiuretic hormone-producing tumors, or pulmonary diseases. The patient was diagnosed with Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) caused by surgical invasion. We started to administer 3% sodium chloride slowly to improve the hyponatremia. Her serum sodium level became normal and stable. Although it is rare for SIADH to be caused by abdominal surgery, if hyponatremia is observed after surgery, the possibility of postoperative SIADH should be considered.

Topics: Colitis, Ulcerative; Female; Humans; Hyponatremia; Inappropriate ADH Syndrome; Middle Aged; Proctocolectomy, Restorative; Sodium; Vasopressins

Inflammatory bowel disease (IBD) is a chronic intestinal disorder, often leading to an impaired quality of life in affected patients. The importance of environmental factors in the pathogenesis of IBD, including their disease-modifying potential, is increasingly recognised. Hypoxia seems to be an important driver of inflammation, as has been reported by our group and others. The aim of the study is to evaluate if hypoxia can alter disease activity of IBD measured by Harvey-Bradshaw Activity Index in Crohn's disease (increase to ≥5 points) and the partial Mayo Score for ulcerative colitis (increase to ≥2 points). To test the effects of hypoxia under standardised conditions, we designed a prospective and controlled investigation in healthy controls and patients with IBD in stable remission.. This is a prospective, controlled and observational study. Participants undergo a 3-hour exposure to hypoxic conditions simulating an altitude of 4000 metres above sea level (m.a.s.l.) in a hypobaric pressure chamber. Clinical parameters, as well as blood and stool samples and biopsies from the sigmoid colon are collected at subsequent time points.. The study protocol was approved by the Ethics Committee of the Kanton Zurich (reference KEK-ZH-number 2013-0284). The results will be published in a peer-reviewed journal and shared with the worldwide medical community.. NCT02849821; Pre-results.

Topics: Adolescent; Adult; Altitude; Angiotensins; Biopsy; Blood Pressure; Colitis, Ulcerative; Colon, Sigmoid; Crohn Disease; Cytokines; Feces; Healthy Volunteers; Humans; Hypoxia; Hypoxia-Inducible Factor 1; Leukocyte L1 Antigen Complex; Middle Aged; Organ Size; Prospective Studies; Research Design; Severity of Illness Index; Sigmoidoscopy; Urinary Bladder; Vasopressins; Young Adult

In case of intestinal bleeding, selective angiography is very informative to detect the cause of bleeding and the site of bleeding. Major diseases examined were ischemic lesions of intestine diverticulosis, myogenic tumors, and severe cases of ulcerative colitis. Operations were carried out when indicated. To the rest of the cases interventional angiography was carried out. Interventional angiography for intestinal bleeding was performed to 52 cases inclusive of 9 cases of bleeding from the tumor, 2 cases of diverticulosis, 3 cases of intestinal Behcet and 28 cases of severe ulcerative colitis. Administered drugs were continuous perfusion of vasopressin to the ruptured vessels and water-soluble bolus intraarterial injection of prednisolone to the inflammatory process of ulcerative colitis. All the vasopressin cases were responded to this therapy. Efficacy of intraarterial injection of prednisolone was evaluated in 56 cases including the cases of cooperative study group. Efficacy was compared to the 5 days intensive intravenous therapy, revealing the similar response rate. It was also reported that seven cases to which the 5 days intensive therapy was ineffective responded to intraarterial injection therapy. Mechanism of intraarterial injection therapy was studied by analyzing the pre and post angiographical findings and by measuring mucosal blood flow and oxygen saturation. Administered high dose of prednisolone may improve the microcirculation. Further studies were indicated.

Topics: Adolescent; Adult; Angiography; Behcet Syndrome; Colitis, Ulcerative; Diverticulum; Female; Gastrointestinal Hemorrhage; Humans; Injections, Intra-Arterial; Intestinal Neoplasms; Male; Middle Aged; Prednisolone; Radiography, Interventional; Vasopressins

Topics: Adolescent; Adult; Age Factors; Aged; Child; Colectomy; Colitis, Ulcerative; Colonic Diseases; Colonoscopy; Electrocoagulation; Embolization, Therapeutic; Gastrointestinal Hemorrhage; Humans; Injections, Intra-Arterial; Injections, Intravenous; Intestine, Small; Laser Therapy; Mesenteric Arteries; Middle Aged; Radiography; Vasopressins

A case of a massive colonic hemorrhage in nontoxic, quiescent ulcerative colitis is described. The source of active colonic bleeding was primarily defined with selective superior mesenteric arteriography and was completely controlled with transcatheter vasopressin infusion. A suubsequent elective segmental distal transverse and descending colectomy revealed chronic ulcerative colitis; localized marked inflammatory giant pseudopolyp formation near the splenic flexure was responsible for the bleeding.

Topics: Aged; Chronic Disease; Colitis, Ulcerative; Colonic Diseases; Female; Gastrointestinal Hemorrhage; Humans; Radiography; Vasopressins

Angiography has added a new dimension to the management of hemorrhage from the large bowel. In patients with diverticular hemorrhage, mesenteric angiography not only localizes the bleeding site but, in addition, the bleeding can be acutely controlled with intraarterial infusion of vasopressin, making an emergency colectomy unnecessary. Similarly in patients bleeding from inflammatory bowel disease or in patients with post-operative hemorrhage, angiography provides information about the nature of the lesion and selective arterial infusions of vasopressin can control the bleeding. At times intestinal varices have angiographically been demonstrated as a potential source of rectal hemorrhage while in patients with unexplained lower gastrointestinal bleeding and repeatedly negative barium and endoscopic examinations, angiography has been valuable for the diagnosis of angiodysplasia of the colon.

Topics: Acute Disease; Aged; Angiography; Blood Vessels; Colitis, Ulcerative; Colon; Colonic Neoplasms; Diverticulum, Colon; Endoscopy; Gastrointestinal Hemorrhage; Humans; Intestinal Polyps; Intestine, Large; Male; Mesenteric Arteries; Middle Aged; Varicose Veins; Vasopressins

Topics: Acute Disease; Adult; Aged; Alcoholism; Animals; Colitis; Colitis, Ulcerative; Diverticulum, Colon; Dogs; Epinephrine; Female; Gastrointestinal Hemorrhage; Humans; Ileitis; Injections, Intra-Arterial; Male; Mesenteric Arteries; Middle Aged; Peptic Ulcer Hemorrhage; Propranolol; Regional Blood Flow; Stomach Ulcer; Vasoconstrictor Agents; Vasopressins

Topics: Adolescent; Adult; Age Factors; Angiography; Bradykinin; Cecal Diseases; Colectomy; Colitis, Ulcerative; Colon; Colon, Sigmoid; Colonic Diseases; Crohn Disease; Duodenal Diseases; Female; Humans; Intestines; Jejunum; Male; Mesenteric Arteries; Middle Aged; Phlebography; Rectal Diseases; Sex Factors; Vasodilator Agents; Vasopressins