THE COURSE AND PROGNOSIS OF ULCERATIVE COLITIS

The authors have produced a unique study of 624 patients with ulcerative colitis for they have achieved a 100% follow-up of all these patients admitted to the Radcliffe Infirmary or to the Churchill Hospital, Oxford, from 1938 to March 1962 inclusive or who attended as out-patients during the same period. They are therefore able to present a most important analysis of the natural history of ulcerative colitis as it occurs in the general population. Part I concerns the short-term prognosis in the initial attack, Part II the long-term prognosis; Part III discusses the complications of the disease, and Part IV the risk of carcinoma.

RIGHT-SIDED COLITIS

The term ;right-sided colitis' has been used to describe a lesion in which the right half of the colon shows maximal inflammatory changes; although the terminal ileum is always involved, the rectum is normal or shows minimal inflammatory changes. Some of these cases appear to be of atypical Crohn's disease, whilst the others resemble chronic ulcerative colitis. The high incidence of Jewish people in this series suggests a racial tendency towards this distribution of the inflammatory change. The right-sided nature of the lesion has led to unnecessarily prolonged medical treatment, to right hemicolectomy, and to ileorectal anastomosis. The results of such procedures have been disappointing, all the more so because the rectum was almost normal and hence would seem ideally suited for ileorectal anastomosis. These patients have progressed very well with ileostomy.

A NEW FLUORIMETRIC METHOD OF PLASMA CORTISOL ASSAY WITH A STUDY OF PITUITARY-ADRENAL FUNCTION USING METYRAPONE (SU. 4885)

To assay falling cortisol levels in the plasma during intravenous metyrapone infusion, a new spectrophoto-fluorimetric method has been devised. The advantages of this method are its ability to estimate low concentrations of cortisol, its precision, the small volumes of plasma required (1·0 ml.) and the rapidity with which results may be obtained (3–4 hr.).

The metyrapone test has been applied to discover its value as a clinical test of pituitary—adrenal function following steroid therapy, before subjecting patients to the stress of surgery. Tests were made on seven normal subjects, and fourteen patients with ulcerative colitis of whom eight had received steroids previously. Three patients in the steroid-treated group and one who had not received steroids previously failed to show a normal response. When subjected to operation, all four showed the usual elevation of plasma cortisol during operative stress. None of those having a normal response to the metyrapone test failed to show a normal plasma cortisol elevation during operation.

Metyrapone i.v. has therefore proved of uncertain value as a clinical test; the failure to respond in four cases did not prove to be an indication for the need for steroid therapy during surgery.