Gastroenterology Group of Rochester

Introduction: Gastroesophageal reflux disease (GERD) is a very common disease that often presents with symptoms such as heartburn, dysphagia, odynophagia, chronic cough, asthma, belching and regurgitation. Common etiologies of GERD are- Transient lower esophageal sphincter(LES) relaxation, motility disorder, lower esophageal sphincter (LES) incompetence, short lower esophageal sphincter (< 2 to 5 cm) and increased intra-abdominal pressure due to obesity or pregnancy for example. Dolichocolon is an uncommon disease in which patients have redundant colon. It commonly presents with constipation, lower abdominal pain and in severe cases, volvulus. Dolichocolon is an unusual cause of GERD. We present an unusual presentation of an uncommon pathology. Case Description/Methods: Our patient is 56-year-old woman presented with chronic cough and chronic abdominal pain. Initially patient was diagnosed with GERD. Fundoplication was planned since patient failed medical management. During workup, dolichocolon was discovered and after subtotal colectomy, the patient’s symptoms of GERD resolved (Figure). Discussion: Dolichocolon is defined as redundant colon. We can use the following criteria to diagnose it. • Sigmoid colon above the line between iliac crests. • Transverse colon below the aforementioned line. • Extra loops at the hepatic and splenic flexure. If all of the aforementioned redundancies are present at the same time a fully developed Dolichocolon is diagnosed. The reason for the redundant sigmoid colon is thought to be the pathological elongation of the hindgut and hence subsequently the elongation of the sigmoid colon. Although Dolichocolon largely is due to congenital malformation, there are certain theories that abnormal fecal transport, loss of Cajal cells and dietary habits also play a role in acquired dolichocolon. The imaging modality of choice for diagnosis is Barium enema, although we could still use computerized tomography, colonic transit study or magnetic resonance imaging. Our proposed theory for the cause of patient’s symptoms is that the redundant colon increasing pressure on the stomach and hence resulting in symptoms of GERD. This case highlights the importance of Dolichocolon as a cause of abdominal complaints and presents an unusual presentation of a rare pathology.Figure 1.: Barium Enema demonstrating redundant colon.

The Centers for Disease Control and Prevention began implementing a national Health Alert Network (HAN) to act as a communications infrastructure for response to bioterrorist events and other emergencies. State and local health departments are starting to use this communication system. The implementation and use of the HAN at the local level is different from use at the state and federal level. At the local level, the users are often responders in the field rather than in office settings and they may be in direct contact with hazards and agents. Monroe County, New York, developed a local HAN by forming an extranet among four county existing networks.

To examine the pharmacokinetics of zidovudine during the menstrual cycle in human immunodeficiency virus- (HIV-) positive women. Open, unblinded study. A women's clinic for acquired immunodeficiency syndrome (AIDS) at a large medical center. HIV-positive women with a CD4+ cell count above 200/mm3, receiving long-term zidovudine therapy, with a history of regular menstrual cycles. All patients received a 100-mg dose of zidovudine in the fasted state on three occasions. Zidovudine and zidovudine-glucuronide plasma concentrations were measured with radioimmunoassay to determine the pharmacokinetic characteristics during each menstrual phase. The drug's mean peak plasma concentrations (range 233-808 ng/ml) were 556 +/- 145, 385 +/- 132, and 495 +/- 143 ng/ml during the menstrual, late follicular-ovulatory, and luteal phases, respectively. Initially, plasma concentrations declined in a linear fashion from 0 to 4 hours, with a prolonged elimination phase in many patients after 4 hours. The mean zidovudine area under the curve was 886 +/- 156, 845 +/- 268, and 775 +/- 167 ng.hour/ml. The mean percentage of dose recovered was 44.2 +/- 26.0, 56.9 +/- 19.1, and 42.2 +/- 16.6, respectively. The pharmacokinetics of zidovudine were not different during the three phases of the menstrual cycle; however, considerable intrapatient and interpatient variability was noted for many of the values.