Simultaneous occurrence of hereditary angioneurotic edema and Crohn disease

Hereditary C1 esterase inhibitor deficiency is often associated with immunpathologic disorders. The authors present a case of the rare coincidence of hereditary angioedema (HAE) and Crohn's disease. The history of the patient is analysed along with the familial occurrence of the disease. Characteristic abdominal manifestations of C1 esterase inhibitor deficiency are compared to the clinical signs of Crohn's disease. Differential diagnostic pitfalls are described along with efficatious therapeutic options.     

Crohn disease: morphologic findings of extra-intestinal disease manifestations

Extraintestinal manifestations occur frequently in patients with Crohn's disease. The spectrum of extraintestinal symptoms reported associated with Crohn's disease involves many organ systems. Commonly recognized extraintestinal manifestations include dermatologic, oral, ocular, skeletal, vascular, hepatobiliary, pancreatic, and pulmonary. Morphological findings on extraintestinal manifestations (erythema nodosum, pyoderma gangrenosum, erythrodermia--granulomatous periostitis and synovitis--granulomatous sialadenitis, aphthous stomatitis--fibrous alveolitis) in Crohn's disease are reported and discussed.     

Prevalence and role of anticardiolipin antibodies in Crohn disease

OBJECTIVES: Anticardiolipin antibodies belong to the group of antiphospholid antibodies, and may be seen in association with endothelial damage and recurrent vascular thrombosis. The aim of our study was to determine in patients with Crohn's disease the frequency of anticardiolipin antibodies, and to correlate their presence with clinical activity and treatment of the disease. METHODS: One hundred and thirty-eight sera from patients with Crohn's disease and 118 from age-matched controls were tested for IgG anticardiolipin antibodies. In the Crohn's disease group, we determined whether the patients had a past history of vascular thrombosis, a clinically active intestinal disease, or a current immunosuppressive therapy (steroids or azathioprine). RESULTS: Anticardiolipin antibodies were found significantly more often in patients with Crohn's disease than in controls: 11.0% versus 2.5%, P < 0.02. Three patients with Crohn's disease had a past history of vascular thrombosis, but none of them had anticardiolipin antibodies. The presence of anticardiolipin antibodies was not correlated with the fact that patients had a clinically active disease (P = 0.77), or a current immunosuppressive therapy at the time of the serological test (P = 0.95). CONCLUSIONS: There is a significantly high prevalence of patients with anticardiolipin antibodies during Crohn's disease. The positivity of the test does not seem to be correlated to the existence of a past history of vascular thrombosis, nor to the clinical activity of the disease.     

Salvage after anastomotic leak in Crohn disease. Utilization of a new, simple diverting ileostomy

It may be possible to manage an anastomotic leak following resection for Crohn disease by drainage, suture, and proximal loop ileostomy. This report describes success with a simple diverting ileostomy.     

Difficulties in differentiation between Crohn disease and ulcerative colitis

We report on the medical history of a 44 year old woman, who has been diagnosed to suffer from ulcerative colitis, first diagnosed in 1991. Until 1994, when she had finally a colectomy, recurrent episodes occurred under full medical treatment. After colectomy the diagnosis had to be revised as histology revealed Crohn's disease. Only a few months after surgery a new episode of Crohns disease developed including the occurrence of an anal fistula.     

Tuberculosis in Hodgkin's disease in a child

During its evolution, Hodgkin disease is accompanied by changes in the cell immunity, mainly of delayed type. Tuberculosis can precede Hodgkin disease or complicate its evolution during a simultaneous development of both diseases, or the lymph node tuberculosis can hurry hemopathy onset. Tb lesions in such patients can have atypical features.     

Elevated diet-induced thermogenesis and lipid oxidation rate in Crohn disease

OBJECTIVE: To examine the relationship between antimalarial therapy and total cholesterol in patients with systemic lupus erythematosus (SLE) with or without steroid therapy. METHODS: Retrospective study for the University of Toronto Lupus Clinic database between 1976 and 1997. The effects of antimalarials on random total cholesterol levels were assessed in the following situations: patients not receiving steroids (part I) that either initiated or discontinued antimalarials; patients receiving steroids (part II) that were either on a stable dose or initiating antimalarials; and patients initiating steroids with or without antimalarials (part III). Paired t test, Fisher's exact test, and 2 way analysis of variance were used when appropriate. RESULTS: Initiation of antimalarials reduced the baseline total cholesterol by 4.1 % at 3 months in 53 patients (p = 0.020) and by 0.6% at 6 months in 30 patients (p = NS), while the cessation of antimalarials increased the total cholesterol by 3.6% at 3 months in 38 patients (p = NS) and 5.4% at 6 months in 22 patients (p = NS). In 181 patients taking steroids and antimalarials, the mean total cholesterol was 11% less than for 201 patients receiving a comparable dose of steroids alone (p = 0.0023). Initiation of antimalarials on a stable dose of steroids reduced the total cholesterol by 11.3% at 3 months in 29 patients (p = 0.0002) and 9.4% at 6 months in 20 patients (p = 0.004). For patients initiating steroids, the percentage increase in cholesterol was lower in those taking antimalarials compared to patients without antimalarial therapy (p = 0.0149). CONCLUSION: Antimalarials lower total cholesterol in patients receiving steroids and may minimize steroid induced hypercholesterolemia.     

Comparison of long-term course of perforating and non-perforating Crohn disease

OBJECTIVES: To evaluate the influence of the indication of the first surgical procedure on the prognosis of Crohn's disease. METHODS: We compared retrospectively the long-term course of 179 patients operated on for a perforating disease and 322 patients operated on for a nonperforating disease. Mean follow-up was 11 years and 2 months in the two groups. RESULTS: Forty of 179 (25%) and 106 of 322 (33%) patients with perforating and nonperforating diseases underwent a second intestinal resection, respectively. The patients who had been operated on for a perforating disease were significantly more often reoperated on for the same indication, and conversely. Patients with perforating diseases experienced less second resections (actuarial rates: 37 +/- 11% vs 51 +/- 8% at ten years respectively), less post-surgical handicaps (mean index 24.9 vs 27.9), and fewer patients required immunosuppressive drugs (25 vs 35%). CONCLUSION: Long-term prognosis of perforating Crohn's disease does not appear to be more severe than that of nonperforating disease.     

Surgical widening of strictures in the small intestine in Crohn disease

Twenty-two stricture plasties were performed in five patients with multiple stenosis of the small intestine due to Crohn's disease. Immediate post-operative results were satisfactory but progressive degradation followed. These findings are similar to those reported in the literature on this technique which does not give better results than other methods since none have an effect on the clinical course of the disease. The only advantage is to decrease the amount of intestinal mutilation.     

Hypertension and pulmonary edema associated with subconjunctival phenylephrine in a 2-month-old child during cataract extraction

We have analysed trends in male:female ratios among newborns between 1950 and 1990 in 29 countries from five continents. The numbers of liveborn males and females over the period 1950-1994 were derived from the World Health Organization (WHO) database. Countries for which reliable data were available included 20 major European countries (excluding the former Soviet Union, Albania and a few small countries), Canada, the USA, selected countries of Central and South America, Japan, Australia and New Zealand. From the original numbers of males and females, we computed the proportion of males among liveborns for each country and for selected broader areas within Europe. In most countries the proportion of male liveborns was constant during the study period. In particular, the proportion of male newborns in the European Union was 0.515 in 1950-1954, 0.514 in 1970-1974 and 0.514 in 1990-1994. In the USA, corresponding values were 0.513, 0.513 and 0.512. In Japan the ratios were 0.513 in 1950-1954, 0.516 and 1970-1974 and 0.514 in 1990-1994. Decreasing ratios were observed in some northern and eastern European countries plus Greece and Portugal and, particularly, in Mexico. In contrast, the proportion of male liveborns tended to increase in southern Europe and Australia. Overall, among the 29 countries considered, the proportion of males declined in 16, increased in six, and remained stable in seven.     

Leucinosis--a case of congenital metabolic disease in a child

Trasditional Chinese medicine is based on inductive-synthetic reasoning with regard to all life processes, in contrast to the causal-analytic orientation in our Western medicine. This philosophical approach is based on a system of comparisons (equivalents), referred to as Yin and Yang. Vital functions are seen as "energizing" processes, whereby the acupuncture points and the system of meridians are seen as a means of regulation for this "energy". A disturbed balance in this energy results in illness. The therapy according to the acupuncture method is to acheive a balance in the disturbed flow of energy by means of acupuncture points. By utilizing biophysical methods of measurement, it is possible to prove that a change in this energy takes place. The complex active principle which results in the effectiveness of acupuncture includes neurophysiological, biochemical and biophysical functional processes.     

Late incidence of cancer after metronidazole use: a matched metronidazole user/nonuser study

OBJECTIVE: To address clinical features of subacute postictal aggression, we examined aggressive behavior beginning hours to days after the acute confusional postictal period. METHODS: Six patients from our database of 1300 were assessed. Data was obtained from the patients, their family and caretakers, and medical records. One patient was studied with closed circuit video/EEG. RESULTS: There is clinical heterogeneity among these individuals with respect to etiology of epilepsy, age of onset, laterality, memory of adverse behaviors, and presence of psychosis. Several clinical features, including male gender, were common to all. The episodes of postictal aggression were not isolated events, but recurred repeatedly; the behaviors were uniquely stereotyped in each patient. Subacute postictal aggression was more likely after a cluster of seizures than after a single ictus. All patients had medically intractable epilepsy and were remorseful in the interictal period. CONCLUSIONS: Subacute postictal aggression, a rare phenomenon within the broad spectrum of epilepsy-related behaviors, appears to be a true clinical entity with several consistently observed manifestations.