Quality of life study in a regional group of patients with Crohn disease. A structured interview study

BACKGROUND: The course and prognosis of Crohn disease has previously been described in a regional group of patients in Copenhagen County. The aim of the present study was to reveal the quality of life. as judged by the patients, and compared to age- and sex-matched healthy controls. METHODS: Out of 100 consecutive out-patients with Crohn disease, 94 patients accepted to participate together with 94 age- and sex-matched healthy controls. A modified McMaster Inflammatory Bowel Disease Questionnaire (IBDQ23) was used, excluding bowel-related questions. Medical students conducted interviews without knowing who were Crohn disease patients and who were controls. The bowel-related questions and Crohn's Disease Activity Index (CDAI) were assessed by gastroenterologists at inclusion in the study. Responses were indicated on a seven-point scale (7 best/1 worst). Mean numeric score was calculated as well as a delta score, i.e. the difference in score between a patient and the matched control. RESULTS: In 21 of 23 questions the median delta score was zero, indicating no difference between patient and control. The median total delta score was 0.4 in favour of healthy controls (P < 0.001), and significantly higher in patients in relapse, 0.9, than in patients in remission, 0.3 (P < 0.01). The median total numeric score was 5.7 for patients and 6.1 for controls. CONCLUSIONS: Although patients with Crohn disease scored significantly lower on the quality of life scale than matched healthy controls, the differences were smaller than could be expected, taking the chronic disease into consideration. Disease activity correlated with the quality of life score.     

Acute ischemia of the lower extremity in an adolescent with Crohn disease]

The authors report a case with a rare form of peripheral ischaemia. A 25-year-old man with Crohn's disease suffers from sudden ischaemia of his right leg. There is no evidence of entrapment of the popliteal artery, of arterial embolism or Buerger's disease. Thrombocytosis in combination with hypercoagulability as described previously in patients with Crohn's disease seems to be the most probable cause. - In this case percutaneous transluminal thrombectomy and thrombolysis were more successful than surgical thrombectomy using balloon catheters.     

Role of Pseudomonas maltophilia and "Pseudomonas like bacteria group Va" in the etiology of Crohn disease

In 1976, Parent and Mitchell isolated cell-wall defective bacteria of the species Pseudomonas maltophilia and Pseudomonas like bacteria group Va from resected bowel tissue of 8 consecutively operated patients with Crohn's disease. The control group, which included patients with ulcerative colitis, was negative in this respect. The isolated strains were available for our own investigations. New Zealand white rabbits were inoculated with killed bacteria to produce specific antisera. Frozen sections of affected tissue from 6 consecutively operated Crohn patients were incubated with the various antisera and investigated by indirect immunofluorescence. No positive reactions were demonstrable in repeated tests with different dilutions of antisera. Our results do not support the hypothesis that bacteria of the species Pseudomonas maltophilia and Pseudomonas like bacteria group Va are an etiologic factor in Crohn's disease.     

Urologic complications in Crohn disease

The main urological complications of Crohn's disease are: vesico-intestinal fistula, ureteral obstruction, formation of urinary calculi and amyloidosis of the kidney. In the course of their illness nearly 4 to 10 per cent of patients with Crohn's disease suffer from these complications. The frequency of vesico-intestinal fistula is nearly 4 per cent; with great fluctuations, the frequency of ureteral obstruction is specified by 6 per cent. 10 per cent of all patients with Crohn's disease will suffer from secondary amyloidosis. In most cases the kidney is the organ of manifestation. In 5 per cent the formation of urinary calculi is complicating Crohn's disease. The specific complications are demonstrated in symptoms, diagnostic and therapy.     

Splenic granulomas in Crohn disease

Granulomas have been described in a wide variety of organs in patients with Crohn disease, but not in spleen. This report describes a patient with noncaseating granulomas of the liver and spleen that responded promptly and fully to glucocorticoid therapy.     

Crohn disease in 3 siblings

Three siblings without a known familiar history of chronic inflammatory disease of the intestine suffered Crohn's disease. They were the 3rd, 4th and 8th siblings of a family of 8 siblings. The onset of the disease and its course were similar in all three patients. Considering the form of familial presentation and the possible influence of environmental factors in this type of patients, a review is made of the influence of these factors in accordance with the clinical patients' evolution.     

Pharmaceutical advertisements in leading medical journals: experts' assessments.

OBJECTIVE: To assess both the accuracy of scientific data presented in print pharmaceutical advertisements and the compliance of these advertisements with current Food and Drug Administration (FDA) standards. DESIGN: Cross-sectional survey. MEASUREMENTS: Each full-page pharmaceutical advertisement (n = 109) appearing in 10 leading medical journals, along with all available references cited in the advertisement (82% of the references cited were available) were sent to three reviewers: two physicians in the relevant clinical area who were experienced in peer review and one academic clinical pharmacist. Reviewers, 95% of whom responded, were asked to evaluate the advertisements using criteria based on FDA guidelines, to judge the educational value and overall quality of the advertisements, and to make a recommendation regarding publication. RESULTS: In 30% of cases, two or more reviewers disagreed with the advertisers' claim that the drug was the "drug of choice." Reviewers felt that information on efficacy was balanced with that on side effects and contraindications in 49% of advertisements but was not balanced in 40%. Reviewers agreed with advertisements' claims that the drug was safe in 86% of the cases but judged that headlines in 32% of the advertisements containing headlines misled the reader about efficacy. In 44% of cases, reviewers felt that the advertisement would lead to improper prescribing if a physician had no other information about the drug other than that contained in the advertisement. Fifty-seven percent of advertisements were judged by two or more reviewers to have little or no educational value. Overall, reviewers would not have recommended publication of 28% of the advertisements and would have required major revisions in 34% before publication. CONCLUSION: In the opinion of the reviewers, many advertisements contained deficiencies in areas in which the FDA has established explicit standards of quality. New strategies are needed to ensure that advertisements comply with standards intended to promote proper use of the products and to protect the consumer.