Alcoholism/Addiction as a Chronic Disease

Summary

Although characterized as a chronic disease for more than 200 years, severe and persistent alcohol and other drug (AOD) problems have been treated primarily in self-contained, acute episodes of care. Recent calls for a shift from this acute treatment model to a sustained recovery management model will require rethinking the natural history of AOD disorders; pioneering new treatment and recovery support technologies; restructuring the funding of treatment services; redefining the service relationship; and altering methods of service evaluation. Recovery-oriented systems of care could offer many advantages over the current model of serial episodes of acute care, but such systems will bring with them new pitfalls in the personal and cultural management of alcohol and other drug problems.     

Multiple Perforations along the Entire Colon as a Complication of Intestinal Behcet's Disease: A Rare Case

Colonic complications of Behcet''s disease due to intestinal involvement are rarely reported in the literature. Ulcers are the most frequently seen intestinal complications that cause bleeding and perforation predominantly in the ileocecal region. In this article, we report a patient with Behcet''s disease who presented with multiple perforations along the entire colon. Postoperative histopathological examination revealed multiple ulcers containing lymphocytic infiltrations in the small peripheral and submucosal venules. Intimal thickening and fresh intraluminal fibrin thrombosis were also seen in these venules.     

Risk Factors,Pattern and Clinical Outcome of Acute Graft Versus Host Disease in Acute Leukemia Patients Undergoing Allogeneic Stem Cell Transplant

We sought to determine risk factors, pattern and outcome of acute graft versus host disease (aGVHD) in seventy-seven acute leukemia patients who underwent allogeneic stem cell transplant at our centre from January 2008 to March 2013. GVHD prophylaxis with cyclosporine-methotrexate or cyclosporine-mycophenolate mofetil was used. Patients were divided in 2 groups, grade II-IV aGVHD (group A) and grade 0-I aGVHD (group B). Incidence of any grade and grade II-IV aGVHD was 44 and 18 %, respectively. The most common site of aGVHD was gastro-intestinal tract (65 %) followed by skin (35 %). Higher total nucleated cell (TNC) dose infused was associated with increased incidence of grade II-IV aGVHD. Incidence of relapse and incidence of slippage of chimerism was 21 and 36 % in group A while 37 and 27 % in group B respectively. Transplant related mortality (TRM) was 21 % in group A and 13 % in group B. Probability of OS and RFS at 4 years was 63 and 34 % in group A compared with 40 and 38 % in group B, respectively. We conclude that higher TNC dose infused is a risk factor for grade II-IV aGVHD with gut being the commonest site. Grade II-IV aGVHD did not have a significant impact on incidence of relapse, TRM and OS.     

Extreme Potassium Loss in a Patient with Severe Graft Versus Host Disease

A 19-year-old male, suffering from post-hepatitis aplastic anaemia, was transplanted with bone marrow cells from his HLA-identical, MLC non-reactive brother. Haematological recovery ensued, but the patient also developed grade IV graft-versus-host disease (GVHD). In addition to involvement of skin, liver and gut, the kidney seemed affected by GVHD since the patient had hypokalaemia and severe hyperkaluria. Other causes of urinary potassium loss were excluded. The amount of potassium loss correlated well with the severity of the GVH-reaction. Although coagulation disorders prohibited a kidney biopsy, the clinical course suggested GVHD to be the cause of the urinary potassium loss.     

The Effect of Dietary Yeast on the Activity of Stable Chronic Crohn's Disease

The effect of dietary yeast on the activity of stable Crohn's disease was assessed in 19 patients. During the 1st month patients continued their usual diet (base-line period), but during the next 2 months dietary yeast was excluded except that during I month patients took baker's yeast capsules while for the other month they took placebo capsules. The patients' mean Pettit Crohn's disease activity index (CDAI) while taking baker's yeast (mean, 107.9; SE, 6.1) was significantly greater than during yeast exclusion (mean, 102.1; SE, 5.7; p < 0.05). The mean of each patient's maximum CDAI during yeast exclusion (mean, 107.1; SE, 5.7) was significantly lower than those during the base-line (mean, 115.2; SE, 6.1; p < 0.05) and baker's yeast inclusion periods (mean, 113.9; SE, 6.7; p < 0.05). Patients with elevated yeast antibodies tended to develop a higher CDAI while receiving baker's yeast (13 of 15). These results suggest that dietary yeast may affect the activity of Crohn's disease.     

Decreased Gelatin-Binding Fibronectin in Patients with Chronic Inflammatory Bowel Diseases

The plasma fibronectin concentration (PF) was measured in 48 patients with chronic inflammatory bowel disease (CIBD) and in 48 age- and sex-matched healthy controls, using electroimmunoassay and a functional (gelatin-binding) assay. Whereas no difference in immunochemically measured PF was found between the two groups, patients with CIBD had significantly lower gelatin-binding PF than healthy controls (p < 0.001). Immunochemically measured PF increased, whereas functionally measured PF tended to decrease with increasing disease activity.     

Turner's Syndrome Associated with Chronic Inflammatory Bowel Disease. A Case Report and Review of the Literature

A 26-year-old woman with Turner's syndrome (45,X/46,X,i(Xq)) and Crohn's disease is reported. The inflammatory bowel disease was aggressive with development of intestinal fistulas. Total proctocolectomy was performed, and the patient recovered remarkably well postoperatively. The association of Turner's syndrome and inflammatory bowel disease is reviewed, with special reference to karyotype, severity, mortality and treatment.     

Serum Copper Compared to Erythrocyte Sedimentation Rate as Indicator of Disease Activity in Hodgkin's Disease

Serum copper and erythrocyte sedimentation rate were recorded in 54 patients with active Hodgkin's disease and at 186 occasions in 78 patients during stable complete remission. Relatively high and age-dependent normal limits for erythrocyte sedimentation rate were used. Each of the tests was elevated in 70 % of patients with active disease. During remission serum copper was elevated in 14 % and erythrocyte sedimentation rate in 16.5 % of the determinations. Thus the two tests are considered not far from equal in their ability to discriminate between presence and absence of specific disease activity in Hodgkin's disease. Simultaneous elevation during remission occurred in less than 5 % of the recordings as compared to 61 % during active disease. It is therefore concluded that serum copper level may be of some value as a supplement to erythrocyte sedimentation rate.     

A Case of Turner's Syndrome with Crohn's Disease

Abstract: A case of Crohn's disease that developed during the follow-up of Turner's syndrome is presented in this paper, together with references to the literature. This case had a mosaic pattern (45X46Xi (Xq)) in chromosomal analysis and BW52, DR2 in HLA typing with autoantibodies.     

Opioid Use is Associated with Decreased Quality of Life in Patients with Crohn's Disease

Background/Aims:

Quality of life is an important consideration in the management of patients with Crohn''s disease. Previous studies suggest that Crohn''s disease patients using opioids may have decreased quality of life and increased risk of mortality. Our aim was to determine the association between health-related quality of life (HRQoL) and opioid use in patients with Crohn''s disease while controlling for disease severity.

Patients and Methods:

We conducted a cross-sectional study recruiting Crohn''s disease patients at our center. Disease activity was measured using the Harvey-Bradshaw Index (HBI), and HRQoL was measured using the Inflammatory Bowel Disease Questionnaire (IBDQ).

Results:

We enrolled 38 Crohn''s disease patients using opioids and 62 patients not using opioids. Patients using opioids had an increased duration of disease (median 18.5 vs. 9 years, P = 0.005), increased surgeries related to Crohn''s disease (median 3 vs. 0, P < 0.001), and increased prednisone use (29% vs. 11.3%, P = 0.03). Patients using opioids had increased disease activity (median HBI score 9.0 vs. 3.0, P < 0.001). Quality of life was lower in patients using opioids (mean IBDQ score 109.3 vs. 162.9, P < 0.001). This finding was significant when controlling for HBI scores, number of previous surgeries, and prednisone use (P = 0.003).

Conclusions:

Opioid use in Crohn''s disease patients appears to be associated with disease activity and severity. HRQoL is markedly decreased in patients using opioids and this association is significant even when controlling for variables reflecting disease severity. Our findings suggest that Crohn''s disease patients using opioids are likely to be significantly impacted by their disease.