Risk factors for the development of fistulas in Crohn disease

The pathophysiology of fistula formation in Crohn's disease is as yet poorly known. We, therefore, studied in 111 patients with Crohn's disease factors which may be associated with the development of fistulas. Male patients, patients with exclusively involved colon or extended disease of the colon and ileum as well as patients treated with prednisone demonstrated an increased relative risk to develop fistulas. In patients with ileitis alone and after laparatomy in combination with resection of the bowel the relative risk was less than 1. Furthermore, in 71% of the patients fistulas developed during active disease. In 65% the patients had underweight at the time of fistula formation. We conclude, that the localization of the disease, a factor which can not be influenced, as well as active disease and malnutrition, both factors which can be influenced, may be involved in the formation of fistulas in Crohn's disease.     

Risk factors for the development and progression of carcinoid heart disease

The development of valvular heart disease in patients with carcinoid syndrome is thought to be related to the secretion of vasoactive substances by a tumor. We sought to identify modifiable risk factors for the development of carcinoid heart disease because this may help define strategies to attenuate the disease process. Two hundred fifty-two patients with carcinoid syndrome were prospectively followed with serial echocardiograms at 6-month intervals. Clinical characteristics, biochemical markers, and radiologic markers were measured at set intervals. An echocardiographic scoring system was applied. Patients were defined as having progression of carcinoid heart disease if the echocardiographic score increased by ≥25%. After a median follow-up of 29 months, 44 patients developed carcinoid heart disease or had progression of existing valvular dysfunction. At time of progression of carcinoid heart disease compared to the previous 6 months, there was a significant increase in median levels of 5-hydroxyindoleacetic acid (5-HIAA; 791 vs 460.5 μmol/24 hours) and flushing episodes (4.5 vs 2 episodes per day). Independent predictors of the development or progression of carcinoid heart disease were a 5-HIAA level ≥ 300 μmol/24 hours and ≥ 3 episodes of flushing per day. 5-HIAA levels of ≥ 300 to 599, 600 to 899, and > 900 μmol/24 hours conferred 2.74, 3.16, and 3.40 times the risk of progression of carcinoid heart disease, respectively. In conclusion, a 5-HIAA level ≥ 300 μmol/24 hours and ≥ 3 flushing episodes per day are predictors of the development or progression of carcinoid heart disease.     

非酒精性脂肪性肝病发生及进展的危险因素

非酒精性脂肪性肝病(NAFLD)的患病率逐年增加,目前成为我国成年人中最常见的慢性肝病之一。NAFLD可由非酒精性肝脂肪变性进展为非酒精性脂肪性肝炎、肝硬化、肝细胞癌及NAFLD相关性心血管事件、死亡等重大疾病。现对NAFLD发生的危险因素以及进展为肝纤维化、肝硬化、肝癌、相关心血管事件和死亡等重大疾病的相关危险因素进行综述,以便进一步探讨NAFLD发生发展的机制,降低NAFLD的患病率,减缓NAFLD的进展程度,降低相关疾病的病死率。     

Pathogenesis of the impaired gall bladder contraction of coeliac disease.

We have investigated the possibility that the abnormally decreased gall bladder contraction after meals in patients with coeliac disease might result in part from an abnormality in the gall bladder response to endogenous cholecystokinetic hormones--for example, cholecystokinin and motilin--rather than solely from decreased secretion of such hormones. Eight patients with untreated coeliac disease and nine controls received intravenous infusions of the pure synthetic cholecystokinin analogue caerulein, 2-16 ng/kg/hour. Gall bladder emptying was measured on a minute-by-minute basis using 99mTc-HIDA scans. In the patients with coeliac disease, gall bladder emptying was greatly decreased (34.6 +/- 9.9 v 61.5 +/- 7.5% at 60 minutes, p less than 0.02), and a much greater dose of caerulein was needed to initiate gall bladder contraction (3.80 +/- 1.08 v 1.49 +/- 0.56 ng/kg, p less than 0.02). These results suggest that the abnormal gall bladder contraction in coeliac disease is not simply because of impaired release of cholecystokinin. Although mechanical factors secondary to the increased gall bladder size in patients with coeliac disease might to some extent account for the findings, the alternative explanation is that the gall bladder muscle is for some reason resistant to the action of cholecystokinetic agents. A similar phenomenon affecting the pancreas might contribute to the abnormally decreased pancreatic secretion found in coeliac disease.     

Torsion of the gall bladder

Torsion of the gall bladder is an acute abdominal emergency hardly ever diagnosed pre-operatively. This is due largely to a lack of awareness of the existence of the condition, resulting in its rarely being entertained as a possibility in the differential diagnosis. A case is described and presented in relation to aetiology and treatment.