Metastatic crohn's disease

PURPOSE: Metastatic Crohn's disease is a rare complication of Crohn's disease that has been infrequently reported in the literature. We report a case where submammary, inguinal, and perineal disease was observed in a patient many years after a proctocolectomy. The proliferative and polypoid morphology of the cutaneous lesions has not been previously described. In addition, this case describes severe cutaneous metastatic Crohn's disease in the absence of active gastrointestinal disease, which to our knowledge has not been reported in the literature. RESULTS: A 55-year-old female with a 25-year history of Crohn's disease was investigated and treated over a 12-month period for metastatic Crohn's disease involving the submammary, inguinal, and perineal areas. These proliferative lesions with erythema and ulceration were histologically consistent with metastatic Crohn's disease. Gram and Ziehl Nielsen stains revealed no pathogenic organisms. The use of topical solutions, antibiotics, immunosuppression, and surgery failed to produce any significant benefit. A review of 42 cases of metastatic Crohn's disease in the literature is reported. CONCLUSION: Cutaneous metastatic Crohn's disease has an extremely variable macroscopic appearance and may be a source of considerable morbidity. It can be present without other significant symptomatology, although it more commonly parallels gastrointestinal disease activity. There are no trials to guide current treatment, which is mainly based on anecdotal reporting.     

Aortoventriculoplasty and left ventricle function: long-term follow-up.

OBJECTIVE: Depressed cardiac function after aortoventriculoplasty is well known during the postoperative period. Little data exist concerning the long-term follow-up. The aim of this study is to determine whether septal incision has any permanent effect on the left ventricle function. METHODS: From 1988 to 2002, 45 patients received aortic mechanical prosthesis. These patients were divided into two groups. Group A consisted of 26 patients 5-18 years old, who underwent simple aortic valve replacement. Group B consisted of 19 patients 4-20 years old, who underwent the Konno procedure. Systolic and diastolic functions of the left ventricle were analyzed using echocardiography. For the systolic function, the following parameters were assessed: pressure gradient between left ventricle and ascending aorta, shortening and ejection fraction of the left ventricle. For the diastolic function, left ventricle-filling parameters were assessed: ratio of early to late filling velocity, deceleration slope of the early filling velocity and left ventricular isovolumetric relaxation time. Furthermore the percentage fraction of the aortic valve index (AOVI%) was calculated and compared between these two groups. RESULTS: After the surgery in group A, AOVI% dropped from 110+/-21 to 98+/-11%, while in group B it increased from 82+/-16 to 114+/-11%. As a result a higher residual pressure gradient across the aortic valve was noted in group A: 21.26+/-15 as compared to 11.17+/-5 mmHg in group B. A mean pressure above 30 mmHg appeared in group A 2 years after the surgery, while in group B this was obtained after 6 years. As for the diastolic function no significant difference was noted between these two groups. Overall there was one late death in group A, and in group B two early deaths, two reoperations because of excessive drainage and in two patients permanent pacemakers had to be implanted. CONCLUSIONS: Improvement of the systolic function after the surgery was noted in both groups. In patients with low AOVI%, postsurgical pressure gradient, either residual or recurrent, appeared during the follow-up. As for the septal incision, it may have some transient effects on the left ventricle function in the postoperative period, but no permanent sequelae were observed in the long-term follow-up.     

Ureterosigmoidostomy complicated by polyp formation

Neoplasia associated with ureterosigmoidostomy is uncommon but important. Two patients, one of whom developed symptoms five years after the ureterosigmoidostomy had been taken down, are reported. The authors support the theory that these tumors may arise from the ureter. When ureterosigmoidostomies are dismantled, the site of implantation should be resected and the patients kept under long-term endoscopic review.     

Numerical analysis of a theoretical one-dimensional amperometric enzyme sensor

The switch-on transient in a miniaturised amperometric sensor with an enzyme layer covered by a diffusion retardation layer is analysed theoretically. The time-dependent mass transfer equations with enzyme catalysed reactions are solved numerically in a one-dimensional geometry with a stationary liquid sample of the same size as the active sensor volume. No steady-state operation is normally achieved and the sensor structure and material parameters have a complicated effect on the oxygen flow behaviour. The theoretical model is used to calculate the measuring range, sensitivity and response time of the sensor. Their dependence on sensor structure is presented in a dimensionless form suitable for sensor design and for analysis of measurement data.     

Fecal diversion in the management of Crohn's disease of the colon

The clinical course of 44 patients undergoing elective proximal fecal diversion for Crohn's disease of the colon is reported. Sustained disease remission was obtained in 31 patients (70 percent). Diversion was associated with a significant reduction in steroid requirements (P<0.01) and a significant improvement in hemoglobin (P<0.001), erythrocyte sedimentation rate (P<0.001), and albumin (P<0.05). Sixteen patients (36.4 percent) have required a proctocolectomy, 19 patients (43.2 percent) remain defunctioned, and four patients (9 percent) have died. Five patients have had intestinal continuity restored, which has remained intact in four patients for a mean follow-up of 99 (range 21–153) months. Fecal diversion for Crohn's disease of the colon produces a high incidence of sustained disease remission, but for the majority of patients the prospect of future restoration of intestinal continuity is limited.     

The prevalence of ay and ad subtypes of the hepatitis B surface antigen in Belgium

Summary Subtyping in various groups of persons positive for hepatitis B surface antigen gave the following results: Among asymptomatic blood donors (healthy carriers) subtypead was found in 20, subtypeay in 24. Among symptomatic patients with acute hepatitis Bad was found in 25,ay in 29. Among patients of an institution for the mentally retardedad was found in 9,ay in 23. Among patients of a geriatric institutionay was found in 9; among medical personnel of the same geriatric institutionay was found in 3 persons. Among symphilis patientsad was found in 6,ay in 29; and in patients of a dialysis centreay was found in 6. These data show that neither subtype is really dominant in Belgium.

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Vorkommen der Hepatitis-B-Oberflächenantigen-Subtypen ay und ad in Belgien

Zusammenfassung Die Bestimmung der Subtypen an verschiedenen Personengruppen mit positivem Hepatitis-B-Oberflächenantigen erbrachte folgende Ergebnisse: Unter asymptomatischen Blutspendern (gesunde Träger) wurde der Subtypad bei 20, der Subtypay bei 24 festgestellt. In einer Gruppe symptomatischer Patienten mit akuter Hepatitis B wurdead bei 25 unday bei 29 ermittelt. Patienten einer Anstalt für geistig Behinderte wiesenad in 9 Fällen unday in 23 Fällen auf. Unter den Patienten einer geriatrischen Klinik wurdeay bei 9 Personen festgestellt, desgleichen bei 3 Personen des ärztlichen Personal derselben geriatrischen Klinik. Bei syphilitischen Patienten wurdead in 6 Fällen unday in 29 Fällen ermittelt. Unter den Patienten eines Dialysezentrums fand sichay in 6 Fällen. Diese Ergebnisse zeigen, daß keiner der beiden Subtypen in Belgien wirlich dominiert.

     

Intake policy as a community organization tool

The intake policy of an agency is presented as an integral part of an agency's impact upon community organization and hence as crucial in the effectiveness and efficiency with which it carries out the mission of total community care. Three possible models for intake policy are elaborated: direct service, extended community management, and extensive community development. Under the latter model the judicious development, communication, and implementation of intake policy are evaluated in terms of impact in creating productive community ferment and thus fostering a community-wide examination of and involvement in the development of adequate services.     

Toward a new philosophy of care: Perspectives on prevention

The history of medical care in America and the present practice of mental health professionals generally reflect the economic structure of the country and of supply and demand. Revision is seriously needed in the areas of service delivery and training to give emphasis to primary prevention, and this requires social action on two levels: redirection of national priorities and development of a new philosophy of care founded in service and committed to prevention. Prevention is a form of response that can be made to existing and anticipated societal difficulties, to attempts to resolve them, and thus to planning properly for the future. Such plans must involve specific goals, purposes, attainable relevant programs, and the ability of providers and consumers to plan and act collaboratively; education of both providers and consumers: and making use of the political process to support this new philosophy of care both morally and financially. The tools of modern technology can be adapted and brought to bear on the problem of mental health care and mental illness prevention so that society can move beyond past failures to a system of care for the mentally ill that can keep pace with our complex modern society.