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Query: UMLS:C0010346 (Crohn's disease)
 21,615 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The clinical course of Crohn's disease in 131 patients was studied for a mean period of 4.2 +/- 3.2 years. The clinical activity of the disease, expressed as percentage of patients per year in an active phase, is high in the first year (70.2 percent) and progressively decreases during subsequent years (25 percent after seven years). The percentage of patients who needed steroid treatment is high during the first year (68 percent) and falls to 19 percent after seven years. An operative risk rate of 54 percent was registered, with a probability of reoperation equal to 34 percent. Clinical relapse after the first surgery occurred in 70 percent of cases. The registered mortality was 6.9 percent, with a ratio of 6 to 1 between observed and expected mortality. In conclusion, the disease, while showing a tendency to reduce its activity over the years, is burdened by a risk of surgery and mortality which progressively increases with time.
Dis Colon Rectum 1987 Nov
PMID:Clinical course of Crohn's disease in Italy. 367 64

Between 1981 and 1986, transanal rectal advancement flaps were employed in the surgical management of 39 anorectal fistulas at the Cleveland Clinic. Included were 23 low rectovaginal, 12 fistulas-in-ano and, four rectourethral fistulas. Nineteen fistulas occurred in patients with Crohn's disease while the other 20 included 11 due to obstetric or surgical injury. This technique has become the Clinic's standard management for low rectovaginal fistulas but is reserved for complex fistulas-in-ano. Active proctitis or malignancy are contraindications to the procedure. Surgery requires elevation of a broad-based rectal flap, curettage of the tract, and advancement and primary suture of the flap over the internal opening. Fistulas were eradicated in 27 cases (69.2 percent) including 11 of 19 due to Crohn's disease (57.9 percent) and 16 of the 20 (80.0 percent) from other causes (mean follow-up, 25 months). Rectovaginal fistulas healed in 60.0 percent of those with Crohn's disease compared with 76.9 percent of those due to other causes. Complex fistulas-in-ano in Crohn's disease did less well. Only two of six of these fistulas healed. Temporary stomal diversion was used on nine occasions and a successful outcome was achieved in only four, indicative of the greater complexity of these cases. It is concluded that the transanal rectal advancement flap can be an effective method of repair for fistulas of the anorectal region including selected cases due to Crohn's disease.
Dis Colon Rectum 1987 Dec
PMID:The use of transanal rectal advancement flaps in the management of fistulas involving the anorectum. 369 Dec 61

Seven patients with widespread, active, stricturing, small intestinal Crohn's disease and two with localized disease were treated by a total of 45 strictureplasties. They have been followed up for a mean of 20 months (range 6 to 30). Two patients had early postoperative complications with enterocutaneous fistulas, one of which may have been related to a strictureplasty. The two patients with localized disease remain well after 16 and 30 months. Of the seven patients with extensive small bowel disease, two are well six and 28 months after surgery. Recurrent symptoms developed in six patients two to six months postoperatively; four of those patients required further surgery. Previous reports of strictureplasty in inactive Crohn's strictures suggest it is a safe operation with good long-term results. Strictureplasty in active Crohn's disease has a much higher recurrence rate of symptoms. Because it is a conservative operation, however, we believe it has a place in the surgical treatment of Crohn's disease.
Dis Colon Rectum 1986 May
PMID:Strictureplasty. A good operation for small bowel Crohn's disease? 369 54

Fifteen black patients with Crohn's disease were seen during a ten-year period (1975-1985). They represented 11 percent of our experience with Crohn's disease during that time. These patients had an earlier age of onset of Crohn's symptoms than our white patients, and correct diagnosis was delayed for an average of four years. All 15 patients required abdominal surgery, and seven (47 percent) suffered recurrences necessitating additional abdominal operations. The five-year actuarial estimate of probability of reoperation was 77 percent. Extraintestinal manifestations were present in all patients, and six (40 percent) had multiple manifestations. These disease manifestations are more severe than those noted in series that studied predominantly caucasian Crohn's populations, and suggest that Crohn's disease in the black patient is a distinctly aggressive form.
Dis Colon Rectum 1986 May
PMID:Clinical and operative experience with non-Caucasian patients with Crohn's disease. 369 55

Three cases of secondary amyloidosis are reported, two in patients who had unequivocal Crohn's disease and one in whom the clinical course was that of Crohn's disease, but with histologic findings that were more suggestive of ulcerative colitis. All had evidence of renal failure. A prospective study of 177 patients with inflammatory bowel disease of greater than five years' duration was carried out in an attempt to establish the incidence of secondary amyloidosis, using rectal biopsy and simple renal function tests. No new cases were found. Neither was there evidence of renal failure due to other conditions. In the absence of renal dysfunction, a search for secondary amyloidosis probably is not justified.
Dis Colon Rectum 1986 May
PMID:The incidence of amyloidosis complicating inflammatory bowel disease. A prospective survey of 177 patients. 369 59

The prevalence of Toxoplasma infection among patients with inflammatory bowel disease was studied. The Sabin-Feldman dye test was performed on 35 patients with Crohn's disease, 44 patients with ulcerative colitis, and 140 control patients. A higher incidence of positive reactions was found in Crohn's disease patients over the age of 40 (P less than 0.05). All other factors showed no significant differences among the three groups of patients. These factors include age younger than 40 years, sex, duration of disease, extent of disease, and type of treatment. It is concluded that there is no correlation between inflammatory bowel diseases and toxoplasmosis. Toxoplasma infection, however, should be considered in patients with Crohn's disease who are over 40 years old, and who present with nonspecific signs of intercurrent infection.
Dis Colon Rectum 1986 Jun
PMID:Sabin-Feldman dye test in ulcerative colitis and Crohn's disease. 370 18

The records of 187 patients with Crohn's disease who underwent resectional surgery were analyzed to evaluate the effect of several clinical and histologic features on the recurrence rate. Recurrence was defined as the need for re-resection. The data were analyzed by the life-table method. Age, sex, age at onset of disease and at time of resection, family history, presence of granuloma, and microscopic involvement at the line of resection did not affect the recurrence rate. The distribution of the disease and duration of symptoms before primary resection did influence the rate of re-resection. Patients with predominantly large bowel disease (N = 56) were found to have a higher rate of re-resection (45 percent) when compared with 32 percent in patients with small bowel involvement (N = 94) and with 35 percent in patients with both small and large bowel involvement (N = 37) (P = 0.04). A detailed review, an analysis of the literature, and a comparison with our results are made.
Dis Colon Rectum 1986 Aug
PMID:Factors affecting recurrence following resection for Crohn's disease. 373 65

As the etiology of inflammatory bowel disease remains unknown, studies of its time trends may provide clues to understanding the underlying mechanisms. This study examines mortality from Crohn's disease and ulcerative colitis in England and Wales and the U.S. during the period 1950 to 1983. Mortality from Crohn's disease and ulcerative colitis changed in both countries similarly. The death rates from Crohn's disease increased until 1970 to 1974 and decreased thereafter. The death rates from ulcerative colitis decreased throughout the observation period. Similar time trends occurred in men and women, and in the U.S. in whites and nonwhites. In the U.S., the death rates from both diseases were twofold higher in whites than nonwhites. The temporal changes suggest that mortality from inflammatory bowel disease is affected by exogenous factors and that these factors are different for Crohn's disease than for ulcerative colitis. These factors seem to have changed similarly in England and in the U.S.
Dis Colon Rectum 1986 Oct
PMID:Mortality from Crohn's disease and ulcerative colitis in England-Wales and the U.S. from 1950 to 1983. 375

A patient with incarcerated Crohn's appendicitis and a spigelian hernia is presented, representing the challenge in diagnosis, incision choice, and choice of definitive surgical procedure. While it is unlikely that the report of such a patient's course will make prospective recognition of this rare entity more likely, a systematic approach to this patient has allowed a satisfactory result with minimal complications.
Dis Colon Rectum 1986 Oct
PMID:Crohn's appendicitis in an incarcerated spigelian hernia. 375 8

From 1976 to 1984, 43 patients with psoas abscess were seen at the Mayo Clinic. Intestinal disease, including Crohn's disease, diverticulitis, and carcinoma, was the most frequent cause (14 patients). Eleven patients had osteomyelitis, five had postoperative complications, four had a foreign-body reaction, and three had a primary staphylococcal abscess. Two patients each had extension of a primary pancreatic and perinephric abscess. One patient had tuberculosis of the spine, and in the remaining patient, an exact cause was not determined. Definitive treatment of psoas abscess includes adequate debridement, drainage of the abscess cavity, and resection of involved bowel.
Dis Colon Rectum 1986 Nov
PMID:Psoas abscess: changing patterns of diagnosis and etiology. 376 83


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