WorldWideScience

Sample records for bei morbus crohn

  1. Percutaneous abscess drainage in Crohn`s disease; Perkutane Abszessdrainage bei Morbus Crohn

    Energy Technology Data Exchange (ETDEWEB)

    Strotzer, M.; Manke, C.; Feuerbach, S. [Klinikum der Univ. Regensburg (Germany). Inst. fuer Roentgendiagnostik; Lock, G.; Bregenzer, N.; Schoelmerich, J. [Klinikum der Univ. Regensburg (Germany). Klinik und Poliklinik fuer Innere Medizin I

    1998-11-01

    Purpose: To evaluate the success of percutaneous, CT-guided abscess drainage (PAD) in patients with Crohn`s disease. Methods: Within the last 5 years 8 patients with Crohn`s disease were treated by PAD for intra-abdominal abscesses. A fistula was determined to be the cause in 4 patients. The abscesses arose spontaneously in 7 patients while one patient had a postperative abscess. We used single lumen 10F- and double lumen 12F- and 14F-catheters for drainage (duration of drainage 8-20 days). Results: In all cases the abscess was successfully drained by PAD. However, an operation-free interval of at least three months was achieved in only two patients. A healing of the fistula was not attained in any of the 4 patients with a proven fistula. No enterocutaneous fistulas arose within the course of PAD. Conclusions: PAD is also useful for patients with Crohn`s disease since it improves the starting situation for the necessary operative interventions. In most cases (especially with enterogenic fistulas), however, a long-lasting therapeutic result cannot be expected. (orig.) [Deutsch] Ziel: Bewertung des Erfolges der perkutanen CT-gezielten Abszessdrainage (PAD) bei Patienten mit Morbus Crohn. Methoden: 8 Patienten mit Morbus Crohn wurden innerhalb der letzten 5 Jahre wegen intraabdomineller Abszesse mittels PAD behandelt. Als Ursache wurde bei 4 Patienten eine Fistel nachgewiesen. Bei 7 Patienten waren die Abszesse spontan entstanden, bei einem Patienten handelte es sich um einen postoperativen Abszess. Zum Einsatz kamen einlumige 10F- und doppellumige 12F- und 14F-Drainagekatheter (Drainagedauer 8-20 Tage). Ergebnisse: In allen Faellen konnte durch die PAD eine Entlastung der Abszesse erzielt werden. Ein operationsfreies Intervall von mindestens drei Monaten wurde nur bei zwei Patienten erreicht. Bei keinem der 4 Patienten mit Fistelnachweis wurde eine Ausheilung der Fistel erreicht. Es kam im Rahmen der PAD zu keiner Bildung von enterokutanen Fisteln. Schlussfolgerungen

  2. Laktoseintoleranz bei Morbus Crohn und Colitis ulcerosa unter Berücksichtigung der ethnischen Herkunft

    OpenAIRE

    Demirci, Ilknur

    2007-01-01

    Die Frage der Inzidenz einer Laktosemalabsorption bei Morbus Crohn und Colitis ulcerosa wurde retrospektiv unter Berücksichtigung der ethnischen Herkunft untersucht. Bei 243 Patienten wurden zur Diagnose einer Laktosemalabsorption der Laktosetoleranztest und der H2-Atemtest durchgeführt. Dabei fand sich bei 23 (14,3%) von 161 Morbus Crohn Patienten eine Laktosemalabsorption. Nach ethnischer Differenzierung, zeigte sich in der mitteleuropäischen Population eine Häufigkeit von 13,2%...

  3. Bildgebung bei Morbus Crohn: Konventionelles Enteroklysma, CT-Enteroklysma oder MR-Enteroklysma?

    Directory of Open Access Journals (Sweden)

    Sailer J

    2006-01-01

    Full Text Available Die Endoskopie mit der Möglichkeit zur Biopsie stellt weiterhin den Goldstandard in der Diagnose des Morbus Crohn dar, allerdings mit der Einschränkung, daß das terminale Ileum bei der Kolonoskopie nicht immer eingesehen werden kann und die Enteroskopie nicht universell zur Verfügung steht. Für die Dünndarmdiagnostik sind daher das konventionelle Enteroklysma, das CT-Enteroklysma und das MR-Enteroklysma unverzichtbare Methoden zur Diagnose des Morbus Crohn. Die Bildgebung gibt Information über Grad, Lokalisation und Ausdehnung des entzündlichen Darmwandbefalles. Schnittbildverfahren wie das CT- oder MR-Enteroklysma liefern ausgezeichnete Information über Ausmaß und Ausdehnung extraintestinaler Komplikationen des Morbus Crohn. Alle erwähnten Methoden erfordern eine nasojejunale Sonde, über welche Flüssigkeit direkt in den Dünndarm appliziert wird. Die Flüssigkeitsdistension des Dünndarmes ist zur Beurteilung der Darmwand bzw. der Schleimhaut unerläßlich. Die Frühform des Morbus Crohn mit kleinsten aphthoiden Schleimhautläsionen wurde ursprünglich am besten mit dem konventionellen Doppelkontrast-Enteroklysma diagnostiziert, wobei diese Untersuchungsmodalität zunehmend vom CT-Enteroklysma abgelöst wird. Das CT-Enteroklysma bietet neben der Darstellung diskretester Schleimhautveränderungen zusätzlich die Möglichkeit zur Detektion von transmuralen und extraintestinalen Komplikationen des Morbus Crohn und wird beim präoperativen Staging oder zur postoperativen Verlaufskontrolle eingesetzt. Fortschritte in der Technik der MR-Bildgebung erlauben nun auch den Einsatz des MR-Enteroklysmas, mit dem Vorteil der fehlenden Strahlenbelastung, weswegen das MR-Enteroklysma gerade bei jüngeren Patientinnen und Patienten eingesetzt wird. Trotz verstärkten Einsatzes der Kapselvideoendoskopie bieten insbesondere CT- und MR-Enteroklysma ausgezeichnete Ergebnisse in der Darstellung des Dünndarms und zur Diagnose des Morbus Crohn. Das

  4. Crohn`s disease: current imaging approach; Die radiologische Abklaerung des Morbus Crohn

    Energy Technology Data Exchange (ETDEWEB)

    Schober, E.; Turetschek, K. [Klinische Abt. Roentgen fuer konservative Faecher, Universitaetsklinik fuer Radiodiagnostik, Vienna (Austria); Mostbeck, G. [Roentgeninstitut, Krankenhaus der Barmherzigen Brueder, Eisenstadt (Austria)

    1998-01-01

    Purpose: This paper discusses the role of different imaging modalities in the diagnostic work-up of Crohn`s disease (CD). Methods: We present a concept, which emphasizes different diagnostic aspects with regard to primary diagnosis, follow-up and assessment of complications of CD. The most effective imaging approach to various diagnostic problems of CD is discussed in detail. Discussion: With regard to the primary diagnosis barium studies should contribute to differentiate between CD and ulcerative colitis. Beyond that, these studies should evaluate location and extent of disease. During the follow-up bowel sonography provides staging of disease and enables the detection of complications at an early stage. CT is a valuable tool in the preoperative assessment of complications, such as fistuale and abscesses. (orig.) [Deutsch] Die vorliegende Uebersichtsarbeit soll die Rolle bildgebender radiologischer Modalitaeten bei der interdiziplinaeren Betreuung von Patienten mit Morbus Crohn (MC) diskutieren. Es wird ein Konzept vorgestellt, welches die unterschiedlichen Anforderungen an die bildgebende Diagnostik im Rahmen der Erstdiagnose, der Verlaufskontrolle sowie bei der Erfassung von Komplikationen eines MC definiert. Davon ausgehend wird versucht, fuer die einzelnen Fragestellungen die jeweils effektivste radiologische Abklaerung vorzuschlagen. Mehrere Tabellen ermoeglichen einen raschen und komprimierten Ueberblick der diagnostischen Problemstellungen im Rahmen einer schrittweisen Abklaerung der Erkrankung. Im Rahmen der Erstdiagnostik soll die radiologische Duenndarmdarstellung bei der Differentialdiagnose (MC vs. Colitis ulcerosa) hilfreich sein und das genaue Ausmass des Duenndarmbefalles eruieren. Im Rahmen der klinischen Verlaufskontrolle ist die Darmsonographie ideal zur Ueberwachung der Erkrankung sowie zur fruehen Erfassung von Komplikationen geeignet. Bei geringstem Verdacht auf eine Komplikation sollte sofort eine CT durchgefuehrt werden. (orig.)

  5. Computed tomography of Crohn`s disease and ulcerative colitis; Computertomographische Morphologie von Morbus Crohn und Colitis ulcerosa

    Energy Technology Data Exchange (ETDEWEB)

    Klein, H.M. [Klinik fuer Radiologische Diagnostik der RWTH, Aachen (Germany); Wein, B. [Klinik fuer Radiologische Diagnostik der RWTH, Aachen (Germany); Adam, G. [Klinik fuer Radiologische Diagnostik der RWTH, Aachen (Germany); Ruppert, D. [Klinik fuer Radiologische Diagnostik der RWTH, Aachen (Germany); Guenther, R.W. [Klinik fuer Radiologische Diagnostik der RWTH, Aachen (Germany)

    1995-07-01

    We analysed the CT examinations of 109 patients with 197 involved bowel locations. 81 patients suffered from Crohn`s disease, 28 from ulcerative colitis. Diagnosis was based on the combination of clinical, endoscopic and histopathologic findings. Three radiologists evaluated the CT series concerning the presence of morphologic changes analogous to conventional radiographic findings. In Crohn`s disease, we found irregular outer contours in 26% of cases. The bowel wall was thickened in 82%. In acute phases, the bowel wall was thickened in 100%. Abscess and fistula as complications of inflammatory disease were present in 26 and 14% respectively. In ulcerative colitis, a target sign of the bowel wall was present in 40%, whereas in Crohn`s disease a homogeneous wall density was present in all but two cases. Reduced attenuation due to submucosal fat deposits was found in 16% and mucosal tunneling in 27% of cases with ulcerative colitis. Even if severe mucosal destructions were found, the outer contour of the gut was smooth and regular in 95% of the ulcerative colitis cases. CT can provide additional information on acuity, extent and complications in inflammatory bowel disease. In combination with conventional radiographic findings a three-step classification for Crohn`s disease and ulcerative colitis (early changes, acute and chronic phase) can be proposed. (orig./MG) [Deutsch] Wir untersuchten computertomographisch 109 Patienten mit 197 erkrankten Darmsegmenten. 81 Patienten litten an M. Crohn und 28 an Colitis ulcerosa. Die Diagnose wurde durch Kombination klinischer, endoskopischer, radiologischer und bioptischer Befunde gesichert. Drei Radiologen bewerteten die Computertomographien und verglichen die Ergebnisse mit den konventionell-radiologischen Befunden. Bei den Patienten mit M. Crohn fanden wir in 26% der Faelle eine irregulaere aeussere Darmwand. Eine Darmwandverdickung lag in 82% vor und fand sich regelmaessig in Darmabschnitten mit floriden Veraenderungen

  6. Erfassung und Trainierbarkeit der posturalen Kontrolle und Modulation des Gangbildes bei Patienten mit Morbus Parkinson

    OpenAIRE

    2015-01-01

    Die vorliegende Arbeit gliedert sich in drei Teile. Zunächst geht es um die Erfassung der posturalen Instabilität bei Patienten mit Morbus Parkinson. Es wurde ein klinischer Gleichgewichtstest (Fullerton Advanced Balance (FAB) Scale) zur Erhebung der posturalen Kontrolle validiert und mit der Berg Balance Scale und dem Mini-Balance Evaluation System Test (Mini-BESTest) verglichen. Hierfür wurden 85 Parkinsonpatienten eingeschlossen und untersucht. Es konnte gezeigt werden, dass die FAB Sc...

  7. Magnetic resonance imaging for ankylosing spondylitis; Magnetresonanztomographie bei ankylosierender Spondylitis (Morbus Struempell-Marie-Bechterew)

    Energy Technology Data Exchange (ETDEWEB)

    Bollow, M. [Augusta-Kranken-Anstalt, Inst. fuer Radiologie, Bochum (Germany)

    2002-12-01

    ] Die ankylosierende Spondylitis (AS) gilt als Prototyp der Spondylarthropathien, welche mit einer Praevalenz von 2% zu den haeufigsten rheumatischen Erkrankungen gerechnet werden. Die Spondylarthropathie umfasst die 5 Entitaeten AS, reaktive Arthritis, Psoriasis arthropathica, enteropathische Arthritis bei Morbus Crohn und Colitis ulcerosa und die undifferenzierte Spondylarthropathie. Bei 99% der Patienten mit AS sind die ersten pathologischen Befunde an den Sakroiliakalgelenken zu finden. Die zur Diagnose einer AS geforderten Roentgenbefunde treten erst mit einer Latenz von 5-9 Jahren nach Beginn der klinischen Symptome in Erscheinung. Mit Hilfe der MRT der Sakroiliakalgelenke lassen sich sowohl chronisch-entzuendliche Veraenderungen (Erosionen, Sklerosierungen, Knochenbruecken) als auch akut-entzuendliche Veraenderungen (Synovitiden, Kapsulitiden, Osteitiden) sicher nachweisen und bezueglich ihrer Chronizitaet und Akuitaet graduieren. Enthesitiden der Ligamenta interossea des Spatium retroarticulare gehoeren zum Bild der AS. Eine Spondylodiszitis (Andersson 1937) kann als entzuendliche und als nichtentzuendliche Form (transdiskaler Ermuedungsbruch) auftreten. Zur Ankylosierung fuehrende Entzuendungen der Facetten- und der kostospinalen Gelenke sind fuer die AS typisch. Veraenderungen der Wirbelkoerper finden sich als Spondylitis anterior (Romanus 1952), posterior und marginalis. Charakteristisch fuer alle Spondylarthropathien sind darueberhinaus asymmetrische Synovitiden an den grossen Gelenken vor allem der unteren Extremitaet (Gonarthritis, Coxitis, Tarsitis, periphere Oligoarthritis), die Fibroostitis rheumatica (pelvine Enthesitis, Calcaneopathia rheumatica) und die Peri- und Synchondritiden der Symphysis pubica und der Synchondrosis sternalis. Da sich bei der AS fruehe entzuendliche Veraenderungen an der Wirbelsaeule und an den extravertebralen Manifestationsorten in der MRT vor deren Auftreten im Roentgenbild nachweisen lassen und damit die diagnostische Luecke

  8. Diagnose und Therapie der Depression bei Morbus Parkinson

    Directory of Open Access Journals (Sweden)

    Klein N

    2004-01-01

    Full Text Available Depressive Episoden sind die häufigsten psychiatrischen Komplikationen bei MP, erschweren oft wesentlich dessen Verlauf und setzen die Lebensqualität der Patienten weiter herab. Als mögliche Risikofaktoren für die Entstehung einer depressiven Symptomatik bei MP gelten: junges Lebensalter und jugendlicher Ausbruch des MP, weibliches Geschlecht, rechtsseitiger Hemiparkinsonismus, zunehmender Schweregrad der körperlichen Beeinträchtigung, Akinesie, Angst und psychotische Symptomatik. Durch die große Überschneidung von Symptomen des MP und der Depression kann es schwierig sein, die Diagnose "Depression bei MP" zu stellen. Der Neuropsychiater sollte diese Komplikation bei MP erwarten bzw. suchen. Pathophysiologisch korreliert die Depression bei Patienten mit MP sowohl mit dem Mangel an Dopamin als auch mit der Beeinträchtigung serotonerger und noradrenerger Neurotransmission. Eine nicht unwesentliche Ursache der Depression bei MP ist auch der Streß, den eine behindernde, chronische und unheilbare Erkrankung subjektiv im Patienten erzeugt. Obwohl die Depression einen entscheidenden Einfluß auf die Lebensqualität der Patienten und ihrer Angehörigen hat und der Behandlung daher ein wichtiger Stellenwert zukommt, wurden bis zum heutigen Tag nur unzureichende Untersuchungen zur Therapie der Depression bei MP durchgeführt. Für die Zukunft gilt es, anhand der Ergebnisse von randomisierten, doppelblinden Studien, Behandlungsalgorithmen für die Therapie der Depression bei Patienten mit MP zu entwickeln.

  9. Förekomst av karies och parodontit hos personer med Morbus Crohn

    OpenAIRE

    Johansson, Annika; Olsson, Sara

    2012-01-01

    Syftet med litteraturstudien var att undersöka förekomsten av karies och parodontit hos personer med Morbus Crohn. Metoden som användes var en allmän litteraturstudie. Materialet till litteraturstudien samlades in genom sökning i databaserna Cinahl, PubMed och ScienceDirect. De sökord som användes vid litteratursökningen i samtliga databaser var ”caries”, ”Crohn’s disease”, ”periodontal disease” och ”periodontitis”. Vetenskapliga artiklar som fick ingå i litteraturstudien begränsades till ”En...

  10. PET and SPECT investigations in Alzheimer's disease; Nuklearmedizin und Demenz - Anwendung bei Morbus Alzheimer

    Energy Technology Data Exchange (ETDEWEB)

    Asenbaum, S. [Universitaetsklinik fuer Nuklearmedizin, Universitaetsklinik fuer Neurologie, Wien (Austria); Abteilung fuer klinische Neurologie, Universitaetsklinik fuer Neurologie, Waehringer Guertel 18-20, 1090, Wien (Austria)

    2003-07-01

    Nuclear medicine offers a wide range of possibilities to investigate dementia. Various SPECT and PET tracers will be introduced in this article first. Different questions concerning evaluation of dementia are discussed taking Alzheimer's disease (AD) as an example. It is important to perform nuclear medicine investigations on high technical level, using standardized methods as statistical parametric mapping (SPM) for evaluation. If neuroprotective therapies are available, an early diagnosis, the determination of risk factors and longitudinal investigations will be the focus of interest and the main goal of nuclear medicine. Apart from measuring cerebral perfusion and glucose metabolism the development of new ligands, concerning the cholinergic system and the visualization of amyloid plaques, is of great importance. (orig.) [German] Nuklearmedizin bietet bei der Erfassung und Beurteilung eines dementiellen Prozesses eine Vielzahl von Untersuchungsmoeglichkeiten. Anhand des Morbus Alzheimer (DAT) werden in dem vorliegenden Artikel neben einer kurzen Schilderung der zur Verfuegung stehenden Methoden die verschiedenen nuklearmedizinisch relevante Fragestellungen angefuehrt, zu deren Beantwortung die funktionelle Bildgebung Informationen liefern kann. Durch den Einsatz bestimmter, standardisierter Auswerteverfahren wie statistical parametric mapping (SPM) ist es moeglich, entscheidende Hinweise zur Diagnose und Differenzialdiagnose der DAT zu erlangen. In Zukunft werden, insbesondere bei einer Verfuegbarkeit neuroprotektiver Therapien, eine moeglichst fruehe Diagnosestellung und die Erfassung von Risikofaktoren sowie die Moeglichkeit einer Verlaufsbeobachtung in den Mittelpunkt des Interesses und in das Zentrum nuklearmedizinischer Untersuchungen ruecken. Vor allem fuer diese Anforderungen ist neben der qualitaetsvollen Untersuchung von zerebraler Perfusion und Glukosestoffwechsel eine Weiterentwicklung spezieller Liganden v. a. das cholinerge System betreffend und

  11. Optimization of radiotherapy for Dupuytren's disease; Optimierung der Radiotherapie bei Morbus Dupuytren. Erste Ergebnisse einer kontrollierten Studie

    Energy Technology Data Exchange (ETDEWEB)

    Seegenschmiedt, M.H.; Olschewski, T.; Guntrum, F. [Alfried-Krupp-Krankenhaus Essen (Germany). Klinik fuer Radioonkologie, Strahlentherapie und Nuklearmedizin

    2001-02-01

    prophylactic radiotherapy for the contralateral hand due to disease progression. Conclusions: Prophylactic radiotherapy reduces symptoms and prevents disease progression in early-stage Dupuytren's disease. Both treatment concepts are well-tolerated and equally effective. Acute toxicity is slightly increased with treatment concept B (7 times 3 Gy), while chronic sequelae are low in both treatment groups. Long-term evaluation with follow-up of more than 5 years has to be awaited to recommend one or the other dose concept. (orig.) [German] Ziel: Es werden zwei Dosiskonzepte bei Bestrahlung des Morbus Dupuytren verglichen, um die Progression der Erkrankung bzw. eine Handoperation zu verhindern. Patienten und Methode: 129 Patienten (67 Maenner, 62 Frauen) wurden prospektiv in zwei Gruppen behandelt und fuer mindestens ein Jahr nachbeobachtet. 69 Patienten waren an beiden Haenden, 60 an einer Hand erkrankt (gesamt: 198 bestrahlte Haende). Nach Tubiana befanden sich 73 Haende im Stadium N, 61 im Stadium N/I ({<=}10 Beugekontraktur), 59 im Stadium I (11 bis 45 ) und fuenf im Stadium II (46 bis 90 ). Bestrahlt wurde am Orthovoltgeraet (120 kV) mit 40 cm Abstand und individuellen Bleigummi-Blenden. Gruppe A (63 Patienten/95 Haende) erhielt 10-mal 3 Gy (gesamt: 30 Gy); 5-mal 3 Gy taeglich in zwei Serien, acht Wochen Pause zwischen den Serien; Gruppe B (66 Patienten/103 Haende) erhielt 7-mal 3 Gy (gesamt: 21 Gy) in zwei Wochen. Die Patienten- und Krankheitsparameter waren in beiden Gruppen gleich verteilt. Die Auswertung (Toxizitaet, Effektivitaet) erfolgte drei und zwoelf Monate nach Bestrahlung. Subjektive (Patient) und objektive Parameter (Palpation, Messungen, Photovergleich-Arzt) wurden bewertet. Ergebnisse: Die Akuttoxizitaet war gering: 76 (38%) Haende hatten Hautreaktionen CTC-Grad 1 und zwoelf (6%) CTC-Grad 2. Chronische Folgen (Trockenheit, Atrophie, Sensibilitaetsstoerungen, LENT-Grad 1) traten bei neun (5%) Haenden auf. Drei und zwoelf Monate nach Radiotherapie wurde

  12. Cerebral neurotransmission in huntington's disease and wilson's disease; Zerebrale Neurotransmission bei Chorea Huntington und Morbus Wilson

    Energy Technology Data Exchange (ETDEWEB)

    Barthel, H.; Sabri, O. [Klinik und Poliklinik fuer Nuklearmedizin, Univ. Leipzig (Germany)

    2002-09-01

    Huntington's disease and Wilson's disease are hereditary disorders with different neuropsychiatric symptoms. In both cases, these symptoms are mainly attributed to functional alterations of neurons, which are located in the basal ganglia. According deficits have been found by investigating the dopaminergic neurotransmission with different PET and SPECT tracers. For both diseases, these deficits revealed to concordantly involve the pre- and postsynaptic compartment. Apart from the dopaminergic system, more recent studies showed alterations of other neurotransmitter systems, like the serotonergic, GABA-ergic and opioide system. Except for scientific studies, nuclear medicine imaging is not regularly required for primary diagnosis of both disorders. In the case of Huntington's disease, however, imaging can be helpful for differential diagnosis to other diseases with similar initial symptoms and to determine the organic manifestation of the gene defect. In addition, neurotransmitter imaging with radiortracers could gain more relevance in the future in supporting decisions on specific treatments or for therapy monitoring in both diseases. (orig.) [German] Bei der Chorea Huntington und dem Morbus Wilson handelt es sich um erbliche Erkrankungen mit unterschiedlicher neuropsychiatrischer Symptomatik, welche im Wesentlichen auf Funktionsstoerungen von im Basalganglienbereich lokalisierten Neuronen zurueckgefuehrt werden. Untersuchungen der dopaminergen Neurotransmission mit verschiedenen PET- und SPECT-Radiopharmaka ergaben dementsprechende Defizite, welche fuer beide Erkrankungen konkordant das prae- und postsynaptische Kompartment betrafen. Juengere Studien deuten darueber hinaus auf Stoerungen anderer Neurotransmitter-Systeme, wie z.B. des serotonergen, GABAergen und Opioid-Systems, hin. Ausserhalb von wissenschaftlichen Fragestellungen ist die nuklearmedizinische Bildgebung bei beiden Erkrankungen in der Primaerdiagnostik eher selten erforderlich. Im

  13. Morbus Coats

    Science.gov (United States)

    Förl, B.; Schmack, I.; Grossniklaus, H.E.; Rohrschneider, K.

    2010-01-01

    Der fortgeschrittene Morbus Coats stellt im Kleinkindalter eine der schwierigsten Differenzialdiagnosen zum Retinoblastom dar. Wir beschreiben die klinischen und histologischen Befunde zweier Jungen im Alter von 9 und 21 Monaten mit einseitiger Leukokorie. Trotz umfassender Diagnostik mittels Narkoseuntersuchung, MRT und Ultraschall konnte ein Retinoblastom nicht sicher ausgeschlossen werden, und es erfolgte eine Enukleation. Histologisch wurde die Diagnose eines Morbus Coats gesichert. Da eine differenzialdiagnostische Abgrenzung zwischen Morbus Coats und Retinoblastom schwierig sein kann, halten wir in zweifelhaften Fällen auch angesichts der eingeschränkten Visusprognose und potenzieller Sekundärkomplikationen beim fortgeschrittenen Morbus Coats eine Enukleation für indiziert. PMID:18299842

  14. Determination of factors influencing the outcome of radioiodine therapy in patients with Graves` disease; Bestimmung von Einflussgroessen fuer den Therapieerfolg der Radioiodtherapie bei Patienten mit Morbus Basedow

    Energy Technology Data Exchange (ETDEWEB)

    Sabri, O.; Schulz, G.; Zimny, M.; Schreckenberger, M.; Zimny, D.; Wagenknecht, G.; Kaiser, H.J.; Dohmen, B.M.; Bares, R.; Buell, U. [Rheinisch-Westfaelische Technische Hochschule (RWTH), Aachen (Germany). Klinik fuer Nuklearmedizin

    1998-05-01

    Aim of this study was to determine whether success of radioiodine therapy (RIT) in Graves` disease depends on thyroid volume, function, thyroideal receptor antibodies (TRAK), thyresotasis, therapeutic dosage, {sup 131}I uptake, or effective half-life. Method: 78 patients received an average of 626{+-}251 MBq of iodine-131 orally for tyroid ablation. 60 were assessed for successful therapy 3 months after RIT. Results: In patients showing hyperthyreosis or a TRAK value >11 U/l at the beginning of RIT, a significantly lower therapeutic doseage and effective iodine half-life were found than in non-hyperthyreotic patients or patients with TRAK{<=}11 U/l. Patients with a thyroid volume {<=}25 ml showed a significantly lower {sup 131}I uptake, but a significantly higher relative uptake ({sup 131}I uptake/volume) than patients with a tyroid volume >25 ml. All failures were treated thyreostatically during RIT and showed a signifiantly lower therapeutic iodine dosage and relative uptake, as well as a significantly higher thyroid volume than patients with a successful therapy. RIT caused a thyroid volume reduction of 44%, with therapy failures showing a significantly lower volume reduction. Patients who received a therapeutic doseage of {<=}250 Gy showed significantly worse results than did those who had received >250 Gy. Only one case of therapy failure received a dosage >250 Gy, while 50% of failures received dosages >200 Gy but <250 Gy. Multivariate analyses (MANOVA, factor analyses) showed thyreostasis as the decisive negative factor for a successful course of therapy. Conclusions: Since most treatment failures occurred in patients under thyreostatic medication, we recommend raising the target dosage to 250 Gy for these cases. (orig.) [Deutsch] Ziel der Studie war es, zu pruefen, inwieweit der Erfolg einer Radioiodtherapie (RIT) des Morbus Basedow (MB) von verschiedenen Parametern (Schilddruesenvolumen [SDVol], Funktion, TRAK, Thyreostase, Therapiedosis, {sup 131}I

  15. Pathologie des Morbus Paget

    Directory of Open Access Journals (Sweden)

    Sulzbacher I

    2012-01-01

    Full Text Available Der Morbus Paget (MP ist eine fortschreitende, mono- oder polyostotische Knochenerkrankung mit pathologischem Remodeling, gekennzeichnet durch umschriebenen Knochenabbau mit Riesenosteoklasten und darauffolgendem unkoordiniertem Knochenaufbau. Die Erkrankung tritt generell nach dem 50. Lebensjahr auf und entspricht nach der Osteoporose der zweithäufigsten metabolischen Osteopathie. Im Mittelpunkt der heutigen ätiopathogenetischen Überlegungen stehen genetische Veränderungen, und zwar Mutationen, welche den osteoklastären RANK-NF-κB-Signalweg beeinträchtigen, sowohl bei Patienten mit familiärem als auch sporadischem MP. Inwieweit diese Mutationen eine kausale Rolle spielen oder lediglich zu einer gesteigerten bzw. abnormen Suszeptibilität gegenüber Umweltfaktoren wie Viren und anderen exogenen Noxen führen, bleibt jedoch weiter zu klären.

  16. Therapie bei CED: Aminosalizylate, Steroide und Probiotika

    Directory of Open Access Journals (Sweden)

    Eigner W

    2014-01-01

    Full Text Available Morbus Crohn (MC und Colitis ulcerosa (CU sind die Hauptformen der chronisch entzündlichen Darmerkrankungen (CED. Trotz neuer Therapieansätze in den vergangenen 15 Jahren spielen sowohl Glukokortikosteroide als auch 5-Aminosalizylat- (5-ASA- Präparate weiterhin eine große Rolle in der Behandlung von CED. Beide Wirkstoffgruppen können bei CED entweder topisch oder systemisch appliziert werden. Bei den Steroiden stehen systemisch wirksame Formen und das topisch wirksame Budesonid zur Verfügung. Welches Präparat und in welcher Applikation eingesetzt wird, entscheidet sich durch die Art der Erkrankung, den Befall und die Krankheitsaktivität. Das Probiotikum E. coli Nissle ist eine Alternative zu 5-ASA-Präparaten für die Erhaltung der Remission bei der mild verlaufenden CU.

  17. Measurement of thyrotropin receptor antibodies (TRAK) with a second generation assay in patients with Graves' disease; Die Bestimmung von Thyreotropin-Rezeptor-Antikoerpern (TRAK) mit einem Assay der zweiten Generation bei Patienten mit Morbus Basedow

    Energy Technology Data Exchange (ETDEWEB)

    Zoephel, K.; Wunderlich, G.; Franke, W.G. [Klinik und Poliklinik fuer Nuklearmedizin, Technische Univ. Dresden (Germany); Koch, R. [Inst. fuer Medizinische Informatik und Biometrie, Technische Univ. Dresden (Germany)

    2000-06-01

    Aim: The detection of TSH-receptor-antibodies (TRAb) in patients (pts) with Graves' disease (GD) is routinely used in nuclear medicine laboratories. It is performed by commercial, porcine radioreceptorassays (RRA) measuring TSH binding inhibitory activity. A second generation assay using the human, recombinant TSH-receptor was developed during the last years. The manufacturer composed this new assay as a coated tube RRA (CT RRA) and claimed a higher sensitivity for GD. Methods: TRAb was measured in 207 pts with various thyroid disorders and 205 healthy controls using the new coated tube RRA (Fa. B.R.A.H.M.S. Diagnostica GmbH, Berlin, Germany) as well as a conventional RRA (Fa. Medipan Diagnostica GmbH, Selchow, Germany): 60 pts suffering from GD showing a relapse after anti-thyroid drug treatment and before radioiodine therapy, 109 pts with disseminated autonomia (DA) and 38 pts suffering from Hashimoto's thyroiditis. A ROC-analysis was performed to find the optimal decision threshold level for positivity. Results: We found 42/60 TRAb-positive pts with GD in the established RRA (threshold 6 U/L) and 52/60 in the CT RRA, respectively. The sensitivity increased from 70% (RRA) to 86,7% (CT RRA). The CT RRA found 2 false positives (one Hashimoto's and one healthy control) and the RRA detected 3 Hashimoto's and 2 healthy controls as false positive. Conclusion: The increased sensitivity of CT RRA for GD provides an advantage compared to conventional RRA, especially in GD-patients relapsing afte antithyroid drug treatment. Functional sensitivity and Interassayvariation of CT RRA are very precisely compared to conventional RRA. Handling of the new assay is also improved. (orig.) [German] Ziel: Die Bestimmung der TSH-Rezeptorantikoerper (TRAK) bei Patienten mit Morbus Basedow ist fester Bestandteil der nuklearmedizinischen In-vitro-Diagnostik. Seit kurzem ist die Bestimmung mit einem TRAK-Assay moeglich, bei dem im Gegensatz zu den herkoemmlichen

  18. MR enterography sequence evaluation for patients with Crohn's disease; Sequenz-Evaluation fuer die MR-Enterografie fuer Patienten mit Morbus Crohn

    Energy Technology Data Exchange (ETDEWEB)

    Schleder, S.; Dendle, L.M.; Friedrich, C.; Wiggermann, P.; Stroszczynski, C.; Schreyer, A.G. [Universitaetsklinikum Regensburg (Germany). Inst. fuer Roentgendiagnostik; Pawlik, M. [Caritas-Krankenhaus St. Josef, Regensburg (Germany). Klinik fuer Anaesthesiologie, Intensiv- und Notfallmedizin; Ott, C. [Universitaetsklinikum Regensburg (Germany). Klinik und Poliklinik fuer Innere Medizin I; Agha, A. [Universitaetsklinikum Regensburg (Germany). Klinik und Poliklinik fuer Chirurgie

    2013-05-15

    Purpose: To evaluate a routine MR enterography (MRE) protocol for patients with Crohn's disease (CD) in order to assess and rank the subjectively most important sequences regarding diagnostic decisions. Materials and Methods: We prospective ly examined 84 patients (42 male) with known CD using a coronal T2/T1-weighted balanced SSFP (TrueFISP), axial T2-weighted single shot TSE (HASTE) as well as an axial T1-weighted gradient-echo sequence (2D-FLASH) before intravenous contrast application and a 2D-FLASH sequence with axial and coronal orientation after in travenous contrast application. 4 experienced radiologists subjectively evaluate d the sequences independently using a scale between 1 and 5 (1 = excellent; 5 = non-diagnostic) regarding their diagnostic significance for a final radiologic d ecision. The ranking of the different sequences was statistically tested by the Friedman analysis. Results: The following ranking was found: HASTE sequences wer e ranked prior to contrast-enhanced axial gradient-echo (2D-FLASH). The third to fifth ranking was TrueFISP, the axial contrast-enhanced 2D-FLASH and the 2D-FLA SH without contrast, respectively. Differences between the first and second rank were significant (p < 0.05), and all other differences were highly significant (p < 0.01). Conclusion: The stable and fast T2-weighted MR sequences without intravenous contrast represented by axial HASTE and coronal TrueFISP were ranked as number 1 and 3. The examination protocol should be completed by a coronal T 1-weighted gradient-echo-sequence after contrast injection, which can be supplemented by an axial acquisition. The T1-weighted gradient-echo sequence without contrast could be omitted. (orig.)

  19. Spondyloarthritis oder Morbus Bechterew: Neue Klassifikation der axialen Spondyloarthritis mit Morbus Bechterew als Endstadium

    Directory of Open Access Journals (Sweden)

    Schirmer M

    2011-01-01

    Full Text Available Mit einer Prävalenz von 0,6–1,9 % ist die axiale Spondyloarthritis (SpA der Sammelbegriff für eine Gruppe von entzündlichen rheumatischen Krankheiten, die vor allem das axiale Skelett und die Insertionsstellen der Sehnen am Knochen (Enthesen betreffen. Je nach Subtyp der SpA besteht eine unterschiedlich starke Assoziation mit dem MHC-I-Antigen HLA-B27. Entsprechend der „Assessment of Spondyloarthritis International Society“ (ASAS wird die SpA anhand der prädominant betroffenen Region in die periphere und die axiale Form unterteilt. Die aktuelle Klassifikation der axialen SpA erfolgt mittels der 2009 veröffentlichten ASAS-Kriterien. Bei Sakroiliitis in der Bildgebung müssen ≥ 1 SpAParameter, bei positivem HLA-B27-Befund ≥ 2 andere SpA-Parameter für die Klassifikation als SpA vorhanden sein. SpA-Parameter sind entzündlicher Rückenschmerz, Arthritis, Familienanamnese, Uveitis anterior, entzündliche Darmerkrankung, Psoriasis, Daktylitis, Enthesitis, gutes Ansprechen auf NSAR und HLA-B27-Positivität. Die Sensitivität dieser Kriterien liegt bei 82,9 %, die Spezifität bei 84,4 %. Für die axiale Beteiligung der Psoriasis arthropathica werden auch die ähnlichen CASPAR-Kriterien verwendet. Für die Klassifikation des Morbus Bechterew werden die 1984 modifizierten New York-Kriterien verwendet, bei denen neben spezifischen klinischen Kriterien radiologisch eine Sacroiliitis Grad 2 oder mehr bilateral oder Grad 3–4 unilateral vorhanden sein muss. Bei schwerem Verlauf kann prinzipiell jede Form der SpA mit einer axialen Beteiligung in einen Morbus Bechterew übergehen. Somit ist der Morbus Bechterew sowohl ein Subtyp der SpA, als auch eine mögliche Spätform anderer Subtypen. Zur Verlaufs- bzw. Therapiekontrolle werden sowohl bei axialer SpA als auch bei Morbus Bechterew spezifische Scores verwendet, um Krankheitsaktivität und Funktionsveränderungen zu dokumentieren (BASFI, BASDAI, ASDAS.

  20. Extraintestinale Manifestationen bei chronisch-entzündlichen Darmerkrankungen

    Directory of Open Access Journals (Sweden)

    Krones E

    2013-01-01

    Full Text Available Extraintestinale Manifestationen umfassen Krankheitsbilder, die außerhalb des Gastrointestinaltrakts bei Morbus Crohn und Colitis ulcerosa auftreten und eine gemeinsame Pathogenese vermuten lassen. Zu den häufigsten extraintestinalen Manifestationen zählen Gelenksbeschwerden sowie Hautmanifestationen, wie das Erythema nodosum oder das Pyoderma gangraenosum, Augenbeteiligungen im Sinne einer Episkleritis oder anterioren Uveitis und die primär sklerosierende Cholangitis. Diese Erkrankungen treten zum Teil schubassoziiert und zum Teil unabhängig von der Aktivität der begleitenden chronisch-entzündlichen Darmerkrankung (CED auf. Das therapeutische Management der schubassoziierten extraintestinalen Manifestationen besteht im Wesentlichen in der Therapie der CED. Neben extraintestinalen Manifestationen im engeren Sinn gilt es bei CED eine Vielzahl an extraintestinalen Komplikationen und assoziierten Autoimmunerkrankungen zu beachten.

  1. Thyroid volume reduction following radioiodine therapy in patients with autonomous goitre and Graves` disease; Volumenreduktion der Schilddruese nach Radiojodtherapie bei Patienten mit Schilddruesenautonomie und Morbus Basedow

    Energy Technology Data Exchange (ETDEWEB)

    Dederichs, B. [Klinik und Poliklinik fuer Nuklearmedizin, Univ. Koeln (Germany); Otte, R. [Klinik und Poliklinik fuer Nuklearmedizin, Univ. Koeln (Germany); Klink, J.E. [Klinik und Poliklinik fuer Nuklearmedizin, Univ. Koeln (Germany); Schicha, H. [Klinik und Poliklinik fuer Nuklearmedizin, Univ. Koeln (Germany)

    1996-10-01

    Aim: It is well known that radioiodine therapy (RITh) leads to a significant thyroid volume reduction (TVR). But until now only little data has been presented due to the course of time and the extent of TVR. Method: Therefore the data of 33 patients with Graves` disease (GD), 36 patients with multifocal (MAG) and 31 with solitary (SAG) autonomous goitre were analyzed retrospectively. Results: All the patients showed a highly significant (p<0.001) TVR, which continued up to 1 year after RITh. Receiving equal effective radiation doses, the extent of TVR was significantly greater for GD than for MAG. This difference developed within six weeks up to 3 months after RITh. Conclusion: This observation suggests that the underlying thyroid disease affects the therapeutic effect of RITh and may be partially explained by the total suppression of non-autonomous thyroid tissue in AG at the time of RITh. In patients with SAG with a 1.7 times higher effective radiation dose than in MAG relative TVR was about 1.6 times stronger in SAG than in MAG. This demonstrates a direct relation between the effective radiation dose and the extent of the TVR after RITh. (orig.) [Deutsch] Ziel: Es ist bekannt, dass die Radiojodtherapie (RJTh) zu einer relvanten Schilddruesenvolumenreduktion (SVR) fuehrt. Bisher wurden jedoch nur vereinzelt systematische Daten zum zeitlichen Verlauf und quantitativen Ausmass der SVR veroeffentlicht. Methode: Daher fuehrten wir eine retrospektive Auswertung der Daten von 33 Patienten mit Morbus Basedow (MB), 36 Patienten mit multifokaler (MFA) und 31 mit unifokaler (UFA) Autonomie der Schilddruese durch. Ergebnisse: Fuer alle Patientengruppen ergab sich eine hochsignifikante (p<0,001) SVR, welche sich bis ein Jahr nach RJTh signifikant fortsetzte. Obwohl die effektive Herddosis nicht signifikant verschieden war, war das Ausmass der SVR fuer Patienten mit MB signifikant groesser als fuer Patienten mit MFA. Dieser Unterschied war bereits innerhalb der ersten 6

  2. Updated German S3-guideline regarding the diagnosis of Crohn's disease. Implementation of radiological modalities; Aktualisierte S3-Leitlinie zur Diagnostik des Morbus Crohn. Radiologische Untersuchungstechniken

    Energy Technology Data Exchange (ETDEWEB)

    Schreyer, A.G. [Inst. fuer Roentgendiagnostik, Univ. Regensburg (Germany); Ludwig, D. [Abt. Innere Medizin, Segeberger Kliniken (Germany); Koletzko, S. [Paed. Gastroenterologie und Hepatologie, Dr. von Haunersches Kinderspital (Germany); Hoffmann, J.C. [Medizinische Klinik I, St. Marien- und St. Annastiftskrankenhaus (Germany); Preiss, J.C.; Zeitz, M. [Medizinische Klinik I, Charite - Universitaetsmedizin Berlin, Campus Benjamin Franklin (Germany); Stange, E.; Herrlinger, K.R. [Abt. fuer Innere Medizin 1, Robert-Bosch-Krankenhaus (Germany)

    2010-02-15

    The recently updated German S3-guideline regarding the diagnosis and treatment of Crohn's disease incorporates several changes concerning the radiological approach compared to the former guideline. This article focuses on guideline-based radiological imaging techniques for patients with Crohn's disease. The new guideline is also compared to former European and German guidelines in the context of recently published radiological literature. (orig.)

  3. Assessment of axonal degeneration in Alzheimer's disease with diffusion tensor MRI; Diffusion tensor imaging zur Erfassung axonaler Degeneration bei Morbus Alzheimer

    Energy Technology Data Exchange (ETDEWEB)

    Stahl, R. [Institut fuer Klinische Radiologie - Grosshadern, Klinikum der Universitaet Muenchen (Germany); Institut fuer Klinische Radiologie - Grosshadern, Klinikum der Universitaet Muenchen, Marchioninistr. 15, 81377, Muenchen (Germany); Dietrich, O.; Reiser, M.F.; Schoenberg, S.O. [Institut fuer Klinische Radiologie - Grosshadern, Klinikum der Universitaet Muenchen (Germany); Teipel, S.; Hampel, H. [Klinik fuer Psychiatrie und Psychotherapie, Klinikum der Universitaet Muenchen (Germany)

    2003-07-01

    Alzheimer disease (AD) causes cortical degeneration with subsequent degenerative changes of the white matter. The aim of this study was to investigate the extent of white matter tissue damage of patients with Alzheimer's disease in comparison with healthy subjects using diffusion tensor MRI (DTI). The value of integrated parallel imaging techniques (iPAT) for reduction of image distortion was assessed. We studied 9 patients with mild AD and 10 age and gender matched healthy controls. DTI brain scans were obtained on a 1.5 tesla system (Siemens Magnetom Sonata) using parallel imaging (iPAT) and an EPI diffusion sequence with TE/TR 71 ms/6000 ms. We used an 8-element head coil and a GRAPPA reconstruction algorithm with an acceleration factor of 2. From the tensor, the mean diffusivity (D), the fractional anisotropy (FA), and the relative anisotropy (RA) of several white matter regions were determined. FA was significantly lower (p <0,05) in the white matter of the genu of corpus callosum from patients with AD than in the corresponding regions from healthy controls. There was a trend observed for slightly higher ADC values in the AD group (p=0,06). No significant changes were observed in the regions of the splenium, internal capsule, pericallosal areas, frontal, temporal, parietal, and occipital lobe. The images obtained with iPAT contained substantially less susceptibility artefacts and were less distorted than images acquired with non-parallel imaging technique. DTI is a method with potential to assess early stages of white matter damage in vivo. The altered FA and ADC values in the genu of corpus callosum of patients with AD presumably reflect the microscopic white matter degeneration. Acquisition time can be reduced by iPAT methods with less image distortion from susceptibility artefacts resulting in a more accurate calculation of the diffusion tensor. (orig.) [German] Bei der Alzheimer-Erkrankung (AD) kommt es zur kortikalen Degeneration und sekundaer zu

  4. Etablierung des Nachweises direkter antibakterieller Wirkung humaner Defensine für die Untersuchung der Defensinproduktion im menschlichen Darm bei Morbus Crohn und Colitis ulcerosa

    OpenAIRE

    Andreou, Andreas

    2010-01-01

    Introduction: As a part of the innate immunity, defensins support the preservation of the intestinal mucosal barrier which is affected in patients with inflammatory bowel disease (IBD). It is interesting whether a potential direct antibacterial activity of defensins in the bowel of IBD patients is changed compared to healthy persons. Since the mechanisms of defensin action are not fully understood, defensins themselves are the only reliable controls in respective studies. Methods: A densit...

  5. Beeinflussung des Essentiellen Tremors und des Tremors beim Morbus Parkinson durch transkranielle Gleichstromstimulation

    OpenAIRE

    Hellriegel, Helge

    2010-01-01

    Ziel dieser Arbeit war es die Rolle des primärmotorischen Kortex bei der Entstehung und Weiterleitung des Essentiellen Tremors und des Tremors beim Morbus Parkinson zu untersuchen. Hierzu wurde eine transkranielle Gleichstromstimulation über dem primärmotorischen Kortex bei Patienten mit oben genannten Tremorsyndromen durchgeführt und die klinischen sowie elektrophysiologisch messbaren Änderungen des Tremors beurteilt.

  6. Radiological interventions in inflammatory bowel disease; Interventionelle Verfahren bei entzuendlichen Darmerkrankungen

    Energy Technology Data Exchange (ETDEWEB)

    Krolak, C.; Rock, C.; Reiser, M. [Institut fuer Klinische Radiologie, Klinikum der Universitaet Muenchen (Germany)

    2003-01-01

    Abscesses, fistulas,hemorrhages and stenoses are common complications of inflammatory bowel diseases.This study provides an overview on various methods of radiological intervention and the clinical usefulness of these methods is analyzed. The success rate of percutaneous abscess drainage (PAD), embolisation of hemorrhages and dilatation of bowel stenoses is reviewed and current literature is adressed.Success rate is defined in terms of cure rate and need for subsequent surgery. After PAD, surgery can be avoided during the observation period in about 50% of patients with abscesses due to Crohn's disease and diverticulitis.Preoperative PAD reduces the degree of invasiveness and thus the risk of surgery.Abscess recurrence is found with the same frecuency following surgery or PAD.Bowel dilatation can be performed both with radiological and with endoscopic guidance.Embolisation of GI-hemorrhage is technically feasible, but the indication should be limited to strictly selected cases. In treating abscesses and fistulas associated with Crohn's disease and diverticulitis, PAD is a valuable treatment option.Embolisation or dilatation are restricted to rare cares. (orig.) [German] Fragestellung Abszesse, Fisteln, Blutungen und Darmstenosen sind typische Komplikationen entzuendlicher Darmerkrankungen. Es werden verschiedene radiologisch-interventionelle Verfahren vorgestellt und ihre Wertigkeit fuer die Behandlung geprueft.Methodik Unter Beruecksichtigung der neueren Literatur werden der Erfolg der perkutanen Abszessdrainage (PAD) hinsichtlich der Ausheilung und Notwendigkeit einer folgenden OP, die perkutane Embolisation und die Dilatation von Darmstenosen bewertet.Ergebnisse Die PAD vermeidet bei 50% der Patienten mit Morbus Crohn und bei 20% der Patienten mit Divertikulitis eine OP im kurzfristigen Verlauf.Die PAD verringert die Invasivitaet einer nachfolgenden OP.Rezidivabszesse treten nach PAD und OP gleich haeufig auf.Die Dilatation entzuendlicher Darmstenosen

  7. Radiotherapy in benign diseases: Morbus Peyronie; Strahlentherapie benigner Erkrankungen: Morbus Peyronie

    Energy Technology Data Exchange (ETDEWEB)

    Meineke, V.; Cordes, N. [Inst. fuer Radiobiologie der Bundeswehr, Muenchen (Germany); Uebler, C.; Koehn, F.M.; Hofmann, H.; Ring, J.; Vogt, H.J. [Klinik und Poliklinik fuer Dermatologie und Allergologie, Technische Univ. Muenchen (Germany)

    2003-03-01

    Patients and Methods: The presented data refer to a retrospective univariant examination of 67 patients, which have been treated for IPP with soft X-rays in the Dermatological Clinic of the Technical University of Munich between 1990 and 1995. The aim of the study was to examine, how far a progression of the disease can be stopped with soft X-rays and how the pain symptomatic is reduced. Results: In 58 of 67 examined patients (86.6%) a progression of the disease could be stopped. 25 out of 67 patients (37.3%) complained of pain before therapy. This symptomatic mostly improved totally in 21 patients (84% of the patients with pain). A complete or partial dissolution of the indurations was to be noticed in 41 of 70 indurations (58.6%). In 23 of 60 patients (38.3%) an improvement or totally regression of the deviation was observed. It could be shown that therapeutic outcome significantly correlates to a shorter duration of anamnesis (p < 0.05), smaller plaque size (p < 0.025) and a tendency to lower age of the patients. Conclusion: Radiotherapy of Morbus Peyronie is extremely effective and has a low rate of side effects. (orig.) [German] Patienten und Methoden: Die dargestellten Untersuchungsergebnisse beziehen sich auf die Daten einer univarianten, retrospektiven Untersuchung von 67 Patienten, die in der Dermatologischen Klinik und Poliklinik der Technischen Universitaet Muenchen im Zeitraum von 1990 bis 1995 wegen einer IPP mit Roentgenweichstrahlen behandelt worden sind. Ziel der Untersuchung war es zu ermitteln, inwieweit durch die Roentgenweichstrahlentherapie ein Fortschreiten der Erkrankung verhindert und die Schmerzsymptomatik abgebaut werden konnte. Ergebnisse: Bei 58 von 67 der untersuchten Patienten (86,6%) konnte ein Fortschreiten der Erkrankung gestoppt werden, 25 von 67 Patienten (37,3%) klagten vor der Therapie ueber Schmerzen, zumeist bei der Erektion. Diese Schmerzsymptomatik besserte sich meist vollstaendig bei 21 Patienten (84% der Schmerzpatienten

  8. The legg-calve-perthes disease; Morbus Perthes

    Energy Technology Data Exchange (ETDEWEB)

    Kramer, J.; Scheurecker, A. [Institut fuer CT- und MRT-Diagnostik, Linz (Austria); Hofmann, S. [Allgemeines und Orthopaedisches LKH, Stolzalpe (Austria); Tschauner, C.

    2002-06-01

    The Legg-Calve-Perthes disease is an idiopathic avascular necrosis of the hip during early childhood. It is characterized by different stages with the main risk of persisting hip deformation, dysfunction of the joint movement, and the potential for early osteoarthritis. For the evaluation of prognosis and therapy planning patients age and extent of the necrotic area of the epiphysis are important factors. For an early diagnosis and sufficient therapy all radiological efforts have to be performed. MR imaging is an ideal method for the assessment of osteonecrotic changes of the Morbus Perthes. Compared to plain radiography by MR imaging pathologic alterations can be detected earlier and with higher specificity. However, conventional radiograms have to be still used as basic imaging modality. Nowadays x-rays and MR imaging should be the main methods for the evaluation of children suffering from Perthes disease. (orig.) [German] Beim Morbus Perthes handelt es sich um eine idiopathische Osteonekrose des Hueftgelenks im fruehkindlichen Alter (3.-12. Lebensjahr). Das Hauptrisiko dieser selbstlimitierenden Erkrankung mit suffizienter Reparatur und charakteristischem stadienhaftem Verlauf ist eine Defektheilung mit deformiertem Hueftkopf (Coxa magna) und sekundaer dysplastischer Pfanne. Diese praearthrotische Deformitaet fuehrt zur Einschraenkung der Hueftfunktion und einer fruehzeitigen Koxarthrose. Zur Abschaetzung der Prognose und Therapieplanung spielen Alter des Patienten bei Krankheitsbeginn sowie Groesse und Lokalisation des Nekroseareals eine entscheidende Rolle. Es ist somit augenscheinlich, dass alle radiologischen Register gezogen werden muessen, um eine moeglichst fruehe Diagnose und eine suffiziente Stadieneinteilung als Voraussetzung fuer eine risikoadaptierte Therapie zu gewaehrleisten. Die MRT eignet sich in idealer Weise zur Beurteilung ischaemischer Knochenmarkveraenderungen im Rahmen des Morbus Perthes. Verglichen mit dem konventionellen Roentgen ist die

  9. Volumetric MRI for evaluation of regional pattern and progression of neocortical degeneration in Alzheimer's disease; MR-Volumetrie zur Darstellung von Verteilung und zeitlicher Abfolge neokortikaler Degeneration bei Morbus Alzheimer

    Energy Technology Data Exchange (ETDEWEB)

    Leinsinger, G. [Institut fuer Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Muenchen (Germany); Institut fuer Klinische Radiologie, LMU Muenchen, Ziemssenstrasse 1, 80336, Muenchen (Germany); Teipel, S.; Pruessner, J.; Hampel, H. [Klinik fuer Psychiatrie, Ludwig-Maximilians-Universitaet Muenchen, Muenchen (Germany); Wismueller, A.; Born, C.; Meindl, T.; Flatz, W.; Schoenberg, S.; Reiser, M. [Institut fuer Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Muenchen (Germany)

    2003-07-01

    Volumetric analysis of the corpus callosum and hippocampus using MRI in Alzheimer's disease (AD) to evaluate the regional pattern and progression of neocortical neurodegeneration. In subsequent studies we investigated patients with AD and healthy controls. Volumetry was based on MRI-data from a sagittal 3D T1w-gradient echo sequence. The corpus callosum (CC) was measured in a midsagittal slice, and subdivided into 5 subregions. Volumetry of the hippocampus/amygdala-formation (HAF) was performed by segmentation in coronary reoriented slices. In AD patients we found a significant atrophy in the rostrum und splenium of CC. The atrophy was correlated with the severity of dementia, but no correlation was found with the load of white matter lesions. In comparison with {sup 18}FDG-PET, we found a significant correlation of regional CC-atrophy with the regional decline of cortical glucose metabolism. A ROC-analysis demonstrated no significant differences in the diagostic accuracy of HAF volumetry and regional CC volumetry of the splenium (region C5) even in mild stages of dementia. Regional atrophy of CC can be used as a marker of neocortical degeneration even in early stages of dementia in AD. (orig.) [German] Volumetrische Analyse des Corpus callosum und Hippokampus mittels MRT bei der Alzheimer-Erkrankung (AD), mit dem Ziel die regionale Verteilung und Progression der neokortikalen relativ zur allokortikalen Neurodegeneration zu erfassen. In mehreren Studienabschnitten wurden Patienten mit AD und gesunde Kontrollen untersucht. Als Grundlage fuer die Volumetrie diente eine sagittale 3D-T1w-Gradientenechosequenz. Die Vermessung des Corpus callosum (CC) erfolgte in der mittsagittalen Schicht, wobei 5 Subregionen definiert wurden. Die Volumetrie des Hippokampus-Amygdala-Komplexes (HAK) wurde durch Segmentierung an koronar reorientierten Schichten durchgefuehrt. Bei Patienten mit AD fand sich eine signifikante Atrophie in Rostrum und Splenium des CC. Dabei zeigte sich

  10. Osler's disease; Morbus Osler

    Energy Technology Data Exchange (ETDEWEB)

    Ahlhelm, F.; Mueller, U. [Kantonsspital Baden AG, Institut fuer Radiologie, Baden (Switzerland); Lieb, J. [Universitaetsspital Basel, Klinik fuer Radiologie und Nuklearmedizin, Basel (Switzerland); Schneider, G. [Universitaetskliniken des Saarlandes, Klinik fuer Diagnostische und Interventionelle Radiologie, Homburg/Saar (Germany); Ulmer, S. [Medizinisch-Radiologisches Institut, Zuerich (Switzerland)

    2013-12-15

    Osler's disease, also known as hereditary hemorrhagic telangiectasia (HHT) and Osler-Weber-Rendu syndrome, is an autosomal dominant disorder leading to abnormal blood vessel formation in the skin, mucous membranes and often in organs, such as the lungs, liver and brain (arteriovenous malformations AVM). Various types are known. Patients may present with epistaxis. Teleangiectasia can be identified by visual inspection during physical examination of the skin or oral cavity or by endoscopy. Diagnosis is made after clinical examination and genetic testing based on the Curacao criteria. Modern imaging modalities, such as computed tomography (CT) or magnetic resonance imaging (MRI) have become more important as they can depict the AVMs. Pulmonary AVMs can be depicted in CT imaging even without the use of a contrast agent while other locations including the central nervous system (CNS) usually require administration of contrast agents. Knowledge of possible clinical manifestations in various organs, possible complications and typical radiological presentation is mandatory to enable adequate therapy of these patients. Interventional procedures are becoming increasingly more important in the treatment of HHT patients. (orig.) [German] Der Mobus Osler (Synonyme: hereditaere haemorrhagische Teleangiektasie [HHT], Morbus Rendu-Osler-Weber) ist eine Multisystemerkrankung und gehoert zur Gruppe der vaskulaeren haemorrhagischen Erkrankungen. Bei der autosomal dominanten Erkrankung, die zu den haeufigsten Phakomatosen zaehlt, kann je nach Gendefekt zwischen verschiedenen Formen, die zu einer Stoerung der Blutgefaessbildung fuehren, unterschieden werden. Neben der genetischen Diagnostik und der klinischen Untersuchung sind bildgebende Verfahren entscheidend fuer die Diagnose. Klinisch stehen die Epistaxis, mukokutane Teleangiektasien und viszerale arteriovenoese Malformationen (AVM) v. a. in Lunge, Leber und Hirn sowie die Folgen dieser Gefaesspathologien wie z. B

  11. Androgenmangel bei Frauen: Wann klinisch relevant?

    Directory of Open Access Journals (Sweden)

    Jaursch-Hancke C

    2011-01-01

    Full Text Available Androgene haben bei Männern und Frauen Einfluss auf Muskulatur, Fettverteilung sowie Sexualität, allgemeine Leistungsfähigkeit und Wohlbefinden. Bei Frauen sind im Unterschied zu Männern Symptome des Hypogonadismus weniger klar definiert und es gibt derzeit keine Messparameter, die eine Androgenmangelsituation bei Frauen sicher erfassen. Der Begriff "Hypoactive Sexual Desire Disorder" (HSDD hat sich für die klinische Symptomatik durchgesetzt. Zu gesicherten Androgenmangelzuständen gehören die chirurgische Menopause, der Panhypopituitarismus, der Morbus Addison, die natürliche Menopause und verschiedene Medikamente, die zu einer Androgensupprimierung führen. Eine Testosteronsubstitution ist nur sinnvoll bei klinischer Symptomatik (HSDD. Die Patientinnen müssen darauf hingewiesen werden, dass es sich um eine noch nicht etablierte Therapie handelt und Langzeitdaten somit fehlen. Bei richtiger Indikationsstellung ist der Erfolg der Therapie aber oftmals überzeugend.

  12. Crohn病和溃疡性结肠炎:对患儿用兔疫抑制剂取代类固醇?%Morbus Crohn und Colitis Ulcerosa Immunsuppressiva statt Steroide bei Kindern?

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    原则上,对Crohn病和溃疡性结肠炎患儿的治疗标准,与慢性炎症性肠道病成年患者相同,但是几乎总是存在发育障碍问题.因此,必须始终减少类固醇的用量.免疫抑制剂可供治疗选择,危急时可施手术治疗.

  13. Cerebral imaging for Wilson disease; Zerebrale Bildgebung bei Morbus Wilson

    Energy Technology Data Exchange (ETDEWEB)

    Andersen, K.; Saleh, A. [Universitaetsklinikum Duesseldorf (Germany). Inst. fuer Diagnostische Radiologie; Suedmeyer, M. [Universitaetsklinikum Duesseldorf (Germany). Klinik fuer Neurologie

    2007-03-15

    Wilson disease is an autosomal recessive inherited copper metabolic disorder that is characterized by diminished biliary excretion of copper and a raised serum level of free copper. This leads to a toxic copper accumulation, particularly in the liver and the brain. Therefore, clinical symptoms are dominated by hepatic and extrapyramidal symptoms. Untreated Wilson disease has an unfavorable outcome. Cerebral changes are depicted most sensitively by magnetic resonance tomography. Pathological findings mainly focus on the basal ganglia, the midbrain and the brainstem. Depending on the therapy and the severity of the neurological symptoms, signal increase as well as signal decrease may be observed in T1-weighted (T1w) and T2-weighted (T2w) images and can be reversible when using an appropriate therapy. Hyperintense areas in T2-weighted images are induced by edema, gliosis, demyelinisation or cystic degeneration. Signal increase in T1-weighted images are found in patients with hepatic insufficiency and are probably due to manganese deposits. Signal decrease in T2-weighted images is probably caused by the paramagnetic effect of the copper accumulation. Furthermore, recent studies show a correlation between the clinical severity and changes in diffusion-weighted sequences. Although cross-section imaging plays a rather subordinate role in the primary diagnostics of Wilson disease, the described cerebral changes in patients with extrapyramidal disturbances should include Wilson disease in the differential. Persistent or progressive hyperintense lesions in T2-weighted images reflect therapy failure, and clinical recovery correlates to an improvement in MR images. Therefore, repeat MR imaging can be used to monitor medical therapy.

  14. Radiation therapy for Morbus Ledderhose - indication and clinical results; Strahlentherapie beim Morbus Ledderhose - Indikation und klinische Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Seegenschmiedt, M.H.; Attassi, M. [Klinik fuer Radioonkologie, Strahlentherapie und Nuklearmedizin, Alfried-Krupp-Krankenhaus, Essen (Germany)

    2003-12-01

    were minimal: during and within 3 months of the RT course only a slight erythema (CTC 1 ) was seen in five treated lesions, while dry skin changes within the RT portal were observed in three cases (11%) in long term FU (> 12 months). Conclusions: radiotherapy is effective in treating ML and may prevent otherwise necessary surgical interventions. Nodules, cords and symptoms regress, but long-term outcome of at least 5 years has to be awaited. Prospective phase III studies should confirm these results. (orig.) [German] Hintergrund: Der morbus ledderhose (ML) ist eine hyperproliferative Erkrankung der Plantaraponeurose, die dem morbus dupuytren (MD) sehr aehnlich ist. Wir prueften, ob eine Bestrahlung die Symptome lindern und die Progression der Erkrankung aufhalten kann. Patienten und Methoden: Von Juni 1996 bis Dezember 2002 wurden zwoelf Frauen und 13 Maenner im Alter von 9-76 (median 56) Jahren mit symptomatischem ML bestrahlt und mindestens 1 Jahr kontrolliert. Insgesamt wurden 36 Fuesse (16 rechts, 20 links) bestrahlt, da elf Patienten beidseits einen Befall hatten. Zwoelf (48%) Patienten hatten auch einen MD. An 36 Fuessen lagen 63 Knoten (mit 0,5-6,5 cm Groesse) und an 13 (52%) Fuessen 20 Straenge (mit 1-4 cm Laenge) vor. Zusaetzlich bestanden 14-mai (56%) starke Fussschmerzen, achtmal (32%) Probleme beim Laufen, zwoelfmal (48%) andere Symptome (Druck, Schwellung, Spannung). Die Orthovolt-Radiotherapie erfasste alle tastbaren Knoten und Straenge. Es wurden zwei Serien zu je 5 x 3 Gy pro Woche (gesamt: 30 Gy) im Abstand von 8-12 Wochen gegeben. Die Auswertung erfolgte am Ende der RT, nach 3 und 12 Monaten und zuletzt im Dezember 2002. Primaerer Endpunkt war die Vermeidung einer Progression bzw. Operation; sekundaere Endpunkte waren mehrere objektive morphologisch-funktionelle sowie subjektive Parameter (visuelle analogskala (VAS)). Ergebnisse: Nach 38 (12-67) Monaten medianem FU war kein Fuss progredient oder musste operiert werden. Bei 11 von 36 (44%) Fuessen nahm

  15. Klinisk differentiering mellem intestinal tuberkulose og morbus Crohn

    DEFF Research Database (Denmark)

    Ørting, Michael; Wejse, Christian; Jensen, Thomas Møller

    2015-01-01

    We describe a case of intestinal tuberculosis in a 34-year-old Indonesian woman. She presented with diarrhoea, weight loss, fever and night sweat over a period of weeks. She underwent colonoscopy which showed a major cobblestone pattern like necrosis in part of the colon. An MR scan showed oedema...

  16. Klinisk differentiering mellem intestinal tuberkulose og morbus Crohn

    DEFF Research Database (Denmark)

    Ørting, Michael; Wejse, Christian; Jensen, Thomas Møller

    2015-01-01

    involving the small intestine near the ileocoecal area and abdominal lymphadenopathy. Because of the patient history of recent TB exposure, ethnicity and positive T-SPOT-TB, she was given a course of four-drug tuberculosis treatment and responded quickly. Later on Mycobacterium tuberculosis was found......We describe a case of intestinal tuberculosis in a 34-year-old Indonesian woman. She presented with diarrhoea, weight loss, fever and night sweat over a period of weeks. She underwent colonoscopy which showed a major cobblestone pattern like necrosis in part of the colon. An MR scan showed oedema...

  17. MRCP in primary sclerosing cholangitis; MRCP bei primaerer sklerosierender Cholangitis

    Energy Technology Data Exchange (ETDEWEB)

    Weber, C.; Krupski, G.; Lorenzen, J.; Adam, G. [Universitaetsklinikum Hamburg-Eppendorf (Germany). Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie; Grotelueschen, R.; Rogiers, X. [Universitaetsklinikum Hamburg-Eppendorf (Germany). Abt. fuer Hepatobilaere Chirurgie; Seitz, U. [Universitaetsklinikum Hamburg-Eppendorf (Germany). Klinik fuer Interdisziplinaere Endoskopie

    2003-02-01

    }-gewichteter Sequenzen. Material und Methoden: 55 Patienten (34 m, 21 f), durchschnittliches Alter 40 Jahre (16-65), mit Verdacht auf PSC wurden in einem 1,5T MRT (Magnetom Vision, Siemens, Erlangen) unter Verwendung einer atemangehaltenen, transversalen und koronaren HASTE-, parakoronaren RARE und Duennschicht-HASTE(DS-HASTE)-Sequenz untersucht. Die qualitative Analyse zur Bildqualitaet erfolgte anonymisiert anhand einer 5-Punkte-Skala mittels ROC-Analyse durch zwei Radiologen. Morphologische Kriterien der PSC wurden fuer die MRCP dokumentiert und zur ERCP korreliert. Die ERCP diente als Goldstandard. Sensitivitaet, Spezifitaet und diagnostische Treffsicherheit wurden in Korrelation zum Goldstandard berechnet. Ergebnisse: Bei 40/55 Patienten konnte eine PSC nachgewiesen werden (ERCP 55/55, Leberbiopsie 37/55). 27/40 Patienten zeigten als Begleiterkrankung eine Colitis ulcerosa, 6/40 einen Morbus Crohn. Die qualitative Analyse zur Bildqualitaet ergab keinen signifikanten Unterschied zwischen RARE, HASTE und DS-HASTE (3,4/3,5/3,2). Sensitivitaet, Spezifitaet und diagnostische Treffsicherheit bei der Detektion der PSC waren in der RARE-Sequenz mit 97% bzw. 64% bzw. 84% am hoechsten, der Unterschied zu HASTE und DS-HASTE war statistisch signifikant (p<0,01). Die MRT wurde bei 29/40 Patienten zu Verlaufskontrollen herangezogen, bei 3/40 Patienten erfolgte eine Lebertransplantation im Verlauf, 1/40 Patienten zeigte bei falsch positiver MRCP buerstenzytologisch einen Klatskin-Tumor. Die Untersuchervariabilitaet war abhaengig von der Sequenz ausreichend bis gut (Kappa 0,4-0,7). (orig.)

  18. The possible involvement of Mycobacterium avium ssp. paratuberculosis in the aetiology of Crohn's disease: a case control study in the Netherlands

    NARCIS (Netherlands)

    Herrewegh AAPM; Overduin P; Roholl PJM; Gielis FK; Robinson JE; Mahmmod N; Lieverse RJ; Robijn RJ; van der Zanden AGM; van Soolingen D; LIS; LPI

    2005-01-01

    De bacterie Mycobacterium avium ssp. paratuberculosis (Map) wordt beschouwd als een mogelijke oorzaak van de ziekte van Crohn (morbus Crohn, MC). In samenwerking met Gelre ziekenhuizen heeft het RIVM een onderzoek uitgevoerd naar het voorkomen van Map in darmbiopten van patienten met MC, patienten

  19. Neurologic involvement in Behcet disease. Case report; Morbus Behcet mit neurologischer Beteiligung. Ein Fallbericht

    Energy Technology Data Exchange (ETDEWEB)

    Boehner, C. [Erlangen-Nuernberg Univ., Erlangen (Germany). Inst. fuer Diagnostische Radiologie; Fellner, F. [Erlangen-Nuernberg Univ., Erlangen (Germany). Inst. fuer Diagnostische Radiologie; Reinhardt, F. [Erlangen-Nuernberg Univ., Erlangen (Germany). Neurologische Klinik mit Poliklinik; Eberhardt, K.E.W. [Erlangen-Nuernberg Univ., Erlangen (Germany). Abt. fuer Neuroradiologie

    1997-05-01

    Morbus Behcet is a very infrequent multi-system disease caused by an immunological vasculitis affecting the arteries and veins. The disease is primarily known in Israel, Turkey, Italy, Great Britain and Japan. It may become manifest as erythema nodosum, polyarthritis, thrombophlebitis, occlusive arterial disease, pulmonary infarction, ulcerous colitis, portal hypertension, or via neurological symptoms (collateral symptoms), and it is not possible to make a clear prognosis. The most frequent signs of the neuro-Behcet syndrome, as in the case reported, is a meningoencephalitis. MRI is an essential modality for diagnosis and follow-up of the disease. In this case, the findings included meningeal irritations as well as an abduction deficit indicating involvement of the brain stem of type 1. As described in the literature, pathologic findings have been obtained by spinal fluid tests, showing increased cell number and proteins and pleocytosis of the granulocytes. (Orig./vhe) [Deutsch] Der Morbus Behcet ist eine seltene Multisystemerkrankung in Form einer immunvermittelten Vaskulitis, die Arterien und Venen betrifft. Die Erkrankung findet man ueberwiegend in Israel, der Tuerkei, Italien, Grossbritannien und Japan. Die Erkrankung ist multisystemisch, kann sich als Erythema nodosum, Polyarthritis, Thrombophlebitis, arterielle Verschlusskrankheit, Lungeninfarkt, ulzeroese Colitis, portale Hypertension oder mit neurologischen Symptomen (Nebensymptome) manifestieren, und basiert auf einer immunvermittelten Vaskulitis mit unklarer Prognose. Am haeufigsten manifestiert sich das Neuro-Behcet-Syndrom, wie beim untersuchten Patienten, in Form einer Meningoenzephalitis. Hierbei fand sich neben meningealen Reizsymptomen ein Abduktionsdefizit als Zeichen der Hirnstammbeteiligung im Sinne eines Typ 1. Wie in der Literatur beschrieben, zeigte sich ein pathologischer Liquorbefund mit Zellzahl- und Proteinerhoehung sowie granulozytaerer Pleozytose. Beim Neuro-Behcet, wie bei den anderen

  20. Radioiodine treatment of Grave's disease; Radiojodtherapie des Morbus Basedow

    Energy Technology Data Exchange (ETDEWEB)

    Heidenreich, P.; Vogt, H.; Dorn, R.; Graf, G.; Kopp, J. [Klinik fuer Nuklearmedizin, Zentralklinikum Augsburg (Germany)

    2001-09-01

    In Germany radioiodine therapy of Grave's disease is performed in patients older than 20 years, after at least one year of unsuccessful antithyroid therapy, intolerance against antithyroid medication, recurrences after surgical interventions and small goiters. Hyperthyroidism is eliminated with an ablative dose concept (300 Gy) in more than 90% associated with rate of hypothyroidism in the outcome of also more than 90%. Adverse prognostic factors are an insufficient dose to the thyroid and/or concomitant antithyreoid medication. Radioiodine therapy in Germany must be an inpatient single time approach due to quality assurance and radiation protection reasons. The mean hospitalization is only 3-4 days with the patient being discharged at an annual dose of less than 1 mSv at 2 m distance (dose rate at discharge < 3,5 {mu}Sv/h at 2 m). An adjuvant treatment with cortisone is recommended in a simultaneous endocrine ophthalmopathy to prevent from deterioration. Radioiodine therapy of Grave's disease is cost effective with a low probability of side-effects and is not associated with an increased genetic or somatic risk. Therapy control and life span follow up has to be carried out by the expert physician legally responsible for the radioiodine therapy. (orig.) [German] Die Radiojodtherapie des Morbus Basedow wird in Deutschland, bei Patienten aelter als 20 Jahre, erst nach mindestens einjaehriger, erfolgloser thyreostatischer Therapie, bei Thyreostatikaunvertraeglichkeit, Rezidiven nach Operation und kleinen Strumen durchgefuehrt. Die Beseitigung der Hyperthyreose wird mit einem ablativen Dosiskonzept (300 Gy) in > 90%, verbunden mit einer Hypothyreoserate von ebenfalls > 90% erreicht. Prognostisch unguenstige Einflussfaktoren sind eine zu niedrig gewaehlte Herddosis und/oder eine begleitende Thyreostase. Aus Gruenden der Qualitaetssicherung und des Strahlenschutzes muss in Deutschland die Radiojodtherapie stationaer als Einzeittherapie durchgefuehrt werden. Die

  1. Morbus-Locke's early essay on disease.

    Science.gov (United States)

    Walmsley, J

    2000-01-01

    John Locke engaged in a systematic study of medicine from the late 1650's. In this period he acquainted himself with the three main competing natural philosophical theories of the time -Galenism, Paracelsianism and Mechanism. He was particularly interested in the work of Sennert, Helmont and Doyle. In 1666, just after the publication of Boyle's The Origine of Formes and Qualities, Locke wrote a short paper entitled Morbus. This paper gave Locke's own view of the nature of disease. Locke went out of his way to criticise Boyle's attempts to give mechanical explanations for biological phenomena. He endorsed Helmont's theory that disease was caused by "ferments" and "Archei" and re-introduced Galenic temperaments as factors of susceptibility in seminal diseases. Locke did not endorse a mechanical corpuscularianism at this stage in his career, when his contact with Boyle was most frequent. Consequently, Locke's espousal of the corpuscular philosophy in the Essay cannot be attributed to Locke's association with Boyle at this time.

  2. Bariumexaminations of the small intestine and the colon in inflammatory bowel disease; Konventionelle Duenn- und Dickdarmdiagnostik bei entzuendlichen Darmerkrankungen

    Energy Technology Data Exchange (ETDEWEB)

    Antes, G. [Abteilung fuer Radiologie, Klinikum Kempten-Oberallgaeu g, GmbH, Kempten (Germany)

    2003-01-01

    , jedoch stieg die Rate der Untersuchungen mit positivem Ergebnis von 46 auf 57%.Der Anteil der entzuendlichen Duenndarmerkrankungen (nicht nur Morbus Crohn) blieb mit 18% konstant. Bei den Kolonuntersuchungen konnte in 7 Faellen die Frage nach einer entzuendlichen Darmerkrankung positiv beantwortet werden. Die Strahlenexposition betraegt beim Enteroklysma von entzuendlichen Erkrankungen 7mSv, beim Kolonkontrasteinlauf 14 mSv.Schlussfolgerung Die Bariumuntersuchungen, insbesondere von Magen und Kolon, sind ruecklaeufig, sodass eine handwerkliche und interpretative Kunst verloren gehen kann.Das Enteroklysma wird immer noch als Referenzmethode fuer andere bildgebende Verfahren angesehen.Die ausgezeichnete Darstellung der Darmoberflaeche und die Beurteilung der Funktion sind ein Vorteil gegenueber den anderen bildgebenden Verfahren. (orig.)

  3. Crohn's Disease

    Science.gov (United States)

    Crohn's disease causes inflammation of the digestive system. It is one of a group of diseases called inflammatory ... small intestine called the ileum. The cause of Crohn's disease is unknown. It may be due to an ...

  4. Crohn disease

    Science.gov (United States)

    ... from doing your everyday activities. You have side effects from medicines you are taking for your condition. Alternative Names Crohn's disease; Inflammatory bowel disease - Crohn's disease; Regional enteritis; Ileitis; ...

  5. Learning about Crohn's Disease

    Science.gov (United States)

    ... genetic terms used on this page. Learning About Crohn's Disease What is Crohn's disease? What are the symptoms ... disease Additional Resources for Crohn's Disease What is Crohn's disease? Crohn's disease, an idiopathic (of unknown cause), chronic ...

  6. Crohn's disease.

    LENUS (Irish Health Repository)

    Shanahan, Fergus

    2012-02-03

    Crohn\\'s disease is a disorder mediated by T lymphocytes which arises in genetically susceptible individuals as a result of a breakdown in the regulatory constraints on mucosal immune responses to enteric bacteria. Regulation of immune reactivity to enteric antigens has improved understanding of the pathophysiological mechanisms of Crohn\\'s disease, and has expanded therapeutic options for patients with this disorder. Disease heterogeneity is probable, with various underlying defects associated with a similar pathophysiological outcome. Although most conventional drug treatments are directed at modification of host response, therapeutic manipulation of the enteric flora is becoming a realistic option.

  7. The causal representation of outpatients with Crohn's disease: is there a link between psychological distress and clinical disease activity?

    Science.gov (United States)

    Banovic, Ingrid; Gilibert, Daniel; Andronikof, Anne; Jebrane, Ahmed; Ajdukovic, Ivan; Cosnes, Jaques

    2013-01-01

    Zielsetzung: Aufgrund des fluktuierenden Charakters des Morbus Crohn (Crohn’s disease, (CD)) müssen Patienten mit der Veränderlichkeit ihres Gesundheitszustandes zurechtkommen. Die wahrgenommene, persönliche Kontrollierbarkeit ist ein wichtiges Element der Anpassungsfähigkeit an die Herausforderungen des Krankheitsbildes. In dieser Arbeit wird untersucht, ob wahrgenommene Kontrolle als Prädiktor klinischer Aktivität der Krankheit und psychologischer Belastung (Depression, Angst) angesehen werden kann.Methode: Der HADS (Hospital Anxiety Depression Scale), die Kausale Dimensonsskala und der CGI (Clinical Global Impression, Einschätzung der wahrgenommenen Schwere) wurden an 160 CD-Patienten erhoben. Entzündungsindikatoren (CRP), Krankheitsdauer und klinische Aktivität der Krankheit wurden ebenfalls erhoben.Ergebnisse: Insgesamt scheinen die Patienten ihre Krankheit weder als persönlich ausgeprägt kontrollierbar noch unkontrollierbar zu empfinden. Während die psychologische Belastung bei klinisch aktivem Symptombild höher ist, erweist sich die Beziehung zwischen den Variablen als komplex. Das Gefühl persönlicher Kontrolle weist einen Zusammenhang zu der klinischen Aktivität der Krankkheit auf (p=0,0001), wie auch die Wahrnehmung der Stabilität der CD (p<0,0001) und die Globalität des Einflusses der Krankheit auf das Leben (p=0,001). Ungeachtet dessen zeigte sich die wahrgenommene persönliche Kontrolle nicht als prädiktiv für den Aktivitätsstatus der Krankheit. Schließlich zeigte sich ein Zusammenhang psychologischer Belastung mit der Wahrnehmung der Kontrollierbarkeit der Krankheit durch das medizinische Team (p=0,00001) und der Globalität der Krankheitsfolgen für das Leben (p<0,005)Schlussfolgerung: Psychologische Behandlungen sollten diese Dimensionen berücksichtigen, um das Wohlbefinden und die Gesundheit der Patienten zu verbessern.

  8. Crohn's Disease

    Science.gov (United States)

    ... prognosis of Crohn's disease in adults. http://www.uptodate.com/home. Accessed June 2, 2014. Smoking and ... cancer surveillance in inflammatory bowel disease. http://www.uptodate.com/home. Accessed June 9, 2014. Inflammatory bowel ...

  9. Long term results of surgery in Perthes disease: Comparison of X-ray and MR-studies; Spaetergebnisse nach operativer Behandlung des Morbus Perthes: Vergleich der roentgenologischen und kernspintomographischen Untersuchung

    Energy Technology Data Exchange (ETDEWEB)

    Tosch, U. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Berlin (Germany); Sparmann, M. [Orthopaedische Klinik im Oskar-Helene-Heim, Berlin (Germany); Stelling, E. [Orthopaedische Klinik im Oskar-Helene-Heim, Berlin (Germany); Tomala, D. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Berlin (Germany)

    1995-05-01

    Twenty patients treated by surgery for Perthes` disease were studied between 4 and 9 years postoperatively. In the clinical investigation eight patients complained of persistent stress-induced pain. In nine patients flexion, extension, ab- and adduction of the hip joint was limited. In the MRI-Study of ten hip joints a reduction of fatty marrow was seen in the femoral head. In 11 hip joints of patients complaining of persistent pain, a deformation of the femoral head (n = 2), a dysplasia of the femoral metaphysis (n = 2), and diaphysis (n = 4) or both (n = 2) were seen. In another five patients an additional dysplasia of the acetabulum was visualized. All these findings were diagnosed by X-ray studies as well. However, only by MRI were the extents of the postoperative defects of femoral spongiosa diagnosed in fifteen hip joints. (orig.) [Deutsch] 20 wegen eines Morbus Perthes operierte Patienten wurden 4-9 Jahre nach einer Umstellungsosteotomie klinisch, radiologisch und kernspintomographisch untersucht. Bei der klinischen Nachuntersuchung gaben 8 Patienten persistierende Beschwerden bei Belastung an. Bei der koerperlichen Untersuchung war die Flexion und Extension bei 9 sowie die Abduktion und Adduktion bei einem Patienten eingeschraenkt. Bei der kernspintomographischen Untersuchung liessen sich bei 10 Hueftgelenken Residuen des M. Perthes im Fettmark des Femurkopfs nachweisen. An 11 Hueftkoepfen wurden pathologische Veraenderungen wie eine Femurkopfentrundung (n = 2), eine Deformierung der Femurmeta- (n = 3) und -diaphyse (n = 4) bis hin zur hirtenstabfoermigen Konfiguration (n = 2) nachgewiesen. Bei 5 Patienten wurde eine Pfannendysplasie gefunden. Diese Befunde waren auch roentgenologisch darzustellen. Als postoperative Defekte waren im Schaftmark des Femurs eine langstreckige Hoehlenbildung mit Zysten oder durch Fettmark aufgefuellte Spongiosadefekte bei 15 Hueftgelenken nur kernspintomographisch nachweisbar. (orig.)

  10. Gaucher disease: MR evaluation of bone marrow features during treatment with enzyme replacement; Morbus Gaucher: Analyse der Knochenmarkveraenderungen in der MRT waehrend Enzymersatztherapie

    Energy Technology Data Exchange (ETDEWEB)

    Poll, L.W.; Koch, J.A.; Boerner, D.; Cohnen, M.; Jung, G.; Scherer, A.; Moedder, U. [Duesseldorf Univ. (DF). Inst. fuer Diagnostische Radiologie; Dahl, S. vom; Haeussinger, D. [Duesseldorf Univ. (Germany). Klinik fuer Gastroenterologie, Hepatologie und Infektiologie; Willers, R. [Rechenzentrum, Heinrich-Heine-Univ. Duesseldorf (Germany); Niederau, C. [Innere Abt., St. Josef-Hospital Oberhausen, Akademisches Lehrkrankenhaus der Univ. Essen (Germany)

    2001-10-01

    Purpose: Enzyme replacement therapy (ERT) arrests and reverses the hematological and visceral symptoms of adult Gaucher disease, the most frequent lysosomal storage disorder. There are only a few studies available evaluating bone disease during ERT. The aim of this study was to investigate the features of bone marrow (bm) by magnetic resonance imaging (MRI) in these patients during ERT. Materials and Methods: MRI was performed prospectively in thirty adult type I Gaucher patients before and during ERT with a mean follow-up of 3 years. Spin-echo sequences (T{sub 1}/T{sub 2}) of the lower extremities were obtained and the reconversion (response) or lack of reconversion (non-response) to fatty marrow during treatment was analyzed. The morphological features of bm involvement, a homogeneous or non-homogeneous distribution of bm changes and focal bone lesions surrounded by a rim of reduced signal intensity (SI), were analyzed. Results: Infiltration of bm by Gaucher cells is characterized by a reduction of Sl on both T{sub 1}- and T{sub 2}-weighted sequences. Bone marrow responses were seen in 19 patients (63%) during treatment. Focal bone lesions, surrounded by a rim of reduced Sl, did not respond to ERT and correlated with a non-homogenous distribution of bone involvement and splenectomy. (orig.) [German] Ziel: Unter Enzymersatztherapie (enzyme replacement therapy = ERT) zeigen Patienten mit adulter Form des Morbus Gaucher, der haeufigsten lysosomalen Speicherkrankheit, eine deutliche Besserung der haematologischen und visceralen Symptome. Bislang liegen nur wenige Untersuchungen zur Analyse der Knochenveraenderungen waehrend der ERT vor. Ziel war es, die Knochenmarkveraenderungen bei Gaucher-Patienten waehrend der Enzymersatztherapie mit Alglucerase/Imiglucerase in der Magnetresonanztomographie (MRT) zu evaluieren. Material und Methoden: In einer prospektiven Untersuchung wurden 30 adulte Patienten mit gesichertem Morbus Gaucher vor und waehrend der ERT in der MRT

  11. Crohn disease - children - discharge

    Science.gov (United States)

    Inflammatory bowel disease in children - Crohn disease; IBD in children - Crohn disease; Regional enteritis - children; Ileitis - children; Granulomatous ileocolitis - children; Colitis in children; CD - children

  12. Therapie des frühen Morbus Parkinson

    OpenAIRE

    Gerschlager W

    2004-01-01

    Levodopa ist weiterhin der Goldstandard in der Therapie des M. Parkinson. Allerdings führt eine Langzeittherapie mit Levodopa bei vielen Patienten zu motorischen Komplikationen. Experimentelle Studien haben gezeigt, daß eine pulsatile Stimulation der Dopaminrezeptoren zur Entwicklung von motorischen Komplikationen beiträgt. Eine initiale Monotherapie mit Dopaminagonisten (DA) wie Cabergolin, Pergolid, Pramipexol oder Ropinirol führt, bei 2- bis 5jährigen Therapieverläufen, seltener zum Auftr...

  13. PERIANAL CROHNS-DISEASE

    NARCIS (Netherlands)

    HOEDEMAKER, HOT

    1994-01-01

    Perianal disease in Crohn's disease is a difficult matter to deal with. The indication for therapy is not always clear in this disease with a relatively mild natural course. More confusion is caused by the fact that not all disease in the perianal region in a patient with Crohn's has to be Crohn-rel

  14. Stereotaktische Behandlungsmöglichkeiten des Morbus Parkinson

    Directory of Open Access Journals (Sweden)

    Alesch F

    2004-01-01

    Full Text Available Die tiefe Hirnstimulation hat heute einen fixen Stellenwert in der Behandlung der fortgeschrittenen Parkinson-Krankheit, sowohl bei Fluktuationen und Dyskinesien als auch bei therapieresistentem Tremor. Durch die chronische Stimulation des Thalamus, Subthalamus oder Globus pallidus internus lassen sich die unterschiedlichen Symptome der Krankheit (Rigor, Tremor, Akinese gezielt und dauerhaft unterdrücken. Dies ermöglicht eine deutliche Reduktion der dopaminergen Therapie und damit auch deren Nebenwirkungen (Dyskinesien, psychotische Zustände. Die Wirkung ist stabil, Hinweise auf ein Nachlassen der Wirksamkeit über die Zeit finden sich bislang nicht. Die Indikationsstellung ist in den letzten Jahren klarer definiert worden und beruht auf einem weitreichenden Konsens zwischen konservativen und invasiven Disziplinen.

  15. Therapie des frühen Morbus Parkinson

    Directory of Open Access Journals (Sweden)

    Gerschlager W

    2004-01-01

    Full Text Available Levodopa ist weiterhin der Goldstandard in der Therapie des M. Parkinson. Allerdings führt eine Langzeittherapie mit Levodopa bei vielen Patienten zu motorischen Komplikationen. Experimentelle Studien haben gezeigt, daß eine pulsatile Stimulation der Dopaminrezeptoren zur Entwicklung von motorischen Komplikationen beiträgt. Eine initiale Monotherapie mit Dopaminagonisten (DA wie Cabergolin, Pergolid, Pramipexol oder Ropinirol führt, bei 2- bis 5jährigen Therapieverläufen, seltener zum Auftreten von motorischen Komplikationen. 10-Jahres-Daten einer unlängst publizierten randomisierten Studie zeigen, daß Patienten, die initial mit Levodopa behandelt wurden, signifikant häufiger motorische Komplikationen entwickeln, als Patienten, die zuerst auf Bromocriptin eingestellt wurden, allerdings treten klinisch relevante mäßige oder starke Dyskinesien in beiden Gruppen gleich häufig auf. Außerdem zeigten alle randomisierten Vergleichsstudien einer frühen Levodopatherapie versus einer Initialtherapie mit einem DA eine bessere symptomatische Wirksamkeit von Levodopa. Weiterhin wird eine initiale Monotherapie mit DA empfohlen. Erst wenn keine befriedigende Kontrolle der motorischen Symptome durch eine Monotherapie mit DA erreicht wird, sollte zusätzlich Levodopa gegeben werden. Bei über siebzigjährigen Patienten ist der Einsatz von DA sorgfältig abzuwägen. Falls keine wesentliche Komorbidität, keine Demenz und keine Anamnese von psychiatrischen Symptomen (z. B. medikamenteninduzierte Psychose vorliegt, kann auch in dieser Subgruppe eine initiale Monotherapie mit DA erfolgen.

  16. Die Psychosen bei Epilepsie

    Directory of Open Access Journals (Sweden)

    Glauninger G

    2001-01-01

    Full Text Available In einer Übersicht werden die verschiedenen Formen psychotischer Zustandsbilder bei Epilepsiepatienten, deren Ätiopathogenese und Möglichkeiten der Behandlung dieser Störungen beschrieben. Risikofaktoren finden sich durch neurobiologische Gegebenheiten - besonders bei Mitbeteiligung des Temporallappens, durch psychosoziale Einflüsse und manchmal auch durch medikamentöse Behandlung. Anhand von Fallbeispielen sollen dem Leser typische Krankheitsverläufe von psychotischen Episoden bei Epilepsiepatienten, die zumeist erst bei einer schon länger dauernden Epilepsie auftreten, nähergebracht werden. Es wird deutlich, daß sich die Beschwerden von Patienten mit Epilepsie nicht auf iktale Phänomene beschränken. Bei der Behandlung dieser Patienten kommt einer guten interdisziplinären Zusammenarbeit besondere Bedeutung zu.

  17. Genetics Home Reference: Crohn disease

    Science.gov (United States)

    ... Me Understand Genetics Home Health Conditions Crohn disease Crohn disease Enable Javascript to view the expand/collapse boxes. Download PDF Open All Close All Description Crohn disease is a complex, chronic disorder that primarily affects ...

  18. Crohn's & Colitis Foundation of America

    Science.gov (United States)

    ... enabled to enjoy the full interactive experience. Crohn's & Colitis Foundation of America Find a Doctor Find a ... Local Chapters News Events Search: What are Crohn's & Colitis? What is Crohn's Disease What is Ulcerative Colitis ...

  19. Radiation therapy for early stages of Morbus Ledderhose

    Energy Technology Data Exchange (ETDEWEB)

    Heyd, Reinhard [Dept. of Radiotherapy, Klinikum Offenbach (Germany); Dorn, Anne Pia; Mueller-Schimpfle, Marcus [Central Inst. of Radiology, Municipal Hospitals, Frankfurt/Main-Hoechst (Germany); Herkstroeter, Markus [Radiotherapeutic Practice at the Municipal Hospitals, Frankfurt/Main-Hoechst (Germany); Roedel, Claus; Fraunholz, Ingeborg [Dept. of Radiotherapy and Oncology, Univ. Hospital Frankfurt/Main (Germany)

    2010-01-15

    Purpose: To evaluate the efficacy of radiation therapy (RT) in the treatment of early stages of benign plantar fibromatosis (Morbus Ledderhose [ML]). Patients and Methods: From 2003 to 2008, 24 patients (33 sites) with a mean age of 52 years received RT for symptomatic ML. Prior to RT, 19 patients complained of pain and 15 had walking difficulties. 21 patients (28 sites) were irradiated with orthovolt-age X-rays and three (five sites) received electron-beam irradiation. The RT protocol consisted of five weekly fractions of 3.0 Gy (15 Gy), repeated after 6 weeks to a total dose of 30 Gy in 20 patients (28 sites). In four patients (five sites), two single fractions of 4.0 Gy were applied, repeated at intervals of 4 weeks to total doses of 24-32 Gy. Primary study endpoints were the prevention of disease progression and the avoidance of a surgical intervention. Secondary endpoints were pain relief, improvement of gait, and patients' subjective satisfaction measured with a linear analog scale (LAS). Results: After a median follow-up of 22.5 months, none of the patients experienced a progression of number and size of the lesions or the clinical symptoms. In eleven sites (33.3%) complete remission of cords or nodules occurred, in 18 (54.5%) a reduced number or size was noted, and four sites (12.1%) were unchanged. Pain relief was achieved in 13/19 patients (68.4%), and an improvement of gait abnormalities was noted in 11/15 patients (73.3%). The patients' subjective satisfaction measured by means of the LAS revealed a median improvement of 3.5 points in 22/24 patients (91.6%). Skin or soft tissues toxicities RTOG grade > 2 were not noted. Conclusion: RT is effective for treatment of the early stages of ML and may obviate the need for a surgical intervention. Long-term follow-up studies including a larger number of patients are required to define the role of RT in the management of this disorder. (orig.)

  20. BEI Resource Repository

    Data.gov (United States)

    U.S. Department of Health & Human Services — BEI Resources provides reagents, tools and information for studying Category A, B, and C priority pathogens, emerging infectious disease agents, non-pathogenic...

  1. Neues bei Kopfschmerzen

    Directory of Open Access Journals (Sweden)

    Diener HC

    2010-01-01

    Full Text Available Neue epidemiologische Studien waren in der Lage, Faktoren zu identifizieren, die den Übergang von episodischer zur chronischen Migräne voraussagen. Zu diesen gehören die häufige Einnahme von Migräne- oder Schmerzmitteln, psychiatrische Begleitmorbidität und niedrige soziale Schicht. In der Migräneprophylaxe zeigte sich Botulinumtoxin bei chronischer Migräne wirksam. Valproinsäure ist bei der Migräne bei Jugendlichen zur Prophylaxe nicht wirksam. Eine neue Option zur Behandlung des chronischen therapieresistenten Clusterkopfschmerzes ist die bilaterale chronische Stimulation des Nervus occipitalis major. Beim Pseudotumor cerebri muss nicht zwangsläufig eine Stauungspapille nachweisbar sein. Bei klinischem Verdacht muss daher zum sicheren Ausschluss eine Liquorpunktion mit Druckmessung erfolgen.

  2. Stammzelltherapie bei PAVK

    Directory of Open Access Journals (Sweden)

    Kopp CW

    2005-01-01

    Full Text Available Die autologe Stammzelltransplantation zur Induktion therapeutischer Angiogenese stellt eine potentiell beinerhaltende Therapieoption bei chronisch kritischer Extremitätenischämie bei Patienten ohne chirurgische oder interventionelle Revaskularisationsmöglichkeit dar. Die folgende Übersicht soll das zugrundeliegende Konzept dieses Therapieansatzes und klinische Richtlinien für die Ausschöpfung des angiogenetischen Potentials von Knochenmarksstammzellen vorstellen. Im Ausblick werden die "Stammzell-Mobilisation" und das gezielte "Homing" als Alternative zur Stammzelltransplantation umrissen.

  3. [Morbus Behçet or inflammatory bowel disease--a diagnostic and therapeutic dilemma].

    Science.gov (United States)

    Schack, S; Weber, M; Oelzner, P; Mireskandari, M; Antonov, D; Stallmach, A

    2015-10-01

    We present the case of a 43-year old caucasian male suffering from a condition initially diagnosed as colitis ulcerosa. For 2 years Azathioprine and anti-TNF-alpha antibodies were used for treatment without convincing benefit but with serious adverse events. After the first occurrence of complex accompanying symptoms like oral and scrotal ulcerations, arthritis and scratch-induced skin lesions the differential diagnosis of a Morbus Adamantiades-Behçet with intestinal evolvement was considered. After introduction of a parenteral Ciclosporin medication, which was later switched to Tacrolimus and Azathioprin, a remission could be achieved that lasted for several months. When a drug-induced acute kidney injury occurred, the regime was changed to Golimumab and a delayed but significant improvement was achieved. To separate Morbus Adamantiades-Behçet from inflammatory bowel disease is of some difficulty, demands interdisciplinary cooperation and is the basis for a successful therapy.

  4. Pellagra complicating Crohn's disease.

    OpenAIRE

    Zaki, I.; Millard, L

    1995-01-01

    We report a 53-year-old patient with clinical features of pellagra as a complication of Crohn's disease. His symptoms improved rapidly on taking oral nicotinic acid and vitamin B complex. We suggest the paucity of reported cases of pellagra in Crohn's disease is a reflection of poor recognition of this complication.

  5. MR spectroscopy in metabolic disorders of the brain; MR-Spektroskopie bei Stoffwechselerkrankungen des Gehirns

    Energy Technology Data Exchange (ETDEWEB)

    Yilmaz, U. [Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Homburg/Saar (Germany)

    2017-06-15

    Metabolic disorders of the brain often present a particular challenge for the neuroradiologist, since the disorders are rare, changes on conventional MR are often non-specific and there are numerous differential diagnoses for the white substance lesions. As a complementary method to conventional brain MRI, MR spectroscopy may help to reduce the scope of the differential diagnosis. Entities with specific MR spectroscopy patterns are Canavan disease, maple syrup urine disease, nonketotic hyperglycinemia and creatine deficiency. (orig.) [German] Die Diagnostik metabolischer Erkrankungen des Gehirns stellt eine besondere Herausforderung in der Neuroradiologie dar, da die Erkrankungen insgesamt selten, die bildmorphologischen Befunde haeufig unspezifisch sind und es eine Vielzahl von Differenzialdiagnosen fuer die Veraenderungen der weissen Substanz gibt. Als zusaetzliche Technik kann die MR-Spektroskopie bei Stoffwechselerkrankungen helfen, die Diagnose einzugrenzen. Krankheitsentitaeten, die spezifische Veraenderungen in der Spektroskopie aufweisen, sind der Morbus Canavan, die Ahornsirupkrankheit, die nichtketotische Hyperglyzinaemie und Kreatinmangelsyndrome. (orig.)

  6. Osteoporose bei polyzystischem Ovarsyndrom

    Directory of Open Access Journals (Sweden)

    Lerchbaum E

    2015-01-01

    Full Text Available Das polyzystische Ovarsyndrom (PCOS ist die häufigste Endokrinopathie bei Frauen im gebärfähigen Alter und geht mit Oligo- oder Anovulation, klinischem oder biochemischem Hyperandrogenismus und polyzystischen Ovarien einher. Während die Hyperandrogenämie einen potenziell protektiven Faktor hinsichtlich der Osteoporose darstellt, könnte das im Rahmen der gestörten Ovulation häufig vorhandene Östrogendefizit den Knochenstoffwechsel und das Osteoporoserisiko ungünstig beeinflussen. Weiters treten beim PCOS gehäuft metabolische Probleme wie Adipositas, Insulinresistenz, Glukosestoffwechselstörungen und das metabolische Syndrom auf, die ebenfalls Einfluss auf den Knochen nehmen können. Auch die medikamentöse Therapie des PCOS wie hormonelle Kontrazeptiva, Antiandrogene und Insulinsensitizer können das Osteoporoserisiko modifizieren. Die bisherige Datenlage zur Knochendichte (BMD beim PCOS ist unklar, die Ergebnisse reichen von ähnlichen Werten bei PCOS und gesunden Frauen, über bessere BMD-Werte bei PCOS-Frauen bis hin zu schlechteren BMD-Werten vor allem bei amenorrhoischen Frauen mit PCOS. Die bislang einzige Studie zum Frakturrisiko bei postmenopausalen Frauen mit PCOS ergab keinen Unterschied zwischen PCOS-Frauen und gesunden Kontrollen. Somit kann anhand der derzeitigen Datenlage nicht zufriedenstellend beurteilt werden, ob das PCOS einen möglichen Risikofaktor für die Osteoporose darstellt oder, im Gegenteil, ein eher protektiver Faktor ist. Es besteht ein großer Bedarf an prospektiven Studien mit adäquater Fallzahl auch bei postmenopausalen Frauen mit PCOS, um diese Frage beantworten zu können. Derzeit muss jede Frau mit PCOS, das ein sehr heterogenes Krankheitsbild darstellt, individuell hinsichtlich des möglichen Osteoporoserisikos beurteilt werden. Der Zusammenhang zwischen PCOS und Osteoporose sollte in Zukunft sowohl in der klinischen Routine als auch bei künftigen Studien vermehrt Beachtung finden.

  7. Impact of pretreatment variables on the outcome of {sup 131}I therapy with a standardized dose of 150 Gray in Graves` disease; Einfluss praetherapeutischer Variablen auf die Wirkung einer standardisierten {sup 131}J-Therapie mit 150 Gray beim Morbus Basedow

    Energy Technology Data Exchange (ETDEWEB)

    Pfeilschifter, J. [Heidelberg Univ., Radiologische Klinik (Germany). Abt. fuer Nuklearmedizin; Elser, H. [Medizinische Universitaetsklinik und Poliklinik Heidelberg (Germany). Abt. fuer Innere Medizin I; Haufe, S. [Medizinische Universitaetsklinik und Poliklinik Heidelberg (Germany). Abt. fuer Innere Medizin I; Ziegler, R. [Heidelberg Univ., Radiologische Klinik (Germany). Abt. fuer Nuklearmedizin; Georgi, P. [Medizinische Universitaetsklinik und Poliklinik Heidelberg (Germany). Abt. fuer Innere Medizin I

    1997-04-01

    Aim: We examined the impact of several pretreatment variables on thyroid size and function in 61 patients with Graves` disease one year after a standardized [131]I treatment with 150 Gray. Methods: FT3, FT4, and TSH serum concentrations were determined before and 1.5, 3, 6, and 12 months after therapy. Thyroid size was measured by ultrasound and scintigraphy before and one year after therapy. Results: One year after therapy, 30% of the patients had latent or manifest hyperthyroidism, 24% were euthyroid, and 46% had developed latent or manifest hypothyroidism. Age and initial thyroid volume were major predictors of posttherapeutical thyroid function. Thus, persistent hyperthyroidism was observed in 70% of the patients age 50 years and older with a thyroid size of more than 50 ml. With few exception, thyroid size markedly decreased after therapy. Initial thyroid size and age were also major predictors of posttherapeutical thyroid volume. Thyroid size normalized in all patients younger than 50 years of age, independent from initial thyroid size. Conclusion: Radioiodine treatment with 150 Gray causes a considerable decrease in thyroid size in most patients with Graves` disease. Age and initial thyroid volume are important determinants of thyroid function and size after therapy and should be considered in dose calculation. (orig.) [Deutsch] Ziel: Bei 61 Patienten mit einem Morbus Basedow haben wir den Einfluss praetherapeutischer Variablen auf die Funktion und das Volumen der Schilddruese ein Jahr nach einer {sup 131}J-Therapie mit 150 Gray untersucht. Methoden: FT3, FT4, und TSH wurden vor Therapie und eineinhalb, 3, 6 und 12 Monate nach Therapie gemessen. Das Schilddruesenvolumen wurde vor Therapie und ein Jahr nach Therapie sonographisch und szintigraphisch bestimmt. Ergebnisse: Ein Jahr nach Therapie waren 30% der Patienten latent oder manifest hyperthyreot, 24% euthyreot, und 46% latent oder manifest hypothyreot. Lebensalter und Ausgangsvolumen der Schilddruese

  8. Herzbeteiligung bei Myopathien

    Directory of Open Access Journals (Sweden)

    Finsterer J

    2001-01-01

    Full Text Available Herzbeteiligung bei Patienten mit Myopathien wird zunehmend häufiger diagnostiziert. Sie manifestiert sich bei diesen Patienten als Störung der Erregungsbildung und -ausbreitung, Wandverdickung, abnorme Textur des Myokards, linksventrikuläre Hypertrabekulierung, Dilatation der Herzhöhlen mit/ohne sekundärer Klappeninsuffizienz, Reduktion der Koronarreserve, intrakardiale Thrombusbildung, Endo-/Myokardfibrose, regionale Wandbewegungsstörung und systolische und/oder diastolische Funktionsstörung mit/ohne Herzinsuffizienz. Herzbeteiligung wurde bisher bei Dystrophinopathien, Emery-Dreifuss-Muskeldystrophie, fazioskapulohumeraler Muskeldystrophie, Sarcoglycanopathien, kongenitaler Muskeldystrophie Fukuyama, myotoner Dystrophie Typ 1 und 2, Glykogenose Typ II, III, IV, VII und IX, Carnitinmangel, Myoadenylat-Deaminase-Mangel, Acyl-CoA-Dehydrogenase-Mangel, lysosomaler Glykogen-Speicherkrankheit, Mitochondriopathien, Desmin-Myopathie, Nemalin-Myopathie, Central Core-Krankheit, kongenitaler Fasertypen-Dysproportion, Barth-Syndrom, McLeod-Syndrom und Bethlem-Myopathie beschrieben. Herzbeteiligung bei Myopathien kann über Monate oder Jahre progredient verlaufen oder auch akut auftreten bzw. sich bis hin zum kardialen Notfall verschlechtern. Die Therapie der Herzbeteiligung richtet sich nach den spezifischen kardialen Abnormitäten und umfaßt Digitalis, Diuretika, ACE-Hemmer, Kalziumantagonisten, Amiodaron, Betablocker, L-Carnitin, Antikoagulation, Kardioversion, Schrittmacher, Defibrillator, Hochfrequenz-Katheter-Ablation und die Herztransplantation. Generell sollten Myopathie-Patienten kardiologisch untersucht werden, sobald die neurologische Diagnose feststeht, da eine suffiziente kardiale Therapie die Herzbeteiligung bei Myopathien positiv beeinflußt. Ein kardiologisches Follow-up ist angezeigt, wenn die Herzbeteiligung klinisch manifest wird bzw. bei rascher Progredienz.

  9. Herzbeteiligung bei Myopathien

    Directory of Open Access Journals (Sweden)

    Finsterer J

    2001-01-01

    Full Text Available Herzbeteiligung bei Patienten mit Myopathien wird zunehmend häufiger diagnostiziert. Sie manifestiert sich bei diesen Patienten als Störung der Erregungsbildung und -ausbreitung, Wandverdickung, abnorme Textur des Myokards, linksventrikuläre Hypertrabekulierung, Dilatation der Herzhöhlen mit/ohne sekundärer Klappeninsuffizienz, Reduktion der Koronarreserve, intrakardiale Thrombusbildung, Endo-/Myokardfibrose, regionale Wandbewegungsstörung und systolische und/oder diastolische Funktionsstörung mit/ohne Herzinsuffizienz. Herzbeteiligung wurde bisher bei Dystrophinopathien, Emery-Dreifuss-Muskeldystrophie, fazioskapulohumeraler Muskeldystrophie, Sarcoglycanopathien, kongenitaler Muskeldystrophie Fukuyama, myotoner Dystrophie Typ 1 und 2, proximal myotoner Myopathie, Glykogenose Typ II, III, IV, VII und IX, Carnitinmangel, Myoadenylat-Deaminase-Mangel, Acyl-CoA-Dehydrogenase-Mangel, lysosomaler Glykogen-Speicherkrankheit, Mitochondriopathien, Desmin-Myopathie, Nemalin-Myopathie, Central Core-Krankheit, kongenitaler Fasertypen-Dysproportion, Barth-Syndrom, McLeod-Syndrom und Bethlem-Myopathie beschrieben. Herzbeteiligung bei Myopathien kann über Monate oder Jahre progredient verlaufen oder auch akut auftreten bzw. sich bis hin zum kardialen Notfall verschlechtern. Die Therapie der Herzbeteiligung richtet sich nach den spezifischen kardialen Abnormitäten und umfaßt Digitalis, Diuretika, ACE-Hemmer, Kalziumantagonisten, Amiodaron, Betablocker, L-Carnitin, Antikoagulation, Kardioversion, Schrittmacher, Defibrillator, Hochfrequenz-Katheter-Ablation und die Herztransplantation. Generell sollten Myopathie-Patienten kardiologisch untersucht werden, sobald die neurologische Diagnose feststeht, da eine suffiziente kardiale Therapie die Herzbeteiligung bei Myopathien positiv beeinflußt. Ein kardiologisches Follow-up ist angezeigt, wenn die Herzbeteiligung klinisch manifest wird bzw. bei rascher Progredienz.

  10. Radioiodine therapy of Graves' disease - a dosimetric comparison of different strategies concerning antithyroid drugs; Radioiodtherapie des Morbus Basedow - dosimetrischer Vergleich verschiedener Therapieregime bezueglich der Thyreostatikabgabe

    Energy Technology Data Exchange (ETDEWEB)

    Urbannek, V.; Voth, E.; Moka, D.; Schicha, H. [Klinik und Poliklinik fuer Nuklearmedizin, Medizinische Einrichtungen der Univ. zu Koeln (Germany)

    2001-08-01

    -half-life, but it is inferior to stopping ATD 2 days prior to RITh. (orig.) [German] Ziel: Eine thyreostatische Medikation (TM) waehrend einer Radioiodtherapie (RITh) fuehrt im Vergleich zu nicht thyreostatisch behandelten Patienten zu einer prozentualen Zunahme an Therapieversagern oder erfordert einen erhoehten Verbrauch an Radioiod (RI). Andererseits ist aus klinischen Gruenden und wegen des in der Hyperthyreose beschleunigten lodstoffwechsels vor RITh eine Kompensation der Stoffwechsellage anzustreben. Ziel dieser Studie war daher, am Beispiel des Morbus Basedow den Einfluss der TM auf die Biokinetik von RI zu untersuchen, um die RITh bei thyreostatisch vorbehandelten Patienten zu optimieren. Methoden: Eingeschlossen wurden 385 konsekutive Patienten, die wegen eines Morbus Basedow erstmalig eine RITh erhielten: Kollektiv A (n = 74): Durchfuehrung der RITh unter laufender TM; Kollektiv B (n = 111): Beginn der RITh unter TM, Absetzen von TM 1-5 Tage nach RITh, falls RI-Uptake unzureichend oder RI-HWZ verkuerzt (n = 61); Kollektiv C (n = 200): Absetzen von TM 2 Tage vor RITh bei allen Patienten. Betrachtet wurde der Einfluss von thyreostatischer Medikation auf den RI-Uptake, die RI-HWZ sowie die an der Schilddruese erzielte Energiedosis in Abhaengigkeit vom SD-Volumen und der eingesetzen RI-Aktivitaet [Therapieeffizienzquotient TEQ, (2)]. Ergebnisse: Im RI-Test (alle Patienten unter TM) war der RI-Uptake in den drei Kollektiven vergleichbar. Bei der RITh waren RI-Uptake, RI-HWZ{sub eff} und damit auch TEQ im Kollektiv C signifikant groesser als in den Kollektiven A und B (jeweils p<0,001). Im Kollektiv B wurde die TM bei 61 der 111 Patienten 1-5 Tage nach RITh abgesetzt. In diesem Unterkollektiv stieg die RI-HWZ von 4,4 {+-} 1,7 d auf 5,1 {+-} 1,6 d nach Absetzen der TM an (p = 0,001). Schlussfolgerung: Absetzen von TM 2 Tage vor RITh fuehrt im Vergleich zur Durchfuehrung der RITh unter TM zu einer Steigerung der Effizienz (TEQ) von etwa 50% und damit zu einer deutlichen

  11. Autoimmunität der Schilldrüse und Bedeutung bei Kinderwunsch und in der Schwangerschaft

    Directory of Open Access Journals (Sweden)

    Quadbeck B

    2009-01-01

    Full Text Available Autoimmunthyreopathien können bei Schilddrüsenstoffwechselstörungen (v. a. Hypothyreose Zyklusstörungen (v. a. Oligomenorrhö verursachen und sich somit auf die Fertilität der Frau negativ auswirken. Häufigste Ursache einer erworbenen Hypothyreose bei Frauen im gebärfähigen Alter ist eine atrophisch verlaufende Autoimmunthyreoiditis mit einer Prävalenz von 0,5 % für manifeste und 5 % für milde Hypothyreosen. Risikopatientinnen sollten daher, da der Bedarf an Schilddrüsenhormon in der Schwangerschaft bis zu 50 % steigen kann, erkannt und frühzeitig mit Schilddrüsenhormon behandelt werden. Eine Schilddrüsenüberfunktion wird im gebärfähigen Alter der Frau in bis zu 85 % der Fälle durch eine immunogene Hyperthyreose vom Typ Morbus Basedow verursacht. Die milden Verlaufsformen sind zumeist nicht mit Zyklusstörungen assoziiert. Eine Therapie mit niedrig dosierten antithyreoidalen Medikamenten ist auf alle Fälle erforderlich, ggf. sollte vor einer Schwangerschaft bei bekannter hoher immunologischer Aktivität über eine frühzeitige definitive Therapie (Operation, Radiojodtherapie nachgedacht werden. Eine im ersten Jahr nach der Geburt auftretende Postpartum-Thyreoiditis kommt bei 2–20 % der Schwangeren vor. Bei ca. 10 % der Schwangeren sind bereits in der Frühschwangerschaft TPO-Antikörper messbar. Von diesen entwickelt jede 2. Schwangere eine Postpartum-Thyreoiditis. Diese kann einen unterschiedlichen Verlauf nehmen (monophasisch – zumeist Entwicklung einer Hypothyreose, vollkommen ausheilen oder nach anfänglich hyperthyreoter Phase in eine manifeste Hypothyreose münden (biphasischer Verlauf. Frühschwangerschaft und die Postpartalzeit gelten bei allen Autoimmunthyreopathien als immunologisch empfindliche Phasen, in denen Risikopatientinnen kontrolliert werden sollten.

  12. Granulomatous Cheilitis and Crohn's Disease

    OpenAIRE

    Ishfaq Ahmad; David Owens

    2001-01-01

    Granulomatous cheilitis is characterized by recurrent swelling of the labial tissues and granulomatous histology. Granulomatous cheilitis has been recognized as an early manifestation of Crohn's disease. It may follow, coincide with or precede the onset of Crohn's disease. The first case presented involved an extraintestinal manifestation of Crohn's disease, and the second case presented is of development of granulomatous cheilitis a year before the onset of symptomatic Crohn's disease. Altho...

  13. Neuroimaging bei Schlaganfall

    Directory of Open Access Journals (Sweden)

    Nasel Ch

    2013-01-01

    Full Text Available Während zunächst die Differenzialdiagnosen des Schlaganfalls erfasst werden sollten, wurde sehr bald das Neuroimaging in den Dienst der Behandlung der akuten Ischämie gestellt. Hier kommt der neuroradiologischen Bildgebung eine besondere Rolle zu, da zunehmend die Auswahl von Patienten für eine bestimmte Therapie von der Bildgebung abhängt. Der Verlauf von zerebralen Ischämien ist, bedingt durch stark variierende Faktoren wie Kollateralisation, frühe Rekanalisation etc., sehr unterschiedlich. Die multimodale MR- und CTBildgebung, welche eine Kombination aus konventioneller Bildgebung des Gehirns, angiographischen Verfahren und funktionellen Messungen, wie z. B. Perfusionsmessungen, darstellt, kann jede Ischämie sehr genau charakterisieren. Wichtig ist dabei ein klares Interpretationskonzept. Bei Patienten, deren Symptombeginn eindeutig innerhalb der letzten 3–4,5 h liegt, kann die Nativ- CT, am besten in Kombination mit der CTA, als ausreichend zur Durchführung der anerkannten systemischen i.v.-Lyse sowie zur Feststellung eines Gefäßverschlusses, der einer weiteren Behandlung bedarf, angesehen werden. Im Zeitfenster 4,5 h, bei unklarem Zeitfenster oder nach frustraner i.v.-Lyse, ist, insbesondere bei einem im Weiteren geplanten endovaskulären Eingriff, die multimodale MRI mit Anwendung des „Mismatch-match“-Konzepts zwischen diffusionsgewichtetem MRI und Perfusions-MRI jedenfalls die Methode der ersten Wahl. Steht diese nicht zur Verfügung, kann alternativ das multimodale CT eingesetzt werden.

  14. Radiotherapy in early stage dupuytren's contracture; Die Radiotherapie des Morbus Dupuytren im Fruehstadium. Langzeitresultate nach einer medianen Nachbeobachtungszeit von 10 Jahren

    Energy Technology Data Exchange (ETDEWEB)

    Adamietz, B.; Sauer, R. [Erlangen-Nuernberg Univ., Erlangen (Germany). Klinik und Poliklinik fuer Strahlentherapie; Keilholz, L. [Erlangen-Nuernberg Univ., Erlangen (Germany). Klinik und Poliklinik fuer Strahlentherapie; Praxis fuer Strahlentherapie, Klinikum Fuerth (Germany); Gruenert, J. [Abt. fuer Plastische und Handchirurgie der Chirurgischen Universitaetsklinik Erlangen-Nuernberg, Erlangen (Germany)

    2001-11-01

    Purpose: In early stage Dupuytren's contracture radiotherapy was applied to prevent disease progression. Long-term results and late toxicity of this treatment were evaluated in a retrospective analysis. Patients and Methods: Between 1982 and 1994, 99 patients (176 hands) received orthovoltage radiotherapy, which consisted of two courses with 5 x 3 Gy (total dose: 30 Gy, daily fractionated; 120 kV, 4 mm Al), separated by a 6 to 8-week pause. The Dupuytren's contracture was staged according to the classification of Tubiana et al. The long-term outcome was analyzed at last follow-up between July and November 1999. The median follow-up was 10 years (range 7-18 years). Late toxicity was assessed using the LENT-SOMA criteria. Results: In Stage N 84% and Stage N/I 67% of cases remained stable. 65% of the cases in Stage I and 83% in Stage II showed progressive nodules and cords. In case of progression we saw no complications after a second radiotherapy or salvage operation. Conclusion: Radiotherapy effectively prevents disease progression for early stage Dupuytren's contracture (Stage N, N/I). Moreover, in case of disease progression despite radiotherapy salvage surgery is still feasible. (orig.) [German] Hintergrund: Im Fruehstadium des Morbus Dupuytren wird die externe Radiotherapie mit dem Ziel eingesetzt, den progressiven Verlauf der Erkrankung zu verhindern. Eine aktuelle Langzeitverlaufskontrolle soll die Ergebnisse und Nebenwirkungen der Radiotherapie darstellen. Patienten und Methode: Wir untersuchten 99 Patienten (176 Haende), welche sich von 1982-1994 einer Radiotherapie an unserer Klinik unterzogen. Jeder Patient erhielt zwei Serien einer Radiotherapie mit jeweils 5 x 3 Gy (Gesamtdosis 30 Gy, 120 kV, 4 mm Al, Bestrahlungspause von 6-8 Wochen nach 15 Gy). Die Beugekontraktur wurde nach Tubiana et al. eingeteilt. Von Juli bis November 1999 erfolgte nach einer medianen Nachbeobachtungszeit von 10 Jahren (7-18 Jahre) eine Kontrolluntersuchung. Die

  15. [Therapy options in the case of advanced therapy resistant Morbus Parkinson].

    Science.gov (United States)

    Hakimi, R

    2010-12-01

    In Germany about 300,000 to 400,000 people are suffering from Morbus Parkinson at present. It is one of the most common neurological diseases both in Germany and in Europe as a whole. With the rising number of elderly people in our population, the number of Parkinson patients will strongly increase as well in future. About 20% of these patients are already in an advanced stage. This stage leaves its marks with motor and non-motor sequelae. With the minority of these patients oral medication is ineffective. For these relatively rare cases an indication for an L-dopa-infusion therapy (duodopa pump), an apomorphine pump therapy or a deep brain stimulation may exist. The indication for one of these 3 therapy forms is given by the neurological clinic in agreement with the patient and is only given in case of failure of oral medication. All 3 therapy options are very expensive. In case of the deep brain stimulation, close cooperation between the neurologist and the neurosurgeon as well as with the patient is necessary. Experts warn about a transplantation of stem cells because there are no clinical studies and only partial clinical improvement with severe side effects are known. The transplantation of stem cells for advanced Morbus Parkinson is not a medically necessary treatment at present.

  16. [Crohn's disease surgery].

    Science.gov (United States)

    Kala, Zdeněk; Marek, Filip; Válek, Vlastimil A; Bartušek, Daniel

    2014-01-01

    Surgery of Crohns disease is an important part of the general treatment algorithm. The role of surgery is changing with the development of conservative procedures. The recent years have seen the return to early treatment of patients with Crohns disease. Given the character of the disease and its intestinal symptoms, a specific approach to these patients is necessary, especially regarding the correct choice of surgery. The paper focuses on the luminal damage of the small and large intestine including complications of the disease. We describe the individual indications for a surgical solution, including the choice of anastomosis or multiple / repeated surgeries.

  17. What Is Crohn's Disease?

    Science.gov (United States)

    ... What are Crohn's & Colitis? > What is Crohn’s Disease? Crohn’s Disease is a Chronic Condition By understanding your body ... live a full and rewarding life What is Crohn’s Disease? Email Print + Share Named after Dr. Burrill B. ...

  18. Management of Crohn's disease.

    Science.gov (United States)

    Kammermeier, Jochen; Morris, Mary-Anne; Garrick, Vikki; Furman, Mark; Rodrigues, Astor; Russell, Richard K

    2016-05-01

    Crohn's disease (CD) is rapidly increasing in children so an up to date knowledge of diagnosis, investigation and management is essential. Exclusive enteral nutrition is the first line treatment for active disease. The vast majority of children will need immunosuppressant treatment and around 20% will need treatment with biologics. Recent guidelines have helped make best use of available therapies.

  19. Enterobiasis mimicking Crohn's disease.

    Science.gov (United States)

    Fernandez-Flores, Angel; Dajil, Saleh

    2004-01-01

    We report a 20-year-old man who presented with abdominal discomfort for 2 months. Colonoscopy showed skip areas with ulceration, resembling Crohn's disease. Biopsies showed chronic inflammation and a non-necrotizing granuloma. An adult pinworm was found in the lumen from an uninvolved segment. The patient responded to mebendazole.

  20. Knochenstoffwechsel bei malignen Erkrankungen

    Directory of Open Access Journals (Sweden)

    Keck A-V

    2003-01-01

    Full Text Available Bei malignen Erkrankungen, wie dem Mammakarzinom, dem Prostatakarzinom, dem Bronchialkarzinom oder dem multiplen Myelom ist der Knochen eines der am häufigsten von Metastasen betroffenen Organe. Das klinische Beschwerdebild ist durch das Auftreten pathologischer Frakturen, Schmerzen und Hyperkalzämien gekennzeichnet. Eine erhöhte Knochenresorptionsrate und Verlust an Knochenmasse im Sinne von osteoporoseartigen Veränderungen bedingt durch eine inadäquat überschießende Osteoklastendifferenzierung und -aktivierung sind ursächlich dafür verantwortlich. Durch jüngst publizierte Ergebnisse diverser Studien und Untersuchungen konnten die genauen Mechanismen der Rekrutierung und Aktivierung von Osteoklasten weiter aufgeklärt werden. Receptor activator of nuclear factor-kappa-B ligand (RANKL, ein Mitglied der Tumor necrosis factor (TNF Superfamilie konnte als entscheidender Faktor in der Osteoklastengenese identifiziert werden. Die Interaktion von RANKL mit seinem Rezeptor RANK (receptor activator of nuclear factor-kappa-B induziert die Entwicklung der osteoklastären Reihe aus dem hämatopoetischen Kompartment und fördert weiters die Differenzierung zu Osteoklastenvorstufen und die Aktivierung reifer Osteoklasten, ebenso wird eine verzögert einsetzende Apoptose bewirkt. Neben RANK und RANKL ist Osteoprotegerin (OPG als dritte Komponente in der Regulation der Knochenresorption involviert. Als Mitglied der TNF-Superfamilie bindet OPG an RANKL und blockiert somit alle stimulierenden Effekte von RANK auf die Osteoklastenentwicklung und neutralisiert so alle biologischen Effekte von RANKL. Diverse Hormone und Zytokine üben durch die Modifikation der Ratio von RANKL zu OPG einen regulatorischen Effekt auf die Knochenresorption aus. Diese ist bei osteolytischen Knochenmetastasen, beim multiplen Myelom und bei der malignen Hyperkalzämie erhöht. Das Gleichgewicht knochenaufbauender wie -abbauender Mechanismen scheint somit durch die Ratio von

  1. Assoziation von funktionell wirksamen Polymorphismen auf dem humanen Chromosom 1 mit der Pathogenese der chronischen Parodontitis

    OpenAIRE

    Fotiadou, Christina

    2016-01-01

    Die chronische Parodontitis und weitere chronisch entzündliche Erkrankungen, wie Morbus Crohn, stellen komplexe multifaktorielle Krankheiten dar. Obwohl pathogene Bakterien und verschiedene Umweltfaktoren bei der Pathogenese der Parodontitis mitwirken, können diese nur einen Teil der Variabilität innerhalb von definierten Populationen der Erkrankung erklären. So spielen genetische Faktoren eine wichtige Rolle bei der Entstehung einer chronischen Parodontitis. In dieser Arbeit wurden die P...

  2. MRI of vulvar Crohn disease

    Energy Technology Data Exchange (ETDEWEB)

    Pai, Deepa; Dillman, Jonathan R.; Mahani, Maryam Ghadimi; Strouse, Peter J. [University of Michigan Health System, Department of Radiology, Section of Pediatric Radiology, C.S. Mott Children' s Hospital, F3503, Ann Arbor, MI (United States); Adler, Jeremy [University of Michigan Health System, Department of Pediatrics and Communicable Diseases, Division of Pediatric Gastroenterology, C. S. Mott Children' s Hospital, Ann Arbor, MI (United States)

    2011-04-15

    Crohn disease is a chronic granulomatous inflammatory disorder that most commonly affects the gastrointestinal tract, particularly the distal small bowel and colon. While certain extraintestinal manifestations of Crohn disease are relatively common and well-known, others, such as metastatic cutaneous involvement, are quite rare and may be difficult to recognize, particularly in the pediatric population. This case report illustrates the magnetic resonance imaging (MRI) appearance of vulvar region cutaneous Crohn disease in an 11-year-old girl. (orig.)

  3. Operative Revaskularisation bei Diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Hausmann H

    2003-01-01

    Full Text Available Patienten mit KHK und Diabetes mellitus haben sowohl bei interventioneller als auch bei chirurgischer Koronarrevaskularisation ein erhöhtes Mortalitätsrisiko. Allerdings ist nach chirurgischer Revaskularisation vor allem die Rate an notwendigen Reinterventionen wesentlich geringer als nach PTCA. Gegenwärtig liegen keine Ergebnisse über den Langzeitverlauf nach Stentimplantation vor. Außerdem ist das Risiko für einen Diabetiker mit KHK, nach einer Bypassoperation an einem Myokardinfarkt zu versterben, deutlich geringer als nach PTCA. Die Bypassoperation mit Sternotomie trägt allerdings bei Diabetikern ein erhöhtes Risiko für die Entwicklung einer postoperativen Mediastinitis, vor allem dann, wenn bei "totaler arterieller" Revaskularisation beide Aa. mammariae verwendet werden. Deshalb sollte bei Diabetikern zur chirurgischen Revaskularisation die A. mammaria nur einseitig genutzt werden. Prä- und perioperativ ist auf eine besonders sorgfältige Blutzuckereinstellung zu achten. Verkalkungen der herznahen Gefäße, wie z. B. der Aorta ascendens und der Karotiden, müssen präoperativ abgeklärt werden. Die Operation ist möglichst schonend durchzuführen, die Wundfläche sollte minimiert werden. Reexplorationen sind unbedingt zu vermeiden. Bei Beachtung dieser Richtlinien sind auch bei Patienten mit KHK und Diabetes mellitus sehr gute chirurgische Revaskularisationsergebnisse zu erreichen.

  4. [A giant field of death: medical and scientific controversies about the cholera morbus epidemic of 1855].

    Science.gov (United States)

    Santos, Luciana Dos

    2016-01-01

    The article examines the cholera morbus epidemic that afflicted the province of Pernambuco, Brazil, in 1855, focusing on the medical and scientific controversies about how the disease spread, which split medical opinion into two camps: contagion and infection. Documents and reports produced by the Society of Medicine of Pernambuco and the General Public Health Board were analyzed, based on which it was possible to describe the official medical and sanitation program, involving engineers, scientists, and physicians, designed to plan a salubrious city - a model of civilization that combined redeveloping the urban space and disseminating new habits amongst the local people. It is essentially an exercise in observing a science and a society as they take shape.

  5. [Medicine and humanism: insights of the Nürnberg city physician Theodericus Ulsenius regarding Morbus Gallicus].

    Science.gov (United States)

    Santing, C G

    1995-01-01

    The Nuremberg physician and humanist Theodericus Ulsenius (c. 1460-1508) was the author of two works on the so-called Morbus Gallicus. In 1496 he published a Vaticinium in epidemicam scabiem, and he also wrote fifty aphorisms, entitled Cura mali francici. In this article I will characterize Ulsenius' ideas and compare these to the measures the Nuremberg town government took to diminish the dangerous effects of the epidemic. In the function of official town physician, Ulsenius was one of the chief advisers and executives of the Nuremberg health policy. As the 'Ratsverlässe' (records of the town-council meetings) give detailed information, the reactions of senate and physicians can be followed from day to day. The Vaticinium a poem of 100 hexameters was printed at the office of Hans Mair and presented as a pamphlet with a woodcut from the workshop of Albrecht Dürer. The verses refer to a dream of the poet, in which the God Apollo addresses him and talks about the terrible disease. The origin and symptoms of the illness are discussed extensively, in accordance with the prevailing medico-astrological conceptions. Nevertheless, the poem ist not a medical piece of work, but a literary-styled and humanistically appropriate description of the recent epidemic, meant for fellow members of the German respublica litteraria. Like most of Ulsenius' writings, the Cura mali francici only survived as a copy made by his colleague Hartmann Schedel. It seems that the author had different types of audience in mind. The aphorisms refer to the Aphorisms of his great example, the famous Ancient medical doctor Hippocrates of Kos. The addresses of the Cura are obviously medical professionals: the physician in the towns harassed by the Morbus Gallicus and especially the medical professors who hat to lecture on the new ailment.

  6. Risikostratifizierung bei akuten Koronarsysdromen

    Directory of Open Access Journals (Sweden)

    Traindl O

    2000-01-01

    Full Text Available Unter dem Begriff der akuten Koronarsyndrome werden die instabile Angina pectoris, nichttransmurale (non-Q-wave Infarkte und transmurale Myokardinfarkte sowie der plötzliche Herztod (Sudden cardiac death zusammengefaßt. Zur Diagnose und Riskoabschätzung werden neben der Klinik des Patienten das EKG und biochemische Marker herangezogen. Die Einteilung nach Braunwald erlaubt heute eine bessere Quantifizierung der individuellen klinischen Beschwerden. Das EKG dient nicht nur zur Diagnostik bei Aufnahme, sondern erlaubt auch Rückschlüsse auf die Langzeitprognose der Patienten. Biochemische Marker ergänzen das nicht immer eindeutige EKG. Die bekannten Enzyme CK und CKMB werden durch die Troponine T und I ergänzt. Diese erfassen bereits wesentlich kleinere myokardiale Läsionen. Die Rolle des Akutphasenproteins CRP als Marker wird derzeit ausführlich untersucht.

  7. Thrombolyse bei Pulmonalembolie

    Directory of Open Access Journals (Sweden)

    Kasper W

    2003-01-01

    Full Text Available Die Lungenembolie ist eine gutartige Erkrankung, wenn sie rechtzeitig entdeckt und effektiv mit Antikoagulanzien behandelt wird. Das Rechtsherzversagen ist die Todesursache bei Lungenembolie. Die Rechtsherzinsuffizienz ist abhängig vom Ausmaß der embolischen Obstruktion der Lungenstrombahn, vom Grad der kardiopulmonalen Vorschädigung und vom Ausmaß der Restthromben in der periphervenösen Zirkulation als Risikofaktor für eine Rezidivembolie. Das Auftreten einer rechtsventrikulären Dysfunktion oder einer Troponin T/I-Erhöhung ist von prognostischer Bedeutung. Für gewöhnlich ist die Prognose während des Krankenhausaufenthaltes gut, wenn keiner der beiden Parameter beobachtet wird. Die thrombolytische Therapie der Lungenembolie ist den Patienten mit hämodynamischer Instabilität vorbehalten. Die klinische Unsicherheit, ob auch Patienten mit submassiver Lungenembolie von einer Thrombolyse profitieren, erklärt sich aus der einzigartigen Beziehung zwischen der embolischen Obstruktion der Lungenstrombahn und der daraus resultierenden Nachlasterhöhung für den rechten Ventrikel. Innerhalb eines engen Bereichs (Miller-Index 17 geht die rechtsventrikuläre Dysfunktion in ein Rechtsherzversagen über. Diese Übergangsphase kann schon durch eine geringe Zunahme der embolischen Obstruktion ausgelöst werden und ist intraindividuell nicht vorhersagbar. Kürzlich wurde eine randomisierte Therapiestudie bei Patienten mit submassiver Lungenembolie durchgeführt, die eine thrombolytische Behandlung gegen eine alleinige Heparintherapie verglich. Die Studie läßt den Schluß zu, daß Patienten mit einer rechtsventrikulären Dysfunktion und einem niedrigen Blutungsrisiko ebenfalls von einer Thrombolyse im Krankheitsverlauf profitieren, obwohl sich kein Unterschied hinsichtlich der Mortalität ergab.

  8. Die Bandscheibenprothese bei schmerzhafter Diskusdegeneration

    Directory of Open Access Journals (Sweden)

    Ogon M

    2004-01-01

    Full Text Available Bandscheibenprothesen sind indiziert bei Patienten mit einer schmerzhaften Bandscheibendegeneration, einer sogenannten DDD (degenerative disc disease, bei gut erhaltenen Facettengelenken. Kontraindikationen stellen eine Instabilität, eine Spondylarthrose, eine spinale Stenose und eine Osteoporose dar. Bei 19 Patienten mit einem Follow-up von mindestens 12 Monaten fand sich eine durchschnittliche Verbesserung des Oswestry Disability Index von präoperativ 50,8 auf 19,8. Der SF-36 Score zur Erfassung der Lebensqualität besserte sich von 31,5 auf 48,8 (Physical Component Summary Score bzw. von 37,8 auf 44,5 (Mental Component Summary Score im 1-Jahres-Follow-up. Nachhaltige Komplikationen traten nicht auf. Bandscheibenprothesen können heute bei Patienten mit therapieresistenten Kreuzschmerzen als gute Alternative zu einer Wirbelfusion angesehen werden.

  9. Imaging Crohn disease: MR enterography.

    Science.gov (United States)

    Rodriguez, Pablo; Mendez, Ramiro; Matute, Fatima; Hernandez, Paula; Mendoza, Juan Luis

    2014-01-01

    Magnetic resonance enterography in Crohn disease management has been rapidly growing in importance during recent years. Being familiar to this technique is essential for radiologists and also, to some extent, for gastroenterologists. Our aim is to study and describe the imaging findings in magnetic resonance enterography in Crohn disease to develop a comprehensive and useful review article and imaging atlas.

  10. Management of active Crohn disease.

    Science.gov (United States)

    Cheifetz, Adam S

    2013-05-22

    Treatment of Crohn disease is rapidly evolving, with the induction of novel biologic therapies and newer, often more intensive treatment approaches. Knowing how to treat individual patients in this quickly changing milieu can be a challenge. To review the diagnosis and management of moderate to severe Crohn disease, with a focus on newer treatments and goals of care. MEDLINE was searched from 2000 to 2011. Additional citations were procured from references of select research and review articles. Evidence was graded using the American Heart Association level-of-evidence guidelines. Although mesalamines are still often used to treat Crohn disease, the evidence for their efficacy is lacking. Corticosteroids can be effectively used to induce remission in moderate to severe Crohn disease, but they do not maintain remission. The mainstays of treatment are immunomodulators and biologics, particularly anti-tumor necrosis factor. Immunomodulators and biologics are now the preferred treatment options for Crohn disease.

  11. Granulomatous Cheilitis and Crohn's Disease

    Directory of Open Access Journals (Sweden)

    Ishfaq Ahmad

    2001-01-01

    Full Text Available Granulomatous cheilitis is characterized by recurrent swelling of the labial tissues and granulomatous histology. Granulomatous cheilitis has been recognized as an early manifestation of Crohn's disease. It may follow, coincide with or precede the onset of Crohn's disease. The first case presented involved an extraintestinal manifestation of Crohn's disease, and the second case presented is of development of granulomatous cheilitis a year before the onset of symptomatic Crohn's disease. Although chronic granulomatous cheilitis is a very rare disorder, once it is diagnosed, the patient should be followed up carefully. These patients should be investigated for asymptomatic Crohn's disease either when the diagnosis of granulomatous cheilitis is confirmed or when gastrointestinal symptoms develop.

  12. Enfermedad de Crohn

    OpenAIRE

    A. López San Román

    2015-01-01

    La enfermedad de Crohn se produce por una respuesta inmune desproporcionada del intestino, frente a un agente aun no claramente identificado, en individuos genéticamente susceptibles, lo que produce una reacción inflamatoria crónica descontrolada de la mucosa intestinal, progresiva y destructiva. Se presenta el caso de una mujer de 52 años, intervenida quirúrgicamente en dos ocasiones, con formación de fístulas a la piel del abdomen tras las dos cirugías. Los síntomas cardinales fueron la dia...

  13. Schrittmachertherapie bei Vorhofflimmern

    Directory of Open Access Journals (Sweden)

    Zweng A

    2006-01-01

    Full Text Available Vorhofflimmern ist die häufigste kardiale Rhythmusstörung, die aufgrund unserer alternden Gesellschaft eine steigende Inzidenz zeigt und zunehmend Ursache für Hospitalisierung und Mortalität ist. Herzschrittmacher werden beim Vorhofflimmern einerseits zur Überbrückung bradykarder Phasen eingesetzt (VVI-Modus, andererseits wurde nachgewiesen, daß durch sogenanntes physiologisches Pacing (Vorhofstimulation – AAI-Modus oder häufiger Zweikammersysteme – DDD-Modus im Vergleich zur Einkammerstimulation (VVI-Modus das Auftreten von Vorhofflimmern signifikant reduziert werden kann. In den letzten Jahren wurden Schrittmacher zunehmend aktiv zur Reduktion der Vorhofflimmerlast bei paroxysmalem Vorhofflimmern eingesetzt. Aufgrund der Ergebnisse der bisher durchgeführten Studien ist noch nicht geklärt, welcher Algorithmus (permanente oder intermittierende atriale Überstimulation, antitachykardes Pacing den größten Vorteil zeigt. Weiters wurden alternative Sondenpositionen im Vorhof, Multi-Site-Pacing bzw. biatriales Vorhofpacing zur Reduktion der Vorhofflimmerlast untersucht. Auch hier fehlen noch konsistente Daten großer randomisierter Studien, sodaß heute noch keine Indikation zum routinemäßigen Einsatz dieser Techniken besteht.

  14. Interventionelle Therapiestrategien bei Aortenerkrankungen

    Directory of Open Access Journals (Sweden)

    Divchev D

    2015-01-01

    Full Text Available Endovaskuläre Therapiestrategien (EVAR mit Implantation von Stentgrafts im Bereich der Aorta thoracalis descendens und der thorakoabdominellen Aorta stellen eine alternative und etablierte Therapieoption bei verschiedenen Krankheitsbildern der Aorta dar. Hierzu zählte primär die Korrektur von Aneurysmata der Aorta thoracalis descendens (TEVAR und die Behandlung der Aortenisthmusstenose, mit nunmehr auch Ausweitung der Einsatzgebiete auf die komplizierte Typ-B-Dissektion, Pseudoaneurysmata der Aorta, das penetrierende Aortenulkus, die traumatische Aortendissektion und auf Pathologien mit Einbezug des Aortenbogens. Entscheidende Vorteile der interventionellen Therapie gegenüber dem offen-chirurgischen Vorgehen sind die Vermeidung von ausgedehnten invasiven Thorakotomien bis hin zu Zwei- Höhlen-Eingriffen, kürzeren postprozeduralen Erho lungszeiten sowie weniger Blutungs komplikationen und geringerer Rate an ischämischen Kom plikationen von Viszera, Niere und Rückenmark [1]. Die vorliegende Übersichtsarbeit bezieht sich vorwiegend auf den Einsatz des Aortenstentings für die Pathologien des thorakalen Aortenaneurysmas und der Varianten der Aortendissektion als thorakales endovaskuläres Aortenreparaturverfahren (TEVAR.

  15. Enfermedad de Crohn

    Directory of Open Access Journals (Sweden)

    Alina Torreblanca Xiques

    2015-02-01

    Full Text Available La enfermedad de Crohn se produce por una respuesta inmune desproporcionada del intestino, frente a un agente aun no claramente identificado, en individuos genéticamente susceptibles, lo que produce una reacción inflamatoria crónica descontrolada de la mucosa intestinal, progresiva y destructiva. Se presenta el caso de una mujer de 52 años, intervenida quirúrgicamente en dos ocasiones, con formación de fístulas a la piel del abdomen tras las dos cirugías. Los síntomas cardinales fueron la diarrea, flatulencia, astenia, caída del cabello y dolores articulares. Los hallazgos en las heces fecales, las radiografías simples y contrastadas y la videocolonoscopía fueron muy sugestivos de enfermedad de Crohn. El estudio histológico confirmó el diagnóstico. La paciente ha mejorado con el tratamiento farmacológico administrado, a la espera de la solución quirúrgica de las fístulas

  16. Syntaktische Störungen bei Aphasie

    OpenAIRE

    Penke, Martina

    2013-01-01

    1 Einleitung 2 Syntaktische Beeinträchtigung bei Broca-Aphasie 3 Syntaktische Beeinträchtigung bei Wernicke-Aphasie 4 Eine Charakterisierung der syntaktischen Beeinträchtigung bei Broca- und Wernicke-Aphasie 5 Resümee 6 Literatur

  17. Bedeutung von Stress und Depression bei chronisch entzündlichen Darmerkrankungen

    Directory of Open Access Journals (Sweden)

    Moser G

    2005-01-01

    Full Text Available Der Einfluß von psychischem Stress auf den klinischen Verlauf von chronisch entzündlichen Darmerkrankungen wird zunehmend beachtet, obwohl die Rolle einzelner Lebensereignisse als Ursache für eine Krankheitsaktivierung kontrovers gesehen wird. Prospektive Studien zeigten widersprüchliche Ergebnisse bezüglich einschneidender Lebensereignisse, es wurde aber ein Zusammenhang zwischen subjektiv empfundenem chronischem (Alltags-Stress und der Krankheitsaktivierung von Colitis ulcerosa gefunden. Es konnte auch gezeigt werden, daß eine depressive Stimmung einen negativen Effekt auf die Krankheitsaktivität des Morbus Crohn haben kann: Betroffene haben nach einer Akutphase der Erkrankung und nach Erreichen der Remission ein früheres Auftreten einer neuerlichen entzündlichen Krankheitsaktivität, wenn eine depressive Stimmungslage vorliegt. Stress und Depression stellen daher ein Risiko für wiederkehrende oder chronische Krankheitsaktivität der chronisch entzündlichen Darmerkrankungen dar. Dieser Effekt kann über die regulatorische Rückkopplung zwischen ZNS, endokrinem und Immunsystem wirken und zur Beeinträchtigung der intestinalen Barriere führen. Für die klinische Betreuung der PatientInnen muß bedacht werden, daß soziale Unterstützung und eine integrierte psychische Betreuung sich positiv auf das Stressempfinden und eine depressive Stimmung auswirken und daher den Krankheitsverlauf der Betroffenen mit CED verbessern können.

  18. Monitoring bei Vorhofflimmern

    Directory of Open Access Journals (Sweden)

    Martinek M

    2011-01-01

    Full Text Available Einleitung: Obwohl Vorhofflimmern (VHF die absolut häufigste Arrhythmie im höheren Lebensalter darstellt, unterschätzen epidemiologische Daten immer noch die Prävalenz der Erkrankung, da adäquate Monitordaten aus größeren Populationen fehlen. Symptomatisches VHF ist nur die Spitze des Eisbergs, da VHF-Episoden in bis zu 90 % asymptomatisch verlaufen. Um dieser großen Anzahl asymptomatischer Episoden und der resultierenden Morbidität (Insult, Herzinsuffizienz und Mortalität Herr zu werden, ist der Einsatz verbesserter Monitoringtechnologien in einer größeren Patientengruppe mit erhöhtem Risiko zu fordern. Nicht-invasives Monitoring: Hier stehen für das Monitoring von VHF-Standard-EKG, Holter- EKGs, Eventrecorder oder transtelefonisches Monitoring zur Verfügung. Ein Großteil der Diagnostik wird aktuell mit einzelnen EKGs oder kurzen Monitoringperioden (24–48-Stunden-Langzeit- EKG durchgeführt, da die Kapazität an längeren Holter-Methoden über 7–30 Tage sehr beschränkt ist. Neuere Methoden könnten hier die Kapazitäten durch automatische Detektionsalgorithmen und „Outsourcing“ aus dem Krankenhaus erhöhen. Invasives Monitoring: Als Goldstandard für das Monitoring von VHF sind sicherlich implantierte Schrittmacher- oder ICDAggregate mit entsprechender Möglichkeit zur Vorhofarrhythmiedetektion anzusehen. Über die Daten dieser Geräte konnten wertvolle, neue Erkenntnisse über Symptomatik, Akut- und Langzeitverlauf sowie Effizienz verschiedener Therapien gewonnen werden. Für Patienten ohne Indikation zur Device-Therapie stehen seit Kürzerem implantierbare Loop-Recordersysteme mit speziellen Softwarealgorithmen zur atrialen Arrhythmiedetektion als permanente Überwachungsmöglichkeit zur Verfügung. Erste Studiendaten ergaben eine durchaus beachtliche Sensitivität von 96,1 % bei einer Spezifität von 85,4 % für die Vorhofflimmerdetektion. Zusammenfassung und Zukunftsperspektiven: Für eine korrekte Diagnostik und

  19. Pathogenesis of Graves` disease and therapeutic implications; Pathogenese des Morbus Basedow und therapeutische Implikationen

    Energy Technology Data Exchange (ETDEWEB)

    Seif, F.J. [Tuebingen Univ. (Germany). Medizinische Klinik und Poliklinik

    1997-12-01

    Graves` disease presents itself clinically mainly as hyperthyroidism and infiltrative ophthalmopathy and to a minimal extent also as dermopathy and acropachy. Autoimmune processes are the basic pathogenesis. Stimulating antibodies against the TSH receptor cause hyperthyroidism. Autoantibodies and autoreactive T lymphocytes against primarily thyroidal antigens cross-react with similar antigens of the eye muscles and orbital connective tissue, thus spreading the disease from the thyroid to the eyes. The therapeutic goal comprises not only the treatment of hyperthyroidism, but also the induction of a steady immuntolerance in order to minimize the irreversible damage to the eye. The therapeutic armamentarium is formed by antithyroid drugs, glucocorticoids, retrobulbar radition and thyroid ablation, either by nearly total thyroidectomy or by radioiodine. The different indications for both ablative procedures are discussed. (orig.) [Deutsch] Der Morbus Basedow manifestiert sich klinisch hauptsaechlich als Hyperthyreose und infiltrative Orbitopathie, waehrend Demopathie und Akropathie selten sind. Der Krankheit liegt ein Autoimmunprozess zugrunde, wobei stimuliernde Autoantikoerper gegen den TSH-Rezeptor die Hyperthyreose hervorrufen. Autoantikoerper und T-Lymphozyten gegen primaer thyreoidale Antigene verursachen durch Kreuzreaktion mit aehnlichen Antigenen an den Augenmuskeln und orbitalem Bindegewebe die Orbitopathie. Das therapeutsiche Ziel besteht nicht nur in der Behandlung der Hyperthyreose, sondern vor allem in der Induktion einer immuntoleranten Remission, um die irreversiblen Schaeden am Auge zu minimieren. Die Therapie umfasst Thyreostatika, Glukokortikoide und Orbitaspitzenbestrahlung sowie eine Schilddruesenablation entweder durch fast totale Schilddruesenresektion oder durch Radiojodtherapie. Die Differentialindikationen fuer die beiden ablativen Massnahmen werden eroertert. (orig.)

  20. Nutritional disturbances in Crohn's disease.

    OpenAIRE

    Harries, A D; Heatley, R V

    1983-01-01

    A wide range of nutritional disturbances may be found in patients with Crohn's disease. As more sophisticated tests become available to measure vitamin and trace element deficiencies, so these are being recognized as complications of Crohn's disease. It is important to recognize nutritional deficiencies at an early stage and initiate appropriate treatment. Otherwise many patients, experiencing what can be a chronic and debilitating illness, may suffer unnecessarily from the consequences of de...

  1. Surgery for Crohn's Disease and Ulcerative Colitis

    Science.gov (United States)

    ... Crohn's Disease & Ulcerative Colitis Go Back Surgery for Crohn's Disease & Ulcerative Colitis Email Print + Share ( Disclaimer: Surgery information ... helps you to learn what to expect. About Crohn’s disease and ulcerative colitis Crohn’s disease and ulcerative colitis ...

  2. Scientists Spot Genes Behind Crohn's, Ulcerative Colitis

    Science.gov (United States)

    ... medlineplus.gov/news/fullstory_166957.html Scientists Spot Genes Behind Crohn's, Ulcerative Colitis Large study finds key ... Researchers say they've come closer to pinpointing genes linked with inflammatory bowel diseases such as Crohn's ...

  3. Diagnosis and management of fistulizing Crohn's disease

    DEFF Research Database (Denmark)

    Nielsen, Ole Haagen; Rogler, Gerhard; Hahnloser, Dieter

    2009-01-01

    The transmural inflammation characteristic of Crohn's disease predisposes patients to the formation of fistulas. Up to 50% of patients with Crohn's disease are affected by fistulas, which is a major problem given the considerable morbidity associated with this complication. Appropriate treatment...... of fistulizing Crohn's disease. Particular focus is given to external and perianal fistulas, for which treatment options are well established. Available therapeutic options, including novel therapies, are discussed. Wherever possible, practical and evidence-based treatment regimens for Crohn's disease...

  4. Crohn disease: pathophysiology, diagnosis, and treatment.

    Science.gov (United States)

    Mazal, Jonathan

    2014-01-01

    Crohn disease (often seen in the literature as "Crohn's disease"), an autoimmune disease with debilitating gastrointestinal and extragastrointestinal manifestations, is on the rise in the United States and Europe. This article discusses the disease process, clinical presentation, diagnostic tools, and treatment options for Crohn disease. Statistics regarding disease prevalence and epidemiology also are reported.

  5. Cutaneous Manifestations of Crohn Disease.

    Science.gov (United States)

    Hagen, Joshua W; Swoger, Jason M; Grandinetti, Lisa M

    2015-07-01

    Awareness of the extraintestinal manifestations of Crohn disease is increasing in dermatology and gastroenterology, with enhanced identification of entities that range from granulomatous diseases recapitulating the underlying inflammatory bowel disease to reactive conditions and associated dermatoses. In this review, the underlying etiopathology of Crohn disease is discussed, and how this mirrors certain skin manifestations that present in a subset of patients is explored. The array of extraintestinal manifestations that do not share a similar pathology, but which are often seen in association with inflammatory bowel disease, is also discussed. Treatment and pathogenetic mechanisms, where available, are discussed.

  6. Decoding norovirus infection in Crohn's disease.

    Science.gov (United States)

    Chamaillard, Mathias; Cesaro, Annabelle; Lober, Pierre-Emmanuel; Hober, Didier

    2014-04-01

    Although a causing viral infectious agent remains untraceable in Crohn's disease, most recent genome-wide association studies have linked the FUT2 W143X mutation (resulting in asymptomatic norovirus infection) with the pathogenesis of Crohn's ileitis and with vitamin B12 deficiency (i.e., a known risk factor for Crohn's disease with ileal involvement). In line with these findings, host variations in additional genes involved in host response to norovirus infection (such as ATG16L1 and NOD2) predispose humans to Crohn's ileitis. One may therefore presume that asymptomatic norovirus infection may contribute to disruption of the stability of the gut microbiota leading to Crohn's ileitis. These paradigms highlight not only the need to revisit the potential transmissibility of Crohn's disease, but also potential safety issues of forthcoming clinical trials on human probiotic infusions in Crohn's ileitis by rigorous donors screening program.

  7. Single-photon-emission-computed-tomography (SPECT) in basal ganglia disorders; Single-Photon-Emissions-Computer-Tomographie (SPECT) bei Erkrankungen der Basalganglien

    Energy Technology Data Exchange (ETDEWEB)

    Tatsch, K. [Klinik und Poliklinik fuer Nuklearmedizin, Klinikum Grosshadern, Muenchen Univ. (Germany)

    1997-03-01

    In the past, SPECT investigations of regional cerebral blood flow have played a minor role in the diagnostic work-up of patients with basal ganglia disorders. More recently, however, interest in nuclear medicine procedures has dramatically increased since with the development of selective receptor ligands diagnostic tools have been provided which address the pathology in basal ganglia disorders more specifically than other diagnostic modalities. Evaluations of the pre- and postsynaptic aspects of the dopaminergic system, for example, deliver not only interesting data from the scientific point of view but also for the daily routine work. This paper summarizes some of the experience reported in the literature on SPECT investigations in basal ganglia disorders, such as Parkinson`s disease, parkinsonian syndromes of other etiology, Wilson`s and Huntington`s disease, focal dystonias, and schizophrenia under treatment with neuroleptics. (orig.) [Deutsch] SPECT-Studien mit Perfusionstracern haben aufgrund ihrer limitierten Aussagekraft in der Vergangenheit eine untergeordnete Rolle fuer die Diagnostik von Basalganglienerkrankungen gespielt. Mit der Entwicklung selektiver Radioliganden fuer die in vivo Abbildung von Rezeptorsystemen hat sich die klinische Bedeutung von SPECT-Untersuchungen grundlegend gewandelt. Da Basalganglien eine hohe Dichte an dopaminergen Synapsen aufweisen, kommt insbesondere diesem System diagnostische Bedeutung zu. Analysen der prae- und postsynaptischen Situation an der dopaminergen Synapse sind nicht nur von wissenschaftlichem Interesse, sondern haben mittlerweile auch klinische Relevanz erlangt. Bei verschiedenen Basalganglienerkrankungen, wie Morbus Parkinson, Parkinson Syndromen anderer Aetiologie, Morbus Wilson, Chorea Huntington, Dystonien und Schizophrenie-Patienten unter Neuroleptikatherapie, wird im Schrifttum ueber charakteristische SPECT-Befunde berichtet und deren diagnostische Bedeutung abgeschaetzt. (orig.)

  8. Effect of radiosynovectomy in patients with inflammatory joint disorders not caused by rheumatoid arthritis; Wirksamkeit der Radiosynoviorthese bei degenerativ-entzuendlichen und chronisch-entzuendlichen Gelenkerkrankungen

    Energy Technology Data Exchange (ETDEWEB)

    Kroeger, S.; Klutmann, S.; Bohuslavizki, K.H.; Clausen, M. [Universitaetskrankenhaus Eppendorf, Hamburg (Germany). Abt. fuer Nuklearmedizin; Sawula, J.A.; Brenner, W.; Henze, E. [Kiel Univ. (Germany). Klinik fuer Nuklearmedizin

    1999-07-01

    Gelenke) mit peripherem Gelenkbefall bei Morbus Bechterew, reaktiver Arthritis, undifferenzierter Kollagenose mit Gelenkbeteiligung, Psoriasis-assoziierter Arthritis, pigmentierter villo-nodulaerer Synovialitis und chronisch-entzuendliche Reizzustaende nach vorangegangener Operation. Die Veraenderung der Beschwerdesymptomatik wurde anhand eines standardisierten Fragebogens entsprechend den ARA-Kriterien subjektiv erfasst und mit T/B-Quotienten in der Blutpoolphase der Skelettszintigraphie vor und nach der RSO quantifiziert. Ergebnisse: In der ersten Gruppe berichteten die Patienten ueber eine deutliche Besserung der Beschwerdesymptomatik in 40% der Faelle. In 51% fand sich eine Beschwerdekonstanz, in 9% eine Verschlechterung des Beschwerdebildes. Analoge Verhaeltnisse fanden sich in der zweiten Patientengruppe. Die Mehrzahl der als unveraendert beschriebenen Gelenke waren kleine Fingergelenke. Hingegen zeigten Hand- und Kniegelenke bessere Ergebnisse. Eine Uebereinstimmung zwischen szintigraphischem Befund und subjektiver Einschaetzung fand sich in der ersten Gruppe bei 38% und in der zweiten Gruppe bei 67%. Schlussfolgerung: Die Radiosynoviorthese stellt auch bei der aktivierten Arthrose und den nicht durch eine rheumatoide Arthritis verursachten Synovialitiden eine nebenwirkungsarme, gut nutzbare lokal anwendbare Therapieoption dar. (orig.)

  9. Morbus Crohn:Infliximab jelzt auch in Deutschland zugelassen%Crohn病:Infliximab现也在德国被批准上市

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    αTNF抗体Infliximab(Remicade(R)),自1999年9月起,在德国被批准用于治疗常规治疗未能奏效的重度活动性crohn病患者和瘘管形成的crohn病患者(参阅DAZ 35/99,P.24-26).专家们希望本品上市对于crohn病的治疗是一个突破,因为本品首次提供有效而安全的治疗选择.

  10. Crohn's Disease Defined in Three Elderly Disters

    Directory of Open Access Journals (Sweden)

    Hugh J Freeman

    2005-01-01

    Full Text Available Three elderly sisters presented with symptomatic Crohn's disease. All had ileocolic involvement, and granulomatous inflammation was documented in endoscopic biopsies or surgically resected intestinal specimens. The present report documents the unusual occurrence of very late phenotypical expression of familial ileocolic Crohn's disease. The observations presented here reflect a possible gene-based predisposition to Crohn's disease or, alternatively, disease clustering related to a commonly shared environmental factor.

  11. Case for diagnosis. Metastatic Crohn's disease*

    Science.gov (United States)

    Gontijo, João Renato Vianna; Leidenz, Franciele Antonieta Bianchi; de Sousa, Maria Silvia Laborne Alves

    2016-01-01

    Metastatic Crohn's disease is a rare skin manifestation, defined by granulomatous skin lesions that are discontinuous to the affected gastrointestinal tract and histopathologically resembling inflammatory bowel lesions. Up to 44% of patients with Crohn's disease have cutaneous manifestations, of which metastatic lesions are the least common. We present a case of an adolescent with refractory Crohn's disease and persistent papules and plaques on the skin. PMID:27579756

  12. Hypovitaminosis D in patients with Crohn's disease

    OpenAIRE

    Rebouças,Priscilla Clímaco; NETINHO,João Gomes; Cunrath,Geni Satomi; Ronchi,Luiz Sergio; MELO,Marcelo Maia Caixeta de; Gonçalves Neto,Francisco de Assis; Muniz,Rafaela Cristina Coelho; Martins,Alissonn Teixeira Silva; Oliveira,Rafael Andrade de; Costa Junior,Ricardo Mendonça

    2016-01-01

    Abstract Objective Vitamin D has been widely studied as a mediator of the immune response, becoming evident the prevalence of hypovitaminosis D in patients with Crohn's disease. This work aims at evaluating the serum levels of vitamin D in patients suffering from Crohn's disease in a southeast region of Brazil. Methods It is a prospective study, with statistical analysis of the values of serum vitamin D measured between April 2014 and April 2015 in patients with Crohn's disease. Individuals...

  13. Fabry disease simulating Crohn's ileitis.

    Science.gov (United States)

    Rubio, Carlos A; Villnow, Elizabeth; Sundelin, Birgitta; Eriksson, Elina; Dolapcsiev, Karoli; Björk, Jan; Befrits, Ragnar; Tengvar, Magnus; Iversen, Henrik

    2014-05-01

    Fabry disease is an inherited (X-linked) lysosomal storage disorder caused by deficiency of α-galactosidase A, leading to accumulation of globotriaosylceramide in various tissues. A 57-year-old male with a family history and laboratory findings of Fabry disease, was consulted for severe abdominal pain, undulating pyrexia, weight loss and diarrhea. The tentative clinical diagnosis of Crohn's ileitis was supported at computed tomographic examination, at laparotomy and at inspection of the resected ileal segment. Histology revealed chronic and acute inflammation, thick-walled occluded vessels, fibrosis and characteristic bi-refringent lamellar deposits of globotriaosylceramide and calcifications. Multi-nucleated giant cells contained phagocytized bi-refringent material. Transmission electron microscopy showed cells with irregular cytoplasmic bodies displaying distinctive zebra-like lamellar structures. It is submitted that the gastrointestinal phenotype of Fabry disease may concur with symptoms resembling abdominal Crohn's disease.

  14. Amyloidosis and crohn's disease Amiloidosis y enfermedad de Crohn

    Directory of Open Access Journals (Sweden)

    Antonio Guardiola-Arévalo

    2011-05-01

    Full Text Available Secondary amyloidosis is a rare but serious complication of inflammatory bowel disease that may influence the prognosis even more than the underlying disease. Due to a better knowledge of the association of secondary amyloidosis to inflammatory bowel disease, early diagnosis of this complication is becoming more frequent, but its treatment continues to pose a challenge. We report 4 cases of patients with Crohn's disease and amyloidosis diagnosed in the inflammatory bowel disease Units of Toledo and Ciudad Real, which represent 0.68% of the patients with Crohn's disease of our health areas. There have been not cases of amyloidosis in patients with ulcerative colitis. In our 4 patients the secondary amyloidosis was clearly related to Crohn's disease, which was often of fistulising type. The predominant clinical picture of amyloidosis was nephrotic syndrome. The patients responded to medical and surgical treatment of Crohn's disease and colchicine, which improved renal function in all cases except in one who required kidney transplantation.La amiloidosis sistémica adquirida es una complicación rara pero grave de la enfermedad inflamatoria intestinal crónica, pudiendo condicionar el pronóstico más que la propia enfermedad de base. Debido al mejor conocimiento de la asociación de amiloidosis secundaria a enfermedad inflamatoria intestinal, el diagnóstico temprano se hace cada vez con mayor frecuencia, pero su tratamiento continúa siendo un reto. Describimos 4 casos clínicos de pacientes con enfermedad de Crohn (EC y amiloidosis diagnosticados en las Unidades de EIIC de Toledo y Ciudad Real, lo que representa el 0,68% de los caso de EC de nuestras áreas sanitarias. No se ha descrito ningún caso de amiloidosis en pacientes con colitis ulcerosa. En los 4 pacientes la AA estaba claramente relacionada con la EC, y predominaron las formas estenosantes-perforantes. El cuadro clínico de presentación de la amiloidosis en la mayoría de los casos

  15. Night blindness and Crohn's disease.

    Science.gov (United States)

    da Rocha Lima, Breno; Pichi, Francesco; Lowder, Careen Y

    2014-10-01

    Signs of malnutrition are common clinical features in Crohn's disease; and bowel resection, commonly needed in these cases, can aggravate malnutrition. These patients are at risk of developing vitamin A deficiency, which can lead to night blindness. We present a 60-year-old male, with history of Crohn's disease and multiple resections for strictures and fistulas leading to short bowel syndrome, with progressive bilateral loss of night vision (nyctalopia). Serum vitamin A level was markedly depleted (11 µg/dL, reference 20-120 µg/dL), and full-field electroretinogram testing demonstrated extinguished scotopic (rod function) responses and decreased amplitudes of photopic responses on 30 Hz flicker (cone function). He was started on vitamin A supplementation (initially intramuscular). His vitamin A level was back to normal (78 µg/dL), and night vision problems subjectively improved. Patients with Crohn's disease should be inquired about night vision problems. The presence of nyctalopia should prompt vitamin A level measurement and ophthalmology referral for further evaluation.

  16. Leberversagen bei Sepsis und Multiorganversagen

    Directory of Open Access Journals (Sweden)

    Kapral C

    2005-01-01

    Full Text Available Eine Störung der Leberfunktion wird bei etwa 20–25% der Patienten mit Organversagen im Rahmen einer schweren Entzündungsreaktion beobachtet. Obwohl der klinische Parameter hierfür – der Anstieg des Bilirubins – in der Regel erst nach Funktionsstörungen anderer Organe auftritt, zeigen sehr sensitive Nachweismethoden einer hepatalen Dysfunktion wie die Indozyangrünclearance, daß die Leberbeteiligung ein sehr frühes Ereignis darstellt. Ursache für die Funktionseinschränkung der Leber sind vor allem Zytokine, die großteils direkt in der Leber selbst auf die verschiedenen Stimuli (Endotoxine, Hypoxie usw. freigesetzt werden. Spezifische Therapiemaßnahmen zur Verbesserung der Leberfunktion stehen dem Kliniker derzeit nicht zur Verfügung. Es gilt auch hier der Grundsatz, daß durch eine frühzeitige Herdsanierung und effektive Kreislauftherapie die Zytokinaktivierung möglichst gering gehalten werden soll, um damit auch Organtoxizitäten zu vermindern. Die zur Verfügung stehenden, kreislaufaktiven Substanzen zeigen eine individuell nur schwer voraussagbare, sehr unterschiedliche Wirkung auf Kreislauf und Funktion der Leber. Einzig Adrenalin dürfte aufgrund der vorliegenden Untersuchungen eine eher ungünstige Wirkung haben und sollte daher nicht zur Anwendung kommen. In der letzten Zeit konnten jedoch durch neue Maßnahmen erste klinische Erfolge nachgewiesen werden, bzw. im Tierexperiment eine Verbesserung der Leberfunktion beobachtet werden. So konnte durch Normalisierung der Blutzuckerkonzentration bei Patienten mit Sepsis eine Verbesserung der Mortalität und auch Verbesserung der mitochondrialen Funktion von Leberzellen beobachtet werden. Durch die Gabe von N-Acetylcystein wurde in Studien an kleinen Fallzahlen eine günstige Wirkung beobachtet, größere Studien werden hier Klarheit schaffen. Ebenfalls in klinischer Erprobung ist die orale Gabe von Gallensäuren, die den Gallensäuregehalt des Darmes erhöhen und damit die

  17. Die Dankesrede bei der Preisverleihung

    Directory of Open Access Journals (Sweden)

    Elenmari Pletikos Olof

    2012-12-01

    Full Text Available Festliche Preisverleihungen sind Gelegenheiten, bei denen von den Preisträgerneine kurze Rede erwartet wird. Obwohl die Dankesrede eine kleinere Randgattung innerhalb des epideiktischen Genres ist, steht sie im Mittelpunkt des Ereignisses. Rhetorikhandbücher geben zahlreiche Ratschläge, wie eine gute Festrede vorbereitet werden soll, um zu unterhalten, zu bewegen und zu belehren. Ziel dieser Untersuchung ist es festzustellen, welche Eigenschaften der Dankesrede die Zuhörer als erwünscht oder unerwünscht wahrnehmen und welche Charakteristika am meisten zur Qualität festlicher Dankesreden beitragen. Das Korpus der gesprochenen Texte bilden 30 Dankesreden anlässlich kroatischer Preisverleihungen in den Bereichen Schauspiel, Sport, Musik, Fernsehen, Literatur und Wirtschaft. Die Audio-Aufnahmen der Dankesreden wurden einer Gruppe von Hörern zur Bewertung in folgenden Kategorien vorgelegt: interessant, geistreich, hoher Sprachstil, feierlich, emotiv, persönlich, originell, bescheiden, vorbereitet und spontan. Zusätzlich wurde zu jeder Rede die offene Frage gestellt, was dem Zuhörer an der Rede gefallen oder nicht gefallen habe. Die Resultate der Perzeptionsanalye lassen erkennen, dass die Interessantheit einer Rede mit der Eigenschaft des Geistreichen, des Originellen, des Emotionalen und des Persönlichen in Verbindung gebracht wird und die Eigenschaft des Festlichen im Wesentlichen nur mit dem hohen Sprachstil und der Vorbereitetheit des Textes korreliert. Einige Eigenschaften können sowohl erwünscht als auch unerwünscht sein, z. B. Dialekt, Persönliches und Kürze. Die besten Dankesreden haben Eigenschaften, die im Grunde schwer miteinander zu verbinden sind: Einerseits soll der Text vorbereitet sein (hoher Stil, Wortwahl, Figuren, Originalität der Geschichte, Humor, andererseits wird bei der Ausführung Spontaneität (Aufrichtigkeit, Emotionalität, Persönlichkeit erwartet.

  18. What is Crohn's Disease | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... of this page please turn JavaScript on. Feature: Crohn's Disease What is Crohn's Disease Past Issues / Winter 2016 Table of Contents As ... large intestine, leading to the anus. Who Gets Crohn's Disease? Both men and women can get Crohn's disease, ...

  19. Crohn's Disease of the Colon, Rectum, and Anus.

    Science.gov (United States)

    Harb, William J

    2015-12-01

    There is no cure for Crohn disease. Newer treatments, such as biological therapy, have led to an improved quality of life. This article focuses on the surgical management of Crohn disease of the colon, rectum, and anus. Restorative and nonrestorative surgical options for colonic Crohn disease are discussed. Treatment options for perianal Crohn disease are also reviewed.

  20. Pinworm Infestation Mimicking Crohns' Disease

    Science.gov (United States)

    Ignatova, Simone; Ekstedt, Mattias

    2013-01-01

    We here report a case of a young man who presented to his general practitioner with diarrhea. Inflammatory bowel disease was suspected and a colonoscopy showed aphthous lesions suggestive of Crohns' disease but biopsies revealed eggs of Enterobius vermicularis. When treated for this parasite, his symptoms were alleviated and a followup colonoscopy revealed a normal colon and distal ileum. Enterobius vermicularis is the most common parasite worldwide and has been attributed with many different presentations and pathologies. It is therefore necessary to maintain vigilance, even in high-income countries, in order to diagnose patients with one of the many atypical presentations of pinworms. PMID:23555063

  1. ACR Appropriateness Criteria Crohn Disease.

    Science.gov (United States)

    Kim, David H; Carucci, Laura R; Baker, Mark E; Cash, Brooks D; Dillman, Jonathan R; Feig, Barry W; Fowler, Kathryn J; Gage, Kenneth L; Noto, Richard B; Smith, Martin P; Yaghmai, Vahid; Yee, Judy; Lalani, Tasneem

    2015-10-01

    Crohn disease is a chronic inflammatory disorder involving the gastrointestinal tract, characterized by episodic flares and times of remission. Underlying structural damage occurs progressively, with recurrent bouts of inflammation. The diagnosis and management of this disease process is dependent on several clinical, laboratory, imaging, endoscopic, and histologic factors. In recent years, with the maturation of CT enterography, and MR enterography, imaging has played an increasingly important role in relation to Crohn Disease. In addition to these specialized examination modalities, ultrasound and routine CT have potential uses. Fluoroscopy, radiography, and nuclear medicine may be less beneficial depending on the clinical scenario. The imaging modality best suited to evaluating this disease may change, depending on the target population, severity of presentation, and specific clinical situation. This document presents seven clinical scenarios (variants) in both the adult and pediatric populations and rates the appropriateness of the available imaging options. They are summarized in a consolidated table, and the underlying rationale and supporting literature are presented in the accompanying narrative. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

  2. [Treatment of fistulizing Crohn's disease].

    Science.gov (United States)

    Tonkić, Ante; Borzan, Vladimir

    2013-04-01

    The treatment of fistulating Crohn's disease should include a combined medical and surgical approach and should be defined on an individual basis. Asymptomatic enteroenteric fistulas usually require no treatment, but internal fistulas (gastrocolic, duodenocolic, enterovesical) that cause severe or persistent symptoms require surgical intervention. While low asymptomatic anal-introital fistula may not need surgical treatment, in case of a symptomatic enterovaginal fistula surgery is usually required. There are no controlled-randomized trials to assess the effect of medical treatment for non-perianal fistulating Crohn's disease. The incidence of perianal fistulae varies according to the location of the disease, with its occurrence varying between 21-23%. The diagnostic approach should include an examination under anesthesia, endoscopy, and either MRI or EUS before the treatment begins. Asymptomatic simple perianal fistulas require no treatment. The presence of a perianal abscess should be ascertained and if present should be drained urgently. In case of a complex perianal disease, seton placement should also be recommended. Antibiotics (metronidazole and ciprofloxacine) are useful for treating complex perianal disease, however, when discontinued, most of the fistulas relapse. The current consensus suggests that azathioprine/6-mercaptopurine is the first line medical therapy for complex perianal disease, which is always given in combination with surgical therapy (seton, fistulotomy/fistulectomy). Anti TNF-alpha agents (infliximab and adalimumab) should be used as a second choice medical treatment. In refractory and extensive complex perianal disease a diverting stoma or proctectomy should be performed.

  3. Cólera e medicina ambiental no manuscrito 'Cholera-morbus' (1832, de Antonio Correa de Lacerda (1777-1852

    Directory of Open Access Journals (Sweden)

    Sanjad Nelson

    2004-01-01

    Full Text Available Na primeira metade do século XIX, o paradigma ambientalista predominou nos debates médicos. No Brasil, ele foi responsável pela construção de uma agenda higienista que condicionou a atuação dos médicos e deu a chave interpretativa para os problemas relacionados à saúde pública. Neste artigo abordam-se estas e outras questões, a partir de um texto do médico português Antonio Correa de Lacerda (1777-1852, que viveu em Belém (PA e São Luís (MA entre 1818 e 1852. Trata-se do manuscrito 'Cholera-morbus', de 1832, ano em que a epidemia atingiu Paris. Nele, Lacerda mobiliza diferentes conhecimentos para apresentar uma explicação coerente sobre a doença, permitindo-nos acompanhar uma interpretação anticontagionista calcada na clínica anatomopatológica e como pôde um médico provincial produzir conhecimentos originais sobre a relação entre clima, saúde e cultura, inclusive sobre o uso medicinal de plantas amazônicas.

  4. Crohn's disease limited to the vermiform appendix

    DEFF Research Database (Denmark)

    Bak, Martin; Andersen, J C

    1987-01-01

    Thirteen cases of Crohn's disease confined to the vermiform appendix were seen during a 12-year period. They constituted 16.9% of patients with primary resection of the bowel for Crohn's disease in the same period, but only 0.4% of the cases of acute appendicitis. In 10 of the 13 cases...... to approach that of recurrence after resection in other parts of the intestines. Collective review of this and three other relatively large case series gave an estimated recurrence rate of 3.5%. We conclude that in Crohn's disease initially confined to the appendix the course appears to be indolent....

  5. Perianal Crohn's disease: Is there something new?

    Institute of Scientific and Technical Information of China (English)

    Cesare Ruffolo; Marilisa Citton; Marco Scarpa; Imerio Angriman; Marco Massani; Ezio Caratozzolo; Nicolò Bassi

    2011-01-01

    Perianal lesions are common in patients with Crohn's disease, and display aggressive behavior in some cas-es. An accurate diagnosis is necessary for the optimal management of perianal lesions. Treatment of perianal Crohn's disease includes medical and/or surgical op-tions. Recent discoveries in the pathogenesis of this disease have led to advances in medical and surgical therapy with good results. Perianal lesions in Crohn's disease remain a challenging aspect for both gastroen-terologists and surgeons and lead to a greatly impaired quality of life for all patients affected by this disease. A multidisciplinary approach is mandatory to obtain the best results.

  6. Intestinal tuberculosis sometimes mimics Crohn's disease.

    Directory of Open Access Journals (Sweden)

    Esfandiar Shojaei

    2013-11-01

    Full Text Available Intestinal tuberculosis is an uncommon presentation of tuberculosis (TB and has clinicopathological similarities with Crohn's disease. In regions where TB is endemic clinicians must aware of this condition and fully evaluate their patients when Crohn's disease is diagnosed. We recommend all pathologic specimens be evaluate effectively for TB.Smear,culture and PCR for Mycobacterium.tuberculosis from samples aside the pathological reviews help for better diagnosis. Here we present a case of intestinal tuberculosis which initially diagnosed as Crohn's disease but after starting immunosuppressive agents he presented with disseminated tuberculosis.

  7. Medical treatment of perianal crohn disease

    Directory of Open Access Journals (Sweden)

    Al-Ghamdi Abdullah

    2002-01-01

    Full Text Available Crohn disease is a chronic illness that affects the gastrointestinal tract from the mouth to the anus. Perianal Crohn develops in 31-94% of patients over the course of their illness. It affects the skin in the perianal area, the anal canal and can cause fistulae. It is diagnosed clinically and by other modalities like endoscopy, barium CT scan, endoscopic sonography and magnetic resonance image examination. The treatment of perianal Crohn disease is either medical or surgical. The current medical treatment will be reviewed in this article

  8. Suspected Intestinal Tuberculosis Might Be Crohn's Disease

    Directory of Open Access Journals (Sweden)

    Semiu Eniola Folaranmi

    2010-01-01

    Full Text Available In this case report we provide evidence that supports a link between mycobacteria and Crohn's disease. The patient in question, KG, presented on three separate occasions over a ten years period with features suggestive of intestinal tuberculosis. He was treated successfully on each occasion with antimycobacterial drugs. When he presented a fourth time with the same symptoms, he was diagnosed with Crohn's disease based on findings from endoscopy, histology and CT. Subsequently he was treated with a course of steroids and made a full recovery. This case adds weight to the theory that mycobateria has an aetiological role in Crohn's disease.

  9. Menopausale Hormontherapie (MHT bei internistischen Erkrankungen

    Directory of Open Access Journals (Sweden)

    Birkhäuser M

    2014-01-01

    Full Text Available Postmenopausale Frauen leiden zusätzlich zu klimakterischen Beschwerden oft an internistischen Grundkrankheiten. Daher ist es wichtig zu wissen, wann eine Hormonsubstitution (Menopausale Hormontherapie [MHT] in welcher Form verordnet werden darf, wenn mit nichthormonalen Alternativen keine genügende Besserung erzielt werden kann, und wo eine MHT kontraindiziert ist. Zur Verminderung des Risikos einer MHT bei internistischen Grundkrankheiten gelten folgende Grundregeln: – Beginn der MHT innerhalb des „günstigen Fensters“ ( 60 Jahren resp. innert 10 Jahre ab Menopause, außer bei den Kontraindikationen Angiopathie, Koronaropathie und bei anderen vaskulären Pathologien. – Verwenden der niedrigsten wirksamen Dosis, wenn möglich = 50 μg Östradiol/Tag transdermal resp. = 2 mg Östradiol/Tag peroral. Praktisch alle bekannten Nebenwirkungen der MHT sind dosisabhängig. – Bei alleinigen urogenitalen Symptomen nur vaginal-lokale Östrogengabe einsetzen. – Zahlreiche internistische Krankheiten werden durch Leberfaktoren beeinflusst oder induzieren selbst Veränderungen bestimmter Leberparameter (z. B. Gerinnungsfaktoren, Renin-Angiotensin-Aldosteron-System. Deshalb ist zur Vermeidung eines unerwünschten First-Pass-Effektes eine transdermale Östradiolgabe (Pflaster oder Gel vorzuziehen. – Bei kombinierter MHT soll außer bei speziellen Indikationen ein metabolisch neutrales Gestagen wie Progesteron, Dydrogesteron oder Dienogest gewählt oder Norethisteronacetat transdermal verabreicht werden. Gestagene mit glukokortikoider Partialwirkung wie Medroxyprogesteronacetat sind außer als Kurzzeitgabe zu vermeiden, v. a. bei erhöhtem Thromboserisiko. – Drospirenon besitzt eine antimineralokortikoide Wirkung, die bei erhöhtem Blutdruck gezielt eingesetzt werden kann. – Zyklische Schwankungen der Serumspiegel sind zu vermeiden und deshalb statt einer sequenziellen eine kontinuierlich-kombinierte MHT durchzuführen. Dabei kann das Gestagen auch

  10. Enterolithiasis-associated ileus in Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    Alexander Perathoner; Pamela Kogler; Christian Denecke; Johann Pratschke; Reinhold Kafka-Ritsch; Matthias Zitt

    2012-01-01

    Stasis of the flow of the intestinal contents,ingested material and unfavorable composition of the chylus can lead to the formation of enteroliths inside the bowel.Enterolithiasis represents a rare disorder of the gastrointestinal tract that can be associated with intermittent abdominal pain or more serious complications such as bleeding or obstruction.Enterolithiasis in Crohn' s disease represents an extremely rare condition and usually occurs only in patients with a long symptomatic history of Crohn's disease.We report an unusual case of enterolithiasis-related intestinal obstruction in a young male patient with Crohn's disease (A2L3B1 Montreal Classification for Crohn's disease 2005) undergoing emergency laparotomy and ileocoecal resection.In addition,we present an overview of the relevant characteristics of enterolithiasis on the basis of the corresponding literature.

  11. Evaluation for postoperative recurrence of Crohn disease.

    Science.gov (United States)

    Swoger, Jason M; Regueiro, Miguel

    2012-06-01

    Disease recurrence following resective surgery for Crohn disease remains a challenging clinical problem, and more studies are needed to better define risk stratification and treatment recommendations in the postoperative setting. Endoscopy remains the gold standard for the assessment of postoperative disease recurrence, and all Crohn disease patients who undergo surgery should undergo ileocolonoscopy within 6 to 12 months of surgery. The degree of endoscopic recurrence in the neoterminal ileum during this procedure provides prognostic information regarding the severity of the future disease course. WCE, MRE, and SICUS are all promising noninvasive modalities to assess for postoperative Crohn disease activity. However, further studies are needed to better define scoring systems, operating characteristics and variability, and prognostic data for each of these modalities. In patients at risk for early disease recurrence, more aggressive prophylactic therapy should be considered, in hopes of delivering true “top-down” therapy that may offer maximum impact in altering the natural history of Crohn disease.

  12. Prevention of postoperative recurrence of Crohn's disease

    NARCIS (Netherlands)

    van Loo, E. S.; Dijkstra, G.; Ploeg, R. J.; Nieuwenhuijs, V. B.

    2012-01-01

    Background: Up to 75% of patients with Crohn's disease (CD) will have intestinal resection during their life. Most patients will, however, develop postoperative recurrence (endoscopic, clinical or surgical). Several medical and surgical strategies have been attempted to prevent postoperative recurre

  13. Meeting the Challenge of Crohn's Disease

    Science.gov (United States)

    ... disease under control with the right medications, healthy foods, plenty of sleep, low stress—and compassionate gastroenterologists. She recently spoke with NIH MedlinePlus magazine about dealing with Crohn's disease. How old were ...

  14. Neurochirurgische OP-Indikation bei malignen Mediainfarkten

    Directory of Open Access Journals (Sweden)

    Gruber A

    2011-01-01

    Full Text Available Bei Patienten mit malignen Mediainfarkten kann durch dekompressive Hemikraniektomie (DHC die unter konservativem Management bei 80 % liegende Mortalität auf 30 % gesenkt werden. Überleben und gutes neurologisches Outcome nach Mediainfarkt und DHC sind vor allem dann zu erwarten, wenn jüngere Patienten ( 60 Jahre früh ( 48 Stunden nach Symptombeginn zur Operation gelangen. Für 60-jährige Patienten sowie für den Zeitraum 48 Stunden nach Symptombeginn gibt es derzeit keine sicheren Daten und die Entscheidung über eine mögliche Operation muss einzelfallabhängig erfolgen. Die diesen Überlegungen zugrunde liegenden Metaanalysen weisen methodische Probleme, konkret Post-hoc- Subgruppenanalysen (2009 und eine Modifikation des primären Studienendpunkts (2007 auf. Die Grundaussage der Studien und damit die Rationale für DHC bei malignem Mediainfarkt bleiben davon jedoch unberührt.

  15. A Rare Presentation of Crohn's Disease

    Directory of Open Access Journals (Sweden)

    Sriram Bhat M

    2008-01-01

    Full Text Available Free peritoneal perforation is a rare complication of Crohn's disease with a report of only 100 cases in the literature. It needs an emergency exploration and an unaware general surgeon is confounded in intraoperative decision-making. We present our experience when this rarity struck us in a district hospital and briefly review the guidelines of optimal management of this complication of Crohn's disease.

  16. CT enterography of pediatric Crohn disease

    Energy Technology Data Exchange (ETDEWEB)

    Dillman, Jonathan R.; Strouse, Peter J. [University of Michigan Health System, Department of Radiology, C.S. Mott Children' s Hospital, Ann Arbor, MI (United States); Adler, Jeremy [University of Michigan Health System, Department of Pediatrics and Communicable Diseases, Division of Pediatric Gastroenterology, Ann Arbor, MI (United States); Zimmermann, Ellen M. [University of Michigan Health System, Department of Internal Medicine, Division of Gastroenterology, Ann Arbor, MI (United States)

    2010-01-15

    CT enterography is an important tool in the noninvasive diagnosis and follow-up of pediatric Crohn disease. This imaging modality is particularly useful for assessing extent of disease (including both intestinal and extraintestinal manifestations), response to medical therapy, and disease-related complications. The purpose of this article is to provide a contemporary review of CT enterography technique as well as the spectrum of intestinal and extraintestinal findings in pediatric Crohn disease. (orig.)

  17. Primary antibody deficiency and Crohn's disease

    OpenAIRE

    Conlong, P; Rees, W; Shaffer, J; Nicholson, D; Jewell, D.; Heaney, M.; Jones, A; Snowden, N

    1999-01-01

    Five patients with primary antibody deficiency were investigated because of intermittent but persistent diarrhoea of several years duration despite immunoglobulin replacement therapy. We found no evidence of Giardia lambia or other intestinal pathogens to explain their gastrointestinal symptoms. All five had definite radiological evidence of small bowel Crohn's disease and three had histological specimens available with abnormalities consistent with Crohn's disease. One patient had a non-case...

  18. Crohn's disease:Innate immunodeficiency?

    Institute of Scientific and Technical Information of China (English)

    Jesus K Yamamoto-Furusho; Joshua R Korzenik

    2006-01-01

    In the past,Crohn's disease (CD) has been understood primarily as an immunologic disorder characterized by an abnormal T-cell response.Recent in vitro and in vivo data suggests that CD may instead be precipitated by innate immune dysfunction resulting from a combination of genetic and environmental factors.Some reports have demonstrated a defective immune response in a variety of other cellular components,including neutrophils,monocytes and dendritic cells.Recent studies of granulocyte-macrophage colony-stimulating factor (GMCSF) in CD,aiming to stimulate the innate immune system with the conception that an innate immune defect underlies the development of the disease,have been demonstrated a clinical benefit and reinforce this evolving understanding of the disease.

  19. Biological treatment of Crohn's disease

    DEFF Research Database (Denmark)

    Nielsen, Ole Haagen; Bjerrum, Jacob Tveiten; Seidelin, Jakob Benedict

    2012-01-01

    Introduction of biological agents for the treatment of Crohn's disease (CD) has led to a transformation of the treatment paradigm. Several biological compounds have been approved for patients with CD refractory to conventional treatment: infliximab, adalimumab and certolizumab pegol (and...... natalizumab in several countries outside the European Union). However, despite the use of biologics for more than a decade, questions still remain about the true efficacy and the best treatment regimens - especially about when to discontinue treatment. Furthermore, a need for optimizing treatment...... with biologics still exists, as 20-40% of patients with CD (depending on selection criteria) do not have any relevant response to the current biological agents (i.e. primary failures). A better patient selection might maximize the clinical outcome while minimizing the complications associated with this type...

  20. Entwicklungstrends bei landwirtschaftlichen Applikationen - ein Zwischenfazit

    Directory of Open Access Journals (Sweden)

    Christa Hoffmann

    2014-10-01

    Full Text Available Globalisierung, volatile Märkte und der vermehrte Rückzug der Agrarpolitik aus der Marktregulierung sorgen dafür, dass die Entscheidungsfindungsprozesse auf landwirtschaftlichen Betrieben an Komplexität zunehmen. Applikationen bieten durch ihre Mobilität und individuellen Ausgestaltungsmöglichkeiten Optionen, um den Landwirt bei seiner täglichen Arbeit zu unterstützen. In diesem Kontext nimmt diese Arbeit eine Bestandsaufnahme und Kategorisierung nativer Applikationen mit landwirtschaftlichem Bezug vor. Die Ergebnisse zeigen unter anderem einen Angebotsschwerpunkt im Produktionszweig Pflanzenbau und bei den Funktionen bestimmte häufig auftretende bedarfsbedingte Kombinationen (z. B. Planung und Analyse.

  1. Vibrant Soundbridge bei Kindern - erste Ergebnisse

    OpenAIRE

    Hey, C; Ernst, B; Leinung, M; Stöver, T

    2012-01-01

    Einleitung: Das Mittelohr-Implantatsystem VIBRANT SOUNDBRIDGE (VSB), Fa. MED-EL GmbH wurde seit 1996 bei erwachsenen Patienten mit konduktiver Hörstörung vielfach erfolgreich implantiert. Seit 2009 ist die VSB auch für Kinder in Europa zugelassen, weltweit jedoch bislang erst bei ca. 100 Kindern eingesetzt, davon nur wenige unter dem 5. Lebensjahr.Material und Methodik: Seit 11/2011 wurden in domo 4 Jungen mit unilateraler Gehörgangsatresie bzw. 1 Mädchen mit bilateraler Gehörgangsatresie (...

  2. 5-Aminosalicylic acid dependency in Crohn's disease: A Danish Crohn Colitis Database study

    DEFF Research Database (Denmark)

    Duricova, D.; Pedersen, N.; Elkjaer, M.

    2010-01-01

    Background and aims The role of 5 aminosalicylic acid (5 ASA) in Crohns disease is unclear The outcome of the first course of 5 ASA monotherapy with emphasis on 5 ASA dependency was retrospectively assessed in consecutive cohort of 537 Crohn s disease patients diagnosed 1953-2007 Methods Following...

  3. Pilzinfektionen des Zentralnervensystems bei immunkompetentem Wirt

    NARCIS (Netherlands)

    K. Tintelnot; G.S. de Hoog; G. Haase

    2014-01-01

    Die Mehrzahl von Pilzinfektionen, die zu mykotischen Tumoren führen und bei Patienten ohne jegliche prädisponierende Vorerkrankung auftreten, wird durch Cryptococcus gattii bzw. C. neoformans oder durch Schwärzepilze, insbesondere durch Cladophialophora bantiana, Ramichloridium mackenziei, Exophiala

  4. Diagnostische Besonderheiten bei der Inkontinenz des Mannes

    Directory of Open Access Journals (Sweden)

    Fischer M

    2004-01-01

    Full Text Available Es gibt 3 Ursachen für die männliche Harninkontinenz: die Detrusorfehlfunktion (drangbedingter Harnverlust bei Blasenreizung; die Obstruktion, meistens durch die Prostata bedingt, welche zur Überlaufinkontinenz führen kann; die (postoperative oder posttraumatische Sphinkterinkompetenz (Schließmuskelläsion mit Stressinkontinenz. Die Aufgabe der Diagnostik ist es, die Ursache(n herauszufinden, teilweise mit therapeutischen Mitteln. In der Stufendiagnostik erfolgt die erste Abklärung beim Facharzt mit Harnanalyse, Restharnbestimmung, Uroflow und je nach Symptomatik sofortiger Endoskopie. Eine alleinige Drangsymptomatik kann medikamentös anbehandelt werden. Die Beseitigung einer Obstruktion muß meist operativ erfolgen, da die medikamentöse Therapie kaum ausreicht. Bei unklaren Befunden bezüglich einer Obstruktion, Therapieresistenz bei Dranginkontinenz, Postprostatektomie-Inkontinenz und bei Verdacht auf neurogene Ursache der Inkontinenz sollte die weitere Abklärung über eine Spezialambulanz großteils inkl. Urodynamik erfolgen (mit Blasendruckmessung, Flow/EMG, Urethradruckmessung und Harnröhrenröntgen. Je nach Ergebnis kann dann eine gezielte Therapie eingeleitet werden.

  5. Schmerz: Symptom, Folge, Behandlung bei Multipler Sklerose

    Directory of Open Access Journals (Sweden)

    Schmidegg S

    2006-01-01

    Full Text Available Schmerz ist ein viel häufigeres Symptom bei Patienten mit Multipler Sklerose als angenommen. In 5,5 % der Patienten ist Schmerz ein vorherrschendes Symptom, entweder alleine oder in Kombination mit anderen Symptomen, z. B. der Spastizität. Häufigste Symptome sind ein zentral neuropathischer Schmerz, die Allodynie und Hyperalgesie sowie Trigeminusneuralgien.

  6. Infliximab, azathioprine, or combination therapy for Crohn's disease

    DEFF Research Database (Denmark)

    Colombel, Jean Frédéric; Sandborn, William J; Reinisch, Walter

    2010-01-01

    The comparative efficacy and safety of infliximab and azathioprine therapy alone or in combination for Crohn's disease are unknown.......The comparative efficacy and safety of infliximab and azathioprine therapy alone or in combination for Crohn's disease are unknown....

  7. Living with Crohn's Disease | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... of this page please turn JavaScript on. Feature: Crohn's Disease Living with Crohn's Disease Past Issues / Winter 2016 Table of Contents Photo ... Why have you chosen to speak out about Crohn's disease? For many years I really didn't talk ...

  8. Uveitis as first manifestation of probably Crohn's disease

    Directory of Open Access Journals (Sweden)

    Ieda Maria Alexandre Barreira

    2012-12-01

    Full Text Available Extraintestinal manifestations of Crohn's disease are common. Although ocular complications of Crohn's disease are infrequent, most ocular manifestations include iritis, uveitis, episcleritis, scleritis and conjuntivitis. We report a patient who developed uveitis two years before diagnose of Crohn's disease.

  9. Successful treatment of metastatic Crohn's disease with cyclosporine.

    Science.gov (United States)

    Carranza, Dafnis C; Young, Lorraine

    2008-08-01

    Metastatic Crohn's disease refers to cutaneous granulomatous lesions that are noncontiguous to the gastrointestinal tract. The treatment of cutaneous Crohn's disease is challenging. A patient with metastatic Crohn's disease whose lesions cleared after a 3-month course of cyclosporine is reported.

  10. Inherited determinants of Crohn's disease and ulcerative colitis phenotypes

    DEFF Research Database (Denmark)

    Cleynen, Isabelle; Boucher, Gabrielle; Jostins, Luke

    2016-01-01

    (-4)). INTERPRETATION: Our data support a continuum of disorders within inflammatory bowel disease, much better explained by three groups (ileal Crohn's disease, colonic Crohn's disease, and ulcerative colitis) than by Crohn's disease and ulcerative colitis as currently defined. Disease location is an intrinsic aspect...

  11. Colorectal cancer risk in Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    Hugh James Freeman

    2008-01-01

    There is recognized increased risk for colorectal cancer in patients with inflammatory bowel disease, particularly in long-standing and extensive ulcerative colitis. There also appears to be an increased rate of intestinal cancer in Crohn's disease, including both colon and small bowel sites. In Crohn's disease, evidence suggests that detection of colorectal cancer may be delayed with a worse progno sis. Some risk factors for cancer in Crohn's disease include the extent of inflammatory change within the colon and the presence of bypassed or excluded segments, inclu ding rectal "stump" cancer. In addition, the risk for other types of intestinal neoplasms may be increased in Crohn's disease, including lymphoma and carcinoid tumors. Earlier detection of colorectal cancer based on colonoscopy scre ening and surveillance may be achieved but, to date, this has not translated into a positive survival benefit. Moreo ver, newer staining methods and evolving micro-endos copic techniques show promise, but have not significantly altered management. Future research should focus on development of molecular or other bio-markers that might predict future dysplasia or cancer development in Crohn's disease.

  12. Diagnosis and management of Crohn's disease.

    Science.gov (United States)

    Wilkins, Thad; Jarvis, Kathryn; Patel, Jigneshkumar

    2011-12-15

    Crohn's disease is a chronic inflammatory condition affecting the gastrointestinal tract at any point from the mouth to the rectum. Patients may experience diarrhea, abdominal pain, fever, weight loss, abdominal masses, and anemia. Extraintestinal manifestations of Crohn's disease include osteoporosis, inflammatory arthropathies, scleritis, nephrolithiasis, cholelithiasis, and erythema nodosum. Acute phase reactants, such as C-reactive protein level and erythrocyte sedimentation rate, are often increased with inflammation and may correlate with disease activity. Levels of vitamin B12, folate, albumin, prealbumin, and vitamin D can help assess nutritional status. Colonoscopy with ileoscopy, capsule endoscopy, computed tomography enterography, and small bowel follow-through are often used to diagnose Crohn's disease. Ultrasonography, computed axial tomography, scintigraphy, and magnetic resonance imaging can assess for extraintestinal manifestations or complications (e.g., abscess, perforation). Mesalamine products are often used for the medical management of mild to moderate colonic Crohn's disease. Antibiotics (e.g., metronidazole, fluoroquinolones) are often used for treatment. Patients with moderate to severe Crohn's disease are treated with corticosteroids, azathioprine, 6-mercaptopurine, or anti-tumor necrosis factor agents (e.g., infliximab, adalimumab). Severe disease may require emergent hospitalization and a multidisciplinary approach with a family physician, gastroenterologist, and surgeon.

  13. Conventional therapy for Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    Carsten Büning; Herbert Lochs

    2006-01-01

    Crohn's disease (CD) is a multifactorial disorder of unknown cause. Outstanding progress regarding the pathophysiology of CD has led to the development of innovative therapeutic concepts. Numerous controlled trials have been performed in CD over the last years. However, many drugs have not been approved by regulatory authorities due to lack of efficacy or severe side effects. Therefore, well-known drugs, including 5-ASA, systemic or topical corticosteroids, and immunosuppressants such as azathioprine, are still the mainstay of CD therapy. Importantly, biologicals such as infliximab have shown to be efficacious in problematic settings such as fistulizing or steroid-dependent CD. This review is intended to give practical guidelines to clinicians for the conventional treatment of CD. We concentrated on the results of randomized, placebo-controlled trials and meta-analyses, when available, that provide the highest degree of evidence. We provide evidence-based treatment algorithms whenever possible. However, many clinical situations have not been answered by controlled clinical trials and it is important to fill these gaps through expert opinions. We hope that this review offers a useful tool for clinicians in the challenging treatment of CD.

  14. MR Imaging of Perianal Crohn Disease.

    Science.gov (United States)

    Sheedy, Shannon P; Bruining, David H; Dozois, Eric J; Faubion, William A; Fletcher, Joel G

    2017-03-01

    Pelvic magnetic resonance (MR) imaging is currently the standard for imaging perianal Crohn disease. Perianal fistulas are a leading cause of patient morbidity because closure often requires multimodality treatments over a prolonged period of time. This review summarizes clinically relevant anal sphincter anatomy, imaging methods, classification systems, and treatment objectives. In addition, the MR appearance of healing perianal fistulas and fistula complications is described. Difficult imaging tasks including the assessment of rectovaginal fistulas and ileoanal anastomoses are highlighted, along with illustrative cases. Emerging innovative treatments for perianal Crohn disease are now available and have the promise to better control sepsis and maintain fecal continence. Different treatment modalities are selected based on fistula anatomy, patient factors, and management goals (closure versus sepsis control). Radiologists can help maximize patient care by being familiar with MR imaging features of perianal Crohn disease and knowledgeable about what features may influence therapy decisions. (©) RSNA, 2017 Online supplemental material is available for this article.

  15. Echokardiographie aktuell: Herzinsuffizienz bei mechanischer Aortenklappenprothese

    Directory of Open Access Journals (Sweden)

    Glaser F

    2007-01-01

    Full Text Available bVorgeschichte/bbr Bei einem 75jährigen Patienten wurde vor 10 Jahren eine 4fach-Bypassoperation und ein mechanischer Aortenklappenersatz (Tecna 21 mm bei koronarer Dreigefäßerkrankung und schwerer Aortenstenose durchgeführt. Seit damals ist eine mäßig reduzierte linksventrikuläre Pumpfunktion bekannt, mit einer Auswurffraktion von 40 % und ausgedehnter posterolateraler und lateraler Akinesie (Abb. 1, 2. Als kardiovaskuläre Risikofaktoren liegen ein inzwischen insulinpflichtiger Diabetes, eine Hypertonie und stattgehabter Nikotinabusus vor. Im Jahr 2004 wurde wegen mäßiger Angina pectoris-Beschwerden eine Koronarangiographie durchgeführt, wobei ein Verschluß des LIMA-Bypasses zum LAD und ein Verschluß eines Venenbypasses zu einem marginalen Ast des Ramus circumflexus nachgewiesen wurde. Der LIMA-Verschluß war allerdings nicht sehr bedeutend, da ein gut funktionierender Venenbypass zum Diagonalast auch den peripheren LAD gut mitversorgt. Die therapeutische Konsequenz war konservativ. Die laufenden kardiologischen Kontrollen, einschließlich regelmäßiger Echokardiographie, wurden vom niedergelassenen Internisten durchgeführt. Der echokardiographische Befund hatte sich über die Jahre nicht verändert. Das Management der Risikofaktoren und die Herzinsuffizienztherapie wurden von seiten des Internisten vorbildlich durchgeführt, bis vor kurzem war der Patient mit seiner mäßig eingeschränkten Leistungsfähigkeit zufrieden.br bDas aktuelle kardiale Problem/bbr In den vergangenen Monaten kam es zu zunehmender Herzinsuffizienzsymptomatik mit Müdigkeit und Leistungslimitierung durch Dyspnoe ohne wesentliche Angina pectoris, entsprechend NYHA III–IV. Echokardiographisch fanden wir bezüglich der Linksventrikelfunktion den oben beschriebenen Befund. Von seiten der diastolischen Parameter fand sich ein nach allen Kriterien „restriktives“ Muster entsprechend einem erhöhten linksventrikulären Füllungsdruck (Abb. 3, 4 und dazu

  16. Optimizing biological therapy in Crohn's disease.

    Science.gov (United States)

    Gecse, Krisztina Barbara; Végh, Zsuzsanna; Lakatos, Péter László

    2016-01-01

    Anti-TNF therapy has revolutionized the treatment of inflammatory bowel diseases, including both Crohn's disease and ulcerative colitis. However, a significant proportion of patients does not respond to anti-TNF agents or lose response over time. Recently, therapeutic drug monitoring has gained a major role in identifying the mechanism and management of loss of response. The aim of this review article is to summarize the predictors of efficacy and outcomes, the different mechanisms of anti-TNF/biological failure in Crohn's disease and identify strategies to optimize biological treatment.

  17. Crohn's病的临床病理分析%Clinicopathologic analysis of Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    戴敏

    2006-01-01

    目的 探讨Crohn's病的临床病理特点.方法 分析医院11例Crohn's病患者的临床及病理资料.结果 Crohn's病以腹痛、腹泻、腹块、瘘管形成和肠梗阻为主要临床表现,往往发生在末段小肠且病变呈现节段性,表面正常的肠管将轮廓清楚的病灶分割开(跳跃性分布).结论 病理学特征和病理学检查,对诊断Crohn's病具有价值.

  18. Lipidsenker bei Hypertonie - Was besagt die Evidenz?

    Directory of Open Access Journals (Sweden)

    Marte T

    2004-01-01

    Full Text Available Die Koexistenz von Risikofaktoren für atherosklerotische Prozesse, wie Hypertonie und Hypercholesterinämie, hat einen multiplikativen Effekt auf das Risiko kardiovaskulärer Ereignisse. Bislang wurden relativ wenige spezifische Daten zur Frage der Lipidintervention bei Hypertoniepatienten veröffentlicht. Post-hoc-Subgruppenanalysen der großen randomisierten kontrollierten Studien mit Statinen in der Primär- und Sekundärprävention lassen schließen, daß der relative kardiovaskuläre Benefit einer lipidsenkenden Behandlung bei normotensiven und hypertensiven Patientenpopulationen ähnlich ist. Dem Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT war es nicht möglich, einen Einfluß einer Statintherapie auf die Gesamtmortalität einer hypertensiven Kohorte zu zeigen. Die schlechte Compliance im Statin-Arm und eine hohe Rate an Statin-Einnahme in der "Kontrollgruppe" waren für dieses negative Ergebnis verantwortlich. Das Anglo-Scandinavian Cardiac Outcomes Trial – Lipid Lowering Arm (ASCOT-LLA untersuchte den Effekt der cholesterinreduzierenden Therapie in der Prävention atherosklerotischer Ereignisse bei Hypertonikern mit Gesamtcholesterinkonzentrationen von 250 mg/dl. Hier war ein Benefit ersichtlich, die absolute Risikoreduktion für diese Patientenpopulation war jedoch gering. Bezüglich der Frage, ob Antihypertensiva einen klinisch signifikanten Effekt auf die Blutfette haben, sind einige Studien durchgeführt worden. Die verfügbaren Daten zeigen aber nur einen marginalen Effekt. Zusammengefaßt sollte die Statintherapie bei gleichzeitig vorhandener Hypertonie vornehmlich in der Sekundärprävention ein integraler Bestandteil der Behandlung sein. In der Primärprävention hingegen sollte die Entscheidung bezüglich Statintherapie vom individuellen Gesamtrisiko abhängig gemacht werden.

  19. Orale Kontrazeptiva und Langzyklus bei Endometriose

    Directory of Open Access Journals (Sweden)

    Göretzlehner G

    2008-01-01

    Full Text Available Die Hormontherapie der Endometriose ist mit GnRH-Analoga, oralen hormonalen Kontrazeptiva (Mikropillen mit einer Ethinylestradiol-Dosis ≤30 µg und einem Gestagen und Gestagenen möglich. Unmittelbar nach der histologischen Sicherung der Diagnose Endometriose sollte mit der Hormontherapie begonnenen werden. Mikropillen können sowohl zyklisch (21/7 Tage, im Langzyklus (84/7– 189/7 Tage oder in kontinuierlicher Langzeiteinnahme angewendet werden. Die klassische zyklische Einnahme der Mikropillen im Rhythmus 21/7 Tage mit 13 Hormonentzugsblutungen pro Jahr und diversen Zusatzblutungen in Form von Spottings und Durchbruchblutungen führt zyklisch immer wieder zur Aktivierung der Gonadotropin-abhängigen Ovarialfunktion mit endogener Steroidbiosynthese. Durch das endogen gebildete Estradiol und die Blutungen werden bei der zyklischen Einnahme der Mikropillen die Endometrioseherde immer wieder stimuliert. Bei der kontinuierlichen Langzeiteinnahme und im Langzyklus wird diese Möglichkeit der Stimulation der Endometriose reduziert oder entfällt gänzlich. Aus diesem Grund wird bei Frauen mit einer Endometriose die kontinuierliche Langzeiteinnahme oder der Langzyklus empfohlen.

  20. Experimentelle erzeugung der immun. Insulitis bei mausen

    Directory of Open Access Journals (Sweden)

    Okada,Soji

    1976-04-01

    Full Text Available Experimentelle Produktion der Immun-Insu1itis wurde aufgrund der aktiven Immunisierung der Mause vom dd-Stamm durch wiederholte Gabe vom rekristallisierten Rinderinsulin im Abstand von 4 Wochen unternommen. Wahrend der Zeitdauer vom 3. Tag bis zur 28. Woche nach der ersten Sensibilisierung wurden serologische sowie histo1ogische Untersuchungen an diesen Tieren vorgenommen. Dabei ergaben sich fo1gende Befunde: (1 Die Immunlnsulitis kam bei allen von 58 Fallen bis zu 16 Wochen nach dem Sensibilisierungsbeginn nicht zur Erscheinung, und trat bei 2 von 8 Fallen erst in der 20. Woche und dann bei 3 von 8 Fallen in der 28. Woche in die Erscheinung. (2 Kein signifikanter Unterschied bestand in Hinsicht des insulinverbindenden Antikorpertiters im Blut zwischen den Fallen mit und ohne Immun-Insulitis in der 20. Woche sowie in der 28. Woche. (3 1m Zeitlauf gab es aber eine gute Koinzidenz zwischen der Entstehung der Immun-Insulitis und der Herabsetzung des Antikorpertiters im Blut. (4 Untersuchungen des Pankreas mit Hi1fe der direkten Fluoreszenz-Antikorpermethode ergaben keine erkennbare spezifische Fluoreszenz innerhalb der Langerhansschen Inseln. Diese Untersuchungsergebnisse liefern der Ansicht einen Beweis, da~ die Insulitis, die fUr den mensch1ichen Diabetes mellitus spezifisch ist, mindestens zum Teil durch einen immuno1ogischen Mechanismus entstehen konnte.

  1. Enfermedad de Crohn con compromiso cutáneo mucoso Crohn disease with cutaneous mucosal involvement

    Directory of Open Access Journals (Sweden)

    R E Achenbach

    2008-03-01

    Full Text Available Comunicamos dos casos de enfermedad de Crohn con compromiso cutáneo-mucoso; el primer paciente con lesiones del denominado "Crohn metastásico" en las piernas y el segundo con importante compromiso en áreas perineo-genital, osteomal y de mucosa bucal, que luego de la remisión de las mismas sufrió una vasculitis leucocitoclásica en miembros inferiores. Los granulomas característicos de la enfermedad de Crohn se hallaron en la pared intestinal y la piel de ambos pacientes.Two cases of Crohn disease are reported, both with cutaneous-mucosal involvement. The first patient showed lesions of the so called "Metastatic Crohn disease" in the legs, whereas the second one presented severe compromise in the perinealgenital, osteomal and oral mucosae. After the remission of the above mentioned, the patient suffered from leucocytoclastic vasculitis in the lower limbs. In both cases, the typical granulomatous lesions of the Crohn disease were found both in the skin and intestinal wall.

  2. Naturheilkunde und Komplementärmedizin bei chronisch entzündlichen Darmerkrankungen

    Directory of Open Access Journals (Sweden)

    Langhorst J

    2016-01-01

    Full Text Available iZiel:/iNaturheilkundliche und komplementäre Verfahren werden häufig von Patienten mit chronisch entzündlichen Darmerkrankungen (CED als Therapieoptionen erwogen. Im Rahmen des vorliegenden Beitrags stellen wir die aktuelle Datenlage zu komplementären und alternativen Therapieverfahren (CAM bei CED entsprechend der Definition der National Institutes of Health bzw. der Cochrane Collaboration mit Ausnahme von Diät- und Nahrungsergänzungsmittel sowie „manipulative and body-based methods“ vor.br iMethoden:/iIm März 2014 erfolgte die Recherche nach Originalarbeiten und systematischen Reviews in medizinischen Datenbanken (Cochrane Library, Pubmed / Medline, Psychinfo und Scopus. Eingeschlossen wurden randomisiert-kontrollierte und klinische Studien in englischer oder deutscher Sprache für CAM bei „Inflammatory Bowel Disease“, „Crohns Disease“ und „ulcerative colitis“.br iErgebnisse:/i Vorgestellt werden Arbeiten zu den Themen Phytotherapie, wie z. B. Aloe-vera- Gel, Kalmegh, Artemisia absinthium, Blutwurz, Boswellia serrata, Cannabis, Curcumin, eine Kombination aus Myrrhe, Kamillenblüten und Kaffeekohle, Plantago ovata, Weizengras-Saft und Wermut, Mind-Body Medizin und Lebensstilmodifikation, Hypnotherapie, Entspannungstraining und Achtsamkeit sowie Akupunktur.br iFazit:/i Verschiedene Studien zeigen erste Hinweise auf eine mögliche Wirksamkeit von komplementären und naturheilkundlichen Therapieverfahren in der Behandlung von chronisch entzündlichen Darmerkrankungen. Aufgrund der geringen Anzahl an Studien zu den einzelnen Verfahren, der relativ geringen Zahl der eingeschlossenen Patienten und der heterogenen methodischen Qualität der Studien ist weitere hochqualitative klinische Forschung notwendig.

  3. Potential value of nutrigenomics in Crohn's disease.

    Science.gov (United States)

    Ferguson, Lynnette R

    2012-03-13

    Crohn's disease is a chronic relapsing condition that has no certain cure. Both genetic susceptibility and nutrition have key roles, but their level of involvement varies between patients. Interacting gene pathways influence the probability of disease development, but these are affected by stress and various environmental factors, including diet. In addition, the role of the gut microbiome must not be underestimated, as it is substantially altered in patients with Crohn's disease. Although an elemental diet might lead to disease remission, reintroducing real foods and sustainable diets in patients with Crohn's disease is currently difficult, and would benefit from the sensitivity and rapid feedback provided by the field of nutrigenomics. Nutrigenomics utilizes high-throughput genomics technologies to reveal changes in gene and protein expression that are modulated by the patient's nutrition. The most widely used technique thus far is transcriptomics, which permits measurement of changes in the expression of thousands of genes simultaneously in one sample. Given the volume of numbers generated in such studies, data-basing and bioinformatics are essential to ensure the correct application of nutrigenomics at the population level. These methods have been successfully applied to animal models of Crohn's disease, and the time is right to move them to human studies.

  4. Diagnosis and treatment of fistulising Crohn's disease

    DEFF Research Database (Denmark)

    Hvas, Christian Lodberg; Dahlerup, Jens Frederik; Jacobsen, Bent Ascanius

    2011-01-01

    A fistula is defined as a pathological connection between the intestine and an inner (bladder or other intestine) or outer (vagina or skin) epithelial surface. Fistulas are discovered in up to 25% of all Crohn's disease patients during long-term follow-up examinations. Most are perianal fistulas...

  5. Muramyl dipeptide responsive pathways in Crohn's disease

    DEFF Research Database (Denmark)

    Salem, Mohammad; Seidelin, Jakob Benedict; Rogler, Gerhard

    2012-01-01

    Crohn's disease (CD) is one of main disease entities under the umbrella term chronic inflammatory bowel disease. The etiology of CD involves alterations in genetic, microbiological, and immunological factors. This review is devoted to the role of the bacterial wall compound muramyl dipeptide (MDP...

  6. Crohn's disease-Defect in innate defence

    Institute of Scientific and Technical Information of China (English)

    Michael Gersemann; Jan Wehkamp; Klaus Fellermann; Eduard Friedrich Stange

    2008-01-01

    Crohn's disease may prinicipally involve the whole gastrointestinal tract. Most commonly, the inflammation occurs in the small intestine and/or in the colon with stable disease location over the years. The pathogenesis of both disease phenotypes is complex, the likely primary defect lies in the innate rather than adaptive immunity, particularly in the chemical antimicrobial barrier of the mucosa Crohn's ileitis is associated with a reduced expression of the Wnt signalling pathway transcription factor T-cell factor 4 (TCF4) ,which is regulating Paneth cell differentiation. As a result, the alpha-defensins and principal Paneth cell products HD5 and HD6 are deficiently expressed in ileal disease, independent of current inflammation. In contrast, Crohn's colitis is typically associated with an impaired induction of the beta-defensins HBD2 and HBD3 caused by fewer gene copy numbers in the gene locus of the beta-defensins on chromosome 8. This ileal and colonic defect in innate defence mediated by a deficiency of the protective alpha- and betadefensins may enable the luminal microbes to invade the mucosa and trigger the inflammation. A better understanding of the exact molecular mechanisms behind ileal and colonic Crohn's disease may give rise to new therapeutic strategies based on a stimulation of the protective innate immune system.(C)2008 The WJG Press. All fights reserved.

  7. Infliximab dependency in children with Crohn's disease

    DEFF Research Database (Denmark)

    Duricova, D; Pedersen, N; Lenicek, M

    2009-01-01

    BACKGROUND: Recently, infliximab dependency has been described. AIM: To assess frequency of ID in 82 consecutive Crohn's disease children treated with infliximab 2000-2006 and to describe clinical and genetic predictors of long-term infliximab response. METHODS: A phenotype model of infliximab...

  8. 'Microerosions' in rectal biopsies in Crohn's disease

    DEFF Research Database (Denmark)

    Poulsen, Steen Seier

    1984-01-01

    Small (less than 1 mm), superficial erosions ('microerosions') have been observed stereo-microscopically in surface-stained rectal biopsies in Crohn's disease (CD). Biopsy specimens from 97 patients with CD, 225 with ulcerative colitis (UC), and a control material of 161 patients were investigated...

  9. Imaging of Cell Trafficking in Crohn's Disease

    NARCIS (Netherlands)

    Glaudemans, Andor W. J. M.; Maccioni, Francesca; Mansi, Luigi; Dierckx, Rudi A. J. O.; Signore, Alberto

    2010-01-01

    Inflammatory bowel diseases are represented by ulcerative colitis and Crohn's disease, both consisting of a chronic, uncontrolled inflammation of the intestinal mucosa of any part of the gastrointestinal tract with patchy or continuous inflammation. Ileo-colonoscopy is considered the current gold st

  10. Impaired innate immunity in Crohn's disease

    NARCIS (Netherlands)

    Comalada, Monica; Peppelenbosch, Maikel P.

    The aetiology of Crohn's disease - a chronic intestinal disorder that involves an immune response against the commensal bacterial flora - remains fiercely debated. Two hypotheses exist: (i) those who think that the disease is caused by genetic defects that produce exaggerated innate responses to the

  11. Genetic variants associated with Crohn's disease

    Directory of Open Access Journals (Sweden)

    Michail S

    2013-07-01

    Full Text Available Sonia Michail,1 Gilberto Bultron,1 R William DePaolo2 1The University of Southern California, Children's Hospital of Los Angeles, Los Angeles, CA, USA; 2Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA Abstract: Crohn's disease is an immune-related disorder characterized by inflammation of the gastrointestinal mucosa, which can occur in any area throughout the digestive tract. This life-long disease commonly presents with abdominal pain, diarrhea, vomiting, and weight loss. While the exact etiology of this disease is largely unknown, it is thought to arise from an interaction between microbial, immunological, and environmental factors in a genetically susceptible host, whereby the immune system attacks the intestine as it cross reacts against gut microbial antigens. The study of genetic variants associated with Crohn's disease has shed light on our understanding of disease pathophysiology. A large number of genetic variants identified in Crohn's disease are related to genes targeting microbial recognition and bacterial wall sensing, the most common being NOD2/CARD15 gene. This review will discuss the recent advance in our knowledge of genetic variants of this disease and how they influence the disease course and prognosis. Keywords: Crohn's disease, genetics, autophagy

  12. Crohn Disease: Epidemiology, Diagnosis, and Management.

    Science.gov (United States)

    Feuerstein, Joseph D; Cheifetz, Adam S

    2017-07-01

    Crohn disease is a chronic idiopathic inflammatory bowel disease condition characterized by skip lesions and transmural inflammation that can affect the entire gastrointestinal tract from the mouth to the anus. For this review article, we performed a review of articles in PubMed through February 1, 2017, by using the following Medical Subject Heading terms: crohns disease, crohn's disease, crohn disease, inflammatory bowel disease, and inflammatory bowel diseases. Presenting symptoms are often variable and may include diarrhea, abdominal pain, weight loss, nausea, vomiting, and in certain cases fevers or chills. There are 3 main disease phenotypes: inflammatory, structuring, and penetrating. In addition to the underlying disease phenotype, up to a third of patients will develop perianal involvement of their disease. In addition, in some cases, extraintestinal manifestations may develop. The diagnosis is typically made with endoscopic and/or radiologic findings. Disease management is usually with pharmacologic therapy, which is determined on the basis of disease severity and underlying disease phenotype. Although the goal of management is to control the inflammation and induce a clinical remission with pharmacologic therapy, most patients will eventually require surgery for their disease. Unfortunately, surgery is not curative and patients still require ongoing therapy even after surgery for disease recurrence. Importantly, given the risks of complications from both Crohn disease and the medications used to treat the disease process, primary care physicians play an important role in optimizing the preventative care management to reduce the risk of complications. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  13. Gallbladder bile composition in patients with Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    Annika Lapidus; Jan-Erik (A)kerlund; Curt Einarsson

    2006-01-01

    AIM: To further elucidate the pathogenesis and mechanisms of the high risk of gallstone formation in Crohn's disease.METHODS: Gallbladder bile was obtained from patients with Crohn's disease who were admitted for elective surgery (17 with ileallileocolonic disease and 7 with Crohn's colitis). Fourteen gallstone patients served as controls. Duodenal bile was obtained from ten healthy subjects before and after the treatment with ursodeoxycholic acid. Bile was analyzed for biliary lipids,bile acids, bilirubin, crystals, and crystal detection time (CDT). Cholesterol saturation index was calculated.RESULTS: The biliary concentration of bilirubin was about 50% higher in patients with Crohn's disease than in patients with cholesterol gallstones. Ten of the patients with Crohn's disease involving ileum and three of those with Crohn's colitis had cholesterol saturated bile. Four patients with ileal disease and one of those with colonic disease displayed cholesterol crystals in their bile. About 1/3 of the patients with Crohn's disease had a short CDT. Treatment of healthy subjects with ursodeoxycholic acid did not increase the concentration of bilirubin in duodenal bile. Several patients with Crohn's disease,with or without ileal resection/disease had gallbladder bile supersaturated with cholesterol and short CDT and contained cholesterol crystals. The biliary concentration of bilirubin was also increased in patients with Crohn's colitis probably not due to bile acid malabsorption.CONCLUSION: Several factors may be of importance for the high risk of developing gallstones of both cholesterol and pigment types in patients with Crohn's disease.

  14. Clostridium difficile infection in a patient with Crohn disease.

    Science.gov (United States)

    Hsu, Chien-Hui; Jeng, Yung-Ming; Ni, Yen-Hsuan

    2012-06-01

    Crohn disease is a chronic inflammatory disorder, which is rare in pediatric patients. The definite etiology and mechanism to induce an acute exacerbation of Crohn disease remains mostly unknown. The authors report on a 14-year-old girl with Crohn disease who has acute gastrointestinal symptoms caused by toxin A-producing Clostridium difficile, which mimicked a flare-up of Crohn disease. There was no preceding antibiotic prescription before the episode. The disease activity did not improve after steroid treatment, which is unusual for Crohn disease. However, all symptoms were dramatically relieved after eradication of C difficile, and led to a symptom-free period for more than 3 years. This case report aims to address the unusual presentation of a usual pathogen, C difficile, in a pediatric patient with Crohn disease.

  15. Hidradenitis suppurativa and perianal Crohn disease: differential diagnosis.

    Science.gov (United States)

    Bassas-Vila, J; González Lama, Y

    2016-09-01

    The first description of perianal fistulas and complications in Crohn disease was made 75 years ago by Penner and Crohn. Published studies have subsequently confirmed that perianal fistulas are the most common manifestations of fistulising Crohn disease. Hidradenitis suppurativa was described in 1854 by a French surgeon, Aristide Verneuil. It is a chronic, inflammatory, recurrent and debilitating disease of the pilosebaceous follicle, that usually manifests after puberty with deep, painful and inflamed lesions in the areas of the body with apocrine glands, usually the axillary, inguinal and anogenital regions. The differential diagnosis between hidradenitis suppurativa and Crohn disease can be challenging, especially when the disease is primarily perianal. When they occur simultaneously, hidradenitis suppurativa and Crohn disease show severe phenotypes and patients can respond to anti-tumour necrosis factor therapy, although adalimumab is currently the only treatment with demonstrated efficacy in hidradenitis suppurativa and Crohn disease. In addition, there is sometimes a need for different complementary surgical procedures.

  16. MRI for myocarditis; MRT bei Myokarditis

    Energy Technology Data Exchange (ETDEWEB)

    Gutberlet, M.; Luecke, C.; Krieghoff, C.; Hildebrand, L.; Steiner, J.; Adam, J.; Grotthoff, M.; Lehmkuhl, L. [Herzzentrum, Universitaet Leipzig, Abteilung fuer Diagnostische und Interventionelle Radiologie, Leipzig (Germany); Lurz, P.; Eitel, I.; Thiele, H. [Herzzentrum, Universitaet Leipzig, Abteilung Kardiologie, Leipzig (Germany)

    2013-01-15

    Cardiovascular magnetic resonance imaging (CMRI) has become the primary tool for the non-invasive assessment in patients with suspected myocarditis, especially after exclusion of acute coronary syndrome (ACS) for the differential diagnosis. Various MRI parameters are available which have different accuracies. Volumetric and functional ventricular assessment and the occurrence of pericardial effusion alone demonstrate only a poor sensitivity and specificity. The calculation of the T2-ratio (edema assessment), the early or global relative myocardial enhancement (gRE) and the late gadolinium enhancement (LGE), which represents irreversibly injured myocardium, are more specific parameters. All MRI parameters demonstrate the best accuracy in infarct-like acute myocarditis, whereas in chronic myocarditis sensitivity and specificity are less accurate. Therefore, a multisequential (at least two out of three parameters are positive) approach is recommended. The assessment of the value of newer, more quantitative MRI sequences, such as T1 and T2-mapping is still under investigation. (orig.) [German] Die kardiale MRT stellt die primaere nichtinvasive bildgebende Modalitaet bei Verdacht auf Myokarditis dar, insbesondere auch nach Ausschluss eines akuten Koronarsyndroms (ACS) zur Differenzialdiagnose. Verschiedene MR-Parameter mit unterschiedlicher Wertigkeit stehen zur Verfuegung. Die Beurteilung der Volumetrie und Ventrikelfunktion weisen ebenso wie der Nachweis eines Perikardergusses alleine nur eine geringe Sensitivitaet und Spezifitaet auf. Die spezifischeren MRT-Inflammationsparameter stellen die T2-Ratio (Oedemnachweis), die fruehe Kontrastmittelanreicherung bzw. das globale relative Enhancement (gRE) und die spaete Kontrastmittelanreicherung, das so genannte Late-Gadolinium-Enhancement (LGE) als Zeichen eines irreversiblen Myokardschadens dar. Alle MR-Parameter zeigen die beste diagnostische Genauigkeit bei einer ''infarktaehnlichen'' akuten

  17. Neue Therapieoptionen bei Neuroendokrinen Tumoren des Gastrointestinaltraktes

    Directory of Open Access Journals (Sweden)

    Lipp RW

    2016-01-01

    Full Text Available Neuroendokrine Tumoren (NET des Gastrointestinaltraktes und des Pankreas (GEP-NET werden zu den seltenen Tumoren gezählt. Auch wenn die jährliche Inzidenz dieser Erkrankung gering erscheint, weist diese Tumorentität die zweithöchste Prävalenz des Gastrointestinaltraktes auf. In den letzten beiden Jahrzehnten bewährten sich Somatostatinanaloga zur Behandlung symptomatischer NET-Patienten mit niedrigen Proliferationsindex Ki67 ≤ 10 % und zeigten zuletzt auch einen antiproliferativen Effekt unabhängig von der Hormonsynthese. In den letzten Jahren konnte das antiproliferative Potential von Everolimus (Afinitor® – ein m-Tor-Inhibitor – und Suntinib (Sutent® – ein Multikinase-Inhibitor – in der Behandlung von symptomatischen und asymptomatischen pankreatischen NET-Patienten gezeigt werden.br Im letzten Jahr wurden zwei Phase-III-Studien veröffentlicht bzw. präsentiert. Die Radiant- 4-Studie zeigte eine Verbesserung des progressionsfreien Überlebens bei asymptomatischen Patienten mit NETs des Gastrointestinaltraktes, der Lunge und bei NET-Patien ten mit „cancer of unknown primary“ (CUP, mit radiologisch gesicherter Tumorprogression zum Studien eintritt. Die NETTER-1-Studie ist die erste randomisierte kontrollierte Multicenter-Studie, die den Effekt der Radioligandentherapie auf das progressionsfreie Überleben bei Patienten mit progredientem Dünndarm-NET untersucht. Diese Übersicht fasst nun die Ergebnisse beider Studien zusammen und gibt einen möglichen Ausblick für die tägliche Praxis.

  18. Rezidivierende Endometriose bei Kinderwunsch: Operieren oder stimulieren?

    Directory of Open Access Journals (Sweden)

    Brunbauer M

    2012-01-01

    Full Text Available Kurzfassung: Endometriose ist neben dem Tubenverschluss und dem PCO-Syndrom eine der Hauptursachen für reduzierte Fertilität bei der Frau. Zur eindeutigen Diagnosesicherung ist die operative Diagnostik Standard. Eine Sanierung ist in vielen Fällen in der gleichen Sitzung möglich. Um nichts unnötig zu (zer- stören, sei die Maxime: eher weniger als mehr. Ein Rezidiv bedeutet eine weitere Reduktion der Schwangerschaftsrate. Eine Zweitoperation kann zwar Beschwerden lindern, verbessert aber die Spontan-Schwangerschaftsrate nur gering. Der Zweiteingriff ist also bezüglich der reinen Schwangerschaftsrate einer modernen IVF-Behandlung eindeutig unterlegen.

  19. Genetische Regulation der Oxacillinresistenz bei Staphylococcus epidermidis

    OpenAIRE

    Huck, Jörn Christian

    2015-01-01

    Für S. epidermidis hängt die Expression der Oxacillinresistenz wesentlich von der Aktivität des alternativen sigma-Faktors sB ab. Durch Ausschaltung des Anti-sigma Faktors rsbW lässt sich mit dieser Arbeit erstmalig eine homogene Expression der Oxacillin Resistenz herbeiführen. Somit wurde ein Gen für S. epidermidis identifiziert, welches bei Inaktivierung in der Lage ist, einen Wechsel von heterogener zu homogener Oxacillinresistenz zu verursachen. Außerdem konnte gezeigt werden, dass dieser...

  20. Crohn's disease and acute pancreatitis. A review of literature.

    Science.gov (United States)

    Jasdanwala, Sarfaraz; Babyatsky, Mark

    2015-03-20

    Crohn's disease, a transmural inflammatory bowel disease, has many well-known extra-intestinal manifestations and complications. Although acute pancreatitis has a higher incidence in patients with Crohn's disease as compared to the general population, acute pancreatitis is still relatively uncommon in patients with Crohn's disease. Patients with Crohn's disease are at an approximately fourfold higher risk than the general population to develop acute pancreatitis. The risk of developing acute pancreatitis is higher in females as compared to males. Acute pancreatitis can occur at any age with higher incidence reported in patients in their 20s and between 40-50 years of age. The severity and prognosis of acute pancreatitis in patients with Crohn's disease is the same as in general population. Acute pancreatitis can occur before onset of intestinal Crohn's disease, this presentation being more common in children than adults. It can also occur as the presenting symptom. However, most commonly it occurs after intestinal symptoms have manifest with a mean time interval between the initial presentation and development of acute pancreatitis being 2 years. There are several etiological factors contributing to acute pancreatitis in patients with Crohn's disease. It is not clear whether acute pancreatitis is a direct extra-intestinal manifestation of Crohn's disease; however, majority of the cases of acute pancreatitis in patients with Crohn's disease are due to GS and medications. Drugs used for the treatment of Crohn's disease that have been reported to cause acute pancreatitis include 5-ASA agents, azathioprine and 6 mercaptopurine, metornidazole and corticosteroids. Recent evidence has emerged correlating both type 1 and 2 autoimmune pancreatitis with Crohn's disease. Understanding the association between the two disease entities is key to effectively manage patients with Crohn's disease and acute pancreatitis.

  1. CT enteroclysis in small bowel Crohn's disease

    Energy Technology Data Exchange (ETDEWEB)

    Kohli, Marc D. [Department of Radiology, Indiana University School of Medicine, Indianapolis, IN (United States); Maglinte, Dean D.T. [Department of Radiology, Indiana University School of Medicine, Indianapolis, IN (United States)], E-mail: dmaglint@iupui.edu

    2009-03-15

    The diagnostic evaluation of small bowel Crohn's disease has changed dramatically over the last decade. The introduction of wireless capsule endoscopy, double balloon endoscopy and the introduction of newer therapeutic agents have changed the role of imaging in the small bowel. Additionally, advances in multidetector CT technology have further changed how radiologic investigations are utilized in the diagnosis and management of small bowel Crohn's disease. This article describes how we perform CT enteroclysis in the investigation of small bowel Crohn's disease and discusses the role of CT enteroclysis in the current management of small bowel Crohn's disease.

  2. Surgical Treatment of Anorectal Crohn Disease

    Science.gov (United States)

    Lewis, Robert T.; Bleier, Joshua I. S.

    2013-01-01

    Crohn disease involves the perineum and rectum in approximately one-third of patients. Symptoms can range from mild, including skin tags and hemorrhoids, to unremitting and severe, requiring a proctectomy in a small, but significant, portion. Fistula-in-ano and perineal sepsis are the most frequent manifestation seen on presentation. Careful diagnosis, including magnetic resonance imaging or endorectal ultrasound with examination under anesthesia and aggressive medical management, usually with a tumor necrosis factor-alpha, is critical to success. Several options for definitive surgical repair are discussed, including fistulotomy, fibrin glue, anal fistula plug, endorectal advancement flap, and ligation of intersphincteric fistula tract procedure. All suffer from decreased efficacy in patients with Crohn disease. In the presence of active proctitis or perineal disease, no surgical therapy other than drainage of abscesses and loose seton placement is recommended, as iatrogenic injury and poor wound healing are common in that scenario. PMID:24436656

  3. Looking in the mouth for Crohn's disease.

    LENUS (Irish Health Repository)

    Rowland, Marion

    2010-02-01

    It is widely acknowledged among gastroenterologists that the oral cavity may be involved in Crohn\\'s disease (CD). However, the specific manifestations are poorly appreciated. Although oral aphthous ulceration is probably not diagnostically useful in patients with suspected CD, disease-specific manifestations do occur and are particularly common in children presenting with CD. These manifestations can be subtle, often are subclinical, yet commonly harbor diagnostically useful material (granulomas). Orofacial granulomatosis (OFG) is conventionally used to describe patients with overt oral disease without obvious involvement of the gastrointestinal tract. However, many patients with OFG have subclinical intestinal CD or will progress to develop overt intestinal CD with time. The management of severe oral disease is challenging and lacks a clear evidence base.

  4. Looking in the mouth for Crohn's disease.

    LENUS (Irish Health Repository)

    Rowland, Marion

    2012-02-01

    It is widely acknowledged among gastroenterologists that the oral cavity may be involved in Crohn\\'s disease (CD). However, the specific manifestations are poorly appreciated. Although oral aphthous ulceration is probably not diagnostically useful in patients with suspected CD, disease-specific manifestations do occur and are particularly common in children presenting with CD. These manifestations can be subtle, often are subclinical, yet commonly harbor diagnostically useful material (granulomas). Orofacial granulomatosis (OFG) is conventionally used to describe patients with overt oral disease without obvious involvement of the gastrointestinal tract. However, many patients with OFG have subclinical intestinal CD or will progress to develop overt intestinal CD with time. The management of severe oral disease is challenging and lacks a clear evidence base.

  5. Hyperbaric oxygen therapy for perineal Crohn's disease.

    Science.gov (United States)

    Noyer, C M; Brandt, L J

    1999-02-01

    Perineal lesions are a frequent and troublesome complication of Crohn's disease. Although there are various surgical and medical therapeutic regimens available to treat these lesions, all have significant associated morbidity, mortality, and toxicity. Recently, the beneficial effects of hyperbaric oxygen therapy (HBOT) have been described in patients with severe or refractory perineal disease, but the role of HBOT in larger groups or less severely affected patients has not yet been studied, nor has the minimum number of treatments required for initial or complete healing of perineal disease in this population been described. This article reviews the known and theoretical tissue effects of HBOT and discusses its potential role in treating patients with perineal Crohn's disease.

  6. [Crohn's disease--standards of treatment 2004].

    Science.gov (United States)

    Kruis, W

    2005-10-12

    In Crohn's disease therapeutic concepts are according to distinct conditions. Course of the disease, the individual disease pattern and the aim of treatment are of particular significance. Care of patients with Crohn's disease requires interdisciplinary cooperation between gastroenterologists and surgeons. Primary therapy in mild to moderate disease comprises aminosalicylates and budesonide. Treatment of refractory or severe cases are corticosteroids. Immunosuppressive therapy is indicated in all kinds of complicated disease. First line immunosuppressants are Azathioprine and 6-Mercaptopurine while Methotrexate, Infliximab, Mycophenolatmofetil and other compounds represent alternative or rescue medications. Maintenance of remission should not be done on a regular basis but rather regarding the individual patients' situation. Risks have to be carefully balanced with possible benefits. The most important aim of treatment is quality of life.

  7. Crohn's and colitis in children and adolescents

    Institute of Scientific and Technical Information of China (English)

    Andrew S Day; Oren Ledder; Steven T Leach; Daniel A Lemberg

    2012-01-01

    Crohn's disease and ulcerative colitis can be grouped as the inflammatory bowel diseases (IBD).These conditions have become increasingly common in recent years,including in children and young people.Although much is known about aspects of the pathogenesis of these diseases,the precise aetiology is not yet understood,and there remains no cure.Recent data has illustrated the importance of a number of genes-several of these are important in the onset of IBD in early life,including in infancy.Pain,diarrhoea and weight loss are typical symptoms of paediatric Crohn's disease whereas bloody diarrhoea is more typical of colitis in children.However,atypical symptoms may occur in both conditions:these include isolated impairment of linear growth or presentation with extra-intestinal manifestations such as erythèma nodosum.Growth and nutrition are commonly compromised at diagnosis in both Crohn's disease and colitis.Consideration of possible IBD and completion of appropriate investigations are essential to ensure prompt diagnosis,thereby avoiding the consequences of diagnostic delay.Patterns of disease including location and progression of IBD in childhood differ substantially from adultonset disease.Various treatment options are available for children and adolescents with IBD.Exclusive enteral nutrition plays a central role in the induction of remission of active Crohn's disease.Medical and surgical therapies need to considered within the context of a growing and developing child.The overall management of these chronic conditions in children should include multi-disciplinary expertise,with focus upon maintaining control of gut inflammation,optimising nutrition,growth and quality of life,whilst preventing disease or treatment-related complications.

  8. Genetic variants associated with Crohn's disease

    OpenAIRE

    Michail S; Bultron G; DePaolo RW

    2013-01-01

    Sonia Michail,1 Gilberto Bultron,1 R William DePaolo2 1The University of Southern California, Children's Hospital of Los Angeles, Los Angeles, CA, USA; 2Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA Abstract: Crohn's disease is an immune-related disorder characterized by inflammation of the gastrointestinal mucosa, which can occur in any area throughout the digestive tract. This life-long disease commonly presen...

  9. Medical Therapy of Fibrostenotic Crohn's Disease.

    Science.gov (United States)

    Siegmund, Britta

    2015-08-01

    The present review serves to provide a concise overview of the current knowledge on therapeutic strategies with regard to fibrostenotic lesions in Crohn's disease. A literature search was performed focusing on the last 5 years, and current concepts of pathophysiology, epidemiology, and treatment have been summarized. Fibrostenotic lesions in Crohn's disease are currently considered to be a consequence of the chronic inflammatory nature of the disease. Hence, therapeutic strategies are limited to the concept that early treatment of the inflammatory lesions can prevent structural changes, and to various endoscopic and surgical approaches. Direct targeting of the fibrostenotic lesion itself has not been the focus until now. This review will provide an overview of the pathophysiology and epidemiology of fibrostenotic lesions including current therapeutic approaches. Since research with regard to other organ systems and fibrosis is far more advanced, current strategies from available studies in these areas will be discussed. The results and the potential impact for Crohn's disease will be considered. The vision of these approaches is to reverse structural changes and restore normal function.

  10. [Crohn's disease associated with focal pulmonare lesion].

    Science.gov (United States)

    Tagle, Martín; Barriga, José; Piñeiro, Andrés

    2003-01-01

    40 year-old male recently diagnosed with Crohn's disease. A routine chest X ray showed a round, well defined opacity in right lung field. A chest CT scan confirmed the finding and also described bronchiectasis. Patient had no respiratory symptoms. He was prescribed with oral sulfasalazine and corticosteroids with rapid improvement of intestinal symptoms as well as resolution of the pulmonary opacity. We describe the clinical presentation of a male newly diagnosed with Crohn's disease who was found to have an asymptomatic pulmonary lesion on imaging studies. Pulmonary complications have been previously described in inflamatory bowel disease being more common in ulcerative colitis than in Crohn's disease; these can involve the lung parenchyma, the tracheobronchial tree, and the pleura. The true prevalence and etiology of these lesions is currently unknown and are not necessarily associated with bowel disease activity. Abnormal pulmonary functions test have been reported during inflammatory bowel disease exacerbations, and although pulmonary findings can present with a variety of symptoms, subclinical presentations have also been described. Pulmonary manifestations are usually steoid-responsive, as was the case in our patients.

  11. Hydro-MRI for abdominal diagnostics in children; Hydro-MRT in der Darmdiagnostik bei Kindern

    Energy Technology Data Exchange (ETDEWEB)

    Kern, A.; Schunk, K.; Oberholzer, K.; Thelen, M. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Radiologie; Kessler, M. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Kinderchirurgie

    2001-11-01

    A clinical evaluation of hydro-MRI as an alternative method to barium studies in children with abdominal pain of unknown origin is presented. Patients and Methods: 20 children with abdominal pain of unknown origin aged from 9 - 16 years were examined after oral bowel opacification using 1000 ml of 2.5% mannitol solution with a 1.0T MRI system. The investigation was done in 2 planes (coronal and axial) under breath-hold conditions. Imaging procedures included various sequences (T2W HASTE + FS, contrast-enhanced T1W FLASH FS). Suspicious findings in bowel segments and extra-intestinal changes were assessed. Results: In 21/24 examinations the small bowel was completely visualized, in 15/24 cases colon segments were identified. An accurate assessment of the terminal ileum was not possible in 3/24 procedures. Breathing artefacts occurred in 3/24 examinations. Signs of Crohn's disease were found in 4 examinations, inflammatory changes of the ileum were detected in 3 cases. Inflammation of the colon was demonstrated in 2 children. Furthermore, pathological findings included constipation in one child and inflammation of the ileo-colic and mesenterial lymph nodes were found in another child. Extra-intestinal changes in 3 children were caused by ovarian cysts, and in one case by pleural effusion. In 4 examinations we detected ascites in the absence of other pathological findings. In 5 children there was no pathological correlation in the bowel or extra-intestinal region for the complaints. The children tolerated the hydro-MRI very well. There were no side effects using oral mannitol. (orig.) [German] Ziel: Klinische Evaluation der Hydro-MRT bei Kindern mit unklarer abdomineller Symptomatik als alternative Methode zur fraktionierten Magen-Darm-Passage. Patienten und Methoden: 20 Kinder und Jugendliche im Alter von 9 bis 16 Jahren mit unklaren abdominellen Beschwerden bzw. mit Verdacht auf eine chronisch entzuendliche Darmerkrankung wurden nach einer oralen

  12. Antikoagulation bei Vorhofflimmern: Wie und mit welchem Medikament?

    Directory of Open Access Journals (Sweden)

    Gary T

    2015-01-01

    Full Text Available Direkte orale Antikoagulantien (DOAKs sind Alternativen zu Vitamin-K-Antagonisten (VKA bei Vorhofflimmerarrhythmie- (VHFA- Patienten und werden diese in dieser Indikation zu weiten Teilen ersetzen. Bei VHFA-Patienten mit Dialyse oder mechanischen Herzklappen sind VKA nach wie vor die einzige Option. Bei der Gabe von DOAKs sollte vor Therapieeinleitung auf das Vorhandensein von Begleiterkrankungen (z. B. Niereninsuffizienz, stattgehabte gastrointestinale Blutungen etc. sowie auf die Begleittherapie der Patienten (z. B. Amiodaron etc. geachtet werden, um die passende Substanz in der richtigen Dosierung zu wählen.

  13. Wirksamkeit von Aromatherapie bei postoperativer Nausea und Vomiting bei Erwachsenen: Systematische Literaturreview

    OpenAIRE

    Schnyder, Samira; Z‘Brun Schnyder, Silvia

    2015-01-01

    Problembeschreibung: Postoperative Nausea und Vomiting (PONV) stellt neben Schmerz eine der häufigsten postoperativen Komplikationen dar. Die Inzidenz beträgt bei gynäkologischen Patientinnen 80%. Symptome und Folgen von PONV können physische, psychische, emotionale und finanzielle Auswirkungen für die Patienten und das Personal haben. Postoperative Nausea und Vomiting wird meistens medikamentös mit Antiemetika behandelt. Diese Medikamente können jedoch viele Nebenwirkungen aufweisen. D...

  14. Infliximab in Crohn's disease-associated toxic megacolon

    NARCIS (Netherlands)

    Geenen, E.J.M. van; Sachar, D.B.

    2012-01-01

    Refractory medical treatment of Crohn disease-associated toxic megacolon usually requires surgery, which carries substantial morbidity and mortality. We report a case of a woman with steroid and antibiotic-refractory fulminant Crohn colitis and ileitis, complicated by a toxic megacolon, who was

  15. Outcomes of Bowel Resection in Patients with Crohn's Disease.

    Science.gov (United States)

    Moghadamyeghaneh, Zhobin; Carmichael, Joseph C; Mills, Steven D; Pigazzi, Alessio; Stamos, Michael J

    2015-10-01

    There is limited data regarding outcomes of bowel resection in patients with Crohn's disease. We sought to investigate complications of such patients after bowel resection. The Nationwide Inpatient Sample databases were used to examine the clinical data of Crohn's patients who underwent bowel resection during 2002 to 2012. Multivariate regression analysis was performed to investigate outcomes of such patients. We sampled a total of 443,950 patients admitted with the diagnosis of Crohn's disease. Of these, 20.5 per cent had bowel resection. Among patients who had bowel resection, 51 per cent had small bowel Crohn's disease, 19.4 per cent had large bowel Crohn's disease, and 29.6 per cent had both large and small bowel Crohn's disease. Patients with large bowel disease had higher mortality risk compared with small bowel disease [1.8% vs 1%, adjusted odds ratio (AOR): 2.42, P Crohn's disease (AOR: 1.90, P Crohn's disease, 20.5 per cent underwent bowel resection during 2002 to 2012. Although colonic disease has a higher mortality risk, small bowel disease has a higher risk of postoperative fistula.

  16. CARD15 gene and the classification of Crohn's disease

    NARCIS (Netherlands)

    Murillo, L; Crusius, JBA; van Bodegraven, AA; Alizadeh, BZ; Pena, AS

    2002-01-01

    An insertion mutation at nucleotide 3020 (3020insC) in the CARD15 gene, originally reported as NOD2, has been strongly associated with Crohn's disease. The CARD15 G2722C missense mutation was also shown to be associated with this disease. We studied 130 Dutch Crohn's disease patients, with a median

  17. Pathogenesis: common pathways between hidradenitis suppurativa and Crohn disease.

    Science.gov (United States)

    García Martínez, F J; Menchén, L

    2016-09-01

    Both hidradenitis suppurativa and Crohn disease are considered chronic inflammatory diseases due to immune dysregulation. The high prevalence of Crohn disease patients diagnosed with hidradenitis suppurativa suggests the existence of common pathogenic links. The present literature review analyses the similarities and differences in the pathogenesis of the two diseases, in the search for new research and knowledge targets.

  18. Samtidig debut af kollagen colitis og mb. Crohn

    DEFF Research Database (Denmark)

    Nøjgaard, Camilla; Nielsen, Preben Løvgreen; Rumessen, Jüri J

    2002-01-01

    A case report of a 69-year-old man with synchronous onset and diagnosis of collagenous colitis and Crohn's disease is discussed.......A case report of a 69-year-old man with synchronous onset and diagnosis of collagenous colitis and Crohn's disease is discussed....

  19. Infliximab in Crohn's disease-associated toxic megacolon

    NARCIS (Netherlands)

    Geenen, E.J.M. van; Sachar, D.B.

    2012-01-01

    Refractory medical treatment of Crohn disease-associated toxic megacolon usually requires surgery, which carries substantial morbidity and mortality. We report a case of a woman with steroid and antibiotic-refractory fulminant Crohn colitis and ileitis, complicated by a toxic megacolon, who was succ

  20. Samtidig debut af kollagen colitis og mb. Crohn

    DEFF Research Database (Denmark)

    Nøjgaard, Camilla; Nielsen, Preben Løvgreen; Rumessen, Jüri J

    2002-01-01

    A case report of a 69-year-old man with synchronous onset and diagnosis of collagenous colitis and Crohn's disease is discussed.......A case report of a 69-year-old man with synchronous onset and diagnosis of collagenous colitis and Crohn's disease is discussed....

  1. Granulomatous Vaginal Ulceration due to Metastatic Cutaneous Crohn's Disease

    Directory of Open Access Journals (Sweden)

    Hugh J Freeman

    1995-01-01

    Full Text Available A 28-year-old woman with a prior history of Crohn's disease was evaluated for painful vaginal ulceration in 1984. Subsequent studies revealed isolated involvement of the vagina with a granulomatous inflammatory process characteristic of metastatic cutaneous Crohn's disease. Conservative symptomatic treatment was associated with resolution and no subsequent recurrence of genital tract disease.

  2. Distinct management issues with Crohn's disease of the small intestine.

    Science.gov (United States)

    Fong, Steven C M; Irving, Peter M

    2015-03-01

    Small bowel Crohn's disease can present with clinical challenges that are specific to its location. In this review, we address some of the areas that present particular problems in small bowel Crohn's disease. A key issue specific to small bowel Crohn's disease relates to its diagnosis given that access to the small bowel is limited. Radiological advances, particularly in small bowel ultrasonography and MRI, as well as the introduction of capsule endoscopy and balloon enteroscopy are helping to address this. In addition, our ability to differentiate small bowel Crohn's disease from other causes of inflammation, such as tuberculosis, is improving on the basis of better understanding of the features that differentiate these conditions. It is also becoming apparent that jejunal Crohn's disease represents a distinct disease phenotype with potentially worse clinical outcomes. Finally, because it is a rare complication, our understanding of small bowel cancer associated with Crohn's disease remains limited. Recent publications are, however, starting to improve our knowledge of this condition. Although small bowel Crohn's disease presents specific management issues not seen in patients with Crohn's disease elsewhere in the gastrointestinal tract, our knowledge of how to manage these is improving.

  3. Perianal fistulas in Crohn's disease: MRI diagnosis and surgical planning: MRI in fistulazing perianal Crohn's disease.

    Science.gov (United States)

    Szurowska, Edyta; Wypych, Joanna; Izycka-Swieszewska, Ewa

    2007-11-01

    Crohn's disease is a chronic, transmural inflammatory process of the gastrointestinal tract. It often affects the colon with the perianal area. The most common intestinal manifestations include external and/or internal fistulas and abscesses. Assessment of the activity of perianal fistulas in the course of Crohn's disease seems to be an important factor influencing therapeutic approach. Fistula's activity is evaluated by such methods as magnetic resonance imaging, anal ultrasound and examination under anaesthesia. Usefulness of imaging methods in the diagnosis of fistulas still remains to be defined.MRI is used to present a wide spectrum of perianal fistulazing Crohn's disease. Additionally, it is an important instrument revealing location, extent and severity of inflammation. It is also very helpful to detect clinically silent sepsis related to small, local inflammation. The most common method used in MR imaging to assess topography of a fistula's track, is Parks' classification.Clinical indications to MRI may include follow-up studies of a diagnosed disease, classification of fistulas' subtypes in the course of Crohn's disease, determination of the extent of fistulas' tracts and spread of an inflammatory process what can guide surgical procedures.

  4. Diffusion-weighted magnetic resonance imaging in ileocolonic Crohn's disease

    DEFF Research Database (Denmark)

    Juel, Mie A; Rafaelsen, Søren Rafael; Nathan, Torben

    coefficients (ADC). Previous studies have shown that dw-MRI combined with conventional MR sequences can be useful for detection of Crohn's disease in the terminal ileum and colon. The present feasibility study examined the diagnostic performance of free-breathing dw-MRI without fasting, bowel preparation...... or contrast administration in ileocolonic Crohn's disease. Methods: A total of 10 patients with known Crohn's disease were included in this prospective and blinded study. dw-MRI was performed with a Philips Achieva 1.5T MR system and body coil (Philips Medical Systems, Eindhoven, The Netherlands). The MR...... Endoscopic Score for Crohn's disease (SES-CD) served as gold standard. Active Crohn's disease was defined as a segmental score ≥ 1. Results: A total of 46 bowel segments were assessed with ileocolonoscopy and dw-MRI of which 22 (48%) were inflamed according to the gold standard (median SES-CD segmental score...

  5. Mycobacterium paratuberculosis as a cause of Crohn's disease.

    Science.gov (United States)

    McNees, Adrienne L; Markesich, Diane; Zayyani, Najah R; Graham, David Y

    2015-01-01

    Crohn's disease is a chronic inflammatory bowel disease of unknown cause, affecting approximately 1.4 million North American people. Due to the similarities between Crohn's disease and Johne's disease, a chronic enteritis in ruminant animals caused by Mycobacterium avium paratuberculosis (MAP) infection, MAP has long been considered to be a potential cause of Crohn's disease. MAP is an obligate intracellular pathogen that cannot replicate outside of animal hosts. MAP is widespread in dairy cattle and because of environmental contamination and resistance to pasteurization and chlorination, humans are frequently exposed through contamination of food and water. MAP can be cultured from the peripheral mononuclear cells from 50-100% of patients with Crohn's disease, and less frequently from healthy individuals. Association does not prove causation. We discuss the current data regarding MAP as a potential cause of Crohn's disease and outline what data will be required to firmly prove or disprove the hypothesis.

  6. Active Crohn's disease is associated with low vitamin D levels

    DEFF Research Database (Denmark)

    Jørgensen, Søren Peter; Hvas, Christian Lodberg; Agnholt, Jørgen

    2013-01-01

    BACKGROUND AND AIMS: Crohn's disease prevalence increases with increasing latitude. Because most vitamin D comes from sunlight exposure and murine models of intestinal inflammation have demonstrated beneficial effects of 1,25-(OH)(2) vitamin D treatment, we hypothesised that Crohn's disease...... activity is associated with low vitamin D levels. METHODS: In a cross-sectional study of 182 CD patients and 62 healthy controls, we measured serum 25-OH vitamin D. Stratified analysis was used to compare 25-OH vitamin D levels with Crohn's disease activity index, C-reactive protein, smoking status, intake...... of oral vitamin D supplements and seasonal variation in CD patients and healthy controls. RESULTS: Serum 25-OH vitamin D was inversely associated with disease activity: Median 25-OH vitamin D levels of Crohn's disease in remission, mildly, and moderately active diseases evaluated by Crohn's disease...

  7. Role of MRI in Crohn's disease

    Energy Technology Data Exchange (ETDEWEB)

    Sinha, R. [Department of Radiology, GI Unit, South Warwickshire NHS Trust, and IBD Network, Coventry and South Warwickshire (United Kingdom)], E-mail: rakesh.sinha@swh.nhs.uk; Murphy, P. [Department of Surgery, GI Unit, South Warwickshire NHS Trust, and IBD Network, Coventry and South Warwickshire (United Kingdom); Hawker, P. [Department of Gastroenterology, GI Unit, South Warwickshire NHS Trust, and IBD Network, Coventry and South Warwickshire (United Kingdom); Sanders, S. [Department of Pathology, GI Unit, South Warwickshire NHS Trust and IBD Network, Coventry and South Warwickshire (United Kingdom); Rajesh, A.; Verma, R. [Department of Radiology, University Hospitals of Leicester, Leicester (United Kingdom)

    2009-04-15

    The traditional imaging of Crohn's disease has relied on barium and computed tomography (CT) examinations. In recent years magnetic resonance imaging (MRI) has emerged as an imaging method that can be used in the diagnosis and assessment of Crohn's disease. The advantages of MRI include lack of ionizing radiation and its superior tissue contrast resolution. The clinical progression of Crohn's disease can be variable, and MRI can be used to assess inflammatory status, disease progression, and complications of Crohn's disease. MRI of the small bowel is an evolving technique and it has the potential to become the preferred technique for imaging of small bowel Crohn's disease in the future.

  8. Orofacial granulomatosis in children: think about Crohn's disease.

    Science.gov (United States)

    Lazzerini, Marzia; Martelossi, Stefano; Cont, Gabriele; Bersanini, Chiara; Ventura, Giovanna; Fontana, Massimo; Zuin, Giovanna; Ventura, Alessandro; Taddio, Andrea

    2015-04-01

    The term orofacial granulomatosis is conventionally used to describe patients with granulomatous lesions affecting the orofacial tissues, in absence of intestinal lesions. Lip swelling and facial swelling are the most common clinical signs. Despite the fact that histologically it is not distinguishable from Crohn's disease, and that both diseases have a chronic/recurrent course, the relationship between orofacial granulomatosis and Crohn's disease is still debated. Herein we present five cases of orofacial granulomatosis. All patients presented concomitant Crohn's disease, supporting the hypothesis that orofacial granulomatosis and Crohn's disease may be one single disease. Thalidomide was effective in inducing remission of oral and intestinal symptoms in all five cases and could be considered a valid treatment opportunity for these patients. Orofacial granulomatosis and Crohn's disease may be part of the same disease; both may respond to thalidomide. Copyright © 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  9. SPECT in epilepsies; SPECT bei Epilepsien

    Energy Technology Data Exchange (ETDEWEB)

    Stefan, H. [Neurologische Klinik, Univ. Erlangen-Nuernberg, Zentrum Epilepsie Erlangen (Germany)

    1997-06-01

    Registration of regional cerebral blood flow provides important new data for the investigation of pathophysiological processes in epilepsies. Further to the registration of perfusions, receptor studies are employed for the differentiation of localisation in focal epilepsies. For ultimative issues interictal registrations are supplemented by ictal recordings during the epileptic seizure. The combination of SPECT and electrophysiological registration can contribute to analysis of propagation of focal epileptic activity. (orig.) [Deutsch] Die Messung der regionalen Hirndurchblutung liefert wichtige neue Erkenntnis zur Untersuchung pathophysiologischer Ablaeufe bei Epilepsien. Ergaenzend zur Registrierung der Perfusion koennen Rezeptor-Studien zur Differenzierung der Lokalisation fokaler Epilepsien beitragen. Interiktale Registrierungen werden fuer letztere Fragestellung durch iktuale Messungen waehrend des epileptischen Anfalls ergaenzt. Die Kombination von SPECT und elektrophysiologischen Registrierungen kann zur Analyse der Propagation fokaler epileptischer Aktivitaet beitragen. (orig.)

  10. Neue orale immunmodulierende Therapien bei Multipler Sklerose

    Directory of Open Access Journals (Sweden)

    Berger T

    2014-01-01

    Full Text Available Seit 20 Jahren sind nun krankheitsmodifizierende Therapien zur Behandlung von Patienten mit insbesondere schubförmiger Multipler Sklerose (MS verfügbar. Ungeachtet der therapeutischen Errungenschaften der aktuellen Basis- und Eskalationstherapien bestehen Limitationen hinsichtlich Nutzen einerseits und Risiken andererseits. Die Konsequenz daraus, gemeinsam mit neuen Konzepten zur Immunopathogenese von MS, ist die Weiterentwicklung neuer und innovativer MS-Therapien. Die vorliegende Übersicht beschreibt im Detail 3 neue orale Immunmodulatoren zur Behandlung der schubförmigen MS. Darüber hinaus werden die Ergebnisse und die erfolgte/anstehende/eingereichte EU-Marktzulassung dieser 3 Therapien in den Kontext der Erwartungshaltungen an neue immunmodulierende Therapien bei MS gesetzt.

  11. Pathomechanismen der Atherosklerose bei Diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Mulac K

    2005-01-01

    Full Text Available Die epidemiologischen Daten weisen darauf hin, daß die Prävalenz des Diabetes mellitus in den nächsten Jahrzehnten ansteigen wird, und damit im Zusammenhang auch die vaskulären Komplikationen zunehmen werden. Die akzelerierte Atherosklerose bei Diabetikern ist durch die über weite Strecken des Tages vorliegende Hyperglykämie, die Dyslipidämie, das Auftreten von erhöhten Werten von asymmetrischem Dimethylarginin und "advanced glycation end products" mitbestimmt. All diese Mechanismen induzieren die Bildung und Freisetzung von Zytokinen, Chemokinen, Adhäsionsmolekülen, freien Sauerstoffradikalen und aktivierten Gerinnungsfaktoren, die über die zu Beginn vorliegende endotheliale Dysfunktion in eine akzelerierte und progrediente Atherosklerose mit allen vaskulären Problemen münden.

  12. Disease outcome for children who present with oral manifestations of Crohn's disease.

    LENUS (Irish Health Repository)

    Hussey, S

    2011-06-01

    To describe the outcome for children with oral Crohn\\'s disease (OCD) at diagnosis, and to determine if there was a difference in the Paediatric Crohn\\'s Disease Activity Index (PCDAI) scores between those with and those without oral lesions at follow-up.

  13. Imaging of hip arthroplasty; Bildgebung bei Hueftprothesen

    Energy Technology Data Exchange (ETDEWEB)

    Breitenseher, M.J. [Abteilung fuer Osteologie, Universitaetsklinik fuer Radiodiagnostik, Wien (Austria); Klinische Abteilung fuer Radiodiagnostik chirurgischer Faecher, Universitaetsklinik fuer Radiodiagnostik, Wien (Austria); Ludwig-Boltzmann-Institut fuer Radiologische Tumordiagnostik, Wien (Austria); Mayerhoefer, M. [Klinische Abteilung fuer Radiodiagnostik chirurgischer Faecher, Universitaetsklinik fuer Radiodiagnostik, Wien (Austria); Gottsauner-Wolf, F. [Universitaetsklinik fuer Orthopaedie, Wien (Austria); Abteilung fuer Orthopaedie, Allgemeines oeffentliches KH, Krems (Austria); Krestan, C.; Imhof, H. [Abteilung fuer Osteologie, Universitaetsklinik fuer Radiodiagnostik, Wien (Austria); Toma, C.D. [Universitaetsklinik fuer Orthopaedie, Wien (Austria)

    2002-06-01

    Hip arthroplasty has become a common and still increasing procedure for the treatment of osteoarthritis, advanced head necrosis, post-inflammatory arthritis or rheumatoid arthritis.Radiography is the most important imaging modality for monitoring the normal, asymptomatic hip arthroplasty. Radiographs are obtained at the end of a surgical treatment, to exclude complications like fracture or component misplacement. In the follow-up radiographs are used for the diagnosis of loosening and infection of the hip arthroplasty as well as soft tissue ossification. Together with the history and clinical information, the analysis of morphological findings allows to find the grade of loosening. MRI has been advocated in the diagnosis of infection, in particular in the localisation of soft tissue involvement.Imaging, especially by radiographs, is used for the evaluation of the normal and complicated follow-up of hip arthroplasty. (orig.) [German] Die Implantation einer Hueftgelenkprothese ist eine immer haeufiger verwendete medizinische Massnahme bei Erkrankungen des Hueftgelenks wie Koxarthrose, Hueftkopfnekrose, postentzuendliche Arthrose oder rheumatoide Arthritis.Von den bildgebenden Methoden ist das konventionelle Roentgen die wichtigste Untersuchung, um den normalen Behandlungsverlauf einer Hueftprothese zu monitieren. Das Roentgen kann fruehzeitige Komplikationen wie Fraktur oder Fehlposition intraoperativ oder eine Luxation postoperativ erfassen. Im laengerfristigen Verlauf ist das Roentgen zur Diagnose von Infektion, Prothesenlockerung und Weichteilverknoecherung geeignet. In Zusammenschau mit der Klinik ermoeglicht die Analyse morphologisch-radiologischer Details, die Wahrscheinlichkeit einer Lockerung abzuschaetzen. Bei Protheseninfektionen ermoeglicht die MRT die Lokalisation von Weichteilentzuendungen.Die Methoden der Bildgebung, besonders das Roentgen, haben in der Beurteilung des normalen und in der Diagnose des komplizierten Verlaufes einen hohen Stellenwert

  14. Das Verhalten von Mastputen bei unterschiedlicher Besatzdichte und Einstreuart

    OpenAIRE

    Günthner, Pia

    2013-01-01

    Die Europäische Union bereitet eine Haltungsverordnung für Puten vor, die in Deutschland die freiwillige Vereinbarung ersetzen soll. Die vorliegende Untersuchung soll wissenschaftliche Grundlagen zum Verhalten der Puten bei unterschiedlichen Besatzdichten liefern, um somit die bevorstehende Revision der Vereinbarung zu unterstützen. In der vorliegenden Arbeit wurden in 2 Mast-Durchgängen (Winter und Sommer) das Verhalten von Puten der Linie B.U.T. Big 6 bei unterschiedlichen Besatzdichten und...

  15. Physostigmin und postoperatives Delir bei Vorschulkindern: eine randomisierte Doppelblindstudie

    OpenAIRE

    Häusler, Julia Maria

    2013-01-01

    Einleitung Ein Teil der Vorschulkinder erwacht nach Narkosen verzögert, schwer agitiert und desorientiert. Bei ähnlichen Zuständen Erwachsener wird Physostigmin unter der Annahme, dass es sich bei diesem postoperativen Delir meist um ein „zentrales anticholinerges Syndrom“ handelt, erfolgreich eingesetzt. Die vorgestellte Studie soll diesen Ansatz auch für Kleinkinder überprüfen. Materialien und Methoden Insgesamt wurden 211 Kinder nach standardisierter Narkose in drei Prüfzentren re...

  16. Osteoporose bei Spondylitis ankylosans - Einfluß von Lebensgewohnheiten

    Directory of Open Access Journals (Sweden)

    Aglas F

    2004-01-01

    Full Text Available Krankheitsbedingte Artefakte können bei der SpA (Spondylitis ankylosans; Mb. Bechterew die Sensitivität einer Knochendichtemessung im Lumbalbereich beeinträchtigen. Das bei dieser rheumatischen Erkrankung bekannte Osteoporoserisiko ist neben genetischen Faktoren und Entzündungsmechanismen auch von verschiedenen exogenen Einflüssen abhängig. An 47 SpA-Patienten wurde mittels DEXA eine vergleichende Knochendichtemessung (BMD an der Hüfte (Schenkelhals und Ward'sches Dreieck sowie im Bereich der Wirbelsäule (L1-L4 vorgenommen. Zusätzlich erfolgte eine Erhebung der Lebens-Ernährungsgewohnheiten der SpA-Patienten in bezug auf die BMD, um exogene Einflüsse erfassen zu können. Die Knochendichtemessungen ergaben an der LWS wesentlich häufiger eine BMD im Normbereich als am proximalen Femur. Besonders deutliche Unterschiede traten im höheren Lebensalter auf, bei dem aufgrund von Kalzifizierungsvorgängen und Syndesmophyten an der LWS fälschlicherweise eine Dichtezunahme vorgetäuscht wird. Es kann daher bei SpA empfohlen werden, die wesentlich sensitivere Dichtemessung am Schenkelhals durchzuführen. Die über einen Zeitraum von 3 Jahren beobachteten, signifikant erhöhten, medianen CRP-Spiegel zeigen, daß eine permanente Aktivierung von Entzündungsprozessen bei SpA auch einen negativen Faktor betreffend des Knochenmasseverlustes darstellt. Die Analyse der Lebensgewohnheiten ergab, daß SpA-Patienten mit normaler BMD ausnahmslos regelmäßig kalziumreiche Nahrungsmittel zu sich nehmen; bei verminderter BMD wurde in der Mehrheit ein fehlender Konsum an Milchprodukten beobachtet. Leider war auch mit abnehmender BMD eine Verminderung der bei SpA empfohlenen Bewegungsübungen festzustellen. Aufgrund der Resultate ergibt sich eine generelle Empfehlung zu regelmäßigen Bewegungsübungen plus Osteoporosediät bei allen Bechterew-Patienten.

  17. Overcoming the Challenges of BeiDou Receiver Implementation

    Directory of Open Access Journals (Sweden)

    Mohammad Zahidul H. Bhuiyan

    2014-11-01

    Full Text Available Global Navigation Satellite System (GNSS-based positioning is experiencing rapid changes. The existing GPS and the GLONASS systems are being modernized to better serve the current challenging applications under harsh signal conditions. These modernizations include increasing the number of transmission frequencies and changes to the signal components. In addition, the Chinese BeiDou Navigation Satellite system (BDS and the European Galileo are currently under development for global operation. Therefore, in view of these new upcoming systems the research and development of GNSS receivers has been experiencing a new upsurge. In this article, the authors discuss the main functionalities of a GNSS receiver in view of BDS. While describing the main functionalities of a software-defined BeiDou receiver, the authors also highlight the similarities and differences between the signal characteristics of the BeiDou B1 open service signal and the legacy GPS L1 C/A signal, as in general they both exhibit similar characteristics. In addition, the authors implement a novel acquisition technique for long coherent integration in the presence of NH code modulation in BeiDou D1 signal. Furthermore, a simple phase-preserved coherent integration based acquisition scheme is implemented for BeiDou GEO satellite acquisition. Apart from the above BeiDou-specific implementations, a novel Carrier-to-Noise-density ratio estimation technique is also implemented in the software receiver, which does not necessarily require bit synchronization prior to estimation. Finally, the authors present a BeiDou-only position fix with the implemented software-defined BeiDou receiver considering all three satellite constellations from BDS. In addition, a true multi-GNSS position fix with GPS and BDS systems is also presented while comparing their performances for a static stand-alone code phase-based positioning.

  18. Overcoming the challenges of BeiDou receiver implementation.

    Science.gov (United States)

    Bhuiyan, Mohammad Zahidul H; Söderholm, Stefan; Thombre, Sarang; Ruotsalainen, Laura; Kuusniemi, Heidi

    2014-11-21

    Global Navigation Satellite System (GNSS)-based positioning is experiencing rapid changes. The existing GPS and the GLONASS systems are being modernized to better serve the current challenging applications under harsh signal conditions. These modernizations include increasing the number of transmission frequencies and changes to the signal components. In addition, the Chinese BeiDou Navigation Satellite system (BDS) and the European Galileo are currently under development for global operation. Therefore, in view of these new upcoming systems the research and development of GNSS receivers has been experiencing a new upsurge. In this article, the authors discuss the main functionalities of a GNSS receiver in view of BDS. While describing the main functionalities of a software-defined BeiDou receiver, the authors also highlight the similarities and differences between the signal characteristics of the BeiDou B1 open service signal and the legacy GPS L1 C/A signal, as in general they both exhibit similar characteristics. In addition, the authors implement a novel acquisition technique for long coherent integration in the presence of NH code modulation in BeiDou D1 signal. Furthermore, a simple phase-preserved coherent integration based acquisition scheme is implemented for BeiDou GEO satellite acquisition. Apart from the above BeiDou-specific implementations, a novel Carrier-to-Noise-density ratio estimation technique is also implemented in the software receiver, which does not necessarily require bit synchronization prior to estimation. Finally, the authors present a BeiDou-only position fix with the implemented software-defined BeiDou receiver considering all three satellite constellations from BDS. In addition, a true multi-GNSS position fix with GPS and BDS systems is also presented while comparing their performances for a static stand-alone code phase-based positioning.

  19. Radiotherapy in early stage Dupuytren`s contracture; Radiotherapie im fruehen Stadium des Morbus Dupuytren. Indikation, Technik und Langzeitergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Keilholz, L. [Univ. Erlangen-Nuernberg, Erlangen (Germany). Strahlentherapeutische Klinik und Poliklinik; Seegenschmiedt, M.H. [Univ. Erlangen-Nuernberg, Erlangen (Germany). Strahlentherapeutische Klinik und Poliklinik]|[Alfried-Krupp-Krankenhaus, Essen (Germany). Klinik fuer Radiologie, Strahlentherapie und Nuklearmedizin; Born, A.D. [Univ. Erlangen-Nuernberg, Erlangen (Germany). Strahlentherapeutische Klinik und Poliklinik; Sauer, R. [Univ. Erlangen-Nuernberg, Erlangen (Germany). Strahlentherapeutische Klinik und Poliklinik

    1997-01-01

    Radiotherapie; das langfristige Ergebnis wurde zwischen Februar und April 1994 ermittelt. Die Nachbeobachtungszeit betrug damit 6{+-}2 (1 bis 12) Jahre. 57 Patienten mit einem minimalen Follow-up von fuenf (Median 7,5; 5 bis 12) Jahren wurden in bezug auf langfristige Resultate (Stabilisierung, Progression) gesondert ausgewertet. Die akute und chronische Toxizitaet der Radiotherapie wurde gemaess der RTOG/EORTC-Kriterien bestimmt. Ergebnisse: Bezogen auf das Stadium, waren 130 (92%) Haende drei Monate nach Radiotherapie stabil, zehn (7%) verbesserten und zwei Haende (1%) verschlechterten sich. Eine objektivierbare Reduktion von Knoten und Straengen wurde bei 107 (75%) Faellen erzielt. Zusaetzlich bemerkten 84 (87%) Patienten einen Rueckgang der Symptomatik. Zum aktuellen Follow-up waren 16 von 142 (11%) Faellen progredient im Stadium. In der Gruppe mit einem Follow-up von {>=}5 Jahren (n=57) waren 44 (77%) Faelle stabil und 13 (23%) progredient, achtmal innerhalb und fuenfmal ausserhalb des Radiotherapie-Feldes. Einige `Versager` haetten vermieden werden koennen, wenn ein groesserer Sicherheitssaum bei der Radiotherapie beruecksichtigt worden waere; einige Versager wurden jedoch noch ein weiteres Mal erfolgreich bestrahlt oder operiert. (orig./AJ)

  20. Crohn's Disease of the Ileoanal Pouch.

    Science.gov (United States)

    Lightner, Amy L; Pemberton, John H; Loftus, Edward J

    2016-06-01

    Crohn's disease (CD) of the pouch is an increasingly recognized diagnosis after ileal pouch-anal anastomosis. This post-ileal pouch-anal anastomosis diagnosis in conjunction with pouchitis remains the leading reason for pouch excision. Unfortunately, CD of the pouch remains a difficult diagnosis with lack of a uniform definition largely because of its similarity to common postoperative pouch complications, including pouchitis, abscess formation, or stricture at the anastomosis. Once diagnosed, treatment algorithms largely include multimodal therapy including biologics. This review focuses on the definition, etiology, diagnosis, and treatment for CD of the pouch, a postoperative de novo diagnosis of CD.

  1. Nutritional therapy for active Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Nutritional therapy for active Crohn's disease (CD) is an underutilised form of treatment in adult patients, though its use is common in the paediatric population. There is evidence that nutritional therapy can effectively induce remission of CD in adult patients. Enteral nutrition therapy is safe and generally well tolerated, leta-analysis data suggest that corticosteroids are superior to nutritional treatment for induction of remission in active CD. However, the potential side effects of such pharmacotherapy must be taken into consideration. This review examines the evidence for the efficacy of elemental and polymeric diets, and the use of total parenteral nutrition in active CD.

  2. Vitamin A deficiency in Crohn's disease.

    OpenAIRE

    Main, A N; Mills, P. R.; Russell, R I; Bronte-Stewart, J; Nelson, L. M.; McLelland, A; Shenkin, A

    1983-01-01

    Fifty two patients with Crohn's disease (31 outpatients and 21 inpatients) were investigated for evidence of vitamin A deficiency. Eleven (21%) had low plasma retinol concentrations (less than 1.2 mumol/l (34.3 micrograms %)). Five of these were outpatients and plasma retinol was only slightly reduced (greater than 1.0 mumol/l (28.6%)). All outpatients weighed 80% or more of ideal, and were considered at low risk of developing vitamin A deficiency. In contrast, of the six inpatients with low ...

  3. Radiation exposure of persons exposed occupationally or in the vicinity of patients treated with unsealed radionuclides as for example with radioiodine; Strahlenexposition von beruflich exponierten Personen und Personen aus der Umgebung des Patienten bei der Therapie mit offenen radioaktiven Stoffen am Beispiel der Radioiodtherapie

    Energy Technology Data Exchange (ETDEWEB)

    Reiners, C.; Lassmann, M.; Haenscheid, H. [Wuerzburg Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin

    2000-07-01

    In Germany, more than 30,000 patients per year are treated with radioiodine for thyroid diseases. The activity used in a treatment ward with 14 beds ranges typically between 1-2 TBq {sup 131}I annually. The mean applied activity in a patient with benign thyroid diseases is 550 MBq and in patients with thyroid cancer 4.3 GBq {sup 131}I. In patients with benign thyroid diseases the mean hospitalisation time ranges between three days (Graves' disease) and five days (toxic goitre), in patients with thyroid cancer it is approximately three days. Regular thyroid monitoring of the therapy ward staff with a semiconductor detector in a shielded whole body counter showed {sup 131}I activities of up to 300 Bq (mean 50 Bq). Assuming a constant {sup 131}I content of 50 Bq over 365 days results in a thyroid dose of 2 mSv and an effective dose of 0.1 mSv. The external exposure controlled by film badges showed a maximum dose per year of 3 mSv and a mean dose of 0.55 mSv. To reduce the exposure of persons close to the patient after dismissal from radioiodine therapy, special guidelines should be followed for approximately one week. Under this condition exposures exceeding the limit of 1 mSv for the general population according to the New German Radiation Protection Ordinance can be avoided. (orig.) [German] Jaehrlich werden in der Bundesrepublik mehr als 30.000 Radioiodbehandlungen von Schilddruesenerkrankungen durchgefuehrt. Der Radioiod-Verbrauch auf einer Therapiestation mit 14 Betten betraegt jaehrlich typischerweise 1-2 TBq {sup 131}I. Die durchschnittlich verabreichte Aktivitaet bei Patienten mit gutartigen Schilddruesenerkrankungen liegt bei 550 MBq, bei Patienten mit Schilddruesenkarzinomen bei 4,3 GBq {sup 131}I. Die mittlere Dauer des stationaeren Aufenthalts bewegt sich bei Patienten mit gutartigen Schilddruesenerkrankungen zwischen drei Tagen (Morbus Basedow) und fuenf Tagen (funktionelle Autonomie), bei Patienten mit Schilddruesenkarzinomen liegt sie bei ca. drei

  4. Surgical treatment of complex small bowel Crohn disease.

    Science.gov (United States)

    Michelassi, Fabrizio; Sultan, Samuel

    2014-08-01

    The clinical presentations of Crohn disease of the small bowel vary from low to high complexity. Understanding the complexity of Crohn disease of the small bowel is important for the surgeon and the gastroenterologist caring for the patient and may be relevant for clinical research as a way to compare outcomes. Here, we present a categorization of complex small bowel Crohn disease and review its surgical treatment as a potential initial step toward the establishment of a definition of complex disease. The complexity of small bowel Crohn disease can be sorted into several categories: technical challenges, namely, fistulae, abscesses, bowel or ureteral obstruction, hemorrhage, cancer and thickened mesentery; extensive disease; the presence of short gut; a history of prolonged use of medications, particularly steroids, immunomodulators, and biological agents; and a high risk of recurrence. Although the principles of modern surgical treatment of Crohn disease have evolved to bowel conservation such as strictureplasty techniques and limited resection margins, such practices by themselves are often not sufficient for the management of complex small bowel Crohn disease. This manuscript reviews each category of complex small bowel Crohn disease, with special emphasis on appropriate surgical strategy.

  5. Concepts of oxidative stress and antioxidant defense in Crohn's disease.

    Science.gov (United States)

    Alzoghaibi, Mohammed A

    2013-10-21

    Oxygen free radical and lipid peroxides (oxidative stress) are highly reactive and represent very damaging compounds. Oxidative stress could be a major contributing factor to the tissue injury and fibrosis that characterize Crohn's disease. An imbalance between increased reactive oxygen species levels and decreased antioxidant defenses occurs in Crohn's patients. Decreased blood levels of vitamins C and E and decreased intestinal mucosal levels of CuZn superoxide dismutase, glutathione, vitamin A, C, E, and β-carotene have been reported for Crohn's patients. Increased levels of proinflammatory cytokines, such as interleukin-1 and -8 and tumor necrosis factor, have been detected in inflammatory bowel disease. Oxidative stress significantly increased the production of neutrophils, chemokines, and interleukin-8. These effects were inhibited by antioxidant vitamins and arachidonic acid metabolite inhibitors in human intestinal smooth muscle cells isolated from the bowels of Crohn's disease patients. The main pathological feature of Crohn's disease is an infiltration of polymorphonuclear neutrophils and mononuclear cells into the affected part of the intestine. Activated neutrophils produce noxious substances that cause inflammation and tissue injury. Due to the physiological and biochemical actions of reactive oxygen species and lipid peroxides, many of the clinical and pathophysiological features of Crohn's disease might be explained by an imbalance of increased reactive oxygen species and a net decrease of antioxidant molecules. This review describes the general concepts of free radical, lipid peroxide and antioxidant activities and eventually illustrates their interferences in the development of Crohn's strictures.

  6. Über die Bedeutung von Magnesium bei der Tumorgenese

    Directory of Open Access Journals (Sweden)

    Golf SW

    2001-01-01

    Full Text Available Magnesium (Mg und die Tumorgenese sind in funktioneller wie in struktureller Hinsicht vielseitig miteinander verknüpft. Die Tumorzelle ist befähigt, Mg zu Lasten der Mg-Pools des Organismus in überhöhter Konzentration zu speichern, auch wenn für den Organismus eine negative Mg-Bilanz vorliegt. Durch diese Veränderung der Mg-Verteilung wird die Zelle in die Lage versetzt, den erhöhten Enegiebedarf bei Zellwachstum, z.B. durch eine induzierte Proteinbiosynthese und RNA-/DNA-Biosynthese, sowie gesteigerte Transportvorgänge zu decken. Andererseits verlaufen zahlreiche Vorgänge bei der Protein-, RNA-/DNA-Synthese, bei der Signalentstehung und -Propagation, bei Teilen der Mitose (Umbau der nukleären Struktur, Meta- und Anaphase sowie bei der Metastase in einem akzelerierten Modus kalziumabhängig, was diese Reaktionen stark Mg-abhängig gestaltet. Ca verbleibt nur wenige Sekunden funktional und wird durch Influx in das endoplasmatische Retikulum (ER aus dem Zytosol eliminiert, wodurch die Prozesse gebremst oder sogar unterbrochen werden. Für den Rücktransport von Ca in die intrazellulären Speicher wird Mg benötigt; somit kann Mg auch als Inhibitor dieser Vorgänge betrachtet werden. Auch die biologische Zytostase z. B. durch alpha-Tumornekrosefaktor (alphaTNF verläuft Mg-abhängig, da eine gesteigerte Resistenz der Tumorzelle gegenüber alphaTNF bei Mg-Mangel besteht. In struktureller Hinsicht kommen Mg bedeutende Wirkungen bei der Tumorgenese zu. Klassisch sind die schützenden Effekte von Mg bei der durch kanzerogene Metalle, z.B. Arsen, Beryllium, Chrom, Blei, Quecksilber und Nickel, ausgelösten Tumorgenese. Eine Schutzwirkung tritt vor allem bei einem Ungleichgewicht zwischen dem kanzerogenen Metall und dem Mg-Status des Organismus ein. In analoger Weise sind auch die Stabilität von DNA und RNA sowie Reparaturmechanismen von DNA-Schäden nur in ausreichender Gegenwart von funktionellem Mg optimiert. Hinsichtlich der Immunkompetenz

  7. Malignant peritoneal mesothelioma and Crohn disease.

    Science.gov (United States)

    Butnor, Kelly J; Pavlisko, Elizabeth N; Sporn, Thomas A; Roggli, Victor L

    2017-03-01

    Mesothelial reaction simulating peritoneal diffuse malignant mesothelioma (MM) has been reported in the setting of Crohn ileitis. To our knowledge, peritoneal MM arising in patients with inflammatory bowel disease (IBD) has not been reported. The purpose of this study is to report the clinicopathological characteristics of patients with peritoneal MM and IBD. A database of approximately 3800 MM was reviewed for cases of MM in patients with IBD. Three patients (0.08%) with peritoneal MM and Crohn disease (CD) were identified, including two women and one man ranging in age from 56 to 65 years. All had a long-standing history of diarrhoea and an established diagnosis of CD of 3 years or greater duration. Two had epithelial MM and one had biphasic MM. Only one had documented asbestos exposure. Peritoneal MM occurs rarely in patients with IBD, but interestingly, has only been observed in the setting of CD and not in patients with ulcerative colitis. Chronic inflammation has been associated with the development of MM in rare instances and these three cases suggest that CD with transmural inflammation may also be a precursor. The precise role of CD-related transmural inflammation in the carcinogenesis of peritoneal MM remains to be determined. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  8. Symptomatic Patency Capsule Retention in Suspected Crohn's Disease

    DEFF Research Database (Denmark)

    Rasmussen, Bjørn; Nathan, Torben; Jensen, Michael Dam

    2016-01-01

    The main limitation of capsule endoscopy is the risk of capsule retention. In patients with suspected Crohn's disease, however, this complication is rare, and if a small bowel stenosis is not reliably excluded, small bowel patency can be confirmed with the Pillcam patency capsule. We present two...... patients examined for suspected Crohn's disease who experienced significant symptoms from a retained patency capsule. Both patients had Crohn's disease located in the terminal ileum. In one patient, the patency capsule caused abdominal pain and vomiting and was visualized at magnetic resonance enterography...

  9. A Practical Approach to Preventing Postoperative Recurrence in Crohn's Disease.

    Science.gov (United States)

    Hashash, Jana G; Regueiro, Miguel

    2016-05-01

    Postoperative Crohn's disease recurrence remains common, and preventing additional surgery remains a challenge. A critical step to postoperative management of Crohn's disease is being able to identify patients who should receive immediate postoperative therapy from the patients who can wait for recurrence prior to starting medications. All patients, regardless of their risk for recurrence, are advised to undergo a colonoscopy at 6 to 12 months after surgery to evaluate for endoscopic evidence of Crohn's disease. Further management of patients depends on symptoms and the presence or absence of endoscopic recurrence.

  10. Maintenance therapy with certolizumab pegol for Crohn's disease

    DEFF Research Database (Denmark)

    Schreiber, Stefan; Khaliq-Kareemi, Mani; Lawrance, Ian C

    2007-01-01

    pegol maintenance therapy in adults with moderate-to-severe Crohn's disease. As induction therapy, 400 mg of certolizumab pegol was administered subcutaneously at weeks 0, 2, and 4. Patients with a clinical response (defined as reduction of at least 100 from the baseline score on the Crohn's Disease....... CONCLUSIONS: Patients with moderate-to-severe Crohn's disease who had a response to induction therapy with 400 mg of certolizumab pegol were more likely to have a maintained response and a remission at 26 weeks with continued certolizumab pegol treatment than with a switch to placebo. (Clinical...

  11. MR enterography of ileocolovesicular fistula in pediatric Crohn disease

    Energy Technology Data Exchange (ETDEWEB)

    Sakala, Michelle D. [Wayne State University School of Medicine, Detroit, MI (United States); Dillman, Jonathan R.; Ladino-Torres, Maria F. [University of Michigan Health System, Department of Radiology, C.S. Mott Children' s Hospital, Section of Pediatric Radiology, Ann Arbor, MI (United States); McHugh, Jonathan B. [University of Michigan Health System, Department of Pathology, Ann Arbor, MI (United States); Adler, Jeremy [University of Michigan Health System, Department of Pediatrics and Communicable Diseases, C. S. Mott Children' s Hospital, Division of Pediatric Gastroenterology, Ann Arbor, MI (United States)

    2011-05-15

    Crohn disease, a form of chronic inflammatory bowel disease is characterized by discontinuous inflammatory lesions of the gastrointestinal tract, has a variety of behavioral patterns, including penetrating or fistulous disease. While magnetic resonance enterography (MRE) excellently depicts inflamed bowel segments, it can also be used to assess for a variety of Crohn-disease-related extraintestinal complications, including fistulae. We present the MRE findings of a complex ileocolovesicular fistula in a 14-year-old boy with Crohn disease, where the fistulous tract to the urinary bladder was best delineated on precontrast T1-W imaging because of the presence of fecal material. (orig.)

  12. A case of phrynoderma in a patient with Crohn's disease.

    Science.gov (United States)

    Cobos, Gabriela; Cornejo, Christine; McMahon, Patrick

    2015-01-01

    Phrynoderma is a type of follicular hyperkeratosis associated with nutritional deficiencies. It is rarely seen in developed countries, although cases have been reported in patients with severe malnutrition or malabsorption secondary to various causes. This report describes a 19-year-old patient with poorly controlled Crohn's disease and malnutrition who developed the characteristic hyperkeratotic papules and plaques on his trunk and extremities in the setting of low serum vitamin A levels. To our knowledge, there are no reports of phrynoderma associated with Crohn's disease. It is likely that our patient's low vitamin A level and subsequent phrynoderma was the result of increased Crohn's disease activity and malnutrition.

  13. Einsparungspotential bei Antihypertensiva durch integriertes, ambulantes Hypertonikertraining

    Directory of Open Access Journals (Sweden)

    Kurz RW

    2001-01-01

    Full Text Available Die arterielle Hypertonie stellt unverändert einen der wichtigsten Risikofaktoren für Herzkreislauferkrankungen dar. Aufgrund der hohen Prävalenz und der zumeist lebenslangen Therapieindikation verursacht die antihypertensive Behandlung hohe Kosten für das Gesundheitswesen. Für verschiedene nicht-pharmakologische Maßnahmen konnte ein blutdrucksenkender Effekt nachgewiesen werden. In einem Versuch, einige dieser Therapiemodalitäten zu kombinieren, wurde am Zentrum für Ambulante Rehabilitation ein integriertes, ambulantes Trainingsprogramm erstellt und wird hypertensiven Patienten angeboten. Dieses Programm kombiniert Bewegungstherapie, Patientenschulung, Entspannungstechniken und Streßmanagement. Bei Bedarf wird individuell eine Psychotherapie angeboten. Die Effektivität des vorgestellten Programms kann durch eine gesteigerte körperliche Leistungsfähigkeit und eine verbesserte Blutdruckregulation trotz signifikanter Reduktion des Medikamentenbedarfs unter Beweis gestellt werden. Gegenwärtig stellen die stark steigenden Medikamentenkosten für die Allgemeinheit Anlaß zur Sorge dar und haben eine teilweise emotional geführte Diskussion um die zukünftige Entwicklung des Gesundheitssystems entfacht. In einer Kosten-Nutzen-Analyse haben wir im weiteren versucht, die Kosten für das beschriebene Trainingsprogramm zu erfassen und haben diese den potentiellen Einsparungen durch reduzierten Medikamentenverbrauch gegenübergestellt. Die vorliegende Arbeit präsentiert eine Zwischenauswertung einer derzeit laufenden Untersuchung und gibt eine Übersicht über die relevante Literatur zum Thema der nicht-phamakologischen Therapie der Hypertonie.

  14. Innovative Therapieoptionen bei therapieresistenter arterieller Hypertonie

    Directory of Open Access Journals (Sweden)

    Linnenweber-Held S

    2012-01-01

    Full Text Available Zwei neue innovative Entwicklungen nicht-medikamentöser Therapieoptionen stehen seit einigen Jahren für die therapieresistente arterielle Hypertonie zur Verfügung: Zum einen kann seit 2003 über die elektrische Stimulierung der Barorezeptoren im Sinus caroticus durch die operative Implantation von Elektroden und einen programmierbaren Pulsgenerator der Blutdruck gesenkt werden. Zum anderen ist seit 2007 die minimalinvasive, kathetergestützte renale Denervierung zur Ablation der sympathischen Nervenfasern in den Nierenarterien möglich. Beide Verfahren reduzieren bei 70–90 % der behandelten Patienten den systolischen Blutdruck um mindestens 10 mmHg. 12 Monate nach Karotisschrittmacherimplantation wird der Blutdruck im Durchschnitt um 30–35/15–20 mmHg gesenkt. Die Ergebnisse für die renale Denervierung liegen im gleichen Bereich, tendenziell aber etwas niedriger. Kontraindikationen für die Barorezeptorstimulation sind eine 50%ige Karotisstenose oder ausgeprägte Plaques. Kontraindikationen für eine renale Denervierung sind eine Nierenarterienstenose oder Z. n. Stenting der Nierenarterie sowie eine Nierenfunktionseinschränkung mit einer geschätzten glomerulären Filtrationsrate (eGFR 45 ml/Min.

  15. Perioperatives Management bei Antiplättchentherapie

    Directory of Open Access Journals (Sweden)

    Mahla E

    2013-01-01

    Full Text Available 10–15 % der Patienten mit akutem Koronarsyndrom müssen sich zeitnah einer aorto-koronaren Bypassoperation unterziehen, 5–25 % der Patienten brauchen eine nichtkardiochirurgische Operation während der ersten 1–5 Jahre nach Stentimplantation. Um Blutungskomplikationen und Transfusionen zu minimieren, wird von europäischen Fachgesellschaften empfohlen, elektive nicht-kardiochirurgische Operationen erst nach vollständiger Dauer der empfohlenen P2Y12-Rezeptorblockertherapie und, sofern vertretbar, unter laufender Therapie mit Aspirin durchzuführen. Bei dringlicher Operationsindikation sollten Clopidogrel und Ticagrelor 5 Tage und Prasugrel 7 Tage präoperativ abgesetzt werden, sofern nicht hohes Ischämierisiko oder Zeichen einer „low clopidogrel responsiveness“ für einen früheren Operationszeitpunkt sprechen. Demgegenüber empfehlen amerikanische Richtlinien, die präoperative Wartezeit an der gemessenen Thrombozytenfunktionshemmung zu orientieren. Die Definition eines „idealen“ Testsystems und eines „Blutungs-Cut-off“ bleiben beide Richtlinien schuldig.

  16. Extraintestinal manifestations in Crohn's disease and ulcerative colitis

    DEFF Research Database (Denmark)

    Isene, Rune; Bernklev, Tomm; Høie, Ole

    2015-01-01

    BACKGROUND: In chronic inflammatory bowel disease (IBD) (Crohn's disease [CD] and ulcerative colitis [UC]), symptoms from outside the gastrointestinal tract are frequently seen, and the joints, skin, eyes, and hepatobiliary area are the most usually affected sites (called extraintestinal...

  17. Asymptomatic ileal adenocarcinoma in the setting of undiagnosed Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    Vikram B Reddy; Harold Aslanian; Namsoo Suh; Walter E Longo

    2008-01-01

    A 53-year old previously healthy male underwent a screening colonoscopy for detection of a potential colorectal neoplasm. The terminal ileum was intubated and a mass was noted. Examination of the colon was normal. The biopsy of the ileal mass was consistent with an adenocarcinoma arising from the terminal ileum. His father who had never been previously ill from gastrointestinal disease died of natural causes,but was found to have Crohn's disease postmortem.The patient underwent exploratory laparotomy and aright hemicolectomy with a 30 cm section of terminal ileum in continuity. Findings were consistent with ileal adenocarcinoma in the setting of Crohn's disease. Thepatient made an uneventful recovery. The pathology was stage 1 adenocarcinoma. This is a unique case in that on a screening colonoscopy, a favorable ileal adenocarcinoma was discovered in the setting of asymptomatic, undiagnosed ileal Crohn's disease in a patient whose father had Crohn's disease diagnosed postmortem.

  18. Dysbiotic gut microbiome: A key element of Crohn's disease.

    Science.gov (United States)

    Øyri, Styrk Furnes; Műzes, Györgyi; Sipos, Ferenc

    2015-12-01

    Since the first publication on "regional ileitis", the relevance of this chronic inflammatory disease condition termed finally as Crohn's disease is continuously increasing. Although we are beginning to comprehend certain aspects of its pathogenesis, many facets remain unexplored. Host's gut microbiota is involved in a wide range of physiological and pathological processes including immune system development, and pathogen regulation. Further, the microbiome is thought to play a key role in Crohn's disease. The presence of Crohn's-associated variants of NOD2 and ATG16L genes appears to be associated not only with alterations of mucosal barrier functions, and bacterial killing, but the gut microbiota, as well, reflecting a potential relationship between the host's genotype and intestinal dysbiosis, involved in disease etiology. This review aims to characterize some exciting new aspect of Crohn's disease pathology, focusing mainly on the role of intestinal microbes, and their interplay with the immune system of the host.

  19. [Adalimumab as induction therapy for Crohn's disease - one center study].

    Science.gov (United States)

    Gonciarz, Maciej; Mularczyk, Aldona; Szkudłapski, Dawid; Piątek, Iwona; Kopała, Marek

    2016-11-25

    Adalimumab is a subcutaneously administered recombinant fully human monoclonal antibody targeting tumor necrosis factor alpha. It has been approved for use in Poland to treat patients with Crohn's disease under the program of Polish National Health Found since 2010.

  20. Guidelines for treatment with infliximab for Crohn's disease

    NARCIS (Netherlands)

    Hommes, D. W.; Oldenburg, B.; van Bodegraven, A. A.; van Hogezand, R. A.; de Jong, D. J.; Romberg-Camps, M. J. L.; van der Woude, J.; Dijkstra, G.

    2006-01-01

    Infliximab is an accepted induction and maintenance treatment for patients with Crohn's disease. The effectiveness of infliximab has been demonstrated for both active luminal disease and for enterocutaneous fistulisation. In addition, infliximab can be administered for extraintestinal symptoms of Cr

  1. Guidelines for treatment with infliximab for Crohn's disease.

    NARCIS (Netherlands)

    Hommes, D.W.; Oldenburg, B.; Bodegraven, A.A; Hogezand, R.A. van; Jong, D.J. de; Romberg-Camps, M.; Woude, J. van der; Dijkstra, G.

    2006-01-01

    Infliximab is an accepted induction and maintenance treatment for patients with Crohn's disease. The effectiveness of infliximab has been demonstrated for both active luminal disease and for enterocutaneous fistulisation. In addition, infliximab can be administered for extraintestinal symptoms of Cr

  2. Smoking Linked to Higher Relapse Risk After Surgery for Crohn's

    Science.gov (United States)

    ... page: https://medlineplus.gov/news/fullstory_160747.html Smoking Linked to Higher Relapse Risk After Surgery for ... 1, 2016 THURSDAY, Sept. 1, 2016 (HealthDay News) -- Smoking increases the risk that Crohn's disease patients will ...

  3. Evolving roles of cross-sectional imaging in Crohn's disease.

    Science.gov (United States)

    Magarotto, Andrea; Orlando, Stefania; Coletta, Marina; Conte, Dario; Fraquelli, Mirella; Caprioli, Flavio

    2016-09-01

    The implementation of cross-sectional imaging techniques for the clinical management of Crohn's disease patients has steadily grown over the recent years, thanks to a series of technological advances, including the evolution of contrast media for magnetic resonance, computed tomography and bowel ultrasound. This has resulted in a continuous improvement of diagnostic accuracy and capability to detect Crohn's disease-related complications. Additionally, a progressive widening of indications for cross-sectional imaging in Crohn's disease has been put forward, thus leading to hypothesize that in the near future imaging techniques can increasingly complement endoscopy in most clinical settings, including the grading of disease activity and the assessment of mucosal healing or Crohn's disease post-surgical recurrence.

  4. Orofacial granulomatosis in a patient with Crohn's disease.

    NARCIS (Netherlands)

    Scheur, van de M.R.; Waal, van der RI; Volker - Dieben, H.J.M.; Knol, E.C.; Starink, T.M.; Waal, van der I.

    2003-01-01

    Orofacial granulomatosis encompasses the previously recognized clinical entities Melkersson-Rosenthal syndrome and cheilitis granulomatosa. We report the case of a 39-year-old patient with cheilitis granulomatosa, intestinal Crohn's disease, and optic neuropathy. Cheilitis granulomatosa and optic ne

  5. Laparoskopiassisteret ileocøkal resektion ved Crohns sygdom

    DEFF Research Database (Denmark)

    Laursen, Stig Borbjerg; Knudsen, Torben; Poornoroozy, Peiman

    2010-01-01

    Laparoscopic surgery has become more widely used in the treatment of patients with inflammatory bowel disease. The aim of this study is retrospectively to describe the results of laparoscopy-assisted ileocolic resection of nineteen patients with Crohn's disease....

  6. Das Low-T3-Syndrom bei Patienten mit akuter Pankreatitis

    OpenAIRE

    Kömpf, Vera Carolin

    2014-01-01

    Die akute Pankreatitis weist bei einem schweren Verlauf nach wie vor eine hohe Letalität auf. Vor allem bei der akuten nekrotisierenden Pankreatitis kommt es zu Komplikationen wie infizierten Nekrosen und Multiorganversagen. Hinzu kommen weitere Phänomene, die auch bei anderen schweren Erkrankungen auftreten und zu einem ungünstigen Verlauf der Grunderkrankung führen. Das Non-Thyroidal-Illness-Syndrom, das bei vielen intensivpflichtigen Erkrankungen auftritt, ist eines davon. In der vorlie...

  7. Granulomatous uveitis in Crohn's disease. A clinicopathologic case report.

    Science.gov (United States)

    Salmon, J F; Wright, J P; Bowen, R M; Murray, A D

    1989-05-01

    Recurrent episodes of uveitis occurred in a young male patient with clinical as well as radiologic and histologic evidence of Crohn's ileocolitis. His left eye became blind and painful, and was enucleated. Histopathologic examination of the eye revealed a panuveitis with evidence of granuloma formation in the choroid. While granulomatous inflammation has previously been demonstrated in extraintestinal sites, to our knowledge, this is the first histopathologic evidence of granuloma formation within the eye in Crohn's disease.

  8. Clinical trials in luminal Crohn's disease: a historical perspective.

    Science.gov (United States)

    Hindryckx, Pieter; Baert, Filip; Hart, Ailsa; Armuzzi, Alessandro; Panès, Julian; Peyrin-Biroulet, Laurent

    2014-11-01

    It goes back to 1932 when Dr. Burrill Bernard Crohn and co-workers published their landmark paper, describing regional ileitis as a disease entity. However, clinical trial research has been developing rather slowly in luminal Crohn's disease. It took until the early seventies before the first randomized clinical trial was set up by the National Co-operative Crohn's Disease Study (NCCDS) group. Although the efforts of this group triggered a first wave of clinical trials in Crohn's disease, the lack of guidelines for conducting a clinical trial in this research area resulted in a variety of study designs and much criticism. Besides having a rather small sample size and a short follow-up time, they were often characterized by vague and subjective assessment of disease activity and treatment response. Following the advent of a new and very potent drug class in the late nineties, the anti-TNF agents, investigators started to re-think their study protocols and the first guidelines were set up by the regulatory authorities. Over the last 15years, clinical trials in luminal Crohn's disease have been evolving significantly. Inclusion criteria have been shifting from clinical scores such as Crohn's Disease Activity Index (CDAI) to more objective disease activity parameters such as biomarkers (C-reactive protein and faecal calprotectin) and endoscopic lesions. Primary endpoints have been developing from clinical response to corticosteroid-free remission and more ambitious end-points such as mucosal healing. In this paper, we will give a historical overview on clinical trials in luminal Crohn's disease, before and within the biologic era, and provide insight into how they have shaped our current understanding of trial designs in Crohn's disease.

  9. Pulmonary necrobiotic nodules: a rare extraintestinal manifestation of Crohn's disease

    Directory of Open Access Journals (Sweden)

    G. Warwick

    2009-03-01

    Full Text Available The present article reports the case of a 22-yr-old female with new onset Crohn's colitis, anterior uveitis and multiple pulmonary nodules which, on histological examination, were necrobiotic nodules. This is a rare but recognised pulmonary extraintestinal manifestation of Crohn's disease and only the fourth reported case. The present case report is followed by a brief review of the relevant literature.

  10. Laparoscopic Surgery for Recurrent Crohn's Disease

    Directory of Open Access Journals (Sweden)

    Antonino Spinelli

    2012-01-01

    Full Text Available In spite of the recent improvements in drug therapy, surgery still represents the most frequent treatment for Crohn's disease (CD complications. Laparoscopy has been widely applied over the last twenty years in colorectal surgery and was associated with lower postoperative pain, shorter hospitalization, faster return to daily activities, and better cosmetic results. Laparoscopy experienced a slower diffusion in inflammatory bowel disease surgery than in oncologic colorectal surgery, but proved to be safe and effective, and is currently considered the gold standard for the treatment of primary uncomplicated ileocolic CD. Indications for laparoscopy in CD have recently been widened to embrace more complicated or recurrent CD. This paper reviews the available data on the subset of recurrent CD patients. The reported results indicate that laparoscopy may be safely applied even in selected recurrent CD cases in hands of IBD surgeons with broad laparoscopic experience.

  11. Crohn disease and the gynecologic patient.

    Science.gov (United States)

    Sides, Cleve; Trinidad, Mari Charisse; Heitlinger, Leo; Anasti, James

    2013-01-01

    Although Crohn disease (CD) is considered an inflammatory bowel disease, extraintestinal gynecologic manifestations are varied, frequent, and oftentimes difficult to manage. Its predilection for young and reproductive-age women makes it an important disease process for the gynecologist to understand, as its complications can have long-term repercussions on the developmental, sexual, reproductive, and psychological health of affected women. Patients may present with a variety of vulvovaginal, perineal, perianal, and urologic complaints. Perianal involvement from an intestinal fistula is the most common skin manifestation seen in CD. Other gynecologic manifestations include metastatic CD and rectovaginal and urovaginal fistulas. Recognition and accurate diagnosis of extraintestinal gynecologic manifestations, as well as a good understanding of the gynecologic effects of chronic disease, are necessary for optimal management. The article provides an overview of CD and highlights the gynecologic considerations in caring for women affected by this disease.

  12. [Toxic megacolon presenting as Crohn's disease].

    Science.gov (United States)

    Sánchez Yubero, S; López Gil, A; Pérez Rojo, J A; Kessler Saiz, P

    1999-11-01

    We introduce a young patient, without history of inflammatory bowel disease (I.B.D.) who started with an acute gastroenteritis, which in the following days progressed to a toxic megacolon. The patient had come to hospital with nausea, vomiting, fever and liquid, explosive diarrhoea without pathologic products. There was no clinical remission with astringent diet, hydroelectrolitic reposition and antidiarrheic opiates. The patient was admitted in hospital when he had blood in the diarrhoea. This progressed to a toxic megacolon in three days and the patient had to be operated on urgently. The surgeons found perforations in the colon and the pathologists diagnosed Crohn disease. Even without previous E.B.D. history we reached the diagnosis from the clinical and analytical data and the plain abdominal radiology. It was impossible to confirm the diagnosis with a colonoscopy because of the high risk of perforation. In cases like this, early surgery may save the life of the patient.

  13. Targeting Specific Immunologic Pathways in Crohn's Disease.

    Science.gov (United States)

    Ramos, Guilherme Piovezani; Faubion, William A; Papadakis, Konstantinos A

    2017-09-01

    Understanding the immunologic pathways in intestinal inflammation is crucial for the development of new therapies that can maximize patient response and minimize toxicity. Targeting integrins and cytokines is intended to control leukocyte migration to effector sites or inhibit the action of proinflammatory cytokines. New approaches to preventing leukocyte migration may target integrin receptors expressed on the intestinal vascular endothelium. The interleukin (IL)-12/IL-23 pathway has been a therapeutic target of interest in controlling active Crohn's disease (CD). New therapeutic approaches in CD may involve the enhancement of anti-inflammatory cytokine pathways and modulation of cellular responses and intranuclear signals associated with intestinal inflammation. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Über die Rückbildung der Kiemenbogen bei den Selachii

    NARCIS (Netherlands)

    Versluys, J.

    1922-01-01

    Das Vorkommen von sieben Kiemenbogen bei Heptanchus, sechs bei Hexanchus, Chlamydoselachus und Pliotrema (REGAN, 1908), und von nur fünf bei den übrigen Selachii weist auf Rückbildung der Zahl der Kiemenbogen innerhalb der Selachii hin. Dadurch entsteht die Frage wie diese Verringerung der Zahl der

  15. Tracheobronchial nodules and pulmonary infiltrates in apatient with Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    De-Gan Lu; Xiao-Qing Ji; Qi Zhao; Cai-Qing Zhang; Zhen-Fang Li

    2012-01-01

    Crohn's disease is a granulomatous systemic disorder of unknown etiology.Obvious pulmonary involvement is exceptional.Tracheal involvement in Crohn's disease is even more unusual,only a few cases have been reported to date.We herein report a rare case of tracheobronchial nodules and pulmonary infiltrates in both lungs as a complication of Crohn's disease.A 42-year-old man underwent pancolectomy for multiple broken colon caused by Crohn's disease.Forty days later pulmonary symptoms and radiologic abnormalities were noted.A search for bacterial (including mycobacteria) and fungal in the repeated sputum proved negative.The treatment consisted of intravenous antimicrobials for one month,but there was no improvement in pyrexia or cough and radiologic abnormalities.Fibreoptic bronchoscopy (FOB)was performed and revealed nodes in the trachea and the right upper lobe opening.Histopathology of tracheobronchial nodules and bronchial mucosa biopsy specimen both showed granulomatous inflammation with proliferation of capillaries and inflammatory cells.Oral steroid and salicylazosulfapyridine were commenced and led to marked improvement in symptoms and an almost complete resolution of his chest radiograph.Repeated FOB showed that nodes in the trachea disappeared and the ones in the right upper lobe opening diminished obviously.Crohn's disease can be associated with several respiratory manifestations.The form of tracheal and bronchopulmonary involvement in Crohn's disease is rare and responded well to steroids.

  16. Cancer of the small intestine in patients with Crohn's disease.

    Science.gov (United States)

    Higashi, Daijiro; Futami, Kitaro; Kojima, Daibo; Futatsuki, Ryo; Ishibashi, Yukiko; Maekawa, Takafumi; Yano, Yutaka; Takatsu, Noritaka; Hirai, Fumihito; Matsui, Toshiyuki; Iwashita, Akinori

    2013-07-01

    Due to an increase in the number of long-term cases of Crohn's disease, the risk of combined cancer in these patients has been assessed in numerous articles. Most of these reports have involved patients with cancer of the large intestine, while cases of cancer of the small intestine combined with Crohn's disease are very rare. We experienced two cases of cancer of the small intestine combined with Crohn's disease. In both cases, the patients had suffered from Crohn's disease for over 10 years and a second operation was performed after a long period without treatment following the first operation, which had achieved a favorable outcome. In both cases of combined cancer, the patients experienced ileus; however, it was difficult to discern this from ileus due to the presence of Crohn's disease. Therefore, making a definitive diagnosis of combined cancer was not possible before surgery, and the definitive diagnosis was obtained based on an intraoperative pathological diagnosis. It is thought that tumor markers transition in a manner parallel to the progression of cancer, providing a clue for cancer diagnosis. In patients with Crohn's disease, there is a pressing need to establish a method for diagnosing cancer of the small intestine at an early stage.

  17. Fistulizing Crohn's Disease Presenting After Surgery on a Perianal Lesion.

    Science.gov (United States)

    Singer, Andrew A M; Gadepalli, Samir K; Eder, Sally J; Adler, Jeremy

    2016-03-01

    Perianal skin lesions, such as skin tags, can be an early presenting sign of Crohn's disease. Surgical intervention on these lesions may increase the risk of fistula development and lead to worse outcomes. This case series examined 8 patients who underwent surgical intervention on what appeared to be benign perianal skin lesions, only to reveal fistulas leading to the diagnosis of Crohn's disease. This patient population comprised 20% of all pediatric patients with Crohn's disease who had perianal fistula present at diagnosis. The initial type of perianal lesion varied from case to case and included skin tags, hemorrhoids, and perianal abscesses. All of the patients had other presenting features that, in retrospect, may have been attributed to Crohn's disease. None presented solely with a perianal lesion. Four patients had weight loss or growth failure. Most of the remainder had abnormal laboratory test results. These findings should raise the awareness of primary care providers that perianal lesions can be the first presenting sign of possible Crohn's disease in otherwise healthy appearing children. Such children should undergo a thorough evaluation for Crohn's disease before surgical intervention on perianal lesions because surgical procedures may be associated with worse outcomes.

  18. Nichterkennen von Vorhofflimmern bei Patienten mit kardialer Resynchronisationstherapie

    Directory of Open Access Journals (Sweden)

    Strohmer B

    2005-01-01

    Full Text Available Obwohl eine Intoleranz der kardialen Resynchronisationstherapie (CRT unüblich ist, sollten entsprechende Symptome auf ihre Ursache hin genau abgeklärt werden. Atriale Tachyarrhythmien (AT werden bei Patienten mit chronischer Herzinsuffizienz relativ häufig beobachtet. Dieser Bericht beschreibt ein rhythmologisches Problem, welches oft unerkannt bleibt und in unserem CRTKollektiv bei knapp 8 % der Patienten aufgetreten ist. Paroxysmales Vorhofflattern wurde durch den CRT-Schrittmacher nicht erkannt, da jede zweite Flatterwelle exakt mit der atrialen Ausblendzeit (PVAB = postventrikuläres atriales Blanking zusammenfiel. Dies führte zu einem Versagen der Mode-Switch-Funktion durch Nichterkennung von stabilem Vorhofflattern, welches mit sehr stabiler Zykluslänge auftrat. Dieses sog. "2:1-lock-in"-Phänomen resultierte in rascher und anhaltender biventrikulärer Stimulation, welche sich bei den betroffenen Patienten klinisch als unangenehmes Herzklopfen mit zunehmender Atemnot bemerkbar machte.

  19. Head injuries in children; Schaedel-Hirn-Trauma bei Kindern

    Energy Technology Data Exchange (ETDEWEB)

    Zimmer, A.; Reith, W. [Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Homburg/Saar (Germany)

    2009-10-15

    Trauma is the reason for 40-60% of emergency callouts concerning children. Approximately half of the children have head injuries. As for adults early recognition of findings indicating an intervention are decisive for the prognosis. In children head injury can be divided into three categories: birth trauma, accidental and non-accidental trauma. This article concentrates on accidental trauma with respect to characteristics of causes, epidemiology, mechanisms of accidents and illustrated morphological findings. (orig.) [German] In 40-60% der Faelle ist ein Trauma die Ursache fuer Noteinsaetze bei Kindern. Dabei weist ca. die Haelfte der Verletzten ein Schaedel-Hirn-Trauma (SHT) auf. Wie bei Erwachsenen ist das fruehzeitige Erkennen interventionspflichtiger Befunde entscheidend fuer die Prognose. Man unterscheidet bei Kindern 3 Formen des SHT: das Geburtstrauma, das akzidentelle und das nichtakzidentelle Trauma. Der folgende Artikel befasst sich mit dem akzidentellen Trauma, wobei Besonderheiten hinsichtlich der Ursachen, der Epidemiologie, des Unfallmechanismus und der bildmorphlogischen Befunde herausgearbeitet werden. (orig.)

  20. Spect in epilepsy; SPECT bei Anfallsleiden

    Energy Technology Data Exchange (ETDEWEB)

    Feistel, H. [Nuklearmedizinische Klinik mit Poliklinik und Neurologische Klinik, Friedrich-Alexander-Univ. Erlangen-Nuernberg, Erlangen (Germany); Weis, M. [Nuklearmedizinische Klinik mit Poliklinik und Neurologische Klinik, Friedrich-Alexander-Univ. Erlangen-Nuernberg, Erlangen (Germany); Michalik, K. [Nuklearmedizinische Klinik mit Poliklinik und Neurologische Klinik, Friedrich-Alexander-Univ. Erlangen-Nuernberg, Erlangen (Germany); Schueler, P. [Nuklearmedizinische Klinik mit Poliklinik und Neurologische Klinik, Friedrich-Alexander-Univ. Erlangen-Nuernberg, Erlangen (Germany); Platsch, G. [Nuklearmedizinische Klinik mit Poliklinik und Neurologische Klinik, Friedrich-Alexander-Univ. Erlangen-Nuernberg, Erlangen (Germany); Stefan, H. [Nuklearmedizinische Klinik mit Poliklinik und Neurologische Klinik, Friedrich-Alexander-Univ. Erlangen-Nuernberg, Erlangen (Germany); Wolf, F. [Nuklearmedizinische Klinik mit Poliklinik und Neurologische Klinik, Friedrich-Alexander-Univ. Erlangen-Nuernberg, Erlangen (Germany)

    1997-06-01

    Fokuslokalisation genutzt werden. In diesem Zusammenhang wird nach dem `Erlanger Modell` auch das periiktuale SPECT eingesetzt, d.h. die Injektion des Tracers geschieht im Anfall (iktuales SPECT), unmittelbar nach Sistieren des Anfalls (postiktual) oder im anfallsfreien Intervall (interiktual). Die iktuale oder postiktuale Applikation des Tracers setzt eine eingespielte Zusammenarbeit zwischen neurologischer und nuklearmedizinischer Abteilung voraus, die unter Beachtung der Strahlenschutzvorschriften im Monitoringzentrum entstehen muss. Im Fall der Temporallappenepilepsie laesst sich durch Serienaufnahmen zeigen, dass zu Anfallsbeginn der Schlaefenlappen grossflaechig hyperperfundiert sein kann bei parietaler Minderdurchblutung, dass der Herd in den ersten beiden Minuten nach Anfallsende am engsten markiert abgebildet wird und bei spaeterer Injektion nur noch minderperfundiert erscheint. Im Fall der Frontallappenepilepsien ist eine fruehe Injektion moeglichst innerhalb von 40 Sekunden anzustreben, andernfalls kann eine Anfallspropagation in distante Hirnareale, auch nach kontralateral, stattfinden. Extraemporale Epilepsien sind haeufig mit Missbildung oder Trauma vergesellschaftet und schwer kategorisierbar. In schwierigen Faellen kann durch die Rezeptorszintigraphie mit z.B. Iomazenil der Fokus in Form einer kalten Gewebslaesion als Ausdruck der gestoerten neuronalen Integritaet lokalisiert werden. (orig.)

  1. Doença de Crohn metastática para axila Metastatic Crohn's disease to the axilla

    Directory of Open Access Journals (Sweden)

    Flávia Balsamo

    2007-03-01

    Full Text Available Relata-se um caso de doença de Crohn com manifestação cutânea axilar extremamente rara, bem como suas peculiaridades em relação ao diagnóstico e tratamento.The description of a case of metastatic Crohn's disease, a rare skin manifestation to the axillar region with diagnostic features and treatment schedules.

  2. Neuropsychologische und psychiatrische Komorbiditäten bei Epilepsien

    Directory of Open Access Journals (Sweden)

    Lehner-Baumgartner E

    2009-01-01

    Full Text Available Neuropsychologische Beeinträchtigungen stellen ein gravierendes Problem für viele Epilepsiepatienten dar und werden im Wesentlichen durch die 3 folgenden Faktoren verursacht und beeinflusst: (1 Morphologische Faktoren – Lokalisation und Art der epileptogenen Läsion. Zudem können umschriebene Läsionen auch zu funktionellen Beeinträchtigungen in von der Läsion entfernten Hirnregionen führen, was durch eine Störung von funktionellen Netzwerken erklärt werden kann. (2 Klinische und demographische Faktoren (Alter zu Erkrankungsbeginn, Erkrankungsdauer, Anfallsfrequenz und -schwere, Geschlecht. (3 Funktionelle Faktoren (antikonvulsive Medikation, allfällige psychiatrische Komorbiditäten, Effekte von Anfällen und interiktale epileptiforme Entladungen. Psychiatrische Erkrankungen (Depressionen, Psychosen und Angststörungen treten bei Epilepsiepatienten signifikant häufiger auf als in der Allgemeinbevölkerung und als bei anderen chronischen Erkrankungen. Psychiatrische Störungen können entweder in einer fixen zeitlichen Beziehung zu den Anfällen auftreten (präiktale, iktale und postiktale psychiatrische Störungen oder sich unabhängig vom Auftreten der Anfälle manifestieren (interiktale psychiatrische Störung. Die Depression stellt die häufigste psychiatrische Begleiterkrankung bei Epilepsie dar, zudem ist eine Depression ein Risikofaktor für das Neu- Auftreten einer Epilepsie. Diese bidirektionale Beziehung könnte durch gemeinsame Pathomechanismen beider Erkrankungen erklärt werden. Obwohl das Vorliegen und der Schweregrad einer Depression die wichtigsten Prädiktoren für die Lebensqualität bei Epilepsiepatienten darstellen, werden Depressionen bei Epilepsiepatienten unterdiagnostiziert und unterbehandelt. Eine psychopharmakologische Behandlung sollte bei Vorliegen einer Begleitdepression unverzüglich initiiert werden, das epileptogene Potenzial von Antidepressiva stellt dabei ein vernachlässigbares Risiko dar.

  3. Die Chirurgie der abdominellen Aorta bei Dissektionen, Aneurysmen und Ruptur

    Directory of Open Access Journals (Sweden)

    Veit FH

    2001-01-01

    Full Text Available Das chirurgische Standardverfahren in der Behandlung geschlossener oder rupturierter abdomineller Aneurysmen ist die "offene" Dissektionsresektion. Mit diesem invasiven konventionellen Verfahren sind alle Formen abdomineller Aneurysmen behandelbar. Bei Patienten mit niedrigem Risikoprofil ist die perioperative Mortalität gering und das Langzeitergebnis ausgezeichnet. Die transfemorale minimal invasive Implantation von Endoprothesen ist bei ausgewählten Patienten mit geeigneter Anatomie eine befriedigende Alternative. Die perioperative Mortalität ist auch beim Hochrisikopatienten gering. Der ungewisse Langzeitverlauf erfordert eine lebenslange Observanz des Aneurysmas.

  4. MRI for chronic inflammatory bowel disease; MRT chronisch entzuendlicher Darmerkrankungen

    Energy Technology Data Exchange (ETDEWEB)

    Hansmann, H.J.; Hess, T.; Hahmann, M.; Erb, G.; Richter, G.M.; Duex, M. [Heidelberg Univ. (Germany). Abt. Roentgendiagnostik; Elsing, C. [Heidelberg Univ. (Germany). Abt. IV - Gastroenterologie

    2001-01-01

    - und Dickdarm nach oraler oder rektaler Fuellung zuverlaessig dargestellt werden. Die Hydro-MRT als spezielles MR-Untersuchungsprotokoll mit Bildakquisition in Atemstillstand unter medikamentoeser Darmhypotonie und Verwendung intestinaler MR-Kontrastmittel erlaubt die Abbildung intestinaler und extraintestinaler pathologischer Veraenderungen beim M. Crohn. Hierzu rechnen einerseits entzuendliche Darmwandverdickung und Stenosen, andererseits Fisteln, entzuendliche Konglomerate und Abszesse. Bei der Colitis ulcerosa ist im Gegensatz zum Morbus Crohn in der Hydro-MRT eine deutlich geringere entzuendliche Wandverdickung typisch. Ferner ist bei der Colitis ulcerosa die Ausdehnung der Befunde in der MRT regelmaessig geringer als in der Endoskopie. Die Hydro-MRT kann nach unseren eigenen Erfahrungen an mehr als 200 Patienten und den Ergebnissen anderer Zentren das Enteroklysma in der Diagnostik chronisch entzuendlicher Darmerkrankungen und die Mehrzahl von Wiederholungsendoskopien beim Morbus Crohn ersetzen. Weiterentwicklungen der Technik erlauben interaktive multiplanare Nachverarbeitungen der MR-Datensaetze. (orig.)

  5. Inflammatory diseases of the large intestine. Colon contrast enema and CT; Entzuendliche Dickdarmerkrankungen. Kolonkontrasteinlauf und CT

    Energy Technology Data Exchange (ETDEWEB)

    Antes, G. [Klinikum Kempten-Oberallgaeu GmbH, Kempten (Germany). Abt. fuer Radiologie

    1998-01-01

    Among the many inflammatory diseases of the colon, Crohn`s disease and ulcerative colitis occur most frequently. For primary evaluation, endoscopy has widely replaced the barium enema (BE) as diagnostic method. BE, however can provide important additional informations in the differential diagnosis of chronic inflammatory colonic diseases. Purpose of this article is the demonstration of typical, but also of atypical radiological changes in different stages of Crohn`s disease and ulcerative colitis, as well as calling attention to the importance of CT. A BE demands a refined examination technique using double contrast. All CT-examinations have to be scrutinized for changes of the bowel and mesentery. A dedicated spiral-CT examination might be indicated in a known disease in order to obtain special information. The advantage of a BE over endoscopy is a clear and reproducible demonstration of the patterns of distribution and character of the disease as well as the detection of fistulae. The classification into one or the other disease entity can be better accomplished. CT is superior in detecting bowel wall thickening, extraintestinal disease and complications. In diagnostic imaging of chronic inflammatory bowel diseases, endoscopy and radiologic techniques are used complementarily. (orig.) [Deutsch] Unter den vielen entzuendlichen Dickdarmerkrankungen sind Morbus Crohn und Colitis ulcerosa bei weitem am haeufigsten. Die Endoskopie hat den Kolonkontrasteinlauf (KE) in der Primaerdiagnostik weitgehend abgeloest. Dennoch kann der KE bei der Differentialdiagnose entzuendlicher Dickdarmerkankungen wichtige Zusatzinformationen liefern. Ziel dieser Arbeit ist die Demonstration der typischen, aber auch atypischen roentgenologischen Veraenderungen in den verschiedenen Stadien bei Morbus Crohn und Colitis ulcerosa sowie der Hinweis auf die Bedeutung der CT. Der KE erfordert eine ausgefeilte Untersuchungstechnik im Doppelkontrast. Bei allen CT-Untersuchungen muessen der Darm und

  6. Plain abdominal radiographs in patients with Crohn's disease: radiological findings and diagnostic value.

    LENUS (Irish Health Repository)

    O'Regan, K

    2012-08-01

    To determine the diagnostic yield and clinical value of plain film of the abdomen (PFA) in Crohn\\'s disease (CD) patients and to determine whether performance of PFA yields definitive diagnostic information or whether additional imaging examinations are required.

  7. Biological therapy in the management of recent-onset Crohn's disease

    NARCIS (Netherlands)

    Lowenberg, Mark; Peppelenbosch, Maikel; Hommes, Daniel

    2006-01-01

    Crohn's disease is a chronic inflammatory bowel disease that may involve any part of the gastrointestinal tract. Conventional therapy consists of corticosteroids, azathioprine or methotrexate, but the clinical management of Crohn's disease is significantly hampered by adverse effects. With the

  8. European evidence based consensus on the diagnosis and management of Crohn's disease: special situations

    NARCIS (Netherlands)

    R. Caprilli; M.A. Gassull; J.C. Escher; G. Moser; P. Munkholm; A. Forbes; D.W. Hommes; H. Lochs; E. Angelucci; A. Cocco; B. Vucelic; H. Hildebrand; S. Kolacek; L. Riis; M. Lukas; R. de Franchis; M. Hamilton; G. Jantschek; P. Michetti; C. O'Morain; M.M. Anwar; J.L. Freitas; I.A. Mouzas; F. Baert; R. Mitchel; C.J. Hawkey

    2006-01-01

    This third section of the European Crohn's and Colitis Organisation (ECCO) Consensus on the management of Crohn's disease concerns postoperative recurrence, fistulating disease, paediatrics, pregnancy, psychosomatics, extraintestinal manifestations, and alternative therapy. The first section on defi

  9. European evidence based consensus on the diagnosis and management of Crohn's disease : special situations

    NARCIS (Netherlands)

    Caprilli, R; Gassull, MA; Escher, JC; Moser, G; Munkholm, P; Forbes, A; Hommes, DW; Lochs, H; Angelucci, E; Cocco, A; Vucelic, B; Hildebrand, H; Kolacek, S; Riis, L; Lukas, M; de Franchis, R; Hamilton, M; Jantschek, G; Michetti, P; O'Morain, C; Anwar, M.M.; Freitas, JL; Mouzas, IA; Baert, F; Mitchel, R; Hawkey, CJ

    2006-01-01

    This third section of the European Crohn's and Colitis Organisation (ECCO) Consensus on the management of Crohn's disease concerns postoperative recurrence, fistulating disease, paediatrics, pregnancy, psychosomatics, extraintestinal manifestations, and alternative therapy. The first section on defi

  10. European evidence based consensus on the diagnosis and management of Crohn's disease : special situations

    NARCIS (Netherlands)

    Caprilli, R; Gassull, MA; Escher, JC; Moser, G; Munkholm, P; Forbes, A; Hommes, DW; Lochs, H; Angelucci, E; Cocco, A; Vucelic, B; Hildebrand, H; Kolacek, S; Riis, L; Lukas, M; de Franchis, R; Hamilton, M; Jantschek, G; Michetti, P; O'Morain, C; Anwar, M.M.; Freitas, JL; Mouzas, IA; Baert, F; Mitchel, R; Hawkey, CJ

    This third section of the European Crohn's and Colitis Organisation (ECCO) Consensus on the management of Crohn's disease concerns postoperative recurrence, fistulating disease, paediatrics, pregnancy, psychosomatics, extraintestinal manifestations, and alternative therapy. The first section on

  11. European evidence based consensus on the diagnosis and management of Crohn's disease : special situations

    NARCIS (Netherlands)

    Caprilli, R; Gassull, MA; Escher, JC; Moser, G; Munkholm, P; Forbes, A; Hommes, DW; Lochs, H; Angelucci, E; Cocco, A; Vucelic, B; Hildebrand, H; Kolacek, S; Riis, L; Lukas, M; de Franchis, R; Hamilton, M; Jantschek, G; Michetti, P; O'Morain, C; Anwar, M.M.; Freitas, JL; Mouzas, IA; Baert, F; Mitchel, R; Hawkey, CJ

    2006-01-01

    This third section of the European Crohn's and Colitis Organisation (ECCO) Consensus on the management of Crohn's disease concerns postoperative recurrence, fistulating disease, paediatrics, pregnancy, psychosomatics, extraintestinal manifestations, and alternative therapy. The first section on defi

  12. Hydro-MRI in inflammatory bowel diseases: a comparison with colonoscopy and histopathology; Hydro-MRT bei entzuendlichen Darmerkrankungen - Eine koloskopisch-histologische Vergleichsstudie

    Energy Technology Data Exchange (ETDEWEB)

    Schunk, K.; Reiter, S.; Kern, A. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Radiologie; Orth, T.; Wanitschke, R. [Mainz Univ. (Germany). Medizinische Klinik und Poliklinik

    2001-08-01

    Purpose: To compare hydro-MRI with colonoscopy and biopsy specimen regarding the assessment of inflammatory activity and the differentiation of inflammatory bowel diseases. Material and methods: After an oral bowel opacification using 1000 ml of a 2.5% mannitol solution and a rectal bowel opacification using 250-500 ml of a 0.9% saline solution, axial and coronal breath-hold sequences {+-}Gd-DTPA (HASTE-['half-Fourier acquisition single-shot turbo spin echo'] and dynamic FLASH-['fast low angle shot']) were acquired in 27 patients with inflammatory bowel disease. The enhancement of the bowel wall as well as morphological MRI findings were correlated with colonoscopy and biopsy specimens. By means of the MRI findings, Crohn's disease (CD) and ulcerative colitis (UC) should be differentiated. Results: In CD, a significant correlation between the contrast enhancement of the inflamed bowel wall ({delta} SI) and the endoscopic/histopathologic indices could be established (r=0.52; p=0.02 and r=0.72; p=0.001). In UC, no correlations between {delta} SI and the endoscopic/histopathologic indices could be found. The correct diagnosis of CD and UC by MRI findings was possible in 22/27 patients (81%). Conclusion: Hydro-MRI with dynamic studies is suitable for the assessment of disease activity in CD, but unreliable in UC. Hydro-MRI provides useful information for the differentiation of CD and UC. (orig.) [German] Zielsetzung: Vergleich der Hydro-MRT mi Koloskopie und Histopathologie bezueglich der Beurteilung der entzuendlichen Aktivitaet und der Differenzierung entzuendlicher Darmerkrankungen. Patienten und Methodik: Bei 27 Patienten mit einer entzuendlichen Darmerkrankung wurden nach einer oralen Darmkontrastierung mit 1000 ml einer 2,5%igen Mannitolloesung und einer rektalen Darmkontrastierung mit 250-500 ml einer 0,9%igen NaCl-Loesung atemangehaltene transversale und koronare Sequenzen {+-} intravenoese Gd-DTPA-Applikation (HASTE

  13. Diagnostic accuracy of computed tomography using lower doses of radiation for patients with Crohn's disease.

    LENUS (Irish Health Repository)

    Craig, Orla

    2012-08-01

    Magnetic resonance and ultrasonography have increasing roles in the initial diagnosis of Crohn\\'s disease, but computed tomography (CT) with positive oral contrast agents is most frequently used to identify those with acute extramural complications. However, CT involves exposure of patients to radiation. We prospectively compared the diagnostic accuracy of low-dose CT (at a dose comparable to that used to obtain an abdominal radiograph) with conventional-dose CT in patients with active Crohn\\'s disease.

  14. Sportmedizinische Aspekte des Judo bei Kindern und Jugendlichen : Auswertung von Sportverletzungen mit Konsequenzen für Trainings- und Wettkampfbetreuung

    OpenAIRE

    Erdmann, Ute

    2000-01-01

    In einer aktuell erhobenen Studie wurde das Auftreten von Sportverletzungen bei Kindern und Jugendlichen im Judo auf Breitensportebene ausgewertet. Bei Wettkampf, Lehrgang und Training wurden 129 Verletzungen bei 107 Verletzten erfasst. Es ergab sich eine Verletzungsinzidenz von 9,6 % bei Wettkämpfen und 37,5 % bei Lehrgängen. Nur 4,7 % der 129 Verletzungen waren schwer, darunter keine Lehrgangsverletzung. In der Gesamtstatistik dominierten Verletzungen an den unteren Extremitäten mi...

  15. Fertilitätsprotektion bei onkologischen Erkrankungen der Frau

    Directory of Open Access Journals (Sweden)

    von Wolff M

    2009-01-01

    Full Text Available Die steigenden Überlebensraten und die zunehmende Bedeutung der Lebensqualität nach einer Krebserkrankung haben den Fertilitätserhalt bei zytotoxischen Therapien in den Fokus der Aufmerksamkeit gerückt. Fortschritte in der Reproduktionsmedizin und die Bildung von regionalen, nationalen und internationalen interdisziplinären Netzwerkstrukturen ermöglichen inzwischen auch bei Frauen die effektive Durchführung von fertilitätsprotektiven Techniken. Angeboten werden einzeln oder in Kombination die ovarielle Stimulation und Kryokonservierung von unfertilisierten und fertilisierten Oozyten, die Entnahme und Kryokonservierung von Ovargewebe und die Gabe von GnRH-Analoga. Die Wahl der Methode muss jedoch insbesondere bei Frauen interdisziplinär und ausschließlich auf dem Boden einer großen reproduktionsmedizinischen Erfahrung gestellt werden. Das Netzwerk FertiPROTEKT (http://www.fertiprotekt.de umfasst spezialisierte Zentren und bietet Unterstützung bei der Beratung der Patienten, der Auswahl, Evaluation und Optimierung der z. T. noch nicht voll etablierten Techniken

  16. Grundlagen und Zahlen zur genetischen Beratung bei komplexen Epilepsien

    Directory of Open Access Journals (Sweden)

    Zimprich F

    2009-01-01

    Full Text Available Aufgrund der erhöhten genetischen Belastung bei komplexen Epilepsieformen suchen Angehörige oder Patienten oft Rat zur Ermittlung des Erkrankungsrisikos für weitere Familienmitglieder. Im vorliegenden Artikel wird versucht, Grundlagen sowie Fakten aus der Literatur zur Beantwortung dieser Frage bereitzustellen.

  17. Anticholinergika bei überaktiver Blase und benignem Prostatasyndrom

    Directory of Open Access Journals (Sweden)

    Gabuev A

    2007-01-01

    Full Text Available Das klinische Bild des benignen Prostatasyndroms (BPS ist vielfältig. Standardmäßig werden die Patienten mit benigner prostatischer Obstruktion operativ behandelt. Ein wesentlicher Anteil der betroffenen Männer leidet vorwiegend unter Drangsymptomen wie Pollakisurie und gehäuftem imperativen Harndrang mit oder ohne Harninkontinenz. Nach dem Versagen der primären konservativen Behandlung mit selektiven Alpha-1- Adrenoblockern und/oder 5-alpha-Reduktasehemmern in dieser Patientengruppe (Non-Responder wird häufig die Indikation zu weniger akzeptablen invasiven Therapieoptionen gestellt. Die Ergebnisse von internationalen multizentrischen Studien zur Wirkung von Anticholinergika bei Patienten mit dem Syndrom „überaktive Blase“ zeigten deren Effizienz und günstiges Nebenwirkungsprofil. Dies führte zur kritischen Betrachtung des Problems der Anwendung von Anticholinergika bei benigner Hyperplasie der Prostata als „klassische“ Kontraindikation und zu einer breiteren Indikationsstellung zur konservativen Therapie bei Non-Respondern. Die vorliegende Analyse der aktuellen Publikationen zur Anwendung von Anticholinergika zeigt, daß ein selektioniertes Patientenkollektiv mit irritativen Beschwerden bei BPS von dieser Therapie profitieren kann. Eine Tendenz zur Entwicklung des akuten Harnverhaltes konnte nicht eindeutig nachgewiesen werden. Eine kontrollierte Anwendung von Anticholinergika in Kombination mit selektiven Alpha-1-Blockern scheint möglich zu sein. Weitere Studien auf diesem Gebiet müssen noch nicht geklärte Fragen beantworten und die Wirkung von neuen anticholinergen Substanzen wie M3-selektiven Antimuskarinika oder Fesoterodin prüfen.

  18. Nagelbefall kann bei Patienten mit Psoriasis auf eine Enthesiopathie hinweisen.

    Science.gov (United States)

    Castellanos-González, Maria; Joven, Beatriz Esther; Sánchez, Julio; Andrés-Esteban, Eva María; Vanaclocha-Sebastián, Francisco; Romero, Pablo Ortiz; Díaz, Raquel Rivera

    2016-11-01

    Obwohl subklinische Enthesiopathie ein gut etabliertes diagnostisches Merkmal der Psoriasisarthritis (PsA) ist, wird sie häufig übersehen, da viele Patienten asymptomatisch sind. Gäbe es klinische Hinweise auf das Vorliegen einer Enthesiopathie, würde dies den Klinikern die Möglichkeit eröffnen, eine PsA frühzeitig zu diagnostizieren. Es wurde eine monozentrische prospektive Studie mit insgesamt 90 Psoriasis-Patienten durchgeführt, um mittels Ultraschall das Vorliegen von Enthesenanomalien zu untersuchen und eine Korrelation mit dem Befall der Nägel festzustellen. Enthesenanomalien wurden bei 23 Patienten (25,5 %) gefunden, von denen 19 (82,6 %) Nagelbefall aufwiesen. Bei 4 Patienten waren die Nägel nicht betroffen. Enthesiopathie lag bei 31,1 % (19/61) der Patienten mit Onychopathie vor, von den Patienten ohne Nagelbefall litten nur 13,8 % (4/29) an Enthesiopathie (p = 0,07). Zwischen dem Target-NAPSI-Score und dem Vorliegen einer Enthesiopathie bestand eine signifikante Korrelation. Eine signifikante Korrelation bestand darüber hinaus auch zwischen dem Vorliegen einer Enthesiopathie und der Anzahl der betroffenen Nägel (p = 0,035). Klinische Belege für eine Onychopathie können der Schlüssel für die frühe Diagnose einer Enthesiopathie bei Psoriasis-Patienten sein. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

  19. Teaching Pablo Neruda and Bei Dao: The Lens of Leaving.

    Science.gov (United States)

    Lichtenstein, Amanda Leigh

    2003-01-01

    Explains how the author invites young poets to tromp through the landscape of their minds in search of all things broken by using two of her favorite poems: Pablo Neruda's "Ode to Broken Things" and Bei Dao's "Comet." Outlines how the students write their own poems dealing with loss. Notes that for poets, a heap of broken images becomes an immense…

  20. Radiological diagnosis in epilepsy; Radiologische Diagnostik bei Epilepsie

    Energy Technology Data Exchange (ETDEWEB)

    Ostertun, B. [Radiologische Universitaetsklinik, Bonn (Germany). Magnetresonanztomographie

    1999-03-01

    Results: Hippocampal sclerosis, the most frequent cause of focal epilepsy, can be detected with 90-98% sensitivity by visual analysis and quantitative signal and volume measurement of the hippocampi in high-resolution coronal T{sub 2}-weighted MR images. Benign tumors, such as gangliogliomas and dysembryoplastic neuoepithelial tumors (DNT), as well as cortical dysplasias are frequently composed of cystic and solid parts, which may show calcification, but never edema. Bloodbrain-barrier disruption as seen in approximately 40% of the benign tumors are the only feature that allows to differentiate them from non-neoplastic dysplasias. In rare cases of totally calcified lesions, CT may be the only diagnostic imaging modality. Proton-density-weighted or FLAIR imaging is essential for the detection of small solid cortical lesion components, because they provide sufficient contrast with adjacent CSF. T{sub 1}-weighted inversion recovery images are most sensitive for the detection of migration and gyration abnormalities. The depiction of calcified lesions and hemosiderin deposits after trauma is most efficient with T{sub 2}* weighted gradient echo sequences. Conclusions: With further rapid improvent of high resolution MRI techniques, the near future will probably show that nearly 100% of focal epilepsies are caused by structural brain abnormalities. With refined imaging techniques applied, the sensitivity of neuroradiological evaluation is 90% at present. Therefore presurgical MRI plays a key role in epilespy surgery. (orig.) [Deutsch] Ergebnisse: Ammonshornsklerosen, die haeufigste Ursache fokaler Epilepsien, werden bei Anwendung hochaufloesender koronarer T{sub 2}-gewichteter Sequenzen durch visuelle Beurteilung und quantitative Messungen von Signal und Volumen der Hippocampi mit 90-98% Sensitivitaet nachgewiesen. Gutartige Tumoren wie Gangliogliome und dysembryoplastische neuroepitheliale Tumoren (DNT) sowie glioneuronale Hamartien weisen gehaeuft zystische Komponenten

  1. Differenzielle pharmakologische Rückfallprophylaxe bei Alkoholabhängigkeit

    Directory of Open Access Journals (Sweden)

    Mutschler J

    2011-01-01

    Full Text Available Alkoholismus stellt weltweit ein großes medizinisches Problem mit weitreichenden ökonomischen und sozialen Folgen dar. Neben psychotherapeutischen Verfahren stehen seit Kurzem auch effektive medikamentöse Behandlungsmöglichkeiten zur Verfügung. Aktuelle Studienergebnisse geben Hinweise darauf, dass Symptome wie Angst, Depression und vor allem der starke Wunsch bzw. Zwang, Alkohol zu konsumieren („Craving“ die Wirksamkeit einer pharmakologischen Rückfallprophylaxe beeinflussen. Weiterhin könnten typologische Differenzierung und Genotypisierung hilfreiche Prädiktoren für eine medikamentöse Rückfallprophylaxe bei der Alkoholabhängigkeit sein. Suchtdruck („Craving“ stellt einen der Hauptgründe für Rückfälle im Rahmen der Alkoholabhängigkeit dar. Es können aktuell drei unterschiedliche Formen von Suchtdruck unterschieden werden: Reward Craving (Belohnung, Relief Craving (Erleichterung/Entspannung und Obsessive Craving (zwanghaft. Für jede Form von Craving werden differenzierbare zentralnervöse pathophysiologische Merkmale vermutet; somit existieren mehrere potenzielle pharmakodynamische Angriffspunkte für Anti-Craving-Substanzen. Die seit über 10 Jahren für die Behandlung von Craving bei der Alkoholabhängigkeit verfügbaren Substanzen sind Acamprosat und Naltrexon. Diese Substanzen sind allerdings nicht bei allen Patienten gleichermaßen wirksam. Allgemein scheint die pharmakotherapeutische Rückfallprophylaxe wirksamer bei Patienten mit einem frühen Beginn der Alkoholabhängigkeit. Bei Patienten mit im Vordergrund stehendem Relief Craving scheint Acamprosat besser zu wirken, bei Patienten mit überwiegendem Reward Craving zeigt sich eine bessere Wirksamkeit für Naltrexon. Disulfiram, die neben Acamprosat und Naltrexon dritte und am längsten zugelassene rückfallprophylaktische Substanz, zeigt Vorteile bei Patienten mit impulsivem Trinkverhalten und ausgeprägtem Kontrollverlust. Weitere klinische Studien unter

  2. Are pancreatic autoantibodies associated with azathioprine-induced pancreatitis in Crohn's disease?

    NARCIS (Netherlands)

    Weersma, Rinse K; Batstra, Manou R; Kleibeuker, Jan H; van Dullemen, Hendrik M

    2008-01-01

    CONTEXT: Azathioprine is frequently used in the treatment of Crohn's disease. A severe side effect is acute pancreatitis, which is specific for Crohn's disease. Autoantibodies against exocrine pancreas occur in about 30% of Crohn's disease cases but not in other inflammatory diseases. Pancreatic

  3. Are pancreatic autoantibodies associated with azathioprine-induced pancreatitis in Crohn's disease?

    NARCIS (Netherlands)

    Weersma, Rinse K; Batstra, Manou R; Kleibeuker, Jan H; van Dullemen, Hendrik M

    2008-01-01

    CONTEXT: Azathioprine is frequently used in the treatment of Crohn's disease. A severe side effect is acute pancreatitis, which is specific for Crohn's disease. Autoantibodies against exocrine pancreas occur in about 30% of Crohn's disease cases but not in other inflammatory diseases. Pancreatic aut

  4. A simple method for assessing intestinal inflammation in Crohn's disease

    Science.gov (United States)

    Tibble, J; Teahon, K; Thjodleifsson, B; Roseth, A; Sigthorsson, G; Bridger, S; Foster, R; Sherwood, R; Fagerhol, M; Bjarnason, I

    2000-01-01

    BACKGROUND AND AIMS—Assessing the presence and degree of intestinal inflammation objectively, simply, and reliably is a significant problem in gastroenterology. We assessed faecal excretion of calprotectin, a stable neutrophil specific marker, as an index of intestinal inflammation and its potential use as a screening test to discriminate between patients with Crohn's disease and those with irritable bowel syndrome.
METHODS—The validity of faecal calprotectin as a marker of intestinal inflammation was assessed in 22 patients with Crohn's disease (35 studies) by comparing faecal excretions and concentrations using four day faecal excretion of 111indium white cells. A cross sectional study assessed the sensitivity of faecal calprotectin concentration for the detection of established Crohn's disease (n=116). A prospective study assessed the value of faecal calprotectin in discriminating between patients with Crohn's disease and irritable bowel syndrome in 220 patients referred to a gastroenterology clinic.
RESULTS—Four day faecal excretion of 111indium (median 8.7%; 95% confidence interval (CI) 7-17%; normal <1.0%) correlated significantly (p<0.0001) with daily (median ranged from 39 to 47 mg; normal <3 mg; r=0.76-0.82) and four day faecal calprotectin excretion (median 101 mg; 95% CI 45-168 mg; normal <11 mg; r=0.80) and single stool calprotectin concentrations (median 118 mg/l; 95% CI 36-175 mg/l; normal <10 mg/l; r=0.70) in patients with Crohn's disease. The cross sectional study showed a sensitivity of 96% for calprotectin in discriminating between normal subjects (2 mg/l; 95% CI 2-3 mg/l) and those with Crohn's disease (91 mg/l; 95% CI 59-105 mg/l). With a cut off point of 30 mg/l faecal calprotectin has 100% sensitivity and 97% specificity in discriminating between active Crohn's disease and irritable bowel syndrome.
CONCLUSION—The calprotectin method may be a useful adjuvant for discriminating between patients with Crohn's disease and

  5. Genetic studies of Crohn's disease: past, present and future.

    Science.gov (United States)

    Liu, Jimmy Z; Anderson, Carl A

    2014-06-01

    The exact aetiology of Crohn's disease is unknown, though it is clear from early epidemiological studies that a combination of genetic and environmental risk factors contributes to an individual's disease susceptibility. Here, we review the history of gene-mapping studies of Crohn's disease, from the linkage-based studies that first implicated the NOD2 locus, through to modern-day genome-wide association studies that have discovered over 140 loci associated with Crohn's disease and yielded novel insights into the biological pathways underlying pathogenesis. We describe on-going and future gene-mapping studies that utilise next generation sequencing technology to pinpoint causal variants and identify rare genetic variation underlying Crohn's disease risk. We comment on the utility of genetic markers for predicting an individual's disease risk and discuss their potential for identifying novel drug targets and influencing disease management. Finally, we describe how these studies have shaped and continue to shape our understanding of the genetic architecture of Crohn's disease.

  6. Development of CAD prototype system for Crohn's disease

    Science.gov (United States)

    Oda, Masahiro; Kitasaka, Takayuki; Furukawa, Kazuhiro; Watanabe, Osamu; Ando, Takafumi; Goto, Hidemi; Mori, Kensaku

    2010-03-01

    The purpose of this paper is to present a CAD prototype system for Crohn's disease. Crohn's disease causes inflammation or ulcers of the gastrointestinal tract. The number of patients of Crohn's disease is increasing in Japan. Symptoms of Crohn's disease include intestinal stenosis, longitudinal ulcers, and fistulae. Optical endoscope cannot pass through intestinal stenosis in some cases. We propose a new CAD system using abdominal fecal tagging CT images for efficient diagnosis of Crohn's disease. The system displays virtual unfolded (VU), virtual endoscopic, curved planar reconstruction, multi planar reconstruction, and outside views of both small and large intestines. To generate the VU views, we employ a small and large intestines extraction method followed by a simple electronic cleansing method. The intestine extraction is based on the region growing process, which uses a characteristic that tagged fluid neighbor air in the intestine. The electronic cleansing enables observation of intestinal wall under tagged fluid. We change the height of the VU views according to the perimeter of the intestine. In addition, we developed a method to enhance the longitudinal ulcer on views of the system. We enhance concave parts on the intestinal wall, which are caused by the longitudinal ulcer, based on local intensity structure analysis. We examined the small and the large intestines of eleven CT images by the proposed system. The VU views enabled efficient observation of the intestinal wall. The height change of the VU views helps finding intestinal stenosis on the VU views. The concave region enhancement made longitudinal ulcers clear on the views.

  7. A case of Crohn's disease involving the gallbladder

    Institute of Scientific and Technical Information of China (English)

    Akira Andoh; Yoshihiro Endo; Ryoji Kushima; Kazunori Hata; Tomoyuki Tsujikawa; Masaya Sasaki; Eiji Mekata; Toru Tani; Yoshihide Fujiyama

    2006-01-01

    Crohn's disease is well known to affect any part of the gastrointestinal tract including the oral cavity and anus.Various extraintestinal complications have been reported in Crohn's disease, but extraintestinal involvement characterized by granulomatous lesions is uncommon. Here, we have reported a case about the involvement of the gallbladder in Crohn's disease. A 33-year-old woman was diagnosed having panperitonitis due to intestinal perforation and cholecystitis. The patient was moved to the surgical service for an emergency operation. On the resected specimen, there was a broad longitudinal ulcer at the mesenteric side. The mucosa of the gallbladder was nodular and granular, and the wall was thickened.The surface epithelium of the gallbladder was partially eroded and pyloric gland metaplasia was observed focally. Rokitansky-Aschoff sinuses were also present.From the lamina propria to the subserosal layer, there were several well-formed epithelioid cell granulomas,which were the non-caseating sarcoidal type different from the foreign-body and xanthomatous granulomas.Periodic-acid Schiff and acid fast stains revealed no organism within the granulomas. Lymphoid aggregates were present throughout the gallbladder wall. Sections from the resected ileum showed typical features of the Crohn's disease. When cholecystectomy is performed in a patient with Crohn's disease, the possibility of gallbladder involvement should be carefully examined by histopathological tests.

  8. Optimal vitamin D levels in Crohn's disease: a review.

    Science.gov (United States)

    Raftery, Tara; O'Sullivan, Maria

    2015-02-01

    Vitamin D deficiency is common among patients with Crohn's disease. Serum 25-hydroxyvitamin D (25(OH)D) is the best measure of an individual's vitamin D status and current cut-off ranges for sufficiency are debatable. Several factors contribute to vitamin D deficiency in Crohn's disease. These include inadequate exposure to sunlight, inadequate dietary intake, impaired conversion of vitamin D to its active metabolite, increased catabolism, increased excretion and genetic variants in vitamin D hydroxylation and transport. The effects of low 25(OH)D on outcomes other than bone health are understudied in Crohn's disease. The aim of the present review is to discuss the potential roles of vitamin D and the possible levels required to achieve them. Emerging evidence suggests that vitamin D may have roles in innate and adaptive immunity, in the immune-pathogenesis of Crohn's disease, prevention of Crohn's disease-related hospitalisations and surgery, in reducing disease severity and in colon cancer prevention. The present literature appears to suggest that 25(OH)D concentrations of ≥75 nmol/l may be required for non-skeletal effects; however, further research on optimal levels is required.

  9. Crohn's disease in one mixed-race population in Brazil

    Institute of Scientific and Technical Information of China (English)

    Genoile Oliveira Santana; Luiz Guilherme Costa Lyra; Tamara Celi Almeida Santana; Lidiane Bianca dos Reis; Jorge Carvalho Guedes; Maria Betania Toralles; André Castro Lyra

    2007-01-01

    AIM: To evaluate the classification and severity of Crohn's disease in different racial groups.METHODS: Patients with Crohn's disease from the outpatient clinic of the University Hospital Prof. Edgard Santos were enrolled in the study. This hospital is a reference centre for inflammatory bowel disease. Race was determined using self-identification. The Vienna's classification was applied for all subjects. The severity of Crohn's disease was determined according to the number of surgical procedures, hospital admissions in the last year and treatment with steroids and immunosuppressors. Statistical analysis was calculated using t test for means, χ2 or F for proportions. A P value < 0.05 was considered to be significant.RESULTS: Sixty-five patients were enrolled. Non-white patients were more frequently diagnosed with Crohn's disease in the age less than 40 years than white patients. The behaviour of disease was similar in both groups with a high frequency of the penetrating form.There was a tendency for non-white patients to have a greater frequency of hospital admissions in the last year compared to white subjects. Non-whites also had a higher rate of colonic and upper gastrointestinal involvement, and were also more frequently on treatment with immunossupressors than white patients although this difference was not statistically significant.CONCLUSION: Non-white patients with Crohn's disease had an earlier diagnosis and appeared to have had a more severe disease presentation than white patients.

  10. Ovarian involvement in Crohn's disease: a rare complication

    Directory of Open Access Journals (Sweden)

    Rosa Saborit

    2016-02-01

    Full Text Available Background: The transmural condition of Crohn's disease predisposes to fistulae or abscesses. The internal fistula incidence is about 15%. Among them, enteroovarian fistula is rarely described on the literature. Herein, the authors present three cases of enteroovarian fistulas. Case reports: Two women are diagnosed with ileal Crohn's disease that presented a pelvic abscess diagnosed by ultrasound and CT. On surgery, an inflammatory mass involving the ileum and the ovary was found. The third woman was operated because of a tuboovarian abscess and was diagnosed with ileal Crohn's disease afterwards. In the three cases, the histopathological analysis of the ovary showed granulomas with abscess compatible with Crohn's disease. In one of the cases, multinucleated giant cells were found in the foreign body reaction to vegetable matter. A right ileocolectomy and an adnexectomy were performed in all three cases. No further involvement of the contralateral ovary or other gynaecological complications was observed. Discussion: The treatment of Crohn's disease complications should be individualized. In the case of ovarian involvement, surgical treatment should include adnexectomy.

  11. Littoral Cell Angioma in a Patient with Crohn's Disease

    Science.gov (United States)

    Björnsson, Bergthor; Ignatova, Simone; Sandström, Per; Ekstedt, Mattias

    2015-01-01

    Littoral cell angioma is a rare vascular tumor of the spleen. The pathogenesis is unknown but the lesion is associated with several malignancies and immunological disorders. The diagnosis requires histopathological examination. The malignant potential of this lesion is unknown, which is why splenectomy is recommend for all cases. Symptomatic cases generally suffer from hypersplenism and pyrexia. A previously healthy 20-year-old female was diagnosed with colonic Crohn's disease; as part of the work-up a magnetic resonance enterography was performed which showed multiple signal changes of the spleen. The patient reported chronic abdominal pain in the left upper quadrant, malaise, and fever. The unknown splenic lesions prompted a laparoscopic splenectomy; pathology revealed a littoral cell angioma. The abdominal pain and malaise remitted but the fever persisted one year despite adequate treatment of the patient's Crohn's disease. Littoral cell angioma is associated with immune-dysregulation including Crohn's disease with several reported cases. Signs and symptoms of hypersplenism and splenic lesions on imaging should raise suspicion of littoral cell angioma in patients with Crohn's disease. Magnetic resonance enterography to assess disease severity in Crohn's disease may provide an opportunity to study the prevalence and natural history of this rare splenic tumor. PMID:25705528

  12. CT enterography for Crohn's disease: optimal technique and imaging issues.

    Science.gov (United States)

    Baker, Mark E; Hara, Amy K; Platt, Joel F; Maglinte, Dean D T; Fletcher, Joel G

    2015-06-01

    CT enterography (CTE) is a common examination for patients with Crohn's disease. In order to achieve high quality, diagnostic images, proper technique is required. The purpose of this treatise is to review the processes and techniques that can optimize CTE for patients with suspected or known Crohn's disease. We will review the following: (1) how to start a CT enterography program; (2) workflow issues, including patient and ordering physician education and preparation; (3) oral contrast media options and administration regimens; (4) intravenous contrast media injection for uniphasic and multiphasic studies; (5) CTE radiation dose reduction strategies and the use of iterative reconstruction in lower dose examinations; (6) image reconstruction and interpretation; (7) imaging Crohn's patients in the acute or emergency department setting; (8) limitations of CTE as well as alternatives such as MRE or barium fluoroscopic examinations; and (9) dictation templates and a common nomenclature for reporting findings of CTE in Crohn's disease. Many of the issues discussed are summarized in the Abdominal Radiology Society Consensus MDCT Enterography Acquisition Protocol for Crohn's Disease.

  13. [Transforming growth factor-beta controls pathogenesis of Crohn disease].

    Science.gov (United States)

    Friess, H; di Mola, F F; Egger, B; Scheuren, A; Kleeff, J; Zimmermann, A; Büchler, M W

    1998-01-01

    The pathogenetic mechanisms which contribute to the progression of Crohn's disease are still not known. Transforming growth factor-beta (TGF-beta) and its subtypes are multifunctional polypeptides which regulate immunological processes as well as the synthesis of the extracellular matrix and fibrogenesis. In the present study, Crohn's disease tissue samples of 18 patients undergoing intestinal resection were analyzed by Northern blot analysis, in situ hybridization and immunostaining for TGF-beta 1-3 and the TGF-beta receptors type I-III (T beta R-I, T beta R-II, T beta R-III). There was a marked overexpression of TGF-beta 1, TGF-beta 3 and T beta R-II in 94% of the Crohn's disease tissue samples. TGF-beta 2 and T beta R-I ALK5 and T beta R-III were enhanced in 72%, 72% and 82% of the Crohn tissue samples, respectively. In situ hybridization and immunostaining revealed that there was frequent coexpression of TGF-beta with its signaling receptors. Our data indicate that TGF-beta and their receptors seem to be involved in the pathogenesis of Crohn's disease. Their enhanced expression might contribute to the increase in extracellular matrix resulting in fibrosis and subsequently in intestinal obstruction.

  14. Omega-3 fatty acids as adjunctive therapy in Crohns disease.

    Science.gov (United States)

    Macdonald, Angie

    2006-01-01

    Crohns disease is an inflammatory bowel disease that can have a significant impact on the health of those afflicted. The etiology of the disease is unknown, but genetic, environmental, dietary, and immunological factors are thought to be involved. Multiple nutrients can become depleted during active disease due to inadequate intake or malabsorption. Preventing these deficiencies is paramount in the care of those suffering from Crohns disease. Often the traditional treatments (medications) have limited effectiveness and negative side effects that inhibit their use. Enteral nutrition has promising therapeutic benefits, but its use is often limited to the pediatric population due to poor patient acceptability. Omega-3 fatty acids have been investigated for their anti-inflammatory properties as an alternative to traditional care. This article reviews the etiology of Crohns disease, nutritional deficiencies, traditional treatments, and the use of omega-3 fatty acids in the prevention of Crohns recurrence. The results from clinical trials have been conflicting, but a new fish oil preparation that limits the side effects of traditional fish oil therapy shows promise as an adjunctive treatment for Crohns disease. Continued research is needed to validate these findings.

  15. Pneumonia in immunosuppressed patients; Pneumonien bei immunsupprimierten Patienten

    Energy Technology Data Exchange (ETDEWEB)

    Solyanik, O.; Gaass, T.; Hellbach, K. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Institut fuer klinische Radiologie, Muenchen (Germany); Dinkel, J. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Institut fuer klinische Radiologie, Muenchen (Germany); Comprehensive Pneumology Center Munich (CPC-M), Muenchen (Germany)

    2017-01-15

    Pulmonary infections are a common complication in immunosuppressed patients with a frequently fatal prognosis despite modern prophylactic therapy. An early and correct diagnosis is important for initiation of the appropriate therapy. Chest radiography is the preferred initial imaging examination but is not accurate enough for the detection of pulmonary infections in immunosuppressed patients. Pneumonia is caused by a broad spectrum of pathogens in immunocompromised patients. In addition to imaging, the clinical history and epidemiology also play an important role in the diagnostics. Using epidemiological and anamnestic information, computed tomography (CT) shows a significantly better sensitivity and specificity particularly for the diagnosis of atypical forms of pneumonia. Due to the exact imaging of the different infiltration patterns CT provides an increased sensitivity with respect to the etiological classification of pulmonary infections. This article reviews in particular the radiological findings of commonly occurring pulmonary infections in immunosuppressed patients. (orig.) [German] Pneumonien bei immunsupprimierten Patienten sind haeufige Komplikationen, die trotzt moderner Prophylaxe toedlich verlaufen koennen. Eine korrekte Diagnose ist daher von entscheidender Bedeutung, um die richtige Therapie einleiten zu koennen. Die Roentgenthoraxaufnahme ist selten spezifisch genug fuer die genaue Einordnung atypischer Pneumonien in Folge einer Immunsuppression. Pneumonien unter Immunsuppression werden durch ein sehr breites Erregerspektrum verursacht. Eine wichtige Rolle bei der Diagnosefindung spielen neben der Bildgebung auch die klinische Anamnese und Epidemiologie. Mithilfe der klinischen Anamnese und Epidemiologie bietet die Computertomographie (CT) bei immunsupprimierten Patienten zum einen eine erhoehte Sensitivitaet bei der Detektion insbesondere atypischer Pneumonien. Zum anderen weist die CT durch die exakte Abbildung unterschiedlicher Infiltratmuster

  16. Evolving role of MRI in Crohn's disease.

    Science.gov (United States)

    Yacoub, Joseph H; Obara, Piotr; Oto, Aytekin

    2013-06-01

    MR enterography is playing an evolving role in the evaluation of small bowel Crohn's disease (CD). Standard MR enterography includes a combination of rapidly acquired T2 sequence, balanced steady-state acquisition, and contrast enhanced T1-weighted gradient echo sequence. The diagnostic performance of these sequences has been shown to be comparable, and in some respects superior, to other small bowel imaging modalities. The findings of CD on MR enterography have been well described in the literature. New and emerging techniques such as diffusion-weighted imaging (DWI), dynamic contrast enhanced MRI (DCE-MRI), cinematography, and magnetization transfer, may lead to improved accuracy in characterizing the disease. These advanced techniques can provide quantitative parameters that may prove to be useful in assessing disease activity, severity, and response to treatment. In the future, MR enterography may play an increasing role in management decisions for patients with small bowel CD; however, larger studies are needed to validate these emerging MRI parameters as imaging biomarkers.

  17. Network Modeling of Crohn's Disease Incidence.

    Directory of Open Access Journals (Sweden)

    Jean-Marc Victor

    Full Text Available Numerous genetic and environmental risk factors play a role in human complex genetic disorders (CGD. However, their complex interplay remains to be modelled and explained in terms of disease mechanisms.Crohn's Disease (CD was modeled as a modular network of patho-physiological functions, each summarizing multiple gene-gene and gene-environment interactions. The disease resulted from one or few specific combinations of module functional states. Network aging dynamics was able to reproduce age-specific CD incidence curves as well as their variations over the past century in Western countries. Within the model, we translated the odds ratios (OR associated to at-risk alleles in terms of disease propensities of the functional modules. Finally, the model was successfully applied to other CGD including ulcerative colitis, ankylosing spondylitis, multiple sclerosis and schizophrenia.Modeling disease incidence may help to understand disease causative chains, to delineate the potential of personalized medicine, and to monitor epidemiological changes in CGD.

  18. Management of postoperative recurrence of Crohn's disease.

    Science.gov (United States)

    van Lent, Anja U; D'Haens, Geert R

    2013-01-01

    The course of Crohn's disease (CD) is unpredictable and potentially destructive. The percentage of patients requiring surgery at some stage in their disease accumulates to over 70%. After resection of the affected intestine, reappearance of CD occurs in the majority of patients. Prophylactic medical therapy to reduce the rate of postoperative recurrence has been proven to be effective, yet the incidence of recurrence remains high. Patient profiling (risk stratification) is important in this postoperative setting. High-risk patients (associated with e.g. smoking, the need of repetitive surgery and penetrating disease) require strong immunosuppressive treatment, which should be commenced immediately after surgery, when recurrent disease activity begins. Additionally, early screening endoscopy should be performed to monitor treatment effect. The efficacy of thiopurines is shown to be higher than mesalazine or imidazole antibiotics alone for preventing and ameliorating endoscopic recurrence of CD postoperatively; however, anti-tumor necrosis factors (anti-TNFs) are increasingly considered the most potent agents. In patients with a risk factor for early postoperative recurrence, the first line of treatment is 6-mercaptopurine, in combination with imidazole antibiotics if tolerated, followed by anti-TNFs. When lesions are found at colonoscopy, therapy should be upscaled. We propose a treatment algorithm to direct therapeutic management of CD postoperatively. © 2013 S. Karger AG, Basel.

  19. [Surgical treatment for perianal Crohn's disease].

    Science.gov (United States)

    Futami, Kitaro; Higashi, Daijiro; Hirano, Yukiko; Ikeda, Yuichi; Mikami, Koji; Hirano, Kimikazu; Miyake, Toru; Takahashi, Hiroyuki; Maekawa, Takafumi

    2015-03-01

    Perianal lesions are a frequent complication of Crohn's disease (CD) and include fistula, abscess, anal ulcer, skin tag, anal stricture, and carcinoma. Perianal fistula is the most commonly observed condition and exhibits multiple incidence and intractable characteristics. The starting point for the management of perianal fistula is an accurate diagnosis, which requires careful exploration during an EUA. The condition is treated with medications such as antibiotics, immunosuppressants, or anti-tumor necrosis factor agents. However, it is difficult to maintain long-term remission. Surgical therapy is selected according to the type of fistula and can include conventional fistulotomy, seton drainage, diverting stoma, and anorectal amputation. After fistulotomy, recurrence is frequent and there is an increased risk of incontinence. Seton drainage is the preferred treatment to improve symptoms and preserve anal function. Stoma is useful to relieve symptoms but difficult to indicate for young patients. The optimum treatment for perianal fistula associated with CD remains controversial. Currently, the goal of therapy for these patients has shifted from complete fistula closure to reducing drainage from the fistula to improve their quality of life. Ongoing careful management is important to control anal symptoms and maintain long-term anal function in the treatment of patients with CD, while monitoring them to detect possible progression to anorectal carcinoma.

  20. Imaging of perianal fistulizing Crohn's disease.

    Science.gov (United States)

    Chidi, Vivian N; Schwartz, David A

    2015-06-01

    Perianal fistula is a complication of Crohn's disease that carries a high morbidity. It is a channel that develops between the lower rectum, anal canal and perianal or perineal skin. The development of perianal fistulas typically connotes a more aggressive disease phenotype and may warrant escalation of treatment to prevent poor outcomes over time. Based on fistula anatomy, debris can form inside these tracts and cause occlusion, which subsequently leads to abscess formation, fever and malaise. The clinical presentation is often with complaints of pain, continuous rectal drainage of fecal matter as well as malodorous discharge. Considering that the presence of fistulas often indicates refractory and aggressive disease, early identification of its presence is important. Some patients may not have the classic symptoms of fistulizing disease at presentation and others may have significant scarring and/or pain from previous fistulizing episodes, which can make an accurate assessment on physical exam alone problematic. As a result, utilizing diagnostic imaging is the best means of identifying the early signs of perianal fistulas or abscess formation in these patients. Several imaging modalities exist which can be used for diagnosis and management. Endoscopic ultrasound and pelvic MRI are considered the most useful in establishing the diagnosis. However, a combination of multiple imaging modalities and/or examination under anesthesia is probably the most ideal. Incomplete characterization of the fistula tract(s) extent or the presence of abscess carries a high morbidity and far-reaching personal expense for the patient - promoting worsening of the disease.

  1. Natalizumab in the treatment of Crohn's disease.

    Science.gov (United States)

    Guagnozzi, Danila; Caprilli, Renzo

    2008-06-01

    The pathogenesis of Crohn's disease (CD) is multifactorial and the activation of specific pathways of immunological system is important. In particular, the adhesion molecules (integrins) mediate the selective binding between the leukocytes and the endothelial cells regulating the migration of leukocytes into the normal and inflamed intestine. Selective adhesion molecule inhibitors interfere with the migration of leukocytes to the sites of inflammation by targeting adhesion molecules (alpha4-integrin or alpha4beta7-integrin). Natalizumab is a humanized IgG4 anti-alpha4-integrin monoclonal antibody that inhibits both alpha4beta7-integrin/mucosal addressin-cell adhesion molecule-1 (MadCAM-1) interaction and alpha4beta1/vascular-cell adhesion molecule-1 (VCAM-1) binding. Pooled data from the four studies, analyzed in a Cochrane review, suggest that natalizumab is effective for induction of clinical response and remission in patients with moderately to severely active CD. In particular, natalizumab may be beneficial for patients with active inflammation or chronically active disease despite the use of conventional therapies with high level of C-reactive protein values at baseline time. Nevertheless, many problems about the utilization of natalizumab in CD remain unsolved (such as the high placebo response, the final definition of dosage and timing schedule, the definition of outcomes and the development of adverse events).

  2. Hormonimplantate zur Kontrazeption bei der Frau

    Directory of Open Access Journals (Sweden)

    Rabe T

    2013-01-01

    Full Text Available Hormonimplantate sind Kontrazeptiva, die, subdermal implantiert, über einen längeren Zeitraum eine zuverlässige Kontrazeption bieten. Als Träger werden inerte oder biologisch abbaubare Stäbchen oder Kapseln verwendet, die das jeweilige Steroid kontinuierlich über einen längeren Zeitraum freisetzen. Seit 1966 forscht das Population Council in New York an der Langzeitkontrazeption mit subdermalen Hormonimplantaten. Diese bestehen aus einem oder mehreren kleinen, flexiblen Stäbchen oder aus einer Kapsel, die unter die Haut des Oberarmes eingesetzt werden. Sie setzen dort je nach Produkt die Gestagene Megestrolazetat, Norethindron, Norgestrinon oder Etonogestrel über einen Zeitraum von 1–5 Jahren frei. Norplant® bestand aus 6 Stäbchen. Jedes dieser Stäbchen enthält 36 mg Levonorgestrel. Die Wirkdauer dieser 6 Stäbchen betrug insgesamt 5 Jahre; seit 2008 wird es nicht mehr vermarktet. Norplant II® (Jadelle®, das Nachfolgeprodukt von Norplant®, besteht aus 2 flexiblen Silikonstäbchen (43 mm × 2,5 mm mit jeweils 75 mg Levonorgestrel und hat ebenfalls eine Wirkdauer von 5 Jahren. In China ist das gleiche Produkt unter dem Namen Sinoplant im Handel. Implanon® ist ein etonogestrelfreisetzendes Hormonimplantat, das im Jahr 2000 von Organon (jetzt MSD zugelassen wurde. Das Stäbchen von 4 cm Länge und 2 mm Durchmesser besteht aus 40 % Ethylenvinylacetat (EVA und 60 % 68-mg-Etonogestrel (3-Keto-Desogestrel. Die Wirkdauer beträgt nach subdermaler Implantation 3 Jahre. Der Pearl-Index liegt nach Herstellerangaben unter 0,1. Insofern zählt es zu den sicheren Verhütungsmethoden. Der Wirkspiegel sinkt in Abhängigkeit vom Körpergewicht mit der Zeit ab. Klinische Erfahrungen mit Implanon® bei adipösen Frauen im 3. Jahr der Anwendung sind beschränkt. Eine Voraussetzung für die Zuverlässigkeit ist die korrekte Einlage. Unter Implanon® gibt es Fälle, in denen das Stäbchen nicht korrekt eingelegt wurde. Dies kann dazu führen, dass

  3. Ramiprilate inhibits functional matrix metalloproteinase activity in Crohn's disease fistulas

    DEFF Research Database (Denmark)

    Efsen, Eva; Saermark, Torben; Hansen, Alastair

    2011-01-01

    Increased expression of matrix metalloproteinase (MMP)-2, -3 and -9 has been demonstrated in Crohn's disease fistulas, but it is unknown whether these enzymes are biologically active and represent a therapeutic target. Therefore, we investigated the proteolytic activity of MMPs in fistula tissue...... and examined the effect of inhibitors, including clinically available drugs that beside their main action also suppress MMPs. Fistula specimens were obtained by surgical excision from 22 patients with Crohn's disease and from 10 patients with fistulas resulting from other causes. Colonic endoscopic biopsies......-diamine-tetraacetic acid (EDTA), the synthetic broad-spectrum inhibitor, GM6001, the angiotensin-converting enzyme (ACE) inhibitor, ramiprilate, and the tetracycline, doxycycline. In Crohn's disease fistulas, about 50% of the total protease activity was attributable to MMP activity. The average total MMP activity...

  4. Ramiprilate inhibits functional matrix metalloproteinase activity in Crohn's disease fistulas

    DEFF Research Database (Denmark)

    Efsen, Eva; Saermark, Torben; Hansen, Alastair

    2011-01-01

    Increased expression of matrix metalloproteinase (MMP)-2, -3 and -9 has been demonstrated in Crohn's disease fistulas, but it is unknown whether these enzymes are biologically active and represent a therapeutic target. Therefore, we investigated the proteolytic activity of MMPs in fistula tissue...... and examined the effect of inhibitors, including clinically available drugs that beside their main action also suppress MMPs. Fistula specimens were obtained by surgical excision from 22 patients with Crohn's disease and from 10 patients with fistulas resulting from other causes. Colonic endoscopic biopsies......-diamine-tetraacetic acid (EDTA), the synthetic broad-spectrum inhibitor, GM6001, the angiotensin-converting enzyme (ACE) inhibitor, ramiprilate, and the tetracycline, doxycycline. In Crohn's disease fistulas, about 50% of the total protease activity was attributable to MMP activity. The average total MMP activity...

  5. Inflammation profile of four early onset Crohn patients.

    Science.gov (United States)

    Marcuzzi, Annalisa; Girardelli, Martina; Bianco, Anna Monica; Martelossi, Stefano; Magnolato, Andrea; Tommasini, Alberto; Crovella, Sergio

    2012-02-10

    Crohn disease (CD) is a multifactorial disorder affecting mainly young adults. Sometimes, however, it can present in the first year of life (Early onset Crohn disease (EOCD)) showing an unpredictable course and can often be more severe than at older ages. Some cases have been associated to an underlying primary immunodeficiency such as IL10R deficiency. We studied the functional response to IL-10 and the genotype of IL-10 receptor in four patients with early onset crohn-like colitis. We found an IL10R variant, which may be associated with a decreased response to the cytokine in one patient. Further studies to determine its pathogenic effect should be performed. In addition IL-10 mediated inhibition of LPS-induced TNFα expression was measured in patient's monocytes.

  6. Crohn's disease presenting as a ceco-urachal fistula.

    Science.gov (United States)

    Tsukui, Hidenori; Koinuma, Koji; Morimoto, Mitsuaki; Horie, Hisanaga; Lefor, Alan Kawarai; Kagaya, Yuka; Takahashi, Haruo; Yano, Tomonori; Matsubara, Daisuke; Yamamoto, Hironori; Sata, Naohiro

    2017-02-01

    We report the case of a patient with Crohn's disease who initially presented with a ceco-urachal fistula. The patient was a 31-year-old female who underwent an appendectomy 6 years before presenting to our institution. She had a one-year history of diarrhea, and had recently developed polyuria and a sensation of residual urine. She was admitted with fever and lower abdominal pain. Endoscopy and computed tomography revealed a ceco-urachal fistula, which was consistent with Crohn's disease. An urachal resection was performed, which included partial cystectomy and ileocecal resection. A ceco-urachal fistula is a rare initial symptom of Crohn's disease. During the surgical management of such cases, it is necessary to resect the urachus, the affected portion of the bladder, the fistula, and the affected part of the digestive tract in order to avoid recurrence.

  7. Granulomatous bronchiolitis with necrobiotic pulmonary nodules in Crohn's disease.

    Science.gov (United States)

    Freeman, Hugh J; Davis, Jennifer E; Prest, Marcia E; Lawson, Edward J

    2004-11-01

    A 37-year-old man with extensive Crohn's disease of the stomach, small and large intestine for almost a decade developed respiratory symptoms and radiological findings suggestive of pneumonia that failed to resolve with antibiotic treatment. Computed tomography scanning of his lungs showed extensive changes with cavitated parenchymal nodules. Histological evaluation of an open lung biopsy showed granulomatous bronchiolitis and pulmonary necrobiosis. Treatment with steroids and immunosuppression resulted in complete resolution of his clinical symptoms of pneumonia and abnormal computed tomography imaging changes. Granulomatous bronchiolitis and necrobiotic nodules may be a manifestation of Crohn's disease in the absence of microbial agents, including mycobacteria or fungal agents. While a multiplicity of complex pulmonary changes may occur in Crohn's disease, their clinical recognition and precise pathological definition may be particularly important if treatment with a biological agent, such as infliximab, is being considered.

  8. Angioedema associated with Crohn's disease: response to biologics.

    Science.gov (United States)

    Habal, Flavio; Huang, Vivian

    2012-09-14

    A 46-year-old female patient with terminal ileum Crohn's disease and ankylosing spondylitis presented with recurrent angioedema and urticaria. Investigations ruled out hereditary angioedema, and environmental or food allergen triggers. She was diagnosed with chronic idiopathic urticaria with angioedema, and was treated with a trial of intravenous immunoglobulin immunotherapy, danazol, prednisone and hydroxyzine. Due to ongoing bowel and arthritic complaints, she was started on infliximab infusions and within 2 treatments, she had complete resolution of the angioedema and urticaria, as well as of the bowel and arthritic symptoms. Unfortunately she developed allergic reactions to the infliximab and was switched to another anti-tumor necrosis factor (TNF)-α agent, adalimumab. Since then, she has had no further angioedema or urticaria, and her Crohn's disease has been quiescent. This is the first known case report of chronic idiopathic urticaria with angioedema coexistent with Crohn's disease that was successfully treated with anti-TNF-α agents.

  9. Role of HLA typing on Crohn's disease pathogenesis

    Science.gov (United States)

    Mahdi, Batool Mutar

    2015-01-01

    Crohn's disease (CD) is the main type of chronic inflammatory bowel disease of unknown etiology. Evidence from family and twin studies suggests that genetics plays a significant role in predisposing an individual to develop Crohn's disease. A susceptibility locus for Crohn's disease has been mapped 3 to chromosome 16: a frameshift variant and two missense variants of NOD2, encoding a member of the Apaf-1/Ced-4 superfamily of apoptosis regulators which is expressed in hematopoietic compartment cells and intestinal epithelial cells as well as in paneth cells, where NOD2 may play an important role in the pathogenesis of Crohn disease in the gastrointestinal system. This leads to alteration the structure of either the leucine-rich repeat domain of the protein or the adjacent region. NOD2 activates nuclear factor NF-kB; this activating function is regulated by the carboxy-terminal leucine-rich repeat domain, which has two functions, first an inhibitory role and also acts as an intracellular receptor for components of microbial pathogens. Thus, NOD2 gene product confers susceptibility to Crohn's disease by altering the recognition of these components and/or by over-activating NF-kB in intestinal epithelial cells as well as in paneth cells. Further confirmation of a genetic predisposition comes from studies of the association between the human leukocyte antigen (HLA) system and CD. The immunogenetic predisposition may be considered an important requirement for the development of CD, as several alleles of human major histocompatibility complex had an association with CD. Although it is difficult to estimate the importance of this region in determining overall genetic susceptibility in a population, studies of HLA allele sharing within families suggest that this region contributes between 10% and 33% of the total genetic risk of Crohn's disease. PMID:26288728

  10. Long-term outcome after surgery for Crohn's anal fistula.

    Science.gov (United States)

    Graf, W; Andersson, M; Åkerlund, J-E; Börjesson, L

    2016-01-01

    Treatment of Crohn's anal fistula remains challenging and little is known about factors associated with healing. The aim of this study was to assess the rate of healing after surgical treatment and analyse clinical variables related to healing. A total of 119 patients [63 women, mean age 36 (±13.7) years] with histopathologically verified Crohn's disease underwent a surgical procedure for anal fistula at four main referral centres in Sweden, January 1998 to December 2009. Baseline and treatment-related variables were recorded and analysed for correlation with fistula healing at a final follow-up after a mean of 7.2 (median 7.1, 1.0-17.5) years. Of the 119 patients 62 (52%) were healed at final follow-up. Fourteen healed after one procedure and the remaining 48 healed after a further median of 4.0 (2-20) procedures. Ten (8%) patients were subjected to a proctectomy. Final healing was more common in patients operated with a procedure aiming at eradicating the fistula (P = 0.0001), without proctitis (P = 0.02) and a shorter duration of Crohn's disease (P = 0.0019). Long-term healing of a Crohn's anal fistula can be expected in about half of the patients, usually after repeated surgical treatment. The probability for cure was higher when a curative operation was performed in a patient without proctitis and with a shorter duration of Crohn's disease. An attempt to close a Crohn's anal fistula is thus often worthwhile. Colorectal Disease © 2015 The Association of Coloproctology of Great Britain and Ireland.

  11. A "false positive" octreoscan in ileal Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    Alberto Fernandez; Olga Tabuenca; Angeles Peteiro

    2008-01-01

    We present a case report of a patient with a suspicious ileal carcinoid turnout.Clinical examination as well as computer tomograghy (CT) scan suggested a tumour.Octeotride scan showed uptake in the same bowel loop reported as pathological in CT.The patient underwent surgery and biopsy which reported Crohn's disease (CD).The interest in the case is due to the fact that this is,to the best of our knowledge,the second report of Crohn's disease as a cause of false positive octeotride scan.Unfortunately,no somatostatin recptors could be found in the sample,so further studies should be performed.

  12. Current treatment of rectovaginal fistula in Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    Yan-Fei Zhu; Guo-Qing Tao; Ning Zhou; Chen Xiang

    2011-01-01

    Rectovaginal fistula (RVF) continues to be the most difficult perianal manifestation of Crohn's disease to treat. This devastating and disabling complication has a significant impact on patients' quality of life and presents unique management challenges.Current therapeutic approaches include many medical therapeutics and surgical treatments with a wide range of success rates reported. However,current evidence is lacking to support any recommendation. The choice of repair depends on various patient and disease factors and basic surgical tenets.In this article,we review the current options to consider in the treatment of Crohn's-related RVF,and try to evaluate their effects on fistulae closure and quality of life.

  13. Magnetic resonance imaging of perianal Crohn disease in children.

    Science.gov (United States)

    Shenoy-Bhangle, Anuradha; Gee, Michael S

    2016-05-01

    Perianal penetrating complications of Crohn disease are among the most important causes of symptoms in the pediatric population. High-quality diagnostic imaging of the perianal region is crucial for treatment planning and therapeutic response assessment. MRI, with its absence of ionizing radiation and high soft-tissue resolution, provides an excellent noninvasive tool for evaluation of perianal fistulae and associated abscesses, as well as their anatomical relationship to the anal sphincter complex. In this review we discuss the role of MRI in initial diagnosis and follow-up of perianal fistulizing Crohn disease in the pediatric population.

  14. Budesonide in the management of patients with Crohn's disease.

    Science.gov (United States)

    Thomson, A B; Sadowski, D; Jenkins, R; Wild, G

    1997-04-01

    Modern medical therapy is increasingly based on evidence. The evidence presented here is that budesonide (Entocort, Astra Pharma) 9 mg/day is superior to placebo and equivalent to systemically active glucocorticosteroids in achieving disease remission in patients with active Crohn's disease, and in prolonging the recurrence time of symptomatic disease. Budesonide causes less disturbance to adrenal function than prednisone or prednisolone and may cause fewer steroid-associated symptoms. Thus, budesonide is the safer, more effective steroid of choice to treat patients with Crohn's disease.

  15. Smoking Cessation for Crohn's Disease: Clearing the Haze.

    Science.gov (United States)

    Kaplan, Gilaad G

    2016-03-01

    The TABACROHN Study Group conducted a multicenter prospective cohort study, demonstrating that smoking cessation improved the prognosis of Crohn's disease. Patients who continued to smoke were 50% more likely to relapse compared with non-smokers. Smoking cessation reduced the risk of flaring, regardless of exposure to anti-tumor necrosis factor agents. Despite the evidence that smoking cessation is beneficial, many patients do not quit smoking after their diagnosis of Crohn's disease. Lack of awareness, physical addiction, and social context of smoking inhibit smoking cessation. In spite of this, comprehensive smoking cessation programs have been shown to be effective and reduce costs.

  16. Intestinal tuberculosis versus crohn's disease: Clinical and radiological recommendations

    Directory of Open Access Journals (Sweden)

    Raju Sharma

    2016-01-01

    Full Text Available Intestinal tuberculosis is a common clinical problem in India. The clinical features of this disease are nonspecific and can be very similar to Crohn's disease. Radiological evaluation of the small bowel has undergone a paradigm shift in the last decade. This long tubular organ that has traditionally been difficult to evaluate can now be well-visualized by some innovative imaging and endoscopic techniques. This article highlights the state-of-the-art evaluation of ulceroconstrictive diseases of the bowel and provides recommendations for the differentiation of intestinal tuberculosis from Crohn's disease.

  17. PET in cerebrovascular disease; PET bei zerebrovaskulaeren Erkrankungen

    Energy Technology Data Exchange (ETDEWEB)

    Herholz, K. [Neurologische Universitaetsklinik der Univ. Koeln (Germany)]|[Max-Planck-Institut fuer Neurologische Forschung, Koeln (Germany)

    1997-03-01

    Tissue viability is of particular interest in acute cerebral ischemia because it may be preserved if reperfusion can be achieved rapidly, e.g. by acute thrombolysis. Measurements of regional cerebral blood flow (CBF) and oxygen consumption by PET can assess tissue viability, and they have substantially increased our knowledge of th pathophysiology of ischemic stroke and the associated penumbra. Widerspread clinical application in acute stroke, however, is unlikely because of the large logistic and personnel resources required. In chronic cerebrovascular disease, measurement of regional CBF and glucose metabolism, which is usually coupled, provide detailed insights in disturbance of cortical function, e.g. due to deafferentiation, and contribute to differentiation of dementia types. Chronic misery perfusion, i.e. reduced perfusion that does not match the metabolic demand of the tissue, can be demonstrated by PET. It may be found in some patients with high-grade arterial stenoses. Less severe impairment of brain perfusion can be demonstrated by measurement of the cerebrovascular reserve capacity. The most frequent clinical situations can be assessed by less demanding procedures, e.g. by SPECT. In conclusion, PET has its role in cerebrovascular disease primarily within scientific studies, where high resolution and absolute quantitation of physiological variables are essential. (orig.). 65 refs. [Deutsch] Beim akuten ischaemischen Insult ist die Vitalitaet des Gewebes von besonderem Interesse, da sie durch rasche Reperfusion, z.B. durch Thrombolyse, erhalten bleiben kann. Messungen der zerebralen Durchblutung und des Sauerstoffumsatzes mittels PET geben darueber wesentliche Aufschluesse, und sie sind wichtig fuer das Verstaendnis der Pathophysiologie ischaemischer Infarkte und der Penumbra mit kritischer Perfusion beim Menschen. Ihre breitere Anwendung in der klinischen Patientenversorgung kommt allerdings wegen des hohen Aufwandes derzeit kaum in Betracht. Bei

  18. Ulkus Aftosa Kompleks Manifestasi Penyakit Crohn

    Directory of Open Access Journals (Sweden)

    Bernadeta Esti Chrismawaty

    2012-06-01

    Full Text Available Latar Belakang: Ulkus aftosa kompleks mengacu pada ulkus mulut kronis berkaitan dengan gangguan sistemik. Kondisi tersebut, selain menimbulkan rasa sakit dan gangguan fungsi, dapat memperburuk kualitas hidup penderitanya. Tujuan: penulisan ini bertujuan untuk melaporkan keterkaitan antara ulkus aftosa kompleks dengan gangguan gastrointestinal, yaitu penyakit crohn. Kasus dan penanganannya: laki-laki 73 tahun mengeluhkan nyeri mulut sejak 3 bulan lalu, yang disertai dengan perut sebah, kembung dan terkadang nyeri ringan disertai dengan sakit kepala. Saat pemeriksaan, tampak adanya ulkus dengan dasar bergranuler, tepi sedikit meninggi dan tertutup lapisan putih pada mukosa lipatan mukobukal, pipi, dasar mulut dan palatum. Permukaan mukosa bibir dan pipi memberikan gambaran seperti batu bata (cobblestoning. Mengacu pada gejala dan temuan klinis, ditegakkan diagnosis kerja ulkus aftosa kompleks manifestasi gangguan gastrointestinal, susprk penyakit crohn. Terapi awal berupa kombinasi spiramycin-metronidazole, methyl-prednisolone, parasetamol dan larutan kumur perhidrol. Satu minggu kemudian, tampak adanya perbaikan lesi dan aktifitas fungsional. Berdasarkan pemerikasaan dari poli penyakit dalam Rumah Sakit Umum Sardjito (RSS, pasien mendapatkan medikasi lanzoprazole, ulsidex dan enzyplex. Terapi lanjutan berupa methyl-prednisolone dengan dosis tapering, anti jamur topical nistatin untuk mencegah infeksi ikutan dan larutan kumur yeng mengandung Benzydamine HCI untuk mengurangi nyeri. Kesimpulan: Ulkus mulut manifestasi penyakit Chohn mempunyai karakteristik unik dan dapat dibedakan dari ulkus mulut kronis lainnya. Dalam penegakan diagnosis ulkus aftosa kompleks, identifikasi etiologi gangguan sistemik yang tepat akan sangat membantu dalam menetapkan perawatan lesi mulut yang sesuai.   Background: complex aphthous refers to chronic oral ulceration, which is related to systemic diseases. This condition can cause oral discomfort, alter the normal oral

  19. Postoperative Crohn's disease recurrence: A practical approach

    Institute of Scientific and Technical Information of China (English)

    Pilar Nos; Eugeni Domènech

    2008-01-01

    Crohn's disease is a chronic inflammatory condition that may involve any segment of the gastrointestinal tract. Although several drugs have proven efficacy in inducing and maintaining disease in remission, resectional surgery remains as a cornerstone in the management of the disease, mainly for the treatment of its stenosing and penetrating complications. However, the occurrence of new mucosal (endoscopic) lesions in the neoterminal ileum early after surgery is almost constant, it is followed in the mid-term by clinical symptoms and, in a proportion of patients, repeated intestinal resections are required. Pathogenesis of postoperative recurrence (POR) is not fully understood, but luminal factors (commensal microbes, dietary antigens) seem to play an important role, and environmental and genetic factors may also have a relevant influence. Hany studies tried to identify clinical predictors for POR with heterogeneous results, and only smoking has repeatedly been associated with a higher risk of POR. Ileocolonoscopy remains as the gold standard for the assessment of appearance and severity of POR, although the real usefulness of the available endoscopic score needs to be revisited and alternative techniques are emerging. Several drugs have been evaluated to prevent POR with limited success. Smoking cessation seems to be one of the more beneficial therapeutic measures. Aminosalicylates have only proved to be of marginal benefit, and they are only used in lowrisk patients. Nitroimidazolic antibiotics, althoug efficient, are associated with a high rate of intolerano and might induce irreversible side effects when used for a long-term. Thiopurines are not widely used after ileocecal resection, maybe because some concerns igiving immunomodulators in asymptomatic patient still remain. In the era of biological agents and geneti testing, a well-established preventive strategy for POR I still lacking, and larger studies to identify good clinica serological, and genetic

  20. Diagnosis and treatment of fistulising Crohn's disease.

    Science.gov (United States)

    Hvas, Christian Lodberg; Dahlerup, Jens Frederik; Jacobsen, Bent Ascanius; Ljungmann, Ken; Qvist, Niels; Staun, Michael; Tøttrup, Anders

    2011-10-01

    A fistula is defined as a pathological connection between the intestine and an inner (bladder or other intestine) or outer (vagina or skin) epithelial surface. Fistulas are discovered in up to 25% of all Crohn's disease patients during long-term follow-up examinations. Most are perianal fistulas, and these may be classified as simple or complex. The initial investigation of perianal fistulas includes imaging (MRI of the pelvis and rectum), examination under anaesthesia (EUA) with digital imaging, endoscopy, probing and anal ultrasound. Non-perianal fistulas require contrast imaging and/or CT/MRI for complete anatomical definition. Any abscess should be drained, and the disease extent throughout the entire gastrointestinal tract should be evaluated. Treatment goals for perianal fistulas include reduced fistula secretion or none, evaluated by clinical examination; the absence of abscesses; and patient satisfaction. MR imaging is required to demonstrate definitive fistula closure. Fistulotomy is considered for simple perianal fistulas. In complex perianal fistulas, antibiotics and azathioprine or 6-mercaptopurine, which are often combined with a loose seton, constitute the first-line medical therapy. In cases with persistent secretion, infliximab at 5 mg/kg is given at weeks 0, 2, and 6 and subsequently every 8 weeks. Adalimumab may improve fistula response in both infliximab-naïve patients and following infliximab treatment failure. Local therapy with fibrin glue or fistula plugs is rarely effective. Definitive surgical closure of perianal fistulas using an advancement flap may be attempted, but this procedure is associated with a high risk of relapse. Colostomy and proctectomy are the ultimate surgical treatment options for fistulas. Intestinal resection is almost always needed for the closure of symptomatic non-perianal fistulas.

  1. Managing refractory Crohn's disease: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Tanida S

    2015-04-01

    Full Text Available Satoshi Tanida, Keiji Ozeki, Tsutomu Mizoshita, Hironobu Tsukamoto, Takahito Katano, Hiromi Kataoka, Takeshi Kamiya, Takashi Joh Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Aichi Prefecture, Japan Abstract: The goals of treatment for active Crohn's disease (CD are to achieve clinical remission and improve quality of life. Conventional therapeutics for moderate-to-severe CD include 5-aminosalicylic acid, corticosteroids, purine analogs, azathioprine, and 6-mercaptopurine. Patients who fail to respond to conventional therapy are treated with tumor necrosis factor (TNF-α inhibitors such as infliximab and adalimumab, but their efficacy is limited due to primary nonresponse or loss of response. It is suggested that this requires switch to another TNF-α inhibitor, a combination therapy with TNF-α blockade plus azathioprine, or granulocyte and monocyte adsorptive apheresis, and that other therapeutic options having different mechanisms of action, such as blockade of inflammatory cytokines or adhesion molecules, are needed. Natalizumab and vedolizumab are neutralizing antibodies directed against integrin a4 and a4ß7, respectively. Ustekinumab is a neutralizing antibody directed against the receptors for interleukin-12 and interleukin-23. Here, we provide an overview of therapeutic treatments that are effective and currently available for CD patients, as well as some that likely will be available in the near future. We also discuss the advantages of managing patients with refractory CD using a combination of TNF-α inhibitors plus azathioprine or intensive monocyte adsorptive apheresis. Keywords: adalimumab, granulocyte and monocyte adsorptive apheresis, combination therapy, complete remission

  2. Ambiguity resolution performance with GPS and BeiDou for LEO formation flying

    Science.gov (United States)

    Verhagen, Sandra; Teunissen, Peter J. G.

    2014-09-01

    The evolving BeiDou Navigation Satellite System constellation brings new opportunities for high-precision applications. In this contribution the focus will be on one such application, namely precise and instantaneous relative navigation of a formation of LEO satellites. The aim is to assess the ambiguity resolution performance with the future GPS and BeiDou constellations depending on system choice (GPS, BeiDou, or GPS+BeiDou), single- or dual-frequency observations, receiver noise, and uncertainties in ionosphere modelling. In addition, for the GPS+BeiDou constellation it will be shown how the growing BeiDou constellation in the years to come can already bring an important performance improvement compared to the GPS-only case. The performance will be assessed based on the percentage of time that the required precision can be obtained with a partial ambiguity resolution strategy.

  3. Enterotomografía en la enfermedad de Crohn CT enterography in Crohn's disease

    Directory of Open Access Journals (Sweden)

    María Alejandra Lalanne

    2012-09-01

    Full Text Available Resumen Objetivos de aprendizaje. Definir el aporte de la enterotomografía (ETC para el diagnóstico, control y pronóstico de la enfermedad de Crohn (EC y detallar su forma de adquisición. Compararlo con otros métodos de diagnóstico utilizados para el estudio del intestino delgado y establecer sus ventajas y desventajas. Revisión del tema. La EC es una enfermedad inflamatoria intestinal crónica, que afecta a todo el tubo digestivo de forma discontinua y transmural. Son objetivos a determinar el compromiso del intestino delgado, el diagnóstico de la etapa aguda de la enfermedad y su respuesta al tratamiento. El curso de la enfermedad, sus complicaciones (sangrado, obstrucción, estrangulamiento, abscesos y fístulas y la severidad de los síntomas presentan una evolución variable. El diagnóstico inicial se basa en la combinación de la clínica, los hallazgos endoscópicos, bioquímicos y radiológicos. Hallazgos en imágenes. Los hallazgos característicos de la enfermedad estudiada con ETC son: aumento del realce mural e imágenes ganglionares con realce luego del contraste E.V. (ambos signos de actividad, incremento del espesor parietal y signo del halo (anillo hipodenso por depósito graso en la submucosa, proliferación de la grasa mesentérica, prominencia de los vasos rectos, áreas de estenosis, fístulas y abscesos. Conclusión. La ETC es un método accesible y fácil de emplear. Permite determinar la extensión y fase de progresión de la enfermedad, el compromiso extraintestinal y las eventuales complicaciones. La combinación de un tiempo corto de examen, una única respiración sostenida, la accesibilidad y disponibilidad del método le otorgan un rol importante en el diagnóstico y seguimiento de estos pacientes.Learning Objectives. To define the contribution of CT enterography (CTE to the diagnosis, follow-up and prognosis of Crohn's disease, and to detail image acquisition. To compare CT enterography with other

  4. Endokrinologische Behandlung der Geschlechtsdysphorie bei Menschen mit Geschlechtsinkongruenz

    Directory of Open Access Journals (Sweden)

    Flütsch N

    2015-01-01

    Full Text Available Es gibt Menschen, die die innere Gewissheit besitzen, dass ihre Geschlechtsidentität nicht zu ihrem biologischen Ursprungsgeschlecht passt. Durch die Entwicklungen in der Medizin in den letzten hundert Jahren ist es möglich geworden, die körperlichen Geschlechtsmerkmale an das innerlich erlebte Geschlecht anzupassen. Die Zahl der Hilfesuchenden in den ärztlichen Ambulanzen und Privatpraxen hat in den vergangenen Jahren deutlich zugenommen. Das Vorgehen bei der Diagnostik und Therapieeinleitung erlebt zurzeit eine deutliche Veränderung hin zu mehr Patientenzentriertheit und Individualisierung des Transitionsprozesses. Dabei bildet die geschlechtsangleichende Hormontherapie ein wesentliches Standbein in der körperlichen Angleichung an das Gegengeschlecht. Unter Beachtung von bestimmten Sicherheitsaspekten ist eine Hormontherapie mit Sexualhormonen sicher und einfach durchzuführen. Regelmäßige Verlaufskontrollen sowie der offene und affirmative Umgang mit den Betroffenen tragen zudem wesentlich zur Sicherheit in der Behandlung bei.

  5. Kulturspezifische Elemente und ihre Problematik bei der Filmsynchronisierung

    Directory of Open Access Journals (Sweden)

    Prof. Dr. Carmen Cuéllar Lázaro

    2013-07-01

    Full Text Available Bei der Untersuchung der Übersetzungsproblematik von kulturspezifischen Elementen geht es darum, diese Konzepte begrifflich abzugrenzen, inhaltlich und sprachlich zu klassifizieren sowie die Problematik ihrer Übersetzung zu beschreiben. Bei der Filmsynchronisierung sind außerdem die Merkmale und besonderen Bedingungen des Mediums und des audiovisuellen Textes zu berücksichtigen. Die Zielsetzung dieser Studie ist, die Übersetzung von kulturspezifischen Elementen der Filmsynchronisierung (Deutsch-Spanisch zu analysieren. Wir schlagen ein Zwei-Ebenen-Modell vor: Die erste Ebene berücksichtigt die Art der erfahrenen sprachlichen Bearbeitung. Auf der zweiten Ebene wird die kulturelle Orientierung der Ergebnisse untersucht. Danach werden einige Schlussfolgerungen aus der spanischen Synchronfassung gezogen.

  6. Kulturspezifische Elemente und ihre Problematik bei der Filmsynchronisierung

    Directory of Open Access Journals (Sweden)

    Prof. Dr. Carmen Cuéllar Lázaro

    2013-07-01

    Full Text Available Bei der Untersuchung der Übersetzungsproblematik von kulturspezifischen Elementen geht es darum, diese Konzepte begrifflich abzugrenzen, inhaltlich und sprachlich zu klassifizieren sowie die Problematik ihrer Übersetzung zu beschreiben. Bei der Filmsynchronisierung sind außerdem die Merkmale und besonderen Bedingungen des Mediums und des audiovisuellen Textes zu berücksichtigen.   Die Zielsetzung dieser Studie ist, die Übersetzung von kulturspezifischen Elementen der Filmsynchronisierung (Deutsch-Spanisch zu analysieren. Wir schlagen ein Zwei-Ebenen-Modell vor: Die erste Ebene berücksichtigt die Art der erfahrenen sprachlichen Bearbeitung. Auf der zweiten Ebene wird die kulturelle Orientierung der Ergebnisse untersucht. Danach werden einige Schlussfolgerungen aus der spanischen Synchronfassung gezogen.

  7. Therapie-Adhärenz bei arterieller Hypertonie

    Directory of Open Access Journals (Sweden)

    Gaul G

    2001-01-01

    Full Text Available Therapieadhärenz ist bei allen chronischen Erkrankungen mit einer über Jahre gehenden, oft lebenslangen Therapie ein zentrales Problem. Hypertonie ist eine Volkserkrankung, die bei einem Viertel der erwachsenen Bevölkerung auftritt. Aufgrund der Auswirkungen auf die Gefäße des gesamten arteriellen Schenkels des Kreislaufsystems und im speziellen auf das Gefäßsystem der Zielorgane Herz, Hirn und Niere ist die Hypertonie - besonders die insuffizient behandelte - eine Hauptursache für das hohe Ausmaß an tödlichen Herz-Kreislauferkrankungen. In der vorliegenden Übersicht wird der Begriff der Therapieadhärenz definiert und die Ursachen einer schlechten und guten Befolgung der therapeutischen Ratschläge diskutiert. Schließlich werden Empfehlungen zur Besserung der Therapieadhärenz aufgezeigt.

  8. Aussprachliche Interferenzen der Studenten bei der DaF-Lehrerausbildung

    Directory of Open Access Journals (Sweden)

    Ayhan BAYRAK

    2013-12-01

    Full Text Available Ziel dieser Untersuchung ist es, die Aussprachefehler der türkischen Studenten, die an der Anadolu Universität Deutsch als Fremdsprache studieren, zu bestimmen und näher auf die wirkenden Einflussfaktoren einzugehen. Dazu wurde von den StudentInnen verlangt, 15 deutsche Sätze und 20 deutsche Wörter vorzulesen, wobei Tonbandaufnahmen gemacht wurden. Danach wurde diese Tonbandaufnahmen analysiert. Im segmentalen Bereich haben sie Schwierigkeiten der kurzen und langen Vokale (% 38. Der zweithäufigste Fehler entstand beim Schwa-Laut [∂] (% 15,9. Bei den Konsonanten wurden folgende Abweichungen festgestellt; [Ik] statt [Iç] (% 8,4; Artikulation des [h] an medialer und finaler Stelle (% 7,3; [s] statt [z] (% 4,2; [z] statt [ts] (% 4,2. Im suprasegmentalen Bereich wurden die Abweichungen von Normen bei der Akzentuierung festgestellt (% 33, 1.

  9. Neurostimulation bei refraktärer Angina pectoris

    Directory of Open Access Journals (Sweden)

    Theres H

    2005-01-01

    Full Text Available Trotz großer Fortschritte der katheterinterventionellen und operativen Versorgung der koronaren Herzkrankheit (KHK verbleiben Patienten, bei denen eine Revaskularisierung nicht möglich ist. Besteht eine ausgeprägte Angina pectoris (CCS III–IV, so sprechen wir von einer "refraktären Angina pectoris". Eine Arbeitsgruppe der Europäischen Gesellschaft für Kardiologie führt die Neurostimulation an erster Stelle der alternativen Therapiemöglichkeiten für diese Patienten an. Zahlreiche Studien belegen, daß es sich dabei um eine effiziente und sichere adjuvante Therapie handelt. Sie führt zu einer Abnahme der Angina pectoris-Symptomatik mit konsekutiver Zunahme der körperlichen Leistungsfähigkeit. Ingesamt wird eine entscheidende Verbesserung der Lebensqualität erzielt, die Angina pectoris als Warnsymptom bei Myokardinfarkt wird jedoch nicht maskiert.

  10. Mutationsanalyse im KCNAB1-Gen bei Rolando-Epilepsie

    OpenAIRE

    2012-01-01

    Epilepsien gehören zu den häufigsten neurologischen Erkrankungen. Ätiologisch unterscheidet man symptomatische Epilepsien, bei denen das Anfallsgeschehen Ausdruck einer Läsion oder Vorerkrankung des Zentralnervensystems ist, von den idiopathischen (genetischen) Epilepsien, denen eine polygene genetische Disposition zugrunde liegt. In exemplarischen Großfamilien konnten vielfach Defekte in Ionenkanalgenen gefunden werden. Die klinische Charakteristik epileptischer Anfälle und der elektroenzep...

  11. MRI in mucoviscidosis (cystic fibrosis); MRT bei Mukoviszidose

    Energy Technology Data Exchange (ETDEWEB)

    Eichinger, M.; Puderbach, M.; Kauczor, H.-U. [Deutsches Krebsforschungszentrum (DKFZ), Abteilung Radiologie, Heidelberg (Germany); Heussel, C.-P. [Universitaetsklinikum Mainz (Germany). Klinik und Poliklinik fuer Radiologie

    2006-04-15

    Cystic fibrosis (CF) is a multi-systemic disease with major impact on the lungs. Pulmonary manifestation is crucial for the prognosis and life expectancy of patients. Imaging modalities and lung function tests reflect the pulmonary status in these patients. The standard imaging modality for diagnosis and follow-up of pulmonary changes is chest x-ray. The gold standard for the detection of parenchymal lung changes remains high resolution computed tomography (HRCT), but this is not used routinely for CF-patients due to radiation exposure. Magnetic resonance imaging (MRI) used to be of no importance in monitoring cystic fibrosis lung disease, as shown in studies from the 1980s and early 1990s. The continuing improvement of MRI techniques, however, has allowed for an adequate application of this non-radiation method in diagnosing the major pulmonary findings in CF, in addition to the assessment of lung function. (orig.) [German] Die Lunge ist Hauptmanifestationsort der Mukoviszidose (zystischen Fibrose, CF) und entscheidend fuer Prognose und Lebenserwartung der Betroffenen. Bildgebende Verfahren spielen in der Diagnostik und Verlaufsbeurteilung der Lungenveraenderungen sowie dem Monitoring pulmonaler Komplikationen bei zystischer Fibrose eine wichtige Rolle. Obwohl die hochaufloesende Computertomographie (HRCT) als Goldstandard zur Beurteilung morphologischer Lungenveraenderungen bei zystischer Fibrose gilt, ist die Roentgenthoraxaufnahme aufgrund der geringeren Strahlenbelastung bei den meist jungen Patienten das derzeit eingesetzte Standardverfahren zur Diagnostik und Verlaufsbeurteilung. Die Magnetresonanztomographie (MRT) spielte bislang in der Diagnostik und Verlaufsbeobachtung der zystischen Fibrose keine Rolle, da Arbeiten aus den 80er und fruehen 90er Jahren keinen sinnvollen Beitrag der MRT zeigen konnten. Durch die kontinuierliche Verbesserung der Technik ist es seit neuestem erstmals moeglich, die MRT als Alternative fuer die Lungenbildgebung bei zystischer

  12. Sicherheitskriterien bei der Auswahl von ERP-Systemen

    OpenAIRE

    Wollersheim, Jan;Konstantinidis, Christos;Krcmar, Helmut

    2014-01-01

    Bei Auswahl und Anpassung von Software as a Service (SaaS) basierten ERP-Systemen (SaaS-ERP) kann auf bew?hrte und erprobte Kriterien zur?ckgegriffen werden. Dieser Beitrag strukturiert exemplarisch ausgew?hlte Sicherheits- und Risiko-Kriterien (S&R-Kriterien) anhand von f?nf Perspektiven. Dabei wird zuerst die Auswahl und im Folgenden die Anpassung von SaaS basierten ERP-Systemen betrachtet.

  13. Potenziale der Produktionsplanung und -steuerung bei IT-Dienstleistern

    OpenAIRE

    Ebert, Nico; Vogedes, Alexander; Hau, Thorsten; Uebernickel, Falk; Brenner, Walter

    2008-01-01

    Aufgrund von steigendem Kostendruck und zunehmender Kundenorientierung nutzen IT-Dienstleister bestehende Konzepte aus der Realgüterfertigung um sich zu professionalisieren. Im Rahmen des Artikels wird untersucht, welche Potenziale in der Übertragung von Ansätzen der Produktionsplanung und -steuerung in die Domäne der Produktion von IT-Dienstleistungen liegen. Dabei wird ein Fallbeispiel bei der Swisscom IT Services herangezogen, um einen ersten Lösungsansatz zu präsentieren.

  14. Ergebnisse der mikrobiologischen und histopathologischen Revisionsdiagnostik bei unklarem Endoprothesenversagen

    OpenAIRE

    Riemann, Johannes; Kienapfel, Heino

    2016-01-01

    Die Endoprothetik ist eine der erfolgreichsten operativen Behandlungs-methoden der modernen Medizin und bietet Patienten mit fortgeschrittener Arthrose eine etablierte Therapiemöglichkeit. In Deutschland gehört der künst-liche Gelenkersatz im Bereich des Hüft- und Kniegelenkes zu den häufigsten durchgeführten Operationen. Bei hohen Implantationszahlen und steigender Lebenserwartung kam es in den letzten Jahren auch zu einem Anstie...

  15. MR spectroscopy in dementia; MR-Spektroskopie bei Demenz

    Energy Technology Data Exchange (ETDEWEB)

    Hauser, T.; Gerigk, L.; Giesel, F.; Schuster, L.; Essig, M. [Deutsches Krebsforschungszentrum (DKFZ) Heidelberg, Abteilung E010, Radiologie, Heidelberg (Germany)

    2010-09-15

    With an increasingly aging population we are faced with the problem of an increasing number of dementia patients. In addition to clinical, neuropsychological and laboratory procedures, MRI plays an important role in the early diagnosis of dementia. In addition to various morphological changes functional changes can also help in the diagnosis and differential diagnosis of dementia. Overall the diagnosis of dementia can be improved by using parameters from MR spectroscopy. This article focuses on MR spectroscopic changes in the physiological aging process as well as on changes in mild cognitive impairment a precursor of Alzheimer's dementia, in Alzheimer's dementia, frontotemporal dementia, vascular dementia and Lewy body dementia. (orig.) [German] Angesichts einer immer aelter werdenden Bevoelkerung sind wir mit dem Problem einer zunehmenden Zahl an Demenzerkrankungen konfrontiert. Neben klinischen, neuropsychologischen und laborchemischen Verfahren spielt die MRT zur Fruehdiagnostik einer Demenz eine wichtige Rolle. Morphologische Veraenderungen wie auch verschiedene funktionelle Verfahren helfen bei der Diagnostik und Differenzialdiagnostik einer Demenz. Insgesamt kann mittels MR-spektroskopischer Parameter die Diagnostik einer Demenz verbessert werden. In diesem Artikel soll auf MR-spektroskopische Veraenderungen im Rahmen des physiologischen Alterungsprozesses eingegangen werden. Ferner werden speziell Veraenderungen bei leichter kognitiver Beeintraechtigung, einer Vorform der Alzheimer-Demenz, bei Alzheimer-, frontotemporaler, vaskulaerer und Lewy-Koerper-Demenz eroertert. (orig.)

  16. Circulating microRNAs as biomarkers of adult Crohn's disease

    DEFF Research Database (Denmark)

    Jensen, Michael D; Andersen, Rikke F; Christensen, Henry

    2015-01-01

    OBJECTIVE: Previous studies have found a differential expression of microRNAs (miRNAs) in the blood of patients with Crohn's disease (CD) compared with healthy controls. The aim of this study was to identify circulating miRNAs expressed in CD and assess their performance as biomarkers in patients...

  17. Increased risk of intestinal cancer in Crohn's disease

    DEFF Research Database (Denmark)

    Jess, Tine; Gamborg, Michael; Matzen, Peter

    2005-01-01

    OBJECTIVES: The risk of intestinal malignancy in Crohn's disease (CD) remains uncertain since risk estimates vary worldwide. The global CD population is growing and there is a demand for better knowledge of prognosis of this disease. Hence, the aim of the present study was to conduct a meta...

  18. The use of adalimumab in severe fistulising Crohn's disease

    DEFF Research Database (Denmark)

    Bang, U.C.; Nielsen, Anette Mertz

    2008-01-01

    So far infliximab is the only approved anti-TNF-alpha antibody for patients with Crohn's disease. Development of antibodies to infliximab may result in allergic reactions or reduced effect. We report three patients who received adalimumab, which induced longstanding remission in all three patients...

  19. On exploration of medical database of Crohn's disease

    Science.gov (United States)

    Manerowska, Anna; Dadalski, Maciej; Socha, Piotr; Mulawka, Jan

    2010-09-01

    The primary objective of this article is to find a new, more effective method of diagnosis of Crohn's disease. Having created the database on this disease we wanted to find the most suitable classification models. We used the algorithms with their implementations stored in R environment. Having carried out the investigations we have reached results interesting for clinical practice.

  20. Onercept for moderate-to-severe Crohn's disease

    DEFF Research Database (Denmark)

    Rutgeerts, Paul; Sandborn, William J; Fedorak, Richard N

    2006-01-01

    BACKGROUND AND AIMS: Onercept is a recombinant, soluble human p55 receptor to tumor necrosis factor-alpha. METHODS: A randomized, double-blind, placebo-controlled, dose-ranging trial was performed to evaluate the efficacy of onercept induction therapy in patients with Crohn's disease (CD). Patients...

  1. Disease phenotype at diagnosis in pediatric Crohn's disease

    DEFF Research Database (Denmark)

    de Bie, Charlotte I; Paerregaard, Anders; Kolacek, Sanja

    2013-01-01

    It has been speculated that pediatric Crohn's disease (CD) is a distinct disease entity, with probably different disease subtypes. We therefore aimed to accurately phenotype newly diagnosed pediatric CD by using the pediatric modification of the Montreal classification, the Paris classification....

  2. Case Report: Takayasu's arteritis associated with Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    You-shi LIU; You-hong FANG; Ling-xiang RUAN; You-ming LI; Lin LI; Ling-ling JIANG

    2009-01-01

    Takayasu's arteritis (TA), also known as the "pulseless disease," is a chronic vasculitis of the aorta and aortic branches. TA with Crohn's disease is rare and has not been documented in China before. In this paper we report on a case of Takayasu's arteritis associated with concurrent Crohn's disease. A 17-year-old Chinese male developed upper limb sourness and a sensation of fatigue, and his upper limb pulses were absent. He was diagnosed with TA and underwent an axillary artery bypass with autolo-gous great saphenous vein on the left subclavian artery. After the surgery, he regained the normal blood pressure. This patient also had years of diarrhea and developed an anal canal ulcer, and was diagnosed with inflammatory bowel disease and ulcerative colitis before. Five months after the TA surgery, he was hospitalized for severe stomachache and diarrhea and was finally diagnosed with Crohn's disease. The possible pathophysiological mechanisms responsible for concurrent existence of TA and Crohn's disease may be associated with immune disorders, especially autoimmunity.

  3. Medical radar considerations for detecting and monitoring Crohn's disease

    Science.gov (United States)

    Smith, Sonny; Narayanan, Ram M.; Messaris, Evangelos

    2014-05-01

    Crohn's disease is a condition that causes inflammation and associated complications along any section of the digestive tract. Over the years, numerous radiological and endoscopic methods as well as the use of ultrasound have been developed to examine and diagnose inflammatory bowel disorders such as Crohn's disease. While such techniques have much merit, an alternative medical solution that is safe, non-invasive, and inexpensive is proposed in this paper. Reflections from electromagnetic signals transmitted by an ultra-wide band (UWB) radar allow for not only range (or extent) information but also spectral analysis of a given target of interest. Moreover, the radar cross-section (RCS) of an object measures how detectable the electromagnetic return energy of such an object is to the radar. In the preliminary phase of research, we investigate how disparities in the dielectric properties of diseased versus non-diseased portions of the intestines can aid in the detection of Crohn's disease. RCS analysis from finite-difference time-domain (FDTD) method simulations using a simple 3D model of the intestines are presented. The ultimate goal of our research is to design a UWB radar system using a suitable waveform to detect and monitor Crohn's disease.

  4. Transperineal ultrasonography in perianal Crohn disease: A valuable imaging modality.

    Science.gov (United States)

    Wright, Emily K; Novak, Kerri L; Lu, Cathy; Panaccione, Remo; Ghosh, Subrata; Wilson, Stephanie R

    2015-01-01

    Aims of treatment for Crohn disease have moved beyond the resolution of clinical symptoms to objective end points including endoscopic and radiological normality. Regular re-evaluation of disease status to safely, readily and reliably detect the presence of inflammation and complications is paramount. Improvements in sonographic technology over recent years have facilitated a growing enthusiasm among radiologists and gastroenterologists in the use of ultrasound for the assessment of inflammatory bowel disease. Transabdominal intestinal ultrasound is accurate, affordable and safe for the assessment of luminal inflammation and complications in Crohn disease, and can be performed with or without the use of intravenous contrast enhancement. Perianal fistulizing disease is a common, complex and often treatment-refractory complication of Crohn disease, which requires regular radiological monitoring. Endoanal ultrasound is invasive, uncomfortable and yields limited assessment of the perineal region. Although magnetic resonance imaging of the pelvis is established, timely access may be a problem. Transperineal ultrasound has been described in small studies, and is an accurate, painless and cost-effective method for documenting perianal fluid collections, fistulas and sinus tracts. In the present article, the authors review the literature regarding perineal ultrasound for the assessment of perianal Crohn disease and use case examples to illustrate its clinical utility.

  5. Indications of capsule endoscopy in Crohn´s disease.

    Science.gov (United States)

    Luján-Sanchis, Marisol; Sanchis-Artero, Laura; Suárez-Callol, Patricia; Medina-Chuliá, Enrique

    2014-01-01

    Capsule endoscopy currently plays a relevant role for Crohn´s disease. This manuscript will discuss the current indications and practical uses of capsule endoscopy in this disease. It is a non-invasive technique that represents a significant advance in the endoscopic diagnosis of small bowel conditions. These circumstances, together with its diagnostic yield and excellent tolerability, make it considerably acceptable by both patients and physicians. This paper discusses the current evidence on the specific circumstances where capsule endoscopy may be indicated for three specific scenarios: Suspected Crohn´s disease, indeterminate colitis, and established Crohn´s disease, where it plays an extensive role. Furthermore, the impact and implications of capsule endoscopy results for follow-up are reviewed. These recommendations must be interpreted and applied in the setting of the integral, individual management of these patients. Understanding its appropriate use in daily clinical practice and an analysis of results may define endoscopic scoring systems to assess activity and mucosal healing in this condition. The present role of capsule endoscopy for Crohn´s disease is subject to ongoing review, and appropriate usage uncovers novel applications likely to result in relevant changes for the future management of these patients.

  6. Extensive spinal epidural abscess as a complication of Crohn's disease.

    Science.gov (United States)

    Smith, Chez; Kavar, Bhadrakant

    2010-01-01

    A spinal epidural abscess is a neurosurgical emergency. Successful treatment frequently requires decompression of the spinal canal in combination with intravenous antibiotics. We report a patient with Crohn's disease who developed an extensive spinal epidural abscess communicating with an intra-abdominal collection.

  7. Management of Crohn's disease in poor responders to adalimumab

    NARCIS (Netherlands)

    Boer, N. de; Lowenberg, M.; Hoentjen, F.

    2014-01-01

    Anti-tumor necrosis factor therapy with adalimumab is an effective therapy for the induction and maintenance of remission in moderate to severe Crohn's disease. Although a large proportion of patients show a favorable clinical response to adalimumab, therapy failure is common. In this review, we pro

  8. Leverabcessen als complicatie bij de ziekte van Crohn

    NARCIS (Netherlands)

    Bokhoven, M.M. van; Drenth, J.P.H.; Nagengast, F.M.

    2005-01-01

    Liver abscesses were found in two women aged 23 and 34 years who suffered from Crohn's disease. The first patient was seen because of fever and thoracic pain and had been treated with infliximab. The second patient, who was pregnant, presented with abdominal pain that was thought to be due to an exa

  9. Neuropathy related to Crohn's disease treated by peripheral nerve decompression

    NARCIS (Netherlands)

    Coert, JH; Dellon, AL

    2003-01-01

    Neurological complications of Crohn's ileitis have been reported, and the aetiology ascribed to vitamin deficiencies and iatrogenic treatment. In this report we describe a patient who developed multiple areas of nerve compression in lower and upper extremities. After failure of conservative treatmen

  10. The Association between Hidradenitis Suppurativa and Crohn's Disease

    DEFF Research Database (Denmark)

    van der Zee, Hessel H; Horvath, Barbara; Jemec, Gregor B E

    2016-01-01

    Hidradenitis suppurativa is a chronic, autoinflammatory skin disease. Shalom et al. demonstrate in a large cross-sectional study an association between Crohn's disease and hidradenitis suppurativa, but not with ulcerative colitis. This association supports the hypothesis that a similar pathogenic...

  11. "Miniguts" from plucked human hair meet Crohn's disease.

    Science.gov (United States)

    Hohwieler, M; Renz, S; Liebau, S; Lin, Q; Lechel, A; Klaus, J; Perkhofer, L; Zenke, M; Seufferlein, T; Illing, A; Müller, M; Kleger, A

    2016-08-01

    Human pluripotent stem cells represent a powerful tool to study human embryonic development and disease but also open up novel strategies for cell replacement therapies. Their capacity to give rise to every cell type of the human body, meanwhile, enables researchers to generate high yields of mesodermal, ectodermal, but also endodermal-derived tissues such as hepatic, pancreatic, or intestinal cells. Another progress in the field came with the advent of 3-dimensional culture conditions, so-called organoids, which facilitate maturation of stem cells and in turn more faithfully recapitulate human tissue architecture. While several studies reported the derivation of organoid cultures from adult intestinal tissue, the derivation of intestinal organoids derived from plucked human hair of Crohn's disease patients has not been reported. The current research project reports such successful generation and characterization of induced pluripotent stem cells (iPSCs) derived from hair sheet keratinocyte cultures of a patient with Crohn's disease. Stepwise differentiation along the intestinal lineage showed no differences in intermediate stages such as definitive endoderm formation. We also directed the patterned primitive gut tube toward intestinal organoids resembling the cellular architecture of human "miniguts". As expected from current pathophysiological knowledge on Crohn's disease, there were no obvious morphological differences in the "miniguts" derived from healthy control and diseased patient-induced pluripotent stem cells. Taken together, our platform will enable for detailed and complementary phenotyping of the pathophysiology of Crohn's disease in a novel disease-in-a-dish format.

  12. Peripheral neutrophil functions and cell signalling in crohn's disease

    NARCIS (Netherlands)

    R. Somasundaram (Rajesh); V.J.A.A. Nuij (Veerle); C.J. van der Woude (Janneke); E.J. Kuipers (Ernst); M.P. Peppelenbosch (Maikel); G.M. Fuhler (Gwenny)

    2013-01-01

    textabstractThe role of the innate immunity in the pathogenesis of Crohn's disease (CD), an inflammatory bowel disease, is a subject of increasing interest. Neutrophils (PMN) are key members of the innate immune system which migrate to sites of bacterial infection and initiate the defence against mi

  13. Predictive factors of small bowel patency in Crohn's disease patients

    Directory of Open Access Journals (Sweden)

    Andreia Albuquerque

    2016-02-01

    Full Text Available Background: Patency capsule was developed to avoid small bowel video capsule endoscopy retention, namely in patients with Crohn's disease. Aims: To evaluate the predictive factors of small bowel patency in Crohn's disease patients. Patients and methods: Retrospective analysis including 151 Crohn's disease patients submitted to patency capsule (Agile® Patency Capsule from 2011 to 2012. Patients that excreted the intact patency capsule were classified as having a patent small bowel (without patency capsule retention, other patients were considered to have negative patency of the small bowel (patency capsule retention. Results: Patients had a mean age of 41±14 years, 54% were female and 25% had been previously submitted to surgery. Stricturing disease was seen in 20% of cases and penetrating disease in 16% of cases. Left-sided colonic lesions and ileal strictures were observed at colonoscopy in 13% and 9% of patients, respectively. In our sample, 28% of patients had negative patency of the small bowel (patency capsule retention. In multivariate analysis, independent factors that were associated with negative patency of the small bowel in Crohn's disease patients were stricturing (OR 10.16, p < 0.001 and penetrating phenotypes (OR 11.73, p = 0.001, left-sided colonic lesions (OR 3.77, p = 0.038, ileal stricture (OR 9.76, p = 0.003; previous intestinal surgery was found to be protective (OR 0.16, p = 0.006. Conclusions: Stricturing or penetrating disease, ileal strictures, no previous surgery and left-sided colonic lesions were the factors associated with negative small bowel patency in Crohn's disease patients.

  14. Mongersen, an oral SMAD7 antisense oligonucleotide, and Crohn's disease.

    Science.gov (United States)

    Monteleone, Giovanni; Neurath, Markus F; Ardizzone, Sandro; Di Sabatino, Antonio; Fantini, Massimo C; Castiglione, Fabiana; Scribano, Maria L; Armuzzi, Alessandro; Caprioli, Flavio; Sturniolo, Giacomo C; Rogai, Francesca; Vecchi, Maurizio; Atreya, Raja; Bossa, Fabrizio; Onali, Sara; Fichera, Maria; Corazza, Gino R; Biancone, Livia; Savarino, Vincenzo; Pica, Roberta; Orlando, Ambrogio; Pallone, Francesco

    2015-03-19

    Crohn's disease-related inflammation is characterized by reduced activity of the immunosuppressive cytokine transforming growth factor β1 (TGF-β1) due to high levels of SMAD7, an inhibitor of TGF-β1 signaling. Preclinical studies and a phase 1 study have shown that an oral SMAD7 antisense oligonucleotide, mongersen, targets ileal and colonic SMAD7. In a double-blind, placebo-controlled, phase 2 trial, we evaluated the efficacy of mongersen for the treatment of persons with active Crohn's disease. Patients were randomly assigned to receive 10, 40, or 160 mg of mongersen or placebo per day for 2 weeks. The primary outcomes were clinical remission at day 15, defined as a Crohn's Disease Activity Index (CDAI) score of less than 150, with maintenance of remission for at least 2 weeks, and the safety of mongersen treatment. A secondary outcome was clinical response (defined as a reduction of 100 points or more in the CDAI score) at day 28. The proportions of patients who reached the primary end point were 55% and 65% for the 40-mg and 160-mg mongersen groups, respectively, as compared with 10% for the placebo group (P<0.001). There was no significant difference in the percentage of participants reaching clinical remission between the 10-mg group (12%) and the placebo group. The rate of clinical response was significantly greater among patients receiving 10 mg (37%), 40 mg (58%), or 160 mg (72%) of mongersen than among those receiving placebo (17%) (P=0.04, P<0.001, and P<0.001, respectively). Most adverse events were related to complications and symptoms of Crohn's disease. We found that study participants with Crohn's disease who received mongersen had significantly higher rates of remission and clinical response than those who received placebo. (Funded by Giuliani; EudraCT number, 2011-002640-27.).

  15. Facial biometrics of peri-oral changes in Crohn's disease.

    Science.gov (United States)

    Zou, L; Adegun, O K; Willis, A; Fortune, Farida

    2014-05-01

    Crohn's disease is a chronic relapsing and remitting inflammatory condition which affects any part of the gastrointestinal tract. In the oro-facial region, patients can present peri-oral swellings which results in severe facial disfigurement. To date, assessing the degree of facial changes and evaluation of treatment outcomes relies on clinical observation and semi-quantitative methods. In this paper, we describe the development of a robust and reproducible measurement strategy using 3-D facial biometrics to objectively quantify the extent and progression of oro-facial Crohn's disease. Using facial laser scanning, 32 serial images from 13 Crohn's patients attending the Oral Medicine clinic were acquired during relapse, remission, and post-treatment phases. Utilising theories of coordinate metrology, the facial images were subjected to registration, regions of interest identification, and reproducible repositioning prior to obtaining volume measurements. To quantify the changes in tissue volume, scan images from consecutive appointments were compared to the baseline (first scan image). Reproducibility test was performed to ascertain the degree of uncertainty in volume measurements. 3-D facial biometric imaging is a reliable method to identify and quantify peri-oral swelling in Crohn's patients. Comparison of facial scan images at different phases of the disease revealed precisely profile and volume changes. The volume measurements were highly reproducible as adjudged from the 1% standard deviation. 3-D facial biometrics measurements in Crohn's patients with oro-facial involvement offers a quick, robust, economical and objective approach for guided therapeutic intervention and routine assessment of treatment efficacy on the clinic.

  16. Pulmonary manifestations in collagen vascular diseases; Pulmonale Manifestationen bei Kollagenosen

    Energy Technology Data Exchange (ETDEWEB)

    Vogel, M.N.A. [Thoraxklinik, Universitaetsklinikum Heidelberg, Abteilung fuer Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Heidelberg (Germany); Universitaetsklinikum Heidelberg, Translational Lung Research Center (TLRC), Heidelberg (Germany); Kreuter, M. [Thoraxklinik, Universitaetsklinikum Heidelberg, Zentrum fuer interstitielle und seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Heidelberg (Germany); Universitaetsklinikum Heidelberg, Translational Lung Research Center (TLRC), Heidelberg (Germany); Kauczor, H.U. [Radiologische Klinik, Universitaetsklinikum Heidelberg, Abteilung fuer Diagnostische und Interventionelle Radiologie, Heidelberg (Germany); Universitaetsklinikum Heidelberg, Translational Lung Research Center (TLRC), Heidelberg (Germany); Heussel, C.P. [Thoraxklinik, Universitaetsklinikum Heidelberg, Abteilung fuer Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Heidelberg (Germany); Radiologische Klinik, Universitaetsklinikum Heidelberg, Abteilung fuer Diagnostische und Interventionelle Radiologie, Heidelberg (Germany); Universitaetsklinikum Heidelberg, Translational Lung Research Center (TLRC), Heidelberg (Germany)

    2016-10-15

    Pulmonary complications are frequent in patients with collagen vascular diseases (CVD). Frequent causes are a direct manifestation of the underlying disease, side effects of specific medications and lung infections. The standard radiological procedure for the work-up of pulmonary pathologies in patients with CVD is multidetector computed tomography (MDCT) with thin-slice high-resolution reconstruction. The accuracy of thin-slice CT for the identification of particular disease patterns is very high. The pattern of usual interstitial pneumonia (UIP) representing the direct pulmonary manifestation of rheumatoid arthritis (RA) can be identified with a sensitivity of 45 % and a specificity of 96 %. Both direct pulmonary manifestations, drug-induced toxicity and certain infections can have a similar appearance in thin-slice MDCT in various forms of CVD. Knowledge of the patterns and causes contributes to the diagnostic certainty. At first diagnosis of a CVD and associated pulmonary symptoms thin-slice MDCT is recommended. Clinical, lung function and imaging follow-up examinations should be performed every 6-12 months depending on the results of the MDCT. In every case the individual CT morphological patterns of pulmonary involvement must be identified. The combination of information on the anamnesis, clinical and imaging results is a prerequisite for an appropriate disease management. (orig.) [German] Pulmonale Komplikationen sind bei Patienten mit Kollagenosen keine Seltenheit. Haeufig sind eine direkte Manifestation der Grunderkrankung, eine Nebenwirkung der medikamentoesen Therapie oder eine Lungeninfektion die Ursachen. Das radiologische Standardverfahren zur Klaerung pulmonaler Pathologien bei Patienten mit Kollagenosen ist die Multidetektorcomputertomographie mit duennschichtigen Rekonstruktionen (Duennschicht-MDCT). Die Treffsicherheit der Duennschicht-MDCT ist fuer die Identifikation eines Erkrankungsmusters sehr hoch. So kann beispielsweise das Muster einer

  17. UMA PROSPOSTA DEDUTIVISTA PARA PRINCÍPIOS CONTÁBEIS

    Directory of Open Access Journals (Sweden)

    Paulo Schmidt

    2009-09-01

    Full Text Available A proposta deste estudo a apresentar um breve relato sobre a evolução do pensamento cientifico ocorrida na física com a substituição dos princípios contábeis e filosófico, desde a Antiguidade grega ate os dias de hoje, como forma de fundamentar o posicionamento contrario ao raciocínio indutivo para o estabelecimento de uma estrutura conceitual para a contabilidade e para o desenvolvimento dos princípios contábeis. Apos essa incursão pelo campo filosófico, será aduzido um dos trabalhos de D. R. Scott, ex-professor da Universidade de Michigan, que já na década de 1930 defendia o processo de raciocínio dedutivo e a necessidade de coerência e unidade para o estabelecimento dos princípios contábeis. Este estudo justifica-se, principalmente, porque ainda existem pesquisadores da área contábil que defendem o método indutivo com único procedimento cientifico capaz de levar a certeza, Como defendia Descartes. Alem disso, mesmo apos a revolução cientifica princípios teóricos de Newton, pelos princípios da teoria da relatividade de Einstein, alguns pesquisadores defendem a imutabilidade dos princípios contábeis, como sendo verdades indubitáveis, não aceitando o permanente desenvolvimento da teoria contábil e sua continua adaptabilidade a nova realidade ambiental. A contabilidade, assim como toda disciplina do conhecimento humano que postula um patamar cientifico, deve estruturar-se com base em um conjunto de princípios racionalmente dispostos. Diante desse panorama, faz-se mister inquirir se os princípios contábeis podem ser oniscientes e impassíveis as mudanças do mundo?

  18. Radiological aspects of Crohn's disease in small intestine: iconographic assay; Aspectos radiologicos da doenca de Crohn no intestino delgado: ensaio iconografico

    Energy Technology Data Exchange (ETDEWEB)

    Barros, Nestor de; Juliano, Adriana G.; Polizini, Jose M.R.; Rejtman, Debora; Cerri, Giovanni Guido; Rocha, Manoel de Souza [Sao Paulo Univ., SP (Brazil). Faculdade de Medicina. Dept. de Radiologia

    1999-12-01

    The authors present the radiological features of Crohn's disease in small intestine as ways of differential diagnosis of others diseases of duodenum and adjacent organs. In this differentiation or confirmation of Crohn's disease the US and TC have proven to be clinically efficacious in the identification of lesions.

  19. Ganganalyse bei Parkinson-Patienten mit Tiefer Hirnstimulation unter Verwendung des Pedar-XSystems Inaugural-Dissertation

    OpenAIRE

    Hilgert, Anika

    2008-01-01

    Eine hochfrequente bilaterale Stimulation des Nucleus subthalamicus beim Morbus Parkinson hat, wie verschiedene Studien gezeigt haben, einen positiven Effekt sowohl auf die gesamtmotorische Symptomatik [21, 47, 49, 60, 69, 76] als auch auf das Gangbild [27, 41, 56, 75]. Der motorische Teil III der UPDRS, nach dem die Gesamtmotorik beurteilt wird, lässt die dynamischen und kinematischen Größen des Gangbildes unberücksichtigt. In de...

  20. Crohn's disease and genetic hitchhiking at IBD5.

    Science.gov (United States)

    Huff, Chad D; Witherspoon, David J; Zhang, Yuhua; Gatenbee, Chandler; Denson, Lee A; Kugathasan, Subra; Hakonarson, Hakon; Whiting, April; Davis, Chadwick T; Wu, Wilfred; Xing, Jinchuan; Watkins, W Scott; Bamshad, Michael J; Bradfield, Jonathan P; Bulayeva, Kazima; Simonson, Tatum S; Jorde, Lynn B; Guthery, Stephen L

    2012-01-01

    Inflammatory bowel disease 5 (IBD5) is a 250 kb haplotype on chromosome 5 that is associated with an increased risk of Crohn's disease in Europeans. The OCTN1 gene is centrally located on IBD5 and encodes a transporter of the antioxidant ergothioneine (ET). The 503F variant of OCTN1 is strongly associated with IBD5 and is a gain-of-function mutation that increases absorption of ET. Although 503F has been implicated as the variant potentially responsible for Crohn's disease susceptibility at IBD5, there is little evidence beyond statistical association to support its role in disease causation. We hypothesize that 503F is a recent adaptation in Europeans that swept to relatively high frequency and that disease association at IBD5 results not from 503F itself, but from one or more nearby hitchhiking variants, in the genes IRF1 or IL5. To test for evidence of recent positive selection on the 503F allele, we employed the iHS statistic, which was significant in the European CEU HapMap population (P=0.0007) and European Human Genome Diversity Panel populations (P≤0.01). To evaluate the hypothesis of disease-variant hitchhiking, we performed haplotype association tests on high-density microarray data in a sample of 1,868 Crohn's disease cases and 5,550 controls. We found that 503F haplotypes with recombination breakpoints between OCTN1 and IRF1 or IL5 were not associated with disease (odds ratio [OR]: 1.05, P=0.21). In contrast, we observed strong disease association for 503F haplotypes with no recombination between these three genes (OR: 1.24, P=2.6×10(-8)), as expected if the sweeping haplotype harbored one or more disease-causing mutations in IRF1 or IL5. To further evaluate these disease-gene candidates, we obtained expression data from lower gastrointestinal biopsies of healthy individuals and Crohn's disease patients. We observed a 72% increase in gene expression of IRF1 among Crohn's disease patients (P=0.0006) and no significant difference in expression of OCTN1

  1. Postural kyfose og morbus Scheuermann

    DEFF Research Database (Denmark)

    Pedersen, Jens Brahe; Al-Aubaidi, Zaid

    2012-01-01

    Scheuermann's kyphosis is the most frequent structural kyphosis in adolescents. There are gaps in the knowledge of epidemiology, aetiology and treatment. There are strong genetic and mechanical factors in the aetiology. Treatment options depend on the cobb's angle measured and the skeletal maturi....... Training and brace treatment yield good results for milder curves, while surgical correction is the most effective for severe curves > 70°. Indications for surgery are subject of debate as complications are not uncommon....

  2. [Postural kyphosis and morbus Scheuermann].

    Science.gov (United States)

    Pedersen, Jens Brahe; Al-Aubaidi, Zaid

    2012-01-09

    Scheuermann's kyphosis is the most frequent structural kyphosis in adolescents. There are gaps in the knowledge of epidemiology, aetiology and treatment. There are strong genetic and mechanical factors in the aetiology. Treatment options depend on the cobb's angle measured and the skeletal maturity. Training and brace treatment yield good results for milder curves, while surgical correction is the most effective for severe curves > 70°. Indications for surgery are subject of debate as complications are not uncommon.

  3. Klinische studie over morbus Brightii

    NARCIS (Netherlands)

    Vogelenzang, Pierre

    1922-01-01

    1. De indeeling der dubbelzijdige, haematogene nieraandoeningen, zooals die door VOLHARD en FAHR is aangegeven, is in de kliniek zeer goed bruikbaar en bezit veel voordeelen boven de indeeling van SENATOR. 2. Naar den tegen woordigen stand onzer kennis is het gerechtigd de zgn. essentiëele hypertens

  4. Morbus paget of the skeleton

    Energy Technology Data Exchange (ETDEWEB)

    Ziegler, R.; Baldauf, M.

    1984-09-01

    Paget's disease of bone seems to be a slow virus infection of a single or several areas of the skeleton. Pagetic lesions are rather common among elderly people, but the disease does not manifest very often. Compared to the incidence of Paget's disease in England, it seems to be rarer in this country. The pelvis is most frequently involved, followed by bones of the leg, skull, lumbar spine. The patients suffer from pains and deformities, arthroses of the adhering ankles, increased temperature of the area, nerval irritation and nerve damage due to increased bone growth (e.g. hearing loss due to Paget's disease of the skull). The development of sarcoma is rare and is only seen in severe cases. Diagnosis is made by X-ray, confirmed by bone biopsy, if necessary. Asymptomatic lesions are detected by bone scintigraphy. The activity of the disease is expressed by increased alkaline serum phosphatase and urinary hydroxyproline excretion. For treatment calcitonins and diphosphonates (especially EHDP, Diphos) are used. Both inhibit the overactive osteoclasts, and the increased bone turnover is normalized. The patients feel considerable relief, the elevated biochemical parameters fall to about 50% of initial values after calcitonin- or EHDP monotherapy. In severe cases the combination of both substances may be profitable. The cytostatic drug mithramycin which can also be effective is only needed exceptionally.

  5. Klinische studie over morbus Brightii

    NARCIS (Netherlands)

    Vogelenzang, Pierre

    1922-01-01

    1. De indeeling der dubbelzijdige, haematogene nieraandoeningen, zooals die door VOLHARD en FAHR is aangegeven, is in de kliniek zeer goed bruikbaar en bezit veel voordeelen boven de indeeling van SENATOR. 2. Naar den tegen woordigen stand onzer kennis is het gerechtigd de zgn. essentiëele hypertens

  6. A Method for Estimating BeiDou Inter-frequency Satellite Clock Bias

    Directory of Open Access Journals (Sweden)

    LI Haojun

    2016-02-01

    Full Text Available A new method for estimating the BeiDou inter-frequency satellite clock bias is proposed, considering the shortage of the current methods. The constant and variable parts of the inter-frequency satellite clock bias are considered in the new method. The data from 10 observation stations are processed to validate the new method. The characterizations of the BeiDou inter-frequency satellite clock bias are also analyzed using the computed results. The results of the BeiDou inter-frequency satellite clock bias indicate that it is stable in the short term. The estimated BeiDou inter-frequency satellite clock bias results are molded. The model results show that the 10 parameters of model for each satellite can express the BeiDou inter-frequency satellite clock bias well and the accuracy reaches cm level. When the model parameters of the first day are used to compute the BeiDou inter-frequency satellite clock bias of the second day, the accuracy also reaches cm level. Based on the stability and modeling, a strategy for the BeiDou satellite clock service is presented to provide the reference of our BeiDou.

  7. Abducensparese bei metastasiertem Prostatakarzinom: kleinvolumige Bestrahlung der Schädelbasis

    Directory of Open Access Journals (Sweden)

    Mayer R

    2001-01-01

    Full Text Available Wir berichten über drei Patienten mit Prostatakarzinom, bei denen eine Metastase im Bereich der Schädelbasis zu einer Abducensparese geführt hatte. Die Patienten klagten über Doppelbilder, die sie bei Verrichtungen des täglichen Lebens behinderten und zu Schwindel beim Gehen bis hin zur Übelkeit führten. Die Bestrahlung mit hochenergetischen Photonen (23 MeV und einer Dosis von 40-50 Gy/2 Gy erfolgte bei zwei Patienten über opponierende Gegenfelder und bei einem Patienten in Drei-Feld-Technik. Zwei Patienten waren bereits vorher wegen eines Adenokarzinoms der Prostata perkutan lokal im Beckenbereich bestrahlt worden, bei einem Patienten stellte die Abducensparese das Erstsymptom dar und das Prostatakarzinom wurde erst im Laufe der weiteren Exploration diagnostiziert. Durch die Bestrahlung der Schädelbasismetastase konnte bei allen drei Patienten ein guter palliativer Effekt erreicht werden, der bis zu ihrem Ableben anhielt. Bei einem Patienten kam es zu einem vollständigen Verschwinden der Doppelbilder, obwohl die Tumorausdehnung bei der Kontrolluntersuchung unverändert war; die beiden anderen Patienten gaben eine deutliche Besserung der Beschwerden und damit verbundene Hebung der Lebensqualität an. Zusammenfassend ist zu sagen, daß durch den Einsatz moderner Planungs- und Bestrahlungsmethoden die externe Strahlentherapie im Bereich der Schädelbasis nebenwirkungsarm und effizient durchgeführt werden kann.

  8. "Updates to Model Algorithms & Inputs for the Biogenic Emissions Inventory System (BEIS) Model"

    Science.gov (United States)

    We have developed new canopy emission algorithms and land use data for BEIS. Simulations with BEIS v3.4 and these updates in CMAQ v5.0.2 are compared these changes to the Model of Emissions of Gases and Aerosols from Nature (MEGAN) and evaluated the simulations against observatio...

  9. Lower extremity necrotizing fasciitis: A unique initial presentation of Crohn's disease

    Directory of Open Access Journals (Sweden)

    Anna Weiss

    2015-09-01

    Full Text Available Crohn's disease is a disease of the bowel, typically presenting with diarrhea, weight loss, and abdominal pain. Complications such as abscesses, fistulas, and strictures may require surgical intervention. We would like to report a patient with Crohn's disease who presented for the first time with left lower extremity necrotizing fasciitis. There are very few reports of necrotizing fasciitis in Crohn's disease as the initial presentation.

  10. Small bowel adenocarcinoma and Crohn's disease: any further ahead than 50 years ago?

    Science.gov (United States)

    Cahill, Caitlin; Gordon, Philip H; Petrucci, Andrea; Boutros, Marylise

    2014-09-07

    This review of the literature on small bowel carcinoma associated with Crohn's disease specifically addresses the incidence, risk factors, and protective factors which have been identified. It also reviews the clinical presentation, the current modalities of diagnosis, the pathology, treatment, and surveillance. Finally, the prognosis and future direction are addressed. Our experience with small bowel adenocarcinoma in Crohn's disease is reported. Readers will be provided with a better understanding of this rare and often poorly recognized complication of Crohn's disease.

  11. Crohn's Disease Associated with Sweet's Syndrome and Sjögren's Syndrome Treated with Infliximab

    Directory of Open Access Journals (Sweden)

    Erina N. Foster

    2005-01-01

    Full Text Available The association of Crohn's disease (CD and Sweet's syndrome is rare and the presence of Sjögren's syndrome in Crohn's disease is even rarer, with only three reports found in the literature. We describe two cases of Crohn's disease associated with Sweet's syndrome, one of which is the first case of CD and Sweet's concomitantly associated with Sjögren's syndrome. Both cases responded rapidly to Infliximab therapy with complete resolution of the skin lesions.

  12. Magnetic resonance tomography in eclampsia; Magetresonanztomographie bei Eklampsie

    Energy Technology Data Exchange (ETDEWEB)

    Uhlig, U. [St.-Vincentius-Krankenhaeuser, Karlsruhe (Germany). Radiologische Klinik

    1995-05-01

    Eclampsia is a rare but severe complication during the course of a pregnancy. The CT-findings at the brain are well known. Reports on MRT-findings are limited, however, especially in German literature. We describe the MRT picture of the cerebral changes caused by eclampsia and discuss the advantages of MRT in comparison with CT. The use of contrast agents with MRT shows breakdown of blood-brain barrier but does not provide any information of therapeutical consequences and should be avoided during pregnancy. An early and targeted use of MRT in any case of unclear or suspicious neurological symptoms during pregnancy is recommended. MRT supports differential diagnosis regarding non pregnancy-related cerebral disease and can be helpful for therapy planning in cases of preeclampsia. Additionally, MRT offers the possibility to control the effect of therapy with regard to brain damage. (orig.) [Deutsch] Die Eklampsie ist eine seltene aber erhebliche Komplikation im Verlauf einer Schwangerschaft. Die computertomographischen Veraenderungen im Gehirn sind bekannt. Mitteilungen von kernspintomographischen Befunden finden sich vor allem in der deutschen Literatur noch selten. Wir beschreiben das kernspintomographische Bild der zerebralen Veraenderungen bei Eklampsie und diskutieren die Vorteile der MRT im Vergleich zur CT. Die Gabe von Kontrastmittel bei der MRT weist zwar die Blut-Hirn-Schrankenstoerung nach, bringt aber keine therapeutisch relevanten Informationen. Sie sollte waehrend der Schwangerschaft vermieden werden. Ein frueher und gezielter Einsatz der MRT bei unklaren oder verdaechtigen neurologischen Symptomen waehrend der Schwangerschaft ist sinnvoll. Die MRT unterstuetzt die Differentialdiagnose in bezug auf nicht schwangerschaftsbezogene zerebrale Leiden und kann fuer die Therapie richtungweisend sein, wenn die Gestose noch nicht ausgepraegt ist. (orig.)

  13. Shoulder injuries in overhead sports; Schultergelenkverletzungen bei Ueberkopfsportarten

    Energy Technology Data Exchange (ETDEWEB)

    Woertler, K. [Technische Universitaet Muenchen (Germany). Institut fuer Roentgendiagnostik

    2010-05-15

    Overhead sport places great demands on the shoulder joint. Shoulder pain in overhead athletes and throwers can in the majority of cases be attributed to lesions resulting from chronic overuse of tendons and capsuloligamentous structures or to sequels of microinstability and secondary impingement. Due to its great impact on therapeutic decisions, imaging in athletes with unclear shoulder pain is a challenge. In this connection, magnetic resonance (MR) arthrography represents the cross-sectional imaging modality of first choice, as it allows depiction and exclusion of pathologic alterations of all relevant joint structures with sufficient confidence. This article reviews the biomechanical and clinical aspects and MR arthrographic features of the most common shoulder pathologies in overhead athletes, including biceps tendinopathy, superior labral anterior-posterior (SLAP) lesions, rotator cuff lesions, as well as extrinsic and intrinsic impingement syndromes. (orig.) [German] Ueberkopfsportarten stellen grosse Anforderungen an das Schultergelenk. Schulterbeschwerden bei Ueberkopf- und Wurfsportlern koennen in der Mehrzahl der Faelle auf eine chronische Ueberlastung von Sehnen und Kapsel-Band-Strukturen oder auf die Folgen einer Mikroinstabilitaet und sekundaerer Impingementsyndrome zurueckgefuehrt werden. Wegen ihres grossen Einflusses auf die Therapieentscheidung stellt die Bildgebung bei Athleten mit unklaren Schulterbeschwerden eine Herausforderung dar. Die MR-Arthrographie ist in diesem Zusammenhang als Schnittbildverfahren der ersten Wahl anzusehen, da sie den Nachweis bzw. Ausschluss pathologischer Veraenderungen aller relevanten Gelenkstrukturen mit ausreichender Sicherheit ermoeglicht. Dieser Artikel gibt eine Uebersicht ueber biomechanische und klinische Aspekte sowie MR-arthrographische Befunde der haeufigsten Schultergelenkpathologien bei Ueberkopfsportlern, wie Bizepstendinopathie, Superior-labral-anterior-posterior- (SLAP-)Laesionen, Laesionen der

  14. Imaging strategies for knee injuries; Bildgebungsstrategie bei Kniegelenkverletzungen

    Energy Technology Data Exchange (ETDEWEB)

    Hegenscheid, K.; Puls, R.; Rosenberg, C. [Ernst-Moritz-Arndt-Universitaet Greifswald, Institut fuer Diagnostische Radiologie und Neuroradiologie, Greifswald (Germany)

    2012-11-15

    Injuries of the knees are common. The Ottawa knee rule provides decisional support to determine whether radiographs are indicated or not. With the use of ultrasound it is possible to detect defects of the extensor ligaments and the anterior cruciate ligament. Furthermore, it is possible to detect indirect signs of an intra-articular fracture, e.g. lipohemarthrosis. In complex fractures, e.g. tibial plateau fractures, further diagnostic procedures with multislice computed tomography (CT) are needed for accurate classification and preoperative planning. Multislice CT with CT angiography enables three-dimensional reconstruction of the knee and non-invasive vascular imaging for detection of vascular injury. Magnetic resonance imaging (MRI) is the gold standard for detection of occult fractures and injuries of the ligaments and menisci. Higher field strengths can be used to improve the diagnostics of cartilage lesions. Virtual MR arthrography is superior to conventional MRI for detection of cartilage lesions especially after meniscus surgery. (orig.) [German] Verletzungen des Kniegelenks sind haeufig. Die Ottawa Knee Rule bietet eine Entscheidungshilfe dahingehend, ob Roentgenaufnahmen indiziert sind. Mittels Sonographie koennen Verletzungen des Streckapparats und vorderen Kreuzbandes erkannt werden. Ebenso gelingt der Nachweis eines Lipohaemarthros als indirektes Zeichen einer intraartikulaeren Fraktur. Bei komplexen Frakturen, z. B. Tibiaplateaufrakturen, ist eine weiterfuehrende Diagnostik mittels Multislice-CT zur Klassifizierung und praeoperativen Planung notwendig. Die Multislice-CT mit gleichzeitiger CT-Angiographie ermoeglicht die Anfertigung dreidimensionaler Rekonstruktionen und die nichtinvasive Gefaessdarstellung. Die Magnetresonanztomographie (MRT) ist der Goldstandard zum Nachweis okkulter Frakturen und Verletzungen an Baendern und Menisken. Bei hoeheren Feldstaerken verbessert sich die Diagnostik von Knorpellaesionen. Die virtuelle MR-Arthrographie ist

  15. Zinc deficiency in men with Crohn's disease may contribute to poor sperm function and male infertility.

    Science.gov (United States)

    El-Tawil, A M

    2003-12-01

    In Great Britain, married couples were reported to have between 1.9 and 2.1 children, while men with Crohn's disease had a mean of 1.2 and of 0.4 children before and after diagnosis, respectively. The role of zinc for male fertility is essential. Although lack of zinc in Crohn's disease is well established in up to 70% of patients, a possible relation between zinc deficiency and male subfertility in Crohn's disease remains unclear. This study is aimed at examining a possible link between zinc deficiency in men with Crohn's disease and male subfertility in this group of patients.

  16. Corticosteroids increase protein breakdown and loss in newly diagnosed pediatric Crohn disease.

    Science.gov (United States)

    Steiner, Steven J; Noe, Joshua D; Denne, Scott C

    2011-11-01

    Children with Crohn disease have altered growth and body composition. Previous studies have demonstrated decreased protein breakdown after either corticosteroid or anti-TNF-α therapy. The aim of this study was to evaluate whole body protein metabolism during corticosteroid therapy in children with newly diagnosed Crohn disease. Children with suspected Crohn disease and children with abdominal symptoms not consistent with Crohn disease underwent outpatient metabolic assessment. Patients diagnosed with Crohn disease and prescribed corticosteroid therapy returned in 2 wk for repeat metabolic assessment. Using the stable isotopes [d5] phenylalanine, [1-(13)C] leucine, and [(15)N(2)] urea, protein kinetics were determined in the fasting state. Thirty-one children (18 controls and 13 newly diagnosed with Crohn disease) completed the study. There were no significant differences in protein breakdown or loss between patients with Crohn disease at diagnosis and controls. After corticosteroid therapy in patients with Crohn disease, the rates of appearance of phenylalanine (32%) and leucine (26%) increased significantly, reflecting increased protein breakdown, and the rate of appearance of urea also increased significantly (273%), reflecting increased protein loss. Whole body protein breakdown and loss increased significantly after 2 wk of corticosteroid therapy in children with newly diagnosed Crohn disease, which may have profound effects on body composition.

  17. Retroperitoneal and pelvic infections complications; Les manifestations genito-urinaires de la maladie de Crohn

    Energy Technology Data Exchange (ETDEWEB)

    Schmutz, G.R.; Racette, R.; Chapuis, F. [Sherbrooke Univ., PQ (Canada); Regent, D. [Centre Hospitalier Universitaire, 54 - Nancy (France); Hannequin, F. [Centre Medical Mgen, 67 - Strasbourg (France); N`Guyen, D. [Clinique Adassa, 67 - Strasbourg (France)

    1995-12-31

    Retroperitoneal and pelvic infections complications are the major types of genito-urinary complications in Crohn`s disease. CT has been shown to be a sensitive, non invasive method of documenting these infectious complications. On the other hand, conventional studies are more sensitive than CT to detect genitourinary fistulae. Some complications may manifest few or no symptom as urinary obstruction and nephrolithiasis, detected easily by sonography. For these reasons, it is important for radiologists to be aware of the genito-urinary complications of Crohn`s disease. (authors). 42 refs., 20 figs.

  18. The Prevalence of Headache in Crohn's Disease: Single-Center Experience.

    Science.gov (United States)

    Anadol Kelleci, Ulker; Calhan, Turan; Sahin, Abdurrahman; Kahraman, Resul; Ozdil, Kamil; Sokmen, Haci Mehmet; Yalcin, Destina

    2016-01-01

    Objectives. This study is aimed at studying the prevalence and characteristics of different types of headaches in patients with Crohn's disease. Materials and Methods. 51 patients in Crohn's disease group (F/M: 26/25) and 51 patients in control group (F/M: 27/24) were involved. Patients in Crohn's disease group were diagnosed and monitored according to European Crohn's and Colitis Organization diagnostic criteria. The control group composed of healthy subjects with similar age and sex to Crohn's disease group. Headache was classified using the International Headache Society II criteria. Results. Headache was reported by 35/51 (68.6%) patients in Crohn's disease group and 21/51 (41.2%) patients in the control group. The prevalence of headache was statistically high in the group with Crohn's disease (OR: 3.125 (95% CI: 1.38-7.04); p = 0.01). Comparing two groups with respect to their subtypes of headaches resulted in that the tension-type headache was statistically (p = 0.008) higher in Crohn's disease group (26/51) than in the control group (12/51). However, no significant difference was found in the migraine-type headache (p = 1). Conclusions. This study indicates that the prevalence of headache is high in patients with Crohn's disease and most commonly associated with the tension-type headache.

  19. Therapeutic Effect of Vitamin D Supplementation in a Pilot Study of Crohn's Patients

    OpenAIRE

    Yang, Linlin; Weaver, Veronika; Smith, Jill P.; Bingaman, Sandra; Hartman, Terryl J.; Cantorna, Margherita T.

    2013-01-01

    OBJECTIVES: Low vitamin D status may be associated with Crohn's disease. A pilot study was performed in patients with mild-to-moderate Crohn's disease to determine the dose of vitamin D needed to raise serum vitamin D levels above 40 ng/ml. METHODS: Patients were evaluated for severity of symptoms using the Crohn's disease activity index (CDAI) and patients with mild-to-moderate (150–400 CDAI scores) Crohn's disease were entered into the study (n=18). Vitamin D3 oral therapy was initiated at ...

  20. Chemoembolisation bei hepatozellulärem Karzinom (HCC

    Directory of Open Access Journals (Sweden)

    Cejna M

    2006-01-01

    Full Text Available Die transarterielle Chemoembolisation (TACE hat ihren Platz im multimodalen Therapieansatz des hepatozellulären Karzinoms (HCC. Zumeist erfolgt die Applikation von Doxorubicin, Mitomycin und Cisplatin mit Lipiodol, gefolgt von der Okklusion der versorgenden Arterie mit Partikeln zur Behandlung von nicht-resektablen HCC bei noch gut erhaltener Leberfunktion. Die Behandlungen erfolgen bis zum Nachweis eines Perfusionsstops des HCC. Verlaufskontrollen (Ultraschall, CT oder MRT sind unerläßlicher Bestandteil der Nachsorge. Mit superselektivem Zugang sind Komplikationen selten. Ähnliche Therapiekonzepte wie Permanentembolisation, Embolisation mit Chemotherapeutika-beladenen Partikeln oder Embolisation mit radioaktiven Partikeln sind derzeit in klinischer Erprobung.

  1. Diagnostic evaluation of deep vein thrombosis; Diagnostik bei tiefer Venenthrombose

    Energy Technology Data Exchange (ETDEWEB)

    Fuerst, G.; Saleh, A. [Universitaetsklinikum Duesseldorf (Germany). Inst. fuer Diagnostische Radiologie

    2001-12-01

    CT and MRI are efficient modalities for the imaging of venous thrombi. Their application currently is restricted to complementary use, in cases when results of US and/or phlebography leave open questions (as e.g. central extension of thrombi, assessment of causes, post-surgery follow-up). (orig./CB) [German] CT und MRT sind effiziente Techniken zur Venendarstellung bei Thrombose. Ihr Einsatz ist derzeit Fragestellungen vorbehalten, die sich sonographisch und/oder phlebographisch nicht ausreichend klaeren lassen (z. B. Thromboseausdehnung nach zentral, Ursachenabklaerung, postoperative Kontrollen). (orig.)

  2. Contrast-Enhanced Ultrasonography in Crohn's Disease Diagnostics.

    Science.gov (United States)

    Białecki, Marcin; Białecka, Agnieszka; Laskowska, Katarzyna; Liebert, Ariel; Kłopocka, Maria; Serafin, Zbigniew

    2015-06-01

    The chronic nature of Crohn's disease (CD) implicates necessity of multiple control assessments throughout patient's life. It is accepted that in patients with CD requiring disease monitoring, magnetic resonance enterography (MRE) and computed tomography enterography (CTE) are--apart from endoscopy--imaging studies of first choice. In practice, diagnostic imaging of patients with CD is troublesome, since MRE is an expensive and complicated study, and CTE exposes patients to high doses of ionizing radiation. Therefore, there is a need for new, both non-invasive and effective, methods of imaging in CD. Contrast-Enhanced Ultrasonography (CEUS) is a relatively new method using gas-filled microbubbles serving as contrast agent. It allows for detailed assessment of blood perfusion within intestine wall and peri-intestinal tissues, which enables detection and monitoring of inflammation and its qualitative assessment. The purpose of this paper is to describe CEUS examination technique and its clinical applications in patients with Crohn's disease.

  3. Genetics of Crohn disease, an archetypal inflammatory barrier disease.

    Science.gov (United States)

    Schreiber, Stefan; Rosenstiel, Philip; Albrecht, Mario; Hampe, Jochen; Krawczak, Michael

    2005-05-01

    Chronic inflammatory disorders such as Crohn disease, atopic eczema, asthma and psoriasis are triggered by hitherto unknown environmental factors that function on the background of some polygenic susceptibility. Recent technological advances have allowed us to unravel the genetic aetiology of these and other complex diseases. Using Crohn disease as an example, we show how the discovery of susceptibility genes furthers our understanding of the underlying disease mechanisms and how it will, ultimately, give rise to new therapeutic developments. The long-term goal of such endeavours is to develop targeted prophylactic strategies. These will probably target the molecular interaction on the mucosal surface between the products of the genome and the microbial metagenome of a patient.

  4. Crohn's disease confined to the duodenum: A case report.

    Science.gov (United States)

    Song, Dong Jin; Whang, Il Soon; Choi, Hyung Wook; Jeong, Cheol Yun; Jung, Sung Hoon

    2016-06-16

    Crohn's disease (CD) can involve any part of the gastrointestinal tract from the mouth to anus. However, gastroduodenal CD is rare with a frequency reported to range between 0.5% and 4.0%. Most patients with gastroduodenal CD have concomitant lesions in the terminal ileum or colon, but isolated gastroduodenal Crohn's disease is an extremely rare presentation of the disease accounting for less than 0.07% of all patients with CD. The symptoms of gastroduodenal CD include epigastric pain, dyspepsia, early satiety, anorexia, nausea, vomiting, and weight loss. The diagnosis of gastroduodenal CD requires a high level of clinical suspicion and can be made by comprehensive clinical evaluation. Here we report a rare case of isolated duodenal CD not confirmed by identification of granuloma on biopsy, but diagnosed by clinical evaluation.

  5. ORAL MANIFESTATIONS OF CROHN'S DISEASE: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Muhvić-Urek Miranda

    2015-12-01

    Full Text Available Crohn´s disease is a chronic inflammatory bowel disease still with unknown etiology. In 0.5-20 % of patients, extraintestinal lesions in the oral cavity can be presented in forms of orofacial granulomatosis, cobblestone and corrugated oral mucosa, mucosal tags, deep linear ulcerations with hyperplastic folds, pyostomatits vegetans, aphthous ulcers, angular cheilitis, labial/facial edema and gingival erythema/edema. We describe a case of a 28-year-old male who was presented with oral lesions of Crohn´s disease and treatment procedure. The patient was candidate for biologic treatment so dental procedures and preparation of the patient for treatment are described. Good communication and cooperation between the patient's doctor and dentist are important for successful treatment.

  6. High-utilizing Crohn's disease patients under psychosomatic therapy*

    Directory of Open Access Journals (Sweden)

    Jantschek Günther

    2008-10-01

    Full Text Available Abstract Objective Few studies have been published on health care utilization in Crohn's disease and the influence of psychological treatment on high utilizers. Methods The present sub study of a prospective multi center investigation conducted in 87 of 488 consecutive Crohn's disease (CD patients was designed to investigate the influence of the course of Crohn's disease on health care utilization (hospital days (HD and sick leave days (SLD collected by German insurance companies and to examine the conditions of high-utilizing patients. Predictors of health care utilization should be selected. Based on a standardized somatic treatment, high health care utilizing patients of the psychotherapy and control groups should be compared before and after a one-year treatment. Results Multivariate regression analysis identified disease activity at randomization as an important predictor of the clinical course (r2 = 0.28, p 2 = 0.15, p = 0.09. The patients' level of anxiety, depression and lack of control at randomization predicted their health-related quality of life at the end of the study (r2 = 0.51, p 2 = 0.22, p Among high utilizers, a significantly greater drop in HD (p Conclusion The course of Crohn's disease is influenced by psychological as well as somatic factors; especially depression seems important here. A significant drop of health care utilization demonstrates the benefit of psychological treatment in the subgroup of high-utilizing CD patients. Further studies are needed to replicate the findings of the clinical outcome in this CD subgroup.

  7. Pediatric Crohn's disease presenting with a large calcified pelvic mass

    OpenAIRE

    Grimberg, Dominic C.; Lau, Lung W.; Dahoud, Wissam; Couturier, Spencer; Redline, Raymond W.; Anne C. Kim

    2017-01-01

    Small bowel Crohn's disease classically presents with symptoms of abdominal pain, diarrhea, and weight loss in the pediatric population. However, there is no published literature on its presentation associated with a dystrophically calcified pelvic mass. We present a case of a 15-year-old female presenting with four weeks of inflammatory bowel disease (IBD) symptoms as well as a large calcified pelvic mass suggestive of chronic, organized inflammatory process versus a calcifying fibrous tumor.

  8. Paneth cells and inflammation dance together in Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    Arthur Kaser; Richard S Blumberg

    2008-01-01

    @@ Inflammatory Bowel Disease (IBD)is a dysregulated response of the immune system associated with intestinal tissues to the commensal microbiota in a genetically susceptible host.The understanding of the genetic basis of IBD has been significantly expanded with the advent of genome-wide association studies (GWAS) which has resulted in the identification of more than 30 loci that are associated with Crohn's disease(CD) and ulcerative colitis (UC).

  9. Hepatotoxicidad inducida por azatioprina en paciente con enfermedad de Crohn

    Directory of Open Access Journals (Sweden)

    D. Ruiz-Clavijo

    2013-08-01

    Full Text Available Los inmunosupresores se encuentran entre los grupos farmacológicos con mayor potencial teórico de inducir reacciones adversas, entre ellas las hepáticas. Presentamos el caso de un paciente de 35 años con enfermedad de Crohn en tratamiento con azatioprina por corticodependencia al que se le diagnosticó tras realización de una biopsia hepática de hiperplasia nodular regenerativa secundaria a este tratamiento.

  10. Genetic variants associated with Crohn's disease

    OpenAIRE

    Michail, Sonia; Bultron,; Depaolo,William

    2013-01-01

    Sonia Michail,1 Gilberto Bultron,1 R William DePaolo2 1The University of Southern California, Children's Hospital of Los Angeles, Los Angeles, CA, USA; 2Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA Abstract: Crohn's disease is an immune-related disorder characterized by inflammation of the gastrointestinal mucosa, which can occur in any area throughout the digestive tract. This life-long disease common...

  11. Predictors of depression in youth with Crohn disease.

    Science.gov (United States)

    Clark, Jeffrey G; Srinath, Arvind I; Youk, Ada O; Kirshner, Margaret A; McCarthy, F Nicole; Keljo, David J; Bousvaros, Athos; DeMaso, David R; Szigethy, Eva M

    2014-05-01

    The aim of the study was to determine whether infliximab use and other potential predictors are associated with decreased prevalence and severity of depression in pediatric patients with Crohn disease (CD). A total of 550 (n = 550) youth ages 9 to 17 years with biopsy-confirmed CD were consecutively recruited as part of a multicenter randomized controlled trial. Out of the 550, 499 patients met study criteria and were included in the analysis. At recruitment, each subject and a parent completed the Children's Depression Inventory (CDI). A child or parent CDI score ≥  12 was used to denote clinically significant depressive symptoms (CSDS). Child and parent CDI scores were summed to form total CDI (CDIT). Infliximab use, demographic information, steroid use, laboratory values, and Pediatric Crohn's Disease Activity Index (PCDAI) were collected as the potential predictors of depression. Univariate regression models were constructed to determine the relations among predictors, CSDS, and CDIT. Stepwise multivariate regression models were constructed to predict the relation between infliximab use and depression while controlling for other predictors of depression. Infliximab use was not associated with a decreased proportion of CSDS and CDIT after adjusting for multiple comparisons. CSDS and CDIT were positively associated with PCDAI, erythrocyte sedimentation rate, and steroid dose (P Disease activity and SES are significant predictors of depression in youth with Crohn disease.

  12. Prioritisation and network analysis of Crohn's disease susceptibility genes.

    Directory of Open Access Journals (Sweden)

    Daniele Muraro

    Full Text Available Recent Genome-Wide Association Studies (GWAS have revealed numerous Crohn's disease susceptibility genes and a key challenge now is in understanding how risk polymorphisms in associated genes might contribute to development of this disease. For a gene to contribute to disease phenotype, its risk variant will likely adversely communicate with a variety of other gene products to result in dysregulation of common signaling pathways. A vital challenge is to elucidate pathways of potentially greatest influence on pathological behaviour, in a manner recognizing how multiple relevant genes may yield integrative effect. In this work we apply mathematical analysis of networks involving the list of recently described Crohn's susceptibility genes, to prioritise pathways in relation to their potential development of this disease. Prioritisation was performed by applying a text mining and a diffusion based method (GRAIL, GPEC. Prospective biological significance of the resulting prioritised list of proteins is highlighted by changes in their gene expression levels in Crohn's patients intestinal tissue in comparison with healthy donors.

  13. Emerging treatments for complex perianal fistula in Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    Carlos Taxonera; David A Schwartz; Damián Garc(i)a-Olmo

    2009-01-01

    Complex perianal fistulas have a negative impact on the quality of life of sufferers and should be treated. Correct diagnosis, characterization and classification of the fistulas are essential to optimize treatment. Nevertheless, in the case of patients whose fistulas are associated with Crohn's disease, complete closure is particularly difficult to achieve. Systemic medical treatments (antibiotics, thiopurines and other immunomodulatory agents, and, more recently, anti-tumor necrosis factor-α agents such as infliximab) have been tried with varying degrees of success. Combined medical (including infliximab) and less aggressive surgical therapy (drainage and seton placement) offer the best outcomes in complex Crohn's fistulas while more aggressive surgical procedures such as fistulotomy or fistulectomy may increase the risk of incontinence. This review will focus on emerging novel treatments for perianal disease in Crohn's patients. These include locally applied infliximab or tacrolimus, fistula plugs, instillation of fibrin glue and the use of adult expanded adipose-derived stem cell injection. More welldesigned controlled studies are required to confirm the effectiveness of these emerging treatments.

  14. Angioedema associated with Crohn's disease: Response to biologics

    Institute of Scientific and Technical Information of China (English)

    Flavio Habal; Vivian Huang

    2012-01-01

    A 46-year-old female patient with terminal ileum Crohn's disease and ankylosing spondylitis presented with recurrent angioedema and urticaria.Investigations ruled out hereditary angioedema,and environmental or food allergen triggers.She was diagnosed with chronic idiopathic urticaria with angioedema,and was treated with a trial of intravenous immunoglobulin immunotherapy,danazol,prednisone and hydroxyzine.Due to ongoing bowel and arthritic complaints,she was started on infliximab infusions and within 2 treatments,she had complete resolution of the angioedema and urticaria,as well as of the bowel and arthritic symptoms.Unfortunately she developed allergic reactions to the infliximab and was switched to another anti-tumor necrosis factor (TNF)-α agent,adalimumab.Since then,she has had no further angioedema or urticaria,and her Crohn's disease has been quiescent.This is the first known case report of chronic idiopathic urticaria with angioedema coexistent with Crohn's disease that was successfully treated with anti-TNF-α agents.

  15. Thalidomide induces mucosal healing in Crohn's disease: Case report

    Institute of Scientific and Technical Information of China (English)

    Márcio Rios Leite; Sandra Sousa Santos; André Castro Lyra; Jaciane Mota; Genoile Oliveira Santana

    2011-01-01

    Crohn's disease is a chronic inflammatory disorder of the gastrointestinal tract that is defined by relapsing and remitting episodes. Tumor necrosis factor alpha (TNF-α) appears to play a central role in the pathophysiology of the disease. Standard therapies for inflammatory bowel disease fail to induce remission in about 30% of patients. Biological therapies have been associated with an increased incidence of infections, especially infection by Mycobacterium tuberculosis (Mtb). Thalidomide is an oral immunomodulatory agent with anti-TNF-α properties. Recent studies have suggested that thalidomide is effective in refractory luminal and fistulizing Crohn's disease. Thalidomide costimulates T lymphocytes, with greater effect on CD8+ than on CD4+ T cells, which contributes to the protective immune response to Mtb infection. We present a case of Crohn's disease with gastric, ileal, colon and rectum involvement as well as steroid dependency, which progressed with loss of response to infliximab after three years of therapy. The thorax computed tomography scan demonstrated a pulmonary nodule suspected to be Mtb infection. The patient was started on thalidomide therapy and exhibited an excellent response.

  16. Effectiveness of infliximab after adalimumab failure in Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    María Chaparro; Mireia Pe(n)alva; Javier P Gisbert; Montserrat Andreu; Manuel Barreiro-de Acosta; Esther García-Planella; Elena Ricart; Eugeni Domènech; María Esteve; Olga Merino; Pilar Nos

    2012-01-01

    AIM:To evaluate the effectiveness of infliximab as a second-line therapy in Crohn's disease patients after adalimumab failure.METHODS:A historical cohort study in a community-based gastroenterology practice evaluated Crohn's disease patients treated with infliximab (induction plus maintenance) after adalimumab failure.Patients were identified using a large Spanish database (ENEIDA).RESULTS:We included 15 Crohn's disease patients who received infliximab after adalimumab failure.Five patients discontinued adalimumab due to loss of response,3 due to adverse events and 7 due to partial response.After infliximab therapy was started,all patients who had interrupted adalimumab due to loss of efficacy regained response.All patients who discontinued adalimumab due to adverse events responded to infliximab and maintained this response; one of these patients had an uneventful course on infliximab,but 2 developed adverse events.None of the 7 patients who interrupted adalimumab due to partial response reached remission with infliximab.CONCLUSION:Switching from adalimumab to infliximab may be useful in patients who develop adverse effects or loss of response,however,the benefit of infliximab in primary nonresponders was not established.

  17. Protein-energy intake and malnutrition in Crohn's disease.

    Science.gov (United States)

    Hodges, P; Gee, M; Grace, M; Sherbaniuk, R W; Wensel, R H; Thomson, A B

    1984-12-01

    A detailed nutrient assessment was made of 23 male and 24 female patients with Crohn's disease who entered sequentially into an outpatient clinic. Assessment included 48-hour dietary recall, anthropometric measurements, and biochemical and hematological tests appropriate to characterize protein-energy malnutrition. Approximately 40% of patients had energy intakes equal to only two-thirds of the Recommended Dietary Allowance (RDA). Three men and five women had relative body weights less than 85% of standard, but body weight was not correlated with energy intake. Relative body weight was correlated with arm muscle circumference in both male and female patients and with triceps skinfold and total lymphocyte count in women. Although the mean protein intake was greater than 150% of the RDA, evidence of protein malnutrition included low arm muscle circumference in 14% of the men and 15% of the women, low serum albumin concentration in 13% of the women, and low total lymphocyte count in one-half of the patients. The Crohn's disease activity index was correlated significantly with serum albumin, energy intake, and duration of disease in men and with serum ferritin and hemoglobin concentration in women. Thus, a reduced relative body weight or reduced serum albumin was not uncommon in patients with Crohn's disease but did not necessarily occur in those with reduced intakes of protein and energy. However, a low relative body weight may indicate need for further nutritional assessment.

  18. Small bowel MR enterography: problem solving in Crohn's disease.

    Science.gov (United States)

    Griffin, Nyree; Grant, Lee Alexander; Anderson, Simon; Irving, Peter; Sanderson, Jeremy

    2012-06-01

    Magnetic resonance enterography (MRE) is fast becoming the first-line radiological investigation to evaluate the small bowel in patients with Crohn's disease. It can demonstrate both mural and extramural complications. The lack of ionizing radiation, together with high-contrast resolution, multiplanar capability and cine-imaging make it an attractive imaging modality in such patients who need prolonged follow-up. A key question in the management of such patients is the assessment of disease activity. Clinical indices, endoscopic and histological findings have traditionally been used as surrogate markers but all have limitations. MRE can help address this question. The purpose of this pictorial review is to (1) detail the MRE protocol used at our institution; (2) describe the rationale for the MR sequences used and their limitations; (3) compare MRE with other small bowel imaging techniques; (4) discuss how MRE can help distinguish between inflammatory, stricturing and penetrating disease, and thus facilitate management of this difficult condition. Main Messages • MR enterography (MRE) is the preferred imaging investigation to assess Crohn's disease. T2-weighted, post-contrast and diffusion-weighted imaging (DWI) can be used. • MRE offers no radiation exposure, high-contrast resolution, multiplanar ability and cine imaging. • MRE can help define disease activity, a key question in the management of Crohn's disease. • MRE can help distinguish between inflammatory, stricturing and penetrating disease. • MRE can demonstrate both mural and extramural complications.

  19. MR enterography in the management of patients with Crohn disease.

    Science.gov (United States)

    Leyendecker, John R; Bloomfeld, Richard S; DiSantis, David J; Waters, Gregory S; Mott, Ryan; Bechtold, Robert E

    2009-10-01

    Crohn disease is a complex pathologic process with an unpredictable lifelong course that includes frequent relapses. It often affects young patients, who are most vulnerable to the potential adverse effects of repeated exposure to ionizing radiation from computed tomography performed for diagnosis and surgical planning. The small intestine is the bowel segment that is most frequently affected, but it is the least accessible with endoscopic techniques. Magnetic resonance (MR) enterography has the potential to safely and noninvasively meet the imaging needs of patients with Crohn disease without exposing them to ionizing radiation. Appropriate use of MR enterography requires a carefully crafted protocol to depict signs of active inflammation as well as complications such as bowel obstruction, fistulas, and abscesses. Interpretation of MR enterographic images requires familiarity with the imaging signs and mimics of active bowel inflammation and stenosis. Although MR enterography currently is helpful for management in individual patients, the standardization of acquisition protocols and interpretive methods would increase its usefulness for more rigorous, systematic assessments of Crohn disease treatment regimens.

  20. Treatment of Crohn's disease with cannabis: an observational study.

    Science.gov (United States)

    Naftali, Timna; Lev, Lihi Bar; Yablecovitch, Doron; Yablekovitz, Doron; Half, Elisabeth; Konikoff, Fred M

    2011-08-01

    The marijuana plant cannabis is known to have therapeutic effects, including improvement of inflammatory processes. However, no report of patients using cannabis for Crohn's disease (CD) was ever published. To describe the effects of cannabis use in patients suffering from CD. In this retrospective observational study we examined disease activity, use of medication, need for surgery, and hospitalization before and after cannabis use in 30 patients (26 males) with CD. Disease activity was assessed by the Harvey Bradshaw index for Crohn's disease. Of the 30 patients 21 improved significantly after treatment with cannabis. The average Harvey Bradshaw index improved from 14 +/- 6.7 to 7 +/- 4.7 (P < 0.001). The need for other medication was significantly reduced. Fifteen of the patients had 19 surgeries during an average period of 9 years before cannabis use, but only 2 required surgery during an average period of 3 years of cannabis use. This is the first report of cannabis use in Crohn's disease in humans. The results indicate that cannabis may have a positive effect on disease activity, as reflected by reduction in disease activity index and in the need for other drugs and surgery. Prospective placebo-controlled studies are warranted to fully evaluate the efficacy and side effects of cannabis in CD.

  1. Focal non granulomatous orchitis in a patient with Crohn's disease.

    Science.gov (United States)

    Piton, Nicolas; Roquet, Marie-Laurence; Sibert, Louis; Sabourin, Jean-Christophe

    2015-04-28

    Crohn's disease is a systemic disease and sometimes involves the testicle, usually leading to granulomatous lesions. We report herein a case of focal non-granulomatous orchitis in a 21-year-old patient with active Crohn's disease treated by an anti-tumor necrosis factor monoclonal antibody. This circumscribed testicular lesion mimicked a tumor, leading to orchiectomy. Pre-operative blood tests (i.e. alpha-fetoprotein, lactate dehydrogenase and human chorionic gonadotrophin) were strictly normal Pathological examination of the testicle revealed a focal inflammatory infiltrate predominantly composed of lymphocytes accompanied by few plasma cells, lacking giant cells or granulomas. Importantly, intratubular germ cell neoplasia, atrophy or lithiasis were not observed.After discussing and excluding other plausible causes (burnt-out /regressed germ cell tumor, infection, vascular or traumatic lesions, iatrogenic effects), we concluded that this particular case of orchitis was most likely an extra-digestive manifestation of inflammatory bowel disease. To our knowledge, this is the first described case of focal non-granulomatous orchitis associated with Crohn's disease. Virtual Slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2117747284160112.

  2. Crohn's disease and hyperbaric oxygen therapy Doença de Crohn e oxigenoterapia hiperbárica

    Directory of Open Access Journals (Sweden)

    Leonardo Estenio Iezzi

    2011-01-01

    Full Text Available PURPOSE: Evaluate the application of Hyperbaric Oxygen Therapy (HBO in patients with Crohn's disease (CD refractory to pharmacologic therapy, who developed abdominal, anorectal or skin complications. METHODS: Fourteen selected patients with refractory CD and treated at the School of Medicine of Ribeirao Preto, University of Sao Paulo (FMRP-USP and at the Center of Hyperbaric Medicine, São Paulo Hospital (CEMEHI were submitted to HBO. RESULTS: Of the 14 patients evaluated, 11 had a satisfactory response. CONCLUSION: HBO has shown benefits in patients with CD refractory to pharmacologic therapy.OBJETIVOS: Avaliar a aplicação da Oxigenoterapia Hiperbárica (HBO nos pacientes com doença de Crohn (CD, refratários a terapia farmacológica, que evoluíram com complicações abdominais, orificiais ou dermatológicas. MÉTODOS: Catorze pacientes selecionados no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo e no Centro de Medicina Hiperbárica do Hospital São Paulo de Ribeirão Preto eram portadores de Doença de Crohn refratária ao tratamento farmacológico e foram submetidos a sessões de HBO. RESULTADOS: Dos 14 pacientes avaliados, 11 apresentaram resposta satisfatória. CONCLUSÃO: A HBO tem demonstrado benefício nos pacientes com Doença de Crohn refratários ao tratamento farmacológico.

  3. Demenz und Depression bei Patienten mit idiopathischem Parkinson-Syndrom

    Directory of Open Access Journals (Sweden)

    Herting B

    2007-01-01

    Full Text Available Das idiopathische Parkinson-Syndrom (IPS ist eine progressive neurodegenerative Erkrankung mit motorischen und nicht-motorischen Symptomen. Bei Patienten mit IPS sind kognitive Defizite und Demenzen mit einer Prävalenz von 20–40 % nachgewiesen worden. Risikofaktoren für das Auftreten einer Parkinson-Demenz (PDe sind hohes Alter bei Krankheitsbeginn, schwere und/oder beidseitige motorische Symptomatik, Verwirrtheitszustände unter Levodopa-Medikation, aber auch Demenzerkrankungen in der Familie und niedriges Bildungsniveau. Patienten mit PDe weisen eine erhöhte Morbidität und Mortalität im Vergleich zu Patienten mit IPS ohne Demenz und der altersgleichen Normalbevölkerung auf, die unabhängig von der Schwere der motorischen Einbußen zweifach erhöht ist. Die Depression ist das häufigste psychiatrische Symptom beim IPS (die Angaben zur Prävalenz schwanken zwischen 4 % und 70 % und beeinflußt neben den Aktivitäten des täglichen Lebens wesentlich die Lebensqualität der Betroffenen. Darin liegt auch die Herausforderung, kognitive und affektive Symptome effizient zu behandeln.

  4. Diagnostic evaluatuin of gastrointestinal tumors; Diagnostik bei Tumoren im Gastrointestinaltrakt

    Energy Technology Data Exchange (ETDEWEB)

    Linke, R.; Tatsch, K. [Ludwig-Maximilians-Univ. Muenchen (Germany). Klinik und Poliklinik fuer Nuklearmedizin

    1998-07-01

    difficult to distinguish between chronic pancreatitis and pancreatic carcinoma. In such cases a PET scan may be helpful. For planning of surgery and for preoperative staging morphological imaging is essential, but in nearly 40% of the patients nonresectable tumors were detected intraoperatively, which were not diagnosed by preoperative CT or MRI. PET seems to be more accurate in this respect, too. (orig.) [Deutsch] Hauptaufgaben der radiologischen und nuklearmedizinischen Diagnostik bei gastrointestinalen Tumoren sind Diagnosesicherung sowie praeoperatives Staging. Die Hohlorgane des oberen und unteren GI-Traktes (Oesophagus, Magen, Duodenum, Kolon, Rektum) werden primaer endoskopisch und endosonographisch abgeklaert. CT oder MRT liefern Informationen ueber Ausdehnung des Tumors, eine Infiltration in umgebende Strukturen und das Vorliegen pathologischer Lymphknoten. Das sensitivste Verfahren zum Nachweis von Lymphknoten- oder Fernmetastasen ist die PET. Auch die Differenzierung eines Lokalrezidivs von postoperativer Narbenbildung, z.B. beim kolorektalen Karzinom, gelingt mit der PET fruehzeitiger als mit den konventionellen morphologischen Verfahren. Lebertumoren sollten primaer sonographisch und bei fraglicher Dignitaet anschliessend mittels MRT untersucht werden. In der Differentialdiagnostik von unklaren Leberherden ist die nuklearmedizinische Rezeptorszintigraphie wegweisend. Benigne Leberlaesionen koennen mit der Neogalaktoalbumin-(NGA-)Szintigraphie sicher von malignen Tumoren (Metastasen, hepatozellulaeres Karzinom [HCC]) abgegrenzt werden, da NGA-Rezeptoren nur auf funktionstuechtigen Hepatozyten experimentiert werden. Die Unterscheidung von Lebermetastasen und dem HCC gelingt mit der Insulinszintigraphie, da sich Insulin aufgrund einer Ueberexpression von Insulinrezeptoren mit HCC vermehrt anreichert. Ergeben die vorgeschalteten Untersuchungen den Verdacht auf einen malignen Prozess, sollte zusaetzlich eine CT-Arterioportographie durchgefuehrt werden, da dieses

  5. Peripheral neutrophil functions and cell signalling in Crohn`s disease.

    Directory of Open Access Journals (Sweden)

    Rajesh Somasundaram

    Full Text Available The role of the innate immunity in the pathogenesis of Crohn's disease (CD, an inflammatory bowel disease, is a subject of increasing interest. Neutrophils (PMN are key members of the innate immune system which migrate to sites of bacterial infection and initiate the defence against microbes by producing reactive oxygen species (ROS, before undergoing apoptosis. It is believed that impaired innate immune responses contribute to CD, but it is as yet unclear whether intrinsic defects in PMN signal transduction and corresponding function are present in patients with quiescent disease. We isolated peripheral blood PMN from CD patients in remission and healthy controls (HC, and characterised migration, bacterial uptake and killing, ROS production and cell death signalling. Whereas IL8-induced migration and signalling were normal in CD, trans-epithelial migration was significantly impaired. Uptake and killing of E. coli were normal. However, an increased ROS production was observed in CD PMN after stimulation with the bacterial peptide analogue fMLP, which was mirrored by an increased fMLP-triggered ERK and AKT signal activation. Interestingly, cleavage of caspase-3 and caspase-8 during GMCSF-induced rescue from cell-death was decreased in CD neutrophils, but a reduced survival signal emanating from STAT3 and AKT pathways was concomitantly observed, resulting in a similar percentage of end stage apoptotic PMN in CD patients and HC. In toto, these data show a disturbed signal transduction activation and functionality in peripheral blood PMN from patients with quiescent CD, which point toward an intrinsic defect in innate immunity in these patients.

  6. Factors affecting recurrence after surgery for Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    Takayuki Yamamoto

    2005-01-01

    Although in Crohn's disease post-operative recurrence is common, the determinants of disease recurrence remain speculative. The aim of this study was to examine factors affecting post-operative recurrence of Crohn's disease. A Medline-based literature review was carried out. The following factors were investigated: age at onset of disease, sex, family history of Crohn's disease,smoking, duration of Crohn's disease before surgery,prophylactic medical treatment (corticosteroids, 5-amino salicylic acid [5-ASA] and immunosuppressants),anatomical site of involvement, indication for surgery (perforating or non-perforating disease), length of resected bowel, anast-omotic technique, presence of granuloma in the specimen, involvement of disease at the resection margin, blood transfusions and postoperative complications. Smoking significantly increases the risk of recurrence (risk is approximately twice as high), especially in women and heavy smokers. Quitting smoking reduces the post-operative recurrence rate. A number of studies have shown a higher risk when the duration of the disease before surgery was short. There were, however, different definitions of 'short' among the studies. Prophylactic cortic-osteroids therapy is not effective in reducing the post-operative recurrence. A number of randomized controlled trials offered evidence of the efficacy of 5-ASA (mesalazine) in reducing post-operative recurrence. Recently, the thera-peutic efficacy of immunosuppressive drugs (azathioprine and 6-mercaptopurine) in the prevention of post-operative recurrence has been investigated and several studies have reported that these drugs might help prevent the recurrence. Further clinical trials would be necessary to evaluate the prophylactic efficacy of immunosuppressants.Several studies showed a higher recurrence rate in patients with perforating disease than in those with non-perforating disease. However, evidence for differing recurrence rates in perforating and non

  7. PENILE AND SCROTAL LYMPHEDEMA AS AN UNUSUAL PRESENTATION OF CROHN'S DISEASE : CASE REPORT AND REVIEW OF THE LITERATURE

    NARCIS (Netherlands)

    Reitsma, W.; Wiegman, M. J.; Damstra, R. J.

    2012-01-01

    Crohn's disease is an inflammatory intestinal disease that primarily causes abdominal pain and diarrhea. We report a male patient who presented with penile and scrotal lymphedema and inguinal fistulas as the first manifestations of Crohn's disease. Extraintestinal or metastatic Crohn's disease initi

  8. PENILE AND SCROTAL LYMPHEDEMA AS AN UNUSUAL PRESENTATION OF CROHN'S DISEASE : CASE REPORT AND REVIEW OF THE LITERATURE

    NARCIS (Netherlands)

    Reitsma, W.; Wiegman, M. J.; Damstra, R. J.

    Crohn's disease is an inflammatory intestinal disease that primarily causes abdominal pain and diarrhea. We report a male patient who presented with penile and scrotal lymphedema and inguinal fistulas as the first manifestations of Crohn's disease. Extraintestinal or metastatic Crohn's disease

  9. PENILE AND SCROTAL LYMPHEDEMA AS AN UNUSUAL PRESENTATION OF CROHN'S DISEASE : CASE REPORT AND REVIEW OF THE LITERATURE

    NARCIS (Netherlands)

    Reitsma, W.; Wiegman, M. J.; Damstra, R. J.

    2012-01-01

    Crohn's disease is an inflammatory intestinal disease that primarily causes abdominal pain and diarrhea. We report a male patient who presented with penile and scrotal lymphedema and inguinal fistulas as the first manifestations of Crohn's disease. Extraintestinal or metastatic Crohn's disease initi

  10. Effect of childbirth on the course of Crohn's disease; results from a retrospective cohort study in the Netherlands

    NARCIS (Netherlands)

    Smink, M.; Lotgering, F.K.; Albers, L.; Jong, D.J. de

    2011-01-01

    BACKGROUND: Pregnant women with Crohn's disease needs proper counselling about the effect of pregnancy and childbirth on their disease. However, Literature about the effect of childbirth on Crohn's disease is limited. This study examined the effect of childbirth on the course of Crohn's disease and

  11. Diffusion-weighted magnetic resonance imaging of the abdomen; Diffusionsgewichtete Magnetresonanztomographie des Abdomens

    Energy Technology Data Exchange (ETDEWEB)

    Schmid-Tannwald, C.; Reiser, M.F.; Zech, C.J. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Institut fuer Klinische Radiologie, Muenchen (Germany)

    2011-03-15

    Diffusion-weighted magnetic resonance imaging (DW-MRI) provides qualitative and quantitative information of tissue cellularity and the integrity of cellular membranes. Since DW-MRI can be performed without ionizing radiation exposure and contrast media application, DW-MRI is a particularly attractive tool for patients with allergies for gadolinium-based contrast agents or renal failure. Recent technical developments have made DW-MRI a robust and feasible technique for abdominal imaging. DW-MRI provides information on the detection and characterization of focal liver lesions and can also visualize treatment effects and early changes in chronic liver disease. In addition DW-MRI is a promising tool for the detection of inflammatory changes in patients with Crohn's disease. (orig.) [German] Die diffusionsgewichtete (DW-)MRT ermoeglicht die Erfassung qualitativer und quantitativer Informationen bzgl. der Gewebezellularitaet und Membranintegritaet. Die DW-MRT ist insbesondere bei Patienten mit einer Allergie gegen gadoliniumhaltige Kontrastmittel oder eingeschraenkter Nierenfunktion attraktiv, da ihr Einsatz nicht mit Strahlenexposition oder Kontrastmittelgabe verbunden ist. Durch technische Weiterentwicklungen ist die robuste Anwendung der DW-MRI in der Bildgebung des Abdomens seit einiger Zeit moeglich geworden. In der Leberdiagnostik lassen sich Zusatzinformationen zur Detektion und Charakterisierung von Leberlaesionen gewinnen, aber auch Therapieerfolge dokumentieren und fruehe chronische Leberveraenderungen visualisieren. Neben ihrer Rolle bei hepatologischen und onkologischen Fragestellungen erscheint der Einsatz der DW-MRT zudem bei entzuendlichen Fragestellungen wie dem Morbus Crohn sehr viel versprechend. (orig.)

  12. Increased incidence of azathioprine-induced pancreatitis in Crohn's disease compared with other diseases

    NARCIS (Netherlands)

    Weersma, RK; Peters, FTM; Oostenbrug, LE; Van den Berg, AP; Van Haastert, M; Ploeg, RJ; Posthumus, MD; Van der Heide, JJH; Jansen, PLM; Van Dullemen, HM

    2004-01-01

    Background: Azathioprine is widely used in Crohn's disease. A major drawback is the occurrence of side-effects, especially acute pancreatitis. Acute pancreatitis is rarely seen when azathioprine is used for other diseases than Crohn's disease. Aim: To survey side-effects of azathioprine after liver

  13. Thalidomide and thalidomide analogues for maintenance of remission in Crohn's disease

    NARCIS (Netherlands)

    A.K. Akobeng; P.C. Stokkers

    2009-01-01

    Background Maintenance of remission is a major issue in the management of Crohn's disease. Thalidomide, a tumour necrosis factor-alpha (TNF-alpha) inhibitor and its analogue, lenalidomide, may have a role in the management of Crohn's disease, but it is not clear whether it is an effective maintenanc

  14. Vitamin D deficiency in Crohn's disease: prevalence, risk factors and supplement use in an outpatient setting.

    LENUS (Irish Health Repository)

    Suibhne, Treasa Nic

    2012-03-01

    Vitamin D deficiency impacts on bone health and has potential new roles in inflammation. We aimed to determine the prevalence of and risk factors for vitamin D deficiency and to explore vitamin D supplement usage in patients with Crohn\\'s disease (CD) in an outpatient setting, compared with controls.

  15. Comparison of Techniques for Monitoring Infliximab and Antibodies Against Infliximab in Crohn's Disease

    DEFF Research Database (Denmark)

    Steenholdt, Casper; Ainsworth, Mark A; Tovey, Michael

    2013-01-01

    Several techniques are used to measure infliximab (IFX) and anti-IFX antibodies (Abs) in Crohn's disease. The aim of this study was to compare different assays for this purpose.......Several techniques are used to measure infliximab (IFX) and anti-IFX antibodies (Abs) in Crohn's disease. The aim of this study was to compare different assays for this purpose....

  16. Increased incidence of azathioprine-induced pancreatitis in Crohn's disease compared with other diseases

    NARCIS (Netherlands)

    Weersma, RK; Peters, FTM; Oostenbrug, LE; Van den Berg, AP; Van Haastert, M; Ploeg, RJ; Posthumus, MD; Van der Heide, JJH; Jansen, PLM; Van Dullemen, HM

    2004-01-01

    Background: Azathioprine is widely used in Crohn's disease. A major drawback is the occurrence of side-effects, especially acute pancreatitis. Acute pancreatitis is rarely seen when azathioprine is used for other diseases than Crohn's disease. Aim: To survey side-effects of azathioprine after liver

  17. Increased colonic mucosal angiotensin I and II concentrations in Crohn's colitis.

    Science.gov (United States)

    Jaszewski, R; Tolia, V; Ehrinpreis, M N; Bodzin, J H; Peleman, R R; Korlipara, R; Weinstock, J V

    1990-06-01

    To define a potential role for the angiotensin system in Crohn's colitis, the colonic mucosal levels of angiotensin I and II were measured in endoscopic biopsy samples from patients with active Crohn's colitis (n = 20), ulcerative colitis (n = 13), other forms of colitis (n = 3), and normal controls (n = 17). Colonic mucosal levels of angiotensin I and II were greater in patients with Crohn's colitis than in normal subjects (p less than 0.001 and p less than 0.001, respectively). Mucosal levels of angiotensin I and II were also higher in Crohn's colitis than in ulcerative colitis (p less than 0.001 and p less than 0.001, respectively), and levels of angiotensin II were higher in Crohn's than in other forms of colitis (p = 0.014). Mucosal levels of angiotensin I and II correlated well with the degree of macroscopic inflammation in Crohn's colitis (r = 0.86, p less than 0.001 and r = 0.68, p less than 0.001, respectively). Mucosal levels of angiotensin I correlated fairly well with the Crohn's Disease Activity Index (r = 0.46, p less than 0.05) while angiotensin II levels correlated poorly. These studies suggest that angiotensin I and II may have a role in the inflammation associated with Crohn's colitis.

  18. A 5-year prospective observational study of the outcomes of international treatment guidelines for Crohn's disease.

    LENUS (Irish Health Repository)

    Cullen, Garret

    2012-02-01

    BACKGROUND & AIMS: Therapeutic strategies for patients with Crohn\\'s disease are based on American and European guidelines. High rates of corticosteroid dependency and low remission rates are identified as weaknesses of this therapy and as justification for early introduction of biologic agents (top-down treatment) in moderate\\/severe Crohn\\'s disease. We reviewed outcomes and corticosteroid-dependency rates of patients with moderate-to-severe disease who were treated according to the international guidelines. METHODS: Consecutive patients (102) newly diagnosed with Crohn\\'s disease in 2000-2002 were identified from a prospectively maintained database. Severity of disease was scored using the Harvey-Bradshaw Index (HBI). Disease was classified by Montreal classification. Five-year follow-up data were recorded. RESULTS: Seventy-two patients had moderate\\/severe disease at diagnosis (HBI >8). Fifty-four (75%) had nonstricturing, nonpenetrating disease (B1). Sixty-four (89%) received corticosteroids, and 44 (61%) received immunomodulators. Twenty-one patients (29%) received infliximab. Thirty-nine patients (54%) required resection surgery. At a median of 5 years, 66 of 72 (92%) patients with moderate\\/severe disease were in remission (median HBI, 1). Twenty-five patients (35%) required neither surgery nor biologic therapy. CONCLUSIONS: When international treatment guidelines are strictly followed, Crohn\\'s disease patients can achieve high rates of remission and low rates of morbidity at 5 years. Indiscriminate use of biologic agents therefore is not appropriate for all patients with moderate-to-severe disease.

  19. Chronic granulomatous otitis externa as an initial presentation of cutaneous Crohn disease.

    Science.gov (United States)

    Raynor, Eileen M

    2014-08-01

    In the limited number of Crohn disease cases involving the head and neck, there is a predilection for mucosal surfaces and rare reports of involvement in the postauricular region. To our knowledge, in all previously reported cases involving the head and neck, the patients had a known diagnosis of Crohn disease. This case describes a 10-year-old boy with a history of psoriasis and psoriasiform dermatitis who presented with bilateral chronic granulomatous otitis externa, obliteration of the external auditory canal, and fissuring, resulting in separation of the lobule from the preauricular skin. Pathologic examination results were consistent with granulomatous dermatitis concerning for cutaneous Crohn disease, and a subsequent gastroenterologic workup confirmed the diagnosis of Crohn disease. This is a report of chronic granulomatous otitis as the initial presentation of cutaneous Crohn disease in a child.

  20. Primary sclerosing cholangitis, Crohn's disease and HLA-B27 in black South African women.

    Science.gov (United States)

    Buchel, O C; Bosch, F J; Janse van Rensburg, J; Bezuidenhout, E; de Vries, C S; van Zyl, J H; Middlecote, B D; de K Grundling, H; Fevery, J

    2012-12-01

    Crohn's disease is rare in South African black people and primary sclerosing cholangitis (PSC) is also rare in black patients with IBD, from South Africa. The presence of HLA-B27 is generally associated with seronegative spondylo-arthropathies and correlates with the occurrence of ankylosing spondylitis, recurrent mouth ulcers and uveitis, in patients with IBD. We describe two women with the combination of Crohn's disease, PSC and HLA-B27 from our cohort of the last 5 years of three black patients with Crohn's disease. Crohn's disease, PSC and HLA-B27 respectively, occur rarely in black South Africans and their concurrent presence in two black women suggests a pathogenetic link of HLA-B27 between Crohn's disease and PSC in this population. Female gender might be an additional determinant in this setting.

  1. Uveitis as first manifestation of probably Crohn's disease Uveíte como primeira manifestação de provável doença de Crohn

    Directory of Open Access Journals (Sweden)

    Ieda Maria Alexandre Barreira

    2012-12-01

    Full Text Available Extraintestinal manifestations of Crohn's disease are common. Although ocular complications of Crohn's disease are infrequent, most ocular manifestations include iritis, uveitis, episcleritis, scleritis and conjuntivitis. We report a patient who developed uveitis two years before diagnose of Crohn's disease.Manifestações extraintestinais da doença de Crohn são comuns. As manifestações oculares são infrequentes e caracterizam-se em sua maioria por irite, uveíte, episclerite, esclerite e conjuntivite. Relatamos o caso de uma paciente que desenvolveu uveíte dois anos antes de firmado o diagnóstico de doenca de Crohn.

  2. Systematic review: Use of ultrasonography, computed tomography and magnetic resonance imaging for the diagnosis, assessment of activity and abdominal complications of Crohn?s disease

    OpenAIRE

    2011-01-01

    Abstract Backgroud: Cross-sectional imaging techniques, including ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI), are increasingly used for evaluation of Crohn?s disease (CD). Aim: To perform an assessment of the diagnostic accuracy of cross-sectional imaging techniques for diagnosis of CD, evaluation of disease extension and activity, and diagnosis of complications, and to provide recommendations for their optimal use. Methods: Relevant ...

  3. Low serum and bone vitamin K status in patients with longstanding Crohn's disease: another pathogenetic factor of osteoporosis in Crohn's disease?

    OpenAIRE

    Schoon, E; Muller, M; Vermeer, C.; Schurgers, L; Brummer, R; Stockbrugger, R.

    2001-01-01

    BACKGROUND—A high prevalence of osteoporosis is reported in Crohn's disease. The pathogenesis is not completely understood but is probably multifactorial. Longstanding Crohn's disease is associated with a deficiency of fat soluble vitamins, among them vitamin K. Vitamin K is a cofactor in the carboxylation of osteocalcin, a protein essential for calcium binding to bone. A high level of circulating uncarboxylated osteocalcin is a sensitive marker of vitamin K deficiency.
AIMS—To determine seru...

  4. Cryotherapy in rheumatic disorders; Kryotherapie bei rheumatischen Erkrankungen

    Energy Technology Data Exchange (ETDEWEB)

    Soerensen, H. [Rheumaklinik Immanuel-Krankenhaus, Berlin (Germany). Innere Rheumatologische Abt.

    1994-12-31

    When applied locally, cold therapy (cryotherapy) has the effect of inhibiting inflammation, occluding blood vessels, and stopping bleeding. Active rheumatic inflammation, activated arthrosis, and swelling after injury can be alleviated by local cold application, while heat application would worsen the situation. In whole-body cryotherapy the whole patient, wearing only a bathing suit, is exposed to a temperature of -100 C. The present paper descrcribes the cold room of the Immanuel Hospital in Berlin-Wannsee. (BWI) [Deutsch] Kaeltetherapie (Kryotherapie) wirkt lokal angewendet entzuendungshemmend, blutgefaessabdichtend und blutstillend. Eine aktive rheumatische Entzuendung, aktivierte Arthrose und Schwellungsreaktionen bei Verletzungen werden durch lokale Kaelteanwendungen gedaempft, wogegen Waerme den akuten Zustand verschlimmern wuerde. In der Ganzkoerperkaeltetherapie wird der ganze Mensch in Badebekleidung einer realen Temperatur von -100 C ausgesetzt. Der vorliegende Beitrag beschreibt die Kaeltekammer des Immanuel Krankenhauses in Berlin Wannsee. (BWI)

  5. Quantifizierung neurodegenerativer Veränderungen bei der Alzheimer Krankheit

    Science.gov (United States)

    Fritzsche, Klaus H.; Giesel, Frederik L.; Thomann, Philipp A.; Hahn, Horst K.; Essig, Marco; Meinzer, Hans-Peter

    Die objektive Bewertung neurodegenerativer Prozesse stellt für die Diagnose und Therapiebegutachtung neuropsychiatrischer Krankheiten eine wichtige Grundlage dar. Computerbasierte radiodiagnostische Verfahren können pathologische Veränderungen in verschiedenen Hirnarealen quantifizieren und hierbei die rein visuelle Beurteilung der Bilddaten ergänzen. Inhalt dieser Studie ist die Evaluation einer voll automatischen Methode zur voxelbasierten Messung atrophischer Veränderungen im Gehirn, wie sie bei der Alzheimer-Demenz (AD) oder der leichten kognitiven Störung (LKS) auftreten. Es wurde eine signifikante Korrelation mit den semiautomatisch extrahierten Volumina der Temporalhörner festgestellt. Die Präzision, Benutzerfreundlichkeit, Beobachterunabh ängigkeit sowie die kurze Rechenzeit des automatischen Verfahrens sind wichtige Voraussetzungen für den routinemäßigen klinischen Einsatz.

  6. Aktuelle Therapieansätze bei der alkoholischen Lebererkrankung

    Directory of Open Access Journals (Sweden)

    Renner F

    2006-01-01

    Full Text Available Alkohol ist einer der wichtigsten Auslöser oder aggravierenden Faktoren für chronische und akute Lebererkrankungen. Pathophysiologisch sind neben nutritiven Defiziten vor allem eine direkte Alkoholtoxizität mit vermehrter Bildung freier Radikale, konsekutiver Störungen des Intermediärstoffwechsels und schließlich eine inadäquate Zytokinaktivierung von Bedeutung. Dementsprechend sind Abstinenz, Ausgleich kalorischer Defizite, sowie bei der schweren Alkoholhepatitis die Gabe von Steroiden und der Einsatz von Pentoxifyllin zur Vermeidung des hepatorenalen Syndroms von gesicherter therapeutischer Effizienz. Die Lebertransplantation hat sich insbesonders in Kombination mit Abstinenz als effizienteste Therapie der alkoholischen Leberzirrhose erwiesen. Leberschutzpräparate und gezielte Nahrungsmittelergänzungen sind von nicht gesichertem Nutzen, über Tumornekrosefaktor- (TNF- alpha Antikörper und Insulinsensitizer liegen erste Ergebnisse vor.

  7. Konservative und operative Therapie bei Harninkontinenz, Deszensus und Urogenitalbschwerden

    Directory of Open Access Journals (Sweden)

    Eberhard J

    2000-01-01

    Full Text Available Urogynäkologische Beschwerden wie Harninkontinenz, Infektionen, vulvo-vaginale und vesikale Reizzustände, Juckreiz, Dyspareunie, Beckenbodenschwäche, Deszensusbeschwerden werden in irgendeiner Form bei fast jeder Frau im Laufe ihres Lebens zur behandlungsbedürftigen Krankheit. Die Ursachen dieser häufigsten Frauenleiden sind vielfältig. Eine erfolgreiche Therapie sollte auf der Polyätiologie urogynäkologischer Krankheiten aufbauen und die verschiedenen Therapiemöglichkeiten zu einem patienten- und krankheitsadaptierten Behandlungskonzept zusammenfügen. Die Bausteine der konservativen Therapie sind: Trink- und Miktionstraining, Physiotherapie mit den Hilfsmitteln Kugeln, Kegel, Elektrostimulation und Biofeedbackmethoden; Östrogene, Pessare, Infekttherapie, Intimpflege, blasenrelaxierende und andere urogynäkologische Medikamente. Der Einsatz dieser Therapiebausteine wird ausführlich besprochen. Auch wird gezeigt, wann und wie operiert werden soll, wenn die konservative Therapie nicht zum Ziel führt.

  8. [Intestinal dysbiosis in pediatric patients with Crohn's disease].

    Science.gov (United States)

    Pueyo, Blanca; Mach, Núria

    2013-11-01

    Introducción La enfermedad de Crohn (EC) pediátrica es un desorden caracterizado por presentar inflamación crónica que puede afectar cualquier segmento del tracto gastrointestinal. La disbiosis intestinal es un factor implicado en la patogénesis multifactorial de esta enfermedad. Diferentes suplementos dietarios se han propuesto como terapia alternativa para inducir o mantener la remisión de la EC. Objetivo Revisar las evidencias científicas publicadas sobre disbiosis intestinal en pacientes de Crohn pediátricos y la eficacia de la terapia con suplementos dietarios (especialmente probióticos). Material y métodos Se ha realizado una extensa búsqueda de publicaciones científicas en las principales bases de datos electrónicas especializadas: NCBI, Elsevier, Scielo, Scirus y Science Direct. Resultados y Discusión Se ha observado en la población pediátrica de EC un aumento de Proteobacteria y una reducción de Firmicutes. Los resultados referentes a los phyla Bacteroidetes y Actinobacteria son divergentes. Referente al uso de suplementos dietarios, el uso de probióticos no ha mostrado ningún impacto positivo en la EC pediátrica. Conclusiones Los resultados publicados hasta la fecha referentes a la disbiosis intestinal en pacientes pediátricos de Crohn, contribuyen al mejor conocimiento y entendimiento de las modificaciones en la flora bacteriana. Sin embargo, no es posible definir una microbiota asociada o causante de la EC. Además, los resultados publicados hasta la fecha no aportan evidencias sólidas de la eficacia de los probióticos como terapia en dichos pacientes.

  9. Prior appendectomy and the phenotype and course of Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    Jacques Cosnes; Philippe Seksik; Isabelle Nion-Larmurier; Laurent Beaugerie; Jean-Pierre Gendre

    2006-01-01

    AIM: To determine whether prior appendectomy modifies the phenotype and severity of Crohn's disease.METHODS: Appendectomy status and smoking habits were specified by direct interview in 2838 patients consecutively seen between 1995 and 2004. Occurrence of complications and therapeutic needs were reviewed retrospectively. Additionally, annual disease activity was assessed prospectively between 1995 and 2004 in patients who had not had ileocecal resection and of a matched control group.RESULTS: Compared to 1770 non-appendectomized patients, appendectomized patients more than 5 years before Crohn's disease diagnosis (n=716) were more often females, smokers, with ileal disease. Cox regression showed that prior appendectomy was positively related to the risk of intestinal stricture (adjusted hazard ratio,1.24; 95% confidence interval, 1.13 to 1.36; P=0.02)and inversely related to the risk of perianal fistulization (adjusted hazard ratio, 0.75; 95% confidence interval,0.68 to 0.83; P=0.002). No difference was observed between the two groups regarding the therapeutic needs, except for an increased risk of surgery in appendectomized patients, attributable to the increased prevalence of ileal disease. Between 1995 and 2004,Crohn's disease was active during 50% of years in appendectomized patients (1318 out of 2637 patient-years) and 51% in non-appendectomized patients (1454out of 2841 patient-years; NS).CONCLUSION: Prior appendectomy is associated with a more proximal disease and has an increased risk of stricture and a lesser risk of anal fistulization. However,the severity of the disease is unaffected.

  10. Clinical features and management of Crohn's disease in Chinese patients

    Institute of Scientific and Technical Information of China (English)

    郑家驹; 史晓华; 褚行琦; 贾黎明; 王风鸣

    2004-01-01

    Background An increasing incidence of Crohn' s disease has been found in China in recent years.Our study has been focused on evaluating the diversity of the clinical manifestations of Crohn' s disease in order to improve early diagnostic accuracy and therapeutic efficacy.Methods Thirty patients with active Crohn's disease were enrolled and their clinical data, including diagnostic and therapeutic results, were analyzed. Endoscopy combined with histological examination of biopsy specimens provided characteristic features of the disease. Transabdominal bowel sonography (TABS) was used for detecting intestinal complications. Nutritional supportive therapy was given to 20 subjects with active cases of the disease.Results Most patients were young adults with a higher proportion of females to males (ratio: 1.14:1). The disease affects any segment or a combination of segments along with the alimentary tract(from the mouth to the anus). In this study, the colon and small bowel were the major sites involved.Recurrent episodes of abdominal pain in the right lower quadrant and watery diarrhea were the most common symptoms. Granulomas were identifiable in nearly one-third (30.8%) of all biopsy specimens. In moderate cases of the disease, remission was achieved more quickly through the use of oral prednisone therapy than with SASP or 5-ASA. Beneficial effects on the host' s nutritional status were observed. Immunosuppressives were used on an individual basis and showed variable therapeutic effects. Sixteen patients had surgery due to intestinal obstruction or failure to respond to drug therapies. Rapid improvement after surgery was reported. Conclusion Endoscopy (with biopsy) and TABS were both crucial procedures for diagnosis. SASP(or 5-ASA) and prednisone were effective as inductive therapies. Azathioprine has demonstrable benefits after induction therapy with prednisone. Surgery, as an alternative treatment, provided another effective choice in selected patients.

  11. Crohn's disease lymphadenopathy: MR imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Gourtsoyianni, Sofia [Department of Radiology, University Hospital of Heraklion, Medical School, University of Crete (Greece)], E-mail: sgty76@gmail.com; Papanikolaou, Nickolas; Amanakis, Emmanouil [Department of Radiology, University Hospital of Heraklion, Medical School, University of Crete (Greece); Bourikas, Leonidas; Roussomoustakaki, Maria [Department of Gastroenterology, University Hospital of Heraklion, Medical School, University of Crete (Greece); Grammatikakis, John; Gourtsoyiannis, Nicholas [Department of Radiology, University Hospital of Heraklion, Medical School, University of Crete (Greece)

    2009-03-15

    Purpose: To assess mesenteric lymph nodes in patients with different Crohn's disease subtypes identified on MR Enteroclysis. Materials and methods: Thirty-four patients, categorized into three different Crohn's disease subgroups, underwent MR Enteroclysis. A high resolution coronal true FISP sequence with fat saturation was applied to assess mesenteric lymph node anatomic distribution, size and shape. Their enhancement ratio (ER) was calculated by dividing signal intensity of each node to signal intensity of nearby vessel on T1 weighted FLASH images, acquired 75 s after intravenous administration of gadolinium. A one-way analysis of variance statistical test was applied to investigate any significant differences regarding mean ER among different disease subgroups. Results: Two hundred and eighty-three mesenteric lymph nodes were assessed, 231 in patients with active inflammatory (AI) disease, 36 in patients with fibrostenotic (FS) and 16 in patients with fistulizing/perforating (FP) disease. Maximum and minimum diameters were 3.2 and 0.3 cm, respectively. 75% of the lymph nodes presented with an oval shape. The majority were identified as being ileocolic (34%) and paracolic (31%). AI subgroup lymph nodes presented with the highest mean ER (0.783 {+-} 0.17) followed by FP (0.706 {+-} 0.1) and FS subgroup (0.652 {+-} 0.17) lymph nodes. The differences in mean values of ER of mesenteric lymph nodes between AI and FS subtypes were statistically significant (p < 0.0001), while mean ER between nodes of FP and the other two subtypes did not present statistically significant differences. Conclusion: ER of mesenteric lymph nodes identified on MR Enteroclysis may vary across different subtypes of Crohn's disease. Such differences may be valuable in clinical practice.

  12. Disbiosis intestinal en enfermos de Crohn pediátricos

    Directory of Open Access Journals (Sweden)

    Blanca Pueyo

    2013-12-01

    Full Text Available Introducción: La enfermedad de Crohn (EC pediátrica es un desorden caracterizado por presentar inflamación crónica que puede afectar cualquier segmento del tracto gastrointestinal. La disbiosis intestinal es un factor implicado en la patogénesis multifactorial de esta enfermedad. Diferentes suplementos dietarios se han propuesto como terapia alternativa para inducir o mantener la remisión de la EC. Objetivo: Revisar las evidencias científicas publicadas sobre disbiosis intestinal en pacientes de Crohn pediátricos y la eficacia de la terapia con suplementos dietarios (especialmente probióticos. Material y métodos: Se ha realizado una extensa búsqueda de publicaciones científicas en las principales bases de datos electrónicas especializadas: NCBI, Elsevier, Scielo, Scirus y Science Direct. Resultados y Discusión: Se ha observado en la población pediátrica de EC un aumento de Proteobacteria y una reducción de Firmicutes. Los resultados referentes a los phyla Bacteroidetes y Actinobacteria son divergentes. Referente al uso de suplementos dietarios, el uso de probióticos no ha mostrado ningún impacto positivo en la EC pediátrica. Conclusiones: Los resultados publicados hasta la fecha referentes a la disbiosis intestinal en pacientes pediátricos de Crohn, contribuyen al mejor conocimiento y entendimiento de las modificaciones en la flora bacteriana. Sin embargo, no es posible definir una microbiota asociada o causante de la EC. Además, los resultados publicados hasta la fecha no aportan evidencias sólidas de la eficacia de los probióticos como terapia en dichos pacientes.

  13. Pathophysiologie des Kollagenstoffwechsels bei Patienten mit Induratio penis plastica (IPP

    Directory of Open Access Journals (Sweden)

    Lahme S

    2000-01-01

    Full Text Available Die Pathogenese der IPP ist bis heute nicht geklärt. Histopathologische Untersuchungen zeigen, daß der Kollagenstoffwechsel eine Rolle spielt. Dies veranlaßte uns zur genauen Analyse der Kollagenstoffwechselparameter bei IPP. Bei 11 Patienten mit IPP und 11 Kontrollpersonen wurden Kollagenstoffwechselparameter (Prokollagen III [PIIIP], PMN-Elastase [PMN-E], Fibronektin [FN], Fibronektinrezeptor [FN-R] und alpha1-Proteinase-Inhibitor [alpha1-PI] im cavernösen und peripheren Blut bestimmt. PMN-E, PIIIP, FN und FN-R waren in den beiden Untersuchungsgruppen nicht unterschiedlich. Die peripher venösen unterschieden sich nicht von den cavernösen Blutproben. Sowohl im peripher venös (158,55 mg/dl als auch im cavernös entnommenen Blut (168,29 mg/dl war die Konzentration des a1-PI signifikant niedriger als in der Kontrollgruppe (214,82 mg/dl. An einem zweiten Kollektiv von 23 Patienten wurden Analysen des Phänotyps für alpha1-PI im Hinblick auf das Vorliegen von genetisch determinierten Mangelallelen vorgenommen. Hier zeigte sich kein signifikanter Unterschied zu einem Kontrollkollektiv von 19 gesunden Probanden. Die alpha1-PI Erniedrigung der IPP-Patienten ist signifikant und liegt unterhalb des Normalwertbereichs für die gesunde Population. Ein Mangel an alpha1-PI kann zur Aktivitätserhöhung der Proteasen und zum Umbau des Kollagengewebes führen. Möglicherweise kommt es zusammen mit einem lokal wirksamen Einflußfaktor schließlich zur dystrophen Kalzifikation. Die humangenetischen Untersuchungen sprechen nicht für eine genetische Determinierung des alpha1-PI-Mangels, sondern legen eine erworbene hepatische Störung nahe.

  14. MRI in dementia-type diseases; MRT bei demenziellen Erkrankungen

    Energy Technology Data Exchange (ETDEWEB)

    Bodea, S.V.; Muehl-Benninghaus, R. [Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Homburg (Germany)

    2015-05-01

    Dementia-inducing conditions represent a leading cause of disability and are a major health concern in industrialized countries. The burden these conditions put on society is certain to rise in the context of an ever-increasing elderly population. As these conditions feature an insidious onset and overlapping clinical features, imaging is a powerful tool in refining the diagnosis and assessing the progression of dementing conditions. The radiologist needs to be aware of and be able to detect underlying pathologies which could be reversible. Furthermore, imaging is important not only in excluding other pathologies but also in improving diagnostic accuracy. This article presents the typical clinical presentations as well as magnetic resonance imaging (MRI) features of the degenerative and the non-degenerative causes of dementia. The focus is on the core knowledge for MRI diagnostics in dementing conditions and a brief presentation of the latest MRI techniques which may become a part of standard imaging protocols in the future. (orig.) [German] Demenzielle Erkrankungen gehoeren in den Industrielaendern zu den haeufigsten Ursachen fuer Beeintraechtigungen im Alltag. Durch eine stetig alternde Population nimmt auch die Belastung fuer die Gesellschaft immer weiter zu. Bei haeufig schleichendem Symptombeginn sowie sich ueberlappender Klinik mit anderen Krankeitsbildern kann die Bildgebung ein gutes Werkzeug zur Praezisierung der Diagnose und Beurteilung eines Progresses sein. Der Radiologe sollte andere und reversible Pathologien erkennen und von demenztypischen Veraenderungen abgrenzen koennen. Dieser Artikel beschreibt typische klinische Symptome und auch bildmorphologische Veraenderungen verschiedener Demenzformen, die durch neurodegenerative und nichtdegenerative Ursachen bedingt sein koennen. Ausserdem werden aktuellste MRT-Techniken vorgestellt. Diese koennten kuenftig im Standartprotokoll zur Bildgebung bei der Abklaerung demenzieller Syndrome verankert sein. (orig.)

  15. Molecular imaging in neurological diseases; Molekulare Bildgebung bei neurologischen Erkrankungen

    Energy Technology Data Exchange (ETDEWEB)

    Reimold, M.; Fougere, C. la [Universitaetsklinikum Tuebingen, Abteilung Nuklearmedizin und Klinische Molekulare Bildgebung, Department Radiologie, Tuebingen (Germany)

    2016-07-15

    In neurodegeneration and in neuro-oncology, the standard imaging procedure, magnetic resonance imaging (MRI), shows limited sensitivity and specificity. Molecular imaging with specific positron-emission tomography (PET) and single-photon emission computed tomography (SPECT) tracers allows various molecular targets and metabolic processes to be assessed and is thus a valuable adjunct to MRI. Two important examples are referred to here: amino acid transport for neuro-oncological issues, and the recently approved PET tracers for detecting amyloid depositions during the preclinical stage of Alzheimer's disease. This review discusses the clinical relevance and indications for the following nuclear medicine imaging procedures: amyloid PET, {sup 18}F-fluorodeoxyglucose (FDG)-PET, and dopamine transporter (DaT)-SPECT for the diagnosis of dementia and the differential diagnosis of Parkinson's disease, in addition to amino acid PET for the diagnosis of brain tumors and somatostatin receptor imaging in meningioma. (orig.) [German] Die Magnetresonanztomographie (MRT) weist als Standardverfahren bei neurodegenerativen und neuroonkologischen Fragestellungen eine eingeschraenkte Sensitivitaet und Spezifitaet auf. Die nuklearmedizinische molekulare Bildgebung mit spezifischen Positronenemissionstomographie(PET)- und single-photon-emission-computed-tomography(SPECT)-Tracern ermoeglicht die Darstellung verschiedener molekularer Targets bzw. Stoffwechselprozesse und stellt damit eine wichtige Ergaenzung zur MRT dar. Hier sei exemplarisch auf die Darstellung des Aminosaeuretransports im Rahmen neuroonkologischer Fragestellungen verwiesen, sowie auf die bereits im praeklinischen Stadium der Alzheimer-Demenz nachweisbaren Amyloidablagerungen mit hierfuer seit Kurzem zugelassenen PET-Tracern. Dieser Uebersichtsbeitrag bespricht die klinische Bedeutung bzw. die Indikationen der folgenden nuklearmedizinischen Untersuchungsverfahren: der Amyloid-PET, der {sup 18}F

  16. Therapeutische Überlegungen bei sensomotorischer diabetischer Neuropathie

    Directory of Open Access Journals (Sweden)

    Bührlen M

    2013-01-01

    Full Text Available Der Begriff der sensomotorischen diabetischen Neuropathie beschreibt einen heterogenen Beschwerdekomplex, der auf einer diabetesbedingten Schädigung des peripheren Nervensystems beruht. Bis zu 50 % der Menschen mit Diabetes mellitus leiden im Verlauf ihrer Erkrankung an Symptomen einer sensomotorischen Neuropathie. Chronische Schmerzen, Dysund Parästhesien sowie die Komplikation des diabetischen Fußsyndroms stellen für die Betroffenen gravierende Folgen dar. Die Optimierung der metabolischen Kontrolle stellt eine wichtige Basismaßnahme dar. Andere, zweifelsfrei gesicherte Möglichkeiten der Prävention oder kausalen Therapie sind nicht bekannt. Bei Auftreten einer schmerzhaften Neuropathie sollte eine gezielte analgetische Therapie möglichst früh begonnen werden. Mit den trizyklischen Antidepressiva, Duloxetin, Gabapentin und Pregabalin stehen Wirkstoffe zur Verfügung, die eine spezifische Therapie neuropathischer Schmerzen ermöglichen. Dabei ist zu beachten, dass in der Regel keine Schmerzfreiheit erreicht werden kann. Entscheidend ist das Erreichen eines für den Patienten tolerablen Schmerzniveaus unter Minimierung medikamentenassoziierter Nebenwirkungen. Das individuelle Ansprechen auf ein Medikament und die optimale Dosis können nicht vorhergesagt, sondern müssen individuell erprobt werden. Bei leichten Schmerzen können die Nicht-Opioid- Analgetika Paracetamol und Metamizol eingesetzt werden. Fehlen Therapiealternativen, dann stellen Opioide eine weitere Möglichkeit der Therapie starker Schmerzen dar. Aufgrund einer zusätzlichen Monoamin-Wiederaufnahmehemmerwirkung nehmen Tramadol und Tapentadol in dieser Gruppe eine Sonderstellung ein. In der Risiko- Nutzen-Abwägung darf das Nebenwirkungs- und Abhängigkeitspotenzial der Opioide in der Langzeittherapie nicht unterschätzt werden. Für andere medikamentöse Therapien oder alternative Therapiemethoden liegt keine ausreichende wissenschaftliche Evidenz vor. Sie können aber im

  17. Thalidomide induces mucosal healing in postoperative Crohn disease endoscopic recurrence

    Science.gov (United States)

    Hu, Huiqin; Wang, Xinying; Liu, Side

    2016-01-01

    Abstract Background: Thalidomide has been successful use in patients with refractory Crohn disease (CD) in recent years. Methods: We collected the data of a postoperative CD patient who was prescribed thalidomide to induce remission and reviewed the relevant literatures. Results: A 51-year-old female was diagnosed as CD after an urgent terminal intestinal resection and presented endoscopic recurrence despite the prophylactic treatment with azathioprine (AZA). Fortunately, she achieved mucosal healing (MH) at a low dose of thalidomide for 15 months. Conclusion: Thalidomide is effective to induce MH in the postoperative CD endoscopic recurrence. PMID:27603389

  18. Crohn's disease and recurrent appendicitis: A case report

    Institute of Scientific and Technical Information of China (English)

    Ron Shaoul; Yosi Rimar; Aurora Toubi; Jorge Mogilner; Reuven Polak; Michael Jaffe

    2005-01-01

    The clinical diagnosis of classic Crohn's disease (CD)of the small bowel is based on a typical history, tender right lower quadrant fullness or mass, and characteristic radiographic findings of the terminal ileum. Appendicitis may as well present with chronic or recurrent symptoms and this presentation may be confused with CD. We herein describe the case of a young teenage girl with a presumptive diagnosis of CD, who was ultimately diagnosed as having chronic nongranulomatous appendicitis. The literature on the subject is reviewed.

  19. Advanced Endoscopic Imaging for Diagnosis of Crohn's Disease

    Directory of Open Access Journals (Sweden)

    Helmut Neumann

    2012-01-01

    Full Text Available Endoscopy in IBD has tremendous importance to diagnose inflammatory activity, to evaluate therapeutic success and for the surveillance of colitis associated cancer. Thus it becomes obvious that there is a need for new and more advanced endoscopic imaging techniques for better characterization of mucosal inflammation and early neoplasia detection in IBD. This paper describes the concept of advanced endoscopic imaging for the diagnosis and characterization of Crohn's disease, including magnification endoscopy, chromoendoscopy, balloon-assisted enteroscopy, capsule endoscopy, confocal laser endomicroscopy, and endocytoscopy.

  20. Chronic inflammatory demyelinating polyradiculoneuropathy in a patient with Crohn's disease.

    Science.gov (United States)

    Ohyagi, Masaki; Ohkubo, Takuya; Yagi, Yousuke; Ishibashi, Satoru; Akiyama, Junko; Nagahori, Masakazu; Watanabe, Mamoru; Yokota, Takanori; Mizusawa, Hidehiro

    2013-01-01

    Crohn's disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract that is frequently accompanied by systemic complications. Neuropathologies have not been well investigated as extraintestinal manifestations of CD. We herein report the case of a 36-year-old man with CD who presented with progressive weakness and numbness. A neurological examination and the results of a nerve conduction study and a sural nerve biopsy led to a diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Plasma exchanges were initially effective; however, the effects gradually declined starting 10 days after the plasma exchange (PE). These results suggest that humoral factors may play an important role in CIDP associated with CD.

  1. Disbiosis intestinal en enfermos de Crohn pediátricos

    OpenAIRE

    Blanca Pueyo; Núria Mach

    2013-01-01

    Introducción: La enfermedad de Crohn (EC) pediátrica es un desorden caracterizado por presentar inflamación crónica que puede afectar cualquier segmento del tracto gastrointestinal. La disbiosis intestinal es un factor implicado en la patogénesis multifactorial de esta enfermedad. Diferentes suplementos dietarios se han propuesto como terapia alternativa para inducir o mantener la remisión de la EC. Objetivo: Revisar las evidencias científicas publicadas sobre disbiosis intestinal en paciente...

  2. Kirurgisk behandling af anale fistler ved Crohns sygdom

    DEFF Research Database (Denmark)

    Heyckendorff-Diebold, Tina; Maeda, Yasuko; Buntzen, Steen;

    2012-01-01

    The treatment of transsphincteric anal fistulas in Crohn's disease is a balance between the elimination of the sepsis and the functional outcome. Loose setons can be used as a preoperative drainage or chronic treatment. Fibrin glue and the anal fistula plug are methods with excellent functional...... outcomes, but the success rate varies. The endorectal advancement flap is considered to be the gold standard. Ligation of the intersphincteric fistula tract is promising. Proctectomy or proctocolectomy in combination with transposition flaps may be necessary. A success rate of 66-70% has been reported....

  3. [Benign multicystic peritoneal mesothelioma in a patient with Crohn disease].

    Science.gov (United States)

    Fluxá, Daniela; Kronberg, Udo; Lubascher, Jaime; O'Brien, Andrés; Las Heras, Facundo; Ibáñez, Patricio; Quera, Rodrigo

    2016-12-01

    Benign multicystic peritoneal mesothelioma is an uncommon lesion arising from the peritoneal mesothelium. It is asymptomatic or presents with unspecific symptoms. Imaging techniques may reveal it, however the final diagnosis can only be made by histopathology. Surgery is the only effective treatment considering its high recurrence rate. We report a 19 years old male with Crohn’s disease. Due to persistent abdominal pain, an abdominal magnetic resonance imaging was performed, showing a complex cystic mass in the lower abdomen. The patient underwent surgery and the lesion was completely resected. The pathological study reported a benign multicystic peritoneal mesothelioma.

  4. Crohn's disease: ultrastructure of interstitial cells in colonic myenteric plexus

    DEFF Research Database (Denmark)

    Rumessen, Jüri J; Vanderwinden, Jean-Marie; Horn, Thomas

    2011-01-01

    The role of the interstitial cells of Cajal (ICC) in chronic inflammatory bowel disease, i.e., ulcerative colitis (UC) and Crohn's disease (CD), remains unclear. Ultrastructural alterations in ICC in the colonic myenteric plexus (ICC-MP) have been reported previously in UC, but descriptions of ICC...... were dilated and appeared to be empty. Lipid droplets and lipofuscin-bodies were prominent in glial cells and neurons. ICC-MP were scanty but, as in controls, had caveolae, prominent intermediate filaments, cytoplasmic dense bodies, and membrane-associated dense bands with a patchy basal lamina. ICC...

  5. Exclusive enteral nutrition in children with Crohn's disease.

    Science.gov (United States)

    Day, Andrew S; Lopez, Robert N

    2015-06-14

    Exclusive enteral nutrition involves the use of a complete liquid diet, with the exclusion of normal dietary components for a defined period of time, as a therapeutic measure to induce remission in active Crohn's disease (CD). This very efficacious approach leads to high rates of remission, especially in children and adolescents newly diagnosed with CD. This intervention also results in mucosal healing, nutritional improvements and enhanced bone health. Whilst several recent studies have provided further elaboration of the roles of exclusive enteral nutrition in the management of CD, other reports have provided new understanding of the mechanisms by which this intervention acts.

  6. Cannabis finds its way into treatment of Crohn's disease.

    Science.gov (United States)

    Schicho, Rudolf; Storr, Martin

    2014-01-01

    In ancient medicine, cannabis has been widely used to cure disturbances and inflammation of the bowel. A recent clinical study now shows that the medicinal plant Cannabis sativa has lived up to expectations and proved to be highly efficient in cases of inflammatory bowel diseases. In a prospective placebo-controlled study, it has been shown what has been largely anticipated from anecdotal reports, i.e. that cannabis produces significant clinical benefits in patients with Crohn's disease. The mechanisms involved are not yet clear but most likely include peripheral actions on cannabinoid receptors 1 and 2, and may also include central actions.

  7. Is vitamin D supplementation a viable treatment for Crohn's disease?

    Science.gov (United States)

    O'Sullivan, Maria

    2016-01-01

    Vitamin D, important for maintaining bone health in Crohn's disease (CD), may have potential as a treatment for the core inflammatory disease process. There is plausible evidence in favor of vitamin D as an anti-inflammatory from animal models, epidemiological and cross sectional studies of CD. Few clinical trials, however, have been published and therefore the translation of this promise into clinical benefit for people with CD remains unclear. The purpose of this piece is to consider the viability of vitamin D as a treatment for CD based on the current available evidence.

  8. Die Ferse schmerzt: Behandlung des M. triceps surae bei Patienten mit Fasciitis plantaris : Ein systematisches Literaturreview

    OpenAIRE

    Brunner, Melanie

    2015-01-01

    Darstellung des Themas: Die Dehnung des M. triceps surae bei Patienten mit Fasciitis plantaris wird in der Literatur als begleitende Intervention empfohlen. Dies lässt einen Zusammenhang zwischen den Plantarflexoren und den Fersenschmerzen vermuten, weshalb die Untersuchung von weiteren Behandlungsmethoden am M. triceps surae von Bedeutung ist. Ziel: Das Ziel dieser Arbeit war, eine Aussage über die Effektivität von verschiedenen Behandlungsmethoden des M. triceps surae bei Patienten mit F...

  9. Kognitive Funktionen bei adoleszenten Patienten mit Anorexia nervosa und unipolaren Affektiven Störungen

    OpenAIRE

    Sarrar, Lea

    2014-01-01

    Anorexia nervosa und unipolare Affektive Störungen stellen häufige und schwerwiegende kinder- und jugendpsychiatrische Störungsbilder dar, deren Pathogenese bislang nicht vollständig entschlüsselt ist. Verschiedene Studien zeigen bei erwachsenen Patienten gravierende Auffälligkeiten in den kognitiven Funktionen. Dahingegen scheinen bei adoleszenten Patienten lediglich leichtere Einschränkungen in den kognitiven Funktionen vorzuliegen. Die Prävalenz der Anorexia nervosa und unipolaren Affektiv...

  10. Research Article. Improved Dual Frequency PPP Model Using GPS and BeiDou Observations

    Directory of Open Access Journals (Sweden)

    Afifi A.

    2017-02-01

    Full Text Available This paper introduces a new dual-frequency precise point positioning (PPP model, which combines GPS and BeiDou observations. Combining GPS and BeiDou observations in a PPP model offers more visible satellites to the user, which is expected to enhance the satellite geometry and the overall PPP solution in comparison with GPSonly PPP solution. However, combining different GNSS constellations introduces additional biases, which require rigorous modelling, including GNSS time offset and hardware delays. In this research, ionosphere-free linear combination PPP model is developed. The additional biases, which result from combining the GPS and BeiDou observables, are lumped into a new unknown parameter identified as the inter-system bias. Natural Resources Canada’s GPSPace PPP software is modified to enable a combined GPS/BeiDou PPP solution and to handle the newly introduced biases. A total of four data sets at four IGS stations are processed to verify the developed PPP model. Precise satellite orbit and clock products from the IGS-MGEX network are used to correct both of the GPS and BeiDou measurements. It is shown that a sub-decimeter positioning accuracy level and 25% reduction in the solution convergence time can be achieved with combining GPS and Bei-Dou observables in a PPP model, in comparison with the GPS-only PPP solution.

  11. BeiDou Inter-Satellite-Type Bias Evaluation and Calibration for Mixed Receiver Attitude Determination

    Directory of Open Access Journals (Sweden)

    Noor Raziq

    2013-07-01

    Full Text Available The Chinese BeiDou system (BDS, having different types of satellites, is an important addition to the ever growing system of Global Navigation Satellite Systems (GNSS. It consists of Geostationary Earth Orbit (GEO satellites, Inclined Geosynchronous Satellite Orbit (IGSO satellites and Medium Earth Orbit (MEO satellites. This paper investigates the receiver-dependent bias between these satellite types, for which we coined the name “inter-satellite-type bias” (ISTB, and its impact on mixed receiver attitude determination. Assuming different receiver types may have different delays/biases for different satellite types, we model the differential ISTBs among three BeiDou satellite types and investigate their existence and their impact on mixed receiver attitude determination. Our analyses using the real data sets from Curtin’s GNSS array consisting of different types of BeiDou enabled receivers and series of zero-baseline experiments with BeiDou-enabled receivers reveal the existence of non-zero ISTBs between different BeiDou satellite types. We then analyse the impact of these biases on BeiDou-only attitude determination using the constrained (C-LAMBDA method, which exploits the knowledge of baseline length. Results demonstrate that these biases could seriously affect the integer ambiguity resolution for attitude determination using mixed receiver types and that a priori correction of these biases will dramatically improve the success rate.

  12. Estimation of Satellite PCO Offsets for BeiDou based on MGEX Net Solution

    Science.gov (United States)

    Yize, Zhang; Junping, Chen; Bin, Wu; Jiexian, Wang

    2015-04-01

    BeiDou Satellite Navigation System currently has a total 14 satellites including GEO/IGSO/MEO satellites and providing a regional PNT service. Due to a lack of publicly available antenna phase center offsets (PCO) for the BeiDou satellites, conventional values of (+0.6 m, 0.0 m, +1.1 m) are recommended for orbit and clock determination of the GEO/IGSO/MEO satellites, which needs to be further estimation and refinement. In this paper, we propose a multi-GNSS network solution for the estimation of BeiDou satellite PCO. More than 35 ground stations of International GNSS MGEX tracking network are used to determine the BeiDou satellite PCO. In this strategy, the GPS and BeiDou satellite orbits and clocks are derived from IGS final products, and GPS satellite PCO and PCV are fixed according to igs08.atx. The BeiDou satellites PCO are estimated together with the station clock, troposphere delay and LC combination ambiguity parameter. Result shows that the RMS of phase residuals for all stations is 1.8cm and is 1.6m for code residual, respectively. The estimated PCO is different for each satellite. Appling the new PCO for precise point positioning, we found that the positioning error improves from 6cm to 2cm in height.

  13. Research Article. Improved Dual Frequency PPP Model Using GPS and BeiDou Observations

    Science.gov (United States)

    Afifi, A.; El-Rabbany, A.

    2017-02-01

    This paper introduces a new dual-frequency precise point positioning (PPP) model, which combines GPS and BeiDou observations. Combining GPS and BeiDou observations in a PPP model offers more visible satellites to the user, which is expected to enhance the satellite geometry and the overall PPP solution in comparison with GPSonly PPP solution. However, combining different GNSS constellations introduces additional biases, which require rigorous modelling, including GNSS time offset and hardware delays. In this research, ionosphere-free linear combination PPP model is developed. The additional biases, which result from combining the GPS and BeiDou observables, are lumped into a new unknown parameter identified as the inter-system bias. Natural Resources Canada's GPSPace PPP software is modified to enable a combined GPS/BeiDou PPP solution and to handle the newly introduced biases. A total of four data sets at four IGS stations are processed to verify the developed PPP model. Precise satellite orbit and clock products from the IGS-MGEX network are used to correct both of the GPS and BeiDou measurements. It is shown that a sub-decimeter positioning accuracy level and 25% reduction in the solution convergence time can be achieved with combining GPS and Bei-Dou observables in a PPP model, in comparison with the GPS-only PPP solution.

  14. Fondaparinux bei Herz-Kreislauf-Erkrankungen: Ein neues Antithrombin mit herausragenden Eigenschaften

    Directory of Open Access Journals (Sweden)

    Huber K

    2008-01-01

    Full Text Available Fondaparinux, ein synthetisches Pentasaccharid, führt zu einer indirekten Hemmung des Gerinnungsfaktors Xa und behindert in der Folge die Bildung von Thrombin. Fondaparinux wurde als Vergleichssubstanz gegenüber unfraktioniertem (Standard- Heparin oder dem niedermolekularen Heparin Enoxaparin in der Prophylaxe oder Therapie von venösen Thrombosen getestet. Zuletzt wurde Fondaparinux auch bei Patienten mit akuten Koronarsyndromen (ACS untersucht: bei Patienten mit ACS ohne ST-Hebung (NSTE-ACS waren sowohl die Blutungsrate als auch die Kurz- und Langzeitmortalität im Fondaparinuxarm (2,5 mg/Tag s. c. signifikant geringer als in den Enoxaparin-behandelten Patienten (1 mg/kg KG 2×/Tag s. c. (OASIS-5-Studie. Bei Patienten mit akutem ST-Strecken-Hebungsinfarkt (STEMI war Fondaparinux in den Subgruppen der konservativ behandelten Patienten (ohne Reperfusion und der Patienten, die eine pharmakologische Reperfusion erhielten (Thrombolyse von Vorteil gegenüber Placebo oder unfraktioniertem Heparin. Hingegen zeigte sich bei Patienten mit STEMI, die einer Akut-PCI unterzogen wurden, eine starke Tendenz zugunsten von unfraktioniertem Heparin gegenüber Fondaparinux (OASIS-6-Studie. Daher wird Fondaparinux in den internationalen Richtlinien als das Antithrombin mit der günstigsten Risiko/Nutzen-Ratio bei NSTEMI aber auch bei STEMI-Patienten mit Ausnahme jener Patienten, die sich einer Akut-PCI unterziehen, empfohlen. Fondaparinux könnte schon in der nahen Zukunft die Heparine in diesen Indikationen weitgehend ersetzen.

  15. Crohn's disease and risk of fracture: does thyroid disease play a role?

    Institute of Scientific and Technical Information of China (English)

    Nakechand Pooran; Pankaj Singh; Simmy Bank

    2003-01-01

    AIM: To assess the role of thyroid disease as a risk for fractures in Crohn's patients.METHODS: A cross-sectional study was conducted from 1998 to 2000. The study group consisted of 210 patients with Crohn's disease. A group of 206 patients without inflammatory bowel disease served as controls. Primary outcome was thyroid disorder. Secondary outcomes included use of steroids, immunosuppressive medications, surgery and incidence of fracture.RESULTS: The prevalence of hyperthyroidism was similar in both groups. However, the prevalence of hypothyroidism was lower in Crohn's patients (3.8 % vs 8.2 %, P=0.05).Within the Crohn's group, the use of immunosuppressive agents (0 % vs11 %), steroid usage (12.5 % vs37 %), small bowel surgery (12.5 % vs 28 %) and large bowel surgery (12.5 % vs27 %) were lower in the hypothyroid subset as compared to the euthyroid subset. Seven (3.4 %) Crohn'spatients suffered fracture, all of whom were euthyroid.CONCLUSION: Thyroid disorder was not found to be associated with Crohn's disease and was not found to increase the risk for fractures. Therefore, screening for thyroid disease is not a necessary component in the management of Crohn's disease.

  16. The impact of pregnancy on surgical Crohn disease: an analysis of the Nationwide Inpatient Sample.

    Science.gov (United States)

    Hatch, Quinton; Champagne, Bradley J; Maykel, Justin A; Davis, Bradley R; Johnson, Eric K; Bleier, Joshua I; Francone, Todd D; Steele, Scott R

    2014-07-01

    The impact of pregnancy on the course of Crohn disease is largely unknown. Retrospective surveys have suggested a variable effect, but there are limited population-based clinical data. We hypothesized pregnant women with Crohn disease will have similar rates of surgical disease as a nonpregnant Crohn disease cohort. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify female Crohn patients from all patients admitted using the Nationwide Inpatient Sample (1998-2009). Women were stratified as either pregnant or nonpregnant. We defined Crohn-related surgical disease as peritonitis, gastrointestinal hemorrhage, intra-abdominal abscess, toxic colitis, anorectal suppuration, intestinal-intestinal fistulas, intestinal-genitourinary fistulas, obstruction and/or stricture, or perforation (excluding appendicitis). Of the 92,335 women admitted with a primary Crohn-related diagnosis, 265 (0.3%) were pregnant. Pregnant patients were younger (29 versus 44 y; PCrohn disease had higher rates of intestinal-genitourinary fistulas (23.4% versus 3.0%; Pdisease (59.6% versus 39.2%; Pdisease (OR, 2.9; 95% CI, 2.3-3.7; PCrohn disease is a significant risk factor for Crohn-related surgical disease, in particular, anorectal suppuration and intestinal-genitourinary fistulas. Published by Elsevier Inc.

  17. Pilot study of endoscopic retrograde 3-dimensional - computed tomography enteroclysis for the assessment of Crohn's disease.

    Science.gov (United States)

    Tanabe, Hiroki; Ito, Takahiro; Inaba, Yuhei; Ando, Katsuyoshi; Nomura, Yoshiki; Ueno, Nobuhiro; Kashima, Shin; Moriichi, Kentaro; Fujiya, Mikihiro; Okumura, Toshikatsu

    2017-01-01

    Endoscopic retrograde ileography (ERIG) is developed in our institute and applied clinically for the diagnosis and assessment of the Crohn's disease activity. We have further improved the technique using 3-dimensional - computed tomography enteroclysis (3D-CTE) and conducted a retrospective study to determine the feasibility and the diagnostic value of endoscopic retrograde 3D-CTE (ER 3D-CTE) in Crohn's disease patients in a state of remission. Thirteen Crohn's patients were included in this pilot study. CTE was performed after the infusion of air or CO2 through the balloon tube following conventional colonoscopy. The primary endpoint of this study was to assess the safety of this method. Secondarily, the specific findings of Crohn's disease and length of the visualized small intestine were assessed. The procedures were completed without any adverse events. Gas passed through the small intestine and enterographic images were obtained in 10 out of 13 cases, but, in the remaining patients, insertion of the balloon tubes into the terminal ileum failed. Various features specific to Crohn's disease were visualized using ER 3D-CTE. A cobble stone appearance or hammock-like malformation was specific and effective for diagnosing Crohn's disease and the features of anastomosis after the surgical operations were also well described. Therefore, this technique may be useful after surgery. In this study, ER 3D-CTE was performed safely in Crohn's disease patients and may be used for the diagnosis and follow-up of this disease.

  18. Crohn's disease: a role of gut microbiota and Nod2 gene polymorphisms in disease pathogenesis.

    Science.gov (United States)

    Hrnčířová, Lucia; Krejsek, Jan; Šplíchal, Igor; Hrnčíř, Tomáš

    2014-01-01

    Crohn's disease is a chronic immune-mediated intestinal inflammation targeted against a yet incompletely defined subset of commensal gut microbiota and occurs on the background of a genetic predisposition under the influence of environmental factors. Genome-wide association studies have identified about 70 genetic risk loci associated with Crohn's disease. The greatest risk for Crohn's disease represent polymorphisms affecting the CARD15 gene encoding nucleotide-binding oligomerization domain 2 (NOD2) which is an intracellular sensor for muramyl dipeptide, a peptidoglycan constituent of bacterial cell wall. The accumulated evidence suggests that gut microbiota represent an essential, perhaps a central factor in the induction and maintaining of Crohn's disease where dysregulation of normal co-evolved homeostatic relationships between intestinal microbiota and host mucosal immune system leads to intestinal inflammation. Taken together, these findings identify Crohn's disease as a syndrome of overlapping phenotypes that involves variable influences of genetic and environmental factors. A deeper understanding of different genetic abnormalities underlying Crohn's disease together with the identification of beneficial and harmful components of gut microbiota and their interactions are essential conditions for the categorization of Crohn's disease patients, which enable us to design more effective, preferably causative, individually tailored therapy.

  19. Infliximab stopped severe gastrointestinal bleeding in Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    Satimai Aniwan; Surasak Eakpongpaisit; Boonlert Imraporn; Surachai Amornsawadwatana; Rungsun Rerknimitr

    2012-01-01

    To report the result of rapid ulcer healing by infliximab in Crohn's patients with severe enterocolic bleeding.During 2005 and 2010,inflammatory bowel disease database of King Chulalongkorn Memorial and Samitivej hospitals were reviewed.There were seven Crohn's disease (CD) patients (4 women and 3 men; mean age 52 ± 10.4 years; range:11-86 years).Two of the seven patients developed severe gastrointestinal bleeding (GIB) as a flare up of CD whereas the other five patients presented with GIB as their first symptom for CD.Their mean hemoglobin level dropped from 12 ± 1.3 g/dL to 8.7 ± 1.3 g/dL in a 3-d period.Median packed red blood cells units needed for resuscitation was 4 units.Because of uncontrolled bleeding,surgical resection was considered.However,due to the poor surgical candidacy of these patients (n =3) and/or possible development of short bowel syndrome (n =6),surgery was not pursued.Likewise angiographic embolization was not considered in any due to the risk of large infarction.All severe GIBs successfully stopped by one or two doses of intravenous infliximab.Our data suggests that infliximab is an alternative therapy for CD with severe GIB when surgery has limitation or patient is a high risk.

  20. Ileal Crohn's disease: MRI with endoscopic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Gallego, Jose C., E-mail: josecarlos.gallego.ojea@sergas.es [Department of Radiology, Hospital A. Marcide, Ferrol (Spain); Echarri, Ana I. [Department of Gastroenterology, Hospital A. Marcide, Ferrol (Spain); Porta, Ana [Department of Radiology, Hospital A. Marcide, Ferrol (Spain); Ollero, Virginia [Department of Gastroenterology, Hospital A. Marcide, Ferrol (Spain)

    2011-11-15

    Purpose: To evaluate activity staging of Crohn's disease (CD) measured with MR-enterography using ileoscopy as reference standard. Materials and methods: A prospective study was made of 61 patients with CD. All patients underwent MR-enterography and ileoscopy. MRI activity was measured by means of an ad hoc developed score, as well as by analysis of the imaging findings, and was compared with the SES-CD score obtained via ileoscopy. Examinations were performed using a 1.0 T scanner. Results: MRI score discriminates between active and inactive disease with an area under the ROC curve of 0.941. Overall correlation with the standard reference SES-CD score was moderate to strong (Spearman's r = 0.62 p < 0.001). Agreement between both methods in staging patients with ileal CD as inactive, mild or moderate to severe was good (Cohen's {kappa} = 0.60). Differences in means of the MRI activity scores of the three groups showed statistical significance (p < 0.01). Conclusions: The MRI score is a reliable predictor of activity in ileal CD and can stage patients in a way comparable to endoscopy. 1.0 T scans are valid for performing radiological evaluation of ileal Crohn's disease.

  1. Genome analysis of E. coli isolated from Crohn's disease patients.

    Science.gov (United States)

    Rakitina, Daria V; Manolov, Alexander I; Kanygina, Alexandra V; Garushyants, Sofya K; Baikova, Julia P; Alexeev, Dmitry G; Ladygina, Valentina G; Kostryukova, Elena S; Larin, Andrei K; Semashko, Tatiana A; Karpova, Irina Y; Babenko, Vladislav V; Ismagilova, Ruzilya K; Malanin, Sergei Y; Gelfand, Mikhail S; Ilina, Elena N; Gorodnichev, Roman B; Lisitsyna, Eugenia S; Aleshkin, Gennady I; Scherbakov, Petr L; Khalif, Igor L; Shapina, Marina V; Maev, Igor V; Andreev, Dmitry N; Govorun, Vadim M

    2017-07-19

    Escherichia coli (E. coli) has been increasingly implicated in the pathogenesis of Crohn's disease (CD). The phylogeny of E. coli isolated from Crohn's disease patients (CDEC) was controversial, and while genotyping results suggested heterogeneity, the sequenced strains of E. coli from CD patients were closely related. We performed the shotgun genome sequencing of 28 E. coli isolates from ten CD patients and compared genomes from these isolates with already published genomes of CD strains and other pathogenic and non-pathogenic strains. CDEC was shown to belong to A, B1, B2 and D phylogenetic groups. The plasmid and several operons from the reference CD-associated E. coli strain LF82 were demonstrated to be more often present in CDEC genomes belonging to different phylogenetic groups than in genomes of commensal strains. The operons include carbon-source induced invasion GimA island, prophage I, iron uptake operons I and II, capsular assembly pathogenetic island IV and propanediol and galactitol utilization operons. Our findings suggest that CDEC are phylogenetically diverse. However, some strains isolated from independent sources possess highly similar chromosome or plasmids. Though no CD-specific genes or functional domains were present in all CD-associated strains, some genes and operons are more often found in the genomes of CDEC than in commensal E. coli. They are principally linked to gut colonization and utilization of propanediol and other sugar alcohols.

  2. Magnetic resonance imaging of small bowel Crohn's disease.

    Science.gov (United States)

    Ramalho, Miguel; Herédia, Vasco; Cardoso, Cláudia; Matos, António P; Palas, João; De Freitas, João; Semelka, Richard C

    2012-01-01

    Crohn's disease (CD) is a chronic relapsing inflammatory disease of the gastrointestinal tract, which mostly affects young patients. Imaging techniques form a very important part for the evaluation of CD and for monitoring disease progression or response to therapy. Currently, imaging of CD is increasingly being performed by cross-sectional modalities, i.e. multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI), since these techniques allow for simultaneous visualization of luminal, mural and extraintestinal disease extension. MR enterography has the potential to safely and noninvasively accomplish the imaging needs of patients with Crohn disease without exposing them to ionizing radiation. The new imaging paradigm should contemplate patient safety as a very important aspect when assessing the role of an imaging modality in comparison with others. For this reason, MRI may be the preferred modality for evaluation of small bowel disease, especially in young patients in the setting of CD, considering that the majority will undergo frequent repeat studies. Also, the information on disease activity is not matched by any other imaging method. In this review article, the authors discuss the essential aspects of MR evaluation of CD, including protocol and imaging findings, also referring the advantages over other radiological studies, concerning safety, accuracy and potential importance for therapeutic approach.

  3. Evaluation of inflammatory activity in Crohn's disease and ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Eduardo Garcia Vilela; Henrique Osvaldo da Gama Torres; Fabiana Paiva Martins; Maria de Lourdes de Abreu Ferrari; Marcella Menezes Andrade; Aloísio Sales da Cunha

    2012-01-01

    Crohn's disease and ulcerative colitis evolve with a relapsing and remitting course.Determination of infiammatory state is crucial for the assessment of disease activity and for tailoring therapy.However,no simple diagnostic test for monitoring intestinal inflammation is available.Noninvasive markers give only indirect assessments of disease activity.Histopathological or endoscopical examinations accurately assess inflammatoryactivity,but they are invasive,time consuming and expensive and therefore are unsuitable for routine use.Imaging procedures are not applicable for ulcerative colitis.The usefulness of ultrasound and Doppler imaging in assessing disease activity is still a matter of discussion for Crohn's disease,and an increased interest in computed tomography enterograph (CTE) has been seen,mainly because it can delineate the extent and severity of bowel wall inflammation,besides detecting extraluminal findings.Until now,the available data concerning the accuracy of magnetic resonance enterography in detecting disease activity is less than CTE.Due to this,clinical activity indices are still commonly used for both diseases.

  4. Short Bowel Syndrome and Intestinal Failure in Crohn's Disease.

    Science.gov (United States)

    Limketkai, Berkeley N; Parian, Alyssa M; Shah, Neha D; Colombel, Jean-Frédéric

    2016-05-01

    Crohn's disease is a chronic and progressive inflammatory disorder of the gastrointestinal tract. Despite the availability of powerful immunosuppressants, many patients with Crohn's disease still require one or more intestinal resections throughout the course of their disease. Multiple resections and a progressive reduction in bowel length can lead to the development of short bowel syndrome, a form of intestinal failure that compromises fluid, electrolyte, and nutrient absorption. The pathophysiology of short bowel syndrome involves a reduction in intestinal surface area, alteration in the enteric hormonal feedback, dysmotility, and related comorbidities. Most patients will initially require parenteral nutrition as a primary or supplemental source of nutrition, although several patients may eventually wean off nutrition support depending on the residual gut anatomy and adherence to medical and nutritional interventions. Available surgical treatments focus on reducing motility, lengthening the native small bowel, or small bowel transplantation. Care of these complex patients with short bowel syndrome requires a multidisciplinary approach of physicians, dietitians, and nurses to provide optimal intestinal rehabilitation, nutritional support, and improvement in quality of life.

  5. Management of Crohn's disease in poor responders to adalimumab

    Directory of Open Access Journals (Sweden)

    de Boer NKH

    2014-04-01

    Full Text Available Nanne KH de Boer,1 Mark Löwenberg,2 Frank Hoentjen3 1Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, the Netherlands; 2Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands; 3Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands Abstract: Anti-tumor necrosis factor therapy with adalimumab is an effective therapy for the induction and maintenance of remission in moderate to severe Crohn's disease. Although a large proportion of patients show a favorable clinical response to adalimumab, therapy failure is common. In this review, we provide a practical overview of adalimumab therapy in patients with Crohn's disease, with a specific focus on the clinical management of adalimumab failure. In the case of inadequate efficacy, a thorough assessment is required to confirm inflammatory disease activity and rule out noninflammatory causes. Evaluation may include biomarkers (fecal calprotectin and serum C-reactive protein, colonoscopy, and/or magnetic resonance enterography/enteroclysis. Furthermore, adalimumab trough levels and antibodies to adalimumab are informational after the confirmation of active inflammation. In the case of low or undetectable adalimumab trough levels, dose escalation to 40 mg weekly is recommended, whereas high antibody titers or adverse events frequently require switching to an alternative anti-TNF agent such as infliximab. Active inflammation despite therapeutic adalimumab trough levels requires alternative strategies such as switching to drugs with a different mode of action or surgical intervention. Keywords: anti-TNF, biological, inflammatory bowel disease, loss of response, infliximab

  6. Practical Approaches to "Top-Down" Therapies for Crohn's Disease.

    Science.gov (United States)

    Amezaga, Aranzazu Jauregui; Van Assche, Gert

    2016-07-01

    Crohn's disease (CD) is a chronic, progressive, and disabling disease that leads in most cases to the development of bowel damage presenting as a fistula, abscess, or stricture. For years, therapy for Crohn's disease has been based on a "step-up" approach, in which anti-TNF agents are administered after the failure of steroids and immunosuppressants. However, recent studies have suggested that early introduction of anti-TNF agents combined with immunosuppressants can modify the natural history of the disease. Patients who could benefit more of this "top-down" strategy would be those at elevated risk of a complicated or severe inflammatory bowel disease or with factors that can predict an aggressive disease course. Therefore, the management of a patient with CD should be personalized, taking into account the patient's specific characteristics and comorbidities, disease activity, site and behavior of the disease, and predictable factors of poor prognosis. A balance between medication and potential adverse effects should be achieved, trying to avoid under or overtreatment, always discussing the different therapeutic options with the patient. The natural history of ulcerative colitis differs from CD and, to date, there is not much scientific evidence on the use of early combined immunosuppression.

  7. Kontrastmittelverstärkte Magnet-Resonanz-Urographie unter forcierter Diurese - Stellenwert in der Differentialdiagnostik bei Obstruktionen des oberen Harntraktes

    Directory of Open Access Journals (Sweden)

    Jung P

    2001-01-01

    Full Text Available Die Magnet-Resonanz-Urographie (MRU ist ein relativ neues Verfahren in der Diagnostik des oberen Harntraktes. Das Ziel dieser Studie war der Vergleich der Aussagefähigkeit der MRU unter Gabe von Gadolinium und Furosemid und dem konventionellen Urogramm (IVU in der Diagnostik der Ursache von Obstruktionen im Bereich des Harnleiters. 82 Patienten mit im IVU nachgewiesener Obstruktion des oberen Harntraktes oder urographisch stummer Niere bei sonographisch nachgewiesener Dilatation wurden der MRU zugeführt. Die Bilder beider Untersuchungsmethoden wurden von voneinander unabhängigen Untersuchern befundet. Zwei Urologen befundeten die IVU-Bilder, zwei Radiologen die MRU-Bilder, die Radiologen kannten die IVU-Diagnose nicht. Bei unklarer Diagnose wurden weitere Untersuchungen wie Computertomographie, retrograde Pyelographie oder Ureteroskopie durchgeführt. Die Diagnosen waren: Harnleitersteine bei 72 Patienten, Harnleitertumore bei 8 Patienten und extraureterale Tumore bei 2 Patienten. Eine richtige Diagnose bei den Steinpatienten wurde durch IVU bei 49 von 72 Patienten und durch MRU bei 64 von 72 Patienten gestellt. In dieser Patientengruppe wurden durch die MRU zwei falsche Diagnosen gestellt. Fehlende Kontrastmittelausscheidung war der Hauptgrund für Versagen der IVU. 3 der 8 Patienten mit Harnleitertumoren wurden durch die IVU richtig dignostiziert, bei dreien wurde eine falsche Diagnose gestellt. Durch die MRU konnten in dieser Gruppe 7 von 8 Patienten korrekt diagnostiziert werden, es wurde keine falsche Diagnose erhoben. IVU wird zunächst die Standarduntersuchungstechnik zur Darstellung des oberen Harntraktes bleiben, aber durch diese Studie konnte die Möglichkeit gezeigt werden, die in der MRU in Kombination mit Gadolinium und Furosemid liegt. Die größte Bedeutung dieser Untersuchung liegt in der urographisch stummen Niere, bei Untersuchungen in der Schwangerschaft, bei Kindern und bei Patienten mit Kontrastmittelunverträglichkeit.

  8. Successful Therapy of Refractory Erythema Nodosum Associated with Crohn's Disease Using Potassium Iodide

    Directory of Open Access Journals (Sweden)

    John K Marshall

    1997-01-01

    Full Text Available Erythema nodosum is a common extraintestinal manifestation of Crohn's disease. While mild skin involvement often responds to conservative management, severe or refractory cases may require systemic corticosteroid or immunosuppressive therapy. This report describes successful treatment of severe, refractory erythema nodosum associated with Crohn's colitis using oral potassium iodide. While the mechanism of action of this agent is poorly understood, it appears to be an effective and nontoxic therapy for Crohn's-related erythema nodosum and warrants further evaluation in a placebo controlled trial.

  9. Development of the Crohn's disease digestive damage score, the Lémann score

    DEFF Research Database (Denmark)

    Pariente, Benjamin; Cosnes, Jacques; Danese, Silvio

    2011-01-01

    Crohn's disease (CD) is a chronic progressive destructive disease. Currently available instruments measure disease activity at a specific point in time. An instrument to measure cumulative structural damage to the bowel, which may predict long-term disability, is needed. The aim of this article...... is to outline the methods to develop an instrument that can measure cumulative bowel damage. The project is being conducted by the International Program to develop New Indexes in Crohn's disease (IPNIC) group. This instrument, called the Crohn's Disease Digestive Damage Score (the Lémann score), should take...

  10. Gastrointestinal stromal tumor causing small bowel intussusception in a patient with Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    George E Theodoropoulos; Dimitrios Linardoutsos; Dimitrios Tsamis; Paraskevas Stamopoulos; Dimitrios Giannopoulos; Flora Zagouri; Nikolaos V Michalopoulos

    2009-01-01

    We report a case of jejunoileal intussusception in a 42-year-old patient with Crohn's disease caused by a gastrointestinal stromal tumor. The patient complained of vague diffuse abdominal pain for a period of 4 mo. Intussusception was suspected at computer tomography and magnetic resonance imaging scans. Segmental resection of the small intestine was performed. Pathological examination of the surgical specimen revealed a gastrointestinal stromal tumor as well as aphthous ulcerations and areas of inflammation, which were characteristic of Crohn's disease. This is the first report of small bowel intussusception due to a gastrointestinal stromal tumor coexisting with Crohn's disease.

  11. Acute coronary syndrome after infliximab therapy in a patient with Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    Vasilios Panteris; Anna Perdiou; Vasilios Tsirimpis; Demetrios Georgios Karamanolis

    2006-01-01

    Infliximab is a potent anti-TNF antibody, which is used with great success in Crohn's disease patients. Since its release in clinical practice, several adverse reactions have been observed. The interest in possible consequences of its administration is still high because of the recent introduction of the drug for the long-term maintenance therapy of refractory luminal and fistulizing Crohn's disease. We present a case of acute coronary syndrome (non-STEMI) in a patient with corticoid resistant Crohn's disease after his first dose of infliximab. By reviewing the scant articles that exist in the literature on this topic we made an effort to delineate the possible mechanisms of this phenomenon.

  12. A case of plummer-vinson syndrome associated with Crohn's disease.

    Science.gov (United States)

    Park, Joon Mo; Kim, Kyeong Ok; Park, Chan Seo; Jang, Byung Ik

    2014-04-01

    Plummer-Vinson syndrome manifests as cervical dysphagia, iron deficiency anemia, an upper esophageal web, and atrophic glossitis. The cause of the esophageal web is thought to be iron deficiency anemia; however, the cause of Plummer-Vinson syndrome has not been established. Crohn's disease is usually accompanied by malnutrition and iron deficiency anemia; however, no case of concomitant Crohn's disease and Plummer-Vinson syndrome with aggravated malnutrition and anemia has been previously reported. Here, we report on a rare case of Plummer-Vinson syndrome in a Crohn's disease patient, which caused malnutrition and constipation.

  13. Influencia de la dieta sobre las citoquinas antiinflamatorias en la enfermedad de Crohn

    OpenAIRE

    González-Isabel, Concepción

    2013-01-01

    La enfermedad de Crohn es una patología digestiva que cursa con inflamación en pacientes genéticamente susceptibles. Dada la relación entre la enfermedad de Crohn, microbiota y dieta, se ha revisado el rol de los alimentos funcionales para modificar la flora microbiana y/o promover la síntesis de citocinas antiinflamatorias y disminuir la inflamación, postulando que una dieta adecuada podría ser utilizada para beneficiar el estado de salud de esta población. La malaltia de Crohn és una pat...

  14. Canadian Association of Gastroenterology Clinical Practice Guidelines: The Use of Infliximab in Crohn's Disease

    Directory of Open Access Journals (Sweden)

    Remo Panaccione

    2004-01-01

    Full Text Available These guidelines are presented as a follow-up to the original Canadian Association of Gastroenterology Clinical Practice Guidelines: The use of infliximab in Crohn's disease, published in the Canadian Journal of Gastroenterology (1. The original guidelines represented publications between 1998 and 2000. The current guidelines have been updated to reflect knowledge gained from two pivotal randomized clinical trails, with the use of infliximab in the maintenance of inflammatory Crohn's disease in remission (2 and in the maintenance of fistulous Crohn's disease in remission (3.

  15. Laparoscopic Pancreaticoduodenectomy for the Management of Localized Crohn's Disease of the Duodenum.

    Science.gov (United States)

    Xingjun, Guo; Feng, Zhu; Min, Wang; Renyi, Qin

    2016-08-01

    Crohn's disease of the duodenum is an uncommon condition. Our case was an extremely rare manifestation of Crohn's disease, who presented with obstruction of the pylorus and the first and the second parts of the duodenum. Because of the severity of the obstruction, he underwent laparoscopic pancreaticoduodenectomy. Postoperative pancreatic leakage and bowel fistula were not observed, and there was no morbidity during the follow-up period. There was also no disturbance in digestive function, postoperatively. This is the first case employing laparoscopic pancreaticoduodenectomy to cure benign lesions leading to duodenal obstruction. Minimally invasive laparoscopic pancreaticoduodenectomy technology shows a very big advantage in treating this rare benign Crohn's disease.

  16. Paciente con enfermedad de Crohn y convulsiones por hipomagnesemia Patient with crohn's disease and seizures due to hypomagnesemia

    Directory of Open Access Journals (Sweden)

    E. Fernández-Rodríguez

    2007-12-01

    Full Text Available Se trata de un paciente con enfermedad de Crohn y afectación intestinal extensa por su enfermedad, que presenta episodios repetidos de convulsiones generalizadas. Fue valorado con pruebas de imagen cerebral y neurofisiología sin conseguir establecer su etiología. En la primera valoración nutricional se objetiva un déficit severo de magnesio, coincidiendo con un episodio convulsivo y consiguiendo el cese de los mismos tras la normalización del magnesio mediante reposición parenteral. Es preciso alertar a los especialistas respectivos de las graves repercusiones del déficit de nutrientes en estos pacientes y de la necesidad de que sean controlados por la Unidad de Nutrición.We report a patient with Crohn's disease who suffered several generalized convulsions. He was studied with cerebral image techniques and neurophysiologic tests without getting the aetiology of the convulsions. A severe depletion in magnesium levels was suspected at the time of the initial evaluation by the Nutritional Team Group. Low serum magnesium levels were confirmed in the first blood test. Convulsions disappeared when magnesium was normalised by intravenous infusion. It is necessary for specialist physicians to be on the alert of severe complications of nutrients deficiency and that this kind of patients should be checked by the Nutrition Team.

  17. Doença de Crohn e farmacobezoar intestinal: relato de caso Crohn's disease and bowel pharmacobezoar: case report

    Directory of Open Access Journals (Sweden)

    Adriana Santos Neves Trece

    2010-06-01

    Full Text Available Bezoares são concreções de materiais diversos, parcialmente ou não digeridos, que podem ser encontrados em qualquer porção do tubo digestivo. Raramente são compostos por fármacos, nestes casos denominados farmacobezoares. Este artigo visa relatar o caso de um paciente com Doença de Crohn complicada por fístula entero-cutânea e áreas de estenoses no íleo terminal apresentando bezoar de mesalazina. Foi enfatizado o caráter multifatorial da gênese dos farmacobezoares, assim como a variada gama de apresentações clínicas e exames diagnósticos úteis no esclarecimento dos casos. Devemos ainda salientar a necessidade de individualização do tratamento para melhor eficácia do mesmo.Bezoars are masses composed of foreign material, partially digested or not, found in any portion of the gastrointestinal tract. Rarely bezoars are composed by medication tablets, becoming known as Pharmacobezoars. This article reports a patient with the Crohn's disease complicated by enteric fistulae and stenotic areas in the ileum presenting Mesalazine pharmacobezoars. The author emphasizes the multi-factorial origin of pharmacobezoars, the wide range of clinical presentations and the diagnostic tools useful in these cases. The individualized treatment necessary to obtain the satisfactory clinical results is also highlighted.

  18. Experience with granulocytapheresis in Crohn's disease Experiencia con la granulocitoaféresis en la enfermedad de Crohn

    Directory of Open Access Journals (Sweden)

    F. Cuenca

    2004-07-01

    Full Text Available Objective: to describe our experience with granulocyte apheresis to induce remission in patients with active Crohn's disease refractory to conventional treatment. We summarize the results previously obtained with this technique. Conclusions: granulocyte apheresis is a safe and well tolerated therapeutic modality that can be a valid therapeutic alternative in the induction of remission in inflammatory bowel disease, although controlled clinical trials must be conducted to define long-term efficacy, as well as to establish “optimal patient” selection, re-treatment interval, and number of sessions.Objetivo: describir nuestra experiencia con la granulocitoaféresis para inducir la remisión en pacientes con enfermedad de Crohn activa refractarios al tratamiento convencional. Realizamos un resumen de los resultados previos obtenidos con esta técnica. Conclusiones: la granulocitoaféresis es una modalidad terapéutica segura y bien tolerada que puede ser una alternativa terapéutica válida en la inducción de la remisión en la enfermedad inflamatoria intestinal, siendo necesaria la realización de ensayos clínicos controlados para poder definir su eficacia a largo plazo, la selección del "paciente óptimo", intervalos de retratamiento y número de sesiones.

  19. Calculation and Analysis of Differential Corrections for BeiDou

    Science.gov (United States)

    Yang, Sainan; Chen, Junping; Zhang, Yize

    2015-04-01

    BeiDou Satellite Navigation System has been providing service forAsia-Pacific area. BeiDou uses observations of regional monitoring network to determine satellite orbit, which limits the satellite orbit accuracy. And the satellite clock error is produced by time synchronization system. The time synchronization delay of antenna device is general obtained through prior Calibration, and the residual calibration error is included in the satellite clock, which affects the prediction accuracy of satellite clock error. In this paper, we study the algorithms of Beidou differential corrections to improve the accuracy of satellite signals to improve the user positioning accuracy. In this algorithm, both pseudo-range and phase observations are used to calculate differential corrections. We process pseudo-range observations to obtain equivalent satellite clock error, which include satellite clock errors and orbit radial errors, as well as the average projection of orbit tangential and normal errors in combination. And the epoch-difference of phase observations are processed to eliminate the ambiguity which simplifies algorithms and ensure the relative accuracy (corrections variety between the epochs). Observations more than 10 stations in China are processed, and the equivalent clock error calculation results are analyzed, which shows that the satellite UDRE are significantly reduced and user location accuracy improves when the equivalent clock error corrections are applied. The residuals deducting equivalent satellite clock error contains the projection difference of satellite orbit error in all station (tangential and normal errors are main). We utilize the residuals to solve the tangential and normal orbit errors which cause the projection difference. The same observation data is processed. The results show that after calculating three-dimensional corrections, the satellite UDRE doesn't improve significantly compared to equivalent satellite clock error corrections and user

  20. Nutrition interventions in patients with Crohn´s disease

    Directory of Open Access Journals (Sweden)

    Eva Beňová

    2016-10-01

    Full Text Available Crohn's disease is a chronic non-specific inflammatory bowel disease of any part of the digestive tract. The seriousness of the disease requires a multi-disciplinary approach when providing patients with secondary and tertiary care. Patients also have specific problems from the nursing perspective that require intervention of nurses, e.g. in the area of nutrition. The role of a nurse in a specific community lies in supporting public health in the field of prevention, health education, group educational activities and care of the acutely or chronically ill. The regulation tool of nursing practice when providing community care is the documented form of nursing data expressed by means of expert terminology. The Omaha System is a standardised terminology for multi-disciplinary teams providing community care. The objective of the research is to draw attention to the possibility of using standardised terminology of the Omaha System when supporting public health in patients with Crohn's disease with nutrition problems. The research was divided into 3 stages: in the first stage we assessed the nutrition problem in 100 patients dispensarised in gastroenterology counselling centres using a form from the Omaha System. Out of these, identified 42 patients suffered from Crohn's disease and had problems with nutrition; in the second stage we chose interventions for nutrition from the Intervention Scheme of the Omaha System: their efficiency in patients was assessed by a nurse/nutritionist in the third stage of the research when the patients came to the gastroenterology counselling centre using Problem Rating Scale for Outcomes. When comparing the initial and final nutrition assessment with socio-demographic indicators we found a statistically significant difference (p = 0.000 between the status assessment where women scored a more remarkable advance than men when comparing the initial and the final assessment. With respect to age groups, education and jobs

  1. Crohn Disease of the Vulva without Gastrointestinal Manifestations in a 16-Year-Old Girl.

    Science.gov (United States)

    Zhang, Ai-jun; Zhan, Shu-hui; Chang, Hong; Gao, Yu-qiang; Li, Yan-qing

    2015-01-01

    Crohn disease of the vulva is a rare disease that is difficult to diagnose. There are limited reports describing treatment of this condition. To describe the diagnosis and treatment of a 16-year-old girl with Crohn disease of the vulva, without onset of intestinal symptoms. Crohn disease was diagnosed by histopathology. The patient was treated with corticosteroids and followed for 1 year. After the final diagnosis, cutaneous lesions responded rapidly to corticosteroid treatment, which was gradually stopped after 6 months. The disease was well controlled at the 1-year follow-up. Crohn disease of the vulva can develop alone without the onset of intestinal symptoms. Diagnosis relies on special pathologic findings. Corticosteroid treatment is effective for this condition. © 2014 Canadian Dermatology Association.

  2. Diagnosis of Helicobacter Pylori Infection is Associated with Lower Prevalence and Subsequent Incidence of Crohn's Disease

    DEFF Research Database (Denmark)

    Bartels, Lars E; Jepsen, Peter; Christensen, Lisbet A

    2016-01-01

    BACKGROUND AND AIMS: Helicobacter pylori infection may protect against some chronic inflammatory diseases. This study examined H. pylori infection and its association with the prevalence of the gastrointestinal diseases Crohn's disease [CD], ulcerative colitis [UC], and coeliac disease [Ce...

  3. Biodegradable stents for the treatment of bowel strictures in Crohn's disease

    DEFF Research Database (Denmark)

    Karstensen, John Gásdal; Christensen, Katrine Risager; Brynskov, Jørn

    2016-01-01

    BACKGROUND AND STUDY AIMS: In patients with Crohn's disease, the idea of biodegradable stents for treatment of bowel strictures with limited effect of endoscopic balloon dilation is tempting and initial results have been promising. The aim of this study was to evaluate the technical and clinical...... success of biodegradable stents for treatment of inflamed Crohn's strictures refractory to endoscopic balloon dilatation. PATIENTS AND METHODS: Consecutive patients treated with biodegradable stents due to Crohn's disease and inflamed bowel strictures refractory to endoscopic balloon dilatation were...... collapse (n = 1). CONCLUSIONS: In Crohn's disease, it is technically feasible to treat bowel strictures with biodegradable stents. However, we have stopped using biodegradable stents due to lack of clinical success and side effects such as mucosal overgrowth and stent collapse....

  4. Incidental findings at MRI-enterography in patients with suspected or known Crohn's disease

    DEFF Research Database (Denmark)

    Jensen, Michael Dam; Nathan, Torben; Kjeldsen, Jens

    2010-01-01

    AIM: To determine the frequency and clinical impact of incidental findings detected with magnetic resonance imaging (MRI)-enterography in patients with suspected or known Crohn's disease (CD). METHODS: Incidental findings were defined as unexpected lesions outside the small intestine...

  5. Ileoscopy reduces the need for small bowel imaging in suspected Crohn's disease

    DEFF Research Database (Denmark)

    Jensen, Michael Dam; Nathan, Torben; Rafaelsen, Søren Rafael

    2012-01-01

    In suspected Crohn's disease (CD), current diagnostic guidelines recommend additional small bowel imaging irrespective of the findings at ileocolonoscopy. Magnetic resonance imaging enterography (MRE) and computed tomography enterography (CTE) are regarded first line imaging techniques and should...

  6. Crohn's disease but not chronic ulcerative colitis induces the expression of PAI-1 in enteric neurons

    DEFF Research Database (Denmark)

    Laerum, O.D.; Illemann, M.; Skarstein, A.

    2008-01-01

    OBJECTIVES: Chronic inflammation of the intestinal wall is the common characteristic of Crohn's disease and ulcerative colitis; disorders, which in some cases can be difficult to distinguish. The inflammation also affects the local neuronal plexuses of the enteric nervous system. It is known...... by immunohistochemical techniques. RESULTS: PAI-1 was found in a subset of neurons primarily located in the submucosal plexus of the small and large intestine in 24 of 28 cases (86%) with Crohn's disease, but in none of 17 cases with chronic ulcerative colitis and other severe inflammatory conditions in the intestinal....... CONCLUSIONS: PAI-1-positive neurons in inflammatory bowel disease are linked to chronic inflammation in Crohn's disease, implying PAI-1 as a potential parameter for the differential diagnosis between Crohn's disease and ulcerative colitis. The findings also suggest that PAI-1 in neurons is related to pain...

  7. Complement activation in plasma before and after infliximab treatment in Crohn disease

    DEFF Research Database (Denmark)

    Zimmermann-Nielsen, E; Agnholt, J; Thorlacius-Ussing, O

    2003-01-01

    BACKGROUND: Crohn disease is characterized by up-regulated intestinal inflammation mainly caused by increased tumour necrosis factor alpha (TNF-alpha) levels. However, the complement system (C) may also have a role in maintaining inflammation. METHODS: Plasma from 26 patients with Crohn disease...... complicated by fistulizing ano-rectal disease was collected before and after three Infliximab infusions (5 mg kg(-1)). RESULTS: Before treatment, the C3-activation capacities (C3-AC) in plasma from patients with Crohn disease were comparable with values obtained from healthy controls. The classical C pathway......-mediated C3-AC, mannan-binding lectin C4-AC, leucocyte count, C-reactive protein concentration and Crohn Disease Activity Index decreased significantly 8 weeks after the first infusion of Infliximab (P

  8. Crohn's disease, ulcerative colitis, and measles vaccine in an English population, 1979–1998

    OpenAIRE

    Seagroatt, V.; Goldacre, M

    2003-01-01

    Study objectives: To study the hospitalised incidence of Crohn's disease (CD) and ulcerative colitis (UC) from 1979 to 1998; and to determine whether the introduction of the measles vaccination programme was associated with an increase in the young.

  9. Mutations in CARD15 and smoking confer susceptibility to Crohn's disease in the Danish population

    DEFF Research Database (Denmark)

    Ernst, Anja; Jacobsen, Bent Ascanius; Østergaard, Mette

    2007-01-01

    Three CAspase Recruitment Domain (CARD15) mutations have shown to predispose to Crohn's disease in Caucasian populations. The aim of this study was to investigate the mutation frequency in patients with inflammatory bowel disease and in healthy controls in Denmark....

  10. Constitutive STAT3 activation in intestinal T cells from patients with Crohn's disease

    DEFF Research Database (Denmark)

    Lovato, Paola; Brender, Christine; Agnholt, Jørgen;

    2003-01-01

    Via cytoplasmic signal transduction pathways, cytokines induce a variety of biological responses and modulate the outcome of inflammatory diseases and malignancies. Crohn's disease is a chronic inflammatory bowel disease of unknown etiology. Perturbation of the intestinal cytokine homeostasis is ...

  11. [Long-term results of the surgical treatment of ileo-colonic Crohn disease].

    Science.gov (United States)

    Forni, E; Orlandoni, G; Voltolini, P; Zadra, F; Stradiotti, G; Bordoni, P; Spelzini, P

    1984-10-01

    18 patients with Crohn's disease primarily treated with excisional surgery were studied. The crude recurrence and reoperation rate were analyzed. The influence of sex, age and length of history prior to operation was in this respect also studied.

  12. Adipositas bei Kindern: Elterliche Rechte, Paternalismus und Gerechtigkeit

    Directory of Open Access Journals (Sweden)

    Giesinger Johannes

    2015-07-01

    Full Text Available Am Beispiel von Adipositas (Fettleibigkeit werden in diesem Beitrag die Konflikte diskutiert, die zwischen elterlichen Rechten und den aus Gerechtigkeitserwägungen erwachsenden Ansprüchen von Kindern entstehen können. Es wird angenommen, dass Kinder Anspruch auf Gesundheit haben, und dass Adipositas sie in ihrer Gesundheit gefährdet. Die Frage lautet, was zu tun ist, wenn das Handeln der Eltern die Entstehung von Adipositas begünstigt. Es werden drei verschiedene Konzeptionen elterlicher Rechte diskutiert. Nach der ersten Konzeption sind elterliche Rechte in den Interessen oder Freiheiten der Eltern fundiert. Gemäß der zweiten Auffassung ergeben sich elterliche Rechte aus elterlichen Pflichten, während der dritte Ansatz die Bedeutung sogenannter Beziehungsgüter hervorhebt. Vor diesem Hintergrund werden zwei Thesen vertreten: Die erste lautet, dass Eltern nicht berechtigt sind, ihre Kinder in einer Weise aufzuziehen, die zu Adipositas führt. Die zweite These ist, dass es trotzdem gute Gründe für Zurückhaltung bei Eingriffen in die Familie gibt.

  13. A vendor`s cost management; Kostenmanagement bei einem Hersteller

    Energy Technology Data Exchange (ETDEWEB)

    Schomer, E. [Siemens AG, Erlangen (Germany). Energieerzeugung (KWU)

    1997-12-01

    The cost base of a company, its ability to innovate, and its customer orientedness are important, distinctive competencies and capabilities in the competition for tomorrow`s markets and contracts. The `top` program implemented throughout the Siemens company serves to strengthen competitiveness and generate a considerable increase in profits. In order to achieve these objectives, the program addresses productivity, innovation, and growth as strategic elements. A thorough, multifaceted change in corporate culture is considered a precondition. This concept encompasses both purely technical and scientific improvements and the increasingly more important non-technical regeneration of business processes. Only a quantum leap in productivity will allow the company to continue to exist in the future. (orig.) [Deutsch] Im Wettbewerb um die Maerkte und Geschaefte von morgen sind die Kostenbasis des Unternehmens, seine Innovationsfaehigkeit und Kundenorientierung wesentliche differenzierende Kompetenzen und Faehigkeiten. Ziele des im gesamten Hause Siemens laufenden Programmes unter dem Titel `top` sind die Staerkung der Wettbewerbskraft sowie eine nachhaltige Ertragssteigerung. Um diese zu erreichen, setzt das Programm bei den strategischen Elementen Produktivitaet, Innovation und Wachstum an, wobei eine umfassende und vielfaeltige Veraenderung der Unternehmenskultur Voraussetzung ist. Dabei werden unter diesem Begriff sowie die rein technisch-wissenschaftlichen Verbesserungen als auch die immer wichtiger gewordenen nicht-technischen Erneuerungen in den Geschaeftsprozessen verstanden. Nur durch einen Quantensprung in der Produktivitaet kann das Unternehmen in der Zukunft bestehen. (orig.)

  14. Gas hydrates in gas storage caverns; Gashydrate bei der Gaskavernenspeicherung

    Energy Technology Data Exchange (ETDEWEB)

    Groenefeld, P. [Kavernen Bau- und Betriebs-GmbH, Hannover (Germany)

    1997-12-31

    Given appropriate pressure and temperature conditions the storage of natural gas in salt caverns can lead to the formation of gas hydrates in the producing well or aboveground operating facilities. This is attributable to the stored gas becoming more or less saturated with water vapour. The present contribution describes the humidity, pressure, and temperature conditions conducive to gas hydrate formation. It also deals with the reduction of the gas removal capacity resulting from gas hydrate formation, and possible measures for preventing hydrate formation such as injection of glycol, the reduction of water vapour absorption from the cavern sump, and dewatering of the cavern sump. (MSK) [Deutsch] Bei der Speicherung von Erdgas in Salzkavernen kann es unter entsprechenden Druck- und Temperaturverhaeltnissen zur Gashydratbildung in den Foerdersonden oder obertaegigen Betriebseinrichtungen kommen, weil sich das eingelagerte Gas mehr oder weniger mit Wasserdampf aufsaettigt. Im Folgenden werden die Feuchtigkeits-, Druck- und Temperaturbedingungen, die zur Hydratbildung fuehren erlaeutert. Ebenso werden die Verringerung der Auslagerungskapazitaet durch die Hydratbildung, Massnahmen zur Verhinderung der Hydratbildung wie die Injektion von Glykol, die Verringerung der Wasserdampfaufnahme aus dem Kavernensumpf und die Entwaesserung der Kavernensumpfs selbst beschrieben.

  15. Can ultrasound be used as the primary imaging in children with suspected Crohn disease?

    Science.gov (United States)

    Tsai, Timothy L; Marine, Megan B; Wanner, Matthew R; Cooper, Matthew L; Steiner, Steven J; Ouyang, Fangqian; Gregory Jennings, S; Karmazyn, Boaz

    2017-07-01

    There is growing literature on the use of ultrasound (US) for evaluation of Crohn disease in adults, but few studies have been conducted on children. Several studies demonstrated high accuracy of US in the diagnosis of Crohn disease. Using US as the primary screening imaging modality for Crohn disease can reduce health care costs, the need for sedation and ionizing radiation exposure. The aim of our study is to determine if US can be used for screening evaluation of pediatric Crohn disease. A prospective cohort study of pediatric patients undergoing MR enterography (MRE) for suspected or known history of Crohn disease was performed, with gray-scale and Doppler US of the terminal ileum done immediately before or after MRE. US images were interpreted by two radiologists (Reader 1 and Reader 2) not involved in image acquisition, in blinded and randomized fashion. US findings of Crohn disease including bowel wall thickening, wall stratification, increased vascularity on Doppler, lymphadenopathy, fat infiltration and extraintestinal complications were evaluated. MRE findings of terminal ileitis were considered the reference standard. Demographic data, body mass index (BMI), symptoms, and laboratory, endoscopic and histopathological data were obtained from electronic medical records. Forty-one patients (mean age: 13.7 years: 4.6-18.9 years) were evaluated. Mean BMI was 21.2 (range: 13-40.2); 10 patients (24.3%) were either overweight or obese. Final diagnoses were Crohn disease (n=24), ulcerative colitis (n=4) and normal/non-inflammatory bowel disease-related diagnoses (n=13). US demonstrated sensitivity of 67% and 78% and specificity of 78% and 83%, by Reader 1 and Reader 2, respectively. MRE sensitivity and specificity were 75% and 100%, respectively, compared to final clinicopathological diagnosis. Interobserver agreement between Reader 1 and Reader 2 was good (0.6Crohn disease in children, US has limited sensitivity for detecting terminal ileitis.

  16. Stereomicroscopic examination of stained rectal biopsies in ulcerative colitis and Crohn's disease

    DEFF Research Database (Denmark)

    Poulsen, Steen Seier

    1980-01-01

    Rectal biopsy samples from 22 healthy control subjects, 54 patients with ulcerative colitis, and 34 with Crohn's disease with involvement of the colon or rectum were investigated in a stereomicroscopic study. Samples were stained as whole mounts with Alcian Green before the stereomicroscopic...... the stereomicroscopic findings and the clinical disease activity, the sigmoidoscopic findings, and the histologic activity. Apart from the stereomicroscopic observation of small superficial erosions in one fourth of the biopsies, no changes of diagnostic value were observed in Crohn's disease....

  17. Mycobacterium avium subsp. Paratuberculosis (MAP) as a modifying factor in Crohn's disease.

    LENUS (Irish Health Repository)

    Sibartie, Shomik

    2010-02-01

    Crohn\\'s disease (CD) is a multifactorial syndrome with genetic and environmental contributions. Mycobacterium avium subspecies paratuberculosis (MAP) has been frequently isolated from mucosal tissues of patients with CD but the cellular immune response to this bacterium has been poorly described. Our aim was to examine the influence of MAP on T-cell proliferation and cytokine responses in patients with inflammatory bowel disease (IBD).

  18. A free terminal ileal perforation from active crohn disease in pregnancy: a diagnostic challenge.

    Science.gov (United States)

    Philip, Sunu; Kamyab, Armin; Orfanou, Paraskevi

    2015-03-01

    The surgical management of the complications of Crohn disease is often challenging. These difficulties are compounded in pregnancy by competing interests of the mother and the baby. In this report, we describe the presentation and surgical management of a patient in her second trimester with active Crohn disease who required emergent surgical intervention. She had presented with the uncommon complication of a free perforation in the presence of active untreated disease.

  19. alpha 1-Antitrypsin-levels and phenotypes in Crohn's disease in the Netherlands.

    Science.gov (United States)

    Klasen, E C; Biemond, I; Weterman, I T

    1980-01-01

    A group of 310 unrelated patients suffering from Crohn's disease has been screened for quantitative and electrophoretic variations of alpha 1-antitrypsin (alpha 1AT). A comparison was made betweeen patients and healthy controls. The distribution of electrophoretic alpha 1AT variants in the patients showed no significant deviation from the controls. The alpha 1AT quantities are significantly higher in the Crohn's disease population than in the controls. PMID:6969207

  20. Severe metabolic alkalosis and recurrent acute on chronic kidney injury in a patient with Crohn's disease

    OpenAIRE

    Schmid Axel; Küttner Axel; Amann Kerstin U; Opgenoorth Mirian; Schnellhardt Susanne; Jacobi Johannes; Eckardt Kai-Uwe; Hilgers Karl F

    2010-01-01

    Abstract Background Diarrhea is common in patients with Crohn's disease and may be accompanied by acid base disorders, most commonly metabolic acidosis due to intestinal loss of bicarbonate. Case Presentation Here, we present a case of severe metabolic alkalosis in a young patient suffering from M. Crohn. The patient had undergone multiple resections of the intestine and suffered from chronic kidney disease. He was now referred to our clinic for recurrent acute kidney injury, the nature of wh...