Plan and organization for utilization review at Queen's Medical Center.
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Biomedical subjects
Publications and source records attributed to H Thompson.
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Multifocal colonic carcinoma occurred in a 65-year-old man with a 13 year history of colonic Crohn's disease. The relationship between solitary and multiple colonic cancer and Crohn's disease is discussed.
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This paper reports the indications for, and results of, excision of the large intestine with ileostomy in 73 patients with Crohn's colitis who have been followed for a mean of nine years since resection. Sixty-four of them are still alive and all but two of the survivors are now in good health.However, 23 (33%) have developed recurrent Crohn's disease since resection. This is higher than that reported in many other series and may be due to differences in the length of follow up, the site and extent of colonic disease, the age of the patient at the time of excision with ileostomy, and differences in the pathological interpretation of the diagnosis of Crohn's disease. The high recurrence rate in this series lends caution to the view that the prognosis after excisional surgery and ileostomy for Crohn's colitis is as good as after the same operation for ulcerative colitis and should influence the decision when the alternative of medical or surgical management are being considered for patients with Crohn's colitis.
The distribution of mucosal changes in adult coeliac disease have been studied in 24 cases within four hours of death. There were six patients on a normal diet who showed flat mucosa in the jejunum, convolutions in the middle third, and digitate villi in the terminal ileum. A more extensive distribution of flat mucosa and convolutions involving most of the small intestine was noted in one case. Eighteen patients had been treated with a gluten-free diet and 11 had responded well clinically and histologically. No evidence of flat mucosa was discovery at necropsy in six of these. Attention is drawn to the high incidence of malignancy in this series (13 out of 24 cases). Other complications of adult coeliac disease are discussed briefly.
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