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Biomedical subjects

S B Hanauer

Publications and source records attributed to S B Hanauer.

122 records · Page 7Linked to original sources
PubMed1986

Prevalence and incidence of inflammatory bowel disease in family members.

To determine the risk of having or developing inflammatory bowel disease (IBD) in a family member of an IBD patient, a population of 245 IBD probands was randomly selected from the University of Chicago IBD Registry and their family history was elucidated by questionnaire and follow-up telephone call. One hundred seventy-nine (73%) probands responded to the questionnaire. There were no demographic distinctions between those eligible for the study, those who were complete responders, those who were nonresponders, and those with a positive family history of IBD. Fifty-four family members from 40 proband families (22%) had confirmed IBD. Prevalence of IBD in family members at the time of diagnosis of the proband was highest for parents (4.6%), siblings (2.6%), and children (1.9%). Grandparents, aunts and uncles, and first cousins had prevalence of IBD of less than 1%. Incident case frequency was determined by dividing the number of cases incident after the diagnosis of the proband by all those ever at risk. The incident case frequency was highest for siblings (1.9%), parents (1.0%), and children (1.0%). There was concordance noted for type of disease in the proband and the relative. No association could be discerned between the familial risk of IBD and gender, race, or religion of the proband. Despite a high occurrence rate of proband families with IBD, the specific risk to first, second, or third degree family members is low.

Adolescent↗
PubMed1986

Acute pancreatitis associated with high-concentration lipid emulsion during total parenteral nutrition therapy for Crohn's disease.

A 17-yr-old boy with Crohn's disease and growth retardation developed an acute abdominal crisis while receiving total parenteral nutritional support. Acute pancreatitis was confirmed surgically. After recovery, in an attempt to provide adequate calories and to elucidate the inciting agent, he was rechallenged with his original total parenteral nutritional solution which contained 500 ml/day of a 20% fat emulsion. Symptoms and signs of acute pancreatitis quickly returned. Total parenteral nutrition was continued without the fat emulsion and symptoms and signs disappeared. This case suggests that acute pancreatitis was due to intolerance of high-concentration lipid emulsion.

Acute Disease↗
PubMed1986

Clostridium difficile culture-positive toxin-negative diarrhea.

Antibiotic-associated colitis (AAC) is confirmed by the isolation of Clostridium difficile cytotoxin from stool in patients with diarrhea. Culture of the organism has not been required to confirm the diagnosis. A review of cases of C. difficile culture-positive patients was performed in an attempt to clarify the significance of culture-positive toxin-negative (CPTN) compared to culture-positive toxin-positive (CPTP) disease. During an 11-month period, 45 patients were identified who had stool cultures positive for C. difficile. Sixteen of the patients studied were CPTP and 29 were CPTN. There were no major differences between the two groups for underlying diseases, antibiotic exposure, or diagnostic testing. Of the CPTP patients, 10 were treated for AAC and all responded. Two untreated patients resolved spontaneously. Of the CPTN patients, none was given specific antibiotic therapy, symptoms spontaneously resolved in 17, and symptoms were unresolved in five (colectomy or expired before resolution). A prospective analysis was performed of all C. difficile isolated from stool samples by the microbiology laboratory. Isolates were incubated in vitro and cytotoxin production was measured. Of isolates from CPTP patients 97% produced cytotoxin compared to 67% of isolates from CPTN patients (p less than 0.005). The results suggest that C. difficile, despite the absence of cytotoxin, may be an etiological factor in certain diarrheal syndromes. Until a randomized therapeutic trial for CPTN patients is conclusive, a positive culture should be considered evidence for treatment of patients with persistent diarrhea.

Anti-Bacterial Agents↗
PubMed1983

Circulating lymphocyte subpopulations in Crohn's disease.

Circulating lymphocytes were enumerated in 28 patients with Crohn's disease and in 12 patients with other diseases by rosetting and by immunofluorescent staining using monoclonal antibodies for T-cell surface phenotypic markers [OKT3 (mature), OKT4 (helper), and OKT8 (suppressor/cytotoxic)] or polyvalent antisera for surface immunoglobulins (B cells). Total lymphocyte counts were reduced only in those with non-steroid-treated active Crohn's disease. Circulating monocyte counts, proportions of peripheral T and B cells, and percentages and absolute numbers of mature, helper, and suppressor T-cell subclasses in Crohn's disease were not significantly different than in the controls. Helper to suppressor T-cell ratios were comparable in all subjects, varying directly with numbers of helper T cells (p less than 0.05). Individual ratios of helper to suppressor T cells did not correlate with disease activity or location, the use of steroids, serum albumin, or total lymphocyte or monocyte counts. This study provides no evidence for underlying abnormalities of circulating lymphocyte subpopulations in Crohn's disease when compared to subjects with other illnesses. The characterization of lymphocyte subclasses in affected tissues is an important area of continuing investigation.

Adrenal Cortex Hormones↗
PubMed1981

Disseminated Trichosporon beigelii (cutaneum).

Two cases of invasive Trichosporon beigelii (syn. cutaneum) infection are reported and are compared with the eight other previous reports. All affected patients were either immunosuppressed or had recently undergone a surgical procedure. The diagnosis had been delayed and the prognosis was poor. Only two patients recovered after vigorous antimycotic therapy and concomitant remission of their leukemia. A biopsy of the skin lesion, as illustrated in one of our patients, may prove to be useful in the early diagnosis.

Aged↗
PubMed1981

Infectious complications associated with hairy cell leukemia.

Infectious complications in 47 patients with hairy cell leukemia were reviewed. Seventeen patients had culture-documented infections, 13 patients had significant clinical infections not documented by culture, and 17 had no serious infections. In the documented group, 64% of the infections were pyogenic and 36% were nonpyogenic. Patients in the two groups with serious infections had an initial median granulocyte count that was significantly lower than the granulocyte count in the uninfected group (P less than 0.05). Ten of the 17 patients with documented infections died, all as a result of their infections. In the uninfected group, two of 17 patients died, both with progressive disease. Four (9%) of the 47 patients had disseminated atypical mycobacterial disease; two of these patients are alive and asymptomatic two and three years, respectively, after the diagnosis of infection.

Abscess↗
PubMedDate not supplied

Pattern and prognosis of liver function test abnormalities during parenteral nutrition in inflammatory bowel disease.

The pattern of liver function test abnormalities was examined during total parenteral nutrition (TPN), using both dextrose and fat emulsions as caloric sources, in 92 patients with inflammatory bowel disease. Seventy-two patients had completely normal tests before TPN while 20 had one or more abnormal liver function tests before TPN was started. Serum bilirubin levels were normal in all patients before TPN; within 2 weeks on TPN, 25% of patients had elevated bilirubin levels. Serum alkaline phosphatase rose to values above normal in 25% of patients with normal starting values but did not change in those with abnormal baseline liver function tests. Elevations of SGPT were characteristically more pronounced than were elevation of SGOT. After 2 weeks of TPN, mean serum SGOT rose from 15 to 26 IU per liter (p less than 0.01) in patients with normal baseline values and from 28 to 50 IU per liter in those with abnormal baseline values. Elevations of serum SGPT were most common, affecting 25% of patients with normal baseline. The mean SGPT value rose from 13 to 38 IU per liter (p less than 0.01) at 1 week of TPN. In patients with abnormal tests before TPN, the mean SGPT value rose from 45 to 102 IU per liter (p less than 0.05). Liver biopsies performed in four patients with substantial elevations of aminotransferases revealed only minor nonspecific changes and no fatty infiltration. Elevated liver function tests promptly returned to baseline after TPN was discontinued, and progressive liver disease was not observed in any patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Alanine Transaminase↗
PubMedDate not supplied

Advances in the management of Crohn's disease: economic and clinical potential of infliximab.

New therapies for Crohn's disease are being developed based on improvements in our understanding of the disease's immune and inflammatory properties. One of these new therapies is infliximab, a monoclonal antibody directed against the proinflammatory cytokine tumor necrosis factor-alpha. Recent studies indicate that treatment of moderately to severely ill Crohn's disease patients with infliximab produces a rapid and profound reduction in the signs, symptoms, and severity of this disease. Beyond its clinical impact, Crohn's disease also carries significant economic consequences. Earlier reports on the costs of managing this disease estimated the average annual medical costs per patient at $9197, with the total annual cost of illness estimated to exceed $1.7 billion. Hospitalizations and surgeries represented 80% of these costs. Additional analyses have been conducted for this review to reflect more current treatment patterns. Assuming that proven increases in response and remission rates lead to diminished disease severity, infliximab can be expected to reduce the number of hospitalizations and surgeries in moderately to severely ill patients, with substantial cost savings. Moreover, improvement in disease status and quality of life may allow Crohn's disease patients to lead more productive lives.

Antibodies, Monoclonal↗
PubMedDate not supplied

Risk-benefit assessment of drugs used in the treatment of inflammatory bowel disease.

Although the aetiology of inflammatory bowel disease remains elusive, many agents are available for the control of symptoms and inflammation. Knowledge of drug pharmacology, indications and side effects is essential to ensure the best possible clinical care while minimising toxicity and inappropriate use. Sulfasalazine consists of sulfapyridine linked to mesalazine (5-aminosalicylic acid) via an azobond. Its use is indicated in the treatment of mild to moderately active ulcerative colitis and in the prevention of relapse in patients with quiescent disease. Patients with mild to moderate colonic or ileocolonic Crohn's disease also benefit from this drug, as do a proportion of patients with isolated small bowel disease. Sulfasalazine has not been uniformly effective in preventing relapse in Crohn's disease, although many clinicians continue its use in patients who respond initially. A high incidence of side effects which limit therapy include intolerance, hypersensitivity reactions and impairment of male infertility. The newer aminosalicylates offer targeted delivery of mesalazine to the bowel, with fewer side effects. Topical mesalazine has proved extremely effective in patients with distal ulcerative colitis; oral forms are effective in the treatment of mild to moderately active ulcerative colitis and in relapse. Both types appear to be effective in the treatment of Crohn's disease, and possibly in preventing relapse. There is no current clinical advantage of one mesalazine preparation over another, nor is there an indication for their use in sulfasalazine-treated patients who have satisfactory response without adverse effects. Corticosteroids are indicated for more severe disease activity where the aminosalicylates have limited efficacy-specifically to induce remission in patients with severe or refractory ulcerative colitis or Crohn's disease. They should not be used to maintain disease remission or in the prevention of postoperative recurrence. Topical corticosteroids allow their local use in distal colitis with minimal systemic side effects. Long term use is limited by side effects, many of which are dose related, although alternate-day therapy may lessen the incidence. Immunosuppressive agents are beneficial for the treatment of refractory inflammatory bowel disease unresponsive to other medications, and may also facilitate the withdrawal of steroids in refractory patients. Mercaptopurine has an added benefit in the treatment of Crohn's disease fistulae; the role of cyclosporin in bowel disease has not been established and its use cannot currently be recommended. The potential toxicity of immunosuppressive agents warrants careful consideration of their use by both physician and patient. Metronidazole is indicated for the treatment of mild to moderate Crohn's disease, including perineal disease. Common side effects include peripheral neuropathy and nausea.(ABSTRACT TRUNCATED AT 400 WORDS)

Adrenal Cortex Hormones↗
PubMedDate not supplied

Crohn's disease therapy: step up or top down therapy.

In most Crohn's disease scenarios a step-up approach has been used to initiate therapy according to disease severity. However, this approach has ignored the concept of inductive therapy followed by maintenance treatment to prevent relapse. It is apparent from clinical trials that the success of maintenance approaches will depend upon the inductive therapy. Furthermore, the step-up approach often results in steroid-dependent or refractory disease. The potential of aggressive initial therapy followed by step-down maintenance therapy affords the potential to modify the disease course, a possibility that has not been accomplished by current therapeutic algorithims.

Crohn Disease↗
PubMedDate not supplied

Biologics in peri-operative management of Crohn's disease.

The role of biologics for peri-operative Crohn's disease will remain speculative until the accumulation of clinical trial data. The potential positioning of peri-operative biologic therapies includes the prevention of surgery, minimizing surgical morbidity or prevention or delaying post-operative disease recurrence. To date, there is limited, indirect data regarding the potential for infliximab to prevent surgery via the effective treatment of refractory disease and the improvement in fistulizing disease. Although there is no controlled data regarding the impact of biologics on surgical morbidity, patients with stricturing disease have undergone resection without added morbidity. Post-operative trials are certainly needed to ascertain the impact on the inevitability of disease recurrence.

Antibodies, Monoclonal↗