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Monozygotic twins with Crohn's disease: A case report
ABSTRACTS
after I0-12 wk. The nonpatched dogs had severe diarrhea and lost 20%-40% of their body weight within 10-12 wk. The possibility of applying this technique to infants with "short gut syndrome" is not raised by this article.--Richard R. Ricketts Small Bowel Duplication as a Rare Cause of Gastrointestinal Bleeding in Infancy. H. Bindewald, M. M~ller, and A.
Sonntag. Z. Kinderchir 31 : 116-120, 1980.
A duplication of the small bowel led to massive intestinal bleeding in a 2.5-mo-old infant. The duplication was diagnosed by 99"-Tc-scanning whereas contrast-roentgenograms were normal. As procedure of choice the selective excision of the duplication and the preservation of the adjacent intestine is recommended. The authors stress the value of the 99m-Tc scanning in the diagnosis of bowel duplications.--Thomas A. AngerpointnelHeterotopic Gastric Mucosa as a Leading Point of Recurrent Intussusception. H. Kuze, H. lkeda, M. Nishida, et al.
Jpn J Pediatr Surg 12:1681-1684, (December), 1980. A case of recurrent intussusception having a tumorous heterotopic gastric mucosa as the leading point in the terminal iluem was reported. This 6-yr-old boy has had recurrent intussusception during the last 3 yr.--H. Suzuki The Many Faces of Meckel's Diverticulum. H. 1I. Firor.
South Med J 73:1507-1511, (November), 1980 Meckel's diverticulum usually presents as a diagnostic problem. Its most common clinical manifestations--lower GI bleeding, small bowel obstruction, and features suggesting acute appendicitis--are fairly well known. Other clinical presentations include a Meckel's diverticulum in an omphalocele, lower G I bleeding followed by perforation, perforation secondary to blunt trauma, and presentation as iron deficiency anemia with and without episodes of overt hemorrhage. Illustrative cases emphasize indications for and usefulness of abdominal scanning as a diagnostic a i d . George Holcomb, Jr. Monozygotic Twins W i t h Crohn's Disease: A Case Report.
G. L. Klein, M. E. Ament, and R. S. Sparkes. Gastroenterology 79:931-933, (November), 1980.
Monozygotic twin brothers with Crohn's disease are reported. Eleven sets of twins with Crohn's disease have been reported thus far. There was approximately a 5% 18% incidence of familial disease in patients who have Crohn's disease. These twins developed symptoms of Crohn's disease at the age of 14 yr and within 8 mo of each other. Both twins demonstrated terminal ileitis as well as extensive colitis. One twin had significant esophageal and pancreatic symptoms while the other one had significant extra-intestinal manifestations including gingivitis, arthritis, and pyoderma gangrenosa. Both twins were raised in the same environment. The authors conclude that while an individual may inherit the tendency to develop Crohn's disease, a more complex interaction of genetic and environmental factors determine the site and severity of disease manifestations.--Richard R. Rickells
417 Continuous Elemental Enteral Alimentation In Children W i t h Crohn's Disease and Growth Failure. C, L Morin, M.
Roulet, C. C. Roy, and A. Weber. Gastroenterology 79:1205 1210, (December), 1980.
Four children aged 11.7 through 13.5 yr with Crohn's disease and growth failure received 6 weeks of continuous elemental enteral alimentation (CEEA) and no other form of treatment. Standard Vivonex (Eaton Lab) was given as a continuous intragastric infusion to an average of 80.5 kcal/ kg body weight/day. All patients were started on a small dose of prednisone at the end of the period of enteral alimentation. All patients were advanced to a normal diet within 10 days after removal of the nasogastric tube, The two patients with active disease became asymptomatic within 8 10 days after the start of CEEA. The disease was quiescent at the end of CEEA in all patients at the end of the study period and remained so for 3 mo in 3 of the 4 patients. All patients experienced significant height and weight gain during the 6 wk of CEEA. There were no significant complications from the therapy. One patient developed intermittent intestinal obstruction and required resectional therapy 2 mo after the study. The other 3 patients continued to grow over a period of 4.5 mo. At that time the disease became active again and the patients resumed their abnormal growth pattern. Therefore, although CEEA can temporarily reestablish growth in children with growth arrest from Crohn's disease, the beneficial have not been maintained for more than 3 mo after the termination of therapy. The possibility of growth stimulation by repeated CEEA treatments is to be further investigated.--Richard R. Ricketts Intestinal Lymphoid Hyperplasia Causing Pseudopolyposis
and Intussusception. P. Schifter, Sz. Szakhll, M. Vizrbirb, and A. Pintbr. Orv Hetil 121,2331-2333, 1980. Three infants aged 6, 7, and 8 mo had acute abdominal symptoms requiring emergency surgery. In all 3 cases laparotomy revealed intussusception. Following reduction in two patients, a malignant intestinal tumor was found and suggested as the cause of the intussusception and an ileocecal resection was done. In the third patient, the necrosis necessitated bowel resection. All three patients have recovered and are thriving. Gross examination and histology documented intestinal lymphoid hyperplasia and pseudopolyposis but nonmalignant changes. The etiology was obscure in all three patients. Laboratory studies suggested only in one infant the general form of lymphoid hyperplasia. Frozen section examination might have revealed the origin of the process and resection therapy might have been avoidable. The surgical management in the acute form of the malady in a previous healthy patient is difficult in the case of lymphoid hyperplasia mimicking a neoplasm.--Andrew Pintbr Intussusception of the Appendix: Hydrostatic Reduction. P.
K. Kleinman. Am J Roentgenol 134:1268-1270, (June), 1980.
A 15-yr-old boy presented with a 4-wk history of central and right abdominal pain exacerbated by meals. Mild right abdominal tenderness was present. A UG1 was normal but SBFT films revealed a filling defect in the cecum. An air contrast study resulted in gradual filling of the appendix as
after I0-12 wk. The nonpatched dogs had severe diarrhea and lost 20%-40% of their body weight within 10-12 wk. The possibility of applying this technique to infants with "short gut syndrome" is not raised by this article.--Richard R. Ricketts Small Bowel Duplication as a Rare Cause of Gastrointestinal Bleeding in Infancy. H. Bindewald, M. M~ller, and A.
Sonntag. Z. Kinderchir 31 : 116-120, 1980.
A duplication of the small bowel led to massive intestinal bleeding in a 2.5-mo-old infant. The duplication was diagnosed by 99"-Tc-scanning whereas contrast-roentgenograms were normal. As procedure of choice the selective excision of the duplication and the preservation of the adjacent intestine is recommended. The authors stress the value of the 99m-Tc scanning in the diagnosis of bowel duplications.--Thomas A. AngerpointnelHeterotopic Gastric Mucosa as a Leading Point of Recurrent Intussusception. H. Kuze, H. lkeda, M. Nishida, et al.
Jpn J Pediatr Surg 12:1681-1684, (December), 1980. A case of recurrent intussusception having a tumorous heterotopic gastric mucosa as the leading point in the terminal iluem was reported. This 6-yr-old boy has had recurrent intussusception during the last 3 yr.--H. Suzuki The Many Faces of Meckel's Diverticulum. H. 1I. Firor.
South Med J 73:1507-1511, (November), 1980 Meckel's diverticulum usually presents as a diagnostic problem. Its most common clinical manifestations--lower GI bleeding, small bowel obstruction, and features suggesting acute appendicitis--are fairly well known. Other clinical presentations include a Meckel's diverticulum in an omphalocele, lower G I bleeding followed by perforation, perforation secondary to blunt trauma, and presentation as iron deficiency anemia with and without episodes of overt hemorrhage. Illustrative cases emphasize indications for and usefulness of abdominal scanning as a diagnostic a i d . George Holcomb, Jr. Monozygotic Twins W i t h Crohn's Disease: A Case Report.
G. L. Klein, M. E. Ament, and R. S. Sparkes. Gastroenterology 79:931-933, (November), 1980.
Monozygotic twin brothers with Crohn's disease are reported. Eleven sets of twins with Crohn's disease have been reported thus far. There was approximately a 5% 18% incidence of familial disease in patients who have Crohn's disease. These twins developed symptoms of Crohn's disease at the age of 14 yr and within 8 mo of each other. Both twins demonstrated terminal ileitis as well as extensive colitis. One twin had significant esophageal and pancreatic symptoms while the other one had significant extra-intestinal manifestations including gingivitis, arthritis, and pyoderma gangrenosa. Both twins were raised in the same environment. The authors conclude that while an individual may inherit the tendency to develop Crohn's disease, a more complex interaction of genetic and environmental factors determine the site and severity of disease manifestations.--Richard R. Rickells
417 Continuous Elemental Enteral Alimentation In Children W i t h Crohn's Disease and Growth Failure. C, L Morin, M.
Roulet, C. C. Roy, and A. Weber. Gastroenterology 79:1205 1210, (December), 1980.
Four children aged 11.7 through 13.5 yr with Crohn's disease and growth failure received 6 weeks of continuous elemental enteral alimentation (CEEA) and no other form of treatment. Standard Vivonex (Eaton Lab) was given as a continuous intragastric infusion to an average of 80.5 kcal/ kg body weight/day. All patients were started on a small dose of prednisone at the end of the period of enteral alimentation. All patients were advanced to a normal diet within 10 days after removal of the nasogastric tube, The two patients with active disease became asymptomatic within 8 10 days after the start of CEEA. The disease was quiescent at the end of CEEA in all patients at the end of the study period and remained so for 3 mo in 3 of the 4 patients. All patients experienced significant height and weight gain during the 6 wk of CEEA. There were no significant complications from the therapy. One patient developed intermittent intestinal obstruction and required resectional therapy 2 mo after the study. The other 3 patients continued to grow over a period of 4.5 mo. At that time the disease became active again and the patients resumed their abnormal growth pattern. Therefore, although CEEA can temporarily reestablish growth in children with growth arrest from Crohn's disease, the beneficial have not been maintained for more than 3 mo after the termination of therapy. The possibility of growth stimulation by repeated CEEA treatments is to be further investigated.--Richard R. Ricketts Intestinal Lymphoid Hyperplasia Causing Pseudopolyposis
and Intussusception. P. Schifter, Sz. Szakhll, M. Vizrbirb, and A. Pintbr. Orv Hetil 121,2331-2333, 1980. Three infants aged 6, 7, and 8 mo had acute abdominal symptoms requiring emergency surgery. In all 3 cases laparotomy revealed intussusception. Following reduction in two patients, a malignant intestinal tumor was found and suggested as the cause of the intussusception and an ileocecal resection was done. In the third patient, the necrosis necessitated bowel resection. All three patients have recovered and are thriving. Gross examination and histology documented intestinal lymphoid hyperplasia and pseudopolyposis but nonmalignant changes. The etiology was obscure in all three patients. Laboratory studies suggested only in one infant the general form of lymphoid hyperplasia. Frozen section examination might have revealed the origin of the process and resection therapy might have been avoidable. The surgical management in the acute form of the malady in a previous healthy patient is difficult in the case of lymphoid hyperplasia mimicking a neoplasm.--Andrew Pintbr Intussusception of the Appendix: Hydrostatic Reduction. P.
K. Kleinman. Am J Roentgenol 134:1268-1270, (June), 1980.
A 15-yr-old boy presented with a 4-wk history of central and right abdominal pain exacerbated by meals. Mild right abdominal tenderness was present. A UG1 was normal but SBFT films revealed a filling defect in the cecum. An air contrast study resulted in gradual filling of the appendix as