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1.
Am J Gastroenterol ; 90(6): 927-32, 1995 Jun.
Article in English | MEDLINE | ID: mdl-7771423

ABSTRACT

OBJECTIVE: This study examines the causes of death from Crohn's disease and ulcerative colitis by comparing death certificates with hospital charts as part of an ongoing, community-based analysis in Rochester, NY. METHODS: A registry of 1358 inflammatory bowel disease patients followed from January 1973 to December 1989 was analyzed for the cause of death by a study of death certificates as well as by a study of hospital records, including surgical pathology and autopsy records. A panel of physicians defined specific criteria for diagnosis, cause of death, and relation of death to inflammatory bowel disease. RESULTS: One hundred and thirty patients (59 with ulcerative colitis and 71 with Crohn's disease) from the registry were found to have death certificates recorded by Monroe County during this period. There was an 80% concordance of the death certificate to the hospital record for the cause of death and its relationship to inflammatory bowel disease. Discordance was noted in cases of colon cancer and surgical complications. CONCLUSIONS: Sixty-eight percent of Crohn's disease and 78% of ulcerative colitis patients died from causes unrelated to their inflammatory bowel disease. Deaths caused by Crohn's disease decreased from 44% in the 1973-1980 period to 6% in the 1981-1989 period. Crohn's disease was a direct cause of death in 25% of the female patients, whereas only 6% of male patients died directly of Crohn's disease. Colorectal cancer caused 14% of the deaths in ulcerative colitis patients, three times more often than in Crohn's disease patients. Excluding cancer, there were only two deaths directly due to ulcerative colitis, both in the first 2 yr after diagnosis.


Subject(s)
Death Certificates , Hospital Records , Inflammatory Bowel Diseases/mortality , Adolescent , Adult , Aged , Aged, 80 and over , Cause of Death , Child , Colorectal Neoplasms/complications , Colorectal Neoplasms/mortality , Female , Humans , Inflammatory Bowel Diseases/complications , Male , Middle Aged
3.
Gastroenterology ; 98(1): 104-10, 1990 Jan.
Article in English | MEDLINE | ID: mdl-2293567

ABSTRACT

The epidemiological understanding of inflammatory bowel disease has been limited by the referral bases of most inflammatory bowel disease studies. The Colitis-Ileitis Study Group of Rochester, N.Y., developed a community-wide, computerized cumulative registry of all inflammatory bowel disease patients hospitalized at the 8 community hospitals for 1973-86. Clinical data were abstracted from each of the 1651 identified hospital charts. All of these patients resided in Monroe County (city and suburbs) and the 5 contiguous counties (Genesee/Finger Lakes Region, population 1,030,640). Of the 1651 hospital patients identified in the study, 1358 resided in Monroe County (Rochester and its immediate suburbs, population 702,238). Incidence, defined as time of onset of symptoms of inflammatory bowel disease, rose from baseline rates in the 1930s to peak in 1980 (Crohn's disease = 50.29/10(5) per decade, ulcerative colitis = 35.12/10(5) per decade) and declined through 1986. For Crohn's disease, the age-specific incidence rates peaked in the 20-29-yr-old group in each of the 5 decades studied. Ulcerative colitis seems to occur at all ages and may have a bimodal distribution. There was a period effect, with the 1970s having the highest incidence of Crohn's disease and ulcerative colitis for each age group. However, the age-specific incidence rate for Crohn's disease showed a 40% decrease in the 1980s compared with the 1970s in the 10-39-yr-old group (p less than 0.001). The age-specific incidence rate for ulcerative colitis showed a 50% decrease in the 1980s compared with the 1970s in the 10-49-yr-old group (p less than 0.001).


Subject(s)
Inflammatory Bowel Diseases/epidemiology , Age Factors , Female , Hospitals, Community , Humans , Incidence , Information Systems , Male , New York , Registries
6.
J Clin Gastroenterol ; 3(4): 321-5, 1981 Dec.
Article in English | MEDLINE | ID: mdl-7040538

ABSTRACT

This report is based on a review of the various investigations attempting to determine the etiology of Crohn's disease. It has paid special attention to three main possible etiologic mechanisms, reported in the literature up to the time of this review; namely, immunologic, unknown transmissible agents or known such as L-forms, protoplasts, or spheroplasts, viral or infectious RNA and/or DNA, and a combination of the preceding causative possibilities. It has discussed the unrewarding immunological mechanisms, the failure to confirm the various investigations suggesting a transmissible agent and/or the speculations concerning the possible combination of factors. It also has included the remarks of Sacchar and Auslander, who stated that four important pieces were missing to allow acceptance of transmissible agent as the cause of Crohn's disease. This review has demonstrated that up to the present time the etiology of Crohn's disease has remained a puzzle and concluded that further investigations are necessary to resolve the etiology of Crohn's disease with the suggestion that evidence for an infectious agent will require experiments that satisfy Koch's postulates.


Subject(s)
Crohn Disease/history , Animals , Crohn Disease/immunology , Crohn Disease/microbiology , Cytopathogenic Effect, Viral , DNA, Viral , History, 20th Century , Humans , L Forms , Mice , Protoplasts , RNA, Viral , Rats , Spheroplasts
18.
J Clin Invest ; 47(10): 2391-401, 1968 Oct.
Article in English | MEDLINE | ID: mdl-4175543

ABSTRACT

Immunoglobulin synthesis by 16 long-term suspension cultures of mononuclear cells derived from peripheral blood of nine patients with heterophile-positive infectious mononucleosis (IM) has been demonstrated by radioimmunoelectrophoretic techniques. All cell lines synthesized molecules with IgG (gamma) heavy chain specificity. 14 cell lines produced molecules with IgM (mu) heavy chain specificity and 11 cell lines produced molecules with IgA (alpha) heavy chain specificity. No detectable synthesis of molecules with IgD (delta) heavy chain specificity was observed by these cell lines derived from peripheral blood of patients with IM. 13 cell lines produced molecules with type K (kappa) light chain specificity and 6 cell lines produced molecules with type L (lambda) light chain specificity. Of interest, 9 of 16 lines produced IgG (gamma), IgA (alpha), and IgM (mu) heavy chain molecules and 5 of these cell lines produced molecules with type K (kappa) and type L (lambda) light chain specificity as well. Further characterization by combined polyacrylamide gel filtration, immunodiffusion, and radioautography indicated the presence of newly synthesized immunoglobulin molecules with both heavy and light polypeptide chains in close association as well as free light polypeptide chain synthesis. Investigation of the localization of immunoglobulin in single cells by immunofluorescent techniques revealed that 5-22% of cells in these lines were strongly reactive with a fluorescein isothiocyanate-conjugated rabbit antisera directed against the antigenic determinants of human IgG and cross-reactive with the determinants common to IgA and IgM. No heterophile antibody, heteroagglutinin, or hemolytic antibody could be demonstrated in these cell lines derived from peripheral blood of patients with heterophile-positive infectious mononucleosis.


Subject(s)
Infectious Mononucleosis/immunology , Leukocytes/immunology , gamma-Globulins/biosynthesis , Adolescent , Adult , Blood Protein Electrophoresis , Carbon Isotopes , Centrifugation , Child , Culture Techniques , Fluorescent Antibody Technique , Gels , Hemagglutination Tests , Hemolysis , Humans , Immune Sera , Immunoelectrophoresis , Infectious Mononucleosis/metabolism , Leukocytes/metabolism , Radioimmunoassay
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