Long-term experience with 6-mercaptopurine in the treatment of Crohn's disease.

We report our observations after 20 yr of clinical experience with 6-mercaptopurine (6-MP) in 148 patients with Crohn's disease who had not satisfactorily responded to steroids and other drugs. Specific therapeutic goals were established for each patient, and the NFIC (now CCFA)-IOIBD index of Crohn's disease activity was calculated pre- and post-therapy. Defined therapeutic goals were achieved in 68%. Major successes include 1) elimination of steroids (66% p < 0.001); 2) healing of internal fistulas and abscesses or improvement by elimination of discharge and tenderness (64% p < 0.05); and 3) healing or improvement by elimination of pain, tenderness and discharge of perirectal fistulas and abscesses (87%, p < 0.05). Other therapeutic goals which achieved 100% success were 1) healing or marked improvement of Crohn's disease of the stomach and duodenum; 2) permitting surgery to be performed electively after 6-MP allowed margins for surgical resection to be delineated. 6-MP was less effective in achieving the therapeutic goals of preventing recurrent small bowel obstruction (43%) and elimination of abdominal masses (55%). Seventy-eight percent of patients showed a reduction in the activity index with a mean of 43% (95% C.I. 36-51%). 6-MP was once again demonstrated to be effective in achieving major therapeutic goals in two of three patients with severe Crohn's disease. Accordingly, the need for surgical resection and subsequent extension of the disease is often postponed or eliminated.

Crohn's disease presenting as isolated jejunitis years after childhood colitis.

We present a case of a patient who had documented ulcerative colitis as a child and later presented with isolated Crohn's jejunitis. Although rare, Crohn's disease must be considered in those patients with segmental inflammation of the small bowel and a prior history of inflammatory bowel disease involving the colon. Patients with colitis that do not show specific criteria for either ulcerative colitis or Crohn's disease should be classified as indeterminant colitis, and a small bowel series is indicated. It may be indicated to obtain a small bowel series in patients with any form of colonic inflammatory bowel disease, periodically, after diagnosis.

Cervical injuries suffered in automobile crashes.

The National Crash Severity Study data in which occupants sustained severe, critical-to-life, or fatal cervical injuries were reviewed. Of passenger cars damaged severely enough to be towed from the scene, it is estimated that one in 300 occupants sustained a neck injury of a severe nature. The neck-injury rate rose to one in 14 occupants for those ejected from their cars, although many of these injuries resulted from contacts within the car before or during the process of ejection. Severe neck injuries were rather rare in cars struck in the rear, but were more common in frontal and side impacts. Occupants between 16 and 25 years of age had such injuries more than twice as often as those in any other age group. Most of the neck injuries of a more severe nature involved the cervical spine or spinal cord. Injuries of the anterior aspect of the neck were relatively infrequent, and usually resulted from direct blunt impacts. National projections of the number of fatalities related to cervical injuries indicates that 5940 deaths, or approximately 20% of all in-car deaths, include fatal cervical spine injuries, and that about 500 cases of quadriplegia per year result from automobile accidents.

Cervical fractures and fracture-dislocations sustained without head impact.

Because of its flexibility and structure, the cervical spine is disposed to various mechanisms of injury: although not so common as injuries caused by head impacts, cervical fractures and/or fracture-dislocations have been reported without direct impact to the head. Some cervical injuries reported have been sustained by wearers of lap and shoulder belts in auto accidents; however, we do not consider belt use a potential hazard because ample evidence has accrued in the medical and engineering literature to document general injury and fatality reduction by use of seatbelts. We believe that in many instances occupants would be more seriously injured or killed were belts not worn. The present paper reviews reports of cervical injuries without head impact found in the literature and case histories of such injuries from the Highway Safety Research Institute of The University of Michigan, as well as experimental studies in animals, cadavers, and volunteer subjects.