A simple index relating clinical activity in Crohn's disease with T cell activation: hematocrit, frequency of liquid stools and urinary neopterin as parameters.

Crohn's disease is characterized by alternating acute and quiescent periods. Several indices for activity of the inflammatory process have been proposed to have criteria for prognosis of the clinical course and therapeutic efficacy. Neopterin is specifically released from human monocytes-macrophages after induction by interferon-gamma secreted from activated human T lymphocytes. Thus, urinary neopterin excretion is elevated in diseases involving activation of cellular immunity. Fifteen clinical and laboratory parameters, including urinary neopterin levels, collected from 35 visits of patients with Crohn's disease, were compared using multiple linear regression analysis with a simple clinical activity index as reference. Prediction of clinical activity was best with the combination of hematocrit, weekly number of liquid stools and neopterin. A simple triple-parametric Crohn's disease activity index was established on the basis of this result. Its quality was tested on independent data obtained from 25 repeat visits of 13 of these patients. A comparison with the well-known Crohn's Disease Activity Index (CDAI) was performed. The results obtained with the proposed activity index were slightly better than those with the eight-parametric CDAI for the data from the first as well as from the repeat visits. We conclude that our simple index is a reliable and easily accessible measure for clinical activity in patients with Crohn's disease.

[Psychometric studies of cerebral performance before and following extra-intracranial bypass operations]. / Psychometrische Untersuchungen zur Hirnleistung vor und nach extra-intrakranieller Bypass-Operation.

34 patients suffering from cerebro-vascular occlusive disease and treated by an extra-intracranial anastomosis (EIAB) were examined by 5 different psychological tests (Test d 2, Benton Test, Revision Test, Subtest "ZN" of the Hawie, K-L-T) before and after the operation. The results showed a significant improvement of intellectual functioning in most cases. In a addition, disturbances of drive and activity and symptoms of depression were all diminished.

Urinary neopterin, a marker of clinical activity in patients with Crohn's disease.

Urinary neopterin excretion was measured in 34 patients with Crohn's disease. Neopterin excretion showed a significant correlation with disease activity using a clinical activity score. An interacting effect of previous medical or surgical therapy on neopterin excretion could be ruled out. Disease localization and extent did not exert any influence on neopterin excretion. Neopterin values were significantly correlated with disease duration, body weight and the presence of a palpable abdominal mass. Multiple stepwise regression analyses identified the combination of neopterin, hematocrit, weekly stool frequency, palpable abdominal mass and related symptoms as predicting clinical activity better than Crohn's Disease Activity Index (CDAI). Thus, neopterin determination may be introduced as an additional biochemical parameter in the assessment of disease activity.

Serum immunoreactive trypsin and pancreatic lipase in cystic fibrosis.

Serum immunoreactive trypsin (IRT) and pancreatic lipase have been measured in 59 patients with cystic fibrosis (age 1 month-27 years). Follow-up values were obtained from 49 patients. Their serum enzyme levels were compared to those of 120 healthy children of all age groups. Faecal fat excretion was determined in selected patients (n = 23) to elucidate the relationship between serum enzyme levels and pancreatic exocrine function. In cystic fibrosis IRT and lipase showed a very similar age-correlated pattern: in infancy levels were markedly elevated. During the following years the concentrations of both enzymes decreased rapidly and were found to be far below the normal range after the 10th year of life. Elevated enzyme levels in infancy as well as low levels in all age groups coincided with steatorrhea. Older patients (11-27 years) without severe pancreatic insufficiency however, had IRT and lipase levels in or above the normal range. In healthy children there was no age dependency of IRT levels, whereas in the first 12 months of life lipase levels were significantly lower than in later childhood.

[Acute-phase proteins and beta 2 microglobulin in the follow-up of Crohn disease and ulcerative colitis]. / Akut-Phase-Proteine und Beta-2-Mikroglobulin bei der Verlaufskontrolle von Morbus Crohn und Colitis ulcerosa.

The concentrations of orosomucoid, CRP, prealbumin and beta-2-microglobulin were measured in 109 serum samples taken from 19 children with M. Crohn and in 62 samples from 7 children with colitis ulcerosa. The levels were correlated with an activity index calculated on the basis of clinical observations and routine laboratory tests. The orosomucoid and CRP levels rose significantly with increasing severity of both diseases, while neither prealbumin nor beta-2-microglobulin revealed a sufficiently close correlation with the clinical activity. The measurement of CRP and orosomucoid, which is simple to carry out (radial immunodiffusion), enables a fairly exact estimate of the severity of inflammation. Both acute-phase-proteins proved to be of valuable assistance not only in difficult decisions regarding therapy but also for follow-up examinations in randomized studies.