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Biomedical subjects

W M Michener

Publications and source records attributed to W M Michener.

At least 19 recordsLinked to original sources
PubMed1991

The spectrum of eosinophilic gastroenteritis. Report of six pediatric cases and review of the literature.

Eosinophilic gastroenteritis is an inflammatory disease of unknown etiology characterized by infiltration of the gastrointestinal tract with eosinophilic leukocytes, accompanied by varying abdominal symptoms and usually by peripheral blood eosinophilia. We report our experience with six pediatric cases presenting to the Cleveland Clinic Foundation over the past eight years. Unusual findings in our patients included ascitic fluid without eosinophilia and eosinophilic pericarditis (one patient), and eosinophilic cholecystitis (one patient). Endoscopic examination and biopsy helped to establish the diagnosis in all patients. Bone marrow aspiration supported the diagnosis by demonstrating eosinophilia and identifying reactivation of the disease, even in cases without peripheral eosinophilia. All six patients responded promptly to prednisone. Diagnosis is challenging and eosinophilic gastroenteritis may be more common than is recognized. This series of cases significantly expands the spectrum of the disease in children, and documents the usefulness of diagnostic endoscopy in this condition.

Adolescent↗
PubMed1990

Management of children and adolescents with inflammatory bowel disease.

The management of children and adolescents with inflammatory bowel disease requires all the skills offered by the health care team. This article reviews the principles of therapy, the specifics of therapy, and the attitudes of the authors relating to long-term management of these patients. Specific recommendations relating to nutritional support for patients are also made. A pertinent updated bibliography is also given.

Adolescent↗
PubMed1989

High prevalence of antibodies to intestinal epithelial antigens in patients with inflammatory bowel disease and their relatives.

STUDY OBJECTIVE: To assess whether healthy members of families of patients with inflammatory bowel disease share an immune reactivity to gut epithelial cell antigens. DESIGN: Assessment of immune reactivity against epithelial-cell-associated components (ECAC). METHODS: Detection of specific anti-ECAC serum antibodies by antibody-dependent cellular cytotoxicity (percent specific lysis) and by immunoblotting (Western blots). PATIENTS: Index cases (131) and first-degree relatives in 17 families with 2 or more affected members, and 13 with only 1 member affected. MAIN RESULTS: Compared with a gastrointestinal disease control group (0.5% +/- 0.8%), specific lysis against ECAC-C (colon-derived) among patients with inflammatory bowel disease was significantly greater in both multiply affected (8.4% +/- 8.2%; P less than 0.01) and singly affected (5.2% +/- 5.4%; P less than 0.05) families. In contrast, specific lysis by patients with other inflammatory processes of the small and large bowel (1.1% +/- 1.4%) or autoimmune disease (0.7% +/- 1.0%) did not differ from that of the gastrointestinal disease control group. Among relatives of patients with inflammatory bowel disease (index cases), specific lysis was also significantly higher than in the control group (4.8% +/- 5.5% for multiply affected, P less than 0.01, and 4.3% +/- 5.5% for singly affected, P less than 0.05). Relatives of patients with chronic inflammatory liver disease had a level of lysis (0.6% +/- 0.9%) similar to that of controls. The prevalence of antibodies to ECAC-C was 69.7% among patients with chronic inflammatory bowel disease, and 55.7% among relatives; both prevalences were significantly higher than that of the control group (8.0%, P less than 0.001). Using small-bowel-derived ECAC, the prevalence of antibodies among patients with inflammatory bowel disease and relatives was also significantly higher than that of controls. Reactivity of sera was directed to a 160- and a 137-kilodalton macromolecule. CONCLUSIONS: Immune sensitization to intestinal epithelial antigens is common in families with chronic inflammatory bowel disease; its high frequency among asymptomatic relatives suggests it may represent a primary phenomenon, perhaps predisposing individuals to gut tissue injury.

Adolescent↗
PubMed1983

Ileorectal anastomosis for inflammatory bowel disease in children and adolescents.

As in any operation for IBD, colectomy and ileorectal anastomosis should be performed only after every effort has been made to control the disease medically. Only in uncontrolled disease should early proctectomy be advised on the grounds of lack of normal physical development and sexual immaturity. Ileorectal anastomosis should not be performed upon every patient requiring surgical treatment any more than proctocolectomy and ileostomy should be performed upon every patient. Unless there is severe persistent disease of the rectum or destruction of the anal sphincter, the rectum should be preserved because severe ulcerative proctitis may heal or improve postoperatively with further medical treatment. If further surgical treatment is necessary, conversion to an ileostomy can be undertaken, and there are now other alternatives, such as the continent ileostomy and the ileoanal anastomosis, with or without a pelvic pouch.

Adolescent↗
PubMed1980

Nutritional support of the critically ill child.

New techniques for meeting the special metabolic requirements of the pediatric patient and the specific nutritional needs created by different disease states have become available both in enteral feeding and parenteral nutrition. Assessment of nutritional status and requirements of critically ill children are outlined, and the indications, techniques of administration, and complications of the available nutritional modalities are discussed.

Adolescent↗
PubMed1979

Prognosis of Crohn's disease with onset in childhood or adolescence.

A long-term follow-up study of 522 patients (1955-1974) with onset of Crohn's disease under age 21 was conducted. Follow-up information was obtained for 513 (98.4%) of the patients. The mean follow-up for the entire series was 7.7 years with a greater than five-year follow-up for 67% of patients. Nearly 60% of the patients were ages 16--20 at onset of disease. Operation had been performed for 69% of the patients and 13 (2.4%) had died. Among the survivors 67% considered themselves to be in suboptimal health. Although clinical features and complications varied considerably with anatomic disease location, colonic disease generally caused more disability than small intestine location of disease. Age at onset did not correlate with clinical severity except for presence of growth retardation. Thus, this long-term follow-up study demonstrated the chronic nature of Crohn's disease with onset under age 21. It also emphasized that the disease more commonly affected adolescents than children, that operation was required in about two thirds of the patients, and that, while mortality was low, morbidity from the disease continued for many years.

Adolescent↗
PubMed1979

Long-term prognosis of ulcerative colitis with onset in childhood or adolescence.

From 1955 through 1974, 336 patients with ulcerative colitis diagnosed before age 21 years were studied. In 93 patients (29%), a blood relative had ulcerative colitis, one case of Crohn's disease being found. The total colon was involved in 63% of patients; the entire colon or all but the rectal stump was removed in 35%. Eighteen patients died, nine of carcinoma of the colon. Sixty-five percent of patients had symptoms for longer than 6 months before the diagnosis of ulcerative colitis. If the diagnosis was delayed more than 24 months, there was a statistically significant correlation with increased rate of operations and complications and less good quality of life. When the 20-year study period was divided into two 10-year periods, the operative and complication rates were significantly different. Early diagnosis and treatment appear to improve the long-term prognosis of young patients with ulcerative colitis.

Acute Disease↗