Patients with IBD often do not receive optimal medical therapy. In particular, there is suboptimal dosing of 5-ASA and immunomodulatory medications, prolonged use of corticosteroids, failure to use steroid-sparing agents, inadequate measures to prevent metabolic bone disease, and inadequate screening for colorectal cancer.
We have developed and prospectively validated a clinical prediction rule for acute severe lower intestinal bleeding. This prediction rule could improve the triage of patients to appropriate levels of care and interventions, and guide a more standardized approach to acute lower intestinal bleeding.
Caucasians with prevalence estimates of 2 to 8 cases per The prevalence of homozygous hereditary hemochro-1,000 population. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Approximately 70% of affected persons matosis (HHC) is estimated at 1:250 in Caucasian adults.possess HLA-A3 alloantigen. 5,[22][23][24][25][26][27][28] Simon et al. hypothesize Little is known about ethnic subpopulations that might that the genetic mutation leading to iron overload originally be at increased risk for this disease. HLA data have sugoccurred in the Celtic peoples and that the HLA marker for gested a Celtic origin for HHC. Screening for HHC was HHC might constitute a genetic tracer of the migratory patoffered to all employees of the Massachusetts Polaroid tern of these peoples. 29 More recently, a non-HLA-linked Corporation. Participants with a transferrin saturation form of iron overload has been described in South African of ú55% or ú45% and an elevated serum ferritin concenblacks. 30 tration on two screenings were referred for liver biopsy.Most studies have dealt with populations from ethnically The diagnosis of HHC was based on histological criteria, homogeneous areas (Table 1). [9][10][11][12][13][14][15][16][17][18][19][20][21]31 Detailed comparisons of quantitative hepatic iron determination, hepatic iron inethnic and racial backgrounds have not been reported. The dex, and the phlebotomy requirement for iron depletion.current study examines the prevalence of HHC in a healthy Participants completed a questionnaire regarding their working population of heterogeneous ethnic and racial backethnic background. Two thousand two hundred ninetyground. We sought to identify ethnic and racial subpopulafour employees were screened, and 5 cases of HHC were tions that might be at high risk for inheriting this disease. tion of HHC with Celtic background (P Å .012). The esti-Polaroid study of prostate-specific antigen values in male employees mated cost of screening per patient identified was over age 50 years, and an additional 1,331 nonduplicate serum sam-$18,041. Polaroid Corporation has a high representation ples were collected through a corporation-wide informational and of employees of British-Irish ancestry. Our data suggest promotional campaign offering free screening for HHC. This included that they are at high risk for developing HHC. A signifi-a telephone hotline outlining the signs and symptoms of HHC and cant association of HHC with Celtic ancestry was found the benefits of early detection. Demographic data for the total Polarin this subpopulation, supporting the concept of a Celtic oid population were made available for comparison ( HLA-A and -B phenotyping of T-lymphocytes was performed on TS, transferrin saturation; HII, hepatic iron index; SF, serum ferritin.probands in anticipation of family screening. 43,44 From the 1 Division of Gastroenterology, Faulkner Hospital, Tufts University School of Medicine, Boston, MA; 2 Medical Department, Polaroid Corporation, Cambridge, MA;Protocol. The initial sc...
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