RESUMO
We report a case of a 15-year-old young man who was admitted for an acute hepatitis. Virological assessment showed both IgM anti-EBV and IgM anti-hepatitis A. IgG anti-EBNA and clinical history allowed to rule out the hypothesis of a recent EBV infection and confirmed the diagnosis of acute hepatitis A infection.
Assuntos
Vírus da Hepatite A/imunologia , Hepatite A/diagnóstico , Herpesvirus Humano 4/imunologia , Imunoglobulina M/análise , Doença Aguda , Adolescente , Emergências , Seguimentos , Hepatite A/imunologia , Humanos , Unidades de Terapia Intensiva , Masculino , Fatores de TempoRESUMO
AIM: To evaluate adjuvant modalities after curative resection for hepatocellular carcinoma using a meta-analysis of randomized and non-randomized controlled trials. METHODS: In a first step, a meta-analysis of randomized controlled trials was carried out. Sensitivity analyses after inclusion of non-randomized controlled trials were performed. Four therapeutic modalities were evaluated: pre-operative transarterial chemotherapy, post-operative transarterial chemotherapy, systemic chemotherapy and a combination of systemic and transarterial chemotherapy. RESULTS: Only post-operative transarterial chemotherapy improved survival significantly at 2 years [difference, 22.8%; confidence interval (CI), 8.6-36.9%; P = 0.002] and 3 years (difference, 27.6%; CI, 8.2-47.1%; P = 0.005), and decreased the probability of no recurrence at 1 year (difference, 28.8%; CI, 16.7-40.8%; P < 0.001), 2 years (difference, 27.6%; CI, 8.2-47.1%; P = 0.005) and 3 years (difference, 28%; CI, 8.2-47.9%; P = 0.006). In a sensitivity analysis after inclusion of non-randomized controlled trials, post-operative transarterial chemotherapy still improved survival at 1 year (difference, 9.6%; CI, 0.8-18.3%; P = 0.03), 2 years (difference, 13.5%; CI, 0.9-26%, P = 0.04) and 3 years (difference, 18%; CI, 7-28.9%; P < 0.001), and decreased the probability of no recurrence at 1 year (difference, 20.3%; CI, 7.7-33%; P = 0.002), 2 years (difference, 35%; CI, 21.4-46.3%; P < 0.001) and 3 years (difference, 34.5%; CI, 18.7-50.3%; P < 0.001). CONCLUSION: Post-operative transarterial chemotherapy improved survival and decreased the cumulative probability of no recurrence. New randomized controlled trials evaluating this modality are required.
Assuntos
Antineoplásicos/uso terapêutico , Carcinoma Hepatocelular/tratamento farmacológico , Quimioterapia Adjuvante , Neoplasias Hepáticas/tratamento farmacológico , Carcinoma Hepatocelular/cirurgia , Ensaios Clínicos Controlados como Assunto , Quimioterapia Combinada , Humanos , Neoplasias Hepáticas/cirurgia , Recidiva Local de Neoplasia/etiologia , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Ensaios Clínicos Controlados Aleatórios como Assunto , Análise de Sobrevida , Resultado do TratamentoRESUMO
Cellular characteristics of bronchoalveolar lavage (BAL) were investigated in 18 consecutive patients with Crohn's disease, who were free of clinical pulmonary symptoms and had normal findings on chest roentgenograms. Total BAL cell count and cellular viability of alveolar macrophages did not differ significantly between patients and control subjects. Percentage of alveolar lymphocytes was increased in 11 of 18 patients (from 18 percent to 79 percent). There was no apparent correlation between BAL differential cell count and abnormal pulmonary function tests noted in 11 patients, drug treatment or Crohn's disease site, and activity. These results demonstrate a high proportion of latent lymphocyte alveolitis as assessed by BAL, suggesting a latent involvement of the lung in Crohn's disease.
Assuntos
Doença de Crohn/complicações , Pneumopatias/etiologia , Linfocitose/etiologia , Alvéolos Pulmonares/patologia , Adolescente , Adulto , Doença de Crohn/patologia , Feminino , Humanos , Pneumopatias/patologia , Linfocitose/patologia , Masculino , Testes de Função Respiratória , Irrigação TerapêuticaRESUMO
BACKGROUND: Classic morphological techniques are of limited value for imaging endocrine duodenopancreatic tumors, and invasive procedures such as intraarterial stimulation are often used. Two noninvasive procedures, endoscopic ultrasonography (EUS) and somatostatin receptor scintigraphy (SRS), were recently described with promising results. METHODS: In this study we correlated the results of preoperative EUS (n = 34) and SRS (n = 30) with operative findings in patients with histologically proven insulinoma (n = 20) or gastrinoma (n = 21). RESULTS: The sensitivity and positive predictive value (PPV) of EUS were respectively 77% and 94% for pancreatic tumors (insulinomas and gastrinomas), 40% and 100% for duodenal gastrinomas, and 58% and 78% for metastatic lymph nodes. The sensitivity and PPV of SRS for insulinoma were 60% and 100%, respectively. In patients with gastrinoma, the sensitivity and PPV of SRS were respectively 25% and 100% for pancreatic gastrinomas, 72% and 100% for duodenal gastrinomas or periduodenal metastatic lymph nodes, and 67% and 80% for liver metastasis. In patients with multiple endocrine neoplasia, neither one of the two techniques detected all tumors. Overall sensitivity of combined EUS and SRS was 89% for insulinoma (n = 9) and 93% for gastrinoma (n = 14). CONCLUSIONS: EUS and SRS for gastrinomas and insulinomas should be considered as the initial preoperative imaging procedures and may render invasive procedures unnecessary for most patients.
Assuntos
Endossonografia , Gastrinoma/diagnóstico por imagem , Insulinoma/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Receptores de Somatostatina/análise , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Cuidados Pré-Operatórios , Cintilografia , Sensibilidade e EspecificidadeRESUMO
Gastrointestinal localizations of sarcoidosis are rare. A total of 14 cases of pancreatic involvement in sarcoidosis has been reported previously. We report here a case of late onset idiopathic chronic pancreatitis diagnosed at the same time as sarcoidosis with liver, colonic, renal, mediastinal and neurologic involvement in a 56-year-old man. This case further suggests a possible relationship between idiopathic chronic pancreatitis and multisystem diseases.
Assuntos
Pancreatite/complicações , Sarcoidose/complicações , Idade de Início , Doença Crônica , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/diagnóstico , Pancreatite/imunologia , Sarcoidose/diagnóstico , Sarcoidose/imunologiaRESUMO
BACKGROUND AND OBJECTIVES: Information about the long-term efficacy of interferon alpha (interferon-alpha) in haemophilic patients with chronic hepatitis not co-infected with the human immunodeficiency virus (HIV-1) is still limited. Previous studies seemed to indicate a low rate of response. The aim of this study was to evaluate the safety and long-term efficacy of interferon treatment in multi-transfused haemophiliacs. METHODS: Fifty-eight haemophiliacs were scheduled to receive 3 MU of interferon-alpha 2b three times a week for 12 months. The patients were followed up for at least 24 months post-treatment. Response was assessed by measurements of serum hepatitis C virus (HCV) RNA. RESULTS: Twenty-four patients (41.4%) dropped out. Except for seven patients, the symptoms that led to interrupting interferon treatment would probably not have resulted in the same decision in non-haemophilic patients. One patient developed an inhibitor to the deficient clotting factor without haemorrhagic consequences. In an intent to treat, the sustained virological response rate was 14%. However, when considering only the 34 patients who received the full treatment, HCV-RNA was cleared in eight patients (23%). CONCLUSIONS: This study suggests that multi-transfused haemophiliacs with chronic hepatitis not co-infected with HIV-1 respond to prolonged treatment with interferon-alpha in a similar proportion to that observed in non-haemophiliacs. There was a high rate of patients who did not complete the interferon-alpha treatment, and this seems to be characteristic of this patient population.
Assuntos
Antivirais/uso terapêutico , Hemofilia A/complicações , Hepatite C Crônica/complicações , Hepatite C Crônica/tratamento farmacológico , Interferon-alfa/uso terapêutico , Adolescente , Adulto , Hepatite C/genética , Hepatite C Crônica/virologia , Humanos , Interferon alfa-2 , Masculino , Pessoa de Meia-Idade , Projetos Piloto , RNA Viral/sangue , Proteínas Recombinantes , Carga ViralRESUMO
In a single-blind multicenter trial, 444 patients with duodenal ulcer (DU) proven by endoscopy were randomly assigned to treatment with either ranitidine, 150 mg, or cimetidine, 400 mg, morning and evening. Clinical assessments were carried out at 2 and 4 weeks and endoscopy at 4 weeks. The patients in the 2 groups were comparable. Cumulative healing rates at 4 weeks were 78.3 p. 100 in the ranitidine group (n = 226) and 65.6 p. 100 in the cimetidine group (n = 218) (p less than 0.003). Pain at the start was of similar severity in both groups, and disappeared at the same rate under ranitidine or cimetidine: 64 p. 100 patients were painless at 1 week, 80 p. 100 at 2 weeks and 88 p. 100 at 4 weeks. Thirty-eight patients complained of mild side effects: 22 on ranitidine (2 trial withdrawals) and 16 on cimetidine (1 trial withdrawal). Multifactorial analysis (logistic model) revealed that linear ulcers had a lower healing probability than round ulcers (p less than 0.002) whatever the treatment group (cimetidine: 47 p. 100 vs 68 p. 100, ranitidine 57 p. 100 vs 80 p. 100 respectively). Smoking habits (p less than 0.057) and age less than 40 years (p = 0.056) did not significantly influence healing rates, although smokers and younger patients under cimetidine had the lowest healing rate. Thus, at the dosage used in our trial, ranitidine is more efficient for healing DU at 4 weeks than cimetidine but not for pain relief.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Cimetidina/uso terapêutico , Úlcera Duodenal/tratamento farmacológico , Ranitidina/uso terapêutico , Doença Aguda , Ensaios Clínicos como Assunto , Úlcera Duodenal/patologia , Feminino , França , Humanos , Masculino , Distribuição AleatóriaRESUMO
This report concerns a case of hepatic epithelioid hemangioendothelioma presenting with liver enlargement, multiple hepatic calcifications on the plain abdominal film and bilateral interstitial pneumonia. Epithelioid hemangioendothelioma is an unusual soft tissue tumor of "intermediate malignancy" characterized by a multicentric involvement of the liver and originating from endothelial cells. Histopathologic diagnosis may be difficult because of possible confusion with sclerosing epithelial tumors.
Assuntos
Calcinose/etiologia , Hemangioendotelioma/complicações , Hepatopatias/etiologia , Neoplasias Hepáticas/complicações , Adulto , Calcinose/diagnóstico por imagem , Hemangioendotelioma/diagnóstico , Hemangioendotelioma/patologia , Hepatomegalia/complicações , Humanos , Hepatopatias/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/patologia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/secundário , Imageamento por Ressonância Magnética , Masculino , Fibrose Pulmonar/etiologia , RadiografiaRESUMO
Strictureplasty is an alternative to extensive and/or multiple small bowel resections in the surgical treatment of Crohn's disease. We here report a series of 22 patients (12 M-10 F--mean age years: 28). All patients had a non-perforative form of Crohn's disease lasting for a mean of 8 years. Nine out of 22 had had previous intestinal resection. A total of 201 stenosis was identified during peroperative examination (mean per patient: 9). Only tight stenoses (diameter < 2 cms) were treated while others were left untouched (n = 22 in 11 patients). Eighty-three stenoses were treated by short strictureplasty and 24 by long strictureplasty using steel thread. One or several resections were simultaneously performed in 15 patients. Mortality was nil. A post operative abscess without loosened suture was drained. The mean follow-up in the 22 patients was 24 months (3-7 years). Clinical and radiological symptoms of stenosis were relieved after strictureplasty. Clinical recurrence occurred in 5 patients among 12 followed-up more than 2 years. Subsequent surgery was required in 4: in one case hemorrhagic ulceration developed within a long strictureplasty and in 3 others stenosis developed in plasty areas but also in previously healthy areas. In conclusion, strictureplasty is a short and long-term efficient procedure in the treatment of Crohn's disease stenosis. It allows limiting extensive intestinal resection. A more prolonged follow-up is needed in order to evaluate the rate of long-term recurrence and complications that would limit the interest of this technique.
Assuntos
Doença de Crohn/cirurgia , Doenças do Íleo/cirurgia , Obstrução Intestinal/cirurgia , Doenças do Jejuno/cirurgia , Adolescente , Adulto , Doença de Crohn/complicações , Feminino , Seguimentos , Humanos , Doenças do Íleo/etiologia , Obstrução Intestinal/etiologia , Doenças do Jejuno/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Recidiva , ReoperaçãoRESUMO
The results of the palliative treatment by laser photo-ablation for esophageal and gastric cancers in 79 nonsurgical patients are reported. The aim of treatment was to relieve dysphagia in 60 patients with an obstructive tumor, to maintain esophageal lumen patency in 8 patients with a nonobstructive tumor, and to completely destroy 11 small tumors. The success rate in the patients with dysphagia was 78 p. 100. Functional improvement lasted as long as patients survived with further treatment required once or twice a month. The best results were obtained in exophytic, non circumferential lesions, and in adenocarcinomas of the esophagogastric junction. The localization at the upper third of the esophagus was associated with poor prognosis. The complication rate was 6.6 p. 100. Eight of the 11 small lesions were completely destroyed, but radiation therapy had been associated in four cases with invasive cancer, one of which recurred after 6 months. No complications occurred in this last group of patients.
Assuntos
Neoplasias Esofágicas/cirurgia , Terapia a Laser , Neoplasias Gástricas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial , Cárdia/cirurgia , Transtornos de Deglutição/terapia , Feminino , Humanos , Fotocoagulação , Masculino , Pessoa de Meia-Idade , Cuidados PaliativosRESUMO
A 43-year-old man with Crohn's disease was hospitalized because of bilateral radicular pain secondary to a presacral abscess penetrating into the extra-dural space from L5 to S3. Conservative treatment using computed tomography guided percutaneous drainage of the abscess and parenteral antibiotherapy allowed complete recovery.
Assuntos
Abscesso/cirurgia , Doença de Crohn/complicações , Doenças da Coluna Vertebral/cirurgia , Abscesso/etiologia , Adulto , Doença de Crohn/cirurgia , Espaço Epidural , Humanos , Região Lombossacral , Masculino , Doenças da Coluna Vertebral/etiologiaRESUMO
Pancreatic involvement is rare in sarcoidosis. We describe a 30-year-old man who had two episodes of acute pancreatitis within one month with no current aetiology. Diagnosis of sarcoidosis was based on the presence of bilateral mediastinal adenopathies, alveolar lymphocytosis on bronchoalveolar lavage and biopsy of an enlarged lymph node showing multiple granulomas. This case and five others previously reported in the literature suggest the diagnosis of sarcoidosis should be considered in apparently acute idiopathic pancreatitis.
Assuntos
Doenças do Mediastino/complicações , Pancreatite/etiologia , Sarcoidose Pulmonar/complicações , Sarcoidose/complicações , Doença Aguda , Adulto , Humanos , Masculino , Pancreatite/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
The aim of this study was to describe and to analyze the results of surgery for Crohn's disease in a retrospective series of 155 operations performed in 124 patients from 1949 to 1981 by the same surgical team. Indications for surgical treatment were as follows: acute complications (25 p. 100), intestinal obstruction (35 p. 100), systemic inflammatory manifestations (40 p. 100). Three patients died postoperatively and complications necessitated a reintervention in 10 other subjects. Surgical indications and late postoperative prognosis were significantly different in patients with right-sided bowel lesions (i. e. terminal ileitis, ileocolitis of the ascending colon) and in those with left colonic involvement (i.e. colitis of the whole or descending colon, rectitis and anoperineal lesions). Surgery was required because of failure of medical treatment in 73 p. 100 of Crohn's disease affecting the left colon and in 17 p. 100 of the right-sided lesions (p less than 0.001). After resection a recurrence rate after 1 year and 3 years of respectively 50 and 62 p. 100 was observed in the left colonic disease group and in 5 and 23 p. 100 of the cases respecting the left colon. Finally 31 reoperations were necessary; no surgical mortality occurred in 12 patients with right-sided lesions whereas 5 among 19 patients with involvement of the left colon died postoperatively. These results: a) confirm the high postoperative rate of recurrence (or relapse) after surgical bowel resection for Crohn's disease (especially when the left colon is affected), b) emphasize the need for the surgeon to be very cautious when determining the extent of resection.
Assuntos
Doença de Crohn/cirurgia , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Recidiva , Estudos RetrospectivosRESUMO
This report concerns three patients with "blue rubber bleb nevus syndrome" presenting with recurrent digestive tract hemorrhage. Tuberous angiomas of the digestive tract associated with typical skin lesions as described by Bean led to diagnosis. Endoscopic coagulation with Nd:YAG laser and bipolar electrocoagulation "Bicap" of gastric and colonic angiomas was performed successfully without complication but did not avoid hemorrhagic recurrence originating from lesions located in the small bowel, as demonstrated during laparotomy in one case.
Assuntos
Hemangioma/radioterapia , Neoplasias Intestinais/radioterapia , Terapia a Laser , Adulto , Criança , Pré-Escolar , Eletrocoagulação/métodos , Endoscopia , Feminino , Hemangioma/cirurgia , Humanos , Neoplasias Intestinais/cirurgia , Masculino , Recidiva , SíndromeRESUMO
A previously healthy 50-year old man presented with acute small bowel obstruction. No etiology was found at laparotomy. Postoperatively, the patient remained symptomatic with nausea, vomiting and severe constipation. Gastroscopy revealed retained food in the stomach. Gastric emptying of solids and liquids was dramatically decreased at scintigraphy. The colon was dilated on X-ray study. Chest X-ray revealed a pneumopathy and a small-cell lung cancer was discovered at bronchoscopy. The patient died 5 months after onset. Histologic study of the gut showed widespread degeneration of the myenteric plexus with plasma cell infiltration, Schwann cell proliferation and a reduced number of neurons of which many were abnormal. Intestinal pseudo-obstruction can reveal a small-cell lung cancer; the mechanism of neuronal impairment leading to pseudo-obstruction remains unknown, but could be related to the pathophysiology of paraneoplastic syndromes.
Assuntos
Carcinoma de Células Pequenas/complicações , Pseudo-Obstrução Intestinal/etiologia , Intestino Delgado , Neoplasias Pulmonares/complicações , Carcinoma de Células Pequenas/diagnóstico , Sistema Digestório/inervação , Humanos , Pseudo-Obstrução Intestinal/patologia , Pseudo-Obstrução Intestinal/cirurgia , Neoplasias Pulmonares/diagnóstico , Masculino , Pessoa de Meia-IdadeRESUMO
We report the case of 4 male patients, smokers, with alcoholic cirrhosis, mean age 54.7 +/- 6 years, treated by sclerotherapy for bleeding esophageal varices. Variceal eradication was obtained following juxtacardial intravariceal injection of 1.5 p. 100 polidocanol in one case (100 ml), and 0.5 p. 100 polidocanol in 3 cases (90, 240 and 310 ml). Local complications were observed in all patients (ulcers: 3; stenosis: 1). Carcinoma of the lower third of the esophagus was detected 12, 20, 22 and 30 months after esophageal sclerosis. Carcinoma was circular (one case), semicircular (2 cases), and nodular superimposed on Barrett's esophagus (one case). Histologic features included squamous cell carcinoma in 3 cases and adenocarcinoma in one case. Sclerotherapy could lead to the development of carcinoma because of mucosal alterations. However, other high risk factors (age, alcohol-tobacco intoxication, Barrett's esophagus) and different histologic features suggest a causal association. Endoscopic follow-up of patients after esophageal sclerosis could confirm this hypothesis.
Assuntos
Adenocarcinoma/induzido quimicamente , Carcinoma de Células Escamosas/induzido quimicamente , Neoplasias Esofágicas/induzido quimicamente , Varizes Esofágicas e Gástricas/terapia , Soluções Esclerosantes/efeitos adversos , Esofagoscopia , Humanos , Masculino , Pessoa de Meia-Idade , Soluções Esclerosantes/uso terapêuticoRESUMO
Late portal vein thrombosis of liver grafts is uncommon and is usually revealed by variceal bleeding. We herein report a case of thrombosis discovered in an adult 10 months after liver transplantation, due to stenosis of the portal vein by extrinsic compression, probably secondary to a biopsy-induced hematoma. Development of venous collateral circulation allowed for normal function of the liver graft.
Assuntos
Biópsia por Agulha/efeitos adversos , Hematoma/complicações , Transplante de Fígado/métodos , Veia Porta/diagnóstico por imagem , Trombose/etiologia , Adulto , Angiografia , Feminino , Rejeição de Enxerto/patologia , Hematoma/diagnóstico por imagem , Humanos , Cirrose Hepática/cirurgia , Hepatopatias/complicações , Hepatopatias/diagnóstico por imagem , Espectroscopia de Ressonância Magnética , Trombose/diagnóstico por imagem , Fatores de Tempo , Tomografia Computadorizada por Raios XRESUMO
Bacterial translocation, the passage of viable indigenous bacteria from the gastrointestinal tract to the mesenteric lymph nodes and other internal organs, has been poorly studied in man to date. Pericolonic lymph nodes, liver, portal blood, and peritoneum specimens were harvested before antibiotics were administered during 20 operations for colorectal cancer and compared with those obtained in 20 operations for non colorectal conditions. Bacterial translocation, defined as the presence of intestinal bacteria in at least one of the specimens, was found in 13 patients (65 percent) in the colorectal cancer group as compared to 6 (30 percent) in the control group (p less than 0.05). The increased incidence of bacterial translocation in colorectal cancers was mainly due to the presence of bacteria in the pericolonic lymph nodes adjacent to the cancer. These findings suggest that intestinal bacteria translocate from the bowel lumen in a high proportion of patients with colorectal cancer and further stress the need for prophylactic antibiotics in colorectal cancer surgery.
Assuntos
Adenocarcinoma/microbiologia , Neoplasias Colorretais/microbiologia , Acalasia Esofágica/microbiologia , Refluxo Gastroesofágico/microbiologia , Pancreatite/microbiologia , Adenocarcinoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/cirurgia , Acalasia Esofágica/cirurgia , Feminino , Refluxo Gastroesofágico/cirurgia , Humanos , Hipertensão Portal/microbiologia , Hipertensão Portal/cirurgia , Masculino , Pessoa de Meia-Idade , Pancreatite/cirurgiaRESUMO
Using clustering analysis, we sought to identify groups of patients on the basis of the disease course among a population of 177 patients with Crohn's disease and followed for 3 years or more, starting from the first frank exacerbation of the disease. The first 36 values of a monthly clinical score represented the active variables of the clustering analysis. This method yielded 2 course groups, A and B, of 95 and 82 patients respectively. The unfavorable course in group A was characterized by the persistence of the clinically active disease at 3 years, whereas group B individuals achieved complete clinical remission within 2 years of onset on the average. Among the initially known clinical data which could explain the course, only the incidence of an occlusive syndrome was higher in group B, which showed a more favorable course. Although we applied clustering analysis to a patient sample over a period of only 3 years, our results do suggest the existence or 2 primary course groups within the population of patients with Crohn's disease. It would appear that the disease course cannot be predicted from the clinical parameters present at the time of onset, but rather becomes apparent during the course of the first 2 years.
Assuntos
Doença de Crohn/epidemiologia , Adulto , Criança , Análise por Conglomerados , Doença de Crohn/classificação , Doença de Crohn/fisiopatologia , Feminino , França/epidemiologia , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Fatores de TempoRESUMO
We report five families with 3 or more children having Crohn's disease. In one family, 6 out of 11 siblings were affected. HLA haplotype study in affected children showed that the probability of random segregation was only 38 percent, making improbable a linkage between the histocompatibility locus and the development of Crohn's disease. However similar clinical patterns in siblings could suggest a genetic factor not linked to the HLA system.