We are lining up on the target! Dr Inman of the GI team had sent slides to associates in Perth, West Australia by the name of Kevin Murray and Dr Vijay Viswanathan from the dept of Pediatric Rheumatology at Princes Margaret Hospital.

They have said that they had seen and treated this disease before. They specifically site a case of a 6 1/2 year old who presented with very similar symptoms and challenging diagnosis over a protracted period of time. They did come to conclude that this, a very rare disease, has a clinical name, "Idiopathic sclerosing Mesenteritis" or ISM for the rest of us. This is an autoimmune disease and there seems to be only a few documented cases dating back to 1924. In fact there are 17 definitive cases diagnosed and if confirmed, Mark will be the 18th among pediatric subjects.

The treatment protocol for the child sited in the case involved the use of steroids, autoimmune counteractives and Methotrexate which is just what they have been doing at PCMC with evident success.

Mark's girth is near normal and his attitude is the most joyful since he came here on Dec 8. He is better this morning than he has been and has had 2 great walks and is joking and mugging for pictures like the clown we all know and love.

The long term success in adult cases has been very good. The long term prognostication in pediatrics is more difficult as there is more time for recurring disease and complications and little or no case history to refer to. Just as with childhood diabetes complications can arise over the years. Therefore the future is likely to include periodic maintenance treatments using the Methotrexate and steroid protocols as required, over the long term. That said, the road to recovery looks brighter with fewer potholes than 7th East in Sandy and better than bollis food and snot straws so freely (?) provided at the great and spacious building in the shadows of the everlasting hills.

Now Dr Crocheron though idiopathic in nature, is less than qualified to make a firm diagnosis as all of you will agree. So the above information doesn't necessarily reflect the opinions of this station or it's management.

Interestingly enough there is only one mention of ascietes in any of the case pathologies and there are some differences manifest in all the cases but similarities are substantial. We are hopeful that this information so long awaited, will prove valuable for those caring for Mark

(Not) Dr Crocheron