15 research outputs found
European evidence-based Consensus on the management of ulcerative colitis: Special situations.
No full textSplenectomy for Visceral Leishmaniasis Out of an Endemic Region: A Case Report and Literature Review
No full textVisceral leishmaniasis (also known as kala-azar) is characterized by fever, weight loss, swelling of the spleen and liver, and pancytopenia. If it is not treated, the fatality rate in developing countries can be as high as 100% within 2 years. In a high risk situation for perioperative bleeding due to severe thrombocytopenia/coagulopathy, we present a rare challenge for urgent splenectomy in a patient with previously undiagnosed visceral leishmaniasis. A histologic examination of the spleen revealed a visceral leishmaniasis, and the patient was successfully treated with amphotericin B
3rd European evidence-based consensus on the diagnosis and management of crohn's disease 2016: Part 2: surgical management and special situations
No full textThis paper is the second in a series of two publications relating to the European Crohn's and Colitis Organisation [ECCO] evidence-based consensus on the diagnosis and management of Crohn's disease [CD] and concerns the surgical management of CD as well as special situations including management of perianal CD and extraintestinal manifestations. Diagnostic approaches and medical management of CD of this ECCO Consensus are covered in the first paper [Gomollon et al JCC 2016]
A pilot study of transrectal endoscopic ultrasound elastography in inflammatory bowel disease
No full textBACKGROUND:
Using standard diagnostic algorithms it is not always possible to establish the correct phenotype of inflammatory bowel
disease which is essential for therapeutical decisions. Endoscopic ultrasound elastography is a new endoscopic procedure
which can differentiate the stiffness of normal and pathological tissue by ultrasound. Therefore, we aimed to investigate
the role of transrectal ultrasound elastography in distiction between Crohn's disease and ulcerative colitis. ----- METHODS:
A total 30 Crohn's disease, 25 ulcerative colitis, and 28 non-inflammatory bowel disease controls were included. Transrectal
ultrasound elastography was performed in all patients and controls. In all ulcerative coltis patients and 80% of Crohn's
disease patients endoscopy was performed to assess disease activity in the rectum. ----- RESULTS:
Significant difference in rectal wall thickness and strain ratio was detected between patients with Crohn's disease and
controls (p = 0.0001). CD patients with active disease had higher strain ratio than patients in remission (p = 0.02). In
ulcerative colitis group a significant difference in rectal wall thickness was found between controls and patients with
active disease (p = 0.03). A significant difference in rectal wall thickness (p = 0.02) and strain ratio (p = 0.0001) was
detected between Crohn's disease and ulcerative colitis patient group. Crohn's disease patients with active disease had a
significantly higher strain ratio compared to ulcerative colitis patients with active disease (p = 0.0001). ----- CONCLUSION:
Transrectal ultrasound elastography seems to be a promising new diagnostic tool in the field of inflammatory bowel
disease. Further study on a larger cohort of patients is needed to definitely assess the role of transrectal ultrasound
elastography in inflammatory bowel disease
Stratification strength and light climate explain variation in chlorophyll a at the continental scale in a European multilake survey in a heatwave summer
No full textTo determine the drivers of phytoplankton biomass, we collected standardized morphometric, physical, and biological data in 230 lakes across the Mediterranean, Continental, and Boreal climatic zones of the European continent. Multilinear regression models tested on this snapshot of mostly eutrophic lakes (median total phosphorus [TP] = 0.06 and total nitrogen [TN] = 0.7 mg L−1), and its subsets (2 depth types and 3 climatic zones), show that light climate and stratification strength were the most significant explanatory variables for chlorophyll a (Chl a) variance. TN was a significant predictor for phytoplankton biomass for shallow and continental lakes, while TP never appeared as an explanatory variable, suggesting that under high TP, light, which partially controls stratification strength, becomes limiting for phytoplankton development. Mediterranean lakes were the warmest yet most weakly stratified and had significantly less Chl a than Boreal lakes, where the temperature anomaly from the long-term average, during a summer heatwave was the highest (+4°C) and showed a significant, exponential relationship with stratification strength. This European survey represents a summer snapshot of phytoplankton biomass and its drivers, and lends support that light and stratification metrics, which are both affected by climate change, are better predictors for phytoplankton biomass in nutrient-rich lakes than nutrient concentrations and surface temperature.Additional co-authors: Jolanda Verspagen, Maria van Herk, Maria G. Antoniou, Nikoletta Tsiarta, Valerie McCarthy, Victor C. Perello, Danielle Machado-Vieira, Alinne Gurjao de Oliveira, Dubravka Špoljaric Maronic, Filip Stevic, Tanja Žuna Pfeiffer, Itana Bokan Vucelic, Petar Žutinic, Marija Gligora Udovic, Anđelka Plenkovic-Moraj, Ludek Blaha, Rodan Geriš, Markéta Frankova, Kirsten Seestern Christoffersen, Trine Perlt Warming, Tõnu Feldmann, Alo Laas, Kristel Panksep, Lea Tuvikene, Kersti Kangro, Judita Koreiviene, Jurate Karosiene, Jurate Kasperoviciene, Ksenija Savadova-Ratkus, Irma Vitonyte, Kerstin Häggqvist, Pauliina Salmi, Lauri Arvola, Karl Rothhaupt, Christos Avagianos, Triantafyllos Kaloudis, Spyros Gkelis, Manthos Panou, Theodoros Triantis, Sevasti-Kiriaki Zervou, Anastasia Hiskia, Ulrike Obertegger, Adriano Boscaini, Giovanna Flaim, Nico Salmaso, Leonardo Cerasino, Sigrid Haande, Birger Skjelbred, Magdalena Grabowska, Maciej Karpowicz, Damian Chmura, Lidia Nawrocka, Justyna Kobos, Hanna Mazur-Marzec, Pablo Alcaraz-Parraga, Elżbieta Wilk-Wozniak, Wojciech Krzton, Edward Walusiak, Ilona Gagala-Borowska, Joana Mankiewicz-Boczek, Magdalena Toporowska, Barbara Pawlik-Skowronska, Michał Niedzwiecki, Wojciech Pęczuła, Agnieszka Napiorkowska-Krzebietke, Julita Dunalska, Justyna Sienska, Daniel Szymanski, Marek Kruk, Agnieszka Budzynska, Ryszard Goldyn, Anna Kozak, Joanna Rosinska, Elżbieta Szeląg-Wasielewska, Piotr Domek, Natalia Jakubowska-Krepska, Kinga Kwasizur, Beata Messyasz, Aleksandra Pełechata, Mariusz Pełechaty, Mikolaj Kokocinski, Beata Madrecka-Witkowska, Iwona Kostrzewska-Szlakowska, Magdalena Frąk, Agnieszka Bankowska-Sobczak, Michał Wasilewicz, Agnieszka Ochocka, Agnieszka Pasztaleniec, Iwona Jasser, Ana M. Antao-Geraldes, Manel Leira, Vitor Vasconcelos, Joao Morais, Micaela Vale, Pedro M. Raposeiro, Vítor Gonçalves, Boris Aleksovski, Svetislav Krstic, Hana Nemova, Iveta Drastichova, Lucia Chomova, Spela Remec-Rekar, Tina Elersek, Lars-Anders Hansson, Pablo Urrutia-Cordero, Andrea G. Bravo, Moritz Buck, William Colom-Montero, Kristiina Mustonen, Don Pierson, Yang Yang, Christine Edwards, Hannah Cromie, Jordi Delgado-Martín, David García, Jose Luís Cereijo, Joan Gomà, Mari Carmen Trapote, Teresa Vegas-Vilarrúbia, Biel Obrador, Ana García-Murcia, Monserrat Real, Elvira Romans, Jordi Noguero-Ribes, David Parreño Duque, Elísabeth Fernandez-Moran, Barbara Úbeda, José Angel Galvez, Núria Catalan, Carmen Pérez-Martínez, Eloísa Ramos-Rodríguez, Carmen Cillero-Castro, Enrique Moreno-Ostos, José María Blanco, Valeriano Rodríguez, Jorge Juan Montes-Pérez, Roberto L. Palomino, Estela Rodríguez-Pérez, Armand Hernandez, Rafael Carballeira, Antonio Camacho, Antonio Picazo, Carlos Rochera, Anna C. Santamans, Carmen Ferriol, Susana Romo, Juan Miguel Soria, Arda Özen, Tünay Karan, Nilsun Demir, Meryem Beklioglu, Nur Filiz, Eti Levi, Ugur Iskin, Gizem Bezirci, Ülkü Nihan Tavsanoglu, Kemal Çelik, Koray Ozhan, Nusret Karakaya, Mehmet Ali Turan Koçer, Mete Yilmaz, Faruk Maras¸lıoglu, Özden Fakioglu, Elif Neyran Soylu, Meral Apaydın Yagcı, Sakir Çınar, Kadir Çapkın, Abdulkadir Yagcı, Mehmet Cesur, Fuat Bilgin, Cafer Bulut, Rahmi Uysal, Köker Latife, Reyhan Akçaalan, Meriç Albay, Mehmet Tahir Alp, Korhan Özkan, Tugba Ongun Sevindik, Hatice Tunca, Burçin Önem, Hans Paerl, Cayelan C. Carey, Bastiaan W. Ibeling
MDR1 polymorphisms are associated with inflammatory bowel disease in a cohort of Croatian IBD patients
No full textBACKGROUND:
Inflammatory bowel diseases (IBD) are chronic diseases of unknown etiology and pathogenesis in which genetic factors contribute to development
of disease. MDR1/ABCB1 is an interesting candidate gene for IBD. The role of two single nucleotide polymorphisms, C3435T and G2677T remains unclear
due to contradictory results of current studies. Thus, the aims of this research were to investigate the association of MDR1 polymorphisms, C3435T
and G2677T, and IBD. ----- METHODS:
A total of 310 IBD patients, 199 Crohn's disease (CD) patients and 109 ulcerative colitis (UC) patients, and 120 healthy controls were included
in the study. All subjects were genotyped for G2677T/A and C3435T polymorphism using RT-PCR. In IBD patients, review of medical records was
performed and patients were phenotyped according to the Montreal classification. ----- RESULTS:
Significantly higher frequency of 2677T allele (p=0.05; OR 1.46, 95% CI (1.0-2.14)) and of the 3435TT genotype was observed among UC patients
compared to controls (p=0.02; OR 2.12; 95% CI (1.11-4.03). Heterozygous carriers for C3435T were significantly less likely to have
CD (p=0.02; OR 0.58, 95% CI (0.36-0.91)). Haplotype analysis revealed that carriers of 3435T/2677T haplotype had a significantly higher risk of
having UC (p=0.02; OR 1.55; 95% CI (1.06-2.28)). ----- CONCLUSION:
MDR1 polymorphisms are associated with both CD and UC with a stronger association with UC
The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: Special situations.
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Appropriate therapy for fistulizing and fibrostenotic Crohn's disease : results of a multidisciplinary expert panel--EPACT II
No full textIntroduction: Many therapeutic decisions in the management of fistulizing and fibrostenotic Crohn's disease (CD) have to be taken without the benefit of strong scientific evidence. For this reason, explicit appropriateness criteria for CD fistula and stenosis treatment were developed by a multidisciplinary European expert panel in 2004 with the aim of making them easily available on the Internet and thus allowing individual case scenario evaluation; these criteria were updated in 2007. Methods: Twelve international experts convened in Geneva, Switzerland in December 2007. Explicit clinical scenarios, corresponding to real daily practice, were rated on a 9-point scale based on evidence from the published literature and panelists' own expertise. Median ratings were stratified into three categories: appropriate (7-9), uncertain (4-6) and inappropriate (1-3). Results: Overall, panelists rated 60 indications pertaining to fistulas. Antibiotics, azathioprine/6-mercaptopurine and conservative surgery are the mainstay of therapy for simple and complex fistulas. In the event of previous failure of azathioprine/6-mercaptopurine therapy, methotrexate and infliximab were considered appropriate for complex fistulas. The panel also rated 72 indications related to the management of fibrostenotic CD. The experts considered balloon dilation, if the stricture was endoscopically accessible, stricturoplasty and bowel resection to be appropriate for small bowel fibrostenotic Crohn's disease, and balloon dilation and bowel resection appropriate for fibrostenotic colonic disease. In the presence of an ileocolonic or ileorectal anastomotic stricture of <7 cm, endoscopic balloon dilation, and bowel resection were considered appropriate. Conclusion: Antibiotics, azathioprine/6-mercaptopurine, and conservative surgery are the mainstay of therapy for fistulizing Crohn's disease. Infliximab is a therapeutic option in patients without prior response to immunosuppressant therapy. In fibrostenotic Crohn's disease, endoscopic balloon dilation, if feasible, or surgical therapy should be considered. These expert recommendations are available online (www.epact.ch). Prospective evaluation is now needed to test the validity of these appropriateness criteria in clinical practice. (C) 2009 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved
Clinical epidemiology of inflammatory bowel disease in Lebanon
No full textBackground: The objectives of this study were to determine the prevalence and incidence of inflammatory bowel disease (IBD) in a representative Lebanese cohort and to describe practice prevalence trends, disease characteristics, and impact on quality of life (QoL) of IBD patients in Lebanon. Methods: All of a university-based health program's 2000-2004 computerized records that listed a diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) were reviewed. In addition, data on patients seen in the gastroenterology clinics and data from the IBD registry at the American University of Beirut Medical Center (AUBMC) from the same period were analyzed. Results: Of 15,073 insured individuals, 8 had a diagnosis of CD and 16 of UC, giving an age-adjusted prevalence of 53.1 per 100,000 people for CD and 106.2 per 100,000 people for UC. The mean age at diagnosis for patients with CD and UC was 28.8 ± 11.1 and 32.0 ± 13.4 years, respectively, and there was a slight female predominance. The mean annual incidence was 4.1 per 100,000 people for UC and 1.4 per 100,000 people for CD (range, 0-6.9-100,000 for both). Of the 10,383 patients seen in the gastroenterology clinic from 2000 to 2004, 251 (2.4percent) had IBD (142 UC, 100 CD, and 9 indeterminate), a ratio that trended upward over time (range, 1.8percent-2.7percent). The median IBD Quality-of-Life (IBDQ) questionnaire score was 124.9 ± 30.5, indicating that the disease had a moderately severe impact on QoL. Conclusions: The prevalence of IBD in this representative Lebanese cohort falls in the intermediate range of that reported for white populations in Europe and North America. Future studies are needed to examine local risk factors, disease genotypes and phenotypes, and epidemiologic time trends. The psychosocial burden of IBD in Lebanon appears significant. Copyright © 2006 Crohn's and Colitis Foundation of America, Inc.ALNAKIB B, 1984, AM J GASTROENTEROL, V79, P191; Al-Shamali MA, 2003, DIGESTION, V67, P218, DOI 10.1159-000072060; Bernstein CN, 1999, AM J EPIDEMIOL, V149, P916; Bjornsson S, 2000, EUR J GASTROEN HEPAT, V12, P31, DOI 10.1097-00042737-200012010-00007; Blanchard JF, 2001, AM J EPIDEMIOL, V154, P328, DOI 10.1093-aje-154.4.328; delaCal JAL, 1997, EUR J GASTROEN HEPAT, V9, P1129; DROSSMAN DA, 1989, DIGEST DIS SCI, V34, P1379, DOI 10.1007-BF01538073; FIREMAN Z, 1989, AM J GASTROENTEROL, V84, P255; GILAT T, 1974, GASTROENTEROLOGY, V66, P335; GROSSMAN A, 1989, HEPATO-GASTROENTEROL, V36, P193; GUYATT GH, 1989, J GEN INTERN MED, V4, P101, DOI 10.1007-BF02602348; Irvine EJ, 1999, J PEDIATR GASTR NUTR, V28, pS23, DOI 10.1097-00005176-199904001-00003; Koss K, 2000, GENES IMMUN, V1, P185, DOI 10.1038-sj.gene.6363657; KURATA JH, 1992, GASTROENTEROLOGY, V102, P1940; Law NM, 1998, J CLIN GASTROENTEROL, V26, P27, DOI 10.1097-00004836-199801000-00008; Loftus EV, 2000, GUT, V46, P336, DOI 10.1136-gut.46.3.336; Loftus EV, 1998, GASTROENTEROLOGY, V114, P1161, DOI 10.1016-S0016-5085(98)70421-4; Loftus EV, 2002, GASTROENTEROL CLIN N, V31, P1, DOI 10.1016-S0889-8553(01)00002-4; MORITA N, 1995, J GASTROENTEROL, V30, P1; Moum B, 1996, SCAND J GASTROENTERO, V31, P355, DOI 10.3109-00365529609006410; Niv Y, 1999, AM J GASTROENTEROL, V94, P2961; Niv Y, 2000, AM J GASTROENTEROL, V95, P693; ODES HS, 1991, GUT, V32, P1024, DOI 10.1136-gut.32.9.1024; ODES HS, 1987, AM J GASTROENTEROL, V82, P854; Odes H S, 1989, Scand J Gastroenterol Suppl, V170, P36; PINCHBECK BR, 1988, J CLIN GASTROENTEROL, V10, P505, DOI 10.1097-00004836-198810000-00007; Radhakrishnan S, 1997, DIGESTION, V58, P266; Rubin GP, 2000, ALIMENT PHARM THERAP, V14, P1553, DOI 10.1046-j.1365-2036.2000.00886.x; Shapira M, 1998, J CLIN GASTROENTEROL, V27, P134, DOI 10.1097-00004836-199809000-00006; Shivananda S, 1996, GUT, V39, P690, DOI 10.1136-gut.39.5.690; STOWE SP, 1990, GASTROENTEROLOGY, V98, P104; Tragnone A, 1996, INT J EPIDEMIOL, V25, P1044, DOI 10.1093-ije-25.5.1044; TRALLORI G, 1991, ITAL J GASTROENTEROL, V23, P559; VUCELIC B, 1991, INT J EPIDEMIOL, V20, P1043, DOI 10.1093-ije-20.4.1043; VUCELIC B, 1991, INT J EPIDEMIOL, V20, P216, DOI 10.1093-ije-20.1.216; WRIGHT JP, 1986, S AFR MED J, V70, P10; Yang SK, 2000, J GASTROEN HEPATOL, V15, P1037, DOI 10.1046-j.1440-1746.2000.02252.x; Yang SK, 2001, INFLAMM BOWEL DIS, V7, P260, DOI 10.1097-00054725-200108000-0001341333
Pegylated Interferon for Treatment of Chronic Hepatitis C in Hemodialysis Patients in Croatia
No full text<i>Background and Aims:</i> Hepatitis C virus (HCV) infection is a frequent complication among long-term dialysis patients. The aim of the present study was to evaluate the efficacy and side effects of pegylated interferon-α<sub>2a</sub> (PEG-IFN-α<sub>2a</sub>) treatment in hemodialysis patients. <i>Methods:</i> We retrospectively reviewed charts of 16 HCV-RNA-positive hemodialysis patients. <i>Results:</i> There were 11 male and 5 female patients treated with dialysis for 6–28 years. Twelve patients had HCV genotype 1b, 2 patients had 3a, and 1 patient had genotype 2a. Although only 10 out of 16 patients completed 48 weeks of treatment, early virological response and end-of-treatment virological response were achieved in 9 and 13 patients, respectively. Sustained virological response was recorded in 9 patients. The most common side effect was anemia. A flu-like syndrome was documented in 6, myalgia in 4, and arthralgia in 5 patients. Rectorrhagia, endocarditis and severe cough were recorded in 1 patient each. Nine patients received a renal transplant, and all 6 responders remained HCV-RNA-negative. <i>Conclusions:</i> PEG-IFN-α<sub>2a</sub> has limited efficacy in dialysis patients. A significant proportion of patients discontinued treatment because of side effects. Additional studies with long-term follow-up are needed to determine the optimal treatment of HCV infection in the dialysis population.</jats:p
