91 research outputs found
An unusual presentation of T-lymphoma in a Crohn's 4 disease patient treated with combo therapy: We are 5 willing to take a risk of serious adverse events for a 6 doubtful benefit?
No full textNoninvasive evaluation of hepatic steatosis and fibrosis in OSA patients at diagnosis
No full textNONALCOHOLIC FATTY LIVER DISEASE, SLEEP APNE
Crohn's disease:a comparative prospective study of transabdominal ultrasonography,small intestine contrastultrasonography and small bowel enema
No full textBackground: Small intestine contrast ultrasonography (SICUS), when performed after distention of the small bowel lumen with an iso-osmolar polyethylene glycol electrolyte-balanced solution, shows high sensitivity (100%) and specificity (97%) in detecting small bowel abnormalities in patients who have not received a diagnosis but in whom there is a suspicion of intestinal diseases. The diagnostic yield of SICUS remains to be established in detecting small bowel lesions in patients with proven Crohn's disease (CD) in comparison with transabdominal ultrasonography (TUS), and in relationship to the experience of the operator, using small bowel enema (SBE) as the "gold standard." Aim: The aim of this study was to evaluate the diagnostic value of SICUS, when performed by a sonologist with 1 year of experience, and TUS, when performed by a sonologist with 10 years of experience, compared to SBE in the assessment of the site, extension, and stenosis of small intestinal lesions in CD patients. Patients and methods: A total of 28 consecutive patients (men, 16; women, 12; age range, 21 to 60 yr) with a diagnosis of CD underwent TUS and SICUS, which were performed by 2 sonologists who were unaware of the radiologic findings, on the same day. SICUS was performed after the ingestion of 375 mL of a polyethylene glycol contrast solution. A standard SBE was performed on a different day by an expert radiologist who was unaware of the sonographic findings. Results: Sensitivities in the detection of small bowel lesions were 96% for TUS and 100% for SICUS. Compared with SBE, SICUS detected the presence of 4 lesions in the jejunum that had been missed by TUS. The mean (±SD) extent of the ileal disease was 22 ± 12.5 cm when measured during SBE, 14.5 ± 8.6 cm when measured during TUS, and 19.5 ± 12.5 cm when measured during SICUS [P = 0.05 (SICUS versus SBE)]. The correlation of the extension of the lesions between SICUS and SBE (r = 0.88) was better than that between TUS and SBE (r = 0.64). The sensitivities of TUS and SICUS in the detection of at least 1 stricture were 76% and 94%, respectively. Sensitivity and specificity in assessing prestenotic dilatation were 50% and 100%, respectively, at TUS, and 100% and 90%, respectively, at SICUS. Conclusion: In inexperienced hands, SICUS is a more accurate technique for assessing CD lesions, and the accuracy is better than that of TUS performed by an expert sonologist. The use of SICUS, instead of SBE, could be indicated for the follow-up of patients with CD
Prognostic indicators of successful endoscopic sclerotherapy for prevention of rebleeding from oesophageal varices in cirrhosis: a long-term cohort study.
No full textBACKGROUND: Although band ligation is now recommended for prevention of rebleeding from oesophageal varices in cirrhosis, sclerotherapy is still widely used. Patients submitted to chronic sclerotherapy undergo several endoscopies and experience a large number of serious complications. However, long-term outcome is poorly defined.
AIMS: To assess the clinical course and prognostic indicators of patients undergoing chronic sclerotherapy for prevention of variceal rebleeding as a basis for future evaluation of long-term band ligation outcome.
METHODS: Prospective cohort study; prognostic analysis by the Cox proportional hazards model.
RESULTS: A total of 218 consecutive cirrhotic patients (37 Child class A, 154 B, 27 C) were enrolled in the study Varices were obliterated in 139 (64%) patients in a mean of 5 (+/-2.6) sessions and recurred in 58/139 (41.7%) within one year. A total of 132 (60%) patients experienced 283 rebleeding episodes and 73 (33%) died. Bleeding from oesophageal ulcers was the most serious complication causing 14% of all rebleeding episodes. Significant prognostic indicators of sclerotherapy outcome were: Child-Pugh class for variceal obliteration; gastric varices and platelet count for recurrence of varices; failure to obliterate varices, variceal size and gastric varices for rebleeding; blood urea nitrogen and failure to obliterate varices for death. Presence of gastric varices was the only prognostic indicator for death in the 79 patients not achieving variceal obliteration. A mean of 10 endoscopies and of 6 hospital admissions were needed per each patient with an estimated cost of US dollars 7154 per patient during the first two years of therapy.
CONCLUSIONS: Sclerotherapy is a very demanding and costly treatment, and is associated with frequent and serious side-effects. The probability of treatment failure is significantly higher in Child C patients with gastric varices. Alternative treatments should be considered for these patients
Is splenectomy a treatment option for aseptic abscesses in patients with Crohn's disease?
No full textThe Role of Portal Vein Thrombosis in the Clinical Course of Inflammatory Bowel Diseases: Report on Three Cases and Review of the Literature
No full textInflammatory bowel diseases are associated with an increased risk of vascular complications. The most important are arterial and venous thromboembolisms, which are considered as specific extraintestinal manifestations of inflammatory bowel diseases. Among venous thromboembolism events, portal vein thrombosis has been described in inflammatory bowel diseases. We report three cases of portal vein thrombosis occurring in patients with active inflammatory bowel disease. In two of them, hepatic abscess was present. Furthermore, we performed a systematic review based on the clinical literature published on this topic
Recommended from our members
Class of 1943
No full textAndron, B. Basch, H. Berman, G. Bohonnon, R., Jr. Boner, E. Breslaw, B. Costello, J. Czalczynski, K. Diamond, J. Ekstein, C. Feiner, J. Fishman, I. Graber, B. Greenberg, A. Greenberg, H. Haeussler, E. Hiller, W. Hoch, T. Kaplowitz, I. Kasten, J. Lakritz, S. Lebenbaum, B. Leonard, P. Leventhal, M. Levinthal, E. Levitz, N. Lindower, A. Luxemberg, H. Lynch, J. Mauskopf, D. Mayer, H. Mintz, E. Mott, E. Phillips, E. Pinel, M. Potoker, M. Raucher, M. Renshaw, R. Robinson, D. Rosen, H. Salzano, S. Scanlan, R., Jr. Schweyer, G., Jr. Sievers, C. Tittler, E. Turner, R. Virdone, T. Zucker, J.https://brooklynworks.brooklaw.edu/bls_classphotos/1016/thumbnail.jp
Class of 1943
No full textAndron, B. Basch, H. Berman, G. Bohonnon, R., Jr. Boner, E. Breslaw, B. Costello, J. Czalczynski, K. Diamond, J. Ekstein, C. Feiner, J. Fishman, I. Graber, B. Greenberg, A. Greenberg, H. Haeussler, E. Hiller, W. Hoch, T. Kaplowitz, I. Kasten, J. Lakritz, S. Lebenbaum, B. Leonard, P. Leventhal, M. Levinthal, E. Levitz, N. Lindower, A. Luxemberg, H. Lynch, J. Mauskopf, D. Mayer, H. Mintz, E. Mott, E. Phillips, E. Pinel, M. Potoker, M. Raucher, M. Renshaw, R. Robinson, D. Rosen, H. Salzano, S. Scanlan, R., Jr. Schweyer, G., Jr. Sievers, C. Tittler, E. Turner, R. Virdone, T. Zucker, J.https://brooklynworks.brooklaw.edu/bls_classphotos/1016/thumbnail.jp
Class of 1943
No full textAndron, B. Basch, H. Berman, G. Bohonnon, R., Jr. Boner, E. Breslaw, B. Costello, J. Czalczynski, K. Diamond, J. Ekstein, C. Feiner, J. Fishman, I. Graber, B. Greenberg, A. Greenberg, H. Haeussler, E. Hiller, W. Hoch, T. Kaplowitz, I. Kasten, J. Lakritz, S. Lebenbaum, B. Leonard, P. Leventhal, M. Levinthal, E. Levitz, N. Lindower, A. Luxemberg, H. Lynch, J. Mauskopf, D. Mayer, H. Mintz, E. Mott, E. Phillips, E. Pinel, M. Potoker, M. Raucher, M. Renshaw, R. Robinson, D. Rosen, H. Salzano, S. Scanlan, R., Jr. Schweyer, G., Jr. Sievers, C. Tittler, E. Turner, R. Virdone, T. Zucker, J.https://brooklynworks.brooklaw.edu/bls_classphotos/1016/thumbnail.jp
Liver Steatosis and Fibrosis in OSA patients After Long-term CPAPTreatment: A Preliminary Ultrasound Study
No full textIn cases of morbid obesity, obstructive sleep apnea (OSA) was associated with biopsy-proven liver damage. The role of non-invasive techniques to monitor liver changes during OSA treatment with continuous positive airway pressure (CPAP) is unknown. We used non-invasive ultrasound techniques to assess liver steatosis and fibrosis in severe OSA patients at diagnosis and during long-term CPAP treatment. Fifteen consecutive patients with severe OSA (apnea hypopnea index 52.5±19.1/h) were studied by liver ultrasound and elastography (Fibroscan) at 6-mo (n=3) or 1-y (n=12) follow-up. Mean age was 49.3±11.9y, body mass index (BMI) was 35.4±6.4kg/m2. Adherence to CPAP was ≥5h/night. At baseline, most patients had severe liver steatosis independent of BMI; at follow-up, liver steatosis was not statistically different, but a relationship between severity of steatosis and BMI became apparent (Spearman's rho: 0.53, p=0.03). Significant fibrosis as assessed by Fibroscan was absent at diagnosis or follow-up (failure or unreliable measurements in four markedly obese patients). Therefore, ultrasound liver assessment is feasible in most OSA patients, and CPAP treatment may positively affect liver steatosis
- …
