Laparoscopic surgery for patients with Crohn's colitis: a case-matched study

INTRODUCTION

The purpose of this study was to compare short and long-term outcomes of laparoscopic colectomy with open colectomy in patients with Crohn's disease confined to the colon.

MATERIALS AND METHODS

We reviewed all patients undergoing laparoscopic colectomy for Crohn's disease at our institution between 1994 and 2005. Laparoscopic colectomies were matched to open colectomies by patient age, gender, American Society of Anesthesiologists score, type, and year of surgery. We excluded patients with concomitant small bowel disease.

RESULTS

Twenty-seven laparoscopic cases were matched with 27 open cases. There were seven conversions (26%). There was no mortality. Median operative times were significantly longer after laparoscopic colectomy (240 vs 150 min, P < 0.01), and estimated blood loss was comparable (325 vs 350 ml, P = 0.4). Postoperative complications were similar. Laparoscopic colectomies had shorter median length of stay (5 vs 6 days, P = 0.07) and median time to first bowel movement (3 vs 4 days, P = 0.4). When overall length of stay included 30-day readmissions, the difference in favor of laparoscopy became statistically significant (P = 0.02). Recurrent disease requiring surgery was decreased after laparoscopy, although median follow-up was significantly shorter.

CONCLUSION

Laparoscopic colectomy is a safe and acceptable option for patients with Crohn's colitis. Longer follow-up is needed to accurately establish recurrence rates.

Stapled hemorrhoidopexy height as outcome indicator

BACKGROUND

Postoperative expectations after stapled hemorrhoidopexy are still being clarified. Our purpose was to evaluate how outcome is affected by staple line height (SLH) above the dentate line and specimen histology.

METHODS

A prospective database identified demographics, SLH, histology, narcotic use, return to work, and resolution or recurrence of preoperative symptoms data for analysis.

RESULTS

One hundred five patients were analyzed; median age was 49 years. Median RTW and narcotic use were 9 and 4 days, respectively. Patients with squamous epithelium-containing specimens had longer narcotic use (P = .038), whereas patients with SLH >20 mm had shorter narcotic use (P = .021). Preoperative pain and bleeding resolved more frequently with SLH >20 mm (P = .036) and less frequently with SLH >40 mm (P = .032). Patients with poor sphincter tone were more likely to have SLH >20 mm (P = .044). Postoperative symptoms recurred more frequently in patients with SLH >40 mm (P = .001).

CONCLUSIONS

Hemorrhoidopexy SLH and histology can impact postoperative outcomes. SLH should be >20 mm yet < or =40 mm above the dentate, avoiding squamous epithelium.

High CD34 cell doses do not worsen regimen-related toxicity or early mortality after autologous blood stem cell transplantation for breast cancer

BACKGROUND

Some transplant-related complications, such as the engraftment syndrome, are thought to be mediated by cytokines released during expansion of hematopoietic progenitors at the time of neutrophil recovery. Since there is an inverse correlation between CD34(+) cell dose and time to neutrophil recovery, we sought to determine if peritransplant toxicity and early mortality were adversely affected by high CD34(+) cell doses.

METHODS

The study group included 186 women with breast cancer who received high-dose cyclophosphamide, carmustine, thiotepa and an autologous PBSC transplant. The median CD34(+) cell dose was 5.9 x 10(6)/kg (1.0-154.7 x 10(6)/kg). Patients were categorized by CD34(+) cell dose (1.0-3.5, 3.6-5.9, 6.0-19.9, and 20.0-154.7 x 10(6)/kg) for assessment of outcomes.

RESULTS

Grades 2-4 mucositis occurred in 49%, cardiac toxicity in 7%, pulmonary toxicity in 5%, cystitis in 4%, diarrhea in 3%, renal toxicity in 1%, and central nervous system toxicity in 1%. A Grade 2-4 regimen-related toxicity occurred in 109 patients (59%) and Grade 3-4 in eight patients (4%). Overall survival was 100% at Day 30, 96% at Day 90, and 89% at 1 year. Treatment-related mortality was 3.8%. In multivariate analyses that included prior chemotherapy, disease status, visceral metastases, prior chest radiation and age, CD34(+) cell dose group was not an independent risk factor for Grade 2-4 mucositis, Grade 2-4 maximum toxicity, Grade > or =3 cumulative toxicity, 90 day survival or 1 year survival.

DISCUSSION

We conclude that CD34(+) cell doses >20 x 10(6)/kg do not affect transplant outcome in a negative or positive fashion.

Molecular cloning of a major Alternaria alternata allergen, rAlt a 2

BACKGROUND

Sensitivity to the fungus Alternaria alternata is a common cause of asthma. Epidemiologic studies from a variety of locations worldwide indicate that A alternata sensitivity is closely linked with the development of asthma. Furthermore, A alternata sensitivity has been associated with severe and potentially fatal attacks of asthma.

OBJECTIVE

The diagnosis of A alternata sensitivity is hampered by the lack of standardized and well-characterized allergenic extracts. Molecular cloning of allergens offers the possibility of providing large quantities of purified, well-characterized allergens not only for diagnostic purposes but also for studying the pathogenesis of A alternata sensitivity. We used molecular cloning to identify, purify, and produce a major A alternata allergen in quantity.

METHODS

We prepared messenger (m)RNA from A alternata to produce a complementary (c)DNA library. The library was screened for A alternata allergens by using sera from A alternata-sensitive individuals. A recombinant allergen was isolated, the cDNA sequence was determined, and the protein was expressed in Pichia pastoris.

RESULTS

A unique A alternata allergen, rAlt a 2, was identified. A 2.2-kb cDNA sequence was obtained that has homology with a common transposable region and mouse RNA-dependent eukaryote initiation factor-2 alpha-kinase but no homology to any known allergen. No N-glycosylation sites were found in the cDNA sequence. The recombinant allergen was recognized by IgE antibodies in the sera of 16 of 26 (61%) individuals allergic to A alternata, which defines Alt a 2 as a major allergen.

CONCLUSIONS

We have molecularly cloned a unique major A alternata allergen, rAlt a 2. Identification and expression of the recombinant allergen should enhance the development of standardized A alternata allergenic extracts and provide stable reagents for investigating the pathogenesis of A alternata sensitivity.

[Thiamine and thiamine pyrophosphate in obsese patients during partial and total fasting (author's transl)]

The development of vitamin B1 (thiamine) deficiency was investigated in 17 obese patients in the course of a 1000 calory diet or during total fasting for a fortnight. Compared with normal persons no changes of concentrations of total thiamine, TPP, and pyruvate in the blood; thiamine excretion in the urine, or activiation coefficient of the eryhrocyte transketolase (alphaETK) were observed during the reducing diet. However, during a fortnight's total fasting all values decreased significantly to those of thiamine deficiency. The thiamine pyrophosphate (TPP) levels in the blood dropped from the 1st to the 14th day, whereas the alphaETK rose accordingly and the pyruvate levels showed a delayed rise. Total thiamine content of the blood and thiamine excretion in the urine only showed significantly different values when comparing the 1st and the 14th day. There was no dependency of thiamine excretion on urinary output. Clinical symptoms of thiamine deficiency could be demonstrated in no case.