Risk factors for postoperative recurrence of Crohn's disease with emphasis on surgical predictors

Intestinal resection for Crohn’s disease is not curative and postoperative recurrence rates remain high. Early detection of indices associated with recurrence and risk stratification are fundamental for the postoperative management of patients. Early endoscopy at 6-12 months is the “gold standard” procedure, whereas other modalities such as fecal calprotectin and imaging techniques can contribute to the diagnosis of recurrence. The purpose of this review is to summarize current data regarding risk factors correlated with postoperative relapse. Smoking is a well-established, modifiable risk factor. There are sufficient data that correlate penetrating disease, perianal involvement, extensive resections, prior surgery, histological features (plexitis and granulomas), and improper management after resection with high rates for recurrence. The literature provides conflicting data for other possible predictors, such as age, sex, family history of inflammatory bowel disease, location of disease, strictureplasties, blood transfusions, and postoperative complications, necessitating further evidence. On the other hand, surgical factors such as anastomotic configuration, open or laparoscopic approach, and microscopic disease at specimen margins when macroscopic disease is resected, seem not to be related with an increased risk of recurrence. Further recognition of histological features as well as gene-related factors are promising fields for research.

Recurrent hamstring injury: consideration following operative and non-operative management

PURPOSE/BACKGROUND

Hamstring injuries are common at all levels of sport, however recurrence rates are disproportionate compared to other soft tissue injuries. Age and previous injury are supported in the literature as risk factors for hamstring injury; nonetheless, debate exists regarding modifiable risk factors. Restoration of peak torque length using lengthening eccentrics and core stability interventions appear to reduce incidence of re-injury. The purpose of this clinical commentary is to review examination techniques and rehabilitation considerations in order to identify important risk factors to reduce recurrence after hamstring strain and total rupture.

DISCUSSION/RELATION TO CLINICAL PRACTICE

Novel clinical examination techniques both at time of acute injury and prior to return to sport may provide valuable prognostic information. Restoration of core stability, neuromuscular control and lengthening eccentric hamstring interventions are proposed key components to reduce hamstring re-injury.

LEVELS OF EVIDENCE

Level 5.

Risk of recurrence after discontinuation of antiepileptic drug therapy in children with epilepsy

Objectives:

The numerous antiepileptic drug (AED) withdrawal studies published in the last 40 years have relied mainly on heterogeneous study groups. There is still no general agreement on the criteria to predict safe discontinuation. The goal of this study was to assess the outcome of AED withdrawal in epileptic children.

Materials and Methods:

Three hundred and eight children with epilepsy were enrolled, and these patients followed at least 1 year after drug withdrawal. Time to seizure relapse and predictive factors were analyzed by survival methods.

Results:

Among the 308 patients, 179 (58.1%) were boys and 129 (41.9%) were girls and the mean age at the seizure onset was 60.41 ± 36.54 months (2-144 months). The recurrence occurred in 73 (23.7%) patients. Mental retardation, history of febrile seizure, etiological of epilepsy, abnormal first electroencephalogram (EEG), abnormal neuroimaging findings, and total number of AED before remission were significantly associated with relapse risk according to univariate analysis. In the multivariate analysis, abnormal first EEG and number of AED before remission (polytherapy) were the risk factors influencing seizure recurrence.

Conclusions:

In our study, recurrence rate was 23.7% in children and most occurred during the 1^st year. The potential risk factors of recurrence are history of febrile seizure, mental retardation, etiological of epilepsy, abnormal first EEG, abnormal neuroimaging findings, and total number of AED before remission. However, we found abnormal first EEG and polytherapy as risk factors of recurrence in multivariate analysis.