AB1243 EFFICACY OF ABATACEPT IN THE TREATMENT OF JUVENILE IDIOPATHIC ARTHRITIS ASSOCIATED UVEITIS

Background

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in pediatric age, uveitis IS the most frequent extra-articular complication (1). Uveitis, if not properly treated, can lead to potentially irreversible ocular complications such as blindness.

The treatment of uveitis associated with JIA (U-JIA) remains a challenge due to the aggressiveness of the disease and the frequency of complications.

Following the current guidelines for screening and treatment of uveitis, the use of topical and sistemic corticosteroids, Methotrexate, cyclosporine or some biological drugs such as Adalimumab constitute the mainstay of treatment in this manifestation.

In some refractory cases, the use of Abatacept has been reported

Objectives

To analyze the efficacy of Abatacept in the treatment of U-JIA from the data avaliable in the scientific literature.

Methods

We perform a systematic review of the scientific literature, following the PRISMA statement, using the following electronic databases: Medline, Embase, Cochrane Library and Web of Science.

Results

An overall of 89 bibliographic references fulfill the inclusion criteria. A total of 64 patients from 6 studies were followed for a mean time per patient of 11.5 months. The mean age of onset of JIA was 5.25 years, with a time of evolution of the disease of 7 and 11.85 years.

In all the series included, a high percentage of patients showed complications secondary to ocular inflammation (synechia, band keratopathy, cataracts, macular cystic edema and/or ocular hypertension) as well as visual deficits secondary to JIA-U.

All patients, fhave shown refractoriness to conventional DMARDs, as well as anti-TNF biological drugs.

In all the studies, the best correct visual activity (BCVA) is used as main outcome measure. Another outcome measures were used: number of uveitis flares, the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), or the number of cells present in the anterior eye chamber.

Four series of cases showed an improvement or stabilization of visual acuity after Abatacept treatment. Two studies provided variations in visual acuity that are not statistically significant.

Regarding the efficacy of Abatacept, we can observe improvement, in the most of the studies we observed a decrease in the severity of the ocular inflammation and/or its complete remission.

Due to the lack of comparable data, a meta-analysis could not be performed. However the data suggest a clear recovery of t JIA-U patients refractory to conventional treatment.

Conclusion

Abatacept is shown as a promising drug in the treatment of U-JIA, considering its efficacy in improving visual acuity, as well as in the control of flare-ups and the decrease in inflammatory eye symptoms. However, more studies are necessary to corroborate the efficacy of Abatacept

References

[1]Sen ES, Ramanan A V. Juvenile idiopathic arthritis-associated uveitis. Best Pract Res Clin Rheumatol. 2017;31(4):517-534. doi:10.1016/j.berh.2018.01.002

[2]Constantin T, Foeldvari I, Anton J, et al. Consensus-based recommendations for the management of uveitis associated with juvenile idiopathic arthritis: The SHARE initiative. Ann Rheum Dis. 2018;77(8):1107-1117. doi:10.1136/annrheumdis-2018-213131

Disclosure of Interests

None declared

AB0902 Efficacy of IL-17 inhibitors in Psoriatic Arhtritis. Sistematic Review of Scientific Literature and Meta-Analysis

Background

Psoriatic arthritis is a chronic inflammatory joint disease with a great heterogeneity of manifestations both at the musculoskeletal (arthritis, enthesitis, dactylitis, axial skeleton involvement) and dermatological (skin, nail involvement) domain. The main goal of treatment is to maximize quality of life by controlling symptoms and preventing structural damage. For this, multidisciplinary management must be carried out without forgetting non-musculoskeletal manifestations and considering comorbidities.

Regarding pharmacological therapy to control arthritis, non-steroidal anti-inflammatory drugs (NSAIDs) and/or intra-articular corticosteroid injections are proposed as initial therapy. When symptoms are not controlled or there are associated poor prognostic factors, conventional disease-modifying antirheumatic drugs (DMARDs) are recommended, especially methotrexate. When the classic DMARDs do not achieve good control of the disease, the next step will be the biological DMARDs, among which are TNF-alpha inhibitors, interleukin-17 inhibitors or inhibitors of the IL12/IL23 axis. Other molecules such as janus kinase (JAK) inhibitors or phosphodiesterase-4 inhibitors such as Apremilast also continue to be incorporated into treatment alternatives.

Although these drugs provide a promising result, the scarcity of direct comparative studies implies a need for more research to determine better treatment strategies.

Objectives

To analyze the efficacy of IL-17 inhibitors (Secukinumab, Ixekizumab, Brodalumab and Bimekizumab) in the treatment of patients diagnosed with psoriatic arthritis based on data published in randomised clinical trials (RCTs).

Methods

We perform a systematic review of the scientific literature using the Pubmed, Cochrane Library, Embase and Web of Science electronic databases, selecting RCTs evaluating the efficacy of IL-17 inhibitors for the treatment of psoriatic arthritis.

A meta-analysis was performed using the random-effects model for each efficacy measure evaluated at different weeks.

Results

23 studies met the selection criteria from a total of 2198 references identified in the search. 14 references contained data on the use of Secukinumab from 7 RCTs. Ixekizumab was the second IL-17 inhibitor most identified with 6 references with data from 5 RCTs. Bimekizumab with 2 references and Brodalumab with 1 reference completed the review.

Despite extracting efficacy data in nail, enthesitic and PROs manifestations. We were only able to perform meta-analyses of the ACR 20, AC50, ACR70 and PASI75 response rates at week 12 of treatment, due to the lack of statistically comparable data.

The meta-analysis performed demonstrated that IL-17 inhibitors are effective in psoriatic arthritis, compared to placebo in the different efficacy outcomes evaluated (ACR20 12 wk (OR: 3.60 [95%CI: 2.85-4. 55]), ACR50 12 wk (OR: 10.85 [95%CI: 6.20-18.94]), ACR70 12 wk (OR: 7.94 [95%CI: 4.23-14.91]) and PASI75 12 wk (OR: 21.26 [95%CI: 13.72-32.95])

Conclusion

Our review concluded that IL-17 inhibitors are effective in the treatment of patients who have shown intolerance or had an unsatisfactory response to other lines of treatment in Psoriatic arthritis.

References

[1]Ritchlin CT, Colbert RA, Gladman DD. Psoriatic Arthritis. N Engl J Med. 2017 Mar 9;376(10):957-70.

[2]Gossec L, Baraliakos X, Kerschbaumer A, de Wit M, McInnes I, Dougados M, et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis. 2020 Jun;79(6):700-12.

Disclosure of Interests

None declared

OP0156 TOCILIZUMAB USE IN SYSTEMIC SCLEROSIS: SYSTEMATIC REVIEW AND META-ANALYSIS

Background

Systemic sclerosis (SSc) is a low-prevalent autoimmune disease with a heterogeneous presentation. Skin involvement is the most frequent symptom and its treatment is orphan, only attending at Raynaud’s phenomenon and classic immunosuppressive therapy for fibrosis. Lung implication is still remaining as the first cause of death. Interstitial lung disease (ILD) is the most frequent presentation and treatments most used includes cyclophosphamide and mycophenolate.1 In 2021, the Food and Drug Administration (FDA) approved the first biologic therapy for ILD-SSc, tocilizumab (TCZ), based on 2 clinical trials.2,3

Objectives

To assess TCZ efficacy in SSc, either in ILD or skin involvement.

Methods

A systematic literature review was made using Medline, Embase, Cochrane Library and the Web of Science databases. Search strategy focused in synonyms of SSc and TCZ, also including MeSH terms. A random-effects model meta-analysis was performed to evaluate TCZ efficacy, when comparable measures were found. Clinical trials, observational studies and case-series were eligible.

Results

Search strategy identified 1036 articles, finally 13 studies were eligible for the review. Regarding the effect of TCZ in SSc skin involvement, measured by the modified Rodnan Skin Score (mRSS), a non-significant 40% improvement in mRSS and change in mean mRSS was reported (OR 1.22 [0.74-2.01], p=0.43 and SMD -0.69 [-1,48-0.10], p=0.09, respectively). About ILD-SSc, a significant non-worsening 10% Forced Vital Capacity (FVC) was reported in patients treated with TCZ (OR 0.45 [0.23-0.86), p=0.02) (Figure 1). As well, a non-significant Diffusing capacity for carbon monoxide (DLCO) was observed in patients treated with TCZ (SMD -0.66 [-1.48- -0.17], p=0.12).

Figure 1.

Conclusion

Our study is the first review and meta-analysis of SSc patients treated with TCZ. This results show that TCZ could delay the worsening of ILD-SSc, being one therapeutic alternative to classical immunosuppressive therapy. Further studies are needed for better disease understanding and TCZ implications in other organ impairment.

References

[1]Desbois AC, Cacoub P. Systemic sclerosis: An update in 2016. Autoinmun Rev. 2016 May; 15 (5): 417-26.

[2]Khanna D, Denton CP, Jahreis A, et al. Safety and efficacy of subcutaneous tocilizumab in adults with systemic sclerosis (fascinate): a phase 2, randomized, controlled trial. Lancet, 2016;387(10038):2630-2640.

[3]Khanna D, Lin CJF, Furst DE, et al. Tocilizumab in systemic sclerosis: a randomized, double-blind, placebo-controlled, phase 3 trial. Lancet Respir Med. 2020;8(10):963-974.

Disclosure of Interests

None declared

Investigation of the protective suitability of a dental fluorinated varnish by means of X Ray fluorescence and Raman spectroscopy

BACKGROUND AND AIM

Evaluating the protective effect in human enamel of a fluorinated varnish after enduring a citric acid erosive challenge.

METHODS

An in vitro model was developed considering the intraoral environment, human saliva and acid erosive procedures. The evaluation of the enamel specimens was undertaken through the direct analysis of enamel by means of Raman spectroscopy and Energy Dispersive X Ray Fluorescence (EDXRF). Ten tooth specimens per group were analysed during three stages: 1- before treatment; 2- After varnish (treatment group) or toothpaste (control) application; 3- After citric acid cycle. Additionally, Particle Induced Gamma Ray emission (PIGE) was used to gauge the fluorine uptake by enamel after the application of the varnish (stage 2). Results were presented as mean and standard deviation with ANOVA and Tukey post hoc performed considering a significance level of 0.05.

RESULTS

A significant (p < 0.05) higher Ca levels were detected in treatment group at stage 2 (37.4 ± 0.4 w/w%) and 3 (37.1 ± 0.1) when compared to the control group. After varnish application in treatment group, depolarization ratios were significant lower (p < 0.05) and anisotropy were significant higher (p < 0.05), however no differences were detected in FWHM.

CONCLUSIONS

The use of a fluorinated dental varnish suggests a protective effect for human enamel against dental erosion demineralization process which was detectable in an in vitro model.

Topographically guided hierarchical mineralization

Material platforms based on interaction between organic and inorganic phases offer enormous potential to develop materials that can recreate the structural and functional properties of biological systems. However, the capability of organic-mediated mineralizing strategies to guide mineralization with spatial control remains a major limitation. Here, we report on the integration of a protein-based mineralizing matrix with surface topographies to grow spatially guided mineralized structures. We reveal how well-defined geometrical spaces defined within the organic matrix by the surface topographies can trigger subtle changes in single nanocrystal co-alignment, which are then translated to drastic changes in mineralization at the microscale and macroscale. Furthermore, through systematic modifications of the surface topographies, we demonstrate the possibility of selectively guiding the growth of hierarchically mineralized structures. We foresee that the capacity to direct the anisotropic growth of such structures would have important implications in the design of biomineralizing synthetic materials to repair or regenerate hard tissues.

Long term outcomes of biomaterial-mediated repair of focal cartilage defects in a large animal model

The repair of focal cartilage defects remains one of the foremost issues in the field of orthopaedics. Chondral defects may arise from a variety of joint pathologies and left untreated, will likely progress to osteoarthritis. Current repair techniques, such as microfracture, result in short-term clinical improvements but have poor long-term outcomes. Emerging scaffold-based repair strategies have reported superior outcomes compared to microfracture and motivate the development of new biomaterials for this purpose. In this study, unique composite implants consisting of a base porous reinforcing component (woven poly(ε-caprolactone)) infiltrated with 1 of 2 hydrogels (self-assembling peptide or thermo-gelling hyaluronan) or bone marrow aspirate were evaluated. The objective was to evaluate cartilage repair with composite scaffold treatment compared to the current standard of care (microfracture) in a translationally relevant large animal model, the Yucatan minipig. While many cartilage-repair studies have shown some success in vivo, most are short term and not clinically relevant. Informed by promising 6-week findings, a 12-month study was carried out and those results are presented here. To aid in comparisons across platforms, several structural and functionally relevant outcome measures were performed. Despite positive early findings, the long-term results indicated less than optimal structural and mechanical results with respect to cartilage repair, with all treatment groups performing worse than the standard of care. This study is important in that it brings much needed attention to the importance of performing translationally relevant long-term studies in an appropriate animal model when developing new clinical cartilage repair approaches.

Evaluation of the effect of fluorinated tooth bleaching products using polarized Raman microscopy and particle induced gamma-ray emission

In this in vitro study, the effect of the application of tooth bleaching products in human enamel was evaluated using polarized Raman microscopy, particle induced gamma-ray emission (PIGE) and Vickers Hardness test. Due to their acidic nature, teeth whitening products are associated with changes in enamel mineralization. Consequently, products have appeared in the market that promote the incorporation of fluorine in order to decrease the solubility of the hydroxyapatite in enamel and prevent demineralization. This way, four commercial products with different active principle concentrations: 16% carbamide peroxide (Opalescence PF® and VivaStyle®) or 6% hydrogen peroxide (Opalescence Go PF® and VivaStyle Paint On®) and presence or not of fluorine were compared. The information on the crystalline state of the enamel was provided by the determination of the depolarization ratio of the symmetric stretching band of phosphate (at 959 cm^-1). Furthermore, the content and uptake of F was evaluated using PIGE in the two fluorinated products as well as in one negative control group. In order to evaluate the microhardness of enamel by means of Vickers test, another group of polished samples was prepared (using Opalescence PF®) and evaluated. Conversely to what could be expected, the obtained results determined a statistically significant decrease of depolarization ratio, leading to an increase of mineralization after the application of the bleaching products, except for VivaStyle®. For this group, no significant variation was obtained before-after treatment, most likely due to the acidity of the product (pH = 5.8). Additionally, an increase of concentration of F in the dental tissues was determined for the fluorinated products. On the other hand, enamel polishing, required for the application of the Vickers test, led to increased susceptibility to erosion, resulting in decreased hardness and an increased enamel depolarization ratio.

Safety and efficacy of endoscopic vacuum therapy for the treatment of perforations and anastomotic leaks of the upper gastrointestinal tract

AIM

To evaluate the efficacy and safety of endoscopic vacuum therapy (EVT) in the management of perforations and anastomotic leaks of the upper gastrointestinal tract.

PATIENTS AND METHODS

This is a retrospective observational study which included patients who underwent EVT due to any upper gastrointestinal defect between April 2017 and February 2019 in three Spanish Hospitals. To this end, we used the only medical device approved to date for endoscopic use (Eso-SPONGEr; B. Braun Melsungen AG, Melsungen, Germany).

RESULTS

11 patients were referred for EVT of an anastomotic leak after esophagectomy (n=7), gastrectomy (n=2), esophageal perforation secondary to endoscopic Zenker's septomiotomy (n=1) and Boerhaave syndrome (n=1). The median size of the cavity was 8×3cm. The median delay between surgery and EVT was 7 days. The median of EVT duration was 28 days. The median number of sponges used was 7 and the mean period replacement was 3.7 days. In 10 cases (91%), the defect was successfully closed. In 9 cases (82%) clinical resolution of the septic condition was achieved. 5 patients presented some adverse event: 3 anastomotic strictures, 1 retropharyngeal pain and 1 case of new-onset pneumonia. The median hospital stay from the start of EVT was 45 days. 1 patient died owing to septic complications secondary to the anastomotic leak.

CONCLUSION

EVT was successful in over 90% of perforations and anastomotic leaks of the upper gastrointestinal tract. Moreover, this is a safe therapy with only mild adverse events associated.

Validation of a Portuguese version of the Groningen radiotherapy-induced xerostomia questionnaire

Background

The aim of this study was to validate and determine at pretest level the reliability of the Portuguese version of the Groningen radiotherapy-induced xerostomia questionnaire.

Material and Methods

This study employed 37 head and neck cancer patients. Each patient signed an informed consent and responded to the Portuguese version of the questionnaire in the form of an interview. This was repeated again after 2 weeks. A standard single question provided a validity check. Data were analyzed using Cronbach’s α to test its reliability and total and interitem correlation, and intraclass correlation to determine its internal consistency and test-retest reliability. Construct validity supported by objective measurements as salivary secretion was also investigated. Significance was set at .05.

Results

Cronbach’s α was 0.91 and 0.89 for the first and second test administrations, respectively, which indicates that the internal consistency was excellent. The intraclass correlation coefficient value for the test-retest reliability was 0.70. The correlation between the total score of the questionnaire and standard single dry mouth question was 0.72 for the first round, indicating a good correlation.

Conclusions

Demonstrating very good psychometric properties, the Portuguese version of the Groningen radiotherapy-induced xerostomia questionnaire is a valid tool and can be considered a reliable instrument to measure xerostomia in head and neck cancer patients.

Key words:Xerostomia, quality of life, xerostomia questionnaire, transcultural validation, head and neck cancer, radiotherapy, saliva.

Patterns and Universals of Adult Romantic Attachment Across 62 Cultural Regions

As part of the International Sexuality Description Project, a total of 17,804 participants from 62 cultural regions completedthe RelationshipQuestionnaire(RQ), a self-reportmeasure of adult romanticattachment. Correlational analyses within each culture suggested that the Model of Self and the Model of Other scales of the RQ were psychometrically valid within most cultures. Contrary to expectations, the Model of Self and Model of Other dimensions of the RQ did not underlie the four-category model of attachment in the same way across all cultures. Analyses of specific attachment styles revealed that secure romantic attachment was normative in 79% of cultures and that preoccupied romantic attachment was particularly prevalent in East Asian cultures. Finally, the romantic attachment profiles of individual nations were correlated with sociocultural indicators in ways that supported evolutionary theories of romantic attachment and basic human mating strategies.

Contribution to the characterization of Opuntia spp. juices by LC-DAD-ESI-MS/MS

Opuntia spp. fruits are considered as health promoting foods due to the diversity of bioactive molecules found in these fruits. The composition in organic acids, flavonols and betalains in the Opuntia ficus-indica juice from a region of Portugal was accomplished for the first time by liquid chromatography and tandem mass spectrometry using an electrospray ionization source operating in negative and positive mode. The methodology used allowed the detection of 44 compounds, from which 32 were identified. Isorhamnetin derivatives were the dominant flavonol glycosides. A total of 9 betalains including 6 betaxanthins and 3 betacyanin were also detected in the fruit juice samples and indicaxanthin, betanin and isobetanin were the major pigments. Phenolic acid and phenylpyruvic acid derivatives were also identified. To our knowledge, it is the first time derivative compounds from piscidic acid, phenolic compounds and betalains are characterized in cactus pear juice using a single LC-DAD-ESI-MS/MS method.

Early experience with the Incisionless Operating Platform™ (IOP) for the treatment of obesity : the Primary Obesity Surgery Endolumenal (POSE) procedure

BACKGROUND

We report our initial experience and 6-month outcomes in a single center using the per-oral Incisionless Operating Platform™ (IOP) (USGI Medical) to place transmural plications in the gastric fundus and distal body using specialized suture anchors (the Primary Obesity Surgery Endolumenal [POSE] procedure).

METHODS

A prospective observational study was undertaken with institutional Ethics Board approval in a private hospital in Barcelona, Spain. Indicated patients were WHO obesity class I-II, or III, where patients refused a surgical approach.

RESULTS

Between February 28, 2011 and March 23, 2012, the POSE procedure was successfully performed in 45 patients: 75.6 % female; mean age 43.4 ± 9.2 SD (range 21.0-64.0). At baseline: mean absolute weight (AW, kg), 100.8 ± 12.9 (75.5-132.5); body mass index (BMI, kg/m(2)), 36.7 ± 3.8 (28.1-46.6). A mean 8.2 suture-anchor plications were placed in the fundus, 3.0 along the distal body wall. Mean operative time, 69.2 ± 26.6 min (32.0-126.0); patients were discharged in <24 h. Six-month mean AW was 87.0 ± 10.3 (68.0-111.5); BMI decreased 5.8 to 31.3 ± 3.3 (25.1-38.6) (p < 0.001); EWL was 49.4 %; TBWL, 15.5 %. No mortality or operative morbidity. Minor postoperative side effects resolved with treatment by discharge. Patients reported less hunger and earlier satiety post procedure. Liquid intake began 12 h post procedure with full solids by 6 weeks.

CONCLUSIONS

At 6-month follow-up of a prospective case series, the POSE procedure appeared to provide safe and effective weight loss without the scarring, pain, and recovery issues of open and laparoscopic bariatric surgery. Long-term follow-up and further study are required.

Early experience with the Incisionless Operating Platform™ (IOP) for the treatment of obesity : the Primary Obesity Surgery Endolumenal (POSE) procedure

BACKGROUND

We report our initial experience and 6-month outcomes in a single center using the per-oral Incisionless Operating Platform™ (IOP) (USGI Medical) to place transmural plications in the gastric fundus and distal body using specialized suture anchors (the Primary Obesity Surgery Endolumenal [POSE] procedure).

METHODS

A prospective observational study was undertaken with institutional Ethics Board approval in a private hospital in Barcelona, Spain. Indicated patients were WHO obesity class I-II, or III, where patients refused a surgical approach.

RESULTS

Between February 28, 2011 and March 23, 2012, the POSE procedure was successfully performed in 45 patients: 75.6 % female; mean age 43.4 ± 9.2 SD (range 21.0-64.0). At baseline: mean absolute weight (AW, kg), 100.8 ± 12.9 (75.5-132.5); body mass index (BMI, kg/m(2)), 36.7 ± 3.8 (28.1-46.6). A mean 8.2 suture-anchor plications were placed in the fundus, 3.0 along the distal body wall. Mean operative time, 69.2 ± 26.6 min (32.0-126.0); patients were discharged in <24 h. Six-month mean AW was 87.0 ± 10.3 (68.0-111.5); BMI decreased 5.8 to 31.3 ± 3.3 (25.1-38.6) (p < 0.001); EWL was 49.4 %; TBWL, 15.5 %. No mortality or operative morbidity. Minor postoperative side effects resolved with treatment by discharge. Patients reported less hunger and earlier satiety post procedure. Liquid intake began 12 h post procedure with full solids by 6 weeks.

CONCLUSIONS

At 6-month follow-up of a prospective case series, the POSE procedure appeared to provide safe and effective weight loss without the scarring, pain, and recovery issues of open and laparoscopic bariatric surgery. Long-term follow-up and further study are required.

Fabrication of hierarchical micro-nanotopographies for cell attachment studies

We report on the development of micro/nanofabrication processes to create hierarchical surface topographies that expand from 50 nm to microns in size on different materials. Three different approaches (named FIB1, FIB2, and EBL) that combine a variety of techniques such as photolithography, reactive ion etching, focused ion beam lithography, electron beam lithography, and soft lithography were developed, each one providing different advantages and disadvantages. The EBL approach was employed to fabricate substrates comprising channels with features between 200 nm and 10 μm in size on polymethylmethacrylate (PMMA), which were then used to investigate the independent or competitive effects of micro- and nanotopographies on cell adhesion and morphology. Rat mesenchymal stem cells (rMSCs) were cultured on four different substrates including 10 μm wide and 500 nm deep channels separated by 10 μm distances (MICRO), 200 nm wide and 100 nm deep nanochannels separated by 200 nm distances (NANO), their combination in parallel (PARAL), and in a perpendicular direction (PERP). Rat MSCs behaved differently on all tested substrates with a high degree of alignment (as measured by both number of aligned cells and average angle) on both NANO and MICRO. Furthermore, cells exhibited the highest level of alignment on PARAL, suggesting a synergetic effect of the two scales of topographies. On the other hand, cells on PERP exhibited the lowest alignment and a consistent change in morphology over time that seemed to be the result of interactions with both micro- and nanochannels positioned in the perpendicular direction, also suggesting a competitive effect of the topographies.

Wireless capsule endoscopy

Wireless capsule endoscopy is a new technique that allows complete exploration of the small bowel without external wires. Its role has been analyzed in many small bowel diseases such as obscure gastrointestinal bleeding, Crohn’s disease and gastrointestinal polyposis syndromes with promising results. Studies on other pathologies (i.e. small bowel tumour, celiac disease) are under evaluation to define the role of this technique.

EUS FNA in intraductal papillary mucinous tumors of the pancreas

BACKGROUND/AIMS

There is little information concerning the potential role of fine-needle aspiration guided by endoscopic ultrasonography in the pathologic diagnosis of intraductal papillary mucinous tumors of the pancreas.

METHODOLOGY

Patients with an intraductal papillary mucinous tumor of the pancreas suggested by endoscopic ultrasonography underwent fine-needle aspiration guided by endoscopic ultrasonography in order to investigate the presence of mucin and/or cytologic changes consistent with this diagnosis. A group of 111 patients with other pancreatic lesions explored during the same period of time was used as a control group.

RESULTS

Fine-needle aspiration guided by endoscopic ultrasonography was safely performed in 19 patients and supported the diagnosis in 17 of them. Nine out of the 17 patients with suspicion of intraductal papillary mucinous tumors of the pancreas went to surgery and this diagnosis was confirmed in the resected specimen in all of them. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of EUS FNA in the diagnosis of IPMT were 82%, 100%, 100%, 92% and 94% respectively.

CONCLUSIONS

Fine-needle aspiration guided by endoscopic ultrasonography is a good technique to support the diagnosis of intraductal papillary mucinous tumors of the pancreas and should be considered in this group of patients if pathologic confirmation is judged to be necessary.

Prospective assessment of the role of antibiotic prophylaxis in ERCP

BACKGROUND/AIMS

Despite the existence of published recommendations, various studies of antibiotic prophylaxis have reached conflicting conclusions, and controversy exists regarding the role of antibiotic prophylaxis in ERCP. The aim of this study was to analyze the efficacy of the intramuscular administration of clindamicine and gentamicine before ERCP.

METHODOLOGY

Sixty-one consecutive patients referred for ERCP were prospectively randomized to receive either clindamicine 600mg and gentamicine 80mg, both intramuscularly one hour before the ERCP (group I; 31 patients) or not (group II; 30 patients). Two blood samples were obtained from every patient (just before endoscopy and within 5 minutes of withdrawal of the endoscope) and were incubated for 7 days and examined daily for growth of bacteria. Patients were closely monitored for 7 days after endoscopy to detect the development of infectious complications.

RESULTS

Only 7 cultures from 7 patients were positive. Four were obtained post-ERCP (two patients in group I and two in group II) and the remaining three before endoscopy. The post-ERCP isolated bacteria were: Streptococcus mitis, Peptoestreptococcus anaerobious, Moraxella spp and Escherichia coli. Two patients, one from each group, developed post-ERCP cholangitis that were solved with medical treatment.

CONCLUSIONS

Our findings indicate that ERCP induce bacteremia in a small group of patients and suggest that prophylactic administration of clindamicine plus gentamicine does not reduce the incidence of bacteremia and cholangitis, and do not support the routine use of prophylactic antibiotics prior to ERCP.

What is the seminal exposition among women requiring emergency contraception? A prospective, observational comparative study

OBJECTIVES

The aim of this study is to determine the number of sperm present in the vagina of women presenting for EC after unprotected intercourse or a condom accident.

STUDY DESIGN

A total of 69 women requesting EC were included in a prospective, observational and comparative study. The absence or presence and number of spermatozoa present were examined under light microscopy in endocervical and vaginal smears. An ethinylestradiol-levonorgestrel combination (100 mcg/500 mg for two doses, 12 h apart) was then prescribed. Twenty couples were taken as controls.

RESULTS

In 25 (36.2%) of the 69 women, spermatozoa were not observed. In the women in whom sperm could be identified, there were no significant differences in the mean (range) sperm count in relation to the reason for requesting EC, i.e., 11.0 (0.03-149.8) for condom slippage or breakage, and 8.1 (3.9-55) for unprotected intercourse. In the group of controls the median (range) number of spermatozoa (32.5 (2.5-304) was significantly higher (p=0.04) than the observed in the study group.

CONCLUSIONS

In one-third of the women presenting for EC, no sperm were identified in the vagina. When sperm were present, the number was much lower than that after intercourse among women wishing to conceive. The risk of an unwanted pregnancy is probably, therefore, lower for women who present for EC compared with that for women who truly have unprotected intercourse.

Skeletal muscle inflammation and nitric oxide in patients with COPD

In chronic obstructive pulmonary disease (COPD) the presence of systemic inflammation has been associated with peripheral muscle abnormalities and weight loss. To study whether inflammatory factors are important in these processes, the present study compared the skeletal muscle levels of nitrite, nitrate, nitrotyrosine, neuronal, endothelial and inducible nitric oxide synthases (nNOS, eNOS, and iNOS, respectively), and inflammatory markers (tumour necrosis factor (TNF)-alpha, CD154 and CD163) in 15 patients (forced expiratory volume in one second 43+/-11%) and 14 controls. All these markers were also compared between patients with normal and low body weight. Nitrite (12.5+/-2.6 versus 17.0+/-3.4 micromol.mg(-1) protein), nitrate (20.7+/-2.4 versus 24.4+/-4.5 micromol.mg(-1) protein) and eNOS (31.9+/-4.6 versus 43.6+/-7.5 ng.mg(-1) protein) were lower in COPD patients than in controls. Nitrotyrosine (25.6+/-5.4 versus 6.6+/-3.3 ng.mg(-1) protein), iNOS expression (32+/-9.5 versus 7.16+/-2.7 ng.mg(-1) protein), TNF-alpha (257+/-160 versus 48.3+/-4.4 pg.mg(-1) protein) and CD163 (6.4+/-2.1 versus 0.8+/-0.4 ng.mg(-1) protein) were higher in COPD patients than in controls. CD154 levels were 15.7+/-7.0 ng.mg(-1) protein in COPD patients and undetectable in controls. Similar levels of all these markers were observed in COPD patients with normal and low body weight. In conclusion, these findings suggest the presence of an inflammatory process in the muscle tissue of chronic obstructive pulmonary disease patients, and argue in favour of its participation in the pathogenesis of skeletal muscle abnormalities.

The European panel on the appropriateness of gastrointestinal endoscopy guidelines colonoscopy in an open-access endoscopy unit: a prospective study

BACKGROUND

The demand for gastrointestinal endoscopy is increasing in most developed countries, resulting in an important rise in overall costs and waiting lists for endoscopic procedures. Therefore, adherence to appropriate indications for these procedures is essential for the rational use of finite resources in an open-access system.

AIM

To assess indications and appropriateness of colonoscopy according to the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE) criteria.

METHODS

From May to June 2004, all consecutive patients referred to our Unit for open-access colonoscopy were considered for inclusion in this prospective study. Appropriateness of each colonoscopy was established according to the EPAGE criteria. In order to evaluate whether appropriateness of use correlated with the diagnostic yield of colonoscopy, relevant endoscopic findings were also recorded.

RESULTS

A total of 350 consecutive patients were included in the study. In 38 of them, the colonoscopy indication was not listed in the EPAGE guidelines and, consequently, they were not evaluated. In the remaining 312 patients, the indication for the procedure was considered inappropriate in 73 (23%) patients. Both referring doctor characteristics (specialty and health care setting) and patient data (age) correlated with appropriateness of endoscopy. The diagnostic yield was significantly higher for appropriate colonoscopies (42%) than in those judged inappropriate (21%) (P = 0.001).

CONCLUSIONS

A noteworthy proportion of patients referred for colonoscopy to an open-access endoscopy unit are considered inappropriate because of their indication, with significant differences among specialties. These results suggest that implementation of validated guidelines for its appropriate use could improve this situation and, considering the correlation between appropriateness and diagnostic yield, even contribute to improve the prognosis of patients with colorectal diseases.

Wireless capsule endoscopy in patients with obscure gastrointestinal bleeding: a comparative study with push enteroscopy

BACKGROUND

The identification and treatment of lesions located in the small intestine in obscure gastrointestinal bleeding is always a clinical challenge.

AIM

To examine prospectively the diagnostic precision and the clinical efficacy of capsule endoscopy compared with push enteroscopy in obscure gastrointestinal bleeding.

METHODS

Forty-two patients (22 men and 20 women) with obscure gastrointestinal bleeding (overt bleeding in 26 cases and occult blood loss with chronic anaemia in 16) and normal oesophagogastroduodenoscopy and colonoscopy were analysed. All patients were instructed to receive the capsule endoscopy and push enteroscopy was performed within the next 7 days. Both techniques were blindly performed by separate examiners. The diagnostic yield for each technique was defined as the frequency of detection of clinically relevant intestinal lesions carrying potential for bleeding.

RESULTS

A bleeding site potentially related to gastrointestinal bleeding or evidence of active bleeding was identified in a greater proportion of patients using capsule endoscopy (74%; 31 of 42) than enteroscopy (19%; eight of 42) (P = 0.05). The most frequent capsule endoscopy findings were: angiodysplasia (45%), fresh blood (23%), jejunal ulcers (10%), ileal inflammatory mucosa (6%) and ileal tumour (6%). No additional intestinal diagnoses were made by enteroscopy. In seven patients (22%), the results obtained with capsule endoscopy led to a successful change in the therapeutic approach.

CONCLUSIONS

Compared with push enteroscopy, capsule endoscopy increases the diagnosis yield in patients with obscure gastrointestinal bleeding, and allows modification on therapy strategy in a remarkable proportion of patients.

[Role of capsule endoscopy in patients with obscure digestive bleeding]

INTRODUCTION

The identification and localization of lesions located in the small intestine that may provoke gastrointestinal bleeding is difficult.

OBJECTIVE

To analyze the role of capsule endoscopy in patients with obscure digestive bleeding and to compare the results obtained with those of enteroscopy.

PATIENTS AND METHODS

Twenty-one patients with obscure digestive bleeding (acute hemorrhage in 11 patients and chronic anemia in 10) and normal total fibergastroscopy and fibrocolonoscopy were analyzed. All patients were instructed to receive the capsule and enteroscopy was performed after 1 week. The results obtained using both procedures were independently compared and without knowledge of the results of the other procedure.

RESULTS

Visualization of findings potentially related to gastrointestinal bleeding was significantly greater (p < 0.05) using the capsule (14 of 21 patients [66%]) than with enteroscopy (4 of 21 patients [19%]). The most frequent lesions were angiodysplasias and jejunal ulcers. In 4 patients, the results obtained led to a change in therapeutic approach. One patient with jejunal stenosis and two with ileal lesions underwent surgery, which confirmed the diagnosis of Crohn's disease in the first patient and carcinoid tumor in the remaining two. Another patient with evidence of angiodysplasia and bleeding was effectively treated with Argon-beam during enteroscopy. The capsule was well tolerated in all patients. In the patient with jejunal stenosis, capsule extraction was required during surgery.

CONCLUSIONS

Capsule endoscopy allows adequate visualization of the entire small intestine and its diagnostic efficacy is greater than that of enteroscopy in patients with obscure digestive bleeding. Moreover, in our series, this procedure allowed modification of therapy in one out of every five patients.

[Role of capsule endoscopy in patients with obscure digestive bleeding]

INTRODUCTION

The identification and localization of lesions located in the small intestine that may provoke gastrointestinal bleeding is difficult.

OBJECTIVE

To analyze the role of capsule endoscopy in patients with obscure digestive bleeding and to compare the results obtained with those of enteroscopy.

PATIENTS AND METHODS

Twenty-one patients with obscure digestive bleeding (acute hemorrhage in 11 patients and chronic anemia in 10) and normal total fibergastroscopy and fibrocolonoscopy were analyzed. All patients were instructed to receive the capsule and enteroscopy was performed after 1 week. The results obtained using both procedures were independently compared and without knowledge of the results of the other procedure.

RESULTS

Visualization of findings potentially related to gastrointestinal bleeding was significantly greater (p < 0.05) using the capsule (14 of 21 patients [66%]) than with enteroscopy (4 of 21 patients [19%]). The most frequent lesions were angiodysplasias and jejunal ulcers. In 4 patients, the results obtained led to a change in therapeutic approach. One patient with jejunal stenosis and two with ileal lesions underwent surgery, which confirmed the diagnosis of Crohn's disease in the first patient and carcinoid tumor in the remaining two. Another patient with evidence of angiodysplasia and bleeding was effectively treated with Argon-beam during enteroscopy. The capsule was well tolerated in all patients. In the patient with jejunal stenosis, capsule extraction was required during surgery.

CONCLUSIONS

Capsule endoscopy allows adequate visualization of the entire small intestine and its diagnostic efficacy is greater than that of enteroscopy in patients with obscure digestive bleeding. Moreover, in our series, this procedure allowed modification of therapy in one out of every five patients.

Endoscopic findings in a biennial follow-up program in patients with pernicious anemia

BACKGROUND/AIMS

It is known that patients with pernicious anemia have a higher risk of gastric neoplasms. However, the optimal endoscopic follow-up in these patients has not been properly defined. This study was aimed to assess the usefulness of an endoscopic follow-up program.

METHODOLOGY

We analyzed the endoscopic and histological findings of the first endoscopy performed in a group of 128 patients with the diagnosis of pernicious anemia who were referred to the Endoscopic Unit, and we evaluated the results of the biannual follow-up endoscopies made to 68 of them.

RESULTS

The initial endoscopy did not provide evidence of any lesions in 107 patients (83.5%), and polypoid lesions were found in 12 cases (9.4%). The histological results showed gastric dysplasia in 3 patients (2.3%) and carcinoid tumor in 2 cases (1.6%). No cases of gastric carcinoma were found. During the endoscopic follow-up of 68 patients, in 52 of them (76.8%) there were no endoscopic findings, and raised lesions were detected in 8 patients (11.8%). Three cases of gastric dysplasia were found. No cases of gastric carcinoma or carcinoid were detected during the follow-up.

CONCLUSIONS

We suggest that a biannual endoscopic follow-up in not useful for the early detection of gastric neoplasms in patients with pernicious anemia.

Neoadjuvant therapy of rectal carcinoma with UFT-leucovorin plus radiotherapy

BACKGROUND

The object of this phase II study was to assess the impact of preoperative external radiation therapy combined with UFT and leucovorin on tumor response, sphincter preservation and tumor control in patients with rectal carcinoma.

PATIENTS AND METHODS

Forty-one patients with resectable extraperitoneal rectal adenocarcinoma received radiation therapy and two courses of chemotherapy. Chemotherapy consisted of a 2-h infusion of 6S-steroisomer of leucovorin (6SLV) 250 mg/m2 on day 1, oral 6SLV 7.5 mg every 12 h on days 2-14, and UFT either 350 or 300 mg/m2 on days 1 to 14 every 28 days. Six additional courses of chemotherapy were given after surgery.

RESULTS

Seven of 16 patients (43%) who received 350 mg/m2/day of UFT had grade 3-4 diarrhea and two other patients (12%) had grade 3-4 dermatitis. The next 25 patients received 300 mg/m2/day of UFT and only 14% of them had grade 3-4 diarrhea. Surgery consisted of low-anterior resection in 26 patients (63%) and abdominal-perineal amputation in 15 (37%). There were six histological complete responses (15%). Downstaging occurred in 25 patients (63%). The overall survival at 3 years was 90% and the pelvic disease-free survival 92%.

CONCLUSIONS

Preoperative therapy with radiotherapy and UFT-6SLV downstaged 63% of tumors and allowed a sphincter-preserving procedure in some patients. Toxicity was moderate. This scheme is convenient because of the oral administration of chemotherapy.

Subaortic stenosis diagnosed in the course of a twins pregnancy: a controversial management

Fixed subaortic stenosis, commonly associated with other congenital cardiac defects, is the cause of 10 per cent of cases of congenital obstruction of the left ventricular outflow. Corrective surgery is frequently a successful treatment, recommendations being based on the transaortic gradient in Europe while in the USA the most prevalent opinion is surgical repair independently of the gradient. We present a case of adult clinical onset of a fixed subaortic stenosis during pregnancy, in which hemodynamic changes are significant, that was medically treated and followed in the outpatient clinic of our hospital, and review the state of the art of the management and surgical indications of this condition.

Somatostatin antagonism prevents elemental diet-induced intestinal atrophy in the rat

Somatostatin is a peptide with known antiproliferative effects on the intestine. The aim of the present work was to determine whether somatostatin (SST) antagonism reduces elemental diet-induced intestinal atrophy in the rat. Male Wistar rats were fed a standard diet and treated for seven days with either continuous infusion of saline or low and high doses of a putative somatostatin antagonist; another group was given a SST antagonist in a pulsatile high dose. All these groups received an elemental diet to induce gut mucosa atrophy. Rats were killed and samples were obtained for morphometric and proliferative measurements of the intestine and for SST and insulin-like growth factor-1 (IGF-1) level determination. The elemental diet decreased mucosal length and proliferation. Pulsatile administration of SST antagonist improved or prevented both effects, whereas continuous SST antagonist delivery prevented decreased crypt proliferation induced by the elemental diet. Somatostatin plasma levels were lowest in rats receiving pulsatile administration of SST antagonist. In conclusion, somatostatin antagonism increases proliferation in the intestinal mucosa, improving elemental diet-induced intestinal atrophy; however, morphological growth is not affected.

Somatostatin blockade improves the proliferative response but not intestinal morphological growth after small bowel resection in rats

OBJECTIVE

To find out whether or not blockade of somatostatin improves intestinal adaptation after small bowel resection.

DESIGN

Laboratory experiment.

SETTING

Teaching hospital, Spain.

SUBJECTS

Eighty adult Wistar rats.

INTERVENTIONS

Animals underwent intestinal resection or sham operation (n = 40 each) and were treated with a somatostatin antagonist either intermittently or continuously in three different doses (n = 8 each).

MAIN OUTCOME MEASURES

Bowel mucosal thickness, proliferation and concentrations of cAMP, somatostatin, insulin-like growth factor 1.

RESULTS

Intestinal resection induced a proliferative and morphometric increase of the mucosa; however, the antagonist increased proliferation only in those animals given the highest dose. Intermittent doses induced a proliferative effect that was stronger than that in the three continuous groups. There was no relationship between trophic stimulus and insulin-like growth factor 1 or cAMP, but somatostatin concentrations increased after the intermittent course.

CONCLUSIONS

Somatostatin receptor blockade with an antagonist does not cause in normal rats an intestinal morphological adaptation process or increase it after resection; however, it did promote a proliferative stimulus in the crypts.

Pesticide safety training

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Population genetic structure of a three-host tick, Amblyomma dissimile, in eastern Venezuela

Patterns of genetic variation for the tick Amblyomma dissimile were analyzed from a total of 200 ticks collected on 12 toads (Bufo marinus), 14 snakes (Boa constrictor), and 8 lizards (Iguana iguana) at 11 localities. The analyses were performed on electrophoretic data from 8 isozyme loci. Mean heterozygosity per locus was 6% (+/-3.1) per population. Differences in allelic frequencies among ticks from different individual hosts were the major source of genetic variability in this study. Host species was a smaller source of genetic variation. Genetic distances between localities varied according to which host species was present in each locality, and these appeared to be related to the extent of habitat overlap between host species. The smallest genetic distances between samples from different host species were recorded for I. iguana and B. constrictor. In contrast, the genetic distances between tick samples from B. marinus and either of the reptile species were significantly larger than between tick samples from this amphibian species. Ecological variables or the geographic distance did not explain the local patterns of differentiation observed in A. dissimile. Major genetic differences between island and mainland sites (0.03702) suggested an association between genetic distances and geographic isolation. The consistency between patterns of genetic variation and those of host home range overlap suggests that host dispersion is the main force structuring the genetic variation within this tick species.

Comparative effect of growth hormone and plerocercoid growth factor in the intestinal resection in rat

OBJECTIVE

After massive bowel resection, absorption depends on how fast the mucosal adaptation takes place. This work aims at assessing the trophic effect of growth hormone (GH) and its analogue, the plerocercoid growth factor (PGF), on the intestinal mucosa after 90% small bowel resection.

EXPERIMENTAL DESIGN

24 male Wistar rats were divided into four groups of 6: Control (laparotomy), 90% small bowel resection (RID), resection and treatment with GH during 14 days (RID + GH) and resection and PGF treatment (RID + PGF). Intestinal mucosal adaptation was assessed by measuring mucosal weight and height, and evaluating the regenerative activity by measuring proliferation cell nuclear antigen (PCNA) labelling index.

RESULTS

Bowel resection itself caused a significant increment of jejunal and ileal mucosal height in comparison with the control group. GH and PGF did not change this increase. Jejunal and ileal proliferation indexes were significantly higher than those in controls and they were significantly higher in both RID + GH and RID + PGF groups.

CONCLUSIONS

GH and PGF cause a proliferative effect on the intestinal mucosa, even in hyperproliferative states such as the small bowel resection. This finding might have a clinic application.

Public awareness and attitudes toward epilepsy in different social segments in Brazil

PURPOSE

To assess public awareness and attitudes toward epilepsy in Brazilians of different cultural and socioeconomic backgrounds.

BACKGROUND

Several studies have examined public awareness and attitudes toward epilepsy in various countries but there are no equivalent data for Brazil or South America.

MATERIAL AND METHODS

We have applied the survey proposed by Caveness and Gallup, with some modifications and adaptations to four groups (I-IV) of subjects: I--105 individuals accompanying patients to the Ophthalmologic outpatient clinic of the Hospital das Clínicas of the State University of Campinas (UNICAMP); II--93 students recently admitted to medical and nursing school; III--101 senior non-medical students; and IV--69 senior medical students. Group II, III, and IV were students at UNICAMP.

RESULTS

Individuals with a low socioeconomic standing had a poor profile of familiarity, knowledge and attitudes toward epilepsy. The pre-university and university students had a relatively good profile when compared to the published international polls. Senior medical students had an excellent level of familiarity and knowledge, but showed no change in their objection to having a son or a daughter marry an epileptic person.

CONCLUSIONS

Our data suggest that there is a clear-cut relationship between the level of education and the individual's familiarity and attitudes toward epilepsy. Effective elimination of the prejudice toward epilepsy requires specific training and not just general, superficial information about the condition.

[A review of infectious endocarditis due to Candida]

OBJECTIVE

As fungal endocarditis is a serious disease, frequently requiring cardiac surgery, a review was made of the experience of our Departments in this pathology.

DESIGN

A retrospective analysis of clinical, echocardiographic and surgical data.

SETTING

Patients studied in a tertiary care Hospital with cardiac surgery available.

PATIENTS

Between 1984 and 1994 there were ten cases of candida endocarditis in nine patients, four male and five female, mean age--45 +/- 12 years (31-65).

INTERVENTIONS

The following parameters were analysed: clinical (predisposing factors, clinical evolution, complications, therapy and mortality), echocardiographic (presence of vegetations, abscesses, valvular regurgitations). Patients studied in other Centres and referred to our Department only for examination (echocardiograms) were excluded from this analysis.

RESULTS

Eight cases in seven patients were prosthetic valve endocarditis and two native valve endocarditis. No patient was drug addicted. Seven cases of prosthetic valve endocarditis developed less than one year after surgery and another had a gynecological fungal infection as the cause of the endocarditis. Four patients had had previous endocarditis. There were four embolic events and three developed heart failure. There were three perivalvular infections, six valvular regurgitations and only one case with huge vegetations on echocardiography. Nine patients were treated with amphotericin B, in five fluocytosin was added and in four ketoconazol, which was replaced by flukonazol in one patient. Therapy was continued for at least eight weeks. Six patients were operated during the acute stage and one died. One patient was operated on late after the infection. Three patients died during the active stage. In a follow up of 5.2 +/- 4.8 years (8 months to 8 years) there was one fatal candida endocarditis relapse, one fatal candida sepsis, one non cardiac death, one patient developed a periprosthetic leak and one had recurrent systemic embolization. Abscesses/pseudoaneurysms were found in five out of seven patients submitted to surgery.

CONCLUSION

Candida infective endocarditis has a bad prognosis, specially in those patients not operated early; it develops in patients with predisposing factors, which in our series were a previous infective endocarditis (four patients) and/or a prosthetic valve implantation less than one year before; it has important morbidity with multiple embolic events, perivalvular involvement, valvular regurgitation and heart failure.

Genetic markers for the identification of two tick species, Amblyomma dissimile and Amblyomma rotundatum

Genetic markers are described for 2 species of reptile and amphibian ticks, Amblyomma dissimile and Amblyomma rotundatum, by allozyme electrophoresis. Fixed allelic differences in 4 out of the 8 examined loci allowed the unequivocal separation of both of these species. A strong correlation was found between these genetic markers and the relative size of the spurs in coxae IV but not with the punctuation pattern of the scutum. Moreover, no overlap was found in the distribution of relative spur sizes between samples of both species. The percent polymorphic loci and the mean percent heterozygosity per locus for A. rotundatum was considerably lower than that for A. dissimile. Differences in the amount of genetic variability may be related to their modes of reproduction.

Neurotensin increases intestinal adaptation and reduces enteroglucagon-like immunoreactivity after large bowel resection in rats

OBJECTIVE

To assess the effects of giving neurotensin on intestinal adaptation after colectomy and their relation to enteroglucagon-like immunoreactivity.

DESIGN

Laboratory experiment.

SETTING

Teaching hospital, Spain.

MATERIAL

55 Male Wistar rats.

INTERVENTIONS

All animals were anaesthetised before undergoing laparotomy; 24 animals had 75% of their colon resected. Half of the animals (12 in each group) were treated with neurotensin (600 micrograms/kg body wt/day) for 14 days.

MAIN OUTCOME MEASURES

Differences in the number of mitoses and in nuclear antigen staining of proliferating cells in the intestinal mucosal crypts; plasma enteroglucagon-like immunoreactivity.

RESULTS

After colon resection, the proliferative status, number of mitoses (p < 0.01), and nuclear antigen staining of proliferating cells (p < 0.001) increased significantly in the jejunum of animals treated with neurotensin (p < 0.05). Less pronounced effects were observed in colon and ileum. Plasma enteroglucagon-like immunoreactivity levels fell significantly in all animals given neurotensin (p < 0.05).

CONCLUSIONS

Neurotensin increases the adaptive intestinal process after colon resection and reduces plasma enteroglucagon-like immunoreactivity in rats.

[Complete anorectal stenosis due to paracetamol and salicylamide suppositories]

A female patient previously diagnosed of psychiatric disease used a compound of paracetamol-salicilamide-codeine in suppositories, daily, for more than one year, for migraine. She developed a complete recto-anal stenosis and bowel obstruction requiring permanent colostomy. Ulceration and recto-anal stenosis have been described in association with the use of suppositories, mainly ergotamine. However, this is the first case of total recto-anal stenosis.