Azathioprine is more effective than mesalazine at preventing recurrent bowel obstruction in patients with ileocecal Crohn's disease.

BACKGROUND: Patients with subocclusive Crohn's disease (CD) who received azathioprine (AZA) therapy had lower re-hospitalization rates due to all causes and for surgical management of CD compared to those treated with mesalazine during a 3-year period. We investigated whether AZA also was effective for prevention of recurrent bowel obstruction. MATERIAL/METHODS: Rates of recurrent bowel occlusion were compared between patients treated with AZA and those treated with mesalazine. We assessed the time interval-off intestinal obstruction as well as the occlusion-free survival for both groups. RESULTS: There was a significantly lower cumulative rate of patients with recurrent subocclusion in the AZA group (56%) compared with the mesalazine group (79%; OR 3.34, 95% CI 1.67-8.6; P=0.003), with the number needed to treat in order to prevent 1 subocclusion episode of 3.7 favoring AZA. The occlusion-free time interval was longer in the AZA group compared with the mesalazine group (28.8 vs. 18.3 months; P=0.000). The occlusion-free survival at 12, 24, and 36 months was significantly higher in the AZA group (91%, 81%, and 72%, respectively) than in the mesalazine group (64.7%, 35.3%, and 23.5%, respectively; P<0.05 for all comparisons). CONCLUSIONS: In an exploratory analysis of patients with subocclusive ileocecal CD, maintenance therapy with AZA is more effective than mesalazine for eliminating or postponing recurrent intestinal obstruction during 3 years of therapy.

Effect of azathioprine or mesalazine therapy on incidence of re-hospitalization in sub-occlusive ileocecal Crohn's disease patients.

BACKGROUND: Although the cost of Crohn's disease (CD) treatment differs considerably, hospitalization and surgery costs account for most of the total treatment cost. Decreasing hospitalization and surgery rates are pivotal issues in reducing health-care costs. MATERIAL/METHODS We evaluated the effect of azathioprine (AZA) compared with mesalazine on incidence of re-hospitalizations due to all causes and for CD-related surgeries. In this controlled, randomized study, 72 subjects with sub-occlusive ileocecal CD were randomized for AZA (2-3 mg/kg per day) or mesalazine (3.2 g per day) therapy during a 3-year period. The primary end point was the re-hospitalization proportion due to all causes, as well as for surgical procedures during this period evaluated between the groups. RESULTS: On an intention-to-treat basis, the proportion of patients re-hospitalized within 36 months due to all causes was lower in patients treated with AZA compared to those on mesalazine (0.39 vs. 0.83, respectively; p=0.035). The AZA group had also significantly lower proportions of re-hospitalization for surgical intervention (0.25 vs. 0.56, respectively; p=0.011). The number of admissions (0.70 vs. 1.41, p=0.001) and the length of re-hospitalization (3.8 vs. 7.7 days; p=0.002) were both lower in AZA patients. CONCLUSIONS: Patients with sub-occlusive ileocecal CD treated with AZA had lower re-hospitalization rates due to all causes and for surgical management of CD compared to those treated with mesalazine during a 3-year period. The long-term use of AZA in ileocecal CD patients recovering from a sub-occlusion episode can save healthcare costs.

Alterações morfométricas da musculatura dos músculos longitudinal e circular de ratos submetidos à criação de piloros no intestino delgado / Morfometric alterations of the longitudinal and circular muscle layers in rats who underwent pylorus construction in the small bowel

OBJETIVO: Realizar um estudo morfométrico comparativo da musculatura longitudinal e circular do intestino delgado de ratos submetidos à construção cirúrgica de um e de dois piloros no intestino delgado utilizando-se da técnica de criação de piloros proposta por Rena et al. MÉTODO: Foram utilizados 52 ratos Wistar machos divididos em três grupos. O Grupo A, destacado como controle, composto de 10 animas, cada um forneceu 20mm de segmento de intestino para o estudo. Os animais do Grupo B, composto de 32 animais, foram submetidos à construção de dois piloros, um a 100mm e outro a 150mm da válvula ileocecal e os animais do grupo C, composto de 10 animais, foram submetidos à construção de um piloro a 100mm da mesma. A eutanásia ocorreu no décimo dia. A morfometria das camadas musculares longitudinal e circular acima e abaixo dos piloros foi estudada com utilização do microscópico modelo "Axiostar plus" conectado à câmera "Axioncam Version 5.05.10" com objetiva X5 / 0,12 no o programa "AxioVision 3.1.2.1". RESULTADOS: As alças apresentaram aumento da espessura da camada muscular acima e abaixo do ponto da operação. O estudo morfométrico comparativo das camadas musculares longitudinal e circular mostrou aumento significativo em comparação ao controle, não demonstrando significância entre os grupos B e C. CONCLUSÃO: Os resultados deste estudo revelaram importante aumento de espessura das camadas musculares, porém, menos acentuados que aqueles descritos na literatura quando foram realizados em animais submetidos à estenose fixa. Esses dados indicam que a construção operatória de piloros pela técnica utilizada promove alterações musculares de menor monta, possivelmente, pela função valvular do piloro.

BACKGROUND AND PURPOSE: To undertake a morphometric comparative study of the longitudinal and circular layers of the small bowel muscularis propria in rats, whom underwent surgical construction of one and two pylorus in the small bowel, utilizing the technique of the creation of two pylorus described by Rena et al. METHODS: 52 male Wistar rats were divided in three groups. Group A, 10 animals, was defined as the control group, and 20 mm of the bowel segment were removed for the study. Group B animals underwent construction of two pylorus, with one at 100 mm and the second at 150 mm from the ileo-cecal valve, 10 animals. Animals from group C, 32 animals, underwent construction of one pylorus at 100 mm from the ileo-cecal valve. The rats were sacrificed at ten days after the procedure. The morphometric analysis of the longitudinal and circular layers of the muscularis propria above and below the pylorus were studied with the help of a microscope Axiostar Plus model connected to the Axioncam camera version 5.05.10 with 5x/0,12 objective utilizing the software Axion Vision 3.1.2.1. RESULTS: The bowel loops demonstrated thickening of the muscular layer in segments above and below the point where the surgical procedure took place. The morphometric comparative study of the longitudinal and circular muscular layers demonstrated significant increase when compared to the control group. There were no significant differences among groups B and C. CONCLUSION: The results demonstrated significant increase in muscle layers, however not to the point of the increase reported in the literature for animals that underwent fixed stenosis. These data indicates that surgical construction of the pylorus by the technic used by us promotes muscular changes of minor significance, possibly, by the valvular function of the pylorus.

Conhecimento de anatomia aplicada ao trauma: estudo realizado com alunos da Faculdade de Enfermagem da Universidade Federal de Juiz de Fora / Anatomic knowledge applied to trauma: study done with the students of the nursing college of the Federal University of Juiz de Fora

Objetivou-se identificar o conhecimento dos alunos da Faculdade de Enfermagem da Universidade Federal de Juiz de Fora - UFJF sobre anatomia aplicada ao trauma, a importância que dão ao tema e o grau de satisfação com o conteúdo ministrado no curso de graduação...