RESUMO
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.
Assuntos
Azatioprina/uso terapêutico , Doença de Crohn/tratamento farmacológico , Doença de Crohn/prevenção & controle , Valva Ileocecal/patologia , Obstrução Intestinal/tratamento farmacológico , Obstrução Intestinal/prevenção & controle , Mesalamina/uso terapêutico , Adulto , Demografia , Feminino , Humanos , Valva Ileocecal/efeitos da radiação , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Recidiva , Fumar/efeitos adversos , Resultado do Tratamento , Adulto JovemRESUMO
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.
Assuntos
Azatioprina/farmacologia , Doença de Crohn/tratamento farmacológico , Doença de Crohn/economia , Doença de Crohn/epidemiologia , Mesalamina/farmacologia , Readmissão do Paciente/estatística & dados numéricos , Adulto , Azatioprina/uso terapêutico , Doença de Crohn/cirurgia , Humanos , Incidência , Estimativa de Kaplan-Meier , Mesalamina/uso terapêutico , Pessoa de Meia-IdadeAssuntos
Colestase Extra-Hepática/patologia , Colestase Extra-Hepática/fisiopatologia , Cistos/patologia , Cistos/fisiopatologia , Abdome/diagnóstico por imagem , Criança , Colestase Extra-Hepática/diagnóstico , Colestase Extra-Hepática/cirurgia , Cistos/diagnóstico , Cistos/cirurgia , Feminino , Humanos , Laparotomia , Radiografia Abdominal , UltrassonografiaRESUMO
Os autores relatam o caso de um paciente com traumatismo grave no membro superior, após acidente automobilístico, com lesão de artéria braquial e grande laceração de partes moles. O paciente foi submetido a reparo primário, com interposição de enxerto venoso anatômico,evoluíndo para infecção e ruptura do mesmo no terceiro dia de pós-operatório. Foi re-operado com reconstrução extra-anatômica,apresentando boa evolução. Neste trabalho, dicutimos o uso da via extra-anatômica como alternativa para revascularização e salvamento de membros nos traumatismos complexos...
Assuntos
Artéria BraquialRESUMO
Historicamente, todas as lesões hepáticas de origem traumática são tratadas pela cirurgia convencional. Em dois terços dos pacientes operados constata-se parada espontânea da hemorragia, o que limita o ato cirúrgico à aspiração do hemoperitônio, limpeza da cavidade com ou sem drenagem. Com o advento da tomografia computadorizada, que possibilitou o estudo de órgãos intra e retroperitoneais, surgiu a opção do tratamento não operatório. Esta conduta é a terapêutica de escolha atual para os pacientes com trauma contuso, conscientes e estáveis hemodinamicamente, à admissão ou após reposição volêmica. A revisão e análise crítica do tema e a experiência do Hospital João XXIII confirmam que o método é simples, seguro, com excelentes resultados. São discutidos neste trabalho, critérios de seleção dos pacientes, riscos, complicações e seu tratamento.