Disease duration did not influence the rates of loss of efficacy of the anti-TNF therapy in Latin American Crohn's disease patients.

BACKGROUND/AIMS: The efficacy of both Infliximab (IFX) and Adalimumab (ADA) can be reduced over time. The aim of this study was to analyze the incidence of loss of efficacy (LOE) of both IFX and ADA, and outline the influence of disease duration on its occurrence. METHODS: Retrospective, multicenter, observational cohort study, with CD patients treated with anti-TNF therapy. LOE was defined as the need for steroids, occurrence of major abdominal surgery during treatment, dose increase, interval shortening or switching of the anti- TNF agent. Patients were allocated in three subgroups based on disease duration (DD): <24 months, between 24 and 60 months and >60 months. RESULTS: 175 patients were included in the study (117 under IFX and 58 under ADA therapy). LOE occurred in 32% of patients with DD <24 months, in 33.3% with DD between 24 and 60 months and in 31.3% of subjects with DD over 60 months (p = 0.975). CONCLUSIONS: Disease duration (DD) did not influence LOE rates. These results suggest that in real-world observational practice, patients with early CD might have the same rates of LOE than patients with a disease prolonging for a longer duration.

T300A genetic polymorphism: a susceptibility factor for Crohn's disease?

CONTEXT: Crohn's disease is characterized by a chronic and debilitating inflammatory disorder of the gastrointestinal tract. Several factors may contribute to its development. From extensive studies of the human genome, the polymorphism T300A of the gene ATG16L1 (autophagy-related 16-like 1) has been related to increased risk of developing this disease. OBJECTIVES: Analyze the role of polymorphism T300A (rs2241880) in patients with Crohn's disease. METHODS: 238 samples from (control group) and 106 samples from patients with Crohn's disease recruited at five Southern Brazilian reference centers were evaluated. The genotyping consisted of the amplification via Polymerase Chain Reaction of the genomic segment encompassing T300A, followed by Restriction Fragment Length Polymorphism analysis. The amplicons and fragments were separated by agarose gel electrophoresis and confirmed under ultraviolet light. RESULTS: The genotype AG was more prevalent among patients and controls (50% vs 44.8%), followed by genotypes AA (26.4% vs 35.1%) and GG (23.6% vs 20.1%). The frequency of the allele G of the polymorphism T300A was higher in the group of patients with Crohn's disease (48.6%) than in controls (42.4%), although not reaching statistical significance. CONCLUSIONS: It was not possible to confirm the increased susceptibility on development of Crohn's disease conferred by polymorphism T300A.

T300A GENETIC POLYMORPHISM: a susceptibility factor for Crohn?s disease? / Polimorfismo genético T300A: fator de susceptibilidade para doença de Crohn?

Context Crohn’s disease is characterized by a chronic and debilitating inflammatory disorder of the gastrointestinal tract. Several factors may contribute to its development. From extensive studies of the human genome, the polymorphism T300A of the gene ATG16L1 (autophagy-related 16-like 1) has been related to increased risk of developing this disease. Objectives Analyze the role of polymorphism T300A (rs2241880) in patients with Crohn’s disease. Methods 238 samples from (control group) and 106 samples from patients with Crohn’s disease recruited at five Southern Brazilian reference centers were evaluated. The genotyping consisted of the amplification via Polymerase Chain Reaction of the genomic segment encompassing T300A, followed by Restriction Fragment Length Polymorphism analysis. The amplicons and fragments were separated by agarose gel electrophoresis and confirmed under ultraviolet light. Results The genotype AG was more prevalent among patients and controls (50% vs 44.8%), followed by genotypes AA (26.4% vs 35.1%) and GG (23.6% vs 20.1%). The frequency of the allele G of the polymorphism T300A was higher in the group of patients with Crohn’s disease (48.6%) than in controls (42.4%), although not reaching statistical significance. Conclusions It was not possible to confirm the increased susceptibility on development of Crohn’s disease conferred by polymorphism T300A. .

Contexto A doença de Crohn caracteriza-se por uma desordem inflamatória, crônica e debilitante do trato gastrointestinal. Diversos fatores contribuem para seu desenvolvimento. A partir da realização de estudos amplos do genoma, o polimorfismo T300A do gene ATG16L1 (autophagy-related 16-like 1) tem sido relacionado com aumento de susceptibilidade ao desenvolvimento desta doença. Objetivos Analisar a incidência do polimorfismo T300A (rs2241880) em pacientes com doença de Crohn. Métodos Foram analisadas 238 amostras de doadores de sangue (grupo controle) e 106 amostras de pacientes com doença de Crohn, procedentes de cinco centros. A genotipagem consistiu em amplificação do segmento gênico T300A, via reação em cadeia da polimerase, seguidos da análise de polimorfismo de comprimentos dos fragmentos de restrição. Os amplicons e fragmentos foram separados via eletroforese em gel de agarose e visualizados sob luz ultravioleta. Resultados O genótipo AG foi mais prevalente entre os pacientes e controles (50% vs 44,8%), seguido dos genótipos AA (26,4% vs 35,1%) e GG (23,6% vs 20,1%). A freqüência do alelo G do polimorfismo T300A foi maior no grupo de pacientes com doença de Crohn (48,6%) do que nos controles (42,4%), embora sem significância estatística. Conclusões Não foi possível confirmar o aumento de susceptibilidade à doença de Crohn conferido pelo polimorfismo T300A. .

Abnormal advanced hemorrhoidal disease: the need of a staged resection.

We present an unusual case of advanced hemorrhoidal disease in an 57-year-old man presenting with anemia, persistent bleeding, anal protrusion. Conventional hemorrhoidectomy was not feasible because of the risk of a massive hemorrhage caused by hypertrophic protruded vascular anal cushions. A two-stage resection was then undertaken. The aim of the first procedure was to reduce the vascularization of the protruded mucosa by a circular series of interrupted mass stitches. This approach was successful and an important reduction of vascularization was obtained. The operation was then completed two weeks later, requiring a radical circular removal of the giant anal cushions and anal canal epithelium with subsequent mucocutaneous anastomosis. A careful submucosal dissection was performed to identify and preserve the anal sphincters. No normal perianal skin was available to preserve bridges between the resected cushions. At the end of the operation, an ectopic mucosa was apparent but gradual reduction was observed in subsequent postoperative days along with recovery of anal sphincter function, and the patient was uneventfully discharged on the seventh postoperative day. On the 30th postoperative day a normal anal canal closure was observed with no ectopic mucosa. Normal continence with no functional disorder was reported and digital examination demonstrated the presence of a mild asymptomatic stenosis. (See Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A1).

[Assessment of patients with pressure sores admitted in a tertiary care center]. / Avaliação dos pacientes portadores de lesão por pressão internados em hospital geral.

BACKGROUND: To determine the prevalence and analyze the profile of patients with pressure sores, focusing on risk factors, the patients' clinical characteristics at a tertiary care center, as well as stage and location of the lesions on the body. METHODS: This was a cross sectional not controlled observational study, all patients admitted from April to June of 2005 were observed daily to identify all cases of pressure sores. The affected patients were evaluated by a standard questionnaire and the Scale of Braden was applied to define the risk of developing ulcers. RESULTS: Of the 690 patients admitted during the referred period, a prevalence of 5.9% of patients with lesions was observed, equivalent to 41 patients 63.9% of which were elderly and the average length of stay was 18 days. In the sample studied 41.5% of patients were found in the internal medicine section and the intensive care unit, ICU. The most common location for sores was the sacral area, corresponding to 73.1% of the patients, and stage II was the most frequent, observed in 58.5% of those patients. According to the Braden scale, most patients, 80.4%, had a high risk of developing pressure ulcers, compared to 9.7% of patients with moderate risk and 7.4% with low risk. CONCLUSION: The affected patients were at high risk of developing pressure sores. Prevalence of these lesions and the clinical and demographic profile of the affected patients are in accordance with the data in literature.

Longitudinal multiple rubber band ligation: an alternative method to treat mucosal prolapse of the anterior rectal wall.

PURPOSE: The aim of this study is to present a new approach for the treatment of mucosal prolapse of the anterior rectal wall using a multiple longitudinal rubber band ligation procedure. METHODS: The therapeutic approach using multiple longitudinal rubber band ligations on anterior rectal wall was undertaken in 17 patients after failure of conventional medical treatment. RESULTS: Double rubber band ligation was undertaken in seven patients and triple ligation in nine patients. In a median follow up of 12 months fourteen patients (87.5 percent) showed complete and persistent remission of symptoms. Two patients remained symptomatic and were treated by a second session of rubber band ligation which was successful in one of them. No complications occurred in this present series except in one patient with internal rectal prolapse patient who complained of persistent pain for seven days. CONCLUSIONS: These encouraging results have suggested this method as an effective alternative in the relief of this usually very symptomatic disorder.

Banco de dados em coloproctologia: proposta de classificaçäo de doenças e operaçöes colorretais para estudos clínicos / Databases in coloproctology: proposal of classification of diseases and colorectal surgeries for clinical studies

A ampla disseminaçäo no uso de computadores pessoais tornou mais fácil a criaçäo de bancos de dados na prática médica, visando manter análises periódicas das atividades clínicas. Um passo importante na criaçäo de um banco de dados é o uso de classificaçäo numérica dos dados para simplificar a inserçäo de informaçöes e reduzir erros na recuperaçäo dos mesmos devido a diferenças ortográficas ou nomenclatura médica. Os autores näo tem conhecimento de uma classificaçäo específica que tenha sido publicada para uso em Coloproctologia. Visando facilitar a realizaçäo do banco de dados do Serviço de Coloproctologia do Hospital Säo José, Joinville, foi elaborada uma classificaçäo de doenças e operaçöes em cirurgia colorretal que tem sido utilizada com sucesso em um banco de dados incluindo mais de 2.000 pacientes consecutivos e 600 operaçöes. Acreditamos que a definiçäo de uma classificaçäo simples é única de doenças e procedimentos em cirurgia colorretal possa contribuir para a criaçäo de bancos de dados compatíveis em diferentes centros, com benefícios na análise comparativa dos dados