Maintenance therapy for ulcerative colitis has no impact on changes in the extent of ulcerative colitis.

BACKGROUND AND AIM: Although the efficacy of maintenance remission therapy in ulcerative colitis (UC) has been proved in many studies, little is known about its possible effect on the extent of the disease. The aim of the present multicenter Belgian study was to evaluate the potential role of UC maintenance therapy on the colonic extension of the disease. MATERIALS AND METHODS: A total of 98 patients, 56 males, 42 females, mean age 52 years, range 22-82 years, from 12 medical centers in Belgium, with an acute exacerbation of well-established, endoscopically and histologically proven left-sided UC, were included. The colonic extension was endoscopically determined at the time of the initial diagnosis and at the actual flare-up. The mean duration of UC was 93+72 months, median was 84 months, and range was 3-372 months. Active smoking was reported in only 7% of patients, while the majority were no-smokers (63%) or ex-smokers (30%). The median colonic extension at the time of initial diagnosis was 25 cm, range 2-70 cm from the anal merge. Sixty-six percent of the patients had quiescent disease without flare-ups during last year. The χ(2)-test was used for statistical analysis. RESULTS: 29/98 (29.6%) patients had not used any maintenance therapy in the last 3 months before the actual exacerbation. The most commonly used maintenance therapy was 5-ASA (43%), while combined therapy with 5-ASA, corticosteroids or immunosuppresives (mainly azathioprine) in all possible combinations was reported by 29.6% of patients. The extent of UC had not changed in 50.7% and 51.7% of patients, respectively, with and without maintaining therapy (NS, p=0.99). Some degree of regression was observed in, respectively, 21.7% and 20.7% (NS, p=0.99), and some degree of extension in, respectively, 27.5% and 27.6% (NS, p=0.99). Furthermore, no relationship was found between changes in colonic extent and type of maintaining therapy, smoking habits or disease activity during the last year before the acute exacerbation. A tendency of beneficial effect of maintenance therapy on disease extent was observed in patients with continuous active disease of short duration. CONCLUSIONS: According to this multicenter study, maintenance remission therapy for left-sided UC was not found to have a statistically significant effect on colonic extension. Further long-term studies are necessary to confirm these results.

Crohn's disease stable remission after human immunodeficiency virus infection.

We retrospectively assessed the clinical course in four patients with long-standing Crohn's disease who became infected with human immunodeficiency virus (HIV). The duration of active Crohn's disease was 21, 10, 4, and 4 years in our four patients. They experienced a stable remission of Crohn's disease symptoms after HIV infection. In three patients Crohn's disease was in stable remission for 5, 8, and 8 years after HIV infection and all three died from acquired immunodeficiency syndrome-related disease. One patient was still alive without recurrence of Crohn's disease symptoms 7 years following HIV detection. Our observations of a spontaneous improvement in the clinical course of Crohn's disease after HIV infection, suggests that the integrity of the immune response, especially that of CD4 T cells, plays a major role in the tissue injury mechanism in Crohn's disease.

Plate fixation of comminuted olecranon fractures: an in vitro biomechanical study.

The stiffness, cyclic stability, and failure strength of posterior and lateral plating were compared in an in vitro model of a comminuted olecranon fracture. Loading was applied to the brachialis and triceps while displacements of the olecranon were measured with an electromagnetic tracking device in six degrees of freedom. No statistical difference was seen in the cyclic or static stability of either plating method. The triceps tendon suture attachment failed during destructive testing in each case between 300 and 500 N of applied loading. No gross failure of the bony fixation of the implant occurred before suture failure. These results suggest that both plating methods are likely to afford adequate stability to permit early protected postoperative range of motion.

Subtalar arthrodesis using interposition iliac crest bone graft after calcaneal fracture.

Fifteen consecutive patients with hindfoot pain after calcaneal fracture underwent subtalar arthrodesis using interposition iliac crest bone graft. Outcome and correction of calcaneal collapse were assessed before and after surgery with clinical examination, visual analogue scores, and standard x-rays while weightbearing. Eleven of the 15 patients were satisfied with the procedure. There were four failures due to transverse tarsal joint arthritis, overcorrection, and reflex sympathetic dystrophy. Radiographic examination revealed restoration of heel height, with 100% union rate of the arthrodesis. The described technique allows arthrodesis and correction of calcaneal collapse after calcaneal fracture.