Health care costs of complex perianal fistula in Crohn's disease.

AIM: To evaluate the use of health care resources and the associated costs of complex perianal Crohn's disease (CD) from the National Health System perspective. METHODS: We conducted a multicenter, retrospective, observational study in which gastroenterologists from 11 hospitals in the Community of Madrid took part. Data was collected on the direct healthcare resources (pharmacological treatments, surgical procedures, laboratory/diagnostic tests, visits to specialists and emergency departments, and hospitalizations) consumed by 97 adult patients with complex perianal CD which was active at some point between January 1, 2005, and case history review. RESULTS: We recorded 527 treatments: 73.1% pharmacological (32.3% antibiotic, 20.5% immunomodulator, 20.3% biological) and 26.9% surgical. Mean annual global cost was €8,289/patient, 75.3% (€6,242) of which was accounted for by pharmacological treatments (€13.44 antibiotics; €1,136 immunomodulators; €5,093 biological agents), 12.4% (€1,027) by hospitalizations and surgery, 7.7% (€640) by medical visits, 4.2% (€350) by laboratory/diagnostic tests, and 0.4% (€30) by emergency department visits. CONCLUSIONS: Pharmacological therapies, and in particular biological agents, are the main cost driver in complex perianal CD; costs due to surgery and hospitalizations are much lower.

Periodontal and gastric convergences within the hypothalamic ventromedial nucleus area--single unit study on anesthetized rats.

Unitary activities were recorded in the ventromedial nucleus of the hypothalamus (VHM) of anesthetized rats. Cells responding to periodontal stimulation (100-200 g disto-mesial traction applied to an upper incisive) were selected. The effects of gastric stimulation (2-5 ml distension) were then investigated. Out of the 40 cells activated (22 cells) or inhibited (18 cells) by periodontal stimulation, only seventeen were influenced by gastric stimulation. Eight of them responded in the same way and nine in the opposite way. Unlike the periodontal stimulation, which elicited specific spatio-temporal patterns, the gastric stimulation had only weak effects. These data nevertheless demonstrate that periodontal-gastric convergences exist in the VHM nucleus, which is consistent with the role previously ascribed to this area in alimentary behaviour.

Electrophysiologic evidence showing the existence of sensory receptors within the alveolar bone in anesthetized cats.

Single-nerve activities were recorded in the gasserian ganglia of anesthetized cats by glass extracellular micro-electrodes to determine whether sensory endings exist within the alveolar bone. Trigeminal cells responded to mechanical and/or thermal stimulation applied to the maxillary bone. Some were activated by specific kinds of fairly precise mechanical stimuli (moderate forces applied in a preferential direction); others exhibited a coarse mechanical sensitivity. In addition, electrical stimulation was applied to the maxillary bone to determine the conduction velocities of the relevant fibers. These mainly ranged between 1 and 6 m/s, which indicates that the fibers belonged to the small-diameter category (thinnest myelinated and unmyelinated fibers). Similar results were obtained from animals with osseointegrated implants. It was concluded that the alveolar bone is endowed with sensory endings capable of detecting mechanical and thermal changes, and that these receptors may provide compensatory sensitivity in edentulous subjects whose main (periodontal) sensitivity has been eliminated.

[The role of intraoral mucosal receptors in the completely edentulous in the discrimination of the layers]. / Le rôle des récepteurs de la muqueuse endo-buccale chez l'édenté complet dans la discrimination d'épaisseurs infimes.

Studies on proprioceptive sensitivity in edentulous subjects let appear prevalent mucosal receptors compared to muscular or articular receptors. Neurophysiological mechanism seem identical in edentulous patients and statistical studies allowed us to highlight the functional characteristics of receptors in the intraoral mucosa; they replace the missing desmodontal receptors. The perception accuracy of extremely thin layers permits the practitioner to perfect his occlusal equilibration as well as to control his patient's occlusal vertical dimension with a new method of reference. The use of patient's sensitive information through their lemniscal systems should lead to a better integration of our dentures and avoid a physiopathology such as dysfunction of the temporomandibular joint.