The efficacy and safety of 4 g 5-aminosalicylic acid (5-ASA) enemas were assessed in 59 patients with ulcerative colitis involving up to 50 cm of their distal colon. Twenty-nine patients received 5-ASA and 30 received a placebo. There were 12 dropouts (five in the active and seven in the placebo group) during the study because of insufficient efficacy. After six weeks of therapy, 63% of the patients receiving the 5-ASA were considered to be "much improved" by the study physician compared to 20% patients on placebo (P less than 0.0001). A disease activity index (DAI), based upon patient symptoms and sigmoidoscopic appearance, was used to assess efficacy. Mean DAI declined 75% for patients on 5-ASA enemas and 32% for patients on placebo (P less than 0.05). The 5-ASA enemas are well tolerated and are of benefit in the treatment of ulcerative colitis confined to the distal colon.
Plasma 25-hydroxycholecalciferol (25-H.C.C.) has been measured in 67 consective cases of fracture of the proximal femur. The values found in these patients were not different from values found in these patients were not different from those in control groups at the same time of the year. Plasma 25-H.C.C. was not correlated to plasma calcium or phosphorus, the Ca times P product, or the alkaline phosphatase. X-rays showed Looser zones in only 1 patient, in whom the lowest plasma 25-H.C.C. was found. Osteomalacia is not uncommon among elderly people in Denmark, but it is more likely to depend on a decline in the renal efficiency to convert 25-H.C.C. to 1,25-dihydroxycholecalciferol than a low dietary intake of vitamin D.
Abatacept is a co-stimulation blocker that inhibits T-cell activation and interrupts the process leading to inflammation in rheumatoid arthritis. Patients with severe arthritis who took abatacept with at least one other disease-modifying antirheumatic drug in six and 12-month clinical trials demonstrated statistically significant improvement in tender, swollen joints and other clinical measures compared with placebo. Mild to moderate adverse events included headache, nasopharyngitis, hypertension and back pain. The adverse events were similar to those seen in placebo groups. Abatacept should not be used in combination with other biologic agents because of reported increased rates of serious adverse events, including serious infections. With its different mechanism of action, abatacept may be an alternative add-on therapy for patients with an inadequate response to other arthritis therapies.
Endovascular grafts are a new, experimental surgery for AAAs that alleviates the need for open abdominal surgery. They offer an important alternative for high risk patients who would be at a greater risk with the more invasive surgical procedure. However, this is based on limited evidence, and more randomized controlled trials are needed. The procedure may be cheaper than open surgery, because of the lengthy hospital stay and operating room time with the latter, provided that the costs of the devices are low enough. However, there is insufficient data on the outcomes with endovascular grafts in different patient groups. As with many new or minimally invasive techniques, there is a "learning curve" which will affect costs and outcomes. Endovascular grafting is no exception, and repeated practical applications are needed for competence, expertise and good outcomes. Continued monitoring of this technique is needed. A registry of elective AAA patients now has 10-year follow-up data on about a third of the Canadian patients operated on in 1988. Further development of such registries will provide more accurate information on success rates, costs, and long-term complications.
Abdominoperineal resection for distal rectal cancer is associated with a higher recurrence rate and a poorer overall prognosis than anterior resection. In order to improve the outcome, a more extensive procedure - extralevator abdominoperineal resection - has been introduced. There are, however, currently no prospective or registry-based studies on the effect of this new procedure on local recurrence rates.
Abdominoperineal extralevator resection (APER) is a registry-based Swedish study investigating local recurrence rate three years postoperatively in the entire population of Swedish patients who underwent abdominoperineal resection or extralevator abdominoperineal resection in the 2007-2009-period. In addition to local recurrence rates, the study also investigates the functional and quality-of-life-related outcome 3-4 years postoperatively in the entire study population.
Distal rectal cancer is a surgical and oncological challenge. The APER study will be able to compare the two operative techniques (standard abdominoperineal resection or extralevator abdominoperineal resection) in terms of oncological and functional outcome.
The trial is registered at ClinicalTrials.gov, identifier NCT01296984.
Ablation trumps meds for atrial fibrillation treatment. Catheter ablation provides better long-term relief from atrial fibrillation than medication, but surgical ablation is best, a second study concludes.