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Abstract: Background: Mesenteric vein thrombosis (MVT) is a rare and frequently underdiagnosed complicationof Crohn''s disease (CD). This study describes the clinical and radiological characteristics of CD /patients with superior mesenteric vein thrombosis (MVT) diagnosed by CT/MRI. Patients and methods: The database of Crohn''s disease patients treated in Sheba Medical Center between 2005-2010 was searched for MVT diagnosis. Imaging studies of identified patients were retrieved and reviewed by an experienced abdominal radiologist. MVT was defined by superior mesenteric vein obliteration and/or thrombus in the vessel lumen on abdominal imaging. The clinical and radiologic data of these patients were collected from the medical records. Results: MVT was demonstrated in 6/460 CD patients. Five patients had stricturing disease, and one patient had a combined fistulizing and stricturing disease phenotype. All patients had small bowel disease, but 3/6 also had colonic involvement. No patient had a prior thromboembolic history or demonstrable hypercoagulability. One patient had an acute SMV thrombus demonstrable on CT scanning, the remaining patients showed an obliteration of superior mesenteric vein. Two patients received anticoagulation upon diagnosis of thrombosis. No subsequent thromboembolic events were recorded. Conclusions: The incidence of mesenteric vein thrombosis is likely to be underestimated in patients with Crohn’s disease. Both CT and MRI imaging demonstrate the extent of enteric disease and coincident SMV thrombosis. In our cohort, thrombosis was associated with stricturing disease of the small bowel. The clinical impact of SMV thrombosis and whether anticoagulation is mandatory for all of these patients remains to be determined. [Copyright &y& Elsevier]

Despite widespread azithromycin use, no audit has targeted this drug to date. Azithromycin was audited in primary military clinics between July 1, 2003 and December 31, 2003 (period I). Consumption (defined dally doses/1000 visits) and economic expenditure of penicillin V, amoxicillin, erythromycin, and azithromycin were evaluated. An educational intervention was performed (dissemination of local guideline regarding indications for azithromycin use) and its impact was assessed between July 1, 2004 and December 31, 2004 (period 2). During periods 1 and 2, 105 and 31 patients were prescribed azithromycin. Azithromycin was appropriately chosen in 5.7% vs. 70.9% of cases (p < 0.0001), but unnecessary in 90.5% vs. 16.2 (p < 0.0001). Azithromycin prescription during period 1 resulted in extrapolated excess expenditure of 420,000 New Israeli shekels/year (1 U.S. dollar = 4.5 New Israeli shekels). There was an attributable decrease of 82.1% in azithromycin consumption (adjusted attributable cost reduction 38.1%), but an increase in amoxicillin consumption (20.2%}. Intervention decreased azithromycin consumption and expenditure but its effect was offset by increased consumption of other agents, mainly amoxicillin. Interventions in primary care settings should target prescribing behavior through a multifaceted approach to increase efficacy while preventing a trade-off effect. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Limited data suggest the absence of infliximab in breast milk, thereby implying the safety of this drug during breast-feeding. We aimed to re-evaluate the presence of infliximab in breast milk of nursing IBD patients. Methods: Serum and breast milk were obtained post-partum from 3 breast-feeding patients with Crohn''s disease before and after re-initiation of infliximab. ELISA assay was employed to measure infliximab level in maternal serum and in breast milk. The level of infliximab was also measured in breast milk of a control group of 8 nursing healthy mothers. Results: Infliximab was undetectable in breast milk prior to the first infusion and was also not measurable in 8 lactating women not exposed to infliximab. Infliximab levels in breast milk rose up to 101ng/ml within 2–3days of the infusion. These levels of infliximab in breast milk were roughly 1/200th of the level in blood. Conclusions: In contrast with prior reports, infliximab can be detected in the breast milk of nursing mothers. The miniscule amounts of infliximab transferred in breast milk are unlikely to result in systemic immune-suppression of the infant. Nonetheless, local effects of this exposure on the neonates'' intestine and potential immune sensitization or tolerization towards the drug can not be excluded and merit further investigations. [Copyright &y& Elsevier]

Despite widespread azithromycin use, no audit has targeted this drug to date. Azithromycin was audited in primary military clinics between July 1, 2003 and December 31, 2003 (period 1). Consumption (defined daily doses/1000 visits) and economic expenditure of penicillin V, amoxicillin, erythromycin, and azithromycin were evaluated. An educational intervention was performed (dissemination of local guideline regarding indications for azithromycin use) and its impact was assessed between July 1, 2004 and December 31, 2004 (period 2). During periods 1 and 2, 105 and 31 patients were prescribed azithromycin. Azithromycin was appropriately chosen in 5.7% vs. 70.9% of cases (p < 0.0001), but unnecessary in 90.5% vs. 16.2 (p < 0.0001). Azithromycin prescription during period 1 resulted in extrapolated excess expenditure of 420,000 New Israeli shekels/year (1 U.S. dollar = 4.5 New Israeli shekels). There was an attributable decrease of 82.1% in azithromycin consumption (adjusted attributable cost reduction 38.1%), but an increase in amoxicillin consumption (20.2%). Intervention decreased azithromycin consumption and expenditure but its effect was offset by increased consumption of other agents, mainly amoxicillin. Interventions in primary care settings should target prescribing behavior through a multifaceted approach to increase efficacy while preventing a trade-off effect. [ABSTRACT FROM AUTHOR]

Abstract: We report a case of a patient with ulcerative colitis and central serous retinopathy, which is a chronic ophthalmological condition that is frequently aggravated by corticosteroid treatment and may sometimes result in severe visual impairment. This case represents an interesting therapeutic dilemma pertaining to the treatment of ulcerative colitis exacerbation in a patient with this rare condition. Awareness of this condition as a cause of visual disturbance in IBD patients and a close ophthalmological cooperation are required in order to provide the optimal care for these patients. [Copyright &y& Elsevier]