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Background and Aims: The ECCO-EpiCom study investigates the differences in the incidence and therapeutic management of inflammatory bowel diseases [IBD] between Eastern and Western Europe. The aim of this study was to analyse the differences in the disease phenotype, medical therapy, surgery, and hospitalization rates in the ECCO-EpiCom 2011 inception cohort during the first year after diagnosis. Methods: Nine Western, five Eastern European centres and one Australian centre with 258 Crohn's disease [CD], 380 ulcerative colitis [UC] and 71 IBD unclassified [IBDU] patients [female/ male: 326/383; mean age at diagnosis: 40.9 years, SD: 17.3 years] participated. Patients' data were registered and entered in the web-based ECCO-EpiCom database [www.epicom-ecco.eu]. Results: In CD, 36 [19%] Western Europe/Australian and 6 [9%] Eastern European patients received biological therapy [p = 0.04], but the immunosuppressive [IS] use was equal and high in these regions [Eastern Europe vs Western Europe/Australia: 53% vs 45%; p = 0.27]. Surgery was performed in 17 [24%] CD patients in Eastern Europe and 13 [7%] in Western Europe/Australia [p < 0.001, pLogRank = 0.001]. Of CD patients from Eastern Europe, 24 [34%] were hospitalized, and 39 [21%] from Western Europe/Australia, [p = 0.02, pLogRank = 0.01]. In UC, exposure to biologicals and colectomy rates were low and hospitalization rates did not differ between these regions during the 1-year follow-up period [16% vs 16%; p = 0.93]. Conclusions: During the first year after diagnosis, surgery and hospitalization rates were significantly higher in CD patients in Eastern Europe compared with Western Europe/Australia, whereas significantly more CD patients were treated with biologicals in the Western Europe/ Australian centres. [ABSTRACT FROM AUTHOR]

Trying to conceive and being pregnant is an emotional period for those involved. In the majority of patients suffering from inflammatory bowel disease, maintenance therapy is required during pregnancy to control the disease, and disease control might necessitate introduction of new drugs during a vulnerable period. In this updated consensus on the reproduction and pregnancy in inflammatory bowel disease reproductive issues including fertility, the safety of drugs during pregnancy and lactation are discussed. [ABSTRACT FROM AUTHOR]

Chronic diseases such as childhood diabetes mellitus (DM) constitute a challenge for both the affected children and their families. Childhood DM is characterized by complex therapeutic management and has a profound physical and psychological impact on the whole family and a number of losses for the parents. The parents of children with DM are reported to react to the diagnosis with anger, denial, frustration and depression, and the mothers differ from the fathers in their reactions. Adolescents with DM experience a very intense period, full of emotional distress and a varied range of extreme feelings, including anger, sorrow, fear and shame about their beliefs, attitudes and overall concept of their health status. It is, therefore, not unusual for a chronic disease diagnosed at this age to result in the adolescent having a negative perception of his or her body image and physical and mental abilities. For these reasons, studies in these fields should focus not only on the needs of the children/adolescents diagnosed with DM but also on the needs of their parents, so that with a global approach better control of DM and its complications may be achieved. It appears that, despite all the difficulties, the families of children with DM in general respond satisfactorily to the demands of the care of the children, and manage to deal effectively with the chronic disease. [ABSTRACT FROM AUTHOR]

OBJECTIVE An increased frequency of psychological problems is documented in the parents of children suffering from type 1 diabetes mellitus (DM). The aim of this study was to investigate the psychological distress of the parents of children with type 1 DM and the differences between fathers and mothers. METHOD The study sample consisted of 83 parents, 18 fathers and 65 mothers, of children with type 1 DM, who were accompanying their children for regular outpatient examination in the pediatric endocrinology departments of one university and one general hospital in a provincial town in Greece. The participants completed the SCL-90 questionnaire which comprises 9 subscales evaluating psychological status, and from which the global severity index, positive symptoms distress index and positive symptoms total are derived. Statistical analysis was conducted using the t-test and x2, with statistical significance set at p<0.05. RESULTS Mothers scored higher than fathers in all subscales other than psychoticism and hostility, although the differences were not statistically significant. The mean value for the positive symptoms distress index was 1.35±0.67 in the fathers and 1.59±0.47 in the mothers (p=0.085). CONCLUSIONS Mothers and fathers of children with type 1 DM report a considerable degree of psychological distress. Mothers show a trend for higher levels of distress than fathers in the dimensions of anxiety and depression. [ABSTRACT FROM AUTHOR]

Background: It has been estimated that 1.3-6.4% of patients with inflammatory bowel diseases (IBD) are complicated by cerebral venous thrombosis (CVT) at some point of time during the course of their disease. Methods: We retrospectively reviewed and subsequently analyzed data from 65 case reports of IBD patients with CVT. Our sources included MEDLINE and EMBASE, and the references of retrieved articles were also screened. Results: Patients with CVT and IBD were significantly younger than CVT patients without IBD. Female patients were complicated more frequently but at an older age when compared with males. The incidence of ulcerative colitis was almost double compared with Crohn's disease. Active disease was detected in 78.4% of the cases and the proportions of patients with active ulcerative colitis or active Crohn's disease were almost equal. The predominant neurological symptom in these patients was persistent headache (80%) and the most common site of CVT was the superior sagittal sinus (50.7%). Severe iron deficiency anemia was highlighted as a significant risk factor for thrombosis in nearly half of the patients. Transient coagulation abnormalities and hereditary thrombogenic mutations were identified in 23 and 20% of the case reports, respectively. Conclusion: The overall outcome was very good, especially in those patients who were treated acutely with heparin or low molecular weight heparin, suggesting that heparin administration is related with improved neurological outcome and decreased mortality rates even in IBD patients complicated with CVT. [ABSTRACT FROM AUTHOR]

BACKGROUND: Worldwide, 480-520 million people are chronically infected with hepatitis B or C virus. In addition to their effects in the liver, chronic hepatitis viral infections may have serious extra hepatic manifestations. These manifestations have been more widely studied in chronic HCV infection, where they are more frequently described, but they have been also reported chronic HBV infection. AIM: Among those, of great interest are the ocular manifestations caused by the HBV or HCV infection or induced by chronic hepatitis therapy. These we attempted to review. MATERIALS AND METHODS: A PubMed search was conducted using the terms hepatitis, ocular, eye. RESULTS: This article describes the ocular symptoms related to HBV and HCV hepatitis such as xerophthalmia, Mooren's ulcer and retinopathy as well as other rare manifestations caused by either the infection or the therapy. CONCLUSIONS: The ocular manifestations of HCV infections best supported by the literature include a dry eye syndrome similar to Sjögren's syndrome, and ischemic retinopathy caused by either HCV-induced vasculitis or treatment with interferon. There are no serious ocular manifestations of HBV infection other than dry eye syndrome. Special consideration should be held for possible connection between HBV vaccine and uveitis. [ABSTRACT FROM AUTHOR]

Introduction: There are no cost-utility data about below-the-knee placement of drug-eluting stents. The authors determined the cost-effectiveness of infrapopliteal drug-eluting stents for critical limb ischemia (CLI) treatment. Methods: The event-free individual survival outcomes defined by the absence of any major events, including death, major amputation, and target limb repeat procedures, were reconstructed on the basis of two published infrapopliteal series. The first included spot Bail-out use of Sirolimus-eluting stents versus bare metal stents after suboptimal balloon angioplasty (Bail-out SES).The second was full-lesion Primary Everolimus-eluting stenting versus plain balloon angioplasty and bail-out bare metal stenting as necessary (primary EES). The number-needed-to-treat (NNT) to avoid one major event and incremental cost-effectiveness ratios (ICERs) were calculated for a 3-year postprocedural period for both strategies. Results: Overall event-free survival was significantly improved in both strategies (hazard ratio (HR) [confidence interval (CI)]: 0.68 [0.41-1.12] in Bail-out SES and HR [CI]: 0.53 [0.29-0.99] in Primary EES). Event-free survival gain per patient was 0.89 (range, 0.11-3.0) years in Bail-out SES with an NNT of 4.6 (CI: 2.5-25.6) and a corresponding ICER of 6,518 (range 1,685-10,112). Survival gain was 0.91 (range 0.25-3.0) years in Primary EES with an NNT of 2.7 (CI: 1.7-5.8) and an ICER of 11,581 (range, 4,945-21,428) per event-free life-year gained. Two-way sensitivity analysis showed that stented lesion length >10 cm and/or DES list price >1000 were associated with the least economically favorable scenario in both strategies. Conclusions: Both strategies of bail-out SES and primary EES placement in the infrapopliteal arteries for CLI treatment exhibit single-digit NNT and relatively low corresponding ICERs. [ABSTRACT FROM AUTHOR]

Purpose: This study was designed to investigate the long-term angiographic and clinical outcomes of percutaneous transluminal angioplasty (PTA) of the arteria profunda femoralis (PFA), in a series of patients suffering from critical limb ischemia (CLI) or severe intermittent claudication (IC). Methods: Our department's database was searched to identify patients who underwent PTA or bail-out stenting of the PFA. Among the study's inclusion criteria were Rutherford categories 3-6 and ≥70% stenosis of the PFA. Only de novo stenotic lesions were assessed. Primary endpoints were technical success, angiographic lesion primary patency, angiographic binary in-lesion restenosis, and target lesion recanalization (TLR) rates. Secondary endpoints included patient survival, limb salvage, and complication rates. Patient's baseline demographics, lesion, and procedural details were analyzed. Results: Between 2001 and 2011, 20 consecutive patients (17 males) with a mean age of 73 ± 9 (range 53-87) years underwent PTA or bail-out stenting in 23 PFA lesions. Critical limb ischemia was the indication in eight of 20 patients (40%). The mean lesion length was 31 ± 9.5 mm. The procedural technical success was 100% (23/23), whereas mean time angiographic and clinical follow-up was 26.8 ± 24.6 months. According to the Kaplan-Meier analysis, primary patency and binary restenosis rate were 95 and 86.1% respectively up to 8 years follow-up. No TLR procedures were performed. The 8-year patient survival and limb salvage rates were 87.5 and 84.7% respectively. Conclusions: PTA or stenting of focal, stenotic, PFA lesions, in patients suffering from CLI or IC, exhibit high long-term primary patency rates, as well as low binary restenosis and TLR rates. Large, multicenter studies are required to validate these results. [ABSTRACT FROM AUTHOR]

In nosological terms, there is a striking pathophysiological resemblance between certain subgroups of skin and gastrointestinal diseases, probably as a result of the overall structural similarity of the two systems. Despite the fact that the term "idiopathic inflammatory disease of the skin" is neither formal nor widely used in current medical literature, it could be applied as an umbrella designation for a group of dermatic disorders with disease characteristics similar to those which define the idiopathic inflammatory bowel diseases (IBD). Interdisciplinary research on these similarities may prove a particularly fruitful field of cooperation for gastroenterologists and dermatologists. In addition, certain skin disorders can mimic symptoms of IBD, such as herpes zoster of the lower thoracic cavity and the abdominal area, which presents with abdominal pain. Awareness of skin conditions masquerading as an IBD relapse is mandatory to the gastroenterologist who monitors patients with established IBD. Appropriate recognition and prevention of potential dermatic side effects of treatment for IBD, and early identification of gastroenterological side effects of treatment given for dermatological disorders in patients with IBD are of capital importance for their optimal care. The possible sequelae of cosmetic preparations in patients with IBD are an emerging medical field with many questions still to be addressed and clarified. All these issues may benefit from collaboration between dermatologists and gastroenterologists. In this review these relevant issues are summarized in the hope of contributing to the continuing promising scientific dialogue between gastroenterologists and dermatologists in the interrelated fields of the "idiopathic inflammatory bowel" and skin disorders. [ABSTRACT FROM AUTHOR]

Skin manifestations are frequent in patients with inflammatory bowel disease (IBD); approximately 10% of patients are initially referred because of a skin condition related to IBD, while 20% of patients develop a dermatological problem requiring specific diagnosis and treatment during the course of the disease. From the practical point of view, dermatological manifestations may be diagnosed at any time during the IBD disease course and they can be classified in many ways: "disease-specific" or "non-specific", in relation to the baseline IBD diagnosis, ulcerative colitis (UC) or Crohn's disease (CD), or in relation to the initial consultant physician, who may be either a gastroenterologist or a dermatologist, especially in cases where the skin manifestations precede the symptoms of bowel disease. The detailed pathogenetic mechanisms of the disease-specific dermatological manifestations in IBD have not yet been elucidated. It is probable that a cross reaction in immunological-related epitopes of bowel epithelium and skin occurs in some of the patients. The non disease specific dermatological manifestations in IBD represent a relatively rare group of non-specific, hyper-allergic immunologically derived conditions. Increased prevalence of skin problems has been noted with all disease manifestations across the whole spectrum of IBD, but with different frequencies for UC and CD. The skin manifestations commonly seen in IBD are: erythema nodosum, pyoderma gangrenosum, Sweet's syndrome, relapsing apthous stomatitis, colostomy/ileostomy dermatitis and neutrophilic dermatitis. In addition, several forms of skin vasculitis may occur, including small vessel vasculitis and dermatic polyarteritis nodosa. The pathognomonic muco-cutaneous manifestations of UC are dermatitis bullosa and pyostomatitis vegetans. The pathognomonic manifestations of CD are fistulas and perianal fissures, and the so-called "metastatic" Crohn's disease in cases where the skin disease is clearly separated from healthy normal tissue, oro-facial CD and Melkersson-Rosenthal granulomatous cheilitis. There are also some specific associations between IBD and idiopathic inflammatory skin diseases such as between CD and psoriasis and hidradenitis suppurativa and between UC and atopic eczema. Skin manifestations may be related to malnutrition and to enteral and parenteral nutrition. Nail and hair abnormalities are also a feature of IBD [ABSTRACT FROM AUTHOR]

The article presents case studies of two prostate cancer patients who were diagnosed with Flutamide (FLU)-related cholestasis. It mentions that 65 year-old male patient was treated with FLU and was planned to receive pelvic radiotherapy as the cancer was inoperable. It suggests that the patients should be closely monitored for possible need for discontinuation of FLU.

Aim: To present the results of a prospective, randomized, single-centre study investigating local anaesthesia before percutaneous common femoral artery (CFA) puncture and catheterization with the use of ultrasound-guided injection of lidocaine versus standard infiltration by manual palpation. Materials and methods: Patients scheduled to undergo diagnostic or therapeutic transfemoral catheter-based procedures gave informed consent and were randomized in two groups. In the first arm local anaesthesia with lidocaine hydrochloride 1% was performed under ultrasound guidance (group U/S), while in the second arm the standard method of manual artery palpation was applied (group M). In both groups, subsequent CFA catheterization was achieved under ultrasound guidance. The primary study endpoint was peri-procedural pain level evaluated with a visual-analogue scale (VAS score 0–10). Results: Between January 2009 and 2010, 200 patients (161 men, mean age 63±12 years) were equally assigned to each group without any significant differences in baseline demographics. Patients in group U/S experienced significantly less pain during CFA catheterization in comparison with group M with a difference of three points in mean VAS score reported (1.6±1.6 versus 4.6±1.9, p <0.0001). In addition, significantly less volume of lidocaine was used in group U/S compared to group M (16±2.7 versus 19±0.8ml, p <0.001).Total vascular access time was similar in both groups (4.4±1.3 versus 4.5±1.3min). Overall complications included two small groin haematomas in each group. Conclusion: Ultrasound-guided local anaesthesia of the CFA prior to percutaneous transcatheter procedures is safe and achieves superior levels of analgesia with minimal patient pain and discomfort compared to the standard method of manual palpation. [ABSTRACT FROM AUTHOR]

Background Patients treated with infliximab for Crohn's disease (CD) frequently require intensified dosage due to loss of response. There are scant data regarding the efficacy of shortening the dosing interval to 6 weeks. Aim We sought to investigate the efficacy of a once every 6 weeks' strategy compared with dose-doubling. Methods This work was a multicentre retrospective study of infliximab-treated CD patients who required dose escalation. The clinical outcome of patients treated by intensification to 5 mg/kg/6 weeks (6-week group) was compared with the outcome of patients whose infliximab was double-dosed (10 mg/kg/8 weeks or 5 mg/kg/4 weeks). Results Ninety-four patients (mean age: 29.8 years) were included in the study, 55 (59%) in the 6-week group and 39 (41%) in the double-dose group. Demographics and disease characteristics were similar between the two groups, although patients with re-emerging symptoms 5-7 weeks postinfusion were more likely to receive 5 mg/kg/6 weeks dosing (OR: 3.4, 95% CI: 1.4-8.8, P < 0.01). Early response to dose-intensification occurred in 69% of patients in the 6-week group and 67% in the double-dose group (P = N.S.). Regained response was maintained for 12 months in 40% compared with 29% of the patients respectively (P = N.S.). Conclusion In CD patients who lost response to standard infliximab dose, especially when symptoms re-emerge 5-7 weeks postinfusion, shortening the dosing interval to 6 weeks appears to be at least as effective as doubling the dose to 10 mg/kg or halving the infusion intervals to once in 4 weeks. [ABSTRACT FROM AUTHOR]