Trial-based cost-effectiveness analysis comparing surgical and endoscopic drainage in patients with obstructive chronic pancreatitis.

Published evidence indicates that surgical drainage of the pancreatic duct was more effective than endoscopic drainage for patients with chronic pancreatitis. This analysis assessed the cost-effectiveness of surgical versus endoscopic drainage in obstructive chronic pancreatitis

Laparoscopic ileocolic resection versus infliximab treatment of distal ileitis in Crohn's disease: a randomized multicenter trial (LIR!C-trial)

Contains fulltext : 69534.pdf (publisher's version ) (Open Access)BACKGROUND: With the availability of infliximab, nowadays recurrent Crohn's disease, defined as disease refractory to immunomodulatory agents that has been treated with steroids, is generally treated with infliximab. Infliximab is an effective but expensive treatment and once started it is unclear when therapy can be discontinued. Surgical resection has been the golden standard in recurrent Crohn's disease. Laparoscopic ileocolic resection proved to be safe and is characterized by a quick symptom reduction.The objective of this study is to compare infliximab treatment with laparoscopic ileocolic resection in patients with recurrent Crohn's disease of the distal ileum with respect to quality of life and costs. METHODS/DESIGN: The study is designed as a multicenter randomized clinical trial including patients with Crohn's disease located in the terminal ileum that require infliximab treatment following recent consensus statements on inflammatory bowel disease treatment: moderate to severe disease activity in patients that fail to respond to steroid therapy or immunomodulatory therapy. Patients will be randomized to receive either infliximab or undergo a laparoscopic ileocolic resection. Primary outcomes are quality of life and costs. Secondary outcomes are hospital stay, early and late morbidity, sick leave and surgical recurrence. In order to detect an effect size of 0.5 on the Inflammatory Bowel Disease Questionnaire at a 5% two sided significance level with a power of 80%, a sample size of 65 patients per treatment group can be calculated. An economic evaluation will be performed by assessing the marginal direct medical, non-medical and time costs and the costs per Quality Adjusted Life Year (QALY) will be calculated. For both treatment strategies a cost-utility ratio will be calculated. Patients will be included from December 2007. DISCUSSION: The LIR!C-trial is a randomized multicenter trial that will provide evidence whether infliximab treatment or surgery is the best treatment for recurrent distal ileitis in Crohn's disease. TRIAL REGISTRATION: Nederlands Trial Register NTR1150

Trial-based cost-effectiveness analysis comparing surgical and endoscopic drainage in patients with obstructive chronic pancreatitis

Objective: Published evidence indicates that surgical drainage of the pancreatic duct was more effective than endoscopic drainage for patients with chronic pancreatitis. This analysis assessed the cost-effectiveness of surgical versus endoscopic drainage in obstructive chronic pancreatitis. Design: This trial-based cost-utility analysis (ISRCTN04572410) was conducted from a UK National Health Service (NHS) perspective and during a 79-month time horizon. During the trial the details of the diagnostic and therapeutic procedures, and pancreatic insufficiency were collected. The resource use was varied in the sensitivity analysis based on a review of the literature. The health outcome was the Quality-Adjusted Life Year (QALY), generated using EQ-5D data collected during the trial. There were no pancreas-related deaths in the trial. All-cause mortality from the trial was incorporated into the QALY estimates in the sensitivity analysis. Setting: Hospital. Participants: Patients with obstructive chronic pancreatitis. Primary and secondary outcome measures: Costs, QALYs and cost-effectiveness. Results: The result of the base-case analysis was that surgical drainage dominated endoscopic drainage, being both more effective and less costly. The sensitivity analysis varied mortality and resource use and showed that the surgical option remained dominant in all scenarios. The probability of cost-effectiveness for surgical drainage was 100% for the base case and 82% in the assessed most conservative case scenario. Conclusions: In obstructive chronic pancreatitis, surgical drainage is highly cost-effective compared with endoscopic drainage from a UK NHS perspective

Acute syphilitic chorioretinitis after a missed primary diagnosis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Syphilis is well known as an infectious disease which can present with a large variety of symptoms. Clinical diagnosis can be difficult and may be complicated in modern medicine by immunosuppressive treatment and possible side effects of medication.</p> <p>Case presentation</p> <p>We describe a rare case of placoid chorioretinitis due to <it>Treponema pallidum </it>which developed after the primary symptom of proteinuria was not recognized as a rare manifestation of syphilis. Diagnosis of syphilitic chorioretinitis and/or endophthalmitis was made by broad range amplification of the bacterial 16S ribosomal RNA gene obtained from vitreous after diagnostic vitrectomy.</p> <p>Conclusion</p> <p>This case shows that clinicians should be alert in patients with proteinuria and chorioretinitis as they can represent rare manifestations of syphilis. Syphilis should be in the differential diagnosis of any unknown symptom and in the presumed side effects of medication.</p

Sedimentology and sequence stratigraphy of the late Precambrian carbonates of the Mbuji-Mayi supergroup in the Sankuru-Mbuji-Mayi-Lomami-Lovoy basin (Democratic Republic of the Congo)

The late Mesoproterozoic-middle Neoproterozoic carbonate succession (1155 Ma-800 Ma) of the Mbuji-Mayi Supergroup (Democratic Republic of Congo) represents a classic late Precambrian carbonate sequence whose architecture is poorly known. Here we present new data and synthesis of microfacies analysis, sequence stratigraphy, Fischer plots coupled with C and O isotopes, to evaluate the paleoecology and sea level variations of the carbonate series of the Mbuji-Mayi Supergroup, and to establish hierarchical approach stratigraphic framework from which to resolve the evolution of the Sankuru-Mbuji-Mayi-Lomami-Lovoy Basin. Our microfacies and sequence stratigraphy analyses show that the carbonate succession consists of strata accumulated on a ramp, during cyclic sedimentation across the inner ramp. Here plurimetric ‘thin’ peritidal cycles (±4 m-thick on average) record a relative maximum sea level of ca. 4 m, with fluctuations in the range around 1-4 m. This shallow-water depth and the abundance of cyanobacteria suggest that water column was oxygenated. By contrast the subtidal cyclic facies at the outer/middle ramp, preserve ‘thick’ subtidal sequences characterized by an average thickness of ±17 m. Accurate relative sea level fluctuations are difficult to assess in this ‘deeper’ environment since the facies could have been deposited in a wide range of shallow water that did not completely fill the accomodation space or available space. A probable magnitude for sea-level fluctuations here is around 10-20 m. These data are the first to place a quantitative constraint on the late Mesoproterozoic to middle Neoproterozoic carbonate deposits that have lively covered much of the Congo Shield at the end of the Precambrian, and is therefore an important type section for Central Africa.SCOPUS: ch.binfo:eu-repo/semantics/publishe