Laparoscopies et adhérences abdominales en pathologie hépatique

Les adhérences abdominales sont fréquemment rencontrées au cours des laparoscopies effectuées pour mise au point d'affections hépatiques. L'étude comporte une partie rétrospective destinée à évaluer les possibilités d'observation laparoscopique du foie malgré la présence d'adhérences, et une partie prospective ayant pour but d'évaluer le rôle des adhérences sur l'apparition de douleurs en cours de laparoscopie. L'étude rétrospective montre un maximum de difficultés dans l'observation hépatique du lobe droit, surtout après chirurgie biliaire, sans que les adhérences constituent une contre-indication à la laparoscopie. L'étude prospective ne montre pas de différences statistiquement significatives en ce qui concerne l'origine et l'intensité des douleurs de patients porteurs ou non d'adhérences abdominales

Granulocyte-Monocyte Apheresis in Steroid-Dependent, Azathioprine-Intolerant/Resistant Moderate Ulcerative Colitis: A Prospective Multicenter Study

Background. Granulocyte-monocyte apheresis has been proposed for the treatment of ulcerative colitis, although it is limited by costs and variability of results. Aim. To assess effectiveness of granulocyte-monocyte apheresis in patients with steroid-dependent, azathioprine-intolerant/resistant moderate ulcerative colitis. Methods. Consecutive patients fulfilling inclusion criteria were prospectively enrolled, treated by apheresis, and followed up for 12 months. The primary end point of the study was steroid-free clinical remission at 12 months, with no need for biologic therapy or surgery. Results. From January to December 2013, 33 patients were enrolled. After one year of follow-up, 12 (36%) patients had clinical remission, were steroid-free, and had no need for biological therapy or surgery; 3 (9%) cases showed a clinical response (but not clinical remission). Moreover, 12 (36%) patients required biologic therapy, 4 (12%) underwent colectomy, and in the other 2 (6%) a reduction, but not withdrawal, of steroid dose was achieved. Conclusions. Our study shows that a standard course of granulocyte-monocyte apheresis is associated with a 36% steroid-free clinical remission in patients with steroid-dependent, azathioprine-intolerant or resistant moderate ulcerative colitis. Apheresis might represent an alternative to biologic therapy or surgery in this specific subgroup of patients. This trial is registered with Clinicaltrial.gov NCT03189888

Dosing Penalty of Erythropoiesis-Stimulating Agents after Switching from Originator to Biosimilar Preparations in Stable Hemodialysis Patients

To the Editor: The efficacy of ESA biosimilars has been tested mainly in the few studies needed for marketing authorization,1-5 whereas data from individual self-reported clinical experience are lacking. Such information, together with pharmacovigilance data, is key to obtaining reassurance regarding the safety of these products. Of note, 2 studies of efficacy when switching from originator to biosimilar in hemodialysis patients have reported a dosing penalty (ie, requiring higher doses to maintain Hb level) of 4% to 13% for HX575 (epoetin alfa; Binocrit) and 10% to 15% for SB309 (epoetin zeta; Retacrit). 4,5 Dosing penalty for biosimilars is relevant not only for cost reasons, but also when considering the significant association of higher ESA dose with adverse outcomes.6 All manufacturers recommend using the lowest effective dose for correcting anemia

Tumour necrosis factor alpha in segmental colitis associated with diverticula

The pathogenesis of segmental colitis associated with diverticula (SCAD) is unclear, but tumour necrosis factor alpha (TNF-alpha) has been shown to play a pivotal role in the pathogenesis of inflammatory bowel diseases. The aim of this study was to assess TNF-alpha levels in patients with SCAD. In a post hoc analysis of a prospective multicenter study, tissue samples from 13 patients diagnosed with SCAD were subjected to histological analyses. The severity of the inflammation was assessed by means of a histological score and histomorphometry (number of inflammatory cells/mm2). Immunohistochemical staining with an antibody against TNF-alpha was performed on all biopsies and the degree of staining expressed as the percentage of positive stromal cells/1000 counted (TNF-alpha score). Matched patients with irritable bowel syndrome (IBS) were used as controls. Over-expression of TNF-alpha was found in all SCAD patients (38.6 +/- 10.4%), and it was associated with a high histological score (2.5 +/- 0.5) and neutrophil cell count (16.3 +/- 3/mm2). These values were distinctly higher than those found in the IBS controls. Our data suggest that TNF-alpha activity is involved in SCAD pathogenesis, similarly to what occurs in Crohn's disease and ulcerative colitis

Risk for chronic kidney disease in the general population: Italian reports for World Kidney Days 2007-2009

The prevalence of chronic kidney disease (CKD) has rapidlyincreased in recent decades in many countries, leading toconsistent economic implications. Considering the fact thatpatients surviving to CKD often develop end-stage renal disease,the number of patients requiring replacement therapyreached 169/million population (pmp) in Italy in 2004 and342 pmp in the Unites States. Furthermore, CKD weighs onpatients survival with a considerably increased cardiovascular(CV) morbidity and mortality