Ovarian surgery for bilateral endometriomas influences age at menopause.

BACKGROUND: Questions remain as to whether surgical excision of ovarian endometriomas might cause damage to ovarian function. To test the hypothesis that ovarian surgery for endometrioma compromises ovarian function and accelerates ovarian failure. METHODS: In a tertiary university Clinic, longitudinal prospective cohort study. Patients who underwent laparoscopy for endometriosis between March 1993 and November 2007 were assessed for inclusion in the study. A prospective follow-up at 3, 6 and 12 months then yearly was conducted. Evolution of menstrual pattern, symptoms and reproductive outcomes were investigated. RESULTS: From over the 14-year period, 302 patients were included in the study. The mean age (±SD) of patients was 32.6 ± 5.6 years; the median duration of follow-up was 8.5 years (range 2-17 years). Menopause was documented in 43 women (14.3%) at a mean age of 45.3 ± 4.3 years (range 32-52 years). Women previously submitted to bilateral cystectomy were younger at menopause than those with monolateral endometrioma (42.1 ± 5.1 years versus 47.1 ± 3.5 years, P = 0.003). Premature ovarian failure (POF) was observed in 7 of 43 (16.3%) menopausal patients; the majority (4, 57.1%) after bilateral cystectomy. The relationship between the preoperative ovarian endometriomas total diameter and menopausal age was significant in case of surgery for bilateral endometriomas (R(2) = 0.754, P = 0.002). CONCLUSIONS: Patients who had been operated on for bilateral endometriomas have an increased risk of POF. Ovarian parenchyma loss at the time of surgery seems related to cyst diameter. In the case of unilateral ovarian endometrioma, the contralateral intact ovary might adequately compensate

Reduced Mortality With Antiplatelet Therapy Deescalation After Percutaneous Coronary Intervention in Acute Coronary Syndromes: A Meta-Analysis

Background:Antiplatelet therapy deescalation has been suggested as an alternative to standard treatment with potent dual antiplatelet therapy (DAPT) for 1 year in low bleeding risk patients with acute coronary syndromes undergoing percutaneous coronary intervention to mitigate the increased risk of bleeding. Whether this strategy preserves the ischemic and survival benefits of potent DAPT is uncertain. Methods:We performed a pairwise meta-analysis in patients with acute coronary syndrome undergoing percutaneous coronary intervention treated with either 1-year standard potent DAPT versus deescalation therapy (potent DAPT for 1-3 months followed by either reduced potency DAPT or ticagrelor monotherapy for up to 1 year). Randomized trials comparing standard DAPT versus deescalation therapy in patients with acute coronary syndrome undergoing percutaneous coronary intervention were searched through MEDLINE, EMBASE, Cochrane databases, and proceedings of international meetings. The primary end point was 1-year all-cause mortality. Results:The meta-analysis included 6 trials in which 20 837 patients were randomized to potent DAPT for 1 to 3 months followed by deescalation therapy for up to 1 year (n=10 392) or standard potent DAPT for 1 year (n=10 445). Deescalation therapy was associated with lower 1-year rates of all-cause mortality compared with standard therapy (odds ratio, 0.75 [95% CI, 0.59-0.95]; P=0.02). Deescalation therapy was also associated with lower rates of major bleeding (odds ratio, 0.59 [95% CI, 0.48-0.72]; P<0.0001), with no significant difference in major adverse cardiac events (major adverse cardiovascular events; odds ratio, 0.89 [95% CI, 0.77-1.04]; P=0.14). Conclusions:In low bleeding risk patients with acute coronary syndrome undergoing percutaneous coronary intervention, compared with 1-year of potent DAPT, antiplatelet therapy deescalation therapy after 1 to 3 months was associated with decreased mortality and major bleeding with similar rates of major adverse cardiovascular events

The role of seizures in the early stages of Alzheimer\u2019s disease.

Epilepsy in Alzheimer Disease animal model and prevention of seizure by AED administration reduces cognitive deficits (compared to alzheimer animals with seizures untreated with AED

Prevalence and effectiveness of psychiatric treatments for patients with IBD: A systematic literature review

Objectives Higher prevalence of psychiatric disorders, such as anxiety and depression, has been found in people with Crohn's disease and Ulcerative Colitis compared to the general population. Nowadays, international guidelines advocate psychotherapy and psycho-pharmacological treatments as playing an important role in IBD care. The main goal of this systematic literature review was summarize the evidence on the utilization and effectiveness of treatments for depression and anxiety in persons with IBD. Methods A systematic literature review was conducted using three different electronic databases: MEDLINE, PsychINFO, and EMBASE to identify studies reporting the prevalence and efficacy of psycho-pharmacological and psychotherapeutic treatments for IBD. A quality appraisal was conducted using several scales as appropriate for each study design. A narrative synthesis was also performed. Results Forty-three studies were included. Although a high rate of psychoactive drug use was found in people with IBD, a low proportion of IBD patients have access to psychiatric referral. 1/3 of the studies found that psychotherapy was effective for improving the quality of life, perception of stress, anxiety and depression as well as disease. Antidepressants proved effective in reducing disease activity, gastrointestinal symptoms, anxiety and depression. Conclusion Our results suggest that psychiatric treatment should be implemented in IBD care. However, further studies are needed to confirm the findings of our systematic review

News and controversy in inflammatory bowel disease treatment

Background: The treatment of Inflammatory bowel disease comes from many years of esperience, clinical trials and mistakes. Discussion: In patients with active Crohn disease steroids are considerated the first choice, but recently, the introduction of anti-TNF alfa agents (infliximab and adalimumab) has changed the protocols. Anti-TNF are also used for closing fistula after surgical curettage. An efficently preventive treatment of Crohn disease still has not been found but hight dose of oral salicylates, azatioprine or 6-MP and antibiotics might be useful. In severe attacks of ulcerative colitis, high dose iv treatment of steroids are required for a few days. Later on, a further treatment with anti- TNF might delay the need of surgery. In patients with mild to moderate attacks of ulcerative colitis, topical treatment is preferred, it consists of enemas, suppositories or foams containing 5-aminosalycilic acid, traditional steroids, topical active steroids. Topical treatment can be associated with oral steroids or oral salicylates. Oral salicylates or azatioprine are used for prevention of relaps

M1085 Use of Infliximab and Adalimumab in Refractory Pouchitis

INTRODUCTION: Ten to 15% of patients with pouchitis experience refractory or recurrent disease. Anti-TNF agents are effective in both refractory ulcerative colitis and Crohn's disease. AIMS & METHODS: This study aimed to evaluate the effectiveness of Infliximab (IFX) or Adalimumab (ADA) in inducing remission and improving quality-of-life (QOL) in such patients. From January 2007 to May 2009, 19 consecutive patients with refractory pouchitis were prospectively followed in a single tertiary center Patients with active pouchitis not responding after 1 month of antibiotic treatment (metronidazole 1g/day or ciprofloxacin 1g/ day) and 2 months of oral budesonide CIR at 9mg/day, were treated with IFX 5mg/kg at 0,2,6 weeks or ADA 160mg/80mg at weeks 0-2 and then 40 mg every-other-week. Shortterm efficacy was evaluated at week 10. Symptomatic, endoscopic and histological evaluations were done before and after treatment using the Pouchitis Disease Activity Index (PDAI) score. Remission was defined as a combination of a clinical PDAI score of 1. QOL was assessed using Inflammatory Bowel less or equal 2 and endoscopic PDAI score less or equal than Disease Questionnaire (IBDQ). RESULTS: Twelve patients (7 males, 5 females, median age 32,6 years) received IFX, 7 (5 males, 2 females, median age 36,4 years) were treated with ADA; 2 of the patients treated with ADA were secondary failure to IFX. Nine of 12 (75 %) and 5 of 7 (71,4%) showed remission respectively in the IFX and ADA group. The median PDAI scores before and after therapy were 13 (range 8-18) and 2 (range 0-9) in IFX group(p&lt;0.001), and 14 (range 9-18) and 2 (range 0-10) in the ADA group (p&lt;0.001). The median IBDQ score also significantly improved from 96 (range 74- 184) to 196 (range 92-230) in the IFX group (p&lt;0.001), and from 105 (range 78-176) to 206 (range 94-226) in the ADA group (p&lt;0.001).No serious side-effects were registered. CONCLUSION: IFX and ADA were both effective in inducing remission and improving QOL in patients with refractory pouchitis, and were well tolerated

Role of conventional therapies in the era of biological treatment in Crohn’s disease

Outstanding progress regarding the pathophysiology of Crohn’s disease (CD) has led to the development of innovative therapeutic concepts. Numerous controlled trials have been performed in CD. This review concentrates on the results of randomized, placebo-controlled trials, and meta-analyses when available, that provide the highest degree of evidence. Current guidelines on the management of CD recommend a step-up approach to treatment involving the addition of more powerful therapies as the severity of disease and refractoriness to therapy increase. The advent of biological drugs has opened new therapeutic horizons for treating CD, modifying the treatment goals. However, the large majority of patients with CD will be managed through conventional therapy, even if they are a prelude to biological therapy

Predictors of early recurrence after strictureplasty for Crohn's disease of the small bowel during the years of biologics

Background: The identification of patients prone to early recurrence of Crohn's disease at the site of a strictureplasty is fundamental in the clinical practice. Aims: Aim of the study is to detect the risk factors for early reoperation for recurrence after primary strictureplasty. Methods: From 2000, patients undergoing a primary strictureplasty and a subsequent reoperation for recurrence of Crohn's disease at the site of a strictureplasty were included. Univariate and multivariable linear regression models were performed to analyse the relationship between the time to recurrence and independent variables. Results: Fifty-nine patients were included. Median time to recurrence was 4.5 years (0.7\u201312.6). At the multivariate linear regression, early relapse was significantly associated with use of biologics before primary surgery ( 122.69, p &lt; 0.0001) and location of disease in the ileum ( 121.61, p 0.017). The use of biologics after surgery was similar between groups (40.7 vs 37.5%, p 0.79). Conclusions: The location of Crohn's disease in the ileum and the use of biologics before surgery are strong predictors of early site-specific recurrence after strictureplasty. In this group of patients, a tailored follow-up and aggressive postoperative treatment should be considered