Femoral Vein Wall Thickness Measurement May Be a Distinctive Diagnostic Tool to Differentiate Behçet’s Disease with Intestinal Involvement and Crohn’s Disease

Digestive Diseases and Sciences - Behçet’s disease (BD) and Crohn’s disease (CD) cannot be easily differentiated in young adults presenting with nonspecific gastrointestinal (GI)...     

Preliminary evidence of a reduced serum level of fibroblast growth factor 19 in patients with biopsy-proven nonalcoholic fatty liver disease

ObjectivesWe sought to determine whether serum concentrations of fibroblast growth factor 19 (FGF19) – an ileum-derived enterokine which plays a role in the control of glucose and lipid homeostasis – are altered in patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD).Design and methodsSerum levels of FGF19 were measured using enzyme-linked immunosorbent assay in 91 patients with biopsy-proven NAFLD and 74 controls.ResultsFGF19 levels were significantly lower in patients with biopsy-proven NAFLD (median: 130 pg/mL) than in controls (median: 210 pg/mL, P < 0.001). Serum FGF19 levels were significantly but modestly associated with hepatocyte ballooning scores in univariate analysis (r = ? 0.25, P < 0.05) but not after adjustment for potential confounders (β = ? 0.18; t = 1.78, P = 0.08).ConclusionsThis pilot study suggests that serum FGF19 levels are decreased in patients with NAFLD but are not independently associated with liver histology findings.     

Hyperbaric Oxygen Therapy Is as Effective as Dexamethasone in the Treatment of TNBS-E-Induced Experimental Colitis

Introduction Hyperbaric oxygen (HBO) has been demonstrated to be useful as an adjunctive therapy for Crohn’s disease. In the present study, HBO was tested as a treatment for trinitrobenzenesulfonic acid–ethanol (TNBS-E)-induced distal colitis, and its effects were compared with dexamethasone therapy. Methods A total of 48 Sprague-Dawley rats were separated into six groups: the control, and those treated with vehicle, TNBS-E, HBO, dexamethasone, or combined HBO + dexamethasone. The HBO treatment group was exposed to 100% HBO at 2 ATM for 75 min twice daily at 6-h intervals in a HBO chamber, both on the day of colitis induction and 3 days thereafter. Treatment with intraperitoneal dexamethasone twice daily was started 1 h before the induction of colitis and was continued for 7 days in the dexamethasone group. The rats were decapitated 8 days after the induction of colitis, and the colonic tissue wet weight, macroscopic and microscopic lesion score, and tissue myeloperoxidase (MPO) activity were determined. Results HBO therapy decreased the activity of experimental colitis measured by the tissue wet weight, macroscopic score, microscopic score, and MPO activity. The dexamethasone treatment significantly reduced the colitis activity as determined by the tissue MPO activity and wet weight. There were also decreases in the macroscopic and microscopic activity scores with the dexamethasone therapy; however, these changes were not statistically significant. The combined therapy with HBO and dexamethasone provided no additional benefit over HBO therapy alone. Conclusion HBO therapy can be a valuable therapeutic option in treatment of patients with inflammatory bowel disease. HBO therapy in the refractory patients deserves further, larger clinical studies.     

Role of robotics in the management of secondary ureteropelvic junction obstruction

Patients with recurrent ureteropelvic junction obstruction (UPJO) present a treatment dilemma to urologists. Second-line therapies have previously been shown to fail at a higher rate than the initial therapeutic procedure. We report our experience with robotic-assisted, dismembered pyeloplasty in patients with secondary UPJO. Since November 2002, 44 robotic-assisted laparoscopic pyeloplasties (RALPs) have been performed at our institution. Of these, seven patients had undergone previous definitive treatment for UPJO. Anderson-Hynes-dismembered pyeloplasty was the preferred reconstructive technique in all patients. The patients were divided into two groups: primary pyeloplasty patients (group 1) and secondary pyeloplasty patients (group 2). Variables examined include operative time, estimated blood loss (EBL), length of hospital stay (LOS) and success rates. All operations were completed laparoscopically, and there were no conversions to open surgery in either group. Mean operative time was 60 min longer in the secondary pyeloplasty group compared with primary cases, but the EBL, LOS and success rates were similar. A patent UPJ was confirmed in both groups by renal scan and/or excretory urography (intravenous pyelogram) examinations. RALP is a viable option in select patients with recurrent UPJO after previous endoscopic or open surgical repair. As expected, operative times were longer in these patients due to a more challenging dissection (p < 0.05). However, the magnification afforded by the robot allows for a precise dissection, and subsequently, there was no significant increase in blood loss, hospital stay or perioperative morbidity in our series (p > 0.05).