Fibrin Glue as an Adjunct to Flap Repair of Anal Fistulas: A Randomized, Controlled Study

Purpose Both flap repair and fibrin glue are accepted sphincter-preserving techniques for managing anal fistulas. Additionally, the two techniques are not mutually exclusive and can be combined. This trial was undertaken to determine whether the combination of flap repair and fibrin glue resulted in better outcomes than flap repair alone. Methods Between July 2000 and March 2004, patients with transsphincteric anal fistulas were randomly assigned to advancement flap repair alone or flap repair combined with fibrin glue obliteration of the fistula tract. Data regarding age, gender, fistula anatomy, race, and previous repairs were collected. Fistulas managed by fistulotomy or caused by Crohn’s disease, acute obstetric trauma, or radiation were excluded from this study. Results There were 58 patients randomized to flap repair alone or flap repair with fibrin glue (47 males; median age, 47 (range, 29–68) years). Mucosal advancement flap was performed in 36 patients and anodermal advancement flap was performed in 22. The median follow-up was 22 (range, 12–36) months. Total fistula recurrence rate for all patients was 32.6 percent. The recurrence rate for fistulas repaired by advancement flap alone was 20 percent, whereas the recurrence rate for fistulas repaired by advancement flap with fibrin glue was 46.4 percent (P < ;0.05). Conclusions The data fail to show improved outcomes when fibrin sealant is used in combination with an advancement flap compared with advancement flap alone for the management of complex anal fistulas. Read at the meeting of The American Society of Colon and Rectal Surgeons, Dallas, Texas, May 8 to 13, 2004. Reprints are not available.     

Fibrin Glue for Anal Fistulas

PURPOSE: The aim of this study was to evaluate the long-term success and complication rate of fibrin-glue treatment of anal fistulas. METHODS: Patients with an anal fistula presenting to a single surgeon over a three-year period were enrolled in this study. At their first operation, all 48 patients (26–72 years old) underwent anoscopy, biopsy, destruction of the internal gland, and placement of a draining seton. Approximately two months later after preoperative bowel preparation, the seton was removed, the internal opening closed with a single suture, and fibrin glue instilled by way of the external opening to seal the fistula tract. Patients were followed closely to document the results of treatment and any complications. Long-term follow-up was done by telephone interview. RESULTS: Cause of the anal fistula was cryptoglandular in 36 (75 percent) patients, Crohns disease in 5 (10 percent), and miscellaneous in 7 (15 percent). Median follow-up was 22 months (range, 6–46 months). After a single treatment with fibrin glue, 29 (60 percent) fistulas closed. Retreatment with fibrin glue brought the successful number of fistula tracts closed to 33 (69 percent). The 15 (29 percent) patients who failed either one or two treatments with fibrin glue were successfully treated with either fistulotomy or advancement flap. Bowel function and fecal incontinence were not altered by the fibrin-glue treatment. In one patient who failed fibrin glue, the fibrin-glue treatment may have created a more complicated fistula tract. Late recurrences (>6 months) occurred in three (6 percent) patients, two of whom were successfully retreated with fibrin glue. CONCLUSIONS: Fibrin-glue treatment of anal fistulas is successful in up to 69 percent of patients if initial failures are retreated. This sphincter-saving technique is associated with minimal complications and no functional detriment. Late recurrences are unusual.     

Fibrin Glue in the Treatment of Pilonidal Sinus: Results of a Pilot Study

INTRODUCTION Pilonidal sinus is a common condition of uncertain etiology. There is no agreed best surgical treatment. Treatment of fistula-in-ano has been described with some success with fibrin tissue glue. The use of fibrin glue is investigated in this pilot study.METHODS Six patients with chronic pilonidal sinus were treated with injection of fibrin tissue glue after curettage of the pits.RESULTS There were no complications. Postoperative discomfort was minimal and early return to normal activities was possible. There was no recurrence of disease in five of six patients at one year.CONCLUSIONS Fibrin tissue glue may be a possible novel treatment for pilonidal disease.Reprints are not available.     

Long-Term Outlook after Successful Fibrin Glue Ablation of Cryptoglandular Transsphincteric Fistula-in-Ano

Purpose

Initial success rates for fibrin glue ablation of cryptoglandular transsphincteric fistulas have been disappointing. We examined long-term outcomes after initially successful fibrin glue ablation of cryptoglandular transsphincteric fistulas.

Methods

Retrospective review identified 36 adult patients with cryptoglandular transsphincteric fistula Tisseel VH® fibrin glue ablation that was performed from May 2000 to March 2005. Fibrin glue ablations were performed under supervision of fellowship-trained colorectal surgeons. Follow-up interval was based on time until recurrence of fistula or time of last fistula-free evaluation.

Results

Twenty-four men and 12 women patients had a mean age of 50 (range, 27–85) years. Twenty patients responded to initial fibrin glue ablation treatment. Two additional patients healed with secondary fibrin glue ablation. Sixty-six percent (22/33 patients) of cryptoglandular transsphincteric fistulas were closed at three months. Eleven patients failed fibrin glue ablation at a mean of 33 (range, 6–41) days. Seventeen of 22 short-term success patients (3 months) were available for long-term follow-up. Ninety-four percent (16/17 patients) remained healed at final long-term follow-up. The remaining patient recurred just before the six-month follow-up.

Conclusions

Despite the suboptimal early success rate of fibrin glue ablation for cryptoglandular transsphincteric fistulas, when a fistula does close for at least six months this appears to be a durable closure. A single patient recurred after appearing healed at the three-month check.

     

Fibrin Glue Treatment of Low Rectal and Pouch-Anal Anastomotic Sinuses

PURPOSE: This report describes a treatment method for patients with persistent anastomostic sinuses in which fibrin glue is used. METHODS: A retrospective review was conducted of the medical records of seven patients with radiologically documented sinus tracts after restorative proctocolectomy or low rectal anastomosis was managed with fibrin glue obliteration of the tract. The sinus was gently debrided with a curette and then filled with fibrin glue. Postoperatively, the patients received metronidazole 1.5 g per day in divided doses for one week. Outpatient examination of the internal opening was performed at 1, 3, and 12 weeks postoperatively. RESULTS: In all patients, healing of the sinus was observed after one week. After an average of 11.2 months (range, 3–15) of follow-up there were no recurrences and no episodes of pelvic sepsis. CONCLUSION: On the basis of this experience, we believe that fibrin glue injection may be an alternative method of managing pelvic anastomotic sinuses. Presented at the American Society of Colon and Rectal Surgeons, Chicago, Illinois, June 3 to 8, 2002     

Efficacy of Anal Fistula Plug vs. Fibrin Glue in Closure of Anorectal Fistulas

Purpose Long-term closure rates of anorectal fistulas using fibrin glue have been disappointing, possibly because of the liquid consistency of the glue. A suturable bioprosthetic plug (Surgisis?, Cook Surgical, Inc.) was fashioned to close the primary opening of fistula tracts. A prospective cohort study was performed to compare fibrin glue vs. the anal fistula plug. Methods Patients with high transsphincteric fistulas, or deeper, were prospectively enrolled. Patients with Crohn's disease or superficial fistulas were excluded. Age, gender, number and type of fistula tracts, and previous fistula surgeries were compared between groups. Under general anesthesia and in prone jackknife position, the tract was irrigated with hydrogen peroxide. Fistula tracts were occluded by fibrin glue vs. closure of the primary opening using a Surgisis^? anal fistula plug. Results Twenty-five patients were prospectively enrolled. Ten patients underwent fibrin glue closure, and 15 used a fistula plug. Patient's age, gender, fistula tract characteristics, and number of previous closure attempts was similar in both groups. In the fibrin glue group, six patients (60 percent) had persistence of one or more fistulas at three months, compared with two patients (13 percent) in the plug group (P < 0.05, Fisher exact test). Conclusions Closure of the primary opening of a fistula tract using a suturable biologic anal fistula plug is an effective method of treating anorectal fistulas. The method seems to be more reliable than fibrin glue closure. The greater efficacy of the fistula plug may be the result of the ability to suture the plug in the primary opening, therefore, closing the primary opening more effectively. Further prospective, long-term studies are warranted. Dr. David Armstrong has a patent-licensing agreement with the manufacturers of Surgisis? (Cook Surgical, Bloomington, IN). Presented at the meeting of The American Society of Colon and Rectal Surgeons, Philadelphia, Pennsylvania, April 30 to May 5, 2005.     

Fibrin Glue Sealing in the Treatment of Perineal Fistulas

PURPOSE: The surgical management of complex perineal fistulas, such as high transsphincteric and suprasphincteric fistulas, or those associated with Crohn's disease, radiotherapy, surgical trauma, or cavity or a secondary tract, is associated with the risk of sphincter injury and significant discomfort. Fibrin glue may close fistula tracts without muscle division. Therefore, the aim of this study was to evaluate the use of fibrin glue sealing in treatment of perineal fistulas. METHODS: A retrospective chart review of all patients in whom fibrin glue was used for the treatment of perineal fistula was performed. Patients were contacted by telephone to establish follow-up. RESULTS: Thirty-seven patients underwent injection of fibrin glue for complex perineal fistulas. Twenty-four patients had fibrin glue injection as the principal treatment for the perineal fistula, and 13 had fibrin glue in conjunction with an endorectal advancement flap. The fistula was of cryptoglandular origin in 16 (42 percent) cases and associated with Crohn's disease and trauma in 7 (19 percent) and 14 (38 percent) patients, respectively. At a mean follow-up of 12.1 months, healing occurred in only 15 (41 percent) patients. The healing rate was 33 percent when fibrin glue was the principal treatment, and 54 percent when used with an endorectal advancement flap. Fistulas of noncryptoglandular origin had a higher success rate, although this difference did not reach statistical significance. There was no morbidity associated with the injection of fibrin glue. CONCLUSION: In this study, fibrin glue had moderate success in the definitive treatment of perineal fistulas. However, 33 percent of the patients in whom fibrin glue was the only treatment used were able to avoid more extensive surgery. Fibrin glue is associated with minimal risk, therefore its application should be considered in patients with complex anal fistulas.     

Treatment of Fistulas-in-Ano With Fibrin Sealant in Combination With Intra-adhesive Antibiotics and/or Surgical Closure of the Internal Fistula Opening

PURPOSE The treatment of fistulas-in-ano with fibrin sealant injection has been moderately successful. Failures can be caused by persistent infection within the tract or early expulsion of the clot. In an attempt to improve the success rate, we examined three modifications of the sealant procedure: the addition of cefoxitin to the sealant, surgical closure of the primary opening, or both.METHODS A prospective, randomized, clinical trial was performed in which patients were treated with Tisseel-VH ^® fibrin sealant according to previously published procedures. In addition, patients were randomized to receive intra-adhesive cefoxitin, surgical closure of the primary opening, or both modifications. Cefoxitin, 100 mg, was added to the sealant for patients randomized to receive intra-adhesive antibiotics. For the appropriate patients, the primary fistula opening was closed with a 3-0 absorbable suture. If fistulas failed to heal, patients were offered a single retreatment with sealant.RESULTS Twenty-four patients were treated in the cefoxitin arm, 25 in the closure arm, and 26 in the combined arm. Median duration of fistulas was 12 months. Patients were followed for a mean of 27 months postoperatively. There was no postoperative incontinence or complications related to the sealant itself. Initial healing rates were 21 percent in the cefoxitin arm, 40 percent in the closure arm, and 31 percent in the combined arm (P = 0.35). One of five patients in the cefoxitin arm, one of seven patients in the closure arm, and one of six patients in the combined arm were successfully retreated; final healing rates were 25, 44, and 35 percent respectively (P = 0.38).CONCLUSIONS Treatment of fistula-in-ano with fibrin sealant with closure of the internal opening was somewhat more successful than sealant with cefoxitin or the combination, however this did not achieve statistical significance. None of the three modifications were more successful than historic controls at our institution treated with sealant alone. Therefore, the addition of intra-adhesive cefoxitin, closure of the internal opening, or both are not recommended modifications of the fibrin sealant procedure.Support by Baxter Healthcare.Read at the meeting of The American Society of Colon and Rectal Surgeons, Dallas, Texas, May 8 to 13, 2004.     

纤维蛋白生物胶外周支持对大鼠颈静脉移植物的增殖和凋亡的影响

目的研究纤维蛋白胶血管外周支持对静脉移植物平滑肌细胞增殖、凋亡的影响。方法建立大鼠颈总动脉自体颈静脉移植模型,按照有无纤维蛋白胶血管外周支持,分为外周支持组、无外周支持组,每组24只。术后1周、2周、4周分别切除移植静脉,用免疫组织化学方法检测静脉移植物平滑肌细胞增殖细胞核抗原(PCNA)表达,用原位DNA断裂位点3’-羟基末端标记(TUNEL)法检测静脉移植物平滑肌细胞凋亡的变化,以及检测内膜厚度。结果静脉移植术后1-4周,无外周支持组静脉移植物血管平滑肌细胞的凋亡和增殖均明显升高,内膜明显增厚;纤维蛋白胶血管外周支持组静脉移植物血管平滑肌细胞的凋亡和增殖同处于低水平,内膜增厚不明显。两组静脉移植物血管平滑肌细胞的凋亡和增殖具有显著相关性。结论纤维蛋白胶外周支持可以抑制血管平滑肌的增殖和凋亡,使两者同时处于低水平,一方面减少细胞凋不足所造成的对血管重塑造成的影响,另一方面使凋亡程度与巨噬细胞及正常血管平滑肌吞噬作用达到平衡,抑制了静脉移植物的内膜增生。     

Collagen Fistula Plug for the Treatment of Anal Fistulas

PURPOSE

This study was designed to evaluate the efficacy of the Surgisis® (Anal Fistula Plug?) in multiple patients at our institution and present early clinical results along with notable clinical observations from our experience.

METHODS

This was a prospective analysis of all patients who received the Anal Fistula Plug? for treatment of anorectal fistulas between April 2006 and February 2007. All tracts were irrigated with peroxide, the plug was inserted in the tract, and buried at the internal opening with 2-0 vicryl and mucosal advancement flap. Statistical analysis was performed with Fisher’s exact test.

RESULTS

Forty-five patients were treated with the Anal Fistula Plug? and one patient was lost to follow-up. There were 27 males and 17 females with average age of 44.1 years treated for simple (n?=?24) or complex (n?=?20) fistulas. Preliminary results indicated an 84 percent healing rate by 3 to 8 weeks postoperatively, which progressively declined from 72.7 percent at 8 weeks to 62.4 percent at 12 weeks and 54.6 percent at a median follow-up of 6.5 (range, 3–13) months. Long-term Anal Fistula Plug? closure rate was significantly higher in patients with simple than complex fistulas (70.8 vs. 35 percent; P?vs. Crohn’s disease (66.7 vs. 26.6 percent; P?vs. 63.9 percent; P?vs. multiple fistula tracts. Postoperative complications included perianal abscess in five patients (3 Crohn’s disease, 2 non-Crohn’s disease).

CONCLUSIONS

Anal Fistula Plug? is most successful in the treatment of simple anorectal fistulas but is associated with a high failure rate in complex fistula and particularly in patients with Crohn’s disease. Repeat plug placement is associated with increased failure. Given the relatively low morbidity associated with the procedure, Anal Fistula Plug? should be considered as a first-line treatment for patients with simple fistulas and as an alternative in selected patients with complex fistulas.     

Prospective Study of Attitudinal and Relationship Predictors of Sexual Risk in the Multicenter AIDS Cohort Study

We examined the influence of attitudes concerning HIV transmission, safe sex, and sexual sensation seeking, as well as negotiated risk reduction with primary partners, on the proportion of unprotected sexual partners (%UASP) among men who have sex with men (MSM). Participants were 263 HIV-seropositive and 238 HIV-seronegative MSM in the Multicenter AIDS Cohort Study between 1999 and 2003 who completed a 20-item attitude survey twice. Behavioral data were collected concurrently and 6–12 months after each survey. Among seropositives, decreased HIV concern and increased safer sex fatigue were associated with higher %UASP at 6 and 12 months. Among seronegatives, increased %UASP at 12 months was associated with safer sex fatigue. At 6 months and 12 months, risk reduction agreements were associated with increased %UASP among seronegatives in seroconcordant monogamous relationships, reflecting their abandonment of condoms in such partnerships. We conclude that HIV prevention efforts should target modifiable attitudes (reduced concern about HIV and safer sex fatigue) and increases in sexual risk-taking of MSM, particularly among HIV+ men having sex with serodiscordant partners.     

Efficacy of Anal Fistula Plug in Closure of Cryptoglandular Fistulas: Long-Term Follow-Up

Purpose

The long-term efficacy of Surgisis^® anal fistula plug in closure of cryptoglandular anorectal fistulas was studied.

Methods

Patients with high cryptoglandular anorectal fistulas were prospectively studied. Additional variables recorded were: number of fistula tracts, and presence of setons. Under general anesthesia and in prone jackknife position, patients underwent irrigation of the fistula tract by using hydrogen peroxide. Each primary opening was occluded by using a Surgisis^® anal fistula plug, which was securely sutured in place at the primary opening and tacked to the periphery of the secondary opening.

Results

Forty-six patients were prospectively enrolled during a two-year period. Follow-up was six months to two years (median, 12 months). At final follow-up, all fistula tracts had been successfully closed in 38 patients, for an overall success rate of 83 percent. Seven patients had multiple tracts, for a total of 55 fistula tracts in the series. Of the 55 individual tracts, 47 (85 percent) were closed at final follow-up. Patients with one primary opening were most likely to have successful closure by using the anal fistula plug, although this was not significant. Successful closure was not correlated with the presence of setons.

Conclusions

Long-term closure of cryptoglandular anorectal fistula tracts using Surgisis^® anal fistula plug is safe and successful in 83 percent of patients and 85 percent of tracts.     

Treatment of Complex Anal Fistulas with the Collagen Fistula Plug

Purpose

Anal fistulas that involve a significant amount of sphincter may be difficult to treat without compromising continence function. In this study, we evaluated our experience with the Surgisis® anal fistula plug, which was recently reported to be successful in >80 percent of patients with complex fistulas.

Methods

We retrospectively collected patient and fistula characteristics, procedure details, and follow-up information for all patients treated with the anal fistula plug at our institution from January 2006 through April 2007. The outcome was considered successful if the external opening was closed and if the patient had no drainage at the last follow-up. Using multivariate statistics, we analyzed the relationship between anal fistula plug success and several key variables.

Results

From January 2006 through April 2007, 47 patients with 49 complex anal fistulas underwent 64 anal fistula plug procedures. The median follow-up time for patients who were considered healed was 6.5 (range, 3–11) months. The success rate was 31 percent per procedure and 43 percent per patient. An increased amount of external sphincter involvement was associated with a higher failure rate (P?

Conclusions

In our early experience with the anal fistula plug, 43 percent of patients with complex anal fistulas were successfully treated. Patients with less external sphincter involvement were more likely to heal.

     

Laparoscopic Approach to Treatment of Sigmoid Diverticulitis: Changes in the Spectrum of Indications and Results of a Prospective,Multicenter Study on 1,545 Patients

BACKGROUND The aim of the present study was to analyze changes regarding the indications for and results of laparoscopic treatment of sigmoid diverticulitis.METHODS The data were collected within the framework of an ongoing prospective multicenter study carried out by the Laparoscopic Colorectal Surgery Study Group and were submitted to a statistical subgroup analysis. The institutions participating in the study were divided into three groups by experience (Group I, >100 procedures; Group II, 30–100 procedures; Group III, <30 procedures).RESULTS Among the 3,868 recruited patients, sigmoid diverticulitis (n = 1,545, 40 percent) was by far the most common indication for surgery, and sigmoid resection (n = 2,160, 55.9 percent) was by far the most common laparoscopic procedure. A total of 1,353 patients (87.6 percent) had uncomplicated diverticulitis, whereas 192 (12.4 percent) had a complicated form of diverticular disease (Hinchey I–IV, diverticular bleeding, fistula formation). Cases of complicated diverticulitis were significantly more frequently operated on at institutions with greater experience (Group I, 20.8 percent; Group II, 8.7 percent; Group III, 7.9 percent). Despite this fact, these institutions still had better intraoperative complication rates (Group I, 5.0 percent; Group II, 5.8 percent; Group III, 6.9 percent), conversion rates (Group I, 4.4 percent; Group II, 6.7 percent; Group III, 7.7 percent), and postoperative morbidity (Group I, 15.9 percent; Group II, 16.6 percent; Group III, 18.6 percent) and mortality (Group I, 0.2 percent; Group II, 0.5 percent; Group III, 0.4 percent) rates.CONCLUSION An increase in experience is associated with an expansion of laparoscopic indications to include complicated forms of diverticulitis, with comparable intraoperative and postoperative complication rates, operating time, and mortality rates.Supported by Ethicon Endosurgery, Norderstedt (Germany) and Takeda Pharma, Aachen (Germany).Reprints are not available.     

Anocutaneous V-Y Advancement Flap for the Treatment of Complex Perianal Fistula

PURPOSE The treatment of intersphincteric and low transsphincteric fistula is well defined, but controversy remains around the management of complex perianal fistula. This study was designed to assess the utility of anocutaneous flap repair in complex types of perianal fistula.METHODS Sixty-five perianal fistula in 65 patients treated with anocutaneous advancement flap for the complex fistula, between April 1998 and December 2002, are included this prospective study. Mean age was 34 ± 2.1 (range, 24–53) years. Magnetic resonance imaging was used for the diagnosis of fistula. Excision of the internal opening and the overlying anoderm, curettage of the fistula tract, closure of internal opening with absorbable polyglactin 3/0 suture, and drainage of the external opening(s) by insertion of penrose drain were common operational steps. Outcome was evaluated in terms of healing and incontinence.RESULTS Successful healing of 59 of 65 complex fistulas was achieved using this technique with no disturbance of continence and minimal complications. Mean follow-up and complete healing time were 32 ± 0.6 (range, 12–52) months and 5.4 ± 0.8 (range, 3–7) weeks respectively.CONCLUSIONS Although the study cases were relatively small in number, this report showed that clinical results of anocutaneous advancement flap are acceptable. However, large studies are needed to reach an ultimate conclusion for assessing the place of anocutaneous flap advancement in complex fistula.Reprints are not available.     

Prospective clinical and manometric study of fistulotomy with primary sphincter reconstruction in the management of recurrent complex fistula-in-ano

Background and aims The aim of this study was to assess the results of fistulotomy with sphincter reconstruction in the management of recurrent complex fistula-in-ano in terms of recurrence and continence.Patients and methods Prospective study of 16 patients undergoing fistulotomy with sphincter reconstruction for recurrent complex fistula-in-ano was done. Preoperative and postoperative evaluation included physical examination, anal ultrasonography and anal manometry, with a 40-month follow-up. The Wexner Continence Grading Scale (0–20) was used to assess faecal continence.Results Fistulas were classified as high transsphincteric in 13 patients (81.3%), suprasphincteric in 2 (12.5%) and extrasphincteric in 1 patient (6.2%). Four patients (25%) had recurred twice or more. Eight patients (50%) complained of varying degrees of prior faecal incontinence. Their mean score decreased from 8.5 to 1.875 after surgery, and all the patients improved except for one whose score remained the same. On anal manometry, the differences between continent and incontinent patients before surgery [maximum resting pressure (MRP) 86.3 vs 57.6 mmHg, maximum squeeze pressure (MSP) 196.5 vs 138.6 mmHg] decreased after surgery (MRP 81.9 vs 63.7 mmHg, MSP 179.8 vs 159.3 mmHg). In fully continent patients, both the clinical score and manometric values were quite similar after surgery. Two fully continent patients (25%) developed occasional flatus incontinence and soiling, scoring two and three points, respectively. One patient recurred (6.25%) 6 months after surgery.Conclusion Fistulotomy with sphincter reconstruction seems to be an effective resource in the management of recurrent complex fistula-in-ano. It improves both anal continence and manometric values in incontinent patients without compromising them in fully continent ones.     

现实中哮喘治疗现状的前瞻性、多中心研究

目的 过去对支气管哮喘(简称哮喘)现状的研究多采用横断面的回顾性调查,结果有局限性.本研究采用前瞻性的方法对重庆地区哮喘防治的现状进行研究,为改进目前哮喘的防治提供依据.方法 利用统一的调查问卷,采用前瞻性、多中心、非干预性的研究方法,对重庆地区9家教学医院、市区级医院就诊的184例哮喘患者进行6个月的前瞻性调查研究,调查患者的哮喘控制水平、用药和经济负担等情况.结果 入选患者以重度(62.0％)居多,哮喘控制不佳的患者比例较高,哮喘控制评分(ACT)＜20分占82.6％,采用吸入激素为主治疗方法的患者仅占29.6％.6个月后失访率为34.8％.研究结束时与基线数据比较,哮喘控制水平明显改善(P＜0.001),哮喘加重显著减少(P＜0.001),而且平均医疗费用减低33.9％.结论 地区哮喘控制现状不佳,规范化治疗的患者比例很低.但经规范治疗和管理后,哮喘控制水平显著改善,急性加重率和治疗费用均显著降低.但仍有约1/3的患者不能接受医师的随访,改善哮喘的管理还需要更多的努力.     

Therapeutic Effects of Gelatin-Resorcin-Formal Glue in the Treatment of Postoperative Fistula Following a Low Anterior Resection: Report of a Case

Abstract Postoperative fistulas are among the most difficult and distressing of surgical problems. We describe a case of a discharging fistula that developed after low anterior resection and was successfully treated with a new biologic adhesive agent, gelatin-resorcin-formal glue. To our knowledge, this is the first reported case of a postoperative fistula after colorectal surgery successfully treated with gelatin-resorcin-formal glue. In conclusion, gelatin-resorcin-formal glue is useful for uncontrollable postoperative fistula.     

Clinical Features and Long-term Prognosis of Crohn’s Disease in Korea: Results from the Prospective CONNECT Study

Background/AimsThe prospective Crohn’s Disease Clinical Network and Cohort Study is a nationwide multicenter cohort study of patients with Crohn’s disease (CD) in Korea, aiming to prospectively investigate the clinical features and long-term prognosis associated with CD.MethodsPatients diagnosed with CD between January 2009 and September 2019 were prospectively enrolled. They were divided into two cohorts according to the year of diagnosis cohort 1 (diagnosed between 2009 and 2011) versus cohort 2 (between 2012 and 2019).ResultsA total of 1,175 patients were included, and the median follow-up duration was 68 months (interquartile range, 39.0 to 91.0 months). The treatment-free durations for thiopurines (p<0.001) and anti-tumor necrosis factor agents (p=0.018) of cohort 2 were shorter than those of cohort 1. Among 887 patients with B1 behavior at diagnosis, 149 patients (16.8%) progressed to either B2 or B3 behavior during follow-up. Early use of thiopurine was associated with a reduced risk of behavioral progression (adjusted hazard ratio [aHR], 0.69; 95% confidence interval [CI], 0.50 to 0.90), and family history of inflammatory bowel disease was associated with an increased risk of behavioral progression (aHR, 2.29; 95% CI, 1.16 to 4.50). One hundred forty-one patients (12.0%) underwent intestinal resection, and the intestinal resection-free survival time was significantly longer in cohort 2 than in cohort 1 (p=0.003). The early use of thiopurines (aHR, 0.35; 95% CI, 0.23 to 0.51) was independently associated with a reduced risk of intestinal resection.ConclusionsThe prognosis of CD in Korea appears to have improved over time, as evidenced by the decreasing intestinal resection rate. Early use of thiopurines was associated with an improved prognosis represented by a reduced risk of intestinal resection.