Efficacy and safety of antiviral therapy in patients with Crohn's disease and chronic hepatitis C

Background  Efficacy and safety of antiviral combination therapy in patients with Crohn's disease (CD) and chronic hepatitis C (CHC) is presently not established and consequently CHC is rarely treated in CD patients.
Aim  To analyse the efficacy and tolerability of antiviral interferon/ribavirin therapy in patients with CHC and CD.
Methods  Eleven HCV-infected CD patients received either 3 × 1.5 μg/kg/week interferon-α-2b or 180 μg/week peginterferon-α-2a (PEGASYS; Roche, Basel, Switzerland) as monotherapy ( n  = 1) or in combination with 800–1200 mg/day ribavirin (COPEGUS; Roche) ( n  = 10) for 24–54 weeks according to HCV-genotype and initial response respectively. Eight patients were under CD-specific therapy.
Results  Five (46%) patients (HCV-1: n  = 3; HCV-2: n  = 0; HCV-3: n  = 1; unknown: n  = 1) achieved a sustained virological response, three (27%) patients relapsed, three (27%) were nonresponders (all GT 1b). At baseline, the Harvey–Bradshaw Index was 0 (0–8) [median (range)], increased on antiviral therapy to 4 (1–15) ( P  = 0.005) and decreased to baseline level 0 (0–6) after 6-month follow-up.
Conclusions  This preliminary experience demonstrates that treatment of CHC in patients with CD is comparable to the treatment of CHC in those without CD. However, gastrointestinal symptoms may be temporarily exacerbated and haemopoietic growth factors may be required.     

Laryngospasm during transtracheal high frequency jet ventilation

A 74-year-old woman developed severe cardiovascular depression during percutaneous transtracheal high frequency jet ventilation for laser surgery of the epiglottis. This was found to be caused by acute airway obstruction secondary to severe laryngospasm. We recommend profound neuromuscular blockade during percutaneous transtracheal jet ventilation, in order to prevent this complication.     

MULTIPLE MYELOMA WITH SYNOVIAL AMYLOID DEPOSITION

A 56-year-old man developed multiple myeloma with severe jointstiffness and arthralgia without definite joint swelling. Atpost-mortem examination large amounts of amyloid were foundby light and electron microscopy in the synovial fluid and onthe surface of the synovial membrane. Smaller amounts of amyloidwere identified beneath the lining cells and in vessel walls.No inflammatory reaction was found in the synovial membraneor fluid. Synovial amyloid may occasionally be responsible forjoint stiffness and arthralgia, as well as for more marked jointchanges mimicking rheumatoid arthritis. The diagnosis can beestablished by synovial biopsy. ^*Supported in part by funds from the Veterans Administration,and grants from the Arthritis Foundation, Eastern PennsylvaniaChapter, and Smith, Kline and French Laboratories.