Management of Crohn’s disease in smokers: Is an alternative approach necessary?

Inflammatory bowel disease(IBD) is a chronic condition with a pathogenic background that involves both genetic and environmental factors.Although important progress has been made regarding the former in the last decade,scarce knowledge is available for the latter.In this sense,smoking remains the most important environmental factor in IBD.Active smoking increases the risk of developing Crohn's disease(CD).Moreover,CD patients who start or continue smoking after disease diagnosis are at risk for poorer outco...     

Endoscopic resection of ampullary tumors: 12-year review of 21 cases

Background  Endoscopic snare papillectomy is increasingly performed with curative intent for benign papillary tumors. This study aimed to evaluate the outcome of endoscopic resection for ampullary tumors at a single center. Methods  All ampullary tumors without macroscopic features of malignancy identified by the endoscopic retrograde cholangiopancreatography (ERCP) from January 1995 to February 2007 were included in the study. Papillectomy was performed by snare resection using electrocautery. Argon plasma coagulation was effective for fulguration of small tissue remnants not amenable to snare resection. Results  Of the 21 patients (9 men and 12 women; mean age, 67.2 ± 14.3 years) evaluated, 11 had adenoma (7 had low-grade dysplasia [LGD] and 4 had high-grade dysplasia [HGD]), and 10 had carcinoma. All the patients underwent papillectomy. Of the 21 patients, 18 had extraductal growth or minimal intraductal growth, and 3 had extensive intraductal growth. The endoscopic complications (23.8%) included one case of mild bleeding, two cases of mild pancreatitis, and two cases of moderate pancreatitis. After papillectomy, 15 patients underwent Whipple procedures (endoscopic failure, 74.1%), including 3 patients with extensive intraductal growth (complete removal of the lesion impossible), 9 patients with carcinoma beyond the mucosal layer, and 3 patients with recurrence treated surgically. Endoscopic success (28.5%) was obtained for the remaining six patients (4 with LGD and 2 with HGD). Papillectomy was determined to be curative after a mean follow-up period of 15.9 ± 14.9 months. Conclusions  In the hands of an experienced endoscopist, endoscopic papillectomy is a clinically effective treatment for ampullary tumors without invasive neoplasia. Evaluation of a prepapillectomy tumor extension is an important criterion for assessment of endoscopic success.     

Management of sleep apnea: concordance between nonreference and reference centers

BACKGROUND: When a disorder is as prevalent as sleep apnea-hypopnea syndrome (SAHS), different medical levels and approaches should be involved in facilitating the diagnosis, at least, of patients with symptoms that disrupt social or working life, and of risk groups such as professional drivers. We sought to analyze the degree of concordance between management and treatment decisions for SAHS patients at sleep reference centers (RCs) and at non-RCs (NRCs). MATERIALS AND METHODS: Eighty-eight consecutive patients with suspected SAHS were referred by family doctors to the NRC. The patients were studied randomly at the RC, using full polysomnography, and at the NRC, employing respiratory polygraphy. The concordance in the therapeutic approach between both centers was analyzed via the outcomes, and the physiologic variables of the sleep studies were also evaluated. RESULTS: The concordance in the final clinical decision was substantial. There was a good agreement with respect to apnea-hypopnea index as a categoric variable and as a continuous variable. CONCLUSIONS: These results suggest that respiratory physicians with simple sleep studies are able to manage a large number of patients with SAHS. Trial registration: Clinicaltrials.gov Identifier: NCT 00424658.