Impact of topical nonsteroidal anti-inflammatory drugs in prevention of macular edema following cataract surgery in diabetic patients

AIM: To evaluate the efficacy of prophylactic administration of topical non-steroidal anti-inflammatory drugs (NSAIDs) on macular edema following cataract surgery in diabetic patients, and to compare between types of NSAIDs (ketorolac tromethamine 0.4% and nepafenac 0.1%). METHODS: Group 1 (control) received artificial tears substitute as a placebo group, group 2 (nepafenac) received topical nepafenac 0.1%, and group 3 (ketorolac) received topical ketorolac tromethamine 0.4%. Patients were examined postoperatively after completing one week, one month, two months and three months'' intervals for evaluating cystoid macular edema (CME) development. The main study outcomes were achieving the best corrected visual acuity (BCVA) and change in the central macular thickness (CMT) measured with optical coherence topography (OCT). RESULTS: Eighty eyes of 76 patients were included in this study. BCVA showed a statistically significant difference at the third month postoperative follow up between the control group and the NSAIDs groups (P=0.04). There was an increase in the CMT in all cases starting from postoperative first week until third month. CMT showed a statistically significant difference between control group and NSAIDs groups from postoperative first month until third month (P=0.008, 0.027, 0.004). There was no statistically significant difference between nepafenac and ketorolac groups in BCVA and OCT CMT. CONCLUSION: Prophylactic preoperative and postoperative NSAIDs may have a role in reducing the frequency and severity of CME in diabetic eyes following cataract surgery.     

Upper endoscopic findings in children with active juvenile chronic arthritis

Aim: To investigate the association between gastroduodenal mucosal damage and symptoms of the digestive tract in children with juvenile chronic arthritis (JCA) Methods: This was a prospective, open, non-randomized study. Gastroscopy was performed on 45 children with active JCA in 1996-2000. Gastrointestinal symptoms before and during the treatment were noted, as was the length of antirheumatic medication, for which the data were retrospectively assessed. Plasma haemoglobin (Hb) and mean corpuscular volume (MCV) levels and erythrocyte sedimentation rate (ESR) were analysed. Mucosal biopsies were obtained for histology and Helicobacter pylori culture. All patients were taking non-steroidal anti-inflammatory drugs (NSAIDs) and 11 (24.4%) were on peroral steroids; 16 (35.6%) were receiving hydorxychloroquine, 9 salazopyrine, 5 myocrisine and 14 methotrexate. Results: Seven children (15.6%) were found to have active inflammation in their gastric and/or duodenal mucosa, two having ulcers and two being infected with H. pylori. Abnormal endoscopic findings were more common in symptomatic children (n = 24) than in children without symptoms (n = 21) (75% vs 38%, p = 0.017). There was no clear association between the Hb or MCV level and the degree of gastroduodenal inflammation (p = 0.98 and 0.7, respectively). Significantly more children (66.6% vs 33.3%) experienced abdominal pain after beginning medical therapy than before therapy (p = 0.02).

Conclusion: Endoscopic evaluation of patients with JCA and receiving NSAIDs should be considered at least in symptomatic cases.     

非甾体类抗炎剂致上消化道溃疡的临床特点

[目的]研究非甾体类抗炎剂（NSAIDs）相关胃、十二指肠溃疡的临床特点。[方法]统计2001年1月～2006年1月消化病专家门诊及住院患者的临床资料。根据胃镜检查前1周内有无服用NSAIDs史，将138例患者分为A（服NSAIDs，41例）、B（未服NSAIDs，97例）组，对2组患者的临床症状、胃镜、活检结果进行比较。[结果]饱胀、烧心、恶心、腹痛4项主症中前3项A组均高于B组，但腹痛B组高于A组（P〈0．05）。A组中胃溃疡（GID占80．5％（多发性为24．4％），十二指肠球部溃疡（DID为19．5％（多发性4．9％）；B组分别为48．5％（12．4％）、51．5％（11．3％）。活动性溃疡A组占63．4％，溃疡灶〈10mm占80．5％；B组分别为42．3％、62．9％，2组间比较P〈0．01。幽门螺杆菌检出率A组63．4％，B组81．3％，B组明显高于A组（P〈0．05）。[结论]提高临床医师对NSAIDs相关溃疡临床特点的认识，加强对必须服用NSAIDs者的防治及医学指导，尽量减少其不良反应。     

Effect of the non-steroidal anti-inflammatory drug sulindac on colorectal adenomas of uncolectomized familial adenomatous polyposis

Background: The aim of the present study was to elucidate the effect of sulindac on uncolectomized familial adenomatous polyposis (FAP). Methods: Seven FAP patients (SU group) without proctocolectomy were given sulindac 300 mg/day orally for 12 months. Six FAP patients without sulindac (non‐SU group) served as controls. Colorectal lesions were assessed by protrusion index (no. radiolucent areas/cm²; PI) under barium enema examination and non‐polypoid lesion were assessed under chromoscopy prior to and at the end of the observation period. In the SU group, germline adenomatous polyposis coli (APC) mutation was determined by protein truncation test. Results: In the SU group, PI decreased significantly in the distal colon (from 3.0 ± 1.1 to 1.1 ± 0.8/cm², P < 0.02) and in the proximal colon (from 3.4 ± 2.4 to 0.9 ± 1.3/cm², P < 0.02). The PI in the non‐SU group slightly but significantly increased in the distal colon (from 1.0 ± 0.8 to 1.2 ± 0.9/cm²; P < 0.05) and it remained unchanged in the proximal colon (from 0.6 ± 0.3 to 0.7 ± 0.3/cm²; P > 0.05). Chromoscopy at the end of observation identified non‐polypoid lesions in five patients in the SU group, whereas such lesions were not found in the non‐SU group (71% vs 0%, P = 0.016). Decrease in PI was not different among distal APC mutation (exons 1–9), proximal APC mutation (exons 10–15) and negative mutation. Conclusion: Sulindac reduces colorectal adenomas of protruding type in uncolectomized FAP. The effect of sulindac may be unrelated to genotype of FAP.     

非甾体抗炎药预防结直肠息肉的系统评价

目的　评价非甾体抗炎药 (NSAIDs )是否能降低结直肠息肉发生的危险性 ,以及长期使用这些药物的安全性。方法　应用国际Cochrane协作网的系统评价方法对全世界关于NSAIDs与安慰剂或空白对照比较的随机临床对照试验进行系统评价。结果　共有 8篇随机临床对照试验被纳入评价。分析结果显示阿司匹林可以预防结直肠腺瘤的发生 (P =0 0 0 3 ) ,但没有证据支持长期使用苏林酸和塞来昔布可以减少结直肠腺瘤发生的危险性 (P >0 0 5) ,也无证据证明结直肠腺瘤预防与NSAIDs的剂量有关。无论使用阿司匹林还是安慰剂 ,结直肠癌发生的机会相似 (P =0 8)。未发现NSAIDs和安慰剂组间不良反应有差异。结论　在结直肠腺瘤或结直肠癌术后的患者 ,长期使用阿司匹林可减少腺瘤的发生 ;目前尚无常规剂量阿司匹林可减少结直肠癌发生的证据 ,也无长期使用苏林酸和塞来昔布可减少结直肠腺瘤发生危险性的证据     

广东地区上消化道出血病因演变及相关因素分析

目的 探讨近20年来广东地区上消化道出血(UGIB)的病因及死亡率变化.方法 回顾性分析1990年1月至2009年10月广东省人民医院确诊的UGIB患者共3140例,按入院时间顺序及年龄分组,对比UGIB病因的变化及其影响因素.结果 UGIB患者中男性多于女性,性别比为2.5∶1,前后10年性别构成比未发生明显变化;消...     

Impact of Anti-Aggregant,Anti-Coagulant and Non-Steroidal Anti-Inflammatory Drugs on Hospital Outcomes in Patients with Peptic Ulcer Bleeding

Background/Aims:

There are a limited number of studies including the impact of antiplatelet drugs use on hospital outcomes for nonvariceal upper gastrointestinal bleeding. The aim of this study was to determine the effect of anti-aggregant, anti-coagulant and non-steroidal anti-inflammatory drugs upon hospital outcomes in patients with peptic ulcer bleeding.

Materials and Methods:

The patients under treatment with antiaggregant, anticoagulant or non-steroidal anti-inflammatory drugs were categorized as exposed group (n = 118) and the patients who were not taking any of these drugs were categorized as non-exposed group (n = 81). We analyzed the data of drug intake, comorbid disease, blood transfusion, duration of hospital stay, Blatchford/total Rockall score and diagnosis of patients.

Results:

In total, 199 patients were included. Of these 59.3% (exposed group) were taking drugs. The patients in exposed group were significantly older than those in non-exposed group (62.9 ± 17.3 years; 55.5 ± 19.3 years, P = 0.005, respectively). Mean number of red blood cell units transfused (2.21 ± 1.51; 2.05 ± 1.87, P = 0.5), duration of hospital stay (3.46 ± 2.80 days; 3.20 ± 2.30 days, P = 0.532) and gastric ulcer rate (33% vs 23.4%, P = 0.172) were higher in exposed group than in non-exposed group but the differences were not statistically significant. Total Rockall and Blatchford scores of the patients were significantly higher in exposed group than in non-exposed group (3.46 ± 1.72 vs 2.94 ± 1.87, P = 0.045; 10.29 ± 3.15 vs 9.31 ± 3.40, P = 0.038).

Conclusıon:

Our study has shown that anticoagulants, antiaggregants and nonsteroidal anti-inflammatory drugs do not effect duration of hospital stay, red blood cell transfusion requirement and rebleeding for peptic ulcer bleeding.