Reducing Psychological Distress in Patients with Inflammatory Bowel Disease by Cognitive-Behavioural Treatment: Exploratory Study of Effectiveness

Background: This prospective study aimed to determine whether cognitive-behavioural group treatment accompanying medical standard care is effective in reducing psychological distress in patients with inflammatory bowel disease. Methods: Twenty-eight outpatients with Crohn disease or ulcerative colitis completed the treatment programme. Psychological treatment consisting of 12 weekly sessions was conducted in a group setting. Medical and psychometric assessments were taken at the beginning of the 3-month pretreatment waiting period, at pretreatment, at post-treatment and at the 3, 6 and 9-month follow-ups. Results: During baseline, no change was observed in psychological distress. Disease-related worries and concerns decreased significantly from pretreatment to the follow-ups. The disease groups differed in the decline of concerns between pre- and post-treatment, with a significant reduction of concerns in patients with ulcerative colitis but not Crohn disease. This difference did not occur at the follow-ups, indicating long-term improvement for both disease groups. Depressive coping decreased significantly in women and remained stable at the follow-ups, whereas depressive coping did not change in men. The same gender difference was found for depressive symptoms. Conclusions: The exploratory findings suggest that psychological group treatment for outpatients is a feasible and effective approach for the short- and long-term reduction of psychological distress for patients with inflammatory bowel disease. However, the revealed gender differences on coping and depression might indicate the necessity to consider gender-specific aspects of inflammatory bowel disease when designing and evaluating psychological interventions.     

Editorial: The CARD15 gene mutation in Crohn disease

Background: The immunosuppressive effects of thiopurine drugs are mainly mediated through their intracellular metabolism into active 6-thioguanine nucleotide (6-TGN) metabolites, which are incorporated into DNA. Erythrocyte 6-TGN (E-6TGN) levels have been proposed as an instrument for monitoring treatment. The aim of the study was to use erythrocyte E-6TGN, methylated mercaptopurine (MeMP) metabolites, and thiopurine methyltransferase (TPMT) measurements in a clinical setting to determine the clinical outcome in relation to thiopurine metabolism. Methods: Fifty-five adult patients with inflammatory bowel disease were included in a prospective study and followed for 6 months. Metabolite levels were measured and correlated to outcome and AZA/6-MP dose. Results: The E-6TGN level was significantly related to the TPMT genotype (P?=?0.008). Patients in disease remission had higher E-6TGN levels than patients with disease activity both at baseline (P?&;lt;?0.05) and after 6 months (P?=?0.02). Active disease was more frequent among subjects with E-6TGN?≤??125?nmol/mmol Hb at baseline (P?=?0.04), but not at 6 months. AZA/6-MP drug dose was positively correlated to E-MeMP levels (r [Formula: See Text]?=?0.48; P?&;lt;?0.001) and E-MeMP/E-6TGN ratio (r [Formula: See Text]?=?0.41; P?=?0.002). Dose changes were positively correlated with the changes in E-MeMP levels (P?=?0.01) and E-MeMP/E-6TGN ratio (P?=?0.03). Conclusions: E-6TGN level was the only factor in this study related to disease activity, while there was no relationship between AZA/6-MP dose and E-6TGN levels. This finding illustrates the clinical usefulness of E-6TGN monitoring in the evaluation of treatment intensity.     

Distribution of prenatal and postnatal risk factors for sudden infant death in Budapest

Mortality from coronary heart disease has decreased by 60% in Finland during the past 25 years. The prevalence of coronary heart disease decreased during the 1990s among the elderly. Silent myocardial infarction was common, especially in elderly women. The number of coronary angioplasty or bypass operations has increased considerably, especially in men. Objective &;#114 - &;#114 To characterise the prevalence of, and changes in, coronary heart disease (CHD) among men and women aged between 64 and 71 years in the 1990s. Design &;#114 - &;#114 A study of clinical epidemiology involving two cohorts of elderly persons in 1990 - 1991 and 1998 - 1999. Setting &;#114 - &;#114 Primary health care in the municipality of Lieto in southwestern Finland. Subjects &;#114 - &;#114 Persons between 64 and 71 years of age in the southwest of Finland in 1990-1991 and 1998-1999. Main outcome measures &;#114 - &;#114 The occurrences of CHD were estimated using the history of a previous myocardial infarction or coronary revascularisation procedure evident in the medical records and with ischaemia or infarction as established on ECG according to the Whitehall criteria. Results &;#114 - &;#114 The prevalence of 'probable' CHD decreased among men and women aged between 64 and 71 years, whereas the prevalence of 'possible' CHD decreased among women alone. Silent myocardial infarctions were common among women of both cohorts. Many more men of the second cohort, compared to the first one, had undergone a coronary angioplasty or bypass operation. Conclusion &;#114 - &;#114 The prevalence of CHD decreased among elderly women more clearly than among young elderly men. The favourable development illustrating a decrease in the prevalence of CHD among women should be sustained, while health promotion activities will need to be directed more actively towards men.     

原发性高血压患者颈动脉粥样硬化与中医证型的关系

目的:探讨原发性高血压患者颈动脉粥样硬化程度与中医辨证分型的关系。方法:用高频(11.4 MHz)彩色多普勒超声检测了130例原发性高血压及心脑血管并发症患者的颈动脉,与37例非高血压心脑血管病患者作对照。结果:高血压各组颈动脉内中膜厚度及斑块检出率均高于对照组,以合并脑血管疾病组内中膜厚度高于单纯高血压组。高血压中医证型之间比较,以痰湿壅盛型内中膜厚度明显高于其他证型,斑块检出率以阴虚阳亢和痰湿壅盛型明显高于其他证型。结论:高血压是引起颈动脉内中膜厚度增加的重要因素。颈动脉粥样硬化程度可作为预测心脑血管病存在的参考指标。动脉硬化的病因病机与痰、瘀密切相关。     

A multi-systemic disease (lupus-like) preceding bronchioloalveolar carcinoma

Summary A patient with a multi-systemic disease (lupus-like) that preceded the onset of a bronchioloalveolar carcinoma is described, and a brief review of the literature is presented. We suggest that this tumor be listed among the neoplasms responsible for multi-systemic diseases with lupus-like characteristics.     

Left ventricular dysfunction during exercise in patients with angina pectoris and angiographically normal coronary arteries (syndrome X)

Left ventricular function during exercise and recovery was investigated in patients with angina pectoris, ST segment depression during exercise and angiographically normal coronary arteries (syndrome X) using a continuous left ventricular function monitor with cadmium telluride detector (CdTe-VEST). Fourteen patients with syndrome X and 14 patients with atypical chest pain without ST segment depression during exercise and normal coronary arteries (control group) performed supine ergometric exercise after administration of 740–925 MBq of technetium-99m labelled red blood cells, and left ventricular function was monitored every 20 s using CdTe-VEST. Left ventricular ejection fraction (EF) response was impaired (55% increase from rest to peak exercise) in 11 or 14 patients with syndrome X but in none of the control patients. Resting EF was similar in the two groups (62.1%±6.7% in patients with syndrome X, 61.9%±6.2% in controls); however, EF increase from rest to peak exercise was lower in syndrome X (–3.1±9.5% vs 14.7%±7.4%, P <0.001). After cessation of exercise, all patients showed rapid EF increase over baseline and this EF overshoot was lower (19.3%±8.3% vs 26.4%±7.3%, P <0.001) with the time to EF overshoot longer (114±43 s vs 74±43 s, P<0.05) in patients with syndrome X. Thus, in patients with syndrome X, left ventricular dysfunction was frequently observed during exercise in spite of normal epicardial coronary arteries. Correspondence to: J. Taki     

Laparoscopic management of colorectal endometriosis

Background: In the past, intestinal endometriosis diagnosed at laparoscopy has generally required conversion to conventional surgery. The purpose of this study was to describe the laparoscopic management of colorectal endometriosis at a tertiary referral center. Methods: From November 1994 to March 1998, 509 consecutive patients with endometriosis requiring laparoscopic intervention were prospectively evaluated. Those with colorectal involvement were analyzed for stage of disease, procedure, operative time, conversion rate, length of hospitalization, and complications. Results: In 30 of the 509 patients (5.9%), colorectal involvement was identified. Twenty-eight of these 30 had stage IV disease. Intestinal involvement was suspected preoperatively in 13 of 30. Twelve required superficial excision of colon or rectal endometriomas. Protectomy/proctosigmoidectomy was done in seven cases, and rectal disc excision was performed in five patients. Four cases required conversion due to the overall severity of the pelvic disease. For those who did (n= 12) and did not (n= 18) require full-thickness excisions/resections, the median operative time was 180 min (range, 90–390) and 110 min (range, 45–355), respectively; the median length of hospitalization was 4 days (range, 3–7) and 1 day (range, 0–4), respectively. A major complication occurred in one patient (colovaginal fistula). At a median follow-up of 10 months (range 1–32), 28 patients were improved, and 24 of these had near or total resolution of preoperative symptoms. Conclusions: Extensive pelvic endometriosis generally requires rectal disc excision or bowel resection. In our experience, laparoscopic treatment of colorectal endometriosis, even in advanced stages, is safe, feasible, and effective in nearly all patients. Received: 1 April 1998/Accepted: 22 March 1999