Mesalazine for diverticular disease of the colon – a new role for an old drug

Colonic diverticulosis is among the most common diseases of developed countries. Its prevalence is ～ 5 – 10% of the population by age 50, and 30, 50 and 66% of those > 50, > 70 and > 85years of age, respectively. Antibiotics have been successfully used in the treatment of uncomplicated diverticular disease; however, the use of mesalazine (alone or in combination with antibiotics) in treating uncomplicated diverticulitis has been successfully developed in recent years. Indeed, mesalazine (with or without antibiotics) showed significant superiority in improving the severity of symptoms, bowel habits, and in preventing symptomatic recurrence of diverticulitis over antibiotics alone. More-over, in light of some preliminary results, it is probable that the association of mesalazine with probiotics may in the future be the first-choice treatment for mild-to-moderate uncomplicated attacks of acute diverticulitis.     

增塑剂及热处理对水性包衣美沙拉秦结肠靶向微丸体外释药 …

以乙基纤维素水分散体Ａｑｕａｃｏａｔ为包衣材料,制备延迟释药的美沙拉秦结肠靶向微丸,考察了４种塑塑剂（三乙酸甘油酯,癸二酯二丁酯、梅楷酸三乙酯、邻苯二甲酸二乙酯）和热处理时间对微丸释药的影响。结果显示,以枸楷酸三乙酯塑化微丸的释药最为理想,在延迟３～４ｈ后开始释药,１２内释药完全,于６０℃处理４ｈ后,释药即趋于稳定。     

抗结肠炎药美沙拉嗪的合成及结构鉴定

报告了抗溃疡性结肠炎药美沙拉嗪的合成工艺及结构鉴定。工艺过程包括重氮化反应、重氮耦合反应和还原反应 ,总收率 6 0 % ,产品含量≥ 99.0 %。通过元素分析、紫外吸收光谱、红外吸收光谱、1 H-核磁共振谱、1 3 C-核磁共振谱和质谱确证了结构     

Pediatric case of mesalazine‐induced interstitial nephritis with literature review

We present the case of a 14‐year‐old boy with ulcerative colitis who was diagnosed with mesalazine‐induced interstitial nephritis (M‐IIN). Improvement in renal function occurred with discontinuation of mesalazine and corticosteroid therapy. We systematically searched the literature for pediatric cases of M‐IIN. There were eight cases. Majority of the cases were boys (75%) with ulcerative colitis (75%). Average duration of mesalazine use prior to the diagnosis of interstitial nephritis was 24 ± 18 months. The median dose was 1.5 g/day. M‐IIN appears to be an idiosyncratic reaction without any relation to dose or duration of mesalazine use. Although there are no guidelines to recommend routine surveillance of renal function, monitoring of serum creatinine in patients on mesalazine remains an inexpensive and non‐invasive test that may lead to early detection and treatment of renal injury.     

Inflammatory bowel disease in subfertile men and the effect of mesalazine on fertility

Abstract

This study aimed to examine the effect of mesalazine on fertility. In this retrospective analysis of 1,225 male subfertile patients, we reviewed the cases of inflammatory bowel disease (IBD) in the medical records and evaluated the prevalence of the disease in our reproduction center. Specifically, we examined IBD patients who ceased mesalazine during male infertility treatment, and compared the seminogram of these patients before and after discontinuation of mesalazine. We also analyzed pregnancy outcome after discontinuation. The prevalence rate of Crohn’s disease and ulcerative colitis in our male infertile patients was 163 per 100,000 men and 490 per 100,000 men, respectively. Seven patients had taken mesalazine and six of them subsequently stopped the medication. The mean values of sperm concentration, sperm motility, percentage of normal formed sperm, semen volume, and total motile sperm count taken before discontinuation increased after discontinuation of mesalazine. Among these parameters, the sperm motility and total motile sperm count were significantly improved (p?<?0.05) after discontinuation. Of the six patients who stopped the drug, four achieved pregnancy with their partners, with two of the four men showing significant improvement not only in the percentage of normal shaped sperm but also sperm motility and total motile sperm count. This study provides further insight into the rarely investigated relationship between male fertility and mesalazine.     

美沙拉秦缓释片治疗溃疡性结肠炎临床研究

目的观察美沙拉秦缓释片在溃疡性结肠炎治疗中的疗效,副作用及半年复发率。方法随机将溃疡性结肠炎患者分为治疗组40例,给美沙拉秦缓释片1 g,3次/d,复方谷胺酰氨0.2 g,3次/d餐后服用。对照组35例,给予柳氮磺胺吡啶1 g,4次/d,复方谷胺酰氨0.2g,3次/d餐后服用,均治疗至4周。而后复查肝肾功能,免疫球蛋白,血尿常规及肠镜,并继续治疗及随访半年。结果治疗组显效率为52.5.0%,总有效率为92.5%,半年复发12.5%,无明显副反应。对照组显效率为25.7%,总有效率为71.4%,半年复发率31.4%;副反应表现白细胞轻度减少4例(11.4%),胃肠道反应8例(22.8%)。结论美沙拉秦缓释片能有效治疗溃疡性结肠炎,副作用少,半年复发低。     

Spectroscopic assessment of dermal melanin using blue vitiligo as an in vivo model

BACKGROUND: Spectroscopic methods have been used to analyze in vivo melanin in the past but the specific effect of melanin depth on autofluorescence and reflectance spectroscopy has not been determined. In patients with blue vitiligo, three distinctive clinicopathologic patterns are present: (1) normal skin with normal epidermal melanin pigmentation (2), skin of blue vitiligo with dermal melanin pigmentation, and (3) tissue of regular vitiligo with no melanin pigmentation. Blue vitiligo may thus serve as an in vivo model to assess dermal pigment using spectroscopic techniques. OBJECTIVES: To evaluate the reflectance and autofluorescence spectra of a patient with blue vitiligo in order to assess the effect of melanin pigmentation and its localization on the optical properties of the skin. METHODS: The blue-gray, normal and depigmented lesions of a patient with blue vitiligo were analyzed using reflectance and fluorescent spectroscopy. The condition was likely induced by a phototoxic reaction in a patient with pre-existing vitiligo. These data were then correlated to the histologic and electron microscopic findings present in the various types of lesions. RESULTS: Reflectance spectroscopy detected little difference in spectral shape between skin sites affected by blue vitiligo vs. vitiligo. Autofluorescence spectroscopy detected an apparent difference between the two types of lesions, with the blue-gray lesions (blue vitiligo) showing lower fluorescence intensity and spectral maximum position red-shifted compared with regular vitiligo, whereas regular vitiligo showed more intense hemoglobin absorption than the blue vitiligo. CONCLUSIONS: Dermal melanin present in blue vitiligo can be well characterized by autofluorescence spectroscopy, while little difference in reflectance spectral shape exists between vitiligo and blue vitiligo. Thus, autofluorescence spectroscopy may better identify deeper structures in skin tissue, such as melanin, than reflectance spectroscopy.     

Mesalazine in treating diverticular disease of the colon

Evaluation of: Kruis W, Meier E, Schumacher M, Mickisch O, Greinwald R, Mueller R; German SAG-20 Study Group. Randomised clinical trial: mesalazine (Salofalk granules) for uncomplicated diverticular disease of the colon – a placebo-controlled study. Aliment. Pharmacol. Ther. 37(7), 680–690 (2013).

Although diverticular disease (DD) is one of the commonest diseases in the western world, robust evidences about its treatment are lack so far. A recent, placebo-controlled study found mesalazine effective in obtaining pain relief in patients suffering from DD. A brief comment is provided herein in order to assess the rationale of this drug in treating DD.     

Maternal use of 5-aminosalicylates in early pregnancy and congenital malformation risk in the offspring

Abstract

Objective. Most previous studies have failed to demonstrate any effect of maternal use of 5-aminosalicylates (5-ASA) on malformation risk, but the number of infants studied have, in most cases, been low. The objective of the study was to get data from a large study with prospectively ascertained exposure information. Material and methods. The study was based on data in the Swedish Medical Birth Register (1996–2011) where identification of maternal drug use is made from midwife interviews in early pregnancy. The presence of congenital malformations was ascertained from three national registers. Adjusted odds ratios were calculated by the Mantel-Haenszel methodology. Results. Among 1,552,109 women, 3651 with 3721 infants had reported the use of 5-ASAs in early pregnancy. The risk of a major malformation was increased (1.37, 95% confidence interval = 1.17–1.62) and still more for a cardiovascular defect (1.74, 1.37–2.22). This effect seemed to be influenced by concomitant use of systemic glucocorticosteroids or immunosuppressants but some confounding by indication may also exist. There was no marked difference between the four 5-ASA drugs studied. Conclusions. Infants born of women who use 5-ASA drugs in early pregnancy have an increased risk of a congenital malformation, notably a cardiovascular defect. This could be a drug effect or an effect of an active inflammatory bowel disease.