Inflammatory bowel disease: re-evaluation of the diagnosis in a prospective population based study in south eastern Norway.

BACKGROUND: The incidence figures for ulcerative colitis (UC) and Crohn's disease (CD) have been difficult to interpret, and geographical variations may be due to differences in classification criteria and study design. Few studies have based the incidence on prospective systematic follow up to confirm the initial diagnosis. METHODS: Between 1990 and 1993, in a prospective incidence study of inflammatory bowel disease (IBD) in south eastern Norway, 527 cases of UC, 228 cases of CD, 36 cases of indeterminate colitis (IND), and 55 cases of possible IBD were identified, yielding an annual incidence of 13.6, 5.9, 0.9, and 1.4 per 10(5) respectively. The diagnosis and all clinical data were reviewed by two gastroenterologists independently of each other. One to two years after diagnosis, all patients were offered a clinical follow up in which the initial diagnosis was assessed. RESULTS: Between the time of diagnosis and the follow up, 16 patients had died, four of complications related to IBD. Of the remaining 830 patients, 98% (814/830) were available for follow up, 93% (772/830) attended a clinical examination which included a colonoscopy in 77% (637/830), and the remainder had had a telephone interview, or reassessment based on hospital records, or both. Twenty seven patients were reclassified as not having IBD (3%), and 65 patients were characterised as possible IBD (8%). Of the patients initially classified as UC, 88% had their diagnosis confirmed, compared with 91% with an initial diagnosis of CD. In patients with indeterminate colitis, 33% were classified as definite UC and 17% as CD. This reclassification of patients yielded a corrected annual incidence of 12.8 for UC and 6.0 for CD. CONCLUSION: At follow up one to two years after the diagnosis of IBD, the initial incidence was only marginally altered. This is probably due to uniform inclusion criteria and careful diagnostic methods. The study also illustrates the importance of the re-evaluation of the initial diagnosis as close to 10%, both among patients with UC and CD, were reclassified at follow up.     

Balance and gait improved in patients with MS after physiotherapy based on the Bobath concept

Background and Purpose . Patients with multiple sclerosis (MS) tend to have movement difficulties, and the effect of physiotherapy for this group of patients has been subjected to limited systematic research. In the present study physiotherapy based on the Bobath concept, applied to MS patients with balance and gait problems, was evaluated. The ability of different functional tests to demonstrate change was evaluated. Method . A single‐subject experimental study design with ABAA phases was used, and two patients with relapsing–remitting MS in stable phase were treated. Tests were performed 12 times, three at each phase: A (at baseline); B (during treatment); A (immediately after treatment); and A (after two months). The key feature of treatment was facilitation of postural activity and selective control of movement. Several performance and self‐report measures and interviews were used. Results . After intervention, improved balance was shown by the Berg Balance Scale (BBS) in both patients, and improved quality of gait was indicated by the Rivermead Visual Gait Assessment (RVGA). The patients also reported improved balance and gait function in the interviews and scored their condition as ‘much improved’. Gait parameters, recorded by an electronic walkway, changed, but differently in the two patients. Among the physical performance tests the BBS and the RVGA demonstrated the highest change, while no or minimal change was demonstrated by the Rivermead Mobility Index (RMI) and Ratings of Perceived Exertion (RPE). Conclusion . The findings indicate that balance and gait can be improved after physiotherapy based on the Bobath concept, but this should be further evaluated in larger controlled trials of patients with MS. Copyright © 2006 John Wiley & Sons, Ltd.     

Post-polio syndrome patients treated with intravenous immunoglobulin: a double-blinded randomized controlled pilot study

Post-polio syndrome (PPS) is characterized by new muscle weakness, atrophy, fatigue and pain developing several years after the acute polio. Some studies suggest an ongoing inflammation in the spinal cord in these patients. From this perspective, intravenous immunoglobulin (IvIg) could be a therapeutic option. We performed a double-blinded randomized controlled pilot study with 20 patients to investigate the possible clinical effects of IvIg in PPS. Twenty patients were randomized to either IvIg 2 g/kg body weight or placebo. Primary endpoints were changes in pain, fatigue and muscle strength 3 months after treatment. Surrogate endpoints were changes in cerebrospinal fluid (CSF) cytokine levels. Secondary endpoints were pain, fatigue and isometric muscle strength after 6 months. Patients receiving IvIg reported a significant improvement in pain during the first 3 months, but no change was noted for subjective fatigue and muscle strength. CSF levels of tumour necrosis factor- α (TNF- α ) were increased compared with patients with non-inflammatory neurological disorders. In conclusion, in this small pilot study no effect was seen with IvIg treatment on muscle strength and fatigue, however IvIg treated PPS patients reported significantly less pain 3 months after treatment. TNF- α was increased in the CSF from PPS patients. The results are promising, but not conclusive because of the low number of patients studied.     

Effect of subcutaneous suture line and surgical technique on wound infection after saphenectomy in coronary artery bypass grafting: a prospective randomised study

Objective. The aim of the study was to evaluate the impact of an additional subcutaneous suture line on the incidence of postoperative (p.o.) infection at the vena saphena magna harvesting site (VSMHS) after coronary artery bypass grafting (CABG). Methods. Two hundred and forty three patients undergoing CABG were included. Patients in Group A (n?=?119) all operated by one physical assistant (PA) were prospectively randomised into Group A1 (n?=?59) receiving intracutaneous closure suture alone whereas 60 patients (Group A2) received an additional subcutaneous suture line. Group B (n?=?120), operated by surgical residents, served as control population. All patients were due to follow-up at six weeks p.o. Results. Subcutaneous suture did not impact the p.o. infection rate (A2 vs. A1; 4/60 vs. 2/59, n.s.). A significant lower p.o. infection rate was observed in Group A vs. Group B (6/119 (5%) vs. 15/120 (13%) p?<?0.05). Conclusion. Subcutaneous suture did not impact the p.o. infection rate at VSMHS. The infection rate observed in patients operated by an experienced PA was significantly lower than in patients operated by various surgical residents.     

Narrowing effect of off-pump CABG on the LIMA-LAD anastomosis: epicardial ultrasound assessment

AIM: Effects of off-pump CABG on LIMA-LAD anastomotic dimensions vs. on-pump CABG assessed by epicardial ultrasound imaging. MATERIAL AND METHODS: LIMA-LAD anastomoses were performed off-pump in 38 patients and on-pump in 12. Intra-operative imaging was by a GE Vivid 7 ultrasound scanner and i13L transducer. Length of the anastomosis (DA), LAD diameters at the toe (D1) and heel (D3) of the anastomosis, the reference downstream LAD (D2) were measured in diastole by two-dimensional imaging (B-mode). Relationships between these dimensions were compared between on- and off-pump patients. RESULTS: In off-pump patients, D3 dimension was smaller than D1 (p=0.004). Both D3 and D1 were smaller than D2 (p<0.01). Ratio D3/D2 was smaller than D1/D2 (p=0.009). In on-pump patients, these ratios were similar. D3/D2 ratio was smaller in off- than in on-pump patients (p=0.01), D1/D2 were similar in the two groups. CONCLUSION: Off-pump CABG may cause a narrowing of the coronaries, especially at the anastomotic heel. The anastomotic technique at the heel may have to be modified to improve its patency.     

Health-related quality of life in patients with inflammatory bowel disease five years after the initial diagnosis

BACKGROUND: Health-related quality of life (HRQOL) has become an important tool in evaluating patient satisfaction in inflammatory bowel disease (IBD). So far, few prospective follow-up studies have been done to identify variables that influence HRQOL. We aimed to identify demographic and clinical variables that influence HRQOL 5 years after diagnosis in patients with ulcerative colitis (UC) or Crohn disease (CD) included in a prospective follow-up study from 1990 to 1994 (the IBSEN study). METHODS: All patients completed the Inflammatory Bowel Disease Questionnaire (IBDQ), a disease-specific quality-of-life questionnaire translated into Norwegian and validated. We present data from 497 patients (328 UC patients and 169 CD patients, mean age 43.3 years, 48% female). The impact of age, gender, smoking, symptom severity, disease distribution, rheumatic symptoms and surgery on IBD patients' HRQOL was analysed. RESULTS: Women had a reduction in IBDQ total score of 10 points compared to men, CD patients had a reduction of 7.5 compared to UC patients. The patients with moderate/severe symptoms had a 50 points lower score than the patients without symptoms. The patients with rheumatic symptoms had a 10 points lower total score than the patients without these symptoms. All differences were statistically significant. The multiple regression analysis showed that symptom severity, rheumatic symptoms and female gender were the strongest predictors of reduction in HRQOL for both diagnosis groups. CONCLUSION: IBD symptoms, rheumatic symptoms and female gender have a significant influence on patients' HRQOL as measured by IBDQ. This was confirmed by the regression analysis.     

The effect of insulin-induced hypoglycemia with and without atropine on plasma vasoactive intestinal polypeptide in man

Plasma vasoactive intestinal polypeptide (VIP) was measured in six healthy male students on 2 separate days after insulin-induced hypoglycemia with and without atropine and on a 3rd day in five of the students after atropine alone. A significant increase in peripheral plasma VIP was observed when atropine was given together with insulin, whereas insulin or atropine alone had no effect on plasma VIP. It is suggested that cholinergic nicotinic receptors may be involved in the increase of VIP after insulin-induced hypoglycemia and that the lack of VIP increase seen after insulin alone may be caused by an inhibitory effect of other gastrointestinal hormones.