Factors associated with anti-tumor necrosis factor effectiveness to prevent postoperative recurrence in Crohn’s disease

Background/Aims@#We assessed the effectiveness of anti-TNF agents and its associated factors to prevent endoscopic and clinical postoperative recurrence (POR) in Crohn’s disease (CD). @*Methods@#From a prospectively-maintained database, we retrieved 316 CD patients who underwent intestinal resection (2011–2017). Endoscopic (Rutgeerts index ≥ i2 at 6 months) and clinical (recurrence of symptoms leading to hospitalization or therapeutic escalation) POR were assessed. @*Results@#In 117 anti-TNF-naïve patients, anti-TNF therapy was more effective than immunosuppressive agents (odds ratio [OR], 8.8; 95% confidence interval [CI], 1.8–43.9; P= 0.008) and no medication/5-aminosalicylates (OR, 5.2; 95% CI, 1.0–27.9; P= 0.05) to prevent endoscopic POR. In 199 patients exposed to anti-TNF prior to the surgery, combination with anti-TNF and immunosuppressive agents was more effective than anti-TNF monotherapy (OR, 2.32; 95% CI, 1.02–5.31; P= 0.046) to prevent endoscopic POR. Primary failure to anti-TNF agent prior to surgery was predictive of anti-TNF failure to prevent endoscopic POR (OR, 2.41; 95% CI, 1.10–5.32; P= 0.03). When endoscopic POR despite anti-TNF prophylactic medication (n = 55), optimizing anti-TNF and adding an immunosuppressive drug was the most effective option to prevent clinical POR (hazard ratio, 7.38; 95% CI, 1.54–35.30; P= 0.012). Anti-TNF therapy was the best option to prevent clinical POR (hazard ratio, 3.10; 95% CI, 1.09–8.83; P= 0.034) in patients with endoscopic POR who did not receive any biologic to prevent endoscopic POR (n = 55). @*Conclusions@#Anti-TNF was the most effective medication to prevent endoscopic and clinical POR. Combination with anti-TNF and immunosuppressive agents should be considered in patients previously exposed to anti-TNF.

Vedolizumab for perianal fistulizing Crohn’s disease: systematic review and meta-analysis

Background/Aims@#Perianal fistulas are a debilitating manifestation of Crohn’s disease (CD). Despite the advent of anti-tumor necrosis factor (anti-TNF) therapy, the medical management of fistulizing CD continues to be challenged by unmet needs. We conducted a systematic review and meta-analysis of the effectiveness of vedolizumab for the management of perianal fistulizing CD. @*Methods@#A search of PubMed, EMBASE and the Cochrane Library was performed from inception to June 2020 for studies reporting rates of perianal fistula healing in CD patients treated with vedolizumab. The primary outcome of interest was complete healing of perianal fistulas and the secondary outcome was partial healing. The pooled fistula healing rates with 95% confidence intervals (CI) were calculated utilizing a random effects model. @*Results@#A total of 74 studies were initially identified, 4 of which met the inclusion criteria. A total of 198 patients with active perianal fistulas were included, 87% of whom had failed previous anti-TNF therapy. The pooled complete healing rate was 27.6% (95% CI, 18.9%–37.3%) with moderate heterogeneity (I2=49.4%) and the pooled partial healing rate was 34.9% (95% CI, 23.2%–47.7%) with high heterogeneity (I2=67.1%). @*Conclusions@#In a meta-analysis of 4 studies that included 198 patients with perianal fistulizing CD, the majority of whom had failed previous anti-TNF therapy, vedolizumab treatment led to healing of perianal fistulas in nearly one-third of the patients. The lack of high-quality data and significant study heterogeneity underscores the need for future prospective studies of fistula healing in patients receiving anti-integrin therapy.

effects of atmospheric processes on Tehran smog forming

Air pollution is one of the most important problems in urban areas that always threaten citizen's health. Photochemical smog is one of the main factors of air pollution in large cities like Tehran. Usually smog is not only a part of nature, but is being analyzed as an independent matter, which highly affects on the nature. It has been used as relationship between atmospheric elements such as temperature, pressure, relative humidity, wind speed with inversion in the time of smog forming and weather map in 500 Hpa level during 9 years descriptive static by using correlation coefficient in this analyze. Results show that there is a meaningful correlation between atmospheric elements and smog forming. This relation is seen between monthly average of these elements and monthly average of smog forming. However, when temperature decreases, corresponding pressure will increase and result of this will be smog forming. Usually smog increases in cold months of year due to enter cold high pressure air masses in Iran during December and January that is simultaneous with decreasing temperature and air pressure increases and inversion height distance decreases from the earth surface which cause to integrate air pollution under its surface, will cause to form smog in Tehran. It shows a meaningful and strong relation, based on resultant relations by correlation coefficient from inversion height and smog forming, so that obtained figure is more than 60%

[Surgical treatment of acetabulum fractures [Report of 52 cases]]

This piece of work consists of a study of 52 cases of acetrabular fractures treated with open reduction and internal fixation in the service of Traumatology Orthopedics of the H.U.C Ibn Rochd of Casablance from 1994 to 2004. The average patient age was 37 years. A road traffic accident was the most involved causative mechanism [90%]. The left side was the most affected [60%]. The Judet and Letournel views confronted to the computed tomography data lead to establish diagnosis, to make classification by Judet and Letournel classification and to appreciate congruency by the Duquennoy-Senegas classification. The Kocher-Langenbeck approach was use in 88% of the cases. We have used plates to fix fractures. Screw were use in association with plates in 73%. The functional outcome is assessing according to the Postel Merle D'aubigne score and the results were excellent to good in 65%, fair in 25% and poor in 10% of the cases. We have won 47% on the both vertical and horizontal congruency TT3 and TC3. As complication, we noted 12 cases of osteoarthritis [30%], 9 cases of heterotopic ossifications [23%] and one case of osteonecrosis of femoral head [2.5%]

[Extra-articular malunion of distal radius. [Report of 20 cases]]

Malunion remains the most common complication following fracture of the distal radius. The consequences of the deformities on the wrist function are analysed and a therapeutic strategy is suggested. The authors report 20 cases of non-articular malunion of the distal radius. Preoperative evaluation requires a comparative analysis with clinical and radiological assessment. Corrective posterior osteotomy is performed on the radius in 47% of the cases, an anterior open osteotomy in 37% of the cases, a lateral osteotomy with a closing osteotomy in 10% of the cases, and in one case; an osteotomy of radius lengthening. The bone graft is associated in 50% the cases. At three years follow-up, the functional results are been studied following the lilloise school quotation. Also, the good results became of 0 to 30% and the bad results of 60 to 10%. The non-articular malunions are usually caused by an insufficient initial treatment. Also, the re-orientation osteotomies with bone graft make good results in long term

[Total hip prostheses in osteonecrosis of the femoral head [about 46 cases]]

The authors report a retrospective study about 50 THP realized at the department of the orthopedic-traumatism wing 32 in UHC Ibn Rochd of Casablanca between January 1992 and December 2001. The group includes 22 men [47,8%] and 24 women [52.2%]. The right hip hs been operated on in 30 cases [60%] and the left hip in 20 cases. 20 patients presented an aseptic osteonecrosis caused by a corticotheraphy, 7 patients suffered from ethylism and 5 patients had already been operated on. Postel and Merle d'Aubigne's quotation was used to value the state the hip before and after the operation. The postero-external tract of Moore was used in 47 cases [94%] and Harding in 3 cases [6%]. The THP were cimented in 34 cases [68%] and not cemented in 14 cases [28%]. After a recession of 4,7 years, we noticed as complications: 4 detachments [8%], 4 cases of the hip stiffness and 3 cases of periarticular ossifications, and accords DMA quotation, the results were satisfactory in 32 cases [64%], medium in 12 cases [24%] and bad in 6 cases [12%]. The THP is a choice method in the treatment of femoral head aseptic osteonecrosis, the success of the intervention depends on the respect of the indication and to correct realization of the operation

[Autogenous bone graft reconstruction and Kerboull ring aseptic acetabular loosening]

62 cases of acetabulum reconstruction by Kerboull cross were performed from 1998 to 2003. This reconstruction was realized in 62 cases of acetabulum loosening with bone defect : type III or IV of the SOFCOT classification. The mean follow up was 4 years. We note an increase of PMA score in 92% and 1 losening due to infection. Reconstruction of the acetabulum. Its fixation, the reconstruction of the acetabulum with Kerboull cross is a good alternative to bone defect in acetabulum. Its fixation, the reconstruction of the acetabulum by the bone grafting and the automatic centralization of the hip seems to be the major points of this technique

[Synovial osteochondromatosis of the shoulder. [Report of 3 cases]]

Synovial osteochondromatosis of shoulder is a rare affection, it becomes on the fourth place after the knee, elbow and hip. We report 3 cases in patients of more than 40 years old, the diagnosis suspected after radiologic study is confirmed by histologic study. All the patients benefited from open sky surgical treatment that permitted to make ablation of foreign bodies followed by a synovialectomy [cases n°l and n°2], a resection of the serous bursa with its synovial and a resection of the biceps tendon sheath for the case n°3. The results is affected by late diagnosis

Actinomycosis of the psoas iliac muscle: concerning a case

Actinomycosis are bacterial infections considered non contagious, caused by Actinomyces, gram positive filamentous bacilli, mucuous buccal digestive saprophytes. The abdominal or pelvic locations are rare, and may stimulate a neoplasic affection by causing delicate diagnosis problems. We here report a case of actinomycosis of the right ilio-psoas muscle in a fifty-year old patient with a tumor syndrome of the right iliac fossa, with no abdominal pelvic compression. We did not notice any entrance. The actinomycosis diagnosis was led thanks to anatomo-pathologic exam. The treatment consisted of a tumor resection with betalactamine based antibiotherapy. The pelvic actinomycosis is a rare affection with a difficult diagnosis because of the failure to recognize it as well as its presentation that is similar to a neoplasic process

[Osteosynthesis of pertochanteric fractures by screw [DHS]]

Our retrospective study concerns 46 patients operated on because of pertrochanteric fractures by DHS from December 1992 to November 1993, and supervised till the consolidation with minimal delay of 6 months. These fractures supervene in old persons [mean age is 61,6 years old], the age brackets are 24 and 8 years. The walking after osteosynthesis has been precocious for all the patients. We noticed one death, 1 superficial infection, any case of vicious callus by varus or pseudarthrosis, and 2 disinsertions of material. The average delay of consolidation in our patients is 45 days with extremes [30-60 days]. The functional results are very good [42 cases], mean [3 cases] and bad [1 case]. The serew [DHS] still subject of critics about all the methods of surgical treatment of the pertochanteric fractures. Newertheless, it presents the advantage of the closed focus surgery, in comparison with the pinning of Ender and the plaque lamina, the precocious supervision what ever is the fracture type

[ dislocation-fracture of the Hip [correlation between the type of injury, therapeutic process and the anatomo functional evolution]]

In this retrospective study of 44 cases collected between 1982 and 1992, we try to analyse the lesional relation ship of the luxations - fractures of the hip, the therapeutic processes and the anatomic and functional evolution of this articulation. The mean age of our patients is 35 years old, the extreems are 13 and 70 years. The highway accident is the most fruquent etiology. In 77% of the cases, the luxation has been associated to the fracture of the posterior panes. The lesional association was varied [cranial traumatism, sciatic lesion]. The treatment was orthopedic especially and consisted in the reduction of the luxation emergently and the traction. The surgical treatment of the fracture depended on the result of the reduction, the articular congruence, the fracture type and the residual displacement. The delay was 1 to 10 years, we noticed 24% of bad result, the cephalic necrosis is more frequent in the luxation -fracture than in pure luxations. The risk of arthrosis is important in relation ship with the fractures of isolate socket, we noticed a non neglectable frequency of the periarticular ossifications. We insist on the rigorous pathologic complete physical examination, the emergent treatment, the accurate value of the state of articular congruence [roof theed, socket head] in order to diminish the risk of complications [necrosis, senile coxarthritis]