ABSTRACT
BACKGROUND: Placebo-controlled studies in maintaining remission of symptomatic uncomplicated diverticular disease (SUDD) of the colon are lacking. AIM: To assess the effectiveness of mesalazine and/or probiotics in maintaining remission in SUDD. METHODS: A multicentre, double-blind, placebo-controlled study was conducted. Two hundred and ten patients were randomly enrolled in a double-blind fashion in four groups: Group M (active mesalazine 1.6 g/day plus Lactobacillus casei subsp. DG placebo), Group L (active Lactobacillus casei subsp. DG 24 billion/day plus mesalazine placebo), Group LM (active Lactobacillus casei subsp. DG 24 billion/day plus active mesalazine), Group P (Lactobacillus casei subsp. DG placebo plus mesalazine placebo). Patients received treatment for 10 days/month for 12 months. Recurrence of SUDD was defined as the reappearance of abdominal pain during follow-up, scored as ≥5 (0: best; 10: worst) for at least 24 consecutive hours. RESULTS: Recurrence of SUDD occurred in no (0%) patient in group LM, in 7 (13.7%) patients in group M, in 8 (14.5%) patients in group L and in 23 (46.0%) patients in group P (LM group vs. M group, P = 0.015; LM group vs. L group, P = 0.011; LM group vs. P group, P = 0.000; M group vs. P group, P = 0.000; L group vs. P group, P = 0.000). Acute diverticulitis occurred in six group P cases and in one group L case (P = 0.003). CONCLUSION: Both cyclic mesalazine and Lactobacillus casei subsp. DG treatments, particularly when given in combination, appear to be better than placebo for maintaining remission of symptomatic uncomplicated diverticular disease. (ClinicalTrials.gov: NCT01534754).
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Diverticulum, Colon/drug therapy , Mesalamine/therapeutic use , Probiotics/therapeutic use , Abdominal Pain/etiology , Aged , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Diverticulum, Colon/pathology , Double-Blind Method , Female , Follow-Up Studies , Humans , Lactobacillus , Male , Mesalamine/administration & dosage , Middle Aged , Secondary Prevention , Treatment OutcomeSubject(s)
Cimetidine/administration & dosage , Duodenal Ulcer/therapy , Duodenum/surgery , Gastroenterostomy , Ranitidine/administration & dosage , Adult , Clinical Trials as Topic , Duodenal Ulcer/drug therapy , Duodenal Ulcer/surgery , Female , Follow-Up Studies , Humans , Male , Middle Aged , Multicenter Studies as Topic , Recurrence , Time FactorsABSTRACT
A retrospective study was made of 66 cases in which subtotal thyroidectomy had been carried for hyperthyroid syndromes, mainly of Basedow type, with a view to establishing a more careful selection of thyrotoxicosis candidates for surgery or other management. The reasons for the different findings and post-operation evaluation of performance are analysed in the light of the time of follow-up, mostly within 5 to 15 yr of surgery. Clinical examination in the light of statistical diagnostic indices was supplemented by evaluation of RIA-T3, TSH and T4, and anti-thyroglobulin antibodies. Four different metabolic states were identified: 1) clinical euthyroidism with normal hormone profile (56.1%); 2) latent hypothyroidism, as shown by high TSH, low T4 and normal RIA-T3 (12.1%); 3) frank hypothyroidism, seen in one case only; 4) high TSH, observed as an isolated finding (30.3%). This last group is fully discussed from the prognostic standpoint. It is not considered as an expression of initial hypothyroidism within the present series and its follow-up range, but as indicative of hypersecretion of an abnormal TSH, or as evidence of an increased hypothalamus-hypophysis axis threshold for the retroactive action of circulating T4 and T3. Attention is drawn to differences between surgical and radio-iodiotherapeutic hypothyroidism. The former, in particular, is less frequent, earlier to appear, and less predictable, whereas the latter displays a gradually increasing pattern.
