ABSTRACT
Cirrhosis with decompensation has a poor prognosis, high symptom burden and causes carer stress. This pilot research in one tertiary hospital found that patients with cirrhosis with decompensation were infrequently referred to specialist palliative care. Despite this, they had a heavy symptom burden, high predicted mortality, frequent unplanned readmissions, long admissions and intensive care unit admissions. Few had adequate advance care planning.
Subject(s)
Heart Failure/epidemiology , Heart Failure/therapy , Liver Cirrhosis/epidemiology , Liver Cirrhosis/therapy , Palliative Care/trends , Tertiary Care Centers/trends , Adult , Advance Care Planning/trends , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Pilot Projects , Referral and Consultation/trendsSubject(s)
Arteriovenous Fistula/pathology , Colon/pathology , Embolization, Therapeutic/adverse effects , Mesenteric Artery, Inferior/pathology , Proctocolitis/etiology , Arteriovenous Fistula/complications , Arteriovenous Fistula/diagnostic imaging , Colon/blood supply , Colon/diagnostic imaging , Colonoscopy/methods , Computed Tomography Angiography/methods , Embolization, Therapeutic/methods , Humans , Male , Mesenteric Artery, Inferior/diagnostic imaging , Mesenteric Ischemia/pathology , Mesenteric Veins/diagnostic imaging , Mesenteric Veins/pathology , Proctocolitis/diagnostic imaging , Proctocolitis/pathology , Sigmoidoscopy/methods , Treatment Outcome , Young AdultABSTRACT
Interferon alpha (IFNα) has immune stimulatory actions implicated in its pulmonary toxicities. We describe deterioration of idiopathic pulmonary fibrosis (IPF) associated with IFNα treatment for chronic hepatitis C in a 58 year old woman culminating in a fatal suspected acute exacerbation of IPF (AE-IPF). Caution should be exercised in the use of IFNα in subjects with concomitant IPF given its known immunostimulatory effects and possible role in this suspected AE-IPF.
ABSTRACT
BACKGROUND: Inflammatory dermatoses in conjunction with inflammatory bowel disease (IBD) comprise a diverse range of disorders. Some but not all of these respond to conventional treatments for the underlying IBD, such as immunomodulating or antibiotic treatments. We describe our experience with high dose vitamin B12, where conventional therapies have failed. CASE REPORTS: The first case had pouchitis complicated by perianal abscesses and a recto-vaginal fistula. The second case had biopsy proven hidradenitis suppurativa affecting the perianal, inguinal and pubic skin. High dose vitamin B12 appeared to be the major factor in preventing the recurrence of suppuration in both patients. Neither patient had vitamin B12 deficiency. Open label experience: high dose vitamin B12 treatment of a further 10 consecutive IBD patients with dermatoses was thought to provide benefit to six of them, but did not appear useful in four patients with perianal Crohn's disease with fistulae as the only manifestation of cutaneous disease. CONCLUSIONS: There appears to be a subset of IBD patients with perianal and more distant inflammatory dermatoses, who benefit from high dose vitamin B12 treatment. Clinical trials in IBD patients with biopsy-characterised suppurative dermatoses will be required in order to properly define the role of this safe and economical therapy.
