ABSTRACT
BACKGROUND & AIMS: Because the reoperation rate for Crohn's disease is high after resective surgery, use of conservative surgery has increased. Mesalamine was investigated for the prevention of postoperative relapse, with disappointing results. The role of azathioprine in the postoperative setting is unknown. We aimed to compare the efficacy and safety of azathioprine and mesalamine in the prevention of clinical and surgical relapse in patients who have undergone conservative surgery for Crohn's disease. METHODS: In a prospective, open-label, randomized study, 142 patients received azathioprine (2 mg. kg -1. day -1 ) or mesalamine (3 g/day) for 24 months. Clinical relapse was defined as the presence of symptoms with a Crohn's Disease Activity Index score >200 and surgical relapse as the presence of symptoms refractory to medical treatment or complications requiring surgery. RESULTS: After 24 months, the risk of clinical relapse was comparable in the azathioprine and mesalamine groups, both on intention-to-treat (odds ratio [OR], 2.04; 95% confidence interval [CI], 0.89-4.67) and per-protocol analyses (OR, 1.79; 95% CI, 0.80-3.97). No difference was observed with respect to surgical relapse at 24 months between the 2 groups. In a subgroup analysis, azathioprine was more effective than mesalamine in preventing clinical relapse in patients with previous intestinal resections (OR, 4.83; 95% CI, 1.47-15.8). More patients receiving azathioprine withdrew from treatment due to adverse events than those receiving mesalamine (22% vs. 8%; P = 0.04). CONCLUSIONS: While no difference was observed in the efficacy of azathioprine and mesalamine in preventing clinical and surgical relapses after conservative surgery, azathioprine is more effective in those patients who have undergone previous intestinal resection.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Azathioprine/administration & dosage , Crohn Disease/prevention & control , Immunosuppressive Agents/administration & dosage , Mesalamine/administration & dosage , Adolescent , Adult , Aged , Crohn Disease/surgery , Digestive System Surgical Procedures/methods , Female , Humans , Male , Middle Aged , Postoperative Period , Prospective Studies , Secondary Prevention , Treatment OutcomeABSTRACT
BACKGROUND/AIMS: Pancreas carcinoma is seldom recognized at an early stage. Through an attentive retrospective evaluation of the patient's history a frequent pattern of early presentation is sought. METHODOLOGY: A series of 64 patients (36 males; 28 females) with histologically proven pancreas carcinoma seen in the Department of Surgery and the Oncology Department of the University of Milan (Ospedale "L. Sacco") in the years 1992 through 2001, is closely scrutinized, tracing the very initial signs and symptoms in each individual case. RESULTS: Weight loss is by far the most frequent early complaint, being the presenting symptom in more than 79% of cases, either alone or associated with one or more additional symptoms, followed by pain (56%), anorexia (28%), jaundice (25%) and asthenia (23%). However it appears that weight loss is often overlooked until other more suggestive symptoms ensue. In particular, slowly developing jaundice was the most common indication for ultrasound scan or computed tomography study, although jaundice was the presenting symptom in only 25% of cases. CONCLUSIONS: In patients presenting with unexplained weight loss, a more liberal use of diagnostic imaging techniques in the upper abdomen might be advisable.
