[Meningitis due to Listeria monocytogenes as a complication of infliximab therapy]. / Meningitis door Listeria monocytogenes als complicatie van behandeling met infliximab.

A 41-year-old woman was admitted to the hospital with meningitis caused by Listeria monocytogenes. Because of her Crohn's disease she used prednisolone and azathioprine. Two weeks before presenting with meningitis, infliximab had been given as the other immunosuppressant drugs had no effect. This tumour necrosis factor alpha (TNF alpha) blocking agent is known to increase the risk of opportunistic infections. This is the first Dutch patient described with meningitis caused by L. monocytogenes after treatment with infliximab. She recovered after antibiotic therapy. When antibiotic treatment is chosen, the possibility of opportunistic infections in patients who use infliximab concurrently with other immunosuppressant drugs should be taken into account.

Retractile mesenteritis: to treat or not to treat.

Retractile mesenteritis is a rare entity characterized by an inflammatory process of the mesenteric adipose tissue. The disease usually presents with abdominal pain or a palpable abdominal mass. In the majority of cases, the disease is self-limiting and the prognosis is favorable. In this paper we describe a patient who presented with a 7 x 8 cm mass in the left upper abdomen, nausea and pain in the lower back. Symptomatic treatment was given with good result. The literature on different therapeutic intervention is briefly discussed.

Combination therapy of sucralfate and ranitidine, compared with sucralfate monotherapy, in patients with peptic reflux esophagitis.

A double-blind, multicenter, randomized study was performed in 75 patients with endoscopically documented reflux esophagitis. Patients were randomly given 1 g sucralfate four times a day or the combination of sucralfate three times a day and 300 mg ranitidine after dinnertime. Endoscopy was performed at the beginning of the study, after 8 weeks, and, if, the reflux esophagitis was not healed, after 16 weeks. Four patients had to be excluded from evaluation; 71 patients could therefore be evaluated. Both groups showed symptomatic improvement to similar extents. Endoscopy showed symptomatic improvement in 67% of the patients treated with sucralfate and in 74% of the combination therapy group. Complete healing or Savary-Miller stage 1 was seen in 26.5% and in 31.4%, respectively. We conclude that sucralfate monotherapy in patients with milder forms of reflux esophagitis is comparable with a combination of sucralfate during the day and ranitidine after dinnertime. This study does not support the commonly used combination of sucralfate and H2-receptor antagonists in reflux esophagitis.

Combination therapy of sucralfate and cimetidine, compared with sucralfate monotherapy, in patients with peptic reflux esophagitis.

A double-blind multicenter, randomized study was performed in 70 patients with endoscopically documented reflex esophagitis. Patients were randomly given 1 g sucralfate four times a day or the combination of sucralfate 1 g three times a day and 400 mg cimetidine at night. After healing of the esophagitis, patients were randomly given either sucralfate maintenance 2 g daily or placebo for a period of six months. Endoscopy was performed at the beginning of the study, after eight weeks, and, in cases with no healing, after 16 weeks of therapy. Sixty-three of the 70 patients who initially entered the study could be evaluated after eight weeks. Both groups showed good symptomatic improvement, and no side effects necessitated withdrawal of subjects. Endoscopy showed complete healing in 19.4 percent of the sucralfate group and in 21.9 percent of the combination sucralfate and cimetidine group. Endoscopic improvement was found in 50 percent of the sucralfate group and in 50 percent of the combination group. After 16 weeks, 56 patients could be evaluated. In the sucralfate group, improvement was seen in 78.6 percent, and healing in 31 percent. For the combination group these values were 59.3 percent and 37 percent (not significant). Twenty-six patients entered the maintenance phase of the study; 15 received sucralfate and 11 received placebo. Evaluation of 20 patients after six months showed endoscopic and/or symptomatic relapse of esophagitis in three of 12 patients receiving sucralfate and in two of the eight patients receiving placebo. It is concluded that sucralfate monotherapy in patients with reflux-esophagitis is effective and comparable with a combination of sucralfate during the day and cimetidine at night. No difference was found between sucralfate and placebo in terms of the relapse rate of esophagitis during long-term treatment.

The operated stomach: a premalignant condition? A prospective endoscopic follow-up study.

2633 consecutive patients in whom a gastric operation had been performed between 1931 and 1960 were selected for an ongoing prospective follow-up study. In 741 already deceased patients mortality due to gastric cancer was 5.13%. 504 asymptomatic postgastrectomy patients participated in an endoscopic-bioptic screening program. Up to now, 10 stump cancers have been detected. Seven had a radical curative resection, and all are still alive. In five of them the cancer was limited to the mucosa and not visible at endoscopy. Gastric dysplasia was found in 70 patients. In three patients with severe dysplasia carcinoma was detected during follow-up study. In 22 patients with prior mild or moderate dysplasia no progression could be demonstrated. Cancer in postgastrectomy patients is estimated to be at least twice as high as in an age-matched Dutch control population with intact stomach. The risk depends on the postoperative interval and the age at which the initial operation was performed. In general, patients from the age of 50 onwards or more than 10-15 years after initial surgery are at risk.