ABSTRACT
OBJECTIVE: The inflammatory bowel disease (EII) has a chronic evolution with a frequent relapses. There is no specific diagnosis method to detect the patients with a high risk to relapse. The aim of the work was to analyse the prognostic value of 99mTc-HMPAO leukocyte scintigraphy (LS) performed during an acute attack of EII. MATERIAL AND METHODS: 18 patients (mean age 32 +/- 10 years) admitted for an acute attack of EII has been prospectively studied (5 ulcerative colitis [UC] and 13 Cronh's disease [CD]), excluding patient with prior steroids or immunosuppressive therapy during the last year. LS were obtained in basal conditions and following 3 weeks of steroid treatment and the scintigraphic activity index (SAI) has been calculated. Colonoscopy has been done in all patients, and CDAI in CD and Truelove index in UC have been calculated. Patients were followed up for 1 year. In the evolution the therapy requirements as well as the good response to initial treatment have been evaluated. RESULTS: All patients with UC and 4 patients with CD showed a SAI decrease > 50 % and all had a good clinical evolution. Only 2 out of the 9 patients with CD showing a IAG decrease < 50 % and had a good clinical evolution, the 7 remaining required additional medical treatment (immunosuppressors or surgery). CONCLUSION: LS may be of prognostic value in the management of EII. A SAI decrease > 50 % at 3 weeks of steroid treatment indicates a good clinical evolution.
Subject(s)
Inflammatory Bowel Diseases/diagnostic imaging , Leukocytes , Radiopharmaceuticals , Technetium Tc 99m Exametazime , Adult , Female , Humans , Male , Prognosis , Prospective Studies , Radionuclide ImagingABSTRACT
Objetivo. La enfermedad inflamatoria intestinal (EII) tiene una evolución crónica recidivante. No existe ningún método específico para detectar a los pacientes con riesgo elevado de recaída. El objetivo del trabajo ha sido analizar el valor pronóstico de la gammagrafía con leucocitos- 99mTc-HMPAO (GLM) realizada durante un ataque agudo de EII. Material y métodos. Se han estudiado 18 pacientes (32 ± 10 años) con sospecha de un ataque agudo de EII (5 colitis ulcerosa [CU] y 13 enfermedad de Crohn [EC]). Se excluyeron los que habían recibido tratamiento con esteroides o con immunosupresores durante el año anterior. Se obtuvo una GLM en condiciones basales y otra a las 3 semanas de tratamiento esteroideo y se calculó el índice de actividad gammagráfica (IAG). Se practicó una colonoscopia y se calcularon los índices clínico-analíticos, índice de actividad de la EC (Crohn's disease activity index [CDAI]) en la EC y Truelove en la CU. Los pacientes fueron evaluados clínicamente durante un año. En la evolución se valoraron la respuesta o no al tratamiento inicial y la necesidad de nuevas terapias. Resultados. Todos los pacientes con CU y 4 pacientes con EC mostraron una disminución de IAG > 50 %, presentando una buena evolución clínica. Sólo 2 de los otros 9 pacientes con EC mostraron una disminución de IAG 50 % a las 3 semanas de tratamiento esteroideo indica una buena evolución clínica y hace poco probable la aparición de nuevos brotes
Objective. The inflammatory bowel disease (EII) has a chronic evolution with a frequent relapses. There is no specific diagnosis method to detect the patients with a high risk to relapse. The aim of the work was to analyse the prognostic value of 99mTc-HMPAO leukocyte scintigraphy (LS) performed during an acute attack of EII. Material and methods. 18 patients (mean age 32 ± 10 years) admitted for an acute attack of EII has been prospectively studied (5 ulcerative colitis [UC] and 13 Cronh's disease [CD]), excluding patient with prior steroids or immunosuppressive therapy during the last year. LS were obtained in basal conditions and following 3 weeks of steroid treatment and the scintigraphic activity index (SAI) has been calculated. Colonoscopy has been done in all patients, and CDAI in CD and Truelove index in UC have been calculated. Patients were followed up for 1 year. In the evolution the therapy requirements as well as the good response to initial treatment have been evaluated. Results. All patients with UC and 4 patients with CD showed a SAI decrease > 50 % and all had a good clinical evolution. Only 2 out of the 9 patients with CD showing a IAG decrease 50 % at 3 weeks of steroid treatment indicates a good clinical evolution
Subject(s)
Male , Female , Humans , Spectrometry, Gamma/methods , Inflammatory Bowel Diseases , Technetium Tc 99m Exametazime , Leukocytes , Prospective Studies , Recurrence/prevention & control , Predictive Value of TestsABSTRACT
OBJECTIVE: Our aim was to evaluate the efficacy and safety of adding adefovir to lamivudine therapy for hepatitis B virus (HBV)-infected patients resistant to Ramivudine. PATIENTS AND METHODS: Among 17 studied patients, 7 had chronic active HBV infection and 10 were posttransplant with HBV infection (9 with de novo HBV). They received lamivudine plus adefovir therapy for 2 years. We assessed reductions in serum HBV-DNA and alanine aminotransferase (ALT) levels, loss of HBeAg (in HBeAg+ cases), and HBsAg clearance. RESULTS: A virological response, as defined by HBV-DNA below the cut off by hybridization, was observed in 12 (70.6%) patients and loss of HBeAg in 4 (44.4%) of the 9 initially HBeAg-positive cases. A biochemical response, defined as a decreased serum ALT to the normal range, occurred in 4 (26.7%) patients. Median serum creatinine increased in 3 of 15 (20%) patients, excluding those on hemodialysis. There were two noteworthy cases of sustained HBsAg seroconversion with adefovir (11.8%): one patient with de novo HBV infection posttransplantation and positive hepatitis C virus-RNA serology, and one patient with decompensated HBV cirrhosis in whom viral replication ceased, making him eligible for transplantation. CONCLUSIONS: Currently, adefovir is an effective rescue therapy that broadens the existing range of options for patients with lamivudine-resistant chronic hepatitis B infection, particularly those with decompensated cirrhosis awaiting a liver graft, and those with recurrent posttransplantation HBV. The relatively small biochemical response seen in these patients may be attributable to the high prevalence of concomitant hepatitis C virus infection (41%).
