RESUMO
OBJECTIVES: Capsule endoscopy (CE) remains the examination of choice for the investigation of obscure gastrointestinal bleeding. Although the factors predicting positive CE findings in the overall obscure gastrointestinal bleeding have been investigated, the clinical characteristics that predict a positive CE in patients with past overt obscure gastrointestinal bleeding (OOGIB) have not been systematically studied. METHODS: Between September 2004 and December 2013, 262 patients underwent CE for evaluation of past OOGIB after negative upper and lower endoscopy, and other diagnostic modalities. Patients' records were retrospectively reviewed to assess the factors that could possibly predict positive CE findings. RESULTS: Two hundred and twenty four patients with a median age of 70 years (range: 17-87) were enrolled in the final analysis and were divided into two groups; those who had positive (group A: 118 patients) and those who had negative CE findings (group B: 106 patients). The overall diagnostic yield of CE was 52.68 %. Multivariate analysis demonstrated that age >65 years, anticoagulant use, antiplatelet use, and non-steroidal anti-inflammatory drugs use were independent predictive factors for positive findings on CE. Of the 118 patients with positive CE, therapeutic interventions were performed in 56 patients (47.46 %). Recurrence of bleeding presented in nine patients of group B compared with 39 patients of group A (p <0.001). CONCLUSIONS: Certain clinical characteristics predict a positive CE in patients with past OOGIB. Patients with OOGIB and negative CE had a considerably lower rebleeding rate, and further invasive investigational procedures may be adjourned or may not be required, though such recommendation warrants further validation. Hippokratia 2016, 20(2): 127-132.
RESUMO
Fraction A, a concentrate derived from short ragweed extract by (NH4)2SO4 precipitation, contains all major allergens including antigen E. Therapeutic efficacy and safety of this alum-adsorbed product was evaluated in a multicenter double-blind clinical trial by comparing it to placebo in 131 randomly matched ragweed hay fever patients who were not treated for at least 1 year. Therapeutic response to fraction A injections was more significant than placebo (p less than 0.05) by investigators' evaluation, by average daily symptom score (1.097 vs. 1.378, p less than 0.05) during the peak ragweed season, or by average proportion of days in which medication was required (0.411 vs. 0.584, p = 0.01). Fraction A patients exhibited a significantly higher (p less than 0.0005) increase in hemagglutinating titer after treatment than placebo controls. Radioallergosorbent binding, evaluated in a subgroup of 31 patients before and after the ragweed season, was unchanged or decreased in 12 of 15 patients treated with fraction A. In contrast, 9 of 16 placebo-treated patients showed an increase in this index. Systemic effects were noted after 42 (1.5%) of 2.641 injections, while local reactions occurred at the rate of 2.3%. It is concluded that a single course of preseasonal immunotherapy wih alum-adsorbed fraction A is effective and relatively safe.
