Clinical presentations and surgical approach of acute intussusception caused by Peutz-Jeghers syndrome in adults.

INTRODUCTION: Peutz-Jeghers syndrome is a rare autosomal dominantly inherited disease characterized by mucocutaneous pigmentations and gastrointestinal polyps. The polyps are located predominantly in the small intestine and usually cause intussusceptions. Adult intussusception caused by Peutz-Jeghers syndrome occurs very rarely. The purpose of this study was to analyze the clinical characteristics, preoperative diagnosis, and surgical management of Peutz-Jeghers syndrome associated with acute intussusception in adult patients. DISCUSSION: Consecutive patients with the postoperative diagnosis of acute intussusception caused by Peutz-Jeghers syndrome from 1995 to 2010 were reviewed retrospectively for this study. Data concerning clinical considerations, morphological examinations, and surgical procedure were analyzed. Different clinical manifestations were presented in patients with intussusception due to Peutz-Jeghers syndrome. Computed tomography associated or not with ultrasonography may be the most accurate examination for acute intussusceptions caused by Peutz-Jeghers syndrome. Surgical intervention is the first choice regimen in acute intussusceptions caused by Peutz-Jeghers syndrome. Prophylaxis and polypectomy of the entire small bowel is a worthy way in Peutz-Jeghers syndrome patients to reduce the frequency of laparotomies.

[The value of erythrocyte sedimentation rate and C-reactive protein in evaluating disease activity in ankylosing spondylitis].

OBJECTIVE: To determine whether erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) is more appropriate in measuring the disease activity in ankylosing spondylitis (AS). METHODS: We studied 126 consecutive patients with AS. The external criteria for disease activity were Cowling clinical assessment of disease activity and the Bath AS disease activity index (BASDAI). In each measure we defined 3 levels of disease activity i.e. no activity, ambiguous activity and definite activity. The patients with AS were divided into 2 groups: those with spinal involvement only and those with peripheral arthritis as well. For each criterion of disease activity, the patients without activity and with definite activity were included in receiver operating characteristic curve, which was used to determine cutoff values with the highest sensitivity and specificity. We also calculated Spearman correlation. RESULTS: The median ESR and CRP were 25.3 mm/1 h and 11.1 mg/L in the spinal group and 30.0 mm/1 h and 15.0 mg/L in the peripheral group. In both groups the Spearman correlation coefficients between ESR and CRP were around 0.30. There was no correlation between ESR, CRP, and the 2 disease activity variables (0.027-0.282). Sensitivity for both ESR and CRP was between 39.4 %and 81.3% for Cowling assessment of disease activity and the BASDAI, while specificity was between 40.0% and 86.7% for all disease activity measures. CONCLUSION: It is concluded that neither ESR nor CRP is superior for assessing disease activity in ankylosing spondylitis.