Inflammatory bowel disease associated with Yersinia enterocolitica O:3 infection.

BACKGROUND: Certain microorganisms may be associated with the development of inflammatory bowel disease (IBD). These pathogens may possess such properties as immunological capability or tissue invasiveness. An association between Yersinia enterocolitica infection and ulcerative colitis (UC) was suggested 30 years ago, and a connection with Crohn's disease (CD) may also exist. The aim of this study was to further elucidate the association between Y. enterocolitica O:3 infection and IBD. METHODS: During the period 1990-1997, antibody response against Y. enterocolitica was estimated in 1588 patients by tube agglutination. Forty-one patients with Y. enterocolitica infection (titer = 320) constituted the study group; 1041 patients without antibody response constituted the control group. The study was completed in 2003, after 6-13 years. RESULTS: At diagnosis of Y. enterocolitica infection, UC of acute onset was demonstrated in three males; another suffered from CD. At follow-up, two additional patients had developed UC and two CD. In the control group, 32 patients were diagnosed as having UC and 10 CD. This difference in IBD prevalence is significant (8/41>42/1041, p=0.00035), as were the differences in prevalence of UC and CD separately (p=0.006; viz. p<0.015). CONCLUSION: The present study supports the concept of the Y. enterocolitica infection as a trigger of chronic IBD.

Influence of failure of primary wound healing on subsequent recurrence of pilonidal sinus. combined prospective study and randomised controlled trial.

OBJECTIVE: To find out whether failure of primary wound healing after excision and primary suture for chronic pilonidal sinus predicts recurrence. DESIGN: Follow-up of one prospective study and one subsequent randomised, multicentre study. SETTING: Three teaching hospitals in WesternNorway. SUBJECTS: A total of 197 consecutive patients operated on for chronic pilonidal sinus. INTERVENTIONS: Fifty two patients in the prospective group were given cloxacillin perioperatively. In the randomised study, 145 patients were randomised to have either a single preoperative dose of cefoxitin 2 g intravenously (n = 73) or no prophylaxis (n = 72). Patients were followed up for a median of 7 years. MAIN OUTCOME MEASURES: Recurrence of pilonidal sinus. RESULTS: In the prospective group there were 10 recurrences (19%). In the randomised study 6 patients (8%) who had been given antibiotic prophylaxis had a recurrence compared with 14 patients (19%) who had not been given prophylaxis (p = 0.09). In both groups, failure of primary normal healing was significantly associated with early recurrence (p = 0.0002). Neither the use of antibiotics nor sex had any significant influence on the incidence of recurrences. Most recurrences occurred within the first year. CONCLUSION: Wound complications significantly influenced the recurrence rate whereas antibiotics did not. Most recurrences were seen early.