Patients In CD Group Research Articles

Chronic subdural hematoma drainage using anti-thrombotic catheter technique

BackgroundBurr hole evacuation is a well-established treatment for symptomatic cases with chronic subdural hematoma (cSDH). Routinely postoperative catheter is left in the subdural space to drain the residual blood. Drainage obstruction is commonly seen, and it can be related to suboptimal treatment. MethodsTwo groups of patients submitted to cSDH surgery were evaluated in a retrospective non-randomized trial, one group that had conventional subdural drainage (CD group, n ​= ​20) and another group that used an anti-thrombotic catheter (AT group, n ​= ​14). We compared the obstruction rate, amount of drainage and complications. Statistical analyses were done using SPSS (v.28.0). ResultsFor AT and CD groups respectively (median ​± ​IQR), the age was 68.23 ​± ​26.0 and 70.94 ​± ​21.5 (p ​> ​0.05); preoperative hematoma width was 18.3 ​± ​11.0 ​mm and 20.7 ​± ​11.7 ​mm and midline shift was 13.0 ​± ​9.2 and 5.2 ​± ​8.0 ​mm (p ​= ​0.49). Postoperative hematoma width was 12.7 ​± ​9.2 ​mm and 10.8 ​± ​9.0 ​mm (p ​< ​0.001 intra-groups compared to preoperative) and MLS was 5.2 ​± ​8.0 ​mm and 1.5 ​± ​4.3 ​mm (p ​< ​0.05 intra-groups). There were no complications related to the procedure including infection, bleed worsening and edema. No proximal obstruction was observed on the AT, but 8/20 (40%) presented proximal obstruction on the CD group (p ​= ​0.006). Daily drainage rates and length of drainage were higher in AT compared to CD: 4.0 ​± ​1.25 days vs. 3.0 ​± ​1.0 days (p ​< ​0.001) and 69.86 ​± ​106.54 vs. 35.00 ​± ​59.67 ​mL/day (p ​= ​0.074). Symptomatic recurrence demanding surgery occurred in two patients of CD group (10%) and none in AT group (p ​= ​0.230), after adjusting for MMA embolization, there was still no difference between groups (p ​= ​0.121). ConclusionThe anti-thrombotic catheter for cSDH drainage presented significant less proximal obstruction than the conventional one and higher daily drainage rates. Both methods demonstrated to safe and effective for draining cSDH.

P166 Predictive markers of Crohn’s disease in small bowel capsule endoscopy

Abstract Background To distinguish between functional gastrointestinal disorders like irritable bowel syndrome (IBS) and Crohn’s disease (CD) can be a burden. The diagnosis is based on symptoms and findings in laboratory tests, endoscopy and imaging. As CD can be limited to small bowel, the diagnosis often requires small bowel capsule endoscopy (SBCE), which is time consuming for both the patient and clinician. Methods To answer this problem, we conducted a retrospective study of 374 patients who underwent SBCE for suspected small bowel CD in Turku University Hospital between 2012 and 2020 and gathered data on the patient’s laboratory, imaging and endoscopic findings at the time of SBCE. The patient’s history, medications and procedures related to CD were also documented after SBCE. SBCE findings were graded along CECDAI (Capsule Endoscopy Crohn’s Disease Activity Index) -scoring system. The main goal was to find predictive markers to rule out clinically significant small bowel CD without proceeding to SBCE. Results Small bowel CD was diagnosed in 110 (29.4%) patients (CD-group). The mean follow-up time for the whole population was 4.4 years. Fecal calprotectin (FC), serum albumin (Alb) and erythrocyte sedimentation rate (ESR) were significantly different between CD and non-CD-groups (p=&amp;lt;0.001, 0.025 and 0.022). Hemoglobin (Hb) and C-reactive protein (CRP) had no significant differences between the two groups (p=0.59, 0.24). FC &amp;lt;50ug/g had sensitivity 96.4%, specificity 19.6%, positive predictive value (PPV) 34.6% and negative predictive value (NPV) 92.5% for small bowel CD. 13 (11.8%) patients in CD-group had FC &amp;lt;100ug/g. CECDAI-score has no previously established clear cut-off-value for the diagnosis of CD. In this study 98.2% of patients in CD-group had CECDAI of 3 or more whereas 90.5% of patients in non-CD-group had CECDAI less than 3 (PPV=81.1%, NPV=99.1%). Sensitivity and specificity were the highest between CECDAI 2.5 and 3.5. Small bowel imaging also had relatively low sensitivity (65.1%) and specificity (72.7%) considering small bowel CD (PPV=52.2%, NPV=81.8%). Conclusion These findings underline our experience, that diagnosis of small bowel CD can be difficult. In this study, we found out that clinically relevant small bowel CD is possible even with FC&amp;lt;100ug/g. Based on our results, we suggest for a follow-up with FC before SBCE for patients with no endoscopic ileitis, negative imaging results and FC &amp;lt;50 ug/g. CECDAI-score of 3 would be a reasonable cut-off value for small bowel CD.

Clinical application value of blood routine examination in judgment of the activity of inflammatory bowel diseases

Objective To explore the clinical application value of blood routine examination in judgment of the activity of inflammatory bowel diseases. Methods 102 patients with inflammatory bowel disease were selected as the main research objects, 60 healthy persons in the same period were selected as the control group, all of the subjects were received routine testing of blood, C-reactive protein and erythrocyte sedimentation rate, and the relationships between disease and blood routine indexes were compared. Results In UC group, the PLT, WBC RDW index levels of remission were higher than those of the control group, the differences were statistically significant(t=6.75, 8.21, 5.73, all P<0.05). In patients with UC, the HGB, HCTand MPV index levels were lower than those in the remission patients and the control group, the differences were statistically significant(t=8.12, 11.03, 6.72, 9.35, 10.23, 8.71, all P<0.05). But the PLT index was higher than that of patients in remission, the RDW and WBC indexes were higher than those in the control group and the remission period, there were statistically significant differences(t=7.59, 8.51, 6.03, all P<0.05). The routine blood indexes of the relief patients of CD group had significant differences compared with the control group(t=6.17, 7.29, 9.01, 10.35, 8.27, 7.69, 8.01, 9.91, all P<0.05), the HCT, MCV, HGB and MPV indexes were lower than those of the control group, the differences were statistically significant(t=9.01, 10.35, 8.27, 9.91, all P<0.05), the WBC, PLT, N and RDW indexes were higher than those of the control group, the differences were statistically significant(t=6.17, 7.29, 7.69, 8.01, all P<0.05). In UC group, the HGB, HCT, MCV and MPV indexes were lower than those in the remission patients and the control group, there were statistically significant differences(t=8.19, 6.97, 7.53, 9.02, all P<0.05). But the PLT, RDW, WBC and N indexes were higher than those in the remission patients and the control group, the differences were statistically significant(t=9.81, 7.94, 8.36, 7.61, P<0.05). In the active patients of CD group, the WBC and N indexes were significantly higher than those of UC group, the differences were statistically significant(t=8.15, 9.07, all P<0.05). In the remission patients of CD group, the PLT index was significantly higher than that in the remission patients of UC group, the difference was statistically significant(t=10.35, P<0.05). Conclusion Indexes of blood routine has obvious significance in activity of inflammatory bowel disease, and it is significant correlation with inflammation index, which can be used as one of the routine clinical method to determine the activity of inflammatory bowel diseases. Key words: Crohn disease; Colitis, ulcerative; Blood; Diagnostic tests, routine

Comparison of Quality of Life Between Iranians Using Two Implant-Retained Overdenture Prosthesis and Conventional Complete Denture

Background: Clinicians and policymakers are recognizing the importance of measuring health-related quality of life (HRQL) to inform patient management and policy decisions. Objectives: With regard to relation between cultural differences and quality of life (QoL), in this study the QoL of Iranian patients with conventional complete denture and implant-retained overdenture prosthesis according to the increasing penchant of use of implant-retained overdenture prosthesis and lack of studies in this field in our country, has been compared. Patients and Methods: In this cross-sectional study, cluster sampling was conducted in two stages and 90 edentulous patients (45 patients with conventional complete dentures for two jaws (CD group) and 45 patients with a conventional maxillary complete dentures and implant-retained mandibular denture based on two intercanine implants (IOD group)) with the age of above 35 years were selected according to our inclusion criteria. After obtaining permission from the patients, who had been treated at the selected healthcare and medical treatment centers of Tehran, basic information was obtained by a checklist, including gender, age, educational status and housing status; and QoL was measured by a questionnaire of oral health impact profile (OHIP-20). Results: In the group of IOD, 55.6% of the patients had "good" QoL vs. 46.7% of the patients in CD group. Three patients (6.6%) in both groups had "poor" QoL. No significant relationship was observed between demographic factors and different dimensions of QoL, except the average of "psychological disability" in the patients of CD group, which was higher in women. Conclusions: According to this study results, implant-retained overdenture prosthesis provided better QoL for Iranian patients.

A comparative study of treatment of chronic subdural hematoma — burr hole drainage versus continuous closed drainage

The incidence of chronic subdural hematoma (CSDH) is about 5 per 100000 per year in the general population & is higher for those aged 70 years and older. The recurrence rates after the initial drainage procedure range from 5% to 30%, and the treatment strategies for reducing the recurrence rates are the focus of the current research. The aim of this study was to evaluate the results of treatment, especially in terms of recurrence, following surgery for the CSDH obtained with “one time burr-hole drainage” (OTD) vs “continuous closed drainage”, using subdural drain (CD). Patients with diagnosis of CSDH, operated at our center during the period from September 2008 through March 2010 were prospectively studied. The patients randomized to two arms, group 1 underwent OTD and group 2 underwent CD. Patients were analyzed by evaluating their hospital clinical, laboratory and radiological data. Recurrence of CSDH was defined as reappearance of clinical symptoms after a minimum period of one month post surgery, with evidence of CSDH in the same site on plain CT head. Clinical outcome was measured using Glasgow outcome score (GOS). Fifty one patients with chronic subdural hematoma were randomized. OTD was done in 26 patients and 25 patients underwent CD. Males outnumbered the females (45 vs. 6). Age ranged from 17 to 85 years (mean 53 ± 15 years). While 47 patients had GCS of 9–15, remaining 4 (7%) had GCS of 8 or less. Deranged coagulation profile was recorded in 9 patients. Imaging showed 9% patients with bilateral CSDH and in 14% patients had isodense CSDH. Hospital stay ranged from 2 to 24 days (mean 3 ± 4 days). Patients with deficit at admission usually had neurological deficit at discharge. GOS at 6 months was better in continuous drainage group (48% vs 44%) but had more complications. Symptomatic recurrence was noticed in 10 (19%) patients; recurrence was lower in the patients in CD group (n= 4, 16%) than in the OTD group (n= 6, 23%) but this was not statistically significant (p value - 0.60). Our study shows that continuous drainage of chronic subdural hematoma does not offer any advantage over simple burr hole drainage.