Showing papers by "K.H. Katsanos published in 2005"

Octreotide plus Total Parenteral Nutrition in Patients with External Digestive Tract Fistulas ñ An Evaluation of our Experience

Abstract: SUMMARY Objective: We conducted a retrospective study to evaluate the use of total parenteral nutrition (TPN) and octreotide (OC), in comparison to standard treatment for the management of external digestive tract fistulas (EDTF) at a major tertiary referral University Hospital. Patients: We analyzed the clinical course of 112 patients with EDTF treated from 1978 to 2001. Thirty-nine patients admitted during the period 1978-1990 (group A) and 73 patients admitted during the period 1991-2001 (group B) were studied. Group A received standard supportive treatment while group B received standard supportive treatment in combination with TPN and OC. The main outcome measures were the duration of hospitalization, the fistula spontaneous closure time, the mortality rate and complications of treatment. Results: A dramatic reduction (81‐4.5%) in fistula output was observed within 48 hours after administration of TPN and OC in group B compared to group A (p<0.05). The incidence of spontaneous fistula closure was increased from 64% in group A to 81% in group B (p<0.05) and the mean fistula closure time decreased from 38‐2.7 in group A to 17‐1.8 days in group B (p<0.05). Complications occurred in 61.5% of group A patients and in 45% of patient group B respectively (p<0.05). The direct fistula related mortality was 7.5% and 2% respectively (p<0.05). Conclusions: The introduction of TPN and OC in EDTF ameliorated in a statistically significant way all the parameters of EDTF healing that were studied. Although fistula related direct mortality was decreased, further studies with well-designed comparative prospective trials are needed. This abstract was accepted and was be presented as a poster at Digestive Disease Week, Chicago, IL, May 14-19, 2005

Perianal condylomata and HPV-negative ileostomal papillomatous lesion in Crohns disease during Infliximab therapy

Abstract: All patients with inflammatory bowel disease (IBD) with peristoma and stoma disorders who receive immunomodulatory therapy must undergo a detailed clinical, histological and microbiological examination including detailed history for pre-existing skin diseases. A 34-year old woman with Crohn’s disease during Infliximab treatment presented with tender verrucous lesions in the perianal area and a small verrucous lesion involving the ileostoma. Perianal lesions were enlarged and had a condylomatous appearance, and had become painful. At the same time, a small grayish-white papillomatous plaque on the upper circumference of the ileostoma, with a sharp outline but with no downward extension into the ileum, was noticed. Light microscopic analysis of the stoma lesion demonstrated only signs of mild chronic inflammation but no definite koilocytosis. In addition, immunohistochemical analysis for HPV was negative. Cryotherapy of perianal lesions was performed successfully while Infliximab infusions were interrupted. The patient was on regular follow-up and was receiving azathioprine and low doses of steroids. In all IBD cases with long-term immunomodulatory drug use, clinical follow-up is mandatory as long term toxicity and carcinogenecity of these new biological agents still remain under investigation. Key words: human papillomavirus (HPV), Crohn, inflammatory bowel disease, Infliximab, Remicade, anti-TNFa