BACKGROUND AND AIMS: Ileocaecal resection (ICR) is frequent in paediatric patients with Crohn's disease (pCD). Despite rates of reoperation being low, the risk of clinical or endoscopic post-operative recurrence (POR) is high; effective medical strategies to prevent POR are thus needed. The aim of this systematic review (SR) was to identify and evaluate the published literature on post-operative medical prevention of POR in pCD to draft a possible therapy guide for pCD patients undergoing ICR. METHODS: We performed an SR according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards and registered it in the PROSPERO database (ID: CRD42024533855). The population, intervention, control, outcome (PICO) model was focussed on post-surgical medical prevention of POR in pCD with clearly expressed definition of recurrence (endoscopically using a standardized scoring system (e.g. Rutgeerts score) or by laboratory markers, for example, faecal calprotectin (F-CPT), C-reactive protein (CRP) or by histological findings or by clinical activity indexes [e.g. weighted paediatric Crohn's disease activity index - (w)PCDAI]. From inception until 29 February 2024, the following databases were searched: PubMed/MEDLINE, Scopus/Embase, Web of Sciences, Evidence-Based Medicine Reviews (including Cochrane), Cochrane Central Registrar of controlled Trials (CENTRAL), ClinicalTrials.gov and EudraCT. Retrieved articles were evaluated for eligibility and finally selected publications for risk of bias using ROBINS-I tool. RESULTS: Out of 811 publications identified by the search, only 5 fulfilled inclusion criteria of the SR. None of the studies fully answered our PICO question. The studies were overall of poor quality and the heterogeneity of the data did not allow us to perform meta-analysis, detailed statistical analysis or formal synthesis of data. Adverse events of post-operative medication were not described in any of the included studies. Existing guidelines of European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), North American Society for Paediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN), European Crohn's and Colitis Organisation (ECCO) and American Gastroenterological Association (AGA) were reviewed and paediatric therapy guide for pCD undergoing ICR was drafted with respect to recent SRs and meta-analyses in adult population and including scarce paediatric data identified by our SR. As pCD patients undergoing ICR are a high-risk population, they should not be left untreated post-operatively. Anti-tumour necrosis factor (anti-TNF) drugs should be considered as first-line therapy in the majority of patients. Non-anti-TNF biologics should be considered in case of anti-TNF failure. Regular endoscopic monitoring starting at 6 months after the surgery and supported by regular F-CPT evaluation should be used to identify early endoscopic recurrence and to escalate the treatment. CONCLUSION: Our SR revealed that there is wide variability in treatment strategies in children, and high-quality data are generally lacking. At the moment, paediatric prophylaxis of POR should be guided by available adult evidence with respect to the high-risk nature of pCD. Extensive research in pCD should be encouraged.
- MeSH
- cékum chirurgie MeSH
- Crohnova nemoc * chirurgie prevence a kontrola MeSH
- dítě MeSH
- ileum chirurgie MeSH
- lidé MeSH
- pooperační komplikace prevence a kontrola MeSH
- recidiva * MeSH
- sekundární prevence metody MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- systematický přehled MeSH
The fused quinazolinone derivative, RX-207, is chemically and functionally related to small molecule inhibitors of protein binding to glycosaminoglycans (SMIGs). Composed of a planar aromatic amine scaffold, it inhibits protein binding to glycosaminoglycans (GAGs). RX-207 reduced neutrophil migration in thioglycollate-induced peritonitis (37%), inhibited carrageenan-induced paw edema (32%) and cerulein-induced pancreatitis (28%), and increased animal survival in the mouse model of cecal ligation and puncture (CLP)-induced sepsis (60%). The mechanism of RX-207 action, analyzed by UV spectroscopy, confirmed that which was elucidated for chemically related anti-inflammatory SMIGs. RX-207 binding to cell surface GAGs can account for the inhibition of neutrophil recruitment via the micro-vasculature and as a consequence, the reduction of neutrophil mediated tissue damage in the animal models of inflammation and improved survival of mice in CLP-induced sepsis.
- Klíčová slova
- glycosaminoglycan, heparin binding protein, inflammation, neutrophil, sepsis,
- MeSH
- antiflogistika farmakologie MeSH
- buněčná adheze účinky léků MeSH
- cékum mikrobiologie chirurgie MeSH
- chinazolinony farmakologie MeSH
- edém chemicky indukované metabolismus patologie prevence a kontrola MeSH
- glykosaminoglykany metabolismus MeSH
- infiltrace neutrofily účinky léků MeSH
- ligace MeSH
- modely nemocí na zvířatech MeSH
- myši inbrední BALB C MeSH
- neutrofily účinky léků metabolismus mikrobiologie MeSH
- pankreatitida chemicky indukované metabolismus patologie prevence a kontrola MeSH
- peritonitida chemicky indukované metabolismus patologie prevence a kontrola MeSH
- punkce MeSH
- sepse metabolismus mikrobiologie patologie prevence a kontrola MeSH
- vazba proteinů MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- antiflogistika MeSH
- chinazolinony MeSH
- glykosaminoglykany MeSH
OBJECTIVES: Intestinal surgery is an important part of Crohn disease (CD) treatment in children. The aim of the present study was to compare the rate of endoscopic recurrence at the sixth month after ileocecal resection (ICR) in children with CD treated with azathioprine between patients who received prior antitumor necrosis factor alpha (anti-TNF-α) therapy and those who were not administered this therapy. Moreover, we tried to identify the potential risk factors for disease recurrence and describe the schedule of long-term follow-up after surgery. METHODS: We prospectively collected data from pediatric patients with CD, who underwent ICR between October 2011 and June 2015 at our hospital and were treated with azathioprine monotherapy after ICR. We evaluated the endoscopic recurrence (Rutgeerts score) at the sixth month after ICR in all included patients. RESULTS: Among 21 included patients, 13 achieved endoscopic remission (Rutgeerts score < i2) at the sixth month after ICR. No difference was found between patients who received prior anti-TNF-α therapy and those who did not. We did not find any clinically relevant factors associated with endoscopic recurrence rate at the sixth month. CONCLUSIONS: Prior anti-TNF-α therapy does not seem to be a strong risk factor for endoscopic recurrence within 6 months after ICR. Further studies on large sample of patients are needed to identify potential predictors of disease recurrence.
- MeSH
- adalimumab terapeutické užití MeSH
- antiflogistika terapeutické užití MeSH
- azathioprin terapeutické užití MeSH
- cékum chirurgie MeSH
- Crohnova nemoc diagnostické zobrazování farmakoterapie chirurgie MeSH
- dítě MeSH
- gastroskopie MeSH
- ileum chirurgie MeSH
- imunosupresiva terapeutické užití MeSH
- infliximab terapeutické užití MeSH
- kojenec MeSH
- kolonoskopie MeSH
- kombinovaná terapie MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- následné studie MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- prospektivní studie MeSH
- recidiva MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
- práce podpořená grantem MeSH
- srovnávací studie MeSH
- Názvy látek
- adalimumab MeSH
- antiflogistika MeSH
- azathioprin MeSH
- imunosupresiva MeSH
- infliximab MeSH
INTRODUCTION: Crohn´s disease (CD) highly affects a patient´s quality of life. The aim of the study was to find out the impact of surgery on the quality of life (QoL) in CD patients and factors affecting their postoperative QoL. METHODS: 90 patients with CD who underwent surgery (bowel resection) filled out an EORTC QLQ-CR29 questionnaire preoperatively and again after the surgical procedure. RESULTS: 77% of the patients experienced a positive change (p<0.001), 22% negative and 11% no change. CONCLUSION: In this cohort, we proved that surgical treatment improves the overall QoL in patients with CD. To determine factors which affect postoperative QoL, more patients need to be enrolled in future studies.Key words: Crohn´s disease - quality of life - surgery - bowel resection - Czech cohort.
- MeSH
- břišní absces epidemiologie MeSH
- cékum chirurgie MeSH
- chirurgie trávicího traktu metody MeSH
- Crohnova nemoc patofyziologie psychologie chirurgie MeSH
- dospělí MeSH
- ileum chirurgie MeSH
- kolektomie MeSH
- kvalita života * MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- netěsnost anastomózy epidemiologie MeSH
- pooperační komplikace epidemiologie MeSH
- pooperační krvácení epidemiologie MeSH
- průzkumy a dotazníky MeSH
- rektum chirurgie MeSH
- rizikové faktory MeSH
- střeva chirurgie MeSH
- střevní obstrukce epidemiologie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE: The aim of this study was to investigate the therapeutic role of an elective ileocecal resection in children with active localized Crohn's disease. METHODS: This was a retrospective multicenter study which included five European referral centers which included all children with Crohn's disease who underwent ileocecal surgery from 2000 to 2011 and had a minimum of 12 months follow-up. RESULTS: Altogether 68 patients fulfilled inclusion criteria. Median age at diagnosis was 13.7 years (6.6-17.9 years) and at surgery 15.2 years (8.6-18.5 years). Median duration of postoperative clinical remission was 20 months (3-95 months). Overall 54 patients (79.4%) were in remission one year after surgery and 38 (55.9%) during the total postsurgical follow up (median 30 months; range 12-95 months). Z score height for age significantly improved postoperatively in children who were at the time of surgery younger than 16 years of age (mean difference 0.232 SD; p=0.029). Cox proportional hazard regression model failed to indicate risk factors associated with postsurgical relapse. CONCLUSION: Elective ileocecal resection is a valid treatment option which should be considered in a subset of pediatric patients with localized Crohn's disease with the aim of achieving clinical remission and to improve growth.
- Klíčová slova
- Children, Crohn's disease, Growth, Surgery, Treatment,
- MeSH
- cékum chirurgie MeSH
- Crohnova nemoc chirurgie MeSH
- dítě MeSH
- elektivní chirurgické výkony * MeSH
- ileum chirurgie MeSH
- lidé MeSH
- mladiství MeSH
- následné studie MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- hodnotící studie MeSH
- multicentrická studie MeSH
OBJECTIVE: The diagnosis of sepsis is difficult in immunocompromised patients owing to their modified response to infection. Our experiment in minipigs was designed to compare responses to sepsis between experimental groups of septic minipigs with and without immunosuppression. METHODS: Minipigs with identical baseline parameters were randomized into 3 groups: Sepsis (n = 10); immunosuppression (n = 11), including cyclosporine, methylprednisolone, and mycophenolate mofetil treatment before surgery, and a sham group (n = 6). Sepsis was induced by cecal ligation and puncture (CLP). We recorded selected clinical and laboratory parameters up to 24 hours postoperatively. RESULTS: All CLP animals developed septic shock with a febrile response, tachycardia, and hypotension requiring noradrenaline administration. The hemodynamic responses to sepsis in septic groups with and without immunosuppression were similar. Noradrenaline infusion was started on average later in the immunosuppression than in the group without immunosuppression; however, the difference was not significant. The kinetics of the plasma levels of most selected cytokines and C-reactive protein were similar in both septic groups. At 10 hours after surgery, the immunosuppression group showed significantly lower interleukin (IL)-6 levels compared with the sepsis group. At 19, 22, and 25 hours after surgery immunosuppressed animals displayed significantly greater increases in IL-10 levels compared with the cohort without immunosuppression. CONCLUSIONS: CLP is a simple, reproducible model of sepsis in minipigs. All CLP animals developed sepsis within 24 hours on average. Significant differences in IL-6 and IL-10 plasma levels were recorded between septic animals with versus without immunosuppression.
- MeSH
- biologické markery krev MeSH
- časové faktory MeSH
- cékum mikrobiologie chirurgie MeSH
- cyklosporin farmakologie MeSH
- hemodynamika MeSH
- imunokompromitovaný pacient * MeSH
- imunosupresiva farmakologie MeSH
- kardiotonika farmakologie MeSH
- kyselina mykofenolová analogy a deriváty MeSH
- ligace MeSH
- mediátory zánětu krev MeSH
- methylprednisolon farmakologie MeSH
- miniaturní prasata MeSH
- modely nemocí na zvířatech MeSH
- noradrenalin farmakologie MeSH
- prasata MeSH
- punkce MeSH
- sepse krev farmakoterapie imunologie mikrobiologie patofyziologie MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- biologické markery MeSH
- cyklosporin MeSH
- imunosupresiva MeSH
- kardiotonika MeSH
- kyselina mykofenolová MeSH
- mediátory zánětu MeSH
- methylprednisolon MeSH
- noradrenalin MeSH
BACKGROUND: Sepsis belongs among the most serious conditions and animal models of sepsis are the basic tools to investigate the pathophysiological response to this condition. MATERIAL AND METHODS: A total of 16 adult minipigs with identical baseline parameters were randomized into two groups. In the sepsis group (n = 10), sepsis was induced using caecal ligation and puncture (CLP). The control group (n = 6) underwent laparotomy without CLP. Selected clinical and laboratory parameters as well as histological findings between the sepsis and control group were subsequently compared. RESULTS: All animals undergoing CLP developed diffuse peritonitis and sepsis. Compared to the control group, experimental animals showed significant increase of body temperature and heart rate (while) requiring noradrenaline to maintain their perfusion pressure. No significant differences in the monitored biochemical parameters (including C-reactive protein levels) between the two groups were found. Histological findings in organs of experimental animals were consistent with changes of organs seen in sepsis, i.e., centrilobular liver necroses, acute tubular renal necrosis, serous fibrinopurulent exudate, myocardial malacias, and pulmonary edema. CONCLUSION: Experimental caecal ligation with a predefined size of the perforation in the intestinal wall is a suitable model for assessing the pathophysiological changes occurring in the body in sepsis.
The authors offer their experience with the use of the ileocoecal segment for orthotopic bladder replacement (in 7 patients) or augmentation (in 2 patients) in contracted bladders after multilpe trauma. The group of patients was followed up for 6-35 months. In no case did replacement result in adverse metabolic changes, and it was invariably instrumental in normalization of the upper urinary tract, if dilated. By virtue of its hypotonic nature, replacement was not associated with incontinence, with urge incontinence persisting only in patients undergoing augmentation, probably in view of the remaining spacious lower urinary bladder segment with inadequate neurogenic signalization. As both intervention provided patients with a sufficiently long intermicturition intervals thus giving them relative comfort, the response by patients was most favourable.
- MeSH
- cékum diagnostické zobrazování chirurgie MeSH
- diverze moči * MeSH
- ileum diagnostické zobrazování chirurgie MeSH
- lidé MeSH
- močový měchýř diagnostické zobrazování zranění chirurgie MeSH
- polytrauma komplikace MeSH
- radiografie MeSH
- ureter chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Implantation of the ureters into a neovesica should be antireflux and prevent thus their obstruction. These demands are met by Le Duc's implantation which is simple and safe. Le Duc's implantation was used in 16 patients with very favourable results documented by cystography, urography and cystoscopy.
At present, the attention of reconstructive surgery is focused on continent reservoirs constructed from detubulized intestinal segments. Based on two-year experience, the authors present an analysis of the results obtained from 26 patients with continent ileal or ileocecal neovesica. These operations improve the quality of life and guarantee more safety. In most cases, the function of the neovesica approximates the natural physiological condition. The authors also discuss the economical aspect as regards the high cost of materials needed for ureteroileostomy--annual expenditure on flanges and bags (firm Pfizer) per 1 person amounts to 32,000 Czechoslovak crowns fco. The continent neovesica does not narrow the therapeutical spectrum of urinary deviations, on the contrary, it extends them, which is why the authors prefer to use it.
- MeSH
- cékum chirurgie MeSH
- diverze moči metody MeSH
- dospělí MeSH
- ileum chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
