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Surgical repair of complex anal fistulas has to achieve a balance between optimal primary healing and best preservation of continence. As traditional surgical techniques confer a risk of continence deterioration, innovative sphincter-preserving techniques have been introduced. A new study indicates that use of bioprosthetic plugs in the surgical treatment of complex anal fistulas is associated with a long-term success rate of 81%.
An improved understanding of thiopurine metabolism has enabled individualized dosing of these agents in patients with IBD. Ansari et al. describe the use of allopurinol to deliberately manipulate thiopurine metabolism in patients who previously could not tolerate therapeutic doses of azathioprine or 6-mercaptopurine. This therapeutic maneuver potentially enables this therapy to be given to a considerable subgroup of patients otherwise unable to tolerate thiopurine therapies.
In a large, randomized, controlled trial conducted in the UK, screening flexible sigmoidsocopy led to substantial reductions in the incidence of and mortality from distal colorectal cancer. Both fecal occult blood testing and flexible sigmoidoscopy screening are now proven to reduce colorectal cancer mortality.
The modern colonoscopist faces two problems: identifying all relevant lesions and then making an appropriate risk assessment of the detected lesions. The latter is crucial for determining patient outcome. A feasibility study suggests that a new endomicroscopy technology could greatly improve the detection and assessment of neoplastic colorectal lesions.
The use of probiotics is increasing in popularity for both the prevention and treatment of a variety of diseases; however, the specific immune and physiological effects of probiotics in health and disease have not been fully elucidated. This Review considers recent advances in clinical trials of probiotics for intestinal disorders. An overview ofin vitro and in vivoresearch related to potential mechanisms of action of various probiotic formulations is also considered.
Chronic infection with HCV is a major cause of liver-related death worldwide and can be treated with interferon α therapy. This Review focuses on pegylated interferons and will discuss the mechanisms of action, structure, and pharmacokinetics of two different pegylated interferons—PEG-IFN-α2a and PEG-IFN-α2b. Alessio Aghemo and colleagues analyze all available data on these two pegylated interferons and discuss and directly compare the efficacy and safety of these drugs.
A 72-year-old man was evaluated for dysgeusia, diarrhea and ano-rexia. 3 months earlier he began to experience taste changes, a de-cline in appetite and 3–7 loose, non-bloody stools per day, followed by nausea, lower abdominal cramping and weight loss of 22.68 kg. Cronkhite–Canada syndrome was diagnosed and treatment started with prednisone, a histamine-2-receptor blocker and oral micronutrient supplementation. All visible polyps were removed and subtotal colectomy with end-to-side ileorectostomy per-formed.
Hepatocellular carcinoma is a global health problem, although developing countries are disproportionally affected. About three-quarters of hepatocellular carcinomas are attributed to chronic HBV and HCV infections. This Review provides an overview of the global variation in hepatocellular carcinoma incidence and etiology, as well as the prevention, screening, diagnosis and treatment of this cancer.
The prognosis for locally advanced pancreatic carcinoma remains dismal despite advances in chemotherapy and radiotherapy over the past few decades. The use of radiotherapy for pancreatic carcinoma is often disputed because of the hypothesis that patients with pancreatic cancer die from distant metastases. This Review discusses the data from prospective and retrospective studies evaluating radiotherapy and other treatment options for locally advanced pancreatic carcinoma.