RESUMEN
AIM OF THE STUDY: To retrospectively evaluate the efficacy, the duration of response, and the tolerance of Remicade in anoperineal Crohn's disease. METHODS: Fifty patients with severe symptomatic and refractory anoperineal Crohn's lesions (38 fistulae and 29 cavitating ulcers and superficial fissures) were treated with 3 intravenous infusions of Remicade (5 mg/kg) at weeks 0, 2 and 6. Efficacy was assessed using Allan's functional score and proctologic examination at 8 weeks (W8) and 24 weeks (W24) after the first infusion. RESULTS: At W8, a response was noted for 71% (27/38) of fistulae and 79% (23/29) of ulcers and fissures. Healing rates were 39% and 49%, respectively. Efficacy of Remicade at W8 did not vary according to sex, number and type of fistulae and other treatments. At W24, 58% (15/26) of patients with fistulae and 63% (10/16) of patients with ulcers or fissures had a response. The response rate at W24 was higher in patients having anoperineal Crohn's lesions for less than one year: 77% vs 32% (P=0.004). Median Allan's score significantly decreased from 3.9 before treatment to 1.7 at W2 (P<0.001), 1.3 at W6 and 0.8 at W8. Median duration of response was 9.5 months (range: 0.5-12.5) after last infusion and was not influenced by associated treatments including immunomodulators. The relapse rate at 1 year was 64% for the responders followed at least one year (n=21). Minor adverse events occurred during 12% of all infusions. Eight patients had an infection, including one pneumonia. Eight patients developed a perineal abscess 16 weeks (range: 4-32) after the first infusion. CONCLUSION: Remicade is rapidly effective and well tolerated in anoperineal Crohn's lesions, but the high relapse rate stresses the need for long term therapeutic strategies in these patients.
Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Enfermedades del Ano/tratamiento farmacológico , Enfermedad de Crohn/complicaciones , Fármacos Gastrointestinales/uso terapéutico , Factor de Necrosis Tumoral alfa/inmunología , Absceso/epidemiología , Adolescente , Adulto , Anciano , Anticuerpos Monoclonales/efectos adversos , Enfermedades del Ano/etiología , Femenino , Fisura Anal/tratamiento farmacológico , Fisura Anal/etiología , Fármacos Gastrointestinales/efectos adversos , Humanos , Infliximab , Masculino , Persona de Mediana Edad , Perineo , Fístula Rectal/tratamiento farmacológico , Fístula Rectal/etiología , Recurrencia , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVES: To assess the accuracy and reproducibility of a new magnetic resonance cholangiopancreatography sequence (MRCP), using long echo time and "single shot" acquisition (providing high-contrast thick slices: 20 mm or more), in the morphological analysis of the biliary tree and pancreatic ducts. METHODS: Fifty four patients with biliary and/or pancreatic disease were investigated with MRCP "single shot" thick slices. Biliary ducts were explored with MRCP "single shot", coronal and oblique coronal 20 mm thick slices on a 256 x 256 matrix. Natives pictures were reviewed by three independent radiologists, from three different institutions. MRCP results were compared with reference examinations in 54 cases (direct biligraphy methods: 54, CT scan: 11, endoscopic ultrasonography: 6, surgery: 6). RESULTS: For detection of bile duct dilatation, the agreement of MRCP "single shot" thick slices was more than 96% (Kappa > 0.92) and the inter-observer agreement was excellent (Kappa=0.92). For detection of biliary tree and/or pancreatic duct obstruction, MRCP "single shot" thick slice sensitivity was above 89% and specificity was 75%. The malignant nature of the lesions was determined with a sensitivity of 100% and a specificity of 92%. MRCP "single shot" thick slices could not differentiate pancreatic carcinomas from distal main bile duct cholangiocarcinomas. MRCP "single shot" thick slices did not detect small stones ( 3 mm) of the common bile duct. CONCLUSION: The excellent sensitivity, specificity and inter-observer agreement of MRCP "single shot" thick slices can be used to limit invasive imaging methods in the diagnosis of extrahepatic cholestasis.