Felty's syndrome (FS) (rheumatoid arthritis with neutropenia and splenomegaly) has a poor prognosis, largely because of the high risk of severe infection. Granulocyte colony-stimulating factor (G-CSF) is an emerging treatment for chronic neutropenia. We prospectively monitored its use in eight patients with recurrent infections or who required joint surgery. Significant side-effects were documented in five, including nausea, malaise, generalized joint pains, and in one patient, a vasculitic skin rash. In two patients treatment had to be stopped, and in these cases G-CSF had been started at full vial dosage (300 micrograms/ml filgrastim or 263 micrograms/ml lenograstim) alternate days or daily. G-CSF treatment was continued in three patients by restarting at reduced dose, and changing the proprietary formulation. G-CSF raised the neutrophil count, reduced severe infection, and allowed surgery to be performed. A combined clinical and laboratory index suggested that long-term treatment (up to 3.5 years) did not exacerbate the arthritis. Once on established treatment, it may be possible to use smaller weekly doses of G-CSF to maintain the same clinical benefit. One of the three patients whose FS was associated with a large granular T-cell lymphocytosis showed a reduction in this subset of lymphocytes during G-CSF treatment.
Toronto, Ontario, Canada received 3730 patients. Of these 335 (9%) sustained a liver injury, 95% being due to blunt trauma. Open peritoneal lavage was performed on 80% of liver trauma patients (267/335), 99% being true positive.A laparotomy was performed on 97% of patients (324/335). Major surgical treatment was required in 132 patients (41%) and minor treatment in 192 patients (59%). The remaining 11 patients were treated conservatively (n 3) or died during resuscitation (n= 8).Morbidity directly related to the liver injury was seen in 29 of 249 surviving patients (11%) although overall morbidity was 27% (67/249). Reoperation was required in 6% (14/249) with abscess or hematoma accounting for 11 of 14 operations.The overall mortality rate was 26% (86/335). Eighty two percent of patients (n 276) had a grade I, II or III liver trauma according to Moore's classification with a mortality of 12% (n 32). The remaining 18% of patients (n 59) had a grade IV or V liver trauma with a mortality of 44% (n 26). Of the 86 deaths, head injury accounted for 48 (56% of deaths); liver hemorrhage for 17 (20%), liver sepsis for (1%) and other causes for 20 deaths (23%). Thus death due to the liver injury itself (hemorrhage and sepsis) occurred in 18 out of 335 patients (5% overall). Head injury accounted for the death of 48 out of 335 patients (14% overall).Over the past 13 years a trend has occurred at our institution whereby we are seeing less liver trauma in our population of multiply injured patients from 12% (1976)(1977)(1978)(1979)(1980)(1981)(1982)(1983) down to 7% (1985)(1986)(1987)(1988)(1989); with a gradual decline in overall mortality from 32% (1976-1983) to 19% (1985-1989), whereas the precentage of deaths due to head injuries and liver injury have increased.
with 2 or more risk factors for poor bowel preparation. Data was analysed using SPSS. Results 1840 colonoscopies were carried out during the time period.. Total number analysed was 1704. Mean age was 61.7 years with a range of 16-94. 404 patients were pre assessed. Pre-assessment has significantly increased the quality of bowel preparation across all groups (OR = 1.605, p = 0.002). In groups 1 and 2 the odds of good quality bowel preparation was 80% and 72% higher respectively in patients who had been preassessed however these improvements were not statistically significant. Patients stratified into group 3 were 52% more likely to have good bowel preparation (p = 0.039) compared to those who were not pre-assessed. 88 patients had eGFR <60 ml/min. They had eGFR checked before and after administration of OBCA. There was a significant difference in the percentage change in eGFR between those patients that had Pre-assessment (Median = 7.7%) compared with those who did not (Median= -6.6%) (p = .006, Mann-Whitney). Conclusion Face-to-face pre-assessment improved the quality of bowel preparation for patients undergoing colonoscopy. It helps to minimise the risk of renal injury in patients with CKD. Those stratified to group 3 saw a significant improvement in the quality of their bowel preparation. We conclude pre-assessment is a prerequisite for patients who are at risk of poor bowel preparation and with significant co-morbidities.
PWE-032 ENDOSCOPIC RESECTION OF LARGE COLORECTAL POLYPS IN A TERTIARY REFERRAL UNIT IS SAFE WITH A LOW RISK OF COMPLICATIONSA Haji*, K Adams. Colorectal Surgery, King's College Hospital, London, UK 10. 1136/gutjnl-2014-307263.292 Introduction Patients with large sessile colorectal polyps can be technically challenging to resect endoscopically and have been subject to colorectal resection in the United Kingdom. Our aims were to determine the safety and efficacy of endoscopic resection of large colorectal lesions at a tertiary referral unit. Methods A prospective observational study of all patients referred for endoscopic resection to a single endoscopist. Consecutive patients were included in the study from June 2010 to March 2013. All patients underwent magnification chromoendoscopy and NBI for polyp assessment under conscious sedation. ESD was undertaken for lesions that were LST -non granular, flat and pseudodepressed type and those with type Vi pit pattern. Piecemeal EMR was undertaken for the remainder of the lesions.All patients underwent colonoscopic surveillance at 3 and 12 months by the same endoscopist to check for recurrence at the scar. Results One hundred and fourteen patients underwent 134 endoscopic resections. There were 54 (47.4%) women and 60 (52.6%) men with a mean age of 71.2 (SD = 10.3 years). 120 lesions underwent EMR (89.6%) and 14 had enbloc resection with ESD (10.5%) with complete resection. The mean size of the lesions was 56 mm (SD 37.1mm). The median lesion size was 50mm (range 25-150 mm).Histological analyses revealed 8 hyperplastic lesions, 28 tubular adenoma...
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