The progress of serotonin-induced renal lesions was studied over a period of 6 mth following a single intraperioneal injection of 40 mg/kg serotonin. The predominant lesion was ischaemic necrosis of tubules of patchy distribution. Parahilar areas were usually spared and a narrow subcapsular strip was less severely affected than deeper parts. The early tubular lesions appeared to be an accelerated form of the lesion of complete renal ischaemia. The necrotic tubules were soon relined by epithelium from surviving segments and became dilated. This phase of dilatation corresponded approximatly with the period of diuresis following serotonin injection and was followed by collapse and atrophy of tubules. Possible mechanisms concerned in the sequential appearance of tubular dilatation and collapse were discussed. Many collapsed tubules eventually atrophied and were associated with basement membrane thickening and round cell infiltration. Reflux of necrotic proximal tubule cytoplasm into glomerular capsular spaces occurred in the early stages of the lesion. This lesion is not specific for serotonin nephropathy and can be produced by allowing normal rat kidney to autolyse.
data heterogeneity and the shortage of applicable studies precludes any firm conclusions being made for clinical practice. Future trials with improved study design (including prospective data collection and consideration of verification bias) may help to further clarify the role of MRI in the assessment and treatment response monitoring of perianal fistulas (particularly in patients with Crohn's disease). We conducted a retrospective study on 50 patients with ulcerative colitis (UC) and 40 patients with Crohn's disease. BMD of lumbar spine and femoral neck were measured by axial dual-energy x-ray absorpiometry scan (DEXA) in 57 patients, and that of forearm by peripheral DEXA scan in 33 patients. Results 60% of all patients (n¼55) had low BMD (8.8% were osteoporotic, 51% were osteopenic). The osteoporotics were predominantly (75%) patients with CD and were smokers. On the other hand, 63% of osteopenics had UC and 28% were smokers. Although most of males (80.7%) had low BMD (73.3% were aged <50 years), only one third of females below the age of 45 years had low BMD. Only five patients had BMI <19, the majority of these patients (80%) had low BMD. All of the osteoporotic CD patients had terminal ileum (TI) involvement, and nearly 60% of patients who underwent surgery for CD had low bone mineral density. Patients who had IBD for 10 years showed low BMD in 62.5%, while 54% of those with disease duration more than 10 years had low BMD. 40% of patients who were on steroid sparing agents had normal BMD. All of the osteoporotic female patients were aged >45 years and were not on bone protection. Conclusion The high prevalence of bone loss in IBD patients treated with oral steroids is multifactorial. Disease type (CD), site of the disease (TI), disease severity (requiring oral steroids and surgical intervention) and low BMI seems to be the major variables and early bone protection is recommended especially in young men.Competing interests None declared. Introduction Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the surgical therapy of choice for patients with chronic ulcerative colitis. However IPPA is frequently accompanied by early and late complications. A proportion of patients require ongoing medical management which this study assesses. Methods A prospectively collected hospital database of patients who were followed up after IPAA at a single centre was retrospectively reviewed. A review of all case notes was carried out to assess surgical intervention prior to IPAA. All post operative complications were recorded and an assessment was made of those patients recommenced on medical therapy. Results 102 patients' case notes were reviewed, (60 male: 42 female mean age 42 years SD of 612.01). The follow-up is ongoing and is currently between 2 and 193 months. The complications included anastomotic leak (n¼4), incisional hernia (n¼7), pouchitis (n¼36), stenosis (n¼15), pre pouch stricture (n¼1), ileitis (n¼2), enterocutaneous fistula (n¼2), perianal fistula (n¼6), pouch vaginal fistula (n¼5), po...
IntroductionThe IBD audit programme, first established in 2004 has conducted several rounds of audit. The programme’s aim is to improve the care of people with IBD by; facilitating the collection of key aspects of data on patient care and organisational services, analysing and disseminating the results, providing recommendations for improvements based on the key findings in the analyses.MethodsSince 2006 the programme has facilitated up to 4 rounds of data collection on adults and children for inpatient care, organisation of IBD services and administration of biological therapies. We also collected data on patients experiences of care and the provision of care in primary care services. In 2015 the programme team hosted 8 regional workshops and proactively helped hospital IBD teams to develop action plans on key aspects of care that required improvements in their local areas.ResultsOver the 10 years of the programme’s work - a high level of participation in the audit has been achieved, >90% participation rate from IBD hospital teams across the UK. There have been many improvements in patient care, the most notable since 2006 to date, are a reduction in mortality during admissions, reduction in unplanned surgery, increased patient contact with an IBD nurse, improved rates of prescribing heparin and bone protection. From the biological therapies audit, results clearly demonstrate biological therapies for IBD are effective and safe treatments. Patterns of prescribing are changing with earlier use in patients with less severe disease suggesting doctors have become more familiar with the treatment.Despite the positive improvements, the most recent audit, reported in 2014, identified that there were still aspects of care requiring improvements including treatment of anaemia, access to dietetic support and management of people attending out patient care. Also, the two audits on patient experience between 2010 and 2012 showed no improvements in patient’s experiences of care.The 8 regional workshops hosted in 2015 across the UK proved to be a successful initiative. They were attended by 84 trusts and healthcare boards. 74% of delegates surveyed at 6 months agreed that these had helped them to improve their service.Conclusion10 years of intensive working and engagement with the IBD community, the programme could not boast of its achievements without acknowledging the support of the community. However further and continued improvements in patient care for people with IBD are necessary. In 2016 the IBD audit programme will be transitioning to the UK IBD Registry. There will be a continued emphasis to help hospital teams to make continued improvements in the quality of care of people with IBD through a number of initiatives.Disclosure of InterestNone Declared
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