Objetivo. Comparar las concentraciones plasmáticas y tisulares de florfenicol (FFC) y su metabolito florfenicol amina (FFC-a) entre ovinos y conejos, posterior a la administración intramuscular de 20 mg/kg de FFC. Materiales y métodos. Cinco ovinos Suffolk Down y seis conejos Neozelandés fueron utilizados en el estudio. Se colectaron muestras de sangre, previo a la administración de FFC, y a las 0.25, 0.5, 1, 1.5, 2, 3 y 4 horas posteriores al tratamiento. A las 4 horas posteriores al tratamiento, a los animales se les aplicó la eutanasia. Las concentraciones plasmáticas y tisulares de FFC y FFC-a fueron determinadas mediante HPLC. Resultados. Las concentraciones plasmáticas máximas, tasa de absorción, vida media de absorción, tasa de distribución y área bajo la curva de FFC, fueron significativamente mayores en conejos respecto a los ovinos. Asimismo, para FFC-a, las concentraciones plasmáticas máximas y área bajo la curva de concentraciones plasmáticas en el tiempo fueron significativamente mayores en conejos respecto a los ovinos. La proporción de metabolito fue mayor en conejos (12.7±3.07%) en comparación con ovinos (3.99±0.87%) (p<0.05), al igual que las concentraciones tisulares de FFC y FFC-a. Conclusiones. Se observaron diferencias significativas en la farmacocinética y concentraciones tisulares de FFC y FFC-a entre estas dos especies. La mayor concentración de FFC-a en conejos indica un mayor nivel de metabolismo de FFC, respecto a los ovinos. Esto es importante de considerar al momento de establecer dosificaciones y frecuencia de administración de FFC en conejos.
Background and aims
Crohn’s disease (CD) can develop penetrating complications at any time during the disease course. Enterocutaneous fistulae (ECF) are disease-related complications with an important impact on quality of life. Our aim was to describe the outcomes of this complication, including its medical and/or surgical management and their temporal trends. The primary endpoint was fistula closure, defined as the absence of drainage, with no new abscess or surgery, over the preceding 6 months.
Methods
Clinical information from all adult patients with CD and at least one ECF -excluding perianal fistulae- were identified from the prospectively-maintained ENEIDA registry. All additional information regarding treatment for this complication was retrospectively reviewed.
Results
A total of 301 ECF in 286 patients (January 1970 - September 2020) were analyzed out of 30,088 records. These lesions were mostly located in the ileum (67%) and they had a median of one external opening (range 1-10). After a median follow-up of 146 months (IQR, 69-233), 69% of patients underwent surgery. Fistula closure was achieved in 84%, mostly after surgery, and fistula recurrence was uncommon (13%). Spontaneous and low-output fistulae were associated with higher closure rates (HR 1.51, 95%CI 1.17-1.93, p=0.001, and HR 1.49, 95%CI 1.07-2.06, p=0.03, respectively), this was obtained more frequently with medical therapy once biologicals have been available.
Conclusions
ECF complicating CD are rare but entail a high burden of medical and surgical resources. Closure rates are high, usually after surgery, and fistula recurrence is uncommon. A significant proportion of patients receiving medical therapy can achieve fistula closure.
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