THE INCIDANCE OF GLUTEN DISEASE OF ERZURUM AREA IN ADULT
A. UYANİKOGLU, M. COSKUN, D.N.BİNİCİ, Y.OZTURK
Erzurum Training Hospital, Erzurum, TURKEY
Aım: Gluten enteropathy is composed by the effect of gliadin fraction of wheat gluten, barley and rye proteins . Gluten-sensitive enteropathy is an autoimmune and familial illness that develops after malabsorption, which is due to dietary intake of some grain products. With the removal of cereals in the diet can improve symptoms and histopathology. Can occur at any age (1 years of age until the age of 80). The gluten frequency varies according to viewed from the method ,is estimated at an average of 300-350 people. The prevalence of 0.05-0.2% in the general population in Europe is. In this study, the frequency of gluten disease in adult population araund Erzurum City were investigated with endoscopy.
Materıals and methods: Between February-June 2010, the gastroscopy reports examined retrospectively, endoscopic incidance of gluten disease and patient demographics characteristics were investigated. Histopathological and serological tests positive patient were accepted gluten. For pathological examination were used Marsh clasification.
Results: Gastroscopy scanned a total of 1950 patients, 924 (47%) male, mean age 48.27 ±17.09 years (range 14-100). 7 patients (0.035%) of gluten were detected by endoscopy, the mean age of 29.85 ± 11.92 (range 17-49), 5 female (70%), 2 males (30%). The patients pathology were; three patient Marsh type 3C, one patient Marsh type 3A, one patient type 3B and two patient Marsh type 1. The six patient were anti-gliadin IgA positive, one patient anti-gliadin IgG pozitive.
Conclusıon: In region of Erzurum, prevalence of gluten has been identified as one of about 280 patients, these patients are young, early middle-aged and often female.
INFLIXIMAB IN INFLAMMATORY BOWEL DISEASE: ATTENTION TO SIDE EFFECTS
A. UYANİKOGLU, F.AKYUZ , B. PİNARBASİ, F. ERMİS,B.BARAN, K. DEMİR, S.OZDİL, F.BESİSİK, G. BOZTAS,Z. MUNGAN, S. KAYMAKOGLUMedical Faculty ofIstanbul University, Istanbul, TURKEY
Aım: To assess the efficacy and side effects of anti-TNF monoclonal antibody infliximab (IFX) which is used in Crohn’s disease (CD) and ulcerative colitis (UC) that are resistant to conventional treatments and fistulizing type of Crohn’s disease.
Material and method: 36 patients receiving IFX between 2007-2009 were followed rospectively. IFX was given in 8 week intervals in doses of 5 mg/kg after the inductions in the 2nd and 6th weeks that followed initiation.
Findings: Mean age of patients were 35 ± 12.18 (17-59), M/F ratio was 17/19. 32 patients (88%) were receiving concomitant long term immune suppressive therapy. Complete or partial response was obtained in 75% of all patients. At least one side effect was seen in a total of 10 patients (30%): anaphylaxis in 2 patients (6%) (in the 2nd and 7th trials; one developed in the second trial which was begun after a break from the first treatment period), mild acute infusion reaction in 2 patients, hypotension in 2 patients, respiratory distress in 2 patients, skin rash and eruptions in 2 patients, one hypertension and one tightness in the chest. Treatment was continued in all patients except the ones with anaphylaxis. No side effect that results in infection, tumor or death was observed in any patient.
Results: Several side effects might be observed in patient that receive infliximab. Care should be given to patients that restart treatment after a treatment break in regard to anaphylaxis. No serious side effect was observed during infliximab treatment except allergic side effects.
TO THE TREATMENT OF PERITONITIS CAUSED BY PATHOLOGY OF LARGE INTESTINE
Stavropol State Medical Academy, Stavropol, RUSSIA
Peritonitis caused by intra-abdominal infection is the most common complication of acute abdominal diseases in surgical practice. Arrest of inflammatory and necrotic process in fecal peritonitis is a difficult task, requiring landmark surgery on abdominal organs.
Materials and methods: We have the experience of the treating of 326 patients with peritonitis with the source of inflammation of peritoneum in large intestine, who were treated at the clinic of contaminated surgery of Stavropol city from 1995 to 2010.
Results: During the operation for elimination of the source of peritonitis, we used the following intervention options: closure of the defect of colon with extraperitonisation - in 27 (8.3%) cases, excretion of the defect of colon to the abdominal wall in the form of hanging (parietal) stomas - at 148 (45.4%) patients, the formation of double-barrel separate stomas - in 56 (17.2%) cases, resection of colon with single-barrel stoma excretion - in 95 (29.1%) patients.
During the treatment patients have mentioned such complications as failure of seams of colostoma in 26 (8.1%), paracolostomic abscess in 18 (5.5%), suppuration of surgical wounds in 38 (11.6%) cases which were eliminated after their identification. In the course of active surgical tactics of treatment of patients with peritonitis with the source in large intestine, died 38 (11.7%) patients. Patients discharged from the hospital with colostomas needed a landmark surgery - reconstructive operations. We believe that the optimal period for reconstructive operations is 4-12 months after the first operation. 198 of 288 patients (68.7%) discharged from hospital underwent subsequent reconstructive surgery in the clinic, the rest 90 (31.3%) patients underwent surgery in the residence in cities and district centers of the region.
Conclusions: Fecal peritonitis of the II-III degree of severity according to Mannheim peritonitis index can be treated effectively by laparostomy with programmed sanitation of abdominal cavity in the period from 7 to 14 days.