Impotentie brengt een constant ongemak met zich mee, net als fysieke en psychologische problemen in uw leven cialis kopen terwijl generieke medicijnen al bewezen en geperfectioneerd zijn

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Sessione Clinica
Evidence-based Clinical Problem Solving 1. Gastroenterologia
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• Il signor Saverio è un agente di polizia tributaria di 28 anni, fumatore, con una lunga storia di malattia di Crohn.
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4-87 comparsa di fistola perianale; alvo regolare curettage chirurgico di fistola perianale 4-93 1° episodio di subocclusione intestinale 8-93 2° episodio di subocclusione intestinale La colonscopia evidenzia una flogosi a livello ileo-colico. L'esame istologico conferma la diagnosi endoscopica di malattia di Crohn Copyright - GIMBE
93-97 Periodiche riaccensioni della malattia con caratteristiche prevalentemente infiammatorie trattate con steroidi o mesalazina 11-97 riacutizzazione della malattia di base a cui segue l’ileo con anastomosi latero-laterale di ansa ileale al tratto di passaggio tra cieco ed ascendente, sul profilo interno. Le anse digiunali e la porzione residua dell’ileo appaiono normodistribuite, con pareti soffici e normale rilievovalvolare. Buona opacizzazione dell’ansa anastomotica.
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Stenosi tubulariforme dell’estremo distale del sigma (diametro max 1,5 cm) e dell’ampolla rettale di 10 cm. Assenza di formazioni ascessuali. Conclusioni: riacutizzazioni cliniche della malattia di base su stenosi serrata del giunto retto-sigmoideo Copyright - GIMBE
CLINICAL QUESTIONS
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• Quali, tra le seguenti opzioni farmacologiche, sono efficaci nella malattia di Crohn sia per indurre la remissione, che per mantenerla? - Steroidi- Mesalazina- Immunosoppressori- Anticorpi monoclonali • La chirurgia può essere risolutiva ? Copyright - GIMBE
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Sandborn W, Sutherland L, Pearson D, The Cochrane Library, Issue 3, 2000. Oxford: Update Software. Copyright - GIMBE
Pearson DC, May GR, Fick G, Sutherland LR. The Cochrane Library, Issue 3, 2000. Oxford: Update Software. Copyright - GIMBE
Steinhart AH, Ewe K, Griffiths AM, The Cochrane Library, Issue 3, 2000. Oxford: Update Software. Copyright - GIMBE
Cochrane Inflammatory Bowel Disease Group • 5-aminosalicylate for maintaining remission of Crohn's disease• Antibiotics for inducing remission of Crohn's disease • Budesonide for inducing remission of Crohn's disease • Budesonide for maintaining remission of Crohn's disease• Cyclosporine for inducing remission of Crohn's disease• Cyclosporine for maintaining remission of Crohn's disease• Enteral nutritional therapy for inducing remission of Crohn's disease Copyright - GIMBE
Camma C, Giunta M, Rosselli M, Cottone M. Mesalamine in the maintenance treatment of Crohn's disease: a meta-analysis adjusted for Gastroenterology 1997;113:1465-73. Copyright - GIMBE
• Mesalamine may be recommended for maintaining remission of quiescent Crohn's disease.
• The benefit is mainly observed in the postsurgical setting, in patients with ileitis and with prolonged disease duration. Camma C, et al. Gastroenterology 1997 Copyright - GIMBE
Antibodies to tumour necrosis factor alpha Lancet. 2000 Mar 11;355(9207):858-60. Copyright - GIMBE
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The role of liquid diet in the management Copyright - GIMBE
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• Smoking significantly increases the risk of recurrenceof disease after operation for Crohn's disease, especially in women and heavy smokers. • Encouraging patients to stop smoking is an important part of the management of Crohn's disease.
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Lochs H, Mayer M, Fleig WE, et al. Prophylaxis of postoperative relapse in Crohn's European Cooperative Crohn's Disease Study VI.
Gastroenterology 2000 Feb;118(2):264-73 Copyright - GIMBE
Ewe K, Bottger T, Buhr HJ, Ecker KW, Otto HF Low-dose budesonide treatment for prevention of postoperative recurrence of Crohn's disease A multicentre randomized placebo-controlled trial. Eur J Gastroenterol Hepatol 1999 Mar;11(3):277-82 Copyright - GIMBE
Hellers G, Cortot A, Jewell D, et al. Oral budesonide for prevention of postsurgical Gastroenterology 1999 Feb;116(2):294-300 Copyright - GIMBE

Source: http://www.gimbe.org/conferenze/wci/2000_ferrara/1.gastro.pdf

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