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Shrinking Lung Detected on Computed Tomography:Pictorial Essay of the Main Findings of the Image

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Open Journal of Medical Imaging 2018年第2期8卷 17-24页

作者： Francisco Barbosa de Araújo Neto Tiago Castello Branco Lyra Rita Karine Veras Gomes de Mello Vinícius Martins Valois Tiago Bezerra Albano Antonio Fernando Lins de Paiva Rodrigo Caruso Chate Cesar Higar Nomura Department of Radiology of the Medical school of the university of sao paulo Sao PauloBrazil Department of Radiology of the hospital Israelita Albert Einstein(HIAE) Sao PauloBrazil Department of Radiology of the hospital Heliopolis Sao PauloBrazil cardiology institute of the clinic hospital of the medicine school of the university of sao paulo Sao PauloBrazil

Shrinking lung refers to a rare complication of systemic lupus erythematosus and is characterized by unexplained dyspnea, a restrictive pattern in lung function tests, and elevation of the diaphragmatic hemicuples. It is postulated to have a predilection for female involvement and occurs mainly during late stages of the disease. Chest X-rays usually show small, diaphragmatic lungs. Occasional basal atelectasis may be present. Chest tomography usually shows reduced lung volumes with diaphragmatic elevation, occasional basal atelectasis, without severe pulmonary or pleuropulmonary disease. Shrinking lung can cause significant morbidity and occasional mortality. There is no definitive therapy, while corticosteroids may decrease symptoms and improve lung function in some patients. The objective of this study was to describe the main imaging findings in Shrinking Lung, an important pulmonary alteration in lupus patients. We highlight the characteristics observed on radiography and computed tomography, with an emphasis on computed tomography. It is important that every radiologist is prepared to recognize these findings and understand the possible clinical repercussions.

关键词： Chest Tomography Pulmonary Diseases Systemic Lupus Erythematosus Shrinking Lung

Impact of triple antithrombotic therapy in patients with acute coronary syndrome undergoing percutaneous coronary intervention in real-world practice

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Journal of Geriatric cardiology 2017年第11期14卷 679-687页

作者： Yan YAN Xiao WANG Jing-Yao FAN Shao-Ping NIE SerGio Raooseiras-Roubin Emad Abu-Assi Jose P Simao Henriques: Fabrizio D'Ascenzo Jorge Saucedo Jose R Gonzalez-Juanate Stephen B Wilton Wouter J Kikkert Ivan Nunez-Gil Albert Ariza-Sole Xian-Tao SONG Dimitrios Alexopoulos Christoph Liebetrau Tetsuma Kawaji Claudio Morettil Zenon Huczek Toshiharu Fujii Luis cL Correia Masa-aki Kawashiri Sasko Kedev Beijing Anzhen hospital Capital Medical University Beijing China university hospital Alvaro Cunqueiro Vigo Spain university Academic Medical Center Amsterdam The Netherlands Dipartimento di Scienze Mediche Divisione di Cardiologia Cittgl della Salute e della Scienza Turin Italy NorthShore university hospital Chicago U.S.A. university clinical hospital of Santiago de Compostela Spain Libin Cardiovascular institute of Alberta Calgary Canada San Carlos hospital Madrid Spain Bellvitge hospital Barcelona Spain university Patras hospital Athens Greece Kerckhoff Heart and Thorax Center Frankfurt Germany Graduate school of medicine Kyoto University Kyoto Japan university clinical hospital Warsaw Poland Tokai university school of medicine Tokyo Japan hospital sao Rafael Salvador Brazil Kan'azawa university Graduate school of medicine Kanazawa Japan university clinic of cardiology Skopje Macedonia

Objective The optimal antithrombotic regimen for patients on oral anticoagulation （OAC） after acute coronary syndrome （ACS） and percutaneous coronary intervention （PCI） remains debated. This study sought to evaluate the efficacy and safety of OAC plus clopidogrel with or without aspirin in a real-world setting. Methods We retrospectively analyzed data from an international, multi-center registry be- tween 2003 and 2014 （n = 15,401）. Patients with ACS and receiving OAC after PCI were screened. The composite primary endpoint was 1-year all-cause death, re-infarction, or severe bleeding. Results The final analysis enrolled 642 patients including 62 patients （9.7%） with OAC and clopidogrel （dual therapy）, and 580 patients （90.3%） with the combination of aspirin, OAC and clopidogrel （triple therapy）. Pa- tients on triple therapy were more often female and were more likely to have comorbidities. There was no significant difference regarding the primary end point between dual therapy with triple therapy patients [17.74% vs. 17.24%; unadjusted hazard ratio （HR）： 1.035; 95% confi- dence interval （CI）： 0.556-1.929; adjusted HR： 1.026; 95% CI： 0.544-1.937]. However, the re-infarction rate was significantly higher in dual therapy than triple therapy patients （14.52% vs. 5.34%; unadjusted HR： 2.807; 95% CI： 1.329-5.928; adjusted HR： 2.333; 95% CI： 1.078-5.047）. In addition, there was no difference between two regimes in all-cause death and severe bleeding. Conclusions In real-life patients with ACS following PCI and with an indication of OAC, triple therapy was not associated with an increased rate of adverse out- comes compared to dual therapy. Moreover, it decreased risk of re-infarction and did not increase risk of severe bleeding.

关键词： Acute coronary syndrome Oral anticoagulation Outcome Triple antithrombotic therapy

Gastric laceration after cardiopulmonary resuscitation:A case report

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Case Reports in clinical medicine 2014年第1期3卷 52-56页

作者： Rita Simone Lopes Moreira Solange Guizilini Natasha Marcondes Ramiro Colleoni Isadora S.Rocco Iran Goncalves Ana Christina Velloso Caluza Vinicius Santos Batista Antonio Carlos de Camargo Carvalho hospital sao paulo-university hospital of Federal university of sao paulo Sao PauloBrazil Department of cardiology Federal University of Sao PauloSao PauloBrazil

The cardiopulmonary resuscitation (CPR) persists as the best practice to maintain cerebral and coronary perfusion after cardiac arrest. Due to the chest compressions and ventilation maneuvers during resuscitation, there are common complications reported. Abdominal organs injuries occur in approximately 30% of patients, although studies show that they are under diagnosticated. The aim of this article is to report a case of massive digestive hemorrhage by gastric laceration after cardiopulmonary resuscitation, due to the event severity and rare clinic diagnostic. A 75-year-old Caucasian man suffered a sudden malaise and cardiac arrest and transferred to an Emergency Unit (EU). The set of measures recommended by Advanced Cardiac Life Support (ACLS) was performed. Despite no resistance to the passage of nasogastric survey and spontaneous healing of fresh blood exteriorization, an endoscopy showed ulcers in gastric notch with clots adhered and active blood. There was no track record of liver or gastrointestinal diseases on this patient, identifying a gastric laceration after cardiopulmonary resuscitation. The mechanism by which the gastric laceration after CPR occurred is uncertain. Nevertheless, some precipitating factors are considered such as positioning of the patient during CPR, ideal point of compressions and ventilation pressure. In conclusion, this event is rare with a hard diagnostic however that could be avoided and minimized with preventive measures.

关键词： Cardiac Arrest Ventilation Emergency Care Complications Gastric Injury Cardiopulmonary Resuscitation

Use of Initial Modified RECIST Tumor Response Evaluation Criteria for Predicting Survival in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization with Drug-Eluting Beads

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Journal of Cancer Therapy 2015年第13期6卷 1115-1123页

作者： Natália Sousa Freitas Queiroz Luciana Kikuchi Regis Otaviano Franca Bezerra Regiane S. S. M. Alencar Aline Lopes Chagas Cláudia Megumi Tani Márcio Augusto Diniz Aline Cristine Barbosa Santos Airton Mota Moreira Manoel de Souza Rocha Luiz Augusto Carneiro D’Albuquerque Francisco César Carnevale Flair José Carrilho sao paulo Clínicas Liver Cancer Group Instituto do Cancer do Estado de Sao Paulo Hospital das Clínicas Department of Gastroenterology University of Sao Paulo School of Medicine Sao Paulo Brazil sao paulo Clínicas Liver Cancer Group Instituto do Cancer do Estado de Sao Paulo Hospital das Clínicas Department of Radiology University of Sao Paulo School of Medicine Sao Paulo Brazil

Introduction: Transarterial chemoembolization (TACE) reduces tumor growth and increases survival in patients with hepatocellular carcinoma (HCC). Drug-eluting beads (DEB) deliver slow-release chemotherapy and reduce systemic toxicity during TACE. This study correlated initial tumor response according to modified RECIST (mRECIST) criteria and 1-year survival in patients with HCC treated with TACE-DEB, and identified predictors of tumor response. Methods: Fifty-two patients with HCC received TACE-DEB loaded with doxorubicin 75 mg during a 6-month period. Tumor response was evaluated 1 month after the procedure according to mRECIST criteria. Results: Most patients were cirrhotic and etiology of liver disease was hepatitis C in 26/52 (50%). Similar numbers of patients had Barcelona clinic Liver Cancer (BCLC) A and BCLC B disease. Most patients had one nodule (66%). Complete response (CR) was achieved in 12/52 (23%), partial response in 19/52 (37%), stable disease in 4/52 (8%) and progressive disease in 17/52 (32%). Largest HCC ≤58 mm and BCLC stage A were associated with CR. The 1-year survival was 74%, with survival rates of 95% and 56% in the BCLC A and B groups, respectively. Variables reflecting tumor extension were associated with better survival. CR according to mRECIST criteria was a predictor of better 1-year survival (100% vs. 64%, P < 0.05). Conclusion: BCLC A and CR according to mRECIST criteria predict improved 1-year survival in patients with HCC treated with TACE-DEB. Further studies are needed to evaluate other predictors of survival and to determine if tumor response predicts long-term survival.

关键词： Hepatocellular Carcinoma mRECIST Criteria Transarterial Chemoembolization Overall Survival Drug-Eluting Beads

Biomedical Perspectives About Women with Chronic Pelvic Pain:A Qualitative Analysis

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International Journal of clinical medicine 2012年第5期3卷 411-418页

作者： Paula P.Souza Adriana P.M.S.Romao Ana Marcia S.Nakano Julio C.Rosa-e-Silva Francisco J.Candido-dos-Reis Antonio A.Nogueira Omero B.Poli-Neto Department of Gynaecology and Obstetrics School of Medicine University HospitalUniversity of Sao Paulo at Ribeirao PretoRibeirao PretoBrazil Department of Public Health School of NursingUniversity of Sao Paulo at Ribeirao PretoRibeirao PretoBrazil school of medicine university hospital University of Sao Paulo at Ribeirao PretoRibeirao PretoBrazil

Because the aetiology of chronic pelvic pain is complex, studies of the condition involve extensive investigation but provide few conclusions. Numerous studies have addressed the experiences of women with chronic pelvic pain, as well as the interaction between those women and their health care providers. Our objective was to investigate how physicians at a specialised clinic perceive the medical care provided to such women. This was a qualitative study employing semi-structured interviews and content analysis. We interviewed seven physicians at the Chronic Pelvic Pain Outpatient clinic of the university hospital, Faculty of medicine of Ribeir?o Preto, university of S?o paulo, Brazil. Medical training and practice constituted the central theme of the study, which was subdivided into categories addressing the influence that the current medical training has on the type of medical care provided to women with chronic pelvic pain. Medical practice has been characterised by a reductionist approach to health and illness, as well as by the fragmentation of health care. These characteristics are, to a certain extent, the result of the biomedical model of education, which has been predominant, ignoring social, cultural, psychological and emotional aspects. There is a need to shift the medical paradigms toward a humanistic model of health care. We hope that we have provided a critical view of current medical training and practice, as well as of their effects in various health care settings, particularly in the provision of care to women with chronic pelvic pain.

关键词： Chronic Pelvic Pain Biomedical Model Qualitative Research

Graves’Disease and Marine Lenhart Syndrome:A Rare clinical Presentation

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Health 2019年第9期11卷 1169-1176页

作者： Fernanda Cardia Martins Ribeiro Larissa Alves Ruas Aluysio Leal Júnior Adriana Andrade de Sousa Adriana Farias Araújo Jonathan Mwambire Ana Luísa Conceicao de Jesus Renata Maksoud Bussuan Larissa Bianca Cunha de Sá Alberto Krayyem Arbex IPEMED Medical school/AFYA Educational Postgraduation in EndocrinologyRio de JaneiroBrazil Internal medicine Malteser Krankenhaus Franziskus HospitalFlensburgGermany Department of Pediatrics University of Sao Paulo(USP)Medical SchoolSao PauloBrazil Medical clinic in Endocrinology and Diabetology Schleswig-FlensburgGermany

The aim of this study is to review and discuss the clinical features and treatment options for the Marine-Lenhart syndrome, an uncommon thyroid disturb. The methodology adopted was a bibliographic research. The results of this study show that different mechanisms are implicated in the pathogenesis of Graves’ disease and in the nodular formation of thyroid tissue with functional autonomy. Graves’ disease is caused by an autoimmune process that involves the entire thyroid gland and is characterized by the presence of TSH receptor stimulating antibodies. The present study concludes that caution should be exercised in interpreting thyroid disease in Graves’ disease. The treatment of thyrotoxicosis requires high doses of oral drugs. Relapsing antithyroid therapy occurs soon after oral antithyroid therapy is discontinued. This presentation should alert the physician about the existence of toxic nodules, and about the possibility of a Marine-Lenhart Syndrome.

关键词： Graves’Disease Marine-Lenhart Syndrome Thyroid Gland Thyroid Nodules

Impact of concomitant use of proton pump inhibitors and clopidogrel or ticagrelor on clinical outcomes in patients with acute coronary syndrome

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Journal of Geriatric cardiology 2016年第3期13卷 209-217页

作者： Yan YAN Xiao WANG Jing-Yao FAN Shao-Ping NIE Sergio Raposeiras-Roubin Emad Abu-Assi Jose P Simao Henriques Fabrizio D'Ascenzo Jorge Saucedo Jose R Gonzfilez-Juanatey Stephen B Wilton Wouter J Kikkert Ivlin Nufiez-Gil Albert Ariza-Sole Xian-Tao SONG Dimitrios Alexopoulos Christoph Liebetrau Tetsuma Kawaji Claudio Moretti Zenon Huczek Toshiharu Fujii Luis C Correia Masa-aki Kawashiril Sasko Kedev Beijing Anzhen hospital Capital Medical University Beijing China university hospital.4lvaro Cunqueiro Vigo Spain university Academic Medical Center Amsterdam the Netherlands Dipartimento di Scienze Mediche Divisione di Cardiologia. Citt& della Salute e della Scienza Turin Italy NorthShore university hospital Chicago. USA university clinical hospital of Santiago de Compostela Spain Libin Cardiovascular institute of Alberta Calgary Canada San Carlos hospital Madrid Spain Bellvitge hospital Barcelona Spain university Patras hospital Athens Greece Kerckhoff Heart and Thorax Center Frankfurt Germany Graduate school of medicine Kyoto University Kyoto Japan university clinical hospital Warsaw Poland Tokai university school of medicine Tokyo Japan hospital sao RafaeL Salvador Brazil Kanazawa university Graduate school of medicine Kanazawa Japan university clinic of cardiology Skopje Macedonia

Background There is great debate on the possible adverse interaction between proton pump inhibitors （PPIs） and clopidogrel. In ad- dition, whether the use of PPIs affects the clinical efficacy of ticagrelor remains less known. We aimed to determine the impact of concomi- tant administration of PPIs and clopidogrel or ticagrelor on clinical outcomes in patients with acute coronary syndrome （ACS） after percuta- neous coronary intervention （PCI）. Methods We retrospectively analyzed data fi＇om a ＂real world＂, international, multi-center registry between 2003 and 2014 （n = 15,401） and assessed the impact of concomitant administration of PPIs and clopidogrel or ticagrelor on 1-year composite primary endpoint （all-cause death, re-infarction, or severe bleeding） in patients with ACS after PCI. Results Of 9429 patients in the final cohort, 54.8% （n = 5165） was prescribed a PPI at discharge. Patients receiving a PPI were older, more often female, and were more likely to have comorbidities. No association was observed between PPI use and the primary endpoint for patients receiving clopidogrel （ad- justed HR： 1.036; 95% CI： 0.903-1.189） or ticagrelor （adjusted HR： 2.320; 95% CI： 0.875-45.151）（Pinteraction = 0.2004）. Similarly, use of a PPI was not associated with increased risk of all-cause death, re-infarction, or a decreased risk of severe bleeding for patients treated with either clopidogrel or ticagrelor. Conclusions In patients with ACS following PCI, concomitant use of PPIs was not associated with in- creased risk of adverse outcomes in patients receiving either clopidogrel or ticagrelor. Our findings indicate it is reasonable to use a PPI in combination with clopidogrel or ticagrelor, especially in patients with a higher risk of gastrointestinal bleeding.

关键词： Acute coronary syndrome Clopidogrel Outcome Proton pump inhibitor Ticagrelor

Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID- 19 pandemic

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Stroke & Vascular Neurology 2021年第4期6卷 542-552,I0026-I0032页

作者： Thanh N Nguyen Diogo C Haussen Muhammad M Qureshi Hiroshi Yamagami Toshiyuki Fujinaka Ossama Y Mansour Mohamad Abdalkader Michael Frankel Zhongming Qiu Allan Taylor Pedro Lylyk Omer F Eker Laura Mechtouff Michel Piotin Fabricio Oliveira Lima Francisco Mont'Alverne Wazim Izzath Nobuyuki Sakai Mahmoud Mohammaden Alhamza R Al-Bayati Leonardo Renieri Salvatore Mangiafico David Ozretic Vanessa Chalumeau Saima Ahmad Umair Rashid Syed Irteza Hussain Seby John Emma Griffin John Thornton Jose Antonio Fiorot Rodrigo Rivera Nadia Hammami Anna M Cervantes-Arslanian Hormuzdiyar H Dasenbrock Huynh Le Vu Viet Quy Nguyen Steven Hetts Romain Bourcier Romain Guile Melanie Walker Malveeka Sharma Don Frei Pascal Jabbour Nabeel Herial Fawaz Al-Mufti Atilla Ozcan Ozdemir Ozlem Aykac Dheeraj Gandhi Chandril Chugh Charles Matouk Pascale Lavoie Randall Edgell Andre Beer-Furlan Michael Chen Monika Killer-Oberpfalzer Vitor Mendes Pereira Patrick Nicholson Vikram Huded Nobuyuki Ohara Daisuke Watanabe Dong Hun Shin Pedro SC Magalhaes Raghid Kikano Santiago Ortega-Gutierrez Mudassir Farooqui Amal Abou-Hamden Tatsuo Amano Ryoo Yamamoto Adrienne Weeks Elena A Cora Rotem Sivan-Hoffmann Roberto Crosa Markus Möhlenbruch Simon Nagel Hosam Al-Jehani Sunil A Sheth Victor S Lopez Rivera James E Siegler Achmad Fidaus Sani Ajit S Puri Anna Luisa Kuhn Gianmarco Bernava Paolo Machi Daniel G Abud Octavio M Pontes-Neto Ajay K Wakhloo Barbara Voetsch Eytan Raz Shadi Yaghi Brijesh P Mehta Naoto Kimura Mamoru Murakami Jin Soo Lee Ji Man Hong Robert Fahed Gregory Walker Eiji Hagashi Steve M Cordina Hong Gee Roh Ken Wong Juan F Arenillas Mario Martinez-Galdamez Jordi Blasco Alejandro Rodriguez Vasquez Luisa Fonseca M Luis Silva Teddy Y Wu Simon John Alex Brehm Marios Psychogios William J Mack Matthew Tenser Tatemi Todaka Miki Fujimura Roberta Novakovic Jun Deguchi Yuri Sugiura Hiroshi Tokimura Rakesh Khatri Michael Kelly Lissa Peeling Yuichi Murayama Hugh Stephen Winters Johnny Wong Mohamed Teleb Jeremy Payne Hiroki Fukuda Kosuke Miyake Junsuke Shimbo Yusuke Sug Neurology RadiologyBoston Medical CenterBostonMassachusettsUSA Neurology Marcus Stroke&Neuroscience CenterGrady Memorial HospitalEmory University School of MedicineAtlantaGAUSA Radiology Radiation OncologyBoston University School of MedicineBostonMassachusettsUSA Neurology National Hospital Organization Osaka National HospitalOsakaJapan Neurosurgery National Hospital Organization Osaka National HospitalOsakaJapan Neurology Alexandria UniversityAlexandriaEgypt Radiology Boston Medical CenterBostonMassachusettsUSA Department of Neurology Xinqiao HospitalChongqingChina Neurosurgery University of Cape TownRondeboschWestern CapeSouth Africa Neurosurgery Interventional NeuroradiologyClinica La Sagrada FamiliaBuenos AiresArgentina Neuroradiologie Neurologie VasculaireHospices Civils de LyonLyonAuvergne-Rhône AlpesFrance Neurologie Vasculaire Hospices Civils de LyonLyonAuvergne-Rhône AlpesFrance Interventional Neuroradiology Fondation Ophtalmologique Adolphe de RothschildParisÎle-de FranceFrance Neurology Hospital Geral de FortalezaFortalezaBrazil Interventional Neuroradiology Hospital Geral de FortalezaFortalezaBrazil Neuroradiology Nottingham University Hospitals NHS TrustNottinghamUK Department of Neurosurgery Kobe City Medical Center General HospitalKobeHyogoJapan Interventional Neurovascular Unit University Hospital CareggiFirenzeToscanaItaly Neuroradiology University Hospital Centre ZagrebZagrebCroatia Interventional Neuroradiology Hopital BicetreLe Kremlin-BicetreFrance Stroke and Interventional Neuroradiology Lahore General HospitalLahorePakistan Neurological institute Cleveland Clinic Abu DhabiAbu DhabiUAE Department of Radiology Beaumont HospitalDublinIreland Neurology Stroke UnitHospital-Estadual CentralVitoriaBrazil Neuroradiology Instituto de Neurocirugia Dr AsengoSantiagoChile Interventional Neuroradiology Institut National de NeurologieTunisTunisia Neurology Boston Medical CenterBostonMassachusettsUSA Neurosurgery Boston Medical Center

Background During the COVID-19 pandemic,decreased volumes of stroke admissions and mechanical thrombectomy were *** study’s objective was to examine whether subarachnoid haemorrhage(SAH)hospitalisations and ruptured aneurysm coiling interventions demonstrated similar *** We conducted a cross-sectional,retrospective,observational study across 6 continents,37 countries and 140 comprehensive stroke *** with the diagnosis of SAH,aneurysmal SAH,ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases,10th Revision,*** 3-month cumulative volume,monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before(1 year and immediately before)and during the pandemic,defined as 1 March-31 May *** prior 1-year control period(1 March-31 May 2019)was obtained to account for seasonal *** There was a significant decline in SAH hospitalisations,with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic,representing a relative decline of 22.5%(95%CI−24.3%to−20.7%,phospitalisation decline from 834 to 626 hospitalisations,a 24.9%relative decline(95%CI−28.0%to−22.1%,phospitals of 41.1%(95%CI 32.3%to 50.6%,p=0.008)despite a decrease in SAH admissions in this *** There was a relative decrease in the volume of SAH hospitalisations,aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 *** findings in SAH are consistent with a decrease in other emergencies,such as stroke and myocardial infarction.

关键词： diagnosis representing subarachnoid

Combination of corticosteroids and 5-aminosalicylates or corticosteroids alone for patients with moderate-severe active ulcerative colitis:A global survey of physicians'practice

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World Journal of Gastroenterology 2017年第16期23卷 2995-3002页

作者： Shomron Ben-Horin Jane M Andrews Konstantinos H Katsanos Florian Rieder Flavio Steinwurz Konstantinos Karmiris Jae Hee Cheon Gordon William Moran Monica Cesarini Christian D Stone Doron Schwartz Marijana Protic Xavier Roblin Giulia Roda Min-Hu Chen Ofir Har-Noy Charles N Bernstein Department of Gastroenterology Sheba Medical CenterSackler School of MedicineTel-Aviv UniversityRamat-Gan 52621Israel the First Affiliated hospital of Sun Yat-Sen university Guangzhou 510700Guangdong provinceChina Department of Gastroenterology and Hepatology Inflammatory Bowel Disease ServiceRoyal Adelaide HospitalSchool of MedicineUniversity of AdelaideAdelaideSA 5005Australia Division of Gastroenterology School of Health SciencesUniversity of IoanninaIoannina 45500Greece Department of Gastroenterology Hepatology and NutritionDigestive Disease Diseases and Surgery InstituteCleveland Clinic FoundationClevelandOH 44109United States Unit of Inflammatory Bowel Disease Hospital Israelita Albert EinsteinSao PauloSP 05652-900Brazil Department of Gastroenterology Venizeleio General HospitalHeraklion71409 CreteGreece Department of Internal medicine Yonsei University College of MedicineSeoul 03722South Korea NIHR Nottingham Digestive Diseases Biomedical Research Unit Nottingham University Hospitals NHS Trust and University of NottinghamNottingham NG7 2UHUnited Kingdom Dipartimento di Medicina Interna e SpecialitàMediche “Sapienza”University of Rome00185 RomaItaly Comprehensive Digestive institute of Nevada Las VegasNV 89113United States Department of Gastroenterology and Hepatology Soroka University Medical CenterBeer-Sheva 6400111Israel Department of Gastroenterology University Hospital ZvezdaraBelgrade 11000Serbia Department of Gastroenterology University-Hospital of Saint-Etienne42100 Saint EtienneFrance Gastroenterology Unit S.Orsola-Malpighi40138 BolognaItaly IBD clinical and Research Centre University of ManitobaWinnipegMB R3T2N2Canada

AIM To examine treatment decisions of gastroenterologists regarding the choice of prescribing 5-aminosalycilates(5ASA) with corticosteroids(CS) versus corticosteroids alone for patients with active ulcerative colitis(UC). METHODS A cross-sectional questionnaire exploring physicians' attitude toward 5ASA + CS combination therapy vs CS alone was developed and validated. The questionnaire was distributed to gastroenterology experts in twelve countries in five continents. Respondents' agreement with stated treatment choices were assessed by standardized Likert scale. Background professional characteristics of respondents were analyzed for correlation with responses. RESULTS Six hundred and sixty-four questionnaires were distributed and 349 received(52.6% response rate). Of 340 eligible respondents, 221(65%) would continue 5ASA in a patient hospitalized for intravenous CS treatment due to a moderate-severe UC flare, while 108(32%) would stop the 5ASA(P hospitalized patient not receiving 5ASA before admission. Most(94%) physicians consider the safety profile of 5ASA as very good. Only 52% consider them inexpensive, 35% perceive them to be expensive and 12% are undecided. On multi-variable analysis, less years of practice and perception of a plausible additive mechanistic effect of 5ASA + CS were positively associated with the decision to continue 5ASA with CS. CONCLUSION Despite the absence of data supporting its benefit, most gastroenterologists endorse combination of 5ASA + CS for patients with active moderate-to-severe UC. Randomized controlled trials are needed to assess if 5ASA confer any benefit for these patients.

关键词： Inflammatory bowel disease Corticosteroids 5-aminosalicylates Ulcerative colitis