Qualidade de vida de adultos com lesão medular: um estudo com WHOQOL-bref

Objetivou-se avaliar a qualidade de vida (QV) de adultos com lesão medular e identificar os domínios que podem influir na qualidade de vida. Para coletar os dados utilizou-se o WHOQOL-bref e um questionário com variáveis sociodemográficas. Participaram 47 sujeitos com média de idade de 42,95 anos, 91,5% do sexo masculino e 8,5% do feminino. Os domínios obtiveram os escores: físico (58,59%), psicológico (63,82%), social (68,79%) e ambiental (55,20%). Por meio de regressão linear múltipla, verificou-se a correlação dos escores dos domínios com a percepção da QV: físico (p < 0,187), psicológico (p < 0,399), social (p < 0,000) e ambiental (p < 0,008). Concluiu-se que a maioria (55,3%) dos participantes está insatisfeita com a QV e que os domínios social e ambiental apresentaram maior correlação com a QV.

Research involving biological material from forensic autopsies: legal and ethical issues.

Recommendations and laws do not always contain specific and clear provisions on the use of cadaveric material in research, and even more rarely do they address explicitly the ethical issues related to research on material obtained during forensic autopsy. In this article we analyse existing legal frameworks in Europe by comparing the legal provisions in 2 European Countries which are member states of the Council of Europe, the UK and Switzerland. They were chosen because they have distinct legal frameworks that make comparisons interesting. In addition, the detailed laws of the UK and a specific law project and national ethical recommendations in Switzerland permit us to define more clearly the legal range of options for researchers using cadaveric material obtained during forensic investigations. The Human Tissue Act 2004 in England, Wales and Northern Ireland, its Scottish equivalent with the same title (2006) and the national ethical guidelines in Switzerland all require consent from the deceased person, an appropriate relative or a person with power of attorney for healthcare decisions before cadaveric biological material can be obtained and used for research. However, if the purpose of the autopsy is purely forensic, no such authorization will be sought to carry out the autopsy and related analyses, which might include genetic testing. In order to be allowed to carry out future research projects, families need to be approached for informed consent, unless the deceased person had left written directives including permission to use his or her tissues for research.

Survival response in the skin

Apoptosis is defined as a programmed cell death process operating in multicellular organisms in order to maintain proper homeostasis of tissues. Caspases are among the best characterized proteases to execute apoptosis although lately many studies have associated them with non-apoptotic functions. In the laboratory an antiapoptotic pathway relying on caspase-3 activation and RasGAP has been described in vitro. RasGAP bears two conserved caspase-3 cleavage sites. Under low stress conditions, RasGAP is first cleaved by low caspase-3 activity generating an N terminal fragment (fragment N) that induces a potent anti-apoptotic response mediated by the Ras/PI3K/Akt pathway. High levels of active caspase-3, associated with increased stress conditions, induce further cleavage of fragment N abrogating this anti-apoptotic response. In the present work I studied the functionality of fragment N-mediated protection in physiological conditions as well as the mechanism by which fragment N induces an anti-apoptotic response, with a focus on survivin, an inhibitor of apoptosis. During my work in the laboratory I found that mice lacking caspase-3 or unable to cleave RasGAP (KI mice) are deficient in Akt activation and more sensitive to apoptosis than wild-type mice in response to stress. This higher sensitivity to stress led to augmented tissue damage, highlighting the importance of this pathway in protection against low stress. In parallel I focused on the study of survivin expression in the skin in response to UV-B light and I found that survivin is induced in the cytoplasm of keratinocytes in response to stress where it may fulfill a cyto-protective role. However fragment N had no effect on survivin expression. In addition, cytoplasmic survivin was increased in keratinocytes exposed to UV-B light, whether RasGAP is cleaved (WT mice) or not (KI mice), indicating that survivin is not involved in fragment N mediated protection. Altogether these data indicate that fragment N is pivotal for cell protection against pathophysiologic damage and can encourage the development of therapies aimed to strengthen the resistance of cells against aggressive treatments. Importantly, this finding contributes to the characterization of how caspase-3 can be activated without inducing cell death, although further studies need to be conducted in order to completely characterize this pro-survival molecular mechanism.

Analysis of LEDGF/p75 expression regulation

Background To replicate, retroviruses must insert DNA copies of their RNA genomes into the host genome. This integration process is catalyzed by the viral integrase protein. The site of viral integration has been shown to be non-random and retrovirus-specific. LEDGF/p75, a splice variant encoded by PSIP1 gene and described as a general transcription coactivator, was identified as a tethering factor binding both to chromatin and to lentiviral integrases, thereby affecting integration efficiency as well as integration site selection. LEDGF/p75 is still a poorly characterized protein, and its cellular endogenous function has yet to be fully determined. In order to start unveiling the roles of LEDGF/p75 in the cell, we started to investigate the mechanisms involved in the regulation of LEDGF/p75. Materials and methods To identify PSIP1 minimal promoter and associated regulatory elements, we cloned a region starting 5 kb upstream the transcription start site (TSS, +1 reference position) to the ATG start codon (+816), as well as systematic truncations, in a plasmid containing the firefly luciferase reporter gene. These constructs were co-transfected into HEK293 cells with a plasmid encoding the Renilla luciferase under the pTK promoter as an internal control for transfection efficiency. Both luciferase activities were assessed by luminescence as an indicator of promoter activity. Results Luciferase assays identified regions -76 to +1 and +1 to +94 as two independent minimal promoters showing respectively a 3.7x and 2.3x increase in luciferase activity. These two independent minimal promoters worked synergistically increasing luciferase activity up to 16.3x as compared to background. Moreover, we identified five regulatory blocks which modulated luciferase activity depending on the DNA region tested, three enhancers (- 2007 to -1159, -284 to -171 and +94 to +644) and two silencers (-171 to -76 and +796 to +816). However, the silencing effect of the region -171 to -76 is dependent on the presence of the +94 to +644 region, ruling out the enhancer activity of the latter. Computational analysis of PSIP1 promoter revealed the absence of TATA box and initiator (INR) sequences, classifying this promoter as nonconventional. TATA-less and INR-less promoters are characterized by multiple Sp1 binding sites, involved in the recruitment of the RNA pol II complex. Consistent with this, PSIP1 promoter contains multiple putative Sp1 binding sequences in regions -76 to +1 and +1 to +94.

Allostatic working memory processing in schizophrenia: Human and animal model coherence

The most evident symptoms of schizophrenia are severe impairment of cognitive functions like attention, abstract reasoning and working memory. The latter has been defined as the ability to maintain and manipulate on-line a limited amount of information. Whereas several studies show that working memory processes are impaired in schizophrenia, the specificity of this deficit is still unclear. Results obtained with a new paradigm, involving visuospatial, dynamic and static working memory processing, suggest that schizophrenic patients rely on a specific compensatory strategy. An animal model of schizophrenia with a transient deficit in glutathione during the development reveals similar substitutive processing, masking the impairment in working memory functions in specific test conditions only. Taken together, these results show coherence between working memory deficits in schizophrenic patients and in animal models. More generally, it is possible to consider that the pathological state may be interpreted as a reduced homeostatic reserve. However, this may be balanced in specific situations by efficient allostatic strategies. Thus, the pathological condition would remain latent in several situations, due to such allostatic regulations. However, to maintain a performance based on highly specific strategies requires in turn specific conditions, limitating adaptative resources in humans and in animals. In summary, we suggest that the psychological and physical load to maintain this rigid allostatic state is very high in patients and animal subjects.

Missale ad usum ecclesiae Parisiensis .

Cf. notice du ms. par Leroquais, Sacramentaires, II, 180-183 n° 366. Les incipit des proses ont été relevés dans la table des incipit. F. 1-6v Calendrier de Paris : 3 janv., en rouge, «Genovefe virg. IX lc.» (1); 22 avr., «Inventio corporis s. Dyonisii sociorumque ejus. Oportune virg. semid.» (2v); 28 mai, en rouge, «Germani ep. Parisiensis semid. Carauni mart. memoria» (3); 25juin, en violet, «Translatio s. Eligii ep.» (3v); en violet, «In prima dominica hujus mensis [augusti] fit d. de cruce» [réception à Notre-Dame d'un fragment de la vraie Croix] (4v); 9 oct., en rouge, «Dyonisii sociorumque ejus duplex» (5v); 28 oct., «Germani ep. Translatio s. Genovefe virg. mart. memoria» (5v); 3 nov. «Marcelli ep. Parisiensis dupl.»; 13 nov., «Gendulphi ep. et conf. [Parisiensis] dupl.»; 26 nov., en violet, «Genovefe virg. de miraculo [ardentium] IX lc.» (6); 4 déc., «Susceptio capillorum b. Marie et capitis b. Dyonisii in ecclesia Parisiensi» (6v). Le calendrier ne contient pas la fête de s. Louis au 25 août (établie en 1298) ni au 17 mai la translation du chef de s. Louis à la Sainte-Chapelle (en 1306); — Ajout du XIVe s. au 30 avr., «Eutropii mart. et conf.» [culte établi à Paris en 1296] (2v); cf. Leroquais, Bréviaires, I, CXII-CXIII, Tableau chronologique des fêtes parisiennes. — Au début de chaque mois, vers sur les jours égyptiaques (éd. Hennig, Traditio, XI (1955), 84 III), sauf celui de janvier (1) qui correspond au premier vers de la série éd. par Riese (Anthol. lat., I2 (1906), 680a); — À la fin de février, vers sur l'année bissextile : «Byssextum sexte martis tenuere kalende...»; cf. ms. Latin 3162, f. 102 (1v); — À la fin de mars, vers sur la date de Pâques : «Post martis nonas ubi sit nova luna requiras...» (2); — Notations astrologiques et de comput, passim. F. 7-353v Temporal, avec parties chantées notées. Incomplet du début par la perte du premier f., il commence dans la prose du premier dimanche de l'Avent : «... [eterna indefici]ens mundi vita...» (7). À remarquer : «dominica IIIa [in Adventu] more ecclesie Parisiensis» (24v); — Cérémonie des Cendres avec rubriques liturgiques (62v-66v); — Dimanche des Rameaux, «congregatis processionibus conventualibus in ecclesia B. Marie, capiceriis portantibus capsam et tribus clericis in albis paratis tres textus, exitur de ecclesia nichil cantando et sic eundum est ad ecclesiam Sancte Genovefe de Monte...» (147); cf. Leroquais, 181; — Dans l'évangile des Rameaux, le Christ est désigné par la lettre L, le narrateur par la lettre C et les autres par la lettre S (153-158); dans les autres évangiles de la Passion (162-186 passim), ces lettres suscrites ont été effacées et remplacées à la mine de plomb de façon sporadique, le Christ étant alors désigné par une croix; — «Oremus pro papa nostro N...» (186v); «... pro christianissimo rege nostro N...» (187); — Parmi les litanies, «s.Stephane... s. Dyonisi...» (191v)..., « s. Lucane... s. Justine... s. Gendulphe... s. Germane...» (199)..., « s. Genovefa...» (201v). — «Incipit ordo misse. Sacerdos primo induat se rocheto dicens : Actiones nostras...» (203v-206); pour les rubriques liturgiques, cf. Leroquais, 181; — Préfaces notées : «Incipiunt prefationes...» (206-210); — Canon de la messe (210-213); pour les rubriques liturgiques, cf. Leroquais, 182; — «In die Re[sur]rectionis» (214); — «In die sancto [Pentecostes]» (262v); — [De sancta Trinitate] (280v); — «Dominica XXVa» (348v); — «In dedicatione ecclesie» (350-353v). La fête du Saint-Sacrement ne figure pas. F. 354-496v Sanctoral, avec parties chantées notées. À noter parmi les saints parisiens : 3 janv., «S. Genovefe virg.» (373v); 22 avr., «Inventio corporis s. Dyonisii, Rustici et Eleuterii» (398v); — 28 mai, «S. Germani ep. Parisiensis» (407v); — 10 juin, «S. Landerici Parisiensis ep.» (410); — 26 juill., «In translatione s. Marcelli» (432); — 11août, «De receptione s. corone...» (443v); —, 4 oct., «Auree virg. [abb. Parisiis]» (480); 9 oct., «In die [s. Dyonisii]», avec octave (481v); — 28oct., «In translatione s. Genovefe» (487); — 3nov., «S. Marcelli Parisiensis ep.», avec octave (489v); — 26 nov., «S. Genovefe de miraculo ardentium» (495); — «De s. Gendulpho. Prosa» (495). F. 497-541 Commun des saints, avec pièces chantées notées. F. 541-559 Messes votives, sans parties notées à l'exception de la messe des morts (551v-556). Aux ff. 546v-547, en marge de la messe «pro amico», deux additions d'une écriture cursive de la fin du XIVe s. précisent : «ducem nostrum et duxissem ejusque prolem». — Prières diverses (556-559). F. 559-563 Rituel de mariage. «Incipit ordo ad sponsam benedicendam. Cum venerint ante valvas ecclesie sponsus et sponsa, accinctus sacerdos alba et stola... auxilium et argentum super scutum positum benedicat dicens : Manda Deus... Tunc aspergatur aqua benedicta et thurificetur et sponsus et sponsa; quo facto sacerdos dicat : Bones genz nos avons faiz les bans III foiz de ces II genz et encore les faison nous, que se il i a nul ne nule qui sache enpeschement par quoi l'un ne puisse avoir l'autre par loi de mariage, si le die. Et re[spon]dent assistentes : Nous ni savons se bien non. Quo audito, accipiat sacerdos manum dexteram sponse et ponat in dextera manu sponsi et dicat... nominandos eos : Vos Marie et vos Jeham vous prometez, fianciez et jurez l'un à l'autre à garder la foi et la loiauté du mariage... Tunc sacerdos tradat anulum sponso et sponsus autem per manum sacerdotis primo in police sponse... dicens... : Marie de cest annel t'espous et de mon cors t'ennor et de douaire qui est devisiez entre mes amis et les tiens. In nomine... Secundo in indice dicens... Tercio in medio dicens : Et Spiritus sancti. Amen... Postea sacerdos extensa manu super illos dicat orationes... Tunc sacerdos centus [sic] sponsum per manum dexteram et sponsam et introducat eos in ecclesiam...» (559-559bis); — Messe de mariage, comportant deux préfaces notées : «Deinde celebratur missa...» (559bis-562v); pour les rubriques liturgiques, cf. Leroquais, 183. — «Missa celebrata, recedant sponsus et sponsa et, ipsis stantibus ante hostium domus illorum presentibus pane et vinum [sic], faciat sacerdos benedictionem super panem dicens : Benedic Domine creaturam... Tunc sponsus mordet in pane, postea sponsa. Item benedictio super vinum... Tunc sponsus bibat, postea sponsa. Quo facto introducit eos sacerdos per manum in domum... Item in sero benedictio thalami... Tunc turificet thalamum, postea sponsum et sponsam sedentes vel jacentes in lecto suo benedicat dicens : Benedic Domine adulescentulos...» (562v-563) (éd. avec variantes par E. Martène, De antiquis Ecclesiae ritibus, II, 374-376, d'après le ms. Latin 859A); même ordo dans le ms. NAL 2649, f. 333-336. F. 563-565v Exorcisme de l'eau et du sel (563-564v). — «Pro Terra sancta» (564v-565). — «Pro rege nostro» (565). — «Benedictio pere et baculi peregrinorum» (565-565v). — «Benedictio crucis... Benedictio novorum fructuum... Benedictio panis» (565v).

Extraits de CHRONIQUES, et en particulier de textes relatifs à la NORMANDIE.

Contient : Extrait des Annales S. Dionysii ad cyclos paschales [cf. E. Berger, dans Bibl. de l'Ecole des chartes, t. XL, p. 270] ; Extrait de la chronologie des rois de France, de Bernard Gui, d'après un ms. de Petau, communiqué par Camuzat ; Fragment sur Philippe le Bel, par un moine de Saint-Denis (Frère Ives) [cf. Molinier, Sources, n° 2847] ; Extrait du Chronicon Colmariense [Mon. Germ., SS., t. XVII, p. 240] ; Lettre de Philippe IV relative à la bataille de Mons-en-Pévèle, septembre 1304 ; Fragment (1285-1343) de la chronique de l'Anonyme de Caen [Molinier, n° 1163] ; Extraits historiques relatifs aux fils de Philippe le Bel ; Chartes de Guillaume le Conquérant et d'Henri Ier pour l'abbaye de Montebourg ; Notice de la fondation de ladite abbaye ; Gesta abbatum Fontanellensium, rédaction abrégée. Incipit : « Wandregisilus qui et Wando... » [cf. Archiv, VIII, 373] ; Gesta abbatum Fontanellensium, précédés de la Commemoratio Ansberti [cf. éd. Loewenfeld, Hanovre, 1888, in-8°, et D'Achery, Spicil., éd. in-fol., t. II, p. 263] ; Chartes de l'abbaye de Saint-Wandrille (1024-1177) et extraits de pièces des XIIIe et XIVe siècles relatives à la même abbaye ; Extraits de la chronique de Robert de Thorigny, d'après un ms. du Mont-Saint-Michel ; Extraits d'Annales de Rouen, d'après un ms. de Bigot [ms. lat. 5530 ; cf. L. Delisle, dans Hist. littér., t. XXXII, p. 196] ; Chronologia urbis Rothomagensis (94-1549), composée par M. de La Mare ; Chron. Nortmannorum [cf. Duchesne, Rer. Franc. scriptores, t. II, p. 524, et L. Delisle, dans Notices et extraits, t. XXXVIII, p. 697] ; Annales de Saint-Wandrille, dites Chronicon Thosanum, [cf. Hist. littér., t. XXXII, p. 204] ; Eloge en vers de Lanfranc [Mabillon, AA. SS. Ben., t. VI, II, p. 659], d'après un ms. de Saint-Florent-lès-Saumur ; Trêve de Dieu pour la Normandie, du temps de Gullaume le Conquérant ; Extrait d'un ms. intitulé « Cursus Normanniae », communiqué par J. Sirmond ; Notice sur les abbés de Fécamp, jusqu'à Henri de Lorraine (1613-1642), d'après un ms. de M. de la Meschinière ; Catalogue des abbés du même monastère jusqu'à François de Joyeuse (1600-1613) ; Extraits d'un cartulaire de Saint-Michel du Tréport ; Extraits d'un calendrier de la même abbaye ; Extraits de la vie de saint Exupère, évêque de Bayeux ; Vers sur l'abbaye de Jumièges, attribués au moine Adrien (cf. Frère, Bibliogr. normand, t. I, p. 154) ; Extraits d'un calendrier des chanoines d'Eu ; Liste des évêques de Lisieux jusqu'à Guillaume Du Vair (1618-1621) ; Evêques de Bayeux jusqu'à Jacques d'Angennes (1606-1647) ; Evêques de Coutances jusqu'à Nicolas de Briroi (1589-1620) ; Evêques d'Evreux jusqu'à François de Péricard (1613-1646) ; Notes sur les chartes de l'abbaye de Savigny ; Chartes du Breuil-Benoît ; Catalogue des abbés de Jumièges ; Fondation de l'abbaye de Blanchelande (1154), et extraits des chartes de ce monastère ; Notes sur le fouage à lever en Normandie et sur les forteresses occupées par le roi, d'après les registres du Trésor des chartes ; Extraits des archives de Notre-Dame d'Ardenne ; Extraits des archives de Saint-Etienne de Caen ; Chartes diverses relatives à la Normandie (1217-1262) ; Annales d'Avranches, 837-1359 [cf. Hist. de Fr., t. XXIII, p. 568] ; Extraits de deux rédactions de la Vita Vanengi [Bibl. hag. lat., 8811 et 8813] ; Traité entre Abu-Issac et Vibaldus, envoyé de l'empereur Frédéric II (1231), traduction latine par M. Obelius Cicero [Mon. Germ., Const., t. II, p. 187] ; Extraits de chroniques arabes relatifs à l'histoire de Sicile, traduits par le même

Drug safety in the treatment of Crohn's disease.

The management of Crohn's disease usually consists of a succession of short-term acute phase treatments followed by long-term maintenance therapy. The disease affects young patients and for this reason the long-term safety of the drugs needs to be especially taken into consideration. The safety, dose, duration for optimal efficacy and the most frequent adverse events will be described in this article.

Postmortem chemistry update part I.

Postmortem chemistry is becoming increasingly essential in the forensic pathology routine and considerable progress has been made over the past years. Biochemical analyses of vitreous humor, cerebrospinal fluid, blood and urine may provide significant information in determining the cause of death or in elucidating forensic cases. Postmortem chemistry may essentially contribute in the determination of the cause of death when the pathophysiological changes involved in the death process cannot be detected by morphological methods (e.g. diabetes mellitus, alcoholic ketoacidosis and electrolytic disorders). It can also provide significant information and useful support in other forensic situations, including anaphylaxis, hypothermia, sepsis and hormonal disturbances. In this article, we present a review of the literature that covers this vast topic and we report the results of our observations. We have focused our attention on glucose metabolism, renal function and electrolytic disorders.

PlGF-1 and VEGFR-1 pathway regulation of the external epithelial hemato-ocular barrier. A model for retinal edema.

VEGF is considered as an important factor in the pathogenesis of macular edema. VEGF induces the rupture of the blood retinal barrier and may also influence the retinal pigment epithelial (RPE) outer retinal barrier. The aim of this work was to analyze the influence of the VEGF receptor pathways in the modulation of the RPE barrier breakdown in vitro and in vivo. The ARPE19 human junctions in culture are modulated by VEGF through VEGFR-1 but not through VEGFR-2. PlGF-1, that is a pure agonist of VEGFR-1, is produced in ARPE-19 cells under hypoxic conditions and mimics VEGF effects on the external retinal barrier as measured by TER and inulin flux. In vivo, the intravitreous injection of PlGF-1 induces a rupture of the external retinal barrier together with a retinal edema. This effect is reversible within 4 days. VEGF-E, that is a pure agonist of VEGFR-2, does not induce any acute effect on the RPE barrier. These results demonstrate that PlGF-1 can reproduce alterations of the RPE barrier occurring during diabetic retinopathy.

Rhumatologie. Une nouvelle option thérapeutique dans la prise en charge de l'inflammation chronique en rhumatologie: les inhibiteurs des janus kinases [A new therapeutical option for chronic inflammation in rheumatology: janus kinases inhibitors (JAK)].

In the last 15 years, the therapeutical options for the treatment of chronic inflammatory diseases in rheumatology have increased a lot. Nevertheless, some patients do not respond or respond partially to the current therapies--including to the biologics therapy. Tofacitinib (Xeljanz) is now on the Swiss market. It inhibits the JAK pathway. Tofacitinib--as monotherapy or with methotrexate--improves the control of rheumatoid arthritis (RA). In a comparative study, tofacitinib was as effective as adalimumab. Further, tofacitinib reduced structural damages in RA and is considered as an alternative, in case of non-response, to anti-TNF and probably to other biologics therapy. The side effects are upper respiratory tract and opportunist infections and tuberculosis. Blood count, lipids, kidney function, liver tests, CK and blood pressure have to be monitored.

Placental transfer of pyrimethamine studied in an ex vivo placental perfusion model.

Pyrimethamine is used as and anti-infectious agent because of its antifolate properties. Its action is synergistic with that of dapsone and sulfamides on Toxoplasma gondii. The goal of the present study was to evaluate the placental transfer of pyrimethamine in an ex vivo model of perfused human placental cotyledon at term. Human placentas were perfused according to the slightly modified method of Schneider. The pyrimethamine fetal transfer rate was approximately 30%, while cotyledon clearance was about 1.8 ml/min. The placental transfer of pyrimethamine seems to be independent of the maternal concentrations of pyrimethamine, suggesting passive diffusion mechanisms or a nonsaturable active transport at the tested concentrations.

Marseille. Collection de copies et de documents originaux concernant l'histoire de Marseille. Collection Mortreuil sur Marseille vol. 12 : Corps religieux (Préfecture des Bouches du Rhône. Archives de l’église d’Arcoules, du monastère de Saint Sauveur et des Grands Trinitaires de Marseille. Actes antérieurs au XIV e siècle. A.M. 1855.)

Copie manuscrite de documents d’archives : F. 1-91. Archives de l’Eglise d’Arcoules de Marseille. F. 92-104. Augustins. F. 105-149. Archives des Dominicains (precheurs) de Marseille. F. 150-153. Abbaye de l’Huveaune, prémontrés. F. 154-178. Frères Mineurs. F. 179-180. La Major. F. 181 -184. St Carmat. F. 185-186. St Etienne des îles Ratoneau. F. 187-191. St Jacques de Corrégie. F. 192-193. St Laurent. F. 194-195. Prieuré de St Lazare. F. 196-199. St Martin F. 200-206. St Michel et St Etienne du Plan. F. 207 -379. Archives du monastère de Saint Sauveur de Marseille. F. 381-387. Sainte Claire. F. 388-391. N.D. de Syon. F. 392 459. Archives des Grands Trinitaires de Marseille.

Treatment of postoperative Crohn's disease.

At 1 year after a first resection, up to 80% of patients show an endoscopic recurrence, 10-20% have clinical relapse, and 5% have surgical recurrence. Smoking is one of the most important risk factors for postoperative recurrence. Preoperative disease activity and the severity of endoscopic lesions in the neoterminal ileum within the first postoperative year are predictors of symptomatic recurrence. Mesalamine is generally the first-line treatment used in the postoperative setting but still provokes considerable controversy as to its efficacy, in spite of the results of a meta-analysis. Immunosuppressive treatment (azathioprine, 6-MP) is based on scant evidence but is currently used as a second-line treatment in postsurgical patients at high risk for recurrence, with symptoms or with early endoscopic lesions in the neoterminal ileum. Nitroimidazole antibiotics (metronidazole, ornidazole) are also effective in the control of active Crohn's disease in the postoperative setting. Given their known toxicity, they may be used as a third-line treatment as initial short-term prevention therapy rather than for long-term use. Conventional corticosteroids, budesonide or probiotics have no proven role in postoperative prophylaxis. Infliximab has not as yet been studied for use in the prevention of relapse after surgery.