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Intravenous Steroids (intravenous + steroid)
Selected AbstractsGranulomatous appendicitis progressing to Crohn's disease with bleeding complicationANZ JOURNAL OF SURGERY, Issue 7 2003Pei Ho Granulomatous appendicitis can be idiopathic or due to a number of specific causes. Idiopathic granulomatous appendicitis is regarded as a separate disease entity and usually has a benign course. We report on a case of granulomatous appendicitis, which progressed to fulminant Crohn's colitis shortly after appendicectomy. During the treatment with intravenous steroid, torrential gastrointestinal bleeding developed and emergency subtotal colectomy had to be performed. The clinical and histological features of the case are presented and the literature on granulomatous appendicitis reviewed. [source] Review article: the optimal medical management of acute severe ulcerative colitisALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 5 2010A. L. Hart Aliment Pharmacol Ther 2010; 32: 615,627 Summary Background, Management of acute severe ulcerative colitis (UC) is a clinical challenge, with a mortality rate of approximately 1,2%. The traditional management with intravenous corticosteroids has been modified by introduction of ciclosporin and more recently, infliximab. Aim, To provide a detailed and comprehensive review of the medical management of acute severe UC. Methods, PubMed and recent conference abstracts were searched for articles relating to treatment of acute severe UC. Results, Two-thirds of patients respond to intravenous steroids in the short term. In those who fail steroids, low-dose intravenous ciclosporin at 2 mg/kg/day is effective. Approximately 75% and 50% of patients treated with ciclosporin avoid colectomy in the short and long-terms, respectively. Long-term outcome of ciclosporin therapy is improved by introduction of azathioprine on discharge from hospital, together with oral ciclosporin as a bridging therapy. Controlled data show that infliximab is effective as rescue therapy for acute severe UC and the effect appears to be durable, although longer-term follow-up data are needed. Conclusions, Both ciclosporin and infliximab have demonstrated efficacy as rescue medical therapies in patients with acute severe UC, but surgery needs to be considered if there is failure to improve or clinical deterioration. [source] Delayed surgery for acute severe colitis is associated with increased risk of postoperative complications,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2010J. Randall Background: This study determined the long-term outcome after colectomy for acute severe ulcerative colitis (ASUC) and assessed whether the duration of in-hospital medical therapy is related to postoperative outcome. Methods: All patients who underwent urgent colectomy and ileostomy for ASUC between 1994 and 2000 were identified from a prospective database. Patient details, preoperative therapy and complications to last follow-up were recorded. Results: Eighty patients were identified, who were treated with intravenous steroids for a median of 6 (range 1,22) days before surgery. Twenty-three (29 per cent) also received intravenous ciclosporin. There were 23 complications in 22 patients in the initial postoperative period. Sixty-eight patients underwent further planned surgery, including restorative ileal pouch,anal anastomosis in 57. During a median follow-up of 5·4 (range 0·5,9·0) years, 48 patients (60 per cent) developed at least one complication. Patients with a major complication at any time during follow-up had a significantly longer duration of medical therapy before colectomy than patients with no major complications (median 8 versus 5 days; P = 0·036). Conclusion: Delayed surgery for patients with ASUC who do not respond to medical therapy is associated with an increased risk of postoperative complications. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Use of intravenous steroids at induction of anaesthesia for adult tonsillectomy to reduce post-operative nausea and vomiting and pain: a double-blind randomized controlled trialCLINICAL OTOLARYNGOLOGY, Issue 1 2006S. McKean Objective:, To assess the effectiveness of intravenous steroids at induction of anaesthetic to reduce post-operative nausea and vomiting and pain after adult tonsillectomy. Design:, Prospective, double-blind, randomized, placebo controlled trial, with ethical approval, following Consolidated Standards of Reporting Trials guidelines. Setting:, District General Hospital in Scotland, UK. Participants:, Seventy-two adults between 16 and 70 years, American Association of Anaethetists (ASA) 1, listed for elective tonsillectomy. Intervention:, Single dose of either 10 mg of dexamethasone or 2 mL of saline after induction with a consistent anaesthetic technique. Main outcome measures:, Patients filled in a visual analogue scale relating to pain and post-operative nausea and vomiting for the day of operation and 7 days after operation. The time to first ingestion of food and drink after operation was also noted. Results:, Data completion rate of 64% (46 of 72 patients enrolled). Statistically significant relative decrease (62%P = 0.001) in the incidence of post-operative nausea and vomiting was seen in those treated with dexamethasone. Statistically significant relative decrease (23%P = 0.016) in post-operative pain scores for the day of operation was seen in those treated with dexamethasone. Significant decrease (17.5%, P < 0.001) in mean pain score for seven post-operative days was seen in those treated with dexamethasone. No adverse effects were seen. Conclusions:, Dexamethasone given as a single dose of 10 mg at induction of anaesthesia for adult tonsillectomy is an effective, safe and inexpensive method for reducing morbidity in adult tonsillectomy. [source] |