@article {8494, title = {Thalidomide for inflammatory bowel disease: Systematic review.}, journal = {Medicine (Baltimore)}, volume = {95}, year = {2016}, month = {2016 Jul}, pages = {e4239}, abstract = {

BACKGROUND: Thalidomide is an immunomodulatory drug used in the experimental treatment of refractory Crohn disease and ulcerative colitis. We aimed to review the existing evidence on the efficacy and safety of thalidomide in the treatment of inflammatory bowel diseases.

METHODS: CENTRAL, MEDLINE, LILACS, POPLINE, CINHAL, and Web of Science were searched in March 2016. Manual search included conference and reference lists. All types of studies, except single case reports, were included. Outcomes evaluated were: induction of remission; maintenance of remission; steroid reduction; effect on penetrating Crohn disease; endoscopic remission; adverse events.

RESULTS: The research strategies retrieved 722 papers. Two randomized controlled trials and 29 uncontrolled studies for a total of 489 patients matched the inclusion criteria. Thalidomide induced a clinical response in 296/427 (69.3\%) patients. Clinical remission was achieved in 220/427 (51.5\%) cases. Maintenance of remission was reported in 128/160 (80.0\%) patients at 6 months and in 96/133 (72.2\%) at 12 months. Reduction in steroid dosage was reported in 109/152 (71.7\%) patients. Fistulas improved in 49/81 (60.5\%) cases and closed in 28/81 (34.6\%). Endoscopic improvement was observed in 46/66 (69.7\%) and complete mucosal healing in 35/66 (53.0\%) patients. Cumulative incidence of total adverse events and of those leading to drug suspension was 75.6 and 19.7/1000 patient-months, respectively. Neurological disturbances accounted for 341/530 (64.3\%) adverse events and were the most frequent cause of drug withdrawal.

CONCLUSION: Existing evidence suggests that thalidomide may be a valid treatment option for patients with inflammatory bowel diseases refractory to other first- and second-line treatments.

}, issn = {1536-5964}, doi = {10.1097/MD.0000000000004239}, author = {Bramuzzo, Matteo and Ventura, Alessandro and Martelossi, Stefano and Lazzerini, Marzia} } @article {8490, title = {Torticollis as the Presenting Sign of Cervical Spondylodiscitis.}, journal = {Pediatr Emerg Care}, year = {2016}, month = {2016 Feb 10}, abstract = {

Acquired torticollis is a common clinical finding in children evaluated in the pediatric emergency department. It may be the presentation symptom of different illnesses, such as trauma, muscle contraction, infections, or malignancies, and an accurate differential diagnosis is required to correctly identify the cause and choose the right treatment. Spondylodiscitis is a low-grade bacterial infection that involves intervertebral disks and the adjacent vertebral bodies. Spondylodiscitis of the cervical spine is unusual and may be a rare cause of torticollis. We report the case of a 4-year-old male patient admitted to the emergency department for a 5-day history of painful torticollis. Blood tests showed an elevated erythrocyte sedimentation rate. The radiograph of the cervical spine showed a thin fifth cervical soma. The magnetic resonance imaging of cervical spine showed the alteration of cervical vertebral bodies and intervertebral disks, suggesting the diagnosis of cervical spondylodiscitis. The patient recovered after endovenous antibiotic treatment. We suggest that cervical spondylodiscitis should be suspected and investigated by means of an magnetic resonance imaging in every case of unexplained torticollis with persisting symptoms.

}, issn = {1535-1815}, doi = {10.1097/PEC.0000000000000643}, author = {Pizzol, Antonio and Bramuzzo, Matteo and Pillon, Roberto and Taddio, Andrea and Barbi, Egidio} } @article {1816, title = {Thromboembolism in pediatric inflammatory bowel disease: systematic review.}, journal = {Inflamm Bowel Dis}, volume = {17}, year = {2011}, month = {2011 Oct}, pages = {2174-83}, abstract = {

BACKGROUND: Several studies suggest an increased risk of venous and arterial thromboembolism (TE) in adults with inflammatory bowel disease (IBD) compared to the general population. We performed a systematic review of studies on incidence and characteristic of TE in children with IBD.

METHODS: We searched Medline, LILACS, EMBASE, POPLINE, CINHAL, and reference lists of identified articles, without language restrictions, in August 2010.

RESULTS: Population studies suggest that there is an increased risk of TE in children with IBD compared to controls. TE occurred in children with IBD in all age ranges, mostly (82.8\%) during active disease, and more frequently in children with ulcerative colitis (odds ratio [OR] 3.7, 95\% confidence interval [CI] 1.8-7.6). At least one specific risk factor for TE was recognized in 50\% of cases; two risk factors were present in 24\%. Out of 92 published cases of TE in children with IBD, 54.3\% occurred in cerebral site, 26\% in the limbs, 13\% in the abdominal vessels, and the remaining in the retina and lungs. After a first episode of TE, an early recurrence was observed in 11.4\% of children, a late recurrence in 10\%. A number of different therapeutic schemes were used. Overall mortality was 5.7\% and was mostly associated with cerebral TE.

CONCLUSIONS: Population studies are needed to clarify the risk of TE in children with IBD, the relative weight of other risk factors, the characteristics of the events, and to define guidelines of therapy and prophylaxis.

}, keywords = {Adult, Child, Humans, Inflammatory Bowel Diseases, Risk Factors, Thromboembolism}, issn = {1536-4844}, doi = {10.1002/ibd.21563}, author = {Lazzerini, Marzia and Bramuzzo, Matteo and Maschio, Massimo and Martelossi, Stefano and Ventura, Alessandro} }