Martinez C.,Institute of Hematology and Oncology |
Rosales M.,Institute of Hematology and Oncology |
Calvo X.,Institute of Hematology and Oncology |
Cuatrecasas M.,Biomedical Diagnostic Center |
And 7 more authors.
Bone Marrow Transplantation | Year: 2012
Gastrointestinal (GI) GVHD after allo-SCT is diagnosed on the basis of symptoms and findings in endoscopic mucosal biopsy specimens. However, GI symptoms often persist despite treatment and whether a second endoscopy may be helpful in determining the most suitable therapy is not established. We identified 31 patients with persistent diarrhea who underwent more than one endoscopic study. All cases underwent serial microbiological stool analysis and CMV-detecting assays on serum and biopsies. Of the 31 initial GI biopsies, 20 (64.5%) were classified as GVHD, two (6.5%) as GVHD with CMV, four (13%) as non-CMV infection, and five (16%) as normal or unspecific. The second GI biopsies were diagnostic of GVHD in nine cases (29%), GVHD simultaneously with CMV infection in four (13%), regenerative changes post-GVHD in five (16%), CMV infection in four (13%), and normal or unspecific in nine (29%). In 22 of the 31 patients (71%), the histological findings of the second/third endoscopic biopsies differed from the findings of the first endoscopy and led to a therapy change in 77%. In conclusion, serial GI endoscopies are of reliable diagnostic value and can impact on therapeutic decision-making for patients with persistent diarrhea after allo-SCT. © 2012 Macmillan Publishers Limited All rights reserved.
Flores L.,Hospital Clinic i Universitari |
Moize V.,Hospital Clinic i Universitari |
Ortega E.,Hospital Clinic i Universitari |
Ortega E.,Idibapsinstitut Dinvestigacions Biomediques August Pi I Sunyer |
And 5 more authors.
Obesity Surgery | Year: 2015
Methods: We performed two open-label, prospective studies in patients undergoing BS from 2009 to 2011. Postoperatively, all patients received Ca citrate 1,000 mg and 800 IU of VD3/day. In the first study, additional VD3 was prescribed according to preoperative 25(OH)D levels— < 25 nmol/L:2,800 IU/day; 26–50 nmol/L:2,000–1,200 IU/day, 51–62 nmol/L:1,000 IU; >63 nmol/L:0 IU/day—and we evaluated the patients at baseline and at 4 months. In the second study, an additional fixed high dose of 2,000 IU/day of VD3 was administered, and we evaluated patients at baseline and at 4 and 12 months after BS.Background: The degree of bariatric surgery (BS) induced vitamin D (VD) malabsorption is not well established.Objective: The aim of this study is to evaluate the efficacy and safety of achieving 25-hydroxy VD (25(OH)D) levels ≥75 nmol/L with two regimens of VD supplementation after BS.Results: The first study included 176 patients [mean age 44 (11)]; 140 were females. Before BS, 171 subjects (98 %) presented 25(OH)D levels <75 nmol/L. Postoperatively, the mean 25(OH)D levels increased from 40 (17) to 77 nmol/L (29) (p < 0.001) with no differences in parathormone (PTH) or 25(OH)D levels between dose groups. In the second study, we enrolled 52 patients [mean age 45 (10)]; 32 were females. Postoperatively, the mean 25(OH)D levels increased from 32 (12) to 80 (22) and to 75 nmol/L (15) (p < 0.001) at 4 and 12 months, respectively. In both studies, a high percentage of patients achieved 25(OH)D ≥75 nmol/L levels and no subject reported any serious adverse event.Conclusions: Both schedules of daily VD3 supplementation were effective and safe under conditions of clinical practice. © 2014, Springer Science+Business Media New York.