PURPOSE: We assessed the clinical outcomes of a seton procedure combined with early versus late institution of infliximab (IFX) therapy. METHODS: This retrospective study comprised 76 patients who underwent surgery for perianal fistula associated with Crohn disease between January 2014 and November 2017. All patients underwent loose seton drainage combined with IFX therapy. Patients categorized as the early group (EG, 49 patients) received IFX therapy within 30 days of completion of the seton procedure. Patients categorized as the late group (LG, 27 patients) received IFX therapy >30 days after the seton procedure. IFX therapy was administered as induction and maintenance therapy. RESULTS: There were no statistically significant intergroup differences in clinical characteristics of the patients. The mean follow-up was 21.0 ± 11.6 months in the EG and 34.5 ± 18.4 months in the LG (P = 0.001). The mean interval between seton procedure and IFX induction therapy was 12.2 days in the EG and 250.2 days in the LG (P = 0.002). Complete remission was observed in 32 patients (65.3%) in the EG and 17 patients (63.0%) in the LG (P = 0.844). Fistula recurrence was observed in 6 patients (7.9%). All recurrences occurred in a previous perianal fistula tract. CONCLUSION: Patients showed a good response to a seton procedure combined with IFX therapy regardless of the time of initiation of IFX therapy.
Crohn Disease ; Drainage ; Fistula ; Follow-Up Studies ; Humans ; Infliximab ; Recurrence ; Retrospective Studies

BACKGROUND: Pulmonary tuberculosis is one of the diseases characterized granuloma formation which was controlled by cellular immune reactions. In the process of granulomatous changes, activated alveolar macrophages and T lymphocytes secrete many cytokines including interleukin-1 (IL-1), tumor necrosis factor-alpha(TNF-alpha), interferon-gamma (INF-gamma) which mediate inflammatory reactions. Intercelluar adhesion molecule-1(ICAM-1) also known to major role player in inflammatory processes, and increased cellular expressions when endothelial cell was stimulated by IL-1, TNF and IFN. METHOD: To evaluate relationships among cellular immune reactions and clinical stages, pulmonary tuberculosis patients were classifed into three groups according to their clinical stages including minimal, moderate and far advance tuberculosis. TNF-alpha, INF-gamma, sICAM-1 (soluble form of ICAM-1) were measured at the time of diagnosis and after 6-months anti-tuberculosis medications by radioimmuno assay or enzyme linked immunosolvent assay. RESULTS: TNF-alpha, INF-gamma, sICAM-1 were singificantly increased in moderate and far advanced pulmonary tuberculosis patients but no meaningful changes in minimal staged patients. 6-months anti-tuberculosis medications reduced serum sICAM-1 levels significantly, related to clinical improvement but no significnat changes were found in the serum levels of TNF-alpha and INF-gamma. In the point of correlations, positive ones revealed between TNF-alpha and sICAM-1, also between IFN-gamma and sICAM-1 but no correlation between TNF-alpha and IFN-gamma. CONCLUSION: Measurement of serum sICAM-1 could be usuful parameter to evaluate the severity of pulmonary tuberculosis and to monitor disease activities durig anti-tubercoulsis medications.
Cytokines ; Diagnosis ; Endothelial Cells ; Granuloma ; Humans ; Interferon-gamma* ; Interleukin-1 ; Macrophages, Alveolar ; Necrosis ; T-Lymphocytes ; Tuberculosis ; Tuberculosis, Pulmonary* ; Tumor Necrosis Factor-alpha*