A ray of hope for patients suffering from Crohn's disease which is otherwise very difficult to manage . Researchers are following several leads from study of immuno-inflammatory process surrounding Crohn's lesion. Newer anti inflammatory and immunosuppressants like Tumor Necrosis Factor -alpha (TNF ) antibodies (infliximab) recombinant interleukin 10 have shown promising results and are soon to be available in India for resistant or very aggressive disease. Other molecules like antisense neucleotides and anti CD-4 antibodies are also being studied and seem to be promising after initial evaluation. Hopefully this type of agents will bring Crohn's disease under control in more predictable way.
Improved medical management of ischaemic heart disease is now possible. Researchers have studied energy metabolism of heart and found that improving energy metabolism could have profound impact on cardiac function and tissue damage. Improving carbohydrate metabolism could have beneficial effect . High level of circulating fatty acids has adverse effect on glucose metabolism and controlling it pharmacologically could be an important step in restricting damage to the myocardium.
Arterial sonography is perhaps the best way to detect atherosclerosis at a very early stage. It has proved its value in research protocols and is now all set to be applied in clinical practice.
Patients with Crohn's disease have something to cheer from ,this time an unusual quarter. A discredited drug like Thalidomide, which was banned from clinical use several years ago has been found to be useful in refractory disease which has not responded to steroids and/ or having debilitating complications of Crohn's disease like fistula. Let us hope that after years of inactivity in Crohn's disease treatment patients have something to look forward to.
Endoscopic ultrasound is making headlines as the prime investigation modality in gastrointestinal diseases. Undiagnosed gallstone diseases, small tumor at the opening of bileduct and pancreatic duct, cancer in the head of pancreas, non cancerous diseases of pancreas , operability of cancer of the oesophagus ( food pipe ) and cancer of colon , sampling of small submucosal lesions ( biopsy ) are conditions where the endoscopic ultrasound is now replacing conventional modes of investigations. It is expected that few patients will remain undiagnosed or enter the operation theatre without having good idea about the operability of their cancers.