***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Inflammatory bowel disease ( IBD ) and colorectal surgery are risk factors for deep venous thrombosis ( DVT ) . The aim of this prospect i ve study was to evaluate the effectiveness of st and ardized prophylactic low molecular weight heparin ( LMWH ) therapy in patients who underwent surgery for ulcerative colitis ( UC ) and Crohn ’s disease ( CD ) . Patients and methods Since 1999 all patients operated on for colorectal diseases in our institute have received 4,000 IU/day LMWH from the day of operation to discharge . The complete series of patients who had major colorectal surgery from 1999 until 2006 were review ed for overt DVT episodes . Furthermore , 60 consecutive patients who were admitted for surgery for IBD were prospect ively enrolled in the 2004–2006 period . Each patient underwent  venous color Doppler ultrasound scan at admission and at discharge . Demographic data , disease activity , and clotting parameters were collected . Data were analyzed with Spearman ’s correlation test , multiple regression , and receiver operating characteristics ( ROC ) curves analysis . Results The rate of DVT in UC patients was significantly higher than in colorectal cancer patients ( p = 0.009 ) , and the odds ratio ( OR ) for postoperative DVT in UC patients was 7.4 ( 95 % CI 1.4–44.4 ; p = 0.017 ) . Female gender , UC diagnosis , active rectal bleeding , aPTT value , aCL IgM , aβ2 IgM , and pANCA levels significantly correlated with postoperative DVT . At multivariate analysis only aCL IgM levels were found to be independently associated with postoperative DVT ( p = 0.05 ) . Conclusions In conclusion , our study showed that prophylactic therapy with 4,000 IU/day LMWH was not completely effective for the prevention of postoperative DVT in patients with CD , and even less so in those with UC . In these patients , a more tailored prophylactic therapy should be considered , and further r and omized controlled trials testing the effectiveness of different prophylactic protocol s would be advisable . Furthermore , aCL IgM serum levels might be helpful in identifying IBD patients who are at higher risk of postoperative DVT AIM To evaluate the effect of perioperative parenteral nutrition on serum immunoglobulin , weight change , and post-operative outcome in severely malnourished patients with Crohn 's disease . METHODS Thirty-two severely malnourished patients with Crohn 's disease who had undergone surgery in our hospital were review ed . Sixteen patients who received perioperative parenteral nutrition  were enrolled in the study group , and the other 16 patients who did not receive parenteral nutrition  were enrolled in the control group . Serum immunoglobulin , body mass index ( BMI ) , liver function , weight change , and postoperative complications were evaluated . RESULTS Serum IgM levels elevated 1 wk before surgery in both groups , and decreased to normal value ( from 139+/-41 to 105+/-29 mg/dL , P = 0.04 ) 4 wk after operation in the study group , while no significant changes was noted in the control group ( from 133+/-16 to 129+/-13 mg/dL , P = 0.34 ) . There were no significant changes in concentrations of IgG and IgA. The BMI of the study group increased from 13.9+/-0.6 to 15.3+/-0.7 kg/m(2 ) ( P = 0.02 ) with no significant change in the control group ( 14.1+/-0.7 and 14.5+/-0.5 , respectively , P = 0.81 ) . The percentage of resuming work was higher in the study group than in the control group . CONCLUSION Perioperative parenteral nutrition possibly ameliorates the humoral immunity , reverses malnutrition , and facilitates rehabilitation Abstract Objective . The effect of preoperative total parenteral nutrition ( TPN ) on the rate of early ( within 30 days ) postoperative complications in patients with moderate to severe Crohn 's disease ( CD ) was examined . Material and methods . A series of 15 consecutive patients with CD ( mean CD activity index score , 270 ) given preoperative TPN for 18–90 days ( mean , 46 days ) and undergoing bowel resection and primary anastomosis was compared with matching controls ( 105 patients ) consecutively selected from all CD patients operated in Stockholm County during a preceding 20-year period without preoperative TPN .  Results . During the preoperative TPN , all the patients studied displayed clinical remission of CD as reflected in improvement in their general well-being , relief of abdominal pain , and abatement of fever and diarrhea . There was no significant early postoperative complication in the TPN-treated group , whereas there were 29 patients with early postoperative complications in the control group , which means a significantly higher rate of postoperative complications when preoperative TPN was not provided . During the preoperative TPN , some crucial variables increased such as the body weight , the serum concentrations of albumin and triiodothyronine reflecting improved nutritional state , whereas the serum concentration of haptoglobin and the white cell count decreased reflecting decreased inflammatory activity . Conclusions . This study shows that preoperative TPN for at least 18 days may be recommended to be given to patients with moderate to severe CD until clinical remission is achieved in order to minimize the risk of early postoperative complications BACKGROUND & AIMS Lifestyle factors have been shown to influence prognosis in Crohn 's disease . The purpose of this study was to prospect ively assess the effects of smoking and oral contraceptive use on clinical relapse rates . METHODS  Placebo-treated patients formed a prospect i ve cohort , followed up for 48 weeks or until relapse . The influence of smoking and the use of oral contraceptives on relapse risk was examined by life-table analysis ( log rank tests ) and Cox proportional hazards modeling , taking into account demographic and disease characteristics . RESULTS Of 152 patients , 61 ( 40 % ) had a relapse .  Univariate analysis showed unfavorable outcomes for women ( P = 0.05 ) , current smokers ( P = 0.005 ) , and use of oral contraceptives ( P = 0.001 ) . Recent surgery was associated with a decreased risk of relapse ( P = 0.02 ) . The Cox model retained current smoking vs. never smoking ( hazard ratio , 2.1 ; 95 % confidence interval , 1.1 - 4.2 ) , oral contraceptive use ( hazard ratio , 3.0 ; 95 % confidence interval , 1.5 - 5.9 ) , and medical compared with surgical induction of remission ( hazard ratio , 2.1 ; 95 % confidence interval , 1.0 - 4.2 ) as predictors of relapse . Ex-smokers did not have an increased risk . Finally , sex , age , time in remission , disease location , and disease duration were not significant predictors . CONCLUSIONS Oral contraceptive use and smoking are associated with an increased risk of relapse in patients with Crohn 's disease Background : Long‐term enteral nutrition may maintain clinical and endoscopic remission in patients with Crohn 's disease ( CD ) . The aim of this prospect i ve study was to investigate the impacts of long‐term enteral nutrition on clinical and endoscopic disease activities and mucosal tissue cytokines in patients with quiescent CD . Methods : Forty patients with CD who achieved clinical remission were included . Of these , 20 received continuous elemental diet ( Elental ) infusion during the nighttime and a low‐fat diet during the daytime ( EN group ) and 20 received neither nutritional therapy nor food restriction ( non‐EN group ) . With these regimens , all 40 patients were monitored for 1 year . Further , ileocolonoscopy was performed at entry , at 6 and 12 months , and mucosal biopsies were taken for cytokine assays . Results : On an intention‐to‐treat basis , 5 patients ( 25 % ) in the EN group and 13 ( 65 % ) in the non‐EN group had a clinical relapse during the 1‐year observation ( P = 0.03 ) . The mean endoscopic inflammation ( EI ) scores were not significantly different between the groups at both entry and 6 months , but at 12 months EI scores were significantly higher in the non‐EN group than in the EN group ( P = 0.04 ) . Additionally , the mucosal tissue interleukin (IL)‐1&bgr ; , IL‐6 , and tumor necrosis factor (TNF)‐&agr ; levels significantly increased with time in the non‐EN group ( entry versus 12 months , IL‐1&bgr ; , P = 0.02 ; IL‐6 , P = 0.002 ; TNF‐&agr ; , P = 0.001 ) . In the EN group these cytokines did not show a significant increase . Conclusions : Long‐term enteral nutrition in patients with quiescent CD has a clear suppressive effect on clinical and endoscopic disease activities and the mucosal inflammatory cytokine levels . ( Inflamm Bowel Dis 2007 Objective : To compare the efficacy and safety of antithrombotic prophylaxis given for 1 week or 4 weeks in patients undergoing laparoscopic surgery for colorectal cancer . Background : Extending antithrombotic prophylaxis beyond 1 week reduces the incidence of venous thromboembolism ( VTE ) after open abdominal surgery for cancer . Methods : In consecutive patients who underwent laparoscopic surgery for colorectal cancer , complete compression ultrasonography of the lower limbs was performed after 8 ± 2 days of antithrombotic prophylaxis . Patients with no evidence of VTE were r and omized to short ( heparin withdrawal ) or to extended ( heparin continued for 3 additional weeks ) prophylaxis  . Complete compression ultrasonography was repeated at day 28 ± 2 after surgery by investigators blinded to treatment allocation . The primary outcome of the study was the composite of symptomatic and ultrasonography-detected VTE at day 28 ± 2 after surgery . Results : Overall , 301 patients were evaluated for inclusion in the study and 225 were r and omized . VTE occurred in 11 of 113 patients r and omized to short ( 9.7 % ) and in none of the 112 patients r and omized to extended heparin prophylaxis ( P = 0.001 ) . The incidence of VTE at 3 months was 9.7 % and 0.9 % in patients r and omized to short or to extended heparin prophylaxis , respectively ( relative risk reduction : 91 % , 95 % confidence interval : 30%–99 % ; P = 0.005 ) . The rate of bleeding was similar in the 2 treatment groups . Two patients died during the study period , 1 in each treatment group . Conclusions : After laparoscopic surgery for colorectal cancer  , extended antithrombotic prophylaxis  is safe and reduces the risk for VTE as compared with 1-week prophylaxis ( NCT01589146 ) Objective : To evaluate the safety of perioperative low-dose steroids ( LDS ) versus high-dose steroids ( HDS ) in steroid-treated patients with inflammatory bowel disease ( IBD ) undergoing major colorectal surgery . Background : Corticosteroid-treated patients undergoing major colorectal surgery are commonly prescribed HDS to prevent perioperative adrenal insufficiency and cardiovascular collapse . There is little evidence to support this practice . Methods : We performed a single-blinded noninferiority trial to compare perioperative hemodynamic instability in 92 steroid-treated IBD patients undergoing major colorectal surgery . Patients were r and omly assigned to receive perioperative high-dose corticosteroids ( HDS ; hydrocortisone , 100 mg , intravenously 3 times daily , followed by taper ) or low-dose corticosteroids ( LDS ; intravenous hydrocortisone equivalent to presurgical oral dosing , followed by taper ) . The primary outcome was the absence of postural hypotension on postoperative day 1 , defined as a decrease in systolic blood pressure by 20 mm Hg after sitting from a supine position . Results : The primary outcome , absence of postural hypotension on postoperative day 1 , occurred in 95 % of those r and omized to receive high doses of corticosteroids compared with 96 % of those who received low doses ( noninferiority 95 % confidence interval = −0.08 to 0.09 ; P = 0.007 ) . Conclusions : In IBD patients undergoing abdominal surgery , the incidence of postural hypotension or adrenal insufficiency is similar among those receiving high doses or low doses of corticosteroids in the perioperative period . To reduce complications associated with unnecessarily high doses of steroids , steroid-treated IBD patients undergoing major colorectal surgery should be treated with low doses of steroids in the perioperative period . ( Clinical trials.gov ID # NCT01559675 BACKGROUND AND AIMS To evaluate the benefit of smoking cessation in individuals with Crohn 's disease , we performed an intervention study in a large cohort of smokers with the disease . METHODS Repeated counseling to stop smoking , with easy access to a smoking cessation program , was given to 4 
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Thiopurines appear to be safe , but it may be prudent to plan the procedure remotely from the last dose of an anti-TNF agent .
Thrombosis prophylaxis prior to surgery is well supported by evidence while extended 4-week prophylaxis needs further research .
Percutaneous ultrasound or CT-guided drainage for intra-abdominal abscesses is recommended , but it is unclear for how long supplementary antibiotics ( ABs ) should be used .
Oral AB 24 h prior to open surgery might improve outcome if given as complementary to IV perioperative AB .
Mechanical bowel preparation is not supported by evidence .
Smoking cessation can be beneficial for wound healing .