human
***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 / AIMS Uncontrolled studies suggest that cyclosporine administered as an enema may be of benefit for left-sided ulcerative colitis and safer than intravenous or oral administration . The efficacy and safety of cyclosporine enemas for left-sided ulcerative colitis in a placebo-controlled trial was assessed . METHODS Steroid and mesalamine enemas were withdrawn before the study . Forty patients were assigned to 1 of 4 strata : no concomitant therapy , oral steroids , oral salicylates , or oral steroids and salicylates . After stratification , patients were r and omized to nightly treatment with 350 mg cyclosporine ( n = 20 ) or placebo ( n = 20 ) enemas . Clinical response was determined at baseline and 4 weeks by endoscopy , physician assessment , and a patient diary of daily symptoms . Trough blood cyclosporine levels were measured by high-performance liquid chromatography . RESULTS At 4 weeks , 8 of 20 patients ( 40 % ) who received cyclosporine showed clinical improvement compared with 9 of 20 patients ( 45 % ) who received placebo . One patient receiving cyclosporine had reversible neutropenia attributable to sulfasalazine , and another patient receiving cyclosporine was unable to tolerate the enema vehicle . No other toxicity was noted during the trial . Blood cyclosporine levels were detectable in only two patients . CONCLUSIONS Cyclosporine enemas administered in a dosage of 350 mg/day for 4 weeks are not efficacious in mildly to moderately active left-sided ulcerative colitis OBJECTIVE To define what effect seminal and controlled clinical trials have on practice patterns within a gastroenterological community . To define whether these practice patterns reproduce reported treatment methods and whether results comparable with those reported in such trials are noted within a community practice setting . METHODS Mailed surveies , with telephone follow-up , were sent to all members of the Pacific Northwest Gastroenterology Society . Respondents were queried regarding cyclosporin use in the precolectomy chronic ulcerative colitis ( CUC ) patient . Data collected included patient demographics , disease duration and extent , pre-treatment use of steroids , method , dosage , and duration of cyclosporin therapy , side effects , and short-term and subsequent clinical results . RESULTS Twenty-one percent of 81 respondents had used cyclosporin for precolectomy CUC , approximately one-half using constant infusion and one-half using parenteral bolus therapy .  Side effects attributed to the cyclosporin were noted in eight of 30 patients ( 27 % ) , and acute colectomy was avoided in 17 patients ( 57 % ) . Subsequent colectomy was required in an additional nine patients ( 73 % total ) within a 6-month follow-up period , a significantly higher colectomy rate than that reported in prospect i ve trials . CONCLUSIONS Potential reasons precluding cyclosporin use within the gastroenterological community may include lack of knowledge about cyclosporin therapy for CUC , lack of opportunity , skepticism , fear of medication side effects , survey sampling error , or treatment philosophy . Potential reasons for failure to duplicate the results reported in controlled trials are more complex but may include inadequate treatment duration the learning curve associated with the use of a new medication , or acceptance of colectomy as the treatment of choice in patients with acutely or chronically debilitating disease BACKGROUND / AIMS Cyclosporin was reported to be useful for steroid-resistant severe ulcerative colitis in the short term , but limited data are available on the long-term follow-up of such patients . Our aim was to assess the short- and long-term efficacy of combination therapy with cyclosporin and corticotropin for steroid-resistant ulcerative colitis . METHODOLOGY Twenty-one patients with ulcerative colitis who did not respond to corticosteroid therapy  , were treated with corticotropin , and 9 patients ( 43 % ) of them achieved complete remission . Twelve patients ( 57 % ) who did not achieve complete remission by corticotropin alone were given combination therapy with cyclosporin and corticotropin . RESULTS In 12 patients who received combined therapy with cyclosporin and corticotropin , clinical severity was distinctly improved in 11 patients ( 92 % ) by combination therapy within 2 weeks and 7 patients ( 58.3 % ) entered into complete remission with salicylazosulfapyridine or 5-aminosalicylic acid alone . Two patients ( 16.7 % ) demonstrated insufficient effect and continue to receive a lower dosage of cyclosporin or corticosteroid . Three patients ( 25 % ) failed to respond to the combination therapy and required colectomy . Three of 7 patients who entered into remission relapsed 0.5 , 5 and 5.5 months ( average : 3.7 months ) after cyclosporin withdrawal , but the clinical severity at the time of relapse was milder than that at the beginning of the treatment , namely , moderate in 2 patients , and mild in 1 patient . There were no significant adverse effects in our series . CONCLUSIONS We demonstrated that oral cyclosporin in combination with corticotropin was highly effective for ulcerative colitis refractory to corticosteroid or corticotropin therapy and severe relapse was uncommon during several years of follow-up UNLABELLED A single r and omized trial evaluated the use of intravenous cyclosporine treatment for severe attacks of ulcerative colitis .  The perceived efficacy and safety of this intervention were measured through a survey of the membership of the Canadian Association of Gastroenterology ( CAG ) . METHODS All CAG members were mailed a survey with questions regarding their familiarity with the data supporting the use of cyclosporine , their perception of the efficacy and toxicity of the drug , and whether patients who fail conventional treatment should receive this therapy . The proportion of respondents who had used cyclosporine to treat severe ulcerative colitis was determined . RESULTS One hundred and sixty-one responses were received ( 34 % response rate ) . Sixty-four per cent of respondents were academic faculty members and 82 % treated patients with severe colitis . Using multivariate analyses , positive associations were found between the respondents ' age ( P = 0.004 ) and subspecialty training in gastroenterology ( P = 0.001 ) , and whether respondents treat patients with severe ulcerative colitis . Twenty-six per cent of individuals had prescribed cyclosporine for this indication , of whom 88 % were in academic practice ( P = 0.007 ) . Over 90 % of respondents believe that further clinical trials are needed before cyclosporine becomes accepted as st and ard therapy . CONCLUSIONS Although the use of cyclosporine is measurable among Canadian gastroenterologists , the majority believe that further clinical trials are necessary before the drug is accepted as a st and ard therapy Thirty five adult patients with precirrhotic primary sclerosing cholangitis were r and omly allocated to treatment for at least one year with low dose ( 4.1 mg/kg/day ) cyclosporin or placebo in a double blind trial . Thirty patients had coexisting ulcerative colitis , including three who had previously undergone colectomy and one who discontinued treatment after three months . Of the remaining 26 patients , 16 received cyclosporin and 10 received placebo . Endoscopy was performed at entry to confirm the diagnosis of inflammatory bowel disease . The ulcerative colitis disease activity was prospect ively classified annually as remission/mild , moderate , or severe using the Truelove and Witt 's criteria . Before treatment there were no differences between the cyclosporin and placebo groups in the number of patients with remission/mild colitis , 14/16 ( 88 % ) v 9/10 ( 90 % ) , and moderate colitis , 2/16 ( 12 % ) v 1/10 ( 10 % ) . During treatment , a remission/mild disease course was present in 15/16 ( 94 % ) v 6/10 ( 60 % ) , p = 0.05 and a moderate disease course in 1/16 ( 6 % ) v 4/10 ( 40 % ) , p = 0.05 . It is concluded that patients treated with cyclosporin for primary sclerosing cholangitis who have coexisting ulcerative colitis have a more benign course of colitis result ing both from improvement of moderately active colitis and from fewer flares of remission/mildly active colitis . These findings suggest that cyclosporin may be of benefit to the colon in patients with ulcerative colitis who are being treated with cyclosporin for primary sclerosing cholangitis Ten patients with treatment-resistant left-sided ulcerative colitis were treated in an open protocol with 350 mg cyclosporine enemas nightly for 4 wk . A 12-point clinical disease activity index ( DAI ) score was calculated at baseline and after 4 wk . Whole blood and colonic tissue cyclosporine concentrations were determined by HPLC at the end of the study . Five of 10 patients responded to treatment , defined as a decrease in the clinical DAI score > or = 3 points . Responders retained the enemas longer than nonresponders ( 7.5 + /- 1.3 vs. 3.3 + /- 2.2 h , p = 0.01 ) , and there was a positive correlation between decrease in the clinical DAI score and enema retention time ( r = 0.64 , p = 0.05 ) . The mean colonic tissue cyclosporine concentration was not significantly higher in responders than in nonresponders ( 2884 + /- 1635 vs. 2359 + /- 576 ng/g , p = 0.52 ) , and the correlation between decrease in the clinical DAI score index and colonic tissue cyclosporine  was weak ( r = 0.39 , p = 0.26 ) . Cyclosporine was undetectable in whole blood sample s from all patients , and there were no apparent side effects with treatment . In conclusion , 50 % of patients with treatment-resistant left-sided ulcerative colitis significantly improved during therapy with cyclosporine enemas for 4 wk . Patients with longer enema retention times were more likely to respond . A controlled trial is underway to investigate these findings further The present study reports the results of intravenous cyclosporine in 32 patients with refractory and /or severe attacks of ulcerative colitis ( UC ) . Twenty of 32 patients responded to intravenous cyclosporine ; cyclosporine was clinical ly effective and improved colonic lesions . However , one colonic perforation and one postoperative death were observed in two patients with severe endoscopic colitis who had failed to reach clinical remission with high-dose corticosteroids and cyclosporine . Moreover , after a median follow-up of 190 days , only one-third of the patients avoided colectomy . No predictive factor of response to cyclosporine was identified . This study confirms that cyclosporine is effective in severe UC but suggests that its use could be associated with serious complications in patients with severe lesions who had failed to settle with corticosteroids and cyclosporine BACKGROUND There has been no new effective drug therapy for patients with severe ulcerative colitis since corticosteroids were introduced almost 40 years ago . In an uncontrolled study , 80 percent of 32 patients with active ulcerative colitis refractory to corticosteroid therapy had a response to cyclosporine therapy . METHODS We conducted a r and omized , double-blind , controlled trial in which cyclosporine ( 4 mg per kilogram of body weight per day ) or placebo was administered by continuous intravenous infusion to 20 patients with severe ulcerative colitis whose condition had not improved after at least 7 days of intravenous corticosteroid therapy .  A response to therapy was defined as an improvement in a numerical symptom score ( 0 indicated no symptoms , and 21 severe symptoms ) leading to discharge from the hospital and treatment with oral medications . Failure to respond to therapy result ed in colectomy , but some patients in the placebo group who had no response and no urgent need for surgery were subsequently treated with cyclosporine . RESULTS Nine of 11 patients ( 82 percent ) treated with cyclosporine had a response within a mean of seven days , as compared with 0 of 9 patients who received placebo ( P < 0.001 ) . The mean clinical -activity score fell from 13 to 6 in the cyclosporine group , as compared with a decrease from 14 to 13 in the placebo group . All five patients in the placebo group who later received cyclosporine therapy had a response . CONCLUSIONS Intravenous cyclosporine therapy is rapidly effective for patients with severe corticosteroid-resistant ulcerative colitis OBJECTIVES The aim of this study was to evaluate the role of metronidazole and tobramycin as an adjunct to corticosteroids in acute , severe ulcerative colitis . METHODS Thirty-nine consecutive patients with severe ulcerative colitis were r and omized on admission to the hospital to receive intravenously either metronidazole ( 0.5 g tid ) and tobramycin ( 4 mg/kg tid ) ( n = 19 ) , or placebo ( n = 20 ) . In addition , they were given parenteral nutrition , intravenous hydrocortisone ( 100 mg qid ) and hydrocortisone enemas ( 100 mg bid ) . All patients were assessed after 10 days of continuous treatment , or at any time a severe complication occurred . RESULTS Twelve of 19 patients ( 63.15 % ) treated with antibiotics and 13/20 patients ( 65 % ) with placebo showed substantial improvement . Seven patients 
    Output:
    
agent
***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 / AIMS Uncontrolled studies suggest that cyclosporine administered as an enema may be of benefit for left-sided ulcerative colitis and safer than intravenous or oral administration . The efficacy and safety of cyclosporine enemas for left-sided ulcerative colitis in a placebo-controlled trial was assessed . METHODS Steroid and mesalamine enemas were withdrawn before the study . Forty patients were assigned to 1 of 4 strata : no concomitant therapy , oral steroids , oral salicylates , or oral steroids and salicylates . After stratification , patients were r and omized to nightly treatment with 350 mg cyclosporine ( n = 20 ) or placebo ( n = 20 ) enemas . Clinical response was determined at baseline and 4 weeks by endoscopy , physician assessment , and a patient diary of daily symptoms . Trough blood cyclosporine levels were measured by high-performance liquid chromatography . RESULTS At 4 weeks , 8 of 20 patients ( 40 % ) who received cyclosporine showed clinical improvement compared with 9 of 20 patients ( 45 % ) who received placebo . One patient receiving cyclosporine had reversible neutropenia attributable to sulfasalazine , and another patient receiving cyclosporine was unable to tolerate the enema vehicle . No other toxicity was noted during the trial . Blood cyclosporine levels were detectable in only two patients . CONCLUSIONS Cyclosporine enemas administered in a dosage of 350 mg/day for 4 weeks are not efficacious in mildly to moderately active left-sided ulcerative colitis OBJECTIVE To define what effect seminal and controlled clinical trials have on practice patterns within a gastroenterological community . To define whether these practice patterns reproduce reported treatment methods and whether results comparable with those reported in such trials are noted within a community practice setting . METHODS Mailed surveies , with telephone follow-up , were sent to all members of the Pacific Northwest Gastroenterology Society . Respondents were queried regarding cyclosporin use in the precolectomy chronic ulcerative colitis ( CUC ) patient . Data collected included patient demographics , disease duration and extent , pre-treatment use of steroids , method , dosage , and duration of cyclosporin therapy , side effects , and short-term and subsequent clinical results . RESULTS Twenty-one percent of 81 respondents had used cyclosporin for precolectomy CUC , approximately one-half using constant infusion and one-half using parenteral bolus therapy .  Side effects attributed to the cyclosporin were noted in eight of 30 patients ( 27 % ) , and acute colectomy was avoided in 17 patients ( 57 % ) . Subsequent colectomy was required in an additional nine patients ( 73 % total ) within a 6-month follow-up period , a significantly higher colectomy rate than that reported in prospect i ve trials . CONCLUSIONS Potential reasons precluding cyclosporin use within the gastroenterological community may include lack of knowledge about cyclosporin therapy for CUC , lack of opportunity , skepticism , fear of medication side effects , survey sampling error , or treatment philosophy . Potential reasons for failure to duplicate the results reported in controlled trials are more complex but may include inadequate treatment duration the learning curve associated with the use of a new medication , or acceptance of colectomy as the treatment of choice in patients with acutely or chronically debilitating disease BACKGROUND / AIMS Cyclosporin was reported to be useful for steroid-resistant severe ulcerative colitis in the short term , but limited data are available on the long-term follow-up of such patients . Our aim was to assess the short- and long-term efficacy of combination therapy with cyclosporin and corticotropin for steroid-resistant ulcerative colitis . METHODOLOGY Twenty-one patients with ulcerative colitis who did not respond to corticosteroid therapy  , were treated with corticotropin , and 9 patients ( 43 % ) of them achieved complete remission . Twelve patients ( 57 % ) who did not achieve complete remission by corticotropin alone were given combination therapy with cyclosporin and corticotropin . RESULTS In 12 patients who received combined therapy with cyclosporin and corticotropin , clinical severity was distinctly improved in 11 patients ( 92 % ) by combination therapy within 2 weeks and 7 patients ( 58.3 % ) entered into complete remission with salicylazosulfapyridine or 5-aminosalicylic acid alone . Two patients ( 16.7 % ) demonstrated insufficient effect and continue to receive a lower dosage of cyclosporin or corticosteroid . Three patients ( 25 % ) failed to respond to the combination therapy and required colectomy . Three of 7 patients who entered into remission relapsed 0.5 , 5 and 5.5 months ( average : 3.7 months ) after cyclosporin withdrawal , but the clinical severity at the time of relapse was milder than that at the beginning of the treatment , namely , moderate in 2 patients , and mild in 1 patient . There were no significant adverse effects in our series . CONCLUSIONS We demonstrated that oral cyclosporin in combination with corticotropin was highly effective for ulcerative colitis refractory to corticosteroid or corticotropin therapy and severe relapse was uncommon during several years of follow-up UNLABELLED A single r and omized trial evaluated the use of intravenous cyclosporine treatment for severe attacks of ulcerative colitis .  The perceived efficacy and safety of this intervention were measured through a survey of the membership of the Canadian Association of Gastroenterology ( CAG ) . METHODS All CAG members were mailed a survey with questions regarding their familiarity with the data supporting the use of cyclosporine , their perception of the efficacy and toxicity of the drug , and whether patients who fail conventional treatment should receive this therapy . The proportion of respondents who had used cyclosporine to treat severe ulcerative colitis was determined . RESULTS One hundred and sixty-one responses were received ( 34 % response rate ) . Sixty-four per cent of respondents were academic faculty members and 82 % treated patients with severe colitis . Using multivariate analyses , positive associations were found between the respondents ' age ( P = 0.004 ) and subspecialty training in gastroenterology ( P = 0.001 ) , and whether respondents treat patients with severe ulcerative colitis . Twenty-six per cent of individuals had prescribed cyclosporine for this indication , of whom 88 % were in academic practice ( P = 0.007 ) . Over 90 % of respondents believe that further clinical trials are needed before cyclosporine becomes accepted as st and ard therapy . CONCLUSIONS Although the use of cyclosporine is measurable among Canadian gastroenterologists , the majority believe that further clinical trials are necessary before the drug is accepted as a st and ard therapy Thirty five adult patients with precirrhotic primary sclerosing cholangitis were r and omly allocated to treatment for at least one year with low dose ( 4.1 mg/kg/day ) cyclosporin or placebo in a double blind trial . Thirty patients had coexisting ulcerative colitis , including three who had previously undergone colectomy and one who discontinued treatment after three months . Of the remaining 26 patients , 16 received cyclosporin and 10 received placebo . Endoscopy was performed at entry to confirm the diagnosis of inflammatory bowel disease . The ulcerative colitis disease activity was prospect ively classified annually as remission/mild , moderate , or severe using the Truelove and Witt 's criteria . Before treatment there were no differences between the cyclosporin and placebo groups in the number of patients with remission/mild colitis , 14/16 ( 88 % ) v 9/10 ( 90 % ) , and moderate colitis , 2/16 ( 12 % ) v 1/10 ( 10 % ) . During treatment , a remission/mild disease course was present in 15/16 ( 94 % ) v 6/10 ( 60 % ) , p = 0.05 and a moderate disease course in 1/16 ( 6 % ) v 4/10 ( 40 % ) , p = 0.05 . It is concluded that patients treated with cyclosporin for primary sclerosing cholangitis who have coexisting ulcerative colitis have a more benign course of colitis result ing both from improvement of moderately active colitis and from fewer flares of remission/mildly active colitis . These findings suggest that cyclosporin may be of benefit to the colon in patients with ulcerative colitis who are being treated with cyclosporin for primary sclerosing cholangitis Ten patients with treatment-resistant left-sided ulcerative colitis were treated in an open protocol with 350 mg cyclosporine enemas nightly for 4 wk . A 12-point clinical disease activity index ( DAI ) score was calculated at baseline and after 4 wk . Whole blood and colonic tissue cyclosporine concentrations were determined by HPLC at the end of the study . Five of 10 patients responded to treatment , defined as a decrease in the clinical DAI score > or = 3 points . Responders retained the enemas longer than nonresponders ( 7.5 + /- 1.3 vs. 3.3 + /- 2.2 h , p = 0.01 ) , and there was a positive correlation between decrease in the clinical DAI score and enema retention time ( r = 0.64 , p = 0.05 ) . The mean colonic tissue cyclosporine concentration was not significantly higher in responders than in nonresponders ( 2884 + /- 1635 vs. 2359 + /- 576 ng/g , p = 0.52 ) , and the correlation between decrease in the clinical DAI score index and colonic tissue cyclosporine  was weak ( r = 0.39 , p = 0.26 ) . Cyclosporine was undetectable in whole blood sample s from all patients , and there were no apparent side effects with treatment . In conclusion , 50 % of patients with treatment-resistant left-sided ulcerative colitis significantly improved during therapy with cyclosporine enemas for 4 wk . Patients with longer enema retention times were more likely to respond . A controlled trial is underway to investigate these findings further The present study reports the results of intravenous cyclosporine in 32 patients with refractory and /or severe attacks of ulcerative colitis ( UC ) . Twenty of 32 patients responded to intravenous cyclosporine ; cyclosporine was clinical ly effective and improved colonic lesions . However , one colonic perforation and one postoperative death were observed in two patients with severe endoscopic colitis who had failed to reach clinical remission with high-dose corticosteroids and cyclosporine . Moreover , after a median follow-up of 190 days , only one-third of the patients avoided colectomy . No predictive factor of response to cyclosporine was identified . This study confirms that cyclosporine is effective in severe UC but suggests that its use could be associated with serious complications in patients with severe lesions who had failed to settle with corticosteroids and cyclosporine BACKGROUND There has been no new effective drug therapy for patients with severe ulcerative colitis since corticosteroids were introduced almost 40 years ago . In an uncontrolled study , 80 percent of 32 patients with active ulcerative colitis refractory to corticosteroid therapy had a response to cyclosporine therapy . METHODS We conducted a r and omized , double-blind , controlled trial in which cyclosporine ( 4 mg per kilogram of body weight per day ) or placebo was administered by continuous intravenous infusion to 20 patients with severe ulcerative colitis whose condition had not improved after at least 7 days of intravenous corticosteroid therapy .  A response to therapy was defined as an improvement in a numerical symptom score ( 0 indicated no symptoms , and 21 severe symptoms ) leading to discharge from the hospital and treatment with oral medications . Failure to respond to therapy result ed in colectomy , but some patients in the placebo group who had no response and no urgent need for surgery were subsequently treated with cyclosporine . RESULTS Nine of 11 patients ( 82 percent ) treated with cyclosporine had a response within a mean of seven days , as compared with 0 of 9 patients who received placebo ( P < 0.001 ) . The mean clinical -activity score fell from 13 to 6 in the cyclosporine group , as compared with a decrease from 14 to 13 in the placebo group . All five patients in the placebo group who later received cyclosporine therapy had a response . CONCLUSIONS Intravenous cyclosporine therapy is rapidly effective for patients with severe corticosteroid-resistant ulcerative colitis OBJECTIVES The aim of this study was to evaluate the role of metronidazole and tobramycin as an adjunct to corticosteroids in acute , severe ulcerative colitis . METHODS Thirty-nine consecutive patients with severe ulcerative colitis were r and omized on admission to the hospital to receive intravenously either metronidazole ( 0.5 g tid ) and tobramycin ( 4 mg/kg tid ) ( n = 19 ) , or placebo ( n = 20 ) . In addition , they were given parenteral nutrition , intravenous hydrocortisone ( 100 mg qid ) and hydrocortisone enemas ( 100 mg bid ) . All patients were assessed after 10 days of continuous treatment , or at any time a severe complication occurred . RESULTS Twelve of 19 patients ( 63.15 % ) treated with antibiotics and 13/20 patients ( 65 % ) with placebo showed substantial improvement . Seven patients 
    Output:
    