Sample records for acute distal ulcerative

  1. Acute genital ulcers. (United States)

    Delgado-García, Silvia; Palacios-Marqués, Ana; Martínez-Escoriza, Juan Carlos; Martín-Bayón, Tina-Aurora


    Acute genital ulcers, also known as acute vulvar ulcers, ulcus vulvae acutum or Lipschütz ulcers, refer to an ulceration of the vulva or lower vagina of non-venereal origin that usually presents in young women, predominantly virgins. Although its incidence is unknown, it seems a rare entity, with few cases reported in the literature. Their aetiology and pathogenesis are still unknown. The disease is characterised by an acute onset of flu-like symptoms with single or multiple painful ulcers on the vulva. Diagnosis is mainly clinical, after exclusion of other causes of vulvar ulcers. The treatment is mainly symptomatic, with spontaneous resolution in 2 weeks and without recurrences in most cases. We present a case report of a 13-year-old girl with two episodes of acute ulcers that fit the clinical criteria for Lipschütz ulcers.

  2. Management and treatment of distal ulcerative colitis

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    Andrea Calafiore


    Full Text Available Ulcerative colitis (UC is a chronic inflammatory condition that is confined to the colonic mucosa. Its main symptoms include diarrhea, rectal bleeding and abdominal pain. Approximately two-thirds of UC patients have disease confined distal to the splenic flexure, which can be treated effectively with topical therapy. This means the active drug can be delivered directly to the site of inflammation, limiting the systemic absorption and potential side effects. Topical treatment with aminosalicylates is the most effective approach in the treatment of these forms, provided that the formulation reaches the upper margin of the disease. Given this, the suppository formulation is the treatment of choice for proctitis and distal sigmoiditis. Thanks to their proximal spread, enemas, foams and gels represent the treatment of choice for proctosigmoiditis and for distal ulcerative colitis. Oral aminosalicylates are less effective than topical therapies in patients with active disease, while the combination of topical and oral treatment is more effective in patients refractory to topical or oral mono-therapy. Topically administered aminosalicylates play an important role in the maintenance of remission, but the long-term adhesion to therapy is poor. For this reason, the oral formulation is the first-line therapy in the maintenance of remission. Refractory patients can be treated with topical steroids or systemic steroids and TNF-alpha inhibitors in severe forms.

  3. Recent advances in the management of distal ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Ioannis; E; Koutroubakis


    The most frequent localization of ulcerative colitis(UC) is the distal colon.In treating patients with active distal UC,efficacy and targeting of the drug to the distal colon are key priorities.Oral and rectal 5-aminosalicylic acid(5-ASA) preparations represent the first line therapy of mild-to-moderate distal UC for both induction and maintenance treatment.It has been reported that many UC patients are not adherent to therapy and that noncompliant patients had a 5-fold risk of experiencing a relapse.These findings led to the introduction of oncedaily oral regimens of 5-ASA as better therapeutic options in clinical practice due to improved adherence.New formulations of mesalazine,including the multimatrix delivery system,and mesalazine granules,which allow once-daily administration,have been developed.They have been demonstrated to be efficacious in inducing and maintaining remission in mild-to-moderate distal UC in large clinical trials.However,existing data for distal UC are rather insufficient to make a comparison between new and classical 5-ASA formulations.It seems that the new formulations are at least as effective as classical oral 5-ASA formulations.Other treatment options,in the case that 5-ASA therapy is not effective,include systemic corticosteroids,thiopurines(azathioprine or 6-mercaptopurine),cyclosporine,infliximab and surgery.The combination of a prompt diagnostic work-up,a correct therapeutic approach and an appropriate follow-up schedule is important in the management of patients with distal UC.This approach can shorten the duration of symptoms,induce a prolonged remission,improve patient’s quality of life,and optimize the use of health resources.

  4. Pharm GKB: Acute ulcerative gingivitis [PharmGKB

    Lifescience Database Archive (English)

    Full Text Available Overview Alternate Names: Synonym ANUG - Acute necrotising ulcerative gingivitis; ANUG - Acute... necrotizing ulcerative gingivitis; AUG - Acute ulcerative gingivitis; Vincent's disease; Vincent...g] (N0000001343) Common Searches Search Medline Plus Search CTD Pharm GKB: Acute ulcerative gingivitis ... ...ive (D005892) SnoMedCT: Acute ulcerative gingivitis (172697005) UMLS: C0017575 (C...'s gingivitis PharmGKB Accession Id: PA165109110 External Vocabularies MeSH: Gingivitis, Necrotizing Ulcerat

  5. Pharm GKB: Acute necrotizing ulcerative gingivostomatitis [PharmGKB

    Lifescience Database Archive (English)

    Full Text Available Overview Alternate Names: Synonym Acute necrotising ulcerative gingivostomatitis; V...lcerative (D005892) SnoMedCT: Acute necrotizing ulcerative gingivostomatitis (173599005) UMLS: C0017575 (C00...lcerative [Disease/Finding] (N0000001343) Common Searches Search Medline Plus Search CTD Pharm GKB: Acute necrotizing ulcerative gingivostomatitis ...

  6. Distal Ulcerative Colitis Refractory to Rectal Mesalamine: Role of Transdermal Nicotine versus Oral Mesalamine


    Mario Guslandi; Roberto Frego; Edi Viale; Pier Alberto Testoni


    BACKGROUND: Distal ulcerative colitis usually responds to treatment with rectal mesalamine, but the management of refractory cases is poorly defined.AIM: To evaluate the possible therapeutic benefit of transdermal nicotine versus oral mesalamine.PATIENTS AND METHODS: Thirty patients with left-sided ulcerative colitis unresponsive to treatment with a mesalamine 4 g enema at bedtime were randomly allocated to additional therapy with either transdermal nicotine 15 mg daily or oral mesalamine 800...

  7. Healing of ulcers on the feet correlated with distal blood pressure measurements in occlusive arterial disease

    DEFF Research Database (Denmark)

    Holstein, P; Lassen, N A


    The frequency of healing in subchronic ulcers in 66 feet in 62 patients with arterial occlusive disease was correlated with the systolic digital blood pressure (SDBP) and the systolic ankle blood pressure (SABP), both measured with a strain gauge, and with the skin perfusion pressure on the heel...... of healing correlated significantly with the three distal blood pressure parameters investigated, the closest correlation being with the SDBP measured at the final examination, i.e. just after healing of the ulcer or just before an inevitable major amputation. Of the 22 cases with SDBP below 20 mmHg only two...... (SPPH) as measured with a photocell. Thirty-two patients (35 feet with ulcerations) had diabetes mellitus. The treatment was conservative. In 42 feet the ulcers healed after an average period of 5.8 months; in 24 feet major amputation became necessary after an average of 4.3 months. The frequency...

  8. Acute necrotising ulcerative gingivitis in an immunocompromised young adult. (United States)

    Hu, Jessie; Kent, Paul; Lennon, Joshua M; Logan, Latania K


    Acute necrotising ulcerative gingivitis is an acute onset disease characterised by ulceration, necrosis, pain and bleeding in gingival surfaces. It is predominantly seen in severely malnourished children and young adults with advanced HIV infection. We present a unique presentation in a young adult with high-grade osteogenic sarcoma.

  9. Lipschutz ulcers: evaluation and management of acute genital ulcers in women. (United States)

    Huppert, Jill S


    Acute genital ulcers are painful and distressing to women and perplexing to the providers who care for them. The differential diagnosis includes sexually and nonsexually transmitted infections, autoimmune conditions, drug reactions, and local manifestations of systemic illness. However, in many cases, no causative agent is identified, and lesions are classified as idiopathic aphthosis. In the setting of fever and acute onset of genital ulcers in girls and women, the term Lipschutz ulcers has been used to describe ulcers associated with an immunologic reaction to a distant source of infection or inflammation. The aims of this article are to review the differential diagnosis and pathogenesis of acute genital ulcers, to offer an evaluation and classification scheme, and to discuss treatment options for the dermatologist who cares for women and girls with vulvar ulcers.

  10. [Appendiceal orifice inflammation in distal ulcerative colitis. Report of a case and review of the literature]. (United States)

    Tagle, Martin; Scavino, Yolanda; Luna, Eduardo


    We report the case of a 45-year-old female patient with an 18 month diagnosis of distal ulcerative colitis (proctosigmoiditis) of 18 months, who presented initially with allergy to salicylates, for which the disease was managed with corticosteroids and azathioprine and subsequently with Infliximab infusions, entering in remission. When she was about to receive her fifth Infliximab infusion she presented an exacerbation of her underlying disease with frequent stools with mucus, blood and tenesmus. Given that her initial diagnosis was made with a sigmoidoscopy we scheduled a total colonoscopy showing marked inflammation, erythema and friability limited to the recto-sigmoid mucosa, like at the disease onset, and when we reached the cecum an erythematous area circumscribed to the appendiceal orifice was observed, with a mucosal aspect identical to the described for the recto-sigmoid mucosa. The biopsies taken from that area were compatible with ulcerative colitis. We herein describe the details of the case and review the literature.

  11. Management of acute severe ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Saurabh; Kedia; Vineet; Ahuja; Rakesh; Tandon


    The management strategy of acute severe ulcerative colitis has evolved over the past decade from being entirely restricted to twin choices of intravenous steroids or colectomy to include colon rescue therapies like cyclosporin as well as infliximab. However it still remains a medical emergency requiring hospitalization and requires care from a multidisciplinary team comprising of a gastroenterologist and a colorectal surgeon. The frame shift in management has been the emphasis on time bound decision making with an attempt to curtail the mortality rate to below 1%. Intravenous corticosteroids are the mainstay of therapy. Response to steroids should be assessed at day 3 of admission and partial/non-responders should be considered for alternative medical therapy/surgery. Medical rescue therapies include intravenous cyclosporin and infliximab. Cyclosporin is administered in a dose of 2 mg/kg per day and infliximab is administered as a single dose intravenous infusion of 5 mg/kg. Approximately 75% patients have short term and 50% patients have long term response to cyclosporin. Long term response to cyclosporin is improved in patients who are thiopurine na?ve and are started on thiopurines on day 7. Infliximab also has a response rate of approximately 70% in short term and 50% in long term. Both cyclosporin and infliximab are equally efficacious medical rescue therapies as demonstrated in a recent randomized control trial. Patientsnot responding to infliximab or cyclosporin should be considered for colectomy.

  12. Acute respiratory distress syndrome associated with severe ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Shiho; Sagara; Yasuo; Horie; Yumiko; Anezaki; Hideaki; Miyazawa; Masahiro; Iizuka


    Various extraintestinal manifestations including pulmonary abnormalities have been reported in patients with ulcerative colitis. Acute respiratory distress syndrome (ARDS) is a serious and fatal pulmonary manifestation. We have experienced a 67-year-old male patient with ARDS associated with a severe type of ulcerative colitis (UC). Severe dyspnea symptoms occurred during the treatment of UC in a previous hospital and the patient was transferred to our hospital on June 27, 2007. Both blood and sputa culture...

  13. Microheterogeneity of acute phase proteins in patients with ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Marian Grzymis(l)awski; Katarzyna Derc; Magdalena Sobieska; Krzysztof Wiktorowicz


    AIM: To estimate the serum α1-antichymotrypsin (ACT),α1-acid glycoprotein (AGP) and transferrin (Tf) concentrations and to evaluate the microheterogeneity of these acute phase proteins in patients with ulcerative colitis. METHODS: Twenty-seven patients with ulcerative colitis (UC) and 17 healthy control subjects were studied. The patients were categorised as severe (n = 9), moderate (n = 10) and mild groups (n = 8) using Truelove and Witts'classification of ulcerative colitis. Microheterogeneity of ACT, AGP and Tf was analysed by crossed immunoaffinity electrophoresis (CIAE) with concanavalin A. In all serum samples standard electrophoresis of serum proteins was performed, iron (Fe) concentration, total iron binding capacity (TIBC) and C-reactive protein (CRP) were also measured.RESULTS: Our patients suffering from ulcerative colitis had significantly higher serum ACT and AGP concentrations and lower serum transferrin concentration in comparison to healthy subjects. Changes in concentrationsof acute phase proteins were dependent on the activityof the inflammatory process. The glycosylation patterns of transferrin were related to the inflammation status. We also observed the correlation between ACT and AGP concentrations, patterns of transferrin glycosylation and changes in standard protein electrophoresis or blood cell count.CONCLUSION: The glycosylation patterns of transferrin obtained from patients suffering from ulcerative colitis are highly branched and sialylated compared with those obtained from healthy subjects. In contrast, the glycosylation patterns of transferrin do not differ according to the activity index of ulcerative colitis. The microheterogeneity patterns of AGP and ACT are similar in ulcerative colitis patients and healthy subjects.

  14. Heat-washout measurements compared to distal blood pressure and perfusion in orthopaedic patients with foot ulcers

    DEFF Research Database (Denmark)

    Midttun, M; Azad, B B S; Broholm, R


    Distal blood pressure and local skin perfusion pressure were compared to measurement of blood flow rate (BFR) measured by the heat-washout method in orthopaedic patients with and without diabetes, all with a foot ulcer in one foot, compared to healthy controls. The correlation was good between heat......-washout and distal blood pressure in patients with diabetes with and without an ulcer (P = 0·024 and 0·059, respectively). The correlation was weak in patients without diabetes with and without an ulcer, most probably due to power problems (P = 0·118 and 0·116, respectively). The correlation in the healthy controls...... the surrounding tissue, and therefore, measurements are easier made in these subjects. BFR in the first toe increased significantly in all patients when the foot was moved from heart level to 50 cm below heart level (P = between 0·03 and 0·05) as previously seen in patients with claudication...

  15. Correlates of Bacterial Ulcers and Acute HSV-2 Infection among Men with Genital Ulcer Disease in South Africa: Age, Recent Sexual Behaviors, and HIV (United States)

    Leichliter, Jami S.; Lewis, David A.; Paz-Bailey, Gabriela


    Data from baseline surveys and STI/HIV laboratory tests (n=615 men) were used to examine correlates of bacterial ulcers (Treponema pallidum, Haemophilus ducreyi, or Chlamydia trachomatis L1–L3 detected in ulcer) and acute HSV-2 ulcers (HSV-2 positive ulcer specimen, HSV-2 sero-negative, and negative for bacterial pathogens) vs. recurrent HSV-2 ulcers (sero-positive), separately. Compared to men with recurrent HSV-2 ulcers, men with bacterial ulcers had larger ulcers but were less likely to be HIV-positive whereas men with acute HSV-2 ulcers were younger with fewer partners. Acute HIV was higher among men with bacterial and acute HSV-2 ulcers; the difference was not statistically significant. PMID:28217702

  16. Correlates of Bacterial Ulcers and Acute HSV-2 Infection among Men with Genital Ulcer Disease in South Africa: Age, Recent Sexual Behaviors, and HIV. (United States)

    Leichliter, Jami S; Lewis, David A; Paz-Bailey, Gabriela


    Data from baseline surveys and STI/HIV laboratory tests (n=615 men) were used to examine correlates of bacterial ulcers (Treponema pallidum, Haemophilus ducreyi, or Chlamydia trachomatis L1-L3 detected in ulcer) and acute HSV-2 ulcers (HSV-2 positive ulcer specimen, HSV-2 sero-negative, and negative for bacterial pathogens) vs. recurrent HSV-2 ulcers (sero-positive), separately. Compared to men with recurrent HSV-2 ulcers, men with bacterial ulcers had larger ulcers but were less likely to be HIV-positive whereas men with acute HSV-2 ulcers were younger with fewer partners. Acute HIV was higher among men with bacterial and acute HSV-2 ulcers; the difference was not statistically significant.

  17. N-butyl cyanoacrylate embolotherapy for acute gastroduodenal ulcer bleeding

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    Choi, Young Ho; Kim, Ji Hoon; Koh, Young Hwan; Han, Dae Hee; Cha, Joo Hee; Seong, Chang Kyu; Song, Chi Sung [Seoul National University Boramae Hospital, Seoul (Korea, Republic of)


    Various embolic agents have been used for embolization of acute gastrointestinal (GI) arterial bleeding. N-butyl cyanoacrylate (NBCA) is not easy to handle, but it is a useful embolic agent. In this retrospective study, we describe our experience with NBCA embolization of acute gastroduodenal ulcer bleeding. NBCA embolization was performed in seven patients with acute upper GI arterial bleeding; they had five gastric ulcers and two duodenal ulcers. NBCA embolization was done in the left gastric artery (n = 3), right gastric artery (n = 2), gastroduodenal artery (n = 1) and pancreaticoduodenal artery (n = 1). Coil was used along with NBCA in a gastric bleeding patient because of difficulty in selecting a feeding artery. NBCA was mixed with Lipiodol at the ratio of 1:1 to 1:2. The blood pressure and heart rate around the time of embolization, the serial hemoglobin and hematocrit levels and the transfusion requirements were reviewed to evaluate hemostasis and rebleeding. Technical success was achieved in all the cases. Two procedure-related complications happened; embolism of the NBCA mixture to the common hepatic artery occurred in a case with embolization of the left gastric artery, and reflux of the NBCA mixture occurred into the adjacent gastric tissue, but these did not cause any clinical problems. Four of seven patients did not present with rebleeding, but two had rebleeding 10 and 16 days, respectively, after embolization and they died of cardiac arrest at 2 months and 37 days, respectively. One other patient died of sepsis and respiratory failure within 24 hours without rebleeding. NBCA embolization with or without other embolic agents could be safe and effective for treating acute gastroduodenal ulcer bleeding.

  18. Association between acute pancreatitis and peptic ulcer disease

    Institute of Scientific and Technical Information of China (English)

    Kang-Moon Lee; Chang-Nyol Paik; Woo Chul Chung; Jin Mo Yang


    AIM:To evaluate the relationship between peptic ulcer disease (PUD) and acute pancreatitis.METHODS:A cohort of 78 patients with acute pancreatitis were included in this study.The presence of PUD and the Helicobacter pylori (H.pylori ) status were assessed by an endoscopic method.The severity of acute pancreatitis was assessed using Ranson's score, the Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score,computed tomography severity index and the clinical data during hospitalization,all of which were compared between the patients with and without PUD.The risk factors for PUD were also evaluated. RESULTS:Among 78 patients,41 patients (52.6%) with acute pancreatitis suffered from PUD,but only 13 (31.7%) patients with PUD were infected by H.pylori .On univariate analysis,male gender,an etiology of alcohol-induced pancreatitis,a history of smoking or alcohol consumption, elevated triglyceride and C-reactive protein levels, and high APACHE Ⅱ score were significantly associated with PUD.However,on multivariate logistic regression analysis,the APACHE Ⅱ score (odds ratio:7.69; 95% confidence interval:1.78-33.33; P < 0.01) was found to be the only independent risk factor for PUD.CONCLUSION:Patients with acute pancreatitis are liable to suffer from PUD.PUD is associated with severe acute pancreatitis according to the APACHE Ⅱ score, and treatment for PUD should be considered for patients with severe acute pancreatitis.

  19. Challenges in the management of acute peptic ulcer bleeding. (United States)

    Lau, James Y W; Barkun, Alan; Fan, Dai-ming; Kuipers, Ernst J; Yang, Yun-sheng; Chan, Francis K L


    Acute upper gastrointestinal bleeding is a common medical emergency worldwide, a major cause of which are bleeding peptic ulcers. Endoscopic treatment and acid suppression with proton-pump inhibitors are cornerstones in the management of the disease, and both treatments have been shown to reduce mortality. The role of emergency surgery continues to diminish. In specialised centres, radiological intervention is increasingly used in patients with severe and recurrent bleeding who do not respond to endoscopic treatment. Despite these advances, mortality from the disorder has remained at around 10%. The disease often occurs in elderly patients with frequent comorbidities who use antiplatelet agents, non-steroidal anti-inflammatory drugs, and anticoagulants. The management of such patients, especially those at high cardiothrombotic risk who are on anticoagulants, is a challenge for clinicians. We summarise the published scientific literature about the management of patients with bleeding peptic ulcers, identify directions for future clinical research, and suggest how mortality can be reduced.

  20. Acute compartment syndrome of the forearm caused by calcific tendinitis of the distal biceps. (United States)

    Garayoa, Santiago Amillo; Romero-Muñoz, Luis M; Pons-Villanueva, Juan


    Acute compartment syndrome of the forearm requires immediate treatment to avoid damage of the soft tissues and a poor functional outcome for the forearm. Muscular and bone lesions are the main causes of acute compartment syndromes. We report a case of acute compartment syndrome of the forearm caused by a calcific tendinitis of the distal biceps.

  1. Efficacy of an aspiration device with distal protection for the treatment in acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    Naoto Inoue


    @@ Hiroshi Fujita Kenji Suzuki Akiko Matsuo Reo Nakamura Tetsuya Tanaka Keiji Inoue Hisayuki Hyogo Takaomi Tokura Objective Percutaneous coronary interventions in the setting of acute myocardial infarction(AMI)have been associated with increased risk of distal embolization and no-reflow phenomenon. To evaluate the efficacy and feasibility of a distal protection using the PercuSurge Guardwire Plus( PSG) in AMI.

  2. Treatment of acute ulcerative colitis with infliximab, a retrospective study from three Danish hospitals

    DEFF Research Database (Denmark)

    Mortensen, Christian; Caspersen, Sarah; Christensen, Niels Lyhne


    In acute steroid-refractory ulcerative colitis, rescue therapy with infliximab has become a therapeutic option in patients facing colectomy. Data on efficacy and safety in this setting are sparse.......In acute steroid-refractory ulcerative colitis, rescue therapy with infliximab has become a therapeutic option in patients facing colectomy. Data on efficacy and safety in this setting are sparse....

  3. Acute ulcerative jejunal diverticulitis: Case report of an uncommon entity

    Institute of Scientific and Technical Information of China (English)

    Wojciech Staszewicz; Michel Christodoulou; Stefania Proietti; Nicolas Demartines


    Jejunal diverticulosis is a rare entity with variable clinical and anatomical presentations. Its reported incidence varies from 0.05% to 6%. Although there is no consensus on the management of asymptomatic jejunal diverticular disease, some complications are potentially life threatening and require early surgical treatment. We report a case of an 88-year-old man investigated for acute abdominal pain with a high biological inflammatory syndrome. Inflammation of multiple giant jejunal diverticulum was discovered at abdominal computed tomography (CT). As a result of the clinical and biological signs of early peritonitis, an emergency surgical exploration was performed. The first jejunal loop showed clear signs of jejunal diverticulitis. Primary segmental jejunum resection with end-to-end anastomosis was performed. Histopathology report confirmed an ulcerative jejunal diverticulitis with imminent perforation and acute local peritonitis. The patient made an excellent rapid postoperative recovery. Jejunal diverticulum is rare but may cause serious complications. It should be considered a possible etiology of acute abdomen, especially in elderly patients with unusual symptomatology. Abdominal CT is the diagnostic tool of choice. The best treatment is emergency surgical management.

  4. The effect of flexor tenotomy on healing and prevention of neuropathic diabetic foot ulcers on the distal end of the toe

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    van Netten Jaap J


    Full Text Available Abstract Background Flexor tenotomy is a minimally invasive surgical alternative for the treatment of neuropathic diabetic foot ulcers on the distal end of the toe. The influence of infection on healing and time to heal after flexor tenotomy is unknown. Flexor tenotomy can also be used as a prophylactic treatment. The effectiveness as a prophylactic treatment has not been described before. Methods A retrospective study was performed with the inclusion of all consecutive flexor tenotomies from one hospital between January 2005 and December 2011. Results From 38 ulcers, 35 healed (92%, with a mean time to heal of 22 ± 26 days. The longest duration for healing was found for infected ulcers that were penetrating to bone (35 days; p = .042. Cases of prophylactic flexor tenotomies (n=9 did not result in any ulcer or other complications during follow-up. Conclusions The results of this study suggest that flexor tenotomy may be beneficial for neuropathic diabetic foot ulcers on the distal end of the toe, with a high healing percentage and a short mean time to heal. Infected ulcers that penetrated to bone took a significantly longer time to heal. Prospective research, to confirm the results of this retrospective study, should be performed.

  5. Acute distal tibiofibular syndesmosis injury: A systematic review of suture-button versus syndesmotic screw repair

    NARCIS (Netherlands)

    T. Schepers (Tim)


    textabstractPurpose: Recently, a new suture-button fixation device has emerged for the treatment of acute distal tibiofibular syndesmotic injuries and its use is rapidly increasing. The current systematic review was undertaken to compare the biomechanical properties, functional outcome, need for imp

  6. Acute genital ulcers in nonsexually active young girls: case series, review of the literature, and evaluation and management recommendations. (United States)

    Rosman, Ilana S; Berk, David R; Bayliss, Susan J; White, Andrew J; Merritt, Diane F


    Acute genital ulcers rarely occur in nonsexually active young girls. When present, they can cause significant physical and emotional distress for the patient and her parents, and prompt an evaluation for sexual abuse and sexually transmitted diseases. With this review, we aim to further characterize acute genital ulcers in nonsexually active young girls by reviewing the medical records of patients with this disorder and to offer an approach to the diagnosis, evaluation, and treatment of acute genital ulcers based on our understanding and knowledge of this condition. We retrospectively review our understanding and knowledge of acute genital ulcers in nonsexually active girls at a pediatric hospital. A review of the recent literature on acute genital ulcers and a multidisciplinary approach to the diagnosis, evaluation, and treatment of acute genital ulcers are also presented. Twelve patients presented with acute genital ulcers, 11 of which were hospitalized for evaluation and pain management. Extensive work-up failed to reveal a specific infectious or autoimmune etiology in all but one patient, who was diagnosed with acute mycoplasma pneumonia. Acute genital ulcers in nonsexually active young girls likely represent a form of idiopathic vulvar aphthosis. Evaluation of a first episode of acute genital ulcers with mild prodromal symptoms should be limited. Treatment consists primarily of supportive care and symptom relief.

  7. Mechanisms of gastric emptying disturbances in chronic and acute inflammation of the distal gastrointestinal tract

    DEFF Research Database (Denmark)

    Keller, Jutta; Beglinger, Christoph; Holst, Jens Juul;


    . Thirteen healthy subjects (CON), 13 patients with Crohn's disease (CD), 10 with ulcerative colitis (UC), and 7 with diverticulitis (DIV) underwent a standardized (13)C-octanoic acid gastric emptying breath test. Plasma glucose, CCK, peptide YY, and glucagon-like peptide-1 (GLP-1) were measured periodically......It is unclear why patients with inflammation of the distal bowel complain of symptoms referable to the upper gastrointestinal tract, specifically to gastric emptying (GE) disturbances. Thus we aimed to determine occurrence and putative pathomechanisms of gastric motor disorders in such patients...

  8. Implementation of pressure ulcer prevention best practice recommendations in acute care: an observational study. (United States)

    Barker, Anna Lucia; Kamar, Jeannette; Tyndall, Tamara Jane; White, Lyn; Hutchinson, Anastasia; Klopfer, Nicole; Weller, Carolina


    Pressure ulcers are a common but preventable problem in hospitals. Implementation of best practice guideline recommendations can prevent ulcers from occurring. This 9-year cohort study reports prevalence data from point prevalence surveys during the observation period, and three practice metrics to assess implementation of best practice guideline recommendations: (i) nurse compliance with use of a validated pressure ulcer risk assessment and intervention checklist; (ii) accuracy of risk assessment scoring in usual-care nurses and experienced injury prevention nurses; and (iii) use of pressure ulcer prevention strategies. The prevalence of hospital-acquired pressure ulcers decreased following implementation of an evidence-based prevention programme from 12·6% (2 years preprogramme implementation) to 2·6% (6 years postprogramme implementation) (P pressure ulcer prevention documentation according to best practice guidelines was high (>84%). A sample of 270 patients formed the sample for the study of risk assessment scoring accuracy and use of prevention strategies. It was found usual-care nurses under-estimated patients' risk of pressure ulcer development and under-utilised prevention strategies compared with experienced injury prevention nurses. Despite a significant reduction in prevalence of hospital-acquired pressure ulcers and high documentation compliance, use of prevention strategies could further be improved to achieve better patient outcomes. Barriers to the use of prevention strategies by nurses in the acute hospital setting require further examination. This study provides important insights into the knowledge translation of pressure ulcer prevention best practice guideline recommendations at The Northern Hospital.

  9. Acute gastric ulcer perforation in a 35 weeks' nulliparous patient with gastric banding. (United States)

    Erez, Offer; Maymon, Eli; Mazor, Moshe


    We present a case of a primiparous patient at 35 weeks' gestation who had had laparoscopic gastric banding, and who presented to labor and delivery with protracted vomiting followed by an acute abdomen and fetal distress. An emergency surgery revealed acute gastric ulcer perforation. This complication, although rare, should be considered.

  10. Ulcers (United States)

    ... someone's risk of getting an ulcer because the nicotine in cigarettes causes the stomach to produce more ... endoscopy is given anesthesia and will have no memory of the procedure. For an endoscopy, the doctor ...

  11. Unusual presenting of acute aortic dissection due to penetrating atheromatous ulcer. (United States)

    Atas, Halil; Durmus, Erdal; Sunbul, Murat; Birkan, Yasar; Ozben, Beste


    Penetrating atheromatous ulcer (PAU) is an atherosclerotic ulcer penetrating the internal elastic lamina of the aortic wall causing a hematoma within the media layer of aorta. They are commonly located in the descending aorta of the elderly and hypertensive patients. They may rarely be complicated by aortic dissection. We report a relative young normotensive patient presenting with acute aortic dissection due to PAU located in the ascending aorta.

  12. Perforated duodenal ulcer a rare cause of acute abdomen in infancy: A report of two cases

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    Kadian Yogender


    Full Text Available Duodenal ulcer perforation is very uncommon in infants and children, that is why it is not usually considered in the differential diagnosis of acute abdomen in this age group. Moreover, the diagnosis of this condition is usually overlooked because of vague and variable symptoms and low index of suspicion on the part of the treating physicians. In this brief report, we are reporting two cases of successfully managed perforated duodenal ulcer in infancy.

  13. [Antisecretory therapy as a component of hemostasis in acute gastroduodenal ulcer bleedings]. (United States)

    Gostishchev, V K; Evseev, M A


    Results of antisecretory therapy (pyrenzepin, H(2)-blockers, inhibitors of proton pump, octreotid) in 962 patients with acute gastroduodenal ulcer bleedings (AGDUB) were analyzed over 14-years period. Antisecretory treatment in AGDUB has principally different goals and potential depending on risk of bleeding's recurrence and morphological changes in tissue of gastroduodenal ulcer. Antisecretory therapy is the main treatment in high risk of AGDUB recurrence or before urgent surgery. Intravenous infusion of omeprazol has demonstrated the highest clinical efficacy due to maximal inhibition of gastric secretion and absence of negative influences on oxygen regimen in tissue of ulcer.

  14. Scrotal ulceration following all-trans retinoic acid therapy for acute promyelocytic leukemia

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    Illias Tazi


    Full Text Available All-trans retinoic acid (ATRA induces complete remission in most cases of acute promyelocytic leukemia. Toxicity of ATRA has been shown to be mild, consisting of headache, dry skin, dermatitis, and gastrointestinal disorders. We describe a case of scrotal ulceration with ATRA use in a Moroccan patient, an occurrence that has been rarely reported in the medical literature. The pathogenesis of scrotal ulceration remains unknown. Our experience indicates the importance of recognizing genital ulcers associated with ATRA in order that appropriate countermeasures can be taken.

  15. Incidence and Clinical Features of Peptic Ulcer Disease In Acute Upper Gastrointestinal Bleeding: -Experience of Moroccan University Hospital Unit-

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    Y. Cherradi


    Full Text Available Introduction: Peptic ulcer disease (PUD has been recognized as the leading cause of acute upper gastrointestinal bleeding (AUGIB. This study aims to report general features of bleeding peptic ulcers in patients who benefit of urgent endoscopy in our department after an acute upper gastrointestinal hemorrhage. Results: A total of 1809 patients were explored for acute upper gastrointestinal bleeding in our unit since 2003 to 2008. Gastroduodenal peptic ulcers were the most frequent diagnosed etiology. They present 38% of all reported causes of bleeding (n=527 (table I. 25% were located at duodenal mucosa (n= 347 and 13% were gastric ulcers (n=180. No esophageal ulcers were reported. Incidence of both duodenal and gastric ulcers decreases during the last years. Conclusion: In our department, incidence of bleeding peptic ulcer disease is decreasing but they continue to be the first cause of AUGIB.

  16. Genital ulcers during treatment with ALL-trans retinoic acid for acute promyelocytic leukemia. (United States)

    Fukuno, Kenji; Tsurumi, Hisashi; Goto, Hideko; Oyama, Masami; Tanabashi, Shinobu; Moriwaki, Hisataka


    Scrotal ulcer is a unique adverse effect of all-trans retinoic acid (ATRA) in patients with acute promyelocytic leukemia (APL). The pathogenesis of scrotal ulceration remains unknown. We describe genital ulcers that developed in four patients with APL who were undergoing ATRA therapy (45 mg/m2 per day p.o.). Two of the patients were female, in whom this condition is quite rare. Genital ulcers with concomitant fever appeared between 17 and 32 days of therapy in all four patients. Genital ulcers healed in three of the patients while another patient developed Fournier's gangrene and underwent left testectomy. Ulcer healing was brought by either local or intravenous corticosteroids. Intravenous dexamethasone actually enabled continued ATRA administration in one patient, while ATRA was discontinued in other two patients. If corticosteroids cannot control progression of genital ulcers nor concomitant fever, ATRA administration should be discontinued so as not to induce Fournier's gangrene nor retionic acid syndrome. Our experience indicates the importance of recognizing genital ulcers associated with ATRA in order that appropriate countermeasures can be taken.

  17. Acute distal tibiofibular syndesmosis injury: A systematic review of suture-button versus syndesmotic screw repair


    Schepers, Tim


    textabstractPurpose: Recently, a new suture-button fixation device has emerged for the treatment of acute distal tibiofibular syndesmotic injuries and its use is rapidly increasing. The current systematic review was undertaken to compare the biomechanical properties, functional outcome, need for implant removal, and the complication rate of syndesmotic disruptions treated with a suture-button device with the current 'gold standard', i.e. the syndesmotic screw. Method: A literature search in t...

  18. Development of a Personalized Model for Pressure Ulcer Prevention Acutely Following Spinal Cord Injury: Biomarkers of Muscle Composition and Resilience (United States)


    AWARD NUMBER: W81XWH-14-1-0618 TITLE: Development of a Personalized Model for Pressure Ulcer Prevention Acutely Following Spinal Cord Injury...Model for Pressure Ulcer Prevention Acutely Following Spinal Cord Injury: Biomarkers of Muscle Composition and Resilience 5a. CONTRACT NUMBER...military and veterans. All persons with SCI are at increased risk of pressure ulcer development which remains one of the most significant secondary

  19. Ganoderma lucidum Pharmacopuncture for the Treatment of Acute Gastric Ulcers in Rats

    Directory of Open Access Journals (Sweden)

    Jae-Heung Park


    Full Text Available Objectives: The gastric ulcer is a common disorder of the stomach and duodenum. The basic physiopathology of a gastric ulcer results from an imbalance between some endogenous aggressive and cytoprotective factors. This study examined whether Ganoderma lucidum pharmacopuncture (GLP would provide protection against acute gastric ulcers in rats. Methods: Sprague-Dawley rats were divided randomly into 4 groups of 8 rats each: normal, control, normal saline (NP and GLP groups. The experimental acute gastric ulcer was induced by using an EtOH/HCl solution and the normal group received the same amount of normal saline instead of ethanol. The NP and the GLP groups were treated once with injections of saline and GLP, respectively. Two local acupoints were used: CV12 (中脘 which is the alarm point of the Stomach Meridian, and ST36 (足三里, which is the sea point of the Stomach Meridian. The stomachs from the rats in each group were collected and analyzed for gross appearance and histology. Also, immunohistochemistry staining for BAX, Bcl-2 and TGF-β1 was performed. Results: Histological observations of the gastric lesions in the control group showed comparatively extensive damage of the gastric mucosa and necrotic lesions had penetrated deeply into the mucosa. The lesions were long, hemorrhagic, and confined to the glandular portions. The lesions were measured microscopically by using the clear depth of penetration into the gastric mucosal surface. The length and the width of the ulcer were measured and the inhibition percentage was calculated. Wound healing of the acute gastric ulcer was promoted by using GLP, and significant alterations of indices in gastric mucosa were observed. Such protection was shown by gross appearance, histology and immunohistochemistry staining for BAX, Bcl-2 and TGF-β1. Conclusion: These results suggest that GLP administered at CV12 and ST36 can provide significant protection to the gastric mucosa against an ethanol

  20. Amylase clearance in differentiating acute pancreatitis from peptic ulcer with hyperamylasemia. (United States)

    Warshaw, A L; Lesser, P B


    Thirty-four patients with abdominal pain, tenderness, and hyperamylasemia suggesting acute pancreatitis were studied prospectively to elucidate the relationship between peptic ulcer disease and pancreatitis. Confirming evidence of pancreatitis and/or ulcer was obtained either at laparotomy of by upper gastrointestinal roentgenograms. The presence or absence of pancreatitis was substantiated by measurement of the amylase/creatinine clearance ratio, which is significantly higher (p less than 0.001) in patients with acute pancreatitis (9.3 plus or minus 0.9), than in patients without pancreatitis (3.1 plus or minus 0.2). Nine of the 34 patients were found to have gastric or duodenal ulcers. However, seven of the nine, despite an elevated serum amylase, had no sign of pancreatitis at surgery, on radiological examination, or by elevation of the amylase/creatinine clearance ratio (3.1 plus or minus 0.4). It is suggested that hyperamylasemia associated with peptic ulcer disease is most often not indicative of acute pancreatitis and that treatment is most appropriately directed at the ulcer.

  1. The р53 expression in cells of marginal zone of duodenal ulcers during acute bleeding

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    Sulayeva O.N.


    Full Text Available The aim of the work was to estimate the intensity and tissue distribution of proapoptogen p53 expression in duodenal mucosa in patients with acute bleeding caused by peptic ulcers. In 31 patients (1st group the healing of ulcer was detected after effective endoscopic hemostasis and in 15 patients rebleeding took place (2nd group. Performed immunocytochemical investigation allow to determine that acute ulcer bleeding was associated with activation of marginal zone cells apoptosis which was maximal in covering epithelium, vascular endothelium and regions infiltrated by lymphocytes. In patients with rebleeding the higher values of р53 expression were detected in crypts epithelium and in endothelium of dilatating vessels accompanied with intensive edema and lymphocytes infiltration of lamina propria and muscularis mucosae with perifocal activation of cells death. Additionally to apoptosis in 2nd group duodenum the necrosis of cells and epithelium desquamation were found, reflecting the tissue disintegration of duodenal mucosa.

  2. [Prognostication of malignization and acute complications of gastric ulcer disease, using multiparametric neuronet clasterization]. (United States)

    Dzyubanovskiy, I Ya; Selskiy, P R; Viytovych, L E


    Results of examination of 20 gastric ulcer disease patients were analyzed for delineation of a high risk group for an acute complications occurrence, and in whom the conduction of organ preserving preventive operative interventions is expedient. For prognostication such following indices were applied: quantity of cells-producents of various immunoglobulins, mitotic and apoptotic indices, relative volume of damaged epitheliocytes, the patients' age.

  3. Distal Gastrectomy of Gastric and Duodenal Ulcer%胃十二指肠溃疡远端胃部分切除术

    Institute of Scientific and Technical Information of China (English)



    目的:探讨胃十二指肠溃疡患者行胃部分切除术治疗效果。方法对30例胃十二指肠溃疡患者行远端胃部分切除术治疗资料进行分析。结果30例十二指肠患者Bil roth I式10例,Bil roth II式20例,重建手术时间40~90 min。吻合口溃疡2例,反流性胃炎1例,残胃炎4例,经治疗所有患者均痊愈出院。结论胃十二指肠溃疡常用的手术方式是远端胃大部切除术,Bil roth I式胃十二指肠吻合或Bil roth I式胃空肠吻合重建,具体视切除的范围和十二指肠残端的情况而定。%Objective The distal gastrectomy effect on patients with gastric and duodenal ulcer to be investigated. Methods Analyze the treatment data selected from 30 patients with gastric and duodenal ulcer who are operated with distal gastrectomy. Results Among 30 patients, 10 patients with duodenal ulcer are categorized into Bil roth I Type, and the other 20 patients are categorized into Bil roth II Type, the operation reconstruction time is from 40 minutes to 90 minutes. And there are two cases of anastomotic ulcer, one case of reflux gastric and 4 cases of residual gastritis. Al of patients are cured and discharged from hospital after treatment. Conclusion The distal gastrectomy, gastric and duodenal anastomosis of Bil roth I Type or gastrojejunostomy reconstruction of Bil roth II Type is the common surgical method to cure gastric and duodenal ulcer, the choice of the surgical method is determined by resection scope and duodenal stump condition.


    Directory of Open Access Journals (Sweden)



    Full Text Available Treatment of Peptic Ulcer Disease in major hospitals is now limited to managing their complications like perforations of stomach or duodenum. This is also a common cause of peritonitis and remains a challenge to the surgeon. Diagnosis is based on clinical parameters like pain in the abdomen, shock, abdominal guarding/rigidity and abdominal distension. The diagnosis is confirmed by ultrasound examination of the abdomen, x-ray abdomen in erect posture. The predisposing factors include the age, smoking, alcohol intake, steroids and NSAIDs usage. The risk factors of mortality are presence of shock and pre-existing medical conditions and time of arrival to the casualty. The mortality and morbidity may be predicted using different scoring systems like ASA scoring and Boey’s scoring. AIM To analyze the different risk factors, clinical features and surgical treatment options of Acute Peptic Ulcer perforation in patients attending a Tertiary Hospital. To evaluate the prognostic factors causing death and complications in this condition. MATERIALS AND METHODS One hundred and sixty five patients attending with signs and symptoms of Acute Perforation of Peptic Ulcer were included. Males were predominantly affected than females with a 1.94:1 ratio. The median duration of illness was 9.64 days. History of smoking in 93.5%, NSAIDs in 78%, alcohol intake in 93.8% and steroids in 84% of the patients was present. Previous history of peptic ulcer disease was reported in 90% of the patients. Gastric ulcers were more common than with duodenal ulcer with a ratio of 1.32:1. The mortality rate was 6.66%. Among the complications wound infection was highest with 26% followed by paralytic ileus 23%. ASA and Boey’s scoring showed statistical significance in predicting the mortality with a P value of 0.00003. RESULTS The incidence of APPU was 0.35% of the total 46080 emergency surgical patients in a 4-year period. The incidence was high among the manual laborers and in

  5. Effects of topical ropivacaine on eicosanoids and neurotransmitters in the rectum of patients with distal ulcerative colitis

    DEFF Research Database (Denmark)

    Hillingsø, Jens; Kjeldsen, J; Schmidt, P T;


    BACKGROUND: Topical administration of lidocaine has been suggested to have beneficial clinical effects in patients with active ulcerative colitis, but the mechanism of action, if any, remains obscure. As local anaesthetics may exert anti-inflammatory actions through their inhibition of nervous......: These findings reveal no evidence of anti-inflammatory actions by ropivacaine in active ulcerative colitis and thus provide no rationale for topical treatment with local anaesthetics....

  6. Effects of topical ropivacaine on eicosanoids and neurotransmitters in the rectum of patients with distal ulcerative colitis

    DEFF Research Database (Denmark)

    Hillingsø, J G; Kjeldsen, J; Schmidt, P T;


    reflexes, we have studied the local effects of a single rectal dose of ropivacaine gel on rectal concentrations of eicosanoids and neurotransmittors in patients with relapsing ulcerative colitis. METHODS: In a randomized, double-blind, placebo-controlled study, concentrations of leukotriene B4, thromboxane...... changes in concentrations of eicosanoids or neuropeptides were observed after ropivacaine or placebo administration. Baseline concentrations of all neuropeptides, except somatostatin, were significantly lower in active ulcerative colitis than in controls with non-inflamed colon. CONCLUSIONS...

  7. Acute Marjolin’s Ulcer in a Postauricular Scar after Mastoidectomy

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    Kholoud A. Alhysoni


    Full Text Available Background. Marjolin’s ulcer is a rare, aggressive cutaneous malignancy that arises primarily in burn scars but can occur in other types of scars. Squamous cell carcinoma is the most common variant, and while malignant degeneration usually takes a long time, it can develop acutely. Case Report. a 30-year-old man who developed Marjolin’s ulcer acutely in a right postauricular scar after mastoidectomy and the incision and drainage of a mastoid abscess. To the best of our knowledge, this report is the first to describe a Marjolin’s ulcer in a postauricular surgical scar. However, it has been reported in others areas in the head and neck. Conclusion. Marjolin’s ulcer is most commonly observed after postburn scars, but it may be observed after any type of scars, as our patient developed an SCC with a postsurgical scar. Early diagnosis is essential, and a biopsy should be performed on any nonhealing wound or chronic wound that undergoes a sudden change. Tissue samples should be taken from both the centre and the margins of the wound.

  8. Clinical course, prognosis and prevention of acute postoperative erosive and ulcerative lesions of gastroduodenal zone in older patients

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    Shapkin Y.G.


    Full Text Available Objective of the research is to improve the results of surgical treatment in patients with postoperative acute bleeding erosions and ulcers of stomach and duodenum by their prediction and validation of methods for prevention and treatment. Materials and methods. A retrospective analysis of 3746 case histories of patients has been made. Acute erosive and ulcerative lesions, complicated by gastroduodenal bleeding, have been diagnosed in 220 cases (5, 9% in the postoperative period. Older patients have been accounted 62, 8%. Results. Acute erosive and ulcerative lesions have been developed in 5.6% of all operated patients of older age, and 0,3% in patients of middle age. Mortality rate in older patients with bleeding acute erosive and ulcerative lesions has accounted 35,8. Conclusion. The development of gastroduodenal acute erosive and ulcerative lesions is considered to be a risk factor degenerating condition of older patients in the postoperative period. The main areas of acute erosive and ulcerative lesions treatment are antisecretory therapy and endoscopic hemostasis. Endoscopic hemostasis should be accompanied by good antisecretory treatment with antacid effect in the stomach. The use of injections of H2-blockers does not prevent bleeding recurrences

  9. A single black ulcer in a child with acute lymphocytic leukemia* (United States)

    Vestita, Michelangelo; Filoni, Angela; Santoro, Nicola; Arcamone, Gianpaolo; Bonamonte, Domenico


    Ecthyma gangrenosum is an uncommon dermatological manifestation characterized by round, indurated ulcers with a central necrotic black eschar and surrounding erythema. This report describes the case of a 5-year-old girl, affected by acute lymphocytic leukemia, presenting with a black eschar on her right thigh. Such lesions should always be correctly identified to avoid potentially fatal bacteraemia. Furthermore, because of its similar clinical presentation, cutaneous anthrax must be ruled out. PMID:28099607

  10. The antiulcer effect of Cibotium barometz leaves in rats with experimentally induced acute gastric ulcer

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    AL-Wajeeh NS


    Full Text Available Nahla Saeed Al-Wajeeh,1 Maryam Hajrezaie,1 Nawal Al-Henhena,1 Sareh Kamran,1 Elham Bagheri,1 Maryam Zahedifard,1 Kamelia Saremi,1 Suzita Mohd Noor,1 Hapipah Mohd Ali,2 Mahmood Ameen Abdulla11Department of Biomedical Science, Faculty of Medicine, 2Department of Chemistry, Faculty of Science, University of Malaya, Kuala Lumpur, MalaysiaAbstract: Cibotium barometz is a pharmaceutical plant customarily used in traditional medicine in Malaysia for the treatment of different diseases, such as gastric ulcer. The gastroprotective effect of C. barometz leaves against ethanol-induced gastric hemorrhagic abrasions in Sprague Dawley rats has been evaluated in terms of medicinal properties. Seven groups of rats (normal control and ulcerated control groups, omeprazole 20 mg/kg, 62.5, 125, 250, and 500 mg/kg of C. barometz correspondingly were used in antiulcer experiment and pretreated with 10% Tween 20. After 1 hour, the normal group was orally administered 10% Tween 20, whereas absolute alcohol was fed orally to ulcerated control, omeprazole, and experimental groups. Gastric’s homogenate were assessed for endogenous enzymes activities. Stomachs were examined macroscopically and histologically. Grossly, the data demonstrated a significant decrease in the ulcer area of rats pretreated with plant extract in a dose-dependent manner with respect to the ulcerated group. Homogenates of the gastric tissue exhibited significantly increased endogenous enzymes activities in rats pretreated with C. barometz extract associated with the ulcerated control group. Histology of rats pretreated with C. barometz extract group using hematoxylin and eosin staining exhibited a moderate-to-mild disruption of the surface epithelium with reduction in submucosal edema and leucocyte infiltration in a dose-dependent manner. In addition, it showed heat shock protein70 protein up-expression and BCL2-associated X protein downexpression. These outcomes might be attributed to the

  11. Effects of topical ropivacaine on eicosanoids and neurotransmitters in the rectum of patients with distal ulcerative colitis

    DEFF Research Database (Denmark)

    Hillingsø, J.G.; Kjeldsen, J.; Schmidt, P.T.;


    reflexes, we have studied the local effects of a single rectal dose of ropivacaine gel on rectal concentrations of eicosanoids and neurotransmittors in patients with relapsing ulcerative colitis.Methods: In a randomized, double-blind, placebo-con trolled study, concentrations of leukotriene B-4...... changes in concentrations of eicosanoids or neuropeptides were observed after ropivacaine or placebo administration. Baseline concentrations of all neuropeptides, except somatostatin, were significantly lower in active ulcerative colitis than in controls with non-inflamed colon.Conclusions: These findings...

  12. Lipschutz ulcer

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    Bhat Ramesh


    Full Text Available Lipschütz first identified an acute disease with ulceration of the external genital organs of young women. The syndrome has been termed acute vulvar ulcer or ulcus vulvae acutum. The following typical case history of a 19-year-old girl is a good illustration of this interesting clinical entity.

  13. Development of perianal ulcer as a result of acute fulminant amoebic colitis

    Institute of Scientific and Technical Information of China (English)

    Takayuki Torigoe; Yoshifumi Nakayama; Koji Yamaguchi


    We report a case of acute fulminant amoebic colitis that resulted in the development of a perianal ulcer in a 29-year-old Japanese homosexual man with acquired immunodeficiency syndrome (AIDS).The patient was admitted to our hospital with a persistent perianal abscess that was refractory to antibiotic therapy administered at another hospital.On admission,we observed a giant ulcer in the perianal region.At first,cytomegalovirus colitis was suspected by blood investigations.Ganciclovir therapy was initiated; however,the patient developed necrosis of the skin around the anus during therapy.We only performed end-sigmoidostomy and necrotomy to avoid excessive surgical invasion.Histopathological examination of the surgical specimen revealed the presence of trophozoite amoebae,indicating a final diagnosis of acute fulminant amoebic colitis.The patient's postoperative course was favorable,and proctectomy of the residual rectum was performed 11 mo later.Amoebic colitis is one of the most severe complications affecting patients with AIDS.Particularly,acute fulminant amoebic colitis may result in a poor prognosis; therefore,staged surgical therapy as a less invasive procedure should be considered as one of the treatment options for these patients.

  14. [Effectiveness of the use of solcoseryl after surgery of acute hemorrhage in gastroduodenal ulcer]. (United States)

    Fomin, P D; Zaplavskiĭ, A V; Ivanchov, P V; Peresh, E E; Lissov, A I; Tikhonenko, A M


    The experience of solcoseryl application in 70 patients, operated on for an acute hemorrhage from gastroduodenal ulcer, was summarized. The preparation was injected intravenously in the dose of 10 ml in 5% solution of glucose every other day during 6 days and then in the dose of 5 ml intramuscularly during 4-5 days. High efficacy of solcoseryl, manifesting by more earlier elimination of pain and oedema, healing of mucosa by first intention, shortening of the treatment duration in stationary by 3-5 days, was established.

  15. Evaluation of the acute toxicity, phytochemical constituents and anti - ulcer properties of methanolic leaf extract of Annona muricata in mice

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    Valentine Uneojo Omoja


    Full Text Available This study investigated the acute toxicity, phytochemical constituents and anti - ulcer properties of methanolic leaf extract of Annona muricata in mice. The anti - ulcer activity was evaluated using absolute ethanol-induced ulcer and aspirin-induced ulcer models in mice. An LD50 of 354.8 +/- 8 mg/kg body weight, bw of the extract was obtained on oral administration. Investigation of the phytochemical constituents of the plant extract revealed the presence of saponins, alkaloids and traces of tannins. All doses of the extract (50, 75 and 100 mg/kg used for the study significantly reduced (p<0.05 the mean number of ulcers in both ulcer models when compared to the untreated group A (10 ml/kg distil water. Optimum antiulcer activity of the extract against absolute ethanol-induced ulcer was noted at 50 mg/kg bw. At this 50 mg/kg, the mean number of ulcers and mean ulcer index of the extract was significantly lower (p<0.05 than that of Cimetidine at 100 mg/kg (3.60 +/- 0.51: 5.00 +/- 0.32; 1.5+/-0.05: 0.98+/-0.03, the treated control group whereas the protective index of the extract was higher than that of cimetidine (50.51 %: 24.24 %. The results obtained from this study strongly suggest that methanolic leaf extract of Annona muricata can be effectively used for the treatment of ulcer in low doses and can provide better therapeutic effect than cimetidine if used in ulcers caused by alcoholism and related agents. [J Intercult Ethnopharmacol 2014; 3(1.000: 37-43

  16. A comparison of roxatidine and ranitidine for the acute treatment of duodenal ulcer. (United States)

    Walt, R P; Logan, R F; Hawkey, C J; Daneshmend, T K; Long, R G; Cooper, B T; Langman, M J; Collins, M; Street, R


    Roxatidine acetate is a new histamine H2-antagonist of about twice the potency of ranitidine on a weight-for-weight basis. Two hundred and thirty-two patients participated in a double-blind randomized trial of duodenal ulcer healing comparing 300 mg ranitidine nocte with 150 mg roxatidine nocte. Endoscopy was repeated fortnightly to 4 weeks in each of four participating centres. Usual exclusion criteria applied but NSAID users were allowed. There were no important demographic differences between treatment recipients. Three analyses were used: protocol (dropouts and violators not included), intention-to-treat I (dropouts considered failures), and intention-to-treat II (dropouts considered failures, but violators outcome included). Healing rates differed markedly (but not significantly) with each analysis. After 2 weeks of treatment ulcers had healed in 51% versus 45% using the intention to treat I analysis with roxatidine and ranitidine, respectively; by the protocol analysis the healing proportions were 60% and 55%. These differences between treatments were not significant. After 4 weeks of treatment healing rates ranged from 71% to 83% on roxatidine and between 69% and 84% on ranitidine depending on the analysis. Differential healing proportions of smokers and non-smokers were non-significant (83% vs. 79%). Both drugs were well tolerated and adverse events were similar with each agent. Roxatidine should prove as effective as ranitidine for acute duodenal ulcer treatment.

  17. Predicting pressure ulcer risk with the modified Braden, Braden, and Norton scales in acute care hospitals in Mainland China. (United States)

    Kwong, Enid; Pang, Samantha; Wong, Thomas; Ho, Jacqueline; Shao-ling, Xue; Li-jun, Tao


    The aim of this study was to develop a modified Braden scale, to evaluate its predictive validity, and to identify a more valid pressure ulcer risk calculator for application in acute care hospitals in Mainland China among the modified Braden, Braden, and Norton scales. The initial modified Braden scale, with the addition of skin type and body build for height, was proposed in this study. Four hundred twenty-nine subjects who were admitted to two acute care hospitals in Mainland China within 24 hr and free of pressure ulcers upon admission were assessed with the initial modified Braden, Braden, and Norton scales by three nurse assessors. This was followed by a daily skin assessment to note any pressure ulcer by a nurse assessor. Nine subjects had pressure ulcers detected at Stages I (89%) and II (11%) after an average stay of 11 days. The descriptive analysis of each subscale scoring item in the initial modified Braden scale indicated that skin type and body build for height were the most distinct predictive factors whereas nutrition was the least distinct factor for predicting pressure ulcer development. Based on these findings, the modified Braden scale was further developed with the addition of skin type and body build for height and by exclusion of nutrition. The predictive validity test reported that the modified Braden scale demonstrated a better balance of sensitivity (89%) and specificity (75%) at a cutoff score of 16, with a higher positive predictive value (7%), than the Braden and Norton scales. This finding revealed that for this sample, the modified Braden scale is more effective in pressure ulcer risk prediction than the other two scales. Because the modified Braden scale is not 100% sensitive and specific, to increase clinical efficacy in the prevention of pressure ulcer, it is recommended that it be adopted combined with nursing judgment to predict pressure ulcer development in acute care settings in Mainland China.

  18. Update on medical and surgical options for patients with acute severe ulcerative colitis: What is new? (United States)

    Andrew, Rachel E; Messaris, Evangelos


    Acute severe ulcerative colitis (UC) is a highly morbid condition that requires both medical and surgical management through the collaboration of gastroenterologists and colorectal surgeons. First line treatment for patients presenting with acute severe UC consists of intravenous steroids, but those who do not respond require escalation of therapy or emergent colectomy. The mortality of emergent colectomy has declined significantly in recent decades, but due to the morbidity of this procedure, second line agents such as cyclosporine and infliximab have been used as salvage therapy in an attempt to avoid emergent surgery. Unfortunately, protracted medical therapy has led to patients presenting for surgery in a poorer state of health leading to poorer post-operative outcomes. In this era of multiple medical modalities available in the treatment of acute severe UC, physicians must consider the advantages and disadvantages of prolonged medical therapy in an attempt to avoid surgery. Colectomy remains a mainstay in the treatment of severe ulcerative colitis not responsive to corticosteroids and rescue therapy, and timely referral for surgery allows for improved post-operative outcomes with lower risk of sepsis and improved patient survival. Options for reconstructive surgery include three-stage ileal pouch-anal anastomosis or a modified two-stage procedure that can be performed either open or laparoscopically. The numerous avenues of medical and surgical therapy have allowed for great advances in the treatment of patients with UC. In this era of options, it is important to maintain a global view, utilize biologic therapy when indicated, and then maintain an appropriate threshold for surgery. The purpose of this review is to summarize the growing number of medical and surgical options available in the treatment of acute, severe UC.

  19. Genital ulcers after treatment with all-trans-retinoic acid in a child with acute promyelocytic leukemia. (United States)

    Unal, Selma; Gümrük, Fatma; Cetin, Mualla; Hiçsönmez, Gönül


    All-trans-retinoic acid (ATRA) has been shown to improve the outcome of patients with acute promyelocytic leukemia (APL). However, various adverse effects of ATRA treatment have been noted, such as scrotal and genital ulcers in adult patients. The authors report genital ulcers that developed in a child with APL after ATRA treatment. An 8-year-old girl with APL was treated with ATRA for 21 days and after discontinuation of ATRA treatment she developed genital ulcers. Systemic and local antibiotic pomades were applied and the lesions improved within 15 days. In conclusion, genital ulcers may develop in children with APL as a complication of ATRA treatment and physicians should be alert to this possibility.

  20. Genital Ulcer Development in Patients with Acute Promyelocytic Leukaemia Treated with All-Trans Retinoic Acid: A Case Series

    Directory of Open Access Journals (Sweden)

    Mohammed Al Huneini


    Full Text Available We report here four cases of genital ulcers that developed after the administration of all-trans retinoic acid (ATRA for the treatment of acute promyelocytic leukemia (APL. Between October 2007 and March 2010, three males and one female (age range 19-35 years were identified to have genital ulcers after being prescribed all-trans retinoic acid (ATRA as a part of chemotherapy for APL. This is the first series of cases describing genital ulcers, as a unique and rare complication of ATRA used for treatment of APL in these patients, with no other cause identified. Following temporary cessation of ATRA for a few days in these three cases, improvement of the ulcers was noted.

  1. Successful Management of Gastrointestinal Haemorrhage Associated with Ischaemic Colonic Ulceration in Acute Pancreatitis with Video Assisted Retroperitoneal Debridement

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    Yogesh Puri


    Full Text Available Context Colonic involvement is an uncommon but potentially lethal complication of severe acute pancreatitis and has received little attention in the surgical literature. Such complications can range from localized colonic pathology to widespread ischaemic pancolitis. Treatment options have historically been limited to resection of the affected segment. Case report We describe the successful role of video assisted retroperitoneal pancreatic debridement in the management of two cases presenting with major gastrointestinal haemorrhage due to localised colonic ulceration on the background of acute necrotising pancreatitis. Conclusion Video assisted retroperitoneal debridement should be considered early in the management of local colonic complications associated with severe acute necrotising pancreatitis.

  2. Evaluation and management of acute genital ulcers in sexually active patients. (United States)

    Kraus, S J


    The causes of genital ulcers vary with the age of the patient. Although sexually related genital ulcers can be seen at any age, they are most common between the ages of 15 and 30. The differential diagnosis includes syphilis, chancroid, genital herpes, lymphogranuloma venereum, granuloma inguinale, fixed drug reactions, and traumatic ulcers.

  3. Dietary unsaponifiable fraction from extra virgin olive oil supplementation attenuates acute ulcerative colitis in mice. (United States)

    Sánchez-Fidalgo, S; Cárdeno, A; Sánchez-Hidalgo, M; Aparicio-Soto, M; Villegas, I; Rosillo, M A; de la Lastra, C Alarcón


    Extra virgin olive oil (EVOO) has demonstrated immunomodulatory and antiinflammatory properties in murine experimental ulcerative colitis (UC). In addition to its high monounsaturated fatty acid content, evidences have accumulated on the favorable properties of minor, although highly bioactive, components present in the unsaponifiable fraction (UF). The present study was designed to evaluate the effects of dietary EVOO's UF supplementation on acute UC. C57BL/6 mice were fed from weaning with sunflower oil (SD), EVOO diet and UF-enriched SD at 5% oil (SD+UF). After 30 days, mice were exposed to 3% dextran sulfate sodium (DSS) for 5 days developing acute colitis. After 4 days of DSS removal, animals were sacrificed and colons were histological and biochemically processed. Disease activity index and microscopic damage score were significantly improved in EVOO and SD+UF dietary groups versus SD group. In addition, both dietary treatments significantly induced decreases in MCP-1 and TNF-α levels, iNOS and COX-2 overexpression and p38 MAPKs activation in colon mucosa. Moreover, an upregulation of IκB expression was also observed after feeding the animals with both diets. However, no statistically differences between data from mice fed with EVOO or UF+SD diets were observed. Dietary enrichment with EVOO's UF reduces the damage in acute colitis model, alleviating the oxidative events and returning proinflammatory proteins expression to basal levels probably through p38 MAPK and NFκB signalling pathways. EVOO's UF diet might provide a basis for developing a new strategy in dietary supplementation for the prevention of UC.

  4. Mechanisms of Gastric Emptying Disturbances in Chronic and Acute Inflammation of the Distal Gastrointestinal Tract

    DEFF Research Database (Denmark)

    Keller, Jutta; Beglinger, Christoph; Holst, Jens Juul;


    in such patients. Methods: 13 healthy subjects (CON), 13 patients with Crohn's disease (CD), 10 with ulcerative colitis (UC) and 7 with diverticulitis (DIV) underwent a standardized (13)C-octanoic acid gastric emptying breath test. Plasma glucose, cholecystokinin (CCK), peptide YY (PYY) and glucagon-like peptide-1...... be a pathophysiological link between decreased GLP-1 release, postprandial hyperglycemia and delayed GE. These explorative data encourage further studies in larger patient groups. Key words: inflammatory bowel disease, diverticulitis, motility, hormonal regulation....

  5. A retrospective study using the pressure ulcer scale for healing (PUSH) tool to examine factors affecting stage II pressure ulcer healing in a Korean acute care hospital. (United States)

    Park, Kyung Hee


    Stage II pressure ulcers (PUs) should be managed promptly and appropriately in order to prevent complications. To identify the factors affecting Stage II PU healing and optimize care, the electronic medical records of patients with a Stage II PU in an acute care hospital were examined. Patient and ulcer characteristics as well as nutritional assessment variables were retrieved, and ulcer variables were used to calculate Pressure Ulcer Scale for Healing (PUSH) scores. The effect of all variables on healing status (healed versus nonhealed) and change in PUSH score for healing rate were compared. Records of 309 Stage II PUs from 155 patients (mean age 61.2 ± 15.2 [range 5-89] years, 182 [58.9%] male) were retrieved and analyzed. Of those, 221 healed and 88 were documented as not healed at the end of the study. The variables that were significantly different between patients with PUs that did and did not heal were: major diagnosis (P = 0.001), peripheral arterial disease (P = 0.007), smoking (P = 0.048), serum albumin ( Braden scale score (P = 0.003), and mean arterial pressure (MAP, mm Hg) (P = 0.026). The Cox proportional hazard model showed a significant positive difference in PUSH score change -indicative of healing - when pressure-redistribution surfaces were used (P <0.001, HR = 2.317), PU size was small (≤3.0 cm2, P = 0.006, HR = 1.670), MAP (within a range of 52-112 mm Hg) was higher P = 0.010, HR = 1.016), and patients were provided multivitamins (P = 0.037, HR=1.431). The results of this study suggest strategies for healing Stage II PUs in the acute care setting should include early recognition of lower-stage PUs, the provision of static pressure-redistribution surfaces and multivitamins, and maintaining higher MAP may facilitate healing and prevent deterioration. Further prospective research is warranted to verify the effect of these interventions.

  6. A case of acute trans-scaphoid volar dislocation of the lunate into the distal forearm

    Institute of Scientific and Technical Information of China (English)

    Mohamed Al Khayarin; Mohamed Al Ateeq Al Dosari; Shibly Abdul Basith; Mohammed Waseemuddin


    Trans-scaphoid volar dislocation of the lunate with displacement into the distal forearm proximal to the radiocarpal joint is an extremely rare, high energy injury with extensive ligament disruption. They are unstable and require open reduction and internal fixation with repair of ligaments. They are associated with significant morbidity and loss of function. We report the case of a patient with this injury. Open reduction, internal fixation and ligament repair were done. The patient had a good functional outcome.

  7. A therapeutic dose of ketoprofen causes acute gastrointestinal bleeding, erosions, and ulcers in rats. (United States)

    Shientag, Lisa J; Wheeler, Suzanne M; Garlick, David S; Maranda, Louise S


    Perioperative treatment of several rats in our facility with ketoprofen (5 mg/kg SC) resulted in blood loss, peritonitis, and death within a day to a little more than a week after surgery that was not related to the gastrointestinal tract. Published reports have established the 5-mg/kg dose as safe and effective for rats. Because ketoprofen is a nonselective nonsteroidal antiinflammatory drug that can damage the gastrointestinal tract, the putative diagnosis for these morbidities and mortalities was gastrointestinal toxicity caused by ketoprofen (5 mg/kg). We conducted a prospective study evaluating the effect of this therapeutic dose of ketoprofen on the rat gastrointestinal tract within 24 h. Ketoprofen (5 mg/kg SC) was administered to one group of rats that then received gas anesthesia for 30 min and to another group without subsequent anesthesia. A third group was injected with saline followed by 30 min of gas anesthesia. Our primary hypothesis was that noteworthy gastrointestinal bleeding and lesions would occur in both groups treated with ketoprofen but not in rats that received saline and anesthesia. Our results showed marked gastrointestinal bleeding, erosions, and small intestinal ulcers in the ketoprofen-treated rats and minimal damages in the saline-treated group. The combination of ketoprofen and anesthesia resulted in worse clinical signs than did ketoprofen alone. We conclude that a single 5-mg/kg dose of ketoprofen causes acute mucosal damage to the rat small intestine.

  8. Bacteriological study of pus isolates from neuropathic plantar ulcers associated with acute inflammatory phase. (United States)

    Ebenezer, G; Daniel, S; Suneetha, S; Reuben, E; Partheebarajan, S; Solomon, S


    In this retrospective study, sensitivity of organisms cultured from ulcers of leprosy patients without and with diabetes mellitus, diabetic patients without leprosy and patients with ulcers from other causes was examined. The profile of organisms grown from these groups of patients did not differ significantly. However, there was a high prevalence of organisms like Proteus, E. coli and Enterococcus in the ulcers of leprosy patients indicating faecal contamination of the ulcers. Co-trimaxazole and tetracycline were of little value in the treatment of these ulcers. We therefore recommend that in situations where there is no culture facility, the patients be started on a course of penicillin and gentamycin. If these antibiotics fail, it would be necessary to use more advanced antibiotics like norfloxacin, amikacin and ciprofloxacin.

  9. Kontribusi Higiene Mulut terhadap Timbulnya Acute Necrotizing Ulcerative Gingivitis (ANUG (Survei Epidemiologi di Kecamatan Pacet Kabupaten Cianjur Jawa Barat

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    Diana Mirna


    Full Text Available This analytical epidemiological survey was aimed to investigate the correlation between oral hygiene and the onset of an infectious, necrotic, ulcerative disease called acute necrotizing ulcerative gingivitis (ANUG. The study involved 319 elementary school children consisting of 163 (52% male and 156 (48% female pupils from Kecamatan Pacet, Cianjur, WestJawa. Samples were chosen by stratified simple random sampling. The obtained data were analyzed with Bivariant Test (Chi2Ttest, and the results showed a quite high prevalence of ANUG, aboout 15.3% in total and consisting 9% male and 6.3% female subjects. The correlation between oral hygiene and the onset of ANUG was found to be significant (p<0.05. It was concluded that oral hygiene has an important contribution to the onset of ANUG.

  10. Results of the 2008-2009 International Pressure Ulcer Prevalence Survey and a 3-year, acute care, unit-specific analysis. (United States)

    VanGilder, Catherine; Amlung, Stephanie; Harrison, Patrick; Meyer, Stephanie


    The National Quality Forum has identified a pressure ulcer as a hospital-acquired condition (HAC) that is high-cost and high-volume and may be preventable with implementation of evidence-based guidelines. The Center for Medicare and Medicaid Services no longer reimburses acute care facilities for the ancillary cost of facility-acquired (FA) ulcers. Benchmarking patient safety indicators, such as FA, may help facilities reduce pressure ulcer rates. The purpose of this observational, cross-sectional cohort study was to report the International Pressure Ulcer Prevalence Survey (IPUP) in the United States in 2008 and 2009. In addition, previously collected data (2006/2007) were used to evaluate and report general and unit-specific prevalence rates in acute care facilities. The overall prevalence and FA pressure ulcer rates were 13.5% and 6% (2008, N = 90,398) and 12.3 and 5% (2009, N = 92,408), respectively. In 2008 and 2009, overall prevalence rates were highest in long-term acute care (22%). FA rates were highest in adult intensive care units (ICUs) and ranged from 9.2% (general cardiac care unit [CCU]) to 12.1% (medical ICU) in 2008 and from 8.8% (general CCU) to 10.3% (surgical ICU) in 2009. In 2009, 3.3% of ICU patients developed severe FA ulcers (Stage III, Stage IV, eschar/unable to stage, or deep tissue injury). In 2009, approximately 10% (n = 1,631) of all ulcers were described as device-related. The most common anatomic locations for device-related ulcers were the ear (20%) and sacral/coccyx region (17%). Both the overall and FA pressure ulcer prevalence rates were lower in 2008 and 2009 than in 2006 and 2007. Results indicate that, although overall prevalence trends are encouraging, there is a stark contrast from the desired state, especially in adult ICUs.

  11. How does disease location affect acute phase reactants in ulcerative colitis?

    Directory of Open Access Journals (Sweden)

    Serkan Ipek


    Conclusion: CRP, ESR, WBC, PLT counts and albumin levels are of limited value in determining disease activity in ulcerative colitis patients, especially in those with proctitis. [Int J Res Med Sci 2015; 3(7.000: 1589-1593

  12. Gastroprotective effects of thymol on acute and chronic ulcers in rats: The role of prostaglandins, ATP-sensitive K(+) channels, and gastric mucus secretion. (United States)

    Ribeiro, Ana Roseli S; Diniz, Polyana B F; Pinheiro, Malone S; Albuquerque-Júnior, Ricardo L C; Thomazzi, Sara M


    Thymol, a monoterpene phenol derivative of cymene, is found in abundance in the essential oils of Thymus, Origanum, and Lippia species. The present study investigated the gastroprotective actions of thymol (10, 30, and 100 mg/kg, p.o.) in the acute (ethanol- and nonsteroidal anti-inflammatory drug-induced ulcers) and chronic (acetic acid-induced ulcers) ulcer models in rats. Some of the mechanisms underlying to the gastroprotective effect of thymol were investigated in the ethanol-induced ulcer model. Gastric secretion parameters (volume, pH, and total acidity) were also evaluated by the pylorus ligature model, and the mucus in the gastric content was determined. The anti-Helicobacter pylori activity of thymol was performed using the agar-well diffusion method. Thymol (10, 30, and 100 mg/kg) produced dose dependent reduction (P ulcer model. The gastroprotective response caused by thymol (30 mg/kg) was significantly attenuated (P ulcer index (P ulcer models, respectively. In the model pylorus ligature, the treatment with thymol failed to significantly change the gastric secretion parameters. However, after treatment with thymol (30 and 100 mg/kg), there was a significant increase (P ulcer models through mechanisms that involve increased in the amount of mucus, prostaglandins, and ATP-sensitive K(+) channels.

  13. [An elderly woman with macrocytic anemia and acute high-output heart failure following acute bleeding due to a gastric ulcer]. (United States)

    Matsuzaki, Gen; Ashida, Terunao; Akanuma, Masao; Fujii, Jun; Seko, Yoshinori


    Although macrocytic anemia can develop in patients with acute blood loss, such anemia in very old patients is uncommon. In this report, we describe the course of an 89-year-old woman who had a rapid recovery from macrocytic anemia by medication only after acute blood loss due to a gastric ulcer. She had been treated with antihypertensive drugs for the previous 28 years at our outpatient clinic, and was admitted because of acute anemia 6 days after she had experienced tarry stool. Her hemoglobin (Hb) count and mean corpuscular volume (MCV) were 8.4 g/dl, and 103 fl, respectively. A gastroscopic examination indicated that the tarry stool originated from a fresh gastric ulcer. She was treated with an iron preparation, a diuretic and a proton pump inhibitor. The anemia was rapidly improved to Hb 10.5 g/dl and MCV 106 fl in one week, and to Hb 14.5 g/dl and MCV 99 fl in 4 weeks. At admission, she had slight pleural effusion and slight edema associated with an increase in her plasma brain natriuretic peptide (BNP) level (323 pg/ml), and her left ventricular ejection fraction was 76% based on the echocardiography findings, which are signs of the high-output heart failure without remarkable left ventricular diastolic dysfunction (E/e': 11.2). However, these signs improved rapidly, and her BNP level thereafter decreased to 114 pg/ml within four weeks.

  14. An exploration of nursing documentation of pressure ulcer care in an acute setting in Ireland.

    LENUS (Irish Health Repository)

    O Brien, J A Jordan


    OBJECTIVE: To explore the nature and quality of documented care planning for pressure ulcers in a large teaching hospital in the Republic of Ireland. METHOD: A mixed method design was used; this encompassed a descriptive survey that retrospectively evaluated nursing records (n=85) in two wards (orthopaedic and care of the older adult) and a focus group (n=13) that explored nurses\\' perspectives of the factors influencing concordance and the quality of nursing documentation. Only records of at-risk patients (Waterlow score of >10) were included. RESULTS: It was identified that 47% (n=40) were assessed as at high or very high risk of developing a pressure ulcer. Fifty-two patients (61%) had a weekly risk assessment, but 25% (n=21) had only one follow-up assessment. Only 45% (n=38) of charts had some evidence of documented care planning, and of those 53% (n=20) had no evidence of implementation of the care plan and 66% (n=25) had no evidence of outcome evaluation. Only 48% (n=41) of this at-risk population was nutritionally assessed. Of patients admitted with and without a pressure ulcer, there was no record of regular positioning in 70% (n=59) and 60% (n=51) respectively. CONCLUSION: Documentation on pressure ulcer care is not standardised and requires development. Conflict of interest: None.

  15. Perforated peptic ulcer in an adolescent boy with acute appendicitis: a case report

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    Aazam Khorassani


    Full Text Available Background: Peptic ulcer disease is one of the most common GI disorders. Perforation has the highest mortality rate of any complication of ulcer disease, while early diagno-sis and emergency treatment save patient life.Case presentation: This paper reports an adolescent boy admitted to the Ziaeian University Hospital. He suffered from severe abdominal pain with dyspnea had been started since past three hours. Periumbilical pain started from past 2-3 days, gradually localized to the right lower quadrant. He had anorexia without nausea and vomiting. He was tachycardic and tachypneic, but he did not have fever. On physical examination, bowel sound was hypoactive, there was generalize tenderness, guarding and rebound tender-ness focused in the right lower quadrant and suprapubic region. Laboratory finding indicated leukocytosis. Chest X-ray showed free air under diaphragm. Once the diagno-sis has been made, the patient was given analgesia and antibiotics, resuscitated with isotonic fluid, and taken to the operating room. Laparotomy was implemented through a midline incision. There was bile secretion in the peritoneal cavity. Appendix was inflamated. Cecum and ileum were normal. A small perforation, 4mm in size was detected in first portion of duodenum. Appendectomy and omental patch repair were done. Ten days later, the patient was discharged in a good state. Serologic test for helicobacter pylori was negative.Conclusion: Stomach and duodenal perforation should be considered in patients with-out peptic ulcer disease, especially in children and adolescents with sudden and severe abdominal pain who are admitted to the hospital for other diseases. Because some patients present with peptic ulcer complications that are seemingly exacerbated by stressful life events.

  16. Spontaneous gastric ulcer perforation and acute spleen infarction caused by invasive gastric and splenic mucormycosis

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    Mushira Abdulaziz Enani


    Full Text Available Mucormycosis is a rare life-threatening fungal infection mostly affecting immunocompromised hosts. The main categories of human disease with the Mucorales are sinusitis/rhinocerebral, pulmonary, cutaneous/subcutaneous, gastrointestinal and disseminated disease. Other disease states occur with a much lower frequency and include cystitis, vaginitis; external otitis and allergic disease. We report a diabetic patient with comorbidities, who developed gastric perforation clinically indistinguishable from perforated peptic ulcer due to invasive gastric mucormycosis complicated by spleen infarction.

  17. Spontaneous gastric ulcer perforation and acute spleen infarction caused by invasive gastric and splenic mucormycosis. (United States)

    Enani, Mushira Abdulaziz; Alharthi, Bandar N; Dewanjee, Nancy; Bhat, Nadeem A; Fagih, Mosa


    Mucormycosis is a rare life-threatening fungal infection mostly affecting immunocompromised hosts. The main categories of human disease with the Mucorales are sinusitis/rhinocerebral, pulmonary, cutaneous/subcutaneous, gastrointestinal and disseminated disease. Other disease states occur with a much lower frequency and include cystitis, vaginitis; external otitis and allergic disease. We report a diabetic patient with comorbidities, who developed gastric perforation clinically indistinguishable from perforated peptic ulcer due to invasive gastric mucormycosis complicated by spleen infarction.

  18. Early Diagnosis of Helicobacter pylori Infection in Vietnamese Patients with Acute Peptic Ulcer Bleeding: A Prospective Study

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    Duc Trong Quach


    Full Text Available Aims. To investigate H. pylori infection rate and evaluate a combined set of tests for H. pylori diagnosis in Vietnamese patients with acute peptic ulcer bleeding (PUD. Methods. Consecutive patients with acute PUB were enrolled prospectively. Rapid urease test (RUT with 3 biopsies was carried out randomly. Patients without RUT or with negative RUT received urea breath test (UBT and serological and urinary H. pylori antibody tests. H. pylori was considered positive if RUT or any noninvasive test was positive. Patients were divided into group A (RUT plus noninvasive tests and group B (only noninvasive tests. Results. The overall H. pylori infection rate was 94.2% (161/171. Groups A and B had no differences in demographic characteristics, bleeding severity, endoscopic findings, and proton pump inhibitor use. H. pylori-positive rate in group A was significantly higher than that in group B (98.2% versus 86.7%, p=0.004. The positive rate of RUT was similar at each biopsy site but significantly increased if RUT results from 2 or 3 sites were combined (p<0.05. Conclusions. H. pylori infection rate in Vietnamese patients with acute PUB is high. RUT is an excellent test if at least 2 biopsies are taken.

  19. Early Diagnosis of Helicobacter pylori Infection in Vietnamese Patients with Acute Peptic Ulcer Bleeding: A Prospective Study (United States)

    Quach, Duc Trong; Luu, Mai Ngoc; To, Thuy-HuongThi; Bui, Quy Nhuan; Tran, Tuan Anh; Tran, Binh Duy; Vo, Minh-Cong Hong; Tanaka, Shinji; Uemura, Naomi


    Aims. To investigate H. pylori infection rate and evaluate a combined set of tests for H. pylori diagnosis in Vietnamese patients with acute peptic ulcer bleeding (PUD). Methods. Consecutive patients with acute PUB were enrolled prospectively. Rapid urease test (RUT) with 3 biopsies was carried out randomly. Patients without RUT or with negative RUT received urea breath test (UBT) and serological and urinary H. pylori antibody tests. H. pylori was considered positive if RUT or any noninvasive test was positive. Patients were divided into group A (RUT plus noninvasive tests) and group B (only noninvasive tests). Results. The overall H. pylori infection rate was 94.2% (161/171). Groups A and B had no differences in demographic characteristics, bleeding severity, endoscopic findings, and proton pump inhibitor use. H. pylori-positive rate in group A was significantly higher than that in group B (98.2% versus 86.7%, p = 0.004). The positive rate of RUT was similar at each biopsy site but significantly increased if RUT results from 2 or 3 sites were combined (p < 0.05). Conclusions. H. pylori infection rate in Vietnamese patients with acute PUB is high. RUT is an excellent test if at least 2 biopsies are taken. PMID:28133477

  20. Construct Validity of the Braden Scale for Pressure Ulcer Assessment in Acute Care: A Structural Equation Modeling Approach. (United States)

    Chen, Hong-Lin; Cao, Ying-Juan; Shen, Wang-Qin; Zhu, Bin


    The Braden Scale is the most widely used pressure ulcer risk assessment system in the world. To investigate its construct validity using structural equation modeling (SEM), a secondary analysis of retrospective data of patients admitted to an acute care facility was conducted using the records of 2588 patients who were at risk for pressure ulcers and admitted between January 2013 and December 2013. Data were extracted to an Excel sheet and analyzed, including demographic characteristics (ie, patients age, gender, weight, and disease spectrum), as well as total Braden scores and subscale scores. The SEM was set according to modification indices suggestion. The original Braden Scale model was supported by χ2(9) = 22.854, CFI = 0.902, GFI = 0.974, root mean square error of approximation (RMSEA) = 0.092, indicating inadequate model fit. After modification according to software indices, χ2(2) = 2.052, CFI = 0.999, GFI = 0.999, RMSEA = 0.020 indicated an acceptable fit of the model (final model). The factor loadings of 6 subscales were all significant (P <.001), with .147 for nutrition, .137 for activity, .167 for friction and shear, .825 for sensory perception, .626 for mobility, and .556 for moisture subscale. The nutrition, activity, and friction and shear subscales were corrected to examine their relationships with other Braden Scale subscales (nutrition with activity [φ -0.063], activity with friction/shear [φ 0.136], and nutrition (φ friction/shear [0.159]). The factor loadings ranged from -0.067 to 0.159. These findings suggest the original Braden Scale has inadequate construct validity for acute care patients and that new risk-predicting scales should be designed based on data mining. Second, according to the factor loadings in the SEM, the most important risk factor in the Braden Scale for this patient population is sensory perception, followed by mobility and moisture. This suggests practitioners should pay particular attention to pressure ulcer prevention

  1. Cytological evaluation and prediction of progression of acute erosive ulcered lesions of upper parts of gastrointestinal tract in acute and early periods of cerebrospinal trauma

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    Norkin I.A.


    Full Text Available 80 cytological preparations derived by fibrogastroduodenoscopy from 20 patients with cerebrospinal trauma at cervical part level served as the research subject. Dynamics of the progression of acute erosive ulcered lesions of mucous membrane of the upper parts of the gastrointestinal tract was studied on the basis of the cytological analyses of mucous membrane biopsy materials. In the course of our work we used endoscopic (fibrogastroduodenoscopy and cytological research methods. Cytological analyses of mucous membrane biopsy materials were carried out on the 7th, 14th, 21st and 28th day. Biopsy material cellular composition was evaluated on the grounds of the calculation of neutrophilic leukocytes and epithelial cells with the use of an immersion objective. In so doing we registered neutrophilic leukocyte number for 100 cells and determined neutrophilic and epithelial index. Monitoring of neutrophilic leukocyte number enables to determine presence or absence of inflammatory changes in stomach mucous membrane and duodenum in different periods of cerebrospinal trauma

  2. Induction of experimental acute ulcerative colitis in rats by administration of dextran sulfate sodium at low concentration followed by intracolonic administration of 30% ethanol

    Institute of Scientific and Technical Information of China (English)


    Several models of experimental ulcerative colitis have been reported previously. However, none of these models showed the optimum characteristics. Although dextran sulfate sodium-induced colitis results in inflammation resembling ulcerative colitis, an obvious obstacle is that dextran sulfate sodium is very expensive. The aim of this study was to develop an inexpensive model of colitis in rats. Sprague-Dawley rats were treated with 2% dextran sulfate sodium in drinking water for 3 d followed by an intracolonic administration of 30% ethanol. The administration of 2% dextran sulfate sodium followed by 30% ethanol induced significant weight loss, diarrhea and hematochezia in rats. Severe ulceration and inflammation of the distal part of rat colon were developed rapidly. Histological examination showed increased infiltration of polymorphonuclear leukocytes,lymphocytes and existence of cryptic abscesses and dysplasia. The model induced by dextran sulfate sodium at lower concentration followed by 30% ethanol is characterized by a clinical course, localization of the lesions and histopathological features similar to human ulcerative colitis and fulfills the criteria set out at the beginning of this study.

  3. Ulcerative colitis flair induced by mesalamine suppositories hypersensitivity. (United States)

    Ding, Hao; Liu, Xiao-Chang; Mei, Qiao; Xu, Jian-Ming; Hu, Xiang-Yang; Hu, Jing


    Mesalamine suppositories have been used widely for the treatment of distal ulcerative colitis and considered to be safer than systemic administration for its limited systemic absorption. However, previous studies have shown that mesalamine suppository occasionally causes severe hypersensitivity reactions including fever, rashes, colitis exacerbation and acute eosinophilic pneumonia. Here we present a 25-year-old woman with ulcerative colitis with bloody diarrhea accompanied by abdominal pain and fever which were aggravated after introduction of mesalamine suppositories. In light of symptom exacerbation of ulcerative colitis, increased inflammatory injury of colon mucosa shown by colonoscopy and elevated peripheral eosinophil count after mesalamine suppositories administration, and the Naranjo algorithm score of 10, the possibility of hypersensitivity reaction to mesalamine suppositories should be considered, warning us to be aware of this potential reaction after administration of mesalamine formulations even if it is the suppositories.

  4. Nerve growth factor receptor gene is at human chromosome region 17q12-17q22, distal to the chromosome 17 breakpoint in acute leukemias

    Energy Technology Data Exchange (ETDEWEB)

    Huebner, K.; Isobe, M.; Chao, M.; Bothwell, M.; Ross, A.H.; Finan, J.; Hoxie, J.A.; Sehgal, A.; Buck, C.R.; Lanahan, A.


    Genomic and cDNA clones for the human nerve growth factor receptor have been used in conjunction with somatic cell hybrid analysis and in situ hybridization to localize the nerve growth factor receptor locus to human chromosome region 17q12-q22. Additionally, part, if not all, of the nerve growth factor receptor locus is present on the translocated portion of 17q (17q21-qter) from a poorly differential acute leukemia in which the chromosome 17 breakpoint was indistinguishable cytogenetically from the 17 breakpoint observed in the t(15;17)(q22;q21) translocation associated with acute promyelocytic leukemia. Thus the nerve growth factor receptor locus may be closely distal to the acute promyelocytic leukemia-associated chromosome 17 breakpoint at 17q21.

  5. Neonatal Pressure Ulcer Prevention. (United States)

    Scheans, Patricia


    The incidence of pressure ulcers in acutely ill infants and children ranges up to 27 percent in intensive care units, with a range of 16-19 percent in NICUs. Anatomic, physiologic, and developmental factors place ill and preterm newborns at risk for skin breakdown. Two case studies illustrate these factors, and best practices for pressure ulcer prevention are described.

  6. The stress ulcer syndrome

    NARCIS (Netherlands)

    H.A. van Essen


    textabstractThe stress ulcer syndrome is described in this thesis. This syndrome is seen in patients admitted to intensive care departments or being treated in field hospitals, in disaster areas, or battle fields. Acute mucosal lesions associated with burns (Curling's ulcers) and central nervous sys

  7. Study on acute ulcerous pain in rats treated with aqueous root extract of Lonchocarpus cyanescens

    Institute of Scientific and Technical Information of China (English)

    Adegbolagun Temitope Adeoye; Adeolu Alex Adedapo; Matthew Oluwole Abatan


    Objective: To evaluate the antiulcer and analgesic effects of the aqueous root extract of Lonchocarpus cyanescens (L. cyanescens) since the plant is said to have medicinal properties. Methods: The filtrate of the aqueous root extract of the plant (100 mg/mL) was used to evaluate for antiulcer activity in 20 rats divided into five groups of four rats each, which were Groups A, B, and C that received 100, 200 and 300 mg/kg doses respectively, while Group D was served as negative control and animals of Group E received 20 mg/kg dose of ranitidine. Indomethacin at a dose of 15 mg/kg was used to induce ulcer on the day of sacrifice. For acetic writhing test (antinociception), same design was used except that Group E received 100 mg/kg dose of acetyl salicylic acid as standard drug. Abdominal contractions were induced in the animals by intraperitoneal administration of 10 mL/kg of 0.6%of acetic acid. Results: The aqueous root extract of L. cyanescens at all doses (100, 200 and 300 mg/kg) showed significant (P < 0.05) decrease in ulcer parameters compared with the negative control. The extract also produced a significant (P < 0.05) decrease in the number of writhing reflexes in treated rats compared with negative control. Conclusions: The aqueous root extract of L. cyanescens exhibited both antiulcer and analgesic effects justifying folklore claim for the health benefits of this plant.

  8. Delayed resolution of acute inflammation in ulcerative colitis is associated with elevated cytokine release downstream of TLR4.

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    Farooq Z Rahman

    Full Text Available BACKGROUND: Ulcerative colitis (UC is widely viewed as a leukocyte-mediated disorder. Although strong evidence implicates an exuberant response to microbial components in its pathogenesis, no intrinsic immune defect has been identified and the underlying pathogenic mechanisms remain obscure. METHODOLOGY/PRINCIPAL FINDINGS: The acute immune response to bacterial injection was determined in UC patients with quiescent disease and directly compared to healthy control subjects. Monocyte-derived macrophages were used to investigate bacterial recognition mechanisms in vitro. An exuberant and protracted acute inflammatory response to bacteria was evident in patients with UC, which coincides with increased systemic levels of CXCL10. Macrophages stimulated with bacteria and Toll-like receptor (TLR ligands revealed a specific defect in the TLR4 response in UC. The defect resulted in the over-expression of a number of pro-inflammatory molecules under transcriptional control of the adaptor TIR-domain containing adaptor inducing interferon-beta (TRIF. CONCLUSION: These findings highlight a dysregulated innate immune response with over-expression of molecules associated with leukocyte recruitment and activation that may eventuate in the hallmark chronic immune-mediated inflammation of UC.

  9. Mesalizine-Induced Acute Pancreatitis and Interstitial Pneumonitis in a Patient with Ulcerative Colitis. (United States)

    Chung, Min Jae; Lee, Jae Hee; Moon, Kyung Rye


    Ulcerative colitis (UC) is a chronic idiopathic inflammatory bowel disease. Mesalizine for the first-line therapy of UC has adverse effects include pancreatitis, pneumonia and pericarditis. UC complicated by two coexisting conditions, however, is very rare. Moreover, drug-related pulmonary toxicity is particularly rare. An 11-year-old male patient was hospitalized for recurring upper abdominal pain after meals with vomiting, hematochezia and exertional dyspnea developing at 2 weeks of mesalizine therapy for UC. The serum level of lipase was elevated. Chest X-ray and thorax computed tomography showed interstitial pneumonitis. Mesalizine was discontinued and steroid therapy was initiated. Five days after admission, symptoms were resolved and mesalizine was resumed after a drop in amylase and lipase level. Symptoms returned the following day, however, accompanied by increased the serum levels of amylase and lipase. Mesalizine was discontinued again and recurring symptoms rapidly improved.

  10. Treatment of Acute Gastric Ulcer Perforation%胃十二指肠溃疡急性穿孔的治疗体会

    Institute of Scientific and Technical Information of China (English)



    Objective To Dinvestigate the clinical treatment of acute gastric ulcer perforation experience. Methods A retrospective analysis of February 2013 to August 36 cases in our hospital patients with acute gastric ulcer perforation. Results 32 cases of simple suture, surgical lesions localized three cases, one case of gastrectomy. There were no blood transfusions, no complications. Conclusion Surgery remains the treatment of acute gastric ulcer perforation effective method, should be early diagnosis, early surgery for perforated shorter atypical symptoms should be closely observed.%目的:探讨胃十二指肠溃疡急性穿孔的临床治疗体会。方法回顾性分析2013年2月~8月我院收治的36例胃十二指肠溃疡急性穿孔患者。结果单纯缝合修补32例,病灶局部切除缝合3例,1例胃大部分切除。术中无患者输血,无并发症发生。结论外科手术仍然是治疗胃十二指肠溃疡急性穿孔行之有效的方法,应早诊断、早手术,对穿孔时间短症状不典型者应严密观察。

  11. The proportion of distal fibula Salter-Harris type I epiphyseal fracture in the paediatric population with acute ankle injury

    DEFF Research Database (Denmark)

    Hofsli, Mikael; Torfing, Trine; Al-Aubaidi, Zaid


    Ankle injuries are common among the paediatric population. There are few prospective studies utilizing MRI to diagnose a clinically suspected Salter-Harris type I of the distal fibula (SH1FDF). The aim of this study was to examine the proportion of clinically suspected SH1FDF in children. All...

  12. [Prognosis of the hemorrhage recurrence in the patients suffering from acute gastroduodenal ulcer bleeding]. (United States)

    Iaroshenko, E A; Didenko, V I; Tsipko, V I; Grabchuk, V N; Cherednichenko, E I; Bendetskiĭ, A M; Pisareva, N N; Gasparian, N G


    The prognostication method for the hemorrhage recurrence, permitting to estimate the risk of its occurrence and to prescribe an adequate antirecurrence treatment, was proposed. Among numerous predictors of recurrence the most significant clinical, endoscopic and laboratory factors were selected to raise the prognostication precision. Depending on therisk degree of a recurrent hemorrhage, different methods of treatment were prescribed to the patients. The proposed method was applied in 112 patients, suffering ulcer gastroduodenal hemorrhage. The hemorrhage recurrence have had occurred in 45 (43.3%) of them, in 5 (4.46%)--operative intervention was conducted, using organpreserving methods. General lethality have had constituted 0.89%, postoperative one in a control group--7.14%, and in the main all the patients were alive. The method proposed permits with a high precision to prognosticate and to determine effective tactics of treatment. Taking into account the additional factors of risk raises the prognosis precision and permits to prescribe antihelicobacter therapy and the proton pump inhibirors in a rational dosage soundly.

  13. Cameron ulcers: An atypical source for a massive upper gastrointestinal bleed

    Institute of Scientific and Technical Information of China (English)

    Samir Kapadia; Sophia Jagroop; Atul Kumar


    Cameron lesions represent linear gastric erosions and ulcers on the crests of mucosal folds in the distal neck of a hiatal hernia (HH).Such lesions may be found in upto 50% of endoscopies performed for another indication.Though typically asymptomatic,these may rarely present as acute,severe upper gastrointestinal bleed (GIB).The aim is to report a case of a non-anemic 87-year-old female with history of HH and atrial fibrillation who presented with hematemesis and melena resulting in hypovolemic shock.Repeat esophagogastroduodenoscopy was required to identify multiple Cameron ulcers as the source.Endoscopy in a patient with HH should involve meticulous visualization of hernia neck and surrounding mucosa.Cameron ulcers should be considered in all patients with severe,acute GIB and especially in those with known HH with or without chronic anemia.

  14. [A multicenter clinical trial. Zinc acexamate versus famotidine in the treatment of acute duodenal ulcer. Study Group of Zinc acexamate (new UP doses)]. (United States)

    García-Plaza, A; Arenas, J I; Belda, O; Diago, A; Domínguez, A; Fernández, C; Martín, L; Pallarés, A; Rodrigo, L; de la Santa, J w


    A multicentric double-blind trial comparing 600 mg/d of Zinc Acexamate (ACZ) and 40 mg/d of Famotidine (FMT) in the short term treatment of acute duodenal ulcer included 199 patients, diagnosed by endoscopy. One-hundred and five patients received ACZ and 94 FMT, during four weeks. A clinical control took place at two weeks and a second clinical and endoscopic control at the end of the treatment (4 weeks). Complete cicatrization of the ulcer was observed in 56.5% of patients on ACZ and in 69.5% of patients of FMT (N.S.). A reduction of more than 50% of the ulcer diameter was recorded in 78.8% of the ACZ group and in 79.9% of the FMT group. Alcohol and smoking did not influence the results. Both treatments were equally effective in the disappearance of symptoms. The incidence of adverse reactions was very low in both groups (< 5%) and no patient dropped from the trial for this reason. In conclusion, a dosage of 600 mg/d of ACZ has shown to be as effective as 40 mg/d of FMT in the healing of duodenal ulcer.

  15. Role of nitric oxide in the impairment of circular muscle contractility of distended, uninflamed mid-colon in TNBS-induced acute distal colitis in rats

    Institute of Scientific and Technical Information of China (English)

    Luciano Onori; Giovanni Latella; Annalisa Aggio; Simona D'Alo'; Paola Muzi; Maria Grazia Cifone; Gabriella Mellillo; Rachele Ciccocioppo; Gennaro Taddei; Giuseppe Frieri


    AIM: To evaluate the role of nitric oxide (NO) in the motor disorders of the dilated uninflamed mid-colon (DUMC)from trinitrobenzene sulfonic acid (TNBS)-induced acute distal colitis in rats.METHODS: Colitis was induced in male Sprague-Dawley rats by a single intracolonic administration of TNBS.Control rats received an enema of 0.9% saline. The rats were killed 48 h after TNBS or saline administration.Macroscopic and histologic lesions of the colon were evaluated. Myeloperoxidase (MPO) and nitric oxide synthase (NOS) activity were measured on the colonic tissue. In TNBS rats, we evaluated spontaneous and evoked contractile activity in circular muscle strips derived from DUMC in comparison to the same colonic segment of control rats, both in the presence and in the absence of a non-selective NOS isoforms inhibitor N-nitro-Larginine (L-NNA). Pharmacological characterization of electric field stimulation (EFS)-evoked contractile responses was also performed.RESULTS: In TNBS rats, the distal colon showed severe histological lesions and a high MPO activity, while the DUMC exhibited normal histology and MPO activity.Constitutive NOS activity was similar in TNBS and control rats, whereas inducible NOS activity was significantly increased only in the injured distal colon of TNBS rats.Isometrically recorded mechanical activity of circular muscle strips from DUMC of TNBS rats showed a marked reduction of the force and frequency of spontaneous contractions compared to controls, as well as of the contractile responses to a contracting stimulus. In the presence of L-NNA, the contractile activity and responses displayed a significantly greater enhancement compared to controls. The pharmacological characterization of EFS contractile responses showed that a cooperative-like interaction between cholinergic muscarinic and tachykinergic neurokinin 1 and 2 receptors mediated transmission in DUMC of TNBS rats vs a simple additive interaction in controls.CONCLUSION: The results of this

  16. Stomach ulcer (United States)

    ... the acid and enzymes by a mucous lining. Ulcers are caused when there is an imbalance between ... protect the lining of the stomach. Symptoms of ulcers may include bleeding. On rare occasions, an ulcer ...

  17. Pressure ulcer prevalence, use of preventive measures, and mortality risk in an acute care population: a quality improvement project. (United States)

    Leijon, Siv; Bergh, Ingrid; Terstappen, Karin


    The primary aim of this quality improvement project was to determine pressure prevalence, risk of mortality, and use of preventive measures in a group of hospitalized patients. Two hundred fifty-eight patients recruited from Skaraborg Hospital in Sweden were assessed. A 1-day point prevalence study was carried out using a protocol advocated by the European PU Advisory Panel. Patients' age, gender, severity of PU (grades I-IV), anatomical location of PU, and use of preventive measures were recorded. The Swedish language version of the Modified Norton Scale was used for PU risk assessment. Data were collected by nurses trained according to the Web-based training: PU classification, "ePuclas2." After 21 months, a retrospective audit of the electronic records for patients identified with pressure ulcers was completed. The point prevalence of pressure ulcers was 23%. The total number of ulcers was 85, most were grade 1 (n = 39). The most common locations were the sacrum (n = 15) and the heel (n = 10). Three percent of patients (n = 9) had been assessed during their current hospital stay using a risk assessment tool. There was a statistically significant relationship between pressure ulcer occurrence and a low total score on the Modified Norton Scale. The patients' ages correlated significantly to the presence of a pressure ulcer. Patients with a pressure ulcer had a 3.6-fold increased risk of dying within 21 months, as compared with those without a pressure ulcer. Based on results from this quality improvement project, we recommend routine pressure ulcer risk assessment for all patients managed in a hospital setting such as ours. We further recommend that particular attention should be given to older and frail patients who are at higher risk for pressure ulcer occurrence and mortality.

  18. Peptic Ulcer (United States)

    A peptic ulcer is a sore in the lining of your stomach or your duodenum, the first part of your small ... and goes for several days or weeks Peptic ulcers happen when the acids that help you digest ...

  19. Peptic ulcer (United States)

    ... result may be: Swollen and inflamed tissue, called ( gastritis ) An ulcer Watch this video about: Stomach ulcer ... PA: Elsevier Saunders; 2016:chap 51. Read More Gastritis Intestinal obstruction Peritonitis Zollinger-Ellison syndrome Patient Instructions ...

  20. Ulcerative Colitis (United States)

    ... or worsen symptoms. Who is more likely to develop ulcerative colitis? Ulcerative colitis can occur in people ... any age. However, it is more likely to develop in people between the ages of 15 and ...

  1. Are proton pump inhibitors the first choice for acute treatment of gastric ulcers? A meta analysis of randomized clinical trials

    Directory of Open Access Journals (Sweden)

    Ward Alexandra


    Full Text Available Abstract Background Gastric ulcers are a frequent problem in the United States. Proton pump inhibitors have been shown to increase healing rates and improve clinical symptoms. The objective of this study is to compare gastric ulcer healing rates for patients treated with a proton pump inhibitor (PPI (omeprazole, rabeprazole, pantoprazole, or lansoprazole, an histamine 2- receptor antagonist (ranitidine or placebo. Methods A literature search was conducted to identify randomized, controlled clinical trials that included a PPI in at least one treatment arm and assessed the gastric ulcer healing rates endoscopically. The healing rates were estimated for each treatment at specific time points, and Rate Ratios (RR and 95% confidence intervals (CI were estimated for each trial. Results Sixteen trials met the inclusion criteria: four compared a PPI versus placebo, nine compared a PPI versus ranitidine (no trials of rabeprazole versus ranitidine met the inclusion criteria, and three compared a newer PPI (lansoprazole, pantoprazole or rabeprazole versus omeprazole. In relation to ranitidine, the pooled RR of PPIs (lansoprazole, omeprazole and pantoprazole was 1.33 (95% CI 1.24 to 1.42 at four weeks. In each trial, greater improvement in the studied clinical symptoms was found with the newer PPIs (rabeprazole, pantoprazole and lansoprazole when compared to omeprazole. Conclusion In this study treatment with PPIs resulted in higher healing rates than ranitidine or placebo. This evidence suggests that the first choice for gastric ulcer treatment for the greater relief of symptoms is one of the newer PPIs.

  2. Distal clavicle edema; Distales Klavikulaoedem

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    Vahlensieck, M.; Schmittke, I. [Radiologie Haydnhaus, Bonn (Germany); Schmidt, H.M. [Universitaet Bonn (Germany). Anatomisches Institut


    Distal clavicle marrow edema: frequency, MRI in the early stage and macroscopic correlation to the bone marrow distribution and to evaluate frequency and diagnostic criteria of a posttraumatic clavicula disorder with an edema pattern on MRI. An additional macroscopic study of the clavicle should elucidate anatomic pecularities which could explain the reaction of the distal clavicle. 285 MRI of traumatized patients were analyzed for edema pattern of the distal clavicle. Pattern A edema within the clavicle and the acromion was distinguished from pattern B edema within the clavicle only. Dissection in 20 cadavers should reveal vascular pecularities and the bone marrow distribution within clavicle and acromion or vascular pecularities. In 38 patients (13,3%) we found edema within the distal clavicle. Pattern A was found in 28 (9,8%) and pattern B in 10 patients (3,5%). Pattern A was usually associated with swelling of the AC joint (27 out of 28). Other injuries were not evident. 18 cadavers showed hematopoetic marrow within the distal clavicle and fatty marrow within the acromion. The distale clavicle can frequently react with edema pattern after trauma without evidence for another injury. Distinguish in cases with and cases without synovitis of the AC joint could have impact on therapy. A peculier vascular supply of the distal clavicle could not be found. (orig.) [German] Bestimmung der Haeufigkeit und diagnostischer Kriterien einer posttraumatischen Klavikulaerkrankung, die mit einem MR-tomographischen Oedemmuster auffaellt. Makroskopische Besonderheiten der Markhoehle sollten gesucht werden, die die besondere Reaktionsform der distalen Klavikula mit erklaeren koennten. 285 Patienten mit traumaassoziierten, zeitversetzt nach dem Unfallereignis bestehenden Schulterbeschwerden, wurden auf MR-tomographische Oedemmuster in der distalen Klavikula untersucht. Das Oedemmuster wurde in ''Klavikula allein'' (Muster B) und ''mit Beteiligung des

  3. Genome Wide Mapping of NR4A Binding Reveals Cooperativity with ETS Factors to Promote Epigenetic Activation of Distal Enhancers in Acute Myeloid Leukemia Cells.

    Directory of Open Access Journals (Sweden)

    Ryan P Duren

    Full Text Available Members of the NR4A subfamily of orphan nuclear receptors regulate cell fate decisions via both genomic and non-genomic mechanisms in a cell and tissue selective manner. NR4As play a key role in maintenance of hematopoietic stem cell homeostasis and are critical tumor suppressors of acute myeloid leukemia (AML. Expression of NR4As is broadly silenced in leukemia initiating cell enriched populations from human patients relative to normal hematopoietic stem/progenitor cells. Rescue of NR4A expression in human AML cells inhibits proliferation and reprograms AML gene signatures via transcriptional mechanisms that remain to be elucidated. By intersecting an acutely regulated NR4A1 dependent transcriptional profile with genome wide NR4A binding distribution, we now identify an NR4A targetome of 685 genes that are directly regulated by NR4A1. We show that NR4As regulate gene transcription primarily through interaction with distal enhancers that are co-enriched for NR4A1 and ETS transcription factor motifs. Using a subset of NR4A activated genes, we demonstrate that the ETS factors ERG and FLI-1 are required for activation of NR4A bound enhancers and NR4A target gene induction. NR4A1 dependent recruitment of ERG and FLI-1 promotes binding of p300 histone acetyltransferase to epigenetically activate NR4A bound enhancers via acetylation at histone H3K27. These findings disclose novel epigenetic mechanisms by which NR4As and ETS factors cooperate to drive NR4A dependent gene transcription in human AML cells.

  4. Genome Wide Mapping of NR4A Binding Reveals Cooperativity with ETS Factors to Promote Epigenetic Activation of Distal Enhancers in Acute Myeloid Leukemia Cells. (United States)

    Duren, Ryan P; Boudreaux, Seth P; Conneely, Orla M


    Members of the NR4A subfamily of orphan nuclear receptors regulate cell fate decisions via both genomic and non-genomic mechanisms in a cell and tissue selective manner. NR4As play a key role in maintenance of hematopoietic stem cell homeostasis and are critical tumor suppressors of acute myeloid leukemia (AML). Expression of NR4As is broadly silenced in leukemia initiating cell enriched populations from human patients relative to normal hematopoietic stem/progenitor cells. Rescue of NR4A expression in human AML cells inhibits proliferation and reprograms AML gene signatures via transcriptional mechanisms that remain to be elucidated. By intersecting an acutely regulated NR4A1 dependent transcriptional profile with genome wide NR4A binding distribution, we now identify an NR4A targetome of 685 genes that are directly regulated by NR4A1. We show that NR4As regulate gene transcription primarily through interaction with distal enhancers that are co-enriched for NR4A1 and ETS transcription factor motifs. Using a subset of NR4A activated genes, we demonstrate that the ETS factors ERG and FLI-1 are required for activation of NR4A bound enhancers and NR4A target gene induction. NR4A1 dependent recruitment of ERG and FLI-1 promotes binding of p300 histone acetyltransferase to epigenetically activate NR4A bound enhancers via acetylation at histone H3K27. These findings disclose novel epigenetic mechanisms by which NR4As and ETS factors cooperate to drive NR4A dependent gene transcription in human AML cells.

  5. Acute cytotoxicity and apoptotic effects after l-Pam exposure in different cocultures of the proximal and distal respiratory system. (United States)

    Pohl, Christine; Hofmann, Helene; Moisch, Michaela; Papritz, Mirko; Iris Hermanns, M; Dei-Anang, Jasmin; Mayer, Eckhard; Kehe, Kai; Kirkpatrick, Charles James


    Sulphur and nitrogen mustard are strong alkylating agents which can cause after inhalation acute lung injury in the larynx, trachea and large bronchi and can lead to alveolar edema. In our study we tested the N-Lost l-Phenylalanine Mustard (l-Pam). Therefore we seeded the alveolar type II cell line NCI H441 on the upper membrane of a Transwell filter plate and the endothelial cell line ISO-Has-1 on the lower side of the membrane for the alveolar model and combined the human bronchial explant-outgrowth cells and fibroblasts in the bronchial model and exposed both models with various concentrations of l-Pam. Treatment with l-Pam led to a concentration-dependent decrease of the transepithelial electrical resistance and therefore impairment of barrier function in both models. Changes in morphology could be observed. In the bronchial model damaged cell organelles whereas in the alveolar model a widening of intercellular spaces could be seen. Loss of cell-matrix adhesion as well as apoptotic and necrotic cell death could be demonstrated. In conclusion, treatment with the nitrogen mustard in the coculture models showed comparable results to sulphur mustard treatment and thus this model could be useful to explore similarities and differences in signal transduction pathways after treatment with both sulphur and nitrogen mustard.

  6. Outcome of Holiday and Nonholiday Admission Patients with Acute Peptic Ulcer Bleeding: A Real-World Report from Southern Taiwan

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    Tsung-Chin Wu


    Full Text Available Background. Recent findings suggest that patients admitted on the weekend with peptic ulcer bleeding might be at increased risk of adverse outcomes. However, other reports found that there was no “holiday effect.” The purpose of this study was to determine if these findings hold true for a real-life Taiwanese medical gastroenterology practice. Materials and Methods. We reviewed the medical files of hospital admissions for patients with peptic ulcer bleeding who received initial endoscopic hemostasis between January 2009 and March 2011. A total of 744 patients were enrolled (nonholiday group, n=615; holiday group, n=129 after applying strict exclusion criteria. Holidays were defined as weekends and national holidays in Taiwan. Results. Our results showed that there was no significant difference in baseline characteristics between the two groups. We also observed that, compared to the nonholiday group, patients in the holiday group received earlier endoscopy treatment (12.20 hours versus 16.68 hours, P=0.005, needed less transfused blood (4.8 units versus 6.6 units, P=0.02, shifted from intravenous to oral proton-pump inhibitors (PPIs more quickly (5.3 days versus 6.9 days, P=0.05, and had shorter hospital stays (13.05 days versus 17.36 days, P=0.005. In the holiday and nonholiday groups, the rebleeding rates were 17.8% and 23.41% (P=0.167, the mortality rates were 11.63% versus 13.66% (P=0.537, and surgery was required in 2.11% versus 4.66% (P=0.093, respectively. Conclusions. Patients who presented with peptic ulcer bleeding on holidays did not experience delayed endoscopy or increased adverse outcomes. In fact, patients who received endoscopic hemostasis on the holiday had shorter waiting times, needed less transfused blood, switched to oral PPIs quicker, and experienced shorter hospital stays.

  7. Vernal ulcer


    Srinivasan M.; Srinivasan S


    Vernal ulcer is a rare entity not reported in Indian ophthalmic literature. 76 patients in the age group ranging from 3-43 years diagnosed as having vernal conjunctivitis had been referred from general ophthalmology clinic to cornea service of the same institute during 1988-89. Among them 60 were males and 16 were females. 55 of the 76 patients had corneal involvement in the form of vernal keratitis or vernal ulcer. 16 had typical vernal ulcers. vernal ulcer was found more in the palpebral ty...

  8. Villous adenoma of the distal appendix. (United States)

    Taylor, J V; Thomas, M G; Kelly, S; Sutton, R


    Villous adenoma confined to the distal appendix has not been previously reported in conjunction with acute apendicitis. The presence of an adenoma indicates a need for further investigation due to an association with neoplasia elsewhere.

  9. [Peripheral ulcerative keratitis]. (United States)

    Stamate, Alina-cristina; Avram, Corina Ioana; Malciolu, R; Oprea, S; Zemba, M


    Ulcerative keratitis is frequently associated with collagen vascular diseases and presents a predilection for peripheral corneal localization, due to the distinct morphologic and immunologic features of the limbal conjunctiva, which provides access for the circulating immune complexes to the peripheral cornea via the capillary network. Deposition of immune complexes in the terminal ends of limbal vessels initiates an immune-mediated vasculitis process, with inflammatory cells and mediators involvement by alteration of the vascular permeability. Peripheral ulcerative keratitis generally correlates with exacerbations of the background autoimmune systemic disease. Associated sceritis, specially the necrotizing form, is usually observed in severe cases, which may evolve in corneal perforation and loss of vision. Although the first-line of treatment in acute phases is represented by systemic administration of corticosteroids, immunosuppressive and cytotoxic agents are necessary for the treatment of peripheral ulcerative keratitis associated with systemic diseases.

  10. Genital ulcers: it is not always simplex …. (United States)

    Haidari, G; MacMahon, E; Tong, C Y W; White, J A


    Patients with vulval aphthae, also termed Lipschütz ulcers, often present to genitourinary medicine clinics. Typically, these ulcers present as acute, painful, vulval ulcers in young women and adolescents. The aetiology is unknown, and often these ulcers are accompanied by flu-like symptoms. Previous case reports have linked such lesions to acute viral infections such as Epstein-Barr virus, cytomegalovirus and influenza A. We report the first case of influenza B virus and adenovirus infections associated with this presentation.

  11. Recording pressure ulcer risk assessment and incidence. (United States)

    Plaskitt, Anne; Heywood, Nicola; Arrowsmith, Michaela


    This article reports on the introduction of an innovative computer-based system developed to record and report pressure ulcer risk and incidence at an acute NHS trust. The system was introduced to ensure that all patients have an early pressure ulcer risk assessment, which prompts staff to initiate appropriate management if a pressure ulcer is detected, thereby preventing further patient harm. Initial findings suggest that this electronic process has helped to improve the timeliness and accuracy of data on pressure ulcer risk and incidence. In addition, it has resulted in a reduced number of reported hospital-acquired pressure ulcers.

  12. [Do proton pump inhibitors after endoscopic control of acute ulcer hemorrhage have an advantage over H2 receptor antagonists?]. (United States)

    Prassler, R; Hendrich, H; Barnert, J; Richter, G; Fleischmann, R; Wienbeck, M


    During a two year period (1992-1993) we investigated whether or not, after endoscopic therapy of bleeding ulcers, the suppression of gastric acid secretion with an administration of a proton pump blocker (Omeprazol) is more effective than the administration of H2-receptor antagonist (Ranitidin) with respect to prevention of recurrent bleeding episodes, frequency of surgical intervention and mortality. 106 patients (64 men, 42 women) were treated with the proton pump blocker and 126 patients (82 men, 44 women) received the H2-receptor antagonist. Patients were treated either with an initial dose of 80 mg Omeprazol followed by 3 x 40 mg Omeprazol i.v. or with a daily dose of 3 mg/kg body weight Ranitidin i.v. No significant differences could be detected between the two treatment regimes with respect to the parameters mentioned above. Rebleeding which could be controlled by endoscopic hemostasis occurred in 19.8% vs. 17.5% (Omeprazol/Ranitidin) of patients. Surgical intervention because of rebleeding was necessary on 8.5% vs. 8.7% of the patients. Mortality due to hemorrhage was 5.7% vs. 4.0%. From these results we conclude that, following endoscopic hemostasis of bleeding ulcers, Omeprazol has no advantage over Ranitidin using our dosage regimes.

  13. Vernal ulcer

    Directory of Open Access Journals (Sweden)

    Srinivasan M


    Full Text Available Vernal ulcer is a rare entity not reported in Indian ophthalmic literature. 76 patients in the age group ranging from 3-43 years diagnosed as having vernal conjunctivitis had been referred from general ophthalmology clinic to cornea service of the same institute during 1988-89. Among them 60 were males and 16 were females. 55 of the 76 patients had corneal involvement in the form of vernal keratitis or vernal ulcer. 16 had typical vernal ulcers. vernal ulcer was found more in the palpebral type of vernal conjunctivitis and affects males more frequently. One patient had an inferior vernal ulcer. It also occurred in the bulbar type of spring catarrh.

  14. Ebrotidine versus ranitidine in the treatment of acute duodenal ulcer. A multicentre, randomized, double-blind, controlled clinical trial. (United States)

    Matov, V; Metchkov, G; Krastev, Z; Tchernev, K; Mitova, R; Márquez, M; Torres, J; Herrero, E; Fillat, O; Ortiz, J A


    A total of 478 patients with endoscopically confirmed duodenal ulcer entered this randomized, parallel, double-blind trial. Patients were randomly assigned to receive ebrotidine (N-[(E)-[[2-[[[2-[(diaminomethylene)amino]- 4-thiazolyl]methyl]thio]ethyl]amino]methylene]-4-bromo-benzenesulfona mid e, CAS 100981-43-9, FI-3542) 400 mg or ranitidine 300 mg tablets (4:1) respectively, administered in single evening doses. Endoscopy, clinical examination and symptom assessment were performed at baseline and at weeks 4 and 8. Safety evaluations including laboratory tests, treatment compliance and antacid consumption checks were conducted at the beginning and/or at the 4 and 8 week visits. Patients whose ulcer showed endoscopic healing at the 4-week control left the study. Both groups were matched in all parameters studied. The healing rates at 4 weeks were 76.4% and 75.3% for ebrotidine and ranitidine respectively, while at 8 weeks the final rates were 95% and 91.8% respectively. Accompanying symptoms disappeared rapidly and the patients returned to normal. Smoking proved to be a highly significant negative risk factor, since healing rates were 83.4% and 71.2% at 4 weeks and 97.4% and 92.3% at 8 weeks in non-smokers and smokers respectively (p = 0.0046). Smokers treated with ranitidine showed significantly lower final healing rates than non-smokers (86% vs 100%; p = 0.0358), while the healing rates among patients treated with ebrotidine were similar regardless of whether they were smokers or not (93.9% and 96.7% N.S.). Ebrotidine (94%) proved to be more effective than ranitidine (86%) in smokers with higher healing rates (p < 0.05). Alcohol intake showed no significant relationship with the healing rates. Both drugs demonstrated an excellent safety. There were no changes in blood parameters, and no significant adverse events were reported.

  15. Treatment progress of acute perforation of gastroduodenal ulcer%胃十二指肠溃疡急性穿孔治疗进展

    Institute of Scientific and Technical Information of China (English)



    In this paper,the author analyzes the clinical treatment of acute perforation of gastroduodenal ulcer in recent years to explore the effective treatment way.Acute perforation of gastroduodenal ulcer has conservative treatment and operation treatment. The operation treatment has laparoscopy and laparotomy perforation suture technique,subtotal gastrectomy and gastric neurectomy. The clinical scholars are more inclined to minimally invasive class laparoscopic simple repair.The conservative treatment is also favored by patients and doctors.The subtotal gastrectomy is an effective complement.Laparoscopic subtotal gastrectomy has great development prospect.but no matter which kind of treatment is choosed,we must strictly grasp the indications,and combine with drug therapy,which can improve the cure rate.%目的:本文分析了近年来胃十二指肠溃疡急性穿孔的临床治疗方法,探讨有效的治疗方式。胃十二指肠溃疡急性穿孔有保守治疗和手术治疗,手术治疗有腹腔镜和开腹穿孔缝合术、胃大部切除术和迷走神经切断术。临床学者更倾向于微创类的腹腔镜单纯修补术,保守治疗也受到患者和医生的青睐,胃大部切除术是一种有效的补充,腹腔镜胃大部切除术也有较大的发展前景;但不管选择哪种治疗方式,都必须严格把握适应证,并结合有效的药物治疗,才能真正提高治愈率。

  16. Three cases of Lipschutz vulval ulceration. (United States)

    Alés-Fernández, M; Rodríguez-Pichardo, A; García-Bravo, B; Ferrándiz-Pulido, L; Camacho-Martínez, F M


    A Lipschütz ulcer or 'ulcus vulvae acutum' is an acute simple ulceration of the vulva or vagina of non-venereal origin which can be associated with lymphadenopathy. Three cases are described with accompanying clinical photographs. Two cases refer to adolescents, one an infant, all without any history of sexual contact. The cases serve to illustrate a little known but potentially important differential diagnosis of vulval ulceration.

  17. Marjolin's Ulcer. A Case Report

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    Sergio Morales Piñeiro


    Full Text Available Marjolin's ulcer is rare and aggressive cutaneous malignancy that develops in previously traumatized or chronically inflamed skin. We present the case of a 43-year-old white man suffering from an exophytic bleeding ulcerated lesion on the distal third of the left leg where he already had a large scar from a compound fracture of the tibia and fibula complicated with chronic osteomyelitis. Surgical excision and biopsy were performed, showing a squamous cell carcinoma consistent with Marjolin's ulcer. We decided to present this case given the rare occurrence of the disease. We concluded that patients with this type of lesion should be subject to periodic examinations to prevent or treat potential recurrences.

  18. Ulcerative colitis - discharge (United States)

    Inflammatory bowel disease - ulcerative colitis - discharge; Ulcerative proctitis - discharge; Colitis - discharge ... were in the hospital because you have ulcerative colitis. This is a swelling of the inner lining ...

  19. Is herpes simplex virus associated with peptic ulcer disease?


    Löhr, J M; Nelson, J. A.; Oldstone, M B


    To test the hypothesis that herpes simplex virus type 1 (HSV-1) may be associated with peptic ulcer disease, we examined ulcerative lesions of the distal stomach and proximal duodenum for the presence of nucleic acids and antibodies specific for HSV-1. Utilizing in situ hybridization, immunocytochemistry, and polymerase chain reaction with sequencing, gastric or duodenal tissues from 4 of 22 patients (18%) with documented peptic ulcer disease demonstrated the presence of both specific HSV-1 n...

  20. The treatment of acute gastric ulcer perforation most of gastric resection%急性胃溃疡穿孔行胃大部切除术治疗的临床研究

    Institute of Scientific and Technical Information of China (English)

    王明会; 郭爱芬


    Objective Analysis of stomach was the clinical curative effect of treatment of acute gastric ulcer perforation. Methods Selected from December 2012 to October 2014 received 80 cases of patients with acute gastric ulcer perforation, all use most of gastric resection on the treatment, and analyze the treatment effect. Results After most of gastric resection in patients with acute gastric ulcer perforation, no death phenomenon; Average treatment time was (163.7 + / - 18.2) min. 66.25% of the patients after the operation, restore to Ⅰ Ⅱon 23.75% of the patients recover an 10% of the patients recoverⅢlevel; Early postoperative concurrent stomach bleeding (3.75%of the patients, and 3 cases with infection after the operation. Conclusions To implement most of gastric resection treatment of patients with acute ulcer perforation, can be fundamentally solved perforated ulcer disease, surgical treatment effect is remarkable, less postoperative complications, mortality is low, worth clinical promotion.%目的:分析胃大部切除术治疗急性胃溃疡穿孔的临床疗效。方法:选取我院2012年12月~2014年10月接收的急性胃溃疡穿孔患者80例,均对其使用胃大部切除术进行治疗,并对治疗效果进行分析。结果:急性胃溃疡穿孔患者进行胃大部切除术后,无死亡现象;患者平均治疗时间为(163.7±18.2)m i n;手术后66.25%的患者恢复为Ⅰ级,23.75%的患者恢复为Ⅱ级,10%的患者恢复为Ⅲ级;术后早期3.75%的患者出现并发胃出血症状,3例患者手术后感染。结论:实施胃大部切除术对急性溃疡穿孔患者进行治疗,可以根本解决溃疡穿孔病症,手术治疗效果显著,术后并发症少,死亡率低,值得临床进行推广。

  1. [Radical operative treatment of perforative gastroduodenal ulcer disease]. (United States)

    Gostishchev, V K; Evseev, M A; Golovin, R A


    Data of 363 patients operated on for perforated gastric or duodenal ulcers were analyzed. Immediate and follow-up results were obtained after simple suture plication, Jadd's ulcer excision combined with stem vagotomy and after distal gastric resection. Predictors of the unfavourable outcome were determined. These are: Mannheim peritonitis index >20, surgical risk of IV-V grade, signs of multiple organ failure and symptomatic character of the ulcer. The comparison of long-term results revealed that patients after suture plication experienced the ulcer recurrence in 78,4% and necessity of further operation occurred in 21,5%. Every third patient after stem vagotomy experienced postvagotomic disorders and ulcer recurrence. Primary gastric resection demonstrated the best long-term results concerning ulcer disease. The algorithm of treatment modalities of the perforative ulcer desease was worked. The algorithm is based on stage-by stage determination of indications and contraindications to gastric resection.

  2. Perforated Peptic Ulcer: new insights

    NARCIS (Netherlands)

    M.J.O.E. Bertleff (Marietta)


    textabstractMuch has been written on perforated peptic ulcer (PPU) during the last hundred years. In 1500, when necropsies were first allowed, often a small hole was found in the anterior wall of the stomach, giving an explanation for symptoms of acute abdominal pain, nausea, vomiting which often le

  3. Anti-ulcer potential of Oxystelma esculentum

    Directory of Open Access Journals (Sweden)

    Devang J Pandya


    Full Text Available Oxystelma esculentum is a perennial twiner growing near water-logged areas in the Indian subcontinent. It is used traditionally in stomach ulcers. The present work deals with the investigation of anti-ulcer potential of O. esculentum. The plant was successively extracted with solvents of varying polarities, which served as the test extracts. Anti-ulcer effect was checked in Wistar rats using aspirin- and ethanol-induced acute ulcer models. The petroleum ether extract was found to possess the most effective anti-ulcer activity. This proves the traditional claim of the plant as an anti-ulcer drug. Phytochemical screening of this extract revealed the presence of important classes of compounds like cardenolides, flavonoids, phenolics, sterols and triterpenoids. This bioactivity-guided phytochemical screening can guide further therapeutic investigations and isolation of pharmacologically active compounds from Oxystelma esculentum.

  4. Healthcare professionals’ views of the use and administration of two salvage therapy drugs for acute ulcerative colitis: a nested qualitative study within the CONSTRUCT trial (United States)

    Clement, Clare; Rapport, Frances; Seagrove, Anne; Alrubaiy, Laith; Williams, John


    Objectives Insight into healthcare professionals’ views and experiences of the use of ciclosporin and infliximab as salvage therapies for acute ulcerative colitis (UC) and how this may affect participation in a comparison trial is lacking. The study aimed to capture views and opinions of healthcare professionals about the two drugs within the CONSTRUCT trial. Design An interview-based qualitative study using Framework Analysis embedded within an open-label, pragmatic randomised trial. Setting National Health Service Health Boards and Trusts, including large teaching and district hospitals in England, Scotland and Wales. Participants Principal Investigators (PIs) for trial sites (who were all consultant gastroenterologists) and nurses responsible for administering and monitoring the salvage therapy drugs across trial sites. 15 PIs and 8 nurses recruited from a range of sites stratified by site recruitment rates were interviewed. Results Interviews revealed that professionals made judgements regarding the salvage therapies largely based on experience of giving the two drugs and perceptions of effectiveness and adverse side effects. A clear preference for infliximab among nurses was revealed, largely based on experiences of administration and drug handling, with some doctors strongly favouring infliximab based on experience of prescribing the drug as well as patient views and the existing evidence base. Most doctors were more equivocal, and all were prepared to suspend preferences and wait for evidence of effectiveness and safety from the CONSTRUCT trial. PIs also questioned guidelines around drug use and restrictions placed on personal autonomy in delivering best patient care. Conclusions Findings highlight healthcare professionals’ preference for the salvage treatment, infliximab in treating steroid-resistant UC, largely based on resource intensive nursing requirements of intravenous administration of ciclosporin. Not all doctors expressed this preference, being

  5. Peptic Ulcers (United States)

    ... ulcer. H. pylori infection is usually contracted in childhood (perhaps through food, water, or close contact with an infected individual), but most people won't have any symptoms until they're older. Although H. pylori ... in childhood, it can cause gastritis (irritation and inflammation of ...

  6. Nursing Observation of Peptic Ulcer Perforation Acute Perioperative%探析消化性溃疡急性穿孔围手术期的护理效果观察

    Institute of Scientific and Technical Information of China (English)



    目的:探讨消化性溃疡急性穿孔围手术期的护理效果。方法选取本院收治的消化性溃疡急性穿孔手术患者84例,比较围手术期护理干预与常规护理的效果。结果干预组患者的并发症发生率明显低于对照组,护理满意度明显高于对照组,P<0.05,具有统计学意义。结论对消化性溃疡急性穿孔患者进行围手术期护理干预,可以有效减少术后并发症,提高患者痊愈率和治疗效果,提高患者的护理满意度,值得临床广泛应用。%Objective To investigate the acute peptic ulcer perforation effect of perioperative nursing. Methods Select our hospital with acute peptic ulcer perforation 84 cases of surgical patients, comparing perioperative nursing intervention and usual care results. Results Complications in patients in the intervention group were signiifcantly lower than the control group, Significantly higher satisfaction with care, P<0.05, statistically significant. Conclusion Patients with peptic ulcer perforation acute perioperative nursing intervention can effectively reduce postoperative complications. Improve the cure rate and treatment of patients, improve patient care and satisfaction, is worthy of wider application.

  7. Safety Analysis of Emergency Treatment of Acute Perforation of Gastric and Duodenal Ulcer%浅析胃十二指肠溃疡急性穿孔急诊治疗安全性

    Institute of Scientific and Technical Information of China (English)



    Objective Ef ect of acute perforation of gastroduodenal ulcer emergency treatment and safety observation analysis.Methods Data of selected self court in July 2012~July 2014 treated 62 cases of patients with acute perforation of gastroduodenal ulcer as the research object,randomly divided into control group and research group,control group underwent surgical treatment,traditional emergency perforation repair team line laparoscopic emergency perforation repair surgery,and the clinical data of two groups of patients were retrospectively analyzed.Results The treatment group ef ective rate was 96.77%,significantly higher than the control group treatment ef ective rate was 83.87%;And operative blood loss and operation time of the team were bet er than the control group,with significant dif erence ( <0.05).Conclusion Emergency perforation repair in laparoscopic surgery in the treatment of acute perforation of gastroduodenal ulcer curative ef ect,good safety,the incidence of complications is low,is an ef ective treatment for acute perforation of gastroduodenal ulcer.%目的对胃十二指肠溃疡急性穿孔急诊治疗的效果及安全性进行观察分析。方法资料选自我院2012年7月~2014年7月收治的胃十二指肠溃疡急性穿孔患者62例作为研究对象,随机均分为对照组及研究组,对照组行传统急诊穿孔修补手术治疗,研究组行腹腔镜急诊穿孔修补手术治疗,并对两组患者的临床资料进行回顾性分析。结果研究组治疗的有效率为96.77%,显著高于对照组治疗的有效率83.87%;且研究组手术出血量及手术时间均优于对照组,差异具有显著性(<0.05)。结论腹腔镜急诊穿孔修补手术治疗胃十二指肠溃疡急性穿孔的疗效确切,安全性好,并发症的发生率低,是胃十二指肠溃疡急性穿孔的有效治疗措施。

  8. Clinical quality indicators of venous leg ulcers

    DEFF Research Database (Denmark)

    Kjaer, Monica L; Mainz, Jan; Soernsen, Lars T


    %) were assessed for venous surgery. Distal arterial pressure was measured following initial examination in 33 of the patients (34%). All patients (100%) were prescribed compression therapy. Of the 98 patients, 11 (11%) had ulcers recur in 3 months and 72 (73%) healed in 12 months, which is in line......In the clinical setting, diagnosis and treatment of venous leg ulcers can vary considerably from patient to patient. The first step to reducing this variation is to document venous leg ulcer care through use of quantitative scientific documentation principles. This requires the development of valid...... and reliable evidence-based quality indicators of venous leg ulcer care. A Scandinavian multidisciplinary, cross-sectional panel of wound healing experts developed clinical quality indicators on the basis of scientific evidence from the literature and subsequent group nominal consensus of the panel...

  9. Once-Daily Bedtime Dose of Roxatidine and Ranitidine in Acute Duodenal Ulcer: A Combined Assessment of Acid Inhibitory Activity and Healing Rate. (United States)

    Savarino, Vincenzo; Mela, Giuseppe Sandro; Zentilin, Patrizia; Mele, Maria Raffaella; Vigneri, Sergio; Termini, Rosanna; Di Mario, Francesco; Ferrana, Marina; Malesci, Alberto; Belicchi, Monica


    This study was carried out in order to compare the antisecretory effect of a single bedtime dose of roxatidine 150 mg and ranitidine 300 mg and to assess the relationship between the degree and the duration of acid suppression and the healing rates obtained in duodenal ulcer patients treated with the above regimens. Sixty-three patients with endoscopically proven ulcer underwent 24-h gastric pH-metry on day 0, day 1, and day 28 of treatment with both roxatidine and ranitidine. Ulcer healing was checked endoscopically after 4 weeks of therapy. RESULTS: Eight patients did not complete the study, leaving 55 patients eligible for final analysis, 28 in the roxatidine group and 27 in the ranitidine group. Duodenal ulcers were healed in 24--28 (85%) patients of the former and in 22--27 (81%) patients of the latter group (p minus sign NS). Gastric pH was significantly higher (p roxatidine and ranitidine. There was also do difference between the two active treatments. The pattern of gastric acidity significantly differed (p roxatidine 150 mg and ranitidine 300 mg was able to heal more than 80% of duodenal ulcers within 4 weeks of treatment. The lack of tolerance to H2-blockers in duodenal ulcer patients contributes to this good result. The antisecretory effect of H2-antagonists is reduced in nonresponder patients with respect to responder patients and this is mainly due to an impaired control of nocturnal acidity.

  10. 小儿肱骨远端骨折严重合并症——骨筋膜室综合征%A Serious Complication of Fracture of Distal Humerus in Children-Acute Osteofaseial Compartment Syndrome

    Institute of Scientific and Technical Information of China (English)

    刘兴炎; 葛宝丰; 文益民; 甄平; 石骥


    32例小儿前臂严重骨筋膜室综合征中,除4例为骨折直接合并肱动脉程度不同损伤继发外,余下之28例均为医源性处理不当所致.基于儿童上肢功能重建的特点,有必要选择外科综合治疗.早期采用骨筋膜室彻底减压,尤其强调早期恢复神经干的血运.对5例晚期缺血性挛缩处理,采用游离吻合血管神经的腓肠肌内侧头肌皮瓣重建手及前臂功能,随访1年以上结果满意.%Thirty-two cases of acute osteofascial compartment syndrome complicated to the distal humerus fracture in chileren were treated.Of them,28 were iatrogenic lesion,others were resulted from fracture of distal humerus complicated by brachial artery injury.The reasons of iatrogenic lesion were discussed in the paper.To protect the residual function of the upper extremity,surgery is essential,In acute stage,early decompression is necessary,including release of the fibrous adhesions around blood vessels,nerves and muscles,in order to improve the blood supply of the nerves.For late sequelae,e.g.ischemic constracture of the forearm,free vascularized medial gastrocnemius muscular flap with neurovascular microsurgical anastomosis was performed.Cases follow up for more than one year showed satisfactory result.

  11. Pathogenesis of foot ulcers and the need for offloading. (United States)

    Rathur, H M; Boulton, A J


    Diabetic foot ulceration represents a major medical, social and economic problem all over the world. While more than 5% of diabetic patients have a history of foot ulceration, the cumulative lifetime incidence may be as high as 15%. Ethnic differences exist in both ulcer and amputation incidences. Foot ulceration results from the interaction of several contributory factors, the most important of which is neuropathy. The use of the total-contact cast is demonstrated in the treatment of plantar neuropathic ulcers. Histological evidence suggests that pressure relief results in chronic foot ulcers changing their morphological appearance by displaying some features of an acute wound. Thus, repetitive stresses on the insensate foot appear to play a major role in maintaining ulcer chronicity. It is hoped that research activity in foot disease will ultimately result in fewer ulcers and less amputation in diabetes.

  12. Management of radionecrosis of the vulva and distal vagina

    Energy Technology Data Exchange (ETDEWEB)

    Roberts, W.S.; Hoffman, M.S.; LaPolla, J.P.; Ruas, E.; Fiorica, J.V.; Cavanagh, D. (Univ. of South Florida, Tampa (USA))


    Twelve patients were seen between January 1983 and June 1989 with the clinical diagnosis of radionecrosis of the vulva or distal vagina. Seven patients received radiation for vulvar cancer, three for distal vaginal cancer, and two for recurrent endometrial cancer. No patient healed spontaneously and the mean delay in surgical therapy was 8.5 months. The radionecrotic site was treated with local therapy, radical local excision (with or without colostomy), or exenteration. The operative defect was closed primarily in three patients and covered with local flaps or myocutaneous flaps in seven patients. The two patients with local care still have radionecrotic ulcers. One of three patients who were closed primarily continues to have an ulcer. All other patients have healed satisfactorily except one who died after two attempts to correct the problem. Radionecrosis of the vulva and distal vagina should generally be treated surgically.

  13. 胃、十二指肠溃疡急性穿孔手术治疗的术前、术后护理%Preoperative and postoperative nursing care for patients with acute perforation of gastric and duodenal ulcer

    Institute of Scientific and Technical Information of China (English)



    Objective:Acute perforation of gastric and duodenal ulcer is a common clinical emergency, and the nursing care of patients before and after surgery plays an important role in the rehabilitation of patients.The nursing of acute perforation of stomach and duodenum will be briefly introduced in this paper.%胃、十二指肠溃疡急性穿孔是临床常见的急症,手术前后的护理对患者的康复起着至关重要的作用.本文简要介绍胃、十二指肠急性穿孔手术前后的护理.

  14. Pictorial essay: Distal colostography

    Directory of Open Access Journals (Sweden)

    Rahalkar Mukund


    Full Text Available Distal colostography (DC, also called distal colography or loopography, is an important step in the reparative management of anorectal malformations (ARMs with imperforate anus, Hirschsprung′s disease (occasionally and colonic atresia (rarely in children and obstructive disorders of the distal colon (colitis with stricture, carcinoma or complicated diverticulosis in adults. It serves to identify/confirm the type of ARM, presence/absence of fistulae, leakage from anastomoses, or patency of the distal colon. We present a pictorial essay of DC in a variety of cases.

  15. Distal nail embbeding

    Directory of Open Access Journals (Sweden)

    Patricia Chang


    Full Text Available Male patient, 35 years old who came to dermatological consultation due to contact dermatitis on back, during his clinical examination alterations of his digits was seen. Dermatological examination reveals a rim of tissue at the distal edge of the nail of both big toenails and thickened nails (Fig.1a – c, 2a, b. Both big toenails were removed due to ingrown nails two times. Diagnosis of distal nail embedding was done. Distal nail embedding is a rim of tissue at the distal edge of the nail. Causes can de acquired or congenital.

  16. Distal and non-distal NIP theories

    CERN Document Server

    Simon, Pierre


    We study one way in which stable phenomena can exist in an NIP theory. We start by defining a notion of 'pure instability' that we call 'distality' in which no such phenomenon occurs. O-minimal theories and the p-adics for example are distal. Next, we try to understand what happens when distality fails. Given a type p over a sufficiently saturated model, we extract, in some sense, the stable part of p and define a notion of stable-independence which is implied by non-forking and has bounded weight. As an application, we show that the expansion of a model by traces of externally definable sets from some adequate indiscernible sequence eliminates quantifiers.

  17. The proportion of distal fibula Salter-Harris type I epiphyseal fracture in the paediatric population with acute ankle injury: a prospective MRI study. (United States)

    Hofsli, Mikael; Torfing, Trine; Al-Aubaidi, Zaid


    Ankle injuries are common among the paediatric population. There are few prospective studies utilizing MRI to diagnose a clinically suspected Salter-Harris type I of the distal fibula (SH1FDF). The aim of this study was to examine the proportion of clinically suspected SH1FDF in children. All paediatric patients with ankle injury, seen at the emergency room from September 2012 to May 2013 at a single institution, underwent a standardized clinical examination, and their radiographs were obtained if found necessary. All images and data were recorded prospectively and patients suspected of having SH1FDF were referred for MRI of the ankle joint. Out of 391 paediatric patients seen at the emergency room with ankle injury, 38 patients had a clinical suspicion of SH1FDF. A total of 31 patients, 18 male and 13 female, with a mean age of 10 ± 2.86 years, were included in the study. Only seven patients were excluded from the study. MRI was obtained on an average of 6.9 ± 2.87 days. None of the included patients had evidence of SH1FDF on MRI. Our study and review of the literature verifies the high false-positive rate of clinically suspected SH1FDF. Most children had ligamentous lesions, bone contusion or joint effusion, rather than SH1FDF.

  18. Laparoscopic repair of acute perforation for gastroduodenal ulcer%腹腔镜胃十二指肠溃疡穿孔修补术13例临床体会

    Institute of Scientific and Technical Information of China (English)

    杨轶杰; 张宝勋; 吴尚德


    Objective To summarize the clinical experience of laparoscopic repair of acute perforation for gastroduodenal ulcer. Methods From June 2003 to December 2007, 13 patients underwent laparoscopic repair of pedorated peptic ulcers. Results Five patients were suffered from pedorated duodenal bulbar ulcer, one patient was suffered from pyloric canal ulcer, and seven patients were suffered from perforated gashie antrum ulcer. The diameter of the perforation was 0. 3-0. 7cm, peritoneal fluid 600-1200ml, the operafive time was 80-180min, only one was shifted to open surgery diagnosed gastric cancer by pathology examination, another twelve laparoscopic operations were successful. Postoperative recovery was smooth, ten surgical incisions were class A healing and two were class B healing, the length of hospitalization were 7-10 days after surgery. With one year followed-up, all deers had healed well by Gastroscopy, we hadn't found reperforation, abdominal infection, ankylenteron, ileac passion ect. operative complications. Conclusions Laparoscopic repair of acute perforated gastroduodenal ulcer is as safe and effective as the open repair. We must do intraoperative rapid pathologic examination, if it was malignant disease we shifted to open surgery.%目的 腹腔镜急性胃、十二指肠溃疡穿孔修补术的临床经验.方法 2003年6月~2007年12月,对13例急性胃、十二指肠溃疡穿孔患者施行腹腔镜溃疡穿孔修补术.结果 13例中十二指肠球部溃疡穿孔5例,幽门管溃疡1例,胃窦部溃疡穿孔7例,穿孔直径为0.3~0.7 cm,腹腔内积液600~1200 mL.手术时间80~180 min,除1例病检胃癌,改开放手术外,其余12例手术均获成功,术后恢复顺利,切口甲级愈合10例,乙级愈合2例.住院天数7~10 d.随访1年,胃镜检查溃疡均愈合,无再穿孔、腹腔感染、肠粘连、肠梗阻等并发症发生.结论 腹腔镜手术治疗急性胃、十二指肠溃疡穿孔,与开腹手术同样安全且有效.胃

  19. Oral Ulcerations

    Directory of Open Access Journals (Sweden)

    Brandon Fetterolf


    Full Text Available A 35-year-old male presented with lower gum pain associated with fever, chills, and sore throat. His medical history included intravenous drug use, human immunodeficiency virus infection, and hepatitis C. Physical exam revealed tachycardia, a temperature of 38.9°C, anterior cervical lymphadenopathy, halitosis, an edematous lower lip, and purulent ulcers anterior and posterior to lower central incisors with marked tenderness and erythema (Figure. His laboratory work was notable for a low white blood cell count (2.6 thousand/µl, neutropenia (0.11 thousand/µl, a low absolute CD4 lymphocyte count (0.5 thousand/µl, and elevated C-reactive protein (129mg/L and sedimentation rate (23mm/hr. A computed tomography study showed a 0.5×1.3×0.3cm abscess anterior to the mandibular symphysis.

  20. Clinical effect of 50 cases of laparoscopic surgery for acute gastric ulcer perforation%腹腔镜手术治疗急性胃十二指肠溃疡穿孔50例疗效分析

    Institute of Scientific and Technical Information of China (English)

    王丽丽; 赵鸿雁


    目的:探讨腹腔镜手术治疗急性胃十二指肠溃疡穿孔的临床疗效。方法:收治急性胃十二指肠溃疡穿孔患者50例,随机分为观察组和对照组,各25例。对照组应用传统开腹手术治疗,观察组应用腹腔镜手术治疗,比较两组的术中出血量、术后肛门排气时间、住院时间及术后并发症情况。结果:治疗后观察组的术中出血量少于对照组(P<0.05);观察组术后肛门排气时间、住院时间明显短于对照组(P<0.05);治疗结束时观察组并发症少于对照组(P<0.05)。结论:腹腔镜手术治疗急性胃十二指肠溃疡穿孔临床效果良好,能减少出血、缩短住院时间,避免并发症。%Objective:To discuss the clinical effect of laparoscopic surgery for acute gastric ulcer perforation.Methodds:50 patients with acute gastric ulcer perforation were selected.They were randomly divided into the observation group and the control group,each of 25 cases.The control group were treated with the traditional open operation.The observation group were treated with laparoscopic operation.The amount of bleeding,postoperative anal exhaust time,hospitalization time and postoperative complications were compared between the two groups.Results:The amount of bleeding in the observation group was less than that of the control group(P<0.05).The postoperative anal exhaust time and hospitalization time of the observation group were significantly shorter than those of the control group(P<0.05).At the end of treatment of complications in the observation group was less than the control group(P<0.05).Conclusion:The clinical effect of laparoscopic surgery for acute gastric ulcer perforation is outstanding.It can reduce the bleeding,shorten the hospital stay,avoid complications.

  1. Distal Radius Fracture (Broken Wrist) (United States)

    .org Distal Radius Fracture (Broken Wrist) Page ( 1 ) The radius is the larger of the two bones of the forearm. The ... the distal end. A fracture of the distal radius occurs when the area of the radius near ...

  2. Clinical analysis of subtotal gastrectomy for patients of acute gastroduodenal ulcer perforation%一期胃大部切除术治疗胃十二指肠溃疡急性穿孔临床分析

    Institute of Scientific and Technical Information of China (English)

    朱武东; 邓光华


    目的:观察一期胃大部切除术治疗胃十二指肠溃疡急性穿孔的临床疗效。方法:选取进行胃十二指肠溃疡急性穿孔手术治疗的178例患者为研究对象,随机分为对照组(单纯开腹修补术)89例和试验组(一期胃大部切除术)89例。术后分别观察两组患者的临床疗效并进行统计学分析。结果:术后1~3年,随访观察发现:①试验组的溃疡复发率为10.11%,二次穿孔复发率为6.74%,并发症发生率为8.99%,均低于手术对照组,两组比较差异具有统计学意义( P<0.05)。②试验组患者对于手术后治疗效果的满意率为94.38%,明显高于对照组的78.65%,两组比较差异有统计学意义( P<0.05)。结论:一期胃大部切除术治疗胃十二指肠溃疡急性穿孔长期疗效好,患者满意度高,术后溃疡复发率较低,并发症相对于保守治疗组较少,适用于长期急重症患者。%Objective To observe the clinical effects of subtotal gastrectomy for patients of acute gastroduodenal ulcer perforation. Methods 178 cases of acute gastroduodenal ulcer perforation treated by operation were divided into control group( operation on simple clo-sure with open)with 89 cases and treatment group( subtotal gastrectomy)with 89 cases. The clinical effects of two groups were observed and statistical analyzed. Results After 1~3 years follow-up observation:①The ulcer recurrence rate of treatment group was 10. 11%, the second gastric perforation was 6. 74%,the incidence of complication was 8. 99%,all these three data were lower than control group. The difference was statistical significance(P<0. 05). Conclusion The long-term results of subtotal gastrectomy for patients of acute gas-troduodenal ulcer perforation was good. The satisfactory was better. The ulcer recurrence rate and the incidence of complication were lower than traditional treatment. It′s fit for critical patients.

  3. Hybrid treatment of penetrating aortic ulcer

    Energy Technology Data Exchange (ETDEWEB)

    Lara, Juan Antonio Herrero; Martins-Romeo, Daniela de Araujo; Escudero, Carlos Caparros; Falcon, Maria del Carmen Prieto; Batista, Vinicius Bianchi, E-mail: [Unidade de Gestao Clinica (UGC) de Diagnostico por Imagem - Hosppital Universitario Virgen Macarena, Sevilha (Spain); Vazquez, Rosa Maria Lepe [Unit of Radiodiagnosis - Hospital Nuestra Senora de la Merced, Osuna, Sevilha (Spain)


    Penetrating atherosclerotic aortic ulcer is a rare entity with poor prognosis in the setting of acute aortic syndrome. In the literature, cases like the present one, located in the aortic arch, starting with chest pain and evolving with dysphonia, are even rarer. The present report emphasizes the role played by computed tomography in the diagnosis of penetrating atherosclerotic ulcer as well as in the differentiation of this condition from other acute aortic syndromes. Additionally, the authors describe a new therapeutic approach represented by a hybrid endovascular surgical procedure for treatment of the disease. (author)

  4. Distal renal tubular acidosis (United States)

    ... get better with treatment. When to Contact a Medical Professional Call your health care provider if you have symptoms of distal renal tubular acidosis. Get medical help right away if you develop emergency symptoms ...

  5. Transphyseal Distal Humerus Fracture. (United States)

    Abzug, Joshua; Ho, Christine Ann; Ritzman, Todd F; Brighton, Brian


    Transphyseal distal humerus fractures typically occur in children younger than 3 years secondary to birth trauma, nonaccidental trauma, or a fall from a small height. Prompt and accurate diagnosis of a transphyseal distal humerus fracture is crucial for a successful outcome. Recognizing that the forearm is not aligned with the humerus on plain radiographs may aid in the diagnosis of a transphyseal distal humerus fracture. Surgical management is most commonly performed with the aid of an arthrogram. Closed reduction and percutaneous pinning techniques similar to those used for supracondylar humerus fractures are employed. Cubitus varus caused by a malunion, osteonecrosis of the medial condyle, or growth arrest is the most common complication encountered in the treatment of transphyseal distal humerus fractures. A corrective lateral closing wedge osteotomy can be performed to restore a nearly normal carrying angle.

  6. Giant distal humeral geode

    Energy Technology Data Exchange (ETDEWEB)

    Maher, M.M. [Department of Radiology, Mater Misericordiae Hospital, Dublin (Ireland); Department of Radiology, St. Vincent' s Hospital, Elm Park, Dublin 4 (Ireland); Kennedy, J.; Hynes, D. [Department of Orthopaedics, Mater Misericordiae Hospital, Dublin (Ireland); Murray, J.G.; O' Connell, D. [Department of Radiology, Mater Misericordiae Hospital, Dublin (Ireland)


    We describe the imaging features of a giant geode of the distal humerus in a patient with rheumatoid arthritis, which presented initially as a pathological fracture. The value of magnetic resonance imaging in establishing this diagnosis is emphasized. (orig.)

  7. Distal splenorenal shunt (United States)

    ... path. As a result, swollen blood vessels called varices form. They develop thin walls that can break ... or x-rays show that you have bleeding varices. Distal splenorenal shunt surgery reduces pressure on the ...

  8. The type 2 CCK/gastrin receptor antagonist YF476 acutely prevents NSAID-induced gastric ulceration while increasing iNOS expression


    Webb, Dominic-Luc; Rudholm-Feldreich, Tobias; Gillberg, Linda; Halim, Abdul; Theodorsson, Elvar; Sanger, Gareth J.; Campbell, Colin A.; Boyce, Malcolm; Näslund, Erik; Per M Hellström


    YF476 differs from the proton pump inhibitor (PPI) esomeprazole in mode of action by antagonizing the type 2 receptor of cholecystokinin/gastrin (CCK-2R). YF476 protection against diclofenac-induced gastric ulcers was compared to esomeprazole and correlated with plasma levels of hormones related to gastric pH (gastrin, ghrelin, and somatostatin), gastric gene expression of these hormones, their receptors, and inducible nitric oxide synthase (iNOS). YF476 or esomeprazole pretreatments were fol...

  9. Distal humeral epiphyseal separation. (United States)

    Moucha, Calin S; Mason, Dan E


    Distal humeral epiphyseal separation is an uncommon injury that is often misdiagnosed upon initial presentation. To make a timely, correct diagnosis, the treating physician must have a thorough understanding of basic anatomical relationships and an awareness of the existence of this injury. This is a case of a child who sustained a separation of the distal humeral epiphysis, as well as multiple other bony injuries, secondary to child abuse.

  10. Pharmacokinetic interaction between ϵ-acetamidocaproic acid (AACA) and cimetidine in indomethacin-induced acute gastric ulcer and control rats: inhibition of active renal secretion of AACA by cimetidine. (United States)

    Choi, Y H; Lee, U; Suh, J H; Kim, Y G; Lee, M; Oh, E; Lee, M G


    After both the intravenous and oral administration of zinc acexamate [ZAC; ion-pairing between zinc and ϵ-acetamidocaproic acid (AACA)] and cimetidine together, the areas under the curve (AUCs) of AACA were significantly greater [by 28.2 and 98.9% after the intravenous and oral administration, respectively, for control rats and 13.5 and 16.9% for indomethacin-induced acute gastric ulcer (IAGU) rats, respectively] than those of ZAC alone due to the significantly slower renal clearance (CL(R)). The significantly greater AUCs of AACA after both the intravenous and oral administration of ZAC and cimetidine together in control and IAGU rats could have been due to the inhibition of active renal tubular secretion of AACA by cimetidine. After the intravenous and oral administration of both drugs together, the AUCs of cimetidine in control and IAGU rats were not different compared with those with cimetidine alone.


    Chernekhovskaya, N E; Povalayev, A V; Layshenko, G A


    In review today conceptions of view to aetiology and pathogenesis gastro-duodenales ulcerative lesions in elderly. Atherosclerosis, ischemic disease of the heart and hypertension are reasons of acute ulcers and erosions in elderly. The breaking of microcirculation are very importance.

  12. 联用乳酸杆菌和丁酸梭菌对小鼠急性溃疡性结肠炎的影响%Influence of combined administration of lactobacilli and clostridium butyricum on acute mice ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    左和宁; 杨伟峰


    Objective To investigate the therapeutic effect of combined administration of lactobacilli and clostridium butyricum on acute mice ulcerative colitis, and explore its therapeutic mechanism.Methods Dextran sulfate sodium (DSS)-induced mice model of acute ulcerative colitis was established. After administration of lactobacilli and clostridium butyricum, the pathological change of tunica mucosa coli was observed and the expression levels of tumor necorisis factor (TNF-α) and tissue factor (TF) were measured.Results Lactobacilli and clostridium butyricum significantly alleviated the damage of tunica mucosa coli and suppressed the expression of TNF-αand TF. By comparison, there were the lightest histological damage and the lowest expression of TNF-αand TF when lactobacilli and clostridium butyricum were administrated combined.Conclusion Both lactobacilli and clostridium butyricum show therapeutic effect on DSS-induced mice ulcerative colitis. The coordinate repression on expression of TNF-αand TF may be the molecular mechanism of the co-effect on mice UC.%目的 观察联用乳酸杆菌和丁酸梭菌对小鼠急性溃疡性结肠炎的疗效并探讨其治疗机制.方法 建立DSS诱导的小鼠急性溃疡性结肠炎(UC)模型,观察给予乳酸杆菌和丁酸梭菌治疗后,小鼠结肠黏膜的病理改变和TNF-α和组织因子(TF)表达的变化.结果 乳酸杆菌和丁酸梭菌可明显减轻小鼠结肠黏膜的损伤;可明显抑制TNF-α和TF的表达,尤以两菌合用组抑制作用最强.结论 乳酸杆菌和丁酸梭菌对DSS诱导的UC有治疗作用,对TNF-α和TF表达的协同抑制作用可能是其发挥协调治疗作用的分子机制.

  13. Noninfectious genital ulcers. (United States)

    Kirshen, Carly; Edwards, Libby


    Noninfectious genital ulcers are much more common than ulcers arising from infections. Still, it is important to take a thorough history of sexual activity and a sexual abuse screen. A physical exam should include skin, oral mucosa, nails, hair, vulva, and vaginal mucosa if needed. The differential diagnosis of noninfectious genital ulcers includes: lipschütz ulcers, complex aphthosis, Behçet's syndrome, vulvar metastatic Crohn's disease, hidradenitis suppurativa, pyoderma gangrenosum, pressure ulcers, and malignancies. It is important to come to the correct diagnosis to avoid undue testing, stress, and anxiety in patients experiencing genital ulcerations.

  14. Effects of using distal protection device on neuroendocrine in patients with acute myocardial infarction%远端保护装置对急性心肌梗死患者神经内分泌的影响

    Institute of Scientific and Technical Information of China (English)

    要英杰; 邵一兵; 王旭; 王正忠


    Objective To study changes of neuroendocrine in patients with ST segment elevation acute myocardial infarction (STEMI) after using distal protection device (GuardWire PlusTM). Method Seventy patients with STEMI received percutaneous coronary intervention (PCI) in Municipal Hospital Qingdao, during September 2004 to December 2006. They were randomdy (random numbs) enrolled in this prospective and control study. All the patients were divided into 2 groups: the distal protection device group (GW) and the non-distal protection device group (NGW).The inclusion criteria were:onset within 6 hours, chest pain more than 30 minutes without response to nitroglycerin, two or more adjacent ST segnents elevated over 0.2 mv,the proximal or middle diameter of infarction artery over 3 mm, and the increased plasma creatine kinase. The exclusion criteria were fluctuation in hemodynamics, severe heart failure, arteriopathy of left main coronary artery, mechanical complications of acute myocardial infarction and multi-vessel disease scheduled for coronary artery bypass. The plasma levels of endothelin(ET) , plasma renin activity (PRA),aldosterone (ALD),angiotensin Ⅱ (Ang Ⅱ), norepinephrine (NE) and epinephrine (E) were measured on the day of operation and on the 1st,2nd,3rd and 5th day after operation, respectively. The t-test was used to compare those neuroendocrine elements between two groups. Results There were no differences in plasma levels of all the neuroendocrine elements between two groups before operation. Compared with the NGW group, the levels of neuroendocrine elements in the plasma rapidly decreased in the GW group at 1 d after the operation ( P < 0.05). Conclusions In patients with ST segment elevation acute myocardial infarction, the distal protection device can decrease the changes in neuroendocrine.%目的 探讨急性ST段抬高性心肌梗死(STEMI)急诊经皮冠状动脉成形术(PCI)中应用远端保护装置对神经内分泌指标的

  15. Diabetic foot disease: impact of ulcer location on ulcer healing

    DEFF Research Database (Denmark)

    Pickwell, KM; Siersma, Volkert Dirk; Kars, M


    Healing of heel ulcers in patients with diabetes is considered to be poor, but there is relatively little information on the influence of ulcer location on ulcer healing.......Healing of heel ulcers in patients with diabetes is considered to be poor, but there is relatively little information on the influence of ulcer location on ulcer healing....

  16. Preventing pressure ulcers (United States)

    ... page: // Preventing pressure ulcers To use the sharing features on this page, please enable JavaScript. Pressure ulcers are also called bedsores, or pressure sores. They ...

  17. Types of Ulcerative Colitis (United States)

    ... Colitis? > Types of Ulcerative Colitis Types of Ulcerative Colitis Email Print + Share If you are diagnosed with ... abdomen may occur in active disease. Left-sided Colitis Continuous inflammation that begins at the rectum and ...

  18. Laparoscopic Distal Pancreatectomy (United States)

    Melotti, Gianluigi; Butturini, Giovanni; Piccoli, Micaela; Casetti, Luca; Bassi, Claudio; Mullineris, Barbara; Lazzaretti, Maria Grazia; Pederzoli, Paolo


    Objective: To describe the clinical characteristics, indications, technical procedures, and outcome of a consecutive series of laparoscopic distal pancreatic resections performed by the same surgical team. Summary Background Data: Laparoscopic distal pancreatic resection has increasingly been described as a feasible and safe procedure, although accompanied by a high rate of conversion and morbidity. Methods: A consecutive series of patients affected by solid and cystic tumors were selected prospectively to undergo laparoscopic distal pancreatectomy performed by the same surgical team. Clinical characteristics as well as diagnostic preoperative assessment and intra- and postoperative data were prospectively recorded. A follow-up of at least 3 months was available for all patients. Results: Fifty-eight patients underwent laparoscopic resection between May 1999 and November 2005. All procedures were successfully performed laparoscopically, and no patient required intraoperative blood transfusion. Splenic vessel preservation was possible in 84.4% of spleen-preserving procedures. There were no mortalities. The overall median hospital stay was 9 days, while it was 10.5 days for patients with postoperative pancreatic fistulae (27.5% of all cases). Follow-up was available for all patients. Conclusions: Our experience in 58 consecutive patients was characterized by the lack of conversions and by acceptable rates of postoperative pancreatic fistulae and morbidity. Laparoscopy proved especially beneficial in patients with postoperative complications as they had a relatively short hospital stay. Solid and cystic tumors of the distal pancreas represent a good indication for laparoscopic resection whenever possible. PMID:17592294

  19. Incidence and management of ulcers in diabetic Charcot feet. (United States)

    Larsen, K; Fabrin, J; Holstein, P E


    This study followed 115 patients with diabetes--who between them had 140 feet with Charcot's arthropathy--over six to 114 months (median: 48). A total of 43 patients (37%) developed ulcers in 53 feet. Their treatment was multifactorial. An offloading regimen was adopted, with the use of crutches and therapeutic sandals with soft, individually moulded insoles, followed by adjusted or bespoke shoes. Recalcitrant ulcers were treated with surgery in 16 patients (37%). Antibiotics were needed by 21 patients (49%). The incidence of ulceration was 17% per year. The median time interval between the acute component of Charcot's arthropathy and ulcer development was 36 months (range: 0-120 months). In seven patients, the ulcer developed during the acute phase. In 12 patients the ulcers were localised to the rockerbottom deformity in the mid-foot region, but in 31 patients other regions were affected. Dynamic footprint analysis was used to help adjust the offloading shoe/insole on the rockerbottom deformity. Such ulcers took twice as long to heal as other ulcers. Surgical treatment comprised: major amputation (two patients), arthrodesis for unstable ankle (three patients), toe amputations (seven patients), resection of the rockerbottom deformity (one patient) and other revisions (three patients). One patient died with an unhealed ulcer. There is a four-fold risk of ulcers in diabetic Charcot deformity compared with the overall risk of foot ulcers in diabetic feet. Healing was achieved in 40 patients (93%). The surgical intervention rate of 37% in ulcer cases in Charcot feet was low compared with the literature.

  20. [Medical therapy of inflammatory bowel diseases: ulcerative colitis]. (United States)

    Lakatos, László; Lakatos, Péter László


    There are fewer significant changes in the medical therapy of ulcerative colitis (UC) compared to Crohn's disease. The most important factors that determine therapy are disease extent and severity. 5-aminosalicylates (5-ASA) constitute the treatment of choice in mild-to-moderate UC. The efficacy of new compounds (e.g. mesalazine) is only mildly improved compared to sulphasalazine; however, their use has become more frequent due to a more favorable side effects profile. Topical medication is more effective in proctitis and distal colitis, and the combination of topical and orally-administered drugs is superior to oral therapy alone also in extensive disease. Thus, this latter regimen should be considered for cases where the escalation of treatment is required. Systemic steroids still represent the first line therapy in acute, severe UC, while in patients who do not respond to steroids, cyclosporine and infliximab should be considered as a second line therapy and as alternatives for colectomy. Maintenance treatment is indicated in all UC cases. 5-ASA compounds are suggested as first line maintenance therapy with the optimal dose still being under investigation. Topical compounds are effective also for maintenance in distal colitis or proctitis, if accepted by the patients. Immunosuppressives, especially azathioprine, should be considered in chronically active, steroid dependent or resistant patients. According to recent publications, azathioprine is almost equally effective in UC and CD. The question of chemoprevention is important during maintenance. There are increasing data supporting the notion that aminosalicylates may lower the risk for UC-associated colorectal cancer. The most important changes in the management of UC are the more frequent use of topical aminosalicylates and azathioprine, the availability of infliximab in severe UC, and increasing use of aminosalicylates for chemoprevention of colorectal carcinoma. Furthermore, adequate attention is needed to

  1. Refractory duodenal ulcer

    Directory of Open Access Journals (Sweden)

    Al Freihi Hussein


    Full Text Available Refractory or intractable ulcer is defined as an ulcer that fails to heal completely after eight to twelve weeks, despite appropriate treatment with a modern antiulcer therapy in a compliant patient. Refractory ulcer should be suspected in individuals diagnosed to have peptic ulcer if their symptoms persist longer than usual: occurrence of complications or simply their ulcers fail to heal, since up to 25% of such patients remain asymptomatic. Conditions associated with refractory ulcer include noncompliance, continuous consumption of nonsteroidal anti-inflam-matory drugs, acid hypersecretion, smoking. male gender and other factors with questionable role like advanced age, large ulcer size, prolonged duration of symptoms and the presence of complication like bleeding. Nonpeptic ulcers like tuberculosis, malignancy, Crohn′s disease and primary intestinal lymphoma should always be considered in the differential diagnosis. Colonization with H. pylori which is well-known as a cause of frequent recurrences, has not been linked with refractoriness. Patients with refractory ulcers must undergo thorough re-evaluation including repeated endoscopies, obtaining biopsies for microbiology and histology and determination of serum-gastrin level. Once diseases with identifiable etiologies have been ruled out, aggressive medical management with single or multiple antiulcer drugs should be instituted. Such treatments will virtually heal all refractory ulcers. Surgery should be reserved for patients whose ulcers fail to respond to optimal medical therapy or those who develop com-plications necessitating surgical intervention.

  2. Rebamipide promotes healing of colonic ulceration through enhanced epithelial restitution

    Institute of Scientific and Technical Information of China (English)

    Tomohisa Takagi; Satoshi Kokura; Hiroshi Ichikawa; Toshikazu Yoshikawa; Yuji Naito; Kazuhiko Uchiyama; Toshimitsu Okuda; Katsura Mizushima; Takahiro Suzuki; Osamu Handa; Takeshi Ishikawa; Nobuaki Yagi


    AIM: To investigate the efficacy of rebamipide in a rat model of colitis and restitution of intestinal epithelial cells in vitro. METHODS: Acute colitis was induced with trinitrobenzene sulfonic acid (TNBS) in male Wistar rats. Rats received intrarectal rebamipide treatment daily starting on day 7 and were sacrificed on day 14 after TNBS administration. The distal colon was removed to evaluate the various parameters of inflammation. Moreover, wound healing assays were used to determine the enhanced restitution of rat intestinal epithelial (RIE) cells treated with rebamipide. RESULTS: Intracolonic administration of rebamipide accelerated TNBS-induced ulcer healing. Increases in the wet weight of the colon after TNBS administration were significantly inhibited by rebamipide. The wound assay revealed that rebamipide enhanced the migration of RIE cells through phosphorylation of extracellular signal-regulated kinase (ERK) and activation of Rho kinase. CONCLUSION: Rebamipide enema healed intestinal injury by enhancing restitution of RIE cells, via ERK activation. Rebamipide might be a novel therapeutic approach for inflammatory bowel disease.

  3. Clinical analysis of subtotal gastrectomy in treatment of 40 cases of acute peptic ulcer perforation%胃大部切除术治疗消化性溃疡急性穿孔40例临床分析

    Institute of Scientific and Technical Information of China (English)



    Objective To investigate the clinical efficacy and safety of subtotal gastrectomy in the treatment of acute gastric ulcer perforation. Methods Eighty patients with acute gastric ulcer perforation admitted to our hospital from February 2009 to April 2011 were analyzed retrospectively.The observation group, consisting of 40 patients,received subtotal gastrectomy;The control group,consisting of 40 patients, received simple neoplasty.The postoperative ulcer recurrence rate,complications,hospital stay,operative time and other indicators of the two groups were compared. Results The observation group had 4 patients with grade Ⅲ Visick and 3 patients with grade Ⅳ Visick,and the control group had 6 patients with grade Ⅲ Visick and 7 patients with grade Ⅳ Visick,with statistically significant difference between the two groups (P0.05).The observation group and the control group had statistically significant differences in the operative time and hospital stay [(2.3±0.5) and (1.2±0.3) hours,(7.3±2.4) and (5.1±1.7) days,t=34.617,30.019,P=0.032,0.041]. Conclusion Subtotal gastrectomy has better long-term efficacy than simple gastric perforation repair.Under permitting conditions and with informed consent of patients, subtotal gastrectomy should be adopted as far as possible for patients with acute gastric perforation.%目的探讨胃大部分切除术急性胃溃疡穿孔的临床疗效及安全性。方法回顾性分析我院2009年2月~2011年4月收治的急性胃溃疡胃穿孔患者40例作为观察组,采用选胃大部切除术;选取同期行单纯修补术治疗急性胃溃疡胃穿孔患者40例作为对照组,比较两组术后溃疡复发率、并发症、住院天数及手术时间等各指标情况。结果观察组患者VisickⅢ级4例,VisickⅣ3例,对照组患者VisickⅢ级6例,VisickⅣ7例,二者差异有统计学意义(P<0.05);两组患者术后并发症发生率(5%和7.5%)比较,差异无统计学意义(P>0.05

  4. Morphological changes of ulcerative plaque in patients received carotid angioplasty and stenting (CAS)

    Energy Technology Data Exchange (ETDEWEB)

    Sadikin, Cindy [Department of Radiology, Dokter Soetomo Hospital, Surabaya (Indonesia); Department of Radiology, Taipei Veteran General Hospital, Taipei, Taiwan (China)], E-mail:; Teng, Michael Mu Huo [Department of Radiology, Taipei Veteran General Hospital, Taipei, Taiwan (China); School of Medicine, National Yang Ming University, Taipei, Taiwan (China)], E-mail:; Yeh, C.-C. [Department of Radiology, Taipei Veteran General Hospital, Taipei, Taiwan (China)], E-mail:; Chang, F.-C. [Department of Radiology, Taipei Veteran General Hospital, Taipei, Taiwan (China)], E-mail:; Luo, C.-B. [Department of Radiology, Taipei Veteran General Hospital, Taipei, Taiwan (China); School of Medicine, National Yang Ming University, Taipei, Taiwan (China)], E-mail:


    Background: Carotid ulceration plaque is a strong risk factor for stroke and systemic vascular events. The purpose of this study was to assess immediate and follow-up ulcer morphology after carotid angioplasty and stenting (CAS). Methods and results: A total of 124 patients were included in the study. Ulcerative plaques were identified in 92 arteries from 81 patients (21% were asymptomatic and 79% symptomatic). The ulcer disappeared immediately after stenting in 36 (39%) of 92 arteries in 50 patients. Patients with initial mild degree of stenosis (50-69% stenosis) prior to stent, Type-3 and Type-4 ulcers were more prone to have residual ulcers immediate after stenting procedure. Ulcers located distal and proximal to the site of maximal stenosis, and ulcers extending outside of the imaginary line connecting the distal and proximal normal borders of the carotid artery were also more likely to have residual ulcers (P < 0.001). Follow-up angiograms (mean time after CAS = 10.1 months, range = 3-28 months) performed in 32 arteries (29 patients) revealed that residual ulceration disappeared in 17 lesions (53%) and became smaller in 15 lesions (47%). During follow-up, ipsilateral neurological symptoms were not evident in any of the 29 patients (mean time after CAS = 20.1 months, range = 9-41 months). Conclusions: Ulceration morphology, and stenosis severity prior to stent procedure had an impact on ulcer coverage after CAS. Our findings suggest that residual ulcers disappear or improve over time and that with appropriate medication, will not lead to embolic strokes.

  5. Distal radioulnar joint injuries

    Directory of Open Access Journals (Sweden)

    Binu P Thomas


    Full Text Available Distal radioulnar joint is a trochoid joint relatively new in evolution. Along with proximal radioulnar joint , forearm bones and interosseous membrane, it allows pronosupination and load transmission across the wrist. Injuries around distal radioulnar joint are not uncommon, and are usually associated with distal radius fractures,fractures of the ulnar styloid and with the eponymous Galeazzi or Essex_Lopresti fractures. The injury can be purely involving the soft tissue especially the triangular fibrocartilage or the radioulnar ligaments.The patients usually present with ulnar sided wrist pain, features of instability, or restriction of rotation. Difficulty in carrying loads in the hand is a major constraint for these patients. Thorough clinical examination to localize point of tenderness and appropriate provocative tests help in diagnosis. Radiology and MRI are extremely useful, while arthroscopy is the gold standard for evaluation. The treatment protocols are continuously evolving and range from conservative, arthroscopic to open surgical methods. Isolated dislocation are uncommon. Basal fractures of the ulnar styloid tend to make the joint unstable and may require operative intervention. Chronic instability requires reconstruction of the stabilizing ligaments to avoid onset of arthritis. Prosthetic replacement in arthritis is gaining acceptance in the management of arthritis.

  6. Anti-ulcer activity of Ficus religiosa leaf ethanolic extract

    Institute of Scientific and Technical Information of China (English)

    Marslin Gregory; B Divya; Revina Ann Mary; M M Hipolith Viji; V K Kalaichelvan; V Palanivel


    Objective:To evaluate the anti-ulcer activity and acute toxicity of Ficus religiosa (F. religiosa) leaf ethanolic extract in animal models. Methods:Anti-ulcer activity of F. religiosa ethanolic extract (250 and 500 mg/kg body weight) was studied on stress induced ulcer animal models. Ranitidine was used as standard. The anti-ulcer activity of F. religiosa was evaluated with the help of ulcer area and histopatholgical examination. Preliminary phyto-chemical screening and acute toxicity studies of F. religiosa also carried out. Results: Results showed that the extract treatments prevented ulcer area and gastric secretion in a dose-dependent manner. Administration of 2 000 mg/kg extract did not show any acute toxicity in albino mice. Preliminary phytochemical analysis identified the presence of flavonoids in the ethanolic extract of F. religiosa. Conclusions: The extract is non-toxic even at relatively high concentrations. The anti-ulcer activity is probably due to the presence of flavanoids.

  7. Multifocal stenosing ulceration of the small intestine

    Institute of Scientific and Technical Information of China (English)

    Hugh James Freeman


    Several reports have described an apparently uncommon clinicopathological disorder that is characterized by multifocal stenosing small-intestinal ulceration. Compared to Crohn's disease, the ulcers are not transmural and typically remain shallow, and involve only the mucosa and submucosa. The disorder seems to be localized in the jejunum and proximal ileum only, and not the distal ileum or colon. Only nonspecific inflammatory changes are present without giant cells or other typical features of granulomatous inflammation. Most patients present clinically with recurrent obstructive events that usually respond to steroids, surgical resection, or both. With the development of newer imaging modalities to visualize the small-intestinal mucosa, such as double-balloon enteroscopy, improved understanding of the long-term natural history of this apparently distinctive disorder should emerge.

  8. Pantoprazole before Endoscopy in Patients with Gastroduodenal Ulcer Bleeding: Does the duration of Infusion and Ulcer Location Influence the Effects?

    Directory of Open Access Journals (Sweden)

    Istvan Rácz


    Full Text Available The aim of this study was to investigate the effect of preemptive pantoprazole infusion on early endoscopic findings in patients with acute ulcer bleeding. Records of 333 patients admitted with acute ulcer bleeding were analyzed. Ulcer bleeders were given either 80 mg bolus of pantoprazole followed by continuous infusion of 8 mg per hour or saline infusion until endoscopy. In 93 patients saline infusion whereas in 240 patients bolus plus infusion of pantoprazole was administrated with mean (±SD durations of 5.45±12.9 hours and 6.9±13.2 hours, respectively (P=0.29. Actively bleeding ulcers were detected in 46/240 (19.2% of cases in the pantoprazole group as compared with 23/93 (24.7% in the saline infusion group (P=0.26. Different durations of pantoprazole infusion (0–4 hours, >4 hours, and >6 hours had no significant effect on endoscopic and clinical outcome parameters in duodenal ulcer bleeders. Gastric ulcer bleeders on pantoprazole infusion longer than 4 and 6 hours before endoscopy had actively bleeding ulcers in 4.3% and 5% compared to the 19.5% active bleeding rate in the saline group (P=0.02 and P=0.04. Preemptive infusion of high-dose pantoprazole longer than 4 hours before endoscopy decreased the ratio of active bleeding only in gastric but not in duodenal ulcer patients.

  9. Gastropericardial fistula complicating benign gastric ulcer: case report

    Energy Technology Data Exchange (ETDEWEB)

    Simice, P.; Zwirewich, C.V. [Univ. of British Columbia, Vancouver General Hospital, Dept. of Radiology, Vancouver, BC (Canada)


    Pneumopericardium is a rare radiologic finding and is most commonly associated with esophageal ulceration or trauma. Benign ulcers of the distal esophagus are the most frequent source of non-traumatic perforation into the pericardial sac. Other etiologies include fistula formation from diseased subdiaphragmatic hollow viscera or subphrenic abscess, recent cardiac surgery, an extension of pneumomediastinum into the pericardium sac, and primary septic pericarditis from gasforming organisms. Pneumopericardium caused by the penetration of a benign gastric ulcer is a recognized but rare phenomenon. Intrathoracic gastric perforations are more commonly associated with pneumomediastium. Risk factors associated with an increased risk of penetration of gastric ulcers into the pericardium include the presence of a giant ulcer in the gastric fundus, an ulcer within a hiatus hernia, a history of hiatus hernia repair, concurrent use of non-steroidal anti-inflammatory drugs and the Zollinger-Ellison syndrome. Scar tissue formation at the site of previous hiatal surgery may result in the adherence of the gastric fundus or lower esophagus to the pericardium and produce a pathway for benign ulcers to erode into the pericardium.

  10. Cushing's ulcer: Further reflections


    Kemp, William J.; Bashir, Asif; Dababneh, Haitham; Cohen-Gadol, Aaron A.


    Background: Brain tumors, traumatic head injury, and other intracranial processes including infections, can cause increased intracranial pressure and lead to overstimulation of the vagus nerve. As a result, increased secretion of gastric acid may occur which leads to gastro-duodenal ulcer formation known as Cushing's ulcer. Methods: A review of original records of Dr. Harvey Cushing's patients suffering from gastro-duodenal ulcers was performed followed by a discussion of the available litera...

  11. Amebic and cytomegalovirus colitis mimic ulcerative colitis

    Directory of Open Access Journals (Sweden)

    Meng-Tzu Weng


    Full Text Available Here we present a 50-year-old man who suffered from progressively bloody diarrhea for 2 months. A colonoscopy revealed pancolonic mucosal inflammation, ulceration, and spontaneous bleeding. Ulcerative colitis was initially diagnosed and sulfasalazine was prescribed. Hypoalbuminemia and renal function deterioration developed 1 year later. Steroids were prescribed for suspected nephrotic syndrome. His bloody diarrhea and abdominal symptoms worsened after steroid use. Progressive sepsis and acute renal function deterioration also developed. Positive human immunodeficiency virus (HIV antibody was found during routine hemodialysis screening. An episode of colon perforation occurred and surgery was performed. The resected colon showed amoeba, cytomegalovirus, and fungal infection. The patient died of sepsis. In this report, we discuss how to diagnose ulcerative colitis. It is important to exclude infection before using an immunosuppressive agent.

  12. Buruli Ulcer (Mycobacterium ulcerans Infection) (United States)

    ... leishmaniasis, extensive ulcerative yaws and ulcers caused by Haemophilus ducreyi 1 . Early nodular lesions are occasionally confused with ... been made. References 1 Mitjà, O et al. Haemophilus ducreyi as a cause of skin ulcers in children ...

  13. Genetics Home Reference: ulcerative colitis (United States)

    ... Understand Genetics Home Health Conditions ulcerative colitis ulcerative colitis Enable Javascript to view the expand/collapse boxes. Download PDF Open All Close All Description Ulcerative colitis is a chronic disorder that affects the digestive ...

  14. Amoebic ulcer of the male genitala: A rare case report

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    Mohanty Indrani


    Full Text Available Amoebic ulcer of the penis is a very rare clinical entity. We report a case of amoebic ulcer of the glans penis in a 47-year-old male homosexual, symptomatic with severe pain and foul-smelling hemopurulent discharge of acute onset. He had received systemic antibiotics like ciprofloxacin and azithromycin prior to presentation with no improvement. Diagnosis was confirmed by wet mount microscopic examination of the discharge. The patient responded well to a course of metronidazole.

  15. Peptic ulcer disease today. (United States)

    Yuan, Yuhong; Padol, Ireneusz T; Hunt, Richard H


    Over the past few decades, since the introduction of histamine H(2)-receptor antagonists, proton-pump inhibitors, cyclo-oxygenase-2-selective anti-inflammatory drugs (coxibs), and eradication of Helicobacter pylori infection, the incidence of peptic ulcer disease and ulcer complications has decreased. There has, however, been an increase in ulcer bleeding, especially in elderly patients. At present, there are several management issues that need to be solved: how to manage H. pylori infection when eradication failure rates are high; how best to prevent ulcers developing and recurring in nonsteroidal anti-inflammatory drug (NSAID) and aspirin users; and how to treat non-NSAID, non-H. pylori-associated peptic ulcers. Looking for H. pylori infection, the overt or surreptitious use of NSAIDs and/or aspirin, and the possibility of an acid hypersecretory state are important diagnostic considerations that determine the therapeutic approach. Combined treatment with antisecretory therapy and antibiotics for 1-2 weeks is the first-line choice for H. pylori eradication therapy. For patients at risk of developing an ulcer or ulcer complications, it is important to choose carefully which anti-inflammatory drugs, nonselective NSAIDs or coxibs to use, based on a risk assessment of the patient, especially if the high-risk patient also requires aspirin. Testing for and eradicating H. pylori infection in patients is recommended before starting NSAID therapy, and for those currently taking NSAIDs, when there is a history of ulcers or ulcer complications. Understanding the pathophysiology and best treatment strategies for non-NSAID, non-H. pylori-associated peptic ulcers presents a challenge.

  16. Peptic Ulcer Disease Different Pathogenesis of Duodenal and Gastric Ulcer

    Directory of Open Access Journals (Sweden)

    Hendra Koncoro


    Full Text Available Despite decrease frequency of Helicobacter pylori (H. pylori due to eradication therapy, peptic ulcer disease as a manifestation of this infection is still remain a health burden. Understanding the physiology of gastric acid secretion and its alteration by H. pylori induced inflammation will aid physician in differentiating peptic ulcer disease based on its location. Duodenal ulcer and gastric ulcer disease are two common condition that usually found in peptic ulcer. Recognition of symptoms and its pathogenesis may lead physician to understand the fate of each condition in the future. This article reviews concept of peptic ulcer pathogenesis according to ulcer etiology.

  17. Desulfovibrio bacterial species are increased in ulcerative colitis.

    LENUS (Irish Health Repository)

    Rowan, Fiachra


    BACKGROUND: Debate persists regarding the role of Desulfovibrio subspecies in ulcerative colitis. Combined microscopic and molecular techniques enable this issue to be investigated by allowing precise enumeration of specific bacterial species within the colonic mucous gel. The aim of this study was to combine laser capture microdissection and quantitative polymerase chain reaction to determine Desulfovibrio copy number in crypt-associated mucous gel in health and in acute and chronic ulcerative colitis. METHODS: Colonic mucosal biopsies were harvested from healthy controls (n = 19) and patients with acute (n = 10) or chronic (n = 10) ulcerative colitis. Crypt-associated mucous gel was obtained by laser capture microdissection throughout the colon. Pan-bacterial 16S rRNA and Desulfovibrio copy number\\/mm were obtained by polymerase chain reaction at each locus. Bacterial copy numbers were interrogated for correlation with location and disease activity. Data were evaluated using a combination of ordinary linear methods and linear mixed-effects models to cater for multiple interactions. RESULTS: Desulfovibrio positivity was significantly increased in acute and chronic ulcerative colitis at multiple levels within the colon, and after normalization with total bacterial signal, the relative Desulfovibrio load was increased in acute colitis compared with controls. Desulfovibrio counts did not significantly correlate with age, disease duration, or disease activity but interlevel correlations were found in adjacent colonic segments in the healthy control and chronic ulcerative colitis groups. CONCLUSION: The presence of Desulfovibrio subspecies is increased in ulcerative colitis and the data presented suggest that these bacteria represent an increased percentage of the colonic microbiome in acute ulcerative colitis.

  18. Zinc compounds, a new treatment in peptic ulcer. (United States)

    Escolar, G; Bulbena, O


    Effects of zinc in gastric ulcer have been reviewed through investigations carried out on zinc acexamate (ZAC). ZAC is an organic compound that has been shown to possess an experimental antiulcer effect and a wide therapeutic index, making it a useful drug in the treatment of peptic ulcer disease. ZAC protects from ulceration in several experimental models such as pylorus occlusion, reserpine-induced ulcer, necrotizing agents, PAF-induced ulcer and cold-restraint stress. ZAC first reduces the gastric acid output by inhibiting the mast cell degranulation, an action likely to be mediated through a membrane stabilizing action. Secondly, it enhances the mucosal protection factors by increasing mucus secretion, inhibiting the H+ retrodiffusion and improving microcirculation. ZAC is also effective in acetic acid-induced chronic ulcer, restoring the continuity of the damaged mucosa. Several clinical trials have shown the usefulness of ZAC in acute and maintenance treatment of both gastric and duodenal ulcers. Endoscopic studies showed that ZAC reduced the inflammatory processes (gastritis and duodenitis) associated with ulcer healing. This reduction was statistically significant and not observed with other comparative treatments (H2-antagonists). The observed side-effects were minimal and affected less than 2% of treated patients. The pharmacological profile, clinical effectiveness and good tolerance of ZAC suggest this compound as an interesting option in the treatment of peptic disease.

  19. Distal arthrogryposis syndrome

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    Kulkarni K


    Full Text Available A 5-month-old male infant presented with weak cry, decreased body movements, tightness of whole body since birth, and one episode of generalized seizure on day 4 of life. He was born at term by elective caesarian section performed for breech presentation. The child had failure to thrive, contractures at elbow and knee joints, hypertonia, microcephaly, small mouth, retrognathia, and camptodactyly. There was global developmental delay. Abdominal examination revealed umbilical and bilateral inguinal hernia. Visual evoked response and brainstem evoked response audiometry were abnormal. Nerve conduction velocity was normal. Magnetic resonance imaging of brain revealed paucity of white matter in bilateral cerebral hemispheres with cerebellar and brain stem atrophy. The differential diagnoses considered in the index patient were distal arthrogryposis (DA syndrome, cerebroculofacioskeletal syndrome, and Pena Shokier syndrome. The index patient most likely represents a variant of DA: Sheldon Hall syndrome.


    Directory of Open Access Journals (Sweden)

    Ramkumar Reddy


    Full Text Available Triceps rupture is an uncommon injury. Fracture of olecranon or a dislocation / fracture is most often common injury for similar mechanism of fall. It is commonly associated with anabolic steroid use, weight lifting, and direct laceration. Risk factors include local steroid injection, olecranon bursitis, and hyperparathyroidism. Distal triceps rupture is usually caused by a fall on an outstretched hand. Eccentric loading of a contracting triceps has been implicated. Initial diagnosis may be difficult because a palpable defect is not always present. Pain and swelling may limit the ability to evaluate strength and elbow range of motion. Although plain radiographs are helpful in ruling out other elbow pathology, MRI is used to confirm the diagnosis, classify the injury, and plan management. Incomplete tears with active elbow extension against resistance are managed non - surgically. Surgical repair is indicated in active persons with complete tears and for incomplete tears with concomitant loss of strength. Good to excellent results have been reported with surgical repair in triceps, even for chronic tears. BACKGROUND: Distal triceps tendon avulsions occur very infrequently, and the diagnosis is often missed when the injury is acute. The literature provides little guidance regarding treatment or the outcome of these injuries. The goal of this report was to report our experience with the diagnosis, timing and technique of surgical treatment, and outcome of treatment of distal triceps tendon rupture.

  1. Diagnostics of pressure ulcer risk and pressure ulcers


    Kottner, Jan


    Pressure ulcers are serious health problems and they develop in every healthcare setting. Pressure ulcer risk scales aim to support practitioners in determining individual pressure ulcer risk and in starting preventive activities. Study results indicate validity problems inherent in pressure ulcer risk scale scores. Since risk scores are too imprecise for individual clinical decision making, it is questionable whether the standardized pressure ulcer risk assessments improve resident and patie...

  2. Peptic Ulcer Disease Different Pathogenesis of Duodenal and Gastric Ulcer


    Hendra Koncoro; I Dewa Nyoman Wibawa


    Despite decrease frequency of Helicobacter pylori (H. pylori) due to eradication therapy, peptic ulcer disease as a manifestation of this infection is still remain a health burden. Understanding the physiology of gastric acid secretion and its alteration by H. pylori induced inflammation will aid physician in differentiating peptic ulcer disease based on its location. Duodenal ulcer and gastric ulcer disease are two common condition that usually found in peptic ulcer. Recognition of symptoms ...

  3. 肿瘤外科术中急性压疮评价指标构建的研究%Study for the construct of evaluation indicators of acute pressure ulcer for patients with oncology surgery

    Institute of Scientific and Technical Information of China (English)

    宋辉; 王悦; 王春梅


    目的 建立肿瘤外科术中急性压疮评价指标体系.方法 采用文献查询、临床调研、专家会议、小组讨论的方法,初拟肿瘤外科术中急性压疮评价指标的框架;采用德尔菲法进行指标的筛选和论证.结果 两轮咨询表回收率分别是95%和100%;第一轮咨询后指标的改变为:保留19个,删除4个,增加3个,修改1个;第二轮咨询后删除六个条目,最终生成16个条目,重要性平均得分>3.0分、满分比>20%、变异系数≤0.25的指标达72.2%;两轮和谐系数分别为0.419和0.495.结论 最终确定肿瘤外科术中急性压疮评价指标16个,专家积极程度、权威程度均较高,结果可取.%To construct the evaluation indicators system of acute pressure ulcer for patients with oncology surgery. Method Design the framework of the evaluation indicators system according to literature inquiry, clinical research, expert meetings and group discussion, then twenty experts were consulted by two rounds Delphi expert consultation. Result The recoveries rate of the two rounds of consultation form were 95% and 100%. The changing of the indicators after the first round expert consultation as following: 19 reserved, four deleted, three added and one modified. Sixteen indicators were formed after the second round,There were 72. 2% indicators met the requirement. The average score of importance was more than 3, full mark ratio was more than 20%, the indicators with ≤ 0. 25 coefficient of variation was, 72. 2%. The Kendall's coefficient of concordance were 0. 419 and 0. 495. Conclusion The final evaluation indicators of acute pressure ulcer for patients with oncology surgery were 16 items. Expert opinions had a good level of coordination and the desirable result.patients with oncology surgery were 16 items. Expert opinions had a good level of coordination and the desirable result.

  4. Imaging of the Distal Tibiofibular Syndesmosis: Anatomy in Relation to Radiological Diagnosis

    NARCIS (Netherlands)

    J.J. Hermans (John)


    textabstractInjury to the distal tibiofibular syndesmosis can occur after an ankle sprain or after an acute ankle fracture. In an estimated 1-11% of all ankle sprains, injury of the distal tibiofibular syndesmosis occurs which is known as a high ankle sprain. However, depending on the type and level

  5. Pressure Ulcers Surveillance Report

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    Zehra Esin Gencer


    Full Text Available Objective: Pressure ulcer is a chronic wound. It reduces the quality of life of the elderly and individuals with restricted range of motion. It prolongs hospital stay and increases the risk of complications. The cost is quite high. Preventive actions for the prevention of pressure ulcers should be developed. Planning protocols and standards of care are among the main targets. Material and Method: Research was conducted in one-year period between 2012 May and 2013 May on patients who were followed up in Akdeniz University Hospital clinics and intensive care unit with pressure ulcers. The research population consisted of 569 patients. Patient data were recorded in SPSS 16 for Windows program. Statistical analyzes were performed with retrospective methods. The demographic characteristics of patients with pressure ulcers were analyzed as frequency and descriptive statistics. Prevalence and incidence of one year were calculated. Results: Of the patients, 58% were males, 42% were females. Of the patients, 36% were in the age range of 61-80 years, and their average length of stay was 42,9 days. Of the patients, 70% were at stage 2 and 3. In 15% of patients pressure ulcers occurred on the first day of hospitalization. Pressure ulcers were developed between days 2 and 10 in 59% of the patients. Prevalence rate was 2.5%, the incidence was 1.9%, the prevalence rate was 5.9% in the intensive care unit. Conclusion: It is easier to prevent pressure ulcers than treating.

  6. Connective tissue ulcers. (United States)

    Dabiri, Ganary; Falanga, Vincent


    Connective tissue disorders (CTD), which are often also termed collagen vascular diseases, include a number of related inflammatory conditions. Some of these diseases include rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis (scleroderma), localized scleroderma (morphea variants localized to the skin), Sjogren's syndrome, dermatomyositis, polymyositis, and mixed connective tissue disease. In addition to the systemic manifestations of these diseases, there are a number of cutaneous features that make these conditions recognizable on physical exam. Lower extremity ulcers and digital ulcers are an infrequent but disabling complication of long-standing connective tissue disease. The exact frequency with which these ulcers occur is not known, and the cause of the ulcerations is often multifactorial. Moreover, a challenging component of CTD ulcerations is that there are still no established guidelines for their diagnosis and treatment. The morbidity associated with these ulcerations and their underlying conditions is very substantial. Indeed, these less common but intractable ulcers represent a major medical and economic problem for patients, physicians and nurses, and even well organized multidisciplinary wound healing centers.

  7. Distally Based Abductor Hallucis Adipomuscular Flap for Forefoot Plantar Reconstruction. (United States)

    Lee, Sanglim; Kim, Min Bom; Lee, Young Ho; Baek, Jeong Kook; Baek, Goo Hyun


    Soft tissue and bone defects of the lower leg, ankle, and heel region often require coverage by local or distant flaps. The authors successfully used the distally based adipomuscular abductor hallucis flap for the treatment of 7 patients with soft tissue defect on the plantar forefoot after diabetic ulcer (n = 2), excision of melanoma at the medial forefoot (n = 3), and posttraumatic defects of the plantar forefoot (n = 2). The size of the defects ranged from 6 to 36 cm. All defects were covered successfully without major complications. The distally based adipomuscular flap from the abductor hallucis muscle provides a reliable coverage for small and moderate defects of the plantar and medial forefoot. This flap is often preferable to the use of free flaps because the surgery is rapidly performed and does not require microsurgical expertise.

  8. Nonspecific genital ulcers. (United States)

    Sehgal, Virendra N; Pandhi, Deepika; Khurana, Ananta


    Recent intervention of nonspecific genital ulcers has added refreshing dimensions to genital ulcer disease. It was considered pertinent to dwell on diverse clinical presentation and diagnostic strategies. It seems to possess spectrum. It includes infective causes, Epstein Bar Virus, tuberculosis, Leishmaniasis, HIV/AIDS related ulcers and amoebiasis. Noninfective causes are immunobullous disorders, aphthosis, Behcet's disease (BD), inflammatory bowel disease, lichen planus and lichen sclerosis et atrophicus, drug reactions, premalignant and malignant conditions, pyoderma gangrenosum, and hidradenitis suppurativa. The diagnostic features and treatment option of each disorder are succinctly outlined for ready reference.

  9. Corneal ulcers in horses. (United States)

    Williams, Lynn B; Pinard, Chantale L


    Corneal ulceration is commonly diagnosed by equine veterinarians. A complete ophthalmic examination as well as fluorescein staining, corneal cytology, and corneal bacterial (aerobic) and fungal culture and sensitivity testing are necessary for all infected corneal ulcers. Appropriate topical antibiotics, topical atropine, and systemic NSAIDs are indicated for all corneal ulcers. If keratomalacia (melting) is observed, anticollagenase/antiprotease therapy, such as autologous serum, is indicated. If fungal infection is suspected, antifungal therapy is a necessity. Subpalpebral lavage systems allow convenient, frequent, and potentially long-term therapy. Referral corneal surgeries provide additional therapeutic options when the globe's integrity is threatened or when improvement has not been detected after appropriate therapy.

  10. Hemoglobinopathies and Leg Ulcers. (United States)

    Alavi, Afsaneh; Kirsner, Robert S


    Major hemoglobinopathies, including sickle cell anemia, are becoming a global health issue. Leg ulcers are the most common cutaneous manifestation of sickle cell disease and an important contributor to morbidity burden in this population. Leg ulcers following sickling disorders are extremely painful, and hard to heal. The clinical evidence for the optimal management of these ulcers is limited. Treating the cause and the strategies to prevent sickling are the mainstay of treatment. The basic principles of wound bed preparation and compression therapy is beneficial in these patients.

  11. Perforated duodenal ulcer: Emerging pattern

    Directory of Open Access Journals (Sweden)

    Murtaza Ali Asger Calcuttawala


    Full Text Available Background: A total of 27 patients of perforated duodenal ulcer admitted in our institution between December 2010 and November 2012 were treated and studied. Materials and Methods: All patients were diagnosed on the basis of clinical and radiological findings, exploratory laparotomy was performed and simple closure of perforation with placement of Graham′s omental patch was carried out. This was followed by triple regimen for Helicobacter pylori eradication. Results: All patients were male, maximum incidence (61.54% was noted in the age group of 21-30, ′O′ +ve blood group was most commonly observed in our patients. Eight patients had history suggestive of acute acid peptic disease. Mean time interval between the start of symptoms and surgery was 43 h. No morbidity except minimal pleural effusion was seen in one case. There was no mortality in our series. Conclusion: We conclude that although a number of definitive surgeries have been described for acid peptic disease, but the requirement of such procedures has come down due to increasing use of H. pylori eradication therapy and proton pump inhibitors. However, surgery for complications especially for duodenal ulcer perforation has not reduced concomitantly. Incidence is greater in young males.

  12. Detection of esophageal ulcerations with technetium-99m albumin sucralfate

    Energy Technology Data Exchange (ETDEWEB)

    Goff, J.S.; Adcock, K.A.; Schmelter, R.


    Technetium-99m albumin-sucralfate ((/sup 99m/Tc)Su) can be used to demonstrate peptic ulcer disease in man and animals. We evaluated the usefulness of (/sup 99m/Tc)Su for detecting various grades of esophagitis. (/sup 99m/Tc)Su adhered to the distal esophagus for up to 3 hr in five of six patients with esophageal ulcers but adhered to only two of nine with lesser degrees of esophagitis. No adherence was seen in five patients without esophagitis. Thus, (/sup 99m/Tc)Su may not be useful for detecting any but the most severe grade of esophagitis. Based on these results, we speculate that the previously documented beneficial effects of sucralfate on mild to moderate esophagitis may be due to other mechanisms besides adherence to the ulcerated mucosa.

  13. Weber B Distal Fibular Fracture Diagnosed by Point of Care Ultrasound in the Emergency Department


    Makinen, James


    We report the case of a 45 year-old woman who presented to the Emergency Department (ED) after an acute ankle inversion injury. After history and physical exam suggested a potential fracture, point of care (POC) ultrasound demonstrated a cortical defect of the distal fibula, consistent with fracture. Plain radiography failed to demonstrate a fracture. Later, the fracture was identified as a Weber B distal fibular fracture by stress-view radiography. This case reviews the evaluation of acute a...

  14. Differential diagnosis of leg ulcers. (United States)

    Pannier, F; Rabe, E


    Leg and foot ulcers are symptoms of very different diseases. The aim of this paper is to demonstrate the differential diagnosis of leg ulcers. The majority of leg ulcers occur in the lower leg or foot. In non-venous ulcers the localization in the foot area is more frequent. The most frequent underlying disease is chronic venous disease. In 354 leg ulcers, Koerber found 75.25% venous leg ulcers, 3.66% arterial leg ulcers, 14.66% ulcers of mixed venous and arterial origin and 13.5% vasculitic ulcers. In the Swedish population of Skaraborg, Nelzen found a venous origin in 54% of the ulcer patients. Each leg ulcer needs a clinical and anamnestic evaluation. Duplex ultrasound is the basic diagnostic tool to exclude vascular anomalies especially chronic venous and arterial occlusive disease. Skin biopsies help to find a correct diagnosis in unclear or non-healing cases. In conclusion, chronic venous disease is the most frequent cause of leg ulcerations. Because 25% of the population have varicose veins or other chronic venous disease the coincidence of pathological venous findings and ulceration is very frequent even in non-venous ulcerations. Leg ulcers without the symptoms of chronic venous disease should be considered as non-venous.

  15. Microcirculatory remodeling in marginal zone of duodenal ulcer after bleeding

    Directory of Open Access Journals (Sweden)

    Sulayeva О.N.


    Full Text Available To estimate objectively vessels network remodeling in duodenal mucosa after ulcer bleeding the morphometric analysis of marginal ulcer zone biopsies was performed in 32 patients. It was shown that reparation is accompanied with chronic inflammation and acute alteration of microcirculation. Injection hemostasis led to enhancement of microcirculation, development of edema and ischemic alteration of mucosal tissues. Acute neutrophilic infiltration during 1 day was changed on 3 day with granular tissue development and angiogenesis stimulation. Intensification and prolongation of angiogenesis paral-leled with lymphocytes infiltration after 7 days resulted to villi dysmorphogenesis and changes in cellular content of intestinal epithelium.

  16. Drug-eluting versus bare metal stents in patients with st-segment-elevation myocardial infarction: eight-month follow-up in the Drug Elution and Distal Protection in Acute Myocardial Infarction (DEDICATION) trial

    DEFF Research Database (Denmark)

    Kelbaek, Henning; Thuesen, Leif; Helqvist, Steffen


    BACKGROUND: Implantation of drug-eluting stents (DES) limits the rate of coronary restenosis in most patients with coronary artery disease, but data are scarce with regard to their use in patients with ST-segment-elevation myocardial infarction and in connection with distal protection of the micr......BACKGROUND: Implantation of drug-eluting stents (DES) limits the rate of coronary restenosis in most patients with coronary artery disease, but data are scarce with regard to their use in patients with ST-segment-elevation myocardial infarction and in connection with distal protection...... of the microvascular perfusion during primary percutaneous coronary intervention. METHODS AND RESULTS: We randomly assigned 626 patients referred within 12 hours from symptom onset of an ST-elevation myocardial infarction to have a DES or a bare metal stent implanted in the infarct-related lesion with or without...... distal protection during primary percutaneous coronary intervention. Quantitative coronary angiography was performed during the index treatment and 8 months later. The primary end point was loss of the lumen diameter in the infarct-related lesion induced by neointimal proliferation. Patients were...

  17. Roxatidine in duodenal ulcer.



    Roxatidine acetate is a new H2-receptor antagonist. A randomized double-blind clinical trial in fifty-three patients with endoscopically proven duodenal ulcers > 5 mm in diameter was undertaken to compare safety and efficacy of roxatidine with that of ranitidine. Twenty-six patients received roxatidine (75 mg bid) while 27 patients received ranitidine (150 mg bid) for 4 weeks. One patient in each group did not come for follow up. Roxatidine and ranitidine had comparable ulcer healing rates...

  18. A pilot study investigating the utilization of crest pads for treatment of toe callus and ulceration. (United States)

    Melo, Monica; Bernecker, Tricia; McCullough, James; Hong, John; Trumbauer, Jane Scott; Miller, Mary Ellen


    Patients with lesser-toe deformities are at increased risk of developing calluses and ulcers on the distal ends of the affected digits because of the increased pressures applied to these areas. The number of diabetic patients in the United States continues to increase, along with associated comorbidities such as peripheral vascular disease and peripheral neuropathy. These conditions predispose patients to developing foot ulcerations, especially if foot deformities are present. Crest pads are a simple-to-make, inexpensive option to treat calluses and ulcerations on the distal ends of digits; however, there is no research available that support their use. Crest pads consist of rolled gauze covered in moleskin, with a large opening that fits over several toes and lies on the dorsal aspect of the foot, with the padded portion resting under the toes. Over several days of use, the pad molds to the plantar aspect of the toes, offloading pressure from the distal end of the affected digit(s). The sample was obtained through a retrospective chart review of patients identified as having had at least one nail care visit and at least one follow-up visit at a vascular surgery practice between August 2011 and December 2014. Potential subjects with toe deformities who presented with callus or ulcer on the distal end of a digit were considered for inclusion, if they received a crest pad as part of their treatment plan. The scholarly project was a preintervention or postintervention design with subjects acting as their own controls. McNemar's test was used to analyze the results which were statistically significant (P ulcer improvement following the crest pad intervention. The results of this scholarly project support the use of crest pads in patients with lesser-toe deformities to treat distal toe calluses and/or ulcerations.

  19. Lipschütz ulcer in a 17-month-old girl: a rare manifestation of Epstein-Barr primoinfection. (United States)

    Burguete Archel, Edurne; Ruiz Goikoetxea, Maite; Recari Elizalde, Eva; Beristain Rementería, Xabier; Gómez Gómez, Lourdes; Iceta Lizarraga, Ainhoa


    Lipschütz ulcer is an uncommon entity that is clinically characterised by a flu-like syndrome accompanied by an acute painful necrotic vulvar ulcer. It typically occurs in young women with no sexual contact history, and it is very rare among children. The aetiology is unknown, although recently several reports have related Epstein-Barr virus primary infection with this entity. We report a 17-month-old girl with fever and an acute genital ulcer. All the complementary tests for the most frequent causes of vulvar ulcers yielded negative results, whereas viral serology and polymerase chain reaction technique confirmed the presence of an acute Epstein-Barr virus infection. When main causes of genital ulcer have been excluded, and there is no history of sexual contact, Lipschütz ulcer should be included in the differential diagnosis. Detection of Epstein-Barr virus genome by polymerase chain reaction can lead to an earlier diagnosis.

  20. [NUG--necrotizing ulcerative gingivitis: a review]. (United States)

    Mizrahi, Y


    Necrotizing Ulcerative Gingivitis (NUG) is an acute and rare (0.5-11% of the population) infectious disease of the gum tissue, which is characterized by ulceration and inflammation of the inter-dental gum tissue. NUG was documented by historians since the fourth century BC, most of the reports from the ancient world were in the context of illness among fighting troops, present studies of NUG in the modern world are still common among soldiers. NUG is associated with poor oral hygiene and weakening of the host, especially in immunocompromised patients, malnutrition and poor living conditions, as well as in the context of mental stress. NUG is more common in young adults, but reports of morbidity in young children with malnutrition in the background are not uncommon. NUG diagnosis is based on three essential symptoms: sore gums, bleeding gums and the most diagnostic characteristic, ulceration and necrosis of the interdental papillae. The disease is considered to have a clear initial infectious etiology, when the main bacteria, associated with the disease, include: Bacteroides intermedius and Fusobacterium sp. The infection involves anaerobic \\ aerobic bacteria with a majority of Gram-negative bacteria. The treatment of NUG is based on combining mechanical removal of tartar with local and systemic delivery of antimicrobial agents. Adequate treatment usually prevent the progression of the disease and ulcer healing is expected in a few days. Nevertheless, lack of treatment can lead to deterioration in the form NUP to Noma.

  1. Infective Endocarditis Presented as a Right Atrium Mass in a Patient with Ulcerative Colitis

    Directory of Open Access Journals (Sweden)

    Ali Asghar Moeinipour


    Full Text Available Involvement of the heart is infrequently seen in irritable bowel syndrome (IBD. We present a case of severe acute infective endocarditis diagnosed as ulcerative colitis in further workup.

  2. Surgery for Crohn's Disease and Ulcerative Colitis (United States)

    ... Crohn's Disease & Ulcerative Colitis Go Back Surgery for Crohn's Disease & Ulcerative Colitis Email Print + Share ( Disclaimer: Surgery information ... helps you to learn what to expect. About Crohn’s disease and ulcerative colitis Crohn’s disease and ulcerative colitis ...

  3. Perforated duodenal ulcer: A rare complication of deferasirox in children (United States)

    Yadav, Sunil Kumar; Gupta, Vipul; El Kohly, Ashraf; Al Fadhli, Wasmi


    Duodenal ulcer perforation in pediatric age group is an uncommon entity; hence, it is not usually considered in the differential diagnosis of acute abdomen in these patients. It is important for the emergency physician to consider perforated peptic ulcer in the differential diagnosis of children presenting with acute abdominal pain, gastrointestinal bleeding, or shock. We report a 6½-year-old male child with thalassemia major who presented to emergency room with an acute abdomen and shock, who was subsequently found to have a perforated duodenal ulcer, probably related to use of oral chelating agent, deferasirox. Although, gastrointestinal symptoms like nausea, vomiting, and abdominal pain has been mentioned as infrequent adverse event in the scientific product information of deferasirox, in our current knowledge this is the first case report of perforated duodenal ulcer after oral deferasirox. The severity of this event justifies the reporting of this case. This patient had an atypical presentation in that there were no signs or symptoms of peptic ulcer disease before perforation and shock he was successfully managed with open surgery after initial resuscitation and stabilization of his general condition. PMID:23833377

  4. Perforated duodenal ulcer: a rare complication of deferasirox in children. (United States)

    Yadav, Sunil Kumar; Gupta, Vipul; El Kohly, Ashraf; Al Fadhli, Wasmi


    Duodenal ulcer perforation in pediatric age group is an uncommon entity; hence, it is not usually considered in the differential diagnosis of acute abdomen in these patients. It is important for the emergency physician to consider perforated peptic ulcer in the differential diagnosis of children presenting with acute abdominal pain, gastrointestinal bleeding, or shock. We report a 6½-year-old male child with thalassemia major who presented to emergency room with an acute abdomen and shock, who was subsequently found to have a perforated duodenal ulcer, probably related to use of oral chelating agent, deferasirox. Although, gastrointestinal symptoms like nausea, vomiting, and abdominal pain has been mentioned as infrequent adverse event in the scientific product information of deferasirox, in our current knowledge this is the first case report of perforated duodenal ulcer after oral deferasirox. The severity of this event justifies the reporting of this case. This patient had an atypical presentation in that there were no signs or symptoms of peptic ulcer disease before perforation and shock he was successfully managed with open surgery after initial resuscitation and stabilization of his general condition.

  5. Perforated duodenal ulcer: A rare complication of deferasirox in children

    Directory of Open Access Journals (Sweden)

    Sunil Kumar Yadav


    Full Text Available Duodenal ulcer perforation in pediatric age group is an uncommon entity; hence, it is not usually considered in the differential diagnosis of acute abdomen in these patients. It is important for the emergency physician to consider perforated peptic ulcer in the differential diagnosis of children presenting with acute abdominal pain, gastrointestinal bleeding, or shock. We report a 6½-year-old male child with thalassemia major who presented to emergency room with an acute abdomen and shock, who was subsequently found to have a perforated duodenal ulcer, probably related to use of oral chelating agent, deferasirox. Although, gastrointestinal symptoms like nausea, vomiting, and abdominal pain has been mentioned as infrequent adverse event in the scientific product information of deferasirox, in our current knowledge this is the first case report of perforated duodenal ulcer after oral deferasirox. The severity of this event justifies the reporting of this case. This patient had an atypical presentation in that there were no signs or symptoms of peptic ulcer disease before perforation and shock he was successfully managed with open surgery after initial resuscitation and stabilization of his general condition.

  6. Laparoscopic repair of gastroduodenal ulcer perforation : clinical analysis of 36 cases%腹腔镜修补急性胃十二指肠溃疡穿孔36例临床分析

    Institute of Scientific and Technical Information of China (English)

    丁涛; 夏德明; 匡勇军; 马达


    目的:总结腹腔镜急性胃十二指肠清疡穿孔修补术的临床经验.方法:回顾分析36例胃十二脂肠溃疡穿孔修补术中应用腹腔镜的临床资料.36例胃十二指肠溃疡穿孔中,十二指肠球部溃疡穿孔30例,胃幽门管穿孔3例,胃窦部前壁穿孔2例,胃体部小弯侧穿孔1例.病理检查6例中良性穿孔5例,癌性穿孔1例.结果:36例中35例获得成功.1例癌性溃疬中转开腹,无手术并发症发生,无死亡病例.良性溃疡患者术后平均8天出院,出院后均予以内科根除幽门杆菌、口服质子泵抑制剂治疗.结论:腹腔镜胃十二指肠溃疡穿孔修补术治疗急性胃十二指肠溃疡穿孔,与开腹手术同样安全有效,具有良好的临床应用价值.%Objective To summarize laparoscopic acute gastric duodenal clear ulcers punch suture clinical experience. Methods Retrospective analysis of 36 patients with gastric bowel ulcer perforation twelve fat in laparoscopic suture application of clinical data. 36 patients with gastric duodenal ulcer perforation, duodenal bulb ulcer perforation 30 cases. Stomach pyloric tube perforation in 3,the distal stomach front wall perforation in 2 cases,gastric body of curvature side perforation 1 case. Pathologic examination of the six cases of benign punch in 5 patients. Cancerous perforation 1 case. Results 36 fall in 35 cases of success. 1 cases of carcinoma sex run Li he-mi-colectomy, no complications happened. No deaths. Benign ulcer patients postoperative average 8 d in the hospital and after discharge shall be called helicobacter pylori eradication internal medicine, oral proton pump inhibitor treatment. Conclusion Laparoscopic gastroduodenal ulcer perforation suture in the treatment of acute gastric duodenal ulcer perforation, and laparotomy also is safe and effective, with good clinical application value.

  7. Clinical analysis of laparoscopic suture in the treatment of 40 cases of acute perforation of peptic ulcer%腹腔镜修补术治疗消化性溃疡急性穿孔40例临床分析

    Institute of Scientific and Technical Information of China (English)

    韩晓鹏; 柳万忠; 刘宏斌


    目的 探讨腹腔镜胃十二指肠溃疡修补术在消化性溃疡急性穿孔患者的临床应用价值.方法 回顾分析我科2010年3月-2011年5月使用腹腔镜行胃十二指肠溃疡修补手术治疗40例消化性溃疡穿孔患者的临床资料.结果 40例患者病理结果均为良性溃疡,手术时间为28 ~ 80 min,平均(40.1±17.8)min;术后下床活动时间为14~24 h,平均(16.8±4.7)h;去除胃肠减压时间为14 ~48 h,平均(19.7±3.5)h;术后镇痛药的使用率为12.5%(5/40);住院时间为4~7d,平均(5.1±1.4)d;术后均辅以内科抗溃疡药物治疗4~6周,随访6月,无溃疡复发.结论 应用腹腔镜胃十二指肠溃疡修补术治疗消化性溃疡穿孔具有安全可靠、疗效好、并发症少、恢复快等优点.%Objective To explore the clinical value of laparoscopic gastric ulcer suture in patients with acute perforation of peptic ulcer. Methods Clinical data of 40 patients with acute perforation of peptic ulcer underwent laparoscopic gastric ulcer suture in our department from March 2010 to May 2011 were retrospectively analyzed. Results Pathologic findings in 40 patients are benign ulcer, operation time is 28 -80 minutes, average operation time is (40 ?17.8) min; postoperative ambulation time is 14 -24h, (16.8?.7)hon average; removal of gastrointestinal decompression time is 14 -48h, (19.7 ?.5)h on average; the rate of postoperative analgesic use is 12.5% (5/40) ; hospitalization time is 4 -7d, (5. 1 ?1. 4)d on average; anti-ulcer drug for the treatment of 4 ~6 week, follow-up for 6 months, no ulcer recurrence. Conclusion Laparoscopic gastric ulcer suture has the features of safety, reliability, good curative effect, less complications and quick recovery.

  8. Prediction of Pressure Ulcer by Combination of Braden Scale Score and Acute Physiology and Chronic Health EvaluationⅡ Score%Braden 量表评分联合急性生理学与慢性健康状况评分系统Ⅱ评分预测压疮发生的价值

    Institute of Scientific and Technical Information of China (English)

    郝娜; 张建波; 高冰洁; 周平


    Background Pressure ulcer assessment is a crucial step in the nursing of pressure ulcer. Braden Scale is a widely used evaluation tool in current assessment of pressure ulcer,but there are limitations in the risk prediction of pressure ulcer in clinic. Objective To evaluate the value of Braden Scale score combined with acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score in pressure ulcer prediction. Methods 310 patients reported by clinic departments(including ICU,CCU,Department of Cardiovascular Disease, Liver Disease, Oncology, Nephrology, Orthopaedics, Emergency, etc. ) from Traditional Chinese Medicine Hospital in Chongqing from June 2014 to June 2015 were selected as the research objects. Patients'scores of Braden Scale and APACHE Ⅱ were collected. The patients scored not more than 12 in Braden Scale were predicted as high - risk pressure ulcer,while those who scored greater than 12 were low - risk pressure ulcer;the patients scored not more than 12 in Braden Scale and not less than 15 in APACHE Ⅱ were predicted as high - risk pressure ulcer,otherwise they would be taken as low - risk pressure ulcer. The receiver operating characteristic(ROC)curve was predicted by Braden Scale or Braden Scale score combined with APACHE Ⅱ score. The areas under curve ( AUC) of ROC,sensibility,specificity,positive predictive value and negative predictive value were also calculated. Results 57 patients developed pressure ulcer,and 253 patients didn't among the 310 inpatients. The 310 patients were predicted as high - risk pressure ulcer and 0 patients were low -risk pressure ulcer by Braden Scale score. The AUC of the occurrence of pressure ulcer predicted by Braden Scale score was 0. 326,95% CI( 0. 241,0. 410 );with 12 as the critical value,the sensitivity,specificity,positive predictive value, negative predictive value,and Youden's index of predicting the occurrence of pressure ulcer were 100% ,0,18. 4% ,0, 18. 4% ,0,and 0 respectively. 63 high - risk

  9. Thoracoscopic pericardial drainage for gastric tube ulcer penetrated into the pericardium. (United States)

    Watanabe, Masayuki; Matsuura, Koki; Baba, Hideo; Yoshizumi, Tomoharu; Ikegami, Toru; Soejima, Yuji; Ikeda, Tetsuo; Kawanaka, Hirofumi; Uchiyama, Hideaki; Yamashita, Yo-ichi; Morita, Masaru; Oki, Eiji; Mimori, Koshi; Sugimachi, Keishi; Saeki, Hiroshi; Maehara, Yoshihiko


    Peptic ulcer occurring in the gastric conduit for esophageal reconstruction sometimes penetrates into the mediastinal structures. We herein reported a case of pericardial penetration of gastric tube ulcer successfully treated with thoracoscopic pericardial drainage. A 66-year-old Japanese man, who had undergone esophagectomy for esophageal cancer 20 months before, visited our emergency room complaining severe back pain. Computed tomography revealed gastric tube ulcer penetrated into the pericardial space. Thoracoscopic pericardiotomy and drainage was performed and the patient made an uneventful recovery. Thoracoscopic pericardial drainage is useful to manage acute pyogenic pericarditis due to penetration of peptic ulcer which occurred in the gastric tube.

  10. Distal DVT: worth diagnosing? Yes. (United States)

    Schellong, S M


    Much of the argument for or against diagnosis of distal deep vain thrombosis (DVT) depends on the extra effort that has to be spent on it. This review presents the data on ultrasound of paired calf veins and calf muscle veins (distal ultrasound) in terms of protocols, feasibility, reliability and expected findings. In summary, provided there is adequate and anatomically sound training of sonographers, distal ultrasound is a valid, 4-minute procedure, which can easily be added to the examination of proximal veins. The second part of the review refers to the pathophysiology of ascending DVT, which is the most common type. Adequate patient care in terms of benefit, harm and cost includes a single non-invasive examination followed by risk adopted treatment allocation. This concept ideally should be valid for any type of DVT. The data extending this concept to distal DVT can only be derived from studies that look closely at this entity (i.e. in fact diagnose distal DVT). Even before these data are available, diagnosing distal DVT at least doubles the number of symptomatic patients in which signs and symptoms can be ascribed to a definitive diagnosis, which in itself is a benefit for patient care.

  11. Management of parastomal ulcers

    Institute of Scientific and Technical Information of China (English)

    Heather Yeo; Farshad Abir; Walter E Longo


    Management of surgically placed ostomies is an important aspect of any general surgical or colon and rectal surgery practice. Complications with surgically placed ostomies are common and their causes are multifactorial. Parastomal ulceration, although rare, is a particularly difficult management problem. We conducted a literature search using MD Consult, Science Direct,OVID, Medline, and Cochrane Databases to review the causes and management options of parastomal ulceration. Both the etiology and treatments are varied.Different physicians and ostomy specialists have used a large array of methods to manage parastomal ulcers;these including local wound care; steroid creams;systemic steroids; and, when conservative measures fail, surgery. Most patients with parastomal ulcers who do not have associated IBD or peristomal pyoderma gangrenosum (PPG) often respond quickly to local wound care and conservative management. Patients with PPG,IBD,or other systemic causes of their ulceration need both systemic and local care and are more likely to need long term treatment and possibly surgical revision of the ostomy. The treatment is complicated, but improved with the help of ostomy specialists.

  12. Venous ulcers of the lower limb: Where do we stand?

    Directory of Open Access Journals (Sweden)

    Chatterjee S Sasanka


    Full Text Available Venous ulcers are the most common ulcers of the lower limb. It has a high morbidity and results in economic strain both at a personal and at a state level. Chronic venous hypertension either due to primary or secondary venous disease with perforator paucity, destruction or incompetence resulting in reflux is the underlying pathology, but inflammatory reactions mediated through leucocytes, platelet adhesion, formation of pericapillary fibrin cuff, growth factors and macromolecules trapped in tissue result in tissue hypoxia, cell death and ulceration. Duplex scan with colour flow is the most useful investigation for venous disease supplying information about patency, reflux, effects of proximal and distal compression, Valsalva maneuver and effects of muscle contraction. Most venous disease can be managed conservatively by leg elevation and compression bandaging. Drugs of proven benefit in venous disease are pentoxifylline and aspirin, but they work best in conjunction with compression therapy. Once ulceration is chronic or the patient does not respond to or cannot maintain conservative regime, surgical intervention treating the underlying venous hypertension and cover for the ulcer is necessary. The different modalities like sclerotherapy, ligation and stripping of superficial varicose veins, endoscopic subfascial perforator ligation, endovenous laser or radiofrequency ablation have similar long-term results, although short-term recovery is best with radiofrequency and foam sclerotherapy. For deep venous reflux, surgical modalities include repair of incompetent venous valves or transplant or transposition of a competent vein segment with normal valves to replace a post-thrombotic destroyed portion of the deep vein.

  13. An integrated approach in the treatment of varicose ulcer

    Directory of Open Access Journals (Sweden)

    Deepa Patil


    Full Text Available Venous ulcers (stasis ulcers, varicose ulcers are the wounds occurring due to inappropriate functioning of venous valves, usually of the legs. It is one of the most serious chronic venous insufficiency complications. The overall incidence rate is 0.76% in men and 1.42% in women. When a venous valve gets damaged, it prevents the backflow of blood, which causes pressure in the veins that leads to hypertension and, in turn, venous ulcers. These are mostly along the medial distal leg, which is often very painful, can bleed, and get infected. Treating varicose ulcers is a difficult task to the physician and a nightmare to the suffering patients, though a good number of the treatment principles are mentioned and practiced in allied sciences. In Ayurveda, this condition is considered as dus.t.a vran.a. It can be managed with the specific s′odhana therapy. So, the same treatment protocol was used to treat the case discussed here, i.e. with Nitya virecana and by Basti karma. The wound was successfully treated and, therefore, is discussed in detail.

  14. Venous ulcers of the lower limb: Where do we stand? (United States)

    Chatterjee, Sasanka S


    Venous ulcers are the most common ulcers of the lower limb. It has a high morbidity and results in economic strain both at a personal and at a state level. Chronic venous hypertension either due to primary or secondary venous disease with perforator paucity, destruction or incompetence resulting in reflux is the underlying pathology, but inflammatory reactions mediated through leucocytes, platelet adhesion, formation of pericapillary fibrin cuff, growth factors and macromolecules trapped in tissue result in tissue hypoxia, cell death and ulceration. Duplex scan with colour flow is the most useful investigation for venous disease supplying information about patency, reflux, effects of proximal and distal compression, Valsalva maneuver and effects of muscle contraction. Most venous disease can be managed conservatively by leg elevation and compression bandaging. Drugs of proven benefit in venous disease are pentoxifylline and aspirin, but they work best in conjunction with compression therapy. Once ulceration is chronic or the patient does not respond to or cannot maintain conservative regime, surgical intervention treating the underlying venous hypertension and cover for the ulcer is necessary. The different modalities like sclerotherapy, ligation and stripping of superficial varicose veins, endoscopic subfascial perforator ligation, endovenous laser or radiofrequency ablation have similar long-term results, although short-term recovery is best with radiofrequency and foam sclerotherapy. For deep venous reflux, surgical modalities include repair of incompetent venous valves or transplant or transposition of a competent vein segment with normal valves to replace a post-thrombotic destroyed portion of the deep vein.

  15. Photoletter to the editor: Oral ulceration in pyoderma gangrenosum.

    LENUS (Irish Health Repository)

    Verma, Saroj


    A 65-year-old woman presented with widespread necrotising cutaneous ulceration and oral involvement. Past history included rheumatoid arthritis, and a left nephrectomy.Examination revealed multiple violaceous undermined ulcers. Blood investigations showed an acute inflammatory response. Skin histopathology showed epidermal ulceration with acute and chronic inflammation. Direct immunofluorescence was negative. A diagnosis of pyoderma gangrenosum with oral involvement was made. Mycophenolate mofetil therapy resulted in complete resolution of her pyoderma gangrenosum. Her treatment was complicated by a left proteus mirabilis psoas abscess. This resolved following four weeks of antibiotics.Pyoderma gangrenosum with oral involvement is rare but has been linked with inflammatory bowel disease and hematological disorders. Oral pyoderma gangrenosum has not previously been described in rheumatoid arthritis. Primary psoas abscess is rare but can develop in immunocompromised patients. Proteus mirabilis has been reported in patients years after nephrectomy. This is a rare case of pyoderma gangrenosum with oral involvement.

  16. Preventive Effect of Periplaneta Americana Extract on Stress Ulcer Bleeding in Patients with Acute Lung Injury or Acute Respiratory Distress Syndrome%美洲大蠊提取物对急性肺损伤/急性呼吸窘迫综合征患者应激性溃疡出血的预防作用

    Institute of Scientific and Technical Information of China (English)

    张宏伟; 魏立友; 张振宇; 刘淑正; 张静


    目的 探讨美洲大蠊提取物对急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)患者应激性溃疡出血的预防作用.方法 选取2009年1月-2010年1月我院中心ICU住院的严重创伤后ALI/ARDS患者64例为研究对象,随机数字表法分为治疗组和对照组,各32例,对照组给予积极常规综合治疗,治疗组在常规综合治疗基础上,于入院当天给予美洲大蠊提取物康复新液预防应激性溃疡出血,经胃管注入,10 ml/次,3次/d,连用7 d.分别于给药前及给药第7天,测定胃液pH值,测定氧分压,计算氧合指数(PaO2/FiO2);同时记录两组应激性溃疡出血发生率及病死率.结果 治疗前,两组患者胃液pH值、PaO2/FiO2比较,差异均无统计学意义(P>0.05);治疗后,两组患者胃液pH值、PaO2/FiO2比较,差异均有统计学意义(P<0.05).两组患者应激性溃疡出血发生率比较,差异有统计学意义(P<0.05);两组患者病死率比较,差异无统计学意义(P>0.05).结论 美洲大蠊提取物可改善ALI/ARDS患者胃液pH值、PaO2/FiO2,对应激性溃疡出血有预防作用.%Objective To study the preventive effect of periplaneta americana extract on stress ulcer bleeding in patients with acute lung injury and acute respiratory distress syndrome. Methods 64 in - patients with acute lung injury ( ALI ) or acute respiratory distress syndrome ( ARDS ) hospitalized in ICU from January 2009 to January 2010 were randomly divided into treatment group and control group with each group 32 cases. The control group was given positive routine treatment, while the treatment group was given periplaneta americana extract on the admission day to prevent stress ulcer bleeding in addition to routine treatment. The periplaneta americana extract was injected via gastronomy tube by 10 ml per time for seven consecutive days with each day three times. The pH value of gastric juice and oxygen partial pressure were detected before treatment and seven days after

  17. Microsurgical Treatment of Mooren's Ulcer

    Institute of Scientific and Technical Information of China (English)

    Hanping Xie; Jiaqi Chen; Xiangming Gong; Chunmao Feng; Longshan Chen; Yuesheng Lin


    Objective: To evaluate effect of microsurgery of lamellar keratoplasty (LKP) on Mooren's corneal ulcer.Methods: The effect, postoperative astigmatism, postoperative vision, ulcer recurrence of postoperation, and surgical complications of two groups of consecutive Mooren's ulcer inpatients treated respectively by non-microsurgery of LKP and microsurgery of LKP were analyzed.Results:There were significant differences of the effect, postoperative astigmatism,postoperative vision, ulcer recurrence of postoperation, and surgical complications between the two groups. The effect and postoperative vision of the microsurgery-treated groupwerebetterthanthoseofthenon-microsurgery-treatedgroup. The postoperative astigmatism, ulcer recurrence of postoperation, and surgical complications of the microsurgery-treated group were less than those of the nonmicrosurgery-treated group.Conclusion: Microsurgery of LKP of Mooren's corneal ulcer can greatly improve the ulcer healing and postoperative vision, and reduce the surgical complication and the ulcer recurrence of postoperation. Eye Science 2000; 16:56 ~ 60.

  18. Prognostic stratification of ulcerated melanoma

    DEFF Research Database (Denmark)

    Bønnelykke-Behrndtz, Marie L; Schmidt, Henrik; Christensen, Ib J


    OBJECTIVES: For patients with melanoma, ulceration is an important prognostic marker and interestingly also a predictive marker for the response of adjuvant interferon. A consensual definition and accurate assessment of ulceration are therefore crucial for proper staging and clinical management. We...... stratification of ulcerated lesions. METHODS: From H&E-stained sections, the status (presence vs absence), extent (percentage of the total tumor length), and type (infiltrative vs attenuative) of ulceration and epidermal involvement were evaluated from 385 patients with cutaneous melanoma. RESULTS: The presence...... of ulceration (hazard ratio [HR], 1.83), an attenuative type of ulceration (HR, 3.02), and excessive ulceration (HR, 3.57) were independent predictors of poor melanoma-specific survival. Further subdivision of minimal/moderate ulceration showed independent prognostic value only for lesions with epidermal...

  19. Treatment for Peptic Ulcer Disease (United States)

    ... Protectants Protectants coat ulcers and protect them against acid and enzymes so that healing can occur. Doctors only prescribe one protectant— sucralfate (Carafate) —for peptic ulcer disease. Tell your doctor if the medicines make you ...

  20. Microsurgical Reconstruction of Plantar Ulcers of the Insensate Foot. (United States)

    Kadam, Dinesh


    Background Plantar, neuropathic, or trophic ulcers are often found in patients with decreased sensation in the foot. These ulcers can be complicated by infection, deformity, and increased patient morbidity. Excision results in wider defects and local tissues are often insufficient for reconstruction Methods Total 26 free flaps were used in 25 patients to reconstruct plantar ulcers between years 2007 and 2013. The etiology included diabetic neuropathy (n = 13), leprosy (n = 3), spinal/peripheral nerve injury (n = 7), spina bifida (n = 1), and peripheral neuropathy (n = 1). The duration of the ulcer ranged from 1 to 18 years. Fifteen patients had associated systemic comorbidities and six had previous attempts. Free flaps used in reconstruction were the anterolateral thigh flap (n = 18), radial artery forearm flap (n = 4), and the gracilis muscle flap (n = 4). Recipient vessels were the posterior tibial artery (end to side) in 19 and the dorsalis pedis artery in 7. Results The average age at presentation was 44.6 years with mean duration of ulcer of 5.8 years predominantly located over weight-bearing areas. Mean size of ulcer was 59.45 cm(2) and mean follow-up period was 48 months. All flaps survived except a partial loss. Average time to resume ambulation was 6 weeks. Three patients had recurrence with mean follow-up of 48 months. Secondary flap reduction and bony resection was done in four. Conclusion Microvascular reconstruction of the sole has advantages of vascularity, adequate tissue, and leaving rest of the foot undisturbed for offloading. Three significant local conditions influencing selection and transfer of the flap include (1) distally located forefoot ulcers, (2) extensive subcutaneous fibrosis secondary to frequent inflammation, and (3) Charcot arthropathy. In our series, the anterolateral thigh flap is our first choice for reconstruction of these defects.

  1. Ulcer disease of trout (United States)

    Fish, F.F.


    During the summer of 1933, lesions of a disease were noted among some fingerling brook, rainbow, blackspotted, and lake trout at the Cortland (New York) trout hatchery. Although these lesions bore a marked superficial resemblance to those of furunculosis, they were sufficiently atypical to warrant further investigation. A more detailed examination of the lesions proved them to be of a distinct disease, which for lack of a better name is herein called "ulcer disease," for the lesions closely resemble those described by Calkins (1899) under this name. Because of the marked resemblance to furunculosis, ulcer disease has not been generally recognized by trout culturists, and any ulcer appearing on fish has been ascribed by them to furunculosis without further question.

  2. Pedal Gangrenous Changes in the Digits of an Adolescent With Ulcerative Colitis: A Case Report. (United States)

    Bhoola, Prashant H; Shtofmakher, Garry; Bahri, Ankur; Patel, Ankur A; Barlizo, Sharon R; Trepal, Michael


    Ulcerative colitis is an autoimmune inflammatory disease of the colon and is occasionally associated with thrombosis. We report the case of an adolescent with ulcerative colitis who presented with bilateral gangrenous toes without signs of ascending cellulitis. Radiographs indicated the presence of bilateral and erosive changes in the distal phalanges. The vascular team referred the patient for podiatric intervention for distal vasculitis and thrombosis of the digital vessels. Transphalangeal amputations were performed, and postoperative antibiotics were initiated. The surgical sites healed uneventfully, and the patient was able to resume daily activities. Thrombosis of the foot in the context of ulcerative colitis is a rare, but serious, complication that can lead to serious comorbidities, including amputation.

  3. Clinical diagnosis and treatment of necrotizing ulcerative gingivitis in the orthodontic patient. A case report.

    Directory of Open Access Journals (Sweden)

    Jesús Rodríguez-Pulido


    Full Text Available Introduction: About 0.1% of the population suffers from necrotizing ulcerative gingivitis, a disease of rapid progression and acute manifestation, which may progress to necrotizing ulcerative periodontitis and eventually to bone sequestration and loss of gingival tissue. Case report: A 21-year-old female patient undergoing orthodontic treatment for six months, diagnosed with necrotizing ulcerative gingivitis due to acute pain in the gingival tissue, spontaneous bleeding, halitosis and abundant plaque. The treatment was conservative and effective, obtaining total remission of the lesion after seven days and three months of postoperative follow-up. Conclusion: Today there are no epidemiological or clinical reports that support the relationship of necrotizing ulcerative gingivitis and orthodontic treatment. Prevention is critical to the success of the treatment, which is why the dentist should recognize the clinical features of necrotizing ulcerative gingivitis to raise awareness of its risks in the orthodontic patient.

  4. Klinefelter Syndrome With Leg Ulcers

    Directory of Open Access Journals (Sweden)

    Narendra G


    Full Text Available Leg ulcers are frequently caused by venous insufficiency, arterial insufficiency, neuropathy, or a combination of these factors. Klinefelter syndrome in association with chronic leg ulcers have been reported earlier. We report a case of Klinefelter syndrome with non- healing ulcer. The diagnosis of the Klinefelter syndrome was confirmed by karyotyping.

  5. Intestinal Behcet's disease with esophageal ulcers and colonic longitudinal ulcers

    Institute of Scientific and Technical Information of China (English)

    Soichiro Fujiwara; Ichiro Shimizu; Momoko Ishikawa; Kohzo Uehara; Hirofumi Yamamoto; Michiyo Okazaki; Takahiro Horie; Arata Iuchi; Susumu Ito


    Intestinal Behcet's disease in a 38-year-old woman was diagnosed because of the history of recurrent oral aphthous ulcers, erythema nodosum-like eruptions,genital ulcer, and endoscopic findings of esophageal and ileocolonic punched-out ulcers with colonic longitudinal ulcers. Esophageal lesions and colonic longitudinalulcers are rarely seen in intestinal Behcet's disease. The ulcers of esophagus and ileocolon healed with 3 wk of treatment with prednisolone and mesalazine without any adverse effect. Mesalazine may decrease the total dose of prednisolone required to treat the disease.

  6. Clinical Study on Risk Factors of Stress Ulcer in Patients With Acute Cerebral Contusion and Laceration%急性脑挫裂伤患者发生应激性溃疡危险因素的临床研究

    Institute of Scientific and Technical Information of China (English)



    目的:探讨急性脑挫裂伤患者发生应激性溃疡的危险因素。方法选择我院脑外科2014年1月~2015年12月收治的急性脑挫裂伤患者60例,将60例病例分别按照性别、年龄、损伤程度、血糖、血压、体温、手术治疗、鼻饲情况分为两组,分别统计每组患者出现应激性溃疡的例数,进行组间数据比较。结果本组60例急性脑挫裂伤患者中共并发应激性溃疡16例,发生率为26.7%;其中发生应激性溃疡与患者的性别和年龄无关,P>0.05,与患者的脑损伤程度、体温、血糖、血压、鼻饲、手术治疗相关,P<0.05。结论高血糖、低血压、损伤程度较重、发热、接受手术治疗、采用鼻饲均是引发急性脑挫裂伤患者应激性溃疡的危险因素,临床上针对这些危险因素应采用适当的预防措施,可以有效的降低发生率,对促进急性脑挫裂伤患者尽早康复和提高其预后质量具有重要意义。%Objective To investigate the acute cerebral contusion in stress ulcer in patients with risk factors.Methods 60 patients with acute cerebral contusion were chosen in January 2014 ~ December 2015, 60 cases respectively according to gender, age, degree of injury, blood glucose, blood pressure, body temperature, surgical treatment, nasogastric divided into two groups, respectively statistics in stress ulcer patients in each group, or to compare data between groups.Results 60 patients with acute cerebral contusion of the communist party of 16 cases complicated with stress ulcer, the rate of 26.7%, which occur stress ulcer has nothing to do with the patient's age and gender,P > 0.05, and the degree of the patients with brain injury, body temperature, blood sugar, blood pressure, nasogastric, surgical treatment, P < 0.05.Conclusion Hyperglycemia, low blood pressure, damage degree is heavier, fever, surgery, using nasal feeding are caused by acute cerebral contusion in stress ulcer in

  7. The Rationale and Results of Gastroplasty/Distal Gastric Bypass. (United States)

    Salmon; McArdle


    A recent review of the results of gastroplasties done at the University of Alberta Hospital showed that there was a high incidence of late weight loss failure. Therefore a new operation, gastroplasty/distal gastric bypass, has been performed on 263 patients. This operation results In a profound (mean greatest percentage excess weight loss of 87% at approximately 2 years) and lasting weight loss (mean final percentage excess weight loss of 78%) at 4 years, range 2-7.5 years post-operatively. Only 0.9 % of patients failed to maintain at least a 40% excess weight loss. The operation achieves its effect through a moderate restriction that permits patients to eat normal table food from the time of discharge and with a mild metabsorption that is not ordinarily associated with diarrhea or notable deficiencies. Certain patients required debanding of the stoma and others developed staple-line eventration. Neither of these events after long-term follow-up resulted in weight loss failure nor in other serious side-effects. It Is concluded that moderate failure of the gastroplasty stoma and staple line does not necessarily result in weight loss failure, because the malabsorptive portion of the operation remains intact. Low hemoglobin occurred in 16% of cases and deficiency of serum iron In 34%; a much smaller number of patients had chronic or Intermittent deficiencies of these entities. Correction was easily achieved with oral replacement. Deficiencies in albumin, calcium, phosphorus and folate were rarely seen and minimal elevation of serum AST values occurred In just over 1% of patients. Chronic deficiencies or elevations were not seen in these patients. Stomal ulcer occurred in 6% of patients and bleeding associated with stomal ulcer in 1%. Half the patients with ulcer were managed with H&inf2; blockers, the other half with vagotomy. Both forms of treatment when individualized effectively prevent re-ulceration.

  8. The application of cluster nursing on acute pressure ulcers prevention among cardiac surgery patients with extracorporeal circulation%应用集束化护理预防成人体外循环心脏手术患者围手术期急性压疮的实践

    Institute of Scientific and Technical Information of China (English)

    智红晓; 宋葆云; 杨巧芳


    目的:评价集束化护理在成人体外循环心脏手术患者围手术期急性压疮预防中的作用。方法:将2014年2月1日至8月31日经体外循环心脏手术后入住ICU的压疮高危患者作为对照组(62例)进行历史回顾,将2014年12月1日至2015年6月30日术后入住ICU的压疮高危患者作为观察组(111例)。采用集束化护理对观察组进行干预。结果:对照组中15例发生I期压疮,2例发生Ⅱ期压疮,1例发生Ⅲ期压疮,压疮发生率为29.03%;观察组中6例发生I期压疮,无Ⅱ期和Ⅲ期压疮发生,压疮发生率为5.41%;两组压疮发生率比较差异有统计学意义(P<0.01)。结论:针对成人体外循环心脏手术压疮高危患者实施集束化压疮预防管理措施,可以有效降低其围手术期压疮的发生率。%Objective: To evaluate the effects of cluster nursing on acute pressure ulcers prevention among cardiac surgery patients with extracorporeal circulation. Methods: High pressure ulcer risk patients with Braden score12 within 24h in ICU from Feb. to Aug. 2014 were recruited and reviewed as control group(62 cases), while the similar patients in ICU from Dec. 2014 to June 2015 were recruited as observation group (111 cases). The observation group received cluster nursing intervention. Results: In the control group, 15 patients, 2 patients and 1 patient developed level I , level II level III pressure ulcers , respectively, The pressure ulcer rate in the control group was 29.03%. In the observation group, only 6 patients developed level I pressure ulcers. The pressure ulcer rate in observation group was 5.41%. The differences of pressure ulcer rate between the two groups was statistically significant (P<0.01). Conclusion: Cluster nursing could decrease the incidence of pressure ulcers among high risk cardiac surgery patients with cardiopulmonary bypass.

  9. Peptic Ulcer Disease (United States)

    ... include:Protein pump inhibitors, like esomeprazole (Nexium) or lansoprazole (Prevacid).Histamine receptor blockers, like famotidine (Pepcid) or ranitidine (Zantac).Protectants, like sucralfate (Carafate).If using NSAIDs caused your peptic ulcer and there’s no H. pylori infection, you may ...

  10. Perforated peptic ulcer

    DEFF Research Database (Denmark)

    Søreide, Kjetil; Thorsen, Kenneth; Harrison, Ewen M


    Perforated peptic ulcer is a common emergency condition worldwide, with associated mortality rates of up to 30%. A scarcity of high-quality studies about the condition limits the knowledge base for clinical decision making, but a few published randomised trials are available. Although Helicobacte...

  11. [Distal humerus fractures in children]. (United States)

    Schneidmueller, D; Boettger, M; Laurer, H; Gutsfeld, P; Bühren, V


    Fractures of the distal humerus belong to the most common injuries of the upper arm in childhood. Most frequently occurring is the supracondylar fracture of the distal humerus. In these cases and in the second most common epicondylar fractures, the metaphysis is affected and these fractures are therefore extra-articular. They have to be distinguished from articular fractures regarding therapy and prognosis. The growth potential of the distal epiphysis is very limited as is the possibility of spontaneous correction so that major dislocations should not be left uncorrected. Unstable and especially dislocated articular fractures must be anatomically reconstructed employing various osteosynthetic techniques, mostly combined with immobilization. Insufficient reconstruction, growth disturbance and non-union can result in axial deformities, such as cubitus valgus and varus, restriction of motion, pain and nerve palsy.

  12. Anti-ulcer effects of Lycium barbarum polysaccharide in rats

    Institute of Scientific and Technical Information of China (English)

    YE Rui-dong; YANG Qian-zi; XIAO Wei; LIU Fang-e; CHEN Jian-kang


    Objective: To investigate the effects of Lycium barbarum polysaccharide (LBP) on experimental gastric ulcers in rats. Methods: The ulcers were induced by water-immersion restraint stress, acetic acid and pylorus-ligation in rats. In each model, animals were divided randomly into 4 groups and administrated with LBP of 100 mg/kg and 300 mg/kg, ranitidine 100 mg/kg (as a reference standard) and saline respectively. Mucosal lesions were scored as ulcer index. In the pylorus-ligation model, we also compared the gastric juice volume, total acidity, acid output and pepsin activity among groups. Results: Oral administration of LBP inhibited the formation of the acute gastric lesions induced by physical stress such as water-immersion restraint (P<0.05), and accelerated the healing of chronic gastric ulcer model induced by acetic acid (P<0.05 to P<0.01). In the pylorus-ligated rats, significant decrease was also seen in ulcer index (P<0.05 to P<0.01), total acidity (P<0.05), acid output (P<0.05 to P<0.01). LBP 300 mg/kg even showed marked reduction of the volume (P<0.05) and pepsin activity (P<0.05) in the gastric juice. These effects were in a dose-dependent manner. Conclusion: LBP has protective effects on treating gastric ulcer and this action may relate to the reduction of acid output and pepsin activity in the gastric juice.

  13. Perforated peptic ulcer following gastric bypass for obesity. (United States)

    Macgregor, A M; Pickens, N E; Thoburn, E K


    Peptic ulcer in the excluded segment of a gastric bypass performed in the management of morbid obesity has only rarely been reported in the literature. The purpose of this study is to review our experience with the condition in a series of 4300 patients who underwent gastric-restrictive surgery between 1978 and 1997. Eleven patients presented with acute perforation of a peptic ulcer in the excluded gastric segment. Nine ulcers were duodenal, one was gastric, and one patient had both gastric and duodenal perforations. The time between primary gastric-restrictive surgery and ulcer perforation varied from 20 days to 12 years. All patients presented with upper abdominal pain. The classical radiological sign of perforated peptic ulcer, free air under the diaphragm, did not occur in any patient. Nine patients were initially treated by primary closure of the perforation with subsequent definitive ulcer therapy by vagotomy, pyloroplasty, or gastrectomy. One case, initially treated elsewhere, was managed by placement of a Malecot catheter through the duodenal perforation, gastrostomy, and peritoneal drainage. One recent case remains symptom-free on H2 blockers after simple closure. There was no mortality. Six cases were previously reported in the literature with a 33 per cent mortality rate.

  14. Study of anti ulcer activity ofFicus religiosa L. on experimentally induced gastric ulcers in rats

    Institute of Scientific and Technical Information of China (English)

    Sarmistha Saha; Gagan Goswami


    Objective:To investigate the gastroprotective activity of hydroalcoholic extract leaves ofFicus religiosa(F. religiosa) in different experimental models of gastric ulcer in rats.Methods: The hydroalcoholic extract leaves ofF. religiosa were studied at two dose levels (250 and500 mg/kg, oral) in rats against absolute ethanol (0.2 mL oral), aspirin (200 mg/kg) and pyloric ligation induced gastric ulcer. Ranitidine (50mg/kg, oral) was used as a standard drug. Mean ulcer indices and oxidative stress were measured. Phytochemical tests and acute toxicity tests were also carried out.Results:Administration ofF. religiosa to rats significantly decreased the ulcer index value when compared with the control treated group. Ranitidine (50 mg/kg, oral) also produced a significant decrease the ulcer index value when compared with the control treated group. Phytochemical analysis revealed the presence of tannins, sterols, saponins, flavonoids, carbohydrates and proteins.Conclusions: The results suggest that the leaves of theF. religiosa possess significant anti ulcer activity.

  15. Topical Rosiglitazone Treatment Improves Ulcerative Colitis by Restoring Peroxisome Proliferator-Activated Receptor-gamma Activity

    DEFF Research Database (Denmark)

    Pedersen, G.; Brynskov, Jørn


    and functional activity in human colonic epithelium and explored the potential of topical treatment with rosiglitazone (a PPAR gamma ligand) in patients with ulcerative colitis. METHODS: Spontaneous and rosiglitazone-mediated PPAR gamma and adipophillin expression (a gene transcriptionally activated by PPAR...... gamma) were measured by reverse transcriptase PCR in colonic biopsies and isolated epithelial cells from patients with ulcerative colitis and controls. Fourteen patients with active distal ulcerative colitis were randomized to either rosiglitazone (4 mg) or mesalazine (1 g) enema treatment once daily...... in epithelial cells from inflamed mucosa in vitro. Rosiglitazone enema treatment was well tolerated and reduced the Mayo ulcerative colitis score from 8.9 to 4.3 (P

  16. [When to worry about before a vascular chronic leg ulcer?]. (United States)

    Lazareth, I


    Leg ulcers are a chronic condition. Healing can be long for venous ulcers and the risk of complications is significant. Infection is the most severe complication and can occur in the form of easily diagnosed acute bacterial dermohypodermitis that generally responds well to antibiotic treatment if given at an appropriate dose or in the form of localized infection that is more difficult to diagnosis. Indeed, no consensus has been reached in the literature on the clinical criteria to retain for the diagnosis of localized infection. Similarly, the most appropriate treatment remains to be established. Local care would be a logical starting point, followed by systemic antibiotics if this approach is unsuccessful. Individual conditions also should be taken into consideration (immunodepression, severe arteriopathy warranting more rapid use of systemic antibiotics). The second most frequent complication is an allergic reaction to a topical agent used for wound care. The rate of sensitivization in patients with leg ulcers is high (60 %), although the rate is declining with modern dressings. No product can be considered perfectly safe for these polysensitized patients. Dermocorticoid therapy can be very effective. Allergology tests are needed. Certain leg ulcers require special care from diagnosis. An arterial origin must be suspected for deep, or necrotic ulcers. Arterial supply must be explored rapidly, followed by a revascularization procedure when necessary. Highly painful superficial extensive necrotic ulcers due to necrotic angiodermitis require hospital care for skin grafts that will control the antiodermitis and provide pain. Carcinoma should be suspected in cases of leg ulcers with an atypical localization exhibiting excessive budding. A biopsy is mandatory for leg ulcers with an unusual course (absence of healing despite well-conducted care).

  17. Diabetes Foot Ulcers: A novel Treatment Strategy

    Directory of Open Access Journals (Sweden)

    Golnaz Namazi


    Full Text Available Foot ulcers are common in 12-25 percent of diabetic patients. Preventing, controlling and treating of these kind chronic wounds are of the major clinical challenges.Evidence based documents revealed that DFU (Diabetic Foot ulcer is a chronic wound type originating from disturbed cellular and molecular mechanisms that have to be in its functional form to overcome its problem. In diabetes and some other chronic based diseases, harmonized acting machine causes chronic phases that result in conditions as foot ulceration and related complications seen commonly in diabetes.DFU needs to be transformed into acute phase in order to be healed in a physiological manner. Disturbed mechanisms have to be corrected reversely and to achieve such a goal it is essential to better understanding of disturbing factors responsible for biological abnormalities. Factors associated with DFU are as cellular and molecular recruitment and function impairments and there is need to repair these mechanisms. For this, we believe that the activated Th-1 cells (T helper-1 Cells might have a critical role in regulation of the several effector functions of the cellular and molecular mechanisms essential to the body to act the best. Evidences and our successful results urge us to suggest this regulatory role for effector cells and molecules generated through activation of Th-1 cells as a treatment strategy.

  18. Distal esophageal spasm: an update. (United States)

    Achem, Sami R; Gerson, Lauren B


    Distal esophageal spasm (DES) is an esophageal motility disorder that presents clinically with chest pain and/or dysphagia and is defined manometrically as simultaneous contractions in the distal (smooth muscle) esophagus in ≥20% of wet swallows (and amplitude contraction of ≥30 mmHg) alternating with normal peristalsis. With the introduction of high resolution esophageal pressure topography (EPT) in 2000, the definition of DES was modified. The Chicago classification proposed that the defining criteria for DES using EPT should be the presence of at least two premature contractions (distal latencylong acting), calcium-channel blockers, anticholinergic agents, 5-phosphodiesterase inhibitors, visceral analgesics (tricyclic agents or SSRI), and esophageal dilation. Acid suppression therapy is frequently used, but clinical outcome trials to support this approach are not available. Injection of botulinum toxin in the distal esophagus may be effective, but further data regarding the development of post-injection gastroesophageal reflux need to be assessed. Heller myotomy combined with fundoplication remains an alternative for the rare refractory patient. Preliminary studies suggest that the newly developed endoscopic technique of per oral endoscopic myotomy (POEM) may also be an alternative treatment modality.

  19. Roxatidine in duodenal ulcer.

    Directory of Open Access Journals (Sweden)

    Habibullah C


    Full Text Available Roxatidine acetate is a new H2-receptor antagonist. A randomized double-blind clinical trial in fifty-three patients with endoscopically proven duodenal ulcers > 5 mm in diameter was undertaken to compare safety and efficacy of roxatidine with that of ranitidine. Twenty-six patients received roxatidine (75 mg bid while 27 patients received ranitidine (150 mg bid for 4 weeks. One patient in each group did not come for follow up. Roxatidine and ranitidine had comparable ulcer healing rates (22/25 vs 22/26; roxatidine, however, resulted in greater reduction in the number and severity of night time pain episodes (p < 0.05. No adverse event was reported during 4 weeks of treatment with roxatidine. Thus roxatidine achieves the primary therapeutic goal of relief of pain better than ranitidine.

  20. Roxatidine in duodenal ulcer. (United States)

    Habibullah, C M; Habeeb, M A; Singh, S P


    Roxatidine acetate is a new H2-receptor antagonist. A randomized double-blind clinical trial in fifty-three patients with endoscopically proven duodenal ulcers > 5 mm in diameter was undertaken to compare safety and efficacy of roxatidine with that of ranitidine. Twenty-six patients received roxatidine (75 mg bid) while 27 patients received ranitidine (150 mg bid) for 4 weeks. One patient in each group did not come for follow up. Roxatidine and ranitidine had comparable ulcer healing rates (22/25 vs 22/26); roxatidine, however, resulted in greater reduction in the number and severity of night time pain episodes (p roxatidine. Thus roxatidine achieves the primary therapeutic goal of relief of pain better than ranitidine.

  1. Another 'Cushing ulcer'. (United States)

    Hoshino, Chisho; Satoh, Noriyuki; Narita, Masashi; Kikuchi, Akio; Inoue, Minoru


    The authors describe the case of a 39-year-old man who presented to our hospital with easy fatigability and malaise. On physical examination, hypertension was noted without any cushingoid appearance. Laboratory testing revealed normochromic-normocytic anaemia with positive results of occult blood in the stool, hyperglycaemia and hypokalemia. Upper endoscopy revealed active gastric ulcer with Helicobacter pylori infection, likely causing gastrointestinal bleeding. Endocrine examinations showed that both serum adrenocorticotropic hormone and cortisol were elevated with loss of diurnal variation. A diagnosis of Cushing's disease secondary to pituitary adenoma was made as results of brain MRI and blood sampling from inferior petrosal sinus. In a patient with peptic ulcer disease, physician should be alert to the possible endocrine background.

  2. Venous Leg Ulcers. (United States)

    Vivas, Alejandra; Lev-Tov, Hadar; Kirsner, Robert S


    This issue provides a clinical overview of venous leg ulcers, focusing on prevention, diagnosis, treatment, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.

  3. Ulcerative Colitis in Infancy


    Md Rukunuzzaman; A. S. M. Bazlul Karim


    Ulcerative colitis (UC) is a chronic idiopathic inflammatory disorder of colon. Frequency of UC is gradually increasing over few years worldwide. Prevalence is 35 to 100/100 000 people in USA, 1% of them are infants. UC develops in a genetically predisposed individual with altered intestinal immune response. An eight-month-old girl presented with loose bloody stool, growth failure, and moderate pallor. The girl was diagnosed as a case of UC by colonoscopy and biopsy. Treatment was thereafter ...

  4. [Correlation between hyperamylasemia and acute pancreatitis]. (United States)

    Monaco, R; Durante, E; Pampolini, M; Tioli, P


    It is often difficult to differentiate acute pancreatitis (A.P.) from some other acute abdominal diseases, when there is an elevated serum amylase. In contrast, the renal clearance of amylase, expressed as a percentage of creatinine clearance, can separate patients with A.P. from patients with acute colecistitis, common duct stone without pancreatitis, hyperamylasemia after biliary surgery, acute peptic ulcer and acute salivary diseases.

  5. Cryoglobulin induced skin ulceration

    Directory of Open Access Journals (Sweden)

    Fatima Razvi


    Full Text Available Lupus Erythematosus (LE is a multi-organ auto-immune disease which results from complex interaction of genetic and environmental factors. The clinical spectrum ranges from minor cutaneous lesions to life threatening multi-organ dysfunction. The skin manifestations are variable and common and range from LE specific to LE non-specific cutaneous disease. Vasculitis is one of the most common non-specific skin lesion of Systemic lupus erythematosus (SLE and appears as purpuric lesions, infarcts along lateral nail folds, peripheral gangrene, sub-cutaneous nodules and ulcers. Mixed cryoglobulinaemia (type II is associated with connective tissue disorders including SLE. Skin manifestations are seen in 60-100% patients and are more common in females. The most common manifestation is palpable purpura of lower extremities seen in 30-100% which often is triggered in winter or on cold exposure. Skin infarction, hemorrhagic crusts and ulcers are seen in 25% of patients. Wide spread necrotic ulcers are seen in 10-25% of patients which are often exacerbated by cold.

  6. Benign duodenocolic fistula as a complication of peptic ulcer disease. (United States)

    Kamani, Fereshteh; Hessami, Reza; Abrishami, Alireza


    A 44-year-old man with upper abdominal pain, diarrhea and 25 kg weight loss since 3 months ago was admitted. He had a history of dyspepsia and peptic ulcer disease 4 months before admission. Gastroduodenal endoscopy and upper gastrointestinal series with barium study were done. Biopsies and CT-scan ruled out malignancies. Endoscopy and radiology studies revealed a duodenocolic fistula. He underwent right hemicolectomy, fistula en bloc excision, and distal gastrectomy surgery with gastrojejunostomy and ileocolic anastomosis. Radiologic modalities are necessary before surgery. Surgery is the only curative treatment in benign cases and reconstruction method is dependent on patient's situation.

  7. [Peptic ulcer disease and stress]. (United States)

    Herszényi, László; Juhász, Márk; Mihály, Emese; Tulassay, Zsolt


    The discovery that Helicobacter pylori infection is the major cause of peptic ulcer disease revolutionised our views on the etiology and treatment of the disease. This discovery has tempted many experts to conclude that psychological factors and, specifically, stress are unimportant. However, Helicobacter pylori infection alone does not explain fully the incidence and prevalence of peptic ulcer disease. It has been demonstrated that stress can cause peptic ulcer disease even in the absence of Helicobacter pylori infection, supporting a multicausal model of peptic ulcer etiology. Psychological stress among other risk factors can function as a cofactor with Helicobacter pylori infection.

  8. Distal clavicle fractures in children☆ (United States)

    Labronici, Pedro José; da Silva, Ricardo Rodrigues; Franco, Marcos Vinícius Viana; Labronici, Gustavo José; Pires, Robinson Esteves Santos; Franco, José Sergio


    Objective To analyze fractures of the distal clavicle region in pediatric patients. Methods Ten patients between the ages of five to eleven years (mean of 7.3 years) were observed. Nine patients were treated conservatively and one surgically. All the fractures were classified using the Nenopoulos classification system. Results All the fractures consolidated without complications. Conservative treatment was used for nine patients, of whom three were in group IIIB, three IIb, two IIa and one IV. The only patient who was treated surgically was a female patient of eleven years of age with a group IV fracture. Conclusion The treatment indication for distal fractures of the clavicle in children should be based on the patient's age and the displacement of the fragments. PMID:26962489

  9. Distal clavicle fractures in children

    Directory of Open Access Journals (Sweden)

    Pedro José Labronici


    Full Text Available ABSTRACT OBJECTIVE: To analyze fractures of the distal clavicle region in pediatric patients. METHODS: Ten patients between the ages of five to eleven years (mean of 7.3 years were observed. Nine patients were treated conservatively and one surgically. All the fractures were classified using the Nenopoulos classification system. RESULTS: All the fractures consolidated without complications. Conservative treatment was used for nine patients, of whom three were in group IIIB, three IIb, two IIa and one IV. The only patient who was treated surgically was a female patient of eleven years of age with a group IV fracture. CONCLUSION: The treatment indication for distal fractures of the clavicle in children should be based on the patient's age and the displacement of the fragments.

  10. Natural history of a randomized trial comparing distal spleno-renal shunt with endoscopic sclerotherapy in the prevention of variceal rebleeding: A lesson from the past

    Institute of Scientific and Technical Information of China (English)

    Roberto Santambrogio; Enrico Opocher; Mara Costa; Savino Bruno; Andrea Pisani Ceretti; Gian Paolo Spina


    AIM: To compare endoscopic sclerotherapy (ES) with distal splenorenal shunt (DSRS) in the prevention of recurrent variceal bleeding in cirrhotic patients during a long-term follow-up period.METHODS: In 1984 we started a prospective, controlled study of patients with liver cirrhosis. Long-term follow-up presents a natural history of liver cirrhosis complicated by advanced portal hypertension. In this study the effects of 2 types of treatment, DSRS or ES, were evaluated. The study population included 80 patients with cirrhosis and portal hypertension referred to our department from October 1984 to March 1991. These patients were drawn from a pool of 282 patients who underwent either elective surgery or ES during the same period of time. Patients were assigned to one of the 2groups according to a random number table: 40 to DSRS and 40 to ES using polidocanol.RESULTS: During the postoperative period, no DSRS patient died, while one ES patient died of uncontrolled hemorrhage. One DSRS patient had mild recurrent variceal hemorrhage despite an angiographically patent DSRS and another patient suffered duodenal ulcer rebleeding. Eight ES patients suffered at least one episode of gastrointestinal bleeding: 4 from varices and 4 from esophageal ulcerations. Eight ES patients developed transitory dysphagia. Long-term followup was completed in all patients except for 5 cases (2DSRS and 3 ES patients). Five-year survival rates for shunt (73%) and ES (56%) groups were statistically different: in this follow-up period and in subsequent follow-ups this difference decreased and ceased to be of statistical relevance. The primary cause of death became hepatocellular carcinoma (HCC). Four DSRS patients rebled due to duodenal ulcer, while eleven ES patients had recurrent bleeding from esophago-gastric sources (seven from varices, three from hypertensive gastropathy, one from esophageal ulcerations) and two from unknown sources. Nine DSRS and 2 ES patients developed a chronic

  11. Acute abdomen

    Directory of Open Access Journals (Sweden)

    Wig J


    Full Text Available 550 cases of acute abdomen have been analysed in detail includ-ing their clinical presentation and operative findings. Males are more frequently affected than females in a ratio of 3: 1. More than 45% of patients presented after 48 hours of onset of symptoms. Intestinal obstruction was the commonest cause of acute abdomen (47.6%. External hernia was responsible for 26% of cases of intestinal obstruction. Perforated peptic ulcer was the commonest cause of peritonitis in the present series (31.7% while incidence of biliary peritonitis was only 2.4%.. The clinical accuracy rate was 87%. The mortality in operated cases was high (10% while the over-all mortality rate was 7.5%.

  12. Chondroblastoma of the distal phalanx. (United States)

    Gregory, James R; Lehman, Thomas P; White, Jeremy R; Fung, Kar-Ming


    Chondroblastoma is a rare, benign primary bone tumor that usually occurs at the epiphysis of long bones. The authors present an example of the diagnosis and successful treatment of this neoplasm in an exceedingly rare location in the distal phalanx. Clinical and radiographic outcomes after 68 months of follow-up are presented. A 15-year-old, right hand-dominant, boy developed painful swelling of the right ring finger. Radiographs revealed a radiolucent lesion of the distal phalanx with expansile remodeling of the bone. An excisional biopsy was performed with curettage and bone grafting of the lesion. The diagnosis of chondroblastoma was made based on pathologic evaluation of the biopsy specimen. Sixty-six months after surgical treatment, the patient was free of recurrence and metastatic disease with excellent clinical and functional outcomes. To the authors' knowledge, this represents only the second reported case of chondroblastoma of the distal phalanx. The diagnosis of chondroblastoma in this rare location was made by pathologic review of the resection specimen. It is imperative to confirm the diagnosis of any resected bone specimen even when the concern for an aggressive or malignant lesion is low. A tumor presenting in an unusual location may require a change in treatment or surveillance.

  13. Acute small bowel obstruction caused by endometriosis: A case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Antonella De Ceglie; Claudio Bilardi; Sabrina Blanchi; Massimo Picasso; Marcello Di Muzio; Alberto Trimarchi; Massimo Conio


    Gastrointestinal involvement of endometriosis has been found in 3%-37% of menstruating women and exclusive localization on the ileum is very rare (1%-7%).Endometriosis of the distal ileum is an infrequent cause of intestinal obstruction,ranging from 7% to 23% of all cases with intestinal involvement.We report a case in which endometrial infiltration of the small bowel caused acute obstruction requiring emergency surgery,in a woman whose symptoms were not related to menses.Histology of the resected specimen showed that endometriosis was mainly prevalent in the muscularis propria and submucosa and that the mucosa was not ulcerated but had inflammation and glandular alteration. Endometrial lymph node involvement,with a cystic glandular pattern was also deted.

  14. Perforated duodenal ulcer in high risk patients: Is percutaneous drainage justified?

    Directory of Open Access Journals (Sweden)

    Aly Saber


    Full Text Available Background: Conservative treatment was recommended as the treatment of choice in perforated acute peptic ulcer. Here, we adjunct percutaneous peritoneal drainage with nonoperative conservative treatment in high risk elderly patients with perforated duodenal ulcer. Aim: The work was to study the efficacy of percutaneous peritoneal drainage under local anesthesia supported by conservative measures in high risk elderly patients, according to the American Society of Anesthesiologists grading, with perforated duodenal ulcer. Patients and Methods: Twenty four high risk patients with age >65 years having associated medical illness with evidence of perforated duodenal ulcer. Results: The overall morbidity and mortality were comparable with those treated by conservative measures alone. Conclusion: In high risk patients with perforated peptic ulcer and established peritonitis, percutaneous peritoneal drainage under local anesthesia seems to be effective with least operative trauma and mortality rate.

  15. Assessment and management of patients with acute red eye. (United States)

    Watkinson, Sue


    This article provides an overview of the role of the nurse in the assessment and management of five ocular conditions that give rise to an acute red eye in older people. The conditions discussed are acute closed angle glaucoma, acute iritis, acute conjunctivitis, herpes zoster ophthalmicus and bacterial corneal ulcer.

  16. CT in nontraumatic acute thoracic aortic disease: typical and atypical features and complications. (United States)

    Castañer, Eva; Andreu, Marta; Gallardo, Xavier; Mata, Josep Maria; Cabezuelo, María Angeles; Pallardó, Yolanda


    Thoracic aortic dissection is the most frequent cause of aortic emergency, and unless it is rapidly diagnosed and treated, the result is death. Helical computed tomography (CT) permits the diagnosis of acute aortic dissection with a sensitivity and specificity of nearly 100%. This imaging modality also enables differentiation between proximal aortic dissection (type A in the Stanford classification) and distal aortic dissection (Stanford type B), which are treated differently and have different prognoses. In 70% of patients in whom nontraumatic acute thoracic aortic dissection is diagnosed after evaluation with helical CT, scans show the typical signs of aortic dissection, with rupture and displacement of the intima. CT also can depict other pathologic entities with similar clinical manifestations, such as intramural hematoma and penetrating atherosclerotic ulcer. Awareness of the different radiologic appearances of these disease entities is essential for differential diagnosis. More than one-third of patients with aortic dissection show signs and symptoms indicative of systemic involvement. Because branch-vessel involvement may increase morbidity and mortality, in this group of patients it is important to evaluate the entire aorta so as to determine the distal extent of the dissection and detect any systemic involvement.

  17. Seronegative Herpes simplex Associated Esophagogastric Ulcer after Liver Transplantation

    Directory of Open Access Journals (Sweden)

    Edouard Matevossian


    Full Text Available Herpes simplex infection is characterized by acute or subacute infection, often followed by a chronic carrier state. Consecutive recurrences may flare up if immunocompromise occurs. Herpes simplex associated esophagitis or duodenal ulcer have been reported in immunocompromised patients due to neoplasm, HIV/AIDS or therapeutically induced immune deficiency. Here we report the case of an HSV-DNA seronegative patient who developed grade III dysphagia 13 days after allogeneic liver transplantation. Endoscopy revealed an esophageal-gastric ulcer, and biopsy histopathology showed a distinct fibroplastic and capillary ulcer pattern highly suspicious for viral infection. Immunohistochemistry staining revealed a distinct nuclear positive anti-HSV reaction. Antiviral therapy with acyclovir and high-dose PPI led to a complete revision of clinical symptoms within 48 h. Repeat control endoscopy after 7 days showed complete healing of the former ulcer site at the gastroesophageal junction. Although the incidence of post-transplantation Herpes simplex induced gastroesophageal disease is low, the viral HSV ulcer may be included into a differential diagnosis if dysphagia occurs after transplantation even if HSV-DNA PCR is negative.

  18. Refractory peptic ulcer disease. (United States)

    Napolitano, Lena


    Refractory PUD is a diagnostic and therapeutic challenge. Optimal management of severe or refractory PUD requires a multidisciplinary team approach, using primary care providers, gastroenterologists, and general surgeons. Medical management has become the cornerstone of therapy. Identification and eradication of H pylori infection combined with acid reduction regimens can heal ulceration and also prevent recurrence. Severe, intractable or recurrent PUD and associated complications mandates a careful and methodical evaluation and management strategy to determine the potential etiologies and necessary treatment (medical or surgical) required.

  19. Helicobacter pylori and Peptic Ulcers

    Centers for Disease Control (CDC) Podcasts


    In this podcast, CDC's Dr. David Swerdlow discusses the relationship between Helicobacter pylori and peptic ulcer disease and trends in hospitalization rates for peptic ulcer disease in the United States between 1998 and 2005.  Created: 8/17/2010 by National Center for Emerging and Zoonotic Infectious Diseases.   Date Released: 8/17/2010.

  20. Marjolin ulcer with multifocal origin

    Directory of Open Access Journals (Sweden)

    Das Sudip


    Full Text Available Marjolin ulcer developed from a twenty years old post burn scar. The patient presented with chronic ulceration followed by multifocal development of squamous cell carcinoma with different growth pattern. One nodular lesion grew rapidly to produce a large lesion with history of a little bleeding after trauma but without any pain. Excision followed by skin grafting resulted in good cosmetic scar.

  1. Pancreatic fistula through the distal common bile duct

    Directory of Open Access Journals (Sweden)

    Čolović Radoje B.


    Full Text Available Pancreatic fistula is usually caused by acute or chronic pancreatitis, injury and operations of the pancreas. The pancreatic juice comes either from the main pancreatic duct or from side branches. Extremely rare pancreatic fistula may come through the distal end of the common bile duct that is not properly sutured or ligated after traumatic or operative transaction. We present a 58-year old man who developed a life threatening high output pancreatic fistula through the distal end of the common bile duct that was simply ligated after resection for carcinoma. Pancreatic fistula was developed two weeks after original surgery and after two emergency reoperations for serious bleeding from the stump of the right gastric artery resected and ligated during radical limphadenectomy. The patient was treated conservatively by elevation of the drain- age bag after firm tunnel round the drain was formed so that there was no danger of spillage of the pancreatic juice within abdomen.

  2. Study of central neurotransmitters in stress-induced gastric ulceration in albino rats.


    Bhargava, K P; Daas, M.; Gupta, G. P.; Gupta, M. B.


    1 Restraint when combined with cold (4 degrees C) consistently induces gastric ulceration in rats at 2 h. The cold-restraint ulcer (CRU) technique provides a suitable model for acute studies. 2 The peripheral mechanisms in CRU seem to be increased sympathetic and parasympathetic outflow since CRU was significantly reduced by prior spinal transection or vagotomy or by appropriate blocking agents. Since metiamide significantly reduced CRU, H2-histamine receptors are also involved. 3 Central cat...

  3. Leg ulcers due to hyperhomocysteinemia

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    Krupa Shankar D


    Full Text Available Chronic leg ulcers are rare in young adults and generally indicate a vascular cause. We report a case of a 26-year-old man with leg ulcers of eight months duration. Doppler study indicated venous incompetence and a postphlebitic limb. However, as the distribution and number of ulcers was not consistent with stasis alone and no features of collagen vascular disease were noted, a hyperviscosity state was considered and confirmed with significantly elevated homocysteine level in the serum. Administration of vitamins B1, B2, B6 and B12, trimethyl-glycine, mecobalamine, folic acid and povidone iodine dressings with culture-directed antibiotic therapy led to a satisfactory healing of ulcers over a period of one month. Hyperhomocysteinemia must be considered in the differential diagnosis of leg ulcers in young individuals.

  4. Pharmacotherapy of recurrent aphthous ulcers

    Directory of Open Access Journals (Sweden)

    J P Angeline Archana


    Full Text Available Aphthous ulcer is the most common type of ulcer affecting the oral cavity and is considered to be one of the most painful conditions. Treatment is often unsatisfactory. Newer treatment modalities are therefore being tried. Amlexanox and rebamipide are the approved drugs for painful aphthous ulcers and have been used in painful symptoms of acid peptic disease as prostaglandin enhancers. Safety and efficacy of the drugs used in the treatment of recurrent aphthous ulcers were evaluated and being used widely by most of the treating physicians choosing a modality of treatment of their experience. There is no proper treatment modality available till date. Various drugs and their efficacy with least adverse drug effects while treating the various aphthous ulcers are discussed.

  5. Cerebral air embolism as a complication of peptic ulcer in the gastric tube: case report

    Directory of Open Access Journals (Sweden)

    Suzuki Takahisa


    Full Text Available Abstract Background The reported incidence of ulcer formation in the gastric tube in esophageal replacement is rare. Case Presentation This is the first report of a case of cerebral air embolism as a result of spontaneous perforation of an ulcer in the constructed gastric tube into the pulmonary vein during post-operative follow-up in a patient with esophageal cancer. Conclusions Cerebral air embolism is a rare complication of penetrating gastric ulcer, but should be considered in patients with a history of esophagectomy with gastric conduit that present with acute neurologic findings.

  6. Relationships between leukoaraiosis and internal carotid artery stenosis and ulcerated plaques in patients with acute cerebral infarction%急性脑梗死患者脑白质疏松与颈内动脉狭窄及溃疡性斑块的关系

    Institute of Scientific and Technical Information of China (English)

    王世芳; 肖卫民; 吴志强; 罗根培; 李润雄


    Objective To investigate the relationships between leukoaraiosis ( LA) and internal carotid artery stenosis and ulcerated plaques in patients with acute cerebral infarction. Methods A total of 102 consecutive patients with the first onset of acute cerebral infarction were enrolled in the study. They were all underwent neck vascular examinations with magnetic resonance imaging and digital subtraction an-giography ( DSA). The internal carotid artery lesions were identified. The patients were divided into LA or non-LA groups according to their MR, and they were redivided into a subcortical LA group and periventric-ular LA group according to the location of LA. The relationships between the location and severity of LA and internal carotid artery stenosis and ulcerated plaque were analyzed. Multivariate logistic regression analysis affected the relevant factors of different locations of LA. Results ①The incidences of internal carotid artery stenosis and ulcerated plaques had no significant difference between the LA group and the non-LA group (all P>0.05). ②In the subcortical LA group, 26. 1% patients (12/46) had ulcerated carotid plaques, which was higher than 10.7% (6/56) in the non-subcortical LA group (P0. 05). ③There was no significant difference in the incidence of ulcerated carotid plaques between the periventricular LA group and the periventricular non-LA group (P>0. 05). ④Multivariate analysis showed that age (OR = 1. 071 , 95% CI 1. 014 - 1. 131 ) , hypertension ( OR = 2. 953, 95% CI 1. 006 -8. 671 ) , and ulcerated carotid plaques ( OR = 1. 949 , 95% CI 1.286 -3.142) were the independent predictors of subcortical LA; the independently associated factors of periventricular LA were age ( OR = 1. 069, 95% CI 1.010-1.131) and hypertension (OR =3. 293, 95% CI 1.984 -11.020). Conclusion Among the patients with acute cerebral infarction , ulcerated carotid plaques are associated with the subcortical leukoaraiosis, and there is no significant relationship with

  7. EP4 agonist alleviates indomethacin-induced gastric lesions and promotes chronic gastric ulcer healing

    Institute of Scientific and Technical Information of China (English)

    Guang-Liang Jiang; Wha Bin Im; Yariv Donde; Larry A Wheeler


    AIM: To investigate EP4-selective agonist effect on indomethacin-induced gastric lesions and on the spontaneous healing of chronic gastric ulcers. METHODS: In a mouse model of gastric bleeding with high dose of indomethacin (20 mg/kg), an EP4-selective agonist was administered orally. Stomach lesions and gastric mucous regeneration were monitored. In a mouse model of chronic gastric ulcer induced by acetic acid, EP4 agonist effect on the healing of chronic gastric ulcer was evaluated in the presence or absence of low dose indomethacin (3 mg/kg). In cultured human gastric mucous cells, EP4 agonist effect on indomethacininduced apoptosis was assessed by flow cytometry. RESULTS: The EP4-selective agonist reduced high dose indomethacin-induced acute hemorrhagic damage and promoted mucous epithelial regeneration. Low-dose indomethacin aggravated ulcer bleeding and inflammation, and delayed the healing of the established chronic gastric ulcer. The EP4 agonist, when applied locally, not only offset indomethacin-induced gastric bleeding and inflammation, but also accelerated ulcer healing. In the absence of indomethacin, the EP4 agonist even accelerated chronic gastric ulcer healing and suppressed inflammatory cell infiltration in the granulation tissue. In vitro , the EP4 agonist protected human gastric mucous cells from indomethacin-induced apoptosis. CONCLUSION: EP4-selective agonist may prevent indomethacin-induced gastric lesions and promote healing of existing and indomethacin-aggravated gastric ulcers, via promoting proliferation and survival of mucous epithelial cells.

  8. Blockade of leukotriene production by a single oral dose of MK-0591 in active ulcerative colitis

    DEFF Research Database (Denmark)

    Hillingsø, Jens; Kjeldsen, J; Laursen, L S;


    dialysis fluid, ex vivo biosynthesis of LTB4 in whole blood, and urinary excretion of leukotriene E4 (LTE4) from 16 patients with mild to moderately active distally located ulcerative colitis were measured by use of radioimmunoassays in a double-blind, placebo-controlled parallel-design study before...... was unchanged. In whole blood, MK-0591 decreased ex vivo biosynthesis of LTB4 (p LTE4 was reduced by more than 85% (p

  9. Ulcerative colitis in infancy

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    Md Rukunuzzaman


    Full Text Available Ulcerative colitis (UC is a chronic idiopathic inflammatory disorder of colon. Frequency of UC is gradually increasing over few years worldwide. Prevalence is 35 to 100/100 000 people in USA, 1% of them are infants. UC develops in a genetically predisposed individual with altered intestinal immune response. An eight-month-old girl presented with loose bloody stool, growth failure, and moderate pallor. The girl was diagnosed as a case of UC by colonoscopy and biopsy. Treatment was thereafter started with immunosuppressive drugs. After initial induction therapy with parenteral steroid and infliximab, the patient is now on remission with azathioprine and mesalamine. UC is rare in Bangladesh, especially in children, and it is rarer during infancy. Several conditions like infective colitis, allergic colitis, Meckel′s diverticulitis, Crohn′s disease, etc. may mimic the features of UC. So, if a child presents with recurrent bloody diarrhea, UC should be considered as differential diagnosis.

  10. Protective effects of pentadecapeptide BPC 157 on gastric ulcer in rats

    Institute of Scientific and Technical Information of China (English)

    Xiao-Chang Xue; Yong-Jie Wu; Ming-Tang Gao; Wen-Guang Li; Ning Zhao; Zeng-Lu Wang; Chun-Jie Bao; Zhen Yan; Ying-Qi Zhang


    AIM: To investigate the protective effects of gastric pentadecapeptide BPC 157 on acute and chronic gastric ulcers in rats and to compare the results in therapy of human gastric ulcers by different administration methods.METHODS: Gastric pentadecapeptide BPC 157 was administered (initial single or continuous administration) into rats either intragastrically or intramuscularly before (induced acute gastric ulcer) or after (induced chronic gastric ulcer) the applications of inducing agents, and each animal was sacrificed to observe the protective effects of BPC 157 on gastric ulcers.RESULTS: Both intramuscular (im) and intragastric (ig) administration of BPC 157 could apparently reduce the ulcer area and accelerate the healing of induced ulcer in different models and the effect of im administered BPC 157 was better than that of ig. The rats treated with higher dosages (400 ng/kg, 800 ng/kg) of BPC 157 (im and ig) showed significantly less lesion (P<0.01 vs excipient or saline control), the inhibition ratio of ulcer formation varied between 45.7% and 65.6%, from all measurements except 400 ng/kg BPC 157 in pylorus ligation induced model (P<0.05),in which the inhibition rate was 54.2%. When im administered (800 ng/kg BPC 157) in three models, the inhibition ratio of ulcer formation was 65.5%, 65.6% and 59.9%, respectively, which was better than that of famotidine (its inhibition rate was 60.8%, 57.2% and 34.3%,respectively). Continuous application of BPC 157 (in chronic acetate induced gastric ulcer) could accelerate rebuilding of glandular epithelium and formation of granulation tissue (P<0.05 at 200 ng/kg and P<0.01 at 400 ng/kg and 800 ng/kg vs excipient or saline control).CONCLUSION: Both im and ig administered gastric pentadecapeptide BPC 157 can apparently ameliorate acute gastric ulcer in rats and antagonize the protracted effect of acetate challenge on chronic ulcer. The effect of im administration of BPC 157 is better than that of ig, and the effective

  11. Prolonged ulcerative laryngitis: a new disease entity. (United States)

    Hsiao, Tzu-Yu


    Over the last decade, a new disease entity, prolonged ulcerative laryngitis (PUL), with unique clinical presentation and prolonged disease course, has been recognized. Until now, very few studies dealing with this disease have been reported in the literature. From 1999 to 2008, we analyzed clinical data from a series of 39 PUL patients who were treated with an observational approach without implementing specific treatments. This disease affects adults, predominantly females. The age of patients in our series ranged from 26 to 76 years with a median of 49.5 years. This disease is characterized by ulcers and signs of acute inflammation on the membranous portion of the vocal folds with a prolonged clinical course. The recovery times of patients ranged from 4 to 20 weeks with an average of 9.4 weeks. The data in this study may reflect a natural history of this disease. PUL seems to be a self-limited disease, but the etiology of this disease is unknown. Specific infections or systemic inflammatory processes involving the larynx must be ruled out before diagnosis, and conservative treatments are suggested.

  12. Open Tracheostomy after Aborted Percutaneous Approach due to Tracheoscopy Revealing Occult Tracheal Wall Ulcer

    Directory of Open Access Journals (Sweden)

    John Schweiger


    Full Text Available Tracheostomy is a common procedure for intensive care patients requiring prolonged mechanical ventilation. In this case report, we describe a 78-year-old female patient admitted for an aneurysm of the cerebral anterior communicating artery. Following immediate endovascular coiling, she remained ventilated and was transferred to the neurological intensive care unit. On postoperative day ten, a percutaneous tracheostomy (PCT was requested; however, a large ulcer or possible tracheoesophageal fistula was identified on the posterior tracheal wall following bronchoscopic assessment of the trachea. Therefore, the requested PCT procedure was aborted. An open tracheostomy in the operating room was completed; however, due to the position and depth of the ulcer, a reinforced endotracheal tube (ETT was placed via the tracheostomy. Four days later, the reinforced ETT was replaced with a Shiley distal extended tracheostomy tube to bypass the ulceration. Careful inspection and evaluation of the tracheostomy site before PCT prevented a potentially life-threatening issue in our patient.

  13. Chronic Ulcers in Thromboangiitis Obliterans (Buerger's Disease: Updating Epidemiology, Physiopathology, and Bosentan—A Novel Strategy of Therapy

    Directory of Open Access Journals (Sweden)

    Ignacio López de Maturana


    Full Text Available Thromboangiitis obliterans (TAO or Buerger's disease is associated with both distal ulcers in the extremities and the possibility of amputation. The only treatment that has been shown to be effective in TAO is complete abstention from smoking. In spite of this, the disease progresses in up to 30 percent of cases and finally results in limb amputation. Only a few pharmacological and surgical options are available to date to improve healing ulcers in TAO. The efficacy of prostaglandin analogues is controversial. This paper summarizes the current evidence for medical treatment with bosentan in chronic ulcers in TAO patients. These available data up to date allow us to conclude that the beneficial effects of bosentan on improving endothelial function, inflammatory processes, and selective vasodilatation of damaged vessels result in a clinical enhancement regarding healing and preventive digital ulcers in such patients. In any case, these promising findings have to be confirmed with larger randomised trials.

  14. PET/CT imaging of abdominal aorta with intramural hematomas, penetrating ulcer, and saccular pseudoaneurysm. (United States)

    Nguyen, Vien X; Nguyen, Ba D


    Acute aortic syndromes, encompassing intramural hematoma, penetrating ulcer, and pseudoaneurysm, are best demonstrated by angiographic CT and magnetic resonance imaging. These imaging modalities provide an accurate evaluation and allow timely therapies of these frequently symptomatic lesions, thus reducing their morbidity and mortality. The inflammatory pathogenesis of these acute aortic syndromes may exhibit positive PET findings predictive of prognosis and outcomes of these vascular events. The authors present a case of PET/CT imaging showing asymptomatic intramural hematomas with penetrating ulcer and saccular pseudoaneurysm of the proximal abdominal aorta.

  15. Nutritional prediction of pressure ulcers. (United States)

    Breslow, R A; Bergstrom, N


    This article focuses on nutritional risk factors that predict the development of pressure ulcers in hospital and nursing home patients. Cross-sectional studies associate inadequate energy and protein intake; underweight; low triceps skinfold measurement; and low serum albumin, low serum cholesterol, and low hemoglobin levels with pressure ulcers. Prospective studies identify inadequate energy and protein intake, a poor score on the Braden scale (a risk assessment instrument that includes a nutrition component), and possibly low serum albumin level as risk factors for developing a pressure ulcer. Nutritionists should provide a high-energy, high-protein diet for patients at risk of development of pressure ulcers to improve their dietary intake and nutritional status.

  16. Venous ulcers - self-care (United States)

    Risk factors for venous ulcers include: Varicose veins History of blood clots in the legs ( deep vein thrombosis ) Blockage of the lymph vessels , which causes fluid to build up in the legs Older age, ...

  17. Challenges in pressure ulcer prevention. (United States)

    Dealey, Carol; Brindle, C Tod; Black, Joyce; Alves, Paulo; Santamaria, Nick; Call, Evan; Clark, Michael


    Although this article is a stand-alone article, it sets the scene for later articles in this issue. Pressure ulcers are considered to be a largely preventable problem, and yet despite extensive training and the expenditure of a large amount of resources, they persist. This article reviews the current understanding of pressure ulcer aetiology: pressure, shear and microclimate. Individual risk factors for pressure ulceration also need to be understood in order to determine the level of risk of an individual. Such an assessment is essential to determine appropriate prevention strategies. The main prevention strategies in terms of reducing pressure and shear and managing microclimate are studied in this article. The problem of pressure ulceration related to medical devices is also considered as most of the standard prevention strategies are not effective in preventing this type of damage. Finally, the possibility of using dressings as an additional preventive strategy is raised along with the question: is there enough evidence to support their use?

  18. 胃大部切除术治疗急性胃溃疡穿孔的临床应用优势研究%Study on the Clinical Application Advantages of Subtotal Gastrectomy in the Treatment of Acute Gastric Ulcer Perforation

    Institute of Scientific and Technical Information of China (English)

    蒋波; 李金祥; 饶兰英


    目的:研究胃大部切除术治疗急性胃溃疡穿孔的临床应用优势。方法:选取笔者所在医院2014年1月-2016年1月收治的急性胃溃疡穿孔患者70例为研究对象,根据手术方法不同分为两组,即胃大部切除组和修补术组,每组35例。修补术组采取单纯修补手术治疗,胃大部切除组采取胃大部切除术治疗。就两组患者手术时间、恢复肠鸣音时间、恢复排气时间、住院天数和术后复发率、并发症发生率进行比较。结果:胃大部切除组术后复发率明显低于修补术组,并发症发生率高于修补术组,差异均有统计学意义(P0.05)。结论:胃大部切除术治疗急性胃溃疡穿孔的临床应用效果较好,虽然并发症较多,但可减少术后复发率,只要术中细心操作,可提高手术安全性。%Objective:To study the clinical application advantages of subtotal gastrectomy in the treatment of acute gastric ulcer perforation.Method:Seventy cases of acute gastric ulcer perforation in our hospital from January 2014 to January 2016 were selected as the objects and divided into two groups according to the operation methods,35 cases in each group.The repair group was treated with simple repair operation,and the subtotal gastrectomy group was treated with subtotal gastrectomy.The operation time,recovery of bowel sound,exhaust time,hospital stay and postoperative recurrence rate and complication rates between the two groups were compared.Result:The recurrence rate of subtotal gastrectomy group was significantly lower than that of the repair group,the complication rate was higher than the repair group,the differences were statistically significant(P0.05).Conclusion:The clinical effect of subtotal gastrectomy in the treatment of acute gastric ulcer perforation is better,although there are more complications,but it can reduce the recurrence rate,the safety of operation can be improved as long as paying more attention

  19. Marjolin ulcer: a case report

    Directory of Open Access Journals (Sweden)

    Beatriz Di Martino Ortiz


    Full Text Available Marjolin’s ulcer is part of a group of neoplasms arising in chronic skin lesions, whether inflammatory or traumatic. Squamous cell carcinoma is the most frequently reported in the literature, it appears most frequently in burn scars, although also described in other types of lesions. We report a case of Marjolin ulcer in a male, native, 65 years old, from the Paraguayan Chaco, with antecedents of scar post trauma in youth.

  20. Pharmacotherapy of Peptic Ulcer Disease

    Directory of Open Access Journals (Sweden)

    F Molina


    Full Text Available The etiology of peptic ulcer is multifactorial; except for omeprazole, all drugs used for the treatment of peptic ulcer result in healing with no statistical difference at four weeks. The healing rare increases with time for active medication and placebo, and is lower among smokers than nonsmokers for all drugs but misoprostol. Mucosal protectives (or ‘cytoprotectives’ as a group seem to have a lower relapse rate than the H2 receptor antagonists at one year. Combination therapy has not yet proved to be better than single drug therapy; however, the number of studies is still small, and more clinical trials are necessary. Resistant ulcers have demonstrated that acid is one of several etiological factors and that more research is needed to elucidate the reason(s for refractoriness. The choice of therapeutic agent is generally made according to patient compliance, medication cost, side effects, effectiveness, relapse rate and physician experience with the drug. Long term maintenance therapy is effective in the prevention of ulcer relapse and is especially recommended for selected patient groups, including patients with recurrent or bleeding ulcer, patients with concomitant nonsteroidal anti-inflammatory drug use, and elderly women. Omeprazole is the treatment of choice for moderate to severe esophagitis and should be reserved for large and resistant ulcers.

  1. [Guidelines of diagnosis for peptic ulcer disease]. (United States)

    Kim, Sang Gyun; Kim, Jae Gyu; Shin, Sung Kwan; Kim, Hyun Soo; Seol, Sang Young


    Peptic ulcer is one of the most prevalent diseases in gastrointestinal field. Recently, evolution was made for pathophysiology of peptic ulcer from "no acid, no ulcer" to Helicobacter pylori and non-steroidal anti-inflammatory drugs. The prevalence of peptic ulcer disease is estimated about 10% in Korea, and has declined due to Helicobacter pylori eradication therapy. Peptic ulcer has the cycle of exacerbation and improvement in the clinical course, and has not occasionally any clinical symptom. Helicobacter pylori eradication has made the marked reduction of relapse of peptic ulcer disease. Although nationwide endoscopic screening has enabled accurate diagnosis of peptic ulcer disease, general guideline for diagnosis of peptic ulcer has not made in Korea. Herein, we propose a guideline for the diagnosis of peptic ulcer according to domestic, international clinical studies, and experts opinions with level of evidence and grade of recommendation.

  2. [Peptic ulcer disease etiology, diagnosis and treatment]. (United States)

    Bak-Romaniszyn, Leokadia; Wojtuń, Stanisław; Gil, Jerzy; Płaneta-Małecka, Izabela


    Authors in this article present etiology, clinical manifestations, diagnostic procedures and treatment of peptic ulcer disease in children and adults. Increased gastric acid output, Helicobacter pylori, NSAIDs and stress are the basic risk factors in peptic ulcer disease. H. pylori infection is a widely known risk factor in peptic ulcer disease and influences diagnostic and treatment procedures. Primary ulcer disease concerns mainly duodenum and is accompanied by H. pylori infection. Gastroscopy and Helicobacter tests are the only reliable procedures to diagnose peptic ulcer disease. Nowadays the most important aim in peptic ulcer treatment is the H. pylori eradication. Therapy with two antibiotics and a protein pomp inhibitor eradicates the bacteria, treats the ulceration and lowers the number of ulcer recurrence. In non-infected H. pylori ulcers or in a long-term treatment protein pomp inhibitors and H2-inhibitors are effective as well in gastroprotective therapy.

  3. Root Cause Analysis of Gastroduodenal Ulceration After Yttrium-90 Radioembolization

    Energy Technology Data Exchange (ETDEWEB)

    Lam, Marnix G. E. H. [Stanford University School of Medicine, Division of Interventional Radiology (United States); Banerjee, Subhas [Stanford University School of Medicine, Division of Gastroenterology and Hepatology (United States); Louie, John D.; Abdelmaksoud, Mohamed H. K. [Stanford University School of Medicine, Division of Interventional Radiology (United States); Iagaru, Andrei H. [Stanford University School of Medicine, Division of Nuclear Medicine and Molecular Imaging (United States); Ennen, Rebecca E.; Sze, Daniel Y., E-mail: [Stanford University School of Medicine, Division of Interventional Radiology (United States)


    IntroductionA root cause analysis was performed on the occurrence of gastroduodenal ulceration after hepatic radioembolization (RE). We aimed to identify the risk factors in the treated population and to determine the specific mechanism of nontarget RE in individual cases. Methods: The records of 247 consecutive patients treated with yttrium-90 RE for primary (n = 90) or metastatic (n = 157) liver cancer using either resin (n = 181) or glass (n = 66) microspheres were reviewed. All patients who developed a biopsy-proven microsphere-induced gastroduodenal ulcer were identified. Univariate and multivariate analyses were performed on baseline parameters and procedural data to determine possible risk factors in the total population. Individual cases were analyzed to ascertain the specific cause, including identification of the culprit vessel(s) leading to extrahepatic deposition of the microspheres. Results: Eight patients (3.2 %) developed a gastroduodenal ulcer. Stasis during injection was the strongest independent risk factor (p = 0.004), followed by distal origin of the gastroduodenal artery (p = 0.004), young age (p = 0.040), and proximal injection of the microspheres (p = 0.043). Prolonged administrations, pain during administration, whole liver treatment, and use of resin microspheres also showed interrelated trends in multivariate analysis. Retrospective review of intraprocedural and postprocedural imaging showed a probable or possible culprit vessel, each a tiny complex collateral vessel, in seven patients. Conclusion: Proximal administrations and those resulting in stasis of flow presented increased risk for gastroduodenal ulceration. Patients who had undergone bevacizumab therapy were at high risk for developing stasis.

  4. Interlocking nailing in fractures of distal tibia

    Directory of Open Access Journals (Sweden)

    Akshay Phadke


    Conclusions: Intramedullary nailing is an effective alternative for the treatment of distal metaphyseal tibial fractures. A proper patient selection, adjuvant fixation of fibula and use of at least two distal interlocking screws is suggested for better outcome. [Int J Res Med Sci 2016; 4(4.000: 1132-1135

  5. Gastric ulcer healing effect of wild honey and its combination with Turmeric (Curcuma domestica Val.) Rhizome on male Wistar rats

    Institute of Scientific and Technical Information of China (English)

    I Ketut Adnyana; Joseph I.Sigit; Larasati A.Kusumawardani


    Gastric ulcer is a common disorder in human at any ages.In this research,the antiulcer activity of wild honey produced by Apis dorsata,alone or in combination with Turmeric Rhizome,was evaluated in healing acute gastric ulcer.Male Wistar albino rats (150-250 g) were induced ulcers with aspirin at 405 mg/kg BW and ethanol.Antiulcer evaluation was done based on the gastric acidity,numbers and diameter of ulcers,ulcer index,healing ratio,histological examinations,and body weight.The results showed that the groups given honey alone,turmeric alone,and combination of turmeric-honey displayed significant ulcer healing compared to the control group.Ulcers in the group administered with combination of turmeric-wild honey was different significantly from the turmeric alone and wild honey alone groups with increased body weight in that group.The result showed that wild honey (2125 mg/kg BW) had the greatest activity in healing ulcers among other groups.The combination of turmeric-wild honey had a good activity in healing ulcers and increased the body weight of the group.

  6. 大蒜对急性白血病化疗后营养及预防口腔溃疡的护理干预%Nursing intervention of garlic on nutrition and prevention of oral ulcers in acute leukemia after chemotherapy

    Institute of Scientific and Technical Information of China (English)

    陆莺; 唐志英; 尤俊; 陆佳; 顾伟英


    Objective To implement nutritional assessment for patients with acute leukemia after chemotherapy and to investigate the effect of garlic on the appetite improvement and prevention of oral ulcers. Methods A questionnaire method was performed for leukemia patients 3 days after chemotherapy to analyze the composing of their food and nutrient intake,and to assess the effect of garlic on the appetite improvement and oral ulcers prevention. Results Acute leukemia patients usually had reduced appetite,weight loss,insufficient immune function,and various degrees of gastrointestinal uncomfortableness and dysfunction after chemotherapy,which seriously affected the chemotherapeutic effect and quality of life. The 20 patients of study group who received garlic after chemotherapy showed no body weight change before (62. 58 ± 5. 99) and after chemotherapy(63 ± 7.03,P = 0. 462). However,the body weight after chemotherapy in 20 patients of the control group (60. 65 ± 5. 69) were significantly lower than that of before chemotherapy (65. 52 ± 7. 32,P = 0. 000) ,with an average weight loss of 1. 9kg. Only 3 of 20 patients of the study group suffered from oral ulcers (15%),while 10 of the 20 patients of the control group suffered oral ulcers (50% ). Seemingly the incidence of oral ulcer in the study group was significantly lower than that of the control group (X2 = 5.812,P = 0.041). Conclusion The consumption of garlic (containing al-licin) can improve anorexia induced by combined chemotherapy,prevent oral ulcers and improve the appetite. This method is easy received by leukemia patients without medical costs.%目的 对急性白血病化疗后患者进行营养评估,食用大蒜头干预,观察改善食欲和预防口腔溃疡的效果.方法 应用问卷调查对白血病化疗结束后3d的患者进行膳食调查,对食物构成和热能、营养素摄人情况进行分析,采用系统的营养评估和食用大蒜头护理干预,评价食欲改

  7. Robotic distal pancreatectomy: a valid option? (United States)

    Jung, M K; Buchs, N C; Azagury, D E; Hagen, M E; Morel, P


    Although reported in the literature, conventional laparoscopic approach for distal pancreatectomy is still lacking widespread acceptance. This might be due to two-dimensional vision and decreased range of motion to reach and safely dissect this highly vascularized retroperitoneal organ by laparoscopy. However, interest in minimally invasive access is growing ever since and the robotic system could certainly help overcome limitations of the laparoscopic approach in the challenging domain of pancreatic resection, notably in distal pancreatectomy. Robotic distal pancreatectomy with and without spleen preservation has been reported with encouraging outcomes for benign and borderline malignant disease. As a result of upgraded endowristed manipulation and three-dimensional visualization, improved outcome might be expected with the launch of the robotic system in the procedure of distal pancreatectomy. Our aim was thus to extensively review the current literature of robot-assisted surgery for distal pancreatectomy and to evaluate advantages and possible limitations of the robotic approach.

  8. Stereomicroscopic and ultrastructural characterization of propionitrile-induced duodenal ulcer in the rat

    DEFF Research Database (Denmark)

    Poulsen, Steen Seier


    Acute duodenal ulcer produced by subcutaneous injection of propionitrile in rats was studied by stereo, light, and electron microscopy in order to gain insight into the localization and mechanism of initial cell injury. Stereomicroscopy revealed an initial fissuring and splitting of the tips...... of the villus folds within 4 hours after two injections of propionitrile. This was followed by sloughing of the epithelium, shortening and effacement of the villus folds, and within 24 hours the appearance of discrete ulcers in the mucosa of the proximal duodenum. In most of the rats, two ulcers developed......: the first and larger ulcer was on the antimesenteric side of the duodenum, and the other, a small and more superficial one, was on the opposite wall. Ultrastructural lesions appeared in the absorptive epithelial cells of the proximal duodenum within 5 hours following a single dose of propionitrile...

  9. A Real World, Observational Registry of Chronic Wounds and Ulcers (United States)


    Diabetic Foot; Varicose Ulcer; Pressure Ulcer; Surgical Wound Dehiscence; Vasculitis; Skin Ulcer; Leg Ulcer; Wounds and Injuries; Pyoderma; Peripheral Arterial Disease; Diabetic Neuropathies; Lymphedema; Venous Insufficiency; Diabetes Complications; Amputation Stump

  10. Diagnostic Features of Common Oral Ulcerative Lesions: An Updated Decision Tree (United States)

    Safi, Yaser


    Diagnosis of oral ulcerative lesions might be quite challenging. This narrative review article aims to introduce an updated decision tree for diagnosing oral ulcerative lesions on the basis of their diagnostic features. Various general search engines and specialized databases including PubMed, PubMed Central, Medline Plus, EBSCO, Science Direct, Scopus, Embase, and authenticated textbooks were used to find relevant topics by means of MeSH keywords such as “oral ulcer,” “stomatitis,” and “mouth diseases.” Thereafter, English-language articles published since 1983 to 2015 in both medical and dental journals including reviews, meta-analyses, original papers, and case reports were appraised. Upon compilation of the relevant data, oral ulcerative lesions were categorized into three major groups: acute, chronic, and recurrent ulcers and into five subgroups: solitary acute, multiple acute, solitary chronic, multiple chronic, and solitary/multiple recurrent, based on the number and duration of lesions. In total, 29 entities were organized in the form of a decision tree in order to help clinicians establish a logical diagnosis by stepwise progression. PMID:27781066

  11. Rectal budesonide and mesalamine formulations in active ulcerative proctosigmoiditis: efficacy, tolerance, and treatment approach

    Directory of Open Access Journals (Sweden)

    Christophi GP


    Full Text Available George P Christophi, Arvind Rengarajan, Matthew A Ciorba Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA Abstract: Ulcerative colitis (UC is an immune-mediated disease of the colon that is characterized by diffuse and continuous inflammation contiguous from the rectum. Half of UC patients have inflammation limited to the distal colon (proctitis or proctosigmoiditis that primarily causes symptoms of bloody diarrhea and urgency. Mild-to-moderate distal UC can be effectively treated with topical formulations (rectal suppositories, enemas, or foam of mesalamine or steroids to reduce mucosal inflammation and alleviate symptoms. Enemas or foam formulations adequately reach up to the splenic flexure, have a minimal side-effect ­profile, and induce remission alone or in combination with systemic immunosuppressive therapy. Herein, we compare the efficacy, cost, patient tolerance, and side-effect profiles of steroid and mesalamine rectal formulations in distal UC. Patients with distal mild-to-moderate UC have a remission rate of approximately 75% (NNT =2 after treatment for 6 weeks with mesalamine enemas. Rectal budesonide foam induces remission in 41.2% of patients with mild-to-moderate active distal UC compared to 24% of patient treated with placebo (NNT =5. However, rectal budesonide has better patient tolerance profile compared to enema formulations. Despite its favorable efficacy, safety, and cost profiles, patients and physicians significantly underuse topical treatments for treating distal colitis. This necessitates improved patient education and physician familiarity regarding the indications, effectiveness, and potential financial and tolerability barriers in using rectal formulations. Keywords: inflammatory bowel disease, treatment cost effectiveness, Crohn’s disease, ulcerative colitis, colon mucosa, proctitis suppositories, topical immunosuppressive therapy

  12. Treatment of distal clavicle fracture with distal radius volar locking compression plate

    Institute of Scientific and Technical Information of China (English)

    YU Chao; SUN Yue-hua; ZHAO Chang-qing; SHI Ding-wei; WANG You


    Objective: To observe the early clinical outcomes of the internal fixation with distal radius volar locking compression plate (LCP) in treatment of distal clavicle fracture.Methods: Six patients with unilateral distal clavicle fractures, identified as type Ⅱ according to Neer classification system, including 4 males and 2 females, were treated with open reduction and internal fixation using a distal radius volar LCP. Bone union was evaluated by routine X-ray radiography, and shoulder joint function were assessed by Constant score system.Results: All fractures achieved bone union at 6 to 8 weeks postoperatively, and Constant scores ranged from 95 to 100 at the postoperative 10 to 12 weeks.Conclusion: Fixation of distal clavicle fracture with distal radius volar LCP demonstrates excellent effects of bone union with rarely early complications, thus providing a new technique to treat distal clavicle fracture.

  13. Potassium Channelopathies and Gastrointestinal Ulceration (United States)

    Han, Jaeyong; Lee, Seung Hun; Giebisch, Gerhard; Wang, Tong


    Potassium channels and transporters maintain potassium homeostasis and play significant roles in several different biological actions via potassium ion regulation. In previous decades, the key revelations that potassium channels and transporters are involved in the production of gastric acid and the regulation of secretion in the stomach have been recognized. Drugs used to treat peptic ulceration are often potassium transporter inhibitors. It has also been reported that potassium channels are involved in ulcerative colitis. Direct toxicity to the intestines from nonsteroidal anti-inflammatory drugs has been associated with altered potassium channel activities. Several reports have indicated that the long-term use of the antianginal drug Nicorandil, an adenosine triphosphate-sensitive potassium channel opener, increases the chances of ulceration and perforation from the oral to anal regions throughout the gastrointestinal (GI) tract. Several of these drug features provide further insights into the role of potassium channels in the occurrence of ulceration in the GI tract. The purpose of this review is to investigate whether potassium channelopathies are involved in the mechanisms responsible for ulceration that occurs throughout the GI tract. PMID:27784845

  14. Hallux ulceration in diabetic patients. (United States)

    ElMakki Ahmed, Mohamed; Tamimi, Abdulhakim O; Mahadi, Seif I; Widatalla, Abubakr H; Shawer, Mohamed A


    We undertook a prospective cohort study to assess risk factors associated with hallux ulceration, and to determine the incidence of healing or amputation, in consecutive patients with diabetes mellitus who were treated over the observation period extending from September 2004 to March 2005, at the Jabir Abu Eliz Diabetic Centre, Khartoum City, Sudan. There were 122 diabetic patients in the cohort (92 males and 30 females) with an overall mean age of 58 +/- 9 years. Fifty-three percent of patients had complete healing within 8 weeks and 43% healed within 20 weeks. The overall mean time to healing was 16 +/- 8 weeks. In 32 (26.2%) patients, osteomyelitic bone was removed, leaving a healed and boneless hallux. The hallux was amputated in 17 (13.9%) patients; in 2 (1.6%) patients it was followed by forefoot amputation and in 7 (5.7%) patients by below-the-knee amputation. In 90 (73.8%) patients the initial lesion was a blister. In conclusion, hallux ulceration is common in patients with diabetes mellitus and is usually preceded by a blister. Neuropathy, foot deformity, and wearing new shoes are common causative factors; and ischemia, osteomyelitis, any form of wound infection, and the size of the ulcer are main outcome determinants. Complete healing occurred in 103 (85%) of diabetic patients with a hallux ulcer. Vascular intervention is important relative to limb salvage when ischemia is the main cause of the ulcer.

  15. Medical management of venous ulcers. (United States)

    Pascarella, Luigi; Shortell, Cynthia K


    Venous disease is the most common cause of chronic leg ulceration and represents an advanced clinical manifestation of venous insufficiency. Due to their frequency and chronicity, venous ulcers have a high socioeconomic impact, with treatment costs accounting for 1% of the health care budget in Western countries. The evaluation of patients with venous ulcers should include a thorough medical history for prior deep venous thrombosis, assessment for an hypercoagulable state, and a physical examination. Use of the CEAP (clinical, etiology, anatomy, pathophysiology) Classification System and the revised Venous Clinical Severity Scoring System is strongly recommended to characterize disease severity and assess response to treatment. This venous condition requires lifestyle modification, with affected individuals performing daily intervals of leg elevation to control edema; use of elastic compression garments; and moderate physical activity, such as walking wearing below-knee elastic stockings. Meticulous skin care, treatment of dermatitis, and prompt treatment of cellulitis are important aspects of medical management. The pharmacology of chronic venous insufficiency and venous ulcers include essentially two medications: pentoxifylline and phlebotropic agents. The micronized purified flavonoid fraction is an effective adjunct to compression therapy in patients with large, chronic ulceration.

  16. A severe case of esophageal ulcer causing a tight stricture despite long-term D-penicillamine treatment. (United States)

    Yapali, Suna; Turan, Ilker; Ozutemiz, Omer; Tekesin, Oktay


    D-penicillamine has long been used in the management of rheumatic diseases due to the effects on inhibition of collagen synthesis. Herein, we report a severe case of esophageal ulcer causing a tight stricture extending through the distal esophagus despite the long-term D-penicillamine treatment in a patient with Wilson's disease. D-penicillamine would theoretically be expected to contribute to the healing of an esophageal ulcer. However, the drug failed to have a favorable outcome, which is notable and worth reporting.

  17. Establishment of Rat Model of Acute Radioactive Dermatitis/Ulceration Induced by Different Dose of X-ray%不同剂量高能X线照射诱导大鼠急性放射性皮炎/溃疡模型的建立

    Institute of Scientific and Technical Information of China (English)

    种树彬; 兰海梅; 赖梅生; 曾抗


    Objective:To establish the rat models of acute radioactive dermatitis/ulceration. Methods:Forty-eight rats were randomly assigned to eight groups , locally treated on two back legs by different dosage of X-ray radiation respectively at 0-, 5-, 15-, 30-, 35-, 38-, 43-and 50 Gy. After phenotypic analysis of optimal dosages for each model , 46 female Wistar Rats were randomly distributed into 38-Gy group(n=20), 43-Gy group(n=20) and control group(n=6).After 18 days, 60 days, the change of the skin and hair in irradiation area and survival situation of the models were visual assessed , and the pathological changes of the skin were detected with optical microscopy and scanning electron microscopy .Results:The rats irradiated by a 38-Gy X-ray pres-ent marked hyperemia and edematous erythema , and hair loss in the exposure zone .Optical mi-croscopy revealed the integral epidermis structure , interstitial edema , genuine layer were infiltra-ted with a small amount of lymphocytes .SEM showed nucleus heterochromatin and nuclear pykno-sisincreased.After 43-Gy irradation, the skin erythema, erosion and more ulcers were observed . Microscopically , the partial epidermal necrosis , significant edema at the upper dermis , degenera-tion and necrosis of capillary blood vessels , surrounded by a large number of neutrophils , eosino-phils and nuclear dust distribution can be obsvered .Ultra-structure analysis were presented in those fingings such as the nucleus pyknosis , cell organelle degeneration , hemal wall degeneration necrosis.Conclusion:Rat models of acute radioactive dermatitis and acute radioactive ulceration were successfully established by 38-Gy and 43-Gy high-dose X-ray radiation respectively , the ap-pearance of the models in the clinical and histopathological were resembe with the features of acute radioactive dermatitis and ulceration .%目的:建立并评价大鼠急性放射性皮炎/溃疡模型。方法:将48只雌性Wistar大鼠随机分成8组,采用直

  18. Molecular genetics of distal hereditary motor neuropathies. (United States)

    Irobi, Joy; De Jonghe, Peter; Timmerman, Vincent


    Inherited peripheral neuropathies comprise a wide variety of diseases primarily affecting the peripheral nervous system. The best-known peripheral neuropathy is Charcot-Marie-Tooth disease (CMT) described in 1886 by J.-M. Charcot, P. Marie and H.H. Tooth. In 1980, A.E. Harding and P.K. Thomas showed that in a large group of individuals with CMT, several only had motor abnormalities on clinical and electrophysiological examination, whereas sensory abnormalities were absent. This exclusively motor variant of CMT was designated as spinal CMT or hereditary distal spinal muscular atrophy, and included in the distal hereditary motor neuropathies (distal HMN). The distal HMN are clinically and genetically heterogeneous and are subdivided according to the mode of inheritance, age at onset and clinical evolution. Since the introduction of positional cloning, 12 chromosomal loci and seven disease-causing genes have been identified for autosomal dominant and recessive distal HMN. Most of the genes involved have housekeeping functions, as in RNA processing, translation synthesis, glycosylation, stress response, apoptosis, but also axonal trafficking and editing. Functional characterization of the mutations will help to unravel the cellular processes that underlie the specificity of motor neuropathies leading to neurogenic muscular atrophy of distal limb muscles. Here we review the recent progress of the molecular genetics of distal HMN and discuss the genes implicated.

  19. Roxatidine versus ranitidine in the treatment of patients with duodenal ulcer: a randomized, double-masked, multicenter study. (United States)

    Zuberi, S J; Khan, A Q; Irshad-ul-Haque, I; Hussain, A; Hasnain, S S; Shah, S; Sadick, A; Yusuf, M Z; Reuter, M


    The comparative efficacy of roxatidine and ranitidine in the treatment of patients with acute duodenal ulcer was assessed at 4 and 6 weeks in this multicenter study. Ninety-four of 192 patients were given roxatidine in a single nightly dose of 150 mg, and 98 patients were given ranitidine in a single nightly dose of 300 mg. All the patients had endoscopically proven duodenal ulcer. Of the 171 assessable patients, ulcers were healed in 88% of the roxatidine group (73 of 83) and in 84% of the ranitidine group (74 of 88). No serious adverse events were reported in either group. We conclude that roxatidine 150 mg once daily is as effective and safe for the treatment of acute duodenal ulcer as ranitidine 300 mg once daily.

  20. The effects of antidepressants on gastric ulcer

    Directory of Open Access Journals (Sweden)

    Mehmet Latif Güneş


    Full Text Available In their daily practice, psychiatrists often experience gastriccomplaints in patients beside psychiatric disorders.Peptic ulcer is one of the diseases, which accompanyto psychiatric disorders including mainly depression. Itis shown that antidepressants can inflame the bleedingsincluding gastrointestinal (GI bleedings, while they havepositive effect on ulcer healing. In this review, studies,which conducted about the positive or negative effects ofantidepressant drugs on ulcer treatment were examined.Accordingly; it was found that opipramol, amitriptyline,imipramine that of tricyclic antidepressants was found tobe helpful in healing of the ulcer. It was stated that SelectiveSerotonin Reuptake Inhibitors generally inflamedulcers, exceptionally fluvoxamine and fluoxetine reducedulcer; moclobemide that of monoamine-oxidase inhibitorand tianeptine and mirtazapine that of atypical antidepressantshad positive effect in ulcer healing. To be carefulin choosing the appropriate antidepressant in psychiatricpatients with gastric ulcer is important in the prognosisof both ulcer and depression.Key words: peptic ulcer; depression; antidepressant drugs

  1. Iloprost infusion in diabetic patients with peripheral arterial occlusive disease and foot ulcers. (United States)

    Mirenda, Francesco; La Spada, Michele; Baccellieri, Domenico; Stilo, Francesco; Benedetto, Filippo; Spinelli, Francesco


    The aim of the study was to evaluate iloprost infusion as an alternative to open surgical revascularisation in diabetic patients with foot ulcers, also as a support measure in conjunction with endovascular procedures. We studied 244 patients with critical ischaemia of the lower limbs, 146 of whom (59.8%) affected by diabetes. A femoro-distal bypass was performed in 175 patients. In the 69 nonsurgical diabetic patients (47.3% of the diabetics) an iloprost infusion was started. These diabetics presented foot ulcers, a palpable or slightly hypo-sphygmic popliteal pulse and high distal arterial flow at the ankle. In 55 of these patients (79.7% of those not operated on and 37.6% of the diabetics) who were non-responders to medical therapy, an endovascular procedure was also performed. The results of the iloprost infusion (69 pts.) were evaluated after one week. In 14 responders treated only with iloprost infusion, complete healing of the lesions occurred during the 3 weeks following the end of the 4-week course of therapy. No severe ischaemia recurrences were reported in the follow-up of these 69 patients. In the 47.3% of subjects with diabetic arteriopathy presenting foot ulcers and high distal flow, it proved possible to avoid an open surgical revascularisation procedure and to resort to medical therapy with iloprost, completed in 79.7% of cases with endovascular procedures. Iloprost infusion improves limb perfusion and, in selected cases may be an important therapeutic tool for the care of ulcerative lesions of the diabetic foot, also as a support measure in conjunction with endovascular procedures.

  2. Herpes simplex ulcerative esophagitis in healthy children

    Directory of Open Access Journals (Sweden)

    Abdulrahman A Al-Hussaini


    Full Text Available Herpes simplex virus is a common cause of ulcerative esophagitis in the immunocompromised or debilitated host. Despite a high prevalence of primary and recurrent Herpes simplex virus infection in the general population, Herpes simplex virus esophagitis (HSVE appears to be rare in the immunocompetent host. We report three cases of endoscopically-diagnosed HSVE in apparently immunocompetent children; the presentation was characterized by acute onset of fever, odynophagia, and dysphagia. In two cases, the diagnosis was confirmed histologically by identification of herpes viral inclusions and culture of the virus in the presence of inflammation. The third case was considered to have probable HSVE based on the presence of typical cold sore on his lip, typical endoscopic finding, histopathological evidence of inflammation in esophageal biopsies and positive serologic evidence of acute Herpes simplex virus infection. Two cases received an intravenous course of acyclovir and one had self-limited recovery. All three cases had normal immunological workup and excellent health on long-term follow-up.

  3. Unilateral Molar Distalization: A Nonextraction Therapy

    Directory of Open Access Journals (Sweden)

    M. Bhanu Prasad


    Full Text Available In the recent years, nonextraction treatment approaches and noncompliance therapies have become more popular in the correction of space discrepancies. One of the conventional approaches for space gaining in the arches without patient compliance is done by using certain extra oral appliances or intraoral appliance. The greatest advantage of certain appliances like fixed functional and molar distalization appliances is that they minimize the dependence on patient cooperation. Molar distalization appliances like pendulum appliance which distalizes the molar rapidly without the need of head gear can be used in patients as a unilateral space gaining procedure due to buccal segment crowding.

  4. The distal hereditary motor neuropathies. (United States)

    Rossor, Alexander M; Kalmar, Bernadett; Greensmith, Linda; Reilly, Mary M


    The distal hereditary motor neuropathies (dHMN) comprise a heterogeneous group of diseases that share the common feature of a length-dependent predominantly motor neuropathy. Many forms of dHMN have minor sensory abnormalities and/or a significant upper-motor-neuron component, and there is often an overlap with the axonal forms of Charcot-Marie-Tooth disease (CMT2) and with juvenile forms of amyotrophic lateral sclerosis and hereditary spastic paraplegia. Eleven causative genes and four loci have been identified with autosomal dominant, recessive and X-linked patterns of inheritance. Despite advances in the identification of novel gene mutations, 80% of patients with dHMN have a mutation in an as-yet undiscovered gene. The causative genes have implicated proteins with diverse functions such as protein misfolding (HSPB1, HSPB8, BSCL2), RNA metabolism (IGHMBP2, SETX, GARS), axonal transport (HSPB1, DYNC1H1, DCTN1) and cation-channel dysfunction (ATP7A and TRPV4) in motor-nerve disease. This review will summarise the clinical features of the different subtypes of dHMN to help focus genetic testing for the practising clinician. It will also review the neuroscience that underpins our current understanding of how these mutations lead to a motor-specific neuropathy and highlight potential therapeutic strategies. An understanding of the functional consequences of gene mutations will become increasingly important with the advent of next-generation sequencing and the need to determine the pathogenicity of large amounts of individual genetic data.

  5. [Genital ulcers--what's new?]. (United States)

    Abu Raya, Bahaa; Bamberger, Ellen; Srugo, Isaac


    The most common infectious causes of genital ulcers are herpes simplex virus and syphilis. However, mixed infections can occur and genital ulcer may increase the risk of acquiring human immunodeficiency virus. Although the history and physical examination can narrow the differential diagnosis, there is a need for initial routine laboratory testing for the most common pathogens that includes: for syphilis: serologic screening and dark field examination of the lesion; for herpes simplex virus: serology, vial culture and/or polymerase chain reaction. Human immunodeficiency testing is mandatory. Recently, some clinical laboratories adapted the reverse screening algorithm for syphilis (initial treponemal test, and, if positive, followed by non-treponemal test) that may potentially lead to overtreatment. Early and prompt therapy may decrease the risk of transmission of the infectious agent to others. This article reviews the infectious pathogens causing genital ulcers, their unique clinical manifestation, diagnosis and treatment.

  6. Management of bleeding gastroduodenal ulcers

    DEFF Research Database (Denmark)

    Laursen, Stig Borbjerg; Jørgensen, Henrik Stig; Schaffalitzky de Muckadell, Ove B


    serious ulcer bleeding is suspected and blood found in gastric aspirate, endoscopy within 12 hours will result in faster discharge and reduced need for transfusions. Endoscopic hemostasis remains indicated for high-risk lesions. Clips, thermocoagulation, and epinephrine injection are effective......Description: A multidisciplinary group of Danish experts developed this guideline on management of bleeding gastroduodenal ulcers. Sources of data included published studies up to March 2011. Quality of evidence and strength of recommendations have been graded. The guideline was approved......-risk stigmata. Although selected patients can be discharged promptly after endoscopy, high-risk patients should be hospitalized for at least 3 days after endoscopic hemostasis. Patients with peptic ulcer bleeding who require secondary cardiovascular prophylaxis should start receiving acetylsalicylic acid (ASA...

  7. Pradaxa-induced esophageal ulcer. (United States)

    Wood, Michele; Shaw, Paul


    Pradaxa (dabigatran) is a direct thrombin inhibitor approved for prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation. We describe a case of esophageal ulceration associated with Pradaxa administration in a 75-year-old man. The patient reported difficulty swallowing and a burning sensation after taking his first dose of Pradaxa. An esophagogastroduodenoscopy (EGD) revealed linear ulcerations in the mid-esophagus. Pradaxa was held beginning the day before the EGD. The patient reported that his pain and difficulty swallowing resolved on stopping Pradaxa. Pradaxa is formulated with a tartaric acid excipient to reduce variability in absorption. We hypothesise that the capsule lodged in the patient's esophagus and the tartaric acid may have caused local damage resulting in an esophageal ulcer. It is important to educate patients on proper administration of Pradaxa, to decrease the risk of this rare, but potentially serious adverse event.

  8. Nonhealing Ulcer: Acroangiodermatitis of Mali

    Directory of Open Access Journals (Sweden)

    Neeraj Varyani


    Full Text Available An 18-year-old male presented with a nonhealing wound on left lower limb, pain and swelling over multiple joints, weight loss, and yellowish discoloration of eyes and urine for the past 4 years. On examination, the patient had pallor, icterus, and generalized lymphadenopathy with a nonhealing unhealthy ulcer over left medial malleolus. He had deformed joints with hepatomegaly and splenomegaly. His laboratory investigations were positive for antinuclear antibody (ANA and anticardiolipin antibody (ACLA. Synovial fluid analysis showed inflammatory findings. Biopsy of margin of the ulcer showed findings consistent with Acroangiodermatitis of Mali. The patient was treated with disease-modifying antirheumatic drugs (DMARDs and aspirin for juvenile idiopathic arthritis and secondary antiphospholipid antibody syndrome (APS, respectively. The ulcer was managed conservatively with systemic antibiotics and topical steroids along with limb elevation and compression elastic stockings. The patient's symptoms improved significantly, and he is in our followup.

  9. Steroid ulcers:Any news?

    Institute of Scientific and Technical Information of China (English)

    Mario; Guslandi


    Steroid ulcers,although a common feature in experimental studies,seldom develop in clinical practice,as observed by the meta-analyses carried out in the 90s.Corticosteroids alone become ulcerogenic only if treatment lasts longer than one month and the total administered dose exceeds 1000 mg.On the other hand concomitant intake of non-steroidal anti-inflammatory drugs results in a synergistic,highly damaging effect on the gastroduodenal mucosa.Thus,despite the survival of the steroid ulcer myth in the medical culture,pharmacological protection against steroid-induced peptic ulcers is a rare necessity while the best prophylactic strategy still remains to be determined.

  10. Characterization of Helicobacter Pylori Infection in Patients with Gastric Ulcer

    Directory of Open Access Journals (Sweden)

    Marcos Félix Osorio Pagola


    Full Text Available Background: Nowadays, infection due to Helicobacter Pylori is recognized as a medical problem worldwide. It causes chronic gastritis, peptic ulcer disease, lymphatic proliferative disorders and it is a risk factor for gastric cancer. Objective: To characterize Helicobacter Pylori infection in patients with gastric ulcer and to relate this infection to gastric histological diagnoses. Methods: An observational, descriptive, correlational retrospective study in patients with gastric ulcers at the Dr.Gustavo Aldereguía Lima Hospital was carried out from January 2005 to December 2007. Endoscopy and mucous gastric biopsy were performed for the histological and diagnostic study of the infection due to Helicobacter Pylori by means of the hematoxiline-eosine and giemsa stain respectively. The sample was composed by 137 patients. Results: the frequency of infection due to Helicobacter pylori was 59,1 % prevailing in the age groups 51-60 years old (34,6 % and 61-70 yearsold. (30,8 %. The highest frequency of malignant ulcers were located at the antral region (85,7 % with predominance of Helicobacter Pylori (80 %. There was a 95 % reliability between the relationship of Helicobacter Pylori and the histological diagnoses. The patients under the diagnosis of Helicobacter Pylori showed a greater probability to present cancer (OR 4,32 IC: 0,58-39,44 and worsened chronic gastritis (OR 2,59 IC: 0,61-11,30. Chronic gastritis did not constitute a risk factor for acute gastritis(OR 0,86 IC: 0,09-7,08. Conclusions: The probability of suffering from gastric cancer, chronic gastritis and worsened chronic gastritis was greater in all those patients who presented with Helicobacter pylori infection but in this study Helicobacter pylori did not constitute a risk factor for acute gastritis

  11. Misoprostol in peptic ulcer disease. (United States)

    Watkinson, G; Akbar, F A


    Misoprostol, a synthetic prostaglandin E1 (PGE1) methyl ester analog has potent antisecretory and cytoprotective effects on the gastric and duodenal mucosa which should make it an effective drug in the treatment of gastric and duodenal ulcer. In two multicenter, randomised, double-blind, controlled studies involving over 900 patients with endoscopically proven benign gastric ulcer and in six similar studies involving over 2000 patients with active duodenal ulcers, differing doses of misoprostol have been compared with either placebo therapy or with conventional doses of cimetidine. In these studies misoprostol 800 mcg daily given as two or four divided doses has been shown to produce rates of complete ulcer healing and pain relief which were significantly superior to placebo therapy and comparable to those achieved with cimetidine. Drug related adverse effects were infrequent. A dose related diarrhea occurred in a small proportion of patients which seldom necessitated suspension of therapy. Because of the known uterotropic effect of prostaglandins the drug should not be used in pregnant women or women of child bearing age unless they are using adequate contraceptive measures. No clinically significant adverse, hematological or biochemical effects have been reported. Two studies suggested that misoprostol reduced the adverse effect of smoking on the healing of duodenal ulcer. In addition, misoprostol has been shown to protect the gastro-duodenal mucosa from the damaging effects of alcohol and non-steroidal anti-inflammatory drugs. This action may prove of value in the treatment of ulcer patients who are inveterate smokers, alcohol users or who are compelled to consume non-steroidal anti-inflammatory drugs for pain relief from rheumatic and allied diseases.

  12. Conocimiento y uso de las directrices de prevención y tratamiento de las úlceras por presión en un hospital de agudos Knowledge and use of the guidelines for prevention and treatment of pressure ulcers in acute-care hospital

    Directory of Open Access Journals (Sweden)

    Juan José Zamora Sánchez


    Full Text Available Introducción: Las úlceras por presión (UPP siguen constituyendo hoy día un importante problema de salud y son un indicador de calidad con una relación directa con los cuidados de enfermería. Se plantea un estudio descriptivo con el objetivo de evaluar el grado de conocimiento y aplicación en su práctica asistencial de las recomendaciones que aparecen en las principales guías de práctica clínica para la prevención y cuidado de las UPP, en los profesionales de enfermería de un hospital de agudos. Material y métodos: Se diseñó un estudio transversal mediante cuestionario autocumplimentado, entre marzo y abril de 2005. La población de estudio es el personal de enfermería (diplomados y auxiliares de enfermería de las unidades de hospitalización y UCI de un hospital de agudos. Resultados: Se obtuvo una tasa de respuesta del 37,5% (75 cuestionarios, 80% enfermeras y 20% auxiliares. En general, el grado de conocimiento de las recomendaciones sobre prevención y tratamiento de las UPP, del GNEAUPP, EPUAP y AHCPR entre los profesionales de enfermería de hospitalización y UCI está en torno al 70%, aunque destaca el bajo conocimiento de las intervenciones desaconsejadas por las guías de práctica clínica citadas, tanto en prevención como en tratamiento (aproximadamenacte, el 40%, Una cuarta parte de la muestra indica no haber recibido formación específica en UPP, ni tan sólo durante la titulación profesional. Aparecen diferencias significativas según los años de experiencia profesional: el 80,77% del grupo Introduction: Pressure ulcers continue to present a significant health problem and serve as a quality indicator that is directly related to nursing care. We propose a descriptive study with the following objective: to evaluate the level of knowledge and the application of the recommendations appearing in the main guides for the prevention of and care for pressure ulcers among nursing professionals in acute-care hospitals

  13. Natural history and outcome of patients with intramural hematomas and penetrating aortic ulcers. (United States)

    Mousa, Albeir Y; Bozzay, Joseph; AbuRahma, Ali F


    All pathologies of acute aortic syndromes should be precisely diagnosed for prompt therapy. Intramural hematomas, as well as penetrating ulcers can be encountered in these patients. Presentations, clinical scenarios, and proper management are outlined in this review, which sums up available current literature to provide the vascular specialist with an adequate understanding of these unique syndromes.

  14. Pressure ulcer education improves interrater reliability, identification, and classification skills by emergency nurses and physicians

    NARCIS (Netherlands)

    Ham, Wietske H W; Schoonhoven, Lisette; Schuurmans, Marieke J.; Veugelers, Rebekka; Leenen, Luke P H


    Introduction: Pressure ulcers (PUs) are a serious health complication that develop as a result of pressure alone or pressure in combination with shearing forces. Although PUs are typically associated with older adults and chronic illness, acutely injured trauma patients may have a particular risk fo

  15. Pressure ulcer education improves interrater reliability, identification, and classification skills by emergency nurses and physicians

    NARCIS (Netherlands)

    Ham, W.H.; Schoonhoven, L.; Schuurmans, M.J.; Veugelers, R.; Leenen, L.P.


    INTRODUCTION: Pressure ulcers (PUs) are a serious health complication that develop as a result of pressure alone or pressure in combination with shearing forces. Although PUs are typically associated with older adults and chronic illness, acutely injured trauma patients may have a particular risk fo

  16. Computed tomographic findings in penetrating peptic ulcer

    Energy Technology Data Exchange (ETDEWEB)

    Madrazo, B.L.; Halpert, R.D.; Sandler, M.A.; Pearlberg, J.L.


    Four cases of peptic ulcer penetrating the head of the pancreas were diagnosed by computed tomography (CT). Findings common to 3 cases included (a) an ulcer crater, (b) a sinus tract, and (c) enlargement of the head of the pancreas. Unlike other modalities, the inherent spatial resolution of CT allows a convenient diagnosis of this important complication of peptic ulcer disease.

  17. Diagnosis and treatment of venous ulcers. (United States)

    Collins, Lauren; Seraj, Samina


    Venous ulcer, also known as stasis ulcer, is the most common etiology of lower extremity ulceration, affecting approximately 1 percent of the U.S. population. Possible causes of venous ulcers include inflammatory processes resulting in leukocyte activation, endothelial damage, platelet aggregation, and intracellular edema. The primary risk factors for venous ulcer development are older age, obesity, previous leg injuries, deep venous thrombosis, and phlebitis. On physical examination, venous ulcers are generally irregular, shallow, and located over bony prominences. Granulation tissue and fibrin are typically present in the ulcer base. Associated findings include lower extremity varicosities, edema, venous dermatitis, and lipodermatosclerosis. Venous ulcers are usually recurrent, and an open ulcer can persist for weeks to many years. Severe complications include cellulitis, osteomyelitis, and malignant change. Poor prognostic factors include large ulcer size and prolonged duration. Evidence-based treatment options for venous ulcers include leg elevation, compression therapy, dressings, pentoxifylline, and aspirin therapy. Surgical management may be considered for ulcers that are large in size, of prolonged duration, or refractory to conservative measures.

  18. Protective Effect of Flos Lonicerae against Experimental Gastric Ulcers in Rats: Mechanisms of Antioxidant and Anti-Inflammatory Action

    Directory of Open Access Journals (Sweden)

    Jung-Woo Kang


    Full Text Available Flos Lonicerae is one of the oldest and most commonly prescribed herbs in Eastern traditional medicine to treat various inflammatory diseases. In the present study, we investigated the effects of ethyl acetate fraction of Flos Lonicerae (GC-7101 on experimental gastric ulcer models and its mechanisms of action in gastric ulcer healing. The pharmacological activity of GC-7101 was investigated in rats on HCl/EtOH, indomethacin, water immersion restraint stress induced acute gastric ulcer, and acetic-acid-induced subchronic gastric ulcer. To determine its gastroprotective mechanisms, gastric wall mucus secretion, mucosal PGE2, mucosal NO content, nuclear translocation of NF-κB, mRNA expression of inflammatory cytokines, lipid peroxidation and glutathione content, and superoxide dismutase and catalase activities were measured. GC-7101 significantly attenuated development of acute gastric ulcer and accelerated the healing of acetic-acid-induced subchronic gastric ulcer. In HCl/EtOH-induced gastric ulcer, GC-7101 markedly enhanced gastric wall mucus content which was accompanied by increased mucosal PGE2 and NO production. Furthermore, treatment of GC-7101 exhibited anti-inflammatory and antioxidant activities as evidenced by decreased myeloperoxidase activity, NF-κB translocation, inflammatory cytokines mRNA expression, and lipid peroxidation and increased glutathione content and superoxide dismutase and catalase activities. These results demonstrated that GC-7101 possesses strong antiulcerogenic effect by modulating oxidative stress and proinflammatory mediators.

  19. Mechanisms and management of diabetic painful distal symmetrical polyneuropathy. (United States)

    Tesfaye, Solomon; Boulton, Andrew J M; Dickenson, Anthony H


    Although a number of the diabetic neuropathies may result in painful symptomatology, this review focuses on the most common: chronic sensorimotor distal symmetrical polyneuropathy (DSPN). It is estimated that 15-20% of diabetic patients may have painful DSPN, but not all of these will require therapy. In practice, the diagnosis of DSPN is a clinical one, whereas for longitudinal studies and clinical trials, quantitative sensory testing and electrophysiological assessment are usually necessary. A number of simple numeric rating scales are available to assess the frequency and severity of neuropathic pain. Although the exact pathophysiological processes that result in diabetic neuropathic pain remain enigmatic, both peripheral and central mechanisms have been implicated, and extend from altered channel function in peripheral nerve through enhanced spinal processing and changes in many higher centers. A number of pharmacological agents have proven efficacy in painful DSPN, but all are prone to side effects, and none impact the underlying pathophysiological abnormalities because they are only symptomatic therapy. The two first-line therapies approved by regulatory authorities for painful neuropathy are duloxetine and pregabalin. α-Lipoic acid, an antioxidant and pathogenic therapy, has evidence of efficacy but is not licensed in the U.S. and several European countries. All patients with DSPN are at increased risk of foot ulceration and require foot care, education, and if possible, regular podiatry assessment.

  20. Differential response of A 68930 and sulpiride in stress-induced gastric ulcers in rats. (United States)

    Rasheed, Naila; Ahmad, Ausaf; Singh, Neetu; Singh, Pratibha; Mishra, Vaibhav; Banu, Naheed; Lohani, Mohtashim; Sharma, Sharad; Palit, Gautam


    Dopamine is linked to gastrointestinal functions. However, its exact nature in stress-induced gastric pathology is still not clear. In the present study, an attempt has been made to identify the effects of dopamine in stress-induced gastric ulcers, and concurrent alterations in various ulcer-influencing factors such as plasma corticosterone levels, gastric mucosal PGE(2) content and proton pump activity. The dopamine D(1) receptor agonist (A 68930) and antagonist (SCH 23390), and D(2) receptor agonist (quinpirole) and antagonist (sulpiride) were used to evaluate their effects on acute stress (single immobilization for 150 min) and chronic unpredictable stress (two different types of stressors for 7 days) induced gastric ulcers in rats. Acute and chronic unpredictable stress significantly increased the gastric ulcer severity, adrenal hypertrophy and corticosterone levels, while gastric mucosal dopamine levels were decreased. Pretreatment of sulpiride (60 mg/kg) significantly reverted the acute stress-induced alterations, while A 68930 (0.25mg/kg) significantly restored the acute and chronic unpredictable stress-induced alterations. In contrast, administration of SCH 23390 (0.1-0.5mg/kg) and quinpirole (0.1-0.5mg/kg) failed to alter acute stress-induced alterations. Further, A 68930 and sulpiride showed different response on proton pump inhibition under in-vitro condition. A 68930 (10-50 microg/ml) inhibited the gastric H(+) K(+)-ATPase activity comparable to positive control omeprazole, while sulpiride (10-50 microg/ml) had no effect. A 68930 also normalized the decreased gastric PGE2 content observed during chronic unpredictable stress. The histopathological evaluation of gastric mucosal tissue supported the observations regarding the gastroprotective effect of sulpiride during acute stress and of A 68930 during both acute and chronic unpredictable stress conditions. Our results provide important insights into the mechanism of dopamine-regulated pathways, which

  1. Pressure ulcers in four Indonesian hospitals: prevalence, patient characteristics, ulcer characteristics, prevention and treatment. (United States)

    Amir, Yufitriana; Lohrmann, Christa; Halfens, Ruud Jg; Schols, Jos Mga


    The objective of this article was to study characteristics of pressure ulcer patients and their ulcers, pressure ulcer preventive and treatment measures in four Indonesian general hospitals. A multicentre cross-sectional design was applied to assess pressure ulcers and pressure ulcer care in adult patients in medical, surgical, specialised and intensive care units. Ninety-one of the 1132 patients had a total of 142 ulcers. Half (44·0%) already had pressure ulcers before admission. The overall prevalence of category I-IV pressure ulcers was 8·0% (95% CI 6·4-9·6), and the overall nosocomial pressure ulcer prevalence was 4·5% (95% CI 3·3-5·7). Most pressure ulcer patients had friction and shear problems, were bedfast, had diabetes and had more bedridden days. Most ulcers (42·3%) were category III and IV. One third of the patients had both pressure ulcers and moisture lesions (36·3%) and suffered from pain (45·1%). The most frequently used prevention measures were repositioning (61·5%), skin moisturising (47·3%), patient education (36·3%) and massage (35·2%). Most pressure ulcer dressings involved saline-impregnated or antimicrobial gauzes. This study shows the complexities of pressure ulcers in Indonesian general hospitals and reveals that the quality of pressure ulcer care (prevention and treatment) could be improved by implementing the recent evidence-based international guideline.

  2. Çocuklarda Distal Hipospadias Cerrahisi: Deneyimlerimiz



    Objective: In this study, patients treated with distal hypospadias and discuscion of our results with literature were aimed. Material and Methods: 46 patients, who underwent distal hypospadias repair in the recent 2,5 years, were avaluated according to age, meatal localization, chordee status, the type of operation technique, postoperative urethral catheterization and hospitalization time, associated genitourinary anomalies, early and late complications. Results: 4 of 46 cases were treated wi...

  3. Mucosal healing in ulcerative colitis

    DEFF Research Database (Denmark)

    Seidelin, Jakob Benedict; Coskun, Mehmet; Nielsen, Ole Haagen


    Ulcerative colitis (UC) is a colonic inflammatory condition with a substantial impact on the quality of life of affected persons. The disease carries a cumulative risk of need of colectomy of 20-30% and an estimated cumulative risk of colorectal cancer of 18% after 30 years of disease duration. W...

  4. FAQs on leg ulcer care. (United States)

    Anderson, Irene; King, Brenda; Knight, Susan; Keynes, Milton

    In a webchat on leg ulcer management issues, hosted by Nursing Times, participants raised three key areas of care: the role of healthcare assistants in compression bandaging; reporting and investigating damage caused by compression therapy; and recommendations for dressings to be used under compression. This article discusses each of these in turn.

  5. Mucosal healing in ulcerative colitis

    DEFF Research Database (Denmark)

    Seidelin, Jakob Benedict; Coskun, Mehmet; Nielsen, Ole Haagen


    Ulcerative colitis (UC) is a colonic inflammatory condition with a substantial impact on the quality of life of affected persons. The disease carries a cumulative risk of need of colectomy of 20-30% and an estimated cumulative risk of colorectal cancer of 18% after 30 years of disease duration...

  6. [Ulcerative colitis and cytomegalovirus infection]. (United States)

    Tárraga Rodríguez, I; Ferreras Fernández, P; Vicente Gutiérrez, M; de Arriba, J J; García Mouriño, M L


    Colitis ulcerous and citomegalovirus infection association have been reported in medical literature in sometimes, althougth this prevalence have lately increased. We report a case record of this association and do a review of this subject. It is not clear what factors are involved in this association, being necessary hore studies to know them.

  7. Management of bleeding gastroduodenal ulcers

    DEFF Research Database (Denmark)

    Laursen, Stig Borbjerg; Jørgensen, Henrik Stig; Schaffalitzky de Muckadell, Ove B.


    -risk stigmata. Although selected patients can be discharged promptly after endoscopy, high-risk patients should be hospitalized for at least 3 days after endoscopic hemostasis. Patients with peptic ulcer bleeding who require secondary cardiovascular prophylaxis should start receiving acetylsalicylic acid (ASA...

  8. Spontaneous rupture of the distal iliopsoas tendon: clinical and imaging findings, with anatomic correlations. (United States)

    Lecouvet, Frederic E; Demondion, Xavier; Leemrijse, Thibaut; Vande Berg, Bruno C; Devogelaer, Jean-Pierre; Malghem, Jacques


    We report the clinical and imaging findings in two elderly female patients with spontaneous rupture of the distal iliopsoas tendon from the lesser trochanter of the femur. We emphasize the key contribution of magnetic resonance (MR) imaging to this diagnosis and provide an anatomic correlation. Spontaneous rupture of the distal iliopsoas tendon should be kept in mind in the differential diagnosis of acute groin pain in the elderly. MR imaging enables positive diagnosis, by showing mass effect on the anterior aspect of the hip joint, proximal muscle thickening, and abnormal signal intensity, and by demonstrating interruption of the psoas tendon, whereas the distal insertion of the lateral portion of the iliacus muscle remains muscular and is preserved.

  9. Spontaneous rupture of the distal iliopsoas tendon: clinical and imaging findings, with anatomic correlations

    Energy Technology Data Exchange (ETDEWEB)

    Lecouvet, Frederic E.; Vande Berg, Bruno C.; Malghem, Jacques [Universite Catholique de Louvain, Department of Radiology and Medical Imaging, Saint Luc University Hospital, Brussels (Belgium); Demondion, Xavier [Centre Hospitalier Universitaire de Lille, Department of Bone Radiology and Laboratory of Anatomy, Lille (France); Leemrijse, Thibaut [Universite Catholique de Louvain, Department of Orthopedic Surgery, Saint Luc University Hospital, Brussels (Belgium); Devogelaer, Jean-Pierre [Universite Catholique de Louvain, Department of Rheumatology, Saint Luc University Hospital, Brussels (Belgium)


    We report the clinical and imaging findings in two elderly female patients with spontaneous rupture of the distal iliopsoas tendon from the lesser trochanter of the femur. We emphasize the key contribution of magnetic resonance (MR) imaging to this diagnosis and provide an anatomic correlation. Spontaneous rupture of the distal iliopsoas tendon should be kept in mind in the differential diagnosis of acute groin pain in the elderly. MR imaging enables positive diagnosis, by showing mass effect on the anterior aspect of the hip joint, proximal muscle thickening, and abnormal signal intensity, and by demonstrating interruption of the psoas tendon, whereas the distal insertion of the lateral portion of the iliacus muscle remains muscular and is preserved. (orig.)

  10. Acute chylous peritonitis due to acute pancreatitis. (United States)

    Georgiou, Georgios K; Harissis, Haralampos; Mitsis, Michalis; Batsis, Haralampos; Fatouros, Michalis


    We report a case of acute chylous ascites formation presenting as peritonitis (acute chylous peritonitis) in a patient suffering from acute pancreatitis due to hypertriglyceridemia and alcohol abuse. The development of chylous ascites is usually a chronic process mostly involving malignancy, trauma or surgery, and symptoms arise as a result of progressive abdominal distention. However, when accumulation of "chyle" occurs rapidly, the patient may present with signs of peritonitis. Preoperative diagnosis is difficult since the clinical picture usually suggests hollow organ perforation, appendicitis or visceral ischemia. Less than 100 cases of acute chylous peritonitis have been reported. Pancreatitis is a rare cause of chyloperitoneum and in almost all of the cases chylous ascites is discovered some days (or even weeks) after the onset of symptoms of pancreatitis. This is the second case in the literature where the patient presented with acute chylous peritonitis due to acute pancreatitis, and the presence of chyle within the abdominal cavity was discovered simultaneously with the establishment of the diagnosis of pancreatitis. The patient underwent an exploratory laparotomy for suspected perforated duodenal ulcer, since, due to hypertriglyceridemia, serum amylase values appeared within the normal range. Moreover, abdominal computed tomography imaging was not diagnostic for pancreatitis. Following abdominal lavage and drainage, the patient was successfully treated with total parenteral nutrition and octreotide.

  11. Acute chylous peritonitis due to acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Georgios K Georgiou; Haralampos Harissis; Michalis Mitsis; Haralampos Batsis; Michalis Fatouros


    We report a case of acute chylous ascites formation presenting as peritonitis (acute chylous peritonitis) in a patient suffering from acute pancreatitis due to hypertriglyceridemia and alcohol abuse.The development of chylous ascites is usually a chronic process mostly involving malignancy,trauma or surgery,and symptoms arise as a result of progressive abdominal distention.However,when accumulation of "chyle" occurs rapidly,the patient may present with signs of peritonitis.Preoperative diagnosis is difficult since the clinical picture usually suggests hollow organ perforation,appendicitis or visceral ischemia.Less than 100 cases of acute chylous peritonitis have been reported.Pancreatitis is a rare cause of chyloperitoneum and in almost all of the cases chylous ascites is discovered some days (or even weeks) after the onset of symptoms of pancreatitis.This is the second case in the literature where the patient presented with acute chylous peritonitis due to acute pancreatitis,and the presence of chyle within the abdominal cavity was discovered simultaneously with the establishment of the diagnosis of pancreatitis.The patient underwent an exploratory laparotomy for suspected perforated duodenal ulcer,since,due to hypertriglyceridemia,serum amylase values appeared within the normal range.Moreover,abdominal computed tomography imaging was not diagnostic for pancreatitis.Following abdominal lavage and drainage,the patient was successfully treated with total parenteral nutrition and octreotide.

  12. Effect of centrally administered oxytocin on gastric and duodenal ulcers in rats%脑室注射催产素对大鼠胃和十二指肠溃疡的作用

    Institute of Scientific and Technical Information of China (English)

    Mohammed ASAD; Deepak Gopal; Kallasam KOUMARAVELOU; Benny K ABRAHAM; Sadashivam VASU; Subramanian RAMASWAMY


    AIM: To investigate the effect of centrally administered oxytocin and its receptor antagonist, atosiban, on gasuic acid secretion and on experimentally induced gastric and duodenal ulcers. METHODS: The acute gastric ulcer models, such as pylorus ligation, indomethacin-induced and ethanol-induced gastric ulcers were used. Chronic gastric ulcers were induced by acetic acid and duodenal ulcers by cysteamine HC1. RESULTS: In pylorus ligated rats, oxytocin ( 10 μg/kg, icv) showed signifi cant antisecretory and antiulcer activity (P<0.01 ). However, it aggravated the ethanol-induced gastric ulcers and did not show any effect on indomethacin-induced gas tric ulcers. Oxytocin increased gastric ulcer healing in acetic acid-induced chronic gastric ulcers. The effect of oxytocin was reversed by atosiban (10 μg/kg, icy), a selective oxytocin receptor antagonist. Atosiban when given alone increased gastric acid secretion and ulcer index in pylorus-ligated rats and also aggravated acetic acid-induced chronic gastric ulcers. It seems the antiul cer activity of oxytocin was due to its anti-secretory ef fect. CONCLUSION: Centrally administered oxytocin possesses gastric anti-secretory and anti-ulcer activity and oxytocin antagonist, atosiban, is pro-ulcerogenic in rats.

  13. Peptic ulcers: mortality and hospitalization. (United States)

    Riley, R


    This study analyzes data on peptic ulcer disease based on deaths for 1951-1988 and hospital separations for 1969-1988. The source of the data are mortality and morbidity statistics provided to Statistics Canada by the provinces. The age-standardized mortality rates (ASMR) for peptic ulcer disease decreased from 1951 to 1988 by 69.4% for men (8.5 to 2.6 per 100,000 population), and 31.8% for women (2.2 to 1.5). Separation rates from hospitals during 1969-1988 for peptic ulcer disease also decreased by 59.8% for men (242.7 to 97.6 per 100,000 population) and 35.6% for women (103.2 to 66.5). Age-specific rates for both mortality and hospital separations increased with age. Epidemiological studies indicate that the incidence of peptic ulcer disease is declining in the general population. The downward trends in mortality and hospitalization rates for peptic ulcer disease reflect this change in incidence, but additional factors probably contribute as well to this decline. Male rates for both mortality and hospital separations were much higher than female rates at the beginning of the study period; but toward the end, the gap between the sexes narrowed considerably, mainly because the male rates declined substantially while the female rates decline moderately. The slower decline in the rates for women may be related to such factors as the increasing labour force participation among women and the slower decline in the population of female smokers.

  14. Dutch Venous Ulcer guideline update. (United States)

    Maessen-Visch, M Birgitte; de Roos, Kees-Peter


    The revised guideline of 2013 is an update of the 2005 guideline "venous leg ulcer". In this special project four separate guidelines (venous leg ulcer, varicose veins, compression therapy and deep venous disorders) were revised and developed simultaneously. A meeting was held including representatives of any organisation involved in venous disease management including patient organizations and health insurance companies. Eighteen clinical questions where defined, and a new strategy was used to accelerate the process. This resulted in two new and two revised guidelines within one year. The guideline committee advises use of the C of the CEAP classification as well as the Venous Clinical Severity Score (VCSS) and a Quality of life (QoL) score in the assessment of clinical signs. These can provide insight into the burden of disease and the effects of treatment as experienced by the patient. A duplex ultrasound should be performed in every patient to establish the underlying aetiology and to evaluate the need for treatment (which is discussed in a separate guideline). The use of the TIME model for describing venous ulcers is recommended. There is no evidence for antiseptic or antibiotic wound care products except for a Cochrane review in which some evidence is presented for cadexomer iodine. Signs of infection are the main reason for the use of oral antibiotics. When the ulcer fails to heal the use of oral aspirin and pentoxifylline can be considered as an adjunct. For the individual patient, the following aspects should be considered: the appearance of the ulcer (amount of exudate) according to the TIME model, the influence of wound care products on moisturising the wound, frequency of changing compression bandages, pain and allergies. The cost of the dressings should also be considered. Education and training of patients t improves compliance with compression therapy but does not influence wound healing rates.

  15. Antiulcer properties of Glycyrrhiza glabra L. extract on experimental models of gastric ulcer in mice. (United States)

    Jalilzadeh-Amin, Ghader; Najarnezhad, Vahid; Anassori, Ehsan; Mostafavi, Mostafa; Keshipour, Hadi


    Glycyrrhiza glabra L. is used in folk medicine for treatment of stomach disorders including peptic ulcers. The hydroalcoholic extract of Glycyrrhiza glabra L. (HEGG) was evaluated for antiulcerogenic activity and acute toxicity profile in mice. Various doses of HEGG (50-200 mg/kg) were administered orally to animals of different groups. Omeprazole and cimetidine at doses of 30 and 100 mg/kg were used as positive controls, respectively. Stomach was opened along the greater curvature then ulceration index was determined examining the inner lining of stomach. Oral administration of the extract at 1600 mg/kg did not produce toxic symptoms and mortality in mice. 2950 mg/kg was determined as the oral LD50. The HEGG (50-200 mg/kg) showed a significant reduction in ulcer index in HCl/Ethanol-induced ulcer. G. glabra extract (50-150 mg/kg) showed antiulcer activity against indomethacin-induced gastric lesions dose dependently. The extract effectively inhibited formation of gastric lesions induced by ethanol. The extract (200 mg/kg) was more potent than omeprazole (30 mg/kg). HEGG reduced the ulcer index in hypothermic stress induced gastric ulcers in mice and the antiulcer effect was comparable to that of cimetidine. The results indicated that G. glabra hydroalcoholic extract exerted an antiulcergenic effect that could be associated with increase in gastric mucosal defensive factors.

  16. Aqueous suspension of anise "Pimpinella anisum" protects rats against chemically induced gastric ulcers

    Institute of Scientific and Technical Information of China (English)

    Ibrahim A Al Mofleh; Abdulqader A Alhaider; Jaber S Mossa; Mohammed O Al-Soohaibani; Syed Rafatullah


    AIM:To substantiate the claims of Unani and Arabian traditional medicine practitioners on the gastroprotective potential effect of a popular spice anise,"Pimpinella anisum L." on experimentally-induced gastric ulceration and secretion in rats.METHODS:Acute gastric ulceration in rats was produced by various noxious chemicals including 80% ethanol,0.2 mol/L NaOH,25% NaCl and indomethacin.Anti-secretory studies were undertaken using pylorusligated Shay rat technique.Levels of gastric non-protein sulfhydryls(NP-SH)and wall mucus were estimated and gastric tissue was also examined histologically.Anise aqueous suspension was used in two doses(250 and 500 mg/kg body weight)in all experiments.RESULTS:Anise significantly inhibited gastric mucosal damage induced by necrotizing agents and indomethacin.The anti-ulcer effect was further confirmed histologically.In pylorus-ligated Shay rats,anise suspension significantly reduced the basal gastric acid secretion,acidity and completely inhibited the rumenal ulceration.On the other hand,the suspension significantly replenished ethanol-induced depleted levels of gastric mucosal NP-SH and gastric wall mucus concentration.CONCLUSION:Anise aqueous suspension possesses significant cytoprotective and anti-ulcer activities against experimentally-induced gastric lesions.The anti-ulcer effect of anise is possibly prostaglandin-mediated and/or through its anti-secretory and antioxidative properties.

  17. Curcumin-induced histone acetylation inhibition improves stress-induced gastric ulcer disease in rats. (United States)

    He, Ping; Zhou, Renmin; Hu, Guorui; Liu, Zhifeng; Jin, Yu; Yang, Guang; Li, Mei; Lin, Qian


    Curcumin is known to possess anti‑inflammatory properties. Despite the fact that curcumin is known to be a strong inhibitor of H+, K+‑ATPase activity, the mechanism underlying the curcumin‑induced inhibition of the transcription of the H+, K+‑ATPase α subunit in gastric mucosal parietal cells remains unclear. The present study investigated the possible mechanism by which curcumin inhibits stomach H+, K+‑ATPase activity during the acute phase of gastric ulcer disease. A rat model of stress‑induced gastric ulcers was produced, in which the anti‑ulcer effects of curcumin were examined. Curcumin‑induced inhibition of the H+, K+‑ATPase promoter via histone acetylation, was verified using a chromatin immunoprecipitation assay. The results showed that curcumin improved stress‑induced gastric ulcer disease in rats, as demonstrated by increased pH values and reduced gastric mucosal hemorrhage and ulcer index. These effects were accompanied by a significant reduction in the level of histone H3 acetylation at the site of the H+, K+‑ATPase promoter and in the expression of the gastric H+,K+‑ATPase α subunit gene and protein. In conclusion, curcumin downregulated the acetylation of histone H3 at the site of the H+, K+‑ATPase promoter gene, thereby inhibiting the transcription and expression of the H+, K+‑ATPase gene. Curcumin was shown to have a preventive and therapeutic effect in gastric ulcer disease.

  18. Hospitalized ulcerative colitis patients have an elevated risk of thromboembolic events

    Institute of Scientific and Technical Information of China (English)

    Jennifer Y Wang; Jonathan P Terdiman; Eric Vittinghoff; Tracy Minichiello; Madhulika G Varma


    AIM: To compare thromboembolism rates between hospitalized patients with a diagnosis of ulcerative colitis and other hospitalized patients at high risk for thromboembolism. To compare thromboembolism rates between patients with ulcerative colitis undergoing a colorectal operation and other patients undergoing colorectal operations. METHODS: Data from the National Hospital Discharge Survey was used to compare thromboembolism rates between (1) hospitalized patients with a discharge diagnosis of ulcerative colitis and those with diverticulitis or acute respiratory failure, and (2) hospitalized patients with a discharge diagnosis of ulcerative colitis who underwent colectomy and those with diverticulitis or colorectal cancer who underwent colorectal operations. RESULTS: Patients diagnosed with ulcerative colitis had similar or higher rates of combined venous thromboembolism (2.03%) than their counterparts with diverticulitis (0.76%) or respiratory failure (1.99%), despite the overall greater prevalence of thromboembolic risk factors in the latter groups. Discharged patients with colitis that were treated surgically did not have significantly different rates of venous or arterial thromboembolism than those with surgery for diverticulitis or colorectal cancer. CONCLUSION: Patients with ulcerative colitis who do not undergo an operation during their hospitalization have similar or higher rates of thromboembolism than other medical patients who are considered to be high risk for thromboembolism.

  19. Effects of nitric oxide on gastric ulceration induced by nicotine and cold-restraint stress

    Institute of Scientific and Technical Information of China (English)

    Bo-Sheng Qui; Qi-Bing Mei; Li Liu; Kam-Meng Tchou-Wong


    AIM: Stress induces gastric ulceration in human and experimental animals. People tend to smoke more cigarettes when under stress. Nitric oxide (NO) and nicotine have opposing effects on gastric integrity. The present study examined the possible therapeutic benefit of NO in nicotinetreated rats with stress-induced gastric ulceration.METHODS: Rats drank a nicotine solution while control rats drank tap water for 20 days. The alkoloid was then replaced by water with or without supplementation of isosorbide dinitrate (NO donor) for an additional 10 days. Isosorbide dinitrate was given twice shortly before experiments (acute)or three times daily by oral gavages for 10 days after the rats stopped drinking nicotine solution. At the end of experiments,ulcer index, gastric adhesion mucus content and MPO activity were measured and analysed.RESULTS: Nicotine treatment decreased gastric mucus content and intensified stress-induced gastric ulcer. A higher ulcer index persisted even after the rats stopped drinking nicotine solution for 10 days. Acute NO donor showed no benefit on both mucus and ulcer index in nicotine treatment or/and stress condition. Chronic NO donor treatment reversed the worsening action of nicotine in stomach. Stress increased gastric mucosal myeloperoxidase (MPO) activity, which was antagonized by chronic NO treatment. However, nicotine was unlikely to change mucosal MPO activity.CONCLUSION: The intensifying action of nicotine on stressinduced gastric ulceration persists for 10 days after cessation.Nicotine treatment significantly decreases gastric mucus content that can be restored by chronic NO donor treatment.The present study suggests that NO antagonizes the ulcerogenic action of nicotine through a cytoprotective way.

  20. Protective effect of chelerythrine against ethanol-induced gastric ulcer in mice. (United States)

    Li, Wei-Feng; Hao, Ding-Jun; Fan, Ting; Huang, Hui-Min; Yao, Huan; Niu, Xiao-Feng


    The quaternary benzo[c]phenanthridine alkaloid, chelerythrine (CHE), is of great practical and research interest because of its pronounced, widespread physiological effects, primarily antimicrobial and anti-inflammatory, arising from its ability to interact with proteins and DNA. Although CHE was originally shown to possess anti-inflammatory properties, its effects on acute gastric ulcer have not been previously explored. The aim of the present study is to evaluate the protective effect of CHE on ethanol induced gastric ulcer in mice. Administration of CHE at doses of 1, 5 and 10mg/kg bodyweight prior to ethanol ingestion dose-dependently inhibited gastric ulcer. The gastric mucosal lesion was assessed by ulcer area, gastric juice acidity, myeloperoxidase (MPO) activities, macroscopic and histopathological examinations. CHE significantly reduced the gastric ulcer index, myeloperoxidase activities, macroscopic and histological score in a dose-dependent manner. In addition, CHE also significantly inhibited nitric oxide (NO) concentration, pro-inflammatory interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) level in serum and gastric mucosal in the mice exposed to ethanol induced ulceration in a dose-dependent manner. In addition, immunohistochemical analysis revealed that CHE markedly attenuated the overexpression of nuclear factor-κB in gastric mucosa of mice. It was concluded that CHE represents a potential therapeutic option to reduce the risk of gastric ulceration. In addition, acute toxicity study revealed no abnormal sign to the mice treated with CHE (15mg/kg). These findings suggest that the gastroprotective activity of CHE might contribute in adjusting the inflammatory cytokine by regulating the NF-κB signalling pathway.

  1. Histoplasmosis Presenting as a Laryngeal Ulcer in an Immunocompetent Host. (United States)

    John, Mary; Koshy, Jency Maria; Mohan, Sangeetha; Paul, Preethi


    Histoplasmosis is a granulomatous disease of worldwide distribution caused by a dimorphic fungus Histoplasma capsulatum. Majority of primary infections in immunocompetent hosts are asymptomatic or may present with flu-like illness. Histoplasmosis may occur in three forms: (i) Primary acute pulmonary form, (ii) chronic pulmonary and (iii) disseminated form. The manifestations of disseminated form of histoplasmosis are fever, weakness, weight loss, hepatosplenomegaly, and mucocutaneous lesions. The mucosal involvement could be oropharyngeal or laryngeal involvement. We report an unusual case of histoplasmosis presenting as a laryngeal ulcer in an immunocompetent host.

  2. A Case of Mucormycosis Presented with Oral Ulcers

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    Pınar Yüksel Başak


    Full Text Available A 62-year-old male patient suffering from oral ulcers and painful throat with pancytopenia was diagnosed as acute myeloid leukemia. Because of uncontrolled fever despite antibiotherapy and that Rhizopus spp. was identified from oral lesions, amphotericin B was added to treatment for two weeks. Oral lesions were completely cleared thereafter and this case was presented to point out that mucormycosis must be kept in mind in the differential diagnosis of oral mucosal lesions in patients with immunosuppression as well as it is a rare disease with high mortality.

  3. Bidirectional crosstalk between stress-induced gastric ulcer and depression under chronic stress.

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    Shuang Zhang

    Full Text Available Stress contributes to a variety of diseases and disorders such as depression and peptic ulcer. The present study aimed to investigate the correlation between stress ulcer and depression in pathogenesis and treatment by using chronic stress depression (CSD, chronic psychological stress ulcer (CPSU and water immersion restrain stress models in rats. Our data showed that the ulcer index of the animals after CSD exposure was significantly higher than that of controls. Depression-like behaviors were observed in rat after CPSU exposure. Fluoxetine hydrochloride significantly reduced the ulcer index of rats exposed to CPSU stress, while ranitidine inhibited depression-like behavior of the animals in CSD group. The ulcer index of rats administered with mifepristone after CPSU stress was markedly reduced compared to CPSU group, although there was no significant difference in the depression-like behavior between mifepristone-treated CSD group and naive controls. We also found that the rats exposed to CPSU or CSD stress displayed a lower level of corticosterone than naive controls, however, the acute stress (AS group showed an opposite result. Additionally, in order to study the relevance of H(2 receptors and depression, we treated the CSD group with cimetidine and famotidine respectively. The data showed that cimetidine inhibited depression-like behavior in CSD rats, and famotidine had no impact on depression. Overall our data suggested that the hypothalamic-pituitary-adrenal (HPA axis dysfunction may be the key role in triggering depression and stress ulcer. Acid-suppressing drugs and antidepressants could be used for treatment of depression and stress ulcer respectively. The occurrence of depression might be inhibited by blocking the central H(2 receptors.

  4. [Assessment of pain in a patient with pressure ulcer]. (United States)

    Píriz-Campos, Rosa María; Martín-Espinosa, Noelia María; Cobo-Cuenca, Ana Isabel


    This is a summary of a presentation made in the symposium "Improved Continuous Quality Care in Patients with Pressure Ulcers and Chronic Injuries", which was held in Toledo in 2009. A 76 year old woman had been assessed (she belonged to the age group that frequently suffers this condition). She lived in a social healthcare centre and had a III stage sacral pressure ulcer. Using Gordon's Functional Health Patterns for assessing "Acute pain", a nursing diagnosis is described and the nursing care plan has been presented according to NANDA, NIC, NOC taxonomy. The aim of this article is to show the importance of considering the pain in patients who suffer from this type of lesion, which, although almost always present, it is often undervalued by nursing staff, resulting in an even worse quality of life for the patient, due to both physical and psychological effects. This case shows how to assess pain in a patient with ulcers, and helps establish an individualised care plan with a priority on pain treatment and relief. As as result of the interventions carried out, a better perception of pain is achieved, thus helping to improve patient's mobility and night rest.

  5. Anesthetic keratopathy presenting as bilateral Mooren-like ulcers

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    Khakshoor H


    Full Text Available Hamid Khakshoor,1 Majid Moshirfar,2 Rachel G Simpson,3 Hamid Gharaee,1 Amir H Vejdani,1 Steven M Christiansen,2 Jason N Edmonds,2 Nicholas L Behunin21Mashhad University of Medical Sciences, Department of Ophthalmology, Mashad, Iran; 2John A Moran Eye Center, University of Utah, Salt Lake City, UT, 3The University of Arizona College of Medicine, Phoenix, AZ, USAAbstract: This observational case report describes the development of bilateral Mooren-like ulcers in a patient with anesthetic keratopathy. A 42-year-old man with a recent history of minor eye trauma and pain self-treated with tetracaine eye drops presented with complaints of acutely worsening vision and severe pain bilaterally. His visual acuity at presentation was limited to hand motion. Slit-lamp examination revealed bilateral epithelial defects at the center of the cornea, and an area of stromal infiltration and thinning with an undermining leading edge resembling a Mooren's ulcer in both eyes. Corneal haze and hypopyon were visible. Anesthetic use was halted immediately and the patient was started on prednisolone and mycophenolate mofetil (Cellcept®, after which visual acuity gradually improved and pain decreased. Despite improvement of symptoms, residual epithelial defects remained, and the patient was ultimately treated with keratoplasty for recovery of vision. We suggest that anesthetic keratopathy should be included in the differential diagnosis for any patient presenting with ring-shaped stromal infiltrates or nonhealing epithelial defects.Keywords: anesthetic abuse, corneal damage, corneal ulceration

  6. Sextant of Sapphires for Molar Distalization (United States)

    Palla, Yudistar Venkata; Ganugapanta, Vivek Reddy


    Introduction Space analysis quantifies the amount of crowding within the arches estimating the severity of space discrepancy. The space gaining procedures include extraction and non-extraction procedures like expansion, proximal stripping and molar distalization. Aim To identify features seen in molar distalization cases. Materials and Methods The sample size comprised 20 patients in whom molar distalization was decided as the treatment plan. The study models and lateral cephalograms of all the patients were taken. Occlusograms were obtained. Model analysis and cephalometric analysis were performed. Descriptive statistical analysis like mean, standard deviation, standard error and mode were done. Results The parameters in Question gave following results. The Bolton analysis showed anterior mandibular excess with mean value of 1.56mm±1.07. The first order discrepancy between maxillary central and lateral incisors was 5±1.95. The premolar rotation showed mean value of 16.58±5.12. The molar rotation showed the value of 7.66±2.26. The nasolabial angle showed the mean of 101.25±8.7 IMPA of 101.4±5.74. Conclusion The six features studied in molar distalization cases [First order discrepancy between upper central and lateral incisors; Rotation of premolars and molars; Bolton’s discrepancy in anterior dentition; Average to horizontal growth pattern; Proclined lower incisors and Obtuse nasolabial angle] can be taken as patterns seen in molar distalization cases and considered as a valid treatment plan. PMID:27656572

  7. Topographic matching of distal radius and proximal fibula articular surface for distal radius osteoarticular reconstruction. (United States)

    Zhang, H; Chen, S; Wang, Z; Guo, Y; Liu, B; Tong, D


    During osteoarticular reconstruction of the distal radius with the proximal fibula, congruity between the two articular surfaces is an important factor in determining the quality of the outcome. In this study, a three-dimensional model and a coordinate transformation algorithm were developed on computed tomography scanning. Articular surface matching was performed and parameters for the optimal position were determined quantitatively. The mean radii of best-fit spheres of the articular surfaces of the distal radius and proximal fibula were compared quantitatively. The radial inclination and volar tilt following reconstruction by an ipsilateral fibula graft, rather than the contralateral, best resembles the values of the native distal radius. Additionally, the ipsilateral fibula graft reconstructed a larger proportion of the distal radius articular surface than did the contralateral. The ipsilateral proximal fibula graft provides a better match for the reconstruction of the distal radius articular surface than the contralateral, and the optimal position for graft placement is quantitatively determined.

  8. Proliferation and mitogenic response to PDGF-BB of fibroblasts isolated from chronic venous leg ulcers is ulcer-age dependent

    DEFF Research Database (Denmark)

    Agren, M S; Steenfos, H H; Dabelsteen, S


    Several pathophysiologic mechanisms have been proposed to explain slow-healing leg ulcers, but little is known about the growth behavior of cells in these wounds. Platelet-derived growth factor-BB applied topically to chronic wounds has shown beneficial effects, although the effects have been les...... chronic wounds have approached or even reached the end of their lifespan (phase III). This might provide one explanation for the non-healing state and therapy resistance to topical platelet-derived growth factor-BB of some venous leg ulcers.......Several pathophysiologic mechanisms have been proposed to explain slow-healing leg ulcers, but little is known about the growth behavior of cells in these wounds. Platelet-derived growth factor-BB applied topically to chronic wounds has shown beneficial effects, although the effects have been less...... pronounced than would have been expected based on studies on acute wounds. The objective of this study was to compare fibroblasts in culture obtained from chronic wounds (non-healing chronic venous leg ulcers), acute wounds and normal dermis regarding growth, mitogenic response to platelet-derived growth...

  9. Clopidogrel delays gastric ulcer healing in rats. (United States)

    Luo, Jiing-Chyuan; Huo, Teh-Ia; Hou, Ming-Chih; Lin, Hsiao-Yi; Li, Chung-Pin; Lin, Han-Chieh; Chang, Full-Young; Lee, Fa-Yauh


    Clopidogrel is not safe enough for the gastric mucosa in patients with high risk of peptic ulcer. This study aimed to explore if clopidogrel delays gastric ulcer healing and elucidate the involved mechanisms. Gastric ulcer was induced in rats and the ulcer size, mucosal epithelial cell proliferation of the ulcer margin, expression of growth factors [epidermal growth factor (EGF), basic fibroblast growth factor] and their receptors, and signal transduction pathways for cell proliferation were measured and compared between the clopidogrel-treated group and untreated controls. For the in vitro part, rat gastric mucosal epithelial cell line (RGM-1 cells) was used to establish EGF receptor over-expressed cells. Cell proliferation and molecular change under EGF treatment (10ng/ml) with and without clopidogrel (10(-6)M) were demonstrated. Ulcer size was significantly larger in the clopidogrel-treated group compared to the control and mucosal epithelial cell proliferation of the ulcer margin was significantly decreased in the clopidogrel-treated group (Pulcer-induced gastric epithelial cell proliferation and ulcer-stimulated expressions of EGF receptor and phosphorylated extracellular signal-regulated kinase (PERK) at the ulcer margin (Pgastric ulcer healing in rats via inhibiting gastric epithelial cell proliferation, at least by inhibition of the EGF receptor-ERK signal transduction pathway.

  10. Progressive Deconstruction of a Distal Posterior Cerebral Artery Aneurysm Using Competitive Flow Diversion. (United States)

    Johnson, Andrew K; Tan, Lee A; Lopes, Demetrius K; Moftakhar, Roham


    Progressive deconstruction is an endovascular technique for aneurysm treatment that utilizes flow diverting stents to promote progressive thrombosis by diverting blood flow away from the aneurysm's parent vessel. While the aneurysm thromboses, collateral blood vessels develop over time to avoid infarction that can often accompany acute parent vessel occlusion. We report a 37-year-old woman with a left distal posterior cerebral artery aneurysm that was successfully treated with this strategy. The concept and rationale of progressive deconstruction are discussed in detail.

  11. [Diagnosis, treatment and prophylaxis of acute ulcero-erosive gastroduodenal bleedings at cardiosurgical patients]. (United States)

    Kazymov, I L; Kirilenko, A S; Faĭbushevic h, A G; Kurbanov, F S; Tarichko, Iu V


    Results of treatment of 495 patients who has undergone various cardiac operations with artificial circulation are analyzed. The complex program "Blood-free surgery" was used at 388 (78.4%) of them. Among the patients treated traditionally the acute gastroduodenal erosions and ulcers were diagnosed at 25.7% patients, the rate of gastroduodenal bleedings was 3.0%. Complex of prophylactic measures permits to reduce the rate of acute erosions and ulcers in 1.5 times (18.4%) and the rate of postoperative gastroduodenal bleedings--to 0.7%. Control of risk factors, timely diagnosis, complex prophylaxis and treatment of acute gastroduodenal erosions and ulcers are effective way to improvement of operations results at cardiosurgical patients. "Blood-free" program doesn't lead to increase of acute postoperative gastroduodenal erosions and ulcers rate. Endoscopic (including repeated) hemostasis at acute ulcero-erosive gastroduodenal bleedings is available method and permits to achieve the stable hemostasis.

  12. Physeal arrest of the distal radius. (United States)

    Abzug, Joshua M; Little, Kevin; Kozin, Scott H


    Fractures of the distal radius are among the most common pediatric fractures. Although most of these fractures heal without complication, some result in partial or complete physeal arrest. The risk of physeal arrest can be reduced by avoiding known risk factors during fracture management, including multiple attempts at fracture reduction. Athletes may place substantial compressive and shear forces across the distal radial physes, making them prone to growth arrest. Timely recognition of physeal arrest can allow for more predictable procedures to be performed, such as distal ulnar epiphysiodesis. In cases of partial arrest, physeal bar excision with interposition grafting can be performed. Once ulnar abutment is present, more invasive procedures may be required, including ulnar shortening osteotomy or radial lengthening.


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    Full Text Available INTRODUCTION: Chondroblastoma was first described as calcified gi ant cell tumour by Ewing. Codman described it as epiphyseal chondromatous giant cell tumour. Jaffe and Lichtenstein named it as chondroblastoma, a rare benign cartilag inous tumour. It represents less than 1% of all primary bone tumours and most commonly originate from the epiphyses of long bones, particularly from the epiphyses of the proximal and dis tal parts of the femur, the proximal part of the humerus, and the proximal part of the tibia. O ther reported sites are talus, scapula , patella, pelvis, distal radius, distal tibia , ribs, proximal fibula, calcaneum. Its occurrence in distal tibia is very rare with 2 documented cases in UK from 1974 to 2000, 3 documented cases in FRANCE from 1950 to 200 5 , no documented case from 1977 to 2000 in Harvard, USA. The purpose is to present a rare tumour occurring at an unusual site.

  14. 腹腔镜与开腹胃十二指肠溃疡穿孔修补术的前瞻性随机对照研究%Comparison of Laparoscopic Versus Open Repair of Acute Peptic Ulcer Perforation:a Prospective Randomized Controlled Trial

    Institute of Scientific and Technical Information of China (English)

    钟锋; 王金重; 赖建生; 陈晓明; 郭永学; 陈福佳; 陈海明; 李嘉兴; 陈亚进


    目的:探讨腹腔镜与开腹行胃十二指肠溃疡穿孔修补术的优缺点。方法2011年4月~2013年6月,将133例胃十二指肠溃疡急性穿孔患者采用抽取信封法随机分为腹腔镜组(68例)和开腹组(65例),2组年龄、性别、穿孔大小、部位和麻醉学评分等方面无显著差异(P>0.05)。对比2组手术时间、术中出血量、术后肠鸣音恢复时间、术后第1天及第3天疼痛评分及镇痛次数、术后并发症发生率和术后住院时间等指标。结果与开腹组相比,腹腔镜组术中出血少[(10.2±2.2)ml vs.(23.7±4.6)ml,t=-21.742,P=0.000],术后肠鸣音恢复早[(26.2±6.1)h vs.(39.4±8.5)h,t=-10.324,P=0.000],术后疼痛轻[第1天疼痛评分(4.1±1.1)vs.(7.6±1.7),t=-14.159,P=0.000,第3天疼痛评分(1.7±0.9)vs.(3.6±1.2),t=-10.360,P=0.000],镇痛次数少[中位数1(0~9) vs.3(0~12),Z=-7.208,P=0.000],术后切口感染发生率低[0(0%) vs.6(9.2%),P=0.012],术后住院时间短[(6.3±1.3)d vs.(8.2±2.7)d,t=-5.206,P=0.000]。2组手术时间差异无显著性( P>0.05)。随访3~6个月,2组均无再次穿孔及死亡。结论腹腔镜手术修补胃十二指肠溃疡急性穿孔安全可靠,具有疼痛轻、切口感染少、康复快、术后住院时间短等优点,是治疗良性胃十二指肠溃疡急性穿孔的理想术式。%Objective To compare the differences of the results between the laparoscopic and open repair in the treatment of acute peptic ulcer perforation . Methods From April 2011 to June 2013, 133 patients with a clinical diagnosis of perforated peptic ulcer were randomly assigned to either laparoscopic (n=68) or open (n=65) repairs.The two groups were comparable in age , sex, size and site of perforations, and American

  15. Esophageal ulceration complicating doxycycline therapy

    Institute of Scientific and Technical Information of China (English)

    Mohammad A. Al-Mofarreh; Ibrahim A. Al Mofleh


    AIM: To report present state of iatrogenic drug-induced esophageal injury (DIEI) induced by medications in a private clinic.METHODS: Iatrogenic drug-induced esophageal injury (DIEI) induced by medications has been more frequently reported. In a private clinic we encountered 36 cases of esophageal ulcerations complicating doxycycline therapy in a mainly younger Saudi population (median age 29 years).RESULTS: The most frequent presenting symptoms were oclynophagia, retrostemal burning pain and dysphagia (94 %,75 % and 56 %, respectively). The diagnosis was according to medical history and confirmed by endoscopy in all patients.Beside withdrawal of doxycycline, when feasible, all patients were treated with a proton-pump inhibitor (PPI) and a prokinetic. Thirty patients who reported to the clinic after treatment were improved within 1-7 (median 1.7) days.CONCLUSION: Esophageal ulceration has to be suspected in younger patients with odynophagia, retrosternal burning pain and/or clysphagia during the treatment with doxycycline.

  16. Intestinal microbiota and ulcerative colitis. (United States)

    Ohkusa, Toshifumi; Koido, Shigeo


    There is a close relationship between the human host and the intestinal microbiota, which is an assortment of microorganisms, protecting the intestine against colonization by exogenous pathogens. Moreover, the intestinal microbiota play a critical role in providing nutrition and the modulation of host immune homeostasis. Recent reports indicate that some strains of intestinal bacteria are responsible for intestinal ulceration and chronic inflammation in inflammatory bowel diseases (IBD) such as ulcerative colitis (UC) and Crohn's disease (CD). Understanding the interaction of the intestinal microbiota with pathogens and the human host might provide new strategies treating patients with IBD. This review focuses on the important role that the intestinal microbiota plays in maintaining innate immunity in the pathogenesis and etiology of UC and discusses new antibiotic therapies targeting the intestinal microbiota.

  17. [Digital ulcers in systemic scleroderma]. (United States)

    Belz, D; Hunzelmann, N; Moinzadeh, P


    Digital ulcers (DU's) are one of the main symptoms of systemic scleroderma and occur in approximately 60% of all scleroderma patients. Due to possible complications such as infections, gangrene or amputation, they require regular medical attention and a good wound treatment by doctors and nursing staff. A definition of DU's has not yet been established. In 2009 the European League Against Rheumatism (EULAR) published guidelines for the treatment of DU's. An improvement of the healing of active ulcers has been described with Iloprost. Bosentan significantly reduced the frequency of occurrence of new DU's. In some small studies PDE-5 inhibitors appear helpful. Further studies with other therapeutic approaches will follow in the next few years.

  18. Rectal Hodgkin lymphoma in a patient with ulcerative colitis: a case study. (United States)

    Rasmussen, Simon Ladefoged; Thomsen, Christian


    A case of Hodgkin lymphoma located in the rectum of a patient with ulcerative colitis is described. The patient was a 44 year old male treated with thiopurines for ulcerative colitis for ten years. He was admitted with malaise, weight loss and abdominal pain. Endoscopy revealed a large ulcerative lesion involving the rectum and distal part of the sigmoid colon. Although it macroscopically resembled a rectal cancer, repeated biopsies did not reveal any malignancy. In order to resolve the symptoms of stenosis and to get the final diagnosis a recto-sigmoid resection was performed. Pathologic examination revealed nodular sclerosis classical Hodgkin lymphoma, positive for Epstein Barr Virus. Subsequent examination revealed disseminated disease involving the pelvic wall, liver, and bone marrow. The patient is currently receiving chemotherapeutic treatment, and follow-up shows disease remission.Hodgkin lymphoma associated with immunosuppressive therapy is rare. However, patients with ulcerative colitis receiving such treatment are at increased risk of lymphoproliferative disordes, potentially due to loss of immunosurveillance and presence of oncogenic viruses (i.e. Epstein-Barr virus). Virtual Slides: The virtual slide(s) for this article can be found here:

  19. The evolution of surgical procedures in the management of duodenal and gastric ulcers. (United States)

    Ajao, O G; Ugwu, B T


    Surgical procedures for the surgical management of duodenal ulcer had evolved through many stages, over the years. It started with gastroenterostomy alone, then followed by subtotal gastrectomy, vagotomy alone, vagotomy and gastro-jejunostomy, vagotomy and pyloroplasty, and highly selective vagotomy - all which started as open surgical procedures. Now unless there are complications the treatment is essentially medical following the work of Marshall and Warren. Currently, even when surgery is indicated, minimal invasive procedures are preferred. Four main types of pyloroplasties are well known. They are Weinberg, Heinecke-Mikulicz, Finney and Jaboulay. Vagotomy can be truncal, selective, and highly selective. Accepted surgical treatment for gastric ulcer is the distal gastric resection to include the ulcerated area, but not resecting more than 50-60% of the stomach. In the uncommon cases of Zollinger-Ellison syndrome, aggressive gastric surgery, the use of drugs, and the resection of the tumour have all been recommended in appropriate cases. With the discovery of Helicobacter pylori and its effective medical treatment, surgery has little role in the initial management of peptic ulcer disease. The place of the history of the surgical procedures employed earlier in the treatment of this disease would remain relevant.

  20. Anti-ulcer potentials of phylum mollusca (tropical snail) slime

    Institute of Scientific and Technical Information of China (English)

    Nwodo NJ; Okonta J M; Ezugwu CO; Attama AA


    Objective:The effectiveness of the slimy substance in snail to regenerate and repair damaged areas on its body/shell lead to this investigation.Methods:The anti-ulcer'property of snail slime extracted from phylum mollusca (tropical snail)from the giant African snail Archachatina marginata (Fam.Arionidae)was investi-gated using histamine,stress and indomethacin-induced ulcers.The solubility profile of extract was investiga-ted in different solvents and at different temperatures.Chemical analysis was carried out to determine the types of constituents present in the slim,while acute toxicity test was carried out to evaluate its profile of toxicity. The effect of the snail slim on gastrointestinal motility was investigated in mice,while the guinea pig ileum was used to study the effect of the extract on contraction produced by acetylcholine and histamine.The snail slime contained copious quantity of protein,with varying amounts of simple sugars,carbohydrates and fats.The slime was not soluble in most common solvents and increases in temperature,did not appear to increase its sol-ubility.Results:The result further indicated that although the snail slime exhibited significant (P <0.05)an-ti-ulcer induced by stress and histamine,it was most potent against ulcer induced by indomethacin.The snail slime potently inhibited gastrointestinal movement in mice in a dose-dependent manner;however,it was not a-ble to inhibit contraction induced by acetylcholine and histamine in guinea pig ileum.Conclusion:The snail mucin possesses potent antiulcer properties without any toxic effect.The mechanism responsible for the anti-ul-cer property may not be postulated with certainty but cytoprotective and anti-spasmodic activities are most likely to be involved.

  1. Scleritis and Peripheral Ulcerative Keratitis


    Galor, Anat; Thorne, Jennifer E.


    Scleritis and peripheral ulcerative keratitis (PUK) can present as isolated conditions or as part of a systemic inflammatory or infectious disorder. Both are serious ocular conditions that can result in vision loss and therefore require early diagnosis and treatment. Nearly two-thirds of patients with non-infectious scleritis require systemic glucocorticoid therapy, and one fourth need a glucocorticoid-sparing agent, as well. Essentially all patients with non-infectious PUK require systemic g...

  2. Ulcerative colitis after Cytomegalovirus Infection

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    Mohammad Aminianfar


    Full Text Available A 21 years old man has been complained of bloody diarrhea, liquid stool containing blood, pus, and fecal matter and crampy abdominal pain from four monthes ago. Ulcerative colitis relies upon the patient's history, clinical symptoms, sigmoidoscopic appearance and histology of colonic biopsy specimens. Treatment of patient started with high dose dexamethasone and prednisolone, asacole, suppository, metronidazole. Patient’s condition not improved and patient admitted in hospital. High dose prednisolone, azathioprine, sulfasalazine and folic acid were given.

  3. Management of pediatric ulcerative colitis

    DEFF Research Database (Denmark)

    Turner, Dan; Levine, Arie; Escher, Johanna C


    Pediatric ulcerative colitis (UC) shares many features with adult-onset disease but there are some unique considerations; therefore, therapeutic approaches have to be adapted to these particular needs. We aimed to formulate guidelines for managing UC in children based on a systematic review (SR......) of the literature and a robust consensus process. The present article is a product of a joint effort of the European Crohn's and Colitis Organization (ECCO) and the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)....

  4. Calcifying aponeurotic fibroma of the distal phalanx. (United States)

    Schonauer, Fabrizio; Avvedimento, Stefano; Molea, Guido


    Calcifying aponeurotic fibroma is a rare benign soft tissue tumor that primarily occurs on the distal portion of the extremities of children and adolescents. It appears like a firm, painless and slowly growing mass with high local recurrence rates. The lesion has characteristic histological features with areas of proliferative plumps of fibroblasts, chondrocytes and foci of calcification. We present a case of calcifying aponeurotic fibroma of the sub-ungual area of the index finger distal phalanx with bone erosion, surgically treated. A 2 year follow up showed satisfactory functional result and no evidence of recurrence.

  5. Management of Malunions of the Distal Radius


    Yaniel Truffin Rodriguez; Osmany Pérez Martínez; Rafael Esmandy Gómez Arregoitía; Indira L. Gómez Gil


    Fractures of the distal radius often present with a group of major complications. Of these, malunion is one of the most disabling. Its management through salvage procedures is essential for its correction. The case of a 60-year-old healthy woman of urban origin treated at the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos because of a malunion of the distal end of the left radius as a result of a previous Colles' fracture is presented. The patient complained of severe p...

  6. Distal splenorenal shunt with partial spleen resection

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    Gajin Predrag


    Full Text Available Introduction: Hypersplenism is a common complication of portal hypertension. Cytopenia in hypersplenism is predominantly caused by splenomegaly. Distal splenorenal shunt (Warren with partial spleen resection is an original surgical technique that regulates cytopenia by reduction of the enlarged spleen. Objective. The aim of our study was to present the advantages of distal splenorenal shunt (Warren with partial spleen resection comparing morbidity and mortality in a group of patients treated by distal splenorenal shunt with partial spleen resection with a group of patients treated only by a distal splenorenal shunt. Method. From 1995 to 2003, 41 patients with portal hypertension were surgically treated due to hypersplenism and oesophageal varices. The first group consisted of 20 patients (11 male, mean age 42.3 years who were treated by distal splenorenal shunt with partial spleen resection. The second group consisted of 21 patients (13 male, mean age 49.4 years that were treated by distal splenorenal shunt only. All patients underwent endoscopy and assessment of oesophageal varices. The size of the spleen was evaluated by ultrasound, CT or by scintigraphy. Angiography was performed in all patients. The platelet and white blood cell count and haemoglobin level were registered. Postoperatively, we noted blood transfusion, complications and total hospital stay. Follow-up period was 12 months, with first checkup after one month. Results In the first group, only one patient had splenomegaly postoperatively (5%, while in the second group there were 13 patients with splenomegaly (68%. Before surgery, the mean platelet count in the first group was 51.6±18.3x109/l, to 118.6±25.4x109/l postoperatively. The mean platelet count in the second group was 67.6±22.8x109/l, to 87.8±32.1x109/l postoperatively. Concerning postoperative splenomegaly, statistically significant difference was noted between the first and the second group (p<0.05. Comparing the

  7. Treatment of lingual traumatic ulcer accompanied with fungal infections

    Directory of Open Access Journals (Sweden)

    Sella Sella


    Full Text Available Background: Traumatic ulcer is a common form of ulceration occured in oral cavity caused by mechanical trauma, either acute or chronic, resulting in loss of the entire epithelium. Traumatic ulcer often occurs in children that are usually found on buccal mucosa, labial mucosa of upper and lower lip, lateral tongue, and a variety of areas that may be bitten. To properly diagnose the ulcer, dentists should evaluate the history and clinical description in detail. If the lesion is allegedly accompanied by other infections, such as fungal, bacterial or viral infections, microbiological or serological tests will be required. One of the initial therapy given for fungal infection is nystatin which aimed to support the recovery and repair processes of epithelial tissue in traumatic ulcer case. Purpose: This case report is aimed to emphasize the importance of microbiological examination in suspected cases of ulcer accompanied with traumatic fungal infection. Case: A 12-year-old girl came to the clinic of Pediatric Dentistry, Faculty of Dentistry, University of Indonesia on June 9, 2011 accompanied with her mother. The patient who had a history of geographic tongue came with complaints of injury found in the middle of the tongue. The main diagnosis was ulcer accompanied with traumatic fungal infection based on the results of swab examination. Case management: This traumatic ulcer case was treated with Dental Health Education, oral prophylaxis, as well as prescribing and usage instructions of nystatin. The recovery and repair processes of mucosal epithelium of the tongue then occured after the use of nystatin. Conclusion: It can be concluded that microbiological examination is important to diagnose suspected cases of ulcer accompanied with traumatic fungal infection. The appropriate treatment such as nystatin can be given for traumatic fungal infection.Latar belakang: Ulkus traumatic merupakan bentuk umum dari ulserasi rongga mulut yang terjadi akibat trauma

  8. Choledochoduodenal fistula of ulcer etiology

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    Čolović Radoje


    Full Text Available Introduction Choledochoduodenal fistulas are very rare and in most cases are caused by a long-lasting and poorly treated chronic duodenal ulcer. They may be asymptomatic or followed by symptoms of ulcer disease, by attacks of cholangitis or bleeding or vomiting in cases of ductoduodenal stenosis. The diagnosis is simple and safe, however treatment is still controversial. If surgery is the choice of treatment, local findings should be taken into consideration. As a rule, intervention involving closure of fistula is not recommended. Case Outline The authors present a 60-year-old woman with a long history of ulcer disease who developed attacks of cholangitis over the last three years. Ultrasonography and CT showed masive pneumobilia due to a choledochoduodenal fistula. . As there was no duodenal stenosis or bleeding, at operation the common bile duct was transected and end-to-side choledochojejunostomy was performed using a Roux-en Y jejunal limb. From the common bile duct, multiple foreign bodies of herbal origin causing biliary obstruction and cholangitis were removed. After uneventful recovery the patient stayed symptom free for four years now. Conclusion The performed operation was a simple and good surgical solution which resulted in complication-free and rapid recovery with a long-term good outcome. .

  9. Gastric Ulcers Syndrome in Donkeys

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    Abelardo Morales Briceño


    Full Text Available This study aimed to describe gastric ulcer in donkeys. 10 donkeys (Equus asinus were studied in Bodonal de la Sierra, Badajoz-Extremadura, Spain. They were referred for necropsy and dead due to non-digestive causes. 4 males and 6 females were examined. The ages were classified of 4-16 years old. The stomach and gastric mucosa was evaluated for classified Merrit, 2003. Samples of gastric tissue were collected. The samples fixed in formalin were processed by conventional histological techniques and examined by histopathology. None of the donkeys presented clinical signs for gastric ulcers syndrome. Of the 10 donkeys studied, 10% had Grade 0; 30% Grade 1; 40% Grade 2; 10% Grade 3; and 10% Grade 4. In 30% (3/10 parasites such as Gasterophilus sp. were observed. The histological slices revealed severe damage on the gastric mucosa, a loss of continuity of the gastric mucosa with corium exposure, and subchorionic edema with parakeratotic hyperkeratosis, together with a mixed lymphoplasmocytic mononuclear infiltrate. In conclusion, we reported gastric ulcers syndrome in donkeys in Spain.

  10. Current treatment of ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Johannes Meier; Andreas Sturm


    Ulcerative colitis (UC) is a chronic disease featuring recurrent inflammation of the colonic mucosa. The goal of medical treatment is to rapidly induce a steroid-free remission while at the same time preventing complications of the disease itself and its treatment. The choice of treatment depends on severity, localization and the course of the disease. For proctitis, topical therapy with 5-aminosalicylic acid (5-ASA) compounds is used. More extensive or severe disease should be treated with oral and local 5-ASA compounds and corticosteroids to induce remission. Patients who do not respond to this treatment require hospitalization. Intravenous steroids or, when refractory, calcineurin inhibitors (cyclosporine, tacrolimus), tumor necrosis factor-α antibodies (infliximab) or immunomodulators (azathioprine, 6-mercaptopurine) are then called for. Indications for emergency surgery include refractory toxic megacolon, perforation, and continuous severe colorectal bleeding. Close collaboration between gastroenterologist and surgeon is mandatory in order not to delay surgical therapy when needed. This article is intended to give a general, practice- orientated overview of the key issues in ulcerative colitis treatment. Recommendations are based on published consensus guidelines derived from national and international guidelines on the treatment of ulcerative colitis.

  11. Current treatment of ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    JohannesMeier; AndreasSturm


    Ulcerative colitis (UC) is a chronic disease featuring re- current inflammation of the colonic mucosa. The goal of medical treatment is to rapidly induce a steroid-free remission while at the same time preventing complica- tions of the disease itself and its treatment. The choice of treatment depends on severity, localization and the course of the disease. For proctitis, topical therapy with 5-aminosalicylic acid (5-ASA) compounds is used. More extensive or severe disease should be treated with oral and local 5-ASA compounds and corticosteroids to induce remission. Patients who do not respond to this treatment require hospitalization. Intravenous steroids or, when refractory, calcineurin inhibitors (cyclosporine, tacrolimus), tumor necrosis factor-α antibodies (infliximab) or immunomodulators (azathioprine, 6-mercaptopurine) are then called for. Indications for emergency surgery include refractory toxic megacolon, perforation, and continuous severe colorectal bleeding. Close collaboration between gastroenterologist and surgeon is mandatory in order not to delay surgical therapy when needed. This article is intended to give a general, practice-orientated overview of the key issues in ulcerative colitis treatment. Recommendations are based on published consensus guidelines derived from national and international guidelines on the treatment of ulcerative colitis.

  12. Reconstrucción y restauración de la rotura aguda del tendón rotuliano con aumento del tendon semitendinoso preservando su inserción distal. Reporte de un caso.[Reconstruction and repair of acute patellar tendon ruptures with semitendinosus autograft].

    Directory of Open Access Journals (Sweden)

    Víctor Andres Ciccarello


    Full Text Available Se presenta un caso de ruptura aguda de tendon rotuliano con mala calidad de tejido remanente , en la que se realiza una tecnica de restauración y aumentación con injerto del tendon semitendinoso ipsilateral , preservando su inseríón distal.

  13. An Unusual Association between Chronic Pancreatitis and Ulcerative Colitis

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    Surya Prakash Bhatt


    Full Text Available Episodes of acute pancreatitis have been described during the course of ulcerative colitis and most of them are due to cholelithiasis or drugs. Idiopathic pancreatitis has rarely been associated with inflammatory bowel disease (IBD. We describe one such case. A 35-year-old male presented in 2001 with a ten year history of recurrent episodes of diarrhea without blood and mucus in the stools. Four years ago, he developed an episode of mild acute pancreatitis. At that time, the serum amylase level was three times the upper normal limit. He was treated conservatively. A month later, he was found to be diabetic and was put on insulin. He was non-alcoholic and there was no history of any chronic drug use. There was no similar family history.

  14. Engaging patients in pressure ulcer prevention. (United States)

    Hudgell, Lynne; Dalphinis, Julie; Blunt, Chris; Zonouzi, Maryam; Procter, Susan


    As patients increasingly care for themselves at home, they require accessible information to enable informed self-care. This article describes the development of an educational electronic application (app) designed for use by patients at risk of pressure ulcers, and their carers. The app can be downloaded to Windows, Android or Apple smartphones or tablets. The app is based on the current pressure ulcer prevention and management guidelines from the National Pressure Ulcer Advisory Panel and the National Institute for Health and Care Excellence, and is designed to educate patients and carers about how to prevent a pressure ulcer, how to recognise a pressure ulcer, and what to do if they suspect they are developing a pressure ulcer. We hope the app will be used to help with educational conversations among patients, carers and healthcare professionals.

  15. Ulcerative necrobiosis lipoidica responsive to colchicine. (United States)

    Schofield, Clare; Sladden, Michael J


    Necrobiosis lipoidica is an uncommon granulomatous disease of unknown aetiology. Few treatments have emerged with consistent efficacy and the ulcerated form of necrobiosis lipoidica can be particularly difficult to treat. A 56-year-old non-diabetic woman with chronic ulcerative necrobiosis lipoidica unresponsive to other therapies was commenced on colchicine treatment. Complete resolution of the ulcers was observed after 2 months' therapy with colchicine 500 µg twice daily.

  16. Pressure ulcers: Back to the basics


    Karoon Agrawal; Neha Chauhan


    Pressure ulcer in an otherwise sick patient is a matter of concern for the care givers as well as the medical personnel. A lot has been done to understand the disease process. So much so that USA and European countries have established advisory panels in their respective continents. Since the establishment of these organizations, the understanding of the pressure ulcer has improved significantly. The authors feel that the well documented and well publicized definition of pressure ulcer is som...

  17. Trophic ulcers in the carpal tunnel syndrome

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    Abelardo Q.-C. Araújo


    Full Text Available A patient with carpal tunnel syndrome (CTS and trophic ulcers is described. Despite the healing of the ulcers after surgery for CTS, the severe sensory deficit and the electrophysiological tests have not shown any significant improvement. We think these findings argue against the hypothesis of the sensory deficit being responsible for the trophic ulcers. We favor a major role for the sympathetic disturbances as the main cause for those lesions.

  18. P53,Bax,Bcl-2蛋白表达及细胞凋亡在急性放射性皮肤溃疡发生发展过程中的作用探讨%The role of P53, Bax, Bcl-2 expression and cell apoptosis in the formation and development of acute radiation-induced skin ulcers

    Institute of Scientific and Technical Information of China (English)

    谷庆阳; 曹卫红; 王德文; 高亚兵; 杨志祥; 赵坡


    目的:研究细胞凋亡及一些凋亡相关基因(p53,bcl-2,bax)的表达在急性放射性皮肤溃疡发生发展过程中的作用.方法:采用Wistar大鼠以60Co γ射线进行局部照射,建立急性放射性皮肤溃疡动物模型,观察病变40 d,然后采用免疫组化方法检测皮肤溃疡组织中P53,Bcl-2,Bax蛋白表达,并采用原位末端标记法(TUNEL)检测细胞凋亡.结果:照后14 d照射野内开始出现皮肤溃疡,之后逐渐扩大、融合、加深;照后11~40 d,P53蛋白表达明显增强,主要定位于血管内皮细胞和小血管平滑肌中;照后14~21 d为Bax蛋白表达高峰,之后逐渐减弱,主要定位于血管内皮细胞、部分成纤维细胞及新生表皮细胞中;Bcl-2则在照后1~11 d呈弱或中度阳性,定位于表皮、毛囊上皮及血管内皮中,之后为阴性或可疑阳性;照后11~35 d,上述细胞特别是血管内皮细胞凋亡率较正常伤口愈合早期增高.结论:辐射诱导的P53,Bax,Bcl-2表达的变化及细胞凋亡率特别是血管内皮细胞凋亡率的增高与放射性皮肤溃疡发生、发展及难愈合(不能形成有效肉芽组织)的分子机制相关.%Objective:To study the expression of P53, Bax, Bcl-2 proteins and the role of cell apoptosis in the formation and development of acute radiation-induced skin ulcers.Methods:A rat model which was locally irradiated with 60 Co γ-rays was used, and the pathological changes were observed for 40 days. Immunohistochemistry and TUNEL assay were performed which enabled the detection of P53, Bax, Bcl-2 and cell apoptosis during the formation and development of radiation skin ulcers.Results: Skin ulcers were found on day 14 after irradiation, and enlarged and deepened gradually during the observation period. P53 was over expressed during days 11 to 40 after irradiation and was localized in vascular endotheliocytes and smooth muscle cells. Bax was moderately positive during days 14 to 21 and weakly positive during days

  19. Ulcer pain in patients with venous leg ulcers related to antibiotic treatment and compression therapy. (United States)

    Akesson, Nina; Oien, Rut Frank; Forssell, Henrik; Fagerström, Cecilia


    The aim of this study was to compare venous leg ulcer patients with and without ulcer pain to see whether ulcer pain affected the use of antibiotic treatment and compression therapy throughout healing. A total of 431 patients with venous leg ulcers were included during the study period. Every patient was registered in a national quality registry for patients with hard-to-heal leg, foot, and pressure ulcers. A high incidence of ulcer pain (57%) was found when the patients entered the study. Patients with ulcer pain had been treated more extensively with antibiotics both before and during the study period. Throughout healing there was a significant reduction of antibiotic use among patients in the 'no pain' group, from 44% to 23% (P=0.008). There was no significant difference between the two groups concerning compression therapy (85% vs. 88%), but 12% of patients in the 'pain' group did not get their prescribed compression compared with 6% of patients in the 'no pain' group. The groups did not differ significantly in terms of ulcer duration, ulcer size or healing time. This study shows a high incidence of ulcer pain, confirming that pain has a great impact on patients with venous leg ulcers. Results further suggest that the presence of ulcer pain increases the prescription of antibiotics but does not affect the use of compression therapy. Several advantages were found from using a national quality registry. The registry is a valuable clinical tool showing the importance of accurate diagnosis and effective treatment.

  20. Incidence of Duodenal Ulcers and Gastric Ulcers in a Western Population: Back to Where It Started

    Directory of Open Access Journals (Sweden)

    Marcel JM Groenen


    Full Text Available BACKGROUND/OBJECTIVES: As recently as 40 years ago, a decline in the incidence of peptic ulcers was observed. The discovery of Helicobacter pylori had a further major impact on the incidence of ulcer disease. Our aim was to evaluate the trends in the incidence and bleeding complications of ulcer disease in the Netherlands.

  1. Refractory leg ulcers associated with Klinefelter syndrome. (United States)

    Yabuno, Yuto; Tosa, Mamiko; Iwakiri, Itaru; Nomoto, Shunichi; Kaneko, Mayuko; Kuwahara, Kousuke; Hyakusoku, Hiko; Murakami, Masahiro


    We present a man with refractory leg ulcers, bilateral varicosis of the lower extremities, and Buerger disease. Autoimmune work-up was negative. However, chromosome analysis showed Klinefelter syndrome (48 XXY). Ulcerative lesions of the lower extremities are a complication of Klinefelter syndrome. To date, the pathogenesis of ulcers in Klinefelter syndrome has not been clarified, but several factors, such as abnormalities of fibrinolysis and prothrombotic states, might be involved. Our present case emphasizes the importance of considering Klinefelter syndrome in the differential diagnosis of a male patient with nonhealing ulcers of the lower extremities.

  2. Pressure ulcer prevention in frail older people. (United States)

    Barry, Maree; Nugent, Linda


    Pressure ulcers are painful and cause discomfort, have a negative effect on quality of life, and are costly to treat. The incidence and severity of preventable pressure ulcers is an important indicator of quality of care; it is essential that healthcare providers monitor prevalence and incidence rates to ensure that care strategies implemented are effective. Frail older people are at increased risk of developing pressure ulcers. This article discusses the complexities of preventing pressure ulcers in frail older people and emphasises the importance of structured educational programmes that incorporate effective clinical leadership and multidisciplinary teamwork.

  3. Cushing's ulcer: the eponym and his own. (United States)

    Wijdicks, Eelco F M


    One of the least remembered eponyms associated with Harvey Cushing is "Cushing's ulcer." The basis of this credit is a paper published in 1932 in which Cushing describes patients who postoperatively and unexpectedly died of perforated peptic ulcers. It is one of the first descriptions of a stress ulcer and a treatise on the brain-stomach connection. Harvey Cushing was puzzled by the pathogenesis of these peptic ulcerations and perforations and advanced several theories. The least plausible included the bile-vomiting theory suggesting that hemorrhagic ulceration could be produced by a combination of bile and acid in a patient recovering from the anesthetic. Other theories were stimulation of a parasympathetic center in the diencephalon or a disturbance of vagal centers in the brainstem. Quite surprisingly to Cushing, the Boston Herald implicitly insinuated that Cushing found the cause of ulcers and this claim upset him greatly. It is ironic that Harvey Cushing, in his later years with failing health, developed an ulcer himself. Cushing noted in his correspondence that he felt the agitation over this newspaper clipping caused his later ulcer. The first description of a neurogenic ulcer remains an important medical observation and is a testament to Cushing's broad accomplishments.

  4. Ischemic Gastropathic Ulcer Mimics Gastric Cancer

    Directory of Open Access Journals (Sweden)

    Saleh Daher


    Full Text Available Gastric ulcer due to mesenteric ischemia is a rare clinical finding. As a result, few reports of ischemic gastric ulcers have been reported in the literature. The diagnosis of ischemic gastropathy is seldom considered in patients presenting with abdominal pain and gastric ulcers. In this case report, we describe a patient with increasing abdominal pain, weight loss, and gastric ulcers, who underwent extensive medical evaluation and whose symptoms were resistant to medical interventions. Finally he was diagnosed with chronic mesenteric ischemia, and his clinical and endoscopic abnormalities resolved after surgical revascularization of both the superior mesenteric artery and the celiac trunk.

  5. Confocal laser endomicroscopy in ulcerative colitis

    DEFF Research Database (Denmark)

    Karstensen, John Gásdal; Săftoiu, Adrian; Brynskov, Jørn


    was to correlate colonic confocal laser endomicroscopy (CLE) in ulcerative colitis with histopathology and macroscopic appearance before and after intensification of medical treatment. METHODS: Twenty-two patients with ulcerative colitis in clinical relapse and 7 control subjects referred for colonoscopy were...... colitis compared with inactive ulcerative colitis...... is an emerging endoscopic technique that reproducibly identifies mucosal changes in ulcerative colitis. With the exception of crypt changes, endomicroscopic features appear to improve slowly with time after medical treatment. ( CLINICAL TRIAL REGISTRATION NUMBER: NCT01684514.)....

  6. [Peptic ulcer disease. Clinical evaluation in 2006]. (United States)

    Malfertheiner, P; Bellutti, M


    Treatment of peptic ulcer disease has undergone a radical change due to the discovery of its main cause, the Helicobacter pylori infection. The management of the chronic infection is now the primary aim. Treatment of peptic ulcer essentially consists of eradicating H. pylori. A current problem is the resistance developed by H. pylori to the antibiotics used in eradication regimen. Ulcers that are induced by nonsteroidal antirheumatic (NSAR) agents and acetylsalicylic acid are gaining in importance. Optimized inhibition of acid secretion with proton pump inhibitors has made it possible to both prevent and cure ulcers in the stomach and duodenum caused by NSAR agents.

  7. Biomedical System for Monitoring Pressure Ulcer Development


    Wang, Frank Tinghwa


    Pressure ulcers (PU) are one of the leading health concerns among patients living in long-term care facilities and are a common occurrence in hospitals. In the United States alone, over 2.5 million patients will suffer from pressure ulcers each year, and over 60,000 patients will die due to pressure ulcer related complications. The cost to treat pressure ulcers including hospitalization costs is also prohibitively expensive; just in the United States alone it is estimated that $9.2-15.6 Billi...

  8. HIV-1 DNA shedding in genital ulcers and its associated risk factors in Pune, India. (United States)

    Gadkari, D A; Quinn, T C; Gangakhedkar, R R; Mehendale, S M; Divekar, A D; Risbud, A R; Chan-Tack, K; Shepherd, M; Gaydos, C; Bollinger, R C


    HIV infection status was determined in 302 consecutive patients with genital ulcer disease (GUD) presenting to two sexually transmitted disease (STD) clinics in Pune, India. Of the 71 (24%) individuals with HIV infection, 67 (94%) were HIV antibody-positive, and 4 (6%) were HIV antibody-negative but p24 antigen-positive at the time of presentation. HIV-1 DNA was detected in 24 (34%) specimens. The genital ulcers of all four acutely infected p24-antigenemic subjects were HIV-1 DNA-positive by polymerase chain reaction (PCR) assay, compared with 20 of 67 (30%) seropositive patients (p = .01). Presence of chancroid, GUD symptoms for > 10 days, and concurrent diagnosis of cervicitis or urethritis were significantly associated risk factors for HIV-1 DNA shedding in ulcers. Early GUD diagnosis and aggressive treatment of HIV-infected patients may significantly reduce secondary transmission of HIV to other sex partners.

  9. Genital ulcers associated with Epstein-Barr virus infection (ulcus vulvae acutum). (United States)

    Sárdy, Miklós; Wollenberg, Andreas; Niedermeier, Andrea; Flaig, Michael J


    Epstein-Barr virus (EBV) infection may rarely be associated with genital ulcers (ulcus vulvae acutum), a very painful manifestation. The aetiopathogenesis of the disease is not fully understood. We describe here a case of an adolescent virgin with multiple, deep genital ulcers associated with acute infectious mononucleosis. The diagnosis was supported by the clinical symptoms, atypical lymphocytosis, elevated circulating levels of liver enzymes, positive EBV serology, and the detection of EBV in a swab sample and a biopsy specimen by PCR. The virus could not be detected by immunohistochemistry or in situ hybridization. After a short course of methylprednisolone as a supportive treatment, the ulcers healed within one month. No relapse occurred during the 2-year follow-up. Available data relating to the aetiopathogenesis of this condition are reviewed, and we speculate that it may have been caused by percutaneous autoinoculation through cervicovaginal fluid.

  10. Peptic Ulcer Perforation as the First Manifestation of Previously Unknown Primary Hyperparathyroidism

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    Eleni I. Efremidou


    Full Text Available A patient admitted for acute abdomen was incidentally found with elevated serum calcium level. In surgery, under conservative treatment of the hypercalcemia, a perforated duodenal ulcer was found and simple closure was performed. Postoperatively, calcium level continued to rise, parathyroid hormone was elevated and ultrasonographic examination showed a lesion in the right anterior neck, while serum gastrin level was normal, thus documenting the diagnosis of primary hyperparathyroidism. Conservative treatment had no effect on calcium level and the patient was subjected to emergency neck exploration, where a large parathyroid adenoma was removed. After surgery, calcium and PTH levels were normalized and the patient was discharged on the 5th postoperative day. Peptic ulcer and its complications are usual manifestations of primary hyperparathyroidism, with or without increased gastrin level. On the other hand, cases of a perforation of peptic ulcer as the first clinical manifestation of primary hyperparathyroidism are extremely rare.

  11. Life threatening bleeding from duodenal ulcer after Roux-en-Y gastric bypass: Case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Arpad; Ivanecz; Marko; Sremec; Davorin; ?erani?; Stojan; Potr?; Pavel; Skok


    Acute upper gastrointestinal bleeding is a rare, but serious complication of gastric bypass surgery. The inaccessibility of the excluded stomach restrains postoperative examination and treatment of the gastric remnant and duodenum, and represents a major challenge, especially in the emergency setting. A 59-year-old patient with previous history of peptic ulcer disease had an upper gastrointestinal bleeding from a duodenal ulcer two years after having a gastric bypass procedure for morbid obesity. After negative upper endoscopy finding, he was urgently evaluated for gastrointestinal bleeding. At emergency laparotomy, the bleeding duodenal ulcer was identified by intraoperative endoscopy through gastrotomy. The patient recovered well after surgical hemostasis, excision of the duodenal ulcer and completion of the remnant gastrectomy. Every general practitioner, gastroenterologist and general surgeon should be aware of growing incidenceof bariatric operations and coherently possible complications after such procedures, which modify patient’s anatomy and physiology.

  12. Hyperextension trauma to the elbow joint induced through the distal ulna or the distal radius

    DEFF Research Database (Denmark)

    Tyrdal, Stein; Olsen, Bo Sanderhoff


    Loads applied to the forearm result in hyperextension of the elbow. The pathomechanics of hyperextension trauma with load applied to the distal radius and ulna were studied in 10 macroscopically normal cadaver elbow joint specimens to reveal patterns of injury with radial traction (n = 5) compared...... trauma to the elbow joint induced through the distal ulna or the distal radius produced the same pattern of injury as reported in hyperextension of the elbow with traction to the forearm when free rotation of the radius relative to the ulna was allowed....

  13. 腹腔镜与开腹手术治疗消化性溃疡急性穿孔疗效比较%Comparison of the effect of laparoscope and open operation in the treatment of acute perforation of peptic ulcer

    Institute of Scientific and Technical Information of China (English)



    Objective To compare the effect of laparoscope and open operation in the treatment of acute perforation of peptic ulcer.Methods Clinical data of 56 peptic ulcer patients were retrospectively analyzed.30 patients (group A) received laparoscopic treatment,26 cases(group B) received traditional open operation treatment.Operation time,hospitalization time,postoperative exhaust time,ambulation time,frequency of using analgesics after operation,incidence rate of complications and the cost of hospitalization were compared between the two groups.Results In A group,the hospitalization time was (4.5 ± 1.4) d,postoperative exhaust time was (23.9 ± 7.2) h,time to ambulation was (14.1 ± 5.6)h,frequency of postoperative analgesic use was 16.7%,the incidence rate of complications was 0,which were better than those in the control group(11.6 ± 7.5) d,(37.6 ± 17.9) h,(43.4 ± 11.8) h,92.3%,19.2% (t =4.23,4.54,6.32,x2 =3.78,4.45,all P < 0.05).Operation time,white blood cell count and cost of hospitalization between two groups showed no significant differences(P > 0.05).Conclusion Laparoscope in treatment of acute perforation of peptic ulcer has advantages of less trauma,less complications,quicker recovery,shorter hospitalization time and good clinical effect.This operation mode is relatively ideal,and is worth the clinical promotion.%目的 比较腹腔镜与开腹手术治疗消化性溃疡急性穿孔的临床效果.方法 回顾分析该院收治的56例消化性溃疡急性穿孔患者,其中30例患者应用腹腔镜(A组)方式治疗,26例应用传统开腹手术(B组)方式治疗,比较两组手术时间、住院时间、术后排气时间、下床活动时间、术后使用止痛药频次、并发症的发生率以及住院费用等.结果 A组住院时间(4.5±1.4)d、术后排气时间(23.9±7.2)h、下床活动时间(14.1±5.6)h、术后使用止痛药频次16.7%、并发症发生率0,均优于对照组的(11.6±7.5)d、(37.6±17.9)h、(43.4±11.8)h、92

  14. Intramedullary nailing in distal tibial fracture

    Directory of Open Access Journals (Sweden)

    Damian Arroquy


    Methods The inclusion criteria of this study were skeletally mature patients with displaced fractures of the distal tibia treated with intramedullary nail with a minimum follow up of one year. Gustilo III open fractures and type C fractures of the AO classification (complete articular Stroke were excluded. The sample comprised 35 patients remained. The follow-up was 29.2 months. We evaluated the time of consolidation, malunion and complications. The functional results were described according to the AOFAS score. Results Of the 35 patients with fracture of the distal third of the tibia all of them presented fracture healing. The average time to union was 17.2 weeks (range: 11-26. Of the total sample, 5 patients had delayed union, requiring dynamic nail on average at 12 weeks. The malunion was present in 4 (11.4% patients. We found no  difference (p = 0.201 in the time to union between fractures associated with fractures of the fibula treated (13sem or not (17sem. The AOFAS score was 86 points. Conclusion Intramedullary nailing with multiple distal locks like a good alternative treatment for distal tibia fractures AO type A or B, with low complication rate and a high rate of consolidation.

  15. Potassium secretion in mammalian distal colon

    DEFF Research Database (Denmark)

    Sørensen, Mads Vaarby


    pre-mRNA splicing and that at least one splice variant could be activated with cAMP. Using molecular biological techniques two different BK subunit splice variants both expressed in the distal colonic epithelial were identified. By the use of two different knock-out mice models, the BK-/- and the CFTR...

  16. Bouveret's syndrome complicated by a distal gallstone ileus

    Institute of Scientific and Technical Information of China (English)

    Rasim Gencosmanoglu; Resit Inceoglu; Caglar Baysal; Sertac Akansel; Nurdan Tozun


    AIM: Gastric outlet obstruction caused by duodenal impaction of a large gallstone migrated through a cholecystoduodenal fistula has been referred as Bouveret's syndrome. Endoscopic lithotomy is the first-step treatment,however, surgery is indicated in case of failure or complication during this procedure.METHODS: We report herein an 84-year-old woman presenting with features of gastric outlet obstruction due to impacted gallstone. She underwent an endoscopic retrieval which was unsuccessful and was further complicated by distal gallstone ileus. Physical examination was irrelevant.RESULTS: Endoscopy revealed multiple erosions around the cardia, a large stone in the second part of the duodenum causing complete obstruction, and wide ulceration in the duodenal wall where the stone was impacted. Several attempts of endoscopic extraction by using foreign body forceps failed and surgical intervention was mandatory. Preoperative ultrasound evidenced pneumobilia whilst computerized tomography showed a large stone, 5 cm×4 cm×3 cm, loggingat the proximal jejunum and another one, 2.5 cm×2 cm×2 cm,in the duodenal bulb causing a closed-loop syndrome. She underwent laparotomy and the jejunal stone was removed by enterotomy. Another stone reported as located in the duodenum preoperatively was found to be present in the gallbladder by intraoperative ultrasound. Therefore,cholecystoduodenal fistula was broken down, the stone was retrieved and cholecystectomy with duodenal repair was carried out. She was discharged after an uneventful postoperative course.CONCLUSION: As the simplest and the least morbid procedure, endoscopic stone retrieval should be attempted in the treatment of patients with Bouveret's syndrome.When it fails, surgical lithotomy consisting of simple enterotomy may solve the problem. Although cholecystectomy and cholecystoduodenal fistula breakdown is unnecessary in every case, conditions may urge the surgeon to perform such operations even though they carry high

  17. Partial tears of the distal biceps tendon: MR appearance and associated clinical findings

    Energy Technology Data Exchange (ETDEWEB)

    Williams, B.D.; Schweitzer, M.E.; Weishaupt, D.; Miller, L.S. [Thomas Jefferson Univ., Philadelphia, PA (United States). Dept. of Radiology; Lerman, J. [Lerman Imaging, Brooklyn, NY (United States); Rubenstein, D.L. [Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA (United States); Rosenberg, Z.S. [Dept. of Diagnostic Radiology, New York Univ. Medical Center, NY (United States)


    Purpose: To describe the magnetic resonance (MR) appearance and associated clinical findings of partial distal biceps tendon tears. Design: Twenty elbow MR images at 1.5 T, performed over a 7 year period, were reviewed for an appearance of partial tears in the distal biceps. These images were assessed by two musculoskeletal radiologists for the extent of: (a) abnormal signal intensity within the tendon, and the presence of (b) bicipitoradial bursitis, and (c) bony microavulsive injury of the radial tuberosity. Medical records for nine of the 20 cases were reviewed for the clinical findings of ecchymosis, trauma, sensation of a ''pop'', loss of function, and acuity of onset. Results: Twenty partial distal biceps tendon tears were seen. All displayed an abnormally increased signal in the distal biceps tendon. Three of 20 (15%) showed a 25% to 50% tear, ten of 20 (50%) showed a 50% tear, and seven of 20 (35%) showed a 75% to 90% tear. Bicipitoradial bursitis was seen in 11 of 20 (55%) cases. Bony microavulsive injury of the radial tuberosity was observed in 10 of 20 (50%). Of the nine cases reviewed for associated clinical findings, surprisingly, only three (33%) experienced an acute traumatic episode with an abrupt onset of pain. An insidious onset was reported in four of nine (44%). Sensation of a ''pop'' was recorded in only two of nine (22%) cases. Ecchymosis and loss of function were not seen in any of the cases. Finally, surgical conformation was obtained for three cases. Conclusion: Partial distal biceps tendon tears have a characteristic MR appearance, demonstrate little functional deficit, and may be attritional in their etiology due to the observation of a low number of patients reporting trauma or an acute onset. (orig.)

  18. Exostectomy for chronic midfoot plantar ulcer in Charcot deformity

    DEFF Research Database (Denmark)

    Laurinaviciene, R.; Kirketerp-Moeller, K.; Holstein, Per Evald


    Charcot midfoot ulcers are rare and very difficult to heal, with surgery being an option. This retrospective study assessed healing rates, complications, and the incidence of re-ulceration and other foot ulcer problems following exostectomies Udgivelsesdato: 2008/2......Charcot midfoot ulcers are rare and very difficult to heal, with surgery being an option. This retrospective study assessed healing rates, complications, and the incidence of re-ulceration and other foot ulcer problems following exostectomies Udgivelsesdato: 2008/2...

  19. Peptic ulcer as a risk factor for postherpetic neuralgia in adult patients with herpes zoster. (United States)

    Chen, Jen-Yin; Lan, Kuo-Mao; Sheu, Ming-Jen; Tseng, Su-Feng; Weng, Shih-Feng; Hu, Miao-Lin


    Postherpetic neuralgia is the most common complication of herpes zoster. Identifying predictors for postherpetic neuralgia may help physicians screen herpes zoster patients at risk of postherpetic neuralgia and undertake preventive strategies. Peptic ulcer has been linked to immunological dysfunctions and malnutrition, both of which are predictors of postherpetic neuralgia. The aim of this retrospective case-control study was to determine whether adult herpes zoster patients with peptic ulcer were at greater risk of postherpetic neuralgia. Adult zoster patients without postherpetic neuralgia and postherpetic neuralgia patients were automatically selected from a medical center's electronic database using herpes zoster/postherpetic neuralgia ICD-9 codes supported with inclusion and exclusion criteria. Consequently, medical record review was performed to validate the diagnostic codes and all pertaining data including peptic ulcer, Helicobacter pylori (H. pylori) infection and ulcerogenic medications. Because no standard pain intensity measurement exists, opioid usage was used as a proxy measurement for moderate to severe pain. In total, 410 zoster patients without postherpetic neuralgia and 115 postherpetic neuralgia patients were included. Multivariate logistic regressions identified 60 years of age and older, peptic ulcer and greater acute herpetic pain as independent predictors for postherpetic neuralgia. Among etiologies of peptic ulcer, H. pylori infection and usage of non-selective nonsteroidal anti-inflammatory drugs were significantly associated with the increased risk of postherpetic neuralgia; conversely, other etiologies were not significantly associated with the postherpetic neuralgia risk. In conclusion, 60 years of age and older, peptic ulcer and greater acute herpetic pain are independent predictors for postherpetic neuralgia in adult herpes zoster patients.

  20. Management of acute nonvariceal upper gastrointestinal bleeding: Current policies and future perspectives

    NARCIS (Netherlands)

    I.L. Holster (Ingrid); E.J. Kuipers (Ernst)


    textabstractAcute upper gastrointestinal bleeding (UGIB) is a gastroenterological emergency with a mortality of 6%-13%. The vast majority of these bleeds are due to peptic ulcers. Nonsteroidal anti-inflammatory drugs and Helicobacter pylori are the main risk factors for peptic ulcer disease. Endosco

  1. Three dimensional finite element analysis of anatomic distal radius Nitinol memory connector treating distal radius fracture

    Institute of Scientific and Technical Information of China (English)

    苏佳灿; 张春才; 禹宝庆; 许硕贵; 王家林; 纪方; 张雪松; 吴建国; 王保华; 薛召军; 丁祖泉


    Objective: To study the memory biomechanical character of anatomic distal radius Nitinol memory connector (DRMC) in treating distal radius fracture. Methods: Establishing three dimensional model and finite element analysis, we calculated the stress in and around the fracture faces when distal radius fracture was fixated with DRMC. Results: Axial holding stress produced by holding part of DRMC on distal radius was 14.66 MPa. The maximum stress of holding part was 40-70 MPa, the minimum stress was 3-7 MPa,and the stress of compression part was 20-40 MPa. Conclusion: The distribution of stress produced by DRMC around the fracture line is reasonable, and axial holding stress can help stabilize fracture during earlier period. The existence of longitudal compression and memory effect can transfer fixated disused section into developed section and enhance fracture healing.

  2. Non-operative treatment for perforated gastro-duodenal peptic ulcer in Duchenne Muscular Dystrophy: a case report

    Directory of Open Access Journals (Sweden)

    Wever Jan


    Full Text Available Abstract Background Clinical characteristics and complications of Duchenne muscular dystrophy caused by skeletal and cardiac muscle degeneration are well known. Gastro-intestinal involvement has also been recognised in these patients. However an acute perforated gastro-duodenal peptic ulcer has not been documented up to now. Case presentation A 26-year-old male with Duchenne muscular dystrophy with a clinical and radiographic diagnosis of acute perforated gastro-duodenal peptic ulcer is treated non-operatively with naso-gastric suction and intravenous medication. Gastrointestinal involvement in Duchenne muscular dystrophy and therapeutic considerations in a high risk patient are discussed. Conclusion Non-surgical treatment for perforated gastro-duodenal peptic ulcer should be considered in high risk patients, as is the case in patients with Duchenne muscular dystrophy. Patients must be carefully observed and operated on if non-operative treatment is unsuccessful.

  3. Sulphomucin expression in ileal pouches: emerging differences between ulcerative colitis and familial adenomatous polyposis pouches.

    LENUS (Irish Health Repository)

    Bambury, Niamh


    PURPOSE: We characterized the expression of sialomucin and sulphomucin in pouches fashioned for familial adenomatous polyposis and ulcerative colitis. We correlated sulphomucin expression with bacterial colonization and mucosal inflammation. METHODS: Ethical approval and informed consent were obtained. Mucosal biopsies from 9 patients with familial adenomatous polyposis and 12 with ulcerative colitis were obtained. Sulphomucin levels were assessed by using the high iron-diamine stain. Mucous gel layer composition was correlated with villous height, crypt depth, and total mucosal thickness. Mucous gel layer composition was correlated with acute and chronic inflammatory infiltrates. Colonization by a panel of seven bacterial species (including sulphate reducing bacteria) was established and correlated with sulphomucin levels. RESULTS: High-iron-diamine positivity (i.e., sulphomucin expression) was greater in ulcerative colitis pouch mucous gel (2.083 +\\/- 0.5 vs. 0.556 +\\/- 0.4, P = 0.003). Sulphomucin expression correlated with reduced crypt depth, villous height, and total mucosal thickness. In the ulcerative colitis group, chronic inflammatory infiltrate scores were significantly greater for high-iron-diamine-positive patients. Colonization by sulphate reducing bacteria was increased in high-iron-diamine-positive patients. CONCLUSIONS: Sulphomucin expression is increased in the mucous gel layer of the ulcerative colitis pouch compared with that of the familial adenomatous polyposis pouch. Sulphomucin expression is associated with colonization by sulphate-reducing bacteria and increased chronic inflammation.

  4. Mortality in perforated duodenal ulcer depends upon pre-operative risk: a retrospective 10-year study.

    LENUS (Irish Health Repository)

    Larkin, J O


    INTRODUCTION: Most patients presenting with acutely perforated duodenal ulcer undergo operation, but conservative treatment may be indicated when an ulcer has spontaneously sealed with minimal\\/localised peritoneal irritation or when the patient\\'s premorbid performance status is poor. We retrospectively reviewed our experience with operative and conservative management of perforated duodenal ulcers over a 10-year period and analysed outcome according to American Society of Anesthesiologists (ASA) score. METHODS: The records of all patients presenting with perforated duodenal ulcer to the Department of Surgery, Mayo General Hospital, between January 1998 and December 2007 were reviewed. Age, gender, co-morbidity, ASA-score, clinical presentation, mode of management, operative procedures, morbidity and mortality were considered. RESULTS: Of 76 patients included, 48 (44 operative, 4 conservative) were ASA I-III, with no mortality irrespective of treatment. Amongst 28 patients with ASA-score IV\\/V, mortality was 54.5% (6\\/11) following operative management and 52.9% (9\\/17) with conservative management. CONCLUSION: In patients with a perforated duodenal ulcer and ASA-score I-III, postoperative outcome is uniformly favourable. We recommend these patients have repair with peritoneal lavage performed, routinely followed postoperatively by empirical triple therapy. Given that mortality is equivalent between ASA IV\\/V patients whether managed operatively or conservatively, we suggest that both management options are equally justifiable.

  5. Association between ulcer site and outcome in complicated peptic ulcer disease

    DEFF Research Database (Denmark)

    Lolle, Ida; Møller, Morten Hylander; Rosenstock, Steffen Jais


    OBJECTIVE: Mortality rates in complicated peptic ulcer disease are high. This study aimed to examine the prognostic importance of ulcer site in patients with peptic ulcer bleeding (PUB) and perforated peptic ulcer (PPU). MATERIALS AND METHODS: Design: a nationwide cohort study with prospective...... and adjusted association between ulcer site (gastric and duodenal) and the outcome measures of interest were assessed by binary logistic regression analysis. RESULTS: Some 20,059 patients with PUB and 4273 patients with PPU were included; 90-d mortality was 15.3% for PUB and 29.8% for PPU; 30-d mortality...... was 10.2% and 24.7%, respectively. Duodenal bleeding ulcer, as compared to gastric ulcer (GU), was associated with a significantly increased risk of all-cause mortality within 90 and 30 d, and with re-intervention: adjusted odds ratio (OR) 1.47 (95% confidence interval 1.30-1.67); p 

  6. Triple gastric peptic ulcer perforation. (United States)

    Radojkovic, Milan; Mihajlovic, Suncica; Stojanovic, Miroslav; Stanojevic, Goran; Damnjanovic, Zoran


    Patients with advanced or metastatic cancer have compromised nutritional, metabolic, and immune conditions. Nevertheless, little is known about gastroduodenal perforation in cancer patients. Described in the present report is the case of a 41-year old woman with stage IV recurrent laryngeal cancer, who used homeopathic anticancer therapy and who had triple peptic ulcer perforation (PUP) that required surgical repair. Triple gastric PUP is a rare complication. Self-administration of homeopathic anticancer medication should be strongly discouraged when evidence-based data regarding efficacy and toxicity is lacking.

  7. Diagnosis and management of genital ulcers. (United States)

    Roett, Michelle A; Mayor, Mejebi T; Uduhiri, Kelechi A


    Herpes simplex virus infection and syphilis are the most common causes of genital ulcers in the United States. Other infectious causes include chancroid, lymphogranuloma venereum, granuloma inguinale (donovanosis), secondary bacterial infections, and fungi. Noninfectious etiologies, including sexual trauma, psoriasis, Behçet syndrome, and fixed drug eruptions, can also lead to genital ulcers. Although initial treatment of genital ulcers is generally based on clinical presentation, the following tests should be considered in all patients: serologic tests for syphilis and darkfield microscopy or direct fluorescent antibody testing for Treponema pallidum, culture or polymerase chain reaction test for herpes simplex virus, and culture for Haemophilus ducreyi in settings with a high prevalence of chancroid. No pathogen is identified in up to 25 percent of patients with genital ulcers. The first episode of herpes simplex virus infection is usually treated with seven to 10 days of oral acyclovir (five days for recurrent episodes). Famciclovir and valacyclovir are alternative therapies. One dose of intramuscular penicillin G benzathine is recommended to treat genital ulcers caused by primary syphilis. Treatment options for chancroid include a single dose of intramuscular ceftriaxone or oral azithromycin, ciprofloxacin, or erythromycin. Lymphogranuloma venereum and donovanosis are treated with 21 days of oral doxycycline. Treatment of noninfectious causes of genital ulcers varies by etiology, and ranges from topical wound care for ulcers caused by sexual trauma to consideration of subcutaneous pegylated interferon alfa-2a for ulcers caused by Behçet syndrome.

  8. Complex interventions for preventing diabetic foot ulceration

    NARCIS (Netherlands)

    Hoogeveen, Ruben C; Dorresteijn, Johannes A N; Kriegsman, Didi M W; Valk, Gerlof D.


    BACKGROUND: Ulceration of the feet, which can lead to the amputation of feet and legs, is a major problem for people with diabetes mellitus, and can cause substantial economic burden. Single preventive strategies have not been shown to reduce the incidence of foot ulceration to a significant extent.

  9. Pressure ulcers: Back to the basics

    Directory of Open Access Journals (Sweden)

    Karoon Agrawal


    Full Text Available Pressure ulcer in an otherwise sick patient is a matter of concern for the care givers as well as the medical personnel. A lot has been done to understand the disease process. So much so that USA and European countries have established advisory panels in their respective continents. Since the establishment of these organizations, the understanding of the pressure ulcer has improved significantly. The authors feel that the well documented and well publicized definition of pressure ulcer is somewhat lacking in the correct description of the disease process. Hence, a modified definition has been presented. This disease is here to stay. In the process of managing these ulcers the basic pathology needs to be understood well. Pressure ischemia is the main reason behind the occurrence of ulceration. Different extrinsic and intrinsic factors have been described in detail with review of literature. There are a large number of risk factors causing ulceration. The risk assessment scales have eluded the surgical literature and mostly remained in nursing books and websites. These scales have been reproduced for completion of the basics on decubitus ulcer. The classification of the pressure sores has been given in a comparative form to elucidate that most of the classifications are the same except for minor variations. The management of these ulcers is ever evolving but the age old saying of "prevention is better than cure" suits this condition the most.

  10. Microsurgical Treatment of Mooren‘s Ulcer

    Institute of Scientific and Technical Information of China (English)

    HanpingXie; JiaqiChen; 等


    Objective:To evaluate effect of lamellar keratoplasty(LKP) on Mooren's corneal ulcer.Methods:The effect ,postoperative astigmatism,postoperative vision,ulcer recurrence of postperation,and surgical complications of two groups of consecutive Mooren's ulcer inpatients treated respectively by non-microsurgery of LKP and microsurgery of LKP were analyzed.Results:There were significant differences of the effect,postoperative astigmatism,postoperative vision,ulcer recurrence of postoperation,and surgical complications be-tween the two groups.The effect and postoperative vision of the microsurgery-tyeated group were betterthan those of the non-microsurgery-treated group.The postoperative astigma-tism,ulcer recurrence of postoperation, and surgical complications of the micro-surgery-treated group were less than those of the nonmicrosurgery-treated group.Conclusion:Microsrugery of LKP of Mooren's corneal ulcer can greatly improve the ul-cer healing and postoperative vision, and reduce the surgical complication and the ulcer recurrence of postoperation.Eye Science 2000;16:56-60.

  11. Crohn's Disease and Ulcerative Colitis: Emotional Factors (United States)

    ... IS THE CAUSE OF ULCERATIVE COLITIS AND CROHN’S DISEASE? The origin of IBD is still unknown. It is possible that a combination of factors may be the underlying cause of Crohn’s disease and ulcerative colitis. Researchers theorize that IBD patients ...

  12. Endoscopic biopsy: Duodenal ulcer penetrating into liver

    Institute of Scientific and Technical Information of China (English)

    Baybora Kircali; Tülay Saricam; Aysegul Ozakyol; Eser Vardareli


    @@ TO THE EDITOR We have read with interest the recent report by E Kayacetin and S Kayacetin of Gastric ulcer penetrating to liver diagnosed by endoscopic biopsy[1] since we diagnosed the duodenal ulcer which penetrated into liver similarly. This is a rather unusual case because of the fifth case in the literature and responding to medical therapy.

  13. Ulcerative colitis flare with splenic ven thrombosis. (United States)

    Bozkurt, Huseyin Sancar; Kara, Banu; Citil, Serdal


    Patients with ulcerative colitis (UC) have an increased risk of thromboembolic events. Here, we present a 28-year-old man with active ulcerative pancolitis presenting via splenic vein thrombosis and left renal superior infarct that was not associated with a surgical procedure.

  14. Corynebacterium macginleyi isolated from a corneal ulcer

    Directory of Open Access Journals (Sweden)

    Kathryn Ruoff


    Full Text Available We report the isolation of Corynebacterium macginleyi from the corneal ulcer culture of a patient, later enrolled in the Steroids for Corneal Ulcer Trial (SCUT. To our knowledge this is the first published report from North America of the recovery of C. macginleyi from a serious ocular infection.

  15. Surgical treatment of perforated gastric ulcer

    Directory of Open Access Journals (Sweden)

    Korica Milan


    Full Text Available Introduction Peptic ulcer perforation is a complication of ulcer disease which requires urgent surgical treatment. The aim of this paper was to point out our experience in surgical treatment of perforated peptic ulcer. Material and methods This retrospective study analyzes results of surgical treatment in 365 patients with perforated peptic ulcer during the period January 1996 to December 2000. Results During the last 5-year period 365 patients were treated following peptic ulcer perforation. The average age was 43.53±8.26, with the span from 18 to 86. The most frequent surgical procedures in treatment of peptic ulcer perforation were: simple closure with biopsy (55.88%, excision of the ulcer with a pyloroplasty and vagotomy (35.29% as nonresection surgical procedures and stomach resection after Billroth II (8.83%. The postoperative mortality was 4.41%. Conclusions The methods of choice in surgical treatment of gastric ulcer perforation are nonresection surgical procedures with drug therapy and eradication of Helicobacter pylori, if present.

  16. Pressure ulcer risk in hip fracture patients

    NARCIS (Netherlands)

    Houwing, RH; Rozendaal, M; Wouters-Wesseling, W; Buskens, E; Keller, P; Haalboom, JRE


    Hip fracture patients have a high risk of pressure ulcers (PU). We followed 121 hip fracture patients for the development of pressure ulcers and evaluated a risk assessment tool for sensitivity and specificity. More than half of the patients presented with PU, mostly stage I. Risk factors for PU wer


    Directory of Open Access Journals (Sweden)

    Hegde Nidarsh D.


    Full Text Available Oral ulcers is a very common disorder of the oral mucosa. Patients with signs or symptoms of oral ulcers are sometimes referred to gastroenterology clinics, however, in most instances the ulcers does not reflect gastrointestinal disease, some with a chronic non- healing ulcer are advised biopsy. Indeed, a spectrum of disorders can give rise to oral mucosal ulcers ranging from minor local trauma to significant local disease such as malignancy or systemic illness. Lesions of the tongue have a broad differential diagnosis ranging from benign idiopathic processes to infections, cancers, and infiltrative disorders. This article will focus on common ulcerative disorders of the tongue in aspects of their clinical features and differential diagnosis, two case reports with the diagnosis and conservative management for long-term chronic ulcers. The two cases which are reported in this article had a differential diagnosis of Squamous cell carcinoma of the tongue. The clinical picture was craterlike lesion, having a velvety-red base and a rolled, indurated border and most important painless in both cases. Removal of the irritant which was the tooth, rehabilitation of the oral mucosa by lubrication with Cocus Nucifera resulted in the healing of the ulcers. Functional components of Cocus Nucifera are Squaline, tocopherol, phytosterols and other sterols which are all plant steroids.

  18. Drug-induced peptic ulcer disease


    Vella, Valerie


    For more than a century, peptic ulcer disease has been a major cause of morbidity and mortality. Peptic ulcer disease is a heterogeneous group of disorders involving the gastrointestinal tract and results from an imbalance between the aggressive forces of gastric acid and pepsin and the defensive mechanisms of the gastric mucosa.

  19. Calcific periarthritis of the elbow presenting as acute tennis elbow. (United States)

    Jawad, F; Jawad, A S M


    A 28-year-old woman presented with sudden acute lateral epicondylitis. There was no history of preceding trauma or repetitive use of the arm. Because of the acute onset and signs of acute inflammation, an X-ray was arranged. The X-ray showed a hyperdense calcified elongated globule distal to the lateral epicondyle. A diagnosis of calcific periarthritis (calcium apatite) of the elbow was made. Calcific periarthritis has rarely been reported as a cause of acute elbow pain.


    Santos, Cláudia; Pereira, Alexandre; Sousa, Marco; Trigeuiros, Miguel; Silva, César


    Distal radioulnar arthroplasty is an attractive solution for treating various pathological conditions of the distal radioulnar joint because it allows restoration of stability, load transmission and function. The main indications are: radioulnar impingement after partial or complete resection of the distal ulna; and degenerative, inflammatory or post-traumatic arthritis of the distal radioulnar joint. The authors present three clinical cases of distal radioulnar pathological conditions: two patients with post-traumatic sequelae and one case of distal radioulnar impingement after a Sauvé-Kapandji operation. The three cases were treated surgically with a metallic prosthesis to replace the distal ulna (First Choice - Ascension®). The first two were treated with a resurfacing prosthesis and the last one with a modular prosthesis. All of the patients had achieved pain relief and increased movement of the distal radioulnar joint after one year of postoperative follow-up. PMID:27047827

  1. Does computer use affect the incidence of distal arm pain?

    DEFF Research Database (Denmark)

    Mikkelsen, Sigurd; Lassen, Christina Funch; Vilstrup, Imogen;


    To study how objectively recorded mouse and keyboard activity affects distal arm pain among computer workers.......To study how objectively recorded mouse and keyboard activity affects distal arm pain among computer workers....

  2. Hospital-acquired pressure ulcers in spinal cord injured patients : time to occur, time until closure and risk factors

    NARCIS (Netherlands)

    van der Wielen, H.; Post, M. W. M.; Lay, V.; Glaesche, K.; Scheel-Sailer, A.


    Study design: Prospective observational cohort study. Objectives: To describe time to occur and time until closure of hospital-acquired pressure ulcers (HAPUs) in patients with spinal cord injury (SCI). Setting: Specialised SCI acute care and rehabilitation clinic in Switzerland. Methods: Daily regi

  3. Surgical treatment of 82 patients with diabetic lower limb ischemia by distal arterial bypass

    Institute of Scientific and Technical Information of China (English)

    GU Yong-quan; WANG Zhong-gao; ZHANG Jian; QI Li-xing; YU Heng-xi; LI Jian-xin; LI Xue-feng; GUO Lian-rui; LUO Tao; CUI Shi-jun


    Background Diabetic lower limb ischemia is a serious complication of diabetes mellitus.This study was conducted to investigate the effectiveness of distal arterial bypass treatment in diabetic patients with lower limb ischemia. Methods From July 2000 to July 2004, 96 lower limbs of 82 diabetic patients (type 2) with severe lower limb ischemia were treated in Xuan Wu Hospital. Arterial bypass with femoro-popliteal polytetrafluoroethylene (PTFE) and graft-tibial autologous grafts was performed on 311 limbs (32.3%). Popliteal-tibial artery bypass alone was performed on 22 limbs (22.9%). Combined iliac artery stenting, femoro-popliteal artery PTFE graft bypass, and graft-tibial artery autologous graft bypass was performed on 12 limbs (12.5%), and femoro-tibial artery graft bypass was performed on 10 limbs (10.4%). Popliteal-tibial-pedal artery graft bypass was performed on 7 limbs (7.3%). Results Arterial grafts in 92 limbs of 79 patients were patent on discharge. Three patients with 4 ischemic limbs (3.7%)died of respiratory failure 12 hours, 3 days and 7 days after operation respectively. Early operation success rate was 96.3% (79/82). Graft patency rate of patients on discharge was 95.8% (92/96). The short-term total effectiveness rate was 83.3% (80/96). Foot ulcer healing rate was 35.7% (10/28). 97.4% (75/77) patients were followed up for a mean of 13.5 months. The long-term total effective rate was 80.7% (71/88). The total amputation rate was 4.5% (4/88). Mortality was 4.5%. The total graft patency rate was 90.9% (80/88).Conclusion In the treatment of diabetic foot, distal lower limb arterial bypass can help to avoid amputation or lower the amputation level, and may promote foot ulcer healing and improve patient's quality of life.

  4. Assessment of foot perfusion in patients with a diabetic foot ulcer. (United States)

    Forsythe, Rachael O; Hinchliffe, Robert J


    Assessment of foot perfusion is a vital step in the management of patients with diabetic foot ulceration, in order to understand the risk of amputation and likelihood of wound healing. Underlying peripheral artery disease is a common finding in patients with foot ulceration and is associated with poor outcomes. Assessment of foot perfusion should therefore focus on identifying the presence of peripheral artery disease and to subsequently estimate the effect this may have on wound healing. Assessment of perfusion can be difficult because of the often complex, diffuse and distal nature of peripheral artery disease in patients with diabetes, as well as poor collateralisation and heavy vascular calcification. Conventional methods of assessing tissue perfusion in the peripheral circulation may be unreliable in patients with diabetes, and it may therefore be difficult to determine the extent to which poor perfusion contributes to foot ulceration. Anatomical data obtained on cross-sectional imaging is important but must be combined with measurements of tissue perfusion (such as transcutaneous oxygen tension) in order to understand the global and regional perfusion deficit present in a patient with diabetic foot ulceration. Ankle-brachial pressure index is routinely used to screen for peripheral artery disease, but its use in patients with diabetes is limited in the presence of neuropathy and medial arterial calcification. Toe pressure index may be more useful because of the relative sparing of pedal arteries from medial calcification but may not always be possible in patients with ulceration. Fluorescence angiography is a non-invasive technique that can provide rapid quantitative information about regional tissue perfusion; capillaroscopy, iontophoresis and hyperspectral imaging may also be useful in assessing physiological perfusion but are not widely available. There may be a future role for specialized perfusion imaging of these patients, including magnetic resonance

  5. Analyzing treatment aggressiveness and identifying high-risk patients in diabetic foot ulcer return to care. (United States)

    Remington, Austin C; Hernandez-Boussard, Tina; Warstadt, Nicholus M; Finnegan, Micaela A; Shaffer, Robyn; Kwong, Jereen Z; Curtin, Catherine


    Rates of diabetes and its associated comorbidities have been increasing in the United States, with diabetic foot ulcer treatment representing a large cost to the patient and healthcare system. These ulcers often result in multiple hospital admissions. This study examined readmissions following inpatient care for a diabetic foot ulcer and identified modifiable factors associated with all-cause 30-day readmissions to the inpatient or emergency department (ED) setting. We hypothesized that patients undergoing aggressive treatment would have lower 30-day readmission rates. We identified patient discharge records containing International Classification of Disease ninth revision codes for both diabetes mellitus and distal foot ulcer in the State Inpatient and Emergency Department databases from the Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project in Florida and New York, 2011-2012. All-cause 30-day return to care visits (ED or inpatient) were analyzed. Patient demographics and treatment characteristics were evaluated using univariate and multivariable regression models. The cohort included 25,911 discharges, having a mean age of 63 and an average of 3.8 comorbidities. The overall rate of return to care was 30%, and 21% of subjects underwent a toe or midfoot amputation during their index stay. The most common diagnosis codes upon readmission were diabetes mellitus (19%) and infection (13%). Patients with a toe or midfoot amputation procedure were less likely to be readmitted within 30 days (odds ratio: 0.78; 95% confidence interval: 0.73, 0.84). Presence of comorbidities, black and Hispanic ethnicities, and Medicare and Medicaid payer status were also associated with higher odds of readmission following initial hospitalization (p < 0.05). The study suggests that there are many factors that affect readmission rates for diabetic foot ulcer patients. Understanding patients at high-risk for readmission can improve counseling and

  6. Correlation of a quantitative videocapillaroscopic score with the development of digital skin ulcers in scleroderma patients

    Directory of Open Access Journals (Sweden)

    A. Antonelli


    Full Text Available Background: Systemic sclerosis (SSc is an autoimmune disease characterized by fibrosis of the skin and visceral organs. The microangiopathy is early detectable in the course of the disease by nailfold videocapillaroscopy (NVC, a non-invasive technique with a high diagnostic value. Objective: Aim of our study was to evaluate the feasibility of a quantitative score and its correlation with the digital skin ulcers, which frequently complicate SSc microangiopathy. Methods: We retrospectively analysed the NVC of 65 SSc patients, performed by 200x videocapillaroscopy connected to image analyse software (Videocap; DS MediGroup, Milan, Italy. The analysis of NVC images included: total number of capillaries in the distal row (N, maximum diameter (D and number of giant capillaries (M, M/N ratio and percentage of M, presence/absence of micro-haemorrhages and tortuosity. Results: 21/65 SSc patients experienced digital ulcers within three months after the NVC examination. The N, D, M/N, and percentage of M significantly correlated with the appearance of ischemic ulcers. A multiple regression analysis showed a statistically significant correlation for N, M/N and D, while sensitivity and specificity of these parameters were unsatisfactory. A capillaroscopic score, according to the formula D·M/N2, showed a high specificity and sensibility (93.2% and 85.7% respectively; area under ROC curve: 0.918 to predict the appearance of digital ulcers. Conclusions: This capillaroscopic score may represent a feasible and simple tool in SSc patients’ assessment. The routinely use of this parameter might permit to recognize and to preventively treat SSc patients at high risk to develop digital ulcers.

  7. Pressure Ulcer Risk and Prevention Practices in Pediatric Patients: A Secondary Analysis of Data from the National Database of Nursing Quality Indicators®. (United States)

    Razmus, Ivy; Bergquist-Beringer, Sandra


    Little is known about pressure ulcer prevention practice among pediatric patients. To describe the frequency of pressure ulcer risk assessment in pediatric patients and pressure ulcer prevention intervention use overall and by hospital unit type, a descriptive secondary analysis was performed of data submitted to the National Database for Nursing Quality Indicators® (NDNQI®) for at least 3 of the 4 quarters in 2012. Relevant data on pressure ulcer risk from 271 hospitals across the United States extracted from the NDNQI database included patient skin and pressure ulcer risk assessment on admission, time since the last pressure ulcer risk assessment, method used to assess pressure ulcer risk, and risk status. Extracted data on pressure ulcer prevention included skin assessment, pressure-redistribution surface use, routine repositioning, nutritional support, and moisture management. These data were organized by unit type and merged with data on hospital characteristics for the analysis. The sample included 39 984 patients ages 1 day to 18 years on 678 pediatric acute care units (general pediatrics, pediatric critical care units, neonatal intensive care units, pediatric step-down units, and pediatric rehabilitation units). Descriptive statistics were used to analyze study data. Most of the pediatric patients (33 644; 89.2%) were assessed for pressure ulcer risk within 24 hours of admission. The Braden Q Scale was frequently used to assess risk on general pediatrics units (75.4%), pediatric step-down units (85.5%), pediatric critical care units (81.3%), and pediatric rehabilitation units (56.1%). In the neonatal intensive care units, another scale or method was used more often (55% to 60%) to assess pressure ulcer risk. Of the 11 203 pediatric patients (39%) determined to be at risk for pressure ulcers, the majority (10 741, 95.8%) received some kind of pressure ulcer prevention intervention during the 24 hours preceding the NDNQI pressure ulcer survey. The frequency

  8. [Progressive external ophthalmoplegia and distal myopathy]. (United States)

    Damian, C


    A patient, 58 years old, presents progressive blepharoptosis, in both eyes and external ophthalmoplegia. The general somatic examination, shows, at the level of the higher limbs, distal myopathy with muscular hypotony and articular deformities fibrosis and tendinous retraction. On examining the eye bottom we found colloid degeneration in the muscle region. Within the same family a ten-year-old nephew presents congenital ptosis. The muscular biopsy from the levator palpebrae shows muscular degenerative lesions with the reduction of nuclei and the proliferation of conjunctive tissue. It is shown that progressive external ophthalmoplegia must be interpreted as an ocular myopathy. The association with the distal myopathy at the level of the higher limbs, in the presented observation, upholds this pathogeny.

  9. [Fracture endoprosthesis of distal humerus fractures]. (United States)

    Müller, L P; Wegmann, K; Burkhart, K J


    The treatment of choice for fractures of the distal humerus is double plate osteosynthesis. Due to anatomical preshaped angle stable plates the primary stability and management of soft tissues has been improved. However, osteoporotic comminuted fractures in the elderly are often not amenable to stable osteosynthesis and total elbow arthroplasty has been established as an alternative therapy. Although complication rates have been reduced, complications of total elbow arthroplasty are still much more frequent than in total hip replacement. Furthermore, patients are advised not to exceed a weight bearing of 5 kg. Therefore, the indications for elbow arthroplasty must be evaluated very strictly and should be reserved for comminuted distal humeral fractures in the elderly with poor bone quality that are not amenable to stable osteosynthesis or for simple fractures in cases of preexisting symptomatic osteoarthritis. This article introduces and discusses modern concepts of elbow arthroplasty, such as modular convertible prosthesis systems, hemiarthroplasty and radial head replacement in total elbow arthroplasty.

  10. Distal renal tubular acidosis with hereditary spherocytosis. (United States)

    Sinha, Rajiv; Agarwal, Indira; Bawazir, Waleed M; Bruce, Lesley J


    Hereditary spherocytosis (HS) and distal renal tubular acidosis (dRTA), although distinct entities, share the same protein i.e. the anion exchanger1 (AE1) protein. Despite this, their coexistence has been rarely reported. We hereby describe the largest family to date with co-existence of dRTA and HS and discuss the molecular basis for the co-inheritance of these conditions.

  11. Periosteal osteoid osteoma of the distal femur

    Directory of Open Access Journals (Sweden)

    Mohammed Fahd Amar


    Full Text Available Periosteal osteoid osteoma is extremely rare. The diagnosis is not always clear. We report a case of periosteal osteoid osteoma arising from the posterior surface of the right distal femur in a 21-year-old woman. After careful evaluation and excisional biopsy, histological examination confirmed the diagnosis of osteoid osteoma, showing the nidus, surrounding osteosclerosis, and catarrhal synovitis. The lesion was treated successfully with excision of the nidus.

  12. Distal biceps tendon injuries: diagnosis and management. (United States)

    Ramsey, M L


    Rupture of the distal biceps tendon occurs most commonly in the dominant extremity of men between 40 and 60 years of age when an unexpected extension force is applied to the flexed arm. Although previously thought to be an uncommon injury, distal biceps tendon ruptures are being reported with increasing frequency. The rupture typically occurs at the tendon insertion into the radial tuberosity in an area of preexisting tendon degeneration. The diagnosis is made on the basis of a history of a painful, tearing sensation in the antecubital region. Physical examination demonstrates a palpable and visible deformity of the distal biceps muscle belly with weakness in flexion and supination. The ability to palpate the tendon in the antecubital fossa may indicate partial tearing of the biceps tendon. Plain radiographs may show hypertrophic bone formation at the radial tuberosity. Magnetic resonance imaging is generally not required to diagnose a complete rupture but may be useful in the case of a partial rupture. Early surgical reattachment to the radial tuberosity is recommended for optimal results. A modified two-incision technique is the most widely used method of repair, but anterior single-incision techniques may be equally effective provided the radial nerve is protected. The patient with a chronic rupture may benefit from surgical reattachment, but proximal retraction and scarring of the muscle belly can make tendon mobilization difficult, and inadequate length of the distal biceps tendon may necessitate tendon augmentation. Postoperative rehabilitation must emphasize protected return of motion for the first 8 weeks after repair. Formal strengthening may begin as early as 8 weeks, with a return to unrestricted activities, including lifting, by 5 months.

  13. [Laparoscopic distal resection of the pancreas]. (United States)

    Gürlich, R; Sixta, B; Oliverius, M; Kment, M; Rusina, R; Spicák, J; Sváb, J


    During the last two years, reports on laparoscopic procedures of the pancreas have been on increase. Laparoscopic resection of the pancreatic cauda is indicated, primarily, for benign cystic lesions of the cauda of the pancreas and for neuroendocrine tumors of the pancreas (mainly insulinomas). We have not recorded any report on the above procedure in the Czech literature. Therefore, in our case review, we have described laparoscopic distal resection of the pancreas with splenectomy for a pseudopapillary tumor of the pancreas.

  14. Distal Adding On in Lenke 1A Scoliosis

    DEFF Research Database (Denmark)

    Wang, Yu; Bünger, Cody Eric; Zhang, Yanqun;


    to determine the onset of distal adding-on in Lenke 1A scoliosis. Such questions as: "Which radiographical parameters should be used for measuring the extent of distal adding-on?" and "What criteria should be applied in determining the onset of distal adding-on?" need to be answered. METHODS: We reviewed all...

  15. Miastenia grave distal: relato de caso

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    Scola Rosana Herminia


    Full Text Available Relatamos o caso de uma mulher de 30 anos com quadro de fraqueza muscular nos membros inferiores com predomínio distal com início há 7 anos. Na evolução apresentou fraqueza muscular nos membros superiores. O exame físico mostrava nervos cranianos sem alterações, hipotrofia bilateral de quadriceps e interósseos dos pés, redução da força muscular mais intensa em tibiais anteriores e interósseos dorsais dos pés e reflexos tendinosos globalmente hipoativos. Foi realizado teste de estimulação repetitiva que mostrou decremento maior que 10% no nervo fibular e ulnar. A dosagem de anticorpos anti-receptor de acetilcolina foi positiva. Tomografia computadorizada de tórax foi normal. Dosagem de hormônios tireoidianos mostrou evidências laboratoriais de hipertireoidismo, porém sem manifestações clínicas. Foi iniciado tratamento com piridostigmina havendo melhora importante do quadro clínico. A fraqueza distal é um sintoma inicial raro na miastenia grave (MG. Contudo, a MG deve entrar no diagnóstico diferencial de doenças que cursam com fraqueza muscular distal de membros superiores ou inferiores.

  16. Novel topical therapies for distal colitis

    Institute of Scientific and Technical Information of China (English)

    Ian; Craig; Lawrance


    Distal colitis(DC) can be effectively treated with topical 5ASA agents.Suppositories target the rectum while enemas can reliably reach the splenic flexure.Used in combination with oral 5ASAs,the control of the inflammation is even more effective.Unfortunately,resistant DC does occur and can be extremely challenging to manage.In these patients,the use of steroids,immunosuppressants and the anti-tumor necrosis factor α agents are often required.These,however,can be associated with systemic side effects and are not always effective.The investigation of new topical therapeutic agents is thus required as they are rarely associated with significant blood drug levels and side effects are infrequent.Some of the agents that have been proposed for use in resistant distal colitis include butyrate,cyclosporine and nicotine enemas as well as tacrolimus suppositories and tacrolimus,ecabet sodium,arsenic,lidocaine,rebamipide and Ridogrel enemas.Some of these agents have demonstrated impressive results but the majority of the agents have only been assessed in small open-labelled patient cohorts.Further work is thus required with the investigation of promising agents in the context of randomized double-blinded placebo controlled trials.This review aims to highlight those potentially effective therapies in the management of resistant distal colitis and to promote interest in furthering their investigation.

  17. Distal symmetrical polyneuropathy: definition for clinical research. (United States)

    England, J D; Gronseth, G S; Franklin, G; Miller, R G; Asbury, A K; Carter, G T; Cohen, J A; Fisher, M A; Howard, J F; Kinsella, L J; Latov, N; Lewis, R A; Low, P A; Sumner, A J


    The objective of this report was to develop a case definition of "distal symmetrical polyneuropathy" to standardize and facilitate clinical research and epidemiological studies. A formalized consensus process was employed to reach agreement after a systematic review and classification of evidence from the literature. The literature indicates that symptoms alone have relatively poor diagnostic accuracy in predicting the presence of polyneuropathy; signs are better predictors of polyneuropathy than symptoms; and single abnormalities on examination are less sensitive than multiple abnormalities in predicting the presence of polyneuropathy. The combination of neuropathic symptoms, signs, and electrodiagnostic findings provides the most accurate diagnosis of distal symmetrical polyneuropathy. A set of case definitions was rank ordered by likelihood of disease. The highest likelihood of polyneuropathy (useful for clinical trials) occurs with a combination of multiple symptoms, multiple signs, and abnormal electrodiagnostic studies. A modest likelihood of polyneuropathy (useful for field or epidemiological studies) occurs with a combination of multiple symptoms and multiple signs when the results of electrodiagnostic studies are not available. A lower likelihood of polyneuropathy occurs when electrodiagnostic studies and signs are discordant. For research purposes, the best approach for defining distal symmetrical polyneuropathy is a set of case definitions rank ordered by estimated likelihood of disease. The inclusion of this formalized case definition in clinical and epidemiological research studies will ensure greater consistency of case selection.

  18. Anti-ulcer and ulcer healing potentials of Musa sapientum peel extract in the laboratory rodents

    Directory of Open Access Journals (Sweden)

    Samuel Adetunji Onasanwo


    Full Text Available Background: This study investigated the anti-ulcer and ulcer healing potentials of the methanol extract of Musa sapientum peel in the laboratory rats. Materials and Methods: Methanol extract of the peels on Musa sapientum (MEMS was evaluated for its anti-ulcer using alcohol-induced, aspirin-induced, and pyloric ligation-induced models, and for its ulcer healing employing acetic acid-induced ulcer models in rats. Results: The findings from this experiment showed that MEMS (50, 100 and 200 mg/kg, b.w. anti-ulcer and ulcer healing activity (P ≤ 0.05 is dose-dependent. Also, MEMS exhibited healing of the ulcer base in all the treated groups when compared with the control group. Conclusion: The outcomes of this experiment revealed that the anti-ulcer effect of MEMS may be due to its anti-secretory and cyto-protective activity. The healing of the ulcer base might not be unconnected with basic fibroblast growth factors responsible for epithelial regeneration.

  19. Omeprazole maintenance therapy prevents recurrent ulcer bleeding after surgery for duodenal ulcer

    Institute of Scientific and Technical Information of China (English)

    Konstantinos Demertzis; Dimitrios Polymeros; Theodoros Emmanuel; Konstantinos Triantafyllou; Pericles Tassios; Spiros D Ladas


    AIM: To evaluate the omeprazole maintenance therapy in patients with recurrent ulcer bleeding after surgery for duodenal ulcer.METHODS: We studied 15 consecutive patients with recurrent ulcer bleeding after surgery for duodenal ulcer.Omeprazole (20 mg/d) maintenance therapy was given after ulcer healing. In addition to clinical follow-up, ambulatory 24-h gastric pH assay was performed before and during omeprazole therapy in those patients and controls with previous duodenal ulcer surgery but no ulcer recurrence.RESULTS: All the 15 ulcers were healed after being treated with omeprazole (40 mg/d) for 2 mo. Eleven patients with two (1-9) episodes of recurrent ulcer bleeding completed the follow-up (43, 12-72 mo). None of them had a bleeding episode while on omeprazole. One patient discontinued the therapy and had recurrent bleeding. The median 24-h fraction time of gastric pH <4 in patients was 80, 46-95% , and was reduced to 32, 13-70% by omeprazole (P = 0.002).CONCLUSION: Long-term maintenance therapy with omeprazole (20 mg/day) is effective in preventing recurrent ulcer bleeding.

  20. [Some aspects of the complex treatment of acute suppurative perionitis]. (United States)

    Kovalev, M M; Roĭ, V P; Zaritskiĭ, I; Konovalenko, V V; Mellin, V M


    The authors present an analysis of the results of complex treatment in 4318 patients operated upon for acute peritonitis, caused by acute appendicitis, perforating gastric and duodenal ulcers, acute cholecystitis, ruptures and perforations of the intestine and other surgical and gynecological diseases. Patients with diffuse purulent peritonitis showed marked disorders in protein-aminoacid, nitrogen, and water electrolyte metabolism, acid-base balance, a reduced nonspecific immune responsiveness of the organism. Therpeutic tactics was delineated taking into account the revealed changes.

  1. An innovative technique to distalize maxillary molar using microimplant supported rapid molar distalizer

    Directory of Open Access Journals (Sweden)

    Meenu Goel


    Full Text Available Introduction: In recent years, enhancements in implants have made their use possible as a mode of absolute anchorage in orthodontic patients. In this paper, the authors have introduced an innovative technique to unilaterally distalize the upper left 1 st molar to obtain an ideal Class I molar relationship from a Class II existing molar relationship with an indigenous designed distalizer. Clinical Innovation: For effective unilateral diatalization of molar, a novel cantilever sliding jig assembly was utilized with coil spring supported by a buccally placed single micro implant. The results showed 3 mm of bodily distalization with 1 mm of intrusion and 2° of distal tipping of upper left 1 st molar in 1.5 months. Discussion: This appliance is relatively easy to insert, well-tolerated, and requires minimal patient cooperation compared to other present techniques of molar distalization. Moreover, it is particularly useful in cases that are Class II on one side and Class I on the other, with a minor midline discrepancy and nominal overjet. Patient acceptance level was reported to be within patients physiological and comfort limits.

  2. Compression Stockings for Treating Venous Leg Ulcers

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    J. P. Benigni


    Full Text Available Background. In order to treat venous leg ulcers, it is recommended to use high pressure compression (30–40 mmHg at the ankle. Compression stockings which are not operator dependant could be the best option because of their pressure control. However 30–40 mmHg compression stockings are often hard to put on. Putting two lower pressure compression stockings over each other could be a good therapeutic alternative. Objectives. To compare the in vitro pressures given by the manufacturers of 2 antiulcer kits with the in vivo interface pressures measured in healthy subjects and to evaluate the stiffness and friction indices from those kits based on the interface pressure in order to assess their clinical properties. Material and Methods. Using a Kikuhime pressure device, interface pressure was measured in 12 healthy subjects at the reference point B1. One stiffness index (Static Stiffness Index (SSI and a friction index have been calculated. Results. Mediven Ulcer kit gets the recommended pressures whereas Jobst’s Ulcer Care kit does not for treating a venous leg ulcer. Jobst’s Ulcer Care transmits entirely the pressure in relation to a friction index close to 1. Conclusion. This antiulcer kit study underlines that in vivo and in vitro pressures can be different (Jobst’s Ulcer Care kit and Mediven Ulcer kit. In order not to lose pressure, it is important to take into account the friction index when superimposing two stockings.


    Directory of Open Access Journals (Sweden)

    P. Rajagopal


    Full Text Available BACKGROUND AND OBJECTIVES Infections of all types are more common in patients with diabetes, on the basis of outcome of retrospective study in Canada. Many types of infections are very common in diabetic than non-diabetic patients. Foot is the most common site. Diabetic foot infections range from mild infections to limb threatening conditions. Most require emergency medical attention. Diabetic foot infection is a global burden and projected to increase from 246 million people to over 380 million people by the year 2025. Many people with diabetes develop complications that seriously affect their quality and length of life. Lower limb complications are common, particularly foot ulcers and gangrene. Development of these complications is attributed to individual risk factors, poverty, racial and ethnic differences, and quality of local and national health care systems. The wide variations noted suggest that best practices in low incidence areas could easily be adapted in high incidence areas to reduce the burden of complications. Almost every infection begins in a wound, often as neuropathic ulceration or a traumatic break in the skin. Infections that begin as a small problem may progress to involve soft tissue, bones and joints. Because of these morbidity and occasional mortality by these foot infections several authoritative groups have recently developed guidelines for assessing and treating diabetic foot. METHODOLOGY 100 Diabetic patients with foot ulcers were admitted and wounds were classified using wagner’s classification. Pus was sent for culture and sensitivity and treated accordingly. RESULTS In our study the most common organism cultured from the wound with diabetes mellitus was staphylococcus. The most sensitive drug for these organisms was found to be chloramphenicol on most occasions. CONCLUSION The rationale of pus culture and sensitivity is not only to definitively treat the diabetic wound after the culture sensitivity report is


    Directory of Open Access Journals (Sweden)

    S.S. Prasad*, Anita Sinha, Kamlesh Patel, Chandresh Dumatar, S.K. Vajpeyee and V.H. Bhavsar


    Full Text Available The aim of this study was to investigate the possibility of gastric-ulceration by ginger-juice (Zingiber officinale Roscoe in rat. (A Albino rats (n=6-12 were administered G.J at two doses (2ml & 4 ml/rat, p.o as single administration and chronic treatment over period of 30 days. Following this assessment was done for possible gastric lesion. Effect of treatment with G.J acutely and chronically (30 days administered, was assessed. Parameters used during assessment were total acidity, gastric volume & pH and ulcer index ‘UI’ (acute and chronic. Acute & chronic administration of G.J (2ml & 4ml/rat, p.o caused an increase in pH and vol. of gastric content, a decrease in total acidity and no significant change in ulcer index.

  5. Acute Necrotizing Ulcerative Gingivitis: Microbial and Immunologic Studies. (United States)


    3. (1983) 3. Periodontol. Set.:557. 58. Nisengard, R. 3., Myers, D., Fischman , S. and Socransky, S. (1976) J. Dent. Res. Spec. Issue B:pB206 this Contract Rose Lai received M. S. degree 12/20/82 David Shaefer Ph.D. candidate Susan Mandel M. S. candidate John Czeculin M. S. candidate

  6. Acute Necrotizing Ulcerative Gingivitis: Microbial and Immunologic Studies (United States)


    34 Odd ii 4n....00p IdaOdifir 0’ block flumber) Periodontal Disease Spirochetes Microbiology Fusobacteria immunology Bacteroides 20. AN3T7RAC~r C4.tft...and serological etudies with ’We 7. nucleatum isolates from patients with ANUG, chronic periodontitis , Juvenile periodontitis , and adults and children...routine periodontal procedures (34-37). Early studies on the histopathology of ANUG lesions reported that the pathological process appears to begin or the

  7. A Retrospective Analysis of Pressure Ulcer Incidence and Modified Braden Scale Score Risk Classifications. (United States)

    Chen, Hong-Lin; Cao, Ying-Juan; Wang, Jing; Huai, Bao-Sha


    The Braden Scale is the most widely used pressure ulcer risk assessment in the world, but the currently used 5 risk classification groups do not accurately discriminate among their risk categories. To optimize risk classification based on Braden Scale scores, a retrospective analysis of all consecutively admitted patients in an acute care facility who were at risk for pressure ulcer development was performed between January 2013 and December 2013. Predicted pressure ulcer incidence first was calculated by logistic regression model based on original Braden score. Risk classification then was modified based on the predicted pressure ulcer incidence and compared between different risk categories in the modified (3-group) classification and the traditional (5-group) classification using chi-square test. Two thousand, six hundred, twenty-five (2,625) patients (mean age 59.8 ± 16.5, range 1 month to 98 years, 1,601 of whom were men) were included in the study; 81 patients (3.1%) developed a pressure ulcer. The predicted pressure ulcer incidence ranged from 0.1% to 49.7%. When the predicted pressure ulcer incidence was greater than 10.0% (high risk), the corresponding Braden scores were less than 11; when the predicted incidence ranged from 1.0% to 10.0% (moderate risk), the corresponding Braden scores ranged from 12 to 16; and when the predicted incidence was less than 1.0% (mild risk), the corresponding Braden scores were greater than 17. In the modified classification, observed pressure ulcer incidence was significantly different between each of the 3 risk categories (P less than 0.05). However, in the traditional classification, the observed incidence was not significantly different between the high-risk category and moderate-risk category (P less than 0.05) and between the mild-risk category and no-risk category (P less than 0.05). If future studies confirm the validity of these findings, pressure ulcer prevention protocols of care based on Braden Scale scores can

  8. Sarcoidosis mimicking a venous ulcer: a case report. (United States)

    Joshi, Smita S; Romanelli, Paolo; Kirsner, Robert S


    Sarcoidosis--a chronic, multisystem disease of unknown etiology characterized by noncaseating granulomas--may cause ulcerative lesions, particularly in African American women. A case of ulcerative sarcoidosis mimicking a venous ulcer is presented. The patient is a 44-year-old African American hypertensive, obese woman with a nonhealing medially based lower leg ulcer of 3 years' duration clinically consistent with a venous ulcer. The ulcer did not heal with compression therapy and pentoxifylline. Subsequent biopsies showed granulomatous inflammation consistent with sarcoidosis. When intralesional triamcinolone was added to compression therapy, the ulcer resolved after 3 months. Given its propensity toward formation on the lower extremities and ulcerative and atrophic appearance, ulcerative sarcoidosis should be considered in the differential diagnosis of a venous ulcer refractory to standard therapy, especially in African American women.

  9. Recurring pressure ulcers: identifying the definitions. A National Pressure Ulcer Advisory Panel white paper. (United States)

    Tew, Cindy; Hettrick, Heather; Holden-Mount, Sarah; Grigsby, Rebekah; Rhodovi, Julie; Moore, Lyn; Ghaznavi, Amir M; Siddiqui, Aamir


    Currently, there is a lack of consensus regarding the accepted terminology pertaining to the pressure ulcer healing progression and recidivism. This lack of uniformity can negatively impact initiation of treatment pathways, completion of appropriate interventions, clinical documentation, medical coding, patient education, discharge planning and healthcare revenue through out the healthcare system. The purpose of this paper is to introduce a standard nomenclature as it pertains to pressure ulcer healing progression and any recidivism that may occur. The National Pressure Ulcer Advisory Panel has formulated a framework of terms regarding pressure ulcer progression. We also developed a clearer nomenclature for lack of progress and recidivism of pressure ulcers. This document should serve as a starting point for the discussion of the pressure ulcer care, research, and terminology.

  10. An Unusual Cause of Anemia: Cameron Ulcer

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    Cenk Aypak


    Full Text Available Cameron ulcer is a linear gatric ulser on the mucosal folds in patients with a large hiatal hernia. Cameron ulcer could be seen in 5% of patients with hiatal hernia who undergo upper gastrointestinal system (GIS endoscopy examination. The clinical relevance of Cameron ulcer is due to its potential complications such as GIS bleeding and anemia. In this report a case who was applied to Family Medicine outpatient clinics with the diagnosis of iron deficiency anemia and determined Cameron ulser at upper gastroentestinal endoscopy was presented. [Cukurova Med J 2013; 38(2.000: 315-318

  11. Diabetic foot ulcers: Part II. Management. (United States)

    Alavi, Afsaneh; Sibbald, R Gary; Mayer, Dieter; Goodman, Laurie; Botros, Mariam; Armstrong, David G; Woo, Kevin; Boeni, Thomas; Ayello, Elizabeth A; Kirsner, Robert S


    The management of diabetic foot ulcers can be optimized by using an interdisciplinary team approach addressing the correctable risk factors (ie, poor vascular supply, infection control and treatment, and plantar pressure redistribution) along with optimizing local wound care. Dermatologists can initiate diabetic foot care. The first step is recognizing that a loss of skin integrity (ie, a callus, blister, or ulcer) considerably increases the risk of preventable amputations. A holistic approach to wound assessment is required. Early detection and effective management of these ulcers can reduce complications, including preventable amputations and possible mortality.

  12. Diabetic foot ulcers: practical treatment recommendations. (United States)

    Edmonds, Michael


    When treating diabetic foot ulcers it is important to be aware of the natural history of the diabetic foot, which can be divided into five stages: stage 1, a normal foot; stage 2, a high risk foot; stage 3, an ulcerated foot; stage 4, an infected foot; and stage 5, a necrotic foot. This covers the entire spectrum of foot disease but emphasises the development of the foot ulcer as a pivotal event in stage 3, which demands urgent and aggressive management. Diabetic foot care in all stages needs multidisciplinary management to control mechanical, wound, microbiological, vascular, metabolic and educational aspects. Achieving good metabolic control of blood glucose, lipids and blood pressure is important in each stage, as is education to teach proper foot care appropriate for each stage. Ideally, it is important to prevent the development of ulcers in stages 1 and 2. In stage 1, the normal foot, it is important to encourage the use of suitable footwear, and to educate the patient to promote healthy foot care and footwear habits. In stage 2, the foot has developed one or more of the following risk factors for ulceration: neuropathy, ischaemia, deformity, swelling and callus. The majority of deformities can be accommodated in special footwear and as callus is an important precursor of ulceration it should be treated aggressively, especially in the neuropathic foot. In stage 3, ulcers can be divided into two distinct entities: those in the neuropathic foot and those in the neuroischaemic foot. In the neuropathic foot, ulcers commonly develop on the plantar surface of the foot and the toes, and are associated with neglected callus and high plantar pressures. In the neuroischaemic foot, ulcers are commonly seen around the edges of the foot, including the apices of the toes and back of the heel, and are associated with trauma or wearing unsuitable shoes. Ulcers in stage 3 need relief of pressure (mechanical control), sharp debridement and dressings (wound control), and

  13. Acid inhibition and peptic ulcer bleeding. (United States)

    Štimac, D; Franjić, N; Krznarić, Ž


    Peptic ulcer bleeding is one of the most common emergency situations in medicine. Combined pharmacological and endoscopic therapy together with emerging interventional radiological procedures are successfully treating peptic ulcer disease, reserving surgical procedures for only a small portion of patients unresponsive to 'conventional' therapy. Technological advancement has seen a great improvement in the field of endoscopic treatment in the form of various methods of hemostasis. However, pharmacological therapy with proton pump inhibitors still plays the central role in the peptic ulcer bleeding treatment algorithm.

  14. Tetracycline ulcers of the oesophagus

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    Winckler, K.


    Two cases of tetracycline ulcers of the oesophagus are reported and compared with thirteen other cases from the literature. In most cases, the patients had taken their capsules with little or no fluid just before going to bed. Some hours later they developed retrosternal pain that was intensified by swallowing. Endoscopy showed sharply demarcated greyish-white areas of mucosal damage which represented layers of stratified squamous cells, separated by oedema, and a dense neutrophilic infiltration of the lamina propria and the muscularis mucosa. Roentgenology was unsuitable to detect the lesions. They healed without complications within one to six weeks. Prolonged retention of the capsules in the oesophagus is thought to cause the mucosal damage. Patients on oral tetracycline or doxycycline treatment should therefore be instructed to take their capsules with a meal or with copious water and not just before going to bed.

  15. Drug therapy for ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Chang-Tai Xu; Shu-Yong Meng; Bo-Rong Pan


    Ulcerative colitis (UC) is an inflammatory destructive disease of the large intestine occurred usually in the rectum and lower part of the colon as well as the entire colon. Drug therapy is not the only choice for UC treatment and medical management should be as a comprehensive whole.Azulfidine, Asacol, Pentasa, Dipentum, and Rowasa all contain 5-aminosalicylic acid (5-ASA), which is the topical anti-inflammatory ingredient. Pentasa is more commonly used in treating Crohn's ileitis because Pentasa capsules release more 5-ASA into the small intestine than Asacol tablets. Pentasa can also be used for treating mild to moderate UC. Rowasa enemas are safe and effective in treating ulcerative proctitis and proctosigmoiditis. The sulfafree 5-ASA agents (Asacol, Pentasa, Dipentum and Rowasa) have fewer side effects than sulfa-containing Azulfidine. In UC patients with moderate to severe disease and in patients who failed to respond to 5-ASA compounds,systemic (oral) corticosteroids should be used. Systemic corticosteroids (prednisone, prednisolone, cortisone, etc.)are potent and fast-acting drugs for treating UC, Crohn's ileitis and ileocolitis. Systemic corticosteroids are not effective in maintaining remission in patients with UC.Serious side effects can result from prolonged corticosteroid treatment. To minimize side effects, corticosteroids should be gradually reduced as soon as the disease remission is achieved. In patients with corticosteroid-dependent or unresponsive to corticosteroid treatment, surgery or immunomodulator is considered. Immunomodulators used for treating severe UC include azathioprine/6-MP,methotrexate, and cyclosporine. Integrated traditional Chinese and Western medicine is safe and effective in maintaining remission in patients with UC.

  16. Cure of peptic gastric ulcer associated with eradication of Helicobacter pylori. Finnish Gastric Ulcer Study Group.


    Seppälä, K; Pikkarainen, P.; Sipponen, P.; Kivilaakso, E.; Gormsen, M H


    The effect of Helicobacter pylori eradication on ulcer healing and the relapse rate were investigated in a multicentre trial of 239 gastric ulcer patients. Patients with H pylori positive gastric ulcer were randomly assigned to one of three groups: (A) 10 days' treatment with metronidazole and eight weeks' treatment with colloidal bismuth subcitrate (CBS) (84 patients); (B) 10 days' treatment with metronidazole placebo and eight weeks with CBS (73 patients); or (C) ranitidine (82 patients). A...

  17. Reconstruction and restoration of neglected ruptured patellar tendon using semitendinosus and gracilis tendons with preserved distal insertions: two case reports. (United States)

    Chen, Bin; Li, Runguang; Zhang, Sheng


    Neglected rupture of the patellar tendon is rare but becomes more difficult to repair the longer it is left untreated. The most common rupture sites are the inferior pole of the patella and distal insertion. Proximal retraction of the patella and extensor mechanism adhesions makes the treatment more difficult than acute tendon rupture. We report two patients with neglected patellar tendon rupture treated by reconstruction and restoration using semitendinosus-gracilis (STG) tendons with preserved distal insertions. Preserved distal insertion provided sufficient blood supply to accelerate healing, while combined fixation with tension-reducing wire, offered the initial stability of the closed-loop sutured tendon. Both patients reacquired near normal strength and stability of the patellar tendon and restoration of function after operation and rehabilitation.

  18. Distal Femoral Locking Compression Plate Fixation in Distal Femoral Fractures: Early Results

    Directory of Open Access Journals (Sweden)

    EJ Yeap


    Full Text Available We conducted a retrospective review on eleven patients who were treated for Type A and C distal femoral fractures (based on AO classification between January 2004 and December 2004. All fractures were fixed with titanium distal femoral locking compression plate. The patient’s ages ranged from 15 to 85 with a mean of 44. Clinical assessment was conducted at least 6 months post-operatively using the Schatzker scoring system. Results showed that four patients had excellent results, four good, two fair and one failure.

  19. Incidence and characteristics of distal radius fractures in a southern Swedish region

    Directory of Open Access Journals (Sweden)

    Atroshi Isam


    Full Text Available Abstract Background The incidence of distal radius fracture has increased substantially during the last 50 years according to several studies that estimated the overall incidence in various general populations. The incidence of fracture classified according to severity has not been well documented. The aim of this population-based study was to estimate the overall and type-specific incidence rates of distal radius fracture in a representative population in southern Sweden. Methods During 2001, all persons older than 18 years with acute distal radius fracture in the southern Swedish region of Northeastern Scania were prospectively recorded. A radiologist classified the fractures according to the AO system and measured volar tilt and ulnar variance. A fracture with volar tilt outside a range of -5° to 20° and/or ulnar variance of 2 mm or greater was defined as displaced. Results 335 persons with acute distal radius fracture were recorded during the 1-year period. The overall incidence rate was 26 (95% confidence interval 23–29 per 10,000 person-years. Among women the incidence rate increased rapidly from the age of 50 and reached a peak of 119 per 10,000 person-years in women 80 years and older. The incidence rate among women 50 to 79 years old (56 per 10,000 person-years was lower than that reported in previous studies of similar populations. Among men the incidence rate was low until the age of 80 years and older when it increased to 28 per 10,000 person-years. Fractures classified as AO type A comprised about 80% of the fractures in women and 64% in men. Almost two-thirds of all fractures were displaced and among men and women 80 years and older more than 80% of the fractures were displaced. Conclusion The incidence rate of distal radius fracture in women 50 to 79 years old was lower than previously reported, which may indicate declining incidence in this group. In both sexes, the incidence was highest in the age group of 80 years and older

  20. Small bowel ulcerative lesions are common in elderly NSAIDs users with peptic ulcer bleeding

    Institute of Scientific and Technical Information of China (English)

    Panagiotis; Tsibouris; Chissostomos; Kalantzis; Periklis; Apostolopoulos; Antonios; Zalonis; Peter; Edward; Thomas; Isaacs; Mark; Hendrickse; Georgios; Alexandrakis


    AIM: To determine the frequency of small bowel ulcerative lesions in patients with peptic ulcer and define the significance of those lesions. METHODS: In our prospective study, 60 consecutive elderly patients with upper gastrointestinal bleeding from a peptic ulceration(cases) and 60 matched patients with a non-bleeding peptic ulcer(controls) underwent small bowel capsule endoscopy, after a negative colonoscopy(compulsory in our institution). Controls were evaluated for non-bleeding indications. Known or suspected chronic inflammatory conditions and medication that could harm the gut were excluded. During capsule endoscopy, small bowel ulcerative lesions were counted thoroughly and classified according to Graham classification. Other small bowellesions were also recorded. Peptic ulcer bleeding was controlled endoscopically, when adequate, proton pump inhibitors were started in both cases and controls, and Helicobacter pylori eradicated whenever present. Both cases and controls were followed up for a year. In case of bleeding recurrence upper gastrointestinal endoscopy was repeated and whenever it remained unexplained it was followed by repeat colonoscopy and capsule endoscopy.RESULTS: Forty(67%) cases and 18(30%) controls presented small bowel erosions(P = 0.0001), while 22(37%) cases and 4(8%) controls presented small bowel ulcers(P < 0.0001). Among non-steroidal antiinflammatory drug(NSAID) consumers, 39(95%) cases and 17(33%) controls presented small bowel erosions(P < 0.0001), while 22(55%) cases and 4(10%) controls presented small bowel ulcers(P < 0.0001). Small bowel ulcerative lesions were infrequent among patients not consuming NSAIDs. Mean entry hemoglobin was 9.3(SD = 1.4) g/d L in cases with small bowel ulcerative lesions and 10.5(SD = 1.3) g/dL in those without(P = 0.002). Cases with small bowel ulcers necessitate more units of packed red blood cells. During their hospitalization, 6(27%) cases with small bowel ulcers presented bleeding recurrence most

  1. A large Italian observational multicentre study on vascular ulcers of the lower limbs (Studio Ulcere Vascolari). (United States)

    Apollonio, Alessandro; Antignani, Pier L; Di Salvo, Michelangelo; Failla, Giacomo; Guarnera, Giorgio; Mosti, Giovanni; Ricci, Elia


    An observational study of 2 years was promoted by the Italian Association for Cutaneous Ulcers (AIUC) in order to monitor the epidemiology of leg ulcers, the trend of healing and the more frequent therapeutic approaches in lower limb ulcers. Fifty-nine sites in 14 different Italian regions involved in the study, with 1333 enrolled patients (1163 patients fully evaluated and followed up for 9 months). A prevalence of females (62%) was observed with a mean age of 70 years and a high rate of hypertension (62%), diabetes (38%) and obesity (29%). Venous ulcer was most frequent (55%), followed by mixed (25%) and diabetic (8·3%) ulcers. Basically, all patients received a local therapy (LT) (compression and advanced local therapies), while 63% of patients have an associated systemic pharmaceutical treatment. Ulcer healing rates progressively increased throughout the study and despite the type of observational study does not allow conclusions on the treatment, it was observed that the patients receiving additional systemic drugs were associated with a more rapid acceleration of healing rates of ulcers compared to LT alone (3 months: 39·7% versus 29·2%; 6 months: 62·0% versus 47·0%; 9 months: 74·7% versus 63·8%). In particular, the Studio Ulcere Vascolari (SUV) study showed that a combination treatment with sulodexide and compression therapy allows for a greater increase in the healing rates in venous ulcers.

  2. Distal fibula fracture diagnosed with ultrasound imaging. (United States)

    Kardouni, Joseph R


    The patient was a 31-year-old man serving in a military special forces unit at a remote location. He presented to a physical therapist with a chief complaint of worsening right lateral ankle pain that limited his ability to bear weight. Because the patient met the Ottawa ankle rules and there was concern for a fracture, radiographs were indicated. However, the nearest facility with radiographic capabilities was only available through air medical evacuation. Therefore, the physical therapist assessed the patient's ankle with an onsite portable ultrasound imaging unit, which demonstrated cortical irregularity along the distal fibula.

  3. Distal extremity necrosis in captive birds. (United States)

    Calle, P P; Montali, R J; Janssen, D L; Stoskopf, M K; Strandberg, J D


    The necropsy files of the National Zoological Park and Baltimore Zoological Society were reviewed for cases of distal extremity necrosis (DEN) in birds. Nineteen cases of DEN occurred following either trauma or frostbite. Six birds developed an apparently primary type of DEN in which no predisposing factors were obvious clinically. The toes and feet were most commonly involved, and in several cases the beak was also affected. Some pathologic evidence is provided that certain cardiovascular lesions may predispose birds to DEN by compromising circulation of the extremities.

  4. Periosteal osteoblastoma of the distal femur

    Energy Technology Data Exchange (ETDEWEB)

    Nakatani, Tetsuya; Yamamoto, Tetsuji; Akisue, Toshihiro; Marui, Takashi; Hitora, Toshiaki; Kawamoto, Teruya; Nagira, Keiko; Yoshiya, Shinichi; Kurosaka, Masahiro [Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe (Japan); Fujita, Ikuo; Matsumoto, Keiji [Department of Orthopaedic Surgery, Hyogo Medical Center for Adults, Akashi, Hyogo (Japan)


    Osteoblastomas located on the surface of the cortical bone, so-called periosteal osteoblastomas, are extremely rare. We report on a case of periosteal osteoblastoma arising from the posterior surface of the right distal femur in a 17-year-old man. Roentgenographic, computed tomographic, magnetic resonance imaging, and histologic features of the case are presented. Periosteal osteoblastoma should be radiologically and histologically differentiated from myositis ossificans, avulsive cortical irregularity syndrome, osteoid osteoma, parosteal osteosarcoma, periosteal osteosarcoma, and high-grade surface osteosarcoma. Although periosteal osteoblastoma is rare, this tumor should be included in the differential diagnosis of surface-type bone tumors. (orig.)

  5. Salter Harris Fractures of the Distal Femur

    Directory of Open Access Journals (Sweden)

    Sean M. McKenna


    Full Text Available Salter Harris–type injuries of the distal femur should be treated as a dislocation of the knee and therefore as a medical emergency. Senior medical staff should be involved early, ankle–brachial index ratio should be measured in all patients and the clinician should have a high index of suspicion for a vascular injury. Ideally reduction, stabilization, and vascular repair, if necessary, should be carried out within 6 hours of the initial event. There should be a low threshold for fasciotomies. These 2 cases demonstrate the importance of having a high index of suspicion for vascular injury and the need for continued reassessment.

  6. Distal Renal Tubular Acidosis and Calcium Nephrolithiasis (United States)

    Moe, Orson W.; Fuster, Daniel G.; Xie, Xiao-Song


    Calcium stones are commonly encountered in patients with congenital distal renal tubular acidosis, a disease of renal acidification caused by mutations in either the vacuolar H+-ATPase (B1 or a4 subunit), anion exchanger-1, or carbonic anhydrase II. Based on the existing database, we present two hypotheses. First, heterozygotes with mutations in B1 subunit of H+-ATPase are not normal but may harbor biochemical abnormalities such as renal acidification defects, hypercalciuria, and hypocitraturia which can predispose them to kidney stone formation. Second, we propose at least two mechanisms by which mutant B1 subunit can impair H+-ATPase: defective pump assembly and defective pump activity.

  7. Strongyloides stercoralis infestation in a patient with severe ulcerative colitis

    Directory of Open Access Journals (Sweden)

    Ghoshal Uday


    Full Text Available Asymptomatic infestation with Strongyloides stercoralis, common in the tropics, may result in potentially fatal hyperinfection during treatment with immunosuppressive drugs used to treat patients with severe ulcerative colitis (UC. Hence, importance of early recognition and treatment of this nematode in patients with UC before starting immunosuppressive drugs can not be overemphasized. We report a 23-yrs old man with UC who presented with acute severe attack. Since his UC did not respond to intravenous hydrocortisone over 6 days, oral cyclosporine was started on 7th day after repeating stool microscopy, which revealed larvae of Strongyloides stercoralis. Duodenal aspirate also confirmed presence of multiple larvae. He responded to treatment for Strongyloides stercoralis , continuation of hydrocortisone and cyclosporine. Importance of early diagnosis of infestation with Strongyloides stercoralis while on treatment with immunosuppressive drugs for severe UC is emphasized. Difficulties in diagnosis and management of Strongyloides stercoralis infestation in patients with UC are discussed.

  8. Primary hyperparathyroidism presenting as acute gallstone pancreatitis

    Institute of Scientific and Technical Information of China (English)

    HE Jian-hong; ZHANG Quan-bao; LI Yu-min; ZHU You-quan; LI Xun; SHI Bin


    @@ Primary hyperparathyroidism (PHPT) is a generalized disorder of calcium metabolism resulting from an abnormally high level of serum calcium and an increased level of parathormone (PTH).1,2 Traditionally, symptomatic PHPT patients present with a variety of disorders including fatigue, amyotrophy, memory impairment, emotional instability, hallucination, irritation, loss of consciousness, abdominal distention, nausea, vomiting, constipation, acute pancreatitis, refractory peptic ulcer, osteopenia, hypertension, etc.3-5 Acute pancreatitis (AP) is an uncommon presentation of PHPT.6-8 We report a typical case of primary hyperparathyroidism with hypercalcemic crisis presenting as acute gallstone pancreatitis.

  9. Best practice in the management of mild-to-moderately active ulcerative colitis and achieving maintenance of remission using mesalazine

    DEFF Research Database (Denmark)

    Munkholm, P.; Michetti, P.; Probert, C.S.;


    Optimizing treatment goals in ulcerative colitis requires recognizing the needs of patients. It is increasingly recognized that adapting treatment strategies aligned with patient needs can improve patient compliance and consequently minimize relapse rates. Tailoring of treatment strategies can...... improve not only patient quality of life, and decrease the number harmed by adverse events from more potent drugs, but can also save valuable healthcare costs by avoiding high-cost treatment interventions associated with acute ulcerative colitis. This review will consider several elements of mesalazine...

  10. Stress ulcer prophylaxis with a proton pump inhibitor versus placebo in critically ill patients (SUP-ICU trial)

    DEFF Research Database (Denmark)

    Krag, Mette; Perner, Anders; Wetterslev, Jørn


    BACKGROUND: Critically ill patients in the intensive care unit (ICU) are at risk of clinically important gastrointestinal bleeding, and acid suppressants are frequently used prophylactically. However, stress ulcer prophylaxis may increase the risk of serious adverse events and, additionally...... prophylaxis with a proton pump inhibitor versus placebo (saline) in 3350 acutely ill ICU patients at risk of gastrointestinal bleeding. The primary outcome measure is 90-day mortality. Secondary outcomes include the proportion of patients with clinically important gastrointestinal bleeding, pneumonia...... on the benefits and harms of stress ulcer prophylaxis with a proton pump inhibitor in critically ill adult patients admitted in the ICU. TRIAL REGISTRATION: Identifier: NCT02467621 ....

  11. Pressure ulcer prevention in care home settings. (United States)

    Ellis, Michael


    Pressure ulcer prevention in the care home setting can be challenging and is often compromised by a lack of access to education and resources. There are measures that have been shown to consistently improve outcomes in pressure ulcer prevention including assessment of the patient and their individual risks, delivery of a consistent plan of care that meets patients' needs, and regular evaluation to identify shortfalls. In addition, there should be a robust approach to investigating events that lead to a person developing a pressure ulcer and that information should be used to improve future practice. Pressure ulcer prevention in care homes is achievable and nurses should all be aware of the necessary measures detailed in this article.

  12. Genital ulcers: their diagnosis and management. (United States)

    Sacks, S L


    THIS ARTICLE OFFERS SOME BACKGROUND INFORMATION ON DIAGNOSIS AND TREATMENT OF THREE MAJOR CAUSES OF GENITAL ULCERS: syphilis, herpes simplex virus (HSV), and chancroid. The author also discusses differential diagnoses and suggests an approach to treatment.

  13. Spitz Naevus With Ulceration - A Rare Presentation

    Directory of Open Access Journals (Sweden)

    Kanwar A. J


    Full Text Available A 25 year old female presented with an asymptomatic reddish brown nodule on the nose. History of ulceration and bleeding suggested a diagnosis of granuloma pyogenicum. The lesion was excised. Histology revealed features of Spitz naevus.

  14. A young man with nonhealing venous ulcers

    NARCIS (Netherlands)

    Vloedbeld, M. G.; Venema, A. W.; Smit, A. J.


    A 35-year-old man presented with nonhealing ulcers at an atypical location on his left foot, caused by a combination of venous insufficiency (after deep venous thrombosis) and arterial insufficiency. The underlying cause was Buerger's disease.

  15. Laparoscopic Repair for Perforated Duodenal Ulcer

    Directory of Open Access Journals (Sweden)

    A. Cotirleţ


    Full Text Available Perforated peptic ulcer (PPU, despite antiulcer medication and Helicobacter eradication, is still the most common indication for emergency gastric surgery associated with high morbidity and mortality. Perforated peptic ulcer is a common abdominal disease that is treated by surgery. The development of laparoscopic surgery has changed the way to treat such abdominal surgical emergencies but there is no consensus on whether the benefits of laparoscopic closure of perforated peptic ulcer outweigh the disadvantages such as prolonged surgery time and greater expense. However we can say that laparoscopic repair is a viable and safe surgical option for patients with perforated peptic ulcer disease and should be considered with the necessary expertise available.

  16. Growth factors for treating diabetic foot ulcers

    DEFF Research Database (Denmark)

    Martí-Carvajal, Arturo J; Gluud, Christian; Nicola, Susana


    BACKGROUND: Foot ulcers are a major complication of diabetes mellitus, often leading to amputation. Growth factors derived from blood platelets, endothelium, or macrophages could potentially be an important treatment for these wounds but they may also confer risks. OBJECTIVES: To assess...... the benefits and harms of growth factors for foot ulcers in patients with type 1 or type 2 diabetes mellitus. SEARCH METHODS: In March 2015 we searched the Cochrane Wounds Group Specialised Register, The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), Ovid MEDLINE, Ovid MEDLINE...... (minimum of one toe), complete healing of the foot ulcer, and time to complete healing of the diabetic foot ulcer as the primary outcomes. DATA COLLECTION AND ANALYSIS: Independently, we selected randomised clinical trials, assessed risk of bias, and extracted data in duplicate. We estimated risk ratios...

  17. [The ulcerative form of skin sarcoidosis]. (United States)

    Rodionov, A N; Samtsov, A V


    A female patient suffering from the ulcerative form of skin sarcoidosis is described and the literature dealing with this problem is reviewed. Peculiar features of this case are described: ulceration of the nodes, which is an extremely rare phenomenon; no involvement of other organs, lungs included, was detectable, which is not typical of ulcerative sarcoidosis; small-nodular elements are parallelled by nodes (Boeck's small-nodular sarcoid and Darier-Roussy's subcutaneous sarcoids) in this patient, this evidencing an uniform pathologic process in the skin and subcutaneous fat. Ulceration in this patient is explained by the development of allergic vasculitis of the immediate hypersensitivity type (leukocytoclastic vasculitis and manifest increase of the level of circulating immune complexes). Prednisolone therapy has resulted in an excellent clinical effect.

  18. Automatic system for corneal ulcer diagnostic: II (United States)

    Ventura, Liliane; Chiaradia, Caio; Faria de Sousa, Sidney J.


    Corneal Ulcer is a deepithelization of the cornea and it is a very common disease in agricultural countries. The clinician most used parameter in order to identify a favorable ulcer evolution is the regress of the affected area. However, this kind of evaluation is subjective, once just the horizontal and vertical axes are measured based on a graduated scale and the affected area is estimated. Also, the registration of the disease is made by photographs. In order to overcome the subjectiveness and to register the images in a more accessible way (hard disks, floppy disks, etc.), we have developed an automatic system in order to evaluate the affected area (the ulcer). An optical system is implemented in a Slit Lamp (SL) and connected to a CCD detector. The image is displayed in PC monitor by a commercial frame grabber and a dedicated software for determining the area of the ulcer (precision of 20 mm) has been developed.

  19. Tannins, peptic ulcers and related mechanisms. (United States)

    de Jesus, Neyres Zinia Taveira; de Souza Falcão, Heloina; Gomes, Isis Fernandes; de Almeida Leite, Thiago Jose; de Morais Lima, Gedson Rodrigues; Barbosa-Filho, Jose Maria; Tavares, Josean Fechine; da Silva, Marcelo Sobral; de Athayde-Filho, Petrônio Filgueiras; Batista, Leonia Maria


    This review of the current literature aims to study correlations between the chemical structure and gastric anti-ulcer activity of tannins. Tannins are used in medicine primarily because of their astringent properties. These properties are due to the fact that tannins react with the tissue proteins with which they come into contact. In gastric ulcers, this tannin-protein complex layer protects the stomach by promoting greater resistance to chemical and mechanical injury or irritation. Moreover, in several experimental models of gastric ulcer, tannins have been shown to present antioxidant activity, promote tissue repair, exhibit anti Helicobacter pylori effects, and they are involved in gastrointestinal tract anti-inflammatory processes. The presence of tannins explains the anti-ulcer effects of many natural products.

  20. Atypical disease phenotypes in pediatric ulcerative colitis

    DEFF Research Database (Denmark)

    Levine, Arie; de Bie, Charlotte I; Turner, Dan


    Definitive diagnosis of pediatric ulcerative colitis (UC) may be particularly challenging since isolated colitis with overlapping features is common in pediatric Crohn's disease (CD), while atypical phenotypes of UC are not uncommon. The Paris classification allows more accurate phenotyping...

  1. Intestinal microecology in rats with ulcerative colitis

    Institute of Scientific and Technical Information of China (English)



    Objective To study the abundance and diversity ofthe gut flora in rats with dextran sulfate sodium(DSS)-induced ulcerative colitis(UC)to provide new knowledge about the pathogenesis of this disease.Methods Twenty-six

  2. Diabetic foot ulcer: assessment and management. (United States)

    Saraogi, Ravi Kant


    Diabetic foot ulcer is a rising health problem with rising prevalence of diabetes. It is the most important cause of non-traumatic foot amputations. Diabetic foot ulcers are primarily due to neuropathy and/or ischaemia, and are frequently complicated by infection. Up to 85% of all diabetic foot related problems are preventable through a combination of good foot care and appropriate education for patients and healthcare providers. The holistic care of diabetic foot ulcer patients requires a multidisciplinary team approach. Apart from blood sugar control, treatment of ulcer involves debridement, offloading, appropriate dressings, vascular maintenance and infection control. Use of adjunctive treatments such as various growth factors, skin replacement dressings and vacuum assisted closure will accelerate healing in selected cases.

  3. Perforated peptic ulcer: How to improve outcome?

    DEFF Research Database (Denmark)

    Møller, Morten Hylander; Adamsen, Sven; Wøjdemann, Morten;


    Despite the introduction of histamine H(2)-receptor antagonists, proton-pump inhibitors and the discovery of Helicobacter pylori, both the incidence of emergency surgery for perforated peptic ulcer and the mortality rate for patients undergoing surgery for peptic ulcer perforation have increased...... with an emphasis on risks that are preventable. A systematic review including randomized studies was carried out. There are a limited number of studies of patients with peptic ulcer perforation. Most of these studies are of low evidential status. Only a few randomized, controlled trials have been published...... to improve the outcome of patients with peptic ulcer perforation, sepsis needs to be factored into the existing knowledge and treatment Udgivelsesdato: 2008/8/27...

  4. Tannins, Peptic Ulcers and Related Mechanisms

    Directory of Open Access Journals (Sweden)

    Leonia Maria Batista


    Full Text Available This review of the current literature aims to study correlations between the chemical structure and gastric anti-ulcer activity of tannins. Tannins are used in medicine primarily because of their astringent properties. These properties are due to the fact that tannins react with the tissue proteins with which they come into contact. In gastric ulcers, this tannin-protein complex layer protects the stomach by promoting greater resistance to chemical and mechanical injury or irritation. Moreover, in several experimental models of gastric ulcer, tannins have been shown to present antioxidant activity, promote tissue repair, exhibit anti Helicobacter pylori effects, and they are involved in gastrointestinal tract anti-inflammatory processes. The presence of tannins explains the anti-ulcer effects of many natural products.

  5. How to Diagnose and Treat Peptic Ulcer?

    Institute of Scientific and Technical Information of China (English)

    HU Xian-guo


    @@ Ulcer of the stomach and duodenum,also called ulcerative disease,is a sharply circumscribed loss of the tissue lining those parts of the digestive tract exposed to gastric juice containing acid and pepsin. Because its formation and development are closely related to the digestive effect of acidic gastric juice and pepsase,the disease is called peptic ulcer. It is a common disease,belonging to epigastric pain in TCM,mainly caused by cold attacking the stomach,stagnated liver-qi affecting the stomach,or spleen and stomach deficiency with deficiency and cold of the middle-jiao. Regulating qi to stop pain is the principle for its treatment. Peptic ulcer is usually differentiated as the following TCM syndromes.

  6. Etiopathogenetic principles and peptic ulcer disease classification. (United States)

    Tytgat, G N J


    Ulceration corresponds to tissue loss, breaching the muscularis mucosae. When ulcers develop in the acid-peptic environment of the gastroduodenum, they are traditionally called peptic ulcer (PUD). Ulcers never develop spontaneously in a healthy gastroduodenal mucosa. Ulceration is the ultimate consequence of a disequilibrium between aggressive injurious factors and defensive mucosa-protective factors. The dominant aggressors are strong acid and high proteolytic (pepsin) activity in gastric secretions. The dominant defensors are the phospholipid surfactant layer, covering the mucus bicarbonate gel, the mucus bicarbonate layer covering the epithelium, the tight junctional structures between the epithelial cells, restricting proton permeability, and the epithelial trefoil peptides, contributing to healing after injury. Initially, acid-peptic aggression was considered the overwhelming cause of PUD, supported by the pioneering work of Schwartz, launching the dictum 'no acid, no ulcer'. This led to the universal therapy directed against intragastric acidity, also interfering with peptic activity when the pH was >4. The therapeutic sequence went from large doses of antacids to H(2)-receptor antagonists and finally to proton pump inhibitors (PPIs). The longer the intragastric pH was >3, the quicker ulcer healing was seen. Unfortunately, ulcers often recurred after stopping therapy, demanding maintenance therapy to keep the ulcers healed and to prevent the need for surgery (vagotomy, partial gastric resection). Later on, the emphasis gradually shifted to weakening/failing of the defensive factors, raising the vulnerability of the gastroduodenal mucosa to luminal secretions. Leading injurious mechanisms jeopardizing the mucosal integrity are numerous: infections, especially Helicobacter pylori, drug-induced injury, particularly acetylsalicylic acid (ASA) and non-steroidal anti-inflammatory drugs (NSAIDs), physicochemical and caustic injury, vascular disorders, interfering

  7. The economics of adalimumab for ulcerative colitis. (United States)

    Xie, Feng


    Ulcerative colitis is a chronic inflammatory disease, characterized by diffuse mucosal inflammation in the colon. Adalimumab, as a TNF-α blocker, offers a safe and efficacious treatment option for patients with moderate to severe ulcerative colitis and refractory or intolerant to conventional medications; however, its cost-effectiveness profile has not yet been well established. Future economic evaluations should choose appropriate comparators in the context of target-reimbursement decision making and focus on cost-effectiveness over a long time horizon.

  8. Pharmacologic treatment of venous leg ulcers. (United States)

    Dormandy, J A


    In terms of prevalence, total cost and morbidity, venous leg ulcers are probably by far the most important type of ulcerations in the leg. The macrocirculatory defect leading to a raised ambulatory venous pressure is now accepted as a common initial pathologic pathway. Most current treatment modalities, such as surgery or external compression, are designed to control the macrovascular defect. However, it is the microcirculatory consequences of the venous hypertension that give rise to the trophic skin changes and ultimately to ulceration. At this microcirculatory level, pharmacotherapy may be a useful adjunct in the treatment of venous leg ulcers. The microcirculatory pathophysiologic changes include decreased fibrinolytic activity, elevated plasma fibrinogen, microcirculatory thrombi, and inappropriate activation of the white blood cells. The oxidative burst from the activated white cells probably plays a key role by releasing locally leukocyte-derived free radicals, proteolytic enzymes, cytokines, platelet-activating factor, and a number of other noxious mediators. An important additional component in recalcitrant venous ulcers is co-existing arterial disease, which is probably present in 15-20% of cases. Decreased arterial perfusion pressure will further aggravate the ischemic changes caused by the venous hypertension. Pentoxifylline downregulates leukocyte activation, reduces leukocyte adhesion, and also has fibrinolytic effects. A number of clinical studies have therefore been carried out to examine the clinical efficacy of pentoxifylline in treatment of venous leg ulcers. Probably the largest published placebo-controlled, double-blind randomized study was reported in 1990. In this study, 80 patients received either pentoxifylline 400 mg three times a day orally or matching placebo for 6 months or until their reference ulcer healed if this occurred sooner. Complete healing of the reference ulcer occurred in 23 of the 38 patients treated with pentoxifylline

  9. [Cycloferon in treating duodenal ulcers in rats]. (United States)

    Bul'on, V V; Khnychenko, L K; Sapronov, N S; Kuznetsova, N N; Anikin, V B; arinenko, R Iu; Kovalenko, A L; Alekseeva, L E


    The possibility of using cycloferon (interferon inductor) for a complex treatment (in combination with the main drug solcoseryl possessing pronounced therapeutic properties) of duodenum ulcers was experimentally studied in male rats. The experiments showed a considerable difference in the interferon status of animals with model duodenum ulcers treated with cycloferon, solcoseryl, their combination, and placebo (control). The healing effect of solcoseryl administered in combination with cycloferon exceeded that of each component administered separately.

  10. Medical device-related pressure ulcers


    Black JM; Kalowes P


    Joyce M Black,1 Peggy Kalowes2 1Adult Health and Illness Department, College of Nursing, University of Nebraska Medical Center, Omaha, NE, 2Nursing Research and Innovation, Long Beach Memorial Miller Children’s & Women’s Hospital, Long Beach, CA, USA Abstract: Pressure ulcers from medical devices are common and can cause significant morbidity in patients of all ages. These pressure ulcers appear in the shape of the device and are most often found from the use of ox...

  11. Radiological aspects of acute abdomen; Aspectos radiologicos do abdomen agudo

    Energy Technology Data Exchange (ETDEWEB)

    Toledo, Renato Muller de; Lacerda, Jose Carlos Teixeira; Georg, Bruno Rigueira; Ramos, Alexandre Ferreira [Hospital Naval Marcilio Dias, Rio de Janeiro, RJ (Brazil). Servico de Radiodiagnostico


    This work demonstrates the main roentgen signs of the most common causes of acute abdomen, through some cases chosen from H.N.M.D. Roentgen Department-Learning Register. First, we will show the normal roentgen anatomy of the abdomen. Then, we will discuss about the basic roentgen routine of acute abdomen and some technical changes depending on the suspected illness, the clinical conditions of the patient and certain roentgen findings. Finally, we will show the most important roentgen signs of the most familiar effects accurate abdomen, putting emphasis on the next things: intestinal obstructions, peritonitis, acute cholecustitis, acute pancreatitis, acute appendicitis, subphrenic abscesses, toxic megacolon of ulcerative retocolitis, gastric or duodenal ulcer perforation and renal colic. (author) 4 refs., 13 figs.

  12. Role of dopamine in distal retina. (United States)

    Popova, E


    Dopamine is the most abundant catecholamine in the vertebrate retina. Despite the description of retinal dopaminergic cells three decades ago, many aspects of their function in the retina remain unclear. There is no consensus among the authors about the stimulus conditions for dopamine release (darkness, steady or flickering light) as well as about its action upon the various types of retinal cells. Many contradictory results exist concerning the dopamine effect on the gross electrical activity of the retina [reflected in electroretinogram (ERG)] and the receptors involved in its action. This review summarized current knowledge about the types of the dopaminergic neurons and receptors in the retina as well as the effects of dopamine receptor agonists and antagonists on the light responses of photoreceptors, horizontal and bipolar cells in both nonmammalian and mammalian retina. Special focus of interest concerns their effects upon the diffuse ERG as a useful tool for assessment of the overall function of the distal retina. An attempt is made to reveal some differences between the dopamine actions upon the activity of the ON versus OFF channel in the distal retina. The author has included her own results demonstrating such differences.

  13. Distal vacuolar myopathy in nephropathic cystinosis. (United States)

    Charnas, L R; Luciano, C A; Dalakas, M; Gilliatt, R W; Bernardini, I; Ishak, K; Cwik, V A; Fraker, D; Brushart, T A; Gahl, W A


    Nephropathic cystinosis is a lysosomal storage disorder leading to renal failure by age 10 years. Prolonged patient survival following renal transplantation has allowed the development of previously unknown long-term complications. Muscle involvement has been reported in a single posttransplant cystinosis patient, but the range of clinical, electrophysiologic, and histologic features has not been fully described. Thirteen of 54 post-renal-transplant patients that we examined developed weakness and wasting in the small hand muscles, with or without facial weakness and dysphagia. Tendon reflexes were preserved and sensory examinations were normal. Electrophysiologic studies in 11 affected patients showed normal nerve conduction velocities and preserved sensory action potentials. The voluntary motor units in the affected distal muscles had reduced amplitude and brief duration, confirmed with quantitative electromyography in 4 patients. Biopsy of the severely affected abductor digiti minimi or extensor carpi radialis brevis muscles in 2 patients revealed marked fiber size variability, prominent acid phosphatase-positive vacuoles, and absence of fiber type grouping or inflammatory cells. Crystals of cystine were detected in perimysial cells but not within the muscle cell vacuoles. The muscle cystine content of clinically affected muscles was markedly elevated. We conclude that a distal vacuolar myopathy is a common late complication of untreated nephropathic cystinosis. Although the cause is unclear, the general lysosomal defect in this disease may also affect the lysosomes within muscle fibers.

  14. Ruptures of the distal biceps tendon. (United States)

    Ward, James P; Shreve, Mark C; Youm, Thomas; Strauss, Eric J


    Distal biceps ruptures occur most commonly in middle-aged males and result from eccentric contraction of the biceps tendon. The injury typically presents with pain and a tearing sensation in the antecubital fossa with resultant weakness in flexion and supination strength. Physical exam maneuvers and diagnostic imaging aid in determining the diagnosis. Nonoperative management is reserved for elderly, low demand patients, while operative intervention is generally pursued for younger patients and can consist of nonanatomic repair to the brachialis or anatomic repair to the radial tuberosity. Anatomic repair through a one-incision or two-incision approach is commonplace, while the nonanatomic repairs are rarely performed. No clear advantage exists in operative management with a one-incision versus two-incision techniques. Chronic ruptures present a more difficult situation, and allograft augmentation is often necessary. Common complications after repair include transient nerve palsy, which often resolves, and heterotopic ossification. Despite these possible complications, most studies suggest that better patient outcomes are obtained with operative, anatomic reattachment of the distal biceps tendon.

  15. Laparoscopic three-port distal pancreatectomy (United States)

    Subhas, Gokulakkrishna; Gupta, Natasha; Mittal, Vijay K; Jacobs, Michael J


    Aims Laparoscopic distal pancreatectomy is becoming a more commonly used procedure, which may involve the use of four to seven ports, depending on the technique. Initial data on feasibility, safety and outcome with the three-port laparoscopic distal pancreatectomy are presented. Methods The patient is placed in a partial thoracoabdominal position exposing the left flank in a reverse Trendelenberg position. A 10-mm Hassan trocar is inserted through a subcostal anterior axillary incision. A 5-mm midclavicular and 10-mm posterior axillary line trocar are placed. The specimen is retrieved from the anterior axillary line port. Results Ten women and seven men, aged 26–88 years (mean 61 years), were evaluated. Their body mass indexes ranged from 18–37 (mean 27). Pancreatic lesion size ranged from 1.0–5.5 cm (mean 3.0 cm). Operative time was 116–296 min (mean 170 min). Blood loss was 10–300 ml (mean 142 ml). No operation required conversion or additional trocar placement. Post-operative stay was 2–7 days (mean 4 days). No patient developed a pancreatic fistula. Conclusion Operative time, blood loss and post-operative stay of this three-port technique compare favourably with published data. PMID:21492337

  16. Autonomic neuropathy and diabetic foot ulceration. (United States)

    Edmonds, M E; Nicolaides, K H; Watkins, P J


    Autonomic function was studied in three groups of insulin-dependent diabetic patients. Heart rate changes during deep breathing and on standing were significantly less in 28 patients with a recent history of foot ulceration compared with 40 patients with peripheral neuropathy but without ulceration (p less than 0.001) and 54 patients without neuropathy (p less than 0.001). Sympathetic function was assessed in 36 of these patients from peripheral arterial diastolic flow patterns obtained by Doppler ultrasound measurements and expressed as the pulsatility index (PI). Patients with a history of ulceration (n = 10) showed considerably increased diastolic flow (PI = 4.28 +/- 0.53, mean +/- S.E.M.) compared with 12 neuropathic patients with no history of ulceration (PI = 7.80 +/- 0.68, p less than 0.002) and 14 patients without neuropathy (PI = 9.55 +/- 0.89, p less than 0.002). Severely abnormal autonomic function occurs in association with neuropathic foot ulceration, but patients without ulcers have lesser degrees of autonomic neuropathy, thus a causal relationship has not been established.

  17. Giant gastric ulcer penetrating into the pancreas. (United States)

    Fujihara, Shintaro; Mori, Hirohito; Nishiyama, Noriko; Kobara, Hideki; Masaki, Tsutomu


    A 57-year-old man developed haematemesis and was referred to our institution. His discomfort had begun 3 weeks earlier and localised to the upper abdomen. Abdominal CT showed a defect of gastric mucosa and gastric wall thickening. Oesophagogastroduodenoscopy showed that he had an active gastric ulcer, 40 mm in diameter, on the lesser curvature in the upper third of the corpus and the presence of a pancreatic body at the ulcer base, penetration to the pancreas. Open gastrectomy was performed with a preoperative diagnosis of localised peritonitis caused by penetration of the stomach into the pancreas. Histopathology of resected specimens showed a benign peptic ulcer, 40×40 mm in size, was found on the lesser curvature in the antrum, and this had penetrated through the pancreas. The most serious complications of PUD include haemorrhage, perforation, penetration, and gastric outlet obstruction. Approximately 7% of patients experience perforation, which occurs when an ulcer erodes through the wall and leaks air and digestive contents into the peritoneal cavity. Antral and duodenal ulcers can penetrate into the pancreas. We report a case of gastric ulcer penetrating into the pancreas.

  18. The stomach ulcer: character of morphogenesis.

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    Scherbinina M.B.


    Full Text Available Until now there were not completely known the causes of ulcerogenesis and chronisation of ulcerous gastric lesions as well as mechanisms of disorders of regeneration of gastroduodenal mucosa at all. The aim of this work was revealing the structural peculiarities of gastric mucosa that led to forming chronic ulcers. There was performed the histological examination of 24 biopsies in patients with mediogastral ulcer as well as the material of autopsies of 18 persons died due to the hemorrhage from gastric peptic ulcer. The biopsy material from curvature minor of gastric corpus in 12 persons without gastroduodenal diseases was control. There were determined the thickness of mucosa, thickness of submucosa, submucosal-mucosal index, height of superficial epitheliocytes and their nuclear diameter, nuclear-cytoplasmic interrelations, volume summary density of microcirculation in mucosa, mitotic index of growth zone of gastric glands using morphometry. Chronic gastric ulcers showed to form in the background of prolonged chronic gastritis associated with Helicobacter pylori. The structural peculiarities wall of a stomach which developed as result of progressing the chronic inflammation and led to forming the chronic ulcers were thickening submucosal layer as well as its sclerosis and hialinization, decrease of volumous summary density of microcircula-tion.

  19. History of Helicobacter pylori, duodenal ulcer, gastric ulcer and gastric cancer. (United States)

    Graham, David Y


    Helicobacter pylori (H. pylori) infection underlies gastric ulcer disease, gastric cancer and duodenal ulcer disease. The disease expression reflects the pattern and extent of gastritis/gastric atrophy (i.e., duodenal ulcer with non-atrophic and gastric ulcer and gastric cancer with atrophic gastritis). Gastric and duodenal ulcers and gastric cancer have been known for thousands of years. Ulcers are generally non-fatal and until the 20th century were difficult to diagnose. However, the presence and pattern of gastritis in past civilizations can be deduced based on the diseases present. It has been suggested that gastric ulcer and duodenal ulcer both arose or became more frequent in Europe in the 19th century. Here, we show that gastric cancer and gastric ulcer were present throughout the 17th to 19th centuries consistent with atrophic gastritis being the predominant pattern, as it proved to be when it could be examined directly in the late 19th century. The environment before the 20th century favored acquisition of H. pylori infection and atrophic gastritis (e.g., poor sanitation and standards of living, seasonal diets poor in fresh fruits and vegetables, especially in winter, vitamin deficiencies, and frequent febrile infections in childhood). The latter part of the 19th century saw improvements in standards of living, sanitation, and diets with a corresponding decrease in rate of development of atrophic gastritis allowing duodenal ulcers to become more prominent. In the early 20th century physician's believed they could diagnose ulcers clinically and that the diagnosis required hospitalization for "surgical disease" or for "Sippy" diets. We show that while H. pylori remained common and virulent in Europe and the United States, environmental changes resulted in changes of the pattern of gastritis producing a change in the manifestations of H. pylori infections and subsequently to a rapid decline in transmission and a rapid decline in all H. pylori-related diseases.

  20. Acute intestinal anisakiasis: CT findings. (United States)

    Ozcan, H N; Avcu, S; Pauwels, W; Mortelé, K J; De Backer, A I


    Small bowel anisakiasis is a relatively uncommon disease that results from consumption of raw or insufficiently pickled, salted, smoked, or cooked wild marine fish infected with Anisakis larvae. We report a case of intestinal anisakiasis in a 63-year-old woman presenting with acute onset of abdominal complaints one day after ingestion of raw wild-caught herring from the Northsea. Computed tomography (CT) scanning demonstrated thickening of the distal small bowel wall, mucosa with hyperenhancement, mural stratification, fluid accumulation within dilated small-bowel loops and hyperemia of mesenteric vessels. In patients with a recent history of eating raw marine fish presenting with acute onset of abdominal complaints and CT features of acute small bowel inflammation the possibility of anisakiasis should be considered in the differential diagnosis of acute abdominal syndromes.