Jennifer Holder-Murray; Alessandro Fichera
Preservation of the anal transition zone has long been a significant source of controversy in the surgical management of ulcerative colitis. The two techniques for restorative proctocolectomy and ileal pouch anal anastomosis (RPC IPAA) in common practice are a stapled anastomosis and a handsewn anastomosis;these techniques differ in the amount of remaining rectal mucosa and therefore the presence of the anal transition zone following surgery. Each technique has advantages and disadvantages in long-term functional outcomes, operative and postoperative complications, and risk of neoplasia. Therefore, we propose a selective approach to performing a stapled RPC IPAA based on the presence of dysplasia in the preoperative endoscopic evaluation.
Ali, Usama Ahmed; Keus, Frederik; Heikens, Joost T.; Bemelman, Willem A.; Berdah, Stephane V.; Gooszen, H. G.; van Laarhoven, Cees J. H. M.
Background Restorative proctocolectomy with ileo pouch anal anastomosis (IPAA) is the main surgical treatment for patients with ulcerative colitis (UC) and familial adenomatous polyposis (FAP). With the advancements of minimal-invasive surgery this demanding operation is increasingly being performed
Sofo, Luigi; Caprino, Paola; Sacchetti, Franco; Bossola, Maurizio
Restorative proctocolectomy with ileal pouch-anal anastomosis (RP-IPAA) is the gold standard surgical treatment for ulcerative colitis. However, despite the widespread use of RP-IPAA, many aspects of this treatment still remain controversial, such as the approach (open or laparoscopic), number of stages in the surgery, type of pouch, and construction type (hand-sewn or stapled ileal pouch-anal anastomosis). The present narrative review aims to discuss current evidence on the short-, mid-, and long-term results of each of these technical alternatives as well as their benefits and disadvantages. A review of the MEDLINE, EMBASE, and Ovid databases was performed to identify studies published through March 2016. Few large, randomized, controlled studies have been conducted, which limits the conclusions that can be drawn regarding controversial issues. The available data from retrospective studies suggest that laparoscopic surgery has no clear advantages compared with open surgery and that one-stage RP-IPAA may be indicated in selected cases. Regarding 2- and 3-stage RP-IPAA, patients who underwent these surgeries differed significantly with respect to clinical and laboratory variables, making any comparisons extremely difficult. The long-term results regarding the pouch type show that the W- and J-reservoirs do not differ significantly, although the J pouch is generally preferred by surgeons. Hand-sewn and stapled ileal pouch-anal anastomoses have their own advantages, and there is no clear benefit of one technique over the other.
Bruno Amaral Medeiros
Full Text Available OBJECTIVE: To evaluate the results of ileal J-pouch anal anastomosis in ulcerative colitis and familial adenomatous polyposis. METHOD: Retrospective analysis of medical records of 49 patients submitted to ileal J-pouch anal anastomosis. RESULTS: Ulcerative colitis was diagnosed in 65% and familial adenomatous polyposis in 34%. Mean age was 39.5 years. 43% were male. Among familial adenomatous polyposis, 61% were diagnosed with colorectal cancer. Thirty-one percent of patients with ulcerative colitis was submitted to a previous surgical approach and 21% of these had toxic megacolon. Average hospital stay was 10 days. Post-operative complications occurred in 50% of patients with ulcerative colitis and 29.4% with familial adenomatous polyposis. Intestinal diversion was performed in 100% of ulcerative colitis and 88% of familial adenomatous polyposis. Pouchitis occurred in eight cases (seven ulcerative colitis and one FAP, requiring excision of the pouch in three ulcerative colitis. Mortality rate was 7.6%: two cases of carcinoma on the pouch and two post-operative complications. Late post-operative complications occurred in 22.4%: six familial adenomatous polyposis and five ulcerative colitis. Two patients had erectile dysfunction, and one retrograde ejaculation. One patient with severe perineal dermatitis was submitted to excision of the pouch. Incontinence occurred in four patients and two reported soil. Mean bowel movement was five times a day. CONCLUSION: Ileal J-pouch anal anastomosis is a safe surgery with acceptable morbidity and good functional results, if well indicated and performed in referral centers.OBJETIVO: Avaliar resultados da anastomose íleo-anal com bolsa ileal em J na colite ulcerativa e na polipose adenomatosa familiar. MÉTODO: Análise retrospectiva dos prontuários de 49 pacientes submetidos a anastomose íleo-anal com bolsa ileal em J. RESULTADOS: 65% de colite ulcerativa e 34% de polipose adenomatosa familiar. Idade m
Freeman, H J
A 26-year-old woman with ulcerative colitis treated with a proctocolectomy and ileal pouch-to-anal anastomosis developed an erosive and ulcerative pouchitis. Although no ophthalmological manifestations were present before the staged surgical procedures, iritis developed after appearance of the pouchitis. Both conditions subsequently resolved with oral corticosteroids and metronidazole.
Hugh James Freeman
Full Text Available A 26-year-old woman with ulcerative colitis treated with a proctocolectomy and ileal pouch-to-anal anastomosis developed an erosive and ulcerative pouchitis. Although no ophthalmological manifestations were present before the staged surgical procedures, iritis developed after appearance of the pouchitis. Both conditions subsequently resolved with oral corticosteroids and metronidazole.
Goldstein, N S; Sanford, W W; Bodzin, J H
Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become an established surgical procedure for ulcerative colitis. Occasional patients who have undergone IPAA develop persistent or recurrent episodes of pouchitis (chronic pouchitis), from which a subset also develop gastrointestinal and systemic complications that are identical to those seen in Crohn's disease. These complications include enteric stenoses or fistulas in the pouch or pouch inlet segment, perianal fistulas or abscesses, pouch fistulas, arthritis, iridocyclitis, and pyoderma gangrenosum. The development of Crohn's-like gastrointestinal complications in a patient with chronic pouchitis frequently engenders concern that the pathologist misinterpreted the proctocolectomy specimen as ulcerative colitis instead of Crohn's disease. We describe eight patients who developed chronic pouchitis and Crohn's-like complications after IPAA and total proctocolectomy. In each case, concern was voiced about misinterpretation of the proctocolectomy specimen as ulcerative colitis instead of Crohn's disease after the development of the Crohn's-like complications. Preoperatively, all eight patients had characteristic clinical, radiographic, and pathologic features of ulcerative colitis. Review of the pathology specimens indicated that all eight had ulcerative colitis. Crohn's-like complications are most likely related to chronic pouchitis, which probably is a form of recrudescent ulcerative colitis within the novel environment of the pouch. A diagnosis of Crohn's disease after IPAA surgery should only be made when reexamination of the original proctocolectomy specimen shows typical pathologic features of Crohn's disease, Crohn's disease arises in parts of the gastrointestinal tract distant from the pouch, pouch biopsies contain active enteritis with granulomas, or excised pouches show the characteristic features of Crohn's disease, including granulomas. There were no histologic differences in the total
Liu Gang; Han Hongqiu; Liu Tong; Fu Qiang; Lyu Yongcheng
Background The incidence of chronic ulcerative colitis (CUC) in China is remarkably increasing,while little information on surgical treatment has been reported.This study aimed to completely describe and analyze the clinical outcome of restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) for CUC in China.Methods Ninety-five consecutive patients,who suffered CUC and had surgical indications,were carefully selected.All patients underwent IPAA.Data on patient characteristics,surgical indications,surgical details,postoperative complications,functional outcome,and quality of life were collected.Results The mean patient age at the time of the operation was 32 years.Twenty-nine (31％) patients underwent an emergency operation,and 66 (69％) underwent elective procedures.Four patients with severe dysplasia underwent operations,but no carcinoma was histologically confirmed.A two-stage operation was performed in 87 (92％) patients,and a hand-sewn technique was applied in 88 (93％) patients.Sixteen patients (17.0％) experienced early complications,and there was a significant difference between the emergency surgery group and the elective group (31.0％ vs.10.6％,respectively; P ＜0.01).Five (5.3％) patients developed pouchitis as a late complication.The mean stool frequency after the operation was 4.6 (2-11) during the first 24 hours and 1.5 (0-4) overnight.According to the Kirwan grading scale,87 (91.8％) patients showed satisfactory anal continence function.The quality of life improved significantly from a preoperative mean value of 0.28-0.61 before ileostomy closure to 0.78 after ileostomy closure (P ＜0.01) according to the Cleveland Global Quality of Life index.Conclusions IPAA is an effective and safe surgical procedure for patients with CUC in China.However,some characteristics,such as the low incidence of pouchitis,require further study.
Cardes García, Fernando
Convencionalmente, los micrófonos dan una salida analógica debida a la variación de presión que produce el sonido, y esta señal se digitaliza por medio de conversores analógico digitales tradicionales. En este proyecto se aborda el diseño de un sistema que obtenga como salida un código digitalizado a partir del sonido recibido por la cápsula microfónica. La principal ventaja de utilizar este sistema es que el circuito analógico que acondiciona la señal se simpli ca considerable...
Henrique Sarubbi Fillmann
Full Text Available O óxido nítrico (NO é um radical livre sintetizado endogenamente por várias células do nosso organismo. Apresenta um amplo espectro de ações fisiológicas, sendo as mais importantes o seu mecanismo de ação parácrino no relaxamento da musculatura lisa, sua atividade neurotransmissora em vários sistemas e seu envolvimento no processo inflamatório. O NO é sintetizado em diferentes tecidos através da conversão da L-arginina em L-citrulina pela ação da enzima óxido nítrico sintase (NOS. OBJETIVOS: Este estudo tem por objetivo demonstrar o envolvimento do óxido nítrico no processo intestinal inflamatório de ratos Wistar submetidos à colite experimental com ácido acético. MATERIAL E MÉTODOS: Foram utilizados 20 ratos machos Wistar, com peso entre 250 e 350 gramas divididos em dois grupos de 10 animais. Os animais do grupo em estudo foram submetidos à administração intracolônica, por enema, de uma solução de ácido acético diluído a 7% e com volume de 3 ml. O grupo controle recebeu apenas enema de solução salina. Foram avaliados os índices histológicos, a expressão da enzima óxido nítrico sintase (iNOS e a pressão anal esfincteriana. RESULTADOS: Os índices histológicos apresentaram uma significativa elevação no grupo colite quando comparados ao grupo controle, tanto na avaliação macroscópica quanto na microscópica. A expressão da enzima iNOS também foi significativamente maior no grupo colite quando comparada ao grupo controle. A pressão anal esfincteriana foi significativamente mais baixa no grupo colite na comparação ao grupo controle. CONCLUSÃO: Os animais submetidos à colite experimental apresentam um aumento da expressão da enzima óxido nítrico sintase induzível (i-NOS. Este aumento, associado ao conseqüente aumento do nível de óxido nítrico, ocasiona uma diminuição dos níveis de pressão anal esfincteriana.The nitric oxide (NO is a free radical synthesized from some cells of our
Banerjee, S; Farquharson, M; Cecil, T D; Gold, D; Moran, B J
Two cases are described of patients who presented with a buttock abscess 3 and 5 years after restorative proctocolectomy for ulcerative colitis. In both the abscess was secondary to a fistula, which was shown on further investigation to be a track traversing the greater sciatic notch. Both patients had had an ileo-anal J-pouch after a proctectomy which had included a mesorectal excision. The possibility that these unusual fistulae might be more common following removal of the mesorectum rather than a close rectal dissection is explored.
Renato Arioni Lupinacci
Full Text Available PURPOSE: To study outcomes and functional results of a telescopic straight ileo-anal anastomosis. METHODS: Thirty-six mongrel dogs were submitted to total proctocolectomy and telescopic straight ileo-anal anastomosis (ileal mucosa-submucosa pulled-through the rectal cuff. They were divided in 3 groups, sacrificed after one, two or eight weeks after the initial procedure. Gross and microscopic (degree of cooptation and signs of ischemia aspects of the anastomosis, as well, the aspect of defecation were analyzed. RESULTS: On microscopy all anastomosis analysed showed a continuous epithelial line and were considered good. After two-months no signs of ischemia were identified. Defecation aspect has considerably changed during the study, so no dogs presented solid defecation within the first two weeks, whereas 80% of dogs presented solid stools after two months. CONCLUSION: Telescopic ileo-anal anastomosis is a safe alternative and may provide good functional results after some small period of time.OBJETIVO: Estudar os resultados cirúrgicos e funcionais de uma anastomose íleo-anal por telescopagem. MÉTODOS: Trinta e seis cães sem raça definida foram submetidos à procto-colectomia total e anastomose ileo-anal por telescopagem da mucosa-submucosa ao coto retal. Os animais foram divididos em três grupos cujos sacrifícios ocorreram 1, 2 e 8 semanas após o procedimento inicial. O aspecto da anastomose foi analisado no momento do sacrifício e microscopicamente (grau de coaptação e sinais de isquemia, bem como o aspecto da evacuação nos canis de cada cão. RESULTADOS: O estudo microscópico evidenciou continuidade do epitélio em todas as anastomoses. Nos cães sacrificados após dois meses não houve sinais de isquemia nas anastomoses. O aspecto das fezes alterou-se consideravelmente com o tempo, assim, enquanto nenhum cão apresentou fezes sólidas nas primeiras duas semanas, ao término do segundo mês 80% dos cães apresentavam fezes s
Antibiotic-associated colitis; Colitis - pseudomembranous; Necrotizing colitis; C difficile - pseudomembranous ... this bacteria from 1 person to another. Pseudomembranous colitis is uncommon in children, and rare in infants. ...
Carlos Alberto Severiche Sierra
Full Text Available En la actualidad la prestación de servicios analíticos de laboratorios, toma de forma ascendente más auge y utilidad. El efecto de un análisis de aguas es forjar resultados correctos y confiables, siendo la verificación de ensayos uno de los aspectos más importantes y factor clave para conseguir este propósito. La determinación de cromo hexavalente en aguas por colorimetría con la difenilcarbazida es la metodología analítica más usada y útil que se conoce en el ámbito científico técnico, principalmente, por su alta selectividad y también debatida por su reacción a las interferencias. En el presente estudio se hizo la valoración analítica del método espectrofotométrico para la determinación de cromo hexavalente en aguas; el objetivo de este trabajo fue confirmar correctamente la aplicación del método para el análisis de aguas. Se trabajaron muestras de diferentes tipos de agua: potable, residual y superficial, siguiéndose estrictamente los protocolos de verificación. Se encontraron resultados satisfactorios en precisión y exactitud con el fin de emitir resultados confiables y reales de la muestra analizada.
Rivera Barquero, Ángelo; Cano López, Francis
La colitis ulcerativa crónica indeterminada (CUCI) se caracteriza por una inflamación que afecta en su inicio principalmente al recto, pudiendo extenderse en forma continua y difusa hacia el colon. La anemia es muy frecuente en pacientes con CUCI debido a sangrados y a la cronicidad de la enfermedad. Además, la CUCI puede disminuir la tolerancia inmunológica, lo que puede desencadenar en algunos casos la anemia hemolítica autoinmune (AHAI) mediada normalmente por anticuerpos del tipo IgG. La ...
Aristides Fraga Lima Filho
Full Text Available Uma solução analítica foi desenvolvida, para avaliar sulcos abertos e em declive, com base na teoria de Balanço de Volume de Walker e Skogerboe (1987. Essa metodologia é capaz de obter, matematicamente, a performance de um sistema, dispensando a construção de gráficos que definem os parâmetros de avaliação. A solução matemática é baseada no ajuste de equações ao modelo potencial, no cálculo das áreas sob as curvas definidas no ajuste e na intercessão de curvas, obtendo-se, assim, a performance de sistemas de irrigação por sulcos abertos e em declive. Para validação da metodologia, foi realizado um experimento de campo, na Fazenda Experimental da Universidade Federal do Ceará, situada no município de Pentecoste, pertencente ao Centro de Ciências Agrárias. Os dados de campo foram submetidos à análise pelas duas metodologias. Os resultados mostraram que a metodologia analítica pode ser usada para avaliar a irrigação por sulcos abertos e em declive.
Magaly Gemio Teixeira
Full Text Available Ileal pouch-anal anastomosis was an important advancement in the treatment of ulcerative colitis. The aim of this study was to determine whether early complications of ileal pouch-anal anastomosis in patients with ulcerative colitis are associated with poor late functional results. PATIENTS AND METHODS: Eighty patients were operated on from 1986 to 2000, 62 patients with ileostomy and 18 without. The early and late complications were recorded. Specific emphasis has been placed on the incidence of pouchitis with prolonged follow-up. RESULTS: The ileostomy was closed an average of 9.2 months after the first operation. Fourteen patients were excluded from the long-term evaluation; 6 patients were lost to regular follow-up, 4 died, and 4 patients still have the ileostomy. Of the 4 patients that died, 1 died from surgical complications. Early complications after operation (41 occurred in 34 patients (42.5%. Late complications (29 occurred in 25 patients as follows: 16 had pouchitis, 3 associated with stenosis and 1 with sexual dysfunction; 5 had stenosis; and there was 1 case each of incisional hernia, ileoanal fistula, hepatic cancer, and endometriosis. Pouchitis occurred in 6 patients (9.8% 1 year after ileal pouch-anal anastomosis, 9 (14.8% after 3 years, 13 (21.3% after 5 years, and 16 (26.2% after more than 6 years. The mean daily stool frequency was 12 before and 5.8 after operation. One pouch was removed because of fistulas that appeared 2 years later. CONCLUSIONS: Ileal pouch-anal anastomosis is associated with a considerable number of early complications. There was no correlation between pouchitis and severe disease, operation with or without ileostomy, or early postoperative complications. The incidence of pouchitis was directly proportional to duration of time of follow-up.A anastomose íleo-anal com reservatório ileal foi um importante avanço no tratamento da retocolite ulcerativa. O objetivo deste trabalho foi determinar se os maus
Carlos A. Severiche
Full Text Available La meta de un análisis químico de aguas es generar resultados correctos y confiables, siendo la validación de ensayos uno de los aspectos más importantes para conseguir este propósito; además constituye un factor clave para la prestación de servicios analíticos. La determinación de ion sulfato en aguas es una de las metodologías analíticas más discutidas que se conoce en el ámbito científico técnico del análisis de aguas, principalmente, por las desventajas que presentan los métodos aceptados internacionalmente (gravimétrico, turbidimétrico y cromatográfico. En el presente estudio se hizo la evaluación del método analítico turbidimétrico, para la determinación de sulfatos en aguas; el objetivo de este trabajo fue incluir una modificación al método estandarizado y confirmar correctamente la aplicación del método modificado para el análisis de aguas. Se trabajaron muestras de diferentes tipos de agua: potable, residual, superficial, de pozo y de piscina, siguiéndose estrictamente los protocolos de validación. Se encontraron resultados satisfactorios en precisión y exactitud con el fin de emitir resultados confiables y reales de la muestra analizada.
目的：探讨溃疡性结肠炎（U C ）患者外科术后生活质量和远期肛门功能恢复情况。方法采用中文版S F-36量表对42例U C患者术后12个月生活质量和90例健康人群生活质量进行评估比较。同时观察患者术后12个月远期肛门功能恢复情况。结果 U C患者术后生活质量在生理机能、躯体疼痛、一般健康状况、精力、社会功能、情感职能、精神健康方面与健康人群比较差异无显著意义（P＞0．05），在生理职能方面低于健康人群，差异有显著意义（P＜0．05）。远期肛门功能恢复情况影响患者术后生活质量。便次少、肛门控便能力好的患者生活质量各维度得分均较高，并从生理机能、生理职能、躯体疼痛等方面影响术后生活质量。结论护理人员应采取有效的个体化健康教育和肛门功能恢复指导，提高UC患者术后生活质量。%Objective To study the quality of life and long-term anal functional recovery for patients with ulcera-tive colitis and provide the basis information for effective nursing intervention .Method 42 patients with ulcerative colitis after operation and 90 normal persons were recruited in the study .SF-36 questionnaire was used to assess the quality of life of these people .The long-term anal functional recovery for patients with ulcerative colitis at 12 months postoperatively was recorded ,and a statistical analysis was undertaken for the quality of life .Result There was no significant difference in scores between patients with ulcerative colitis after operation and normal people in terms of physical functioning ,bodily pain ,general health ,vitality ,social functioning ,role-emotional and mental health (P>0 .05) .The scores of role-physical for patients with ulcerative colitis were significantly lower than that of normal people (P<0 .05) .The quality of life for patients with ulcerative colitis after operation was influenced by long-term anal
... 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 ...
Oswaldo Marques Jr
Full Text Available BACKGROUND: Diarrhea in seropositive human immunodeficiency virus patients is one of the most important and disabling symptoms, and often decreases their quality of life. Cytomegalovirus colitis is among the principal causes of this symptom and colonoscopy is the gold standard examination to diagnose it. AIM: To define the main endoscopic findings in seropositive human immunodeficiency virus patients with cytomegalovirus colitis. METHODS: Two hundred and forty-three colonoscopies were performed in 200 seropositive human immunodeficiency virus patients with diarrhea associated or not to abdominal pain or gastrointestinal bleeding, over 10-year period, whom 51 patients were diagnosed with cytomegalovirus colitis. Full length colonoscopy with ileum intubation was always tried and multiple biopsies of all segments examined, including endoscopically normal segments, were attempted. All diagnoses were confirmed by histologic and immunohistochemical studies. RESULTS: Total colonoscopy was possible in 98.03% and ileum intubation in 88.23% of these cytomegalovirus colitis patients. At colonoscopy, a heterogeneous ulcerative pattern was presented in 72.54%, an inflammatory process of the mucosa in 21.56% and 5.88% of the patients mucosa was endoscopically normal. CONCLUSION: Full length colonoscopy with ileum intubation and multiples biopsies of all segments, even when they are endoscopically normal, have always to be attempted in cases of seropositive human immunodeficiency virus patient with diarrhea.RACIONAL: Diarréia em pacientes soropositivos para o vírus da imunodeficiência adquirida é um dos sintomas mais importantes e debilitantes e freqüentemente reduz sua qualidade de vida. Colite por citomegalovírus está entre as principais causas desse sintoma e a colonoscopia é o exame padrão-ouro para seu diagnóstico. OBJETIVO: Definir os principais achados endoscópicos em pacientes HIV+ com colite por citomegalovírus. MÉTODO: Duzentas e
This paper aims at demonstrating a currently beleaguered assumption: the central importance, the continuing vitality, and the appropriate complexity of Freud's theory of the drives and of his idea of the primacy of the body ego. It is not enough to consider man a thinking machine or a social being; his animal nature must be given a central place in psychology. The paper postulates that 'anal or sphincter defensiveness' is one of the precursors of the repression barrier. Anality has been comparatively neglected in recent psychoanalytic literature, and so has its explorer, Karl Abraham. The paper's thesis is that there is a special defensive importance to anal erogeneity and libido, and to those aspects of ego and superego that are functionally operative (as the 'sadistic-anal organization' (Freud, 1917)) during the so-called 'sadistic-anal' developmental phase. Any of the psychic danger situations can evoke regression to manifestations of 'anal narcissim'--an attempt to master overwhelming feeling by a kind of emotional sphincter action, narrowing down the world to the controllable and the predictable. The basic assumption here is Fliess's idea that the attainment of anal sphincter control functions--with, as-it-were, 'psychic resonance'--as a means to master primal (murderous, cannibalistic) affect. For optimal psychic development, a proper balance must be attained between anal control of, and anal expression of, instinctual derivatives--especially of affect laden with aggression.
Florentino Malaver Rodríguez
Full Text Available Este artículo se compone de dos partes. En la primera se identifican las tendencias que enmarcan las transformaciones ocurridas en la industria de artes gráficas, imprentas y editoriales en las dos últimas décadas del siglo XX. Entre estas se destacan la conformación de grupos empresariales en medio de un notable impacto del cambio técnico impulsado por la digitalización de la producción gráfica y una acelerada convergencia tecnológica que propicia la integración de la industria gráfica con las de la información, la comunicación y el entretenimiento. A causa de ello esta industria está inmersa en una reconfiguración que afecta su morfología. En la segunda parte, se intentan dilucidar los retos analíticos que se desprenden de las transformaciones detectadas, y se plantea que para interpretar la dinámica de las transformaciones empresariales detectadas y el papel vital que en ellas juega el cambio técnico se pueden integrar los aportes de la teoría de los costos de transacción, la perspectiva evolutiva del cambio técnico y el enfoque de los recursos y las capacidades. Se sugiere, igualmente, que síntesis analíticas como la propuesta reclaman una apertura disciplinaria concordante con los desafíos que abren transformaciones empresariales como la descrita en la primera parte del artículo y que poco se han estudiado en el país.
Este libro aborda la reproducción de la obra de arte a través de los nuevos medios como Internet para analizar los cambios que la revolución tecnológica ha traído al campo de la imagen. La desmaterialización de las formas de producción y difusión del conocimiento ha provocado la multiplicación de imágenes que circulan libremente por la red y que se nos presentan sin apenas límite de tiempo o espacio a través de los dispositivos. En este proceso, que trae consigo consecuencias estéticas, polít...
... split or tear in the thin moist tissue ( mucosa ) lining the lower rectum (anus). Causes Anal fissures ... Chronic Constipation in infants and children Crohn disease Mucosa Review Date 5/24/2016 Updated by: Mary ...
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 ...
... 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 ...
Münch, A; Aust, D; Bohr, Jakob
Microscopic colitis (MC) is an inflammatory bowel disease presenting with chronic, non-bloody watery diarrhoea and few or no endoscopic abnormalities. The histological examination reveals mainly two subtypes of MC, lymphocytic or collagenous colitis. Despite the fact that the incidence in MC has...... been rising over the last decades, research has been sparse and our knowledge about MC remains limited. Specialists in the field have initiated the European Microscopic Colitis Group (EMCG) with the primary goal to create awareness on MC. The EMCG is furthermore a forum with the intention to promote...
Heikens, J.T.; Vries, I.J.M. de; Laarhoven, C.J.H.M. van
AIM: There are numerous studies on quality of life (QoL), health-related quality of life (HRQoL), and health status (HS) in patients undergoing surgery for ulcerative colitis. A systematic review of published literature was conducted to establish the quality of these studies and to determine QoL, HR
Lindström, C G
Collagenous colitis is now regarded by an overwhelming majority of authors as a clinicopathological entity and has been taken up as a such in many text-books and diagnostic atlases (Morson & Dawson, 1990, Fenoglio-Preiser et al., 1989, Whitehead 1985, Whitehead 1989). A good, detailed review of cases of collagenous colitis published up to 1988 was performed by Perri et al. Collagenous colitis was also presented to a wider medical public through a clinicopathological conference case at Massachusetts General Hospital (Case 29-1988). Finally it may be added that collagenous colitis has been included in the new fourth edition of Robbins Pathologic Basis of Disease (Cotran, Kumar, Robbins, 1989), where the possibility of an autoimmune disease is stressed.
Pseudomembranous colitis is an inflammatory condition of the colon characterized by elevated yellow-white plaques that coalesce to form pseudomembranes on the mucosa. Patients with the condition commonly present with abdominal pain, diarrhea, fever, and leukocytosis. Because pseudomembranous colitis is often associated with C. difficile infection, stool testing and empiric antibiotic treatment should be initiated when suspected. When results of C. difficile testing are negative and symptoms p...
Gianluca Ianiro; Giovanni Cammarota; Luca Valerio; Brigida Eleonora Annicchiarico; Alessandro Milani; Massimo Siciliano; Antonio Gasbarrini
Microscopic colitis may be defined as a clinical syndrome,of unknown etiology,consisting of chronic watery diarrhea,with no alterations in the large bowel at the endoscopic and radiologic evaluation.Therefore,a definitive diagnosis is only possible by histological analysis.The epidemiological impact of this disease has become increasingly clear in the last years,with most data coming from Western countries.Microscopic colitis includes two histological subtypes [collagenous colitis (CC) and lymphocytic colitis (LC)] with no differences in clinical presentation and management.Collagenous colitis is characterized by a thickening of the subepithelial collagen layer that is absent in LC.The main feature of LC is an increase of the density of intra-epitll lial lymphocytes in the surface epithelium.A number of pathogenetic theories have been proposed over the years,involving the role of luminal agents,autoimmunity,eosinophils,genetics (human leukocyte antigen),biliary acids,infections,alterations of pericryptal fibroblasts,and drug intake; drugs like ticlopidine,carbamazepine or ranitidine are especially associated with the development of LC,while CC is more frequently linked to cimetidine,non-steroidal antiinflammatory drugs and lansoprazole.Microscopic colitis typically presents as chronic or intermittent watery diarrhea,that may be accompanied by symptoms such as abdominal pain,weight loss and incontinence.Recent evidence has added new pharmacological options for the treatment of microscopic colitis:the role of steroidal therapy,especially oral budesonide,has gained relevance,as well as immunosuppressive agents such as azathioprine and 6-mercaptopurine.The use of anti-tumor necrosis factor-α agents,infliximab and adalimumab,constitutes a new,interesting tool for the treatment of microscopic colitis,but larger,adequately designed studies are needed to confirm existing data.
Martínez, Mónica; Troncoso, Carolina; Riveros, Isabel; Rojas, Jaime
Se presentan en este artículo los resultados obtenidos durante el desarrollo y validación de una metodología analítica para la determinación de cocaína y sus metabolitos, benzoilecgonina y cocaetileno, en saliva por cromatografía en fase gaseosa. El método consiste en una purificación previa por extracción en fase sólida y determinación por cromatografía en fase gaseosa con detector selectivo para nitrógeno y fósforo (NPD), empleando lidocaína como estándar interno. El método es preciso, e...
Echevarría Anaya, Julio Antonio
La presente tesis tiene como objetivo analizar los resultados que se tiene en los aprendizajes al abordar un problema sobre circunferencia desde los cuadros de la geometría sintética y geometría analítica. Se espera que el tránsito entre estos dos cuadros favorezca la comprensión del objeto. Para el estudio se ha tomado como base la Teoria de Juego de cuadros, en donde se describen fases por las cuales los estudiantes deben transitar para que las interacciones entre cuadros per...
Nielsen, Ole Haagen; Jess, Tine; Bjerrum, Jacob Tveiten
Ulcerative colitis (UC) is a prevalent inflammatory bowel disease of the colonic mucosa affecting approximately 20,000-25,000 Danes. Apart from subgroups with early onset, extensive and long-standing inflammation, or primary sclerosing cholangitis the risk of developing colorectal cancer is of th......Ulcerative colitis (UC) is a prevalent inflammatory bowel disease of the colonic mucosa affecting approximately 20,000-25,000 Danes. Apart from subgroups with early onset, extensive and long-standing inflammation, or primary sclerosing cholangitis the risk of developing colorectal cancer...
Mitchell, Peter J; Klarskov, Niels; Telford, Karen J;
Anal acoustic reflectometry is a new technique of assessing anal sphincter function. Five new variables reflecting anal canal function are measured: the opening and closing pressure, the opening and closing elastance, and hysteresis.......Anal acoustic reflectometry is a new technique of assessing anal sphincter function. Five new variables reflecting anal canal function are measured: the opening and closing pressure, the opening and closing elastance, and hysteresis....
Ljungmann, Ken; Bendixen, Anette; Laurberg, Søren;
INTRODUCTION: Restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) has become the operation of choice for patients with ulcerative colitis and familial polyposis. However, the procedure is complex with a long learning curve, and carries a risk of both early and late complications...
Colitis - cytomegalovirus; Gastroenteritis - cytomegalovirus; Gastrointestinal CMV disease ... or after bone marrow or organ transplant Ulcerative colitis or Crohn disease Rarely, serious CMV infection involving ...
Kjaer, Mie Dilling; Laursen, Stig Borbjerg; Qvist, Niels;
BACKGROUND: Ileal pouch-anal anastomosis (IPAA) is performed in patients with ulcerative colitis and familial adenomatous polyposis where the majority of patients are sexually active. Laparoscopic surgery is becoming the preferred technique for most colorectal interventions, and we examined...
Gonzalo González - Rey
Full Text Available ResumenEn el contexto de las actuales normas internacionales, no se dispone de información suficiente paraenfrentar el cálculo analítico de la potencia transmisible por una correa dentada. Esta situaciónrestringe el desarrollo de un cálculo computacional o la estimación de la potencia nominal de lascorreas dentadas para casos no contemplados en los datos declarados por los fabricantes yderivados de ensayos experimentales. Por tal motivo, y con el interés de difundir el cálculo analíticode la potencia nominal en transmisiones por correas dentadas, se proporcionan en este trabajofórmulas de potencias nominales y también términos y factores de corrección apropiados para elcálculo y estudio de transmisiones por correas dentadas con dos poleas. Además, se presentanvalores óptimos de velocidad de correa para valores obtener valores máximos de potenciatransmisible por una correa dentada en función del paso. Estos resultados han sido base de unapropuesta informativa incorporada a la norma cubana NC-ISO 5295:2010 referida al cálculo de laspotencias nominales de correas dentadas con flancos de perfil recto.Palabras claves: Correa dentada, potencia nominal, Norma ISO 5295, velocidad óptima._____________________________________________________________________________AbstractIn the current context of the International Standards, there is not enough information to face theanalytical calculation of the power rating of synchronous belt drives. It’s practical habitual to usepower rating diagrams or tables offered by belt manufacturers with limitation to implementcomputational procedures, and for calculating ratings which are out of the range of speed or numberof teeth of pulleys conditions shown in the power rating diagrams or tables. For such a reason, thisarticle presents some useful results and detailed formulae based in ISO Standard 5295 for powerratings, together with appropriate correction terms and analytical factors used in the
Picinelli, Anna; Antón, M.J. (María); Hortal, Rodrigo; Pando, Rosa; Suárez, Belén
La sidra de hielo o licorosa es un producto novedoso obtenido a partir de la fermentación de mostos enriquecidos en sólidos solubles por crioextracción (prensado a baja temperatura de manzanas congeladas) o por crioconcentración (congelación del mosto fresco y posterior descongelado para separar fracciones de zumo).
Kawaratani, Hideto; Tsujimoto, Tatsuhiro; Toyohara, Masahisa; Kin, Kenichi; Taniguchi, Tomoyasu; Shirai, Yasuyo; Ikenaka, Yasuhide; Nakayama, Masaki; Fujii, Hisao; Fukui, Hiroshi
Clostridium difficile toxin (CD toxin) causes antibiotic-associated colitis, or pseudomembranous colitis (PMC). Although CD toxin is sometimes found in the stools of patients with ulcerative colitis (UC), UC is rarely complicated by PMC. We report herein a case of PMC complicating UC, and present a review of the literature. A 71-year-old woman was diagnosed as having UC of the left colon, and treated with prednisolone and mesalazine. Later, however, lumbar spinal stenosis was also detected. After surgery for lumbar spinal stenosis, she suffered postoperative infection of the lumbar region. After 3-week treatment with antibiotics, she developed diarrhea, bloody stools, and abdominal pain. Colonoscopy revealed PMC of the cecum, ascending colon, sigmoid colon, and rectum. Stools were positive for CD toxin. As cefotiam hydrochloride, levofloxacin hydrate (LVFX), and prednisolone were suspected as the causative agents, she was treated with 1.5 g vancomycin (VCM) daily for 2 weeks without ceasing LVFX. Her symptoms improved, and colonoscopy confirmed resolution of PMC. The possibility of PMC should be considered in UC patients treated with antibiotics, immunosuppressive agents or corticosteroids who complain of gastrointestinal symptoms. These patients should be thoroughly investigated by several modalities, including colonoscopy and CD toxin testing.
Full Text Available RESUMO A espécie Solidago chilensis Meyen, Asteraceae é conhecida como erva-lanceta ou arnica-brasileira, sendo utilizada popularmente como antimicrobiana e para o tratamento de inflamações tópicas. No entanto, estudos fitoquímicos e farmacológicos para as partes aéreas são escassos. Neste trabalho, realizou-se a determinação de flavonoides por espectrofotometria de UV/Vis, prospecção fitoquímica da fração acetato de etila visando o isolamento do constituinte químico majoritário e validação analítica por cromatografia líquida de alta eficiência (CLAE. O teor de flavonoides totais foi de 5,42%, representados como hiperosídeo. O fracionamento químico utilizando métodos cromatográficos (cromatografia líquida em coluna gel de sílica; CHCl3:EtOH; 8:2 v/v e espectroscópicos (1H RMN,13C RMN e ESI-MS revelou o isolamento de quercetina-3-O-α-L-ramnosídeo(quercitrina. A sensibilidade e a linearidade (r = 0,999 da validação analítica, utilizando a quercitrina isolada do extrato hidroalcoólico da planta, revelaram um rendimento de 5,29% do analito em relação à droga vegetal. Precisão, recuperação e robustez, além dos valores estabelecidos para os limites de detecção (LOD e de quantificação (LOQ, poderão ser utilizados como parâmetros de qualidade para extratos à base de S. chilensis.
Nielsen, Ole Haagen; Jess, Tine; Bjerrum, Jacob Tveiten;
Ulcerative colitis (UC) is a prevalent inflammatory bowel disease of the colonic mucosa affecting approximately 20,000-25,000 Danes. Apart from subgroups with early onset, extensive and long-standing inflammation, or primary sclerosing cholangitis the risk of developing colorectal cancer...... is of the same magnitude as in the background population. The symptoms are usually diarrhoea including bloody stools, rectal tenesmi, anaemia, and fatigue. This review is an update on diagnostics and treatment strategies of relevance for clinicians, and as UC often affects patients during their peak reproductive...
... to determine if antibiotics are indicated. TREATMENT OF ANAL FISTULA Currently, there is no medical treatment available for ... surgery is almost always necessary to cure an anal fistula. If the fistula is straightforward (involving minimal sphincter ...
Rodolfo Neri Vela; Luis Alán Valiente Montaño; Vladimir Hernández Solís
Las propiedades de operación de arreglos horizontales y verticales formados con tres antenas Yagi son analizadas por el método de momentos, considerando la impedancia mutua entre ellas, para Yagis con número creciente de elementos ( 3, 6 y 9), optimizando la impedancia total de entrada de cada arreglo a una frecuencia central de 500 MHz. Adicionalmente, el patrón de radiación obtenido para cada caso es comparado con la aproximación dada por el método de multiplicación de patrones, variando la...
Andrade, Maria Emilia Rabelo
Recent studies have demonstrated the benefits of immunomodulators, such as arginine, in the regulation of inflammatory responses and trophism of the intestinal mucosa. The aim of this study was to evaluate the possible mechanisms action of arginine (pretreatment or treatment) in experimental model of ulcerative colitis induced by dextran sodium sulfate (DSS). C57BL/6 mice were randomized into 5 groups: Control group (C): standard diet and water; Arginine group (ARG): diet supplementation with arginine and water; Colitis group (COL): standard diet and DSS solution; Pretreated group (PT): diet supplementation with arginine before and during colitis induction; Treated group (T): diet supplementation with arginine during colitis induction. Colitis was induced by administration of 1.5% DSS for 5 days. After this, all the mice were euthanized and blood, organs and intestinal fluid were collected for carrying out analyzes. Parameters such as intestinal permeability (IP), bacterial translocation (BT), histological analysis (histological score, morphometric analysis, collagen and mucins stain), nitrate and nitrite, cytokines and chemokines, secretory immunoglobulin A (sIgA), inflammatory infiltrate and oxidative stress were performed. The ARG group did not show difference compared to group C in the investigated parameters (C vs ARG: p> 0.05). The COL group showed increased IP (C vs COL: p < 0.05) and BT (C vs COL: p <0.05). In the histological analysis, the COL group showed severe inflammation and reduction the crypts length. In addition, in the group COL observed increase infiltration of eosinophils, neutrophils and macrophages in the colon, increase cytokine IL-17 and chemokine KC in serum and oxidative stress in the colon (COL vs C: p <0.05). In the arginine-supplemented groups (PT and T) was observed decrease IP and BT to blood, liver and lung (PT and T vs Col: p <0.05). Histological analysis showed that the arginine (PT and T) preserved the intestinal mucosa and crypts
Memory embedded in Markov models specified in Statecharts: simulation versus analytical approaches Tratamento de memória em modelos Markovianos especificados em Statecharts: abordagens por simulação e analítica
Nandamudi Lankalapalli Vijaykumar
Full Text Available Statecharts are a graphical representation to model reactive systems that respond to external or internal stimuli by changing the state of a given system. Statecharts can be seen as an extension of state-transition diagrams that allows modeling hierarchy, orthogonality, and interdependence. Due to their features to represent reactive systems, Statecharts have been adapted to represent and deal analytically with performance models (reactive systems whose performance is to be evaluated. An interesting feature present in Statecharts is to record the system's state, which cannot be represented in Markov models in a straightforward manner due to its "memory-less" property. The contributions of this paper are: show that Statecharts are a feasible alternative to specify a reactive system so that its performance can be evaluated by both analytical and simulation techniques; show that the inclusion of the memory representation in the Statecharts specification can indeed be made by both analytical and simulation techniques. The results of a case study of a manufacturing system show that the objectives are achieved.Statecharts representam graficamente sistemas reativos que respondem aos estímulos externos ou internos e mudam estados de um dado sistema. Statecharts estendem diagramas de estado com hierarquia, paralelismo e interdependência. Devido às suas características, eles foram adaptados para representar e tratar analiticamente modelos de desempenho (sistemas reativos cujo desempenho deve ser avaliado. Uma característica presente em Statecharts é registrar (ou memorizar um estado do sistema que não é possível representar numa forma direta em modelos Markovianos devido à sua propriedade de "sem memória". São duas as contribuições deste artigo: mostrar que Statecharts são viáveis para especificar sistemas reativos e avaliar o seu desempenho tanto por técnicas analíticas quanto por simulação; mostrar que a inclusão de representa
Chang, Jason; Mclemore, Elisabeth; Tejirian, Talar
Despite the fact that countless patients suffer from anal problems, there tends to be a lack of understanding of anal health care. Unfortunately, this leads to incorrect diagnoses and treatments. When treating a patient with an anal complaint, the primary goals are to first diagnose the etiology of the symptoms correctly, then to provide an effective and appropriate treatment strategy.The first step in this process is to take an accurate history and physical examination. Specific questions include details about bowel habits, anal hygiene, and fiber supplementation. Specific components of the physical examination include an external anal examination, a digital rectal examination, and anoscopy if appropriate.Common diagnoses include pruritus ani, anal fissures, hemorrhoids, anal abscess or fistula, fecal incontinence, and anal skin tags. However, each problem presents differently and requires a different approach for management. It is of paramount importance that the correct diagnosis is reached. Common errors include an inaccurate diagnosis of hemorrhoids when other pathology is present and subsequent treatment with a steroid product, which is harmful to the anal area.Most of these problems can be avoided by improving bowel habits. Adequate fiber intake with 30 g to 40 g daily is important for many reasons, including improving the quality of stool and preventing colorectal and anal diseases.In this Special Report, we provide an overview of commonly encountered anal problems, their presentation, initial treatment options, and recommendations for referral to specialists.
Chang, Jason; McLemore, Elisabeth; Tejirian, Talar
Despite the fact that countless patients suffer from anal problems, there tends to be a lack of understanding of anal health care. Unfortunately, this leads to incorrect diagnoses and treatments. When treating a patient with an anal complaint, the primary goals are to first diagnose the etiology of the symptoms correctly, then to provide an effective and appropriate treatment strategy. The first step in this process is to take an accurate history and physical examination. Specific questions include details about bowel habits, anal hygiene, and fiber supplementation. Specific components of the physical examination include an external anal examination, a digital rectal examination, and anoscopy if appropriate. Common diagnoses include pruritus ani, anal fissures, hemorrhoids, anal abscess or fistula, fecal incontinence, and anal skin tags. However, each problem presents differently and requires a different approach for management. It is of paramount importance that the correct diagnosis is reached. Common errors include an inaccurate diagnosis of hemorrhoids when other pathology is present and subsequent treatment with a steroid product, which is harmful to the anal area. Most of these problems can be avoided by improving bowel habits. Adequate fiber intake with 30 g to 40 g daily is important for many reasons, including improving the quality of stool and preventing colorectal and anal diseases. In this Special Report, we provide an overview of commonly encountered anal problems, their presentation, initial treatment options, and recommendations for referral to specialists. PMID:27723447
Nnenna Okpara; Bassam Aswad; Gyorgy Baffy
Eosinophilic colitis (EC) is a rare form of primary eosinophilic gastrointestinal disease with a bimodal peak of prevalence in neonates and young adults. EC remains a little understood condition in contrast to the increasingly recognized eosinophilic esophagitis. Clinical presentation of EC is highly variable according to mucosal, transmural, or serosal predominance of inflammation. EC has a broad differential diagnosis because colon tissue eosinophilia often occurs in parasitic infection, drug-induced allergic reactions,inflammatory bowel disease, and various connective tissue disorders, which require thorough searching for secondary causes that may be specifically treated with antibiotics or dietary and drug elimination.Like eosinophilic gastrointestinal disease involving other segments of the gastrointestinal tract, EC responds very well to steroids that may be spared by using antihistamines, leukotriene inhibitors and biologics.
Camila Aparecida Borges
Full Text Available Resumo: Objetivo: Descrever as soluções adotadas nas múltiplas etapas de utilização das técnicas multivariadas para obtenção de padrão alimentar (PA no que tange: ao objetivo dos estudos, à escolha do método de aferição do consumo alimentar, aos critérios de grupamento dos alimentos, à quantidade de grupos alimentares utilizada, ao número de PA extraído e aos critérios para nomenclatura. Métodos: Foram selecionadas publicações das bases MEDLINE e Lilacs tendo como descritores: "padrão alimentar" versus "análise fatorial"; "análise de componentes principais"; "análise de cluster " e "reduced regression rank ". A busca inicial resultou em 1.752 artigos, que após critérios de inclusão e exclusão somaram 189 publicações. Resultados: Foram relevantes entre os estudos os seguintes aspectos: a predominância da análise de componentes principais (ACP; a predominância no uso de 4 a 5 PAs nos estudos de associação com desfechos de saúde; o uso de 30 ou mais grupos de alimentos provenientes do Questionário de Frequência Alimentar (QFA; a predominância de estudos que associaram PAs com desfechos de saúde e fatores socioeconômicos; a heterogeneidade de critérios adotados ao longo das etapas analíticas das técnicas multivariadas. Conclusão: A heterogeneidade entre as publicações se concentra nos critérios de agrupamento dos alimentos, na nomenclatura e no número de padrões alimentares extraídos, que variou em função do número de grupos alimentares presentes nas análises. Entender, aplicar e explorar em sua totalidade as técnicas multivariadas tem se tornado necessário para melhorar a confiabilidade dos resultados e, consequentemente, aprimorar as relações com desfechos de saúde e fatores socioeconômicos.
Este artículo se compone de dos partes. En la primera se identifican las tendencias que enmarcan las transformaciones ocurridas en la industria de artes gráficas, imprentas y editoriales en las dos últimas décadas del siglo XX. Entre estas se destacan la conformación de grupos empresariales en medio de un notable impacto del cambio técnico impulsado por la digitalización de la producción gráfica y una acelerada convergencia tecnológica que propicia la integración de la industria gráfica con l...
permite situar cada línea en su posición real en el espacio. Estos modelos de líneas son transparentes, lo que impide ocultar las líneas que su sitúan en un segundo plano, y ocupan gran cantidad de memoria, lo que dificulta su manipulación informática. Para resolver ese problema es necesario descomponer el modelo 3D por archivos y capas de dibujo. Cada archivo de dibujo incluye las líneas restituidas de un elemento constructivo y se identifica por la tipología del elemento y su posición en el espacio del edificio. Las líneas se separan en capas según su orientación geográfica y su tipología (arista, contorno, fisura, etc.. La gestión del conjunto de archivos que componen el modelo 3D se realiza directamente por designación o gráficamente mediante un plano guía simplificado en el que cada línea es una llamada a un archivo. El modelo 3D analítico en una maqueta informática del monumento que nos permite visualizaciones y análisis métricos, geométricos, constructivos y estructurales imposibles sin esta herramienta. Al conectar informáticamente cada una de las entidades dibujadas con un sistema de bases de datos externo de los estudios del monumento se establecerá lo que conocemos como «Monument Information System», MIS.
Yuan, Shan; Reyes, Victoria; Bronner, Mary P
The classic clinical and histologic features of collagenous colitis are well characterized; however, the acute or neutrophilic inflammatory changes that may accompany this entity are less well established. In this report of 10 patients, we describe the first series of pseudomembranous collagenous colitis. Because superimposed Clostridium difficile infection was only demonstrated in one patient and no other causes of pseudomembranous colitis were evident in the remaining nine patients, we conclude that pseudomembranes are part of the spectrum of collagenous colitis itself. This case series illustrates the importance of searching for collagenous colitis in the evaluation of pseudomembranous colitis. At the same time, superimposed infectious or ischemic etiologies need to be excluded clinically in any patient with superimposed pseudomembranes. The existence of pseudomembranes in collagenous colitis also lends support to the hypothesis that toxin- and/or ischemia-mediated injury may be involved in the pathogenesis of collagenous colitis.
D.B. de Lima
Full Text Available Múltiplos agentes estão envolvidos na etiopatogenia da diarréia em Aids. O exame de fezes e a colonoscopia são elementos decisivos para o diagnóstico específico. A enterocolite por CMV pode cursar com febre, emagrecimento, diarréia intermitente e hematoquesia. Outros agentes causadores de diarréia podem ter o mesmo espectro de apresentação. OBJETIVO: Definir o perfil clínico da enterocolite por CMV em pacientes com Aids, comparando os parâmetros clínicos, endoscópicos e de tempo de sobrevida entre dois grupos com diarréia crônica, grupo A com CMV e grupo B sem CMV. MÉTODOS: Foram acompanhados 48 pacientes com Aids e diarréia de duração maior que 30 dias, sendo 27 do grupo A e 21 do grupo B. Os parâmetros analisados foram idade, situação de risco, duração da diarréia, hematoquesia, intervalo de tempo entre diagnóstico da infecção por HIV e início de diarréia, achados endoscópicos e sobrevida. Foram realizados exames parasitológicos, culturas e colonoscopia com biópsias. Foi utilizado o teste "t-student" para amostras não pareadas e o teste Qui-Quadrado com correção de Yates para variáveis não paramétricas. Foram construídas curvas de sobrevida pelo método descrito por Kaplan-Meier e aplicado o teste de Mantel - Haenszel. Foi assumido como nível de significância estatística o valor de P menor que 0.05. RESULTADOS: O padrão endoscópico da infecção por CMV correspondeu a ulcerações associadas a hemorragia de submucosa 14 (51.8% P P > 0.001. Os outros parâmetros estudados não mostraram significância estatística. CONCLUSÕES: A presença de enterocolite por CMV em Aids é marcador de mau prognóstico e menor sobrevida. Existe um padrão endoscópico sugestivo da infecção por CMV.OBJECTIVE: To determine the clinical profile of CMV colitis in AIDS patients, comparing clinical, endoscopic parameters and survival time between 2 groups of AIDS patients having chronic diarrhea. Group A being CMV
Paredes, E.; Gallego, R; A.M. CANAL; ARAYA, O.; E. CHAHUÁN; Thomas, P; Zamora, J
Se describe, por primera vez en el país, el aislamiento de Rhodococcus equi a partir de una infección en un potrillo de 3 meses de edad, que sufría de enteritis y neumonía crónica. También, se dan a conocer las lesiones constatadas en el examen postmortem e histopatológico, consistentes en nódulos pulmonares múltiples con zonas de inflamación crónica, necrosis central con exudado purulento y nódulos linfáticos bronquiales aumentados de tamaño: hiperémicos y exudativos. Además, el colon mayor ...
Sneider, Erica B; Maykel, Justin A
Benign anorectal diseases, such as anal abscesses and fistula, are commonly seen by primary care physicians, gastroenterologists, emergency physicians, general surgeons, and colorectal surgeons. It is important to have a thorough understanding of the complexity of these 2 disease processes so as to provide appropriate and timely treatment. We review the pathophysiology, presentation, diagnosis, and treatment options for both anal abscesses and fistulas.
Simon P Bach; Neil J Mortensen
Ulcerative colitis (UC) is a relapsing and remitting disease characterised by chronic mucosal and submucosal inflammation of the colon and rectum.Treatment may vary depending upon the extent and severity of inflammation. Broadly speaking medical treatments aim to induce and then maintain remission.Surgery is indicated for inflammatory disease that is refractory to medical treatment or in cases of neoplastic transformation. Approximately 25% of patients with UC ultimately require colectomy. Ileal pouch-anal anastomosis (IPAA) has become the standard of care for patients with ulcerative colitis who ultimately require colectomy. This review will examine indications for IPAA, patient selection, technical aspects of surgery,management of complications and long term outcome following this procedure.
Rigidez do papelão ondulado: comparação entre resultados experimentais e os obtidos por cálculo analítico Bending stiffness evaluation of cardboard: comparison between experimental and analytically results
Paulo G. Magalhães
Full Text Available Embalagens de papelão ondulado para produtos hortícolas têm como função principal a proteção do produto. O dimensionamento de uma embalagem de papelão requer o conhecimento da rigidez à flexão, que depende dos módulos de elasticidade dos elementos que o constituem. Este trabalho teve por objetivo calcular, a partir da caracterização física do papelão em laboratório, o módulo de elasticidade por diferentes métodos, comparando os resultados com os valores obtidos experimentalmente. Dez corpos de prova de cada um dos papéis selecionados para este estudo foram testados na direção de fabricação e na direção transversal. A resistência à tração dos papéis, capa e miolo, utilizada para calcular a rigidez, foi determinada em máquina universal de ensaios. Para a obtenção da rigidez à flexão, foi realizado o teste de quatro pontos. Foi observada expressiva variação entre os métodos pelos quais se obtêm os módulos de elasticidade que reflete nos valores de rigidez da estrutura. Os valores de rigidez obtidos experimentalmente foram sempre superiores aos valores obtidos por cálculos analíticos. Essa diferença pode ser atribuída a dois fatores conjugados: o processo de fabricação que confere maior rigidez do que os componentes isoladamente, e o outro componente é a adição de camada adesiva que não é levada em consideração nos cálculos analíticos.Cardboard packing for horticultural products has as main function to protect them. The design of a cardboard packing request the knowledge of the bending stiffens which is depending on the modulus of elasticity. The objective of this work was to calculate the cardboard modulus of elasticity from data obtained in laboratory using physical characterization test, with different methods, and comparing the results with the values obtained experimentally. Ten samples of each cardboard selected for this study were tested in the paper fabrication direction and in its
PURPOSE: Ileal pouch-anal anastomosis remains the "gold standard" in surgical treatment of ulcerative colitis and familial adenomatous polyposis. Pouchitis occurs mainly in patients with a background of ulcerative colitis, although the reasons for this are unknown. The aim of this study was to characterize differences in pouch bacterial populations between ulcerative colitis and familial adenomatous pouches. METHODS: After ethical approval was obtained, fresh stool samples were collected from patients with ulcerative colitis pouches (n = 10), familial adenomatous polyposis (n = 7) pouches, and ulcerative colitis ileostomies (n = 8). Quantitative measurements of aerobic and anaerobic bacteria were performed. RESULTS: Sulfate-reducing bacteria were isolated from 80 percent (n = 8) of ulcerative colitis pouches. Sulfate-reducing bacteria were absent from familial adenomatous polyposis pouches and also from ulcerative colitis ileostomy effluent. Pouch Lactobacilli, Bifidobacterium, Bacteroides sp, and Clostridium perfringens counts were increased relative to ileostomy counts in patients with ulcerative colitis. Total pouch enterococci and coliform counts were also increased relative to ileostomy levels. There were no significant quantitative or qualitative differences between pouch types when these bacteria were evaluated. CONCLUSIONS: Sulfate-reducing bacteria are exclusive to patients with a background of ulcerative colitis. Not all ulcerative colitis pouches harbor sulfate-reducing bacteria because two ulcerative colitis pouches in this study were free of the latter. They are not present in familial adenomatous polyposis pouches or in ileostomy effluent collected from patients with ulcerative colitis. Total bacterial counts increase in ulcerative colitis pouches after stoma closure. Levels of Lactobacilli, Bifidobacterium, Bacteroides sp, Clostridium perfringens, enterococci, and coliforms were similar in both pouch groups. Because sulfate-reducing bacteria are
... enabled to enjoy the full interactive experience. Crohn's & Colitis Foundation of America Find a Doctor Find a ... Local Chapters News Events Search: What are Crohn's & Colitis? What is Crohn's Disease What is Ulcerative Colitis ...
Yaman, Aytaç; Kuloğlu, Zarife; Doğu, Figen; İkincioğulları, Aydan; Ensari, Arzu; Çiftçi, Ergin; Kansu, Aydan
Chronic granulomatous disease (CGD) is an autosomal recessive or X-linked disorder caused by NADPH oxidase deficiency leading to an impaired ability of reactive superoxide anion and metabolite formation and recurring severe bacterial and fungal infections, with a high mortality rate. Diarrhea, colitis, ileus, perirectal abscess formation and anal fissures are reported gastrointestinal findings in these patients. We report a case of intractable colitis associated with CGD in a young girl.
Full Text Available Desenvolveu-se e validou-se método analítico simples, rápido e específico para quantificação de meloxicam (inibidor da COX-2 em plasma humano através da cromatografia líquida de alta eficiência, para aplicação em estudos de bioequivalência. Piroxicam foi utilizado como padrão interno. Empregou-se cromatografia em fase reversa com coluna modelo Synergi RP-MAX (150 x 4,6 mm, à temperatura de 30 ºC e fase móvel constituída por mistura de acetonitrila e tampão fosfato 0,025 mol/L pH 4,5 (40:60, v/v, a um fluxo de 1,0 mL/min. Os analitos foram detectados por UV a 364 nm. As amostras de plasma foram acidificadas com ácido clorídrico 1 mol/L, extraídas utilizando-se éter terc-butil metílico e, após filtração e secagem, o resíduo foi reconstituído em 250 mL de fase móvel para injeção em CLAE. Os tempos de retenção para meloxicam (padrão e piroxicam (padrão interno foram 3,35 e 4,19 minutos, respectivamente. Este método apresentou linearidade na faixa de concentração entre 50-4000 ng/mL (R² = 0,9995, com limite de quantificação inferior de 50 ng/mL e exatidão de 114%. O método analítico desenvolvido neste trabalho demonstrou especificidade, linearidade, precisão e exatidão adequadas, permitindo sua aplicação em ensaios de bioequivalência.A simple, rapid and specific high-performance liquid cromatographic (HPLC method was developed and validated to estimate meloxicam (COX-2 inhibitor levels in human plasma. Piroxicam was used as internal standard. Reversed phase chromatography was conducted using a Synergi RP-MAX (150 x 4.6 mm column at 30 ºC and a mobile phase of acetonitrile and 0.025 mol/L pH 4,5 phosphate buffer (40:60, v/v, at a flow rate of 1mL/min. Analytes were detected at 364 nm. Plasma samples were acidified with 1 mol/L hydrochloric acid and extracted with tert-butyl methyl ether, evaporated to dryness, reconstituted in 250 mL of mobile phase and injected in the column. The retention time of
Ljungmann, K.; Bendixen, A.; Laurberg, S.;
INTRODUCTION: Restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) has become the operation of choice for patients with ulcerative colitis and familial polyposis. However, the procedure is complex with a long learning curve, and carries a risk of both early and late complications...
Fesneau, M.; Champeaux-Orange, E. [Service de radiotherapie, Centre regional universitaire de cancerologie Henry-S.-Kaplan CHU de Tours, Hopital Bretonneau, 37 - Tours (France); Champeaux-Orange, E. [Service d' oncologie-radiotherapie, Centre hospitalier regional d' Orleans, 45 - Orleans (France); Hennequin, C. [Service de cancerologie-radiotherapie, hopital Saint-Louis, 75 - Paris (France)
Anal canal epidermoid carcinomas represent 1.2% of digestive cancers and 6% of ano-rectal cancers. For localized diseases, the treatment is based on radiotherapy with or without chemotherapy (5-FU and cisplatin or mitomycin), according to tumour and nodal extension. The recommended treatment dose is 45 Gy in the anal canal, the mesorectum, para-rectal lymph nodes, and inguinal lymph nodes. An additional dose of 15 to 20 Gy is delivered in the initial tumour for good responders. Salvage surgery is necessary in case of poor response. The organs at risk to be considered are bladder, femur heads, small intestine and vulva. The objective of this work is to summarize the epidemiological and radio-anatomic and prognostic characteristics of this tumour. The conformal radiotherapy technique is illustrated by a case report. (authors)
Newsom-Davis, Thomas; Bower, Mark
HIV-associated anal carcinoma, a non-AIDS-defining cancer, is a human papillomavirus-associated malignancy with a spectrum of preinvasive changes. The standardized incidence ratio for anal cancer in patients with HIV/AIDS is 20-50. Algorithms for anal cancer screening include anal cytology followed by high-resolution anoscopy for those with abnormal findings. Outpatient topical treatments for anal intraepithelial neoplasia include infrared coagulation therapy, trichloroacetic acid, and imiqui...
Beck, Andrew; McNeil, Candice; Abdelsayed, George; Chin-Lue, Roland; Kassis, Simon; Manthous, Constantine A
Pseudomembranous colitis is most often associated with antibiotic use and caused most often by Clostridium difficile. Aclinical syndrome and pathology that is identical can be caused rarely by other organisms. We report a case of Salmonella enterica pseudomembranous colitis and briefly review the literature regarding rare causes of this syndrome.
Wörmann, B; Höchter, W; Seib, H J; Ottenjann, R
We report on a 45-year-old woman with ulcerative colitis of the rectum that arose after the use of up to 6 suppositories of a preparation containing ergotamine daily over a period of 6 years. On the basis of a review of the literature the clinical, endoscopic and histological features of the ergotamine-induced colitis are characterized.
Hugh James Freeman
Microscopic forms of colitis have been described, including collagenous colitis. This disorder generally has an apparently benign clinical course. However, a number of gastric and intestinal complications, possibly coincidental, may develop with collagenous colitis. Distinctive inflammatory disorders of the gastric mucosa have been described, including lymphocytic gastritis and collagenous gastritis. Celiac disease and collagenous sprue (or collagenous enteritis) may occur. Colonic ulceration has been associated with use of nonsteroidal anti-inflammatory drugs, while other forms of inflammatory bowel disease, including ulcerative colitis and Crohn's disease, may evolve from collagenous colitis. Submucosal "dissection", colonic fractures or mucosal tears and perforation from air insufflation during colonoscopy may occur and has been hypothesized to be due to compromise of the colonic wall from submucosal collagen deposition. Similar changes may result from increased intraluminal pressure during barium enema contrast studies. Finally, malignant disorders have also been reported, including carcinoma and lymphoproliferative disease.
Castro Rubio, Florentina
Debido a la ausencia de métodos analíticos fiables, en este trabajo, se han desarrollado y validado nuevas metodologías analíticas para la determinación de proteínas de soja en productos cárnicos crudos y procesados utilizando HPLC con fases estacionarias perfusivas. Las metodologías desarrolladas consistían en el desgrasado de las muestra con acetona, solubilización de las proteínas de soja en un medio salino a pH básico y análisis de las proteínas extraídas por Cromatografía Líquida de Alt...
Juan Carlos Cataño Correa
Full Text Available El cáncer anal solía ser una neoplasia infrecuente que afectaba principalmente a mujeres y personas mayores de 65 años, pero recientemente su incidencia ha venido en aumento debido a la pandemia de VIH, fenómeno que tiende a empeorar porque la terapia antirretroviral altamente activa (HAART, por su sigla en inglés no solo alarga la vida de los pacientes, sino que al mismo tiempo hace posible una prolongada evolución de las lesiones precancerosas que conducen a cáncer anal; además, está plenamente demostrado que la HAART no evita la evolución de las lesiones intraepiteliales escamosas hacia cáncer anal. La citología anal ha demostrado ser una prueba de tamización poblacional útil y costoefectiva para el diagnóstico de las lesiones precancerosas producidas por Papilomavirus humano en el canal anal de hombres homosexuales y bisexuales, principalmente de aquellos positivos para VIH. Esta revisión tiene como objetivo llamar la atención sobre la creciente incidencia de cáncer anal en la población de pacientes VIH positivos, y sobre la utilidad del diagnóstico temprano utilizando la citología anal en este grupo de pacientes de riesgo. Anal cancer used to be an uncommon neoplasia that affected mainly women and people aged over 65 years, but recently its incidence has been growing, mostly due to the HIV pandemic, and it will become worse because highly active antiretroviral therapy (HAART at the same time that lengthens life expectancy in HIV positive subjects, will increase the possibility to develop anal cancer; it has already been demonstrated that HAART does not prevent the evolution of intraepithelial squamous lesions to anal cancer. Anal cytology has demonstrated to be an useful and cost-effective screening tool for detection of precancerous lesions associated with human Papillomavirus (HPV infection in the anal canal of homosexual and bisexual men, specially in those that are HIV positive. This article is an update of the
Full Text Available Obstetric anal sphincter injuries can be associated with significant short and long term consequences causing devastating impacts on the quality of lives of young, otherwise healthy women. The major consequence is anal incontinence which may be short or long term and vary in severity. The other consequences include pain, infection, dyspareunia and sexual dysfunction. This may in turn result in considerable economic burden to health care providers and patients. It also has an implication on future deliveries. Although it can never be eliminated, it can be reduced by improving practice, training and provision of high quality multidisciplinary care in order to reduce long-term morbidity. Obstetric anal sphincter injuries are also a source of litigation which can be distressing to both patients and clinicians. The aim of this review article is to explore the available evidence on epidemiology, strategies for preventions, prognosis and also how to deal with governance issues.
Remon Keriakos; Deepa Gopinath
Obstetric anal sphincter injuries can be associated with significant short and long term consequences causing devastating impacts on the quality of lives of young, otherwise healthy women. The major consequence is anal incontinence which may be short or long term and vary in severity. The other consequences include pain, infection, dyspareunia and sexual dysfunction. This may in turn result in considerable economic burden to health care providers and patients. It also has an implication on future deliveries. Although it can never be eliminated, it can be reduced by improving practice, training and provision of high quality multidisciplinary care in order to reduce long-term morbidity. Obstetric anal sphincter injuries are also a source of litigation which can be distressing to both patients and clinicians. The aim of this review article is to explore the available evidence on epidemiology, strategies for preventions, prognosis and also how to deal with governance issues.
... 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 ...
BANNURA C,GUILLERMO; ROSS R,GONZALO; GABLER N,FERNANDO; ESPERGUEL G,CARLOS
Se presenta el caso de una paciente de 46 años sometida a una artroplastía de cadera bilateral que presenta diarrea secundaria a infección por Clostridium difficile (CD), que fi1e tratada con metronidazol y vancomicina por 10 días con buena evolución. Reingresa 3 días después con un cuadro caracterizado por fiebre, compromiso del estado general, diarrea, distensión abdominal, deshidratación y signos de hipotensión. La tomografía computada (TC) mostró imágenes compatibles con colitis pseudomem...
Alina Torreblanca Xiques
La colitis ulcerativa es una enfermedad crónica, inflamatoria y ulcerosa, que se origina en la mucosa del colon y se caracteriza por la inflamación crónica del tracto gastrointestinal, casi siempre por una diarrea, que puede ser profusa y sanguinolenta. Se trata de un paciente masculino, de 35 años de edad, de raza blanca, con antecedentes de salud previa, que acude al médico por presentar desde hace cuatro meses diarreas con sangre, moco y pus, acompañado de dolor abdominal, astenia, anorexi...
de Parades, V; Zeitoun, J-D; Atienza, P
Fistula arising from the glands of the anal crypts is the most common form of anoperineal sepsis. It is characterized by a primary internal orifice in the anal canal, a fistulous tract, and an abscess and/or secondary perineal orifice with purulent discharge. Antibiotics are not curative. The treatment of an abscess is urgent and consists, whenever possible, of incision and drainage under local anesthesia. Definitive treatment of the fistulous tract can await a second stage. The primary aim is to control infection without sacrificing anal continence. Fistulotomy is the basis for all treatments but the specific technique depends on the height of the fistula in relation to the sphincteric mechanism. Overall results of fistulotomy are excellent but there is some risk of anal incontinence. This explains the growing interest in sphincter sparing techniques such as the mucosal advancement flap, the injection of fibrin glue, and the plug procedure. However, results of these procedures are not yet good enough and leave much room for improvement.
Effect of soluble fiber or fructooligosaccharide supplementation upon trinitrobenzenesulphonic acid induced colitis in rats Efeito da suplementação de fibra solúvel ou frutooligossacarídeo na colite induzida por ácido trinitrobenzenossulfônico em ratos
Sthela Maria Murad-Regadas
Full Text Available PURPOSE: To evaluate the effect of soluble fiber or fructooligosaccharide (FOS supplementation upon trinitrobenzene sulphonic acid (TNBS-induced colitis in rats. METHODS: 64 Wistar rats were given water, soluble fiber or FOS intragastrically during 14 days prior to colitis induction with TNBS (n=48 or rectal enema with water (n=16; control group. On the 7th or 14th day following colitis induction the rats were weighed and euthanized in order to determine the colon weight/length ratio and macroscopic and microscopic scores. RESULTS: On the 7th day following colitis induction the body weight had decreased significantly, the colon weight/length ratio had increased and macroscopic and microscopic colon lesions were observed. On the 14th day following colitis induction no difference in body weight was observed, in spite of the persistence of macroscopic and microscopic lesions and increased colon weight/length ratio. Supplementation with soluble fiber or FOS did not revert colon lesions or any of the study parameters. Supplementation with FOS, but not with fiber, was associated with increased colon weight/length ratio on the 14th day. CONCLUSION: Supplementation with soluble fiber or FOS produced no significant impact on TNBS-induced colitis in rats.OBJETIVO: Avaliar a suplementação de fibra solúvel ou frutooligossacarídeos (FOS na colite induzida por TNBS em ratos. MÉTODOS: Sessenta e quatro ratos Wistar receberam por gavagem água, fibra solúvel ou FOS. Após 14 dias, foram submetidos à indução de colite com TNBS. O grupo controle recebeu água por gavagem e por enema retal. Decorridos 7 ou 14 dias, após a avaliação do peso, os ratos foram sacrificados e o peso do colo, escores macroscópicos e microscópicos da lesão cólica foram aferidos. RESULTADOS: No 7º dia após indução da colite, houve uma significativa diminuição do peso dos ratos, um aumento do peso do cólon e lesão cólica macroscópica/microscópica. A suplementa
Sherid, Muhammed; Sifuentes, Humberto; Samo, Salih; Deepak, Parakkal; Sridhar, Subbaramiah
Ischemic colitis accounts for 6%-18% of the causes of acute lower gastrointestinal bleeding. It is often multifactorial and more commonly encountered in the elderly. Several medications have been implicated in the development of colonic ischemia. We report a case of a 54-year old woman who presented with a two-hour history of nausea, vomiting, abdominal pain, and bloody stool. The patient had recently used lubiprostone with close temporal relationship between the increase in the dose and her symptoms of rectal bleeding. The radiologic, colonoscopic and histopathologic findings were all consistent with ischemic colitis. Her condition improved without any serious complications after the cessation of lubiprostone. This is the first reported case of ischemic colitis with a clear relationship with lubiprostone (Naranjo score of 10). Clinical vigilance for ischemic colitis is recommended for patients receiving lubiprostone who are presenting with abdominal pain and rectal bleeding.
Montoya, Eduardo; Torres, Blanca
El presente trabajo describe un sistema simple que permite al análisis por espectrofotometría de absorción atómica con llama (FAAS) mediante FIA, la conocida técnica de promediado conjunto de la señal analítica con la finalidad de incrementar la relación señal / ruido, mejorando los límites de detección obtenibles en un laboratorio con equipamiento corriente.
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.
de Parades, Vincent; Zeitoun, Jean-David; Bauer, Pierre; Atienza, Patrick
Cryptoglandular anal fistulae are the most frequently occurring form of perianal sepsis. Characteristically they have an endoanal primary opening, a fistula track and an abscess and/or an external purulent opening. Antibiotic therapy is not of use in initial management except in special cases. Treatment of an abscess, if present, is required urgently and when possible, consists of its incision under local anaesthesia. Treating the fistula track occurs afterwards and aims to dry up the purulent discharge and avoid recurrence of the abscess by means of surgical fistulotomy. These techniques are very effective in terms of eradication of the problem but there is sometimes a risk of anal incontinence. This explains the increasing interest in sphincter preserving techniques using the advancement of a covering flap of rectal mucosa and the injection of fibrin glue.
Landi, E; Landa, L; Fianchini, A; Marmorale, C; Piloni, V
Restorative proctocolectomy with various types of reservoir is widely used in the elective surgery of ulcerative colitis and familial adenomatous polyposis. Both, advantages and disadvantages of this procedure are well known and documented. Straight ileo-anal anastomosis (IAA) yields unsatisfactory clinical results due to the lack of storage capacity of the distal ileum and the frequency of bowel movements related to high pressure ileal waves. In an attempt to create an alternative to the above procedures, we have performed a straight ileo-anal anastomosis with two rectangular (10 cm x 1 cm) myectomies down to 2 cm, above the anastomotic line. The two myectomies are spaced at 120 degrees to each other and to the mesenteric border of the ileal loop. The rationale of this approach is to reduce the peristaltic drive of the ileum by weakening the muscular wall. This study presents the results in three patients operated on with this new method in the last year.
Nielsen, O.H.; Vainer, B.; Rask-Madsen, J.
A wide range of etiologies and pathogenic mechanisms underlie colitis. This Review provides and overview of the pathophysiology, epidemiology, histopathology, and clinical characteristics of noninfectious and non-IBD forms of colitis: microscopic colitis, Behcet's syndrome, diversion colitis......, diverticular colitis, eosinophilic colitis, ischemic colitis, and radiation colitis. These more recently characterized and rare forms of colitis occur as either primary conditions or complications of other diseases. Most of these diseases are uncommon; therefore, epidemiologic data and data from controlled...... trials are not readily available. Practical guidelines for the diagnosis and therapy of these more recently characterized and rarer forms of colitis are given where possible Udgivelsesdato: 2008/1...
Nielsen, Ole Haagen; Vainer, Ben; Rask-Madsen, Jørgen
A wide range of etiologies and pathogenic mechanisms underlie colitis. This Review provides an overview of the pathophysiology, epidemiology, histopathology, and clinical characteristics of noninfectious and non-IBD forms of colitis: microscopic colitis, Behçet's syndrome, diversion colitis......, diverticular colitis, eosinophilic colitis, ischemic colitis, and radiation colitis. These more recently characterized and rare forms of colitis occur as either primary conditions or complications of other diseases. Most of these diseases are uncommon; therefore, epidemiologic data and data from controlled...... trials are not readily available. Practical guidelines for the diagnosis and therapy of these more recently characterized and rarer forms of colitis are given where possible....
Bejarano, Pablo A; Boutros, Marylise; Berho, Mariana
Diagnosis, follow up, and treatment of anal intraepithelial neoplasia are complex and not standardized. This may be partly caused by poor communication of biopsy and cytology findings between pathologists and clinicians as a result of a disparate and confusing terminology used to classify these lesions. This article focuses on general aspects of epidemiology and on clarifying the current terminology of intraepithelial squamous neoplasia, its relationship with human papilloma virus infection, and the current methods that exist to diagnose and treat this condition.
Omega 3 fatty acids supplementation has an ameliorative effect in experimental ulcerative colitis despite increased colonic neutrophil infiltration Los suplementos de ácidos grasos omega 3 tienen efectos beneficiosos en colitis ulcerosa a pesar del aumento de la infiltracción por neutrófilos del colon
Full Text Available Purpose: omega 3 polyunsaturated fatty acids have anti-inflammatory properties and can be beneficial in the treatment of inflammatory diseases, such as ulcerative colitis. Dextran sodium sulphate (DSS colitis in rats appears to mimic nearly all of the morphological characteristics and lesion distributions of ulcerative colitis. The purpose of the current study was to investigate the efficacy of omega 3 fatty acids in the treatment of experimental ulcerative colitis. Methods: thirty-six Wistar rats were randomly assigned to group A or group B receiving 5% dextran sulfate sodium (DSS in their drinking water for eight days. For the next eight days post-DSS, group A animals received tap-water, and group B animals were fed a nutritional solution containing high levels of omega 3 polyunsaturated fatty acids (ProSure®, Abbott Laboratories, Zwolle, Netherlands once per day, administrated with a orogastric feeding tube. Results: animals fed an omega 3 rich diet exhibited a statistically significant increase in hematocrit and hemoglobin levels, compared to animals drinking tap water, and a trend towards histopathological and clinical improvement, with the administration of omega 3 fatty acids ameliorating epithelial erosion by day 8 post-DSS, but no statistically significant difference was observed between group A and group B animals at 4 or 8 days post-DSS. Also, a statistically significant increase in neutrophil infiltration was observed, as depicted by myelohyperoxidase activity. Conclusion: our findings support a positive role of omega 3 polyunsaturated fatty acids supplementation in an experimental model of ulcerative colitis despite the increased colonic neutrophil infiltration. Further studies are needed in order to investigate the role of increased neutrophils in colonic mucosa.
Cystic fibrosis (CF) patients may require frequent courses of antibiotics and repeated hospital admissions. Although children with CF have high carriage rate for C.difficile, they rarely develop colitis. Pseudomembranous colitis is more common in adult post lung transplant CF patients. Although rare, paseudomembranous colitis should be considered in CF patients presenting with abdominal symptoms even in the absence of diarrhoea.
Hipoalbuminemia como factor asociado con sobreanticoagulación por Warfarina durante los primeros 4 días de tratamiento en pacientes mayores de 60 años estudio observacional analítico de cohorte prospectivo concurrente
Mesa Urdinola, Alejandro
Objetivo: Determinar si existe relación entre la hipoalbuminemia y el incremento del International Normalized Ratio (INR) en pacientes de 60 a más años en tratamiento con warfarina durante los primeros 4 días de tratamiento. Diseño: Estudio observacional analítico de cohorte concurrente. Lugar: Hospital Universitario de San Ignacio Bogotá, Colombia. Población: 174 pacientes mayores de 60 años hospitalizados en el Hospital Universitario San Ignacio entre agosto de 2008 y septiembre de 2010 c...
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.
Adriana Chebar Lozinsky
Full Text Available OBJECTIVE: To review the literature for clinical data on infants with allergic or eosinophilic colitis. DATA SOURCE: MEDLINE search of all indexes was performed using the words ''colitis or procto-colitis and eosinophilic'' or ''colitis or proctocolitis and allergic'' between 1966 and February of 2013. All articles that described patients' characteristics were selected. DATA SYNTHESIS: A total of 770 articles were identified, of which 32 met the inclusion criteria. The 32 articles included a total of 314 infants. According to the available information, 61.6% of infants were male and 78.6% were younger than 6 months. Of the 314 patients, 49.0% were fed exclusively breast milk, 44.2% received cow's milk protein, and 6.8% received soy protein. Diarrheal stools were described in 28.3% of patients. Eosinophilia was found in 43.8% (115/263 of infants. Colonic or rectal biopsy showed infiltration by eosinophils (between 5 and 25 perhigh-power field in 89.3% (236/264 of patients. Most patients showed improvement with theremoval of the protein in cow's milk from their diet or the mother's diet. Allergy challenge tests with cow's milk protein were cited by 12 of the 32 articles (66 patients. CONCLUSIONS: Eosinophilic colitis occurs predominantly in the first six months of life and in males. Allergy to cow's milk was considered the main cause of eosinophilic colitis. Exclusion of cow'smilk from the diet of the lactating mother or from the infant's diet is generally an effective therapeutic measure.
The focus of this article is the anatomy and histology of the anal canal, and its clinical relevance to anal cancers. The article also highlights the recent histological and anatomical changes to the traditional terminology of the anal canal. The terminology has been adopted by the American Joint Committee on Cancer, separating the anal region into the anal canal, the perianal region and the skin. This paper describes the gross anatomy of the anal canal, along with its associated blood supply, venous and lymphatic drainage, and nerve supply. The new terminology referred to in this article may assist clinicians and health care providers to identify lesions more precisely through naked eye observation and without the need for instrumentation. Knowledge of the regional anatomy of the anus will also assist in management decisions.
Pravin J. Gupta
AIM: Hypertrophied anal papillae and fibrous anal polyps are not given due importance in the proctology practice.They are mostly ignored being considered as normal structures. The present study was aimed to demonstrate that hypertrophied anal papillae and fibrous anal polyps could cause symptoms to the patients and that they should be removed in treatment of patients with chronic fissure in anus.METHODS: Two groups of patients were studied. A hundred patients were studied in group A in which the associated fibrous polyp or papillae were removed by radio frequency surgical device after a lateral subcutaneous sphincterotomy for relieving the sphincter spasm. Another group of a hundred patients who also had papillae or fibrous polyps, were treated by lateral sphincterotomy alone. They were followed up for one year.RESULTS: Eighty-nine percent patients from group A expressed their satisfaction with the treatment in comparison to only 64% from group B who underwent sphincterotomy alone with the papillae or anal polyps left untreated. Group A patients showed a marked reduction with regard to pain and irritation during defecation (P= 0.0011),pricking or foreign body sensation in the anus (P = 0.0006)and pruritus or wetness around the anal verge (P = 0.0008).CONCLUSION: Hypertrophied anal papillae and fibrous anal polyps should be removed during treatment of chronic anal fissure. This would add to effectiveness and completeness of the procedure.
Uno de los desafíos actuales para los estudios sobre movilidad y transporte en América Latina es adoptar un enfoque multidimensional de la movilidad que trascienda la noción más estrecha de desplazamiento o viaje y que, a la vez, permita integrar este tema a la discusión más general acerca del efecto de la movilidad sobre la pobreza y la exclusión social. Este artículo aborda el desafío y propone un marco analítico que recoja la -aún incipiente en nuestra región- experiencia teórico-empírica ...
Alina Torreblanca Xiques
Full Text Available La colitis ulcerativa es una enfermedad crónica, inflamatoria y ulcerosa, que se origina en la mucosa del colon y se caracteriza por la inflamación crónica del tracto gastrointestinal, casi siempre por una diarrea, que puede ser profusa y sanguinolenta. Se trata de un paciente masculino, de 35 años de edad, de raza blanca, con antecedentes de salud previa, que acude al médico por presentar desde hace cuatro meses diarreas con sangre, moco y pus, acompañado de dolor abdominal, astenia, anorexia y pérdida de peso, y en ocasiones de fiebre de 39 grados centígrados. Se realizaron estudios hematológicos, radiológicos y endoscópicos. Se confirmó el diagnóstico por anatomía patológica de colitis ulcerativa idiopática. Se aplicó terapéutica actualizada con el uso de mesalazina. El paciente evolucionó satisfactoriamente
Vesoulis, Z; Lozanski, G; Loiudice, T
Synchronous collagenous and pseudomembranous colitis has not been previously reported. A 73-year-old woman presented with chronic watery diarrhea and abdominal cramping of six weeks' duration. Biopsies of the colon revealed findings of collagenous colitis involving the endoscopically normal right colon, and superimposed collagenous and pseudomembranous colitis involving the rectosigmoid colon. Endoscopically, the left colon revealed discrete ulcerative plaques, and Clostridium difficile toxin A assay was positive. The patient partially responded to a three-week regimen of metronidazole, and symptoms resolved completely with subsequent steroid therapy. At follow-up endoscopy four months later, colon biopsies demonstrated persistence of subepithelial collagen but no pseudomembranes. The patient remained asymptomatic during this interval. Collagenous colitis has been reported in association with other inflammatory bowel diseases, including lymphocytic colitis, sprue and idiopathic inflammatory bowel disease. This unique association of collagenous colitis with an endotoxigenic inflammatory bowel disease is presented with a review of related disease features.
CRYPTOGLANDULAR ANAL FISTULA: Perianal abscesses are caused by cryptoglandular infections. Not every abscess will end in a fistula. The formation of a fistula is determined by the anatomy of the anal sphincter and perianal fistulas will not heal on their own. The therapy of a fistula is oriented between a more aggressive approach (operation) and a conservative treatment with fibrin glue or a plug. Definitive healing and the development of incontinence are the most important key points. ANAL FISSURES: Acute anal fissures should be treated conservatively by topical ointments, consisting of nitrates, calcium channel blockers and if all else fails by botulinum toxin. Treatment of chronic fissures will start conservatively but operative options are necessary in many cases. Operation of first choice is fissurectomy, including excision of fibrotic margins, curettage of the base and excision of the sentinel pile and anal polyps. Lateral internal sphincterotomy is associated with a certain degree of incontinence and needs critical long-term observation.
Pereira, David Duarte Lopes
Tese de mestrado, Química (Química Analítica), Universidade de Lisboa, Faculdade de Ciências, 2015 A Toxicologia Forense tem como principal objetivo a identificação e quantificação de substâncias tóxicas em amostras biológicas como sangue, urina ou fígado. A amostra mais utilizada quer em situações post-mortem quer em situações in vivo é o sangue, por ser a que melhor pode estabelecer uma correlação entre as concentrações determinadas e os efeitos tóxicos. Contudo, em certos casos post-mor...
Paulina Silva Trejos
Se validó la metodología analítica para la determinación de hierro en alimentos de la canasta básica del costarricense por espectroscopia de absorción atómica con llama. La digestión de las muestras se realizó en recipientes cerrados, con horno de microondas con HNO3 al 65% m/m, para muestras de 0,5 g, dependiendo del tipo de alimento; las cantidades óptimas de ácido nítrico variaron de 6 a 10 mL, obteniéndose porcentajes de recuperación que variaron de 90,0±0,5% a 106,0±0,5%. El ámbito de li...
Zeng, Xiandong; Zhang, Yong
Anal fistula is a common disease. It is also quite difficult to be solved without recurrence or damage to the anal sphincter. Several techniques have been described for the management of anal fistula, but there is no final conclusion of their application in the treatment. This article summarizes the history of anal fistula management, the current techniques available, and describes new technologies. Internet online searches were performed from the CNKI and Wanfang databases to identify articles about anal fistula management including seton, fistulotomy, fistulectomy, LIFT operation, biomaterial treatment and new technology application. Every fistula surgery technique has its own place, so it is reasonable to give comprehensive individualized treatment to different patients, which may lead to reduced recurrence and avoidance of damage to the anal sphincter. New technologies provide promising alternatives to traditional methods of management. Surgeons still need to focus on the invention and improvement of the minimally invasive techniques. Besides, a new therapeutic idea is worth to explore that the focus of surgical treatment should be transferred to prevention of the formation of anal fistula after perianal abscess.
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 ...
Sánchez Herrera, Manuel; Patiño Camargo, Luis
Los Profesores Manuel Sánchez Herrera y Luis Patiño Camargo presentan un caso de Colitis Ulcerosa Idiopática. Hacen la exposición de motivos, presentan a la Academia la historia clínica, y detallado estudio anatomopatológico, sustentando su opinión en frente de los otros diagnósticos considerados, especialmente el de Amibiasis aguda.II En vista de tratarse de un caso controvertido, por intermedio de la Embajada de Colombia en Inglaterra consultan el concepto de autoridad del Prof. Philip Mans...
José URRUTIKOETXEA LIZARRAGA
Full Text Available Los estudios sobre demografía histórica en el marco de la historiografía vasca han experimentado algunos cambios notables en los últimos decenios. Hacer un balance de los mismos, por un lado, y profundizar en el análisis de espacios y de ámbitos hasta hace poco tiempo desconocidos o marginados en este territorio histórico, por otro, son los retos que se plantean en este artículo. Las herramientas analíticas y metodológicas empleadas permiten al autor concluir sobre el vigor y los déficits de la demografía histórica vasca, las líneas centrales de investigación y los nuevos temas de análisis.
Hugh J Freeman
Full Text Available Collagenous colitis is an inflammatory mucosal disorder of the colon with distinctive histopathological features, including a thickened subepithelial collagen layer. The clinical course is usually benign, but serious complications, including death, may occur. In the present report, a 69-year-old woman with watery diarrhea and collagenous colitis developed bloody diarrhea that was refractory to treatment medications, including corticosteroids and azathioprine. Endoscopic and histopathological studies showed a focal neutrophilic inflammatory process that progressed to a diffuse and extensive form of colitis, eventually requiring total proctocolectomy. Careful histological review of the resected colon showed no evidence of persistent collagenous colitis. These findings suggest an important need for continued long-term follow-up of patients with collagenous colitis because superimposed and serious colonic complications may occur, including a severe and extensive pancolitis refractory to medications and necessitating total proctocolectomy.
Limura, Elsa; Giordano, Pasquale
Ideal surgical treatment for anal fistula should aim to eradicate sepsis and promote healing of the tract, whilst preserving the sphincters and the mechanism of continence. For the simple and most distal fistulae, conventional surgical options such as laying open of the fistula tract seem to be relatively safe and therefore, well accepted in clinical practise. However, for the more complex fistulae where a significant proportion of the anal sphincter is involved, great concern remains about damaging the sphincter and subsequent poor functional outcome, which is quite inevitable following conventional surgical treatment. For this reason, over the last two decades, many sphincter-preserving procedures for the treatment of anal fistula have been introduced with the common goal of minimising the injury to the anal sphincters and preserving optimal function. Among them, the ligation of intersphincteric fistula tract procedure appears to be safe and effective and may be routinely considered for complex anal fistula. Another technique, the anal fistula plug, derived from porcine small intestinal submucosa, is safe but modestly effective in long-term follow-up, with success rates varying from 24%-88%. The failure rate may be due to its extrusion from the fistula tract. To obviate that, a new designed plug (GORE BioA®) was introduced, but long term data regarding its efficacy are scant. Fibrin glue showed poor and variable healing rate (14%-74%). FiLaC and video-assisted anal fistula treatment procedures, respectively using laser and electrode energy, are expensive and yet to be thoroughly assessed in clinical practise. Recently, a therapy using autologous adipose-derived stem cells has been described. Their properties of regenerating tissues and suppressing inflammatory response must be better investigated on anal fistulae, and studies remain in progress. The aim of this present article is to review the pertinent literature, describing the advantages and limitations of
Ferenc Nagy; Tamas Molnar; Eva Makula; Ildiko Kiss; Peter Milassin; Eva Zollei; Laszlo Tiszlavicz; Janos Lonovics
The early hypersensitivity reaction and late bone marrow depression are well-known side-effects of azathioprine,whereas interstitial pneumonia is a rare complication.A 40-year old male patient had been treated with azathioprine in consequence of extensive ulcerative colitis for 10 years. He then complained of 7 d of fever,cough and catarrhal signs, without symptoms of active colitis. Opportunistic infections were ruled out. The chest X-ray, CT and lung biopsy demonstrated the presence of interstitial inflammation. Azathioprine therapy was discontinued as a potential source of the pulmonary infiltrate. In response to steroid therapy, and intensive care, the pulmonary infiltrate gradually decreased within 4 wk. Three months later, his ulcerative colitis relapsed,and ileo-anal pouch surgery was performed. In cases of atypical pneumonia, without a proven infection,azathioprine-associated interstitial pneumonitis may be present, which heals after withdrawal of the drug.
Guido Ma Van Rosendaal
Full Text Available Two cases of idiopathic colitis affecting the sigmoid colon in elderly patients with underlying diverticulosis are presented. Segmental resection has permitted close review of the histopathology in this syndrome which demonstrates considerable similarity to changes seen in idiopathic ulcerative colitis. The reported experience with this syndrome and its clinical features are reviewed.
Luís Marcelo Alves Ramos
O texto faz uma introdução à Psicologia Analítica do psicólogo e psiquiatra suíço Carl Gustav Jung: define o conceito de Psicologia Analítica, traz uma biografia resumida de Carl Gustav Jung, indica as principais diferenças entre a Psicologia Analítica e a Psicanálise, descreve a estrutura e o funcionamento da psique e, por fim, apresenta sinteticamente as características dos tipos de personalidades traçadas por Jung. The text makes an introduction to the Analytical Psychology of the psycholo...
Hornung, B R; Mitchell, P J; Carlson, G L;
Anal acoustic reflectometry (AAR) is a reproducible technique providing a novel physiological assessment of anal sphincter function. It may have advantages over conventional anal manometry. The aims of this study were to determine the ability of AAR and anal manometry to identify changes in anal...
Song, Kee Ho
Surgery for an anal fistula may result in recurrence or impairment of continence. The ideal treatment for an anal fistula should be associated with low recurrence rates, minimal incontinence and good quality of life. Because of the risk of a change in continence with conventional techniques, sphincter-preserving techniques for the management complex anal fistulae have been evaluated. First, the anal fistula plug is made of lyophilized porcine intestinal submucosa. The anal fistula plug is exp...
Full Text Available Uno de los desafíos actuales para los estudios sobre movilidad y transporte en América Latina es adoptar un enfoque multidimensional de la movilidad que trascienda la noción más estrecha de desplazamiento o viaje y que, a la vez, permita integrar este tema a la discusión más general acerca del efecto de la movilidad sobre la pobreza y la exclusión social. Este artículo aborda el desafío y propone un marco analítico que recoja la -aún incipiente en nuestra región- experiencia teórico-empírica sobre estos fenómenos. Luego de revisar la literatura y argumentar a favor de la adopción de diversos postulados, se propone el enfoque de activos y estructuras de oportunidades para el estudio de la accesibilidad. Esta es concebida como el grado de ajuste entre las estructuras de oportunidades de movilidad, y los recursos y activos con que cuentan los hogares para aprovecharlas. El esquema propuesto permite maximizar la comprensión del efecto de la movilidad sobre el bienestar y el rol del transporte público.One of the major current challenges for mobility and transport studies in Latin America is the adoption of a multidimensional approach that goes beyond the narrower notion of trip and that does not neglect a broader discussion about mobility's effect on po verty and social exclusion. This article seeks to tackle this challenge and posits an analyticalframework that takes into account the theoretical and empirical regional background on these phenomena. After reviewing existing literature and affiliating to some necessary assumptions, it proposes the assets and opportunities structures approach as a useful device to study accessibility. This concept is defined as the level of adjustment between the structures of opportunity for mobility and household's resource and assets to take advantagefrom them. I argue that thisframework is adequate in order to maximize understanding of mobility's effect on welfare and the role of public transport.
Maeshiro, Tatsuji; Hokama, Akira; Kinjo, Tetsu; Fujita, Jiro
We present a case of diverticular colitis of the ascending colon preceding the onset of ulcerative colitis. A 58-year-old man presented with positive faecal occult blood test. Colonoscopy disclosed diverticular colitis of the ascending colon. After a year's follow-up, typical ulcerative colitis developed and diverticular colitis improved. Diverticular colitis is a newly established disorder of chronic segmental mucosal inflammation affected by diverticular disease. There is increasing recogni...
Full Text Available Introducción: El concepto de validación se refiere a la evaluación estadística de los resultados obtenidos en la aplicación de técnicas analíticas, mediante pruebas convenientemente documentadas y demostrativas de que un método es lo suficientemente fiable a fin de producir el resultado previsto bajo condiciones definidas, como son: sistema analítico, intervalo de concentración, infraestructura y talento humano. Objetivo: Describir el proceso de validación del método analítico para la cuantificación de valsartán en plasma humano por HPLC-UV y su aplicación en estudios farmacocinéticos, de biodisponibilidad y bioequivalencia de medicamentos que contengan valsartán como principio activo.Metodología: Se desarrolló un método para la detección y cuantificación de valsartán en plasma humano, con elución isocrática por cromatografía líquida de fase reversa, con detección ultravioleta a 265 nm, mediante el método de adición de estándar. Se utilizó losartán como estándar interno. El método implica una extracción en fase sólida de los principios activos ( valsartán y losartán con cartuchos C8. La separación se realizó en una columna C18 en fase reversa y la fase móvil fue una mezcla de acetonitrilo: buffer fosfato (45:55 v/v ajustado a pH 2.7±0.1 con ácido fosfórico concentrado. El método se validó en el rango de concentraciones de 0.05 a 20 µg/ml con adición de estándar de valsartán de 2.5 µg/ml. Resultados y conclusiones: La curva de calibración fue lineal en el rango de concentraciones establecido. Se evaluó la reproducibilidad, estabilidad y porcentaje de recuperación del método. El método para determinar el valsartán en plasma humano por HPLC/UV fue preciso y exacto con un límite de cuantificación de 1.485 µg/ml. Este método fue suficientemente sensible para su aplicación en estudios farmacocinéticos de valsartán.
Mironov, I L; Ratnikova, L I; Pirogov, D V; Mil'chenko, I B
Pseudomembranous colitis (PMC), is characterized by acute onset, severe diarrhea, hypovolemic shock, toxic expansion of colon perforation, thrombus syndrome and without treatment in some cases leading to death of the patient. The paper describes a clinical case of pseudomembranous colitis in patients 35 years that developed on the background of the massive antibiotic therapy. The diagnosis was made only at autopsy. This case is unique, and dictates the need to inform doctors of practical health care of the complications of antibiotic therapy, such as pseudomembranous colitis.
Zubaidi, Ahmad M
Anal fistula is a common benign condition that typically describes a miscommunication between the anorectum and the perianal skin, which may present de novo, or develop after acute anorectal abscess. Athough anal fistulae are benign, the condition can still negatively influence a patient's quality of life by causing minor pain, social hygienic embarrassment, and in severe cases, frank sepsis. Despite its long history and prevalence, anal fistula management remains one of the most challenging and controversial topics in colorectal surgery today. The end goals of treatment include draining the local infection, eradicating the fistulous tract, and minimizing recurrence and incontinence rates. The goal of this review is to ensure surgeons and physicians are aware of the different imaging and treatment choices available, and to report expected outcomes of the various surgical modalities so they may select the most suitable treatment.
Zakharova, N V; Fil', T S
The article reviews a pathogenesis of Pseudomembranous colitis. Questions of prevention and treatment of Clostridium difficile--associated diarrhea are shown by the Evidence-based medicine. There is an accent on the rational prescription of antibiotics.
William Gemio Jacobsen Teixeira
Full Text Available Pouchitis is the most frequent complication of ileal pouch-anal anastomosis for treatment of ulcerative colitis. There are several possible explanations. Among them, we focus on the one that considers pouchitis as an extracolonic manifestation of ulcerative colitis. The aim of this study was to investigate the association between pouchitis and extra-intestinal manifestations (EIM, which are frequent in these patients. Sixty patients underwent restorative proctocolectomy with an ileal J pouch (IPAA from September 1984 to December 1998. Pouchitis was defined by clinical, endoscopic, and histologic criteria. The following extra-intestinal manifestations were studied: articular, cutaneous, hepatobiliary, ocular, genitourinary, and growth failure. Thirteen patients, of which 10 were female (76.9%, developed one or more episodes of pouchitis. Twelve patients of this group (92.3% presented some kind of extra-intestinal manifestation, 4 pre-operatively (exclusively, 2 post-operatively (exclusively, and 6 both pre- and post-operatively (1.7 per patient. Twenty patients (42.7% of the 47 without pouchitis did not present extra-intestinal manifestations; 10/35 (28.5% of females had pouchitis, compared to 3/35 (12.0% of men. Pouchitis was more frequent among females, though not statistically significant. EIM increases the risk of pouchitis. Pouchitis is related to EIM in 92.3 % of cases, corroborating the hypothesis that it could be an extracolonic manifestation of ulcerative colitis.A bolsite é a complicação mais freqüente da anastomose íleo-anal com reservatório realizada para o tratamento da retocolite ulcerativa. Há várias hipóteses para explicá-la. Entre elas, focalizamos a que a considera como manifestação extracolônica da retocolite ulcerativa. O propósito deste estudo foi o de investigar a associação entre bolsite e manifestações extra-intestinais que são freqüentes nestes doentes. Sessenta doentes foram submetidos a colectomia
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)....
Full Text Available La enfermedad inflamatoria intestinal (EII agrupa dos entidades clínicas bien diferenciadas entre sí, la colitis ulcerosa (CU y la enfermedad de Crohn (EC. La CU se caracteriza por una inflamación difusa del colon, con compromiso del recto, que se extiende de manera proximal y continua. El proceso inflamatorio habitualmente se localiza en la mucosa y la submucosa colónica. La EC es una inflamación crónica y transmural, que afecta todas las capas del intestino y puede llegar a incluir a uno o varios segmentos del tracto digestivo, con localización predominante en íleon terminal, colon y región perianal. Los tramos entre zonas afectadas histológicamente son normales. Ambos trastornos se acompañan de manifestaciones tanto digestivas como extradigestivas en ocasiones: articulares, muco-cutáneas, hepatobiliares, nefro-urológicas y oculares principalmente. Tienen un curso crónico, donde se alternan fases de actividad con fases de latencia. Generalmente, con una buena anamnesis, y la ayuda de datos clínicos, analíticos, endoscópicos, histopatológicos y de distintas técnicas de imagen se puede llegar a un diagnóstico diferencial entre CU y EC. Los índices de actividad de la enfermedad son de gran utilidad para el adecuado control evolutivo.
Arakaki, Mariana Sousa; Santos,Carlos Henrique Marques dos; Falcão, Gustavo Ribeiro; Cassino,Pedro Carvalho; Nakamura, Ricardo Kenithi; Gomes,Nathália Favero; Santos,Ricardo Gasparin Coutinho dos
INTRODUCTION: the management of anal fistula remains debatable. The lack of a standard treatment free of complications stimulates the development of new options. OBJECTIVE: to develop an experimental model of anal fistula in rats. METHODS: to surgically create an anal fistula in 10 rats with Seton introduced through the anal sphincter musculature. The animals were euthanized for histological fistula tract assessment. RESULTS: all ten specimens histologically assessed had a lumen and surroundi...
Full Text Available Surgical treatment is often needed for patients with ulcerative colitis because of toxic dilation, intractability or risk of cancer. Precise diagnosis is vital to exclude Crohn's disease and infective colitis, although patients with `indeterminate' colitis often do well after reconstructive surgery. Restorative proctocolectomy, in which the anal sphincter is preserved and a pelvic ileal reservoir is used as a substitute for the rectum, is the standard surgical procedure, supplanting panproctocolectomy with ileostomy. Ileorectal anastomosis should also be considered, but is only suitable for patients with relative rectal sparing, and meticulous sigmoidoscopic follow-up is essential. For toxic dilation, colectomy with ileostomy and mucous fistula is recommended, proctectomy and reconstruction being deferred until the patient is fitter. For most patients, the entire colon and rectum are removed and a pelvic ileal reservoir is anastomosed to the anus. Many types of reservoir have been proposed, but randomized trials are few, and it seems that the J pouch is as good as the S or W pouches, and technically is simpler. The operative mortality of restorative proctocolectomy worldwide has been about 1%, thanks largely to the routine use of a temporary defunctioning ileostomy. A one-stage procedure without ileostomy is permissible if the patient is relatively fit and the surgeon is in attendance for 10 days after operation, but omission of the ileostomy certainly increases the risk to life and the postoperative morbidity, and should thus not be done in debilitated patients or in those on high dose steroids. Resection of the mucosal lining of the anal canal above the dentate line (`mucosal proctectomy' was formerly routine, but leads to diminished sphincter pressure and sensation, such that preservation of the entire motor and sensory sphincteric complex is now advocated by many authors. Omission of mucosal stripping renders the procedure technically
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...
Atif Saleem; Brahmbhatt, Parag A.; Sarah Khan; Mark Young; LeSage, Gene D.
Microscopic Colitis (MC) is characterized by chronic watery diarrhea, grossly normal appearing colonic mucosa during conventional white light endoscopy, and biopsy showing microscopic inflammation. We report a case of collagenous colitis with gross endoscopic findings.
Lean, Qi Ying; Eri, Rajaraman D; Fitton, J Helen; Patel, Rahul P; Gueven, Nuri
Inflammatory bowel diseases (IBD), such as ulcerative colitis and Crohn's disease, are an important cause of morbidity and impact significantly on quality of life. Overall, current treatments do not sustain a long-term clinical remission and are associated with adverse effects, which highlight the need for new treatment options. Fucoidans are complex sulphated, fucose-rich polysaccharides, found in edible brown algae and are described as having multiple bioactivities including potent anti-inflammatory effects. Therefore, the therapeutic potential of two different fucoidan preparations, fucoidan-polyphenol complex (Maritech Synergy) and depyrogenated fucoidan (DPF) was evaluated in the dextran sulphate sodium (DSS) mouse model of acute colitis. Mice were treated once daily over 7 days with fucoidans via oral (Synergy or DPF) or intraperitoneal administration (DPF). Signs and severity of colitis were monitored daily before colons and spleens were collected for macroscopic evaluation, cytokine measurements and histology. Orally administered Synergy and DPF, but not intraperitoneal DPF treatment, significantly ameliorated symptoms of colitis based on retention of body weight, as well as reduced diarrhoea and faecal blood loss, compared to the untreated colitis group. Colon and spleen weight in mice treated with oral fucoidan was also significantly lower, indicating reduced inflammation and oedema. Histological examination of untreated colitis mice confirmed a massive loss of crypt architecture and goblet cells, infiltration of immune cells and oedema, while all aspects of this pathology were alleviated by oral fucoidan. Importantly, in this model, the macroscopic changes induced by oral fucoidan correlated significantly with substantially decreased production of at least 15 pro-inflammatory cytokines by the colon tissue. Overall, oral fucoidan preparations significantly reduce the inflammatory pathology associated with DSS-induced colitis and could therefore represent
Development and validation of the analytical method by high performance liquid chromatography (HPLC for Lamotrigine raw material = Desenvolvimento e validação do método analítico por cromatografia líquida de alta eficiência (CLAE para a matéria prima Lamotrigina
Guilherme Nobre Lima do Nascimento
Full Text Available Currently when all roads lead to the pursuit of total quality in production of drugs, it is essential to fully understand each phase of a production process. In this case, validation is the appropriate tool to ensure reliability of a production process involving new equipment and the analytical methodology, either in the pharmaceutical, food, computer, microelectronics area or any other area where the quality of the manufactured product is one of the main reasons for the existence of a given company. This study aimed to analyze the main aspects of the validation of analytical methods for Lamotrigine, new drug for bipolar disorder with wide use today. In conclusion, the proposed analytical method for determination of the lamotrigine content in raw materials is adequate, effective and capable of reproducing reliable results during analysis. This method is fast (running time of 10 minutes, selective, accurate, precise and robust for the determination of the drug, with no observedinterfering substances in the optimum wavelength. It could be concluded that this may be a routine method for quality control laboratories to certify the quality of Lamotrigine. Atualmente quando todos os caminhos levam à busca da qualidade total na produção de medicamentos, torna-se indispensável conhecer perfeitamente cada fase de um processo produtivo. Neste caso, a validação é a ferramenta adequada para garantir a confiabilidade de instalação de um processo produtivo, de equipamento novo e, inclusive, da metodologia analítica, seja do setor farmacêutico, alimentício, informática microeletrônico ou qualquer outra área onde a qualidade do produto fabricado é uma das principais razões da existência da empresa. O presente trabalho teve por objetivo analisar os principais aspectos da validação de métodos analíticos para Lamotrigina, fármaco novo para transtorno bipolar com amplo usoatualmente. Em conclusão, o método analítico proposto para determina
JOSé ALEXSANDRO SILVA
Full Text Available Foi desenvolvido e validado neste estudo um método analítico para quantificação de diclofenaco de dietilamônio em pele humana por cromatografia líquida de alta eficiência, segundo a Resolução 899/2003 da Agência Nacional de Vigilância Sanitária (ANVISA. Empregou-se cromatografia em fase reversa com coluna C18 150 x 4,6 mm, 5 µm Shimpack®, à temperatura de 40 ºC e fase móvel, constituída por mistura de acetonitrila e tampão fosfato de sódio 20 mM pH 3,0 (70:30, v/v com fluxo de 1,2 mL min-1. Os analitos foram detectados por UV a 280 nm e o método foi especifico, preciso, exato, robusto e linear no intervalo de 0,05 a 20 µg mL-1 (R2 = 0,998, mostrando que pode ser utilizado em estudos de penetração cutânea in vitro tendo como modelo de membrana a pele humana. Palavras-chave: Diclofenaco dietilamônio. Retenção cutânea. Validação. ABSTRACT Development and validation of an analytical method for quantitation of diclofenac diethylamine in human skin by high performance liquid chromatography An analytical method has been developed and validated for the quantitation of diclofenac diethylamine (DDA in human skin by high performance liquid chromatography (HPLC, in accordance with Regulation 899/2003 of the National Sanitary Surveillance Agency (ANVISA. The HPLC column was a reversed-phase Shimpack® C18, with a 5 µm particle bed, measuring 150 x 4.6 mm i.d., eluted isocratically at 40C with 20 mM sodium phosphate buffer (pH 3.0:acetonitrile (30:70, v/v, the mobile phase flowing at 1.2 mL min-1. Analytes were measured by a UV detector set at 280 nm. The results revealed that the method was specific, precise, accurate, robust and linear (R2=0.998 in the range from 0.05 to 20 µg mL-1. Therefore, it can safely be used to assess DDA in vitro penetration of human skin in kinetic studies. Keywords: Diclofenac diethylamine. Human skin retention. Validation.
Jeon, Hae Jeong; Kim, Young Jun; ParK, Hee Sun; Jung, Sung Il; Park, Sang Woo; Choi, Young Chil; Shin, Hyun Joon; Park, Uug Chae [Konkuk University School of Medicine, Seoul (Korea, Republic of); Jin, Yong Hyun [Sung Ae General Hospital, Seoul (Korea, Republic of)
Endoanal ultrasonography has recently emerged as a popular diagnostic modality for mapping and imaging the anal sphincter. This procedure can be performed as an outpatient procedure: it is relatively quick and virtually painless. The imaging typically is performed in a proximal to distal manner with defining a variety of levels of the anal canal as it progresses. Anal ultrasound can provide a detailed image of the anal sphincter musculature. The internal anal sphincter appears endosonographically as a hypoechoic circular band that is most prominently seen at the level of the mid-anal canal. The external anal sphincter appears as a thicker circular mixed echogenic band outside of the hypoechoic internal sphincter. Anal ultrasound can be used to evaluate patients with anal fistulas with or without abscess. Imaging is performed and the fistulous tracts or abscesses are identified by hypoechogenicity within the external sphincter muscle or the ischiorectal fossa. Its ability to clearly image the anal sphincters has allowed its use for the evaluation of anal fistulas. Moreover, anal ultrasound has emerged as the technique of choice for imaging the anal sphincters and for evaluating incontinence. Each of the individual physiologic tests offers valuable information that is relevant to the continence mechanism, and the ultrasound yields results that are complementary to other tests. Ultrasound serves as a surveillance tool to monitor the results after sphincterplasty. We illustrate the endo-anal sonographic features of various anal diseases and the ultrasound-anatomic correlation for the anus
Jegadeesan, Ramprasad; Liu, Xiuli; Pagadala, Mangesh R.; Gutierrez, Norma; Butt, Mujtaba; Navaneethan, Udayakumar
Lymphocytic and collagenous colitis are forms of microscopic colitis which typically presents in elderly patients as chronic watery diarrhea. The association between microscopic colitis and inflammatory bowel disease is weak and unclear. Lymphocytic colitis progressing to ulcerative colitis has been previously reported; however there is limited data on ulcerative colitis evolving into microscopic (lymphocytic or collagenous) colitis. We report a series of six patients with documented ulcerati...
Jensen, Tim Kåre; Christensen, A. S.; Boye, Mette
The weakly beta-hemolytic porcine spirochete Brachyspira murdochii is considered a normal intestinal commensal. In the present study, however, a field case of B murdochii–associated catarrhal colitis was identified in a pig, as characterized by extensive spirochetal colonization of the surface...... epithelium. Experimentally, 8 weaned pigs were challenged with the B murdochii isolate, reproducing catarrhal colitis in 2 animals. By applying fluorescent in situ hybridization using a species-specific oligonucleotide probe targeting 23S rRNA, B murdochii organisms were found in high numbers and were...... closely associated with the surface epithelium in the pigs with catarrhal colitis. The results indicate that, when present in high numbers, B murdochii is low pathogenic for pigs....
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.)....
Paulina Silva Trejos
Full Text Available Se validó la metodología analítica para la determinación de hierro en alimentos de la canasta básica del costarricense por espectroscopia de absorción atómica con llama. La digestión de las muestras se realizó en recipientes cerrados, con horno de microondas con HNO3 al 65% m/m, para muestras de 0,5 g, dependiendo del tipo de alimento; las cantidades óptimas de ácido nítrico variaron de 6 a 10 mL, obteniéndose porcentajes de recuperación que variaron de 90,0±0,5% a 106,0±0,5%. El ámbito de linealidad óptimo que se obtuvo fue de 0,05 m/L a 6,0 mg/L, con un coeficiente de correlación de 0,9991. Los límites de detección y cuantificación reportados fueron de 0,006 mg/L y 0,009 mg/L, respectivamente. La veracidad se determinó utilizando un patrón certificado de la NIST, SRM 1846 Infant Formula, con un valor reportado para hierro de 63,1±4,0 mg/kg, el valor obtenido fue de 63,8 mg/L, con un porcentaje de error de 1,1%.
Tinoco Hernandez, Rosanna; Paredes Bejarano, Margarita; Romero Chaglia, Norman; Yapur Auad, Miguel Eduardo
El presente trabajo trata sobrees el diseño y la implementación de un graficador de señales cardiacas por computadora, para lo cual diseñamos un circuito electrónico capaz de recibir la senal analógica proveniente de la actividad electrica del corazón , amplificarla, y luego convertirla en una señal digital para ser procesada por software y finalmente ser graficada, siendo posible así observar la señal cardiaca en el monitor de un computador como un tren de pulsos. Cabe destacar que par...
Bøgeskov, Reneé; Nickelsen, Carsten Nahne Amtoft; Secher, Niels Jørgen
UNLABELLED: Abstract Objectives: To determine the risk of recurrent anal sphincter rupture (ASR), and compare the risk of anal incontinence (AI) after recurrent ASR, with that seen in women with previous ASR who deliver by caesarean section or vaginally without sustaining a recurrent ASR. METHODS...... uncomplicated vaginal delivery or caesarean section. RESULTS: There were 93 437 vaginal deliveries. ASR occurred in 5.5% (n = 2851) of the nulliparous and 1.5% (n = 608) of the multiparous women. Recurrent ASR occurred in 8% (n = 49) of whom 50% reported symptoms of AI. We found no difference in the occurrence...... of AI between women with recurrent ASR, and those who delivered vaginally without repeat ASR (p = 0.37; OR = 2.0) or by caesarean section (p = 0.77; OR = 1.3). CONCLUSION: Women with a past history of ASR have an 8% risk of recurrence. AI affects half of the women with recurrent ASR. Larger studies...
Araki, Toshimitsu; Okita, Yoshiki; Fujikawa, Hiroyuki; Ohi, Masaki; Tanaka, Koji; Inoue, Yasuhiro; Uchida, Keiichi; Mohri, Yasuhiko; Kusunoki, Masato
Pouch failure has been reported to occur after ileal pouch-anal anastomosis for Crohn's disease. We report two cases of patients with Crohn's disease, who underwent redo ileal pouch-anal anastomosis (redo-IPAA) combined with anti-TNF-α maintenance therapy, with good functional results. The first patient, a man with presumed ulcerative colitis, suffered pelvic fistula recurrence and anastomotic dehiscence. He underwent redo-IPAA, at which time longitudinal ulcers were found. Infliximab was started 4 days postoperatively and continued. The second patient, a woman treated for ulcerative colitis, underwent laparoscopic IPAA 8 years later. After the development of a pelvic fistula, twisted mesentery of the ileal pouch was found intraoperatively and Crohn's disease was diagnosed. Adalimumab therapy resulted in fistula closure. Redo-IPAA was performed to normalize the twisted mesentery of the ileal pouch. No complications have been observed in either patient, both of whom have experienced good functional results after closure of the covering stomas.
Determinación de esteroles y dialcoholes triterpénicos en aceite de oliva mediante separación de la fracción por cromatografía líquida de alta eficacia y análisis por cromatografía de gases. Estandarización del método analítico.
Full Text Available A method is developed for the analysis of sterols together with triterpenic alcohols (erythrodiol and uvaol in vegetable oils. The method involves obtention of the unsaponifiable matter, isocratic HPLC separation with refractive index detector, preparation of silylderivatives, and analysis by capillary GC. Four procedures involving GC analysis of sterol and sterol+dialcohol fractions obtained by HPLC and CCF separations are compared. A collaborative trial comparing HPLC-sterols+dialcohols and CCF-sterols (official methods is carried out. For Δ7-sterols, higher values and better repeatability and reproducibility were observed in the first method, but no differences for the remainder sterols were found. The erythrodiol+uvaol determinations by HPLC-sterols+dialcohols and CCF-sterols+dialcohols (official methods resulted in similar precision.
Se presenta un método para la determinación conjunta de esteróles y dialcoholes triterpénicos (eritrodiol y uvaol en aceites de oliva que consta de las etapas siguientes: obtención del insaponificable, fraccionamiento mediante cromatografía líquida de alta eficacia (CLAE en régimen isocrático con detector de índice de refracción, preparación de derivados sililados y análisis por cromatografía de gases en columna capilar. Se comparan cuatro procedimientos que utilizan el análisis por cromatografía de gases de las fracciones de esteroles y de esteroles + dialcoholes obtenidas tanto por CLAE como por CCF. Se lleva a cabo un análisis colaborativo para la determinación de esteroles comparando los métodos CLAE-esteroles+dialcoholes y CCFesteroles (método oficial. Los resultados mostraron que por el primer procedimiento la determinación de Δ7-esteroles se realiza con mayor repetibilidad y reproducibilidad, aunque los valores resultantes son más altos. No se encontraron diferencias en los parámetros de precisión ni en los valores de los restantes esteroles. Las determinaciones de
Full Text Available Os objetivos deste estudo foram avaliar a frequência de HPV anal em pacientes com neoplasia intraepitelial cervical (NIC, verificar a concordância entre os subtipos encontrados nos dois locais e investigar os fatores que influenciaram a ocorrência de HPV anal em mulheres com NIC sem evidências clínicas de imunodepressão. Foram avaliadas 52 mulheres com idades entre 16 e 72 anos e diagnóstico de neoplasia intraepitelial cervical graus I, II e III. A identificação do DNA (ácido desoxirribonucleico do HPV e de sete subtipos dos vírus foi realizada por meio da reação em cadeia da polimerase (PCR em material colhido no ânus e colo uterino. Foram pesquisados fatores que poderiam contribuir para a infecção anal, como paridade, número de parceiros, tabagismo, manipulação e coito anal e o tipo de doença ginecológica. Das 52 mulheres, foi diagnosticado HPV na região anal em 25 (48%, das quais 23 (44% também apresentavam HPV no colo uterino - resultado significativo para existência do HPV em portadoras de NIC. Em 16 (31% o HPV foi diagnosticado somente no colo uterino e em 11 (21% não foi identificado em colo ou ânus. Houve associação significativa nas variáveis paridade (p=0,02 e número de parceiros (p=0,04. Concluiu-se que: as mulheres com HPV genital têm mais probabilidade de serem acometidas por HPV anal; não há concordância unânime entre os subtipos do HPV do colo do útero e do ânus e a paridade e o número de parceiros contribuem para aumentar a incidência de HPV anal nas mulheres sem imunodeficiência e com HPV cervical.This study aims were to assess the frequency of HPV anal infection in patients with cervical intra-epithelial neoplasia (CIN, to find out the relation between the found subtypes, when present in both regions, and investigate factors that influenced the occurrence of anal HPV in women with CIN. Fifty two women with age between 16 and 72 years and cervical intra-epithelial neoplasia (CIN diagnosis
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...
Full Text Available Gastrointestinal bleeding appears to be a common adverse event associated with dasatinib therapy. Here we present a case of a 59-year-old man with chronic myeloid leukaemia (CML developing the rarest complication of haemorrhagic colitis with dasatinib therapy which resolved rapidly after treatment withdrawal.
Patodi, Nishant; Sagar, Nidhi; Rudzki, Zbigniew; Langman, Gerald; Sharma, Naveen
Gastrointestinal bleeding appears to be a common adverse event associated with dasatinib therapy. Here we present a case of a 59-year-old man with chronic myeloid leukaemia (CML) developing the rarest complication of haemorrhagic colitis with dasatinib therapy which resolved rapidly after treatment withdrawal. PMID:23316400
Full Text Available Background: Ischemic colitis (IC is an uncommon adverse event associated with antipsychotic agents, more commonly found with phenothiazine drugs and atypical neuroleptics such as clozapine. The risk of developing ischemic colitis increases when anticholinergic drugs are associated. Case report: We report the case of a 38-year-old woman with a history of schizoaffective disorder who had been on chronic quetiapine for 3 years, and presented to the ER because of diarrhea for 5 days. Four months previously, olanzapine had been added to her psychiatric drug regimen. Physical examination revealed abdominal distension with abdominal tympanic sounds and tenderness. Emergency laboratory tests were notable for increased acute phase reagents. Tomography revealed a concentric thickening of the colonic wall in the transverse, descending and sigmoid segments, with no signs of intestinal perforation. Colonoscopy demonstrated severe mucosal involvement from the sigmoid to the hepatic flexure, with ulcerations and fibrinoid exudate. Biopsies confirmed the diagnosis of ischemic colitis. The only relevant finding in her history was the newly added drug to her baseline regimen. An adverse effect was suspected because of its anticholinergic action at the intestinal level, and the drug was withdrawn. After 6 months of follow-up clinical, laboratory and endoscopic recovery was achieved. Discussion: Antipsychotic medication should be considered as a potential cause of ischemic colitis, particularly atypical antipsychotics such as clozapine and olanzapine; despite being uncommon, this adverse event may result in high morbidity and mortality.
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...
Kallesøe, Jane; Langholz, E.; Frisch, Morten
Ulcerative colitis (UC) is believed to carry a predisposition to colorectal cancer (CRC) development. International clinical guidelines suggest that UC patients should have a colonoscopy performed every year or up to every third year from approximately eight years after diagnosis for early...
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.
Suelene Suassuna Silvestre de Alencar
Full Text Available INTRODUCTION: Ulcerative colitis (UC is a chronic inflammatory disease that affects the rectum and colon, involving periods of exacerbation and remission. A considerable number of patients requires surgery during the course of this disease. OBJECTIVE: The purpose of this study is to analyze the profile and therapeutic approach of patients with UC. METHODS: This is a retrospective study that analyzed medical records of patients diagnosed with UC between 1999 and 2010. We selected 45 patients and analyzed the following variables: age, gender, ethnic group, interval between onset of symptoms and diagnosis, extraintestinal manifestations, extent of colonic involvement, disease complications, pharmacological treatment, indication for surgery, time between diagnosis and indication, surgical procedures, early and late complications and pathological results of surgical specimens. Data were analyzed descriptively and compared with other studies. RESULTS: The clinical profile of the patients was consistent with the literature. Nine patients underwent surgical treatment: seven were submitted to proctocolectomy with anastomosis in the ileo-anal pouch and two were submitted to total colectomy; in addition, eight were submitted to ileostomy. Postoperative complications occurred in 55.5% of patients. CONCLUSIONS: The study confirms data from the literature regarding the profile and therapeutic approach of patients with ulcerative colitis.INTRODUÇÃO: A retocolite ulcerativa (RCU é uma doença inflamatória crônica que acomete reto e cólon, cursando com períodos de exacerbação e remissão. Uma parcela considerável de pacientes necessita de procedimento cirúrgico ao longo do curso dessa enfermidade. OBJETIVO: Este estudo objetiva analisar perfil e abordagem terapêutica de portadores de RCU. MÉTODOS: Trata-se de estudo retrospectivo realizado por meio da análise de prontuários de pacientes acompanhados com diagnóstico de RCU no período de 1999 a
Shibata, Chikashi; Funayama, Yuji; Fukushima, Kouhei; Takahashi, Ken-Ichi; Ogawa, Hitoshi; Haneda, Sho; Watanabe, Kazuhiro; Kudoh, Katsuyoshi; Kohyama, Atsushi; Hayashi, Kei-Ichi; Sasaki, Iwao
The aim of the present study was to determine if calcium polycarbophil ameliorates diarrhea after ileal J-pouch anal anastomosis for ulcerative colitis. Twenty-one randomized patients were given either bifidobacterium (3 g/day) plus calcium polycarbophil (3 g/day), in the polycarbophil group (11 patients), or bifidobacterium (3 g/day), in the control group (10 patients), p.o. for 6 months. Anal manometry was performed and bowel function (stool frequency, stool consistency, and nighttime soiling) was assessed via a questionnaire before and 1, 3, and 6 months after drug administration. Eight patients were deemed eligible in each group; five patients were excluded from the study, including two patients whose stool consistency was too firm and who experienced difficulty in defecating attributed to polycarbophil. Anal manometry and stool consistency did not change with time and did not differ between the polycarbophil and the control groups. Stool frequency decreased with time in both groups and did not differ between the groups. Nighttime soiling improved with time in the polycarbophil group but did not change in the control subjects. These results suggest that polycarbophil might be able to improve nighttime soiling without obviously affecting stool frequency and consistency after ileal J-pouch anal anastomosis for ulcerative colitis.
Song, Jong Gi; Han, Joon Koo; Kim, Seung Hoon; Choo, Sung Wook; Kim, Seung Cheol; Choi, Byung Ihn [Seoul National University College of Medicine, Seoul (Korea, Republic of)
To evaluate the radiologic findings of granulomatous colitis on double contrast barium enema and changes on follow-up studies. Serial double contrast barium enema of six patients with granulomatous colitis confirmed by endoscopic biopsy were reviewed. We analyzed the radiologic findings and their follow-up changes, including aphthous ulcers, lymphoid hyperplasia, deep ulcers, cobble stone appearance, geographic ulcers, asymmetric involvement of ulcers, skip lesions, sinus tract, fistula formation, pseudosacculation, focal stricture, and small bowel involvement. Pretreatment double contrast barium enema findings were aphthous ulcers in five patients, deep ulcer in six, cobble stone appearance in five, longitudinal geographic ulcers in two, fistulas in one, pseudosacculations in two, focal stricture in one, and pseudopolyps in six. Also, anal ulcers were observed in two patients, asymmetric involvement of ulcers in three, skip lesions in four, and small bowel involvement in five in five patients proved to have inactive disease after treatment, aphthous ulcers and deep ulcers disappeared. Geographic ulcers of two patients and anal ulcer of one patients decreased in size or depth. Pseudosacculation in one patient disappeared. Pseudopolyps decreased in two patients, increased in one, and decreased after increase in two. One patient whose disease remained active after treatment showed maintenance or increase of ulcers or fistula. And their pseudosacculation or focal stricture unchanged and pseudopolyps decreased. The major radiologic findings of chronic granulomatous colitis on double contrast barium enema are aphthous ulcer, deep ulcer, cobble stone appearance, discontinuity of the lesion and coexistence of ulcers and pseudopolyps. And, double contrast barium enema is good follow-up modality because its findings correlate with clinical course of the granulomatous colitis after treatment.
Abou-Zeid, Ahmed A
Anal fistula surgery is a commonly performed procedure. The diverse anatomy of anal fistulae and their proximity to anal sphincters make accurate preoperative diagnosis essential to avoid recurrence and fecal incontinence. Despite the fact that proper preoperative diagnosis can be reached in the majority of patients by simple clinical examination, endoanal ultrasound or magnetic resonance imaging, on many occasions, unexpected findings can be encountered during surgery that can make the operation difficult and correct decision-making crucial. In this article we discuss the difficulties and unexpected findings that can be encountered during anal fistula surgery and how to overcome them.
Ahmed A Abou-Zeid
Anal fistula surgery is a commonly performed procedure. The diverse anatomy of anal fistulae and their proximity to anal sphincters make accurate preoperative diagnosis essential to avoid recurrence and fecal incontinence. De-spite the fact that proper preoperative diagnosis can be reached in the majority of patients by simple clinical ex-amination, endoanal ultrasound or magnetic resonance imaging, on many occasions, unexpected findings can be encountered during surgery that can make the oper-ation difficult and correct decision-making crucial. In this article we discuss the difficulties and unexpected find-ings that can be encountered during anal fistula sur-gery and how to overcome them.
Pancreatitis aguda recidivante con enteropatía por gluten asociada: Características clínico-analíticas y evolutivas en 34 pacientes Relapsing acute pancreatitis associated with gluten enteropathy: Clinical, laboratory, and evolutive characteristics in thirty-four patients
Full Text Available Objetivos: describir la frecuencia y características clínico-analíticas de la pancreatitis aguda (PA recidivante con enteropatía por gluten (EG asociada. Pacientes y métodos: estudiamos de forma prospectiva los casos de pancreatitis agudas ingresados en nuestro Servicio durante el año 2006. Registramos un total de 185 pacientes. A las formas recurrentes que fueron 40 en total (22%, les aplicamos un protocolo clínico-analítico consistente en la determinación de marcadores serológicos, genéticos y biopsias duodenales, para descartar una EG asociada. Resultados: un total de 34 pacientes (18% cumplían criterios clínico-biológicos de EG asociada (grupo 1 y se compararon con el resto de las PA no-EG (n = 161 (grupo 2. La edad media en la EG fue de 54 ± 25 años, ligeramente inferior al grupo 2, (61 ± 14 (NS. Existía un ligero predominio de mujeres (50% en el grupo 1, respecto al grupo 2 (38,5% (NS. Siete pacientes del grupo 1 (20% presentaron una PA grave, frente a 27 (17% en el grupo 2 (NS. La presencia de colelitiasis en el grupo 1, fue de 6 casos (18%, significativamente inferior a la del grupo 2, de 72 casos (45% (p Objectives: to describe the frequency and the clinical and laboratory characteristics of relapsing acute pancreatitis (AP associated with gluten enteropathy (GE. Patients and methods: we prospectively examined all acute pancreatitis cases admitted to our Department in 2006. We recorded a total of 185 patients. With recurring forms, 40 (22% in all, we used a clinical-lab protocol including serologic and genetic markers, and duodenal biopsy to rule out GE. Results: a total of 34 patients (18% met clinical-biological criteria for GE (group 1, and were compared to the remaining non-GE AP cases (n = 161 (group 2. Mean age in the GE group was 54 ± 25 years, slightly younger than group 2 (61 ± 14 (NS. There was a mild predominance of women (50% in group 1 versus group 2 (38.5% (NS. Seven patients in group 1 (20% had severe
Fiehn, Anne-Marie Kanstrup; Engel, Ulla; Holck, Susanne
Microscopic colitis (MC) is a common cause of chronic watery diarrhea. Traditionally, MC encompasses the 2 subgroups lymphocytic colitis (LC) and collagenous colitis, but recently, an additional subgroup, MC incomplete, has been introduced. Distinguishing between the subgroups relies exclusively...
Bhardwaj, R; Vaizey, C J; Boulos, P B; Hoyle, C H
Lateral sphincterotomy diminishes internal anal sphincter hypertonia and thereby reduces anal canal pressure. This improves anal mucosal blood flow and promotes the healing of anal fissures. However, sphincterotomy can be associated with long term disturbances of sphincter function. The optimal treatment for an anal fissure is to induce a temporary reduction of anal canal resting pressure to allow healing of the fissure without permanently disrupting normal sphincter function. Broader understanding of the intrinsic mechanisms controlling smooth muscle contraction has allowed pharmacological manipulation of anal sphincter tone. We performed an initial Medline literature search to identify all articles concerning "internal anal sphincter" and "anal fissures". This review is based on these articles and on additional publications obtained by manual cross referencing. Internal anal smooth muscle relaxation can be inhibited by stimulation of non-adrenergic non-cholinergic enteric neurones, parasympathetic muscarinic receptors, or sympathetic beta adrenoceptors, and by inhibition of calcium entry into the cell. Sphincter contraction depends on an increase in cytoplasmic calcium and is enhanced by sympathetic adrenergic stimulation. Currently, the most commonly used pharmacological agent in the treatment of anal fissures is topical glyceryl trinitrate, a nitric oxide donor. Alternative agents that exhibit a similar effect via membrane Ca2+ channels, muscarinic receptors, and alpha or beta adrenoceptors are also likely to have a therapeutic potential in treating anal fissures.
Yuji Toiyama; Toshimitsu Araki; Shigeyuki Yoshiyama; Chikao Miki; Masato Kusunoki
We report a case of secondary pouchitis, defined as a mucosal inflammatory lesion in the ileal reservoir provoked by pouch-related complication following total colectomy and pouch anal anastomosis, which was successfully treated by salvage surgery. A 20-year-old woman with ulcerative colitis developed acute severe bloody diarrhea following proctocolectomy, ileal pouchanal anastomosis and diverting ileostomy. She was diagnosed as having a secondary pouchitis mainly caused by a peripouch abscess and partly concerned with the abnormal pouch formation. The remnantrectum and ileal pouch were excised and ileal pouch-anal anastomosis and diverting ileostomy were constructed.The postoperative course was uneventful with no sign of pouchitis. Salvage surgery may be indicated to treat secondary pouchitis when caused by surgery-related complications.
Full Text Available Synchronous collagenous and pseudomembranous colitis has not been previously reported. A 73-year-old woman presented with chronic watery diarrhea and abdominal cramping of six weeks’ duration. Biopsies of the colon revealed findings of collagenous colitis involving the endoscopically normal right colon, and superimposed collagenous and pseudomembranous colitis involving the rectosigmoid colon. Endoscopically, the left colon revealed discrete ulcerative plaques, and Clostridium difficile toxin A assay was positive. The patient partially responded to a three-week regimen of metronidazole, and symptoms resolved completely with subsequent steroid therapy. At follow-up endoscopy four months later, colon biopsies demonstrated persistence of subepithelial collagen but no pseudomembranes. The patient remained asymptomatic during this interval. Collagenous colitis has been reported in association with other inflammatory bowel diseases, including lymphocytic colitis, sprue and idiopathic inflammatory bowel disease. This unique association of collagenous colitis with an endotoxigenic inflammatory bowel disease is presented with a review of related disease features.
Jan J(o)zefczuk; Bogdan Marian Wozniewicz
AIM: To describe a new clinical and pathological subtype of microscopic colitis in children.METHODS: A selected group of children with abdominal pain, constipation and/or diarrhoea showing discrete or no macroscopic abnormalities on endoscopy was described.RESULTS: Multiple biopsies of colon showed large mononuclear clear cells in lamina propria of mucous membrane provided that good quality histological sections were performed and observed under a higher magnification. Otherwise, they could be misinterpreted as artefacts. Their presence in routine histology might suggest a systemic storage disease (Whipple's disease), and neuronal intestine dysplasia.Using immunohistochemical staining and electron microscopy we confirmed their origin from CD68 positive mononuclear macrophages.CONCLUSION: The presence of large clear cells is a constant microscopic feature. Failure of transient large bowel stationary macrophages plays a role in the pathogenesis of this benign microscopic clear cell colitis,sometimes coexisting with allergy.
Full Text Available Collagenous colitis and lymphocytic colitis, the two types of microscopic colitis, cause watery diarrhea. Budesonide, a glucocorticoid medication with limited systemic availability, is commonly used to treat these illnesses. Budesonide has proven efficacy in the induction of clinical remission in both collagenous colitis and lymphocytic colitis. Budesonide is effective as a maintenance drug for patients with collagenous colitis, but has not been studied for this indication in patients with lymphocytic colitis. This drug improves quality of life in patients while causing few mild adverse events. Budesonide is an effective treatment of microscopic colitis that is safe and well tolerated.
Full Text Available Microscopic colitis – including collagenous colitis and lymphocytic colitis – causes chronic watery diarrhea, usually in middle-aged or elderly patients. There is an association with celiac disease and certain medications. Medical treatment includes various antidiarrheal agents, mesalamine, corticosteroids and immunosuppressant drugs. Rarely, patients require surgery for refractory disease. An evidence-based and practical approach to treatment should optimize the treatment response while minimizing potential adverse events.
Hugh; James; Freeman
The risk of developing colon cancer is increased in colitis patients, particularly if the disease is extensive and its duration long-standing. Endoscopic guidelines have been developed with the goal of detecting early neoplastic changes prior to development of advanced malignancy. Unfortunately, the natural history of this superimposed neoplastic process in colitis appears to be very heterogeneous and poorly understood. Moreover, there are numerous confounding variables in colitis patients that limit accura...
Fenger, C; Schrøder, H D
In a consecutive series of minor surgical specimens from the anal canal, neuronal hyperplasia was found in nine of 56 haemorrhoidectomy specimens and in four of 23 fibrous polyps. In an additional series of 14 resections of the anal canal, neuronal hyperplasia was present in six cases, of which...
In this thesis we investigated several aspects of anal intraepithelial neoplasia (AIN) in HIV+ men who have sex with men (MSM). This condition has gained clinical interest because of the impressive increase of the anal cancer incidence in HIV+ MSM since the introduction of combination antiretroviral
Clark, A. F.; Tayler, P J; Bhate, S R
Two cases of late onset faecal soiling as a result of anal masturbation in children who were neither mentally handicapped nor psychotic were studied. The role of soiling in aiding the young person and his family to avoid separating and maturing is highlighted. We suggest that the association of anal masturbation and resistant nocturnal soiling may be unrecognised.
Luís Marcelo Alves Ramos
Full Text Available O texto faz uma introdução à Psicologia Analítica do psicólogo e psiquiatra suíço Carl Gustav Jung: define o conceito de Psicologia Analítica, traz uma biografia resumida de Carl Gustav Jung, indica as principais diferenças entre a Psicologia Analítica e a Psicanálise, descreve a estrutura e o funcionamento da psique e, por fim, apresenta sinteticamente as características dos tipos de personalidades traçadas por Jung. The text makes an introduction to the Analytical Psychology of the psychologist and swiss psychiatrist Carl Gustav Jung: it defines the concept of Analytical Psychology, brings a summarized biography of Carl Gustav Jung, indicates the main differences between Analytical Psychology and the Psychoanalysis, describes the structure and the functioning of psyche and, finally, presents synthetically the characteristics of the types of personalities traced by Jung.
Vinicius Anciães Darriba
Full Text Available Este artigo tem como objetivo investigar, na obra de Freud, a demarcação que se institui entre o terapêutico e o analítico. Tal investigação enfoca, primeiramente, a passagem da hipnose à associação livre e o direcionamento do autor à questão da causa, o que estabelece uma visada para a cura analítica em confluência com o que se desdobra da exploração do campo do inconsciente e da consideração de um domínio pulsional. Delimitados por esta via os objetivos terapêuticos e analíticos, interroga-se, em seguida, como a dimensão do terapêutico se veria reintroduzida nos termos da nova direção de cura proposta por Freud.
Shahram Paydar; Ahmad Izadpanah; Leila Ghahramani; Seyed Vahid Hosseini; Alimohammad Bananzadeh; Salar Rahimikazerooni; Faranak Bahrami
Background: On an average 30-50% of patients who undergo incision and drainage (I and D) of anal abscess will develop recurrence or fistula formation. It is claimed that finding the internal orifice of anal abscess to distract the corresponding anal gland duct; will decline the rate of future anal fistula. Surgeons supporting I and D alone claim that finding the internal opening is hazardous. This study is conducted to assess short-term results of optional method to manage patients with anal ...
Cronin, Edmond M
Autoimmune hepatitis is a rare, chronic inflammatory disorder which has been associated with a number of other auto-immune conditions. However, there are no reports in the medical literature of an association with microscopic (lymphocytic) colitis. We report the case of a 53-year-old woman with several autoimmune conditions, including lymphocytic colitis, who presented with an acute hepatitis. On the basis of the clinical features, serology, and histopathology, we diagnosed autoimmune hepatitis. To our knowledge, this is the first report of autoimmune hepatitis in association with lymphocytic colitis, and lends support to the theory of an autoimmune etiology for lymphocytic colitis.
Wildt, Signe; Rumessen, Jüri J; Csillag, Claudio
Collagenous colitis (CC) is an inflammatory bowel disease of unknown aetiology and pathogenesis. In ulcerative colitis and Crohn's disease, prostaglandins may be involved in the pathogenesis of inflammation, and increased expression of cyclo-oxygenase-2 (COX-2) has been detected. The purpose...... with samples from eight normal controls, and samples from eight patients with ulcerative colitis or Crohn's disease. Specimens from patients with CC expressed COX-2 protein in increased amounts compared with controls, but similar to patients with ulcerative colitis and Crohn's disease. COX-2 expression...
Yebra Biurrun, María del Carmen
Esta unidade didáctica enfócase de maneira que permita proporcionar unha visión global da Química Analítica e a súa terminoloxía básica, mostrando a importancia da Química Analítica para a resolución de problemas de diversos ámbitos. Este enfoque faise sobre o esquema do proceso analítico como medio de resolución dunha determinada problemática analítica real. Deste xeito, partindo dun esquema sinxelo, explícase o obxectivo e as distintas etapas do proceso analítico: definición do problema...
GU Jin; LI Jiyou; YAO Yunfeng; LU Aiping; WANG Hongyi
It is difficult to distinguish a tectal carcinoma with anal metastases from coexistent synchronous anorectal carcinomas.The therapeutic strategy for rectal and anal carcinoma is so different that it should be clearly identified.Here,we report on the case of a 63-year-old man who presented with an upper-third rectal adenocarcinoma.Five months after resection,he developed an adenocarcinoma in the anal canal.The histological slides of both tumors were reviewed and immunohistochemical studies for cytokeratins(CKs)7 and 20 were performed.The index tumor demonstrated CK 7-/CK 20+and the second showed CK7+/CK20+.For this reason,we believe the present case had synchronous adenocarcinomas arising from anal canal and the rectum separately.It is very important to difierentiate the anorectal lesions pathologically because of the impact on the therapeutic options available,especially for the lesion arising in the anal canal.
Rudd, Joanne [Department of Radiology, West Suffolk Hospital, Hardwick Lane, Bury St Edmunds, Suffolk IP33 2QZ (United Kingdom)]. E-mail: firstname.lastname@example.org
This case study followed the pathway taken by an elderly patient who presented as an emergency with rectal bleeding. Views obtained of the colon by flexible sigmoidoscopy suggested an initial diagnosis of colorectal carcinoma but this proved to be incorrect. It was a combination of the histology obtained from the initial and subsequent endoscopies, barium enema and the clinical history that finally gave rise to the correct diagnosis of ischaemic colitis. Opinion is currently divided as to whether sigmoidoscopy or colonoscopy is the most appropriate test for those patients presenting with rectal bleeding. Ischaemic colitis is a disease that can present with many differing symptoms depending on the degree of severity of the ischaemia.
van Meegdenburg, Maxime M.; Trzpis, Monika; Heineman, Erik; Broens, Paul M. A.
Chronic anal fissure is a painful disorder caused by linear ulcers in the distal anal mucosa. Even though it counts as one of the most common benign anorectal disorders, its precise etiology and pathophysiology remains unclear. Current thinking is that anal fissures are caused by anal trauma and pai
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.
Mitchell, Peter J; Klarskov, Niels; Telford, Karen J;
Anal acoustic reflectometry is a new reproducible technique that allows a viscoelastic assessment of anal canal function. Five new variables reflecting anal canal function are measured: the opening and closing pressure, opening and closing elastance, and hysteresis.......Anal acoustic reflectometry is a new reproducible technique that allows a viscoelastic assessment of anal canal function. Five new variables reflecting anal canal function are measured: the opening and closing pressure, opening and closing elastance, and hysteresis....
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.
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.
De Petris, Giovanni; Chen, Longwen
Microscopic colitis (MC) is an umbrella term that encompasses lymphocytic colitis (LC) and collagenous colitis (CC). Several histological variants of these 2 entities exist; among them is the uncommon giant cell colitis (GCC), in which histiocytic giant cells (GCs) are present in background of CC or LC. We report the case of a 71-year-old woman complaining of watery diarrhea for several years that was diagnosed with CC. At follow-up, she developed giant cell colitis (GCC). Nine years later, a colectomy revealed a form of microscopic colitis in which significant intraepithelial lymphocytosis and collagen plate thickening have disappeared while GCs persisted with diffuse mononuclear cells inflammation of the lamina propria. Thinning of the collagen plate in association with GCs has been described previously. The case contributes the possibility of further evolution of MC into a pure giant cell colitis in which the prototypical manifestations of MC have all but disappeared.
Barcellos,Lêda Pereira de; Russomano, Fábio Bastos; Coutinho,José Ricardo Hildebrandt
Objetivo: verifi car o valor da citologia convencional no diagnóstico de lesões macroscópicas do canal anal e descrever as limitações das amostras obtidas. Método: avaliamos 395 exames citológicos convencionais obtidos por escovado do canal anal de pacientes predominantemente do sexo masculino, soropositivos para HIV, e comparamos com a presença de lesões macroscópicas do canal anal constatadas ao exame proctológico. Resultado: o percentual de amostras adequadas foi de 91,6%...
Song, Kee Ho
Surgery for an anal fistula may result in recurrence or impairment of continence. The ideal treatment for an anal fistula should be associated with low recurrence rates, minimal incontinence and good quality of life. Because of the risk of a change in continence with conventional techniques, sphincter-preserving techniques for the management complex anal fistulae have been evaluated. First, the anal fistula plug is made of lyophilized porcine intestinal submucosa. The anal fistula plug is expected to provide a collagen scaffold to promote tissue in growth and fistula healing. Another addition to the sphincter-preserving options is the ligation of intersphincteric fistula tract procedure. This technique is based on the concept of secure closure of the internal opening and concomitant removal of infected cryptoglandular tissue in the intersphincteric plane. Recently, cell therapy for an anal fistula has been described. Adipose-derived stem cells have two biologic properties, namely, ability to suppress inflammation and differentiation potential. These properties are useful for the regeneration or the repair of damaged tissues. This article discusses the rationales for, the estimated efficacies of, and the limitations of new sphincter-preserving techniques for the treatment of anal fistulae.
This review focuses on the early diagnosis of anal cancer and its precursor lesions through routine screening. Anumber of risk-stratification strategies as well as screeningtechniques have been suggested, and currently littleconsensus exists among national societies. Much ofthe current clinical rationale for the prevention of analcancer derives from the similar tumor biology of cervicalcancer and the successful use of routine screening toidentify cervical cancer and its precursors early in thedisease process. It is thought that such a strategy ofidentifying early anal intraepithelial neoplasia will reducethe incidence of invasive anal cancer. The low prevalenceof anal cancer in the general population prevents theuse of routine screening. However, routine screeningof selected populations has been shown to be a morepromising strategy. Potential screening modalities includedigital anorectal exam, anal Papanicolaou testing, humanpapilloma virus co-testing, and high-resolution anoscopy.Additional research associating high-grade dysplasiatreatment with anal cancer prevention as well as directcomparisons of screening regimens is necessary todevelop further anal cancer screening recommendations.
A case is presented in which the patient's traumatically derived intense anal erogeneity (associated with traumatic anxiety as well as with castration anxiety) inhibited his phallic sensations and potency and also his power to sustain productive thought. His passive cravings were disguised and reacted against in his compulsive-exhibitionistically phallic role of a Don Juan. He described at least two levels of anal feelings: a dangerous but exciting, tolerable or even pleasurable tension associated with the imago of the goose; and an unbearable, terrifying overcharged level embodied in the imago of the rat. (He had read of, and had felt himself identified with, Freud's Rat Man.) Contrasts are presented with François Rabelais' account of the instinctual development and anal training of Gargantua, in which the connotations of the goose lead to a happy anal, phallic and intellectual control. Generalizations are ventured about the crucial attainment of command over the anal sphincter for the taming of 'primal affect'(Fliess). With early psychopathology there is a defensive overcathexis of anal control (and of anal mechanisms and character traits) to try to contain over-stimulation. In contrast true anal mastery contributes to the acquisition of optimal genital feelings and functioning and to the capacity for sustaining integrative thinking so necessary for 'owning' one's affects and impulses, and therefore for a feeling of identity. Finally, some remarks of Freud on Rabelais are reviewed in relation to levels of urethral erogeneity, seen as developmental way stations between the anal and the phallic, and partaking of both.
Yebra Biurrun, María del Carmen
Esta unidade didáctica é a primeira toma de contacto do alumnado co estudo do tratamento dos datos analíticos e a comprobación da súa calidade. Este estudo poderase completar máis adiante dentro do programa desta materia cando se presente o resto dos parámetros de calidade dos métodos analíticos. A importancia deste tema radica en que unha vez obtidos os datos analíticos, o primeiro aspecto que se ten que considerar é a verificación da calidade dos mesmos en termos de exactitude e precisió...
Kawamura, Mikio; ARAKI, TOSHIMITSU; Okita, Yoshiki; Kondo, Satoru; Ichikawa, Takashi; FUJIKAWA, HIROYUKI; Uchida, Keiichi; Mohri, Yasuhiko; KUSUNOKI, MASATO
Background Spinal epidural abscess is a rare condition with high morbidity and mortality, for which a delay in diagnosis and treatment can lead to irreversible neurologic deficit or even death. Although patients with spinal epidural abscess have systemic predisposing immunocompromised conditions, spinal intervention, or trauma, this condition has been reported as a result of perforation or fistulization arising from inflammatory bowel disease. We describe herein a rare case of spinal epidural...
... 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 ...
van der Wouden, E J; Karrenbeld, A; Kleibeuker, J H; Dijkstra, Gerard
Chronic diarrhoea is a frequent complaint in clinical practice. Microscopic colitis is the cause of this symptom in 10% of these cases and the prevalence is rising. To exclude microscopic colitis a colonoscopy with multiple biopsies of different regions of the colon is mandatory. A sigmoidoscopy alo
Hansen, Lars Koch
Gennemgang af T-cellers kalium kanaler og deres mulige rolle i Colitis Ulcerosa. Artiklen skrevet til Den danske Colitis-Crohn Forenings Medlemsblad.......Gennemgang af T-cellers kalium kanaler og deres mulige rolle i Colitis Ulcerosa. Artiklen skrevet til Den danske Colitis-Crohn Forenings Medlemsblad....
... see the section Understanding Recurrence . For patients with colostomies Most people treated for anal cancer don’t ... APR, you will need to have a permanent colostomy. If you have a colostomy, follow-up is ...
Full Text Available Background: On an average 30-50% of patients who undergo incision and drainage (I and D of anal abscess will develop recurrence or fistula formation. It is claimed that finding the internal orifice of anal abscess to distract the corresponding anal gland duct; will decline the rate of future anal fistula. Surgeons supporting I and D alone claim that finding the internal opening is hazardous. This study is conducted to assess short-term results of optional method to manage patients with anal abscess and fitula-in-ano at the same time. Materials and Methods: In this cross-sectional descriptive study 49 from 77 patients with anal abscess whose internal orifice was not identified by pressing on the abscess, diluted hydrogen peroxide (2% and methylene blue was injected into the abscess cavity and the anal canal was inspected to find out the internal opening. Once the opening was distinguished, an incision was given from the anal verge to the internal opening. Results: The internal orifice was identified in 44 out of 49 patients (90% who underwent this new technique. Up to 18 months during follow-up, only 2.5% of patients with primary fistulotomy developed fistula on the site of a previous abscess. Conclusion: Conventional method to seek the internal orifice of anal abscesses is successful in about one-third of cases. By applying this new technique, surgeons would properly find the internal opening in >90% of patients. Needless to say, safe identification of the anal gland orifice in anal abscess disease best helps surgeons to do primary fistulotomy and in turn it would significantly decrease the rate of recurrence in anal abscess and fistula formation.
Mendes,Carlos Ramon Silveira; FERREIRA, Luciano Santana de Miranda; Sapucaia,Ricardo Aguiar; LIMA, Meyline Andrade; Araujo, Sergio Eduardo Alonso
INTRODUCTION: Anal fistula is an epithelised path between the rectum or anal canal and the perianal region. The use of laparoscopic surgery with a minimally invasive procedure has led to the development of video-assisted surgical treatment of anal fistula.OBJECTIVE: To describe the surgical technique VAAFT as a new approach to fistula.CONCLUSION: This is a safe and reproducible procedure. It enables the study of the entire fistula, obtaining the identification of accessory paths, cavitations ...
Aguinaga B. Oscar William
Full Text Available "Las malformaciones ano-rectales están entre las más comunes de las malformaciones de tipo congénito causadas por anormalidades del desarrollo, aproximadamente uno de cada cinco mil partos con producto vivo, en Estados Unidos". Clasificaciones existen muchas, pero la de uso más generalizado y tenida en cuenta en el Hospital de la Misericordia, servicio de quirúrgicas, es: Estenosis anal congénita, agenecia anal, atresia rectal, fístula rectoperineal, fístula rectovaginal.
Sierra Fernández, J.; J. Bosque Sendra; García Campaña, A.; Blanc García, R.; Del Iruela, M.; Gámiz Gracia, L.; Alés Barrero, F.
Este trabajo forma parte de un proyecto de innovación docente financiado por la Universidad de Granada durante el curso 2008-09 y pretende que el alumnado del Departamento de Química Analítica de los primeros cursos de Química, Ingeniería Química, Ciencias Ambientales y Farmacia sea capaz de interrelacionar los aspectos teóricos y prácticos de diversos procesos analíticos mediante el uso de laboratorios virtuales en las sesiones prácticas. Con este fin, las clases prácticas son planificadas y...
Desenvolvimento e validação de método analítico para nistatina creme vaginal por cromatografia líquida de alta eficiência Development and validation of an analytical method for Nystatin vaginal cream by high performance liquid chromatography
Zênia Maria Maciel Lavra
Full Text Available A nistatina é um antibiótico poliênico, com características fungistáticas e fungicidas, que age desestruturando a membrana celular de fungos e leveduras. O creme vaginal de nistatina é usado para o tratamento da candidíase vaginal. Até recentemente, os compêndios oficiais preconizavam o ensaio microbiológico para doseamento deste antibiótico, método este considerado inviável na rotina de centros de controle de qualidade, devido ao tempo excessivo para liberação dos resultados. Visando obter um método alternativo para o doseamento do creme vaginal de nistatina, procurou-se desenvolver e validar um método cromatográfico (CLAE. O método desenvolvido utilizou como fase estacionária uma coluna de fase reversa, C18, 3,9 x 150 mm, 4 mm, à temperatura de 30 ºC. A fase móvel foi constituída por tampão fosfato de sódio 0,25 mM e EDTA 0,025 mM, pH 6,00, metanol e acetonitrila (40:30:30, vazão de 1,0 mL/minuto e comprimento de onda 305 nm. O método validado revelou-se exato, preciso, robusto, linear e específico, além de rápido e prático, podendo ser utilizado para o doseamento analítico de creme vaginal de nistatina.Nystatin is a polyenic antibiotic with fungistatic and fungicide characteristics that acts by de-structuring the cellular membrane of fungi and yeast. The nystatin vaginal cream is used for the treatment of vaginal candidiasis. Until recently, the official compendia professed the microbiological trial for dosing this antibiotic, method considered as non-feasible in the routine of quality control centers due to the excessive time for release of results. Aiming at obtaining an alternative method for dosing nystatin vaginal cream, a chromatographic method (HPLC was developed and validated. The method developed used a reversible phase column of C18, 3.9 x 150 mm, 4 mm, at 30 ºC. The mobile phase was made up of a 0.25 mM sodium phosphate buffer and 0.025 mM EDTA, pH 6.00, methanol and acetonitrile (40:30:30, rate of
Matthew B Grisham
Full Text Available Nitric oxide (NO is thought to play an important role in modulating the inflammatory response by virtue of its ability to affect bloodflow, leukocyte function and cell viability. The objective of this study was to assess the role that NO may play in mediating the mucosal injury and inflammation in a model of chronic granulomatous colitis using two pharmacologically different inhibitors of nitric oxide synthase (NOS. Chronic granulomatous colitis with liver and spleen inflammation was induced in female Lewis rats via the subserosal (intramural injection of peptidoglycan/polysaccharide (PG/PS derived from group A streptococci. Chronic NOS inhibition by oral administration of NG-nitro-L-arginine methyl ester (L-NAME (15 µmol/kg/day or amino-guanidine (AG (15 µmol/ kg/day was found to attenuate the PG/PS-induced increases in macroscopic colonic inflammation scores and colonic myeloperoxidase activity. Only AG -- not L-NAME – attenuated the PG/PS-induced increases in colon dry weight. Both L-NAME and AG significantly attenuated the PG/PS-induced increases in spleen weight whereas neither was effective at significantly attenuating the PG/PS-induced increases in liver weight. Although both L-NAME and AG inhibited NO production in vivo, as measured by decreases in plasma nitrite and nitrate levels, only AG produced significantly lower values (38±3 versus 83±8 µM, respectively, P<0.05. Finally, L-NAME, but not AG, administration significantly increased mean arterial pressure from 83 mmHg in colitic animals to 105 mmHg in the PG/PS+ L-NAME-treated animals (P<0.05. It is concluded that NO may play an important role in mediating some of the pathophysiology associated with this model of chronic granulomatous colitis.
Park, Tina; Cave, David; Marshall, Christopher
Microscopic colitis is a common cause of chronic, nonbloody diarrhea. Microscopic colitis is more common in women than men and usually affects patients in their sixth and seventh decade. This article reviews the etiology and medical management of microscopic colitis. The etiology of microscopic colitis is unknown, but it is associated with autoimmune disorders, such as celiac disease, polyarthritis, and thyroid disorders. Smoking has been identified as a risk factor of microscopic colitis. Ex...
Hugh J Freeman
Full Text Available An 18-year-old female with ankylosing spondylitis developed fever, abdominal pain and diarrhea on two occasions after starting sulphasalazine therapy. Flexible sigmoidoscopy revealed pseudomembranous colitis; fecal cultures were positive for Clostridium difficile; and C difficile toxin assay was positive. Despite the frequent use of sulphasalazine in the management of inflammatory bowel disease, this complication has been apparently rare. Clinicians should be wary of the onset of diarrhea in patients receiving sulphasalazine, whether for inflammatory bowel disease or other conditions.
Chen, Tun-Chieh; Lu, Po-Liang; Lin, Wei-Ru; Lin, Chun-Yu; Wu, Jeng-Yih; Chen, Yen-Hsu
Pseudomembranous colitis (PMC) is known to develop after antibiotic treatment, but is rarely associated with antituberculosis (anti-TB) agents. We report a 28-year-old woman without underlying diseases developing PMC after 126 days of anti-TB treatment. Severe diarrhea and abdominal cramping pain were experienced. Colonoscopic biopsy proved the diagnosis of PMC. Her symptoms improved after discontinuing the anti-TB agents but recurred shortly after challenging with rifampin and isoniazid. Metronidazole administration and replacement of rifampin with levofloxacin successfully cured the PMC. Our report supports the notion that rifampin can induce PMC.
Tetsushi Kinugasa; Yoshito Akagi
Surgical therapy for ulcerative colitis(UC) depends on the medical therapy administered for the patient’s condition. UC is a benign disease. However, it has been reported that the rare cases of cancer in UC patients are increasing, and such cases have a worse prognosis. Recently, surgical therapy has greatly changed, there has been quite an increase in the number of UC patients with high-grade dysplasia and/or cancer. These lesions are known as colitis-associated cancer(CAC). The relationship between inflammation and tumorigenesis is well-established, and in the last decade, a great deal of supporting evidence has been obtained from genetic, pharmacological, and epidemiological studies. Inflammatory bowel disease, especially UC, is an important risk factor for the development of colon cancer. We should determine the risk factors for UC patients with cancer based on a large body of data, and we should attempt to prevent the increase in the number of such patients using these newly identified risk factors in the near future. Actively introducing the surgical treatment in addition to medical treatment should be considered. Several physicians should analyze UC from their unique perspectives in order to establish new clinically relevant diagnostic and treatment methods in the future. This article discusses CAC, including its etiology, mechanism, diagnosis, and treatment in UC patients.
Hennild, V.; Kjaergaard, H.; Kuld Hansen, L.
A radiologic investigation was performed in 26 patients subjected to colectomy, mucosal proctectomy and endorectal ileo-anal anastomosis after the creation of an ileal reservoir. The patients had suffered from ulcerative colitis or familial polyposis. The reservoir and its efferent leg was best demonstrated by contrast enema. The size and position of the reservoir and the efferent leg was demonstrated, and stenoses, abscesses and fistulae could be identified. Examination of the small bowel with a contrast medium showed slight dilatation of the ileum orally to the reservoir in all instances and one patient had a stenosis at the junction of the afferent leg of the reservoir. Erect and supine projections of the abdomen showed gas in the intestine and fluid levels in the reservoir. These radiographic findings should not be confused with ileus or pelvic abscess. Radiology was of great value in disclosing postoperative complications.
Full Text Available Abstract Background Microscopic colitis presents with similar symptoms to classic inflammatory bowel diseases. Osteoporosis is a common complication of Crohn's disease but there are no data concerning bone metabolism in microscopic colitis. Aims The aim of the present study was to evaluate bone density and metabolism in patients with microscopic colitis. Methods Fourteen patients microscopic colitis were included in the study, and 28 healthy persons and 28 age and gender matched Crohn's disease patients were enrolled as controls. Bone mineral density was measured using dual x-ray absorptiometry at the lumbar spine, femoral neck and the radius. Serum bone formation and bone resorption markers (osteocalcin and beta-crosslaps, respectively were measured using immunoassays. Results Low bone mass was measured in 57.14% patients with microscopic colitis. Bone mineral density at the femoral neck in patients suffering from microscopic colitis and Crohn's disease was lower than in healthy controls (0.852 ± 0.165 and 0.807 ± 0.136 vs. 1.056 ± 0.126 g/cm2; p 2; p 2. Mean beta-crosslaps concentration was higher in microscopic colitis and Crohn's disease patients than controls (417.714 ± 250.37 and 466.071 ± 249.96 vs. 264.75 ± 138.65 pg/ml; p Conclusions Low bone mass is frequent in microscopic colitis, and alterations to bone metabolism are similar to those present in Crohn's disease. Therefore, microscopic colitis-associated osteopenia could be a significant problem in such patients.
Gaa, J. (Heidelberg Univ., Klinikum Mannheim, Inst. fuer Klinische Radiologie (Germany)); Lee, M.J. (Massachusetts General Hospital, Boston, MA (United States). Dept. of Gastrointestinal Radiology); Georgi, M. (Heidelberg Univ., Klinikum Mannheim, Inst. fuer Klinische Radiologie (Germany))
Pseudomembranous colitis (PMC) is an infectious colitis usually occurring as a complication of antibiotic therapy. The computed tomography (CT) findings of 10 patients with PMC are reviewed. All patients demonstrated an abnormal large bowel wall with an average thickness of 13 mm (range 7-31 mm). Additional, but less frequent findings included mesenteric inflammation, ascites, pleural effusions, and dilatation of the large or small bowel. Pancolonic involvement was seen in 7 cases, while three patients had focal colitis. Although the CT appearance of PMC is not specific, the diagnosis may be suggested in the proper clinical setting. (orig.)
Mridula, T; Pai, R R; Mathai, A M; Tantry, B V; Adhikari, P
Pseudomembranous colitis in association with pregnancy has not been well described in English literature. Recent studies show a drastic increase in the incidence and severity of Pseudomembranous colitis in pregnant women, who were once thought to be at low risk. We report here a case of Pseudomembranous colitis in a young healthy immunocompetent pregnant lady. An early suspicion of this entity with the characteristic appearance of pseudomembranes on colonoscopy and histology confirmed the diagnosis enabling prompt treatment and complete recovery without any serious consequences.
Rasmussen, Eva; Grønbaek, Karin; Linnemann, Dorte
haematochezia remained present after six months. Development of IBD subsequent to CMV colitis has previously been described, and is now suspected in our patient. CMV colitis is a rare but possible differential diagnosis in immunocompetent patients with fever, elevated liver enzymes and bloody stools......A healthy young man was hospitalized due to fever, malaise and bloody stools for three weeks. The patient had a primary CMV infection based on biochemical, serological and ultrasonic results, and a colonoscopy was consistent with left-sided CMV colitis. He recovered spontaneously, though...
temporária em outro. Um paciente necessitou reoperação precoce por deiscência de linha de sutura. Os resultados tardios foram classificados como bons em 67 (87%. Não houve reoperação por recorrência de estenose. CONCLUSÃO: A facilidade técnica, os bons resultados funcionais e a ausência de complicações graves demonstraram que as técnicas de avanço de retalho de Sarner e Musiari são efetivas e seguras para correção de estenose anal, particularmente nos casos em que a fibrose cutânea é o principal fator etiológico.
Kim, Jae Hi; Park, Jin Hyung
Pseudomembranous colitis is a dangerous but unusual side effect of antibiotics usage. We report a case of pseudomembranous colitis that developed in a 50-year-old female patient with diabetes mellitus during first line anti-tuberculous therapy including rifampicin. The patient was diagnosed with active pulmonary tuberculosis 70 days earlier. On admission, she suffered intermittent abdominal pain and watery diarrhea for 2 weeks. Colonoscopy revealed exudative, punctuate, raised plaques with skip areas or edematous hyperemic mucosa, and histopathologic findings were consistent with pseudomembranous colitis with typical volcano-like exudate. Symptoms improved on treatment with metronidazole. There was no recurrence after reinstitution of the anti-tuberculous agents excluding rifampicin. In patients with persistent diarrhea receiving anti-tuberculosis treatment, rifampicin associated pseudomembranous colitis should always be kept in mind.
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
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.
Full Text Available Acute ischaemic colitis (AIC is being increasingly recognised as an uncommon cause of abdominal pain associated with fresh bleeding per rectum. It is paramount to maintain a high index of suspicion and adopt appropriate management strategies to avoid complications and inappropriate interventions. In this paper, we describe a case of AIC and review literature pertinent to the management of this condition. Keywords: Ischaemic colitis, acute abdomen, management.
Morlino, A; Tramutola, G; Rossi, M T; Scutari, F
The aim of study is to report the results of our experience about ultra-low rectum carcinomas treated with anterior resection and colo-anal anastomosis. The surgery still represents the treatment of choice for the cancer of the rectum. The problems concern the conservation of the sphincter functions (anal and urethral), and sexual function and the reduction of the locoregional recurrences. From 2005 to 2007, 33 patients underwent surgery for low and ultralow rectal carcinoma (30 treated with neoadjuvant radio-chemotherapy, and 3 only with surgery). In 16 of these we have performed a colo-anal anastomosis, in 11 an ultralow colorectal anastomosis and in 7 a Miles resection. We report our updated results.
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.
Bloom, D.A. [Department of Radiology, Children`s Radiological Institute, Columbus Children`s Hospital, OH (United States); Buonomo, C. [Department of Radiology, Children`s Hospital, Harvard Medical School, Boston, Massachusetts (United States); Fishman, S.J. [Department of Surgery, Children`s Hospital, Harvard Medical School, Boston, Massachusetts (United States); Furuta, G.; Nurko, S. [Department of Gastroenterology, Children`s Hospital, Harvard Medical School, Boston, Massachusetts (United States)
Background. Allergy to cow milk protein is a common cause of gastrointestinal symptoms in infancy. Milk allergy is usually a clinical diagnosis, and thus there have been few reports of the radiographic findings. Objective. To describe the barium enema findings of allergic colitis and differentiate them from Hirschsprung disease. Materials and methods. Four infants (age range 7 days-5 weeks) with constipation underwent barium enema to exclude Hirschsprung disease. Radiographic findings were correlated with the pathologic specimens from suction rectal biopsy. Results. All enemas revealed irregular narrowing of the rectum and a transition zone. Rectal biopsies in each case demonstrated ganglion cells and evidence of an allergic colitis, with inflammatory infiltrates in the lamina propria. A diagnosis of milk allergy colitis was made and symptoms resolved after removal of milk from the diet. Conclusions. Milk allergy is common in infancy. The rectum is a primary target organ, with allergic colitis often diagnosed on clinical grounds alone. However, a child with allergic colitis may be referred to radiology for barium enema, especially if constipation is present. The radiologist should be aware of the unique imaging findings of allergic colitis, so as to avoid confusion with Hirschsprung disease and perhaps an unnecessary rectal biopsy. (orig.) With 4 figs., 1 tab., 17 refs.
Hugh James Freeman
In the past,there has been considerable focus on a host of drugs and chemicals that may produce colonic toxicity.Now,a variety of new biological monoclonal antibody agents,usually administered by infusion,have appeared in the clinical realm over the last decade or so to treat different chronic inflammatory or malignant disorders.For some of these agents,adverse effects have been documented,including apparently new forms of immune-mediated inflammatory bowel disease.In some,only limited symptoms have been recorded,but in others,severe colitis with serious complications,such as bowel perforation has been recorded.In others,adverse effects may have a direct vascular or ischemic basis,while other intestinal effects may be related to a superimposed infection.Some new onset cases of ulcerative colitis or Crohn's disease may also be attributed to the same agents used to treat these diseases,or be responsible for disease exacerbation.Dramatic and well documented side effects have been observed with ipilimumab,a humanized monoclonal antibody developed to reduce and overcome cytotoxic T-lymphocyte antigen 4,a key negative feedback regulator of the T-cell anti-tumor response.This agent has frequently been used in the treatment of different malignancies,notably,malignant melanoma.Side effects with this agent occur in up to 40％ and these are believed to be largely immune-mediated.One of these is a form of enterocolitis that may be severe,and occasionally,fatal.Other agents include rituximab (an antiCD20 monoclonal antibody),bevacizumab (a monoclonal antibody against the vascular endothelial growth factor) and anti-tumor necrosis factor agents,including infliximab,adalimumab and etanercept.
Arévalo, Fernando; Aragón, Violeta; Montes, Pedro; Perez Narrea, Teresa; Monge, Eduardo
Objetivos: 1) Determinar la prevalencia de incremento de eosinófilos en mucosa colónica en pacientes con colitis linfocítica (CL). 2) Determinar la coexistencia de colitis eosinofílica (CE) en pacientes con CL. Materiales y métodos: Las biopsias colónicas de pacientes adultos con diarrea crónica diagnosticados como CL en el hospital Daniel A. Carrión durante octubre 2009 a marzo 2012 fueron revisadas de forma independiente por 2 patólogos. Microscópicamente, se investigó y cuantificó la prese...
Perner, Anders; Lassen, Inge Nordgaard; Matzen, Peter;
with ulcerative colitis, 10 patients with collagenous colitis and 20 controls with uninflamed mucosa. METHODS: The tip of a Teflon tube was placed in the caecum during colonoscopy. Subsequently, argon was infused at a constant rate for 70-180 min. Argon and NO in gas sampled from the rectum were measured...
Mitsuro Chiba; Takeshi Sugawara; Haruhiko Tozawa; Hidehiko Tsuda; Toru Abe; Takuo Tokairin; Iwao Ono; Eriko Ushiyama
There have only been a few reports on lansoprazoleassociated collagenous colitis. Colonic mucosa of collagenous colitis is known to be endoscopically normal. We present a case of collagenous colitis where the mucosa showed diffuse cloudiness mimicking ulcerative colitis. A 70-year-old woman developed watery diarrhea four to nine times a day. She had interstitial pneumonia at 67 and reflux esophagitis at 70 years. Lansoprazole 30 mg/d had been prescribed for reflux esophagitis for nearly 6 mo. Lansoprazole was withdrawn due to its possible side effect of diarrhea. Colonoscopy disclosed diffuse cloudiness of the mucosa which suggested ulcerative colitis. Consequently sulfasalazine 2 g/d was started. The patient's diarrhea dramatically disappeared on the following day. However, biopsy specimens showed subepithelial collagenous thickening and infiltration of inflammatory cells in the lamina propria, confirming the diagnosis of collagenous colitis. One month after sulfasalazine therapy was initiated, colonoscopic and histological abnormalities resolved completely. Five months later the diarrhea recurred. The findings on colonoscopy and histology were the same as before, confirming a diagnosis of collagenous colitis relapse. We found that the patient had begun to take lansoprazole again 3 mo ahead of the recent diarrhea. Withdrawal of lansoprazole promptly resolved the diarrhea. Endoscopic and histological abnormalities were also completely resolved, similar to the first episode. Retrospectively, the date of commencement of sulfasalazine and discontinuation of lansoprazole in the first episode was found to be the same. We conclude that this patient had lansoprazole-associated collagenous colitis.
Ma Silvia Fresneda Fuentes
Full Text Available La confección de presupuestos públicos austeros para la consecución de los criterios de convergencia impuestos por el Tratado de Maastricht ha originado una preocupación en todo el Sector Público en general, y en el hospitalario en particular, por la contención de los costes. Esta situación ha puesto de manifiesto la necesidad de introducir sistemas de Contabilidad para la Gestión interna de las organizaciones hospitalarias públicas. Así, la Contabilidad Analítica o de Costes se constituye como un componente más de dichos sistemas y está llamada a alcanzar dos objetivos muy claros, por un lado, la determinación del coste del producto hospitalario para en base a él realizar una presupuestación prospectiva, y por otro, suministrar información interna que permita llevar a cabo un verdadero Control de Gestión. Con este trabajo se pretenden describir los modelos de costes alternativos propuestos por la literatura especializada, señalando su idoneidad en base a la consecución de los objetivos que la Contabilidad Analítica debe satisfacer. Se pondrá de manifiesto la tendencia actual a establecer modelos basados en la nueva definición de producto hospitalario, los cuales tienen como finalidad la determinación de los costes totales de dicho producto, dejando a un lado el objetivo del control de la eficacia y eficiencia de la gestión.The development of strict Public Budgets in order to reach the goals settled by Maastricht agreements have caused a deep concern in the Public Sector and mostly in hospitals in order to brake the growth of costs. Such a situation has stated clearly the necessity of implementing Management Accounting Systems in Public Hospitals organizations. Therefore, costs accounting cames to be a part of such systems, which is to reach two very clear objetives. In one hand, the definition of the hospital product cost using it as the base to develop the hospital budget. On the other hand, to supply internal
Beuchot, O.P., Mauricio
Este artículo se inscribe en la filosofía de la religión y trata de aplicar la hermenéutica. Concretamente, una hermenéutica analógica, que ya ha sido elaborada durante varios años por el autor y que ha encontrado diversas aplicaciones por otros investigadores. Enfocar así el fenómeno religioso conduce a buscar el sentido que la religión puede brindar al hombre de hoy. Sobre todo, se toman en cuenta la filosofía analítica, que exige referencia y demostración, y la filosofía posmoderna, que va...
Bregnbak, David; Mortensen, Christian; Bendtsen, Flemming
Infliximab treatment may increase the risk of subsequent postoperative complications in patients with ulcerative colitis. The main purpose of the present study therefore was to assess postoperative complications in patients who have undergone colectomy for ulcerative colitis with and without...
Feagan, Brian G; Rutgeerts, Paul; Sands, Bruce E
Gut-selective blockade of lymphocyte trafficking by vedolizumab may constitute effective treatment for ulcerative colitis.......Gut-selective blockade of lymphocyte trafficking by vedolizumab may constitute effective treatment for ulcerative colitis....
Serup-Hansen, Eva; Linnemann, Dorte; Høgdall, Estrid
the frequency and the prognostic value of KRAS and BRAF mutations in a large cohort of patients with anal cancer. One hundred and ninety-three patients with T1-4N0-3M0-1 anal carcinoma were included in the study. Patients were treated with curative (92%) or palliative intent (8%) between January 2000...... and January 2010. KRAS mutations were detected using Therascreen(®)KRAS real-time PCR assay (Qiagen) and V600E or V600D/K BRAF mutations were uncovered using Pyrosequencing. The frequency of KRAS and BRAF mutations was low; KRAS mutations were detected in 1.6% and BRAF mutations in 4.7% of the biopsies....... No impact of KRAS or BRAF status on survival was found. In conclusion, both KRAS and BRAF mutations are rare in anal cancer. The low frequency of KRAS mutations support protocols exploring EGFR-targeted therapy in patients with metastatic anal cancer, while treatment with BRAF inhibitors might be relevant...
Geile, Dorothea; Osterholzer, Georg; Rosenberg, Robert
Anal incontinence is diagnosed primarily by clinical and proctologic examination. Etiological factors of the disease are found in 85% of the patients by additional examinations. Motility dysfunction of colon and rectum has to be excluded (stenosis, dyschezia, internal hernias). Because anal incontinence is a multifactorial disease as a rule, the single compounds have to be diagnosed and have to undergo therapy. Accordingly, useful investigations are: endorectal ultrasound (defect of muscle, inflammatory or tumour infiltration), manometry (alteration of either anal resting pressure and/or anal squeezing pressure) and surface electromyography (ability of contraction, duration of contraction, strength). Neurophysiological examinations are: needle electromyography, pudendal nerve latency time measurement (PNLT). The occurrence of nerve damage determines the outcome of operative intervention! Conservative treatment is indicated in 80 to 90% of all patients, even higher when one includes all patients in the perioperative period. Possible therapy modalities are: nutrition consultation, physiotherapy, pelvic floor training, biofeedback training of pelvic floor and sphincter muscles, electrostimulation and the combination of both (EMG-triggered electrostimulation). Short-term results are satisfying in up to 85% of patients, but later, successful results depend on the patient's willingness or ability to continue training, and on his/her age.
... cells are more likely to become cancerous. Lowered immunity When the body is less able to fight off infections, viruses like HPV can become more active, which might trigger the development of anal cancer. HIV, the virus that causes AIDS, weakens the ...
Lundby, Lilli; Hagen, Kikke; Christensen, Peter;
The course of the fistula tract in relation to the anal sphincter is identified by clinical examination under general anaesthesia using a fistula probe and injection of fluid into the external fistula opening. In the event of a complex fistula or in the case of fistula recurrence, this should be ...
Porri, Anneli, 1980-
Kunstiteose analüüsi seosest riikliku õppekavaga, ülevaade kunstiteose analüüsimeetoditest kunstiteaduses ning metoodilistest tähelepanekutest kunsti ja visuaalkultuuri kujutiste vaatamise kohta gümnaasiumi kunstitunnis
Park, Eunkyoung; Park, Young Sook; Park, Dae Rim; Jung, Sung Ae; Han, Dong Soo; Jang, Byung Ik; Kim, Young Ho; Kim, Won Ho; Jo, Yun Ju; Lee, Ki Ho; Lee, Won Mi; Kim, Eun Kyung; Koo, Hae Soo
Background/Aims Microscopic colitis is characterized by chronic watery diarrhea with specific pathological changes that can be diagnosed by microscopic examination. We performed immunohistochemical analysis of proinflammatory cytokines to investigate the pathogenic mechanism of microscopic colitis. Methods This study consisted of six patients with lymphocytic colitis, six patients with collagenous colitis, and six patients with functional diarrhea but normal pathology. We performed an immunoh...
The key to the treatment of anal fistula lies in scavenging the infected anal gland thoroughly, which is the source of anal fistula infection. The fistula tract at the internal orifice of the anal fistula is cut 1 cm using laser with the infectious source completely degenerated and the wound gassified and scanned. The residual distal fistula softens and disappears upon the action of organic fibrinolysin.
Fitzgerald, S C
Collagenous colitis is a microscopic colitis characterized by normal appearing colonic mucosa on endoscopy. It is regarded as a clinically benign disease which rarely results in serious complications. We report a case of toxic megacolon occurring in a patient with collagenous colitis. This is the first reported case of toxic megacolon occurring in this subset of patients.
Una metodología analítica fue desarrollada y validada para la determinación de butabarbital, pentobarbital y fenobarbital en muestras de sangre, utilizando aprobarbital como estándar interno. Para la identificación de los diferentes fármacos se llevó a cabo una extracción líquido-líquido con posterior separación cromatográfica empleando una columna capilar en modo de inyección pulsado sin división con rampa de temperatura, helio como gas de arrastre y detector de ionización de llama. La metod...
Hauwers, K.W.M. d'
OBJECTIVES: To describe the type-specific prevalence of anal and cervical human papillomavirus (HPV) infections and the cytology in HIV-negative women without a history of cervical cancer, attending a colposcopy clinic. To examine if an HPV positive anal smear is related to anal pathology and conseq
Full Text Available Anal fistulae are common and debilitating; they are characterized by severe pain and discharge. They arise following infection near the anal canal, or as a primary event from an abscess in the abdomen, fistulating into the vagina or perianal skin. The term ‘cryptoglandular’ is given to abscesses arising from the anal glands.
R.S. van Onkelen (Robbert)
markdownabstractAbstract The objective of modern anal fistula treatment is healing of the fistula without diminished fecal continence. Sphincter saving techniques have been developed for anal fistulas, for which fistulotomy is not suitable. Treatment of these anal fistulas remains challenging and
Natalia Z. Rosado-Dawid
Full Text Available Physical exercise has been related with both beneficial effects on the gastrointestinal tract as with adverse effects on the latter. Gastrointestinal bleeding is one of these. In general, gastrointestinal bleeding is transient and mild. However, some cases caused by intestinal ischemia can sometimes be more serious due to the amount of bleeding and the presence of mucosal lesions. We present the case of a patient with abdominal pain and rectal bleeding caused by an extensive ischemic colitis due to vigorous physical exercise.El ejercicio físico se ha relacionado con beneficios sobre el tracto digestivo así como efectos adversos sobre el mismo. El sangrado gastrointestinal es una de las complicaciones descritas asociadas al mismo. Por lo general, la hemorragia digestiva en estos casos es transitoria y leve. Sin embargo, algunos casos ocasionados por isquemia intestinal tienen una repercusión más grave por la cuantía de la hemorragia y la propia alteración de la mucosa intestinal. Presentamos el caso de un paciente con dolor abdominal y rectorragia causada por colitis isquémica extensa secundaria a la práctica de un entrenamiento intenso.
Winston, John H.; Li, Qingjie; Sarna, Sushil K.
Morphological and functional changes in the enteric nervous system (ENS) have been reported in inflammatory bowel disease. We examined the effects of inflammation on the expression of choline acetyltransferase (ChAT) and nNOS in the muscularis externae of two models of colonic inflammation, trinitrobenzene sulfonic acid (TNBS)-induced colitis, which models Crohn's disease-like inflammation, and DSS-induced colitis, which models ulcerative Colitis-like inflammation. In TNBS colitis, we observe...
Full Text Available Elisabeth Lippert, Martina Müller, Claudia Ott University Hospital Regensburg, Department of Internal Medicine I, Regensburg, Germany Abstract: Ulcerative colitis (UC is a chronic inflammation mainly affecting the colon mucosa. It predominantly occurs in younger patients. Until recently, the main goals in the treatment of UC were to temper the symptoms, such as diarrhea, pain, and weight loss, by using mesalazine and steroids. With newer medications, such as immunomodulators (thiopurines and the biologics providing blockade of tumor necrosis factor (TNF, the goals of the therapy in UC have changed to long-term remission and mucosal healing. The first available anti-TNF therapy in UC included infusion therapy with infliximab every few weeks. In 2012, subcutaneously administered adalimumab gained approval for the treatment of UC in Germany. In patients with a mild disease, therapy with mesalazine, orally or topically, can be sufficient. In patients with moderate to severe disease, therapy with azathioprine or anti-TNF is often required to reach disease control; however, this is only efficient in about two-thirds of patients. Some patients either show no response or a lost response while on treatment. So, further medical options are warranted in the treatment of UC. With golimumab, a new approach in the treatment of mild to moderate UC recently became available in Germany and is a promising new option in the therapy regimen for patients with UC. Keywords: anti-TNF, biological therapy, inflammatory bowel disease
Schwartz, Lauren M.; Castle, Philip E.; Follansbee, Stephen; Borgonovo, Sylvia; Fetterman, Barbara; Tokugawa, Diane; Lorey, Thomas S.; Sahasrabuddhe, Vikrant V.; Luhn, Patricia; Gage, Julia C; Darragh, Teresa M.; Wentzensen, Nicolas
Background. Carcinogenic human papillomaviruses (HPVs) cause a large proportion of anal cancers. Human immunodeficiency virus (HIV)–infected men who have sex with men (MSM) are at increased risk of HPV infection and anal cancer compared with HIV-negative men. We evaluated risk factors for HPV infection and anal precancer in a population of HIV-infected MSM.
Jangö, Hanna; Langhoff-Roos, Jens; Rosthøj, Susanne
BACKGROUND: Primiparous women have an increased risk of obstetric anal sphincter injury; because most of these patients deliver again, there are major concerns about mode of delivery: the risk of recurrent obstetric anal sphincter injury and the risk of long-term symptoms of anal incontinence...
Full Text Available Diffuse amyloid goiter (AG is an entity characterized by the deposition of amyloid in the thyroid gland. AG may be associated with either primary or secondary amyloidosis. Secondary amyloidosis is rarely caused by inflammatory bowel diseases. Secondary amyloidosis is relatively more common in the patients with Crohn’s disease, whereas it is highly rare in patients with ulcerative colitis. Diffuse amyloid goiter caused by ulcerative colitis is also a rare condition. In the presence of amyloid in the thyroid gland, medullary thyroid cancer should be kept in mind in the differential diagnosis. Imaging techniques and biochemical tests are not very helpful in the diagnosis of secondary amyloid goiter and the definitive diagnosis is established based on the histopathologic analysis and histochemical staining techniques. In this report, we present a 35-year-old male patient with diffuse amyloid goiter caused by secondary amyloidosis associated with ulcerative colitis.
Curt Tysk; Johan Bohr; Nils Nyhlin; Anna Wickbom; Sune Eriksson
Microscopic colitis,comprising collagenous and lymphocytic colitis,is characterized clinically by chronic watery diarrhea,and a macroscopically normal colonic mucosa where diagnostic histopathological features are seen on microscopic examination.The annual incidence of each disorder is 4-6/100000 inhabitants,with a peak incidence in 60-70-year-old individuals and a noticeable female predominance for collagenous colitis.The etiology is unknown.Chronic diarrhea,abdominal pain,weight loss,fatigue and fecal incontinence are common symptoms,which impair the health-related quality of life of the patient.There is an association with other autoimmune disorders such as celiac disease,diabetes mellitus,thyroid disorders and arthritis.Budesonide is the best-documented shortterm treatment,but the optimal long-term strategy needs further study.The long-term prognosis is good and the risk of complications including colonic cancer is low.
Dídia Bisamra Cury; Marcelo de Souza Cury; Geraldo Vinicius Hemerly Elias; Sender Jankiel Mizsputen
A 48-year-old female with severe ulcerative colitis refractory to conventional therapy was referred to our facility for management. The patient showed extensive ulcerative colitis since the age of 20 years and had failed therapy with 5-aminosalicylic acid agents and azathioprine. The disease remained active despite treatment with steroids and cyclosporine. The clinical and endoscopic parameters were consistent with severe disease. Infectious precipitants were ruled out. Given the severity of the disease and in order to avoid a colectomy, we started the patient on infliximab therapy. A dramatic clinical and endoscopic response was observed and she remained in remission at the end of a 1-year follow-up period. We discuss findings in the literature regarding the use of infliximab therapy in patients with ulcerative colitis who have failed steroids and cyclosporine.
The diagnosis and treatment of complex anal fistula has been a significant challenge. Unwise incision and excessive exploration will lead to the secondary branch, sinus and perforation. A simple fistula may become a surgical problem and result in disastrous consequences. Preoperative accurate diagnosis of anal fistula, including in the internal opening, primary track and location of the fistula, extensions and abscess, is important for anal fistula treatment. In the diagnosis of anal fistula, imaging examination, especially MRI plays a crucial role. Localization and demarcation of anal fistula and the relationship with sphincter are important. MRI has been an indispensable confirmatory imaging examination.
The glands of Hermann and Desfosses, located in the thickness of the anal canal, drain into the canal at the dentate line. Infection of these anal glands is responsible for the formation of abscesses and/or fistulas. When this presents as an abscess, emergency drainage of the infected cavity is required. At the stage of fistula, treatment has two sometimes conflicting objectives: effective drainage and preservation of continence. These two opposing constraints explain the existence of two therapeutic concepts. On one hand the laying-open of the fistulous tract (fistulotomy) in one or several operative sessions remains the treatment of choice because of its high cure rates. On the other hand surgical closure with tract ligation or obturation with biological components preserves sphincter function but suffers from a higher failure rate.
Martin, F T
Squamous cell carcinoma ofthe anal canal represents 1.5% of all malignancies affectingthe gastrointestinal tract. Over the past 20 years dramatic changes have been seen in both the epidemiological distribution of the disease and in the therapeutic modalities utilised to manage it. CLINICAL MANAGEMENT: Historically abdominoperineal resection had been the treatment of choice with local resection reserved for early stage disease. Work by Nigro et al. has revolutionised how we currently manage carcinoma of the anal canal, demonstrating combined modality chemoradiotherapy as an appropriate alternative to surgical resection with the benefit of preserving sphincter function. Surgery is then reserved for recurrent disease with salvage abdominoperineal resection. This article reviews current literature and highlights the changing therapeutic modalities with selected clinical cases
Wildt, Signe; Madsen, Jan L; Rumessen, Jüri J
OBJECTIVE: Collagenous colitis (CC) is a chronic inflammatory bowel disease that affects the colon. However, some patients with CC present with accompanying pathologic small-bowel manifestations such as coeliac disease, defects in bile acid absorption and histopathologic changes in small-intestin......OBJECTIVE: Collagenous colitis (CC) is a chronic inflammatory bowel disease that affects the colon. However, some patients with CC present with accompanying pathologic small-bowel manifestations such as coeliac disease, defects in bile acid absorption and histopathologic changes in small...
Pineda, Carlos E.; Welton, Mark L.
Anal squamous intraepithelial lesions include both low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL) and are caused by chronic infection with the human papillomavirus (HPV). The disease is increasing in both incidence and prevalence, especially among patients with the following risk factors: homosexual men, acquired or iatrogenic immunosuppression, and presence of other HPV-related diseases. Although the natural history of the disease is ...
The treatment regime in anal carcinoma is changing from being a mainly surgical problem. Combined radio-chemotherapy is of increasing interest as treatment of choice. The new treatment modality, including chemotherapy with Mitomycin C and 5-fluorouracil combined with percutaneous and interstitial radiotherapy is presented. The treatment regimes performed at the University Department for Radiotherapy and Radiobiology Vienna is discussed with regard to tolerance, side effects and local control.
Full Text Available Anal intraepitelial neoplasia (AIN constitutes a major health problem in certain risk groups, such as patients with immunosuppression of varied origin, males who have sexual relations with other males, and females with a previous history of vaginal or cervical abnormalities in cytology. Its relationship with the human papillomavirus (HPV infection has been well documented; however, many of the factors involved in the progression and regression of the viral infection to dysplasia and anal carcinoma are unknown. AIN can be diagnosed through cytology of the anal canal or biopsy guided by high-resolution anoscopy. However, the need for these techniques in high-risk groups remains controversial. Treatment depends on the risk factors and given the high morbidity and high recurrence rates the utility of the different local treatments is still a subject of debate. Surgical biopsy is justified only in the case of progression suggesting lesions. The role of the vaccination in high-risk patients as primary prevention has been debated by different groups. However, there is no general consensus on its use or on the need for screening this population.
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.
Full Text Available Background: infliximab is a monoclonal antiTNF-α antibody that has repeatedly shown to be effective in the management of Crohn's disease. However, data are scarce about its efficacy in ulcerative colitis. Aim: to describe the joint experience of three Spanish hospitals in the use of infliximab in patients with active refractory ulcerative colitis. Patients and methods: we present seven cases of ulcerative colitis (6 with chronic active disease despite immunosuppressive therapy, and one with acute steroid-refractory ulcerative colitis treated with infliximab 5 mg/kg of body weight. Clinical response was evaluated by means of the Clinical Activity Index at 2, 4 and 8 weeks after initial infusion. Biochemical (erythrocyte sedimentation rate and C-reactive protein, endoscopic, and histological changes were also assessed. Results: mean age of patients was 45.8 ± 17 years (range 23-77; 4 were female. No adverse effects were recorded. Inflammatory activity diminished significantly in 6 of 7 patients (85.7%; CI 95%: 42-99% both from a clinical (p = 0.01 and biochemical (p Introducción: infliximab, un anticuerpo monoclonal quimérico antiTNF-α ha demostrado su eficacia en pacientes con enfermedad de Crohn. Sin embargo, son escasos los datos sobre su efectividad en el tratamiento de la colitis ulcerosa. Objetivo: describir la experiencia conjunta de 3 hospitales españoles en el uso de infliximab en enfermos con CU activa resistente a otros tratamientos. Pacientes y métodos: se presentan 7 casos de colitis ulcerosa (6 con enfermedad crónicamente activa a pesar de tratamiento con inmunosupresor y 1 con colitis aguda grave refractaria a esteroides tratados con infliximab a dosis de 5 mg/kg de peso. Se evaluó la respuesta clínica mediante un Índice de Actividad Clínica trascurridas 2, 4 y 8 semanas de la infusión inicial. Así mismo, se estudiaron los cambios analíticos (velocidad de sedimentación y proteína C reactiva, endoscópicos e histol
Análise tensional e morfológica da anastomose colônica na colite induzida por ácido acético a 10%, em ratos Wistar, tratados com extrato aquoso de aroeira-do-sertão a 10% (Myracrodruon urundeuva fr. all. Tensional and morphologic analysis of the colonic anastomosis on 10% acetic acid induced colitis, in Wistar rats, treated with 10% aroeira-do-sertão (Myracrodruon urundeuva fr. all. aqueous extract
Antonio Rubens Soares Martins Cavalcante
Full Text Available OBJETIVO: Verificar, do ponto de vista tensional e morfológico, o efeito do extrato aquoso de aroeira-do-sertão a 10% na anastomose colônica, na vigência de colite induzida por ácido acético a 10%, em ratos Wistar. MÉTODOS: Foram utilizados 48 ratos da linhagem Wistar, distribuídos em dois grupos. Todos os animais foram submetidos à indução da colite por solução aquosa de ácido acético a 10%. Vinte e quatro horas após, os animais foram submetidos à laparotomia, colotomia transversa total e anastomose término-terminal com fio de polipropileno 5-0. Grupo A (veículo, animais tratados com veículo à base de carboximetilcelulose. Grupo B (aroeira, animais tratados com extrato aquoso de aroeira a 10%. Ambos tratamentos foram sob a forma de enema. Os grupos A e B foram distribuídos em subgrupos A3, A7, A14 e A21; B3, B7, B14 e B21, respectivamente, conforme a data prevista para a eutanásia (3, 7, 14 e 21 dias. Nas respectivas datas, os animais foram relaparotomizados, o segmento colônico contendo a anastomose foi ressecado, submetido ao teste de pressão e em seguida à análise histológica. Para o estudo morfológico, as lâminas foram coradas com hematoxilina-eosina e avaliou-se a condição de cicatrização baseado numa tabela de escores que variava de 0 a 16. Quanto maior o escore melhor o grau de cicatrização. RESULTADOS: Na avaliação do estudo morfológico, que quantifica a evolução e o grau de cicatrização, como resultado final do processo cicatricial, o grupo aroeira foi superior ao grupo veículo (pPURPOSE: Verify, from a morphologic and tensional view point, the effect of the 10% aqueous extract of aroeira-do-sertão on the colonic anastomosis, during the occurrence of 10% acetic acid induced colitis, in Wistar rats. METHODS: There were used 48 Wistar rats, distributed in two groups. All animals were subjected to induction of colitis by aqueous solution of 10% acetic acid. Twenty-four hours later, the animals
Se desarrollo un metodo analitico rapido y sencillo por Cromatografia de Liquidos de Alta Resolucion (CLAR) con deteccion UV para la determinacion de indometacina en crema al 2.5%. Se probaron diferentes condiciones para la cuantificacion, encontrando mejores resultados con una columna L, (Supelcosil LC18, 250 mm x 4.6 mm, 5 ¿Êm), una fase movil compuesta por metanol y solucion amortiguadora de fosfatos pH 7.1 (70:30), una velocidad de flujo de 1.0 mL/min y una longitud de onda de deteccion d...
Full Text Available Thrombosis, mainly venous, is a rare and well-recognized extraintestinal manifestation of inflammatory bowel disease (IBD. We describe a 25-year-old Caucasian man affected by ulcerative colitis and sclerosing cholangitis with an episode of right middle cerebral arterial thrombosis resolved by intraarterial thrombolysis. We perform a brief review of the International Literature.
Villanacci, Vincenzo; Cristina, Silvia; Muscarà, Maurizio; Saettone, Silvia; Broglia, Laura; Antonelli, Elisabetta; Salemme, Marianna; Occhipinti, Pietro; Bassotti, Gabrio
Pseudomembranous collagenous colitis is a rare pathological condition, not related to infectious agents, and characterized by thickening of the subepithelial collagen and formation of pseudomembranes. We report one such case, which responded to budesonide treatment after failures of previous approaches given, being unaware of the correct diagnosis.
Tang, Derek M; Urrunaga, Nathalie H; von Rosenvinge, Erik C
Although Clostridium difficile infection is the cause of most cases of pseudomembranous colitis, clinicians should consider less common causes, especially if pseudomembranes are seen on endoscopy but testing remains negative for C difficile or if presumed C difficile infection does not respond to treatment. Histologic review of colonic mucosal biopsy specimens can provide clues to the underlying cause.
@@ TO THE EDITOR Reviewing the available therapeutic options in the medical treatment of ulcerative colitis, Xu et al., have omitted to mention an important aspect in the pharmacological management of the disease, namely the possibility to promote clinical and endoscopic improvement by manipulating the enteric flora.
Castro Leonaldson dos Santos
Full Text Available After fecal diversion, nonspecific colitis may be seen in the defunctionalized colon. The purpose of this prospective study is to identify specific findings that could help in the differential diagnosis between diversion colitis and other inflammatory bowel diseases in order to avoid inappropriate diagnosis and therapy. It was studied, prospectively, thirteen consecutive patients from two public hospitals of Rio de Janeiro who had undergone temporary colostomy for indications other than inflammatory bowel disease. They were submitted to endoscopy with biopsy of both proximal and distal colorectal segments, and prospectively evaluated before and after restoration of intestinal continuity. Endoscopy with biopsy of both proximal and distal excluded colorectal segments showed a nonspecific mucosal and submucosal inflammation, resembling ulcerative colitis ( p < 0.01. There was endoscopic resolution in all patients once restoration of intestinal continuity was established (p < 0.01 and also histologic improvement after the stoma closure. In conclusion there are no specific findings that make possible an unequivocal distinction between diversion colitis and other nonspecific inflammatory diseases. Diagnosis should be achieved if after stoma closure occur remission of endoscopic large bowel inflammatory signs with improvement in mucosal histologic appearance and prompt relief of clinical complaints.
In de Mayo Clinic te Rochester werden in de jaren 1925 tot 1931 een groot aantal patienten, lijdende aan colitis ulcerosa chronica, door Bargen met veel succes behandeld. Hij isoleerde n.l. uit de darmulcera dezer patienten een diplo-coccus, welken hij, op grond van dierexperimenten, als den verwekk
Lowenberg, M.; Boer, N. de; Hoentjen, F.
The introduction of therapeutic antibodies against tumor necrosis factor (TNF) had a major impact on the treatment of ulcerative colitis (UC). Infliximab and adalimumab are powerful agents that are used for remission induction and maintenance therapy in UC and have an acceptable safety profile. Howe
Kristensen, Nanna Ny; Claesson, M H
Crohn's disease and Ulcerative Colitis, collectively termed inflammatory bowel disease (IBD), are chronic inflammatory disorders of the bowel. It is generally accepted that the pathology associated with IBD is characterized by a hyper-reactive immune response in the gut wall directed against...
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.
Inflammatory Bowel disease (IBD) is a condition characterised by chronic recidivous inflammation of the bowel and intestine. IBD includes chron´s disease (CD) and ulcerative colitis (UC). The combined prevalence of CD and UC are app. 1 in 500 in the general Caucasian population. In 25% of the cases...
Bennike, Tue Bjerg; Carlsen, Thomas Gelsing; Ellingsen, Torkell
BACKGROUND: The etiology of the inflammatory bowel diseases, including ulcerative colitis (UC), remains incompletely explained. We hypothesized that an analysis of the UC colon proteome could reveal novel insights into the disease etiology. METHODS: Mucosal colon biopsies were taken by endoscopy...
Wildt, Signe; Madsen, Jan L; Rumessen, Jüri J
Collagenous colitis (CC) is a chronic inflammatory bowel disease that affects the colon. However, some patients with CC present with accompanying pathologic small-bowel manifestations such as coeliac disease, defects in bile acid absorption and histopathologic changes in small-intestinal biopsies...
Estudo pré-analítico e de validação para determinação de malondialdeído em plasma humano por cromatografia líquida de alta eficiência, após derivatização com 2,4-dinitrofenilhidrazina Preanalytical and validation studies for the determination of malondialdehyde in human plasma through high performance liquid chromatography after derivatization with 2,4-dinitrophenylhydrazine
Marina Venzon Antunes
Full Text Available O malondialdeído (MDA é um importante biomarcador utilizado na avaliação do estresse oxidativo. O objetivo deste estudo foi desenvolver uma metodologia para a quantificação plasmática de MDA, através de cromatografia líquida de alta eficiência com detecção por arranjo de diodos (CLAE-DAD, após processo de derivatização com 2,4-dinitrofenilhidrazina (DNPH, avaliando as principais variáveis pré-analíticas. A curva de calibração em plasma (0 a 40 µM apresentou elevada linearidade (r²=0,998. Os principais parâmetros de validação foram: recuperação absoluta: 78%; limite de detecção: 0,11 µM e limite de quantificação: 0,38 µM. Os valores de MDA determinados em indivíduos adultos saudáveis (n=38 foram 3,31 ± 0,38 µM (média ± DP. Estudos de estabilidade do padrão de MDA, reagente derivatizante e MDA plasmáticos, indicaram que a solução padrão pode ser armazenada a -20 e 4 ºC.Malondialdehyde (MDA is an important biomarker for the evaluation of oxidative stress status. The aim of this study was to develop a method for plasma MDA quantification by high performance liquid chromatography with diode-array detection (HPLC-DAD, following derivatization with 2,4-dinitrophenylhydrazine (DNPH, evaluating the main preanalytical variables. The calibration curve in plasma (0 to 40 µM presented high linearity (r² = 0.998. Main validation parameters were: recovery: 78%; LOD: 0.11 µM and LOQ: 0.38 µM. The MDA values obtained in healthy volunteers (n=38 were 3.31 ± 0.38 µM (mean ± SD. Stability studies of MDA standard solution and derivatizing reagent and plasma MDA indicated that the standard solution can be stored at -20 and 4 ºC, remaining stable for at least 30 days.
Bosmat Dayan; Dan Turner
Despite the growing use of medical salvage therapy,colectomy has remained a cornerstone in managing acute severe ulcerative colitis (ASC) both in children and in adults.Colectomy should be regarded as a life saving procedure in ASC,and must be seriously considered in any steroid-refractory patient.However,colectomy is not a cure for the disease but rather the substitution of a large problem with smaller problems,including fecal incontinence,pouchitis,irritable pouch syndrome,cuffitis,anastomotic ulcer and stenosis,missed or de-novo Crohn's disease and,in young females,reduced fecundity.This notion has led to the widespread practice of offering medical salvage therapy before colectomy in most patients without surgical abdomen or toxic megacolon.Medical salvage therapies which have proved effective in the clinical trial setting include cyclosporine,tacrolimus and infliximab,which seem equally effective in the short term.Validated predictive rules can identify a subset of patients who will eventually fail corticosteroid therapy after only 3-5 d of steroid therapy with an accuracy of 85％-95％.This accuracy is sufficiently high for initiating medical therapy,but usually not colectomy,early in the admission without delaying colectomy if required.This approach has reduced the colectomy rate in ASC from 30％-70％ in the past to 10％-20％ nowadays,and the mortality rate from over 70％ in the 1930s to about 1％.In general,restorative proctocolectomy (ileoanal pouch or ileal pouch-anal anastomosis),especially the J-pouch,is preferred over straight pullthrough (ileo-anal) or ileo-rectal anastomosis,which may still be considered in young females concerned about infertility.Colectomy in the acute severe colitis setting,is usually performed in three steps due to the severity of the inflammation,concurrent steroid treatment and the generally reduced clinical condition.The first surgical step involves colectomy and constructing an ileal stoma,the second-constructing the
Prevalência de papilomavirus humano (HPV anal, genital e oral, em ambulatório geral de coloproctologia Prevalence of anal, genital and oral human papillomavirus (HPV in general ambulatory for diseases of colon and rectum
João Carlos Magi
Full Text Available O Papilomavirus Humano (HPV anal tem alta prevalência e incidência na população. O objetivo deste trabalho é verificar a prevalência de HPV anal, bucal e genital em ambulatório público de Coloproctologia, com base no exame de captura hibrida. Foram estudados 64 pacientes atendidos no ambulatório geral de Coloproctologia do Hospital Heliópolis, no período de 22/11/2005 a 20/12/2005, onde foram levantados, de forma prospectiva, dados clínicos, pessoais e comportamentais, identificando o perfil do grupo como não sendo de risco para HPV. Nenhum paciente deste grupo veio à consulta com queixa ou apresentando sinais de HPV ou outra doença sexualmente transmissível. Foram colhidos para cada paciente um esfregaço com escova de boca, outro de vulva/pênis e outro do ânus. O resultado mostrou que 15,62% dos pacientes apresentaram HPV anal, bucal ou genital, sendo que 4,68% do total de pacientes apresentavam HPV anal, um paciente de alto risco associado ao HPV genital, outro misto e outro de baixo risco. Trinta por cento dos pacientes HPV+ apresentavam dor anal como queixa principal. A conclusão é que a prevalência de HPV anal, genital e bucal é elevada, sendo que 4,68% apresentavam HPV anal e daqueles HPV positivos 30% apresentavam dor anal na queixa principal.Anal Human Papilomavirus (HPV has a high prevalence and incidence in the population. The purpose of this project is to verify the prevalence of anal, oral and genital HPV at the Coloproctology Clinic, based on the hybrid capture exam. Sixty four patients were assisted at the clinic from November 22nd to December 20th 2005. Clinical, personal and behavioral data of the patients were set up in a prospective way. The group profile was identified as not being a risky one to HPV. No patient of this group, when was assisted, had complained of or had presented any symptoms of HPV or any other sexually transmitted disease (STD. From each patient it was collected a mouth sample, a vulva
La razón de esta propuesta, está fundamentada en brindar una exposición simple de una prueba de un teorema de geometría analítica, utilizado por nuestros estudiantes en la educación media y la educación media superior. Mi idea nació de la iniciativa de postular una demostración a un nivel básico, de tal forma que cualquier estudiante que conozca algunos principios generales de álgebra de polinomios, geometría analítica y trigonometría, pueda comprenderla sin mayor complicación.
Thanaa EA Helal; Naglaa S Ahmed; Osama Abo El Fotoh
AIM: To find out the role of bacteria as a possible etiological factor in lymphocytic colitis.METHODS: Twenty patients with histopathological diagnosis of lymphocytic colitis and 10 normal controls were included in this study. Colonoscopic biopsies were obtained from three sites (hepatic and splenic flexures and rectosigmoid region). Each biopsy was divided into two parts. A fresh part was incubated on special cultures for bacterial growth. The other part was used for the preparation of histologic tissue sections that were examined for the presence of bacteria with the help of Giemsa stain.RESULTS: Culture of tissue biopsies revealed bacterial growth in 18 out of 20 patients with lymphocytic colitis mostly Escherichia coli(14/18), which was found in all rectosigmoid specimens (14/14), but only in 8/14 and 6/14 of splenic and hepatic flexure specimens respectively. In two of these cases, E coliwas associated with proteus. Proteus was found only in one case, Klebsiella in two cases, and Staphylococcus aureus in one case. In the control group, only 2 out of 10 controls showed the growth of E coliin their biopsy cultures.Histopathology showed rod-shaped bacilli in the tissue sections of 12 out of 14 cases with positive E coliin their specimen's culture. None of the controls showed these bacteria in histopathological sections.CONCLUSION: This preliminary study reports an association between E coliand lymphocytic colitis, based on histological and culture observations. Serotyping and molecular studies are in process to assess the role of E coliin the pathogenesis of lymphocytic colitis.
There are two forms of anal fistulas arising from its pathogenesis: the acute stage is the abscess, whereas the chronic stage is the fistula in ano. The classification of the fistula in ano is named after Parks. Pathogenesis and classification are explained. For complete cure, every abscess needs precise examination to be able to show the course and shape of the fistula. The surgical procedure depends on the fistula tract. Most fistulas can be operated by means of a fistulotomy or fistulectomy. Recovery depends on locating the total fistula tract.
Mata Botella, Elena
Cuaderno de apoyo a la docencia del DIBUJO DE ARQUITECTURA que pretende hacer reflexionar al alumno (de primero o segundo de carrera) sobre un tipo de dibujo que aquí se ha llamado “dibujo analítico”. Un dibujo que a través de operaciones gráficas y conceptuales como la esquematización y la selección de información, tiende a alejarse de la descripción del objeto arquitectónico para adentrarse en determinados aspectos o dimensiones que subyacen en el proyecto arquitectónico. Unas notas intr...
Lundby, Lilli; Hagen, Kikke; Christensen, Peter;
The course of the fistula tract in relation to the anal sphincter is identified by clinical examination under general anaesthesia using a fistula probe and injection of fluid into the external fistula opening. In the event of a complex fistula or in the case of fistula recurrence, this should...... be supplemented with an endoluminal ultrasound scan and/or an MRI scan. St. Mark's fistula chart should be used for the description. Simple fistulas are amenable to fistulotomy, whereas treatment of complex fistulas requires special expertise and management of all available treatment modalities to tailor...
Roberts, Joseph R; Siekas, Lacey L; Kaz, Andrew M
Anal intraepithelial neoplasia (AIN) is a premalignant lesion of the anal mucosa that is a precursor to anal cancer. Although anal cancer is relatively uncommon, rates of this malignancy are steadily rising in the United States, and among certain high risk populations the incidence of anal cancer may exceed that of colon cancer. Risk factors for AIN and anal cancer consist of clinical factors and behaviors that are associated with the acquisition and persistence of human papilloma virus (HPV) infection. The strongest HPV-associated risk factors are HIV infection, receptive anal intercourse, and high risk sexual behavior. A history of HPV-mediated genital cancer, which suggests infection with an oncogenic HPV strain, is another risk factor for AIN/anal cancer. Because progression of AIN to anal cancer is known to occur in some individuals over several years, screening for AIN and early anal cancer, as well as treatment of advanced AIN lesions, is reasonable in certain high-risk populations. Although randomized controlled trials evaluating screening and treatment outcomes are lacking, experts support routine screening for AIN in high risk populations. Screening is performed using anal cytological exams, similar to those performed in cervical cancer screening programs, along with direct tissue evaluation and biopsy via high resolution anoscopy. AIN can be treated using topical therapies such as imiquimod, 5-flurouracil, and trichloroacetic acid, as well as ablative therapies such as electrocautery and laser therapy. Reductions in AIN and anal cancer rates have been shown in studies where high-risk populations were vaccinated against the oncogenic strains of HPV. Currently, the CDC recommends both high-risk and average-risk populations be vaccinated against HPV infection using the quadrivalent or nonavalent vaccines. It is important for clinicians to be familiar with AIN and the role of HPV vaccination, particularly in high risk populations. PMID:28255426
Helena Tabry; Farrands, Paul A
Anal fistulae are common and debilitating; they are characterized by severe pain and discharge. They arise following infection near the anal canal, or as a primary event from an abscess in the abdomen, fistulating into the vagina or perianal skin. The term ‘cryptoglandular’ is given to abscesses arising from the anal glands.For many years, the treatment of choice was to lay open the fistula; however, this risks causing incontinence with potentially devastating consequences. Alternative surgic...
Mellett, S; Verganti, S; Murphy, S; Bowlt, K
Anal sac squamous cell carcinoma is rare in dogs. Five cases have been previously reported, treatment of which involved surgery alone. This report describes three further cases of canine anal sac squamous cell carcinoma which underwent medical (meloxicam) management alone, resulting in survival of up to seven months. No metastases were identified. Squamous cell carcinoma, although extremely uncommon, should be considered as a possible differential diagnosis when a dog is presented for investigation of an anal sac mass.
Ek, Rauf Onur; Serter, Mukadder; Ergin, Kemal; Cecen, Serpil; Unsal, Cengiz; Yildiz, Yuksel; Bilgin, Mehmet D.
The aim of this study was to investigate the effects of citicoline on the development of colitis and antioxidant parameters in rats subjected to tribenzene sulfonic acid (TNBS)-induced colitis. Twenty four Wistar Albino female rats were divided into four subgroups (n=6) (control, colitis control, colitis + 50 mg/kg citicoline, colitis + 250 mg/kg citicoline). Colitis was induced using an enema of TNBS and ethanol; following which citicoline was administrated for 3 days and effects of citicoli...
Leonor I. Lega
Full Text Available Los resultados del análisis estadístico sugieren una diferencia entre los dos grupos de enfermos en cuanto a manifestaciones psíquicas. El patrón de la personalidad de los enfermos con colitis ulcerativa idiopática es bien definido, y lo encontrado en el grupo del presente estudio, no difiere de lo escrito en la literatura mundial. En estos pacientes se han encontrado circunstancias psíquicas o físicas, que han tenido estrecha relación con la exacerbación y persistencia de la enfermedad, así como también la remisión de los síntomas aun por períodos muy largos, cuando el enfermo logra superar sus problemas emocionales serios. En conclusión, los resultados de esta investigación parecen confirmar que existe una relación estrecha entre las recurrencias de la enfermedad, los estados emocionales y la mejoría marcada, a veces por muchos años, al solucionar sus problemas.
Chassaing, Benoit; Aitken, Jesse D; Malleshappa, Madhu; Vijay-Kumar, Matam
Inflammatory bowel diseases (IBD), mainly comprising ulcerative colitis and Crohn's Disease, are complex and multifactorial diseases with unknown etiology. For the past 20 years, to study human IBD mechanistically, a number of murine models of colitis have been developed. These models are indispensable tools to decipher underlying mechanisms of IBD pathogenesis as well as to evaluate a number of potential therapeutics. Among various chemically induced colitis models, the dextran sulfate sodium (DSS)-induced colitis model is widely used because of its simplicity and many similarities with human ulcerative colitis. This model has both advantages and disadvantages that must be considered when employed. This protocol describes the DSS-induced colitis model, focusing on details and factors that could affect DSS-induced pathology.
M. J. García-Montes
excluyeron del estudio pacientes con fisura anal y con hemorroides internas de cualquier grado, enfermedad supurativa perianal y cirugía pélvica. Se utilizó un ecógrafo ALOKA ProSound SSD-4000 al que se conectó un transductor radial multifrecuencia ASU-67 (7,5 y 10 MHz. Resultados: un paciente no toleró la exploración. En 8 pacientes (20% de los casos estudiados se detectaron alteraciones en el estudio ecográfico: en 4 pacientes, 10% de los casos (1 hombre y 3 mujeres, hipertrofia del esfínter anal interno (EAI y en 5 pacientes (4 mujeres y 1 hombre rotura del complejo esfinteriano. En una mujer se observó rotura de EAI en canal alto e hipertrofia del mismo en el canal medio. Conclusiones: la ecografía rectoanal es una prueba sencilla, económica y útil para el estudio de la patología rectoanal. Si bien, en la mayoría de los casos estudiados no se han detectado lesiones en el canal anal ni en la pared rectal, en un porcentaje no desdeñable de pacientes hemos observado engrosamiento del EAI, que podría considerarse posible causa del dolor anal. Por tanto, consideramos que la ecografía rectoanal debe ser incluida en el estudio del dolor anal crónico idiopático.
Tato práce se zabývá problematikou elektromagnetické analýzy a aplikací elektromagnetického postranního kanálu. První a druhá část práce popisují základy kryptografie, funkci kryptografického modulu a útoky vedené postranními kanály. Třetí část práce rozebírá možnosti elektromagnetické analýzy, konstrukci sondy, popis laboratorního pracoviště, elektromagnetickou emisi PIC16F84A, algoritmus AES a přípravu na laboratorní měření. Čtvrtá část práce popisuje konkrétní laboratorní měření a extrakci...
Pineda, Carlos E; Welton, Mark L
Anal squamous intraepithelial lesions include both low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL) and are caused by chronic infection with the human papillomavirus (HPV). The disease is increasing in both incidence and prevalence, especially among patients with the following risk factors: homosexual men, acquired or iatrogenic immunosuppression, and presence of other HPV-related diseases. Although the natural history of the disease is unknown, there is significant evidence that untreated HSIL progresses to squamous cell carcinoma in 11% of patients and in up to 50% of patients with extensive disease and immunosuppression. Anal cytology and reflex HPV DNA testing are used to screen for disease, particularly among patients with the aforementioned risk factors. Evaluation of the patient should include physical examination and high-resolution anoscopy (HRA) to evaluate for disease above and below the dentate line. Intervention is warranted and this can be achieved in many ways. The treatment option associated with the best outcomes is ablation directed with HRA, which can be performed in the office or in the operating room with minimal morbidity. This strategy is effective in patients with both low-volume and high-volume disease and is associated with a malignant progression rate of 0.4% in patients with treated HSIL.
Dan Carter; David Olchovsky; Russell Pokroy; David Ezra
Cytomegalovirus (CMV) colitis rarely occurs in immunocompetent patients. We report a case of disabling and life threatening diarrhea in an immunocompetent elderly woman due to CMV colitis. The diagnosis of CMV was based on histological examination of tissues biopsied at colonoscopy, positive CMV antigen and high CMV-IgM titer in peripheral blood samples and a good response to systemic gancyclovir treatment.We conclude that CMV should be considered in the differential diagnosis of colitis in elderly immunocompetent patients.
Ana Paula GUIMARÃES
Full Text Available Racional - O câncer de canal anal é um tipo raro de neoplasia, sendo responsável por 4% dos tumores de intestino grosso. São descritos os aspectos clínicos e o tratamento dos pacientes com câncer escamoso desta região. Casuística - Analisaram-se, retrospectivamente, 11 pacientes com carcinoma espinocelular de canal anal. Nove pacientes eram do sexo feminino e dois do masculino. A idade média dos pacientes foi de 57,6 anos (variação 35-82 anos. Resultados - Os sintomas mais freqüentes foram sangramento retal, tumoração e dor local. Seis pacientes tinham lesão benigna prévia local e dois tinham doença metastática na ocasião do diagnóstico. Todos foram submetidos a quimioterapia sistêmica com 5-fluorouracil e mitomicina. Após o tratamento quimio e radioterápico, quatro apresentavam doença residual e foram submetidos a ressecção abdômino-perineal. Três pacientes apresentaram recidiva e quatro morreram pela evolução da própria doença. Conclusão - A maioria dos doentes era do sexo feminino. A químio e a radioterapia podem ser tratamentos curativos nos pacientes com doença localizada; no entanto, aqueles com doença residual devem ser submetidos a ressecção abdômino-perineal. Embora o câncer espinocelular de canal anal seja doença curável, quatro pacientes foram a óbito por terem sido diagnosticados em fase avançada.Background - Anal cancer is an uncommon malignancy accounting for only a small (4% percentage of intestinal cancer. The authors described the clinical aspects and the treatment of the patients with squamous cell carcinoma of the canal anal. Patients - Eleven patients with squamous cell carcinoma treated among 1995 and 1999, were analyzed retrospectively. Nine were women and two were men. The mean age was 57.6 years old (range 35-82 years old. Results - The most common symptoms were rectal bleeding, local tumor and pain. Six of them had previous anal benign disease and two had metastases at the
Maria Auxiliadora Prolungatti Cesar
Full Text Available INTRODUÇÃO: A retocele é causa comum de constipação por defecação obstruída. Freqüentemente está relacionada com outras causas de defecação obstruída, e os exames de fisiologia anal são importantes para o diagnóstico preciso da causa de constipação intestinal. OBJETIVO: observar a influência da retocele nos exames de fisiologia anal, e a necessidade da realização desses após o diagnóstico da retocele. MÉTODO: Para este trabalho foram estudados 40 pacientes com diagnóstico de defecação obstruída. Todos os pacientes foram submetidos aos exames de manometria, sensibilidade retal, eletromiografia, latência do nervo pudendo e proctografia, e foram separados em 2 grupos: portadores e não portadores de retocele . Foram encontrados 18 pacientes com retocele, e o diagnóstico mais freqüentemente associado foi o anismus . Em relação aos exames foi encontrada diferença significante apenas na proctografia no ângulo ano retal, demonstrando que a presença de retocele não interferiu nos resultados de exames de fisiologia anal quando comparados com outros constipados, mas esteve associada a outras causas de constipação, como anismus que necessita de outro tipo de tratamento. CONCLUSÃO: A retocele não interferiu nos valores dos exames de fisiologia anal, mas esteve associada a outros diagnósticos, sendo importante a realização dos mesmos.INTRODUCTION: Rectocele is a common cause of constipation for obstructed defecation. It often is related with other causes of outlet obstruction and the examinations of anal physiology tests are important for necessary diagnosis of the constipation cause. OBJECTIVE: To observe the influence of rectocele in the anal physiology tests and the necessity of its accomplishment to the diagnosis of rectocele. METHOD: In this study, 40 patients with diagnosis of outlet obstruction had been analyzed. All the patients had been submitted to manometry, rectal sensitivity, electromyography, pudendal
Tang, Derek M; Urrunaga, Nathalie H; De Groot, Hannah; von Rosenvinge, Erik C; Xie, Guofeng; Ghazi, Leyla J
Although classically pseudomembranous colitis is caused by Clostridium difficile, it can result from several etiologies. Certain medications, chemical injury, collagenous colitis, inflammatory bowel disease, ischemia, and other infectious pathogens can reportedly cause mucosal injury and subsequent pseudomembrane formation. We present the case of a middle-aged woman with vascular disease who was incorrectly diagnosed with refractory C. difficile infection due to the presence of pseudomembranes. Further imaging, endoscopy, and careful histopathology review revealed chronic ischemia as the cause of her pseudomembranous colitis and diarrhea. This case highlights the need for gastroenterologists to consider non-C. difficile etiologies when diagnosing pseudomembranous colitis.
Sakellakis, Minas; Makatsoris, Thomas; Gkermpesi, Maria; Peroukidis, Stavros; Kalofonos, Haralabos
The association between inflammatory bowel disease and colorectal cancer is well known. Ulcerative colitis is a risk factor for the development of colorectal cancer, and this risk increases with the activity and duration of bowel inflammation. Here we describe the case of a 52-year-old man who developed ulcerative colitis 6 years after the diagnosis and treatment of colon cancer. Although this could be a coincidence, there could be additional possibilities, like pre-existence of quiescent colitis, late effect of therapy, or maybe the existence of common pathogenetic factors contributing to the development of ulcerative colitis and colorectal cancer. PMID:24855393
Derek M. Tang
Full Text Available Although classically pseudomembranous colitis is caused by Clostridium difficile, it can result from several etiologies. Certain medications, chemical injury, collagenous colitis, inflammatory bowel disease, ischemia, and other infectious pathogens can reportedly cause mucosal injury and subsequent pseudomembrane formation. We present the case of a middle-aged woman with vascular disease who was incorrectly diagnosed with refractory C. difficile infection due to the presence of pseudomembranes. Further imaging, endoscopy, and careful histopathology review revealed chronic ischemia as the cause of her pseudomembranous colitis and diarrhea. This case highlights the need for gastroenterologists to consider non-C. difficile etiologies when diagnosing pseudomembranous colitis.
Ferrer Márquez, Manuel; Hernández Martínez, Álvaro; Reina Duarte, Ángel; Rosado Cobián, Rafael
Fulminant colitis is not a well-defined entity, that constitutes a severe complication. It usually occurs in the course of úlcerative colitis and Clostridium difficile colitis. A multidisciplinary management combining gastroenterologist and surgeons is crucial with intensive medical treatment and early surgery in non-responders. It is important to distinguish if we are facing a flare of IBD or, on the contrary, it is an infectious colitis, due to the fact that although general therapeutic measures to adopt will be the same, they will demand opposed specific measures.
Frisch, M; Glimelius, B; van den Brule, A. J.; Wohlfahrt, J; Meijer, C. J.; Walboomers, J M; Adami, H. O.; Melbye, M.
A central role in anal carcinogenesis of high-risk types of human papillomaviruses (hrHPV) was recently established, but the possible role of benign anal lesions has not been addressed in hrHPV-positive and -negative anal cancers. As part of a population-based case-control study in Denmark and Sweden, we interviewed 417 case patients (93 men and 324 women) diagnosed during the period 1991-94 with invasive or in situ anal cancer, 534 patients with adenocarcinoma of the rectum and 554 populatio...
Gotteland, M; Jimenez, I; Brunser, O; Guzman, L; Romero, S; Cassels, B K; Speisky, H
The cytoprotective and anti-inflammatory effects of boldine in an experimental model of acute colitis are reported. The administration of boldine to animals with colitis induced by the intrarectal administration of acetic acid, was found to protect against colonic damage as expressed by major reductions in the extent of cell death, tissue disorganization, and edema. Boldine also reduced the colonic neutrophil infiltration, as measured by the myeloperoxidase activity, but it did not significantly affect tissue lipoperoxides. Boldine was found to preserve the colonic fluid transport, a function otherwise markedly affected in the tissue of acid-treated animals. Results presented here provide experimental evidence supporting new cytoprotective and anti-inflammatory properties of boldine.
Full Text Available BACKGROUND: Previous weight-loss medications have received cautious support due to their association with pulmonary hypertension and valvular heart disease. However, newer drugs are increasingly being recommended as potentially safer and more efficacious. We report a case of ischemic colitis possibly linked to the use of a weight-loss drug, and review the literature to highlight an important latent consequence of these medications.
Full Text Available Sulfasalazine is a well-established disease-modifying agent. It is commonly used in the treatment of rheumatic disorders and inflammatory bowel disease. The most frequently reported adverse effects are gastrointestinal effects, headache, dizziness and rash; myelosuppression can also occur. Patients treated with sulfasalazine can develop thrombocytopenia which is immune mediated. We report a case of ulcerative colitis that was on sulfasalazine subsequently developing thrombocytopenia.
Full Text Available Hemolytic uremic syndrome (HUS can be associated with different infectious etiologies, but the relationship between pseudomembranous colitis and HUS was first described in the 1970s in some childhood patients. There is very limited published literature on Clostridium difficile-associated HUS. We report a case of C. difficile-related HUS in an adult patient and provide a review of the literature.
Keshtkar-Jahromi, Maryam; Mohebtash, Mahsa
Hemolytic uremic syndrome (HUS) can be associated with different infectious etiologies, but the relationship between pseudomembranous colitis and HUS was first described in the 1970s in some childhood patients. There is very limited published literature on Clostridium difficile-associated HUS. We report a case of C. difficile-related HUS in an adult patient and provide a review of the literature. PMID:23882375
Padronização de método analítico para avaliação do grau de exposição da fenilalanina em hidrolisados de caseína, por espectrofotometria derivada segunda Standardization of analytical method to determination of phenylalanine exposure in casein hydrolysates by second derivative spectrophotometry
Cristiane Márcia da Silva Barbosa
Full Text Available Hidrolisados protéicos com baixo teor ou isentos de fenilalanina (Phe têm sido empregados em formulações para fenilcetonúricos. Várias condições de hidrólise enzimática têm sido propostas na literatura para promover a liberação de Phe e, assim, facilitar sua remoção posterior. Neste trabalho, a espectrofotometria derivada segunda (EDS, um método analítico rápido, simples e de custo relativamente baixo, foi utilizada, inicialmente, para a caracterização dos aminoácidos aromáticos e, em seguida, para a determinação do grau de exposição da Phe em diferentes hidrolisados de caseína, obtidos pela ação da papaína. Os resultados obtidos indicam que o hidrolisado preparado à temperatura de 37 ºC, relação enzima/substrato de 4%, pH 7,5, foi o que apresentou o maior grau de exposição da Phe, sendo o mais indicado para a preparação de dietas para fenilcetonúricos. Com relação à caracterização dos aminoácidos aromáticos, o emprego da EDS permitiu a separação dos picos de tirosina (Tyr e triptofano (Trp, em pH 13,0. Além disso, observou-se semelhança entre os espectros de derivada segunda das soluções contendo somente os aminoácidos aromáticos e dos hidrolisados de caseína.Dietetic formulations for phenylketonurics generally contain free or low phenylalanine protein hydrolysates. Several hydrolytic conditions have been proposed in the literature to increase phenylalanine (Phe exposure, in order to favor its subsequent removal. The second derivative spectrophotometry (SDS, a fast, simple and low cost analytical method, was used, in this work, for the determination of Phe exposure in different casein hydrolysates, prepared by using papain, and also for the characteriztion of aromatic amino acids. A temperature of 37 ºC, an enzyme:substrate ratio of 4% and a pH 7.5 showed to be the most suitable condition for preparing phenylketonuric diets, since they led to the highest Phe exposure. Concerning the
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.
Full Text Available Inflammatory bowel disease (IBD is a group of chronic inflammatory disorders that affect individuals throughout life. Although the etiology and pathogenesis of IBD are largely unknown, studies with animal models of colitis indicate that dysregulation of host/microbial interactions are requisite for the development of IBD. Patients with long-standing IBD have an increased risk for developing colitis-associated cancer (CAC, especially 10 years after the initial diagnosis of colitis, although the absolute number of CAC cases is relatively small. The cancer risk seems to be not directly related to disease activity, but is related to disease duration/extent, complication of primary sclerosing cholangitis, and family history of colon cancer. In particular, high levels and continuous production of inflammatory mediators, including cytokines and chemokines, by colonic epithelial cells (CECs and immune cells in lamina propria may be strongly associated with the pathogenesis of CAC. In this article, we have summarized animal models of CAC and have reviewed the cellular and molecular mechanisms underlining the development of carcinogenic changes in CECs secondary to the chronic inflammatory conditions in the intestine. It may provide us some clues in developing a new class of therapeutic agents for the treatment of IBD and CAC in the near future.
Yildiz, Gulserap; Yildiz, Yuksel; Ulutas, Pinar A; Yaylali, Asl; Ural, Muruvvet
Inflammatory bowel disease (IBD) is a chronic intestinal inflammatory disease in humans constituting a major health concern today whose prevalence has been increasing over the world. Production of reactive oxygen species (ROS) and disturbed capacity of antioxidant defense in IBD subjects have been reported. Antioxidants may play a significant role in IBD treatment. This study aimed at evaluating ameliorative effects of intraperitoneal resveratrol pretreatment on trinitrobenzene sulphonic acid (TNBS)-induced colitis in rats. Thirty five Wistar-Albino female rats were divided equally into five groups. Inflammation was induced by the intrarectal administration of TNBS under anesthesia. Intraperitoneal administration of resveratrol (RSV) at a concentration of 10mg/kg/day for 5 days before the induction of colitis significantly reduced microscopy score and malondialdehyde (MDA) levels and increased glutathione peroxidase (GSH Px) activity compared to TNBS and vehicle groups. Also an insignificant increase in catalase (CAT) activity was observed in the RSV treated group compared to TNBS and vehicle groups. In this paper, the most recent patent on the identification and treatment of IBD was indicated. In conclusion, antioxidant RSV proved to have a beneficial effect on TNBS colitis in rats. In light of these advantageous results, the RSV can be considered as adjuvant agent in IBD treatments.
Liiv, Innar, 1982-
Sotsiaalvõrgustike analüüs (social network analys - SNA) on tehnikate, meetodite ning vahendite kogum, mis aitab avastada mustreid sotsiaalsetes struktuurides. Analüüsi kasutamisest energeetikaettevõtte Enron ja kohalike ettevõtete võrgustike näitel. Skeemid
Schrøder, H D; Reske-Nielsen, E
Seven normal human striated urethral and anal sphincters obtained by autopsy were examined using histochemical techniques. In both the urethral sphincter and the subcutaneous (s.c.) and superficial part of the anal sphincter a characteristic pattern with two populations of muscle fibers, abundant...... contractions and to react in stress conditions with fast increase in tension....
Gauri J. Desai
Conclusions: Nulliparity, instrumental delivery, increasing birth weight were high risk factors for obstetrical anal sphincter injuries. Obstetrician needs to be more careful while delivering a patient with multiple risk factors for OASIs. Primary suturing of anal sphincter injury with good post-operative care has a favorable outcome. [Int J Reprod Contracept Obstet Gynecol 2016; 5(10.000: 3568-3571
Mandaliya, Rohan; DiMarino, Anthony J.; Moleski, Stephanie; Rattan, Satish; Cohen, Sidney
Background Despite the surge of new medical and surgical approaches to treat fecal incontinence, the types of sphincter abnormalities in patients with incontinence have not been well characterized. We aimed to categorize anal sphincter dysfunction using anorectal manometry in patients with fecal incontinence as a potential guide for improved treatment. Methods A retrospective review of 162 consecutive patients with fecal incontinence referred for anorectal manometry was performed. Resting anal pressure and maximal squeeze pressure were considered as measures of internal anal sphincter and external anal sphincter function respectively. Results Mean age of the patients was 63 years (13-89); females (81.5%) and males (18.5%). 74% of the patients had sphincter dysfunction on anorectal manometry. Internal anal sphincter dysfunction was present in 62% patients vs. external anal sphincter dysfunction present in 44% patients. 80% females had abnormal manometry vs. 44% in males (P<0.0001). Internal anal sphincter dysfunction was present in 68% females vs. 37% in males (P=0.0026). Conclusions Overall, abnormal anorectal manometry studies revealed that internal anal sphincter dysfunction is the most common finding, alone or in combination with external anal sphincter dysfunction. We suggest that anorectal manometry may be important to delineate anal sphincter function prior to using newer therapeutic mechanical devices. Future studies using pharmacological agents to increase internal anal sphincter tone may be of clinical importance. Finally, the classification of fecal incontinence based on the type of sphincter dysfunction may be an improved guide in the selection of newer agents in treating fecal incontinence. PMID:26423466
Lundby, Lilli; Hagen, Kikke; Christensen, Peter; Buntzen, Steen; Thorlacius-Ussing, Ole; Andersen, Jens; Krupa, Marek; Qvist, Niels
The course of the fistula tract in relation to the anal sphincter is identified by clinical examination under general anaesthesia using a fistula probe and injection of fluid into the external fistula opening. In the event of a complex fistula or in the case of fistula recurrence, this should be supplemented with an endoluminal ultrasound scan and/or an MRI scan. St. Mark's fistula chart should be used for the description. Simple fistulas are amenable to fistulotomy, whereas treatment of complex fistulas requires special expertise and management of all available treatment modalities to tailor the right operation to the individual patient. The given levels of evidence and grades of recommendations are according to the Oxford Centre for Evidence-based Medicine (www.cemb.net).
Ródenas Torralba, Eva
RESUMEN Una línea prioritaria en la Química Analítica es el desarrollo de dispositivos que incrementen el grado de automatización y, por tanto, reduzcan la participación humana en los procedimientos de análisis. La demanda de información hace necesario el desarrollo de metodologías sencillas, de bajo coste, rápidas e inocuas para el medio ambiente, al alcance de cualquier laboratorio de control o de investigación. La principal aportación de esta Tesis ha sido el estudio, ...
Rodríguez Zamora, José Miguel
El artículo presenta una aproximación al mito del héroe, fundamental en el discurso literario, desde la psicología analítica propuesta por Carl Jung. Se estudia su origen, su desarrollo y sus consecuencias literarias como arquetipo funcional de la narrativa. This article presents an approximation to the myth of the hero, fundamental within the literary discourse, from the analytical psychology proposed by Carl Jung. It discusses its origin, its development and its literary consequences as ...
Saba, Reza Bagherzadeh; Tizmaghz, Adnan; Ajeka, Somar; Karami, Mehdi
Introduction Recurrent and complex high fistulas remain a surgical challenge. This paper reports our experience with the anal fistula plug in patients with complex fistulas. Methods Data were collected prospectively and analyzed from consecutive patients undergoing insertion of a fistula plug from January 2011 through April 2014 at Hazrat-e-Rasoul Hospital in Tehran. We ensured that sepsis had been eradicated in all patients prior to placement of the plug. During surgery, a conical shaped col...
Mohammad hassan Emami
Full Text Available
Antônio Arildo Reginaldo de Holanda
Full Text Available OBJETIVO: analisar pacientes com candidíase vulvovaginal quanto a sintomatologia, fatores de risco e resultados da cultura anal, identificar a freqüência de Candida albicans e não C. albicans e correlacionar as colonizações anal e vaginal. MÉTODOS: foram incluídas 99 pacientes com suspeita clínica de candidiase vulvovaginal, procedentes de Natal, RN, atendidas entre maio de 2003 e maio de 2005, perfazendo-se o total de 294 coletas. O material clínico, colhido por zaragatoas, foi semeado em CHROMagar Candida®. As leveduras foram identificadas pelo método clássico, além da prova de crescimento a 42 e 45ºC e da prova do caldo Sabouraud hipertônico. A sintomatologia, fatores de risco e colonização anal foram analisados de acordo com a positividade ou negatividade para Candida spp. As culturas positivas para C. albicans nos dois sítios foram comparadas com outros resultados encontrados. Para análise estatística utilizou-se o teste do chi2, com correção de Yates e o teste exato de Fisher. RESULTADOS: a espécie mais frequente foi C. albicans em 69% dos casos. Uso de roupas íntimas justas e/ou sintéticas, presença de doenças alérgicas, ocorrência de prurido, leucorréia e hiperemia apresentaram associação com a positividade vaginal para Candida spp. A chance de uma paciente com colonização anal positiva de apresentar positividade vaginal concomitante foi 2,8 e 4,9 vezes maior, respectivamente, para Candida spp e C. albicans. A chance de uma paciente com cultura anal positiva para C. albicans de apresentar resultado vaginal positivo foi 3,7 vezes maior quando comparada a espécies não C. albicans. CONCLUSÕES: C. albicans foi a espécie mais comum, tendo sido observada associação da positividade vaginal para Candida spp com uso de roupas justas e/ou sintéticas, doenças alérgicas, prurido, leucorréia e eritema (pPURPOSE: to analyze patients with vulvovaginal candidiasis with respect to risk factors, symptomatology
@@ Chronic ulcerative colitis (chronic non-specific ulcerative colitis) is a kind of non-specific inflammation occurred in the colonic mucosa layers. As a lingering and troublesome condition that often attacks people aged 20-40, it is characterized by recurrent diarrhea, abdominal pain, pus- and mucus-stained stools in clinic.
Cho, Kyung Sik; Lee, Joong Suk; Suh, Soo Jhi [Kyung Hee University Hospital. Seoul (Korea, Republic of)
Amebic colitis was common disease in Korea as well as in the world especially frequent in tropical area such as Africa, India and South America. Clinicopathological forms of this condition were ulcerative rectocolitis (95%), typhloappendicitis (3%), ameboma (1.5%), and fulminating colitis with toxic megacolon (0.5%). The fulminating amebic colitis with toxic megacolon was very rare and dangerous condition which was reported by Wruble on 1966. Toxic megacolon was seen in the cases of ulcerative colitis, Crohn's disease, typhoid fever, cholera, and acute bacillary dysentery. Radiological findings of fulminating amebic colitis with toxic megacolon were megacolon, multiple polypoid filling defects, thumbprinting, and cobble stone appearance, which were resemble with ulcerative colitis. The cause of toxic megacolon was not well known, but it has been speculated that this results from transmural disease with destruction of muscle and the myenteric plexus with resultant loss of muscle tone. Authors experienced a case of fulminating amebic colitis with toxic megacolon which was resemble with ulcerative colitis by radiologically at Kyung Hee University Hospital and reported it with review of the literatures.
Hugh J Freeman
Full Text Available Microscopic forms of colitis have been described, including collagenous colitis, a possibly heterogeneous disorder. Collagenous colitis most often appears to have an entirely benign clinical course that usually responds to limited treatment. Sometimes significant extracolonic disorders, especially arthritis, spondylitis, thyroiditis and skin disorders, such as pyoderma gangrenosum, dominate the clinical course and influence the treatment strategy. However, rare fatalities have been reported and several complications, some severe, have been attributed directly to the colitis. Toxic colitis and toxic megacolon may develop. Concomitant gastric and small intestinal inflammatory disorders have been described including celiac disease and more extensive collagenous inflammatory disease. Colonic ulceration has been associated with the use of nonsteroidal anti-inflammatory drugs, while other forms of inflammatory bowel disease, including ulcerative colitis and Crohn disease, may evolve directly from collagenous colitis. Submucosal ‘dissection’, colonic fractures, or mucosal tears and perforation, possibly from air insufflation during colonoscopy, have been reported. Similar changes may result from increased intraluminal pressures that may occur during radiological imaging of the colon. Neoplastic disorders of the colon may also occur during the course of collagenous colitis, including colon carcinoma and neuroendocrine tumours (ie, carcinoids. Finally, lymphoproliferative disease has been reported.
@@ Ulcerative colitis is also called nonspecific chronic ulcerative colitis. The author of this essay has treated 76 such cases with acupuncture and obtained satisfactory therapeutic effect. Meanwhile, the results were compared with 45 cases treated with azulfidine.A report follows.
Nøjgaard, Camilla; Nielsen, Preben Løvgreen; Rumessen, Jüri J
A case report of a 69-year-old man with synchronous onset and diagnosis of collagenous colitis and Crohn's disease is discussed.......A case report of a 69-year-old man with synchronous onset and diagnosis of collagenous colitis and Crohn's disease is discussed....
Chan, Khee-Siang; Lee, Wen-Ying; Yu, Wen-Liang
Cytomegalovirus (CMV) colitis usually occurs in immunocompromised patients with human immunodeficiency virus infection, organ transplantation, and malignancy receiving chemotherapy or ulcerative colitis receiving immunosuppressive agents. However, CMV colitis is increasingly recognized in immunocompetent hosts. Notably, CMV colitis coexisting with Clostridium difficile infection (CDI) in apparently healthy individuals has been published in recent years, which could result in high morbidity and mortality. CMV colitis is a rare but possible differential diagnosis in immunocompetent patients with abdominal pain, watery, or especially bloody diarrhea, which could be refractory to standard treatment for CDI. As a characteristic of CDI, however, pseudomembranous colitis may be only caused by CMV infection. Real-time CMV-polymerase chain reaction (PCR) for blood and stool samples may be a useful and noninvasive diagnostic strategy to identify CMV infection when treatment of CDI eventually fails to show significant benefits. Quantitative CMV-PCR in mucosal biopsies may increase the diagnostic yield of traditional histopathology. CMV colitis is potentially life-threatening if severe complications occur, such as sepsis secondary to colitis, massive colorectal bleeding, toxic megacolon, and colonic perforation, so that may necessitate pre-emptive antiviral treatment for those who are positive for CMV-PCR in blood and/or stool samples while pending histological diagnosis.
Wildt, Signe; Lassen, Inge Nordgaard; Bendtsen, Flemming
To evaluate the excretion of the inflammatory and metabolic faecal markers calprotectin, lactoferrin, and short-chain fatty acids in symptomatic and quiescent collagenous colitis.......To evaluate the excretion of the inflammatory and metabolic faecal markers calprotectin, lactoferrin, and short-chain fatty acids in symptomatic and quiescent collagenous colitis....
Leth, Thomas; Wilkens, Rune; Bonderup, Ole Kristian
Cocaine-induced ischemic colitis is a recognized entity. The diagnosis is based on clinical and endoscopic findings. However, diagnostic imaging is helpful in the evaluation of abdominal symptoms and prior studies have suggested specific sonographic findings in ischemic colitis. We report...
Nielsen, Ann; Plum, Christian Edinger Munk; Kjaer, Susanne K
The aim of the study was to determine the incidences of anal cancer and high-grade anal intraepithelial neoplasia (AIN2/3) over time in Danish women and men. Describing the burden of anal cancer and AIN may be valuable in future evaluations of the human papillomavirus (HPV) vaccine. We included all......-associated histological types levelled out or even declined during the 30 years of observation. In women, the increase in HPV-associated cancers was more pronounced among those under 60 years of age. Our findings indicate that vaccines against HPV might play an important role in the prevention of anal cancer and its...... cases of AIN2/3 during the study period. The average annual percentage change of 5% between 1998 and 2008 represents a steep increase in the incidence of AIN in both genders. Furthermore, the incidence rate of HPV-associated anal cancers increased significantly, whereas that of non-HPV...
Catalina M. Cortada
Full Text Available La glicoproteína gp-P, codificada por el MDR1 es una bomba de eflujo transmembrana capaz de movilizar una gran cantidad de fármacos de uso frecuente. Se expresa en la cara luminal del epitelio intestinal, en linfocitos y otros tejidos con función de barrera. MDR1 ha sido postulado como gen candidato en la colitis ulcerosa. El objetivo del presente trabajo fue evaluar la función de la gp-P en linfocitos aislados de sangre periférica de pacientes con colitis en actividad (n = 27 clasificados clínicamente como refractarios (n=16 o respondedores (n = 11 al tratamiento. Se estudió el eflujo de rodamina 123, sustrato de la glicoproteína P, en ausencia y presencia del inhibidor verapamilo (100 μM determinando la fluorescencia intracelular por citometría de flujo. Los resultados se expresaron evaluando el comportamiento de dos marcadores que corresponden al % de células que contienen máxima (M1/mínima (M2 concentración del colorante, reflejando inactividad/actividad de la bomba. Utilizando el test de Kruskal-Wallis y post test de Dunn, se observaron diferencias significativas entre refractarios versus respondedores (p P-glycoprotein (P-gp, encoded by MDR-1, is a transmembrane efflux pump that has been involved in relevant clinical drug transport. It is expressed in lymphocytes, luminal epithelium of colon and other tissues with barrier function. MDR1 was proposed as a candidate gene for ulcerative colitis. The aim of the present work was to investigate the role of P-gp in therapeutic response of ulcerative colitis by studying its functionality in lymphocytes isolated from peripheral blood. Samples were taken from 27 patients with active colitis classified clinically in refractory (n = 16 and responders (n = 11 to treatment. Rhodamine 123 (a fluorescent P-glycoprotein substrate efflux was studied by flow cytometry as absence and presence of an inhibitor (verapamil, 100 μM. Data were expressed evaluating the behaviour of two markers defined
Rastreamento e seguimento dos portadores das lesões anais induzidas pelo papilomavírus humano como prevenção do carcinoma anal Screening and follow-up of patients with anal HPV induced lesions for anal carcinoma prevention
Sidney Roberto Nadal
Full Text Available O Papilomavírus humano (HPV é o agente sexualmente transmissível mais comum na região perianal. O vírus provoca lesões clínicas e subclínicas que podem evoluir para carcinoma anal. É descrito o aumento da incidência desse tipo de tumor naqueles que praticam sexo anal; nos portadores, de ambos os sexos, de lesões genitais HPV induzidas; nas pessoas com neoplasias intraepiteliais anais de alto grau, o precursor do carcinoma, com maior incidência nos infectados pelo vírus da imunodeficiência humana (HIV, e com outras causas de supressão imunológica. Outra característica das lesões HPV induzidas é a elevada incidência de recidivas. Daí, a importância do seguimento por longo prazo e da pesquisa de meios terapêuticos para reduzir essa ocorrência. A possibilidade da detecção das lesões precursoras indica que programas padronizados de rastreamento para a prevenção do câncer anal deveriam ser instituídos. Os esfregaços anais para citologia vêm sendo realizados, com eficácia semelhante a das coletas cervicais e a colposcopia anal tem sido indicada para biópsias dirigidas quando a citologia mostrou-se alterada, embora muitos recomendam-na, também, como método de rastreamento. Nesse artigo, descrevemos a padronização da coleta de material para citologia anal e o método de realização da colposcopia anal, bem como a periodicidade com que devem ser repetidos.The human papillomavirus is the most frequent sexually transmitted agent in anorectal area. This virus provokes clinical and sub-clinical lesions that can evolve to anal carcinoma. Its incidence is increasing among those who practice anal receptive sex; in both gender patients with genital HPV induced lesions; in those with high grade anal intra-epithelial neoplasia, anal carcinoma precursor, mainly among HIV infected persons or with other causes of immunodeficiency. Another HPV induced lesions characteristic is their elevated incidence of recurrences. Therefore
Park, Ji Young; Kim, Joon Seok; Jeung, Sun Jong; Kim, Myung Sook; Kim, Seok Chan
Pseudomembranous colitis is known to develop with long-term antibiotic administration, but antitubercular agents are rarely reported as a cause of this disease. We experienced a case of pseudomembranous colitis associated with rifampin. The patient was twice admitted to our hospital for the management of frequent bloody, mucoid, jelly-like diarrhea and lower abdominal pain that developed after antituberculosis therapy that included rifampin. Sigmoidoscopic appearance of the rectum and sigmoid colon and mucosal biopsy were compatible with pseudomembranous colitis. The antitubercular agents were discontinued and metronidazole was administered orally. The patient's symptoms were resolved within several days. The antituberculosis therapy was changed to isoniazid, ethambutol and pyrazinamide after a second bout of colitis. The patient had no further recurrence of diarrhea and abdominal pain. We report here on a case of pseudomembranous colitis associated with rifampin.
Full Text Available Minas Sakellakis,1 Thomas Makatsoris,1 Maria Gkermpesi,2 Stavros Peroukidis,1 Haralabos Kalofonos11Division of Oncology, Department of Medicine, 2Department of Pathology, University, Hospital of Patras, Patras, GreeceAbstract: The association between inflammatory bowel disease and colorectal cancer is well known. Ulcerative colitis is a risk factor for the development of colorectal cancer, and this risk increases with the activity and duration of bowel inflammation. Here we describe the case of a 52-year-old man who developed ulcerative colitis 6 years after the diagnosis and treatment of colon cancer. Although this could be a coincidence, there could be additional possibilities, like pre-existence of quiescent colitis, late effect of therapy, or maybe the existence of common pathogenetic factors contributing to the development of ulcerative colitis and colorectal cancer.Keywords: ulcerative, colitis, colorectal, cancer, inflammation
Cytomegalovirus(CMV) is a common virus in patients with ulcerative colitis receiving immunosuppressive drugs. Many studies suggested that CMV infection is an exacerbating factor in patients with ulcerative colitis. The role of CMV in exacerbations of ulcerative colitis has been discussed. One of studies starting this discussion is an article entitled "CMV positive ulcerative colitis: A single center experience and literature review" by Kopylov et al. However, we think that there are some points that should be emphasized about the study. Especially, the small number of patients in the study has led to meaningless results. Large controlled prospective trials are needed to clarify the benefit of antiviral therapy for active ulcerative colitis patients.
Thorsteinsdottir, Sigrun; Gudjonsson, Thorkell; Nielsen, Ole Haagen
One of the most serious complications of ulcerative colitis is the development of colorectal cancer. Screening patients with ulcerative colitis by standard histological examination of random intestinal biopsy samples might be inefficient as a method of cancer surveillance. This Review focuses...... on the current understanding of the pathogenesis of ulcerative colitis-associated colorectal cancer and how this knowledge can be transferred into patient management to assist clinicians and pathologists in identifying patients with ulcerative colitis who have an increased risk of colorectal cancer. Inflammation....... Although progress has been made in the understanding of inflammation-driven carcinogenesis, markers based on these findings possess insufficient sensitivity or specificity to be usable as reliable biomarkers for risk of colorectal cancer development in patients with ulcerative colitis. However, screening...
Perner, A; Nordgaard, I; Matzen, P;
Nitric oxide (NO) produced in excess by the inflamed human colon is generally considered a pathway of mucosal damage. In an attempt to quantify colonic mucosal production of NO in various forms of colitis we performed 'steady-state' gas perfusion of whole colon in 11 patients with ulcerative coli...
Chia Bin Fang
Full Text Available O megacólon resulta de lesão extensa dos plexos mioentéricos, a qual se traduz por incoordenação motora do cólon com inércia funcional e acalasia do esfíncter anal. Disso resulta duplo distúrbio, em que à dificuldade motora agrega-se o obstáculo para evacuar. Para que haja eliminação fecal é necessário que a pressão retal ultrapasse a anal, havendo um gradiente reto-anal. O objetivo do trabalho foi avaliar este gradiente em 29 pacientes portadores de megacólon, em que as pressões retais e anais foram medidas ao evacuar, comparadas com pessoas normais. Os resultados mostraram que havia pressão retal em centímetros de água aumentada em homens (72,2 ± 29,1 e mulheres (64,5 ± 20,1, superando as respectivas pressões anais de evacuação (66,4 ± 23,2 e 62,1 ± 28,7. As pressões de evacuação, por sua vez, eram muito maiores que as do grupo controle. Isto permitiu concluir haver uma reação adaptativa com maior esforço muscular para evacuar, a fim de superar o obstáculo da acalasia.Megacolon is the result of an extensive lesion of the mioenteric plexus, with lack of motor coordination and achalasia of the anal sphincter. The motility disorder caused by the muscle contraction problems added to a mechanical obstacle results cause constipation. The defecation rectal pressure increases and reaches its peak with the start of fecal flow, exceeding the anal pressure. The objective of this work was to assess the ratio of rectal / anal pressure on 29 megacolon sufferers, compared to normal subjects. Results have shown that defecation rectal pressure was higher than expected for both men (72,2 ± 29,1 cm water and women (64,5 ± 20,1 cm water exceeding the defecation anal pressure (66,4 ± 23,2 and 62,1 ± 28,7 cm water, for men and women, respectively. The defecation pressures were much higher than those of the control group, what led to the conclusion that as an adaptive reaction, muscular effort increases to make evacuation
Bakalářská práce si za svůj cíl vytyčila problematiku strategické analýzy, která je důležitou součástí tvorby strategie. Výstupem strategické analýzy je SWOT analýza. Na závěr práce jsou uvedeny a zhodnoceny používané strategie, které utváří rámec hospodaření Citibank a. s. Stručný obsah: 1. Strategická analýza 1.1. Externí analýza 1.2. Interní analýza 1.3. SWOT analýza 2. Vize a poslání Citibank 3. Zhodnocení zvolené strategie 3.1. Konkurenční strategie 3.2. Investiční strategie 3.3. Strateg...
Heo, Tae Haeng; Shin, Hyun Joon; Cho, Young Kwon; Park, Dong Rib; Jeon, Hae Jeong; Park, Jeong Hee; Choi, Yong Chil; Park, Ung Chae; Choi, Jin Yong [Konkuk Univ. College of Medicine, Seoul (Korea, Republic of)
To evaluate the usefulness of endoanal ultrasonography and to determine the imaging features of patients with fecal incontinence, anal abscess or anal fistula. Twenty five patients underwent endoanal ultrasonography between October 1995 and July 1996. Ten of these were fecal incontinence cases, eight had an anal abscess, and seven, an anal fistula. The incontinence grading scale (IGS) was used for clinical grading of fecal incontinence and pudendal nerve terminal motor latency (PNTML) for pudendal nerve injury. Endoanal ultrasonographic features and operative findings were retrospectively reviewed. Endoanal ultrasonography revealed defective sphincteric muscles in all three patients with myogenic fecal incontinence, but in six of seven cases with neurogenic fecal incontinence, these muscles were not difective. Myogenic and neurogenic incontience showed different findings (p=3D0.033). In comparison with surgical findings, endoanal ultrasonography was 88% accurate in anal abscess cases and 86% accurate in those of anal fistula. Endoanal ultrasonography in conjunction with PNTML was very useful for the detection of the site and severity of sphincteric muscle defect and diagnosis of the etiology of fecal incontinence. Through analysis of the site and type of lesion, the procedure can also serve as a guide to the surgical treatment of patients with anal abscess or fistula.=20.
Luciane Maria Oliveira Brito
Full Text Available Introdução: Entre as doenças virais sexualmente transmissíveis, a infecção pelo Papilomavírus Humano (HPV configura-se como a mais comum, e sua incidência vem aumentando acentuadamente nos últimos trinta anos. A infecção anal por subtipos específicos do HPV predispõe o indivíduo à neoplasia intraepitelial anal, que pode evoluir para o câncer de forma similar ao colo uterino. Objetivo: avaliar a associação tipo-específica entre infecções anais e cervicais, assim como os aspectos citopatológicos das lesões anais pelo vírus HPV em mulheres de São Luís, Maranhão. Métodos: Estudo analítico transversal com 27 mulheres atendidas no Centro de Pesquisa Clínica da UFMA, entre agosto de 2012 e julho de 2015, mediante entrevista e realização de exames complementares. Resultados: As mulheres tinham, em média, 32 anos. Em relação ao resultado do PCR, 77,7% das pacientes apresentaram resultado positivo para HPV anal, sendo o subtipo 16 o mais frequente (47,6%. Na região cervical, 88,8% apresentaram PCR positivo, sendo o mais comum o subtipo 16 (47,8%. A coinfecção anal e cervical pelo HPV foi observada em 74% das mulheres. 93,3% dos resultados de citologia anal não apresentaram alteração, assim como 72,2% das anuscopias realizadas. Conclusões: A infecção cervical por HPV é um fator sugestivo de risco para o desenvolvimento da infecção na região anal.
Atresia anal, fístula uretrorretal congênita, bolsa escrotal acessória e pseudo-hermafroditismo em bezerro mestiço Anal atresia, congenital urethrorectal fistula, accessory scrotum and pseudohermafroditism in a crossbred calf
Thaís Gomes Rocha
Full Text Available Neste trabalho, é descrito o caso de um bezerro mestiço recém-nascido que apresentava atresia anal tipo 2, fístula uretrorretal congênita, bolsa escrotal bífida e pseudo-hermafroditismo masculino. O principal sinal clínico era a eliminação de fezes por meio do óstio prepucial, uma apresentação incomum em casos de fístula uretrorretal em animais machos. Apesar de o quadro de atresia anal ser relativamente comum nessa espécie, os outros defeitos congênitos encontrados são pouco frequentes.In this study, the case of a newborn calf, which presented type 2 anal atresia, congenital urethrorectal fistula, bifid scrotum and male pseudohermafroditism is described. The main clinical sign was the elimination of feces by the prepucial ostium, an unusual finding in cases of urethrorectal fistula in male animals. Although anal atresia is relatively common in bovines, the other congenital defects found in this case are uncommon.
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.
Full Text Available Introduction The restorative proctocolectomy (RPC with ileal pouch-anal anastomosis (IPAA is currently the preferred surgical method for most patients with ulcerative colitis and familial adenomatous polyposis and sometimes, functional bowel diseases. Infection around the pouch, remaining rectal stump, stricture at anastomosis site, pouch dysfunction and refractory pouchitis can lead to pouch failure. Pouch salvage surgery could prevent pouch failure in some cases. Case Presentation In this report, five patients were introduced, who underwent pouch salvage surgery after RPC/IPAA surgery failure. Two of the patients were male and three were female and the relevant age range was 16 to 41. Initially, RPC/IPAA surgery was performed on these five patients. Four of the patients underwent RPC/IPAA surgery as a result of ulcerative colitis and, one of the patients as a result of familial adenomatous polyposis. However, due to pouch failure from the RPC/IPAA surgery, pouch-salvage surgery was performed on each of these five patients. Two of the patients underwent pouch-salvage surgery due to infection and pouch fistula, and the other three underwent this surgery due to the remaining rectal stump, anastomosis stenosis and pouch dysfunction. The average time for when pouch-salvage surgery was performed was 3.5 years (three months to five years after the initial operation and the patients were under follow-up care for two to seven years. Conclusions After performing pouch salvage operation, pouch function was acceptable in all patients and we could close ileostomies of all of them.
Resíduo da semente de urucum (Bixa orellana L. como corante da gema, pele bico e ovário de poedeiras avaliado por dois métodos analíticos Evaluating of annatto (Bixa orellana L. seeds by-product as yolk, skin, beak and ovary coloring of hens using two analytical methods
José Humberto Vilar da Silva
Full Text Available O experimento foi realizado com o objetivo de avaliar o resíduo da semente de urucum (RSU como ingrediente e aditivo corante de diferentes tecidos de 125 poedeiras Lohmann-LSL, com 22 semanas de idade e 1,65 kg de peso vivo, distribuídas num delineamento inteiramente ao acaso em cinco tratamentos com cinco repetições de cinco aves. O tratamento 1 (T1 = ração à base de milho+farelo de soja (M+FS; T2 = ração à base de sorgo (40% + FS; T3 = T2 + 4% RSU; T4 = T2 + 8% RSU e T5 = T2 + 12% RSU. Foram fornecidos 110 g de ração/ave/dia e água à vontade. As coletas foram realizadas em três períodos de 28 dias. A pigmentação dos diferentes tecidos foi avaliada pelo método 1 (M1 do leque colorimétrico da Roche® e, pelo método 2 (M2 do escore "b+", que mede a cor amarela, pelo cromatográfo Minolta® CR-10. Excetuando-se os T1 e T2 da análise de variância, o aumento do RSU na ração com 40% de sorgo melhorou, linearmente, o consumo, produção, massa, conversão alimentar por massa e por dúzia de ovos. A pigmentação da gema analisada pelos M1 e M2, do bico pelo M2 e do ovário pelo M1 melhoraram com o aumento do RSU. Alta correlação (r = 0,72; P A experiment was carried out in the poultry science station of CFT/UFPB with the objective to evalluate the annatto seeds bran (ASB as an ingredient and as an additive colouring of several tissue in 125 hens Lohmann LSL with twenty-two weeks of age, 1.65 kg of live weight, allocated in the completely randomized design, with five treatments and five replication of five hens. The treatment 1 (T1 = diet based on corn and soybean meal; T2 = diet + 40% of sorghum; T3 = T2 + 4% ASB; T4 = T2 + 8% ASB; e T5 = T2 + 12% ASB. The birds were fed 110 g of diet/day and water ad libitum. The collect were obtained in three periods of twenty-eight days. Collor changes were measured with yolk the Roche® collor fan method (M1 and score calculated from "b+" (yellowness of Minolta® CR-10 instrument (M2
The results of primary radiotherapy in anal carcinoma are reported in a retrospective study. Fourteen patients have been treated by primary radiotherapy between 1970 and 1982. The three-year survival rate is 11/14 (corrected 11/12). Among eleven patients followed up, ten have a normal anal function. The importance of radio-oncology as a therapy of choice in conservative, function-preserving treatment of the anal carcinoma is discussed regarding the retrospective results as well as possible combinations of radiotherapy and chemotherapy.
The results of primary radiotherapy in anal carcinoma are reported in a retrospective study. Fourteen patients have been treated by primary radiotherapy between 1970 and 1982. The three-year survival rate is 11/14 (corrected: 11/12). Among eleven patients followed up, ten have a normal anal function. The importance of radio-oncology as a therapy of choice in conservative, function-preserving treatment of the anal carcinoma is discussed regarding the retrospective results as well as possible combinations of radiotherapy and chemotherapy.
Andrew S Day; Oren Ledder; Steven T Leach; Daniel A Lemberg
Crohn's disease and ulcerative colitis can be grouped as the inflammatory bowel diseases (IBD).These conditions have become increasingly common in recent years,including in children and young people.Although much is known about aspects of the pathogenesis of these diseases,the precise aetiology is not yet understood,and there remains no cure.Recent data has illustrated the importance of a number of genes-several of these are important in the onset of IBD in early life,including in infancy.Pain,diarrhoea and weight loss are typical symptoms of paediatric Crohn's disease whereas bloody diarrhoea is more typical of colitis in children.However,atypical symptoms may occur in both conditions:these include isolated impairment of linear growth or presentation with extra-intestinal manifestations such as erythèma nodosum.Growth and nutrition are commonly compromised at diagnosis in both Crohn's disease and colitis.Consideration of possible IBD and completion of appropriate investigations are essential to ensure prompt diagnosis,thereby avoiding the consequences of diagnostic delay.Patterns of disease including location and progression of IBD in childhood differ substantially from adultonset disease.Various treatment options are available for children and adolescents with IBD.Exclusive enteral nutrition plays a central role in the induction of remission of active Crohn's disease.Medical and surgical therapies need to considered within the context of a growing and developing child.The overall management of these chronic conditions in children should include multi-disciplinary expertise,with focus upon maintaining control of gut inflammation,optimising nutrition,growth and quality of life,whilst preventing disease or treatment-related complications.
Suzhen Zhang; Xuhui Zhao; Dechun Zhang
Ulcerative colitis (UC) is an inflammatory disease of the rectal and colonic mucosa and seems to result from a complex series of interactions between susceptibility genes, the environment and the immune system. Various components of the mucosal immune system are implicated in the immunopathogenesis of UC. Evidence from animal models also suggests that an altered immune response to the commensal microflora of the host plays a central role in the development of UC. So in this review, we elucidate the cells and molecules which are implicated in the immunopathogenesis of the disease from four aspects: antigens in the intestine, dendritic cells, toll like receptors and NF-κB in the UC.
Roediger, W E
Anaerobic bacteria constitute more than 90% of the bacteria in the colon. An anaerobic environment is needed to maintain their growth and the production of short-chain fatty acids by these bacteria from carbohydrates. Short-chain fatty acids are rapidly absorbed and essential for metabolic as well as functional welfare of the colonic mucosa. The importance of these acids in water absorption and in the patogenesis of colitis is discussed in relation to the concept of "energy deficiency diseases" of the colonic mucosa.
Apriso (Salix) is a new formulation of mesalamine (5-aminosalicylic acid; 5-ASA) approved by the FDA for maintenance of remission in mild to moderate ulcerative colitis (UC). Mesalamine is a locally acting antiinflammatory agent that is widely used both to maintain and induce remission in inflammatory bowel disease. Various mesalamine formulations have been developed to target drug delivery to areas of the small intestine and colon. Most of these agents require frequent dosing and have a high pill burden. The newest products--Lialda, introduced in 2007, and now Apriso--can be dosed once daily.
Tanaka, Hiroshi; Nakayama, Masanari; Takase, Katsuaki
A 9-month-old French bulldog was referred for signs of chronic large bowel diarrhea. The dog had an increased frequency of defecation, tenesmus and hematochezia. Flexible colonoscopy showed hyperemia, irregularities and ulcerations with multifocal hemorrhages in the mucosa from the descending colon to the proximal rectum. Multiple colonic biopsies were characterized by infiltrations of PAS positive histiocytes in the lamina propria. A diagnosis of histiocytic ulcerative colitis (HUC) was made, and the animal showed only minimal improvement, although it was treated with nutritional and medical therapies. This is the second case of HUC in French bulldog, a breed which has ancestral relations to Boxer dogs.
Sthela Maria MURAD-REGADAS
Full Text Available Objectives To evaluate anal sphincter anatomy using three-dimensional ultrasonography (3-DAUS in incontinent women with vaginal delivery, correlate anatomical findings with symptoms of fecal incontinence and determine the effect of vaginal delivery on anal canal anatomy and function. Methods Female with fecal incontinence and vaginal delivery were assessed with Wexner’s score, manometry, and 3DAUS. A control group comprising asymptomatic nulliparous was included. Anal pressure, the angle of the defect and length of the external anal sphincter (EAS, the anterior and posterior internal anal sphincter (IAS, the EAS + puborectal and the gap were measured and correlated with score. Results Of the 62, 49 had fecal incontinence and 13 were asymptomatic. Twenty five had EAS defects, 8 had combined EAS+IAS defects, 16 had intact sphincters and continence scores were similar. Subjects with sphincter defects had a shorter anterior EAS, IAS and longer gap than women without defects. Those with a vaginal delivery and intact sphincters had a shorter anterior EAS and longer gap than nulliparous. We found correlations between resting pressure and anterior EAS and IAS length in patients with defects. Conclusions Avaliar a anatomia do esfíncter anal usando ultra-sonografia tridimensional (3D-US em mulheres incontinentes com parto vaginal, correlacionar os achados anatômicos com sintomas de incontinência fecal e, determinar o efeito do parto vaginal sobre a anatomia e função do canal anal.
Forty-eight patients with anal canal cancers were treated with surgery and irradiation or irradiation alone during the period 1970-1982. All cases were treated by external megavoltage equipment. The overall 5-year survival was 50%, and the local recurrence rate 33%. According to the therapy, four major groups were analysed: radical surgery followed by post-operative irradiation (5-year survival 43%, local recurrence rate 38%), incomplete major surgery and post-operative irradiation with very inferior prognosis (none of the patients surviving beyond 52 months). Two groups of patients had sphincter-saving procedures: local surgery followed by irradiation (5-year survival 78%, local recurrence rate 22%) and primary irradiation (5-year survival 57%, local recurrence rate 14%). Lymph node positive patients showed a median survival of 24.5 months against 52 months in N0 cases (5-year survival 21% against 50%). Side-effects of radiotherapy were transient and mild, and no late severe sequelae were seen. The data indicate that post-operative external radiotherapy seems insufficient and unable to decrease the local recurrence rate, especially when surgery is incomplete. Both spincter-saving surgery and radiotherapy, as well as primary irradiation, are effective treatment modalities. These data are analysed and future aspects considering combined radiochemotherapy are discussed.
Diplomová práce se zabývá problematikou technické analýza a jejího využití při tvorbě automatických obchodních systémů. V teoretické části práce jsou vysvětleny základní principy fungování měnového trhu (Forex) a technických identifikátorů. Výstupem práce je portfolio strategií, které je aplikováno na měnové páry Euro/Americký dolar a Britská libra/Americký dolar. Obchodní strategie jsou navrhnuté v programu Adaptrade Builder pomocí genetických algoritmů a následně otestované v obchodní platf...
Determinação do ácido trans,trans-mucônico em urina: validação de um método analítico por cromatografia líquida de alta eficiência Determination of trans,trans-muconic acid in urine: validation of a high performance liquid chromatographic method
Full Text Available A finalidade primordial da monitorização biológica é proteger a saúde dos trabalhadores, prevenindo a exposição excessiva às substâncias químicas. O ácido trans,trans-mucônico (ttAM, um produto de biotransformação do benzeno, tem sido preconizado como um bioindicador sensível da exposição ao benzeno e este trabalho foi desenvolvido com o propósito de validar método de detecção do ttAM urinário, visando à sua utilização na biomonitorização de trabalhadores expostos a esse solvente. A técnica escolhida foi a cromatografia líquida de alta eficiência (CLAE com coluna de fasereversa, Lichrosorb RP 18, e detector de ultravioleta. O método mostrou-se linear entre 0,2 a 5,0 mg/L (r² = 0,9943. Os limites de detecção e de quantificação obtidos foram, respectivamente, 0,1 e 0,2 mg/L. A porcentagem de recuperação absoluta média foi de 77,1% e de inexatidão de 27,9%. Os coeficientes de variação médios foram de 7,7% e 10,6% para a precisão intra-ensaio e interensaio, respectivamente. O analito permaneceu estável na matriz por um período de 6 semanas para a concentração de 0,2 mg/L e de 15 semanas para a de 2,0 mg/L, se armazenada em freezer (-20 ºC, e por até dez dias sob refrigeração (4 ºC para os adicionados de 0,2; 2,0 e 5,0 mg/L. Com estes resultados, a validação foi considerada satisfatória e o método mostrou-se adequado, quando aplicado em amostras de trabalhadores que manipulam benzeno, coletadas no final da jornada de trabalho, em que se detectou um valor médio de 0,8 mg ttAM/g creatinina (mediana=0,6 mg/g creatinina.The main purpose of biological monitoring is to protect the workers's health, preventing the toxic effects that can occur from occupational exposure to chemicals. Trans, trans-muconic acid (ttMA, a benzene metabolite, has been recommended as a sensitive bioindicator in the biological monitoring of workers exposed to this solvent. This work was developed in order to validate a
Geraldo de Aguiar Cavalcanti
Full Text Available São descritas observações do registro do reflexo pudendo-anal em mulheres sem queixas de incontinência urinária. Foram estudadas 31 voluntárias adultas, com estimulação elétrica bilateral e independente do clitóris e registros de superfície em ambos os lados do músculo esfíncter externo do ânus (EEA. As respostas foram obtidas com pulsos duplos de 0,2 ms de duração e intervalos de 5 ms, aplicados a uma freqüência menor que 0,5 Hz. Foram medidas as latências iniciais das respostas. Não foram evidenciadas diferenças entre as respostas obtidas de cada lado do EEA e nem entre os lados, com relação aos estímulos. Uma das voluntárias não apresentou respostas após estimulação de um dos lados. Não foram observadas diferenças relacionadas a paridade total e nem com a presença de partos vaginais. A idade e o índice de massa corpórea não se correlacionaram com as respostas. Em 12% das respostas, a medida das latências foi dificultada pela baixa relação sinal-ruído.The pudendo-anal reflex was studied in a sample of 31 normal women. Responses were obtained after bilateral independent stimulation of the clitoris, with surface recordings from both sides of the external anal sphincter. Reponses were elicited with double-pulses of 0,2 ms duration with a interstimulus interval of 5 ms, frequency of stimulation was lower than 0,5 Hz. A minimal of four responses were recorded after supramaximal stimulation. In one volunteer no response was recorded after unilateral stimulation. Latencies of the responses from the right and left sides of the anal sfincter after right and left stimulation were 36.35±6.37, 36.28±6.23, 35.88±4.68, 36.44±4.45ms, respectively. No relation was detected between latencies and age, body mass index and parity (considering either total parity or vaginal delivery only. In 12% of the recordings uncertainty was introduced in the latency measurements related to a poor signal-noise ratio.
Kim, Jae-Kyung; Lee, Seung Hoon; Lee, Seon-Young; Kim, Eun-Kyung; Kwon, Jeong-Eun; Seo, Hyeon-Beom; Lee, Han Hee; Lee, Bo-In; Park, Sung-Hwan; Cho, Mi-La
DSS induced colitis is a chronic inflammatory disease characterized by inflammation in the gastrointestinal tract, which destabilizes the gut and induces an uncontrolled immune response. Although DSS induced colitis is generally thought to develop as a result of an abnormally active intestinal immune system, its pathogenesis remains unclear. Gene associated with retinoid interferon induced mortality (Grim) 19 is an endogenous specific inhibitor of STAT3, which regulates the expression of proinflammatory cytokines. In this study, we investigated the influence of GRIM19 in a DSS induced colitis mouse model. We hypothesized that Grim19 would ameliorate DSS induced colitis by altering STAT3 activity and intestinal inflammation. Grim19 ameliorated DSS induced colitis severity and protected intestinal tissue. The expression of STAT3 and proinflammatory cytokines such as IL-1β and TNF-α in colon and lymph nodes was decreased significantly by Grim19. Moreover, DSS induced colitis progression in a Grim19 transgenic mouse line was inhibited in association with a reduction in STAT3 and IL-17 expression. These results suggest that Grim19 attenuates DSS induced colitis by suppressing the excessive inflammatory response mediated by STAT3 activation.
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.
Højgaard, Helle Manfeld; Rahr, Hans
assessment. Following caesarian section, diagnostic workup showed multiple liver metastases. Rectal cancer in pregnancy is rare, while haemorrhoids are common. We recommend keeping the differential diagnoses in mind and performing a digital rectal examination if pregnant women have anal symptoms....
Full Text Available Management of anal cancer is a challenge. The goal of treatment is to eradicate tumor without sacrificing the anal sphincters. The idea of organ preservation emerged following the discovery of a high complete response rate from preoperative combined chemoradiation (CRT prior to abdominoperineal resection.CRT is widely accepted as the standard therapy for treating anal squamous cell cancer. The combination of external beam radiotherapy with interstitial brachytherapy increases the dose to the tumor volume and decreases dose to normal tissues. The current goal is to avoid colostomy, and surgery has become a salvage or secondary therapy. In this article, we review the non-surgical management of anal cancer with special emphasis on CRT, role of intensity modulated radiation therapy and brachytherapy.
Tato práce se zabývá teoretickým popisem možností řízení rizik především v oblasti informačních technologií a popisuje metody sloužící k analýze rizik. Rozebrané metody jsou analýza stromu událostí, analýza stromu poruch, FMEA, HAZOP a Markovova analýza. Praktická část práce zahrnuje návrh a implementaci aplikace, která vizualizuje rozhodovací stromy a určuje pravděpodobnosti jednotlivých prvků. This thesis focuses on the theoretical description of risk management options related to inform...
Bhupinder S Anand; Gordana Verstovsek; George Cole
Tumors arising from the anal canal are usually of epithelial origin and are mostly squamous cell carcinoma or basal cell carcinoma. We present a case of benign anal adenomas arising from the anus, an extremely rare diagnosis. A 78-year-old white man presented with rectal bleeding of several months duration. Examination revealed a 4 cm friable mass attached to the anus by a stalk. At surgery, the mass was grasped with a Babcock forceps and was resected using electrocautery.Microscopic examination revealed a tubulovillus adenoma with no areas of high grade dysplasia or malignant transformation. The squamocolumnar junction was visible at the edges of the lesion confirming the anal origin of the tumor. We believe the tubulovillus adenoma arose from either an anal gland or its duct that opens into the anus. Although seen rarely, it is important to recognize and treat these tumors at an early stage because of their potential to transform into adenocarcinoma.
D. Martínez Ares
Full Text Available Introducción: el hallazgo de lesiones endoscópicas severas en un paciente con colitis ulcerosa desaconseja la realización de una exploración completa del colon. No obstante el conocimiento de la extensión precisa de la enfermedad tiene gran importancia en las decisiones terapéuticas a tomar y también en el pronóstico de la enfermedad. Por todo ello, la validación de una técnica no invasiva para el estudio de extensión de la colitis ulcerosa cobra gran interés e importancia. Material y método: se incluyen en el estudio pacientes con diagnóstico previo de colitis ulcerosa o en el debut de la enfermedad y, de forma prospectiva y ciega se evalúa la precisión de la ecografía digestiva en la valoración de la extensión de la colitis ulcerosa. Las exploraciones ecográficas son realizadas todas ellas por el mismo explorador y siempre con anterioridad al estudio endoscópico completo, que se usa como patrón oro. No se emplea la técnica hidrocolónica en ningún caso. Resultados: han sido incluidos en el estudio 20 pacientes, 13 varones (65% y 7 mujeres (35%, con una edad media de 51,7 años (rango de 24 a 82 años. Los estudios endoscópicos mostraron una afectación severa en 5 casos (25%, moderada en 12 pacientes (60% y lesiones leves en los 3 casos restantes (15%. El estudio ecográfico del colon fue considerado satisfactorio en 18 casos (90% y la extensión de la enfermedad establecida en el estudio ecográfico coincide en todos los casos con la determinada por la colonoscopia: 3 pacientes (16,6% presentaban una proctitis ulcerosa, 9 (50% una colitis izquierda y 6 (33,3% una colitis extensa. Conclusiones: la ecografía digestiva permite el estudio del marco colónico en la mayoría de los pacientes, especialmente si existe actividad inflamatoria, permitiendo establecer con gran precisión la extensión de la colitis ulcerosa, independientemente del grado de actividad de la misma.Introduction: a full examination of the colon
Winge, K; Jennum, Poul Jørgen; Løkkegaard, Annemette;
The role of electromyography (EMG) recorded from the external anal sphincter (EAS) in the diagnosis of atypical parkinsonian syndromes is a matter for continuous debate. Most studies addressing this issue are retrospective.......The role of electromyography (EMG) recorded from the external anal sphincter (EAS) in the diagnosis of atypical parkinsonian syndromes is a matter for continuous debate. Most studies addressing this issue are retrospective....
Full Text Available Gastrointestinal stromal tumor (GIST is a rare mesenchymal neoplasm of the gastrointestinal tract. GIST of anal canal is very rare representing only 3% of all anorectal mesenchymal tumors. We report an extremely rare case of GIST of the anal canal in 60-years-old man with history of irregular bowel habits with dark colored stool mixed with blood and constipation from 6 month. Diagnosis was made on the basis of histomorphological and immunohistochemical examination.
Lee, Seung Hyun; Park, Se Jin; Heo, Ju Yeol; Paik, Woo Hyun; Bae, Won Ki; Kim, Nam-Hoon; Kim, Kyung-Ah; Lee, June Sung
A 57-year-old man with chronic kidney disease and a history of using numerous herbal medications visited Inje University Ilsan Paik Hospital for abdominal pain and vomiting. An abdominal radiograph showed diffuse small bowel distension containing multiple air-fluid levels and extensive calcifications along the colon. Computed tomography showed colon wall thickening with diffuse calcification along the colonic mesenteric vein and colonic wall. Colonoscopy, performed without bowel preparation, showed bluish edematous mucosa from the transverse to the distal sigmoid colon, with multiple scar changes. At the mid transverse colon, a stricture was noted and the scope could not pass through. A biopsy of the stricture site revealed nonspecific changes. The patient was diagnosed with phlebosclerotic colitis. After the colonoscopy, the obstructive ileus spontaneously resolved, and the patient was discharged without an operation. Currently, after 2 months of follow-up, the patient has remained asymptomatic. Herein, we report the rare case of an obstructive ileus caused by phlebosclerotic colitis with a colon stricture. PMID:27799889
Full Text Available Mark Löwenberg,1 Nanne KH de Boer,2 Frank Hoentjen3 1Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands; 2Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, the Netherlands; 3Inflammatory Bowel Disease Center, Radboud University Medical Center, Nijmegen, the Netherlands Abstract: The introduction of therapeutic antibodies against tumor necrosis factor (TNF had a major impact on the treatment of ulcerative colitis (UC. Infliximab and adalimumab are powerful agents that are used for remission induction and maintenance therapy in UC and have an acceptable safety profile. However, a proportion of UC patients for whom therapy with anti-TNF agents is indicated fail or become intolerant to treatment with infliximab or adalimumab. Hence, there remains an unmet need for novel anti-TNF agents. Golimumab (Simponi®, a human anti-TNF antibody that is administered by monthly subcutaneous injections, is the most recently introduced TNF blocker for the treatment of UC. Here, we will discuss recent literature on clinical efficacy and safety of golimumab induction and maintenance treatment in patients with UC. Furthermore, we will discuss the positioning of golimumab for UC in current treatment algorithms. Keywords: ulcerative colitis, UC, antitumor necrosis factor, TNF, antibodies, golimumab
Conrad, Karsten; Roggenbuck, Dirk; Laass, Martin W
Ulcerative colitis (UC) is a chronic relapsing inflammatory bowel disease (IBD) characterised by superficial mucosal ulceration, rectal bleeding, diarrhoea, and abdominal pain. In contrast to Crohn's disease (CrD), UC is restricted to the colon and the inflammation is limited to the mucosal layer. Classic UC affects the colon in a retrograde and continuous fashion starting from the rectum and extending proximally. Dependent on the anatomic extent of involvement, UC can be classified as proctitis, left-sided colitis, or pancolitis. Inflammatory arthropathies and primary sclerosing cholangitis (PSC) are the most common and clinically most important extraintestinal manifestations of UC. The aetiopathogenesis of UC is incompletely understood, but immune-mediated mechanisms are responsible for dysregulated immune responses against intraluminal antigens in genetically predisposed individuals. The diagnosis is based on the history, as well as clinical, radiological, endoscopic and histological features. Autoantibodies, mainly antineutrophil cytoplasmic antibodies (ANCA) and anti-goblet cell antibodies (GAB) may be helpful in the early diagnosis of UC and in differentiating it from CrD.
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.
I. Pascual Migueláñez
Full Text Available Objective: to evaluate the effectiveness of endoanal ultrasound with hydrogen peroxide enhancement in the assessment of anal fistula (tract and internal opening, and to value the utility of this examination for anal or perianal suppuration when performed by a colorectal surgeon trained in this technique. Patients: endoanal ultrasound was performed in 103 patients with anal or perianal suppuration. Twenty patients were excluded: 9 had the external opening closed, and 11 had cryptoglandular abscesses. All ultrasound scans were performed by the same explorer using a B&K Diagnostic Ultrasound System with a 7 MHz endoprobe. The examination was based on the identification of the three anal planes, then hydrogen peroxide was infused and the procedure was repeated. Results: out of 83 patients included, 11 had a perianal sinus and 72 an anal fistula. In all fistulas the main tract was found: 24 were inter-sphinteric (33.33%, 33 trans-sphincteric (45.83%, 3 supra-sphincteric (4.17%, and 12 extra-sphincteric (16.67%. An internal opening was identified in 69 (95.83%. Conclusions: endoanal ultrasound with hydrogen peroxide enhancement is an effective examination to visualize fistulous tracts and internal openings. We think it is highly useful for anal or perianal suppuration to identify abscesses, to recognize a perianal sinus, to check the sphincteric condition, and to plan subsequent surgery.
Kuhroha, Masatake; Kinouchi, Yoshitaka; Shimosegawa, Tooru
We experienced a rare case of 72-year-old woman with acute onset collagenous colitis (CC) induced by lansoprazole. The patient developed acute abdominal pain, watery diarrhea, and melena that are quite rare in usual CC. We could find the characteristic colonoscopic findings such as active long liner ulcers in the patient. We also observed the healing courses of these unique findings. Our case indicates two important points of view. (1) CC sometimes develops with acute onset symptoms which resemble those of ischemic colitis. (2) Colonoscopy would be useful and necessary to distinguish acute onset CC and ischemic colitis. PMID:25610672
Full Text Available We experienced a rare case of 72-year-old woman with acute onset collagenous colitis (CC induced by lansoprazole. The patient developed acute abdominal pain, watery diarrhea, and melena that are quite rare in usual CC. We could find the characteristic colonoscopic findings such as active long liner ulcers in the patient. We also observed the healing courses of these unique findings. Our case indicates two important points of view. (1 CC sometimes develops with acute onset symptoms which resemble those of ischemic colitis. (2 Colonoscopy would be useful and necessary to distinguish acute onset CC and ischemic colitis.
Gilardi, D; Fiorino, G; Allocca, M; Bravatà, I; Danese, S
Monoclonal antibodies directed against tumor necrosis factor alpha (anti-TNF-α agents) have dramatically changed the therapeutical approach to inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis. A new anti-TNF drug, golimumab, has recently been approved for patients with moderate to severe ulcerative colitis. Its efficacy has been demonstrated by preclinical and clinical studies and the drug showed an efficacy and safety profile in line with the other anti-TNF agents, such as infliximab and adalimumab. This review gives an overview on golimumab in the treatment of moderate to severe ulcerative colitis.
Marcos Gonçalves de Almeida
Full Text Available INTRODUCTION: Diversion colitis (DC is a benign condition characterized by the appearance of inflammation in the mucosa of the colon or rectum devoid of fecal stream. Oxidative stress has been associated with the etiopathogenesis of the disease. N-acetylcysteine (NAC is a substance with antioxidant properties, used in different treatments of inflammatory diseases. The purpose of this study was to evaluate the effects of topical applications of NAC in an experimental model of DC. METHODS: Thirty-six Wistar rats were submitted to deviation of fecal stream by proximal colostomy and a distal mucosal fistula. They were distributed into 3 experimental groups of 12 animals according to the daily application of enemas containing 0.9% saline or 2 doses of NAC, 25 mg/kg and 100 mg/kg, respectively. In each group, half of the animals were sacrificed after two weeks of irrigation and half after four weeks of irrigation. The diagnosis of colitis was assessed by histopathological analysis and the grade of inflammation by inflammatory grading scale. The results were evaluated with the Mann-Whitney test, adopting significance level of 5% (pINTRODUÇÃO: Colite de exclusão (CE é uma condição benigna caracterizada pelo desenvolvimento de inflamação na mucosa do cólon desprovida de trânsito fecal. O estresse oxidativo tem sido implicado na patogênese da doença. A n-acetilcisteína (NAC é uma substância com efeitos antioxidantes, sendo utilizada no tratamento de várias doenças inflamatórias. OBJETIVO: Avaliar os efeitos da aplicação tópica de NAC em modelo de CE. MÉTODO: Trinta e seis ratos Wistar foram submetidos ao desvio do trânsito por meio de colostomia proximal e fístula mucosa distal. Os animais foram distribuídos em três grupos experimentais de igual tamanho segundo a aplicação de enemas diários contendo soro fisiológico 0,9% ou NAC nas concentrações de 25 mg/kg ou 100 mg/kg. Em cada grupo, metade dos animais foi sacrificada ap
Lambrecht, W; Kluth, D; Lierse, W
The epithelial coating of the rectal pouch and fistula was studied morphologically in 33 newborn piglets with high and low forms of anal atresia and was found to be similar to the epithelial coating of the anal canal in normal piglets: the typical epithelium of the rectum changed its character into transitional epithelium at the region of the internal sphincter which surrounded the fistulae in all animals. In the caudal part of the fistula the transitional epithelium was followed by squamous epithelium. Only in male piglets with deformities and recto-urethral fistulae no squamous epithelium was found. In these cases transitional epithelium covered all parts of the fistula and the region of the internal sphincter. Anal glands were found in all animals, with or without anorectal malformations. They always invaded the internal sphincter. According to our morphological studies the fistula in anorectal malformations represents an ectopic anal canal.
Ioannis E Koutroubakis
A variety of inflammatory diseases of the colon,which can be differentiated from inflammatory bowel disease (IBD) and infectious colitis by their clinical,endoscopic and histological characteristics,are reported as nonIBD and non-infectious colitis.These diseases include microscopic colitis,ischemic colitis,segmental colitis associated with diverticula,radiation colitis,diversion colitis,eosinophilic colitis and Behcet's colitis.The etiopathogenesis of most of these diseases remains obscure and the epidemiological data are rather limited.These conditions are often troublesome for the patient and are associated with diagnostic difficulties for the physician.In many cases the treatment is empirical and there is a need for future research using randomized controlled trials.
Phadke, Varun K.; Friedman-Moraco, Rachel J.; Quigley, Brian C.; Farris, Alton B.; Norvell, J. P.
Abstract Background: Herpesvirus infections often complicate the clinical course of patients with inflammatory bowel disease; however, invasive disease due to herpes simplex virus is distinctly uncommon. Methods: We present a case of herpes simplex virus colitis and hepatitis, review all the previously published cases of herpes simplex virus colitis, and discuss common clinical features and outcomes. We also discuss the epidemiology, clinical manifestations, diagnosis, and management of herpes simplex virus infections, focusing specifically on patients with inflammatory bowel disease. Results: A 43-year-old man with ulcerative colitis, previously controlled with an oral 5-aminosalicylic agent, developed symptoms of a colitis flare that did not respond to treatment with systemic corticosteroid therapy. One week later he developed orolabial ulcers and progressive hepatic dysfunction, with markedly elevated transaminases and coagulopathy. He underwent emergent total colectomy when imaging suggested bowel micro-perforation. Pathology from both the colon and liver was consistent with herpes simplex virus infection, and a viral culture of his orolabial lesions and a serum polymerase chain reaction assay also identified herpes simplex virus. He was treated with systemic antiviral therapy and made a complete recovery. Conclusions: Disseminated herpes simplex virus infection with concomitant involvement of the colon and liver has been reported only 3 times in the published literature, and to our knowledge this is the first such case in a patient with inflammatory bowel disease. The risk of invasive herpes simplex virus infections increases with some, but not all immunomodulatory therapies. Optimal management of herpes simplex virus in patients with inflammatory bowel disease includes targeted prophylactic therapy for patients with evidence of latent infection, and timely initiation of antiviral therapy for those patients suspected to have invasive disease. PMID:27759636
Rhodes, J M; Gallimore, R; Elias, E; Allan, R N; Kennedy, J F
Because the normal faecal flora includes bacteria which can produce mucus-digesting glycosidases, it follows that increased digestion of colonic mucus by these bacterial enzymes could be important in the pathogenesis of ulcerative colitis. Faecal activities of potential mucus-degrading glycosidases have therefore been assayed in samples from patients with inflammatory bowel disease and normal controls. The enzymes alpha-D-galactosidase, beta-D-galactosidase, beta-NAc-D-glucosaminidase alpha-L-fucosidase and neuraminidase were assayed. Considerable glycosidase activity was present in most faecal samples. Similar activities of all the enzymes assayed were found in faeces from patients with ulcerative colitis, Crohn's disease and normal controls and there was no significant correlation with disease activity. These results imply that relapse of ulcerative colitis is not initiated by increased degradation of colonic mucus by faecal glycosidases but do not exclude a role for bacterial mucus degradation in the pathogenesis of ulcerative colitis.
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.
Isene, Rune; Bernklev, Tomm; Høie, Ole
BACKGROUND: In chronic inflammatory bowel disease (IBD) (Crohn's disease [CD] and ulcerative colitis [UC]), symptoms from outside the gastrointestinal tract are frequently seen, and the joints, skin, eyes, and hepatobiliary area are the most usually affected sites (called extraintestinal...
DAI Yan-cheng; TANG Zhi-peng; MA Gui-tong; GONG Yu-ping; LIU Wen; ZHANG Ya-li; WANG Xin-zhong
@@ Qingchang Shuan(清肠栓)is a commonly used Chinese herbal suppository for treatment of ulcerative colitis(UC).It has the effects of clearing away heat and toxic materials, and promoting tissue regeneration by removing blood stasis.
María E Negrón
Full Text Available BACKGROUND: The impact of Clostridium difficile infections among ulcerative colitis (UC patients is well characterized. However, there is little knowledge regarding the association between C difficile infections and postoperative complications among UC patients.
Takashi Iwata; Takayuki Yamamoto; Satoru Umegae; Koichi Matsumoto
We report a case of pouchitis and pre-pouch ileitis, and inflammation in the neo-terminal ileum proximal to the pouch, developed after restorative proctocolectomy for ulcerative colitis. A 35-year old female presented with fever and abdominal pain five weeks after ileostomy closure following proctocolectomy. Computed tomography showed collection of feces in the pouch and proximal ileum. A drainage tube was placed in the pouch perianally,and purulent feces were discharged. With antibiotic treatment, her symptoms disappeared, but two weeks later, she repeatedly developed fever and abdominal pain along with anal bleeding. Pouchscopy showed mucosal inflammation in both the pouch and the pre-pouch ileum. The mucosal cytokine production was elevated in the pouch and pre-pouch ileum. With antibiotic and corticosteroid therapy, her symptoms were improved along with improvement of endoscopic inflammation and decrease of mucosal cytokine production. The fecal stasis with bacterial overgrowth is the major pathogenesis of pouchitis and pre-pouch ileitis in our case.
Full Text Available La era actual se caracteriza por una búsqueda de la identidad del hombre, donde el pivote del cambio organizacional es el individuo; cambiar en este entorno depende, en gran medida, de los valores que imperen en la cultura de la organización. Este trabajo documental intenta identificar aquellos valores, condición sine-qua-non, para el logro de los objetivos de cambio y analizarlos a fin de determinar sus indicadores, con el objeto de presentar una herramienta a las organizaciones que les facilite adaptarse a los nuevos tiempos. Se encontró que los valores: Delegación, Comunicación, Colaboración, Participación y Aprendizaje, son esenciales en los cambios integrales de esta era. Se determinaron 20 indicadores de su presencia. Se concluye que con esta información cada ente puede elaborar instrumentos que le permitan saber si los valores requeridos están presentes y en caso contrario tomar decisiones que alineen a la organización alrededor de los valores humanistas planteados, incrementando así las posibilidades de éxito en el proceso de cambio y por ende, las posibilidades de supervivencia en esta nueva época.
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.
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...
Full Text Available Clostridium difficile colitis is a common infection that can be difficult to resolve and may result in recurrent infections. Reactive arthritis is a rare presentation of this disease and its treatment is not well differentiated in the literature. We describe a case of reactive arthritis occurring in a patient with a history of recurrent Clostridium difficile colitis while currently receiving a taper of oral vancomycin. His arthritis symptoms resolved with corticosteroids and continued treatment with anticlostridial antibiotics.
Although classically pseudomembranous colitis is caused by Clostridium difficile, it can result from several etiologies. Certain medications, chemical injury, collagenous colitis, inflammatory bowel disease, ischemia, and other infectious pathogens can reportedly cause mucosal injury and subsequent pseudomembrane formation. We present the case of a middle-aged woman with vascular disease who was incorrectly diagnosed with refractory C. difficile infection due to the presence of pseudomembrane...
Datta, Indraneel; Brar, Savtaj S.; Andrews, Christopher N; Dupre, Marc; Ball, Chad G.; Buie, W. Donald; Beck, Paul L.
Microscopic colitis (MC) is an inflammatory condition of the colon distinct from Crohn disease or ulcerative colitis that can cause chronic diarrhea as well as cramping and bloating. Although it was first described 30 years ago, awareness of this entity as a cause of diarrhea has only become more widespread recently. Up to 20% of adults with chronic diarrhea who have an endoscopically normal colonoscopy may have MC. Endoscopic and radiological examinations are usually normal, but histology re...
Park, Eui Ju; Lee, Joon Seong; Lee, Tae Hee; Choi, Dae Han; Kim, Eui Bae; Jeon, Seong Ran; Hong, Su Jin; Kim, Jin-Oh
"Cat scratch colon" is a gross finding characterized by hemorrhagic mucosal scratches on colonoscopy. It is usually associated with a normal colon and is rarely associated with collagenous colitis. In a previous report, cat scratch colon was noted in the cecum and ascending colon, but has also been observed in the distal transverse colon. The patient in this study was also diagnosed with ischemic colitis that may have played a role in the development of cat scratch colon.
Sabiye Akbulut; Ersan Ozaslan; Firdevs Topal; Levent Albayrak; Burcak Kayhan; Cumali Efe
A number of cutaneous changes are known to occur in the course of inflammatory bowel diseases (IBD),including pyoderma gangrenosum, erythema nodosum,perianal disease, erythematous eruptions, urticaria, and purpura. However, occurrence of skin manifestations prior to the development of ulcerative colitis is a rare occasion. Here, we report a case of ulcerative colitis associated with leukocytoclastic vasculitis in which the intestinal symptoms became overt 8 mo after the development of skin lesions.
Yazbeck, Roger; Sulda, Melanie L; Howarth, Gordon S
We have previously demonstrated that inhibition of dipeptidyl peptidase (DP) activity partially attenuates dextran sulfate sodium (DSS) colitis in mice. The aim of this study was to further investigate the mechanisms of this protection.......We have previously demonstrated that inhibition of dipeptidyl peptidase (DP) activity partially attenuates dextran sulfate sodium (DSS) colitis in mice. The aim of this study was to further investigate the mechanisms of this protection....
Efstathios Antoniou; Georgios Antonios Margonis; Anastasios Angelou; Anastasia Pikouli; Paraskevi Argiri; Ioannis Karavokyros; Apostolos Papalois; Emmanouil Pikoulis
Background: Despite recent advances the pathogenesis of Crohn's disease remains incompletely understood. A variety of animal models have been utilized in an effort to provide further insights and develop more therapeutic options. In order to simulate, to an extent, the pathogenesis and the clinical course of the disease, TNBS induced colitis is often used. Various approaches for inducing TNBS -colitis have been described in the literature. Methods/results: In this review, we sought to pres...
Coffey, J C
PURPOSE: Although functional results after ileal pouch-anal anastomosis are excellent, imperfections of function do occur. In this setting, quality-of-life assessment is an invaluable tool in determining overall therapeutic efficacy. We evaluated the impact of dietary restrictions, preoperative diagnosis (ulcerative colitis vs. familial adenomatous polyposis), and pregnancy (after pouch insertion) on quality of life. METHODS: After ethical approval, 64 patients were reviewed (mean age, 31 (range, 15-54) years). Long-term quality of life in patients after ileal pouch-anal anastomosis was assessed using the Cleveland Global Quality of Life instrument or Fazio score. The Cleveland Global Quality of Life score is a novel quality-of-life instrument specifically designed for patients with ileal pouches. Stool frequency and continence were recorded to establish the functional status of this group. RESULTS: Sixty-one patients (95.3 percent) complained of some form of dietary restriction and adopted a fixed dietary regimen. All such patients felt that a breach of this regimen would impinge significantly on their quality of life. Late eating and alcohol were associated with diarrhea, whereas smoking was not. Constipation was infrequently reported. The mean Cleveland Global Quality of Life score of patients with ulcerative colitis (0.81 +\\/- 0.13) was greater than that of patients with ulcerative colitis and a background of pouchitis (0.78 +\\/- 0.16; P = 0.042). Whereas postoperative stool frequency in patients with familial adenomatous polyposis was always higher than the preoperative level (4 vs. 2 movements per day; P = 0.04), the Cleveland Global Quality of Life score of this group was lower than that of ulcerative colitis patients (0.77 vs. 0.81; P = 0.047). The Cleveland Global Quality of Life score of females who had had pregnancies after pouch formation was 0.70, significantly lower (P = 0.039) than that of ulcerative colitis patients, although pouch function was
Full Text Available In this review, we examined studies published on oral and topical formulations of budesonide (Entocort® and Budenofalk®, in Spain: Entocord® and Intestifalk® for the treatment of ulcerative colitis. This glycocorticosteroid has a potent local action and an important first-pass liver metabolism. It has proven successful over the last years as a controlled-release formulation. It obtained results similar to prednisolone, without the latter's significant suppression of plasma cortisol. Many publications exist on the effects of oral budesonide for the treatment of Crohn's disease (CD. These have led to the registration of this drug for the treatment of CD. Studies on oral formulations of budesonide for the treatment of ulcerative colitis (UC are scarce. After reviewing published evidence, we suggest the conduction of controlled trials for the treatment of UC to obtain evidence-based efficacy and safety results in order to benefit patients with this form of inflammatory bowel disease (IBD.En esta revisión repasamos los estudios publicados hasta la fecha con las formulaciones orales y las preparaciones tópicas rectales de budesonida (Entocort® y Budenofalk®, en España Entocord® e Intestifalk® para el tratamiento de la colitis ulcerosa. Este glucocorticosteroide de una elevada acción tópica y un importante metabolismo de primer paso hepático se ha utilizado en los últimos años como una formulación de liberación controlada, proporcionando resultados similares a la prednisolona pero sin suprimir de forma apreciable los niveles de cortisol plasmático. Aunque se han publicado muchos estudios sobre los efectos de la budesonida oral para el tratamiento de la enfermedad de Crohn, los estudios sobre esta misma forma galénica de administración de budesonida para el tratamiento de los pacientes con colitis ulcerosa son escasos. Después de revisar los trabajos publicados al respecto, se sugiere la necesidad de realizar un estudio controlado
Ramachandran, I. [Department of Radiology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW (United Kingdom); Sinha, R. [Department of Radiology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW (United Kingdom)]. E-mail: email@example.com; Rodgers, P. [Department of Radiology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW (United Kingdom)
In recent years there has been a marked increase in the incidence of pseudomembranous colitis (PMC). PMC is more common in patients over 65 years of age and can cause significant morbidity. The purpose of this article is to review the imaging features of PMC on plain radiography, sonography, computed tomography (CT), scintigraphy and magnetic resonance imaging (MRI). It is important to recognize the imaging findings of PMC using different imaging methods and encourage urgent confirmation of the diagnosis serologically, as the differential includes other fulminant colitides for which colectomy may be the required. Awareness of the spectrum of imaging findings of PMC can help radiologists make the primary or incidental diagnosis of PMC.
Hugh James Freeman
An inflammatory process that involves the sigmoid colonic segment associated with diverticular disease (SCAD) appears to be a distinct clinical and pathological disorder. It has been described in older adults, often presenting with rectal bleeding. Host of the patients seem to respond to treatment only with a 5-aminosalicylate, but some spontaneously resolve with no treatment. Endoscopic evaluation usually shows a non-specific inflammatory process localized in the sigmoid colon alone that may resolve completely with histologically normal colonic mucosa. Repeated symptomatic events with discrete episodes of segmental colitis may occur, but most patients have an entirely benign clinical course. Definition of the underlying molecular events that occur with SCAD may be critically important in understanding the critical elements present in a colonic inflammatory process that can completely resolve without pharmacological or biological treatment.
Zipser, R.D.; Patterson, J.B.; Kao, H.W.; Hauser, C.J.; Locke, R.
Inflammation of the colon is associated with increased production of prostaglandins (PG) and thromboxanes (Tx), and these eicosanoids may contribute to the inflammatory, secretory, and motility dysfunctions in colitis. To evaluate the potential role of peptide hormones in the enhanced eicosanoid release, colitis was established in rabbits by a delayed-type hypersensitivity reaction to dinitrochlorobenzene and by an immune-complex-mediated reaction. PG and Tx were identified in the venous effluent of isolated perfused colons by radiochromatography after ( UC)arachidonic acid prelabeling, as well as by bioassay, and then quantitated by immunoassay. The two colitis models were morphologically similar. Basal release of PGE2, PGI2, and TxA2 was two- to threefold greater from colitis tissue than from control tissue. Bradykinin (BK) and angiotensin II (ANG II) increased release of UC-labeled eicosanoids, whereas several gastrointestinal hormones had no effect. In control colons, BK and ANG II increased PGE2 and PGI2 release (by about 2-fold) but did not alter TxA2. In contrast, BK and ANG II markedly exaggerated the release of eicosanoids in colitis. Since BK and possibly ANG II are increased at sites of inflammation, the hypersensitive eicosanoid response to these peptides may augment the eicosanoid-mediated manifestations of colitis.
Liu, Jiamin; Lay, Nathan; Wei, Zhuoshi; Lu, Le; Kim, Lauren; Turkbey, Evrim; Summers, Ronald M.
Colitis is inflammation of the colon due to neutropenia, inflammatory bowel disease (such as Crohn disease), infection and immune compromise. Colitis is often associated with thickening of the colon wall. The wall of a colon afflicted with colitis is much thicker than normal. For example, the mean wall thickness in Crohn disease is 11-13 mm compared to the wall of the normal colon that should measure less than 3 mm. Colitis can be debilitating or life threatening, and early detection is essential to initiate proper treatment. In this work, we apply high-capacity convolutional neural networks (CNNs) to bottom-up region proposals to detect potential colitis on CT scans. Our method first generates around 3000 category-independent region proposals for each slice of the input CT scan using selective search. Then, a fixed-length feature vector is extracted from each region proposal using a CNN. Finally, each region proposal is classified and assigned a confidence score with linear SVMs. We applied the detection method to 260 images from 26 CT scans of patients with colitis for evaluation. The detection system can achieve 0.85 sensitivity at 1 false positive per image.
Alicja Wiercinska-Drapalo; Robert Flisiak; Jerzy Jaroszewicz; Danuta Prokopowicz
AIM: The aim of this study was to evaluate the association between ulcerative colitis activity and plasma or mucosal concentrations of interleukin (IL)-18.METHODS:Il-18 concentrations were measured in plasma and mucosal samples from 15 patients with active ulcerative colitis (UC).RESULTS: The mean plasma concentration of IL-18 measured in all patients (422±88 pg/mL) doubled the mean value in healthy controls (206±32 pg/mL); however,the difference was not statistically significant. Plasma IL-18 levels revealed a significant positive correlation with scored endoscopic degree of mucosal injury, disease activity index, clinical activity index and C-reactive protein concentration. The mean concentration of plasma IL-18 was significantly higher in patients with severe ulcerative colitis (535±115 pg/mL) than in patients with mild ulcerative colitis (195±41 pg/mL), and in healthy controls.Although the mucosal mean IL-18 concentration in severe ulcerative colitis (2 523±618 pg/mg protein) doubled values observed in mild one (1 347±308 pg/mg protein), there was no statistically significant difference.CONCLUSION: Plasma IL-18 can be considered as a surrogate marker helpful in evaluation of ulcerative colitis activity.
Gert Van Assche; Séverine Vermeire; Paul Rutgeerts
Although systemic steroids are highly efficacious in ulcerative colitis (UC),failure to respond to steroids sUll poses an important challenge to the surgeon and physician alike. Even if the life Lime risk of a fulminant UC flare is only 20%, this condition is potentially life threatening and should be managed in hospital. If patients fail 3 to 5 d of intravenous corticosteroids and optimal supportive care, they should be considered for any of three options: intravenous cyclosporine (2 mg/kg for 7 d, and serum level controlled),infliximab (5 mg/kg N,0-2-6 wk) or total colectomy.The choice between these three options is a medicalsurgical decision based on clinical signs, radiological and endoscopic findings and blood analysis (CRP, serum albumin).Between 65 and 85% of patients will initially respond to cyclosporine and avoid colectomy on the short term. Over 5 years only 50% of initial responders avoid colectomy and outcomes are better in patients naive to azathioprine (bridging strategy).The data on infliximab as a medical rescue in fulminant colitis are more limited although the efficacy of this anti tumor necrosis factor (TNF) monoclonal antibody has been demonstrated in a controlled trial. Controlled data on the comparative efficacy of cyclosporine and infliximab are not available at this moment. Both drugs are immunosuppressants and are used in combination with steroids and azathioprine, which infers a risk of serious, even fatal, opportunistic infections. Therefore,patients not responding to these agents within 5-7 d should be considered for colectomy and responders should be closely monitored for infections.
Full Text Available Stephen E Weis1,2 1Division of Dermatology, Department of Internal Medicine, University of North Texas Health Science Center at Fort Worth, 2Preventive Medicine Clinic, Tarrant County Public Health, Fort Worth, TX, USA Abstract: Anal squamous cell cancer is an uncommon malignancy caused by infection with oncogenic strains of Human papilloma virus. Anal cancer is much more common in immunocompromised persons, including those infected with Human immunodeficiency virus. High-grade anal intraepithelial neoplasia (HGAIN, the precursor of anal cancer, is identified by clinicians providing care for patients with anorectal disease, and is increasingly being identified during screening of immunosuppressed patients for anal dysplasia. The traditional treatment for HGAIN has been excision of macroscopic disease with margins. This approach is effective for patients with small unifocal HGAIN lesions. Patients with extensive multifocal HGAIN frequently have recurrence of HGAIN after excision, and may have postoperative complications of anal stenosis or fecal incontinence. This led to the suggestion by some that treatment for HGAIN should be delayed until patients developed anal cancer. Alternative approaches in identification and treatment have been developed to treat patients with multifocal or extensive HGAIN lesions. High-resolution anoscopy combines magnification with anoscopy and is being used to identify HGAIN and determine treatment margins. HGAIN can then be ablated with a number of modalities, including infrared coagulation, CO2 laser, and electrocautery. These methods for HGAIN ablation can be performed with local anesthesia on outpatients and are relatively well tolerated. High-resolution anoscopy-directed HGAIN ablation is evolving into a standard approach for initial treatment and then subsequent monitoring of a disease which should be expected to be recurrent. Another treatment approach for HGAIN is topical treatment, principally with 5
Cosman, B C
Textual and contextual evidence suggests that the French king's fistula, a central plot device in Shakespeare's play All's Well That Ends Well, is a fistula-in-ano. Anal fistula was known to the lay public in Shakespeare's time. In addition, Shakespeare may have known of the anal fistula treatise of John Arderne, an ancestor on Shakespeare's mother's side. Shakespeare's use of anal fistula differs from all previous versions of the story, which first appeared in Boccaccio's Decameron and from its possible historical antecedent, the fistula of Charles V of France. This difference makes sense given the conventions of Elizabethan comedy, which included anal humor. It is also understandable when one looks at what wounds in different locations mean in European legend. In this light, it is not surprising that subsequent expurgations treat Boccaccio's and Shakespeare's fistulas differently, censoring only Shakespeare's. This reading has implications for the staging of All's Well That Ends Well, and for our view of the place of anal fistulas in cultural history.
Nushijima, Youichirou; Nakano, Katsutoshi; Sugimoto, Keishi; Nakaguchi, Kazunori; Kan, Kazuomi; Maruyama, Hirohide; Doi, Sadayuki; Okamura, Shu; Murata, Kohei
A 47-year-old man with no history of anal fistula was admitted to our hospital with a complaint of perianal pain. Computed tomography (CT) imaging revealed perianal abscess. Incision and drainage were performed under spinal anesthesia. Ten months after drainage, magnetic resonance imaging revealed anal fistula on the left side of the anus. Subsequently, core-out and seton procedures were performed for ischiorectalis type III anal fistula. Pathological examination of the resected specimen of anal fistula revealed a moderately differentiated adenocarcinoma, leading to the diagnosis of carcinoma associated with anal fistula. No distant metastases or enlarged lymph nodes were observed on positron emission tomography (PET)/CT. We performed abdominoperineal resection with wide resection of ischiorectalis fat tissue. The pathology results were tub2, A, ly0, v0, n0, PM0, DM0, RM0, H0, P0, M0, Stage II. Negative pressure wound therapy was performed for perineum deficiency, after which rapid wound healing was observed. Left inguinal lymph node recurrence was detected 8 months after surgery, for which radiotherapy was administered. Distant metastasis was detected 11 months after surgery. The patient died 21 months after surgery.
Full Text Available Abstract Background Anal smears are increasingly being used as a screening test for anal squamous intraepithelial lesions (ASILs. This study was undertaken to assess the usefulness and limitations of anal smears in screening for ASILs. Methods The cytomorphological features of 200 consecutive anal smears collected in liquid medium from 198 patients were studied and findings were correlated with results of surgical biopsies and/or repeat smears that became available for 71 patients within six months. Results Adequate cellularity was defined as an average of 6 or more nucleated squamous cells/hpf. A glandular/transitional component was not required for adequacy. Dysplastic cells, atypical parakeratotic cells and bi/multinucleated cells were frequent findings in ASIL while koilocytes were infrequent. Smears from LSIL cases most frequently showed mildly dysplastic and bi/multinucleate squamous cells followed by parakeratotic cells (PK, atypical parakeratotic cells (APK, and koilocytes. HSIL smears contained squamous cells with features of moderate/severe dysplasia and many APKs. Features of LSIL were also found in most HSIL smears. Conclusions In this study liquid based anal smears had a high sensitivity (98% for detection of ASIL but a low specificity (50% for predicting the severity of the abnormality in subsequent biopsy. Patients with cytologic diagnoses of ASC-US and LSIL had a significant risk (46–56% of HSIL at biopsy. We suggest that all patients with a diagnosis of ASC-US and above be recommended for high resolution anoscopy with biopsy.
Arain, Shehla; Walts, Ann E; Thomas, Premi; Bose, Shikha
BACKGROUND: Anal smears are increasingly being used as a screening test for anal squamous intraepithelial lesions (ASILs). This study was undertaken to assess the usefulness and limitations of anal smears in screening for ASILs. METHODS: The cytomorphological features of 200 consecutive anal smears collected in liquid medium from 198 patients were studied and findings were correlated with results of surgical biopsies and/or repeat smears that became available for 71 patients within six months. RESULTS: Adequate cellularity was defined as an average of 6 or more nucleated squamous cells/hpf. A glandular/transitional component was not required for adequacy. Dysplastic cells, atypical parakeratotic cells and bi/multinucleated cells were frequent findings in ASIL while koilocytes were infrequent. Smears from LSIL cases most frequently showed mildly dysplastic and bi/multinucleate squamous cells followed by parakeratotic cells (PK), atypical parakeratotic cells (APK), and koilocytes. HSIL smears contained squamous cells with features of moderate/severe dysplasia and many APKs. Features of LSIL were also found in most HSIL smears. CONCLUSIONS: In this study liquid based anal smears had a high sensitivity (98%) for detection of ASIL but a low specificity (50%) for predicting the severity of the abnormality in subsequent biopsy. Patients with cytologic diagnoses of ASC-US and LSIL had a significant risk (46-56%) of HSIL at biopsy. We suggest that all patients with a diagnosis of ASC-US and above be recommended for high resolution anoscopy with biopsy.
Full Text Available La presencia de plomo en el medio ambiente es un hecho indiscutible. Ello es objeto de gran interés sanitario pues repercute tanto en la salud de los animales como en la del ser humano. El plumbismo es una intoxicación que puede afectar a cualquier especie animal. En el ámbito de la fauna silvestre se asocia principalmente a la actividad cinegética en los humedales y a la ingestión de plomo metálico por parte de las aves que frecuentan estos ecosistemas. En España cada año mueren decenas de miles de aves acuáticas como consecuencia de la ingesta de perdigones de plomo. En los individuos capturados enfermos se pueden observar signos clínicos, mientras que a partir de muestras de cadáveres se obtienen datos sobre niveles tisulares de plomo. Sin embargo la evaluación de lesiones anatomopatológicas en animales de vida silvestre es difícil de realizar por la dificultad de encontrar animales recién muertos o afectados de un cuadro agudo mortal. La reproducción de esta patología en animales de experimentación se suele realizar en cisnes, palomas o patos, pero no en flamencos, por lo que no es usual disponer de datos histológicos en esta especie. En este trabajo presentamos la clínica, analítica y estudio microscópico de diferentes tejidos de un flamenco común (Phoenicopterus roseus muerto por plumbismo.
XIAO Yuan-hong; LIU Gui-lin
Background Manometric pressure asymmetry of the anal sphincter exists in the anal canal. There are reports about the anatomy of the anal sphincter, but the relationship between the configuration and the pressure asymmetry of the anal sphincter is not clear. This study is to investigate the anatomic evidence and clinical application of anal sphincter pressure asymmetry. Methods PC polygram HR at the state of relaxing and squeezing was used in 27 normal children and 12 abnormal ones with fecal incontinence.Results In normal children, longitudinal pressure gradients existed at eight channels in the anal canal, and the maximal pressure 1 cm from the anal verge. Longitudinal pressure asymmetry changes of eight channels also existed in the anal canal, from 3 cm to 2 cm to 1 cm from the anal verge. The high pressure distribution changed from the posterior to the anterior anal canal. Anteriorly, 1 cm from the anal verge, the maximal pressure was formed in the anal canal. However, neither longitudinal pressure gradients nor longitudinal pressure asymmetry changes were seen in patients with fecal incontinence. Conclusion The configuration and function of the striated muscle complex possibly contribute to the formation of the pressure asymmetry of the anal sphincter, which is essential to anal control.
Sailer, M; Eisoldt, S; Möllmann, C
Anal and transanal tumor operations are safe and are associated with a very low morbidity. Perianal and anal lesions as well as low rectal tumors can be excised by direct exposure using an anal retractor. For lesions situated in the middle or upper third of the rectum, special instrumentation, such as transanal endoscopic microsurgery (TEM) and transanal endoscopic operation (TEO) should be used to avoid unnecessary R1 resections. Fatal complications are extremely rare and most complications, such as urinary retention or temporary subfebrile temperatures, are minor. Suture line dehiscences are usually clinically unremarkable. Major complications comprise significant hemorrhage and opening of the peritoneal cavity. The latter must be recognized intraoperatively and can usually be managed by primary suturing. Infections, abscess formation, rectovaginal fistula, injury of the prostate or even urethra are extremely rare complications.
Sica, Giuseppe S; Di Carlo, Sara; Tema, Giorgia; Montagnese, Fabrizio; Del Vecchio Blanco, Giovanna; Fiaschetti, Valeria; Maggi, Giulia; Biancone, Livia
Anal fistulas are a common manifestation of Crohn's disease (CD). The first manifestation of the disease is often in the peri-anal region, which can occur years before a diagnosis, particularly in CD affecting the colon and rectum. The treatment of peri-anal fistulas is difficult and always multidisciplinary. The European guidelines recommend combined surgical and medical treatment with biologic drugs to achieve best results. Several different surgical techniques are currently employed. However, at the moment, none of these techniques appear superior to the others in terms of healing rate. Surgery is always indicated to treat symptomatic, simple, low intersphincteric fistulas refractory to medical therapy and those causing disabling symptoms. Utmost attention should be paid to correcting the balance between eradication of the fistula and the preservation of fecal continence.
Esplin, D G; Wilson, S R; Hullinger, G A
Tumors of the perianal area of dogs are common and include multiple tumor types. Whereas perianal adenomas occur often, adenocarcinomas of the apocrine glands of the anal sac occur less frequently. A review of the literature revealed no reports of squamous cell carcinomas arising from the epithelial lining of the anal sac. Squamous cell carcinomas originating from the lining of the anal sac were diagnosed in five dogs. Microscopically, the tumors consisted of variably sized invasive nests and cords of epithelial cells displaying squamous differentiation. Four of the five dogs were euthanatized because of problems associated with local infiltration by the tumors. In the fifth dog, there was no evidence of tumor 7 months after surgical removal, but further follow up was not available.
Haig Dudukgian; Herand Abcarian
Anal fistula is among the most common illnesses af-fecting man. Medical literature dating back to 400 BC has discussed this problem. Various causative factors have been proposed throughout the centuries, but it appears that the majority of fistulas unrelated to spe-cific causes (e.g. Tuberculosis, Crohn's disease) result from infection (abscess) in anal glands extending from the intersphincteric plane to various anorectal spaces. The tubular structure of an anal fistula easily yields itself to division or unroofing (fistulotomy) or excision (fistulectomy) in most cases. The problem with this single, yet effective, treatment plan is that depending on the thickness of sphincter muscle the fistula trans-gresses, the patient will have varying degrees of fecal incontinence from minor to total. In an attempt to pre-serve continence, various procedures have been pro-posed to deal with the fistulas. These include: (1) sim-ple drainage (Seton); (2) closure of fistula tract using fibrin sealant or anal fistula plug; (3) closure of prima-ry opening using endorectal or dermal flaps, and more recently; and (4) ligation of intersphincteric fistula tract (LIFT). In most complex cases (i.e. Crohn's disease), a proximal fecal diversion offers a measure of symptom-atic relief. The fact remains that an "ideal" procedure for anal fistula remains elusive. The failure of each sphincter-preserving procedure (30%-50% recurrence) often results in multiple operations. In essence, the price of preservation of continence at all cost is multi-ple and often different operations, prolonged disability and disappointment for the patient and the surgeon. Nevertheless, the surgeon treating anal fistulas on an occasional basis should never hesitate in referring the patient to a specialist. Conversely, an expert colorectal surgeon must be familiar with many different opera-tions in order to selectively tailor an operation to the individual patient.
Fistula in ano is a common proctological disease. Several authors stated that internal and external anal sphincters preservation is in the interest of continence maintenance. The aim of the present study is to report our experience using a decisional algorithm on sphincter saving procedures that achieved us to obtain good results with low rate of complications. From 2008 to 2011, 206 patients underwent surgical treatment for anal fistula; 28 patients underwent perianal abscess drainage plus seton placement of trans-sphincteric or supra-sphincteric fistula (13.6 %), 41 patients underwent fistulotomy for submucosal or low inter-sphincteric or low trans-sphincteric anal fistula (19.9 %) and 137 patients underwent partial fistulectomy or partial fistulotomy (from cutaneous plan to external sphincter muscle plan) and cutting seton placement without internal sphincterotomy for trans-sphincteric anal fistula (66.50 %). Healing rates have been of 100 % and healing times ranged from 1 to 6 months in 97 % of patients treated by setons. Transient fecal soiling was reported by 19 patients affected by trans-sphincteric fistula (11.5 %) for 4-6 months and then disappeared or evolved in a milder form of flatus occasional incontinence. No major incontinence has been reported also after fistulotomy. Fistula recurred in five cases of trans-sphincteric fistula treated by seton placement (one with abscess) (1/28) (3.5 %) and four with trans-sphincteric fistula (4/137) (3 %). Our algorithm permitted us to reduce to 20 % sphincter cutting procedures without reporting postoperative major anal incontinence; it seems to open an interesting way in the treatment of anal fistula.
Dudukgian, Haig; Abcarian, Herand
Anal fistula is among the most common illnesses affecting man. Medical literature dating back to 400 BC has discussed this problem. Various causative factors have been proposed throughout the centuries, but it appears that the majority of fistulas unrelated to specific causes (e.g. Tuberculosis, Crohn's disease) result from infection (abscess) in anal glands extending from the intersphincteric plane to various anorectal spaces. The tubular structure of an anal fistula easily yields itself to division or unroofing (fistulotomy) or excision (fistulectomy) in most cases. The problem with this single, yet effective, treatment plan is that depending on the thickness of sphincter muscle the fistula transgresses, the patient will have varying degrees of fecal incontinence from minor to total. In an attempt to preserve continence, various procedures have been proposed to deal with the fistulas. These include: (1) simple drainage (Seton); (2) closure of fistula tract using fibrin sealant or anal fistula plug; (3) closure of primary opening using endorectal or dermal flaps, and more recently; and (4) ligation of intersphincteric fistula tract (LIFT). In most complex cases (i.e. Crohn's disease), a proximal fecal diversion offers a measure of symptomatic relief. The fact remains that an "ideal" procedure for anal fistula remains elusive. The failure of each sphincter-preserving procedure (30%-50% recurrence) often results in multiple operations. In essence, the price of preservation of continence at all cost is multiple and often different operations, prolonged disability and disappointment for the patient and the surgeon. Nevertheless, the surgeon treating anal fistulas on an occasional basis should never hesitate in referring the patient to a specialist. Conversely, an expert colorectal surgeon must be familiar with many different operations in order to selectively tailor an operation to the individual patient.
Dietary influences may affect microbiome composition and host immune responses, thereby modulating propensity toward inflammatory bowel diseases: Crohn disease and ulcerative colitis. Dietary n-6 fatty acids have been associated with ulcetative colitis in prospective studies. However, the critical d...
Maíra Costa Ferreira; Tatiana Pereira Braz; Ana Maria Oliveira Machado; Gabriel Ribeiro; Rosana Cristina Pererira de Andrade
INTRODUÇÃO: a incontinência anal (IA) é uma disfunção de origem multifatorial com impacto significativo na qualidade de vida do indivíduo. Dentre as diversas etiologias para IA encontra-se a traumática, provocada pela penetração de objetos no canal anal. A inclusão do ânus na atividade sexual, já vem sendo descrita, principalmente entre homossexuais do sexo masculino. A partir desta premissa, questionou-se nesta pesquisa a possibilidade da penetração do pênis no ânus se enquadrar como etiolog...
Heyckendorff-Diebold, Tina; Maeda, Yasuko; Buntzen, Steen;
The treatment of transsphincteric anal fistulas in Crohn's disease is a balance between the elimination of the sepsis and the functional outcome. Loose setons can be used as a preoperative drainage or chronic treatment. Fibrin glue and the anal fistula plug are methods with excellent functional...... outcomes, but the success rate varies. The endorectal advancement flap is considered to be the gold standard. Ligation of the intersphincteric fistula tract is promising. Proctectomy or proctocolectomy in combination with transposition flaps may be necessary. A success rate of 66-70% has been reported....
Full Text Available Abstract Introduction Myotonic dystrophy (MD or Steinert's syndrome is a rare cause of chronic diarrhea and anal incontinence. In the presence of chronic diarrhea and fecal incontinence with muscle weakness, neuromuscular disorders such as myotonic dystrophy should be considered in the differential diagnosis. Case Presentation We present the case of a 45-year-old Turkish man with Steinert's syndrome, who was not diagnosed until the age of 45. Conclusions In clinical practice, the persistence of diarrhea and fecal incontinence with muscle weakness should suggest that the physician perform an anal manometric study and electromyography. Neuromuscular disorders such as myotonic dystrophy should be considered in the differential diagnosis.
ERSAN, Yılmaz; YAVUZ, Nihat; KUŞASLAN, Ramazan; ÇİÇEK, YUSUF; ERGÜNEY, Sabri
Background.- Chronic anal fissure (Chronic fissure in ano) is a longitudinal or pear-shaped defect of the anal canal mucosa extending usually from the dentate line to the external verge of the anal canal. Circular fibers of the internal anal sphincter are visible on the floor of the fissure and secondary changes; such as a sentinel tag, hypertrophied anal papilla and a degree of anal stenosis frequently accompany chronic fissures. A fissure in ano may occur at any age, but is most common betw...
Fischer, R E; Juni, S
Psychoanalytic implications of anal characterology were operationalized, and an experimental situation devised to test hypotheses of various aspects of interpersonal behavior. Subjects selected for the study had been found to score either high or low on Kline's (Ai3) Anality Scale. Self-disclosure and disclosure reciprocity were shown to be negative functions of anality: productivity and superego measures were also shown to be functions of anality. Self-esteem and socio-economic status did not relate to anality levels, while the hypothesis linking anality with negativism was only partially confirmed. Implications for psychoanalytic and social psychology research are discussed.
Quantification by computerized morphometry of tissue levels of sulfomucins and sialomucins in diversion colitis in rats Quantificação por morfometria computadorizada dos níveis teciduais de sulfomucinas e sialomucinas na colite de exclusão em ratos
Carlos Augusto Real Martinez
Full Text Available PURPOSE: To quantify the intensity of sulfomucin and sialomucin expression in the colon mucosa, by means of computer-assisted image processing, comparing segments with and without fecal stream and correlating with the duration of fecal transit exclusion. METHODS: Forty-five Wistar rats were subjected to diversion of the fecal stream in the left colon by means of constructing a proximal colostomy and distal mucosal fistula. They were distributed randomly into three experimental groups of 15 animals, of which 10 were subjected to colon diversion (experimental subgroup and five were only subjected to laparotomy, without colon diversion (control subgroup. The three experimental groups were formed according to the sacrifice date, which was to be performed six weeks after the surgical procedure (Group A, 12 weeks (Group B and 18 weeks (Group C. The sulfomucin and sialomucin expression in the colon mucosa was evaluated using the histochemical technique of high iron diamine-alcian blue (HID-AB. The tissue expression was quantified for each animal, in the segments with and without fecal stream, at a location where there were four complete contiguous crypts in two random fields, with the aid of the computer-assisted image analysis software. The final value was taken to be the mean reading from the two fields selected, in the segments with and without fecal stream. To compare the expressions of the two mucin subtypes in the segments with and without fecal stream, the paired Student t test was used. To analyze variance according to duration of exclusion, ANOVA with the Newman-Keuls post-test was used, setting the significance level at 5% (pOBJETIVO: Quantificar, por meio de processamento de imagem assistida por computador, a intensidade de expressão de sulfomucinas e sialomucinas na mucosa cólica comparando segmentos com e sem trânsito e relacionando-a ao tempo de exclusão de trânsito fecal. MÉTODOS: Quarenta e cinco ratos Wistar machos foram
Takuya Inoue; Ken Toshina; Takashi Nishikawa; Norihiro Hamamoto; Ken Nakagawa; Ken-Ichi Katsu; Ichiro Hirata; Yutaro Egashira; Kumi Ishida; Ken Kawakami; Eijiro Morita; Naoko Murano; Shingo Yasumoto; Mitsuyuki Murano
Various hepato-biliary complications are an increased incidence in patients with inflammatory bowel disease,and portal bacteremia is well documented in patients with ulcerative colitis (UC). However, few reports mention UC in association with liver abscesses. Recently, there are several reports describing cytomegalovirus (CMV) infection in association with disease exacerbation and steroid refractoriness in patients with UC. Here we present a case of refractory UC accompanied with multiple liver abscesses and CMV colitis. The patient, a 72-year-old male, with a five-year history of repeated admissions to our hospital for UC, presented with an exacerbation of his UC.Sigmoidoscopy performed on admission suggested that his UC was exacerbated, then he was given prednisolone and mesalazine orally, and betamethasone enemas.However, he had exacerbated symptoms. Repeat sigmoidoscopy revealed multiple longitudinal ulcers and pseudopolyps in the rectosigmoid colon. Although immunohistochemical staining of biopsy specimens and the serum testing for antigenemia were negative on admission and after the repeat sigmoidoscopy, they became histologically positive for CMV. Nonetheless, the patient developed spiking fevers, soon after ganciclovir was administered. Laboratory studies revealed an increased white cell count with left shift, and Enterococcus fecalis grew in blood cultures. An abdominal computed tomography (CT) scan was obtained and the diagnosis of liver abscesses associated with UC was made, based on CT results. The hepatic abscesses were successfully treated with intravenous meropenem for 6 wk, without further percutaneous drainage. To our knowledge, this is the first reported case of multiple liver abscesses that develop during UC exacerbation complicated by CMV colitis.
Laura Rodríguez Moya
Full Text Available En los años 80 y 90, A. Ryle desarrolló un modelo de tratamiento denominado Psicoterapia Cognitivo Analítica (PCA. Con un enfoque integrador, breve y focal, la PCA se ha aplicado a diversas patologías, siendo su uso más frecuente con pacientes con trastorno de personalidad, sobre todo con trastorno límite. Estos pacientes poseen un número de disfunciones metacognitivas que dificultan el proceso de darse cuenta de sus diferentes estados mentales y de sus componentes. A través del modelo de Múltiples Estados del self, el objetivo es ayudar al paciente a identificar los procesos disfuncionales o restrictivos del self que está experimentando y dotarle de recursos para que pueda sustituirlos por otros más adaptativos.
o presente trabalho pretende responder à questão da adequação ou não da atual estrutura organizacional do Senado Federal frente às novas exigências decorrentes da promulgação da Constituição de 1988 e da mudança de parâmetros e valores trazida pelo paradigma emergente na Administração Pública a partir de 1990. O estudo se propõe a correlacionar de modo analítico quais são as funções de uma Casa legislativa com o órgão técnico responsável por sua realização, priorizando valores ...
Jorge Ponciano Ribeiro
Full Text Available O autor faz um estudo da resistência em grupo baseado na obra de Siegmund Heinrich Foulkes, fundador da Psicoterapia Grupo Analítica. Foulkes utilizava os conceitos da Psicologia da Gestalt e da Teoria do Campo para fazer compreender o processo de mudança nos seus grupos, embora essas referências passassem desapercebidas, talvez pela dificuldade epistemológica que ele encontrava em combinar Psicanálise e essas teorias. O autor retoma os rastros de Foulkes e desenvolve, a partir dos conceitos de figura e fundo e aqui e agora, uma visão diferente na perspectiva foulkesiana, acenada por ele, mas não desenvolvida. Foulkes tem também uma linguagem fenomenológica que o autor procura explorar.
Molina Martínez, José L.
Full Text Available ResumenSe realizó un estudio sobre la efectividad terapéutica de la electroacupuntura (EA en la colitis ulcerosa (CU provocada experimentalmente en ratas Sprague Dawley por administración intracolónica de una disolución de ácido acético al 4%. El experimento se realizó en 57 ratas distribuidas en tres grupos: Grupo I (control placebo, al que se administró solución salina fisiológica mediante instilación intracolónica, Grupo II (control no tratado y Grupo III (estudio, integrado ambos por animales en que se reprodujo artificialmente la colitis ulcerosa. El estudio histopatológico de muestras tomadas mediante biopsias permitió corroborar la instauración de la entidad. Los acupuntos seleccionados fueronLI-4 (Hegu y ST-36 (Zusanli y la aplicación de la EA se realizó a las 24, 48 y 72 horas posteriores a la reproducción experimental de la CU. En las condiciones del estudio se comprobó que una sesión de EA a las 24 horas posteriores a la reproducción de la entidad, posee efecto anti inflamatorio y mejora notablemente la lesión tisular, no siendo eficaz en los tratamientos realizados a las 48 y 72 horas, influyendo en ello el mecanismo de transducción. Mediante el estudio histopatológico de muestras tomadas mediante biopsias se puede evaluar el estado de la mucosa en la CU y su respuesta al tratamiento mediante EA, sin necesidad de acudir a otros procedimientos más sofisticados y costosos. Se comprobó que el modelo experimental utilizado es adecuado para estudios sobre esta afección.SummaryA study was carried out on the therapeutic effectiveness ofelectroacupuncture (EA in the ulcerous colitis (UC experimentally provoked in Sprague Dawley rats by intracolonic administration of a 4 % acetic acid dissolution. The experiment was realized in 57 rats distributed in three groups: Group I (placebo control, to which physiological saline solution was administered by intracolonic instillation, Group II (not treated control and Group
Kendrick, Jessica B; Risbano, Michael; Groshong, Steve D; Frankel, Stephen K
Escherichia coli Ol57:H7 infection ranges from mild diarrheal illness to severe hemorrhagic colitis but may rarely be complicated by pseudomembranous colitis and/or necrosis. Herein, we report a sporadic case of ischemic E. coli Ol57:H7 pseudomembranous colitis in an adult that occurred during a national outbreak of E. coli Ol57:H7 in the United States.
Conclusion About 70% of our patients with ulcerative colitis in clinical remission had an active disease. Clinical remission in ulcerative colitis can be best expressed as true and false remission depending on histological grading in a revised ulcerative colitis disease activity index. Some inflammatory markers can be useful for the detection of true remission.
14 APPENDICES None. 2 Targeting of the MUC1-C Oncoprotein in Colitis ...xenografts in nude mice and to develop a MUC1+/IL-10-/- model of colitis to determine whether MUC1 function affects the inflammatory response and colon...function affects the inflammatory response and colon tumorigenesis in a MUC1+/IL-10-/- mouse model of colitis . Intestinal inflammation increases
Thijs, WJ; van Baarlen, J; Kleibeuker, JH; Kolkman, JJ
Background: Microscopic colitis presents with chronic diarrhoea with or without abdominal pain. Microscopic colitis is an important cause of chronic diarrhoea. It can be distributed throughout the colon, as well as limited to the right colon. Microscopic colitis is associated with coeliac disease. W
Perry Hookman; Jamie S Barkin
A new, hypervirulent strain of Clostridium difficile, called NAP1/BI/027, has been implicated in C. difficile outbreaks associated with increased morbidity and mortality since the early 2000s. The epidemic strain is resistant to fluoroquinolones in vitro, which was infrequent prior to 2001. The name of this strain reflects its characteristics, demonstrated by different typing methods: pulsed-field gel electrophoresis (NAP1), restriction endonuclease analysis (BI) and polymerase chain reaction (027). In 2004 and 2005, the US Centers for Disease Control and Prevention (CDC) emphasized that the risk of C. difficile-associated diarrhea (CDAD) is increased, not only by the usual factors, including antibiotic exposure, but also gastrointestinal surgery/manipulation, prolonged length of stay in a healthcare setting, serious underlying illness, immune-compromising conditions, and aging. Patients on proton pump inhibitors (PPIs) have an elevated risk, as do peripartum women and heart transplant recipients. Before 2002, toxic megacolon in C. difficile-associated colitis (CDAC), was rare, but its incidence has increased dramatically. Up to twothirds of hospitalized patients may be infected with C. difficile. Asymptomatic carriers admitted to healthcare facilities can transmit the organism to other susceptible patients, thereby becoming vectors. Fulminant colitis is reported more frequently during outbreaks of C. difficile infection in patients with inflammatory bowel disease (IBD). C. difficile infection with IBD carries a higher mortality than without underlying IBD. This article reviews the latest information on C. difficile infection, including presentation, vulnerable hosts and choice of antibiotics, alternative therapies, and probiotics and immunotherapy. We review contact precautions for patients with known or suspected C. difficileassociated disease. Healthcare institutions require accurate and rapid diagnosis for early detection of possible outbreaks, to initiate
Full Text Available son trastornos crónicos que inflaman y destruyen el tejido intestinal de forma periódica y recurrente. Las EII se clasifican en dos tipos: enfermedad de Crohn (EC y colitis ulcerosa (CU. La etiología tanto de la EC como de la CU es poco conocida y el curso está influido por múltiples factores de tipo biopsicosocial. Al respecto, diversas investigaciones están aportando evidencia de la implicación de factores psicológicos en el curso de las EII, tales como el estrés psicosocial, las estrategias de afrontamiento, las características de personalidad, los síntomas psicopatológicos y el apoyo social
En la actualidad se considera que el TDAH es uno de los trastornos psicológico – comportamentales de la infancia más comúnmente diagnosticados. Los niños que lo padecen no pueden usar lo que han aprendido porque el sistema del conocimiento no interactúa con los mecanismos que regulan el comportamiento y la conducta. Tras realizar una revisión teórico – práctica, se propone un programa de intervención mediante razonamiento analógico por ser este una “estrategia valiosa tanto par...
Full Text Available Background: Golimumab is a TNF-blocking agent indicated as a second-line therapy in ulcerative colitis. Purpose: To research the effectiveness and safety of golimumab in patients with ulcerative colitis in clinical practice. Methods: Retrospective study of the effectiveness and safety of golimumab in patients with ulcerative colitis. All patients received golimumab 200 mg subcutaneously at week 0, and golimumab 100 mg subcutaneously at week 2. After the induction treatment, each patient received 50 mg sc. every 4 weeks in patients with body weight less than 80 kg, and 100 mg every 4 weeks in patients with body weight greater than or equal to 80 kg. Results: Study of a group of 23 ulcerative colitis patients, 7 of whom were naive to any anti-TNF therapy, and 16 patients who had previously been treated with an anti-TNF agent other than golimumab (non-naive patients. The average treatment time with golimumab was 14.3 weeks. Globally, withdrawal of corticosteroids was observed in 74% of cases. Clinical response was observed in 85.5% of patients who had not received biological treatment previously, and in patients who had previously received biological treatment the response rate was 75%. Conclusions: In this short study, golimumab seems to be an alternative treatment in naive and non-naive anti-TNF ulcerative colitis patients. It is also a safe therapy, given that there were no adverse effects in the patients studied.
Matsuo, Yukiko; Azuma, Yasu-Taka; Kuwamura, Mitsuru; Kuramoto, Nobuyuki; Nishiyama, Kazuhiro; Yoshida, Natsuho; Ikeda, Yoshihito; Fujimoto, Yasuyuki; Nakajima, Hidemitsu; Takeuchi, Tadayoshi
Inflammatory bowel disease results from chronic dysregulation of the mucosal immune system and aberrant activation of both the innate and adaptive immune responses. Interleukin (IL)-19, a member of the IL-10 family, functions as an anti-inflammatory cytokine. Here, we investigated the contribution of IL-19 to intestinal inflammation in a model of T cell-mediated colitis in mice. Inflammatory responses in IL-19-deficient mice were assessed using the 2,4,6-trinitrobenzene sulfonic acid (TNBS) model of acute colitis. IL-19 deficiency aggravated TNBS-induced colitis and compromised intestinal recovery in mice. Additionally, the exacerbation of TNBS-induced colonic inflammation following genetic ablation of IL-19 was accompanied by increased production of interferon-gamma, IL-12 (p40), IL-17, IL-22, and IL-33, and decreased production of IL-4. Moreover, the exacerbation of colitis following IL-19 knockout was also accompanied by increased production of CXCL1, G-CSF and CCL5. Using this model of induced colitis, our results revealed the immunopathological relevance of IL-19 as an anti-inflammatory cytokine in intestinal inflammation in mice.
Halaweish, Ihab; Alam, Hasan B
Severe colitis, an umbrella encompassing several entities, is one of the most common acute gastrointestinal disorders resulting in critical illness. Clostridium difficile infection is responsible for the majority of nosocomial diarrhea with fulminant C difficile colitis (CDC) carrying a high mortality. Optimal outcomes can be achieved by early identification and treatment of fulminant CDC, with appropriate surgical intervention when indicated. Ischemic colitis, on the other hand, is uncommon with a range of etiological factors including abdominal aortic surgery, inotropic drugs, rheumatoid diseases, or often no obvious triggering factor. Most cases resolve with nonsurgical management; however, prompt recognition of full-thickness necrosis and gangrene is crucial for good patient outcomes. Fulminant colitis is a severe disease secondary to progressive ulcerative colitis with systemic deterioration. Surgical intervention is indicated for hemorrhage, perforation, or peritonitis and failure of medical therapy to control the disease. Although, failure of medical management is the most common indication, it can be difficult to define objectively and requires a collaborative multidisciplinary approach. This article proposes some simple management algorithms for these clinical entities, with a focus on critically ill patients.
Shirley, Debbie-Ann; Moonah, Shannon
Background Amebic colitis, caused by intestinal infection with the parasite, Entamoeba histolytica, is a common cause of diarrhea worldwide. Fulminant amebic colitis is the most devastating complication of this infection, associated with both high mortality and morbidity. We conducted a review of the English literature to describe cases of fulminant amebic colitis associated with exposure to corticosteroid medications in order to identify the risk factors for poor outcome and determine difficulties in diagnosis and treatment. Methodology and Principal Findings Articles reporting severe and fulminant forms of amebic colitis between 1991 and 2016 were collected. 525 records were screened to identify 24 cases for qualitative analysis associated with corticosteroid use. Cases arose from areas of high endemicity or travel to such areas. Most cases (14 of 24, 58%) were given corticosteroids for initially misdiagnosed colitis, mainly inflammatory bowel, resulting in rapid progression of disease. Nearly half of all cases underwent surgical intervention, and 25% of cases died, despite all patients eventually receiving treatment with metronidazole. The odds of death did not differ significantly by prior misdiagnosis, co-morbidities, bowel perforation or need for surgery. Conclusions and Significance Infection with E. histolytica should be considered prior to the administration of corticosteroids, in particular for patients residing in endemic areas or those with appropriate travel history, especially prior to the diagnosis of inflammatory bowel disease. The development of preventative and treatment interventions are needed to improve outcomes of fulminant disease. PMID:27467600
Full Text Available El artículo tiene como objetivo presentar una metodología alterna para el análisis de transcripciones de entrevistas semi-estructuradas considerando el paradigma cualitativo y aplicando la propuesta filosófica de la hermenéutica analógica impulsada por Beuchot (2009. Partiendo de una estrategia metodológica de Estudio de Caso, se describe en un primer momento, la contextualización y justificación del proyecto de investigación sobre la transformación estructural de la Universidad de Guanajuato (UG en México. Posteriormente se detalla el modelo de análisis hermenéutico aplicado a los textos surgidos de ocho entrevistas semiestructuradas realizadas con los principales actores que impulsaron, protagonizaron o se opusieron a este cambio organizacional, como rectores, diputados, profesores y funcionarios universitarios. A diferencia de un análisis cualitativo basado en la construcción de categorías y sub categorías identificadas en el texto de la entrevista, se explican las ventajas de un abordaje hermenéutico basado en una analogía, que nos permite mantener un equilibrio entre la univocidad y la equivocidad. La univocidad se entiende como una minería de la verdad, en donde uno y sólo un significado es válido y aceptable; y en el otro sentido, la equivocidad es entendida como una construcción interpretativa muy abierta que depende del contexto situacional o histórico de quien interpreta. La aplicación de esta metodología ha permitido la construcción de un referente analógico hermenéutico, conformado por un rango de interpretaciones válidas para este estudio de caso. Como resultado de esta metodología se presenta un mapa conceptual que integraesta gama de interpretaciones y se comentan las ventajas de tener este referente analógico no como una interpretación final sino como una herramienta para avanzar en un proceso hermenéutico continuo.
Cantril, S.T. (Children' s Hospital of San Francisco, CA); Green, J.P.; Schall, G.L.; Schaupp, W.C.
From 1966 to 1981, 47 patients with a diagnosis of anal carcinoma were irradiated. This group was composed of 23 males and 24 females, with age ranging from 38 to 84 years (average 64.4 years). Five patients were treated preoperatively and 34 were treated definitively with cancericidal doses of irradiation. Acute radiation reactions requiring a rest-break were noted in 28% of patients, but all were managed as outpatients without untoward chronic sequelae. Chronic complications were noted in 13 patients, including two patients who required colostomy for severe anal stenosis and two who required A-P resection for large painful ulcers. Twenty-eight of 35 patients (80%) treated with irradiation alone have remained locally controlled without further treatment. An additional four have been salvaged by surgery. Only three patients had interstitial implants as part of their treatment course. Actuarial survival at five years for the N/sub 0/ patients and the group as a whole are 95.6 and 79.3%, respectively. It is concluded that external beam irradiation alone, properly fractionated to cancericidal doses, can control anal carcinoma with acceptable morbidity rates and without the use of either chemotherapy or interstitial implants in most cases. There is also a strong correlation suggesting that anal intercourse and male homosexuality play a significant role in the etiology of this disease.
Kolodziejczak, Malgorzata [Department of Proctology, Hospital at Solec, Warsaw (Poland); Sudol-Szopinska, Iwona, E-mail: firstname.lastname@example.org [Department of Proctology, Hospital at Solec, Warsaw (Poland); Department of Diagnostic Imaging, Second Faculty of Warsaw Medical University, Warsaw (Poland); Stefanski, Robert [Department of Proctology, Hospital at Solec, Warsaw (Poland); Department of Diagnostic Imaging, Second Faculty of Warsaw Medical University, Warsaw (Poland); Panorska, Anna K. [Department of Mathematics and Statistics, University of Nevada, Reno (United States); Gardyszewska, Agnieszka [Second Clinic of Obstetrics and Gynecology, Warsaw (Poland); Krasnodebski, Ireneusz [Department of General and Gastroenterological Surgery and Nutrition, Medical University, Warsaw (Poland)
Objective: To estimate a frequency of obstetric anal sphincters defects in women after vaginal delivery. Methods: The study included 102 women, aged from 16 to 40 years (mean age 28.6 years). 28 women had perineal lacerations of 3rd and 4th degree. 22 women had instrumental delivery. Anal endosonography was performed on all participants using BK Medical scanner Pro focus with a 3D endoprobe during the first week after delivery. Starck's classification was used to score sphincters defects. Results: The endosonographic images were abnormal in 8 out of 102 women (7.8%). Follow-up examinations after 6 weeks confirmed defects in 6 out of 102 women (5.8%). Five women had external anal sphincter torn, and 1 woman had both sphincters, internal and external, defected. Discordance between endosonographic diagnosis of defect and clinical assessment of sphincters continuity was demonstrated in 6 (5.9%) out of 8 initially found, including 2 (1.9%) false endosonographic results and 4 (3.9%) false clinical diagnosis (occult sphincter defects). The endosonography sensitivity and accuracy in sphincter defect diagnostic amounted to 100% and 98%, respectively. Conclusions: (1) Anal sphincters' tears in symptomatic women are not as frequent as it was believed. (2) The defect diagnosis in the first week after delivery should be verified by a follow-up endosonography in 6 weeks, after regression of the edema and hematoma.
Se considera una nueva psicoterapia de orientación conductual: la Psicoterapia Analítico Funcional. Se describen brevemente sus fundamentos teóricos, metodológicos y aplicados. Se discuten sus aspectos funcionales desde un punto de vista contextual.
Diplomová práce je zaměřena na analýzu realitní společnosti M&M reality holding, a.s.. V rámci mapování společnosti se zaměřuji na rozbor oborového okolí pomocí PEST analýzy, Porterův model pěti konkurenčních sil, SWOT analýzu a finanční analýzu. V závěru práce navrhuji doporučení, která by měla vést ke zlepšení současné situace. The master´s thesis is focused on the analysis of real estate company M&M reality holding, a.s.. The mapping of the analysis focuses on the professional environme...
Due, Ulla; Ottesen, Marianne
offered pelvic floor muscle examination and instruction by a specialist physiotherapist. In relation to that, a non-validated questionnaire about anal and urinary incontinence was to be answered six months after childbirth. Method. The original questionnaire was revised and a pilot test was performed...
Suzuki, Shinichiro; Matsumoto, Akihiko (Yokohama City Univ. (Japan). Faculty of Medicine); Kono, Kazuo (and others)
Preoperative CT examination was performed on 30 cases of deep anal fistula and one case with an anal fistular carcinoma, and its usefulness and the limit of applicability were investigated. The deep anal fistula was recognized as a funicular or tumorous shadow on CT image. The differentiation of tumorous shadow and carcinoma was performed by biopsy under CT observation. While, there were also unidentifiable cases including three out of eight cases (37.5%) in II HC type and one out of 11 cases (9.1%) in II HC and III B types. Particularly, patients with a rectostenosis as the madn lesion could not be identified on CT images. The benefits of CT examination in deep anal fistula were compared with transrectal ultrasonography to establish a procedure for image diagnosis. Transrectal ultrasonography is performed as a routine test and CT examination is added when a lesion waving diameter of more than one cm is observed. Furthermore, active biopsy for patients with suspected carcinoma is planned under CT observation. (author).
Full Text Available Aim: To review 12 cases of anovestibular fistula with normal anal opening. Methods: Retrospective analysis of 12 children with anovestibular fistula and normal anal opening were treated between the years 2000 and 2007. Of these, 11 patients were diagnosed as having acquired anovestibular fistula with normal anal opening and were managed by conservative management. Results: Most of them presented with diarrhea and labial redness. One patient was considered to have fistula of congenital origin and was managed surgically. Eleven patients presented between the ages of 1.5-11 months and were considered as cases of acquired anovestibular fistula and only two of them required surgical management in the form of colostomy and fistula excision. Others were successfully managed by conservative treatment; the fistulous output and labial redness decreased gradually within a period of 5-19 (average 11.5 days. Conclusions: Not all presentations of anovestibular fistula with normal anal opening can be considered as congenital. Presence of inflammation, paramedian fistula, and a favourable response to conservative management/colostomy suggest acquired etiology. Trial of conservative management should be given in the acquired variety.
Javier Virués Ortega
Full Text Available Se considera una nueva psicoterapia de orientación conductual: la Psicoterapia Analítico Funcional. Se describen brevemente sus fundamentos teóricos, metodológicos y aplicados. Se discuten sus aspectos funcionales desde un punto de vista contextual.
Human immunodeficiency virus (HIV) infection contributes substantially to the epidemic of anal cancer in men, but not women in the United States, according to new research from NCI. Chart shows overall incidence rates of anal cancers in general population
Romelaer, Charlotte; Abramowitz, Laurent
Gastrointestinal tuberculosis represents 1% of extrapulmonary tuberculoses and only sporadic cases of anal tuberculosis have been reported in the literature. We report two cases of tuberculous anal abscess and a review of the literature for diagnosis and treatment.
Paas, Marge, 1976-
Analüüsitakse vaataja esteetilist kogemust kunstiteose suhtes. Autor tugineb Edith Steini empaatia kogemuse uurimusele ja fenomenoloogilisele uurimismeetodile. Vaataja empaatia kogemuse analüüs Maarit Murka maalisarjas "Hairpower" kujutatud subjekti suhtes
Jango, Hanna; Langhoff-Roos, Jens; Rosthøj, Susanne
To determine modifiable risk factors and incidence of obstetric anal sphincter injury (OASIS) in primiparous women.......To determine modifiable risk factors and incidence of obstetric anal sphincter injury (OASIS) in primiparous women....
Garib, Ricardo; Garla, Priscila; Torrinhas, Raquel S; Bertevello, Pedro L; Logullo, Angela F; Waitzberg, Dan L
Objetivo: Estudiar los efectos de los diferentes protocolos de infusión de la emulsion de lípidos de aceite de pescado (Fole) sobre la inflamación aguda en el modelo de colitis en la rata. Material y métodos: Ratas Wistar macho adultas (n = 51) fueron asignados al azar en 5 grupos para recibir infusión parenteral de solución salina (SS) o emulsión de lípidos de aceite de soja (SO), como controles, y Fole compone de: aceite de pescado solo (FO), una mezcla (9:1 v/v) de SO con FO (SO/FO), o 30% de aceite de soja, 30% triglicéridos de cadena media, 25% de aceite de oliva, y 15% de aceite de pescado (SMOF). Después de 72 h de infusión intravenosa, colitis experimental fue inducida con ácido acético. Después de 24 h, las muestras de colon se analizaron para determinar cambios histológicos y citoquinas. Resultados: En relación en el SS grupo, necrosis macroscópica fue menos frecuente en el grupo FO y necrosis histológica fue más frecuente en el grupo de SMOF. Existe una relación directa e inversa de colon interleuquina (IL) -1 e IL-4, respectivamente, con necrosis histológica. En comparación con el grupo SS, en el FO hubo aumento de IL-4 e IFN-gamma y disminución de TNF-alfa, SO/FO disminuyó TNF-alfa, y en el SMOF hubo aumento de IL-1 y la disminución de IL-4. Conclusión: En la colitis inducida por ácido acético, la infusion aislada de Fole compuesto de aceite de pescado por sí solo fue más ventajosa en la atenuacion de la inflamacióndo que la infusión de Fole contiendo otros aceites, y esta diferencia puede ser debida las influencias de su diferente contenido de ácido graso.
To propose a new pathogenesis called Radical Induction to explain the genesis and progression of ulcerative colitis (UC). UC is an inflammatory bowel disease. Colonic inflammation in UC is mediated by a buildup of white blood cells (WBCs) within the colonic mucosal lining; however,to date there is no answer for why WBCs initially enter the colonic mucosa to begin with. A new pathogenesis termed "Radical Induction Theory" is proposed to explain this and states that excess un-neutralized hydrogen peroxide, produced within colonic epithelial cells as a result of aberrant cellular metabolism, diffuses through cell membranes to the extracellular space where it is converted to the highly damaging hydroxyl radical resulting in oxidative damage to structures comprising the colonic epithelial barrier. Once damaged, the barrier is unable to exclude highly immunogenic fecal bacterial antigens from invading the normally sterile submucosa. This antigenic exposure provokes an initial immune response of WBC infiltration into the colonic mucosa. Once present in the mucosa,WBCs are stimulated to secrete toxins by direct exposure to fecal bacteria leading to mucosal ulceration and bloody diarrhea characteristic of this disease.
Blickman, J.G. [Massachusetts General Hospital, Boston, MA (United States); Boland, G.W.L. [Massachusetts General Hospital, Boston, MA (United States); Cleveland, R.H. [The Children`s Hospital, Boston, MA (United States); Bramson, R.T. [Massachusetts General Hospital, Boston, MA (United States); Lee, M.J. [Massachusetts General Hospital, Boston, MA (United States)
A spectrum of nodular haustral thickening and an `accordion` pattern have been reported as specific features of pseudomembranous colitis (PMC) in adults. A retrospective review of nine patients with PMC was performed to assess whether this spectrum of CT findings also occurred in children. In four girls and five boys, CT scans were performed within 3 days of a positive stool toxin assay for Clostridium difficile. Documented CT abnormalities included nodular haustral thickening, the `accordion` pattern, colonic wall thickening, ascites, and pericolonic edema. These results were then correlated as to their impact on the clinical outcome. Circumferential colon wall thickening was identified in 7/9 (78%) patients (mean thickening 14.5 mm). Nodular haustral thickening was identified in 4/9 (44%) and the `accordion` pattern in 2/9 (22%). Other findings included pericolonic edema in 3/9 (33%) and ascites in 1/9 (11%). Wall thickening was confined to the left colon and rectum in 2/9 (22%), to the right colon in 2/9 (22%), and involved the whole colon in 3/9 (33%). Although CT findings associated with PMC in children may be suggestive for this diagnosis, CT is less specific than laboratory and clinical findings. (orig.)
Zhi-peng Tang; Jia-wei Wu; Yan-cheng Dai; Ya-li Zhang; Rong-rong Bi
Objective To explore the relationship between ulcerative colitis (UC) and lung injuries by assessing their clinical manifestations and characteristics. Methods From July 2009 to April 2012, 91 UC patients presenting to Longhua Hospital who met the established inclusion and exclusion criteria were enrolled in this retrospective study. According to the scores of disease activity index, the patients were divided into the mild, moderate, and severe groups. Meanwhile, the records of pulmonary symptoms, chest X-ray image, and pulmonary function were reviewed. Results Sixty-eight (74.7%) patients had at least 1 pulmonary symptom, such as cough (38.5%), shortness of breath (27.5%), and expectoration (17.6%). And 77 (84.6%) had at least 1 ventilation abnormality. Vital capacity value was significantly lower in the severe group than that in the mild group (91.82%±10.38%vs. 98.92%±12.12%, P Conclusions Lung injury is a common extraintestinal complication of UC. According to the theory in Traditional Chinese Medicine that the lung and large intestine are related, both the lungs and large intestine should be treated simultaneously.
Full Text Available Antineutrophil cytoplasmic autoanibodies (ANCA were detecte in patients with certain autoimmune vascular disease such as Wegner’s granulomatosis, polyarthrits nodosa and systemic luuc erythematous. Indirect immunofluorescence (IIF technique was employed to detec these autoantibodies.ANCA have been recently detected in some forms of inflammatory bowel disease (IBD, ulcerative colitis (U.C. Crohn’s disease (C.D and primary sclerosing cholangitis (PSC. By IIF method, two general patterns of ANCA were seen: a cytoplasmic (C-ANCA and perinuclear form (P-ANCA. In this study we evaluated the presece of ANCA in 52 U.C. patients and 69 matched normal control group by IIF technique, and it’s relationship with disease activity. Site of colon involvement and, lesion extent. The results showed that all control group were ANCA negative, but 58% of patients had ANCA, and most cases (70% had C- ANCA. The obtained results also revealed that there was no relationship between ANCA and disease activity
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.
Fabiana Pirani Carneiro
Full Text Available Condiloma acuminado e ovos de Schistosoma são freqüentemente encontrados na região anal, mas não há nenhum caso descrito de associação dessas doenças nessa região. No colo uterino a associação de infecção por HPV (vírus do papiloma humano e ovos de Schistosoma em paciente HIV (vírus da imunodeficiência humana-positivo já foi relatada e há evidências de que essa associação possa alterar a história natural dessas doenças. Assim como no colo uterino, é possível que essa interação também ocorra na região anal. Nosso objetivo, portanto, é relatar um caso de condiloma anal em paciente HIV-positivo, que foi submetido a ressecção cirúrgica e que apresentou no exame histopatológico numerosos ovos de Schistosoma mansoni.Condilomata acuminata and Schistosoma eggs are frequently found in the anal region, but there is no report about the association of these diseases in this region. The association of HPV infection and Schistosoma eggs in an HIV-positive patient was found in uterine cervix and there is evidence suggesting that this association can alters the natural history of these diseases. Like in the cervix, it is possible that this interaction also occurs in the anal region. So, we report a case of anal Condilomata acuminata, in an HIV-positive patient, that was ressected and contained on histopathologic examination, multiple Schistosoma eggs.
Klein, H.M. [Klinik fuer Radiologische Diagnostik der RWTH, Aachen (Germany); Wein, B. [Klinik fuer Radiologische Diagnostik der RWTH, Aachen (Germany); Adam, G. [Klinik fuer Radiologische Diagnostik der RWTH, Aachen (Germany); Ruppert, D. [Klinik fuer Radiologische Diagnostik der RWTH, Aachen (Germany); Guenther, R.W. [Klinik fuer Radiologische Diagnostik der RWTH, Aachen (Germany)
We analysed the CT examinations of 109 patients with 197 involved bowel locations. 81 patients suffered from Crohn`s disease, 28 from ulcerative colitis. Diagnosis was based on the combination of clinical, endoscopic and histopathologic findings. Three radiologists evaluated the CT series concerning the presence of morphologic changes analogous to conventional radiographic findings. In Crohn`s disease, we found irregular outer contours in 26% of cases. The bowel wall was thickened in 82%. In acute phases, the bowel wall was thickened in 100%. Abscess and fistula as complications of inflammatory disease were present in 26 and 14% respectively. In ulcerative colitis, a target sign of the bowel wall was present in 40%, whereas in Crohn`s disease a homogeneous wall density was present in all but two cases. Reduced attenuation due to submucosal fat deposits was found in 16% and mucosal tunneling in 27% of cases with ulcerative colitis. Even if severe mucosal destructions were found, the outer contour of the gut was smooth and regular in 95% of the ulcerative colitis cases. CT can provide additional information on acuity, extent and complications in inflammatory bowel disease. In combination with conventional radiographic findings a three-step classification for Crohn`s disease and ulcerative colitis (early changes, acute and chronic phase) can be proposed. (orig./MG) [Deutsch] Wir untersuchten computertomographisch 109 Patienten mit 197 erkrankten Darmsegmenten. 81 Patienten litten an M. Crohn und 28 an Colitis ulcerosa. Die Diagnose wurde durch Kombination klinischer, endoskopischer, radiologischer und bioptischer Befunde gesichert. Drei Radiologen bewerteten die Computertomographien und verglichen die Ergebnisse mit den konventionell-radiologischen Befunden. Bei den Patienten mit M. Crohn fanden wir in 26% der Faelle eine irregulaere aeussere Darmwand. Eine Darmwandverdickung lag in 82% vor und fand sich regelmaessig in Darmabschnitten mit floriden Veraenderungen
Yutaka Hirayama; Takafumi Ando; Yoshiki Hirooka; Osamu Watanabe; Ryoji Miyahara; Masanao Nakamura; Takeshi Yamamura; Hidemi Goto
AIM: To identify characteristic endoscopic findings and risk factors for cytomegalovirus(CMV)-associated colitis in patients with active ulcerative colitis(UC).METHODS: A total of 149 UC patients admitted to the Department of Gastroenterology, Nagoya University Hospital, from January 2004 to December 2013 with exacerbation of UC symptoms were enrolled in this retrospective study. All medical records, including colonoscopy results, were reviewed. CMV infection was determined by the presence of CMV antigen, CMV inclusion bodies in biopsy specimens, or positive specific immunohistochemical staining for CMV. Multivariate analysis was used to identify independent risk factors for CMV colitis.RESULTS: Multivariate analysis indicated independent associations with the extent of disease(pancolitis) anduse of > 400 mg corticosteroids for the previous 4 wk. In contrast, no association was seen with sex, age at UC diagnosis, immunomodulator use, or infliximab use. Punched-out ulceration was also significantly associated with CMV infection in patients with active UC(odds ratio = 12.672, 95%CI: 4.210-38.143).CONCLUSION: Identification of a total corticosteroid dose > 400 mg for 4 wk, extensive colitis and a specific endoscopic finding of punched-out ulcer might facilitate the more rapid diagnosis and timely initiation of antiviral therapy for CMV-associated colitis in patients with active UC.
Ahmed Madisch; Birgit Bethke; Manfred Stolte; Stephan Miehlke
@@ TO THE EDITOR With great interest we read the recent retrospectice study by Barta et al (1) dealing with the clinical presentation of patients with microscopic colitis. They investigated in a cohort of 53 patients with microscopic colitis (46 with collagenous colitis, 7 with lymphocytic colitis)the relationship between microscopic colitis and both constipation and diarrhea. One of their mean finding was that abdominal pain, diarrhea and constipation was a common symptom complex of patients with microscopic colitis, thus the face of microcopic colitis resembles the subgroups of irritable bowel syndrome (IBS).
Jang, Jong-Chan; Lee, Kang Min; Ko, Seong-Gyu
We examined the protective effects of Angelica acutiloba Kitagawa (AAK) extract on a murine model of acute experimental colitis. Colitis was induced by 4% dextran sulfate sodium (DSS) in the drinking water of male C57BL/6 mice, for 7 consecutive days. Oral administration of AAK extract (500 mg/kg/day) significantly alleviated DSS-induced symptoms such as anorexia, weight loss, events of diarrhea or bloody stools, and colon shortening. Histological damage was also ameliorated, as evidenced by the architectural preservation and suppression of inflammatory cell infiltration in colonic samples. Treatment improved the colonic mRNA expression of different inflammatory markers: cytokines, inducible enzymes, matrix metalloproteinases, and tight junction-related proteins. In the isolated serum, IgE levels were downregulated. Collectively, these findings indicate the therapeutic potentials of AAK as an effective complementary or alternative modality for the treatment of ulcerative colitis.
Thorsteinsdottir, Sigrun; Gudjonsson, Thorkell; Nielsen, Ole Haagen;
One of the most serious complications of ulcerative colitis is the development of colorectal cancer. Screening patients with ulcerative colitis by standard histological examination of random intestinal biopsy samples might be inefficient as a method of cancer surveillance. This Review focuses......-driven mechanisms of DNA damage, including the generation and effects of reactive oxygen species, microsatellite instability, telomere shortening and chromosomal instability, are reviewed, as are the molecular responses to genomic stress. We also discuss how these mechanisms can be translated into usable biomarkers....... Although progress has been made in the understanding of inflammation-driven carcinogenesis, markers based on these findings possess insufficient sensitivity or specificity to be usable as reliable biomarkers for risk of colorectal cancer development in patients with ulcerative colitis. However, screening...
Provenzale, D; Onken, J
This review article on the surveillance of patients with ulcerative colitis provides an overview of the criteria for evaluating screening and surveillance programs and applies the criteria to the available evidence to determine the effectiveness of the surveillance of patients with ulcerative colitis. We examine the clinical outcomes associated with surveillance, the additional clinical time required to confirm the diagnosis of dysplasia and cancer, compliance with surveillance and follow-up, and the effectiveness of the individual components of a surveillance program, including colonoscopy and pathologist's interpretation. The disability associated with colectomy is considered, as are the cost and acceptability of surveillance programs. Patients with long-standing ulcerative colitis are at risk for developing colorectal cancer. Recommended surveillance colonoscopy should be supported. New endoscopic and histopathologic techniques to improve the identification of high-risk patients may enhance the effectiveness and cost-effectiveness of surveillance practices.
Irfan Ahmad Rather
Full Text Available Animal model of intestinal inflammation is of paramount significance that aids in discerning the pathologies underlying ulcerative colitis and Crohn’s disease, the two clinical presentations of inflammatory bowel disease. The 2,4,6-trinitrobenzene sulfonic acid (TNBS colitis model represents one such intestinal inflammation-prototype that is generated in susceptible strains of mice through intra-rectal instillation of compound TNBS. In this paper, we demonstrate the experimental induction of TNBS-mediated colitis in a susceptible strain of ICR mice. This can be done by the following steps: a acclimation, b induction and c observation. TNBS-mouse model provides the information in shortest possible time and simultaneously represents a cost effective and highly reproducible model method of studying the pathogenesis of inflammatory bowel disease.
Cleynen, Isabelle; Boucher, Gabrielle; Jostins, Luke
BACKGROUND: Crohn's disease and ulcerative colitis are the two major forms of inflammatory bowel disease; treatment strategies have historically been determined by this binary categorisation. Genetic studies have identified 163 susceptibility loci for inflammatory bowel disease, mostly shared...... between Crohn's disease and ulcerative colitis. We undertook the largest genotype association study, to date, in widely used clinical subphenotypes of inflammatory bowel disease with the goal of further understanding the biological relations between diseases. METHODS: This study included patients from 49...... centres in 16 countries in Europe, North America, and Australasia. We applied the Montreal classification system of inflammatory bowel disease subphenotypes to 34,819 patients (19,713 with Crohn's disease, 14,683 with ulcerative colitis) genotyped on the Immunochip array. We tested for genotype...
Angeliki Theodoropoulou; Ioannis E Koutroubakis
Ischemic colitis is the most common form of ischemic injury of the gastrointestinal tract and can present either as an occlusive or a non-occlusive form.It accounts for 1 in 1000 hospitalizations but its incidence is underestimated because it often has a mild and transient nature.The etiology of ischemic colitis is multifactorial and the clinical presentation variable.The diagnosis is based on a combination of clinical suspicion,radiographic,endoscopic and histological findings.Therapy and outcome depends on the severity of the disease.Most cases of the non-gangrenous form are transient and resolve spontaneously without complications.On the other hand,high morbidity and mortality and urgent operative intervention are the hallmarks of gangrenous ischemic colitis.
Differences in the pressures of canal anal and rectal sensitivity in patients with fecal incontinence, chronic constipation and healthy subjects Diferencias en las presiones del canal anal y la sensibilidad rectal en pacientes con incontinencia anal, estreñimiento crónico y sujetos sanos
C. Ciriza de los Ríos
Full Text Available Introduction: There exist a great variability in the manometric findings between patients with anal incontinence (AI and healthy subjects. The correlation between the pressures of the anal canal and the AI is not exact by the wide rank of normal values. Objectives: Prospective study to evaluate differences in the pressures of the anal canal and in rectal sensitivity in patients with AI, chronic constipation (CC and healthy subjects. Material and methods: Ninety four patients with AI, 36 patients with CC and 15 healthy subjects were included. The following data were obtained: age, sex, resting pressure, anal canal length (ACL, squeeze maximum pressure (SMP, squeeze pressure duration (SPD, first sensation, urge and maximum tolerated volume (MTV. Statistical study: test of Kruskal-Wallis, test of Mann-Whitney, and multinomial logistic regression test. Results: There were significant differences in the resting pressure (p Introducción: Existe gran variabilidad en los hallazgos manométricos entre pacientes con incontinencia anal (IA y sujetos sanos. La correlación entre las presiones del canal anal y la IA no es exacta por el amplio rango de valores normales. Objetivos: Estudio prospectivo para evaluar diferencias en las presiones del canal anal y en la sensibilidad rectal en pacientes con IA, estreñimiento crónico (EC y sujetos sanos. Material y métodos: Noventa y cuatro pacientes con IA, 36 pacientes con EC y 15 sujetos sanos. Se obtuvieron: edad, sexo, presión de reposo, longitud del canal anal (LCA, presión de máxima contracción voluntaria (PMCV, duración de la contracción voluntaria, primera sensación, sensación de urgencia y máximo volumen tolerado (MVT. Estudio estadístico: test de Kruskal-Wallis, test de Mann-Whitney, regresión logística multinomial. Resultados: Se encontraron diferencias significativas en la edad (p < 0,001, la presión de reposo (p < 0,001, la LCA (p < 0,001 y la PMCV (p < 0,01 en el grupo de IA con
Grant I Chen
Full Text Available Three cases of coexisting ulcerative colitis and Crohn’s disease are presented. In the first case, the patient had a long-standing history of ulcerative proctitis before developing Crohn’s colitis. In the two remaining cases, the patients presented initially with Crohn’s disease of the ileum and, subsequent to resection, developed ulcerative colitis. Well-documented cases of patients diagnosed with both ulcerative colitis and Crohn’s disease are rare. The literature on such cases is reviewed, and the controversy over whether ulcerative colitis and Crohn’s disease are two distinct diseases is explored.
Broens, PMA; Penninckx, FM
PURPOSE: The aim of this study was to assess the effect of age and sex on the rectal filling sensation and anal electrosensitivity and to explore the relation between anal electrosensitivity and the parameters of the rectal filling sensation. METHODS: Anal mucosal electrosensitivity and anorectal ma
Sunesen, Kåre G; Nørgaard, Mette; Lundby, Lilli;
In anal cancer, colostomy-free survival is a measure of anal sphincter preservation after treatment with radiotherapy or chemoradiotherapy. Failure to control anal cancer and complications of treatment are alternative indications for colostomy. However, no data exist on cause-specific colostomy...
Wu, Cong; Xu, Zheng; Gai, Renhua; Huang, Kehe
Interleukin-10 (IL-10)-deficient mice spontaneously develop T cell-mediated colitis. Previous reports have shown that Matrine may reduce the symptoms of acute colitis induced by trinitrobenzene sulfonic acid (TNBS). However, whether Matrine impacts chronic colitis remains unknown. In this study, we investigated whether Matrine could limit the symptoms of spontaneously developed colitis and its potential molecular mechanisms. IL-10 deficient mice were given Matrine or a PBS control by oral gavage daily for 4weeks and were euthanized at week 2 or week 4. We measured body weight, colon length and weight, and histological scores. We also evaluated the spontaneous secretion of IL-12/23p40, IFN-γ and IL-17 in colon explant cultures as well as IFN-γ and IL-17 secretion in unseparated mesenteric lymph node (MLN) cells, and assessed IFN-γ, IL-17, IL-1β and IL-6 mRNA expression in colon tissue. In addition, we analyzed the proportions of CD4-positive and CD8-positive cells in unseparated MLN cells. Our results show that Matrine-treated mice exhibited better body weight recovery than controls and that histological scores and spontaneously secreted IL-12/23p40, IFN-γ and IL-17 in colon tissue were significantly decreased in treated mice compared with controls. The proportion of CD4-positive cells of MLNs in treated mice was significantly smaller than that in controls at week 4. Both cytokine production and mRNA expression of IFN-γ and IL-17 were significantly reduced in treated mice compared with controls. Taken together, our results indicate that Matrine may ameliorate spontaneously developed chronic colitis and could be considered as a therapeutic alternative for chronic colitis.
Jannis Kountouras; Christos Zavos
Radiation colitis,an insidious,progressive disease of increasing frequency,develops 6 mo to 5 years after regional radiotherapy for malignancy,owing to the deleterious effects of the latter on the colon and the small intestine.When dealing with radiation colitis and its complications,the most conservative modality should be employed because the areas of intestinal injury do not tend to heal.Acute radiation colitis is mostly selflimited,and usually,only supportive management is required.Chronic radiation colitis,a poorly predictable progressive disease,is considered as a precancerous lesion;radiation-associated malignancy has a tendency to be diagnosed at an advanced stage and to bear a dismal prognosis.Therefore,management of chronic radiation colitis remains a major challenge owing to the progressive evolution of the disease,including development of fibrosis,endarteritis,edema,fragility,perforation,partial obstruction,and cancer.Patients are commonly managed conservatively.Surgical intervention is difficult to perform because of the extension of fibrosis and alterations in the gut and mesentery,and should be reserved for intestinal obstruction,perforation,fistulas,and severe bleeding.Owing to the difficulty in managing the complications of acute and chronic radiation colitis,particular attention should be focused onto the prevention strategies.Uncovering the fibrosis mechanisms and the molecular events underlying radiation bowel disease could lead to the introduction of new therapeutic and/or preventive approaches.A variety of novel,mostly experimental,agents have been used mainly as a prophylaxis,and improvements have been made in radiotherapy delivery,including techniques to reduce the amount of exposed intestine in the radiation field,as a critical strategy for prevention.
Full Text Available A 71-year-old female patient was admitted with intractable diarrhea and abdominal distention following several courses of broad spectrum antibiotic therapy. Colonic biopsy revealed pseudomembranous colitis with foci of signet ring cell (SRC change. The SRCs possessed bland nuclei and were confined to the basement membranes of the crypts with no infiltration into the lamina propria. Benign SRCs in pseudomembranous colitis is an uncommon phenomenon. Awareness of this rare, but potential pitfall is of utmost importance to avoid a misdiagnosis of SRC carcinoma.
Kramer, E.L.; Charap, M.; Sanger, J.J.; Tiu, S.S.
A case of antibiotic-associated pseudomembranous colitis is presented in which the Gallium scan was the first diagnostic modality to alert the clinicians to the existence of an inflammatory bowel process. The mechanism of localization of the radiopharmaceutical in inflammatory bowel disease is discussed. Although colonoscopy is far more specific and should be the first-line diagnostic tool used in assessing the presence of pseudomembranous colitis, Gallium scanning may have a role in the follow-up of treatment and in cases of relapse.
Jacob, Sunitha; Zayyani, Najah R
A 71-year-old female patient was admitted with intractable diarrhea and abdominal distention following several courses of broad spectrum antibiotic therapy. Colonic biopsy revealed pseudomembranous colitis with foci of signet ring cell (SRC) change. The SRCs possessed bland nuclei and were confined to the basement membranes of the crypts with no infiltration into the lamina propria. Benign SRCs in pseudomembranous colitis is an uncommon phenomenon. Awareness of this rare, but potential pitfall is of utmost importance to avoid a misdiagnosis of SRC carcinoma.
Full Text Available Introduction: Ulcerative colitis is a chronic intestinal inflammation, part of inflammatory bowel disease, which also includes Crohn’s disease. Both have extraintestinal manifestations, but those that tend to occur more commonly with ulcerative colitis include chronic active hepatitis, pyoderma gangrenosum and ankylosing spondylitis. Many individuals present with overlapping non-diagnostic features of more than one of these conditions that is referred to in the literature as autoimmune overlap syndrome. Sclerosing cholangitis associated with IBD is often referred to as overlap syndrome.
Noboru Hanaoka; Katsuhiko Higuchi; Satoshi Tanabe; Tohru Sasaki; Kenji Ishido; Takako Ae; Wasaburo Koizumi; Katsunori Saigenji
A 52-year-old man had bloody stools during chemotherapy for gastric cancer. A colonoscopy revealed necrotizing ulcer-like changes. A biopsy confirmed the presence of amoebic trophozoites. Subsequently,peritonitis with intestinal perforation developed, and emergency peritoneal lavage and colostomy were performed. After surgery, endotoxin adsorption therapy was performed and metronidazole was given. Symptoms of peritonitis and colonitis resolved.with the progression of gastric cancer. The patient died 50 d after surgery. Fulminant amoebic colitis is very rarely associated with chemotherapy. Amoebic colitis should be considered in the differential diagnosis of patients who have bloody stools during chemotherapy.
Iva Hojsak; Ana M Pavić; Sanja Kolaček
Background: There are reports on mesalamine-induced bloody diarrhea mimicking ulcerative colitis (UC) relapse, mostly in adults. Methods: Herein we present a case of a child with UC who developed relapse of hemorrhagic colitis related to mesalamine. Results: A 10-year-old girl developed severe symptoms mimicking UC relapse 3 weeks after introduction of mesalamine therapy. After mesalamine was withdrawn, her symptoms improved, but deteriorated again during the challenge of mesalamine despite concomitant use of corticosteroids. Conclusion: This is the fi rst case report on such a young child during the concomitant use of corticosteroids.
Jong; Bin; Kim; Won; Moon; Seun; Ja; Park; Moo; In; Park; Kyu-Jong; Kim; Jae; Nam; Lee; Seong; Joo; Kang; Lee; La; Jang; Hee; Kyung; Chang
Mesotherapy and anti-obesity medications are gradually gaining worldwide popularity for purposes of body contouring and weight loss.Their adverse effects are various,but there is a tendency to disregard them.Ischemic colitis is one of the most common diseases associated with non-obstructive blood vessel disorders.However,there have been no case reports about the adverse effects resulting from mesotherapy only or in combination with anti-obesity medications.We report on an interesting case of ischemic coliti...
Purpose To observe the curative effect of acupuncture on ulcerative colitis. Methods and Results Sixty-two patients with ulcerative colitis were treated mainly by needle-warming moxibustion at Lower He-Sea points and Front-mu points, with the cooperation of syndomic differentiation-based selection of acupoints and oral administration of patent Chinese medicine. After treatment the total effective rate was 91.94% and T cell subgroups returned nearly to normal. Conclusion This treatment method can help the internal environment of human immune system to tend to balance.
Colorectal cancer (CRC) remains a feared and potentially life-threatening complication of both ulcerative colitis and Crohn\\'s colitis. Currently, the main preventive strategy is a secondary one, i.e. surveillance colonoscopy usually after 8 years of disease duration, when the risk for neoplasia begins to increase. Despite its widespread acceptance, dysplasia and cancer surveillance is unproven in terms of reducing mortality or morbidity and there is a remarkable lack of uniformity in the manner in which it is practised. In this review article, the pitfalls of dysplasia surveillance are summarized and the need for novel chemopreventive and perhaps pharmabiotic approaches for prevention are highlighted.
Ek, Rauf Onur; Serter, Mukadder; Ergin, Kemal; Cecen, Serpil; Unsal, Cengiz; Yildiz, Yuksel; Bilgin, Mehmet D
The aim of this study was to investigate the effects of citicoline on the development of colitis and antioxidant parameters in rats subjected to tribenzene sulfonic acid (TNBS)-induced colitis. Twenty four Wistar Albino female rats were divided into four subgroups (n=6) (control, colitis control, colitis + 50 mg/kg citicoline, colitis + 250 mg/kg citicoline). Colitis was induced using an enema of TNBS and ethanol; following which citicoline was administrated for 3 days and effects of citicoline was subsequently evaluated. Based on microscopic damage scores, there was no difference between rats of the TNBS-colitis and 50 mg/kg citicoline treated groups, whereas treatment with 250 mg/kg citicoline, caused significant reduction in colon injury compared to that observed in rats of TNBS-colitis group. In terms of the biochemical analyses, myeloperoxidase (MPO), malondialdehyde (MDA), reduced glutathione (GSH), and IL-6 levels in rats from 250 mg/kg citicoline group were significantly different from that TNBS-colitis group. The levels of MPO, MDA, GSH and IL-6 in control rats were also significantly different those of rats in the TNBS-colitis group. Citicoline may have a positive protective effect on the inflammatory bowel disease treatment process and could, therefore, be used as an adjunct therapy in colitis. These effects of citicoline may exist through anti-inflammatory and antioxidant mechanism.
Fons, Mark E; Stein, Daniel J; Patel, Anna; Ferrer, Modeson-Samuel; Ammon, Helmut; Mackinnon, Alexander C; Komorowski, Richard A; Yan, Benjamin C
"Pseudomembranous collagenous colitis" is a morphologic variant of collagenous colitis in which active inflammation with pseudomembrane formation is prominent and which has been associated with infectious, toxic, and ischemic etiologies. However, extracolonic morphologic findings in patients with pseudomembranous collagenous colitis have not been previously described. Here, we present a case of a patient with pseudomembranous collagenous colitis with abnormal extracolonic findings. These include gastric antral mucosa with histologic features reminiscent of ischemic injury and reactive gastropathy with intraepithelial lymphocytosis and partial villous atrophy in the duodenal and ileal biopsies. The findings in the small intestinal biopsies resemble those seen in enteric mucosa in patients with conventional collagenous colitis. Our pathologic findings as well as the clinical course of the patient further emphasize the clinical and histologic similarities shared by pseudomembranous collagenous colitis and conventional collagenous colitis.
Wen-Bin Xiao; Yu-Lan Liu
AIM: To summarize the characteristics of patients suffered from primary biliary cirrhosis associated with ulcerative colitis.METHODS: To report a new case and review the literature.RESULTS: There were 18 cases (including our case) of primary biliary cirrhosis complicated with ulcerative colitis reported in the literature. Compared with classical primary biliary cirrhosis, the patients were more often males and younger similar. The bowel lesions were usually mild with proctitis predominated. While ulcerative colitis was diagnosed before primary biliary cirrhosis in 13 cases, the presentation of primary biliary cirrhosis was earlier than that of ulcerative colitis in our new case reported here. The prevalence of primary biliary cirrhosis among patients of ulcerative colitis was almost 30 times higher than in general population.CONCLUSION: Association of primary biliary cirrhosis with ulcerative colitis is rare. It should be considered in the differential diagnosis of hepatobiliary disease in patients with ulcerative colitis, and vice versa.
Winston, John H; Li, Qingjie; Sarna, Sushil K
Morphological and functional changes in the enteric nervous system (ENS) have been reported in inflammatory bowel disease. We examined the effects of inflammation on the expression of choline acetyltransferase (ChAT) and nNOS in the muscularis externae of two models of colonic inflammation, trinitrobenzene sulfonic acid (TNBS)-induced colitis, which models Crohn's disease-like inflammation, and DSS-induced colitis, which models ulcerative Colitis-like inflammation. In TNBS colitis, we observed significant decline in ChAT, nNOS, and protein gene product (PGP) 9.5 protein and mRNA levels. In DSS colitis, ChAT and PGP9.5 were significantly upregulated while nNOS levels did not change. The nNOS dimer-to-monomer ratio decreased significantly in DSS- but not in TNBS-induced colitis. No differences were observed in the percentage of either ChAT (31 vs. 33%)- or nNOS (37 vs. 41%)-immunopositive neurons per ganglia or the mean number of neurons per ganglia (55 ± 5 vs. 59 ± 5, P > 0.05). Incubation of the distal colon muscularis externae in vitro with different types of inflammatory mediators showed that cytokines decreased ChAT and nNOS expression, whereas H₂O₂, a component of oxidative stress, increased their expression. NF-κB inhibitor MG-132 did not prevent the IL-1β-induced decline in either ChAT or nNOS expression. These findings showed that TNBS- and DSS-induced inflammation differentially regulates the expression of two critical proteins expressed in the colonic myenteric neurons. These differences are likely due to the exposure of the myenteric plexus neurons to different combinations of Th1-type inflammatory mediators and H₂O₂ in each model.
Ali, Syed O; Welch, John P; Dring, Robert J
The objective of this study of a retrospective case series was to determine factors associated with survival after surgical intervention in pseudomembranous colitis (PMC). The study was conducted at a tertiary care medical center and comprised 36 patients who underwent colectomy for fulminant PMC from 1995 to 2006. Patients including 21 females ranged from 40 to 89 years of age (mean, 70 years). Comorbidities included diabetes (39%), cardiovascular disease (77%), chronic obstructive pulmonary disease (47%), and intake of immunosuppressive medications (45%). Seventy-two per cent received antibiotics in the previous 2 months. Only patients with a confirmation of PMC on pathology specimens were included in the study. All patients underwent colectomy. Patients were stratified into two groups: survivors and nonsurvivors. Various clinical factors/ parameters used in the management of patients with PMC were studied in these two groups. Survival was correlated with mean white blood cell count (23,000 survivors versus 40,000 nonsurvivors, P < 0.01); multisystem organ failure (16 per cent survivors versus 47 per cent nonsurvivors, P < 0.05); and preoperative pressors (16 per cent survivors versus 47 per cent nonsurvivors, P < 0.05). Overall mortality for the study period was 47 per cent. Mortality rate analysis revealed a lower rate for the more recent years (32 per cent for 2000 to 2006 versus 65 per cent for 1995 to 1999, P < 0.05). In the more recent years, the time elapsing before colectomy was also lower (1.4 days versus 2.5 days, nonsignificant), and patients had less preoperative hemodynamic instability (70 per cent versus 31 per cent, P < 0.03). In one institution, survival after surgery for PMC was found to be associated with a mean white blood cell count (< 37,000), nondependence on preoperative vasopressors, and surgical intervention before the onset of hemodynamic instability.
I. Pascual Migueláñez
Full Text Available Objective: to evaluate the effectiveness of endoanal ultrasound with hydrogen peroxide enhancement in the assessment of anal fistula (tract and internal opening, and to value the utility of this examination for anal or perianal suppuration when performed by a colorectal surgeon trained in this technique. Patients: endoanal ultrasound was performed in 103 patients with anal or perianal suppuration. Twenty patients were excluded: 9 had the external opening closed, and 11 had cryptoglandular abscesses. All ultrasound scans were performed by the same explorer using a B&K Diagnostic Ultrasound System with a 7 MHz endoprobe. The examination was based on the identification of the three anal planes, then hydrogen peroxide was infused and the procedure was repeated. Results: out of 83 patients included, 11 had a perianal sinus and 72 an anal fistula. In all fistulas the main tract was found: 24 were inter-sphinteric (33.33%, 33 trans-sphincteric (45.83%, 3 supra-sphincteric (4.17%, and 12 extra-sphincteric (16.67%. An internal opening was identified in 69 (95.83%. Conclusions: endoanal ultrasound with hydrogen peroxide enhancement is an effective examination to visualize fistulous tracts and internal openings. We think it is highly useful for anal or perianal suppuration to identify abscesses, to recognize a perianal sinus, to check the sphincteric condition, and to plan subsequent surgery.Objetivo: evaluar la efectividad de la ecografía endoanal contrastada con inyección de agua oxigenada para establecer la topografía fistulosa (trayecto y localización del orificio interno y valorar la conveniencia de esta exploración en la supuración anal o perianal cuando es realizada por un cirujano general dedicado a coloproctología y entrenado en esta técnica. Pacientes: se hizo ecografía endoanal a 103 pacientes con supuración anal o perianal. Se excluyeron 20 pacientes del estudio: 9 tenían el orificio externo de la fístula cerrado y 11 presentaban
Cassandra Chaptini, MBBS
Full Text Available We report a 20-year-old female with generalized, severe, recessive dystrophic epidermolysis bullosa who developed secondary chronic anal fissures. This resulted in anal sphincter spasm and severe, disabling pain. She was treated with five botulinum toxin A injections into the internal anal sphincter over a period of 2 years and gained marked improvement in her symptoms. This case demonstrates the successful use of botulinum toxin A injections to relieve anal sphincter spasm and fissuring, with long-term improvement.
Julio Cesar Guimarães
A geração de energia elétrica utilizando sistemas fotovoltaicos solares é uma tendência para melhorar e eficiência energética. Seguindo esta tendência, este trabalho mostra o projeto de um sistema eletrônico analógico para posicionamento de painéis solares em dois eixos. O sistema proposto é apto para operar por uma lógica de controle por modulação da largura de pulso (PWM) para inversores em ponte completa, acoplados a dois motores, que mantém o sistema fotovoltaico posicionado perpendicular...
Jayasekera, Hasanga; Gorissen, Kym; Francis, Leo; Chow, Carina
A non-healing peri-anal abscess can be difficult to manage and is often attributed to chronic disease. This case documents a male in his seventh decade who presented with multiple peri-anal collections. The abscess cavity had caused necrosis of the internal sphincter muscles resulting in faecal incontinence. Biopsies were conclusive for diffuse large B-cell lymphoma. A de-functioning colostomy was performed and the patient was initiated on CHOP-R chemotherapy. Anal lymphoma masquerading as a peri-anal abscess is rare. A high degree of suspicion must be maintained for an anal abscess which does not resolve with conservative management.
Full Text Available [es] El propósito de este artículo es someter a una revisión analítica el concepto de “mediatización”, con especial énfasis en lo que podría considerarse una sub-variante, “la mediatización de la política”, pero que considerada desde el punto de vista de la constitución de un campo problemático, es en realidad un antecedente antes que un derivado. La tarea que nos proponemos ha sido realizada, con alcances desiguales y diverso esfuerzo de sistematización, por otros investigadores.Nos sumamos, pues, a una larga fila, pero no para actualizar un estado del arte sino para recortar las propiedades teóricas del concepto (y por lo tanto, para valorar su potencial heurístico, a la vez que nos permitimos sugerir una distinción de niveles analíticos que pueden ser útiles para orientar futuras investigaciones empíricas.
Procuramos na Introdução à Metafísica, um dos primeiros trabalhos no qual Bergson nos apresenta seu método da intuição e dele faz uma aplicação, respostas às seguintes perguntas: como uma Metafísica positiva seria possível? Por que duas vias de acesso ao real? E de que forma elas se relacionam com a Metafísica proposta por Bergson? Pelo exame do método intuitivo de Bergson e de sua contraposição ao método analítico, chegamos também às oposições entre tempo e espaço, conhecimento metafísico (c...
Maria Puglisi; Emanuela Varaldo; Michela Assalino; Gianluca Ansaldo; Giancarlo Torre; Giacomo Borgonovo
We report a case of isolated gastrointestinal metastasis from breast lobular carcinoma, which mimicked primary anal cancer. In July 2000, an 88-year-old woman presented with infiltrating lobular cancer (pT1/G2/N2). The patient received postoperative radiotherapy and hormonal therapy. Four years later,she presented with an anal polypoid lesion. The mass was removed for biopsy. Immunohistochemical staining suggested a breast origin. Radiotherapy was chosen for this patient, which resulted in complete regression of the lesion. The patient died 3 years after the first manifestation of gastrointestinal metastasis.According to the current literature, we consider the immunohistochemistry features that are essential to support the suspicion of gastrointestinal breast metastasis, and since we consider the gastrointestinal involvement as a sign of systemic disease, the therapy should be less aggressive and systemic.
Caio Sergio Rizkallah Nahas
Full Text Available INTRODUÇÃO: O carcinoma espino-celular do canal anal é doença que atinge os adultos de meia idade e corresponde a 4% dos cânceres do trato gastrointestinal baixo. Na população geral a incidência é de 1 em 100.000 habitantes, e entre os homens que fazem sexo com homens essa incidência atinge 35 por 100.000 habitantes, sendo que os portadores de HIV têm esse risco duplicado (70 por 100.000 habitantes. MÉTODO: Foi realizada revisão da literatura com consulta nos periódicos das bases Medline/Pubmed, Scielo e Lilacs cruzando os descritores Rastreamento, Lesões pré-cancerosas, Neoplasias do ânus e HIV. Além da revisão bibliográfica, foi adicionada a este trabalho a experiência pessoal dos autores, e a obtida no Departamento de Gastroenterologia - Divisão Cirúrgica, no ICESP - Instituto do Câncer do Estado de São Paulo Octávio Frias de Oliveira, no Departamento de Moléstias Infeciosas - Casa da AIDS e no Serviço de Coloproctologia do Hospital das Clínicas da Universidade de São Paulo, SP, Brasil. CONCLUSÕES: HIV+ é um grande fator de risco no desenvolvimento de carcinoma espino-celular anal em indivíduos infectados por HPV. A avaliação desses pacientes não deve se restringir à erradicação de condilomas, mas principalmente incluir o rastreamento de lesões displásicas subclínicas potencialmente neoplásicas. Apesar dos métodos de rastreamento ainda não serem ideais, o grande benefício do rastreamento baseia-se no fato de oferecer acompanhamento rigoroso, tornando possível à prevenção ou detecção cada vez mais precoce do carcinoma espino-celular anal.INTRODUCTION: Squamous cell carcinoma of the anal canal is a disease that affects the middle-aged adults and accounts for 4% of cancers of the gastrointestinal tract below. In the general population the incidence is 1 in 100,000, and among men who have sex with men the incidence is 35 per 100,000 inhabitants, those with HIV have doubled this risk (70 per 100
A. M. Vieira
Full Text Available Objective: endoanal ultrasonography can detect organic causes of anal pain without pathology on physical examination. The aim of this study is to evaluate the importance of endoanal ultrasonography in the diagnosis and therapeutic management of idiopathic and functional anal pain. Material and methods: retrospective study, between 15 March 2005 and 15 June 2008, of all patients with proctalgia and normal examination or with alterations not responsible for anal pain at proctologic exam that have undergone an endoanal ultrasonography. Results: a total of 90 patients were analyzed, with a mean age of 50.5 years, 58% were female. Twenty-three patients had functional anal pain clinic criteria. Endoanal ultrasonography revealed alterations in 49% of patients. The primary findings were changes in sphincters in 14 patients, followed by anal sepsis in 12 patients, anal fissure in 10 patients, perirectal lesions in 6 patients and ulcer of the anal canal in 2 patients. Of the patients with sphincter defects, 5 patients had criteria of chronic anal pain. In this group of patients, no differences were found in manometric and defecographic results between the different ultrasound abnormalities. Conclusions: the endoanal ultrasonography detected occult organic lesions to proctologic examination, in half the patients with anal pain. Ultrasound abnormalities were found in 22% of patients with functional anal pain. However, there was no correlation between ultrasound findings and physiological studies, and therefore could not find etiological or pathogenic factors of functional anal pain.Objetivo: la ecografía endoanal puede detectar causas orgánicas en el dolor anal sin patología en la exploración física. El objetivo de este estudio es evaluar la importancia de la ecografía endoanal en el diagnóstico y en el abordaje terapéutico del dolor anal idiopática y funcional. Material y métodos: estudio retrospectivo realizado entre el 15 de marzo de 2005 y el
Sakse, Abelone Elisabeth
Afhandlingen havde til formål at undersøge muskulære forandringer på bækkenbundsmuskulaturen i relation til første fødsel, med særligt fokus på anal inkontinens. Forsvaret fandt sted d. 10. september 2010 kl. 14:00 i Auditoriet på Hvidovre Hospital. ...
The objective of this article is to describe the academic impact, the editorial process quality, and the editorial and visibility strategies of Bibliotecas. Anales de Investigacion (BAI), a scientific Cuban journal edited by National Library of Cuba Jose Marti. The academic impact is determined through a citation analysis, which considers Google Scholar database as reference source. The bibliometric indicators applied are: citation per year, citation vs. self-citation, citable journals vs. no...
Munck, Lars Kristian; Wildt, Signe; Engell, Peter Johan Heiberg;
Microscopic colitis (MC) is a common cause of chronic, non-bloody diarrhoea in the elderly population. In Denmark the incidence has been rising for the last decades. Sufficient biopsy material from colon mucosa is essential for the diagnosis. Treatment is important to improve the patient's quality...
Parang, Bobak; Barrett, Caitlyn W; Williams, Christopher S
Our understanding of colitis-associated carcinoma (CAC) has benefited substantially from mouse models that faithfully recapitulate human CAC. Chemical models, in particular, have enabled fast and efficient analysis of genetic and environmental modulators of CAC without the added requirement of time-intensive genetic crossings. Here we describe the Azoxymethane (AOM)/Dextran Sodium Sulfate (DSS) mouse model of inflammatory colorectal cancer.
Lozano Sánchez, F; Sánchez Fernández, J; Palacios, E; Fernández, M; Ingelmo Morin, A; Gómez Alonso, A
We present a rare postoperative complication after surgical procedures for rupture of abdominal aortic aneurysms. The disease, a pseudomembranous colitis, was early recognized (by evidence of clostridium difficile after a coprocultive) and satisfactorily treated with vancomycin. From the literature review we found only a similar case but results were absolutely different from our case.
Kwon, Jae-Cheol; Kang, Min-Kyu; Kim, Si-Hyun; Choi, Su-Mi; Kim, Hee-Je; Min, Woo-Sung; Lee, Dong-Gun
This is a case report on a 35-year-old man with acute myelogenous leukemia who presented fever and intermittent mucoid loose stool to the emergency center. He had been taking voriconazole for invasive pulmonary aspergillosis. The flexible sigmoidoscopy was consistent with the diagnosis of pseudomembranous colitis.
Alperovich, G; Idiarte, L; Besasso, O; Avagnina, A
Ischemic colitis is a well-recognized complication occurring in renal transplant recipients. It has often been associated with cytomegalovirus (CMV) vasculitis. However, the diagnosis of this pathology in the absence of CMV suggests that other etiological factors might be involved. Drugs inducing mesenteric vasoconstriction, such as non-steroidal anti-inflamatory drugs (NSAIDs) and cyclosporine could be related to this entity.
Full Text Available While it has long been established that the chemokine receptor CCR9 and its ligand CCL25 are essential for the movement of leukocytes into the small intestine and the development of small-intestinal inflammation, the role of this chemokine-receptor pair in colonic inflammation is not clear. Toward this end, we compared colonic CCL25 protein levels in healthy individuals to those in patients with ulcerative colitis. In addition, we determined the effect of CCR9 pharmacological inhibition in the mdr1a−/− mouse model of ulcerative colitis. Colon samples from patients with ulcerative colitis had significantly higher levels of CCL25 protein compared to healthy controls, a finding mirrored in the mdr1a−/− mice. In the mdr1a−/− mice, CCR9 antagonists significantly decreased the extent of wasting and colonic remodeling and reduced the levels of inflammatory cytokines in the colon. These findings indicate that the CCR9:CCL25 pair plays a causative role in ulcerative colitis and suggest that CCR9 antagonists will provide a therapeutic benefit in patients with colonic inflammation.
Anastasios J. Karayiannakis
Full Text Available Diabetes mellitus may affect the gastrointestinal tract possibly as a result of autonomic neuropathy. Here we present a 68-year-old male with non-insulin-dependent diabetes mellitus who presented with prolonged watery diarrhea and in whom imaging studies demonstrated ischemic colitis of the left colon. Resection of the affected colon resulted in sustained disappearance of symptoms.
Sun, Jihong; Lin, Jingmei; Parashette, Kalayan; Zhang, Jianjun; Fan, Rong
Characterized by colonic mucosa intraepithelial lymphocytosis, lymphocytic colitis is primarily an entity presented in the middle-aged to elderly patient population. Very few large series of lymphocytic colitis of childhood occurrence are available in the medical literature. Ten cases each of lymphocytic colitis and of colonic lymphocytosis of other diagnosis, all with duodenal disaccharidases analysis data, were collected from the files of our institution. The electronic medical records were reviewed and multiple variables were analyzed. The ten patients with lymphocytic colitis presented with diarrhea. Of these, three had abdominal pain. The age range was 2-18 years. Nearly all patients were Caucasian (90%) and 70% were female. Endoscopically, most had normal appearing colonic mucosa. Significant past medical history, family medical history and associated comorbidities included celiac disease, Down syndrome, juvenile arthritis and other autoimmune diseases. Interestingly, the most revealing observation was that the majority of cases (80%) were associated with lactase deficiency and, for the most part, gastrointestinal symptoms improved simply by treatment with Lactaid or avoidance of dairy products. This association is statistically significant. Our clinicopathological study indicates that the typical pediatric patient is a female Caucasian. A large of portion of the patients had associated lactase deficiency and improved on Lactaid supplement alone.
Helieh S. Oz
Full Text Available Arginine deiminase (ADI, an arginine-metabolizing enzyme involved in cell signaling, is dysregulated in multiple inflammatory diseases and cancers. We hypothesized that pegylated ADI (ADI-PEG provide protection against colitis. Methods. Dextran sodium sulfate colitis was induced in IL-10-deficient and BALB/c (WT mice. ADI-PEG was administered i.p., and inflammatory mediators and pathology were evaluated. Results. Acute colitis in mice was manifested by increases in inflammatory biomarkers, such as serum amyloid A (SAA, P<0.001, IL-12 p40, and disease index (3-Fold. In contrast, ADI-PEG significantly decreased clinical disease index, SAA levels, and inflammatory cytokines in blood as well as in colonic explants. Animals developed moderate (2.2±0.3 WT to severe (3.6±0.5 IL-10 deficient colonic pathology; and ADI-PEG treatment significantly improved the severity of colitis (P<0.05. Marked infiltration of CD68+ macrophages and iNOS expression were detected in colonic submucosa in colitic animals but not detected in ADI-PEG-treated animals. Conclusion. ADI-PEG attenuated inflammatory responses by suppression of macrophage infiltration and iNOS expression in colitic animals. ADI-PEG can serve as a potential therapeutic value in IBD.
Um, Min Young; Park, Jae Ho; Gwon, So Young; Ahn, Jiyun; Jung, Chang Hwa; Ha, Tae Youl
Agaricus bisporus (white button mushroom, WBM) is widely consumed in most countries and is reported to have anti-inflammatory and antioxidant activities. However, little is known regarding its effects in dextran sulfate sodium (DSS)-induced colitis, which are related to dysfunction of intestinal immunity. The aim of the present study was to investigate the effects of WBMs in an animal model of DSS-induced colitis. Male, 4-week-old ICR mice (n=10 per group) were fed a normal diet with or without 10% WBM for 4 weeks, and colitis was induced by 3% DSS in drinking water for 7 days. WBMs prevented DSS-induced shortening of colon length (P=.033) and diminished diarrhea (P=.049) and gross bleeding (P=.001), resulting in a decreased disease activity index. Results of histological analysis showed that WBMs suppressed mucosal damage. In addition, WBMs attenuated the DSS-induced increase in myeloperoxidase activity (P=.012) and upregulation of proinflammatory cytokine tumor necrosis factor-α (P=.020) in the colon segment. Taken together, these findings suggest a possible role for the WBM as an immunomodulator that can prevent and/or treat ulcerative colitis.
Objective To explore the clinical characteristics and medicine treatment of patients with severe ulcerative colitis(UC),the efficacy of rescue treatment in patients with glucocorticoid(GCS)resistant severe UC,and the clinical risk factors in patients with GCS-refractory severe UC.Methods From January 2001 to December 2012,
Schroeder, T V; Christoffersen, J K; Andersen, J
A review of 23 patients with ischemic colitis after surgical treatment of the abdominal aorta disclosed a pathogenetic heterogeneous finding. Ligation of the inferior mesenteric artery, abolished collateral blood supply or nonocclusive low flow state, or both, was a common feature. An incidence...
Seidelin, J.B.; Bjerrum, J.T.; Coskun, Mehmet
, airway inflammation and arthritis in animal models. We now report IL-33 to be produced by colonic epithelial cells in humans and it is highly upregulated in ulcerative colitis (UC). Little mRNA expression was found in control subjects (N=9), whereas patients with UC in remission (N=7) and active UC (N=9...
Decreased consumption of dietary fibers, such as cellulose, has been proposed to promote the emergence of inflammatory bowel diseases (Crohn disease and ulcerative colitis) where intestinal microbes are recognized to play an etiologic role. However, it is not known if transient fiber consumption dur...
Brückner, Markus; Lenz, Philipp; Mücke, Marcus M; Gohar, Faekah; Willeke, Peter; Domagk, Dirk; Bettenworth, Dominik
Inflammatory bowel diseases (IBD) such as Crohn's disease and ulcerative colitis are chronic-remittent inflammatory disorders of the gastrointestinal tract still evoking challenging clinical diagnostic and therapeutic situations. Murine models of experimental colitis are a vital component of research into human IBD concerning questions of its complex pathogenesis or the evaluation of potential new drugs. To monitor the course of colitis, to the present day, classical parameters like histological tissue alterations or analysis of mucosal cytokine/chemokine expression often require euthanasia of animals. Recent advances mean revolutionary non-invasive imaging techniques for in vivo murine colitis diagnostics are increasingly available. These novel and emerging imaging techniques not only allow direct visualization of intestinal inflammation, but also enable molecular imaging and targeting of specific alterations of the inflamed murine mucosa. For the first time, in vivo imaging techniques allow for longitudinal examinations and evaluation of intra-individual therapeutic response. This review discusses the latest developments in the different fields of ultrasound, molecularly targeted contrast agent ultrasound, fluorescence endoscopy, confocal laser endomicroscopy as well as tomographic imaging with magnetic resonance imaging, computed tomography and fluorescence-mediated tomography, discussing their individual limitations and potential future diagnostic applications in the management of human patients with IBD.
Kjær, Mie Dilling; Simonsen, Jane Angel; Hvidsten, Svend
scintigraphic intestinal transit time, scintigraphic defecography and any association with QoL, and pouch function. Method A cross-sectional study including 20 patients with ulcerative colitis and an IPAA. Scintigraphic transit time was determined after oral administration of a Tc-99m-labelled omelette...
Kanstrup, Anne-Marie Fiehn; Kristensson, Martin; Engel, Ulla
PURPOSE: The aim of this study was to develop an automated image analysis software to measure the thickness of the subepithelial collagenous band in colon biopsies with collagenous colitis (CC) and incomplete CC (CCi). The software measures the thickness of the collagenous band on microscopic...
ulcerøs colitis, der er karakteriseret ved en kronisk recidiverende, sårdannende inflammation af kolorektalslimhinden. I nærværende sammenlignende studie er ekspressionen af iNOS og aktiviteten af enzymets transkriptionsfaktor, nukleær faktor-kappa B (NF-B), i slimhindebiopsier fra colonslimhinden hos...