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Sample records for buruli ulcer disease

  1. Wound care in Buruli ulcer disease in Ghana and Benin

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    Velding, Kristien; Klis, Sandor-Adrian; Abass, Kabiru M.; Tuah, Wilson; Stienstra, Ymkje; van der Werf, Tjip

    2014-01-01

    Buruli ulcer (BU) is a disease affecting the skin, subcutaneous fat, and bone tissues. Wound care is important in the prevention of disabilities. Awareness of current wound care practices in BU-endemic regions is necessary for future wound care interventions. Thirty-one health care workers in Ghana

  2. Wound care in Buruli ulcer disease in Ghana and Benin

    OpenAIRE

    Velding, Kristien; Klis, Sandor-Adrian; Abass, Kabiru M.; Tuah, Wilson; Stienstra, Ymkje; van der Werf, Tjip

    2014-01-01

    Buruli ulcer (BU) is a disease affecting the skin, subcutaneous fat, and bone tissues. Wound care is important in the prevention of disabilities. Awareness of current wound care practices in BU-endemic regions is necessary for future wound care interventions. Thirty-one health care workers in Ghana and Benin were interviewed with a semi-structured interview, complemented by structural observations. Quantitative data were analyzed through t tests and one-way analysis of variance, and qualitati...

  3. Treatment Outcome of Patients with Buruli Ulcer Disease in Togo.

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    Marcus Beissner

    Full Text Available Following introduction of antimycobacterial treatment of Buruli ulcer disease (BUD, several clinical studies evaluated treatment outcomes of BUD patients, in particular healing times, secondary lesions and functional limitations. Whereas recurrences were rarely observed, paradoxical reactions and functional limitations frequently occurred. Although systematic BUD control in Togo was established as early as 2007, treatment outcome has not been reviewed to date. Therefore, a pilot project on post-treatment follow-up of BUD patients in Togo aimed to evaluate treatment outcomes and to provide recommendations for optimization of treatment success.Out of 199 laboratory confirmed BUD patients, 129 could be enrolled in the study. The lesions of 109 patients (84.5% were completely healed without any complications, 5 patients (3.9% had secondary lesions and 15 patients (11.6% had functional limitations. Edema, category III ulcers >15 cm, healing times >180 days and a limitation of movement at time of discharge constituted the main risk factors significantly associated with BUD related functional limitations (P180 days and limitation of movement at discharge constituted the main risk factors for functional limitations in Togolese BUD patients. Standardized treatment plans, patient assessment and follow-up, as well as improved management of medical records are recommended to allow for intensified monitoring of disease progression and healing process, to facilitate implementation of therapeutic measures and to optimize treatment success.

  4. [Mycobacterium ulcerans disease (Buruli ulcer) in Gabon: 2005-2011].

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    Bayonne Manou, L S; Portaels, F; Eddyani, M; Book, A U; Vandelannoote, K; de Jong, B C

    2013-01-01

    The first cases of Buruli ulcer (BU) in Gabon were described in the 1960s. Between 2005 and 2011, 301 clinically suspected cases of BU were found in all nine provinces of Gabon, and their lesions sampled for microbiological confirmation. Polymerase chain reaction (PCR) found 120 (39.9%) of these lesions positive and 181 (60.1%) negative for Mycobacterium ulcerans. The confirmed cases came mainly from the province of Moyen-Ogooué, particularly from localities along the Ogooué River (n=117; 52.5% of the samples in this province were PCR-positive). The detection rates per 100,000 inhabitants in this province ranged from 94.7 cases in 2005 to 28 in 2007, after an absence of active case-finding in 2006. The final three PCR-positive cases were found in the province of Estuaire. The characteristics of the confirmed BU patients (that is, PCR-positive) were identical to those described in other African countries: most patients were younger than 15 years old, and most lesions were found on both the upper and lower limbs. The group of suspected cases (PCR-negative) differed from the PCR-positive group for patient age (most patients were aged 15 to 49 years), lesion location (more frequently on the lower limbs), and ulceration (more frequent in the suspected cases). Some PCR-negative patients probably had other diseases; this underlines the importance of the differential diagnosis of BU. The cure rate of PCR(-)confirmed cases in our study was 88%; treatment was the antibiotic combination recommended by the World Health Organization (WHO). Our study demonstrates that BU is endemic in Gabon and is a public health problem there. Patients consult late with often extensive lesions. Awareness campaigns should be pursued to ensure earlier treatment of patients. The influence of HIV on BU in Gabon also deserves particular attention.

  5. Comparative Study of the Sensitivity of Different Diagnostic Methods for the Laboratory Diagnosis of Buruli Ulcer Disease

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    Herbinger, Karl-Heinz; Adjei, Ohene; Awua-Boateng, Nana-Yaa; Nienhuis, Willemien A.; Kunaa, Letitia; Siegmund, Vera; Nitschke, Joerg; Thompson, William; Klutse, Erasmus; Agbenorku, Pius; Schipf, Alexander; Reu, Simone; Racz, Paul; Fleischer, Bernhard; Beissner, Marcus; Fleischmann, Erna; Helfrich, Kerstin; van der Werf, Tjip S.; Loescher, Thomas; Bretzel, Gisela

    2009-01-01

    Background. Several diagnostic laboratory methods are available for case confirmation of Buruli ulcer disease. This study assessed the sensitivity of various diagnostic tests in relation to clinical presentation of the disease, type of diagnostic specimen, and treatment history. Methods. Swab sample

  6. Landscape Fragmentation as a Risk Factor for Buruli Ulcer Disease in Ghana.

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    Wu, Jianyong; Smithwick, Erica A H

    2016-07-01

    Land cover and its change have been linked to Buruli ulcer (BU), a rapidly emerging tropical disease. However, it is unknown whether landscape structure affects the disease prevalence. To examine the association between landscape pattern and BU presence, we obtained land cover information for 20 villages in southwestern Ghana from high resolution satellite images, and analyzed the landscape pattern surrounding each village. Eight landscape metrics indicated that landscape patterns between BU case and reference villages were different (P landscape fragmentation and diversity indices were positively associated with BU presence in a village. Specifically, for each increase in patch density and edge density by 100 units, the likelihood of BU presence in a village increased 2.51 (95% confidence interval [CI] = 1.36-4.61) and 4.18 (95% CI = 1.63-10.76) times, respectively. The results suggest that increased landscape fragmentation may pose a risk to the emergence of BU.

  7. David Barker, Buruli ulcer and the epidemiology of a neglected tropical disease.

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    Phillips, D I W

    2015-10-01

    In 1969, David Barker, his wife and four children moved to Uganda to work at Makerere Medical School in the capital Kampala. During the 1960s, Makerere had become a research and teaching centre with an international reputation based on the work of Trowell, Burkitt, Hutt and many others who had pioneered studies explaining the disease patterns in the West Nile area on the basis of the local climate, nutrition and lifestyle. David Barker was funded by the Medical Research Council to carry out research on a poorly understood disease, Buruli ulcer, joining Scottish surgeon Wilson Carswell, who was later to achieve fame as the role model for Dr Garrigan in Giles Foden's novel The Last King of Scotland.

  8. Buruli ulcer: wound care and rehabilitation

    OpenAIRE

    Phillips, Richard

    2016-01-01

    Michael Frimpong,1 Fred Stephen Sarfo,2 Mabel Sarpong Duah,1 Mark Wansbrough-Jones,3 Richard O Phillips2 1Kumasi Centre for Collaborative Research in Tropical Medicine, 2Department of Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; 3Institute for Infection and Immunity, St George’s University of London, London, UK Abstract: Buruli ulcer caused by Mycobacterium ulcerans is a neglected tropical disease characterized by extensive...

  9. Buruli ulcer: wound care and rehabilitation

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    Frimpong M

    2016-06-01

    Full Text Available Michael Frimpong,1 Fred Stephen Sarfo,2 Mabel Sarpong Duah,1 Mark Wansbrough-Jones,3 Richard O Phillips2 1Kumasi Centre for Collaborative Research in Tropical Medicine, 2Department of Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; 3Institute for Infection and Immunity, St George’s University of London, London, UK Abstract: Buruli ulcer caused by Mycobacterium ulcerans is a neglected tropical disease characterized by extensive ulceration involving predominantly the upper and lower limbs of patients. The disease is common in rural tropical communities in West and Central Africa, where access to proper health care is limited. Pathogenesis of the characteristic painless ulcers is linked to the elaboration by M. ulcerans of a lipid toxin called mycolactone that has potent cytopathic, immunosuppressive, and analgesic effects on a host of cells in cutaneous tissues. Mycolactone is known to profoundly inhibit secretion of a plethora of proteins that are essential for wound healing. Even though a combination antibacterial therapy of streptomycin and rifampicin for 8 weeks is effective for treatment, it relies on good and appropriate wound management to prevent secondary bacterial infections and improve healing. Evidence-based interventions for wound care in Buruli ulcer disease are often lacking and have relied on expert advice and recommendations. Surgical interventions are limited to debridement of necrotic tissue and grafting of extensive ulcers, usually after antibiotic therapy. Patients’ rehabilitation is an important component of care to reduce disabilities associated with the disease and proper integration into the community after treatment. Keywords: Buruli ulcer, Mycobacterium ulcerans disease, Mycobacterium ulcerans, wound care, rehabilitation, disability

  10. Environmental transmission of Mycobacterium ulcerans drives dynamics of Buruli ulcer in endemic regions of Cameroon

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    Garchitorena, Andrés; Ngonghala, Calistus N.; Texier, Gaëtan; Landier, Jordi; Eyangoh, Sara; Bonds, Matthew H.; Guégan, Jean-François; Roche, Benjamin

    2015-12-01

    Buruli Ulcer is a devastating skin disease caused by the pathogen Mycobacterium ulcerans. Emergence and distribution of Buruli ulcer cases is clearly linked to aquatic ecosystems, but the specific route of transmission of M. ulcerans to humans remains unclear. Relying on the most detailed field data in space and time on M. ulcerans and Buruli ulcer available today, we assess the relative contribution of two potential transmission routes -environmental and water bug transmission- to the dynamics of Buruli ulcer in two endemic regions of Cameroon. The temporal dynamics of Buruli ulcer incidence are explained by estimating rates of different routes of transmission in mathematical models. Independently, we also estimate statistical models of the different transmission pathways on the spatial distribution of Buruli ulcer. The results of these two independent approaches are corroborative and suggest that environmental transmission pathways explain the temporal and spatial patterns of Buruli ulcer in our endemic areas better than the water bug transmission.

  11. Combined inflammatory and metabolic defects reflected by reduced serum protein levels in patients with Buruli ulcer disease.

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    Richard O Phillips

    2014-04-01

    Full Text Available Buruli ulcer is a skin disease caused by Mycobacterium ulcerans that is spreading in tropical countries, with major public health and economic implications in West Africa. Multi-analyte profiling of serum proteins in patients and endemic controls revealed that Buruli ulcer disease down-regulates the circulating levels of a large array of inflammatory mediators, without impacting on the leukocyte composition of peripheral blood. Notably, several proteins contributing to acute phase reaction, lipid metabolism, coagulation and tissue remodelling were also impacted. Their down-regulation was selective and persisted after the elimination of bacteria with antibiotic therapy. It involved proteins with various functions and origins, suggesting that M. ulcerans infection causes global and chronic defects in the host's protein metabolism. Accordingly, patients had reduced levels of total serum proteins and blood urea, in the absence of signs of malnutrition, or functional failure of liver or kidney. Interestingly, slow healers had deeper metabolic and coagulation defects at the start of antibiotic therapy. In addition to providing novel insight into Buruli ulcer pathogenesis, our study therefore identifies a unique proteomic signature for this disease.

  12. Clinical and Laboratory Diagnosis of Buruli Ulcer Disease: A Systematic Review

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    Aboagye, Samuel Y.

    2016-01-01

    Background. Buruli ulcer (BU) is a necrotizing cutaneous infection caused by Mycobacterium ulcerans. Early diagnosis is crucial to prevent morbid effects and misuse of drugs. We review developments in laboratory diagnosis of BU, discuss limitations of available diagnostic methods, and give a perspective on the potential of using aptamers as point-of-care. Methods. Information for this review was searched through PubMed, web of knowledge, and identified data up to December 2015. References from relevant articles and reports from WHO Annual Meeting of the Global Buruli Ulcer initiative were also used. Finally, 59 articles were used. Results. The main laboratory methods for BU diagnosis are microscopy, culture, PCR, and histopathology. Microscopy and PCR are used routinely for diagnosis. PCR targeting IS2404 is the gold standard for laboratory confirmation. Culture remains the only method that detects viable bacilli, used for diagnosing relapse and accrued isolates for epidemiological investigation as well as monitoring drug resistance. Laboratory confirmation is done at centers distant from endemic communities reducing confirmation to a quality assurance. Conclusions. Current efforts aimed at developing point-of-care diagnostics are saddled with major drawbacks; we, however, postulate that selection of aptamers against MU target can be used as point of care. PMID:27413382

  13. Beliefs and attitudes toward Buruli ulcer in Ghana

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    Stienstra, Y; van der Graaf, WTA; Asamoa, K; van der Werf, TS

    2002-01-01

    Buruli ulcer is a devastating emerging disease in tropical countries. Quantitative and qualitative data were obtained by interviewing patients with this disease and control subjects in Ghana. Common perceived causes were witchcraft and curses. Other reported causes were personal hygiene, environment

  14. Functional limitations after surgical or antibiotic treatment for buruli ulcer in benin

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    Barogui, Y.; Johnson, R.C.; van der Werf, T.S.; Sopoh, G.; Dossou, A.; Dijkstra, P.U.; Stienstra, Y.

    2009-01-01

    Almost half of patients have functional limitations after treatment of Buruli ulcer disease. Antibiotic treatment (along with surgery) was introduced in the National Program for Buruli ulcer in Benin in 2005. The aim of this study was to compare functional limitations in patients who were treated by

  15. Genetic Diversity of Staphylococcus aureus in Buruli Ulcer

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    Amissah, Nana Ama; Glasner, Corinna; Ablordey, Anthony; Tetteh, Caitlin S.; Kotey, Nana Konama; Prah, Isaac; van der Werf, Tjip; Rossen, John W.; van Dijl, Jan Maarten; Stienstra, Ymkje

    2015-01-01

    Background Buruli ulcer (BU) is a necrotizing skin disease caused by Mycobacterium ulcerans. Previous studies have shown that wounds of BU patients are colonized with M. ulcerans and several other microorganisms, including Staphylococcus aureus, which may interfere with wound healing. The present st

  16. Mycolactone diffuses into the peripheral blood of Buruli ulcer patients--implications for diagnosis and disease monitoring.

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    Fred S Sarfo

    2011-07-01

    Full Text Available BACKGROUND: Mycobacterium ulcerans, the causative agent of Buruli ulcer (BU, is unique among human pathogens in its capacity to produce a polyketide-derived macrolide called mycolactone, making this molecule an attractive candidate target for diagnosis and disease monitoring. Whether mycolactone diffuses from ulcerated lesions in clinically accessible samples and is modulated by antibiotic therapy remained to be established. METHODOLOGY/PRINCIPAL FINDING: Peripheral blood and ulcer exudates were sampled from patients at various stages of antibiotic therapy in Ghana and Ivory Coast. Total lipids were extracted from serum, white cell pellets and ulcer exudates with organic solvents. The presence of mycolactone in these extracts was then analyzed by a recently published, field-friendly method using thin layer chromatography and fluorescence detection. This approach did not allow us to detect mycolactone accurately, because of a high background due to co-extracted human lipids. We thus used a previously established approach based on high performance liquid chromatography coupled to mass spectrometry. By this means, we could identify structurally intact mycolactone in ulcer exudates and serum of patients, and evaluate the impact of antibiotic treatment on the concentration of mycolactone. CONCLUSIONS/SIGNIFICANCE: Our study provides the proof of concept that assays based on mycolactone detection in serum and ulcer exudates can form the basis of BU diagnostic tests. However, the identification of mycolactone required a technology that is not compatible with field conditions and point-of-care assays for mycolactone detection remain to be worked out. Notably, we found mycolactone in ulcer exudates harvested at the end of antibiotic therapy, suggesting that the toxin is eliminated by BU patients at a slow rate. Our results also indicated that mycolactone titres in the serum may reflect a positive response to antibiotics, a possibility that it will be

  17. Recent advances: role of mycolactone in the pathogenesis and monitoring of Mycobacterium ulcerans infection/Buruli ulcer disease.

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    Sarfo, Fred Stephen; Phillips, Richard; Wansbrough-Jones, Mark; Simmonds, Rachel E

    2016-01-01

    Infection of subcutaneous tissue with Mycobacterium ulcerans can lead to chronic skin ulceration known as Buruli ulcer. The pathogenesis of this neglected tropical disease is dependent on a lipid-like toxin, mycolactone, which diffuses through tissue away from the infecting organisms. Since its identification in 1999, this molecule has been intensely studied to elucidate its cytotoxic and immunosuppressive properties. Two recent major advances identifying the underlying molecular targets for mycolactone have been described. First, it can target scaffolding proteins (such as Wiskott Aldrich Syndrome Protein), which control actin dynamics in adherent cells and therefore lead to detachment and cell death by anoikis. Second, it prevents the co-translational translocation (and therefore production) of many proteins that pass through the endoplasmic reticulum for secretion or placement in cell membranes. These pleiotropic effects underpin the range of cell-specific functional defects in immune and other cells that contact mycolactone during infection. The dose and duration of mycolactone exposure for these different cells explains tissue necrosis and the paucity of immune cells in the ulcers. This review discusses recent advances in the field, revisits older findings in this context and highlights current developments in structure-function studies as well as methodology that make mycolactone a promising diagnostic biomarker. PMID:26572803

  18. Experimental infection of the pig with Mycobacterium ulcerans: a novel model for studying the pathogenesis of Buruli ulcer disease.

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    Miriam Bolz

    2014-07-01

    Full Text Available Buruli ulcer (BU is a slowly progressing, necrotising disease of the skin caused by infection with Mycobacterium ulcerans. Non-ulcerative manifestations are nodules, plaques and oedema, which may progress to ulceration of large parts of the skin. Histopathologically, BU is characterized by coagulative necrosis, fat cell ghosts, epidermal hyperplasia, clusters of extracellular acid fast bacilli (AFB in the subcutaneous tissue and lack of major inflammatory infiltration. The mode of transmission of BU is not clear and there is only limited information on the early pathogenesis of the disease available.For evaluating the potential of the pig as experimental infection model for BU, we infected pigs subcutaneously with different doses of M. ulcerans. The infected skin sites were excised 2.5 or 6.5 weeks after infection and processed for histopathological analysis. With doses of 2 × 10(7 and 2 × 10(6 colony forming units (CFU we observed the development of nodular lesions that subsequently progressed to ulcerative or plaque-like lesions. At lower inoculation doses signs of infection found after 2.5 weeks had spontaneously resolved at 6.5 weeks. The observed macroscopic and histopathological changes closely resembled those found in M. ulcerans disease in humans.Our results demonstrate that the pig can be infected with M. ulcerans. Productive infection leads to the development of lesions that closely resemble human BU lesions. The pig infection model therefore has great potential for studying the early pathogenesis of BU and for the development of new therapeutic and prophylactic interventions.

  19. Buruli ulcer disease prevalence in Benin, West Africa: Associations with land use/cover and the identification of disease clusters

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    Wagner, T.; Benbow, M.E.; Brenden, T.O.; Qi, J.; Johnson, R.C.

    2008-01-01

    Background: Buruli ulcer (BU) disease, caused by infection with the environmental mycobacterium M. ulcerans, is an emerging infectious disease in many tropical and sub-tropical countries. Although vectors and modes of transmission remain unknown, it is hypothesized that the transmission of BU disease is associated with human activities in or around aquatic environments, and that characteristics of the landscape (e.g., land use/cover) play a role in mediating BU disease. Several studies performed at relatively small spatial scales (e.g., within a single village or region of a country) support these hypotheses; however, if BU disease is associated with land use/cover characteristics, either through spatial constraints on vector-host dynamics or by mediating human activities, then large-scale (i.e., country-wide) associations should also emerge. The objectives of this study were to (1) investigate associations between BU disease prevalence in villages in Benin, West Africa and surrounding land use/cover patterns and other map-based characteristics, and (2) identify areas with greater and lower than expected prevalence rates (i.e., disease clusters) to assist with the development of prevention and control programs. Results: Our landscape-based models identified low elevation, rural villages surrounded by forest land cover, and located in drainage basins with variable wetness patterns as being associated with higher BU disease prevalence rates. We also identified five spatial disease clusters. Three of the five clusters contained villages with greater than expected prevalence rates and two clusters contained villages with lower than expected prevalence rates. Those villages with greater than expected BU disease prevalence rates spanned a fairly narrow region of south-central Benin. Conclusion: Our analyses suggest that interactions between natural land cover and human alterations to the landscape likely play a role in the dynamics of BU disease. For example

  20. Survey of water bugs in bankim, a new buruli ulcer endemic area in cameroon.

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    Jean-François Guégan; Philippe Legall; Jordi Landier; Laurent Marsollier; Estelle Marion; Sara Eyangoh; Solange Meyin A Ebong

    2012-01-01

    Buruli ulcer is a debitliating human skin disease with an unknown transmission mode although epidemiological data link it with swampy areas. Data available suggest that aquatic insects play a role in the dissemination and/or transmission of this disease. However, their biodiversity and biology remain poorly documented. We conducted an entomological survey in Bankim, Cameroon, an area recently described as endemic for Buruli ulcer in order to identify the commonly occurring aquatic bugs and do...

  1. Infection with Mansonella perstans Nematodes in Buruli Ulcer Patients, Ghana.

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    Phillips, Richard O; Frimpong, Michael; Sarfo, Fred S; Kretschmer, Birte; Beissner, Marcus; Debrah, Alexander; Ampem-Amoako, Yaw; Abass, Kabiru M; Thompson, William; Duah, Mabel Sarpong; Abotsi, Justice; Adjei, Ohene; Fleischer, Bernhard; Bretzel, Gisela; Wansbrough-Jones, Mark; Jacobsen, Marc

    2014-06-01

    During August 2010-December 2012, we conducted a study of patients in Ghana who had Buruli ulcer, caused by Mycobacterium ulcerans, and found that 23% were co-infected with Mansonella perstans nematodes; 13% of controls also had M. perstans infection. M. perstans co-infection should be considered in the diagnosis and treatment of Buruli ulcer. PMID:24857346

  2. Burden of Mycobacterium ulcerans disease (Buruli ulcer and the underreporting ratio in the territory of Songololo, Democratic Republic of Congo.

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    Delphin Mavinga Phanzu

    Full Text Available BACKGROUND: Cutaneous infection by Mycobacterium ulcerans, also known as Buruli ulcer (BU, represents the third most common mycobacterial disease in the world after tuberculosis and leprosy. Data on the burden of BU disease in the Democratic Republic of Congo are scanty. This study aimed to estimate the prevalence rate and the distribution of BU in the Songololo Territory, and to assess the coverage of the existing hospital-based reporting system. METHODS: We conducted a cross-sectional survey (July-August 2008 using the door-to-door method simultaneously in the two rural health zones (RHZ of the Songololo Territory (RHZ of Kimpese and Nsona-Mpangu, each containing twenty health areas. Cases were defined clinically as active BU and inactive BU in accordance with WHO-case definitions. RESULTS: We detected 775 BU patients (259 active and 516 inactive in a total population of 237,418 inhabitants. The overall prevalence of BU in Songololo Territory was 3.3/1000 inhabitants, varying from 0 to 27.5/1000 between health areas. Of the 259 patients with active BU, 18 (7% had been reported in the hospital-based reporting system at Kimpese in the 6-8 months prior to the survey. CONCLUSION: The survey demonstrated a huge variation of prevalence between health areas in Songololo Territory and gross underreporting of BU cases in the hospital-based reporting system. Data obtained may contribute to better targeted and improved BU control interventions, and serve as a baseline for future assessments of the control program.

  3. Loop-Mediated Isothermal Amplification for Laboratory Confirmation of Buruli Ulcer Disease-Towards a Point-of-Care Test.

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    Marcus Beissner

    2015-11-01

    Full Text Available As the major burden of Buruli ulcer disease (BUD occurs in remote rural areas, development of point-of-care (POC tests is considered a research priority to bring diagnostic services closer to the patients. Loop-mediated isothermal amplification (LAMP, a simple, robust and cost-effective technology, has been selected as a promising POC test candidate. Three BUD-specific LAMP assays are available to date, but various technical challenges still hamper decentralized application. To overcome the requirement of cold-chains for transport and storage of reagents, the aim of this study was to establish a dry-reagent-based LAMP assay (DRB-LAMP employing lyophilized reagents.Following the design of an IS2404 based conventional LAMP (cLAMP assay suitable to apply lyophilized reagents, a lyophylization protocol for the DRB-LAMP format was developed. Clinical performance of cLAMP was validated through testing of 140 clinical samples from 91 suspected BUD cases by routine assays, i.e. IS2404 dry-reagent-based (DRB PCR, conventional IS2404 PCR (cPCR, IS2404 qPCR, compared to cLAMP. Whereas qPCR rendered an additional 10% of confirmed cases and samples respectively, case confirmation and positivity rates of DRB-PCR or cPCR (64.84% and 56.43%; 100% concordant results in both assays and cLAMP (62.64% and 52.86% were comparable and there was no significant difference between the sensitivity of the assays (DRB PCR and cPCR, 86.76%; cLAMP, 83.82%. Likewise, sensitivity of cLAMP (95.83% and DRB-LAMP (91.67% were comparable as determined on a set of 24 samples tested positive in all routine assays.Both LAMP formats constitute equivalent alternatives to conventional PCR techniques. Provided the envisaged availability of field friendly DNA extraction formats, both assays are suitable for decentralized laboratory confirmation of BUD, whereby DRB-LAMP scores with the additional advantage of not requiring cold-chains. As validation of the assays was conducted in a third

  4. Pain Associated with Wound Care Treatment among Buruli Ulcer Patients from Ghana and Benin

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    Alferink, Marike; de Zeeuw, Janine; Sopoh, Ghislain; Agossadou, Chantal; Abass, Karibu M.; Phillips, Richard O.; Loth, Susanne; Jutten, Emma; Barogui, Yves T.; Stewart, Roy E.; van der Werf, Tjip S.; Stienstra, Ymkje; Ranchor, Adelita V.

    2015-01-01

    Buruli ulcer (BU) is a necrotizing skin disease caused by Mycobacterium ulcerans. People living in remote areas in tropical Sub Saharan Africa are mostly affected. Wound care is an important component of BU management; this often needs to be extended for months after the initial antibiotic treatment

  5. Distribution of Mycobacterium ulcerans in buruli ulcer endemic and non-endemic aquatic sites in Ghana.

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    Heather R Williamson

    Full Text Available Mycobacterium ulcerans, the causative agent of Buruli ulcer, is an emerging environmental bacterium in Australia and West Africa. The primary risk factor associated with Buruli ulcer is proximity to slow moving water. Environmental constraints for disease are shown by the absence of infection in arid regions of infected countries. A particularly mysterious aspect of Buruli ulcer is the fact that endemic and non-endemic villages may be only a few kilometers apart within the same watershed. Recent studies suggest that aquatic invertebrate species may serve as reservoirs for M. ulcerans, although transmission pathways remain unknown. Systematic studies of the distribution of M. ulcerans in the environment using standard ecological methods have not been reported. Here we present results from the first study based on random sampling of endemic and non-endemic sites. In this study PCR-based methods, along with biofilm collections, have been used to map the presence of M. ulcerans within 26 aquatic sites in Ghana. Results suggest that M. ulcerans is present in both endemic and non-endemic sites and that variable number tandem repeat (VNTR profiling can be used to follow chains of transmission from the environment to humans. Our results suggesting that the distribution of M. ulcerans is far broader than the distribution of human disease is characteristic of environmental pathogens. These findings imply that focal demography, along with patterns of human water contact, may play a major role in transmission of Buruli ulcer.

  6. Survey of Water Bugs in Bankim, a New Buruli Ulcer Endemic Area in Cameroon

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    Solange Meyin A. Ebong

    2012-01-01

    Full Text Available Buruli ulcer is a debitliating human skin disease with an unknown transmission mode although epidemiological data link it with swampy areas. Data available suggest that aquatic insects play a role in the dissemination and/or transmission of this disease. However, their biodiversity and biology remain poorly documented. We conducted an entomological survey in Bankim, Cameroon, an area recently described as endemic for Buruli ulcer in order to identify the commonly occurring aquatic bugs and document their relative abundance, diversity, and spatial distribution. Collection of aquatic bugs was realized over a period of one month by daily direct capture in different aquatic environments (streams, ponds, and rivers and through light traps at night. Globally, the data obtained showed the presence of five families (Belostomatidae, Naucoridae, Nepidae, Notonectidae, and Gerridae, their abundance, distribution and diversity varying according to the type of aquatic environments and light attraction.

  7. Survey of water bugs in bankim, a new buruli ulcer endemic area in cameroon.

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    Ebong, Solange Meyin A; Eyangoh, Sara; Marion, Estelle; Landier, Jordi; Marsollier, Laurent; Guégan, Jean-François; Legall, Philippe

    2012-01-01

    Buruli ulcer is a debitliating human skin disease with an unknown transmission mode although epidemiological data link it with swampy areas. Data available suggest that aquatic insects play a role in the dissemination and/or transmission of this disease. However, their biodiversity and biology remain poorly documented. We conducted an entomological survey in Bankim, Cameroon, an area recently described as endemic for Buruli ulcer in order to identify the commonly occurring aquatic bugs and document their relative abundance, diversity, and spatial distribution. Collection of aquatic bugs was realized over a period of one month by daily direct capture in different aquatic environments (streams, ponds, and rivers) and through light traps at night. Globally, the data obtained showed the presence of five families (Belostomatidae, Naucoridae, Nepidae, Notonectidae, and Gerridae), their abundance, distribution and diversity varying according to the type of aquatic environments and light attraction. PMID:22666273

  8. What role do traditional beliefs play in treatment seeking and delay for Buruli ulcer disease?--insights from a mixed methods study in Cameroon.

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    Koen Peeters Grietens

    Full Text Available BACKGROUND: Victims of Buruli ulcer disease (BUD frequently report to specialized units at a late stage of the disease. This delay has been associated with local beliefs and a preference for traditional healing linked to a reportedly mystical origin of the disease. We assessed the role beliefs play in determining BUD sufferers' choice between traditional and biomedical treatments. METHODS: Anthropological fieldwork was conducted in community and clinical settings in the region of Ayos and Akonolinga in Central Cameroon. The research design consisted of a mixed methods study, triangulating a qualitative strand based on ethnographic research and quantitative data obtained through a survey presented to all patients at the Ayos and Akonolinga hospitals (N = 79 at the time of study and in four endemic communities (N = 73 belonging to the hospitals' catchment area. RESULTS: The analysis of BUD sufferers' health-seeking behaviour showed extremely complex therapeutic itineraries, including various attempts and failures both in the biomedical and traditional fields. Contrary to expectations, nearly half of all hospital patients attributed their illness to mystical causes, while traditional healers admitted patients they perceived to be infected by natural causes. Moreover, both patients in hospitals and in communities often combined elements of both types of treatments. Ultimately, perceptions regarding the effectiveness of the treatment, the option for local treatment as a cost prevention strategy and the characteristics of the doctor-patient relationship were more determinant for treatment choice than beliefs. DISCUSSION: The ascription of delay and treatment choice to beliefs constitutes an over-simplification of BUD health-seeking behaviour and places the responsibility directly on the shoulders of BUD sufferers while potentially neglecting other structural elements. While more efficacious treatment in the biomedical sector is likely to

  9. Assessment and Treatment of Pain during Treatment of Buruli Ulcer.

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    Janine de Zeeuw

    Full Text Available Buruli ulcer (BU is described as a relatively painless condition; however clinical observations reveal that patients do experience pain during their treatment. Knowledge on current pain assessment and treatment in BU is necessary to develop and implement a future guideline on pain management in BU.A mixed methods approach was used, consisting of information retrieved from medical records on prescribed pain medication from Ghana and Benin, and semi-structured interviews with health care personnel (HCP from Ghana on pain perceptions, assessment and treatment. Medical records (n = 149 of patients treated between 2008 and 2012 were collected between November 2012 and August 2013. Interviews (n = 11 were audio-taped, transcribed verbatim and qualitatively analyzed.In 113 (84% of the 135 included records, pain medication, mostly simple analgesics, was prescribed. In 48% of the prescriptions, an indication was not documented. HCP reported that advanced BU could be painful, especially after wound care and after a skin graft. They reported not be trained in the assessment of mild pain. Pain recognition was perceived as difficult, as patients were said to suppress or to exaggerate pain, and to have different expectations regarding acceptable pain levels. HCP reported a fear of side effects of pain medication, shortage and irregularities in the supply of pain medication, and time constraints among medical doctors for pain management.Professionals perceived BU disease as potentially painful, and predominantly focused on severe pain. Our study suggests that pain in BU deserves attention and should be integrated in current treatment.

  10. Long Term Streptomycin Toxicity in the Treatment of Buruli Ulcer : Follow-up of Participants in the BURULICO Drug Trial

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    Klis, Sandor; Stienstra, Ymkje; Phillips, Richard O.; Abass, Kabiru Mohammed; Tuah, Wilson; van der Werf, Tjip S.

    2014-01-01

    Background: Buruli Ulcer (BU) is a tropical infectious skin disease that is currently treated with 8 weeks of intramuscular streptomycin and oral rifampicin. As prolonged streptomycin administration can cause both oto- and nephrotoxicity, we evaluated its long term toxicity by following-up former BU

  11. On the origin of Mycobacterium ulcerans, the causative agent of Buruli ulcer

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    Doig Kenneth D

    2012-06-01

    Full Text Available Abstract Background Mycobacterium ulcerans is an unusual bacterial pathogen with elusive origins. While closely related to the aquatic dwelling M. marinum, M. ulcerans has evolved the ability to produce the immunosuppressive polyketide toxin mycolactone and cause the neglected tropical disease Buruli ulcer. Other mycolactone-producing mycobacteria (MPM have been identified in fish and frogs and given distinct species designations (M. pseudoshottsii, M. shinshuense, M. liflandii and M. marinum, however the evolution of M. ulcerans and its relationship to other MPM has not been defined. Here we report the comparative analysis of whole genome sequences from 30 MPM and five M. marinum. Results A high-resolution phylogeny based on genome-wide single nucleotide polymorphisms (SNPs showed that M. ulcerans and all other MPM represent a single clonal group that evolved from a common M. marinum progenitor. The emergence of the MPM was driven by the acquisition of the pMUM plasmid encoding genes for the biosynthesis of mycolactones. This change was accompanied by the loss of at least 185 genes, with a significant overrepresentation of genes associated with cell wall functions. Cell wall associated genes also showed evidence of substantial adaptive selection, suggesting cell wall remodeling has been critical for the survival of MPM. Fine-grain analysis of the MPM complex revealed at least three distinct lineages, one of which comprised a highly clonal group, responsible for Buruli ulcer in Africa and Australia. This indicates relatively recent transfer of M. ulcerans between these continents, which represent the vast majority of the global Buruli ulcer burden. Our data provide SNPs and gene sequences that can differentiate M. ulcerans lineages, suitable for use in the diagnosis and surveillance of Buruli ulcer. Conclusions M. ulcerans and all mycolactone-producing mycobacteria are specialized variants of a common Mycobacterium marinum progenitor that have

  12. The incubation period of Buruli ulcer (Mycobacterium ulcerans infection.

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    Jason A Trubiano

    Full Text Available INTRODUCTION: Buruli Ulcer (BU is caused by the environmental microbe Mycobacterium ulcerans. Despite unclear transmission, contact with a BU endemic region is the key known risk factor. In Victoria, Australia, where endemic areas have been carefully mapped, we aimed to estimate the Incubation Period (IP of BU by interviewing patients who reported defined periods of contact with an endemic area prior to BU diagnosis. METHOD: A retrospective review was undertaken of 408 notifications of BU in Victoria from 2002 to 2012. Telephone interviews using a structured questionnaire and review of notification records were performed. Patients with a single visit exposure to a defined endemic area were included and the period from exposure to disease onset determined (IP. RESULTS: We identified 111 of 408 notified patients (27% who had a residential address outside a known endemic area, of whom 23 (6% reported a single visit exposure within the previous 24 months. The median age of included patients was 30 years (range: 6 to 73 and 65% were male. 61% had visited the Bellarine Peninsula, currently the most active endemic area. The median time from symptom onset to diagnosis was 71 days (range: 34-204 days. The midpoint of the reported IP range was utilized to calculate a point estimate of the IP for each case. Subsequently, the mean IP for the cohort was calculated at 135 days (IQR: 109-160; CI 95%: 113.9-156, corresponding to 4.5 months or 19.2 weeks. The shortest IP recorded was 32 days and longest 264 days (Figure 1 & 2. IP did not vary for variables investigated. CONCLUSIONS: The estimated mean IP of BU in Victoria is 135 days (IQR: 109-160 days, 4.5 months. The shortest recorded was IP 34 days and longest 264 days. A greater understanding of BU IP will aid clinical risk assessment and future research.

  13. Assessment and Treatment of Pain during Treatment of Buruli Ulcer

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    Barogui, Yves T.; Sopoh, Ghislain; Phillips, Richard O.; van der Werf, Tjip S.; Loth, Susanne; Molenbuur, Bouwe; Plantinga, Mirjam; Ranchor, Adelita V.; Stienstra, Ymkje

    2015-01-01

    Background Buruli ulcer (BU) is described as a relatively painless condition; however clinical observations reveal that patients do experience pain during their treatment. Knowledge on current pain assessment and treatment in BU is necessary to develop and implement a future guideline on pain management in BU. Methodology A mixed methods approach was used, consisting of information retrieved from medical records on prescribed pain medication from Ghana and Benin, and semi-structured interviews with health care personnel (HCP) from Ghana on pain perceptions, assessment and treatment. Medical records (n = 149) of patients treated between 2008 and 2012 were collected between November 2012 and August 2013. Interviews (n = 11) were audio-taped, transcribed verbatim and qualitatively analyzed. Principal Findings In 113 (84%) of the 135 included records, pain medication, mostly simple analgesics, was prescribed. In 48% of the prescriptions, an indication was not documented. HCP reported that advanced BU could be painful, especially after wound care and after a skin graft. They reported not be trained in the assessment of mild pain. Pain recognition was perceived as difficult, as patients were said to suppress or to exaggerate pain, and to have different expectations regarding acceptable pain levels. HCP reported a fear of side effects of pain medication, shortage and irregularities in the supply of pain medication, and time constraints among medical doctors for pain management. Conclusions Professionals perceived BU disease as potentially painful, and predominantly focused on severe pain. Our study suggests that pain in BU deserves attention and should be integrated in current treatment. PMID:26402069

  14. The Application of Modern Dressings to Buruli Ulcers: Results from a Pilot Implementation Project in Ghana.

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    Velding, Kristien; Klis, Sandor-Adrian; Abass, K Mohammad; van der Werf, Tjip S; Stienstra, Ymkje

    2016-07-01

    Buruli ulcer (BU) is a tropical, infectious skin disease. The resulting ulcer can take a long time to heal, and a high standard of wound care is essential. Currently, the only dressing used for BU wound care is gauze, and its removal causes pain and bleeding. We performed a pilot implementation project using HydroTac(®) (HARTMANN, Heidenheim, Germany), a modern dressing combining foam with a hydrogel component. For future BU treatment, we recommend to use a more absorbent dressing than the HydroTac dressing used in the current project. However, we show that modern dressings can be applied to BUs and that HydroTac dressings yield clean, healing wounds, and prevent the pain and bleeding associated with gauze dressings. Wound care is a vital but to date neglected aspect of BU management. PMID:27162271

  15. Occurrence of free-living amoebae in communities of low and high endemicity for Buruli ulcer in southern Benin.

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    Eddyani, Miriam; De Jonckheere, Johan F; Durnez, Lies; Suykerbuyk, Patrick; Leirs, Herwig; Portaels, Françoise

    2008-11-01

    Buruli ulcer or Mycobacterium ulcerans disease occurs mainly in areas in proximity to standing or slowly running freshwater, habitats in which free-living amoebae occur. For this reason, a possible link between the habitat of M. ulcerans and free-living amoebae was investigated. Free-living amoebae and mycobacteria were isolated from water and biofilm specimens taken from protected and unprotected sources of water in villages known to have either high or low endemicity for Buruli ulcer in Benin. Amoebae were isolated from 78.8% of samples. A greater proportion of water bodies in areas of high endemicity had amoebae than in areas of low endemicity (83.3% versus 66.7%). Protected sources of water were significantly more likely to contain amoebae in areas of high endemicity than in areas of low endemicity (88.0% versus 11.1%). Several pathogenic free-living amoebae and mycobacteria were isolated. However, no M. ulcerans was isolated and no specimen was positive for IS2404 PCR. Our results show that the study area has a water hygiene problem, which is greater in areas of high Buruli ulcer endemicity than in areas of low endemicity. Our observations indicate that additional studies are required to explore the possible link between free-living amoebae and mycobacteria.

  16. A disseminated case of Buruli ulcer at Macenta in the forest region of Guinea in West Africa

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    Bafende Aombe Eric; Strahm Stefan; Loua Richard.; Beavogui Galada Daniel; Kolie Valentin; Guilavogui Raphael; Keita Samba

    2012-01-01

    The author report a confirmed case of Buruli ulcer at Macenta in the forest region of Guinea in West Africa. An 8 years old girl came to the general hospital of Macenta located in the forest region of Guinea at 800km south-west of Conakry. Her story reveals that she used to swim in the local river of Man region in Ivory Coast. There is no notion of trauma or insect bite .The disease started 2 years ago by a nodule of the skin in her right leg which had ulcerated; she received various traditional treatments.

  17. Situated knowledge of pathogenic landscapes in Ghana: Understanding the emergence of Buruli ulcer through qualitative analysis.

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    Tschakert, Petra; Ricciardi, Vincent; Smithwick, Erica; Machado, Mario; Ferring, David; Hausermann, Heidi; Bug, Leah

    2016-02-01

    Successfully addressing neglected tropical diseases requires nuanced understandings of pathogenic landscapes that incorporate situated, contexualized community knowledge. In the case of Buruli ulcer (BU), the role of social science is vital to investigate complex human-environment interactions and navigate different ways of knowing. We analyze a set of qualitative data from our interdisciplinary project on BU in Ghana, drawing from participatory mapping, focus group discussions, semi-structured interviews, and open-ended survey questions to explore how people in endemic and non-endemic areas see themselves embedded in changing environmental and social landscapes. We pay particular attention to landscape disturbance through logging and small-scale alluvial gold mining. The results from our participatory research underscore the holistic nature of BU emergence in landscapes, encapsulated in partial and incomplete local descriptions, the relevance of collective learning to distill complexity, and the potential of rich qualitative data to inform quantitative landscape-disease models. PMID:26761375

  18. Situated knowledge of pathogenic landscapes in Ghana: Understanding the emergence of Buruli ulcer through qualitative analysis.

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    Tschakert, Petra; Ricciardi, Vincent; Smithwick, Erica; Machado, Mario; Ferring, David; Hausermann, Heidi; Bug, Leah

    2016-02-01

    Successfully addressing neglected tropical diseases requires nuanced understandings of pathogenic landscapes that incorporate situated, contexualized community knowledge. In the case of Buruli ulcer (BU), the role of social science is vital to investigate complex human-environment interactions and navigate different ways of knowing. We analyze a set of qualitative data from our interdisciplinary project on BU in Ghana, drawing from participatory mapping, focus group discussions, semi-structured interviews, and open-ended survey questions to explore how people in endemic and non-endemic areas see themselves embedded in changing environmental and social landscapes. We pay particular attention to landscape disturbance through logging and small-scale alluvial gold mining. The results from our participatory research underscore the holistic nature of BU emergence in landscapes, encapsulated in partial and incomplete local descriptions, the relevance of collective learning to distill complexity, and the potential of rich qualitative data to inform quantitative landscape-disease models.

  19. Enhancing Buruli ulcer control in Ghana through social interventions: a case study from the Obom sub-district

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    Ahorlu Collins K

    2013-01-01

    Full Text Available Abstract Background Buruli ulcer is considered a re-emerging disease in West Africa where it has suffered neglect over the years, though children below the age of 16 years are the worst affected in most endemic regions. Due to delayed health seeking, the disease leads to disabilities resulting from amputation and loss of vital organs like the eye leading to school dropout and other social and economic consequences for the affected family. Early treatment with antibiotics is effective; however, this involves daily oral and intramuscular injection at distant health facilities for 56 days making it a challenge among poor rural folks living on daily subsistence work. The mode of transmission of Buruli ulcer is not known and there is no effective preventive vaccine for Buruli ulcer. Thus the only effective control tool is early case detection and treatment to reduce morbidity and associated disabilities that occurs as a result of late treatment. It is therefore essential to implement interventions that remove impediments that limit early case detection; access to early effective treatment and this paper reports one such effort where the feasibility of social interventions to enhance Buruli ulcer control was assessed. Methods This was a qualitative study using in-depth interviews to generate information to ascertain the benefit or otherwise of the intervention implemented. Clinical records of patients to generate data to determine the feasibility and effectiveness of social interventions in the fight against Buruli ulcer was examined. In all, 56 in-depth interviews (28 at baseline and 28 at evaluation were conducted for this report. Results At full implementation, treatment default and dropout reduced significantly from 58.8% and 52.9% at baseline to 1.5% and 1.5% respectively. The number of early case detection went up significantly. Affected families were happy with social interventions such as provision of transportation and breakfast to patients

  20. Good Quality of Life in Former Buruli Ulcer Patients with Small Lesions : Long-Term Follow-up of the BURULICO Trial

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    Klis, Sandor; Ranchor, Adelita; Phillips, Richard O.; Abass, Kabiru M.; Tuah, Wilson; Loth, Susanne; Velding, Kristien; van der Werf, Tjip S.; Stienstra, Ymkje

    2014-01-01

    Background: Buruli Ulcer is a tropical skin disease caused by Mycobacterium ulcerans, which, due to scarring and contractures can lead to stigma and functional limitations. However, recent advances in treatment, combined with increased public health efforts have the potential to significantly improv

  1. Family relationship, water contact and occurrence of Buruli ulcer in Benin.

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    Ghislain Emmanuel Sopoh

    Full Text Available BACKGROUND: Mycobacterium ulcerans disease (Buruli ulcer is the most widespread mycobacterial disease in the world after leprosy and tuberculosis. How M. ulcerans is introduced into the skin of humans remains unclear, but it appears that individuals living in the same environment may have different susceptibilities. OBJECTIVES: This study aims to determine whether frequent contacts with natural water sources, family relationship or the practice of consanguineous marriages are associated with the occurrence of Buruli ulcer (BU. DESIGN: Case control study. SETTING: Department of Atlantique, Benin. SUBJECTS: BU-confirmed cases that were diagnosed and followed up at the BU detection and treatment center (CDTUB of Allada (Department of the Atlantique, Benin during the period from January 1st, 2006, to June 30th, 2008, with three matched controls (persons who had no signs or symptoms of active or inactive BU for age, gender and village of residence per case. MAIN OUTCOMES MEASURED: Contact with natural water sources, BU history in the family and the practice of consanguineous marriages. RESULTS: A total of 416 participants were included in this study, including 104 cases and 312 controls. BU history in the family (p<0.001, adjusted by daily contact with a natural water source (p = 0.007, was significantly associated with higher odds of having BU (OR; 95% CI = 5.5; 3.0-10.0. The practice of consanguineous marriage was not associated with the occurrence of BU (p = 0.40. Mendelian disorders could explain this finding, which may influence individual susceptibility by impairing immunity. CONCLUSION: This study suggests that a combination of genetic factors and behavioral risk factors may increase the susceptibility for developing BU.

  2. Illness meanings and experiences for pre-ulcer and ulcer conditions of Buruli ulcer in the Ga-West and Ga-South Municipalities of Ghana

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    Ackumey Mercy M

    2012-05-01

    Full Text Available Abstract Background Ghana is a Buruli ulcer (BU endemic country yet there is paucity of socio-cultural research on BU. Examining distinctive experiences and meanings for pre-ulcers and ulcers of BU may clarify the disease burden, illness experience and local perceptions of causes and spread, and environmental features of BU, which are useful to guide public health programmes and future research. This study aimed to explain local meanings and experiences of BU for persons with pre-ulcers and ulcers in the Ga-West and Ga-South municipalities in Accra. Methods Semi-structured interviews based on the Explanatory Model Interview Catalogue framework were administered to 181 respondents comprising 15 respondents with pre-ulcers and 166 respondents with ulcers. The Wilcoxon rank-sum test was used to compare categories of illness experiences (PD and perceived causes (PC among respondents with pre-ulcer and ulcer conditions. The Fisher’s exact test was used to compare the most troubling PD and the most important PC variables. Qualitative phenomenological analysis of respondents’ narratives clarified illness experiences and meanings with reference to PC and PD variables. Results Families of respondents with pre-ulcers and the respondents themselves were often anxious about disease progression, while families of respondents with ulcers, who had to give care, worried about income loss and disruption of school attendance. Respondents with pre-ulcers frequently reported swimming in ponds and rivers as a perceived cause and considered it as the most important PC (53.3%. Respondents with ulcers frequently attributed their BU illness to witchcraft (64.5% and respondents who claimed they had no water contact, questioned the credibility of health messages Conclusions Affected persons with pre-ulcers are likely to delay treatment because of social and financial constraints and the absence of pain. Scepticism on the role of water in disease contagion and

  3. A Genomic Approach to Resolving Relapse versus Reinfection among Four Cases of Buruli Ulcer.

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    Miriam Eddyani

    2015-11-01

    Full Text Available Increased availability of Next Generation Sequencing (NGS techniques allows, for the first time, to distinguish relapses from reinfections in patients with multiple Buruli ulcer (BU episodes.We compared the number and location of single nucleotide polymorphisms (SNPs identified by genomic screening between four pairs of Mycobacterium ulcerans isolates collected at the time of first diagnosis and at recurrence, derived from a collection of almost 5000 well characterized clinical samples from one BU treatment center in Benin.The findings suggest that after surgical treatment-without antibiotics-the second episodes were due to relapse rather than reinfection. Since specific antibiotics were introduced for the treatment of BU, the one patient with a culture available from both disease episodes had M. ulcerans isolates with a genomic distance of 20 SNPs, suggesting the patient was most likely reinfected rather than having a relapse.To our knowledge, this study is the first to study recurrences in M. ulcerans using NGS, and to identify exogenous reinfection as causing a recurrence of BU. The occurrence of reinfection highlights the contribution of ongoing exposure to M. ulcerans to disease recurrence, and has implications for vaccine development.

  4. Risk of Buruli ulcer and detection of Mycobacterium ulcerans in mosquitoes in southeastern Australia.

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    Caroline J Lavender

    2011-09-01

    Full Text Available BACKGROUND: Buruli ulcer (BU is a destructive skin condition caused by infection with the environmental bacterium, Mycobacterium ulcerans. The mode of transmission of M. ulcerans is not completely understood, but several studies have explored the role of biting insects. In this study, we tested for an association between the detection of M. ulcerans in mosquitoes and the risk of BU disease in humans in an endemic area of southeastern Australia. METHODOLOGY/PRINCIPAL FINDINGS: Adult mosquitoes were trapped in seven towns on the Bellarine Peninsula in Victoria, Australia, from December 2004 to December 2009 and screened for M. ulcerans by real-time PCR. The number of laboratory-confirmed cases of BU in permanent residents of these towns diagnosed during the same period was tallied to determine the average cumulative incidence of BU in each location. Pearson's correlation coefficient (r was calculated for the proportion of M. ulcerans-positive mosquitoes per town correlated with the incidence of BU per town. We found a strong dose-response relationship between the detection of M. ulcerans in mosquitoes and the risk of human disease (r, 0.99; 95% CI, 0.92-0.99; p < 0.001. CONCLUSIONS/SIGNIFICANCE: The results of this study strengthen the hypothesis that mosquitoes are involved in the transmission of M. ulcerans in southeastern Australia. This has implications for the development of intervention strategies to control and prevent BU.

  5. Pain Associated with Wound Care Treatment among Buruli Ulcer Patients from Ghana and Benin.

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    Marike Alferink

    Full Text Available Buruli ulcer (BU is a necrotizing skin disease caused by Mycobacterium ulcerans. People living in remote areas in tropical Sub Saharan Africa are mostly affected. Wound care is an important component of BU management; this often needs to be extended for months after the initial antibiotic treatment. BU is reported in the literature as being painless, however clinical observations revealed that some patients experienced pain during wound care. This was the first study on pain intensity during and after wound care in BU patients and factors associated with pain. In Ghana and Benin, 52 BU patients above 5 years of age and their relatives were included between December 2012 and May 2014. Information on pain intensity during and after wound care was obtained during two consecutive weeks using the Wong-Baker Pain Scale. Median pain intensity during wound care was in the lower range (Mdn = 2, CV = 1, but severe pain (score > 6 was reported in nearly 30% of the patients. Nevertheless, only one patient received pain medication. Pain declined over time to low scores 2 hours after treatment. Factors associated with higher self-reported pain scores were; male gender, fear prior to treatment, pain during the night prior to treatment, and pain caused by cleaning the wound. The general idea that BU is painless is incorrect for the wound care procedure. This procedural pain deserves attention and appropriate intervention.

  6. Pain Associated with Wound Care Treatment among Buruli Ulcer Patients from Ghana and Benin

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    Alferink, Marike; de Zeeuw, Janine; Sopoh, Ghislain; Agossadou, Chantal; Abass, Karibu M.; Phillips, Richard O.; Loth, Susanne; Jutten, Emma; Barogui, Yves T.; Stewart, Roy E.; van der Werf, Tjip S.; Stienstra, Ymkje; Ranchor, Adelita V.

    2015-01-01

    Buruli ulcer (BU) is a necrotizing skin disease caused by Mycobacterium ulcerans. People living in remote areas in tropical Sub Saharan Africa are mostly affected. Wound care is an important component of BU management; this often needs to be extended for months after the initial antibiotic treatment. BU is reported in the literature as being painless, however clinical observations revealed that some patients experienced pain during wound care. This was the first study on pain intensity during and after wound care in BU patients and factors associated with pain. In Ghana and Benin, 52 BU patients above 5 years of age and their relatives were included between December 2012 and May 2014. Information on pain intensity during and after wound care was obtained during two consecutive weeks using the Wong-Baker Pain Scale. Median pain intensity during wound care was in the lower range (Mdn = 2, CV = 1), but severe pain (score > 6) was reported in nearly 30% of the patients. Nevertheless, only one patient received pain medication. Pain declined over time to low scores 2 hours after treatment. Factors associated with higher self-reported pain scores were; male gender, fear prior to treatment, pain during the night prior to treatment, and pain caused by cleaning the wound. The general idea that BU is painless is incorrect for the wound care procedure. This procedural pain deserves attention and appropriate intervention. PMID:26030764

  7. Health services for Buruli ulcer control: lessons from a field study in Ghana.

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    Mercy M Ackumey

    2011-06-01

    Full Text Available BACKGROUND: Buruli ulcer (BU, caused by Mycobacterium ulcerans infection, is a debilitating disease of the skin and underlying tissue. The first phase of a BU prevention and treatment programme (BUPaT was initiated from 2005-2008, in the Ga-West and Ga-South municipalities in Ghana to increase access to BU treatment and to improve early case detection and case management. This paper assesses achievements of the BUPaT programme and lessons learnt. It also considers the impact of the programme on broader interests of the health system. METHODS: A mixed-methods approach included patients' records review, review of programme reports, a stakeholder forum, key informant interviews, focus group discussions, clinic visits and observations. PRINCIPAL FINDINGS: Extensive collaboration existed across all levels, (national, municipality, and community, thus strengthening the health system. The programme enhanced capacities of all stakeholders in various aspects of health services delivery and demonstrated the importance of health education and community-based surveillance to create awareness and encourage early treatment. A patient database was also created using recommended World Health Organisation (WHO forms which showed that 297 patients were treated from 2005-2008. The proportion of patients requiring only antibiotic treatment, introduced in the course of the programme, was highest in the last year (35.4% in the first, 23.5% in the second and 42.5% in the third year. Early antibiotic treatment prevented recurrences which was consistent with programme aims. CONCLUSIONS: To improve early case management of BU, strengthening existing clinics to increase access to antibiotic therapy is critical. Intensifying health education and surveillance would ultimately increase early reporting and treatment for all cases. Further research is needed to explain the role of environmental factors for BU contagion. Programme strategies reported in our study: collaboration

  8. Amoebae as potential environmental hosts for Mycobacterium ulcerans and other mycobacteria, but doubtful actors in Buruli ulcer epidemiology.

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    Sophie Gryseels

    Full Text Available BACKGROUND: The reservoir and mode of transmission of Mycobacterium ulcerans, the causative agent of Buruli ulcer, remain unknown. Ecological, genetic and epidemiological information nonetheless suggests that M. ulcerans may reside in aquatic protozoa. METHODOLOGY/PRINCIPAL FINDINGS: We experimentally infected Acanthamoeba polyphaga with M. ulcerans and found that the bacilli were phagocytised, not digested and remained viable for the duration of the experiment. Furthermore, we collected 13 water, 90 biofilm and 45 detritus samples in both Buruli ulcer endemic and non-endemic communities in Ghana, from which we cultivated amoeboid protozoa and mycobacteria. M. ulcerans was not isolated, but other mycobacteria were as frequently isolated from intracellular as from extracellular sources, suggesting that they commonly infect amoebae in nature. We screened the samples as well as the amoeba cultures for the M. ulcerans markers IS2404, IS2606 and KR-B. IS2404 was detected in 2% of the environmental samples and in 4% of the amoeba cultures. The IS2404 positive amoeba cultures included up to 5 different protozoan species, and originated both from Buruli ulcer endemic and non-endemic communities. CONCLUSIONS/SIGNIFICANCE: This is the first report of experimental infection of amoebae with M. ulcerans and of the detection of the marker IS2404 in amoeba cultures isolated from the environment. We conclude that amoeba are potential natural hosts for M. ulcerans, yet remain sceptical about their implication in the transmission of M. ulcerans to humans and their importance in the epidemiology of Buruli ulcer.

  9. Healthcare seeking behaviour for Buruli ulcer in Benin : a model to capture therapy choice of patients and healthy community members

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    Mulder, Annelies A.; Boerma, Roelien P.; Barogui, Yves; Zinsou, Claude; Johnson, R. Christian; Gbovi, Jules; van der Werf, Tjip S.; Stienstra, Ymkje

    2008-01-01

    Buruli ulcer is a devastating condition emerging in West Africa. We investigated why patients often report late to the hospital. Health seeking behaviour determinants and stigma were studied by in-depth interviews in patients treated in hospital (n = 107), patients treated traditionally (n = 46) of

  10. Molecular Characterization of Staphylococcus aureus Isolates Transmitted between Patients with Buruli Ulcer.

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    Nana Ama Amissah

    Full Text Available Buruli ulcer (BU is a skin infection caused by Mycobacterium ulcerans. The wounds of most BU patients are colonized with different microorganisms, including Staphylococcus aureus.This study investigated possible patient-to-patient transmission events of S. aureus during wound care in a health care center. S. aureus isolates from different BU patients with overlapping visits to the clinic were whole-genome sequenced and analyzed by a gene-by-gene approach using SeqSphere(+ software. In addition, sequence data were screened for the presence of genes that conferred antibiotic resistance.SeqSphere(+ analysis of whole-genome sequence data confirmed transmission of methicillin resistant S. aureus (MRSA and methicillin susceptible S. aureus among patients that took place during wound care. Interestingly, our sequence data show that the investigated MRSA isolates carry a novel allele of the fexB gene conferring chloramphenicol resistance, which had thus far not been observed in S. aureus.

  11. Community-based study on knowledge, attitude and practice on the mode of transmission, prevention and treatment of the Buruli ulcer in Ga West District, Ghana.

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    Renzaho, Andre M N; Woods, Paul V; Ackumey, Mercy M; Harvey, Simon K; Kotin, Jacob

    2007-03-01

    Buruli ulcer disease (BUD), a devastating tropical disease caused by Mycobacterium ulcerans, occurs in more than 80% of the administrative districts of Ghana. To elucidate community perceptions and understanding of the aetiology of BUD, attitudes towards Buruli patients and treatment-seeking behaviours, we conducted a survey with 504 heads of households and seven focus group discussions in Ga West District, Ghana. Although 67% of participants regarded BUD as a health problem, 53% did not know its cause. Sixteen per cent attributed the cause to drinking non-potable water, 8.1% mentioned poor personal hygiene or dirty surroundings, and 5.5% identified swimming or wading in ponds as a risk factor. About 5.2% thought that witchcraft and curses cause BUD, and 71.8% indicated that BU sufferers first seek treatment from herbalists and only refer to the hospital as a last resort. The main reasons were prospects of prolonged hospital stay, cost of transport, loss of earnings and opportunity associated with parents attending their children's hospitalization over extended period, delays in being attended by medical staff, and not knowing the cause of the disease or required treatment. The level of acceptance of BUD sufferers was high in adults but less so in children. The challenge facing health workers is to break the vicious cycle of poor medical outcomes leading to poor attitudes to hospital treatment in the community. Because herbalists are often the first people consulted by those who contract the disease, they need to be trained in early recognition of the pre-ulcerative stage of Buruli lesions.

  12. Phase change material for thermotherapy of Buruli ulcer: a prospective observational single centre proof-of-principle trial.

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    Thomas Junghanss

    Full Text Available BACKGROUND: Buruli ulcer (BU is an infection of the subcutaneous tissue leading to chronic necrotizing skin ulcers. The causative pathogen, Mycobacterium ulcerans, grows best at 30 degrees C-33 degrees C and not above 37 degrees C. We explored the safety, tolerability and efficacy of phase change material (PCM, a novel heat application system for thermotherapy of BU. METHODOLOGY/PRINCIPAL FINDINGS: In a prospective observational single centre proof-of-principle trial in Ayos/Cameroon, six laboratory reconfirmed patients with ulcerative Buruli lesions received 28-31 (ulcers 2 cm days of thermotherapy with the PCM sodium acetate trihydrate as heat application system. This PCM is widely used in commercial pocket heat pads, it is easy to apply, rechargeable in hot water, non-toxic and non-hazardous to the environment. All patients enrolled in the trial completed treatment. Being completely mobile during the well-tolerated heat application, acceptability of the PCM bandages was very high. In patients with smaller ulcers, wounds healed completely without further intervention. Patients with large defects had skin grafting after successful heat treatment. Heat treatment was not associated with marked increases in local inflammation or the development of ectopic lymphoid tissue. One and a half years after completion of treatment, all patients are relapse-free. CONCLUSIONS/SIGNIFICANCE: Our reusable PCM-based heat application device appears perfectly suited to treat BU in endemic countries with limited resources and infrastructure. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN88392614.

  13. Mycobacterium ulcerans DNA Not Detected in Faecal Samples from Buruli Ulcer Patients: Results of a Pilot Study

    Science.gov (United States)

    Sarfo, Fred S.; Lavender, Caroline J.; Fyfe, Janet A. M.; Johnson, Paul D. R.; Stinear, Timothy P.; Phillips, Richard O.

    2011-01-01

    It has recently been shown that in a Buruli ulcer (BU) endemic region of southeastern Australia, significant numbers of possums (native tree-dwelling marsupials) have clinical BU disease. Furthermore, based on quantitative PCR (qPCR) analysis, animals with BU lesions (and some without) shed M. ulcerans DNA in their faeces, indicative of bacterial loads of up to 108 organisms/gram. These findings led us to propose that humans might also harbour M. ulcerans in their gastrointestinal tract and shed the bacterium in their faeces. We conducted a pilot study and collected faecal swabs from 26 patients with confirmed BU and 31 healthy household controls. Faecal samples were also collected from 10 healthy controls from non-endemic regions in Ghana. All 67 specimens were negative when tested by IS2404 PCR. The detection sensitivity of this method was ≥104 bacteria per gram (wet-weight) of human faecal material. We conclude that the human gastrointestinal tract is unlikely to be a significant reservoir of M. ulcerans. PMID:21573192

  14. Mycobacterium ulcerans DNA not detected in faecal samples from Buruli ulcer patients: results of a pilot study.

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    Fred S Sarfo

    Full Text Available It has recently been shown that in a Buruli ulcer (BU endemic region of southeastern Australia, significant numbers of possums (native tree-dwelling marsupials have clinical BU disease. Furthermore, based on quantitative PCR (qPCR analysis, animals with BU lesions (and some without shed M. ulcerans DNA in their faeces, indicative of bacterial loads of up to 10(8 organisms/gram. These findings led us to propose that humans might also harbour M. ulcerans in their gastrointestinal tract and shed the bacterium in their faeces. We conducted a pilot study and collected faecal swabs from 26 patients with confirmed BU and 31 healthy household controls. Faecal samples were also collected from 10 healthy controls from non-endemic regions in Ghana. All 67 specimens were negative when tested by IS2404 PCR. The detection sensitivity of this method was ≥10(4 bacteria per gram (wet-weight of human faecal material. We conclude that the human gastrointestinal tract is unlikely to be a significant reservoir of M. ulcerans.

  15. Mycolactone-Dependent Depletion of Endothelial Cell Thrombomodulin Is Strongly Associated with Fibrin Deposition in Buruli Ulcer Lesions.

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    Joy Ogbechi

    2015-07-01

    Full Text Available A well-known histopathological feature of diseased skin in Buruli ulcer (BU is coagulative necrosis caused by the Mycobacterium ulcerans macrolide exotoxin mycolactone. Since the underlying mechanism is not known, we have investigated the effect of mycolactone on endothelial cells, focussing on the expression of surface anticoagulant molecules involved in the protein C anticoagulant pathway. Congenital deficiencies in this natural anticoagulant pathway are known to induce thrombotic complications such as purpura fulimans and spontaneous necrosis. Mycolactone profoundly decreased thrombomodulin (TM expression on the surface of human dermal microvascular endothelial cells (HDMVEC at doses as low as 2 ng/ml and as early as 8 hrs after exposure. TM activates protein C by altering thrombin's substrate specificity, and exposure of HDMVEC to mycolactone for 24 hours resulted in an almost complete loss of the cells' ability to produce activated protein C. Loss of TM was shown to be due to a previously described mechanism involving mycolactone-dependent blockade of Sec61 translocation that results in proteasome-dependent degradation of newly synthesised ER-transiting proteins. Indeed, depletion from cells determined by live-cell imaging of cells stably expressing a recombinant TM-GFP fusion protein occurred at the known turnover rate. In order to determine the relevance of these findings to BU disease, immunohistochemistry of punch biopsies from 40 BU lesions (31 ulcers, nine plaques was performed. TM abundance was profoundly reduced in the subcutis of 78% of biopsies. Furthermore, it was confirmed that fibrin deposition is a common feature of BU lesions, particularly in the necrotic areas. These findings indicate that there is decreased ability to control thrombin generation in BU skin. Mycolactone's effects on normal endothelial cell function, including its ability to activate the protein C anticoagulant pathway are strongly associated with this

  16. Buruli Ulcer in Cameroon: The Development and Impact of the National Control Programme.

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    Earnest Njih Tabah

    2016-01-01

    Full Text Available Cameroon is endemic for Buruli ulcer (BU and organised institutional BU control began in 2002. The objective was to describe the evolution, achievements and challenges of the national BU control programme (NBUCP and to make suggestions for scaling up the programme.We analysed collated data on BU from 2001 to 2014 and reviewed activity reports NBUCP in Cameroon. Case-detection rates and key BU control indicators were calculated and plotted on a time scale to determine trends in performance. A linear regression analysis of BU detection rate from 2005-2014 was done. The regression coefficient was tested statistically for the significance in variation of BU detection rate.In 14 years of BU control, 3700 cases were notified. The BU detection rate dropped significantly from 3.89 to 1.45 per 100 000 inhabitants. The number of BU endemic health districts rose from two to 64. Five BU diagnostic and treatment centres are functional and two more are planned for 2015. The health system has been strengthened and BU research and education has gained more interest in Cameroon.Although institutional BU control Cameroon only began 30 years after the first cases were reported in 1969, a number of milestones have been attained. These would serve as stepping stones for charting the way forward and improving upon control activities in the country if the major challenge of resource allocation is dealt with.

  17. Cellular immunity confers transient protection in experimental Buruli ulcer following BCG or mycolactone-negative Mycobacterium ulcerans vaccination.

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    Alexandra G Fraga

    Full Text Available BACKGROUND: Buruli ulcer (BU is an emerging infectious disease caused by Mycobacterium ulcerans that can result in extensive necrotizing cutaneous lesions due to the cytotoxic exotoxin mycolactone. There is no specific vaccine against BU but reports show some degree of cross-reactive protection conferred by M. bovis BCG immunization. Alternatively, an M. ulcerans-specific immunization could be a better preventive strategy. METHODOLOGY/PRINCIPAL FINDINGS: In this study, we used the mouse model to characterize the histological and cytokine profiles triggered by vaccination with either BCG or mycolactone-negative M. ulcerans, followed by footpad infection with virulent M. ulcerans. We observed that BCG vaccination significantly delayed the onset of M. ulcerans growth and footpad swelling through the induction of an earlier and sustained IFN-γ T cell response in the draining lymph node (DLN. BCG vaccination also resulted in cell-mediated immunity (CMI in M. ulcerans-infected footpads, given the predominance of a chronic mononuclear infiltrate positive for iNOS, as well as increased and sustained levels of IFN-γ and TNF. No significant IL-4, IL-17 or IL-10 responses were detected in the footpad or the DLN, in either infected or vaccinated mice. Despite this protective Th1 response, BCG vaccination did not avoid the later progression of M. ulcerans infection, regardless of challenge dose. Immunization with mycolactone-deficient M. ulcerans also significantly delayed the progression of footpad infection, swelling and ulceration, but ultimately M. ulcerans pathogenic mechanisms prevailed. CONCLUSIONS/SIGNIFICANCE: The delay in the emergence of pathology observed in vaccinated mice emphasizes the relevance of protective Th1 recall responses against M. ulcerans. In future studies it will be important to determine how the transient CMI induced by vaccination is compromised.

  18. Good quality of life in former Buruli ulcer patients with small lesions: long-term follow-up of the BURULICO trial.

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    Sandor Klis

    2014-07-01

    Full Text Available Buruli Ulcer is a tropical skin disease caused by Mycobacterium ulcerans, which, due to scarring and contractures can lead to stigma and functional limitations. However, recent advances in treatment, combined with increased public health efforts have the potential to significantly improve disease outcome.To study the Quality of Life (QoL of former Buruli Ulcer patients who, in the context of a randomized controlled trial, reported early with small lesions (cross-sectional diameter <10 cm, and received a full course of antibiotic treatment.127 Participants of the BURULICO drug trial in Ghana were revisited. All former patients aged 16 or older completed the Dermatology Life Quality Index (DLQI and the abbreviated World Health Organization Quality of Life scale (WHOQOL-BREF. The WHOQOL-BREF was also administered to 82 matched healthy controls. Those younger than 16 completed the Childrens' Dermatology Life Quality Index (CDLQI only.The median (Inter Quartile Range score on the DLQI was 0 (0-4, indicating good QoL. 85% of former patients indicated no effect, or only a small effect of the disease on their current life. Former patients also indicated good QoL on the physical and psychological domains of the WHOQOL-BREF, and scored significantly higher than healthy controls on these domains. There was a weak correlation between the DLQI and scar size (ρ = 0.32; p<0.001.BU patients who report early with small lesions and receive 8 weeks of antimicrobial therapy have a good QoL at long-term follow-up. These findings contrast with the debilitating sequelae often reported in BU, and highlight the importance of early case detection.

  19. Good Quality of Life in Former Buruli Ulcer Patients with Small Lesions: Long-Term Follow-up of the BURULICO Trial

    Science.gov (United States)

    Klis, Sandor; Ranchor, Adelita; Phillips, Richard O.; Abass, Kabiru M.; Tuah, Wilson; Loth, Susanne; Velding, Kristien; van der Werf, Tjip S.; Stienstra, Ymkje

    2014-01-01

    Background Buruli Ulcer is a tropical skin disease caused by Mycobacterium ulcerans, which, due to scarring and contractures can lead to stigma and functional limitations. However, recent advances in treatment, combined with increased public health efforts have the potential to significantly improve disease outcome. Objectives To study the Quality of Life (QoL) of former Buruli Ulcer patients who, in the context of a randomized controlled trial, reported early with small lesions (cross-sectional diameter <10 cm), and received a full course of antibiotic treatment. Methods 127 Participants of the BURULICO drug trial in Ghana were revisited. All former patients aged 16 or older completed the Dermatology Life Quality Index (DLQI) and the abbreviated World Health Organization Quality of Life scale (WHOQOL-BREF). The WHOQOL-BREF was also administered to 82 matched healthy controls. Those younger than 16 completed the Childrens' Dermatology Life Quality Index (CDLQI) only. Results The median (Inter Quartile Range) score on the DLQI was 0 (0–4), indicating good QoL. 85% of former patients indicated no effect, or only a small effect of the disease on their current life. Former patients also indicated good QoL on the physical and psychological domains of the WHOQOL-BREF, and scored significantly higher than healthy controls on these domains. There was a weak correlation between the DLQI and scar size (ρ = 0.32; p<0.001). Conclusions BU patients who report early with small lesions and receive 8 weeks of antimicrobial therapy have a good QoL at long-term follow-up. These findings contrast with the debilitating sequelae often reported in BU, and highlight the importance of early case detection. PMID:25010061

  20. "It is me who endures but my family that suffers": social isolation as a consequence of the household cost burden of Buruli ulcer free of charge hospital treatment.

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    Koen Peeters Grietens

    Full Text Available Despite free of charge biomedical treatment, the cost burden of Buruli ulcer disease (Bu hospitalisation in Central Cameroon accounts for 25% of households' yearly earnings, surpassing the threshold of 10%, which is generally considered catastrophic for the household economy, and calling into question the sustainability of current Bu programmes. The high non-medical costs and productivity loss for Bu patients and their households make household involvement in the healing process unsustainable. 63% of households cease providing social and financial support for patients as a coping strategy, resulting in the patient's isolation at the hospital. Social isolation itself was cited by in-patients as the principal cause for abandonment of biomedical treatment. These findings demonstrate that further research and investment in Bu are urgently needed to evaluate new intervention strategies that are socially acceptable and appropriate in the local context.

  1. Long term streptomycin toxicity in the treatment of Buruli Ulcer: follow-up of participants in the BURULICO drug trial.

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    Sandor Klis

    2014-03-01

    Full Text Available BACKGROUND: Buruli Ulcer (BU is a tropical infectious skin disease that is currently treated with 8 weeks of intramuscular streptomycin and oral rifampicin. As prolonged streptomycin administration can cause both oto- and nephrotoxicity, we evaluated its long term toxicity by following-up former BU patients that had received either 4 or 8 weeks of streptomycin in addition to other drugs between 2006 and 2008, in the context of a randomized controlled trial. METHODS: Former patients were retrieved in 2012, and oto- and nephrotoxicity were determined by audiometry and serum creatinine levels. Data were compared with baseline and week 8 measurements during the drug trial. RESULTS: Of the total of 151 former patients, 127 (84% were retrieved. Ototoxicity was present in 29% of adults and 25% of children. Adults in the 8 week streptomycin group had significantly higher hearing thresholds in all frequencies at long term follow-up, and these differences were most prominent in the high frequencies. In children, no differences between the two treatment arms were found. Nephrotoxicity that had been detected in 14% of adults and in 13% of children during treatment, was present in only 2.4% of patients at long term follow-up. CONCLUSIONS: Prolonged streptomycin administration in the adult study subjects caused significant persistent hearing loss, especially in the high frequency range. Nephrotoxicity was also present in both adults and children but appeared to be transient. Streptomycin should be given with caution especially in patients aged 16 or older, and in individuals with concurrent risks for renal dysfunction or hearing loss.

  2. Perceptions on the Effectiveness of Treatment and the Timeline of Buruli Ulcer Influence Pre-Hospital Delay Reported by Healthy Individuals

    NARCIS (Netherlands)

    Alferink, Marike; van der Werf, Tjip S.; Sopoh, Ghislain E.; Agossadou, Didier C.; Barogui, Yves T.; Assouto, Frederic; Agossadou, Chantal; Stewart, Roy E.; Stienstra, Ymkje; Ranchor, Adelita V.

    2013-01-01

    Background: Delay in seeking treatment at the hospital is a major challenge in current Buruli ulcer control; it is associated with severe sequelae and functional limitations. Choosing alternative treatment and psychological, social and practical factors appear to influence delay. Objectives were to

  3. Steps Toward Creating A Therapeutic Community for Inpatients Suffering from Chronic Ulcers: Lessons from Allada Buruli Ulcer Treatment Hospital in Benin

    Science.gov (United States)

    Amoussouhoui, Arnaud Setondji; Johnson, Roch Christian; Sopoh, Ghislain Emmanuel; Agbo, Ines Elvire; Aoulou, Paulin; Houezo, Jean-Gabin; Tingbe-Azalou, Albert; Boyer, Micah; Nichter, Mark

    2016-01-01

    Background Reducing social distance between hospital staff and patients and establishing clear lines of communication is a major challenge when providing in-patient care for people afflicted by Buruli ulcer (BU) and chronic ulcers. Research on hospitals as therapeutic communities is virtually non-existent in Africa and is currently being called for by medical anthropologists working in the field of health service and policy planning. This paper describes a pioneering attempt to establish a therapeutic community for patients suffering from BU and other chronic ulcers requiring long term hospital care in Benin. Methods A six-month pilot project was undertaken with the objectives of establishing a therapeutic community and evaluating its impact on practitioner and patient relations. The project was designed and implemented by a team of social scientists working in concert with the current and previous director of a hospital serving patients suffering from advanced stage BU and other chronic ulcers. Qualitative research initially investigated patients’ understanding of their illness and its treatment, identified questions patients had about their hospitalization, and ascertained their level of social support. Newly designed question–answer health education sessions were developed. Following these hospital wide education sessions, open forums were held each week to provide an opportunity for patients and hospital staff to express concerns and render sources of discontent transparent. Patient group representatives then met with hospital staff to problem solve issues in a non-confrontational manner. Psychosocial support for individual patients was provided in a second intervention which took the form of drop-in counseling sessions with social scientists trained to serve as therapy facilitators and culture brokers. Results Interviews with patients revealed that most patients had very little information about the identity of their illness and the duration of their

  4. Amoebae as Potential Environmental Hosts for Mycobacterium ulcerans and Other Mycobacteria, but Doubtful Actos in Buruli Ulcer Epidemiology

    DEFF Research Database (Denmark)

    Gryseels, Sophie; Amissah, Diana; Durnez, Lies;

    2012-01-01

    in Ghana, from which we cultivated amoeboid protozoa and mycobacteria. M. ulcerans was not isolated, but other mycobacteria were as frequently isolated from intracellular as from extracellular sources, suggesting that they commonly infect amoebae in nature. We screened the samples as well as the amoeba...... cultures for the M. ulcerans markers IS2404, IS2606 and KR-B. IS2404 was detected in 2% of the environmental samples and in 4% of the amoeba cultures. The IS2404 positive amoeba cultures included up to 5 different protozoan species, and originated both from Buruli ulcer endemic and non-endemic communities....... Conclusions/Significance This is the first report of experimental infection of amoebae with M. ulcerans and of the detection of the marker IS2404 in amoeba cultures isolated from the environment. We conclude that amoeba are potential natural hosts for M. ulcerans, yet remain sceptical about their implication...

  5. Identification of the Mycobacterium ulcerans protein MUL_3720 as a promising target for the development of a diagnostic test for Buruli ulcer.

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    Anita Dreyer

    2015-02-01

    Full Text Available Buruli ulcer (BU caused by Mycobacterium ulcerans is a devastating skin disease, occurring mainly in remote West African communities with poor access to health care. Early case detection and subsequent antibiotic treatment are essential to counteract the progression of the characteristic chronic ulcerative lesions. Since the accuracy of clinical BU diagnosis is limited, laboratory reconfirmation is crucial. However, currently available diagnostic techniques with sufficient sensitivity and specificity require infrastructure and resources only accessible at a few reference centres in the African endemic countries. Hence, the development of a simple, rapid, sensitive and specific point-of-care diagnostic tool is one of the major research priorities for BU. In this study, we have identified a previously unknown M. ulcerans protein, MUL_3720, as a promising target for antigen capture-based detection assays. We show that MUL_3720 is highly expressed by M. ulcerans and has no orthologs in other prevalent pathogenic mycobacteria. We generated a panel of anti-MUL_3720 antibodies and used them to confirm a cell wall location for MUL_3720. These antibodies could also specifically detect M. ulcerans in infected human tissue samples as well as in lysates of infected mouse footpads. A bacterial 2-hybrid screen suggested a potential role for MUL_3720 in cell wall biosynthesis pathways. Finally, we demonstrate that a combination of MUL_3720 specific antibody reagents in a sandwich-ELISA format has sufficient sensitivity to make them suitable for the development of antigen capture-based diagnostic tests for BU.

  6. Cultural Understanding of Wounds, Buruli Ulcers and Their Management at the Obom Sub-district of the Ga South Municipality of the Greater Accra Region of Ghana.

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    Eric Koka

    2016-07-01

    Full Text Available This study was conducted with the aim to understand some of the cultural belief systems in the management of wounds and patients practices that could contaminate wounds at the Obom sub-district of the Ga South Municipality of Ghana.This was an ethnographic study using in-depth interviews, Focus Group Discussions and participant observation techniques for data collection. Observations were done on Buruli ulcer patients to document how they integrate local and modern wound management practices in the day-to-day handling of their wounds. Content analysis was done after the data were subjected to thematic coding and representative narratives selected for presentation.It was usually believed that wounds were caused by charms or spirits and, therefore, required the attention of a native healer. In instances where some patients' wounds were dressed in the hospital by clinicians whose condition/age/sex contradict the belief of the patient, the affected often redress the wounds later at home. Some of the materials often used for such wound dressing include urine and concoctions made of charcoal and gunpowder with the belief of driving out evil spirits from the wounds.Clinicians must therefore be aware of these cultural beliefs and take them into consideration when managing Buruli ulcer wounds to prevent redressing at home after clinical treatment. This may go a long way to reduce secondary infections that have been observed in Buruli ulcer wounds.

  7. Clinical Epidemiology of Buruli Ulcer from Benin (2005-2013: Effect of Time-Delay to Diagnosis on Clinical Forms and Severe Phenotypes.

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    Carlos Capela

    Full Text Available Buruli Ulcer (BU is a neglected infectious disease caused by Mycobacterium ulcerans that is responsible for severe necrotizing cutaneous lesions that may be associated with bone involvement. Clinical presentations of BU lesions are classically classified as papules, nodules, plaques and edematous infiltration, ulcer or osteomyelitis. Within these different clinical forms, lesions can be further classified as severe forms based on focality (multiple lesions, lesions' size (>15 cm diameter or WHO Category (WHO Category 3 lesions. There are studies reporting an association between delay in seeking medical care and the development of ulcerative forms of BU or osteomyelitis, but the effect of time-delay on the emergence of lesions classified as severe has not been addressed. To address both issues, and in a cohort of laboratory-confirmed BU cases, 476 patients from a medical center in Allada, Benin, were studied. In this laboratory-confirmed cohort, we validated previous observations, demonstrating that time-delay is statistically related to the clinical form of BU. Indeed, for non-ulcerated forms (nodule, edema, and plaque the median time-delay was 32.5 days (IQR 30.0-67.5, while for ulcerated forms it was 60 days (IQR 20.0-120.0 (p = 0.009, and for bone lesions, 365 days (IQR 228.0-548.0. On the other hand, we show here that time-delay is not associated with the more severe phenotypes of BU, such as multi-focal lesions (median 90 days; IQR 56-217.5; p = 0.09, larger lesions (diameter >15 cm (median 60 days; IQR 30-120; p = 0.92 or category 3 WHO classification (median 60 days; IQR 30-150; p = 0.20, when compared with unifocal (median 60 days; IQR 30-90, small lesions (diameter ≤15 cm (median 60 days; IQR 30-90, or WHO category 1+2 lesions (median 60 days; IQR 30-90, respectively. Our results demonstrate that after an initial period of progression towards ulceration or bone involvement, BU lesions become stable regarding size and focal

  8. Beninese Medicinal Plants as a Source of Antimycobacterial Agents: Bioguided Fractionation and In Vitro Activity of Alkaloids Isolated from Holarrhena floribunda Used in Traditional Treatment of Buruli Ulcer

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    Achille Yemoa

    2015-01-01

    Full Text Available Buruli ulcer (BU imposes a serious economic burden on affected households and on health systems that are involved in diagnosing the disease and treating patients. Research is needed to find cost-effective therapies for this costly disease. Plants have always been an important source of new pharmacologically active molecules. Consequently we decided to undertake the study of plants used in traditional treatment of BU in Benin and investigate their antimycobacterial activity as well as their chemical composition. Extracts from forty-four (44 plant species were selected on account of reported traditional uses for the treatment of BU in Benin and were assayed for antimycobacterial activities. Crude hydroethanolic extract from aerial parts of Holarrhena floribunda (G. Don T. Durand and Schinz was found to have significant antimycobacterial activity against M. ulcerans (MIC = 125 µg/mL. We describe here the identification of four steroidal alkaloids from Mycobacterium ulcerans growth-inhibiting fractions of the alkaloidal extract of the aerial parts of Holarrhena floribunda. Holadysamine was purified in sufficient amount to allow the determination of its MCI (=50 µg/mL. These results give some support to the use of this plant in traditional medicine.

  9. The "Buruli Score": Development of a Multivariable Prediction Model for Diagnosis of Mycobacterium ulcerans Infection in Individuals with Ulcerative Skin Lesions, Akonolinga, Cameroon.

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    Yolanda K Mueller

    2016-04-01

    Full Text Available Access to laboratory diagnosis can be a challenge for individuals suspected of Buruli Ulcer (BU. Our objective was to develop a clinical score to assist clinicians working in resource-limited settings for BU diagnosis.Between 2011 and 2013, individuals presenting at Akonolinga District Hospital, Cameroon, were enrolled consecutively. Clinical data were collected prospectively. Based on a latent class model using laboratory test results (ZN, PCR, culture, patients were categorized into high, or low BU likelihood. Variables associated with a high BU likelihood in a multivariate logistic model were included in the Buruli score. Score cut-offs were chosen based on calculated predictive values. Of 325 patients with an ulcerative lesion, 51 (15.7% had a high BU likelihood. The variables identified for the Buruli score were: characteristic smell (+3 points, yellow color (+2, female gender (+2, undermining (+1, green color (+1, lesion hyposensitivity (+1, pain at rest (-1, size >5cm (-1, locoregional adenopathy (-2, age above 20 up to 40 years (-3, or above 40 (-5. This score had AUC of 0.86 (95%CI 0.82-0.89, indicating good discrimination between infected and non-infected individuals. The cut-off to reasonably exclude BU was set at scores <0 (NPV 96.5%; 95%CI 93.0-98.6. The treatment threshold was set at a cut-off ≥4 (PPV 69.0%; 95%CI 49.2-84.7. Patients with intermediate BU probability needed to be tested by PCR.We developed a decisional algorithm based on a clinical score assessing BU probability. The Buruli score still requires further validation before it can be recommended for wide use.

  10. Whole genome comparisons suggest random distribution of Mycobacterium ulcerans genotypes in a Buruli ulcer endemic region of Ghana.

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    Anthony S Ablordey

    2015-03-01

    Full Text Available Efforts to control the spread of Buruli ulcer--an emerging ulcerative skin infection caused by Mycobacterium ulcerans--have been hampered by our poor understanding of reservoirs and transmission. To help address this issue, we compared whole genomes from 18 clinical M. ulcerans isolates from a 30 km2 region within the Asante Akim North District, Ashanti region, Ghana, with 15 other M. ulcerans isolates from elsewhere in Ghana and the surrounding countries of Ivory Coast, Togo, Benin and Nigeria. Contrary to our expectations of finding minor DNA sequence variations among isolates representing a single M. ulcerans circulating genotype, we found instead two distinct genotypes. One genotype was closely related to isolates from neighbouring regions of Amansie West and Densu, consistent with the predicted local endemic clone, but the second genotype (separated by 138 single nucleotide polymorphisms [SNPs] from other Ghanaian strains most closely matched M. ulcerans from Nigeria, suggesting another introduction of M. ulcerans to Ghana, perhaps from that country. Both the exotic genotype and the local Ghanaian genotype displayed highly restricted intra-strain genetic variation, with less than 50 SNP differences across a 5.2 Mbp core genome within each genotype. Interestingly, there was no discernible spatial clustering of genotypes at the local village scale. Interviews revealed no obvious epidemiological links among BU patients who had been infected with identical M. ulcerans genotypes but lived in geographically separate villages. We conclude that M. ulcerans is spread widely across the region, with multiple genotypes present in any one area. These data give us new perspectives on the behaviour of possible reservoirs and subsequent transmission mechanisms of M. ulcerans. These observations also show for the first time that M. ulcerans can be mobilized, introduced to a new area and then spread within a population. Potential reservoirs of M. ulcerans

  11. Surgery for Crohn's Disease and Ulcerative Colitis

    Science.gov (United States)

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

  12. [Peptic ulcer disease and stress].

    Science.gov (United States)

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

    2015-08-30

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

  13. Socio-Environmental Factors Associated with the Risk of Contracting Buruli Ulcer in Tiassale, South Cote d'Ivoire: A Case-Control Study.

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    Raymond T A S N'krumah

    2016-01-01

    Full Text Available Buruli ulcer (BU is a cutaneous infectious disease caused by Mycobacterium ulcerans. The exact mode of transmission remains elusive; yet, some studies identified environmental, socio-sanitary, and behavioral risk factors. The purpose of this study was to assess the association of such factors to contracting BU in Tiassalé, south Côte d'Ivoire.A case-control study was conducted in 2012. Cases were BU patients diagnosed according to clinical definition put forth by the World Health Organization, readily confirmed by IS2404 polymerase chain reaction (PCR analysis prior to our study and recruited at one of the health centers of the district. Two controls were matched for each control, by age group (to the nearest 5 years, sex, and living community. Participants were interviewed after providing oral witnessed consent, assessing behavioral, environmental, and socio-sanitary factors.A total of 51 incident and prevalent cases and 102 controls were enrolled. Sex ratio (male:female was 0.9. Median age was 25 years (range: 5-70 years. Regular contact with unprotected surface water (adjusted odds ratio (aOR = 6.5; 95% confidence interval (CI = 2.1-19.7 and absence of protective equipment during agricultural activities (aOR = 18.5, 95% CI = 5.2-66.7 were identified as the main factors associated with the risk of contracting BU. Etiologic fractions among exposed to both factors were 84.9% and 94.6%, respectively. Good knowledge about the risks that may result in BU (aOR = 0.3, 95% CI = 0.1-0.8 and perception about the disease causes (aOR = 0.1, 95% CI = 0.02-0.3 showed protection against BU with a respective preventive fraction of 70% and 90%.Main risk factors identified in this study were the contact with unprotected water bodies through daily activities and the absence of protective equipment during agricultural activities. An effective strategy to reduce the incidence of BU should involve compliance with protective equipment during agricultural

  14. Crohn's Disease and Ulcerative Colitis: Emotional Factors

    Science.gov (United States)

    ... Ulcerative Colitis: Emotional Factors Q & A Go Back Crohn’s Disease and Ulcerative Colitis: Emotional Factors Q & A Email ... WHAT IS THE CAUSE OF ULCERATIVE COLITIS AND CROHN’S DISEASE? The origin of IBD is still unknown. It ...

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

    Institute of Scientific and Technical Information of China (English)

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

    2006-01-01

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

  16. Helicobacter pylori and peptic ulcer disease.

    OpenAIRE

    Feldman, M; Peterson, W. L.

    1993-01-01

    Medical therapy for duodenal or gastric ulcer disease has traditionally involved gastric acid antisecretory therapy for 4 to 8 weeks to promote initial healing and indefinitely to prevent recurrences of ulcer. The discovery of Helicobacter pylori in most patients with peptic ulcer disease has led to a change in this approach. Therapy designed to eradicate H pylori may facilitate ulcer healing with acid antisecretory agents and, more important, may greatly reduce the incidence of ulcer recurre...

  17. Peptic Ulcer Disease

    Science.gov (United States)

    ... ACG on Facebook About ACG ACG Store ACG Patient Education & Resource Center Home GI Health and Disease Recursos en Español What is a Gastroenterologist? Podcasts and Videos GI Health Centers Colorectal Cancer Hepatitis C Inflammatory Bowel Disease Irritable Bowel Syndrome Obesity © ...

  18. Cytokine Response to Antigen Stimulation of Whole Blood from Patients with Mycobacterium ulcerans Disease Compared to That from Patients with Tuberculosis

    OpenAIRE

    Phillips, R; Horsfield, C.; Kuijper, S.; Sarfo, S. F.; Obeng-Baah, J.; Etuaful, S.; Nyamekye, B.; Awuah, P.; Nyarko, K M; Osei-Sarpong, F.; Lucas, S.; Kolk, A. H. J.; Wansbrough-Jones, M.

    2006-01-01

    Mycobacterium ulcerans disease (Buruli ulcer) is a skin-ulcerating infection common in some parts of the tropics. We have investigated cytokine secretion after stimulation of whole blood from Buruli ulcer (BU) patients in a region of endemicity in Ghana with M. ulcerans sonicate or culture filtrate antigens to investigate the development of the response over time and its specificity by comparison with the response to Mycobacterium tuberculosis sonicate in human immunodeficiency virus-negative...

  19. Large leg ulcers due to autoimmune diseases

    OpenAIRE

    Rozin, Alexander P; Egozi, Dana; Ramon, Yehuda; Toledano, Kohava; Braun-Moscovici, Yolanda; Markovits, Doron; Schapira, Daniel; Bergman, Reuven; Melamed, Yehuda; Ullman, Yehuda; Balbir-Gurman, Alexandra

    2011-01-01

    Summary Background Large leg ulcers (LLU) may complicate autoimmune diseases. They pose a therapeutic challenge and are often resistant to treatment. To report three cases of autoimmune diseases complicated with LLU. Case Report Case 1. A 55-year old woman presented with long-standing painful LLU due to mixed connective tissue disease (MCTD). Biopsy from the ulcer edge showed small vessel vasculitis. IV methylprednisolone (MethP) 1 G/day, prednisolone (PR) 1mg/kg, monthly IV cyclophosphamide ...

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

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  1. Atypical disease phenotypes in pediatric ulcerative colitis

    DEFF Research Database (Denmark)

    Levine, Arie; de Bie, Charlotte I; Turner, Dan;

    2013-01-01

    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...

  2. [Dyspepsia, Ulcer Disease – Helicobacter pylori, Gastroesophageal Reflux Disease].

    Science.gov (United States)

    Wirth, Hans-Peter

    2016-06-01

    Prevalence of H. pylori (HP) is declining, whereas reflux disease and the proportion of non-steroidal antiinflammatory drugs (NSAR) to HP-induced ulcers increase. Eradication heals HP-ulcer disease, interrupts cancerous progression and can improve dyspeptic symptoms. NSAR-ulcers heal under proton pump inhibitor (PPI) therapy but tend to recur after reexposition. Anticoagulants and antiplatlet agents increase the risk additionally. PPI reduces NSAR-ulcer recurrence. Reflux patients with severe inflammation and complications often need long-term therapy. Barrett’s esophagus patients are at risk of esophageal adenocarcinoma. PMID:27269775

  3. [Dyspepsia, Ulcer Disease – Helicobacter pylori, Gastroesophageal Reflux Disease].

    Science.gov (United States)

    Wirth, Hans-Peter

    2016-06-01

    Prevalence of H. pylori (HP) is declining, whereas reflux disease and the proportion of non-steroidal antiinflammatory drugs (NSAR) to HP-induced ulcers increase. Eradication heals HP-ulcer disease, interrupts cancerous progression and can improve dyspeptic symptoms. NSAR-ulcers heal under proton pump inhibitor (PPI) therapy but tend to recur after reexposition. Anticoagulants and antiplatlet agents increase the risk additionally. PPI reduces NSAR-ulcer recurrence. Reflux patients with severe inflammation and complications often need long-term therapy. Barrett’s esophagus patients are at risk of esophageal adenocarcinoma.

  4. Mycobacterium ulcerans disease

    NARCIS (Netherlands)

    van der Werf, TS; Stienstra, Y; Johnson, RC; Phillips, R; Adjei, O; Fleischer, B; Wansbrough-Jones, MH; Johnson, PDR; Portaels, F; van der Graaf, WTA; Asiedu, K

    2005-01-01

    Mycobacterium ulcerans disease (Buruli ulcer) is an important health problem in several dwest African countries. It is prevalent in scattered foci around the world, predominantly in riverine areas with a humid, hot climate. We review the epidemiology, bacteriology, transmission, immunology, patholog

  5. Prolonged ulcerative laryngitis: a new disease entity.

    Science.gov (United States)

    Hsiao, Tzu-Yu

    2011-03-01

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

  6. Association between ulcer site and outcome in complicated peptic ulcer disease

    DEFF Research Database (Denmark)

    Lolle, Ida; Møller, Morten Hylander; Rosenstock, Steffen Jais

    2016-01-01

    OBJECTIVE: Mortality rates in complicated peptic ulcer disease are high. This study aimed to examine the prognostic importance of ulcer site in patients with peptic ulcer bleeding (PUB) and perforated peptic ulcer (PPU). MATERIALS AND METHODS: Design: a nationwide cohort study with prospective...... and adjusted association between ulcer site (gastric and duodenal) and the outcome measures of interest were assessed by binary logistic regression analysis. RESULTS: Some 20,059 patients with PUB and 4273 patients with PPU were included; 90-d mortality was 15.3% for PUB and 29.8% for PPU; 30-d mortality...... was 10.2% and 24.7%, respectively. Duodenal bleeding ulcer, as compared to gastric ulcer (GU), was associated with a significantly increased risk of all-cause mortality within 90 and 30 d, and with re-intervention: adjusted odds ratio (OR) 1.47 (95% confidence interval 1.30-1.67); p 

  7. Cutaneous metastases presenting as genital ulcer disease

    Directory of Open Access Journals (Sweden)

    S Vasuki

    2014-01-01

    Full Text Available Cutaneous metastasis from an internal organ malignancy is rare and as, the presenting sign of malignancy is an uncommon phenomenon. Their presence, signals a poor prognosis. We report a case of 50-year-old female who was referred to sexually transmitted diseases - out patient department, with complaints of multiple genital ulcers to rule out sexually transmitted infections. After thorough evaluation, she was found to be a case of carcinoma cervix with metastatic squamous cell carcinomatous deposits on external genitalia. This case was unique because of relatively asymptomatic nature of internal malignancy and atypical presentation of carcinoma cervix as cutaneous metastasis.

  8. Current Medical Management of Peptic Ulcer Disease

    OpenAIRE

    Lukie, Bryan E.

    1989-01-01

    Peptic ulceration occurs when the digestive action of gastric secretions overcomes gastroduodenal mucosal defences. The therapeutic strategy used to correct this imbalance uses drugs that either reduce gastric secretion or increase mucosal resistance. Traditional therapies of dietary manipulation and antacid administration no longer play major roles in peptic ulcer therapy. Uncomplicated peptic ulcers respond quite well to drug treatment, although recurrences are common and may require long-t...

  9. Perforated peptic ulcer disease: A review of history and treatment

    NARCIS (Netherlands)

    M.J.O.E. Bertleff (Marietta); J.F. Lange (Johan)

    2010-01-01

    textabstractBackground: In the last one hundred years much has been written on peptic ulcer disease and the treatment options for one of its most common complications: perforation. The reason for reviewing the literature was evaluating most common ideas on how to treat perforated peptic ulcers (PPU)

  10. Psychosocial factors in peptic ulcer and inflammatory bowel disease.

    Science.gov (United States)

    Levenstein, Susan

    2002-06-01

    Over the past decade, while gastroenterologists' interest in mind-body interactions in organic disorders dwindled, stronger evidence has linked psychosocial factors with the incidence and recurrence of peptic ulcer and with the course of inflammatory bowel disease. Psychological-behavioral approaches to treatment continue to be disappointing. Psychosocial factors may affect ulcer by increasing duodenal acid load, altering local circulation or motility, intensifying Helicobacter pylori infection, stimulating corticosteroid secretion, and affecting health risk behaviors; possible mechanisms for inflammatory bowel disease include immune deregulation, gut permeability changes, and poor medication adherence. Both belong to the growing category of diseases thought to have an infectious component: for peptic ulcer the bacterium Helicobacter pylori, for inflammatory bowel disease an exaggerated immune response to gut bacteria. Peptic ulcer and inflammatory bowel disease, which present unique interactions among psychological, immunologic, endocrine, infectious, and behavioral factors, are splendid paradigms of the biopsychosocial model.

  11. [Hepatobiliary diseases in Crohn disease and ulcerative colitis].

    Science.gov (United States)

    Kruis, W

    1987-02-01

    Hepatobiliary diseases are certainly not very frequent extraintestinal complications of chronic intestinal inflammatory diseases, however, they are an important prognostic factor. 2% of patients with ulcerative colitis develop liver cirrhosis but 10% of those die as a direct result of liver failure. Other associated severe hepatobiliary diseases include primary sclerosing cholangitis, carcinoma of the bile duct and amyloidosis. The present review attempts to divide the associated hepatobiliary diseases into three groups. 1. those that are the result of therapy. 2. those that are the result of the pathophysiological mechanisms of the underlying disease and 3. those of unknown etiological origin. This division might serve not only for a better understanding of the various mechanisms but should have some impact on therapeutic regimens.

  12. Inherited determinants of Crohn's disease and ulcerative colitis phenotypes

    DEFF Research Database (Denmark)

    Cleynen, Isabelle; Boucher, Gabrielle; Jostins, Luke;

    2016-01-01

    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...

  13. Faecal mucus degrading glycosidases in ulcerative colitis and Crohn's disease.

    Science.gov (United States)

    Rhodes, J M; Gallimore, R; Elias, E; Allan, R N; Kennedy, J F

    1985-08-01

    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.

  14. Faecal mucus degrading glycosidases in ulcerative colitis and Crohn's disease.

    Science.gov (United States)

    Rhodes, J M; Gallimore, R; Elias, E; Allan, R N; Kennedy, J F

    1985-08-01

    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. PMID:2991089

  15. Surgical perspectives in peptic ulcer disease and gastritis

    Institute of Scientific and Technical Information of China (English)

    Tamar Lipof; David Shapiro; Robert A Kozol

    2006-01-01

    For much of the twentieth century, surgery was frequently the solution for peptic ulcer disease. Our understanding of the pathophysiology of ulcers paralleled the development of potent pharmaceutical therapy. As the surgical world developed parietal cell vagotomy which would minimize the complications of surgery,patients failing medical therapy became rare. Emergent surgery for complicated peptic ulcers has not declined however. The development of proton pump inhibitors and the full understanding of the impact of H pylori has led to a trend towards minimalism in surgical therapy for complicated peptic ulcer disease. In addition to the changes in patient care, these developments have had an impact on the training of surgeons. This article outlines these trends and developments.

  16. Granulomatous Vaginal Ulceration due to Metastatic Cutaneous Crohn's Disease

    Directory of Open Access Journals (Sweden)

    Hugh J Freeman

    1995-01-01

    Full Text Available A 28-year-old woman with a prior history of Crohn's disease was evaluated for painful vaginal ulceration in 1984. Subsequent studies revealed isolated involvement of the vagina with a granulomatous inflammatory process characteristic of metastatic cutaneous Crohn's disease. Conservative symptomatic treatment was associated with resolution and no subsequent recurrence of genital tract disease.

  17. Extraintestinal manifestations in Crohn's disease and ulcerative colitis

    DEFF Research Database (Denmark)

    Isene, Rune; Bernklev, Tomm; Høie, Ole;

    2015-01-01

    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 manifest......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......, skin, and liver) manifestations: 20.1% versus 10.4% (p colitis compared to proctitis in UC increased the risk of EIM. CONCLUSION: In a European inception cohort, EIMs in IBD...

  18. Endoscopic Evaluation of Peptic Ulcer Disease During Ramadan Fasting

    Directory of Open Access Journals (Sweden)

    G. M. Malik

    1996-01-01

    Full Text Available The effects of fasting on peptic ulcer disease were evaluated in a prospective study, involving 23 fasting patients who underwent endoscopy before and after Ramadan. Eighteen patients took an H2-blocker (ranitidine, 150 mg twice daily regularly at “Suhur” and “Iftar” as prescribed, while 5 were drug defaulters. On the first endoscopy the diagnosis in 4 patients was active acute duodenal ulcer (AADU, in 8 patients was active chronic duodenal ulcer (ACDU in 8 patients was healed duodenal ulcer (HDU, in 2 patients was erosive duodenitis (ED, and in 1 patient was chronic gastric ulcer (CGU. All of the patients with AADU showed signs of healing on repeat endoscopy. None of the ACDU patients showed signs of healing on repeat endoscopy. Instead, 7 patients in this group bled during fasting. All of the 5 drug defaulters belonged to the ACDU group. One patient in the HDU group had developed an active ulcer near the previous scar, as which was seen on repeat endoscopy. The 2 patients with ED showed signs of healing, while the only patient with CGU had bled from the same ulcer as seen on repeat endoscopy. The results were compared with those of 15 nonfasting control subjects (6 patients with ACDU, 3 with HDU, and 6 with ED as diagnosed on the first endoscopy, who took an H2-blocker regularly. The repeat endoscopy did not show any change in these patients. In conclusion, we inferred that Ramadan fasting may prove hazardous in patients with peptic ulcer disease in general and with active chronic ulcers in particular, although the fact that only 23 patients volunteered for this study, of whom 5 were drug defaulters, is a limitation.

  19. Mucosal reactive oxygen metabolite production in duodenal ulcer disease.

    OpenAIRE

    Davies, G. R.; Simmonds, N J; Stevens, T R; Grandison, A; D. R. Blake; Rampton, D S

    1992-01-01

    To investigate the hypothesis that reactive oxygen metabolites are important in the pathophysiology of duodenal ulcer disease, their production by duodenal mucosal biopsy specimens was measured using luminol and lucigenin amplified chemiluminescence. Luminol chemiluminescence, expressed as background corrected median photon emission/mg/min x 10(3) (95% confidence intervals), was increased in duodenal inflammation as assessed macroscopically: ulcers 20.3 (4.8 to 51.3), n = 29; severe duodeniti...

  20. Comparison of Two Assays for Molecular Determination of Rifampin Resistance in Clinical Samples from Patients with Buruli Ulcer Disease

    OpenAIRE

    Jansson, M.; Beissner, M.; Phillips, R. O.; Badziklou, K.; Piten, E.; Maman, I.; Sarfo, F S; Huber, K. L.; Rhomberg, A.; Symank, D.; Wagner, M.; Wiedemann, F; Nitschke, J.; Banla Kere, A.; Herbinger, K.-H.

    2014-01-01

    This study evaluates a novel assay for detecting rifampin resistance in clinical Mycobacterium ulcerans isolates. Although highly susceptible for PCR inhibitors in 50% of the samples tested, the assay was 100% M. ulcerans specific and yielded >98% analyzable sequences with a lower limit of detection of 100 to 200 copies of the target sequence.

  1. LEG ULCERS IN SICKLE CELL DISEASE: CURRENT PATTERNS AND PRACTICES

    OpenAIRE

    Delaney, Kara-Marie H.; Axelrod, Karen C.; Buscetta, Ashley; Hassell, Kathryn L.; Adams-Graves, Patricia E.; Seamon, Catherine; Kato, Gregory J.; Minniti, Caterina P.

    2013-01-01

    Leg ulcers are a debilitating complication of patients with sickle cell disease, and their frequency in North America was reported to be 2.5% by the Cooperative Study of Sickle Cell Disease more than 20 years ago. We sought to determine if the frequency of leg ulcers in sickle cell patients in the United States had declined and to assess which treatments providers use most commonly. We sent an e-mail survey to health professionals belonging to the national Sickle Cell Adult Provider Network. ...

  2. Epidemiology of peptic ulcer disease in Wuhan area of China from 1997 to 2002

    Institute of Scientific and Technical Information of China (English)

    Wei-Guo Dong; Chun-Sheng Cheng; Shao-Ping Liu; Jie-Ping Yu

    2004-01-01

    AIM: To describe the epidemiological features of peptic ulcer disease in Wuhan area during 1997-2002, to analyze the sex, age and occupation characteristics, as well as the geographic distribution of peptic ulcer disease, and to determine the effective methods of preventing and controlling peptic ulcer disease.METHODS: In the early 1980s, the peptic ulcer disease registry system was established to collect the data of peptic ulcer disease in Wuhan area. Here we performed a statistically detailed analysis of 4876 cases of peptic ulcer disease during 1997-2002.RESULTS: The morbidity of peptic ulcer disease between males and females was significantly different (x2 = 337.9,P<0.001). The majority of peptic ulcer diseases were found at the age of 20 to 50 years. Because of different occupations,the incidence of peptic ulcer disease was different in different areas.CONCLUSION: The incidence of peptic ulcer disease is highly associated with sex, age, occupation and geographic environmental factors. By analyzing the epidemiological features of peptic ulcer disease, we can provide the scientific data for prevention and control of peptic ulcer disease.

  3. Cryptogenic Multifocal Ulcerous Stenosing Enteritis: An Exceptionally Rare Disease

    Directory of Open Access Journals (Sweden)

    Amandeep Kaur

    2016-01-01

    Full Text Available Cryptogenic Multifocal Ulcerous Stenosing Enteritis (CMUSE is a rare idiopathic disease of the small bowel. Its origin and pathophysiology has not been well described. Clinicopathologic features include unexplained ileal strictures with supercial ulceration. We present a case of a 31-year-old HIV positive lady who was admitted with complaints of recurrent abdominal pain and constipation. Laboratory investigations revealed iron deciency anemia. Ultrasonography of the abdomen showed dilated bowel loops and a subsequent barium follow through showed ve strictures in the ileum. Segmental small bowel resection with end-to-end anastomosis was performed. Grossly ileum showed ve ileal strictures. The diagnosis of CMUSE was made on histopathology after ruling out other causes of strictures. The present case highlights the importance of considering CMUSE in patients with chronic or recurrent episodes of intestinal obstruction with multiple small intestinal ulcers and strictures after other common causes have been ruled out.

  4. Effect of Helicobacter pylori eradication on the natural history of duodenal ulcer disease

    OpenAIRE

    Goggin, N; Rowland, M; Imrie, C; Walsh, D.; Clyne, M.; Drumm, B

    1998-01-01

    BACKGROUND—Duodenal ulcer disease is strongly associated with Helicobacter pylori infection of the gastric mucosa. Eradication of H pylori from the gastric mucosa in adults is associated with long term healing of ulcers.
AIMS—To follow a cohort of children with duodenal ulcer disease for a minimum of two years after the eradication of H pylori.
PATIENTS AND METHODS—Over a three year period, all children diagnosed with duodenal ulcer disease had their symptoms documented a...

  5. An oral ulceration associated with Morgellons disease: a case report.

    Science.gov (United States)

    Grosskopf, Courtney; Desai, Bhavik; Stoopler, Eric T

    2011-08-01

    Morgellons disease is a psycho-dermatologic condition in which patients report fibers or filaments "growing" out of their skin. This case report highlights an oral ulceration in a young woman associated with Morgellons disease, a condition that has not been previously described in the dental literature. An increasing number of individuals are self-reporting this condition and oral health care providers must be familiar with this disorder. PMID:21749875

  6. Two for One: Coexisting Ulcerative Colitis and Crohn’s Disease

    Directory of Open Access Journals (Sweden)

    Grant I Chen

    2002-01-01

    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.

  7. [Diagnosis and Treatment of Peptic Ulcer Disease: Present and Future Perspective].

    Science.gov (United States)

    Kim, Byung Wook

    2016-06-25

    Peptic ulcer disease is one of the most commonly encountered diseases in gastroenterology clinics. After the discovery of Helicobacter pylori by Warren and Marshall, it has been identified as the most important cause of peptic ulcer. Eradication of H. pylori markedly reduces the post-treatment recurrence rate of peptic ulcer. However, as human populations age, the incidence of cardiovascular and musculoskeletal diseases increases and consequent use of aspirin and non-steroidal anti-in-flammatory drugs increases. Thus causes and presenting patterns of peptic ulcer have changed. In this review, I describe new diagnostic and therapeutic strategies for peptic ulcer disease and explore future perspectives. PMID:27312832

  8. The Association Between Peptic Ulcer Disease and Ischemic Stroke

    OpenAIRE

    Cheng, Tain-Junn; Guo, How-Ran; Chang, Chia-Yu; Weng, Shih-Feng; Li, Pi-I; Wang, Jhi-Joung; Wu, Wen-Shiann

    2016-01-01

    Abstract Stroke is a common cause of death worldwide, but about 30% of ischemic stroke (IS) patients have no identifiable contributing risk factors. Because peptic ulcer disease (PUD) and vascular events share some common risk factors, we conducted a population-based study to evaluate the association between PUD and IS. We followed up a representative sample of 1 million residents of Taiwan using the National Health Insurance Research Database from 1997 to 2011. We defined patients who receiv...

  9. [Peptic Ulcer Disease Associated with Helicobacter pylori Infection].

    Science.gov (United States)

    Yeo, Se-Hwan; Yang, Chang-Hun

    2016-06-25

    Although the global prevalence of peptic ulcer disease (PUD) is decreasing, PUD is still one of the most common upper gastrointestinal diseases in the world due to Helicobacter pylori infection and increased use of non-steroidal anti-inflammatory drugs. In Korea, the prevalence of H. pylori infection is also declining, but it is still the major cause of PUD. The outcomes of H. pylori infection are caused by imbalances between bacterial virulence factors, host factors, and environmental influences. In this review, we describe the prevalence trends of H. pylori infection in Korea, the mechanism of H. pylori infection-related PUD, and treatment strategies.

  10. Etiology of genital ulcers and prevalence of human immunodeficiency virus coinfection in 10 US cities. The Genital Ulcer Disease Surveillance Group.

    Science.gov (United States)

    Mertz, K J; Trees, D; Levine, W C; Lewis, J S; Litchfield, B; Pettus, K S; Morse, S A; St Louis, M E; Weiss, J B; Schwebke, J; Dickes, J; Kee, R; Reynolds, J; Hutcheson, D; Green, D; Dyer, I; Richwald, G A; Novotny, J; Weisfuse, I; Goldberg, M; O'Donnell, J A; Knaup, R

    1998-12-01

    To determine the etiology of genital ulcers and to assess the prevalence of human immunodeficiency virus (HIV) infection in ulcer patients in 10 US cities, ulcer and serum specimens were collected from approximately 50 ulcer patients at a sexually transmitted disease clinic in each city. Ulcer specimens were tested using a multiplex polymerase chain reaction assay to detect Haemophilus ducreyi, Treponema pallidum, and herpes simplex virus (HSV); sera were tested for antibody to HIV. H. ducreyi was detected in ulcer specimens from patients in Memphis (20% of specimens) and Chicago (12%). T. pallidum was detected in ulcer specimens from every city except Los Angeles (median, 9% of specimens; range, 0%-46%). HSV was detected in >/=50% of specimens from all cities except Memphis (42%). HIV seroprevalence in ulcer patients was 6% (range by city, 0%-18%). These data suggest that chancroid is prevalent in some US cities and that persons with genital ulcers should be a focus of HIV prevention activities.

  11. Ulcerative colitis - discharge

    Science.gov (United States)

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

  12. Excessive bleeding from genital ulcers of Behçet's disease.

    Science.gov (United States)

    Bostankolu, A; Aksungur, V L; Aksungur, E H; Ozpoyraz, M; Yücel, A; Memisoglu, H R

    1997-09-01

    Although genital ulcers are a common manifestation of Behçet's disease, bleeding from these lesions is unusual. In this report, a patient with excessive bleeding from genital ulcers is presented. A 22-year-old man with recurrent oral and genital ulcers, erythema nodosum, folliculitis, positive pathergic reaction, uveitis, superior vena cava syndrome, and generalized lymphadenopathy fulfilled the diagnostic criteria of Behçet's disease. Three years after presenting he was admitted to our clinic with excessive bleeding from large ulcers on the scrotum and upper thighs and with a leg ulcer. Bleeding was controlled with compresses. Examination of a biopsy specimen obtained from the leg ulcer showed findings consistent with Kaposi-like acroangiodermatitis. Results of various radiologic investigations showed thrombosis of the inferior vena cava, peritesticular varicosities, and venous insufficiency of the lower extremities. We suggest that the bleeding was secondary to the extension of genital ulcers to the varicose veins.

  13. [Genital ulcers caused by sexually transmitted diseases: current therapies, diagnosis and their relevance in HIV pandemy].

    Science.gov (United States)

    Da Costa, João Borges; Domingues, Dulce; Castro, R; Exposto, Filomena

    2006-01-01

    The sexual transmitted pathogens associated with genital ulcers are Treponema pallidum, Haemophilus ducreyi, Calymmatobacterium granulomatis, Chlamydia trachomatis and Herpes simplex virus type 1 or 2. Although geographic differences still exist, herpetic infections prevalence is growing worldwide as the most frequent ulcerative sexual transmitted disease. The failure of the many different used guidelines in achieving a sustained reduction in the number of new cases, in particular the WHO syndromic management, leads into an over treatment of bacterial agents and missing of viral agents. This situation is also associated with poor efficacy and wasting of economical resources. Ulcerative and non-ulcerative sexual transmitted diseases are important in the world HIV pandemy because they promote HIV transmission and are also associated with the disease evolution. Portugal had until recently the highest incidence of HIV infection in Europe and that points out to importance of treating and control of both ulcerative and non-ulcerative sexual transmitted diseases in order.

  14. Effects of active and passive smoking on disease course of Crohn's disease and ulcerative colitis

    NARCIS (Netherlands)

    van der Heide, Frans; Dijkstra, Arie; Weersma, Rinse K.; Albersnagel, Frans A.; van der Logt, Elise M. J.; Faber, Kloos Nico; Sluiter, Wim J.; Kleibeuker, Jan H.; Dijkstra, Gerard

    2009-01-01

    Background: Smoking is a remarkable risk factor for inflammatory bowel disease (IBD). aggravating Crohn's disease (CD) while having beneficial effects On Ulcerative colitis (UC). We Studied the effects of active and passive smoking in Dutch IBD patients. Methods: A questionnaire focusing Oil cigaret

  15. Fulminant ulcerative colitis associated with steroid-resistant minimal change disease and psoriasis: A case report

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    A 43-year-old Chinese patient with a history of psoriasis developed fulminant ulcerative colitis after immunosuppressive therapy for steroid-resistant minimal change disease was stopped. Minimal change disease in association with inflammatory bowel disease is a rare condition. We here report a case showing an association between ulcerative colitis, minimal change disease,and psoriasis. The possible pathological link between 3 diseases is discussed.

  16. [Non-Helicobacter pylori, Non-nonsteroidal Anti-inflammatory Drug Peptic Ulcer Disease].

    Science.gov (United States)

    Chang, Young Woon

    2016-06-25

    Non-Helicobacter pylori, non-NSAID peptic ulcer disease (PUD), termed idiopathic PUD, is increasing in Korea. Diagnosis is based on exclusion of common causes such as H. pylori infection, infection with other pathogens, surreptitious ulcerogenic drugs, malignancy, and uncommon systemic diseases with upper gastrointestinal manifestations. The clinical course of idiopathic PUD is delayed ulcer healing, higher recurrence, higher re-bleeding after initial ulcer healing, and higher mortality than the other types of PUD. Genetic predisposition, older age, chronic mesenteric ischemia, cigarette smoking, concomitant systemic diseases, and psychological stress are considered risk factors for idiopathic PUD. Diagnosis of idiopathic PUD should systematically explore all possible causes. Management of this disease is to treat underlying disease followed by regular endoscopic surveillance to confirm ulcer healing. Continuous proton pump inhibitor therapy is an option for patients who respond poorly to the standard ulcer regimen. PMID:27312831

  17. [Non-Helicobacter pylori, Non-nonsteroidal Anti-inflammatory Drug Peptic Ulcer Disease].

    Science.gov (United States)

    Chang, Young Woon

    2016-06-25

    Non-Helicobacter pylori, non-NSAID peptic ulcer disease (PUD), termed idiopathic PUD, is increasing in Korea. Diagnosis is based on exclusion of common causes such as H. pylori infection, infection with other pathogens, surreptitious ulcerogenic drugs, malignancy, and uncommon systemic diseases with upper gastrointestinal manifestations. The clinical course of idiopathic PUD is delayed ulcer healing, higher recurrence, higher re-bleeding after initial ulcer healing, and higher mortality than the other types of PUD. Genetic predisposition, older age, chronic mesenteric ischemia, cigarette smoking, concomitant systemic diseases, and psychological stress are considered risk factors for idiopathic PUD. Diagnosis of idiopathic PUD should systematically explore all possible causes. Management of this disease is to treat underlying disease followed by regular endoscopic surveillance to confirm ulcer healing. Continuous proton pump inhibitor therapy is an option for patients who respond poorly to the standard ulcer regimen.

  18. Epstein-Barr Virus Association with Peptic Ulcer Disease

    Directory of Open Access Journals (Sweden)

    María G. Cárdenas-Mondragón

    2015-01-01

    Full Text Available Background. Helicobacter pylori (HP infection and nonsteroidal anti-inflammatory drugs (NSAID use are considered the main risk to develop peptic ulcer disease (PUD. However, PUD also occurs in the absence of HP infection and/or NSAID use. Recently, we have found evidence that Epstein-Barr virus (EBV reactivation increases the risk to develop premalignant and malignant gastric lesions. Objective. To study a possible association between EBV and PUD. Methods. Antibodies against an EBV reactivation antigen, HP, and the HP virulence factor CagA were measured in sera from 207 Mexican subjects, controls (healthy individuals, n = 129, and PUD patients (n = 78, 58 duodenal and 20 gastric ulcers. Statistical associations were estimated. Results. Duodenal PUD was significantly associated with high anti-EBV IgG titers (p = 0.022, OR = 2.5, while anti-EBV IgA was positively associated with gastric PUD (p = 0.002, OR = 10.1. Conclusions. Our study suggests that EBV reactivation in gastric and duodenal epithelium increases the risk to develop PUD.

  19. Epstein-Barr Virus Association with Peptic Ulcer Disease

    Science.gov (United States)

    Cárdenas-Mondragón, María G.; Torres, Javier; Flores-Luna, Lourdes; Carreón-Talavera, Ricardo; Camorlinga-Ponce, Margarita; Fuentes-Pananá, Ezequiel M.

    2015-01-01

    Background. Helicobacter pylori (HP) infection and nonsteroidal anti-inflammatory drugs (NSAID) use are considered the main risk to develop peptic ulcer disease (PUD). However, PUD also occurs in the absence of HP infection and/or NSAID use. Recently, we have found evidence that Epstein-Barr virus (EBV) reactivation increases the risk to develop premalignant and malignant gastric lesions. Objective. To study a possible association between EBV and PUD. Methods. Antibodies against an EBV reactivation antigen, HP, and the HP virulence factor CagA were measured in sera from 207 Mexican subjects, controls (healthy individuals, n = 129), and PUD patients (n = 78, 58 duodenal and 20 gastric ulcers). Statistical associations were estimated. Results. Duodenal PUD was significantly associated with high anti-EBV IgG titers (p = 0.022, OR = 2.5), while anti-EBV IgA was positively associated with gastric PUD (p = 0.002, OR = 10.1). Conclusions. Our study suggests that EBV reactivation in gastric and duodenal epithelium increases the risk to develop PUD. PMID:26199856

  20. Epstein-Barr virus association with peptic ulcer disease.

    Science.gov (United States)

    Cárdenas-Mondragón, María G; Torres, Javier; Flores-Luna, Lourdes; Carreón-Talavera, Ricardo; Camorlinga-Ponce, Margarita; Fuentes-Pananá, Ezequiel M

    2015-01-01

    Background. Helicobacter pylori (HP) infection and nonsteroidal anti-inflammatory drugs (NSAID) use are considered the main risk to develop peptic ulcer disease (PUD). However, PUD also occurs in the absence of HP infection and/or NSAID use. Recently, we have found evidence that Epstein-Barr virus (EBV) reactivation increases the risk to develop premalignant and malignant gastric lesions. Objective. To study a possible association between EBV and PUD. Methods. Antibodies against an EBV reactivation antigen, HP, and the HP virulence factor CagA were measured in sera from 207 Mexican subjects, controls (healthy individuals, n = 129), and PUD patients (n = 78, 58 duodenal and 20 gastric ulcers). Statistical associations were estimated. Results. Duodenal PUD was significantly associated with high anti-EBV IgG titers (p = 0.022, OR = 2.5), while anti-EBV IgA was positively associated with gastric PUD (p = 0.002, OR = 10.1). Conclusions. Our study suggests that EBV reactivation in gastric and duodenal epithelium increases the risk to develop PUD.

  1. Peptic ulcer disease and other complications in patients receiving dexamethasone palliation for brain metastasis

    Energy Technology Data Exchange (ETDEWEB)

    Penzner, R.D.; Lipsett, J.A.

    1982-11-01

    A retrospective analysis was done of 106 patients who received radiation therapy for brain metastasis. Dexamethasone therapy was instituted in 97 patients. Peptic ulcer disease developed in 5 of 89 patients (5.6 percent) who received a dosage of at least 12 mg a day, but did not occur in patients who received a lower dose or in those who did not receive steroids. The interval between institution of dexamethasone therapy and the development of peptic ulcer disease ranged from three to nine weeks. Two patients had perforated ulcers, one of whom required surgical resection. Peptic ulcer disease contributed to the general deterioration and death of three of the five patients. Overall, in 14 of the 89 patients (15.7 percent) a complication of steroid therapy developed in the form of peptic ulcer disease, steroid myopathy or diabetes mellitus (or a combination of these).

  2. Peptic ulcer disease and other complications in patients receiving dexamethasone palliation for brain metastasis

    International Nuclear Information System (INIS)

    A retrospective analysis was done of 106 patients who received radiation therapy for brain metastasis. Dexamethasone therapy was instituted in 97 patients. Peptic ulcer disease developed in 5 of 89 patients (5.6 percent) who received a dosage of at least 12 mg a day, but did not occur in patients who received a lower dose or in those who did not receive steroids. The interval between institution of dexamethasone therapy and the development of peptic ulcer disease ranged from three to nine weeks. Two patients had perforated ulcers, one of whom required surgical resection. Peptic ulcer disease contributed to the general deterioration and death of three of the five patients. Overall, in 14 of the 89 patients (15.7 percent) a complication of steroid therapy developed in the form of peptic ulcer disease, steroid myopathy or diabetes mellitus (or a combination of these)

  3. THE CLINICAL MANIFESTATIONS AND COURSE OF DUODENAL ULCER DISEASE AFTER PERFORATED ULCER

    Directory of Open Access Journals (Sweden)

    L. A. Lyubskaya

    2014-01-01

    Full Text Available Objective: to compare clinical manifestations, course, mental status in duodenal ulcer (DU patients with a history of perforated ulcer and its uncomplicated course.Subjects and methods. One hundred and thirteen patents with DU were examined. Group 1 included 61 patients with uncomplicated DUand Group 2 comprised 52 patients with a history of perforated ulcer. A comparison group consisted of 20 patients who had undergone laparotomy. Physical and mental status examinations, esophagogastroduodenoscopy (EGDS, and 24-hour pH-metry were performed.Results. Classical pain syndrome was observed in 75 % of the patients with uncomplicated DU. Prior to perforation, the pain and dyspeptic syndromes were distinguished only by a significantly lower degree in Group 2; following perforation, the pain syndrome was recorded more frequently, it was more extensive, meal-unrelated, and similar to that in the patients who had undergone laparotomy and had diminished appetite (36.5 %. EGDS showed that the complicated course was accompanied by the significantly higher incidence of erosive esophagitis (21.2 %, gastritis (51.9 %, duodenitis (25.0 %, multiple ulcers (28.8 %, and larger ulcers. 24-hour pH-metry indicated that the level of hyperacidity in Group 2 was higher and the circadian intragastric pH variations were less marked than those in uncomplicated DU. The patients with a history of perforated ulcer showed a high rate of anxiety and depressive changes. Conclusion. In complicated DU, marked monotonic hyperacidity causes common erosive-ulcerative lesions in the gastroduodenal area in relatively mild pain syndrome, late referrals, and long-term ulcer healing. After perforation followed by wound closure, the pain and dyspeptic syndromes become more pronounced, which is associated with anxiety and depressive changes in the mental status, as well as with early referrals and less healing time.

  4. THE CLINICAL MANIFESTATIONS AND COURSE OF DUODENAL ULCER DISEASE AFTER PERFORATED ULCER

    Directory of Open Access Journals (Sweden)

    L. A. Lyubskaya

    2014-11-01

    Full Text Available Objective: to compare clinical manifestations, course, mental status in duodenal ulcer (DU patients with a history of perforated ulcer and its uncomplicated course.Subjects and methods. One hundred and thirteen patents with DU were examined. Group 1 included 61 patients with uncomplicated DUand Group 2 comprised 52 patients with a history of perforated ulcer. A comparison group consisted of 20 patients who had undergone laparotomy. Physical and mental status examinations, esophagogastroduodenoscopy (EGDS, and 24-hour pH-metry were performed.Results. Classical pain syndrome was observed in 75 % of the patients with uncomplicated DU. Prior to perforation, the pain and dyspeptic syndromes were distinguished only by a significantly lower degree in Group 2; following perforation, the pain syndrome was recorded more frequently, it was more extensive, meal-unrelated, and similar to that in the patients who had undergone laparotomy and had diminished appetite (36.5 %. EGDS showed that the complicated course was accompanied by the significantly higher incidence of erosive esophagitis (21.2 %, gastritis (51.9 %, duodenitis (25.0 %, multiple ulcers (28.8 %, and larger ulcers. 24-hour pH-metry indicated that the level of hyperacidity in Group 2 was higher and the circadian intragastric pH variations were less marked than those in uncomplicated DU. The patients with a history of perforated ulcer showed a high rate of anxiety and depressive changes. Conclusion. In complicated DU, marked monotonic hyperacidity causes common erosive-ulcerative lesions in the gastroduodenal area in relatively mild pain syndrome, late referrals, and long-term ulcer healing. After perforation followed by wound closure, the pain and dyspeptic syndromes become more pronounced, which is associated with anxiety and depressive changes in the mental status, as well as with early referrals and less healing time.

  5. Genital ulcers, other sexually transmitted diseases, and the sexual transmission of HIV.

    Science.gov (United States)

    Piot, P; Laga, M

    1989-03-11

    There is increasing evidence that genital ulceration, including syphilis, chancroid, and herpes simplex type 2, increases susceptibility to HIV infection. It may be that the HIV penetrates more easily through ulcerated membranes or that the lymphocytes associated with the inflammatory response present target cells for HIV infection. There is also evidence that HIV-infected women with genital ulcers are themselves more infective due to shedding of the virus in the genital tract. Nonulcerative sexually-transmitted diseases have also been associated as cofactors of HIV infection. Programs for the control of sexually transmitted diseases should be strengthened and should focus on eliminating chancroid, which is easily treated with antibiotics. Patients with genital ulcer disease should receive counseling, so that they will know that untreated genital ulcers increase the risk of HIV infection.

  6. Choledochoduodenal fistula complicating duodenal ulcer disease (a report of 3 cases.

    Directory of Open Access Journals (Sweden)

    Shah P

    1990-07-01

    Full Text Available Choledochoduodenal fistula complicating duodenal ulcer disease is a rare occurrence. The present paper describes 3 such cases which were incidentally picked up on upper gastro-intestinal (GI radiographic study and endoscopy done for ulcer like symptoms. The relevant literature is reviewed.

  7. Ulcerative colitis and Crohn's disease tissue cytotoxins

    Energy Technology Data Exchange (ETDEWEB)

    McLaren, L.C.; Gitnick, G.

    1982-06-01

    Bowel-wall tissue filtrates from patients with inflammatory bowel disease produce cytopathic effects in tissue culture. The cytopathic effects inducers have been reported to have the characteristics of a small RNA virus. Clostridium difficile toxin also produces cytopathic effects and has been found in the stools of patients with Crohn's disease and ulcerative colitis. The present study concerns the further characterization of the cytopathic inducers in tissues of inflammatory bowel disease patients. It was found that they are nonsedimentable at 148,000 g for 2 h and resistant to inactivation by UV light. They are proteins that are distinct from C. difficile toxin and are unique cytotoxins which are associated with the early cytopathic effects observed in Riff-free chick embryo and rabbit ileum cell cultures. These results suggest that the early cytopathic effects previously described are not produced by a virus. They do not explain the delayed cytopathic effects seen in rabbit ileum or WI-38 cells.

  8. Ulcerative colitis and Crohn's disease: factor XIII, inflammation and haemostasis.

    Science.gov (United States)

    Seitz, R; Leugner, F; Katschinski, M; Immel, A; Kraus, M; Egbring, R; Göke, B

    1994-01-01

    An important role has been ascribed to plasma factor XIII (FXIII) in inflammation and wound healing. FXIII is necessary for fibrin stabilization and interacts with connective tissue and adhesive proteins and cells. In a prospective study, FXIII activity and parameters of coagulation, fibrinolysis and inflammation, were determined in patients with ulcerative colitis (UC; 13 active, 22 moderate) and Crohn's disease (CD; 36 active, 45 moderate). FXIII levels were lower in active than in moderate UC and CD, and were < 70% of normal values in 7/13 patients with active UC, and in 7/36 patients with active CD, although the median values did not fall below the normal range. FXIII was somewhat higher in active UC patients responding to therapy. The FXIII levels were widely scattered, and low values appear to be due to greatly enhanced turnover. A correlation between FXIII and the systemic levels of markers of activation of haemostasis and inflammation was lacking, but there was a correlation with the extent of bowel involvement. FXIII levels were lower in the patients with involvement beyond the sigmoid colon in CU (p = 0.0045), and both small and large bowel segments in CD (p = 0.0223) patients. This points to local consumption and/or loss of FXIII within the inflamed tissue, and provides an argument for FXIII substitution in the treatment of acute episodes of inflammatory bowel diseases.

  9. Evidence-based clinical practice guidelines for peptic ulcer disease 2015.

    Science.gov (United States)

    Satoh, Kiichi; Yoshino, Junji; Akamatsu, Taiji; Itoh, Toshiyuki; Kato, Mototsugu; Kamada, Tomoari; Takagi, Atsushi; Chiba, Toshimi; Nomura, Sachiyo; Mizokami, Yuji; Murakami, Kazunari; Sakamoto, Choitsu; Hiraishi, Hideyuki; Ichinose, Masao; Uemura, Naomi; Goto, Hidemi; Joh, Takashi; Miwa, Hiroto; Sugano, Kentaro; Shimosegawa, Tooru

    2016-03-01

    The Japanese Society of Gastroenterology (JSGE) revised the evidence-based clinical practice guidelines for peptic ulcer disease in 2014 and has created an English version. The revised guidelines consist of seven items: bleeding gastric and duodenal ulcers, Helicobacter pylori (H. pylori) eradication therapy, non-eradication therapy, drug-induced ulcer, non-H. pylori, non-nonsteroidal anti-inflammatory drug (NSAID) ulcer, surgical treatment, and conservative therapy for perforation and stenosis. Ninety clinical questions (CQs) were developed, and a literature search was performed for the CQs using the Medline, Cochrane, and Igaku Chuo Zasshi databases between 1983 and June 2012. The guideline was developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Therapy is initially provided for ulcer complications. Perforation or stenosis is treated with surgery or conservatively. Ulcer bleeding is first treated by endoscopic hemostasis. If it fails, surgery or interventional radiology is chosen. Second, medical therapy is provided. In cases of NSAID-related ulcers, use of NSAIDs is stopped, and anti-ulcer therapy is provided. If NSAID use must continue, the ulcer is treated with a proton pump inhibitor (PPI) or prostaglandin analog. In cases with no NSAID use, H. pylori-positive patients receive eradication and anti-ulcer therapy. If first-line eradication therapy fails, second-line therapy is given. In cases of non-H. pylori, non-NSAID ulcers or H. pylori-positive patients with no indication for eradication therapy, non-eradication therapy is provided. The first choice is PPI therapy, and the second choice is histamine 2-receptor antagonist therapy. After initial therapy, maintenance therapy is provided to prevent ulcer relapse.

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

    Directory of Open Access Journals (Sweden)

    Serkan Ipek

    2015-07-01

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

  11. Disodium cromoglycate in the treatment of ulcerative colitis and Crohn's disease.

    OpenAIRE

    Binder, V; Elsborg, L.; Greibe, J; Hendriksen, C; Høj, L; Jensen, K. B.; Kristensen, E.; Madsen, J R; Marner, B; Riis, P; Willumsen, L

    1981-01-01

    A controlled clinical study on disodium cromoglycate (DSCG) at a dose of 800 mg per day versus placebo was carried out in 141 patients with ulcerative colitis and 25 patients with Crohn's disease. Those of the ulcerative colitis patients who had been on sulphasalazine treatment continued that treatment during the trial (101 patients). Forty patients were intolerant of sulphasalazine. No patient received steroids during the last month before the study. Patients with Crohn's disease had their p...

  12. Association between acute pancreatitis and peptic ulcer disease

    Institute of Scientific and Technical Information of China (English)

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

    2011-01-01

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

  13. Risk of ulcerative colitis and Crohn's disease among offspring of patients with chronic inflammatory bowel disease

    DEFF Research Database (Denmark)

    Orholm, Marianne; Fonager, Kirsten; Sørensen, Henrik Toft

    1999-01-01

    OBJECTIVE: The incidence of inflammatory bowel disease (IBD) varies among and within countries, but several studies have indicated that genetic factors may play an important role in the etiology of IBD. A Danish regional study has observed an almost 10-fold increased risk for ulcerative colitis (UC...... significantly increased. CONCLUSION: The risk for UC and CD among offspring of patients with IBD is 2-13 times higher than the risk within the general population....

  14. Dietary Supplement Therapies for Inflammatory Bowel Disease: Crohn's Disease and Ulcerative Colitis.

    Science.gov (United States)

    Parian, Alyssa; Limketkai, Berkeley N

    2016-01-01

    Inflammatory bowel disease (IBD) including ulcerative colitis and Crohn's disease are chronic relapsing and remitting chronic diseases for which there is no cure. The treatment of IBD frequently requires immunosuppressive and biologic therapies which carry an increased risk of infections and possible malignancy. There is a continued search for safer and more natural therapies in the treatment of IBD. This review aims to summarize the most current literature on the use of dietary supplements for the treatment of IBD. Specifically, the efficacy and adverse effects of vitamin D, fish oil, probiotics, prebiotics, curcumin, Boswellia serrata, aloe vera and cannabis sativa are reviewed. PMID:26561079

  15. Phenotypic and genotypic characterization of Helicobacter pylori from patients with and without peptic ulcer disease

    DEFF Research Database (Denmark)

    Petersen, A M; Fussing, V; Colding, H;

    2000-01-01

    BACKGROUND: Helicobacter pylori plays an important role in peptic ulcer disease, although not all H. pylori-infected persons will develop a peptic ulcer. Currently, H. pylori strains cannot be divided into commensals and pathogens. METHODS: Fifty H. pylori strains were cultured from patients......) profile of H. pylori strains were recorded; randomly amplified polymorphic DNA (RAPD) and urease gene typing were performed and correlated with diagnostic groups. RESULTS: Electron micrographs showed that H. pylori strains from patients with gastric ulcers adhered more frequently through filamentous...... strands and were less frequently found free in mucus than any other diagnostic group (P pylori strains from patients with gastric...

  16. [Peritonitis following gastroduodenal ulcer perforation disease in children: report of 4 cases].

    Science.gov (United States)

    Ndour, O; Bansouda, J; Fall, A F; Alumeti, D M; Diouf, C; Ngom, G; Ndoye, M

    2012-10-01

    Peritonitis due to gastroduodenal ulcer perforation disease is a rare entity in pediatric surgery. In Senegal, no study has been dedicated to ulcer complications in children. The aim of this study was to describe the epidemiology, diagnosis, and treatment of perforated peptic ulcer in patients less than 15 years old. This retrospective study was conducted in the Surgical Emergencies and Paediatric Surgery Department at Aristide Le Dantec University Hospital Center in Dakar, Senegal, during a period of 11 years (January 1999 to December 2010). We found 4 children who presented perforated gastroduodenal ulcer: 3 females and 1 male. The average age of these patients was 9 years (range, 7-14 years). No family history was found. We noted 3 cases of perforated duodenal ulcer and one perforated gastric ulcer. The clinical diagnosis was suspected based on a peritoneal irritation syndrome. A plain x-ray of the abdomen was taken in all patients, which objectified a pneumoperitoneum image in 3 cases. The leukocytosis was constant. Treatment in all patients consisted on pre-, intra-, and postoperative intensive care, supra- and infraumbilical midline laparotomy, which allowed us to perform a debridement-suture of the gap followed by epiploplasty and extensive washing with lukewarm physiologic serum. Adjuvant therapy based on anti-ulcer and antibiotic therapy was initiated. Bacteriological examination of peritoneal fluid isolated a polymicrobial flora. Helicobacter pylori was not isolated. Histological examination of the biopsied perforation edges showed a benign ulcer in all cases. The follow-up endoscopy was performed 4 weeks after surgery and showed cicatrization of the ulcer in all patients. After a mean of 2 years, no recurrence was noted. The gastric or duodenal ulcer in children is rare. It is often discovered at the stage of perforation, a complication for which the essential treatment is surgery. Routine screening would certainly help to reduce the risk of this

  17. Molecular hydrogen in human breath: a new strategy for selectively diagnosing peptic ulcer disease, non-ulcerous dyspepsia and Helicobacter pylori infection.

    Science.gov (United States)

    Maity, Abhijit; Pal, Mithun; Maithani, Sanchi; Ghosh, Barnali; Chaudhuri, Sujit; Pradhan, Manik

    2016-01-01

    The gastric pathogen Helicobacter pylori utilizes molecular hydrogen (H2) as a respiratory substrate during colonization in the gastric mucosa. However, the link between molecular H2 and the pathogenesis of peptic-ulcer disease (PUD) and non-ulcerous dyspepsia (NUD) by the enzymatic activity of H. pylori still remains mostly unknown. Here we provide evidence that breath H2 excretion profiles are distinctly altered by the enzymatic activity of H. pylori for individuals with NUD and PUD. We subsequently unravelled the potential molecular mechanisms responsible for the alteration of H2 in exhaled breath in association with peptic ulcers, encompassing both gastric and duodenal ulcers, along with NUD. We also established that carbon-isotopic fractionations in the acid-mediated bacterial environment regulated by bacterial urease activity cannot discriminate the actual disease state i.e. whether it is peptic ulcer or NUD. However, our findings illuminate the unusual molecular H2 in breath that can track the precise evolution of PUD and NUD, even after the eradication of H. pylori infection. This deepens our understanding of the pathophysiology of PUD and NUD, reveals non-invasively the actual disease state in real-time and thus offers a novel and robust new-generation strategy for treating peptic-ulcer disease together with non-ulcer related complications even when the existing (13)C-urea breath test ((13)C-UBT) fails to diagnose. PMID:27448107

  18. Molecular hydrogen in human breath: a new strategy for selectively diagnosing peptic ulcer disease, non-ulcerous dyspepsia and Helicobacter pylori infection.

    Science.gov (United States)

    Maity, Abhijit; Pal, Mithun; Maithani, Sanchi; Ghosh, Barnali; Chaudhuri, Sujit; Pradhan, Manik

    2016-07-22

    The gastric pathogen Helicobacter pylori utilizes molecular hydrogen (H2) as a respiratory substrate during colonization in the gastric mucosa. However, the link between molecular H2 and the pathogenesis of peptic-ulcer disease (PUD) and non-ulcerous dyspepsia (NUD) by the enzymatic activity of H. pylori still remains mostly unknown. Here we provide evidence that breath H2 excretion profiles are distinctly altered by the enzymatic activity of H. pylori for individuals with NUD and PUD. We subsequently unravelled the potential molecular mechanisms responsible for the alteration of H2 in exhaled breath in association with peptic ulcers, encompassing both gastric and duodenal ulcers, along with NUD. We also established that carbon-isotopic fractionations in the acid-mediated bacterial environment regulated by bacterial urease activity cannot discriminate the actual disease state i.e. whether it is peptic ulcer or NUD. However, our findings illuminate the unusual molecular H2 in breath that can track the precise evolution of PUD and NUD, even after the eradication of H. pylori infection. This deepens our understanding of the pathophysiology of PUD and NUD, reveals non-invasively the actual disease state in real-time and thus offers a novel and robust new-generation strategy for treating peptic-ulcer disease together with non-ulcer related complications even when the existing (13)C-urea breath test ((13)C-UBT) fails to diagnose.

  19. A study of psychiatric morbidity in patients of peptic ulcer diseases

    Directory of Open Access Journals (Sweden)

    Jagpal Singh Klair

    2012-01-01

    Full Text Available Aims and Objectives: To study the prevalence of psychiatric morbidity among patients of peptic ulcer disease and to study the patients of peptic ulcer disease with psychiatric morbidity in comparison to patients of peptic ulcer disease without psychiatric morbidity on following variables: sociodemographic variables and attributes/risk factors of peptic ulcer disease. Materials and Methods: Fifty cases of clinically proven acid peptic diseases and 30 cases of the control group were screened in department of General Medicine, outdoor as well as indoor patients. Instruments applied for the purpose of the study were Personal Bio-data Performa (Appendix-I, (SCL- 80 (Appendix-II, Hamilton rating scale for anxiety and depression, (P.S.L.E.; clinical diagnosis of psychiatric disorders was made as per ICD- 10 criteria. Data collected shall be subjected to statistical analysis. Results and Findings: The psychiatric morbidity was significantly (P10 years, compared to 23.80% in patients without psychiatric morbidity. Lastly, 48.27% of patients with psychiatric morbidity had significantly (P<0.01 stronger family history of acid peptic disease compared to 9.52% in patients without psychiatric morbidity. Conclusions: There is a significant relationship between the peptic ulcer disease and the various psychiatric morbidity factors as illustrated from the findings of this study.

  20. Recurrent Oral and Genital Ulcers in an Infant: Neonatal Presentation of Pediatric Behçet Disease.

    Science.gov (United States)

    Johnson, Emma F; Hawkins, Danielle M; Gifford, Laura K; Smidt, Aimee C

    2015-01-01

    Behçet disease is a complex, multisystem disease characterized by recurrent oral and genital ulcerations. It rarely occurs in infants or children. Neonatal Behçet disease has been reported in infants whose ulcers resolve at or before 9 weeks of age. Few cases of neonatal Behçet disease persisting into childhood have previously been reported. We report the case of a 1-month-old infant who presented with severe recurrent genital ulcerations and at 6 months developed recurrent oral ulcerations. Her orogenital ulcerations continue to recur. Human leukocyte antigen testing revealed HLA-B51 and B44 positivity. This is a case of pediatric Behçet disease in the neonatal period. Behçet disease should be considered in the differential diagnosis of recurrent genital and oral ulcerations in infants and children.

  1. Helicobacter pylori and peptic ulcer disease. Current evidence for management strategies.

    OpenAIRE

    Chiba, N; Lahaie, R; Fedorak, R N; Bailey, R.; Veldhuyzen van Zanten, S J; Bernucci, B.

    1998-01-01

    OBJECTIVE: To review current evidence for primary care physicians who manage Helicobacter pylori in peptic ulcer disease. QUALITY OF EVIDENCE: MEDLINE was searched to August 1997 for randomized controlled trials, systematic overviews, and consensus reports. High-quality recent reviews were often found. Randomized controlled trials presented as abstracts at recent meetings were reviewed. MAIN FINDINGS: Helicobacter pylori is found in most case of duodental and gastric ulcer, and eradication of...

  2. Surveillance issues in inflammatory bowel disease: ulcerative colitis.

    Science.gov (United States)

    Provenzale, D; Onken, J

    2001-02-01

    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.

  3. Crohn's disease but not chronic ulcerative colitis induces the expression of PAI-1 in enteric neurons

    DEFF Research Database (Denmark)

    Laerum, O.D.; Illemann, M.; Skarstein, A.;

    2008-01-01

    by immunohistochemical techniques. RESULTS: PAI-1 was found in a subset of neurons primarily located in the submucosal plexus of the small and large intestine in 24 of 28 cases (86%) with Crohn's disease, but in none of 17 cases with chronic ulcerative colitis and other severe inflammatory conditions in the intestinal......OBJECTIVES: Chronic inflammation of the intestinal wall is the common characteristic of Crohn's disease and ulcerative colitis; disorders, which in some cases can be difficult to distinguish. The inflammation also affects the local neuronal plexuses of the enteric nervous system. It is known....... CONCLUSIONS: PAI-1-positive neurons in inflammatory bowel disease are linked to chronic inflammation in Crohn's disease, implying PAI-1 as a potential parameter for the differential diagnosis between Crohn's disease and ulcerative colitis. The findings also suggest that PAI-1 in neurons is related to pain...

  4. Curcumin-induced histone acetylation inhibition improves stress-induced gastric ulcer disease in rats.

    Science.gov (United States)

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

    2015-03-01

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

  5. HLA-DR expression and disease activity in ulcerative colitis

    DEFF Research Database (Denmark)

    Poulsen, L O; Elling, P; Sørensen, Flemming Brandt;

    1986-01-01

    In 12 patients with active ulcerative colitis (UC) the rectal epithelial cells were analyzed for HLA-DR antigens by an immunohistochemical technique. The clinical, rectoscopic, and histologic stages were also determined. The investigations were carried out at the beginning of the study and 2 weeks...

  6. Detection of longitudinal ulcer using roughness value for computer aided diagnosis of Crohn's disease

    Science.gov (United States)

    Oda, Masahiro; Kitasaka, Takayuki; Furukawa, Kazuhiro; Watanabe, Osamu; Ando, Takafumi; Goto, Hidemi; Mori, Kensaku

    2011-03-01

    The purpose of this paper is to present a new method to detect ulcers, which is one of the symptoms of Crohn's disease, from CT images. Crohn's disease is an inflammatory disease of the digestive tract. Crohn's disease commonly affects the small intestine. An optical or a capsule endoscope is used for small intestine examinations. However, these endoscopes cannot pass through intestinal stenosis parts in some cases. A CT image based diagnosis allows a physician to observe whole intestine even if intestinal stenosis exists. However, because of the complicated shape of the small and large intestines, understanding of shapes of the intestines and lesion positions are difficult in the CT image based diagnosis. Computer-aided diagnosis system for Crohn's disease having automated lesion detection is required for efficient diagnosis. We propose an automated method to detect ulcers from CT images. Longitudinal ulcers make rough surface of the small and large intestinal wall. The rough surface consists of combination of convex and concave parts on the intestinal wall. We detect convex and concave parts on the intestinal wall by a blob and an inverse-blob structure enhancement filters. A lot of convex and concave parts concentrate on roughed parts. We introduce a roughness value to differentiate convex and concave parts concentrated on the roughed parts from the other on the intestinal wall. The roughness value effectively reduces false positives of ulcer detection. Experimental results showed that the proposed method can detect convex and concave parts on the ulcers.

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

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    Y. Cherradi

    2015-12-01

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

  8. Active and passive smoking behaviour and cessation plans of patients with Crohn's disease and ulcerative colitis

    NARCIS (Netherlands)

    van der Heide, Frans; Dijkstra, Arie; Albersnagel, Frans A.; Kleibeuker, Jan H.; Dijkstra, Gerard

    2010-01-01

    Background: Smoking is a remarkable risk factor in inflammatory bowel disease (IBD), with negative effects on Crohn's disease (CD) and positive effects on ulcerative colitis (UC). This makes different changes in smoking behaviour after diagnosis between CD and UC likely. Changes in active smoking, c

  9. Comparison of Behçet's Disease and Recurrent Aphthous Ulcer According to Characteristics of Gastrointestinal Symptoms

    OpenAIRE

    Rhee, Seung-Ho; Kim, Young-Bae; Lee, Eun-So

    2005-01-01

    Behçet's disease (BD) is a multisystemic chronic inflammatory disease. It is characterized by recurrent oral and genital ulcers, uveitis, skin lesions and other manifestations, including neurologic, vascular, joint, and gastrointestinal ulcers of variable severity. Recurrent aphthous ulcer (RAU) represents a very common, but poorly understood, mucosal disorder. If a patient of RAU without any other typical symptoms of BD has gastrointestinal symptoms, it is difficult to distinguish this RAU f...

  10. The Helicobacter pylori theory and duodenal ulcer disease. A case study of the research process

    DEFF Research Database (Denmark)

    Christensen, A H; Gjørup, T

    1995-01-01

    OBJECTIVES: To describe the medical research process from the time of the generation of a new theory to its implementation in clinical practice. The Helicobacter pylori (H. pylori) theory, i.e. the theory that H. pylori plays a significant causal role in duodenal ulcer disease was chosen as a case....... MATERIAL: Abstracts from 1984 to 1993, identified in the CD-Rom, Medline system, ("Silverplatter"), using the search terms Campylobacter pylori and Helicobacter pylori, and reviews and editorials about H. pylori in some of the most widespread clinical journals. RESULTS: 2204 papers on H. pylori were....... pylori in duodenal ulcer disease had been published in some of the most widespread clinical journals. In half of the papers the authors were convinced of the causal role of H. pylori in duodenal ulcer disease, while in the remainder they were sceptical. In seven cases the authors stated which patients...

  11. Chronic venous ulceration of leg associated with peripheral arterial disease: an underappreciated entity in developing country.

    Science.gov (United States)

    Nag, Falguni; De, Abhishek; Hazra, Avijit; Chatterjee, Gobinda; Ghosh, Arghyaprasun; Surana, Trupti V

    2014-10-01

    Chronic venous ulcer can often be associated with asymptomatic peripheral arterial disease (PAD), which usually remains undiagnosed adding significantly to the morbidity of these patients. The Ankle-Brachial Pressure Index (ABPI) is suggested for PAD evaluation. Many PAD studies were conducted in western countries, but there is a scarcity of data on the prevalence of PAD in clinical venous ulcer patient in developing countries. We conducted a study in a tertiary care hospital of eastern part of India to find out the prevalence of PAD in venous ulcer patients, and also to find the sensitivity of ABPI as a diagnostic tool in these patients. We evaluated clinically diagnosed patients with venous ulcer using ABPI and Colour Doppler study for the presence of PAD. Possible associations such as age, sex, body mass index (BMI), smoking, hypertension and atherosclerosis were studied. All results were analysed using the software Statistica version 6. PAD was present in 23 (27·71%) patients. Older age, longer duration, smoking, high BMI and hypertension were found to be significantly associated with PAD. A very strong level of agreement was found between venous Doppler and ABPI. Assessment for the presence of PAD is important in all clinically diagnosed venous ulcer patients. ABPI being a simple, non-invasive outpatient department (OPD)-based procedure, can be routinely used in cases of venous ulcer to find out the hidden cases of PAD even in developing countries. PMID:23170845

  12. Mortality forecast from gastroduodenal ulcer disease for different gender and age population groups in Ukraine

    Directory of Open Access Journals (Sweden)

    Duzhiy I.D.

    2016-03-01

    Full Text Available Until 2030 the ulcer mortality will have a growing trend as estimated by the World Health Organization. Detection of countries and population groups with high risks for the ulcer mortality is possible using forecast method. The authors made a forecast of mortality rate from complicated ulcer disease in males and females and their age groups (15-24, 25-34, 35-54, 55-74, over 75, 15 - over 75 in our country. The study included data of the World Health Organization Database from 1991 to 2012. The work analyzed absolute all-Ukrainian numbers of persons of both genders died from the ulcer causes (К25-К27 coded by the 10th International Diseases Classification. The relative mortality per 100 000 of alive persons of the same age was calculated de novo. The analysis of distribution laws and their estimation presents a trend of growth of the relative mortality. A remarkable increase of deaths from the ulcer disease is observed in males and females of the age after 55 years old. After the age of 75 years this trend is more expressed.

  13. Genital ulcers disease among sexually transmitted disease clinic attendees in Ibadan, Nigeria.

    Science.gov (United States)

    Fawole, O I; Okesola, A O; Fawole, A O

    2000-03-01

    Genital ulcer disease (GUD) is a risk factor in the transmission of human immuno deficiency virus (HIV). The goal of this study is to estimate proportion, identify risk factors, and improve prevention and control of GUD. This is a retrospective study of 211 cases of GUD seen between 1993 and 1997 in an urban public sexually transmitted disease (STD) clinic. Genital ulcers form 7.6% of all STDs seen. Overall, genital herpes was commonest (89 or 42.25%). It was the predominant infection (84 or 44.7%) in the males, while lymphogranuloma venereum (52 or 24.7%) was in females. The peak incidence in both sexes occurred in the 20-29 age group. Males out numbered females by a ratio of 8:1. Most of the patients were single 114 (68.3%) and most 70 or 33.3% were students. Risk markers identified were: casual sex (103 or 53.5%) and multiple sexual partners (77 or 36.5%). Both were significantly higher (P < 0.05) in single patients. Self-treatment, use of multiple drugs and incomplete course of antibiotics were also common. The need to intensify STDS education programmes to all occupational groups and to students in particular is highlighted. Commercial sex workers require periodic education, screening and treatment.

  14. Fecal Calprotectin and Clinical Disease Activity in Pediatric Ulcerative Colitis

    OpenAIRE

    Kaija-Leena Kolho; Dan Turner

    2013-01-01

    Objective. To explore fecal calprotectin levels in pediatric ulcerative colitis (UC) in relation with the validated clinical activity index PUCAI. Methods. This study included all 37 children (median age 14 years) with UC who had calprotectin measured (PhiCal ELISA Test) by the time of PUCAI assessment at the Children's Hospital of Helsinki in a total of 62 visits. Calprotectin values 1000  μ g/g). The best cut-off value for calprotectin for predicting poor outcome was 800  μ g/g (sensitivity...

  15. Genital Ulcer Disease: How Worrisome Is It Today? A Status Report from New Delhi, India

    Directory of Open Access Journals (Sweden)

    Sumathi Muralidhar

    2013-01-01

    Full Text Available Background and Objectives. Genital ulcer diseases represent a diagnostic dilemma, especially in India, where few STI clinics have access to reliable laboratory facility. The changing STI trends require that a correct diagnosis be made in order to institute appropriate treatment and formulate control policies. The objective of this study was to determine recent trends in aetiology of genital ulcers, by using accurate diagnostic tools. Methods. Specimens from 90 ulcer patients were processed for dark field microscopy, stained smears, culture for H. ducreyi, and real-time PCR. Blood samples were collected for serological tests. Results. Prevalence of GUD was 7.45 with mean age at initial sexual experience as 19.2 years. Use of condom with regular and nonregular partners was 19.5% and 42.1%, respectively. Sexual orientation was heterosexual (92.2% or homosexual (2.2%. There were 8 cases positive for HIV (8.9%. Herpes simplex virus ulcers were the commonest, followed by syphilis and chancroid. There were no cases of donovanosis and LGV. Conclusions. A valuable contribution of this study was in validating clinical and syndromic diagnoses of genital ulcers with an accurate aetiological diagnosis. Such reliable data will aid treatment and better define control measures of common agents and help eliminate diseases amenable to elimination, like donovanosis.

  16. Cilostazol prevents foot ulcers in diabetic patients with peripheral vascular disease.

    Science.gov (United States)

    de Franciscis, Stefano; Gallelli, Luca; Battaglia, Luigi; Molinari, Vincenzo; Montemurro, Rossella; Stillitano, Domenico M; Buffone, Gianluca; Serra, Raffaele

    2015-06-01

    Diabetic patients are at high risk of foot ulcerations that may lead to limb amputations with important socio-economic impact. Peripheral vascular disease may be frequently associated in diabetes mellitus type II with its main symptom, intermittent claudication. Many studies reported the known efficacy of cilostazol in treating vascular claudication. Metalloproteinase-9 (MMP-9) seems to be a biochemical marker implicated in chronic wounds and in particular in diabetic foot ulcers. Cilostazol appears to have a lowering effect on MMP-9 levels and this may suggest a beneficial effect in order to prevent or retard the onset of foot ulcer in diabetic patients. In our study, two groups of diabetic patients with peripheral vascular disease were divided into two groups according to the presence of claudication in order to receive cilostazol. Group A (31 patients without claudication) were not eligible to receive cilostazol whereas Group B (47 patients with claudication) received cilostazol administration for 24 weeks (100 mg orally twice daily). Median follow up was of 16 months. During the follow up, 4·25% of patients of Group B and 35·48% of patients of Group A (P ulceration. Although further randomised and controlled studies are required cilostazol seems to show beneficial effects for primary prevention of diabetic foot ulcers.

  17. Managing peptic ulcer and gastroesophageal reflux disease in elderly Chinese patients – focus on esomeprazole

    Directory of Open Access Journals (Sweden)

    Tang RS

    2013-10-01

    Full Text Available Raymond SY Tang, Justin CY Wu Institute of Digestive Disease, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong Abstract: Peptic ulcer disease (PUD and gastroesophageal reflux disease (GERD are not uncommon in elderly patients. Clinical presentations of these acid-related disorders may be atypical in the geriatric population. Older individuals are at increased risk for poor outcomes in complicated PUD and for development of GERD complications. Multiple risk factors (eg, Helicobacter pylori [HP], use of nonsteroidal anti-inflammatory drugs [NSAIDs], aspirin contribute to the development of PUD. Recent data has shown that HP-negative, NSAID-negative idiopathic peptic ulcers are on the rise and carry a higher risk of recurrent ulcer bleeding and mortality. Effective management of PUD in the geriatric population relies on identification and modification of treatable risk factors. Elderly patients with GERD often require long-term acid suppressive therapy. Proton pump inhibitors (PPI including esomeprazole are effective in the treatment of reflux esophagitis, maintenance of GERD symptomatic control, and management of PUD as well as its complications. Potential safety concerns of long-term PPI use have been reported in the literature. Clinicians should balance the risks and benefits before committing elderly patients to long-term PPI therapy. Keywords: elderly patients, peptic ulcer disease, gastroesophageal reflux disease, proton pump inhibitor, esomeprazole

  18. Is there any relationship between season/weather and oral ulcer in Behçet’s disease?

    Science.gov (United States)

    Cansu, Döndü Üsküdar; Kaşifoğlu, Timuçin; Korkmaz, Cengiz

    2014-01-01

    Objective Some rheumatic diseases are being influenced by weather conditions. We examined the relationship between oral ulcers and weather/season in Behçet’s disease (BD) patients and evaluated the oral ulcers’ characteristics by the patients’ perspectives. Material and Methods Patients with BD were evaluated using a self-questionnaire, including patients’ clinical and demographical characteristics and detailed characteristics of oral ulcers and the association with season. Results The most common site of oral ulcers was the tongue (89%). Of 90 patients, there were predisposing factors in oral ulcers. Among patients with BD, 30 believed that seasonal variation aggravated their oral ulcers, especially in winter and autumn. Conclusion The exacerbation of oral ulcers in patients with BD may be related to the seasons. The weather changes in our study are based on the patients’ impression; these should be confirmed by objective findings and clinical assessment in further studies.

  19. The Etiology of Genital Ulcer Disease among Patients Attending Sexually Transmitted Disease Clinics in Guangzhou, China

    Institute of Scientific and Technical Information of China (English)

    GU Jin(谷进); ZENG Zhirong(曾志荣); CHEN Rongzhang(陈荣章); ZHU Huilan(朱慧兰); QIU Xiaoshan(邱晓珊)

    2002-01-01

    Objectives: To investigate the etiology of genital ulcerdisease (GUD) among patients attending sexuallytransmitted disease (STD) clinics in Guangzhou, China.Methods: Between September 8, 1998, and August 9,2001, 267 patients with a genital ulcer were clinicallyassessed. Clinical etiology of GUD was dependent onphysical appearance and microbiologic examination,including the following: dark field microscopy and serologyfor Treponema pallidum (TP), swabs of genital ulcer forHerpes simplex virus (HSV), processed quantitativefluorescent polymerase chain reaction (QF-PCR) forsimultaneous detection of HSV, TP, Haemophilus ducreyi(HD), Human papillomavirus (HPV), and serology for HIVinfection.Results: Two hundred thirty men and thirty-sevenwomen with a median age of 33.4 (range 16-74 years) wereanalyzed. The etiology of GUD was syphilis (26.59%)(71/267), genital herpes (17.60%) (47/267), condylomataacuminata (4.87%) (13/267), candidiasis (3.37%) (9/267),bacterial infection (3.75%) (10/267), and multiple infection(6.74%) (18/267). The seroprevalence of HIV was 0.75%(2/267). No etiology was identified in 50.56% (135/267).Conclusion: The etiology of GUD among STD patients inour area was multifactorial with a predominance of syphilisand genital herpes. Based on this limited data obtained atSTD clinics, HIV infection was not common.

  20. [Prognostication of malignization and acute complications of gastric ulcer disease, using multiparametric neuronet clasterization].

    Science.gov (United States)

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

    2015-03-01

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

  1. The incidence of ulcerative colitis (1995-2011) and Crohn's disease (1995-2012)

    DEFF Research Database (Denmark)

    Nørgård, Bente Mertz; Nielsen, Jan; Fonager, Kirsten;

    2014-01-01

    BACKGROUND AND AIMS: The incidence of ulcerative colitis (UC) and Crohn's disease (CD) has increased during the 20th century in North America and Western Europe. However, there are conflicting reports whether the incidence has declined, stabilized or even continued to increase. No nationwide Danish...

  2. Lipschutz ulcer

    Directory of Open Access Journals (Sweden)

    Bhat Ramesh

    2007-01-01

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

  3. Spontaneous pneumobilia revealing choledocho-duodenal fistula: A rare complication of peptic ulcer disease

    Directory of Open Access Journals (Sweden)

    Massimo Tonolini

    2013-01-01

    Full Text Available Spontaneous pneumobilia without previous surgery or interventional procedures indicates an abnormal biliary-enteric communication, most usually a cholelithiasis-related gallbladder perforation. Conversely, choledocho-duodenal fistulisation (CDF from duodenal bulb ulcer is currently exceptional, reflecting the low prevalence of peptic disease. Combination of clinical data (occurrence in middle-aged males, ulcer history, absent jaundice and cholangitis and CT findings including pneumobilia, normal gallbladder, adhesion with fistulous track between posterior duodenum and pancreatic head allow diagnosis of CDF, and differentiation from usual gallstone-related biliary fistulas requiring surgery. Conversely, ulcer-related CDF are effectively treated medically, whereas surgery is reserved for poorly controlled symptoms or major complications.

  4. [Environmental risk factors in Crohn's disease and ulcerative colitis (excluding tobacco and appendicectomy)].

    Science.gov (United States)

    Jantchou, Prévost; Monnet, Elisabeth; Carbonnel, Franck

    2006-01-01

    A rapid increase in the incidence of Crohn's disease and ulcerative colitis in developed countries, the occurrence of Crohn's disease in spouses, and a lack of complete concordance in monozygotic twins are strong arguments for the role of environmental factors in inflammatory bowel disease (IBD). Research in the field of environmental factors in IBD is based upon epidemiological (geographical and case-control), clinical and experimental studies. The role of two environmental factors has clearly been established in IBD. Smoking is a risk factor for Crohn's disease and a protective factor for ulcerative colitis; appendectomy is a protective factor for ulcerative colitis. Many other environmental factors for IBD have been investigated, including infectious agents, diet, drugs, stress and social status. They are detailed in the present review. Among them, atypical Mycobacteria, oral contraceptives and antibiotics could play a role in Crohn's disease. To date, three hypotheses associate environmental factors with the pathophysiology of IBD (loss of tolerance of intestinal immune system towards commensal bacterial flora): the hygiene, infection and cold chain hypotheses. Much work remains to be done to identify risk factors for IBD. Research identifying environmental factors that might cause a predisposition to IBD is useful. It may lead to disease prevention in subjects who are genetically predisposed and disease improvement in patients. PMID:16885870

  5. Polymorphonuclear leucocytes in Crohn's disease and ulcerative proctocolitis: association between enhanced adherence to nylon fibre and disease variables.

    OpenAIRE

    Cason, J; Ainley, C C; Wolstencroft, R. A.; Thompson, R P

    1988-01-01

    The adherence of polymorphonuclear leucocytes (PMN) to nylon fibre was investigated in patients with Crohn's disease, ulcerative proctocolitis, and anorexia nervosa, and compared with changes of circulating PMNs, C reactive protein concentrations, erythrocyte sedimentation rates, and clinical assessment of disease activity. PMN adherence was in excess of the maximum value detected for healthy subjects in 14 of 25 patients with Crohn's disease and two of 10 with proctocolitis, but it was withi...

  6. Fecal calprotectin level correlated with both endoscopic severity and disease extent in ulcerative colitis

    OpenAIRE

    Kawashima, Kousaku; Ishihara, Shunji; Yuki, Takafumi; Fukuba, Nobuhiko; Oshima, Naoki; Kazumori, Hideaki; Sonoyama, Hiroki; Yamashita, Noritsugu; Tada, Yasumasa; Kusunoki, Ryusaku; Oka, Akihiko; Mishima, Yoshiyuki; Moriyama, Ichiro; Kinoshita, Yoshikazu

    2016-01-01

    Background The relationship between fecal calprotectin (FC) and disease extent in ulcerative colitis (UC) has not been fully elucidated. The aim of this study was to clarify the correlation of FC with disease extent and severity in UC patients. Methods UC patients scheduled to undergo an ileocolonoscopy were enrolled and fecal samples for FC measurement were collected prior to the procedure. A Mayo endoscopic subscore (MES) was determined for each of 5 colonic segments. To evaluate the associ...

  7. Sexual behaviour in Zulu men and women with genital ulcer disease.

    OpenAIRE

    O'Farrell, N; Hoosen, A A; Coetzee, K D; van den Ende, J.

    1992-01-01

    OBJECTIVE--To investigate patterns of sexual behaviour in men and women with genital ulcer disease (GUD) and their relevance to HIV-1 transmission. METHODS--A sexual behaviour questionnaire was administered by the same interviewer to all participants who were also entered into a study of the microbial aetiology of GUD. SETTING--City Health Sexually Transmitted Diseases Clinic, King Edward VIII Hospital, Durban, South Africa. PARTICIPANTS--100 Zulu men and 100 Zulu women. RESULTS--36 (%) of me...

  8. Accuracy of abdominal ultrasound and MRI for detection of Crohn disease and ulcerative colitis in children

    Energy Technology Data Exchange (ETDEWEB)

    Ziech, Manon L.W.; Smets, Anne M.J.B.; Lavini, Cristina; Caan, Matthan W.A.; Nederveen, Aart J.; Bipat, Shandra; Stoker, Jaap [Academic Medical Center, Department of Radiology, Amsterdam (Netherlands); Hummel, Thalia Z.; Benninga, Marc A.; Kindermann, Angelika [Emma Children' s Hospital, Academic Medical Center, Department of Pediatric Gastroenterology, Amsterdam (Netherlands); Nievelstein, Rutger A.J. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Roelofs, Joris J.T.H. [Academic Medical Center, Department of Pathology, Amsterdam (Netherlands)

    2014-11-15

    Endoscopy is currently the primary diagnostic technique for inflammatory bowel disease (IBD) in children. To assess the accuracy of US and dynamic contrast-enhanced MRI for diagnosing inflammatory bowel disease and for distinguishing Crohn disease and ulcerative colitis in comparison to a reference standard. Consecutive children with suspected IBD underwent diagnostic workup including ileocolonoscopy and upper gastrointestinal endoscopy as the reference standard, abdominal US, and MR enterography and colonography at 3 T. The protocol included a dynamic contrast-enhanced 3-D sequence. Sensitivity, specificity and kappa values were calculated for one ultrasonographer and two MRI observers. We included 28 children (15 boys) with mean age 14 years (range 10-17 years). The diagnosis was IBD in 23 children (72%), including 12 with Crohn disease, 10 with ulcerative colitis and 1 with indeterminate colitis. For the diagnosis of inflammatory bowel disease the sensitivity was 55% for US and 57% (both observers) for MR entero- and colonography, and the specificity was 100% for US and 100% (observer 1) and 75% (observer 2) for MR entero- and colonography. Combined MRI and US had sensitivity and specificity of 70% and 100% (observer 1) and 74% and 80% (observer 2), respectively. With the addition of a dynamic contrast-enhanced MR sequence, the sensitivity increased to 83% and 87%. US and MRI could only distinguish between Crohn disease and ulcerative colitis when terminal ileum lesions were present. US and MR entero- and colonography have a high accuracy for diagnosing inflammatory bowel disease in children but cannot be used to distinguish Crohn disease and ulcerative colitis. (orig.)

  9. Fecal Calprotectin and Clinical Disease Activity in Pediatric Ulcerative Colitis

    Science.gov (United States)

    Kolho, Kaija-Leena; Turner, Dan

    2013-01-01

    Objective. To explore fecal calprotectin levels in pediatric ulcerative colitis (UC) in relation with the validated clinical activity index PUCAI. Methods. This study included all 37 children (median age 14 years) with UC who had calprotectin measured (PhiCal ELISA Test) by the time of PUCAI assessment at the Children's Hospital of Helsinki in a total of 62 visits. Calprotectin values 1000 μg/g). The best cut-off value for calprotectin for predicting poor outcome was 800 μg/g (sensitivity 73%, specificity 72%; area under the ROC curve being 0.71 (95%CI 0.57–0.85)) and for the PUCAI best cut-off values >10 (sensitivity 62%, specificity 64%; area under the ROC curve 0.714 (95%CI 0.58–0.85)). Conclusion. The clinical relevance of somewhat elevated calprotectin during clinical remission in pediatric UC is not known and, until further evidence accumulates, does not indicate therapy escalation. PMID:23533791

  10. Helicobacter pylori virulence genes and host genetic polymorphisms as risk factors for peptic ulcer disease.

    Science.gov (United States)

    Miftahussurur, Muhammad; Yamaoka, Yoshio

    2015-01-01

    Helicobacter pylori infection plays an important role in the pathogenesis of peptic ulcer disease (PUD). Several factors have been proposed as possible H. pylori virulence determinants; for example, bacterial adhesins and gastric inflammation factors are associated with an increased risk of PUD. However, differences in bacterial virulence factors alone cannot explain the opposite ends of the PUD disease spectrum, that is duodenal and gastric ulcers; presumably, both bacterial and host factors contribute to the differential response. Carriers of the high-producer alleles of the pro-inflammatory cytokines IL-1B, IL-6, IL-8, IL-10, and TNF-α who also carry low-producer allele of anti-inflammatory cytokines have severe gastric mucosal inflammation, whereas carriers of the alternative alleles have mild inflammation. Recent reports have suggested that the PSCA and CYP2C19 ultra-rapid metabolizer genotypes are also associated with PUD.

  11. A STUDY ON HEALTH SEEKING BEHAVIOR OF PATIENTS WITH GENITAL ULCER DISEASE

    OpenAIRE

    Meetesh; Swarupa

    2014-01-01

    BACKGROUND: In developing countries, the proportion with STDs who present with genital ulcers is high compared to developed nations. AIM: 1. To study reaction of the cases toward their disease. 2. To study communication of cases with their partners. 3. To study treatment of symptoms and starting treatment, selfmedication & completion of treatment. 4. To study approach of health care providers. STUDY SETTINGS: Present study was carried out in Department of skin and VD, Medical College and SSG ...

  12. Comparison of Behcet's disease and recurrent aphthous ulcer according to characteristics of gastrointestinal symptoms.

    Science.gov (United States)

    Rhee, Seung-Ho; Kim, Young-Bae; Lee, Eun-So

    2005-12-01

    Behcet's disease (BD) is a multisystemic chronic inflammatory disease. It is characterized by recurrent oral and genital ulcers, uveitis, skin lesions and other manifestations, including neurologic, vascular, joint, and gastrointestinal ulcers of variable severity. Recurrent aphthous ulcer (RAU) represents a very common, but poorly understood, mucosal disorder. If a patient of RAU without any other typical symptoms of BD has gastrointestinal symptoms, it is difficult to distinguish this RAU from true BD with gastrointestinal involvement. Because pathognomonic clinical features and tools are absent, the differential diagnosis of these two diseases relies on the characteristic clinical features and the judgement of an experienced physician. Sixty-five out of a total 960 RAU patients and forty-four of 556 BD patients with gastrointestinal symptoms between January 1996 and December 2003 participated in this study. All were evaluated with esophagogastroduodenoscopy and colonoscopy. Clinical, endoscopic and histopathologic findings were analyzed and ELISA tests were conducted to detect serum levels of ASCA and pANCA. No significant difference was found between the two groups. Differential diagnosis between RAU with gastrointestinal symptoms and BD with gastrointestinal involvement requires further prospective, large-scale study. PMID:16361807

  13. Opinions in Denmark on the causes of peptic ulcer disease. A survey among Danish physicians and patients

    DEFF Research Database (Denmark)

    Christensen, A H; Gjørup, T; Andersen, I B;

    1994-01-01

    The aim of the study was to investigate opinions among Danish patients and physicians on causes of peptic ulcer disease. Fifty-nine patients with an ulcer history and 77 physicians with a special interest in gastroenterology participated. They were given a questionnaire listing 16 possible causes...... of peptic ulcer and indicated for each whether they believed it was a contributory cause of the disease. The patients stated 0-10 causes each (median, 4), and the physicians 3-12 causes (median, 6) (p causes than did the older ones (p ... stated more causes than did their male colleagues (p causes of peptic ulcer disease, whereas only around 40% believed that coffee/tea, alcohol, smoking, side effects...

  14. Do clinicians accept the role of Helicobacter pylori in duodenal ulcer disease: a survey of European gastroenterologists and general practitioners

    DEFF Research Database (Denmark)

    Christensen, A H; Logan, R P; Noach, L A;

    1994-01-01

    OBJECTIVES. To examine to what extent clinicians in Europe accepted the theory of the casual role of Helicobacter pylori (H.pylori) in duodenal ulcer disease in the year 1992, and to what extent the theory had influenced their diagnostic and therapeutic habits in the management of duodenal ulcer...... to be a significant cause of duodenal ulcer disease, use of diagnostic tests for detection of H. pylori and therapeutic regimens for eradicating H. pylori. RESULTS. Four hundred and forty-two doctors replied. Eighty-four per cent of the British doctors, 73% of the Dutch doctors, and 47% of the Danish doctors accepted...... the role of H. pylori in duodenal ulcer disease. The rates were higher among gastroenterologists than among general practitioners. Eighty-four per cent of the British doctors, 80% of the Dutch doctors, and 48% of the Danish doctors used diagnostic tests for H. pylori, most frequently histological...

  15. The Association of Helicobacter pylori Eradication with the Occurrences of Chronic Kidney Diseases in Patients with Peptic Ulcer Diseases

    Science.gov (United States)

    Wang, Jiunn-Wei; Hsu, Chien-Ning; Tai, Wei-Chen; Ku, Ming-Kun; Hung, Tsung-Hsing; Tseng, Kuo-Lun; Yuan, Lan-Ting; Nguang, Seng-Howe; Liang, Chih-Ming; Yang, Shih-Cheng; Wu, Cheng-Kun; Hsu, Pin-I; Wu, Deng-Chyang; Chuah, Seng-Kee

    2016-01-01

    The association of Helicobacter pylori eradication with the occurrence of renal dysfunction in patients with peptic ulcer diseases is still unclear. This study aimed to clarify the relevance of H. pylori eradication to the occurrence of chronic kidney diseases in patients with peptic ulcer diseases. Data that were available from 2000–2011 were extracted from the National Health Insurance Research Database in Taiwan, and all patients with peptic ulcer diseases (n = 208 196) were screened for eligibility. We divided randomly selected patients into an H. pylori eradication cohort (cohort A, n = 3593) and matched them by age and sex to a without H. pylori eradication cohort (cohort B, n = 3593). Subgroup analysis was further performed for H. pylori eradication within ≤ 90 days of the diagnosis date (early eradication, n = 2837) and within 91–365 days (non-early eradication, n = 756). Cox proportional hazards regression analysis was used to estimate the association of H. pylori eradication with the risk of developing chronic kidney diseases and mortality. We observed that there were more patients suffering from chronic kidney disease in cohort B than in the early eradication subgroup of cohort A (8.49% vs. 6.70%, respectively, p = 0.0075); the mortality rate was also higher in cohort B (4.76% vs. 3.70%, respectively, p = 0.0376). Old age, pulmonary disease, connective tissue disorders, and diabetes were risk factors for chronic kidney diseases but early H. pylori eradication was a protective factor against chronic kidney diseases (hazard ratio: 0.68, 95% confidence interval: 0.52–0.88, p = 0.0030), and death (hazard ratio: 0.69, 95% confidence interval: 0.49–0.96, p = 0.0297). In conclusion, our findings have important implications suggesting that early H. pylori eradication is mandatory since it is associated with a protective role against the occurrence of chronic kidney diseases. PMID:27764171

  16. Ulcerative enteritis-like disease associated with Clostridium sordellii in quail.

    Science.gov (United States)

    Crespo, Rocio; Franca, Monique; Shivaprasad, H L

    2013-09-01

    A natural outbreak of ulcerative enteritis-like disease associated with Clostridium sordellii was diagnosed in two commercial quail flocks. Clinical signs in the quail included anorexia, weakness, and increased mortality in the flocks. Lesions in the intestine were characterized by ulcers covered with fibrinonecrotic exudate in the small intestine and occasional hemorrhages. There were also multifocal pale areas of necrosis in the liver. Clostridium sordellii was isolated from the intestine and liver. A retrospective study of avian cases submitted to the California Animal Health and Food Safety Laboratories revealed that C. sordellii had been isolated in 45 avian submissions, most commonly in chickens and turkeys. In most of these cases the birds were diagnosed with necrotic enteritis, with or without hepatitis. Clostridium sordellii has occasionally been associated with gangrenous dermatitis in poultry, but this is the first report of enteritis in an avian species.

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

    DEFF Research Database (Denmark)

    Holstein, P; Lassen, N A

    1980-01-01

    The frequency of healing in subchronic ulcers in 66 feet in 62 patients with arterial occlusive disease was correlated with the systolic digital blood pressure (SDBP) and the systolic ankle blood pressure (SABP), both measured with a strain gauge, and with the skin perfusion pressure on the heel...... of healing correlated significantly with the three distal blood pressure parameters investigated, the closest correlation being with the SDBP measured at the final examination, i.e. just after healing of the ulcer or just before an inevitable major amputation. Of the 22 cases with SDBP below 20 mmHg only two...... and peripheral neuropathy were frequent in the diabetic group. The data show that the systolic digital blood pressure is a particularly valuable prognostic parameter....

  18. Genotyping of Helicobacter pylori Strains Isolated from Patients with Gastric Ulcer and Non Ulcer Disease using RFLP-PCR of ureAB, vacA , cagA Genes

    Directory of Open Access Journals (Sweden)

    Sh. Farshad

    2008-10-01

    Full Text Available Introduction & Objective: Different studies show that the reasons for clinically diverse outcomes of infections caused by H. pylori may include host and environmental factors as well as differences in the prevalence or expression of bacterial virulence factors. The aim of this study was to study the distribution of different genotypes of major virulence factors cagA, vacA and ureAB among H. pylori strains isolated from patients with gastric ulcer (ulcerative disease and patients with gastritis (non ulcerative disease.Materials & Methods: In this cross sectional study 65 H. pylori strains, 30 from patients with gastric ulcer and 35 from patients with non ulcerative gastritis disease were investigated by RFLP-PCR.Results: The prevalence of vacA-positive strains in ulcerative patients was significantly more than that in non ulcerative patients (P0.05.Conclusion: It seems that in the patients under our study the presence of cagA gene may not necessarily be a risk factor for ulcer disease, while a homologous genotype of vacA appears to be associated with an increase risk of ulcer development. Lastly, despite the existence of a high degree of genomic variability within ureAB, conserved DNA banding profiles are distributed in our areas.

  19. Concentrations of metals in gastric juice in health and peptic ulcer disease.

    OpenAIRE

    Powell, J J; S. M. Greenfield; Thompson, R P

    1992-01-01

    The concentrations of essential metal cations in gastric juice, collected at endoscopy from 17 normal patients and 11 with peptic ulcer disease, were determined by inductively coupled plasma emission spectrometry. Mean fasting levels in normal gastric juice were as follows: sodium 47.7 mM, potassium 14.6 mM, calcium 0.8 mM, magnesium 0.36 mM, zinc 13 microM, and copper 1.2 microM: these did not differ significantly in health or disease. Because samples were contaminated with iron, the concent...

  20. Necrosante periodontal disease: ulcerative gengivitis necrosante – case report

    Directory of Open Access Journals (Sweden)

    Maurício Colin B. CORDEIRO

    2004-11-01

    Full Text Available This project proposes to discuss the clinical characteristics ofGUN and its differentiated diagnostics with the PUN under thenew optical classification of necrosante periodontal disease. Dealswith a clinical case of an 18 year old female patient, with symptomsof limited gingival necroses at the gingival vestibule edge and theinter-dental papilla in the upper back region, with painfulsymptoms, gum bleeding when touched, dental calculus, largequantity of visible bacterial plaque and bad breath not significant,with the absence of linfoadenopathy, fever, pseudomembrane, andno discomfort. During the discussion of the patient’s medicalhistory she reports that she is healthy, except for the possibledevelopment of emotional stress. The treatment plan isconservative (educational orientation on health, coronary scraping,and smoothing out of the root on the entire oral cavity, prophylaxis,topical chemical treatment, of the bacterial plaque with hydrogenperoxide H2O2 and oral hygiene monitoring utilizing the visibleindex of plaque – IPV – and the edge gum bleeding – ISG. Antibiotictherapy was not used. The treatment is weekly. At the end of thisperiod there is a complete reestablishing of the periodontal healthso, her return for preventive periodontal maintenance wasscheduled, in 4 months. For this reason, this case agrees with thedecision of the committee responsible for the elaboration of thenew classification for the periodontal disease for it to be placed inthe same category “necrosante periodontal disease”.

  1. Management of leg ulcers

    OpenAIRE

    Sarkar, P; Ballantyne, S

    2000-01-01

    Leg ulcer is a leading cause of morbidity among older subjects, especially women in the Western world. About 400 years BC, Hippocrates wrote, "In case of an ulcer, it is not expedient to stand, especially if the ulcer be situated on the leg". Hippocrates himself had a leg ulcer. The best treatment of any leg ulcer depends upon the accurate diagnosis and the underlying aetiology. The majority of leg ulcers are due to venous disease and/or arterial disease, but the treatment of the underlying c...

  2. Use of Recombinant Virus Replicon Particles for Vaccination against Mycobacterium ulcerans Disease.

    Science.gov (United States)

    Bolz, Miriam; Kerber, Sarah; Zimmer, Gert; Pluschke, Gerd

    2015-01-01

    Buruli ulcer, caused by infection with Mycobacterium ulcerans, is a necrotizing disease of the skin and subcutaneous tissue, which is most prevalent in rural regions of West African countries. The majority of clinical presentations seen in patients are ulcers on limbs that can be treated by eight weeks of antibiotic therapy. Nevertheless, scarring and permanent disabilities occur frequently and Buruli ulcer still causes high morbidity. A vaccine against the disease is so far not available but would be of great benefit if used for prophylaxis as well as therapy. In the present study, vesicular stomatitis virus-based RNA replicon particles encoding the M. ulcerans proteins MUL2232 and MUL3720 were generated and the expression of the recombinant antigens characterized in vitro. Immunisation of mice with the recombinant replicon particles elicited antibodies that reacted with the endogenous antigens of M. ulcerans cells. A prime-boost immunization regimen with MUL2232-recombinant replicon particles and recombinant MUL2232 protein induced a strong immune response but only slightly reduced bacterial multiplication in a mouse model of M. ulcerans infection. We conclude that a monovalent vaccine based on the MUL2232 antigen will probably not sufficiently control M. ulcerans infection in humans.

  3. Use of Recombinant Virus Replicon Particles for Vaccination against Mycobacterium ulcerans Disease.

    Directory of Open Access Journals (Sweden)

    Miriam Bolz

    Full Text Available Buruli ulcer, caused by infection with Mycobacterium ulcerans, is a necrotizing disease of the skin and subcutaneous tissue, which is most prevalent in rural regions of West African countries. The majority of clinical presentations seen in patients are ulcers on limbs that can be treated by eight weeks of antibiotic therapy. Nevertheless, scarring and permanent disabilities occur frequently and Buruli ulcer still causes high morbidity. A vaccine against the disease is so far not available but would be of great benefit if used for prophylaxis as well as therapy. In the present study, vesicular stomatitis virus-based RNA replicon particles encoding the M. ulcerans proteins MUL2232 and MUL3720 were generated and the expression of the recombinant antigens characterized in vitro. Immunisation of mice with the recombinant replicon particles elicited antibodies that reacted with the endogenous antigens of M. ulcerans cells. A prime-boost immunization regimen with MUL2232-recombinant replicon particles and recombinant MUL2232 protein induced a strong immune response but only slightly reduced bacterial multiplication in a mouse model of M. ulcerans infection. We conclude that a monovalent vaccine based on the MUL2232 antigen will probably not sufficiently control M. ulcerans infection in humans.

  4. Review article: insurance risks for patients with ulcerative colitis or Crohn's disease.

    Science.gov (United States)

    Travis, S P

    1997-02-01

    Prospective population-based studies have allowed a re-evaluation of the risks of insuring patients with ulcerative colitis or Crohn's disease. Life expectancy, the risk of cancer and working capacity are very much better than previously recognised and are normal for many patients. Three population-based studies in ulcerative colitis have shown a mortality similar to or slightly less than the general population except in the first year after diagnosis, whilst two have shown a slightly higher mortality (standardized mortality ratio, SMR = 1.4), except for those with proctitis. In Crohn's disease, two population-based studies have also shown an increased mortality (SMR = 1.4), which is similar to that of unskilled manual labourers (SMR = 1.43) from all causes of death. Three other studies have shown no increase in overall mortality, except in the first 5 years after diagnosis, in those with proximal small intestinal disease and in some patients needing multiple operations. Insurance risks should be evaluated on an individual basis, after details of the extent and pattern of disease have been obtained. Although the 'standard life' in insurance terms differs from that of the general population, because people who seek life assurance are self-selected from a more affluent section of society, many patients can be identified who have a particularly good prognosis. These include patients with ulcerative proctitis, those with left-sided colitis in extended remission (> 12 months), and patients more than 30 years old with localized ileal or ileocaecal Crohn's disease that has responded to treatment. From the published data, it is difficult to justify increasing the insurance premium in such patients.

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

    Directory of Open Access Journals (Sweden)

    Ignacio López de Maturana

    2013-01-01

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

  6. Diabetic foot disease: From the evaluation of the “foot at risk” to the novel diabetic ulcer treatment modalities

    OpenAIRE

    Amin, Noha; Doupis, John

    2016-01-01

    The burden of diabetic foot disease (DFD) is expected to increase in the future. The incidence of DFD is still rising due to the high prevalence of DFD predisposing factors. DFD is multifactorial in nature; however most of the diabetic foot amputations are preceded by foot ulceration. Diabetic peripheral neuropathy (DPN) is a major risk factor for foot ulceration. DPN leads to loss of protective sensation resulting in continuous unconscious traumas. Patient education and detection of high ris...

  7. [Peptic ulcer disease and helicobacter pylori: How we know what we know].

    Science.gov (United States)

    Scholl, Raphael

    2015-07-01

    The bacterium Helicobacter pylori is one of the main causes of peptic ulcers. But how was this causal relationship demonstrated? A historical and philosophical analysis of a series of studies conducted during the 1980s can elucidate the question. In the beginning, a mere correlation between the newly discovered bacterium and peptic ulcers was found in gastric biopsies. It remained an open question whether the bacterium caused the disease, or whether it constituted merely an opportunistic infection. Yet determining the direction of causality was difficult in the absence of an animal model: Even though gastritis was observed in a courageous self-experiment involving a swallowed bacterial culture, tf!e significance of the individual case was small. The failings of the self-experiment could only be rectified by a randomised, placebo-controlled trial which met the requirements of Koch's third postulate. Moreover, it was necessary to gain an initial understanding of the mechanism by which the causal relationship between H. pylori and peptic ulcers is mediated: How, forexample, does the bacterium survive in the acid environment of the stomach? The study of the case from the perspective of the history and philosophy of science illustrates how medical knowledge is established incrementally.

  8. Polymorphonuclear leucocytes in Crohn's disease and ulcerative proctocolitis: association between enhanced adherence to nylon fibre and disease variables.

    Science.gov (United States)

    Cason, J; Ainley, C C; Wolstencroft, R A; Thompson, R P

    1988-03-01

    The adherence of polymorphonuclear leucocytes (PMN) to nylon fibre was investigated in patients with Crohn's disease, ulcerative proctocolitis, and anorexia nervosa, and compared with changes of circulating PMNs, C reactive protein concentrations, erythrocyte sedimentation rates, and clinical assessment of disease activity. PMN adherence was in excess of the maximum value detected for healthy subjects in 14 of 25 patients with Crohn's disease and two of 10 with proctocolitis, but it was within the normal range for all eight with anorexia nervosa. High adherence in Crohn's disease, however, was not associated with quantitative or qualitative changes of PMN populations, absolute concentrations of C reactive protein, erythrocyte sedimentation rates, disease severity, drug regimens, malnutrition, or zinc deficiency. High PMN adherence in Crohn's disease may therefore reflect the activation in vivo of normal PMN by humoral factors. PMID:3360954

  9. Helicobacter pylori among patients with symptoms of gastroduodenal ulcer disease in rural Uganda

    Directory of Open Access Journals (Sweden)

    Lawrence Tsongo

    2015-11-01

    Full Text Available Introduction: To meet key millennium development goals, the rural population needs to be reached for health assessment and service delivery. Gastroduodenal ulcer disease is a common ailment affecting the health of people in Uganda. A cross-sectional study was conducted at Bwera Hospital in Kasese district of western Uganda, to establish the prevalence and predisposing factors of Helicobacter pylori among gastroduodenal ulcer disease patients. Methods: A sample of 174 patients with symptoms of gastroduodenal ulcer disease was purposively obtained. Using two laboratory test methods, the prevalence of H. pylori among these patients was determined. A structured questionnaire was administered to participants to establish their demographic background and selected aspects of their lifestyle. Finally, the results obtained by enzyme-linked immunosorbent assay (ELISA and immunochromatographic rapid test (IRT were compared. Results: We established the prevalence of H. pylori as 29.9% (52/174 by ELISA and 37.4% (65/174 by IRT. Cigarette smoking, poor sanitation, and lack of formal education were the significant predisposing factors with p-values <0.05. The two tests gave identical results in 87.9% of the patients. Discussion: The prevalence of H. pylori by IRT and ELISA test methods was similar to what has been reported elsewhere in developed countries; but was lower than previously reported in developing countries including Uganda. The previous studies in Uganda were carried out in the urban population and on young children; and some used antibody-detection methods only, therefore leading to different prevalence as a result of difference in study population and methods.

  10. Noninfectious genital ulcers.

    Science.gov (United States)

    Kirshen, Carly; Edwards, Libby

    2015-12-01

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

  11. A study of endotoxemia in ulcerative colitis and Crohn's disease. I. Clinical study.

    Directory of Open Access Journals (Sweden)

    Aoki,Kunitake

    1978-06-01

    Full Text Available Endotoxin (lipopolysaccharide, LPS and LPS antibody in the blood were studied in 61 cases of ulcerative colitis (U.C. by radioimmunoassay. Lysozyme (LZM concentration was also studied by the turbidimetric method. As a result, it was found that the blood LPS value as well as serum LZM concentration reflects the clinical observations. The case of endotoxemia in the active phase group showed a positive correlation between the LPS value and LZM concentration. LPS antibody which could not be detected in many cases of the active phase, had a high titer in cases of remission with a long history of the disease. These results would suggest that in U.C. with damaged intestinal mucosal barrier, LPS originating from intestinal flora enters into the blood and aggravates the disease and further that this invading LPS releases LZM into the blood. The same studies were performed on 7 cases of Crohn's disease and the same result was obtained.

  12. Risk factors and therapeutic response in Chinese patients with peptic ulcer disease

    Institute of Scientific and Technical Information of China (English)

    Shou-Wu; Lee; Teng-Yu; Lee; Hong-Zen; Yeh; Chun-Fang; Tung; Yen-Chun; Peng

    2010-01-01

    AIM:To assess the risk factors and the eff icacy of medications of patients with gastric and duodenal ulcers among Chinese patients in Taiwan.METHODS:Patients with peptic ulcers,diagnosed by upper endoscopy,were retrospectively collected between January 2008 and December 2008.The differences were compared.RESULTS:Among all 448 cases,254(56.6%) and 194(43.4%) patients had gastric ulcers and duodenal ulcers respectively.Patients with gastric ulcers were younger than those with duodenal ulcers.Although more me...

  13. Selective biologics for ulcerative colitis and Crohn's disease – clinical utility of vedolizumab

    Directory of Open Access Journals (Sweden)

    Petkau JM

    2016-03-01

    Full Text Available Jill MV Petkau, Bertus Eksteen Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada Abstract: Inflammatory bowel disease (IBD encompasses a cluster of different disease phenotypes which are broadly classified into ulcerative colitis and Crohn's disease. Disease pathogenesis is driven by abnormal host immune responses to their resident gut microbiome in genetically susceptible individuals. Clinical disease features and outcomes are heterogenous and not unexpected as over 163 genetic loci are associated with disease susceptibility, and there are great variability in environmental exposures. Despite this variability, there has been relatively few efficacious therapies for particularly moderate-to-severe IBD. Treatment has been dominated by antitumor necrosis alpha agents with significant success but equally potentially serious adverse events. Therapeutic targeting of leucocyte trafficking has emerged as a viable alternative therapy, with vedolizumab being the lead compound. This review focuses primarily on its biological function as a selective gut immunotherapy, its safety and efficacy, and its emerging role as a mainstream therapy in managing IBD. Keywords: adhesion molecule antagonist, anti-α4β7 integrin, inflammatory bowel disease, leukocyte trafficking, monoclonal antibody, selective gut immunotherapy, tumor necrosis factor alpha

  14. Importance of Helicobacter pylori eradcation for maintenance of remission of drug associated peptic ulcer disease

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    Dajani A

    2006-01-01

    Full Text Available Background: The role of Helicobacter pylori (H. pylori eradication in non-steroidal anti inflammatory drug (NSAID users with peptic ulcer disease is controversial especially in countries with a high prevalence of the infection. Furthermore the value of low dose omeprazole for maintenance of remission is not yet known. Patients and methods: 138 symptomatic out-patients receiving continuous COX 1 NSAID therapy, were treated with omeprazole 40mg/day upon endoscopic confirmation of gastro-duodenal ulceration or erosions while those infected with H. pylori received in addition clarithromycin 500 mg and amoxycillin 1000 mg twice daily during the first week of treatment. After endoscopic confirmation of healing at the end of week 5, the patients were randomized to receive omeprazole 10 mg (n=50 or 20 mg once daily (n=66 and endoscopy repeated after 20 weeks. Results: The overall healing rate (per protocol at five weeks (116/128 was 90.6% while in 85.5% (65/76 eradication was successful. The healing rate for the H. pylori eradicated patients (58/65 was 89.2%. For those who failed eradication (8/11 it was 72.7% (NS, while for patients not infected with H. pylori at entry to the study (50/52 it was 96.2% (NS. An intention to treat analysis showed that after 20 weeks of omeprazole prophylaxis with the 10mg dose 86% (43/50 had maintained healing while for the 20mg dose a similar figure was observed (87.9; 58/66. Only three patients in the two groups (pp had persistent H. pylori infection, all of whom relapsed. No patients discontinued treatment because of adverse effects of the drugs. Conclusion: H. pylori eradication was not associated with impaired ulcer healing in a Middle Eastern population with symptomatic NSAID induced gastro/duodenal lesions, when a high healing dose of omeprazole (40 mg was used. After eradication, omeprazole 10 or 20 mg per day were highly and equally effective for maintenance of gastroduodenal mucosal integrity during continued

  15. Diabetic foot disease: From the evaluation of the “foot at risk” to the novel diabetic ulcer treatment modalities

    Science.gov (United States)

    Amin, Noha; Doupis, John

    2016-01-01

    The burden of diabetic foot disease (DFD) is expected to increase in the future. The incidence of DFD is still rising due to the high prevalence of DFD predisposing factors. DFD is multifactorial in nature; however most of the diabetic foot amputations are preceded by foot ulceration. Diabetic peripheral neuropathy (DPN) is a major risk factor for foot ulceration. DPN leads to loss of protective sensation resulting in continuous unconscious traumas. Patient education and detection of high risk foot are essential for the prevention of foot ulceration and amputation. Proper assessment of the diabetic foot ulceration and appropriate management ensure better prognosis. Management is based on revascularization procedures, wound debridement, treatment of infection and ulcer offloading. Management and type of dressing applied are tailored according to the type of wound and the foot condition. The scope of this review paper is to describe the diabetic foot syndrome starting from the evaluation of the foot at risk for ulceration, up to the new treatment modalities. PMID:27076876

  16. Diabetic foot disease: From the evaluation of the "foot at risk" to the novel diabetic ulcer treatment modalities.

    Science.gov (United States)

    Amin, Noha; Doupis, John

    2016-04-10

    The burden of diabetic foot disease (DFD) is expected to increase in the future. The incidence of DFD is still rising due to the high prevalence of DFD predisposing factors. DFD is multifactorial in nature; however most of the diabetic foot amputations are preceded by foot ulceration. Diabetic peripheral neuropathy (DPN) is a major risk factor for foot ulceration. DPN leads to loss of protective sensation resulting in continuous unconscious traumas. Patient education and detection of high risk foot are essential for the prevention of foot ulceration and amputation. Proper assessment of the diabetic foot ulceration and appropriate management ensure better prognosis. Management is based on revascularization procedures, wound debridement, treatment of infection and ulcer offloading. Management and type of dressing applied are tailored according to the type of wound and the foot condition. The scope of this review paper is to describe the diabetic foot syndrome starting from the evaluation of the foot at risk for ulceration, up to the new treatment modalities.

  17. Opinions in Denmark on the causes of peptic ulcer disease. A survey among Danish physicians and patients

    DEFF Research Database (Denmark)

    Christensen, A H; Gjørup, T; Andersen, I B;

    1994-01-01

    stated more causes than did their male colleagues (p psychologic factors, such as grief, anxiety, and stress, were contributory causes of peptic ulcer disease, whereas only around 40% believed that coffee/tea, alcohol, smoking, side effects...... of medicine, and working conditions played a causal role. Around 95% of the physicians indicated that medical drugs and smoking were contributory causes of peptic ulcer disease, and around 80% that alcohol and psychologic factors were so. Only 30-40% of the physicians believed that coffee/tea, food habits...

  18. Differential diagnosis of leg ulcers.

    Science.gov (United States)

    Pannier, F; Rabe, E

    2013-03-01

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

  19. A pilot study of Helicobacter pylori genotypes and cytokine gene polymorphisms in reflux oesophagitis and peptic ulcer disease.

    Science.gov (United States)

    Akdogan, R A; Ozgur, O; Gucuyeter, S; Kaklikkaya, N; Cobanoglu, U; Aydin, F

    2014-01-01

    Helicobacter pylori causes various diseases such as chronic gastritis, peptic ulcer and gastric cancer. While majority of the people infected with H. pylori is asymptomatic, 15-20 % of them develop such diseases. The main factors, which determine the development of H. pylori related diseases might be bacterial virulence, host genetic and environmental factors.The aim of this study was to reveal the factors that play a role in the disease development in patients with reflux esophagitis and peptic ulcer, infected with Helicobacter pylori. Environmental factors such as medical agents, smoking and body mass index were evaluated. The factors specific to bacteria such as vacA, CagA, babA and iceA virulence genotypes and the host factors such as IL-1, IL-2, IL-4, IL-6, IL-10, IL-12, interferon-γ, TNF-α, ve TGF-β1 gene polymorphisms were compared between the two groups.H. pylori infected twenty five patients with reflux esophagitis and peptic ulcer were enrolled in the study. There was no statistical difference between the two groups regarding environmental factors. IL-2 -330T +166T (p=0.037) and IL10 -1082A; -819C (p=0.049) gene polymorphisms were significantly more common in the group of patients with peptic ulcer compared to the group with reflux esophagitis. In both groups of patients, either with reflux esophagitis or peptic ulcer, multiple H. pylori virulence genotypes (cagA, vacA, babA) (mean values 74 %, 78 %, 54 % respectively) were observed.In this study, we revealed that cytokine gene polymorphisms may play a role in the development peptic ulcer while H. pylori virulence genotypes seem to be crucial for the development of associated diseases (Tab. 4, Ref. 51).

  20. An erosive/ulcerative alimentary disease of undetermined etiology in Swedish moose (AIces alces L.

    Directory of Open Access Journals (Sweden)

    Margareta Stéen

    1993-12-01

    Full Text Available During the years 1985 to 1987, 689 moose (Alces alces L. collected throughout Sweden were necrop-sied at the National Veterinary Institute in Uppsala, Sweden. Sixty-eight of those investigated had catarrhal to hemorrhagic enteritis, atrophied lymphoid organs, and/or numerous erosive, uclerative, necrotizing lesions of the digestive mucosa. Histopathology of the mucous membranes revealed marked inter- and intracellular oedema, erosions, ulcers and intracytoplasmic inclusion bodies. Neither Bovine Virus Diarrhoea/Mucosal Disease (BVD/MD or Infectious Bovine Rhinotracheitis (IBR virus could be isolated from the diseased animals. It is suggested that the syndrome resembling BVD/MD complex, may have been caused by an yet unidentified virus.

  1. Acute genital ulcers.

    Science.gov (United States)

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

    2014-01-28

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

  2. Fecal Microbial Composition of Ulcerative Colitis and Crohn’s Disease Patients in Remission and Subsequent Exacerbation

    OpenAIRE

    Edgar S Wills; Jonkers, Daisy M. A. E.; Paul H Savelkoul; Masclee, Ad A.; Pierik, Marieke J.; John Penders

    2014-01-01

    BACKGROUND: Limited studies have examined the intestinal microbiota composition in relation to changes in disease course of IBD over time. We aimed to study prospectively the fecal microbiota in IBD patients developing an exacerbation during follow-up. DESIGN: Fecal samples from 10 Crohn's disease (CD) and 9 ulcerative colitis (UC) patients during remission and subsequent exacerbation were included. Active disease was determined by colonoscopy and/or fecal calprotectine levels. Exclusion crit...

  3. Herpes simplex virus type 1 in peptic ulcer disease: An inverse association with Helicobacter pylori

    Institute of Scientific and Technical Information of China (English)

    Klisthenis Tsamakidis; Efstathia Panotopoulou; Dimitrios Dimitroulopoulos; Dimitrios Xinopoulos; Maria Christodoulou; Alexandra Papadokostopoulou; Ioannis Karagiannis; Elias Kouroumalis; Emmanuel Paraskevas

    2005-01-01

    AIM: To assess the frequency of herpes simplex virus type Ⅰ in upper gastrointestinal tract ulcers and normal mucosa with the modern and better assays and also with a larger number of well characterized patients and controls and its relationship to Helicobacter pylori(H pylori).METHODS: Biopsy specimens from 90 patients (34 with gastric ulcer of the prepyloric area and 56 with duodenal ulcer) were evaluated. Biopsies from 50 patients with endoscopically healthy mucosa were considered as the control group. The method used to identify herpes simplex virus-1 (HSV-1) was polymerase chain reaction.H pylori was detected by the CLO-test and by histological method.RESULTS: Herpes simplex virus-1 was detected in 28 of 90 patients with peptic ulcer (31%) [11 of 34 patients with gastric ulcer (32.4%) and 17 of 56 with duodenal ulcer (30.4%)] exclusively close to the ulcerous lesion.All control group samples were negative for HSV-1.The likelihood of H pylori negativity among peptic ulcer patients was significantly higher in HSV-1 positive cases than in HSV-1 negative cases (P = 0.009). Gastric ulcer patients with HSV-1 positivity were Strongly associated with an increased possibility of Helicobacter pylori negativity compared to duodenal ulcer patients (P= 0.010).CONCLUSION: HSV-1 is frequent in upper gastrointestinal tract ulcers but not in normal gastric and duodenal mucosa. There is an inverse association between HSV-1 and H pylori infection.

  4. Does the declining prevalence of Helicobacter pylori unmask patients with idiopathic peptic ulcer disease? Trends over an 8 year period

    NARCIS (Netherlands)

    Arents, NLA; Thijs, JC; van Zwet, AA; Kleibeuker, JH

    2004-01-01

    Objectives Recent studies have suggested that the prevalence of Helicobacter pylori infection in patients with ulcer disease who were not using non-steroidal anti-inflammatory drugs (NSAIDs) has been overestimated. The decreasing prevalence of H. pylori could lead to a relative increase in the numbe

  5. Antibacterial activity of extracts from Zostera marina against pathogens of Apostichopus japonicus skin ulceration disease

    Science.gov (United States)

    Liu, Yang; Jiang, Guoliang; Wu, Zhiqiang

    2010-03-01

    The purpose of this study was to investigate the antibacterial activity of extracts from Zostera marina against the pathogens of Apostichopus japonicus skin ulceration disease. When 95% ethanol (v/v) solvent was used to extract Zostera marina at 50°C, aqueous extract (ZA) showed obvious bacteriostatic effects on the tested bacterial strains (inhibition halo diameters between 8.23 mm and 13.62 mm), whereas the ethyl acetate extract (ZE) was almost inactive. The minimal inhibitory concentration (MIC) of ZA against four pathogens were homogeneous at 12.8 g L-1. ZA components were analyzed by thin layer chromatography (TLC) assay and six fractions were obtained. In another study, the six fractions showed inhibitory effects against the tested bacteria while their functions seemed to counteract the ZA activity.

  6. Different risk factors influence peptic ulcer disease development in a Brazilian population

    Institute of Scientific and Technical Information of China (English)

    Rodrigo Buzinaro Suzuki; Rodrigo Faria Cola; Larissa Tranquilino Bardela Cola; Camila Garcia Ferrari; Fred Ellinger; Altino Luiz Therezo; Luis Carlos da Silva

    2012-01-01

    AIM:To investigate age,sex,histopathology and Helicobacter pylori (H.pylori) status,as risk factors for gastroduodenal disease outcome in Brazilian dyspeptic patients.METHODS:From all 1466 consecutive dyspeptic patients submitted to upper gastroscopy at Hospital das Clinicas of Marilia,antral biopsy specimens were obtained and subjected to histopathology and H.pylori diagnosis.All patients presenting chronic gastritis (CG)and peptic ulcer (PU) disease localized in the stomach,gastric ulcer (GU) and/or duodenal ulcer (DU) were included in the study.Gastric biopsies (n =668) positive for H.pylori by rapid urease test were investigated for vacuolating cytotoxin A (vacA) medium (m) region mosaicism by polymerase chain reaction.Logistic regression analysis was performed to verify the association of age,sex,histopathologic alterations,H.pylori diagnosis and vacA m region mosaicism with the incidence of DU,GU and CG in patients.RESULTS:Of 1466 patients submitted to endoscopy,1060 (72.3%) presented CG [male/female =506/554;mean age (year) ± SD =51.2 ± 17.81],88 (6.0%)presented DU [male/female =54/34; mean age (year)± SD =51.4 ± 17.14],and 75 (5.1%) presented GU[male/female =54/21; mean age (year) ± SD =51.3± 17.12] and were included in the comparative analysis.Sex and age showed no detectable effect on CG incidence (overall x2 =2.1,P =0.3423).Sex [Odds ratios (OR) =1.8631,P =0.0058] but not age (OR =0.9929,P =0.2699) was associated with DU and both parameters had a highly significant effect on GU (overall x2 =30.5,P < 0.0001).The histopathological results showed a significant contribution of ageing for both atrophy (OR =1.0297,P < 0.0001) and intestinal metaplasia (OR =1.0520,P < 0.0001).Presence of H.pylori was significantly associated with decreasing age (OR =0.9827,P < 0.0001) and with the incidence of DU (OR =3.6077,P < 0.0001).The prevalence of ml in DU was statistically significant (OR =2.3563,P =0.0018) but not in CG (OR =2.678,P =0.0863) and

  7. Use of blood based biomarkers in the evaluation of Crohn’s disease and ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Edward; L; Barnes; Choong-Chin; Liew; Samuel; Chao; Robert; Burakoff

    2015-01-01

    Despite significant improvements in our understanding of Crohn’s disease(CD) and ulcerative colitis(UC) in recent years, questions remain regarding the best approaches to assessment and management of these chronic diseases during periods of both relapse and remission. Various serologic biomarkers have been used in the evaluation of patients with both suspected and documented inflammatory bowel disease(IBD), and while each has potential utility in the assessment of patients with IBD, potential limitation remain with each method of assessment. Given these potential shortcomings, there has been increased interest in other means of evaluation of patients with IBD, including an expanding interest in the role of gene expression profiling. Among patients with IBD, gene expression profiles obtained from whole blood have been used to differentiate active from inactive CD, as well as to differentiate between CD, UC, and non-inflammatory diarrheal conditions. There are many opportunities for a non-invasive, blood based test to aid in the assessment of patients with IBD, particularly when considering more invasive means of evaluation including endoscopy with biopsy. Furthermore, as the emphasis on personalized medicine continues to increase, the potential ability of gene expression analysis to predict patient response to individual therapies offers great promise. While whole blood gene expression analysis may not completely replace more traditional means of evaluating patients with suspected or known IBD, it does offer significant potential to expand our knowledge of the underlying genes involved in the development of these diseases.

  8. Association between early Helicobacter pylori eradication and a lower risk of recurrent complicated peptic ulcers in end-stage renal disease patients.

    Science.gov (United States)

    Chang, Shen-Shong; Hu, Hsiao-Yun

    2015-01-01

    End-stage renal disease (ESRD) patients exhibit an increased incidence of peptic ulcer disease. Helicobacter pylori plays a central role in the development of peptic ulcers. The effect of early H pylori eradication on the recurrence of complicated peptic ulcer disease in ESRD patients remains unclear. The aim of the present study was to explore whether early H pylori eradication therapy in ESRD patients can reduce the risk of recurrent complicated peptic ulcers.We conducted a population-based cohort study and recruited patients with ESRD who had developed peptic ulcers. We categorized patients into early (time lag ≦120 days after peptic ulcer diagnosis) and late H pylori eradication therapy groups. The Cox proportional hazards model was used. The endpoint was based on hospitalization for complicated recurrent peptic ulcers.The early and late H pylori eradication therapy groups consisted of 2406 and 1356 ESRD patients, respectively, in a time lag of 120 days. After adjusting for possible confounders, the early eradication group exhibited a lower rate of complicated recurrent peptic ulcer disease (hazard ratio [HR] = 0.76, 95% confidence interval [CI] = 0.64-0.91, P = 0.003) in a time lag of ≦120 days, but a similar rate of complicated recurrent peptic ulcer disease in time lags of ≦1 year (HR = 0.97, 95% CI 0.79-1.19, P = 0.758) and 2 years (HR = 1.11, 95% CI 0.86-1.44, P = 0.433) compared with the late eradication group.We recommend administering H pylori eradication within 120 days after peptic ulcer diagnosis to H pylori infected ESRD patients who have developed peptic ulcers.

  9. Sweet's syndrome: an unusual cutaneous feature of Crohn's disease or ulcerative colitis. The South West Gastroenterology Group.

    Science.gov (United States)

    Travis, S; Innes, N; Davies, M G; Daneshmend, T; Hughes, S

    1997-07-01

    Sweet's syndrome is characterized by tender, red inflammatory nodules or papules, usually affecting the upper limbs, face or neck. It is part of the group of acute neutrophilic dermatoses that includes pyoderma gangrenosum, but can be distinguished by its appearance, distribution and histological features. Four patients with Sweet's syndrome and Crohn's disease are reported. A total of 30 cases from the literature suggest that Sweet's syndrome is an unusual extraintestinal manifestation of either Crohn's disease or ulcerative colitis. There is a strong predilection for women (87%), patients with colonic disease (100%) and those with other extraintestinal features (77%). The rash is associated with active disease in 67-80%, but may precede the onset of intestinal symptoms in 21% and has been reported 3 months after proctocolectomy for ulcerative colitis. PMID:9262983

  10. A Real World, Observational Registry of Chronic Wounds and Ulcers

    Science.gov (United States)

    2016-05-18

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

  11. Do patients with non-ulcer dyspepsia respond differently to Helicobacter pylori eradication treatments from those with peptic ulcer disease? A systematic review

    Institute of Scientific and Technical Information of China (English)

    Jia-Qing Huang; Ge-Fan Zheng; Richard H Hunt; Wai-Man Wong; Shiu-Kum Lam; Johan Karlberg; Benjamin Chun-Yu Wong

    2005-01-01

    AIM: It is controversial whether patients with non-ulcer dyspepsia (NUD) respond differently to Helicobacter pylori (H pylori) eradication treatment than those with peptic ulcer disease (PUD). To review the evidence for any difference in H pylori eradication rates between PUD and NUD patients. METHODS: A literature search for full articles and meeting abstracts to July 2004 was conducted. We included studies evaluating the efficacy of a proton pump inhibitor (P) or ranitidine bismuth citrate (RBC) plus two antibiotics of clarithromycin (C), amoxicillin (A), metronidazole (M), or P-based quadruple therapies for eradicating theinfection.RESULTS: Twenty-two studies met the criteria. No significant difference in eradication rates was found between PUD and NUD patients when treated with 7-d RBCCA, 10-d PCA or P-based quadruple therapies. When the 7-d PCA was used, the pooled H pylori eradication rate was 82.1% (431/525) and 72.6% (448/617) for PUD and NUD patients, respectively, yielding a RR of 1.15(95%CI 1.01-1.29). However, the statistically significant difference was seen only in meeting abstracts, but not in full publications.CONCLUSION: There is no convincing evidence to suggest that NUD patients respond to H pylori eradication treatments differently from those with PUD, although a trend exists with the 7-d PCA therapy.

  12. Simple, Rapid Mycobacterium ulcerans Disease Diagnosis from Clinical Samples by Fluorescence of Mycolactone on Thin Layer Chromatography.

    Directory of Open Access Journals (Sweden)

    Anita Wadagni

    2015-11-01

    Full Text Available Mycobacterium ulcerans infection, known as Buruli ulcer, is a disease of the skin and subcutaneous tissues which is an important but neglected tropical disease with its major impact in rural parts of West and Central Africa where facilities for diagnosis and management are poorly developed. We evaluated fluorescent thin layer chromatography (f-TLC for detection of mycolactone in the laboratory using samples from patients with Buruli ulcer and patients with similar lesions that gave a negative result on PCR for the IS2404 repeat sequence of M. ulcerans.Mycolactone and DNA extracts from fine needle aspiration (FNA, swabs and biopsy specimen were used to determine the sensitivity and specificity of f-TLC when compared with PCR for the IS2404. For 71 IS2404 PCR positive and 28 PCR negative samples the sensitivity was 73.2% and specificity of 85.7% for f-TLC. The sensitivity was similar for swabs (73%, FNAs (75% and biopsies (70%.We have shown that mycolactone can be detected from M. ulcerans infected skin tissue by f-TLC technique. The technique is simple, easy to perform and read with minimal costs. In this study it was undertaken by a member of the group from each endemic country. It is a potentially implementable tool at the district level after evaluation in larger field studies.

  13. Fecal microbial composition of ulcerative colitis and Crohn's disease patients in remission and subsequent exacerbation.

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    Edgar S Wills

    Full Text Available BACKGROUND: Limited studies have examined the intestinal microbiota composition in relation to changes in disease course of IBD over time. We aimed to study prospectively the fecal microbiota in IBD patients developing an exacerbation during follow-up. DESIGN: Fecal samples from 10 Crohn's disease (CD and 9 ulcerative colitis (UC patients during remission and subsequent exacerbation were included. Active disease was determined by colonoscopy and/or fecal calprotectine levels. Exclusion criteria were pregnancy, antibiotic use, enema use and/or medication changes between consecutive samples. The microbial composition was assessed by 16S rDNA pyrosequencing. RESULTS: After quality control, 6,194-11,030 sequences per sample were available for analysis. Patient-specific shifts in bacterial composition and diversity were observed during exacerbation compared to remission, but overarching shifts within UC or CD were not observed. Changes in the bacterial community composition between remission and exacerbation as assessed by Bray-Curtis dissimilarity, were significantly larger in CD versus UC patients (0.59 vs. 0.42, respectively; p = 0.025. Thiopurine use was found to be a significant cause of clustering as shown by Principal Coordinate Analysis and was associated with decreases in bacterial richness (Choa1 501.2 vs. 847.6 in non-users; p<0.001 and diversity (Shannon index: 5.13 vs. 6.78, respectively; p<0.01. CONCLUSION: Shifts in microbial composition in IBD patients with changing disease activity over time seem to be patient-specific, and are more pronounced in CD than in UC patients. Furthermore, thiopurine use was found to be associated with the microbial composition and diversity, and should be considered when studying the intestinal microbiota in relation to disease course.

  14. Systemic lupus erythematosus in association with ulcerative colitis: related autoimmune diseases.

    Science.gov (United States)

    Stevens, H P; Ostlere, L S; Rustin, M H

    1994-03-01

    We report a patient who developed urticaria, angio-oedema and polyarthropathy secondary to the hypocomplementaemic urticarial vasculitis syndrome, a year prior to the onset of ulcerative colitis. Ten years later, primary sclerosing cholangitis and the antiphospholipid syndrome developed concomitantly. We believe this patient represents only the second reported case of idiopathic systemic lupus erythematosus (SLE) occurring in association with ulcerative colitis. PMID:8148283

  15. Do We Eradicate Helicobacter pylori in Hospitalized Patients with Peptic Ulcer Disease?

    Directory of Open Access Journals (Sweden)

    Frank Wong

    2013-01-01

    Full Text Available BACKGROUND: Helicobacter pylori infection is the most common chronic infection in humans. It is a major contributor to the cause of duodenal and gastric ulcers worldwide. Its eradication has been shown to reduce rates of H pylori-related ulcers as well as other complications such as gastric cancer.

  16. Infections Requiring Hospitalization as Predictors of Pediatric-Onset Crohn’s Disease and Ulcerative Colitis

    Directory of Open Access Journals (Sweden)

    Susan Hutfless

    2015-01-01

    Full Text Available Objectives. To assess the relationship between infections and the risk of pediatric-onset inflammatory bowel disease (IBD. Methods. We conducted a nested case-control study of 501 incident cases aged ≤17 years and 9,442 controls who were members of Kaiser Permanente Northern California for at least one consecutive year between 1996 and 2006. IBD was confirmed and the incidence date was adjudicated by pediatric gastroenterologists. Hospitalized infections were identified from the principal diagnosis code of electronic inpatient records. Medications to treat infections were identified during the hospitalization. Conditional logistic regression was used to assess the associations between hospitalized infections, medications, and Crohn’s disease and ulcerative colitis. Results. In the year prior to diagnosis, both hospitalized infection of any system (OR 6.3; 95% CI 1.6–23.9 and hospitalized intestinal infection (OR 19.4; 95% CI 2.6–143.2 were associated with CD. Hospitalized infections of any system were inversely associated with UC after excluding the year prior to diagnosis (OR 0.4; 95% CI 0.2–0.9. No UC case had a hospitalized gastrointestinal infection prior to diagnosis. Conclusion. Infections appear to play opposite roles prior to the diagnosis of CD and UC. Infections may be associated with an increased risk of CD and a decreased risk of UC.

  17. Adult hypertrophic pyloric stenosis due to peptic ulcer disease: a rare presentation

    Directory of Open Access Journals (Sweden)

    Shameer Deen

    2016-05-01

    Full Text Available Primary adult hypertrophic stenosis is uncommon with an uncertain etiopathogenesis and associated gastric outlet obstruction mimics gastric carcinoma. We present a case of AHPS as sequel of peptic ulcer disease in a 72 year old male. With the advent of proton pump inhibitors as a mainstay of medical therapy, complication into gastric outlet obstruction is a rare disease today. Upper GI endoscopy revealed a distended stomach, residual food and a hyperemic bulky pylorus not accommodating the endoscope. Barium meal follow-through revealed a dilated stomach and minimal barium passing through the pylorus. Histological analysis revealed mild dysplasia at the focus with dense inflammatory infiltrates composed of lymphocytes and eosinophils in the lamina propria. No evidence of malignancy was noted, favouring chronic gastritis. The condition mimics other forms of proliferative disorders like carcinoma, gastrointestinal stromal tumors. We present the clinical findings, imaging analysis and discuss etiopathogenesis and management. [Int J Res Med Sci 2016; 4(5.000: 1730-1732

  18. Clinical value of fecal calprotectin in determining disease activity of ulcerative colitis

    Science.gov (United States)

    Xiang, Jun-Ying; Ouyang, Qin; Li, Guo-Dong; Xiao, Nan-Ping

    2008-01-01

    AIM: To investigate possibility and clinical application of fecal calprotectin in determining disease activity of ulcerative colitis (UC). METHODS: The enzyme-linked immunosorbent assay (ELISA) was used to measure the concentrations of calprotectin in feces obtained from 66 patients with UC and 20 controls. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), acid glycoprotein (AGP) were also measured and were compared with calprotectin in determining disease activity of UC. The disease activity of UC was also determined by the Sutherland criteria. RESULTS: The fecal calprotectin concentration in the patients with active UC was significantly higher than that in the inactive UC and in the controls (402.16 ± 48.0 μg/g vs 35.93 ± 3.39 μg/g, 11.5 ± 3.42 μg/g, P < 0.01). The fecal calprotectin concentration in the inactive UC group was significantly higher than that in the control group (P < 0.05). A significant difference was also found in the patients with active UC of mild, moderate and severe degrees. The area under the curve of the receiver operating characteristics (AUCROC) was 0.975, 0.740, 0.692 and 0.737 for fecal calprotectin, CRP, ESR and AGP, respectively. There was a strong correlation between the fecal calprotectin concentration and the endoscopic gradings for UC (r = 0.866, P < 0.001). CONCLUSION: Calprotectin in the patient’s feces can reflect the disease activity of UC and can be used as a rational fecal marker for intestinal inflammation in clinical practice. This kind of marker is relatively precise, simple and noninvasive when compared with other commonly-used markers such as CRP, ESR and AGP. PMID:18176961

  19. Clinical value of fecal calprotectin in determining disease activity of ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Jun-Ying Xiang; Qin Ouyang; Guo-Dong Li; Nan-Ping Xiao

    2008-01-01

    AIM:To investigate possibility and clinical application of fecal calprotectin in determining disease activity of ulcerative colitis (UC).METHODS: The enzyme-linked immunosorbent assay(ELISA) was used to measure the concentrations of calprotectin in feces obtained from 66 patients with UC and 20 controls. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), acid glycoprotein (AGP) were also measured and were compared with calprotectin in determining disease activity of UC. The disease activity of UC was also determined by the Sutherland criteria.RESULTS: The fecal calprotectin concentration in the patients with active UC was significantly higher than that in the inactive UC and in the controls (402.16±48.0 μg/g vs 35.93±3.39 μg/g, 11.5±3.42 μg/g, P < 0.01). The fecal calprotectin concentration in the inactive UC group was significantly higher than that in the control group (P < 0.05). A significant difference was also found in the patients with active UC of mild, moderate and severe degrees. The area under the curve of the receiver operating characteristics (AUCROC) was 0.975, 0.740, 0.692 and 0.737 for fecal calprotectin, CRP, ESR and AGP,respectively. There was a strong correlation between the fecal calprotectin concentration and the endoscopic gradings for UC (r = 0.866, P < 0.001).CONCLUSION: Calprotectin in the patient's feces can reflect the disease activity of UC and can be used as a rational fecal marker for intestinal inflammation in clinical practice. This kind of marker is relatively precise, simple and noninvasive when compared with other commonly-used markers such as CRP, ESR and AGR.

  20. Bacterial colonization of colonic crypt mucous gel and disease activity in ulcerative colitis.

    LENUS (Irish Health Repository)

    Rowan, Fiachra

    2012-02-01

    OBJECTIVE: To optimize total bacterial 16S rRNA quantification in microdissected colonic crypts in healthy controls and patients with ulcerative colitis (UC) and to characterize the findings with disease activity. BACKGROUND: Microscopic and molecular techniques have recently converged to allow bacterial enumeration in remote anatomic locations [eg, crypt-associated mucous gel (CAMG)]. The aims of this study were to combine laser capture microdissection (LCM) and 16S rRNA-based quantitative polymerase chain reaction (qPCR) to determine total bacterial copy number in CAMG both in health and in UC and to characterize the findings with disease activity. METHODS: LCM was used to microdissect CAMG from colonic mucosal biopsies from controls (n = 20) and patients with acute (n = 10) or subacute (n = 10) UC. Pan-bacterial 16S rRNA copy number per millimeter square in samples from 6 locations across the large bowel was obtained by qPCR using Desulfovibrio desulfuricans as a reference strain. Copy numbers were correlated with the UC disease activity index (UCDAI) and the simple clinical colitis activity index (SCCAI). RESULTS: Bacterial colonization of CAMG was detectable in all groups. Copy numbers were significantly reduced in acute UC. In subacute colitis, there was a positive correlation between copy number and UCDAI and SCCAI in the ascending, transverse and sigmoid colon. CONCLUSIONS: This study describes a sensitive method of quantitatively assessing bacterial colonization of the colonic CAMG. A positive correlation was found between CAMG bacterial load and subacute disease activity in UC, whereas detectable bacterial load was reduced in acute UC.

  1. A STUDY ON HEALTH SEEKING BEHAVIOR OF PATIENTS WITH GENITAL ULCER DISEASE

    Directory of Open Access Journals (Sweden)

    Meetesh

    2014-03-01

    Full Text Available BACKGROUND: In developing countries, the proportion with STDs who present with genital ulcers is high compared to developed nations. AIM: 1. To study reaction of the cases toward their disease. 2. To study communication of cases with their partners. 3. To study treatment of symptoms and starting treatment, selfmedication & completion of treatment. 4. To study approach of health care providers. STUDY SETTINGS: Present study was carried out in Department of skin and VD, Medical College and SSG Hospital Baroda between June 2001 to Feb. 2003. MATERIAL AND METHODS: A cross sectional study was conducted. Sexually active male or female having genital ulcer with history of exposure in patient or partner. Total 216 cases were included in the study. Detailed history was taken and was recorded. An attempt was made to study health care seeking behavior in 60 cases. These cases were questioned about their reaction towards the disease treatment seeking including completion of treatment and time gap between appearance of symptoms and treatment taken were asked. They were also asked about the approach of the health care providers from whom they took treatment before coming to our clinic. RESULTS: It was observed that 57% of the cases among males were frightened after having GUD. They were likely to come to STD clinics at the earliest for treatment. Spousal communication was only 45% in male cases. Only 1/3rd cases came directly to STD clinic and the other visited other practitioners. Among these, only 60% took treatment from MBBS doctors or STD specialist. Rest of them went to unqualified health. Awareness about protective value of condom, as for as STI prevention is concerned, was 70% but consistent use was seen only in 2% cases. Twenty one percent cases did not know how to use condom, and 7% did not know about condoms at all. As many as 89% cases didn’t feel it necessary to use condoms during sexual relations with wife. CONCLUSION: Creating awareness

  2. Helicobacter pylori heterogeneity in patients with gastritis and peptic ulcer disease.

    Science.gov (United States)

    Armitano, Rita Inés; Matteo, Mario José; Goldman, Cinthia; Wonaga, Andrés; Viola, Luis Alberto; De Palma, Gerardo Zerbetto; Catalano, Mariana

    2013-06-01

    Genetic diversification allows Helicobacter pylori to persist during chronic colonization/infection. We investigated the intra-host variation of several markers that suggested microevolution in patients with chonic gastritis (CG) and peptic ulcer disease (PUD). One-hundred twenty-six isolates recovered from 14 patients with CG and 13 patients with PUD were analysed. cag pathogenicity island (cagPAI), oipA, vacA, bab gene status and the presence of jhp0926, jhp0945, jhp0947, jhp0949 and jhp0940 genes from the genomic Plasticity Zone (PZ) were taken into accout to investigate intra-host variation. lspA-glmM-RFLP was performed to identify mixed infections. Only one patient was colonised/infected by two ancestrally unrelated strains. Among the 126 isolates, a significant association among cagPAI genotypes, oipA status and vacA alleles was indicated. Complete cagPAI, oipA "on", and vacA s1-m1 variants were significantly found in patients with PUD, without intra-host variations. Isolates from 7/14 patients with CG lacked babA in all chromosomal loci. In contrast, isolates from all or several biopsies of PUD patients carried babA, but in one patient only, the isolates showed positive Lewis b (Leb) binding assay. Considering cagPAI, vacA, oipA, bab genotypes, intra-host variation was also significantly higher in patients with CG. Conversely, a similarly high intra-host variation in almost PZ genes was observed in isolates from patients with CG and PUD. In conclusion, the lowest intra-host variation in cagPAI, oipA, vacA, and bab genes found in patients with PUD suggests the selection of a particular variant along the bacteria-host environment interplay during ulceration development. However, the predominance of this variant may be a refletion of the multifactorial etiology of the disease rather than the cause, as it was also found in patients with CG. The intra-host variation in PZ genes may predict that this genomic region and the other markers of microevolution studied

  3. Helicobacter pylori heterogeneity in patients with gastritis and peptic ulcer disease.

    Science.gov (United States)

    Armitano, Rita Inés; Matteo, Mario José; Goldman, Cinthia; Wonaga, Andrés; Viola, Luis Alberto; De Palma, Gerardo Zerbetto; Catalano, Mariana

    2013-06-01

    Genetic diversification allows Helicobacter pylori to persist during chronic colonization/infection. We investigated the intra-host variation of several markers that suggested microevolution in patients with chonic gastritis (CG) and peptic ulcer disease (PUD). One-hundred twenty-six isolates recovered from 14 patients with CG and 13 patients with PUD were analysed. cag pathogenicity island (cagPAI), oipA, vacA, bab gene status and the presence of jhp0926, jhp0945, jhp0947, jhp0949 and jhp0940 genes from the genomic Plasticity Zone (PZ) were taken into accout to investigate intra-host variation. lspA-glmM-RFLP was performed to identify mixed infections. Only one patient was colonised/infected by two ancestrally unrelated strains. Among the 126 isolates, a significant association among cagPAI genotypes, oipA status and vacA alleles was indicated. Complete cagPAI, oipA "on", and vacA s1-m1 variants were significantly found in patients with PUD, without intra-host variations. Isolates from 7/14 patients with CG lacked babA in all chromosomal loci. In contrast, isolates from all or several biopsies of PUD patients carried babA, but in one patient only, the isolates showed positive Lewis b (Leb) binding assay. Considering cagPAI, vacA, oipA, bab genotypes, intra-host variation was also significantly higher in patients with CG. Conversely, a similarly high intra-host variation in almost PZ genes was observed in isolates from patients with CG and PUD. In conclusion, the lowest intra-host variation in cagPAI, oipA, vacA, and bab genes found in patients with PUD suggests the selection of a particular variant along the bacteria-host environment interplay during ulceration development. However, the predominance of this variant may be a refletion of the multifactorial etiology of the disease rather than the cause, as it was also found in patients with CG. The intra-host variation in PZ genes may predict that this genomic region and the other markers of microevolution studied

  4. Turbulence intensity measurements using particle image velocimetry in diseased carotid artery models: effect of stenosis severity, plaque eccentricity, and ulceration.

    Science.gov (United States)

    Kefayati, Sarah; Holdsworth, David W; Poepping, Tamie L

    2014-01-01

    Clinical decision-making for the treatment of patients with diseased carotid artery is mainly based on the severity of the stenosis. However, stenosis severity alone is not a sensitive indicator, and other local factors for the assessment of stroke risk are required. Flow disturbance is of particular interest due to its proven association with increased thromboembolic activities. The objective of this study was to investigate the level of turbulence intensity (TI) with regards to certain geometrical features of the plaque - namely stenosis severity, eccentricity, and ulceration. A family of eight carotid-artery bifurcation models was examined using particle image velocimetry. Results showed a marked difference in turbulence intensity among these models; increasing degree of stenosis severity resulted in increased turbulence intensity, going from 0.12 m/s for mild stenosis to 0.37 m/s for severe stenosis (with concentric geometry). Moreover, independent of stenosis severity, eccentricity led to further elevations in turbulence intensity, increasing TI by 0.05-0.10 m/s over the counterpart concentric plaque. The presence of ulceration (in a 50% eccentric plaque) produced a larger portion of moderate turbulence intensity (~0.10 m/s) compared to the non-ulcerated model, more proximal to the bifurcation apex in the post-stenotic recirculation zone. The effect of plaque eccentricity and ulceration in enhancing the downstream turbulence has potential clinical implications for a more sensitive assessment of stroke risk beyond stenosis severity alone.

  5. Trends in peptic ulcer disease and the identification of Helicobacter Pylori as a causative organism: Population-based estimates from the US nationwide inpatient sample

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    Bronislava Bashinskaya

    2011-01-01

    Full Text Available Background: Peptic ulcer disease can lead to serious complications including massive hemorrhage or bowel perforation. The modern treatment of peptic ulcer disease has transitioned from the control of gastric acid secretion to include antibiotic therapy in light of the identification of Helicobacter pylori as a causative infectious organism. We sought to determine trends related to this discovery by using a national database. Materials and Methods: Patient discharges with peptic ulcer disease and associated sequelae were queried from the Nationwide Inpatient Sample, 1993 to 2007, under the auspices of a data user agreement. To account for the Nationwide Inpatient Sample weighting schema, design-adjusted analyses were used. Standard error was calculated using SUDAAN software (Research Triangle International, NC, USA. Results: Decreases in the incidences of gastrointestinal perforation, gastrointestinal hemorrhage, and surgical procedures most specific to peptic ulcer disease were statistically significant over the study period [range of P value (two tailed = 0.000 - 0.00353; significant at P < 0.001 to < 0.01]. The incidence of H. pylori rose dramatically, peaking at an estimated 97,823 cases in 1998 [SE = 3155; 95% CI = 6,184]. Since that time it has decreased and then stabilized. Conclusions: The identification of H. pylori as the causative agent in the majority of peptic ulcer disease has revolutionized the understanding and management of the disease. Medical conditions and surgical procedures associated with end-stage peptic ulcer disease have significantly decreased according to analysis of selected index categories. Resident physician education objectives may need to be modified in light of these trends. Review Criteria: We reviewed patients with peptic ulcer disease. The database used was the Nationwide Inpatient Sample, 1993 to 2007. Message for the Clinic: Medical therapy has resulted in decreased morbidity from H. pylori infection as it

  6. Ulcer disease prophylaxis in koi carp by bath immersion with chicken egg yolk containing anti-Aeromonas salmonicida IgY.

    Science.gov (United States)

    Gan, Hongjian; He, Haiwen; Sato, Atsushi; Hatta, Hajime; Nakao, Miki; Somamoto, Tomonori

    2015-04-01

    Ulcer disease, caused by atypical Aeromonas salmonicida, is a serious concern in ornamental koi carp, because it induces skin ulceration, disfiguring ornamental fish and causing economic loses. The present study aimed to establish a novel prophylaxis with chicken egg yolk immunoglobulin, IgY, against ulcer disease and to assess its feasibility in the ornamental fish industry. Addition of egg yolk powder containing anti-A. salmonicida IgY to rearing water provided significant protection against an A. salmonicida bath infection, whereas administration of non-specific IgY did not. Consecutive immersion of fish into rearing water containing specific IgY completely prevented ulcer disease resulting from cohabitation infection, indicating that this prophylaxis could prevent infection from such type of contact. Thus, passive immunization induced by immersing fish into aquarium water containing specific IgY is a prospective prophylaxis against diseases caused by pathogens that invade the skin and gills. PMID:25687817

  7. DETECTION OF PATHOGENS CAUSING GENITAL ULCER DISEASE BY MULTIPLEX POLYMERASE CHAIN REACTION

    Institute of Scientific and Technical Information of China (English)

    Ai-ying Liu; Ming-jun Jiang; Yue-ping Yin; Jiang-fang Sun

    2005-01-01

    Objective To establish a multiplex polymerase chain reaction (M-PCR) assay for simultaneous detection of pathogens causing genital ulcer disease (GUD).Methods Based on the gene-specific region of the following pathogens: Chlamydia trachomatis ompl/ompb, herpes simplex virus (HSV) DNA polymerase, Treponema pallidum tpp47, Haemophilus ducreyi 16s rRNA, four sets of primers were designed and an M-PCR assay was developed to detect four pathogens in one test. The assay was evaluated with diagnostic result of golden standard for each pathogen.Results Of the 51 clinical samples, M-PCR showed slightly higher positive rate (47.1%) of HSV than cell culture (23.6%).Meanwhile, the positive rate of T. p allidum detected by M-PCR and dark-field microscopy was 19.6% ( 10/51) and 15.7% (8/51),respectively. Only one sample was positive for H. ducreyiand no sample was positive for C. trachomatis detected by both M-PCR assay and culture.Conclusion This primary study indicated that M-PCR assay can simultaneously and rapidly detect the four etiologic pathogens causing GUD.

  8. Wound Chronicity, Inpatient Care, and Chronic Kidney Disease Predispose to MRSA Infection in Diabetic Foot Ulcers

    Science.gov (United States)

    Yates, Christopher; May, Kerry; Hale, Thomas; Allard, Bernard; Rowlings, Naomi; Freeman, Amy; Harrison, Jessica; McCann, Jane; Wraight, Paul

    2009-01-01

    OBJECTIVE To determine the microbiological profile of diabetes-related foot infections (DRFIs) and the impact of wound duration, inpatient treatment, and chronic kidney disease (CKD). RESEARCH DESIGN AND METHODS Postdebridement microbiological samples were collected from individuals presenting with DRFIs from 1 January 2005 to 31 December 2007. RESULTS A total of 653 specimens were collected from 379 individuals with 36% identifying only one isolate. Of the total isolates, 77% were gram-positive bacteria (staphylococci 43%, streptococci 13%). Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from 23%; risk factors for MRSA included prolonged wound duration (odds ratio 2.31), inpatient management (2.19), and CKD (OR 1.49). Gram-negative infections were more prevalent with inpatient management (P = 0.002) and prolonged wound duration (P < 0.001). Pseudomonal isolates were more common in chronic wounds (P < 0.001). CONCLUSIONS DRFIs are predominantly due to gram-positive aerobes but are usually polymicrobial and increase in complexity with inpatient care and ulcer duration. In the presence of prolonged duration, inpatient management, or CKD, empiric MRSA antibiotic cover should be considered. PMID:19587371

  9. Iron Deficiency Anaemia Caused by Nonspecific (Idiopathic Small Bowel Ulceration: An Uncommon Presentation of an Uncommon Disease

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    Gabriele Capurso

    2002-01-01

    Full Text Available Ulcers of the small bowel are rare, and in most cases are due to infections, inflammatory bowel diseases, malignancies or drugs. When none of these causes is recognized, they are classified as ‘nonspecific’ or idiopathic. Such lesions are uncommon, and in most cases present with occlusion. A case of a middle-aged woman with iron deficiency anemia due to occult bleeding, with negative gastroscopy and colonoscopy is presented. The diagnosis of a small bowel pathology resembling Crohn’s disease was made by small bowel follow through and small intestine contrast ultrasonography. An ileal ulcer was identified at surgery, and after resection the patient experienced a stable recovery from the anemia without ulcer recurrence. Neither histology nor clinical or biochemical features suggested the diagnosis of an inflammatory bowel disease. Other possible causes were unlikely and the lesion was therefore diagnosed as idiopathic. This report also focuses on the need and the modality to investigate the small bowel in iron deficiency anemia patients.

  10. Foot & Mouth Disease & Ulcerative/Vesicular Rule-outs: Challenges Encountered in Recent Outbreaks

    Energy Technology Data Exchange (ETDEWEB)

    Hullinger, P

    2008-01-28

    development and subsequent rupturing of vesicles at the coronary band and in the oral cavity. Vesicles and ulcerations can also occur on the mammary gland. Recovery in adult animals usually occurs in 8-15 days. Clinical signs for most serotypes are less dramatic in sheep and goats. Swine can develop very severe coronary band lesions and high mortality in piglets has been observed. One of the challenges of diagnosing FMD is that it may be clinically similar to several other vesicular or ulcerative diseases. FMD is clinically indistinguishable from Vesicular stomatitis, Swine vesicular disease and Vesicular exanthema of swine. It may also resemble Bovine viral diarrhea, Mucosal disease, Infectious bovine rhinotracheitis, Bluetongue, Bovine papular stomatitis, Bovine mammillitis and Rinderpest.

  11. Measurement of the healing ability of ischemic ulcers in the lower limbs in chronic arterial obstructive disease using 201Tl-Cl

    International Nuclear Information System (INIS)

    Evaluation of the healing ability of ischemic ulcers by a method involving measurement of the ulcer index (U. I.) and mean ulcer index of toes (mU. I.) using 201Tl-Cl before and after the treatment of chronic arterial obstructive disease accompanied by ischemic ulcer was studied. The lesions consisted of 56 ulcers in 41 limbs. Reactive hyperemia following avascularization stress was used for measurement, and U. I. was determined according to the method of Siegel et al. For cases with toe ulcers, the mU. I. was measured from plantar scintigrams, twice under stress and upon redistribution after 3 hours' rest. The following results were obtained. 1) The healing ability of the cases with a U. I. value of more than 1.4 was good, but even among cases with a pretreatment U. I. of 0.9 - 1.4, ulcer healing was also good in cases in which the U. I. was maintained above 1.4 as a result of various treatments. 2) Significant increases in U. I. were observed in the arterial reconstruction group after treatment, compared to the conservative treatment group and the lumbar sympathectomy group. 3) The healing ability was good in cases with an mU. I. of more than 1.2 at stress except for 2 ASO cases complicated by diabetes. 4) Although it was difficult to prognosticate the healing ability of cases with an mU. I. of less than 1.2 before treatment, healing ability could be evaluated after treatment on the basis of the appearance of significant increase in blood flow on stress in the ulcerated toes. 5) A stress index seemed to reflect the ischemic conditions in ulcerated toes in relation to stress. 6) U. I. and mU. I. measured using 201Tl-Cl were significantly correlated with the degree of inflammatory and reactive hyperemia in the floor of ulcers and in the ulcerated toes. (J.P.N.)

  12. Computed tomography of Crohn`s disease and ulcerative colitis; Computertomographische Morphologie von Morbus Crohn und Colitis ulcerosa

    Energy Technology Data Exchange (ETDEWEB)

    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)

    1995-07-01

    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

  13. Application of fecal calprotectin and myeloperoxidase in evaluation of disease activity of ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    柏明见

    2013-01-01

    Objective To explore the clinical value of fecal calprotectin and myeloperoxidase in evaluation of ulcerative colitis(UC) activity.Methods Specimens of serum and feces over the same period were collected from

  14. Cytotoxic isolates of Helicobacter pylori from Peptic Ulcer Diseases decrease K+-dependent ATPase Activity in HeLa cells

    Directory of Open Access Journals (Sweden)

    Archana Ayyagari

    2003-11-01

    Full Text Available Abstract Background Helicobacter pylori is a Gram negative bacterium that plays a central role in the etiology of chronic gastritis and peptic ulcer diseases. However, not all H. pylori positive cases develop advanced disease. This discriminatory behavior has been attributed to the difference in virulence of the bacteria. Among all virulence factors, cytotoxin released by H. pylori is the most important factor. In this work, we studied variation in H. pylori isolates from Indian dyspeptic patients on the basis of cytotoxin production and associated changes in K+-dependent ATPase (one of its targets enzyme activity in HeLa cells. Methods The patients were retrospectively grouped on the basis of endoscopic and histopathological observation as having gastritis or peptic ulcer. The HeLa cells were incubated with the broth culture filtrates (BCFs of H. pylori isolates from patients of both groups and observed for the cytopathic effects: morphological changes and viability. In addition, the K+-dependent ATPase activity was measured in HeLa cells extracts. Results The cytotoxin production was observed in 3/7 (gastritis and 4/4 (peptic ulcer H. pylori isolates. The BCFs of cytotoxin producing H. pylori strains reduced the ATPase activity of HeLa cells to 40% of that measured with non-cytotoxin producing H. pylori strains (1.33 μmole Pi/mg protein and 3.36 μmole Pi/mg protein, respectively, p Conclusions Our results suggest that the isolation of cytotoxic H. pylori is more common in severe form of acid peptic diseases (peptic ulcer than in gastritis patients from India. Also the cytotoxin released by H. pylori impairs the ion-transporting ATPase and is a measure of cytotoxicity.

  15. Herpes simplex virus type 2, genital ulcers and HIV-1 disease progression in postpartum women.

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    Alison C Roxby

    Full Text Available BACKGROUND: Co-infection with herpes simplex virus type 2 (HSV-2 has been associated with increased HIV-1 RNA levels and immune activation, two predictors of HIV-1 progression. The impact of HSV-2 on clinical outcomes among HIV-1 infected pregnant women is unclear. METHODS: HIV-1 infected pregnant women in Nairobi were enrolled antenatally and HSV-2 serology was obtained. HIV-1 RNA and CD4 count were serially measured for 12-24 months postpartum. Survival analysis using endpoints of death, opportunistic infection (OI, and CD4<200 cells µL, and linear mixed models estimating rate of change of HIV-1 RNA and CD4, were used to determine associations between HSV-2 serostatus and HIV-1 progression. RESULTS: Among 296 women, 254 (86% were HSV-2-seropositive. Only 30 (10% women had prior or current genital ulcer disease (GUD; median baseline CD4 count was 422 cells µL. Adjusting for baseline CD4, women with GUD were significantly more likely to have incident OIs (adjusted hazard ratio (aHR 2.79, 95% CI: 1.33-5.85, and there was a trend for association between HSV-2-seropositivity and incident OIs (aHR 3.83, 95% CI: 0.93-15.83. Rate of change in CD4 count and HIV-1 RNA did not differ by HSV-2 status or GUD, despite a trend toward higher baseline HIV-1 RNA in HSV-2-seropositive women (4.73 log10 copies/ml vs. 4.47 log10 copies/ml, P = 0.07. CONCLUSIONS: HSV-2 was highly prevalent and pregnant HIV-1 infected women with GUD were significantly more likely to have incident OIs than women without GUD, suggesting that clinically evident HSV-2 is a more important predictor of HIV-1 disease progression than asymptomatic HSV-2.

  16. Pregnancy, fertility, and disease course in patients with Crohn's disease and ulcerative colitis

    DEFF Research Database (Denmark)

    Munkholm, NN

    2000-01-01

    Pattern recognition of the long-term disease course before, during, and after pregnancy can provide us with data about the influence of pregnancy on IBD, and vice versa. Determinants that predict an indolent versus an aggressive disease course are currently being sought. Our intention is to analyze...... the disease course during pregnancy in an EU-IBD inception cohort of 1200 patients diagnosed from 1991 to 1993 and followed up for 10 years. We also attempt to evaluate such factors as smoking and medication and to predict pregnancy course and fertility in IBD as well as in a cross-sectional study of members...... immune deficits. Glycoprotein YKL-40, which causes fibrosis in RA and cirrhosis, is speculated to be lower in multiparous women than in nonpregnant women due to the fetal lymphocytes that secrete a protein that is a potential immune modulator. Knowledge gained from future EC-IBD studies may result in new...

  17. Cytokine Response to Antigen Stimulation of Whole Blood from Patients with Mycobacterium ulcerans Disease Compared to That from Patients with Tuberculosis

    Science.gov (United States)

    Phillips, R.; Horsfield, C.; Kuijper, S.; Sarfo, S. F.; Obeng-Baah, J.; Etuaful, S.; Nyamekye, B.; Awuah, P.; Nyarko, K. M.; Osei-Sarpong, F.; Lucas, S.; Kolk, A. H. J.; Wansbrough-Jones, M.

    2006-01-01

    Mycobacterium ulcerans disease (Buruli ulcer) is a skin-ulcerating infection common in some parts of the tropics. We have investigated cytokine secretion after stimulation of whole blood from Buruli ulcer (BU) patients in a region of endemicity in Ghana with M. ulcerans sonicate or culture filtrate antigens to investigate the development of the response over time and its specificity by comparison with the response to Mycobacterium tuberculosis sonicate in human immunodeficiency virus-negative tuberculosis patients. Significant gamma interferon (IFN-γ) production in response to whole-blood stimulation with M. ulcerans sonicate was detected in patients with ulcers, which was higher than that in patients with nodules but similar to subjects with healed BU. The mean IFN-γ response in household contacts of BU patients was not significantly different from that in healthy control subjects from an area of nonendemicity. Results in patients with untreated, smear-positive pulmonary tuberculosis and tuberculosis patients on treatment for more than 2 weeks showed that BU patients responded better to M. ulcerans antigens than tuberculosis patients. In contrast, interleukin-10 results were higher in patients with active M. ulcerans disease than in those with healed lesions, but the pattern of response was similar to that seen in tuberculosis. A similar pattern of cytokine secretion was found using M. tuberculosis sonicate as an antigen. Neither of the two culture filtrate antigens of M. ulcerans appeared to be more specific than M. ulcerans sonicate. In the early stages of M. ulcerans disease there was a mixed Th1 and Th2 cytokine response, but the Th1 response emerged as the dominant type. PMID:16467334

  18. Does Helicobacter pylori Eradication Reduce the Risk of Open Angle Glaucoma in Patients With Peptic Ulcer Disease?

    Science.gov (United States)

    Chen, Hsin-Yi; Lin, Cheng-Li; Chen, Wen-Chi; Kao, Chia-Hung

    2015-09-01

    To investigate whether Helicobacter pylori (H pylori) eradication would influence the risk of primary open angle glaucoma (POAG) in patients with peptic ulcer disease. From the Longitudinal Health Insurance Database 2000, 6061 patients with peptic ulcer and receiving H pylori eradication therapy were recruited. The study cohort was subdivided into early (within 1 year) and late (after 1 year) eradication cohorts. The 24,244 control cohort subjects were those who without peptic ulcer and without receiving H pylori eradication therapy and were frequency-matched with the H pylori eradication cohort by age, sex, and the year of receiving H pylori eradication therapy. The higher incidence of POAG was observed in late H pylori eradication cohort and in early H pylori eradication cohort than in control cohort (1.57, 1.32, and 0.95, per 1000 person-year, respectively). However, overall risk of glaucoma was not significantly higher in the late eradication than in the early eradication (adjusted hazard ratio = 0.85, 95% confidence interval = 0.48-1.53). The POAG incidence was greater in the late H pylori eradication cohort when follow-up duration ≤ 5 years (1.59, per 1000 person-years). However, when follow-up duration >5 years, the incidence of POAG was greater in the early H pylori eradication cohort (1.68, per 1000 person-years). These relationships were not associated with a significantly increased or decreased risk of POAG in multivariable analyses. Either early or late H pylori eradication does not significantly reduce the risk of glaucoma in patients with peptic ulcer disease compared with normal control.

  19. Nonspecific genital ulcers.

    Science.gov (United States)

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

    2014-01-01

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

  20. Peptic Ulcer Disease in Healthcare Workers: A Nationwide Population-Based Cohort Study.

    Science.gov (United States)

    Lin, Hong-Yue; Weng, Shih-Feng; Lin, Hung-Jung; Hsu, Chien-Chin; Wang, Jhi-Joung; Su, Shih-Bin; Guo, How-Ran; Huang, Chien-Cheng

    2015-01-01

    Health care workers (HCWs) in Taiwan have heavy, stressful workloads, are on-call, and have rotating nightshifts, all of which might contribute to peptic ulcer disease (PUD). We wanted to evaluate the PUD risk in HCWs, which is not clear. Using Taiwan's National Health Insurance Research Database, we identified 50,226 physicians, 122,357 nurses, 20,677 pharmacists, and 25,059 other HCWs (dieticians, technicians, rehabilitation therapists, and social workers) as the study cohort, and randomly selected an identical number of non-HCW patients (i.e., general population) as the comparison cohort. Conditional logistical regression analysis was used to compare the PUD risk between them. Subgroup analysis for physician specialties was also done. Nurses and other HCWs had a significantly higher PUD risk than did the general population (odds ratio [OR]: 1.477; 95% confidence interval [CI]: 1.433-1.521 and OR: 1.328; 95% CI: 1.245-1.418, respectively); pharmacists had a lower risk (OR: 0.884; 95% CI: 0.828-0.945); physicians had a nonsignificantly different risk (OR: 1.029; 95% CI: 0.987-1.072). In the physician specialty subgroup analysis, internal medicine, surgery, Ob/Gyn, and family medicine specialists had a higher PUD risk than other physicians (OR: 1.579; 95% CI: 1.441-1.731, OR: 1.734; 95% CI: 1.565-1.922, OR: 1.336; 95% CI: 1.151-1.550, and OR: 1.615; 95% CI: 1.425-1.831, respectively). In contrast, emergency physicians had a lower risk (OR: 0.544; 95% CI: 0.359-0.822). Heavy workloads, long working hours, workplace stress, rotating nightshifts, and coping skills may explain our epidemiological findings of higher risks for PUD in some HCWs, which might help us improve our health policies for HCWs. PMID:26301861

  1. Assessment of risk factors of helicobacter pylori infection and peptic ulcer disease

    Directory of Open Access Journals (Sweden)

    Rahul S Mhaskar

    2013-01-01

    Full Text Available Background: Helicobacter pylori (H. pylori infection is a risk factor for peptic ulcer. There have been no studies addressing environmental and dietary risk factors in western India. We conducted a case control study enrolling peptic ulcer patients in Pune, India. Materials and Methods: Risk factors for peptic ulcer and H. pylori infection were assessed in a participant interview. H. pylori status was assessed from stool by monoclonal antigen detection. Results: We enrolled 190 peptic ulcer, 35 stomach cancer patients, and 125 controls. Fifty-one percent (180/350 of the participants were infected with H. pylori. Lower socioeconomic status (SES [odds ratio (OR: 1.10, 95% confidence interval (CI: 1.02-1.39], meat consumption (OR: 2.35, 95% CI: 1.30-4.23, smoking (OR: 2.23, 95% CI: 1.24-4.02, eating restaurant food (OR: 3.77, 95% CI: 1.39-10.23, and drinking nonfiltered or nonboiled water (OR: 1.05, 95% CI: 1.01-1.23 were risk factors for H. pylori infection. H. pylori infection (OR: 1.70, 95% CI: 1.03-2.89, meat (OR: 1.10, 95% CI: 1.02-1.75, fish (OR: 1.05, 95% CI: 1.02-1.89 consumption, and a family history of ulcer (OR: 1.20, 95% CI: 1.08-1.60 were risk factors for peptic ulcer. Consumption of chili peppers (OR: 0.20, 95% CI: 0.10-0.37 and parasite infestation (OR: 0.44, 95% CI: 0.24-0.80 were protective against H. pylori infection. Conclusion: H. pylori infection is associated with peptic ulcer. Lower SES, consumption of restaurant food, meat, nonfiltered water, and smoking are risk factors for H. pylori. Consumption of meat, fish, and a family history of peptic ulcer are risk factors for peptic ulcer. Consumption of chili peppers and concurrent parasite infestation appear to be protective against H. pylori.

  2. Connective tissue ulcers.

    Science.gov (United States)

    Dabiri, Ganary; Falanga, Vincent

    2013-11-01

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

  3. Eosinophilic gastroenteritis with refractory ulcer disease and gastrointestinal bleeding as a rare manifestation of seronegative gastrointestinal food allergy.

    Science.gov (United States)

    Raithel, Martin; Hahn, Markus; Donhuijsen, Konrad; Hagel, Alexander F; Nägel, Andreas; Rieker, Ralf J; Neurath, Markus F; Reinshagen, Max

    2014-09-17

    Gastrointestinal bleeding and iron deficiency anaemia may cause severe symptoms and may require extensive diagnostics and substantial amounts of health resources.This case report focuses on the clinical presentation of a 22 year old patient with recurrent gastrointestinal bleeding from multilocular non-healing ulcers of the stomach, duodenum and jejunum over a period of four years. Extensive gastroenterological and allergological standard diagnostic procedures showed benign ulcerative lesions with tissue eosinophilia, but no conclusive diagnosis. Multiple diagnostic procedures were performed, until finally, endoscopically guided segmental gut lavage identified locally produced, intestinal IgE antibodies by fluoro-enzyme-immunoassay.IgE antibody concentrations at the intestinal level were found to be more-fold increased for total IgE and food-specific IgE against nuts, rye flour, wheat flour, pork, beef and egg yolk compared with healthy controls.Thus, a diet eliminating these allergens was introduced along with antihistamines and administration of a hypoallergenic formula, which resulted in complete healing of the multilocular ulcers with resolution of gastrointestinal bleeding. All gastrointestinal lesions disappeared and total serum IgE levels dropped to normal within 9 months. The patient has been in remission now for more than two years.Eosinophilic gastroenteritis (EG) is well known to induce refractory ulcer disease. In this case, the mechanisms for intestinal damage and gastrointestinal bleeding were identified as local gastrointestinal type I allergy. Therefore, future diagnostics in EG should also be focused on the intestinal level as identification of causative food-specific IgE antibodies proved to be effective to induce remission in this patient.

  4. Is there a role for vedolizumab in the treatment of ulcerative colitis and Crohn’s disease?

    Directory of Open Access Journals (Sweden)

    Gilroy L

    2014-05-01

    Full Text Available Leah Gilroy, Patrick B Allen Department of Gastroenterology, Ulster Hospital, Dundonald, Belfast, Northern Ireland Abstract: Inflammatory bowel disease (IBD is an important cause of morbidity and mortality for millions of patients worldwide. Current treatment options include corticosteroids, 5-aminosalicylates, immunosuppressants, and TNFα antagonists. However, these are frequently ineffective in achieving sustained response and remission over time. At present, gastroenterologists lack safe and effective treatments if patients fail anti-TNF therapy. Vedolizumab is a promising new agent for IBD patients refractory to anti-TNF therapy. Vedolizumab is an integrin antagonist which is thought to act by reducing inflammation by selectively inhibiting leukocyte migration in the gut. Emerging evidence from clinical trials suggests a potential role for vedolizumab in both ulcerative colitis (UC and Crohn’s disease (CD, particularly in patients who have previously failed biological therapy. The safety profile of vedolizumab appears reasonable, possibly because it has a “gut-selective” mode of action, with no reported cases of progressive multifocal leukoencephalopathy, a condition which has been linked to another integrin antagonist, natalizumab. This review discusses the available evidence for integrin antagonists and their potential role in the management of IBD. Keywords: vedolizumab, ulcerative colitis, Crohn’s disease, inflammatory bowel disease

  5. How host regulation of Helicobacter pylori-induced gastritis protects against peptic ulcer disease and gastric cancer.

    Science.gov (United States)

    Dhar, Poshmaal; Ng, Garrett Z; Sutton, Philip

    2016-09-01

    The bacterial pathogen Helicobacter pylori is the etiological agent of a range of gastrointestinal pathologies including peptic ulcer disease and the major killer, gastric adenocarcinoma. Infection with this bacterium induces a chronic inflammatory response in the gastric mucosa (gastritis). It is this gastritis that, over decades, eventually drives the development of H. pylori-associated disease in some individuals. The majority of studies investigating H. pylori pathogenesis have focused on factors that promote disease development in infected individuals. However, an estimated 85% of those infected with H. pylori remain completely asymptomatic, despite the presence of pathogenic bacteria that drive a chronic gastritis that lasts many decades. This indicates the presence of highly effective regulatory processes in the host that, in most cases, keeps a check on inflammation and protect against disease. In this minireview we discuss such known host factors and how they prevent the development of H. pylori-associated pathologies.

  6. Is Childhood Physical Abuse Associated with Peptic Ulcer Disease? Findings from a Population-Based Study

    Science.gov (United States)

    Fuller-Thomson, Esme; Bottoms, Jennifer; Brennenstuhl, Sarah; Hurd, Marion

    2011-01-01

    This study investigated childhood physical abuse and ulcers in a regionally representative community sample. Age, race and sex were controlled for in addition to five clusters of potentially confounding factors: adverse childhood conditions, adult socioeconomic status, current health behaviors, current stress and marital status, and history of…

  7. Molecular diagnosis of lymphogranuloma venereum in patients with genital ulcer disease.

    NARCIS (Netherlands)

    Sturm, P.D.J.; Moodley, P.; Govender, K.; Bohlken, L.; Mali, T. van; Sturm, A.W.

    2005-01-01

    The detection of herpes, chancroid, and syphilis in genital ulcers is done by PCR. This is not so for lymphogranuloma venereum (LGV). We report on the use of a PCR with digestion that differentiates the LGV biovar from the trachoma biovar. Our findings suggest that the clinical description of LGV in

  8. [The importance of multidisciplinary foot-care services in the management of diabetic patients with peripheral artery disease and diabetic foot ulcers].

    Science.gov (United States)

    Ran, Xing-Wu; Zhao, Ji-Chun

    2012-09-01

    Diabetic peripheral artery disease and diabetic foot ulcers are leading causes of hospitalization, for patients with diabetes mellitus, and also are the most important causes of amputation of the lower extremity in those patients, which contribute to the increased mortality and cardiovascular death. The incidence of diabetic peripheral artery disease and diabetic foot ulcers shows increasing trend. Diabetic peripheral artery disease and diabetic foot ulcers can be successfully treated only by the multidisciplinary foot-care services which provide more comprehensive and integrated care as compared to ordinary medical team or single specialist. Multidisciplinary foot-care services are provided by the team consist of: diabetologist, diabetes nurse, vascular surgeon, general surgeon, orthopedist, orthopaedic surgeon, podiatrist and orthotist, interventional radiologist and a radiology coordinator, microbiologist, psychologist, educators, shoemaker and rehabilitation team. Contrary to developed countries, multidisciplinary foot-care team has not been constructed in most centres in China. Diabetic education, appropriate foot care, early detection of risk factors of foot ulcers and early intervention are key components in the overall management of diabetic foot disorders and have assumed important roles in programs focused on amputation prevention. Prompt and aggressive treatments of diabetic peripheral artery disease and diabetic foot ulcers can often prevent an exacerbation of the problem and the potential need for amputation, which include correction of biomechanical abnormalities, infection control, serial debridement of ulcers, peripheral revascularization and wound coverage, etc. It is very important to construct a multidisciplinary diabetic foot care team to more effectively improve the survival and prognosis of patients with diabetic peripheral artery disease and diabetic foot ulcers with comprehensive treatments.

  9. Analysis of the formula for ulcer and sore diseases in Jijiu Xianfang%《急救仙方》疡科方辨析

    Institute of Scientific and Technical Information of China (English)

    樊建开; 仇菲

    2011-01-01

    六卷所载方药,为背疮、疔疮治法之先导,内外并重,辨析详尽,对了解疡科急救方剂的历史渊源,发掘利用古代医方有着重要的文献价值.%Jijiu Xianfang in 6 volumes, recorded the formulas for ulcer and sore diseases. The formula treated both the internal and the external disorders with clear differentiation and analysis. It has important documentary value for researchers to know the historical origin of the ulcers and sore diseases and to treat the disease with ancient prescriptions.

  10. Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE Study

    DEFF Research Database (Denmark)

    Prompers, L.; Schaper, N.; Apelqvist, J.;

    2008-01-01

    Aims/hypothesis Outcome data on individuals with diabetic foot ulcers are scarce, especially in those with peripheral arterial disease (PAD). We therefore examined the clinical characteristics that best predict poor outcome in a large population of diabetic foot ulcer patients and examined whether...... such predictors differ between patients with and without PAD. Methods Analyses were conducted within the EURODIALE Study, a prospective cohort study of 1,088 diabetic foot ulcer patients across 14 centres in Europe. Multiple logistic regression modelling was used to identify independent predictors of outcome (i...... ulcer size, peripheral neuropathy and PAD. When analyses were performed according to PAD status, infection emerged as a specific predictor of non-healing in PAD patients only. Conclusions/Interpretation Predictors of healing differ between patients with and without PAD, suggesting that diabetic foot...

  11. Helicobacter pylori and Peptic Ulcers

    Centers for Disease Control (CDC) Podcasts

    2010-08-17

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

  12. Isocitrate dehydrogenase of Helicobacter pylori potentially induces humoral immune response in subjects with peptic ulcer disease and gastritis.

    Directory of Open Access Journals (Sweden)

    M Abid Hussain

    Full Text Available BACKGROUND: H. pylori causes gastritis and peptic ulcers and is a risk factor for the development of gastric carcinoma. Many of the proteins such as urease, porins, flagellins and toxins such as lipo-polysaccharides have been identified as potential virulence factors which induce proinflammatory reaction. We report immunogenic potentials of isocitrate dehydrogenase (ICD, an important house keeping protein of H. pylori. METHODOLOGY/PRINCIPAL FINDINGS: Amino acid sequences of H. pylori ICD were subjected to in silico analysis for regions with predictably high antigenic indexes. Also, computational modelling of the H. pylori ICD as juxtaposed to the E. coli ICD was carried out to determine levels of structure similarity and the availability of surface exposed motifs, if any. The icd gene was cloned, expressed and purified to a very high homogeneity. Humoral response directed against H. pylori ICD was detected through an enzyme linked immunosorbent assay (ELISA in 82 human subjects comprising of 58 patients with H. pylori associated gastritis or ulcer disease and 24 asymptomatic healthy controls. The H. pylori ICD elicited potentially high humoral immune response and revealed high antibody titers in sera corresponding to endoscopically-confirmed gastritis and ulcer disease subjects. However, urea-breath-test negative healthy control samples and asymptomatic control samples did not reveal any detectable immune responses. The ELISA for proinflammatory cytokine IL-8 did not exhibit any significant proinflammatory activity of ICD. CONCLUSIONS/SIGNIFICANCE: ICD of H. pylori is an immunogen which interacts with the host immune system subsequent to a possible autolytic-release and thereby significantly elicits humoral responses in individuals with invasive H. pylori infection. However, ICD could not significantly stimulate IL8 induction in a cultured macrophage cell line (THP1 and therefore, may not be a notable proinflammatory agent.

  13. Genetic analysis of innate immunity in Crohn's disease and ulcerative colitis identifies two susceptibility loci harboring CARD9 and IL18RAP

    NARCIS (Netherlands)

    Zhernakova, Alexandra; Festen, Eleanora M; Franke, Lude; Trynka, Gosia; van Diemen, Cleo C; Monsuur, Alienke J; Bevova, Marianna; Nijmeijer, Rian M; van 't Slot, Ruben; Heijmans, Roel; Boezen, Hendrika; van Heel, David A; van Bodegraven, Adriaan A; Stokkers, Pieter C F; Wijmenga, Cisca; Crusius, J Bart A; Weersma, Rinse K

    2008-01-01

    The two main phenotypes of inflammatory bowel disease (IBD)--Crohn's disease (CD) and ulcerative colitis (UC)--are chronic intestinal inflammatory disorders with a complex genetic background. Using a three-stage design, we performed a functional candidate-gene analysis of innate immune pathway in IB

  14. Parameters of proliferation and apoptosis of epithelial cells in the gastric mucosa in indigenous and non-indigenous residents of Khakassia with Helicobacter pylori positive duodenal ulcer disease.

    Science.gov (United States)

    Tsukanov, V V; Shtygasheva, O V; Vasyutin, A V; Amel'chugova, O S; Butorin, N N; Ageeva, E S

    2015-02-01

    We evaluated parameters of apoptosis in the mucosa of the gastric antrum and body of indigenous and non-indigenous residents of Khakassia with duodenal ulcer disease associated with Helicobacter pylori infection. In the gastric antrum, apoptotic index was significantly increased in patients with ulcer disease in comparison with healthy individuals in both populations. The ratio of proliferation index to apoptotic index was lower in patients with ulcer disease in comparison with healthy individuals in both populations. Similar, but less pronounced processes were recorded in the body of the stomach. Significant changes in the parameters of proliferation and apoptosis were noted in the gastric antrum and body of the stomach in both populations, but they were more pronounced in Caucasians in comparison with Khakasses.

  15. H_2-receptor Antagonist Therapy : With Special Reference to Ranitidine(Current Medical Therapy for Upper Gastrointestinal Ulcer Disease)

    OpenAIRE

    渡辺,裕; 村山, 久夫; Watanabe, Yutaka; Murayama, Hisao

    1988-01-01

    The cure rate for endoscopic therapy was determined in 61 patients with a gastroduodenal ulcer who received Ranitidine at a dose of 150 mg twice daily, in the morning and evening. The ulcer patients were classified into initial-, recurrent-and intractable-ulcer groups, and the cumulative cure rate was compared among the three types of ulcers. The cure rate was 93% for the initial ulcer, 78% for recurrent and 50% for intractable. Uncured ulcers accounted for about 10% of the patients, and the ...

  16. Crohn's disease and ulcerative colitis. Occurrence, course and prognosis during the first year of disease in a European population-based inception cohort

    DEFF Research Database (Denmark)

    Burisch, Johan

    2014-01-01

    nurses were not used in Eastern European IBD centres. Expenses for the cohort during the initial year of disease exceeded four million Euros with most money spent on diagnostics and surgery. Biological therapy accounted for one fourth costs in Western European CD patients. Long-term follow-up of the Epi......Inflammatory bowel diseases (IBD), consisting of Crohn's disease (CD) and ulcerative colitis (UC), are chronic immune mediated diseases of unknown aetiology. Traditionally, the highest occurrence of both UC and CD is found in North America and Europe, including Scandinavia and the United Kingdom......, while the diseases remain rare in Eastern Europe. Until recently, few population-based cohort data were available on the epidemiology of IBD in Eastern Europe. However, recent studies from Hungary and Croatia have reported steep increases in IBD incidence that means they are now comparable with Western...

  17. Microbial diversity of genital ulcer disease in men enrolled in a randomized trial of male circumcision in Kisumu, Kenya.

    Directory of Open Access Journals (Sweden)

    Supriya D Mehta

    Full Text Available BACKGROUND: Medical male circumcision (MMC reduces the risk of genital ulcer disease (GUD in men by 50%. In Ugandan and Kenyan trials, a sexually transmissible agent was not identified in 50-60% of GUD specimens by polymerase chain reaction (PCR assay. We sought to better define the etiology of GUD in men participating in the Kenyan trial and examine how MMC affects GUD etiology. METHODS: We defined GUD of unknown etiology as negative for HSV (type 1 and type 2, T. pallidum, and H. ducreyi by PCR, and negative for HSV-2 and T. pallidum by serology. We identified bacterial microbiota in a subset of 59 GUD specimens using multitag pyrosequencing of the 16S rRNA gene, and compared results by unknown vs. STI-associated etiology. Statistical analysis employed Bray-Curtis similarity measure of bacterial community by etiology, hierarchical clustering and logistic regression. RESULTS: In 59 GUD specimens from 59 men, 23 (39% had unknown etiology. Bacterial diversity was greater in GUD of unknown than STI etiology (p = 0.01. Fusobacteria (Fusobacterium spp. and Sneathia spp. were more commonly detected in men with GUD of unknown etiology [adjusted OR = 5.67; 95% CI: 1.63-19.8] as were Oxobacter spp. and Anaerovorax spp. [adjusted OR = 3.12; 95% CI: 0.83-11.7]. Sequences from these four anaerobic bacterial taxa were more often detected in uncircumcised men than circumcised men (p<0.05. CONCLUSIONS: Anaerobic bacteria are more common in genital ulcers of uncircumcised men. The specific anaerobic bacteria associated with GUD of unknown etiology have cytotoxic properties that can exacerbate epithelial disruptions leading to ulcer-like appearance. MMC may reduce GUD through a reduction in these anaerobic bacteria.

  18. Crohn's disease and ulcerative colitis. Occurrence, course and prognosis during the first year of disease in a European population-based inception cohort

    DEFF Research Database (Denmark)

    Burisch, Johan

    2014-01-01

    Inflammatory bowel diseases (IBD), consisting of Crohn's disease (CD) and ulcerative colitis (UC), are chronic immune mediated diseases of unknown aetiology. Traditionally, the highest occurrence of both UC and CD is found in North America and Europe, including Scandinavia and the United Kingdom......, while the diseases remain rare in Eastern Europe. Until recently, few population-based cohort data were available on the epidemiology of IBD in Eastern Europe. However, recent studies from Hungary and Croatia have reported steep increases in IBD incidence that means they are now comparable with Western....... The aim of this thesis was to create a prospective European population-based inception cohort of incident IBD patients in order to investigate whether an East-West gradient in the incidence of IBD exists in Europe. Furthermore, we investigated possible differences throughout Europe during the first year...

  19. Complex and dynamic times of being chronically ill: Beyond disease trajectories of patients with ulcerative colitis.

    Science.gov (United States)

    Shubin, Sergei; Rapport, Frances; Seagrove, Anne

    2015-12-01

    This article contributes to health research literature by problematizing the linear, sequential and intelligible understanding of time in the studies of illness. Drawing on the work of Martin Heidegger, it attempts to overcome the problem of considering the time of illness as either a framework controlling patients' experiences or a mind-dependent feature of their lives. The paper offers a conceptual analysis of the stories of ulcerative colitis patients from a recent clinical trial to present temporalities of illness as both objective and subjective, relational and dynamic. We attend to a combination of temporalities related to the ambiguous unfolding of illness and patients' relationships with such an unpredictable world of changing bodies, medical practices and temporal norms. Furthermore, our analysis reveals openness of times and considers ulcerative colitis patients as constantly evolving beings, with multiple possibilities brought about by illness. The paper highlights co-existence of times and considers patients' lives as incorporating a multiplicity of futures, presents and pasts. It concludes with conceptual observations about the consequences of developing complex approaches to illness in health research, which can better highlight the situatedness of patients and their multi-dimensional temporal foundations. PMID:26560409

  20. Receptor binding sites for substance P in surgical specimens obtained from patients with ulcerative colitis and Crohn disease

    Energy Technology Data Exchange (ETDEWEB)

    Mantyh, C.R.; Gates, T.S.; Zimmerman, R.P.; Welton, M.L.; Passaro, E.P. Jr.; Vigna, S.R.; Maggio, J.E.; Kruger, L.; Mantyh, P.W.

    1988-05-01

    Several lines of evidence indicate that tachykinin neuropeptides (substance P (SP), substance K (SK), and neuromedin K (NK)) play a role in regulating the inflammatory and immune responses. To test this hypothesis in a human inflammatory disease, quantitative receptor autoradiography was used to examine possible abnormalities in tachykinin binding sites in surgical specimens from patients with inflammatory bowel disease. In all cases, specimens were processed for quantitative receptor autoradiography by using /sup 125/I-labeled Bolton-Hunter conjugates of NK, SK, and SP. In colon tissue obtained from ulcerative colitis and Crohn disease patients, very high concentrations of SP receptor binding sites are expressed by arterioles and venules located in the submucosa, muscalairs mucosa, external circular muscle, external longitudinal muscle, and serosa, in contrast to control patients. These results demonstrate that receptor binding sites for SP, but not SK or NK, are ectopically expressed in high concentrations by cells involved in mediating inflammatory and immune responses. These data suggest that SP may be involved in the pathophysiology of inflammatory bowel disease and might provide some insight into the interaction between the nervous system and the regulation of inflammation and the immune response in human inflammatory disease.

  1. Associations between diet and disease activity in ulcerative colitis patients using a novel method of data analysis

    Directory of Open Access Journals (Sweden)

    Curno Richard

    2005-02-01

    Full Text Available Abstract Background The relapsing nature and varying geographical prevalence of ulcerative colitis (UC implicates environmental factors such as diet in its aetiology. Methods In order to determine which foods might be related to disease activity in UC a new method of dietary analysis was developed and applied. Eighty-one UC patients were recruited at all stages of the disease process. Following completion of a 7 d diet diary, clinical assessment including a sigmoidoscopic examination (scale 0 (normal mucosa to 6 (very active disease was conducted. Food weights for each person were adjusted (divided by the person's calorific intake for the week. Each food consumed was given a food sigmoidoscopy score (FSS calculated by summing the products of the (adjusted weight of food consumed and sigmoidoscopy score for each patient and occurrence of food and dividing by the total (adjusted weight of the food consumed by all 81 patients. Thus, foods eaten in large quantities by patients with very active disease have high FSSs and vice versa. Foods consumed by Results High FSS foods were characterized by high levels of the anti-thiamin additive sulfite (Mann-Whitney, p Conclusions The dietary analysis method described provides a new tool for establishing relationships between diet and disease and indicates a potentially therapeutic diet for UC.

  2. INFLAMMATORY BOWEL DISEASE IN HISPANIC COMMUNITIES: a concerted South American approach could identify the aetiology of Crohn’s disease and ulcerative colitis

    Directory of Open Access Journals (Sweden)

    Affifa FARRUKH

    2014-12-01

    Full Text Available Despite intensive research we remain ignorant of the cause of both Crohn’s disease and ulcerative colitis. The dramatic rise in incidence, particularly of Crohn’s disease, points towards environmental factors as playing a significant role. A major purpose of this review is to stimulate a co-ordinated international effort to establish an on-going data base in Central and South America in which new cases are registered and through which investigations into aetiology can be conducted. In both Brazil and Mexico there is evidence that the incidence of ulcerative colitis is increasing, as also is the case for Crohn’s disease in Brazil. The pattern of disease is, therefore, directly comparable to that reported from Europe and the USA during the 1970s and 1980s, but much lower than contemporary data from Spain. Although the incidence is similar to that reported from Portugal, the studies from Almada and Braga were conducted a decade before that from Sao Paulo. The situation in Brazil compares dramatically with Uruguay and Argentina where the reported incidence of inflammatory bowel disease is significantly less. However, with growing industrialisation it is likely that there will be an explosion of inflammatory bowel disease in some areas of Central and South America over the next 20 years. The creation of a network of researchers across South and Central America is a real possibility and through a Concerted Action there is the possibility that major strides could be made towards understanding the cause of inflammatory bowel disease and so develop preventive strategies.

  3. Mouth and genital ulcers with inflamed cartilage: MAGIC syndrome. Five patients with features of relapsing polychondritis and Behçet's disease.

    Science.gov (United States)

    Firestein, G S; Gruber, H E; Weisman, M H; Zvaifler, N J; Barber, J; O'Duffy, J D

    1985-07-01

    Five patients with features of coexistent relapsing polychondritis and Behçet's disease are described. Review of the literature supports the overlap of the clinical manifestations of these two conditions. A common immunologic abnormality is likely, and elastin is cited as a possible target antigen. The "mouth and genital ulcers with inflamed cartilage (MAGIC) syndrome" is the proposed name for this entity.

  4. Attempt to validate breakpoint MIC values estimated from pharmacokinetic data obtained during oxolinic acid therapy of winter ulcer disease in Atlantic salmon ( Salmo salar )

    DEFF Research Database (Denmark)

    Coyne, R.; Bergh, Ø.; Samuelsen, O.;

    2004-01-01

    Concentrations of oxolinic acid (OXA) were measured in the plasma, muscle, liver, and kidney of 48 Atlantic salmons (Salmo salar) 1 day after the end of an oral administration. OXA was administered over a period of 13 days to control an outbreak of winter ulcer disease in a commercial marine farm...

  5. FVB/N Mice Spontaneously Heal Ulcerative Lesions Induced by Mycobacterium ulcerans and Switch M. ulcerans into a Low Mycolactone Producer.

    Science.gov (United States)

    Marion, Estelle; Jarry, Ulrich; Cano, Camille; Savary, Caroline; Beauvillain, Céline; Robbe-Saule, Marie; Preisser, Laurence; Altare, Frederic; Delneste, Yves; Jeannin, Pascale; Marsollier, Laurent

    2016-03-15

    Buruli ulcer, a debilitating disease, is caused by Mycobacterium ulcerans. The incidence of this neglected tropical disease is steadily increasing. As a rule, without treatment, skin ulcers occur and a lengthy healing process may be observed associated with severe functional disabilities. Mouse models are already available to study establishment of lesions or evaluation of therapy but a lack of a suitable animal model, mimicking all clinical stages, in particular the healing process, remains an obstacle to understand the pathophysiology of M. ulcerans infection. M. ulcerans was s.c. inoculated in three consanguine mouse strains, that is, BALB/c and C57BL/6, classically used to study mycobacterial infection, and FVB/N. Strikingly, FVB/N mice, although as sensitive as all other mouse strains with respect to M. ulcerans infection, presented a spontaneous healing after the ulcerative phase despite stable bacterial load, and mycolactone toxin was not detected in the healed tissues. The spontaneous healing process was accompanied by an activation of the innate immune system. The adaptive response initiated by FVB/N mice was not involved in the healing process and did not confer protection against M. ulcerans. Our work highlights the importance of innate immune responses to control M. ulcerans infection. This in vivo model of M. ulcerans infection now paves the way for new avenues of research toward the elucidation of critical stages of this disease, such as the characterization of the regulation of mycolactone production, a better understanding of the pathophysiology of M. ulcerans infection, and the development of new therapeutic strategies. PMID:26873988

  6. Leg ulcers due to hyperhomocysteinemia

    OpenAIRE

    Krupa Shankar D; Akhib Syed

    2006-01-01

    Chronic leg ulcers are rare in young adults and generally indicate a vascular cause. We report a case of a 26-year-old man with leg ulcers of eight months duration. Doppler study indicated venous incompetence and a postphlebitic limb. However, as the distribution and number of ulcers was not consistent with stasis alone and no features of collagen vascular disease were noted, a hyperviscosity state was considered and confirmed with significantly elevated homocysteine level in the serum. Admin...

  7. Prevalence of Helicobacter Pylori-Negative, Non-Steroidal Anti-Inflammatory Drug Related Peptic Ulcer Disease in Patients Referred to Afzalipour Hospital.

    Science.gov (United States)

    Seyed Mirzaei, Seyed Mahdi; Zahedi, Mohammad Javad; Shafiei Pour, Sara

    2015-10-01

    BACKGROUND Although Helicobacter pylori and non-steroidal anti-inflammatory drugs (NSAIDs) are the main causes of peptic ulcers disease (PUD), recently the prevalence of idiopathic peptic ulcer (IPU) is increasing in most parts of the world. The aim of this study was to assess the prevalence of IPU in Kerman, the center of largest province in south-east Iran. METHODS We included 215 patients with peptic ulcer in our study. Combined methods rapid urease test (RUT), histology, and real time polymerase chain reaction (PCR) was performed on endoscopic samples of peptic ulcers. NSAID use was determined by medical history. SPSS software version 16 was used for data analysis. p valueulcer, four (1.8%) had H.pylorinegative and NSAID-negative PUD. There were not significant differences between patients with IPU and patients with peptic ulcer associated with H.pylori or NSAIDs regarding the sex, age, cigarette smoking, and opioid abuse. CONCLUSION Our study showed that in contrast to other reports from western and some Asian countries, the prevalence of IPU is low in Kerman and H.pylori infection is still the major cause of PUD. We recommend a large and multi-central study to determine the prevalence of IPU in Iran.

  8. Psychological status in Iranian patients with ulcerative colitis and its relation to disease activity and quality of life

    Directory of Open Access Journals (Sweden)

    Mahshid Tabatabaeian

    2015-01-01

    Full Text Available Background: Psychological profile of inflammatory bowel disease patients is not well studied in Iran. We investigated the psychological status of Iranian patients with ulcerative colitis (UC and its relationship with disease activity and quality of life (QOL. Materials and Methods: A cross-sectional study was conducted on adult UC patients. The Lichtiger Colitis Activity Index, Hospital Anxiety and Depression Scale, General Health Questionnaire-12, and WHOQOL-BREF, were completed by the patients. Results: From 120 studied patients, 35 (29.2%, 48 (40.0%, and 46 (38.3% had significant anxiety, depression, and psychological distress, respectively. Anxiety, depression, and psychological distress were strongly correlated with disease activity (r = 0.357 to 0.439, P < 0.01. Disease activity was negatively correlated with all QOL dimensions (r = −0.245 to −0.550, P < 0.01. Anxiety, depression, and psychological distress were also negatively correlated with all QOL domains (r = −0.356 to −0.789, P < 0.01. In the regression models, anxiety was independently associated with active disease (β = 4.150, P = 0.049. Furthermore, disease activity was associated with the physical health (β = −0.371, P < 0.001. For almost all of the QOL domains, depression and psychological distress were independent predictors (β = −0.296 to −0.453, P < 0.001. Conclusion: Anxiety, depression, and psychological distress are highly frequent in UC patients of our society and are strongly associated with disease activity. Depression and psychological distress are important predictors of poor QOL in these patients. Further prospective studies, as well as clinical trials, are warranted in this regard.

  9. [Peripheral ulcerative keratitis].

    Science.gov (United States)

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

    2014-01-01

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

  10. Association of Helicobacter pylori Ig A antibodies with the risk of peptic ulcer disease and gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Timo U Kosunen; Kari Sepp(a)l(a); Seppo Sarna; Arpo Aromaa; Paul Knekt; Jarmo Virtamo; Anniina Salomaa-R(a)s(a)nen; Hilpi Rautelin

    2005-01-01

    AIM: To compare the prevalence of Helicobacter pylori (Hpylori) IgG and IgA antibodies between adult subjects,with defined gastric diseases, nondefined gastric disorders and those representing the population.METHODS: Data on H pylori IgG and IgA antibodies,determined by enzyme immunoassay, were analyzed in 3 252 subjects with DGD including 482 patients with gastric ulcer, 882 patients with duodenal ulcer, 1 525patients with chronic gastritis only and 363 subjects with subsequent gastric cancer, 19 145 patients with NoDg and4 854 POPUL subjects. The age-adjusted prevalences were calculated for 1- and 20-year age cohorts.RESULTS: The prevalences of IgG antibodies were equally high (89-96%) in all 20-year age cohorts of the DGD groups, whereas the prevalences of IgG antibodies were lower and increased by age in the POPUL and NoDg groups. The prevalences of IgA antibodies were also higher in the DGD groups; among them CA (84-89%) and GU groups (78-91%) showed significantly higher prevalences than DU (68-77%) and CG patients (59-74%) (OR 2.49, 95%CI 1.86-3.34 between the GU and DU groups). In the CA, GU, and DU groups, the IgA prevalences showed only minor variation according to age, while they increased by age in the CG, POPUL, and NoDg groups (P≤0.0001). The IgA response, but not the IgG response, was associated with an increased risk of CA (OR 2.41, 95%CI 1.79-3.53) and GU (OR 2.57,95%CI 1.95-3.39) in comparison with CG patients.CONCLUSION: An IgA antibody response during H pylori infection is significantly more common in CA and GU patients as compared with CG patients.

  11. Significant Differences Between Crohn's Disease and Ulcerative Colitis Regarding the Impact of Body Mass Index and Initial Disease Activity on Responsiveness to Azathioprine: Results from a European Multicenter Study in 1,176 Patients

    NARCIS (Netherlands)

    M.H. Holtmann; F. Krummenauer; C. Claas; K. Kremeyer; D. Lorenz; O. Rainer; I. Vogel; U. Boecker; S. Boehm; C. Buening; R. Duchmann; G. Gerken; H. Herfarth; N. Luegering; W. Kruis; M. Reinshagen; J Schmidt; A. Stallmach; J. Stein; A. Sturm; P.R. Galle; D.W. Hommes; G. D'Haens; P. Rutgeerts; M.F. Neurath

    2010-01-01

    In a survey comprising 1,176 patients with inflammatory bowel disease (IBD) we recently showed that azathioprine (AZA) beyond 4 years is beneficial in ulcerative colitis (UC) patients and in a subset of Crohn's disease (CD) patients. Here, we show for the first time that azathioprine responsiveness

  12. Stereomicroscopic examination of stained rectal biopsies in ulcerative colitis and Crohn's disease

    DEFF Research Database (Denmark)

    Poulsen, Steen Seier

    1980-01-01

    the stereomicroscopic findings and the clinical disease activity, the sigmoidoscopic findings, and the histologic activity. Apart from the stereomicroscopic observation of small superficial erosions in one fourth of the biopsies, no changes of diagnostic value were observed in Crohn's disease....

  13. Incidence of Duodenal Ulcers and Gastric Ulcers in a Western Population: Back to Where It Started

    Directory of Open Access Journals (Sweden)

    Marcel JM Groenen

    2009-01-01

    Full Text Available BACKGROUND/OBJECTIVES: As recently as 40 years ago, a decline in the incidence of peptic ulcers was observed. The discovery of Helicobacter pylori had a further major impact on the incidence of ulcer disease. Our aim was to evaluate the trends in the incidence and bleeding complications of ulcer disease in the Netherlands.

  14. Histopathologic features of Mycobacterium ulcerans infection

    NARCIS (Netherlands)

    Guarner, J; Bartlett, J; Whitney, EAS; Raghunathan, PL; Stienstra, Y; Asamoa, K; Etuaful, S; Klutse, E; Quarshie, E; van der Werf, TS; van der Graaf, WTA; King, CH; Ashford, DA

    2003-01-01

    Because of the emergence of Buruli ulcer disease, the World Health Organization launched a Global Buruli Ulcer Initiative in 1998. This indolent skin infection is caused by Mycobacterium ulcerans. During a study of risk factors for the disease in Ghana, adequate excisional skin-biopsy specimens were

  15. Fecal Microbial Composition of Ulcerative Colitis and Crohn’s Disease Patients in Remission and Subsequent Exacerbation

    Science.gov (United States)

    Wills, Edgar S.; Jonkers, Daisy M. A. E.; Savelkoul, Paul H.; Masclee, Ad A.; Pierik, Marieke J.; Penders, John

    2014-01-01

    Background Limited studies have examined the intestinal microbiota composition in relation to changes in disease course of IBD over time. We aimed to study prospectively the fecal microbiota in IBD patients developing an exacerbation during follow-up. Design Fecal samples from 10 Crohn’s disease (CD) and 9 ulcerative colitis (UC) patients during remission and subsequent exacerbation were included. Active disease was determined by colonoscopy and/or fecal calprotectine levels. Exclusion criteria were pregnancy, antibiotic use, enema use and/or medication changes between consecutive samples. The microbial composition was assessed by 16S rDNA pyrosequencing. Results After quality control, 6,194–11,030 sequences per sample were available for analysis. Patient-specific shifts in bacterial composition and diversity were observed during exacerbation compared to remission, but overarching shifts within UC or CD were not observed. Changes in the bacterial community composition between remission and exacerbation as assessed by Bray-Curtis dissimilarity, were significantly larger in CD versus UC patients (0.59 vs. 0.42, respectively; p = 0.025). Thiopurine use was found to be a significant cause of clustering as shown by Principal Coordinate Analysis and was associated with decreases in bacterial richness (Choa1 501.2 vs. 847.6 in non-users; p<0.001) and diversity (Shannon index: 5.13 vs. 6.78, respectively; p<0.01). Conclusion Shifts in microbial composition in IBD patients with changing disease activity over time seem to be patient-specific, and are more pronounced in CD than in UC patients. Furthermore, thiopurine use was found to be associated with the microbial composition and diversity, and should be considered when studying the intestinal microbiota in relation to disease course. PMID:24608638

  16. Infliximab therapy for moderately severe Crohn’s disease and ulcerative colitis: a retrospective comparison over 6 years

    Directory of Open Access Journals (Sweden)

    Raed Alzafiri

    2011-01-01

    Full Text Available Raed Alzafiri1, Christina A Holcroft2, Paula Malolepszy1, Albert Cohen1, Andrew Szilagyi11Jewish General Hospital, Division of Gastroenterology, Department of Medicine, McGill University School of Medicine, Montreal, Quebec, Canada; 2Centre for Clinical Epidemiology and Community Studies, McGill University School of Medicine, Montreal, Quebec, CanadaBackground: Infliximab has shown benefit in Crohn’s disease (CD and ulcerative colitis (UC.Objective: Evaluation of long-term outcome of therapy for both diseases.Methods: We analyzed retrospectively patients treated at infusion centers from one institution. Demographic, laboratory parameters leading up to biologic therapy and the subsequent pattern of outcomes in either disease were established as a database. Initial failure, subsequent need to change therapy, or need to adjust therapy were evaluated. Kruskal–Wallis (nonparametric tests to compare two groups and Kaplan–Meier survival curve analysis were used to compare outcomes.Results: Over approximately 6 years, 71 CD and 26 UC patients received 999 and 215 infusions, respectively, for a median of 62 months. Of these, 17% for CD and 19% for UC patients were primary failures. Following the start of infliximab, 18% of CD and 11% of UC patients required stoppage and switching to another type of therapy. In either CD or UC patients, 54% or 62%, respectively, continued therapy without the need to change to other treatments. Few serious side effects were noted. No important statistically significant differences in treatment patterns or outcome were observed between the groups.Discussion: Long-term treatment of both inflammatory bowel diseases reflects outcomes of clinical trials.Conclusions: This study emphasizes similarities between CD and UC and reports therapeutic success for an extended time.Keywords: infliximab, inflammatory bowel diseases

  17. Low Level Laser Therapy to Reduce Recurrent Oral Ulcers in Behçet's Disease.

    Science.gov (United States)

    Babu, D B Gandhi; Chavva, Sunanda; Waghray, Shefali; Allam, Neeharika Satya Jyothi; Kondaiah, Marella

    2016-01-01

    Behçet's disease (BD) is a chronic, relapsing multisystemic vascular condition. Behçet's disease was described by Hulusi Behçet in 1937. This rare multisystem relapsing-remitting inflammatory disease is poorly understood but is thought to be an autoimmune inflammatory vasculitic process in a genetically predisposed population. Diagnosis of Behçet's disease is based on International Criteria of Behçet's Disease (ICBD). The present paper describes a case report of Behçet's syndrome where aphthous stomatitis was treated with low level laser therapy. PMID:27555969

  18. Low Level Laser Therapy to Reduce Recurrent Oral Ulcers in Behçet's Disease

    Science.gov (United States)

    Babu, D. B. Gandhi; Chavva, Sunanda; Waghray, Shefali

    2016-01-01

    Behçet's disease (BD) is a chronic, relapsing multisystemic vascular condition. Behçet's disease was described by Hulusi Behçet in 1937. This rare multisystem relapsing-remitting inflammatory disease is poorly understood but is thought to be an autoimmune inflammatory vasculitic process in a genetically predisposed population. Diagnosis of Behçet's disease is based on International Criteria of Behçet's Disease (ICBD). The present paper describes a case report of Behçet's syndrome where aphthous stomatitis was treated with low level laser therapy. PMID:27555969

  19. Low Level Laser Therapy to Reduce Recurrent Oral Ulcers in Behçet’s Disease

    Directory of Open Access Journals (Sweden)

    D. B. Gandhi Babu

    2016-01-01

    Full Text Available Behçet’s disease (BD is a chronic, relapsing multisystemic vascular condition. Behçet’s disease was described by Hulusi Behçet in 1937. This rare multisystem relapsing-remitting inflammatory disease is poorly understood but is thought to be an autoimmune inflammatory vasculitic process in a genetically predisposed population. Diagnosis of Behçet’s disease is based on International Criteria of Behçet’s Disease (ICBD. The present paper describes a case report of Behçet’s syndrome where aphthous stomatitis was treated with low level laser therapy.

  20. Disease Severity and Immune Activity Relate to Distinct Interkingdom Gut Microbiome States in Ethnically Distinct Ulcerative Colitis Patients

    Directory of Open Access Journals (Sweden)

    Jordan S. Mar

    2016-08-01

    Full Text Available Significant gut microbiota heterogeneity exists among ulcerative colitis (UC patients, though the clinical implications of this variance are unknown. We hypothesized that ethnically distinct UC patients exhibit discrete gut microbiotas with unique metabolic programming that differentially influence immune activity and clinical status. Using parallel 16S rRNA and internal transcribed spacer 2 sequencing of fecal samples (UC, 30; healthy, 13, we corroborated previous observations of UC-associated bacterial diversity depletion and demonstrated significant Saccharomycetales expansion as characteristic of UC gut dysbiosis. Furthermore, we identified four distinct microbial community states (MCSs within our cohort, confirmed their existence in an independent UC cohort, and demonstrated their coassociation with both patient ethnicity and disease severity. Each MCS was uniquely enriched for specific amino acid, carbohydrate, and lipid metabolism pathways and exhibited significant luminal enrichment of the metabolic products of these pathways. Using a novel ex vivo human dendritic cell and T-cell coculture assay, we showed that exposure to fecal water from UC patients caused significant Th2 skewing in CD4+ T-cell populations compared to that of healthy participants. In addition, fecal water from patients in whom their MCS was associated with the highest level of disease severity induced the most dramatic Th2 skewing. Combined with future investigations, these observations could lead to the identification of highly resolved UC subsets based on defined microbial gradients or discrete microbial features that may be exploited for the development of novel, more effective therapies.

  1. Live birth and adverse birth outcomes in women with ulcerative colitis and Crohn's disease receiving assisted reproduction

    DEFF Research Database (Denmark)

    Nørgård, Bente Mertz; Larsen, P V; Fedder, J;

    2016-01-01

    OBJECTIVE: To examine the chance of live births and adverse birth outcomes in women with ulcerative colitis (UC) and Crohn's disease (CD) compared with women without inflammatory bowel disease (IBD) who have undergone assisted reproductive technology (ART) treatments. METHODS: This was a nationwide...... cohort study based on Danish health registries, comprising all women with an embryo transfer during 1 January 1994 through 2013. The cohorts comprised 1360 ART treatments in 432 women with UC, 554 ART treatments in 182 women with CD and 148 540 treatments in 52 489 women without IBD. Our primary outcome.......92), but not significantly reduced in the full model of ART treatments in women with CD (OR=0.77, 95% CI 0.52 to 1.14). Surgery for CD before ART treatment significantly reduced the chance of live birth for each embryo transfer (OR=0.51, 95% CI 0.29 to 0.91). In children conceived through ART treatment by women with UC...

  2. Quality of Life Is Related to Fecal Calprotectin Concentrations in Colonic Crohn Disease and Ulcerative Colitis, but not in Ileal Crohn Disease.

    Science.gov (United States)

    Gauss, Annika; Geib, Thomas; Hinz, Ulf; Schaefert, Rainer; Zwickel, Philipp; Zawierucha, Anna; Stremmel, Wolfgang; Klute, Lukas

    2016-04-01

    To formulate therapy goals, we aimed to define the relationship between fecal calprotectin and health-related quality of life in inflammatory bowel diseases (IBDs). This retrospective single-center cross-sectional study included ambulatory IBD patients who had completed standardized questionnaires comprising items of health-related quality of life (Short Inflammatory Bowel Disease Questionnaire) and clinical disease activity scores, and who had provided stool samples for calprotectin determination within 30 days of questionnaire completion. Correlation analyses were performed between the indicated parameters. Post hoc analysis was conducted, taking into account only data from patients with fecal calprotectin concentrations measured within 3 days of questionnaire completion. One hundred ninety-seven patients with Crohn disease and 111 patients with ulcerative colitis were enrolled in the study. Lower fecal calprotectin concentrations were associated with better health-related quality of life. The correlations were weak, but stronger if only fecal calprotectin concentrations measured within 3 days of questionnaire completion were included (results for 3 days; Crohn disease: n = 86, rS = -0.419, P care should be taken to keep the time between clinical evaluation of IBD patients and the determination of fecal calprotectin concentrations as short as possible. PMID:27100452

  3. Differences in Visceral Fat and Fat Bacterial Colonization between Ulcerative Colitis and Crohn’s Disease. An In Vivo and In Vitro Study

    OpenAIRE

    Zulian, Alessandra; Cancello, Raffaella; Ruocco, Chiara; Gentilini, Davide; Di Blasio, Anna Maria; Danelli, Piergiorgio; Micheletto, Giancarlo; Cesana, Elisabetta; Invitti, Cecilia

    2013-01-01

    Crohn’s disease (CD) is notably characterized by the expansion of visceral fat with small adipocytes expressing a high proportion of anti-inflammatory genes. Conversely, visceral fat depots in ulcerative colitis (UC) patients have never been characterized. Our study aims were a) to compare adipocyte morphology and gene expression profile and bacterial translocation in omental (OM) and mesenteric (MES) adipose tissue of patients with UC and CD, and b) to investigate the effect of bacterial inf...

  4. The polymorphism rs3024505 proximal to IL-10 is associated with risk of ulcerative colitis and Crohns disease in a Danish case-control study

    DEFF Research Database (Denmark)

    Andersen, V.; Ernst, A.; Christensen, J.;

    2010-01-01

    Background: Crohns disease (CD) and ulcerative colitis (UC) are characterized by a dysregulated inflammatory response to normal constituents of the intestinal flora in the genetically predisposed host. Heme oxygenase-1 (HO-1/HMOX1) is a powerful anti-inflammatory and anti-oxidant enzyme, whereas...... and UC in this Danish study, suggesting that IL-10, but not IL-1 beta or HO-1, has a role in IBD etiology in this population....

  5. Differences in Visceral Fat and Fat Bacterial Colonization between Ulcerative Colitis and Crohn’s Disease. An In Vivo and In Vitro Study

    OpenAIRE

    Alessandra Zulian; Raffaella Cancello; Chiara Ruocco; Davide Gentilini; Anna Maria Di Blasio; Piergiorgio Danelli; Giancarlo Micheletto; Elisabetta Cesana; Cecilia Invitti

    2013-01-01

    Crohn's disease (CD) is notably characterized by the expansion of visceral fat with small adipocytes expressing a high proportion of anti-inflammatory genes. Conversely, visceral fat depots in ulcerative colitis (UC) patients have never been characterized. Our study aims were a) to compare adipocyte morphology and gene expression profile and bacterial translocation in omental (OM) and mesenteric (MES) adipose tissue of patients with UC and CD, and b) to investigate the effect of bacterial inf...

  6. The effects of antidepressants on gastric ulcer

    Directory of Open Access Journals (Sweden)

    Mehmet Latif Güneş

    2013-12-01

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

  7. Genetics Home Reference: ulcerative colitis

    Science.gov (United States)

    ... my area? Other Names for This Condition colitis gravis idiopathic proctocolitis inflammatory bowel disease, ulcerative colitis type ... for professional medical care or advice. Users with questions about a personal health condition should consult with ...

  8. Ulcerative Colitis Activity Presenting as Fever of Unknown Origin, in a Patient with Longstanding Disease under Continuous Treatment with Mesalazine

    Directory of Open Access Journals (Sweden)

    Panagiota Voukelatou

    2016-01-01

    Full Text Available Background. The presence of ulcerative colitis (UC with no bowel symptoms, as fever of unknown origin (FUO, is uncommon. Objective. To describe the case of an 80-year-old woman who presented with fever, with a history of UC under treatment with mesalazine. Case Presentation. She was admitted due to fever lasting for 12 days with no associated symptoms. Seven years earlier, she was diagnosed with UC. After an extended workup for FUO that failed to reach the diagnosis, she underwent a gallium-67 scintigraphy. This revealed a persistent diffuse concentration of gallium-67 in the ascending colon at 24-hour imaging that remained stable at 48- and 72-hour imaging without any topographic change after the use of laxatives. Considering the results and in the absence of another diagnosis, the patient was treated with 30 mg prednisone daily and mesalazine, as treatment of active UC. Subsequently, the patient’s condition improved markedly and the fever retreated. One month later, she was reevaluated with a gallium-67 scintigraphy with total absence of gallium-67 concentration in the ascending colon. Conclusion. UC activity must be included in the differential diagnosis of FUO in patients with longstanding disease, since fever may present alone, with no other manifestations.

  9. Ulcerative Colitis Activity Presenting as Fever of Unknown Origin, in a Patient with Longstanding Disease under Continuous Treatment with Mesalazine.

    Science.gov (United States)

    Voukelatou, Panagiota; Sfendouraki, Elissavet; Karianos, Theodoros; Saranti, Sofia; Tsitsimelis, Dimitrios; Vrettos, Ioannis; Kalliakmanis, Andreas

    2016-01-01

    Background. The presence of ulcerative colitis (UC) with no bowel symptoms, as fever of unknown origin (FUO), is uncommon. Objective. To describe the case of an 80-year-old woman who presented with fever, with a history of UC under treatment with mesalazine. Case Presentation. She was admitted due to fever lasting for 12 days with no associated symptoms. Seven years earlier, she was diagnosed with UC. After an extended workup for FUO that failed to reach the diagnosis, she underwent a gallium-67 scintigraphy. This revealed a persistent diffuse concentration of gallium-67 in the ascending colon at 24-hour imaging that remained stable at 48- and 72-hour imaging without any topographic change after the use of laxatives. Considering the results and in the absence of another diagnosis, the patient was treated with 30 mg prednisone daily and mesalazine, as treatment of active UC. Subsequently, the patient's condition improved markedly and the fever retreated. One month later, she was reevaluated with a gallium-67 scintigraphy with total absence of gallium-67 concentration in the ascending colon. Conclusion. UC activity must be included in the differential diagnosis of FUO in patients with longstanding disease, since fever may present alone, with no other manifestations. PMID:27504121

  10. Leisure-time physical activity in Canadians living with Crohn disease and ulcerative colitis: population-based estimates.

    Science.gov (United States)

    Mack, Diane E; Wilson, Philip M; Gilmore, Jennica C; Gunnell, Katie E

    2011-01-01

    The purpose of this study was to provide population-based estimates of leisure-time physical activity (LTPA) in Canadians diagnosed with Crohn disease (CD) or ulcerative colitis (UC). Data were derived from the Canadian Community Health Survey Cycle 3.1 (2005). Those diagnosed with CD (n = 474; 61.60% female) or UC (n = 637; 65.10% female) were compared with those not reporting CD/UC (n = 113,685; 53.60% female). The most prevalent forms of LTPA reported were walking and gardening/yard work. Individuals with CD were more likely to be classified as "inactive" (OR = 1.34; 95% CI [1.12, 1.61]) and less likely to be "active" (OR = 0.69; 95% CI [0.55, 0.87]) than those not reporting CD/UC. These trends were mirrored for those living with UC, although statistical significance was not attained. Despite claims advocating the benefits of LTPA for ameliorating complications associated with CD/UC, prevalence estimates from a population-based sample of Canadians living with CD/UC suggest that the majority do not meet current public health guidelines. Results offer benchmarks for prevalence of LTPA in those diagnosed with CD/UC. Findings suggest that many living with this condition will not benefit from the protective role of LTPA on complications associated with CD/UC. PMID:21814062

  11. Leg ulcers due to hyperhomocysteinemia

    Directory of Open Access Journals (Sweden)

    Krupa Shankar D

    2006-01-01

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

  12. A galectin-specific signature in the gut delineates Crohn's disease and ulcerative colitis from other human inflammatory intestinal disorders.

    Science.gov (United States)

    Papa Gobbi, Rodrigo; De Francesco, Nicolás; Bondar, Constanza; Muglia, Cecilia; Chirdo, Fernando; Rumbo, Martín; Rocca, Andrés; Toscano, Marta A; Sambuelli, Alicia; Rabinovich, Gabriel A; Docena, Guillermo H

    2016-01-01

    Inflammatory bowel diseases (IBD) are chronic and relapsing inflammatory conditions of the gastrointestinal tract including Crohn's disease (CD) and ulcerative colitis (UC). Galectins, defined by shared consensus amino acid sequence and affinity for β-galactosides, are critical modulators of the inflammatory response. However, the relevance of the galectin network in the pathogenesis of human IBD has not yet been explored. Here, we analyzed the expression of relevant members of the galectin family in intestinal biopsies, and identified their contribution as novel mucosal markers in IBD. Colonic biopsies were obtained from 59 IBD patients (22 CD and 37 UC), 9 patients with gut rejection after transplantation, 8 adult celiac patients, and 32 non-IBD donors. Galectin mRNA expression was analyzed by RT-PCR and qPCR using specific primers for individual galectins. A linear discriminant analysis (LDA) was used to analyze galectin expression in individual intestinal samples. Expression of common mucosal-associated galectins (Gal-1, -3, -4, -9) is dysregulated in inflamed tissues of IBD patients compared with non-inflamed IBD or control samples. LDA discriminated between different inflammation grades in active IBD and showed that remission IBD samples were clusterized with control samples. Galectin profiling could not distinguish CD and UC. Furthermore, inflamed IBD was discriminated from inflamed tissue of rejected gut in transplanted patients and duodenum of celiac patients, which could not be distinguished from control duodenum samples. The integrative analysis of galectins discriminated IBD from other intestinal inflammatory conditions and could be used as potential mucosal biomarker.

  13. Quality of Life Is Related to Fecal Calprotectin Concentrations in Colonic Crohn Disease and Ulcerative Colitis, but not in Ileal Crohn Disease.

    Science.gov (United States)

    Gauss, Annika; Geib, Thomas; Hinz, Ulf; Schaefert, Rainer; Zwickel, Philipp; Zawierucha, Anna; Stremmel, Wolfgang; Klute, Lukas

    2016-04-01

    To formulate therapy goals, we aimed to define the relationship between fecal calprotectin and health-related quality of life in inflammatory bowel diseases (IBDs). This retrospective single-center cross-sectional study included ambulatory IBD patients who had completed standardized questionnaires comprising items of health-related quality of life (Short Inflammatory Bowel Disease Questionnaire) and clinical disease activity scores, and who had provided stool samples for calprotectin determination within 30 days of questionnaire completion. Correlation analyses were performed between the indicated parameters. Post hoc analysis was conducted, taking into account only data from patients with fecal calprotectin concentrations measured within 3 days of questionnaire completion. One hundred ninety-seven patients with Crohn disease and 111 patients with ulcerative colitis were enrolled in the study. Lower fecal calprotectin concentrations were associated with better health-related quality of life. The correlations were weak, but stronger if only fecal calprotectin concentrations measured within 3 days of questionnaire completion were included (results for 3 days; Crohn disease: n = 86, rS = -0.419, P life was found in patients with colonic involvement (n = 59, rS = -0.470, P life should be used in combination with other markers for IBD management. This is even more important in isolated ileal Crohn disease, where no significant correlation between fecal calprotectin concentration and health-related quality of life was found. Especially for use in research studies, care should be taken to keep the time between clinical evaluation of IBD patients and the determination of fecal calprotectin concentrations as short as possible.

  14. A study of psychiatric morbidity in patients of peptic ulcer diseases

    OpenAIRE

    Sidhu, B. S.; Jagpal Singh Klair

    2012-01-01

    Background: A stressful life event or situation-internal or external, acute or chronic-generates challengesto which the organism cannot adequately respond some times. Recent studies have found that the peoplewho face general stresses pessimistically are apt to experience psychosomatic disorders. Psychologicalfactors like stress are important in development of initiation, progression, aggravation, predisposition orreaction to disease. For example, a stressful event might lead to exacerbation o...

  15. Foot & Mouth Disease & Ulcerative/Vesicular Rule-outs: Challenges Encountered in Recent Outbreaks

    Energy Technology Data Exchange (ETDEWEB)

    Hullinger, P

    2008-01-28

    Foot and mouth disease (FMD) is a highly infectious and contagious viral disease affecting bovidae (cattle, zebus, domestic buffaloes, yaks), sheep, goats, swine, all wild ruminants and suidae. Camelidae (camels, dromedaries, llamas, vicunas) have low susceptibility. Foot and mouth disease is caused by a RNS virus of the family Picornaviridae, genus Aphthovirus. There are seven immunologically distinct serotypes: A, O, C, SAT1, SAT2, SAT3, Asia 1. Foot and mouth disease causes significant economic loss both to countries who manage it as an endemic disease (with or without vaccination), as well as those FMD free countries which may become infected. The mortality rate is low in adult animals, but often higher in young due to myocarditis. Foot and mouth disease is endemic in parts of Asia, Africa, the Middle East and South America (sporadic outbreaks in free areas). The Office of International Epizootics (OIE), also referred to the World Organization for Animal Health maintains an official list of free countries and zones.1 The OIE Terrestrial Code (Chapter 2.2.10) provides detailed information on the categories of freedom that can be allocated to a country as well as guidelines for the surveillance for foot and mouth disease (Appendix 3.8.7). In short, countries may be completely free of FMD, free with vaccination or infected with foot and mouth disease virus (FMDV). Source of FMDV include incubating and clinically affected animals with virus present in breath, saliva, faeces, urine, milk and semen. In experimental settings virus has been detected in milk several days before the onset of clinical signs2. Additional sources of virus are meat and by-products in which pH has remained above 6.0 as well as persistently infected carrier animals. Carrier animals may include cattle and water buffalo; convalescent animals and exposed vaccinates (virus persists in the oropharynx for up to 30 months in cattle or longer in buffalo, 9 months in sheep). Pigs do not become carriers

  16. Genetic Analysis of Innate Immunity in Crohn's Disease and Ulcerative Colitis Identifies Two Susceptibility Loci Harboring CARD9 and IL18RAP

    OpenAIRE

    Zhernakova, Alexandra; Festen, Eleanora M.; Franke, Lude; Trynka, Gosia; Diemen, Cleo C van; Monsuur, Alienke J.; Bevova, Marianna; Nijmeijer, Rian M.; van ‘t Slot, Ruben; Heijmans, Roel; Boezen, H. Marike; van Heel, David A; van Bodegraven, Adriaan A.; Stokkers, Pieter C. F.; Wijmenga, Cisca

    2008-01-01

    The two main phenotypes of inflammatory bowel disease (IBD)—Crohn's disease (CD) and ulcerative colitis (UC)—are chronic intestinal inflammatory disorders with a complex genetic background. Using a three-stage design, we performed a functional candidate-gene analysis of innate immune pathway in IBD. In phase I, we typed 354 SNPs from 85 innate immunity genes in 520 Dutch IBD patients (284 CD, 236 UC) and 808 controls. In phase II, ten autosomal SNPs showing association at p < 0.006 in phase I...

  17. ULCERATED ACROCHORDON IN VULVA

    Directory of Open Access Journals (Sweden)

    Borré-Arrieta Orlando

    2015-01-01

    Full Text Available Introduction: the acrochordon, also known as soft fibromas, is a dermatological disease of common location in the cutaneous folds. Its appearance in external genitalia is weird, but it generates negative consequences regarding the quality of life of the patients. Due to the typical characteristics of the genital area in women, it increases the risk of ulceration and superinfection. Case record: patient in the third decade of life with lesion of slow growth in the vulvar area, who attended late to the emergency service because of the presence of laceration and infection signs in the genital lesion. Conclusions: the acrochordon in vulva or vulvar fibroma is a vulvar benign and uncommon disease, however it always merits opportune treatment by esthetic reason as for the ulceration risk. Revista ciencias biomédicas. 2015;6(1:138-141 KEYWORDS Vulva; Vulvar diseases; Vulvar neoplasms.

  18. Proinflammatory cytokines and thrombomodulin in patients with peptic ulcer disease and gastric cancer, infected with Helicobacter pylori

    Directory of Open Access Journals (Sweden)

    Mehrdad Haghazali

    2011-01-01

    Full Text Available Backgrounds: Helicobacter pylori infect more than half of the global population. It is suggested to be related with gastritis, peptic ulcer disease (PUD, and gastric cancer. Aims: The aim of this present study was to evaluate proinflammatory cytokines including interleukin 1, 6, 8, 10, and thrombomodulin in H. pylori-infected patients with PUD and gastric cancer. Patients: This cross-sectional study was conducted in Taleghani Hospital on 111 patients with H. pylori infection. Materials and Methods: Patients were divided into three groups of PUD, cancer, and control (normal on endoscopy, according to the results of endoscopy. The serum levels of interleukins 1, 6, 8, and 10 and thrombomodulin was determined using enzyme-linked immunosorbent assay (ELISA technique. H. pylori infection was diagnosed by histological examination of the endoscopic biopsy. Results: One hundred eleven patients were included in the study; 30 as PUD group, 30 as gastric cancer group, and 51 as controls. There was no significant difference between the means of IL-1 and IL-10 levels among the three groups (P = 0.744 and 0.383, respectively. IL-6, IL-8, and thrombomodulin levels were found to be statically different among the three groups (P < 0.05. The level of IL-6, IL-8, and thrombomodulin in cancer group was significantly higher than PUD and control groups (P < 0.05. Conclusion: There is a significant association between H. pylori infection and serum IL-6, IL-8, and thrombomodulin but such relation is not present between H. pylori and IL-1 and IL-10. Immunity response (IL-6, IL-8 and thrombomodulin is more severe in cancer patient than PUD.

  19. Studies on the pathogenic bacterium of ulcer disease in Epinephelus awoara

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Studies were conducted to determine the cause of the acute mortality of cage-cultured Epinephelus awoara in the Tong'an Bay of Xiamen, China during the summer of 2002. Predominant bacteria strain TS-628 was isolated from the diseased grouper. The virulence test confirmed that TS-628 was the pathogenic bacterium. Biochemical characteristics of the isolates were determined using the automatic bacterial identification system and standard tube tests. To further confirm the identification, a 1 121 bp 16S rRNA gene sequence of the isolate was amplified by PCR, which had been deposited into Genbank (accession number: AY747308). According to the biochemical characteristics and by comparing the 16S rRNA gene homology of the isolate, the pathogenic bacterium was identified as Vibrio harveyi. Drug sensitivity tests showed that this pathogenic bacterium was sensitive to 16 antibacterials, especially to chloramphenicol and actinospectacin, but completely resistant to antibacterials likes vancomycin, penicillin, lincomycin, and so on.

  20. Metabonomics of human fecal extracts characterize ulcerative colitis, Crohn's disease and healthy individuals

    DEFF Research Database (Denmark)

    Bjerrum, Jacob Tveiten; Wang, Yulan; Hao, Fuhua;

    2015-01-01

    metabolome in inflammatory bowel disease (IBD). Stool samples from 113 individuals (UC 48, CD 44, controls 21) were analyzed by (1)H nuclear magnetic resonance (NMR) spectroscopy (Bruker 600 MHz, Bruker BioSpin, Rheinstetten, Germany). Data were analyzed with principal component analysis and orthogonal......-projection to latent structure-discriminant analysis using SIMCA-P + 12 and MATLAB. Significant differences were found in the metabolic profiles making it possible to differentiate between active IBD and controls and between UC and CD. The metabolites holding differential power primarily belonged to a range of amino...... acids, microbiota-related short chain fatty acids, and lactate suggestive of an inflammation-driven malabsorption and dysbiosis of the normal bacterial ecology. However, removal of patients with intestinal surgery and anti-TNF-α antibody treatment eliminated the discriminative power regarding UC versus...

  1. Omeprazole, Furazolidone, and Tetracycline: an eradication treatment for resistant H. pylori in Brazilian patients with peptic ulcer disease Omeprazol, Tetraciclina e Furazolidona, um tratamento para erradicação do H. pylori resistente em pacientes ulcerosos do Brasil

    OpenAIRE

    Fernando Marcuz Silva; Jaime Natan Eisig; Ethel Zimberg Chehter; Júlio Jovino da Silva; Antonio Atílio Laudanna

    2002-01-01

    OBJECTIVES: To determine the efficacy of a simple, short-term and low-cost eradication treatment for Helicobacter pylori (H. pylori) using omeprazole, tetracycline, and furazolidone in a Brazilian peptic ulcer population, divided into 2 subgroups: untreated and previously treated for the infection. PATIENTS AND METHODS: Patients with peptic ulcer disease diagnosed by endoscopic examination and infected by H. pylori diagnosed by the rapid urease test (RUT) and histological examination, untreat...

  2. Mucosa-associated but not luminal Escherichia coli is augmented in Crohn’s disease and ulcerative colitis

    Directory of Open Access Journals (Sweden)

    de Souza Helton Luis

    2012-12-01

    Full Text Available Abstract Background Escherichia coli is believed to participate in the etiology of Crohn’s disease (CD and possibly of ulcerative colitis (UC, due at least in part to the observed rise in the number of these bacteria in the gut microbiota of CD and UC patients. Nevertheless, it is not fully understood whether this quantitative variation occurs equally throughout the mucosal and luminal spaces of the gut. To assess this question, stools and mucosa biopsies from distinct intestinal sites were cultured aiming at determining their E. coli concentration. The cultures were additionally screened for the presence of some virulence genes of pathogenic E. coli. Results Analyses of clinical materials from 14 controls (38 biopsies and 14 stools samples, 11 CD (25 biopsies and 11 stools samples and 7 UC patients (18 biopsies and 7 stools samples indicated no significant variation in the number of E. coli present in stools, but a rise of at least one log10 CFU/mg in biopsies from the ileum of CD patients and the sigmoid and rectum of CD and UC patients. The cultures were screened for the presence of E. coli attaching and effacing (eae, invasion plasmid antigen H (ipaH, aggregative adherence transcriptional activator (aggR, Shiga cytotoxins (stx, and heat labile enterotoxin (elt and the following serine proteases autotransporters of Enterobacteriaceae (SPATE genes: plasmid encoded toxin (pet, secreted autotransporter toxin (sat, Shigella extracellular protein (sepA, protein involved in intestinal colonization (pic and Shigella IgA-like protease homolog (sigA. Six of the 10 genes screened were detected in the total of samples investigated: aggR, eae, pet, sat, sepA and sigA. No difference in the prevalence of any of these markers was observed in cultures from different clinical materials or groups of patients. Methods Bacterial quantitation was carried out following cultures of diluted samples suspensions in MacConkey agar, Wilkins Chalgren agar for anaerobes

  3. Genetic variation in the familial Mediterranean fever gene (MEFV and risk for Crohn's disease and ulcerative colitis.

    Directory of Open Access Journals (Sweden)

    Alexandra-Chloé Villani

    Full Text Available The familial Mediterranean fever (FMF gene (MEFV encodes pyrin, a major regulator of the inflammasome platform controlling caspase-1 activation and IL-1beta processing. Pyrin has been shown to interact with the gene product of NLRP3, NALP3/cryopyrin, also an important active member of the inflammasome. The NLRP3 region was recently reported to be associated with Crohn's disease (CD susceptibility. We therefore sought to evaluate MEFV as an inflammatory bowel disease (IBD susceptibility gene.MEFV colonic mucosal gene expression was significantly increased in experimental colitis mice models (TNBS p<0.0003; DSS p<0.006, in biopsies from CD (p<0.02 and severe ulcerative colitis (UC patients (p<0.008. Comprehensive genetic screening of the MEFV region in the Belgian exploratory sample set (440 CD trios, 137 UC trios, 239 CD cases, 96 UC cases, and 107 healthy controls identified SNPs located in the MEFV 5' haplotype block that were significantly associated with UC (rs224217; p = 0.003; A allele frequency: 56% cases, 45% controls, while no CD associations were observed. Sequencing and subsequent genotyping of variants located in this associated haplotype block identified three synonymous variants (D102D/rs224225, G138G/rs224224, A165A/rs224223 and one non-synonymous variant (R202Q/rs224222 located in MEFV exon 2 that were significantly associated with UC (rs224222: p = 0.0005; A allele frequency: 32% in cases, 23% in controls. No consistent associations were observed in additional Canadian (256 CD trios, 91 UC trios and Scottish (495 UC, 370 controls sample sets. We note that rs224222 showed marginal association (p = 0.012; G allele frequency: 82% in cases, 70% in controls in the Canadian sample, but with a different risk allele. None of the NLRP3 common variants were associated with UC in the Belgian-Canadian UC samples and no significant interactions were observed between NLRP3 and MEFV that could explain the observed flip-flop of the rs224222 risk

  4. A study of 113 cases of genital ulcerative disease and urethral discharge syndrome with validation of syndromic management of sexually transmitted diseases

    Directory of Open Access Journals (Sweden)

    Chintan Bhavsar

    2014-01-01

    Full Text Available Aims: To validate syndromic management of cases having genital ulcerative disease (GUD and urethral discharge syndrome (UDS. Materials and Methods: A study of 113 cases of GUD and UDS was carried out in the Department of Skin and VD from March 2011 to August 2012. All cases having history and clinical evidence suggestive of GUD and UDS were included in the study. Results: According to syndromic diagnosis, GUD herpetic syndrome was the most common 71 (62.27%, followed by GUD non-herpetic syndrome 25 (21.89% and UDS 17 (14.91%. Out of 71 cases clinically diagnosed as GUD herpetic, 16 (22.53% were validated by immunoglobulin M (IgM anti herpes simplex virus-2 (HSV serology, 14 (19.71% by Tzanck smear and 3 (4.22% by both. 24 (33.80% were Reactive plasma Reagin (RPR(<1:8 reactive and trepenomma palidum haem-agglutination positive. Out of total 25 clinically diagnosed GUD non herpetic cases, 22 (88% were validated by laboratory tests Out of 17 cases of UDS, 15 (88% were validated by smear. Conclusion: Sensitivity and specificity of clinically diagnosed syndrome is not so high particularly for GUD herpetic syndrome Continuous monitoring of diagnostic component of syndromic approach is key to success of STD control program.

  5. Accuracy of a rapid 10-minute carbon-14 urea breath test for the diagnosis of Helicobacter pylori-associated peptic ulcer disease

    International Nuclear Information System (INIS)

    Urease in the human gastric mucosa is a marker for infection with Helicobacter pylori (HP), an organism which is associated with peptic ulcer disease. To detect gastric urease, we examined 184 patients (144 males, 40 females; mean age: 49.8±15.6 years) with suspected peptic ulcer disease. Fasting patients were given orally 5 μCi of carbon-14 labelled urea. For each patient only one breath sample was collected in hyamine at 10 min. The amount of 14C collected at 10 min was expressed as follows: [(DPM/mmol CO2 collected)/(DPM administered)]x100xbody weight (kg). The presence of HP colonization was determined by examination of multiple endoscopic prepyloric antral biopsy specimens subjected to culture or a rapid urease test. For the purpose of this study, HP-positive patients were defined as those with characteristic bacteria as indicated by a positive result of either the culture or the rapid urease test; HP-negative patients were defined as those with negative findings on both the culture and the rapid urease test. Of the 184 cases, 99 (53.8%) were positive for HP infection, and 85 (46.2%), negative. The sensitivity and specificity of the rapid 10 min 14C-urea breath test for the diagnosis of HP-associated peptic ulcer disease were evaluated by a receiver operating characteristic (ROC) curve with a variable cut-off value from 1.5 to 4.5. When a cut-off value of 1.5 was selected, the sensitivity was 100% and the specificity, 83.5%; when a cut-off value of 4.5 was selected, the sensitivity was 54.5% and the specificity, 97.6%. (orig.)

  6. ULCERATED ACROCHORDON IN VULVA

    OpenAIRE

    Borré-Arrieta Orlando; Monsalve-Montoya Rosa

    2015-01-01

    Introduction: the acrochordon, also known as soft fibromas, is a dermatological disease of common location in the cutaneous folds. Its appearance in external genitalia is weird, but it generates negative consequences regarding the quality of life of the patients. Due to the typical characteristics of the genital area in women, it increases the risk of ulceration and superinfection. Case record: patient in the third decade of life with lesion of slow growth in the vulvar area...

  7. High-density mapping of the MHC identifies a shared role for HLA-DRB1*01:03 in inflammatory bowel diseases and heterozygous advantage in ulcerative colitis

    DEFF Research Database (Denmark)

    Goyette, Philippe; Boucher, Gabrielle; Mallon, Dermot;

    2015-01-01

    Genome-wide association studies of the related chronic inflammatory bowel diseases (IBD) known as Crohn's disease and ulcerative colitis have shown strong evidence of association to the major histocompatibility complex (MHC). This region encodes a large number of immunological candidates, including...... high-density SNP typing of the MHC in >32,000 individuals with IBD, implicating multiple HLA alleles, with a primary role for HLA-DRB1*01:03 in both Crohn's disease and ulcerative colitis. Noteworthy differences were observed between these diseases, including a predominant role for class II HLA...... variants and heterozygous advantage observed in ulcerative colitis, suggesting an important role of the adaptive immune response in the colonic environment in the pathogenesis of IBD....

  8. The Use of Hyperbaric Oxygen Therapy in the Treatment of Non-healing Ulcers Secondary to Graft-versus-host Disease

    OpenAIRE

    Heyboer, Marvin; Taylor, Justin; Morgan, Monica; Mariani, Peter; Jennings, Shane

    2014-01-01

    We present the case of a 69 year-old gentleman with non-healing ulcers of the bilateral medial malleoli as a result of graft-versus-host disease (GvHD). The patient discussed was diagnosed with stage IV mantle cell lymphoma. Over the course of 4 years the patient was treated with autologous stem cell transplant, later reduced-intensity allogeneic stem cell transplant, and finally donor lymphocyte infusion due to recurrence. Following these therapies, the patient developed extensive GvHD that ...

  9. Steroid unresponsive case of ulcerative Mucha-habermann disease (Febrile Ulcernecrotic Mucha-Habermann disease treated with methotrexate

    Directory of Open Access Journals (Sweden)

    Deepam J Shah

    2014-01-01

    Full Text Available A 20 year old male presented with fever associated with eruption of papules, plaques and vesiculobullous lesions on the chest, back, extremities, palms, soles, and genital mucosa of 20 days duration. Histopathological examination revealed epidermal clefts, edema and vacuolar degeneration of keratinocytes, basal cell degeneration, and dermal perivascular lymphocytic infiltrate. On the basis of clinical features and histology, a diagnosis of febrile ulceronecrotic Mucha-Habermann disease (FUMHD was made. Treatment with doxycycline (100 mg BD for 4 weeks and oral prednisolone 60 mg/day tapered to 25 mg in 4 weeks led to initial response that was followed by a relapse on tapering steroid. Addition of methotrexate (7.5 mg increased to 15 mg in 2 weeks led to a dramatic response.

  10. Comparison of Omeprazole with Ranitidine for Treatment of Symptoms Associated with Gastroesophageal Reflux Disease and Uncomplicated Duodenal Ulcer

    Directory of Open Access Journals (Sweden)

    Andre P Archambault

    1996-01-01

    Full Text Available This randomized, single-blind, parallel group study was conducted to compare omeprazole with ranitidine for the treatment of symptoms associated with gastroesophageal reflux disease (GERD, uncomplicated duodenal ulcer (DU or both. After baseline assessments, patients were randomized to receive daily treatment with either 20 mg omeprazole or 300 mg ranitidine for four weeks. In total, 1481 patients (1001 omeprazole, 480 ranitidine with a diagnosis of GERD (n=904 and/or DU (n=577, confirmed by endoscopy or barium meal and reporting moderate to severe symptoms, were included in the analyses. The seventy of overall daytime symptoms reported by the omeprazole group at clinic visits was lower than that reported by the ranitidine group at week 2 for the entire patient group (P=0.0002 and at both weeks 2 and 4 for the subgroup of patients with GERD (P=0.0001 and P=0.001, respectively. The severity of overall night-time symptoms reported by the omeprazole group was lower than that reported by the ranitidine group at week 4 for all patients as a whole (P=0.042 and at both weeks 2 and 4 for the subgroup of patients with GERD (P=0.035 and P=0.010, respectively. There were no significant differences in reports of adverse events. In the omeprazole group, 19% of patients at week 2 and 15% of patients at week 4 reported adverse events, while the corresponding results from the ranitidine group were 21% and 11%. In conclusion, patients with GERD, DU or both treated with omeprazole 20 mg daily for four weeks showed statistically significant reductions in symptoms compared with patients treated with ranitidine 300 mg daily for the same period of time. The percentage of patients with any remaining daytime symptoms was 12% lower in the omeprazole group compared with the ranitidine group at week 2, and 7% lower at week 4. Five per cent fewer patients in the omeprazole group experienced night-time symptoms at either week 2 or week 4.

  11. Effects of Moringa oleifera, A Plant Extract Coded OBAYOKOU on Ulcers Caused by Mycobacterium ulcerans In Children under 15 Years in Côte d'Ivoire

    Directory of Open Access Journals (Sweden)

    Kodia M

    2014-04-01

    Full Text Available The aqueous extract of a plant coded OBAYOKOU (Moringa oleifera has been tested on the healing of ulcers in children under 15 years, two lots of 15 children each were made all presenting clinical forms of Buruli ulcer. The aqueous plant extract of Moringa oleifera was added to the food supply given to Lot B (lot of experimental subjects at a rate of 330 ml per meal per child for six weeks. Children of Lot A (control Lot received normal diet without Moringa oleifera. The results of this study have shown that children in (lot B in addition to the normal diet received 330 ml of Moringa oleifera per meal, had a higher rate of healing than Lot A (Witness Lot who received only normal diet. Thus, the rate of healing of ulcers with M. oleifera (24 mm is superior to healing without M. oleifera (10 mm after six weeks. This study shows that we can overcome Buruli ulcer with medicinal plants that is abundantly available in Africa. It also shows that it is necessary to conduct research on a wider range of fractions of Moringa oleifera to improve the activity of antimycobacteriennes molecules in the aqueous extract of Moringa oleifera.

  12. Pressure ulcers: Back to the basics

    OpenAIRE

    Karoon Agrawal; Neha Chauhan

    2012-01-01

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

  13. Clinical and economic outcomes in a population-based European cohort of 948 ulcerative colitis and Crohn's disease patients by Markov analysis

    DEFF Research Database (Denmark)

    Odes, S.; Vardi, H.; Friger, M.;

    2010-01-01

    P>Background Forecasting clinical and economic outcomes in ulcerative colitis (UC) and Crohn's disease (CD) patients is complex, but necessary. Aims To determine: the frequency of treatment-classified clinical states; the probability of transition between states; and the economic outcomes. Methods....../surgical remission (medication-free) and mild disease (on 5-aminosalicylates, antibiotics, topical corticosteroids), comprising 28% and 62% of UC cycles and 24% and 51% of CD cycles respectively. The probability of drug-response in patients receiving systemic corticosteroids/immunomodulators was 0.74 in UC, 0.66 in...... CD. Both diseases had similar likelihood of persistent drug-dependency or drug-refractoriness. Surgery was more probable in CD, 0.20, than UC, 0.08. In terms of economic outcomes, surgery was costlier in UC per cycle, but the outlay over 10 years was greater in CD. Drug-refractory UC and CD cases...

  14. E-health: Web-guided therapy and disease self-management in ulcerative colitis. Impact on disease outcome, quality of life and compliance.

    Science.gov (United States)

    Elkjaer, Margarita

    2012-07-01

    Ulcerative Colitis (UC) together with Crohn's disease (CD) belongs to inflammatory bowel diseases (IBD). IBD is to date as frequent as Insulin Dependent Diabetes (IDDM) and is second to Rheumatoid Arthritis (RA) in its chronicity. The majority (91%) of patients with UC have a mild to moderate disease course eligible for 5-ASA treatment. Poor adherence in UC is a well known phenomenon, which is associated with a 5-fold increased risk of relapse and increased health care costs. Web-based treatment solution with self-initiated 5-ASA treatment in UC based on the patient's pattern recognition of the disease course had not been published previously. The aims of the thesis were: 1) In a European evidence based consensus to assess the IBD patients' need for Quality of Health Care (QoHC); 2) To validate the influence of a Patient Educational Center (PEC) and a web-based treatment solution program, www.constant-care.dk, on patients' disease self-management, adherence, Quality of Life, and disease course after 1 year of self-initiated 5-ASA treatment. UC patients in a conventional out-patient setting were used as controls; 3) To validate two new quantitative rapid tests (RT scanning and HT photo) for Faecal Calprotectin (FC) measurement, and to assess whether HT photo can be useful as a home test to help the patients deciding on self-initiated treatment. The ECCO Consensus found evidence for optimising QoHC by "information"; "education", "benchmarking", and "psychological analysis", which could help to improve patient compliance, QoL, and to decrease depression and anxiety. UC patients, educated in the PEC, significantly improved the level of disease specific knowledge. Patient education and training on www.constant-care.dk, being validated on first 21 Danish patients and subsequently on 233 Danish and 100 Irish patients, showed that the new web guided approach was feasible, safe, and cost effective for the selected group of the patients included in the trial. Use of the web

  15. Mucosal healing in ulcerative colitis

    DEFF Research Database (Denmark)

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

    2013-01-01

    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...

  16. PARASYMPATHETIC DENERAVATION OF GASTRIUM AS A TREATMENT OF PEPTIC ULCER DISEASE PRECIPITATE MOTILITY DISORDER OF GALLBLADDER : A STUDY

    OpenAIRE

    Purujit

    2015-01-01

    A prospective clinical study on choleakinesia following total vagectomy (Bilateral truncal vagotomy) was carried out during the period from April 2005 to December 2010.Total 55 cases were studied who was suffering from chronic duodenal ulcer. Out of these total 55 cases fifteen cases had gastric outlet obstruction with hugely dilated stomach which was considered as control group in this study. Other 40 cases were considered as study group. Truncal vagotomy with retr ocoli...

  17. Effects of Cichorium Intybus L. Root Extract on Secretory Activity of the Stomach in Health and Ulcer Disease.

    Science.gov (United States)

    Krylova, S G; Vymyatnina, Z K; Zueva, E P; Amosova, E N; Razina, T G; Litvinenko, V I

    2015-09-01

    Gastroprotective effect of Cichorium intybus L. root extract is demonstrated on H. Shay's model of experimental ulcer in rats. The effect is attributed to the antisecretory activity of the plant and stimulation of defense barrier function of the gastric mucosa. The regulatory effect of the phytocomplex on seasonal characteristics of the gastric secretory and defense functions in dogs with Basov's fistula is detected. PMID:26468023

  18. Isocitrate Dehydrogenase of Helicobacter pylori Potentially Induces Humoral Immune Response in Subjects with Peptic Ulcer Disease and Gastritis

    OpenAIRE

    M Abid Hussain; Naveed, Shaik A.; Sechi, Leonardo A; Sarita Ranjan; Ayesha Alvi; Irshad Ahmed; Akash Ranjan; Sangita Mukhopadhyay; Niyaz Ahmed

    2008-01-01

    BACKGROUND: H. pylori causes gastritis and peptic ulcers and is a risk factor for the development of gastric carcinoma. Many of the proteins such as urease, porins, flagellins and toxins such as lipo-polysaccharides have been identified as potential virulence factors which induce proinflammatory reaction. We report immunogenic potentials of isocitrate dehydrogenase (ICD), an important house keeping protein of H. pylori. METHODOLOGY/PRINCIPAL FINDINGS: Amino acid sequences of H. pylori ICD wer...

  19. Clinical and pathological importance of vacA allele heterogeneity and cagA status in peptic ulcer disease in patients from North Brazil

    Directory of Open Access Journals (Sweden)

    Luisa Caricio Martins

    2005-12-01

    Full Text Available We have examined the prevalence of gene cagA and vacA alleles in 129 patients, 69 with gastritis and 60 with peptic ulcer diseases from North Brazil and their relation with histopathological data. vacA and cagA genotype were determined by polymerase chain reaction. Hematoxylin-eosin staining was used for histological diagnosis. 96.6% of the patients were colonized by Helicobacter pylori strains harboring single vacA genotype (nont-mixed infection. Among them, 11.8% had subtype s1a, 67.8% had subtype s1b, and 17% subtype s2. In regard to the middle region analysis, m1 alleles were found in 75.4% and m2 in 21.2% of patients. The cagA gene was detected in 78% patients infected with H. pylori and was associated with the s1-m1 vacA genotype. The H. pylori strains, vacA s1b m1/cagA-positive, were associated with increased risk of peptic ulcer disease and higher amounts of lymphocytic and neutrophilic infiltrates and the presence of intestinal metaplasia. These findings show that cagA and vacA genotyping may have clinical relevance in Brazil.

  20. NURSING CARE OF PATIENTS WITH DUODENAL ULCER

    OpenAIRE

    SZCZEPAŃSKA, URSZULA; GARCZYŃSKI, WOJCIECH; Zukow, Walery

    2011-01-01

    Peptic ulcer disease is one of the most common gastrointestinal disease worldwide. The prevalence of peptic ulcer disease is now so large that it has entailed the development of diagnostic and treatment methods improve. Currently used drug combination may produce effects even at 80% of cases, which is virtually unheard of in any other disease entity. Over 60% of peptic ulcers are located in the duodenum (3-4 times more than in the stomach). Estimates suggest that 5-10% of adults are affected ...

  1. Clinical and economic outcomes in a population-based European cohort of 948 ulcerative colitis and Crohn's disease patients by Markov analysis

    DEFF Research Database (Denmark)

    Odes, S.; Vardi, H.; Friger, M.;

    2010-01-01

    P>Background Forecasting clinical and economic outcomes in ulcerative colitis (UC) and Crohn's disease (CD) patients is complex, but necessary. Aims To determine: the frequency of treatment-classified clinical states; the probability of transition between states; and the economic outcomes. Methods...... CD. Both diseases had similar likelihood of persistent drug-dependency or drug-refractoriness. Surgery was more probable in CD, 0.20, than UC, 0.08. In terms of economic outcomes, surgery was costlier in UC per cycle, but the outlay over 10 years was greater in CD. Drug-refractory UC and CD cases...... engendered high costs in the cohort. Conclusions Most patients on 5-aminosalicylates, corticosteroids and immunomodulators had favourable clinical and economic outcomes over 10 years. Drug-refractory and surgical patients exhibited greater long-term expenses...

  2. Ulcerative Colitis

    Science.gov (United States)

    ... Research Training & Career Development Grant programs for students, postdocs, and faculty Research at NIDDK Labs, faculty, and ... diabetes, digestive and liver diseases, kidney diseases, weight control and nutrition, urologic diseases, endocrine and metabolic diseases, ...

  3. TO COMPARE THE SAFETY AND EFFICACY OF THREE DIFFERENT, PROTON PUMP INHIBITORS OMEPRAZOLE, ESO M EPRAZOLE AND RABEPRAZOLE IN A TRIPLE DRUG REGIMEN IN PATIENTS WITH PEPTIC ULCER DISEASE IN THE ERADICATION OF H. PYLORI INFECTION

    Directory of Open Access Journals (Sweden)

    Margaret Viola

    2015-03-01

    Full Text Available Peptic ulcer disease continues to be issue especially due to its high prevalence in the developing world. Helicobacter pylori ( H. pylori infection associated duodenal ulcers should undergo eradication therapy. There are many regimens offered for H. pylori eradication which include triple , quadruple , or sequential therapy regimens. In our study we planned to see whether these differences in pharmacokinetic properties show any difference in t he efficacy and safety parameters between treatment with omeprazole rabeprazole and esomeprazole in the triple drug regimen for eradication of H.pylori infection in peptic ulcer patients in our hospital Osmania General Hospital / Osmania Medical College , Hyderabad. MATERIALS AND METHODS: A total number of 45 patients were enrolled in the study. Patients with either sex suffering from peptic ulcer defined as ulcer crater of >2.5mm in size by endoscopy. Study Design : It was a randomized double blind , paralle l and comparative study. CONCLUSION: Two weeks after triple drug treatment , H.pylori was negative in 66.7% , 73% and 80% and Rapid urease test was negative in 53% , 60% and 66% in group A , B and C respectively. Endoscopy findings showed significant reduction in size and healing of ulcers in group A , B and C. There was improvement in signs and symptoms by 53 to 80% , after 2 weeks. Hence after therapy with triple drug regimen H.pylori eradication was 66 - 80% and healing of ulcers was 83 – 100% which was higher in Rabeprazole group. At 6 weeks , there was complete relief of signs and symptoms. At the follow up of 10 weeks there was no ulcer recurrence. No adverse effects were noted in all the groups. In conclusion , Triple drug regimen had shown to eradicate H.pylori infection in the treatment of Peptic ulcer. There was healing of ulcers in all the groups which was highly significant. There was no recurrence of peptic ulcer with these regimens in all the groups. However Rabeprazole group patients

  4. Longitudinal study of influence of Helicobacter pylori on current risk of duodenal ulcer relapse. The Hvidovre Ulcer Project Group

    DEFF Research Database (Denmark)

    Clausen, M R; Franzmann, M B; Holst, C;

    1992-01-01

    Seventy-four patients with duodenal ulcer were followed up longitudinally for 2 years after initial ulcer healing. Endoscopy including biopsy of the antral mucosa was performed every 3rd month and whenever clinical symptoms of relapse occurred. The presence of Helicobacter pylori in the biopsy...... acid output, time of healing of the preceding ulcer, treatment of the present ulcer (cimetidine, antacids, or no treatment), or type and degree of gastritis. Thus, although H. pylori is prevalent in patients with duodenal ulcer disease, the present study indicates that H. pylori does not have a...... substantial note in the precipitation of active duodenal ulcer....

  5. "Enfermedad de las tres mentiras": síndrome de la úlcera rectal solitaria A disease of three lies: solitary rectal ulcer syndrome

    Directory of Open Access Journals (Sweden)

    L. Crespo Pérez

    2007-11-01

    Full Text Available El síndrome de la úlcera rectal solitaria es una entidad benigna poco común cuyos síntomas más frecuentes son la rectorragia y el dolor anal. Los hallazgos anatomopatológicos son típicos. Se suele evidenciar engrosamiento de la mucosa, elongación y distorsión de las glándulas, una lámina propia edematosa con gran cantidad de colágena y engrosamiento de la muscularis mucosae. El diagnóstico se realiza mediante endoscopia con toma de biopsias. No siempre se trata de lesiones ulceradas. Se suele localizar preferentemente en la cara rectal anterior y/o lateral, aunque hasta un 30% de las lesiones son múltiples, existiendo casos de afectación del colon sigmoide y descendente. Por tanto, la presentación puede ser heterogénea y este es el motivo por el que esta entidad es también conocida como la "enfermedad de las tres mentiras". Presentamos un caso de síndrome de la ulcera rectal solitaria manifestado endoscópicamente como una placa eritematosa localizada en la cara lateral izquierda del recto.Solitary rectal ulcer syndrome is an uncommon benign condition characterized by rectal bleeding, passage of mucus, and pain. Histological features are well established as obliteration of the lamina propria by fibrosis and smooth-muscle fibers extending from a thickened muscularis mucosa to the lumen. Diagnosis can usually be made on sigmoidoscopy, and biopsies should always be taken. Ulceration is not universally present, and polypoid, non-ulcerated lesions and erythematous areas are also seen. The lesion or lesions are most often found on the anterior or anterolateral wall of the rectum, although they can also be located in the left colon and be more extensive or even circumferential. Lesions are multiple in 30 percent of cases. These are the reasons why this entity is also known as "the disease of three lies". We report a case of solitary rectal ulcer syndrome presenting at endoscopy with an erythematous area on the left side wall of the

  6. Gastric ulcer penetrating to liver diagnosed by endoscopic biopsy

    Institute of Scientific and Technical Information of China (English)

    Ertugrul Kayacetin; Serra Kayacetin

    2004-01-01

    Liver penetration is a rare but serious complication of peptic ulcer disease. Usually the diagnosis is made by operation or autopsy. Clinical and laboratory data were no specific. A 64-year-old man was admitted with upper gastrointestinal bleeding. Hepatic penetration was diagnosed as the cause of bleeding. Endoscopy showed a large gastric ulcer with a pseudotumoral mass protruding from the ulcer bed. Definitive diagnosis was established by endoscopic biopsies of the ulcer base.

  7. Pressure ulcers: Back to the basics

    Directory of Open Access Journals (Sweden)

    Karoon Agrawal

    2012-01-01

    Full Text Available Pressure ulcer in an otherwise sick patient is a matter of concern for the care givers as well as the medical personnel. A lot has been done to understand the disease process. So much so that USA and European countries have established advisory panels in their respective continents. Since the establishment of these organizations, the understanding of the pressure ulcer has improved significantly. The authors feel that the well documented and well publicized definition of pressure ulcer is somewhat lacking in the correct description of the disease process. Hence, a modified definition has been presented. This disease is here to stay. In the process of managing these ulcers the basic pathology needs to be understood well. Pressure ischemia is the main reason behind the occurrence of ulceration. Different extrinsic and intrinsic factors have been described in detail with review of literature. There are a large number of risk factors causing ulceration. The risk assessment scales have eluded the surgical literature and mostly remained in nursing books and websites. These scales have been reproduced for completion of the basics on decubitus ulcer. The classification of the pressure sores has been given in a comparative form to elucidate that most of the classifications are the same except for minor variations. The management of these ulcers is ever evolving but the age old saying of "prevention is better than cure" suits this condition the most.

  8. Update on peripheral ulcerative keratitis

    Directory of Open Access Journals (Sweden)

    Yagci A

    2012-05-01

    Full Text Available Ayse YagciEge University, School of Medicine, Department of Ophthalmology, Izmir, TurkeyAbstract: Ulcerative inflammation of the cornea occurs in the perilimbal cornea, and is associated with autoimmune collagen vascular and arthritic diseases. Rheumatoid arthritis is the most frequent underlying disease. The tendency for peripheral location is due to the distinct morphologic and immunologic characteristics of the limbal conjunctiva, which provides access for circulating immune complexes to the peripheral cornea via the capillary network. Deposition of immune complexes in the terminal ends of limbal vessels initiates immune-mediated vasculitis, and causes inflammatory cell and protein leakage due to vessel wall damage. Development of peripheral ulcerative keratitis associated with systemic disease may represent worsening of a potentially life-threatening disease. Accompanying scleritis, particularly the necrotizing form, is usually observed in severe cases, which may result in corneal perforation and loss of vision. Although first-line treatment with systemic corticosteroids is indicated for acute phases, immunosuppressive and cytotoxic agents are required for treatment of peripheral ulcerative keratitis associated with multisystem disorders. Recently, infliximab, a chimeric antibody against proinflammatory cytokine tumor necrosis factor-alpha, was reported to be effective in cases refractory to conventional immunomodulatory therapy. The potential side effects of these therapies require close follow-up and regular laboratory surveillance.Keywords: autoimmune disease, peripheral ulcerative keratitis, treatment, tumor necrosis factor-alpha

  9. Oral Ulcerations

    Directory of Open Access Journals (Sweden)

    Brandon Fetterolf

    2015-12-01

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

  10. Turner Syndrome with Ulcerative Colitis

    OpenAIRE

    Hyodo, Hiromi; TOMITA, Yuichiro; Hirai, Kohta; HIRAKAWA, Hitoshi; Ueno, Shigeru; Ishiguro, Hiroyuki

    2009-01-01

    Turner syndrome is a chromosomal disease frequently associated with autoimmune disorders including diabetes mellitus, thyroid disease and inflammatory bowel disease (IBD). Although the etiology of IBD has not been fully elucidated, genetic analysis has recently revealed several susceptibility genes. Recently, cases with Turner syndrome associated with IBD have been reported. We report here a 13-yr-old girl with Turner syndrome associated with ulcerative colitis. The patient was undergoing gro...

  11. History of Helicobacter pylori, duodenal ulcer, gastric ulcer and gastric cancer.

    Science.gov (United States)

    Graham, David Y

    2014-05-14

    Helicobacter pylori (H. pylori) infection underlies gastric ulcer disease, gastric cancer and duodenal ulcer disease. The disease expression reflects the pattern and extent of gastritis/gastric atrophy (i.e., duodenal ulcer with non-atrophic and gastric ulcer and gastric cancer with atrophic gastritis). Gastric and duodenal ulcers and gastric cancer have been known for thousands of years. Ulcers are generally non-fatal and until the 20th century were difficult to diagnose. However, the presence and pattern of gastritis in past civilizations can be deduced based on the diseases present. It has been suggested that gastric ulcer and duodenal ulcer both arose or became more frequent in Europe in the 19th century. Here, we show that gastric cancer and gastric ulcer were present throughout the 17th to 19th centuries consistent with atrophic gastritis being the predominant pattern, as it proved to be when it could be examined directly in the late 19th century. The environment before the 20th century favored acquisition of H. pylori infection and atrophic gastritis (e.g., poor sanitation and standards of living, seasonal diets poor in fresh fruits and vegetables, especially in winter, vitamin deficiencies, and frequent febrile infections in childhood). The latter part of the 19th century saw improvements in standards of living, sanitation, and diets with a corresponding decrease in rate of development of atrophic gastritis allowing duodenal ulcers to become more prominent. In the early 20th century physician's believed they could diagnose ulcers clinically and that the diagnosis required hospitalization for "surgical disease" or for "Sippy" diets. We show that while H. pylori remained common and virulent in Europe and the United States, environmental changes resulted in changes of the pattern of gastritis producing a change in the manifestations of H. pylori infections and subsequently to a rapid decline in transmission and a rapid decline in all H. pylori-related diseases.

  12. Microbiological, histological, immunological, and toxin response to antibiotic treatment in the mouse model of Mycobacterium ulcerans disease.

    Directory of Open Access Journals (Sweden)

    Fred Stephen Sarfo

    Full Text Available Mycobacterium ulcerans infection causes a neglected tropical disease known as Buruli ulcer that is now found in poor rural areas of West Africa in numbers that sometimes exceed those reported for another significant mycobacterial disease, leprosy, caused by M. leprae. Unique among mycobacterial diseases, M. ulcerans produces a plasmid-encoded toxin called mycolactone (ML, which is the principal virulence factor and destroys fat cells in subcutaneous tissue. Disease is typically first manifested by the appearance of a nodule that eventually ulcerates and the lesions may continue to spread over limbs or occasionally the trunk. The current standard treatment is 8 weeks of daily rifampin and injections of streptomycin (RS. The treatment kills bacilli and wounds gradually heal. Whether RS treatment actually stops mycolactone production before killing bacilli has been suggested by histopathological analyses of patient lesions. Using a mouse footpad model of M. ulcerans infection where the time of infection and development of lesions can be followed in a controlled manner before and after antibiotic treatment, we have evaluated the progress of infection by assessing bacterial numbers, mycolactone production, the immune response, and lesion histopathology at regular intervals after infection and after antibiotic therapy. We found that RS treatment rapidly reduced gross lesions, bacterial numbers, and ML production as assessed by cytotoxicity assays and mass spectrometric analysis. Histopathological analysis revealed that RS treatment maintained the association of the bacilli with (or within host cells where they were destroyed whereas lack of treatment resulted in extracellular infection, destruction of host cells, and ultimately lesion ulceration. We propose that RS treatment promotes healing in the host by blocking mycolactone production, which favors the survival of host cells, and by killing M. ulcerans bacilli.

  13. The relationship between the Five-Factor Model personality traits and peptic ulcer disease in a large population-based adult sample.

    Science.gov (United States)

    Realo, Anu; Teras, Andero; Kööts-Ausmees, Liisi; Esko, Tõnu; Metspalu, Andres; Allik, Jüri

    2015-12-01

    The current study examined the relationship between the Five-Factor Model personality traits and physician-confirmed peptic ulcer disease (PUD) diagnosis in a large population-based adult sample, controlling for the relevant behavioral and sociodemographic factors. Personality traits were assessed by participants themselves and by knowledgeable informants using the NEO Personality Inventory-3 (NEO PI-3). When controlling for age, sex, education, and cigarette smoking, only one of the five NEO PI-3 domain scales - higher Neuroticism - and two facet scales - lower A1: Trust and higher C1: Competence - made a small, yet significant contribution (p personality traits that are associated with the diagnosis of PUD at a particular point in time. Further prospective studies with a longitudinal design and multiple assessments would be needed to fully understand if the FFM personality traits serve as risk factors for the development of PUD. PMID:26437682

  14. Complement activation capacity in plasma before and during high-dose prednisolone treatment and tapering in exacerbations of Crohn's disease and ulcerative colitis

    Directory of Open Access Journals (Sweden)

    Baatrup Gunnar

    2005-09-01

    Full Text Available Abstract Background Ulcerative colitis (UC and Crohn's disease (CD are characterized by intestinal inflammation mainly caused by a disturbance in the balance between cytokines and increased complement (C activation. Our aim was to evaluate possible associations between C activation capacity and prednisolone treatment. Methods Plasma from patients with exacerbations of UC (n = 18 or CD (n = 18 were collected before and during high dose prednisolone treatment (1 mg/kg body weight and tapering. Friedman's two way analysis of variance, Mann-Whitney U test and Wilcoxon signed-rank sum test were used Results Before treatment, plasma from CD patients showed significant elevations in all C-mediated analyses compared to the values obtained from 38 healthy controls (p Conclusion Our findings indicate that C activation capacity is up-regulated significantly in plasma from CD patients. The decreases observed after prednisolone treatment reflect a general down-regulation in immune activation.

  15. Glycoaminoglycan (GAG) deficiency in protective barrier as an underlying, primary cause of ulcerative colitis, Crohn's disease interstitial cystitis and possibly Reiter's syndrome.

    Science.gov (United States)

    Russell, A L

    1999-04-01

    Ulcerative colitis, Crohn's disease and interstitial cystitis share many common features, the most important of which is a defect in the glycoaminoglycan (GAG) defensive barrier. This defect allows penetration of toxins causing localized inflammatory response, followed by fibrosis and distant pathological changes, together with a myriad of biochemical and immunological changes. The latter has caused confusion as to etiology of the aforementioned disorders. This hypothesis is somewhat supported by the fact that agents such as glucosamine and pentosan polysulphate (Elmiron) that replace the GAG layer, improve the conditions. The potential for extrapolation of this hypothesis to atherosclerosis and arthropathies exists. There is a great danger in modern medical research that if one misses the wood for the trees, one becomes hopelessly lost in the minutiae of research. At present, it is embarrassing that ulcerative colitis (UC), Crohn's (CR) and interstitial cystitis (IC) are the cause of a great deal of morbidity and occasionally mortality, yet after intensive research, the etiology and effective treatment eludes us. The research in the past has focused extensively on inflammatory response in the mucosal lining, and biochemical, infective and immunological changes in the serum. This has led to a vast array of research pathways that seem at the present time to be totally lost and, might I say, aimless in direction, as a cause for these conditions, that remain amongst the most imperically treated in modern medicine. Another possible syndrome in this class would be Reiter's, which has many features in common with the above. The basic tenet of a GAG deficiency hypothesis is that, as shown in Figure 1A, an intact GAG layer provides, firstly, a mechanical and electrostatic defence against penetration of infective agents, toxins, antigenic protein moieties, etc. and, secondly, the prevention of extravasation of body fluid components. A degraded GAG layer is the start of the

  16. Mice lacking myosin IXb, an inflammatory bowel disease susceptibility gene, have impaired intestinal barrier function and superficial ulceration in the ileum.

    Science.gov (United States)

    Hegan, Peter S; Chandhoke, Surjit K; Barone, Christina; Egan, Marie; Bähler, Martin; Mooseker, Mark S

    2016-04-01

    Genetic studies have implicated MYO9B, which encodes myosin IXb (Myo9b), a motor protein with a Rho GTPase activating domain (RhoGAP), as a susceptibility gene for inflammatory bowel disease (IBD). Moreover, we have recently shown that knockdown of Myo9b in an intestinal epithelial cell line impairs wound healing and barrier function. Here, we investigated whether mice lacking Myo9b have impaired intestinal barrier function and features of IBD. Myo9b knock out (KO) mice exhibit impaired weight gain and fecal occult blood (indicator of gastrointestinal bleeding), and increased intestinal epithelial cell apoptosis could be detected along the entire intestinal axis. Histologic analysis revealed intestinal mucosal damage, most consistently observed in the ileum, which included superficial ulceration and neutrophil infiltration. Focal lesions contained neutrophils and ultrastructural examination confirmed epithelial discontinuity and the deposition of extracellular matrix. We also observed impaired mucosal barrier function in KO mice. Transepithelial electrical resistance of KO ileum is >3 fold less than WT ileum. The intestinal mucosa is also permeable to high molecular weight dextran, presumably due to the presence of mucosal surface ulcerations. There is loss of tight junction-associated ZO-1, decreased lateral membrane associated E-cadherin, and loss of terminal web associated cytokeratin filaments. Consistent with increased Rho activity in the KO, there is increased subapical expression of activated myosin II (Myo2) based on localization of phosphorylated Myo2 regulatory light chain. Except for a delay in disease onset in the KO, no difference in dextran sulfate sodium-induced colitis and lethality was observed between wild-type and Myo9b KO mice.

  17. Update in the treatment of paediatric ulcerative colitis.

    Science.gov (United States)

    Greifer, Melanie K; Markowitz, James F

    2006-10-01

    Ulcerative colitis is an important disease in the paediatric population. Ulcerative colitis is one of the chronic inflammatory bowel diseases, and is medically incurable. However, the arsenal of medications has grown as knowledge of the pathogenesis of this disease advances. This review looks at the classical treatments for children with ulcerative colitis, including the 5-aminosalicylates, corticosteroids and imunomodulators, as well as biological therapy and other, newer modalities. PMID:17020417

  18. Evaluation of dairy allergy among ulcerative colitis patients

    OpenAIRE

    judaki, Arezo; Hafeziahmadi, Mohamadreza; Yousefi, Atefe; Havasian, Mohamad Reza; Panahi, Jafar; Sayehmiri, Koroush; Alizadeh, Sajjad

    2014-01-01

    The intestine is the largest mucosal organ of the body and also the first line immune homeostasis. Inflammatory bowel disease or IBD is divided into ulcerative colitis and Crohn's disease. One of the problems that can occur with UC is dietary allergy to some foods. This study aimed to evaluated the dairy allergy among patients with ulcerative colitis. This study is a Case - control study, that studied 72 patients with Ulcerative Colitis, after recording history of the disease, colonoscopy and...

  19. In Vitro Activity of Selected West African Medicinal Plants against Mycobacterium ulcerans Disease

    OpenAIRE

    Patrick Valere Tsouh Fokou; Abena Adomah Kissi-Twum; Dorothy Yeboah-Manu; Regina Appiah-Opong; Phyllis Addo; Lauve Rachel Tchokouaha Yamthe; Alvine Ngoutane Mfopa; Fabrice Fekam Boyom; Alexander Kwadwo Nyarko

    2016-01-01

    Buruli ulcer (BU) is the third most prevalent mycobacteriosis, after tuberculosis and leprosy. The currently recommended combination of rifampicin-streptomycin suffers from side effects and poor compliance, which leads to reliance on local herbal remedies. The objective of this study was to investigate the antimycobacterial properties and toxicity of selected medicinal plants. Sixty-five extracts from 27 plant species were screened against Mycobacterium ulcerans and Mycobacterium smegmatis, u...

  20. Pathogenesis of foot ulcers and the need for offloading.

    Science.gov (United States)

    Rathur, H M; Boulton, A J

    2005-04-01

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

  1. Manifestações articulares em pacientes com doença de Crohn e retocolite ulcerativa Articular manifestations in patients with Crohn's disease and ulcerative colitis

    Directory of Open Access Journals (Sweden)

    Cristina Costa Duarte Lanna

    2006-06-01

    Full Text Available Os sintomas articulares constituem a manifestação extra-intestinal mais comum em pacientes com doença de Crohn e com retocolite ulcerativa. Reconhecida como artrite colítica, e mais recentemente, artrite enteropática, está classificada como uma das doenças do grupo das espondiloartropatias. Reconhecidamente, há dois padrões de acometimento articular: 1 periférico, habitualmente, associado aos períodos de atividade da doença intestinal e sem associação com o antígeno HLA B27, e 2 axial, caracterizado por espondilite e sacroiliíte, com curso clínico e radiográfico independente da doença intestinal e associado ao HLA B27.Joint involvement is the most commom extraintestinal manifestation in patients with Crohn's disease and ulcerative colitis. The colitic arthritis, lately called enteropathic arthritis, is classified as one of the diseases of the spondyloarthropathies group. There are two patterns of joint involvement: 1 peripheral arthritis, usually coincides with exacerbations of the inflammatory bowel disease and is not associated with the HLA B27 antigen; and 2 axial involvement, characterized by spondylitis and sacroiliitis, which the clinical course is independent of the intestinal disease, and has an association with HLA B27.

  2. A young man with nonhealing venous ulcers

    NARCIS (Netherlands)

    Vloedbeld, M. G.; Venema, A. W.; Smit, A. J.

    2006-01-01

    A 35-year-old man presented with nonhealing ulcers at an atypical location on his left foot, caused by a combination of venous insufficiency (after deep venous thrombosis) and arterial insufficiency. The underlying cause was Buerger's disease.

  3. Intestinal microecology in rats with ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    韩晓霞

    2013-01-01

    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

  4. [Mixed leg ulcers].

    Science.gov (United States)

    Willenberg, Torsten

    2011-03-01

    Coexisting peripheral arterial disease is not uncommon (15 - 21 %) in patients with ulcera cruris primarily based on a venous etiology. Patient's history, clinical examination and detection of ABI as well as duplex scan will establish diagnosis of mixed arterial-venous ulcera. Clinical significance of coexisting arterial disease is often difficult to define and should be evaluated by a vascular specialist. The concept of treatment of mixed ulcers should always include the arterial component. Frequently peripheral arterial perfusion and healing can be improved by minimal invasive, endovascular revascularization. Compression therapy is the corner stone in treatment of venous disease and should be complemented by contemporary two piece graduated compression systems if ulcera are present. According to circumstances ablation of varicose veins must be considered. PMID:21360460

  5. Nonhealing Ulcer: Acroangiodermatitis of Mali

    Directory of Open Access Journals (Sweden)

    Neeraj Varyani

    2011-01-01

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

  6. Peptic ulcers: mortality and hospitalization.

    Science.gov (United States)

    Riley, R

    1991-01-01

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

  7. Sunitinib induced pyoderma gangrenosum-like ulcerations

    OpenAIRE

    Akanay-Diesel S; Hoff NP; Kürle S; Haes J; Erhardt A; Häussinger D.; Schulte KW; Bölke E; Matuschek C; Budach W; Gerber PA; Homey B

    2011-01-01

    Abstract Pyoderma gangrenosum is a non-infectious neutrophilic skin disease commonly associated with underlying systemic diseases. Histopathological and laboratory diagnostics are unspecific in the majority of the cases and the diagnosis is made in accordance with the clinical picture. Here, we report the case of a 69-year old man with progredient pyoderma gangrenosum-like ulcerations under treatment with sunitinib due to hepatocellular carcinoma. A conventional ulcer therapy did not lead to ...

  8. Receptor binding sites for substance P, but not substance K or neuromedin K, are expressed in high concentrations by arterioles, venules, and lymph nodules in surgical specimens obtained from patients with ulcerative colitis and Crohn disease.

    OpenAIRE

    Mantyh, C R; Gates, T S; Zimmerman, R P; Welton, M L; Passaro, E P; Vigna, S R; Maggio, J E; Kruger, L.; Mantyh, P W

    1988-01-01

    Several lines of evidence indicate that tachykinin neuropeptides [substance P (SP), substance K (SK), and neuromedin K (NK)] play a role in regulating the inflammatory and immune responses. To test this hypothesis in a human inflammatory disease, quantitative receptor autoradiography was used to examine possible abnormalities in tachykinin binding sites in surgical specimens from patients with inflammatory bowel disease. Surgical specimens of colon were obtained from patients with ulcerative ...

  9. How to Diagnose and Treat Peptic Ulcer?

    Institute of Scientific and Technical Information of China (English)

    HU Xian-guo

    2009-01-01

    @@ Ulcer of the stomach and duodenum,also called ulcerative disease,is a sharply circumscribed loss of the tissue lining those parts of the digestive tract exposed to gastric juice containing acid and pepsin. Because its formation and development are closely related to the digestive effect of acidic gastric juice and pepsase,the disease is called peptic ulcer. It is a common disease,belonging to epigastric pain in TCM,mainly caused by cold attacking the stomach,stagnated liver-qi affecting the stomach,or spleen and stomach deficiency with deficiency and cold of the middle-jiao. Regulating qi to stop pain is the principle for its treatment. Peptic ulcer is usually differentiated as the following TCM syndromes.

  10. Surgical treatment of perforated gastric ulcer

    Directory of Open Access Journals (Sweden)

    Korica Milan

    2002-01-01

    Full Text Available Introduction Peptic ulcer perforation is a complication of ulcer disease which requires urgent surgical treatment. The aim of this paper was to point out our experience in surgical treatment of perforated peptic ulcer. Material and methods This retrospective study analyzes results of surgical treatment in 365 patients with perforated peptic ulcer during the period January 1996 to December 2000. Results During the last 5-year period 365 patients were treated following peptic ulcer perforation. The average age was 43.53±8.26, with the span from 18 to 86. The most frequent surgical procedures in treatment of peptic ulcer perforation were: simple closure with biopsy (55.88%, excision of the ulcer with a pyloroplasty and vagotomy (35.29% as nonresection surgical procedures and stomach resection after Billroth II (8.83%. The postoperative mortality was 4.41%. Conclusions The methods of choice in surgical treatment of gastric ulcer perforation are nonresection surgical procedures with drug therapy and eradication of Helicobacter pylori, if present.

  11. Management of BU-HIV co-infection

    OpenAIRE

    O'Brien, D P; Ford, N.; Vitoria, M; Christinet, V; Comte, E; Calmy, A; Stienstra, Y; Eholie, S.; Asiedu, K

    2014-01-01

    Buruli Ulcer (BU)-HIV co-infection is an important emerging management challenge for BU disease. Limited by paucity of scientific studies, guidance for management of this co-infection has been lacking.

  12. Effects of adacolumn selective leukocytapheresis on plasma cytokines during active disease in patients with active ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Hiroyuki Hanai; Yasushi Iwaoka; Akiko Nakamura; Kazuhisa Hirayama; Abby R Saniabadi; Fumitoshi Watanabe; Takayuki Iida; Masami Yamada; Yoshihiko Sato; Ken Takeuchi; Tatsuo Tanaka; Kenji Kondo; Masataka Kikuyama; Yasuhiko Maruyama

    2006-01-01

    AIM: To investigate the relationship between ulcerative colitis (UC) clinical activity index (CAI) and circulating levels of IL-1ra, IL-10, IL-6 and IL-18.METHODS: Blood levels of IL-1ra, IL-10, IL-6 and IL-18 were measured in 31 patients with active UC, the mean CAI was 11.1, ranging from 5-25; and 12 healthy individuals as controls. Patients were given granulocyte and monocyte adsorptive apheresis (GMA) with Adacolumn. Leucocytes which bear the FcyR and complement receptors were adsorbed to the column leucocytapheresis carriers. Each patient could receive up to 11 GMA sessions over 8 wk.RESULTS: We found strong correlations between CAI and IL-10 (r = 0.827, P < 0.001), IL-6 (r = 0.785, P <0.001) and IL-18 (r = 0.791, P < 0.001). IL-1ra was not correlated with CAI. Following GMA therapy, 24 of the 31 patients achieved remission and the levels of all 4 cytokines fell to the levels in healthy controls. Further,blood levels of IL-1ra and IL-10 increased at the column outflow and inflow at 60 min suggesting release from leucocytes that adhered to the carriers.CONCLUSION: Elevated blood levels of IL-6 and IL-18 together with peripheral blood granulocytes and monocytes/macrophages in patients with active UC show activative behaviour and increased survival time can be proinflammatory and the targets of GMA therapy.

  13. MicroRNAs Expression in the Ileal Pouch of Patients with Ulcerative Colitis Is Robustly Up-Regulated and Correlates with Disease Phenotypes

    Science.gov (United States)

    Sherman Horev, Hadas; Elad, Hofit; Baram, Liran; Issakov, Ofer; Tulchinsky, Hagit; Pasmanik-Chor, Metsada; Shomron, Noam; Dotan, Iris

    2016-01-01

    Background Gene expression alterations are associated with disease behavior in inflammatory bowel disease (IBD). microRNAs (miRNAs) are dominant in the regulation of gene expression, and may affect IBD phenotype. Our aim was to assess mucosal miRNA expression in IBD and the correlation with intestinal inflammation. Methods We performed a large-scale analysis of ileal mucosal miRNA. Biopsies were retrieved from patients with ileal Crohn’s disease (CD), unoperated ulcerative colitis (UC) patients, UC patients after pouch surgery, and normal controls (NC). Pouch UC patients were classified as having a normal pouch (NP), chronic pouchitis (CP), and Crohn’s-like disease of the pouch (CLDP). miRNA expression was analyzed by parallel massive (next-generation) sequencing (NGS). Bioinformatics tools were applied for clustering and the detection of potential targets. Results Sixty-one subjects were recruited. The ileum of unoperated UC patients was comparable with NC. There were significant miRNA expression alterations (fold change ≥2, corrected P ≤.05) in NP (n = 6), CP (n = 40) and CLDP (n = 139), but only two expression alterations were noted in CD. More than 90% of the altered miRNAs were up-regulated, and many were predicted to be associated with significantly decreased transcripts. miRNAs alterations were generally clustered with disease phenotypes. Conclusions Ileal inflammation causes increased miRNA expression. miRNA alterations correlate with IBD phenotype, apparently by controlling the down-regulation of specific mRNAs. PMID:27536783

  14. Quality of life in patients with ulcerative colitis treated surgically

    OpenAIRE

    Kozłowska, Katarzyna A.; Bączyk, Grażyna; Krokowicz, Piotr

    2014-01-01

    Introduction Ulcerative colitis belongs to the group of inflammatory bowel diseases. The specific symptoms and chronic nature of the disease significantly affect the quality of patients’ lives. Quality-of-life assessment helps to define its determining factors as well as the efficiency of surgical procedures. Aim Quality-of-life evaluation of patients with ulcerative colitis treated surgically. Material and methods A retrospective review was carried out on 35 patients with ulcerative colitis,...

  15. Highly selective vagotomy in the treatment of peptic ulcer diathesis.

    Science.gov (United States)

    Kaushik, S P; Kohli, P; Kumar, P; Pradeep, R; Saxena, R; Choudhary, S R; Suresh, A

    1990-09-01

    The results of highly selective vagotomy in 174 Indian patients have been analysed. Compared to other procedures on the stomach, HSV has a definite advantage both on long term as well as on short term basis. HSV has therefore become the procedure of choice in the treatment of duodenal ulcer disease provided the expertise is available locally. HSV has also been used now in the treatment of ulcer complications and benign gastric ulcer disease. PMID:2092027

  16. [THE EFFECTIVENESS OF ERADICATION IN PATIENTS WITH PEPTIC ULCER DISEASE ASSOCIATED WITH HELICOBACTER PYLORI, DEPENDING ON THE GENOTYPE OF THE DRUGMETABOLISM OF PROTON PUMP INHIBITORS].

    Science.gov (United States)

    Elokhina, E V; Kostenko, M B; Livzan, M A; Scalskiy, S V

    2015-01-01

    One of the most likely causes of the lack of effectiveness of eradication therapy of peptic ulcer associated with Helicobacter pylori, is a feature of omeprazole metabolism by cytochrome CYP2C19. The paper work presents evidence that the rate of reduction of the clinical picture and the likelihood of scarring ulcers and eradication rates higher in patients slow metabolizers of omeprazole.

  17. Gastroprotective and Anti-ulcer activity of Aloe vera juice, Papaya fruit juice and Aloe vera and Papaya fruit combined juice in Ethanol induced Ulcerated Rats

    OpenAIRE

    Mr. S. Gopinathan; D. Naveenraj

    2013-01-01

    Peptic ulcer is the most prevalent gastrointestinal disease. Even though a wide range of drugs are available for the treatment of peptic ulcer, but many of these do not fulfill all the requirements and have side effects. These factors have attracted researchers to investigate the natural products which have more efficacy, less side effects and less expensive for the treatment of peptic ulcer disease. In the present study the anti ulcer activity of (1) Aloe vera juice, (2) papaya fruit juice (...

  18. Sunitinib induced pyoderma gangrenosum-like ulcerations.

    Science.gov (United States)

    Akanay-Diesel, S; Hoff, N P; Kürle, S; Haes, J; Erhardt, A; Häussinger, D; Schulte, K-W; Bölke, Edwin; Matuschek, C; Budach, W; Gerber, P A; Homey, B

    2011-11-10

    Pyoderma gangrenosum is a non-infectious neutro?philic skin disease commonly associated with underlying systemic diseases. Histopathological and laboratory diagnostics are unspecific in the majority of the cases and the diagnosis is made in accordance with the clinical picture. Here, we report the case of a 69-year old man with progredient pyoderma gangrenosum-like ulcerations under treatment with sunitinib due to hepatocellular carcinoma. A conventional ulcer therapy did not lead to a regression of the lesions. Solely cessation of sunitinib therapy resulted in an improvement of the ulcerations. Sunitinib is a multikinase inhibitor that targets the PDGF-α- and ?β-, VEGF-1-3-, KIT-, FLT3-, CSF-1- and RET-receptor, thereby impairing tumour proliferation, pathological angiogenesis and metastasation. Here, we demonstrate that pyoderma gangrenosum-like ulcers may represent a serious side effect of sunitinib-based anti-cancer treatment. PMID:22027642

  19. Sunitinib induced pyoderma gangrenosum-like ulcerations

    Directory of Open Access Journals (Sweden)

    Akanay-Diesel S

    2011-11-01

    Full Text Available Abstract Pyoderma gangrenosum is a non-infectious neutrophilic skin disease commonly associated with underlying systemic diseases. Histopathological and laboratory diagnostics are unspecific in the majority of the cases and the diagnosis is made in accordance with the clinical picture. Here, we report the case of a 69-year old man with progredient pyoderma gangrenosum-like ulcerations under treatment with sunitinib due to hepatocellular carcinoma. A conventional ulcer therapy did not lead to a regression of the lesions. Solely cessation of sunitinib therapy resulted in an improvement of the ulcerations. Sunitinib is a multikinase inhibitor that targets the PDGF-α - and -β-, VEGF-1-3-, KIT-, FLT3-, CSF-1- and RET-receptor, thereby impairing tumour proliferation, pathological angiogenesis and metastasation. Here, we demonstrate that pyoderma gangrenosum-like ulcers may represent a serious side effect of sunitinib-based anti-cancer treatment.

  20. Laparoscopic Repair for Perforated Duodenal Ulcer

    Directory of Open Access Journals (Sweden)

    A. Cotirleţ

    2015-01-01

    Full Text Available Perforated peptic ulcer (PPU, despite antiulcer medication and Helicobacter eradication, is still the most common indication for emergency gastric surgery associated with high morbidity and mortality. Perforated peptic ulcer is a common abdominal disease that is treated by surgery. The development of laparoscopic surgery has changed the way to treat such abdominal surgical emergencies but there is no consensus on whether the benefits of laparoscopic closure of perforated peptic ulcer outweigh the disadvantages such as prolonged surgery time and greater expense. However we can say that laparoscopic repair is a viable and safe surgical option for patients with perforated peptic ulcer disease and should be considered with the necessary expertise available.

  1. Actovegin administration in patients with ulcerated gout tophuses

    Directory of Open Access Journals (Sweden)

    M S Eliseev

    2005-01-01

    Full Text Available Objective. To study actovegin efficacy in the treatment of chronic skin ulcers due to ulceration of tophuses in pts with chronic tophaceous gout. Materials and methods. 6 pts with chronic tophaceous gout aged 52 to 77 years with disease duration from 6 to 20 years with longstanding persisting skin ulcers due to tophuses ulceration were included. In addition to allopuri- nol, steroid and nonsteroidal anti-inflammatory drugs they were treated with actovegin 20% intravenously and local applications of 2% actovegin gel. Clinical examination was performed before and after the course of therapy- Results. Two from six pts showed healing of single chronic ulcers to the end of the treatment course. In the remaining pts ulcer count and size decrease was achieved. Conclusion. Actovegin administration in combined therapy of chronic skin ulcers in pts with chronic tophaceous gout promoted healing of the defects in all cases.

  2. Idiopathic genital ulcers in women infected with human immunodeficiency virus.

    Science.gov (United States)

    Anderson, J; Clark, R A; Watts, D H; Till, M; Arrastia, C; Schuman, P; Cohn, S E; Young, M; Bessen, L; Greenblatt, R; Vogler, M; Swindells, S; Boyer, P

    1996-12-01

    A national survey of investigators caring for human immunodeficiency virus (HIV)-infected women was undertaken to describe the clinical presentation of idiopathic genital ulcer disease. Patients with negative syphilis and herpes simplex testing and/or negative genital ulcer biopsy were included in this study. Study participants (n = 29) were generally severely immunocompromised (median CD4 cell count was 50/mm3, and 68% had an acquired immunodeficiency syndrome [AIDS]-defining opportunistic process). Thirty-seven percent had coexistent oral ulcers and 19% had their genital ulcer progress to fistula formation (four rectovaginal and one vaginal-perineal). There was generally a favorable response to topical, systemic, and intralesional steroid treatment. This study suggests that idiopathic or probable aphthous genital ulcers in women have similar clinical characteristics to aphthous oroesophageal ulcers. Although infrequent, these genital ulcers can cause severe morbidity. Further research is warranted to better define the pathophysiology and optimal management.

  3. Current treatment of ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    JohannesMeier; AndreasSturm

    2011-01-01

    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.

  4. Current treatment of ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Johannes Meier; Andreas Sturm

    2011-01-01

    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.

  5. PARASYMPATHETIC DENERAVATION OF GASTRIUM AS A TREATMENT OF PEPTIC ULCER DISEASE PRECIPITATE MOTILITY DISORDER OF GALLBLADDER : A STUDY

    Directory of Open Access Journals (Sweden)

    Purujit

    2015-07-01

    Full Text Available A prospective clinical study on choleakinesia following total vagectomy (Bilateral truncal vagotomy was carried out during the period from April 2005 to December 2010.Total 55 cases were studied who was suffering from chronic duodenal ulcer. Out of these total 55 cases fifteen cases had gastric outlet obstruction with hugely dilated stomach which was considered as control group in this study. Other 40 cases were considered as study group. Truncal vagotomy with retr ocolic isoperistaltic GJA done in study group and only retrocolic isoperistaltic GJA operation done in control group. Two patients had incomplete vagotomy. All the patients were male and average age was 38.1 years. 32.7% cases were belonging to the age gro up between 26 - 35 years which was the highest. Though the cases were operated till September 2010, they were followed up till December 2013. Gastric acidity, oral cholecystography and ultrasonography of upper abdomen was done in both pre and post - operative period. All cases were meticulously examined to exclude other associated pathology. Cases were diagnosed by Barium meal and clinical analysis.14days post - operatively gastric acid analysis and three months post - operatively oral cholecystography was done. In the post - operative follow up period ultrasonography upper abdomen was done. 39(71% patients were turned up for checkup in post - operative period out of which 29 patients belong to complete vagotomy group. In conclusion it was seen that following total vag otomy the contraction of gall bladder was definitely reduced with decrease % loss of bile results stasis of bile. There was more than double dilatation of the gall bladder as detected three months post - operatively [1] after complete section of vagus. 7.5% o f patients of complete vagotomy group developed gall stones till three to four years post - operatively and 20% patients developed minimal gall bladder sludge and 5% patients developed dense peripheral sludge

  6. Birth outcome in women with ulcerative colitis and Crohn's disease, and pharmacoepidemiological aspects of anti-inflammatory drug therapy

    DEFF Research Database (Denmark)

    Nørgård, Bente Mertz

    2011-01-01

    prescription Database, the Danish National Hospital Discharge Registry, the Danish Medical Birth Registry, and review of selected medical records. After exposure to sulfasalazine during pregnancy our data suggest. No significantly increased overall relative risk of congenital abnormalities and no significantly...... with similar underlying diseases. It is difficult to rule out an influence of uncontrolled confounding. These were the first published data from a controlled observational study on exposed women with chronic inflammatory bowel disease. After preconceptional paternal use of azathioprine/6-mercaptopurine our...... National Hospital Discharge Registry, the nationwide Danish Prescription Database and the Danish Medical Birth Registry. Furthermore, birth outcomes are examined in Crohn's disease women with disease activity during pregnancy, based on data from review of hospital records, the Danish National Hospital...

  7. Intestinal microbiota and ulcerative colitis.

    Science.gov (United States)

    Ohkusa, Toshifumi; Koido, Shigeo

    2015-11-01

    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.

  8. Fragments of Citrullinated and MMP-degraded Vimentin and MMP-degraded Type III Collagen Are Novel Serological Biomarkers to Differentiate Crohn's Disease from Ulcerative Colitis

    DEFF Research Database (Denmark)

    Mortensen, Joachim Høg; Godskesen, Line Elbjerg; Jensen, Michael Dam;

    2015-01-01

    BACKGROUND AND AIMS: A hallmark of inflammatory bowel disease [IBD] is chronic inflammation, which leads to excessive extracellular matrix [ECM] remodelling and release of specific protein fragments, called neoepitopes. We speculated that the biomarker profile panel for ulcerative colitis [UC......-degraded vimentin [VICM] were studied with a competitive ELISA assay system in a cohort including 164 subjects [CD n = 72, UC n = 60, and non-IBD controls n = 32] and a validation cohort of 61 subjects [CD n = 46, and UC n = 15]. Receiver operating characteristic curve analysis and logistic regression modelling....... Furthermore, the biomarkers C1M [AUC = 0.81], C3M [AUC = 0.83], VICM [AUC = 0.83], and P1NP [AUC = 0.77] were best to differentiate UC from non-IBD. The best combinations of biomarkers to differentiate CD from UC and UC from non-IBD were VICM, C3M, C4M [AUC = 0.90] and VICM, C3M [AUC = 0.98] respectively...

  9. Epidemiological evidence of the association between lichen planus and two immune-related diseases. Alopecia areata and ulcerative colitis. Gruppo Italiano Studi Epidemiologici in Dermatologia.

    Science.gov (United States)

    1991-05-01

    Between September 1986 and February 1988, a case-control study involving 27 Italian dermatological centers collaborating in the Gruppo Italiano Studi Epidemiologici in Dermatologia was conducted, concerning the relationship between history of several medical conditions and exposures to drugs and the risk of lichen planus. The cases were all consecutive patients with a new diagnosis of lichen planus, and the controls were patients under dermatological care observed under the same conditions. A total of 711 cases and 1395 controls met the admission criteria and were interviewed by trained investigators. Patients with histories of alopecia areata were found to be at risk for lichen planus (relative risk = 2.7; 95% confidence interval, 1.1 to 6.5). Five patients (0.7%) in the group with lichen planus had a history of ulcerative colitis, while none of the controls had this disease. The risk of lichen planus was also increased in patients with a history of chronic active hepatitis, but this increase was not statistically significant (relative risk = 4.7; 95% confidence interval, 0.7 to 29.4).

  10. Expression of T-cell KV1.3 potassium channel correlates with pro-inflammatory cytokines and disease activity in ulcerative colitis

    DEFF Research Database (Denmark)

    Koch Hansen, Lars; Møller, Linda Maria Sevelsted; Rabjerg, Maj;

    2014-01-01

    BACKGROUND AND AIMS: Potassium channels, KV1.3 and KCa3.1, have been suggested to control T-cell activation, proliferation, and cytokine production and may thus constitute targets for anti-inflammatory therapy. Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized...... with active UC (n=33) and controls (n=15). Protein and mRNA expression of KV1.3 and KCa3.1, immune cell markers, and pro-inflammatory cytokines were determined by quantitative-real-time-polymerase-chain-reaction (qPCR) and immunofluorescence, and correlated with clinical parameters of inflammation. In......% of CD8(+) T-cells. KV1.3 was virtually absent on infiltrating macrophages. KV1.3 mRNA expression correlated significantly with mRNA expression of pro-inflammatory cytokines TNF-α (R(2)=0.61) and IL-17A (R(2)=0.51), the mayo endoscopic subscore (R(2)=0.13), and histological inflammation (R(2)=0.23). In...

  11. Management of pediatric ulcerative colitis

    DEFF Research Database (Denmark)

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

    2012-01-01

    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)....

  12. Risk factors influencing the outcome of peptic ulcer bleeding in chronic kidney disease after initial endoscopic hemostasis: A nationwide cohort study.

    Science.gov (United States)

    Liang, Chih-Ming; Hsu, Chien-Ning; Tai, Wei-Chen; Yang, Shih-Cheng; Wu, Cheng-Kun; Shih, Chih-Wei; Ku, Ming-Kun; Yuan, Lan-Ting; Wang, Jiunn-Wei; Tseng, Kuo-Lun; Sun, Wei-Chih; Hung, Tsung-Hsing; Nguang, Seng-Howe; Hsu, Pin-I; Wu, Deng-Chyang; Chuah, Seng-Kee

    2016-09-01

    Patients with chronic kidney disease (CKD) who had peptic ulcer bleeding (PUB) may have more adverse outcomes. This population-based cohort study aimed to identify risk factors that may influence the outcomes of patients with CKD and PUB after initial endoscopic hemostasis. Data from 1997 to 2008 were extracted from the National Health Insurance Research Database in Taiwan. We included a cohort dataset of 1 million randomly selected individuals and a dataset of patients with CKD who were alive in 2008. A total of 18,646 patients with PUB were screened, and 1229 patients admitted for PUB after endoscopic hemostasis were recruited. The subjects were divided into non-CKD (n = 1045) and CKD groups (n = 184). We analyzed the risks of peptic ulcer rebleeding, sepsis events, and mortality among in-hospital patients, and after discharge. Results showed that the rebleeding rates associated with repeat endoscopic therapy (11.96% vs 6.32%, P = 0.0062), death rates (8.7%, vs 2.3%, P < 0.0001), hospitalization cost (US$ 5595±7200 vs US$2408 ± 4703, P < 0.0001), and length of hospital stay (19.6 ± 18.3 vs 11.2 ± 13.1, P < 0.0001) in the CKD group were higher than those in the non-CKD group. The death rate in the CKD group was also higher than that in the non-CKD group after discharge. The independent risk factor for rebleeding during hospitalization was age (odds ratio [OR], 1.02; P = 0.0063), whereas risk factors for death were CKD (OR, 2.37; P = 0.0222), shock (OR, 2.99; P = 0.0098), and endotracheal intubation (OR, 5.31; P < 0.0001). The hazard ratio of rebleeding risk for aspirin users after discharge over a 10-year follow-up period was 0.68 (95% confidence interval [CI]: 0.45-0.95, P = 0.0223). On the other hand, old age (P < 0.0001), CKD (P = 0.0090), diabetes (P = 0.0470), and congestive heart failure (P = 0.0013) were the independent risk factors for death after discharge. In-hospital patients with CKD and PUB after endoscopic therapy

  13. Gastrin releasing peptide receptor expression is decreased in patients with Crohn’s disease but not in ulcerative colitis

    OpenAIRE

    ter Beek, W P; Muller, E S M; van Hogezand, R A; Biemond, I; Lamers, C B H W

    2004-01-01

    Background: Gastrin releasing peptide (GRP) and neuromedin B are bombesin (BN)-like peptides involved in regulating motility and inflammation in the gastrointestinal tract, which may be useful in treating inflammatory bowel disease (IBD). Three bombesin-like peptide receptors have been reported, but no studies have investigated their localisation in normal and inflamed human intestine.

  14. Combined NADPH oxidase 1 and interleukin 10 deficiency induces chronic endoplasmic reticulum stress and causes ulcerative colitis-like disease in mice.

    Science.gov (United States)

    Tréton, Xavier; Pedruzzi, Eric; Guichard, Cécile; Ladeiro, Yannick; Sedghi, Shirin; Vallée, Mélissa; Fernandez, Neike; Bruyère, Emilie; Woerther, Paul-Louis; Ducroc, Robert; Montcuquet, Nicolas; Freund, Jean-Noel; Van Seuningen, Isabelle; Barreau, Frédérick; Marah, Assiya; Hugot, Jean-Pierre; Cazals-Hatem, Dominique; Bouhnik, Yoram; Daniel, Fanny; Ogier-Denis, Eric

    2014-01-01

    Ulcerative colitis (UC) is a chronic inflammatory bowel disease affecting the rectum which progressively extents. Its etiology remains unknown and the number of treatments available is limited. Studies of UC patients have identified an unbalanced endoplasmic reticulum (ER) stress in the non-inflamed colonic mucosa. Animal models with impaired ER stress are sensitive to intestinal inflammation, suggesting that an unbalanced ER stress could cause inflammation. However, there are no ER stress-regulating strategies proposed in the management of UC partly because of the lack of relevant preclinical model mimicking the disease. Here we generated the IL10/Nox1dKO mouse model which combines immune dysfunction (IL-10 deficiency) and abnormal epithelium (NADPH oxidase 1 (Nox1) deficiency) and spontaneously develops a UC-like phenotype with similar complications (colorectal cancer) than UC. Our data identified an unanticipated combined role of IL10 and Nox1 in the fine-tuning of ER stress responses in goblet cells. As in humans, the ER stress was unbalanced in mice with decreased eIF2α phosphorylation preceding inflammation. In IL10/Nox1dKO mice, salubrinal preserved eIF2α phosphorylation through inhibition of the regulatory subunit of the protein phosphatase 1 PP1R15A/GADD34 and prevented colitis. Thus, this new experimental model highlighted the central role of epithelial ER stress abnormalities in the development of colitis and defined the defective eIF2α pathway as a key pathophysiological target for UC. Therefore, specific regulators able to restore the defective eIF2α pathway could lead to the molecular remission needed to treat UC. PMID:25014110

  15. Combined NADPH oxidase 1 and interleukin 10 deficiency induces chronic endoplasmic reticulum stress and causes ulcerative colitis-like disease in mice.

    Directory of Open Access Journals (Sweden)

    Xavier Tréton

    Full Text Available Ulcerative colitis (UC is a chronic inflammatory bowel disease affecting the rectum which progressively extents. Its etiology remains unknown and the number of treatments available is limited. Studies of UC patients have identified an unbalanced endoplasmic reticulum (ER stress in the non-inflamed colonic mucosa. Animal models with impaired ER stress are sensitive to intestinal inflammation, suggesting that an unbalanced ER stress could cause inflammation. However, there are no ER stress-regulating strategies proposed in the management of UC partly because of the lack of relevant preclinical model mimicking the disease. Here we generated the IL10/Nox1dKO mouse model which combines immune dysfunction (IL-10 deficiency and abnormal epithelium (NADPH oxidase 1 (Nox1 deficiency and spontaneously develops a UC-like phenotype with similar complications (colorectal cancer than UC. Our data identified an unanticipated combined role of IL10 and Nox1 in the fine-tuning of ER stress responses in goblet cells. As in humans, the ER stress was unbalanced in mice with decreased eIF2α phosphorylation preceding inflammation. In IL10/Nox1dKO mice, salubrinal preserved eIF2α phosphorylation through inhibition of the regulatory subunit of the protein phosphatase 1 PP1R15A/GADD34 and prevented colitis. Thus, this new experimental model highlighted the central role of epithelial ER stress abnormalities in the development of colitis and defined the defective eIF2α pathway as a key pathophysiological target for UC. Therefore, specific regulators able to restore the defective eIF2α pathway could lead to the molecular remission needed to treat UC.

  16. Demographic, clinical and antibody characteristics of patients with digital ulcers in systemic sclerosis

    DEFF Research Database (Denmark)

    Denton, Christopher P; Krieg, Thomas; Guillevin, Loic;

    2012-01-01

    OBJECTIVES: The Digital Ulcers Outcome (DUO) Registry was designed to describe the clinical and antibody characteristics, disease course and outcomes of patients with digital ulcers associated with systemic sclerosis (SSc). METHODS: The DUO Registry is a European, prospective, multicentre......, observational, registry of SSc patients with ongoing digital ulcer disease, irrespective of treatment regimen. Data collected included demographics, SSc duration, SSc subset, internal organ manifestations, autoantibodies, previous and ongoing interventions and complications related to digital ulcers. RESULTS...

  17. Aphthous ulcers (recurrent)

    OpenAIRE

    Porter, Stephen R; Scully CBE, Crispian

    2007-01-01

    Most people with recurrent aphthous ulcers develop a few ulcers less than 1 cm in diameter, that heal after 5 to 14 days without scarring. The causes are unknown, but risks of recurrence may decrease if the person gives up smoking.Local physical trauma may trigger ulcers in susceptible people.In 10% of sufferers, lesions are more than 1 cm in diameter and can cause scarring.

  18. ETIOPATHOGENESIS OF PEPTIC ULCER: back to the past?

    Directory of Open Access Journals (Sweden)

    Mariana Barbosa ARAÚJO

    2014-04-01

    Full Text Available Objectives To review some aspects of the etiopathogenesis of peptic ulcerous disease especially on the basis of studies on its correlation with Helicobacter pylori (H. pylori. Methods A search was made in the data bases MEDLINE, LILACS and PubMed, and in Brazilian and foreign books, referring to the incidence and prevalence of infection by H. pylori and of peptic ulcerous disease in various populations of different countries. Results It was observed that the prevalence of H. pylori infection is similar in individuals with peptic ulcerous disease and the general population. There are differences between countries with respect to the prevalence of infection and of gastric or duodenal peptic ulcers. In many countries the prevalence of infection by H. pylori shows stability while the prevalence of peptic ulcerous disease is declining. The prevalence of peptic ulcerous disease without H. pylori infection varies between 20% and 56% in occidental countries. Discussion The observations might be suggestive of H. pylori being only one more factor to be summed together with other aggressive components in the genesis of peptic ulcerous disease. We would therewith be returning to the classic concept that peptic gastric and duodenal ulcers have multifactorial etiology and would result from imbalance between aggressive and defensive factors. The focus of studies should be enriched with the identification of the defensive factors and of other aggressive factors besides the well known H. pylori and non-steroidal anti-inflammatory drugs, since these two aggressors do not exhaust the full causal spectrum.

  19. Clinical quality indicators of venous leg ulcers

    DEFF Research Database (Denmark)

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

    2005-01-01

    and reliable evidence-based quality indicators of venous leg ulcer care. A Scandinavian multidisciplinary, cross-sectional panel of wound healing experts developed clinical quality indicators on the basis of scientific evidence from the literature and subsequent group nominal consensus of the panel......In the clinical setting, diagnosis and treatment of venous leg ulcers can vary considerably from patient to patient. The first step to reducing this variation is to document venous leg ulcer care through use of quantitative scientific documentation principles. This requires the development of valid......; an independent medical doctor tested the feasibility and reliability of these clinical indicators, assessing the quality of medical technical care on 100 consecutive venous leg ulcer patients. Main outcome measures were healing, recurrence, pain, venous disease diagnosis, differential diagnosis and treatment...

  20. Bactericidal activity does not predict sterilizing activity: the case of rifapentine in the murine model of Mycobacterium ulcerans disease.

    Directory of Open Access Journals (Sweden)

    Deepak V Almeida

    Full Text Available BACKGROUND: Since 2004, treatment of Mycobacterium ulcerans disease, or Buruli ulcer, has shifted from surgery to daily treatment with streptomycin (STR + rifampin (RIF for 8 weeks. For shortening treatment duration, we tested the potential of daily rifapentine (RPT, a long-acting rifamycin derivative, as a substitute for RIF. METHODOLOGY/PRINCIPAL FINDINGS: BALB/c mice were infected with M. ulcerans in the right hind footpad and treated either daily (7/7 with STR+RIF or five days/week (5/7 with STR+RIF or STR+RPT for 4 weeks, beginning 28 days after infection when CFU counts were 4.88±0.51. The relative efficacy of the drug treatments was compared by footpad CFU counts during treatment and median time to footpad swelling after treatment cessation as measure of sterilizing activity. All drug treatments were bactericidal. After 1 week of treatment, the decline in CFU counts was significantly greater in treated mice but not different between the three treated groups. After 2 weeks of treatment, the decline in CFU was greater in mice treated with STR+RPT 5/7 than in mice treated with STR+RIF 7/7 and STR+RIF 5/7. After 3 and 4 weeks of treatment, CFU counts were nil in mice treated with STR+RPT and reduced by more than 3 and 4 logs in mice treated with STR+RIF 5/7 and STR+RIF 7/7, respectively. In sharp contrast to the bactericidal activity, the sterilizing activity was not different between all drug regimens although it was in proportion to the treatment duration. CONCLUSIONS/SIGNIFICANCE: The better bactericidal activity of daily STR+RIF and especially of STR+RPT did not translate into better prevention of relapse, possibly because relapse-freecure after treatment of Buruli ulcer is more related to the reversal of mycolactone-induced local immunodeficiency by drug treatment rather than to the bactericidal potency of drugs.

  1. A Gastroenterologist’s Perspective of The Medical Management of Patients with Crohn’s Disease and Ulcerative Colitis

    Directory of Open Access Journals (Sweden)

    ABR Thomson

    1996-01-01

    Full Text Available Medical therapy in patients with inflammatory bowel disease (IBD has specific objectives that need to be remembered when considering any form of intervention. These objectives include to improve the quality of life, to improve symptoms, to improve nutrition and reduce the risk of nutritional deficiencies, to reduce the frequency and severity of recurrences, to reduce complications, including the need for surgery, and to cure the disease. Medical therapy potentially helps to achieve all of these objectives for sufferers of IBD, except the last one – until the pathogenesis of the recurrent or continuous episodes of bowel inflammation is better understood, this last objective will remain "a riddle, wrapped in a mystery, inside an enigma".

  2. Neutrophil Extracellular Traps in Ulcerative Colitis

    DEFF Research Database (Denmark)

    Bennike, Tue Bjerg; Carlsen, Thomas Gelsing; Ellingsen, Torkell;

    2015-01-01

    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...

  3. Microarray Assisted Gene Discovery in Ulcerative Colitis

    DEFF Research Database (Denmark)

    Brusgaard, Klaus

    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...

  4. Choledochoduodenal fistula of ulcer etiology

    Directory of Open Access Journals (Sweden)

    Čolović Radoje

    2010-01-01

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

  5. Infliximab to treat severe ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Dídia Bisamra Cury; Marcelo de Souza Cury; Geraldo Vinicius Hemerly Elias; Sender Jankiel Mizsputen

    2009-01-01

    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.

  6. Differences in visceral fat and fat bacterial colonization between ulcerative colitis and Crohn's disease. An in vivo and in vitro study.

    Directory of Open Access Journals (Sweden)

    Alessandra Zulian

    Full Text Available Crohn's disease (CD is notably characterized by the expansion of visceral fat with small adipocytes expressing a high proportion of anti-inflammatory genes. Conversely, visceral fat depots in ulcerative colitis (UC patients have never been characterized. Our study aims were a to compare adipocyte morphology and gene expression profile and bacterial translocation in omental (OM and mesenteric (MES adipose tissue of patients with UC and CD, and b to investigate the effect of bacterial infection on adipocyte proliferation in vitro. Specimens of OM and MES were collected from 11 UC and 11 CD patients, processed and examined by light microscopy. Gene expression profiles were evaluated in adipocytes isolated from visceral adipose tissue using microarray and RTqPCR validations. Bacteria within adipose tissue were immuno-detected by confocal scanning laser microscopy. Adipocytes were incubated with Enterococcus faecalis and cells counted after 24 h. Morphology and molecular profile of OM and MES revealed that UC adipose tissue is less inflamed than CD adipose tissue. Genes linked to inflammation, bacterial response, chemotaxis and angiogenesis were down-regulated in adipocytes from UC compared to CD, whereas genes related to metallothioneins, apoptosis pathways and growth factor binding were up-regulated. A dense perinuclear positivity for Enterococcus faecalis was detected in visceral adipocytes from CD, whereas positivity was weak in UC. In vitro bacterial infection was associated with a five-fold increase in the proliferation rate of OM preadipocytes. Compared to UC, visceral adipose tissue from CD is more inflamed and more colonized by intestinal bacteria, which increase adipocyte proliferation. The influence of bacteria stored within adipocytes on the clinical course of IBD warrants further investigations.

  7. Altered colonic mucosal Polyunsaturated Fatty Acid (PUFA derived lipid mediators in ulcerative colitis: new insight into relationship with disease activity and pathophysiology.

    Directory of Open Access Journals (Sweden)

    Mojgan Masoodi

    Full Text Available OBJECTIVES: Ulcerative colitis (UC is a relapsing inflammatory disorder of unconfirmed aetiology, variable severity and clinical course, characterised by progressive histological inflammation and with elevation of eicosanoids which have a known pathophysiological role in inflammation. Therapeutic interventions targetting eicosanoids (5-aminosalicylates (ASA are effective first line and adjunctive treatments in mild-moderate UC for achieving and sustaining clinical remission. However, the variable clinical response to 5-ASA and frequent deterioration in response to cyclo-oxygenase (COX inhibitors, has prompted an in depth simultaneous evaluation of multiple lipid mediators (including eicosanoids within the inflammatory milieu in UC. We hypothesised that severity of inflammation is associated with alteration of lipid mediators, in relapsing UC. DESIGN: Study was case-control design. Mucosal lipid mediators were determined by LC-MS/MS lipidomics analysis on mucosal biopsies taken from patients attending outpatients with relapsing UC. Univariate and multivariate statistical analyses were used to investigate the association of mucosal lipid mediators, with the disease state and severity graded histologically. RESULTS: Levels of PGE2, PGD2, TXB2, 5-HETE, 11-HETE, 12-HETE and 15-HETE are significantly elevated in inflamed mucosa and correlate with severity of inflammation, determined using validated histological scoring systems. CONCLUSIONS: Our approach of capturing inflammatory mediator signature at different stages of UC by combining comprehensive lipidomics analysis and computational modelling could be used to classify and predict mild-moderate inflammation; however, predictive index is diminished in severe inflammation. This new technical approach could be developed to tailor drug treatments to patients with active UC, based on the mucosal lipid mediator profile.

  8. Quality of Life Is Related to Fecal Calprotectin Concentrations in Colonic Crohn Disease and Ulcerative Colitis, but not in Ileal Crohn Disease

    OpenAIRE

    Gauss, Annika; Geib, Thomas; Hinz, Ulf; Schaefert, Rainer; Zwickel, Philipp; Zawierucha, Anna; Stremmel, Wolfgang; Klute, Lukas

    2016-01-01

    Abstract To formulate therapy goals, we aimed to define the relationship between fecal calprotectin and health-related quality of life in inflammatory bowel diseases (IBDs). This retrospective single-center cross-sectional study included ambulatory IBD patients who had completed standardized questionnaires comprising items of health-related quality of life (Short Inflammatory Bowel Disease Questionnaire) and clinical disease activity scores, and who had provided stool samples for calprotectin...

  9. [Piracetam in combined pathogenetic therapy of recurrent duodenal ulcer].

    Science.gov (United States)

    Tsimmerman, Ia S; Shchetkin, D I

    2002-01-01

    Duodenal ulcer cure, as a systemic gastroenterologic disease, can be achieved in some patients by the addition of the nootropic drug piracetam to current antisecretory and antihelicobacter therapy. Piracetam corrects vegetative and psychoemotional disorders in duodenal ulcer, normalizes gastric motility, has an antioxidant effect and improves cerebral circulation. An optimal effect on clinico-endoscopic manifestations of recurrent duodenal ulcer was achieved in combination of piracetam with current antisecretory (omeprazole) and antihelicobacter (de-nol, amoxicillin, metronidazole) medicines. Such combination improves both short- and long-term outcomes of duodenal ulcer treatment.

  10. The stress ulcer syndrome

    NARCIS (Netherlands)

    H.A. van Essen

    1986-01-01

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

  11. Neonatal Pressure Ulcer Prevention.

    Science.gov (United States)

    Scheans, Patricia

    2015-01-01

    The incidence of pressure ulcers in acutely ill infants and children ranges up to 27 percent in intensive care units, with a range of 16-19 percent in NICUs. Anatomic, physiologic, and developmental factors place ill and preterm newborns at risk for skin breakdown. Two case studies illustrate these factors, and best practices for pressure ulcer prevention are described. PMID:26803094

  12. Bipolar aphthosis presenting as mutilating genital ulcers in women

    Directory of Open Access Journals (Sweden)

    Gupta Somesh

    2004-11-01

    Full Text Available Three women with large, mutilating genital ulcers of long duration, destroying almost the lower half of the external genitalia, are reported. They had a history of recurrent oral ulcers as well. All patients had been diagnosed as having ′genital ulcer syndrome′ in the past and had been treated with antimicrobials. Histopathology of the biopsy from the margin of the ulcer revealed features of leukocytoclastic vasculitis. Considering the history, clinical features and histology, a diagnosis of bipolar aphthosis was made in all patients. All patients responded well to immunosuppressive therapy. The cases are reported because of the presence of genital ulcers of an unusually large size, mutilating character and their close similarity to genital ulcers due to sexually transmitted diseases, especially genital herpes and donovanosis.

  13. Bipolar aphthosis presenting as mutilating genital ulcers in women.

    Science.gov (United States)

    Gupta, Somesh; Ajith, C; Malhotra, S; Kumar, Bhushan

    2004-01-01

    Three women with large, mutilating genital ulcers of long duration, destroying almost the lower half of the external genitalia, are reported. They had a history of recurrent oral ulcers as well. All patients had been diagnosed as having 'genital ulcer syndrome' in the past and had been treated with antimicrobials. Histopathology of the biopsy from the margin of the ulcer revealed features of leukocytoclastic vasculitis. Considering the history, clinical features and histology, a diagnosis of bipolar aphthosis was made in all patients. All patients responded well to immunosuppressive therapy. The cases are reported because of the presence of genital ulcers of an unusually large size, mutilating character and their close similarity to genital ulcers due to sexually transmitted diseases, especially genital herpes and donovanosis.

  14. Bipolar aphthosis presenting as mutilating genital ulcers in women

    Directory of Open Access Journals (Sweden)

    Gupta Somesh

    2004-01-01

    Full Text Available Three women with large, mutilating genital ulcers of long duration, destroying almost the lower half of the external genitalia, are reported. They had a history of recurrent oral ulcers as well. All patients had been diagnosed as having ′genital ulcer syndrome′ in the past and had been treated with antimicrobials. Histopathology of the biopsy from the margin of the ulcer revealed features of leukocytoclastic vasculitis. Considering the history, clinical features and histology, a diagnosis of bipolar aphthosis was made in all patients. All patients responded well to immunosuppressive therapy. The cases are reported because of the presence of genital ulcers of an unusually large size, mutilating character and their close similarity to genital ulcers due to sexually transmitted diseases, especially genital herpes and donovanosis.

  15. The stomach ulcer: character of morphogenesis.

    Directory of Open Access Journals (Sweden)

    Scherbinina M.B.

    2007-01-01

    Full Text Available Until now there were not completely known the causes of ulcerogenesis and chronisation of ulcerous gastric lesions as well as mechanisms of disorders of regeneration of gastroduodenal mucosa at all. The aim of this work was revealing the structural peculiarities of gastric mucosa that led to forming chronic ulcers. There was performed the histological examination of 24 biopsies in patients with mediogastral ulcer as well as the material of autopsies of 18 persons died due to the hemorrhage from gastric peptic ulcer. The biopsy material from curvature minor of gastric corpus in 12 persons without gastroduodenal diseases was control. There were determined the thickness of mucosa, thickness of submucosa, submucosal-mucosal index, height of superficial epitheliocytes and their nuclear diameter, nuclear-cytoplasmic interrelations, volume summary density of microcirculation in mucosa, mitotic index of growth zone of gastric glands using morphometry. Chronic gastric ulcers showed to form in the background of prolonged chronic gastritis associated with Helicobacter pylori. The structural peculiarities wall of a stomach which developed as result of progressing the chronic inflammation and led to forming the chronic ulcers were thickening submucosal layer as well as its sclerosis and hialinization, decrease of volumous summary density of microcircula-tion.

  16. [AETIOLOGY AND PATHOGENESIS GASTRO-DUODENALES ULCERATIVE LESIONS IN ELDERLY].

    Science.gov (United States)

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

    2015-01-01

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

  17. T-lymphocyte subsets in recurrent aphthous ulceration

    DEFF Research Database (Denmark)

    Pedersen, A; Klausen, B; Hougen, H P;

    1989-01-01

    Peripheral T-lymphocyte subsets: T-helper (OKT4) and T-suppressor (OKT8) cells were studied quantitatively in 20 patients with recurrent aphthous ulceration (RAU) in ulcerative, as well as inactive, stages of the disease. The figures were compared with T-lymphocyte subsets from matched control...

  18. [Ulcerated duodenitis revealing Henoch-Schönlein purpura].

    Science.gov (United States)

    Marting, A; Defrance, P; Wain, E; Van Severen, M; Deflandre, J

    2015-01-01

    Inflammation and duodenal ulcers can meet many etiologies. We report the case of a young adult with an ulcerated duodenitis revealing Henoch-Schönlein purpura. The abdominal symptoms preceded the emergence of the classical cutaneous signs of the disease. PMID:26376566

  19. A case series to describe the clinical characteristics of foot ulceration in patients with rheumatoid arthritis.

    Science.gov (United States)

    Siddle, Heidi J; Firth, Jill; Waxman, Robin; Nelson, E Andrea; Helliwell, Philip S

    2012-03-01

    The aim of this study was to describe the clinical characteristics of foot ulceration in patients with rheumatoid arthritis (RA). Adults with RA and current foot ulceration but without diabetes were recruited. Clinical examination included assessment of RA disease activity, foot deformity, peripheral vascular disease, neuropathy and plantar pressures. Location, wound characteristics and time to healing were recorded for each ulcer. Participants completed the Health Assessment Questionnaire and Leeds Foot Impact Scale. Thirty-two cases with 52 current ulcers were recruited. Thirteen patients (41%) experienced more than one current ulcer: 5 (16%) had bilateral ulceration, 15 (47%) had previous ulceration at a current ulcer site. The majority (n = 33) of open ulcers were located over the dorsal aspect of the interphalangeal joints (n = 12), plantar aspect of the metatarsophalangeal joints (MTPJs) (n = 12) and medial aspect of first MTPJs (n = 9). In ulcerated limbs (n = 37), ankle brachial pressure index (ABPI) was 6 kg/cm(2) in 6 (16%). Mean ulcer size was 4.84 by 3.29 mm. Most ulcers (n = 42, 81%) were superficial; five (9.6%) were infected. Time to healing was available for 41 ulcers: mean duration was 28 weeks. Three ulcers remained open. In conclusion, foot ulceration in RA is recurrent and multiple ulcers are common. Whilst ulcers are small and shallow, time to achieve healing is slow, posing infection risk. Reduced protective sensation is common in affected patients. The prevalence of arterial disease is low but may be under estimated due to high intolerance of ABPI. PMID:22052587

  20. Aetiopathology of ulcers of oral cavity and oropharynx: a cross sectional study

    Directory of Open Access Journals (Sweden)

    Thimmappa T.D.

    2013-08-01

    Full Text Available Background: Oral ulcers are common diseases for which patient seeks medical advice. Till date the clinical profile to diagnose the oral ulcers, management and risk of malignancy is not well established. Hence, the study has been taken up to investigate the aetiopathology of ulcers of oral cavity and oropharynx. Methods: 60 cases of ulcers of oral cavity and oropharynx were included in the study. The aetiopathology of ulcers of oral cavity and oropharynx were investigated on the basis of age, sex, duration, etiological factors, symptom Index, socioeconomic status and anatomical distribution. Values are expressed as percentages. Results: The highest incidence was found in low socioeconomic status. The lesions studied in this study were 50% of Non Specific ulcers [Short term (3 wks 10-33%], 15% of Aphthous ulcers, 8.3% of Traumatic Ulcers, 6.5% of Malignant ulcers, 6.5% of Dental ulcers, 3.2% of HIV infection & AIDS, 3.2% of ulcer due to T.B and 6.5% of ulcers. The majority of the cases were between the age 21-30 years constituting 35% followed by 11-12 years constituting 26.6%.d 62% of the short term ulcers, Female 38%. Conclusions: Low socioeconomic status, lack of education, bad oral hygiene, bad habits cultivated in early childhood is predisposing factors. Hence early diagnosis and prompt treatment is advised in all cases of ulcers. [Int J Res Med Sci 2013; 1(4.000: 496-500

  1. A community survey on the knowledge of neglected tropical diseases in Cameroon

    Directory of Open Access Journals (Sweden)

    Kamga HLF

    2012-01-01

    Full Text Available Background: The neglected tropical diseases are a group of 13 infections that affect more than one billion people worldwide, especially those who live in extreme poverty. Aim: This study was conducted to determine community knowledge of these neglected tropical diseases (NTD in Cameroon. Materials and Methods: A random sampling method was used to administer questionnaires to 3345 adults. Results: 2566 (76.7% of people approached responded to the questionnaire. This comprised 1313 (51.2% females and 1253 (48.8% males. There was a significant level of association between the opinion of the respondents and their region of residence (P<0.05. Globally the percentage of persons with good knowledge of one of the neglected tropical diseases was low (ranging from 23.1% to 80.9%. Diseases for which the population had the highest percentages of knowledge were leprosy (80.9%, soil-transmitted helminth infections (75.3%, lymphatic filariosis (70.3%, onchocerciasis (66.2% and human African trypanosomiasis (57.8%. Diseases for which people had the least percentages of knowledge were leishmaniosis (18.0%, dracunculiasis (23.1%, buruli ulcer (23.8%, trachoma (38.2%, endemic treponematosis (41.5% and schistosomiasis (49.1%. Populations living in urban areas had a greater knowledge of the neglected tropical diseases than those living in rural and peri-urban areas (P<0.05 and males exhibited a greater knowledge than females (P<0.05. Conclusion: There was low community knowledge pattern of neglected tropical diseases, mostly among the female populations and people living in rural areas. We advocate mass media health education to be adopted as one of the strategies for the national control policy of NTDs.

  2. Diagnostics of pressure ulcer risk and pressure ulcers

    OpenAIRE

    Kottner, Jan

    2011-01-01

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

  3. Amyloid Goiter Secondary to Ulcerative Colitis

    Directory of Open Access Journals (Sweden)

    Bunyamin Aydin

    2016-01-01

    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.

  4. Amyloid Goiter Secondary to Ulcerative Colitis.

    Science.gov (United States)

    Aydin, Bunyamin; Koca, Yavuz Savas; Koca, Tugba; Yildiz, Ihsan; Gerek Celikden, Sevda; Ciris, Metin

    2016-01-01

    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. PMID:27051538

  5. Pressure Ulcers Surveillance Report

    Directory of Open Access Journals (Sweden)

    Zehra Esin Gencer

    2015-04-01

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

  6. Diabetic foot ulcer treatment by activated platelet rich plasma: a clinical study

    OpenAIRE

    Tung Dang-Xuan Tran; Phuong Thi-Bich Le and Phuc Van Pham

    2014-01-01

    Diabetic foot ulcer is a major complication of diabetes mellitus. It occurred in about 15% of all diabetic patients. To date, the outcome of management of diabetic foot ulcer is poor and low sufficient. Some new therapies were suggested to manage and treat this disease. In almost therapies, management of diabetic foot ulcer relates to debridement of the wound, revascularization, off-loading of the ulcer, antibacterial actions, stimulating granulation, epidermization and angiogenesis. This stu...

  7. Treatment of a Non-Healing Diabetic Foot Ulcer With Platelet-Rich Plasma

    OpenAIRE

    Suresh, Deepak H; Shwetha Suryanarayan; Sacchidanand Sarvajnamurthy; Srikanth Puvvadi

    2014-01-01

    Lower extremity ulcers and amputations are an increasing problem among individuals with diabetes. Among diabetes mellitus-related complications, foot ulceration is the most common, affecting approximately 15% of diabetic patients during their lifetime. The pathogenesis of diabetic ulcer is peripheral sensory neuropathy, calluses, oedema and peripheral vascular disease. Diabetic ulcer is managed by adequate control of infections and blood sugar levels, surgical debridement with various dressin...

  8. An eHealth System for Pressure Ulcer Risk Assessment Based on Accelerometer and Pressure Data

    OpenAIRE

    Dieter Hayn; Markus Falgenhauer; Jürgen Morak; Karin Wipfler; Viktoria Willner; Walter Liebhart; Günter Schreier

    2015-01-01

    Pressure ulcers are a common skin disease which is associated with pain, reduced autonomy, social isolation, and reduced quality of life. There are several systems for monitoring of pressure ulcer-related risk factors on the market, but up to now no satisfactory solution is available, especially for people with medium pressure ulcer risk. We present a novel pressure ulcer risk assessment and prevention system, which combines the advantages of accelerometer and pressure sensors for monitoring ...

  9. Bidirectional Crosstalk between Stress-Induced Gastric Ulcer and Depression under Chronic Stress

    OpenAIRE

    Shuang Zhang; Zhiwei Xu; Yan Gao; Yonghong Wu; Zhihui Li; Haifeng Liu; Chenggang Zhang

    2012-01-01

    Stress contributes to a variety of diseases and disorders such as depression and peptic ulcer. The present study aimed to investigate the correlation between stress ulcer and depression in pathogenesis and treatment by using chronic stress depression (CSD), chronic psychological stress ulcer (CPSU) and water immersion restrain stress models in rats. Our data showed that the ulcer index of the animals after CSD exposure was significantly higher than that of controls. Depression-like behaviors ...

  10. PERFORATED PEPTIC ULCER: A CLINICAL ANALYSIS AND OUTCOME

    Directory of Open Access Journals (Sweden)

    Bijit

    2016-03-01

    Full Text Available BACKGROUND The incidence of perforated peptic ulcer is approximately 7-10 cases per one lakh population per year. Perforation is seen in about 7% of patients hospitalized for peptic ulcer disease. Peptic ulcer perforation, which can be gastric/duodenal perforation can be a serious life-threatening condition if not detected early and treated urgently. Peptic ulcer disease has decreased considerably worldwide with the advent of potent anti-ulcer medicines, but its complication like peptic ulcer perforation has not. Our study is to analyse the clinical, radiological and management related findings in influencing the outcome of patients of peptic ulcer perforation after surgery. MATERIALS AND METHODS A series of 47 patients of peptic ulcer perforation were evaluated. Patients expiring within six hours of admission were not included in this study. RESULTS Age of the patients ranged from 17-80 years. The incidence of perforation was highest in the age group of 41-50 years (31.9%. Out of 47 patients, 41 (87.2% survived. CONCLUSION The incidence of perforation was highest in the age group of 41-50 years. Prognosis becomes poor with age, delayed treatment, shock at admission and concomitant diseases. Direct repair of the perforation with pedicled omentum gave excellent results.

  11. Peptic ulcer pathophysiology: acid, bicarbonate, and mucosal function

    DEFF Research Database (Denmark)

    Højgaard, L; Mertz Nielsen, A; Rune, S J

    1996-01-01

    The previously accepted role of gastric acid hypersecretion in peptic ulcer disease has been modified by studies showing no correlation between acid output and clinical outcome of ulcer disease, or between ulcer recurrence rate after vagotomy and preoperative acid secretion. At the same time......, studies have been unable to demonstrate increased acidity in the duodenal bulb in patients with duodenal ulcer, and consequently more emphasis has been given to the mucosal protecting mechanisms. The existence of an active gastric and duodenal mucosal bicarbonate secretion creates a pH gradient from...... cell removal and repair regulated by epidermal growth factor. Sufficient mucosal blood flow, including a normal acid/base balance, is important for subepithelial protection. In today's model of ulcer pathogenesis, gastric acid and H. pylori work in concert as aggressive factors, with the open question...

  12. Incidence and clinical features of endoscopic ulcers developing after gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Woo Chul Chung; Eun Jung Jeon; Kang-Moon Lee; Chang Nyol Paik; Sung Hoon Jung; Jung Hwan Oh; Ji Hyun Kim

    2012-01-01

    AIM:To determine the precise incidence and clinical features of endoscopic ulcers following gastrectomy.METHODS:A consecutive series of patients who underwent endoscopic examination following gastrectomy between 2005 and 2010 was retrospectively analyzed.A total of 78 patients with endoscopic ulcers and 759 without ulcers following gastrectomy were enrolled.We analyzed differences in patient age,sex,size of the lesions,method of operation,indications for gastric resection,and infection rates of Helicobacter pylori (H.pylori)between the nonulcer and ulcer groups.RESULTS:The incidence of endoscopic ulcers after gastrectomy was 9.3% and that of marginal ulcers was 8.6%.Ulcers were more common in patients with Billroth Ⅱ anastomosis and pre-existing conditions for peptic ulcer disease (PUD).Infection rates of H.pyloridid not differ significantly between the two groups.The patients who underwent operations to treat PUD had lower initial levels of hemoglobin and higher rates of hospital admission.CONCLUSION:H.pylori was not an important factor in ulcerogenesis following gastrectomy.For patients who underwent surgery for PUD,clinical course of marginal ulcers was more severe.

  13. Diabetes - foot ulcers

    Science.gov (United States)

    ... of the ulcer area. This will help speed healing. Be sure to wear shoes that do not ... American Diabetes Association. Standards of medical care in diabetes -- 2014. Diabetes Care. 2014;37:S14-S80. PMID: 24357209 www. ...

  14. Stasis dermatitis and ulcers

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/000834.htm Stasis dermatitis and ulcers To use the sharing features on this page, please enable JavaScript. Stasis dermatitis is a change in the skin that occurs ...

  15. Giant duodenal ulcers

    Institute of Scientific and Technical Information of China (English)

    Eric Benjamin Newton; Mark R Versland; Thomas E Sepe

    2008-01-01

    Giant duodenal ulcers (GDUs) are a subset of duodenal ulcers that have historically resulted in greater morbidity than usual duodenal ulcers. Until recently,few cases had been successfully treated with medical therapy. However, the widespread use of endoscopy,the introduction of H-2 receptor blockers and proton pump inhibitors, and the improvement in surgical techniques all have revolutionized the diagnosis,treatment and outcome of this condition. Nevertheless,GDUs are still associated with high rates of morbidity,mortality and complications. Thus, surgical evaluation of a patient with a GDU should remain an integral part of patient care. These giant variants, while usually benign, can frequently harbor malignancy. A careful review of the literature highlights the important differences when comparing GDUs to classical peptic ulcers and why they must be thought of differently than their more common counterpart.

  16. A Maximum Likelihood Estimator of a Markov Model for Disease Activity in Crohn's Disease and Ulcerative Colitis for Annually Aggregated Partial Observations

    DEFF Research Database (Denmark)

    Borg, Søren; Persson, U.; Jess, T.;

    2010-01-01

    cycle length of 1 month. The purpose of these models was to enable evaluation of interventions that would shorten relapses or postpone future relapses. An exact maximum likelihood estimator was developed that disaggregates the yearly observations into monthly transition probabilities between remission...... observed data and has good face validity. The disease activity model is less suitable for UC due to its transient nature through the presence of curative surgery...... Hospital, Copenhagen, Denmark, during 1991 to 1993. The data were aggregated over calendar years; for each year, the number of relapses and the number of surgical operations were recorded. Our aim was to estimate Markov models for disease activity in CD and UC, in terms of relapse and remission, with a...

  17. A Maximum Likelihood Estimator of a Markov Model for Disease Activity in Crohn's Disease and Ulcerative Colitis for Annually Aggregated Partial Observations

    DEFF Research Database (Denmark)

    Borg, Søren; Persson, U.; Jess, T.;

    2010-01-01

    Hospital, Copenhagen, Denmark, during 1991 to 1993. The data were aggregated over calendar years; for each year, the number of relapses and the number of surgical operations were recorded. Our aim was to estimate Markov models for disease activity in CD and UC, in terms of relapse and remission...... data and has good face validity. The disease activity model is less suitable for UC due to its transient nature through the presence of curative surgery......, with a cycle length of 1 month. The purpose of these models was to enable evaluation of interventions that would shorten relapses or postpone future relapses. An exact maximum likelihood estimator was developed that disaggregates the yearly observations into monthly transition probabilities between remission...

  18. Trigeminal Neurotrophic Ulceration

    OpenAIRE

    El-Daly, Ahmed; Snyderman, Carl H.

    1997-01-01

    A 74 year-old female developed a trigeminal neurotrophic ulcer (TNU) 20 years following surgical ablation of the trigeminal nerve. The diagnosis of this unusual disorder is suggested when an ulcerative lesion develops. In the ala nasi in a patient with trigeminal sensory loss. A history of self-induced trauma to that area and some form of mental impairment further support the diagnosis.

  19. Cerebral Arterial Thrombosis in Ulcerative Colitis

    Directory of Open Access Journals (Sweden)

    Giovanni Casella

    2013-01-01

    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.

  20. Barrett's ulcer: cause of spontaneous oesophageal perforation.

    OpenAIRE

    Limburg, A. J.; Hesselink, E. J.; Kleibeuker, J H

    1989-01-01

    We report two patients, who presented within six months with the classic clinical picture of 'spontaneous' oesophageal perforation, which was caused by a perforated Barrett's ulcer. These two cases underline the importance of postoperative endoscopy in ruling out intrinsic oesophageal disease as the cause of the rupture in every patient, who survives this life threatening condition.

  1. Manipulation of enteric flora in ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Mario Guslandi

    2005-01-01

    @@ TO THE EDITOR Reviewing the available therapeutic options in the medical treatment of ulcerative colitis, Xu et al.[1], 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.

  2. 消化性溃疡病中医证型的客观化临床研究%Clinical study of objectification of TCM syndrome type in peptic ulcer disease

    Institute of Scientific and Technical Information of China (English)

    晏喻婷; 蔣波涛; 张朋; 周州; 李荣华; 陶阳

    2014-01-01

    目的:研究消化性溃疡病中医证型与消化性溃疡分类、溃疡分期、胃镜征象、幽门螺杆菌( H.pylori)感染的相关性,从而为消化性溃疡中医辨证分型提供客观依据。方法216例消化性溃疡患者均经中医辨证分型,并行胃镜检查、H.pylori检查。对中医证型与消化性溃疡分类、溃疡分期、胃镜征象、H.pylori感染的关系进行统计学相关性分析。结果中医证型与西医溃疡分类的构成比比较无显著性差异( P>0.05)。溃疡期中胃热炽盛型34例,愈合期和癖痕期中肝胃气滞型58例,均明显高于同期其他证型( P均<0.05)。胃镜下溃疡面积与中医证型之间没有显著性差异(P>0.05)。肝胃气滞及脾胃虚实患者胃黏膜水肿,溃疡色泽白,溃疡面覆白苔为主;胃热炽盛及寒邪犯胃患者胃黏膜水肿,溃疡色泽黄,溃疡上覆黄苔为主;胃阴亏虚患者黏膜溃疡色泽白,溃疡面上覆白苔为主;食滞胃肠患者黏膜水肿,黏膜色泽黄,溃疡上覆白苔为主;瘀阻胃络患者黏膜水肿,黏膜色泽白,溃疡上覆白苔为主。胃热炽盛及肝胃气滞患者H.pylori感染率分别为88.46%及71.23%,胃热炽盛型H.pylori感染率显著高于其他证型(P<0.05)。结论胃镜检查观察胃和十二指肠黏膜的病变情况,不宜作为中医证型判断标准,可作为望诊之延伸应用于临床,可为中医辨证提供一定的客观化指标,提高对消化性溃疡病中医辨证治疗规律的认识。%Objective It is to study the correlations of TCM syndrome of peptic ulcer with ulcer stage and classification , gastroscopic signs ,H.pylori infection , thus to provide objective basis for the syndrome differentiation of this disease .Methods 216 patients with peptic ulcer were diagnosed by syndrome differentiation of traditional Chinese medicine , H.pylori examina-tion and gastroscopy

  3. Hybrid treatment of penetrating aortic ulcer

    Energy Technology Data Exchange (ETDEWEB)

    Lara, Juan Antonio Herrero; Martins-Romeo, Daniela de Araujo; Escudero, Carlos Caparros; Falcon, Maria del Carmen Prieto; Batista, Vinicius Bianchi, E-mail: jaherrero5@hotmail.com [Unidade de Gestao Clinica (UGC) de Diagnostico por Imagem - Hosppital Universitario Virgen Macarena, Sevilha (Spain); Vazquez, Rosa Maria Lepe [Unit of Radiodiagnosis - Hospital Nuestra Senora de la Merced, Osuna, Sevilha (Spain)

    2015-05-15

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

  4. Golimumab: clinical update on its use for ulcerative colitis.

    Science.gov (United States)

    Gilardi, D; Fiorino, G; Allocca, M; Bravatà, I; Danese, S

    2015-03-01

    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.

  5. Invasive mucormycosis in benign gastric ulcer.

    Science.gov (United States)

    Al-Rikabi, A C; Al-Dohayan, A D; Al-Boukai, A A

    2000-03-01

    Fungal elements are frequently noted overlying the base of chronic peptic ulcers of the stomach and it has been suggested that the fungi enhance the degree of necrosis and that these cases have protracted disease and deeper ulcers with more perforations. It has also been postulated that the number of fungal elements might be increased in the stomach of patients who are receiving potent medications such as H2-receptor antagonists to reduce gastric acidity, but there have not been adequate control studies, and the deleterious effects from the presence of the fungi in these cases have not been substantiated. We present a very rare case of invasive mucormycosis (phycomycosis) occurring in the base of a chronic gastric ulcer in a 55 years old diabetic male. This case was clinically and radiologically been mistaken for a gastric carcinoma. In addition, the ulcer was complicated by perforation and fungal septicemia with subsequent fatal outcome. The clinical, radiological and histopathological features are described together with a literature review of other reported fungal gastric ulcers.

  6. Clinical Application of Multiplex PCR Assay for the Diagnosis of the Etiology of Genital Ulcer Disease Among Patients Attending STD Clinics in Guangzhou, China

    Institute of Scientific and Technical Information of China (English)

    朱慧兰; 苏向阳; 林路洋; 叶兴东

    2002-01-01

    Objectives: To develop a method of simultaneous PCRdetection of Haemophilus ducreyi, Treponema pallidum, andHerpes Simplex Virus Types 1 and 2 from genital ulcersamong patients attending STD clinics in Guangzhou, China;and evaluate the clinical application of multiplex PCR (M-PCR) assay for diagnosing the etiology of genital ulcerdiseases (GUD). Methods: 244 patients with a genital ulcer were evaluated.Clinical etiology of GUD was based on physical appearanceand microbiologic evaluations that included dark fieldmicroscopy examination (D-F) and serology test for syphilis(STS). Swabs of each genital ulcer were tested for HSVantigen by enzyme immunoassay (EIA) and processed in anM-PCR assay for simultaneous detection of T. pallidum, HSVand H. ducreyi. Results: The standard strains of T. pallidum, HSV and H.ducreyi were amplified by M-PCR, producing amplifiedproducts of 260bp,432bp,170bp, respectively. The sensitivityof M-PCR is 102pg DNA. M-PCR assay for T. pallidum, HSVand H. ducreyi showed good agreement when compared withD-F detection for T. pallidum, STS, H. ducreyi culture and EIAfor HSV antigen (Kappa scores are 0.774,0.704,0.793,0.756,respectively). Conclusions: The M-PCR is a convenient, accurate andreliable assay for the detection of T. pallidum, HSV and H.ducreyi from genital ulcers, and can be used as a method of diagnosing the etiology of GUD.

  7. Ulcerative colitis Presenting as leukocytoclastic vasculitis of skin

    Institute of Scientific and Technical Information of China (English)

    Sabiye Akbulut; Ersan Ozaslan; Firdevs Topal; Levent Albayrak; Burcak Kayhan; Cumali Efe

    2008-01-01

    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.

  8. A study on the clinical profile of ulcers and membranous lesions of oral cavity and oropharynx

    Directory of Open Access Journals (Sweden)

    T. D. Thimmappa

    2014-02-01

    Full Text Available Background: An ulcer is a discontinuity of an epithelial surface. Many a times, patients with oral ulcers are treated sympathetically without even coming to a definitive conclusion of their problem. Oral ulcers are common diseases for which patient seeks medical advice. Till date the clinical profile to diagnose the oral ulcers, membranous lesions of oral cavity and oropharynx is not well established. Hence, the study has been taken up to investigate the aetiopathology of ulcers of oral cavity and oropharynx. Methods: 60 cases of ulcers of oral cavity and oropharynx were included in the study. The aetiopathology of ulcers of oral cavity and oropharynx were investigated on the basis of age, sex, duration, etiological factors, symptom Index, socioeconomic status and anatomical distribution. Values are expressed as percentages. Results: The highest incidence was found to be in low socioeconomic group, where there is lack of education, improper food habits, cultivation of bad habits in early childhood and negligence of the disease are the predisposing factors in most of the malignancies. The highest incidence was found in low socioeconomic status. The lesions studied in this study were 50% of non-specific ulcers (Short term (3 wks 10-33%, 15% of Aphthous ulcers, 8.3% of Traumatic Ulcers, 6.5% of Malignant ulcers, 6.5% of Dental ulcers, 3.2% of HIV infection & AIDS, 3.2% of ulcer due to T.B. and 6.5% of ulcers. The majority of the cases were between the age 21-30 yrs constituting 35% followed by 11-12 years constituting 26.6%.d 62% of the short term ulcers, Female 38%. Conclusions: Low socioeconomic status, lack of education, bad oral hygiene, bad habits cultivated in early childhood is predisposing factors. Hence early diagnosis and prompt treatment is advised in all cases of ulcers. [Int J Res Med Sci 2014; 2(1.000: 180-185

  9. Management of parastomal ulcers

    Institute of Scientific and Technical Information of China (English)

    Heather Yeo; Farshad Abir; Walter E Longo

    2006-01-01

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

  10. Clinical and microbiologic studies of genital ulcers in Kenyan women.

    Science.gov (United States)

    Plummer, F A; D'Costa, L J; Nsanze, H; Karasira, P; MacLean, I W; Piot, P; Ronald, A R

    1985-01-01

    The etiology of genital ulcers in women in tropical regions is poorly understood. Eighty-nine women, presenting to a sexually transmitted disease clinic in Nairobi (Kenya) with a primary complaint of genital ulcers, were evaluated prospectively in a clinical and laboratory study. A final etiologic diagnosis was possible for 60 (67%) of the women. Culture for Haemophilus ducreyi was positive for 43 women, eight had secondary syphilis with ulcerated condyloma latum, three had primary syphilis, one had both chancroid and syphilis, two had moniliasis, two had herpetic ulceration, and one had a traumatic ulcer. The clinical characteristics that best distinguished chancroid from secondary syphilis were ulcer excavation and a rough ulcer base. No etiologic diagnosis was established for 29 patients. However, the clinical and epidemiologic features of these patients suggested that they were similar if not identical to the patients with H. ducreyi culture-positive chancroid. Further studies are necessary to determine the etiology of ulcers in females in whom no pathogen was identified.

  11. 养殖日本鳗鲡腐皮病真菌性病原的分离与鉴定%ISOLATION AND IDENTIFICATION OF FUNGAL PATHOGEN FROM DERMAL ULCERATION DISEASE ON CULTURED ANGUILLA JAPONICA

    Institute of Scientific and Technical Information of China (English)

    曾占壮; 樊海平; 卓玉琛; 吴斌; 张新艳; 陈灵

    2011-01-01

    In recent years, dermal ulceration disease is one of the most serious diseases on cultured Japanese eels (An-guilla japonica), which occurs widely, spreads quickly and has caused great expense through the winter. In the beginning, the grume of the diseased eels are hyperplastic and then broken off. Following the evolvement of the illness, the derma is bareness and the muscle is necrotic. Eventually, the derma and the muscle are rotted.The isolation and identification of the fungal pathogen of this disease was studied. The fungal strain Js80122 was isolated from diseased eels by cultured on kernels of wheat. Strain Js80122 was confirmed as the causative pathogen of the dermal ulceration disease by artificial infection tests, which lasted for 2 weeks. In these tests, healthy eels were infected with four kinds of different methods, namely, injected with spores (0.3 mL/ind.) on dorsal muscle, marinated with 3 dish of culture after ravaged, daubed with spores(1.0x108 cell/mL)on wound and injected with spores and bacteria (0.3 mL/ind.) on dorsal muscle. The results showed that dermal ulceration disease could be recurred well on the experimental eels by any infection method; the symptom and process were similar to the naturally diseased eels. During the course of the artificial infection tests, the mortality were up to 100% in the group injected with spores (5.0x107 cell/mL) and bacteria (5.0x107CFU/mL) on dorsal muscle, 80% in the group injected with spores (l.OxlO8 cell/mL) on dorsal muscle, 60% in the group daubed with spores on wound, 20% in the group marinated with culture after ravaged, respectively. Observation on the morphology and life history of strain Js80122 cultured on slide and cover glass showed that strain Js80122 was the filamentous fungi and could grow well at 15℃, 20℃ and 25℃. Its hyphae were non-aseptate with plentiful branches, the reproductive modes were asexual and sexual. The asexual structure of Js80122 could be well produced at 20℃ or 25

  12. Comparison of dextranomer and streptokinase-streptodornase in the treatment of venous leg ulcers and other infected wounds.

    Science.gov (United States)

    Hulkko, A; Holopainen, Y V; Orava, S; Kangas, J; Kuusisto, P; Hyvärinen, E; Ervasti, E; Silvennoinen, E

    1981-01-01

    The clinical efficacy of dextranomer (Debrisan) and streptokinase-streptodornase (Varidase) was compared in a controlled randomized in-patient study. There were two patient groups: Group A consisting of 28 patients with a total of 31 venous leg ulcers and Group B consisting of 56 patients with other infected wounds (posttraumatic and postoperative wounds, amputation stumps, burn wounds, arteriosclerotic ulcers, decubital ulcers, ulcers due to bone disease, rheumatic ulcers, ulcers due to erysipelas and wounds of mixed aetiology). Both agents have a good cleansing effect as well as a good effect on infection and wet necrosis. Dextranomer stimulates the formation of granulation tissue faster than streptokinase-streptodornase. PMID:6172073

  13. Clinical Features of Recurrent Aphthous Ulcer in Behcet's Disease%白塞病患者口腔黏膜病变的特点:附127例临床分析

    Institute of Scientific and Technical Information of China (English)

    高碧霞; 吴庆军; 李菁; 唐福林

    2011-01-01

    Objective To analyze the characteristics of recurrent aphthous ulcer (RAU) of mouth in Behcet's disease (BD). Methods We retrospectively studied the clinical manifestations of 127 patients with BD and features of RAU in 66 cases with details. Results There were 78 men and 49 women with a mean age of 37 (range from 8 to 77). They presented with multiple organ or system involvements, including RAU (93.0%), genital ulcer (69.3%), rash (52.0%), large blood vessel (30.7%), eye (23.6%), gastrointestinal tract (22.0%), central nervous system (8.7%), myelodysplasia syndrome (7.9%) and heart (4.7%). RAU of 66 cases were described in details, in which 59 (89.4%) had minor types, 5 (7.6%) had major types and 2 (3.0%) had herpetiform RAU. The most common site of minor oral ulcer was the tongue (54.2%), followed by the buccal mucosa (42.4%) and lip (33.9%). Most RAU were acute ulcer (86.4%) with good prognosis. In our study, 2 patients had giant pharyngeal ulcer and 1 suffered stenosis of pharyngeal cavity with poor response to corticosteroid. Conclusion RAU is the most common and the first-onset presentation of BD. Most RAU were minor type with good prognosis. Some chronic giant ulcers were atypical, resulting in stenosis of pharyngeal cavity.%目的 总结白塞病(BD)口腔黏膜病变特点,以提高对该病的认识.方法 回顾性分析2006年1月至2010年5月入住北京协和医院的127例BD患者的临床表现,尤其是66例BD患者的口腔黏膜病变特点.结果 127例BD患者中男性78例,平均发病年龄37(范围8~77)岁.复发性阿弗他口腔溃疡(RAU)(93%)、外生殖器溃疡(69.3%)及皮肤病变(52.0%)是三大常见表现,并出现大血管(30.7%)、眼(23.6%)、胃肠道(22.0%)、神经系统(8.7%)、骨髓增生异常综合征(7.9%)、心脏(4.7%)受累.66例对口腔黏膜病变有详尽描述,其中小溃疡59例(89.4%),好发部位依次为舌(54.2%)、颊黏膜(42.4%)、唇(33.9%),大溃疡5例(7.6%)

  14. ANTI-ULCER ACTIVITY OF LEGUMINOSAE PLANTS

    Directory of Open Access Journals (Sweden)

    Noemi D. PAGUIGAN

    2014-03-01

    Full Text Available Context Ulcer is the most common gastrointestinal disturbance resulting from an inadequate gastric mucosal defense. Several drugs are available in the market to address the disease; however, these drugs are associated with unnecessary side effects. Objectives Previous research have confirmed the efficacy of plant extracts for possible treatment of the disease. This research aims to evaluate the anti-ulcer properties of medicinal plants. Methods Methanol extracts from the leaves of Intsia bijuga, Cynometra ramiflora, Tamarindus indica, Cassia javanica, Cassia fistula, Bauhini purpurea, Senna spectabilis, Senna siamea and Saraca thaipingensis were evaluated for their anti-ulcer activity using HCl-ethanol as ulcerogen. Results All extracts showed inhibitory activity with I. bijuga, T. indica, S. spectabilis and S. thaipingensis exhibiting more than 50% inhibition. S. thaipingensis showed the highest activity at 80%. S. spectabilis and S. thaipingensis were partitioned further into hexane, ethyl acetate and aqueous fractions. The aqueous and ethyl acetate fractions of S. spectabilis showed significant increased in its activity while the hexane and ethyl acetate fractions of S. thaipingensis gave higher activity than its aqueous portions. Conclusions We conclude that plant extracts are potential sources of new anti-ulcer agents.

  15. Giant Ulcerative Dermatofibroma

    Directory of Open Access Journals (Sweden)

    Turgut Karlidag

    2013-01-01

    Full Text Available Dermatofibroma is a slowly growing common benign cutaneous tumor characterized by hard papules and nodules. The rarely seen erosions and ulcerations may cause difficulties in the diagnosis. Dermatofibrosarcoma protuberans, which is clinically and histopathologically of malignant character, displays difficulties in the diagnosis since it has similarities with basal cell carcinoma, epidermoid carcinoma, and sarcomas. Head and neck involvement is very rare. In this study, a giant dermatofibroma case, which is histopathologically, ulcerative dermatofibroma, the biggest lesion of the head and neck region and seen rarely in the literature that has characteristics similar to dermatofibrosarcoma protuberans, has been presented.

  16. Klinefelter Syndrome With Leg Ulcers

    Directory of Open Access Journals (Sweden)

    Narendra G

    1999-01-01

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

  17. [Dynamics of production of interleukin-1 by monocytes after hemosorption in patients with peptic ulcer].

    Science.gov (United States)

    Ketlinskiĭ, S A; Zhidkov, K P; Pigareva, N V

    1991-02-01

    The spontaneous and induced production of monokine++-interleukin-1 (IL-1) by the peripheral blood monocytes under the influence of autotransfusions of hemosorbent-treated blood (AHTB) was studied in 22 patients with an unfavorable course of ulcer disease. The spontaneous production of IL-1 was found to grow successively after a course of AHTB in patients with ulcer disease with terms of cicatrization more than 2 weeks. In patients with slow cicatrization of ulcers the IL-1 production did not change.

  18. [Corrective effects of electromagnetic radiation in a millimeter wavelength range on the parameters of oxidative stress after standard anti-helicobacterial therapy in patients with ulcer disease].

    Science.gov (United States)

    Ivanishkina, E V; Podoprigorova, V G

    2012-01-01

    We assessed the possibilities of correction of oxidative stress parameters in the serum and gastroduodenal mucosa using electromagnetic radiation in a millimeter wavelength range in 127 patients with gastric and duodenal ulcer after eradication therapy. Control group included 230 healthy subjects. Parameter of lipid oxidation by free radicals were measured by direct methods (hemiluminescence and EPR-spectroscopy). The results show that standard eradication therapy does not influence parameters of oxidative stress. More pronounced effect of electromagnetic radiation in a millimeter wavelength range may be due to the correction of prooxidant-antioxidant and antioxidant disbalance. This observation provides pathogenetic substantiation for the inclusion of this physical method in modern therapeutic modalities.

  19. Glucagonoma, chronic recurrent peptic ulcer disease, and enhanced amylase-creatinine clearance ratio. Report of a case with review of the literature.

    Science.gov (United States)

    Pitchumoni, C S; Thelmo, W; Ahmed, K S; Kumar, A; Davidian, M; Einhorn, R; Adler, J; McCarthy, J

    1979-09-01

    A 53-year-old white woman developed diabetes mellitus, migratory erythema, and anemia, clinical features suggesting the presence of a "glucagonoma." Ten years earlier, after laparotomy and pancreatic biopsy, she had been told that she had an inoperable pancreatic carcinoma. Review of that biopsy together with current hormonal assay now confirms the diagnosis of glucagonoma. The recurrent peptic ulcer in this patient despite high levels of glucagon, a gastric inhibitory agent, is noted but not explained. An enhanced amylase-creatinine clearance ratio supports the notion that glucagon increases the clearances of amylase.

  20. Management of patients with ulcer bleeding.

    Science.gov (United States)

    Laine, Loren; Jensen, Dennis M

    2012-03-01

    This guideline presents recommendations for the step-wise management of patients with overt upper gastrointestinal bleeding. Hemodynamic status is first assessed, and resuscitation initiated as needed. Patients are risk-stratified based on features such as hemodynamic status, comorbidities, age, and laboratory tests. Pre-endoscopic erythromycin is considered to increase diagnostic yield at first endoscopy. Pre-endoscopic proton pump inhibitor (PPI) may be considered to decrease the need for endoscopic therapy but does not improve clinical outcomes. Upper endoscopy is generally performed within 24h. The endoscopic features of ulcers direct further management. Patients with active bleeding or non-bleeding visible vessels receive endoscopic therapy (e.g., bipolar electrocoagulation, heater probe, sclerosant, clips) and those with an adherent clot may receive endoscopic therapy; these patients then receive intravenous PPI with a bolus followed by continuous infusion. Patients with flat spots or clean-based ulcers do not require endoscopic therapy or intensive PPI therapy. Recurrent bleeding after endoscopic therapy is treated with a second endoscopic treatment; if bleeding persists or recurs, treatment with surgery or interventional radiology is undertaken. Prevention of recurrent bleeding is based on the etiology of the bleeding ulcer. H. pylori is eradicated and after cure is documented anti-ulcer therapy is generally not given. Nonsteroidal anti-inflammatory drugs (NSAIDs) are stopped; if they must be resumed low-dose COX-2-selective NSAID plus PPI is used. Patients with established cardiovascular disease who require aspirin should start PPI and generally re-institute aspirin soon after bleeding ceases (within 7 days and ideally 1-3 days). Patients with idiopathic ulcers receive long-term anti-ulcer therapy. PMID:22310222

  1. Ulcerative Colitis: Update on Medical Management.

    Science.gov (United States)

    Iskandar, Heba N; Dhere, Tanvi; Farraye, Francis A

    2015-11-01

    Ulcerative colitis (UC) is a chronic inflammatory bowel disease whose pathogenesis is multifactorial and includes influences from genes, the environment, and the gut microbiome. Recent advances in diagnosis and treatment have led to significant improvement in managing the disease. Disease monitoring with the use of therapeutic drug monitoring, stool markers, and assessment of mucosal healing have garnered much attention. The recent approval of vedolizumab for treatment of moderate to severe UC has been a welcome addition. Newer biologics, including those targeting the Janus tyrosine kinase (JAK) pathway, are on the horizon to add to the current armamentarium of anti-TNF alpha and anti-integrin therapies. The recent publication of the SCENIC consensus statement on surveillance and management of dysplasia in UC patients supports the use of chromoendoscopy over random biopsies in detecting dysplasia. This review highlights these recent advances along with others that have been made with ulcerative colitis.

  2. PEPTIC ULCER: A REVIEW ON ETIOLOGY AND PATHOGENESIS

    Directory of Open Access Journals (Sweden)

    Kaur Amandeep

    2012-06-01

    Full Text Available A peptic ulcer is a sore on the lining of the stomach or duodenum. The two most common types of peptic ulcer are called “gastric ulcers” and “duodenal ulcers”. Peptic ulcers are found to be due to an imbalance between aggressive factors such as hydrochloric acid (HCL, pepsin, refluxed bile, leukotrienes (LTs, reactive oxygen species (ROS and defensive factors, which include the function of the mucus-bicarbonate barrier, prostaglandins (PGs, mucosal blood flow, cell renewal and migration, nonenzymatic and enzymatic antioxidants and some growth factors. H. pylori infection and the use of nonsteroidal anti-inflammatory drugs (NSAIDs are the predominant causes of peptic ulcer disease. Also, a numbers of factors are implicated in the pathogenesis of gastric ulcer, among which major factors involved are bacterial infection (Helicobacter pylori, certain medications (NSAID, chemicals (Hcl/ethanol ,gastric cancer and minor factors are stress, smoking, spicy food and nutritional deficiencies. The idea behind treating ulcers is to lower the amount of acid that your stomach makes, to neutralize the acid that is made and to protect the injured area so it can have time to heal. The main aim of this review article has to summarize the ulcerogenic mechanisms of various mediators involved in Peptic ulcer disease.

  3. Ulcerative colitis six years after colon cancer: only a coincidence?

    Science.gov (United States)

    Sakellakis, Minas; Makatsoris, Thomas; Gkermpesi, Maria; Peroukidis, Stavros; Kalofonos, Haralabos

    2014-01-01

    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

  4. Drug therapy for ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Chang-Tai Xu; Shu-Yong Meng; Bo-Rong Pan

    2004-01-01

    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.

  5. Primary biliary cirrhosis and ulcerative colitis: A case report and review of literature

    Institute of Scientific and Technical Information of China (English)

    Wen-Bin Xiao; Yu-Lan Liu

    2003-01-01

    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.

  6. Ulcerated lesion of the alveolar ridge.

    Science.gov (United States)

    Bokmeyer, T J

    1980-10-01

    Histoplasmosis is a generalized fungal infection that is caused by the organism H capsulatum. In the most common disease-producing mechanism, the organism is inhaled and lodges in the lung, where it initiates an inflammatory focus. The peribronchial lymph nodes are subsequently involved, forming a primary complex that may ultimately calcify and become radiographically evident. From the primary complex, dissemination by the bloodstream may lead to colonization elsewhere. In the less frequent disease-producing complex, the organism is introduced directly into the tissue through a break in its continuity. A primary complex is then formed by involvement of the lymph nodes. Dissemination from such a focus is rare. It is generally believed that oral and pharyngeal lesions of the histoplasmosis represent symptoms of a systemic disease and are not a localized form of the disease. Histoplasmosis can occur at all ages; however, it is more often found in infancy and old age, especially in white males. Any area in the oral cavity may be affected; the most common sites are: larynx, tongue, palate, buccal mucosa. gingiva, and pharynx. The most frequently reported symptoms are pain, hoarseness, loss of weight, ulcer, and sore throat. The appearance of the oral and pharyngeal lesions may vary and may manifest as ulcers, nodules, or verrucous plaques. Deep, indurated ulcers are common, accounting for the predominant clinical impression of squamous carcinoma. PMID:6934220

  7. The Incidence of Gastric Metaplasia in Patients with Duodenal Ulcer *

    OpenAIRE

    Min, Young II; LEE, BYOUNG WOOK; Chang, Young Woon; Chi, Hyun Sook; Lee, Jung Kook

    1987-01-01

    To investigate the incidence of duodenal gastric metaplasia and its underlying gastric or duodenal diseases, the authors obtained endoscopic biopsy specimens from the duodenal bulb at random sites during endoscopy from 19 normal subjects, 11 patients with gastric ulcer, 18 with duodenal and/or prepyloric ulcer (s), 7 with duodenitis and 8 with gastric erosions. The biopsy specimens were assessed with PAS staining to confirm gastric metaplasia. The incidence of duodenal gastric metaplasia was ...

  8. SPONTANEOUS DUODENO-BILIARY FISTULA CAUSED BY DUODENAL PEPTIC ULCER

    Directory of Open Access Journals (Sweden)

    N. Danila

    2005-07-01

    Full Text Available Spontaneous duodeno-biliary fistula represents a rare complication of chronic duodenal peptic ulcer. The authors present two cases with this pathology and also the particularities of surgical approach. Spontaneous duodeno-biliary fistula caused by chronic peptic ulcer is often a surprising diagnostic in the era of H2 blockers. The difficulties and the complexity of the diagnosis associated with the particularities of surgical technique represent the key of this rare disease.

  9. Spatial analysis of factors implicated in Mycobacterium ulcerans infection in Ghana

    NARCIS (Netherlands)

    Duker, A.A.

    2005-01-01

    Buruliulcer (BU), the common terminology for the disease caused by Mycobacteriumulcerans (MU) infection manifests as disfiguring skin ulceration which is difficult to treat. In its advanced st

  10. A case of ulcerative colitis presenting as pyoderma gangrenosum and lung nodule

    Directory of Open Access Journals (Sweden)

    Xin Li

    2014-02-01

    Full Text Available Pyoderma gangrenosum is a phenomenon of cutaneous ulceration where etiology is not well understood. About half of the cases have an associated extracutanoeus manifestation or associated systemic diseases. Most commonly associated systemic disorders include inflammatory bowel disease, hematologic malignancies, autoimmune arthritis, and vasculitis. We are reporting a case where pyoderma gangrenosum has presenting features for ulcerative colitis.

  11. Results of Surgery for Perforated Gastroduodenal Ulcers in a Dutch Population

    NARCIS (Netherlands)

    Hemmer, P. H. J.; de Schipper, J. S.; van Etten, B.; Pierie, J. P. E. N.; Bonenkamp, J. J.; de Graaf, P. W.; Karsten, T. M.

    2011-01-01

    Objective: Despite improvements in anesthesiology and intensive care medicine, mortality for perforated gastroduodenal ulcer disease remains high. This study was designed to evaluate the results of surgery for perforated ulcer disease and to identify prognostic factors for mortality in order to opti

  12. The personality pattern of duodenal ulcer patients in relation to spontaneous ulcer healing and relapse

    DEFF Research Database (Denmark)

    Jess, P; von der Lieth, L; Matzen, Peter;

    1989-01-01

    stressful life events before entrance to the study (P less than 0.05) and, like the neurotic patients, they had lower ego-strength to cope with such events (P less than 0.05). The results indicate that personality assessments make it possible to distinguish between subgroups of duodenal ulcer patients......One hundred consecutive out-patients with duodenal ulceration from a hospital and a gastroenterological clinic were tested with the Minnesota Multiphasic Personality Inventory (MMPI). This was carried out in order to investigate whether neuroticism or other personality disorders were...... characteristics of duodenal ulcer patients, and whether the presence of such possible personality disorders might influence the prognosis of the disease. Neuroticism occurred in 53% of the patients, but only in 5% of controls (P less than 0.0001). Overall, personality disorders were present in 69% of the patients...

  13. Receptor Binding Sites for Substance P, but not Substance K or Neuromedin K, are Expressed in High Concentrations by Arterioles, Venules, and Lymph Nodules in Surgical Specimens Obtained from Patients with Ulcerative Colitis and Crohn Disease

    Science.gov (United States)

    Mantyh, Christopher R.; Gates, Troy S.; Zimmerman, Robert P.; Welton, Mark L.; Passaro, Edward P.; Vigna, Steven R.; Maggio, John E.; Kruger, Lawrence; Mantyh, Patrick W.

    1988-05-01

    Several lines of evidence indicate that tachykinin neuropeptides [substance P (SP), substance K (SK), and neuromedin K (NK)] play a role in regulating the inflammatory and immune responses. To test this hypothesis in a human inflammatory disease, quantitative receptor autoradiography was used to examine possible abnormalities in tachykinin binding sites in surgical specimens from patients with inflammatory bowel disease. Surgical specimens of colon were obtained from patients with ulcerative colitis (n = 4) and Crohn disease (n = 4). Normal tissue was obtained from uninvolved areas of extensive resections for carcinoma (n = 6). In all cases, specimens were obtained artifacts and were processed for quantitative receptor autoradiography by using 125I-labeled Bolton--Hunter conjugates of NK, SK, and SP. In the normal colon a low concentration of SP receptor binding sites is expressed by submucosal arterioles and venules and a moderate concentration is expressed by the external circular muscle, whereas SK receptor binding sites are expressed in low concentrations by the external circular and longitudinal muscle. In contrast, specific NK binding sites were not observed in any area of the human colon. In colon tissue obtained from ulcerative colitis and Crohn disease patients, however, very high concentrations of SP receptor binding sites are expressed by arterioles and venules located in the submucosa, muscularis mucosa, external circular muscle, external longitudinal muscle, and serosa. In addition, very high concentrations of SP receptor binding sites are expressed within the germinal center of lymph nodules, whereas the concentrations of SP and SK binding sites expressed by the external muscle layers are not altered significantly. These results demonstrate that receptor binding sites for SP, but not SK or NK, are ectopically expressed in high concentrations (1000-2000 times normal) by cells involved in mediating inflammatory and immune responses. These data suggest

  14. Ileal pouch surgery for ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Simon P Bach; Neil J Mortensen

    2007-01-01

    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.

  15. Doença veno-linfática: alterações linfocintilográficas nas úlceras venosas Venous-lymphatic disease: lymphoscintigraphic abnormalities in venous ulcers

    Directory of Open Access Journals (Sweden)

    José Humberto Silva

    2009-03-01

    Full Text Available Contexto: O sistema linfático tem papel relevante em qualquer tipo de edema periférico. Atualmente, a linfocintilografia é considerada o principal exame para diagnóstico da doença linfática das extremidades. Embora haja associação entre edema linfático e úlcera de estase venosa crônica, a fisiopatologia dessas alterações permanece indefinida. Objetivo: Verificar as alterações linfocintilográficas qualitativas que ocorrem em pacientes portadores de úlceras de estase dos membros inferiores. Métodos: Quarenta pacientes portadores de úlcera de estase venosa crônica ou cicatriz unilateral foram submetidos a linfocintilografia de ambos os membros inferiores. Foram estudados 25 mulheres e 15 homens, com média de idade de 53,7 anos (28 a 79 anos e tempo médio de úlcera de 71,5 meses (3 a 240 meses. Foram comparados qualitativamente os parâmetros linfocintilográficos dos membros inferiores, previamente classificados em três grupos de acordo com a classificação clínica, etiológica, anatômica e patológica (CEAP: I, membros sem sinais clínicos de doença venosa ou com telangiectasias e veias reticulares (classes 0 e 1; II, membros inferiores com veias varicosas, edema e/ou alterações de pele e subcutâneo (classes 2, 3 e 4; III, membros inferiores com úlcera e/ou cicatriz (classes 5 e 6. Resultados: Quando foi comparada a presença de alterações linfocintilográficas dos membros com úlcera ou cicatriz (grupo III - classes 5 e 6 com as dos membros sem úlcera (grupos I e II - classes 0, 1, 2, 3 e 4, houve diferença significativa (p Background: The lymphatic system plays a relevant role in any type of peripheral edema. Lymphoscintigraphy is currently considered the primary test in the diagnosis of lymphatic disease of the lower limbs. Although there is an association between lymphatic edema and chronic venous ulcers, the physiopathology of such changes remains uncertain. Objective: To assess qualitative

  16. Relationship between trace elements, immune indexes and recurrent oral ulcer

    Institute of Scientific and Technical Information of China (English)

    Ju-Wu Li; Xiao-Ming Rao

    2016-01-01

    Objective:To investigate the relationship between the trace elements, immune indexes and recurrent oral ulcer. Methods:Sixty-five patients with recurrent oral ulcer who had been treated in our hospital from January 2013 to April 2014 and all met the criteria for our study subjects were selected and regarded as the observation group and meanwhile 65 healthy persons were selected as the control group. Then, the serum trace elements, cellular immunity and erythrocyte immunity states of the two groups were compared and the relationship between the trace elements and immune indexes were studied. Results:The serum Zn,Se and Fe of the observation group were all lower than those of the control group;while its Cu/Zn was higher than that of the control group;and the related indexes of cellular immunity and erythrocyte immunity state were all worse than those of the control group;the detection results of patients with severe recurrent oral ulcer were all worse than those of patients with mild recurrent oral ulcer and herpes, and the results of patients with herpes were worse than those of patients with mild recurrent oral ulcer. After logistic analysis, the research indexes had close relationship with recurrent oral ulcer. Conclusions:Patients with recurrent oral ulcer show obvious abnormity of trace elements and immune indexes, and the disease have close relationship with the above indexes.

  17. Gastropericardial fistula complicating benign gastric ulcer: case report

    Energy Technology Data Exchange (ETDEWEB)

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

    2000-08-01

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

  18. Quality of healing of gastric ulcers: Natural products beyond acid suppression.

    Science.gov (United States)

    Kangwan, Napapan; Park, Jong-Min; Kim, Eun-Hee; Hahm, Ki Baik

    2014-02-15

    Gastric ulcer is a chronic disease featured with unexpected complications, including bleeding, stenosis and perforation, as well as a high incidence of recurrence. Clinical treatments for gastric ulcer have allowed the rapid development of potent anti-ulcer drugs during the last several decades. Gastric ulcer healing is successful with conventional treatments including H2-receptor antagonists, and proton pump inhibitors (PPIs) have been essential for ulcer healing and prevention of complications. Additionally, Helicobacter pylori eradication therapy is effective in reducing ulcer recurrence and leads to physiological changes in the gastric mucosa which affect the ulcer healing process. However, in spite of these advancements, some patients have suffered from recurrence or intractability in spite of continuous anti-ulcer therapy. A new concept of the quality of ulcer healing (QOUH) was initiated that considers the reconstruction of the mucosal structure and its function for preventing ulcer recurrence. Although several gastroprotection provided these achievements of the QOUH, which PPI or other acid suppressants did not accomplish, we found that gastroprotection that originated from natural products, such as a newer formulation from either Artemisia or S-allyl cysteine from garlic, were very effective in the QOUH, as well as improving clinical symptoms with fewer side effects. In this review, we will introduce the importance of the QOUH in ulcer healing and the achievements from natural products.

  19. Fecal calprotectin and ulcerative colitis endoscopic activity index as indicators of mucosal healing in ulcerative colitis.

    Science.gov (United States)

    Taghvaei, Tarang; Maleki, Iradj; Nagshvar, Farshad; Fakheri, Hafez; Hosseini, Vahid; Valizadeh, Seyed Mohammad; Neishaboori, Hassan

    2015-04-01

    Ulcerative colitis (UC) is a chronic, idiopathic, inflammatory large bowel disease with recurrent variable periods of exacerbation. The aim of the current study is to evaluate the correlation of UCEIS with fecal calprotectin (FC) level to assess disease activity in UC patients in order to determine whether FC can prognosticate clinical outcome and disease activity of UC instead of colonoscopic evaluation. Our endoscopic investigations revealed the extension of UC as the following: proctitis (11.6%), procto-sigmoiditis (18.5%), left-sided colitis (15.8%), extensive colitis (11.7%), and normal endoscopy (42.4%). Conclusively, we suggest that FC can be used as a reliable tool to evaluate disease activity in ulcerative colitis patients. Moreover, our findings indicate a significant correlation between FC level and mucosal healing. PMID:25366383

  20. Recurrent oral ulcers--an overview.

    Science.gov (United States)

    Gaffar, A

    2001-01-01

    Recurrent oral ulcers (ROUs) are the most common oral mucosal disease. The etiology of ROUs is complex. The factors include mechanical trauma, genetics, stress, smoking, and viral and bacterial infections. Treatment modalities depend on the differential diagnosis of ROUs and could consist of antimicrobial agents, anti-inflammatory agents, immunomodulators, or over-the-counter medications. New therapy available in the form of a coating polymer, Colgate ORABASE Soothe.N.Seal, is clinically proven to provide rapid relief and healing of ROUs.

  1. Genital ulcers in women: clinical, microbiologic and histopathologic characteristics.

    Science.gov (United States)

    Gomes, Christiane Maria Moreira; Giraldo, Paulo César; Gomes, Francis de Assis Moraes; Amaral, Rose; Passos, Mauro Romero Leal; Gonçalves, Ana Katherine da Silveira

    2007-04-01

    Female genital ulcer is a disease that affects a large number of women, and its etiologic diagnosis can be difficult. The disease may increase the risk of acquiring HIV. Genital ulcer may be present in sexually transmitted diseases (STD)--syphilis, chancroid, genital herpes, donovanosis, lymphogranuloma venereum; and other non-STD disorders (NSTD)--Behçet's syndrome, pemphigus, Crohn's disease, erosive lichen planus and others. This study evaluated the clinical-histopathologic-microbiologic characteristics of female genital ulcers. A cross-sectional descriptive prospective study was conducted during a six-month period to investigate the first 53 women without a definitive diagnosis, seeking medical care for genital ulcers at a genital infections outpatient facility in a university hospital. A detailed and specific history was taken, followed by a dermatologic and gynecologic examination. In addition to collecting material from the lesions for microbiologic study, a biopsy of the ulcer was performed for histopathologic investigation. The average age of the patients was 32.7 years, 56.6% had junior high school education and higher education. The most frequent etiology was herpetic lesion, followed by auto-immune ulcers. At the time of their first consultation, around 60% of the women were using inadequate medication that was inconsistent with the final diagnosis. Histologic diagnosis was conclusive in only 26.4% of the patients (14/53). Cure was obtained in 99% of the cases after proper therapy. The female genital ulcers studied were equally distributed between sexually transmitted and non-sexually transmitted causes. Herpes was the most frequent type of genital ulcer, affecting women indiscriminately, mostly between the ages of 20 and 40 years. The etiologic diagnosis of herpetic ulcers is difficult to make even when various diagnostic methods are applied. It is imperative that NSTD should be included in the differential diagnoses of female genital ulcers. The

  2. Genital ulcers in women: clinical, microbiologic and histopathologic characteristics

    Directory of Open Access Journals (Sweden)

    Christiane Maria Moreira Gomes

    2007-04-01

    Full Text Available Female genital ulcer is a disease that affects a large number of women, and its etiologic diagnosis can be difficult. The disease may increase the risk of acquiring HIV. Genital ulcer may be present in sexually transmitted diseases (STD - syphilis, chancroid, genital herpes, donovanosis, lymphogranuloma venereum and other non-STD disorders (NSTD - Behçet's syndrome, pemphigus, Crohn's disease, erosive lichen planus and others. This study evaluated the clinical-histopathologic-microbiologic characteristics of female genital ulcers. A cross-sectional descriptive prospective study was conducted during a six-month period to investigate the first 53 women without a definitive diagnosis, seeking medical care for genital ulcers at a genital infections outpatient facility in a university hospital. A detailed and specific history was taken, followed by a dermatologic and gynecologic examination. In addition to collecting material from the lesions for microbiologic study, a biopsy of the ulcer was performed for histopathologic investigation. The average age of the patients was 32.7 years, 56.6% had junior high school education and higher education. The most frequent etiology was herpetic lesion, followed by auto-immune ulcers. At the time of their first consultation, around 60% of the women were using inadequate medication that was inconsistent with the final diagnosis. Histologic diagnosis was conclusive in only 26.4% of the patients (14/53. Cure was obtained in 99% of the cases after proper therapy. The female genital ulcers studied were equally distributed between sexually transmitted and non-sexually transmitted causes. Herpes was the most frequent type of genital ulcer, affecting women indiscriminately, mostly between the ages of 20 and 40 years. The etiologic diagnosis of herpetic ulcers is difficult to make even when various diagnostic methods are applied. It is imperative that NSTD should be included in the differential diagnoses of female

  3. Golimumab in unresponsive ulcerative colitis

    Directory of Open Access Journals (Sweden)

    Lippert E

    2014-05-01

    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

  4. Perforated peptic ulcer

    DEFF Research Database (Denmark)

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

    2015-01-01

    Perforated peptic ulcer is a common emergency condition worldwide, with associated mortality rates of up to 30%. A scarcity of high-quality studies about the condition limits the knowledge base for clinical decision making, but a few published randomised trials are available. Although Helicobacter...... pylori and use of non-steroidal anti-inflammatory drugs are common causes, demographic differences in age, sex, perforation location, and underlying causes exist between countries, and mortality rates also vary. Clinical prediction rules are used, but accuracy varies with study population. Early surgery...... need further assessment. Adequate trials with low risk of bias are urgently needed to provide better evidence. We summarise the evidence for perforated peptic ulcer management and identify directions for future clinical research....

  5. Gastric acid secretion in relation to personality, affect and coping ability in duodenal ulcer patients. A multivariate analysis. Hvidovre Ulcer Project Group

    DEFF Research Database (Denmark)

    Jess, P

    1994-01-01

    The role of personality, mood state (affect) and coping ability (ego strength) on basal and stimulated gastric acid secretion were assessed in 56 duodenal ulcer patients using the Minnesota, Multiphasic Personality Inventory. The patients had high scores on most MMPI scales, but basal acid output...... disorders found in peptic ulcer patients may evidently be consequences of the disease rather than causal factors....

  6. Cholecystokinin-like activity in the duodenal mucosa of duodenal ulcer patients.

    OpenAIRE

    Kataoka, S

    1982-01-01

    Cholecystokinin-like activity in the duodenal mucosa was measured by the bioassay method described by Ljungberg to elucidate its significance in 14 duodenal ulcer patients as well as in 13 normal subjects with no evidence of gastrointestinal diseases. The stage of duodenal ulceration was determined endoscopically according to the criterion of the Japanese Gastroenterological Endoscopic Society. The cholecystokinin-like activity in the duodenal mucosa of duodenal ulcer patients in active stage...

  7. The Diminished Expression of Proangiogenic Growth Factors and Their Receptors in Gastric Ulcers of Cirrhotic Patients

    OpenAIRE

    Jiing-Chyuan Luo; Yen-Ling Peng; Ming-Chih Hou; Kuang-Wei Huang; Hui-Chun Huang; Ying-Wen Wang; Han-Chieh Lin; Fa-Yauh Lee; Ching-Liang Lu

    2013-01-01

    OBJECTIVES: The pathogenesis of the higher occurrence of peptic ulcer disease in cirrhotic patients is complex. Platelets can stimulate angiogenesis and promote gastric ulcer healing. We compared the expressions of proangiogenic growth factors and their receptors in the gastric ulcer margin between cirrhotic patients with thrombocytopenia and those of non-cirrhotic patients to elucidate possible mechanisms. METHODS: Eligible cirrhotic patients (n = 55) and non-cirrhotic patients (n = 55) who ...

  8. Xanthogranulomatous pseudotumor of stomach induced by perforated peptic ulcer mimicking a stromal tumor.

    Science.gov (United States)

    Lai, Hsin-Yi; Chen, Jeon-Hor; Chen, Chi-Kuan; Chen, Yung-Fang; Ho, Yung-Jen; Yang, Mei-Due; Shen, Wu-Chung

    2006-10-01

    Perforation is a serious complication of peptic ulcer disease occurring in 5% of such patients. Occasionally, the perforation may be sealed off by the omentum or the adjacent organs. Sealed perforated ulcer with pseudotumor formation is very rarely encountered. Here we present a case of gastric pseudotumor induced by perforation of a peptic ulcer. The imaging features in a barium sulfate study and computed tomography mimic an intramural tumor of the stomach.

  9. Contact Lens Related Corneal Ulcer

    OpenAIRE

    Loh, KY; P Agarwal

    2010-01-01

    A corneal ulcer caused by infection is one of the major causes of blindness worldwide. One of the recent health concerns is the increasing incidence of corneal ulcers associated with contact lens user especially if the users fail to follow specific instruction in using their contact lenses. Risk factors associated with increased risk of contact lens related corneal ulcers are: overnight wear, long duration of continuous wear, lower socio-economic classes, smoking, dry eye and poor hygiene. Th...

  10. Ulcerative colitis six years after colon cancer: only a coincidence?

    Directory of Open Access Journals (Sweden)

    Sakellakis M

    2014-04-01

    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

  11. Diabetic foot ulcers: Part I. Pathophysiology and prevention.

    Science.gov (United States)

    Alavi, Afsaneh; Sibbald, R Gary; Mayer, Dieter; Goodman, Laurie; Botros, Mariam; Armstrong, David G; Woo, Kevin; Boeni, Thomas; Ayello, Elizabeth A; Kirsner, Robert S

    2014-01-01

    Diabetes mellitus is a serious, life-long condition that is the sixth leading cause of death in North America. Dermatologists frequently encounter patients with diabetes mellitus. Up to 25% of patients with diabetes mellitus will develop diabetic foot ulcers. Foot ulcer patients have an increased risk of amputation and increased mortality rate. The high-risk diabetic foot can be identified with a simplified screening, and subsequent foot ulcers can be prevented. Early recognition of the high-risk foot and timely treatment will save legs and improve patients' quality of life. Peripheral arterial disease, neuropathy, deformity, previous amputation, and infection are the main factors contributing to the development of diabetic foot ulcers. Early recognition of the high-risk foot is imperative to decrease the rates of mortality and morbidity. An interprofessional approach (ie, physicians, nurses, and foot care specialists) is often needed to support patients' needs.

  12. [PPI treatment for gastric ulcer patients in the elderly].

    Science.gov (United States)

    Itoh, Toshiyuki; Minami, Maya; Naito, Chisako; Chiba, Tsutomu

    2010-11-01

    Proton pump inhibitor (PPI) is an effective and safe medication for the elderly people for the treatment of peptic ulcer disease. However, some PPIs have been reported that they have metabolic interactions with some drugs. Therefore, drug-interactions should be considered when the PPI is prescribed to the elderly people. The number of NSAIDs ulcer patients is thought to increase along with the increase of those who take NSAIDs in the elderly. Although PPI is indispensable for the prevention of the NSAIDs ulcer, PPI has not obtained authorization for the purpose of prevention in Japan. PPIs are strongly expected to be approved for prevention of NSAIDs ulcer by the Japanese government in the near future. PMID:21061533

  13. Update on Peptic Ulcers in the Pediatric Age

    Directory of Open Access Journals (Sweden)

    Graziella Guariso

    2012-01-01

    Full Text Available Background. Peptic ulcer disease (PUD in children is reported worldwide, although it is relatively rare as compared with adults. Helicobacter pylori (HP infection is a common cause of PUD in the pediatric age. Other risk factors include the use of nonsteroidal anti-inflammatory agents (NSAIDs, steroids, immunosuppressive drugs, and stressful events. Aim. To critically review the evidence on epidemiology, diagnostic management, and available treatments for PUD in the pediatric age. Methods. A MEDLINE search was performed indicating keywords as “Peptic Ulcer Disease,” “Epidemiology,” “Pediatric,” “Helicobacter pylori,” “Gastric ulcer,” “Bulbar Ulcer,” and “Upper Gastrointestinal Bleeding.” A selection of clinical trials, systematic reviews, and meta-analyses within the time period 2002–2012 was performed. Results. PUD in children is reported worldwide with an estimated frequency of 8.1% in Europe and of 17.4% in the US. When the underlying cause of PUD is addressed, the prognosis is excellent. Standard triple therapy, bismuth-based quadruple therapy, and the sequential therapy represent the current recommended treatments for HP related ulcers. NSAIDs related ulcers are treated by stopping the causative medications and by administration of proton-pump inhibitors or antisecretory drugs. Conclusions. PUD still represents a major concern in the paediatric age. A careful differential diagnosis and an adequate treatment constitute an excellent prognosis.

  14. Spontaneous gastrojejunal fistula is a complication of gastric ulcer

    Institute of Scientific and Technical Information of China (English)

    (D)or(d)e M (C)ulafi(c); Olivera D Mateji(c); Vladimir S (D)uki(c); Miodrag D Vuk(c)evi(c); Mirko D Kerkez

    2007-01-01

    Spontaneous gastrojejunal fistula formation is an extremely rare complication of gastric ulcer disease. We report a 77-year old woman who presented with diffuse abdominal pain, weight loss, malaise, nausea, and occasional dark stools. Laboratory tests showed extreme hyposideremic anemia with inflammatory syndrome. In addition, biochemical parameters of malnourishment were presented. Upper endoscopy revealed the patent esophagus along the full length without any pathological changes. Large and deep ulceration with perforation in the small intestine was detected in the posterior gastric wall. The small intestine loop was reached by endoscope through spontaneously developed gastrojejunal fistula.Polytopic biopsies of described ulcerative change were carried out. Histopathologically reepithelialized ulcerous zone was seen in the gastric mucosa. Also,gastrojejunal fistula was visualized after wide opening of hepatogastric and gastrocolic ligament. Jejunal loop 25cm from ligament of Treitz was attached to mesocolon and posterior gastric wall because of ulcer penetration.Postoperative course was uneventful. Per oral intake started on the 4th postoperative day, and the patient was discharged on the 8th postoperative day. In summary,this case indicates that persistent symptoms of peptic ulcer disease associated with nutritional disturbances may be caused by gastrojejunal fistula.

  15. Spontaneous gastrojejunal fistula is a complication of gastric ulcer.

    Science.gov (United States)

    Culafić, Dorde-M; Matejić, Olivera-D; Dukić, Vladimir-S; Vukcević, Miodrag-D; Kerkez, Mirko-D

    2007-01-21

    Spontaneous gastrojejunal fistula formation is an extremely rare complication of gastric ulcer disease. We report a 77-year old woman who presented with diffuse abdominal pain, weight loss, malaise, nausea, and occasional dark stools. Laboratory tests showed extreme hyposideremic anemia with inflammatory syndrome. In addition, biochemical parameters of malnourishment were presented. Upper endoscopy revealed the patent esophagus along the full length without any pathological changes. Large and deep ulceration with perforation in the small intestine was detected in the posterior gastric wall. The small intestine loop was reached by endoscope through spontaneously developed gastrojejunal fistula. Polytopic biopsies of described ulcerative change were carried out. Histopathologically reepithelialized ulcerous zone was seen in the gastric mucosa. Also, gastrojejunal fistula was visualized after wide opening of hepatogastric and gastrocolic ligament. Jejunal loop 25 cm from ligament of Treitz was attached to mesocolon and posterior gastric wall because of ulcer penetration. Postoperative course was uneventful. Per oral intake started on the 4(th) postoperative day, and the patient was discharged on the 8(th) postoperative day. In summary, this case indicates that persistent symptoms of peptic ulcer disease associated with nutritional disturbances may be caused by gastrojejunal fistula.

  16. Human immunodeficiency virus, genital ulcers and the male foreskin: synergism in HIV-1 transmission.

    Science.gov (United States)

    Jessamine, P G; Plummer, F A; Ndinya Achola, J O; Wainberg, M A; Wamola, I; D'Costa, L J; Cameron, D W; Simonsen, J N; Plourde, P; Ronald, A R

    1990-01-01

    Epidemiologic studies in Nairobi and elsewhere in Africa, have shown that men infected with HIV-1 more commonly have a history of genital ulcer disease compared to uninfected men. In one study, HIV infected men were three times as likely to have a recent history of genital ulcers. In a prospective study of seronegative men, those presenting with chancroid had a five-fold risk of seroconversion during follow-up compared to men presenting with urethritis. Uncircumcised men had an increased risk of seroconversion which was independent of their risk of genital ulcer disease. Over 95% of attributable risk in men with STD was either genital ulceration or the presence of a foreskin. Genital ulcers are a major risk factor for HIV infection among prostitutes. The increased risk is about 10-fold among prostitutes with ulcers compared to a cohort who did not. We hypothesize from these studies that genital ulcers are the major portals of entry for HIV infection and also increased shedding of virus infected cells into the vaginal secretions. HIV seropositive prostitutes are more susceptible to chancroid with a two-fold increase in the prevalence of genital ulcers as compared to HIV negative women. The use of condoms by their clients prevents both genital ulcer disease and HIV acquisition among prostitutes. Chancroid is more difficult to treat in HIV infected men with one-third of patients failing single dose treatment regimens as compared to less than five percent of men without HIV infection.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. A comparison of DNA extraction procedures for the detection of Mycobacterium ulcerans, the causative agent of Buruli ulcer, in clinical and environmental specimens

    DEFF Research Database (Denmark)

    Durnez, Lies; Stragier, Pieter; Roebben, Karen;

    2008-01-01

    , at the moment, research is based on the detection by PCR of the insertion sequence IS2404 present in M. ulcerans and some closely related mycobacteria. In the present study, we compared four DNA extraction methods for detection of M. ulcerans DNA, namely the one tube cell lysis and DNA extraction procedure (OT...... of the extracted DNA and the time and effort needed were compared as well. All methods were performed on environmental specimens and the two best methods (MB and M16) were tested on clinical specimens for detection of M. ulcerans DNA. When comparing the DLs of the DNA extraction methods, the MB and M16 had...... a significantly lower DL than the OT and FP. For the different PCR targets, IS2404 showed a significantly lower DL than mlsA, MIRU1, MIRU5 and VNTR6. The FP and M16 were considerably faster than the MB and OT, while the purity of the DNA extracted with the MB was significantly higher than the DNA extracted...

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

    Directory of Open Access Journals (Sweden)

    Chatterjee S Sasanka

    2012-01-01

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

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

    Science.gov (United States)

    Chatterjee, Sasanka S

    2012-05-01

    Venous ulcers are the most common ulcers of the lower limb. It has a high morbidity and results in economic strain both at a personal and at a state level. Chronic venous hypertension either due to primary or secondary venous disease with perforator paucity, destruction or incompetence resulting in reflux is the underlying pathology, but inflammatory reactions mediated through leucocytes, platelet adhesion, formation of pericapillary fibrin cuff, growth factors and macromolecules trapped in tissue result in tissue hypoxia, cell death and ulceration. Duplex scan with colour flow is the most useful investigation for venous disease supplying information about patency, reflux, effects of proximal and distal compression, Valsalva maneuver and effects of muscle contraction. Most venous disease can be managed conservatively by leg elevation and compression bandaging. Drugs of proven benefit in venous disease are pentoxifylline and aspirin, but they work best in conjunction with compression therapy. Once ulceration is chronic or the patient does not respond to or cannot maintain conservative regime, surgical intervention treating the underlying venous hypertension and cover for the ulcer is necessary. The different modalities like sclerotherapy, ligation and stripping of superficial varicose veins, endoscopic subfascial perforator ligation, endovenous laser or radiofrequency ablation have similar long-term results, although short-term recovery is best with radiofrequency and foam sclerotherapy. For deep venous reflux, surgical modalities include repair of incompetent venous valves or transplant or transposition of a competent vein segment with normal valves to replace a post-thrombotic destroyed portion of the deep vein. PMID:23162226

  20. Multifocal stenosing ulceration of the small intestine

    Institute of Scientific and Technical Information of China (English)

    Hugh James Freeman

    2009-01-01

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

  1. Association between footwear use and neglected tropical diseases: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Sara Tomczyk

    Full Text Available The control of neglected tropical diseases (NTDs has primarily focused on preventive chemotherapy and case management. Less attention has been placed on the role of ensuring access to adequate water, sanitation, and hygiene and personal preventive measures in reducing exposure to infection. Our aim was to assess whether footwear use was associated with a lower risk of selected NTDs.We conducted a systematic review and meta-analysis to assess the association between footwear use and infection or disease for those NTDs for which the route of transmission or occurrence may be through the feet. We included Buruli ulcer, cutaneous larva migrans (CLM, leptospirosis, mycetoma, myiasis, podoconiosis, snakebite, tungiasis, and soil-transmitted helminth (STH infections, particularly hookworm infection and strongyloidiasis. We searched Medline, Embase, Cochrane, Web of Science, CINAHL Plus, and Popline databases, contacted experts, and hand-searched reference lists for eligible studies. The search was conducted in English without language, publication status, or date restrictions up to January 2014. Studies were eligible for inclusion if they reported a measure of the association between footwear use and the risk of each NTD. Publication bias was assessed using funnel plots. Descriptive study characteristics and methodological quality of the included studies were summarized. For each study outcome, both outcome and exposure data were abstracted and crude and adjusted effect estimates presented. Individual and summary odds ratio (OR estimates and corresponding 95% confidence intervals (CIs were calculated as a measure of intervention effect, using random effects meta-analyses.Among the 427 studies screened, 53 met our inclusion criteria. Footwear use was significantly associated with a lower odds of infection of Buruli ulcer (OR=0.15; 95% CI: 0.08-0.29, CLM (OR=0.24; 95% CI: 0.06-0.96, tungiasis (OR=0.42; 95% CI: 0.26-0.70, hookworm infection (OR=0.48; 95

  2. Cellular and Molecular Immunopathogenesis of Ulcerative Colitis

    Institute of Scientific and Technical Information of China (English)

    Suzhen Zhang; Xuhui Zhao; Dechun Zhang

    2006-01-01

    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.

  3. Peptic Ulcer at the End of the 20th Century: Biological and Psychological Risk Factors

    Directory of Open Access Journals (Sweden)

    Susan Levenstein

    1999-01-01

    Full Text Available The prevailing concept of peptic ulcer etiology has swung over entirely in just a few years from the psychological to the infectious, yet the rich literature documenting an association between psychosocial factors and ulcer is not invalidated by the discovery of Helicobacter pylori. Physical and psychological stressors interact to induce ulcers in animal models, concrete life difficulties and subjective distress predict the development of ulcers in prospective cohorts, shared catastrophes such as war and earthquakes lead to surges in hospitalizations for complicated ulcers, and stress or anxiety can worsen ulcer course. Many known ulcer risk factors, including smoking, nonsteroidal anti-inflammatory drug use, heavy drinking, loss of sleep and skipping breakfast, can increase under stress; the association of low socioeconomic status with ulcer is also accounted for in part by psychosocial factors. Among possible physiological mechanisms, stress may induce gastric hypersecretion, reduce acid buffering in the stomach and the duodenum, impair gastroduodenal blood flow, and affect healing or inflammation through psychoneuroimmunological mechanisms. Psychosocial factors seem to be particularly prominent among idiopathic or complicated ulcers, but they are probably operative in run of the mill H pylori disease as well, either through additive effects or by facilitating the spread of the organism across the pylorus, while gastrointestinal damage by nonsteroidal anti-inflammatory drugs can also be potentiated by stress. Although the clinical importance of peptic ulcer is fading along with the millenium, due to secular trends and new therapies, it remains worthy of study as a splendid example of the biopsychosocial model.

  4. A brief analysis of patients suffering from stomach or duodenal ulcers in Almaty hospital №1

    Directory of Open Access Journals (Sweden)

    Aryzbekova Aliya

    2015-12-01

    Full Text Available Peptic ulcers are a serious problem worldwide, and affect about 4 million people each year. Their etiology is connected with the presence of Helicobacter pylori, the act of smoking, drinking alcohol, being stress, and taking excessively nonsteroidal anti-inflammatory drugs, as well as steroids. The most common symptoms are abdominal pain, nausea, chest pain and fatigue, while less frequent symptoms include vomiting and weight loss. Helicobacter pylori is responsible for about 80% of gastric and 90% of duodenal ulcer cases. In this work, an analysis is made of a correlation between stomach or duodenal ulcer and gender, residence and number of patients hospitalized in the Almaty hospital №1, from 2009-2012, in order to learn about trends in the incidence of these diseases in Kazakhstan. A total number of 950 patients with stomach and duodenal ulcers, in 2009-2012, were questioned. The patient’s residence, gender and stomach or duodenal ulcer problem were taken into account in the study. The result of this work reveals that the largest amount of hospitalized patients suffering from stomach or duodenal ulcers came from urban areas. Moreover, more women than men suffered from peptic ulcers. Furthermore, the number of patients admitted to the hospital due to duodenal ulcers did not show any variation throughout the study. However, the least number of patients suffering from gastric ulcers was noticed in December 2009, and the greatest was in October and November 2011. The obtained data show that ulcers are a serious problem in Kazakhstan.

  5. Tofacitinib in ulcerative colitis.

    Science.gov (United States)

    Archer, Thomas P; Moran, Gordon W; Ghosh, Subrata

    2016-05-01

    Cytokines orchestrate immune and inflammatory responses involved in the pathogenesis of ulcerative colitis (UC). Protein kinases are essential for signal transduction in eukaryotic cells. Janus kinases (JAKs) are a family of protein tyrosine kinases that play a pivotal role in cytokine receptor signaling. Indeed, a major subgroup of cytokines use Type I and II cytokine receptors which signal via the activation of JAKs. Tofacitinib is an oral JAK inhibitor that has been studied in autoimmune pathologies, including UC and rheumatoid arthritis with good overall efficacy and acceptable safety profile. This literature review was performed with the goal of summarizing the knowledge on JAK inhibitors in UC treatment. PMID:27140405

  6. A case of oesophageal ulcer developed after taking homeopathic pill in a young woman

    Institute of Scientific and Technical Information of China (English)

    Vito D Corleto; Lidia D'Alonzo; Ermira Zykaj; Antonella Carnuccio; Francesca Chiesara; Cristiano Pagnini; Salvatore Di Somma; Gianfranco Delle Fave

    2007-01-01

    Oesophageal ulcers occur mainly as a result of gastrooesophageal reflux disease (GERD). However, pillinduced oesophageal ulcers are a fairly common event.The lesion is mainly due to entrapment of the pill and/or its chemical composition thereof. This case report describes an oesophageal mucosa ulcer occurred in a healthy 35-year old woman who had no previous history of oesophageal disorders and received homeopathic medication. The present case reveals that pill entrapment can occur even in the oesophagus of healthy young individuals and that oesophageal mucosal ulcer can be triggered by substances generally thought devoid of any potentially mucosal aggressive effect.

  7. Prognostic stratification of ulcerated melanoma

    DEFF Research Database (Denmark)

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

    2014-01-01

    OBJECTIVES: For patients with melanoma, ulceration is an important prognostic marker and interestingly also a predictive marker for the response of adjuvant interferon. A consensual definition and accurate assessment of ulceration are therefore crucial for proper staging and clinical management. We...

  8. Marjolin ulcer with multifocal origin

    Directory of Open Access Journals (Sweden)

    Das Sudip

    2009-01-01

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

  9. A retrospective analysis of 20-year data of the surgical management of ulcerative colitis patients in Taiwan: a study of Taiwan Society of Inflammatory Bowel Disease

    Science.gov (United States)

    Lin, Chun-Chi; Wei, Shu-Chen; Lin, Been-Ren; Tsai, Wen-Sy; Chen, Jinn-Shiun; Hsu, Tzu-Chi; Lin, Wei-Chen; Huang, Tien-Yu; Chao, Te-Hsin; Lin, Hung-Hsin; Wong, Jau-Min

    2016-01-01

    Background/Aims With the recent progress in medical treatment, surgery still plays a necessary and important role in treating ulcerative colitis (UC) patients. In this study, we analyzed the surgical results and outcomes of UC in Taiwan in the recent 20 years, via a multi-center study through the collaboration of Taiwan Society of IBD. Methods A retrospective analysis of surgery data of UC patients from January 1, 1995, through December 31, 2014, in 6 Taiwan major medical centers was conducted. The patients' demographic data, indications for surgery, and outcome details were recorded and analyzed. Results The data of 87 UC patients who received surgical treatment were recorded. The median post-operative follow-up duration was 51.1 months and ranged from 0.4 to 300 months. The mean age at UC diagnosis was 45.3±16.0 years and that at operation was 48.5±15.2 years. The 3 leading indications for surgical intervention were uncontrolled bleeding (16.1%), perforation (13.8%), and intractability (12.6%). In total, 27.6% of surgeries were performed in an emergency setting. Total or subtotal colectomy with rectal preservation (41.4%) was the most common operation. There were 6 mortalities, all due to sepsis. Emergency operation and low pre-operative albumin level were significantly associated with poor survival (P=0.013 and 0.034, respectively). Conclusions In the past 20 years, there was no significant change in the indications for surgery in UC patients. Emergency surgeries and low pre-operative albumin level were associated with poor survival. Therefore, an optimal timing of elective surgery for people with poorly controlled UC is paramount. PMID:27433147

  10. Accelerated detection of mycolactone production and response to antibiotic treatment in a mouse model of Mycobacterium ulcerans disease.

    Science.gov (United States)

    Converse, Paul J; Xing, Yalan; Kim, Ki Hyun; Tyagi, Sandeep; Li, Si-Yang; Almeida, Deepak V; Nuermberger, Eric L; Grosset, Jacques H; Kishi, Yoshito

    2014-01-01

    Diagnosis of the neglected tropical disease, Buruli ulcer, can be made by acid-fast smear microscopy, specimen culture on mycobacterial growth media, polymerase chain reaction (PCR), and/or histopathology. All have drawbacks, including non-specificity and requirements for prolonged culture at 32°C, relatively sophisticated laboratory facilities, and expertise, respectively. The causative organism, Mycobacterium ulcerans, produces a unique toxin, mycolactone A/B (ML) that can be detected by thin layer chromatography (TLC) or mass spectrometric analysis. Detection by the latter technique requires sophisticated facilities. TLC is relatively simple but can be complicated by the presence of other lipids in the specimen. A method using a boronate-assisted fluorogenic chemosensor in TLC can overcome this challenge by selectively detecting ML when visualized with UV light. This report describes modifications in the fluorescent TLC (F-TLC) procedure and its application to the mouse footpad model of M. ulcerans disease to determine the kinetics of mycolactone production and its correlation with footpad swelling and the number of colony forming units in the footpad. The response of all three parameters to treatment with the current standard regimen of rifampin (RIF) and streptomycin (STR) or a proposed oral regimen of RIF and clarithromycin (CLR) was also assessed. ML was detectable before the onset of footpad swelling when there were 10(5) CFU per footpad. Mycolactone concentrations increased as swelling increased whereas CFU levels reached a plateau. Treatment with either RIF+STR or RIF+CLR resulted in comparable reductions of mycolactone, footpad swelling, and CFU burden. Storage in absolute ethanol appears critical to successful detection of ML in footpads and would be practical for storage of clinical samples. F-TLC may offer a new tool for confirmation of suspected clinical lesions and be more specific than smear microscopy, much faster than culture, and simpler than

  11. Accelerated detection of mycolactone production and response to antibiotic treatment in a mouse model of Mycobacterium ulcerans disease.

    Directory of Open Access Journals (Sweden)

    Paul J Converse

    Full Text Available Diagnosis of the neglected tropical disease, Buruli ulcer, can be made by acid-fast smear microscopy, specimen culture on mycobacterial growth media, polymerase chain reaction (PCR, and/or histopathology. All have drawbacks, including non-specificity and requirements for prolonged culture at 32°C, relatively sophisticated laboratory facilities, and expertise, respectively. The causative organism, Mycobacterium ulcerans, produces a unique toxin, mycolactone A/B (ML that can be detected by thin layer chromatography (TLC or mass spectrometric analysis. Detection by the latter technique requires sophisticated facilities. TLC is relatively simple but can be complicated by the presence of other lipids in the specimen. A method using a boronate-assisted fluorogenic chemosensor in TLC can overcome this challenge by selectively detecting ML when visualized with UV light. This report describes modifications in the fluorescent TLC (F-TLC procedure and its application to the mouse footpad model of M. ulcerans disease to determine the kinetics of mycolactone production and its correlation with footpad swelling and the number of colony forming units in the footpad. The response of all three parameters to treatment with the current standard regimen of rifampin (RIF and streptomycin (STR or a proposed oral regimen of RIF and clarithromycin (CLR was also assessed. ML was detectable before the onset of footpad swelling when there were 10(5 CFU per footpad. Mycolactone concentrations increased as swelling increased whereas CFU levels reached a plateau. Treatment with either RIF+STR or RIF+CLR resulted in comparable reductions of mycolactone, footpad swelling, and CFU burden. Storage in absolute ethanol appears critical to successful detection of ML in footpads and would be practical for storage of clinical samples. F-TLC may offer a new tool for confirmation of suspected clinical lesions and be more specific than smear microscopy, much faster than culture, and

  12. Desulfovibrio bacterial species are increased in ulcerative colitis.

    LENUS (Irish Health Repository)

    Rowan, Fiachra

    2012-02-01

    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.

  13. Treatment of a non-healing diabetic foot ulcer with platelet-rich plasma.

    Science.gov (United States)

    Suresh, Deepak H; Suryanarayan, Shwetha; Sarvajnamurthy, Sacchidanand; Puvvadi, Srikanth

    2014-01-01

    Lower extremity ulcers and amputations are an increasing problem among individuals with diabetes. Among diabetes mellitus-related complications, foot ulceration is the most common, affecting approximately 15% of diabetic patients during their lifetime. The pathogenesis of diabetic ulcer is peripheral sensory neuropathy, calluses, oedema and peripheral vascular disease. Diabetic ulcer is managed by adequate control of infections and blood sugar levels, surgical debridement with various dressings and off loading of the foot from pressure. In spite of these standard measures, some recalcitrant non-healing ulcers need additional growth factors for healing. Autologous platelet-rich plasma is easy and cost-effective method in treating diabetic ulcers as it provides necessary growth factors which enhance healing.

  14. Perforated peptic ulcer and short-term mortality among tramadol users

    DEFF Research Database (Denmark)

    Tørring, Marie Louise; Riis, Anders; Christensen, Steffen;

    2007-01-01

    AIM: Use of nonsteroidal anti-inflammatory drugs (NSAIDs) increases risk and worsens prognosis for patients with complicated peptic ulcer disease. Therefore, patients who are at high risk of peptic ulcer often use tramadol instead of NSAIDs. Tramadol's effect on peptic ulcer prognosis is unknown....... The aim was to examine mortality in the 30 days following hospitalization for perforated peptic ulcer among tramadol and NSAID users compared with non-users. METHODS: The study was based on data on reimbursed prescriptions and hospital discharge diagnoses for the 1993-2004 period, extracted from...... population-based healthcare databases. All patients with a first-time diagnosis of perforated peptic ulcer were identified, excluding those with previous ulcer diagnoses or antiulcer drug use. Cox regression was used to estimate 30-day mortality rate ratios for tramadol and NSAID users compared with non...

  15. Treatment of a non-healing diabetic foot ulcer with platelet-rich plasma

    Directory of Open Access Journals (Sweden)

    Deepak H Suresh

    2014-01-01

    Full Text Available Lower extremity ulcers and amputations are an increasing problem among individuals with diabetes. Among diabetes mellitus-related complications, foot ulceration is the most common, affecting approximately 15% of diabetic patients during their lifetime. The pathogenesis of diabetic ulcer is peripheral sensory neuropathy, calluses, oedema and peripheral vascular disease. Diabetic ulcer is managed by adequate control of infections and blood sugar levels, surgical debridement with various dressings and off loading of the foot from pressure. In spite of these standard measures, some recalcitrant non-healing ulcers need additional growth factors for healing. Autologous platelet-rich plasma is easy and cost-effective method in treating diabetic ulcers as it provides necessary growth factors which enhance healing.

  16. Predictive factors for diabetic foot ulceration: a systematic review.

    Science.gov (United States)

    Monteiro-Soares, M; Boyko, E J; Ribeiro, J; Ribeiro, I; Dinis-Ribeiro, M

    2012-10-01

    Improving ability to predict and prevent diabetic foot ulceration is imperative because of the high personal and financial costs of this complication. We therefore conducted a systematic review in order to identify all studies of factors associated with DFU and assess whether available DFU risk stratification systems incorporate those factors of highest potential value. We performed a search in PubMed for studies published through April 2011 that analysed the association between independent variables and DFU. Articles were selected by two investigators-independently and blind to each other. Divergences were solved by a third investigator. A total of 71 studies were included that evaluated the association between diabetic foot ulceration and more than 100 independent variables. The variables most frequently assessed were age, gender, diabetes duration, BMI, HbA(1c) and neuropathy. Diabetic foot ulceration prevalence varied greatly among studies. The majority of the identified variables were assessed by only two or fewer studies. Diabetic neuropathy, peripheral vascular disease, foot deformity and previous diabetic foot ulceration or lower extremity amputation - which are the most common variables included in risk stratification systems - were consistently associated with diabetic foot ulceration development. Existing diabetic foot ulceration risk stratification systems often include variables shown repeatedly in the literature to be strongly predictive of this outcome. Improvement of these risk classification systems though is impaired because of deficiencies noted, including a great lack of standardization in outcome definition and variable selection and measurement.

  17. Plasma interleukin-18 reflects severity of ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Alicja Wiercinska-Drapalo; Robert Flisiak; Jerzy Jaroszewicz; Danuta Prokopowicz

    2005-01-01

    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.

  18. Isolation of human immunodeficiency virus from genital ulcers in Nairobi prostitutes.

    Science.gov (United States)

    Kreiss, J K; Coombs, R; Plummer, F; Holmes, K K; Nikora, B; Cameron, W; Ngugi, E; Ndinya Achola, J O; Corey, L

    1989-09-01

    Recent epidemiologic studies have implicated genital/anorectal ulcer disease as an important cofactor for acquisition and transmission of human immunodeficiency virus (HIV) during sexual intercourse. To better understand the mechanism for the association between genital ulcers and HIV, exudates from 62 genital ulcers of 56 HIV-seropositive prostitutes in Nairobi (Kenya) were cultured for HIV. Twenty-six ulcer cultures could not be evaluated for the presence of HIV because of bacterial or fungal contamination. HIV was isolated from 4 (11%) of the 36 remaining uncontaminated ulcer cultures (2 introital, 1 vaginal, and 1 cervical) from 4 separate women. HIV was isolated from the cervical os from only 2 of the 4 women. HIV p24 antigen was detected in exudate from 1 of the 4 culture-positive ulcers and 0 of 32 culture-negative ulcers. Genital ulcers in seropositive patients should be regarded as potential sources of HIV, which could be important in transmission of HIV during intercourse. Public health measures aimed at controlling sexually transmitted genital ulcer diseases should be an integral part of acquired immunodeficiency syndrome (AIDS) prevention programs.

  19. [The value of corticosteroids in the treatment of sterile ulcer in rheumatoid arthritis: a case report].

    Science.gov (United States)

    Elasri, F; Souhail, H; Reda, K; Iferkhass, S; Massoudi, R; Idrissi, A; Naoumi, A; Chana, H; Oubaaz, A

    2011-12-01

    Ocular manifestations of rheumatoid arthritis are mainly dry eye syndrome, scleritis, and keratitis. The occurrence of corneal ulceration in the course of this disease is a rare complication but can lead to ocular perforation. We report the case of a woman followed for rheumatoid arthritis who presented a bilateral sterile paracentral ulcer that responded well to medical treatment.

  20. 940 nm diode laser therapy in management of recurrent apthous ulcer

    OpenAIRE

    Misra, Neeta; Maiti, Debasmita; Misra, Pradyumna; Singh, Ashish Kumar

    2013-01-01

    Recurrent apthous stomatitis (RAS) is one of the most common oral inflammatory diseases characterised by painful recurrent ulcerations of the orofacial region. The ulcers occur in three clinical forms: minor, major and herpetiform. Several therapies have been advocated to manage these lesions such as topical corticosteroids (triamcinolone acetonide, hydrocortisone acetate and clobetasol propionate), chlorhexidine mouth rinses, tetracycline oral rinses, thalidomide, fluocinonide, colchicines a...