AIM:To evaluate the clinical efficacy of small-diameter acellular porcine corneal stroma(SAPS)for the treatment of peripheral corneal ulceration(PCU).METHODS:This retrospective clinical study included 18 patients(18 e...AIM:To evaluate the clinical efficacy of small-diameter acellular porcine corneal stroma(SAPS)for the treatment of peripheral corneal ulceration(PCU).METHODS:This retrospective clinical study included 18 patients(18 eyes)with PCU between April 2018 and December 2020.All patients had PCU and underwent lamellar keratoplasty with SAPS.Observation indicators included preoperative and postoperative best-corrected visual acuity(BCVA)and transparency of SAPS.The infection control rate in the surgical eye-lesion area was also calculated.RESULTS:Eighteen patients underwent lamellar keratoplasty with SAPS to treat PCU.None of the patients experienced rejection after 6mo(18/18)and 12mo(16/16)of follow-up.The BCVA(0.47±0.30)at the 6mo followup after operation was significantly improved compared with the baseline(0.99±0.80),and the difference was statistically significant(Z=-3.415,P<0.05).The BCVA at the 12mo follow-up after operation was not statistically significant compared to the 6mo(Z=0,P=1).With time,the SAPS graft gradually became transparent.At the 6mo(18/18)and 12mo(16/16)follow-up,none of the patients had recurrent corneal infection.CONCLUSION:SAPS is clinically effective in the treatment of PCU,improving the patient’s BCVA and reducing the incidence of rejection after keratoplasty.展开更多
The complexity of oral ulcerations poses considerable diagnostic and therapeutic challenges to oral specialists.The expert consensus was conducted to summarize the diagnostic work-up for difficult and complicated oral...The complexity of oral ulcerations poses considerable diagnostic and therapeutic challenges to oral specialists.The expert consensus was conducted to summarize the diagnostic work-up for difficult and complicated oral ulcers,based on factors such as detailed clinical medical history inquiry,histopathological examination,and ulceration-related systemic diseases screening.Not only it can provide a standardized procedure of oral ulceration,but also it can improve the diagnostic efficiency,in order to avoid misdiagnosis and missed diagnosis.展开更多
Geographically the prevalence of duodenal ulceration is related to the staple foods in the diet in regions of developing countries where the diet is stable.It is higher in regions where the diet is based on milled ric...Geographically the prevalence of duodenal ulceration is related to the staple foods in the diet in regions of developing countries where the diet is stable.It is higher in regions where the diet is based on milled rice,refined wheat or maize,yams,cassava,sweet potato,or green bananas,and is lower in regions where the staple diet is based on unrefined wheat or maize,soya,certain millets or certain pulses.Experiments on rat gastric and duodenal ulcer models showed that it was the lipid fraction in staple foods from low prevalence areas that was protective against bothgastric and duodenal ulceration,including ulceration due to non-steroidal anti-inflammatory drugs(NSAIDs).It also promoted ulcer healing.The lipid from the pulse,Dolichos biflorus,horse gram which was highly protective was used to identify the fractions with protective activity in the lipid.The protective activity lay in the phospholipid,sterol and sterol ester fractions.In the phospholipid fraction phosphatidyl choline(lethicin) and phosphatidyl ethanolamine(cephalin) were predominant.In the sterol fraction the sub-fractions showing protective activity contained β-sitosterol,stigmasterol,and an unidentified isomer of β-sitosterol.The evidence from animal models shows that certain dietary phospholipids and phytosterols have a protective action against gastroduodenal ulceration,both singly and in combination.This supports the protective role of staple diets in areas of low duodenal ulcer prevalence and may prove to be of importance in the prevention and treatment of duodenal ulceration and management of recurrent ulcers.A combination of phospholipids and phytosterols could also play an important role in protection against ulceration due to NSAIDs.展开更多
AIM： To investigate whether NSAIDs/ASA lesions in the colon can histologically be diagnosed on the basis of ischemic necrosis similar to biopsy-based diagnosis of NSAIDs/ASA- induced erosions and ulcers of the stomac...AIM： To investigate whether NSAIDs/ASA lesions in the colon can histologically be diagnosed on the basis of ischemic necrosis similar to biopsy-based diagnosis of NSAIDs/ASA- induced erosions and ulcers of the stomach. METHODS： In the period between 1997 and 2002, we investigated biopsy materials obtained from 611 patients （415 women, 196 men, average age 60.5 years） with endoscopic focal erosions, ulcerations, strictures or diaphragms in the colon. In the biopsies obtained from these lesions, we always established the suspected diagnosis of NSA/D-inducecl lesions whenever necroses of the ischemic type were found. Together with the histological report, we enclosed a questionnaire to investigate the use of medication. The data provided by the questionnaire were then correlated with the endoscopic findings, the location, number and nature of the lesions, and the histological findings. RESULTS： At the time of their colonoscopy, 86.1% of the patients had indeed been taking NSAID/ASA medication for years （43.9%） or months （29.5%）. The most common indication for the use of these drugs was pain （64.3%）, and the most common indication for colonoscopy was bleeding （55.5%）. Endoscopic inspection revealed multiple erosions and/or ulcers in 60.6%, strictures in 15.8%, and diaphragms in 3.0% of the patients. The lesions were located mainly in the right colon including the transverse colon （79.9%）. A separate analysis of age and sex distribution, endoscopic and histological findings for NSAIDs alone, ASA alone, combined NSAID/ASA, and for patients denying the use of such drugs, revealed no significant differences among the groups. CONCLUSION： This uncontrolled retrospective study based on the histological finding of an ischemic necrosis shows that the histologically suspected diagnosis of NSAID-induced lesions in the colon is often correct. The true diagnostic validity of this finding and the differentiation from ischemic colitis should, however, be investigated in a prospective controlled study.展开更多
Reports from countries with a high prevalence of Helicobacter pylori （H pylori） infection do not show a proportionately high prevalence of duodenal ulceration, suggesting the possibility that H pylori cannot be a pr...Reports from countries with a high prevalence of Helicobacter pylori （H pylori） infection do not show a proportionately high prevalence of duodenal ulceration, suggesting the possibility that H pylori cannot be a primary cause of duodenal ulceration. It has been mooted that this discrepancy might be explained by variations in the prevalence of virulence factors in different populations. The aim of this paper is to determine whether the published literature gives support to this possibility. The relevant literature was reviewed and analyzed separately for countries with a high and low prevalence of Hpylori infection and virulence factors. Although virulent strains of Hpylori were significantly more often present in patients with duodenal ulcer than without the disease in countries with a low prevalence of H pylori infection in the population, there was no difference in the prevalence of virulence factors between duodenal ulcer, nonulcer dyspepsia or normal subjects in many countries, where the prevalence of both Hpylori infection and of virulence factors was high. In these countries, the presence of virulence factors was not predictive the clinical outcome. To explain the association between virulence factors and duodenal ulcer in countries where H pylori prevalence is low, only two papers were found that give little support to the usual model proposed, namely that organisms with the virulence factors are more likely than those without them to initiate a duodenal ulcer. We offer an alternative hypothesis that suggests virulence factors are more likely to interfere with the healing of a previously produced ulcer. The presence of virulence factors only correlates with the prevalence of duodenal ulcer in countries where the prevalence of H pylori is low. There is very little evidence that virulence factors initiate duodenal ulceration, but they may be related to failure of the ulcer to heal.展开更多
The facts that H pylori infection is commoner in duodenal ulcer (DU) patients than in the normal population, and that eradication results in most cases being cured, have led to the belief that it causes DU. However, e...The facts that H pylori infection is commoner in duodenal ulcer (DU) patients than in the normal population, and that eradication results in most cases being cured, have led to the belief that it causes DU. However, early cases of DU are less likely than established ones to be infected. H pylori-negative cases are usually ascribed to specific associated factors such as non-steroidal anti-inflammatory drugs (NSAIDs), Crohn’s disease, and hypergastrinaemia, but even after excluding these, several H pylori-negative cases remain and are particularly common in areas of low prevalence of H pylori infection. Moreover, this incidence of H pylori negative DU is not associated with a fall in overall DU prevalence when compared with countries with a higher H pylori prevalence. In countries with a high H pylori prevalence there are regional differences in DU prevalence, but no evidence of an overall higher prevalence of DU than in countries with a low H pylori prevalence. There is no evidence that virulence factors are predictive of clinical outcome. After healing following eradication of H pylori infection DU can still recur. Medical or surgical measures to reduce acid output can lead to long-term healing despite persistence of H pylori infection. Up to half of cases of acute DU perforation are H pylori negative. These findings lead to the conclusion that H pylori infection does not itself cause DU, but leads to resistance to healing, i.e., chronicity. This conclusion is shown not to be incompatible with the universally high prevalence of DU compared with controls.展开更多
Skin ulceration syndrome(SUS)is the main diseases aff ected the development of sea cucumber(Apostichopus japonicus)culture industries.To better observe the changes in the sea cucumber A.japonicus with SUS and understa...Skin ulceration syndrome(SUS)is the main diseases aff ected the development of sea cucumber(Apostichopus japonicus)culture industries.To better observe the changes in the sea cucumber A.japonicus with SUS and understand the pathogenesis of the disease,activities of superoxide dismutase(SOD),catalase(CAT),and level of malondialdehyde(MDA)in coelomic fluid were detected using the Assay Kit and metabolites in the body wall were assessed using ultra-performance liquid chromatography and quadrupole-time of flight mass spectrometry.The results indicated that level of MDA was increased during SUS compared with healthy individuals(P<0.01),but activities of SOD and CAT were reduced(P<0.05).In metabolomics analysis,metabolites,such as adenosine,choline,betaine aldehyde,palmitic acid,and taurine,were found to be upregulated and 2-oxoadipic acid,anthranilic acid(vitamin L1),thioetheramide-PC,cholesterol-3-sulfate,and pentadecanoic acid were downregulated(VIP>1 and P<0.1).Pathway enrichment analysis indicated most enrichment of KEGG pathways were mainly related to energy metabolism,immunity,and osmoregulation such as ABC transporters,glycine,serine and threonine metabolism,tryptophan metabolism and neuroactive ligand-receptor interaction.Our study reflected the difference in enzyme activity and metabolites between A.japonicus with SUS and those without,which will provide reference data for investigating SUS.展开更多
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 t...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℃,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.展开更多
AIM: To study the effects of amphetamine, an indirect- acting adrenomimetic compound on the indomethacin- induced gastric ulcerations in rats. METHODS: Male Wistar-Bratislava rats were randomly divided into four group...AIM: To study the effects of amphetamine, an indirect- acting adrenomimetic compound on the indomethacin- induced gastric ulcerations in rats. METHODS: Male Wistar-Bratislava rats were randomly divided into four groups: Group 1 (control), received an ulcerogenic dose of indomethacin (50 μmol/kg) and Groups 2, 3 and 4, treated with amphetamine (10, 25 and 50 μmol/kg). The drug was administered simulta- neously with indomethacin and once again 4 h later. The animals were sacrificed 8 h after indomethacin treatment. The stomachs were opened and the inci- dence, the number of lesions and their severity were evaluated. The results were expressed as percentage and as mean ± standard error (mean ± SE). RESULTS: The incidence of ulceration in the control group was 100%. Amphetamine, at doses of 10, 25 and 50 μmol/kg, lowered the incidence to 88.89%, 77.78% and 37.5% respectively. The protection ratio was posi- tive: 24.14%, 55.17% and 80.6% respectively. The total number of ulcerations/rat was 12.44 ± 3.69 in the con- trol group. It decreased to 7.33 ± 1.89, 5.33 ± 2.38 and 2.25 ± 1.97 under the effects of the above-mentioned doses of amphetamine. CONCLUSION: Amphetamine affords a significant dose-dependent protection against the indomethacin- induced gastric ulcerations in rats. It is suggested that the adrenergic system is involved in the gastric mucosa protection.展开更多
A 41-year-old man presented with severe gastric ulceration 3 mo after beginning treatment with atorvastatin 20 mg once daily for hypercholesterolemia. The patient was not taking any ulcerogenic drugs and had no eviden...A 41-year-old man presented with severe gastric ulceration 3 mo after beginning treatment with atorvastatin 20 mg once daily for hypercholesterolemia. The patient was not taking any ulcerogenic drugs and had no evidence of Helicobacter pylori infection. Proton pump inhibitor therapy was initiated and atorvastatin was replaced by simvastatin with complete resolution of gastrointestinal symptoms. To our knowledge, this is the first report of atorvastatin-induced gastric ulceration,which should be looked for in patients who develop abdominal pain while on this drug.展开更多
Oxygen was first discovered by Sweden chemist Scheele in 1773 and convinced as an essential factor for living by French scientists in 1777.To tackle with different hypoxic emergencies,corresponding medical approaches,...Oxygen was first discovered by Sweden chemist Scheele in 1773 and convinced as an essential factor for living by French scientists in 1777.To tackle with different hypoxic emergencies,corresponding medical approaches,e.g.mask or nasal catheter oxygen inhalation,breathing machine,hyperbaric oxygen therapy etc.,have been contrived in succession.However,one mortal trouble exists in all these conventional ways,i.e.they must rely on the ventilation and gas exchange via lungs,thus not being able to promptly render oxygen to specific hypoxia tissues.Hyperoxygenated solution(HOS),a new kind of medical liquid which can be orally taken or intravenously administrated,has been widely applied as an auxiliary method of offering oxygen in China.A large number of experiments have proved its validity in the treatment of myocardial and cerebral ischemia/reperfusion injury,nerve lesions,shock,respiratory diseases,neonatal hypoxia and so forth.These findings suggest that HOS might not only play a role of increasing oxygen pressure in local region,but also conspicuously contribute to improving the pathologic process of hypoxia,which coincidently is the vital link in stress-induced lesions in the gastrointestinal tract.Additionally,Helicobacter pylori(H.pylori),a kind of microaerophilic(anaerobic)bacterium which can hardly survive in an aerobic atmosphere,has also been identified as an independent risk factor for the occurrence and development of ulceration.Considering the etiology of peptic ulceration and the features of HOS,we hypothesize that drinking HOS might prevent gastric ulceration caused by stress or anaerobic H.pylori.展开更多
BACKGROUND This study describes the use of a moisture chamber to treat corneal ulceration due to temporary lagophthalmos in a critically ill patient.CASE SUMMARY A 46-year-old woman was admitted to the intensive care ...BACKGROUND This study describes the use of a moisture chamber to treat corneal ulceration due to temporary lagophthalmos in a critically ill patient.CASE SUMMARY A 46-year-old woman was admitted to the intensive care unit after a car accident.She suffered multiple injuries that included brain injury and presented with moderately decreased consciousness and lagophthalmos in her right eye.Within 6 d,her consciousness improved considerably;at which time,exposure keratopathy occurred and worsened to corneal ulceration.Lubricating gel,antibiotic ointment,and bandage contact lens were all ineffective in preventing or treating the exposure keratopathy.Instead of tarsorrhaphy,a moisture chamber was applied which successfully controlled the corneal ulceration.The moisture chamber was discontinued when complete eyelid closure recovered a week later.CONCLUSION A moisture chamber may be an effective,noninvasive alternative to tarsorrhaphy for treating severe exposure keratopathy due to temporary lagophthalmos.展开更多
The purpose of this study was to assess the correlation between iron deficiency and recurrent aphthous ulceration (RAU). Radioimmunoassay was used to examine the serum ferritin level (SFL) in 52 patients with RAU and ...The purpose of this study was to assess the correlation between iron deficiency and recurrent aphthous ulceration (RAU). Radioimmunoassay was used to examine the serum ferritin level (SFL) in 52 patients with RAU and in 54 controls. Both were divided into 2 groups in accordance with sex. The 36 female patients were subdivided into 3 age-groups as follows: 8 aged 22-24, 10 aged 25-34, and 18 aged 35-50 while the male patients were gathered as one single group aged 26-57. The subdivision was adapted similarly for the normal age-grouts. Although no significant difference in SFL was found between the male control and the male patient groups, differences between the female control and female patient groups showed highly significant which levels, with the ascendance of age, were P【0.001, P【0.005 and P【0.001, respectively. Also the difference between male and female control groups were significant (P【0.05). However, no significant differences in SFL were discovered among the 3 patient groups. 10 female patients with SFL【12ng/ml were tested with ferrous sulfate for one month, then their SFL was reexamined one week after the treatment. A highly significant difference in SFL was noted between the pre-ad post-treatment (P【0.001). 9 of them showed that the interval of recurrences were prolonged, the number of ulcers reduced, the pain less intensive and its duration shorter than those before the treatment. This study demonstrated that a singificant decrease in iron-storage occurred in female RAU patients. The authors concluded that the decrease SFL was possibly related to menstruation and child bearing.展开更多
Genital ulceration is the loss of integrity of the mucous membranes (or genital skin) leaving the dermis uncovered and almost always accompanied by satellite lymphadenopathies. Beyond a month of evolution, it is said ...Genital ulceration is the loss of integrity of the mucous membranes (or genital skin) leaving the dermis uncovered and almost always accompanied by satellite lymphadenopathies. Beyond a month of evolution, it is said to be chronic. Sexually transmitted diseases are infections due to microbial agents among which parasites, bacteria, viruses and fungi that can be associated with each other to varying degrees. Sexually transmitted infections must be mentioned before any genital ulceration. Hence the interest of the case that we report of chronic anogenital ulcerations complicating a polymicrobial pelvic infection in a patient immunocompromised to HIV. The physical examination reveals a hypogastric sensitivity to deep palpation, the presence of a superinfected anogenital ulceration exposing the deep dermis covered with purulent serosities interesting the labia minora, the posterior vaginal fork, the anal region, the clitoris and an extension of the lesions to the gluteal fold is observed. We found a satellite lymphadenopathy in the right inguinal fold. The screening finds the HIV1 positive serology with a viral load of 28,000 copies, the herpes simplex 1&2 and Chlamydia trachomatis serologies were all positive. The genital samples are marked by the presence of bacterial vaginosis with Candida Albicans and Gardnerella Vaginalis, the presence of urogenital mycoplasmas of the Ureaplasma Urealyticum The pelvic ultrasound was in favor of a bilateral adnexitis. A protocol was put in place: the first step consisted of seat baths, antifungi and antibiotics administration: fluconazole 150 mg and tinidazole 2 g in single doses, then josamycin 1 g/24h in two doses per os for two weeks. The second stage consists of the administration of doxycycline 200 mg for 21 days, Aciclovir 500 mg for 10 days, and the administration of ARV (Tenofovir + Lamivudine + Dolutegravir) or one tablet daily. The evolution is marked by a progressive healing of the clitoris, the labia majora and labia minora, the posterior vaginal fork. In case of chronicity, a biopsy in search of a tumor process is not mandatory when there is a satisfactory response to treatment and good healing. The patient’s death two weeks after the beginning of ARV treatment, can be explained by a probable immune reconstitution syndrome.展开更多
Background: Marginal ulceration (MU) is a recognized complication of Roux-en-Y gastric bypass (RYGB) surgery. While several possible risk factors have been reported, the mechanism of MU remains incompletely understood...Background: Marginal ulceration (MU) is a recognized complication of Roux-en-Y gastric bypass (RYGB) surgery. While several possible risk factors have been reported, the mechanism of MU remains incompletely understood. The aim of this study was to compare the effect of surgical technique on the incidence of MU. Methods and Material: This was a retrospective study of 749 patients undergoing RYGB over a ten-year period with at least one year of follow-up. The diagnosis of MU was made based on clinical symptoms and confirmed by postoperative endoscopy (POE). We assessed four different gastric bypass (GBP) techniques: T1—Open, non-divided stomach, circular stapler, non-vagotomy (n = 332);T2—Open, divided stomach, circular stapler, vagotomy (n = 91);T3—Laparoscopic, divided, circular stapler, vagotomy (n = 152);T4—Laparoscopic, divided, linear stapler, vagotomy (n = 174). Results: The four groups were similar with respect to age and mean BMI. The frequency of POE was 16%, 25%, 28% and 27% in groups T1-T4 respectively (NS). The incidence of MU was significantly lower in T1 (2.1%) compared to T2 (5.5%), T3 (15.1%) and T4 (12.6%), p 0.05. MU occurred significantly more frequently with an antecolic Roux limb versus retrocolic (14.5% vs 5.6%, p 0.05). Conclusion: The incidence of MU after RYGB surgery is influenced by surgical technique. The lowest incidence of MU was with a non-divided stomach, no vagotomy, transverse staple line, and circular stapled anastomosis. A retrocolic Roux limb was protective. There was no difference in the incidence of MU using laparoscopic versus open bypass if a similar technique was employed or using linear versus circular stapler for the gastrojejunostomy.展开更多
Background: Diabetic foot together with open wounds in distal type peripheral arterial disease constitutes a challenge in therapeutic planning. Ozone therapy may unveil new horizons in management. Case Report: A 67-ye...Background: Diabetic foot together with open wounds in distal type peripheral arterial disease constitutes a challenge in therapeutic planning. Ozone therapy may unveil new horizons in management. Case Report: A 67-year-old woman with diabetes mellitus was applied with open wounds at the bottom of her foot with purulent discharge, with a decision for above ankle amputation. She had had numerous interventions for her wounds including metatarsal amputations due to osteomyelitis and had been on an intense treatment including antibiotics, insulin, antihypertensives and antiaggregants. Angiogram revealed diffuse peripheral arterial disease in lower extremities. All medication but antihypertensives was stopped. She received major medical ozone application as 2000 gamma/session i.v. for 2 weeks, external ozone sac application starting from 60 and dropping to 30 gamma/session for 3 weeks and ozone insuflation 40 gamma/session for 10 sessions. Her purulent discharge ceased after the third session and the atonic debris of the wounds exfoliated, the wounds healed from the base towards the surface of the skin. She was then put on cilostazol and clopidogrel therapy. Conclusion: By being one of the known strongest bactericide, virucide, and fungicide elements, medical ozone therapy stimulates and upregulates the antioxidant system of the body with its hormesis effects. After the cessation of all circulatory system supporting medication (as their interaction with ozone is not clear yet), appropriate ozone therapy may bring new horizons for patients when all classically known methods of treatment have been completed, before assigning the patients for amputation.展开更多
Epstein-Barr virus (EBV) mucocutaneous ulceration is a rare complication of immunosuppression that results in painful ulceration of the tongue or gingiva, and less commonly, refractory ulceration of the gastrointestin...Epstein-Barr virus (EBV) mucocutaneous ulceration is a rare complication of immunosuppression that results in painful ulceration of the tongue or gingiva, and less commonly, refractory ulceration of the gastrointestinal tract. High clinical suspicion is required, as failure to diagnose EBV mucocutaneous ulceration may result in significant morbidity and mortality. We report the case of a 64-year-old female renal transplant recipient requiring admission to hospital for management of severe oral and epigastric pain. Examination revealed a large, superficial, well-circumscribed ulcer at the base of the tongue. Blood tests suggested a secondary immunodeficiency characterised by mild leucopenia, hypogammaglobulinaemia, and low memory B-cells with normal immunophenotype. Endoscopy revealed four, cratered ulcers in the pre-pyloric region of the stomach. A core biopsy of the tongue ulcer confirmed EBV mucocutaneous ulceration. The patient’s immunosuppression was optimised, which resulted in complete resolution of the tongue and gastric ulcers at eight and twelve weeks of follow-up respectively.展开更多
INTRODUCTIONIt is generally accepted that Helicobacter pylori ( H.pylori) infection has a role in duodenal ulceration .Eradicaton of H .pylori accelerates healing compared with placebo in the absence of control of ga...INTRODUCTIONIt is generally accepted that Helicobacter pylori ( H.pylori) infection has a role in duodenal ulceration .Eradicaton of H .pylori accelerates healing compared with placebo in the absence of control of gastric secretion and reduces ulcer recurrence .There is increasing evidence ,however ,that is may not be the primary cause of duodenal ulceration ,but that is may be a secondary factor in a nnmber of cases .This possibility is supported by four sets of observations : 1 Geographical distribution:展开更多
AIM To investigate management of patients who develop ipilimumab-mediated enterocolitis, including association of endoscopic findings with steroid-refractory symptoms and utility of infliximab as second-line therapy.M...AIM To investigate management of patients who develop ipilimumab-mediated enterocolitis, including association of endoscopic findings with steroid-refractory symptoms and utility of infliximab as second-line therapy.METHODS We retrospectively reviewed all patients at our centerwith metastatic melanoma who were treated with ipilimumab between March 2011 and May 2014. All patients received a standard regimen of intravenous ipilimumab 3 mg/kg every 3 wk for four doses or until therapy was stopped due to toxicity or disease progression. Basic demographic and clinical data were collected on all patients. For patients who developed grade 2 or worse diarrhea(increase of 4 bowel movements per day), additional data were collected regarding details of gastrointestinal symptoms, endoscopic findings and treatment course. Descriptive statistics were used.RESULTS A total of 114 patients were treated with ipilimumab during the study period and all were included. Sixteen patients(14%) developed ≥ grade 2 diarrhea. All patients were treated with high-dose corticosteroids(1-2 mg/kg prednisone daily or equivalent). Nine of 16 patients(56%) had ongoing diarrhea despite highdose steroids. Steroid-refractory patients received one dose of intravenous infliximab at 5 mg/kg, and all but one had brisk resolution of diarrhea. Fourteen of the patients underwent either colonoscopy or sigmoidoscopy with variable endoscopic findings, ranging from mild erythema to colonic ulcers. Among 8 patients with ulcers demonstrated by sigmoidoscopy or colonoscopy, 7 patients(88%) developed steroidrefractory symptoms requiring infliximab. With a median follow-up of 264 d, no major adverse events associated with prednisone or infliximab were reported.CONCLUSION In patients with ipilimumab-mediated enterocolitis, the presence of colonic ulcers on endoscopy was associated with a steroid-refractory course.展开更多
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 transmura...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 nonspecif ic 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.展开更多
基金Key R&D Plan of Shaanxi Province(No.2021SF-331).
文摘AIM:To evaluate the clinical efficacy of small-diameter acellular porcine corneal stroma(SAPS)for the treatment of peripheral corneal ulceration(PCU).METHODS:This retrospective clinical study included 18 patients(18 eyes)with PCU between April 2018 and December 2020.All patients had PCU and underwent lamellar keratoplasty with SAPS.Observation indicators included preoperative and postoperative best-corrected visual acuity(BCVA)and transparency of SAPS.The infection control rate in the surgical eye-lesion area was also calculated.RESULTS:Eighteen patients underwent lamellar keratoplasty with SAPS to treat PCU.None of the patients experienced rejection after 6mo(18/18)and 12mo(16/16)of follow-up.The BCVA(0.47±0.30)at the 6mo followup after operation was significantly improved compared with the baseline(0.99±0.80),and the difference was statistically significant(Z=-3.415,P<0.05).The BCVA at the 12mo follow-up after operation was not statistically significant compared to the 6mo(Z=0,P=1).With time,the SAPS graft gradually became transparent.At the 6mo(18/18)and 12mo(16/16)follow-up,none of the patients had recurrent corneal infection.CONCLUSION:SAPS is clinically effective in the treatment of PCU,improving the patient’s BCVA and reducing the incidence of rejection after keratoplasty.
基金supported by grants from the National Natural Science Foundations of China(No.U19A2005,81771081,81870775)CAMS Innovation Fund for Medical Sciences(CIFMS)(2019-12M-5-004,2020-I2M-C&T-A-023)。
文摘The complexity of oral ulcerations poses considerable diagnostic and therapeutic challenges to oral specialists.The expert consensus was conducted to summarize the diagnostic work-up for difficult and complicated oral ulcers,based on factors such as detailed clinical medical history inquiry,histopathological examination,and ulceration-related systemic diseases screening.Not only it can provide a standardized procedure of oral ulceration,but also it can improve the diagnostic efficiency,in order to avoid misdiagnosis and missed diagnosis.
文摘Geographically the prevalence of duodenal ulceration is related to the staple foods in the diet in regions of developing countries where the diet is stable.It is higher in regions where the diet is based on milled rice,refined wheat or maize,yams,cassava,sweet potato,or green bananas,and is lower in regions where the staple diet is based on unrefined wheat or maize,soya,certain millets or certain pulses.Experiments on rat gastric and duodenal ulcer models showed that it was the lipid fraction in staple foods from low prevalence areas that was protective against bothgastric and duodenal ulceration,including ulceration due to non-steroidal anti-inflammatory drugs(NSAIDs).It also promoted ulcer healing.The lipid from the pulse,Dolichos biflorus,horse gram which was highly protective was used to identify the fractions with protective activity in the lipid.The protective activity lay in the phospholipid,sterol and sterol ester fractions.In the phospholipid fraction phosphatidyl choline(lethicin) and phosphatidyl ethanolamine(cephalin) were predominant.In the sterol fraction the sub-fractions showing protective activity contained β-sitosterol,stigmasterol,and an unidentified isomer of β-sitosterol.The evidence from animal models shows that certain dietary phospholipids and phytosterols have a protective action against gastroduodenal ulceration,both singly and in combination.This supports the protective role of staple diets in areas of low duodenal ulcer prevalence and may prove to be of importance in the prevention and treatment of duodenal ulceration and management of recurrent ulcers.A combination of phospholipids and phytosterols could also play an important role in protection against ulceration due to NSAIDs.
文摘AIM： To investigate whether NSAIDs/ASA lesions in the colon can histologically be diagnosed on the basis of ischemic necrosis similar to biopsy-based diagnosis of NSAIDs/ASA- induced erosions and ulcers of the stomach. METHODS： In the period between 1997 and 2002, we investigated biopsy materials obtained from 611 patients （415 women, 196 men, average age 60.5 years） with endoscopic focal erosions, ulcerations, strictures or diaphragms in the colon. In the biopsies obtained from these lesions, we always established the suspected diagnosis of NSA/D-inducecl lesions whenever necroses of the ischemic type were found. Together with the histological report, we enclosed a questionnaire to investigate the use of medication. The data provided by the questionnaire were then correlated with the endoscopic findings, the location, number and nature of the lesions, and the histological findings. RESULTS： At the time of their colonoscopy, 86.1% of the patients had indeed been taking NSAID/ASA medication for years （43.9%） or months （29.5%）. The most common indication for the use of these drugs was pain （64.3%）, and the most common indication for colonoscopy was bleeding （55.5%）. Endoscopic inspection revealed multiple erosions and/or ulcers in 60.6%, strictures in 15.8%, and diaphragms in 3.0% of the patients. The lesions were located mainly in the right colon including the transverse colon （79.9%）. A separate analysis of age and sex distribution, endoscopic and histological findings for NSAIDs alone, ASA alone, combined NSAID/ASA, and for patients denying the use of such drugs, revealed no significant differences among the groups. CONCLUSION： This uncontrolled retrospective study based on the histological finding of an ischemic necrosis shows that the histologically suspected diagnosis of NSAID-induced lesions in the colon is often correct. The true diagnostic validity of this finding and the differentiation from ischemic colitis should, however, be investigated in a prospective controlled study.
文摘Reports from countries with a high prevalence of Helicobacter pylori （H pylori） infection do not show a proportionately high prevalence of duodenal ulceration, suggesting the possibility that H pylori cannot be a primary cause of duodenal ulceration. It has been mooted that this discrepancy might be explained by variations in the prevalence of virulence factors in different populations. The aim of this paper is to determine whether the published literature gives support to this possibility. The relevant literature was reviewed and analyzed separately for countries with a high and low prevalence of Hpylori infection and virulence factors. Although virulent strains of Hpylori were significantly more often present in patients with duodenal ulcer than without the disease in countries with a low prevalence of H pylori infection in the population, there was no difference in the prevalence of virulence factors between duodenal ulcer, nonulcer dyspepsia or normal subjects in many countries, where the prevalence of both Hpylori infection and of virulence factors was high. In these countries, the presence of virulence factors was not predictive the clinical outcome. To explain the association between virulence factors and duodenal ulcer in countries where H pylori prevalence is low, only two papers were found that give little support to the usual model proposed, namely that organisms with the virulence factors are more likely than those without them to initiate a duodenal ulcer. We offer an alternative hypothesis that suggests virulence factors are more likely to interfere with the healing of a previously produced ulcer. The presence of virulence factors only correlates with the prevalence of duodenal ulcer in countries where the prevalence of H pylori is low. There is very little evidence that virulence factors initiate duodenal ulceration, but they may be related to failure of the ulcer to heal.
文摘The facts that H pylori infection is commoner in duodenal ulcer (DU) patients than in the normal population, and that eradication results in most cases being cured, have led to the belief that it causes DU. However, early cases of DU are less likely than established ones to be infected. H pylori-negative cases are usually ascribed to specific associated factors such as non-steroidal anti-inflammatory drugs (NSAIDs), Crohn’s disease, and hypergastrinaemia, but even after excluding these, several H pylori-negative cases remain and are particularly common in areas of low prevalence of H pylori infection. Moreover, this incidence of H pylori negative DU is not associated with a fall in overall DU prevalence when compared with countries with a higher H pylori prevalence. In countries with a high H pylori prevalence there are regional differences in DU prevalence, but no evidence of an overall higher prevalence of DU than in countries with a low H pylori prevalence. There is no evidence that virulence factors are predictive of clinical outcome. After healing following eradication of H pylori infection DU can still recur. Medical or surgical measures to reduce acid output can lead to long-term healing despite persistence of H pylori infection. Up to half of cases of acute DU perforation are H pylori negative. These findings lead to the conclusion that H pylori infection does not itself cause DU, but leads to resistance to healing, i.e., chronicity. This conclusion is shown not to be incompatible with the universally high prevalence of DU compared with controls.
基金Supported by the National Natural Science Foundation of China(No.31772849)the Scientific Research Funding Project of Liaoning Provincial Department of Education in 2019(No.DL201901)the Program for Liaoning Innovative Research Team in University(No.LT2019003)。
文摘Skin ulceration syndrome(SUS)is the main diseases aff ected the development of sea cucumber(Apostichopus japonicus)culture industries.To better observe the changes in the sea cucumber A.japonicus with SUS and understand the pathogenesis of the disease,activities of superoxide dismutase(SOD),catalase(CAT),and level of malondialdehyde(MDA)in coelomic fluid were detected using the Assay Kit and metabolites in the body wall were assessed using ultra-performance liquid chromatography and quadrupole-time of flight mass spectrometry.The results indicated that level of MDA was increased during SUS compared with healthy individuals(P<0.01),but activities of SOD and CAT were reduced(P<0.05).In metabolomics analysis,metabolites,such as adenosine,choline,betaine aldehyde,palmitic acid,and taurine,were found to be upregulated and 2-oxoadipic acid,anthranilic acid(vitamin L1),thioetheramide-PC,cholesterol-3-sulfate,and pentadecanoic acid were downregulated(VIP>1 and P<0.1).Pathway enrichment analysis indicated most enrichment of KEGG pathways were mainly related to energy metabolism,immunity,and osmoregulation such as ABC transporters,glycine,serine and threonine metabolism,tryptophan metabolism and neuroactive ligand-receptor interaction.Our study reflected the difference in enzyme activity and metabolites between A.japonicus with SUS and those without,which will provide reference data for investigating SUS.
基金supported by the National Key Technology Research and Development Program (2007BAD 62B04)
文摘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℃,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.
文摘AIM: To study the effects of amphetamine, an indirect- acting adrenomimetic compound on the indomethacin- induced gastric ulcerations in rats. METHODS: Male Wistar-Bratislava rats were randomly divided into four groups: Group 1 (control), received an ulcerogenic dose of indomethacin (50 μmol/kg) and Groups 2, 3 and 4, treated with amphetamine (10, 25 and 50 μmol/kg). The drug was administered simulta- neously with indomethacin and once again 4 h later. The animals were sacrificed 8 h after indomethacin treatment. The stomachs were opened and the inci- dence, the number of lesions and their severity were evaluated. The results were expressed as percentage and as mean ± standard error (mean ± SE). RESULTS: The incidence of ulceration in the control group was 100%. Amphetamine, at doses of 10, 25 and 50 μmol/kg, lowered the incidence to 88.89%, 77.78% and 37.5% respectively. The protection ratio was posi- tive: 24.14%, 55.17% and 80.6% respectively. The total number of ulcerations/rat was 12.44 ± 3.69 in the con- trol group. It decreased to 7.33 ± 1.89, 5.33 ± 2.38 and 2.25 ± 1.97 under the effects of the above-mentioned doses of amphetamine. CONCLUSION: Amphetamine affords a significant dose-dependent protection against the indomethacin- induced gastric ulcerations in rats. It is suggested that the adrenergic system is involved in the gastric mucosa protection.
文摘A 41-year-old man presented with severe gastric ulceration 3 mo after beginning treatment with atorvastatin 20 mg once daily for hypercholesterolemia. The patient was not taking any ulcerogenic drugs and had no evidence of Helicobacter pylori infection. Proton pump inhibitor therapy was initiated and atorvastatin was replaced by simvastatin with complete resolution of gastrointestinal symptoms. To our knowledge, this is the first report of atorvastatin-induced gastric ulceration,which should be looked for in patients who develop abdominal pain while on this drug.
基金Supported by the National Natural Science Foundation of China(81270330)
文摘Oxygen was first discovered by Sweden chemist Scheele in 1773 and convinced as an essential factor for living by French scientists in 1777.To tackle with different hypoxic emergencies,corresponding medical approaches,e.g.mask or nasal catheter oxygen inhalation,breathing machine,hyperbaric oxygen therapy etc.,have been contrived in succession.However,one mortal trouble exists in all these conventional ways,i.e.they must rely on the ventilation and gas exchange via lungs,thus not being able to promptly render oxygen to specific hypoxia tissues.Hyperoxygenated solution(HOS),a new kind of medical liquid which can be orally taken or intravenously administrated,has been widely applied as an auxiliary method of offering oxygen in China.A large number of experiments have proved its validity in the treatment of myocardial and cerebral ischemia/reperfusion injury,nerve lesions,shock,respiratory diseases,neonatal hypoxia and so forth.These findings suggest that HOS might not only play a role of increasing oxygen pressure in local region,but also conspicuously contribute to improving the pathologic process of hypoxia,which coincidently is the vital link in stress-induced lesions in the gastrointestinal tract.Additionally,Helicobacter pylori(H.pylori),a kind of microaerophilic(anaerobic)bacterium which can hardly survive in an aerobic atmosphere,has also been identified as an independent risk factor for the occurrence and development of ulceration.Considering the etiology of peptic ulceration and the features of HOS,we hypothesize that drinking HOS might prevent gastric ulceration caused by stress or anaerobic H.pylori.
基金Supported by Huashan Hospital,Fudan University,No.2016QD03.
文摘BACKGROUND This study describes the use of a moisture chamber to treat corneal ulceration due to temporary lagophthalmos in a critically ill patient.CASE SUMMARY A 46-year-old woman was admitted to the intensive care unit after a car accident.She suffered multiple injuries that included brain injury and presented with moderately decreased consciousness and lagophthalmos in her right eye.Within 6 d,her consciousness improved considerably;at which time,exposure keratopathy occurred and worsened to corneal ulceration.Lubricating gel,antibiotic ointment,and bandage contact lens were all ineffective in preventing or treating the exposure keratopathy.Instead of tarsorrhaphy,a moisture chamber was applied which successfully controlled the corneal ulceration.The moisture chamber was discontinued when complete eyelid closure recovered a week later.CONCLUSION A moisture chamber may be an effective,noninvasive alternative to tarsorrhaphy for treating severe exposure keratopathy due to temporary lagophthalmos.
文摘The purpose of this study was to assess the correlation between iron deficiency and recurrent aphthous ulceration (RAU). Radioimmunoassay was used to examine the serum ferritin level (SFL) in 52 patients with RAU and in 54 controls. Both were divided into 2 groups in accordance with sex. The 36 female patients were subdivided into 3 age-groups as follows: 8 aged 22-24, 10 aged 25-34, and 18 aged 35-50 while the male patients were gathered as one single group aged 26-57. The subdivision was adapted similarly for the normal age-grouts. Although no significant difference in SFL was found between the male control and the male patient groups, differences between the female control and female patient groups showed highly significant which levels, with the ascendance of age, were P【0.001, P【0.005 and P【0.001, respectively. Also the difference between male and female control groups were significant (P【0.05). However, no significant differences in SFL were discovered among the 3 patient groups. 10 female patients with SFL【12ng/ml were tested with ferrous sulfate for one month, then their SFL was reexamined one week after the treatment. A highly significant difference in SFL was noted between the pre-ad post-treatment (P【0.001). 9 of them showed that the interval of recurrences were prolonged, the number of ulcers reduced, the pain less intensive and its duration shorter than those before the treatment. This study demonstrated that a singificant decrease in iron-storage occurred in female RAU patients. The authors concluded that the decrease SFL was possibly related to menstruation and child bearing.
文摘Genital ulceration is the loss of integrity of the mucous membranes (or genital skin) leaving the dermis uncovered and almost always accompanied by satellite lymphadenopathies. Beyond a month of evolution, it is said to be chronic. Sexually transmitted diseases are infections due to microbial agents among which parasites, bacteria, viruses and fungi that can be associated with each other to varying degrees. Sexually transmitted infections must be mentioned before any genital ulceration. Hence the interest of the case that we report of chronic anogenital ulcerations complicating a polymicrobial pelvic infection in a patient immunocompromised to HIV. The physical examination reveals a hypogastric sensitivity to deep palpation, the presence of a superinfected anogenital ulceration exposing the deep dermis covered with purulent serosities interesting the labia minora, the posterior vaginal fork, the anal region, the clitoris and an extension of the lesions to the gluteal fold is observed. We found a satellite lymphadenopathy in the right inguinal fold. The screening finds the HIV1 positive serology with a viral load of 28,000 copies, the herpes simplex 1&2 and Chlamydia trachomatis serologies were all positive. The genital samples are marked by the presence of bacterial vaginosis with Candida Albicans and Gardnerella Vaginalis, the presence of urogenital mycoplasmas of the Ureaplasma Urealyticum The pelvic ultrasound was in favor of a bilateral adnexitis. A protocol was put in place: the first step consisted of seat baths, antifungi and antibiotics administration: fluconazole 150 mg and tinidazole 2 g in single doses, then josamycin 1 g/24h in two doses per os for two weeks. The second stage consists of the administration of doxycycline 200 mg for 21 days, Aciclovir 500 mg for 10 days, and the administration of ARV (Tenofovir + Lamivudine + Dolutegravir) or one tablet daily. The evolution is marked by a progressive healing of the clitoris, the labia majora and labia minora, the posterior vaginal fork. In case of chronicity, a biopsy in search of a tumor process is not mandatory when there is a satisfactory response to treatment and good healing. The patient’s death two weeks after the beginning of ARV treatment, can be explained by a probable immune reconstitution syndrome.
文摘Background: Marginal ulceration (MU) is a recognized complication of Roux-en-Y gastric bypass (RYGB) surgery. While several possible risk factors have been reported, the mechanism of MU remains incompletely understood. The aim of this study was to compare the effect of surgical technique on the incidence of MU. Methods and Material: This was a retrospective study of 749 patients undergoing RYGB over a ten-year period with at least one year of follow-up. The diagnosis of MU was made based on clinical symptoms and confirmed by postoperative endoscopy (POE). We assessed four different gastric bypass (GBP) techniques: T1—Open, non-divided stomach, circular stapler, non-vagotomy (n = 332);T2—Open, divided stomach, circular stapler, vagotomy (n = 91);T3—Laparoscopic, divided, circular stapler, vagotomy (n = 152);T4—Laparoscopic, divided, linear stapler, vagotomy (n = 174). Results: The four groups were similar with respect to age and mean BMI. The frequency of POE was 16%, 25%, 28% and 27% in groups T1-T4 respectively (NS). The incidence of MU was significantly lower in T1 (2.1%) compared to T2 (5.5%), T3 (15.1%) and T4 (12.6%), p 0.05. MU occurred significantly more frequently with an antecolic Roux limb versus retrocolic (14.5% vs 5.6%, p 0.05). Conclusion: The incidence of MU after RYGB surgery is influenced by surgical technique. The lowest incidence of MU was with a non-divided stomach, no vagotomy, transverse staple line, and circular stapled anastomosis. A retrocolic Roux limb was protective. There was no difference in the incidence of MU using laparoscopic versus open bypass if a similar technique was employed or using linear versus circular stapler for the gastrojejunostomy.
文摘Background: Diabetic foot together with open wounds in distal type peripheral arterial disease constitutes a challenge in therapeutic planning. Ozone therapy may unveil new horizons in management. Case Report: A 67-year-old woman with diabetes mellitus was applied with open wounds at the bottom of her foot with purulent discharge, with a decision for above ankle amputation. She had had numerous interventions for her wounds including metatarsal amputations due to osteomyelitis and had been on an intense treatment including antibiotics, insulin, antihypertensives and antiaggregants. Angiogram revealed diffuse peripheral arterial disease in lower extremities. All medication but antihypertensives was stopped. She received major medical ozone application as 2000 gamma/session i.v. for 2 weeks, external ozone sac application starting from 60 and dropping to 30 gamma/session for 3 weeks and ozone insuflation 40 gamma/session for 10 sessions. Her purulent discharge ceased after the third session and the atonic debris of the wounds exfoliated, the wounds healed from the base towards the surface of the skin. She was then put on cilostazol and clopidogrel therapy. Conclusion: By being one of the known strongest bactericide, virucide, and fungicide elements, medical ozone therapy stimulates and upregulates the antioxidant system of the body with its hormesis effects. After the cessation of all circulatory system supporting medication (as their interaction with ozone is not clear yet), appropriate ozone therapy may bring new horizons for patients when all classically known methods of treatment have been completed, before assigning the patients for amputation.
文摘Epstein-Barr virus (EBV) mucocutaneous ulceration is a rare complication of immunosuppression that results in painful ulceration of the tongue or gingiva, and less commonly, refractory ulceration of the gastrointestinal tract. High clinical suspicion is required, as failure to diagnose EBV mucocutaneous ulceration may result in significant morbidity and mortality. We report the case of a 64-year-old female renal transplant recipient requiring admission to hospital for management of severe oral and epigastric pain. Examination revealed a large, superficial, well-circumscribed ulcer at the base of the tongue. Blood tests suggested a secondary immunodeficiency characterised by mild leucopenia, hypogammaglobulinaemia, and low memory B-cells with normal immunophenotype. Endoscopy revealed four, cratered ulcers in the pre-pyloric region of the stomach. A core biopsy of the tongue ulcer confirmed EBV mucocutaneous ulceration. The patient’s immunosuppression was optimised, which resulted in complete resolution of the tongue and gastric ulcers at eight and twelve weeks of follow-up respectively.
文摘INTRODUCTIONIt is generally accepted that Helicobacter pylori ( H.pylori) infection has a role in duodenal ulceration .Eradicaton of H .pylori accelerates healing compared with placebo in the absence of control of gastric secretion and reduces ulcer recurrence .There is increasing evidence ,however ,that is may not be the primary cause of duodenal ulceration ,but that is may be a secondary factor in a nnmber of cases .This possibility is supported by four sets of observations : 1 Geographical distribution:
文摘AIM To investigate management of patients who develop ipilimumab-mediated enterocolitis, including association of endoscopic findings with steroid-refractory symptoms and utility of infliximab as second-line therapy.METHODS We retrospectively reviewed all patients at our centerwith metastatic melanoma who were treated with ipilimumab between March 2011 and May 2014. All patients received a standard regimen of intravenous ipilimumab 3 mg/kg every 3 wk for four doses or until therapy was stopped due to toxicity or disease progression. Basic demographic and clinical data were collected on all patients. For patients who developed grade 2 or worse diarrhea(increase of 4 bowel movements per day), additional data were collected regarding details of gastrointestinal symptoms, endoscopic findings and treatment course. Descriptive statistics were used.RESULTS A total of 114 patients were treated with ipilimumab during the study period and all were included. Sixteen patients(14%) developed ≥ grade 2 diarrhea. All patients were treated with high-dose corticosteroids(1-2 mg/kg prednisone daily or equivalent). Nine of 16 patients(56%) had ongoing diarrhea despite highdose steroids. Steroid-refractory patients received one dose of intravenous infliximab at 5 mg/kg, and all but one had brisk resolution of diarrhea. Fourteen of the patients underwent either colonoscopy or sigmoidoscopy with variable endoscopic findings, ranging from mild erythema to colonic ulcers. Among 8 patients with ulcers demonstrated by sigmoidoscopy or colonoscopy, 7 patients(88%) developed steroidrefractory symptoms requiring infliximab. With a median follow-up of 264 d, no major adverse events associated with prednisone or infliximab were reported.CONCLUSION In patients with ipilimumab-mediated enterocolitis, the presence of colonic ulcers on endoscopy was associated with a steroid-refractory course.
文摘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 nonspecif ic 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.
