RESUMEN
BACKGROUND: Colonic angiodysplasia (AGD) is a common cause of gastrointestinal bleeding. However, information on the characteristics and prevalence of colonic AGD is limited. We determined the clinical features of and risk factors for active bleeding in colonic AGD in a Taiwanese population. METHODS: From February 2007 to December 2016, 13,047 patients undergoing 16,760 colonoscopies at the Tri-Service General Hospital were included in this study. Eighty-four patients were diagnosed with AGD. We conducted a retrospective study by analyzing the medical records of these patients. The clinical features and endoscopic findings were evaluated. Furthermore, we distinguished colonic AGD into bleeding and non-bleeding types and identified the risk factors for bleeding in colonic AGD. RESULTS: In our study, the prevalence of colonic AGD was 0.6% among all patients who received colonoscopy. Among patients with colonic AGD, we found that many were aged; in all, 58.3% of patients with colonic AGD were older than 65 years. More than half of the patients had hypertensive cardiovascular disease (53.6%) and the AGD lesions were predominantly located in the left-sided colon (41.7%). We analyzed several factors to identify those associated with bleeding colonic AGD. Our results indicated that age (p < 0.001), hypertension (p = 0.020), atrial fibrillation (p = 0.027), and in-patient status (p = 0.006) were significant factors associated with active bleeding lesions. On multivariate analysis, old age was the only significant risk factor. CONCLUSION: Angiodysplastic lesions in Taiwanese patients were predominantly identified in the left-sided colon. Old age was an independent risk factor associated with active bleeding in colonic angiodysplasia.
Asunto(s)
Angiodisplasia/epidemiología , Colon/patología , Enfermedades del Colon/epidemiología , Colonoscopía , Hemorragia Gastrointestinal/etiología , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Angiodisplasia/complicaciones , Pueblo Asiatico , Enfermedades del Colon/complicaciones , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estudios Retrospectivos , Factores de Riesgo , Taiwán/epidemiología , Adulto JovenRESUMEN
BACKGROUND/AIM: The mortality rate for alimentary tract hemorrhage remains high due to a variety of contributing factors. In this report, we present a case of post-severe trauma patient with life-threatening gastrointestinal bleeding caused by cytomegalovirus (CMV)-induced damage to the terminal ileum. CASE REPORT: A 76-year-old female with a history of hypertension and gastrointestinal bleeding developed CMV ileitis post-severe trauma. Despite negative CMV IgM antibodies, PCR testing confirmed CMV infection in the biopsy tissue. Histopathological examination revealed viral inclusion bodies, with immunohistochemistry confirming CMV presence. RESULTS: Intravenous ganciclovir effectively managed symptoms and halted bleeding. CMV ileitis, typically seen in immunocompromised states, may occur sporadically in immunocompetent individuals, including post-orthopedic surgery patients. The exact mechanism remains unclear, possibly related to surgical stress. Diagnosis relies on histopathology and immunohistochemistry. CONCLUSION: Early recognition and treatment are vital for optimal outcomes, emphasizing the need for awareness among orthopedic surgeons regarding CMV as a potential cause of postoperative complications.
Asunto(s)
Infecciones por Citomegalovirus , Citomegalovirus , Ileítis , Humanos , Infecciones por Citomegalovirus/complicaciones , Infecciones por Citomegalovirus/diagnóstico , Femenino , Anciano , Citomegalovirus/genética , Ileítis/diagnóstico , Ileítis/etiología , Ileítis/virología , Ileítis/complicaciones , Ileítis/patología , Antivirales/uso terapéutico , Ganciclovir/uso terapéutico , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/virología , Heridas y Lesiones/complicacionesRESUMEN
The pervasive presence of plastic waste in the aquatic environment is widely viewed as one of the most serious environmental challenges for current and future generations. Microplastics ultimately degrade into nano and smaller-sizes. In turn, their biological and ecological impacts become more complicated and ambiguous. Nano-plastic particles travel from freshwater systems to estuarine and oceanic regions, during which they can interact with dissolved organic matter (DOM) to form microgels. Microgel formation is ubiquitous in aquatic systems, serving as a shunt between DOM and particulate organic matter (POM), as well as playing key roles in particle aggregation/sedimentation and pollutant transport. Currently the influences and mechanisms of the aggregation behavior and environmental fate of nano-plastics in different aquatic environments is poorly understood. Here, we report that 25 nm polystyrene nano-particles in lake and river water can promote POM (microgel) formation and accelerate the DOM-POM transition. We also adjusted various salinities of water samples to simulate scenarios based on plastic transport in waters flowing from rivers to seas. The results indicate polystyrene nanoparticles can interact with organic matter to form large organic particles, which may undergo further settling in response to specific salinity levels. Polystyrene-induced microgel formation appears to involve the hydrophobic interactions between plastics and DOM. Our data provides much needed information for modeling and understanding the retention and sedimentation of nano-plastics. We show that nano-plastics alter the DOM-POM shunt to cause unanticipated perturbations in the functionality of aquatic ecosystems.