Immersion Ultrasound Therapy in Combination with Manual Therapy in the Treatment of Ischemic Digital Ulcers in Systemic Sclerosis.

Background and Objectives: Digital ulcers (DUs) are the most common complication in patients with Systemic Sclerosis (SSc). They cause pain with hand dysfunction and negatively impact activities of daily and working life. Our study aims to evaluate the efficacy of a combined treatment of manual therapy and ultrasound therapy in SSc patients with ischemic DU (IDU) compared to manual therapy alone. Materials and Methods: We conducted a before-and-after study (non-randomized study). We enrolled a consecutive series of IDU patients undergoing rehabilitation treatment and divided them into two groups: a treatment group consisting of patients undergoing a combination of manual therapy and US water immersion and a standard care group consisting of patients subjected to manual therapy alone. At the time of the first visit (T0) and at the end of the 4-week rehabilitation period (T1), we evaluated functional capacity, pain intensity, ulcer evolution, and quality of life. Results: In the treatment group, we observed a statistically significant improvement in the functional capacity of the hand (DHI: 28.15 ± 11.0 vs. 19.05 ± 8.83; p < 0.05), pain (NRS: 5.55 ± 1.2 vs. 2.9 ± 1.09; p < 0.05), and PSST score (24.4 ± 4.0 vs. 16.2 ± 2.36; p < 0.05). In the standard care group, we observed a statistically significant improvement only for the functional capacity of the hand (DHI: 28.85 ± 9.72 vs. 22.7 ± 7.68; p < 0.05). Finally, from the comparison between the treatment group and the standard care group, we observed statistically significant improvements in pain (2.9 ± 1.09 vs. 4.5 ± 1.07; p < 0.05) and in the PSST scale (16.2 ± 2.36 vs. 20.4 ± 4.02; p < 0.05). Furthermore, at the end of treatment in the treatment group, 15 ulcers (62.5%) were completely healed, while in the standard care group, only 3 ulcers were completely healed (14.3%). Conclusions: Combined treatment with manual therapy and ultrasound therapy appears to be useful in the management of IDU in patients with scleroderma.

Advances in the pharmacotherapeutic management of refractory peptic ulcers.

INTRODUCTION: Refractory peptic ulcer is now a rare disease since most peptic ulcers heal with appropriate treatment with proton pump inhibitors (PPIs) and/or Helicobacter pylori eradication. AREAS COVERED: The most frequent cause of apparent refractoriness is lack of adherence to treatment. Persistence of H. pylori infection, use or abuse (often surreptitious) of high dose non-steroidal anti-inflammatory drugs (NSAIDs) or aspirin (ASA) are the two major causes of true refractory ulcers. There is a growing number of peptic ulcers which are not linked to either NSAIDs or H. pylori infection. Refractoriness in these ulcers can be linked to gastric acid hypersecretion, rapid PPI metabolization, ischemia, chemo-radiotherapy, immune diseases, more rarely to other drugs or be fully idiopathic. Treatment of the cause of the ulcer, if known, is essential. This review is based on pertinent publications retrieved by a selective search in PubMed, with particular attention to refractory peptic ulcer. EXPERT OPINION: High-dose PPI or the new potassium competitive acid blocker or the combination of PPIs with misoprostol can be recommended in these cases. Other more experimental treatments such the topical application of platelet-rich plasma or mesenchymal stem cells have also been suggested. Surgery is the last option, but there is no guarantee of success, especially in NSAID or ASA abusers.

Endoscopic Submucosal Dissection and Teprenone for Early Gastric Cancer, With Evaluation of eCura Scoring System.

Context: Early gastric cancer is a common, malignant, tumor disease. Compared with traditional surgical methods, endoscopic mucosal dissection (ESD) is a minimally invasive surgery; however, in practice, it still carries some surgical risks. Teprenone is a common drug that protects the gastric mucosa and promotes the recovery of gastric mucosal and gastrointestinal function. Objective: The study intended to investigate the clinical efficacy of endoscopic mucosal dissection combined with teprenone for early gastric cancer, including an evaluation of the combined treatment using the eCura scoring system, with a view to providing the results as a reference for the choice of treatment modality for early gastric cancer. Design: The research team performed a prospective controlled study. Setting: The study took place in the Department of General Surgery, Huidong, at Zigong Fourth People's Hospital in Zigong, China. Participants: Participants were patients with early gastric cancer, 58 who were admitted to the hospital between January 2019 and June 2020 and 58 who were admitted between July 2020 and December 2021. Intervention: The research team assigned: (1) the 58 patients in the earlier group to the control group, and they received treatment using endoscopic mucosal dissection; and (2) the 58 patients in the latter group to be the intervention group, and they received treatment using endoscopic mucosal dissection combined with teprenone. Outcome Measures: The research team examined participants' postoperative: (1) abdominal pain scores; (2) size of ulcer wound area, (3) complications-delayed bleeding, ulcer perforation, fever, or abdominal pain; (4) risk as measured by the eCura scoring system-low, medium, or high risk; and (5) survival rates of those assessed at different risks under the eCura scoring systems. Results: Postoperatively, the intervention group's abdominal pain scores on days 3 and 5 and the size of the groups' ulcer areas at days 7 and 14 were significantly lower than those of the control group (all P < .001). The intervention group's total incidence of postoperative complications, at 3.45%, was significantly lower than that in the control group, at 20.69% (P = .004). The number of participants low risk was 39 (67.25%), as assessed by eCura scoring system, which was significantly higher than that of the control group, at 22 participants (37.93%). The intervention groups' overall survival rate, at 98.28%, was significantly higher than that of the control group, at 69.49% (P < .001). Conclusions: Endoscopic mucosal dissection combined with teprenone as a treatment for early gastric cancer can achieve a significantly better therapeutic effect than can endoscopic mucosal dissection only. It can reduce the risk of postoperative complications and improve the assessment of risk found with the eCura scoring system. It can have an important role in improving the postoperative survival rate of patients with early gastric cancer and is worthy of clinical application.

Epstein-Barr virus-positive mucocutaneous ulcer, plasmablastic type, associated with nodal CD4+ angioimmunoblastic T-cell lymphoma and generalised pruritus: a self-limiting lymphoproliferative disorder resembling cutaneous plasmablastic lymphoma.

A woman in her 80s reported of generalised pruritus, which was treated with phototherapy and steroid administration. Two months after onset, lymph node biopsy revealed CD4+ angioimmunoblastic T-cell lymphoma with systemic superficial nodal involvement. Intractable prurigo was judged as T-cell lymphoma related. After effective chemotherapy (7 months later), skin nodules appeared multifocally, including on the lip, thumb and lower leg. The biopsied infiltrative lesion on the right lower leg microscopically revealed subcutaneous growth of atypical plasmablasts with nearly 100% Ki-67 labelling and Epstein-Barr virus (EBV)-encoded small nuclear RNA positivity. Plasmablastic lymphoma (CD45/CD19/CD38/CD138/MUM1+, CD20/CD79a/PAX5-) was suspected. Immunoglobulin light-chain restriction and nuclear expression of c-myc protein were undetectable, and the ulcers were spontaneously epithelialised by the cessation of steroid administration. After 10 months, non-progressive prurigos persisted on the extremities, but without regrowth of nodal T-cell lymphoma and cutaneous lymphoproliferative lesion. Reactive nature of the EBV-induced mucocutaneous plasmablastic growth (EBV-positive mucocutaneous ulcer, plasmablastic type) is discussed.

Treatment of Raynaud phenomenon and ischemic ulcers associated to systemic sclerosis with hyperbaric oxygen.

We describe 4 patients with Raynaud's phenomenon associated with systemic sclerosis, 3 with ischaemic ulcers, successfully treated with hyperbaric oxygen. This therapy has been useful in the treatment of chronic wounds due to its anti-inflammatory, antimicrobial and angiogenic effects. Hyperbaric oxygen treatment could be a therapeutic option in patients with Raynaud's phenomenon refractory to conventional treatment.

Machaerium hirtum (Vell.) Stellfeld Alleviates Acute Pain and Inflammation: Potential Mechanisms of Action.

:Machaerium hirtum (Vell.) Stellfeld (Fabaceae) known in Brazil as "jacaranda de espinho" or "espinheira santa nativa" is a medicinal plant commonly used in folk medicine to treat ulcers, cough and diarrhea. This study aimed to investigate the anti-inflammatory and antinociceptive effects of hydroalcoholic extracts from M. hirtum twig (HEMh) using in vivo experimental models of nociception through the involvement of transient receptor potential channels, acid-sensing ion channel (ASIC), nitrergic, opioidergic, glutamatergic, and supraspinal pathways. Our results revealed an antinociceptive effect of HEMh mediated by the opioidergic, L-arginine-nitric oxide and glutamate systems, as well as by interactions with TRPA1/ASIC channels. The anti-inflammatory effect of HEMh evaluated with a xylene-induced ear edema and by the involvement of arachidonic acid and prostaglandin E2 (PGE2) showed involvement of the COX pathway, based on observed decreases in PGE2 levels. A phytochemical investigation of the HEMh led to the isolation of α-amyrin, ß-amyrin, allantoin, apigenin-7-methoxy-6-C-ß-D-glucopyranoside, and apigenin-6-C-ß-D-glucopyranosyl-8-C-ß-D-xylopyranoside. In conclusion, the acute oral administration of HEMh inhibits the nociceptive behavioral response in animals through the nitrergic, opioid, glutamatergic pathways, and by inhibition of the TRPA1 and ASIC channels, without causing locomotor dysfunction. In addition, its anti-inflammatory effect is associated with the COX pathway and decreased PGE2 levels.

Successful treatment of repeated hematemesis secondary to postsclerotherapy esophageal ulcer in a cirrhotic patient: A case report.

Esophageal variceal bleeding is a common lethal complication of cirrhosis. Endoscopic injection sclerotherapy (EIS) is one of the major endoscopic approaches for treating esophageal variceal bleeding. However, complications may occur after EIS, which mainly include retrosternal discomfort/pain, dysphagia, re-bleeding, esophageal ulcer, esophageal strictures, and esophageal perforation, etc. In this article, we reported a 36-year-old male who developed esophageal ulcer related bleeding after EIS. Currently, there is no consensus on the treatment strategy for esophageal ulcer-related bleeding after EIS. In the present case, the following treatment strategy may be effective for ulcer related bleeding. The first step is to inhibit gastric acid secretion and reduce portal pressure by intravenous infusion of esomeprazole and somatostatin, respectively. The second is local hemostasis by oral norepinephrine and lyophilizing thrombin powder. The third is to protect digestive tract mucosa by oral Kangfuxin Ye and aluminum phosphate.

Carotenoid-enriched transgenic corn delivers bioavailable carotenoids to poultry and protects them against coccidiosis.

Carotenoids are health-promoting organic molecules that act as antioxidants and essential nutrients. We show that chickens raised on a diet enriched with an engineered corn variety containing very high levels of four key carotenoids (ß-carotene, lycopene, zeaxanthin and lutein) are healthy and accumulate more bioavailable carotenoids in peripheral tissues, muscle, skin and fat, and more retinol in the liver, than birds fed on standard corn diets (including commercial corn supplemented with colour additives). Birds were challenged with the protozoan parasite Eimeria tenella and those on the high-carotenoid diet grew normally, suffered only mild disease symptoms (diarrhoea, footpad dermatitis and digital ulcers) and had lower faecal oocyst counts than birds on the control diet. Our results demonstrate that carotenoid-rich corn maintains poultry health and increases the nutritional value of poultry products without the use of feed additives.

Atividade antiulcerogênica do extrato aquoso de Salvia officinalis L. (Lamiaceae) / Antiulcerogenic activity of aqueous extract of Salvia officinalis L. (Lamiaceae)

RESUMO As úlceras pépticas são decorrentes de um desequilíbrio entre os agentes agressores endógenos, exógenos e agentes protetores. Neste estudo avaliou-se a atividade antiulcerogênica in vivo para o extrato aquoso de Salviaofficinalis (EAS). Após os tratamentos (n = 6; v.o) com o controle (C) água; pantoprazol (30 mg/kg) e EAS (100, 250 e 400 mg/kg, respectivamente) os ratos receberam uma solução de HCl 0,3 M em etanol 60% (v.o) e realizaram-se avaliações morfológicas dos estômagos por meio de uma tabela de escores de lesão (ANOVA; one way e Tukey). EAS (400 mg/kg) apresentou atividade antiulcerogênica (31,47%) semelhante ao pantoprazol (33,83%) em comparação (p<0,0001) com o grupo C. A análise fitoquímica por cromatografia líquida de alta eficiência revelou uma elevada concentração de ácido rosmarínico (3,53%) para EAS. Os flavonoides (0,25%) e os fenóis totais (309,0 EAG) foram quantificados por espectrofotometria de UV/Vis. EAS e ácido rosmarínico apresentaram elevadas atividades antioxidantes por DPPH (Concentração Efetiva 50%-CE50 9,2 e 0,7 mg/mL, respectivamente) justificando pelo menos em parte, o efeito antiulcerogênico do extrato.

ABSTRACT Peptic ulcers are caused by an unbalance among endogenous, exogenous damaging agents and protective agents. In this study we evaluated the in vivo antiulcerogenic activity for the aqueous extract of Salvia officinalis (EAS). After treatments (n = 6; v.o) with control (C) water; pantoprazole (30 mg/kg) and EAS (100, 250 and 400 mg/kg, respectively) the rats received a 0.3 M HCl solution in ethanol 60% (v.o) and it were performed morphological evaluations of the stomachs through the use of a table of injury scores (ANOVA, one way and Tukey). The EAS (400 mg/kg) showed an antiulcerogenic activity (32.53%). Similar to the pantoprazole (29.91%), in comparison with (p<0.0001) the group C. The phytochemical analysis through high performance liquid chromatography revealed high acid rosmarinic (3.53%) for the EAS. The flavonoids (0.25%) and the total phenolics (GAE 309.0) were quantified by spectrophotometry UV/Vis. The EAS and the rosmarinic acid exhibited elevated antioxidant activities by DPPH (Effective Concentration 50% -EC50 9.2 and 0.7 mg/mL, respectively,) at least partially explaining the antiulcerogenic effect of the extract.

Scleroderma and evidence based non-pharmaceutical treatment modalities for digital ulcers: a systematic review.

OBJECTIVE: Digital ulcers are difficult to heal, increasing the chance of infection, gangrene, amputation and limited functional use of hands. They are a complication in scleroderma or systematic sclerosis (SSc) and occur in approximately 50% of patients. This is a systematic review of the evidence supporting the use of non-pharmaceutical therapeutic modalities and their effectiveness to facilitate the healing of chronic digital ulcers in patients with scleroderma. METHOD: A comprehensive review of computerised databases from 2000-2013: PubMed/MEDLINE, CINAHL, Pedro, OT Seeker, OT Search, OVID, and Proquest as well as manual review of other resources was completed using the following search terms scleroderma or systemic sclerosis and/or digital ulcers, specific modalities (low level laser therapy, electrical stimulation, intermittent compression, ultrasound, vitamin E, myofascial release, wound dressings, iontophoresis, negative pressure therapy, and exercise), chronic wounds, and wound care. English language studies, from 2000 to January 2013, which used therapeutic modalities to facilitate healing of digital ulcers and use healing of the digital ulcer as an outcome measure were reviewed. RESULTS: Of the 403 identified articles, only 11 studies addressed non-pharmaceutical treatment modalities to facilitate healing for digital ulcers. Exercise had no direct effect on healing ulcers. The following studies were positive but have limitations in design and sample size:: hyperbaric oxygen therapy (n=2), negative pressure therapy (n=1), intermittent compression (n=27) and acoustic pressure wound healing (n=1). Vitamin E gel showed a significant difference compared to a control group (n=27). Iontophoresis studies have shown that the modality increases blood flow but the results in five different studies are mixed and the application and intensity were inconsistent. CONCLUSION: No one modality was proven to be the most effective. Larger efficacy studies on treating digital ulcers are needed in order to develop appropriate care guidelines to improve outcomes, promote function and lower health-care costs.

Comparison of hemostatic efficacy of argon plasma coagulation with and without distilled water injection in treating high-risk bleeding ulcers.

BACKGROUND: Argon plasma coagulation (APC) is useful to treat upper gastrointestinal bleeding, but its hemostatic efficacy has received little attention. Aims. This investigation attempted to determine whether additional endoscopic injection before APC could improve hemostatic efficacy in treating high-risk bleeding ulcers. METHODS: From January 2007 to April 2011, adult patients with high-risk bleeding ulcers were included. This investigation compared APC plus distilled water injection (combined group) to APC alone for treating high-risk bleeding ulcers. Outcomes were assessed based on initial hemostasis, surgery, blood transfusion, hospital stay, rebleeding, and mortality at 30 days posttreatment. RESULTS: Totally 120 selected patients were analyzed. Initial hemostasis was accomplished in 59 patients treated with combined therapy and 57 patients treated with APC alone. No significant differences were noted between these groups in recurred bleeding, emergency surgery, 30-day mortality, hospital stay, or transfusion requirements. Comparing the combined end point of mortality plus the failure of initial hemostasis, rebleeding, and the need for surgery revealed an advantage for the combined group (P = 0.040). CONCLUSIONS: Endoscopic therapy with APC plus distilled water injection was no more effective than APC alone in treating high-risk bleeding ulcers, whereas combined therapy was potentially superior for patients with poor overall outcomes.

Actualización de la enfermedad de Behçet. A propósito de 2 casos en atención primaria / Update of Behçet disease. A presentation of 2 cases in Primary Care

La enfermedad de Behçet es una enfermedad inflamatoria multisistémica crónica que evoluciona por brotes. Es más común en Asia y en los países de la cuenca mediterránea oriental (Ruta de la Seda). En España la prevalencia es de 5 a 10 casos por 100.000 habitantes. Es una enfermedad de difícil diagnóstico por las numerosas y variadas manifestaciones clínicas y porque no se dispone de pruebas de laboratorio patognomónicas. El retraso en el diagnóstico, frecuente en países de baja prevalencia como España, aumenta la morbilidad y la mortalidad de los pacientes con enfermedad de Behçet (AU)

Behçet's disease is an inflammatory multisystemic chronic disease that progresses by outbreaks. It is more common in Asia and countries in the eastern Mediterranean basin (Silk Route). In Spain the prevalence is between 5 and 10 cases per 100,000 inhabitants. It is a difficult disease to diagnose because of the multiple and varied clinical manifestations, and because there are not pathognomonic laboratory tests available. The delay in the diagnosis, which is frequent in countries of low prevalence like Spain, increases the morbidity and the mortality of patients with Behçetìs disease (AU)

A rare cause of chronic rectal bleeding in children; solitary rectal ulcer: case report.

Solitary rectal ulcer causing lower gastrointestinal bleeding is extremely rare in children. Rare presentation, non-specific symptoms, insufficient experience, and characteristics mimicking other rectal diseases may cause misdiagnosis or delay of diagnosis in some pediatric patients. Here, we report a 10-year-old boy with solitary rectal ulcer diagnosed two years after onset of the symptoms who responded well to the conservative therapy, including high-fiber diet, laxatives, defecation training, and sucralfate enema.

[Esophageal sinus formation due to cyanoacrylate injection for esophageal variceal ligation-induced ulcer bleeding in a cirrhotic patient].

Intravariceal injection of N-butyl-2-cyanoacrylate is widely used for the hemostasis of bleeding gastric varices, but not routinely for esophageal variceal hemorrhage because of various complications such as pyrexia, bacteremia, deep ulceration, and pulmonary embolization. We report a rare case of esophageal sinus formation after cyanoacrylate obliteration therapy for uncontrolled bleeding from post-endoscopic variceal ligation (EVL) ulcer. A 50-year-old man with alcoholic liver cirrhosis presented with hematemesis. Emergent esophagogastroscopy revealed bleeding from large esophageal varices with ruptured erosion, and bleeding was initially controlled by EVL, but rebleeding from the post-EVL ulcer occurred at 17th day later. Although we tried again EVL and the injections of 5% ethanolamine oleate at paraesophageal varices, bleeding was not controlled. Therefore, we administered 1 mL cyanoacrylate diluted with lipiodol and bleeding was controlled. Three months after the endoscopic therapy, follow-up endoscopy showed medium to large-sized esophageal varices and sinus at lower esophagus. Barium esophagography revealed an outpouching in esophageal wall and endoscopic ultrasonography demonstrated an ostium with sinus. It is noteworthy that esophageal sinus can be developed as a rare late complication of endoscopic cyanoacrylate obliteration therapy.

Esophageal Sinus Formation due to Cyanoacrylate Injection for Esophageal Variceal Ligation-induced Ulcer Bleeding in a Cirrhotic Patient / 대한소화기학회지

Intravariceal injection of N-butyl-2-cyanoacrylate is widely used for the hemostasis of bleeding gastric varices, but not routinely for esophageal variceal hemorrhage because of various complications such as pyrexia, bacteremia, deep ulceration, and pulmonary embolization. We report a rare case of esophageal sinus formation after cyanoacrylate obliteration therapy for uncontrolled bleeding from post-endoscopic variceal ligation (EVL) ulcer. A 50-year-old man with alcoholic liver cirrhosis presented with hematemesis. Emergent esophagogastroscopy revealed bleeding from large esophageal varices with ruptured erosion, and bleeding was initially controlled by EVL, but rebleeding from the post-EVL ulcer occurred at 17th day later. Although we tried again EVL and the injections of 5% ethanolamine oleate at paraesophageal varices, bleeding was not controlled. Therefore, we administered 1 mL cyanoacrylate diluted with lipiodol and bleeding was controlled. Three months after the endoscopic therapy, follow-up endoscopy showed medium to large-sized esophageal varices and sinus at lower esophagus. Barium esophagography revealed an outpouching in esophageal wall and endoscopic ultrasonography demonstrated an ostium with sinus. It is noteworthy that esophageal sinus can be developed as a rare late complication of endoscopic cyanoacrylate obliteration therapy.

Healing of solitary rectal ulcers with multiple sessions of argon plasma coagulation.

BACKGROUND: Solitary rectal ulcer syndrome (SRUS) is an uncommon disorder of evacuation. Management of bleeding ulcers is usually unsatisfactory with conventional treatment. Argon plasma coagulation (APC) has been reported to control bleeding; however, it has not been shown to result in ulcer healing. The aim of the present study was to: (i) to investigate the efficacy and safety of APC in controlling bleeding from SRUS; and (ii) to study its efficacy in the healing of ulcer/s. METHODS: Twenty-four patients with bleeding SRUS diagnosed on clinical, colonoscopic, and histological findings were randomized to receive either standard care alone (12 patients) or to undergo multiple sessions of APC in addition (12 patients). All patients were followed up to determine ulcer healing. RESULTS: Twenty-four patients with a mean duration of symptoms of 12.6 +/- 4.8 months were included. Bleeding was controlled with one (n = 5) or two sessions (n = 7) of APC. Reduction in size and depth of ulcer was noted. Eight out of 12 patients who received APC had complete healing of ulcers after four to eight sessions, carried out 2-4 weeks apart. The remaining four patients had a reduction in size and depth of ulcers compared to their pretreatment appearance. All patients were advised to have a high intake of fluids, fiber and laxatives, and to undergo biofeedback and behavior modification therapy in addition to the treatment. CONCLUSIONS: APC controls bleeding in patients with SRUS and it also improves the healing of these ulcers.

Esophageal ulcer in Brazilian patients with HIV: prevalence and comparative analysis among diagnostic methods.

Esophageal ulcer (EU) represents an important comorbidity in AIDS. We evaluated the prevalence of EU, the accuracy of the endoscopic and histologic methods used to investigate viral EU in HIV-positive Brazilian patients and the numerical relevance of tissue sampling. A total of 399 HIV-positive patients underwent upper gastrointestinal (UGI) endoscopy. HIV-positive patients with EU determined by UGI endoscopy followed by biopsies were analyzed by the hematoxylin-eosin (HE) and immunohistochemical (IH) methods. EU was detected in 41 patients (mean age, 39.2 years; 23 males), with a prevalence of 10.27%. The median CD4 count was 49 cells/mm(3) (range, 1-361 cells/mm(3)) and the viral load was 58,869 copies per milliliter (range, 50-77,3290 copies per milliliter). UGI endoscopy detected 29 of 41 EU suggestive of cytomegalovirus (CMV) infection and 7 of 41 indicating herpes simplex virus (HSV) infection. HE histology confirmed 4 of 29 ulcers induced by CMV, 2 of 7 induced by HSV, and 1 of 7 induced by HSV plus CMV. IH for CMV and HSV confirmed the HE findings and detected one additional CMV-induced case. UGI endoscopy showed 100% sensitivity and 15% specificity for the diagnosis of EU due to CMV or HSV compared to HE and IH. HE proved to be an adequate method for etiologic evaluation, with 87% sensitivity and 100% specificity compared to IH. The number of samples did not influence the etiologic evaluation. The data support the importance of IH as a complementary method for HE in the diagnosis of EU of viral etiology.

Healing of a bleeding solitary rectal ulcer with multiple sessions of argon plasma.

BACKGROUND: Solitary rectal ulcer syndrome (SRUS) is an uncommon disorder of evacuation. Management of bleeding ulcers is usually unsatisfactory with conventional treatments. Argon plasma coagulation (APC) has been reported in case reports to control bleeding; however, it has not been shown to result in ulcer healing. OBJECTIVE: To investigate the efficacy and safety of APC in controlling bleeding from SRUS and to study its efficacy in eventual healing of ulcers. DESIGN: A randomized, controlled trial of the management of 24 consecutive patients with SRUS. SETTING: The gastroenterology unit at 2 tertiary care hospitals. PATIENTS: Twenty-four patients with bleeding SRUS. MAIN OUTCOME MEASUREMENTS: Control of bleeding and endoscopic healing of SRUS. METHODS: Twenty-four patients with bleeding SRUS, whose diagnoses were based on clinical, colonoscopic, and histologic findings, were randomized to receive either standard care only (12 patients, biofeedback therapy [BT] group) or multiple sessions of APC in addition to BT (12 patients, APC group). All patients were advised to intake a high level of fluids and fibers, laxatives, biofeedback, and behavior modification therapy in addition to the treatment. Patients were followed to determine whether ulcers healed. RESULTS: Twenty-four patients with symptoms that lasted 12.6 +/- 4.8 months were included. Bleeding was controlled in all 12 patients in the APC group, but only in 5 of 12 patients in BT group. We also made the following observations about healing of the ulcers: 8 of 12 patients in the APC group had complete healing of their ulcers after 4 to 8 sessions, whereas in the BT group, ulcers healed in only 2 of 12 patients. CONCLUSIONS: APC controls the bleeding in patients with SRUS and also improves the healing of these ulcers.

Avaliação dos efeitos clínicos da fototerapia em úlceras venosas / Evaluation of clinical effects of phototherapy in venous ulcers

As úlceras venosas são lesões do sistema tegumentar de difícil cicatrização. Essas lesões são freqüentes em pacientes portadores de insuficiência venosa crônica e representam cerca de 80 por cento das lesões ulcerativas em membros inferiores. O objetivo deste trabalho foi avaliar os efeitos da ledterapia sobre o processo de cicatrização de úlceras venosas crônicas em uma paciente do gênero feminino, portadora de insuficiência venosa. Os resultados mostraram que todas as lesões apresentaram sinais de cicatrização, com redução da área das feridas após a introdução da ledterapia, sugerindo que esse recurso foi eficaz em aprimorar o processo de cicatrização das úlceras venosas da participante deste caso.

The venous ulcers are lesions of cutaneous tissue very difficult to heal. These lesions are frequent in patients with chronic venous insufficiency and about 80 percent of ulcerated lesions are on lower limbs. The objective of this study was to evaluate the effects of LED therapy on healing process of chronic venous ulcers of a female patient with venous insufficiency. The results showed that all lesions showed signs of healing, with wounds area reduction after beginning LED therapy, suggesting that this action was effective in improving healing process of venous ulcers of the participant of this case study.