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1.
BMJ Case Rep ; 14(6)2021 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-34127500

RESUMO

A 26-year-old man, returned to the UK having travelled extensively in Asia. He was referred with a 3-month history of distal leg ulceration following an insect bite while in Thailand. Despite multiple courses of oral antibiotics, he developed two adjacent ulcers. A wound swab isolated an organism identified as Burkholderia thailandensis The histology of the skin biopsy was non-specific. A diagnosis of cutaneous melioidosis was made, based on clinical and microbiological grounds. The ulcers re-epithelialised on completion of intravenous ceftazidime followed by 3 months of high dose co-trimoxazole and wound care. Many clinical microbiology laboratories have limited diagnostics for security-related organisms, with the result that B. pseudomallei, the causative bacterium of melioidosis, may be misidentified. This case highlights the importance of maintaining high levels of clinical suspicion and close microbiological liaison in individuals returning from South-East Asia and northern Australia with such symptoms.


Assuntos
Burkholderia pseudomallei , Melioidose , Adulto , Ásia Sudeste , Austrália , Burkholderia , Humanos , Perna (Membro) , Masculino , Melioidose/complicações , Melioidose/diagnóstico , Melioidose/tratamento farmacológico , Tailândia , Úlcera
3.
Gan To Kagaku Ryoho ; 48(4): 549-551, 2021 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-33976044

RESUMO

This case is that of an 84‒year‒old woman in whom upper gastrointestinal endoscopy revealed a giant ulcerative lesion with irregular margins on the upper curvature of the stomach. Abdominal contrast computed tomography(CT)showed marked thickening of the stomach wall in contact with the pancreatic body and enlargement of the regional lymph nodes, suggesting a tumor metastasis to the lymph nodes. At the patient's request, she was followed‒up without surgery, and 8 months later, upper gastrointestinal endoscopy revealed that the ulcerative lesion was scarred and covered with a non‒ tumor mucosa. Contrast CT showed an improvement in the thickening of the stomach wall and shrinking the enlarged lymph nodes. She is currently being followed‒up in an outpatient clinic with no progression since 1 year 8 months. Total gastrectomy for the elderly is associated with perioperative complications and postoperative loss of appetite, which may lead to a decreased QOL. For gastric cancer cases with giant ulcers, it is necessary to carefully consider the surgical indications, bearing in mind the malignant cycle and perforation complications.


Assuntos
Adenocarcinoma , Neoplasias Gástricas , Adenocarcinoma/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Gastrectomia , Humanos , Qualidade de Vida , Neoplasias Gástricas/cirurgia , Úlcera/etiologia , Úlcera/cirurgia
4.
Georgian Med News ; (312): 7-14, 2021 Mar.
Artigo em Russo | MEDLINE | ID: mdl-33964818

RESUMO

The aim of the study was to study the effectiveness of complex treatment of decompensated chronic venous insufficiency (CVI) using innovative techniques and proteolysis inhibitors with a wide spectrum of activity in patients with SARS-CoV-2 (COVID-19) in COVID hospital. This study was performed in the surgical department of COVID hospital on the basis of the Clinical Hospital No. 4 of the First Moscow State Medical University named I.M. Sechenov (Sechenov University). During the period from April 2020 to February 2021, 32 patients with confirmed SARS-CoV-2 (COVID-19) and the presence of venous trophic ulcers (VTU) of the lower extremities were treated. All patients underwent complex therapy for viral pneumonia in accordance with the order of the Ministry of Health of the Russian Federation. The protease inhibitor Aprotinin (Gordox ™) was used to improve microcirculation and prevent the development of a "cytokine storm". To accelerate the cleansing and epithelialization of venous trophic ulcers, the surface of the trophic ulcer was treated with an air plasma flow of NO and injections into the trophic ulcer of autoplasma. Against the background of complex treatment, all patients showed positive dynamics of the clinical picture: relief of hyperthermia, increase or stabilization of SpO2 values from 95% and above, significant decrease in CRP, LDH, D-dimer indices, increase in the number of lymphocytes, decrease in the VTU area by 1.5 times, active granulation and marginal epithelialization of the ulcer. In 14 patients (43.8%), complete epithelialization of the VTU defect was noted by the end of the third week. According to the CIVIQ-20 questionnaire, all 32 patients participating in the study showed positive dynamics. There were no lethal outcomes. Multicomponent therapy of decompensated forms of CVI of the lower extremities in the COVID hospital in patients with moderate severity of coronavirus infection with the use of proteolysis inhibitors leads to a rapid relief of symptoms of intoxication, prevents the progression of lung tissue and parenchymal organ damage and contributes to the positive dynamics of healing of ulcerative defects in the vast majority of patients.


Assuntos
COVID-19 , Úlcera , Hospitais , Humanos , Federação Russa , SARS-CoV-2 , Resultado do Tratamento
5.
BMC Oral Health ; 21(1): 273, 2021 05 20.
Artigo em Inglês | MEDLINE | ID: mdl-34016110

RESUMO

BACKGROUND: The emergence of COVID-19 has devastated many parts of the world. From asymptomatic to symptomatic, the virus causes a wide spectrum of presentations. COVID-19 patients may present with oral manifestations. In Afghanistan, where COVID-19 has severely strained the health care system, much of the population lacks proper oral hygiene. This makes the oral cavity a perfect site for SARS-CoV-2 to manifest clinical signs. CASE PRESENTATION: A 62-year-old male was evaluated in the Dentistry Teaching Clinic of Kabul University of Medical Sciences for a painful erosive lesion on dorsal surface of his tongue. He also complained of fever, cough, and taste alteration. He was referred to Afghan Japan Hospital for COVID-19 testing and tested positive. He was followed on for the treatment of SARS-CoV2. After 2 weeks, the patient tested negative and returned to the dentistry clinic for follow-up. Although there were no other signs of COVID-19, the painful erosive lesion on his tongue persisted. Oral evaluation were performed and the patient was advised to practice good hygiene. After 10 days, we observed an asymptomatic geographic tongue without fever and myalgias and the lesion of dorsal surface of tongue improved from severe condition to moderate. CONCLUSION: In conclusion, patients with suspected or confirmed SARS-CoV-2 should be screened for symptoms and physical findings in the oral mucosa To prevent such an outcome, awareness programs need to be implemented for the diagnosis and management of clinical symptoms among patients.


Assuntos
COVID-19 , Teste para COVID-19 , Humanos , Japão , Masculino , Pessoa de Meia-Idade , RNA Viral , SARS-CoV-2 , Língua , Úlcera
6.
BMJ Case Rep ; 14(5)2021 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-33952571

RESUMO

Acute genital ulcers (AGU), known as Lipschütz ulcers, are painful vulvar ulcers typically affecting non-sexually active girls and women. AGU have been associated with viral infections, namely, Epstein-Barr virus (EBV). Here, we describe a case of AGU in the setting of SARS-CoV-2 in a non-sexually active adolescent girl hospitalised for pain control and urinary retention, who failed a course of oral corticosteroids and then improved with colchicine. Testing for herpes simplex virus, EBV and Behcet's syndrome were all negative. Testing for SARS-CoV-2 was positive. COVID-19 increases cytokines such as tumour necrosis factor alpha, which has been shown to affect endothelial cell adhesion and neutrophil chemotaxis, leading to aphthosis.


Assuntos
COVID-19 , Infecções por Vírus Epstein-Barr , Adolescente , Infecções por Vírus Epstein-Barr/complicações , Infecções por Vírus Epstein-Barr/diagnóstico , Feminino , Genitália , Herpesvirus Humano 4 , Humanos , SARS-CoV-2 , Úlcera/diagnóstico
7.
Biomed Res Int ; 2021: 8848686, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33954200

RESUMO

Background: The incidence of small intestinal injury caused by low-dose aspirin (LDA) is high, but the pathogenesis and intervention measures of it have not been elucidated. Recent studies have found gut microbiota to be closely associated with onset and development of NSAID-induced intestinal injury. However, studies of the changes in the gut microbiota of rats with LDA-related intestinal injury have been lacking recently. In this study, we investigated fecal 16S rRNA gene sequencing analysis of changes in the gut microbiota of rats with LDA-related intestinal injury. Methods: Sprague-Dawley (SD) rat models of small intestinal injury were established by intragastric administration of LDA. The small intestinal tissues and the fecal samples were harvested. The fecal samples were then analyzed using high-throughput sequencing of 16S rRNA V3-V4 amplicons. The gut microbiota composition and diversity were analyzed and compared using principal coordinate analysis (PCoA), nonmetric multidimensional scaling (NMDS) analysis, the unweighted pair-group method with arithmetic mean (UPGMA) clustering analysis, multivariate statistical analysis (ANOSIM, MetaStats, and LEfSe), and spatial statistics. Results: The LDA rat model was successfully established. Decreased Firmicutes and increased Bacteroidetes abundances in rats with LDA-induced small intestinal injury were revealed. MetaStats analysis between the before administration of LDA (CG) and after administration of LDA (APC) groups showed that the intestinal floras exhibiting significant differences (P < 0.05, q < 0.1) were Firmicutes, Bacteroides, Cyanobacteria, Melainabacteria, Coriobacteriia, Bacteroidia, Bacteroidales, Eubacteriaceae, and Streptococcaceae. In addition, the bacterial taxa showing significant differences between the control (NS) and APC groups were Firmicutes, Bacteroides, Verrucomicrobiaceae and Peptococcaceae. Conclusions: The alterations in the gut microbiota composition and diversity of rats with LDA-related intestinal injury were found in the present study. The change of gut microbiota in LDA-related intestinal injury will lay the foundation for further research on the function and signaling pathways of the intestinal flora and promote the use of intestinal flora as drug targets to treat LDA-induced small intestinal injury.


Assuntos
Aspirina/efeitos adversos , Fezes/microbiologia , Microbioma Gastrointestinal/genética , Intestinos/lesões , RNA Ribossômico 16S/genética , Análise de Sequência de RNA , Animais , Biodiversidade , Análise por Conglomerados , Relação Dose-Resposta a Droga , Mucosa Intestinal/patologia , Intestinos/patologia , Masculino , Filogenia , Análise de Componente Principal , Ratos Sprague-Dawley , Coloração e Rotulagem , Aderências Teciduais/patologia , Úlcera/patologia
8.
Rev Soc Bras Med Trop ; 54(suppl 1): e2020663, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34008730

RESUMO

Infections that cause genital ulcers are one of the themes comprising the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. The Protocol and Guidelines have been developed based on scientific evidence and validated in discussions with specialists. This article addresses clinical genital ulcer syndrome caused by sexually transmitted infections and its most common etiological agents: Treponema pallidum (syphilis), herpes simplex virus-2 (genital herpes) and herpes simplex virus-1 (perioral herpes), Haemophilus ducreyi (chancroid), Chlamydia trachomatis serotypes L1, L2 and L3 (lymphogranuloma venereum), and Klebsiella granulomatis (donovanosis). Epidemiological and clinical aspects of these infections and guidelines for their diagnosis and treatment are presented, including strategies for surveillance, prevention, and control actions to support health managers and professionals in the qualification of care. Approximately 70% of the genital ulcers attended in specialized clinics are due to sexually transmitted infections, particularly in adolescents and young adults.


Assuntos
Cancroide , Doenças Sexualmente Transmissíveis , Sífilis , Adolescente , Brasil/epidemiologia , Genitália , Humanos , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/epidemiologia , Sífilis/diagnóstico , Sífilis/epidemiologia , Úlcera , Adulto Jovem
9.
Artigo em Inglês | MEDLINE | ID: mdl-34035053

RESUMO

INTRODUCTION: The aim of the study was to develop and validate a clinical prediction rule (CPR) for foot ulceration in people with diabetes. RESEARCH DESIGN AND METHODS: Development of a CPR using individual participant data from four international cohort studies identified by systematic review, with validation in a fifth study. Development cohorts were from primary and secondary care foot clinics in Europe and the USA (n=8255, adults over 18 years old, with diabetes, ulcer free at recruitment). Using data from monofilament testing, presence/absence of pulses, and participant history of previous ulcer and/or amputation, we developed a simple CPR to predict who will develop a foot ulcer within 2 years of initial assessment and validated it in a fifth study (n=3324). The CPR's performance was assessed with C-statistics, calibration slopes, calibration-in-the-large, and a net benefit analysis. RESULTS: CPR scores of 0, 1, 2, 3, and 4 had a risk of ulcer within 2 years of 2.4% (95% CI 1.5% to 3.9%), 6.0% (95% CI 3.5% to 9.5%), 14.0% (95% CI 8.5% to 21.3%), 29.2% (95% CI 19.2% to 41.0%), and 51.1% (95% CI 37.9% to 64.1%), respectively. In the validation dataset, calibration-in-the-large was -0.374 (95% CI -0.561 to -0.187) and calibration slope 1.139 (95% CI 0.994 to 1.283). The C-statistic was 0.829 (95% CI 0.790 to 0.868). The net benefit analysis suggested that people with a CPR score of 1 or more (risk of ulceration 6.0% or more) should be referred for treatment. CONCLUSION: The clinical prediction rule is simple, using routinely obtained data, and could help prevent foot ulcers by redirecting care to patients with scores of 1 or above. It has been validated in a community setting, and requires further validation in secondary care settings.


Assuntos
Diabetes Mellitus , Pé Diabético , Adolescente , Adulto , Regras de Decisão Clínica , Estudos de Coortes , Pé Diabético/diagnóstico , Pé Diabético/epidemiologia , Europa (Continente) , Humanos , Úlcera
10.
An. Fac. Cienc. Méd. (Asunción) ; 54(1): 93-100, 20210000.
Artigo em Espanhol | LILACS | ID: biblio-1178639

RESUMO

El 15% de los individuos con DM2 presenta una úlcera en el pie y una fracción importante de ellos sufrirá en algún momento una amputación. Se realizó un estudio analítico, de corte trasversal retrospectivo de muestreo no probabilístico de casos consecutivos en pacientes con diagnóstico de pie diabético que acudieron al servicio de Urgencias del Hospital de Clínicas de San Lorenzo, en el periodo Enero ­ Diciembre del año 2019. Sobre un número total de 138 pacientes, se observa que el 51% recibió un manejo quirúrgico, con amputaciones de varios tipos. Se comparó el manejo instaurado en los pacientes, sea este quirúrgico o conservador según la presencia o no de ciertas comorbilidades, como edad mayor a 65 años, lugar de procedencia, glicemia capilar promedio del paciente e hipertensión arterial al ingreso; de estos existió una relación estadísticamente significativa (p<0,05) entre la necesidad de amputación y la glicemia capilar y la hipertensión arterial. El éxito de la intervención requiere un completo entendimiento de la patogénesis de las úlceras del pie diabético y una implementación rápida y estandarizada de un tratamiento efectivo. El manejo multidisciplinario puede lograr el salvataje de la extremidad, que conducirá a una mejor calidad de vida y sobrevida.


Among diabetic patients, 15% have a foot ulcer and a significant fraction of them will suffer an amputation at some point. An analytical, retrospective cross-sectional study of non-probabilistic sampling of consecutive cases was carried out in patients with a diagnosis of diabetic foot who attended the Emergency Service of the Clínicas Hospital in San Lorenzo, during January - December of the year 2019. In a total of 138 patients, the management established in the patients, whether surgical or. conservative, was compared according to certain comorbidities, such as age over 65 years, place of origin, average capillary glycemia and arterial hypertension on admission; Of these, there was a statistically significant relationship (p <0.05) between the need for amputation and capillary glycemia and arterial hypertension. Successful intervention requires a thorough understanding of the pathogenesis of diabetic foot ulcers and a rapid and standardized implementation of effective treatment. Multidisciplinary management can achieve limb salvage, leading to better quality of life and survival.


Assuntos
Úlcera , Patogênese Homeopática , Úlcera do Pé , Pé Diabético , Amputação , Hipertensão , Estudos Transversais , Diagnóstico
11.
Wiad Lek ; 74(2): 202-206, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33813472

RESUMO

OBJECTIVE: The aim: To determine clinical and endoscopical features of gastroduodenal hemorrhages in elderly patients with concomitant cardio-vascular pathology in a way by studying, main indicators of the immune system for drawing up further tactics. PATIENTS AND METHODS: Material and methods: The study included 609 patients with ulcerative gastroduodenal bleeding, complicated by cardio-vascular system pathology in 2017-2019 years. The observed patients were distributed into the groups: I - patients, who received treatment according to the standard system of cardiovascular pathology treatment (n=541), II - "double" therapy (n=68). Control group consists of 20 relatively healthy patients were similar to the research group. RESULTS: Results: Blood lost of a big amount and massive blood lost were noticed in 113 (18.56%±1.58) and 121 (19.87%±1.62) patients respectively. Active bleeding (F I) was revealed in 38 patients (6.24%±0.98), a high risk of hemorrhage relapse was determined in 486 patients (79.80%±1.63). Signs of recent hemorrhage were absent in 85 patients (13.96%±1.40). A high level of pro-inflammatory cytokines IL-6, TNF-α and a low activity of the anti-inflammatory mediator IL-10 define the process activity, their long-term circulation in patients with ulcerative hemorrhages of the gastro-intestinal tract are associated with unfavorable prognosis. In 5 cases conditionally-radical surgical interventions were performed. Palliative surgery - 3 patients (р>0.05). CONCLUSION: Conclusions: The patients of second group ("double therapy") with big and massive blood loss was 2.7 times higher than similar indices in patients of the first group (standard therapy). The patients who received "double therapy" had 3.3 times more active hemorrhage percentage than the patients who received standard therapy (р<0.05).


Assuntos
Hemorragia Gastrointestinal , Úlcera , Idoso , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Prognóstico , Recidiva
13.
Int J Mol Sci ; 22(8)2021 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-33917759

RESUMO

Extracellular vesicles (EVs) derived from mesenchymal stem cells isolated from both bone marrow (BMSCs) and adipose tissue (ADSCs) show potential therapeutic effects. These vesicles often show a similar beneficial effect on tissue regeneration, but in some contexts, they exert different biological properties. To date, a comparison of their molecular cargo that could explain the different biological effect is not available. Here, we demonstrated that ADSC-EVs, and not BMSC-EVs, promote wound healing on a murine model of diabetic wounds. Besides a general similarity, the bioinformatic analysis of their protein and miRNA cargo highlighted important differences between these two types of EVs. Molecules present exclusively in ADSC-EVs were highly correlated to angiogenesis, whereas those expressed in BMSC-EVs were preferentially involved in cellular proliferation. Finally, in vitro analysis confirmed that both ADSC and BMSC-EVs exploited beneficial effect on cells involved in skin wound healing such as fibroblasts, keratinocytes and endothelial cells, but through different cellular processes. Consistent with the bioinformatic analyses, BMSC-EVs were shown to mainly promote proliferation, whereas ADSC-EVs demonstrated a major effect on angiogenesis. Taken together, these results provide deeper comparative information on the cargo of ADSC-EVs and BMSC-EVs and the impact on regenerative processes essential for diabetic wound healing.


Assuntos
Complicações do Diabetes/terapia , Vesículas Extracelulares/metabolismo , Células-Tronco Mesenquimais/metabolismo , Úlcera/etiologia , Úlcera/terapia , Cicatrização , Tecido Adiposo/citologia , Animais , Células da Medula Óssea , Exossomos/metabolismo , Exossomos/ultraestrutura , Vesículas Extracelulares/ultraestrutura , Citometria de Fluxo , Perfilação da Expressão Gênica , Imuno-Histoquímica , Células-Tronco Mesenquimais/citologia , Camundongos
15.
J Nanosci Nanotechnol ; 21(5): 3028-3034, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33653476

RESUMO

This study's objective is to analyze the effect of epidermal growth factor (EGF) nanoparticles on the healing of diabetic skin wounds and also, simultaneously, to investigate the mechanism of EGF nanoparticles to promote healing. In this manuscript, EGF nanoparticles were prepared, and also the drug loading rate of EGF nanoparticles was measured. In the meantime, a diabetic skin wound model was prepared with the use of rats. Then, the rats were split into four groups: EGF nanogroup, EGF group, empty particle group, and control group. Additionally, the results indicate that this study was successful in preparing EGF nanoparticles with a stable performance, and the drug was released for 24 hours. The wound healing in the EGF nanoparticle group was quicker than that in the EGF group. Furthermore, the area of EGF receptor-positive cells in the wound surface of the EGF nanogroup was higher than that of the EGF group, with the results demonstrating that EGF nanoparticles upregulated the expression of EGF receptors in wound surface cells, promoted wound surface healing, and had better efficacy than EGF.


Assuntos
Diabetes Mellitus , Nanopartículas , Animais , Fator de Crescimento Epidérmico , Ratos , Pele , Úlcera , Cicatrização
16.
An Bras Dermatol ; 96(3): 352-354, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33775479

RESUMO

Cutaneous leishmaniasis is characterized by ulcers with raised edges and a granular bottom, mainly on the lower limbs. This is a case report of a male patient with an ulcer on the left plantar region. The diagnosis was confirmed by positive PCR for L. braziliensis and the presence of amastigotes of Leishmania sp. in the histopathological examination. After treatment with Glucantime, the patient showed full healing of the ulcer. The unusual location of the ulceration calls attention to atypical presentations of leishmaniasis, and the importance of histopathological examination and PCR, leading to the appropriate diagnosis and treatment.


Assuntos
Úlcera do Pé , Leishmania braziliensis , Leishmania , Leishmaniose Cutânea , Humanos , Leishmaniose Cutânea/diagnóstico , Leishmaniose Cutânea/tratamento farmacológico , Masculino , Antimoniato de Meglumina , Úlcera
17.
An Bras Dermatol ; 96(3): 315-318, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33775483

RESUMO

Lymphocytic thrombophilic arteritis is a recently described entity, histopathologically characterized by lymphocytic vasculitis that affects the arterioles of the dermo-hypodermic junction, associated with deposition of fibrin and a luminal fibrin ring. A 49-year-old female patient presented with achromic maculae and a well-defined ulcer on the medial aspect of the left lower limb. The biopsy showed intense inflammatory infiltrate in the papillary dermis with a predominance of lymphocytes, and medium-caliber vessels surrounded by mononuclear infiltrates in the deep reticular dermis. Masson's trichrome staining showed intense destruction of the muscle layer of the vascular wall and a fibrin ring. Good clinical response was attained with azathioprine. The authors believe that the ulceration might be another clinical presentation or represent an atypical progression of this condition.


Assuntos
Arterite , Úlcera da Perna , Biópsia , Feminino , Humanos , Úlcera da Perna/etiologia , Linfócitos , Pessoa de Meia-Idade , Úlcera
18.
Rev Soc Bras Med Trop ; 54: e0772-2020, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33759929

RESUMO

Leishmaniasis is a tropical infectious disease caused by Leishmania spp. protozoa and is transmitted by insects from the Phlebotominae subfamily. It can manifest as cutaneous leishmaniasis, a painless ulcer that can develop into a more serious systemic affliction as the protozoa spreads lymphatically or hematogenously, depending on the host's immunity. In this case series, the authors present a rare form of genital mucocutaneous leishmaniasis, with consideration of epidemiologic characteristics, clinical presentation, differential diagnosis, and treatments offered.


Assuntos
Leishmania , Leishmaniose Cutânea , Leishmaniose Mucocutânea , Animais , Diagnóstico Diferencial , Genitália , Leishmaniose Cutânea/diagnóstico , Leishmaniose Mucocutânea/diagnóstico , Úlcera
19.
BMC Infect Dis ; 21(1): 252, 2021 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-33691621

RESUMO

BACKGROUND: Cytomegalovirus (CMV) is an important pathogen among immunocompromised hosts. Typically, CMV in human immunodeficiency virus (HIV) infection causes diseases of the retina, digestive tract, lungs and liver, but there are few cases of CMV infection of the pharynx and larynx. CASE PRESENTATION: A 57-year-old man with HIV infection was admitted because of pharyngeal pain. Before and after admission, pharyngeal biopsies guided by laryngeal endoscopy were performed four times, but pathological examination showed nonspecific inflammation, and the cause of pharyngeal ulceration was unclear. Additionally, the ulceration deteriorated after initiation of retroviral therapy. Laryngomicrosurgery was conducted under general anesthesia to remove tissue, and pathological diagnosis confirmed CMV infection. Pathological features included enlargement of the cytoplasm and nucleus in infected cells, and intranuclear bodies called owl's eye inclusions. Ganciclovir dramatically improved the symptoms and laryngoscopic findings. CONCLUSIONS: This case was diagnosed as pharyngitis and pharyngeal ulceration caused by CMV infection, related to immune reconstitution inflammatory syndrome. In previous reports of CMV-induced pharyngeal or laryngeal ulceration in HIV infection, we found six cases similar to our present case. All cases were diagnosed by biopsy. The present case indicates the importance of biopsy for definitive diagnosis. CMV infection should be considered as a differential diagnosis of pharyngeal ulceration in patients with HIV infection.


Assuntos
Infecções por Citomegalovirus/etiologia , Infecções por HIV/complicações , Doenças Faríngeas/virologia , Úlcera/virologia , Citomegalovirus/imunologia , Infecções por Citomegalovirus/diagnóstico , Ganciclovir/uso terapêutico , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Doenças Faríngeas/etiologia , Úlcera/etiologia
20.
Zhonghua Shao Shang Za Zhi ; 37(3): 225-231, 2021 Mar 20.
Artigo em Chinês | MEDLINE | ID: mdl-33706436

RESUMO

Objective: To investigate the clinical effect of staged repair strategy for chronic sacrococcygeal radiation ulcer. Methods: The retrospective cohort study method was applied. Twelve patients with chronic sacrococcygeal radiation ulcer were admitted to Beijing Jishuitan Hospital from January 2010 to June 2020, including 7 males and 5 females, aged 38-74 years. The thorough debridement was performed in the first stage, with wounds area after debridement ranging from 8 cm×6 cm to 22 cm×14 cm, and continuous vacuum sealing drainage (VSD) was performed after the debridement operation. In the second stage, personalized surgery scheme was formulated according to the patient's age, systemic condition, vascular condition, and the position, size, and depth of wound. Six cases were reconstructed with superior/inferior gluteal artery perforator flaps, 4 cases were repaired with gluteus maximus myocutaneous flaps, 1 case was repaired with pedicled latissimus dorsi myocutaneous flap, and 1 case was reconstructed with free transplantation of latissimus dorsi myocutaneous flap. The area of flaps or myocutaneous flaps ranged from 10 cm×8 cm to 25 cm×18 cm. Donor sites of the flaps were sutured primarily in 9 patients and in the other 3 patients were repaired with intermediate split-thickness skin graft in back. The survival of flap or myocutaneous flap after operation, recurrence of tumor, and the appearance and texture of flap or myocutaneous flap, and wound healing were observed during follow-up. Results: Flaps or myocutaneous flaps in 11 patients survived after operation, and superior gluteal artery perforator flap in 1 patient had partial distal necrosis, which was covered again with flap pushed to the distal after debridement and resection of the necrotic tissue. The wounds in 8 patients achieved primary healing, 1 patient repaired with superior gluteal artery perforator flap experienced subcutaneous infection, 1 patient repaired with superior gluteal artery perforator flap suffered distal venous congestion of the flap, and 1 patient repaired with gluteus maximus myocutaneous flap had hematoma under myocutaneous flap, and 1 patient repaired with retrograde latissimus dorsi myocutaneous flap had incision exudation and dehiscence, which were all healed after dressing change, etc. There was no recurrence of tumor after the operation. The wounds healed well during follow-up of 2-52 months after discharge, with no recurrence of infection, and the flaps were soft in texture, with satisfactory appearance and well healed donor sites. Conclusions: On the basis of thorough debridement and VSD in the first stage, superior/inferior gluteal artery perforator flap, gluteus maximus myocutaneous flap, or pedicled/free latissimus dorsi myocutaneous flap with abundant blood supply is applied to repair chronic sacrococcygeal radiation ulcer in the second stage. The staged operation is reliable, with minimal injury to the donor site of flap and satisfactory therapeutic effect.


Assuntos
Retalho Miocutâneo , Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplante de Pele , Lesões dos Tecidos Moles/cirurgia , Resultado do Tratamento , Úlcera
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