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1.
Medicine (Baltimore) ; 99(18): e19836, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358354

RESUMO

INTRODUCTION: Acute hemorrhagic rectal ulcer (AHRU) is a rare entity which has most frequently been described in Japan and Taiwan literature. This study characterizes 11 AHRUs identified and managed at an urban acute care hospital in the United States of America (USA). METHODS: A total of 2253 inpatients underwent colonoscopy. In 1172 patients (52%), colonoscopy was performed for evaluation of lower gastrointestinal (LGI) bleeding. Eleven (0.9%) of the 1172 patients with LGI bleeding had AHRU. RESULTS: AHRU is characterized by a sudden onset of painless and massive lower rectal bleeding in elderly, bedridden patients (pts) with major underlying diseases. The endoscopic findings were classified into 4 types. All 11 ulcers were located in the distal rectum within 10 cm of the dentate line. All 11 patients required blood transfusion (mean = 3.7 units; range 2-9 units). Seven patients responded to blood, plasma, and platelet transfusions. The other 4 patients required endoscopic hemostasis.Three patients died within a month of colonoscopy from comorbidities. None had bleeding as a cause of death. Eight surviving patients did not have recurrent bleeding. CONCLUSION: AHRU does exist in the USA and should be considered as an important cause of acute lower GI bleeding in elderly, critically ill, and bedridden patients. AHRU should be recognized and managed correctly.


Assuntos
Colonoscopia/estatística & dados numéricos , Hemorragia Gastrointestinal/cirurgia , Hemostase Endoscópica/métodos , Doenças Retais/cirurgia , Úlcera/cirurgia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hospitais Urbanos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Retais/diagnóstico , Reto/irrigação sanguínea , Reto/cirurgia , Úlcera/diagnóstico , Estados Unidos
3.
Rev. méd. Urug ; 35(4): 325-331, dic. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1026238

RESUMO

Introducción: las úlceras genitales se caracterizan por su gran heterogeneidad clínica y etiológica. Pueden corresponder a entidades patológicas cutáneas o sistémicas de naturaleza infecciosa o no infecciosa. Dentro de estas últimas, se destacan las úlceras de Lipschütz y la enfermedad de Behcet. Objetivo: describir cuatro casos clínicos de adolescentes con úlceras vulvares agudas de causa no infecciosa hospitalizadas en dos prestadores del Sistema Nacional Integrado de Salud de Montevideo con el objetivo de brindar herramientas a profesionales para el correcto abordaje diagnóstico y terapéutico. Discusión: la realización de una anamnesis detallada y un examen físico minucioso son esenciales para realizar un adecuado abordaje diagnóstico y terapéutico. En el análisis clínico es importante considerar la edad de la paciente, el inicio de relaciones sexuales, el número, topografía y características de las úlceras incluyendo la presencia o no de dolor, así como la asociación de manifestaciones sistémicas. Resulta necesario el conocimiento de esta patología poco frecuente en niñas y adolescentes cuyo abordaje diagnóstico y terapéutico depende de la orientación etiológica basada en criterios epidemiológicos y clínicos bien definidos. Ello contribuirá a mejorar la calidad de la asistencia y a minimizar las repercu¬siones biológicas y psicológicas.


Introduction: genital ulcers are characterized by great clinical and etiological heterogeneity. They may correspond to infectious or non-infectious skin or systemic pathologies. Lipschütz ulcer and Behcet disease stand out among non-infectious conditions. Objective: to describe four clinical cases of adolescents with non-infectious severe vulvar ulcers hospitalized in two institutions of the national integrated health system in Montevideo, with the purpose of providing professionals with tools for the adequate diagnostic and therapeutic approach. Discussion: a detailed anamnesis questionnaire and a thorough physical examination are of the essence for an adequate diagnostic and therapeutic approach. The clinical analysis should include considering the patient's age, initiation of sexual intercourse, the number, topography and characteristics of the ulcers including finding out whether there is pain or not, as well as the association of systemic manifestations. It is important to learn about this rather unusual condition in girls and adolescents, whose diagnostic and therapeutic approach depends on the etiological orientation based on well-defined epidemiological and clinical criteria. This will contribute to improving the quality of assistance and minimizing biological and psychological effects.


Introdução: as úlceras genitais se caracterizam por uma grande heterogeneidade clínica e etiológica. Podem ser causadas por patologias cutâneas ou sistémicas tanto infecciosas como não infecciosas. Entre as últimas, destacam-se as úlceras de Lipschütz e a doença de Behçet. Objetivo: descrever quatro casos clínicos de adolescentes com úlceras vulvares agudas de causa não infecciosa hospitalizadas em duas unidades de saúde do sistema nacional integrado de saúde de Montevidéu buscando oferecer ferramentas para uma correta abordagem diagnóstica e terapêutica. Discussão: é fundamental realizar uma anamnese detalhada e um exame físico minucioso para uma abordagem diagnóstica e terapêutica adequada. O exame clínico deve incluir a idade da paciente, o inicio das relações sexuais, o número, topografia e características das úlceras incluindo a presencia ou não de dor, bem como a associação com manifestações sistémicas. É necessário conhecer esta patologia pouco frequente em meninas e adolescentes cuja abordagem diagnóstica e terapêutica depende da orientação etiológica baseada em critérios epidemiológicos e clínicos bem definidos. Isso contribuirá para melhorar a qualidade da assistência e a minimizar as repercussões biológicas e psicológicas.


Assuntos
Humanos , Feminino , Criança , Adolescente , Doenças da Vulva/diagnóstico , Doenças da Vulva/etiologia , Úlcera/diagnóstico
4.
Clin Interv Aging ; 14: 2137-2143, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31849457

RESUMO

Atypical ulcers show atypical clinical features, histology, localization, and resistance to standard therapies. The persistence of a chronic ulcer despite treatment with standard therapies requires a more specific diagnostic investigation. Diagnosis involves obtaining the history and performing clinical examination and additional tests. A skin biopsy is frequently used to confirm unclear diagnosis. In difficult cases, microbiological and immunohistochemical examinations, laboratory blood tests, or instrumental tests should be evaluated. The treatment of atypical wounds is characterized by local systemic therapy and pain control. Our results highlight the need for early diagnosis, and standardized and targeted management by a multidisciplinary wound healing center.


Assuntos
Úlcera/diagnóstico , Úlcera/terapia , Cicatrização , Bandagens , Biópsia , Humanos , Pessoa de Meia-Idade , Exame Físico , Pele/fisiopatologia , Úlcera/fisiopatologia
5.
Monaldi Arch Chest Dis ; 89(3)2019 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-31850698

RESUMO

Ulceration in the bronchial mucosa is noted rarely in bronchoscopy. In the past, it was frequently encountered in endobronchial tuberculosis. Deep necrotic bronchial ulcers are seen very rarely in clinical practice. Here we are reporting a first-ever case report of malignant bronchial ulcer presenting as necrotic deep bronchial ulcer, in a 70-year-old male, chronic smoker, who complained of breathlessness for 3 months, cough for 3 months, loss of weight and of appetite for 1 month. Bronchoscopy showed a large necrotic ulcer with dense anthracotic pigmentation which bleeds in touch with forceps. Bronchial washings, brushings, endobronchial biopsy were taken from the ulcer which was suggestive of poorly differentiated bronchogenic carcinoma. TBNA from the mediastinal nodes showed the features of caseous necrosis with granulomatous inflammation. Consequently, with the diagnosis of poorly differentiated carcinoma with pulmonary tuberculosis and COPD, the patient was started on anti-tuberculosis drugs, inhaled bronchodilators and referred to an oncologist for chemotherapy.


Assuntos
Broncopatias/complicações , Carcinoma Broncogênico/complicações , Neoplasias Pulmonares/complicações , Tuberculose Pulmonar/complicações , Úlcera/complicações , Idoso , Broncopatias/diagnóstico , Broncopatias/etiologia , Broncoscopia , Carcinoma Broncogênico/diagnóstico , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Membrana Mucosa/patologia , Necrose , Tuberculose Pulmonar/diagnóstico , Úlcera/diagnóstico , Úlcera/etiologia
6.
Lakartidningen ; 1162019 Nov 26.
Artigo em Sueco | MEDLINE | ID: mdl-31769859

RESUMO

Solitary rectal ulcer syndrome (SRUS) is a rare disorder likely to be caused by a traumatic and ischemic mucosal injury related to latent or overt rectal prolapse. Mucosal damage can vary between erythema and up to intractable ulceration. The typical symptoms of SRUS may resemble those of inflammatory bowel disease (IBD)-related proctitis or rectal malignancy with mucus- and blood-mixed defecation with urgency and sometimes transient incontinence. The purpose of this paper is to raise awareness of this rare, quality-of-life impacting and difficult-to-treat disease and the not so well-known argon plasma coagulation (APC) treatment that can provide very good and long lasting symptom relief.


Assuntos
Coagulação com Plasma de Argônio , Doenças Retais/cirurgia , Úlcera/cirurgia , Adulto , Procedimentos Clínicos , Endoscopia , Feminino , Humanos , Doenças Retais/diagnóstico , Doenças Retais/etiologia , Doenças Retais/patologia , Síndrome , Úlcera/diagnóstico , Úlcera/etiologia , Úlcera/patologia
9.
Medicine (Baltimore) ; 98(37): e17159, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517864

RESUMO

RATIONALE: Penetrating aorta ulcer (PAU) with isolated left vertebral artery (ILVA) is a rare condition, accounting for no more than 1% of all kinds of aorta diseases. And traditional treatment was open surgery with total arch replacement by elephant trunk. Here, we report a case of PAU combined with ILVA managed by thoracic endovascular aortic repair (TEVAR) technique. PATIENT CONCERNS: A 65-year-old male with chronic hypertension and Nicotine abuse underwent intermittent back pain for 2 years and aggravated a bit for 1 week. DIAGNOSES: Preoperative computed tomography angiogram (CTA) indicated PAU combined with ILVA. INTERVENTIONS: TEVAR was performed for PAU following with retrograde in situ fenestration and chimney technique for revascularization of ILVA and left subclavian artery (LSA), respectively. OUTCOMES: The operation was successfully and the patient was discharged from hospital after 1 week of treatment. Postoperatively, the images of CTA illustrated the patency of aorta, ILVA, and LSA without obvious endoleak. Besides, no ischemia attack or other relative syndromes were detected at 6-months follow-up. LESSONS: This case demonstrates that TEVAR is an alternative to elephant trunk especially for PAU with ILVA. And it also showed the precise exposure of ILVA and necessity to reconstruct ILVA during TEVAR operation in order to reduce the occurrence of ischemia attack.


Assuntos
Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Procedimentos Endovasculares , Úlcera/cirurgia , Artéria Vertebral/cirurgia , Idoso , Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/diagnóstico , Diagnóstico Diferencial , Procedimentos Endovasculares/métodos , Humanos , Masculino , Úlcera/diagnóstico , Artéria Vertebral/diagnóstico por imagem
11.
J Vet Diagn Invest ; 31(5): 783-787, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31347467

RESUMO

Rhodococcus equi infection in horses is common and is characterized by pyogranulomatous pneumonia and ulcerative enterocolitis. R. equi clinical disease in cattle, however, is rare and typically manifests as granulomatous lymphadenitis discovered in the abattoir. A 19-mo-old female Santa Gertrudis had a history of intermittent inappetence and weight loss for a 3-mo period before euthanasia. Gross and histologic examination revealed severe, chronic, ulcerative, and granulomatous inflammation in the tongue, pharynx, and small intestine. Also, the heifer had severe, granulomatous pharyngeal and mesenteric lymphadenitis. Bacterial cultures from the ileum, tongue, and liver yielded numerous-to-moderate numbers of R. equi. PCR analysis of the isolate detected the linear virulence plasmid vapN, which is often identified in bovine isolates (traA- and vapN-positive). The bacteria also lack the circular plasmids vapA and vapB that are associated with virulence in horses and swine, respectively. We report herein an atypical and unusual clinical presentation of R. equi infection in cattle, which has zoonotic potential.


Assuntos
Infecções por Actinomycetales/veterinária , Doenças dos Bovinos/diagnóstico , Enterite/veterinária , Glossite/veterinária , Rhodococcus equi/isolamento & purificação , Infecções por Actinomycetales/diagnóstico , Infecções por Actinomycetales/microbiologia , Animais , Bovinos , Doenças dos Bovinos/microbiologia , Enterite/diagnóstico , Enterite/microbiologia , Evolução Fatal , Feminino , Glossite/diagnóstico , Glossite/microbiologia , Granuloma/diagnóstico , Granuloma/microbiologia , Granuloma/veterinária , Úlcera/diagnóstico , Úlcera/microbiologia , Úlcera/veterinária
12.
BMC Res Notes ; 12(1): 452, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337435

RESUMO

OBJECTIVE: This was a 5 year retrospective study of patients' hospital records to find out how patients with cellulitis are managed and the care provided by nurses to these patients in some hospitals in Fako, Cameroon. RESULTS: Of the 236 cases of cellulitis identified from a study of hospital records, 202 were included in the study. Most of the participants (55%) were female and the mean (SD) age was 43 (1.1) years. Cellulitis accounted for 2.3% of admissions in this study. The predisposing factors identified were; the presence of trauma (60.5%), HIV infection (18.6%), alcohol consumption (8.4%) and tobacco use (4.8%). Commonly recorded complications were necrosis (32.2%), sepsis (23%), abscess formation (19.5%), and ulcer development (19.5%). Medical management was with antibiotic therapy, including mostly penicillin (26.5%), aminoglycoside (22.1%), nitroimidazole (20.2%) and cephalosporin (19.6%). Debridement (46.7%), and incision and drainage (44.4%) were the most implemented surgical interventions. Nursing care, as found in patients' hospital records were predominantly on medication administration (98.0%), vital signs assessment (90.5%) and patient assessment (53%). Cellulitis therefore was found among a substantial number of patients and management was predominantly with combination antibiotics therapy and inadequate nursing care.


Assuntos
Antibacterianos/uso terapêutico , Celulite (Flegmão)/terapia , Desbridamento/métodos , Drenagem/métodos , Papel do Profissional de Enfermagem/psicologia , Abscesso/diagnóstico , Abscesso/patologia , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/fisiopatologia , Aminoglicosídeos/uso terapêutico , Camarões , Celulite (Flegmão)/etiologia , Celulite (Flegmão)/cirurgia , Cefalosporinas/uso terapêutico , Gerenciamento Clínico , Feminino , Infecções por HIV/complicações , Infecções por HIV/patologia , Infecções por HIV/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Necrose/diagnóstico , Necrose/patologia , Nitroimidazóis/uso terapêutico , Enfermeiras e Enfermeiros/organização & administração , Penicilinas/uso terapêutico , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/patologia , Estudos Retrospectivos , Fatores de Risco , Sepse/diagnóstico , Sepse/patologia , Fumar/efeitos adversos , Fumar/fisiopatologia , Úlcera/diagnóstico , Úlcera/patologia , Ferimentos e Lesões/complicações , Ferimentos e Lesões/patologia
14.
BMC Infect Dis ; 19(1): 485, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31146691

RESUMO

BACKGROUND: Bordetella trematum is an infrequent Gram-negative coccobacillus, with a reservoir, pathogenesis, a life cycle and a virulence level which has been poorly elucidated and understood. Related information is scarce due to the low frequency of isolates, so it is important to add data to the literature about this microorganism. CASE PRESENTATION: We report a case of a 74-year-old female, who was referred to the hospital, presenting with ulcer and necrosis in both legs. Therapy with piperacillin-tazobactam was started and peripheral artery revascularization was performed. During the surgery, a tissue fragment was collected, where Bordetella trematum, Stenotrophomonas maltophilia, and Enterococcus faecalis were isolated. After surgery, the intubated patient was transferred to the intensive care unit (ICU), using vasoactive drugs through a central venous catheter. Piperacillin-tazobactam was replaced by meropenem, with vancomycin prescribed for 14 days. Four days later, levofloxacin was added for 24 days, aiming at the isolation of S. maltophilia from the ulcer tissue. The necrotic ulcers evolved without further complications, and the patient's clinical condition improved, leading to temporary withdrawal of vasoactive drugs and extubation. Ultimately, however, the patient's general condition worsened, and she died 58 days after hospital admission. CONCLUSIONS: Despite being a rare finding, B. trematum is typically associated with the clinical manifestation of disorders that predispose to ulcer development, which can be infected by microorganisms. The combination of antibiotic therapy and surgical debridement plays a key role in preventing systemic infections. Monitoring the appearance of new cases of B. trematum is essential, since it can be an emerging microorganism. Isolating and defining the clinical relevance of unusual bacteria yields a more accurate perspective in the development of new diagnostic tools and allows for assessment of proper antimicrobial therapy.


Assuntos
Infecções por Bordetella/diagnóstico , Bordetella , Idoso , Antibacterianos/uso terapêutico , Bordetella/isolamento & purificação , Infecções por Bordetella/tratamento farmacológico , Infecções por Bordetella/microbiologia , Coinfecção , Pé Diabético/complicações , Pé Diabético/diagnóstico , Pé Diabético/tratamento farmacológico , Pé Diabético/microbiologia , Enterococcus faecalis/isolamento & purificação , Evolução Fatal , Feminino , Infecções por Bactérias Gram-Negativas/complicações , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Unidades de Terapia Intensiva , Testes de Sensibilidade Microbiana , Necrose/diagnóstico , Necrose/microbiologia , Combinação Piperacilina e Tazobactam/uso terapêutico , Stenotrophomonas maltophilia/isolamento & purificação , Úlcera/diagnóstico , Úlcera/microbiologia
15.
An Bras Dermatol ; 94(2): 236-238, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31090835

RESUMO

Leprosy is a chronic neglected and stigmatizing disease. Due to involvement of the peripheral nerves, it can result in physical disabilities, deformities, and emotional damage if not diagnosed and treated promptly. This is the case of a young patient with testicular pain and swelling and no improvement after a specific therapeutic scheme for tuberculosis. Clinical and laboratory reevaluation revealed hypoesthetic skin patches associated with post-burn crusted ulcers on the left arm, thickening of ulnar nerves, atrophy of interosseous muscles of the hands, positive skin smear microscopy, and testicular histopathology with numerous bacilli forming globi. These findings indicated lepromatous leprosy with type II reaction.


Assuntos
Diagnóstico Tardio , Hanseníase Virchowiana/diagnóstico , Doenças Testiculares/tratamento farmacológico , Tuberculose dos Genitais Masculinos/tratamento farmacológico , Úlcera/diagnóstico , Adulto , Braço , Humanos , Hanseníase Virchowiana/complicações , Masculino , Orquite/complicações , Orquite/diagnóstico , Doenças Testiculares/patologia , Tempo para o Tratamento , Úlcera/complicações
16.
J Obstet Gynaecol Res ; 45(8): 1593-1596, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31074169

RESUMO

Causes of cervical ulceration include infection, collagen disease, malignant tumors and external stimuli. Cervical ulceration during pregnancy is rare. We present a case of cervical ulceration caused by group C streptococcal infection during pregnancy. A 36-year-old woman (gravida 1, para 0) complained of metrorrhagia, and a circular cervical ulcer of about 1.5 cm in diameter was detected on her cervix at 37 weeks' gestation. A biopsy and a cultivation test of the ulcer were performed, and pathological diagnosis was made as suppurative inflammation, and group C streptococcal infection was detected by the cultivation test. The ulcer had expanded to about 3 cm in diameter at the onset of labor at 40 weeks' gestation. An emergency cesarean section was performed because of failed induction of labor, and she was delivered of a male baby. The ulcer became gradually smaller after delivery, and completely disappeared on the 35th day after delivery.


Assuntos
Complicações Infecciosas na Gravidez/diagnóstico , Infecções Estreptocócicas/diagnóstico , Úlcera/diagnóstico , Doenças do Colo do Útero/diagnóstico , Adulto , Feminino , Humanos , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/microbiologia , Úlcera/etiologia , Úlcera/microbiologia , Doenças do Colo do Útero/etiologia , Doenças do Colo do Útero/microbiologia
17.
Korean J Gastroenterol ; 73(5): 299-302, 2019 May 25.
Artigo em Coreano | MEDLINE | ID: mdl-31132828

RESUMO

Rectal involvement by systemic lupus erythematosus (SLE) is quite rare. Approximately 14 cases have been reported worldwide, but only one with ischemic colitis has been reported in Korea. A 17-year-old female patient was hospitalized with abdominal pain and hematochezia. Sigmoidoscopy revealed only a simple rectal ulcer without ischemic colitis. cytomegalovirus and bacterial infections were excluded. A sigmoidoscopic rectal biopsy indicated a rectal invasion by SLE, but the patient showed an acute worsening conditions that did not respond to treatment. This paper reports a case of rectal ulcer that developed in SLE without ischemic colitis with a review of the relevant literature.


Assuntos
Lúpus Eritematoso Sistêmico/diagnóstico , Doenças Retais/diagnóstico , Abscesso/etiologia , Adolescente , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Doenças Retais/complicações , Doenças Retais/patologia , Sigmoidoscopia , Esteroides/uso terapêutico , Tomografia Computadorizada por Raios X , Úlcera/complicações , Úlcera/diagnóstico
18.
Obstet Gynecol ; 133(6): 1269-1273, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31135744

RESUMO

BACKGROUND: Genital ulcers that are not the result of sexually transmitted infections (STIs) are uncommon, and case reports predominantly feature pubertal girls. CASE: A 38-year-old monogamous, nulliparous woman acutely developed painful vaginal ulcers 7 days after babysitting a child who was subsequently diagnosed with hand, foot, and mouth disease. The patient developed nonspecific systemic symptoms followed by painful and rapidly expanding genital ulcers. Laboratory test results for herpes, syphilis, human immunodeficiency virus, gonorrhea, chlamydia, and Epstein-Barr virus were all negative. The patient was treated with brief inpatient observation, oral prednisone, meticulous wound care, and debridement. The ulcers resolved over a 3-week period. CONCLUSION: Although typically associated with pubertal girls, genital ulcers that are not the result of STIs can affect adults as well. The cornerstone of management regardless of age is supportive care, debridement and wound care, and treatment with steroids.


Assuntos
Doença de Mão, Pé e Boca/transmissão , Úlcera/diagnóstico , Úlcera/etiologia , Vagina/patologia , Adulto , Criança , Desbridamento , Feminino , Humanos , Prednisona/administração & dosagem , Úlcera/terapia
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