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1.
Medicine (Baltimore) ; 99(9): e19357, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118778

RESUMO

BACKGROUND: Vonoprazan is a potassium-competitive acid blocker (P-CAB) that is frequently used in Japan for Helicobacter pylori (H. pylori) eradication, treatment of gastroesophageal reflux disease, and treatment of post endoscopic submucosal dissection (ESD) complications. We sought to determine if vonoprazan was superior to proton pump inhibitors (PPIs) for treating ESD-induced ulcers (as assessed by ulcer healing and shrinkage ratios) and preventing delayed bleeding over various treatment durations (2, 4, and 8 weeks). METHODS: We collected randomized controlled trials (RCTs) and observational studies that discussed the effectiveness of vonoprazan and PPIs on ESD-induced ulcers and bleeding from PubMed, Cochrane Library, ClinicalTrials.gov, and Google Scholar. Studies were selected according to pre-established eligibility criteria and data were extracted separately by 2 researchers with double-check. We used the Cochrane risk of bias tool to assess RCTs and the Newcastle-Ottawa Quality Assessment Scale to assess observational studies. Meta-analyses, based on the random-effects model, were conducted to compare differences in ulcer shrinkage ratios (%) and odds ratios (ORs) for ulcer healing and delayed bleeding. Publication bias was evaluated using funnel plots and Egger regression test. Heterogeneity was assessed using I statistics. A sensitivity analysis was conducted to check the robustness of results. The evidential quality of the findings was assessed using the GRADE profiler. RESULTS: Thirteen studies were included in this meta-analysis. The OR effect sizes of vonoprazan relative to PPIs for ulcer healing were 1.33 (P = .13) with a 95% CI (0.33-3.21) at 4 weeks and 1.48 (P = .09) with a 95% CI (0.81-5.20) at 8 weeks. The overall effect size for the shrinkage ratio was 12.24% (P = .16) with a 95% CI (-4.96-29.44) at 2 weeks. The effect size of its subgroup of H. pylori-positive patients was 19.51% (P < .001) with a 95% CI (11.91-27.12). The overall OR for the occurrence of delayed bleeding was 0.66 (P = .26) with a 95% CI (0.32-1.35). After excluding combination drug studies, the overall ORs between vonoprazan and PPIs on ulcer healing and delayed bleeding were 1.44 and 0.76, respectively. CONCLUSION: During the first 2 weeks of treatment, vonoprazan was more effective than PPIs for treating H. pylori-positive patients with ESD-induced gastric ulcers.


Assuntos
Ressecção Endoscópica de Mucosa/efeitos adversos , Inibidores da Bomba de Prótons/normas , Pirróis/normas , Sulfonamidas/normas , Úlcera/tratamento farmacológico , Adulto , Ressecção Endoscópica de Mucosa/instrumentação , Ressecção Endoscópica de Mucosa/métodos , Humanos , Estudos Observacionais como Assunto/estatística & dados numéricos , Complicações Pós-Operatórias , Inibidores da Bomba de Prótons/uso terapêutico , Pirróis/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Sulfonamidas/uso terapêutico , Úlcera/etiologia
2.
Int J Radiat Oncol Biol Phys ; 106(3): 464-471, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31697990

RESUMO

PURPOSE: Our purpose was to assess the feasibility, safety, and efficacy of stereotactic ablative radiation therapy (SAbR) as an alternative for intracavitary/interstitial brachytherapy boost for locally advanced cervical cancer (LACC) after initial chemoradiation. METHODS AND MATERIALS: A single arm institutional phase II study of SAbR as a boost for LACC was conducted. Eligible patients had LACC FIGO 2009 stage IB2-IVB, performance status 0 to 3, and one of the following: medically unfit or refused intracavitary or tumor extent required interstitial brachytherapy for coverage. The cervix planning target volume boost (PTVboost) received 28 Gy in 4 fractions. RESULTS: The study was closed with 15 of 21 patients completed owing to concern for toxicity. Median follow-up for this cohort was 19 months. Patients had predominantly advanced stage (III-IV, 53%) with median Charlson comorbidity score of 4. Most tumors were large with a median SAbR boost PTV size of 139 cc (range, 51-268 cc). Tumor size and patient comorbidities probably contributed to the lower-than-expected 2-year local control, progression free, and overall survival of 70.1%, 46.7%, and 53.3%, respectively. The SAbR boost 2 year cumulative grade ≥ 3 toxicity of 26.7% was predominantly rectal (ulcer/fistula).The median SAbR PTV volume was 225 cc versus 95 cc for patients with and without grade ≥ 3 toxicity. On dosimetric analysis, only the percentage of rectal circumference receiving 15 Gy (PRC15) for the SAbR boost was associated with development of grade 3 ulcer or rectovaginal fistula (P = .04), with PRC15 > 62.7% being the strongest predictor of toxicity (AUC, 0.93; sensitivity, 100%; specificity, 90%). CONCLUSIONS: In this SAbR boost series suboptimal outcomes were probably related to patient selection and very large tumor volume. This approach may still be considered in patients with smaller tumors unable to undergo standard brachytherapy for cervix cancer.


Assuntos
Radiocirurgia/métodos , Neoplasias do Colo do Útero/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Braquiterapia , Quimiorradioterapia , Término Precoce de Ensaios Clínicos , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Avaliação de Estado de Karnofsky , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Estudos Prospectivos , Radiocirurgia/efeitos adversos , Doenças Retais/etiologia , Fístula Retovaginal/etiologia , Reto/efeitos da radiação , Segurança , Sensibilidade e Especificidade , Carga Tumoral , Úlcera/etiologia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/terapia
3.
Int J Radiat Biol ; 96(1): 100-111, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-29447591

RESUMO

Purpose: Characterization of a novel partial-body irradiation (PBI) shielding strategy in nonhuman primates (NHP; rhesus macaques), aimed at protecting the oral cavity, with respect to various gastrointestinal acute radiation syndrome (GI-ARS) syndrome parameters as well as buccal ulceration development.Materials and methods: NHPs were irradiated using a Cobalt-60 gamma source, in a single uniform dose, ranging from 9-13 Gy and delivered at 0.60-0.80 Gy min-1. Animals were either partially shielded via oral cavity shielding (PBIOS) or underwent total-body irradiation (TBI).Results: Clinical manifestations of GI-ARS, and also radiation-induced hematology and clinical chemistry changes, following PBIOS were comparable to the PBI NHP GI-ARS model utilizing shielding of the distal pelvic limbs and were significantly milder than TBI at similar radiation doses. Nadir citrulline levels were comparable between PBIOS and TBI but signs of recovery appeared earlier in PBIOS-treated animals. The PBIOS model prevented oral mucositis, whereas the TBI model presented buccal ulcerations at all tested radiation dose levels.Conclusions: Taken together, these results suggest that the PBIOS model is a suitable alternative to traditional PBI. For GI-ARS investigations requiring orally administered medical countermeasures, PBIOS confers added value due to the prevention of oral mucositis over traditional PBI.


Assuntos
Boca/efeitos da radiação , Proteção Radiológica/métodos , Síndrome Aguda da Radiação/sangue , Síndrome Aguda da Radiação/etiologia , Síndrome Aguda da Radiação/patologia , Animais , Citrulina/sangue , Radioisótopos de Cobalto/efeitos adversos , Raios gama/efeitos adversos , Macaca mulatta , Masculino , Análise de Sobrevida , Úlcera/sangue , Úlcera/etiologia , Úlcera/patologia
4.
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
6.
Mater Sci Eng C Mater Biol Appl ; 103: 109870, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31349408

RESUMO

Endoscopic submucosal dissection (ESD) is a useful tool for the treatment of early gastric neoplasms, however post-ESD bleeding and perforation restrict its widespread application. In this study, we developed the chitosan/ß-glycerophosphate/collagen (CS/GP/Col) thermo-sensitive systems to satisfy the requirements for the endoscopic treatment for ESD-induced ulcer. The results indicated that the addition of collagen to CS/GP system did not lead to remarkable changes on the physicochemical properties of the systems, which can transform from solution to hydrogels under physiological temperature within 90s, technically makes it suitable to be applied through catheter to gastric ulcer during ESD operation. Besides, hydrogels with high collagen concentration showed better biocompatibility, effectively protected L929, GES-1, HVSMC and CCD-18Co cells from acidic condition, induced more growth factors such as EGF, VEGF and FGF in those cells, and promoted coagulation. These results indicated that the CS/GP/Col thermo-sensitive hydrogel might be a promising biomaterial for the endoscopic treatment of ESD-induced ulcer, and further research can be carried out.


Assuntos
Quitosana , Colágeno , Mucosa Gástrica/cirurgia , Gastroscopia/efeitos adversos , Glicerofosfatos , Hidrogéis , Complicações Pós-Operatórias/tratamento farmacológico , Neoplasias Gástricas/cirurgia , Úlcera , Animais , Linhagem Celular , Quitosana/química , Quitosana/farmacologia , Colágeno/química , Colágeno/farmacologia , Mucosa Gástrica/patologia , Glicerofosfatos/química , Glicerofosfatos/farmacologia , Humanos , Hidrogéis/química , Hidrogéis/farmacologia , Camundongos , Ratos , Ratos Sprague-Dawley , Neoplasias Gástricas/patologia , Úlcera/tratamento farmacológico , Úlcera/etiologia
7.
Medicine (Baltimore) ; 98(24): e15860, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31192917

RESUMO

BACKGROUND: Vonoprazan, a novel potassium-competitive acid blocking agent, has been used in the management of endoscopic submucosal dissection (ESD)-induced artificial ulcers. This study aimed to perform a systematic review and meta-analysis for the comparison of the effects of vonoprazan and proton pump inhibitors (PPIs) in treating ESD-induced artificial ulcers and preventing delayed bleeding in randomized controlled trial and cohort studies. METHODS: We searched OVID-MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar, and clinical trial registries in April 2018 to identify all studies that assess and compare the effects of vonoprazan and PPI in treating ESD-induced artificial ulcers and preventing delayed bleeding. Primary outcome of ulcer healing rate and secondary outcomes of shrinkage rate, ulcer size, and delayed bleeding were studied. RESULTS: A total of 1265 patients from 12 studies were included in the final analysis. Healing rate at 4 weeks post-ESD was significantly higher in the vonoprazan group than in the PPI group (relative ratio [RR] 1.20 [1.03-1.40]). However, healing rate at 8 weeks post-ESD was significantly higher in the PPI group than in the vonoprazan group (RR 0.68 [0.48-0.97]).There was no evidence of significant difference between groups in shrinkage rate at 4 weeks post-ESD, shrinkage rate at 8 weeks post-ESD, delayed bleeding, ulcer size at 0 weeks post-ESD, and ulcer size at 8 weeks post-ESD. CONCLUSIONS: There was no substantial difference in ulcer healing and post-ESD bleeding between vonoprazan and PPIs. However, vonoprazan more rapidly and effectively treated artificial ulcers after ESD than did PPIs.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Ressecção Endoscópica de Mucosa/efeitos adversos , Inibidores da Bomba de Prótons/uso terapêutico , Pirróis/uso terapêutico , Sulfonamidas/uso terapêutico , Úlcera/tratamento farmacológico , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Úlcera/etiologia
8.
Rev Gastroenterol Peru ; 39(1): 84-87, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31042243

RESUMO

Vascular abnormalities of the gastrointestinal tract are a common cause of gastrointestinal bleeding. Most of them are located within the reach of the upper endoscopy or colonoscopy, although once discarded, it forces to consider small bowel as the source of bleeding. The successful management of a gastrointestinal bleeding depends mainly on the timely location of the source of bleeding. Nevertheless this task can be difficult when the cause is not within the reach of conventional methods. We present a case of a 21 year-old men in which the diagnosis of bleeding yeyunal phlebectasia was made by the findings of the capsule endoscopy and laparoscopy.


Assuntos
Angiodisplasia/complicações , Hemorragia Gastrointestinal/etiologia , Doenças do Jejuno/complicações , Angiodisplasia/diagnóstico por imagem , Angiodisplasia/cirurgia , Endoscopia por Cápsula , Dilatação Patológica , Humanos , Doenças do Jejuno/diagnóstico por imagem , Doenças do Jejuno/cirurgia , Jejuno/irrigação sanguínea , Laparoscopia , Masculino , Trombose/etiologia , Úlcera/etiologia , Veias/patologia , Adulto Jovem
9.
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
10.
Hautarzt ; 70(9): 715-722, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31076814

RESUMO

This article reports the remarkable course of a facial ulcer in a patient receiving prednisolone for Crohn's disease. Based on the initially unclear origin of the ulcer the patient received a triple anti-infective treatment (antiviral, antibiotic, antimycotic) but the lesion showed a rapid progression. An orthopoxvirus infection could be verified later by extensive diagnostics and relevant differential diagnoses could be ruled out. Extensive necrotic changes were observed in the first weeks resulting in cicatricial healing after months. Human cowpox infections have been repeatedly reported in Germany and are a relevant zoonosis. Cats and rodents are main carriers. The differential diagnoses include infections caused by other bacterial, mycobacterial, mycotic and parasitic agents that are thoroughly discussed here both clinically and histopathologically. Especially cutaneous leishmaniasis must be named as the incidence is continuously rising. With inadequate treatment infectious facial ulcers may give rise to life-threatening complications and extensive disfiguring scarring, therefore treatment must be initiated in a timely manner.


Assuntos
Orthopoxvirus/isolamento & purificação , Infecções por Poxviridae/diagnóstico , Úlcera/etiologia , Animais , Gatos/virologia , Diagnóstico Diferencial , Face/patologia , Alemanha , Humanos , Necrose , Infecções por Poxviridae/virologia , Zoonoses
12.
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
14.
J Int Med Res ; 47(5): 2126-2134, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30938568

RESUMO

OBJECTIVE: Both compound vitamin B mixtures and GeneTime® have been used in treatment of oral inflammation. This study aimed to assess the therapeutic effects of a compound vitamin B mixture combined with GeneTime® on radiation-induced oral mucositis. METHODS: A total of 100 patients with radiation-induced oral mucositis were randomly divided into a control group (vitamin B alone; n = 50 patients) and an observation group (vitamin B plus GeneTime®, n = 50 patients). Clinical outcomes were compared between the two groups for the following 3 weeks. RESULTS: The observation group had a significantly greater number of grade 0-I patients and significantly fewer grade II-IV patients than the control group. Among patients in the observation group, a significantly greater number of ulcers healed within 1-2 weeks, compared with those in patients in the control group. Significantly fewer ulcers healed among patients in the observation group at 3 weeks; notably, there were fewer ulcers to heal in the observation group, compared with the control group. CONCLUSIONS: Use of a compound vitamin B mixture combined with GeneTime® exerted obvious therapeutic effects on radiation-induced oral mucositis and markedly shortened ulcer healing time. Therefore, this strategy may be useful in clinical applications.


Assuntos
Lesões por Radiação/complicações , Proteínas Recombinantes/uso terapêutico , Estomatite/tratamento farmacológico , Estomatite/etiologia , Complexo Vitamínico B/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Proteínas Recombinantes/farmacologia , Úlcera/tratamento farmacológico , Úlcera/etiologia , Complexo Vitamínico B/farmacologia , Cicatrização/efeitos dos fármacos
15.
Reumatismo ; 71(1): 19-23, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30932439

RESUMO

Klotho is a transmembrane and soluble glycoprotein that governs vascular integrity. Previous studies have demonstrated reduced serum klotho concentrations in patients with systemic sclerosis (SSc), and it is known that klotho deficiency can impair the healing of digital ulcers related to microvessel damage. The aim of this study was to evaluate the association between serum klotho levels and nailfold capillaroscopic abnormalities in SSc patients. We retrospectively enrolled 54 consecutive patients with SSc diagnosed on the basis of the 2013 EULAR/ACR criteria [11 with diffuse SSc; 47 females; median age 68.0 years (IQ 18); median disease duration 11.0 years (IQ 7)]. Serum klotho concentrations were determined by means of an enzyme-linked immunosorbent assay. On the basis of the 2000 classification of Cutolo et al., 14 patients had normal nailfold capillaroscopic findings, 8 had an early scleroderma pattern, 21 an active scleroderma pattern, and 11 a late scleroderma pattern. The median serum klotho concentration was 0.29 ng/mL (IQ 1). Regression analysis of variation showed an inverse correlation between serum klotho concentrations and the severity of the capillaroscopic pattern (p=0.02; t -2.2284), which was not influenced by concomitant treatment. Logistic regression did not reveal any significant association between the risk of developing digital ulcers and nailfold capillaroscopic patterns, serum klotho levels, or concomitant medications. The presence of avascular areas significantly correlated with calcinosis (p=0.006). In line with previous studies, our findings confirm that klotho plays a role in preventing microvascular damage detected with nailfold capillaroscopy.


Assuntos
Calcinose/complicações , Glucuronidase/sangue , Angioscopia Microscópica , Doenças da Unha/sangue , Unhas/irrigação sanguínea , Escleroderma Sistêmico/sangue , Adulto , Idoso , Anticorpos Antinucleares/sangue , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Unha/etiologia , Análise de Regressão , Estudos Retrospectivos , Úlcera/etiologia
17.
Medicine (Baltimore) ; 98(9): e14624, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30817580

RESUMO

RATIONALE: Behçet's disease (BD) is a chronic immune-mediated inflammatory disorder involving multiple organ systems. In BD, intestinal ulcers can present as a refractory lesion capable of perforation, which makes the choice of treatment difficult. PATIENT CONCERNS: A 34-year-old male who was diagnosed with intestinal BD and suffered with an ileocecal perforation. He underwent surgery for an ileostomy and was given corticosteroids as treatment. However, the ulcerative lesion remained resistant to the therapy that was provided which delayed the closure operation. DIAGNOSIS: Intestinal BD with severe post-operative complication. INTERVENTIONS: A course of adalimumab (ADa) therapy was started. Subsequently surgery was performed. And ADa and thalidomide were used as a maintenance therapy. OUTCOMES: In this case, a course of ADa therapy was given which healed the intestinal ulcers and allowed us to successfully perform the closure operation. LESSONS: This case indicates that ADa may be an effective treatment option in future cases, minimizing complications and allowing the closure operation to be performed successfully.


Assuntos
Adalimumab/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Síndrome de Behçet/terapia , Ileostomia/efeitos adversos , Perfuração Intestinal/terapia , Complicações Pós-Operatórias/terapia , Adulto , Ceco/lesões , Humanos , Ileostomia/métodos , Íleo/lesões , Enteropatias/etiologia , Enteropatias/terapia , Perfuração Intestinal/etiologia , Masculino , Complicações Pós-Operatórias/etiologia , Reoperação , Resultado do Tratamento , Úlcera/etiologia , Úlcera/terapia
19.
Int J Mycobacteriol ; 8(1): 29-34, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30860176

RESUMO

Background: Erythema nodosum leprosum (ENL) classically presents with tender, coppery, evanescent nodules along with constitutional features and visceral involvement. However, uncommon morphological variants of ENL-like erythema nodosum necroticans, erythema multiforme (EM)-like ENL, Sweet's syndrome (SS)-like ENL, Lucio phenomenon, and reactive perforating type of ENL have also been described in the literature. The primary objective of this study was to describe the clinical features of the severe and uncommon morphological variants of ENL. Methods: This was an observational case series with retrospective review of records of all ENL patients with ulceronecrotic lesions admitted in the Department of Dermato-venereo-leprology of a tertiary health center of central India over a period of 2 years. Results: Eighteen patients were included, all of whom had ulceronecrotic lesions. Four out of them had EM like ENL, two had SS-like presentation, and one of them had annular bullous lesions over old infiltrated plaques of leprosy. Conclusions: Uncommon variants of ENL can be very commonly misdiagnosed in patients, especially in those who have not been previously diagnosed with leprosy. Hence, a high index of suspicion is required in such cases to avoid delay in the diagnosis and resulting morbidity.


Assuntos
Eritema Nodoso/diagnóstico , Eritema Nodoso/patologia , Hanseníase Virchowiana/diagnóstico , Hanseníase Virchowiana/patologia , Úlcera/etiologia , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Necrose/etiologia , Necrose/patologia , Estudos Retrospectivos , Centros de Atenção Terciária , Úlcera/patologia , Adulto Jovem
20.
Medicine (Baltimore) ; 98(8): e14567, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30813173

RESUMO

Radiation therapy can have adverse effects on normal tissue and cause chronic ulcers. The purpose of this study was to compare breast cancer patients who underwent single-stage reconstruction with patients who underwent 2-stage reconstruction for chronic radiation-induced necrotic ulcers of the chest wall.This retrospective study comprised of 50 patients with chronic radiation-induced chest wall ulcers who underwent chest wall reconstruction in our hospital between January 2002 and January 2016. All patients developed ulcers after undergoing breast cancer surgery, followed by radiation therapy. These patients were divided into 2 groups: group A, patients who underwent debridement and reconstruction with tissue flaps simultaneously in a single-stage procedure; group B, patients who underwent debridement and omentum majus tamping in the 1st stage, followed by surgical reconstruction with skin grafting or flap transfer 2 weeks later. The postoperative complications and outcomes were evaluated and compared.These patients were followed up for 48 to 55 months (mean: 50 months), and overall survival was 98%. One patient in group A died of septicemia 5 days after the operation. Six patients in group A developed flap infection, among which 4 patients progressed to flap necrosis (group A: 6/25 vs group B: 0/25; P = .000).Compared to single-stage reconstruction, surgical reconstruction in 2 stages was safer and more effective in treating chronic radiation-induced ulcers of the chest wall, and is associated with fewer postoperative complications. The omentum majus flap was the most ideal tissue for the repair of these defects.


Assuntos
Lesões por Radiação/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Parede Torácica/cirurgia , Úlcera/cirurgia , Idoso , Neoplasias da Mama/radioterapia , Desbridamento/métodos , Feminino , Seguimentos , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Estudos Retrospectivos , Transplante de Pele/métodos , Taxa de Sobrevida , Parede Torácica/patologia , Úlcera/etiologia
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