A 63-year-old man with chronic lymphocytic leukaemia developed pyodermagan grenosum following minortrauma to the leg. He required intensive inpatient management with a multitude of treatmentsincludinglarvaltherapy,sur...A 63-year-old man with chronic lymphocytic leukaemia developed pyodermagan grenosum following minortrauma to the leg. He required intensive inpatient management with a multitude of treatmentsincludinglarvaltherapy,surgicaldebridement,ciclosporin, methotrexate, thalidomide, pulsed intravenous methyl prednisolone and high-dose intravenous immunoglobulin, clofazamine and high dose oral corticosteroids, none of which were helpful. Treatment complications included steroid-induced diabetes, Cushing’ s syndrome and perforated peptic ulcer. The pyoderma remained refractory to treatment and continued to extend until he received intravenous infliximab 5 mg/kg at weeks 0, 2 and 6.展开更多
Despite advances in preoperative evaluation and postoperative care, intervention, especially surgery, for relief of obstructive jaundice still carries high morbidity and mortality rates, mainly due to sepsis and renal...Despite advances in preoperative evaluation and postoperative care, intervention, especially surgery, for relief of obstructive jaundice still carries high morbidity and mortality rates, mainly due to sepsis and renal dysfunction. The key event in the pathophysiology of obstructive jaundice-associated complications is endotoxemia of gut origin because of intestinal barrier failure. This breakage of the gut barrier in obstructive jaundice is multi-factorial, involving disruption of the immunologic, biological and mechanical barrier. Experimental and clinical studies have shown that obstructive jaundice results in increased intestinal permeability. The mechanisms implicated in this phenomenon remain unresolved, but growing research interest during the last decade has shed light in our knowledge in the field. This review summarizes the current concepts in the pathophysiology of obstructive jaundice-induced gut barrier dysfunction, analyzing pivotal factors, such as altered intestinal tight junctions expression, oxidative stress and imbalance of enterocyte proliferation and apoptosis. Clinicians handling patients with obstructive jaundice should not neglect protecting the intestinal barrier function before, during and after intervention for the relief of this condition, which may improve their patients’ outcome.展开更多
Post-infectious irritable bowel syndrome (PI-IBS) is a common disorder wherein symptoms of IBS begin after an episode of acute gastroenteritis. Published studies have reported incidence of PI-IBS to range between 5% a...Post-infectious irritable bowel syndrome (PI-IBS) is a common disorder wherein symptoms of IBS begin after an episode of acute gastroenteritis. Published studies have reported incidence of PI-IBS to range between 5% and 32%. The mechanisms underlying the development of PI-IBS are not fully understood, but are believed to include persistent sub-clinical inflammation, changes in intestinal permeability and alteration of gut flora. Individual studies have suggested that risk factors for PI-IBS include patients' demographics, psychological disorders and the severity of enteric illness. However, PI-IBS remains a diagnosis of exclusion with no specific disease markers and, to date, no definitive therapy exists. The prognosis of PIIBS appears favorable with spontaneous and gradual resolution of symptoms in most patients.展开更多
As is the case in all parts of gastroenterology and hepatology,there have been many advances in our knowledge and understanding of small intestinal diseases.Over 1000 publications were reviewed for 2008 and 2009,and t...As is the case in all parts of gastroenterology and hepatology,there have been many advances in our knowledge and understanding of small intestinal diseases.Over 1000 publications were reviewed for 2008 and 2009,and the important advances in basic science as well as clinical applications were considered.In Part Ⅰ of this Editorial Review,seven topics are considered:intestinal development;proliferation and repair;intestinal permeability;microbiotica,infectious diarrhea and probiotics;diarrhea;salt and water absorption;necrotizing enterocolitis;and immunology/allergy.These topics were chosen because of their importance to the practicing physician.展开更多
文摘A 63-year-old man with chronic lymphocytic leukaemia developed pyodermagan grenosum following minortrauma to the leg. He required intensive inpatient management with a multitude of treatmentsincludinglarvaltherapy,surgicaldebridement,ciclosporin, methotrexate, thalidomide, pulsed intravenous methyl prednisolone and high-dose intravenous immunoglobulin, clofazamine and high dose oral corticosteroids, none of which were helpful. Treatment complications included steroid-induced diabetes, Cushing’ s syndrome and perforated peptic ulcer. The pyoderma remained refractory to treatment and continued to extend until he received intravenous infliximab 5 mg/kg at weeks 0, 2 and 6.
文摘Despite advances in preoperative evaluation and postoperative care, intervention, especially surgery, for relief of obstructive jaundice still carries high morbidity and mortality rates, mainly due to sepsis and renal dysfunction. The key event in the pathophysiology of obstructive jaundice-associated complications is endotoxemia of gut origin because of intestinal barrier failure. This breakage of the gut barrier in obstructive jaundice is multi-factorial, involving disruption of the immunologic, biological and mechanical barrier. Experimental and clinical studies have shown that obstructive jaundice results in increased intestinal permeability. The mechanisms implicated in this phenomenon remain unresolved, but growing research interest during the last decade has shed light in our knowledge in the field. This review summarizes the current concepts in the pathophysiology of obstructive jaundice-induced gut barrier dysfunction, analyzing pivotal factors, such as altered intestinal tight junctions expression, oxidative stress and imbalance of enterocyte proliferation and apoptosis. Clinicians handling patients with obstructive jaundice should not neglect protecting the intestinal barrier function before, during and after intervention for the relief of this condition, which may improve their patients’ outcome.
文摘Post-infectious irritable bowel syndrome (PI-IBS) is a common disorder wherein symptoms of IBS begin after an episode of acute gastroenteritis. Published studies have reported incidence of PI-IBS to range between 5% and 32%. The mechanisms underlying the development of PI-IBS are not fully understood, but are believed to include persistent sub-clinical inflammation, changes in intestinal permeability and alteration of gut flora. Individual studies have suggested that risk factors for PI-IBS include patients' demographics, psychological disorders and the severity of enteric illness. However, PI-IBS remains a diagnosis of exclusion with no specific disease markers and, to date, no definitive therapy exists. The prognosis of PIIBS appears favorable with spontaneous and gradual resolution of symptoms in most patients.
文摘As is the case in all parts of gastroenterology and hepatology,there have been many advances in our knowledge and understanding of small intestinal diseases.Over 1000 publications were reviewed for 2008 and 2009,and the important advances in basic science as well as clinical applications were considered.In Part Ⅰ of this Editorial Review,seven topics are considered:intestinal development;proliferation and repair;intestinal permeability;microbiotica,infectious diarrhea and probiotics;diarrhea;salt and water absorption;necrotizing enterocolitis;and immunology/allergy.These topics were chosen because of their importance to the practicing physician.
