The complexity of oral ulcerations poses considerable diagnostic and therapeutic challenges to oral specialists.The expert consensus was conducted to summarize the diagnostic work-up for difficult and complicated oral...The complexity of oral ulcerations poses considerable diagnostic and therapeutic challenges to oral specialists.The expert consensus was conducted to summarize the diagnostic work-up for difficult and complicated oral ulcers,based on factors such as detailed clinical medical history inquiry,histopathological examination,and ulceration-related systemic diseases screening.Not only it can provide a standardized procedure of oral ulceration,but also it can improve the diagnostic efficiency,in order to avoid misdiagnosis and missed diagnosis.展开更多
Solitary rectal ulcer syndrome(SRUS)is an uncommon benign disease,characterized by a combination of symptoms,clinical findings and histological abnormalities.Ulcers are only found in 40%of the patients;20%of the patie...Solitary rectal ulcer syndrome(SRUS)is an uncommon benign disease,characterized by a combination of symptoms,clinical findings and histological abnormalities.Ulcers are only found in 40%of the patients;20%of the patients have a solitary ulcer,and the rest of the lesions vary in shape and size,from hyperemic mucosa to broad-based polypoid.Men and women are affected equally,with a small predominance in women.SRUS has also been described in children and in the geriatric population.Clinical features include rectal bleeding,copious mucus discharge,prolonged excessive straining,perineal and abdominal pain,feeling of incomplete defecation,constipation,and rarely,rectal prolapse.This disease has well-described histopathological features such as obliteration of the lamina propria by fibrosis and smooth muscle fibers extending from a thickened muscularis mucosa to the lumen.Diffuse collage deposition in the lamina propria and abnormal smooth muscle fiber extensions are sensitive markers for differentiating SRUS from other conditions.However,the etiology remains obscure,and the condition is frequently associated with pelvic floor disorders.SRUS is difficult to treat,and various treatment strategies have been advocated,ranging from conservative management to a variety of surgical procedures.The aim of the present review is to summarize the clinical features,pathophysiology,diagnostic methods and treatment strategies associated with SRUS.展开更多
Background: Microbial keratitis often results in poor visual outcome despite treatment. A revision of treatment protocol based on local evidence may be required in order to obtain better treatment outcome. Objectives:...Background: Microbial keratitis often results in poor visual outcome despite treatment. A revision of treatment protocol based on local evidence may be required in order to obtain better treatment outcome. Objectives: To determine the predisposing factors and predominant microbiological diagnosis of corneal ulcers seen at the Federal Teaching Hospital Abakaliki (FETHA), Ebonyi State, Nigeria. Materials and Methods: This is a preliminary report of an on-going longitudinal descriptive study of all consenting corneal ulcer patients managed at the FETHA eye clinic over a 4-month period. Information obtained were socio-demographic data, presenting complaints, duration of symptoms prior to presentation, history of preceding trauma, medications used before presentation, presenting and final visual acuity and microbiological diagnosis. Results: A diagnosis of corneal ulcer was made in 8 out of the 852 outpatients seen over the study period giving a hospital prevalence rate of 0.59%. Five patients (62.50%) were males, five (62.50%) were farmers and 4 patients (50%) were above 60 years of age. The microbial diagnoses were bacterial keratitis 37.5% (Staphylococcus aureus), fungal keratitis 25% (Fusarium spp. and aspergillus) and acanthamoeba (25%). None of the patients ever used contact lenses. There was a history of eye trauma in 50% of the patients. All the eyes presented blind after a period of failed attempts to treat by self or quacks. Mean duration before presentation was two weeks. Treatment improved the visual acuity in 37.5% of patients. Conclusion: Bacteria, fungi and acanthamoeba organisms were the microbiological isolates from the scrapings of corneal ulcer patients seen in the eye clinic of FETHA;with bacterial organisms being the most common. Farming activities, preceding eye trauma, delayed presentation, self-medication and use of traditional eye medications (TEM) were common findings among the patients. A future larger study is recommended to confirm the findings of this study. Eye health education campaigns should be directed at farmers to encourage early presentation to hospitals.展开更多
BACKGROUND Ulcerative colitis(UC)is characterised by mucosal inflammation from the rectum to its proximal area in a symmetric and continuous fashion.However,although uncommon,we encounter cases of UC with rectal spari...BACKGROUND Ulcerative colitis(UC)is characterised by mucosal inflammation from the rectum to its proximal area in a symmetric and continuous fashion.However,although uncommon,we encounter cases of UC with rectal sparing in the initial stage.AIM To evaluate the clinical characteristics and clinical course for rectal sparing UC compared with typical UC.METHODS We looked at records from 2004 to 2015,and selected patients who were newly diagnosed with UC,and who could be followed up for at least 5 years in our hospital.We then retrospectively analysed the medical records and endoscopic findings of those patients.To compare the clinical course and prognosis,we matched each patient with rectal sparing UC 1:3 with controls by age,sex,and disease extent.RESULTS Of 619 UC patients,24(3.9%)showed rectal sparing at diagnosis.During the follow-up period(median 8 years),in two(8.3%)of the 24 patients,rectal sparing remained through follow-up inspections;but for the other 22(91.7%)patients,obvious rectal inflammation was found at follow-up endoscopy.Of the 24 patients,8(33.3%)were initially misdiagnosed with infectious colitis.No diagnosis was changed to Crohn’s disease.The uses of corticosteroid or biologic agents,hospitalisation rate,and colectomy rates were not different between the rectal sparing UC group and typical UC group.CONCLUSION Some patients with UC can reveal atypical patterns of disease distribution,such as rectal sparing in its initial stage;but despite this,the clinical course and prognosis may not differ from those of typical UC patients.展开更多
结外鼻型NK/T细胞淋巴瘤(extranodal nasal type NK/T-cell lymphoma,ENKTL)是一种以破坏面部中份结构为主的NK/T细胞来源的非霍奇金淋巴瘤,临床少见。以口腔黏膜溃疡为首发症状的病例罕见且易与其他疾病相混淆,在诊断上极其困难。本文...结外鼻型NK/T细胞淋巴瘤(extranodal nasal type NK/T-cell lymphoma,ENKTL)是一种以破坏面部中份结构为主的NK/T细胞来源的非霍奇金淋巴瘤,临床少见。以口腔黏膜溃疡为首发症状的病例罕见且易与其他疾病相混淆,在诊断上极其困难。本文报道1例以颊黏膜及牙龈溃疡为首发表现的ENKTL的多学科诊疗,并分析该疾病的临床病理学特征、诊断、鉴别诊断和治疗,以期为临床诊治相关病例提供参考。展开更多
舌嗜酸性溃疡(eosinophilic ulcer of the tongue, EUT)是一种良性反应性疾病,通常呈自限性。该病较为罕见,临床常表现为快速增大的孤立溃疡,易被误诊为恶性肿瘤。本文报道1例持续1月余的舌嗜酸性溃疡,探讨该病的临床特点、组织病理学...舌嗜酸性溃疡(eosinophilic ulcer of the tongue, EUT)是一种良性反应性疾病,通常呈自限性。该病较为罕见,临床常表现为快速增大的孤立溃疡,易被误诊为恶性肿瘤。本文报道1例持续1月余的舌嗜酸性溃疡,探讨该病的临床特点、组织病理学特征及诊治原则,以期为临床诊疗提供参考。展开更多
BACKGROUND Inflammatory bowel disease(IBD)comprises two distinct diseases,Crohn’s disease(CD)and ulcerative colitis(UC),both of which are chronic,relapsing inflammatory disorders of the gastrointestinal tract with a ...BACKGROUND Inflammatory bowel disease(IBD)comprises two distinct diseases,Crohn’s disease(CD)and ulcerative colitis(UC),both of which are chronic,relapsing inflammatory disorders of the gastrointestinal tract with a mostly unknown etiology.The incidence and prevalence of IBD are continually increasing,indicating the need for further studies to investigate the genetic determinants of these diseases.Since microRNAs(miRNAs)regulate protein translation via complementary binding to mRNA,discovering differentially expressed miRNAs(DE)in UC or CD patients could be important for diagnostic biomarker identification,assisting in the appropriate disease differentiation progressing the understanding of IBD pathogenesis.AIM To determine the miRNA expression profile in UC and CD patients and the potential pathophysiological contributions of differentially expressed miRNA.METHODS A total of 20 formalin-fixed paraffin-embedded colonic samples were collected from the Pathology Department of Botucatu Medical School at São Paulo State University(Unesp).The diagnosis of UC or CD was based on clinical,endoscopic,radiologic,and histological criteria and confirmed by histopathological analysis at the time of selection.The TaqMan™Array Human MicroRNA A+B Cards Set v3.0(Applied Biosystems™)platform was used to analyze 754 miRNAs.Targets of DE-miRNAs were predicted using miRNA Data Integration Portal(mirDIP)and the miRNA Target Interaction database(MiRTarBase).All statistical analyses were conducted using GraphPad Prism software.Parametric and nonparametric data were analyzed using t-tests and Mann-Whitney U tests,respectively.RESULTS The results showed that of the 754 miRNAs that were initially evaluated,643 miRNAs were found to be expressed in at least five of the patients who were diagnosed with either CD or UC;the remaining 111 miRNAs were not considered to be expressed in these patients.The expression levels of 28 miRNAs were significantly different between the CD and UC patients(P≤0.05);13 miRNAs demonstrated a fold-change in expression level greater than 1.Five miRNAs with a downregulated expression were selected for enrichment analysis.The miRNAs whose expression levels were significantly lower in UC patients than in CD patients were enriched in certain signaling pathways that were mostly correlated with cancer-related processes and respective biomarkers.CONCLUSION MiRNAs could be used to differentiate UC from CD,and differently expressed miRNAs could help explain the distinct pathophysiology of each disease.展开更多
Wireless capsule endoscopes (WCEs) have been used widely to detect abnormalities inside regions of the small intestine that are not accessible when using traditional endoscopy techniques. However, an experienced clini...Wireless capsule endoscopes (WCEs) have been used widely to detect abnormalities inside regions of the small intestine that are not accessible when using traditional endoscopy techniques. However, an experienced clinician must spend an average of 2 hours to view and analyze the approximately 60,000 images produced during one examination. Therefore, developing a computeraided system for processing WCE images is crucial. This paper proposes a novel method used for detecting bleeding and ulcers in WCE images. This approach involves using color features to determine the status of the small intestine. The experimental results revealed that the proposed scheme is promising in detecting bleeding and ulcer regions.展开更多
Ulcerative colitis (UC) is a chronic disease featuring re- current inflammation of the colonic mucosa. The goal of medical treatment is to rapidly induce a steroid-free remission while at the same time preventing comp...Ulcerative colitis (UC) is a chronic disease featuring re- current inflammation of the colonic mucosa. The goal of medical treatment is to rapidly induce a steroid-free remission while at the same time preventing complica- tions of the disease itself and its treatment. The choice of treatment depends on severity, localization and the course of the disease. For proctitis, topical therapy with 5-aminosalicylic acid (5-ASA) compounds is used. More extensive or severe disease should be treated with oral and local 5-ASA compounds and corticosteroids to induce remission. Patients who do not respond to this treatment require hospitalization. Intravenous steroids or, when refractory, calcineurin inhibitors (cyclosporine, tacrolimus), tumor necrosis factor-α antibodies (infliximab) or immunomodulators (azathioprine, 6-mercaptopurine) are then called for. Indications for emergency surgery include refractory toxic megacolon, perforation, and continuous severe colorectal bleeding. Close collaboration between gastroenterologist and surgeon is mandatory in order not to delay surgical therapy when needed. This article is intended to give a general, practice-orientated overview of the key issues in ulcerative colitis treatment. Recommendations are based on published consensus guidelines derived from national and international guidelines on the treatment of ulcerative colitis.展开更多
Solitary rectal ulcer syndrome(SRUS) is a benign and chronic disorder well known in young adults and less in children.It is often related to prolonged excessive straining or abnormal defecation and clinically presents...Solitary rectal ulcer syndrome(SRUS) is a benign and chronic disorder well known in young adults and less in children.It is often related to prolonged excessive straining or abnormal defecation and clinically presents as rectal bleeding,copious mucus discharge,feeling of incomplete defecation,and rarely rectal prolapse.SRUS is diagnosed based on clinical symptoms and endoscopic and histological findings.The current treatments are suboptimal,and despite correct diagnosis,outcomes can be unsatisfactory.Some treatment protocols for SRUS include conservative management such as family reassurance,regulation of toilet habits,avoidance of straining,encouragement of a high-fiber diet,topical treatments with salicylate,sulfasalazine,steroids and sucralfate,and surgery.In children,SRUS is relatively uncommon but troublesome and easily misdiagnosed with other common diseases,however,it is being reported more than in the past.This condition in children is benign;however,morbidity is an important problem as reflected by persistence of symptoms,especially rectal bleeding.In this review,we discuss current diagnosis and treatment for SRUS.展开更多
AIM To investigate the characteristic radiologic findings of cryptogenic multifocal ulcerous stenosing enteritis(CMUSE) which can be differentiated from other similar bowel disease and to assess their clinical behavio...AIM To investigate the characteristic radiologic findings of cryptogenic multifocal ulcerous stenosing enteritis(CMUSE) which can be differentiated from other similar bowel disease and to assess their clinical behavior.METHODS Twenty pathologically and clinically confirmed CMUSE patients(males:females = 8:12; mean age: 40.4 years) between March 2002 and August 2015 from seven academic centers in South Korea were retrospectively reviewed. We evaluated small bowel series(SBS; n = 25), computed tomography(CT) enterography(n = 21), magnetic resonance(MR) enterography(n = 2), and abdominopelvic CT(n = 18) images, focusing on enteric and perienteric manifestations. Any change in radiologic features during followup period was recorded. We evaluated clinical data including presenting symptoms, laboratory finding and presence of relapse from electronic medical records. Histopathologic findings were also evaluated. RESULTS The main symptoms were abdominal pain(n = 12) and anemia(n = 10). All patients showed small bowel strictures(n = 52, mean: 2.6 per patient) on initial CT/MR, located in the ileum(n = 47) or jejunum(n = 5). Strictures showed short-length(mean: 10.44 mm) and circumferential bowel wall thickening(mean: 5.56 mm) with layered enhancement(n = 48) that were also noted on initial SBS(n = 36) with shallow ulcers(n = 10). Some ulcerative lesions or wall thickening progressed into strictures on follow-up SBS/CT, and some strictures revealed recurrent ulceration on followup SBS. There were no penetrating disease features like fistula or abscess and no gastrointestinal tract involvement except the small bowel. Nine patients experienced disease recurrence(median relapse-free period: 32 mo) even post-operatively. Histopathologic features of surgically resected specimens were characterized as multiple superficial ulcerations confined to mucosa or submucosa and multiple strictures.CONCLUSION Under characteristic radiologic findings with multiple short-segmental strictures and/or shallow ulcers of the small intestine, CMUSE should be considered when assessing patients with recurrent abdominal pain and anemia.展开更多
目的探究CT小肠造影(CTE)对结肠型克罗恩病与溃疡性结肠炎的诊断及鉴别诊断价值。方法选取蚌埠医学院第一附属医院和南京中医药大学附属江苏省中医院于2019年1月~2022年1月收治的结肠型克罗恩病患者36例和溃疡性结肠炎患者36例行CTE检查...目的探究CT小肠造影(CTE)对结肠型克罗恩病与溃疡性结肠炎的诊断及鉴别诊断价值。方法选取蚌埠医学院第一附属医院和南京中医药大学附属江苏省中医院于2019年1月~2022年1月收治的结肠型克罗恩病患者36例和溃疡性结肠炎患者36例行CTE检查,分别观察两组影像特征,结合实验室指标、临床表现对克罗恩病和溃疡性结肠炎患者进行回顾性分析。结果36例克罗恩病患者中,CTE影像示肠壁不均匀增厚21例、肠道狭窄22例、瘘管形成7例及累及升结肠21例,均高于溃疡性结肠炎患者,差异有统计学意义(P<0.05);36例溃疡性结肠炎患者,粘液便18例及血便22例高于克罗恩病患者(P<0.05),溃疡性结肠炎患者平均发病年龄较结肠型克罗恩病患者平均发病年龄大(P<0.05)。克罗恩病患者与溃疡性结肠炎患者的C反应蛋白及红细胞沉降率含量均值分别为28.17 mg/L vs 17.67 mg/L、32.25 mm/h vs 22.95 mm/h;C反应蛋白及红细胞沉降率含量的平均值对克罗恩病与溃疡性结肠炎的鉴别无统计学意义(P>0.05)。结论通过CTE影像特征更直观地对结肠型克罗恩病与溃疡性结肠炎进行鉴别,结合临床、内镜表现及病理诊断,为治疗方案设计提供更可靠的依据。展开更多
基金supported by grants from the National Natural Science Foundations of China(No.U19A2005,81771081,81870775)CAMS Innovation Fund for Medical Sciences(CIFMS)(2019-12M-5-004,2020-I2M-C&T-A-023)。
文摘The complexity of oral ulcerations poses considerable diagnostic and therapeutic challenges to oral specialists.The expert consensus was conducted to summarize the diagnostic work-up for difficult and complicated oral ulcers,based on factors such as detailed clinical medical history inquiry,histopathological examination,and ulceration-related systemic diseases screening.Not only it can provide a standardized procedure of oral ulceration,but also it can improve the diagnostic efficiency,in order to avoid misdiagnosis and missed diagnosis.
文摘Solitary rectal ulcer syndrome(SRUS)is an uncommon benign disease,characterized by a combination of symptoms,clinical findings and histological abnormalities.Ulcers are only found in 40%of the patients;20%of the patients have a solitary ulcer,and the rest of the lesions vary in shape and size,from hyperemic mucosa to broad-based polypoid.Men and women are affected equally,with a small predominance in women.SRUS has also been described in children and in the geriatric population.Clinical features include rectal bleeding,copious mucus discharge,prolonged excessive straining,perineal and abdominal pain,feeling of incomplete defecation,constipation,and rarely,rectal prolapse.This disease has well-described histopathological features such as obliteration of the lamina propria by fibrosis and smooth muscle fibers extending from a thickened muscularis mucosa to the lumen.Diffuse collage deposition in the lamina propria and abnormal smooth muscle fiber extensions are sensitive markers for differentiating SRUS from other conditions.However,the etiology remains obscure,and the condition is frequently associated with pelvic floor disorders.SRUS is difficult to treat,and various treatment strategies have been advocated,ranging from conservative management to a variety of surgical procedures.The aim of the present review is to summarize the clinical features,pathophysiology,diagnostic methods and treatment strategies associated with SRUS.
文摘Background: Microbial keratitis often results in poor visual outcome despite treatment. A revision of treatment protocol based on local evidence may be required in order to obtain better treatment outcome. Objectives: To determine the predisposing factors and predominant microbiological diagnosis of corneal ulcers seen at the Federal Teaching Hospital Abakaliki (FETHA), Ebonyi State, Nigeria. Materials and Methods: This is a preliminary report of an on-going longitudinal descriptive study of all consenting corneal ulcer patients managed at the FETHA eye clinic over a 4-month period. Information obtained were socio-demographic data, presenting complaints, duration of symptoms prior to presentation, history of preceding trauma, medications used before presentation, presenting and final visual acuity and microbiological diagnosis. Results: A diagnosis of corneal ulcer was made in 8 out of the 852 outpatients seen over the study period giving a hospital prevalence rate of 0.59%. Five patients (62.50%) were males, five (62.50%) were farmers and 4 patients (50%) were above 60 years of age. The microbial diagnoses were bacterial keratitis 37.5% (Staphylococcus aureus), fungal keratitis 25% (Fusarium spp. and aspergillus) and acanthamoeba (25%). None of the patients ever used contact lenses. There was a history of eye trauma in 50% of the patients. All the eyes presented blind after a period of failed attempts to treat by self or quacks. Mean duration before presentation was two weeks. Treatment improved the visual acuity in 37.5% of patients. Conclusion: Bacteria, fungi and acanthamoeba organisms were the microbiological isolates from the scrapings of corneal ulcer patients seen in the eye clinic of FETHA;with bacterial organisms being the most common. Farming activities, preceding eye trauma, delayed presentation, self-medication and use of traditional eye medications (TEM) were common findings among the patients. A future larger study is recommended to confirm the findings of this study. Eye health education campaigns should be directed at farmers to encourage early presentation to hospitals.
文摘BACKGROUND Ulcerative colitis(UC)is characterised by mucosal inflammation from the rectum to its proximal area in a symmetric and continuous fashion.However,although uncommon,we encounter cases of UC with rectal sparing in the initial stage.AIM To evaluate the clinical characteristics and clinical course for rectal sparing UC compared with typical UC.METHODS We looked at records from 2004 to 2015,and selected patients who were newly diagnosed with UC,and who could be followed up for at least 5 years in our hospital.We then retrospectively analysed the medical records and endoscopic findings of those patients.To compare the clinical course and prognosis,we matched each patient with rectal sparing UC 1:3 with controls by age,sex,and disease extent.RESULTS Of 619 UC patients,24(3.9%)showed rectal sparing at diagnosis.During the follow-up period(median 8 years),in two(8.3%)of the 24 patients,rectal sparing remained through follow-up inspections;but for the other 22(91.7%)patients,obvious rectal inflammation was found at follow-up endoscopy.Of the 24 patients,8(33.3%)were initially misdiagnosed with infectious colitis.No diagnosis was changed to Crohn’s disease.The uses of corticosteroid or biologic agents,hospitalisation rate,and colectomy rates were not different between the rectal sparing UC group and typical UC group.CONCLUSION Some patients with UC can reveal atypical patterns of disease distribution,such as rectal sparing in its initial stage;but despite this,the clinical course and prognosis may not differ from those of typical UC patients.
文摘结外鼻型NK/T细胞淋巴瘤(extranodal nasal type NK/T-cell lymphoma,ENKTL)是一种以破坏面部中份结构为主的NK/T细胞来源的非霍奇金淋巴瘤,临床少见。以口腔黏膜溃疡为首发症状的病例罕见且易与其他疾病相混淆,在诊断上极其困难。本文报道1例以颊黏膜及牙龈溃疡为首发表现的ENKTL的多学科诊疗,并分析该疾病的临床病理学特征、诊断、鉴别诊断和治疗,以期为临床诊治相关病例提供参考。
文摘舌嗜酸性溃疡(eosinophilic ulcer of the tongue, EUT)是一种良性反应性疾病,通常呈自限性。该病较为罕见,临床常表现为快速增大的孤立溃疡,易被误诊为恶性肿瘤。本文报道1例持续1月余的舌嗜酸性溃疡,探讨该病的临床特点、组织病理学特征及诊治原则,以期为临床诊疗提供参考。
基金São Paulo Research Foundation(FAPESP)grants,No.2017/03959-8 and No.2015/15267-8.
文摘BACKGROUND Inflammatory bowel disease(IBD)comprises two distinct diseases,Crohn’s disease(CD)and ulcerative colitis(UC),both of which are chronic,relapsing inflammatory disorders of the gastrointestinal tract with a mostly unknown etiology.The incidence and prevalence of IBD are continually increasing,indicating the need for further studies to investigate the genetic determinants of these diseases.Since microRNAs(miRNAs)regulate protein translation via complementary binding to mRNA,discovering differentially expressed miRNAs(DE)in UC or CD patients could be important for diagnostic biomarker identification,assisting in the appropriate disease differentiation progressing the understanding of IBD pathogenesis.AIM To determine the miRNA expression profile in UC and CD patients and the potential pathophysiological contributions of differentially expressed miRNA.METHODS A total of 20 formalin-fixed paraffin-embedded colonic samples were collected from the Pathology Department of Botucatu Medical School at São Paulo State University(Unesp).The diagnosis of UC or CD was based on clinical,endoscopic,radiologic,and histological criteria and confirmed by histopathological analysis at the time of selection.The TaqMan™Array Human MicroRNA A+B Cards Set v3.0(Applied Biosystems™)platform was used to analyze 754 miRNAs.Targets of DE-miRNAs were predicted using miRNA Data Integration Portal(mirDIP)and the miRNA Target Interaction database(MiRTarBase).All statistical analyses were conducted using GraphPad Prism software.Parametric and nonparametric data were analyzed using t-tests and Mann-Whitney U tests,respectively.RESULTS The results showed that of the 754 miRNAs that were initially evaluated,643 miRNAs were found to be expressed in at least five of the patients who were diagnosed with either CD or UC;the remaining 111 miRNAs were not considered to be expressed in these patients.The expression levels of 28 miRNAs were significantly different between the CD and UC patients(P≤0.05);13 miRNAs demonstrated a fold-change in expression level greater than 1.Five miRNAs with a downregulated expression were selected for enrichment analysis.The miRNAs whose expression levels were significantly lower in UC patients than in CD patients were enriched in certain signaling pathways that were mostly correlated with cancer-related processes and respective biomarkers.CONCLUSION MiRNAs could be used to differentiate UC from CD,and differently expressed miRNAs could help explain the distinct pathophysiology of each disease.
文摘Wireless capsule endoscopes (WCEs) have been used widely to detect abnormalities inside regions of the small intestine that are not accessible when using traditional endoscopy techniques. However, an experienced clinician must spend an average of 2 hours to view and analyze the approximately 60,000 images produced during one examination. Therefore, developing a computeraided system for processing WCE images is crucial. This paper proposes a novel method used for detecting bleeding and ulcers in WCE images. This approach involves using color features to determine the status of the small intestine. The experimental results revealed that the proposed scheme is promising in detecting bleeding and ulcer regions.
文摘Ulcerative colitis (UC) is a chronic disease featuring re- current inflammation of the colonic mucosa. The goal of medical treatment is to rapidly induce a steroid-free remission while at the same time preventing complica- tions of the disease itself and its treatment. The choice of treatment depends on severity, localization and the course of the disease. For proctitis, topical therapy with 5-aminosalicylic acid (5-ASA) compounds is used. More extensive or severe disease should be treated with oral and local 5-ASA compounds and corticosteroids to induce remission. Patients who do not respond to this treatment require hospitalization. Intravenous steroids or, when refractory, calcineurin inhibitors (cyclosporine, tacrolimus), tumor necrosis factor-α antibodies (infliximab) or immunomodulators (azathioprine, 6-mercaptopurine) are then called for. Indications for emergency surgery include refractory toxic megacolon, perforation, and continuous severe colorectal bleeding. Close collaboration between gastroenterologist and surgeon is mandatory in order not to delay surgical therapy when needed. This article is intended to give a general, practice-orientated overview of the key issues in ulcerative colitis treatment. Recommendations are based on published consensus guidelines derived from national and international guidelines on the treatment of ulcerative colitis.
文摘Solitary rectal ulcer syndrome(SRUS) is a benign and chronic disorder well known in young adults and less in children.It is often related to prolonged excessive straining or abnormal defecation and clinically presents as rectal bleeding,copious mucus discharge,feeling of incomplete defecation,and rarely rectal prolapse.SRUS is diagnosed based on clinical symptoms and endoscopic and histological findings.The current treatments are suboptimal,and despite correct diagnosis,outcomes can be unsatisfactory.Some treatment protocols for SRUS include conservative management such as family reassurance,regulation of toilet habits,avoidance of straining,encouragement of a high-fiber diet,topical treatments with salicylate,sulfasalazine,steroids and sucralfate,and surgery.In children,SRUS is relatively uncommon but troublesome and easily misdiagnosed with other common diseases,however,it is being reported more than in the past.This condition in children is benign;however,morbidity is an important problem as reflected by persistence of symptoms,especially rectal bleeding.In this review,we discuss current diagnosis and treatment for SRUS.
文摘AIM To investigate the characteristic radiologic findings of cryptogenic multifocal ulcerous stenosing enteritis(CMUSE) which can be differentiated from other similar bowel disease and to assess their clinical behavior.METHODS Twenty pathologically and clinically confirmed CMUSE patients(males:females = 8:12; mean age: 40.4 years) between March 2002 and August 2015 from seven academic centers in South Korea were retrospectively reviewed. We evaluated small bowel series(SBS; n = 25), computed tomography(CT) enterography(n = 21), magnetic resonance(MR) enterography(n = 2), and abdominopelvic CT(n = 18) images, focusing on enteric and perienteric manifestations. Any change in radiologic features during followup period was recorded. We evaluated clinical data including presenting symptoms, laboratory finding and presence of relapse from electronic medical records. Histopathologic findings were also evaluated. RESULTS The main symptoms were abdominal pain(n = 12) and anemia(n = 10). All patients showed small bowel strictures(n = 52, mean: 2.6 per patient) on initial CT/MR, located in the ileum(n = 47) or jejunum(n = 5). Strictures showed short-length(mean: 10.44 mm) and circumferential bowel wall thickening(mean: 5.56 mm) with layered enhancement(n = 48) that were also noted on initial SBS(n = 36) with shallow ulcers(n = 10). Some ulcerative lesions or wall thickening progressed into strictures on follow-up SBS/CT, and some strictures revealed recurrent ulceration on followup SBS. There were no penetrating disease features like fistula or abscess and no gastrointestinal tract involvement except the small bowel. Nine patients experienced disease recurrence(median relapse-free period: 32 mo) even post-operatively. Histopathologic features of surgically resected specimens were characterized as multiple superficial ulcerations confined to mucosa or submucosa and multiple strictures.CONCLUSION Under characteristic radiologic findings with multiple short-segmental strictures and/or shallow ulcers of the small intestine, CMUSE should be considered when assessing patients with recurrent abdominal pain and anemia.
文摘目的探究CT小肠造影(CTE)对结肠型克罗恩病与溃疡性结肠炎的诊断及鉴别诊断价值。方法选取蚌埠医学院第一附属医院和南京中医药大学附属江苏省中医院于2019年1月~2022年1月收治的结肠型克罗恩病患者36例和溃疡性结肠炎患者36例行CTE检查,分别观察两组影像特征,结合实验室指标、临床表现对克罗恩病和溃疡性结肠炎患者进行回顾性分析。结果36例克罗恩病患者中,CTE影像示肠壁不均匀增厚21例、肠道狭窄22例、瘘管形成7例及累及升结肠21例,均高于溃疡性结肠炎患者,差异有统计学意义(P<0.05);36例溃疡性结肠炎患者,粘液便18例及血便22例高于克罗恩病患者(P<0.05),溃疡性结肠炎患者平均发病年龄较结肠型克罗恩病患者平均发病年龄大(P<0.05)。克罗恩病患者与溃疡性结肠炎患者的C反应蛋白及红细胞沉降率含量均值分别为28.17 mg/L vs 17.67 mg/L、32.25 mm/h vs 22.95 mm/h;C反应蛋白及红细胞沉降率含量的平均值对克罗恩病与溃疡性结肠炎的鉴别无统计学意义(P>0.05)。结论通过CTE影像特征更直观地对结肠型克罗恩病与溃疡性结肠炎进行鉴别,结合临床、内镜表现及病理诊断,为治疗方案设计提供更可靠的依据。
