Small-diameter acellular porcine corneal stroma for peripheral corneal ulceration treatment

AIM:To evaluate the clinical efficacy of small-diameter acellular porcine corneal stroma(SAPS)for the treatment of peripheral corneal ulceration(PCU).METHODS:This retrospective clinical study included 18 patients(18 eyes)with PCU between April 2018 and December 2020.All patients had PCU and underwent lamellar keratoplasty with SAPS.Observation indicators included preoperative and postoperative best-corrected visual acuity(BCVA)and transparency of SAPS.The infection control rate in the surgical eye-lesion area was also calculated.RESULTS:Eighteen patients underwent lamellar keratoplasty with SAPS to treat PCU.None of the patients experienced rejection after 6mo(18/18)and 12mo(16/16)of follow-up.The BCVA(0.47±0.30)at the 6mo followup after operation was significantly improved compared with the baseline(0.99±0.80),and the difference was statistically significant(Z=-3.415,P<0.05).The BCVA at the 12mo follow-up after operation was not statistically significant compared to the 6mo(Z=0,P=1).With time,the SAPS graft gradually became transparent.At the 6mo(18/18)and 12mo(16/16)follow-up,none of the patients had recurrent corneal infection.CONCLUSION:SAPS is clinically effective in the treatment of PCU,improving the patient’s BCVA and reducing the incidence of rejection after keratoplasty.

Chronic Anogenital Ulcerations and Polymicrobial Pelvic Infections: About a Case

Genital ulceration is the loss of integrity of the mucous membranes (or genital skin) leaving the dermis uncovered and almost always accompanied by satellite lymphadenopathies. Beyond a month of evolution, it is said to be chronic. Sexually transmitted diseases are infections due to microbial agents among which parasites, bacteria, viruses and fungi that can be associated with each other to varying degrees. Sexually transmitted infections must be mentioned before any genital ulceration. Hence the interest of the case that we report of chronic anogenital ulcerations complicating a polymicrobial pelvic infection in a patient immunocompromised to HIV. The physical examination reveals a hypogastric sensitivity to deep palpation, the presence of a superinfected anogenital ulceration exposing the deep dermis covered with purulent serosities interesting the labia minora, the posterior vaginal fork, the anal region, the clitoris and an extension of the lesions to the gluteal fold is observed. We found a satellite lymphadenopathy in the right inguinal fold. The screening finds the HIV1 positive serology with a viral load of 28,000 copies, the herpes simplex 1&2 and Chlamydia trachomatis serologies were all positive. The genital samples are marked by the presence of bacterial vaginosis with Candida Albicans and Gardnerella Vaginalis, the presence of urogenital mycoplasmas of the Ureaplasma Urealyticum The pelvic ultrasound was in favor of a bilateral adnexitis. A protocol was put in place: the first step consisted of seat baths, antifungi and antibiotics administration: fluconazole 150 mg and tinidazole 2 g in single doses, then josamycin 1 g/24h in two doses per os for two weeks. The second stage consists of the administration of doxycycline 200 mg for 21 days, Aciclovir 500 mg for 10 days, and the administration of ARV (Tenofovir + Lamivudine + Dolutegravir) or one tablet daily. The evolution is marked by a progressive healing of the clitoris, the labia majora and labia minora, the posterior vaginal fork. In case of chronicity, a biopsy in search of a tumor process is not mandatory when there is a satisfactory response to treatment and good healing. The patient’s death two weeks after the beginning of ARV treatment, can be explained by a probable immune reconstitution syndrome.

Role of dietary phospholipids and phytosterols in protection against peptic ulceration as shown by experiments on rats

Geographically the prevalence of duodenal ulceration is related to the staple foods in the diet in regions of developing countries where the diet is stable.It is higher in regions where the diet is based on milled rice,refined wheat or maize,yams,cassava,sweet potato,or green bananas,and is lower in regions where the staple diet is based on unrefined wheat or maize,soya,certain millets or certain pulses.Experiments on rat gastric and duodenal ulcer models showed that it was the lipid fraction in staple foods from low prevalence areas that was protective against bothgastric and duodenal ulceration,including ulceration due to non-steroidal anti-inflammatory drugs(NSAIDs).It also promoted ulcer healing.The lipid from the pulse,Dolichos biflorus,horse gram which was highly protective was used to identify the fractions with protective activity in the lipid.The protective activity lay in the phospholipid,sterol and sterol ester fractions.In the phospholipid fraction phosphatidyl choline(lethicin) and phosphatidyl ethanolamine(cephalin) were predominant.In the sterol fraction the sub-fractions showing protective activity contained β-sitosterol,stigmasterol,and an unidentified isomer of β-sitosterol.The evidence from animal models shows that certain dietary phospholipids and phytosterols have a protective action against gastroduodenal ulceration,both singly and in combination.This supports the protective role of staple diets in areas of low duodenal ulcer prevalence and may prove to be of importance in the prevention and treatment of duodenal ulceration and management of recurrent ulcers.A combination of phospholipids and phytosterols could also play an important role in protection against ulceration due to NSAIDs.

Difficult and complicated oral ulceration:an expert consensus guideline for diagnosis

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.

Metabolomics analysis for skin ulceration syndrome of Apostichopus japonicus based on UPLC/Q-TOF MS

Skin ulceration syndrome(SUS)is the main diseases aff ected the development of sea cucumber(Apostichopus japonicus)culture industries.To better observe the changes in the sea cucumber A.japonicus with SUS and understand the pathogenesis of the disease,activities of superoxide dismutase(SOD),catalase(CAT),and level of malondialdehyde(MDA)in coelomic fluid were detected using the Assay Kit and metabolites in the body wall were assessed using ultra-performance liquid chromatography and quadrupole-time of flight mass spectrometry.The results indicated that level of MDA was increased during SUS compared with healthy individuals(P<0.01),but activities of SOD and CAT were reduced(P<0.05).In metabolomics analysis,metabolites,such as adenosine,choline,betaine aldehyde,palmitic acid,and taurine,were found to be upregulated and 2-oxoadipic acid,anthranilic acid(vitamin L1),thioetheramide-PC,cholesterol-3-sulfate,and pentadecanoic acid were downregulated(VIP>1 and P<0.1).Pathway enrichment analysis indicated most enrichment of KEGG pathways were mainly related to energy metabolism,immunity,and osmoregulation such as ABC transporters,glycine,serine and threonine metabolism,tryptophan metabolism and neuroactive ligand-receptor interaction.Our study reflected the difference in enzyme activity and metabolites between A.japonicus with SUS and those without,which will provide reference data for investigating SUS.

Oral administration of hyperoxygenated solution for the prophylaxis of gastric ulceration induced by stress or Helicobacter pylori

Oxygen was first discovered by Sweden chemist Scheele in 1773 and convinced as an essential factor for living by French scientists in 1777.To tackle with different hypoxic emergencies,corresponding medical approaches,e.g.mask or nasal catheter oxygen inhalation,breathing machine,hyperbaric oxygen therapy etc.,have been contrived in succession.However,one mortal trouble exists in all these conventional ways,i.e.they must rely on the ventilation and gas exchange via lungs,thus not being able to promptly render oxygen to specific hypoxia tissues.Hyperoxygenated solution(HOS),a new kind of medical liquid which can be orally taken or intravenously administrated,has been widely applied as an auxiliary method of offering oxygen in China.A large number of experiments have proved its validity in the treatment of myocardial and cerebral ischemia/reperfusion injury,nerve lesions,shock,respiratory diseases,neonatal hypoxia and so forth.These findings suggest that HOS might not only play a role of increasing oxygen pressure in local region,but also conspicuously contribute to improving the pathologic process of hypoxia,which coincidently is the vital link in stress-induced lesions in the gastrointestinal tract.Additionally,Helicobacter pylori(H.pylori),a kind of microaerophilic(anaerobic)bacterium which can hardly survive in an aerobic atmosphere,has also been identified as an independent risk factor for the occurrence and development of ulceration.Considering the etiology of peptic ulceration and the features of HOS,we hypothesize that drinking HOS might prevent gastric ulceration caused by stress or anaerobic H.pylori.

Management of corneal ulceration with a moisture chamber due to temporary lagophthalmos in a brain injury patient:A case report

BACKGROUND This study describes the use of a moisture chamber to treat corneal ulceration due to temporary lagophthalmos in a critically ill patient.CASE SUMMARY A 46-year-old woman was admitted to the intensive care unit after a car accident.She suffered multiple injuries that included brain injury and presented with moderately decreased consciousness and lagophthalmos in her right eye.Within 6 d,her consciousness improved considerably;at which time,exposure keratopathy occurred and worsened to corneal ulceration.Lubricating gel,antibiotic ointment,and bandage contact lens were all ineffective in preventing or treating the exposure keratopathy.Instead of tarsorrhaphy,a moisture chamber was applied which successfully controlled the corneal ulceration.The moisture chamber was discontinued when complete eyelid closure recovered a week later.CONCLUSION A moisture chamber may be an effective,noninvasive alternative to tarsorrhaphy for treating severe exposure keratopathy due to temporary lagophthalmos.

RADIOIMMUNOASSAY OF SERUM FERRITIN LEVEL IN PATIENTS WITH RECURRENT APHTHOUS ULCERATION

The purpose of this study was to assess the correlation between iron deficiency and recurrent aphthous ulceration (RAU). Radioimmunoassay was used to examine the serum ferritin level (SFL) in 52 patients with RAU and in 54 controls. Both were divided into 2 groups in accordance with sex. The 36 female patients were subdivided into 3 age-groups as follows: 8 aged 22-24, 10 aged 25-34, and 18 aged 35-50 while the male patients were gathered as one single group aged 26-57. The subdivision was adapted similarly for the normal age-grouts. Although no significant difference in SFL was found between the male control and the male patient groups, differences between the female control and female patient groups showed highly significant which levels, with the ascendance of age, were P【0.001, P【0.005 and P【0.001, respectively. Also the difference between male and female control groups were significant (P【0.05). However, no significant differences in SFL were discovered among the 3 patient groups. 10 female patients with SFL【12ng/ml were tested with ferrous sulfate for one month, then their SFL was reexamined one week after the treatment. A highly significant difference in SFL was noted between the pre-ad post-treatment (P【0.001). 9 of them showed that the interval of recurrences were prolonged, the number of ulcers reduced, the pain less intensive and its duration shorter than those before the treatment. This study demonstrated that a singificant decrease in iron-storage occurred in female RAU patients. The authors concluded that the decrease SFL was possibly related to menstruation and child bearing.

Surgical Technique Affects the Incidence of Marginal Ulceration after Roux-en-Y in Gastric Bypass

Background: Marginal ulceration (MU) is a recognized complication of Roux-en-Y gastric bypass (RYGB) surgery. While several possible risk factors have been reported, the mechanism of MU remains incompletely understood. The aim of this study was to compare the effect of surgical technique on the incidence of MU. Methods and Material: This was a retrospective study of 749 patients undergoing RYGB over a ten-year period with at least one year of follow-up. The diagnosis of MU was made based on clinical symptoms and confirmed by postoperative endoscopy (POE). We assessed four different gastric bypass (GBP) techniques: T1—Open, non-divided stomach, circular stapler, non-vagotomy (n = 332);T2—Open, divided stomach, circular stapler, vagotomy (n = 91);T3—Laparoscopic, divided, circular stapler, vagotomy (n = 152);T4—Laparoscopic, divided, linear stapler, vagotomy (n = 174). Results: The four groups were similar with respect to age and mean BMI. The frequency of POE was 16%, 25%, 28% and 27% in groups T1-T4 respectively (NS). The incidence of MU was significantly lower in T1 (2.1%) compared to T2 (5.5%), T3 (15.1%) and T4 (12.6%), p 0.05. MU occurred significantly more frequently with an antecolic Roux limb versus retrocolic (14.5% vs 5.6%, p 0.05). Conclusion: The incidence of MU after RYGB surgery is influenced by surgical technique. The lowest incidence of MU was with a non-divided stomach, no vagotomy, transverse staple line, and circular stapled anastomosis. A retrocolic Roux limb was protective. There was no difference in the incidence of MU using laparoscopic versus open bypass if a similar technique was employed or using linear versus circular stapler for the gastrojejunostomy.

Ozone Therapy in a Patient with Diabetic Foot Ulcerations and a Decision for Amputation

Background: Diabetic foot together with open wounds in distal type peripheral arterial disease constitutes a challenge in therapeutic planning. Ozone therapy may unveil new horizons in management. Case Report: A 67-year-old woman with diabetes mellitus was applied with open wounds at the bottom of her foot with purulent discharge, with a decision for above ankle amputation. She had had numerous interventions for her wounds including metatarsal amputations due to osteomyelitis and had been on an intense treatment including antibiotics, insulin, antihypertensives and antiaggregants. Angiogram revealed diffuse peripheral arterial disease in lower extremities. All medication but antihypertensives was stopped. She received major medical ozone application as 2000 gamma/session i.v. for 2 weeks, external ozone sac application starting from 60 and dropping to 30 gamma/session for 3 weeks and ozone insuflation 40 gamma/session for 10 sessions. Her purulent discharge ceased after the third session and the atonic debris of the wounds exfoliated, the wounds healed from the base towards the surface of the skin. She was then put on cilostazol and clopidogrel therapy. Conclusion: By being one of the known strongest bactericide, virucide, and fungicide elements, medical ozone therapy stimulates and upregulates the antioxidant system of the body with its hormesis effects. After the cessation of all circulatory system supporting medication (as their interaction with ozone is not clear yet), appropriate ozone therapy may bring new horizons for patients when all classically known methods of treatment have been completed, before assigning the patients for amputation.

Epstein-Barr Virus Upper Gastrointestinal Tract Mucocutaneous Ulceration in a Renal Transplant Recipient with Leucopenia and Hypogammaglobulinaemia

Epstein-Barr virus (EBV) mucocutaneous ulceration is a rare complication of immunosuppression that results in painful ulceration of the tongue or gingiva, and less commonly, refractory ulceration of the gastrointestinal tract. High clinical suspicion is required, as failure to diagnose EBV mucocutaneous ulceration may result in significant morbidity and mortality. We report the case of a 64-year-old female renal transplant recipient requiring admission to hospital for management of severe oral and epigastric pain. Examination revealed a large, superficial, well-circumscribed ulcer at the base of the tongue. Blood tests suggested a secondary immunodeficiency characterised by mild leucopenia, hypogammaglobulinaemia, and low memory B-cells with normal immunophenotype. Endoscopy revealed four, cratered ulcers in the pre-pyloric region of the stomach. A core biopsy of the tongue ulcer confirmed EBV mucocutaneous ulceration. The patient’s immunosuppression was optimised, which resulted in complete resolution of the tongue and gastric ulcers at eight and twelve weeks of follow-up respectively.

Helicobacter pylori: the primary cause of duodenal ulceration or a secondary infection?

INTRODUCTIONIt is generally accepted that Helicobacter pylori ( H.pylori) infection has a role in duodenal ulceration .Eradicaton of H .pylori accelerates healing compared with placebo in the absence of control of gastric secretion and reduces ulcer recurrence .There is increasing evidence ,however ,that is may not be the primary cause of duodenal ulceration ,but that is may be a secondary factor in a nnmber of cases .This possibility is supported by four sets of observations : 1 Geographical distribution:

Colonic ulcerations may predict steroid-refractory course in patients with ipilimumab-mediated enterocolitis

AIM To investigate management of patients who develop ipilimumab-mediated enterocolitis, including association of endoscopic findings with steroid-refractory symptoms and utility of infliximab as second-line therapy.METHODS We retrospectively reviewed all patients at our centerwith metastatic melanoma who were treated with ipilimumab between March 2011 and May 2014. All patients received a standard regimen of intravenous ipilimumab 3 mg/kg every 3 wk for four doses or until therapy was stopped due to toxicity or disease progression. Basic demographic and clinical data were collected on all patients. For patients who developed grade 2 or worse diarrhea(increase of 4 bowel movements per day), additional data were collected regarding details of gastrointestinal symptoms, endoscopic findings and treatment course. Descriptive statistics were used.RESULTS A total of 114 patients were treated with ipilimumab during the study period and all were included. Sixteen patients(14%) developed ≥ grade 2 diarrhea. All patients were treated with high-dose corticosteroids(1-2 mg/kg prednisone daily or equivalent). Nine of 16 patients(56%) had ongoing diarrhea despite highdose steroids. Steroid-refractory patients received one dose of intravenous infliximab at 5 mg/kg, and all but one had brisk resolution of diarrhea. Fourteen of the patients underwent either colonoscopy or sigmoidoscopy with variable endoscopic findings, ranging from mild erythema to colonic ulcers. Among 8 patients with ulcers demonstrated by sigmoidoscopy or colonoscopy, 7 patients(88%) developed steroidrefractory symptoms requiring infliximab. With a median follow-up of 264 d, no major adverse events associated with prednisone or infliximab were reported.CONCLUSION In patients with ipilimumab-mediated enterocolitis, the presence of colonic ulcers on endoscopy was associated with a steroid-refractory course.

Measurement of prostaglandin metabolites is useful in diagnosis of small bowel ulcerations

BACKGROUND We recently reported on a hereditary enteropathy associated with a gene encoding a prostaglandin transporter and referred to as chronic enteropathy associated with SLCO2 A1 gene(CEAS). Crohn's disease(CD) is a major differential diagnosis of CEAS, because these diseases share some clinical features. Therefore, there is a need to develop a convenient screening test to distinguish CEAS from CD.AIM To examine whether prostaglandin E major urinary metabolites(PGE-MUM) can serve as a biomarker to distinguish CEAS from CD.METHODS This was a transactional study of 20 patients with CEAS and 98 patients with CD.CEAS was diagnosed by the confirmation of homozygous or compound heterozygous mutation of SLCO2 A1. We measured the concentration of PGEMUM in spot urine by radioimmunoassay, and the concentration was compared between the two groups of patients. We also determined the optimal cut-off value of PGE-MUM to distinguish CEAS from CD by receiver operating characteristic(ROC) curve analysis.RESULTS Twenty Japanese patients with CEAS and 98 patients with CD were enrolled.PGE-MUM concentration in patients with CEAS was significantly higher than that in patients with CD(median 102.7 vs 27.9 μg/g × Cre, P < 0.0001). One log unit increase in PGE-MUM contributed to 7.3 increase in the likelihood for the diagnosis of CEAS [95% confidence interval(CI) 3.2-16.7]. A logistic regression analysis revealed that the association was significant even after adjusting confounding factors(adjusted odds ratio 29.6, 95%CI 4.7-185.7). ROC curve analysis revealed the optimal PGE-MUM cut-off value for the distinction of CEAS from CD to be 48.9 μg/g × Cre with 95.0% sensitivity and 79.6% specificity.CONCLUSION PGE-MUM measurement is a convenient, non-invasive and useful test for the distinction of CEAS from CD.

Genetic analysis is helpful for the diagnosis of small bowel ulceration

The widespread use of capsule endoscopy and balloonassisted endoscopy has provided easy access for detailed mucosal assessment of the small intestine. However, the diagnosis of rare small bowel diseases, such as cryptogenic multifocal ulcerous stenosing enteritis(CMUSE), remains difficult because clinical and morphological features of these diseases are obscure even for gastroenterologists. In an issue of this journal in 2017, Hwang et al reviewed and summarized clinical and radiographic features of 20 patients with an established diagnosis of CMUSE. Recently, recessive mutations in the PLA2G4A and SLCO2A1 genes have been shown to cause small intestinal diseases. The small bowel ulcers in each disease mimic those in the other and furthermore those found in nonsteroidal anti-inflammatory drug-induced enteropathy. These recent and novel findings suggest that a clinical diagnosis exclusively based on the characteristics of small bowel lesions is possibly imprecise. Genetic analyses seem to be inevitable for the diagnosis of rare small bowel disorders such as CMUSE.

Topological Modelling of Deep Ulcerations in Patients with Ulcerative Colitis

Aims: Steadily the clinicians of our team in inflammatory bowel disease encounter ulcerative colitis patients that develop deep ulcers during their treatment. Currently, these practitioners are only equipped with their grade of expertise in inflammatory domains to decide what new therapy maybe use in such cases. Encouraged by the limited knowledge of this frequent pathology, we seek to determine the molecular conditions underlying the recurrent formation of deep ulcerations in certain group of patients. Method: The goal of this strategy is to expose differences between groups of patients based on similarities computed by random walk graph kernels and performing functional inference on those differences. Results: We apply the methodology to a cohort of eleven miRNA microarrays of ulcerative colitis patients. Our results showed how the group of ulcerative colitis patients with presence of deep ulcers is topologically more similar (0.35) than ulcerative colitis patients (0.18) to control. Such topological constraint drove functional inference to complete the information that clinicians need. Conclusions: Our analyses reveal highly interpretable in the guidance of practitioners to eventually correct initial therapies of ulcerative colitis patients that develop deep ulcers. The methodology can provide them with useful molecular hypotheses necessaries prior to make any decision on the newest course of the treatment.

Oral ulcerations as the first manifestations of acute leukemia: A case report

Acute myeloblastic leukemia (AML) is a highly fatal malignant bone marrow disease. Physicians, dentists and all other healthcare professionals should be aware of sinister oral signs and symptoms in order to early diagnosis and referral of patients. Here we report a case of AML who presented with oral ulcers. Ulcers developed after a parrot bite, which initially misled the physicians. Unfortunately our patient did not survive, but early diagnosis and prompt investigation and treatment can be life-saving in many other similar cases.

<i>In Vivo</i>Study of Healing Effects of Sida acuta Leaf Extracts on <i>Helicobacter pylori</i>Induced Ulceration in Mice

Helicobacter pylori is a human pathogen that is widely distributed and known to cause peptic ulcer, gastritis and gastric cancer. Treatment is usually by combination of acid inhibitory therapy and antibiotics because of drug resistance problems. Studies now focus on the use of medicinal plants for treatment of H. pylori induced ulcers because they are inexpensive and have limited side effects. This study was undertaken to determine the effects of cold water and ethanol extracts of Sida acuta leaves on H. pylori induced ulcer in mice. Oral administration with the aid of a feeding tube of 0.5 ml of 107 CFU/ml of H. pylori (Accession number LT799736) in phosphate buffer saline (pH 6.8) was used to induce ulcer in mice. Effects of various concentrations of cold water and ethanol extracts of S. acuta leaves on the ulcer parameters and histology examinations of stomach tissues of mice were investigated after 2 weeks of administration of extracts into the mice. Mice treated with clarithromycin served as positive control while mice administered with H. pylori but not treated served as negative control. One-way analysis of variance (ANOVA) was used for data analysis and results were considered significant if p < 0.05. Bacterial load of stomach tissue showed significant reduction from 15.4 × 106 CFU/ml to 3.5 × 106 CFU/ml and 2.6 × 106 CFU/ml for cold water and ethanol extracts respectively. Reduction in ulcer severity (2.00 ± 0.10 to 0.080 ± 0.05), ulcer index (8.50 ± 1.10 to 4.26 ± 0.03) and gastric volume (1.32 ± 0.12 to 0.54 ± 0.13) were observed. Histology of stomach tissues of mice treated with extracts revealed clear granulation indicating tissue repair and wound healing. S. acuta extracts were observed to enhance ulcer healing in a mice model.

Undifferentiated Pleomorphic Sarcoma of the Cheek with Surface Ulceration: Mimicking Spindle Cell Squamous Cell Carcinoma

Undifferentiated pleomorphic sarcoma (UPS), also called malignant fibrous histiocytoma (MFH), belongs to the soft tissue tumors and is more likely in elder patients. UPS currently accounts for approximately 18% of cutaneous soft tissue sarcoma except Kaposi sarcoma. The most common sites are the extremities and head and neck. UPS is rapidly enlarging, and easily invades subcutaneous tissue and muscle without overlying skin changes. UPS tumors, which are confined to subcutaneous tissue, have been reported to be less than 10%. On the other hand, the involvement of the epidermis, occasionally with ulceration, is rare. Here, we describe a case of UPS of the cheek with surface ulceration. An 83-year-old man presented with a 1-year history of a red nodule on his left cheek. The size of the nodule gradually increased. Clinical examination revealed a 55 × 45 mm red, hard mass in the center of his left cheek with a large cratershaped ulcer involving the subcutaneous tissue. The bottom of the ulcer contained necrotic tissue. No cervical lymph nodes were palpable. A biopsy revealed a high-grade, pleomorphic spindle cell neoplasm and frequent abnormal mitotic figures within the dermis. We temporarily diagnosed and suspected a soft tissue sarcoma, but we could not rule out spindle cell squamous cell carcinoma (SCSCC). The patient underwent tumor resection and skin grafting. The tumor had reached the muscle layer of his left cheek with invasion and ulceration of the overlying skin. Histopathological examination of the totally resected tumor revealed a neoplasm of mesenchymal origin, rich in cells with morphology and immunohistochemical characteristics compatible with UPS. Malignant cells were not found in the epidermis. Immunohistochemical analyses were positive for vimentin, α-anti-trypsin, α-smooth muscle actin (α-SMA), and CD10, and negative for cytokeratins (CAM5.2 and AE1/AE3), lysozyme, epithelial membrane antigen (EMA), CD34, S-100, desmin, and caldesmon. Two months after total resection, the tumor recurred, and the patient was treated with radiation therapy. However, he died 2 months later from multiple lung metastases. We thought that the metastases were from the UPS, because his prostatic carcinoma had not progressed. According to published literatures, the UPS rarely accompanies with surface ulceration. On the other hand, SCC commonly occurs on sun-exposed sites of the head and neck with surface changes including scaling, ulceration, crusting, and the presence of a cutaneous horn. In our case, it was very difficult to distinguish UPS from SCSCC by clinical examination and conventional histopathological staining (e.g. hematoxylin and eosin). Therefore, the immunohistochemistry was required to obtain the final diagnosis.

Test Case Analysis Application of Jiawei-yinhuo Soup the Treatment of Recurrent Oral Ulceration

Recurrent oral ulceration,which is small but not easy to cure,seriously affects the quality of life of the patients.This paper analyzes professor Wang Xiaoyan's application of Yinhuotanghuacai to treat oral ulcer with floating of yang in deficiency condition,which can significantly improve the clinical symptoms of patients and improve the quality of life of patients.