Management of patients with stercoral perforation of the sigmoid colon:Report of five cases

到我们的知识，冒号的粪的穿孔很少比 90 个案例在文学报导到日期为止与少数被看见。我们探索了管理的原则与这个条件在五个病人阻止逼近的死亡。五个病人，二男性和三女性，其中部的年龄是 64 年，支撑了 S 字形的冒号的粪的穿孔。长期的便秘是在这些病人之中的普通症状。三个病人经历了一个 Hartmannos 过程和另外一个二与吻合和转移结肠开口术与部分结肠切除术被对待。有一外科的死亡，另外的病人让一所平静医院留下来。与广泛的腹洗室年龄一起阻止或对待任何联系败血的及时干预和在主要粪的溃疡地点的结肠的织物结合了移开 diseased 的外科的干预为腹膜炎的好攻击的治疗是在抢救与冒号的粪的穿孔介绍的病人的关键治疗形式。

Microscopic colitis as a missed cause of chronic diarrhea

AIM: To determine the prevalence of increased intraepithelial lymphocytes, using immunohistochemistry in patients with normal colonoscopy and near normal biopsy. METHODS: We retrospectively reviewed all non-malignant colon mucosal biopsies between 2005 and 2007, reported as normal, chronic inflammation or melanosis coli in patients who were undergoing routine colonoscopy. Immunohistochemistry using CD3 was performed on all mucosal biopsies and an intraepithelial lymphocyte count (IEL) was determined. Cases with an IEL count of ≥ 20 IELs per 100 surface epithelial cells were correlated with demographic, clinical and follow-up data. A further subgroup was evaluated for lymphocytic colitis.RESULTS: Twenty (8.3%) of 241 cases revealed an IEL count ≥ 20. Six (2.5%) patients were identified as having lymphocytic colitis (P < 0.001), of whom, five were missed on initial evaluation (P = 0.01). Four of these five patients were labeled with diarrhea-predominant irritable bowel syndrome (IBS). On follow-up, three of the remaining 20 cases were diagnosed with malignancy (renal cell carcinoma and myelodysplastic syndrome) and one had an unknown primary tumor with multiple liver metastases. Two cases of collagenous colitis with an IEL count < 10 were included in this study. Increased IELs were not confined to patients with diarrhea as a primary presenting symptom, but were also present in patients with abdominal pain (n = 7), constipation (n = 3) and loss of weight (n = 1). CONCLUSION: Immunohistochemistry using CD3 is of value in identifying and quantifying IELs for the presence of microscopic colitis in patients with diarrheapredominant IBS.

Delayed ischemic gangrene change of distal limb despite optimal decompressed colostomy constructed in obstructedsigmoid colon cancer:A case report

为解压缩创造喷水孔结肠开口术能为一个严重地削弱的案例向一个节省时间、有效的外科的过程提供一种完全妨碍的颜色表面的癌症。复杂并发症作为脱垂，收回，和 paracolostomal 脓肿被报导。然而，复杂并发症与一是化学家远侧的手足没被报导。我们为减轻恶意的 S 字形的冒号阻塞在减压结肠开口术以后报导批评 intra 腹的疾病的一个案例；一个潜在的致命的条件应该被警告。76 岁的男性与肮脏气味的呕吐为与妨碍的 S 字形的结肠肿瘤有关的症状访问了我们的紧急情况部门我们包含象粪便一样材料。对妨碍的 S 字形的损害近似的突现的喷水孔结肠开口术被创造，并且完全的冒号阻塞的分辨率被追求。不幸地，有有白细胞减少的高发烧的像板的腹部和骤起的广泛的腹的痛苦的膨胀随后发展了。如此的急腹症与 S 字形的肿瘤的切除术显示了第二等的剖腹术与一起一是近似地定位直到以前创造的结肠开口术的化学家冒号片断。最后，病人让一所平静手术后的医院留下来。在现在的文章，我们在喷水孔结肠开口术以后描述了远侧的手足局部缺血的骤起的一个突现的条件并且断定尽管有减压结肠开口术，那将高效地解决尖锐恶意的冒号阻塞；逼近是化学家肠可以与可能的不可逆的腹膜炎进行。任何病人，没有妨碍的损害的切除术，经历减压结肠开口术，应该经常与白血球计数和腹的条件调查被监视。

TNFR1 Deficiency Protects Mice from Colitis-Associated Colorectal Cancer Coupled with a Decreased Level of Oxidative Damage in the Colon: Implications for Anti-TNF Therapy of Unremitting Colitis

It has long been appreciated that there is a direct relationship between the intensity and duration of inflammatory bowel diseases (IBD) and increasing intestinal cancer risk but which elements of the inflammatory response are responsible have not been identified. Anti-TNF drugs have been successful at treating IBD but considering the presumed anti-tumor activity of TNF, it is important to understand whether the treatment impacts on the patients’ intestinal cancer risk. We modeled this relationship by “treating mice lacking TNF receptors with a colon cancer causing combination of azoxymethane followed by repeated dextran sulphate sodium exposures (AOM + DSS regime). TNF receptor type1 gene deficient (TNFR1-/-) and TNFR2-/- mice experienced similar clinical illnesses and colonic inflammation as C57BL/6 wildtype controls during the AOM + DSS regime. Despite the inflammation, TNFR1-/- mice developed significantly fewer colon tumors than the other strains. The reduced tumor incidence was a product of the combined lack of receptor expression on hematopoietic and nonhematopoietic cells, shown using bone marrow cell chimeras of wildtype and TNFR1-/- mice. As oxidative damage is a potent contributing factor to tumorigenesis and inflammatory leukocytes make copious amounts of reactive oxygen radicals, we measured oxidative damage in the animals’ colons. TNFR1-/- mice showed less damage compared to the other strains. We subsequently examined mice deficient in their leukocyte NADPH oxidative pathway (Nox2-/-) for their cancer incidence using the AOM + DSS regime. Nox2-/- mice became inflamed but had fewer tumors than wildtype mice. We conclude that TNF promotes colon cancer including through promoting oxidative processes utilizing TNFR1 in leukocytes. Moreover, the C57BL/6 strain can be used to dissociate mechanisms of colon inflammation from tumorigenic processes. We interpret our results to mean that IBD patients on TNF antagonist therapies will potentially benefit with reduced colon cancer risk even if they do not respond with reduced inflammation.

Composite prognostic models across the non-alcoholic fatty liver disease spectrum: Clinical application in developing countries

Heterogeneity in clinical presentation, histological severity, prognosis and therapeutic outcomes characteristic of non-alcoholic fatty liver disease(NAFLD) necessitates the development of scientifically sound classification schemes to assist clinicians in stratifying patients into meaningful prognostic subgroups. The need for replacement of invasive liver biopsies as the standard method whereby NAFLD is diagnosed, graded and staged with biomarkers of histological severity injury led to the development of composite prognostic models as potentially viable surrogate alternatives. In the present article, we review existing scoring systems used to(1) confirm the presence of undiagnosed hepatosteatosis;(2) distinguish between simple steatosis and NASH; and(3) predict advanced hepatic fibrosis, with particular emphasis on the role of NAFLD as an independent cardio-metabolic risk factor. In addition, the incorporation of functional genomic markers and application of emerging imaging technologies are discussed as a means to improve the diagnostic accuracy and predictive performance of promising composite models found to be most appropriate for widespread clinical adoption.

Desferrioxamine in warm reperfusion media decreases liver injury aggravated by cold storage

AIM:To evaluate whether desferrioxamine decreases ischemia and perfusion injury aggravated by cold storage(CS)in a rat liver perfusion model. METHODS:Isolated rat livers were kept in CS in University of Wisconsin Solution for 20 h at 4℃,then exposed to 25 min of warm ischemia(WI)at 37℃ followed by 2 h of warm perfusion(WP)at 37℃with oxygenated(95%oxygen and 5%carbon dioxide) Krebs-Henseleit buffer.Desferrioxamine(DFO),an iron chelator,was added at different stages of storage,ischemia and perfusion:in CS only,in WI only,in WP only, in WI and perfusion,or in all stages.Effluent samples were collected after CS and after WI.Perfusate samples and bile were collected every 30 min(0,0.5,1,1.5 and 2 h)during liver perfusion.Cellular injury was assessed by the determination of lactate dehydrogenase(LDH) and aspartate aminotransferase(AST)in the effluent and perfusate samples.Total iron was analysed in the perfusate samples.After WP,the liver was collected for the determination of liver swelling(wet to dry ratio) and liver morphological examination(hematoxylin and eosin staining). RESULTS:Increased CS time caused increased liver dysfunction during WP.After 2 h of WP,liver injury was indicated by increased release of AST(0.5 h CS:9.4± 2.2 U/g liver vs 20 h CS:45.9±10.8 U/g liver,P<0.05) and LDH(0.5 h CS:59±14 U/g liver vs 20 h CS:297 ±71 U/g liver,P<0.05).There was an associated increase in iron release into the perfusate(0.5 h CS:0.11 ±0.03μmoL/g liver vs 20 h CS:0.58±0.10μmoL/g liver,P<0.05)and reduction in bile flow(0.5 h CS: 194±12μL/g vs 20 h CS:71±8μL/g liver,P<0.05). When DFO was added during WI and WP following 20 h of CS,release of iron into the perfusate was de- creased(DFO absent 0.58±0.10μmoL/g liver vs DFO present 0.31±0.06μmoL/g liver,P<0.05),and liver function substantially improved with decreased release of AST(DFO absent 45.9±10.8 U/g liver vs DFO present 8.1±0.9 U/g liver,P<0.05)and LDH(DFO absent 297±71 U/g liver vs DFO present 56±7 U/g liver,P<0.05),and increased bile flow(DFO absent 71±8μL/g liver vs DFO present 237±36μL/g liver, P<0.05).DFO was also shown to improve liver morphology after WP.Cellular injury(the release of LDH and AST)was significantly reduced with the addition of DFO in CS medium but to a lesser extent compared to the addition of DFO in WP or WI and perfusion.There was no effect on liver swelling or bile flow when DFO was only added to the CS medium. CONCLUSION:DFO added during WI and perfusion decreased liver perfusion injury aggravated by extended CS.

早期带状疱疹的征象:疱疹仅累及毛囊皮脂腺单位

The histopathological changes of herpes simplex,herpes zoster, and varicella are considered to beindistinguishable from one another. Evaluation of the clinical setting, with adjunctive studies if necessary, generally clarifies the specific diagnosis. Vesicular lesions in all three conditions can involve epidermal and adnexal epithelium with characteristic cytopathic features. We describe three patients with non- vesicular eruptions on the head and neck whose biopsies revealed exclusive folliculosebaceous involvement by herpes. All three patients developed typical herpes zoster within days of the biopsy. There is compelling scientific evidence in the literature indicating that, in herpes zoster, the virus is transported from dorsal root or trigeminal ganglia via myelinated nerves to the skin. These terminate at the isthmus of hair follicles and primary infection of follicular and sebaceous epithelium occurs. Spread of infection to the epidermis follows. In contrast, data pertaining to recurrent herpes simplexindicates that axonaltran sport of the virus from sensory ganglia to the skin is directed primarily to the epidermis, via terminal non- myel- inated nerve twigs. The clinical evolution of our three cases and scientific data in the literature indicate that exclusive folliculosebaceous involvement by herpes, in the setting of a non- vesicular eruption, represents early herpes zoster.

Acute hepatitis with autoimmune features after COVID-19 vaccine:coincidence or vaccine-induced phenomenon?

Introduction Autoimmune diseases result from a breach of immunological self-tolerance and tissue damage by autoreactive T lymphocytes.Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)infection is characterized by an inflammatory dysregulation that has been associated with the development of autoimmune processes[1].