-
In Vivo (Athens, Greece) 2021Anal canal toxicity tends to be ignored in pelvic radiotherapy (RT). However, patients with hemorrhoids can be troubled by lower radiation dose. We tried to determine...
BACKGROUND/AIM
Anal canal toxicity tends to be ignored in pelvic radiotherapy (RT). However, patients with hemorrhoids can be troubled by lower radiation dose. We tried to determine whether a correlation exists between hemorrhoids and anal symptoms in patients with cervical cancer undergoing RT.
PATIENTS AND METHODS
The insurance claim data of patients who underwent definitive treatment for cervical cancer from 2015 to 2019 were analyzed. Adverse events including bleeding, proctitis, and hemorrhoids, were documented for 1 year after treatment completion. Odds ratios (ORs) were estimated by unconditional Poisson regression and adjusted for age, treatments, chemotherapy, and comorbidities.
RESULTS
Details of 67,114 insured cervical cancer patients treated between 2015 and 2019 were obtained. Among them, 5,919 patients with follow-up data for at least one year, treated with curative intent, were analyzed. The OR of the definitive radiotherapy group (DRT group) for anal bleeding was 10.57 higher than that of the operation alone group (surgical group) (p<0.01). Newly developed hemorrhoids gradually increased in the surgical group (3.17%), the postoperative radiotherapy group (5.38%), and the DRT group (7.58%). The OR of the DRT group for newly developed hemorrhoids was 2.38 higher than that of the surgical group (p<0.01), and ORs increased to 1.99 and 1.61 in patients that received chemotherapy and patients with diabetes, respectively (p<0.01).
CONCLUSION
Pelvic RT increased anal bleeding and symptomatic hemorrhoids. In particular, chemotherapy and diabetes also increased the risk. If patients with hemorrhoids receive pelvic RT, attention is required to prevent hemorrhoid aggravation.
Topics: Anal Canal; Female; Hemorrhoids; Humans; Pelvis; Uterine Cervical Neoplasms
PubMed: 34182518
DOI: 10.21873/invivo.12512 -
Case Reports in Gastrointestinal... 2021A 49-year-old man presented with abdominal pain and rectal bleeding for two days associated with a 50-pound unintentional weight loss. History was notable for...
A 49-year-old man presented with abdominal pain and rectal bleeding for two days associated with a 50-pound unintentional weight loss. History was notable for hypertension, chronic kidney disease, obesity, gout, and acute cholecystitis status post cholecystectomy. Computed tomography (CT) of the abdomen and pelvis showed rectal wall thickening. Colonoscopy showed proctitis with superficial ulcerations. In the setting of renal insufficiency, malabsorption, and low-voltage QRS complexes on electrocardiogram (ECG), amyloidosis was considered in the differential diagnosis. Rectal and renal biopsies with subsequent retrospective staining of gallbladder tissue confirmed amyloid deposition. Gastrointestinal involvement of amyloidosis is relatively uncommon. Particularly, amyloid deposition in the gallbladder and rectum is very rare. The development of AA amyloidosis in our patient may have been related to gout, obesity, and the presence of a heterozygous complex variant for the MEFV (familial Mediterranean fever) gene. Awareness of this atypical presentation of amyloidosis is important, as additional staining of biopsy samples is necessary, and diagnosis allows for directed treatment.
PubMed: 33927906
DOI: 10.1155/2021/6663391 -
World Journal of Gastroenterology Apr 2022Crohn's disease (CD) is a chronic nonspecific intestinal inflammatory disease. The aetiology and pathogenesis of CD are still unclear. Anal fistula is the main...
BACKGROUND
Crohn's disease (CD) is a chronic nonspecific intestinal inflammatory disease. The aetiology and pathogenesis of CD are still unclear. Anal fistula is the main complication of CD and is a difficult problem to solve at present. The main limitation of developing new therapies is bound up with the short of preclinical security and effectiveness data. Therefore, an ideal animal model is needed to establish persistent anal fistula and an inflamed rectal mucosa.
AIM
To improve the induction method of colitis and establish a reliable and reproducible perianal fistulizing Crohn's disease animal model to evaluate new treatment strategies.
METHODS
Twenty male New Zealand rabbits underwent rectal enema with different doses of 2,4,6-trinitrobenzene sulfonic acid to induce proctitis. Group A was treated with an improved equal interval small dose increasing method. The dosage of group B was constant. Seven days later, the rabbits underwent surgical creation of a transsphincteric fistula. Then, three rabbits were randomly selected from each group every 7 d to remove the seton from the fistula. The rabbits were examined by endoscopy every 7 days, and biopsy forceps were used to obtain tissue samples from the obvious colon lesions for histological analysis. The disease activity index (DAI), colonoscopy and histological scores were recorded. Perianal endoscopic ultrasonography (EUS) was used to evaluate the healing of fistulas.
RESULTS
Except for the DAI score, the colonoscopy and histological scores in group A were significantly higher than those in group B ( < 0.05). In the ideal model rabbit group, on the 7 day after the removal of the seton, all animals had persistent lumens on EUS imaging, showing continuous full-thickness high signals. Histological inspection of the fistula showed acute and chronic inflammation, fibrosis, epithelialization and peripheral proctitis of the adjoining rectum.
CONCLUSION
The improved method of CD colitis induction successfully established a rabbit perianal fistula CD preclinical model, which was confirmed by endoscopy and pathology.
Topics: Animals; Colitis; Crohn Disease; Humans; Male; Proctitis; Rabbits; Rectal Fistula; Treatment Outcome
PubMed: 35582134
DOI: 10.3748/wjg.v28.i15.1536 -
World Journal of Gastroenterology Dec 2021Inflammatory bowel disease (IBD) is a chronic condition that requires continuous medical treatment. To date, the medical management of patients with... (Review)
Review
Inflammatory bowel disease (IBD) is a chronic condition that requires continuous medical treatment. To date, the medical management of patients with moderately-to-severely active IBD who develop dependence or resistance to corticosteroids is based on immunomodulator drugs. Such therapies are licenced after passing through three phases of randomized controlled trials (RCTs), and are subsequently adopted in clinical practice. However, the real-life population of IBD patients who require these therapies can significantly differ from those included in RCTs. As a matter of fact, there is a number of exclusion criteria - nearly ubiquitous in all RCTs - that prevent the enrolment of specific patients: Chronic refractory pouchitis or isolated proctitis in ulcerative colitis, short-bowel syndrome and stomas in Crohn's disease, ileorectal anastomosis in both ulcerative colitis and Crohn's disease, and elderly age are some representative examples. In this frontier article, we aim to give an overview of current literature on this topic, in order to address the main knowledge gaps that need to be filled in the upcoming years.
Topics: Aged; Chronic Disease; Colitis, Ulcerative; Crohn Disease; Humans; Inflammatory Bowel Diseases; Pouchitis
PubMed: 35068853
DOI: 10.3748/wjg.v27.i47.8047 -
Annals of Gastroenterology 2023The current monkeypox virus (MPV) outbreak is now a global health concern. MPV, a zoonotic double-stranded DNA virus, may be transmitted from human to human or by... (Review)
Review
The current monkeypox virus (MPV) outbreak is now a global health concern. MPV, a zoonotic double-stranded DNA virus, may be transmitted from human to human or by contaminated surfaces. Understanding the clinical characteristics and risks of MPV transmission are important, especially for health care workers, who may unknowingly encounter the virus while fulfilling their clinical responsibilities. The World Health Organization has recognized this orthopoxvirus outbreak as a public health emergency and the knowledge gaps regarding MPV's transmission are likely to have contributed to its spread. Instituting proper infection controls in all settings, including the endoscopy suite, is critical to stemming this developing epidemic. Direct contact with skin lesions is the primary mode of transmission, and anorectal lesions are the most common skin manifestation. Hence, gastroenterologists and endoscopists are very likely to see patients with MPV infection. In this context, patients may present with symptoms of proctitis, or lesions may be encountered unexpectedly during anoscopy, sigmoidoscopy, or colonoscopy. In consequence, preprocedural exams and endoscopic procedures may increase exposure risk, especially if characteristic lesions go unrecognized. In this review, we provide background epidemiological and virological information, but focus on the potential risk of MPV exposure during gastrointestinal endoscopy and evaluate current practices regarding personal protective equipment and post-procedure instrument and endoscopy suite decontamination.
PubMed: 36593811
DOI: 10.20524/aog.2022.0770 -
Clinical Gastroenterology and... Oct 2022We examined whether relationships between known risk factors for Crohn's disease (CD) and ulcerative colitis (UC) differ according to disease phenotype, defined by...
BACKGROUND & AIMS
We examined whether relationships between known risk factors for Crohn's disease (CD) and ulcerative colitis (UC) differ according to disease phenotype, defined by Montreal classification, at the time of diagnosis.
METHODS
We performed a prospective cohort study of 208,070 adults from the Nurses' Health Study (NHS), NHSII, and Health Professionals Follow-Up Study (HPFS). Dietary, lifestyle, and medical data were obtained at baseline and every 2-4 years. We confirmed cases of inflammatory bowel disease (IBD) and their phenotypes via medical record review. We tested for heterogeneity across CD subtypes using the likelihood ratio test and for linear heterogeneity across UC subtypes using the meta-regression method.
RESULTS
We ascertained 346 cases of CD and 456 cases of UC over 5,117,021 person-years of follow-up (1986-2016 for NHS and HPFS; 1991-2017 for NHSII). Fiber intake was associated with decreased risk for ileocolonic but not ileal or colonic CD (P = .04). Physical activity was associated with decreased risk of nonstricturing and nonpenetrating CD but not of penetrating CD (P = .02). Higher body mass index and current smoking were associated with decreased risk of proctitis and left-sided UC but not of pan-UC (P= .004 and .02, respectively). The associations between other risk factors examined and risk of CD and UC did not differ by disease phenotype (all P > .06).
CONCLUSIONS
In 3 large prospective cohorts, we observed that dietary and lifestyle risk factors for IBD may differ according to disease phenotype. These findings highlight the need for disease stratification in future epidemiologic studies.
Topics: Chronic Disease; Colitis, Ulcerative; Crohn Disease; Follow-Up Studies; Humans; Inflammatory Bowel Diseases; Phenotype; Prospective Studies; Risk Factors
PubMed: 35031525
DOI: 10.1016/j.cgh.2022.01.003 -
Health Science Reports Oct 2023The 2022-mpox outbreak has spread worldwide in a short time. Integrated knowledge of the epidemiology, clinical characteristics, and transmission of mpox are limited....
BACKGROUND AND AIMS
The 2022-mpox outbreak has spread worldwide in a short time. Integrated knowledge of the epidemiology, clinical characteristics, and transmission of mpox are limited. This systematic review of peer-reviewed articles and gray literature was conducted to shed light on the epidemiology, clinical features, and transmission of 2022-mpox outbreak.
METHODS
We identified 45 peer-reviewed manuscripts for data analysis. The standards of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement and Cochrane Collaboration were followed for conducting the study.
RESULTS
The case number of mpox has increased about 100 times worldwide. About 99% of the cases in 2022 outbreak was from non-endemic regions. Men (70%-98% cases) were mostly infected with homosexual and bisexual behavior (30%-60%). The ages of the infected people ranged between 30 and 40 years. The presence of HIV and sexually transmitted infections among 30%-60% of cases were reported. Human-to-human transmission via direct contact and different body fluids were involved in the majority of the cases (90%-100%). Lesions in genitals, perianal, and anogenital areas were more prevalent. Unusually, pharyngitis (15%-40%) and proctitis (20%-40%) were more common during 2022 outbreak than pre-2022 outbreaks. Brincidofovir is approved for the treatment of smallpox by FDA (USA). Two vaccines, including JYNNEOSTM and ACAM2000®, are approved and used for pre- and post-prophylaxis in cases. About 100% of the cases in non-endemic regions were associated with isolates of IIb clade with a divergence of 0.0018-0.0035. Isolates from B.1 lineage were the most predominant followed by B.1.2 and B.1.10.
CONCLUSION
This study will add integrated knowledge of the epidemiology, clinical features, and transmission of mpox.
PubMed: 37808926
DOI: 10.1002/hsr2.1603 -
HCA Healthcare Journal of Medicine 2021Description Chemical colitis is defined as inflammation of the large intestine or colon as a result of exposure from a harsh chemical through an enema or other...
Description Chemical colitis is defined as inflammation of the large intestine or colon as a result of exposure from a harsh chemical through an enema or other procedure. In this case, the chemical is hydrogen peroxide, which is commonly used as an antiseptic for minor abrasions. Hydrogen peroxide enemas were once popular for difficult to treat constipation. However, resultant colitis and proctitis limited its use. When administered rectally in a high enough concentration, intense abdominal pain and transient bloody diarrhea can occur, with the majority of affected patients making a full recovery with supportive management. Here we discuss a case of an accidental low concentration hydrogen peroxide enema in an otherwise healthy young adult that emphasized the dangers of hydrogen peroxide damage to mucosal membranes.
PubMed: 37425640
DOI: 10.36518/2689-0216.1096 -
Journal of Contemporary Brachytherapy Feb 2022The aim of the study was to report the outcomes of pre-operative high-dose-rate brachytherapy (pHDR-BT), followed by hysterectomy in patients with early cervical cancer.
PURPOSE
The aim of the study was to report the outcomes of pre-operative high-dose-rate brachytherapy (pHDR-BT), followed by hysterectomy in patients with early cervical cancer.
MATERIAL AND METHODS
From January, 1998 to December, 2003, 113 women with IB1, IB2, and IIA1 cervical cancer (according to International Federation of Gynecology and Obstetrics [FIGO] 2018) were treated with pHDR-BT, and 6 to 8 weeks later followed by radical hysterectomy. Patients found to have positive lymph nodes, residual cervical cancer, involved parametria, or lymphovascular space invasion (LVSI) received post-operative adjuvant therapy.
RESULTS
Post-operatively, 81.4% of patients had a complete response to pHDR-BT in the cervix, and 18.6% had residual cervical cancer. Failures occurred in 11/113 (9.7%) patients (all were stage IIA1), with pelvic recurrences in 5/113 (4.4%) and distant metastasis (DM) in 6/113 (5.3%). The 5- and 10-year disease-free survival (DFS) rates were 100% for IB1 and IB2, and 86.4% and 81.3% for IIA1, respectively. Lymph node involvement and/or residual cervical cancer correlated with worse DFS. Two vesicovaginal fistulas were observed (one in a patient treated only with pHDR-BT and one in a woman, who underwent adjuvant external-beam radiotherapy [EBRT]). Two rectovaginal fistulas and one case of proctitis were observed in patients treated with adjuvant EBRT.
CONCLUSIONS
pHDR-BT in early cervical cancer is well-tolerated and effective in sterilizing tumor cells in the cervix. The growing number of publications in this area may help define an optimal therapeutic scheme, but randomized trials are required to determine the best candidates for this treatment modality.In our opinion, cervical cancer patients with FIGO stage IIA1 are not good candidates for pHDR-BT, and could be given this treatment only after rigorous selection, including assessment with state-of-the-art imaging, due to higher probability of treatment failure.
PubMed: 35233234
DOI: 10.5114/jcb.2022.112697 -
Cancers Aug 2022(1) Background: To report the long-term clinical outcomes of computer-tomography (CT)-guided brachytherapy (BT) for locally advanced cervical cancer. (2) Methods: A...
(1) Background: To report the long-term clinical outcomes of computer-tomography (CT)-guided brachytherapy (BT) for locally advanced cervical cancer. (2) Methods: A total of 135 patients with FIGO stage IB-IVA cervical cancer treated with definitive radiotherapy +/- chemotherapy with an IGABT boost at Queen Mary Hospital, Hong Kong, between November 2013 and December 2019 were included. Treatment included pelvic radiotherapy 40 Gy/20 Fr/4 weeks +/- chemotherapy then CT-guided BT (7 Gy × 4 Fr) and a sequential parametrial boost. The primary outcome was local control. Secondary outcomes were pelvic control, distant metastasis-free survival, overall survival (OS) and late toxicities. (3) Results: The median follow-up was 53.6 months (3.0-99.6 months). The five-year local control, pelvic control, distant metastasis-free survival and OS rates were 90.7%, 84.3%, 80.0% and 87.2%, respectively. The incidence of G3/4 long-term toxicities was 6.7%, including proctitis (2.2%), radiation cystitis (1.5%), bowel perforation (0.7%), ureteric stricture (0.7%) and vaginal stenosis and fistula (0.7%). Patients with adenocarcinomas had worse local control (HR 5.82, 95% CI 1.84-18.34, = 0.003), pelvic control (HR 4.41, 95% CI 1.83-10.60, = 0.001), distant metastasis-free survival (HR 2.83, 95% CI 1.17-6.84, = 0.021) and OS (HR 4.38, 95% CI: 1.52-12.67, = 0.003) rates. Distant metastasis-free survival was associated with HR-CTV volume ≥ 30 cm (HR 3.44, 95% CI 1.18-9.42, = 0.025) and the presence of pelvic lymph node (HR 3.44, 95% CI 1.18-9.42, = 0.025). OS was better in patients with concurrent chemotherapy (HR 4.33, 95% CI: 1.40-13.33, = 0.011). (4) Conclusions: CT-guided BT for cervical cancer achieved excellent long-term local control and OS. Adenocarcinoma was associated with worse clinical outcomes. (4) Conclusion: CT-guided BT for cervical cancer achieved excellent long-term local control and OS. Adenocarcinoma was associated with worse clinical outcomes.
PubMed: 36010927
DOI: 10.3390/cancers14163934