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Clinical Gastroenterology and... Dec 2013Pouchitis is the most common complication among patients with ulcerative colitis who have undergone restorative proctocolectomy with ileal pouch-anal anastomosis.... (Review)
Review
Pouchitis is the most common complication among patients with ulcerative colitis who have undergone restorative proctocolectomy with ileal pouch-anal anastomosis. Pouchitis is actually a spectrum of diseases that vary in etiology, pathogenesis, phenotype, and clinical course. Although initial acute episodes typically respond to antibiotic therapy, patients can become dependent on antibiotics or develop refractory disease. Many factors contribute to the course of refractory pouchitis, such as the use of nonsteroidal anti-inflammatory drugs, infection with Clostridium difficile, pouch ischemia, or concurrent immune-mediated disorders. Identification of these secondary factors can help direct therapy.
Topics: Colonic Pouches; Humans; Pouchitis
PubMed: 23602818
DOI: 10.1016/j.cgh.2013.03.033 -
Practical Radiation Oncology 2022A 61 year-old female kidney transplant recipient developed radiologic and biopsy-confirmed cortical necrosis in her transplant with elevated serum creatinine levels...
A 61 year-old female kidney transplant recipient developed radiologic and biopsy-confirmed cortical necrosis in her transplant with elevated serum creatinine levels during concurrent chemoradiation therapy for anal squamous cell carcinoma. Acute anatomic and pathologic changes within a transplanted kidney during chemoradiation therapy have not been described previously in the literature. Further research is required to ascertain the potential significance and long-term clinical consequences of such findings.
Topics: Anus Neoplasms; Carcinoma, Squamous Cell; Female; Humans; Kidney; Kidney Transplantation; Middle Aged; Necrosis
PubMed: 34547505
DOI: 10.1016/j.prro.2021.09.003 -
Journal of Clinical Laboratory Analysis Feb 2020MicroRNAs (miRNAs) can be used for early diagnosis of myocardial infarction. However, due to a lack of standardized operating procedures, their value for clinical...
BACKGROUND
MicroRNAs (miRNAs) can be used for early diagnosis of myocardial infarction. However, due to a lack of standardized operating procedures, their value for clinical application is low.
METHODS
Detection of plasma miRNAs was optimized by analyzing factors influencing miRNA variance and myocardial infarction risk scores during analysis (extraction, reverse transcription, and real-time PCR) and pre-analysis (dietary status, anticoagulants, storage conditions, and hemolysis).
RESULTS
Regarding variable factors during analysis, the centrifugal column method was superior to Trizol LS reagent when extracting miRNA from plasma. Recovery rate was highest with plasma volumes of 200 and 300 µL. During analysis, the main source of miRNA detection inaccuracy was derived from RNA extraction (mainly organic extraction), and not reverse transcription or PCR. MiRNA variance could be reduced by use of an internal reference. During analysis, 95% of risk score variation fluctuated within a range of 6.267. The variable factors pre-analysis mainly involved dietary status, anticoagulant selection, and storage conditions. Hemolysis positively correlated with miRNA levels, but there was no significant change in risk score after internal reference calibration.
CONCLUSION
Preliminary standardization for miRNA detection provides a reference for clinical blood testing of miRNAs.
Topics: Adult; Aged; Anticoagulants; Blood Specimen Collection; Fasting; Female; Hemolysis; Humans; Male; MicroRNAs; Middle Aged; Myocardial Infarction; Real-Time Polymerase Chain Reaction; Reproducibility of Results
PubMed: 31617231
DOI: 10.1002/jcla.23058 -
Langenbeck's Archives of Surgery Nov 2023Delayed coloanal anastomosis (DCAA) is a two-stage procedure. DCAA has been increasingly reused in recent years in the management of rectal cancer. Such increased use of...
INTRODUCTION
Delayed coloanal anastomosis (DCAA) is a two-stage procedure. DCAA has been increasingly reused in recent years in the management of rectal cancer. Such increased use of DCAA has highlighted the complications associated with this procedure. We aimed to evaluate the risk and risk factors of ischemia/necrosis of the colonic stump between the two stages of DCAA.
PATIENTS AND METHODS
All patients who underwent a proctectomy with a DCAA were included in this retrospective single-centre study from November 2012 to June 2022. Two groups of patients were defined: patients with a well vascularized colonic stump (well vascularized group) and those who experienced ischemia or necrosis of the colonic stump (ischemic group). The primary endpoint was the rate of ischemia or necrosis of the colonic stump and an evaluation of the associated risk factors.
RESULTS
During the study period, 43 patients underwent DCAA. Amongst them, 32 (75%) had a well-vascularized colonic stump (well-vascularized group) and 11 (25%) ischemia of the colonic stump (ischemic group). Relative to patients in the well-vascularized group, those in the ischemic group were more often men (81.8% vs 40.6%, p = 0.034), had a higher BMI (29.2 kg/m vs 25.7 kg/m, p = 0.03), were more frequently diabetic (63.6% vs 21.9%, p = 0.01) and more frequently had had preoperative radiotherapy (100% vs 53.1%, p = 0.008). On the preoperative CT scan, the interspinous diameter was shorter in the ischemic group (9.4 ± 1.01 cm vs 10.6 ± 1.01 cm, p = 0.001), the intertuberosity diameter was shorter (9.2 ± 1.18 cm vs 11.9 ± 1.18 cm, p < 0.0001), and the length of the anal canal was longer (31.9 ± 3 mm vs 27.4 ± 3.2 mm, p < 0.0001).
CONCLUSION
This study highlights clear risk factors for ischemia/necrosis of the colonic stump after proctectomy with DCAA.
Topics: Male; Humans; Retrospective Studies; Treatment Outcome; Anastomosis, Surgical; Proctectomy; Rectal Neoplasms; Anal Canal; Colon; Risk Factors; Necrosis; Postoperative Complications
PubMed: 37910292
DOI: 10.1007/s00423-023-03157-z -
Lifetime Data Analysis Jan 2013In many clinical research applications the time to occurrence of one event of interest, that may be obscured by another--so called competing--event, is investigated.... (Review)
Review
In many clinical research applications the time to occurrence of one event of interest, that may be obscured by another--so called competing--event, is investigated. Specific interventions can only have an effect on the endpoint they address or research questions might focus on risk factors for a certain outcome. Different approaches for the analysis of time-to-event data in the presence of competing risks were introduced in the last decades including some new methodologies, which are not yet frequently used in the analysis of competing risks data. Cause-specific hazard regression, subdistribution hazard regression, mixture models, vertical modelling and the analysis of time-to-event data based on pseudo-observations are described in this article and are applied to a dataset of a cohort study intended to establish risk stratification for cardiac death after myocardial infarction. Data analysts are encouraged to use the appropriate methods for their specific research questions by comparing different regression approaches in the competing risks setting regarding assumptions, methodology and interpretation of the results. Notes on application of the mentioned methods using the statistical software R are presented and extensions to the presented standard methods proposed in statistical literature are mentioned.
Topics: Cause of Death; Death; Humans; Life Tables; Models, Statistical; Myocardial Infarction; Proportional Hazards Models; Regression Analysis; Risk; Risk Factors
PubMed: 23010807
DOI: 10.1007/s10985-012-9230-8 -
Updates in Surgery Jun 2012Lateral internal sphincterotomy is the surgical treatment of choice of chronic anal fissure after failure of conservative measures. Several randomized trials identified...
Lateral internal sphincterotomy is the surgical treatment of choice of chronic anal fissure after failure of conservative measures. Several randomized trials identified an overall risk of incontinence of 10 % mostly for flatus. Fissurectomy is the most commonly used procedure to preserve the integrity of the anal sphincters. However, a possible complication is keyhole defect that may lead to faecal soiling. In this study, chronic anal fissure (CAF) was treated by fissurectomy and anal advancement flap to preserve the anatomo-functional integrity of sphincters and to reduce healing time and the risk of anal stenosis. In patients with hypertonia, surgical treatment was combined with chemical sphincterotomy by injection of botulinum toxin to enhance tissue perfusion. Forty eight patients with CAF underwent fissurectomy and anal advancement flap. In 22 subjects with hypertonia of the internal anal sphincter, intrasphincter injection of 30 UI of botulinum toxin at the completion of the surgical operation was used. All patients were followed up to 24 months. Since the first defecation, the intensity and duration of pain were significantly reduced. Two patients had urinary retention, five had infections and three had partial breakdowns. No anal stenosis, keyhole deformity or necrosis flap was recorded. At the 24 months follow-up visit, anal incontinence was similar to those detected preoperatively. Only four recurrences were detected at 18 and 20 months. After medical treatment failure, fissurectomy with advancement flap is a valid sphincter-conserving procedure for treatment of anterior or posterior CAF, regardless of hypertonia of the internal anal sphincter.
Topics: Adolescent; Adult; Aged; Botulinum Toxins, Type A; Chronic Disease; Digestive System Surgical Procedures; Female; Fissure in Ano; Follow-Up Studies; Humans; Injections, Intramuscular; Male; Middle Aged; Neuromuscular Agents; Prospective Studies; Plastic Surgery Procedures; Recovery of Function; Surgical Flaps; Treatment Outcome
PubMed: 22488270
DOI: 10.1007/s13304-012-0147-2 -
The Pan African Medical Journal 2019The whole of the lesions associated with Crohn's disease affecting the anal canal, the skin of the perineum, the bottom-rectum and the recto vaginal septum are referred...
The whole of the lesions associated with Crohn's disease affecting the anal canal, the skin of the perineum, the bottom-rectum and the recto vaginal septum are referred to as anoperineal lesions of Crohn's disease. The main types of primary lesions include ulcerations, suppurations and stenoses. Crohn's disease-like anoperineal lesions are often suspected in patients with severe inflammatory process, peri-anal skin thickening, œdematous marisques, multiple lesions and lesions extending above pectineal line. Fistulas usually originate from an ulceration or a scar rather than the crypts of the anal canal. Elementary lesions of Crohn's disease are rarely isolated and they are, in most cases, combined lesions. The presence of a stenosis of the anal canal or of the rectum is very often associated with an inflammatory and suppurative process. Anal ulcerations are complicated with suppuration in half of the cases. We report the case of 45-year old woman treated for autoimmune thyroiditis and vitiligo who presented with knife-cut painful perineal ulcerations. The patient reported episodes of diarrhea during interview. Histological examination of skin lesions showed epitheliogigantocellular granuloma without caseous necrosis and digestive exploration suggested Crohn's disease which was confirmed with histology.
PubMed: 31692744
DOI: 10.11604/pamj.2019.33.231.17761 -
Techniques in Coloproctology Sep 2017Anoperineal lesion (APL) occurrence is a significant event in the evolution of Crohn's disease (CD). Management should involve a multidisciplinary approach combining the... (Review)
Review
BACKGROUND
Anoperineal lesion (APL) occurrence is a significant event in the evolution of Crohn's disease (CD). Management should involve a multidisciplinary approach combining the knowledge of the gastroenterologist, the colorectal surgeon and the radiologist who have appropriate experience in this area. Given the low level of evidence of available medical and surgical strategies, the aim of this work was to establish a French expert consensus on management of anal Crohn's disease. These recommendations were led under the aegis of the Société Nationale Française de Colo-Proctologie (SNFCP). They report a consensus on the management of perianal Crohn's disease lesions, including fistulas, ulceration and anorectal stenosis and propose an appropriate treatment strategy, as well as sphincter-preserving and multidisciplinary management.
METHODOLOGY
A panel of French gastroenterologists and colorectal surgeons with expertise in inflammatory bowel diseases reviewed the literature in order to provide practical management pathways for perianal CD. Analysis of the literature was made according to the recommendations of the Haute Autorité de Santé (HAS) to establish a level of proof for each publication and then to propose a rank of recommendation. When lack of factual data precluded ranking according to the HAS, proposals based on expert opinion were written. Therefore, once all the authors agreed on a consensual statement, it was then submitted to all the members of the SNFCP. As initial literature review stopped in December 2014, more recent European or international guidelines have been published since and were included in the analysis.
RESULTS
MRI is recommended for complex secondary lesions, particularly after failure of previous medical and/or surgical treatments. For severe anal ulceration in Crohn's disease, maximal medical treatment with anti-TNF agent is recommended. After prolonged drainage of simple anal fistula by a flexible elastic loop or loosely tied seton, and after obtaining luminal and perineal remission by immunosuppressive therapy and/or anti-TNF agents, the surgical treatment options to be discussed are simple seton removal or injection of the fistula tract with biological glue. After prolonged loose-seton drainage of the complex anal fistula in Crohn's disease, and after obtaining luminal and perineal remission with anti-TNF ± immunosuppressive therapy, surgical treatment options are simple removal of seton and rectal advancement flap. Colostomy is indicated as a last option for severe APL, possibly associated with a proctectomy if there is refractory rectal involvement after failure of other medical and surgical treatments. The evaluation of anorectal stenosis of Crohn's disease (ARSCD) requires a physical examination, sometimes under anesthesia, plus endoscopy with biopsies and MRI to describe the stenosis itself, to identify associated inflammatory, infectious or dysplastic lesions, and to search for injury or fibrosis of the sphincter. Therapeutic strategy for ARSCD requires medical-surgical cooperation.
Topics: Adult; Anal Canal; Anus Neoplasms; Combined Modality Therapy; Consensus; Crohn Disease; Digestive System Surgical Procedures; Drainage; Female; France; Gastrointestinal Agents; Humans; Male; Perineum; Practice Guidelines as Topic; Rectal Fistula; Treatment Outcome; Tumor Necrosis Factor-alpha
PubMed: 28929282
DOI: 10.1007/s10151-017-1684-y -
Nanomaterial-based biosensors and immunosensors for quantitative determination of cardiac troponins.Journal of Pharmaceutical and... Sep 2018Cardiovascular diseases (CVDs) are the most frequent mortality cause in many countries. The acute myocardial infraction (AMI) is one of the most common types of CVDs.... (Review)
Review
Cardiovascular diseases (CVDs) are the most frequent mortality cause in many countries. The acute myocardial infraction (AMI) is one of the most common types of CVDs. Cardiac troponin I (cTnI) and cardiac troponin T (cTnT) as predominant cardiac infarction biomarkers considered as "gold standard" for diagnosis of acute myocardial infraction (AMI). The restrictions of traditional methods have encouraged the development of highly sensitive and specific methods for cTnI and cTnT detection. The rapid, early, reliable, and cost-effective diagnosis of CVDs not only helps with patient survival, but also save cost and time to prosperous prognosis. In recent years, the concept of biosensors has opened new horizons in high precision detection. Once combined with nanomaterials, nano-scale biosensors provide powerful analytical platforms for diagnosing of cTnI and cTnT. In this article, after a brief overview of the cardiac troponins, a classification and description of the research progresses of biosensors and immunosensors for the detection and quantitative determination of cardiac troponins based on optical and electrochemical platforms are presented.
Topics: Biomarkers; Biosensing Techniques; Humans; Myocardial Infarction; Nanostructures; Troponin I; Troponin T
PubMed: 30041152
DOI: 10.1016/j.jpba.2018.07.031 -
Experimental and Therapeutic Medicine Sep 2016Anal fistula is common in patients with Crohn's disease (CD) and leads to significant morbidity. The efficacy of seton drainage combined with anti-tumor necrosis...
Anal fistula is common in patients with Crohn's disease (CD) and leads to significant morbidity. The efficacy of seton drainage combined with anti-tumor necrosis factor-α monoclonal antibody (anti-TNF-α) or immunosuppressant in the treatment of CD-related anal fistula remains unclear. The aim of the present study was to compare the efficacy between seton drainage combined with anti-TNF-α and seton drainage combined with immunosuppressant postoperatively on the treatment of CD-related anal fistula. A total of 65 patients with CD-related anal fistula who had received seton drainage combined with postoperative medication were divided into an antibiotics only group, anti-TNF-α group and immunosuppressant group; all patients were treated with antibiotics. Fistula closure, external orifice exudation rate and recurrence rate were assessed among these patients. The duration of follow-up ranged from 3 to 84 months with an average of 25.3 months. There were 11 (16.9%) cases of recurrence after seton drainage, 9 of which underwent a second seton drainage. In the total study group, 34 (52.3%) cases achieved complete fistula closure, and 10 (15.4%) cases showed external orifice exudation. No significant difference was found among these three groups, regarding fistula closure rate, closure time of fistula and recurrence rate. The external orifice exudation rate was significantly higher in the anti-TNF-α group compared with the antibiotics only group and immunosuppressant group (P=0.004 and P=0.026, respectively). Seton drainage is an effective treatment for CD-related anal fistula. The efficacy is similar whether combined with anti-TNF-α or immunosuppressant.
PubMed: 27588113
DOI: 10.3892/etm.2016.3552