Case Of Ulcer Research Articles

Gastroprotective Effect of Samudradya Churna wsr of Parinama Shula: A Classical Review

According to several researches on the number of cases of duodenal ulcers, these conditions are believed to affect 5 to 15% of the general population. While dyspepsia is among the most common accompanying symptom of duodenal ulcers, the presentation can range in severity, including gastrointestinal bleeding, gastric outlet obstruction, perforation, or fistula development. This whole entity compared as Parinama Shoola is an Avaranjanya Tridoshaja Vyadhi caused by Vata vitiation, which causes avarana in Kapha and Pitta. It worsens during meal digestion and 3-4 hours after food intake when it gets to the intestines. In modern science, there are drugs for symptomatic relief in the treatment of ulcers (Parinama Shula) that have severe adverse consequences over time. In the Current era, there is a critical need to protect the microbiota of the gut as well as digestive health through the use of Ayurvedic formulations both for preventive and therapeutic purposes. Finally, it is discussed the use of one of the Ayurveda Formulation “Samudradya Churna” with respect to its role in health and disease. This article reviews the indications, contraindications, pharmaceutical action, adverse events, and other key elements in the clinical setting as relates to the essential points.

The association between Helicobacter pylori virulence factor genotypes and gastroduodenal diseases in children

Objective: To investigate the association between Helicobacter pylori (Hp) virulence factor genotypes and the degree and activity of gastric mucosa pathological changes in pediatric gastroduodenal diseases. Methods: This retrospective cohort study was conducted from May 2020 to October 2020. The frozen strains of Hp, which were cultured with the gastric mucosa of 68 children with gastroscopy confirmed gastroduodenal diseases who visited the children's hospital of Zhejiang University School of Medicine from April 2012 to December 2014, were resuscitated. After extracting DNA from these Hp strains, PCR amplification and agarose gel electrophoresis were performed to determine the detection rate of cytotoxin-associated protein A (cagA),vacuolating cytotoxin A (vacA)(s1a、s1b/s2,m1/m2), outer inflammatory protein A (oipA),blood group antigen binding adhesin (babA),duodenal ulcer promoting protein A (dupA) genes; oipA genes were sequenced to determine the gene status. The patients were divided into different groups according to the findings of gastroscopy and gastric mucosa pathology. The detection rates of various virulence factor genotypes among different groups were compared using χ2 tests or Fisher's exact tests. Results: The 68 Hp strains all completed genetic testing. According to the diagnostic findings of gastroscopy, the 68 cases were divided into 47 cases of superficial gastritis and 21 cases of peptic ulcer. Regarding the pathological changes of gastric mucosa, 8 cases were mild, and 60 cases were moderate and severe according to the degree of inflammation; 61 cases were active and 7 cases inactive according to the activity of inflammation. The overall detection rates of cagA, vacA, vacA s1/m2, functional oipA, babA2, and dupA virulence factor genes were 100% (68/68), 100% (68/68), 94% (64/68), 99% (67/68), 82% (56/68), and 71% (48/68), respectively. In the superficial gastritis group, their detection rates were 100% (47/47), 100% (47/47), 96% (45/47), 98% (46/47), 81% (38/47), and 70% (33/47), respectively; in the peptic ulcer group, their detection rates were 100% (21/21), 100% (21/21), 90% (19/21), 100% (21/21), 86% (18/21), and 71% (15/21), respectively. There was no statistically significant difference between the two groups (all P>0.05). In the mild gastric mucosa inflammation group, the detection rates of the above six genotypes were 8/8, 8/8, 8/8, 7/8, 7/8, and 5/8, respectively; and in the moderate to severe inflammation groups, the detection rates were 100% (60/60), 100% (60/60), 93% (56/60), 100% (60/60), 82% (49/60), and 72% (43/60), respectively, with no statistically significant difference between the two groups (all P>0.05). In the active inflammation group, the detection rate of six genotypes were 100% (61/61), 100% (61/61), 93% (57/61), 98% (60/61), 82% (50/61), and 72% (44/61), respectively; and in the inactive inflammation group, they were 7/7, 7/7, 7/7, 7/7, 6/7, and 4/7, respectively. Again, there was no statistically significant difference between the two groups (all P>0.05). There was no statistically significant difference in the detection rate of combinations of 4 or 5 virulence factor genes among the different groups (all P>0.05). Conclusions: CagA, vacA, vacA s1/m2, functional oipA, babA2, and dupA genes are not associated with superficial gastritis and peptic ulcer in children, or with the degree and activity of gastric mucosa pathological inflammation. Different gene combinations of cagA, vacA, oipA, babA2, and dupA have no significant effects on predicting the clinical outcome of Hp infection in children.

Case Report of Candida Parapsilosis Keratitis After Cataract Surgery Leading to Corneal Perforation

Purpose:The objective of this study was to report and document a rare case ofCandida parapsilosiskeratitis that occurred following a routine clear corneal incision cataract surgery, ultimately resulting in a perforated corneal ulcer and subsequent need for a penetrating keratoplasty (PK). By presenting this case, the study aims to contribute to the existing literature and raise awareness about the potential risk ofC. parapsilosiskeratitis as a complication of cataract surgery.Methods:In this case report, we describe the presentation and management of a rare fungal infection following routine cataract extraction in an 80-year-old male patient. The patient initially received treatment for suspected endophthalmitis and bacterial keratitis but experienced worsening symptoms, including a small corneal perforation. Upon referral to the clinic, the patient exhibited a fluffy stromal infiltrate near the cataract wound site, an epithelial defect, and a hypopyon. Treatment with compounded topical 1% voriconazole was initiated but did not prevent the progression of the corneal perforation. Attempts to seal the perforation with corneal glue were unsuccessful, leading to the decision to perform a PK. During the surgery, corneal tissue was biopsied and cultured to identify the causative agent.Results:Following PK, the corneal cultures revealed the growth ofC. parapsilosis, confirming the fungal nature of the infection. The patient was then reinitiated on topical voriconazole for a prolonged course of 7 months. Throughout this period, the patient was closely monitored and followed up in the clinic. Fortunately, there were no recurrences of the fungal lesion during this time.Conclusions:No prior cases of a perforated corneal ulcer resulting fromC. parapsilosiskeratitis after routine cataract surgery have been reported in the literature to our knowledge. Our patient experienced postoperative complications characterized by recurrent inflammation, which was treated with potent and frequent topical steroids. This treatment masked the underlying mycotic infection and contributed to corneal perforation. Ultimately, the patient underwent a successful PK procedure to remove the infectious nidus, followed by an extended 7-month course of topical voriconazole. No recurrence of the lesion was observed. Therefore, clinicians should be vigilant for mycotic keratitis, specificallyC. parapsilosis, in patients who display late-onset, persistent inflammation and white plaques at the clear corneal incision site after cataract surgery. The combination of PK and an extended postoperative treatment with topical antifungal agents proves to be an effective strategy for managing corneal perforations caused byC. parapsilosiskeratitis.

Chronic Wound to Marjolin’s Ulcer: A Threatening Complication

Abstract Awareness of the potential for an ulcer to become a Marjolin’s ulcer is important for chronic wound management. Here we describe four cases of chronic ulcers progressing to malignant transformation with four completely different scenario and injury pattern. First case was a 41 years old male who presented with 24 years old complete traumatic paraplegia with ulcer as fungating mass at outer inferior quadrant of left gluteal region. The second case was a 15 year old traumatic knee injury with open wound which resulted in insensate foot and chronic osteomyelitis with recurrent ulcer with transformation to malignant ulcer. Third case is again 12 years old recurrent wound due to crush injury and osteomyelitis in the involved lower limb and last 57 years old case is different from the others, developed chronic wound from a minor cut without any specific precipitating factor which finally resulted in to marjolin’s ulcer. All the cases highlight the progression of chronic ulcer in to marjolin’s ulcer which is a very rare but deadly complication of recurrent or non-healing type of ulcers.

Anal squamous cell carcinoma mimicking pyoderma gangrenosum in a patient with crohn’s disease

Anal neoplasia in Inflammatory Bowel Disease is rare and has been associated with HPV and perianal disease. We report a case of a large perianal ulcer in a patient with a non perianal Crohns disease that it was initially misdiagnosed and treated as pyoderma gangrenosum.

Targeted delivery of a short antimicrobial peptide (CM11) against Helicobacter pylori gastric infection using concanavalin A-coated chitosan nanoparticles

Helicobacter pylori is the cause of most cases of stomach ulcers and also causes some digestive cancers. The emergence and spread of antibiotic-resistant strains of H. pylori is one of the most important challenges in the treatment of its infections. The present study aims to develop a concanavalin A (ConA) coated chitosan (CS) nanocarrier-based drug delivery for the targeted release of peptides to the site of H. pylori infection. Accordingly, chitosan was used as an encapsulating agent for CM11 peptide delivery by applying ionotropic gelation method. Con-A was used for coating CS nanoparticles to target H. pylori. The CS NPs and ConA-CS NPs were characterized by FTIR, dynamic light scattering (DLS), and scanning electron microscopy (SEM). The MIC of CM11-loaded ConA-CS NPs against H. pylori SS1 strain was analyzed in vitro. In order to evaluate the treatment efficiency in vivo, a gastric infection model of H. pylori SS1 strain was established in mice and histopathological studies and IL-1β cytokine assay were performed. Based on the results, the size frequency for CS NPs and ConA-CS NPs was about 200 and 350 nm, respectively. The prepared CM11-loaded ConA-CS NPs exhibited antibacterial activity against H. pylori SS1 strain with a concentration of 32 µg/ml. The highest healing process was observed in synthesized CM11-loaded ConA-CS NPs treatments and a significant decrease in IL-1β was observed. Our findings highlight the potential of chitosan nanoparticles as a drug delivery vehicle in the treatment of gastric infection model of H. pylori SS1 strain.Graphical

Impact of Primary Tumor Variables on Predicting Nodal Metastasis in Lower Extremity Marjolin's Ulcer: A Retrospective Cohort Study.

Background Marjolin's ulcer or scar carcinoma is a rare disease arising from the conversion of chronic scar into malignancy. Studies show Marjolin's ulcer squamous cell carcinoma has more chances of lymph nodal metastasis and is more aggressive with a worse survival rate. To date, no established guidelines exist for managing regional lymph nodes in cases of Marjolin's ulcer with clinically N0 nodes. Observation vs elective node dissection remains an option. In developing countries, long-term follow-up is not consistently leading to the risk of patients being kept on observation for regional nodes; presenting late with inoperable regional nodes is possible. This study aims to identify clinicopathological factors of lower extremity Marjolin's ulcer, which are associated with a high risk of inguinal lymph node metastasis. Identifying such risk factors may help provide a rationale for performing elective nodal dissection instead of observation in high-risk cases. Material and methods All clinically N0 lower extremity Marjolin's ulcer cases, more than 3 cm in size, treated at King George's Medical University, India, during the last five years, have been included in this study. Demographic, clinical, and pathological data of eligible patients were retrieved from institutional records. Various clinical and pathological factors were studied and correlated with lymph node positivity, and the strength of the correlation was tested using statistical methods. Factors correlated strongly with inguinal lymph node positivity were identified as high-risk factors. Results A total of 66 patients with lower extremity Marjolin's ulcer had no preoperative pathologically confirmed inguinal lymph nodes documented by ultrasonography and fine needle aspiration cytology. All patients underwent surgery for primary, followed by elective, inguinal lymph nodal dissection. The majority were males (n=51/66; 71%), and the most common age group was 30-50 years (n=40/66; 60%). The leg was the most common site (n=31/66; 47%). The least common site was below the ankle (n=14/66; 22%). Maximum dimension ranged from 3 cm to >15 cm, with the majority between 6 and 10 cm (n=40/66; 56%). Extension beyond the scar site was present in 24% (n=15/66) of patients. Most of the lesions in this study were well differentiated, 85% (n=56/66), and moderately differentiated, 15% (n=10/66), and none of the lesions was poorly differentiated. Perineural invasion, lymphovascular invasion, tumor necrosis, and extension below subcutaneous tissue were present in 82%, 14%, 28%, and 26%, respectively. Of 66 patients, 21.2% (n=14/66) had pathological nodal disease after elective nodal dissection. Perineural invasion (p<0.0001), depth of lesion (p<0.0001), and tumor necrosis (p=0.0002) had a statistically significant correlation with node metastasis. On ROC curve analysis, 7.5 cm was the cut-off size, above which chances of nodal metastasis increased significantly. Conclusions Marjolin's ulcer patients with no preoperative positive nodes may be segregated into high-risk and low-risk groups as per their risk of harboring cancer cells in regional lymph nodes. Those having one or more of the following risk factors should be classified as high risk: dimension more than 7.5 cm, presence of perineural invasion, tumor necrosis, and deep tumors extending below subcutaneous tissue. We recommend that such patients undergo prophylactic regional lymph node dissection instead of observation during primary surgery.

Acute Hemorrhagic Rectal Ulcer Complicated by Cytomegalovirus Enteritis following Steroid Pulse Therapy for Acute Exacerbation of Interstitial Pneumonia: A Case Report.

We herein report a rare case of acute hemorrhagic rectal ulcer (AHRU) complicated by cytomegalovirus enteritis following steroid pulse therapy for interstitial pneumonia. An 86-year-old woman underwent steroid pulse therapy for interstitial pneumonia. She was bedridden with dyspnea and suddenly developed melena. Colonoscopy revealed AHRU, which did not improve with conservative treatment, but did improve with ganciclovir administration for cytomegalovirus enteritis. Pulmonologists administer steroid pulse therapy for interstitial pneumonia; however, this gastrointestinal complication does not receive its due attention. Delayed treatment of this complications can be fatal. Caution should be taken when administering steroid pulse therapy to bedridden patients with interstitial pneumonia.

Deep learning for AI-based diagnosis of skin-related neglected tropical diseases: A pilot study.

Deep learning, which is a part of a broader concept of artificial intelligence (AI) and/or machine learning has achieved remarkable success in vision tasks. While there is growing interest in the use of this technology in diagnostic support for skin-related neglected tropical diseases (skin NTDs), there have been limited studies in this area and fewer focused on dark skin. In this study, we aimed to develop deep learning based AI models with clinical images we collected for five skin NTDs, namely, Buruli ulcer, leprosy, mycetoma, scabies, and yaws, to understand how diagnostic accuracy can or cannot be improved using different models and training patterns. This study used photographs collected prospectively in Côte d'Ivoire and Ghana through our ongoing studies with use of digital health tools for clinical data documentation and for teledermatology. Our dataset included a total of 1,709 images from 506 patients. Two convolutional neural networks, ResNet-50 and VGG-16 models were adopted to examine the performance of different deep learning architectures and validate their feasibility in diagnosis of the targeted skin NTDs. The two models were able to correctly predict over 70% of the diagnoses, and there was a consistent performance improvement with more training samples. The ResNet-50 model performed better than the VGG-16 model. A model trained with PCR confirmed cases of Buruli ulcer yielded 1-3% increase in prediction accuracy across all diseases, except, for mycetoma, over a model which training sets included unconfirmed cases. Our approach was to have the deep learning model distinguish between multiple pathologies simultaneously-which is close to real-world practice. The more images used for training, the more accurate the diagnosis became. The percentages of correct diagnosis increased with PCR-positive cases of Buruli ulcer. This demonstrated that it may be better to input images from the more accurately diagnosed cases in the training models also for achieving better accuracy in the generated AI models. However, the increase was marginal which may be an indication that the accuracy of clinical diagnosis alone is reliable to an extent for Buruli ulcer. Diagnostic tests also have their flaws, and they are not always reliable. One hope for AI is that it will objectively resolve this gap between diagnostic tests and clinical diagnoses with the addition of another tool. While there are still challenges to be overcome, there is a potential for AI to address the unmet needs where access to medical care is limited, like for those affected by skin NTDs.

A Long-Standing Case of Venous Leg Ulcer Treated with Constitutional Homoeopathic Medicine: A Case Report

AbstractVenous leg ulcers, also called varicose or stasis ulcers, are a result of damage to the valves in the veins of the legs, which increases venous pressure. Chronic venous insufficiency (CVI) is a well-known factor that contributes to the emergence of venous leg ulcer. Blood reflux, obstruction, or a combination of both mechanisms may result in CVI and lead to macro- and microcirculatory dysfunction. The primary risk factors for venous ulcer development are older age, obesity, previous leg injuries, deep venous thrombosis and phlebitis.A 57-year-old patient, with a pre-diagnosed case of venous leg ulcer, presented to the outpatient department of National Institute of Homoeopathy, Kolkata, with complaints of swelling and multiple ulcers in both legs. The ulcers were shallow and irregular in shape and presented with itching and persistent sticky discharge. The leg ulcer completely healed within two and half months of duration with Graphites 30/4 doses, which were given as a constitutional homoeopathic medicine. The outcome assessment of this case was done by using the Modified Naranjo Criteria (MONARCH) inventory. This case study suggests homoeopathic treatment as a promising complementary or alternative therapy, emphasising the significance of repertorisation in constitutional homoeopathic prescription for the management of ulcers.

Pharmacotherapeutic Management of Pressure Wound in Sushma Koirala Memorial Hospital

Background: Pressure ulcers are the serious kinds of wounds that get developed within the skin tissues. They affect larger surface areas of the body resulting severe pain in the infected body parts of the patients. Pressure wound, thus has been presented as one of the major health problem worldwide. This study was aimed to find out different aspects of pressure ulcer cases and outcomes in Sushma Koirala Memorial Hospital (SKMH). Along with this, the study was targeted to study major affected body part, role of diet in healing wounds, grades of pressure ulcers and medicines used during the management and treatment of such chronic wounds.&#x0D; Methods: A descriptive, unicentric, retrospective study was conducted in 2018 at Sushma Koirala Memorial Hospital. A total of 163 patient records from October 2016 to October 2018 were reviewed. The data was entered in SPSS 16 version for analysis.&#x0D; Results: Pressure ulcers were common among people from the age group 21-40 years. The males were more vulnerable than female. Most people stayed for 41-60 days while the most affected body part in many patients was the sacral region. Third grade sacral region pressure wound was mostly found in the admitted patients. Wounds and injuries were common cause for development of pressure ulcers. The usage of third generation cephalosporin- ceftriaxone was predominantly found during surgery as well as post-surgery. During surgery, most commonly used medications include fentanyl, paracetamol, midazolam and propofol. After surgery, analgesics like ketorolac, combination of ibuprofen and paracetamol were frequently used. For post-surgical condition, ceftriaxone, ascorbic acid, ranitidine and pantoprazole were mostly used. Patients with pressure ulcers were advised to take high protein diet.&#x0D; Conclusion: This study showed sacral region was most affected body part and grade 3 pressure wound were predominant in most of the admitted patients. Ceftriaxone was mostly prescribed antibiotics and combination of paracetamol and ibuprofen was mostly prescribed for analgesic effects.

Vulvar Lichen Sclerosus Clinical Severity Scales and Histopathologic Correlation: A Case Series.

Several vulvar lichen sclerosus (VLS) clinical severity scales have recently been proposed. In this prospective case series, we characterized histopathology in the context of clinical severity in 6 treatment-naïve postmenopausal patients with VLS. The Vulvar Quality of Life Index (VQLI) and an adaptation of the 2018 International Society for the Study of Vulvovaginal Disease Delphi consensus VLS severity score were administered. Vulvar skin punch biopsies were obtained to measure inflammatory density, constituent inflammatory cells, thickness of the stratum corneum and other epidermal layers, dermal edema, and dermal sclerosis. Clinicopathologic correlations were assessed. Two cases demonstrated sparse inflammatory densities, 1 case demonstrated patchy and nodular inflammatory density, 1 case demonstrated dense lichenoid inflammatory density, and 2 cases demonstrated dense lichenoid and epitheliotropic inflammatory densities. Those patients who reported severe pruritus demonstrated the greatest lymphocytic inflammatory densities on histopathological examination. Both cases of ulceration or erosion were associated with severe VQLI scores. Severe VQLI scores were also associated with trends for higher average thickness of the epidermal layers and of dermal sclerosis. Altogether, histopathologic grading of biopsy sites may reflect clinical severity in patients with VLS.

Клинический случай развития язвы роговицы на фоне ношения ортокератологических линз у ребенка 11 лет

Purpose. To represent a clinical case of the rapidly progressive purulent ulcer in 11-year-old patient applying orthokeratological contact lenses. Material and methods. Case history of patient S., who was admitted in the 2nd Ophthalmological Department of the Semashko Hospital in Ryazan. Medical history of patient S. From the Helmholtz National Research Center for Eye Diseases also was used. Results. An 11-year-old child arrived for medical help with complaints of lacrimation, photophobia, decreased vision in the left eye. The anamnesis suggests trauma, as a result of wearing orthokeratological lenses for about 2 years. At the time of admission, the objective status of the patient was the following: visual acuity of the left eye – 0.2 n/c, blepharospasm, narrowing of the palpebral fissure. Objectively, a mixed injection was determined, in the optical zone of the cornea there was a superficial defect of the epithelium, an infiltrate of irregular shape 2×2 mm. The dynamics against the background of antibacterial antiseptic, detoxification, antihistamine therapy is reflected. Discussion. The case of acute ulcer demonstrated in the article from a clinical point of view, despite the rapidly progressive course, had a favorable outcome. Early admition, adequate treatment and good tissue regeneration in children contributed to the preservation of vision in the left eye. Conclusion. It is necessary to immediately treat keratitis or erosion that occurs in patients wearing orthokeratological lenses due to the early formation of corneal ulcers and high risk of complications. Key words: corneal erosion, corneal ulcer, keratitis, orthokeratological lenses

Early and midterm outcomes of in situ fenestration via adjustable puncture needle for Ankura aortic stent graft: A single-center experience.

An analysis was conducted to demonstrate early and midterm outcomes of using adjustable puncture needle-based in situ fenestration (ISF) technique for Ankura aortic stent graft to reconstruct the supra-arch branch in thoracic endovascular aortic repair (TEVAR). A retrospective analysis of 68 cases of aortic lesions with insufficient proximal anchoring area admitted to our department from March 2017 to December 2021 was performed. In situ fenestration thoracic endovascular repair (TEVAR) was performed at the same time during the operation. Among them, there were fifty-eight cases of thoracic aortic dissection, seven cases of thoracic aortic aneurysm, and three cases of thoracic aortic ulcer. Intraoperative adjustable puncture with needle was used for the Ankura aorta stent graft to perform ISF and reconstruction of the supra-arch branch. The success rate of ISF was 94.1% (64/68). Only in four cases, attempts were made to create ISF in the left subclavian artery (LSA), and all the four were unsuccessful because of sharp and tortuosity angle. Among them, forty-four cases were only LSA fenestration, and one case was left common carotid artery (LCCA) fenestration + LSA embolism. LSA + left vertebral artery (LVA) fenestration was performed in two cases, LSA fenestration +LCCA chimney was performed in fourteen cases, LCCA + LSA fenestration + innominate artery (INA) chimney was performed in one case, and LCCA fenestration + INA chimney + LSA embolism was performed in two cases. The overall neurologic event rate was 3.1% (spinal cord ischemia 0, with stroke observed in two cases). Postoperatively, one patient (1.6%) died on the third day after TEVAR due to the retrograde dissections. There were four cases of endoleak (6.3%; three type I and one type II). The average follow-up was 29.2 ± 14.4months, and no patient died during the follow-up period. Three cases of endoleak disappeared, and one case did not increase further. In addition, other two cases of retrograde dissections were observed at 3 and 5months after TEVAR. Fortunately, they were scheduled for emergency surgery with ascending aorta replacement and improved well. There was only one case of LSA occlusion after ISF which was reconstructed by endovascular treatment. Two patients were found with distal stent graft-induced new entries (dSINE), and TEVAR was performed again during the follow-up period. Early and midterm outcomes demonstrated that ISF via the adjustable puncture needle device for the Ankura aorta stent graft is a feasible and effective treatment method, which can achieve high technical success and satisfactory short-term results.

Retrograde type A aortic dissection during or after thoracic endovascular aortic repair: a single center 16-year experience.

This article aims to investigate the incidence rate of retrograde type A aortic dissection (RTAD) and the risk factors of RTAD in relation to thoracic endovascular aortic repair (TEVAR). Patients with thoracic aortic disease who underwent TEVAR at Henan Provincial People's Hospital from January 2004 to December 2019 were enrolled in the present research. The risk factors associated with RTAD following TEVAR using univariate and multiple logistic regression analyses. During the study period, A total of 1,688 TEVAR patients were included in this study, and of these, 1,592 cases were included in the type B aortic dissection (TBAD) group, and 96 cases were included in the non-TBAD group. There were 1,230 cases of aortic dissection and 362 cases of aortic intramural hematoma and/or penetrating ulcer in the TBAD group. The non-TBAD group included 68 cases of thoracic aortic aneurysm, 21 cases of thoracic aortic pseudoaneurysm, and seven cases of congenital aortic coarctation. The overall incidence rate of RTAD was 1.1% (18/1,688) in patients, all of which occurred in the TBAD group. The cohort comprised 18 RTAD patients with an average age of 56.78, consisting of 13 males and 5 females. Among them, 13 individuals exhibited hypertension. Ten instances happened within the TEVAR perioperative period, including two cases during the surgery, six cases occurred within three months, two cases occurred after one year, and the longest interval was 72 months following TEVAR. TEVAR was successfully implemented in 17 patients, while the operation technique was temporarily altered in one case. The new entry position for RTAD was identified as the proximal region of the stent graft (SG) in 13 patients, while in five cases, the entry site was more than 2 cm away from the proximal region of the SG. 17 cases were at the greater curvature of the aorta, and one case was at the lesser curvature. Multivariate logistic regression analysis revealed that the SG oversizing ratio is a relevant risk factor for RTAD. However, ascending aortic diameter, aortic arch type, SG type, and anchored region were not directly related to the occurrence of RTAD. RTAD is a rare yet catastrophic complication. It could occur both during the procedure, early and late postoperative periods. Maintaining an appropriate SG oversizing ratio is crucial to minimize the risk of RTAD.

CLINICAL STUDY OF DIABETIC FOOT, ITS RISK FACTORS, CLINICOPATHOGENESIS, INVESTIGATIONS AND MANAGEMENT

Objectives: The objectives of the study are to study epidemiology and clinicopathogenesis of diabetic foot ulcers and (2) to study investigations that correlate with diabetic foot recurrence and its management. Methods: This study was done among diabetic patients came to surgery outpatient department with complaints of ulcer, swelling, gangrene, over foot, toes/leg+foot/ankle and admitted in surgery ward of C.R. Gardi Hospital, Ujjain, Madhya Pradesh, in time period between October 2017 and November 2018. Detailed history and thorough clinical examination were done in all cases. A total of 85 cases of diabetic foot ulcers were analyzed. Results: Out of 85 patients involved in study, peak incidence of diabetic foot ulcer is seen in age group of 51–60 years and the lowest, i.e., 3.5% of incidence seen in age group of &lt;40 years. The most common cause of ulcer formation was trauma, i.e., 61.2% and rest 38.8% were spontaneous as patients were unaware of any injury that might have caused it. In this study, it is seen that patients with duration of diabetes 11–15 years were most consisting 40% of all patients and more than 15 years being the least with 7.2%. Conclusion: On the basis of our study findings, we found out that most common mode of ulcer formation was due to injury rather than spontaneous. It can be due to the fact that majority of population is from rural areas and less educated and mostly involved and open-field work such as farming and laborer.

Painless ulceration due to digital hypoperfusion ischaemic syndrome: case report and literature review

Digital hypoperfusion ischaemic syndrome (DHIS), also known as steal syndrome, is a well recognised serious complication of haemodialysis (HD) access creation. The clinical presentation varies from cyanosis to tissue loss due to necrosis or gangrene. In this article, we present a case of painless digital ulceration due to DHIS and provide a review of the literature. A 40-year-old-female presented with multiple painless digital ulcerations of the left hand. Her medical profile included atherosclerotic disease, hypertension, hyperparathyroidism and type I diabetes causing retinopathy, peripheral neuropathy, gastroparesis and end-stage renal disease (ESRD). Her ESRD required HD with the construction of a left-arm basilic vein transposition arteriovenous fistula (AVF). A year later, she developed intermittent, painless ulcerations of the left hand. A Doppler ultrasound confirmed the diagnosis of DHIS. The patient was treated with AVF ligation surgery. At six months postoperatively, she had near complete re-epithelialisation of her ulcers. This case is unique in that the patient did not have preceding pain, likely due to her underlying diabetic neuropathy. While DHIS in haemodialysis patients with AVF is well documented in literature, digital ulceration in this context is an advanced form of this condition. Early recognition of digital ulceration as a complication of DHIS may enable early intervention and prevent permanent damage.

Undiagnosed Behçet Syndrome Presenting with Abdominal Wall Ulceration: A Case Report

Behçet syndrome (BS) is a chronic inflammatory disease that damages blood vessels and affects multiple systems, including the skin, mucosa, joints, eyes, nervous system, and gastrointestinal tract. The disease follows a relapsing course, characterized by recurrent episodes of inflammation. Cutaneous lesions are a common manifestation of BS, presenting as ulcerations exhibiting the pathergy response, posing a challenge for healing. We report an unusual case of abdominal wall ulceration in a female patient with previously undiagnosed BS. The atypical characteristics and course of the ulcerations, as well as the data obtained from the patient’s medical history and laboratory findings, prompted a multidisciplinary approach. The findings, in conjunction with the clinical suspicion, resulted in a diagnosis of BS. Following the diagnosis, the patient received appropriate management, including local wound care and medical treatment for BS, resulting in rapid wound epithelialization within a few days of treatment initiation. The patient was referred to a rheumatologist for further evaluation and long-term management of BS. This case underscores the significance of including BS in the differential diagnosis of unusual ulcerations.

CD14 Mouth ulcer mayhem secondary to dental fillings

Abstract Dental amalgam contains mercury, which may cause an uncommon lichenoid allergic contact dermatitis (ACD) affecting the oral mucosa in direct contact with the amalgam filling. Distinguishing a lichenoid amalgam reaction from oral lichen planus is challenging, both clinically and histopathologically. This case illustrates the important role that patch testing to dental materials can play in providing a simple answer in the management of resistant cases of mouth ulceration, protecting patients from exposure to potentially toxic immunosuppressive treatments. A 64-year-old woman presented with a 5-year history of oral ulceration affecting the buccal mucosa and tongue bilaterally. These ulcers were persistent, very painful and bled intermittently, causing a significant adverse effect on her quality of life. She worked as a manager at a local wildlife sanctuary, and hobbies included walking, writing and artwork. An incisional biopsy taken from an ulcer in the left buccal mucosa demonstrated a dense lichenoid inflammatory cell infiltrate. The oral surgical team treated her for presumed ulcerative oral lichen planus with multiple treatments, including topical steroids, high doses of oral prednisolone, hydroxychloroquine, mycophenolate mofetil and azathioprine. She gained only very minimal benefit. The oral surgeons then requested dermatological advice for the next potential treatment option, which was suggested to be rituximab. At this point, the surgeons noticed that the ulcers seemed to be most prominent at sites of the patient’s longstanding amalgam fillings and she was referred for patch testing. Patch tests were performed to the British Standard series, medicaments series and oral and dental series. Positive reactions were noted to both amalgam (D2+/D4+) and mercury (D2+/D4+). The patient had her amalgam fillings replaced with white acrylate fillings, and her oral ulceration completely healed without the need for any further immunosuppression. Clinically and histologically, lichenoid ACD secondary to dental fillings can be indistinguishable from idiopathic oral erosive lichen planus. However, the proximity of ulceration to dental filling materials should always raise the possibility of a lichenoid ACD and trigger referral for patch testing, preferably prior to systemic medications being tried. This case highlights the importance of patch testing in patients with localized, asymmetrical, difficult-to-treat oral ulcers adjacent to amalgam fillings, which could spare the patient from exposure to potentially harmful immunosuppressive treatments.

Bilateral corneal ulceration in a cat after general anaesthesia

AbstractGeneral anaesthesia is accompanied by a loss of the blink reflex, decreased tear production, inability to close the eye and decreased stability of the tear film. Protection of the eye with corneal lubricant is standard during general anaesthesia, but clear recommendations are missing. Moreover, the anaesthetic event may trigger other factors that increase susceptibility to corneal ulceration. In this case report, we describe a clinical case of bilateral corneal ulceration in a cat following general anaesthesia. We discuss how our practice may be improved, and examine the possibility that feline herpes virus resurgence during veterinary care may be a risk factor for corneal lesions.