Case Of Ulcer Research Articles

Use of autologous tissue regeneration matrix (pro prf) in the treatment of diabetic ulcers: case series

Introduction: diabetes mellitus significantly contributes to chronic ulcers, with over 30% of diabetics over 40 affected by lower limb ulcers, which can lead to severe complications if untreated. The Progressive Platelet Rich Fibrin (PRO-PRF) tissue regeneration matrix can be a technique to improve the dimensions of the membrane, its strength and cell distribution, aiding in the treatment of tissue reconstruction. Objective: to describe a series of cases of diabetic ulcers treated with autologous tissue regeneration matrix (PRO-PRF). Methods: a prospective, interventional case series study using a new tissue regeneration matrix protocol for the treatment of diabetic ulcers. This is an autologous matrix obtained by collecting peripheral blood and centrifuging it in a protocol of progressively increasing speeds. Results: 29 patients were evaluated with a mean age of 60.54±9.75 years. 82.8% of the sample was male with an average body mass index (BMI) of 29.29±8.04Kg/m2 . Most of the lesions (41.4%) were located on the hallux. The median number of days of treatment was 14 (25% percentile of 7 and 75% percentile of 63 days). Statistical analysis showed a significant reduction in the size of the ulcers after treatment with PRO-PRF. Conclusion: the use of PRO-PRF proved to be an easy-to-use, low-cost and effective therapeutic option for treating chronic skin wounds on diabetic feet.

Treatment of exposed tibial bone by old school burr holes – a case report

Background: We report a successful wound treatment of a chronic ulcer with bone exposure using a somehow forgotten technique of creating burr holes into the bone. Most clinics would promote flap surgery to cover wounds with bone exposure, however, in some cases invasive surgery is not mandatory. We bring up an alternative treatment for such cases. Case: We report a case of chronic ulcers on both lower extremities in a 43-year-old Caucasian male. He suffers from a leukocytoclastic vasculitis and sarcoidosis which is medicated by immunosuppressive medication. The patient‘s wounds were initially treated with mechanical debridement and split-thickness skin grafts, however, his wounds tended to worsen the more they were manipulated and finally resulted in tibial bone exposure. After levelling up his immune suppressive drugs, the wounds finally stabilized but didn’t heal after several weeks of follow-up. The wound was ultimately treated by placing burr holes in the underlying cortical bone. Conclusion: Chronic ulcers with bone exposure at the lower leg are challenging to treat. They often require local or free flap surgery. In some cases, because of underlying systemic disease, it is mandatory to stay away from invasive flap surgery. With this case, we like to put under attention an old technique of decorticating the exposed bone to promote secondary wound healing. It has been described mainly for scalp injuries, however, we have proven the viability of this technique for pretibial wounds as well.

Lower limb gait joint coordination variability in people with diabetes-related foot ulcers

BackgroundDiabetes-related foot ulcers pose substantial health risks globally, yet the biomechanical intricacies underlying their development remain incompletely understood. This study aimed to evaluate lower limb gait joint coordination variability in individuals with diabetes-related foot ulcers compared to those with diabetes (without diabetes-related foot ulcers) and healthy controls. MethodsA total of 99 participants (diabetes-related foot ulcers cases – 16, Diabetes controls – 50, Health controls – 33) compared three self-paced walking trials. Vector coding, a technique quantifying movement coordination, was employed, analysing hip-knee, knee-ankle, and hip-angle joint couplings in the sagittal plane. FindingsNo significant differences in coordination variability were found among the groups. However, distinct coupling pattern frequencies emerged, with diabetes-related foot ulcers cases exhibiting unique anti-phase hip and ankle coupling frequency counts compared to healthy controls. InterpretationThese findings challenge conventional understandings of diabetes-related foot ulcers biomechanics and underscore the complexity of gait in this population.

Predictive value of neutrophil-lymphocyte ratio in assessing the outcomes of diabetic foot ulcer.

To assess the correlation of neutrophil-lymphocyte ratio with clinical outcomes in diabetic foot ulcer cases. The retrospective, cross-sectional, single-centre study was conducted at Section of Vascular Surgery, Aga Khan University Hospital, Karachi (Pakistan), and comprised data from January 2019 to January 2022 of diabetic foot inpatients of either gender aged at least 18 years. Hospital complications and outcomes were noted along with other data on a self-designed proforma. Diagnostic performance of neutrophil-lymphocyte ratio and its correlation with qualitative variables were assessed. Data was analysed using SPSS 26. Of the 130 patients with mean age 60.13+/-11.75 years, 98(75.4%) were males. Surgical intervention was needed in 118(90.8%) cases, with below-knee amputation being the most frequent procedure 38(32.3%). Neutrophil-lymphocyte ratio >4 was significantly associated with a higher grade of diabetic foot ulcer, major amputation, and postoperative complications (p<0.0001) as well as with in-hospital (p=0.008) and 1-year mortality (p=0.01). Neutrophil-lymphocyte ratio could be potentially used as a sensitive and economically feasible biomarker for evaluating the prognosis of patients presenting with diabetic foot ulcers.

Dupilumab-Associated Bilateral Conjunctival Papillomas and Corneal Perforation.

We report a unique case of significant human papillomavirus-associated conjunctival papillomas and severe corneal ulceration leading to corneal perforation in a patient treated with dupilumab for atopic dermatitis. This study is a case report and literature review of severe corneal side effects related to dupilumab. A 27-year-old man with severe atopic dermatitis and no ocular history was administered dupilumab 300 mg via subcutaneous injections every 2 weeks with an excellent response. Following the onset of treatment, the patient developed conjunctivitis, conjunctival papillomas, and dry eyes, which were initially treated with lubricating eye drops. Fourteen months after commencing dupilumab, he had a rapid onset of painful visual loss in the OD accompanied by severe bilateral conjunctival injection and was found to have a central corneal ulcer and diffuse papillomas on the palpebral and bulbar conjunctiva. Despite management with intravenous methylprednisolone and topical dexamethasone, the patient's corneal ulcer progressed to a corneal melt, resulting in perforation 2 months after diagnosis, which necessitated a corneal graft. We present the third reported case of dupilumab-associated corneal perforation and the first case to our knowledge of dupilumab-associated conjunctival papillomas. As dupilumab usage increases, awareness of these potential complications among prescribers is essential.

Gastric-like (pseudopyloric and pseudofoveolar) metaplasia and Paneth cell hyperplasia-neglected histological features of chronic ileal inflammation.

Architectural distortion and basal plasmacytosis are the most widely recognized histologic features of chronic ileal inflammation. However, these features might be difficult to assess in small, poorly oriented, or superficial biopsies. Additional features of chronic mucosal damage, including pseudopyloric or pseudofoveolar metaplasia and Paneth cell hyperplasia, have been less commonly reported, and their broader appreciation could facilitate the diagnosis of chronic ileal inflammatory conditions. The prevalence of gastric-like (pseudopyloric and pseudofoveolar) metaplasia and Paneth cell hyperplasia was evaluated in 102 ileal biopsies obtained from patients with Crohn's disease (n = 47), ulcerative colitis with endoscopically normal ileum (n = 20) or with backwash ileitis (n = 20), and nonsteroidal anti-inflammatory drugs- (NSAIDs-) induced ileitis (n = 15). Gastric-like metaplasia was identified in 23% of CD and 13% of NSAID-induced ileitis cases, whereas it was absent among all ulcerative colitis cases. Pseudopyloric metaplasia, pseudofoveolar metaplasia, or a combination of both was documented in 13%, 2%, and 9% of Crohn's disease cases, respectively. NSAID-associated cases showed only pseudopyloric metaplasia. Paneth cell hyperplasia was detected in 43% of Crohn's disease cases, 13% of NSAID-induced ileitis cases, and 5% of backwash ileitis cases. Accordingly, pseudofoveolar metaplasia, pseudopyloric metaplasia, and Paneth cell hyperplasia are not uncommon in conditions causing chronic ileal inflammation. They are most frequently detected in Crohn's disease, but may also be present in NSAID-induced ileitis, whereas they are significantly less common in backwash ileitis and absent in normal ileum. Given the surface localization of pseudofoveolar metaplasia, its identification can be particularly helpful when dealing with poorly oriented or superficial samples.

Multiple Decubitus Ulcers in Dm type II Patients with Autologous Plasma-Rich Platelet therapy : A Case Report

Background:Multiple decubitus ulcers are a condition of injury that appears on several parts of the body’s skin due to pressure for a long time without any change in position. This condition usually occurs in someone with limited movement, for example, due to experiencing certain disease conditions that require the person to rest in bed for a long time, especially patients in the Intensive Care Unit (ICU) or after ICU care with chronic diseases and limited movement. Case Presentation: This case report assesses the success of multiple cases of decubitus ulcers in patients with type II diabetes mellitus with Autologous Plasma Rich Platelet therapy. Case report: Autologous PRP therapy is given by intralesional injection; debridement is done every three days and assessed every one week. Patients are also subjected to blood sugar control, blood pressure control, blood correction, and albumin to speed up the wound healing process in multiple decubitus ulcers. Conclusion:the conclusion of this case report with additional management in the form of intralesional injection of autologous PRP performed on multiple decubitus ulcer patients with Diabetes Mellitus, which is rich in growth hormone, will greatly help the wound healing process.

Pancreaticogastrostomy: A Safe and Effective Reconstruction Method After Pancreaticoduodenectomy: A Short Observational Study

Background: Pancreaticoduodenal resection is usually performed in patients with a localised small carcinoma in the head of the pancreas, at the lower end of the common bile duct or at the ampulla and occasionally for chronic pancreatitis.The mortality following pancreaticoduodenal resection has fallen and is now below 5% 1-6 .However, leakage from the anastomosis between pancreas and the jejunum has been and remains, one of the most worrying complications of the operation. The data from papers published in the last 8 years show that the incidence of pancreatic leak is 14% and the mortality of this complication 24%3,4,6-16 .Pancreaticogastrostomy is a potentially safer alternative to pancreaticojejunostomy in the reconstruction following Whipple's operation. Aim: The aim of the study was to observe pancreaticogastrostomy is a potentially safer alternative to pancreaticojejunostomy after pancreaticoduodenectomy. Methods: This prospective observational study was conducted at the Department of Surgery in Shaheed Suhrawardy Medical College Hospital, for One year (August 2021 to July 2022). Patients with a localised small carcinoma in the head of the pancreas, at the lower end of the common bile duct or at the ampulla, and occasionally for chronic pancreatitis admitted in the department of surgery were approached for inclusion in the study. Total 41 patients were selected according to inclusion and exclusion criteria. Informed written consent was taken from each patient. All patients underwent pancreaticogastrostomy. Detail clinical and demographic history was taken along with thorough physical examination relevant investigations. All patients were evaluated preoperatively and post operatively at discharge, 1 month and 3 months. Outcome was assessed post operatively. Collected data were checked and analysed in SPSS 23. Results: Two patients died within 30 days of the operation (mortality 4.9%), one from perioperative haemorrhage and another from septicaemia due to a biliary infection, which may have resulted from preoperative transhepatic biliary drainage. Both operations were carried out for carcinoma of the head of the pancreas. One patient developed a biliary leak which closed in 6 days. A postoperative pancreatic leak occurred in one patient with carcinoma of the ampulla; the fistula closed after 5 mdays, and did not delay his discharge from hospital. This patient remains well 36 months after operation, although he has now developed mild diabetes.One other patient developed diabetes mellitus postoperatively. This woman had evidence of obstructive pancreatitis at operation. She died 6 months later of recurrent carcinoma of the head of the pancreas. One patient with chronic pancreatitis has uncontrolled steatorrhoea, with up to four bowel movements a day. Four other patients take regular pancreatic supplements together with H2 receptor antagonists in order to maintain normal defaecation. There has been no case of stomal ulceration. None of the patients were lost to follow-up. The median survival for patients operated on for carcinoma of the head of the pancreas was 13 months, and for patients with carcinoma of the bile duct, 14 months. Median survival of patients with ampullary carcinoma was 38 months. Conclusion: Seventy two percent of patients had good outcome after Pancreaticogastrostomy(PG). Significant relief in symptoms of pain were noted after PG. Further larger study is recommended to validate this findings. J Shaheed Suhrawardy Med Coll 2023; 15(1): 66-72

Molecular detection of Epstein-Barr virus in paraffin-embedded tissue samples of patients suffering gastric cancer in Ahvaz, Iran: a case-control study.

Gastric cancer (GC) is the third most common cause of cancer-related mortality. Epstein-Barr virus (EBV) is associated with several human tumors. The present research was performed to investigate the prevalence of EBV-associated gastric cancer (EBVaGC) among Iranian patients. Seventy cases of gastric cancer and 30 cases of gastric ulcer, all preserved in formalin-fixed paraffin-embedded (FFPE), were examined in a case-control study conducted between 2011 and 2018. The specimens underwent analysis to detect the presence of the EBV genome using a Nested-PCR method targeting EBNA1. Subsequently, samples testing positive for the EBNA1 underwent further testing for the presence of the EBER gene using PCR. Finally, Positive samples were subjected to sequencing. Five out of 70 cases (7%) were found to be positive for EBV based on EBNA1 testing, while all EBNA1 positive samples were negative for EBER. Notably, EBV was not detected in patients with gastric ulcer. The mean age of EBV-positive gastric carcinomas pateints was 64.5 years. Within this group, 60% were male and 40% were female. A higher prevalence of EBV association was observed in diffuse-type cases, with 60% (3 out of 24) testing positive, compared to intestinal-type cases where 40% (2 out of 46) were EBV-positive. Most cases of EBVaGC belonged to grade Ⅰ. This research demonstrates a low prevalence of EBVaGC in Iran. Discrepancies in EBVaGC occurrence among countries could be attributed to epidemiological variables and dietary practices. A comprehensive studies will provide significant contributions to understanding of its etiology.

Lipschütz ulcer following first dose of COVID-19 tozinameran vaccine: Report of a case and review of a World Health Organization pharmacovigilance database.

Lipschütz ulcer (LU) is a condition known for painful vulvar ulcers, typically affecting young women and often linked to infectious agents. Recent reports have indicated a potential connection between LU and COVID-19 vaccination, particularly after the second or booster doses. This study presents a case of LU following the first dose of tozinameran in a young woman who had a previous SARS-CoV-2 infection and investigates similar cases globally. An 18-year-old woman experienced vulvar pain and ulcers 2-days after her initial COVID-19 vaccine dose. After ruling out infections through serological tests, a diagnosis of LU was made, and her symptoms resolved after 10 days. A literature search and VigiBase® analysis revealed 11 cases of LU following COVID-19 vaccination, and 519 vulvovaginal ulcer cases associated with these vaccines were identified in Vigibase®, with a median onset of 2 days. Most LU cases occurred after the second dose or booster shots. The primary hypothesis for this association is a type 3 hypersensitivity reaction mediated by immune complexes, possibly triggered by prior exposure, as many cases occurred after the second dose. Interestingly, the presented case suggests that prior COVID-19 infection could serve as sensitization. In conclusion, this study highlights the potential occurrence of LU after the initial COVID-19 vaccine dose in young patients with prior COVID-19 infection. While the risk of recurrence after subsequent vaccinations or infections remains uncertain, the benefits of vaccination outweigh the risks. Clinicians and patients should be aware of this potential issue to make informed decisions regarding vaccination.

Effective treatment of refractory oral ulcers using a compound Chinese herbal mouthwash: A report of two cases

Oral ulcers are a prevalent oral mucosal disorder, characterized by benignancy and self-limiting progression. However, a subset of these ulcers exhibits resistance to conventional therapeutic interventions, necessitating alternative treatment strategies. In this study, we present two cases of refractory oral ulcers that demonstrated limited responsiveness to standard treatments but achieved significant therapeutic benefits following the application of a compound Chinese herbal mouthwash. Case 1 involved a 60-year-old female patient diagnosed with Behçet's syndrome. Initial treatment with glucocorticoids and immunosuppressants yielded limited improvement in her oral ulcers; however, combination therapy involving the Chinese herbal mouthwash resulted in significant improvement and complete healing after a 2-week period. Case 2 presented a 48-year-old female patient with chronic tongue ulceration pain persisting for one year without any detectable systemic etiology. Despite receiving oral vitamin supplementation and local analgesic jelly, her symptoms remained unalleviated. A 3-week treatment regimen involving the administration of the Chinese herbal mouthwash in conjunction with thalidomide led to the complete resolution of her oral ulcers. The findings from this study suggest that the compound Chinese herbal mouthwash may serve as an adjuvant therapeutic approach for managing chronic oral ulcers that are resistant to conventional treatment.

S4027 Challenges in Managing Hemobilia Post-ERCP: A Case of Ulceration and Successful Intervention

S4027 Challenges in Managing Hemobilia Post-ERCP: A Case of Ulceration and Successful Intervention

S4740 A Case of Small and Large Bowel Ischemic Ulcerations in a Patient With Atypical Hemolytic Uremic Syndrome

S4740 A Case of Small and Large Bowel Ischemic Ulcerations in a Patient With Atypical Hemolytic Uremic Syndrome

A Rare Case of Uvulitis Following Endotracheal Intubation Using C- Mac Videolaryngoscope and How To Avoid It

Uvular injuries are uncommon after general anesthesia and can result from direct trauma to the posterior part of the soft palate or compression and restriction of blood flow to the uvula caused by the inadvertent placement of the airway or suction devices in the oral cavity. There have been cases of inflammation and ulceration occurring in the midline oropharyngeal structures such as the uvula after general anesthesia with a tube or laryngeal mask airway, even in the absence of direct trauma or infection, presumably due to compression ischemia. While sore throat following general anesthesia is a common symptom, it is important to evaluate any severe or persistent pain to exclude uvulitis. Here we present a case of uvulitis that developed after the insertion of a flexometallic endotracheal tube using the midline technique during C-Mac video laryngoscopy. We also emphasize the measures that can be implemented to prevent such a complication. The entrapment of the uvula during intubation often goes unnoticed due to limited oral space after insertion of the video laryngoscope blade, with the intubating anesthetist staying focused on the monitor. This complication following the use of a C-Mac video laryngoscope has not been previously documented.

S4773 Diagnostic Challenges in Abdominal Pain: A Case of Toothpick-Induced Duodenal Ulcer

S4773 Diagnostic Challenges in Abdominal Pain: A Case of Toothpick-Induced Duodenal Ulcer

When the Crystals Do Not Align: A Rare Case of Sevelamer-Induced Colonic Ulceration and Crystal Deposition

When the Crystals Do Not Align: A Rare Case of Sevelamer-Induced Colonic Ulceration and Crystal Deposition

A Case of Anal Mucosal Ulcer due to Cytomegalovirus Infection During Bullous Pemphigoid

A Case of Anal Mucosal Ulcer due to Cytomegalovirus Infection During Bullous Pemphigoid

The Role of Ultrasound in Assessment of Disease Activity in Inflammatory Bowel Disease Patients

Abstract Aim This study aim to evaluate the role of Ultrasound in assessment of disease activity in Inflammatory Bowel Disease patients (IBD). Patients and Methods The was performed at Radiology Department and involved a diagnosed cases of Inflammatory Bowel Diseases referred from the Gastroenterology Unit, Ain Shams University Hospitals. A total Thirty six patients inflammatory bowel disease patients (Ulcerative colitis and Chron's disease) were subjected to Intestinal Ultrasound assessment (IUS), Fecal Calprotectin (CP) analysis and calculation of the Clinical Activity Indices. Twenty five patients were subjected to Endoscopic Activity Assessment. Intestinal Ultrasound (IUS) parameters including intestinal wall thickness (BWT) and intestinal bowel wall vascularity, were compared with Endoscopic Activity, Fecal Calprotectin levels (CP) and Clinical Activity Indices. Results Among the thirty-six patients, there were fourteen diagnosed Chron`s cases (38.9%) and twenty-two Ulcerative Colitis cases (61.1%). Roc curve analysis revealed the ability of the ultrasound bowel wall thickness (BWT) to differentiate between mild and moderate disease activity in IBD patients with sensitivity of 90.91% and specificity of 100.0%, with area under curve (AUC) of 0.909 using the endoscopic activity as a gold standard. A statistically significant difference was found between the (BWT) measurements and Simple Endoscopic score (SES-CD) (P = 0.002) as well as between the (BWT) measurements and Endoscopic Mayo score (P = 0.001). A statistically significant correlation was found between the fecal CP levels and Intestinal bowel wall thickness among Ulcerative colitis and Chron's patients with (r = 0.708, P &amp;lt; 0.001) and (r = 0.736, P &amp;lt; 0.01) respectively. There was also statistically significant difference between the Clinical Activity Indices (Harvey-Bradshaw Index and Partial Mayo Score) and the (BWT) among both the Chron's and Ulcerative colitis patients with P-value (0.004) and (0.001) respectively. A statistically significant difference was found between Doppler (Limberg Score) and SES-CD endoscopic activity score (p = 0.009) as well as between Doppler (Limberg Score) and Endoscopic activity Mayo score (p = 0.005). Conclusion The results of the study suggest that the Bowel Wall Thickness (BWT) and Color Doppler Signal could serve as non-invasive parameters of detecting IBD activity. Intestinal US could be one of the promising methods for the detection of the disease activity as well as monitoring of IBD patients.

Buruli ulcer: An epidemiological update from Japan.

Japan is one of the rare non-tropical countries with documented cases of Buruli ulcer (BU). Mycobacterium ulcerans subsp. shinshuense has been identified as the causative agent. The first report of BU in Japan dates back to 1982, with sporadic reports thereafter. Recently, the number of cases has been on the increase, and 50 cases (57.7%) are from the past decade alone, out of a total of 87 cases reported to date. Japan's well-developed healthcare facilities play a crucial role in enabling detailed investigations and providing appropriate treatment for patients, contributing to a favorable prognosis. However, the rarity of the disease results in lack of awareness among healthcare professionals, leading to frequent delays in diagnosis. This article aims to offer an updated overview of BU cases in Japan and to raise awareness of BU among dermatologists and other healthcare professionals in a non-endemic setting.

746. ESOPHAGECTOMY, WITH CHOLECYSTECTOMY HAS A HIGH INCIDENCE OF REFLUX ESOPHAGITIS AND GASTRIC TUBE ULCER

Abstract The surgical methods for thoracic esophageal cancer was subtotal esophagectomy, with gastric pull up via retrosternal route, and cervical anastomosis. However, some cases were complicated by acute cholecystitis in the early postoperative period, and cholecystectomy was performed intraoperatively to prevent postoperative cholecystitis in some cases. The disruption of normal anti-reflux mechanisms including the lower esophageal sphincter, angle of His, and diaphragmatic muscle and the denervation of the vagus nerve are generally thought to be the main factors that interfere with gastric motor function. Furthermore, the pressure difference between thoracic (negative) and abdominal cavity (positive) is another factor that promotes reflux across the anastomosis. Due to these factors, postoperative reflux esophagitis is frequently experienced. Furthermore, after cholecystectomy, due to loss of gallbladder reservoir function after cholecystectomy and decrease in antroduodenal motility, bile is not excreted by food intermittently but continuously, resulting in duodenogastric reflux. We investigated postoperative reflux esophagitis and gastric tube ulcers in cases with and without intraoperative cholecystectomy for the past three years. We investigated cholecystectomy with esophagectomy (n=65) and non-cholecystectomy with esophagectomy (n=101) in 166 cases of radical surgery for esophageal cancer in which 2-3 regions had been dissected in the past 3 years. As shown in Fig. 1, there are no differences in location, TNM, gender, and PPI administration .reflux esophagitis of the cervical esophagus is A:0 B:2 (3%), C:5 (8%), D:3 (5%) for chole(+), A:2 (2%), B:2 (2%), C:2 (2%), and D:2 (2%) for chole(-). Gastritis was Chole(+) superficial gastritis 14 (21%), metaplasia 4 (6%), chole(-) superficial gastritis 25 (25%), metaplasia 3 (2%). However, gastric tube ulcers occurred in 5 cases (7%) of Chole(+) and 1 case of perforation, while only 1 case (1%) of gastric tube ulcers occurred in Chole(-).. (Conclusion) Esophagectomy, gastric pull up with cholecystectomy has a high incidence of reflux esophagitis in the neck and can also cause ulcers in the gastric tube. Therefore, care should be taken in postoperative follow-up.