Ulcer Location Research Articles

Early Attempts to Eradicate Helicobacter pylori after Endoscopic Resection of Gastric Neoplasm Significantly Improve Eradication Success Rates.

PurposeAfter endoscopic resection (ER) of gastric tumors, eradication of Helicobacter pylori (H. pylori) infection is advised to reduce metachronous recurrence. Optimal timing of such therapy (yet to be established) was investigated herein, examining early active and late scarring stages of post-ER iatrogenic ulcers.Materials and MethodsAnalysis included 514 patients who received proton-pump inhibitor (PPI)-based triple therapy for H. pylori eradication after ER for gastric neoplasms between January 2008 and June 2015. Clinicopathologic characteristics, particularly the timing of triple therapy, were used to compare eradication rates, assigning patients to early- (≤2 weeks), intermediate- (2–8 weeks), and late-phase (≥8 weeks) treatment groups.ResultsH. pylori eradication rates differed significantly by timing of triple therapy after ER (early, 90.0%; intermediate, 76.2%, late, 72.4%; p <.001). However, eradication success rates were not significantly affected by age, smoking, alcohol consumption, preexisting comorbidity, method of ER, size and location of iatrogenic ulcer, and duration of therapeutic regimen. Early initiation of H. pylori eradication was also identified as a significant independent predictor of eradication success in multivariate analysis (Odds ratio = 3.67, 95% CI 2.18–6.16; p <.001).ConclusionIn patients undergoing ER of gastric tumors, early post-ER attempts at eradication of H. pylori offer the best chance of eradication success.

A new concept: ‘Relative position between the external force and the bony prominence’ explains location-specific occurrence of superficial injury over an undermining lesion

AimA pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. Although the external forces and bony prominences differ depending on ulcer location, the way in which these anatomical differences affect pressure ulcer development is not well studied. MethodsTo clarify the location-dependent factors for pressure ulcer development, we focused on superficial injuries that develop over an undermining lesion, which we have termed them bilayer pressure ulcers. Because it is thought that a deep pressure ulcer is caused by ischemia at the deep lesion and a shallow pressure ulcer is caused by shear force to the superficial skin, a bilayer pressure ulcer can be considered a mixed phenotype, induced by both pressure and shear force. We retrospectively examined the frequency of bilayer pressure ulcers by location in a total of 568 pressure ulcers. ResultsThe ratio of bilayer pressure ulcers to deep pressure ulcers staged III or more was significantly larger for pressure ulcers over the sacrum. ConclusionA new concept, the relative position between the external force and bony prominence, could explain the frequency and developmental mechanism of bilayer pressure ulcers. The external forces, shape of the bony prominence, and mobility of the soft tissue may be responsible for this concept.

Clinical and imaging characteristics of 53 ulcers of post-radiation nasopharyngeal necrosis in patients with nasopharyngeal carcinoma.

It is widely accepted that a mucosal ulcer induced by radiation (RIMU) is the predominant type of post-radiation nasopharyngeal ulcer in patients with nasopharyngeal carcinoma (NPC) who underwent radiotherapy (RT); however, another type of ulcer, an ulcer of post-radiation nasopharyngeal necrosis (UPRNN), has rarely been reported for patients with NPC. In the present study, the clinical and imaging features of 53 patients who were treated at the Zhejiang Provincial Cancer Center (Zhejiang Cancer Hospital, Hangzhou, China) between March 2009 and December 2015, and who were diagnosed with UPRNN, were reviewed. The clinical factors, laboratory examinations, magnetic resonance imaging (MRI) features and endoscopic findings were analysed. A UPRNN has its characteristic imaging features and ulcer locations at the primary tumour bed, which are different from a traditional RIMU. In the retrospective analysis of the clinical factors, a tumour (T) 3/4 stage, with invasion of muscular tissue, poor response of neoadjuvant chemotherapy and anaemia during the RT, may be associated with the occurrence of a UPRNN. To evaluate the severity, a UPRNN was divided into three grades according to the invasion depth of the ulcer based on its appearance in MRI, and the subsequent treatment and prognosis varied according to the severity of the UPRNN. In conclusion, a UPRNN has its clinical features and characteristic MRI appearances, and the occurrence of a UPRNN may be associated with several clinical factors.

Spatial distribution and epidemiological features of cutaneous leishmaniasis in southwest of Iran

IntroductionLeishmaniasis, as a major health concern exists in 14 out of 22 countries of the Eastern Mediterranean Region (EMR). Therefore, the aim of present investigation was to evaluate the epidemiological features and spatial distribution of cutaneous leishmaniasis (CL) during six consecutive years (2009–2014). Material and methodsIn current retrospective cross-sectional study among 2009–2014, simple direct smear was taken from all suspicious CL subjects who referred to health centers affiliated to Ahvaz Jundishapur University of Medical Sciences. For each patient a questionnaire including some demographic details was filled. Eventually data analysis was done by SPSS.16. ResultsTrend of CL in the region was unstable. Spatial distribution of CL in central and west cities was higher than in others. During the years, a total of 4137 smear positive individuals were diagnosed. Of these 55.7% lived in urban and 44.3% lived in rural districts. Frequency of CL was higher in men (60.1%) than in women (39.9%). Also based on age range, 11–30 was the most afflicted group (45.7%). Anatomic location of ulcers was as follows: hands 45.7%, feet 27.4%, face 19.1% and other places 7.8%. ConclusionsRegarding high incidence of CL in southwest of Iran, special programs related to vector and reservoir control should be adopted and implemented. Traffic control of immigrants and travelers from neighboring endemic countries, also can be helpful.

Preferential location of idiopathic peptic ulcers

Objective: Helicobacter pylori infection-negative, nonsteroidal antiinflammatory drugs (NSAIDs)-negative peptic ulcers, which are termed idiopathic peptic ulcers (IPUs), have been increasing worldwide. In this study, we investigated the preferential locations of gastric ulcers according to their cause (e.g., H. pylori and NSAIDs), with special attention to IPUs.Material and methods: A total of 361 patients consecutively diagnosed with a peptic ulcer over a period of one year were classified into four groups according to H. pylori-infection status and NSAIDs usage. The ulcer location was divided into the antrum, angularis, and body, and was compared among the four ulcer groups.Results: The ulcers of 43 patients were classified as IPUs. Compared with simple H. pylori ulcers, IPUs more preferentially located in the antrum (14% vs. 52%, p < 0.01). The difference was more pronounced in the analysis of IPUs in which patients with a history of H. pylori eradication or those with severe atrophic gastritis were excluded, and 79% of these IPUs were located in the antrum. With duodenal ulcers taken together, the vast majority of (86%) these IPUs occurred in the duodenal bulb or the antrum. The proportion of antral ulcers in NSAISs users also differed depending on the presence of concomitant H. pylori infection (positive: 22% vs. negative: 62%, p < 0.01).Conclusion: There was a striking difference in the ulcer location within the stomach depending on the cause of the ulcer, and IPUs predominantly occurred in the antrum. This information on the preferential locations of ulceration should provide endoscopists with some hints concerning the etiology of ulcers.

Perceived role of therapeutic footwear in the prevention of diabetic foot ulcers: A survey of patients with diabetes mellitus in Kaduna State

Background: There is a paucity of literature about the status of therapeutic footwear and their role in prevention of diabetic foot ulcers in Nigeria. The purpose of this study is thus 2-fold. (1) To determine the perceived role of therapeutic footwear in the prevention of foot ulcers among patients with diabetes mellitus, (2) to establish strategies that will encourage the use of therapeutic footwear in the prevention of diabetic foot ulcers. Materials and Methods: This cross-sectional study was carried out among patients with diabetes mellitus in Kaduna state, between December 2012 and March 2013. All the participants in this study had a history of foot ulceration. Exclusion criteria were patients with amputations and non-ambulatory status. Pre-tested questionnaires were used to collect data. The questionnaire was divided into four sections. The first section illustrates the demographics of the respondents. The second section explores the anatomic location of diabetic foot ulcers. The third section evaluates the type of regular footwear worn and experience of participants. The fourth section explores the awareness of respondents regarding therapeutic footwear features. Simple descriptive statistics were used; frequency with percentage distribution for categorised variables. Results: The anatomic subunit in the plantar surface with the highest number of ulcer was the phalanges 23% in males and 26% in females. In the dorsolateral surface, the phalanges 22% and 17% were the most common location in males and females, respectively. Slippers were regularly worn by 71% of respondents, whereas only 1% of respondents were reported to wear therapeutic footwear. More than 75% of respondents were willing to use footwear, as well as buy therapeutic footwear. Conclusion: Majority of the patients are reported to have foot ulcers located on the phalanges and these are related to the wearing of inappropriate footwear. However, they are willing to use therapeutic footwear if recommended by a physician.

High rate of Helicobacter pylori reinfection in Lithuanian peptic ulcer patients.

To evaluate the frequency of Helicobacter pylori (H. pylori) reinfection in peptic ulcer patients during 9 years after H. pylori eradication. We invited 117 peptic ulcer patients in whom eradication of H. pylori was confirmed 1 year after eradication treatment both by histology and by rapid urease test. In total, 57 patients were available for the study procedures: 34 (59.6%) male, 23 (40.4%) female; mean age 52.3 ± 13.0 years. There were 45 (78.9%) patients with duodenal ulcer and 12 (21.1%) with gastric ulcer. H. pylori was diagnosed by a rapid urease test and histology if endoscopy was performed. If endoscopy was refused, H. pylori was diagnosed by the C14-urea breath test and serology. H. pylori was established if at least one of the tests was positive. The mean follow-up was 8.9 ± 1.0 years (range, 6-12). H. pylori was established in 15 patients. In 2 H. pylori-negative patients, H. pylori was established during the follow-up period and eradicated. Therefore, we consider that reinfection occurred in 17 patients. In the per protocol analysis, reinfection was established in 17 of 57 (29.8%; 95%CI: 19.2-42.2) patients during the follow-up period. The annual rate of infection was 3.36%. If all non-responders were considered H. pylori-negative, reinfection would be 14.5% (17/117), the annual rate being 1.63%. The mean age of patients with reinfection was 51.8 ± 14.0 years, and without reinfection was 52.5 ± 13.0 years, P > 0.05; the mean body mass index of patients with reinfection was 27.2 ± 4.1 kg/m(2), and without reinfection was 25.7 ± 4.2 kg/m(2), P > 0.05. There were no differences in the reinfection rates according the location of the peptic ulcer, the eradication regimen used, and smoking status. The reinfection rate of H. pylori is relatively high in Lithuania and probably related to the high prevalence of H. pylori, what may reflect differences in the socioeconomic status between Western and Eastern European countries.

Nutritional management of gastric ulceration

SummaryGastric ulcers are common in horses and equine gastric ulcer syndrome describes ulcers in the distal oesophagus, nonglandular and glandular stomach as well as the proximal duodenum. Ulcers in the distal oesophagus and nonglandular region of the stomach are probably caused by hydrochloric acid, whereas ulcers in the glandular stomach and proximal duodenum are likely to be caused by a breakdown in the mucosal defence mechanisms. Regardless of the location of ulcers, initial treatment with pharmacological agents is necessary to suppress hydrochloric acid; however, nutrition and management changes are required to maintain ulcer healing and help prevent recurrence. In addition, many dietary supplements have been marketed to help maintain stomach health and some scientific data on their effects on gastric ulcer scores and gastric juice pH are presented.

Abstract: Notes from the Field: Establishing Baseline Data for Pressure Ulcers in a Rwandan Intensive Care Unit

Abstract Background Pressure ulcers are a common iatrogenic medical problem. Pressure ulcers increase the morbidity and mortality of hospitalized patients as well as the length and cost of hospitalization. It was observed that patients in the Intensive Care Unit (ICU) of a large, referral hospital in Kigali, Rwanda, often had pressure ulcers, however, no data on the ulcers existed. Objectives The objective of this study was to establish baseline data and compare prevalence, incidence, and severity of pressure ulcers in this ICU before and after educational classes. Methods Educational classes on pressure ulcer assessment and classification were held for all ICU nurses. After training, data collection was instituted and conducted over a three month period. Patients were screened upon admission and daily for the presence of pressure ulcers, number of ulcers, ulcer location and ulcer severity. All information was documented in a database. Results Currently, 41 patient stays have been assessed. Eleven patients (27%) arrived with preexisting ulcers, six patients (15%) developed new ulcers during their ICU stay. No pre-existing ulcers notably worsened in severity in the ICU, and new onset ulcers showed a maximum severity of Stage 2. The most common location for both preexisting and new ulcers was the buttocks, and the most common severity for both pre-existing and new onset ulcers was also Stage 2. Conclusion So far, pressure ulcer incidence (new occurrence) has been found to be at 15%, and prevalence at 41%. These statistics suggests that the ICU has an average incidence and moderately high prevalence of pressure ulcers. Further data collection is needed to verify these results. In light of resource limitations and short-staffing, these results are quite positive. Once baseline data is established with further study, the ICU will be able to evaluate the efficacy of future nursing practice changes designed to reduce pressure ulcer incidence and severity in the ICU setting. Key words : pressure ulcer, ICU, quality indicator

High probability of healing without amputation of plantar forefoot ulcers in patients with diabetes.

Diabetic foot ulcer is an important entity which in many cases is the first serious complication in diabetes. Although a plantar forefoot location is common, there are few studies on larger cohorts and in such studies there is often a combination of various types of ulcer and ulcer locations. The purpose of this study is to discern the outcome of plantar forefoot ulcers and their specific characteristics in a large cohort. All patients (n = 770), presenting with a plantar forefoot ulcer at a multidisciplinary diabetes foot clinic from January 1, 1983 to December 31, 2012 were considered for the study. Seven hundred one patients (median age 67 [22-95]) fulfilled the inclusion criteria and were followed according to a preset protocol until final outcome (healing or death). Severe peripheral vascular disease was present in 26% of the patients and 14% had evidence of deep infection upon arrival at the foot clinic. Fifty-five percent (385/701) of the patients healed without foot surgery, 25% (173/701) healed after major debridement, 9% (60/701) healed after minor or major amputation and 12% (83/701) died unhealed. Median healing time was 17 weeks. An ulcer classified as Wagner grade 1 or 2 at inclusion and independent living were factors associated with a higher healing rate. Seventy-nine percent of 701 patients with diabetes and a plantar forefoot ulcer treated at a multidisciplinary diabetes foot clinic healed without amputation. For one third some form of foot surgery was needed to achieve healing.

Prognosis for Off-Hour Patients of Hemorrhagic Gastroduodenal Ulcers Treated by Endoscopic Hemostasis Is Equivalent to That of Office-Hour Patients in Japan

Introduction: Efficacy of emergency endoscopic hemostasis on peptic ulcer bleeding is well established. One of the problems in the emergency endoscopy is timing in hospital visit of outpatients. This study aimed i) to compare the characteristics and outcome between office-hour outpatients and off-hour outpatients, and ii) to reveal risk factors for re-bleeding. Methods: This study included 145 outpatients who received emergency endoscopic hemostasis in Karatsu Red Cross Hospital from January, 2008 to April, 2015. The patients were divided into two groups with hospital visiting time: group A of 70 patients; outpatients who visited the hospital during officehour (8:30 to 17:00 on weekdays), and group B of 75 patients; outpatients who visited the hospital during off-hour (17:00 to 8:30 on weekdays or holidays). Characteristics and outcomes were compared between the two groups. In addition, risk factors for re-bleeding were evaluated. Results: Background characteristics of the patients including age, gender, underlying disease, medication, chief complaint, location of ulcer, and Forrest classification were not different between groups A and B. Treatment outcomes of endoscopic hemostasis including primary hemostasis, re-bleeding, endoscopy related complications, and number of deaths within 30 days were not different between the two groups. Anti-platelet agent was a only risk factor for re-bleeding (p = 0.024). Conclusion: Treatment outcomes did not depend on the visiting time to the hospital, suggesting a small number of medical staffs during overtime of the hospital appropriately treated the patients with bleeding ulcers in Japan. In addition, the results suggested that more careful care was required in the patients taking anti-platelet agent.

Aerobic bacterial profile and antibiotic resistance in patients with diabetic foot infections

This study aimed to determine the frequencies of bacterial isolates cultured from diabetic foot infections and assess their resistance and susceptibility to commonly used antibiotics. This prospective study included 41 patients with diabetic foot lesions. Bacteria were isolated from foot lesions, and their antibiotic susceptibility pattern was determined using the Kirby-Bauer disk diffusion method and/or broth method [minimum inhibitory concentration (MIC)]. The most common location of ulceration was the toe (54%), followed by the plantar surface (27%) and dorsal portion (19%). A total of 89 bacterial isolates were obtained from 30 patients. The infections were predominantly due to Gram-positive bacteria and polymicrobial bacteremia. The most commonly isolated Gram-positive bacteria were Staphylococcus aureus, followed by Staphylococcus saprophyticus, Staphylococcus epidermidis, Streptococcus agalactiae, and Streptococcus pneumoniae. The most commonly isolated Gram-negative bacteria were Proteus spp. and Enterobacterspp., followed by Escherichia coli, Pseudomonasspp., and Citrobacterspp. Nine cases of methicillin-resistant Staphylococcus aureus (MRSA) had cefoxitin resistance, and among these MRSA isolates, 3 were resistant to vancomycin with the MIC technique. The antibiotic imipenem was the most effective against both Gram-positive and Gram-negative bacteria, and gentamicin was effective against Gram-negative bacteria. The present study confirmed the high prevalence of multidrug-resistant pathogens in diabetic foot ulcers. It is necessary to evaluate the different microorganisms infecting the wound and to know the antibiotic susceptibility patterns of the isolates from the infected wound. This knowledge is crucial for planning treatment with the appropriate antibiotics, reducing resistance patterns, and minimizing healthcare costs.

Development of the Tardivo Algorithm to Predict Amputation Risk of Diabetic Foot.

Diabetes is a chronic disease that affects almost 19% of the elderly population in Brazil and similar percentages around the world. Amputation of lower limbs in diabetic patients who present foot complications is a common occurrence with a significant reduction of life quality, and heavy costs on the health system. Unfortunately, there is no easy protocol to define the conditions that should be considered to proceed to amputation. The main objective of the present study is to create a simple prognostic score to evaluate the diabetic foot, which is called Tardivo Algorithm. Calculation of the score is based on three main factors: Wagner classification, signs of peripheral arterial disease (PAD), which is evaluated by using Peripheral Arterial Disease Classification, and the location of ulcers. The final score is obtained by multiplying the value of the individual factors. Patients with good peripheral vascularization received a value of 1, while clinical signs of ischemia received a value of 2 (PAD 2). Ulcer location was defined as forefoot, midfoot and hind foot. The conservative treatment used in patients with scores below 12 was based on a recently developed Photodynamic Therapy (PDT) protocol. 85.5% of these patients presented a good outcome and avoided amputation. The results showed that scores 12 or higher represented a significantly higher probability of amputation (Odds ratio and logistic regression-IC 95%, 12.2–1886.5). The Tardivo algorithm is a simple prognostic score for the diabetic foot, easily accessible by physicians. It helps to determine the amputation risk and the best treatment, whether it is conservative or surgical management.

The relationship between computed tomography findings and the locations of perforated peptic ulcers: it may provide better information for gastrointestinal surgeons

BackgroundComputed tomography (CT) plays an important role in diagnosing gastrointestinal perforation. This study explored the relationship between CT findings and the locations of perforated peptic ulcers (PPUs), which may help further surgical planning. MethodsDuring a 34-month period, 175 patients had CT scans. We categorized those 175 patients into 2 groups: patients with and without a PPU at a difficult ulcer site for a laparoscopic approach. Both clinical data and the CT images were reviewed and analyzed. ResultsBased on the univariate analysis results, we conducted multivariate analyses of 3 factors: age, American Society of Anesthesiologists classification of 3 or more, and positive lesser sac image findings. The positive lesser sac findings in CT were the only independent factor that was correlated to the PPU site. ConclusionsPositive lesser sac CT findings may help to predict PPUs in sites where a laparoscopic approach might be difficult. Our study re-evaluates the additional value of CT scanning in diagnosing PPU, and the results may assist with surgical planning in clinical practice.

Analysis of Severity and Anatomical Distribution of Diabetic Foot Ulcers; A Single Unit Experience

Diabetes is the commonest cause of foot ulceration in developing countries leading to severe morbidity and mortality. The main aim of this study was to assess anatomical distribution of diabetic foot lesions, categorize it according to Wagner wound grading, find any association between smoking packs years and the severity of the foot lesions. Also to assess the relationship between the bony deformities and anatomical distribution of the ulcers. This was a cross sectional descriptive study conducted in a casualty surgical unit in a tertiary care teaching hospital for a period of 4 months. 91 diabetic patients with a diabetes related foot lesion were enrolled after simple randomization. Pretested interviewer administered questionnaire was used to gather data. Variety of soft tissue and bony changes of diabetic foot were assessed. Lesions were classified according to Wagner classification. Data was analysed using Epidata software. From the 91 participants, 55 (61 %) were males and 36 (39%) females. Mean age was at 60. 12 ± 10. 19 years. Median diabetes duration was 10 years (Interquartile range = 4.25 – 16.75). Wagner grade 1, 2, 3, 4 and 5 were 17.7%, 40.65%, 28.8%, 13.3% and 0% respectively. Commonest ulcer location was margins of foot (31.87%). There was no statistically significant association between the pack years of cigarette smoking males and severity of foot lesions (Spearman’s rank correlation coefficient = - 0.037, p = 0.82). Patients with claw and hammer toe deformities had their ulcers located in fingertips and toes (p = 0.0185). But there was no statistically significant association with flat foot deformity and ulcer distribution on any particular anatomical area in the foot (p = 0.0511). In conclusion there is a statistically significant association between toe deformities and ulcer occurrence in finger tips. No significant correlation between severity of smoking and severity of foot lesions among males is present. KEYWORDS: Diabetic ulcers, Diabetic foot lesions, Wagner classification, Dlcer distribution

A 9-year retrospective evaluation of 102 pressure ulcer reconstructions.

Several pressure ulcer (PU) risk factors including paralysis and age greater than 70 have been identified, while others such as nutrition are debated. The object of this study is to identify perioperative risk factors that may predict improved outcomes and reduced complications in primary and recurrent PU reconstructions. A retrospective chart review of patients treated surgically for PUs from 2004 to 2013 at the University of Toledo Medical Center, Toledo, Ohio, US, was completed. Data collected included ulcer and medical history, as well as risk factors, complications and postoperative outcome. Data were statistically analysed for perioperative variances between primary and recurrent ulcers and closure status. A total of 49 patients with 102 reconstructions were reviewed. Spinal cord injured patients accounted for 90% receiving flap coverage of ulcers. Numerous differences between primary and recurrent ulcers were identified, including ulcer location, patient nutritional status, wound infection, postoperative course and recurrence. Multivariate analysis revealed a flap reconstruction prediction model using creatinine, haematocrit, haemoglobin, and prealbumin that is able to successfully predict closure outcome in 83.6% of cases. Many factors play a role in the development, course and treatment of PUs. It is vital to understand the role of patient risk factors in the development of PUs, to direct subsequent management and reconstruction, and to prevent future recurrences. The authors have no conflicts of interest to disclose.

Clinical value of multislice spiral computed tomography examination on risk assessment of gastrointestinal stromal tumor

Objective To summarize the features of multislice spiral computed tomography (MSCT) examination of gastrointestinal stromal tumors (GISTs) , and investigate the relationship between predictors and risk of MSCT examination for GISTs. Methods The clinical data of 110 patients with GISTs who were admitted to the Tianjin Medical University Cancer Institute and Hospital from July 2011 to February 2014 were retrospectively analyzed. All the patients received 64-slices spiral CT (64S-SCT) or 16-slices spiral CT (16S-SCT) scan, and the data were transported to the PACS work station for multiplanar reconstruction. All the tumor samples were collected during operation and diagnosed by morphological manifestation and immunohistochemistry of tumors. Very low, low, and medium risk of GISTs were regarded as lower risk grade, and high risk of GISTs as high risk grade. The univariate analysis and multivariate analysis about features of imaging and risk were done by chi-square test and multivariate logistic regression model. Results Tumors located at the stomach in 81 cases, small intestines in 26 cases and colorectum in 3 cases. Diameter of tumors was 0.8-25.0 cm. Smaller tumors were in round or oval shape with well demarcated boundary, and larger tumors were irregular with unclear boundary. Endo-luminal growth of lessions was detected in 25 cases, duplex growth in 35 cases and extra-luminal growth in 50 cases. Enhanced CT scan showed that most of tumors in 105 patients demostrated moderate and high enhancement, heterogeneous enhancement in 74 cases, low density sacvariable necrosis area without enhancement in 60 cases and superficial, cracked-like and deep ulcer without calcification, metastasis and ascites in 23 cases. According to the features of GISTs by MSCT examination, location of tumor, diameter, shape, boundary, growth , enhancement, cystic necrosis, ulcer and metastasis were risk factors affecting risk classification of tumors by univariate analysis (χ2=7.442, 49.966, 31.513, 46.038, 13.836, 16.626, 23.489, 8.280, 6.811, P <0.05). Diameter of tumor more than 10 cm and ulcer were independent risk factors affecting risk classification of tumors by multivariate analysis (OR =9.927, 0.070; 95% confidence interval: 1.888-52.180, 0.012-0.398, P <0.05). Conclusion There is a characterization in the location, diameter, shape, boundary of tumor, growth, enhancement, cystic necrosis, ulcer and metastasis, and diameter of tumor more than 10cm and ulcer are independent risk factors affecting the risk classification of GISTs. Key words: Gastrointestinal stromal tumors; Tomography, X-ray computed; Risk

Delayed healing of gastric ulcer is associated with downregulation of connexin 32 in the gastric mucosa

Summary Background/Aims Most benign gastric ulcers are healed through suppression of gastric acid by a proton pump inhibitor (PPI). Despite prolonged use of a PPI, some gastric ulcers still do not heal. The primary goal of this study is to investigate the relationship between the expression of connexin 32 (Cx32), a major gap junction protein expressed in the gastric mucosa, and the healing response of gastric ulcers. Methods Patients with endoscopically verified gastric ulcer were treated with a standard dose of PPI for 12 weeks. Histological studies were performed to exclude malignancy. In total, 10 patients having endoscopically verified gastric ulcers with delayed healing at the end of the PPI course were included in this study. The control group consisted of 11 patients with gastric ulcers that healed normally. The expression of Cx32 in the gastric mucosa of the ulcer margin was analyzed by immunoblotting. Results Patients with gastric ulcer showing delayed healing had significantly reduced Cx32 expression in the gastric mucosa compared with the patients in whom the ulcers healed normally (i.e., controls). Age, sex, presence of duodenal ulcers, location and size of gastric ulcer, ulcer staging, Helicobacter pylori infection, use of nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin, smoking, and alcohol consumption were similar in both the control and delayed healing groups. H. pylori infection, use of NSAIDs, smoking, and alcohol consumption all had no significant impacts on the expression of Cx32. Age and expression of Cx32 were not correlated. Conclusion Downregulation of Cx32 in the gastric mucosa of the ulcer margin may predict delayed healing in patients with gastric ulcer following acid-suppression therapy.

Changes in classifications of chronic lower-limb wound codes in patients with diabetes: ICD-9-CM versus ICD-10-CM.

To enhance the learner's competence with knowledge of changes in classifications of chronic lower limb wound codes from ICD-9-CM to ICD-10-CM in patients with diabetes. This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Identify the upcoming transition date and coding differences of ICD-9-CM and ICD-10-CM coding.2. Interpret the author's study population, methods, and design.3. Summarize the author's study findings comparing ICD-9-CM coding to ICD-10-CM coding. To determine the sensitivity and specificity of International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) and ICD-10-CM codes for individuals with diabetes and foot ulcers. Wound care providers and researchers are concerned about the potential impacts when the United States transitions from ICD-9-CM to ICD-10-CM. To identify the impact on diabetic foot ulcers, health history and wound variables were prospectively assessed with criterion-standard data from a prospective study of 49 patients with 65 foot ulcer episodes representing 81 incident foot ulcers. The ICD-9-CM and ICD-10-CM code sets were mapped to correctly classify individuals with diabetes and foot ulcers. Frequencies for health history variables were similar in both systems. The ICD-9 code did not capture any data on laterality (left or right) or ulcer depth/severity. The ICD-9 captured 69 of 81 incident ulcers (85%) and 94% of heel and midfoot ulcers, whereas the ICD-10 code captured 78 of 81 incident ulcers (96%) and all incident heel or midfoot ulcers. Sensitivity and specificity for ulcer characteristics were consistently lower in ICD-9 than in ICD-10. The ICD-9 and ICD-10 are similar for data capture on health history variables, but wound variables are captured more accurately using ICD-10. The increased specificity of ICD-10 for ulcer location and severity improves identification and tracking ulcers during an episode of care.

Impact of disease location on fecal calprotectin levels in Crohn’s disease

Objective. The correlation between the Simple Endoscopic Score for Crohn’s Disease (SES-CD) and fecal calprotectin is well established in (ileo)colonic Crohn’s disease (CD). However, for ileal CD, existing data are conflicting. The aim of this study is to evaluate the biomarker profile in CD patients with varying severity and location of mucosal ulceration. Materials and methods. An electronic patient database search identified CD patients in whom ileocolonoscopy, fecal calprotectin (CALPRO), serum C-reactive protein (CRP) and blood leukocyte counts (LEU) were measured within a 4-week interval without changes in medication. Ileocolonoscopies were scored for the presence of ulcers in each segment as defined by the SES-CD and the sum of segmental ulcer scores resulted in a partial SES-CD (pSES-CD). Results. Fourty-four patients were identified, of whom 9/44 had ileal CD, 20/44 colonic and 15/44 ileocolonic CD based on the Montreal classification. In the total study population CALPRO correlated best with pSES-CD (r = 0.76, p < 0.0001), followed by LEU (r = 0.54, p = 0.0004) and CRP (r = 0.45, p = 0.0026). Patients with ileal CD had significantly lower CALPRO level than those with (ileo)colonic disease even in the presence of large and/or very large ulcers (mean ± SEM: 297 ± 81 μg/g vs. 1523 ± 97 μg/g, p < 0.0001). LEU was also significantly lower in the presence of large and/or very large ulcers in ileal CD compared to those with (ileo)colonic disease (mean ± SEM: 6.7 ± 0.9 × 109/l vs. 10.6 ± 0.8 × 109/l, p = 0.02). A similar trend was identified regarding CRP levels. Conclusions. Even in the presence of large or very large ulcers, patients with ileal Crohn’s may not have markedly elevated fecal calprotectin levels.