MRI predictors of treatment response for perianal fistulizing Crohn disease in children and young adults.

PubMed

Shenoy-Bhangle, Anuradha; Nimkin, Katherine; Goldner, Dana; Bradley, William F; Israel, Esther J; Gee, Michael S

2014-01-01

Magnetic resonance imaging (MRI) is considered the imaging standard for diagnosis and characterization of perianal complications associated with Crohn disease in children and adults. To define MRI criteria that could act as potential predictors of treatment response in fistulizing Crohn disease in children, in order to guide more informed study interpretation. We performed a retrospective database query to identify all children and young adults with Crohn disease who underwent serial MRI studies for assessment of perianal symptoms between 2003 and 2010. We examined imaging features of perianal disease including fistula number, type and length, presence and size of associated abscess, and disease response/progression on follow-up MRI. We reviewed imaging studies and electronic medical records. Statistical analysis, including logistic regression, was performed to associate MR imaging features with treatment response and disease progression. We included 36 patients (22 male, 14 female; age range 8-21 years). Of these, 32 had a second MRI exam and 4 had clinical evidence of complete response, obviating the need for repeat imaging. Of the parameters analyzed, presence of abscess, type of fistula according to the Parks classification, and multiplicity were not predictors of treatment outcome. Maximum length of the dominant fistula and aggregate fistula length in the case of multiple fistulae were the best predictors of treatment outcome. Maximum fistula length <2.5 cm was a predictor of treatment response, while aggregate fistula length ≥2.5 cm was a predictor of disease progression. Perianal fistula length is an important imaging feature to assess on MRI of fistulizing Crohn disease.

Prospective Comparison of Magnetic Resonance Imaging, Transrectal and Transperineal Sonography, and Surgical Findings in Complicated Perianal Crohn Disease.

PubMed

Bor, Renáta; Farkas, Klaudia; Bálint, Anita; Szűcs, Mónika; Ábrahám, Szabolcs; Milassin, Ágnes; Rutka, Mariann; Nagy, Ferenc; Milassin, Péter; Szepes, Zoltán; Molnár, Tamás

2016-11-01

Magnetic resonance imaging (MRI) and transrectal sonography are the two accepted imaging modalities for evaluation of perianal fistulas and abscesses. Transperineal sonography is a new technique that is easy to learn and can be performed at any time. The purpose of this study was to prospectively compare the diagnostic accuracy of MRI, transrectal sonography, and transperineal sonography with surgical findings in patients with perianal Crohn disease. All patients with perianal Crohn disease underwent MRI, transrectal sonography, and transperineal sonography within a few days before surgery. Fistulas were classified as simple (43.8%) or complex (52.2%) based on surgical findings. Twenty-three patients with active perianal Crohn disease (12 women and 11 men; mean age, 29.9 years; current therapy: antibiotics, 69.6%; azathioprine, 56.5%; and biologics, 73.9%; previous surgery, 26.1%; and proportion of smokers, 39.1%) were included. Sensitivity values for MRI, transrectal sonography, and transperineal sonography for diagnosis of fistulas were 84.6%, 84.6%, and 100%, respectively. Transperineal sonography was more sensitive for diagnosis of perianal abscesses than MRI and transrectal sonography (100%, 58.8%, and 92.8%). Transperineal sonography is a very accurate diagnostic method with outstanding sensitivity compared with MRI and transrectal sonography for evaluation of complicated perianal Crohn disease. Due to its simplicity and low cost, it is recommended that transperineal sonography be the first diagnostic modality in these cases. © 2016 by the American Institute of Ultrasound in Medicine.

Treatment of Bowen Disease With Photodynamic Therapy and the Advantages of Sequential Topical Imiquimod.

PubMed

Victoria-Martínez, A M; Martínez-Leborans, L; Ortiz-Salvador, J M; Pérez-Ferriols, A

2017-03-01

Photodynamic therapy (PDT) has been shown to be useful and effective in the treatment of actinic keratosis, Bowen disease, and basal cell carcinoma. We present a series of 13 Bowen disease lesions treated using PDT. Complete responses were achieved in 11 (84%) of the lesions after 3 months of treatment; at 18 months, complete responses were seen in 9 (70%) of the lesions. Patients who presented a partial response or recurrence were treated with topical 5% imiquimod and achieved complete responses. The lesions that presented partial response or recurrence were the largest lesions, between 3 and 5cm in diameter. PDT in monotherapy or combined sequentially with imiquimod is an excellent and well-tolerated therapeutic option for Bowen disease. The treatment has few adverse effects and shows satisfactory results, particularly in multiple large lesions in areas of difficult surgical reconstruction or in elderly patients with a high surgical risk. Copyright © 2016 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

Perianal disease, small bowel disease, smoking, prior steroid or early azathioprine/biological therapy are predictors of disease behavior change in patients with Crohn's disease.

PubMed

Lakatos, Peter Laszlo; Czegledi, Zsofia; Szamosi, Tamas; Banai, Janos; David, Gyula; Zsigmond, Ferenc; Pandur, Tunde; Erdelyi, Zsuzsanna; Gemela, Orsolya; Papp, Janos; Lakatos, Laszlo

2009-07-28

To assess the combined effect of disease phenotype, smoking and medical therapy [steroid, azathioprine (AZA), AZA/biological therapy] on the probability of disease behavior change in a Caucasian cohort of patients with Crohn's disease (CD). Three hundred and forty well-characterized, unrelated, consecutive CD patients were analyzed (M/F: 155/185, duration: 9.4 +/- 7.5 years) with a complete clinical follow-up. Medical records including disease phenotype according to the Montreal classification, extraintestinal manifestations, use of medications and surgical events were analyzed retrospectively. Patients were interviewed on their smoking habits at the time of diagnosis and during the regular follow-up visits. A change in disease behavior was observed in 30.8% of patients with an initially non-stricturing, non-penetrating disease behavior after a mean disease duration of 9.0 +/- 7.2 years. In a logistic regression analysis corrected for disease duration, perianal disease, smoking, steroid use, early AZA or AZA/biological therapy use were independent predictors of disease behavior change. In a subsequent Kaplan-Meier survival analysis and a proportional Cox regression analysis, disease location (P = 0.001), presence of perianal disease (P < 0.001), prior steroid use (P = 0.006), early AZA (P = 0.005) or AZA/biological therapy (P = 0.002), or smoking (P = 0.032) were independent predictors of disease behavior change. Our data suggest that perianal disease, small bowel disease, smoking, prior steroid use, early AZA or AZA/biological therapy are all predictors of disease behavior change in CD patients.

Perianal Pediatric Crohn Disease Is Associated With a Distinct Phenotype and Greater Inflammatory Burden.

PubMed

Assa, Amit; Amitai, Michal; Greer, Mary-Louise; Castro, Denise A; Kuint, Ruth C; Martínez-León, Maria; Herman-Sucharska, Izabela; Coppenrath, Eva; Anupindi, Sudha; Towbin, Alexander; Moote, Douglas; Konen, Osnat; Pratt, Li-Tal; Griffiths, Anne; Turner, Dan

2017-09-01

Data on the outcomes of children with perianal Crohn disease (pCD) are limited, although its presence is often used for justifying early use of biologics. We aimed to assess whether pCD in children is associated with more severe outcomes as found in adults. Data were extracted from the ImageKids database, a prospective, multicenter, longitudinal cohort study. The study enrolled 246 children at disease onset or thereafter. All patients underwent comprehensive clinical, endoscopic, and radiologic evaluation at enrollment; 98 children had repeat evaluation at 18 months. Of the 234 included patients (mean age 14.2 ± 2.4 years; 131 [56%] boys), 57 (24%) had perianal findings, whereas only 21 (9%) had fistulizing perianal disease. Children with pCD had reduced weight and height z scores compared with non-pCD patients (-0.9 vs -0.35, P = 0.03 and -0.68 vs -0.23, respectively; P = 0.04), higher weighted pediatric CD activity index (32 [interquartile range 16-50] vs 20 [8-37]; P = 0.004), lower serum albumin (3.6 ± 0.7 vs 4.5 ± 0.8, P = 0.016), and higher magnetic resonance enterography global inflammatory score (P = 0.04). Children with pCD had more rectal (57% vs 38%, P = 0.04), and jejunal involvement (31% vs 11% P = 0.003) and a higher prevalence of granulomas (64% vs 23%, P = 0.0001). Magnetic resonance enterography-based damage scores did not differ between groups. Patients with skin tags/fissures only, had similar clinical, endoscopic, and radiologic characteristics as patients with no perianal findings. Pediatric patients with pCD with fistulizing disease have distinct phenotypic features and a predisposition to a greater inflammatory burden.

Perianal disease, small bowel disease, smoking, prior steroid or early azathioprine/biological therapy are predictors of disease behavior change in patients with Crohn’s disease

PubMed Central

Lakatos, Peter Laszlo; Czegledi, Zsofia; Szamosi, Tamas; Banai, Janos; David, Gyula; Zsigmond, Ferenc; Pandur, Tunde; Erdelyi, Zsuzsanna; Gemela, Orsolya; Papp, Janos; Lakatos, Laszlo

2009-01-01

AIM: To assess the combined effect of disease phenotype, smoking and medical therapy [steroid, azathioprine (AZA), AZA/biological therapy] on the probability of disease behavior change in a Caucasian cohort of patients with Crohn’s disease (CD). METHODS: Three hundred and forty well-characterized, unrelated, consecutive CD patients were analyzed (M/F: 155/185, duration: 9.4 ± 7.5 years) with a complete clinical follow-up. Medical records including disease phenotype according to the Montreal classification, extraintestinal manifestations, use of medications and surgical events were analyzed retrospectively. Patients were interviewed on their smoking habits at the time of diagnosis and during the regular follow-up visits. RESULTS: A change in disease behavior was observed in 30.8% of patients with an initially non-stricturing, non-penetrating disease behavior after a mean disease duration of 9.0 ± 7.2 years. In a logistic regression analysis corrected for disease duration, perianal disease, smoking, steroid use, early AZA or AZA/biological therapy use were independent predictors of disease behavior change. In a subsequent Kaplan-Meier survival analysis and a proportional Cox regression analysis, disease location (P = 0.001), presence of perianal disease (P < 0.001), prior steroid use (P = 0.006), early AZA (P = 0.005) or AZA/biological therapy (P = 0.002), or smoking (P = 0.032) were independent predictors of disease behavior change. CONCLUSION: Our data suggest that perianal disease, small bowel disease, smoking, prior steroid use, early AZA or AZA/biological therapy are all predictors of disease behavior change in CD patients. PMID:19630105

Transperineal ultrasonography: First level exam in IBD patients with perianal disease.

PubMed

Terracciano, Fulvia; Scalisi, Giuseppe; Bossa, Fabrizio; Scimeca, Daniela; Biscaglia, Giuseppe; Mangiacotti, Michele; Valvano, Maria Rosa; Perri, Francesco; Simeone, Anna; Andriulli, Angelo

2016-08-01

A pelvic magnetic resonance imaging (MRI) represents the front-line method for evaluating perianal disease in patients with inflammatory bowel disease (IBD). Recently, transperineal ultrasonography (TPUS) has been proposed as a simple, safe, time-sparing and useful diagnostic technique to assess different pathological conditions of the pelvic floor. The aim of this prospective single centre study was to evaluate the accuracy of TPUS versus MRI for the detection and classification of perineal disease in IBD patients. From November 2013 to November 2014, 28 IBD patients underwent either TPUS or MRI. Fistulae and abscesses were classified according to Parks' and AGA's classification methods. A concordance was assessed by k statistics. Overall, 33 fistulae and 8 abscesses were recognized by TPUS (30 and 7 by MRI, respectively). The agreement between TPUS and MRI was 75% according to Parks' classification (k=0.67) and 86% according to AGA classification (k=0.83), while it was 36% (k=0.34) for classifying abscesses. TPUS proved to be as accurate as MRI for detecting superficial and small abscesses and for classifying perianal disease. Both examinations may be performed at the initial presentation of the patient, but TPUS is a cheaper, time-sparing procedure. The optimal use of TPUS might be in follow-up patients. Copyright © 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Genital Bowen's Disease in a Bulgarian Patient: Complete Remission after Surgical Approach.

PubMed

Tchernev, Georgi; Lotti, Torello; Wollina, Uwe; Gianfaldoni, Serena; Lozev, Ilia; Lotti, Jacopo; França, Katlein; Batashki, Atanas; Chokoeva, Anastasiya

2017-07-25

A 60-year-old male patient presented with complaints of persistent red to a brown-colored plaque on his scrotum, with duration of approximately three years. The patient had been treated with oral and topical antifungals for inguinal tinea for several months and after that with topical corticosteroids for eczema for several more months. None of the regimens achieved any therapeutic effect. The histopathological evaluation revealed the presence of atypical keratinocytes in all layers of the epidermis with the altered epidermal pattern, spread parabasal mitotic activity, without secondary satellites, multiple dyskeratotic cells and multinucleated cells. The diagnosis of an intraepithelial non-invasive squamous cell carcinoma, associated with koilocytic dysplasia and hyperplasia was made, meeting the criteria for Bowen disease. An elliptic surgical excision of the lesion was made, while the defect was closed with single stitches, with excellent therapeutic and aesthetic result. First described by John T. Bowen in 1912, Bowen disease (BD) represents a squamous cell carcinoma (SCC) in situ with the potential for significant lateral spread. Treatment options include the application of topical 5-flurorouracil cream - useful in non-hairy areas, imiquimod cream or destructive methods such as radiation, curettage, cryotherapy, laser ablation and photodynamic therapy, especially useful in nail bed involvement. Despite the early lesions, surgical excision is the preferred treatment option, regarding the potential malignant transformation risk.

Quadruple cancer including Bowen's disease after arsenic injections 40 years earlier: report of a case.

PubMed

Murata, K; Iwazawa, T; Takayama, T; Yamashita, K; Okagawa, K

1994-01-01

This report describes the successful treatment of quadruple cancer including Bowen's disease in a 71-year-old man who had been given injections of salvarsan, an arsenic compound, for syphilis more than 40 years earlier. Resection of a skin lesion on his chest subsequently confirmed a diagnosis of Bowen's disease, 3 years after which he was operated on for concurrent gastric cancer and sigmoid colon cancer. A fourth cancer was discovered on his left vocal cord 2 weeks after this operation; it was resected 2 years later. A discussion of multiple malignant neoplasms and the possible relationship between arsenic and cancer is presented following this case report.

Magnetic Resonance Imaging (MRI) Characterization of Perianal Fistulous Disease in a Rural Based Tertiary Hospital of North India.

PubMed

Chauhan, Narvir Singh; Sood, Dinesh; Shukla, Anurag

2016-01-01

To diagnose and characterize the perianal fistulous disease using Magnetic resonance imaging (MRI) in a hilly and rural area of North India. This prospective hospital based study was conducted for a period of one year from April 2014 to April 2015 in the departments of Radiodiagnosis and Surgery of our institute. A total of 50 consecutive patients presenting with perianal fistulous disease fulfilling the inclusion and exclusion criteria were included in the study and taken up for MRI. The perianal fistulae were classified according to St James University hospital classification and tracks were assessed with regard to anatomical plane, length, ramifications, abscess formation, enteric communication, external cutaneous opening, enhancement and suprasphincteric extension. Surgical correlation was done in 31 patients who opted for surgical treatment. Rest of the 19 patients preferred alternative medicine for treatment or chose to postpone their surgery. The disease was much more prevalent in males in comparison to females with male to female ratio of 24:1. Grade 4 was the most common type of fistula (34%) while Grade 5 was the least common type (4%).MRI showed a high sensitivity of 93.7% and positive predictive value (PPV) of 96.7% when correlated with surgical findings. A substantial number of patients (38%) preferred alternative medicine or non surgical form of treatment. MRI is a very sensitive modality for the evaluation of perianal fistula. In our study group, the disease predominantly affected middle aged men. Ramifications and abscesses were commonly seen, affecting nearly half of the patients and majority of the patients had active fistulous tracks with posteriorly located enteric opening. Overall, transsphincteric fistulae were most common. Significant number of patients avoided surgery or showed preference for non surgical treatment.

Perianal atypical leiomyoma: A case report.

PubMed

Sun, Pingliang; Ou, Hailing; Huang, Shen; Wei, Longxiang; Zhang, Sen; Liu, Jiali; Geng, Shuguang; Yang, Kun

2017-12-01

Reports on perianal atypical leiomyoma, a perianal tumor, are rare. We confirmed a perianal atypical leiomyoma by its clinical presentation, magnetic resonance imaging findings, and immunohistochemistry. A 28-year-old female with a perianal mass found more than 4 years ago. The 5cm_4cm_4cm sized mass was located on the left side of the anus and vagina; The magnetic resonance imaging (MRI) scan revealed: A 4.1cm × 5.2cm × 4.9cm sized round mass was observed on the left side of the circumference. Perianal atypical leiomyoma. anal peripheral mass resection was performed under lumbar anesthesia. The postoperative course was uneventful, healing, the patient was discharged. Perianal atypical leiomyomas are benign tumors, but with the clinically atypical leiomyoma, it is sometimes difficult to distinguish between potential malignant smooth muscle tumors,and there may be malignant changes. Surgery should ensure complete resection, and to avoid postoperative recurrence, there should be a regular follow-up.

Primary peri-anal adenocarcinoma of intestinal type - a new proposed entity.

PubMed

Gill, Pelvender S; Wong, Newton A C S

2018-02-21

The currently recognised subtypes of anal canal/peri-anal adenocarcinoma are those arising from low rectal mucosa or columnar cuff, fistula-related tumours and anal gland carcinoma. This report presents two examples of a hitherto undescribed subtype of peri-anal adenocarcinoma with an intestinal phenotype. A 74-year-old man had a peri-anal tumour locally excised, whereas a 73-year-old female underwent an abdominoperineal resection for peri-anal Paget's disease with an underlying carcinoma. Neither patient had a history of perineal fistulae, Crohn's disease or previous gastrointestinal neoplasia, and neither showed clinical, radiological or endoscopic evidence of another abdominal or pelvic tumour. Both resection specimens contained adenocarcinoma, which were similar in demonstrating an intestinal morphology and CDX2 immunopositivity. The man has shown a disease-free outcome thus far, but the woman has suffered with nodal and pelvic recurrence within a few months of surgery. The name 'primary peri-anal adenocarcinoma of intestinal type' is proposed for this previously unrecognised subtype of perineal neoplasia. Awareness of its distinct existence - by recognising its intestinal morphology and immunophenotype while excluding metastasis from the intestinal tract - should help to collate data to determine its specific prognosis and to formulate its best management. © 2018 John Wiley & Sons Ltd.

[Perianal pyoderma].

PubMed

Slauf, P; Antos, F; Novák, J; Benes, J; Kálal, J

1993-10-01

Perianal pyoderma (hidradenitis suppurativa-acne conglobata) is a chronic disease which in its progressive form cannot be treated by conservative methods. Extensive suppurative foci must be radically excised incl. all systems of fistulas right down to the fascia and the defects which develop are allowed to heal per secundam or after several weeks they can at a different period of time be covered by a skin transplant. The authors present their 30-year experience with surgical treatment of 39 patients. Treatment was in all instances successful after radical surgical excision. All these patients have fully recovered as regards work capacity as well as social aspects.

Cyclosporine and ketoconazole for the treatment of perianal fistulas in dogs.

PubMed

Patricelli, Alison J; Hardie, Robert J; McAnulty, Jonathan E

2002-04-01

To evaluate efficacy and cost of using cyclosporine and ketoconazole for the treatment of perianal fistulas in dogs. Clinical trial. 12 dogs with perianal fistulas. Dogs received cyclosporine and ketoconazole orally (target whole blood trough cyclosporine concentrations of 400 to 600 ng/ml). Study endpoints were resolution of clinical signs, remission, and recurrence of disease. Adverse effects and cost of medications were reported. Results were compared with those from previous studies in humans and in dogs in which single agent cyclosporine treatment for perianal fistulas was used. All dogs had resolution of clinical signs. Eight dogs went into remission; however, 5 of those 8 had recurrence of fistulas. Adverse effects of treatment were minimal and well tolerated. Cost of treatment was comparable to traditional surgical options and less than single agent cyclosporine treatment. Administration of cyclosporine with ketoconazole is an effective and cost-comparable treatment for perianal fistulas in dogs.

Multicentric squamous cell carcinona in a paca (Agouti paca) resembling Bowen's disease.

PubMed

Luppi, Marcela M; Malta, Marcelo C C; Costa, Maria E L T; Motta, Rafael O C; Santos, Renato L

2008-06-01

An 8-yr-old female paca (Agouti paca) was admitted at the Veterinary Hospital of the Belo Horizonte Zoo (Brazil) with an ulcerated cutaneous nodule of approximately 1.5 cm in diameter in the left ear. One week later, other cutaneous nodules were detected in various body locations. The animal died during a surgical procedure to remove the tumors. All cutaneous nodules were histologically similar with features of squamous cell carcinoma. Considering the predominant in situ nature of the lesion as well as its multicentric localization, the disease reported here closely resembles Bowen's disease, which has been described in humans and which has been identified as a rare neoplastic disease of cats, with one single report in a dog. This is the first report of a neoplastic disease in Agouti

MRI-based score helps in assessing the severity and in follow-up of pediatric patients with perianal Crohn disease.

PubMed

Kulkarni, Sakil; Gomara, Roberto; Reeves-Garcia, Jesse; Hernandez, Erick; Restrepo, Ricardo

2014-02-01

The radiologic healing of perianal fistulizing Crohn disease (PfCD) lags behind the clinical healing. Contrast-enhanced pelvic magnetic resonance imaging (MRI) is the radiologic study of choice used to diagnose PfCD in children. The aim was to study whether the various MRI-based radiologic parameters and score can help in staging and follow-up of patients with PfCD. We performed a retrospective chart review of children with PfCD who underwent contrast-enhanced MRI of the pelvis. The demographic profile, clinical status, and laboratory data of the patients at the time of each MRI examination were noted. Based on the clinical status of the patient at the time of MRI examinations, the MRIs were classified into 3 groups: severe disease, mild-to-moderate disease, and asymptomatic. Each MRI examination was reviewed by a radiologist, who was blinded to the clinical status of the patient. Of the radiologic parameters, the number of fistulas, the complexity of fistulas, and the number of abscesses were significantly lower in the asymptomatic group compared with the mild-to-moderate and severe disease groups. The Van Assche MRI-based score was significantly lower in the asymptomatic group compared with the mild-to-moderate disease (P = 0.01) and the severe disease group (P = 0.002). The percentage increase in fistula activity after gadolinium administration was significantly lower in the asymptomatic group compared with the mild-to-moderate disease (P = 0.026) and severe disease (P = 0.019) groups. The MRI-based scores were significantly higher in the MRI examinations performed at diagnosis compared with those that were performed while the patients were receiving the treatment (P = 0.017). The Van Assche MRI score and the percentage increase in fistula activity after gadolinium administration help in assessing the severity perianal Crohn disease. The Van Assche MRI score may be helpful in documenting healing during therapy of perianal Crohn disease.

[Perianal and rectal ulcers due to abuse of paracetamol-codeine suppositories].

PubMed

Wagner, G; Sand, C; Sachse, M M

2015-03-01

A 61-year-old woman presented with a progressive perianal ulcer which had developed 4 months ago. Upon further examination, another ulcer of the rectum was detected. Anorectal malignancies, viral infections or primary inflammatory bowel disease were not found. It could be demonstrated that the ulcers were induced by paracetamol and codeine suppositories. After discontinuation of these suppositories, the perianal ulcers healed almost completely within 3 weeks. The pathogenesis of paracetamol-induced ulcers is unknown. However, dose-dependent vasoconstriction is a possible explanation.

Autologous Mesenchymal Stem Cells, Applied in a Bioabsorbable Matrix, for Treatment of Perianal Fistulas in Patients With Crohn's Disease.

PubMed

Dietz, Allan B; Dozois, Eric J; Fletcher, Joel G; Butler, Greg W; Radel, Darcie; Lightner, Amy L; Dave, Maneesh; Friton, Jessica; Nair, Asha; Camilleri, Emily T; Dudakovic, Amel; van Wijnen, Andre J; Faubion, William A

2017-07-01

In patients with Crohn's disease, perianal fistulas recur frequently, causing substantial morbidity. We performed a 12-patient, 6-month, phase 1 trial to determine whether autologous mesenchymal stem cells, applied in a bioabsorbable matrix, can heal the fistula. Fistula repair was not associated with any serious adverse events related to mesenchymal stem cells or plug placement. At 6 months, 10 of 12 patients (83%) had complete clinical healing and radiographic markers of response. We found placement of mesenchymal stem cell-coated matrix fistula plugs in 12 patients with chronic perianal fistulas to be safe and lead to clinical healing and radiographic response in 10 patients. ClinicalTrials.gov Identifier: NCT01915927. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

Combined Papillated Bowen Disease and Clear Cell Atypical Fibroxanthoma

PubMed Central

Suárez-Vilela, Dimas; Izquierdo-García, Francisco; Domínguez-Iglesias, Francisco; Méndez-Álvarez, Jose Ramón

2010-01-01

We describe a case of papillated Bowen disease (PBD), associated with a clear cell atypical fibroxanthoma (CCAFXA). The epidermal lesion showed a bowenoid papillomatous growth pattern with histologic features suggestive of infection by human papilloma virus (HPV). In the dermis a neoplasm made up by spindled or polygonal cells with wide clear cytoplasm and moderate nuclear pleomorphism was found. Immunohistochemical characteristics of these two lesions were clearly different. The atypical cells of the intraepidermal proliferation were positive for AE1-AE3 anticytokeratin antibody, EMA, p16, p53 and p63. The dermal tumor was positive for vimentin, CD10, CD68, CD99, alpha-1-antitrypsin and c-kit. Histological features and immunohistochemical profile of the dermal tumor corresponded to a CCAFXA, a very uncommon neoplasm of which only 10 cases have been reported. In situ hybridization for numerous types of HPVs was negative in both lesions. PMID:21103191

Perianal nodular hidradenocarcinoma. Case report.

PubMed

Sierra Montenegro, Ernesto; Sierra Luzuriaga, Gastón; Leone Stay, Gaetano; Salazar Menéndez, Vilma; Quiñonez Auria, Carlos

2010-01-01

Eccrine glands (sweat glands) appear in all sites of the skin and are more abundant in hands and feet. Nodular hidradenocarcinoma (NH) is a rare malignant and aggressive tumor of the eccrine glands. The objective of this study is to report a case of perianal hidradenocarcinoma. We present the case of a 75-year-old female with diabetes, hypertension, and hypothyroidism. Physical examination revealed a small perianal tumor that was palpated near the anal canal. Biopsy was done. Pathology report revealed perianal hidradenoma. Rectosigmoidoscopy was normal. Computed tomography showed 1-cm adenopathies in inguinal and right iliac regions. Extensive resection of the tumor was done. Definitive pathology report was malignant eccrine acrospiroma. The patient underwent adjuvant chemotherapy in the Oncology Service and died 1 month later. In patients with a first symptom of metastases in the inguinal region, suspicion must be directed to the anal canal.

Perianal and periumbilical dermatitis: Report of a woman with group G streptococcal infection and review of perianal and periumbilical dermatoses.

PubMed

Kallini, Joseph R; Cohen, Philip R

2013-04-15

We describe a woman with perianal and periumbilical dermatitis secondary to group G Streptococcus, summarize the salient features of this condition, and review other cutaneous conditions that clinically mimic streptococcal dermatitis of the umbilicus. Periumbilical and perianal streptococcal dermatitis are conditions that commonly occur in children and usually result from beta-hemolytic group A Streptococcus. Rarely, non-group A streptococcal and staphylococcal infections have been reported in adults. A 31-year-old woman developed perianal and periumbilical group G streptococcal dermatitis. Symptoms were present for six months and were refractory to clotrimazole 1 percent and betamethasone dipropionate 0.05 percent cream. The etiology of perianal and periumbilical dermatitis is unclear, but is perhaps explained by virulence of previously asymptomatic colonized bacteria. Perianal streptococcal dermatitis is more common in children. A number of adult infections have been reported, most of which were secondary to group A beta-hemolytic Streptococcus. Men are more often affected than women. Group G Streptococcus is rarely the infective etiology of perianal streptococcal dermatitis. This condition presents as a superficial well demarcated erythematous patch on clinical examination. Diagnosis is ascertained by diagnostic swabs and serological tests: antistreptolysin O (ASO) or anti-DNase titer. Treatments include oral amoxicillin, penicillin, erythromycin, and mupirocin ointment. Our patient expands on the clinical presentation typical of streptococcal dermatitis. We describe a rare occurrence of an adult woman infected with non-group A Streptococcus. Several conditions can mimic the presentation of perianal streptococcal dermatitis. Although rare, group G Streptococcus should be considered in the setting of virulent infections usually attributed to group A species. Streptococcal dermatitis can be added to the list of conditions affecting the umbilicus.

Perianal sinuses in neonates and infants.

PubMed

Al-Wattar, Kais M

2002-12-01

The aim of this study is to evaluate the etiology of perianal abscess or discharges in neonates and infants and some of them are perianal sinuses with blind inner end without connection to the anal canal, and some of these cases have a different histological pattern. Complete surgical excision and primary closure of their wounds can cure these patients. Between January 1988 and December 2000, (81) neonates and infants (aged 2 weeks to 2 years) with perianal sinuses, fistula-in-ano abscess dealt in the Al-Zahrawi and Al-Khansa Teaching Hospitals, Mosul, Iraq, were studied. Fifty-one patients displayed an onset of symptoms during their first year of age, all cases had a gentle probing and proctoscopy under general anesthesia, and the discharge from abscess from the patients were sent for culture. Thirty patients with proper sinuses had excision of the sinus and primary closure; children with fistulae underwent fistulectomy; perianal abscesses drained. All the excised specimens were examined histopathologically. All children, except 3, were boys. Out of the 81 cases studied, 30 patients (37%) proved to have proper sinuses with blind inner end. Eight of these showed a different histological pattern, and in 2 cases, the histopathology was that of rectal duplication, the microbiology of the discharge from the proper sinuses was showing a predominance of non-gut derived organisms. All patients cured by excision of the sinuses and primary closure. Fistulae are the most common perianal discharging lesions in neonates and infants, blind sinuses are another cause in a considerable number. We propose a diagnostic strategy and treatment for those children presenting with discharging perianal lesions; for anticipation of these sinuses 3 points need to be considered before attempting surgery. 1) Blind sinus tract on gentle probing. 2) Normal anal and rectal mucosa on proctoscopy. 3) High bacterial yield of non-gut derived organisms on culture of the pus or discharge. Their

Perianal rhabdomyosarcoma in a dog.

PubMed

Ueno, H; Kadosawa, T; Isomura, H; Okada, Y; Ochiai, K; Umemura, T; Okumura, M; Fujinaga, T

2002-05-01

A perianal rhabdomyosarcoma was diagnosed in an 11-year-old neutered male Labrador retriever. Following two incomplete surgical excisions of the tumour, the dog was treated by means of surgery combined with local radiotherapy and systemic chemotherapy using one cycle of vincristine sulphate, doxorubicin and cyclophosphamide (VAC protocol). The dog died 252 days after the first combined therapy. Radiography at this time demonstrated enlargement of the iliac lymph nodes, suggesting metastasis of the tumour. To the authors' knowledge, this is the first report of treatment of canine perianal rhabdomyosarcoma.

A theoretically based determination of bowen-ratio fetch requirements

USGS Publications Warehouse

Stannard, D.I.

1997-01-01

Determination of fetch requirements for accurate Bowen-ratio measurements of latent- and sensible-heat fluxes is more involved than for eddy-correlation measurements because Bowen-ratio sensors are located at two heights, rather than just one. A simple solution to the diffusion equation is used to derive an expression for Bowen-ratio fetch requirements, downwind of a step change in surface fluxes. These requirements are then compared to eddy-correlation fetch requirements based on the same diffusion equation solution. When the eddy-correlation and upper Bowen-ratio sensor heights are equal, and the available energy upwind and downwind of the step change is constant, the Bowen-ratio method requires less fetch than does eddy correlation. Differences in fetch requirements between the two methods are greatest over relatively smooth surfaces. Bowen-ratio fetch can be reduced significantly by lowering the lower sensor, as well as the upper sensor. The Bowen-ratio fetch model was tested using data from a field experiment where multiple Bowen-ratio systems were deployed simultaneously at various fetches and heights above a field of bermudagrass. Initial comparisons were poor, but improved greatly when the model was modified (and operated numerically) to account for the large roughness of the upwind cotton field.

Bowen durring EVA 1

NASA Image and Video Library

2011-02-28

ISS026-E-030715 (28 Feb. 2011) --- NASA astronauts Steve Bowen and Alvin Drew (mostly obscured at center right), both STS-133 mission specialists, participate in the mission?s first session of extravehicular activity (EVA) as construction and maintenance continue on the International Space Station. During the six-hour, 34-minute spacewalk, Bowen and Drew installed the J612 power extension cable, move a failed ammonia pump module to the External Stowage Platform 2 on the Quest Airlock for return to Earth at a later date, installed a camera wedge on the right hand truss segment, installed extensions to the mobile transporter rail and exposed the Japanese ?Message in a Bottle? experiment to space.

Bowen durring EVA 1

NASA Image and Video Library

2011-02-28

ISS026-E-030865 (28 Feb. 2011) --- NASA astronauts Steve Bowen and Alvin Drew (mostly obscured at center right), both STS-133 mission specialists, participate in the mission?s first session of extravehicular activity (EVA) as construction and maintenance continue on the International Space Station. During the six-hour, 34-minute spacewalk, Bowen and Drew installed the J612 power extension cable, move a failed ammonia pump module to the External Stowage Platform 2 on the Quest Airlock for return to Earth at a later date, installed a camera wedge on the right hand truss segment, installed extensions to the mobile transporter rail and exposed the Japanese ?Message in a Bottle? experiment to space.

The Clinical Features and Predictive Risk Factors for Reoperation in Patients With Perianal Crohn Diseases; A Multi-Center Study of a Korean Inflammatory Bowel Disease Study Group

PubMed Central

Lee, Jae Bum; Yoon, Seo-Gue; Park, Kyu Joo; Lee, Kang Young; Kim, Dae Dong; Yoon, Sang Nam

2015-01-01

Purpose Perianal lesions are common in Crohn disease, but their clinical course is unpredictable. Nevertheless, predicting the clinical course after surgery for perianal Crohn disease (PCD) is important because repeated operations may decrease patient's quality of life. The aim of this study was to predict the risk of reoperation in patients with PCD. Methods From September 1994 to February 2010, 377 patients with PCD were recruited in twelve major tertiary university-affiliated hospitals and two specialized colorectal hospitals in Korea. Data on the patient's demographics, clinical features, and surgical outcomes were analyzed. Results Among 377 patients, 227 patients were ultimately included in the study. Among the 227 patients, 64 patients underwent at least one reoperation. The median period of reoperation following the first perianal surgery was 94 months. Overall 3-year, 5-year, and 10-year cumulative rates of reoperation-free individuals were 68.8%, 61.2%, and 50.5%, respectively. In multivariate analysis (Cox-regression hazard model), reoperation was significantly correlated with an age of onset less than 20 years (hazard ratio [HR], 1.93; 95% confidence interval [CI], 1.07-3.48; P = 0.03), history of abdominal surgery (HR, 1.99; 95% CI, 1.08-3.64; P = 0.03), and the type of surgery. Among types of surgery, fistulotomy or fistulectomy was associated with a decreased incidence of reoperation in comparison with incision and drainage (HR, 0.19; 95% CI, 0.09-0.42; P < 0.001). Conclusion Young age of onset and a history of abdominal surgery were associated with a high risk of reoperation for PCD, and the risk of reoperation were relatively low in fistulotomy or fistulectomy procedures. PMID:26576395

Vaccine-associated paralytic poliomyelitis in an infant with perianal abscesses.

PubMed

Higashigawa, Masamune; Maegawa, Kayoka; Honma, Hitoshi; Yoshino, Ayako; Onozato, Kaori; Nashida, Yuji; Fujiwara, Takashi; Inoue, Masakazu

2010-10-01

We describe a case of vaccine-associated paralytic poliomyelitis (VAPP) in a 7-month-old infant with perianal abscesses. The infant had suffered from perianal abscesses from 3 weeks after birth. The abscesses repeatedly developed and spontaneously drained through the orifice. Twenty-seven days before admission, a live attenuated oral poliovirus vaccine (OPV) was given to the infant for the first time for routine immunization. His body temperature rose to 38°C 19 days after receiving the OPV and fell 4 days later. Flaccid paralysis of the right leg appeared 26 days after receipt of the OPV. A Sabin type 3 poliovirus was isolated from a stool obtained at admission. The DNA sequences of the VP1 region of the isolated virus were more than 99% identical with those of the vaccine strain. Mild muscle atrophy with moderate motor impairment in the right leg persisted at 18 months of age. One VAPP case provoked by a perianal abscess has been reported from the United Kingdom. Database search revealed that one of nine VAPP cases reported during 2003-2008 in Japan had a perianal abscess. Taken together, these reports and our case imply that we should give OPV with caution to infants with a perianal abscess.

Performance of the Bowen ratio systems on a 22 deg slope

NASA Technical Reports Server (NTRS)

Nie, D.; Flitcroft, I.; Kanemasu, E. T.

1990-01-01

The Bowen ratio energy balance technique was used to assess the energy fluxes on inclined surfaces during the First ISLSCP Field Experiment (FIFE). Since air flow over sloping surface may differ from that over flat terrain, it is important to examine whether Bowen ratio measurements taken on sloping surfaces are valid. In this study, the suitability of using the Bowen ratio technique on sloping surfaces was tested by examining the assumptions that the technique requires for valid measurements. This was accomplished by studying the variation of Bowen ratio measurements along a selected slope at the FIFE site. In September 1988, four Bowen ratio systems were set up in a line along the 22 degree north-facing slope with northerly air flow (wind went up the slope). In July of 1989, six Bowen ratio systems were similarly installed with southerly air flow (the wind went down slope). Results indicated that, at distances between 10 to 40 meters from the top of the slope, no temperature or vapor pressure gradient parallel to the slope was detected. Uniform Bowen ratio values were obtained on the slope, and thus the sensible or latent heat flux should be similar along the slope. This indicates that the assumptions for valid flux measurements are reasonably met at the slope. The Bowen ratio technique should give the best estimates of the energy fluxes on slopes similar to that in this study.

Cyclosporin and ketoconazole interaction for treatment of perianal fistulas in the dog.

PubMed

Mouatt, J G

2002-04-01

To assess the use of concurrent ketoconazole and low dose cyclosporin administration in a group of dogs with clinical evidence of perianal fistulas, and to determine if this combination could be used to manage perianal fistulas effectively. Prospective clinical trial Sixteen dogs with clinical evidence of perianal fistulas were given ketoconazole (10 mg/kg once daily) and cyclosporin (1 mg/kg twice daily initially) for 16 weeks. Blood cyclosporin assays were performed regularly and cyclosporin doses were altered to achieve a stable blood level above 200 ng/mL. Regular examinations assessed the dogs' general health, changes in clinical behaviour, fistula size and number. A complete blood count and serum biochemical analysis was performed in all dogs before and after the treatment period, and after 8 weeks of treatment in 12 dogs. Dogs were assessed for recurrence of lesions at 1, 3 and 12 months after the trial. All dogs showed marked improvement in lesions and behaviour within 14 days of the medication. Fourteen dogs completed the trial. Two dogs were excluded due to concurrent disease. Thirteen dogs (93%) showed complete resolution of fistulas during the treatment period. Seven dogs (50%) had no recurrence after 12 months. Recurrence was seen in three dogs (21%) at 8, 10 and 12 months after treatment, and in three dogs (21%) within 1 month of treatment. The medication was well tolerated. Side effects included transient anorexia, vomiting and lethargy in some dogs, increased shedding of hair and gingival hyperplasia. Ketoconazole administration allowed a dramatic reduction in cyclosporin dose (over 90% in 12 dogs and 80% in the other two) compared to previously reported cases treated with cyclosporin alone. The use of combined ketoconazole and cyclosporin provided an effective treatment for perianal fistulas. Outcomes were similar to those seen with cyclosporin alone, but allowed a significant reduction in cyclosporin dose and, therefore, cost. The use of

Surgical approach to extensive hidradenitis suppurativa in the perineal/perianal and gluteal regions.

PubMed

Balik, Emre; Eren, Tunc; Bulut, Türker; Büyükuncu, Yilmaz; Bugra, Dursun; Yamaner, Sümer

2009-03-01

Verneuil's disease, or hidradenitis suppurativa, is a chronic suppurative disease with a tendency to sinus formation, fibrosis, and sclerosis. It is a disease of the apocrine sweat glands and may arise from each of the localizations where apocrine glands are prominent: axilla, nipples, umbilicus, perineum, groin, and buttocks. Extensive hidradenitis suppurativa of the perineal/perianal and the gluteal regions constitute a serious social problem. In this study, we present our experience with stage III extensive hidradenitis suppurativa cases, including our treatment methods and patient outcomes. A retrospective review of the medical records from January 1990 to July 2003 of 15 patients was performed. Fifteen patients underwent treatment for extensive hidradenitis suppurativa in the gluteal, perineal/perianal, and inguinal areas with total surgical excision. All patients were men (100%) and their mean age was 42.5 (range, 23-66) years. The patients underwent a total number of 21 operations. In 11 patients wounds were left open for secondary healing, and the mean time for complete wound healing in this group was 12.2 (range, 9.5-22) weeks. Two patients underwent primary wound closure by the application of rotation flaps, and their complete healing times were observed to be approximately 2 weeks. Delayed skin grafting was used for the remaining two patients in whom the wounds had been left open after the initial operation. In this group, complete wound healing took a total of 8 weeks. Only one diverting colostomy was needed in a patient in the delayed skin-grafting group. Squamous cell carcinoma was diagnosed in the specimens of one patient treated with total excision followed by the application of a rotation flap. This patient had had complaints of gluteal discharge for approximately 30 years. The cancer recurred after 6 months in the perianal region and immediate abdominoperineal resection was performed. He died during the second postoperative month due to systemic

Obituary: George Hamilton Bowen Jr. (1925-2009)

NASA Astrophysics Data System (ADS)

Willson, Lee Anne; Struck, Curtis

2011-12-01

Our colleague and collaborator George Hamilton Bowen, Jr., passed away November 1, 2009 in Ames, Iowa. George was born June 20, 1925 in Tulsa, Oklahoma to George and Dorothy (Huntington) Bowen. He married Marjorie Brown June 19, 1948 in Redondo Beach, California; they had five children, with eight grandchildren and five great-grandchildren at the time of his death. George H. Bowen's third or perhaps his fourth career was in astronomy. He was drafted into the navy in 1944, at the end of his first year as a student at Caltech, and ended his war-time service as an electronic technician on the aircraft carrier Shangri-La. He later said "In just nine months, starting from scratch (Ohm's law!), we learned an amazing amount - not by memorization, of course, but by study and real understanding of the basic function of the most advanced AC circuits then being used for instrumentation, measurements, communications, control systems, and much more." He gained a confidence that he could quickly and accurately diagnose and solve technical problems that stood him well in future work. One accomplishment he took particular pride in was figuring out how the radar control used cams and gears to solve the trigonometry for accurate pointing. He also described how the captain was alarmed when weather conditions changed so that refraction no longer showed them distant, small boats around the curvature of Earth. After the war, George Bowen returned to undergraduate and eventually graduate study at Caltech, where he was recruited to the biophysics research group headed by future Nobel Laureate Max Delbrück. George often described his joy in working with these first-rate scientists and finding himself accepted as a part of the effort. He finished his BS with honors in 1949 and his PhD in 1953 with a thesis on "Kinetic Studies on the Mechanism of Photoreactivation of Bacteriophase T2 Inactivated by Ultraviolet Light" involving work with E Coli. This work was supported by grants from the U

A link between perianal strep and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS).

PubMed

Toufexis, Megan; Deoleo, Caroline; Elia, Josephine; Murphy, Tanya K

2014-04-01

Perianal streptococcal dermatitis is an infection caused by group A streptococcus (GAS). Children with a pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) phenotype may have tics or obsessive compulsive symptoms secondary to a systemic immune activation by GAS infecting perianal areas. In this retrospective case series, the authors describe three children with symptoms consistent with PANDAS and a confirmed perianal streptococcal dermatitis as the likely infectious trigger. Concomitant perianal dermatitis and new-onset obsessive-compulsive symptoms and/or tics are strong indications for perianal culture and rapid antigen detection test in young children.

The Female Voice: Applications to Bowen's Family Systems Theory.

ERIC Educational Resources Information Center

Knudson-Martin, Carmen

1994-01-01

Responds to calls from feminist scholars to address potential biases against women in theories of family therapy. Summarizes findings from studies of female development and integrates findings into expanded model of Bowen's family systems theory. Includes case example comparing expanded model with traditional application of Bowen's theory.…

Bowen and Drew durring EVA 1

NASA Image and Video Library

2011-02-28

ISS026-E-030864 (28 Feb. 2011) --- NASA astronauts Steve Bowen (foreground) and Alvin Drew, both STS-133 mission specialists, participate in the mission?s first session of extravehicular activity (EVA) as construction and maintenance continue on the International Space Station. During the six-hour, 34-minute spacewalk, Bowen and Drew installed the J612 power extension cable, move a failed ammonia pump module to the External Stowage Platform 2 on the Quest Airlock for return to Earth at a later date, installed a camera wedge on the right hand truss segment, installed extensions to the mobile transporter rail and exposed the Japanese ?Message in a Bottle? experiment to space.

Bowen and Drew durring EVA 1

NASA Image and Video Library

2011-02-28

ISS026-E-030716 (28 Feb. 2011) --- NASA astronauts Steve Bowen (foreground) and Alvin Drew, both STS-133 mission specialists, participate in the mission?s first session of extravehicular activity (EVA) as construction and maintenance continue on the International Space Station. During the six-hour, 34-minute spacewalk, Bowen and Drew installed the J612 power extension cable, move a failed ammonia pump module to the External Stowage Platform 2 on the Quest Airlock for return to Earth at a later date, installed a camera wedge on the right hand truss segment, installed extensions to the mobile transporter rail and exposed the Japanese ?Message in a Bottle? experiment to space.

Bowen works electric batteries during EVA 1

NASA Image and Video Library

2010-05-17

S132-E-008102 (17 May 2010) --- NASA astronaut Steve Bowen, STS-132 mission specialist, participates in the mission's first session of extravehicular activity (EVA) as construction and maintenance continue on the International Space Station. During the seven-hour, 25-minute spacewalk, Bowen and NASA astronaut Garrett Reisman (out of frame), mission specialist, loosened bolts holding six replacement batteries, installed a second antenna for high-speed Ku-band transmissions and adding a spare parts platform to Dextre, a two-armed extension for the station’s robotic arm.

Use of Bowen Theory.

ERIC Educational Resources Information Center

Gibson, Joan M.; Donigian, Jeremiah

1993-01-01

Notes that theory-based approach to treatment of codependency is missing in fields of chemical dependency and mental health. Presents Bowen family systems therapy as foundation and framework for treatment goals and interventions. Illustrates similarities between characteristics of low levels of differentiation of self and codependency. (Author/NB)

Extramammary Paget's disease of the perianal region: a 20-year experience.

PubMed

Rajendran, Saissan; Koh, Cherry E; Solomon, Michael J

2017-03-01

To evaluate the results obtained from cases of perianal Paget's disease (PPD) and to provide a current perspective in the diagnostic evaluation and surgical management of this condition. A retrospective review of a single quaternary referral centre's experience with PPD from January 1994 to December 2013 was performed. Medical records were reviewed to collect data on demographics, preoperative investigations, complications, pathology and recurrence. A review of existing literature was also performed. Five patients (four females, one male) with histologically confirmed PPD were identified. The median age of presentation was 72 (range 61 to 78). Three patients were recurrences following previous excisions and first presentations in two patients. Only one patient had an underlying diagnosis of cancer. The median time to diagnosis was 24 months. Four patients underwent wide local excision with skin graft and/or local flap reconstruction and one patient required an abdominoperineal excision for recurrence. Four patients had involved lateral margins despite wide local excision but follow-up to date has only revealed one local recurrence. A review of available literature suggests that synchronous cancers can occur in up to 33% of patients and that a further 10% may be associated with metachronous cancers. Surveillance recommendations seem anecdotal and do not appear to be supported by available literature. PPD is a management challenge. Association with synchronous and metachronous carcinomas may not be as strong as initially thought. Surgery is the mainstay treatment with the need to balance between minimizing disease recurrence and functional sequelae from excessive tissue loss. © 2014 Royal Australasian College of Surgeons.

Bowen and Drew durring EVA 1

NASA Image and Video Library

2011-02-28

ISS026-E-030869 (28 Feb. 2011) --- NASA astronaut Steve Bowen, STS-133 mission specialist, participates in the mission?s first session of extravehicular activity (EVA) as construction and maintenance continue on the International Space Station. During the six-hour, 34-minute spacewalk, Bowen and NASA astronaut Alvin Drew (out of frame), mission specialist, installed the J612 power extension cable, move a failed ammonia pump module to the External Stowage Platform 2 on the Quest Airlock for return to Earth at a later date, installed a camera wedge on the right hand truss segment, installed extensions to the mobile transporter rail and exposed the Japanese ?Message in a Bottle? experiment to space.

Bowen and Drew durring EVA 1

NASA Image and Video Library

2011-02-28

ISS026-E-030708 (28 Feb. 2011) --- NASA astronauts Steve Bowen and Alvin Drew (partially obscured at center right), both STS-133 mission specialists, participate in the mission’s first session of extravehicular activity (EVA) as construction and maintenance continue on the International Space Station. During the six-hour, 34-minute spacewalk, Bowen and Drew installed the J612 power extension cable, move a failed ammonia pump module to the External Stowage Platform 2 on the Quest Airlock for return to Earth at a later date, installed a camera wedge on the right hand truss segment, installed extensions to the mobile transporter rail and exposed the Japanese “Message in a Bottle” experiment to space.

Bowen and Drew durring EVA 1

NASA Image and Video Library

2011-02-28

ISS026-E-030710 (28 Feb. 2011) --- NASA astronauts Steve Bowen and Alvin Drew (mostly obscured at center), both STS-133 mission specialists, participate in the mission?s first session of extravehicular activity (EVA) as construction and maintenance continue on the International Space Station. During the six-hour, 34-minute spacewalk, Bowen and Drew installed the J612 power extension cable, move a failed ammonia pump module to the External Stowage Platform 2 on the Quest Airlock for return to Earth at a later date, installed a camera wedge on the right hand truss segment, installed extensions to the mobile transporter rail and exposed the Japanese ?Message in a Bottle? experiment to space.

Bowen and Drew durring EVA 1

NASA Image and Video Library

2011-02-28

ISS026-E-030711 (28 Feb. 2011) --- NASA astronauts Steve Bowen and Alvin Drew (partially obscured at center), both STS-133 mission specialists, participate in the mission?s first session of extravehicular activity (EVA) as construction and maintenance continue on the International Space Station. During the six-hour, 34-minute spacewalk, Bowen and Drew installed the J612 power extension cable, move a failed ammonia pump module to the External Stowage Platform 2 on the Quest Airlock for return to Earth at a later date, installed a camera wedge on the right hand truss segment, installed extensions to the mobile transporter rail and exposed the Japanese ?Message in a Bottle? experiment to space.

The operative management of children with complex perianal Crohn's disease.

PubMed

Seemann, Natashia M; King, Sebastian K; Elkadri, Abdul; Walters, Thomas; Fish, Joel; Langer, Jacob C

2016-12-01

Perianal Crohn's disease (PCD) can affect both quality of life and psychological wellbeing. A subset of pediatric patients with complex PCD require surgical intervention, although appropriate timing and treatment regimens remain unclear. This study aimed to describe a large pediatric cohort in a tertiary center to determine the range of surgical management in children with complex PCD. A retrospective review of children requiring operative intervention for PCD over 13 years (2002-2014) was performed. PCD was divided into simple and complex based on the type of surgical procedure, and the two groups were compared. The 57 children were divided into two groups: the simple group (N=43) underwent abscess drainage ± seton insertion alone, and the complex group (N=14) underwent loop ileostomy ± more extensive surgery. In the complex group, females were more predominant (57% of complex vs 30% of simple), and the average age at diagnosis was lower. Anti-TNF therapy was utilized in 79.1% of simple and 100% of complex PCD. All 14 complex patients underwent a defunctioning ileostomy, with 7 requiring further operations (subtotal colectomy=4, proctocolectomy ± anal sparing=5, plastic surgery reconstruction with perineal flap/graft=4). Complex PCD represents a small but challenging subset of patients in which major surgical intervention may be necessary to alleviate the symptoms of this debilitating condition. retrospective case study with no control group - level IV. Copyright © 2016 Elsevier Inc. All rights reserved.

Bowen-York trumpet data and black-hole simulations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hannam, Mark; Murchadha, Niall O; Husa, Sascha

2009-12-15

The most popular method to construct initial data for black-hole-binary simulations is the puncture method, in which compactified wormholes are given linear and angular momentum via the Bowen-York extrinsic curvature. When these data are evolved, they quickly approach a trumpet topology, suggesting that it would be preferable to use data that are in trumpet form from the outset. To achieve this, we extend the puncture method to allow the construction of Bowen-York trumpets, including an outline of an existence and uniqueness proof of the solutions. We construct boosted, spinning and binary Bowen-York puncture trumpets using a single-domain pseudospectral elliptic solver,more » and evolve the binary data and compare with standard wormhole-data results. We also show that for boosted trumpets the black-hole mass can be prescribed a priori, without recourse to the iterative procedure that is necessary for wormhole data.« less

All in the family: a belated response to Knudson-Martin's feminist revision of Bowen theory.

PubMed

Horne, K Blake; Hicks, Mary W

2002-01-01

The first formal attempt at revising Bowen theory within the marriage and family therapy literature is represented in the work of Knudson-Martin (1994). Claiming that several of the theory's concepts are defined at odds with female development, Knudson-Martin (1994) reconceptualizes and expands Bowen theory to rectify these perceived shortcomings. In turn, we address several fundamental concerns with Knudson-Martin's critique and revision of Bowen theory. An alternative representation of Bowen Theory, as well as its relationship to feminist thought, is put forth. Suggestions for the field's future relationship to Bowen theory are also discussed.

Cow's Milk Allergy Is a Major Contributor in Recurrent Perianal Dermatitis of Infants.

PubMed

El-Hodhod, Mostafa Abdel-Aziz; Hamdy, Ahmad Mohamed; El-Deeb, Marwa Talaat; Elmaraghy, Mohamed O

2012-01-01

Background. Recurrent perianal inflammation has great etiologic diversity. A possible cause is cow's milk allergy (CMA). The aim was to assess the magnitude of this cause. Subjects and Methods. This follow up clinical study was carried out on 63 infants with perianal dermatitis of more than 3 weeks with history of recurrence. Definitive diagnosis was made for each infant through medical history taking, clinical examination and investigations including stool analysis and culture, stool pH and reducing substances, perianal swab for different cultures and staining for Candida albicans. Complete blood count and quantitative determination of cow's milk-specific serum IgE concentration were done for all patients. CMA was confirmed through an open withdrawal-rechallenge procedure. Serum immunoglobulins and CD markers as well as gastrointestinal endoscopies were done for some patients. Results. Causes of perianal dermatitis included CMA (47.6%), bacterial dermatitis (17.46%), moniliasis (15.87%), enterobiasis (9.52%) and lactose intolerance (9.5%). Predictors of CMA included presence of bloody and/or mucoid stool, other atopic manifestations, anal fissures, or recurrent vomiting. Conclusion. We can conclude that cow's milk allergy is a common cause of recurrent perianal dermatitis. Mucoid or bloody stool, anal fissures or ulcers, vomiting and atopic manifestations can predict this etiology.

Innovation in the imaging perianal fistula: a step towards personalised medicine

PubMed Central

Sahnan, Kapil; Adegbola, Samuel O.; Tozer, Philip J.; Patel, Uday; Ilangovan, Rajpandian; Warusavitarne, Janindra; Faiz, Omar D.; Hart, Ailsa L.; Phillips, Robin K. S.; Lung, Phillip F. C.

2018-01-01

Background: Perianal fistula is a topic both hard to understand and to teach. The key to understanding the treatment options and the likely success is deciphering the exact morphology of the tract(s) and the amount of sphincter involved. Our aim was to explore alternative platforms better to understand complex perianal fistulas through three-dimensional (3D) imaging and reconstruction. Methods: Digital imaging and communications in medicine images of spectral attenuated inversion recovery magnetic resonance imaging (MRI) sequences were imported onto validated open-source segmentation software. A specialist consultant gastrointestinal radiologist performed segmentation of the fistula, internal and external sphincter. Segmented files were exported as stereolithography files. Cura (Ultimaker Cura 3.0.4) was used to prepare the files for printing on an Ultimaker 3 Extended 3D printer. Animations were created in collaboration with Touch Surgery™. Results: Three examples of 3D printed models demonstrating complex perianal fistula were created. The anatomical components are displayed in different colours: red: fistula tract; green: external anal sphincter and levator plate; blue: internal anal sphincter and rectum. One of the models was created to be split in half, to display the internal opening and allow complexity in the intersphincteric space to better evaluated. An animation of MRI fistulography of a trans-sphincteric fistula tract with a cephalad extension in the intersphincteric space was also created. Conclusion: MRI is the reference standard for assessment of perianal fistula, defining anatomy and guiding surgery. However, communication of findings between radiologist and surgeon remains challenging. Feasibility of 3D reconstructions of complex perianal fistula is realized, with the potential to improve surgical planning, communication with patients, and augment training. PMID:29854001

Combined Medical and Surgical Approach Improves Healing of Septic Perianal Crohn's Disease.

PubMed

Choi, Christine S; Berg, Arthur S; Sangster, William; Schieffer, Kathleen M; Harris, Leonard R; Deiling, Sue M; Koltun, Walter A

2016-09-01

Septic perianal Crohn's disease (SPCD) is a treatment challenge in spite of tumor necrosis factor antagonists (anti-TNF). Our aim was to define the success of SPCD management with a combined medical and surgical approach and to identify clinical and genetic factors predictive of healing. A retrospective chart review of patients with SPCD treated at the Penn State Milton S Hershey Medical Center was done. Primary end point was complete healing (ie normal clinical exam and no pain for at least 6 months). Genetic analysis of 185 single nucleotide polymorphisms associated with Crohn's disease was performed in 78 patients. One hundred and thirty-five episodes of SPCD were identified in 114 patients with a mean follow-up of 77 ± 7.4 months. Overall, 80 of 135 episodes healed (59.3%) and did not differ between those receiving anti-TNF and not (60.4% vs 56.8%). There appeared to be a consistent improved heal rate in each subcategory of surgically managed patients that received anti-TNF. Female sex was significantly predictive of healing in only those receiving anti-TNF agents (63.6% vs 25.0%; p = 0.0005). Twenty-two (19.3%) patients ultimately received a permanent diversion with either a total proctocolectomy or completion proctectomy. Multivariate analysis suggested several single nucleotide polymorphisms in Crohn's disease-associated genes to be possibly associated with healing, but lost significance after Bonferroni correction. Overall, there is an approximate 60% rate of healing SPCD using a combined medical and surgical approach. About 20% of SPCD patients will require a permanent stoma. There were no clear genetic predictors of healing SPCD. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Sensitivity of perianal tape impressions to diagnose pinworm (Syphacia spp.) infections in rats (Rattus norvegicus) and mice (Mus musculus).

PubMed

Hill, William Allen; Randolph, Mildred M; Mandrell, Timothy D

2009-07-01

We determined the sensitivity of perianal tape impressions to detect Syphacia spp. in rats and mice. We evaluated 300 rat and 200 mouse perianal impressions over 9 wk. Pinworm-positive perianal tape impressions from animals with worm burdens at necropsy were considered as true positives. Conversely, pinworm-negative perianal tape impressions from animals with worm burdens were considered false negatives. The sensitivity of perianal tape impressions for detecting Syphacia muris infections in rats was 100%, and for detecting Syphacia obvelata in mice was 85.5%. Intermittent shedding of Syphacia obvelata ova is the most probable explanation for the decreased sensitivity rate we observed in mice. We urge caution in use of perianal tape impressions alone for Syphacia spp. screening in sentinel mice and rats.

Bowen works with the Battery ORUs during EVA 1

NASA Image and Video Library

2010-05-17

S132-E-008106 (17 May 2010) --- NASA astronaut Steve Bowen, STS-132 mission specialist, participates in the mission's first session of extravehicular activity (EVA) as construction and maintenance continue on the International Space Station. During the seven-hour, 25-minute spacewalk, Bowen and NASA astronaut Garrett Reisman (out of frame), mission specialist, loosened bolts holding six replacement batteries, installed a second antenna for high-speed Ku-band transmissions and adding a spare parts platform to Dextre, a two-armed extension for the station’s robotic arm.

Bowen works with the Battery ORUs during EVA 1

NASA Image and Video Library

2010-05-17

S132-E-008100 (17 May 2010) --- NASA astronaut Steve Bowen, STS-132 mission specialist, participates in the mission's first session of extravehicular activity (EVA) as construction and maintenance continue on the International Space Station. During the seven-hour, 25-minute spacewalk, Bowen and NASA astronaut Garrett Reisman (out of frame), mission specialist, loosened bolts holding six replacement batteries, installed a second antenna for high-speed Ku-band transmissions and adding a spare parts platform to Dextre, a two-armed extension for the station’s robotic arm.

Negative pressure wound therapy combined with skin grafting improves surgical wound healing in the perianal area.

PubMed

Jia-Zi, Shi; Xiao, Zhai; Jun-Hui, Li; Chun-Yu, Xue; Hong-da, Bi

2016-08-01

Management of large tissue defects resulting from local wide resection of perianal is a clinical challenge for surgeons. The aim of the present study was to investigate the efficacy of negative pressure wound therapy (NPWT) following skin grafting on perianal surgical wound healing.Included in this study were 12 patients with perianal tumors who received skin grafting after perianal tumor resection between December 2012 and December 2014. A self-designed negative pressure drainage device was then applied to maintain a standard negative pressure at -150 mm Hg and removed on day 8 postoperation. The outcome was recorded immediately after NPWT and at 6-month follow-up.All skin grafts survived without infection, hematoma, and necrosis in all 12 patients. No tumor recurrence was detected during 6-month follow-up. Natural folds were observed around the anus. All patients showed normal bowel movements.NPWT following skin grafting was effective for perianal surgical wound healing and infection prevention, thus benefiting anatomical and functional recovery of the anus.

[Actinic keratosis, Bowen's disease, keratoacanthoma and squamous cell carcinoma of the skin].

PubMed

Majores, M; Bierhoff, E

2015-02-01

Actinic (solar) keratosis is an intraepidermal squamous neoplasm of sun-damaged skin and by far the most frequent neoplastic skin lesion. A subdivison into three grades has been proposed with increasing acceptance not least because of the therapeutic consequences. The transition to invasive squamous cell carcinoma is reported in 5-10 % and with immunosuppression in 30 % of patients.Bowen's disease is a variant of squamous cell carcinoma in situ of the skin and the mucocutaneous junction. The differentiation from bowenoid papulosis as a lesion associated with human papillomavirus (HPV), actinic (solar) keratosis grade III, intraepidermal poroid lesions and in cases of clonal type from clonal seborrhoic keratosis and Paget's disease is very important.Keratoacanthoma is currently uniformly interpreted as a variant of highly differentiated squamous cell carcinoma of the skin with clinical and histomorphological characteristics. Clinically keratoacanthoma erupts rapidly and is capable of resolving spontaneously. Histologically, there is a characteristic growth pattern and various stages of regression. The final histomorphological diagnosis needs the entire specimen.Squamous cell carcinoma of the skin is the second most common type of skin cancer following basal cell carcinoma. With respect to reccurrencies and risk of metastases the subtyping of cutaneous squamous cell carcinoma is very important. The classification system of the Union Internationale Contra le Cancer (UICC) is based solely on the anatomical spread and the classification system of the American Joint Committee on Cancer (AJCC) also considers so-called high-risk features in the staging between stages I and II.

Perianal pain as a presentation of lumbosacral neurofibroma: a case report.

PubMed

Moghaddasi, Mehdi; Aghaii, Mahboubeh; Mamarabadi, Mansoureh

2014-12-01

Rectal and perianal pain is a common problem. Most people have experienced it at least once in their lifetime. It usually manifests as mild discomfort, but sometimes the pain can be so severe that it is incapacitating. A 59-year-old woman admitted with a 2-year history of paroxysmal perianal pain underwent a full work-up including proctoscopy, sigmoidoscopy, full colonoscopy, and barium enema that were unremarkable. Lumbosacral magnetic resonance imaging with and without gadolinium showed an intradural-extramedullary lesion at the level of L5. The pathologic diagnosis was a neurofibroma. She underwent surgery, and after a few weeks she felt well and medication was no longer needed for her paroxysmal pain. Although one should consider the usual causes of colorectal pain such as hemorrhoids, anal fissure, proctalgia fugax, and chronic perianal pain syndrome, we should keep in mind that some referral pain may mimic local pathologies and should be evaluated properly.

Perianal Pain as a Presentation of Lumbosacral Neurofibroma: A Case Report

PubMed Central

Moghaddasi, Mehdi; Aghaii, Mahboubeh; Mamarabadi, Mansoureh

2014-01-01

Rectal and perianal pain is a common problem. Most people have experienced it at least once in their lifetime. It usually manifests as mild discomfort, but sometimes the pain can be so severe that it is incapacitating. A 59-year-old woman admitted with a 2-year history of paroxysmal perianal pain underwent a full work-up including proctoscopy, sigmoidoscopy, full colonoscopy, and barium enema that were unremarkable. Lumbosacral magnetic resonance imaging with and without gadolinium showed an intradural-extramedullary lesion at the level of L5. The pathologic diagnosis was a neurofibroma. She underwent surgery, and after a few weeks she felt well and medication was no longer needed for her paroxysmal pain. Although one should consider the usual causes of colorectal pain such as hemorrhoids, anal fissure, proctalgia fugax, and chronic perianal pain syndrome, we should keep in mind that some referral pain may mimic local pathologies and should be evaluated properly. PMID:25485211

Photodynamic therapy (PDT) for perianal bowenoid papulosis

NASA Astrophysics Data System (ADS)

Gahlen, Johannes; Stern, Josef; Graschew, Georgi; Kaus, Michael R.; Tilgen, W.

1995-03-01

HPV associated bowenoid papulosis of the anogenital region are classified as carcinoma in situ. The treatment can be difficult and recurrence rates are high. Extended surgical resections may have complications such as anal sphincter insufficiency. PDT does have some advantages and less side effects in the treatment of these tumors. We treated one female patient with an extended perianal bowenoid papulosis. Previous surgical resection led to local recurrence and partial sphincter insufficiency. Twenty-four hours before local laser light radiation (Ar-Dye laser, 630 nm wavelength), a systemic photosensitizer was applied (Photofrin II, 1.5 mg/kg BW). Four courses of PDT were performed within one year. We observed a total tumor necrosis in every radiation area. The previous sphincter insufficiency improved during the sessions. Side effects were rare. Pain in the radiation was stopped within 2 - 3 days under pain medication. PDT can induce a total local tumor necrosis in perianal bowenoid papulosis. Concerning local expansion, PDT can be a curable treatment.

N III Bowen Lines and Fluorescence Mechanism in the Symbiotic Star AG Peg

NASA Astrophysics Data System (ADS)

Hyung, Siek; Lee, Seong-Jae; Lee, Kang Hwan

2018-03-01

We have investigated the intensities and full width at half maximum (FWHM) of the high dispersion spectroscopic N III emission lines of AG Peg, observed with the Hamilton Echelle Spectrograph (HES) in three different epochs at Mt. Hamilton's Lick Observatory. The earlier theoretical Bowen line study assumed the continuum fluorescence effect, presenting a large discrepancy with the present data. Hence, we analyzed the observed N III lines assuming line fluorescence as the only suitable source: (1) The O III and N III resonance line profiles near λ 374 were decomposed, using the Gaussian function, and the contributions from various O III line components were determined. (2) Based on the theoretical resonant N III intensities, the expected N III Bowen intensities were obtained to fit the observed values. Our study shows that the incoming line photon number ratio must be considered to balance at each N III Bowen line level in the ultraviolet radiation according to the observed lines in the optical zone. We also found that the average FWHM of the N III Bowen lines was about 5 km·s-1 greater than that of the O III Bowen lines, perhaps due to the inherently different kinematic characteristics of their emission zones.

The effects of the Bowen technique on hamstring flexibility over time: a randomised controlled trial.

PubMed

Marr, Michelle; Baker, Julian; Lambon, Nicky; Perry, Jo

2011-07-01

The hamstring muscles are regularly implicated in recurrent injuries, movement dysfunction and low back pain. Links between limited flexibility and development of neuromusculoskeletal symptoms are frequently reported. The Bowen Technique is used to treat many conditions including lack of flexibility. The study set out to investigate the effect of the Bowen Technique on hamstring flexibility over time. An assessor-blind, prospective, randomised controlled trial was performed on 120 asymptomatic volunteers. Participants were randomly allocated into a control group or Bowen group. Three flexibility measurements occurred over one week, using an active knee extension test. The intervention group received a single Bowen treatment. A repeated measures univariate analysis of variance, across both groups for the three time periods, revealed significant within-subject and between-subject differences for the Bowen group. Continuing increases in flexibility levels were observed over one week. No significant change over time was noted for the control group. Copyright © 2010 Elsevier Ltd. All rights reserved.

Cyclosporine treatment of perianal gland adenoma concurrent with benign prostatic hyperplasia in a dog

PubMed Central

Park, Chul; Yoo, Jong-Hyun; Kim, Ha-Jung; Lim, Chae-Young; Kim, Ju-Won; Lee, So-Young; Kim, Jung-Hyun; Jang, Jae-Im; Park, Hee-Myung

2010-01-01

A 13-year-old, intact male, mixed-breed dog was evaluated for multiple intradermal nodules around the anus. The nodules were diagnosed as perianal gland adenoma based on histopathologic examination. After therapy with cyclosporin A for 5 wk, the perianal masses were moderately shrunken. The dog’s condition has remained stable over 6 mo. PMID:21286331

Colostomy for Perianal Sepsis With Ecthyma Gangrenosum in Immunocompromised Children.

PubMed

Vuille-dit-Bille, Raphael N; Berger, Christoph; Meuli, Martin; Grotzer, Michael A

2016-01-01

Perianal sepsis with ecthyma gangrenosum is a severe and potentially mutilating complication in immunocompromised children. Therapies include antimicrobial treatment, incision and drainage, generous tissue debridement, and skin transplantation. We describe 3 children with acute lymphoblastic leukemia having sepsis with Pseudomonas aeruginosa in febrile neutropenia and severe perianal infections treated relatively early with a protective colostomy. Indications for colostomy were nonhealing wounds, and ceaseless pain. All patients showed a rapid reduction of pain. Complete wound healing was seen in 2 patients, and considerable pain reduction and increased quality of life were seen in a third patient during palliative care. These results suggest that a protective colostomy should be considered early in the management of immunocompromised children with ecthyma gangrenosum.

Perianal Crohn disease.

PubMed

Asma, Sioud Dhrif; Soumaya, Youssef; Kahena, Jaber; Raouf, Dhaoui Mohamed; Nejib, Doss

2006-12-10

Crohn disease is a chronic inflammatory disease characterized by sharply demarcated segments of gastrointestinal involvement from mouth to anus. Its perineal manifestations are among the most devastating and mutilating complications. They occur at any time and may precede the intestinal manifestations. Their most common presentations are perineal ulceration, fistula, and abscess. Proliferative and polypoid morphology of the cutaneous lesions mimicking warts and condyloma are rarely described. We report a 25-year-old woman with a 4-month history of confluent plaques of the perineal region with vegetant surfaces, suspected to be genital warts. The lesions progressed to fistulas, inducing deep ulcerations surrounded by pseudocondylomatous tumors. About 2 months prior to presentation she began to suffer from gastrointestinal symptoms and noted weight loss. Physical examination, endoscopic examination, and pathological interpretation led to the diagnosis of Crohn disease with perineal involvement being the initial presenting sign. Significant improvement was induced with prednisone (45 mg daily) and azathioprine. Our observation is notable for the pseudocondylomatous appearance and the dramatic response to medical treatment despite severe involvement.

Management of acute perianal sepsis in neutropenic patients with hematological malignancy.

PubMed

Baker, B; Al-Salman, M; Daoud, F

2014-04-01

In neutropenic patients with acute perianal sepsis in the setting of hematological malignancy, the classical clinical features of abscess formation are lacking. Additionally, the role of surgical intervention is not well established. In this review, we discuss the challenges and controversy regarding diagnosis and optimal management when clear surgical guidelines are absent. In the literature, there is great diversity in the surgical approach to these patients, which leads to a high percentage of diagnostic errors, risks of complications, and unnecessary interventions. We review the literature and assess whether surgical intervention produces better outcomes than a non-surgical approach. Studies published on perianal sepsis in neutropenic cancer patients were identified by searching PubMed using the following key words: "perianal sepsis/abscesses, anorectal sepsis/abscess, neutropenia, hematological malignancy, cancer". No randomized or prospective studies on the management of acute perianal sepsis in hematological malignancies were found. The largest retrospective study and most comprehensive clinical data demonstrated that 42% of patients were treated successfully without surgical intervention and without morbidity or mortality related to treatment chosen. Small retrospective studies advocated surgical intervention, while the majority of successes were in a non-operative treatment. It is difficult to formulate a conclusion given the small retrospective series on management of neutropenic patients with hematological malignancies. While there is no evidence mandating a routine surgical approach in this category of patients, non-surgical management including careful follow-up to determine whether the patient's condition is deteriorating or treatment has failed is an acceptable approach in selected patients without pathognomonic features of abscess. Comprehensive and well-designed prospective studies are needed to firmly establish the guidelines of treatment

Vulval intraepithelial neoplasia and periungual Bowen's disease concordant for mucosal (HPV-34) and epidermodysplasia verruciformis (HPV-21) human papillomavirus types

PubMed Central

Ekeowa-Anderson, A. L.; Harwood, C. A.; Perrett, C. M.; Sahota, A.; Annan, H.; Ran, H.; Leigh, I. M.; Gibbon, K. L.

2008-01-01

Summary Human papillomavirus (HPV) infection is associated with genital malignancy and specific cutaneous malignancies. We report a case of an HPV-associated concurrent vulval intraepithelial neoplasia and periungual Bowen's disease in a young immunocompetent Afro-Caribbean woman with no known risk factors for either disease. HPV genotyping studies detected multiple α and β papillomaviruses with concordance for HPV-34 [a high-risk (HR) mucosal type], and HPV-21 [an epidermodyslasia verruciformis (EV) type] in both vulval and finger tissue. Although the HR-mucosal viruses detected are likely to have a pathogenic role in vulval intraepithelial neoplasia, this is the first report of concordance for EV HPV types in both genital and nongenital skin premalignancies. This case, in the context of accumulating epidemiological and experimental data in cutaneous SCC, raises the question of whether EV HPV may contribute to vulval malignancy, and further study is merited. PMID:17362236

The Reverend Thomas Jefferson Bowen: An Introductory Background to His Linguistic Works, 1850-1856

ERIC Educational Resources Information Center

Awoniyi, Timothy A.

1974-01-01

A historical narrative background for the linguistic works of Thomas Jefferson Bowen, an American missionary who was the first non-Nigerian to publish a grammar of Yoruba (1858). The author points up a need for further scholarly review of Bowen's pioneering work and contribution to Yoruba studies. (JT)

Association of Coloproctology of Great Britain and Ireland consensus exercise on surgical management of fistulating perianal Crohn's disease.

PubMed

Lee, M J; Heywood, N; Sagar, P M; Brown, S R; Fearnhead, N S

2017-05-01

Management of fistulating perianal Crohn's disease (fpCD) is a significant challenge for a colorectal surgeon. A recent survey of surgical practice in this condition showed variation in management approaches. As a result we set out to devise recommendations for practice for UK colorectal surgeons. Results from a national survey were used to devise a set of potential consensus statements. Consultant colorectal surgeons were invited to participate in the exercise via the previous survey and the mailing list of the professional society. Iterative voting was performed on each statement using a five-point Likert scale and electronic voting, with opportunity for discussion and refinement between each vote. Consensus was defined as > 80% agreement. Seventeen surgeons and two patient representatives voted upon 51 statements. Consensus was achieved on 39 items. Participants advocated a patient-centred approach by a colorectal specialist, within strong multidisciplinary teamworking. The use of anti-TNFα therapy is advocated. Where definitive surgical techniques are considered they should be carefully selected to avoid adverse impact on function. Ano/rectovaginal fistulas should be managed by specialists in fistulating disease. Stoma or proctectomy could be discussed earlier in a patient's treatment pathway to improve choice, as they may improve quality of life. This consensus provides principles and guidance for best practice in managing patients with fpCD. Colorectal Disease © 2017 The Association of Coloproctology of Great Britain and Ireland.

Bowen with LiOH cans on Discovery middeck

NASA Image and Video Library

2011-03-01

S133-E-007462 (28 Feb. 2011) --- NASA astronaut Steve Bowen, STS-133 mission specialist, works with lithium hydroxide (LiOH) canisters from beneath space shuttle Discovery’s middeck while docked with the International Space Station. Photo credit: NASA or National Aeronautics and Space Administration

Development of perianal ulcer as a result of acute fulminant amoebic colitis.

PubMed

Torigoe, Takayuki; Nakayama, Yoshifumi; Yamaguchi, Koji

2012-09-14

We report a case of acute fulminant amoebic colitis that resulted in the development of a perianal ulcer in a 29-year-old Japanese homosexual man with acquired immunodeficiency syndrome (AIDS). The patient was admitted to our hospital with a persistent perianal abscess that was refractory to antibiotic therapy administered at another hospital. On admission, we observed a giant ulcer in the perianal region. At first, cytomegalovirus colitis was suspected by blood investigations. Ganciclovir therapy was initiated; however, the patient developed necrosis of the skin around the anus during therapy. We only performed end-sigmoidostomy and necrotomy to avoid excessive surgical invasion. Histopathological examination of the surgical specimen revealed the presence of trophozoite amoebae, indicating a final diagnosis of acute fulminant amoebic colitis. The patient's postoperative course was favorable, and proctectomy of the residual rectum was performed 11 mo later. Amoebic colitis is one of the most severe complications affecting patients with AIDS. Particularly, acute fulminant amoebic colitis may result in a poor prognosis; therefore, staged surgical therapy as a less invasive procedure should be considered as one of the treatment options for these patients.

A new method to measure Bowen ratios using high-resolution vertical dry and wet bulb temperature profiles

NASA Astrophysics Data System (ADS)

Euser, T.; Luxemburg, W. M. J.; Everson, C. S.; Mengistu, M. G.; Clulow, A. D.; Bastiaanssen, W. G. M.

2014-06-01

The Bowen ratio surface energy balance method is a relatively simple method to determine the latent heat flux and the actual land surface evaporation. The Bowen ratio method is based on the measurement of air temperature and vapour pressure gradients. If these measurements are performed at only two heights, correctness of data becomes critical. In this paper we present the concept of a new measurement method to estimate the Bowen ratio based on vertical dry and wet bulb temperature profiles with high spatial resolution. A short field experiment with distributed temperature sensing (DTS) in a fibre optic cable with 13 measurement points in the vertical was undertaken. A dry and a wetted section of a fibre optic cable were suspended on a 6 m high tower installed over a sugar beet trial plot near Pietermaritzburg (South Africa). Using the DTS cable as a psychrometer, a near continuous observation of vapour pressure and air temperature at 0.20 m intervals was established. These data allowed the computation of the Bowen ratio with a high spatial and temporal precision. The daytime latent and sensible heat fluxes were estimated by combining the Bowen ratio values from the DTS-based system with independent measurements of net radiation and soil heat flux. The sensible heat flux, which is the relevant term to evaluate, derived from the DTS-based Bowen ratio (BR-DTS) was compared with that derived from co-located eddy covariance (R2 = 0.91), surface layer scintillometer (R2 = 0.81) and surface renewal (R2 = 0.86) systems. By using multiple measurement points instead of two, more confidence in the derived Bowen ratio values is obtained.

All in the Family: A Belated Response to Knudson-Martin's Feminist Revision of Bowen Theory

ERIC Educational Resources Information Center

Horne, K. Blake; Hicks, Mary W.

2002-01-01

The first formal attempt at revising Bowen theory within the marriage and family therapy literature is represented in the work of Knudson-Martin (1994). Claiming that several of the theory's concepts are defined at odds with female development, Knudson-Martin (1994) reconceptualizes and expands Bowen theory to rectify these perceived shortcomings.…

Mammary and extramammary Paget's disease*

PubMed Central

Lopes, Lauro Lourival; Lopes, Ione Maria Ribeiro Soares; Lopes, Lauro Rodolpho Soares; Enokihara, Milvia M. S. S.; Michalany, Alexandre Osores; Matsunaga, Nobuo

2015-01-01

Paget's disease, described by Sir James Paget in 1874, is classified as mammary and extramammary. The mammary type is rare and often associated with intraductal cancer (93-100% of cases). It is more prevalent in postmenopausal women and it appears as an eczematoid, erythematous, moist or crusted lesion, with or without fine scaling, infiltration and inversion of the nipple. It must be distinguished from erosive adenomatosis of the nipple, cutaneous extension of breast carcinoma, psoriasis, atopic dermatitis, contact dermatitis, chronic eczema, lactiferous ducts ectasia, Bowen's disease, basal cell carcinoma, melanoma and intraductal papilloma. Diagnosis is histological and prognosis and treatment depend on the type of underlying breast cancer. Extramammary Paget's disease is considered an adenocarcinoma originating from the skin or skin appendages in areas with apocrine glands. The primary location is the vulvar area, followed by the perianal region, scrotum, penis and axillae. It starts as an erythematous plaque of indolent growth, with well-defined edges, fine scaling, excoriations, exulcerations and lichenification. In most cases it is not associated with cancer, although there are publications linking it to tumors of the vulva, vagina, cervix and corpus uteri, bladder, ovary, gallbladder, liver, breast, colon and rectum. Differential diagnoses are candidiasis, psoriasis and chronic lichen simplex. Histopathology confirms the diagnosis. Before treatment begins, associated malignancies should be investigated. Surgical excision and micrographic surgery are the best treatment options, although recurrences are frequent. PMID:25830993

Alveolar soft part sarcoma causing perianal abscess.

PubMed

Sullivan, Niall; McCulloch, Tom; Leverton, David

2011-07-01

A 34-year-old woman presented with a perianal abscess that communicated with the vagina. There was a background of a one-year history of a conservatively treated, traumatic, paravaginal haematoma. Histology of the fistula tract showed alveolar soft part sarcoma and subsequent imaging identified a large soft tissue mass in the pelvis with lung metastases. Alveolar soft part sarcoma is a rare soft tissue sarcoma of unknown cellular origin affecting predominantly young women, often in deep soft tissues and lower extremities.

Continental-scale magmatic carbon dioxide seepage recorded by dawsonite in the Bowen-Gunnedah-Sydney basin system, eastern Australia

DOE Office of Scientific and Technical Information (OSTI.GOV)

Baker, J.C.; Bai, G.P.; Hamilton, P.J.

1995-07-03

Dawsonite, NaAlCO{sub 3}(OH){sub 2}, is widespread as a cement, replacement, and cavity filling in Permo-Triassic sedimentary rocks of the Bowen-Gunnedah-Sydney basin system eastern Australia. The origin of dawsonite in these rocks was studied by petrographic and stable isotope analysis. Dawsonite {delta}{sup 13}C (PDB) values range from {minus}4.0 to +4.1{per_thousand} and are remarkably consistent throughout the Bowen-Gunnedah-Sydney basin system. These values indicate either a marine carbonate or magmatic source for carbon in the dawsonite. A magmatic carbon source is considered more likely on the basis that (1) evidence of and the cause for widespread marine carbonate dissolution in the sedimentary successionsmore » are not apparent, (2) dawsonite is widespread in both marine and nonmarine facies, (3) the region has been the site of major igneous activity, (4) other dawsonite deposits of similar carbon isotopic composition are linked to igneous activity, and (5) magmatic CO{sub 2} accumulations are known in parts of the Bowen-Gunnedah-Sydney basin system. The timing of igneous activity in the Bowen Basin constrains the timing of dawsonite formation in the Bowen-Gunnedah-Sydney basin system to the Tertiary, consistent with textural relationships, which indicate that dawsonite formed late during the burial history of the Permo-triassic sequences. The distribution and interpreted origin of dawsonite implies magmatic CO{sub 2} seepage in the Bowen-Gunnedah-Sydney basin system on a continental scale.« less

Spectrophotometry of Bowen resonance fluorescence lines in three planetary nebulae

NASA Technical Reports Server (NTRS)

O'Dell, C. R.; Miller, Christopher O.

1992-01-01

The results are presented of a uniquely complete, carefully reduced set of observations of the O III Bowen fluorescence lines in the planetary nebulae NGC 6210, NGC 7027, and NGC 7662. A detailed comparison with the predictions of radiative excitation verify that some secondary lines are enhanced by selective population by the charge exchange mechanism involving O IV. Charge exchange is most important in NGC 6210, which is of significantly lower ionization than the other nebulae. In addition to the principal Bowen lines arising from Ly-alpha pumping of the O III O1 line, lines arising from pumping of the O3 line are also observed. Comparison of lines produced by O1 and O3 with the theoretical predictions of Neufeld indicate poor agreement; comparison with the theoretical predictions of Harrington show agreement with NGC 7027 and NGC 7662.

Boe and Bowen on Middeck with LiOH canisters

NASA Image and Video Library

2011-02-28

S133-E-007942 (28 Feb. 2011) --- NASA astronauts Eric Boe (left), STS-133 pilot; and Steve Bowen, mission specialist, work with lithium hydroxide (LiOH) canisters from beneath space shuttle Discovery’s middeck while docked with the International Space Station. Photo credit: NASA or National Aeronautics and Space Administration

Modified perianal/pericapsular anesthesia for transrectal biopsy of prostate in patients with anal rectal problems.

PubMed

Kravchick, Sergey; Yoffe, Boris; Cytron, Shmuel

2007-01-01

To modify our technique of perianal anesthesia and use it in patients with painful conditions of the rectum and/or anus. A total of 31 consecutive patients with anal-rectal problems underwent prostate needle biopsy. Of these, 17 were referred to our hospital after vain attempts to insert a transrectal ultrasound probe. Patients received a perianal-pericapsular injection of 1% lidocaine. Pain perception was separately assessed for probe insertion and biopsies using a visual pain analog score. Only in 1 patient were we unable to insert the transrectal ultrasound probe. The mean patient age was 65.28 +/- 5.35 years. We performed a mean of 12.25 biopsies per case. At probe insertion, the mean pain score was 2.2 +/- 0.83. During the biopsy punctures, the mean pain level was 2.53 +/- 1.054. We did not find any increase in the complication rate related to the anesthesia method. Modified perianal anesthesia can be used for transrectal ultrasound-guided biopsy of the prostate in patients with anal-rectal problems, because it provides significant pain relief.

Comparison of Bowen-ratio, eddy-correlation, and weighing-lysimeter evapotranspiration for two sparse-canopy sites in eastern Washington

USGS Publications Warehouse

Tomlinson, S.A.

1996-01-01

This report compares evapotranspiration estimated with the Bowen-ratio and eddy-correlation methods with evapotranspiration measured by weighing lysimeters for two sparse-canopy sites in eastern Washington. The sites are located in a grassland area (grass lysimeter site) and a sagbrush- covered area (sage lysimeter site) on the Arid Lands Ecology Reserve in Benton County, Washington. Lysimeter data were collected at the sites from August 1990 to November 1994. Bowen-ratio data were collected for varying periods from May 1993 to November 1994. Additional Bowen-ratio data without interchanging air- temperature and vapor-pressure sensors to remove sensor bias (fixed-sensor system) were collected from October 1993 to June 1994. Eddy-correlation data were collected at the grass lysimeter site from March to April 1994, and at the sage lysimeter site from April to May 1994. The comparisons of evapotranspiration determined by the various methods differed considerably, depending on the periods of record being compared and the sites being analyzed. The year 1993 was very wet, with about 50 percent more precipitation than average; 1994 was a very dry year, with only about half the average precipitation. The study showed that on an annual basis, at least in 1994, Bowen-ratio evapotranspiration closely matched lysimeter evapotranspiration. In 1993, Bowen-ratio and lysimeter evapotranspiration comparisons were variable. Evapotranspiration estimated with the Bowen-ratio method averaged 5 percent more than evapotranspiration measured by lysimeters at the grass lysimeter site from October 1993 to November 1994, and 3 percent less than lysimeters at the sage lysimeter site from November 1993 to October 1994. From March 24 to April 5, 1994, at the grass lysimeter site, the Bowen-ratio method estimated 11 percent less, the Bowen-ratio method utilizing the fixed sensor system about 7 percent more, and the eddy-correlation method about 28 percent less evapotranspiration than the

Enhancement of Wound Healing by the Traditional Chinese Medicine Herbal Mixture Sophora flavescens in a Rat Model of Perianal Ulceration

PubMed Central

XU, XIAOPING; LI, XIAOHUA; ZHANG, LEI; LIU, ZHAOHUI; PAN, YUAN; CHEN, DONG; BIN, DONGHUA; DENG, QUN; SUN, YU; HOFFMAN, M. ROBERT; YANG, ZHIJIAN; YUAN, HONG

2017-01-01

Background/Aim: Hemorrhoidectomy is often associated with significant postoperative complications that may result in slow wound healing. The traditional Chinese medicine (TCM) compound Sophora flavescens (CSF) has shown efficacy on many inflammatory disorders. The aim of the present study was to examine the efficacy of CSF on wound healing in a rat model of perianal ulceration. Materials and Methods: A rat model of perianal ulceration was induced by subcutaneous injection of 75% glacial acetic acid. The animals with induced perianal ulcer received topical treatment of low, medium, and high doses of CFS twice daily. Potassium permanganate (PP); 0.02%) was given to the animals for comparison. Macroscopic and histological assessments of the ulcerated area were performed after treatment. The expression of pro-inflammatory cytokines prostaglandin E2 (PGE2) and interleukin-8 (IL-8) was detected by immunohistochemical analysis. Results: Topical administration of medium- and high-dose CSF significantly enhanced perianal ulcer healing as compared to the untreated control (p<0.05). The macroscopic ulceration score was significantly reduced only in the high-dose CSF-treated group as compared to the control (p<0.01). All doses of CSF and PP ameliorated histological damages in the rats with induced perianal ulceration. High-dose CSF or PP significantly reduced the expression of PGE2 and IL-8 as compared to the control (p<0.01). No treatment-related toxicity was found in either the CSF- or the PP-treated mice. Conclusion: CSF enhances wound healing in a rat model of perianal ulceration. The inhibitory effect of CSF on pro-inflammatory cytokines PGE2 and IL-8 may be involved in the mechanism of enhanced wound-healing. PMID:28652418

Lancefield group G Streptococcus dysgalactiae subsp. equisimilis: an unusual aetiology of perianal streptococcal dermatitis acquired from heterosexual oral-anal intercourse.

PubMed

Abdolrasouli, A; Hemmati, Y; Amin, A; Roushan, A; Butler, I

2012-12-01

Perianal streptococcal dermatitis (PSD) is an uncommon superficial cutaneous infection of the perianal area, almost exclusively described in children and mainly caused by group A streptococci. We report here a case of PSD caused by Streptococcus dysgalactiae subsp. equisimilis, Lancefield group G, in an adult man due to heterosexual oral-anal sexual contact.

Polyphenon E 10% ointment: in immunocompetent adults with external genital and perianal warts.

PubMed

Hoy, Sheridan M

2012-08-01

Polyphenon E 10% ointment, which contains a mixture of green tea catechins, is indicated for the treatment of external genital and perianal warts (Condylomata acuminata) in immunocompetent patients aged ≥18 years. In two double-blind, multinational studies in adults with external genital and perianal warts, polyphenon E 10% ointment for up to 16 weeks was significantly more effective than vehicle with regard to the complete clearance of all warts (i.e. those at baseline and newly appearing during treatment) [primary endpoint]. In gender subgroup analyses, polyphenon E 10% ointment was more effective than vehicle in both men and women in one of two individual studies, and in pooled data from both studies. Polyphenon E 10% ointment was also significantly more effective than vehicle with regard to several secondary endpoints, including the complete clearance of baseline warts and partial clearance of at least 50% of all warts in both studies. Rates of recurrence of any warts or development of new warts were low (<9%) in both treatment arms during a 12-week follow-up period in both studies. Polyphenon E 10% ointment was generally well tolerated in adults with external genital and perianal warts. According to pooled data from the two clinical studies, the majority of adverse events associated with polyphenon E 10% ointment involved application site and local skin reactions at the treatment site.

Enhancement of Wound Healing by the Traditional Chinese Medicine Herbal Mixture Sophora flavescens in a Rat Model of Perianal Ulceration.

PubMed

Xu, Xiaoping; Li, Xiaohua; Zhang, Lei; Liu, Zhaohui; Pan, Yuan; Chen, Dong; Bin, Donghua; Deng, Qun; Sun, Y U; Hoffman, Robert M; Yang, Zhijian; Yuan, Hong

2017-01-01

Hemorrhoidectomy is often associated with significant postoperative complications that may result in slow wound healing. The traditional Chinese medicine (TCM) compound Sophora flavescens (CSF) has shown efficacy on many inflammatory disorders. The aim of the present study was to examine the efficacy of CSF on wound healing in a rat model of perianal ulceration. A rat model of perianal ulceration was induced by subcutaneous injection of 75% glacial acetic acid. The animals with induced perianal ulcer received topical treatment of low, medium, and high doses of CFS twice daily. Potassium permanganate (PP); 0.02%) was given to the animals for comparison. Macroscopic and histological assessments of the ulcerated area were performed after treatment. The expression of pro-inflammatory cytokines prostaglandin E 2 (PGE 2 ) and interleukin-8 (IL-8) was detected by immunohistochemical analysis. Topical administration of medium- and high-dose CSF significantly enhanced perianal ulcer healing as compared to the untreated control (p<0.05). The macroscopic ulceration score was significantly reduced only in the high-dose CSF-treated group as compared to the control (p<0.01). All doses of CSF and PP ameliorated histological damages in the rats with induced perianal ulceration. High-dose CSF or PP significantly reduced the expression of PGE 2 and IL-8 as compared to the control (p<0.01). No treatment-related toxicity was found in either the CSF- or the PP-treated mice. CSF enhances wound healing in a rat model of perianal ulceration. The inhibitory effect of CSF on pro-inflammatory cytokines PGE 2 and IL-8 may be involved in the mechanism of enhanced wound-healing. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

A Rare Case of Anal and Perianal Chemical Burn in a Child due to Potassium Permanganate Crystals.

PubMed

Dash, Suvashis; Bhojani, Jatin; Sharma, Sharadendu

2018-02-09

Many chemicals used as medical treatments can cause chemical burns as an untoward side effect. One of such chemicals is potassium permanganate. It is a caustic chemical used as a disinfectant. The most common sites of burn by potassium permanganate are exposed sites like the face and hands. Chemical burns in the perianal and anal region are rare in clinical practice and even sparser in the pediatric age group. In this article, we report a case of perianal and anal chemical burn in an 18-month-old, male child, caused by potassium permanganate crystal applied wrongly for the treatment of pinworm infestation. As a chemical burn in this region can have serious complications, it is necessary to be vigilant when using such chemicals in these cases. Early and timely management in such cases leads to good outcomes. This is the first of such cases of chemical burn caused by potassium permanganate in the anal and perianal region.

The NOD2 Single Nucleotide Polymorphism rs72796353 (IVS4+10 A>C) Is a Predictor for Perianal Fistulas in Patients with Crohn's Disease in the Absence of Other NOD2 Mutations.

PubMed

Schnitzler, Fabian; Friedrich, Matthias; Wolf, Christiane; Stallhofer, Johannes; Angelberger, Marianne; Diegelmann, Julia; Olszak, Torsten; Tillack, Cornelia; Beigel, Florian; Göke, Burkhard; Glas, Jürgen; Lohse, Peter; Brand, Stephan

2015-01-01

A previous study suggested an association of the single nucleotide polymorphism (SNP) rs72796353 (IVS4+10 A>C) in the NOD2 gene with susceptibility to Crohn's disease (CD). However, this finding has not been confirmed. Given that NOD2 variants still represent the most important predictors for CD susceptibility and phenotype, we evaluated the association of rs72796353 with inflammatory bowel disease (IBD) susceptibility and the IBD phenotype. Genomic DNA from 2256 Caucasians, including 1073 CD patients, 464 patients with ulcerative colitis (UC), and 719 healthy controls, was genotyped for the NOD2 SNP rs72796353 and the three main CD-associated NOD2 mutations rs2066844, rs2066845, and rs2066847. Subsequently, IBD association and genotype-phenotype analyses were conducted. In contrast to the strong associations of the NOD2 SNPs rs2066844 (p=3.51 x 10(-3)), rs2066845 (p=1.54 x 10(-2)), and rs2066847 (p=1.61 x 10(-20)) with CD susceptibility, no significant association of rs72796353 with CD or UC susceptibility was found. However, in CD patients without the three main CD-associated NOD2 mutations, rs72796353 was significantly associated with the development of perianal fistulas (p=2.78 x 10(-7), OR 5.27, [95% CI 2.75-10.12] vs. NOD2 wild-type carriers). Currently, this study represents the largest genotype-phenotype analysis of the impact of the NOD2 variant rs72796353 on the disease phenotype in IBD. Our data demonstrate that in CD patients the IVS4+10 A>C variant is strongly associated with the development of perianal fistulas. This association is particularly pronounced in patients who are not carriers of the three main CD-associated NOD2 mutations, suggesting rs72796353 as additional genetic marker for the CD disease behaviour.

p16 immunostaining in keratinocytic neoplasia in organ transplant recipients: Bowen's disease shows a characteristic pattern.

PubMed

Genders, Roel E; Beck, Samuel; Bouwes Bavinck, Jan Nico; van den Munckhof, Henk A M; Kouwenhoven, Stijn T P; de Koning, Maurits N C; de Gruijl, Frank R; Jenkins, David; Willemze, Rein; Quint, Koen D

2017-01-01

For selecting therapy, it is important to distinguish different types of keratinocytic neoplasia. It is sometimes difficult to make histopathologic diagnosis, especially in organ transplant recipients (OTR) who develop numerous lesions. To investigate p16 immunostaining in different types of keratinocytic neoplasia in OTR, we studied 59 actinic keratoses (AK), 51 Bowen' s disease (BD), 63 squamous cell carcinomas (SCC), 16 benign keratotic lesions (BKL) from 31 OTR patients and 25 controls (eczema and psoriasis). Tissue sections were stained for H&E and p16. We scored intensity, proportion and distribution of p16 positive lesional cells. In 19% of AK, 92% of BD, 35% of SCC and 12% of BKL more than 15% of lesional cells were p16-positive. In 16% of AK, 80% of BD, 18% of SCC and 13% of BKL strong p16 staining was observed. BKL, AK and SCC showed focal and patchy staining, BD showed diffuse pattern with strong staining of all atypical cells. Sparing of the basal layer was predominantly seen in BD. No control specimen showed p16-overexpression. p16 immunostaining shows a characteristic pattern in BD, but not in AK, SCC and BKL. It appears useful in recognizing BD, but not in differentiating between other keratinocytic neoplasia. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Energy Balance Bowen Ratio (EBBR) Handbook

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cook, D. R.

2016-01-01

The Energy Balance Bowen Ratio (EBBR) system produces 30-minute estimates of the vertical fluxes of sensible and latent heat at the local surface. Flux estimates are calculated from observations of net radiation, soil surface heat flux, and the vertical gradients of temperature and relative humidity (RH). Meteorological data collected by the EBBR are used to calculate bulk aerodynamic fluxes, which are used in the Bulk Aerodynamic Technique (BA) EBBR value-added product (VAP) to replace sunrise and sunset spikes in the flux data. A unique aspect of the system is the automatic exchange mechanism (AEM), which helps to reduce errors frommore » instrument offset drift.« less

Detection of Human Papillomavirus Types 6 and 11 in Pubic and Perianal Hair from Patients with Genital Warts

PubMed Central

Boxman, Ingeborg L. A.; Hogewoning, Arjan; Mulder, Linda H. C.; Bavinck, Jan Nico Bouwes; ter Schegget, Jan

1999-01-01

Genital human papillomavirus (HPV) types 6 and 11 are of clinical importance due to their role in the development of anogenital warts. A pilot study was performed to investigate whether DNAs from HPV types 6 and 11 are present in hairs plucked from the pubic and perianal regions and eyebrows of patients with genital warts at present and patients with a recent history of genital warts. Genital HPV DNA was detected in 9 of 25 (36%) pubic hair samples and in 11 of 22 (50%) perianal hair samples by the CPI/CPIIg PCR. After sequencing of 17 of 20 samples, HPV type 6 or 11 was detected in 6 of 25 (24%) hair samples from the pubis and 8 of 22 (36%) hair samples from the perianal region. These types were not detected in plucked eyebrow hairs. In contrast, the HPV types associated with epidermodysplasia verruciformis were detected in similar proportions (62%) in both samples of pubic and eyebrow hairs. Moreover, HPV type 6 and 11 DNAs were detected in pubic hairs plucked from two patients who had been successfully treated and who did not show any lesion at the time of hair collection; this finding is an argument that HPV DNA may persist in this region. The presence of genital HPV types in plucked pubic and perianal hair suggests that there is an endogenous reservoir for HPV which may play a role in the recurrences of genital warts. PMID:10364596

Detection of human papillomavirus types 6 and 11 in pubic and perianal hair from patients with genital warts.

PubMed

Boxman, I L; Hogewoning, A; Mulder, L H; Bouwes Bavinck, J N; ter Schegget, J

1999-07-01

Genital human papillomavirus (HPV) types 6 and 11 are of clinical importance due to their role in the development of anogenital warts. A pilot study was performed to investigate whether DNAs from HPV types 6 and 11 are present in hairs plucked from the pubic and perianal regions and eyebrows of patients with genital warts at present and patients with a recent history of genital warts. Genital HPV DNA was detected in 9 of 25 (36%) pubic hair samples and in 11 of 22 (50%) perianal hair samples by the CPI/CPIIg PCR. After sequencing of 17 of 20 samples, HPV type 6 or 11 was detected in 6 of 25 (24%) hair samples from the pubis and 8 of 22 (36%) hair samples from the perianal region. These types were not detected in plucked eyebrow hairs. In contrast, the HPV types associated with epidermodysplasia verruciformis were detected in similar proportions (62%) in both samples of pubic and eyebrow hairs. Moreover, HPV type 6 and 11 DNAs were detected in pubic hairs plucked from two patients who had been successfully treated and who did not show any lesion at the time of hair collection; this finding is an argument that HPV DNA may persist in this region. The presence of genital HPV types in plucked pubic and perianal hair suggests that there is an endogenous reservoir for HPV which may play a role in the recurrences of genital warts.

High-risk human papillomavirus infection in Bowen's disease of the nail unit: report of three cases and review of the literature.

PubMed

Grundmeier, Natalie; Hamm, Henning; Weissbrich, Benedikt; Lang, Sabrina Christine; Bröcker, Eva-Bettina; Kerstan, Andreas

2011-01-01

Bowen's disease (BD) of the nail unit is associated with human papillomavirus (HPV) infection. This study aimed to investigate the frequency of high-risk HPV infection, gender, age and digital distribution in this condition. Biopsy specimens of 3 consecutive cases with periungual BD were investigated for the presence of HPV DNA by in situ hybridization and by polymerase chain reaction (PCR). Furthermore, 74 cases of ungual BD conducted with HPV genotyping as reported in the literature were reviewed. PCR of biopsy specimens revealed in 2 cases infection with HPV-16 and in 1 case with HPV-73. Additionally, in 1 HPV-16-positive case HPV-31/33 was detected by in situ hybridization. In line, review of the literature demonstrated a clear association of HPV-positive BD with high-risk HPV types. Interestingly, age at diagnosis was significantly lower in women. Whereas in both genders the second to fourth fingers on both hands were commonly diseased, only in men the thumbs were also prominently affected. Infection with high-risk HPV types is common in BD of the nail unit suggesting the aetiological cause. Therefore, patients and partners should be closely followed up for digital and genital HPV-associated lesions. Copyright © 2012 S. Karger AG, Basel.

Perianal lesions after return from Togo: An isolated cutaneous manifestation of schistosomiasis.

PubMed

Note, Stéphanie; Vanbrabant, Peter; Soentjens, Patrick

2016-12-01

Isolated perianal lesions in a returned traveller from Togo were observed. Eosinophilia was the lead to schistosomiasis, although no systemic symptoms were reported. This case report of cutaneous schistosomiasis demonstrates the importance of a travel history, especially geographic and exposure features, and treats the differential diagnosis of eosinophilia in a returned traveller with skin lesions.

3D high-resolution anorectal manometry in patients with perianal fistulas: comparison with 3D-anal ultrasound.

PubMed

Felt-Bersma, Richelle J F; Vlietstra, Maarten S; Vollebregt, Paul F; Han-Geurts, Ingrid J M; Rempe-Sorm, Vera; Vander Mijnsbrugge, Grietje J H; Molenaar, Charlotte B H

2018-04-04

Perianal fistula surgery can damage the anal sphincters which may cause faecal incontinence. By measuring regional pressures, 3D-HRAM potentially provides better guidance for surgical strategy in patients with perianal fistulas. The aim was to measure regional anal pressures with 3D-HRAM and to compare these with 3D-EUS findings in patients with perianal fistulas. Consecutive patients with active perianal fistulas who underwent both 3D-EUS and 3D-HRAM at a clinic specialised in proctology were included. A group of 30 patients without fistulas served as controls. Data regarding demographics, complaints, previous perianal surgical procedures and obstetric history were collected. The mean and regional anal pressures were measured with 3D-HRAM. Fistula tract areas detected with 3D-EUS were analysed with 3D-HRAM by visual coding and the regional pressures of the corresponding and surrounding area of the fistula tract areas were measured. The study was granted by the VUmc Medical Ethical Committee. Forty patients (21 males, mean age 47) were included. Four patients had a primary fistula, 19 were previously treated with a seton/abscess drainage and 17 had a recurrence after previously performed fistula surgery. On 3D-HRAM, 24 (60%) fistula tract areas were good and 8 (20%) moderately visible. All but 7 (18%) patients had normal mean resting pressures. The mean resting pressure of the fistula tract area was significantly lower compared to the surrounding area (47 vs. 76 mmHg; p < 0.0001). Only 2 (5%) patients had a regional mean resting pressure < 10 mmHg of the fistula tract area. Using a Δ mean resting pressure ≥ 30 mmHg difference between fistula tract area and non-fistula tract area as alternative cut-off, 21 (53%) patients were identified. In 6 patients 3D-HRAM was repeated after surgery: a local pressure drop was detected in one patient after fistulotomy with increased complaints of faecal incontinence. Profound local anal pressure drops are found

Condylomata acuminata, giant condyloma acuminatum (Buschke-Loewenstein tumour) and verrucous squamous carcinoma of the perianal and anorectal region: a continuous precancerous spectrum?

PubMed

Bogomoletz, W V; Potet, F; Molas, G

1985-11-01

Seven patients with perianal and anorectal giant condyloma acuminatum (Buschke-Loewenstein tumour) are presented. In five of these patients histopathological examination of the lesions disclosed varying degrees of dysplasia and/or squamous carcinoma. The clinicopathological features and aetiology of perianal and anorectal condylomata acuminata, giant condyloma acuminatum and verrucous carcinoma are discussed. The viral induction and malignant transformation of these papillomatous squamous lesions are emphasized.

Energy Balance Bowen Ratio Station (EBBR) Handbook

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cook, DR

2011-02-23

The energy balance Bowen ratio (EBBR) system produces 30-minute estimates of the vertical fluxes of sensible and latent heat at the local surface. Flux estimates are calculated from observations of net radiation, soil surface heat flux, and the vertical gradients of temperature and relative humidity (RH). Meteorological data collected by the EBBR are used to calculate bulk aerodynamic fluxes, which are used in the Bulk Aerodynamic Technique (BA) EBBR value-added product (VAP) to replace sunrise and sunset spikes in the flux data. A unique aspect of the system is the automatic exchange mechanism (AEM), which helps to reduce errors frommore » instrument offset drift.« less

Predicting factors of fistula healing and clinical remission after infliximab-based combined therapy for perianal fistulizing Crohn's disease.

PubMed

Tougeron, David; Savoye, Guillaume; Savoye-Collet, Céline; Koning, Edith; Michot, Francis; Lerebours, Eric

2009-08-01

Perianal fistulizing Crohn's disease (PFCD) treatment is based on fistula drainage, antibiotics, immunosuppressant (IS) drugs, and infliximab. Our aim was to study the effectiveness of combination therapy on PFCD and to search for clinical or imaging features associated with the initial complete clinical response and its stability overtime. All patients with PFCD treated in our tertiary center between 2000 and 2005 by infliximab in combination with seton placement and/or IS and evaluated by MRI before treatment were included in the study. Basal clinical and MRI characteristics were recorded. Response to treatment was evaluated after the infliximab induction regiment and at the end of the follow-up. Twenty-six patients were included and followed-up for an average 4.9 years. A complex fistula was present in 69% (18/26 patients) of cases and eight (8/26 patients) had an ano-vaginal fistula. After infliximab induction therapy, 13 patients (50%) achieved a complete clinical response. The initial clinical response was significantly associated with the absence of both, active intestinal disease (54% vs. 8%, P = 0.03) and active proctitis (77% vs. 23%, P = 0.01). No initial MRI characteristics were linked to the initial response. In multivariate analysis, only the presence of active proctitis was associated with the lack of response (P = 0.047). At the end of the follow-up, 42% of the patients remained in clinical remission. No clinical characteristics were associated to sustained response when among long-standing responders two exhibited a normal post-treatment MRI. An initial complete response of PFCD was observed in half of the patients after combined therapy including infliximab that decreased to 42% later on. Complete healing of fistulas on MRI was possible but unusual. The initial response seemed related to the absence of active intestinal disease, especially in the rectum, when the long-term response could not be predicted by the basal characteristics of patients.

Taste and odor occurrence in Lake William C. Bowen and Municipal Reservoir #1, Spartanburg County, South Carolina

USGS Publications Warehouse

Journey, Celeste; Arrington, Jane M.

2009-01-01

The U.S. Geological Survey and Spartanburg Water are working cooperatively on an ongoing study of Lake Bowen and Reservoir #1 to identify environmental factors that enhance or influence the production of geosmin in the source-water reservoirs. Spartanburg Water is using information from this study to develop management strategies to reduce (short-term solution) and prevent (long-term solution) geosmin occurrence. Spartanburg Water utility treats and distributes drinking water to the Spartanburg area of South Carolina. The drinking water sources for the area are Lake William C. Bowen (Lake Bowen) and Municipal Reservoir #1 (Reservoir #1), located north of Spartanburg. These reservoirs, which were formed by the impoundment of the South Pacolet River, were assessed in 2006 by the South Carolina Department of Health and Environmental Control (SCDHEC) as being fully supportive of all uses based on established criteria. Nonetheless, Spartanburg Water had noted periodic taste and odor problems due to the presence of geosmin, a naturally occurring compound in the source water. Geosmin is not harmful, but its presence in drinking water is aesthetically unpleasant.

Technical note: Using distributed temperature sensing for Bowen ratio evaporation measurements

NASA Astrophysics Data System (ADS)

Schilperoort, Bart; Coenders-Gerrits, Miriam; Luxemburg, Willem; Jiménez Rodríguez, César; Cisneros Vaca, César; Savenije, Hubert

2018-01-01

Rapid improvements in the precision and spatial resolution of distributed temperature sensing (DTS) technology now allow its use in hydrological and atmospheric sciences. Introduced by ) is the use of DTS for measuring the Bowen ratio (BR-DTS), to estimate the sensible and latent heat flux. The Bowen ratio is derived from DTS-measured vertical profiles of the air temperature and wet-bulb temperature. However, in previous research the measured temperatures were not validated, and the cables were not shielded from solar radiation. Additionally, the BR-DTS method has not been tested above a forest before, where temperature gradients are small and energy storage in the air column becomes important. In this paper the accuracy of the wet-bulb and air temperature measurements of the DTS are verified, and the resulting Bowen ratio and heat fluxes are compared to eddy covariance data. The performance of BR-DTS was tested on a 46 m high tower in a mixed forest in the centre of the Netherlands in August 2016. The average tree height is 26 to 30 m, and the temperatures are measured below, in, and above the canopy. Using the vertical temperature profiles the storage of latent and sensible heat in the air column was calculated. We found a significant effect of solar radiation on the temperature measurements, leading to a deviation of up to 3 K. By installing screens, the error caused by sunlight is reduced to under 1 K. Wind speed seems to have a minimal effect on the measured wet-bulb temperature, both below and above the canopy. After a simple quality control, the Bowen ratio measured by DTS correlates well with eddy covariance (EC) estimates (r2 = 0.59). The average energy balance closure between BR-DTS and EC is good, with a mean underestimation of 3.4 W m-2 by the BR-DTS method. However, during daytime the BR-DTS method overestimates the available energy, and during night-time the BR-DTS method estimates the available energy to be more negative. This difference could be

Progression From Perianal High-Grade Anal Intraepithelial Neoplasia to Anal Cancer in HIV-Positive Men Who Have Sex With Men.

PubMed

Tinmouth, Jill; Peeva, Valentina; Amare, Henok; Blitz, Sandra; Raboud, Janet; Sano, Marie; Steele, Leah; Salit, Irving E

2016-09-01

High-grade intraepithelial neoplasia is known to progress to invasive squamous-cell carcinoma of the anus. There are limited reports on the rate of progression from high-grade intraepithelial neoplasia to anal cancer in HIV-positive men who have sex with men. The purpose of this study was to describe in HIV-positive men who have sex with men with perianal high-grade intraepithelial neoplasia the rate of progression to anal cancer and the factors associated with that progression. This was a prospective cohort study. The study was conducted at an outpatient clinic at a tertiary care center in Toronto. Thirty-eight patients with perianal high-grade anal intraepithelial neoplasia were identified among 550 HIV-positive men who have sex with men. All of the patients had high-resolution anoscopy for symptoms, screening, or surveillance with follow-up monitoring/treatment. We measured the incidence of anal cancer per 100 person-years of follow-up. Seven (of 38) patients (18.4%) with perianal high-grade intraepithelial neoplasia developed anal cancer. The rate of progression was 6.9 (95% CI, 2.8-14.2) cases of anal cancer per 100 person-years of follow-up. A diagnosis of AIDS, previously treated anal cancer, and loss of integrity of the lesion were associated with progression. Anal bleeding was more than twice as common in patients who progressed to anal cancer. There was the potential for selection bias and patients were offered treatment, which may have affected incidence estimates. HIV-positive men who have sex with men should be monitored for perianal high-grade intraepithelial neoplasia. Those with high-risk features for the development of anal cancer may need more aggressive therapy.

[Efficacy of infliximab in the treatment of korean patients with crohns disease].

PubMed

Kim, Sai Hui; Yang, Suk; Kim, Kyung Jo; Kim, Eun Hee; Yoon, Soon Man; Ye, Byong Duk; Byeon, Jeong Sik; Myung, Seung Jae; Kim, Jin Ho

2009-08-01

Infliximab has been proven to be effective for refractory luminal and fistulizing Crohns disease (CD). We performed this study to demonstrate the efficacy of infliximab in Korean CD patients. Medical records of 40 CD patients who had been treated with infliximab were reviewed retrospectively. Among 40 patients, 11 (27.5%) patients were treated for refractory luminal disease, 14 (35%) for fistulizing disease, and 15 (37.5%) for both types. Clinical response rate was higher in 26 patients with refractory luminal disease (Complete response (CR), 73.1%; Partial response (PR), 23.1%) than in 29 patients with fistulizing disease (CR, 41.4%; PR, 31%) (p=0.024). The clinical response rate tended to be higher in 28 patients with external fistulas (CR, 46.4%; PR, 32.2%) than 4 patients with internal fistulas (PR, 25%; NR, 75%) (p=0.064). Among patients with external fistulas, the response rate of 8 patients with enterocutaneous fistulas (CR, 50%; PR, 12.5%) was not different from 20 patients with perianal fistulas (CR, 45%; PR, 40%). Among 20 patients with perianal fistulas, the response rate of 6 patients with perianal fistulas without a history of operation (CR, 83.3%; PR, 0%) was higher than 14 patients with perianal fistulas resistant to previous surgical treatment (CR, 28.6%; PR, 57.1%) (p=0.044). As for adverse reaction, 7 patients experienced mild infusion reaction, and 2 patients developed serious infection. Infliximab is more effective for refractory luminal disease than for fistulizing disease. In addition, clinical responses to infliximab are different according to subtypes of fistulas. These findings should be considered for the proper use of infliximab.

A Bowen Family Systems Model of Generalized Anxiety Disorder and Romantic Relationship Distress.

PubMed

Priest, Jacob B

2015-07-01

Many individuals with generalized anxiety disorder (GAD) do not respond well to currently available treatments. Moreover, treatments are less effective when GAD is accompanied by romantic relationship distress. In order to develop effective treatments for GAD and relationship distress, it is necessary to conduct theory-based research to identify links common to both GAD and romantic relationship distress. Drawing on Bowen's family systems theory, the roles of family abuse/violence and differentiation in GAD and romantic relationship distress were examined using existing data from the National Comorbidity Survey Replication (n = 2,312; 2005). As predicted, family abuse/violence was directly linked to both GAD and romantic relationship distress. Differentiation mediated the relationship between family abuse/violence and GAD, and partially mediated the relationship between family abuse/violence and romantic relationship distress. Findings suggest that current and past relationship processes may help maintain chronic anxiety and that Bowen's theory may be a useful framework for developing couple therapy treatment of GAD and romantic relationship distress. © 2013 American Association for Marriage and Family Therapy.

Photodynamic therapy in combination with CO2 laser for the treatment of Bowen's disease.

PubMed

Cai, Hong; Wang, Yi-xia; Zheng, Ji-Chun; Sun, Ping; Yang, Zhi-yong; Li, Yuan-li; Liu, Xiao-yong; Li, Qiang; Liu, Wei

2015-07-01

Photodynamic therapy (PDT) involves the activation of a previously administered photosensitizing agent by visible light to induce tumor necrosis. Photosensitizers are topically applied in the treatment of skin tumors to avoid systemic side effects. In this study, we evaluated the feasibility and efficacy of aminolevulinic acid (ALA) as a photosensitizer (ALA-PDT) in combination with CO2 laser in the treatment of Bowen's disease (BD; intraepithelial squamous cell carcinoma). Twenty-two lesions from 18 patients were randomized into two groups: 11 lesions were treated with topical ALA-PDT (180 J/cm(2) at 100 mW/cm(2)) + CO2 laser for one to three sessions. The remaining 11 lesions were treated with CO2 laser alone, serving as control group. All patients were reviewed at ≤1-week intervals. Biopsies were taken from BD lesions prior to treatment. The initial evaluation was undertaken 1 month after treatment, and biopsies were harvested for histological evaluation. Patients who did not respond to the three sessions of treatment were referred to surgical treatment. In the ALA-PDT + CO2 laser group, 72.73 % (8/11) of BD lesions showed complete remission, with an overall clearance of 90.91 %, and only one recurred (9 %) during follow-up. Local side effects included mild erythema, edema, erosion, and burning and/or stinging sensation. No systemic side effects were observed. In the control group, 63.63 % (7/11) of lesions had complete remission and the overall clearance was 54.55 %. However, five lesions (45.45 %) had recurrence. Local side effects included mild to moderate edema, erosion, ulceration, delayed healing, prolonged pain, and scarring. There existed a significant difference in recurrence rate between the two groups (P < 0.05). Moreover, after ALA-PDT plus CO2 laser treatment, complete necrosis was observed in responsive lesions, and 3 months later, the atypical BD cells were replaced by normal keratinocytes. Topical ALA-PDT in combination

Limnological Conditions in Lake William C. Bowen and Municipal Reservoir #1, Spartanburg County, South Carolina, August to September 2005, May 2006, and October 2006

USGS Publications Warehouse

Journey, Celeste A.; Abrahamsen, Thomas A.

2008-01-01

The U.S. Geological Survey, in cooperation with the Spartanburg Water System, conducted three spatial surveys of the limnological conditions in Lake William C. Bowen (Lake Bowen) and Municipal Reservoir #1 (Reservoir #1), Spartanburg County, South Carolina, during August to September 2005, May 2006, and October 2006. The surveys were conducted to identify spatial distribution and concentrations of geosmin and 2-methylisoborneol, common trophic state indicators (nutrients, transparency, and chlorophyll a), algal community structure, and stratification of the water column at the time of sampling. Screening tools such as the Carlson trophic state index, total nitrogen to total phosphorus ratios, and relative thermal resistance to mixing were used to help compare data among sites and among seasons. Water-column samples were collected at two depths at each selected site: a near-surface sample collected above a 1-meter depth and a lake-bottom sample collected at a depth of 2.5 to 7 meters, depending on the depth at the site. The degree of stratification of the water column was demonstrated by temperature-depth profiles and computed relative thermal resistance to mixing. Seasonal occurrence of thermal stratification (August to September 2005; May 2006) and de-stratification (October 2006) was evident in the depth profiles of water temperature in Lake Bowen. The most stable water-column (highest relative thermal resistance to mixing) conditions occurred in Lake Bowen during the August to September 2005 survey. The least stable water-column (destratified) conditions occurred in Lake Bowen during the October 2006 survey and Reservoir #1 during all three surveys. Changes with depth in dissolved oxygen (decreased with depth to near anoxic conditions in the hypolimnion), pH (decreased with depth), and specific conductance (increased with depth) along with thermal stratification indicated Lake Bowen was exhibiting characteristics common to both mesotrophic and eutrophic

Efficacy of Bowen Theory on Marital Conflict in the Family Nursing Practice: A Randomized Controlled Trial.

PubMed

Yektatalab, Shahrzad; Seddigh Oskouee, Fatemeh; Sodani, Mansour

2017-03-01

Family plays an important role in health and illness, and preparing the nurses to assess and improve the family functioning and relationship based on a theoretical framework is of critical importance. This randomized controlled trial was performed to evaluate the effectiveness of Bowen system theory on marital conflict in the family nursing practice. A total of 42 couples referring to the family court of Shiraz, Iran were randomly assigned to either the intervention (receiving eight 90-minute sessions of Bowen systemic family therapy) or the control group (receiving no interventions). Outcomes were measured before, after and after one month of the follow up by marital conflict questionnaire and analyzed using repeated measure ANOVAs and t-test. The study results revealed no statistically significant differences between the study groups regarding the total marital conflict scores (t = 2.8, p = .935) or any of the seven subscales of conflict before the intervention (p > .05). However, a significant difference was observed between the two groups in this regard immediately and one month after the intervention (p < .05). The results demonstrated a significant difference between the intervention and control groups regarding the conflict scores and its subscales during the three study periods and groups (F = 79.43, p < .001). This study highlighted the importance of applying Bowen systemic family therapy by nurses in decreasing marital conflicts. Similar studies with larger sample sizes and longer follow-ups are recommended to be conducted on the issue.

Sinecatechins and imiquimod as proactive sequential therapy of external genital and perianal warts in adults.

PubMed

Schöfer, Helmut; Tatti, Silvio; Lynde, Charles W; Skerlev, Mihael; Hercogová, Jana; Rotaru, Maria; Ballesteros, Juan; Calzavara-Pinton, Piergiacomo

2017-12-01

This review about the proactive sequential therapy (PST) of external genital and perianal warts (EGW) is based on the most current available clinical literature and on the broad clinical experience of a group of international experts, physicians who are well versed in the treatment of human papillomavirus-associated diseases. It provides a practical guide for the treatment of EGW, including epidemiology, etiology, clinical appearance, and diagnostic procedures for these viral infections. Furthermore, the treatment goals and current treatment options, elucidating provider- and patient-applied therapies, and the parameters driving treatment decisions are summarized. Specifically, the mode of action of the topical treatments sinecatechins and imiquimod, as well as the PST for EGW to achieve rapid and sustained clearance is discussed. The group of experts has developed a treatment algorithm giving healthcare providers a practical tool for the treatment of EGW which is very valuable in the presence of many different treatment options.

Fistulizing Crohn's disease: Diagnosis and management.

PubMed

Gecse, Krisztina; Khanna, Reena; Stoker, Jaap; Jenkins, John T; Gabe, Simon; Hahnloser, Dieter; D'Haens, Geert

2013-06-01

Fistulizing Crohn's disease represents an evolving, yet unresolved, issue for multidisciplinary management. Perianal fistulas are the most frequent findings in fistulizing Crohn's disease. While enterocutaneous fistulas are rare, they are associated with considerable morbidity and mortality. Detailed evaluation of the fistula tract by advanced imaging techniques is required to determine the most suitable management options. The fundamentals of perianal fistula management are to evaluate the complexity of the fistula tract, and exclude proctitis and associated abscess. The main goals of the treatment are abscess drainage, which is mandatory, before initiating immunosuppressive medical therapy, resolution of fistula discharge, preservation of continence and, in the long term, avoidance of proctectomy with permanent stoma. The management of enterocutaneous fistulas comprises of sepsis control, skin care, nutritional optimization and, if needed, delayed surgery.

Squamous cell carcinoma of the anal and perianal area in a bull.

PubMed

Musser, J M; Russell, K E; Veatch, J K; St-Jean, G

1993-01-01

A squamous cell carcinoma located adjacent to the anus was diagnosed in a 15-year-old light colored Longhorn bull. The tumor restricted the anal orifice to a diameter of 3 cm. Upon histological evaluation, islands of squamous cells were present deep in the dermis and the submucosal connective tissue. It was not possible to determine whether the tumor originated from the perianal region or the anus. This is the first diagnosed and reported occurrence in North America of squamous cell carcinoma in the anal region of a bull.

The Rising Cost of Higher Education: Charles Eliot's "Free Money" Strategy and the Beginning of Howard Bowen's "Revenue Theory of Cost," 1869-1979

ERIC Educational Resources Information Center

Kimball, Bruce A.

2014-01-01

In order to explain the rising cost of higher education, economist Howard Bowen in 1980 proposed his "famous law" of institutional finance. Bowen based his "revenue theory of cost" on a study of aggregate quantitative data extending from 1929 to 1979. Neither he nor subsequent economists asked whether or how that…

Spectrophotometry near the atmospheric cutoff of the strongest Bowen resonance fluorescence lines of O III in two planetary nebulae

NASA Technical Reports Server (NTRS)

O'Dell, C. R.; Opal, Chet B.

1989-01-01

Spectrophotometric results are presented for the stronger, well-resolved Bowen O III resonance fluorescence emission lines in the planetary nebulae 7027 and NGC 7662 down to and including the intrinsically strong line at 3133 A. These data are combined with results from the IUE atlas of spectra and similar results for the longer wavelength lines by Likkel and Aller (1986) to give the first full coverage of the Bowen lines. Good agreement is found with fluorescence theory for the primary cascade lines, except for the Likkel and Aller results. The efficiency of conversion of the exciting He II Ly-alpha into O III lines is determined, and values comparable to other planetary nebulae are found.

Bowen emission from Aquila X-1: evidence for multiple components and constraint on the accretion disc vertical structure

NASA Astrophysics Data System (ADS)

Jiménez-Ibarra, F.; Muñoz-Darias, T.; Wang, L.; Casares, J.; Mata Sánchez, D.; Steeghs, D.; Armas Padilla, M.; Charles, P. A.

2018-03-01

We present a detailed spectroscopic study of the optical counterpart of the neutron star X-ray transient Aquila X-1 during its 2011, 2013 and 2016 outbursts. We use 65 intermediate resolution GTC-10.4 m spectra with the aim of detecting irradiation-induced Bowen blend emission from the donor star. While Gaussian fitting does not yield conclusive results, our full phase coverage allows us to exploit Doppler mapping techniques to independently constrain the donor star radial velocity. By using the component N III 4640.64/4641.84 Å, we measure Kem = 102 ± 6 km s-1. This highly significant detection (≳13σ) is fully compatible with the true companion star radial velocity obtained from near-infrared spectroscopy during quiescence. Combining these two velocities we determine, for the first time, the accretion disc opening angle and its associated error from direct spectroscopic measurements and detailed modelling, obtaining α = 15.5 ^{+ 2.5}_{-5} deg. This value is consistent with theoretical work if significant X-ray irradiation is taken into account and is important in the light of recent observations of GX339-4, where discrepant results were obtained between the donor's intrinsic radial velocity and the Bowen-inferred value. We also discuss the limitations of the Bowen technique when complete phase coverage is not available.

Fistulizing Crohn’s disease: Diagnosis and management

PubMed Central

Gecse, Krisztina; Khanna, Reena; Stoker, Jaap; Jenkins, John T; Gabe, Simon; Hahnloser, Dieter

2013-01-01

Fistulizing Crohn’s disease represents an evolving, yet unresolved, issue for multidisciplinary management. Perianal fistulas are the most frequent findings in fistulizing Crohn’s disease. While enterocutaneous fistulas are rare, they are associated with considerable morbidity and mortality. Detailed evaluation of the fistula tract by advanced imaging techniques is required to determine the most suitable management options. The fundamentals of perianal fistula management are to evaluate the complexity of the fistula tract, and exclude proctitis and associated abscess. The main goals of the treatment are abscess drainage, which is mandatory, before initiating immunosuppressive medical therapy, resolution of fistula discharge, preservation of continence and, in the long term, avoidance of proctectomy with permanent stoma. The management of enterocutaneous fistulas comprises of sepsis control, skin care, nutritional optimization and, if needed, delayed surgery. PMID:24917961

A case of lymphogranuloma venereum of 20 years' duration. Isolation of Chlamydia trachomatis from perianal lesions.

PubMed Central

Dan, M; Rotmensch, H H; Eylan, E; Rubinstein, A; Ginsberg, R; Liron, M

1980-01-01

Chlamydia trachomatis was isolated from perianal lesions in a patient in whom lymphogranuloma venereum had been diagnosed 20 years previously. Treatment with tetracycline resulted in a pronounced improvement. Although C trachomatis is known to persist for a long time in the host, isolation of the micro-organism from infected tissues after such a prolonged period has not previously been reported. Images PMID:7427708

Anorectal Complications During Neutropenic Period in Patients with Hematologic Diseases

PubMed Central

Solmaz, Soner; Korur, Aslı; Gereklioğlu, Çiğdem; Asma, Süheyl; Büyükkurt, Nurhilal; Kasar, Mutlu; Yeral, Mahmut; Kozanoğlu, İlknur; Boğa, Can; Ozdoğu, Hakan

2016-01-01

Background Neutropenic patients are susceptible to any anorectal disease, and symptomatic anorectal disease afflicts 2–32% of oncology patients. Perianal infections are the most feared complication, considering the lack of natural defense against infectious microorganisms. When septic complications develop, the anorectal disease is potentially fatal, especially in neutropenic patients in whom mortality rates range between 11–57%. Although anorectal diseases are a frequent complication with potentially fatal outcomes among patients with hematologic diseases, sufficient data are not available in the literature. In this study, we aimed to investigate the anorectal complications developing during the neutropenic period in patients with hematologic diseases. Methods A total of 79 patients whose neutropenic period (absolute neutrophil count <500/mcL) continued for 7 days, or longer were included in the study. Results A total of 34 patients out of 79 (43%) were detected to develop anorectal complications, of them 6 (7.6%) developed an anorectal infection. The patients were characterized according to the hematological disease and its status (active or not), the type of treatment and the presence of a history of an anorectal pathology before the onset of the hematologic disease. Nineteen (24.1%) patients had the history of anorectal disturbances before diagnosis of the hematologic disease, and recurrence of an anorectal pathology was found in 14 out of 19 patients(73.7%). In addition, the overall mortality rate was higher among the patients who developed anorectal complications compared to another group (41.2% vs. 22.2%, p=0.059). Conclusion Anorectal pathology is a common complication with high recurrence rate in neutropenic patients. Perianal infections are important as they can cause life-threatening outcomes although they are relatively rare among all anorectal complications. Therefore perianal signs and symptoms should be meticulously evaluated concerning early

Anomalously high intercombination line ratios in symbiotic stars - Extreme Bowen pumping?

NASA Technical Reports Server (NTRS)

Kastner, S. O.; Bhatia, A. K.; Feibelman, W. A.

1989-01-01

International Ultraviolet Explorer observations of the ratio of the O III intercombination lines near 1660 A are assembled, showing that the observed ratios in symbiotic stars are significantly higher than the theoretically predicted optically thin limit of 2.5. The presence of an enhancing physical process is thereby indicated. It is suggested that Bowen pumping of the lower level of the 1666.2 A line in an 'external saturation' limit, coupled with appreciable optical depth, could logically explain the high ratios. Some tentative evidence for this is presented and the relevance of far-infrared observations of the O III 51.8 and 88.3 micron lines in symbiotic sources is emphasized.

A prospective evaluation of the ligation of the intersphincteric tract procedure for complex anal fistula in patients with Crohn's disease.

PubMed

Gingold, Daniel S; Murrell, Zuri A; Fleshner, Phillip R

2014-12-01

To evaluate 2- and 12-month outcomes after ligation of the intersphincteric fistula tract (LIFT) in Crohn's disease (CD). Surgical approaches to perianal fistulas in CD are frequently ineffective and hampered by concerns over adequate wound healing and sphincter injury. The efficacy of LIFT in CD patients is unknown. Consecutive cases of CD patients with transsphincteric fistulas were prospectively analyzed. Fistula healing and 2 validated quality-of-life indices were assessed. Fifteen CD patients (9 women; mean age = 34.8 years) were identified. Location of the fistula was lateral (n = 10; 67%) or midline (n = 5; 33%). LIFT site healing was seen in 9 patients (60%) at 2-month follow-up. No patient developed fecal incontinence. LIFT site healing was seen in 8 of the 12 patients (67%) with complete 12-month follow-up. Significant factors for long-term LIFT site healing were lateral versus midline location (P = 0.02) and longer mean fistula length (P = 0.02). Patients who had successful operations significantly improved both their mean Wexner Perianal Crohn's Disease Activity Index and McMaster Perianal Crohn's Disease Activity Index quality-of-life scores at 2-month follow-up (14.0-3.8, P = 0.001, and 10.4-1.8, P = 0.0001, respectively). CD-associated anal fistulas may be treated with LIFT. This surgical procedure is a safe, outpatient procedure that minimizes both perianal wound creation and sphincter injury.

Higher Education in the Digital Age. Updated Edition. The William G. Bowen Memorial Series in Higher Education

ERIC Educational Resources Information Center

Bowen, William G.

2015-01-01

Two of the most visible and important trends in higher education today are its exploding costs and the rapid expansion of online learning. Could the growth in online courses slow the rising cost of college and help solve the crisis of affordability? In this short and incisive book, William G. Bowen, one of the foremost experts on the intersection…

The Chabot Emotional Differentiation Scale: A Theoretically and Psychometrically Sound Instrument for Measuring Bowen's Intrapsychic Aspect of Differentiation

ERIC Educational Resources Information Center

Licht, Carolyn; Chabot, David

2006-01-01

Bowen's theory (1978) of differentiation is the personality variable most critical to mature development and the attainment of psychological health. The study of psychological differentiation has been confounded by confusion regarding the constructs being studied and the measurement tools used to assess them. The purpose of this review is to…

Verifying the distributed temperature sensing Bowen ratio method for measuring evaporation

NASA Astrophysics Data System (ADS)

Schilperoort, Bart; Coenders-Gerrits, Miriam; Luxemburg, Willem; Cisneros Vaca, César; Ucer, Murat

2016-04-01

Evaporation is an important process in the hydrological cycle, therefore measuring evaporation accurately is essential for water resource management, hydrological management and climate change models. Current techniques to measure evaporation, like eddy covariance systems, scintillometers, or lysimeters, have their limitations and therefore cannot always be used to estimate evaporation correctly. Also the conventional Bowen ratio surface energy balance method has as drawback that two sensors are used, which results in large measuring errors. In Euser et al. (2014) a new method was introduced, the DTS-based Bowen ratio (BR-DTS), that overcomes this drawback. It uses a distributed temperature sensing technique (DTS) whereby a fibre optic cable is placed vertically, going up and down along a measurement tower. One stretch of the cable is dry, the other wrapped with cloth and kept wet, akin to a psychrometer. Using this, the wet and dry bulb temperatures are determined every 12.5 cm over the height, from which the Bowen ratio can be determined. As radiation and wind have an effect on the cooling and heating of the cable's sheath as well, the DTS cables do not necessarily always measure dry and wet bulb temperature of the air accurately. In this study the accuracy in representing the dry and wet bulb temperatures of the cable are verified, and evaporation observations of the BR-DTS method are compared to Eddy Covariance (EC) measurements. Two ways to correct for errors due to wind and solar radiation warming up the DTS cables are presented: one for the dry cable and one for the wet cable. The measurements were carried out in a pine forest near Garderen (The Netherlands), along a 46-meter tall scaffold tower (15 meters above the canopy). Both the wet (Twet) and dry (Tdry) temperature of the DTS cable were compared to temperature and humidity (from which Twet is derived) observations from sensors placed along the height of the tower. Underneath the canopy, where there was

Intersphincteric proctectomy with end-colostomy for anorectal Crohn's disease results in early and severe proximal colonic recurrence.

PubMed

de Buck van Overstraeten, Anthony; Wolthuis, Albert M; Vermeire, Séverine; Van Assche, Gert; Rutgeerts, Paul; Penninckx, Freddy; D'Hoore, André

2013-07-01

Perianal Crohn's disease (CD) represents a more aggressive phenotype of inflammatory bowel disease and often coincides with proctocolitis. This study aims to assess the outcome of patients undergoing proctectomy with end-colostomy. A retrospective outcome analysis of 10 consecutive patients who underwent intersphincteric proctectomy with end-colostomy between February 2007 and May 2011 was performed. All patients suffered from refractory distal and perianal CD. The proximal colon was normal at endoscopy. All data were extracted from a prospectively maintained database. The main outcome parameter was disease recurrence and need for completion colectomy. Severe and early endoscopic recurrence in the proximal colon occurred in 9/10 patients at a median time interval of 9.5 months (range: 1.9-23.6 months). Despite protracted medical treatment, completion colectomy was necessary in 5 patients. One patient, who underwent a second segmental colectomy with a new end-colostomy, showed again endoscopic recurrence and is currently treated with anti-TNF agents. Intersphincteric proctectomy with colostomy seems to be an ineffective surgery for perianal CD with coexisting proctitis and results in a high risk of recurrence of the disease in the remaining colon. Therefore, despite a normal appearance of the proximal colon, a proctocolectomy with end-ileostomy seems to be the surgical approach of choice in these patients. Copyright © 2012 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

On the Economics of American Higher Education: A Bibliography of Howard R. Bowen. Public Administration Series: Bibliography P-1105.

ERIC Educational Resources Information Center

Quay, Richard H., Comp.

A bibliography of approximately 150 materials authored, coauthored, or edited by Howard R. Bowen from 1935 through 1982 on the economics of American higher education is presented. Specific topics include the following: the wide disparity among colleges in educational cost per student; costs colleges spend per student; adult learning, higher…

Clinical Features and Extraintestinal Manifestations of Crohn Disease in Children

PubMed Central

Lee, Young Ah; Chun, Peter; Hwang, Eun Ha; Mun, Sang Wook; Lee, Yeoun Joo

2016-01-01

Purpose The aim of this study was to investigate the clinical features and extraintestinal manifestations (EIMs) of Crohn disease (CD) in Korean pediatric patients. Methods The medical records of 73 children diagnosed with CD were retrospectively reviewed. Data regarding baseline demographic and clinical characteristics, including CD phenotype at diagnosis based on the Montreal classification, and clinical features and course of EIMs were investigated. Results Fifty-two (71.2%) of the patients were males. The mean age of the patients was 12.5 years. The mean follow-up period was 3.4 years. The disease location was ileal in 3 (4.1%) of the patients, colonic in 13 (17.8%), ileocolonic in 56 (76.7%). The clinical behavior was inflammatory in 62 (84.9%) of the patients, stricturing in 8 (11.0%), and penetrating in 3 (4.1%). Perianal abscesses or fistulas were found in 37 (50.7%) of the patients. EIMs observed during the study period were anal skin tag in 25 patients (34.2%), hypertransaminasemia in 20 (27.4%), peripheral arthritis in 2 (2.7%), erythema nodosum in 2 (2.7%), vulvitis in 1 (1.4%), uveitis in 1 (1.4%), and pulmonary thromboembolism in 1 (1.4%). Conclusion Perianal diseases and manifestations were present in more than half of Korean pediatric CD patients at diagnosis. Inspection of the anus should be mandatory in Korean children with suspicious CD, as perianal fistulas, abscesses, and anal skin tags may be the first clue to the diagnosis of CD. PMID:28090468

Risk Factors for Hidradenitis Suppurativa in Patients with Inflammatory Bowel Disease.

PubMed

Lukach, Alexis J; Saul, Melissa I; Ferris, Laura K; Swoger, Jason M

2018-03-01

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder characterized by recurrent nodules, abscesses, and sinus tracts that can be debilitating and significantly impair quality of life. Small studies and case reports have suggested a possible association between HS and inflammatory bowel disease (IBD). We performed a case-control study to further characterize IBD patients with HS in terms of smoking status, BMI, sites affected by HS, IBD type and features, and IBD medication history. A total of 38 patients with HS and IBD were identified and matched on age, gender, and IBD type to 136 controls with IBD but not HS. Clinical characteristics of interest were obtained through extensive review of the electronic health record. Among patients with HS and IBD, the most common sites affected by HS were the inguinal, perianal, and axillary regions. Relative to patients with IBD alone, patients with HS and IBD were nearly six times more likely to be current smokers (p < 0.01) and nearly 11 times more likely to be obese (p < 0.01). Patients with HS and Crohn's were significantly more likely to have ileocolonic and perianal disease than patients with CD only (OR 8.31, 95% CI 2.90-23.80 and OR 2.85, 95% CI 1.19-6.81, respectively; p < 0.01 for both). Relative to patients with IBD who do not develop HS, patients with IBD and HS are more likely to be overweight or obese, to be former or current smokers, and to have ileocolonic and/or perianal disease.

Effects of different eddy covariance correction schemes on energy balance closure and comparisons with the modified Bowen ratio system

Treesearch

Adam Wolf; Nick Saliendra; Kanat Akshalov; Douglas A. Johnson; Emilio Laca

2008-01-01

Eddy covariance (EC) and modified Bowen ratio (MBR) systems have been shown to yield subtly different estimates of sensible heat (H), latent heat (LE), and CO2 fluxes (Fc). Our study analyzed the discrepancies between these two systems by first considering the role of the data processing algorithm used to estimate fluxes using EC and later...

NF-kappa B activation correlates with disease phenotype in Crohn’s disease

PubMed Central

Han, Yoo Min; Koh, Jaemoon; Lee, Changhyun; Koh, Seong-Joon; Kim, ByeongGwan; Lee, Kook Lae; Im, Jong Pil; Kim, Joo Sung

2017-01-01

Background/Aims Unregulated activation of nuclear factor-κB (NF-κB) plays a critical role in the pathogenesis of Crohn’s disease. In this study, we investigated the clinical characteristics and disease outcome of Crohn’s disease patients with varying levels of the NF-κB activation. Methods Crohn’s disease patients who underwent surgical bowel resection were divided into two groups, based on the activation status of NF-κB. NF-κB activation was assessed by the immunoreactivity of nuclear NF-κB during immunohistochemical staining of bowel resection specimens. We compared the demographic, clinical and histologic characteristics between groups. Furthermore, the occurrence of reoperation, readmission, and medication change due to disease flare-up were investigated according to NF-κB activation status. Results Among 83 Crohn’s disease patients, 47 (56%) showed high NF-κB activity and 36 (44%) showed low NF-κB activity. Patients with high NF-κB activity had higher frequency of ileocolonic involvement (P = 0.028) and lower frequency of perianal involvement (P = 0.042) relative to those with low NF-κB activity. Total histologic scores were significantly higher in patients with high NF-κB activity than those with low NF-κB activity (P = 0.044). There was no significant difference in the frequency of reoperation, readmission, and medication change in relation to NF-κB activation status. Conclusions Crohn’s disease patients with high NF-κB activation showed specific clinical manifestations of higher frequency of ileocolonic involvement and lower frequency of perianal involvement relative to those with low NF-κB activation. High NF-κB activity was associated with higher histologic scores. However, the NF-κB activity did not affect the outcome and disease course after surgery. PMID:28753650

Bathymetry of Lake William C. Bowen and Municipal Reservoir #1, Spartanburg County, South Carolina, 2008

USGS Publications Warehouse

Nagle, D.D.; Campbell, B.G.; Lowery, M.A.

2009-01-01

The increasing use and importance of lakes for water supply to communities enhance the need for an accurate methodology to determine lake bathymetry and storage capacity. A global positioning receiver and a fathometer were used to collect position data and water depth in February 2008 at Lake William C. Bowen and Municipal Reservoir #1, Spartanburg County, South Carolina. All collected data were imported into a geographic information system database. A bathymetric surface model, contour map, and stage-area and -volume relations were created from the geographic information database.

Prospective Evaluation of Acute Toxicity and Quality of Life After IMRT and Concurrent Chemotherapy for Anal Canal and Perianal Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Han, Kathy; Cummings, Bernard J.; Lindsay, Patricia

Purpose: A prospective cohort study was conducted to evaluate toxicity, quality of life (QOL), and clinical outcomes in patients treated with intensity modulated radiation therapy (IMRT) and concurrent chemotherapy for anal and perianal cancer. Methods and Materials: From June 2008 to November 2010, patients with anal or perianal cancer treated with IMRT were eligible. Radiation dose was 27 Gy in 15 fractions to 36 Gy in 20 fractions for elective targets and 45 Gy in 25 fractions to 63 Gy in 35 fractions for gross targets using standardized, institutional guidelines, with no planned treatment breaks. The chemotherapy regimen was 5-fluorouracil and mitomycin C. Toxicitymore » was graded with the National Cancer Institute Common Terminology Criteria for Adverse Events, version 3. QOL was assessed with the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and CR29 questionnaires. Correlations between dosimetric parameters and both physician-graded toxicities and patient-reported outcomes were evaluated by polyserial correlation. Results: Fifty-eight patients were enrolled. The median follow-up time was 34 months; the median age was 56 years; 52% of patients were female; and 19% were human immunodeficiency virus—positive. Stage I, II, III, and IV disease was found in 9%, 57%, 26%, and 9% of patients, respectively. Twenty-six patients (45%) required a treatment break because of acute toxicity, mainly dermatitis (23/26). Acute grade 3 + toxicities included skin 46%, hematologic 38%, gastrointestinal 9%, and genitourinary 0. The 2-year overall survival (OS), disease-free survival (DFS), colostomy-free survival (CFS), and cumulative locoregional failure (LRF) rates were 90%, 77%, 84%, and 16%, respectively. The global QOL/health status, skin, defecation, and pain scores were significantly worse at the end of treatment than at baseline, but they returned to baseline 3 months after treatment. Social functioning and appetite scores were

Diagnostic Delay in Romanian Patients with Inflammatory Bowel Disease: Risk Factors and Impact on the Disease Course and Need for Surgery

PubMed Central

Zaharie, Roxana; Zaharie, Florin; Tantau, Marcel; Gheorghe, Liana; Gheorghe, Cristian; Gologan, Serban; Cijevschi, Cristina; Trifan, Anca; Dobru, Daniela; Goldis, Adrian; Constantinescu, Gabriel; Iacob, Razvan; Diculescu, Mircea

2016-01-01

Background: The epidemiology of inflammatory bowel disease [IBD] in Eastern Europe is poorly understood, particularly with regard to diagnostic delay. Here we investigated the factors leading to delayed diagnosis and the effect of the delay on several disease progression and outcome measures. Methods: A total of 1196 IBD cases [682 ulcerative colitis [UC], 478 Crohn’s disease [CD], 36 indeterminate colitis] from the Romanian national registry IBDPROSPECT were reviewed. Standard clinical and demographic factors were evaluated as predictors of a long diagnostic delay in both CD and UC. Diagnostic delay was subsequently evaluated as a potential risk factor for bowel stenoses, bowel fistulas, perianal fistulas, perianal surgery, and intestinal surgery in CD patients. Results: The median diagnostic delay was significantly longer in CD [5 months] than in UC [1 month] patients [p < 0.001]. Compared with 5 months for UC patients, 75% of CD patients were diagnosed within 18 months of symptom onset. In CD patients, extra-ileal location was a protective factor (odds ratio [OR], 0.5; p = 0.03), whereas being an active smoker [OR, 2.09; p = 0.01] and symptom onset during summer [OR, 3.35; p < 0.001] were independent risk factors for a long diagnostic delay [> 18 months]. In UC patients, an age > 40 years was a protective factor [OR, 0.68; p = 0.04] for a long delay. Regarding outcomes, a long diagnostic delay in CD patients positively correlated with bowel stenoses [OR, 3.38; p < 0.01] and any IBD-related surgery [OR, 1.95; p = 0.03] and had a positive trend for intestinal fistulas [OR, 2.64; p = 0.08] and perianal fistulas [OR, 2.9; p = 0.07]. Disease duration since diagnosis positively correlated with bowel stenoses [OR, 1.04; p = 0.04], any IBD-related surgery [OR, 1.04; p = 0.02], and intestinal surgery [OR, 1.07; p < 0.01]. Conclusions: A long diagnostic delay in IBD correlates with an increased frequency of bowel stenoses and need for IBD-related surgery. PMID:26589956

Patterns of Failure for Rhabdomyosarcoma of the Perineal and Perianal Region

DOE Office of Scientific and Technical Information (OSTI.GOV)

Casey, Dana L.; Wexler, Leonard H.; LaQuaglia, Michael P.

2014-05-01

Purpose: To analyze prognostic factors and patterns of failure for rhabdomyosarcoma of the perineal and perianal region (PRMS), with an emphasis on radiation therapy for locoregional control. Methods and Materials: Detailed records of all 14 patients treated for PRMS at Memorial Sloan-Kettering Cancer Center between 1998 and 2012 were reviewed. The Kaplan-Meier method was used to assess the event-free survival (EFS) and overall survival (OS), and a competing-risks analysis was used to assess the cumulative incidence of local, regional, and distant failures. Results: Median age was 15.8 years (range, 1.1-31.9 years). High-risk features were identified: 9 of 14 patients (64%) had groupmore » 3 disease and 3 of 14 (21%) had group 4; 11 of 14 tumors (78%) were alveolar; 12 of 14 tumors (86%) were ≥5 cm; and 9 of 14 patients (64%) had involved lymph nodes (N1). Of those aged ≥10 years at diagnosis, 9 of 10 (90%) had alveolar histology, all had tumors ≥5 cm, and 8 of 10 (80%) presented with N1 disease. The rates of local, regional, and distant failure at 5 years were 17%, 31%, and 52%, respectively. Although 3 of the 4 patients with regional failure received nodal irradiation, only one of the nodal failures occurred in the radiation therapy field. The 5-year EFS was 33%, and OS was 39%. Age ≥10 years was associated with poor outcomes: EFS was 13% in patients aged ≥10 years, compared with 75% in those aged <10 years (P=.04); the OS was 13% in patients aged ≥10 years, compared with 100% in those aged <10 years (P=.04). Conclusions: Patients with PRMS, especially those aged ≥10 years, present with poor prognostic features and continue to have poor outcomes. Given the high incidence of regional node recurrence, we recommend prophylactic ilioinguinal lymph node irradiation for all patients aged ≥10 years. For children aged <10 years, nodal evaluation is essential to determine the role for lymph node irradiation.« less

Extra-large remnant recoil velocities and spins from near-extremal-Bowen-York-spin black-hole binaries

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dain, Sergio; Max Planck Institute for Gravitational Physics; Lousto, Carlos O.

2008-07-15

We evolve equal-mass, equal-spin black-hole binaries with specific spins of a/m{sub H}{approx}0.925, the highest spins simulated thus far and nearly the largest possible for Bowen-York black holes, in a set of configurations with the spins counteraligned and pointing in the orbital plane, which maximizes the recoil velocities of the merger remnant, as well as a configuration where the two spins point in the same direction as the orbital angular momentum, which maximizes the orbital hangup effect and remnant spin. The coordinate radii of the individual apparent horizons in these cases are very small and the simulations require very high centralmore » resolutions (h{approx}M/320). We find that these highly spinning holes reach a maximum recoil velocity of {approx}3300 km s{sup -1} (the largest simulated so far) and, for the hangup configuration, a remnant spin of a/m{sub H}{approx}0.922. These results are consistent with our previous predictions for the maximum recoil velocity of {approx}4000 km s{sup -1} and remnant spin; the latter reinforcing the prediction that cosmic censorship is not violated by merging highly spinning black-hole binaries. We also numerically solve the initial data for, and evolve, a single maximal-Bowen-York-spin black hole, and confirm that the 3-metric has an O(r{sup -2}) singularity at the puncture, rather than the usual O(r{sup -4}) singularity seen for nonmaximal spins.« less

Perianal implantation of bioengineered human internal anal sphincter constructs intrinsically innervated with human neural progenitor cells.

PubMed

Raghavan, Shreya; Miyasaka, Eiichi A; Gilmont, Robert R; Somara, Sita; Teitelbaum, Daniel H; Bitar, Khalil N

2014-04-01

The internal anal sphincter (IAS) is a major contributing factor to pressure within the anal canal and is required for maintenance of rectoanal continence. IAS damage or weakening results in fecal incontinence. We have demonstrated that bioengineered, intrinsically innervated, human IAS tissue replacements possess key aspects of IAS physiology, such as the generation of spontaneous basal tone and contraction/relaxation in response to neurotransmitters. The objective of this study is to demonstrate the feasibility of implantation of bioengineered IAS constructs in the perianal region of athymic rats. Human IAS tissue constructs were bioengineered from isolated human IAS circular smooth muscle cells and human enteric neuronal progenitor cells. After maturation of the bioengineered constructs in culture, they were implanted operatively into the perianal region of athymic rats. Platelet-derived growth factor was delivered to the implanted constructs through a microosmotic pump. Implanted constructs were retrieved from the animals 4 weeks postimplantation. Animals tolerated the implantation well, and there were no early postoperative complications. Normal stooling was observed during the implantation period. At harvest, implanted constructs were adherent to the perirectal rat tissue and appeared healthy and pink. Immunohistochemical analysis revealed neovascularization. Implanted smooth muscle cells maintained contractile phenotype. Bioengineered constructs responded in vitro in a tissue chamber to neuronally evoked relaxation in response to electrical field stimulation and vasoactive intestinal peptide, indicating the preservation of neuronal networks. Our results indicate that bioengineered innervated IAS constructs can be used to augment IAS function in an animal model. This is a regenerative medicine based therapy for fecal incontinence that would directly address the dysfunction of the IAS muscle. Copyright © 2014 Mosby, Inc. All rights reserved.

Impact of the early use of immunomodulators or TNF antagonists on bowel damage and surgery in Crohn's disease.

PubMed

Safroneeva, E; Vavricka, S R; Fournier, N; Pittet, V; Peyrin-Biroulet, L; Straumann, A; Rogler, G; Schoepfer, A M

2015-10-01

The impact of early treatment with immunomodulators (IM) and/or TNF antagonists on bowel damage in Crohn's disease (CD) patients is unknown. To assess whether 'early treatment' with IM and/or TNF antagonists, defined as treatment within a 2-year period from the date of CD diagnosis, was associated with development of lesser number of disease complications when compared to 'late treatment', which was defined as treatment initiation after >2 years from the time of CD diagnosis. Data from the Swiss IBD Cohort Study were analysed. The following outcomes were assessed using Cox proportional hazard modelling: bowel strictures, perianal fistulas, internal fistulas, intestinal surgery, perianal surgery and any of the aforementioned complications. The 'early treatment' group of 292 CD patients was compared to the 'late treatment' group of 248 CD patients. We found that 'early treatment' with IM or TNF antagonists alone was associated with reduced risk of bowel strictures [hazard ratio (HR) 0.496, P = 0.004 for IM; HR 0.276, P = 0.018 for TNF antagonists]. Furthermore, 'early treatment' with IM was associated with reduced risk of undergoing intestinal surgery (HR 0.322, P = 0.005), and perianal surgery (HR 0.361, P = 0.042), as well as developing any complication (HR 0.567, P = 0.006). Treatment with immunomodulators or TNF antagonists within the first 2 years of CD diagnosis was associated with reduced risk of developing bowel strictures, when compared to initiating these drugs >2 years after diagnosis. Furthermore, early immunomodulators treatment was associated with reduced risk of intestinal surgery, perianal surgery and any complication. © 2015 John Wiley & Sons Ltd.

Temporal Change in Phenotypic Behaviour in Patients with Crohn's Disease: Do Indian Patients Behave Differently from Western and Other Asian Patients?

PubMed

Kalaria, Rishikesh; Desai, Devendra; Abraham, Philip; Joshi, Anand; Gupta, Tarun; Shah, Sudeep

2016-03-01

In Western studies, one-third of patients with Crohn's disease have stricturing or penetrating disease at presentation and one-half will progress to complicated disease in 20 years. Asian studies indicate that the Asian disease phenotype may be different. Our aim was to study the disease behaviour in Indian patients with Crohn's disease. In this hospital-based study, we analysed [Montreal classification] disease phenotype, presence of perianal disease, need for intestinal surgery, and changes in the Montreal classification over time in Crohn's disease patients from our database. In the 178 patients (median age 35, interquartile range [IQR] 21 years; 97 males) with Crohn's disease, the proportion of various features was as follows. More patients had ileo-colonic[L3: 43.8%] than ileal[L1: 27.5%] or colonic[L2: 28.7%] disease. Perianal disease was seen in 11.8% at baseline. Non-stricturing, non-fistulising disease[B1] was seen in 74.7%, 65.7%, 50%, and 44.4% at baseline, at 5, 10 and 15 years, respectively. Stricturing disease[B2] was seen in 21.4%, 21.9%, 28.9%, and 33.3%; penetrating disease[B3] in 3.9%, 11.4%, 21%, and 16.7%; and intestinal surgery was required in 10.7%, 20%, 34.2%, and 55.5%, respectively. KaplanMeier analysis showed no association between progression of disease and patient age or the location of the disease. Gender distribution and predominant ileo-colonic location of disease were similar to earlier Asian reports on Crohn's disease. Perianal disease was less frequent than reported in Western and other Asian studies. One-fourth of Indian patients had aggressive disease at diagnosis, but the tendency to progress towards aggressive disease over time was less pronounced than in Western patients. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Effect of phenotype on health care costs in Crohn's disease: A European study using the Montreal classification.

PubMed

Odes, Selwyn; Vardi, Hillel; Friger, Michael; Wolters, Frank; Hoie, Ole; Moum, Bjørn; Bernklev, Tomm; Yona, Hagit; Russel, Maurice; Munkholm, Pia; Langholz, Ebbe; Riis, Lene; Politi, Patrizia; Bondini, Paolo; Tsianos, Epameinondas; Katsanos, Kostas; Clofent, Juan; Vermeire, Severine; Freitas, João; Mouzas, Iannis; Limonard, Charles; O'Morain, Colm; Monteiro, Estela; Fornaciari, Giovanni; Vatn, Morten; Stockbrugger, Reinhold

2007-12-01

Crohn's disease (CD) is a chronic inflammation of the gastrointestinal tract associated with life-long high health care costs. We aimed to determine the effect of disease phenotype on cost. Clinical and economic data of a community-based CD cohort with 10-year follow-up were analyzed retrospectively in relation to Montreal classification phenotypes. In 418 patients, mean total costs of health care for the behavior phenotypes were: nonstricturing-nonpenetrating 1690, stricturing 2081, penetrating 3133 and penetrating-with-perianal-fistula 3356 €/patient-phenotype-year (P<0.001), and mean costs of surgical hospitalization 215, 751, 1293 and 1275 €/patient-phenotype-year respectively (P<0.001). Penetrating-with-perianal-fistula patients incurred significantly greater expenses than penetrating patients for total care, diagnosis and drugs, but not surgical hospitalization. Total costs were similar in the location phenotypes: ileum 1893, colon 1748, ileo-colonic 2010 and upper gastrointestinal tract 1758 €/patient-phenotype-year, but surgical hospitalization costs differed significantly, 558, 209, 492 and 542 €/patient-phenotype-year respectively (P<0.001). By multivariate analysis, the behavior phenotype significantly impacted total, medical and surgical hospitalization costs, whereas the location phenotype affected only surgical costs. Younger age at diagnosis predicted greater surgical expenses. Behavior is the dominant phenotype driving health care cost. Use of the Montreal classification permits detection of cost differences caused by perianal fistula.

Evaluation and management of perianal abscess and anal fistula: a consensus statement developed by the Italian Society of Colorectal Surgery (SICCR).

PubMed

Amato, A; Bottini, C; De Nardi, P; Giamundo, P; Lauretta, A; Realis Luc, A; Tegon, G; Nicholls, R J

2015-10-01

Perianal sepsis is a common condition ranging from acute abscess to chronic fistula formation. In most cases, the source is considered to be a non-specific cryptoglandular infection starting from the intersphincteric space. The key to successful treatment is the eradication of the primary track. As surgery may lead to a disturbance of continence, several sphincter-preserving techniques have been developed. This consensus statement examines the pertinent literature and provides evidence-based recommendations to improve individualized management of patients.

Trends in the Surgical Management of Crohn's Disease.

PubMed

Geltzeiler, Cristina B; Hart, Kyle D; Lu, Kim C; Deveney, Karen E; Herzig, Daniel O; Tsikitis, Vassiliki L

2015-10-01

Although medical management of Crohn's disease has changed in recent years, it is unclear whether surgical management has altered. We examined rate changes of surgical interventions, stoma constructions, and subset of ileostomy and colostomy constructions. We reviewed the Nationwide Inpatient Sample database from 1988 to 2011. We examined the number of Crohn's-related operations and stoma constructions, including ileostomies and colostomies; a multivariable logistic regression model was developed. A total of 355,239 Crohn's-related operations were analyzed. Operations increased from 13,955 in 1988 to 17,577 in 2011, p < 0.001. Stoma construction increased from 2493 to 4283, p < 0.001. The subset of ileostomies increased from 1201 to 3169, p < 0.001 while colostomies decreased from 1351 to 1201, p = 0.05. Operation percentages resulting in stoma construction increased from 18 to 24 %, p < 0.001. Weight loss (OR 2.25, 95 % CI 1.88, 2.69) and presence of perianal fistulizing disease (OR 2.91, 95 % CI 2.31, 3.67) were most predictive for requiring stoma construction. Crohn's-related surgical interventions and stoma constructions have increased. The largest predictors for stoma construction are weight loss and perianal fistulizing disease. As a result, nutrition should be optimized and the early involvement of a multidisciplinary team should be considered.

Destructive bone disease in early syphilis.

PubMed

Dismukes, W E; Delgado, D G; Mallernee, S V; Myers, T C

1976-12-06

Although destructive bone disease is a well-known complication of tertiary syphilis, osteitis or osteomyelitis are not commonly recognized as complications of early (primary or secondary) syphillis. A patient with secondary syphilis characterized by generalized lymphadenopathy, perianal condyloma lata, and positive rapid plasma reagin (RPR) and fluorescent treponemal antibody-absorption (FTA-ABS) tests also complained of headache, right should pain, and right anterior chest pain and swelling. Roentgenograms showed mottled osteolytic lesions consistent with previously described luetic bone disease. Biopsy confirmed the diagnosis of syphilitic osteomyelitis, and treatment with penicillin resulted in prompt resolution of symptoms.

A family report of Crohn's disease in three children immigrating from Albania to Greece and review of the literature.

PubMed

Katsanos, Konstantinos H; Karetsos, Vasileios; Tsianos, Epameinondas V

2010-11-01

Cases of immigrant families affected by IBD have rarely been reported and seem to be of exceptional interest towards a better understanding of disease aetiopathogenesis. The first case of Crohn's disease in a family of immigrants from Albania to Greece with three offspring is described herein. A family with three children, one 22 year-old male and two 18-year-old twin females immigrated from southern Albania to northwest Greece ten years ago. The whole family lived in the same house and had no previous history of bowel or other chronic diseases. Two years ago the boy complained of diarrhoea, perianal pain and loss of weight. Subsequent investigation revealed ileal and perianal Crohn's disease. One year after Crohn's disease was diagnosed in the boy, one of the twins was diagnosed with ileal Crohn's disease. Six months afterwards, the second twin underwent emergency appendectomy due to acute appendicitis; four months later she was diagnosed with ileal Crohn's disease. Genetically predisposed individuals seem to be vulnerable to a continuous pressure of a still unknown environmental factor(s). In addition, lifestyle modification seems to represent a predisposing factor toward inflammatory bowel disease in immigrants. Copyright © 2010 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

Intrathecal dexmedetomidine as adjuvant for spinal anaesthesia for perianal ambulatory surgeries: A randomised double-blind controlled study.

PubMed

Nethra, S S; Sathesha, M; Dixit, Aanchal; Dongare, Pradeep A; Harsoor, S S; Devikarani, D

2015-03-01

The newer trend in regional anaesthesia for ambulatory anorectal surgeries advocate use of lower dose of local anaesthetic, providing segmental block with adjuvants such as opioids and α2 agonists to prolong analgesia. The current study investigated effects of addition of 5 μg of dexmedetomidine to 6 mg of hyperbaric bupivacaine on duration of analgesia, sensory and motor block characteristics for perianal ambulatory surgeries. This study is a prospective randomised controlled double blind study. Forty adult patients between 18 and 55 years of age were divided into 2 groups. Group D received intrathecal 0.5% hyperbaric bupivacaine 6 mg (1.2 ml) with injection dexmedetomidine 5 μg in 0.5 ml of normal saline and Group N received intrathecal 0.5% hyperbaric bupivacaine 6 mg (1.2 ml) with 0.5 ml of normal saline. The parameters assessed were time to regression of sensory blockade, motor blockade, ambulation, time to void, first administration of analgesic. Statistical analysis was done using appropriate tests. Time for regression of sensory level and time for first administration of analgesic were prolonged in Group D (430.05 ± 89.13 min, 459.8 ± 100.9 min, respectively) in comparison to Group N (301.10 ± 94.86 min, 321.85 ± 95.08 min, respectively). However, the duration of motor blockade, time to ambulation, and time to void were also significantly prolonged in Group D (323.05 ± 54.58 min, 329.55 ± 54.06 min, 422.30 ± 87.59 min) than in Group N (220.10 ± 63.61 min, 221.60 ± 63.84 min, 328.45 ± 113.38 min). Intrathecal dexmedetomidine 5 μg added to intrathecal bupivacaine 6 mg as adjuvant may not be suitable for ambulatory perianal surgeries due to prolongation of motor blockade.

Clinical Factors and Disease Course Related to Diagnostic Delay in Korean Crohn's Disease Patients: Results from the CONNECT Study.

PubMed

Moon, Chang Mo; Jung, Sung-Ae; Kim, Seong-Eun; Song, Hyun Joo; Jung, Yunho; Ye, Byong Duk; Cheon, Jae Hee; Kim, You Sun; Kim, Young-Ho; Kim, Joo Sung; Han, Dong Soo

2015-01-01

Diagnostic delay frequently occurs in Crohn's disease (CD) patients because of diagnostic limitations. However, diagnostic delay and its related factors remain poorly defined. Therefore, we aimed to identify the predictors associated with diagnostic delay and to evaluate the impact of diagnostic delay on clinical course in a Korean CD patient cohort. We performed a multicenter retrospective analysis of 1,047 CD patients registered in the Crohn's Disease Clinical Network and Cohort study in Korea. The mean interval of diagnostic delay was 16.0 ± 33.1 months. Multivariate analysis showed that older age at diagnosis (≥40 years) (p = 0.014), concomitant upper gastrointestinal (UGI) disease (p = 0.012) and penetrating disease behavior at diagnosis (p = 0.001) were positively associated with long diagnostic delay (≥18 months). During the longitudinal follow-up, long diagnostic delay was independently predictive of further development of intestinal stenosis (hazard ratio [HR], 1.43; 95% confidence interval [CI], 1.07-1.93; p = 0.017), internal fistulas (HR, 1.62; 95% CI, 1.12-2.33; p = 0.011), and perianal fistulas (HR, 1.38; 95% CI, 1.06-1.80; p = 0.016). However, as for the risk of abscess formation, bowel perforation, and CD-related abdominal surgery, no significant association with diagnostic delay was observed. Older age at diagnosis, UGI involvement, and penetrating behavior are associated with long diagnostic delay in Korean CD patients. Moreover, diagnostic delay is associated with an increased risk of CD-related complications such as intestinal stenosis, internal fistulas, and perianal fistulas.

Diagnostic delay in Crohn's disease is associated with a complicated disease course and increased operation rate.

PubMed

Schoepfer, Alain M; Dehlavi, Mohamed-Ali; Fournier, Nicolas; Safroneeva, Ekaterina; Straumann, Alex; Pittet, Valérie; Peyrin-Biroulet, Laurent; Michetti, Pierre; Rogler, Gerhard; Vavricka, Stephan R

2013-11-01

The impact of diagnostic delay (a period from appearance of first symptoms to diagnosis) on the clinical course of Crohn's disease (CD) is unknown. We examined whether length of diagnostic delay affects disease outcomes. Data from the Swiss IBD cohort study were analyzed. Patients were recruited from university centers (68%), regional hospitals (14%), and private practices (18%). The frequencies of occurrence of bowel stenoses, internal fistulas, perianal fistulas, and CD-related surgery (intestinal and perianal) were analyzed. A total of 905 CD patients (53.4% female, median age at diagnosis 26 (20-36) years) were stratified into four groups according to the quartiles of diagnostic delay (0-3, 4-9, 10-24, and ≥25 months, respectively). Median diagnostic delay was 9 (3-24) months. The frequency of immunomodulator and/or antitumor necrosis factor drug use did not differ among the four groups. The length of diagnostic delay was positively correlated with the occurrence of bowel stenosis (odds ratio (OR) 1.76, P=0.011 for delay of ≥25 months) and intestinal surgery (OR 1.76, P=0.014 for delay of 10-24 months and OR 2.03, P=0.003 for delay of ≥25 months). Disease duration was positively associated and non-ileal disease location was negatively associated with bowel stenosis (OR 1.07, P<0.001, and OR 0.41, P=0.005, respectively) and intestinal surgery (OR 1.14, P<0.001, and OR 0.23, P<0.001, respectively). The length of diagnostic delay is correlated with an increased risk of bowel stenosis and CD-related intestinal surgery. Efforts should be undertaken to shorten the diagnostic delay.

Clinical experience with infliximab therapy in 100 patients with Crohn's disease.

PubMed

Farrell, R J; Shah, S A; Lodhavia, P J; Alsahli, M; Falchuk, K R; Michetti, P; Peppercorn, M A

2000-12-01

The aim of this study was to assess our clinical experience with infliximab, a monoclonal antitumor necrosis factor antibody, following its approval for treatment of refractory Crohn's disease (CD). We followed 100 consecutive patients with CD (53 women and 47 men; mean age, 41 yr) who received a total of 233 infliximab (5 mg/kg) infusions. Adverse events were noted and clinical response assessed every 2 wk for 6 months after each infusion using the Harvey Bradshaw Index (HBI) for active disease, the Perianal Disease Activity Index (PDAI) for fistulous disease, and steroid withdrawal rates for steroid-sparing efficacy. Indications for therapy were active disease (n = 57), perianal fistulous disease (n = 33), and steroid dependency (n = 10). Significant infusion reactions occurred in 16 patients (6.9% of infusions) including anaphylactic shock in one patient. Fourteen patients experienced infectious adverse events, 13 of whom were on concurrent steroids. Sixty percent of patients with active disease experienced > or = 50% HBI reduction at 2 wk; mean duration of response, 8.2 wk. Three of 26 first-time nonresponders with active disease (12%) responded to a second infusion. Sixty-nine percent of patients with fistulous disease experienced >50% reduction in their PDAI at 2 wk; mean duration of response, 10.9 wk. Four of 10 steroid-dependent patients (40%) discontinued steroid therapy, one of whom recommenced steroid therapy at 24 wk. Our clinical response rates mirror the efficacy reported in the controlled trials for active and fistulous disease. Steroid-sparing efficacy was seen in 40% of steroid-dependent patients. Concurrent steroids did not reduce the risk of significant infusion reactions (6.9%), but did increase the risk of infections.

Clinical Factors and Disease Course Related to Diagnostic Delay in Korean Crohn’s Disease Patients: Results from the CONNECT Study

PubMed Central

Moon, Chang Mo; Jung, Sung-Ae; Kim, Seong-Eun; Song, Hyun Joo; Jung, Yunho; Ye, Byong Duk; Cheon, Jae Hee; Kim, You Sun; Kim, Young-Ho; Kim, Joo Sung; Han, Dong Soo

2015-01-01

Diagnostic delay frequently occurs in Crohn’s disease (CD) patients because of diagnostic limitations. However, diagnostic delay and its related factors remain poorly defined. Therefore, we aimed to identify the predictors associated with diagnostic delay and to evaluate the impact of diagnostic delay on clinical course in a Korean CD patient cohort. We performed a multicenter retrospective analysis of 1,047 CD patients registered in the Crohn’s Disease Clinical Network and Cohort study in Korea. The mean interval of diagnostic delay was 16.0 ± 33.1 months. Multivariate analysis showed that older age at diagnosis (≥40 years) (p = 0.014), concomitant upper gastrointestinal (UGI) disease (p = 0.012) and penetrating disease behavior at diagnosis (p = 0.001) were positively associated with long diagnostic delay (≥18 months). During the longitudinal follow-up, long diagnostic delay was independently predictive of further development of intestinal stenosis (hazard ratio [HR], 1.43; 95% confidence interval [CI], 1.07–1.93; p = 0.017), internal fistulas (HR, 1.62; 95% CI, 1.12–2.33; p = 0.011), and perianal fistulas (HR, 1.38; 95% CI, 1.06–1.80; p = 0.016). However, as for the risk of abscess formation, bowel perforation, and CD-related abdominal surgery, no significant association with diagnostic delay was observed. Older age at diagnosis, UGI involvement, and penetrating behavior are associated with long diagnostic delay in Korean CD patients. Moreover, diagnostic delay is associated with an increased risk of CD-related complications such as intestinal stenosis, internal fistulas, and perianal fistulas. PMID:26647084

Indications for mode of delivery in pregnant women with inflammatory bowel disease

PubMed Central

Burke, Kristin E.; Haviland, Miriam J.; Hacker, Michele R.; Shainker, Scott A.; Cheifetz, Adam S.

2017-01-01

Background Reasons for the increased incidence of cesarean delivery among women with inflammatory bowel disease remain unclear. We assessed cesarean delivery incidence and factors influencing mode of delivery in women with inflammatory bowel disease. Methods We performed a 10-year retrospective cohort study of nulliparous women who delivered a singleton infant at our institution. We compared risk for each mode of delivery in women with Crohn's disease and ulcerative colitis to women without inflammatory bowel disease. We assessed mode of delivery indications for patients with inflammatory bowel disease and whether cesarean deliveries were planned. Results The overall incidence of cesarean delivery among women with Crohn's disease (24/59; 40.7%) was similar to women without inflammatory bowel disease (7868/21805; 36.1%) (RR 1.1 [95% CI: 0.83,1.5]; p=0.46), but was increased in the subgroups with active and inactive perianal disease (RR 2.3; p<0.01). Women with ulcerative colitis had a 1.8-fold increased relative risk of cesarean delivery (41/65; 63.1%) (95% CI 1.5, 2.1; p<0.01), with highest incidence in patients with ileal pouch-anal anastomosis. Forty-nine percent of ulcerative colitis and 66.7% of Crohn's disease cesarean deliveries were unplanned, with only one unplanned delivery performed for active inflammatory bowel disease. Most unplanned deliveries were for arrest of descent/dilation and non-reassuring fetal heart tracings. Seventy-five percent of planned cesarean deliveries were for inflammatory bowel disease-related indications. Conclusions Women with ulcerative colitis and perianal Crohn's disease have an increased incidence of cesarean delivery. At least half of cesarean deliveries are unplanned. PMID:28426453

Predictors of favourable outcome in inflammatory Crohn's disease. A retrospective observational study.

PubMed

Zabana, Yamile; Garcia-Planella, Esther; van Domselaar, Manuel; Mañosa, Míriam; Gordillo, Jordi; López-Sanromán, Antonio; Cabré, Eduard; Domènech, Eugeni

2013-12-01

No studies have specifically searched for predictors of a favourable outcome that would allow a conservative therapeutic approach in adult Crohn's disease (CD). To identify predictors of a favourable disease course over time at CD diagnosis. We identified and included all patients diagnosed with CD between January 1994 and December 2003, who had CD with an inflammatory pattern and no perianal disease at diagnosis, and who were followed up for at least 5 years. Clinical and therapeutic features until December 2008 and losses to follow-up were identified. We defined a favourable outcome as the absence of stricturing and penetrating complications of the disease (including perianal disease), together with the absence of need for anti-TNF therapy or resectional surgery during follow up. One hundred and forty-five patients were included and followed up for a median of 96 months (IQR, 79-140). At diagnosis, location was ileal in 39%, colonic in 28%, and ileocolonic in 32%; 50% of the patients were active smokers, and 41% used immunomodulators. Eighty-two patients (57%) met the criteria for a favourable outcome at the end of follow-up. The only factor associated with a favourable outcome was isolated colonic involvement (P=0.022), with 73% of these patients meeting the criteria for a favourable outcome. A favourable outcome of initially uncomplicated CD is not easily predicted at disease diagnosis by means of clinical or epidemiologic factors. Nevertheless, patients with isolated colonic disease are less likely to have an aggressive course. Copyright © 2013 Elsevier España, S.L. and AEEH y AEG. All rights reserved.

Penetrating Disease, Narcotic Use, and Loop Ostomy Are Associated with Ostomy and IBD-related Complications After Ostomy Surgery in Crohn's Disease Patients.

PubMed

Hirsch, Ayal; Yarur, Andres J; Dezheng, Hou; Rodriquez, Dylan; Krugliak Cleveland, Noa; Ali, Tauseef; Hurst, Roger D; Umanskiy, Konstantin; Hyman, Neil; Colwell, Janice; Rubin, David T

2015-10-01

For medically refractory or obstructive Crohn's disease (CD), ostomy surgery remains an important therapeutic option. Outcomes and complications of this approach have not been well described in the era of biological therapies. Our study aims to characterize CD patients undergoing ostomy creation and assess outcome predictors. We performed a retrospective chart review of CD patients who underwent ostomy creation in our center from 2011 to 2014. Data collected include patient demographics, detailed disease- and surgery-related variables, and clinical outcomes after 26 weeks of follow-up. Of the 112 patients, 54 % were female, the median age was 39 years (range 19-78), the median disease duration was 13 years (range 0-50), 54 % had ileo-colonic disease, 55 % had stricturing phenotype, and 59 % had perianal disease. Sixty-two percent received end ostomies, and 38 % received loop ostomies. The leading indications for surgery were stricturing, fistulizing, and perianal disease (35 %). Forty-three (38 %) patients had 76 major complications, including dehydration (22 cases), intra-abdominal infection (16), and obstruction (14). Increased major postoperative complications correlated with penetrating disease (p = 0.02, odds ratio [OR] = 5.52, 95 % confidence interval [CI] = 1.25-24.42), the use of narcotics before surgery (p = 0.04, OR = 2.54, 95 % CI = 1.02-6.34), and loop ostomies (p = 0.004, OR = 4.2, 95 % CI = 1.57-11.23). Penetrating phenotype, the use of narcotics before surgery, and loop ostomies are associated with major complications in CD patients undergoing ostomy creation. These findings may influence risk management of CD patients needing ostomies.

Evolution of disease phenotype in adult and pediatric onset Crohn’s disease in a population-based cohort

PubMed Central

Lovasz, Barbara Dorottya; Lakatos, Laszlo; Horvath, Agnes; Szita, Istvan; Pandur, Tunde; Mandel, Michael; Vegh, Zsuzsanna; Golovics, Petra Anna; Mester, Gabor; Balogh, Mihaly; Molnar, Csaba; Komaromi, Erzsebet; Kiss, Lajos Sandor; Lakatos, Peter Laszlo

2013-01-01

AIM: To investigate the evolution of disease phenotype in adult and pediatric onset Crohn’s disease (CD) populations, diagnosed between 1977 and 2008. METHODS: Data of 506 incident CD patients were analyzed (age at diagnosis: 28.5 years, interquartile range: 22-38 years). Both in- and outpatient records were collected prospectively with a complete clinical follow-up and comprehensively reviewed in the population-based Veszprem province database, which included incident patients diagnosed between January 1, 1977 and December 31, 2008 in adult and pediatric onset CD populations. Disease phenotype according to the Montreal classification and long-term disease course was analysed according to the age at onset in time-dependent univariate and multivariate analysis. RESULTS: Among this population-based cohort, seventy-four (12.8%) pediatric-onset CD patients were identified (diagnosed ≤ 17 years of age). There was no significant difference in the distribution of disease behavior between pediatric (B1: 62%, B2: 15%, B3: 23%) and adult-onset CD patients (B1: 56%, B2: 21%, B3: 23%) at diagnosis, or during follow-up. Overall, the probability of developing complicated disease behaviour was 49.7% and 61.3% in the pediatric and 55.1% and 62.4% in the adult onset patients after 5- and 10-years of follow-up. Similarly, time to change in disease behaviour from non stricturing, non penetrating (B1) to complicated, stricturing or penetrating (B2/B3) disease was not significantly different between pediatric and adult onset CD in a Kaplan-Meier analysis. Calendar year of diagnosis (P = 0.04), ileal location (P < 0.001), perianal disease (P < 0.001), smoking (P = 0.038) and need for steroids (P < 0.001) were associated with presence of, or progression to, complicated disease behavior at diagnosis and during follow-up. A change in disease location was observed in 8.9% of patients and it was associated with smoking status (P = 0.01), but not with age at diagnosis. CONCLUSION: Long

Retroperitoneal Necrotizing Fasciitis Masquerading as Perianal Abscess - Rare and Perilous.

PubMed

Amaranathan, Anandhi; Sahoo, Ashok Kumar; Barathi, Deepak; Shankar, Gomathi; Sistla, Sarath Chandra

2017-01-17

Necrotizing fasciitis is one of the uncommon presentations of a rapidly spreading subcutaneous tissue infection. Although the actual cause is unclear in many cases, most of them are due to the rapid proliferation of microorganisms. Retroperitoneal necrotizing fasciitis is extremely rare. It is a potentially lethal infection that requires immediate and aggressive surgical care. Early diagnosis is the key to a better prognosis. The possibility of retroperitoneal necrotizing fasciitis should be suspected in patients with symptoms of sepsis that are disproportionate to clinical findings. The rapid deterioration of the patient also gives a clue towards the diagnosis. We report a 35-year-old male with perianal abscess who had been progressed to retroperitoneal necrotizing fasciitis. The patient was managed successfully with aggressive debridement and drainage after laparotomy. Appropriate antibiotics were used to combat the sepsis. The patient recovered well at follow up, three months after discharge. Another patient, a 45-year-old male with a retroperitoneal abscess, progressed to retroperitoneal necrotizing fasciitis, and extra peritoneal drainage and debridement was done. Antibiotics depending upon the culture and sensitivity were used to control sepsis. But the patient succumbed to death 45 days after surgery due to uncontrolled sepsis. Necrotizing fasciitis of any anatomical site needs aggressive surgical care with early intervention. But retroperitoneal necrotizing fasciitis needs an extra effort for diagnosis. After diagnosis, it needs timely surgical intervention and appropriate antibiotic therapy for the recovery of the patients.

Testing a model of codependency for college students in Taiwan based on Bowen's concept of differentiation.

PubMed

Chang, Shih-Hua

2018-04-01

The purpose of this study was to test a model of codependency based on Bowen's concept of differentiation for college students in Taiwan. The relations between family-of-origin dysfunction, differentiation of self, codependency traits and related symptoms including low self-esteem, relationship distress and psychological adjustment problems were examined. Data were collected from 567 college students from 2 large, urban universities in northern Taiwan. Results indicated a significantly negative relationship between levels of codependency and self-differentiation and that self-differentiation partially mediated the relationship between family-of-origin dysfunction and codependency. The implications of these findings for counselling Taiwanese college students who experience codependency traits and related symptoms as well as suggestions for future research are discussed. © 2016 International Union of Psychological Science.

Pregnancy and the Patient with Inflammatory Bowel Disease: Fertility, Treatment, Delivery, and Complications.

PubMed

McConnell, Ryan A; Mahadevan, Uma

2016-06-01

For many women with inflammatory bowel disease (IBD), the illness coincides with their childbearing years. IBD increases the risk of pregnancy complications and adverse pregnancy outcomes. The multidisciplinary care team should emphasize the importance of medication adherence to achieve preconception disease control and maintain corticosteroid-free remission throughout pregnancy. Medication adjustments to reduce fetal exposure may be considered on an individualized basis in quiescent disease; however, any benefits of such adjustments remain theoretic and there is risk of worsening disease activity. Mode of delivery is determined by obstetric indications, except for women with active perianal disease who should consider cesarean delivery. Copyright © 2016 Elsevier Inc. All rights reserved.

Ciliated median raphe cyst of perineum presenting as perianal polyp: a case report with immunohistochemical study, review of literature, and pathogenesis.

PubMed

Sagar, Jayesh; Sagar, Bethani; Patel, Adam F; Shak, D K

2006-03-05

Median raphe cyst is a very rare, benign congenital lesion occurring mainly on the ventral aspect of the penis, but can develop anywhere in the midline between the external urethral meatus and anus. We report a case of median raphe cyst in the perineum presenting as a perianal polyp in a 65-year-old, English white male with exceptionally rare ciliated epithelium. According to our knowledge, this is the third such case of ciliated median raphe cyst in the English literature. This case, also the first case of ciliated median raphe cyst in the perineum location, focuses on pathogenesis of median raphe cyst.

Close-slow analysis for head-on collision of two black holes in higher dimensions: Bowen-York initial data

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yoshino, Hirotaka; Graduate School of Science and Engineering, Waseda University, Tokyo 169-8555; Shiromizu, Tetsuya

2006-12-15

Scenarios of large extra dimensions have enhanced the importance for the study of black holes in higher dimensions. In this paper, we analyze an axisymmetric system of two black holes. Specifically, the Bowen-York method is generalized for higher dimensions in order to calculate the initial data for head-on collision of two equal-mass black holes. Then, the initial data are evolved adopting the close-slow approximation to study gravitational waves emitted during the collision. We derive an empirical formula for radiation efficiency, which depends weakly on the dimensionality. Possible implications of our results for the black hole formation in particle colliders aremore » discussed.« less

Malignant transformation in perianal fistulas of Crohn's disease: a systematic review of literature.

PubMed

Thomas, Mathew; Bienkowski, Robert; Vandermeer, Thomas J; Trostle, Douglas; Cagir, Burt

2010-01-01

Malignant transformation of perineal fistula in Crohn's disease has rarely been reported. The aim of this study is to define the patient's characteristics and clinical presentation of this rare disease. A systematic review of case series and reports published in English language between 1950 and 2008 was conducted. All cases with malignancy in low pelvic/perineal fistula in patients with Crohn's disease were included. All selected cases were then analyzed with respect to age, gender, duration of Crohn's disease and fistula, location of fistula, presenting symptoms, method of diagnosis, delay in diagnosis, histopathology, treatment, and outcome. Data analyses were done using chi-squared or Fisher's exact test and the Mann-Whitney test. Literature review revealed 61 cases of carcinomas arising in perineal fistulas in Crohn's disease. Sixty-one percent (37) of the patients were females. Females were significantly younger than males at the time of diagnosis of cancer (47 vs. 53 years, P < 0.032). Males were also noted to have significantly longer duration of Crohn's disease compared to females (24 vs. 18 years, P = 0.005). However, females were noted to have the fistula for significantly shorter duration prior to cancer transformation when compared to males (8.3 vs. 16 years, P = 0.0035). On initial examination, malignancy was suspected and proven only in 20% of patients (n = 12). Adenocarcinoma was the most common histology (59%, n = 36), followed by squamous cell carcinoma (31%, n = 19). In most patients (59%, n = 36), the fistula was rectal in origin. A high suspicion for malignancy in chronic perineal fistulas associated with Crohn's disease should be maintained in spite of negative biopsies. Especially in women, the shorter duration of Crohn's fistulas prior to malignant degeneration necessitates an aggressive approach to rule out cancer.

Treatment of metastatic cutaneous Crohn disease with certolizumab.

PubMed

Kiuru, Maija; Camp, Brendan; Adhami, Katayun; Jacob, Vinita; Magro, Cynthia; Wildman, Horatio

2015-11-18

Metastatic Crohn disease is a rare cutaneous manifestation of Crohn disease characterized by granulomatous lesions discontinuous with the diseased areas of the gastrointestinal tract. We report a case of a 32-year-old woman with history of Crohn disease who was admitted for treatment of cellulitis after presenting with a tender erythematous plaque of the left calf. Microbiological tests including tissue cultures were negative. A skin biopsy revealed granulomatous dermatitis consistent with metastatic cutaneous Crohn disease. Owing to concomitant perianal fistulas and abscesses and prior infusion reaction to infliximab, the patient was treated with certolizumab, a pegylated tumor necrosis factor (TNF) inhibitor combined with methotrexate resulting in complete resolution of the skin lesion. This case emphasizes the importance of recognizing this rare skin manifestation of Crohn disease and adds certolizumab as one of TNF inhibitors useful in the treatment of metastatic cutaneous Crohn disease.

RELATIONSHIP BETWEEN ENTEROBIUS VERMICULARIS INFECTION AND PELVIC INFLAMMATORY DISEASES IN CHILDREN AT SOHAG GOVERNORATE, EGYPT.

PubMed

Hussien, Salah M M; Taha, Mohammad A A; Omran, Eman Kh

2015-12-01

A cohort of children presented with pelvic inflammatory diseases (gastrointestinal and/or genitourinary surgical conditions) and had concomitant infection with E. vermicularis. To find out this relationship, a total of 135 patients suffering from different gastrointestinal and genitourinary surgical conditions were selected from Departments of Surgery and Gynecology. They were subjected to stool analysis, peri-anal swabs and blood examination mainly for eosinophilia. The results showed that 26 patients out of 135 (19.2%) had. E. vermicularis with high eosinophilia in 30 cases (22.2%). Identification of E. vermicularis by peri-anal swab test in the cohort was successful (16.30%). Males were more affected than females with ratio 2.2:1 and age mean 7.13 +/- 1.92. As to residence and housing, rural children with bad housing (73.08% & 88.46% respectively) were more affected than those living in urban areas with healthy housing (26.92% and 11.54% respectively).

Crohn's disease and smoking: is it ever too late to quit?

PubMed

Lawrance, Ian C; Murray, Kevin; Batman, Birol; Gearry, Richard B; Grafton, Rachel; Krishnaprasad, Krupa; Andrews, Jane M; Prosser, Ruth; Bampton, Peter A; Cooke, Sharon E; Mahy, Gillian; Radford-Smith, Graham; Croft, Anthony; Hanigan, Katherine

2013-12-01

Smoking increases CD risk. The aim was to determine if smoking cessation at, prior to, or following, CD diagnosis affects medication use, disease phenotypic progression and/or surgery. Data on CD patients with disease for ≥5 yrs were collected retrospectively including the Montreal classification, smoking history, CD-related abdominal surgeries, family history, medication use and disease behaviour at diagnosis and the time when the disease behaviour changed. 1115 patients were included across six sites (mean follow-up-16.6 yrs). More non-smokers were male (p=0.047) with A1 (p<0.0001), L4 (p=0.028) and perianal (p=0.03) disease. Non-smokers more frequently received anti-TNF agents (p=0.049). (p=0.017: OR 2.5 95%CI 1.18-5.16) and those who ceased smoking prior to diagnosis (p=0.045: OR 2.3 95%CI 1.02-5.21) progressed to complicated (B2/B3) disease as compared to those quitting at diagnosis. Patients with uncomplicated terminal ileal disease at diagnosis more frequently developed B2/B3 disease than isolated colonic CD (p<0.0001). B2/B3 disease was more frequent with perianal disease (p<0.0001) and if i.v. steroids (p=0.004) or immunosuppressants (p<0.0001) were used. 49.3% (558/1115) of patients required at least one intestinal surgery. More smokers had a 2nd surgical resection than patients who quit at, or before, the 1st resection and non-smokers (p=0.044: HR=1.39 95%CI 1.01-1.91). Patients smoking >3 cigarettes/day had an increased risk of developing B2/B3 disease (p=0.012: OR 3.8 95%CI 1.27-11.17). Progression to B2/B3 disease and surgery is reduced by smoking cessation. All CD patients regardless of when they were diagnosed, or how many surgeries, should be strongly encouraged to cease smoking. Copyright © 2013 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

Multicentre observational study of outcomes after drainage of acute perianal abscess.

PubMed

Pearce, L; Newton, K; Smith, S R; Barrow, P; Smith, J; Hancock, L; Kirwan, C C; Hill, J

2016-07-01

Management of perianal abscesses has remained largely unchanged for over 50 years. The evidence for postoperative wound packing is limited and may expose patients to painful procedures with no clinical benefit and at considerable increased cost. Patients were recruited in 15 UK centres between December 2013 and October 2014. Outcome measures included number of dressing (pack) changes, healing, recurrence, return to work/normal function, postoperative fistula in ano and health utility scores (EQ-5D™). Pain was measured before, during and after dressing change on a visual analogue scale. Some 141 patients were recruited (median age 39 (range 18-86) years). The mean number of dressing changes in the first 3 weeks was 13 (range 0-21), equating to an annual cost to the National Health Service of €6 453 360 in England alone per annum. Some 43·8 per cent of wounds were healed by 8 weeks after surgery and 86 per cent of patients had returned to normal function. Some 7·6 per cent of abscesses had recurred and 26·7 per cent of patients developed a fistula in ano by 6 months following surgery. Patients reported a twofold to threefold increase in pain scores during and after dressing changes. Recurrent abscess is rare and fistula occurs in one-quarter of the patients. Packing is painful and costly. © 2016 BJS Society Ltd Published by John Wiley & Sons Ltd.

Long-standing Crohn's disease and its implication on anal squamous cell cancer management.

PubMed

Lightner, Amy L; Moncrief, Sara B; Smyrk, Thomas C; Pemberton, John H; Haddock, Michael G; Larson, David W; Dozois, Eric J; Mathis, Kellie L

2017-05-01

Anal squamous cell carcinoma (ASCC) is rare, accounting for only 1% of gastrointestinal malignancies. We sought to better understand management strategies for ASCC in the setting of Crohn's disease (CD). A retrospective chart review from 2001 to 2016 was conducted using ICD-9/10 codes for CD (555.9/K50) and ASCC (154.3/C44.520). Adult patients with a diagnosis of CD at the time of ASCC diagnosis were included. Seven patients (five female) were included with a median age of 50 years. The majority presented with perianal pain (three) and bleeding (four). Mean duration of CD was 20 years. Five patients had active perianal fistulizing disease at the time of ASCC diagnosis. Clinical stage at diagnosis of ASCC was stage 0 (n = 1), stage I (n = 1), stage II (n = 1), stage III (n = 2), stage IV (n = 1), and unknown (n = 1). All patients were treated with radiation and chemotherapy. Three patients experienced complications during radiation therapy: fistulizing disease, stenotic disease, and flap necrosis. Two patients had persistent disease at 6 months; one patient underwent abdominoperineal resection (APR) and the other chemotherapy and radiation. Two patients developed locally residual and metastatic disease and died within 1 year of diagnosis. Five-year disease-free survival was 56%. While the standard Nigro protocol remains standard of care in patients with ASCC, in the setting of CD, patients may be best approached as a case-by-case basis and may even require an operation first due to complications from radiation and aggressive nature of disease. Due to poor treatment outcomes, surveillance guidelines for this patient population are necessary.

Perianal streptococcal cellulitis

MedlinePlus

... usually occurs in children, often during or after strep throat , nasopharyngitis, or streptococcal skin infection ( impetigo ). Children ... fistula , or abscess Bleeding, discharge Bloodstream or other streptococcal infections (including heart, joint, and bone) Kidney disease (acute ...

Preliminary geologic map of the Bowen Mountain quadrangle, Grand and Jackson Counties, Colorado

USGS Publications Warehouse

Cole, James C.; Braddock, William A.; Brandt, Theodore R.

2011-01-01

The map shows the geology of an alpine region in the southern Never Summer Mountains, including parts of the Never Summer Wilderness Area, the Bowen Gulch Protection Area, and the Arapaho National Forest. The area includes Proterozoic crystalline rocks in fault contact with folded and overturned Paleozoic and Mesozoic sedimentary rocks and Upper Cretaceous(?) and Paleocene Middle Park Formation. The folding and faulting appears to reflect a singular contractional deformation (post-Middle Park, so probably younger than early Eocene) that produced en echelon structural uplift of the Proterozoic basement of the Front Range. The geologic map indicates there is no through-going \\"Never Summer thrust\\" fault in this area. The middle Tertiary structural complex was intruded in late Oligocene time by basalt, quartz latite, and rhyolite porphyry plugs that also produced minor volcanic deposits; these igneous rocks are collectively referred to informally as the Braddock Peak intrusive-volcanic complex whose type area is located in the Mount Richthofen quadrangle immediately north (Cole and others, 2008; Cole and Braddock, 2009). Miocene boulder gravel deposits are preserved along high-altitude ridges that probably represent former gravel channels that developed during uplift and erosion in middle Tertiary time.

[Chronic vulvar lymphedema revealing Crohn disease in a teenage girl].

PubMed

Aounallah, A; Ghariani Fetoui, N; Ksiaa, M; Boussofara, L; Saidi, W; Mokni, S; Sriha, B; Belajouza, C; Denguezli, M; Ghariani, N; Nouira, R

2017-04-01

Cutaneous Crohn disease is a rare cutaneous manifestation of Crohn disease in children. Herein is reported a case of persistent vulvar lymphedema revealing Crohn disease in a teenage girl. A 14-year-old girl presented with an 8-month history of persistent vulvar swelling associated with chronic macrocheilia. Dermatologic examination showed an inflammatory vulvar lymphedema, associated with perianal fissures and hypertrophic gingivitis. Vulvar skin biopsy revealed non-necrotizing granulomatous inflammation. Gastrointestinal endoscopy yielded no significant findings. The diagnosis of Crohn disease presenting as vulvar lymphedema was established. Oral metronidazole therapy resulted in partial improvement of cutaneous lesions beginning the 1st week. The originality of this case lies in the presentation of chronic macrocheilia with persistent vulvar lymphedema in a child, revealing Crohn disease without gastrointestinal involvement. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Three Views of the River: Three Reviews of "The Shape of the River: Long-Term Consequences of Considering Race in College and University Admissions" by William G. Bowen and Derek Bok.

ERIC Educational Resources Information Center

Chavez, Linda; Lerner, Robert; O'Neill, Dave; Clegg, Roger

This paper presents three reviews of the book, "The Shape of the River: Long-Term Consequences of Considering Race in College and University Admissions," by William Bowen and Derek Bok. The book defends affirmative action in college admissions. The first review says that the book presents important data, but it is seriously flawed…

Mucosal healing with thalidomide in refractory Crohn's disease patients intolerant of anti-TNF-α drugs: report of 3 cases and literature review.

PubMed

Scribano, Maria Lia; Cantoro, Laura; Marrollo, Marzia; Cosintino, Rocco; Kohn, Anna

2014-07-01

Thalidomide is an oral immunomodulatory and anti-inflammatory drug with antitumor necrosis factor-α (TNF-α) activity. Several case reports and some clinical trials have demonstrated its efficacy in the treatment of refractory Crohn's disease (CD). We report the effect and tolerability of thalidomide in 3 patients with moderate-to-severe CD who were not responsive to anti-TNF-α therapies, and review the relevant literature. The first case is of a 28-year-old female affected by Crohn's colitis complicated by a severe fistulizing perianal disease; she was treated with infliximab, adalimumab, and certolizumab pegol, which were stopped because of intolerance. The second case is of a 39-year-old female with fistulizing ileocolitis complicated by severe arthralgias and perianal disease with loss of response to infliximab and intolerance of certolizumab pegol. The third case is of a 39-year-old male with gastric and ileocolonic CD refractory to immunosuppressors and intolerant of infliximab. All the 3 cases achieved complete clinical remission and endoscopic healing of mucosal lesions at a low dose of thalidomide (50 to 150 mg/d). In our CD patients who experienced loss of response or were unable to tolerate anti-TNF-α drugs, thalidomide was an effective and well-tolerated therapy for inducing and maintaining long-term remission.

MRI in patients with inflammatory bowel disease

PubMed Central

Gee, Michael S.; Harisinghani, Mukesh G.

2011-01-01

Inflammatory bowel disease (IBD) affects approximately 1.4 million people in North America and, because of its typical early age of onset and episodic disease course, IBD patients often undergo numerous imaging studies over the course of their lifetimes. CT has become the standard imaging modality for assessment of IBD patients because of its widespread availability, rapid image acquisition, and ability to evaluate intraluminal and extraluminal disease. However, repetitive CT imaging has been associated with a significant ionizing radiation risk to patients, making MRI an appealing alternative IBD imaging modality. Pelvic MRI is currently the imaging gold standard for detecting perianal disease, while recent studies indicate that MRI bowel-directed techniques (enteroclysis, enterography, colonography) can accurately evaluate bowel inflammation in IBD. With recent technical innovations leading to faster and higher resolution body MRI, the role of MRI in IBD evaluation is likely to continue to expand. Future applications include surveillance imaging, detection of mural fibrosis, and early assessment of therapy response. PMID:21512607

Pancreatic Autoantibodies Against CUZD1 and GP2 Are Associated with Distinct Clinical Phenotypes of Crohn's Disease.

PubMed

Michaels, Maike Anna; Jendrek, Sebastian Torben; Korf, Tobias; Nitzsche, Thomas; Teegen, Bianca; Komorowski, Lars; Derer, Stefanie; Schröder, Torsten; Baer, Florian; Lehnert, Henrik; Büning, Jürgen; Fellerman, Klaus; Sina, Christian

2015-12-01

Inflammatory bowel disease (IBD) is characterized by a broad spectrum of clinical phenotypes with different outcomes. In the last decades, several IBD-associated autoantibodies have been identified and investigated for their diagnostic relevance. Autoantibodies against the pancreatic glycoproteins (PAB) CUB and zona pellucida-like domains-containing protein 1 (CUZD1), and glycoprotein 2 (GP2) have been demonstrated to possess high specificity for the diagnosis of IBD. Although several studies have shown significant interrelations of anti-GP2 positivity with disease phenotype, associations of clinical phenotypes with anti-CUZD1 are still unknown. The aim was to identify the association of clinical phenotypes with anti-CUZD1 and anti-GP2 in a well-defined German IBD cohort. Patients with IBD (224 patients with Crohn's disease and 136 patients with ulcerative colitis), who were tested for anti-GP2 and anti-CUZD1 immunoglobulin G and immunoglobulin A by indirect immunofluorescence on transfected cells between 2005 and 2013, were included. Serotype and specified phenotypic data were collected in retrospect and statistically analyzed. Both anti-GP2 (P < 0.001) and anti-CUZD1 (P < 0.001) were significantly more prevalent in patients with Crohn's disease than in ulcerative colitis. PAB positivity was associated with ileocolonic disease (P = 0.002), perianal disease (P = 0.011), immunosuppressive treatment (P = 0.036), and ASCA positivity (P = 0.036). Anti-CUZD1 positivity was associated with ileocolonic (P = 0.016) and perianal disease (P = 0.002), whereas anti-GP2 positivity was positively associated with stricturing behavior (P = 0.016). We found distinct clinical phenotypes to be associated with PAB positivity. Therefore, determination of PABs and their subgroup analysis might identify patients with complicated disease behavior. However, the clinical relevance of our findings should be further evaluated in prospective cohorts.

Estimates of fetch-induced errors in Bowen-ratio energy-budget measurements of evapotranspiration from a prairie wetland, Cottonwood Lake Area, North Dakota, USA

USGS Publications Warehouse

Stannard, David L.; Rosenberry, Donald O.; Winter, Thomas C.; Parkhurst, Renee S.

2004-01-01

Micrometeorological measurements of evapotranspiration (ET) often are affected to some degree by errors arising from limited fetch. A recently developed model was used to estimate fetch-induced errors in Bowen-ratio energy-budget measurements of ET made at a small wetland with fetch-to-height ratios ranging from 34 to 49. Estimated errors were small, averaging −1.90%±0.59%. The small errors are attributed primarily to the near-zero lower sensor height, and the negative bias reflects the greater Bowen ratios of the drier surrounding upland. Some of the variables and parameters affecting the error were not measured, but instead are estimated. A sensitivity analysis indicates that the uncertainty arising from these estimates is small. In general, fetch-induced error in measured wetland ET increases with decreasing fetch-to-height ratio, with increasing aridity and with increasing atmospheric stability over the wetland. Occurrence of standing water at a site is likely to increase the appropriate time step of data integration, for a given level of accuracy. Occurrence of extensive open water can increase accuracy or decrease the required fetch by allowing the lower sensor to be placed at the water surface. If fetch is highly variable and fetch-induced errors are significant, the variables affecting fetch (e.g., wind direction, water level) need to be measured. Fetch-induced error during the non-growing season may be greater or smaller than during the growing season, depending on how seasonal changes affect both the wetland and upland at a site.

Persistent erythematous lesion of the vulva: a diagnostic and treatment challenge.

PubMed

Lazaridou, Elizabeth; Fotiadou, Christina; Giannopoulou, Christina; Ioannides, Demetrios

2012-01-01

The painful, erythematous and eroded vulva often proves to be a diagnostic problem both clinically and histologically. Its differential diagnosis includes both non-neoplastic and neoplastic diseases like Bowen's disease and squamous cell carcinoma (SCC). We report the case of a 62-year-old woman diagnosed, after considerable delay, with Bowen's disease of the vulva that eventually progressed to invasive SCC, despite the treatment with imiquimod 5% cream. Our case indicates, on one hand, that dermoscopy could contribute to the accuracy of the pre-operative clinical diagnosis. On the other hand it confirms the fact that treatment of Bowen's disease of the vulva could be rather intriguing. Although imiquimod 5% cream is an effective, non-invasive treatment option for large lesions or poor healing sites, it should be administered with great consideration in carefully selected cases.

Inter-observer agreement for Crohn's disease sub-phenotypes using the Montreal Classification: How good are we? A multi-centre Australasian study.

PubMed

Krishnaprasad, Krupa; Andrews, Jane M; Lawrance, Ian C; Florin, Timothy; Gearry, Richard B; Leong, Rupert W L; Mahy, Gillian; Bampton, Peter; Prosser, Ruth; Leach, Peta; Chitti, Laurie; Cock, Charles; Grafton, Rachel; Croft, Anthony R; Cooke, Sharon; Doecke, James D; Radford-Smith, Graham L

2012-04-01

Crohn's disease (CD) exhibits significant clinical heterogeneity. Classification systems attempt to describe this; however, their utility and reliability depends on inter-observer agreement (IOA). We therefore sought to evaluate IOA using the Montreal Classification (MC). De-identified clinical records of 35 CD patients from 6 Australian IBD centres were presented to 13 expert practitioners from 8 Australia and New Zealand Inflammatory Bowel Disease Consortium (ANZIBDC) centres. Practitioners classified the cases using MC and forwarded data for central blinded analysis. IOA on smoking and medications was also tested. Kappa statistics, with pre-specified outcomes of κ>0.8 excellent; 0.61-0.8 good; 0.41-0.6 moderate and ≤0.4 poor, were used. 97% of study cases had colonoscopy reports, however, only 31% had undergone a complete set of diagnostic investigations (colonoscopy, histology, SB imaging). At diagnosis, IOA was excellent for age, κ=0.84; good for disease location, κ=0.73; only moderate for upper GI disease (κ=0.57) and disease behaviour, κ=0.54; and good for the presence of perianal disease, κ=0.6. At last follow-up, IOA was good for location, κ=0.68; only moderate for upper GI disease (κ=0.43) and disease behaviour, κ=0.46; but excellent for the presence/absence of perianal disease, κ=0.88. IOA for immunosuppressant use ever and presence of stricture were both good (κ=0.79 and 0.64 respectively). IOA using MC is generally good; however some areas are less consistent than others. Omissions and inaccuracies reduce the value of clinical data when comparing cohorts across different centres, and may impair the ability to translate genetic discoveries into clinical practice. Crown Copyright © 2011. Published by Elsevier B.V. All rights reserved.

Health Information Management Leaders and the Practice of Leadership through the Lens of Bowen Theory.

PubMed

Sheridan, Patty Thierry; Watzlaf, Valerie; Fox, Leslie Ann

2016-01-01

Even though leadership is one of the most examined topics in the organizational literature, its application in the field of health information management (HIM) has not been studied extensively. This descriptive, mixed-methodology study examined HIM leadership through the lens of Bowen theory. The researchers conducted surveys of HIM directors and managers, administrators and colleagues of HIM leaders, and HIM staff using focus groups, observations of meetings, and face-to-face interviews. Results showed that HIM leaders are valued for HIM expertise in electronic health records, privacy, security, and coding; for being the center or heart of the organization; and for commonly valued leadership behaviors and skills including dependability, strategic planning, project management, listening ability, and fairness. Leadership was seen as a reciprocal process, and a team approach was preferred. Good communication, education, and training on HIM topics were also valued. However, HIM leaders believed that they spend more time on management activities than on leadership activities, although they would prefer the reverse. Future research is needed to examine how HIM leadership can be practiced more consistently in the workplace across different HIM functions.

Health Information Management Leaders and the Practice of Leadership through the Lens of Bowen Theory

PubMed Central

Sheridan, Patty Thierry; Watzlaf, Valerie; Fox, Leslie Ann

2016-01-01

Even though leadership is one of the most examined topics in the organizational literature, its application in the field of health information management (HIM) has not been studied extensively. This descriptive, mixed-methodology study examined HIM leadership through the lens of Bowen theory. The researchers conducted surveys of HIM directors and managers, administrators and colleagues of HIM leaders, and HIM staff using focus groups, observations of meetings, and face-to-face interviews. Results showed that HIM leaders are valued for HIM expertise in electronic health records, privacy, security, and coding; for being the center or heart of the organization; and for commonly valued leadership behaviors and skills including dependability, strategic planning, project management, listening ability, and fairness. Leadership was seen as a reciprocal process, and a team approach was preferred. Good communication, education, and training on HIM topics were also valued. However, HIM leaders believed that they spend more time on management activities than on leadership activities, although they would prefer the reverse. Future research is needed to examine how HIM leadership can be practiced more consistently in the workplace across different HIM functions. PMID:27134609

Gut microbiota and inflammatory bowel disease: the role of antibiotics in disease management.

PubMed

Kerman, David H; Deshpande, Amar R

2014-07-01

Imbalances in the composition and number of bacteria in the gut microbiota have been implicated in inflammatory bowel disease (IBD), and modulation of the gut microbiota by probiotics and antibiotics in IBD has been an active area of research, with mixed results. This narrative review summarizes the findings of relevant publications identified using the PubMed database. Although antibiotics have been associated with an increased risk of IBD development and flares, several meta-analyses demonstrate that antibiotics are efficacious for the induction of remission and treatment of flares in patients with IBD. Data supporting their use include a large number of antibiotic studies in Crohn's disease and evidence suggests antibiotics are efficacious in both Crohn's disease and ulcerative colitis, although there are fewer studies of the latter. For Crohn's disease, antibiotics have been shown to be useful for the induction of remission and in the postoperative management of patients undergoing surgery. Additionally, patients with fistulizing disease, particularly perianal, can benefit from antibiotics administered short term. Both antimicrobials and probiotics have been shown to be useful for the treatment of pouchitis. Additional randomized controlled trials are needed to further elucidate the role of bacteria in IBD and to better inform clinicians about appropriate antibiotic therapies.

Endoscopy and cross-sectional imaging for assessing Crohn׳s disease activity.

PubMed

Stidham, Ryan W; Cross, Raymond K

2016-07-01

Crohn's disease (CD) is principally characterized by chronic and recurrent inflammation of the gastrointestinal tract, most commonly found in the ileo-colonic region. The chronicity and severity of intestinal inflammation together contribute to progressive, cumulative, deep, transmural intestinal damage, including stricturing, obstruction, abscesses, and fistulae. Both intestinal inflammation and its chronic complications result in a range of symptoms subsequently leading to patient presentations with diarrhea, abdominal pain, and anemia related to intestinal blood loss. Measuring disease activity and severity are essential for decision of treatment intensity early in the disease course and longitudinal monitoring of therapeutic efficacy. This review will summarize the transition from subjective symptoms driving disease activity indices, into increasingly objective and quantitative measures of intestinal injury by direct mucosal assessment (endoscopy), cross-sectional imaging, and surrogate biomarkers. Specific commentary on intestinal stricture and perianal fistula assessment and management are presented in accompanying sections of this series.

Stem cell transplant in inflammatory bowel disease: a promising modality of treatment for a complicated disease course.

PubMed

Salem, George A; Selby, George B

2017-01-01

Inflammatory bowel disease (IBD) is a complex, relapsing and remitting, disease characterized by an exaggerated immune response in a susceptible host. The symptoms and complications of the disease can be debilitating. Advances in medical treatment in the last decade changed the course of the disease in many patients. Despite the use of novel agents for controlling disease, a proportion of patients' disease courses continue to be either refractory, or become resistant, to available therapeutic options. Stem-cell therapy, with hematopoietic stem cells (HSCs) or mesenchymal stem cells (MSCs), is a promising modality of treatment for severe refractory cases, mainly Crohn's disease (CD) patients. HSCs have the ability to migrate to damaged tissue, which provides them with further properties to differentiate to epithelial or immune-modulatory cells to restore normal mucosal tissue and integrity. MSCs therapy is a promising model for patients with perianal CD due to their immunosuppressive properties, ability to migrate to areas of injury, and demonstration of colonic healing, including fistulizing tracts. The results from ongoing clinical trials will provide a valuable understanding of the future of stem-cell therapy as a treatment option in refractory cases of IBD, a disease whose pathogenesis remains unknown, and is notoriously difficult to treat.

Rare occurrence of metastasis from lung cancer to the anus: case report and review of the literature.

PubMed

Al-Tarakji, Mohannad; Feilchenfeldt, Jonas; Haidar, Abdulrazzaq; Szabados, Lajos; Abdelaziem, Sherif; Sayed, Ali; Toro, Adriana; Di Carlo, Isidoro

2016-06-08

Anal metastases from lung cancer are infrequent, and there are only 10 published cases. Life expectancy is no longer than 1 year after diagnosis because of the typically advanced stage of disease. Treatment, which is typically inefficient, is administered with the intent to cure or avoid local complications. We report a case of a patient with non-small cell lung cancer presenting with perianal metastasis mimicking an abscess. Because perianal masses may be misdiagnosed, patients with lung and other cancers should be evaluated for metastatic disease.

3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn's Disease 2016: Part 1: Diagnosis and Medical Management.

PubMed

Gomollón, Fernando; Dignass, Axel; Annese, Vito; Tilg, Herbert; Van Assche, Gert; Lindsay, James O; Peyrin-Biroulet, Laurent; Cullen, Garret J; Daperno, Marco; Kucharzik, Torsten; Rieder, Florian; Almer, Sven; Armuzzi, Alessandro; Harbord, Marcus; Langhorst, Jost; Sans, Miquel; Chowers, Yehuda; Fiorino, Gionata; Juillerat, Pascal; Mantzaris, Gerassimos J; Rizzello, Fernando; Vavricka, Stephan; Gionchetti, Paolo

2017-01-01

This paper is the first in a series of two publications relating to the European Crohn's and Colitis Organisation [ECCO] evidence-based consensus on the diagnosis and management of Crohn's disease and concerns the methodology of the consensus process, and the classification, diagnosis and medical management of active and quiescent Crohn's disease. Surgical management as well as special situations including management of perianal Crohn's disease of this ECCO Consensus are covered in a subsequent second paper [Gionchetti et al JCC 2016]. Copyright © 2016 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Predicting Outcomes to Optimize Disease Management in Inflammatory Bowel Diseases.

PubMed

Torres, Joana; Caprioli, Flavio; Katsanos, Konstantinos H; Lobatón, Triana; Micic, Dejan; Zerôncio, Marco; Van Assche, Gert; Lee, James C; Lindsay, James O; Rubin, David T; Panaccione, Remo; Colombel, Jean-Frédéric

2016-12-01

Efforts to slow or prevent the progressive course of inflammatory bowel diseases [IBD] include early and intensive monitoring and treatment of patients at higher risk for complications. It is therefore essential to identify high-risk patients - both at diagnosis and throughout disease course. As a part of an IBD Ahead initiative, we conducted a comprehensive literature review to identify predictors of long-term IBD prognosis and generate draft expert summary statements. Statements were refined at national meetings of IBD experts in 32 countries and were finalized at an international meeting in November 2014. Patients with Crohn's disease presenting at a young age or with extensive anatomical involvement, deep ulcerations, ileal/ileocolonic involvement, perianal and/or severe rectal disease or penetrating/stenosing behaviour should be regarded as high risk for complications. Patients with ulcerative colitis presenting at young age, with extensive colitis and frequent flare-ups needing steroids or hospitalization present increased risk for colectomy or future hospitalization. Smoking status, concurrent primary sclerosing cholangitis and concurrent infections may impact the course of disease. Current genetic and serological markers lack accuracy for clinical use. Simple demographic and clinical features can guide the clinician in identifying patients at higher risk for disease complications at diagnosis and throughout disease course. However, many of these risk factors have been identified retrospectively and lack validation. Appropriately powered prospective studies are required to inform algorithms that can truly predict the risk for disease progression in the individual patient. © European Crohn’s and Colitis Organisation 2016.

Medical and surgical treatment of haemorrhoids and anal fissure in Crohn's disease: a critical appraisal.

PubMed

D'Ugo, Stefano; Franceschilli, Luana; Cadeddu, Federica; Leccesi, Laura; Blanco, Giovanna Del Vecchio; Calabrese, Emma; Milito, Giovanni; Di Lorenzo, Nicola; Gaspari, Achille L; Sileri, Pierpaolo

2013-03-11

The principle to avoid surgery for haemorrhoids and/or anal fissure in Crohn's disease (CD) patients is still currently valid despite advances in medical and surgical treatments. In this study we report our prospectively recorded data on medical and surgical treatment of haemorrhoids and anal fissures in CD patients over a period of 8 years. Clinical data of patients affected by perianal disease were routinely and prospectively inserted in a database between October 2003 and October 2011 at the Department of Surgery, Tor Vergata University Hospital, Rome. We reviewed and divided in two groups records on CD patients treated either medically or surgically according to the diagnosis of haemorrhoids or anal fissures. Moreover, we compared in each group the outcome in patients with prior diagnosis of CD and in patients diagnosed with CD only after perianal main treatment. Eighty-six CD patients were included in the study; 45 were treated for haemorrhoids and 41 presented with anal fissure. Conservative approach was initially adopted for all patients; in case of medical treatment failure, the presence of stable intestinal disease made them eligible for surgery. Fifteen patients underwent haemorrhoidectomy (open 11; closed 3; stapled 1), and two rubber band ligation. Fourteen patients required surgery for anal fissure (Botox ± fissurectomy 8; LIS 6). In both groups we observed high complication rate, 41.2% for haemorrhoids and 57.1% for anal fissure. Patients who underwent haemorrhoidectomy without certain diagnosis of CD had significantly higher risk of complications. Conservative treatment of proctologic diseases in CD patients has been advocated given the high risk of complications and the evidence that spontaneous healing may also occur. From these preliminary results a role of surgery is conceivable in high selected patients, but definitve conclusions can't be made. Further randomized trials are needed to establish the efficacy of the surgical approach, giving

[Cutaneous involvement in chronic inflammatory bowel disease : Crohn's disease and ulcerative colitis].

PubMed

Richter, L; Rappersberger, K

2016-12-01

Over recent decades, both the incidence and prevalence of chronic inflammatory bowel disease have continued to rise in industrialized countries; the disease is frequently associated with extracutaneous involvement and comorbidity. The purpose of this work was to investigate the frequency and specificity of mucocutaneous manifestations in Crohn's disease (CD) and ulcerative colitis (UC). An extensive search in peer-reviewed journals via PubMed was performed; presented is a summary and analysis of various studies and data, including data of patients treated at our department. CD and UC are frequently associated with mucocutaneous symptoms; however, primary/specific disease-associations are exclusively seen in CD patients. These include peri-anal and -stomal fistulas and ulcerations, "metastatic" Crohn's disease as well as oral granulomatous disease. Moreover, in both CD and UC, there occur several other inflammatory skin conditions such as erythema nodosum, pyoderma gangrenosum, hidradenitis suppurativa, chronic oral aphthous disease, Sweet syndrome, pyostomatitis vegetans, and bowel-associated dermatosis-arthritis syndrome. Malnutrition syndromes (zinc and vitamin deficiencies) are only rarely observed. On skin and oral/genital mucous membranes various different inflammatory manifestations may be observed during the course of CD or UC. However, most data about a direct pathogenic relationship of the gastrointestinal and dermatologic disorders are quite heterogeneous or even contradictory. Nevertheless, knowledge of these conditions and their possible association with CD and UC could be crucial for early diagnosis and initiation of an appropriate therapy and thus be essential to prevent secondary tissue damage.

Use of antibiotics in the treatment of Crohn's disease.

PubMed

Scribano, Maria Lia; Prantera, Cosimo

2013-02-07

Many data coming from animal models and clinical observations support an involvement of intestinal microbiota in the pathogenesis of Crohn's disease (CD). It is hypothesized in fact, that the development of chronic intestinal inflammation is caused by an abnormal immune response to normal flora in genetically susceptible hosts. The involvement of bacteria in CD inflammation has provided the rationale for including antibiotics in the therapeutic armamentarium. However, randomized controlled trials have failed to demonstrate an efficacy of these drugs in patients with active uncomplicated CD, even if a subgroup of patients with colonic location seems to get benefit from antibiotics. Nitroimidazole compounds have been shown to be efficacious in decreasing CD recurrence rates in operated patients, and the use of metronidazole and ciprofloxacin is recommended in perianal disease. However, the appearance of systemic side effects limits antibiotic long-term employment necessary for treating a chronic relapsing disease. Rifaximin, characterized by an excellent safety profile, has provided promising results in inducing remission of CD.

Endoscopy and cross-sectional imaging for assessing Crohn׳s disease activity

PubMed Central

Stidham, Ryan W.; Cross, Raymond K.

2016-01-01

Crohn’s disease (CD) is principally characterized by chronic and recurrent inflammation of the gastrointestinal tract, most commonly found in the ileo-colonic region. The chronicity and severity of intestinal inflammation together contribute to progressive, cumulative, deep, transmural intestinal damage, including stricturing, obstruction, abscesses, and fistulae. Both intestinal inflammation and its chronic complications result in a range of symptoms subsequently leading to patient presentations with diarrhea, abdominal pain, and anemia related to intestinal blood loss. Measuring disease activity and severity are essential for decision of treatment intensity early in the disease course and longitudinal monitoring of therapeutic efficacy. This review will summarize the transition from subjective symptoms driving disease activity indices, into increasingly objective and quantitative measures of intestinal injury by direct mucosal assessment (endoscopy), cross-sectional imaging, and surrogate biomarkers. Specific commentary on intestinal stricture and perianal fistula assessment and management are presented in accompanying sections of this series. PMID:28458507

Limnological Conditions and Occurrence of Taste-and-Odor Compounds in Lake William C. Bowen and Municipal Reservoir #1, Spartanburg County, South Carolina, 2006-2009

USGS Publications Warehouse

Journey, Celeste A.; Arrington, Jane M.; Beaulieu, Karen M.; Graham, Jennifer L.; Bradley, Paul M.

2011-01-01

Limnological conditions and the occurrence of taste-and-odor compounds were studied in two reservoirs in Spartanburg County, South Carolina, from May 2006 to June 2009. Lake William C. Bowen and Municipal Reservoir #1 are relatively shallow, meso-eutrophic, warm monomictic, cascading impoundments on the South Pacolet River. Overall, water-quality conditions and phytoplankton community assemblages were similar between the two reservoirs but differed seasonally. Median dissolved geosmin concentrations in the reservoirs ranged from 0.004 to 0.006 microgram per liter. Annual maximum dissolved geosmin concentrations tended to occur between March and May. In this study, peak dissolved geosmin production occurred in April and May 2008, ranging from 0.050 to 0.100 microgram per liter at the deeper reservoir sites. Peak dissolved geosmin production was not concurrent with maximum cyanobacterial biovolumes, which tended to occur in the summer (July to August), but was concurrent with a peak in the fraction of genera with known geosmin-producing strains in the cyanobacteria group. Nonetheless, annual maximum cyanobacterial biovolumes rarely resulted in cyanobacteria dominance of the phytoplankton community. In both reservoirs, elevated dissolved geosmin concentrations were correlated to environmental factors indicative of unstratified conditions and reduced algal productivity, but not to nutrient concentrations or ratios. With respect to potential geosmin sources, elevated geosmin concentrations were correlated to greater fractions of genera with known geosmin-producing strains in the cyanobacteria group and to biovolumes of a specific geosmin-producing cyanobacteria genus (Oscillatoria), but not to actinomycetes concentrations. Conversely, environmental factors that correlated with elevated cyanobacterial biovolumes were indicative of stable water columns (stratified conditions), warm water temperatures, reduced nitrogen concentrations, longer residence times, and high

Computed Tomography Enterography for Evaluation of Inflammatory Bowel Disease

PubMed Central

Park, Min Jung

2013-01-01

Computed tomography enterography (CTE) has become a main modality for the evaluation of inflammatory bowel disease (IBD). It simultaneously offers visualization of the small bowel and extraintestinal status, which is helpful for diagnosing IBD. Crohn disease has long segmental enhancing wall thickening related with the eccentric longitudinal distribution. In addition, mural stratification, fibrofatty proliferation, positive comb sign by increased mesenteric vascularity and internal/perianal fistula are characteristics of Crohn disease and can be identified on CTE. Short segmental inflammatory wall thickening and the central low attenuated lymph nodes are favorable CT finding of intestinal tuberculosis. A geographic, relatively large, and deep penetrating ulcer with bowel wall thickening and mural hyperenhancement in ileocecal area are characteristics of intestinal Behcet disease. Each of CTE findings for the IBDs is helpful for differential diagnosis. The main disadvantage of this technique is the requisite radiation exposure of patients, particularly in young patients. However, recent development of advanced CT techniques is promising for radiation dose reduction without compromising diagnostic image quality. PMID:23964329

Crohn Disease: Epidemiology, Diagnosis, and Management.

PubMed

Feuerstein, Joseph D; Cheifetz, Adam S

2017-07-01

Crohn disease is a chronic idiopathic inflammatory bowel disease condition characterized by skip lesions and transmural inflammation that can affect the entire gastrointestinal tract from the mouth to the anus. For this review article, we performed a review of articles in PubMed through February 1, 2017, by using the following Medical Subject Heading terms: crohns disease, crohn's disease, crohn disease, inflammatory bowel disease, and inflammatory bowel diseases. Presenting symptoms are often variable and may include diarrhea, abdominal pain, weight loss, nausea, vomiting, and in certain cases fevers or chills. There are 3 main disease phenotypes: inflammatory, structuring, and penetrating. In addition to the underlying disease phenotype, up to a third of patients will develop perianal involvement of their disease. In addition, in some cases, extraintestinal manifestations may develop. The diagnosis is typically made with endoscopic and/or radiologic findings. Disease management is usually with pharmacologic therapy, which is determined on the basis of disease severity and underlying disease phenotype. Although the goal of management is to control the inflammation and induce a clinical remission with pharmacologic therapy, most patients will eventually require surgery for their disease. Unfortunately, surgery is not curative and patients still require ongoing therapy even after surgery for disease recurrence. Importantly, given the risks of complications from both Crohn disease and the medications used to treat the disease process, primary care physicians play an important role in optimizing the preventative care management to reduce the risk of complications. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Diagnostic Yield of Next-Generation Sequencing in Very Early-Onset Inflammatory Bowel Diseases: A Multicenter Study.

PubMed

Charbit-Henrion, Fabienne; Parlato, Marianna; Hanein, Sylvain; Duclaux-Loras, Rémi; Nowak, Jan; Begue, Bernadette; Rakotobe, Sabine; Bruneau, Julie; Fourrage, Cécile; Alibeu, Olivier; Rieux-Laucat, Frédéric; Lévy, Eva; Stolzenberg, Marie-Claude; Mazerolles, Fabienne; Latour, Sylvain; Lenoir, Christelle; Fischer, Alain; Picard, Capucine; Aloi, Marina; Amil Dias, Jorge; Ben Hariz, Mongi; Bourrier, Anne; Breuer, Christian; Breton, Anne; Bronski, Jiri; Buderus, Stephan; Cananzi, Mara; Coopman, Stéphanie; Crémilleux, Clara; Dabadie, Alain; Dumant-Forest, Clémentine; Egritas Gurkan, Odul; Fabre, Alexandre; Fischer, Aude; German Diaz, Marta; Gonzalez-Lama, Yago; Goulet, Olivier; Guariso, Graziella; Gurcan, Neslihan; Homan, Matjaz; Hugot, Jean-Pierre; Jeziorski, Eric; Karanika, Evi; Lachaux, Alain; Lewindon, Peter; Lima, Rosa; Magro, Fernando; Major, Janos; Malamut, Georgia; Mas, Emmanuel; Mattyus, Istvan; Mearin, Luisa M; Melek, Jan; Navas-Lopez, Victor Manuel; Paerregaard, Anders; Pelatan, Cecile; Pigneur, Bénédicte; Pinto Pais, Isabel; Rebeuh, Julie; Romano, Claudio; Siala, Nadia; Strisciuglio, Caterina; Tempia-Caliera, Michela; Tounian, Patrick; Turner, Dan; Urbonas, Vaidotas; Willot, Stéphanie; Ruemmele, Frank M; Cerf-Bensussan, Nadine

2018-05-18

An expanding number of monogenic defects have been identified as causative of severe forms of very early-onset inflammatory bowel diseases (VEO-IBD). The present study aimed at defining how next-generation sequencing (NGS) methods can be used to improve identification of known molecular diagnosis and adapt treatment. 207 children were recruited in 45 Paediatric centres through an international collaborative network (ESPGHAN GENIUS working group) with a clinical presentation of severe VEO-IBD (n=185) or an anamnesis suggestive of a monogenic disorder (n=22). Patients were divided at inclusion into three phenotypic subsets: predominantly small bowel inflammation, colitis with perianal lesions, and colitis only. Methods to obtain molecular diagnosis included functional tests followed by specific Sanger sequencing, custom-made targeted NGS, and in selected cases whole exome sequencing (WES) of parents-child trios. Genetic findings were validated clinically and/or functionally. Molecular diagnosis was achieved in 66/207 children (32%): 61% with small bowel inflammation, 39% with colitis and perianal lesions and 18% with colitis only. Targeted NGS pinpointed gene mutations causative of atypical presentations and identified large exonic copy number variations previously missed by WES. Our results lead us to propose an optimised diagnostic strategy to identify known monogenic causes of severe IBD.

Colonic Crohn's Disease Is Associated with Less Aggressive Disease Course Than Ileal or Ileocolonic Disease.

PubMed

Arora, Umang; Kedia, Saurabh; Garg, Prerna; Bopanna, Sawan; Jain, Saransh; Yadav, Dawesh P; Goyal, Sandeep; Gupta, Vipin; Sahni, Peush; Pal, Sujoy; Dash, Nihar Ranjan; Madhusudhan, Kumble Seetharama; Sharma, Raju; Makharia, Govind; Ahuja, Vineet

2018-06-01

The literature on disease characteristics of colonic Crohn's disease (CD) is sparse, especially from Asia, where the burden of inflammatory bowel disease is on the rise. The present study aims to describe the disease characteristics of colonic CD, and compare it with that of ileal/ileocolonic disease. This retrospective study included adult patients of CD (diagnosed by standard criteria, follow-up duration > 6 months) on follow-up between August 2004 and January 2016. The disease location was classified by Montreal classification. The data were recorded on demographic characteristics, smoking status, disease phenotype, disease course, treatment received, hospitalization and surgeries. Of 406 CD patients, 123 had colonic [mean age (at onset) 30.4 ± 13.2 years, 59.3% males] and 265 had ileal/ileocolonic disease [mean age (at onset) 32.9 ± 13.8 years, 61.5% males] while 18 patients had isolated upper GI disease. The frequency of inflammatory behavior (B1 phenotype; 61.8 vs. 46.4%, p = 0.003), perianal disease (23.6 vs. 4.5%, p < 0.001), and extra-intestinal manifestation (42.3 vs. 30.2%, p = 0.019) was higher in colonic than ileal/ileocolonic CD. Though not statistically significant, requirement of atleast one course of steroid was lower in colonic CD (72.7 vs. 84.2%, p = 0.098). Although there was no difference in the frequency of hospitalization (30.1 vs. 27.1%, p = 0.45), the overall requirement for surgery was significantly lower in colonic CD (17.1 vs. 26.1%, p = 0.032) and patients with colonic disease had a lower cumulative probability of first surgery in the first 10 years of follow-up [Hazard ratio 0.556 (95% CI 0.313-0.985), p = 0.045]. Colonic CD was associated with less aggressive disease behavior and lower requirement of surgery as compared to ileal/ileocolonic CD.

Efficacy and safety of certolizumab pegol in an unselected crohn's disease population: 26-week data of the FACTS II survey.

PubMed

Vavricka, Stephan R; Schoepfer, Alain M; Bansky, Georg; Binek, Janek; Felley, Christian; Geyer, Martin; Manz, Michael; Rogler, Gerhard; de Saussure, Philippe; Sauter, Bernhard; Scharl, Michael; Seibold, Frank; Straumann, Alex; Michetti, Pierre

2011-07-01

Certolizumab pegol (Cimzia, CZP) was approved for the treatment of Crohn's disease (CD) patients in 2007 in Switzerland as the first country worldwide. This prospective phase IV study aimed to evaluate the efficacy and safety of CZP over 26 weeks in a multicenter cohort of practice-based patients. Evaluation questionnaires at baseline, week 6, and week 26 were completed by gastroenterologists in hospitals and private practices. Adverse events were evaluated according to World Health Organization (WHO) guidelines. Sixty patients (38F/22M) were included; 53% had complicated disease (stricturing or penetrating), 45% had undergone prior CD-related surgery. All patients had prior exposure to systemic steroids, 96% to immunomodulators, 73% to infliximab, and 43% to adalimumab. A significant decrease of the Harvey-Bradshaw Index (HBI) was observed under CZP therapy (12.2 ± 4.9 at week 0 versus 6.3 ± 4.7 at week 6 and 6.7 ± 5.3 at week 26, both P < 0.001). Response and remission rates were 70% and 40% (week 6) and 67% and 36%, respectively (week 26). The complete perianal fistula closure rate was 36% at week 6 and 55% at week 26. The frequency of adverse drug reactions attributed to CZP was 5%. CZP was continued in 88% of patients beyond week 6 and in 67% beyond week 26. In a population of CD patients with predominantly complicated disease behavior, CZP proved to be effective in induction and maintenance of response and remission. This series provides the first evidence of CZP's effectiveness in perianal fistulizing CD in clinical practice. Copyright © 2010 Crohn's & Colitis Foundation of America, Inc.

Incidence, disease phenotype at diagnosis, and early disease course in inflammatory bowel diseases in Western Hungary, 2002-2006.

PubMed

Lakatos, Laszlo; Kiss, Lajos S; David, Gyula; Pandur, Tunde; Erdelyi, Zsuzsanna; Mester, Gabor; Balogh, Mihaly; Szipocs, Istvan; Molnar, Csaba; Komaromi, Erzsebet; Lakatos, Peter Laszlo

2011-12-01

Recent trends indicate a change in the epidemiology of inflammatory bowel diseases (IBD), with previously low incidence areas now reporting a progressive rise in the incidence. Our aim was to analyze the incidence and disease phenotype at diagnosis in IBD in the population-based Veszprem Province database, which included incident patients diagnosed between January 1, 2002 and December 31, 2006. Data of 393 incident patients were analyzed (ulcerative colitis [UC]: 220, age-at-diagnosis: 40.5 years; Crohn's disease [CD]: 163, age-at-diagnosis: 32.5 years; and indeterminate colitis [IC]: 10). Both hospital and outpatient records were collected and comprehensively reviewed. Adjusted mean incidence rates were 8.9/10(5) person-years for CD and 11.9/10(5) person-years in UC. Peak onset age in both CD and UC patients was 21-30 years old. Location at diagnosis in UC was proctitis in 26.8%, left-sided colitis in 50.9%, and pancolitis in 22.3%. The probability of proximal extension and colectomy after 5 years was 12.7% and 2.8%. The disease location in CD was ileal in 20.2%, colonic in 35.6%, ileocolonic in 44.2%, and upper gastrointestinal in four patients. Behavior at diagnosis was stenosing/penetrating in 35.6% and perianal in 11.1%. Patients with colonic disease were older at diagnosis compared to patients with ileal or ileocolonic disease. In a Kaplan-Meier analysis, probability of surgical resection was 9.8%, 18.5%, and 21.3% after 1, 3, and 5 years of disease duration, respectively. The incidence of IBD in Veszprem Province in the last decade was high, equal to that in high-incidence areas in Western European countries. Early disease course is milder compared to data reported in the literature. Copyright © 2011 Crohn's & Colitis Foundation of America, Inc.

Genital and reproductive organ complications of Crohn disease: technical considerations as it relates to perianal disease, imaging features, and implications on management.

PubMed

Kammann, Steven; Menias, Christine; Hara, Amy; Moshiri, Mariam; Siegel, Cary; Safar, Bashar; Brandes, Steven; Shaaban, Akram; Sandrasegaran, Kumar

2017-06-01

A relatively large proportion of patients with Crohn disease (CD) develop complications including abscess formation, stricture, and penetrating disease. A subset of patients will have genital and reproductive organ involvement of CD, resulting in significant morbidity. These special circumstances create unique management challenges that must be tailored to the activity, location, and extent of disease. Familiarity with the epidemiology, pathogenesis, imaging features, and treatment strategies for patients with genital CD can aid imaging diagnoses and guide appropriate patient management. The purpose of this study is to illustrate the spectrum of CD in the genital tract and reproductive organs and discuss the complex management strategies in these patients as it relates to imaging. Given the impact on patient outcome and treatment planning, familiarity with the epidemiology, pathogenesis, imaging features, and treatment of patients with genital Crohn disease can aid radiologic diagnoses and guide appropriate patient management.

Diagnosing and Managing IBD

MedlinePlus

... of your abdomen. Newer scanners have an open design to minimize claustrophobia. A CT of the abdomen ... CE) Upper tract Crohn’s disease EGD-Upper GI Series (UGIS) Perianal Crohn’s disease MRI-EUS PSC (primary ...

RandomForest4Life: a Random Forest for predicting ALS disease progression.

PubMed

Hothorn, Torsten; Jung, Hans H

2014-09-01

We describe a method for predicting disease progression in amyotrophic lateral sclerosis (ALS) patients. The method was developed as a submission to the DREAM Phil Bowen ALS Prediction Prize4Life Challenge of summer 2012. Based on repeated patient examinations over a three- month period, we used a random forest algorithm to predict future disease progression. The procedure was set up and internally evaluated using data from 1197 ALS patients. External validation by an expert jury was based on undisclosed information of an additional 625 patients; all patient data were obtained from the PRO-ACT database. In terms of prediction accuracy, the approach described here ranked third best. Our interpretation of the prediction model confirmed previous reports suggesting that past disease progression is a strong predictor of future disease progression measured on the ALS functional rating scale (ALSFRS). We also found that larger variability in initial ALSFRS scores is linked to faster future disease progression. The results reported here furthermore suggested that approaches taking the multidimensionality of the ALSFRS into account promise some potential for improved ALS disease prediction.

Medical and surgical treatment of haemorrhoids and anal fissure in Crohn’s disease: a critical appraisal

PubMed Central

2013-01-01

Background The principle to avoid surgery for haemorrhoids and/or anal fissure in Crohn’s disease (CD) patients is still currently valid despite advances in medical and surgical treatments. In this study we report our prospectively recorded data on medical and surgical treatment of haemorrhoids and anal fissures in CD patients over a period of 8 years. Methods Clinical data of patients affected by perianal disease were routinely and prospectively inserted in a database between October 2003 and October 2011 at the Department of Surgery, Tor Vergata University Hospital, Rome. We reviewed and divided in two groups records on CD patients treated either medically or surgically according to the diagnosis of haemorrhoids or anal fissures. Moreover, we compared in each group the outcome in patients with prior diagnosis of CD and in patients diagnosed with CD only after perianal main treatment. Results Eighty-six CD patients were included in the study; 45 were treated for haemorrhoids and 41 presented with anal fissure. Conservative approach was initially adopted for all patients; in case of medical treatment failure, the presence of stable intestinal disease made them eligible for surgery. Fifteen patients underwent haemorrhoidectomy (open 11; closed 3; stapled 1), and two rubber band ligation. Fourteen patients required surgery for anal fissure (Botox ± fissurectomy 8; LIS 6). In both groups we observed high complication rate, 41.2% for haemorrhoids and 57.1% for anal fissure. Patients who underwent haemorrhoidectomy without certain diagnosis of CD had significantly higher risk of complications. Conclusions Conservative treatment of proctologic diseases in CD patients has been advocated given the high risk of complications and the evidence that spontaneous healing may also occur. From these preliminary results a role of surgery is conceivable in high selected patients, but definitve conclusions can’t be made. Further randomized trials are needed to establish the

Staged marginal contoured and central excision technique in the surgical management of perianal Paget's disease.

PubMed

Möller, Mecker G; Lugo-Baruqui, Jose Alejandro; Milikowski, Clara; Salgado, Christopher J

2014-04-01

Extramammary Paget's disease (EMPD) is an adenocarcinoma of the apocrine glands with unknown exact prevalence and obscure etiology. It has been divided into primary EMPD and secondary EMPD, in which an internal malignancy is usually associated. Treatment for primary EMPD usually consists of wide lesion excision with negative margins. Multiple methods have been proposed to obtain free-margin status of the disease. These include visible border lesion excision, punch biopsies, and micrographic and frozen-section surgery, with different results but still high recurrence rates. The investigators propose a method consisting of a staged contoured marginal excision using "en face" permanent pathologic analysis preceding the steps of central excision of the lesion and the final reconstruction of the surgical defect. Advantages of this method include adequate margin control allowing final reconstruction and tissue preservation, while minimizing patient discomfort. The staged contoured marginal and central excision technique offers a new alternative to the armamentarium for surgical oncologists for the management of EMPD in which margin control is imperative for control of recurrence rates. Copyright © 2014 Elsevier Inc. All rights reserved.

Penetrating or stricturing diseases are the major determinants of time to first and repeat resection surgery in Crohn's disease.

PubMed

Pittet, Valerie; Rogler, Gerhard; Michetti, Pierre; Fournier, Nicolas; Vader, John-Paul; Schoepfer, Alain; Mottet, Christian; Burnand, Bernard; Froehlich, Florian

2013-01-01

About 80% of patients with Crohn's disease (CD) require bowel resection and up to 65% will undergo a second resection within 10 years. This study reports clinical risk factors for resection surgery (RS) and repeat RS. Retrospective cohort study, using data from patients included in the Swiss Inflammatory Bowel Disease Cohort. Cox regression analyses were performed to estimate rates of initial and repeated RS. Out of 1,138 CD cohort patients, 417 (36.6%) had already undergone RS at the time of inclusion. Kaplan-Meier curves showed that the probability of being free of RS was 65% after 10 years, 42% after 20 years, and 23% after 40 years. Perianal involvement (PA) did not modify this probability to a significant extent. The main adjusted risk factors for RS were smoking at diagnosis (hazard ratio (HR) = 1.33; p = 0.006), stricturing with vs. without PA (HR = 4.91 vs. 4.11; p < 0.001) or penetrating disease with vs. without PA (HR = 3.53 vs. 4.58; p < 0.001). The risk factor for repeat RS was penetrating disease with vs. without PA (HR = 3.17 vs. 2.24; p < 0.05). The risk of RS was confirmed to be very high for CD in our cohort. Smoking status at diagnosis, but mostly penetrating and stricturing diseases increase the risk of RS. Copyright © 2013 S. Karger AG, Basel.

Technetium-99m-HMPAO labeled leukocyte single photon emission computerized tomography (SPECT) for assessing Crohn's disease extent and intestinal infiltration.

PubMed

Biancone, L; Schillaci, O; Capoccetti, F; Bozzi, R M; Fina, D; Petruzziello, C; Geremia, A; Simonetti, G; Pallone, F

2005-02-01

Scintigraphy using radiolabeled leukocytes is a useful technique for assessing intestinal infiltration in Crohn's disease (CD). However, limits of planar images include overlapping activity in other organs and low specificity. To investigate the usefulness of (99m)Tc-HMPAO (hexametyl propylene amine oxime) labeled leukocyte single photon emission computerized tomography (SPECT) for assessing CD lesions, in comparison with planar images. Twenty-two inflammatory bowel disease patients (19 CD; 2 ulcerative colitis, UC; 1 ileal pouch) assessed by conventional endoscopy or radiology were enrolled. Leukocytes were labeled with (99m)Tc-HMPAO. SPECT images were acquired at 2 h and planar images at 30 min and 2 h. Bowel uptake was quantitated in nine regions (score 0-3). Both SPECT and planar images detected a negative scintigraphy (score 0) in the UC patient with no pouchitis and a positive scintigraphy (score 1-3) in the 21 patients showing active inflammation by conventional techniques. SPECT showed a higher global score than planar images (0.71 +/- 0.09 vs 0.30 +/- 0.05; p < 0.001), and in particular in the right iliac fossa (p= 0.003), right and left flank (p < 0.001; p= 0.02), hypogastrium (p= 0.002), and mesogastrium (p < 0.001). SPECT provided a better visualization and a higher uptake than planar images in patients with ileal and ileocolonic CD (6.45 +/- 0.82 vs 2.8 +/- 0.55, p < 0.001; 5.5 +/- 1.6 vs 2.6 +/- 0.7, p= 0.03), and with perianal CD (6.6 +/- 1.6 vs 3.4 +/- 1.2; p= 0.03). (99m)Tc-HMPAO labeled leukocyte SPECT provides a more detailed visualization of CD lesions than planar images. This technique may better discriminate between intestinal and bone marrow uptake, thus being useful for assessing CD lesions within the pelvis, including perianal disease.

Perianal Dermatitis, Its Incidence, and Patterns of Topical Therapies in a Level IV Neonatal Intensive Care Unit.

PubMed

Malik, Anuj; Witsberger, Emily; Cottrell, Lesley; Kiefer, Autumn; Yossuck, Panitan

2018-04-01

 To define the incidence of perianal dermatitis (PD) and determine the usage pattern and cost efficacy of diaper products among neonates admitted to a level IV neonatal intensive care unit (NICU) including those with a diagnosis of neonatal abstinence syndrome (NAS).  A retrospective cohort study to evaluate neonates with PD based on number of orders for Aquaphor, Bagbalm, Desitin, Flanders, or Nystatin. Various demographic and clinical parameters were recorded. Usage patterns of these five products were analyzed, and their costs estimated. Subgroup analysis was performed among infants with NAS.  Of 1,241 admissions, 56.2% had at least one diaper product ordered during their NICU stay, while 52.6% had multiple products ordered. Only 23.0% of all neonates had appropriate documentation of PD. The most common product ordered first was Aquaphor (64.3%), followed by Desitin (19.2%). Note that 86% term NAS infants had PD compared with 28% term non-NAS infants. The estimated product cost was $14,139 over 2 years, averaging $20 per patient.  Over half of NICU neonates were exposed to one or more diaper products, usually without documented PD diagnosis. Term NAS infants had three times higher incidence of PD than term non-NAS infants. The cost of diaper product use was significant, and possibly underestimated due to lack of documentation. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

[Brownish coloration of the left nipple in a 60-year-old woman].

PubMed

Blum, A; Hartmann, K W; Rütten, A

2010-01-01

Pigmented Paget disease of the nipple is a rare disease. We report on a 60-year-old woman in whom this diagnosis was made based on clinical findings, dermoscopy, histology and immunohistology. Circumscribed pigmentation of the nipple includes a wide spectrum of benign and malignant differential diagnostic considerations. Dermoscopy can enhance the clinical diagnosis. Biopsies should always be performed on unclear pigmentation of the nipple in both women and men. On histology, rare melanocytic tumors must be differentiated from pigmented Paget disease and pigmented Bowen disease. Pagetoid intraepithelial cells of a melanocytic tumor are positive for S100, HMB45 or melan A, but not for cytokeratins. Intraepithelial tumor cells of Paget disease are positive for cytokeratin 7. The clear cells in Bowen diseases are usually not positive for cytokeratin 7 and are also negative for all melanocytic markers.

3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn's Disease 2016: Part 2: Surgical Management and Special Situations.

PubMed

Gionchetti, Paolo; Dignass, Axel; Danese, Silvio; Magro Dias, Fernando José; Rogler, Gerhard; Lakatos, Péter Laszlo; Adamina, Michel; Ardizzone, Sandro; Buskens, Christianne J; Sebastian, Shaji; Laureti, Silvio; Sampietro, Gianluca M; Vucelic, Boris; van der Woude, C Janneke; Barreiro-de Acosta, Manuel; Maaser, Christian; Portela, Francisco; Vavricka, Stephan R; Gomollón, Fernando

2017-02-01

This paper is the second in a series of two publications relating to the European Crohn's and Colitis Organisation [ECCO] evidence-based consensus on the diagnosis and management of Crohn's disease [CD] and concerns the surgical management of CD as well as special situations including management of perianal CD and extraintestinal manifestations. Diagnostic approaches and medical management of CD of this ECCO Consensus are covered in the first paper [Gomollon et al JCC 2016]. Copyright © 2016 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Disease severity in familial cases of IBD.

PubMed

Andreu, M; Márquez, L; Domènech, E; Gisbert, J P; García, V; Marín-Jiménez, I; Peñalva, M; Gomollón, F; Calvet, X; Merino, O; Garcia-Planella, E; Vázquez-Romero, N; Esteve, M; Nos, P; Gutiérrez, A; Vera, I; Cabriada, J L; Martín, M D; Cañas-Ventura, A; Panés, J

2014-03-01

Phenotypic traits of familial IBD relative to sporadic cases are controversial, probably related to limited statistical power of published evidence. To know if there are phenotype differences between familial and sporadic IBD, evaluating the prospective Spanish registry (ENEIDA) with 11,983 cases. 5783 patients (48.3%) had ulcerative colitis (UC) and 6200 (51.7%) Crohn's disease (CD). Cases with one or more 1st, 2nd or 3rd degree relatives affected by UC/CD were defined as familial case. In UC and CD, familial cases compared with sporadic cases had an earlier disease onset (UC: 33 years [IQR 25-44] vs 37 years [IQR 27-49]; p<0.0001); (CD: 27 years [IQR 21-35] vs 29 years [IQR 22-40]; p<0.0001), higher prevalence of extraintestinal immune-related manifestations (EIMs) (UC: 17.2% vs 14%; p=0.04); (CD: 30.1% vs 23.6%; p<0.0001). Familial CD had higher percentage of ileocolic location (42.7% vs 51.8%; p=0.0001), penetrating behavior (21% vs 17.6%; p=0.01) and perianal disease (32% vs 27.1%; p=0.003). Differences are not influenced by degree of consanguinity. When a sufficiently powered cohort is evaluated, familial aggregation in IBD is associated to an earlier disease onset, more EIMs and more severe phenotype in CD. This feature should be taken into account at establishing predictors of disease course. © 2013.

Assessing internet-based information used to aid patient decision-making about surgery for perianal Crohn's fistula.

PubMed

Marshall, J H; Baker, D M; Lee, M J; Jones, G L; Lobo, A J; Brown, S R

2017-06-01

Decision-making in perianal Crohn's fistula (pCD) is preference sensitive. Patients use the internet to access healthcare information. The aim of this study was to assess the online information and patient decision aids relating to surgery for pCD. A search of Google™ and the Decision Aids Library Inventory (DALI) was performed using a predefined search strategy. Patient-focussed sources providing information about pCD surgery were included in the analysis. Written health information was assessed using the International Patient Decision Aids Standards (IPDAS) and DISCERN criteria. The readability of the source content was assessed using the Flesch-Kincaid score. Of the 201 sources found, 187 were excluded, leaving 14 sources for analysis. Three sources were dedicated to pCD, and six sources mentioned pCD-specific outcomes. The most common surgical intervention reported was seton insertion (n = 13). The least common surgical intervention reported was proctectomy (n = 1). The mean IPDAS and DISCERN scores were 4.43 ± 1.65 out of 12 (range = 2-8) and 2.93 ± 0.73 out of 5 (range = 1-5), respectively. The mean reading ease was US college standard. We found no patient decision aids relating to surgery for pCD. The online sources relating to surgery for pCD are few, and their quality is poor, as seen in the low IPDAS and DISCERN scores. Less than half of the sources mentioned pCD-specific outcomes, and three sources were solely dedicated to providing information on pCD. Healthcare professionals should look to create a patient tool to assist decision-making in pCD.

Expression of hypoxia-inducible factor-1α, vascular endothelial growth factor and prolyl hydroxylase domain protein 2 in cutaneous squamous cell carcinoma and precursor lesions and their relationship with histological stages and clinical features.

PubMed

An, Xiangjie; Xu, Guangfen; Yang, Liu; Wang, Yuejue; Li, Yan; McHepange, Uwesu O; Shen, Guanxin; Tu, Yating; Tao, Juan

2014-01-01

The hypoxia-inducible factor-1 (HIF-1α) pathway is associated with tumor growth, angiogenesis and metastasis in various carcinomas. Little is known regarding the role of the HIF-1α signaling pathway in cutaneous squamous cell carcinoma (SCC). We investigated the expression of HIF-1α, vascular endothelial growth factor (VEGF) and the HIF negative regulator, prolyl hydroxylase domain protein 2 (PHD2), in cutaneous SCC, Bowen's disease, seborrheic keratosis (SK) and normal skin by immunohistochemistry and in situ hybridization. Additionally, we explored the relationships between these factors and the clinical and histological characteristics of each disease. Our study indicated that the expression of HIF-1α and VEGF was significantly higher (P < 0.05) in cutaneous SCC than in Bowen's disease, SK or normal skin. In contrast, PHD2 showed significantly higher expression in normal skin compared with SK, Bowen's disease and cutaneous SCC (P < 0.05). Grade II-IV cutaneous SCC had higher expression levels of nuclear HIF-1α and cytoplasm VEGF protein but less nuclear PHD2 protein than grade Ι cutaneous SCC (P < 0.05). Overexpression of HIF-1α and VEGF, as well as the decreased expression of PHD2, may play important roles in the development of cutaneous SCC. © 2013 Japanese Dermatological Association.

Comparing topical hydrocortisone cream with Hai's Perianal Support in managing symptomatic hemorrhoids in pregnancy: a preliminary trial.

PubMed

Lim, Soo Soo; Yu, Chye Wah; Aw, Lin Da

2015-02-01

The prevalence of hemorrhoids among pregnant women is high in late pregnancy. This study was to evaluate the efficacy between drug treatment with Procort (topical hydrocortisone cream 1%) and mechanical treatment with a Hai's Perianal Support (HPS) toilet seat device in managing symptomatic hemorrhoids during the third trimester of pregnancy. A prospective randomized controlled study was conducted on 23 pregnant women with gestation above the 28th week and presented with symptomatic hemorrhoids. Pre- and post-interventional assessment was carried out to obtain data on symptoms of pain, itching, swelling, discomfort and bleeding associated with hemorrhoids. The control group was treated with topical hydrocortisone cream 1% and the test group was provided and taught to use a HPS, a posterior perineal support toilet seat device (Colorec). The results showed improvement in symptoms of pain, swelling, bleeding, itching and discomfort in both the test and control groups. However, statistically significant differences were found on symptoms of pain, swelling and discomfort between the test and control groups. There was also a statistically significant difference in well-being and overall improvement between the test and control groups. HPS has to a certain extent significantly reduced the symptoms of hemorrhoids in pregnancy and improved the well-being of pregnant women in comparison with topical treatment with hydrocortisone cream. However, more clinical trials need to be carried out to recomfirm the role of HPS in hemorrhoids in pregnancy. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

Smoking does influence disease behaviour and impacts the need for therapy in Crohn's disease in the biologic era.

PubMed

Nunes, T; Etchevers, M J; Domènech, E; García-Sánchez, V; Ber, Y; Peñalva, M; Merino, O; Nos, P; Garcia-Planella, E; Casbas, A G; Esteve, M; Taxonera Samsó, C; Montoro Huguet, M; Gisbert, J P; Martín Arranz, M D; García-Sepulcre, M F; Barreiro-de Acosta, M; Beltrán, B; Alcaide Suárez, N; Saro Gismera, C; Cabriada, J L; Cañas-Ventura, A; Gomollón, F; Panés, J

2013-10-01

Recently, the notion that smoking may adversely affect Crohn's disease (CD) outcomes has been challenged by the suggestion that the widespread use of immunosuppressants and anti-TNF drugs might offset the adverse effects of tobacco. To reassess the influence of tobacco smoking on disease phenotype and complications on a time-dependent analysis, taking into account the different therapeutic interventions. We designed a retrospective cohort study of 3224 patients with Crohn's disease. The data were collected from the Spanish national inflammatory bowel disease registry (ENEIDA), including information regarding demographics, clinical characteristics, disease complications, therapeutic interventions and smoking status. Patients were classified as nonsmokers, smokers and former smokers, according to their present and past smoking habits. In the univariate analysis, smokers had more strictures (22.6% vs. 19.3%, P < 0.05) and less colonic involvement (7.2% vs. 10.9%, P < 0.05), and were more frequently under treatment with steroids (91.6% vs. 85.8%, P < 0.05), immunosuppressants (73.5% vs. 63.6% P < 0.05) or anti-TNF drugs (31.4% vs. 25.1%, P < 0.05) than nonsmokers. In the time-dependent multivariate analysis, smokers were found to have a significantly decreased survival free of stricturing disease (HR: 1.5, CI 95% 1.18-1.90) or perianal complications (HR: 1.50, CI 95% 1.01-1.46), and had a higher risk for requiring thiopurine therapy (HR: 1.20, CI 95% 1.05-1.30). These results suggest that, despite the widespread use of immunosuppressants and anti-TNF drugs, smokers with Crohn's disease still have a more severe disease course, with increased therapeutic requirements when compared with nonsmokers. © 2013 John Wiley & Sons Ltd.

The Roswell Park Cancer Institute experience with extramammary Paget's disease.

PubMed

Zollo, J D; Zeitouni, N C

2000-01-01

Extramammary Paget's disease (EMPD) is a rare intraepithelial neoplasm. Common sites of occurrence include the vulva, perianal region, perineum and scrotum. Despite frequent recurrences, surgery is the standard treatment. This study examines the recurrence rate for EMPD treated by conventional surgical management. Alternative and multimodal therapeutic approaches are reviewed. This retrospective analysis included all 30 patients treated for EMPD at Roswell Park Cancer Institute (RPCI) between 1970 and 1998. Following conventional surgical treatment, 44% of our patients developed recurrence. Vulvectomy provided the lowest recurrence rate, but involved extensive tissue loss and functional debility. Multimodal treatment using Mohs' micrographic surgery and photodynamic therapy has been used at RPCI to manage EMPD with minimal tissue loss and no functional impairment. Surgical treatment offers a moderate chance of EMPD cure. Long-term multimodal approaches require close follow-up, but may conserve both tissue and function.

Photodynamic therapy of nonmelanoma skin cancer with topical hypericum perforatum extract--a pilot study.

PubMed

Kacerovská, Denisa; Pizinger, Karel; Majer, Filip; Smíd, Frantisek

2008-01-01

Hypericin, the photoactive compound of Hypericum perforatum, is probably the most powerful photosensitizer found in nature. This compound has shown high potency in the photodynamic treatment of tumor cells. However, there is only limited knowledge regarding the photodynamic effect of hypericin on nonmelanoma skin cancer cells. The aim of this prospective study was to investigate the efficacy of photodynamic therapy with topical application of an extract of H. perforatum in actinic keratosis, basal cell carcinoma (BCC) and morbus Bowen (carcinoma in situ). The study was carried out on 34 patients--eight with actinic keratoses (AKs), 21 with BCC and five with Bowen's disease. The extract of H. perforatum was applied on the skin lesions under occlusion and that was followed by irradiation with 75 J cm(-2) of red light 2 h later. The treatment was performed weekly for 6 weeks on average. The percentage of complete clinical response was 50% for AKs, 28% in patients with superficial BCC and 40% in patients with Bowen's disease. There was only a partial remission seen in patients with nodular BCCs. A complete disappearance of tumor cells was found in the histologic preparation of 11% of patients with superficial BCCs and 80% in the patients with Bowen's disease. All patients complained of burning and pain sensations during irradiation. Although the results of this first clinical trial could be regarded as disappointing, there are still possibilities for improvement. Better preparation of the lesions, enhancement of hypericin delivery and other types of light exposure procedures could significantly improve the clinical outcomes of this relatively inexpensive treatment modality.

Pregnancy related issues in inflammatory bowel disease: evidence base and patients' perspective.

PubMed

Selinger, Christian P; Leong, Rupert Wl; Lal, Simon

2012-06-07

Inflammatory bowel disease (IBD) affects women of childbearing age and can influence fertility, pregnancy and decisions regarding breastfeeding. Women with IBD need to consider the possible course of disease during pregnancy, the benefits and risks associated with medications required for disease management during pregnancy and breastfeeding and the effects of mode of delivery on their disease. When indicated, aminosalicylates and thiopurines can be safely used during pregnancy. Infliximab and Adalimumab are considered probably safe during the first two trimesters. During the third trimester the placenta can be crossed and caution should be applied. Methotrexate is associated with severe teratogenicity due to its folate antagonism and is strictly contraindicated. Women with IBD tend to deliver earlier than healthy women, but can have a vaginal delivery in most cases. Caesarean sections are generally recommended for women with active perianal disease or after ileo-anal pouch surgery.While the impact of disease activity and medication has been addressed in several studies, there are minimal studies evaluating patients' perspective on these issues. Women's attitudes may influence their decision to have children and can positively or negatively influence the chance of conceiving, and their beliefs regarding therapies may impact on the course of their disease during pregnancy and/or breastfeeding. This review article outlines the impact of IBD and its treatment on pregnancy, and examines the available data on patients' views on this subject.

Erythroplasia of Queyrat

MedlinePlus

... ed. Clinical Dermatology . 6th ed. Philadelphia, PA: Elsevier; 2016:chap 21. Regan TD, Lawrence N. Bowen's disease and erythroplasia of Queyrat. In: Lebwohl MG, Heymann WR, Berth-Jones J, Coulson IH, eds. Treatment of Skin Disease: ...

Hemorrhoids and anal fissures in inflammatory bowel disease.

PubMed

D'Ugo, S; Stasi, E; Gaspari, A L; Sileri, P

2015-12-01

Perianal disease is a common complication of inflammatory bowel disease (IBD). It includes different conditions from more severe and potentially disabling ones, such as abscesses and fistulas, to more benign conditions such as hemorrhoids, skin tags and fissures. Most literature has been focused on anal sepsis and fistulae, as they carry the majority of disease burden and often alter the natural course of the disease. Hemorrhoids and anal fissures in patients with IBD have been overlooked, although they can represent a challenging problem. The management of hemorrhoids and fissures in IBD patients may be difficult and may significantly differ compared to the non-affected population. Historically surgery was firmly obstructed, and hemorrhoidectomy or sphincterotomy in patients with associated diagnosis of IBD was considered harmful, although literature data is scant and based on small series. Various authors reported an incidence of postoperative complications higher in IBD than in the general populations, with potential severe events. Considering that a spontaneous healing is possible, the first line management should be a medical therapy. In patients non-responding to conservative measures it is possible a judicious choice of surgical options on a highly selective basis; this can lead to acceptable results, but the risk of possible complications needs to be considered. In this review it is analyzed the current literature on the incidence, symptoms and treatment options of hemorrhoids and anal fissures in patients with Crohn's disease and ulcerative colitis.

Fiber and colorectal diseases: separating fact from fiction.

PubMed

Tan, Kok-Yang; Seow-Choen, Francis

2007-08-21

Whilst fruits and vegetables are an essential part of our dietary intake, the role of fiber in the prevention of colorectal diseases remains controversial. The main feature of a high-fiber diet is its poor digestibility. Soluble fiber like pectins, guar and ispaghula produce viscous solutions in the gastrointestinal tract delaying small bowel absorption and transit. Insoluble fiber, on the other hand, pass largely unaltered through the gut. The more fiber is ingested, the more stools will have to be passed. Fermentation in the intestines results in build up of large amounts of gases in the colon. This article reviews the physiology of ingestion of fiber and defecation. It also looks into the impact of dietary fiber on various colorectal diseases. A strong case cannot be made for a protective effect of dietary fiber against colorectal polyp or cancer. Neither has fiber been found to be useful in chronic constipation and irritable bowel syndrome. It is also not useful in the treatment of perianal conditions. The fiber deficit - diverticulosis theory should also be challenged. The authors urge clinicians to keep an open mind about fiber. One must be aware of the truths and myths about fiber before recommending it.

Therapy with stem cells in inflammatory bowel disease

PubMed Central

Martínez-Montiel, María del Pilar; Gómez-Gómez, Gonzalo Jesús; Flores, Ana Isabel

2014-01-01

Inflammatory bowel disease (IBD) affects a part of the young population and has a strong impact upon quality of life. The underlying etiology is not known, and the existing treatments are not curative. Furthermore, a significant percentage of patients are refractory to therapy. In recent years there have been great advances in our knowledge of stem cells and their therapeutic applications. In this context, autologous hematopoietic stem cell transplantation (HSCT) has been used in application to severe refractory Crohn’s disease (CD), with encouraging results. Allogenic HSCT would correct the genetic defects of the immune system, but is currently not accepted for the treatment of IBD because of its considerable risks. Mesenchymal stem cells (MSCs) have immune regulatory and regenerative properties, and low immunogenicity (both autologous and allogenic MSCs). Based on these properties, MSCs have been used via the systemic route in IBD with promising results, though it is still too soon to draw firm conclusions. Their local administration in perianal CD is the field where most progress has been made in recent years, with encouraging results. The next few years will be decisive for defining the role of such therapy in the management of IBD. PMID:24574796

Conventional medical management of inflammatory bowel disease.

PubMed

Burger, Daniel; Travis, Simon

2011-05-01

Conventional therapies for ulcerative colitis and Crohn's disease (CD) include aminosalicylates, corticosteroids, thiopurines, methotrexate, and anti-tumor necrosis factor agents. A time-structured approach is required for appropriate management. Traditional step-up therapy has been partly replaced during the last decade by potent drugs and top-down therapies, with an accelerated step-up approach being the most appropriate in the majority of patients. When patients are diagnosed with CD or ulcerative colitis, physicians should consider the probable pattern of disease progression so that effective therapy is not delayed. This can be achieved by setting arbitrary time limits for administration of biological therapies, changing therapy from mesalamine in patients with active ulcerative colitis, or using rescue therapy for acute severe colitis. In this review, we provide algorithms with a time-structured approach for guidance of therapy. Common mistakes in conventional therapy include overprescription of mesalamine for CD; inappropriate use of steroids (for perianal CD, when there is sepsis, or for maintenance); delayed introduction or underdosing with azathioprine, 6-mercaptopurine, or methotrexate; and failure to consider timely surgery. The paradox of anti-tumor necrosis factor therapy is that although it too is used inappropriately (when patients have sepsis or fibrostenotic strictures) or too frequently (for diseases that would respond to less-potent therapy), it is also often introduced too late in disease progression. Conventional drugs are the mainstay of current therapy for inflammatory bowel diseases, but drug type, timing, and context must be optimized to manage individual patients effectively. Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.

Combining Magnetic Resonance Imaging (MRI) and Medical Infrared Thermography (MIT) in the pre- and per-operating management of severe Hidradenitis Suppurativa (HS).

PubMed

Derruau, Stéphane; Renard, Yohann; Pron, Hervé; Taiar, Redha; Abdi, Ellie; Polidori, Guillaume; Lorimier, Sandrine

2018-05-12

Hidradenitis suppurativa (HS) is a chronic, inflammatory, and recurrent skin disease. Surgical excision of wounds appears to be the only curative treatment for the prevention of recurrence of moderate to severe stages. Magnetic resonance imaging (MRI) is a standard reference examination for the detection of HS peri-anal inflammatory fistula. In this case study, the use of real-time medical infrared thermography, in combination with MRI as appropriate imaging, is proposed. The aim is to assist surgeons in the pre- and peri-surgical management of severe perianal hidradenitis suppurativa with the intent to ensure that all diseased lesions were removed during surgery and therefore to limit recurrence. The results show that medical infrared thermography (MIT), coupled with MRI, could be highly effective strategy to address thermally distinguished health tissues and inflammatory sites during excision, as characterised by differential increases in temperature. Medical infrared thermography could be used to check the total excision of inflammatory lesions as a noninvasive method that is not painful, not radiant, and is easily transportable during surgery. Ultimately, this method could be complementary with MRI in providing clinicians with objective data on the status of tissues below the perianal skin surface in the pre- and per-operating management of severe hidradenitis suppurativa. Copyright © 2018 Elsevier B.V. All rights reserved.

Use of antibiotics in patients with Crohn's disease: a systematic review and meta-analysis.

PubMed

Su, Jie Wen; Ma, Jing Jing; Zhang, Hong Jie

2015-02-01

Some studies have suggested that antibiotic treatment might be efficient for patients with active Crohn's disease (CD). However, the results are conflicting. The aim of this study was to summarize the available evidence on the efficacy of antibiotics, especially ciprofloxacin, in treating patients with CD. A literature search was conducted on the PubMed, Medline, Web of Science and Excerpta Medica Database (EMBASE) for manuscripts published until March 2014. Randomized controlled trials that mainly evaluated the efficacy of antibiotic treatment in patients with CD using clinical remission or response as the key outcome of interest were included. Intention-to-treat analyses were used to evaluate the relative risk (RR) and 95% confidence intervals (CI). In all, 15 randomized placebo-controlled clinical trials involving 1407 participants were included in the meta-analysis. A pooled analysis revealed that compared with placebo, antibiotics benefited CD patients to a certain extent (RR 1.33, 95% CI 1.17-1.51, P < 0.00001). The random-effects model showed that there was no significant difference between patients treated with ciprofloxacin and placebo (combined RR 1.35, 95% CI 0.92-1.97, P = 0.12). However, ciprofloxacin exhibited significant clinical benefits in patients with perianal fistulas (RR 1.64, 95% CI 1.16-2.32, P = 0.005). The utility of antibiotics was beneficial for patients with CD. Nevertheless, subgroup analyses indicated that treatment with ciprofloxacin alone was significantly efficient for CD patients with perianal fistulas. © 2014 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

Age-related differences in the clinical course of Crohns disease in an Asian population: a retrospective cohort review.

PubMed

Law, Siu-Tong; Li, Kin Kong

2013-12-01

The aim of this study was to compare the clinical characteristics and treatment outcomes of patients with young and adult onset Crohns disease. Among 79 consecutive Crohns disease patients (11 (13.92%) with onset =16 years old), young onset Crohns disease was significantly associated with fever (36.36 vs. 14.71%, P 0.041), weight loss (72.7 vs. 29.4%, P 0.003), isolated abdominal pain (45.45 vs. 16.18%, P 0.013), lower body mass index ( 17.32 vs. 21.29 kgm2, P 0.019), and extraintestinal manifestation, particularly oral (45.5% vs. 22.1%, P 0.049) and perianal lesion (63.6% vs. 36.8%, P 0.046). In both groups, ileocolonic disease and inflammatory lesion were the most prevalent site of involvement and dominant disease behavior respectively. Their complication and bowel resection rate were similar but the former took a longer period of time to develop in the young onset group (84 vs. 24 month, P 0.018). Cox proportional hazard regression analysis revealed that active smoking and delayed use of immunosuppressive therapy were the only independent risk factors associated with increased risk of complications.

Epidemiology of inflammatory bowel disease in racial and ethnic migrant groups.

PubMed

Misra, Ravi; Faiz, Omar; Munkholm, Pia; Burisch, Johan; Arebi, Naila

2018-01-21

To summarise the current literature and define patterns of disease in migrant and racial groups. A structured key word search in Ovid Medline and EMBASE was undertaken in accordance with PRISMA guidelines. Studies on incidence, prevalence and disease phenotype of migrants and races compared with indigenous groups were eligible for inclusion. Thirty-three studies met the inclusion criteria. Individual studies showed significant differences in incidence, prevalence and disease phenotype between migrants or race and indigenous groups. Pooled analysis could only be undertaken for incidence studies on South Asians where there was significant heterogeneity between the studies [95% for ulcerative colitis (UC), 83% for Crohn's disease (CD)]. The difference between incidence rates was not significant with a rate ratio South Asian: Caucasian of 0.78 (95%CI: 0.22-2.78) for CD and 1.39 (95%CI: 0.84-2.32) for UC. South Asians showed consistently higher incidence and more extensive UC than the indigenous population in five countries. A similar pattern was observed for Hispanics in the United States. Bangladeshis and African Americans showed an increased risk of CD with perianal disease. This review suggests that migration and race influence the risk of developing inflammatory bowel disease. This may be due to different inherent responses upon exposure to an environmental trigger in the adopted country. Further prospective studies on homogenous migrant populations are needed to validate these observations, with a parallel arm for in-depth investigation of putative drivers.

Intra-seasonal and Inter-annual variability of Bowen Ratio over rain-shadow region of North peninsular India

NASA Astrophysics Data System (ADS)

Morwal, S. B.; Narkhedkar, S. G.; Padmakumari, B.; Maheskumar, R. S.; Deshpande, C. G.; Kulkarni, J. R.

2017-05-01

Intra-seasonal and inter-annual variability of Bowen Ratio (BR) have been studied over the rain-shadow region of north peninsular India during summer monsoon season. Daily grid point data of latent heat flux (LHF), sensible heat flux (SHF) from NCEP/NCAR Reanalysis for the period 1970-2014 have been used to compute daily area-mean BR. Daily grid point rainfall data at a resolution of 0.25° × 0.25° from APHRODITE's Water Resources for the available period 1970-2007 have been used to study the association between rainfall and BR. The study revealed that BR rapidly decreases from 4.1 to 0.29 in the month of June and then remains nearly constant at the same value (≤0.1) in the rest of the season. High values of BR in the first half of June are indicative of intense thermals and convective clouds with higher bases. Low values of BR from July to September period are indicative of weak thermals and convective clouds with lower bases. Intra-seasonal and inter-annual variability of BR is found to be inversely related to precipitation over the region. BR analysis indicates that the land surface characteristics of the study region during July-September are similar to that over oceanic regions as far as intensity of thermals and associated cloud microphysical properties are concerned. Similar variation of BR is found in El Nino and La Nina years. During June, an increasing trend is observed in SHF and BR and decreasing trend in LHF from 1976 to 2014. Increasing trend in the SHF is statistically significant.

Fiber and colorectal diseases: Separating fact from fiction

PubMed Central

Tan, Kok-Yang; Seow-Choen, Francis

2007-01-01

Whilst fruits and vegetables are an essential part of our dietary intake, the role of fiber in the prevention of colorectal diseases remains controversial. The main feature of a high-fiber diet is its poor digestibility. Soluble fiber like pectins, guar and ispaghula produce viscous solutions in the gastrointestinal tract delaying small bowel absorption and transit. Insoluble fiber, on the other hand, pass largely unaltered through the gut. The more fiber is ingested, the more stools will have to be passed. Fermentation in the intestines results in build up of large amounts of gases in the colon. This article reviews the physiology of ingestion of fiber and defecation. It also looks into the impact of dietary fiber on various colorectal diseases. A strong case cannot be made for a protective effect of dietary fiber against colorectal polyp or cancer. Neither has fiber been found to be useful in chronic constipation and irritable bowel syndrome. It is also not useful in the treatment of perianal conditions. The fiber deficit - diverticulosis theory should also be challenged. The authors urge clinicians to keep an open mind about fiber. One must be aware of the truths and myths about fiber before recommending it. PMID:17696243

[Circumscribed palmar hypokeratosis (CPM): The diagnostic value of dermoscopy].

PubMed

Topin-Ruiz, S; Debarre, J-M; Blanchard, E; Kettani, S; Valmier, P-J; Martin, L; Le Corre, Y

2017-03-01

Circumscribed palmar hypokeratosis (CPH) is a rare skin disease, first described in 2002, associated with sudden localized reduction of the corneal layer. In most cases, it presents as an isolated rounded erythematous palmar lesion on the thenar eminence. We describe the dermoscopic semiology of CPH in 3 cases. Three patients between the ages of 59 and 72 presented very limited erythematous lesions suggestive of CPH. Dermoscopic examination of these lesions provided similar findings. Biopsy, which was performed in one patient, confirmed the diagnosis of CPH. Two dermoscopic elements of CPH are characteristic: (1) the sides of the lesion have a "stair step" or "geological strata" type of configuration, and the thickness of the different strata varies; (2) the centre of the lesion showed a homogeneous erythematous area with a vascular pattern composed of dotted vessels of the superficial dermis and sometime vascular loops. These dermoscopic aspects are characteristic and enable CPH to be differentiated from Bowen's disease or porokeratosis of Mibelli. In Bowen's disease, there is no stair step like aspect to the sides of lesions; further, the centre of the lesion shows glomerular vessels (coiled vessels) and/or globular vessels (small red clods). In porokeratosis, peripheral keratotic "white track" structures comprise a single pigmented channel or a double white line. There is no "stair step" or central vascular pattern. The dermoscopic semiology of CPH is highly characteristic and enables differentiation from Bowen's disease and porokeratosis. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Review article: non-malignant oral manifestations in inflammatory bowel diseases.

PubMed

Katsanos, K H; Torres, J; Roda, G; Brygo, A; Delaporte, E; Colombel, J-F

2015-07-01

Patients with inflammatory bowel diseases (IBD) may present with lesions in their oral cavity. Lesions may be associated with the disease itself representing an extraintestinal manifestation, with nutritional deficiencies or with complications from therapy. To review and describe the spectrum of oral nonmalignant manifestations in patients with inflammatory bowel diseases [ulcerative colitis (UC), Crohn's disease (CD)] and to critically review all relevant data. A literature search using the terms and variants of all nonmalignant oral manifestations of inflammatory bowel diseases (UC, CD) was performed in November 2014 within Pubmed, Embase and Scopus and restricted to human studies. Oral lesions in IBD can be divided into three categories: (i) lesions highly specific for IBD, (ii) lesions highly suspicious of IBD and (iii) nonspecific lesions. Oral lesions are more common in CD compared to UC, and more prevalent in children. In adult CD patients, the prevalence rate of oral lesions is higher in CD patients with proximal gastrointestinal tract and/or perianal involvement, and estimated to range between 20% and 50%. Oral lesions can also occur in UC, with aphthous ulcers being the most frequent type. Oral manifestations in paediatric UC may be present in up to one-third of patients and are usually nonspecific. Oral manifestations in IBD can be a diagnostic challenge. Treatment generally involves managing the underlying intestinal disease. In cases presenting with local disabling symptoms and impaired quality of life, local and systemic medical therapy must be considered and/or oral surgery may be required. © 2015 John Wiley & Sons Ltd.

Canine perineal tumours.

PubMed

Berrocal, A; Vos, J H; van den Ingh, T S; Molenbeek, R F; van Sluijs, F J

1989-12-01

One hundred and thirty nine canine perineal tumours were histologically evaluated. The vast majority (134 tumours = 96.4%) appeared to originate from the characteristic glandular structures of this region. They were classified as well differentiated perianal gland tumours (58.3%), as moderately or poorly differentiated perianal gland tumours (21.6%) and as carcinomas without perianal gland differentiation (16.5%). Only 5 tumours (3.6%) appeared to originate from non-characteristic perineal structures. A prominent male predominance was found with respect to the perianal gland tumours, whereas the carcinomas showed a distinct female predisposition. Tumours showing perianal gland differentiation almost invariably will have a benign behaviour. The carcinomas lacking any perianal gland differentiation often show a distinct malignant behaviour with metastases to regional lymph nodes and internal organs. These malignant neoplasms showed morphological and clinical features comparable to canine anal sac gland adenocarcinomas and carcinoids in man and animals.

Inflammatory bowel disease in India - Past, present and future.

PubMed

Ray, Gautam

2016-09-28

There is rising incidence and prevalence of inflammatory bowel disease (IBD) in India topping the Southeast Asian (SEA) countries. The common genes implicated in disease pathogenesis in the West are not causal in Indian patients and the role of "hygiene hypothesis" is unclear. There appears to be a North-South divide with more ulcerative colitis (UC) in north and Crohn's disease (CD) in south India. IBD in second generation Indian migrants to the West takes the early onset and more severe form of the West whereas it retains the nature of its country of origin in migrants to SEA countries. The clinical presentation is much like other SEA countries (similar age and sex profile, low positive family history and effect of smoking, roughly similar disease location, use of aminosalicylates for CD, low use of biologics and similar surgical rates) with some differences (higher incidence of inflammatory CD, lower perianal disease, higher use of aminosalicylates and azathioprine and lower current use of corticosteroids). UC presents more with extensive disease not paralleled in severity clinically or histologically, follows benign course with easy medical control and low incidence of fulminant disease, cancer, complications, and surgery. UC related colorectal cancer develop in an unpredictable manner with respect to disease duration and site questioning the validity of strict screening protocol. About a third of CD patients get antituberculosis drugs and a significant number presents with small intestinal bleed which is predominantly afflicted by aggressive inflammation. Biomarkers have inadequate diagnostic sensitivity and specificity for both. Pediatric IBD tends to be more severe than adult. Population based studies are needed to address the lacunae in epidemiology and definition of etiological factors. Newer biomarkers and advanced diagnostic techniques (in the field of gastrointestinal endoscopy, molecular pathology and genetics) needs to be developed for proper disease

Inflammatory bowel disease in India - Past, present and future

PubMed Central

Ray, Gautam

2016-01-01

There is rising incidence and prevalence of inflammatory bowel disease (IBD) in India topping the Southeast Asian (SEA) countries. The common genes implicated in disease pathogenesis in the West are not causal in Indian patients and the role of “hygiene hypothesis” is unclear. There appears to be a North-South divide with more ulcerative colitis (UC) in north and Crohn’s disease (CD) in south India. IBD in second generation Indian migrants to the West takes the early onset and more severe form of the West whereas it retains the nature of its country of origin in migrants to SEA countries. The clinical presentation is much like other SEA countries (similar age and sex profile, low positive family history and effect of smoking, roughly similar disease location, use of aminosalicylates for CD, low use of biologics and similar surgical rates) with some differences (higher incidence of inflammatory CD, lower perianal disease, higher use of aminosalicylates and azathioprine and lower current use of corticosteroids). UC presents more with extensive disease not paralleled in severity clinically or histologically, follows benign course with easy medical control and low incidence of fulminant disease, cancer, complications, and surgery. UC related colorectal cancer develop in an unpredictable manner with respect to disease duration and site questioning the validity of strict screening protocol. About a third of CD patients get antituberculosis drugs and a significant number presents with small intestinal bleed which is predominantly afflicted by aggressive inflammation. Biomarkers have inadequate diagnostic sensitivity and specificity for both. Pediatric IBD tends to be more severe than adult. Population based studies are needed to address the lacunae in epidemiology and definition of etiological factors. Newer biomarkers and advanced diagnostic techniques (in the field of gastrointestinal endoscopy, molecular pathology and genetics) needs to be developed for proper

Amyloidosis in Inflammatory Bowel Disease: A Systematic Review of Epidemiology, Clinical Features, and Treatment.

PubMed

Tosca Cuquerella, Joan; Bosca-Watts, Marta Maia; Anton Ausejo, Rosario; Tejedor Alonso, Sandra; Mora De Miguel, Francisco; Minguez Perez, Miguel

2016-10-01

Amyloidosis is a rare complication of inflammatory bowel disease [IBD]; its low prevalence has hindered both descriptive and therapeutic studies. The aim of this study was to estimate the prevalence of amyloidosis in IBD and the risk factors associated with this complication. This paper presents an observational study, followed by a systematic review of the epidemiological and clinical characteristics of the disease and a review of the diagnostic and therapeutic options. The prevalence of amyloidosis among IBD patients is 0.53% (95% confidence interval [CI]: 0.32-0.75), although epidemiological data suggest that it may be under-diagnosed. The phenotype most frequently associated with amyloidosis is males with aggressive and extensive Crohn's disease, fistulising behaviour, perianal disease, and extra-intestinal complications, with the development of proteinuria and renal failure. Identifying risk factors of amyloidosis in IBD patients and screening for proteinuric renal dysfunction are useful to improve diagnostic accuracy. Referral of biopsies to a tertiary centre should also be considered, to improve diagnostic accuracy. Although there is no reliable evidence on the effectiveness of treatment, it seems reasonable to treat the underlying disease with potent immunosuppression to minimise inflammatory activity, thereby switching off amyloidogenesis. Copyright © 2016 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Evaluation of the perianal muscular complex in the prenatal diagnosis of anorectal atresia in a high-risk population.

PubMed

Ochoa, J H; Chiesa, M; Vildoza, R P; Wong, A E; Sepulveda, W

2012-05-01

To investigate whether sonographic identification of the fetal perianal muscular complex (PAMC) is of value in the prenatal detection of anorectal atresia in a high-risk population. During an 8-year study period, a total of 189 pregnancies at high risk for fetal anorectal atresia were prospectively examined for the presence/absence of the PAMC on axial ultrasound views of the fetal perineum. The prenatal findings were confirmed postnatally or at the time of postmortem examination. The median gestational age at examination was 27 (range, 15-37) weeks. The PAMC was identified in 175 fetuses, all of which had a normal anorectal canal at the time of delivery or at postmortem examination. The PAMC was not identified prenatally in the 14 remaining cases, and the anus was absent in 11 fetuses with anorectal atresia and in two with urorectal septum malformation sequence. There was one false-positive case, in which the anus was anatomically and functionally normal but ectopically located, opening into the vaginal vestibule. Among these 14 cases of anorectal malformation, prenatal dilatation of the distal bowel was seen in nine (64.3%) and intraluminal calcified meconium or enterolithiasis in five (35.7%). Overall, absent PAMC on prenatal sonography in this high-risk population had a sensitivity of 100%, specificity of 99%, true-positive rate of 93% and false-positive rate of 7% for the diagnosis of anorectal atresia. In a high-risk population, the absence of PAMC seems to be a highly sensitive and specific sonographic marker for anorectal atresia. The role of routine sonographic identification of the PAMC at the second-trimester scan to screen for cases of isolated anal atresia remains to be determined. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.

Epidemiology of inflammatory bowel disease in racial and ethnic migrant groups

PubMed Central

Misra, Ravi; Faiz, Omar; Munkholm, Pia; Burisch, Johan; Arebi, Naila

2018-01-01

AIM To summarise the current literature and define patterns of disease in migrant and racial groups. METHODS A structured key word search in Ovid Medline and EMBASE was undertaken in accordance with PRISMA guidelines. Studies on incidence, prevalence and disease phenotype of migrants and races compared with indigenous groups were eligible for inclusion. RESULTS Thirty-three studies met the inclusion criteria. Individual studies showed significant differences in incidence, prevalence and disease phenotype between migrants or race and indigenous groups. Pooled analysis could only be undertaken for incidence studies on South Asians where there was significant heterogeneity between the studies [95% for ulcerative colitis (UC), 83% for Crohn’s disease (CD)]. The difference between incidence rates was not significant with a rate ratio South Asian: Caucasian of 0.78 (95%CI: 0.22-2.78) for CD and 1.39 (95%CI: 0.84-2.32) for UC. South Asians showed consistently higher incidence and more extensive UC than the indigenous population in five countries. A similar pattern was observed for Hispanics in the United States. Bangladeshis and African Americans showed an increased risk of CD with perianal disease. CONCLUSION This review suggests that migration and race influence the risk of developing inflammatory bowel disease. This may be due to different inherent responses upon exposure to an environmental trigger in the adopted country. Further prospective studies on homogenous migrant populations are needed to validate these observations, with a parallel arm for in-depth investigation of putative drivers. PMID:29391765

Diverting Ileostomy for the Treatment of Severe, Refractory, Pediatric Inflammatory Bowel Disease.

PubMed

Maxwell, Elizabeth C; Dawany, Noor; Baldassano, Robert N; Mamula, Petar; Mattei, Peter; Albenberg, Lindsey; Kelsen, Judith R

2017-09-01

Diverting ileostomy is used as a temporizing therapy in patients with perianal Crohn disease; however, little data exist regarding its use for colonic disease. The primary aim of the present study was to determine the role of diversion in severe refractory colonic inflammatory bowel disease (IBD) in a pediatric population. Retrospective study of patients who underwent diverting ileostomy at The Children's Hospital of Philadelphia from 2000 to 2014 for the management of severe, refractory colonic IBD. Clinical variables were compared in the 1 year before ileostomy and 1 year after diversion. Surgical and disease outcomes including changes in diagnosis were reviewed through 2015. Twenty-four patients underwent diverting ileostomy for refractory colonic disease. Initial diagnoses were Crohn disease in 10 (42%), ulcerative colitis in 1 (4%), and IBD-unclassified in 13 patients (54%). Comparing data before and after surgery, there were statistically significant improvements in height and weight velocities, height velocity z score, blood transfusion requirement, hemoglobin, and hospitalization rates. Chronic steroid use decreased from 71% to 22%. At the conclusion of the study, 10 patients had undergone subsequent colectomy, 7 had successful bowel reanastomosis, and 7 remain diverted. Seven patients (29%) had a change in diagnosis. There were 13 surgical complications in 7 subjects, including prolapse reduction, stoma revision, and resection of ischemic bowel. In pediatric patients with refractory colonic IBD, diverting ileostomy can be a successful intervention to induce clinical stability. Importantly, diversion is a steroid-sparing therapy and allows additional time to clarify the diagnosis.

Haemorrhoids and anal fissures during pregnancy and after childbirth: a prospective cohort study.

PubMed

Poskus, T; Buzinskienė, D; Drasutiene, G; Samalavicius, N E; Barkus, A; Barisauskiene, A; Tutkuviene, J; Sakalauskaite, I; Drasutis, J; Jasulaitis, A; Jakaitiene, A

2014-12-01

To identify the incidence and risk factors of haemorrhoids and fissures during pregnancy and after childbirth. Prospective observational cohort study. University hospital and outpatient clinics in Lithuania. A total of 280 pregnant women followed up until 1 month after delivery. Women were examined four times through pregnancy and after delivery; those that developed peri-anal diseases were compared with those that did not. Incidence, time and risk factors of haemorrhoids and fissures. In all, 123 (43.9%) women developed peri-anal disease: 1.6% in the first trimester, 61% during the third trimester, 34.1% after delivery and 3.3% 1 month after delivery; 114 (40.7%) women were diagnosed with haemorrhoids, seven (2.5%) with haemorrhoids and anal fissure and two (0.71%) with anal fissure. Ninety-nine (80.5%) women had vaginal delivery and 24 (19.5%) women had undergone caesarean section. Multivariate analysis identified personal history of peri-anal diseases (odds ratio [OR] 11.93; 95% confidence interval [95% CI] 2.18-65.30), constipation (OR 18.98; 95% CI 7.13-50.54), straining during delivery for more than 20 minutes (OR 29.75; 95% CI 4.00-221.23) and birthweight of newborn>3800 g (OR 17.99; 95% CI 3.29-98.49) as significant predictors of haemorrhoids and anal fissures during pregnancy and perinatal period. Haemorrhoids and fissures are common during the last trimester of pregnancy and 1 month after delivery, with constipation, personal history of haemorrhoids or fissures, birthweight of newborn>3800 g, straining during delivery for more than 20 minutes being independently associated risk factors. © 2014 Royal College of Obstetricians and Gynaecologists.

Phenotypic concordance in familial inflammatory bowel disease (IBD). Results of a nationwide IBD Spanish database.

PubMed

Cabré, Eduard; Mañosa, Míriam; García-Sánchez, Valle; Gutiérrez, Ana; Ricart, Elena; Esteve, Maria; Guardiola, Jordi; Aguas, Mariam; Merino, Olga; Ponferrada, Angel; Gisbert, Javier P; Garcia-Planella, Esther; Ceña, Gloria; Cabriada, José L; Montoro, Miguel; Domènech, Eugeni

2014-07-01

Disease outcome has been found to be poorer in familial inflammatory bowel disease (IBD) than in sporadic forms, but assessment of phenotypic concordance in familial IBD provided controversial results. We assessed the concordance for disease type and phenotypic features in IBD families. Patients with familial IBD were identified from the IBD Spanish database ENEIDA. Families in whom at least two members were in the database were selected for concordance analysis (κ index). Concordance for type of IBD [Crohn's disease (CD) vs. ulcerative colitis (UC)], as well as for disease extent, localization and behaviour, perianal disease, extraintestinal manifestations, and indicators of severe disease (i.e., need for immunosuppressors, biological agents, and surgery) for those pairs concordant for IBD type, were analyzed. 798 out of 11,905 IBD patients (7%) in ENEIDA had familial history of IBD. Complete data of 107 families (231 patients and 144 consanguineous pairs) were available for concordance analyses. The youngest members of the pairs were diagnosed with IBD at a significantly younger age (p<0.001) than the oldest ones. Seventy-six percent of pairs matched up for the IBD type (κ=0.58; 95%CI: 0.42-0.73, moderate concordance). There was no relevant concordance for any of the phenotypic items assessed in both diseases. Familial IBD is associated with diagnostic anticipation in younger individuals. Familial history does not allow predicting any phenotypic feature other than IBD type. Copyright © 2013 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

Role of endoscopy in inflammatory bowel disease

PubMed Central

Bharadwaj, Shishira; Narula, Neeraj; Tandon, Parul; Yaghoobi, Mohammad

2018-01-01

Abstract Crohn’s disease (CD) and ulcerative colitis (UC) constitute the two most common phenotypes of inflammatory bowel disease (IBD). Ileocolonoscopy with biopsy has been considered the gold standard for the diagnosis of IBD. Differential diagnosis of CD and UC is important, as their medical and surgical treatment modalities and prognoses can be different. However, approximately 15% of patients with IBD are misdiagnosed as IBD unclassified due to the lack of diagnostic certainty of CD or UC. Recently, there has been increased recognition of the role of the therapeutic endoscopist in the field of IBD. Newer imaging techniques have been developed to aid in the differentiation of UC vs CD. Furthermore, endoscopic balloon dilation and stenting have become an integral part of the therapeutic armamentarium of CD stricture management. Endoscopic ultrasound has been recognized as being more accurate than magnetic resonance imaging in detecting perianal fistulae in patients with CD. Additionally, chromoendoscopy may help to detect dysplasia earlier compared with white-light colonoscopy. Hence, interventional endoscopy has become a cornerstone in the diagnosis, treatment and management of IBD complications. The role of endoscopy in the field of IBD has significantly evolved in recent years from small-bowel imaging to endoscopic balloon dilation and use of chormoendoscopy in dysplasia surveillance. In this review article, we discuss the current evidence on interventional endoscopy in the diagnosis, treatment and management of IBD compications. PMID:29780594

Epidemiology of skin diseases in renal transplant recipients in a tertiary hospital.

PubMed

Chen, Qi Ping; Aw, Derrick C W

2010-12-01

There is no published epidemiological data on skin diseases in kidney transplant recipients in this tropical country, which has multi-ethnic groups with the Chinese as the predominant ethnic group. Skin diseases of 143 renal transplant recipients were studied in a skin clinic of a tertiary institution during annual surveillance visits from June 2006 to March 2009. Our study showed that except the common drug specific skin manifestations, sebaceous hyperplasia (56.6%), seborrheic keratosis (60.8%), melanocytic naevi (76.9%), skin tags (37.1%) and viral (29.4%) and fungal (20.3%) infections were the most prevalent skin diseases among renal transplant recipients living in Singapore. The prevalence of pre-malignant and malignant tumours was very low (11.2% actinic keratosis, 1.4% Bowen's disease, 1.4% squamous cell carcinoma, 0.7% basal cell carcinoma, 0.7% keratoacanthoma). Male predominance was seen in sebaceous hyperplasia (72.4% vs 32.1%), actinic keratosis (17.2% vs 1.8%), viral (36.8% vs 19.6%) and fungal (27.6% vs 8.9%) infections. Our study also showed increased prevalence of sebaceous hyperplasia with increased age but its prevalence was significantly higher than that reported in the age matched general population. The prevalence of seborrheic keratosis, actinic keratosis and viral infection correlated positively with post-transplant duration. Our study provides epidemiological data for the prevalence of skin diseases in renal transplant recipients. It emphasises the importance of dermatologic follow-up for renal transplant patients in order to obtain a diagnosis and manage treatable skin diseases.

Atypical desquamation in a 2.5-year-old boy with Kawasaki disease: A case report.

PubMed

Adib, Ali; Fazel, Ali; Nabavizadeh, Seyed Hesamedin; Alyasin, Sohaila; Kashef, Sara

2017-02-01

Kawasaki disease (KD) is a vasculitis that mostly affects children under 5 years of age. This article presents a 2.5-year-old boy who presented with 6 days of fever, generalized maculopapular rash, bilateral non-exudative conjunctivitis, cracked lips, right cervical lymphadenopathy, erythematous extremities, and perianal desquamation. Laboratory studies showed leukocytosis and sterile pyuria. Because diagnosis of KD was proved, oral acetylsalicylic acid with the anti-inflammatory dose and intravenous immunoglobulin were started for him. On the seventh day of admission time, he developed desquamation and erythema on the site of his right cervical lymphadenopathy as well as periungual scaling. About three weeks after starting the treatment, scaling of the cervical lymphadenopathy and periungual area stopped. Echocardiography was performed for him three times: at the time of diagnosis, four weeks, and 6 months later and revealed normal coronary arteries. We report this sign, desquamation on the site of cervical lymphadenopathy, as a new finding.

Psychometry and Pescatori projective test in coloproctological patients.

PubMed

Caetano, Ana Célia; Oliveira, Dinis; Gomes, Zaida; Mesquita, Edgar; Rolanda, Carla

2017-01-01

Psychological assessment is not commonly performed nor easily accepted by coloproctological patients. Our aim was to evaluate the psychological component of coloproctological disorders using uncommon tools. The 21-Item Depression Anxiety and Stress Scale and the Pescatori projective test were applied to coloproctological outpatients of the Gastroenterology Department of our hospital as well as to healthy volunteers. Seventy patients (median age 47 years, 22 male) divided in 4 groups (functional constipation, constipated irritable bowel syndrome, benign anorectal disease and perianal Crohn's disease) and 52 healthy volunteers (age 45 years, 18 male) completed the tests. Proctological patients showed higher scores of depression (P<0.001), anxiety (P<0.001), and stress (P<0.001) compared to healthy participants. Compared to the control group, patients with functional constipation, irritable bowel syndrome and perianal Crohn's disease maintained the highest scores in all subscales (P<0.05), while patients with benign anorectal disease only had higher anxiety and stress (P<0.001) scores. The patients' also showed lower scores in the Pescatori projective test (P=0.012). A weak association between the projective test and the depression subscale was found (P=0.05). Proctological patients had higher scores of depression, anxiety and stress and lower scores in the Pescatori projective test compared to healthy controls.

Global Effects of SuperParameterization on Hydro-Thermal Land-Atmosphere Coupling on Multiple Timescales and an Amplification of the Bowen Ratio

NASA Astrophysics Data System (ADS)

Qin, H.; Pritchard, M. S.; Kooperman, G. J.; Parishani, H.

2017-12-01

Conventional General Circulation Models (GCMs) in the Global Land-Atmosphere Coupling Experiment (GLACE) tend to produce overly strong Land-Atmosphere coupling (L-A coupling) strength. We investigate the effects of cloud SuperParameterization (SP) on L-A coupling on timescales longer than the diurnal where it has been previously shown to have a strong effect. Using the Community Atmosphere Model v3.5 (CAM3.5) and its SuperParameterized counterpart SPCAM3.5, we conducted experiments following the GLACE and Atmospheric Model Intercomparison Project (AMIP) protocols. On synoptic-to-subseasonal timescales, SP significantly mutes hydrologic L-A coupling on a global scale, through the atmospheric segment. But on longer seasonal timescales, SP does not exhibit detectable effects on hydrologic L-A coupling. Two regional effects of SP on thermal L-A coupling are also discovered and explored. Over the Arabian Peninsula, SP strikingly reduces thermal L-A coupling due to a control by mean regional rainfall reduction. Over the Southwestern US and Northern Mexico, however, SP remarkably enhances the thermal L-A coupling independent of rainfall or soil moisture. We argue that the cause may be a previously unrecognized effect of SP to amplify the simulated Bowen ratio. Not only does this help reconcile a puzzling local enhancement of thermal L-A coupling over the Southwestern US, but it is also demonstrated to be a robust, global effect of SP over land that is independent of model version and experiment design, and that has important consequences for climate change prediction.

Prevalence of adverse food reactions in 130 dogs in Italy with dermatological signs: a retrospective study.

PubMed

Proverbio, D; Perego, R; Spada, E; Ferro, E

2010-07-01

To determine the prevalence of adverse food reactions (AFRs) in dogs with dermatological signs presented to the referral dermatological clinic of the University of Milan. The medical records of dogs with dermatological signs were reviewed. Prevalence of AFRs was calculated. Owner and clinician pruritus scores were compared. Breed, sex and age predisposition were statistically tested, as was the association between AFR and selected clinical features. The prevalence of AFRs in dogs with dermatological signs was 12% (16 of 130). AFR was diagnosed in 26% of dogs with allergic disease and 48% of those subjected to a dietary trial. There was a significant association between AFRs and early onset of clinical signs (< 1 year) (OR=3.8; P=0.0221, 95% CI=1.27 to 11.16). There was a significant association between AFRs and both otitis externa (OR=5.9; P=0.0015, 95% CI=2 to 17.9) and perianal fistula (OR=26.1; P=0.0058, 95% CI=2.52 to 269.4), although all dogs with perianal fistulas were German shepherd dogs. The prevalence of AFRs in the study population was higher than most reported values. Further studies are warranted to investigate the true prevalence of AFR and its possible association with perianal fistula and other potential markers.

Ulcerative colitis presenting as leukocytoclastic vasculitis of skin.

PubMed

Akbulut, Sabiye; Ozaslan, Ersan; Topal, Firdevs; Albayrak, Levent; Kayhan, Burcak; Efe, Cumali

2008-04-21

A number of cutaneous changes are known to occur in the course of inflammatory bowel diseases (IBD), including pyoderma gangrenosum, erythema nodosum, perianal disease, erythematous eruptions, urticaria, and purpura. However, occurrence of skin manifestations prior to the development of ulcerative colitis is a rare occasion. Here, we report a case of ulcerative colitis associated with leukocytoclastic vasculitis in which the intestinal symptoms became overt 8 mo after the development of skin lesions.

Prevalence and predictors of hospitalization in Crohn's disease in a prospective population-based inception cohort from 2000-2012.

PubMed

Golovics, Petra A; Lakatos, Laszlo; Mandel, Michael D; Lovasz, Barbara D; Vegh, Zsuzsanna; Kurti, Zsuzsanna; Szita, Istvan; Kiss, Lajos S; Pandur, Tunde; Lakatos, Peter L

2015-06-21

To analyze the prevalence, length and predictors of hospitalization in the biological era in the population-based inception cohort from Veszprem province. Data of 331 incident Crohn's disease (CD) patients diagnosed between January 1, 2000 and December 31, 2010 were analyzed (median age at diagnosis: 28; IQR: 21-40 years). Both in- and outpatient records were collected and comprehensively reviewed. Probabilities of first CD-related hospitalization and re-hospitalization were 32.3%, 45.5%, 53.7% and 13.6%, 23.9%, 29.8%, respectively after one, three and five years of follow-up in Kaplan-Meier analysis. First-year hospitalizations were related to diagnostic procedures (37%), surgery or disease activity (27% and 21%). Non-inflammatory disease behavior at diagnosis (HR = 1.32, P = 0.001) and perianal disease (HR = 1.47, P = 0.04) were associated with time to first CD-related hospitalization, while disease behavior change (HR = 2.38, P = 0.002) and need for steroids (HR = 3.14, P = 0.003) were associated with time to first re-hospitalization in multivariate analyses. Early CD-related hospitalization (within the year of diagnosis) was independently associated with need for immunosuppressives (OR = 2.08, P = 0.001) and need for surgeries (OR = 7.25, P < 0.001) during the disease course. Hospitalization and re-hospitalization rates are still high in this cohort, especially during the first-year after the diagnosis. Non-inflammatory disease behavior at diagnosis was identified as the pivotal predictive factor of both hospitalization and re-hospitalization.

Estimates of evapotranspiration in alkaline scrub and meadow communities of Owens Valley, California, using the Bowen-ratio, eddy-correlation, and Penman-combination methods

USGS Publications Warehouse

Duell, L. F. W.

1988-01-01

In Owens Valley, evapotranspiration (ET) is one of the largest components of outflow in the hydrologic budget and the least understood. ET estimates for December 1983 through October 1985 were made for seven representative locations selected on the basis of geohydrology and the characteristics of phreatophytic alkaline scrub and meadow communities. The Bowen-ratio, eddy-correlation, and Penman-combination methods were used to estimate ET. The results of the analyses appear satisfactory when compared to other estimates of ET. Results by the eddy-correlation method are for a direct and a residual latent-heat flux that is based on sensible-heat flux and energy budget measurements. Penman-combination potential ET estimates were determined to be unusable because they overestimated actual ET. Modification in the psychrometer constant of this method to account for differences between heat-diffusion resistance and vapor-diffusion resistance permitted actual ET to be estimated. The methods may be used for studies in similar semiarid and arid rangeland areas in the Western United States. Meteorological data for three field sites are included in the appendix. Simple linear regression analysis indicates that ET estimates are correlated to air temperature, vapor-density deficit, and net radiation. Estimates of annual ET range from 300 mm at a low-density scrub site to 1,100 mm at a high-density meadow site. The monthly percentage of annual ET was determined to be similar for all sites studied. (Author 's abstract)

Estimates of evapotranspiration in alkaline scrub and meadow communities of Owens Valley, California, using the Bowen-ratio, eddy-correlation, and penman-combination methods

USGS Publications Warehouse

Duell, Lowell F. W.

1990-01-01

In Owens Valley, evapotranspiration (ET) is one of the largest components of outflow in the hydrologic budget and the least understood. ET estimates for December 1983 through October 1985 were made for seven representative locations selected on the basis of geohydrology and the characteristics of phreatophytic alkaline scrub and meadow communities. The Bowen-ratio, eddy-correlation, and Penman-combination methods were used to estimate ET. The results of the analyses appear satisfactory when compared with other estimates of ET. Results by the eddy-correlation method are for a direct and a residual latent-heat flux that is based on sensible-heat flux and energy-budget measurements. Penman-combination potential-ET estimates were determined to be unusable because they overestimated actual ET. Modification of the psychrometer constant of this method to account for differences between heat-diffusion resistance and vapor-diffusion resistance permitted actual ET to be estimated. The methods described in this report may be used for studies in similar semiarid and arid rangeland areas in the Western United States. Meteorological data for three field sites are included in the appendix of this report. Simple linear regression analysis indicates that ET estimates are correlated to air temperature, vapor-density deficit, and net radiation. Estimates of annual ET range from 301 millimeters at a low-density scrub site to 1,137 millimeters at a high-density meadow site. The monthly percentage of annual ET was determined to be similar for all sites studied.

Application of intense pulsed light in the treatment of dermatologic disease: a systematic review.

PubMed

Wat, Heidi; Wu, Douglas C; Rao, Jaggi; Goldman, Mitchel P

2014-04-01

The Food and Drug Administration (FDA) has approved intense pulsed light (IPL) devices for the treatment of a variety of benign pigmentary and vascular lesions, but the range of disease amenable to IPL treatment continues to expand, and there are no evidence-based clinical guidelines for its use in FDA-approved and off-label indications. To provide evidence-based recommendations to guide physicians in the application of IPL for the treatment of dermatologic disease. A literature search of the CENTRAL (1991 to May 6, 2013), EMBASE (1974 to May 6, 2013), and MEDLINE in-process and nonindexed citations and MEDLINE (1964 to present) databases was conducted. Studies that examined the role of IPL in primary dermatologic disease were identified, and multiple independent investigators extracted and synthesized data. Recommendations were based on the highest level of evidence available. Level 1 evidence was found for the use of IPL for the treatment of melasma, acne vulgaris, and telangiectasia. Level 2 evidence was found for the treatment of lentiginous disease, rosacea, capillary malformations, actinic keratoses, and sebaceous gland hyperplasia. Level 3 or lower evidence was found for the treatment of poikiloderma of Civatte, venous malformations, infantile hemangioma, hypertrophic scars, superficial basal cell carcinoma, and Bowen's disease. IPL is an effective treatment modality for a growing range of dermatologic disease and in some cases may represent a treatment of choice. It is typically well tolerated. Further high-quality studies are required. © 2014 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.

Prevalence and predictors of hospitalization in Crohn’s disease in a prospective population-based inception cohort from 2000-2012

PubMed Central

Golovics, Petra A; Lakatos, Laszlo; Mandel, Michael D; Lovasz, Barbara D; Vegh, Zsuzsanna; Kurti, Zsuzsanna; Szita, Istvan; Kiss, Lajos S; Pandur, Tunde; Lakatos, Peter L

2015-01-01

AIM: To analyze the prevalence, length and predictors of hospitalization in the biological era in the population-based inception cohort from Veszprem province. METHODS: Data of 331 incident Crohn’s disease (CD) patients diagnosed between January 1, 2000 and December 31, 2010 were analyzed (median age at diagnosis: 28; IQR: 21-40 years). Both in- and outpatient records were collected and comprehensively reviewed. RESULTS: Probabilities of first CD-related hospitalization and re-hospitalization were 32.3%, 45.5%, 53.7% and 13.6%, 23.9%, 29.8%, respectively after one, three and five years of follow-up in Kaplan-Meier analysis. First-year hospitalizations were related to diagnostic procedures (37%), surgery or disease activity (27% and 21%). Non-inflammatory disease behavior at diagnosis (HR = 1.32, P = 0.001) and perianal disease (HR = 1.47, P = 0.04) were associated with time to first CD-related hospitalization, while disease behavior change (HR = 2.38, P = 0.002) and need for steroids (HR = 3.14, P = 0.003) were associated with time to first re-hospitalization in multivariate analyses. Early CD-related hospitalization (within the year of diagnosis) was independently associated with need for immunosuppressives (OR = 2.08, P = 0.001) and need for surgeries (OR = 7.25, P < 0.001) during the disease course. CONCLUSION: Hospitalization and re-hospitalization rates are still high in this cohort, especially during the first-year after the diagnosis. Non-inflammatory disease behavior at diagnosis was identified as the pivotal predictive factor of both hospitalization and re-hospitalization. PMID:26109815

Clinical and Phenotypic Differences in Inflammatory Bowel Disease Among Arab and Jewish Children in Israel.

PubMed

Rinawi, Firas; Assa, Amit; Bashir, Husam; Peleg, Sarit; Shamir, Raanan

2017-08-01

Data on inflammatory bowel disease (IBD) phenotypes among the Arab population in Israel or in the neighboring Arab countries is scarce. We aimed to assess differences in disease phenotype among Arab and Jewish children living in Israel. We performed a retrospective chart review of pediatric IBD cases, which were diagnosed at the Schneider Children's Medical Center and Ha'Emek Medical Center in Israel between 2000 and 2014. Demographic, clinical, and phenotypic variables were compared between Arabs and Jews from Eastern (Sephardic) and Western (Ashkenazi) origin. Seventy-one Arab children with IBD were compared with 165 Ashkenazi and 158 Sephardic Jewish children. Age and gender did not differ between groups. Sephardic and Ashkenazi Jewish Crohn's disease (CD) patients had significantly more stenotic behavior (24 and 26 vs. 5%, p = 0.03) and less fistulzing perianal disease (15 and 11 vs. 31%, p = 0.014) compared with Arab patients. Arab children with ulcerative colitis (UC) had more severe disease at diagnosis compared to Sephardic and Ashkenazi Jews reflected by higher Pediatric UC Activity Index (45 vs. 35 and 35, respectively, p = 0.03). Arab patients had significantly lower proportion of anti-Saccharomyces cerevisiae antibodies positivity (in CD) and perinuclear anti-neutrophil cytoplasmic antibodies positivity (in UC) than both Sephardic and Ashkenazi Jewish children (23 vs. 53 and 65%, p = 0.002 and 35 vs. 60 and 75%, respectively, p = 0.002). Arab and Jewish children with IBD differ in disease characteristics and severity. Whether genetic or environmental factors are the cause for these differences is yet to be determined.

Systematic Review and Meta-analysis: Phenotype and Clinical Outcomes of Older-onset Inflammatory Bowel Disease.

PubMed

Ananthakrishnan, Ashwin N; Shi, Hai Yun; Tang, Whitney; Law, Cindy C Y; Sung, Joseph J Y; Chan, Francis K L; Ng, Siew C

2016-10-01

Little is known of the clinical outcome of patients with older-onset inflammatory bowel disease [IBD]. We performed a systematic review to determine phenotype and outcomes of older-onset IBD compared with younger-onset subjects. A systematic search of Embase and Medline up to June 2015 identified studies investigating phenotype and outcomes of older-onset [diagnosed at age ≥ 50 years] Crohn's disease [CD] and ulcerative colitis [UC] subjects. Pooled analyses of disease phenotype, medication use, and disease-related surgery were calculated. We analysed findings from 43 studies comprising 8274 older-onset and 34641 younger-onset IBD subjects. Compared with younger-onset patients, older-onset CD patients were more likely to have colonic disease (odds ratio [OR] 2.56, 95% confidence interval [CI] 1.88 - 3.48) and inflammatory behaviour [OR 1.19, 95% CI 1.07 - 1.33], and less likely to have penetrating disease or perianal involvement. More older-onset UC patients had left-sided colitis [OR 1.49, 95% CI 1.18 - 1.88]. Although fewer older-onset IBD patients received immunomodulators [CD: OR 0.44; UC: OR 0.60] or biologicals [CD: OR 0.34; UC: OR 0.41], older-onset CD was similar in the need for surgery [OR 0.70, 95% CI 0.40 - 1.22] whereas more older-onset UC patients underwent surgery [OR 1.36, 95% CI 1.18 - 1.57]. Elderly IBD patients present with less complicated disease, but have similar or higher rates of surgery than non-elderly patients. Whether this reflects a non-benign disease course, physicians' reluctance to employ immunomodulators, or both, merits further study which is essential for improving the care of IBD in the elderly. Copyright © 2016 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Relationship between red vent syndrome and anisakid larvae burden in wild atlantic salmon (salmo salar).

PubMed

Larrat, Sylvain; Bouchard, Francis; Séguin, Guylaine; Lair, Stéphane

2013-04-01

The pathogenesis of the recently recognized "red vent syndrome" in wild Atlantic salmon (Salmo salar) is not fully understood. Pathologic observations indicate that this syndrome is associated with the presence of nonencapsulated larvae of the nematode Anisakis simplex in the body wall, the lower intestinal wall, and the visceral cavity surrounding the vent region. We evaluated the relationship between the occurrence of red vent syndrome and intensity of infection with Anisakis sp. larvae in naturally infected fish. Salmon caught by sport anglers were opportunistically evaluated to detect red vent syndrome. We included 106 salmon with red vent syndrome and 98 without red vent syndrome in this study. Intensity of infection was established by counting the total number of perivisceral larvae and by determining the number of larvae per gram in 10 g of pepsin-digested perianal tissue. The severity of inflammatory changes was also evaluated in standard histologic sections of the perianal area using a semiquantitative scale. Salmon with red vent syndrome had significantly higher intensity of inflammation than salmon without red vent syndrome (P=0.008). The odds of having red vent syndrome increased with the number of perianal larvae per gram of perianal tissue (P=0.002; odds ratio [OR]=1.12; 95% confidence interval: [1.05; 1.22]) but not with the number of perivisceral larvae, fish length, or gender. Although these results support the association between this syndrome and intensity of infection by A. simplex, the relationship is not strong (OR near 1), suggesting that the clinical expression of red vent syndrome at an individual level, and the emergence of this disease on a global scale, must be determined by other factors, such as timing of infection.

Disagreement in high-grade/low-grade intraepithelial neoplasia and high-risk/low-risk HPV infection: clinical implications for anal cancer precursor lesions in HIV-positive and HIV-negative MSM.

PubMed

Pimenoff, V N; Félez-Sánchez, M; Tous, S; Clavero, O; Godínez, J M; Klaustermeier, J; Saunier, M; Molijn, A; Alemany, L; Quint, W; Bosch, F X; de Sanjosé, S; McCloskey, J; Bravo, I G

2015-06-01

Anal condylomata are common in HIV-positive individuals and among men who have sex with men (MSM). Generally attributable to infection by low-risk human papillomaviruses (HPVs), condylomata are considered benign low-grade squamous intraepithelial lesions (SILs). However, anal condylomata have occasionally been linked to high-grade SIL and to oncogenic, high-risk HPVs. Here we describe the range of intraepithelial lesions and of the associated HPVs in heterosexual men and women and MSM. Perianal and anal condylomata were collected from 243 patients (56 heterosexual women, 61 heterosexual men and 126 MSM, including 41 HIV-positive MSM). We assessed lesion histology and HPV genotype. Prevalence estimates and Poisson models were used. Irrespective of HIV infection status, MSM showed a higher proportion of condylomata as high-grade SILs compared to heterosexual men/women. High-grade SILs were also more prevalent in anal than in perianal lesions in all patient groups. HIV-positive MSM exhibited increased prevalence ratio (4.6; 95% confidence interval 2.1-10.0) of perianal low-grade SILs containing only high-risk HPVs compared to HIV-negative MSM. In addition, more than 64% of anal SILs with a high-grade component, regardless of HIV infection, were exclusively associated with low-risk HPVs. In anal condylomata, both high-grade and low-grade SILs can be associated with high-risk and/or low-risk HPVs. Particularly, low-grade perianal SILs associated with high-risk HPVs were common in HIV-positive MSM, while presence of only low-risk HPVs in high-grade SILs were common in both MSM groups. Our findings sound a note of caution for the common clinical practice for the treatment of anal condylomata as benign lesions in MSM and HIV-positive patients. Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Psychometry and Pescatori projective test in coloproctological patients

PubMed Central

Caetano, Ana Célia; Oliveira, Dinis; Gomes, Zaida; Mesquita, Edgar; Rolanda, Carla

2017-01-01

Background Psychological assessment is not commonly performed nor easily accepted by coloproctological patients. Our aim was to evaluate the psychological component of coloproctological disorders using uncommon tools. Methods The 21-Item Depression Anxiety and Stress Scale and the Pescatori projective test were applied to coloproctological outpatients of the Gastroenterology Department of our hospital as well as to healthy volunteers. Results Seventy patients (median age 47 years, 22 male) divided in 4 groups (functional constipation, constipated irritable bowel syndrome, benign anorectal disease and perianal Crohn’s disease) and 52 healthy volunteers (age 45 years, 18 male) completed the tests. Proctological patients showed higher scores of depression (P<0.001), anxiety (P<0.001), and stress (P<0.001) compared to healthy participants. Compared to the control group, patients with functional constipation, irritable bowel syndrome and perianal Crohn’s disease maintained the highest scores in all subscales (P<0.05), while patients with benign anorectal disease only had higher anxiety and stress (P<0.001) scores. The patients’ also showed lower scores in the Pescatori projective test (P=0.012). A weak association between the projective test and the depression subscale was found (P=0.05). Conclusion Proctological patients had higher scores of depression, anxiety and stress and lower scores in the Pescatori projective test compared to healthy controls. PMID:28655980

Similar risk of Depression and Anxiety following surgery or hospitalization for Crohn’s disease and Ulcerative colitis

PubMed Central

Ananthakrishnan, Ashwin N.; Gainer, Vivian S.; Cai, Tianxi; Perez, Raul Guzman; Cheng, Su-Chun; Savova, Guergana; Chen, Pei; Szolovits, Peter; Xia, Zongqi; De Jager, Philip L; Shaw, Stanley; Churchill, Susanne; Karlson, Elizabeth W.; Kohane, Isaac; Perlis, Roy H; Plenge, Robert M.; Murphy, Shawn N.; Liao, Katherine P.

2013-01-01

Introduction Psychiatric co-morbidity is common in Crohn’s disease (CD) and ulcerative colitis (UC). IBD-related surgery or hospitalizations represent major events in the natural history of disease. Whether there is a difference in risk of psychiatric co-morbidity following surgery in CD and UC has not been examined previously. Methods We used a multi-institution cohort of IBD patients without a diagnosis code for anxiety or depression preceding their IBD-related surgery or hospitalization. Demographic, disease, and treatment related variables were retrieved. Multivariate logistic regression analysis was performed to individually identify risk factors for depression and anxiety. Results Our study included a total of 707 CD and 530 UC patients who underwent bowel resection surgery and did not have depression prior to surgery. The risk of depression 5 years after surgery was 16% and 11% in CD and UC respectively. We found no difference in the risk of depression following surgery in CD and UC patients (adjusted OR 1.11, 95%CI 0.84 – 1.47). Female gender, co-morbidity, immunosuppressant use, perianal disease, stoma surgery, and early surgery within 3 years of care predicted depression after CD-surgery; only female gender and co-morbidity predicted depression in UC. Only 12% of the CD cohort had ≥ 4 risk factors for depression, but among them nearly 44% were subsequently received a diagnosis code for depression. Conclusion IBD-related surgery or hospitalization is associated with a significant risk for depression and anxiety with a similar magnitude of risk in both diseases. PMID:23337479

[Complications of hemorrhoids].

PubMed

Slauf, P; Antoš, F; Marx, J

2014-04-01

The most common and serious complications of haemorrhoids include perianal thrombosis and incarcerated prolapsed internal haemorrhoids with subsequent thrombosis. They are characterised by severe pain in the perianal region possibly with bleeding. In a short history of the perianal thrombosis, acute surgical incision or excision is indicated, which can result in rapid relief of the painful symptoms. In incarcerated prolapsed internal haemorrhoids, emergency haemorrhoidectomy may also be indicated. Segmental haemorrhoidectomy in the most affected quadrants followed by further elective surgery for haemorrhoids in the next stage is preferred.

Assessment and classification of fistula-in-ano in patients with Crohn's disease by hydrogen peroxide enhanced transanal ultrasound.

PubMed

Sloots, C E; Felt-Bersma, R J; Poen, A C; Cuesta, M A; Meuwissen, S G

2001-09-01

Crohn's disease is well known for its perianal complications, among which fistulas-in-ano are the most common abnormalities. Fistulas-in-ano in Crohn's disease tend to be complex and have a high recurrence rate. Therefore the role of surgery is generally more conservative. Hydrogen peroxide enhanced transanal ultrasound has proven superior to physical examination, fistulography, computed tomography, and conventional ultrasound in demonstrating the fistula tract. This study examined the fistula tracks in patients with Crohn's disease. Forty-one patients with Crohn's disease and fistula-in-ano were investigated using physical examination, sondage of the fistula, proctoscopy and transanal ultrasound. Hydrogen peroxide was infused via a small catheter into the fistula. The main track and the ramification of the fistula were classified according to the anatomical Parks' classification. Only 9 (22%) patients had a single inter- or transsphincteric fistula. In 5 (12%) patients a single supra- or extrasphincteric fistula (high fistula) was found, in 14 (34%) more than one fistula track (ramified), and in 13 (32%) an anovaginal fistula. Thus 78% of patients had a surgically difficult to treat fistula. In the ramified fistula the main track follows the Parks' classification, but ramifications can have a bizarre pattern which is not in agreement with this classification. Optimal documentation by means of hydrogen peroxide enhanced transanal ultrasound is therefore mandatory before surgery or before other therapies such as anti-tumor necrosis factor treatment.

The Toronto Consensus Statements for the Management of Inflammatory Bowel Disease in Pregnancy.

PubMed

Nguyen, Geoffrey C; Seow, Cynthia H; Maxwell, Cynthia; Huang, Vivian; Leung, Yvette; Jones, Jennifer; Leontiadis, Grigorios I; Tse, Frances; Mahadevan, Uma; van der Woude, C Janneke

2016-03-01

The management of inflammatory bowel disease (IBD) poses a particular challenge during pregnancy because the health of both the mother and the fetus must be considered. A systematic literature search identified studies on the management of IBD during pregnancy. The quality of evidence and strength of recommendations were rated using the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. Consensus was reached on 29 of the 30 recommendations considered. Preconception counseling and access to specialist care are paramount in optimizing disease management. In general, women on 5-ASA, thiopurine, or anti-tumor necrosis factor (TNF) monotherapy for maintenance should continue therapy throughout pregnancy. Discontinuation of anti-TNF therapy or switching from combination therapy to monotherapy may be considered in very select low-risk patients. Women who have a mild to moderate disease flare while on optimized 5-ASA or thiopurine therapy should be managed with systemic corticosteroid or anti-TNF therapy, and those with a corticosteroid-resistant flare should start anti-TNF therapy. Endoscopy or urgent surgery should not be delayed during pregnancy if indicated. Decisions regarding cesarean delivery should be based on obstetric considerations and not the diagnosis of IBD alone, with the exception of women with active perianal Crohn's disease. With the exception of methotrexate, the use of medications for IBD should not influence the decision to breast-feed and vice versa. Live vaccinations are not recommended within the first 6 months of life in the offspring of women who were on anti-TNF therapy during pregnancy. Optimal management of IBD before and during pregnancy is essential to achieving favorable maternal and neonatal outcomes. Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.

Changes in Crohn's disease phenotype over time in the Chinese population: validation of the Montreal classification system.

PubMed

Chow, Dorothy K L; Leong, Rupert W L; Lai, Larry H; Wong, Grace L H; Leung, Wai-Keung; Chan, Francis K L; Sung, Joseph J Y

2008-04-01

Phenotypic evolution of Crohn's disease occurs in whites but has never been described in other populations. The Montreal classification may describe phenotypes more precisely. The aim of this study was to validate the Montreal classification through a longitudinal sensitivity analysis in detecting phenotypic variation compared to the Vienna classification. This was a retrospective longitudinal study of consecutive Chinese Crohn's disease patients. All cases were classified by the Montreal classification and the Vienna classification for behavior and location. The evolution of these characteristics and the need for surgery were evaluated. A total of 109 patients were recruited (median follow-up: 4 years, range: 6 months-18 years). Crohn's disease behavior changed 3 years after diagnosis (P = 0.025), with an increase in stricturing and penetrating phenotypes, as determined by the Montreal classification, but was only detected by the Vienna classification after 5 years (P = 0.015). Disease location remained stable on follow-up in both classifications. Thirty-four patients (31%) underwent major surgery during the follow-up period with the stricturing [P = 0.002; hazard ratio (HR): 3.3; 95% CI: 1.5-7.0] and penetrating (P = 0.03; HR: 5.8; 95% CI: 1.2-28.2) phenotypes according to the Montreal classification associated with the need for major surgery. In contrast, colonic disease was protective against a major operation (P = 0.02; HR: 0.3; 95% CI: 0.08-0.8). This is the first study demonstrating phenotypic evolution of Crohn's disease in a nonwhite population. The Montreal classification is more sensitive to behavior phenotypic changes than is the Vienna classification after excluding perianal disease from the penetrating disease category and was useful in predicting course and the need for surgery.

Surgical Treatment in Childhood-onset Inflammatory Bowel Disease-A Nationwide Register-based Study of 4695 Incident Patients in Sweden 2002-2014.

PubMed

Nordenvall, Caroline; Rosvall, Oda; Bottai, Matteo; Everhov, Åsa H; Malmborg, Petter; Smedby, Karin E; Ekbom, Anders; Askling, Johan; Ludvigsson, Jonas F; Myrelid, Pär; Olén, Ola

2018-01-24

The incidence of childhood-onset [< 18 years] inflammatory bowel disease [IBD] is increasing worldwide, and some studies suggest that it represents a more severe disease phenotype. Few nationwide, population-based studies have evaluated the surgical burden in patients with childhood-onset IBD, and whether the improved medical treatment has influenced the need for gastrointestinal surgery. The aim was to examine whether the surgical treatment at any age of patients with childhood-onset IBD has changed over time. In a nationwide cohort study we identified 4695 children [< 18 years] diagnosed with incident IBD in 2002-2014 through the Swedish Patient Register [ulcerative colitis: n = 2295; Crohn's disease: n = 2174; inflammatory bowel disease-unclassified: n = 226]. Abdominal [intestinal resections and colectomies] and perianal surgeries were identified through the Swedish Patient Register. The cumulative incidences of surgeries were calculated using the Kaplan-Meier method. In the cohort, 44% were females and 56% males. The median age at inflammatory bowel disease diagnosis was 15 years and the maximum age at end of follow-up was 31 years. The 3-year cumulative incidence of intestinal surgery was 5% in patients with ulcerative colitis and 7% in patients with Crohn's disease, and lower in children aged < 6 years at inflammatory bowel disease diagnosis [3%] than in those aged 15-17 years at diagnosis [7%]. Calendar period of inflammatory bowel disease diagnosis was not associated with risk of surgery. Over the past 13 years, the risk of surgery in childhood-onset inflammatory bowel disease has remained unchanged. Copyright © 2017 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com

Bowen ratio/energy balance technique for estimating crop net CO2 assimilation, and comparison with a canopy chamber

NASA Astrophysics Data System (ADS)

Held, A. A.; Steduto, P.; Orgaz, F.; Matista, A.; Hsiao, T. C.

1990-12-01

This paper describes a Bowen ratio/energy balance (BREB) system which, in conjunction with an infra-red gas analyzer (IRGA), is referred to as BREB+ and is used to estimate evapotranspiration ( ET) and net CO2 flux ( NCF) over crop canopies. The system is composed of a net radiometer, soil heat flux plates, two psychrometers based on platinum resistance thermometers (PRT), bridge circuits to measure resistances, an IRGA, air pumps and switching valves, and a data logger. The psychrometers are triple shielded and aspirated, and with aspiration also between the two inner shields. High resistance (1 000 ohm) PRT's are used for dry and wet bulbs to minimize errors due to wiring and connector resistances. A high (55 K ohm) fixed resistance serves as one arm of the resistance bridge to ensure linearity in output signals. To minimize gaps in data, to allow measurements at short (e.g., 5 min) intervals, and to simplify operation, the psychrometers were fixed at their upper and lower position over the crop and not alternated. Instead, the PRT's, connected to the bridge circuit and the data logger, were carefully calibrated together. Field tests using a common air source showed appartent effects of the local environment around each psychrometer on the temperatures measured. ET rates estimated with the BREB system were compared to those measured with large lysimeters. Daily totals agreed within 5%. There was a tendency, however, for the lysimeter measurements to lag behind the BREB measurements. Daily patterns of NCF estimated with the BREB+ system are consistent with expectations from theories and data in the literature. Side-by-side comparisons with a stirred Mylar canopy chamber showed similar NCF patterns. On the other hand, discrepancies between the results of the two methods were quite marked in the morning or afternoon on certain dates. Part of the discrepancies may be attributed to inaccuracies in the psychrometric temperature measurements. Other possible causes

Spotlighting the role of photodynamic therapy in cutaneous malignancy: an update and expansion.

PubMed

Ross, Kate; Cherpelis, Basil; Lien, Mary; Fenske, Neil

2013-12-01

Topical photodynamic therapy (PDT) is an option for the treatment of cutaneous malignancy. To present an update and expansion on a previous review of the use of PDT in the current literature in the treatment of actinic keratoses (AK), superficial and nodular basal cell carcinoma (sBCC, nBCC), squamous cell carcinoma (SCC), Bowen's disease, cutaneous T cell lymphoma (CTCL), malignant melanoma, and its use in chemoprevention. Extensive PubMed search January 2013. We find sufficient evidence to recommend the use of PDT in certain patients in the treatment of AK, Bowen's disease, sBCC, and nBCC. It is especially useful in those with contraindications to surgery, widespread areas of involvement, and large lesions. Not only can it be considered superior to other therapies as far as recovery time, tolerance, and cosmetic outcomes, but it also should be considered, when indicated, as first-line treatment in the above conditions. Investigations continue for the use of PDT in the treatment of melanoma, SCC, chemoprevention, and CTCL. © 2013 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.

Underway Recovery Test 6 (URT-6) - Day 4 Activities

NASA Image and Video Library

2018-01-20

Astronaut Stephen Bowen checks out the choppy sea conditions as part of Underway Recovery Test 6 aboard the USS Anchorage. Bowen is an observer of the testing—giving an astronaut’s perspective to Kennedy Space Center’s NASA Recovery Team. The purpose of testing is to perfect recovery efforts to minimize impact to astronauts like Bowen once they have splashed down in the Pacific Ocean inside the Orion capsule.

Sexually transmitted diseases of the anus and rectum: Causal agents, coinfections, HIV infection and high-risk sexual behaviour.

PubMed

Morgado-Carrasco, Daniel; Alsina Gibert, Mercè; Bosch Mestres, Jordi; Álvarez Martínez, Miriam; Blanco Arévalo, José Luís; Fuertes de Vega, Irene

2018-04-18

Sexually transmitted infections of the rectum and anus (STI-RA) mainly affect men who have sex with men (MSM). The incidence of STI-RA among them has increased in recent years. Retrospective study in patients with diagnoses of STI-RA in an STI unit during the years 2014 and 2015. Epidemiological, clinical and microbiological data were collected. We included 95 patients, all of whom were MSM; 88.42% were HIV+; 67.17% did not use a condom during their most recent sexual intercourse; 17.91% had had sex with sex workers and 72.22% had used drugs during sexual intercourse during the previous year. A percentage of 32.92 reported symptoms that had lasted longer than 30 days. Lymphogranuloma venereum (LGV) was diagnosed in 54.73% of the patients. All patients who presented with proctitis and perianal ulcers were diagnosed with LGV infection. All those who presented perianal ulcers without proctitis were diagnosed with syphilis. All the patients affected by STI-RA were MSM, most of them HIV+, had engaged in high-risk sexual behaviour and had suffered prolonged symptomatology. Clinical and microbiological characteristics of STI-AR could help adjust the empiric therapy. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

An open-label pilot study of granulocyte colony-stimulating factor for the treatment of severe endoscopic postoperative recurrence in Crohn's disease.

PubMed

Dejaco, Clemens; Lichtenberger, Conny; Miehsler, Wolfgang; Oberhuber, Georg; Herbst, Friedrich; Vogelsang, Harald; Gangl, Alfred; Reinisch, Walter

2003-01-01

Recombinant human granulocyte colony-stimulating factor (rhG-CSF) promoted healing of Crohn's disease (CD)-like intestinal lesions in chronic granulomatous disease and glycogen storage disease Ib, both characterized by defective neutrophil functions. We performed a prospective, open-label pilot study with rhG-CSF for the treatment of CD. Five patients with clinically inactive CD, but with severe endoscopic ileitis within 1 year after intestinal resection and ileocolonic anastomosis, received 300 microg of rhG-CSF (Filgrastim; Neupogen) subcutaneously, three times weekly for a total of 12 weeks. Safety was evaluated by assessment of clinical and laboratory data and disease activity. The primary parameter of efficacy was complete mucosal healing, as defined by the Rutgeerts score. Anti-inflammatory mediators were repeatedly measured during treatment. All patients completed the protocol in clinical remission. In 1 subject transient headache resolved after halving the rhG-CSF dosage. Complete mucosal healing was observed in 2 patients: in 1 patient after 12 weeks of therapy and in 1 patient 9 months after treatment cessation. In a single patient, closure of an anovaginal and of a perianal fistula was noted. Neutrophil counts and interleukin-1 receptor antagonist and soluble tumor necrosis factor receptor p55 and p75 levels were found to be increased during drug administration. rhG-CSF seems to be safe, well tolerated, and might provide efficacy in CD. Copyright 2003 S. Karger AG, Basel

Intestinal lymphangiectasia in a patient with infantile systemic hyalinosis syndrome: a rare cause of protein-losing enteropathy.

PubMed

Alreheili, Khalid; AlMehaidib, Ali; Alsaleem, Khalid; Banemi, Mohammad; Aldekhail, Wajeeh; Al-Mayouf, Sulaiman M

2012-01-01

Infantile systemic hyalinosis (ISH) is a rare autosomal recessive disease. Typically, ISH patients present with progressive painful joint contractures, intractable diarrhea, hyperpigmented skin lesions, and peri-anal fleshy nodules. We report a case of a 19-month-old male child with atypical ISH presentation. His main clinical finding was protein-losing enteropathy due to intestinal lymphangectasia. This report is intended to enhance awareness about the gastrointestinal tract presentation of ISH.

Split-shot sinker facilitates seton treatment of anal fistulae.

PubMed

Awad, M L; Sell, H W; Stahlfeld, K R

2009-06-01

The cutting seton is an inexpensive and effective method of treating high complex perianal fistulae. Following placement of the seton, advancement through the external sphincter muscles requires progressive tightening of the seton. The requirement for maintaining the appropriate tension and onset of perianal pressure necrosis are problems frequently encountered using this technique. Using a 3-0 polypropylene suture, a red-rubber catheter, and a nontoxic tin split-shot sinker, we minimized or eliminated these problems. We initially used this technique in one patient with satisfactory results. This technique is technically easy, safe, inexpensive, and efficient, and we are using it in all patients with high perianal fistulae who require a seton.

Genetic polymorphisms predict response to anti-tumor necrosis factor treatment in Crohn's disease.

PubMed

Netz, Uri; Carter, Jane Victoria; Eichenberger, Maurice Robert; Dryden, Gerald Wayne; Pan, Jianmin; Rai, Shesh Nath; Galandiuk, Susan

2017-07-21

To investigate genetic factors that might help define which Crohn's disease (CD) patients are likely to benefit from anti-tumor necrosis factor (TNF) therapy. This was a prospective cohort study. Patients were recruited from a university digestive disease practice database. We included CD patients who received anti-TNF therapy, had available medical records (with information on treatment duration and efficacy) and who consented to participation. Patients with allergic reactions were excluded. Patients were grouped as ever-responders or non-responders. Genomic DNA was extracted from peripheral blood, and 7 single nucleotide polymorphisms (SNPs) were assessed. The main outcome measure (following exposure to the drug) was response to therapy. The patient genotypes were assessed as the predictors of outcome. Possible confounders and effect modifiers included age, gender, race, and socioeconomic status disease, as well as disease characteristics (such as Montreal criteria). 121 patients were included. Twenty-one were non-responders, and 100 were ever-responders. Fas ligand SNP (rs763110) genotype frequencies, TNF gene -308 SNP (rs1800629) genotype frequencies, and their combination, were significantly different between groups on multivariable analysis controlling for Montreal disease behavior and perianal disease. The odds of a patient with a Fas ligand CC genotype being a non-responder were four-fold higher as compared to a TC or TT genotype ( P = 0.009, OR = 4.30, 95%CI: 1.45-12.80). The presence of the A (minor) TNF gene -308 allele correlated with three-fold higher odds of being a non-responder ( P = 0.049, OR = 2.88, 95%CI: 1.01-8.22). Patients with the combination of the Fas ligand CC genotype and the TNF -308 A allele had nearly five-fold higher odds of being a non-responder ( P = 0.015, OR = 4.76, 95%CI: 1.35-16.77). No difference was seen for the remaining SNPs. The Fas-ligand SNP and TNF gene -308 SNP are associated with anti-TNF treatment response in CD and

Efficacy and safety of certolizumab pegol induction therapy in an unselected Crohn's disease population: results of the FACTS survey.

PubMed

Schoepfer, Alain M; Vavricka, Stephan R; Binek, Janek; Felley, Christian; Geyer, Martin; Manz, Michael; Rogler, Gerhard; de Saussure, Philippe; Sauter, Bernhard; Seibold, Frank; Straumann, Alex; Michetti, Pierre

2010-06-01

Switzerland was the first country to approve certolizumab pegol (Cimzia, CZP) for the treatment of patients with moderate to severe Crohn's disease (CD) in September 2007. This phase IV study aimed to evaluate the efficacy and safety of CZP in a Swiss multicenter cohort of practice-based patients. Baseline and Week 6 evaluation questionnaires were sent to all Swiss gastroenterologists in hospitals and private practices. Disease activity was assessed with the Harvey-Bradshaw Index (HBI) and adverse events were evaluated according to WHO guidelines. Fifty patients (31 women, 19 men) were included; 56% had complicated disease (stricture or fistula) and 52% had undergone prior CD-related surgery. All patients had prior exposure to systemic steroids, 96% to immunomodulators, 78% to infliximab, and 50% to adalimumab. A significant decrease in HBI was observed at Week 6 (versus Week 0) following induction therapy with CZP 400 mg subcutaneously at Weeks 0, 2, and 4 (12.6 +/- 4.7 Week 0 versus 6.2 +/- 4.4 Week 6, P < 0.001). Response and remission rates at Week 6 were 54% and 40%, respectively. We identified 8/11 CD patients undergoing a 50% fistula response (P = 0.021). The frequency of adverse drug reactions attributed to CZP was 6%. CZP was continued in 80% of patients beyond Week 6. In a population of CD patients with complicated disease behavior, CZP induced a response and remission in 54% and 40% of patients, respectively. This series provides the first evidence of the effectiveness of CZP in perianal fistulizing CD.

Field Evaluation of Polymer Capacitive Humidity Sensors for Bowen Ratio Energy Balance Flux Measurements

PubMed Central

Savage, Michael J.

2010-01-01

The possibility of reliable, reasonably accurate and relatively inexpensive estimates of sensible heat and latent energy fluxes was investigated using a commercial combination thin-film polymer capacitive relative humidity and adjacent temperature sensor instrument. Long-term and unattended water vapour pressure profile difference measurements using low-power combination instruments were compared with those from a cooled dewpoint mirror hygrometer, the latter often used with Bowen ratio energy balance (BREB) systems. An error analysis, based on instrument relative humidity and temperature errors, was applied for various capacitive humidity instrument models. The main disadvantage of a combination capacitive humidity instrument is that two measurements, relative humidity and temperature, are required for estimation of water vapour pressure as opposed to one for a dewpoint hygrometer. In a laboratory experiment using an automated procedure, water vapour pressure differences generated using a reference dewpoint generator were measured using a commercial model (Dew-10) dewpoint hygrometer and a combination capacitive humidity instrument. The laboratory measurement comparisons showed that, potentially, an inexpensive model combination capacitive humidity instrument (CS500 or HMP50), or for improved results a slightly more expensive model (HMP35C or HMP45C), could substitute for the more expensive dewpoint hygrometer. In a field study, in a mesic grassland, the water vapour pressure measurement noise for the combination capacitive humidity instruments was greater than that for the dewpoint hygrometer. The average water vapour pressure profile difference measured using a HMP45C was highly correlated with that from a dewpoint hygrometer with a slope less than unity. Water vapour pressure measurements using the capacitive humidity instruments were not as accurate, compared to those obtained using a dewpoint hygrometer, but the resolution magnitudes for the profile

Emergence of rifampin-resistant staphylococci after rifaximin administration in cirrhotic patients.

PubMed

Chang, Ji Young; Kim, Seong-Eun; Kim, Tae Hun; Woo, So-Youn; Ryu, Min Sun; Joo, Yang-Hee; Lee, Ko Eun; Lee, Jihyun; Lee, Kang Hoon; Moon, Chang Mo; Jung, Hye-Kyung; Shim, Ki-Nam; Jung, Sung-Ae

2017-01-01

Rifaximin, a poorly absorbed antibiotics, has gut-specific therapeutic effects. Although frequently prescribed to manipulate intestinal luminal bacterial population in various diseases, the possible induction of antibacterial cross-resistance to a target pathogen is a major concern in long-term rifaximin administration. We aimed to evaluate whether rifampin-resistant staphylococci could evolve after rifaximin treatment in cirrhotic patients. A total of 25 cirrhotic patients who were administered rifaximin for the prevention of hepatic encephalopathy were enrolled. Swabs from both hands and the perianal skin were acquired on day 0 (before rifaximin treatment), period 1 (1-7 weeks after treatment), and period 2 (8-16 weeks after treatment) the staphylococcal strain identification and rifampin-resistance testing. A total of 198 staphylococcal isolates from 15 species were identified. Staphylococcus epidermidis was isolated most frequently, and Staphylococcus haemolyticus was the most common resistant species both from hands and perianal skin. Eleven patients (44.0%) developed rifampin-resistant staphylococcal isolates in period 1. Among these patients, only six (54.5%) were found to have rifampin-resistant isolates in period 2, with no significant infectious events. Rifampin-resistant staphylococcal isolates were more frequently found in perianal skin than from the hands. No patients acquired a newly resistant strain in period 2. About one-half of cirrhotic patients in this study developed rifampin-resistant staphylococcal isolates after rifaximin treatment. Although the resistant strains were no longer detected in about half of the patients in the short-term, the long-term influence of this drug treatment should be determined.

Emergence of rifampin-resistant staphylococci after rifaximin administration in cirrhotic patients

PubMed Central

Chang, Ji Young; Woo, So-Youn; Ryu, Min Sun; Joo, Yang-Hee; Lee, Ko Eun; Lee, Jihyun; Lee, Kang Hoon; Moon, Chang Mo; Jung, Hye-Kyung; Shim, Ki-Nam; Jung, Sung-Ae

2017-01-01

Objectives Rifaximin, a poorly absorbed antibiotics, has gut-specific therapeutic effects. Although frequently prescribed to manipulate intestinal luminal bacterial population in various diseases, the possible induction of antibacterial cross-resistance to a target pathogen is a major concern in long-term rifaximin administration. We aimed to evaluate whether rifampin-resistant staphylococci could evolve after rifaximin treatment in cirrhotic patients. Method A total of 25 cirrhotic patients who were administered rifaximin for the prevention of hepatic encephalopathy were enrolled. Swabs from both hands and the perianal skin were acquired on day 0 (before rifaximin treatment), period 1 (1–7 weeks after treatment), and period 2 (8–16 weeks after treatment) the staphylococcal strain identification and rifampin-resistance testing. Results A total of 198 staphylococcal isolates from 15 species were identified. Staphylococcus epidermidis was isolated most frequently, and Staphylococcus haemolyticus was the most common resistant species both from hands and perianal skin. Eleven patients (44.0%) developed rifampin-resistant staphylococcal isolates in period 1. Among these patients, only six (54.5%) were found to have rifampin-resistant isolates in period 2, with no significant infectious events. Rifampin-resistant staphylococcal isolates were more frequently found in perianal skin than from the hands. No patients acquired a newly resistant strain in period 2. Conclusions About one-half of cirrhotic patients in this study developed rifampin-resistant staphylococcal isolates after rifaximin treatment. Although the resistant strains were no longer detected in about half of the patients in the short-term, the long-term influence of this drug treatment should be determined. PMID:28982166

Randomized single-blind clinical trial of intradermal methylene blue on pain reduction after open diathermy haemorrhoidectomy.

PubMed

Sim, H-L; Tan, K-Y

2014-08-01

Open haemorrhoidectomy has been associated with considerable postoperative pain and discomfort. Perianal intradermal injection of methylene blue has been shown to ablate perianal nerve endings and may bring about temporary pain relief after haemorrhoidectomy. We hypothesized that the administration of intradermal methylene blue would reduce postoperative pain during the initial period after surgery. A randomized, prospective, single-blind placebo-controlled trial was conducted. Patients were randomized to intradermal injection at haemorrhoidectomy of either 4 ml 1% methylene blue and 16 ml 0.5% marcaine or of 16 ml 0.5% marcaine and 4 ml saline prior to surgical dissection. Patients were asked to fill in a pain diary with a visual analogue scale. The primary outcome measure was pain score and analgesic use. Secondary outcomes were complications. There were 37 patients in the methylene blue arm and 30 patients in the placebo arm. There were no statistically significant differences in the sex, type of haemorrhoid, number of haemorrhoids excised, duration of surgery or hospital stay. The mean pain scores were significantly lower and the use of paracetamol was also significantly less in the methylene blue group during the first three postoperative days. The risk ratio of acute urinary retention occurring when methylene blue was not used was 2.320 (95% CI 1.754-3.067). Other complication rates were not significantly different. Perianal intradermal injection of methylene blue was useful in reducing the initial postoperative pain of open haemorrhoidectomy. Colorectal Disease © 2014 The Association of Coloproctology of Great Britain and Ireland.

Incidence, clearance, and disease progression of genital human papillomavirus infection in heterosexual men.

PubMed

Moreira, Edson Duarte; Giuliano, Anna R; Palefsky, Joel; Flores, Carlos Aranda; Goldstone, Stephen; Ferris, Daron; Hillman, Richard J; Moi, Harald; Stoler, Mark H; Marshall, Brooke; Vuocolo, Scott; Guris, Dalya; Haupt, Richard M

2014-07-15

In this analysis, we examine the incidence and clearance of external genital human papillomavirus (HPV) infection among heterosexual males aged 16-24 years. A total of 1732 males aged 16-24 years old in the placebo arm of a quadrivalent HPV vaccine trial were included in this analysis. Participants were enrolled from 18 countries in Africa, the Asia-Pacific region, Europe, Latin America, and North America. Subjects underwent anogenital examinations and sampling of the penis, scrotum, and perineal/perianal regions. The incidence rate of any HPV DNA genotype 6, 11, 16, and/or 18 detection was 9.0 cases per 100 person-years. Rates of HPV DNA detection were highest in men from Africa. Median time to clearance of HPV genotypes 6, 11, 16, and 18 DNA was 6.1, 6.1, 7.7, and 6.2 months, respectively. Median time to clearance of persistently detected HPV 6, 11, 16, and 18 DNA was 6.7, 3.2, 9.2, and 4.7 months, respectively. The study results suggest that the acquisition of HPV 6, 11, 16, and/or 18 in males is common and that many of these so-called infections are subsequently cleared, similar to findings for women. Nevertheless, given the high rate of HPV detection among young men, HPV vaccination of males may reduce infection in men and reduce the overall burden of HPV-associated disease in the community. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Clearance of human papillomavirus related anal condylomas after oral and endorectal multistrain probiotic supplementation in an HIV positive male: A case report.

PubMed

Ceccarelli, Giancarlo; Cavallari, Eugenio Nelson; Savinelli, Stefano; Bianchi, Luigi; Pierangeli, Alessandra; Vullo, Francesco; Ciardi, Antonio; D'ettorre, Gabriella

2018-04-01

Here we present the case of a 56-year-old human immunodeficiency virus (HIV)-infected man with multiple anal condylomas and positivity for human papilloma virus (HPV) 18 on anal brushing. Biopsies of the anal mucosa led to the diagnosis of Bowen's disease and a subsequent pelvic magnetic resonance imaging (MRI) scan evidenced multiple reactive lymphoadenopathies and large intra-anal condylomas. The patient was treated with a complete excision of Bowen's lesion and with a 4 months course of supplementation with a high concentration multistrain probiotic formulation administered orally and by rectal instillation with the purpose to reduce local inflammation and to enhance local mucosal immunity. An MRI performed at the end of the supplementation period evidenced the clearance of the anal condylomas previously described and no evidence of residual lymphadenopathies. Trials are therefore required to confirm this therapeutic possibility and for a better understanding of the mechanisms by which this specific probiotic formulation interacts with local epithelium when administered by the anal route.

Anti-food and anti-microbial IgG subclass antibodies in inflammatory bowel disease.

PubMed

Jansen, Anke; Mandić, Ana D; Bennek, Eveline; Frehn, Lisa; Verdier, Julien; Tebrügge, Irene; Lutz, Holger; Streetz, Konrad; Trautwein, Christian; Sellge, Gernot

2016-12-01

Inflammatory bowel disease (IBD), particularly Crohn's disease (CD), is associated with increased microbial-specific IgG and IgA antibodies, whereas alterations of anti-food antibodies are still disputed. The knowledge about IgG subclass antibodies in IBD is limited. In this study we analysed IgG subclass antibodies specific for nutritional and commensal antigens in IBD patients and controls. Serum IgG1, IgG2, IgG3 and IgG4 specific for wheat and milk extracts, purified ovalbumin, Escherichia coli and Bacteroides fragilis lysates and mannan from Saccharomyces cerevisiae were analysed by ELISA in patients with CD (n = 56), ulcerative colitis (UC; n = 29), acute gastroenteritis/colitis (n = 12) as well as non-inflammatory controls (n = 62). Anti-Saccharomyces cerevisiae antibodies (ASCA) of all IgG subclasses and anti-B. fragilis IgG1 levels were increased in CD patients compared to UC patients and controls. The discriminant validity of ASCA IgG2 and IgG4 was comparable with that of ASCA pan-IgG and IgA, whereas it was inferior for ASCA IgG1/IgG3 and anti-B. fragilis IgG1. Complicated CD defined by the presence of perianal, stricturing or penetrating disease phenotypes was associated with increased ASCA IgG1/IgG3/IgG4, anti-B. fragilis IgG1 and anti-E. coli IgG1 levels. Anti-food IgG subclass levels were not different between IBD patients and controls and did not correlate with food intolerance. In contrast to anti-microbial Abs, food-specific IgG responses were predominately of the IgG4 isotype and all food-specific IgG subclass levels correlated negatively with age. Our study supports the notion that the adaptive immune recognition of food and commensal antigens are differentially regulated.

Direct and indirect effects of atmospheric conditions and soil moisture on surface energy partitioning revealed by a prolonged drought at a temperate forest site

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gu, Lianhong; Meyers, T. P.; Pallardy, Stephen G.

2006-01-01

The purpose of this paper is to examine the mechanism that controls the variation of surface energy partitioning between latent and sensible heat fluxes at a temperate deciduous forest site in central Missouri, USA. Taking advantage of multiple micrometeorological and ecophysiological measurements and a prolonged drought in the middle of the 2005 growing season at this site, we studied how soil moisture, atmospheric vapor pressure deficit (VPD), and net radiation affected surface energy partitioning. We stratified these factors to minimize potential confounding effects of correlation among them. We found that all three factors had direct effects on surface energy partitioning,more » but more important, all three factors also had crucial indirect effects. The direct effect of soil moisture was characterized by a rapid decrease in Bowen ratio with increasing soil moisture when the soil was dry and by insensitivity of Bowen ratio to variations in soil moisture when the soil was wet. However, the rate of decrease in Bowen ratio when the soil was dry and the level of soil moisture above which Bowen ratio became insensitive to changes in soil moisture depended on atmospheric conditions. The direct effect of increased net radiation was to increase Bowen ratio. The direct effect of VPD was very nonlinear: Increased VPD decreased Bowen ratio at low VPD but increased Bowen ratio at high VPD. The indirect effects were much more complicated. Reduced soil moisture weakened the influence of VPD but enhanced the influence of net adiation on surface energy partitioning. Soil moisture also controlled how net radiation influenced the relationship between surface energy partitioning and VPD and how VPD affected the relationship between surface energy partitioning and net radiation. Furthermore, both increased VPD and increased net radiation enhanced the sensitivity of Bowen ratio to changes in soil moisture and the effect of drought on surface energy partitioning. The direct and

Early Course of Inflammatory Bowel Disease in a Population-Based Inception Cohort Study From 8 Countries in Asia and Australia.

PubMed

Ng, Siew C; Zeng, Zhirong; Niewiadomski, Ola; Tang, Whitney; Bell, Sally; Kamm, Michael A; Hu, Pinjin; de Silva, H Janaka; Niriella, Madunil A; Udara, W S A A Yasith; Ong, David; Ling, Khoon Lin; Ooi, Choon Jin; Hilmi, Ida; Lee Goh, Khean; Ouyang, Qin; Wang, Yu Fang; Wu, Kaichun; Wang, Xin; Pisespongsa, Pises; Manatsathit, Sathaporn; Aniwan, Satimai; Limsrivilai, Julajak; Gunawan, Jeffri; Simadibrata, Marcellus; Abdullah, Murdani; Tsang, Steve W C; Lo, Fu Hang; Hui, Aric J; Chow, Chung Mo; Yu, Hon Ho; Li, Mo Fong; Ng, Ka Kei; Ching, Jessica Y L; Chan, Victor; Wu, Justin C Y; Chan, Francis K L; Chen, Minhu; Sung, Joseph J Y

2016-01-01

The incidence of inflammatory bowel disease (IBD) is increasing in Asia, but little is known about disease progression in this region. The Asia-Pacific Crohn's and Colitis Epidemiology Study was initiated in 2011, enrolling subjects from 8 countries in Asia (China, Hong Kong, Indonesia, Sri Lanka, Macau, Malaysia, Singapore, and Thailand) and Australia. We present data from this ongoing study. We collected data on 413 patients diagnosed with IBD (222 with ulcerative colitis [UC], 181 with Crohn's disease [CD], 10 with IBD unclassified; median age, 37 y) from 2011 through 2013. We analyzed the disease course and severity and mortality. Risks for medical and surgical therapies were assessed using Kaplan-Meier analysis. The cumulative probability that CD would change from inflammatory to stricturing or penetrating disease was 19.6%. The cumulative probabilities for use of immunosuppressants or anti-tumor necrosis factor agents were 58.9% and 12.0% for patients with CD, and 12.7% and 0.9% for patients with UC, respectively. Perianal CD was associated with an increased risk of anti-tumor necrosis factor therapy within 1 year of its diagnosis (hazard ratio, 2.97; 95% confidence interval, 1.09-8.09). The cumulative probabilities for surgery 1 year after diagnosis were 9.1% for patients with CD and 0.9% for patients with UC. Patients with CD and penetrating disease had a 7-fold increase for risk of surgery, compared with patients with inflammatory disease (hazard ratio, 7.67; 95% confidence interval, 3.93-14.96). The overall mortality for patients with IBD was 0.7%. In a prospective population-based study, we found that the early course of disease in patients with IBD in Asia was comparable with that of the West. Patients with CD frequently progress to complicated disease and have accelerated use of immunosuppressants. Few patients with early stage UC undergo surgery in Asia. Increasing our understanding of IBD progression in different populations can help optimize therapy

An inter-comparison of surface energy flux measurement systems used during FIFE, 1987

NASA Technical Reports Server (NTRS)

Nie, D.; Kanemasu, E. T.; Fritschen, L. J.; Weaver, H.; Smith, E. A.; Verma, S. B.; Field, R. T.; Kustas, W.; Stewart, J. B.

1990-01-01

During the first International Satellite Land Surface Climatology Program Field Experiment (FIFE-87), surface energy fluxes were measured at 22 flux sites by nine groups of scientists using different measuring systems. A rover Bowen ratio station was taken to nearly all the flux stations to serve as a reference for estimating the instrument related differences. The rover system was installed within a few meters from the host instrument of a site. Net radiation, Bowen ratio, and latent heat fluxes were compared between the rover and the host for the stations visited. Linear regression analysis was used to examine the relationship between rover measurements and host measurements. These inter-comparisons are needed to examine the influence of instrumentation on measurement uncertainty. Highly significant effects of instrument type were detected from these comparisons. Instruments of the same type showed average differences of less than 5 percent for net radiation, 10 percent for Bowen ratio, and 6 percent for latent heat flux. The corresponding average differences for different types of instruments can be up to 10, 30, and 20 percent respectively. The Didcot net radiometer gave higher net radiation while the Swissteco type showed lower values, as compared to the corrected REBS model. The 4-way components methed and the Thornswaite type give similar values to the REBS. The SERBS type Bowen ratio systems exhibit slightly lower Bowen ratios and thus higher latent heat fluxes, compared to the AZET systems. Eddy correlation systems showed slightly lower latent heat flux in comparison to the Bowen ratio systems.

[Clinical and evolutive profile of Crohn's disease in Hospital Rebagliati (Lima-Peru)].

PubMed

Bendaño, Teófilo; Frisancho, Oscar

2010-01-01

Crohn's Disease (CD) is uncommon in Peru, in that respect, we don't know its clinical and developmental profile. This is a descriptive, retrospective, transversal and observational patients diagnosed with CD in the last 20 years in the Department of Gastroenterology, Hospital Nacional Edgardo Rebagliati Martins'. For the small size of the population, we used a census record. The diagnosis was made using the criteria of Lennard-Jones. We present seventeen cases, most female (11 / 6). The average age was 39.9 years (60% over 40 years). Only one patient had family history (second degree of consanguinity). Sixteen were latins and one white. Clinical manifestations were abdominal pain (88.2%), diarrhea (76.5%), weight loss (76, 5%), bleeding (58.8%) and fever (58.8%). Laboratory findings showed: anemia (76.5%), thrombocytosis (58.8%), hypoalbuminemia (52.9%), leukocytosis (23.5%), nitrogen retention (11.7%), leukopenia (5.9%), and elevated acute phase reactants ( c-reactive protein or erythrocyte sedimentation rate) 76.5%. Extraintestinal manifestations were cutaneous (29.4%), articular diseases (17.6%) and hepatobiliary (11.7%). Five patients (29.4%) received treatment of tuberculosis without success (before diagnosis). Nine patients (52.9%) had acute complications requiring emergency care. The phenotypic pattern type (Montreal's classification) was: non-stricturing non-penetrating 35.3%, stricturing 35.3% and penetrating 29.4%. Inflammation of the ileon was found in 70.5% (47% ileocolonic and ileal 23.5%), nine (53%) had perianal lesions. The activity at diagnosis was mild moderate disease in 8 (47.0%), moderate severe disease in 7 (41.2%) and severe ulminant 2 (11.8%). The macroscopic lesions were predominant stenosis 13 (76.5%), followed by ulcers in 12 (70.6%), erosive erythematous inflammation 11 (64.7%) and thickening of folds in 10 (58.8 %), seven (41%) had fistulas. As initial treatment were used aminosalicylates (13 patients) and systemic corticosteroids in 6

Beta-papillomaviruses in anogenital hairs plucked from healthy individuals.

PubMed

Potocnik, Marko; Kocjan, Bostjan J; Seme, Katja; Luzar, Bostjan; Babic, Dunja Z; Poljak, Mario

2006-12-01

A total of 150 specimens of anogenital hairs plucked from the scrotal, pubic, and perianal region of 51 immunocompetent healthy male individuals were tested for the presence of beta-papillomaviruses (beta-HPV) using the nested M(a)/H(a) polymerase chain reaction. Beta-HPV were found in a total of 38 (25.3%) of 150 hair samples. According to the sampling sites, beta-HPV were detected in 18/51 (35.3%), 13/50 (26.0%), and 7/49 (14.3%) plucked hair samples obtained from the pubic, scrotal, and perianal region, respectively. The prevalence of beta-HPV in the plucked pubic hairs was significantly higher than in the perianal hairs (P = 0.013). In contrast, the difference in the prevalence of beta-HPV in the pubic and scrotal hairs as well as in scrotal and perianal hairs did not reach statistical significance (P = 0.302 and P = 0.227, respectively). The difference in the lifetime-cumulative sun exposure is the most likely explanation for the differences obtained on beta-HPV prevalence. Beta-HPV genotype HPV-38 was detected most frequently, followed by HPV-36, HPV-15, and HPV-14D. In addition to the beta-HPV recognized officially five partial DNA sequences suggesting putative new HPV genotypes were identified. (c) 2006 Wiley-Liss, Inc.

Occupational skin cancer due to UV-irradiation--Analyses of notified cases as "virtually-certain" occupational disease in Germany between 2005 and 2011.

PubMed

Schmitt, Jochen; Diepgen, Thomas L

2014-06-01

UV-induced skin cancer is not yet included in the German ordinance on occupational diseases and can only be notified and recognized acknowledged as "virtually-certain" occupational disease. The objective of the study was to analyze notified and acknowledged cases of occupational skin cancer due to UV-irradiation in Germany between 2005 and 2011. All notified cases of occupational skin cancer due to UV-irradiation have been analyzed which have been registered by the German Statutory accident insurance as of May 2012 were analyzed. The data analyze was descriptive stratified annually for presenting time trends.Data analysis was descriptive, stratified by year to defect time trends. Notified cases have increased annually with a total of 548 registered cases of occupational skin cancer induced by UV-irradiation between 2005 and 2011, and 74 recognized acknowledged cases. In 56 cases the procedure was not yet finished. Squamous cell carcinoma (SCC) and in-situ squamous cell carcinoma (actinic keratosis, Bowen's disease) were most frequent and have been the most frequentlyobserved in 333 notified cases. and between 15.6 % and 24.9 % have been recognizedof cases with SCC and actinic keratosis were recognized, respectively. 184 patients with basal cell carcinoma were notified but only 6.5 % recognized acknowledged and only 3 cases with exclusive basal cell carcinoma. Out of 50 notified patients with Mmelanoma only one was recognizedacknowledged. The results are in good agreement with the proposal of the German Minister of labor to establish UV-induced skin cancer as a new occupational disease. © 2014 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Differentiation of Self, Personal Adjustment, Problem Solving, and Ethnic Group Belonging among Persons of Color.

ERIC Educational Resources Information Center

Skowron, Elizabeth A.

2004-01-01

This study focused on examining the cross-cultural validity of Bowen family systems theory (M. Bowen, 1978), namely differentiation of self for individuals of color. Ethnic minority men and women completed measures of differentiation of self, ethnic group belonging, and 3 indices of personal adjustment. Initial support for the cross-cultural…

Increasing Small Arms Lethality in Afghanistan Taking Back the Infantry Half-Kilometer

DTIC Science & Technology

2009-05-21

John A. Malinowski , and Robert E. Bowen. "Bullet Fragmentation: A Major Cause of Tissue Disruption." JTrauma, 1984: 35-39. 67 Initial muzzle...Fackler, Martin L, M.D., M.A. John S. Surinchak, B.S. John A. Malinowski , and Robert E. Bowen. "Bullet Fragmentation: A Major Cause of Tissue

The application of 5-aminolevulinic acid in the treatment of precancerous lesions, skin cancer, and a new approach to the control of therapy

NASA Astrophysics Data System (ADS)

Kulas, Zbigniew; Bereś-Pawlik, Elżbieta; Bieniek, Andrzej; Matusiak, Łukasz

2009-02-01

The aim of our work was to determine a therapeutic effect of photodynamic therapy (PDT). Twenty five patients with the Bowen's disease, actinic keratosis and basal cell carcinoma (superficial, nodular) were examined. They were treated with photosensitizer - aminolevulinic acid (metabolized in protoporphyrin IX), and the new red light source built of high-power diodes. A new method, based on numerical analysis of fluorescence imaging of tissues, was proposed as a way for controlling therapy.

Pharmacological Treatment of Glutamate Excitotoxicity Following Traumatic Brain Injury

DTIC Science & Technology

2009-01-14

31.5%) associated with TBI. In a subsequent study, Rao, et al. (2001) found that treatment with the non-competitive NMDA blocker, memantine ...Dogan A, Todd KG, Bowen KK, Dempsey RJ. Neuroprotection by memantine , a non-competitive NMDA receptor antagonist after traumatic brain injury in...R, Stöffler A, Schmitt F, Ferris S, Möbius HJ; Memantine Study Group. Memantine in moderate-to-severe Alzheimer’s disease. N Engl J Med. 2003 Apr

Results of second-stage screening for skin cancers in Oita Prefecture, Japan.

PubMed

Kai, Yoshitaka; Ishikawa, Kazushi; Goto, Mayuko; Sakai, Takashi; Ito, Akiko; Shono, Tomoko; Shimada, Hiromitsu; Shimizu, Fumiaki; Goto, Mizuki; Hatano, Yutaka; Okamoto, Osamu; Katagiri, Kazumoto; Aono, Hiroshi; Eshima, Nobuoki; Fujiwara, Sakuhei

2015-12-01

We performed skin cancer screenings for 2 or 3 days annually from 2006 through 2013 in Oita Prefecture, Japan. Screening of approximately 3000 people in total allowed us to identify and treat several skin cancers, including five cases of malignant melanoma, four of squamous cell carcinoma, 16 of basal cell carcinoma, 11 of Bowen's disease, 17 of actinic keratosis, one of extramammary Paget's disease and one of metastatic breast carcinoma. The sensitivity and specificity for the category defined by an identified lesion associated with risk of cancer and requiring further examination (category C) were 92.7% and 95%, respectively. We cannot estimate the outcome of our skin cancer screenings in terms of cancer mortality because of the small number of subjects examined and the brief follow-up period. However, we did estimate the effectiveness of these screenings in terms of stages or sizes of cancerous lesions. The relative numbers of subjects with malignant melanoma at various clinical stages, identified during skin cancer screenings and during a routine visit to our hospital, were significantly different. We also compared, statistically, the sizes of lesions in Bowen's disease that were found during cancer screenings and during a direct visit to our hospital. The former lesions were smaller than the latter. Our data suggest the benefits of our skin cancer screenings and the importance of campaigns and education to encourage people to visit dermatologists for the detection of skin cancers at an early stage. © 2015 Japanese Dermatological Association.

Short communication: risk factors for methicillin-resistant Staphylococcus aureus colonization among HIV patients at hospital admission.

PubMed

Lee, Linda K; Win, Mar Kyaw; Veeraraghavan, Meyyur A; Wong, Chia Siong; Chow, Angela L; Leo, Yee-Sin

2013-05-01

Methicillin-resistant Staphylococcus aureus (MRSA) is a nosocomial pathogen that has become increasingly prominent in hospitals and the community. HIV-positive patients may be one of the most MRSA-susceptible populations because of their immunocompromised status. At the Communicable Disease Centre, Tan Tock Seng Hospital, Singapore, we implemented a universal MRSA screening program and performed a case-control study to identify risk factors for MRSA colonization among 294 HIV patients at admission from January 2009 to January 2010. Among 54 HIV-positive patients who were MRSA positive at hospital admission, 16 (29.6%) were positive at the nares/axilla/groin (NAG; one combined swab), 14 (25.9%) were NAG and perianal positive, 3 (5.6%) were NAG and throat positive, 10 (18.5%) were NAG, perianal, and throat positive, 6 (11.1%) were throat positive, and 5 (9.3%) were perianal positive. Upon multivariate analysis, we found that age [odds ratio (OR)=1.04, 95% confidence interval (CI): 1.01-1.07, p=0.006] and CD4 count <200/μl within the past 6 months (OR=4.29, 95% CI: 1.83-10.06, p=0.001) were significant risk factors for MRSA colonization. We generated a receiver operating characteristic curve using these two variables and found that the area under the curve was 0.69, indicating that age and CD4 count <200/μl performed moderately well in discriminating between those with MRSA colonization and those without. The results of our study indicate that HIV patients of older age and reduced CD4 count may have increased risk of MRSA colonization. These risk factors may serve as indicators for cohorting or isolating HIV patients at hospital admission.

Effect of fetch length on latent heat flux data accuracy calculated by Bowen ratio energy balance method

NASA Astrophysics Data System (ADS)

Pozníková, Gabriela; Fischer, Milan; Trnka, Miroslav; Orság, Matěj; Kučera, Jiří; Žalud, Zdeněk

2013-04-01

Bowen ratio energy balance (BREB) is one of the most widely used indirect methods for deriving latent heat (LE) and sensible heat fluxes. The BREB technique relies on net radiation, ground heat flux, and air temperature and humidity gradients measurements. Whilst the first two mentioned can be practically considered as point measurements, the source area of temperature and humidity gradients is at least one order of magnitudes larger. Therefore, the horizontal, homogeneous and extensive area is necessary prerequisite for correct flux determination by BREB method. An ideal fetch for BREB has been reported to be within 10 to 200 times the height of upper measuring level above zero plane displacement. This broad range is a result of different atmospheric stratifications and surface roughness, but the fetch to height ratio 100:1 has become generally acknowledged as a rule of thumb. In this study, data from four different BREB systems above various covers (two poplar plantations, grassland and turf grass field) will be used to calculate and analyse LE for different fetches. Data were recorded in Domanínek near Bystřice nad Pernštejnem in Czech-Moravian highlands where two BREB systems have measured above poplar plantation and turf grass since summer 2008 until present and two more systems have been placed above grassland and another poplar plantation at the beginning of 2011 and have measured until present time. During the measurements changing wind direction limited the fetch of particular BREB systems on the sites. That is why LE calculated for particular fetch lengths will be split into three categories - fetch classes ("good", "medium", and "bad") according to prevailing wind direction and corresponding fetch. These categories will be delimited using the simple footprint model. Fetches with more than 75% of the measured entities coming from the area of interest will be considered as the "good" ones. The "medium" class will contain fetches with 50-75% of the flux

Evapotranspiration from areas of native vegetation in west-central Florida

USGS Publications Warehouse

Bidlake, W.R.; Woodham, W.M.; Lopez, M.A.

1993-01-01

A study was made to examine the suitability of three different micrometeorological methods for estimating evapotranspiration from selected areas of native vegetation in west-central Florida and to estimate annual evapotranspiration from those areas. Evapotranspiration was estimated using the energy- balance Bowen ratio and eddy correlation methods. Potential evapotranspiration was computed using the Penman equation. The energy-balance Bowen ratio method was used to estimate diurnal evapotrans- piration at unforested sites and yielded reasonable results; however, measurements indicated that the magnitudes of air temperature and vapor-pressure gradients above the forested sites were too small to obtain reliable evapotranspiration measurements with the energy balance Bowen ratio system. Analysis of the surface energy-balance indicated that sensible and latent heat fluxes computed using standard eddy correlation computation methods did not adequately account for available energy. Eddy correlation data were combined with the equation for the surface energy balance to yield two additional estimates of evapotranspiration. Daily potential evapotranspiration and evapotranspira- tion estimated using the energy-balance Bowen ratio method were not correlated at a unforested, dry prairie site, but they were correlated at a marsh site. Estimates of annual evapotranspiration for sites within the four vegetation types, which were based on energy-balance Bowen ratio and eddy correlation measurements, were 1,010 millimeters for dry prairie sites, 990 millimeters for marsh sites, 1,060 millimeters for pine flatwood sites, and 970 millimeters for a cypress swamp site.

Measuring Evapotranspiration of five Alley Cropping systems in Germany using the Eddy-Covariance- and Bowen-Ratio Energy-Balance methods

NASA Astrophysics Data System (ADS)

Markwitz, Christian; Knohl, Alexander; Siebicke, Lukas

2017-04-01

The inclusion of trees into the agricultural landscape of Europe is gaining popularity as a source for energy production. Fast growing tree species such as poplar or willow are included as short rotation coppice or alley cropping systems, which consist of tree alleys interleaved by annual rotating crops or perennial grasslands. Estimating turbulent fluxes of those systems using the eddy-covariance- (ECEB) and bowen-ratio energy-balance (BREB) method is challenging due to the methods limitation to horizontally homogeneous terrain and steady state conditions. As the conditions are not fulfilled for those systems the energy-balance is commonly not fully closed, with the non-closure being site specific. An underestimation of measured heat fluxes leads to an overestimation of the latent heat fluxes inferred from the ECEB method. The aim of our study is to 1) quantify the site specific non-closure of the energy-balance and 2) characterize the performance of both methods, compared to direct eddy-covariance measurements using a high frequency infra-red gas analyzer (LI-7200, Licor Inc.). To assess continuous evapotranspiration (ET) rates on a 30-minute time scale we installed a combined ECEB and BREB system at five alley cropping and five agricultural reference sites across Germany. For time periods of four weeks we performed direct eddy covariance flux measurements for H2O and CO2 over one crop- and one grassland alley cropping- and their respective reference systems during the growing season of 2016. We found a non-closure between 21 and 26 % for all sites, considering all day- and night-time data. The residual energy was highest during the morning and lowest in the afternoon. Related to that the energy-balance ratio (EBR), i.e. the ratio between the turbulent heat fluxes and available energy, was below one in the morning hours and increased slightly during the day up to 1.8, until the EBR decreased sharply after sunset. The EBR correlated to the daily cycle of solar

Primary invasive carcinoma of the vagina after Le Fort partial colpocleisis for stage IV pelvic organ prolapse: a case report.

PubMed

Cho, Moon Kyoung; Kim, Chul Hong; Kim, Yoon Ha

2011-11-01

We present here the case report of a postmenopausal woman who complained of recurrent pus-like vaginal discharge and perianal pain 1 year after Le Fort colpocleisis, which was subsequently identified as a primary invasive carcinoma of the vagina. Biopsy confirmed a squamous cell carcinoma in the vagina, and the disease was classified as stage III according to FIGO staging. The patient received pelvic radiotherapy. This case emphasizes that differential diagnosis of recurrent vaginal discharge that presents remote from obliterative procedure for pelvic organ prolapse should consider not only pyometra, but also other causes.

Cyclosporine in veterinary dermatology.

PubMed

Palmeiro, Brian S

2013-01-01

Cyclosporine is an immunomodulatory medication that is efficacious and approved for atopic dermatitis in dogs and allergic dermatitis in cats; it has also been used to successfully manage a variety of immune-mediated dermatoses in dogs and cats. This article reviews the use of cyclosporine in veterinary dermatology including its mechanism of action, pharmacokinetics, drug interactions, side effects, and relevant clinical updates. Dermatologic indications including atopic/allergic dermatitis, perianal fistulas, sebaceous adenitis, and other immune-mediated skin diseases are discussed. Copyright © 2013 Elsevier Inc. All rights reserved.

Prospective validation study of the International Classification of Functioning, Disability and Health score in Crohn's disease and ulcerative colitis.

PubMed

Leong, Rupert W L; Huang, Tony; Ko, Yanna; Jeon, Ari; Chang, Jeff; Kohler, Friedbert; Kariyawasam, Viraj

2014-10-01

Inflammatory bowel diseases (IBD) may result in disability. We aim to validate a novel scoring system for the IBD disability index (IBD-DI), and identify predictors of disability and its correlation with work absenteeism. This prospective IBD ambulatory clinic cohort study measured IBD-DI, Crohn's Disease Activity Index (CDAI) for Crohn's disease (CD) or partial Mayo score (pMayo) for ulcerative colitis (UC), IBDQ quality-of-life, and Work Productivity and Activity Impairment. Negative IBD-DI represented greater disability. Validation tests were performed and predictors and extent of work absenteeism were determined. 166 consecutive subjects were recruited (75 CD, 41 UC, 50 controls). IBD-DI correlated with CDAI (r=-0.77, P<0.001), pMayo (r=-0.82, P<0.001) and IBDQ (r=0.86, P<0.001). IBD-DI differentiated CD, and UC from controls (medians -7, -4, +10; P<0.001) with a score of >3.5 identifying controls with 94% sensitivity and 83% specificity (area-under-curve 0.92). Stable patients had unchanged IBD-DI (P=ns) but not in those who relapsed (P<0.001). Intraclass correlation was 0.89 and Cronbach's alpha of internal consistency was 0.94. Diagnosis age, sex, phenotype, perianal disease, prior surgery, steroid-use and disease duration did not influence the IBD-DI but active use of biological agents significantly reduced disability (P=0.03). 21.6% of IBD patients had moderate-severe disability equating to missing >25% of work hours in the previous week. Multivariate analysis identified that only IBD-DI to be predictive of unemployment status (OR: 0.94; 95% CI: 0.89-0.99). The IBD-DI is a valid tool measuring disability in both CD and UC and correlates with workforce participation. It is a potential useful tool in the assessment of participation restriction and activity limitation. ACTRN12613000903785. Copyright © 2014 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

Comparison of health-related quality of life and disability in ulcerative colitis patients following restorative proctocolectomy with ileal pouch-anal anastomosis versus anti-tumor necrosis factor therapy.

PubMed

van Gennep, Sara; Sahami, Saloomeh; Buskens, Christianne J; van den Brink, Gijs R; Ponsioen, Cyriel Y; D'Hoore, André; de Buck van Overstraeten, Anthony; van Assche, Gert; Ferrante, Marc; Vermeire, Séverine; Bemelman, Willem A; D'Haens, Geert R A M; Löwenberg, Mark

2017-03-01

Health-related quality of life (HRQL) and disability were compared in ulcerative colitis (UC) patients who underwent restorative proctocolectomy versus patients who received treatment with anti-tumor necrosis factor (anti-TNF) agents. UC patients who underwent restorative proctocolectomy or started anti-TNF treatment between January 2010 and January 2015 were included at two tertiary referral centers. A matched cohort was created using propensity score matching for the covariates disease duration, Montreal classification, age, and sex. HRQL and disability were assessed using the Colorectal Functional Outcome (COREFO), Inflammatory Bowel Disease Disability Index (IBD-DI), EuroQol-5D-3L, and Short Form 36 (SF-36) questionnaires. In total, 297 patients were included, of whom 205 (69%) patients responded. Fifty-nine pouch patients were matched to 59 anti-TNF-treated patients. Pouch patients reported better general health scores (P=0.042) compared with the anti-TNF group (SF-36). No differences were found for the EuroQol-5D-3L and IBD-DI between the two groups. Pouch patients had significantly higher COREFO scores compared with anti-TNF-treated patients for 'stool frequency' (P<0.001), 'antidiarrheal medication use' (P<0.001), and 'stool-related aspects' (P=0.004), of which the latter was because of a higher perianal skin irritation frequency (P<0.001). UC patients who underwent restorative proctocolectomy reported a higher bowel movement frequency and more perianal skin irritation compared with anti-TNF-treated patients, but this did not affect overall disease-specific disability outcomes. Patients in the surgery group reported better outcomes for generic health compared with those in the anti-TNF group.

Underway Recovery Test 6 (URT-6) - Day 4 Afternoon Activities

NASA Image and Video Library

2018-01-20

During Underway Recovery Test 6, NASA astronaut Stephen Bowen talks with sailors about the correlations between his Navy and NASA experiences. Bowen is aboard USS Anchorage as Kennedy Space Center’s NASA Recovery Team works with the U.S. Navy to improve recovery procedures and hardware ahead of Orion's next flight, Exploration Mission-1, when it splashes down in the Pacific Ocean.

ARL: A Bimonthly Report on Research Library Issues and Actions from ARL, CNI, and SPARC. Special Issue on the Role of the Library in a Digital Landscape, Number 243

ERIC Educational Resources Information Center

Bowen, William G.; Barrett, G. Jaia, Ed.

2005-01-01

This special issue of "ARL: A Bimonthly Report" contains the remarks that William G. Bowen delivered to the research library community in October 2005 at the 147th Membership Meeting of ARL. For the past 17 years Dr. Bowen has served as President of The Andrew W. Mellon Foundation. In these remarks, entitled "New Times Always; Old Time We Cannot…

Anal skin tags in inflammatory bowel disease: new observations and a clinical review.

PubMed

Bonheur, Jennifer L; Braunstein, Jared; Korelitz, Burton I; Panagopoulos, Georgia

2008-09-01

The association between intestinal Crohn's disease (CD) and specific perianal abnormalities called anal skin tags (AST) has been recognized but not well defined. Skin tags have been classified into 2 types: 1) raised, broad, or narrow, single or multiple, soft or firm, and painless, often referred to as "elephant ears"; or 2) edematous, hard, often cyanotic, tender or not, and typically arising from a healed anal fissure, ulcer, or hemorrhoid. The aims of this study were to i) better characterize those skin tags identified by the term "elephant ears" and differentiate them from other types of AST; ii) compare their prevalence in patients with CD and ulcerative colitis (UC); iii) observe the relationship of the skin tags to the location of the primary bowel disease; and iv) to discuss the value of these typical AST in making an early diagnosis of CD. Photographs of all AST were taken when present at lower endoscopy in 170 consecutive patients with inflammatory bowel disease (IBD) seen in the private office of the senior investigator and Lenox Hill Hospital. Data was gathered with respect to major differences between the 2 types of AST. The location of the primary bowel disease for these patients was obtained from an extensive IBD computer database and review of details from charts. Specific features of AST were described and served to favor type 1 versus type 2. AST were found more frequently in patients with CD (75.4%) as compared to patients with UC (24.6%), confirming previous observations that they are more diagnostic of CD (P = 0.005). Subset analysis revealed a trend with a greater incidence of AST in patients with colitis (46.9%) as compared to patients with ileitis (36.7%) and ileocolitis (16.3%) (P = 0.067). We provide photographs with the most characteristic features of AST and attempt to separate elephant ears (type 1) from less typical AST (type 2) in CD. Our study confirms previous reports that AST are more commonly found in association with CD as

Rubber band ligation and infrared photocoagulation for the outpatient treatment of hemorrhoidal disease.

PubMed

Ricci, Maurício Pichler; Matos, Délcio; Saad, Sarhan Sydney

2008-01-01

To compare the results of rubber band ligation and infrared photocoagulation for the treatment of hemorrhoidal disease through the analysis of the incidence of complications after each treatment and respective success rate. Forty-eight patients with first, second or third degree hemorrhoidal disease were randomized to receive treatment with either rubber band ligation (n=23) or infrared photocoagulation (n=25). Each patient was assessed at 1 week and 4 week intervals after treatment. We compared the incidence of complications and efficiency of each treatment modality and Qui-square, Fisher's Exact Test and Student's t Test were used to statistical analysis. Bleeding occured in eight (34,7%) patients treated with rubber band ligation and in four (16,0%) after infrared photocoagulation (p=0,243). Thirteen (52,0%) patients felt pain during infrared photocoagulation and 9 (39,1%) after rubber band ligation (p=0,546). After rubber band ligation, 14 (60,8%) required medication for pain relief. One patient (4,0%) required medication after infrared photocoagulation (p<0,001). Three (13,0%) patients treated with rubber band ligator and 1 (4,0%) treated with infrared photocoagulation had symptomatic mucosal ulcers. Perianal dermatitis occured in two (8,0%) patients treated with infrared photocoagulation and one patient (4,3%) was observed to have prolapsed thrombosed piles after rubber band ligation. One month after treatment, 17 of 23 patients treated with rubber band ligation (73,9%) and 18 of 25 patients treated with infrared photocoagulation were asymptomatic. Rubber band ligation treated bleeding and prolapse in 90,0% and 82,4% respectively. Infrared photocoagulation treats bleeding and prolapse in 93,7% and 87,5% respectively. Those differences are not significant. Rubber band ligation causes significantly more pain than infrared photocoagulation during the first week after the procedures and their success rate are not different after four weeks of treatment.

The current role of in vivo reflectance confocal microscopy within the continuum of actinic keratosis and squamous cell carcinoma: a systematic review.

PubMed

Nguyen, Kim P; Peppelman, Malou; Hoogedoorn, Lisa; Van Erp, Piet E J; Gerritsen, Marie-Jeanne P

2016-12-01

Clinical differentiation between actinic keratosis (AK), squamous cell carcinoma (SCC) in situ, and invasive SCC and its variants may be difficult. Reflectance confocal microscopy (RCM) is a non-invasive technique for in vivo skin imaging. To explicate the diagnostic and monitoring use of RCM within the spectrum of AK and SCC, and evaluate the accuracy of RCM for these diagnoses relative to histopathology. A systematic literature search was performed in PubMed, EMBASE, the Cochrane Library, and Web of Science databases. The quality was assessed using the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist. Twenty-five eligible studies were included. Different diagnostic RCM features have been described for AK, actinic cheilitis (AC), erythroplasia of Queyrat, Bowen disease, invasive SCC, and keratoacanthoma (KA). The overall range of sensitivity and specificity of RCM for the diagnosis of SCC, AK, SCC in situ, and KA was 79-100% and 78-100%, respectively. The current literature describes the use of RCM for diagnosing AK, AC, erythroplasia of Queyrat, Bowen disease, invasive SCC, and KA, as well as for monitoring treatments of AK, with good accuracy. Unfortunately, studies with high methodological quality are lacking. Pre-treatment of hyperkeratotic lesions and uniform definitions of RCM features are required to simplify the differentiation between AKs, SCC in situ, and SCC and its variants in clinical practice.

[Acute anal pain].

PubMed

Pittet, Olivier; Demartines, Nicolas; Hahnloser, Dieter

2013-07-01

Acute anal pain is a common proctological problem. A detailed history together with the clinical examination are crucial for the diagnosis. An acute perianal vein thrombosis can be successfully excised within the first 72 hours. Acute anal fissures are best treated conservatively using stool regulation and topical medications reducing the sphincter spasm. A chronic anal fissure needs surgery. Perianal abscesses can very often be incised and drained in local anesthesia. Proctalgia fugax and the levator ani syndrome are exclusion diagnoses and are treated symptomatically.

Increased fatigability of external anal sphincter in inflammatory bowel disease: significance in fecal urgency and incontinence.

PubMed

Papathanasopoulos, Athanasios A; Katsanos, Konstantinos H; Tatsioni, Athina; Christodoulou, Dimitrios K; Tsianos, Epameinondas V

2010-11-01

Fatigability of external anal sphincter (EAS) has not been studied in inflammatory bowel disease (IBD) patients. We evaluated EAS fatigability in IBD patients with and without fecal incontinence (FI) and urgency, and correlated fatigability with demographic and clinical factors, and EAS endosonography. Fifty-eight consecutive IBD cases and 14 healthy volunteers completed Bristol stool form and a FI severity scale. Groups I, II and III included 27 patients with urgency including 13 with concomitant FI, 31 patients without FI or urgency, and 14 controls, respectively. We performed stationary pull-through manometry with an 8-channel water-perfused catheter. Fatigue rate (FR) was calculated by linear regression during a 20-s anal squeeze, and fatigue rate index (FRI) as the ratio of squeeze pressure increment to FR. EAS thickness and deficits were evaluated with an endoanal 10-MHz probe. Patients underwent sigmoidoscopy. Group I demonstrated a higher Bristol score, more frequent defecations, and more EAS defects compared to group II. Resting, peak squeeze pressures and EAS thickness did not differ between groups. FR was increased in group I versus II, and in group II versus III; FRI was decreased in group I versus II and in group II versus III (p<0.001, adjusting for age and BMI). Gender, oral glucocorticoids, presence of proctitis, perianal disease and EAS defects did not interact with group membership on FR or FRI. IBD is associated with increased fatigue rate and decreased fatigue rate index. These differences were even more striking in patients with incontinence or urgency. Copyright © 2010 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

Determination of the actual evapotranspiration by using remote sensing methods

NASA Astrophysics Data System (ADS)

Bora, Eser

2017-10-01

Evapotranspiration is so crucial for determining amount of the irrigation and the effective water management planning. Moreover, it is vital for determining agricultural drought management and determination the actual evapotranspiration ın a region is critical for early drought warning systems. The main object of this study was to assess accuracy of the remote sensing method (METRIC) by calibrating with the bowen ratio observations at the same time. The research was carried out in the west of Marmara Region, Turkey. Landsat 5 images was used to determine the metric algorithm. By using this algorithms are found. Landsat 5 images file were used to determine actual evapotranspiration and the image's date was June 11 in 2010. This date was used for calibration with available terrestrial observation by using bowen ratio in that time. Landsat images obtained from the web site, earthexplorer.usgs.gov, and results of bowen ratio taken from micrometeorology station. As a result, energy balance parameters that are net radiation, soil heat flux and latent heat flux were compared both metric algorithm and the bowen ration in the images time. The results are found so close to each other.

Surgical management of recto-sigmoid Hirschsprung's disease.

PubMed

Nouira, F; Ben Ahmed, Y; Sarrai, N; Ghorbel, S; Jlidi, S; Khemakhem, R; Charieg, A; Chaouachi, B

2012-01-01

Over the years, the surgical management of recto-sigmoid Hirschsprung's disease (HD) has evolved radically and at present a single stage transanal pull-through can be done in suitable cases, which obviates the need for multiple surgeries. The aim of this paper was to evaluate the role of transanal pull-through in the management of recto-sigmoid HD in our institution. A retrospective analysis (between January 2003 and December 2009) was carried out on all cases of Hirschsprung's reporting to unity of pediatric surgery of Tunis Children's Hospital that were managed by transanal pull-through as a definitive treatment. All selected patients including neonates had an aganglionic segment confined to the rectosigmoid area, confirmed by preoperative barium enema and postoperative histology. Twenty-six children (86%) had their operation done without construction of prior colostomy. Transanal pull-through was performed in 31 children. Mean operating time was 150 minutes (range 64 to 300 minutes). No patients required laparotomy because all patients including neonates had an aganglionic segment confined to the rectosigmoid area. Blood loss ranged between 20 to 56 ml without blood replacement. Since all children were given an epidural caudal block, the requirement of analgesia in these cases was minimal. Postoperative complications included perianal excoriation in 7 out of 31 patients lasting from 3 weeks to 6 months. Complete anorectal continence was noted in 21 of 31 (67%) children in follow up of 3-5 years. Transanal endorectal pull-through procedure for the management of rectosigmoid HD is now a well-established and preferred approach. Parental satisfaction is immense due to the lack of scars on the abdomen. As regards the continence, a long-term follow-up is necessary to appreciate better the functional results of this surgery.

Bowenoid epidermotropic metastatic squamous cell carcinoma.

PubMed

Ihm, C W; Park, S L; Sung, S Y; Lee, I S

1996-10-01

Epidermotropic metastatic squamous cell carcinoma produced full-thickness cellular atypia of bowenoid carcinoma in situ or vulvar intraepithelial neoplasia, grade 3 (VIN 3), in a 73-year-old woman who had past history of uterine cervical carcinoma. The presence of intravascular tumor cell nests and areas showing smooth continuity of the malignant squamous cell nodules with the adjoining benign epidermis supported the possibility of the epidermotropic metastasis. To our knowledge, metastatic epidermotropic squamous carcinoma clinicopathologically simulating primary Bowen's disease has not been reported.

Topical photodynamic therapy with 5-ALA in the treatment of arsenic-induced skin tumors

NASA Astrophysics Data System (ADS)

Karrer, Sigrid; Szeimies, Rolf-Markus; Landthaler, Michael

1995-03-01

A case of a 62-year-old woman suffering from psoriasis who was treated orally with arsenic 25 years ago is reported. The cumulative dose of arsenic trioxide was 800 mg. Since 10 years ago arsenic keratoses, basal cell carcinomas, Bowen's disease and invasive squamous cell carcinomas mainly on her hands and feet have developed, skin changes were clearly a sequence of arsenic therapy. Control of disease was poor, her right little finger had to be amputated. Topical photodynamic therapy with 5-aminolevulinic acid was performed on her right hand. Clinical and histological examinations 6 months after treatment showed an excellent cosmetic result with no signs of tumor residue.

[Lymphogranuloma venereum: the first Hungarian cases].

PubMed

Bánvölgyi, András; Balla, Eszter; Bognár, Péter; Tóth, Béla; Ostorházi, Eszter; Bánhegyi, Dénes; Kárpáti, Sarolta; Marschalkó, Márta

2015-01-04

Lymphogranuloma venereum is a sexually transmitted infection caused by the Chlamydia trachomatis serovars L1-3. It has been found to be endemic in tropical countries. In the last decades several cases have been reported in Western Europe, particularly in men who have sex with men population infected with human immunodeficiency virus. The authors present three cases of lymphogranuloma venereum infections, observed at their department in 2013 and 2014. The three human immunodeficiency virus infected patients who belonged to men who have sex with men population had casual sexual contacts in Western Europe. The symptoms included urethral discharge, discomfort and inguinal lymphadenomegaly in two patients, and rectal pain, discharge and perianal ulceration in one patient. The diagnosis was confirmed by nucleic acid amplification test performed in samples obtained from urethral discharge and exudate of perianal ulcer; lymphogranuloma venereum 2b serovars were demonstrated in two patients and serovar 2 in one patient. Doxycyclin (daily dose of two times 100 mg for 21 days) resolved the symptoms in all cases. The authors conclude that lymphogranuloma venereum is a diagnostic challenge in Hungary, too. It is important to be aware of the altered clinical features of this disease to prevent complications and spreading.

Anal metastasis of rectal cancer-adenocarcinoma of squamous cells: a case report and literature review.

PubMed

Sasaki, Shun; Sugiyama, Masahiko; Nakaji, Yu; Nakanishi, Ryota; Nakashima, Yuichiro; Saeki, Hiroshi; Oki, Eiji; Oda, Yoshinao; Maehara, Yoshihiko

2017-12-01

Anal metastasis of colorectal cancer is very rare and is usually associated with a history of anal disease, including anal fistula, fissure, hemorrhoidectomy, and anastomotic injury. We report a case of rectal cancer with a synchronous anal metastasis consisting of adenocarcinoma of squamous cells without a history of anal disease. A 60-year-old woman had a chief complaint of melena. She had a 1.5-cm anal tumor on the perianal skin, and a Bollman type 2 rectal tumor on the Ra portion was found on colonoscopy. Biopsy of both tumors revealed a similar histology of well- to moderately differentiated adenocarcinoma. There was no sign of metastases in lymph nodes or other organs. For the purpose of diagnosis and treatment, transperineal local resection of the anal tumor was performed, and it was histologically identified as adenocarcinoma of squamous cells with no invasion to muscles, lymph ducts, or microvessels. The pathological margin was free. Then, to achieve radical cure, laparoscopic low anterior resection (LAR) with D3 lymphadenectomy was performed. The histological diagnosis of the anal tumor was adenocarcinoma of squamous cells without invasion to muscles, lymph ducts, or vessels. The surgical margin was completely free. Immunohistochemical analysis of both tumors revealed similar staining patterns, and the final diagnosis was rectal cancer with metastasis to the anal skin. The patient received no postoperative therapy, and no recurrences have been observed 12 months after surgery. We expect that our sphincter-preserving surgical strategy provided a good prognosis for the synchronous rectal cancer and anal metastasis. This is a rare report of a case with an anal metastasis of colorectal cancer on perianal squamous cells without a history of anal disease that was resected while preserving anal function.

Fe II fluorescence and anomalous C IV doublet intensities in symbiotic novae

NASA Technical Reports Server (NTRS)

Michalitsianos, A. G.; Kafatos, M.; Meier, S. R.

1992-01-01

The variation of absolute intensities of Bowen-excited Fe II emission in the symbiotic stars RR Tel, RX Pup, and AG Peg is examined. The C IV doublet intensity ratios in RR Tel were not anomalous between 1979 and 1989, and the ratio had typical values within the optically thin range. The intensity of individual Fe II Bowen-excited lines is correlated with the C IV 1548.2 A flux, suggesting the presence of a foreground Fe II region in which fluorescent-excited material responds to flux variations of C IV 1548.2 A. In RX Pup the combined fluxes of Fe II Bowen-pumped lines can account for an appreciable fraction of the flux deficit in the C IV 1548.2 A line when the C IV doublet ratio is less than the optically thick limit of unity. The Fe II Bowen lines in RX Pup exhibit a velocity range from 0 to 80 km/s, where several strong Fe II emission lines correspond to deep absorption structure in the C IV 1548.2 A line profile. In AG Peg and C IV 1548.2 A flux deficit cannot be explained by Fe II fluorescent absorption alone when the C IV doublet ratio anomaly is at an extreme.

Detection of Crohn disease lesions of the small and large bowel in pediatric patients: diagnostic value of MR enterography versus reference examinations.

PubMed

Maccioni, Francesca; Al Ansari, Najwa; Mazzamurro, Fabrizio; Civitelli, Fortunata; Viola, Franca; Cucchiara, Salvatore; Catalano, Carlo

2014-11-01

The purpose of this article is to prospectively determine the accuracy of MR enterography in detecting Crohn disease lesions from the jejunum to the anorectal region in pediatric patients, in comparison with main reference investigations. Fifty consecutive children with known Crohn disease underwent MR enterography with oral contrast agent and gadolinium-chelate intravenous injection. Two radiologists detected and localized lesions by dividing the bowel into nine segments (450 analyzed segments in 50 patients). Ileocolonoscopy, barium studies, intestinal ultrasound, and capsule endoscopy were considered as first- and second-level reference examinations and were performed within 15 days of MR enterography. MR enterography detected lesions in 164 of 450 segments, with 155 true-positive and nine false-positive findings; overall sensitivity, specificity, and positive and negative predictive values for small- and large-bowel lesions were 94.5%, 97%, 94.5%, and 97%, respectively (ĸ = 0.93; 95% CI, 0.89-0.97). Sensitivity and specificity values were 88% and 97%, respectively, for the jejunum, 100% and 97% for the proximal-to-mid ileum, 100% and 100% for the distal ileum, 93% and 100% for the cecum, 70% and 97% for the ascending colon, 80% and 100% for the transverse colon, 100% and 92% for the descending colon, 96% and 90% for the sigmoid colon, and 96% and 88% for the rectum. From jejunum to rectum, the AUC value ranged between 0.916 (jejunum) and 1.00 (distal ileum). Perianal fistulas were diagnosed in 15 patients, and other complications were found in 13 patients. MR enterography showed an accuracy comparable to that of reference investigations, for both small- and large-bowel lesions. Because MR enterography is safer and more comprehensive than the reference examinations, it should be considered the primary examination for detecting Crohn disease lesions in children.

MMP-10 (Stromelysin-2) and MMP-21 in human and murine squamous cell cancer.

PubMed

Boyd, Sonja; Virolainen, Susanna; Pärssinen, Jenita; Skoog, Tiina; van Hogerlinden, Max; Latonen, Leena; Kyllönen, Lauri; Toftgard, Rune; Saarialho-Kere, Ulpu

2009-12-01

The squamous cell cancers (SCC) of renal transplant recipients are more aggressive and metastasize earlier than those of the non-immunocompromised population. Matrix metalloproteinases (MMPs) have a central role in tumor initiation, invasion and metastasis. Our aim was to compare the expression of MMPs-10, -12 and -21 in SCCs from immunosuppressed (IS) and control patients and the contribution of MMPs-10 and -21 to SCC development in the FVB/N-Tg(KRT5-Nfkbia)3Rto mouse line. Immunohistochemical analysis of 25 matched pairs of SCCs, nine of Bowen's disease and timed back skin biopsies of mice with selective inhibition of Rel/NF-kappaB signalling were performed. Semiquantitatively assessed stromal MMP-10 expression was higher (P = 0.009) in the control group when compared with IS patients. Tumor cell-derived MMP-10, -12 and -21 expression did not differ between the groups but stromal fibroblasts of the control SCCs tended to express MMP-21 more abundantly. MMP-10 expression was observed already in Bowen's disease while MMP-21 was absent. MMP-10 and -21 were present in inflammatory or stromal cells in ageing mice while dysplastic keratinocytes and invasive cancer were negative. Our results suggest that MMP-10 may be important in the initial stages of SCC progression and induced in the stroma relating to the general host-response reaction to skin cancer. MMP-21 does not associate with invasion of SCC but may be involved in keratinocyte differentiation.

Bowenoid transformation in seborrheic keratosis: A retrospective analysis of 429 patients

PubMed Central

Rajabi, Parvin; Adibi, Neda; Nematollahi, Pardis; Heidarpour, Mitra; Eftekhari, Mehdi; Siadat, Amir Hossein

2012-01-01

Background: Seborrheic keratosis is a common, benign skin tumor. Numerous reports have shown its possibility of malignant transformation. This study was designed to demonstrate the occurrence of concomitant seborrheic keratosis and skin cancers. Materials and Methods: Data was retrospectively reviewed from all patients with a diagnosis of seborrheic keratosis in pathology department of Alzahra Hospital and a private pathology laboratory in Isfahan, Iran over a 4-year period. We classified all demographic data and associated dysplasia or Bowen's disease and analyzed them by student-t or chi-square tests. Results: From all 429 specimens, 5 (1.2%) were found to be associated with Bowen's disease and one (0.2%) with mild dysplasia in squamous epithelium. All cases arose within the clinically, atypical seborrheic keratosis. More men were affected with lesions alone and with malignancy (230/423 (54.4%) and 5/6 (83.3%), respectively) compared to women. The average age of patients suffering from lesions with and without associated malignancy was 57 and 54 years, respectively. The common site of lesion alone was head and neck but lesions with malignancy involved lower extremities. The two lesions were significantly different in site of occurrence (p < 0.001). Conclusion: Generally, although the association between seborrheic keratosis and skin malignancy appears to be accidental, it must always be in mind. Therefore, histopathologic examination of all seborrheic keratosis should be considered, especially when seborrheic keratosis has atypical clinical manifestations. PMID:23267371

The Danish Nonmelanoma Skin Cancer Dermatology Database.

PubMed

Lamberg, Anna Lei; Sølvsten, Henrik; Lei, Ulrikke; Vinding, Gabrielle Randskov; Stender, Ida Marie; Jemec, Gregor Borut Ernst; Vestergaard, Tine; Thormann, Henrik; Hædersdal, Merete; Dam, Tomas Norman; Olesen, Anne Braae

2016-01-01

The Danish Nonmelanoma Skin Cancer Dermatology Database was established in 2008. The aim of this database was to collect data on nonmelanoma skin cancer (NMSC) treatment and improve its treatment in Denmark. NMSC is the most common malignancy in the western countries and represents a significant challenge in terms of public health management and health care costs. However, high-quality epidemiological and treatment data on NMSC are sparse. The NMSC database includes patients with the following skin tumors: basal cell carcinoma (BCC), squamous cell carcinoma, Bowen's disease, and keratoacanthoma diagnosed by the participating office-based dermatologists in Denmark. Clinical and histological diagnoses, BCC subtype, localization, size, skin cancer history, skin phototype, and evidence of metastases and treatment modality are the main variables in the NMSC database. Information on recurrence, cosmetic results, and complications are registered at two follow-up visits at 3 months (between 0 and 6 months) and 12 months (between 6 and 15 months) after treatment. In 2014, 11,522 patients with 17,575 tumors were registered in the database. Of tumors with a histological diagnosis, 13,571 were BCCs, 840 squamous cell carcinomas, 504 Bowen's disease, and 173 keratoakanthomas. The NMSC database encompasses detailed information on the type of tumor, a variety of prognostic factors, treatment modalities, and outcomes after treatment. The database has revealed that overall, the quality of care of NMSC in Danish dermatological clinics is high, and the database provides the necessary data for continuous quality assurance.

Methicillin-resistant Staphylococcus aureus colonization, behavioral risk factors, and skin and soft-tissue infection at an ambulatory clinic serving a large population of HIV-infected men who have sex with men.

PubMed

Szumowski, John D; Wener, Kenneth M; Gold, Howard S; Wong, Michael; Venkataraman, Lata; Runde, Carrie A; Cohen, Daniel E; Mayer, Kenneth H; Wright, Sharon B

2009-07-01

We conducted a prospective cohort study of 795 outpatients, many of whom were human immunodeficiency virus-infected men who have sex with men, to characterize risk of skin and soft-tissue infection (SSTI) associated with methicillin-resistant Staphylococcus aureus (MRSA) nares and perianal colonization. Multivariate analysis revealed that perianal colonization, drug use, and prior SSTIs were strongly associated with development of an SSTI. Of the patients who were colonized with MRSA at study entry, 36.7% developed an SSTI during the ensuing 12 months, compared with 8.1% of persons who were not colonized with MRSA.

Lightning activity with rainfall during El Nino and La Nina events over India

NASA Astrophysics Data System (ADS)

Tinmaker, M. I. R.; Aslam, M. Y.; Ghude, Sachin D.; Chate, D. M.

2017-10-01

This paper appraises the association of lightning flash count (FC) with rainfall using the satellite-borne Lightning Imaging Sensor's (LIS) data along with gridded rainfall data (0.5o × 0.5o) for Indian summer monsoon seasons over 10 years (2001-2010). During strong El Nino years, 2002 and 2009, FCs were greater in magnitude by about 26.5 % and 37 %, than the long-term average, respectively, while during weak El Nino year (2004), it was more by 8 %. During the same years, the rainfall was deficient by about 10 % than the long-term average. Similarly, a rise in aerosol optical depth (AOD) over its average value (by about 15 % and 20 %) reduces the ratio of rainfall to FC (RLR) by 41 % and 44 % for strong El Nino years 2002 and 2009, respectively, and for weak El Nino year (2004), a 6.5 % rise in AOD lowers the RLR by 20 %. Bowen ratio more by 11 % and 17 % of its average value reduces the RLR by 41 % and 44 % for strong El Nino years 2002 and 2009, respectively, and, also, Bowen ratio higher by 8 % for 2004 declines RLR by 20 %. On the other hand, Bowen ratio less by 9 % and 6 % raises the RLR by 19 % and 56 % for moderate La Nina year (2007) and strong La Nina year (2010), respectively. Results for the daily rainfall, AOD and Bowen ratio over Indian regions, are discussed for strong El Nino and La Nina years. Correlations of FC with AOD and Bowen ratio of 0.66 and 0.71, respectively, while, that of FC with ONI of 0.56 indicates numerous (fewer) break days during El Nino (La Nina) years.

Inflammatory bowel disease: A descriptive study of 716 local Chilean patients

PubMed Central

Simian, Daniela; Fluxá, Daniela; Flores, Lilian; Lubascher, Jaime; Ibáñez, Patricio; Figueroa, Carolina; Kronberg, Udo; Acuña, Raúl; Moreno, Mauricio; Quera, Rodrigo

2016-01-01

AIM: To demographically and clinically characterize inflammatory bowel disease (IBD) from the local registry and update data previously published by our group. METHODS: A descriptive study of a cohort based on a registry of patients aged 15 years or older who were diagnosed with IBD and attended the IBD program at Clínica Las Condes in Santiago, Chile. The registry was created in April 2012 and includes patients registered up to October 2015. The information was anonymously downloaded in a monthly report, and the information on patients with more than one visit was updated. The registry includes demographic, clinical and disease characteristics, including the Montreal Classification, medical treatment, surgeries and hospitalizations for crisis. Data regarding infection with Clostridium difficile (C. difficile) were incorporated in the registry in 2014. Data for patients who received consultations as second opinions and continued treatment at this institution were also analyzed. RESULTS: The study included 716 patients with IBD: 508 patients (71%) were diagnosed with ulcerative colitis (UC), 196 patients (27%) were diagnosed with Crohn’s disease (CD) and 12 patients (2%) were diagnosed with unclassifiable IBD. The UC/CD ratio was 2.6/1. The median age was 36 years (range 16-88), and 58% of the patients were female, with a median age at diagnosis of 29 years (range 5-76). In the past 15 years, a sustained increase in the number of patients diagnosed with IBD was observed, where 87% of the patients were diagnosed between the years 2001 and 2015. In the cohort examined in the present study, extensive colitis (50%) and colonic involvement (44%) predominated in the patients with UC and CD, respectively. In CD patients, non-stricturing/non-penetrating behavior was more frequent (80%), and perianal disease was observed in 28% of the patients. There were significant differences in treatment between UC and CD, with a higher use of corticosteroids, and immunosuppressive

Sequential treatment for proctalgia fugax. Mid-term follow-up.

PubMed

Gracia Solanas, J A; Ramírez Rodríguez, J M; Elía Guedea, M; Aguilella Diago, V; Martínez Díez, M

2005-07-01

Proctalgia fugax (PF) is a benign, self-limiting disease characterized by episodes of intense anorectal pain at frequent intervals in the absence of organic proctological disease. Even though PF was described more than a century ago, its etiology remains unclear. Currently there is no information available. Few papers quoting many ways of management have been published. The aim of this study was to investigate patients complaining of this condition and to treat them with sequential therapy. We devised a descriptive, prospective study of patients complaining of acute perianal pain--duration less than 30 minutes--without organic disease or previous perianal surgery since 1996 to 2002 in our Department. We treated these patients using a three-step treatment (1: information, hip bath, benzodiazepines; 2: sublingual nifedipine 10 mg, or topic 0.1% nitroglycerin on demand; 3: internal anal sphincterotomy if hypertrophy of the internal anal sphincter was demonstrated by anal ultrasonography and no improvement was confirmed with the previous steps of treatment). We defined remarkable improvement as a decrease in the number of episodes by half or in pain intensity by 50%. Fifteen patients with an average follow-up of 4 years. Anal endosonography confirmed a grossly thickened internal anal sphincter (IAS) in 5 cases. After the first step of treatment 7 patients improved and 1 patient was cured; after the second step of treatment 3 patients improved and 1 was cured; the third step was applied to 3 patients with a thickened IAS; 1 patient improved and 1 patient was cured. A total resolution of PF is not always possible, but we may improve symptoms and their frequency. Almost 50% of patients in our series improved with the first step of treatment; 30% of our patients had IAS hypertrophy. Anal endosonography can help in the diagnosis of organic diseases or IAS hypertrophy, for which we can perform an internal anal sphincter myectomy.

Photodynamic therapy using 5-aminolevulinic acid-induced photosensitization: current clinical status

NASA Astrophysics Data System (ADS)

Marcus, Stuart L.; Golub, Allyn L.; Shulman, D. Geoffrey

1995-03-01

Photodynamic therapy using 5-aminolevulinic acid-induced photosensitization (ALA PDT) via endogenous protoporphyrin IX (PpIX) synthesis has been reported as efficacious, using topical formulations, in the treatment of a variety of dermatologic diseases including superficial basal cell carcinoma, Bowen's disease, and actinic (solar) keratoses. Application of ALA PDT to the detection and treatment of both malignant and non-malignant diseases of internal organs has recently been reported. Local internal application of ALA has been used for the detection, via PpIX fluorescence, of pathological conditions of the human urinary bladder and for selective endometrial ablation in animal model systems. Systemic, oral administration of ALA has been used for ALA PDT of superficial head and neck cancer and of colorectal cancer. This paper reviews the current clinical status of ALA PDT.

Establishing Key Performance Indicators [KPIs] and Their Importance for the Surgical Management of Inflammatory Bowel Disease-Results From a Pan-European, Delphi Consensus Study.

PubMed

Morar, Pritesh S; Hollingshead, James; Bemelman, Willem; Sevdalis, Nick; Pinkney, Thomas; Wilson, Graeme; Dunlop, Malcolm; Davies, R Justin; Guy, Richard; Fearnhead, Nicola; Brown, Steven; Warusavitarne, Janindra; Edwards, Cathryn; Faiz, Omar

2017-10-27

Key performance indicators [KPIs] exist across a range of areas in medicine. They help to monitor outcomes, reduce variation, and drive up standards across services. KPIs exist for inflammatory bowel disease [IBD] care, but none specifically cover inflammatory bowel disease [IBD] surgical service provision. This was a consensus-based study using a panel of expert IBD clinicians from across Europe. Items were developed and fed through a Delphi process to achieve consensus. Items were ranked on a Likert scale from 1 [not important] to 5 [very important]. Consensus was defined when the inter quartile range was ≤ 1, and items with a median score > 3 were considered for inclusion. A panel of 21 experts [14 surgeons and 7 gastroenterologists] was recruited. Consensus was achieved on procedure-specific KPIs for ileocaecal and perianal surgery for Crohn's disease, [N = 10] with themes relating to morbidity [N = 7], multidisciplinary input [N = 2], and quality of life [N = 1]; and for subtotal colectomy, proctocolectomy and ileoanal pouch surgery for ulcerative colitis [N = 11], with themes relating to mortality [N = 2], morbidity [N = 8], and service provision [N = 1]. Consensus was also achieved for measures of the quality of IBD surgical service provision and quality assurance in IBD surgery. This study has provided measurable KPIs for the provision of surgical services in IBD. These indicators cover IBD surgery in general, the governance and structures of the surgical services, and separate indicators for specific subareas of surgery. Monitoring of IBD services with these KPIs may reduce variation across services and improve quality. Copyright © 2017 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com

Intensity-Modulated Radiation Therapy for Anal Malignancies: A Preliminary Toxicity and Disease Outcomes Analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pepek, Joseph M.; Willett, Christopher G.; Wu, Q. Jackie

Purpose: Intensity-modulated radiation therapy (IMRT) has the potential to reduce toxicities associated with chemoradiotherapy in the treatment of anal cancer. This study reports the results of using IMRT in the treatment of anal cancer. Methods and Materials: Records of patients with anal malignancies treated with IMRT at Duke University were reviewed. Acute toxicity was graded using the NCI CTCAEv3.0 scale. Overall survival (OS), metastasis-free survival (MFS), local-regional control (LRC) and colostomy-free survival (CFS) were calculated using the Kaplan-Meier method. Results: Forty-seven patients with anal malignancy (89% canal, 11% perianal skin) were treated with IMRT between August 2006 and September 2008.more » Median follow-up was 14 months (19 months for SCC patients). Median radiation dose was 54 Gy. Eight patients (18%) required treatment breaks lasting a median of 5 days (range, 2-7 days). Toxicity rates were as follows: Grade 4: leukopenia (7%), thrombocytopenia (2%); Grade 3: leukopenia (18%), diarrhea (9%), and anemia (4%); Grade 2: skin (93%), diarrhea (24%), and leukopenia (24%). The 2-year actuarial overall OS, MFS, LRC, and CFS rates were 85%, 78%, 90% and 82%, respectively. For SCC patients, the 2-year OS, MFS, LRC, and CFS rates were 100%, 100%, 95%, and 91%, respectively. Conclusions: IMRT-based chemoradiotherapy for anal cancer results in significant reductions in normal tissue dose and acute toxicities versus historic controls treated without IMRT, leading to reduced rates of toxicity-related treatment interruption. Early disease-related outcomes seem encouraging. IMRT is emerging as a standard therapy for anal cancer.« less

Pyoderma gangrenosum in infants and children.

PubMed

Graham, J A; Hansen, K K; Rabinowitz, L G; Esterly, N B

1994-03-01

Pyoderma gangrenosum is an uncommon ulcerative skin disorder that occurs in all age groups. Approximately 4% of patients are infants and children. There are several notable differences between the childhood and adult manifestations of the disease, including the distribution of lesions and associated disorders. We reviewed the childhood cases (< or = 18 yrs of age) of unequivocal pyoderma gangrenosum in the English literature and tabulated the trends in clinical features, associated disorders, and therapy. We report our 3-week-old patient, the youngest documented case. Of the 46 patients, only 4 were less than 1 year of age. A systemic illness was present in 74% of the older children, most commonly, ulcerative colitis. Only one infant had an associated problem (HIV+) at the time of onset. Infants appear to have an unusual distribution of perianal and genital lesions not often described in other age groups. Our review suggests that pyoderma gangrenosum in children has a similar clinical appearance to that in adults. It is associated with some of the same underlying disorders, but with different frequencies. The distribution of lesions in children is similar, often involving the lower extremities, but pyoderma gangrenosum of the head and face appears to be more common in children. Infants may have ulcers in genital and perianal areas. The most frequently prescribed treatment for children is systemic corticosteroids, which generally are very effective.

The effects of ground hydrology on climate sensitivity to solar constant variations

NASA Technical Reports Server (NTRS)

Chou, S. H.; Curran, R. J.; Ohring, G.

1979-01-01

The effects of two different evaporation parameterizations on the climate sensitivity to solar constant variations are investigated by using a zonally averaged climate model. The model is based on a two-level quasi-geostrophic zonally averaged annual mean model. One of the evaporation parameterizations tested is a nonlinear formulation with the Bowen ratio determined by the predicted vertical temperature and humidity gradients near the earth's surface. The other is the linear formulation with the Bowen ratio essentially determined by the prescribed linear coefficient.

Underway Recovery Test 6 (URT-6) - Day 3 Activities

NASA Image and Video Library

2018-01-19

NASA astronaut Stephen Bowen gets a birds-eye view of the rough seas during part of Underway Recovery Test 6. Bowen is watching the testing so he can provide the team with an astronaut’s perspective. The testing with Kennedy Space Center's NASA Recovery Team and the U.S. Navy will provide important data that is being used to improve recovery procedures and hardware ahead of Orion's next flight, Exploration Mission-1, when it splashes down in the Pacific Ocean.

A comprehensive review and update on Crohn's disease.

PubMed

Gajendran, Mahesh; Loganathan, Priyadarshini; Catinella, Anthony P; Hashash, Jana G

2018-02-01

The term inflammatory bowel disease (IBD) refers principally to two major categories of chronic relapsing inflammatory intestinal disorders: Crohn's disease (CD) and ulcerative colitis (UC). In the United States, it is currently estimated that about 1.5 million people suffer from IBD, causing considerable suffering, mortality and economic loss every year. Yet the cause of IBD is unknown, and until we understand more, prevention or cure will not be possible. There is a lot of variation in the incidence and prevalence of CD based on geographic region, environment, immigrant population, and ethnic groups. The annual incidence of CD in North America is reported to be 3.1-20.2 per 100,000 with a prevalence of 201 per 100,000 population. Based on the epidemiological, genetic and immunological data, CD is considered to be a heterogeneous disorder with multifactorial etiology in which genetics and environment interact to manifest the disease. Several genes have been studied so for with respect to CD, but thus far the strong and replicated associations have been identified with NOD2, IL23R and ATG16L1 genes. The risk factors implicated with CD include smoking, low fiber- high carbohydrate diet, altered microbiome and medications such as non-steroidal anti-inflammatory drugs. CD is typically characterized by transmural inflammation of the intestine and could affect any part of the gastrointestinal tract from mouth to perianal area. In terms of distribution of the disease 25% of the patients have colitis only, 25% is ileitis only and 50% have ileocolitis. The Montreal classification is based on the age at diagnosis (<16, 17-40, > 40), disease location (Ileal, colonic, Ileocolonic) and the disease behavior (nonstricturing/nonpenetrating, stricturing, penetrating). The key features for diagnosing CD comprises a combination of radiographic, endoscopic and pathological findings demonstrating focal, asymmetric, transmural or granulomatous features. Abdominal Computed tomography

Juvenile hyaline fibromatosis: a case report and review of literature.

PubMed

Ribeiro, Sandra Lúcia; Guedes, Erilane L; Botan, Valeria; Barbosa, Alessandra; Freitas, Ernani J

2009-01-01

Juvenile hyaline fibromatosis (JHF) is a rare disease with autosomal recessive inheritance that occurs mainly in childhood and is characterized by the deposition of amorphous hyaline material in the skin and other organs. There are approximately 70 cases reported in the literature. Herein we describe the case of a 14-month-old boy with multiple cutaneous nodules around small and large joints, papulous skin lesions, hyperpigmented plaques and nodules in the perianal region, flexion contractures and stiffness of joints and diffuse osteoporosis. Symptoms were present since the second month of life. Histopathologic studies of joint nodulations demonstrated the presence of hyaline material, confirming the diagnosis of juvenile hyaline fibromatosis.

Group A beta-hemolytic streptococcal hemorrhagic colitis complicated with pharyngitis and impetigo.

PubMed

Isozaki, Atsushi; Matsubara, Keiko; Yui, Takako; Kobayashi, Kenji; Kawano, Yutaka

2007-12-01

A 6-year-old boy with bloody diarrhea was diagnosed with group A beta-hemolytic streptococcal hemorrhagic colitis. Complications included pharyngitis and impetigo, both caused by the same organisms. In addition to being isolated from stools, Streptococcus pyogenes was also isolated from skin lesions. Furthermore, a rapid group A streptococcal antigen test by throat swab was also positive. Hemorrhagic colitis caused by group A beta-hemolytic streptococcus is extremely rare, and much rarer are its complications with pharyngitis and impetigo. Compared with findings in reports of group A beta-hemolytic streptococcal proctitis and perianal and perineal diseases, this case suggests a distinct pathogenesis for hemorrhagic colitis.

STS-126 suitup

NASA Image and Video Library

2008-02-26

JSC2008-E-015735 (26 Feb. 2008) --- Astronauts Robert S. (Shane) Kimbrough and Stephen G. Bowen (partially obscured), both STS-126 mission specialists, are submerged in the waters of the Neutral Buoyancy Laboratory (NBL) near Johnson Space Center. Kimbrough and Bowen are attired in training versions of the Extravehicular Mobility Unit (EMU) spacesuit. SCUBA-equipped divers (out of frame) are in the water to assist the crewmembers in their rehearsal, intended to help prepare them for work on the exterior of the International Space Station.

Diseases associated with hidranitis suppurativa: part 2 of a series on hidradenitis.

PubMed

Scheinfeld, Noah

2013-06-15

diseases is likely underreported. Pyoderma vegetans has been noted in 2 cases of HS and 4 cases of Inflammatory Bowel Disease (IBD) and is likely a clue to the linkage of the pathology of IBD and HS. Pityriasis rubra pilaris, in particular Type VI related to HIV, has a relationship more commonly with acne conglobata, but with HS also. Single case reports of diseases associated with HS include systemic lupus erythematosus, acromegaly, Down syndrome, Bazex-Dupre´-Christol, and prurtis ani, but these might be coincidences. Pyogenic Arthritis, Pyoderma gangrenosum, and Acne (PAPA Syndrome) and Pyoderma gangrenosum, Acne, and Suppurative Hidradenitis (PASH Syndrome) are pyodermic-arthritic syndromes that are associated with HS. Erythema nodosum and granulomatous lobular mastitis have been reported with HS but the significance of these reports is uncertain. Because of scarring, HS can result in lymphedema including scrotal elephantiasis and verrucous lymphedema. HS is sometimes accompanied by obesity, hypertension, and anemia and can be considered a disease in the spectrum of metabolic syndrome, a skin disease with systemic consequences. HS, like other types of chronic inflammation when long standing in the perianal and perineal areas, can result in squamous cell cancer. A variety of drugs can induce HS. These include lithium, sirolimus, cyclosporine, vemurafenib, and oral contraceptives. Inverse psoriasis or psoriasis vulgaris as a side effect of infliximab therapy may be associated with HS. These associations aside, most cases of HS occur in isolation without coincident morbidity.

Footprint-weighted tile approach for a spruce forest and a nearby patchy clearing using the ACASA model

NASA Astrophysics Data System (ADS)

Gatzsche, Kathrin; Babel, Wolfgang; Falge, Eva; Pyles, Rex David; Tha Paw U, Kyaw; Raabe, Armin; Foken, Thomas

2018-05-01

The ACASA (Advanced Canopy-Atmosphere-Soil Algorithm) model, with a higher-order closure for tall vegetation, has already been successfully tested and validated for homogeneous spruce forests. The aim of this paper is to test the model using a footprint-weighted tile approach for a clearing with a heterogeneous structure of the underlying surface. The comparison with flux data shows a good agreement with a footprint-aggregated tile approach of the model. However, the results of a comparison with a tile approach on the basis of the mean land use classification of the clearing is not significantly different. It is assumed that the footprint model is not accurate enough to separate small-scale heterogeneities. All measured fluxes are corrected by forcing the energy balance closure of the test data either by maintaining the measured Bowen ratio or by the attribution of the residual depending on the fractions of sensible and latent heat flux to the buoyancy flux. The comparison with the model, in which the energy balance is closed, shows that the buoyancy correction for Bowen ratios > 1.5 better fits the measured data. For lower Bowen ratios, the correction probably lies between the two methods, but the amount of available data was too small to make a conclusion. With an assumption of similarity between water and carbon dioxide fluxes, no correction of the net ecosystem exchange is necessary for Bowen ratios > 1.5.

Potential of systemic photosensitizers for PDT of skin malignancies

NASA Astrophysics Data System (ADS)

Philipp, Carsten M.; Müller, Ute; Urban, Peter; Berlien, H.-Peter

2008-04-01

Usually systemic photosensitizers (PS) require a long period of incubation (48-96h) after systemic admission. On the other hand clearing from healthy skin needs weeks or months. Severe side effects on skin are possible in case of uncontrolled light exposure. Topical PDT may solve this problem, but deep portions may not be sufficiently sensitized, resulting in a survival of some tumor cell population after PDT and recurrence. The same problem counts for actinic keratosis and Bowen's disease, but with even worse consequences as a resulting infiltrating growing squamous cell carcinoma (SCC) is likely to produce metastatic lesions. Light dosimetry is crucial also. Wavelenght, fluence and total energy may influence outcome of any PDT substantially. 17 patients with Bowen's disease or BCC where treated using a novel systemic PS (Fotolon ®) and 665nm light from a diode laser. Follow up time ranges between 2.5 and 1 years after treatment. 2 patients received a second PDT, in 15 patients one treatment was efficient. We found a remissions in 1, local control in 2 and no evidence of disease in 14 patients. Significant fluorescence was noted in all lesions. With a light protection protocol for only 48 hours no severe side effects where seen. One patient developed mild redness of sunlight exposed skin sites 24h after being discharged from light protection protocol. In comparison with currently available topical PS Fotolon ® offers some important advantages as secure photosenzitation of deep portions, single treatment, high selectivity combined with a high cure rate. In comparison with currently available systemic PS Fotolon ® offers short incubation time, high selectivity and short time of elimination, while efficiency was comparable to HPD (hematoporphyrin-derivate) PDT combined with ALA-5 PDT and without need for additional local PS-application for PDD.

Comparison of different local anesthesia techniques during TRUS-guided biopsies: a prospective pilot study.

PubMed

Kravchick, Sergey; Peled, Ronit; Ben-Dor, David; Dorfman, Dov; Kesari, David; Cytron, Shmuel

2005-01-01

To introduce two forms of anesthesia and compare them with standard local anesthesia techniques. A total of 114 consecutive patients underwent prostate needle biopsy. The patients were sequentially randomized to receive different kinds of anesthesia: 2% rectal lidocaine gel, 40% dimethyl sulfoxide (DMSO) with lidocaine, perianal injection of 1% lidocaine, or periprostatic nerve block. Pain perception was separately assessed for probe insertion and biopsies using a visual pain analog score. One-way analysis of variance was used to compare the data scale among the four groups. A linear regression model was used to define the independent variables that predicted the level of pain. The groups were similar in terms of age, prostate-specific antigen levels, digital rectal examination findings, prostate volume, pain tolerance, biopsy time, and number of cores taken. The lowest pain scores for probe insertion were for the perianal injection and DMSO/lidocaine groups (0.89 and 1.38, respectively). The difference between these scores and those for the other two groups was statistically significant (P <0.001). Pain perception during biopsy did not differ significantly among the DMSO/lidocaine, perianal, or periprostatic groups and was greatest in the lidocaine gel group (4.147; P <0.001). We did not observe any statistically significant correlation between the pain level during probe insertion and biopsy and pain tolerance (P = 0.514 and P = 0.788, respectively). The anesthesia type was the strongest single predictor of the pain level during biopsy (P <0.001). The use of 40% DMSO with lidocaine instilled into the rectal vault for 10 minutes avoids any need for injection and is capable of decreasing the discomfort or pain experienced during probe insertion and prostate biopsy comparable to the perianal and periprostatic protocols.

Los Alamos Climatology 2016 Update

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bruggeman, David Alan

The Los Alamos National Laboratory (LANL or the Laboratory) operates a meteorology monitoring network to support LANL emergency response, engineering designs, environmental compliance, environmental assessments, safety evaluations, weather forecasting, environmental monitoring, research programs, and environmental restoration. Weather data has been collected in Los Alamos since 1910. Bowen (1990) provided climate statistics (temperature and precipitation) for the 1961– 1990 averaging period, and included other analyses (e.g., wind and relative humidity) based on the available station locations and time periods. This report provides an update to the 1990 publication Los Alamos Climatology (Bowen 1990).

Covariance of biophysical data with digital topograpic and land use maps over the FIFE site

NASA Technical Reports Server (NTRS)

Davis, F. W.; Schimel, D. S.; Friedl, M. A.; Michaelsen, J. C.; Kittel, T. G. F.; Dubayah, R.; Dozier, J.

1992-01-01

This paper discusses the biophysical stratification of the FIFE site, implementation of the stratification utilizing geographic information system methods, and validation of the stratification with respect to field measurements of biomass, Bowen ratio, soil moisture, and the greenness vegetation index (GVI) derived from TM satellite data. Maps of burning and topographic position were significantly associated with variation in GVI, biomass, and Bowen ratio. The stratified design did not significantly alter the estimated site-wide means for surface climate parameters but accounted for between 25 and 45 percent of the sample variance depending on the variable.

Basic Research on Processing of Ceramics for Space Structures

DTIC Science & Technology

1989-01-31

Surfaces, 9, 33-46 (1984). 5 18. R . H. Heistand, II, Y. Oguri, H. Okamura, W. C. Moffatt, B. Novich, E. A. Barringer , and H. K. Bowen, "Synthesis and...1983. E.A. Barringer , R . Brook, and H.K. Bowen, "The Sintering of Monodisperse TiO 2 " pp. 1-21 in Materials Science Research, Vol. 16. Edited by G.C...22a. NAME OF RESPONSIBLE INDIVIDUAL 22b. TELEPHONE (Include Area Code) 22c. OFFICE SYMBOL Donald R . Ulrich (202) 767-4963 1 Al 00 Form 1473, JUN 86

Foundation on Economic Trends v. Bowen.

PubMed

1989-10-04

The National Enviromental Policy Act requires that government agencies make a detailed enviromental impact statement (EIS) for all research significantly affecting the environment. These statements must be supplemented if the project substantially changes or if new information is obtained. The Foundation on Economic Trends argued that three developments in recombinant DNA research will significantly alter the enviromental impact, thereby mandating a new EIS by the National Institutes of Health (NIH). These developments are cloning oncogenic viruses, engineering the human immunodeficiency virus into cells not normally susceptible to it, and introducing AIDS genetic codes into mice. The U.S. District Court, District of Columbia, held that the first two projects do not pose a greater risk and that the enviromental assessment being prepared by NIH on the third satisfies the requirements of the National Enviromental Policy Act.

Genetics Home Reference: Bowen-Conradi syndrome

MedlinePlus

... Page Armistead J, Khatkar S, Meyer B, Mark BL, Patel N, Coghlan G, Lamont RE, Liu S, Wiechert J, ... or Free article on PubMed Central Armistead J, Patel N, Wu X, Hemming R, Chowdhury B, Basra ...

Multi-Satellite Estimates of Land-Surface Properties for Determination of Energy and Water Budgets

NASA Technical Reports Server (NTRS)

Menzel, W. Paul; Rabin, Robert M.; Neale, Christopher M. U.; Gallo, Kevin; Diak, George R.

1998-01-01

Using the WETNET database, existing methods for the estimation of surface wetness from SSM/I data have been assessed and further developed. A physical-statistical method for optimal estimation of daily surface heat flux and Bowen ratio on the mesoscale has been developed and tested. This method is based on observations of daytime planetary boundary layer (PBL) growth from operational ravansonde and daytime land-surface temperature amplitude from Geostationary Operational Environmental (GOES) satellites. The mesoscale patterns of these heat fluxes have been compared with an AVHRR-based vegetation index and surface wetness (separately estimated from SSM/I and in situ observations). Cases of the 1988 Midwest drought and a surface/atmosphere moisture gradient (dry-line) in the southern Plains were studied. The analyses revealed significant variations in sensible heat flux (S(sub 0), and Bowen ratio, B(sub 0)) associated with vegetation cover and antecedent precipitation. Relationships for surface heat flux (and Bowen ratio) from antecedent precipitation and vegetation index have been developed and compared to other findings. Results from this project are reported in the following reviewed literature.

Anorectal abscess

MedlinePlus

Anal abscess; Rectal abscess; Perirectal abscess; Perianal abscess; Gland abscess; Abscess - anorectal ... of anorectal abscess include: Blocked glands in the anal area Infection of an anal fissure Sexually transmitted ...

Comparison of two sampling techniques to assess quantity and distribution of Malassezia yeasts on the skin of Basset Hounds.

PubMed

Bensignor, E; Jankowski, F; Seewald, W; Touati, F; Deville, M; Guillot, J

2002-10-01

Cytological examination using the tape-strip technique and fungal culture using contact plates with modified Dixon's medium were compared to evaluate the carriage of Malassezia yeasts on four cutaneous sites (left pinna, umbilical region, axilla and perianal area) in adult Basset Hounds. Twenty animals were included in the study. High numbers of Malassezia were isolated from at least one area in 100% of the animals. The frequencies of isolation and population sizes differed significantly according to anatomical location. They were greater on the pinna, followed by the umbilical area, axilla and perianal area. Fungal culture was more sensitive than cytology for the isolation of Malassezia yeasts. Frequencies of isolation were greater using this method, but population sizes were constantly smaller than with cytology.

Squamous cell carcinoma of the anal sac in five dogs.

PubMed

Esplin, D G; Wilson, S R; Hullinger, G A

2003-05-01

Tumors of the perianal area of dogs are common and include multiple tumor types. Whereas perianal adenomas occur often, adenocarcinomas of the apocrine glands of the anal sac occur less frequently. A review of the literature revealed no reports of squamous cell carcinomas arising from the epithelial lining of the anal sac. Squamous cell carcinomas originating from the lining of the anal sac were diagnosed in five dogs. Microscopically, the tumors consisted of variably sized invasive nests and cords of epithelial cells displaying squamous differentiation. Four of the five dogs were euthanatized because of problems associated with local infiltration by the tumors. In the fifth dog, there was no evidence of tumor 7 months after surgical removal, but further follow up was not available.

Decreased CD8+CD28+/CD8+CD28- T cell ratio can sensitively predict poor outcome for patients with complicated Crohn disease.

PubMed

Dai, Shi-Xue; Gu, Hong-Xiang; Lin, Qian-Yi; Wu, Yan-Kun; Wang, Xiao-Yan; Huang, Shao-Zhuo; Xing, Tiao-Si; Chen, Min-Hua; Zhang, Qing-Fang; Zheng, Zhong-Wen; Sha, Wei-Hong

2017-06-01

Crohn disease (CD) with complications such as penetrating, stricturing, and perianal disease is called complicated CD. The aim of this study is to test the efficiency with which the CD8CD28/CD8CD28 cell balance can predict a subsequent active stage in patients with newly diagnosed complicated CD.Seventeen patients with complicated CD and 48 CD patients with no complications were enrolled. Blood CD8 T cells were tested from all of the 65 newly diagnosed CD patients upon enrollment. The potential risk factors were compared between the 2 groups. A 30-week follow-up was performed, and the efficiency of the CD8 cell balance at predicting active CD was analyzed using receiver-operating characteristic curves. The cumulative remission lasting rates (CRLRs) were analyzed using the Kaplan-Meier method.Compared with the control CD group, patients with complicated CD were predominantly male and younger in age; they also had lower body mass indices (BMIs), higher Crohn disease activity indices (CDAIs), higher immunosuppressant and steroid prescription rates, and significantly higher surgical rates. The CD8CD28/CD8CD28 balance was associated with BMI, CDAI, steroids, and surgery. The CD8CD28/CD8CD28 ratios were significantly lower at week 0 and on the 6th, 22nd, and 30th week during follow-up with a shorter lasting time of remission for the complicated CD patients. The CD8CD28/CD8CD28 ratio could accurately predict the active stage for the patients with complicated CD, and the highest sensitivity (89.2%) and specificity (85.3%) were found when the ratio was 1.03. Treatment with steroids and surgery, along with a significantly lower CD8CD28/CD8CD28 ratio and lower CRLRs, was closely related to a worse outcome for the patients with complicated CD.Patients requiring steroids and surgery experience more severe disease activity and thus a disequilibrated immunological balance, which could be the main reason for a decreased CD8CD28/CD8CD28 ratio. This ratio can sensitively predict the

Pigmented basal cell carcinoma mimicking a superficial spreading melanoma.

PubMed

Hasbún Acuña, Paula; Cullen Aravena, Roberto; Maturana Donaire, César; Ares Mora, Raúl; Porras Kusmanic, Ninoska

2016-12-20

Basal cell carcinoma is the most common form of skin cancer, especially in elderly people. Pigmented basal cell carcinoma is a rare subtype and has been described in the literature as a nodular and hyperpigmented lesion; rarely, it can appear as an extensive pigmented plate, which may be clinically indistinguishable from superficial spreading melanoma and Bowen disease. Dermatoscopy has a high sensitivity in the diagnosis of basal cell carcinoma. When Menzies criteria are used; however, the final diagnosis is made by histopathology. The objective of the present report is to analyze the case of a patient with pigmented basal cell carcinoma simulating a superficial spreading melanoma.

The use of infrared thermography to detect the stages of estrus cycle and ovulation time in anatolian shepherd dogs.

PubMed

Olğaç, Kemal Tuna; Akçay, Ergun; Çil, Beste; Uçar, Burak Mehmet; Daşkın, Ali

2017-01-01

The aim of the study is to evaluate the effectiveness of thermographic monitoring, using the temperature changes of perianal and perivulvar areas for the determination of estrus in Anatolian Shepherd bitches. Fifteen bitches were used in the study. Blood and vaginal smear samples were collected and thermographic monitoring of perianal and perivulvar areas were carried out starting from proestrus to early diestrus. Also, external signs of estrus were investigated. Smear samples were evaluated by light microscopy after Diff-Quik staining method and superficial and keratinized superficial cells were determined as percentage (S + KS%). Progesterone and luteinizing hormone measurements were done by radioimmunoassay. The difference in temperature between perianal and perivulvar areas was evaluated through thermographic images by FLIR ResearchIR Software. According to the results obtained from the study, differences between progesterone and S + KS% were statistically significant ( P  < 0,05). Although temperature showed increase and decrease with progesterone and S + KS%, the differences were not important statistically ( P  > 0,05). Serum luteinizing hormone levels did not sign any difference ( P  > 0,05). As a result, thermographic monitoring alone is not enough for estrus detection in Anatolian Shepherd bitches. However, it can be used to assist the actual estrus detection technique in terms of providing some foreknowledge by evaluating the differences in temperature.

Photodynamic Therapy and Skin Appendage Disorders: A Review

PubMed Central

Megna, Matteo; Fabbrocini, Gabriella; Marasca, Claudio; Monfrecola, Giuseppe

2017-01-01

Photodynamic therapy (PDT) is a noninvasive treatment that utilizes light treatment along with application of a photosensitizing agent. In dermatology, PDT is commonly used and approved for the treatment of oncological conditions such as actinic keratosis, Bowen disease and superficial basal cell carcinoma. In the last 2 decades however, PDT has also been used for the treatment of several nonneoplastic dermatological diseases. The present review summarizes published data on PDT application in skin appendage disorders. Our literature review shows that: (a) PDT may be a suitable treatment for acne, folliculitis decalvans, hidradenitis suppurativa, nail diseases, and sebaceous hyperplasia; (b) there is a lack of agreement on PDT features (type, concentrations and incubation period of used substances, number and frequency of PDT sessions, optimal parameters of light sources, and patient characteristics [e.g., failure to previous treatments, disease severity, body surface area involved, etc.] which should guide PDT use in these diseases); (c) further research is needed to establish international guidelines helping dermatologists to choose PDT for the right patient at the right time. PMID:28232927

Incidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific Crohn's and colitis epidemiology study.

PubMed

Ng, Siew C; Tang, Whitney; Ching, Jessica Y; Wong, May; Chow, Chung Mo; Hui, A J; Wong, T C; Leung, Vincent K; Tsang, Steve W; Yu, Hon Ho; Li, Mo Fong; Ng, Ka Kei; Kamm, Michael A; Studd, Corrie; Bell, Sally; Leong, Rupert; de Silva, H Janaka; Kasturiratne, Anuradhani; Mufeena, M N F; Ling, Khoon Lin; Ooi, Choon Jin; Tan, Poh Seng; Ong, David; Goh, Khean L; Hilmi, Ida; Pisespongsa, Pises; Manatsathit, Sathaporn; Rerknimitr, Rungsun; Aniwan, Satimai; Wang, Yu Fang; Ouyang, Qin; Zeng, Zhirong; Zhu, Zhenhua; Chen, Min Hu; Hu, Pin Jin; Wu, Kaichun; Wang, Xin; Simadibrata, Marcellus; Abdullah, Murdani; Wu, Justin Cy; Sung, Joseph J Y; Chan, Francis K L

2013-07-01

Inflammatory bowel diseases (IBD) are becoming more common in Asia, but epidemiologic data are lacking. The Asia-Pacific Crohn's and Colitis Epidemiology Study aimed to determine the incidence and phenotype of IBD in 8 countries across Asia and in Australia. We performed a prospective, population-based study of IBD incidence in predefined catchment areas, collecting data for 1 year, starting on April 1, 2011. New cases were ascertained from multiple overlapping sources and entered into a Web-based database. Cases were confirmed using standard criteria. Local endoscopy, pathology, and pharmacy records were searched to ensure completeness of case capture. We identified 419 new cases of IBD (232 of ulcerative colitis [UC], 166 of Crohn's disease [CD], and 21 IBD-undetermined). The crude annual overall incidence values per 100,000 individuals were 1.37 for IBD in Asia (95% confidence interval: 1.25-1.51; 0.76 for UC, 0.54 for CD, and 0.07 for IBD-undetermined) and 23.67 in Australia (95% confidence interval: 18.46-29.85; 7.33 for UC, 14.00 for CD, and 2.33 for IBD-undetermined). China had the highest incidence of IBD in Asia (3.44 per 100,000 individuals). The ratios of UC to CD were 2.0 in Asia and 0.5 in Australia. Median time from symptom onset to diagnosis was 5.5 months (interquartile range, 1.4-15 months). Complicated CD (stricturing, penetrating, or perianal disease) was more common in Asia than Australia (52% vs 24%; P = .001), and a family history of IBD was less common in Asia (3% vs 17%; P < .001). We performed a large-scale population-based study and found that although the incidence of IBD varies throughout Asia, it is still lower than in the West. IBD can be as severe or more severe in Asia than in the West. The emergence of IBD in Asia will result in the need for specific health care resources, and offers a unique opportunity to study etiologic factors in developing nations. Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights

KSC-2011-1511

NASA Image and Video Library

2011-02-20

CAPE CANAVERAL, Fla. -- At NASA's Kennedy Space Center in Florida, space shuttle Discovery's STS-133 Mission Specialist Steve Bowen arrives on the Shuttle Landing Facility runway aboard a T-38 jet. In the days leading up to their launch to the International Space Station, Bowen and his crew members will check the fit of their launch-and-entry suits, review launch-day procedures, receive weather briefings and remain medically quarantined to prevent sickness. Bowen replaces astronaut Tim Kopra, who was injured in a bicycle accident in January 2011. This will be the second launch attempt for Discovery's crew, following a scrub in November 2010 due to a hydrogen gas leak at the ground umbilical carrier plate (GUCP) as well as modifications to the external fuel tank's intertank support beams, called stringers. Scheduled to lift off Feb. 24 at 4:50 p.m. EST, Discovery and its crew will deliver the Permanent Multipurpose Module, packed with supplies and critical spare parts, as well as Robonaut 2, the dexterous humanoid astronaut helper, to the orbiting outpost. For more information on the STS-133 mission, visit www.nasa.gov/mission_pages/shuttle/shuttlemissions/sts133/. Photo credit: NASA/Kim Shiflett

[Anorectal manifestations of sexually transmitted infections].

PubMed

Lautenschlager, Stephan

2013-07-01

The incidence of sexually transmitted infections is rising in Europe and in Switzerland since the beginning of the third millenium. Many organisms may affect the perianal skin and the anorectum. While some of these infections are a result of contigous spread from genital infection, most result from receptive anal intercourse affecting males who have sex with males but is seen increasingly in females as well since there is evidence of the increasing popularity of anal sex among heterosexuals. The symptoms of specific infections are largely dependent on the route and site of inoculation. Organisms that cause typical genital symptoms - such as syphilis, chancroid, herpes simplex or HPV-infection - result in similar symptoms when the perianal skin, the anoderm or the distal anal canal are the site of infection. Patients with proctitis may have unspecific signs in various degrees including mucous discharge, rectal bleeding, anorectal pain, superficial ulcers and sometimes generalized lymphadenopathy and fever. It is of utmost importance to include STIs (e. g. lymphogranuloma venereum, gonorrhea, non-LGV-chlamydia and herpes simplex) in the differential diagnosis in these patients. Unfortunately rectal infection with chlamydia and gonorrhea is asymptomatic in the majority of cases of men having sex with men and in high-risk females. A careful history and physical examination is essential in establishing a correct diagnosis, usually supported by proctoscopy, culture, PCR, serology and histology. Certain organisms, more commonly thought of as food- or water-borne disease may be sexually transmitted by direct or indirect fecal-oral contact from various sexual practices.

Therapeutic management of anal eczema: an evidence-based review

PubMed Central

Havlickova, B; Weyandt, G H

2014-01-01

Aim To conduct a systematic review of treatments for anal eczema (AE). Methods We conducted a Medline search for clinical trial data for the treatment of perianal diseases including AE, including papers not published in the English language. We assessed the study reports using the system recommended by the Oxford Centre for Evidence-based Medicine. No meta-analysis was attempted. Results The evidence base for topical treatments used to treat AE is very poor: there are very few studies and many of those that exist are of poor quality. The best evidence was found for medications that are yet to be licensed for AE. Among products with existing licences for the treatment of eczema, our assessment found some evidence to support the continued use of mild-to-moderate corticosteroids first line in most patients. Discussion Features of the perianal region, and the fact that it is almost always occluded, mean that not all medications recommended in the general treatment guidelines for eczema are appropriate for AE. However, there are no specific treatment guidelines for these patients. This may in part be because of the lack of high-quality evidence-based medicine in this therapy area. Many frequently prescribed medications were developed and licensed many years ago, in an era when clinical trial design was not expected to be as rigorous as it is today. Conclusion This review highlights the need to conduct more high-quality clinical trials in patients with AE in order that specific guidelines for the management of this difficult proctological condition can be prepared. PMID:24898365

Traditional Chinese Medicine herbs for stopping bleeding from haemorrhoids.

PubMed

Gan, Tao; Liu, Yue-Dong; Wang, Yiping; Yang, Jinlin

2010-10-06

Haemorrhoids is a common perianal disease, which often causes haematochezia. Besides a surgical operation or minimally invasive treatment, a variety of traditional Chinese medicinal herbs (TCMHs) have been used to treat bleeding haemorrhoids. To assess the effectiveness of traditional Chinese medicinal herbs for stopping bleeding from haemorrhoids and the adverse effects caused by these herbs. We searched the Cochrane Colorectal Cancer Group Trials Register, Cochrane Central Register of Contolled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, CMCD (Chinese Medicine Conference Disc) and CBMD (Chinese Bio-Medicine Disc). All randomised clinical trials (RCTs) of Chinese herbs for bleeding haemorrhoids were included. Two authors independently extracted the data, which were analysed using RevMan 5.0 software. We estimated the relative risk for dichotomous data and calculated the weighted mean difference for continuous data. Nine trials involving 1822 patients with bleeding haemorrhoids were identified. The included trials were generally not of high quality and used one TCMH preparation compared with another TCMH preparation (Type I) (five trials) or western medicines (Type II) (four trials). We could not pool the data to perform a meta-analysis as only two of the included trials used the same intervention or comparison.In the nine trials, TCMHs showed a statistically significant difference for the improvement in the general curative effects or total grade of symptoms in six trials (P < 0.05; P < 0.01), of hematochezia in three trials (P < 0.05; P < 0.001), and of inflammation of perianal mucosa in one trial (P < 0.05). The adverse effects reported were not serious and were scarce. This review did not provide strong evidence concerning the effectiveness of TCMHs for stopping bleeding from haemorrhoids. Most of the included studies were of low quality and there was a scarcity of eligible trials and numbers of participants. Limited, weak evidence showed that

[Verification of the hygienic hypothesis by evaluating the regional incidence of eosinophilic pustular folliculitis].

PubMed

Nakashima, Daiki; Fukamachi, Akiko; Nakamura, Motonobu; Tokura, Yoshiki

2013-09-01

Eosinophilic pustular folliculitis (EPF) is a disorder associated with a high expression of interleukin-5 by T helper 2 cells. Treatment involving T helper 1 (Th1) modulation has been shown to be effective. We report that the occurrence of Bowen's disease in the medical care zone of the University of Occupational and Environmental Health in the Kitakyushu industrial area is more frequent in Yahatahigashi-ku, Yahatanishi-ku, and Wakamatsu-ku than in Tobata-ku, Kokurakita-ku, and Kokuraminamiku. We also show that these cases are more common in the regions with steel- and coal-related industries, which is suggestive of a higher rate of Th1 modulation associated with these occupations. Similarly, the incidence of EPF per unit population was found to be high in Tobata-ku and low in Yahatahigashi-ku, which indicates that EPF is a typical disease of hygiene hypothesis.

2. Historic American Buildings Survey, Laurence E. Tilley, Photographer April, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

2. Historic American Buildings Survey, Laurence E. Tilley, Photographer April, 1958 DINING ROOM SHOWING SOUTHEAST PARLOR THROUGH DOORWAY. - Isaac Bowen, Jr. House, 312 Benefit Street, Providence, Providence County, RI

[Significance of group A streptococcal infections in human pathology].

PubMed

Cvjetković, Dejan; Jovanović, Jovana; Hrnjaković-Cvjetković, Ivana; Aleksić-Dordević, Mirjana; Stefan-Mikić, Sandra

2008-01-01

Group A streptococci is the causative agent in 80 percents of human streptococcal infections. The only member of this group is Streptococcus pyogenes. CLINICALFEATURES OF GAS INFECTIONS: The various clinical entities and related complications caused by pyogenic streptococci are reviewed in the article. Pharyngitis, scarlet fever, skin and soft tissue infections (pyoderma, cellulitis, perianal dermatitis, necrotising fasciitis) and streptococcal toxic shock syndrome are described. The way of setting the diagnosis including epidemiological data, clinical features and the course of illness, laboratory findings and supportive diagnostic methods are represented in the article. The most important clinical entities which should be discussed in differential diagnosis of diseases caused by pyogenic streptococci are listed. The major principles of etiologic treatment through widely accepted strategies related to first choice antibiotics and alternatives are reviewed.

Ectopic cutaneous schistosomiasis-perigenital infiltrative granulomata in a 34-year-old French pregnant woman.

PubMed

Pistone, Thierry; Ezzedine, Khaled; Accoceberry, Isabelle; Receveur, Marie-Catherine; Juguet, Frédéric; Malvy, Denis

2008-05-01

Schistosomiasis, an infection with the three anthropophilic species of Schistosoma, is endemic throughout wide areas of the tropics and subtropics with an estimated rate of over 200 million people infected worldwide. Whereas symptoms and signs of vesical and gastrointestinal forms of the infection are recognized readily, cutaneous manifestations are still a challenging diagnosis particularly in Western countries. A case is described of a 34-year-old Caucasian pregnant woman who presented to our department and was diagnosed with a cutaneous schistosomiasis involvement of the perianal region. Shistosoma haematobium was shown to be present in the lesion by histopathology and was considered to be the causative organism of the disease. Treatment with a course of oral praziquantel in a dose of 40mg/kg allowed resolution of the symptoms.

New treatment options for inflammatory bowel diseases.

PubMed

Verstockt, Bram; Ferrante, Marc; Vermeire, Séverine; Van Assche, Gert

2018-05-01

The advent of anti-TNF agents has dramatically changed the treatment algorithms for IBD in the last 15 years, but primarily and more importantly secondary loss of response is often observed. Fortunately , new treatment options have been actively explored and some have already entered our clinical practice. In the class of anti-cytokine agents, the anti-IL12/IL23 monoclonal antibodies (mAbs) have entered clinical practice with the anti-p40 mAb ustekinumab in Crohn's disease (CD). Also, more selective anti-IL23 agents (anti-p19) have shown efficacy and are being further developed, in contrast to agents inhibiting IL-17 downstream which have failed in clinical trials despite their clear efficacy in psoriasis (Verstockt et al. in Expert Opin Biol Ther 17(1):31-47, 2017; Verstockt et al. in Expert Opin Drug Saf 16(7):809-821, 2017). Following up on the efficacy of the anti-adhesion molecule vedolizumab, etrolizumab (anti-beta-7 integrin) and PF-00547659, an anti-MadCam mAb, are being developed (Lobaton et al. in Aliment Pharmacol Ther 39(6):579-594, 2014). Oral anti-trafficking agents, such as ozanimod, targeting the S1P receptor responsible for the efflux of T-cells from the lymph nodes, have also shown efficacy in patients with ulcerative colitis (UC) (Sandborn et al. in N Engl J Med 374(18):1754-1762, 2016). Oral agents inhibiting cell signaling have been explored successfully in IBD. Tofacitinib, a non-selective oral Janus kinase (JAK) inhibitor, is effective in patients with UC and several other more or less selective Jak1, 2 and 3 inhibitors are being developed for the treatment of CD and UC (Sandborn et al. in N Engl J Med 376(18):1723-1736, 2017; Vermeire et al. in Lancet 389(10066):266-275, 2017; De Vries et al. in J Crohns Colitis 11(7):885-93, 2017). Finally, despite initial disappointing results with systemic administration of mesenchymal stem cells, Alofisel, adipose tissue derived, allogeneic mesenchymal stem cells, locally injected in perianal fistula

Postoperative pain after haemorrhoidectomy: role of impaired evacuation.

PubMed

Puigdollers, A; Cisternas, D; Azpiroz, F

2011-08-01

We hypothesized that obstructive defaecation is associated with more postoperative pain after haemorrhoidectomy. Fifty patients with grade IV haemorrhoids were included in a prospective study. Impaired evacuation was defined as the inability to evacuate a rectal balloon. Perianal sensitivity was evaluated by means of an algometer, and anxiety and depression were assessed by the hospital anxiety and depression (HAD) scale. Over the first 10 days after a Milligan-Morgan haemorrhoidectomy, the following parameters were measured on daily questionnaires: pain (associated with and unrelated to defaecation by means of visual analogue scales), number of bowel movements, faecal consistency and analgesic requirement on demand (tramadol 50 mg p.o., number of doses). Results are expressed as median and interquartile range or mean ± SE. Patients with impaired evacuation (14 women, eight men; age range 28-61 years) experienced more postoperative pain than patients with nonimpaired evacuation (eight women, 20 men; age range 24-70 years): 3.2 (2.1) vs 2.1 (1.8) defaecatory pain, respectively (P = 0.045), and 2.4 (2.3) vs 1.7 (2.3) nondefecatory pain, respectively (P = 0.048). There was no difference between the groups regarding stool consistency, number of bowel movements [12.5 (7.3) vs 15.5 (7.2), respectively; NS] and analgesic requirement [1.0 (6.1) vs 1.0 (5.2) extra doses on demand, respectively; NS] during the 10 postoperative days. No differences related to age, sex, HAD scores or perianal sensitivity were found. Impaired anal evacuation is predictive of postoperative pain after haemorrhoidectomy. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.

Tips for Postpartum Dads and Partners

MedlinePlus

... Blues: Partners Interview with Wade Bowen Coping with Suicide & Loss Tips for Postpartum Dads and Partners Pregnancy and postpartum mood and anxiety disorders affect the whole family. Here are some tips ...

The Use of Vedolizumab in Preventing Postoperative Recurrence of Crohn's Disease.

PubMed

Yamada, Akihiro; Komaki, Yuga; Patel, Nayan; Komaki, Fukiko; Pekow, Joel; Dalal, Sushila; Cohen, Russell D; Cannon, Lisa; Umanskiy, Konstantin; Smith, Radhika; Hurst, Roger; Hyman, Neil; Rubin, David T; Sakuraba, Atsushi

2018-02-15

Clinical and endoscopic recurrence are common after surgery in Crohn's disease (CD). Vedolizumab has been increasingly used to treat CD, however, its effectiveness in preventing postoperative recurrence remains unknown. We aimed to investigate the use of vedolizumab in the postoperative setting and compare the risk of recurrence between patients receiving vedolizumab and anti-tumor necrosis factor (TNF)-α agents. Medical records of CD patients who underwent surgery between April 2014 and June 2016 were reviewed. We first analyzed how frequently vedolizumab is used to prevent postoperative recurrence and compared the patient characteristics with those being treated with other therapies. Furthermore, the rates of endoscopic remission, defined as a simple endoscopic score for CD of 0, at 6-12 months after surgery were compared between patients receiving vedolizumab and anti-TNF-α agents. Clinical, biological, and histologic outcomes such as Harvey-Bradshaw index, C-reactive protein, and histologic inflammation also were compared between the 2 groups. Risks of recurrence were assessed by univariate, multivariate, and propensity score-matched analyses. Among 203 patients that underwent a CD related surgery, 22 patients received vedolizumab as postoperative treatment. There were 58, 38, and 16 patients who received anti-TNF-α agents, immunomodulators, and metronidazole, respectively, whereas 69 patients were monitored without any medication. Patients receiving vedolizumab were young and frequently had perianal disease. Patients postoperatively treated with vedolizumab or anti-TNF-α agents were mostly treated with the same agent pre- and postoperatively. Rate of endoscopic remission at 6-12 months in the vedolizumab group was 25%, which was significantly lower as compared to anti-TNF-α agent group (66%, P = 0.01). Vedolizumab use was the only factor that was associated with an increased risk of endoscopic recurrence on both univariate (odds ratio (OR) 5.58, 95

Tripartite differentiation (squamous, glandular, and melanocytic) of a primary cutaneous neuroendocrine carcinoma. An immunocytochemical and ultrastructural study.

PubMed

Isimbaldi, G; Sironi, M; Taccagni, G; Declich, P; Dell'Antonio, A; Galli, C

1993-06-01

We report a case of primary cutaneous neuroendocrine carcinoma (PCNEC) with squamous, glandular, and melanocytic differentiation and associated Bowen disease. The paranuclear globular positivity of low-molecular-weight cytokeratins agrees with the ultrastructural observations of paranuclear fibrous bodies in the small neuroendocrine cells, while the diffuse cytoplasmic positivity corresponds to the sparse intermediate filaments in large cells with squamous differentiation. "Transitional forms" are characterized by both diffuse and globular cytoplasmic positivity for cytokeratins and by the ultrastructural evidence of neuroendocrine and squamous features. Therefore the ultrastructural demonstration of intracytoplasmic tonofibrils and tonofilaments, intercellular glandular lumina, lined by well-formed microvilli, and immature premelanosomes in the neurosecretory cells supports the proposed tripartite differentiation of neuroendocrine cells of this case of PCNEC.

Health hazards and mitigation of chronic poisoning from arsenic in drinking water: Taiwan experiences.

PubMed

Chen, Chien-Jen

2014-01-01

There are two endemic areas of long-term exposure to arsenic from drinking water in Taiwan. Residents in the southwestern and northeastern endemic areas started using high-arsenic artesian well water in the early 1910s and late 1940s, respectively. Public water supply system using surface water was implemented in southwestern and northeastern endemic areas in the 1970s and 1990s, respectively. Systemic health hazards of long-term exposure to arsenic in drinking water have been intensively investigated since the 1960s, especially after 1985 in Taiwan. Several diseases have been well documented to be associated with chronic arsenic poisoning from drinking water showing a dose-response relation. They include characteristic skin lesions like hyperpigmentation or depigmentation, hyperkeratosis in palms and soles, and Bowen disease, peripheral vascular disease (specifically blackfoot disease), ischemic heart disease, cerebral infarction, microvascular diseases, abnormal peripheral microcirculation, carotid atherosclerosis, QT prolongation and increased dispersion in electrocardiography, hypertension, goiter, diabetes mellitus, cataract (specifically posterior subcapsular lens opacity), pterygium, slow neural conduction, retarded neurobehavioral development, erectile dysfunction, and cancers of the skin, lung, urinary bladder, kidney, and liver. The method of choice to mitigate arsenic poisoning through drinking water is to use safe drinking water from uncontaminated sources.

Epidemiology and genotypic characteristics of Methicillin-Resistant Staphylococcus aureus strains of porcine origin

USDA-ARS?s Scientific Manuscript database

The main goal of this study was to determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), particularly livestock-associated (LA)-MRSA in pigs and pork. Genotypic relatedness of isolates on-farm, at slaughter and retail was assessed. Paired nasal and peri-anal swab samples we...

Dermoscopy of keratinocyte skin cancer.

PubMed

Kupsa, Romana; Deinlein, Teresa; Woltsche, Nora; Hofmann-Wellenhof, Rainer; Zalaudek, Iris

2016-12-01

Keratinocyte skin cancer (KSC) refers to a broad class of tumors with a regrettably rising incidence worldwide. The term KSC stands for different stages of skin cancer including actinic keratosis (AK), Bowen's Disease (BD) and invasive squamous cell carcinoma (SCC). These tumors tend to grow slow, are unlikely to result in distant metastatic disease and death but they frequently destroy underlying tissues and should therefore be removed at the earliest possible stage. The fact that the cure rate is very high when KSC is detected in early stages emphasizes once more the applicability of dermoscopy as an integrative part of the clinical examination of skin tumors. In the first part of this review article, we summarize key points of the dermoscopic diagnosis of KSC including different stages of AK, BD and SCC. In the second part we want to focus on the progression model of KSC and the role of dermoscopy in the management of keratinocyte skin cancer.

Chronic arthritis of the hip joint: an unusual complication of an inadequately treated fistula-in-ano

PubMed Central

Raghunath, Rajat; Varghese, Gigi; Simon, Betty

2014-01-01

We report a case of chronic arthritis of the right hip joint in an otherwise healthy young male athlete as a complication of inadequately treated anal fistula. A young male athlete presented with symptoms of right hip pain and difficulty in walking and intermittent fever for 2 months. He had a history of perianal abscess drainage. On examination he was found to have a tender right hip joint with severe restriction of movements. He was also found to have a partially drained right ischiorectal abscess. X-ray and MRI of the hip joint revealed chronic arthritis of the right hip joint, which was communicating with a complex fistula-in-ano. He underwent a diversion sigmoid colostomy and right ischiorectal abscess drainage along with appropriate antibiotics with a plan for definitive hip joint procedure later. He was lost to follow-up and succumbed to severe perianal sepsis within a few months. PMID:25414226

Omentalization of cystic sublumbar lymph node metastases for long-term palliation of tenesmus and dysuria in a dog with anal sac adenocarcinoma.

PubMed

Hoelzler, M G; Bellah, J R; Donofro, M C

2001-12-15

A 13-year-old castrated male Bassett Hound was examined because of a 2-week history of severe constipation and tenesmus. Radiography revealed a large cystic mass in the caudal portion of the abdomen that was compressing the urethra and obstructing the pelvic canal. A small perianal mass was also noticed in the region of the left anal sac. Exploratory surgery was performed, but the mass was deemed unresectable. Instead, the mass was incised, drained, and omentalized in an attempt to establish continuous drainage after surgery. Cytologic evaluation of the perianal mass was consistent with a diagnosis of anal sac adenocarcinoma. Histologic evaluation of the abdominal mass revealed it was a lymph node effaced by adenocarcinoma. Despite the poor prognosis for anal sac adenocarcinoma with metastatic spread to the sublumbar lymph nodes, tenesmus and dysuria in this dog remained palliated until the dog's death 18 months after surgery. Omentalization was successful in providing a continuous method of fluid drainage for this cystopapillary abdominal tumor.

[A severe epicutaneous test reaction to the bufexamac in a hemorrhoidal therapeutic preparation].

PubMed

Bauer, A; Greif, C; Gebhardt, M; Elsner, P

1999-10-08

A 49-year-old woman presented with acute perianal vesicular/bullous contact dermatitis. Other areas were over the trunk, face, neck and wrists. She reported occasional application of an ointment (Mastu S) to treat her hemorrhoids. Patch tests (basic series, anal block, own ointment, local anesthetic, cosmetics) provoked strong vesicular and bullous reactions of persisting crescendo type, spreading far beyond the site of application, to Bufexamac, to a derivative of hydroxxamine acid, and to local applied ointment with mild or moderate antiinflammatory action. A week after the patch tests there was a flare-up of the previous foci of dermatitis. These reactions subsided two days later after intravenous injection of prednisolone. The skin lesions healed after rapid reduction of the systemic treatment and local application of corticosteroids, bathing with tanning substances and basic preparations. While Bufexamac is not absorbed when applied rectally, perianal contamination may not be avoidable on intra-anal application and can produce sensitization.

76 FR 34968 - Notice of Availability for Exclusive, Non-Exclusive, or Partially; Exclusive Licensing of an...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-15

... INFORMATION: The invention relates to a dynamic exoskeletal orthosis applied to the leg below the knee, designed to compensate for weakness, pain, and/or decreased range of motion at the ankle. Brenda S. Bowen...

Endoscopic management of Crohn’s strictures

PubMed Central

Bessissow, Talat; Reinglas, Jason; Aruljothy, Achuthan; Lakatos, Peter L; Van Assche, Gert

2018-01-01

Symptomatic intestinal strictures develop in more than one third of patients with Crohn’s disease (CD) within 10 years of disease onset. Strictures can be inflammatory, fibrotic or mixed and result in a significant decline in quality of life, frequently requiring surgery for palliation of symptoms. Patients under the age of 40 with perianal disease are more likely to suffer from disabling ileocolonic disease thus may have a greater risk for fibrostenotic strictures. Treatment options for fibrostenotic strictures are limited to endoscopic and surgical therapy. Endoscopic balloon dilatation (EBD) appears to be a safe, less invasive and effective alternative modality to replace or defer surgery. Serious complications are rare and occur in less than 3% of procedures. For non-complex strictures without adjacent fistulizaation or perforation that are less than 5 cm in length, EBD should be considered as first-line therapy. The aim of this review is to present the current literature on the endoscopic management of small bowel and colonic strictures in CD, which includes balloon dilatation, adjuvant techniques of intralesional injection of steroids and anti-tumor necrosis factor, and metal stent insertion. Short and long-term outcomes, complications and safety of EBD will be discussed. PMID:29740201

[Internal and external haemorrhoids].

PubMed

Schuurman, J P; Go, P M N Y H

2011-01-01

In this article, we present 3 cases of patients with different types of haemorrhoidal disease. The first patient is a 27-year-old woman who had been experiencing incidental rectal blood loss without pain during defecation for 3 months. The second patient is a 76-year-old woman who had been bothered by varying degrees of pain from a swelling nearby the anus for 1 year. The third case involves a 31-year-old man who had had continuous severe pain in the anal area for 3 consecutive days. The first patient appeared to have internal hemorrhoids, whereas different forms of external hemorrhoids affected the patients in the other 2 cases. Internal haemorrhoids develop from the intraluminal corpus cavernosum recti; external haemorrhoids from the perianal marginal veins. Patients with internal haemorrhoids present with symptoms that include blood loss and prolaps feeling during defecation. In patients with external haemorrhoids pain is the prominent symptom. Internal haemorrhoids are treated either conservatively or surgically, depending upon their severity. Considering external haemorrhoidal disease surgical treatment provides the most rapid and persistent relief of symptoms.

Anal carcinoma and HIV infection: is it time for screening?

PubMed

Herranz-Pinto, P; Sendagorta-Cudós, E; Bernardino-de la Serna, J I; Peña-Sánchez de Rivera, J M

2014-03-01

A 38-year-old white man had a 10-year history of human immunodeficiency virus (HIV) infection (A3), with no episodes of opportunistic diseases and in good immunologic recovery (CD4 cell count: 450 and indetectable HIV viral load) while on HAART. He presented with a two-month history of mild anal symptoms, including pruritus and episodic bleeding. He referred past episodes of anal warts, self-treated with several topical compounds, all proven unsuccessful. Perianal examination showed erythema and scratching. A 0.5cm sized tumor, with infiltration at the base was detected on digital exam, located at 15mm from the anal margin. Local biopsy driven by high-resolution anuscopy (AAR) yielded a final diagnosis of infiltrative epidermoid carcinoma. Might that neoplasia have been prevented? Copyright © 2013 Elsevier España, S.L. All rights reserved.

Development, evaluation and application of a modified micrometeorological gradient method for long-term estimation of gaseous dry deposition over forest canopies.

EPA Science Inventory

Small pollutant concentration gradients between levels above a plant canopy result in large uncertainties in estimated air–surface exchange fluxes when using existing micrometeorological gradient methods, including the aerodynamic gradient method (AGM) and the modified Bowen rati...

78 FR 77107 - Notice of Availability for Exclusive, Non-Exclusive, or Partially-Exclusive Licensing of an...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-20

... antibodies (and fragments thereof) suitable for use, for example, in reducing the risk of HIV-1 infection in... fragments. Brenda S. Bowen, Army Federal Register Liaison Officer. [FR Doc. 2013-30367 Filed 12-19-13; 8:45...

Genetics Home Reference: multiple familial trichoepithelioma

MedlinePlus

... 13. Citation on PubMed Bowen S, Gill M, Lee DA, Fisher G, Geronemus RG, Vazquez ME, Celebi JT. ... Fernandez-Figueras, Maria Tereza]. Citation on PubMed Lee DA, Grossman ME, Schneiderman P, Celebi JT. Genetics of ...

Genetics Home Reference: Brooke-Spiegler syndrome

MedlinePlus

... article on PubMed Central Bowen S, Gill M, Lee DA, Fisher G, Geronemus RG, Vazquez ME, Celebi JT. ... 124(5):919-20. Citation on PubMed Lee DA, Grossman ME, Schneiderman P, Celebi JT. Genetics of ...

Therapeutic value of trichloroacetic acid in the treatment of isolated genital warts on the external female genitalia.

PubMed

Taner, Zeki M; Taskiran, Cagatay; Onan, Anil M; Gursoy, Rifat; Himmetoglu, Ozdemir

2007-06-01

To evaluate the value of 85% trichloroacetic acid (TCA) in the treatment of human papillomavirus (HPV)-associated genital warts of the external genitalia and to detect the recurrence rate and side effects of this therapeutic regimen. All patients with a suspected HPV-related papillary vulvar lesion after initial examination underwent vulvoscopic evaluation with a magnification of 8-20x using acetic acid and toluidine blue. Under local anesthesia, biopsies were taken from acuminate or papillary warts for histopathologic confirmation and from suspicious areas to exclude preinvasive or invasive diseases. Following histopathologic diagnosis, patients were treated with 85% TCA. Overall, 51 patients with isolated vulvar and/or perianal genital warts were included. Of those patients, 11 (21.5%) had acuminate and 40 (78.5%) had papular genital warts. All the women had lesions of the labia minora. The other localizations were as follows: labia majora, 18 (35.3%); lateral vulva, 5 (9.8%); clitoris, 9 (17.6%); fourchette, 16 (31.3%); and perianal area, 7 (13.7%). All lesions were successfully treated by the end of the treatment period (median, 4; range 2-5). None of the patients had recurrence or new lesions during the 6-month follow-up period. In the second 6 months, 9 patients (17.6%) were diagnosed with recurrent lesions. Although all the patients experienced transient burning pain during therapy, none of them discontinued the therapy. Ulceration was observed in 8 patients (15.6%). Of those patients only 3 had permanent scarring (5.8%). We recommend the use of TCA in patients with external genital warts, especially for mild to moderate cases. It is associated with a high success rate and low morbidity if sufficient care is taken during application.

21 CFR 346.3 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-04-01

... receptors. (d) Astringent drug. A drug that is applied topically (externally) to the skin or mucous... anorectal drug product to the skin of the perianal area and/or the skin of the anal canal. (f) Intrarectal..., forming a protective coating over skin or mucous membranes. (j) Vasoconstrictor. A drug that causes...

21 CFR 346.3 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-04-01

... receptors. (d) Astringent drug. A drug that is applied topically (externally) to the skin or mucous... anorectal drug product to the skin of the perianal area and/or the skin of the anal canal. (f) Intrarectal..., forming a protective coating over skin or mucous membranes. (j) Vasoconstrictor. A drug that causes...

21 CFR 346.3 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-04-01

... receptors. (d) Astringent drug. A drug that is applied topically (externally) to the skin or mucous... anorectal drug product to the skin of the perianal area and/or the skin of the anal canal. (f) Intrarectal..., forming a protective coating over skin or mucous membranes. (j) Vasoconstrictor. A drug that causes...

A retrospective review of pain control by a two-step irradiance schedule during topical ALA-photodynamic therapy of non-melanoma skin cancer.

PubMed

Zeitouni, Nathalie C; Paquette, Anne D; Housel, Joseph P; Shi, Yi; Wilding, Gregory E; Foster, Thomas H; Henderson, Barbara W

2013-02-01

Photodynamic therapy (PDT) with topical δ-aminolevulinic acid (ALA) of non-melanoma skin cancers is often associated with treatment-limiting pain. A previous study on basal cell carcinomas (BCCs) at Roswell Park Cancer Institute evaluated a two-step irradiance scheme as a means of minimizing pain, preserving outcomes, and limiting treatment time. We used an initial low irradiance until 90% of the protoporphyrin IX was photobleached, followed by a high irradiance interval until the prescribed fluence was delivered. Success of this pilot investigation motivated integration of the protocol into routine practice. Here, we present a retrospective review of recent clinical experience in a broad patient population. This was a retrospective review of an existing dermatology database. Fourteen caucasion patients-nine men and five women, ages 18-80, with a total of 51 superficial and 73 nodular BCCs, and three Bowen's disease lesions-were included. ALA was applied to each lesion for approximately 4 hours. Lesions received an initial irradiance of 30-50 mW/cm(2) for 20 J/cm(2) , followed by 150 mW/cm(2) for a total fluence of 200-300 J/cm(2) . Pain was assessed using a visual analog scale (VAS). Clinical outcome was determined at 6-12 months. Median VAS scores were 1.0 for both irradiances. Five of 127 lesions required pain control with 1% xylocaine. Pain was strongly influenced by lesion location but not by lesion type, number, or size. Complete responses were achieved in 84.1% of BCCs, which compares favorably with reported results for single ALA-PDT treatments. Two of three Bowen's disease lesions showed a complete response. Complete responses for nodular BCCs were 37%, which are also within the range of reported outcomes. A two-step irradiance protocol in ALA-PDT effectively minimizes pain, maintains excellent clinical outcomes in superficial lesions, and adds minimal treatment time. Copyright © 2013 Wiley Periodicals, Inc.

A Retrospective Review of Pain Control by a Two-Step Irradiance Schedule During Topical ALA-Photodynamic Therapy of Non-melanoma Skin Cancer

PubMed Central

Zeitouni, Nathalie C.; Paquette, Anne D.; Housel, Joseph P.; Shi, Yi; Wilding, Gregory; Foster, Thomas H.; Henderson, Barbara W.

2013-01-01

Background and Objective Photodynamic therapy (PDT) with topical δ-aminolevulinic acid (ALA) of non-melanoma skin cancers is often associated with treatment-limiting pain. A previous study on basal cell carcinomas (BCCs) at Roswell Park Cancer Institute evaluated a two-step irradiance scheme as a means of minimizing pain, preserving outcomes, and limiting treatment time. We used an initial low irradiance until 90% of the protoporphyrin IX was photobleached, followed by a high irradiance interval until the prescribed fluence was delivered. Success of this pilot investigation motivated integration of the protocol into routine practice. Here we present a retrospective review of recent clinical experience in a broad patient population. Study Design/Materials and Methods This was a retrospective review of an existing dermatology data base. Fourteen caucasion patients - 9 men and 5 women, ages 18 to 80, with a total of 51 superficial and 73 nodular BCCs, and three Bowen's disease lesions – were included. ALA was applied to each lesion for approximately 4h. Lesions received an initial irradiance of 30 - 50 mW/cm2 for 20 J/cm2, followed by 150 mW/cm2 for a total fluence of 200-300 J/cm2. Pain was assessed using a visual analog scale (VAS). Clinical outcome was determined at 6-12 months. Results Median VAS scores were 1.0 for both irradiances. Five of 127 lesions required pain control with 1% xylocaine. Pain was strongly influenced by lesion location but not by lesion type, number, or size. Complete responses were achieved in 84.1% of BCCs, which compares favorably with reported results for single ALA-PDT treatments. Two of three Bowen's disease lesions showed a complete response. Complete responses for nodular BCCs were 37%, which are also within the range of reported outcomes. Conclusions A two-step irradiance protocol in ALA-PDT effectively minimizes pain, maintains excellent clinical outcomes in superficial lesions, and adds minimal treatment time. PMID:23390058

Decreasing trends in hospitalizations during anti-TNF therapy are associated with time to anti-TNF therapy: Results from two referral centres.

PubMed

Mandel, Michael D; Balint, Anita; Golovics, Petra A; Vegh, Zsuzsanna; Mohas, Anna; Szilagyi, Blanka; Szabo, Agnes; Kurti, Zsuzsanna; Kiss, Lajos S; Lovasz, Barbara D; Gecse, Krisztina B; Farkas, Klaudia; Molnar, Tamas; Lakatos, Peter L

2014-11-01

Hospitalization is an important outcome measure and a major driver of costs in patients with inflammatory bowel disease. We analysed medical and surgical hospitalization rates and predictors of hospitalization before and during anti-TNF therapy. Data from 194 consecutive patients were analysed retrospectively (males, 45.4%, median age at diagnosis, 24.0 years, infliximab/adalimumab: 144/50) in whom anti-TNF therapy was started after January 1, 2008. Total follow-up was 1874 patient-years and 474 patient-years with anti-TNF exposure. Hospitalization rates hospitalization decreased only in Crohn's disease (odds ratio: 0.59, 95% confidence interval: 0.51-0.70, median 2-years' anti-TNF exposure) with a same trend for surgical interventions (p=0.07), but not in ulcerative colitis. Need for hospitalization decreased in Crohn's disease with early (within 3-years from diagnosis, p=0.016 by McNemar test), but not late anti-TNF exposure. At logistic regression analysis complicated disease behaviour (p=0.03), concomitant azathioprine (p=0.02) use, but not anti-TNF type, gender, perianal disease or previous surgeries were associated with the risk of hospitalization during anti-TNF therapy. Hospitalization rate decreased significantly in patients with Crohn's disease but not ulcerative colitis after the introduction of anti-TNF therapy and was associated with time to therapy. Complicated disease phenotype and concomitant azathioprine use were additional factors defining the risk of hospitalization. Copyright © 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Mapping surface energy balance components by combining landsat thematic mapper and ground-based meteorological data

USGS Publications Warehouse

Moran, M.S.; Jackson, R. D.; Raymond, L.H.; Gay, L.W.; Slater, P.N.

1989-01-01

Surface energy balance components were evaluated by combining satellite-based spectral data with on-site measurements of solar irradiance, air temperature, wind speed, and vapor pressure. Maps of latent heat flux density (??E) and net radiant flux density (Rn) were produced using Landsat Thematic Mapper (TM) data for three dates: 23 July 1985, 5 April 1986, and 24 June 1986. On each date, a Bowen-ratio apparatus, located in a vegetated field, was used to measure ??E and Rn at a point within the field. Estimates of ??E and Rn were also obtained using radiometers aboard an aircraft flown at 150 m above ground level. The TM-based estimates differed from the Bowen-ratio and aircraft-based estimates by less than 12 % over mature fields of cotton, wheat, and alfalfa, where ??E and Rn ranged from 400 to 700 Wm-2. ?? 1989.

The role of thought suppression in the relation between mindfulness meditation and alcohol use

PubMed Central

Bowen, Sarah; Witkiewitz, Katie; Dillworth, Tiara M.; Marlatt, G. Alan

2007-01-01

Previous studies have demonstrated that attempts to suppress thoughts about using substances may actually lead to increases in substance use. Vipassana, a mindfulness meditation practice, emphasizes acceptance, rather than suppression, of unwanted thoughts. Bowen and colleagues (2006) studied the effects of a Vipassana course on substance use and in an incarcerated population, showing significant reductions in substance use among the Vipassana group as compared to a treatment as usual control condition (Bowen, Witkiewitz, Dillworth, Chawla, Simpson, Ostafin, et al., 2006). The current study further examines the mediating effects of thought suppression in the relationship between participation in the course and subsequent alcohol use in an incarcerated population. Those who participated in the course reported significant decreases in avoidance of thoughts when compared to controls. The decrease in avoidance partially mediated effects of the course on post-release alcohol use and consequences. PMID:17300875

Recommended documentation of evapotranspiration measurements and associated weather data and a review of requirements for accuracy

USDA-ARS?s Scientific Manuscript database

More and more evapotranspiration (ET) models, ET crop coefficients, and associated measurements of ET are reported in the literature. These measurements base from a range of measurement systems including lysimeters, eddy covariance, Bowen ratio, water balance (gravimetric, neutron meter, other soil ...

76 FR 38122 - Notice of Availability for Exclusive, Non-Exclusive, or Partially-Exclusive Licensing of an...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-29

... compounds have radical curative antimalarial activity. Brenda S. Bowen, Army Federal Register Liaison... Guanidylimidazoline Derivatives as Antimalarial Agents, Synthesis of and Methods of Use Thereof AGENCY: Department of... ``Guanidylimidazole and Guanidylimidazoline Derivatives as Antimalarial Agents, Synthesis of and Methods of Use...

Fecal bacterial communities of wild-captured and stranded green turtles (Chelonia mydas) on the Great Barrier Reef.

PubMed

Ahasan, Md Shamim; Waltzek, Thomas B; Huerlimann, Roger; Ariel, Ellen

2017-12-01

Green turtles (Chelonia mydas) are endangered marine herbivores that break down food particles, primarily sea grasses, through microbial fermentation. However, the microbial community and its role in health and disease is still largely unexplored. In this study, we investigated and compared the fecal bacterial communities of eight wild-captured green turtles to four stranded turtles in the central Great Barrier Reef regions that include Bowen and Townsville. We used high-throughput sequencing analysis targeting the hypervariable V1-V3 regions of the bacterial 16S rRNA gene. At the phylum level, Firmicutes predominated among wild-captured green turtles, followed by Bacteroidetes and Proteobacteria. In contrast, Proteobacteria (Gammaproteobacteria) was the most significantly dominant phylum among all stranded turtles, followed by Bacteroidetes and Firmicutes. In addition, Fusobacteria was also significantly abundant in stranded turtles. No significant differences were found between the wild-captured turtles in Bowen and Townsville. At the family level, the core bacterial community consisted of 25 families that were identified in both the wild-captured and stranded green turtles, while two unique sets of 14 families each were only found in stranded or wild-captured turtles. The predominance of Bacteroides in all groups indicates the importance of these bacteria in turtle gut health. In terms of bacterial diversity and richness, wild-captured green turtles showed a higher bacterial diversity and richness compared with stranded turtles. The marked differences in the bacterial communities between wild-captured and stranded turtles suggest the possible dysbiosis in stranded turtles in addition to potential causal agents. © FEMS 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

[Effectiveness of contemporary injection of botulinum toxin and topical application of glyceryl trinitrate against postoperative pain after Milligan-Morgan haemorrhoidectomy].

PubMed

Patti, Rosalia; Angileri, Mariangela; Migliore, Giovanni; Sammartano, Sergio; Termine, Stefania; Crivello, Floriana; Gioè, Franco Paolo; Di Vita, Gaetano

2006-01-01

After haemorrhoidectomy the maximum resting pressure (MRP) of the anal canal is significantly increased. This increase play an important role in the making of postoperative pain. Recently, both the topical application of glyceryl trinitrate (GT) and the intrasphincter injection of botulinum toxin (Tox), resulted effective, in reducing temporary the MRP although with different mechanism of action. In this study the effectiveness and safe of contemporary injection of Tox and topical application of 300 mg/die of GT after Milligan-Morgan haemorrhoidectomy, were evaluated. Ten patients, undergoing Milligan-Morgan haemorrhoidectomy for 3rd and 4th degree haemorrhoids are included in this study. In all subjects, preoperatively and after 5 and 40 day following surgery, an ano-rectal manometry was performed. At the end of surgery, in all patients, 0.4 ml of solution containing 20UI of Tox was injected and 100 mg of 0.2% of GT was applied in the anal canal and in the perianal wounds. Afterwards the patients has been instructed to apply 100 mg of GT three times daily, for seven days. Time of perianal wounds healing, of first defecation, to return to work, of duration of surgery, of hospital stay, the complications, postoperative pain either on resting or during defecation, the analgesic consumption and side effects were recordered. On the 5th and 40th postoperative day, the MRP resulted significantly reduced as compared to preoperative values. Postoperative pain either on resting or during defecation was higher on the 1st assessment, afterwards it progressively decreased. Anal incontinence was observed only in two patients, whereas headache only in one case. The contemporary intrasphincter injection of Tox and perianal application of 300 mg/die of GT is safe and effective, with an incidence of complications similar to those detected when this drugs are given alone.

Correlation of Propionibacterium acnes Populations with the Presence of Triglycerides on Nonhuman Skin

PubMed Central

Webster, Guy F.; Ruggieri, Michael R.; McGinley, Kenneth J.

1981-01-01

The skins of mice, rats, rabbits, sheep, guinea pigs, and dogs were cultured for Propionibacterium acnes. Only the sebaceous regions (perianal gland) of guinea pigs harbored a significant P. acnes population. Analysis of the lipid from this region revealed a significant percentage of triglycerides, compounds lacking in the sebum of the other animals. PMID:7259157

Syndrome in question.

PubMed

Wu, Yinhua; Qiao, Jianjun; Fang, Hong

2014-01-01

Vulvovaginal-gingival syndrome is characterized by erosions and desquamation of the vulva, vagina, and gingiva. We reported a case of a 32-year-old woman presenting with an 8-year history of damage to the vulval and perianal anatomy and limitation of mouth opening. The patient's symptoms were relieved after treatment with topical tacrolimus cream.

[Meningoradiculitis caused by herpes simplex virus type 2].

PubMed

Bollen, A E; Venema, A W; Veldkamp, K E

2007-10-27

A 24-year-old immune-competent woman was admitted to hospital with a three-day history of fever and headache. On examination bilateral facial nerve palsy, lumbosacral radicular pain, reduced sacral sensibility and urinary retention were found. Open perianal lesions were suspect for genital herpes. The symptoms were compatible with a meningoradiculitis including a sacral polyradiculitis. On testing, cerebrospinal fluid was found to be abnormal with a lymphocytic cell reaction. Polymerase chain reaction (PCR) of cerebrospinal fluid and of the perianal lesions was positive for herpes simplex virus type 2 (HSV-2). An MRI scan showed colouration of part of the cauda equina. The patient was treated by intravenous injections of acyclovir 10 mg/kg t.i.d. for 21 days, after which she completely recovered. HSV-2 infection of the nervous system can cause lymphocytic, and sometimes recurrent meningitis as well as sacral polyradiculitis. It may also occur without any symptomatic genital herpes infection. A positive result from a PCR test of the cerebrospinal fluid confirms this diagnosis. Treatment with acyclovir should be started as soon as possible.

Comparative analysis of the frequency, distribution and population sizes of yeasts associated with canine seborrheic dermatitis and healthy skin.

PubMed

Yurayart, Chompoonek; Chindamporn, Ariya; Suradhat, Sanipa; Tummaruk, Padet; Kajiwara, Susumu; Prapasarakul, Nuvee

2011-03-24

The purpose of this study was to investigate the diversity of yeast associated with the degree of canine seborrheic dermatitis (SD) by anatomical sites. Fifty-seven samples were divided as 17 healthy skin, 20 with primary seborrheic dermatitis (PSD), and 20 with secondary seborrheic dermatitis (SSD). Yeast isolation and characterization were carried out based on microscopical features and biochemical properties. DNA analysis at the internal transcribed spacer I of 26S rDNA region was utilized for species confirmation. Four species of yeast consisting Malassezia pachydermatis, Malassezia furfur, Candida parapsilosis and Candida tropicalis recovered from examined dogs. M. pachydermatis and C. parapsilosis were isolated from all dogs, but C. tropicalis and M. furfur were recovered from 3 healthy dogs and one diseased dog, respectively. The number of M. pachydermatis and C. parapsilosis in diseased dogs was higher than that of healthy specimens (P<0.01). High frequency and population size of C. parapsilosis were closely associated to PSD, while those of M. pachydermatis were associated with both PSD and SSD (P<0.01). C. parapsilosis were predominant at the perianal area. This study demonstrated the co-colonization of M. pachydermatis and C. parapsilosis in large amounts and frequency associated with stage of disease and anatomical site. Copyright © 2010 Elsevier B.V. All rights reserved.

75 FR 39667 - Availability for Non-Exclusive or Partially Exclusive Licensing of a U.S. Patent Application

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-12

..., which issued on December 15, 2009, entitled ``Use of Shigella Invaplex to Transport Functional Proteins... Functional Proteins and Transcriptionally Active Nucleic Acids Across Mammalian Cell Membranes In Vitro and... functional proteins and biologically active nucleic acids, across eukaryotic cell membranes. Brenda S. Bowen...

History of reference materials for food and nutrition metrology: As represented in the series of BERM Symposia

USDA-ARS?s Scientific Manuscript database

Establishment of a metrology-based measurement system requires the solid foundation of traceability of measurements to available, appropriate certified reference materials (CRM). In the early 1970s the first “biological” Reference Material (RM) of Bowens Kale, Orchard Leaves, and Bovine Liver from ...

Seasonal and interannual variability in surface energy partitioning and vegetation cover with grazing at shortgrass steppe

USDA-ARS?s Scientific Manuscript database

We evaluated shortgrass steppe energy budgets based on the Bowen Ratio Energy Balance method for three different grazing intensity treatments at the Central Plains Experimental Range Long-Term Ecological Research (CPER-LTER) site. We tested the correlations between aboveground biomass and surface en...

Family Counseling Interventions: Understanding Family Systems and the Referral Process.

ERIC Educational Resources Information Center

McWhirter, Ellen Hawley; And Others

1993-01-01

This article describes concepts underlying the idea of the "family as a system"; compares and contrasts four approaches to family therapy (those of Virginia Satir, Jay Haley, Murray Bowen, and Salvador Minuchin); and offers suggestions to teachers referring parents for family counseling. (DB)

Differentiation of Self and Spirituality: Empirical Explorations

ERIC Educational Resources Information Center

Jankowski, Peter J.; Vaughn, Marsha

2009-01-01

This study explored the relationships between an individual's interpersonal functioning, perceived spirituality, and selected spiritual practices. Using Bowen's family systems theory, the authors proposed that an individual's level of spiritual development and level of differentiation are correlated and that certain spiritual practices are…

Combination of photodynamic therapy and immunotherapy - evolving role in dermatology

NASA Astrophysics Data System (ADS)

Wang, Xiu-Li; Wang, Hong-Wei; Huang, Zheng

2008-02-01

Photodynamic therapy (PDT) is a promising treatment modality. It offers alternative options in the treatment of cancer and vascular diseases. In cancer treatment, PDT has been used primarily for localized superficial or endoluminal malignant and premalignant conditions. More recently, its application has also been expanded to solid tumors. However, its antitumor efficacy remains debatable and its acceptance still variable. Pre-clinical studies demonstrate that, in addition to the primary local cytotoxicity, PDT might induce secondary host immune responses, which may further enhance PDT's therapeutic effects on primary tumor as well as metastasis. Therefore, PDT-induced local and systemic antitumor immune response might play an important role in successful control of malignant diseases. Furthermore, PDT's antitumor efficacy might also be enhanced through an effective immunoadjuvant or immunomodulator. Our recent clinical data also indicate that improved clinical outcomes can be obtained by a combination of PDT and immunomodulation therapy for the treatment of pre-malignant skin diseases. For instance, the combination of topical ALA-PDT and Imiquimod is effective for the treatment of genital bowenoid papulosis. This presentation will also report our preliminary data in developing combination approaches of PDT and immunotherapy for actinic keratosis (AK), basal cell carcinomas (BCCs) and Bowen's disease.

Syndrome in question*

PubMed Central

Wu, Yinhua; Qiao, Jianjun; Fang, Hong

2014-01-01

Vulvovaginal-gingival syndrome is characterized by erosions and desquamation of the vulva, vagina, and gingiva. We reported a case of a 32-year-old woman presenting with an 8-year history of damage to the vulval and perianal anatomy and limitation of mouth opening. The patient's symptoms were relieved after treatment with topical tacrolimus cream. PMID:25184936

Global Effects of Superparameterization on Hydrothermal Land-Atmosphere Coupling on Multiple Timescales

NASA Astrophysics Data System (ADS)

Qin, Hongchen; Pritchard, Michael S.; Kooperman, Gabriel J.; Parishani, Hossein

2018-02-01

Many conventional General Circulation Models (GCMs) in the Global Land-Atmosphere Coupling Experiment (GLACE) tend to produce what is now recognized as overly strong land-atmosphere (L-A) coupling. We investigate the effects of cloud Superparameterization (SP) on L-A coupling on timescales beyond diurnal where it has been recently shown to have a favorable muting effect hydrologically. Using the Community Atmosphere Model v3.5 (CAM3.5) and its Superparameterized counterpart SPCAM3.5, we conducted soil moisture interference experiments following the GLACE and Atmospheric Model Intercomparison Project (AMIP) protocols. The results show that, on weekly-to-subseasonal timescales, SP also mutes hydrologic L-A coupling. This is detectable globally, and happens through the evapotranspiration-precipitation segment. But on seasonal timescales, SP does not exhibit detectable effects on hydrologic L-A coupling. Two robust regional effects of SP on thermal L-A coupling have also been explored. Over the Arabian Peninsula, SP reduces thermal L-A coupling through a straightforward control by mean rainfall reduction. More counterintuitively, over the Southwestern US and Northern Mexico, SP enhances the thermal L-A coupling in a way that is independent of rainfall and soil moisture. This signal is associated with a systematic and previously unrecognized effect of SP that produces an amplified Bowen ratio, and is detectable in multiple SP model versions and experiment designs. In addition to amplifying the present-day Bowen ratio, SP is found to amplify the climate sensitivity of Bowen ratio as well, which likely plays a role in influencing climate change predictions at the L-A interface.

Surface Meteorological Station - ANL 10m, (1) Sonics, (1) EBBR, Physics site-3 - Raw Data

DOE Data Explorer

Muradyan, Paytsar

2017-10-23

Sonic anemometers from Physics Site-3 and Site-9 provide wind components and virtual temperature. The energy balance Bowen ratio (EBBR) station at Physics site-3 provides measurements of the surface fluxes of latent and sensible heat, net radiation, and surface soil heat flux.

Surface Meteorological Station - ANL 10m, (1) Sonic, Physics site-9 - Raw Data

DOE Data Explorer

Muradyan, Paytsar

2017-10-23

Sonic anemometers from Physics Site-3 and Site-9 provide wind components and virtual temperature. The energy balance Bowen ratio (EBBR) station at Physics site-3 provides measurements of the surface fluxes of latent and sensible heat, net radiation, and surface soil heat flux.

Surface Meteorological Station - ANL 10m, (1) Sonics, (1) EBBR, Physics site-3 - Reviewed Data

DOE Data Explorer

Muradyan, Paytsar

2018-03-14

Sonic anemometers from Physics Site-3 and Site-9 provide wind components and virtual temperature. The energy balance Bowen ratio (EBBR) station at Physics site-3 provides measurements of the surface fluxes of latent and sensible heat, net radiation, and surface soil heat flux.

Surface Meteorological Station - ANL 10m, (1) Sonic, Physics site-9 - Reviewed Data

DOE Data Explorer

Muradyan, Paytsar

2018-03-14

Sonic anemometers from Physics Site-3 and Site-9 provide wind components and virtual temperature. The energy balance Bowen ratio (EBBR) station at Physics site-3 provides measurements of the surface fluxes of latent and sensible heat, net radiation, and surface soil heat flux.

78 FR 36683 - Radio Broadcasting Services; Summit, Mississippi

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-19

.... SUMMARY: In this document, the Audio Division, at the request of Bowen Broadcasting, allots FM Channel... Audio Division reclassifies Station WQUE-FM, New Orleans, Louisiana, to specify operation on FM Channel... Communications Commission. Nazifa Sawez, Assistant Chief, Audio Division, Media Bureau. For the reasons discussed...

BACTERIAL FLUX FROM CHAPARRAL INTO THE ATMOSPHERE IN MID-SUMMER AT A HIGH DESERT LOCATION

EPA Science Inventory

Estimates of the bacterial flux for a daylight cycle were observed at the Hanford Nuclear Reservation, Richland, WA, during June 1992, using a modified Bowen ratio method. he upward daytime bacterial flux was coupled with the solar radiation/sensible heat cycle, but commenced 2 h...

A Spatial View of the Interpersonal Structure of Family Interviews: Similarities and Differences Across Counselors.

ERIC Educational Resources Information Center

Friedlander, Myrna L.; Highlen, Pamela S.

1984-01-01

Examined the interpersonal structures of interviews by Ackerman, Bowen, Jackson, and Whitaker with the same family to identify common features across counselors. Multidimensional scaling provided a spatial representation of the hidden structure in the communication patterns of these interviews. Correlations indicated counselors' interactions were…

Measurement of sub-canopy evaporation in a flooded forest

USDA-ARS?s Scientific Manuscript database

Evapotranspiration is the dominant water efflux in many forested wetlands, but few studies have quantified the contribution of subcanopy evaporation. The goal of this study is to investigate the subcanopy energy balance to more fully understand physical controls over evaporation. We used Bowen ratio...

Collegiate Aviation Research and Education Solutions to Critical Safety Issues. UNO Aviation Monograph Series. UNOAI Report.

ERIC Educational Resources Information Center

Bowen, Brent, Ed.

This document contains four papers concerning collegiate aviation research and education solutions to critical safety issues. "Panel Proposal Titled Collegiate Aviation Research and Education Solutions to Critical Safety Issues for the Tim Forte Collegiate Aviation Safety Symposium" (Brent Bowen) presents proposals for panels on the…

Redefining Student Affairs through Digital Technology: A Ten-Year Historiography of Digital Technology Use by Student Affairs Administrators

ERIC Educational Resources Information Center

Cabellon, Edmund T.

2016-01-01

The student affairs profession is at a crossroads (Torres & Walbert, 2010) given digital technology's growth and the academy's administrative expansion (Bowen, 2013). Student affairs administrators must simultaneously respond to digital technology's implications in students' lives (Kirschner & Karpinski, 2010) and to new state and federal…

EXCHANGE PROCESSES OF VOLATILE ORGANIC COMPOUNDS ABOVE A TROPICAL RAIN FOREST: IMPLICATIONS FOR MODELING TROPOSPHERIC CHEMISTRY ABOVE DENSE VEGETATION

EPA Science Inventory

Measurements of bi-directional ammonia exchange over a fertilized soybean canopy are presented for an 8 week period during the summer of 2002. This modified Bowen-ratio approach was used to determine fluxes from vertical NH3 and temperature gradients in combination with eddy cova...

Teaching Mands for Information Using "When" to Children with Autism

ERIC Educational Resources Information Center

Landa, Robin K.; Hansen, Bethany; Shillingsburg, M. Alice

2017-01-01

Previous research has evaluated contrived motivating operations to teach mands for information. However, literature evaluating acquisition of the mand "when?" is comparatively limited. As an extension of Shillingsburg, Bowen, Valentino, & Pierce (2014), we taught three children with autism to engage in mands for information using…

Vulvar Lichen Sclerosus et Atrophicus

PubMed Central

Nair, Pragya Ashok

2017-01-01

Vulvar lichen sclerosus (VLS) is a chronic inflammatory dermatosis characterized by ivory-white plaques or patches with glistening surface commonly affecting the vulva and anus. Common symptoms are irritation, soreness, dyspareunia, dysuria, and urinary or fecal incontinence. Anogenital lichen sclerosus (LS) is characterized by porcelain-white atrophic plaques, which may become confluent extending around the vulval and perianal skin in a figure of eight configuration. Thinning and shrinkage of the genital area make coitus, urination, and defecation painful. LS is not uncommon in India and present as an itchy vulvar dermatosis which a gynecologist may mistake for candidal vulvovaginitis. There is often a delay in diagnosis of VLS due to its asymptomatic nature and lack of awareness in patients as well as physicians. Embarrassment of patients due to private nature of the disease and failure to examine the genital skin properly are the other reasons for delay in diagnosis. There is no curative treatment for LS. Various medications available only relieve the symptoms. Chronic nature of the disease affects the quality of life. Proper and regular follow-up is required as there are chances of the development of squamous cell carcinoma. PMID:28706405

Key Issue: Enhancing Teacher Leadership

ERIC Educational Resources Information Center

National Comprehensive Center for Teacher Quality, 2007

2007-01-01

"Teachers are leaders when they function in professional communities to affect student learning; contribute to school improvement; inspire excellence in practice; and empower stakeholders to participate in educational improvement" (Childs-Bowen, Moller, & Scrivner, 2000, p. 28). Enhancing teacher leadership can help schools and districts reach the…

Reference Materials for Food and Nutrition Metrology: Past, Present and Future

USDA-ARS?s Scientific Manuscript database

Establishment of a metrology-based measurement system requires the solid foundation of traceability of measurements to available, appropriate certified reference materials (CRM). In the early 1970’s the first “biological” RM of Bowens Kale, as well as Orchard Leaves and Bovine Liver SRMs, from the ...

75 FR 27736 - Availability for Non-Exclusive, Exclusive, or Partially Exclusive Licensing of U.S. Provisional...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-18

... Cooling Method for Protective Clothing Ensembles AGENCY: Department of the Army, DoD. ACTION: Notice... Protective Clothing Ensembles,'' filed March 30, 2010. The United States Government, as represented by the... to a two- stage evaporative cooling method for use in protective clothing ensembles. Brenda S. Bowen...

Interdistrict Magnet High School Students' Perceived Social Support: An Exploratory Investigation

ERIC Educational Resources Information Center

LaRocco, Diana J.; Fitzgerald, Jessica

2010-01-01

Magnet high school attendance seems to lead to improved academic performance (Cobb, Bifulco, & Bell, 2009; U.S. Department of Education, 2008; Yu & Taylor, 1997). Likewise, perceived social support has been linked with positive outcomes for adolescents, including improved academic performance (Rosenfeld, Richman, & Bowen, 2000; Demaray & Malecki,…

76 FR 38122 - Notice of Availability for Exclusive, Non-Exclusive, or Partially-Exclusive Licensing of an...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-29

... curative antimalarial activity. Brenda S. Bowen, Army Federal Register Liaison Officer. [FR Doc. 2011-16258... Derivatives as Antimalarial Agents, Synthesis of and Methods of Use Thereof AGENCY: Department of the Army, Do...-Imidazoline Derivatives as Antimalarial Agents, Synthesis and Methods of Use Thereof,'' filed on April 26...

Evapotranspiration under advective conditions.

PubMed

Figuerola, Patricia I; Berliner, Pedro R

2005-07-01

Arid and semi-arid regions are heterogeneous landscapes in which irrigated fields are surrounded by arid areas. The advection of sensible heat flux from dry surfaces is a significant source of energy that has to be taken into consideration when evaluating the evaporation from crops growing in these areas. The basic requirement of most of the common methods for estimating evapotranspiration [Bowen ratio, aerodynamic and Penman-Monteith (PM) equation] is that the horizontal fluxes of sensible and latent heat are negligible when compared to the corresponding vertical fluxes. We carried out measurements above an irrigated tomato field in a desert area. Latent and sensible heat fluxes were measured using a four-level Bowen machine with aspirated psychrometers. Our results indicate that under advective conditions only measurements carried out in the lowest layer are satisfactory for the estimation of latent heat fluxes and that the use of the PM equation with an appropriately parameterized canopy resistance may be preferable.

78 FR 44237 - Improving Government Regulations; Unified Agenda of Federal Regulatory and Deregulatory Actions

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-23

.... Brenda Bowen, telephone 703-428-6173, or write to the U.S. Army Records Management and Declassification..., Administration and Management. Defense Acquisition Regulations Council--Final Rule Stage Regulation Sequence No... Ownership of Offeror 0750-AH58 (DFARS Case 2011-D044). 120 Release of Fundamental 0750-AH92 Research...

77 FR 45575 - Agenda and Notice of Public Meeting of the Arkansas Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-01

... COMMISSION ON CIVIL RIGHTS Agenda and Notice of Public Meeting of the Arkansas Advisory Committee The original notice contains an error, the meeting location has changed. The meeting will not be held at the University of Little Rock Willliam H. Bowen School of Law Auditorium, 1201 McMath Avenue...

Outcomes Assessment--A New Era in Accreditation. The Proceedings of the Annual Convention of the Middle States Association of Colleges and Schools (93rd, Philadelphia, Pennsylvania, December 5-7, 1979).

ERIC Educational Resources Information Center

Middle States Association of Colleges and Schools, Philadelphia, PA.

Proceedings are presented of the 1979 meeting of the Middle States Association of Colleges and Schools, which includes speeches on outcomes assessment along with the business meeting of the Association. In the keynote address, "Outcomes Assessment--A New Era in Accreditation," Howard R. Bowen identifies goals an educational institution…

Psychological Models of the Impact of College on Students.

ERIC Educational Resources Information Center

Korn, Harold A.

Summary findings are presented on research about the impact of college in order to identify key issues related to understanding the lives of individual students. Five perspectives are offered: Bowen's outcomes and goals; Feldman and Newcomb's student personality, values, and beliefs; Pace's achievement testing; Astin's longitudinal studies; and…

The Differentiation of Self Inventory: Development and Initial Validation.

ERIC Educational Resources Information Center

Skowron, Elizabeth A.; Friedlander, Myrna L.

The development and initial validation of a new self-report instrument, the Differentiation of Self Inventory (DSI), are presented. The DSI represents the first attempt to create a multidimensional measure of differentiation based on Bowen Theory, focusing specifically on adults (aged over 25 years), their current significant relationships, and…

The Aeronautics Education, Research, and Industry Alliance (AERIAL) 2002 Report. UNO Aviation Monograph Series. UNOAI Report.

ERIC Educational Resources Information Center

Bowen, Brent D.; Box, Richard C.; Fink, Mary M.; Gogos, George; Lehrer, Henry R.; Narayanan, Ram M.; Nickerson, Jocelyn S.; O'Neil, Patrick D.; Tarry, Scott E.; Vlasek, Karisa D.

This document contains four papers on aeronautics education, research, and partnerships that partly supported through the Aeronautics Education, Research, and Industry Alliance (AERIAL). The paper "2002 AERIAL Monograph" (Brent D. Bowen, Jocelyn S. Nickerson, Mary M. Fink, et al.) presents an overview of research and development in the…

77 FR 783 - Notice of Availability for Exclusive, Non-Exclusive, or Partially-Exclusive Licensing of an...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-06

..., as represented by the Secretary of the Army, has rights to this invention. U.S. and selected foreign rights are available. ADDRESSES: Commander, U.S. Army Medical Research and Materiel Command, ATTN... the drug to a patient during real-time. Brenda S. Bowen, Army Federal Register Liaison Officer. [FR...

Faculty Perceptions of Division I Male Student-Athletes: The Relationship between Student-Athlete Contact, Athletic Department Involvement, and Perceptions of Intercollegiate Athletics

ERIC Educational Resources Information Center

Tovar, Elizabeth A.

2011-01-01

It has been widely recognized that student-athletes, especially in the sports of men's basketball and football, endure stereotyping (Bowen & Levin, 2003; Simons, Bosworth, Fujita, & Jensen, 2007, Baucom & Lantz, 2001). Although stereotypes about male basketball and football student-athletes academic behaviors are expressed by many sectors of the…

Lessons Learned: Reflections of a University President

ERIC Educational Resources Information Center

Bowen, William G.

2010-01-01

"Lessons Learned" gives unprecedented access to the university president's office, providing a unique set of reflections on the challenges involved in leading both research universities and liberal arts colleges. In this landmark book, William Bowen, former president of Princeton University and of the Andrew W. Mellon Foundation, and…

ALTA injection sclerosing therapy:non-excisional treatment of internal hemorrhoids.

PubMed

Miyamoto, Hidenori; Asanoma, Michihito; Miyamoto, Hideyuki; Shimada, Mitsuo

2012-01-01

Aluminum potassium sulfate and tannic acid (ALTA) is a new sclerosing therapy for internal hemorrhoids. This injection therapy is a four-step direct injection sclerosing procedure intended to shrink and harden internal hemorrhoids to eliminate hemorrhoidal prolapse and bleeding. The aim of this study was to assess the short term efficacy of this treatment. The procedure was conducted using a four-step injection process under perianal local anesthesia. The entry point for the four-step injection of ALTA is the submucosa of the superior pole, the submucosa in the central part, the mucous lamina propria in the central part and the submucosa at the inferior pole of hemorrhoid. From January 2009 to March 2010, we performed the ALTA sclerosing therapy on 28 patients (14 men and 14 women; mean age, 64.6 years), including 5 second-degree, 16 third-degree and 7 fourth-degree hemorrhoids. There were 6 postoperative complications (2 cases of low grade fever, 2 anal pains, 1 necrosis at injection site and 1 perianal dermatitis). All symptoms of prolapse or bleeding disappeared after 29 postoperative days. There were 3 recurrent cases (10.7%). ALTA sclerosing therapy is a useful and less invasive treatment for internal hemorrhoids.

Clinical use of a 15-W diode laser in small animal surgery: results in 30 varied procedures

NASA Astrophysics Data System (ADS)

Crowe, Dennis T.; Swalander, David; Hittenmiller, Donald; Newton, Jenifer

1999-06-01

The use of a 15-watt diode laser (CeramOptec)in 30 surgical procedures in dogs and cats was reviewed. Ease of use, operator safety, hemostasis control, wound healing, surgical time, complication rate, and pain control were observed and recorded. Procedures performed were partial pancreatectomy, nasal carcinoma ablation, medial meniscus channeling, perianal and anorectal mass removal (5), hemangioma and hemangiopericytoma removal from two legs, benign skin mass removal (7), liver lobectomy, partial prostatectomy, soft palate resection, partial arytenoidectomy, partial ablation of a thyroid carcinoma, photo-vaporization of the tumor bed following malignant tumor resection (4), neurosheath tumor removal from the tongue, tail sebaceous cyst resection, malignant mammary tumor and mast cell tumor removal. The laser was found to be very simple and safe to use. Hemostasis was excellent in all but the liver and prostate surgeries. The laser was particularly effective in preventing hemorrhage during perianal, anal, and tongue mass removal. It is estimated that a time and blood loss savings of 50% over that of conventional surgery occurred with the use of the laser. All external wounds made by laser appeared to heal faster and with less inflammation than those made with a conventional or electrosurgical scalpel.

Sources of sensitization, cross-reactions, and occupational sensitization to topical anaesthetics among general dermatology patients.

PubMed

Jussi, Liippo; Lammintausta, Kaija

2009-03-01

Contact sensitization to local anaesthetics is often from topical medicaments. Occupational sensitization to topical anaesthetics may occur in certain occupations. The aim of the study was to analyse the occurrence of contact sensitization to topical anaesthetics in general dermatology patients. Patch testing with topical anaesthetics was carried out in 620 patients. Possible sources of sensitization and the clinical histories of the patients are analysed. Positive patch test reactions to one or more topical anaesthetics were seen in 25/620 patients. Dibucaine reactions were most common (20/25), and lidocaine sensitization was seen in two patients. Six patients had reactions to ester-type and/or amide-type anaesthetics concurrently. Local preparations for perianal conditions were the most common sensitizers. One patient had developed occupational sensitization to procaine with multiple cross-reactions and with concurrent penicillin sensitization from procaine penicillin. Dibucaine-containing perianal medicaments are the major source of contact sensitization to topical anaesthetics. Although sensitization to multiple anaesthetics can be seen, cross-reactions are possible. Contact sensitization to lidocaine is not common, and possible cross-reactions should be determined when reactions to lidocaine are seen. Occupational procaine sensitization from veterinary medicaments is a risk among animal workers.

A Hermeneutic Phenomenological Study of Non-Completers in Online Doctor of Education Programs

ERIC Educational Resources Information Center

Wyman, Bernadette Marie

2012-01-01

The chance of an individual completing a traditional doctorate program is 50% (Bowen & Rudenstine, 1992; Council of Graduate Schools Ph.D. Completion Project, 2008; Ivankova & Stick, 2007). Student attrition in online programs is 10% to 20% greater than that of traditional, residential programs (Allen & Seaman, 2010; Carr, 2000; Diaz,…

Ethnic and Gender Differences in Science Graduation at Selective Colleges with Implications for Admission Policy and College Choice

ERIC Educational Resources Information Center

Smyth, Frederick L.; McArdle, John J.

2004-01-01

Using Bowen and Bok's data from 23 selective colleges, we fit multilevel logit models to test two hypotheses with implications for affirmative action and group differences in attainment of science, math, or engineering (SME) degrees. Hypothesis 1, that differences in precollege academic preparation will explain later SME graduation disparities,…

Partitioning evapotranspiration into evaporation and transpiration in a corn field

USDA-ARS?s Scientific Manuscript database

Evapotranspiration (ET) is a main component of the hydrology cycle. It consists of soil water evaporation (E) and plant transpiration (T). Accurate partitioning of ET into E and T is challenging. We measured soil water E using heat pulse sensors and a micro-Bowen ratio system, T using stem flow gaug...

Morphological Make-up as the Predictor of English Word Accent

ERIC Educational Resources Information Center

Salmani-Nodoushan, Mohammad Ali

2009-01-01

For years, phoneticians have tried to simplify pronunciation for EFL/ESL learners. Some have identified four degrees of primary, secondary, tertiary, and weak stress, and others only three degrees: primary, secondary, and weak. Still others have concentrated on two stress levels: accented versus unaccented, or stressed versus unstressed (Bowen,…

76 FR 45543 - Notice of Availability for Exclusive, Non-Exclusive, or Partially-Exclusive Licensing of U.S...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-29

... Polypeptide II, a Biomarker for Use in Diagnosis of Brain Injury,'' and U.S. Patent Application Serial No. 12... and Treatment of Brain Injury,'' filed August 19, 2010. The United States Government, as represented... type of brain injury. Brenda S. Bowen, Army Federal Register Liaison Officer. [FR Doc. 2011-19205 Filed...

A randomized, prospective, double-blind, placebo-controlled trial of the effect of a calcium channel blocker ointment on pain after hemorrhoidectomy.

PubMed

Silverman, Ralph; Bendick, Phillip J; Wasvary, Harry J

2005-10-01

Spasm of the internal sphincter plays a role in hemorrhoidal disease and may be a source of anal pain after hemorrhoid surgery. We have evaluated the effects of topical diltiazem, a calcium channel blocker, in reducing pain after hemorrhoidectomy. After hemorrhoidectomy, 18 patients were randomly assigned to receive 2 percent diltiazem ointment (n = 9) or a placebo ointment (n = 9). Ointments were applied to the perianal region three times daily for seven days. Patients were prescribed hydrocodone bitartrate (Vicodin) to take as needed. The type and number of prescribed or nonprescribed medications taken during the postoperative period were recorded. Patients maintained a log to measure postoperative pain daily and perceived benefit of the ointment, using a Visual Analog Scale ranging from 0 to 10. Any postoperative morbidity noted during the follow-up period was recorded. Patients using the diltiazem ointment had significantly less pain and greater benefit than those in the placebo group throughout the first postoperative week. Postoperative pain scores in the placebo group averaged 8.8 +/- 1.2 early and diminished to 5.2 +/- 1.7 at the end of one week, compared to the diltiazem group of 5.2 +/- 2.4 early and 2.3 +/- 1.2 at the end of one week (P < 0.001, both time periods). Perceived benefit in the placebo group averaged 2.7 +/- 1.2 vs. 5.6 +/- 1.4 in the diltiazem group (P < 0.001). Total and daily narcotic use was higher in the placebo group, but this was not statistically significant (P = 0.13). No differences in the frequency of use of nonsteroidal anti-inflammatory drugs and acetaminophen were seen between the two groups, and there were no differences in morbidity between the two groups. Perianal application of 2 percent diltiazem ointment after hemorrhoidectomy significantly reduces postoperative pain and is perceived as beneficial, with no increase in associated morbidity. Patients using a placebo ointment tend to take more prescription narcotics for pain

Inference of domain-disease associations from domain-protein, protein-disease and disease-disease relationships.

PubMed

Zhang, Wangshu; Coba, Marcelo P; Sun, Fengzhu

2016-01-11

Protein domains can be viewed as portable units of biological function that defines the functional properties of proteins. Therefore, if a protein is associated with a disease, protein domains might also be associated and define disease endophenotypes. However, knowledge about such domain-disease relationships is rarely available. Thus, identification of domains associated with human diseases would greatly improve our understanding of the mechanism of human complex diseases and further improve the prevention, diagnosis and treatment of these diseases. Based on phenotypic similarities among diseases, we first group diseases into overlapping modules. We then develop a framework to infer associations between domains and diseases through known relationships between diseases and modules, domains and proteins, as well as proteins and disease modules. Different methods including Association, Maximum likelihood estimation (MLE), Domain-disease pair exclusion analysis (DPEA), Bayesian, and Parsimonious explanation (PE) approaches are developed to predict domain-disease associations. We demonstrate the effectiveness of all the five approaches via a series of validation experiments, and show the robustness of the MLE, Bayesian and PE approaches to the involved parameters. We also study the effects of disease modularization in inferring novel domain-disease associations. Through validation, the AUC (Area Under the operating characteristic Curve) scores for Bayesian, MLE, DPEA, PE, and Association approaches are 0.86, 0.84, 0.83, 0.83 and 0.79, respectively, indicating the usefulness of these approaches for predicting domain-disease relationships. Finally, we choose the Bayesian approach to infer domains associated with two common diseases, Crohn's disease and type 2 diabetes. The Bayesian approach has the best performance for the inference of domain-disease relationships. The predicted landscape between domains and diseases provides a more detailed view about the disease

Primary Swenson's pull-through in children with chronic constipation: a preliminary report.

PubMed

Bakare Tajudeen, I B; Badmus, T A; Lawal, A O; Katung, A I

2010-01-01

The discrepancy in diameters of the resected ends coupled with the heavy faecal loads in the colon of chronically constipated children with Hirschsprung's disease makes definitive primary pull-through procedure quite difficulty in this group. Four consecutive patients (aged 5 months to 11 years) who presented with chronic constipation were given warm saline enema along with Castor oil per oram twice daily for 1 week before and 2 weeks after full-thickness biopsies that confirmed Hirschsprung's disease. All patients had intravenous Cefuroxime or Ceftriaxone plus Metronidazole at induction of anaesthesia. Intra-operatively, the levels of resections were 6-8 cm proximal to the most contractile part of the colon adjacent to the transition zone observed after complete division of mesenteric vessels. There were three males and one female, aged 5 months to 11 years. The levels of aganglionosis were in the rectosigmoid region, except one in the descending colon. There was one case each of anastomotic stenoses, mild enterocolitis and deep peri-anal excoriation. The bowel motions were two to four times daily within 1 month post-operatively. It can be concluded from this preliminary study that with pre-operative saline enema and oral Castor oil for about 3 weeks in chronically constipated children with Hirschsprung's disease primary pull-through procedures can be performed successfully. However, further prospective work is required with this method.

Comparative study between cold air analgesia and supraorbital and supratrochlear nerve block for the management of pain during photodynamic therapy for actinic keratoses of the frontotemporal zone.

PubMed

Serra-Guillen, C; Hueso, L; Nagore, E; Vila, M; Llombart, B; Requena Caballero, C; Botella-Estrada, R; Sanmartin, O; Alfaro-Rubio, A; Guillen, C

2009-08-01

Photodynamic therapy (PDT) is an effective treatment for actinic keratoses, Bowen's disease and basal cell carcinoma. The main drawback of PDT is pain during application. To compare the efficacy of supratrochlear and supraorbital nerve block with cold air analgesia to control the pain experienced during PDT. A controlled open clinical trial was conducted in 34 patients having multiple actinic keratoses in the frontal region treated with PDT. On one side of the frontal region the supratrochlear and supraorbital nerves were blocked, while on the other side cold air was used as the method of analgesia. Pain was recorded on a visual analogue scale after treatment. Thirty-one of 34 patients reported less pain in the zone treated with nerve block. This difference was statistically significant. Nerve block is superior to cold air and is an easy, safe, effective means of controlling the pain associated with PDT.

The expression of keratins, vimentin, neurofilament proteins, smooth muscle actin, neuron-specific enolase, and synaptophysin in tumors of the specific glands in the canine anal region.

PubMed

Vos, J H; van den Ingh, T S; Ramaekers, F C; Molenbeek, R F; de Neijs, M; van Mil, F N; Ivanyi, D

1993-07-01

Eight canine tumors originating from specific glandular structures in the anal region, as well as metastatic tumor tissue of two of these cases (case Nos. 7, 8), were immunohistochemically analyzed using various monoclonal antibodies (MoAbs) directed against human keratin types, vimentin, neurofilament proteins, and alpha-smooth muscle actin. These tumors also were stained for the broad-spectrum neuroendocrine markers neuron-specific enolase (NSE) and synaptophysin. In histologically normal canine anal structures, alpha-smooth muscle actin and NSE antibodies stained basally localized (probably myoepithelial) cells in the anal glands and the anal sac glands. NSE staining also was present in a limited number of luminal cells in both anal glands and anal sac glands. Synaptophysin labeling was not observed in any of these glandular structures. Histologically, the tumors were differentiated into well- and moderately differentiated perianal gland tumors (n = 5) and carcinomas without perianal gland differentiation (n = 3), corresponding to the so-called apocrine carcinomas of the anal region. Immunohistochemically, the perianal gland tumors could be differentiated from the carcinomas by marked differences in staining pattern with the various keratin MoAbs, particularly MoAbs directed against human keratin types 7 and 18. The keratin-staining characteristics of the carcinomas suggest a glandular luminal cell origin. Metastases of the carcinomas showed loss of some keratin-staining characteristics as compared with the primary tumor. Staining for NSE was only observed in solitary cells and small cell clusters in the carcinomas and their metastases, whereas the alpha-smooth muscle actin antibody did not react with the carcinoma cells. None of the tumors stained for neurofilament proteins or synaptophysin. An unequivocal neuroendocrine nature of the carcinomas could not be substantiated by our immunohistochemical study, although the presence of a population of neuroendocrine

The Wizards of Odds: Leadership Journeys of Education Deans.

ERIC Educational Resources Information Center

Bowen, Larry S., Ed.

This monograph contains reflections by current and former deans of schools of education on their experiences in providing leadership for change, their attempts at reform, their perceived successes and failures, and the lessons they learned. It opens with a preface by Larry S. Bowen describing the conference that led to the monograph, the…

75 FR 12597 - Endangered and Threatened Species; Proposed Listing of Nine Distinct Population Segments of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-16

... result in a significant gap in the range of the taxon; (c) evidence that the discrete segment represents... appear to have shaped the evolution of these two matriarchal lineages with the onset of glacial cycles...-directional invasion by the temperate-adapted loggerheads into the respective basins (Bowen et al., 1994; J.S...

NASA STS-132 Air and Space Museum

NASA Image and Video Library

2010-07-26

STS -132 astronauts from left, Steve Bowen, Tony Antonelli, Garrett Reisman, Ken Ham, Piers Sellers, and Michael Good are seen with students fromthe Summer of Innovation program following a presentation by the crew at the Smithsonian National Air and Space Museum, Tuesday, July 27, 2010, in Washington. Photo Credit: (NASA/Paul E. Alers)

The Teaching Naked Cycle: Technology Is a Tool, but Psychology Is the New Pedagogy

ERIC Educational Resources Information Center

Bowen, José Antonio

2014-01-01

This article by José Antonio Bowen was presented at the 2014 annual meeting of the "Association of American Colleges and Universities" where the discussion included the question of how technology was bringing new tools and new competition to higher education, but was also changing basic rules about how "we operate" as human…

Born Free but in Chains: Academic Freedom and Rights of Governance

ERIC Educational Resources Information Center

Academe, 2005

2005-01-01

This article presents the address delivered by Roger Bowen, American Association of University Professors' (AAUP) general secretary, last fall to the Coalition of Faculty Associations of Western New York. The AAUP's history could be rendered in a series of biographies about academic dissenters who dared to speak truth to power. His address centers…

Visual Impairment and Self-Esteem: What Makes a Difference?

ERIC Educational Resources Information Center

Bowen, Jayne

2010-01-01

This account follows on from the research report "Visual impairment and its impact on self-esteem" (Bowen, 2010) published in this journal. The original article reported the results of an investigation of self-esteem levels amongst a sample group of 60 children with visual impairment. Four children, whose self-esteem was measured as…

Goal Direction and Effectiveness, Emotional Maturity, and Nuclear Family Functioning

ERIC Educational Resources Information Center

Klever, Phillip

2009-01-01

Differentiation of self, a cornerstone concept in Bowen theory, has a profound influence over time on the functioning of the individual and his or her family unit. This 5-year longitudinal study tested this hypothesis with 50 developing nuclear families. The dimensions of differentiation of self that were examined were goal direction and…

Workpapers in Teaching English as a Second Language. Vol. 10.

ERIC Educational Resources Information Center

Povey, John, Ed.

This is the tenth annual issue of the UCLA TESL (teaching English as a second language) workpapers. It includes the following papers: (1) "An Attempt to Model the Role of Cognitions in Language Learning," by R.L. Allwright; (2) "A Comparison of Language Proficiency Tests," by J. Donald Bowen; (3) "Language Study Through…

Rainfall and evapotranspiration data for southwest Medina County, Texas, August 2006-December 2009

USGS Publications Warehouse

Slattery, Richard N.; Asquith, William H.; Ockerman, Darwin J.

2011-01-01

During August 2006-December 2009, the U.S. Geological Survey (USGS), in cooperation with the U.S. Army Corps of Engineers, Fort Worth District, collected rainfall and evapotranspiration data to help characterize the hydrology of the Nueces River Basin, Texas. The USGS installed and operated a station to collect continuous (30-minute interval) rainfall and evapotranspiration data in southwest Medina County approximately 14 miles southwest of D'Hanis, Texas, and 23 miles northwest of Pearsall, Texas. Rainfall data were collected by using an 8-inch tipping bucket raingage. Meteorological and surface-energy flux data used to calculate evapotranspiration were collected by using an extended Open Path Eddy Covariance system from Campbell Scientific, Inc. Data recorded by the system were used to calculate evapotranspiration by using the eddy covariance and Bowen ratio closure methods and to analyze the surface energy budget closure. During August 2006-December 2009 (excluding days of missing record), measured rainfall totaled 86.85 inches. In 2007, 2008, and 2009, annual rainfall totaled 40.98, 12.35, and 27.15 inches, respectively. The largest monthly rainfall total, 12.30 inches, occurred in July 2007. During August 2006-December 2009, evapotranspiration calculated by using the eddy covariance method totaled 69.91 inches. Annual evapotranspiration calculated by using the eddy covariance method totaled 34.62 inches in 2007, 15.24 inches in 2008, and 15.57 inches in 2009. During August 2006-December 2009, evapotranspiration calculated by using the Bowen ratio closure method (the more refined of the two datasets) totaled 68.33 inches. Annual evapotranspiration calculated by using the Bowen ratio closure method totaled 32.49, 15.54, and 15.80 inches in 2007, 2008, and 2009, respectively (excluding days of missing record).

EMG1 is essential for mouse pre-implantation embryo development.

PubMed

Wu, Xiaoli; Sandhu, Sumit; Patel, Nehal; Triggs-Raine, Barbara; Ding, Hao

2010-09-21

Essential for mitotic growth 1 (EMG1) is a highly conserved nucleolar protein identified in yeast to have a critical function in ribosome biogenesis. A mutation in the human EMG1 homolog causes Bowen-Conradi syndrome (BCS), a developmental disorder characterized by severe growth failure and psychomotor retardation leading to death in early childhood. To begin to understand the role of EMG1 in mammalian development, and how its deficiency could lead to Bowen-Conradi syndrome, we have used mouse as a model. The expression of Emg1 during mouse development was examined and mice carrying a null mutation for Emg1 were generated and characterized. Our studies indicated that Emg1 is broadly expressed during early mouse embryonic development. However, in late embryonic stages and during postnatal development, Emg1 exhibited specific expression patterns. To assess a developmental role for EMG1 in vivo, we exploited a mouse gene-targeting approach. Loss of EMG1 function in mice arrested embryonic development prior to the blastocyst stage. The arrested Emg1-/- embryos exhibited defects in early cell lineage-specification as well as in nucleologenesis. Further, loss of p53, which has been shown to rescue some phenotypes resulting from defects in ribosome biogenesis, failed to rescue the Emg1-/- pre-implantation lethality. Our data demonstrate that Emg1 is highly expressed during mouse embryonic development, and essential for mouse pre-implantation development. The absolute requirement for EMG1 in early embryonic development is consistent with its essential role in yeast. Further, our findings also lend support to the previous study that showed Bowen-Conradi syndrome results from a partial EMG1 deficiency. A complete deficiency would not be expected to be compatible with a live birth.

Investigating the mechanisms responsible for the lack of surface energy balance closure in a central Amazonian tropical rainforest

DOE PAGES

Gerken, Tobias; Ruddell, Benjamin L.; Fuentes, Jose D.; ...

2017-04-29

This work investigates the diurnal and seasonal behavior of the energy balance residual (E) that results from the observed difference between available energy and the turbulent fluxes of sensible heat (H) and latent heat (LE) at the FLUXNET BR-Ma2 site located in the Brazilian central Amazon rainforest. The behavior of E is analyzed by extending the eddy covariance averaging length from 30 min to 4 h and by applying an Information Flow Dynamical Process Network to diagnose processes and conditions affecting E across different seasons. Results show that the seasonal turbulent flux dynamics and the Bowen ratio are primarily drivenmore » by net radiation (R n), with substantial sub-seasonal variability. The Bowen ratio increased from 0.25 in April to 0.4 at the end of September. Extension of the averaging length from 0.5 (94.6% closure) to 4 h and thus inclusion of longer timescale eddies and mesoscale processes closes the energy balance and lead to an increase in the Bowen ratio, thus highlighting the importance of additional H to E. Information flow analysis reveals that the components of the energy balance explain between 25 and 40% of the total Shannon entropy with higher values during the wet season than the dry season. Dry season information flow from the buoyancy flux to E are 30–50% larger than that from H, indicating the potential importance of buoyancy fluxes to closing E. While the low closure highlights additional sources not captured in the flux data and random measurement errors contributing to E, the findings of the information flow and averaging length analysis are consistent with the impact of mesoscale circulations, which tend to transport more H than LE, on the lack of closure.« less

Investigating the mechanisms responsible for the lack of surface energy balance closure in a central Amazonian tropical rainforest

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gerken, Tobias; Ruddell, Benjamin L.; Fuentes, Jose D.

This work investigates the diurnal and seasonal behavior of the energy balance residual (E) that results from the observed difference between available energy and the turbulent fluxes of sensible heat (H) and latent heat (LE) at the FLUXNET BR-Ma2 site located in the Brazilian central Amazon rainforest. The behavior of E is analyzed by extending the eddy covariance averaging length from 30 min to 4 h and by applying an Information Flow Dynamical Process Network to diagnose processes and conditions affecting E across different seasons. Results show that the seasonal turbulent flux dynamics and the Bowen ratio are primarily drivenmore » by net radiation (R n), with substantial sub-seasonal variability. The Bowen ratio increased from 0.25 in April to 0.4 at the end of September. Extension of the averaging length from 0.5 (94.6% closure) to 4 h and thus inclusion of longer timescale eddies and mesoscale processes closes the energy balance and lead to an increase in the Bowen ratio, thus highlighting the importance of additional H to E. Information flow analysis reveals that the components of the energy balance explain between 25 and 40% of the total Shannon entropy with higher values during the wet season than the dry season. Dry season information flow from the buoyancy flux to E are 30–50% larger than that from H, indicating the potential importance of buoyancy fluxes to closing E. While the low closure highlights additional sources not captured in the flux data and random measurement errors contributing to E, the findings of the information flow and averaging length analysis are consistent with the impact of mesoscale circulations, which tend to transport more H than LE, on the lack of closure.« less

Puncture initial data for black-hole binaries with high spins and high boosts

NASA Astrophysics Data System (ADS)

Ruchlin, Ian; Healy, James; Lousto, Carlos O.; Zlochower, Yosef

2017-01-01

We solve the Hamiltonian and momentum constraints of general relativity for two black holes with nearly extremal spins and relativistic boosts in the puncture formalism. We use a non-conformally-flat ansatz with an attenuated superposition of two Lorentz-boosted, conformally Kerr or conformally Schwarzschild 3-metrics and their corresponding extrinsic curvatures. We compare evolutions of these data with the standard Bowen-York conformally flat ansatz (technically limited to intrinsic spins χ =S /MADM2=0.928 and boosts P /MADM=0.897 ), finding, typically, an order of magnitude smaller burst of spurious radiation and agreement with inspiral and merger. As a first case study, we evolve two equal-mass black holes from rest with an initial separation of d =12 M and spins χi=Si/mi2=0.99 , compute the waveforms produced by the collision, the energy and angular momentum radiated, and the recoil of the final remnant black hole. We find that the black-hole trajectories curve at close separations, leading to the radiation of angular momentum. We also study orbiting nonspinning and moderate-spin black-hole binaries and compare these with standard Bowen-York data. We find a substantial reduction in the nonphysical initial burst of radiation which leads to cleaner waveforms. Finally, we study the case of orbiting binary black-hole systems with spin magnitude χi=0.95 in an aligned configuration and compare waveform and final remnant results with those of the SXS Collaboration [54 A. H. Mroue et al., Phys. Rev. Lett. 111, 241104 (2013)., 10.1103/PhysRevLett.111.241104], finding excellent agreement. This represents the first moving puncture evolution of orbiting and spinning black holes exceeding the Bowen-York limit. Finally, we study different choices of the initial lapse and lapse evolution equation in the moving puncture approach to improve the accuracy and efficiency of the simulations.

Scaling up... : Professional Development to Serve Young Children in Chinese Welfare Institutions

ERIC Educational Resources Information Center

Edwards, Carolyn Pope; Cotton, Janice N.; Zhao, Wen; Muntaner-Gelabert, Jeronia

2010-01-01

In 1998 a group of American adoptive parents led by Jenny Bowen created Half the Sky Foundation (HTS) to provide nurturing care and education for children living in Chinese orphanages (known as children's welfare institutions). Jenny, a former screenwriter and film director, and her husband Richard wanted to ensure that the children still waiting…

Topical Therapy for non-invasive penile cancer (Tis)-updated results and toxicity.

PubMed

Manjunath, Aditya; Brenton, Thomas; Wylie, Sarah; Corbishley, Catherine M; Watkin, Nick A

2017-10-01

Penile cancer is a rare malignancy estimated to affect 26,000 men globally each year. The association with penile cancer, in particular non-invasive disease, and human papilloma virus (HPV) is well known. Ninety-five percent of cases of penile cancer are squamous cell carcinoma (SCC), which are staged using the TNM staging system. Terminology describing the histological appearance of non-invasive penile cancer has changed with all cases grouped under the umbrella term of penile intraepithelial neoplasia (PeIN); either undifferentiated or differentiated. This replaces previous terms such as carcinoma in situ (CIS) and eponymous names such as Bowen's disease. This change is recognised by the World Health Organisation (WHO). The topical treatments most commonly used for PeIN are 5-fluorouracil (5-FU) and imiquimod (IQ). Other treatments such as photodynamic therapy (PDT) are used but to a lesser degree. The evidence for all of these treatments is heterogenous with no randomised data available. Overall up to 57% complete response has been reported with a low number of serious adverse events. In this article, we aim to review the available evidence for the topical treatment of non-invasive penile cancer specifically regarding its efficacy and toxicity.

Photodynamic therapy (PDT) and photodiagnosis (PD) using endogenous photosensitization induced by 5-aminolevulinic acid (ALA): current clinical and development status

NASA Astrophysics Data System (ADS)

Marcus, Stuart L.; Sobel, Russel S.; Golub, Allyn L.; Carroll, Ronald L.; Lundahl, Scott L.; Shulman, D. Geoffrey

1996-04-01

Exogenous provision of ALA to many tissues results in the accumulation of sufficient quantities of the endogenous photosensitizer protoporphyrin IX, (PpIX), to produce a photodynamic effect. Therefore, ALA may be considered the only current PDT agent in clinical development which is a biochemical precursor of a photosensitizer. Topical ALA application, followed by exposure to activating light (ALA PDT), has been reported effective for the treatment of a variety of dermatologic diseases including cutaneous T-cell lymphoma, superficial basal cell carcinoma, Bowen's disease, and actinic (solar) keratoses, and is also being examined for treatment of acne and hirsutism. PpIX induced by ALA application also may serve as a fluorescence detection marker for photodiagnosis (PD) of malignant and pre- malignant conditions of the urinary bladder and other organs. Local internal application of ALA has also been used for selective endometrial ablation in animal model systems and is beginning to be examined in human clinical studies. Systemic, oral administration of ALA has been used for ALA PDT of superficial head and neck cancer, various gastrointestinal cancers, and the condition known as Barrett's esophagus. This brief paper reviews the current clinical and development status of ALA PDT.

Disease networks. Uncovering disease-disease relationships through the incomplete interactome.

PubMed

Menche, Jörg; Sharma, Amitabh; Kitsak, Maksim; Ghiassian, Susan Dina; Vidal, Marc; Loscalzo, Joseph; Barabási, Albert-László

2015-02-20

According to the disease module hypothesis, the cellular components associated with a disease segregate in the same neighborhood of the human interactome, the map of biologically relevant molecular interactions. Yet, given the incompleteness of the interactome and the limited knowledge of disease-associated genes, it is not obvious if the available data have sufficient coverage to map out modules associated with each disease. Here we derive mathematical conditions for the identifiability of disease modules and show that the network-based location of each disease module determines its pathobiological relationship to other diseases. For example, diseases with overlapping network modules show significant coexpression patterns, symptom similarity, and comorbidity, whereas diseases residing in separated network neighborhoods are phenotypically distinct. These tools represent an interactome-based platform to predict molecular commonalities between phenotypically related diseases, even if they do not share primary disease genes. Copyright © 2015, American Association for the Advancement of Science.

The Conference Proceedings of the 1998 Air Transport Research Group (ATRG) of the WCTR Society. Volume 4

NASA Technical Reports Server (NTRS)

Bowen, Brent D. (Editor); Oum, Tae Hoon (Editor)

1998-01-01

The Air Transport Research Group of the WCTR Society was formally launched as a special interest group at the 7h Triennial WCTR in Sydney, Australia in 1995. Since then, our membership base has expanded rapidly, and now includes over 400 active transportation researchers, policy-makers, industry executives, major corporations and research institutes from 28 countries. It became a tradition that the ATRG would hold an international conference at least once a year. In 1998, the ATRG organized a consecutive stream of 14 aviation sessions at the 8th Triennial WCTR Conference (July 12-17: Antwerp). Again, on 19-21 July, 1998, the ATRG Symposium was organized and executed every successfully by Dr. Aisling Reynolds-Feighan of the University College of Dublin. The Aviation Institute at the University of Nebraska at Omaha has published the Proceedings of the 1998 ATRG Dublin Symposium (being co-edited by Dr. Aisling Reynolds-Feighan and Professor Brent Bowen), and the Proceedings of the 1998 WCTR- ATRG Conference (being co-edited by Professors Tae H. Oum and Brent Bowen).

The Symposium Proceedings of the 1998 Air Transport Research Group (ATRG). Volume 2

NASA Technical Reports Server (NTRS)

Reynolds-Feighan, Aisling (Editor); Bowen, Brent D. (Editor)

1998-01-01

The Air Transport Research Group of the World Conference on Transportation Research (WCTR) Society was formally launched as a special interest group at the 7th Triennial WCTR in Sydney, Australia in 1995. Since then, our membership base has expanded rapidly, and now includes over 400 active transportation researchers, policy-makers, industry executives, major corporations and research institutes from 28 countries. It became a tradition that the ATRG would hold an international conference at least once a year. In 1998, the ATRG organized a consecutive stream of 14 aviation sessions at the 8th Triennial WCTR Conference (July 12-17: Antwerp). Again, on 19-21 July, 1998, the ATRG Symposium was organized and executed very successfully by Dr. Aisling Reynolds-Feighan of the University College of Dublin. The Aviation Institute at the University of Nebraska at Omaha has published the Proceedings of the 1998 ATRG Dublin Symposium (being co-edited by Dr. Aisling Reynolds-Feighan and Professor Brent Bowen), and the Proceedings of the 1998 WCTR-ATRG Conference (being co-edited by Professors Tae H. Oum and Brent Bowen).

People’s Republic of China Scientific Abstracts, Number 159

DTIC Science & Technology

1976-12-14

Sciences TITLE: "Early Mesozoic Ostracods From Some Localities in Southwest China" SOURCE: Peking KU-SHENG-WU HSUEH-PAO [ACTA PAIAEONTOLOGICA SINICA] in...analysis of 202 cases treated between 1971-1974 was made. The operative procedure was described in detail. Low sacral or local perianal anesthesia...made. During operation, anal skin bridges were preserved between the dissections. After operation long acting anesthetic compound was injected on the

Evolution of the HIV-1 Envelope Glycoprotein Genes and Neutralizing Antibody Response in an Individual with Broadly Cross Neutralizing Antibodies

DTIC Science & Technology

2010-08-31

genital fluids HIV -1 infected cells are present in more substantial numbers than free virus, and the former may account for the majority of...Severe acquired immunodeficiency in male homosexuals, manifested by chronic perianal ulcerative herpes simplex lesions. N Engl J Med 1981 , 305:1439...1994,179:463-472. 59. Miller CJ: Localization of Simian immunodeficiency virus-infected cells in the genital tract of male and female Rhesus macaques. J

Anal sac adenocarcinoma in a Siamese cat.

PubMed

Mellanby, R J; Foale, R; Friend, E; Woodger, N; Herrtage, M E; Dobson, J D

2002-12-01

A 12-year-old male neutered Siamese cat presented with a history of inappetance and lethargy and an enlarged left anal sac. The anal sac was surgically excised and histopathology confirmed the diagnosis of anal sac adenocarcinoma. Perianal tumours are rare in the cat and anal sac adenocarcinoma has not been previously reported. This is in contrast to the dog where anal sac adenocarcinoma is a well recognised albeit uncommon tumour.

An unusual encounter of an epidermoid cyst

PubMed Central

Sritharan, Kaji; Ghani, Yaser; Thompson, Hilary

2014-01-01

Epidermoid cysts are extremely common and can occur in any hair-containing area. We present the case of a 20-year-old man with an epidermoid cyst in the perianal region. Epidermal cysts have been described in this area previously after haemorrhoidectomy, but cysts of the size seen in this case are rare in the absence of previous anal trauma. The diagnosis was confirmed by excision biopsy. PMID:24825558

State of Flood Related Modeling Along Middle Rio Grande: Report Documentary 2007-2008 Work

DTIC Science & Technology

2010-07-01

Chile Peppers 3%Miscellaneous Vegetables2 4%Grain 4%Corn 35%Pasture Grass 53% Alfalfa PERCENTAGE OF TOTAL ACRES PLANTEDCROP 1 Chermak et al...Cottonwood/Willow/( Alfalfa ) Dense Saltcedar (~200 gal/plant-yr) Bowen Ratio Energy Balance -500 0 500 1000 E n e r g y F l u x ( W m - 2 ) 0 12 0

Crewmembers in Kibo following Hatch Opening

NASA Image and Video Library

2010-05-16

ISS023-E-041799 (16 May 2010) --- Soon after initial hatch opening, four STS-132 crew members and Russian cosmonaut Oleg Kotov (left), Expedition 23 commander, are pictured in the Kibo laboratory of the International Space Station. Pictured (front to back) are NASA astronauts Michael Good, mission specialist; Tony Antonelli, pilot; Steve Bowen and Piers Sellers, both mission specialists.

Translating Strategy, Values and Identities in Higher Education: The Case of Multi-Campus Systems

ERIC Educational Resources Information Center

Pinheiro, Rómulo; Charles, David; Jones, Glen

2017-01-01

Multi-campus university systems are not a new phenomenon. In their foundational analysis of multi-campus universities in the United States published in 1971, Lee and Bowen noted that almost 40% of American students were enroled in institutions that were part of multi-campus systems. The role of these complex multi-campus systems has continued to…

The Source of the River: The Social Origins of Freshmen at America's Selective Colleges and Universities

ERIC Educational Resources Information Center

Massey, Douglas S.; Charles, Camille Z.; Lundy, Garvey F.; Fischer, Mary J.

2006-01-01

African Americans and Latinos earn lower grades and drop out of college more often than whites or Asians. Yet thirty years after deliberate minority recruitment efforts began, we still don't know why. In "The Shape of the River," William Bowen and Derek Bok documented the benefits of affirmative action for minority students, their communities, and…

Family Systems Theory in the Workplace.

ERIC Educational Resources Information Center

Rogers, Vivian

This paper presents a summary of Murray Brown's family systems theory as it applies to the workplace, lists some indicators of when a system is working well, and cites some other guidelines for gauging and improving one's own functioning in the work system. Major concepts of Bowen's theory include: (1) the family and the workplace are systems; (2)…

Civilian First Responder Decontamination Equipment Characteristics Survey Results

DTIC Science & Technology

2010-01-01

EQUIPMENT CHARACTERISTICS SURVEY RESULTS Scott Kooistra Shawn Bowen John Walther PROGRAM INTEGRATION DIRECTORATE Michael B. DeZearn ENGINEERING...COVERED (From - To) Mar 2007-Feb 2008 4. TITLE AND SUBTITLE Civilian First Responder Decontamination Equipment Characteristics Survey Results 5a...Department of Homeland Security/National Institute of Standards and Technology (DHS/NIST) Standards Development Team to develop a survey to

The man behind the machine

NASA Astrophysics Data System (ADS)

Cerf, Vint

2018-01-01

As a practising computer scientist, I thought I had a fairly good grasp of Alan Turing’s many contributions to the field. But The Turing Guide by Jack Copeland, Jonathan Bowen, Mark Sprevak and Robin Wilson has opened up a universe of Turing's other pursuits I knew nothing about, inflating my admiration for him and his work.

Comparing the effect of An's Shaobei Injection ([symbols; see text]) with Xiaozhiling Injection ([symbols; see text]) in patients with internal hemorrhoids of grade I-III: a prospective cohort study.

PubMed

An, A-yue; Feng, Da-yong; Wang, Chun-hui; Shi, Yu-ying; Xiang, Jing-jing; Bai, Zhi-yong; Li, Kun-cheng; Liu, Jin-yang

2014-07-01

To compare the effect of An's Shaobei Injection ([symbols; see text]) with Xiaozhiling Injection ([symbols; see text]) in patients with internal hemorrhoids of grade I-III. This cohort study included 1,520 internal hemorrhoids patients with grade I-III who were scheduled for liquid injection treatment from July 2003 to July 2009. The cohort included patients who underwent either An's Shaobei Injection treatment (the treatment group, 760 cases) or Xiaozhiling Injection treatment (the control group, 760 cases). All patients were followed up regularly for 3 years; the observing indices included anal function recovery and clinical response after operation. Among the 1,520 patients, 1,508 (99.2%) completed the 3-year follow-up. The efficacy rate was 97.5% in the treatment group, significantly higher than the control group (91.8%, P<0.01). The recurrence rate in the treatment group was 0.5%, significantly lower than that of the control group (1.3%, P<0.01). In addition, perianal callosity occurred in 8 cases (1.1%) and anorectal stricture in 26 cases (3.5%) after operation in the control group. There was no perianal callosity and anorectal stricture in the treatment group. The treatment with An's Shaobei Injection demonstrated superior clinical effect to Xiaozhiling Injection with fewer adverse effects.

Biofeedback-guided pelvic floor exercise therapy for obstructive defecation: An effective alternative

PubMed Central

ba-bai-ke-re, Ma-Mu-Ti-Jiang A; Wen, Ni-Re; Hu, Yun-Long; Zhao, Liang; Tuxun, Tuerhongjiang; Husaiyin, Aierhati; Sailai, Yalikun; Abulimiti, Alimujiang; Wang, Yun-Hai; Yang, Peng

2014-01-01

AIM: To compare biofeedback-guided pelvic floor exercise therapy (BFT) with the use of oral polyethylene glycol (PEG) for the treatment of obstructive defecation. METHODS: A total of 88 subjects were assigned to treatment with either BFT (n = 44) or oral PEG (n = 44). Constipation symptoms (including difficult evacuation, hard stool, digitation necessity, incomplete emptying sensation, laxative dependence, perianal pain at defecation, and constipation satisfaction), Wexner Scores, and quality of life scores were assessed after 1, 3, and 6 mo. RESULTS: At the 6 mo follow-up, the symptoms of the BFT group patients showed significantly greater improvements compared with the PEG group regarding difficult evacuation, hard stools, digitation necessity, laxative dependence, perianal pain at defecation, constipation satisfaction, Wexner Constipation Score, and quality of life score (P < 0.05). The quality of life score of the BFT group at the final follow-up time (6 mo) was 80 ± 2.2. After a complete course of training, improvements in the clinical symptoms of the BFT group were markedly improved (P < 0.05), and the Wexner Constipation Scores were greatly decreased compared with the oral PEG group (P < 0.05). CONCLUSION: We concluded that manometric biofeedback-guided pelvic floor exercise training is superior to oral polyethylene glycol therapy for obstructive defecation. PMID:25083090

Biofeedback-guided pelvic floor exercise therapy for obstructive defecation: an effective alternative.

PubMed

Ba-Bai-Ke-Re, Ma-Mu-Ti-Jiang A; Wen, Ni-Re; Hu, Yun-Long; Zhao, Liang; Tuxun, Tuerhongjiang; Husaiyin, Aierhati; Sailai, Yalikun; Abulimiti, Alimujiang; Wang, Yun-Hai; Yang, Peng

2014-07-21

To compare biofeedback-guided pelvic floor exercise therapy (BFT) with the use of oral polyethylene glycol (PEG) for the treatment of obstructive defecation. A total of 88 subjects were assigned to treatment with either BFT (n = 44) or oral PEG (n = 44). Constipation symptoms (including difficult evacuation, hard stool, digitation necessity, incomplete emptying sensation, laxative dependence, perianal pain at defecation, and constipation satisfaction), Wexner Scores, and quality of life scores were assessed after 1, 3, and 6 mo. At the 6 mo follow-up, the symptoms of the BFT group patients showed significantly greater improvements compared with the PEG group regarding difficult evacuation, hard stools, digitation necessity, laxative dependence, perianal pain at defecation, constipation satisfaction, Wexner Constipation Score, and quality of life score (P < 0.05). The quality of life score of the BFT group at the final follow-up time (6 mo) was 80 ± 2.2. After a complete course of training, improvements in the clinical symptoms of the BFT group were markedly improved (P < 0.05), and the Wexner Constipation Scores were greatly decreased compared with the oral PEG group (P < 0.05). We concluded that manometric biofeedback-guided pelvic floor exercise training is superior to oral polyethylene glycol therapy for obstructive defecation.

Rectal cancer and Fournier’s gangrene - current knowledge and therapeutic options

PubMed Central

Bruketa, Tomislav; Majerovic, Matea; Augustin, Goran

2015-01-01

Fournier’s gangrene (FG) is a rapid progressive bacterial infection that involves the subcutaneous fascia and part of the deep fascia but spares the muscle in the scrotal, perianal and perineal region. The incidence has increased dramatically, while the reported incidence of rectal cancer-induced FG is unknown but is extremely low. Pathophysiology and clinical presentation of rectal cancer-induced FG per se does not differ from the other causes. Only rectal cancer-specific symptoms before presentation can lead to the diagnosis. The diagnosis of rectal cancer-induced FG should be excluded in every patient with blood on digital rectal examination, when urogenital and dermatological causes are excluded and when fever or sepsis of unknown origin is present with perianal symptomatology. Therapeutic options are more complex than for other forms of FG. First, the causative rectal tumor should be removed. The survival of patients with rectal cancer resection is reported as 100%, while with colostomy it is 80%. The preferred method of rectal resection has not been defined. Second, oncological treatment should be administered but the timing should be adjusted to the resolution of the FG and sometimes for the healing of plastic reconstructive procedures that are commonly needed for the reconstruction of large perineal, scrotal and lower abdominal wall defects. PMID:26290629

Cytogenetics of melanoma and nonmelanoma skin cancer.

PubMed

Carless, Melanie A; Griffiths, Lyn R

2014-01-01

Cytogenetic analysis of melanoma and nonmelanoma skin cancers has revealed recurrent aberrations, the frequency of which is reflective of malignant potential. Highly aberrant karyotypes are seen in melanoma, squamous cell carcinoma, actinic keratosis, Merkel cell carcinoma and cutaneous lymphomas with more stable karyotypes seen in basal cell carcinoma, keratoacanthoma, Bowen's disease and dermatofibrosarcoma protuberans. Some aberrations are common among a number of skin cancer types including rearrangements and numerical abnormalities of chromosome 1, -3p, +3q, partial or entire trisomy 6, trisomy 7, +8q, -9p, +9q, partial or entire loss of chromosome 10, -17p, +17q and partial or entire gain of chromosome 20. Combination of cytogenetic analysis with other molecular genetic techniques has enabled the identification of not only aberrant chromosomal regions, but also the genes that contribute to a malignant phenotype. This review provides a comprehensive summary of the pertinent cytogenetic aberrations associated with a variety of melanoma and nonmelanoma skin cancers.

Daylight-mediated photodynamic therapy in Spain: advantages and disadvantages.

PubMed

Pérez-Pérez, L; García-Gavín, J; Gilaberte, Y

2014-09-01

Photodynamic therapy (PDT) is an option for the treatment of actinic keratosis, Bowen disease, and certain types of basal cell carcinoma. It is also used to treat various other types of skin condition, including inflammatory and infectious disorders. The main disadvantages of PDT are the time it takes to administer (both for the patient and for health professionals) and the pain associated with treatment. Daylight-mediated PDT has recently been reported to be an alternative to the conventional approach. Several studies have shown it to be similar in efficacy to and better tolerated than classic PDT for the treatment of mild to moderate actinic keratosis. Nevertheless, most of these studies are from northern Europe, and no data have been reported from southern Europe. The present article reviews the main studies published to date, presents the treatment protocol, and summarizes our experience with a group of treated patients. Copyright © 2013 Elsevier España, S.L.U. y AEDV. All rights reserved.

Streptococcal infections in cats: ABCD guidelines on prevention and management.

PubMed

Frymus, Tadeusz; Addie, Diane D; Boucraut-Baralon, Corine; Egberink, Herman; Gruffydd-Jones, Tim; Hartmann, Katrin; Horzinek, Marian C; Hosie, Margaret J; Lloret, Albert; Lutz, Hans; Marsilio, Fulvio; Pennisi, Maria Grazia; Radford, Alan D; Thiry, Etienne; Truyen, Uwe; Möstl, Karin

2015-07-01

Streptococcus canis is most prevalent in cats, but recently S equi subsp zooepidemicus has been recognised as an emerging feline pathogen. S canis is considered part of the commensal mucosal microflora of the oral cavity, upper respiratory tract, genital organs and perianal region in cats. The prevalence of infection is higher in cats housed in groups; and, for example, there may be a high rate of vaginal carriage in young queens in breeding catteries. A wide spectrum of clinical disease is seen, encompassing neonatal septicaemia, upper respiratory tract disease, abscesses, pneumonia, osteomyelitis, polyarthritis, urogenital infections, septicaemia, sinusitis and meningitis. S equi subsp zooepidemicus is found in a wide range of species including cats. It was traditionally assumed that this bacterium played no role in disease of cats, but it is now considered a cause of respiratory disease with bronchopneumonia and pneumonia, as well as meningoencephalitis, often with a fatal course. Close confinement of cats, such as in shelters, appears to be a major risk factor. As horses are common carriers of this bacterium, contact with horses is a potential source of infection. Additionally, the possibility of indirect transmission needs to be considered. Streptococci can be detected by conventional culture techniques from swabs, bronchoalveolar lavage fluid or organ samples. Also real-time PCR can be used, and is more sensitive than culture. In suspected cases, treatment with broad-spectrum antibiotics should be initiated as soon as possible and, if appropriate, adapted to the results of culture and sensitivity tests. © Published by SAGE on behalf of ISFM and AAFP 2015.

[Surgical treatment of anal fistula].

PubMed

Zeng, Xiandong; Zhang, Yong

2014-12-01

Anal fistula is a common disease. It is also quite difficult to be solved without recurrence or damage to the anal sphincter. Several techniques have been described for the management of anal fistula, but there is no final conclusion of their application in the treatment. This article summarizes the history of anal fistula management, the current techniques available, and describes new technologies. Internet online searches were performed from the CNKI and Wanfang databases to identify articles about anal fistula management including seton, fistulotomy, fistulectomy, LIFT operation, biomaterial treatment and new technology application. Every fistula surgery technique has its own place, so it is reasonable to give comprehensive individualized treatment to different patients, which may lead to reduced recurrence and avoidance of damage to the anal sphincter. New technologies provide promising alternatives to traditional methods of management. Surgeons still need to focus on the invention and improvement of the minimally invasive techniques. Besides, a new therapeutic idea is worth to explore that the focus of surgical treatment should be transferred to prevention of the formation of anal fistula after perianal abscess.

[Acute periproctal abscesses].

PubMed

Slauf, P; Antoš, F; Marx, J

2014-04-01

Periproctal inflammations related to the anus are characterized by the rapid spread of the infection to the surrounding tissue, which is determined by the anatomical characteristics and infectious agents. Inflammation, which starts as a phlegmon, quickly forms boundaries and an abscess develops in most cases. Up to 80-90% of anorectal abscesses develop according to the crypto-glandular theory on the basis of infection of the anal glands, spilling into the Morgagni crypts in the anal canal. Up to two-thirds of such abscesses are associated with the emergence of anorectal fistulas. Anorectal abscesses can be divided into marginal and subcutaneous perianal abscesses, submucosal, intersphincteric, ischiorectal and supralevator abscesses. Their diagnosis is based on thorough physical examination, sometimes also with the help of imaging methods such as computed tomography, magnetic resonance imaging and endoanal ultrasound. What is decisive for the successful treatment of anorectal abscessess is their early and adequate surgical drainage. Adjuvant antibiotic therapy is necessary only when the overall signs of sepsis are present and for patients with a comorbidity such as diabetes, valvular heart disease, or immunodeficiency.

Management of rare, low anal anterior fistula exception to Goodsall's rule with Kṣārasūtra.

PubMed

Shindhe, Pradeep S

2014-01-01

Anal fistula (bhagandara) is a chronic inflammatory condition, a tubular structure opening in the ano-rectal canal at one end and surface of perineum/peri-anal skin on the other end. Typically, fistula has two openings, one internal and other external associated with chronic on/off pus discharge on/off pain, pruritis and sometimes passing of stool from external opening. This affects predominantly male patients due to various etiologies viz., repeated peri-anal infections, Crohn's disease, HIV infection, etc., Complex and atypical variety is encountered in very few patients, which require special treatment for cure. The condition poses difficulty for a surgeon in treating due to issues like patient hesitation, trouble in preparing kṣārasūtra, natural and routine infection with urine, stool etc., and dearth of surgical experts and technique. We would like to report a complex and atypical, single case of anterior, low anal fistula with tract reaching to median raphe of scrotum, which was managed successfully by limited application of kṣārasūtra.

Emborrhoid: A New Concept for the Treatment of Hemorrhoids with Arterial Embolization: The First 14 Cases

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vidal, V., E-mail: vincent.vidal@ap-hm.fr; Sapoval, M., E-mail: marc.sapoval@gmail.com; Sielezneff, Y., E-mail: igor.sielezneff@ap-hm.fr

2015-02-15

PurposeThe ‘emborrhoid’ technique consists of the embolization of the hemorrhoidal arteries. The endovascular arterial occlusion is performed using coils placed in the terminal branches of the superior rectal arteries. The emborrhoid technique has been modeled after elective transanal Doppler-guided hemorrhoidal artery ligation which has been shown to be effective in hemorrhoidal disease. We report the first 14 cases of our experience with emborrhoid technique.Materials and MethodsFourteen patients with disabling chronic rectal bleeding were treated using the emborrhoid technique (3 women, 11 men). The stage of the hemorrhoidal disease was II (10 patients), III (3), and IV (1). This treatment wasmore » decided by a multidisciplinary team (proctologist, visceral surgeon, and radiologist). Seven patients underwent previous proctological surgery. Ten patients had coagulation disorders (anticoagulants or cirrhosis). Superior rectal arteries were embolized with pushable microcoils (0.018).ResultsTechnical success of the embolization procedure was 100 %. Clinical success at 1 month was 72 % (10/14). Of the 4 patients who experienced rebleeding, two underwent additional embolization of the posterior rectal arteries with success. No pain or ischemic complications were observed in 13 patients. One patient experienced a temporary painful and edematous, perianal reaction.ConclusionOur case studies suggest that coil embolization of the superior rectal arteries is technically feasible, safe and well tolerated. Additional studies are needed to evaluate the efficacy of this new ‘emborrhoid’ technique in the management of hemorrhoidal disease.« less

Hand-to-Hand Combat and the Use of Combatives Skills: An Analysis of United States Army Post Combat Surveys from 2004-2008

DTIC Science & Technology

2014-11-19

to develop virtual environments for practicing stress management skills with military personnel prior to deployment. Cyberpsychology , Behavior , and... Social Networking , 13, 83-94. doi: 10.1089=cyber.2009.0336 Bowen, G. A. (2009). Document analysis as a qualitative research method. Qualitative... Behavioral Science and Leadership, was very helpful in providing insight and advice as the project progressed. Matt Larsen, US Army (Retired), former

STS-133 Crew Meets with President Obama

NASA Image and Video Library

2011-05-09

STS-133 Commander Steven Lindsey, far left, presents a montage to President Barack Obama as crew members Michael Barratt, Pilot Eric Boe, Nicole Stott, and Stephen Bowen look on during a visit to the Oval Office in the White House, Monday, May 9, 2011, in Washington. Also in attendance but not seen, was Mission Specialist Alvin Drew. Photo Credit: (NASA/Paul E. Alers)

Some Important Diseases of Tree Fruits - Diseases of Vegetable Crops - Diseases of Grapes - Diseases of Tree Nuts.

ERIC Educational Resources Information Center

Petersen, Donald H.; And Others

This agriculture extension service publication from Pennsylvania State University consists of four sections on plant disease recognition and control. The titles of these four sections are: (1) Some Important Diseases of Tree Fruits; (2) Diseases of Vegetable Crops; (3) Diseases of Crops; and (4) Diseases of Tree Nuts. The first section discusses…

Renal disease in patients with celiac disease.

PubMed

Boonpheng, Boonphiphop; Cheungpasitporn, Wisit; Wijarnpreecha, Karn

2018-04-01

Celiac disease, an inflammatory disease of small bowel caused by sensitivity to dietary gluten and related protein, affects approximately 0.5-1% of the population in the Western world. Extra-intestinal symptoms and associated diseases are increasingly recognized including diabetes mellitus type 1, thyroid disease, dermatitis herpetiformis and ataxia. There have also been a number of reports of various types of renal involvement in patients with celiac disease including diabetes nephropathy, IgA nephropathy, membranous nephropathy, membranoproliferative glomerulonephritis, nephrotic syndrome related to malabsorption, oxalate nephropathy, and associations of celiac disease with chronic kidney disease and end-stage kidney disease. This review aims to present the current literature on possible pathologic mechanisms underlying renal disease in patients with celiac disease.

Silicone rubber band treatment of rectal prolapse.

PubMed

Jackaman, F R; Francis, J N; Hopkinson, B R

1980-09-01

Fifty-two patients with rectal prolapse have been treated by the silicone rubber band perianal suture technique and satisfactory results have been obtained in 46 (89%). Eleven patients required reoperation to achieve this result. The procedure is a minor one, with little morbidity and no mortality. Provided that faecal impaction can be avoided in patients having this operation a successful outcome, can be expected. It is recommended especially for the frail and elderly with rectal prolapse.

Silicone rubber band treatment of rectal prolapse.

PubMed Central

Jackaman, F. R.; Francis, J. N.; Hopkinson, B. R.

1980-01-01

Fifty-two patients with rectal prolapse have been treated by the silicone rubber band perianal suture technique and satisfactory results have been obtained in 46 (89%). Eleven patients required reoperation to achieve this result. The procedure is a minor one, with little morbidity and no mortality. Provided that faecal impaction can be avoided in patients having this operation a successful outcome, can be expected. It is recommended especially for the frail and elderly with rectal prolapse. PMID:7002011

Soil water dynamics and evapotranspiration in alpine ecosystems in the NE of Qinghai-Tibet Plateau, China

NASA Astrophysics Data System (ADS)

Li, Xiao-Yan; Zhang, Si-Yi; Ma, Yu-Jun

2015-04-01

Interactions between surface energy flux, evapotranspiration and soil water were poorly understood in the alpine ecosystems in the Qinghai-Tibet Plateau, which is a sensitive and vulnerable region to global climate change. For the first time, we continuously measured surface energy flux and soil water content (SWC) and estimated ET using bowen ratio energy balance method in the Qinghai Lake watershed, located in the northeast of Qinghai-Tibet Plateau between 2012 and 2013. The three ecosystems were Kobresia meadow (KMd.), Potentilla fruticosa shrub (PFSh.) and Achnatherum splendens steppe (ASSt.). Results indicated that there was a good negative correlation between ecosystem Bowen ratios and SWC in the growing season for the three ecosystems. Annual ET at KMd. and PFSh. was 16% and 3% less than local annual precipitation, while that at ASSt. was 26% larger than annual precipitation. Average annual ET was 507.9, 493.2 and 413.7 mm at PFSh., KMd. and ASSt., respectively. Fluctuations of daily ET at alpine ecosystems were primarily controlled by solar radiation, especially in the growing season, whereas, at ASSt. where precipitation and SWC was limited, ET was also controlled by water supply.

Inflammatory bowel disease and airway diseases.

PubMed

Vutcovici, Maria; Brassard, Paul; Bitton, Alain

2016-09-14

Airway diseases are the most commonly described lung manifestations of inflammatory bowel disease (IBD). However, the similarities in disease pathogenesis and the sharing of important environmental risk factors and genetic susceptibility suggest that there is a complex interplay between IBD and airway diseases. Recent evidence of IBD occurrence among patients with airway diseases and the higher than estimated prevalence of subclinical airway injuries among IBD patients support the hypothesis of a two-way association. Future research efforts should be directed toward further exploration of this association, as airway diseases are highly prevalent conditions with a substantial public health impact.

[Periodontal disease in pediatric rheumatic diseases].

PubMed

Fabri, Gisele M C; Savioli, Cynthia; Siqueira, José T; Campos, Lucia M; Bonfá, Eloisa; Silva, Clovis A

2014-01-01

Gingivitis and periodontitis are immunoinflammatory periodontal diseases characterized by chronic localized infections usually associated with insidious inflammation This narrative review discusses periodontal diseases and mechanisms influencing the immune response and autoimmunity in pediatric rheumatic diseases (PRD), particularly juvenile idiopathic arthritis (JIA), childhood-onset systemic lupus erythematosus (C-SLE) and juvenile dermatomyositis (JDM). Gingivitis was more frequently observed in these diseases compared to health controls, whereas periodontitis was a rare finding. In JIA patients, gingivitis and periodontitis were related to mechanical factors, chronic arthritis with functional disability, dysregulation of the immunoinflammatory response, diet and drugs, mainly corticosteroids and cyclosporine. In C-SLE, gingivitis was associated with longer disease period, high doses of corticosteroids, B-cell hyperactivation and immunoglobulin G elevation. There are scarce data on periodontal diseases in JDM population, and a unique gingival pattern, characterized by gingival erythema, capillary dilation and bush-loop formation, was observed in active patients. In conclusion, gingivitis was the most common periodontal disease in PRD. The observed association with disease activity reinforces the need for future studies to determine if resolution of this complication will influence disease course or severity. Copyright © 2014 Elsevier Editora Ltda. All rights reserved.

Critical Design Parameters for Pylon-Aided Gaseous Fuel Injection Upstream of a Flameholding Cavity

DTIC Science & Technology

2009-03-01

Spencer Bowen and Neil Rogers was critical to not only the successful completion of this research but my sanity as well. The care, support, and motivation...missile presents a relatively inexpensive alternative that while complex is much more feasible to achieve in the near term. The hypersonic bomber and...scramjet engine operates supersonically throughout. Though aerodynamically complex the scramjet engine is relatively simple, consisting of an inlet

JPRS Report. Soviet Union Foreign Military Review, No. 2, February 1989.

DTIC Science & Technology

1989-08-11

phenomena in ethnic relationships in the period of stagnation engen - dered problems retarding the development of Soviet society and degrading Armed Forces...and ventilation systems for purifying external air entering the manned compartment when crossing areas of radioactive or chemical contamination. The...Machinery Chemical Corporation (over 800 produced), and from 1971 through 1983 by Bowen-McLaughlin- York (1,018 vehicles). In addition to the U.S

List of U.S. Army Research Institute Research and Technical Publications. Fiscal Year 2006

DTIC Science & Technology

2007-08-01

performance support systems and computer-generated simulations powered by artificial intelligence , and super-broad bandwidth. We then present a set of...dialogue, Artificial Intelligence SBIR Phase I Report 61 FY 2006 Books and Book Chapters Durlach, P.J., Neuman, J.L., & Bowens, L.D...mediation of the social intelligence -social performance relationship by social knowledge, was supported for three out of five social performance

Improving surface stability of elevated spoil landforms using natural landform analogy and geological information

NASA Astrophysics Data System (ADS)

Emmerton, Bevan; Burgess, Jon; Esterle, Joan; Erskine, Peter; Baumgartl, Thomas

2017-04-01

Large-scale open cut mining in the Bowen Basin, Queensland, Australia has undergone an evolutionary process over the period of a few decades, transitioning from shallow mining depths, limited spoil elevation and pasture based rehabilitation to increased mining depths, escalating pre-stripping, elevated mesa-like landforms and native woody species rehabilitation. As a consequence of this development, the stabilisation of recent constructed landforms has to be assured through means other than the establishment of vegetative cover. Recent developments are the specific selection and partitioning of resilient fragmental spoil types for the construction of final landform surface. They can also be used as cladding resources for stabilizing steep erosive batters and this has been identified as a practical methodology that has the potential to significantly improve rehabilitation outcomes. Examples of improvements are an increase of the surface rock cover, roughness and infiltration and reducing inherent erodibility and runoff and velocity of surface flow. However, a thorough understanding of the properties and behavior of individual spoil materials disturbed during mining is required. Relevant information from published literature on the geological origins, lithology and weathering characteristics of individual strata within the Bowen Basin Coal Measures located in Queensland, Australia (and younger overlying weathered strata) has been studied, and related both to natural landforms and to the surface stability of major strata types when disturbed by mining. The resulting spoil classification developed from this study is based primarily on inherent geological characteristics and weathering behaviour of identifiable lithologic components, and as such describes the expected fragmental resilience likely within disturbed materials at Bowen Basin coal mines. The proposed classification system allows the allocation of spoil types to use categories which have application in pre

Impacts of large scale afforestation on regional climate: a case study in the Kubuqi Desert, Inner Mongolia based on WRF model

NASA Astrophysics Data System (ADS)

Wang, L.; Lin, G.; Feng, D.; Chen, S.; Schultz, N. M.; Fu, C.; Wei, Z.; Yin, C.; Wang, W.; Lee, X.

2017-12-01

To better design climate mitigation strategies, it is important to understand the response of regional climatic indicators and related biophysical forcings to large scale afforestation projects. The response of surface temperature (Ts) caused by afforestation activities in the Kubuqi Desert, Inner Mongolia, China is simulated by the weather research and forecasting (WRF) model and the temperature changes (ΔTs) are decomposed into contributions from changes in surface albedo, surface roughness, Bowen ratio and ground heat flux using the intrinsic biophysical mechanism (IBPM). The 30-m resolution land cover maps of the Kubuqi Desert corresponding to 2000 and 2010 conditions are analyzed and the major land use changes are found to be an increase in the area of grassland (6%) and shrubland (15%), but a decrease in the area of bare land (21%) owed to the aerial seeding afforestation activities organized by Elion Resources Group, Co. and local government agencies. Our WRF simulations show that during winter, the increased cover of vegetation mainly has a warming effect (0.38 K) in the daytime due to the changes in albedo (0.24 K) and Bowen ratio (0.15 K). In the nighttime, the vegetation has a slight warming effect (0.2 K) mainly caused by energy redistribution associated with roughness change (0.2 K) as a result of vegetation turbulence, which brought heat from aloft to the surface. Although both roughness change (-0.35 K) and Bowen ratio change (-0.35 K) have cooling effects during summer days, the warming effect caused by radiative forcing (0.93 K) dominates the ΔTs. During summer nights, the change in surface temperature is not significant. Our findings demonstrate that the large-scale afforestation project in the Kubuqi Desert during a decade alters the regional surface temperature and the analysis of biophysical forcings changes using WRF simulation provides useful information for developing climate change mitigation strategies in semi-arid and arid regions.

[Enterobiasis among schoolchildren in a rural population from Estado Falcón, Venezuela, and its relation with socioeconomic level].

PubMed

Acosta, María; Cazorla, Dalmiro; Garvett, María

2002-09-01

Between may and july 2001, a survey was conducted in order to investigate the prevalence and symptoms of Enterobius vermicularis infection and its relationship with the socio-economic status and household crowding of 154 schoolchildren aged 6-12 years from a rural village in Falcon State, Venezuela. The Graham technique (perianal swabs with an adhesive cellulose tape) was used to perform the parasitological diagnosis. The overall prevalence was high (57.79%). There was no difference in the prevalence between sexes (X2 = 0.005; d.f. = 1) or ages (X2 = 3.63; d.f. = 6) (p > 0.05), suggesting similar risk conditions for all individuals. Anal pruritus was the most common clinical finding (53.9%). Other less frequent manifestations were the following: perianal lesions (34.8%) and vulvovaginitis (32.6%). Graffar analysis revealed that the majority of schoolchildren belong to the poorer socioeconomic strata: IV (55.9%) and V (29.87%), with overcrowded living conditions. The correlation between E. vermicularis infection and crowding rates was found to be statistically significant (r = 0.98; p < 0.001). In the light on these results, it can be concluded that poverty, overcrowding, anal pruritus, scarcity of water, inadequate personal and community hygiene play a relevant role on the transmission dynamics and endemic maintenance of enterobiasis among schoolchildren from Sabaneta.