Gastrointestinal Bleeding with Dabigatran, a Comparative Study with Warfarin: A Multicenter Experience / 대한소화기학회지

BACKGROUND/AIMS: The risk of gastrointestinal (GI) bleeding with dabigatran when compared to warfarin has been controversial in the literature. The aim of our study was to assess this risk with the use of dabigatran. METHODS: We examined the medical records of patients who were started on dabigatran or warfarin from October 2010 to October 2012. The study was conducted in two hospitals. RESULTS: A total of 417 patients were included (208 dabigatran vs. 209 warfarin). GI bleeding occurred in 10 patients (4.8%) in the dabigatran group compared to 21 patients (10.1%) in the warfarin group (p=0.0375). Multivariate analysis showed that patients who were on dabigatran for 100 days (p=0.0007). The odds of GI bleeding in patients who were on dabigatran for 100 days. The incidence of GI bleeding in patients >65 years old was higher than in those 65 years, and a history of previous GI bleeding.

Bexarotene monotherapy for patient with refractory early stage mycosis fungoides

Mycosis fungoides [MF] is a subtype of cutaneous T-Cell lymphoma and oftenly difficult to treat. We report a case of mycosis fungoides in which several lines of therapy were employed including both skin-directed and systemic treatment strategies with no clinical remission. This case highlights MF's insidious onset. In this patient, the early stage of disease was marked by erythematous plaque and misdiagnosed as tinea corporis. The lack of symptomatic control led to biopsy of the lesion, which in turn precipitated the accurate diagnosis of MF. Several lines of treatment were initiated with unsatisfactory outcomes. Bexarotene therapy was started and good clinical and histological response was observed. We conclude bexarotene as salvage therapy is an efficacious therapeutic option for this patient with plaque mycosis fungoides and its safety profile is favorable for longterm use

Widespread eosinophilic pustular folliculitis in a nonimmunocompromised patient

We present a case of eosinophilic pustular folliculitis, a rare dermatosis which is often associated with HIV infection or internal malignancies. Clinical Presentation and Intervention: We report the case of a 66-year-old man with a medical history of hypertension. Histopathological examination showed a dense follicular inflammatory infiltrate with abundant eosinophils. The clinical response to indomethacin was excellent with no recurrence during the follow-up. The patient responded well to indomethacin treatment

Risk Factors of Recurrent Ischemic Colitis: A Multicenter Retrospective Study / 대한소화기학회지

BACKGROUND/AIMS: Recurrence of ischemic colitis (IC) has not been studied extensively. The aim of this study was to investigate the characteristics of recurrent IC in the community setting and to identify any risk factors. METHODS: We conducted a retrospective study in two community hospitals. Medical records of patients with IC from January 2007 to January 2013 were reviewed. Demographic details, clinical features, co-morbidities, concomitant use of medications, laboratory studies, imaging findings, endoscopic and histological features, surgery, hospital stay, and death within 30 days were collected. Patients were divided into two groups (recurrent IC group, non-recurrent IC group). RESULTS: A total of 118 patients with IC were identified. IC recurred in 10 patients (8.5%) during the study period. Half of the patients in the recurrent IC group were current smokers as compared to only 18.7% of patients in the non-recurrent group. In the recurrent IC group, 20.0% of patients never smoked as compared to 61.7% in the non-recurrent group (p=0.027). Abdominal aortic aneurysm (AAA) was more frequent in the recurrent IC group (40.0% vs. 4.7%; p=0.003). No differences in other clinical symptoms, CT scan findings, comorbidities, endoscopic features, or use of concomitant medications were observed between the two groups. The need for surgical intervention, blood transfusion, intensive care unit stay, mechanical ventilation, length of hospital stay, and anatomic location of affected segments did not differ between the two groups. CONCLUSIONS: IC recurred in 8.5% of patients during the six-year study period. Current smoking status and presence of AAA were identifying risk factors for recurrence of IC.

Pioderma gangrenoso en un paciente con insuficiencia renal crónica sobre fístula arteriovenosa secundaria a granulomatosis de Wegener: estudio de un caso / Pyoderma gangrenosum in a patient with chronic kidney disease on arteriovenous fistula secondary to Wegener´s granulomatosis: a case study

Fundamento y objetivo: El pioderma gangrenoso es un trastorno crónico que consiste en una ulceración dolorosa, de etiología desconocida. Puede desarrollarse en áreas que han sufrido un trauma o heridas quirúrgicas. El objetivo de este estudio fue la evaluación v atención de enfermería en un paciente varón de 47 años afecto de Granulomatosis de Wegener, con Insuficiencia Renal Crónica (IRC) en hemodiálisis desde hace 7 años. Pacientes: El paciente tras 15 días de intervención quirúrgica para realización de fístula arteriovenosa (FAV) comenzó a desarrollar, una úlcera dolorosa que aumentó de tamaño de manera progresiva. Resultados y conclusiones: Desde el comienzo se puso en marcha el tratamiento, que consistía, entre otras cosas, en curas locales con solución salina la aplicación tópica de valerato de betametasona con gentamicina, obteniendo una mejora significativa ele la úlcera. Se concluye (que el tratamiento local fué un éxito, siendo recomendable la realización de un protocolo para pacientes con enfermedades autoinmunes, que aunque raras, pueden causar este tipo de lesiones.

Background and objectives: Pyoderrna gangrenosum is a chronic, painful, ulcerative skin of unknown etiology. In 50% of cases, is associated with systemic diseases, mainly inflammatory bowel disease. lt can develop in areas of trauma or surgical wounds. The aim of this study was the evaluation and nursing care in a patient with chronic kidney disease stage undergoes dialysis Wegener's granulomatosis, pyoderrna gangrenosum who developed a scar on cephalic arteriovenous fistula in his right hand. Patient and method: Since the beginning of the ulcer and 40 days was set in motion the plan, which consisted of local treatment with saline and topical betamethasone valerate with gentamicin, for a significant improvernent of the ulcer. Results and conclusion: Local treatment with saline and topical betamethasone valerate with gentamicin was a success, although it is clearly essential to nursing, performing a protocol for patients with autoimmune diseases, although rare, can cause this type injury, so interdisplicinar collaboration is essential to act quickly when they occur, the prevention of major risks to the patient.

Candidiasis cutánea generalizada en recién nacido a término / Generalized cutaneous candidiasis in newborn at term

Introducción. La candidiasis cutánea es una enfermedad que afecta tanto a población infantil como adulta. Las forma de presentación puede ser localizada o sistémica y el agente etiológico múltiple, siendo las especies infecciosas de Candida albicans más prevalentes en niños. Objetivo. Presentar un caso de candidiasis cutánea congénita cuya causa aparente fue la transmisión vertical durante el parto. Material y metodología. Se describe el caso de un recién nacido a término expuesto a una candidiasis vaginal subclínica, que desarrolló una candidiasis cutánea congénita por C. albicans asociada a sepsis y dificultad respiratoria en las primeras 24 horas de vida. Se practicaron hemocultivos, biopsia cutánea de las lesiones pápulopústulo-vesiculosas, análisis de sangre y punción lumbar. Resultados. En la bioquímica y el hemograma se encontró una proteína C reactiva de 5,7 mg/dl, leucocitosis con desviación a la izquierda y anemia leve. A las 24 horas, en el control se encontró una proteína C reactiva (7,82 mg/dl) que fue en aumento progresivo durante tres días, por lo que se practicó punción lumbar. El hemocultivo fue positivo para Staphylococcus aureus. La biopsia cutánea dio como resultado histológico la candidiasis cutánea. Conclusiones. El diagnóstico precoz es fundamental para prevenir complicaciones derivadas del cuadro producido por C. albicans en neonatos.

Introduction. Cutaneous candidiasis is a disease that affects children as well as adults. The presentation may be localized or systemic, and with multiple etiological agents. The most prevalent infecting species in children differs from that of the adult. Objective. A case is presented where a congenital cutaneous candidiasis was transmitted to the child during birth. Materials and methods. A full term newborn was exposed to a subclinical vaginal candidiasis infection, and 24 hr after birth, developed congenital cutaneous candidiasis. The etiological agent was Candida albicans, and was associated with sepsis and respiratory distress. Blood cultures, cutaneous biopsy of vesicular lesions, blood tests and lumbar puncture were performed. Results. Biochemistry and blood count showed a CRP of 5.7 mg/dl, leukocytosis with left shift and mild anemia. After 24 hr, the blood analyses showed an increase in a CRP (7.8 mg/dl) and increased progressively for three days; consequently, a lumbar puncture was performed. Blood culture was positive for Staphylococcus aureus. Cutaneous biopsy confirmed the cutaneous candidiasis. Conclusions. The early diagnosis is essential to prevent complications derived by the Candida albicans in newborns.