Exuberant pyoderma gangrenosum in a patient with autoimmune hepatitis

Abstract: Pyoderma gangrenosum is a rare neutrophilic dermatosis, which usually presents as ulcers with erythematous-violaceous undermined edges and a rough base with purulent or sanguinous exudate. It can be primary or associated with an underlying disease. However, rare cases of its association with autoimmune hepatitis have been described in the literature. Diagnosis is based on a characteristic clinical picture and ruling out other causes of ulcers. This paper aims to discuss the management of corticosteroid therapy and the importance of local treatment. We report a case with torpid evolution, presented with multiple and deep ulcers in a young patient with autoimmune hepatitis, causing pain and significant disability. We observed complete healing of lesions after two months of successful treatment.

Combinatorial protective effects of α-melanocyte-stimulating hormone and carboxymethylcellulose on ocular surface in dry eye rat models / 中华实验眼科杂志

Background Reasearches showed that α-melanocyte-stimulating hormone (α-MSH) inhibits inflammation and ameliorates the ocular surface abnormalities in a scopolamine-induced dry eye rat model,and the managing effect of sodium carboxymethylcellulose (CMC) on dry eyes also has been determined.However,whether α-MSH can enhance the therapeutic effects of CMC remains to be investigated.Objective This study was to investigate the protective effects of α-MSH combined with CMC on ocular surface in a scopolamine-induced dry eye rat model.Methods Sixty clean female Wistar rats were randomly divided into normal control group,model control group,NaCl group,CMC group,α-MSH group and α-MSH+CMC group,and 10 rats for each group.The dry eye models were established by subcutaneous injection of scopolamine hydrobromide at 9:00,12:00,15:00 and 18:00 per day for 28 days.0.9％ NaCl solution,1×10 3 mg/ml α-MSH solution,0.5％ CMC eye drop,and 1 ×10-3 mg/ml α-MSH+0.5％ CMC solution were topically administered twice a day (8:00,17:00) since the initial day of modeling according to grouping.Shirmer Ⅰ test (S Ⅰ t),breakup time of tear film (BUT) and corneal fluorescence staining were performed before and 7,14,21,28 days after the application of drugs.At 28 days following the administration of drugs,the eyeballs of the rats were collected.Hemotoxylin and eosin staining was employed to examine the morphology of corneas,and periodic acid schiff (PAS) staining was used to count the conjunctival goblet cells.This study protocol was approved by Experimental Animal Ethic Committee of Tianjin Medical University (SYXK 2009-0001),and the use and care of the rats complied with ARVO Statement.Results The S Ⅰ t and BUT values were significantly reduced,and the corneal fluorescence staining scores were significantly increased over time following modeling in the model control group (all at P＜0.01).No significant differences were found in the S Ⅰ t,BUT and corneal fluorescence staining scores between model control group and NaCl group at various time points (all at P＞0.05).At 7,14 and 21 days after intervention,the S Ⅰ t values were (4.800±0.789),(4.100±0.516) and (4.300±0.856) mm in the α-MSH+CMC group,which were considerably higher than (2.875 ±0.719),(2.375 ±0.619) and (2.532±0.957)mm in the NaCl group (all at P＜0.01).At 7 days after intervention,the BUT values were (4.938± 1.843) seconds and (5.000±1.491) seconds in the α-MSH group and α-MSH+CMC group,which were significantly higher than (3.250±1.000) seconds in the NaCl group (both at P＜0.01).The corneal fluorescence staining scores in the CMC group,α-MSH group and α-MSH+CMC group were significantly lower than that in the NaCl group,with the lowest score in the α-MSH +CMC group (all at P＜0.05).The thickening of corneal epithelial layer,corneal edema and arrangement disorder of corneal stroma were found in the model control group and NaCl group;while slight corneal edema and epithelial cell proliferation were exhibited in the α-MSH+CMC group by hemotoxylin and eosin staining.PAS staining showed that the number of goblet cells was much more in the CMC group,α-MSH group and α-MSH+ CMC group than that in the model control group and NaCl group (all at P ＜ 0.01).Conclusions The sole application of α-MSH or CMC alleviates ocular surface damage and morphological abnormality to certain extent,and the combination of α-MSH and CMC generates more effective protection in comparison with sole administration of α-MSH or CMC.The early application of the drugs plays an improvement role in tear secretion and tear film stability in dry eyes.

Efficacy and Safety of Sodium Hyaluronate with 1,4-Butanediol Diglycidyl Ether Compared to Sodium Carboxymethylcellulose in Preventing Adhesion Formation after Lumbar Discectomy

OBJECTIVE: Epidural injection of hyaluronic acid may prevent adhesion formation after spine surgery, but the compounds used to stabilize hyaluronidase could interfere with its anti-adhesion effects. The present study was conducted as a clinical trial to evaluate the efficacy and safety of an experimental medical gel in preventing adhesion formation. METHODS: This study was designed as a multicenter, randomized, double-blind, and comparative controlled clinical trial with an observation period of 6 weeks. Subjects were randomly assigned into two groups: group A with sodium hyaluronate + 1,4-butanediol diglycidyl ether (BDDE) and group B with sodium hyaluronate + sodium carboxymethylcellulose (CMC). Visual analogue scale (VAS) of back and leg pain and the Oswestry disability index (ODI) and scar score ratings were assessed after surgery. RESULTS: Mean scar grade was 2.37+/-1.13 in group A and 2.75+/-0.97 in group B, a statistically significant difference (p=0.012). VAS of back and leg pain and ODI scores decreased significantly from baseline to 3 and 6 weeks postoperatively in both groups (p0.3). The number of adverse reactions related to the anti-adhesion gels was not statistically different (p=0.569), but subsequent analysis of nervous adverse reactions showed group B was superior with a statistically difference (p=0.027). CONCLUSION: Sodium hyaluronate with BDDE demonstrated similar anti-adhesion properties to sodium hyaluronate with CMC. But, care should be used to nervous adverse reactions by using sodium hyaluronate with BDDE.

La saliva y sistemas adhesivos alternativos para prótesis total / Saliva and alternative adhesive systems for complete dentures

Las prótesis totales pueden presentar problemas biomecánicos relacionados con la retención y estabilidad, que pueden originarse a partir de errores del profesional durante la toma de impresión funcional de los tejidos, diseño y confección de las prótesis; además de errores durante la fase de laboratorio a cargo de los técnicos o simplemente a cambios biológicos que experimentan los tejidos subyacentes como la reabsorción ósea, atrofia de los maxilares y disminución del flujo salival. Esta última circunstancia es de principal preocupación, ya que la saliva tiene un papel importante en la retención de las prótesis como “adhesivo natural”, por lo que durante años se han propuesto diversos métodos alternativos de retención, especialmente sistemas adhesivos complementarios cuyas propiedades se han perfeccionado con la inclusión de otros compuestos como algunos polímeros sintéticos, agentes antimicrobianos, colorantes, aditivitos y preservativos; además se encuentran disponibles en diferentes presentaciones comerciales. El objetivo de esta revisión es exaltar las propiedades de la saliva como adhesivo natural y la posibilidad de mejorar la retención de las prótesis, cuando estas no poseen la capacidad de asegurar resultados deseados mediante sistemas adhesivos complementarios, que son una alternativa segura y efectiva, siempre que el odontólogo asuma la responsabilidad y la competencia de prescribir el tipo de adhesivo en relación con condiciones específicas del paciente para evitar situaciones indeseables como efectos sistémicos por la ingesta excesiva y prolongada de sales de zinc incluidas en algunas presentaciones comerciales de adhesivos para prótesis.

Complete dentures may show biomechanical problems related to retention and stability, which can arise from professional errors during functional tissue impression, as well as during prostheses design and manufacturing, in addition to errors during the laboratory phase by technicians or simply by biological changes of adjacent tissues, such as bone resorption, maxillaries atrophy, and decreased salivary flow. The latter is a circumstance of major concern because saliva plays an important role in prosthesis retention as a “natural adhesive”; therefore, various alternative retention methods have been suggested over time, especially in terms of complementary adhesive systems whose properties have been improved by including other compounds such as synthetic polymers, antimicrobial agents, colorants, additives, and preservatives, which are available in different commercial presentations. The goal of this review is to highlight the properties of saliva as a natural adhesive and the possibility of improving denture retention when it lacks the ability to guarantee the desired results by additional adhesive systems, which are a safe and effective alternative, provided that the dentist is responsible and competent enough to prescribe the right adhesive in relation to specific patient conditions to avoid undesirable situations such as systemic effects due to prolonged and excessive intake of zinc salts included in some commercial presentations of denture adhesives.

Results of the Mixed Solution of Hyaluronate and Sodium Carboxymethylcellulose in Endonasal Dacryocystorhinostomy

PURPOSE: To evaluate the long-term results of the application of a mixed solution of hyaluronate and sodium carboxymethlycellulose (HACMC, Guardix-sol) intraoperatively in endonasal dacryocystorhinostomy (Endo-DCR). METHODS: In this retrospective randomized controlled study, Endo-DCR and silicone tube intubation were performed on 83 eyes of 83 patients who were diagnosed with nasolacrimal duct obstruction. In group A (40 patients, 40 eyes), HACMC was applied to the osteotomy site in the nasal cavity after standard Endo DCR procedure. In group B (43 patients, 43 eyes), a standard Endo-DCR procedure was performed without HACMC. The results for the two groups were evaluated by asking patients about the tearing condition and examining the patency of irrigation, complications, and related treatment. RESULTS: There were no statistically significant differences in age, sex, silicone tube insertion duration, or mean follow-up time between the two groups. The primary success rates of the group A and the group B were 87.5% (35/40) and 81.4% (35/43), respectively. The final success rates after the revisonal surgery were 92.5% (37/40) and 86.0% (37/43), respectively, and there were no statistically significant differences between the two groups (P=0.348, Fisher's exact test). CONCLUSIONS: Applying HACMC to the nasal cavity will be useful in treating patients with poor prognosis, although the higher average primary success rate of patients receiving HACMC, as compared to those who did not, was not statistically significant.

Clinical Effect of the Mixed Solution of Sodium Hyaluronate and Sodium Carboxymethylcellulose After Endonasal Dacryocystorhinostomy

PURPOSE: To evaluate the effects of a mixed solution of sodium hyaluronate and sodium carboxymethylcellulose (HACMC, Guardix-sol(R)) for reducing postoperative adhesion after endonasal dacryocystorhinostomy. METHODS: Endonasal dacryocystorhinostomy was performed on 58 patients with obstructions of the nasolacrimal system. We divided the 58 patients into two groups. At the completion of endonasal dacryocystorhinostomy, HACMC was applied to the operative site in the experimental group (n=26) and normal saline was applied in the control group (n=32). For the evaluation of clinical effectsand postoperative adhesion, subjective symptom score evaluations, lacrimal irrigation tests, fluorescein disappearance tests, and endoscopic examinations were performed at 1 week, 1 month, 3 months, and 6 months postoperatively. RESULTS: The HACMC-treated patients showed better results than the control patients for subjective symptom scores, lacrimal irrigation tests, and fluorescein disappearance tests, but these differences were not statistically significant. Upon endoscopic examination, the HACMC group revealed lower incidence of adhesion at 1 week after surgery and lower severity of adhesion throughout the period of observation (p<0.05). CONCLUSIONS: The application of a mixed solution of HACMC may effectively reduce postoperative adhesion after endonasal dacryocystorhinostomy.

Antiadhesive Effect of the Mixed Solution of Hyaluronate and Sodium Carboxymethylcellulose After Strabismus Surgery

PURPOSE: To evaluate the effect of the mixed solution of hyaluronate and sodium carboxymethylcellulose (HACMC, Guardix-sol(R)) in reducing postoperative adhesion following strabismus surgery. METHODS: In 16 rabbits out of 20 rabbits, 3 mm recession of the superior rectus muscle was performed on both eyes and HACMC solution was applied only to one eye which was randomly chosen. The rabbits were divided into a surgery-HACMC group and a surgery-no HACMC group. As a control group, the remaining 4 rabbits had no procedures performed. After 3 weeks, both eyes of 8 rabbits with surgery and 2 rabbits of the control group were enucleated. After staining with hematoxylin-eosin and Masson's trichrome, a histologic examination was performed. In the remaining 10 rabbits, the severity of adhesion in muscle and adjacent tissues was observed by blunt dissection. A researcher blind to the experiments performed all the examinations. RESULTS: A significant reduction in the degree of adhesion (P=0.005) as well as decreased fibrosis (P=0.015) was observed in the surgery-HACMC group. CONCLUSIONS: The mixed solution of HACMC was effective in reducing postoperative adhesion after strabismus surgery in rabbits.

GUARDIX-SL(R) in Sinus Surgery: A Preclinical Animal Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The most frequent complication of FESS (functional endoscopic sinus surgery) is stenosis of the operation site. The complication may influence the postoperative wound healing and the outcome of surgery. There are several measures proposed to prevent the complication. We sought to determine the efficacy of GUARDIX-SL which is made from sodium hyaluronate and sodium carboxymethylcellulose in soluble form. MATERIALS AND METHOD: For 7 rabbits, we made a surgical opening anterior to sinus ostium of the maxillary sinuses on both sides. We put the gelfoams soaked with GUARDIX-SL into the left openings and those soaked with normal saline into the right openings as a control group. We measured the size of the openings after two weeks. RESULTS: There was no synechiae in GUARDIX-SL group whereas we found synechiae developed in two openings in the control group. The mean area of the opening was 9.29 mm2 and 1.61 mm2 in GUARDIX-SL group and the control group (p=0.027), respectively. CONCLUSION: GUARDIX-SL was effective in reducing postoperative stenosis in the animal model.

Comparative study on adhesive strength of three colloid materials and their complexes as bone adhesives / 中国海洋药物

sodium carboxymethylcellulose.Their complexes also obtained the stongest adhesive strength in their saturated water solutions,but their adhesive strength was between their component colloid materials.The complexes integrate the characteristics of the three colloid materials and would provide valuable complex materials for the study of bone adhesives.