ABSTRACT
Background@#Inflammatory bowel disease (IBD) is a chronic, relapsing, inflammatory disease of the gastrointestinal tract. IBD tends to coincide with several cutaneous symptoms and signs; previous studies have suggested a link between IBD and immune-mediated skin diseases (ISDs) such as psoriasis, rosacea, and atopic dermatitis. However, there is a paucity of reports on extraintestinal cutaneous manifestations in patients with IBD from Asia and Korea. @*Objective@#We examined the prevalence of cutaneous manifestations in IBD patients and investigated the possible association between IBD and various dermatoses in a Korean tertiary care hospital. @*Methods@#Detailed questionnaires were administered to 120 patients diagnosed with IBD treated at the gastrointestinal center of our hospital. We also extracted their medical records retrospectively to obtain additional information about both their cutaneous manifestations and IBD, including disease duration and treatment course. A literature review on the prevalence of psoriasis in IBD patients was performed to clarify the association between those diseases. @*Results@#Crohn’s disease and ulcerative colitis were noted in 58 and 62 cases, respectively. Reactive skin lesions including aphthous stomatitis, erythema nodosum, and pyoderma gangrenosum were found in 12 cases (10%). ISDs such as psoriasis, rosacea, and atopic dermatitis were present in 3.3%, 21.7%, and 12.5% of cases, respectively. Other dermatoses including herpes zoster, xerosis, and skin fungal infection were also detected. @*Conclusion@#The prevalence of cutaneous manifestations in IBD is similar to that reported previously in Asian patients. Future investigations on the associations between skin diseases and IBD are needed to understand the pathogenesis and immunologic background of their comorbidities.
ABSTRACT
Pneumatosis intestinalis (PI) is a rare condition that is characterized by multiple subserosal and submucosal gas-filled areas in the bowel wall. Gastric pneumatosis describes the presence of gas within the stomach wall. This is caused by a disruption in gastric mucosa leading to the dissection of air into the wall. The extract cause of PI is still unknown; however, it may be associated with coexisting disease. Gastric PI has been rarely documented. So, we report on a 75-year-old man with acute gastric pneumatosis following his palliative chemotherapy. He underwent 3rd cycle of gemcitabine and erlotinib 3 weeks prior to admission. The treatment was started with nasogastric tube insertion and parenteral nutrition. Then, gastric pneumatosis was improved. However, the patient was died because of worsening underline disease and general condition. We suggest that chemotherapy should be considered the case of pneumatosis and careful X-ray interpretation will be necessary for detecting the pneumatosis earlier.
Subject(s)
Aged , Humans , Drug Therapy , Gastric Mucosa , Pancreatic Neoplasms , Parenteral Nutrition , Stomach , Erlotinib HydrochlorideABSTRACT
Warfarin is a commonly prescribed anticoagulant drug for the prevention of thromboembolic disorders. We investigated the contribution of genetic variations of four genes and clinical factors to warfarin dose requirement and provided a warfarin-dosing algorithm based on genetic and clinical variables in Korean patients. We recruited 564 Korean patients on stable anticoagulation. Single nucleotide polymorphisms (SNPs) for the VKORC1, CYP2C9, CYP4F2 and GGCX were analyzed. Using multiple regression analysis, we developed a model to predict the warfarin requirement. The SNPs of VKORC1, CYP2C9, CYP4F2 and GGCX showed significant correlation with warfarin dose. Patients with the 3730AA genotype received significantly higher doses of warfarin than those with the 3730GG (P=0.0001). For CYP2C9, the highest maintenance dose was observed in the patients with wild-type genotype compared with the variant allele carriers (P<0.0001). The multiple regression model including age, gender, body surface area (BSA), international normalized ratio (INR) and four genetic polymorphisms accounted for 35% of total variations in warfarin dose (R(2)=0.3499; P<0.0001). This study shows that age, gender, BSA, INR and VKORC1, CYP2C9 and CYP4F2 polymorphism affect warfarin dose requirements in Koreans. Translation of this knowledge into clinical guidelines for warfarin prescription may contribute to improve the efficacy and safety of warfarin treatment for Korean patients.
Subject(s)
Algorithms , Anticoagulants/administration & dosage , Asian People/genetics , Models, Biological , Pharmacogenetics/methods , Warfarin/administration & dosage , Age Factors , Aged , Analysis of Variance , Aryl Hydrocarbon Hydroxylases/genetics , Body Size , Cytochrome P-450 CYP2C9 , Cytochrome P-450 Enzyme System/genetics , Cytochrome P450 Family 4 , Dose-Response Relationship, Drug , Female , Gene Frequency , Genome-Wide Association Study , Humans , Male , Middle Aged , Mixed Function Oxygenases/genetics , Polymorphism, Single Nucleotide/genetics , Regression Analysis , Sex Factors , Vitamin K Epoxide ReductasesABSTRACT
BACKGROUND/AIMS: CyberKnife(TM) stereotactic body radiotherapy (SBRT) has been thought as a promising treatment modality for inoperable or recurred pancreaticobiliary malignancies. But, clinical course of CyberKnife(TM) treatment have not been established yet, so we report the experience of CyberKnife(TM) treatment in 19 patients with recurred or advanced pancreaticobilliary malignancies. METHODS: Between July 2008 and May 2009, 19 patients (gallbladder cancer 4, common bile duct cancer 5, and pancreatic cancer 10) with recurred (12) and advanced pancreaticobiliary cancer (7) underwent CyberKnife(TM) treatment in Soonchunhyang University Hospital. Tumor size was evaluated at 1, 3, 6, 8 and every 3 months after SBRT. RESULTS: The mean age was 60.2 years, and the mean size of target lesions was 28.1+/-1.30 mm. After CyberKnife(TM) treatment, the average size of target lesions was decreased; 2.53+/-4.18 mm from months 0-1 in 19 patients, 2.47+/-4.7 mm from months 1-3 in 15 patients, 0.08+/-5.11 mm from months 3-6 in 12 patients. However, the average size of target lesions was increased 3.67+/-8.98 mm from months 6-8 in 6 patients. There were 2 cases of massive duodenal ulcer bleeding after CyberKnife(TM) treatment, one of them expired due to ulcer bleeding. Also, other minor complications appeared such as 1 case of abdominal pain and 1 case of diarrhea. CONCLUSIONS: CyberKnife(TM) treatment seems to be effective in local control of pancreaticobiliary cancer, but we experienced serious complications. Further prospective studies will be needed for the proper evaluation of role of Cyberknife(TM) treatment in patients with advanced pancreaticobiliary malignancies.
