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Fucoidan
Published in Se-Kwon Kim, Marine Biochemistry, 2023
Ellya Sinurat, Dina Fransiska, Nurhayati, Hari Eko Irianto
Gastric ulcers and duodenal ulcers are the two most prevalent forms of peptic ulcers. These designations indicate the location of the ulcer. Gastric ulcers are ulcers that form in the stomach. The duodenum, which is the initial segment of the small intestine, is where duodenal ulcers occur. Gastric and duodenal ulcers may occur at the same time in an individual. The presence of acid and peptic activity in gastric juice and the deterioration of mucosal defenses are factors in peptic ulcers formation. The stomach and the first few millimeters of the duodenum are the most prevalent sites for ulcers. Acute peptic ulcers affect tissues down to the submucosa, and lesions can be single or numerous. The epithelium and muscular layers of the stomach wall are both penetrated by chronic peptic ulcers (Rambhai & Sisodia, 2018).
Questions for part F
Published in Henry J. Woodford, Essential Geriatrics, 2022
An 83-year-old woman was admitted with shortness of breath. Blood tests found her to have iron-deficient anaemia (test results as below). An upper gastrointestinal endoscopy showed a duodenal ulcer that was treated endoscopically. The aspirin that she had been taking for primary prevention was discontinued. She is prone to constipation and takes senna when required but is not prescribed any regular medications.Haemoglobin81(115–165 g/L)MCV73(80–99 fL)Ferritin6(12–250 ug/L)
Two Centimeter D1–2 Anterior Perforation Presenting 24 Hours Later
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Laparoscopic surgery has been found to be feasible for duodenal ulcer perforation. Meta-analysis of randomized trials has not shown any difference in overall morbidity and mortality, however, laparoscopic approach had lower rate of surgical site infection, shorter nasogastric tube duration, and less postoperative pain than an open approach [4]. Thus, laparoscopic approach may be preferred if technical expertise is available. However, laparoscopic approach is considered safe only in younger patients (<70 years), who present early (<24 hours), do not have shock at presentation, and do not have significant comorbid illnesses. Thus, only patients with Boey score 0 and 1 (Table 14.1) are suitable candidates for laparoscopic surgery. As our patient had presented after 24 hours, had significant comorbid illnesses, and had shock at presentation, we chose the open surgical approach.
Long-term safety and effectiveness of vonoprazan for prevention of gastric and duodenal ulcer recurrence in patients on nonsteroidal anti-inflammatory drugs in Japan: a 12-month post-marketing surveillance study
Published in Expert Opinion on Drug Safety, 2023
Takashi Kawai, Chihiro Suzuki, Youichirou Honda, Jovelle L. Fernandez
All data were entered into a web-based electronic data capture system by the surveillance investigator. Collected information included: (i) patient demographics and medical history, including self-reported H. pylori infection; (ii) concurrent medical conditions and treatments including the date of initiation, reason for use, dosage, and administration of vonoprazan, NSAIDs, and any concomitant medications; (iii) assessments for gastric/duodenal ulcer or hemorrhagic lesions, including the date of endoscopy (if performed, as it was not mandatory; ulcer sizes were not confirmed and the presence of ‘bleeding’ was based on the physician’s judgment) or diagnosis; and (iv) liver function tests and assessment of serum gastrin. For safety, the following information was collected: presence or absence of adverse events (AEs) during the observation period, including terms used, date of onset, seriousness, reason for seriousness, causal relationship to vonoprazan, and reason for discontinuation of vonoprazan if related to safety. Any AE that was reported after initiation of vonoprazan and for which vonoprazan could not be ruled out as the cause was defined as an adverse drug reaction (ADR). Hospitalization was regarded as a serious AE and was reported as such. Data on adherence to medications were not collected.
Rebleeding in peptic ulcer bleeding – a nationwide cohort study of 19,537 patients
Published in Scandinavian Journal of Gastroenterology, 2022
Stig B. Laursen, Adrian J. Stanley, Loren Laine, Ove B. Schaffalitzky de Muckadell
Ninety percent of patients who developed rebleeding had one or more of the following findings: 1. high-risk stigmata of bleeding in the ulcer base, 2. duodenal ulcers, and 3. presentation with hemodynamic instability. All three conditions were present in 1,439/18,213 (7.9%) of patients. This subgroup had a rebleeding rate of 23.8% [95% CI: 21.6–26.1%] that often could not be controlled by endoscopic therapy (49.7% [95% CI: 47.1–52.3%]) and had a 30-day mortality rate of 23.4% [95% CI: 21.2–25.7%]. Patients fulfilling two out of the three conditions (5,426/18,213; 30%) had a rebleeding rate of 15.9% [95% CI: 14.9–16.9%] and a 30-day mortality rate of 13.0% [95% CI: 12.1–13.9%]. Among patients with none of the three conditions present (4,399/18,213; 24%), only 3.6% [95% CI: 3.0–4.2%] developed rebleeding. The Rebleeding Triad had an AUROC [95% CI] of 0.67 [0.65–0.68] for predicting rebleeding. Further details on the discriminative ability of the Rebleeding Triad are presented in Supplementary Appendix 5.
Ear canal and middle-ear tumors: a single-institution series of 87 patients
Published in Acta Oto-Laryngologica, 2022
Taija K. Nicoli, Timo Atula, Saku T. Sinkkonen, Jarkko Korpi, Matej Vnencak, Jussi Tarkkanen, Antti A. Mäkitie, Jussi Jero
Six (12%) patients with a benign tumor, and eight (25%) with a malignant tumor experienced short-term complications. Conversely, three (6%) patients with a benign tumor and eight (25%) with a malignant tumor experienced long-term complications. CNVII palsy, present mainly in those who had undergone LTBR/STBR and parotidectomy, was the most frequent short-term and long-term complication. Post-operative hearing status was not routinely quantified even if maximal post-operative conductive hearing loss was expected in patients who had undergone EAC closure. Two major post-operative complications were recorded. One patient, who had undergone removal of a sigmoid sinus/jugular foramen meningioma through a combined middle fossa transmastoid resection and suboccipital craniotomy, experienced CNIX palsy on the first post-operative day. A 4-day treatment with tracheostomy ensued during which CNIX regained its normal function. Another patient with MES metastasis developed hematemesis post-operatively. Gastroscopy revealed a bleeding duodenal ulcer which was treated. At the end of follow-up, three (6%) patients with a benign tumor suffered from TM perforation (n = 1), and CNVII palsy (n = 2). Four of the eight patients with a malignant tumor had deceased by the end of follow-up. The long-term symptoms had resolved for the other three patients, while one patient suffered from CNVII palsy because of its sacrifice. Table 2 reviews the short-term (lasting < 6 months) and long-term (lasting > 6 months) minor and major post-operative complications.