20 research outputs found
Zespół samotnego wrzodu odbytnicy i enterocele u 13-letniego chłopca
Zespół samotnego wrzodu odbytnicy (solitary rectal ulcer syndrome - SURS) jest rzadkim schorzeniem u dzieci i młodzieży.
Zwykle objawia się zaburzeniami oddawania stolca i bólami
brzucha. Powszechnie uważa się, że w patogenezie tego schorzenia odgrywają rolę zaburzenia defekacji. W niniejszej pracy
przedstawiono opis przypadku 13-letniego chłopca z zespołem
nadpobudliwości psychoruchowej i SURS. Głównymi objawami,
które zgłaszał pacjent, były: zwiększona częstość oddawania
stolca z obecnością śluzu, okresowe krwawienia z odbytnicy,
uczucie parcia na stolec i niepełnego wypróżnienia oraz bóle
brzucha. W badaniu kolonoskopowym stwierdzono okrężne
owrzodzenie i uniesioną, nieregularną zmianę sięgającą esicy
z typowym dla SURS obrazem mikroskopowym. Defekografia
uwidoczniła typowy dla enterocele obraz wpuklenia się pętli jelita cienkiego w ścianę prostnicy. Chłopcu i jego matce wyjaśniono łagodny, chociaż przewlekły, charakter schorzenia. Leczenie
zachowawcze obejmowało zalecenie unikania wysiłkowego oddawania stolca oraz stosowanie diety bogatobłonnikowej, aby
zapobiegać zaparciom. W SURS obraz zmian makroskopowych
jest bardziej różnorodny, niż powszechnie się uważa. Ustalenie
właściwego rozpoznania zależy w dużej mierze od wnikliwości
zarówno klinicysty, jak i patologa.Solitary rectal ulcer syndrome (SRUS) is a rare disorder of childhood, which usually presents with any of the manifestations of
anorectal disease, bowel habit alteration and abdominal pain.
It is commonly accepted that pathogenesis is associated with
disturbances of defecation. We describe a 13-year-old boy with
attention deficit hyperactivity disorder (ADHD) and SRUS. He
complained of increased stool frequency associated with the
passage of blood and mucus, tenesmus, sensation of incomplete defecation and abdominal pain. Circumferential ulcer
and flat lesion extending up to the sigmoid colon with typical
microscopic findings were revealed upon colonoscopy.
Defecography showed an opacified small bowel invaginating
into the rectal wall, the pictures consistent with enterocele.
Conservative treatment, including reassuring the patient and
his mother of the benign nature of the disease, recommendation to avoid straining defecation and use of a high-fiber diet
to prevent constipation, was applied. The macroscopic appearance of rectal lesions in SRUS are much more variable than is
usually realized. An early diagnosis requires a high index of
suspicion both for clinicians and the pathologist
Effect of selected factors on the serum 25(OH)D concentration in women treated for breast cancer
Maintaining an optimal vitamin D concentration reduces the risk of recurrence and extends survival time in patients after breast cancer treatment. Data on vitamin D deficiency among Polish women after breast cancer therapy are limited. Thus, the aim of the study was the analysis of vitamin D status in post-mastectomy patients, considering such factors as seasons, social habits, vitamin D supplementation and its measurements. The study involved 94 women after breast cancer treatment. Serum vitamin D concentration was measured, and a questionnaire, gathering demographic and clinical data regarding cancer, diet, exposure to sun radiation, and knowledge of recommendations on vitamin D supplementation, was delivered twice, in both winter and in summer. The control group consisted of 94 age-matched women with no oncological history. In women after breast cancer treatment, 25-hydroxyvitamin D (25(OH)D) deficiency was much more frequent than in the general population. Only about half of the patients supplemented vitamin D at the beginning of the study. After the first test and the issuing of recommendations on vitamin D supplementation, the percentage of vitamin D supplemented patients increased by about 30% in study groups. The average dose of supplement also increased. None of the women that were not supplementing vitamin D and were tested again in winter had optimal 25(OH)D concentration. It was concluded that vitamin deficiency is common in women treated for breast cancer. Medical advising about vitamin D supplementation and monitoring of 25(OH)D concentration should be improved
Clinical value of serum eosinophilic cationic protein assessment in children with inflammatory bowel disease
Introduction: Eosinophils contribute to the pathogenesis of inflammatory bowel disease (IBD) in the intestine. Eosinophilic cationic protein (ECP) is one of the
most important eosinophilic specific mediators released during activation. The
aim of the study was to evaluate the clinical value of serum ECP determination
in children with active and inactive IBD and its correlation with disease activity.
Material and methods: There were 125 children with IBD (63 with Crohn’s disease - CD, 44 with ulcerative colitis - UC, 18 indeterminate colitis - IC) enrolled
in the study. Among them 83 children were in the active phase of the disease,
while the remaining 42 were in remission. The control group consisted of
56 healthy children. The ECP was assessed three times in children with active IBD,
at baseline and after 2 and 6 weeks of treatment and once in children with inactive IBD and controls using fluoroenzymeimmunoassays.
Results: We found elevated ECP at baseline in the total active IBD group when
compared to the inactive IBD and control groups, decreasing during treatment.
Serum ECP was also elevated in the active UC and CD groups when compared
to the inactive UC and CD groups, and correlated with clinical UC and CD activity (R = 0.57 and R = 0.52, p < 0.05, respectively) and duration of the clinical
manifestation in UC (R = 0.62, p < 0.05) but not with the disease location in the
gastrointestinal tract, or endoscopic and histopathological activity.
Conclusions: Evaluation of serum ECP in children with IBD may be useful in disease activity assessment at onset and during the treatment
Serum concentrations of fibrosis markers in children with inflammatory bowel disease
Background and study aims: The aim of the study was to assess the usefulness of
serum concentrations of YKL-40/ CHI3L1 (a 40-kilodalton glycoprotein also referred to as chitinase 3 like- 1 - CHI3L1) and PIIINP (N-terminal propeptide of type III procollagen), markers of fibrosis, in the monitoring of inflammatory processes and fibrosis in children with inflammatory bowel disease (IBD). Patients and methods: In 60 patients (41 with Crohn’s disease (CD), 19 with ulcerative colitis (UC)) concentrations of investigated parameters were measured at baseline (day 0), after 3 and after 6-8 weeks of pharmacological treatment. Results: PIIINP concentrations were significantly higher in CD patients compared to UC (baseline results: median concentrations 1013.73 vs 78.30 ng/mL; P = 0.06 for the Kruskall-Wallis test; results at 6-8 weeks: 1076.48 vs 53.10 ng/mL, P = 0.01). Fibrosis was clearly present in patients with CD and its severity increased (reflected by both YKL-40/ CHI3L1 and PIIINP concentrations) in 6–8 weeks of follow up, regardless of the treatment used during that time. In patients with UC the levels of YKL-40/CHI3L1 and PIIINP were lower at baseline and further decreased after 6–8 weeks (median concentrations were respectively: 39.5 ng/mL vs 24.7 ng/mL and
78.3 ng/mL vs 53.1 ng/mL). Conclusion: Fibrosis was more severe in CD than in UC patients. The marker that more accurately reflected these differences was PIIINP