•Anti-Anisakis IgA/IgG4 ratio is associated with chronic urticaria.•Anti-Anisakis IgA plays an important role in the recognition of larval allergens.•Ani s 3 immunoreactivity differs from other ...Anisakis allergens.
The phenotype of allergic diseases associated with Anisakis determines the pattern of cytokines related to antibody production. However, the role of serum IgA and the immunomodulatory mechanisms exerted by active infection of L3 or passive mucosal contact with A. simplex specific antigens has not been studied before. We measured serum cytokine by flow cytometry (IL-2, IL-4, IL-6, IL-10, TNF-α, IFN-γ, IL-17A, TGF-β1) and antibody levels (IgE, IgG4, IgA) by ELISA against total and excretory-secretory (ES) antigens, Ani s 3,and the group of major allergens Ani s 1, Ani s 7, and Ani s 13 in sera from 10 patients with gastro-allergic anisakiasis (GAA), 11 Anisakis sensitization associated chronic urticaria (CU+) as well as 17 non-Anisakis-sensitized patients with chronic urticaria (CU-), compared with the urticaria control group (18 subjects). Specific IgE, IgG4 and IgA were high in the GAA, but IgA levels were significantly higher in the CU+ with respect the CONTROL group. We observed higher levels of the ratio IgA/IgG4 in CU+ than GAA group for Ani s 1, Ani s 7, Ani s 13 and ES. Furthermore, chronic urticaria (CU) patients showed significant lower levels of IL-10, IFN-γ and IL-17A than patients without CU. The anti-Ani s 13 IgA/IgG4 ratio correlated positively with pro-inflammatory cytokines and ratios (TNF-α, IL-17A, Th17/Th2, Type1/Type2 and TNF-α/IL-10) in CONTROL group. In general, Anti-Anisakis IgA/G4 ratio was high in CU patients. In conclusion, this study demonstrates the importance of serum IgA because it is associated with chronic urticaria independently of Anisakis sensitization.
Causes and Management of Pruritus Ani Sacks, Olivia A; Beresneva, Olga
Diseases of the colon & rectum,
01/2023, Letnik:
66, Številka:
1
Journal Article
Recenzirano
A 48-year-old healthy man presented to the office reporting a long-standing history of anal pruritus. He had tried various over-the-counter creams without much success. Besides an anal fissure in the ...past, which responded to nitroglycerin ointment, his medical history was unremarkable. On physical examination, he was found to have grade I hemorrhoids and mild fecal smearing on perianal skin. Recent colonoscopy and laboratory work ordered by the primary care provider were normal. He was counseled on common inciting agents and local irritants and was advised on hygiene, diet modification, and stool-bulking agents. The colorectal surgeon recommended that the patient keep a journal about his symptoms, foods, and household chemicals used. He was seen twice more over the course of 6 months to pinpoint the cause of his pruritus. A short-course trial of topical steroid, barrier cream, and topical tacrolimus was not helpful. A biopsy of perianal skin was performed and was unrevealing. Eventually, given the persistence of symptoms, it was decided that he would undergo methylene blue injection to address his pruritus (Fig. 1). The procedure consisted of several intradermal and subcutaneous injections of 10 mL of 1% methylene blue combined with 7.5 mL of 0.25% bupivacaine with adrenaline (1/100,000) and 7.5 mL 0.5% lidocaine. After the methylene blue injection, the severity of his symptoms improved, but pruritus still persisted. A methylene blue injection of the same concentration was repeated in 3 months with complete resolution of symptoms.
The without a time limitation. Most recent search was performed on 1st June 2022.
Thorough history and physical examination are very important in view of multiple possible causes of anal pruritus. ...Most of the focus during examination is drawn on to the perianal region. A digital rectal examination and an anoscopy are essential. It is necessary aim of this narrative review is to overview the classification, diagnostics, possible treatment options and future perspective of anal pruritus.
The search was performed by two authors (AD and MJ) independently in the following electronic databases: PubMed, EMBASE, Web of Science, Cochrane Library, CENTRAL and the Allied and Complementary Medicine Databases (AMED). Search was restricted to English language only to avoid moisture and the use of soaps in the perianal region. Furthermore, the patient should avoid certain foods and increase the intake of fiber. If the symptoms do not resolve, topical steroids, capsaicin (0.006%) and tacrolimus (0.1%) ointments may be used. For intractable cases, intradermal methylene blue injection might give a long-lasting symptom relief.
Anal pruritus is a long-term deteriorating quality of life issue. Most of the time it is a symptom with a difficult diagnosis. Thorough history and examination should be performed for the best possible treatment.
In patients who are candidates for craniotomy, scalp nerve blocks have been shown to be effective in relieving pain intensity as well as postoperative hemodynamic stability after surgery, but the ...results have been inconsistent. We aimed to assess the effect of scalp block on pain control, intraoperative drug use under Analgesia Nociception Index (ANI) monitoring, and postoperative pain in patients who were candidates for elective craniotomy.
In this randomized, single-blinded clinical trial study, candidates for craniotomy were randomly (using the block randomization method) divided into two groups before entering the operating room. The first group received a scalp block with bupivacaine (intervention), and the second group did not receive a scalp block (control) besides the routine anesthetic procedure in these patients. ANI, hemodynamic parameters, and the amounts of received remifentanil were conducted and compared.
Patients under scalp block received less dosage of fentanyl than the non-scalp block group (mean = 57.14±15.59 mcg vs. 250.00±65.04 mcg, respectively). Similarly, the dose of remifentanil required in the scalp block group was less (mean = 3.04±1.95mg and 5.54±2.57mg, respectively). No difference was observed in hemodynamic parameters such as blood pressure and heart rate (before, during, and after surgery). However, the group receiving scalp block had higher ANI means than the control group.
Scalp nerve block has an effective role in pain control (increasing ANI), consequently reducing the need for analgesic drugs such as fentanyl and remifentanil following craniotomy without changing the hemodynamic condition.
Anorectal Disorders Rao, Satish S.C.; Bharucha, Adil E.; Chiarioni, Giuseppe ...
Gastroenterology (New York, N.Y. 1943),
05/2016, Letnik:
150, Številka:
6
Journal Article
Recenzirano
Odprti dostop
This report defines criteria and reviews the epidemiology, pathophysiology, and management of the following common anorectal disorders: fecal incontinence (FI), functional anorectal pain, and ...functional defecation disorders. FI is defined as the recurrent uncontrolled passage of fecal material for at least 3 months. The clinical features of FI are useful for guiding diagnostic testing and therapy. Anorectal manometry and imaging are useful for evaluating anal and pelvic floor structure and function. Education, antidiarrheals, and biofeedback therapy are the mainstay of management; surgery may be useful in refractory cases. Functional anorectal pain syndromes are defined by clinical features and categorized into 3 subtypes. In proctalgia fugax, the pain is typically fleeting and lasts for seconds to minutes. In levator ani syndrome and unspecified anorectal pain, the pain lasts more than 30 minutes, but in levator ani syndrome there is puborectalis tenderness. Functional defecation disorders are defined by ≥2 symptoms of chronic constipation or irritable bowel syndrome with constipation, and with ≥2 features of impaired evacuation, that is, abnormal evacuation pattern on manometry, abnormal balloon expulsion test, or impaired rectal evacuation by imaging. It includes 2 subtypes: dyssynergic defecation and inadequate defecatory propulsion. Pelvic floor biofeedback therapy is effective for treating levator ani syndrome and defecatory disorders.
•Levator ani muscle (LAM) avulsion injury occurs occultly during childbirth, most commonly during operative vaginal deliveries.•Injuries of levator ani muscle have long term sequelae for pelvic floor ...health for example incontinence of urine or faeces, prolapse and pain.•Diagnosis of this condition can be difficult as there is no agreed ‘gold standard’ imaging modality.•There is also no consensus regarding surgical management of LAM avulsion.•This condition has a profound impact on new mothers quality of life and we currently cannot treat it well, therefore focus should be on prevention.
Key Content
• Levator ani muscle (LAM) avulsion injury occurs occultly during childbirth, most commonly during operative vaginal deliveries.
• Injuries of levator ani have long term sequelae for pelvic floor health. As life expectancy increases the burden of disease upon urogynaecology services will need to be considered.
• Diagnosis of this condition can be difficult as there is no agreed ‘gold standard’ imaging modality.
• There is no consensus regarding surgical management of LAM avulsion.
Learning objectives
• Review anatomy and function of levator ani muscle
• Identify the risk factors for levator ani avulsion injury
• Role of imaging to appropriately identify LAM injury and current management options including appropriate follow up
• Management of subsequent pregnancy following LAM avulsion
Ethical issues
• Is there value to the patient in diagnosing levator ani avulsion when there is no recommended treatment for these injuries?
Articolul rezumă periplul revistei Bucovina Forestieră, ce împlinește în 2023 opt decenii de la apariția primului număr. Prima parte a articolului conține o serie de citate din primul editorial al ...revistei, precum și conținutul primului număr, inclusiv autorii articolelor respective. Structura primului număr a rămas neschimbată de-a lungul anilor, fapt ce dovedește nu doar consecvență, ci și larga deschidere către diverse categorii de cititori, revista nefiind dedicată doar publicării articolelor științifice. În partea a doua a articolui este omagiată personalitatea d-lui dr. Radu Ichim, ce s-a implicat cel mai mult nu doar în reluarea activității editoriale, ci și în formarea unui colectiv redacțional puternic motivat de apartenența la corp profesional ce a căutat și cauntă în continuaer să mențină standarde profesionale menite a proteja nu doar pădurile și pe cei ce locuiesc în proximitatea lor.
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