Large-scale epidemiological data on vascular disorders of the intestine

Abstract

Objectives: This article aims to provide updates on the worldwide epidemiology of vascular disorders of the intestine.

Methods: A comprehensive search for obtaining worldwide epidemiologic information on the burden of vascular disorders of the intestine was carried out in the Global Health Data Exchange (GHDx) repository. The condition ‘vascular intestinal disorders’ was associated with other epidemiologic variables such as year, sex, age, location and socioeconomic status.

Results: The current global incidence and mortality of vascular disorders of the intestine are 8.11 per 100,000 cases/year and 1.26 per 100,000 deaths/year, respectively, translating into a death rate of 15.5%. Both global incidence and mortality are 32% higher in the female sex and have both displayed a continuous increase during the past 20 years (+29.3% and +18.4% since 1998, respectively). Incidence and mortality curves appear similar between sexes, with the incidence increasing after the age of 40 years and mortality after the age of 50 years, respectively. The peak of both worldwide incidence and mortality was seen in very elderly people. The death rate increased in parallel with incidence and mortality, from ～1% to 3% in childhood up to ～50% after the age of 95 years. Both incidence and mortality displayed a positive association with socioeconomic status. Future projections suggest that incidence and mortality will display 44% and 24% growths by the year 2050.

Conclusions: Our analysis demonstrates that the clinical and societal burden of vascular disorders of the intestine is especially higher in women, in the elderly and in people with higher socioeconomic status.     

Recent updates on worldwide gout epidemiology

Clinical Rheumatology - To provide recent statistics on worldwide gout epidemiology. Current and prediction data on gout epidemiology were retrieved from the Global Health Data Exchange (GHDx)...     

Spontaneous clostridial myonecrosis after pregnancy – emergency treatment to the limb salvage and functional recovery: a case report

Clostridial myonecrosis (CM) is a rare, life threatening necrotizing infection of a skeletal muscle caused by Clostridium perfringens in the majority of cases. The diagnosis may be difficult because of few diagnostic and cutaneous signs early in its course. Standard therapy involves surgical debridements of a devitalized tissue and high‐dose organism‐specific antibiotic therapy. The hyperbaric oxygen has also showed its usefulness in the treatment of these infections. Autograft systems as tissue replacement, based on bioengineered materials, have been demonstrated to be safe and effective treatments for chronic wounds and a suitable physiotherapy is recommended for the recovery of functional impairments of upper extremities. We present a rare case of CM of right upper limb treated with a combination of standard treatments and new techniques.     

Laparoscopic surgical management of localized recurrent ovarian cancer: a single-institution experience

Background

Optimally, secondary cytoreduction is acknowledged as a valid option in terms of oncologic outcome for patients with platinum-sensitive recurrent ovarian cancer. In cases of localized relapse, a laparoscopic approach has been attempted at various institutions, but studies on its role for this subset of patients still are limited. This report describes the authors’ experience using laparoscopic secondary cytoreduction for patients with localized recurrent ovarian cancer. The results from a retrospective analysis of a prospective case series are reported.

Methods

Between October 2011 and May 2013, 29 patients with localized recurrent ovarian cancer were selected for a laparoscopic cytoreduction. Two conversions to laparotomy occurred. The analyzed outcome variables included stage and site of disease, type of surgical procedure, operative time, blood loss, length of hospital stay, complications, and oncologic outcome.

Results

The median operating time was 188 min. The median estimated blood loss was 150 mL, and the median hospital stay was 4 days. Complete debulking was achieved for 96.2 % of the patients. No intraoperative complications occurred, and postoperative complications were noted in only one patient. The median disease-free survival time was 14 months.

Conclusions

For selected patients, laparoscopy is a feasible and safe approach to optimal cytoreduction for patients with localized recurrent ovarian cancer.     

Toll-like receptors,immunoproteasome and regulatory T cells in children with Henoch–Schönlein purpura and primary IgA nephropathy

Background

Henoch–Schönlein purpura (HSP) nephritis and primary IgA nephropathy (pIgAN) present with glomerular IgA deposits, but differ with regard to clinical features. The suspected involvement of different immune system pathways is largely unknown.

Methods

This study was aimed at investigating some of the immunological features including Toll-like receptors (TLR), proteasome (PS)/immunoproteasome (iPS) switch, and the regulatory T cell system (Treg/Th17 cells) in 63 children with HSP with/without renal involvement and in 25 with pIgAN. Real-time PRC (Taqman) was used to quantify mRNA levels in peripheral blood mononuclear cells (PBMC).

Results

The expression of mRNAs encoding for TLR4 in both HSP and pIgAN was higher than in controls (HC) and in both diseases FoxP3mRNA and TGF-β1mRNA expression was significantly lower than in HC. A switch from PS to iPS (LMP2/β1) was detected only in PBMC of HSP and it correlated with the level of TLR2mRNA, which was selectively increased only in children with HSP.

Conclusion

Children with HSP and pIgAN present with similar signs of engagement of the innate immunity and regulatory T cell depression. The increased immunoproteasome switch, which correlated with TLR2 activation, may suggest an innate immunity pathway peculiar to HSP vasculitic presentation. This research area also deserves further investigation for possible therapeutic applications.