Incomplete small bowel obstruction in a patient with ankylosing spondylitis.
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ABSTRACT:
SUBMITTER: Chiang HC
PROVIDER: S-EPMC8259219 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Intestinal obstruction resulted from balloon migration is an extremely rare but serious late complication of the intragastric balloon (IGB). The aim of this study is to report a case of small bowel obstruction occurring in a middle age corpulent female following embedding of IGB. A 47-year-old obese female presented with abdominal pain, nausea, and vomiting for two days. She had a history of an endoscopically placed IGB nine months before presentation. Physical examination showed an obese woman with mild distress, and the right upper abdomen was tender. The plain abdominal radiograph showed gas shadow in the stomach and the duodenum, esophago-gastro-duodenoscopy showed an empty stomach and balloon migration from the stomach. Under general anesthesia, laparotomy was performed, a three-centimeter antimesenteric enterotomy was done and the balloon extracted from the proximal jejunum. Intestinal obstruction is an extremely rare complication of IGB. It should be managed by laparotomy and extraction of the balloon.
| S-EPMC6168928 | biostudies-literature
Project description:We have compared synovial biopsies from ankylosing spondylitis and undifferentiated spondylitis patients with healthy controls and osteoarthritis patients Objective: In spondylarthropies, whole-genome gene expression profiling studies have been limited to peripheral blood to date. By undertaking a study in knee synovial biopsies from spondylarthropy (SpA) and ankylosing spondylitis (AS) patients we aimed to identified joint-specific candidate genes and pathways. These pathways may mediate systemic inflammation driven joint damaging processes and more specifically, the osteoproliferation that is characteristic of these conditions. Methods: RNA was extracted from six seronegative SpA, two AS, three osteoarthritis (OA) and four normal control knee synovial biopsies. Whole genome expression profiling was undertaken using the Illumina DASL system, which assays 24000 cDNA probes. Differentially expressed candidate genes were then validated using quantitative PCR and immunohistochemistry. Results: 416 differentially expressed genes were identified that clearly delineated between AS/SpA and control groups. Pathway analysis showed altered gene-expression in oxidoreductase activity, osteoblast activity, B-cell associated, matrix catabolic, and metabolic pathways. The inflammatory mediator, MMP3, was strongly upregulated in AS/SpA samples and the Wnt pathway inhibitors DKK3 and Kremen1 were downregulated. Conclusion: Pathways mediating both systemic inflammation as well as local tissue changes were identified. This suggests initial systemic inflammation in spondylarthropies transfers to and persists in the local joint environment, subsequently mediating changes in genes directly involved in the destructive tissue remodelling. Fifteen knee synovial biopsy tissue samples consisting of six seronegative spondyloarthropy (SpA), two ankylosing spondylitis (AS), three osteoarthritis (OA) and four normal control biopsies were obtained from the Synovial Tissue Bank at the Repatriation General Hospital in Adelaide, South Australia with the appropriate ethical approval (Supplementary Table 1). All patients provided informed written consent.
2012-12-01 | E-GEOD-41038 | biostudies-arrayexpress
Project description:Advances in genomic technology have enabled a greater understanding of the genetics of common immune-mediated diseases such as ankylosing spondylitis (AS), inflammatory bowel disease (IBD) and psoriasis. The substantial overlap in genetically identified pathogenic pathways has been demonstrated between these diseases. However, to date, gene discovery approaches have only mapped a minority of the heritability of these common diseases, and most disease-associated variants have been found to be non-coding, suggesting mechanisms of disease-association through transcriptional regulatory effects.Epigenetics is a major interface between genetic and environmental modifiers of disease and strongly influence transcription. DNA methylation is a well-characterised epigenetic mechanism, and a highly stable epigenetic marker, that is implicated in disease pathogenesis. DNA methylation is an under-investigated area in immune-mediated diseases, and many studies in the field are affected by experimental design limitations, related to study design, technical limitations of the methylation typing methods employed, and statistical issues. This has resulted in both sparsity of investigations into disease-related changes in DNA methylation, a paucity of robust findings, and difficulties comparing studies in the same disease.In this review, we cover the basics of DNA methylation establishment and control, and the methods used to examine it. We examine the current state of DNA methylation studies in AS, IBD and psoriasis; the limitations of previous studies; and the best practices for DNA methylation studies. The purpose of this review is to assist with proper experimental design and consistency of approach in future studies to enable a better understanding of the functional role of DNA methylation in immune-mediated disease.
| S-EPMC6547594 | biostudies-literature
Project description:Case presentationA 67-year-old female presented to the emergency department (ED) complaining of generalized abdominal pain, nausea, and vomiting. Point-of-care ultrasound (POCUS) demonstrated dilated bowel loops measuring up to 4.1 centimeters and localized free fluid, consistent with a small bowel obstruction (SBO). A nasogastric tube was placed without complications. The patient was admitted to the hospital and conservatively managed with an uncomplicated course.DiscussionIn elderly patients with abdominal pain, POCUS is an excellent initial imaging modality to assist emergency physicians in rapid and accurate diagnosis of a variety of pathologies to expedite management. Point-of-care ultrasound can be used to rule out and evaluate for conditions encountered in emergency medicine, including acute cholecystitis, renal colic, abdominal aortic aneurysm, and intraperitoneal free fluid. As demonstrated in our case presentation, POCUS had an integral role in the early diagnosis and management of a SBO.
| S-EPMC7872622 | biostudies-literature
Project description:We have compared synovial biopsies from ankylosing spondylitis and undifferentiated spondylitis patients with healthy controls and osteoarthritis patients Objective: In spondylarthropies, whole-genome gene expression profiling studies have been limited to peripheral blood to date. By undertaking a study in knee synovial biopsies from spondylarthropy (SpA) and ankylosing spondylitis (AS) patients we aimed to identified joint-specific candidate genes and pathways. These pathways may mediate systemic inflammation driven joint damaging processes and more specifically, the osteoproliferation that is characteristic of these conditions. Methods: RNA was extracted from six seronegative SpA, two AS, three osteoarthritis (OA) and four normal control knee synovial biopsies. Whole genome expression profiling was undertaken using the Illumina DASL system, which assays 24000 cDNA probes. Differentially expressed candidate genes were then validated using quantitative PCR and immunohistochemistry. Results: 416 differentially expressed genes were identified that clearly delineated between AS/SpA and control groups. Pathway analysis showed altered gene-expression in oxidoreductase activity, osteoblast activity, B-cell associated, matrix catabolic, and metabolic pathways. The inflammatory mediator, MMP3, was strongly upregulated in AS/SpA samples and the Wnt pathway inhibitors DKK3 and Kremen1 were downregulated. Conclusion: Pathways mediating both systemic inflammation as well as local tissue changes were identified. This suggests initial systemic inflammation in spondylarthropies transfers to and persists in the local joint environment, subsequently mediating changes in genes directly involved in the destructive tissue remodelling.
2012-12-01 | GSE41038 | GEO
Project description:Whole blood RNA-sequencing data from 5 AS patients who met 1984 AS criteria and 3 healthy human were obtained to gain insight into the potential mechanism of ankylosing spondylitis.
2021-11-10 | GSE181364 | GEO
Project description:IntroductionWe describe the journey to diagnosis of ankylosing spondylitis (AS) from the patient perspective and examine differences in this journey by sex.MethodsUS adults aged ≥ 18 years with a self-reported AS diagnosis were recruited online through CreakyJoints, a patient support community, and ArthritisPower, a patient research registry. Respondents completed a web-based survey on sociodemographics, disease burden, and diagnosis history. Results were stratified by sex and time to diagnosis using two-sample t tests and χ2 tests, respectively, to observe differences across the groups; P < 0.05 was considered statistically significant.ResultsAmong 235 respondents, 174 (74.0%) were female. Mean (SD) ages of female and male respondents were 48.6 (10.6) and 53.1 (10.3) years, respectively. From the time respondents began seeking medical attention, 87 were diagnosed within ≤ 1 year, 71 in 2-9 years, and 77 after ≥ 10 years. Symptoms that led respondents to seek treatment were back pain (73.2%) and joint pain (63.8%); fatigue and difficulty sleeping were more common among respondents with longer times to diagnosis. During the diagnosis process, men with AS tended to receive quicker AS diagnosis compared with women. Overall, commonly reported initial diagnoses among respondents with longer time to AS diagnosis included back problems and psychosomatic disorders. Significantly more women reported misdiagnoses of fibromyalgia (20.7 vs. 6.6%) and psychosomatic disorders (40.8 vs. 23.0%) compared with men.ConclusionsDiagnosis delays and misdiagnoses were common among respondents with AS. Increasing awareness about AS among referring providers may minimize diagnosis delay.FundingNovartis Pharmaceuticals Corporation. Plain language summary available for this article.
| S-EPMC6513959 | biostudies-literature
Project description:Phytobezoars are concretions of indigested fruit and vegetables fibers in the gastrointestinal tract. The past of gastric surgery is most common risk factor of phytobezoar. We present the case of a 39-year-old female was admitted to the emergency department and who presented with small bowel obstruction due to phytobezoar, her past medical history was marqued by truncal vagotomy and simple suture recurrent perforated gastric ulcer 15 years earlier. Her postoperative recovery was uneventful.
| S-EPMC7847810 | biostudies-literature
Project description:Ankylosing spondylitis (AS) or Bechterew disease is a chronic, usually progressive, systemic inflammatory joint disease, which predominantly affects the spine and sacroiliac joints. In these joints, early inflammatory changes are followed by lumbosacral pain and progressive restriction of spinal movement associated with radiologically visible intervertebral ossification. Peripheral joint involvement occurs in 10 to 30% of patients and shows a predilection for the shoulders, knees, ankles, feet, and wrists. Temporomandibular joint (TMJ) involvement has been described, and its reported frequency varies from 11 to 35%. However, ankylosis is uncommon with a single documented case utilizing an alloplastic prosthesis for total joint replacement. A case report of bilateral ankylosis of the jaw treated with alloplastic prostheses for total TMJ replacement using a Brazilian system in a patient with AS is presented.
| S-EPMC4078120 | biostudies-other
Project description:We present a case of paraplegia due to cord compression from epidural hematoma following an uneventful epidural catheter insertion in a patient with ankylosing spondylitis.A 65-year-old gentleman was scheduled for a major laparotomy for abdominal wall reconstruction. He has a past medical history of mild asthma, ankylosing spondylitis, duodenal ulcer and a superior mesenteric artery thrombosis in the past which led to bowel ischemia and intestinal failure. His drug allergies included Oxycodone. The anaesthetic plan was to do an awake epidural with catheter insertion followed by a general anaesthetic. The insertion of the epidural and the catheter was uneventful with the space identified in first attempt and no bloody tap. Intra-operative analgesia was maintained by a continuous epidural infusion of low dose local anaesthetic and opioid. The total operative time was eight hours and the patient was extubated at the end of the surgery. Following extubation, the motor block was checked in recovery using the modified Bromage scale. A dense block was noted and the epidural infusion was stopped. An MR scan was performed immediately, which showed an epidural hematoma in T5 - T11 segments. An urgent decompressive laminectomy was performed to evacuate the haematoma. However, neurological recovery was minimal with persistent paraplegia.The increased incidence of epidural haematoma in patients with ankylosing spondylitis is well documented . Earlier detection and decompression can help in preserving neurological function. We recommend being more cautious when the decision for epidural analgesia is made in patients with higher grades of ankylosing spondylitis. If an epidural is considered necessary, use of x-ray guidance and some form of intra-operative neurological monitoring should be considered, particularly in prolonged surgeries which last over several hours.
| S-EPMC5559664 | biostudies-other