: Crohn's disease (CD) which usually leads to anal fistulas among patients is the most important inflammatory bowel disease that causes morbidity in many people around the world. This review article proposes using MSCs as a hopeful therapeutic strategy for CD and anal fistula treatment in both preclinical and clinical conditions. Finally, Darvadstrocel - a cell based medication to treat complex anal fistulas in adults- as the only European Medicines Agency (EMA)-approved product for the treatment of anal fistulas in CD is addressed. Although several common therapies such as surgery and anti-tumor necrosis factor-alpha (TNF-α) drugs as well as a combination of these methods is used to improve this disease, however, due to the low effectiveness of these treatments, the use of new strategies with higher efficiency is still recommended. Cell therapy is among the new emerging therapeutic strategies that have attracted great attention from clinicians due to its unique capabilities. One of the most widely used cell sources administrated in cell therapy is mesenchymal stem cell (MSC). This review article will discuss preclinical and clinical studies about MSCs as a potent and promising therapeutic option in the treatment of CD and anal fistula.
Background and Objectives: Splenic hematoma is one of the common complications following abdominal blunt trauma, but non-traumatic splenic hematomas are not common and occurs in some cases, such as hematologic disorders and/or infections. Idiopathic splenic hematoma that occurs spontaneously without an underlying disease, is a rare occurrence, which its diagnosis needs strong clinical suspicion. Case report:The patient was a young man who referred to the emergency department with sustained lower abdominal pain during the past day. The pain aggravated by bending and was worsened by lying down. The patient reported no specific concomitant symptoms. His past medical history and drug history were negative. Chest x-ray and laboratory tests did not show any abnormal finding. In the upright radiograph of the abdomen, the shadow of the spleen seemed larger than the normal size. Abdominal sonography showed extensive subcutaneous hematoma of the spleen, which was confirmed by CT scan. The patient was under observation in the intensive care unit for 48 hours, that due to the pain intensification of the candidate, the splenectomy was performed. Pathologic study of splenic tissue was normal and he discharged within one week with satisfactory general health condition.
Background: Flexible rectosigmoidoscopy is an easy and accessible exam to diagnose distal colon diseases, although many patients refuse undergoing it due to pain and discomfort during the procedure. Studies show that the application of local lidocaine, as an analgesic, has no effect on pain relief in patients undergoing rectosigmoidoscopy. The current study aimed at comparing the effects of diltiazem gel, an antispasmoic drug with local pain-reducing effects, with lidocaine gel in patients undergoing flexible rectosigmoidoscopy. Materials and Methods: The current double-blinded, randomized, clinical trial was performed to compare the effect of two topical drugs, lidocaine and diltiazem, on pain relief in patients undergoing rectosigmoidoscopy. A total of 80 patients who were potential candidates for rectosigmoidoscopy were enrolled in the study after obtaining the informed consent, and then randomly assigned to one of the lidocaine gel (2 mL) or diltiazem gel (2 mL) group, 10 minutes prior to rectosigmoidoscopy. The level of pain in the patients during the procedure was measured using the visual analogue scale (VAS) and the results were recorded. The data were analyzed using paired samples t-test and independent t-test as well as analysis of covariance (ANOVA) with SPSS version 18. P-value <0.05 was considered the level of significance. Results: Of 80 patients, 35 (43.75%) were male and 45 (56.25%) female. The mean age and body mass index (BMI) of the patients were 51.45 ± 15.21 years and 25.95 ± 7.47 kg/m2 , respectively, and there was no significant difference between the groups. The most frequent indications for rectosigmoidoscopy were abdominal pain (46.3%) and rectorrhagia (31.3%). The mean VAS score for pain reported by the patients in the lidocaine and diltiazem groups were 3.97 ± 2.89 and 2.60 ± 2.36, respectively. The VAS score for pain in the diltiazem group was significantly lower than of the lidocaine group (P = 0.023). Conclusion: The application of local diltiazem gel around the anus, in spite of no side effects, can effectively reduce the pain and discomfort in patients during rectosigmoidoscopy.
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