Co-occurrence of IPMN and malignant IPNB complicated by a pancreatobiliary fistula: A case report and review of the literature

BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB) is pathologically similar to intraductal papillary mucinous neoplasm(IPMN). However, there are several significant differences between them. The rate of IPMN associated with extrapancreatic malignancies has been reported to range from 10%-40%, and it may occasionally be complicated with the presence of fistulas. IPMN associated with malignant IPNB is extremely rare and only nine cases have been reported in the literature.CASE SUMMARY We report a 52-year-old man who presented with recurrent cholangitis for nine months. Computed tomography and magnetic resonance cholangiopancreatography showed the common bile duct stricture with dilated pancreatobiliary duct without other abnormal findings. The underlying pathogenesis could not be identified based on the radiologic images. Endoscopic retrograde cholangiopancreatography revealed a pancreatobiliary fistula with dilated main pancreatic duct, biliary stricture with dilated biliary tree, and mucus discharge from the enlarged orifice of the major papilla. The patient underwent SpyGlass cholangiopancreatoscopy due to a suspected mucin-producing biliary neoplasm and indeterminate main pancreatic duct dilatation. Multiple papillary growing neoplasms with vascular images, with the extent of lesions spreading in the biliopancreatic ductal lumens, were identified by SpyGlass. In addition, the presence of a pancreatobiliary fistula was also identified. The patient was diagnosed as having benign IPMN and malignant IPNB with focal invasion by postoperative pathology. Furthermore, varying histological subtypes were present in both IPMN and IPNB. Pylorus-preserving pancreaticoduodenectomy was performed on the patient with excellent results during the 52 month followup period.CONCLUSION We deemed that pancreatography and SpyGlass allowed for an efficient diagnosis of IPMN with pancreatobiliary fistula, whereas the etiology could not be identified by radiologic imaging.     

小型节能头灯的制做与应用

医院(特别是儿童医院)在日常的诊断和治疗护理工作中,需要在小局部范围、短时间光源照明.目前市场上各种医用头灯存在着价格昂贵,使用不方便;我院医护人员在加05年10月至2007年3月使用我院自行研制的节能头灯,采用现代电子技术,在夜间给病人注射、换药和其他治疗以及查房巡视等小范围用光场合,取得了良好的效果.     

Cervicogenic exophthalmos: Possible etiology and pathogenesis

BACKGROUND Unilateral exophthalmos is often caused by inflammation, neoplasm, infection,metabolic disease, vascular disorder and several other less common conditions.Reflex sympathetic dystrophy related to unilateral exophthalmos has not been reported in the past literature.CASE SUMMARY We describe a 45-year-old female with unilateral exophthalmos caused by reflex sympathetic dystrophy and its unexpected spontaneous disappearance after a standard anterior cervical discectomy and fixation operation with two PEEK interbody cages and a plate. To our surprise, the patient’s left unilateral exophthalmos improved spontaneously in the morning on postoperative day 2-with no relapse, without any further medication, as of seven years. We have named this condition "cervicogenic exophthalmos."CONCLUSION We would inform other clinicians that unilateral exophthalmos was caused not only by inflammation, vascular disorder, infection, neoplasm, or metabolic disease, but also by reflex sympathetic dystrophy related with cervicogenic spondylosis. To the best of our knowledge, ours is the first related case report and use of the term "cervicogenic exophthalmos" after reviewing previous literature.     

Photodynamic therapy as salvage therapy for residual microscopic cancer after ultra-low anterior resection: A case report

BACKGROUND The rate of positive resection margins(R1) in patients with low rectal cancer is substantial. Recommended remedies such as extended resection or chemoradiotherapy have their own serious drawbacks. It has been reported that photodynamic therapy(PDT) as a remedial treatment for esophageal cancer.Colorectal cancer and esophageal cancer has many similarities,however,PDT as a salvage therapy for rectal cancer is rare.CASE SUMMARY Here,we describe a 56-year-old man who was admitted to the hospital due to a 6-mo history of hemafecia,which had been aggravated for 1 mo. Colonoscopy revealed a 3 × 4 cm ulcerated mass in the rectum 4 cm from the anus.Preoperative pathological examination showed villous adenoma,moderate-tohigh-grade dysplasia,good differentiation,and invasion of the mucosal muscle.The patient had R1 after ultra-low anterior resection,but he refused extended resection and experienced severe liver function impairment after 3 cycles of chemotherapy. Ultimately,the patient underwent PDT to remove R1. After five years of follow-up,there was no liver function impairment,recurrence,metastasis,sexual dysfunction,or abnormal defecation function.CONCLUSION This is the first case worldwide in which R1 of rectal cancer were successfully treated by PDT.     

Endodontic management of the maxillary first molars with two root canals: A case report and review of the literature

BACKGROUND The complex anatomy of the maxillary first molars has always been a major challenge for complete root canal treatment in endodontic therapy. Here, we present two cases of maxillary first molars, each with only two root canals, which have been rarely reported. We also perform a literature review of maxillary first molar anatomy.CASE SUMMARY The two patients were referred to the hospital after 1) finding a cavity in their tooth with a color change and, 2) a toothache during mastication, respectively.Both of these cases were diagnosed as apical periodontitis by X-ray imaging and cone beam computed tomography(CBCT). Non-surgical endodontic therapy was performed with the assistance of a dental operating microscope(DOM). CBCT showed rare but accurate images of both patients, each with two root canals and two roots in their maxillary first molars. Both roots were located in the buccal in the palatal direction, and each root had only one clear root canal. In addition,each maxillary first molar in both patients was symmetrical to that on the opposing side with only two separate root canals. Non-surgical endodontic therapy was performed with the assistance of a DOM. Finally, the teeth were restored using composite resin and the patients were satisfied with the results.CONCLUSION Making full use of CBCT and DOM would contribute to helping dentists make correct diagnoses and successfully treat teeth with rare root canal morphologies.     

读片窗及答案

病例 男,62岁.以"发现尿黄5天"为主诉入院.无发热、恶心及厌食等伴随症状.查体:血压150/100mmHg,巩膜轻度黄染,腹软无压痛,肝区无叩击痛,肝肋下未触及.实验室检查:血WBC 13.1×109/L,EO 5.2×109/L,占39.7%.TBIL 36.6μmol/L,DBIL 21.5μmol/L,UDBIL 15.1μmol/L.ALT 88U/L,GGT 201U/L.AFP及CEA阴性.HBsAb阳性,其余4项均阴性.     

结合中医理论对上呼吸道感染的护理

上呼吸道感染一年四季均可发病,但以冬春季节为多.此类病人病程一般在10 d以上,易反复,有的甚至迁延不愈达1个月以上,造成门诊输液量增加、交叉感染机会增多,在医治过程中医护人员也易感染.此病虽然不像癌症使人恐惧,但它的发病率高,有的1年内可发病3次～5次,给身体和生活造成很大的不便.此类病人的症状为鼻塞、流涕、喷嚏、咳嗽、咽干、咽痛、头痛、发热、乏力、全身不适等,护理一般采取对症施护:休息、保持室内空气清新、多饮水、清淡饮食等,而应用中医理论施护则更具体、更有效,对于疾病的痊愈会有极大的促进作用.     

伸缩式垂直升降护理机的适用性探讨

昏迷病人、截瘫病人、慢性消耗性疾病及脑卒中后遗症病人常伴有肢体瘫痪而长期卧床,生活不能自理,大小便失禁,易发生压疮,给病人带来极大痛苦,给家属带来繁重的负担[1].为解决这一难题,人们研究了一些护理器械,如"升降护理装置",这种护理装置由铁床、软布带、支架杆、绑绳钢筋、软网布、定滑轮组件、动滑轮组件、万向节连接件和钢丝绳组成.     

世界疼痛日——中国镇痛周暨建立疼痛科新闻发布会隆重召开中华医学会疼痛学分会第七届年会胜利闭幕

世界疼痛日中国镇痛周暨建立疼痛科新闻发布会、中华医学会疼痛学分会第七届年会于2007年10月12～16日在北京九华山庄隆重举行.全国人大副委员长中科院韩启德院士、原全国人大副委员长中科院吴阶平院士、卫生部陈啸宏副部长、卫生部医政司王羽司长、卫生部科教司刘雁飞司长、中华医学会吴明江常务副会长、原卫生部副部长中国医师协会殷大奎会长及有关方面的领导、专家及参加大会的疼痛医学专家代表约五百人参加了新闻发布会.     

多功能病号服在临床中的应用

病人在医院接受治疗时,往往在需要暴露局部治疗部位时,必需脱去整件衣、裤,由于春季、秋季、冬季室内温度低于体温,使病人易着凉、感冒,诱发其他并发症等,引起身体的不适.局部肿瘤放疗病人,指导放疗病人和家属将放疗局部的内衣剪开,露出局部皮肤进行治疗,这样不影响治疗,还可保暖,但这一方法还有待改进.另外住院病人的病号服颜色单调,款式单一,功能缺乏,根本不能满足住院病人的身心及治疗的需要.因此,近几年,通过大量的研究和临床实践,设计出多功能病号服,获国家实用型专利.现将其介绍如下.     

韶关市农村留守儿童孤独感状况调查

目的了解广东省韶关市农村地区留守儿童孤独感现状及其影响因素。方法对韶关市某地区两所农村小学3～6年级学生中的489名留守儿童采用儿童孤独量表和自编调查表进行问卷调查。结果17．6％留守儿童存在孤独感，不同性别孤独感发生率无差异性，不同年龄及不同年级间孤独感发生率差异均有极显著性（P〈0.01）；随年级增加，孤独感发生率呈下降趋势（X^2趋势=5．970，P〈0.05）。留守儿童孤独感与健康状况、学习成绩、学习困难程度、父母教育方式、父母间关系和老师教育方式等因素显著相关（P〈0.01～0．05）。结论农村地区留守儿童中存在一定程度的孤独感问题，老师和家长应以正确的态度和方法对待留守儿童，以减少其孤独感的发生。     

Determination of loss of quality of life

Physiatrists are a valuable resource in legal settings, where assessment of functional capacity to perform work and of future medical needs must be determined. Physiatrists help determine what future medical care is needed to restore and maintain an individual at the maximum level of life function. This article focuses on the use of a quality of life (QOL) rehabilitation model, rather than a medical model, for enhancing functional performance, modifying environments, and facilitating patient coping. We discuss use of the QOL model to describe and influence a patient's physical, psychological, cognitive, vocational/economic, and social/leisure domains.     

产科新生儿不同部位经皮测黄报警预值的可靠性观察

目的对比观察产科新生儿不同部位经皮胆红素（TCB）报警预值的可靠性。方法132例产科新生儿采取随机数字分组法分为正常产组和剖宫产组各66例,新生儿均于产后第4天同一时间点应用KJ8000经皮测黄仪分别测量额、胸、腹、额胸、额胸腹TCB值,TCB〉12．9mg／dl者,取得亲属同意抽取静脉血检测血清胆红素（SB）,对比分析不同部位TCB及其与sB值的差异。结果两组分别有17例或21例达到TCB报警预值。两组TCB或sB相同方法及相同部位比较,差异无统计学意义（P〉0．05）;两组TCB不同部位对比,额部值最低、胸部值最高,且与其他部位同组对比差异均有统计学意义（P〈0．01）;两组sB值对比差异无统计学意义（t=1．53,P〉0．05）,与不同部位TCB对比均以胸部数值差异无统计学意义（P〉0．05）,而与其他部位TCB两组差异均有统计学意义（P〈0．01）。结论正常产与剖宫产新生儿术后sB对比差异无意义;TCB动态监测以胸部结果更接近SB。     

The characteristics of interpretation of results of analysis of protein amount in urine of pregnant women

The adequacy of implementation of present proteinuria diagnostic thresholds under examination of pregnant women was examined. The analysis was applied to all urine samples of pregnant women from December 2009 to March 20010. The amount of protein in urine was concurrently evaluated by turbidimetric analysis with sulfosalicylic acid, colorimetric analysis with pyrogallol red, "dry chemistry" technology (the diagnostic strips). It is established that the mentioned techniques of analysis of protein in urine provide independent results. The results of colorimetric analysis are characterized by better precision and adequacy. However, in case of pregnant women the diagnostic threshold of protein concentration should be shifted from 0.120 to 0.150 g/l.     

超声评价放疗对颈动脉溃疡斑块形成的影响

目的 探讨超声在评价放疗对颈动脉溃疡斑块形成的影响的价值。方法 回顾性收集经病理学证实为头颈部肿瘤、放疗前后的颈动脉超声资料以及其他基线资料完整的患者93例,比较放疗前后放疗侧颈动脉和非放疗侧颈动脉粥样硬化斑块和溃疡斑块的总数量、平均内膜-中膜厚度、最大斑块面积、最大溃疡斑块的面积、最大溃疡口的面积。结果 放疗前后颈动脉超声检查的平均间隔时间为（6.1±1.9）年;放疗前放疗侧斑块总数量、平均内膜-中膜厚度、最大斑块面积、溃疡斑块的总数量、最大溃疡斑块的面积、最大溃疡口的面积与非放疗侧比较差异均无统计学意义（P均>0.05）;放疗后放疗侧斑块总数量、平均内膜-中膜厚度、最大斑块面积、溃疡斑块的总数量、最大溃疡斑块的面积、最大溃疡口的面积均较非放疗侧加重,差异有统计学意义（P均<0.05）。结论 放疗可导致头颈部肿瘤患者颈动脉粥样硬化斑块的形成和进展,且斑块具有易损性特点。