嗜酸细胞性胃肠炎的临床及内镜特点分析

目的:分析嗜酸细胞性胃肠炎(eosinophilic gastroenteritis,EG)的临床及内镜特点,探讨其误诊原因.方法:回顾性分析12例EG惠者的病史、症状体征、实验室检查、内镜表现、影像学检查及治疗情况.结果:EG多以腹痛(83.3%)、腹泻(50.0%)、腹胀(50.0%)为主要症状,也可有消化道梗阻、腹水等表现.外周血嗜酸细胞比例达37%～68.4%;骨髓中嗜酸细胞增多达26.8%～60%;腹水见大量嗜酸细胞;内镜表现多为黏膜充血、水肿及糜烂;病理见大量嗜酸细胞浸润.激素治疗可迅速缓解症状,并可使外周血嗜酸细胞迅速下降(治疗前后差异有统计学意义,t=-4.63,P＜0.05),结论:EG的症状和内镜表现缺乏特异性,易误诊,外周血、骨髓及腹水嗜酸细胞,尤其是内镜下多点活检是诊断的关键.     

嗜酸粒细胞性胃肠炎1例并文献回顾性分析

目的 探讨嗜酸粒细胞性胃肠炎（EG）的临床与内镜特点并分析其误诊原因。方法 对我院收治的1例及1979年1月至2005年5月中国期刊全文数据库报道的131例EG的临床特点、实验室检查、内镜表现和治疗预后进行分析。结果 20．61％的EG患者与进食有关，12．21％有过敏性疾病史。临床表现多样。消化不良型EG占51．91％，梗阻型占7．63％，腹腔积液型占18．32％，混合型占22．14％。75．58％的EG患者外周血嗜酸粒细胞计数明显增高，嗜酸粒细胞的比例为0．07—0．74，嗜酸粒细胞的绝对值为（0．48-7．64）×10^9／L。腹腔积液中可见大量嗜酸粒细胞。内镜表现多为黏膜充血水肿、糜烂、溃疡和息肉样增生，病理见大量嗜酸粒细胞浸润。应用激素可在1周内迅速缓解症状，并逐渐使嗜酸粒细胞恢复正常。结论 EG临床和内镜表现无特异性，多数患者外周血和腹腔积液中嗜酸粒细胞计数明显增高，胃肠黏膜组织中嗜酸粒细胞浸润是诊断的关键。     

嗜酸细胞性胃肠炎误诊6例分析

对我院近年来收治的嗜酸细胞性胃肠炎6例分析如下。1临床资料1.1一般资料本组男4例,女2例,年龄20~61(43.3±2.5)岁。病程1周~2个月。诊断依据[1]:(1)有腹痛、腹泻、腹胀、恶心、呕吐等消化道症状;(2)病理证实胃肠黏膜或腹水中有嗜酸细胞浸润及外周血嗜酸细胞增高;(3)除外其他嗜酸细胞增高的疾病。分型[2]:仅表现为腹痛、腹泻,嗜酸细胞局限于黏膜层和黏膜下层,为黏膜型;有胃肠蠕动减弱或消失,肠梗阻,嗜酸细胞浸润至固有肌层,为肌型;出现腹水、腹膜炎,腹水中可见大量嗜酸细胞或腹腔镜活检见浆膜下嗜酸细胞浸润,为浆膜型。分析6例患者的临床表…     

13例嗜酸细胞性胃肠炎临床分析

目的:分析嗜酸细胞性胃肠炎(EG)的临床特征、治疗及预后.方法:收集完整的13例EG患者的住院资料,并回顾性分析临床表现、内镜下表现、病理结果、治疗和预后等.结果:13例中4例既往有过敏史;临床表现以腹痛(9例)、腹泻(7例)为主,分型以黏膜型(11例)为主,10例出现外周血嗜酸性粒细胞计算升高,3例IgE升高.内镜下病变表现为黏膜肿胀、红斑、糜烂、溃疡,无特异性,好发于胃窦及十二指肠,组织病理学及腹水检查均提示大量嗜酸性粒细胞浸润.12例应用泼尼松、1例应用酮替芬治疗有效,治疗2～7d症状缓解,10例患者治疗后嗜酸性粒细胞计数明显下降(P＜0.01).结论:过敏史、嗜酸性粒细胞计数升高及IgE水平升高对诊断EG有提示价值,但黏膜组织及腹水检查见较多嗜酸性粒细胞浸润为主要诊断标准,治疗以糖皮质激素治疗为主,酮替芬治疗亦有效.     

嗜酸细胞性胃肠炎:附16例临床分析

目的:探讨嗜酸细胞性胃肠炎(eosinophilic gastroenteritis,EG)的临床特点、误诊原因、治疗和预后。方法:选择复旦大学附属中山医院2005-2011年收治的EG患者16例,对其临床资料进行回顾分析。结果:(1)EG患者的临床表现多样,包括腹泻(9例)、腹痛(7例)、便血(5例)、低热(2例)、不完全性肠梗阻(2例)、腹水(1例);(2)EG患者中9例有过敏体质;(3)9例患者外周血中嗜酸性粒细胞(eosinophil,EOS)计数明显增高,随症状缓解而下降;(4)患者内镜检查无明显特异性表现,可见黏膜散在充血、点片状糜烂、出血灶或浅溃疡,以胃窦、十二指肠、回肠末端、回盲部最明显,活体组织检查可见大量EOS浸润;(5)影像学检查无特异性表现,13例(81.3%)黏膜型EG的CT或消化道钡餐检查无特殊发现,2例(12.5%)肌型EG肠壁肌层受累时可见不全肠梗阻,1例(6.3%)浆膜型EG出现腹水;(6)激素为治疗EG的一线药物,可迅速缓解症状并使EOS恢复正常;(7)本病是一种自限性变应性疾病,虽可反复发作,但多数患者预后良好。结论:EG的临床及内镜表现缺乏特异性,极易误诊。深层活检胃肠黏膜组织中EOS增多是诊断关键。     

嗜酸细胞性胃肠炎16例临床分析

目的：探讨嗜酸细胞性胃肠炎（eosinophilic gastroenteritis，EG）临床特点和治疗。方法：检索我院1997—2005年共收治的16例EG患者，对他们的临床特点、实验室检查、内镜表现和治疗随访情况进行系统分析。结果：（1）EG患者的临床表现多样，包括腹痛、腹泻、腹胀、恶心、呕吐、低热及体重下降等，其主要取决于病变累及的范围和程度。（2）外周血和骨髓中嗜酸细胞计数随着症状的缓解而下降。（3）内镜下表现多为黏膜糜烂和水肿。缺乏特异性，以胃窭和回盲部最常受累。活检可见大量嗜酸细胞浸润。（4）激素为治疗EG的一线药物，可迅速缓解症状。并使嗜酸细胞恢复正常。（5）病情可反复，反复复发的患者可考虑延长激素的治疗时间或应用免疫抑制剂。结论：EG在诊断上极易造成误诊，最后的诊断需要依靠活组织检查来证实。     

以腹痛为首发症状的嗜酸粒细胞性胃肠炎临床病理特征分析

目的 探讨以腹痛为首发症状的嗜酸粒细胞性胃肠炎(EG)的临床病理特征、内镜下表现,以减少其漏诊和误诊.方法 回顾性分析我院近6年以腹痛为首发症状27例EG患者的临床资料,病理分型及诊治方法.结果 27例EG患者中23例(85.19%)有不同程度腹痛,以中上腹部和脐周为主,绞痛者达39.13%;其中黏膜型17例(62.96%),浆膜型4例(14.81%),黏膜、浆膜混合型5例(18.52%)及黏膜肌层混合型1例(3.71%).内镜检查病变多分布在胃窦、十二指肠降部和回盲部.活体组织病理学检查或腹水细胞学发现大量嗜酸粒细胞浸润.予以糖皮质激素或抗组胺类药物,腹痛症状均在1周内缓解.结论 EG主要发生于青中年,以黏膜型最常见,多以腹痛为首发症状且常规镇痛药物疗效不佳,糖皮质激素治疗疗效显著.     

嗜酸细胞性胃肠炎11例诊疗研究

目的探讨嗜酸细胞性胃肠炎(EG)的临床特点及诊治方法。方法回顾性分析2017年1月至2018年12月首都医科大学附属北京友谊医院收治的11例EG患者的临床资料,观察其临床表现、实验室检查、影像学特征、内镜特征、病理特征及预后,采用电话、门诊及住院复查进行随访,随访截至2019年4月。结果 EG临床表现缺乏特异性,可表现为腹痛、腹泻、便血等症状。外周血及骨髓嗜酸性粒细胞(EOS)可明显升高。影像学检查缺乏特异性表现。内镜检查表现为多发黏膜充血、水肿,病理可见大量EOS浸润。所有患者经激素治疗后症状均得到缓解,复发病例再次应用激素治疗有效。结论 EG临床表现、影像学检查、内镜检查均缺乏特异性,外周血、骨髓EOS升高及内镜病理有助于诊断,激素治疗预后良好。     

儿童嗜酸细胞性胃肠炎30例临床分析

目的总结嗜酸细胞性胃肠炎(eosinophilic gastroenteritis, EG)患儿的临床特征。方法回顾性分析30例EG患儿的临床资料,包括临床表现,实验室检测、胃/肠镜检查结果,诊断、治疗及随访情况。结果 EG临床主要表现为反复发作的慢性腹痛,可伴呕吐、腹泻、便血。外周血嗜酸性粒细胞百分比、嗜酸性粒细胞计数增高24例;血清总IgE升高13例;骨髓穿刺示12例存在不同程度的嗜酸性粒细胞浸润;食物不耐受IgG检测结果阳性12例;30例自身抗体均为阴性。3例有腹腔积液者抽取积液,1例呈血性,3例常规和生化检测均提示为渗出液,镜下见大量嗜酸性粒细胞浸润。胃/肠镜检查示食管、胃、十二指肠、结肠等部位可见黏膜不同程度的充血、水肿、不规则片状糜烂、红斑、溃疡,多点活检组织病理示29例存在嗜酸性粒细胞浸润,病理分型为黏膜+浆膜型3例、黏膜+肌层型2例、肌层型1例、黏膜型24例。18例经膳食回避,常规应用奥美拉唑、孟鲁司特咀嚼片后症状明显缓解;12例联合应用甲泼尼龙后症状明显缓解,3例有腹腔积液者治疗2～4周后腹腔积液消失。出院后继续膳食回避,应用孟鲁司特咀嚼片3～6个月。随访6个月～4年,25例未再发作,1例反复发作,4例迁延不愈。结论 EG患儿的临床及胃/肠镜表现无特异性,腹腔积液常规及生化检测、胃/肠镜活检组织病理证实大量嗜酸性粒细胞浸润是诊断的关键。同时重视血常规检测和胃/肠镜的多点活检,可提高该病的检出率。膳食回避及糖皮质激素治疗EG的效果确切。     

嗜酸细胞性胃肠炎八例误诊

目的 提高对嗜酸细胞性胃肠炎(eosinophilic gastroenteritis,EG)的认识,减少误诊.方法 对我院1997～2009年误诊的8例EG的临床资料进行回顾性分析.结果 本组7例有不同程度的腹痛,腹泻3例,恶心、呕吐3例,腹胀2例,低热、肠梗阻各1例;3例有不同程度的焦虑症状.误诊为慢性浅表性胃炎4例,十二指肠炎、慢性结肠炎,克罗恩病、溃疡性结肠炎各1例.内镜下多点活检示受累胃肠黏膜有嗜酸细胞浸润7例,1例术中快速冷冻切片及术后病理检查均示回肠肌层见嗜酸细胞浸润,慢性肠系膜淋巴结炎伴大量嗜酸细胞浸润,确诊为EG.经内科保守治疗7例,经外科手术治疗后再行内科治疗1例,均治愈,随访0.5～1.0年无复发.结论 胃肠道黏膜病理学检查是EG确诊的关键,同时重视血常规检查和消化内镜的多点活检,可提高该病的检出率,糖皮质激素对EG的治疗效果肯定.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.