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.     

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.     

手术室与供应室一体化运作中手术器械的管理

我院为一家拥有800张床位的综合性医院,年手术量1万多例,有一个现代化的供应室,由于手术器械从手术室到供应室环节多,很容易出现手术器械丢失或无菌手术器械不能及时供应而延误手术的现象.为达到资源共享,我院于2003年6月实行手术室与供应室一体化运作,经过4年尝试,在工作中不断总结经验,形成了一定的管理模式,取得满意结果.     

介绍一种眼科点眼药盘

眼科工作中给病人点眼药是主要治疗方法之一,一般是多种眼药水放在一个药盘或药框中,眼药水品种繁多,且眼药水瓶东倒西歪摆放没有规律,甚至会出现作用相反的眼药水(膏)拿错的现象,如缩瞳类和散瞳类就是两个作用完全相反的眼药.因此,使用时往往需要仔细寻找或凭经验才能快速找到所需的眼药,如果使用不当就会给病人造成严重的后果.为减少不良后果的发生,在临床实践中,我们制作了一种简易、方便使用的点眼药盘.现介绍如下.     

1例脐尿管漏合并妊娠的护理

脐尿管瘘是一种膀胱畸形疾病,男性多见.临床表现为脐部漏尿,漏尿程度视瘘管的大小而定,脐部漏口为皮肤或黏膜所覆盖.静脉注射靛胭脂或从尿道导管将亚甲蓝注入膀胱,可见染色尿液自脐部漏出,故可诊断[1].     

ICU护士了解自由基和抗氧化剂的重要性

对自由基和抗氧化剂的基本知识,自由基在ICU常见疾病发生发展中的作用以及抗氧剂的临床应用四方面内容进行综述,提示了ICU护士了解这四方面内容是临床实践的组成部分.     

类风湿关节炎、高热、黑便、血三系减少

1病例介绍患者女,67岁。因"发热半个月,黑便1d"于2006年6月9日入院。患者半个月前起发热,多次测得体温≥39.0℃,无寒战,无咳嗽、咳痰,无腹痛、腹泻,无尿急、尿痛,无腰痛、咽痛,当地医院予抗生素、激素治疗体温反复,昨日起解黑便,共2次,伴头晕,晕厥1次,无呕血,为进一步诊治转入本院。既往类风湿关节炎     

代谢综合征的疗养护理

代谢综合征又称代谢异常心血管综合征，它是一组心血管疾病危险因素的聚集和组合，包括高血压、高血脂（血脂异常）、高血糖（糖尿病、血糖调节受损、糖耐量异常）、肥胖、吸烟、炎症、血凝增强、纤溶降低等。心血管疾病是人类头号杀手，给社会和家庭带来了沉重的经济负担。对于心血管疾病这种新的流行病学表现，     

Clinical effects of apatinib mesylate for treatment of multiple brain micrometastases:Two case reports

BACKGROUND Apatinib is a small-molecule multitargeted tyrosine kinase inhibitor.Apatinib has demonstrated encouraging antitumor activities.This study aimed to observe the efficacy and safety of apatinib for the treatment of multiple brain micrometastases.CASE SUMMARY We report two patients with multiple brain micrometastases after failure of second-line treatment.Both patients had extracerebral metastases.When the patients took 250 mg/d apatinib orally,the intracerebral lesions disappeared.The extracerebral lesions were partially alleviated.Both patients had a progressionfree survival of more than 12 mo and were still stable.The safety was good.The main adverse events(AEs)were mild hypertension and proteinuria,which could be controlled.CONCLUSION Apatinib has clear efficacy and good tolerance in patients with multiple brain micrometastases after failure of second-line treatment.     

青霉素的发现及应用

青霉素能杀灭各种病菌,却对人体几乎没有毒性,因此是迄今为止在临床上应用最为广泛的抗生素.历史上,它的发现及应用与3个人密不可分.他们分别是亚历山大·弗莱明(Alexander Fleming)、霍华德·弗洛里(Howard Florey).恩斯特·钱恩(Ernst Chain).     

胎儿肾积水12例超声研究

目的研究胎儿肾积水的不同特点及转归,防范不必要的中止妊娠.方法利用B超对12例18只集合系统分离径＞1.0cm积水胎肾进行随访观察和研究.结果Ⅰ组为可复性肾积水,10例16只,积水宽度在1.01～1.63cm之间,肾实质较厚在1.02～0.58cm之间,此类胎儿肾积水于分娩后即日或一到二月后相继消失;Ⅱ组为不可复性肾积水,2例2只,集合系统分离径为2.15cm和2.56cm,实质较薄为0.3cm和0.2cm,随访至出生后1.5年和2.0年仍为重度积水表现.结论晚妊胎儿肾积水宽度＜1.63cm或实质厚度＞0.58cm者应视为可复性;积水宽度＞2.15cm或肾实质厚度＜0.2cm者为不可复性的肾积水,出生后应及时治疗.     

Fetus in fetu: a rare cause of a neonatal mass.

Fetus in fetu is an unusual digression from the normal twinning process which often presents as a mass in neonates. Approximately 80 reports have been documented in the literature to date. The increasing use of routine obstetric ultrasound has identified more cases during the antenatal period. This allows more time for both the neonatology team and the parents to develop a coordinated treatment plan for the anticipated child. We report a case of a fetus in fetu which was first seen as a complex cystic mass during antenatal ultrasound at 21 weeks and was confirmed by subsequent imaging and surgical treatment shortly after birth.     

Bilirubin Conjugation in the Human Fetus

Quantitative determination of bilirubin (unconjugated, by chloroform extraction), bilirubin diglucuronide (by the isotope derivative method) and albumin was done in 26 specimens of amniotic fluid from cases suspected of hemolytic disease in utero.

A hypothetical scheme of fetal bilirubin metabolism is proposed, presuming unidirectional transplacental elimination of unconjugated bilirubin. On the basis of theoretical considerations of the mechanism of conjugation it is thought possible that bilirubin in the fetal liver is in chemical equilibrium with its diglucuronide. Both pigments are in equilibrium with the pigments in the amniotic fluid. Equilibration takes place through the fetal plasma. The ratio of concentrations of bilirubin and bilirubin diglucuronide in the amniotic fluid is determined by the following three factors: the relative affinities of the binding of the two pigments to albumin, the ratio of concentrations of UDPGA to UDP in the liver, and the standard free energy of conjugation. The slow glycogen synthesis in the fetal liver may be responsible for a high ratio of UDPGA to UDP and hence for a high proportion of conjugated bilirubin in amniotic fluid.

The experimental findings are in agreement with this hypothesis, offering an alternative to the generally accepted conception of low transferase activity and impaired hepatic excretion of conjugate before and shortly after birth.     

临产前后胎心率监护预测产时胎儿情况的调查

目的 对孕妇临产前后行胎心率监护,预测胎儿在宫内的储备能力,以降低胎儿或新生儿的病死率.方法 对孕龄在37～41周的750例住院孕妇临产前后进行常规的胎心率监护,包括无应激试验(non-stress test,NST)、宫缩应激试验(contraction stress test,CST)和缩宫素应激试验(oxytocin challenge test,OCT)试验,并分析胎心监护与胎儿脐带绕颈、新生儿窒息和胎儿生长受限之间的关系.结果 胎心率监护750例中,出现频繁的变异减速与胎儿脐带绕颈关系显著;胎心率评分与新生儿窒息及胎儿生长受限关系显著(P＜0.01).结论 临产前后行NST、CST或OCT试验,可预测产时胎儿在宫内的储备能力并及时发现胎儿宫内缺氧等不良反应,从而尽快改善围产儿的预后.     

Delivering the Dead Fetus

At the University of Iowa Hospitals, physicians have studied the delivery of dead fetuses from 360 patients. Labor was spontaneous in 58.9 percent but induced in 36.4 percent. Eleven patients who had retained a dead fetus from 4 to 10 weeks evidenced hypofibrinogenemia. Aggressive management for fetal death in utero is recommended.     

羊水过多与胎儿畸形

目的：探讨羊水过多与胎儿畸形的关系。方法：对医院1997—2006年153例羊水过多患者的临床资料进行回顾性分析及产后新生儿随访。结果：153例羊水过多中有149例分娩，胎儿畸形23例，其中消化道畸形8例、肢体畸形7例、神经系统畸形5例；剖宫产11例，利凡诺引产9例，自然流产3例。结论：早期诊断羊水过多是否存在胎儿畸形是处理母儿疾病及预后的关键。