Crohn's disease with gastroduodenal involvement: Diagnostic approach

Crohn's disease(CD) is a chronic idiopathic inflammatory disease of gastrointestinal tract characterizedby segmental and transmural involvement of gastrointestinal tract. Ileocolonic and colonic/anorectal is a most common and account for 40% of cases and involvement of small intestine is about 30%. Isolated involvement of stomach is an extremely unusual presentation of the disease accounting for less than 0.07% of all gastrointestinal CD. To date there are only a few documented case reports of adults with isolated gastric CD and no reports in the pediatric population. The diagnosis is difficult to establish in such cases with atypical presentation. In the absence of any other source of disease and in the presence of nonspecific upper gastrointestinal endoscopy and histological findings, serological testing can play a vital role in the diagnosis of atypical CD. Recent studies have suggested that perinuclear anti-neutrophil cytoplasmic antibody and anti-Saccharomycescervisia antibody may be used as additional diagnostic tools. The effectiveness of infliximab in isolated gastric CD is limited to only a few case reports of adult patients and the long-term outcome is unknown.     

不同护理路径在脑出血护理中的应用效果分析

目的比较不同护理路径在脑出血患者护理中的应用效果。方法选取我院收治的48例脑出血患者,随机均分为对照组(常规护理)和观察组(临床护理路径),使用日常生活活动量表(Barthel指数)对患者日常生活活动能力进行评定,比较2组患者护理前后Barthel指数、疾病知晓情况和护理满意度。结果护理后观察组Barthel指数和疾病知晓情况均显著优于对照组(P<0.05);观察组护理满意度95.8%,高于对照组的70.8%,2组比较差异有统计学意义(P<0.05)。结论临床护理路径应用于脑出血患者效果确切,可有效提高患者对疾病的认知程度和生活自理能力,值得临床推广使用。     

扬州地区肝硬化食管静脉曲张初次出血80例患者诊治分析

目的探讨扬州地区肝硬化食管静脉曲张初次出血患者诊治特点。方法回顾性分析2010年1月-2013年12月苏北人民医院消化内科收治的80例肝硬化食管静脉曲张初次出血患者病例资料。计数资料用率或构成比表示,率的比较采用χ2检验。结果由乙型肝炎导致肝硬化所引起的食管静脉曲张破裂出血所占比例最大;三腔二囊管临床运用可最大限度地挽救患者生命,为后期治疗提供时间;基础治疗包括止血、输血、抑酸、补液等,后期以硬化剂、套扎、硬化剂+套扎、手术、经颈静脉肝内门体分流术(TIPS)为主,但套扎运用最为广泛;患者出血初期各项指标变化有利于指导临床治疗,对患者预后具有良好的评估作用。结论扬州地区肝硬化引起的食管静脉曲张破裂出血病因呈现复杂交叉性,治疗方法仍需进一步完善,以达到个体化治疗水平;及时正确的救治,对提高临床疗效、降低病死率有重要意义;早期的健康体检,对疾病诊治起关键性的作用。     

临床护理路径对脑出血偏瘫患者康复效果的影响

目的 探究与分析临床护理路径对脑出血偏瘫患者康复效果的影响.方法 选取本院自2013年7月至2015年7月收治的90例脑出血偏瘫患者,按照就诊时间顺序分为常规护理组与临床护理路径组,每组45例.常规护理组给予基础护理对策,包括入院时宣教、介绍病情、观察病情变化等;临床护理路径组指派至少由1名护士长及3名以上护理人员建立临床护理路径小组,由护士长组织组内人员系统性的学习并加强脑出血偏瘫后康复护理的相关知识,根据每位患者的个体情况给予评估,并对每个阶段后的康复护理效果给予评价.对比两组患者康复护理效果、活动能力、肢体功能及负面情绪评分.结果 临床护理路径组的护理效果总有效率明显高于常规护理组,差异具有统计学意义(P＜0.05).两组患者治疗后较治疗前相比Barthel评分及Harris评分均明显升高,临床护理路径组较常规护理组相比Barthel评分及Harris评分升高更加明显,差异具有统计学意义(P＜0.05).两组患者治疗后较治疗前相比HAMA评分及HAMD评分评分均明显降低,临床护理路径组较常规护理组相比HAMA评分及HAMD评分降低更加明显,差异具有统计学意义(P＜0.05).结论 临床护理路径可有效提高脑出血偏瘫患者的护理效果,促进改善日常活动能力及肢体功能,降低负面情绪.     

Prognostic factors in patients with active non-variceal upper gastrointestinal bleeding

Background and study aims

Acute upper gastrointestinal bleeding is one of the main causes of hospitalisation. The purpose of this study was to determine the prognostic factors in non-variceal upper gastrointestinal bleeding.

卒中合并脑微出血的影像学研究

目的 探讨ICH和脑梗死患者合并脑微出血（cerebral microbleeds，CMBs）数量分级及部位分布差异。 方法 连续选取2017年8月-2018年12月在北京市大兴区人民医院神经内科病房住院且资料完整的 卒中患者，分为ICH和脑梗死两组。收集患者发病2周内头颅MRI磁敏感加权成像影像，统计ICH与脑梗 死患者中CMBs数量分级及部位分布特点。 结果 共入组患者234例，其中ICH组79例，脑梗死组155例。ICH组合并CMBs 65例（82.3%），其中 CMBs＞5个的患者41例（51.9%）；脑梗死组合并CMBs 73例（47.1%），其中CMBs＞5个的患者21例 （13.6%），两组差异有统计学意义（P＜0.001）。ICH组中，CMBs同时累及脑叶和深部脑组织的患者40例 （50.6%）；脑梗死组中，CMBs同时累及脑叶和深部脑组织的患者25例（16.1%），两组差异有统计学意 义（P＜0.001）。 结论 CMBs病灶＞5个多见于ICH患者；CMBs同时累及脑叶及深部脑组织多见于ICH患者。     

New onset acute promyelocytic Leukemia during pregnancy: report of 2 cases

Acute promyelocytic leukemia (APL) is one of the most fatal hematological malignancies. APL during pregnancy is a rare comorbidity and can lead to adverse outcomes, such as maternal and/or fetal death, without timely and appropriate management. Medical management for APL during pregnancy remains challenging. We reported 2 patients with no regular prenatal visits who were diagnosed with APL during pregnancy. One presented with typical hematological abnormalities related to infection, while the other presented with intracranial hemorrhage, which is rare. Although supportive measures and chemotherapy were administered after APL was diagnosed, these two patients had completely different outcomes. The pregnancy outcomes of APL patients depend greatly on the timely diagnosis and appropriate management of the disease. Physicians should pay more attention to APL during pregnancy and thus may save more maternal and fetal lives. Further study of the management of APL during pregnancy is warranted.

Abbreviations: AML: acute myeloid leukemia; APL: acute promyelocytic leukemia; WBC: white blood cell; RBC: red blood cell; Hb: hemoglobin; PT: prothrombin time; TT: thrombin time; APTT: activated partial thromboplastin time; TP: total protein; ALB: albumin; AST: aspartate transaminase; ALT: alanine aminotransferase; LDH: lactate dehydrogenase; ATRA: all-trans retinoic acid; ICH: intracranial hemorrhage; DIC: disseminated intravascular coagulation     

Postpartum hemorrhage with pelvic arterial embolization,study of 33 cases

Objective: To describe our cases of postpartum hemorrhage (PPH) with pelvic arterial embolization (PAE).

Material and methods: All patients with PPH who underwent PAE in our center in the interval 2011–1016 were retrospectively studied, evaluating the technical procedure, clinical results, and subsequent fertility.

Results: There were 33 cases of PPH with PAE. The majority occurred in primiparous women (N?=?22, 66.6%) who delivered vaginally (N?=?20, 61%). In addition, most PPH with PAE cases had an early onset (N?=?26, 79%) and were caused by uterine atony (N?=?14, 42.4%). Success of PAE occurred in 27 (81.8%) cases and a satisfactory clinical follow-up was the rule, with 21 (64%) women recovering their normal menstruation, and six (18.2%) becoming pregnant in the following years.

Conclusions: PAE is a safe and efficacious technique with minor complications. Moreover, it allows conservation of the uterus with preservation of fertility.