儿童结直肠息肉的临床特征

结直肠息肉是儿童常见病,是儿童无痛性便血的常见病因。随着儿童结肠镜检查技术的推广,越来越多的结直肠息肉患儿得到了诊断和治疗。结直肠息肉多在幼儿期、学龄前期出现症状,通过结肠镜检查,能够确认息肉的部位、大小、数量,能够进行病理检查确定其性质。儿童结直肠息肉有炎性息肉、错构瘤性息肉、腺瘤性息肉等多种类型。儿科医生需要提高认识,对有症状或有相关家族史的患儿积极进行结肠镜检查。     

电针“阳陵泉”穴对急性胆囊炎家兔白细胞计数和胆囊壁厚度的影响

目的:观察电针"阳陵泉""阴陵泉"穴对急性胆囊炎家兔白细胞计数、胆囊壁厚度以及组织病理的影响,探讨"合治内府"理论之胆和阳陵泉的相关性。方法:健康成年雄性家兔随机分为正常组、模型组、阳陵泉组、阴陵泉组,每组8只。胆囊内注射大肠杆菌液制成急性胆囊炎模型。两个治疗组电针相应穴位,连续7d。对比治疗前后白细胞计数,B超下观察胆囊壁厚度变化,光镜下观察胆囊组织病理变化。结果:与正常组比较,模型组白细胞计数显著升高,胆囊壁显著增厚(均P0.05);电针后,阳陵泉组、阴陵泉组的白细胞计数较模型组明显降低,胆囊壁显著变薄(均P0.05);与阴陵泉组比较,电针后,阳陵泉组的胆囊壁更薄(P0.05)。病理观察显示,模型组胆囊上皮黏膜变短,有全层坏死改变,胆囊上皮乳头水肿,间质内炎细胞浸润;阳陵泉组基层增生,散在炎细胞浸润;阴陵泉组血管腔内含有成堆的中性粒细胞。结论:阳陵泉穴和阴陵泉穴都能有效地治疗急性胆囊炎。从改善急性胆囊炎家兔的胆囊壁厚度来看,阳陵泉穴比阴陵泉穴效果更明显。     

Multiple soft fibromas of the lid

Fibromas are benign tumors that are composed of fibrous or connective tissue. They can grow in all organs, arising from mesenchymal tissue (a type of loose connective tissue). The term “fibroblastic” or “fibromatous” is used to describe tumors like the fibroma. This 69-year-old male presented to us with giant, multiple, very slowly progressive, painless, noninflammatory, soft, trans-illuminant, pedunculated lid swellings with a two decade history. There were no other swellings on the body. He was clinically normal on systemic examination except for the immature cataracts in both eyes. The diagnosis was confirmed on histopathology. Simple excision removed all the soft fibromas virtually leaving no scar. A review of literature world-wide using Medline Plus/PubMed revealed this to be the only reported case of multiple giant soft fibromas of the lid.     

阑尾管状绒毛状腺瘤临床特征、内镜特点及文献复习

阑尾肿瘤临床上十分少见，占胃肠道肿瘤的0．4％。尤其是发生于阑尾的管状绒毛状腺瘤在临床上属少见病，具有癌变潜能由于本病症状不典型或无明显临床症状，特别是电子肠镜下特点总结较少，故常导致临床漏诊及误诊，为加深对本病的认识和了解，我们收集浙江中医药大学附属第一医院近年收治的阑尾管状绒毛状腺瘤患者2例，对其临床症状、病理基础和肠镜下表现进行总结分析，并进行文献复习。     

气囊辅助内镜治疗小肠息肉的临床价值研究

目的：探讨应用气囊辅助内镜（ BAE）治疗小肠息肉的可行性、安全性及临床价值。方法回顾性总结2006年8月至2014年7月对199例小肠息肉患者行BAE检查及内镜下息肉切除治疗情况,评价其可行性、安全性及小肠息肉内镜治疗的临床价值。结果199例小肠息肉患者共接受558例次BAE诊治术,摘除小肠息肉共3391枚,其中直径5～10 mm 801枚（23．62％）,11～30 mm 1887枚（55．65％）,31～50 mm 563枚（16．60％）,＞50 mm 140枚（4．13％）,最大者约为7 cm ×10 cm。发生21例次（3．76％）手术相关并发症,包括15例息肉残根出血和6例肠穿孔。结论 BAE是一种安全有效的小肠息肉治疗方法,对大多数小肠息肉患者,可替代外科手术而作为首选治疗方法,具有较好的临床应用价值及发展前景。     

涡阳县人民医院实施胆囊结石腹腔镜胆囊切除术临床路径效果分析

目的 评价胆囊结石腹腔镜胆囊切除术临床路径的临床应用效果.方法 将涡阳县人民医院2013年3月至2014年11月实施临床路径管理的259例胆囊结石腹腔镜胆囊切除术患者纳为路径组,未实施临床路径管理的256例胆囊结石腹腔镜胆囊切除术患者纳为对照组,对两组患者的平均住院天数、手术前住院天数、住院费用、药品费用、检查费用、药品费用比例、术后并发症率和患者满意度等指标进行比较评价.结果 路径组平均住院天数为(5.3±1.6)d,手术前住院天数为(1.2±0.4)d,与对照组比较,差异有统计学意义(P<0.05);路径组较对照组的住院费用和检查费增加,药品费用减少,差异有统计学意义(P<0.05).术后随访,路径组患者满意度高于对照组,差异有统计学意义(P<0.05);两组术后并发症差异无统计学意义(P>0.05).结论 胆囊结石腹腔镜胆囊切除术临床路径的实施可以有效缩短住院时间,降低治疗费用,减轻患者经济负担,提高患者满意度,对提升医院社会和经济效益有着积极意义.     

Higher prevalence of proximal colon polyps and villous histology in African-Americans undergoing colonoscopy at a single equal access center

Background

In the United States, African Americans (AA) have the highest incidence and mortality from colorectal cancer (CRC) of any racial group. Few studies have evaluated if AA who undergo colonoscopy are more likely to have aggressive neoplasia (polyp) tumor biology compared to Caucasians (C). The primary aim of the study was to compare polyp characteristics between AA and C undergoing outpatient colonoscopy.

Methods

A single center retrospective cohort study was performed at a single Veteran Administration (VA) health care system. The charts of 4,038 veterans undergoing colonoscopy from 2005 to 2008 were reviewed. After applying exclusion criteria, data was analyzed for 1,388 persons. Categorical variables were compared using the chi-square test and data were expressed as percentages. Continuous variables were compared using student’s t-test and the data were expressed as mean with standard deviation.

Results

A total of 37% of AA had proximal polyps compared to 21% of C (P<0.0001). Twenty-four percent of AA had polyps with villous histology compared to 16% of C (P=0.01). Twelve percent of AA had hyperplastic polyps compared to 20% of C (P=0.02). There was no difference in the overall prevalence of tubular adenomas, adenomatous polyps with high-grade dysplasia, number, size or polyp morphology between groups.

Conclusions

In an equal access healthcare system and under varying indications, AA have more proximal polyps and polyps with more aggressive histology compared to C. This could partially explain the higher incidence of CRC in AA, and the increased likelihood for AA to develop advanced proximal neoplasia.     

细胞间黏附分子-1和P-选择素在鼻息肉中的表达

目的:揭示细胞间黏附分子-1(ICAM-1,CD54)和P-选择素(CD62p)在鼻息肉发病机制中的作用.方法:收集鼻息内标本32例,炎性鼻甲黏膜11例,正常鼻黏膜12例作对照,应用FACScan流式细胞仪测定不同标本内表达这两种黏附分子的阳性细胞数量.结果:鼻息肉和炎性鼻甲黏膜ICAM-1和P-选择素的细胞阳性率均明显高于正常鼻黏膜(P＜0.001);鼻息肉和炎性鼻甲黏膜之间ICAM-1和P-选择素的细胞阳性率差异无显著性(P＞0.05);ICAM-1和P-选择素在鼻息肉中的表达有正相关关系(r=0.900 1,P＜0.001).结论:ICAM-1和P-选择素在鼻炎和鼻息肉发病过程中都起了重要作用,在鼻息肉中二者表达有一致性.     

Diagnostic accuracy of the double-contrast enema for colonic polyps in patients with or without diverticular disease

The accuracy of the double-contrast enema for the diagnosis of polypoid lesions in the presence or absence of diverticula was evaluated by retrospectively reviewing the medical records of 202 patients subjected to examination and endoscopy. Analysis of the data on 215 polypoid lesions showed that (a) the diagnostic accuracy of the examination is not affected significantly by the presence of diverticula; (b) the sensitivity of the examination is highly dependent on the size of the polyps (smaller or larger than 0.5 cm) but not on the form (sessile or pedunculated); and (c) the positive predictive value is higher in patients without diverticula. The doublecontrast enema was confirmed to be a valid method for the diagnosis of polypoid lesions.     

Effect of histone deacetylase inhibitor on proliferation of biliary tract cancer cell lines

AIM： To explore the effect of histone deacetylase inhibitor, trichostatin A （TSA） on the growth of biliary tract cancer cell lines （gallbladder carcinoma cell line and cholangiocarcinoma cell line） in vivo and in vitro, and to investigate the perspective of histone deacetylase inhibitor in its clinical application. METHODS： The survival rates of gallbladder carcinoma cell line （Mz-ChA-l cell line） and cholangiocarcinoma cell lines （QBC939, KMBC and OZ cell lines） treated with various doses of TSA were detected by methylthiazoy tetrazolium （MTT） assay. A nude mouse model of transplanted gallbladder carcinoma （Mz-ChA-l cell line） was successfully established, and changes in the growth of transplanted tumor after treated with TSA were measured. RESULTS： TSA could inhibit the proliferation of gallbladder carcinoma cell line （Mz-ChA-l cell line） and cholangiocarcinoma cell lines （QBC939, KMBC and OZ cell lines） in a dose-dependent manner. After the nude mouse model of transplanted gallbladder carcinoma （Mz- ChA-l cell line） was successfully established, the growth of cancer was inhibited in the model after treated with TSA. CONCLUSION： TSA can inhibit the growth of cholangiocarcinoma and gallbladder carcinoma cell lines in vitro and in vivo.