62例轻度胃肠炎伴婴幼儿良性惊厥临床分析

目的探讨轻度胃肠炎伴婴幼儿良性惊厥的临床特征,以提高对该病的认识。方法回顾性分析2018年1月至2020年1月西北妇女儿童医院收治的62例年龄为4~31个月轻度胃肠炎伴婴幼儿良性惊厥患儿的病例资料,并对电话随访结果进行分析。结果患儿2岁前发病占79.03%,秋冬季节发病占69.35%;83.87%的患儿于急性胃肠道症状2~3天后出现惊厥,67.74%出现2次及以上惊厥发作,82.26%为全面性发作,72.58%发作持续时间小于5分钟;对15例患儿行脑脊液检查结果显示正常,所有患儿发作间期视频脑电图及头颅影像学检查未见明显异常。随访时间最少1个月,最长为2年,暂未出现复发病例,所有患儿精神运动发育正常。结论轻度胃肠炎伴婴幼儿良性惊厥是一种年龄相关的发作性疾病,临床以伴随轻度胃肠炎症状,全面性、丛集性发作为特征,辅助检查多无明显异常,绝大多数患儿预后良好。     

一起群体性臆症事故的调查

目的分析2008年1月汕头市潮阳区某小学一起群体性臆症的原因。方法抽取学生就餐的定型包装纯牛奶及蛋糕进行检测,采用《个案调查表》对病例进行流行病学调查,并采用描述性流行病学方法进行分析。结果牛奶及蛋糕均未检出致病菌及其他有害因素。结论学生空腹进食纯牛奶少数人胃肠不适,诱发其他学生出现群体性臆症。     

诺氟沙星与加味藿香正气丸联合治疗急性肠胃炎的疗效分析

目的探讨诺氟沙星与加味藿香正气丸联合治疗急性肠胃炎的疗效分析。方法选择2017年5月～2018年5月在我院消化内科治疗的120例急性肠胃炎患者随机分为两组,对照组采用常规治疗方法 ,口服诺氟沙星,补液、抗感染、解痉、纠正电解质紊乱,观察组在此基础上使用加味藿香正气丸治疗,比较两组患者的临床疗效、症状改善时间、不良反应、生活质量。结果观察组治疗有效率为96.67%,明显高于对照组的78.33%(P0.05);观察组腹泻、腹痛、恶心呕吐、发热等症状消失时间明显短于对照组(P0.05);两组治疗后复查血尿常规、肝肾功能等均无明显异常,少数有皮疹、头晕、腹痛等不良反应发生;观察组治疗后SF-36量表评分明显高于对照组(P0.05)。结论诺氟沙星与加味藿香正气丸联合治疗急性肠胃炎的疗效显著,能快速抑制炎症,促进胃肠道症状的快速缓解,加快恢复速度,且安全性高,有效提升了患者的生活质量,具有积极的临床意义。     

Eosinophilic gastroenteritis with abdominal pain and ascites: A case report

BACKGROUNDEosinophilic gastroenteritis (EGE) is a rare disease that presents many unspecific gastroenterological symptoms. The disease includes three types depending on the depth of eosinophil infiltration in the gastrointestinal tract. The serosal type is the most rare, presenting as ascites. CASE SUMMARYA 34-year-old man presented with abdominal pain, diarrhea without bloody stool, or nausea. Laboratory test results revealed a peripheral blood eosinophil count (4.85 × 10⁹/L), which was remarkedly elevated. Computed tomography scan demonstrated extensive intestinal wall edema thickening in the duodenum, jejunum, ascending colon and transverse colon; multiple exudative effusion surrounding the intestinal tract, and ascites in the abdominal cavity. A series of examinations excluded eosinophil elevation in secondary diseases. Endoscopic multipoint biopsy detected eosinophilic infiltration in the mucous layer of the transverse colon, with ≥ 50 eosinophils/high power field. All symptoms vanished after a few days of steroid therapy and ascites disappeared within 2 wk.CONCLUSIONEGE should be considered in patients with abdominal pain, ascites, and eosinophilia. Multiple point biopsies are essential for diagnosis.     

Esophageal dilation: simple and effective treatment for adults with eosinophilic esophagitis and esophageal rings and narrowing

The goal of this article is to present the results of the long‐term treatment with esophageal dilation of a consecutive series of adults with eosinophilic esophagitis (EoE). EoE in adults is a disease of middle aged white males, with recurrent food impactions and dysphagia. The exact treatment of EoE is unknown due to the uncertainty of the pathogenesis. Currently, the long‐term follow‐up of adult EoE patients is limited. Sixteen consecutive adult patients (12 males/4 females between ages 27 and 58 years) with EoE underwent a detailed history and baseline upper gastrointestinal endoscopy (EGD) with multiple esophageal biopsies. Thirteen had esophageal dilation. Fifteen were on proton pump inhibitor (PPI) therapy. After dilation, one patient was treated with a restrictive diet. One patient took prn fluticasone. Most of the patients had allergy testing for food and aeroallergens. Follow‐up evaluation with similar testing was on average 22 months (range: 12–40 months). Six patients were not available for follow‐up. None of the remaining 10 patients had a food impaction; one required further esophageal dilation. Only two patients had intermittent dysphagia. The average dysphagia score decreased from 2.1 to 0.3 (P < 0.002). The average number of eosinophils at follow‐up was not significantly different from baseline (120 eosinophils/HPF proximally and 165 eosinophils/HPF distally (P= 0.75). The gross endoscopy findings were unchanged in all patients except one who normalized. A total of 62% and 75% of patients had positive tests for aeroallergens and food allergens, respectively. Over an average of two years, esophageal dilation provided excellent symptomatic relief among 10 adult EoE patients despite no improvement in the mucosal eosinophilia or gross endoscopic appearance.     

Diagnosis of eosinophilic esophagitis after fundoplication for ‘refractory reflux’: implications for preoperative evaluation

A small percentage of patients who carry the diagnosis of refractory gastroesophageal reflux disease (GERD) actually have eosinophilic esophagitis (EoE). The purpose of this study was to describe a series of patients who underwent fundoplication for presumed refractory GERD, but subsequently were found to have EoE. We performed a retrospective analysis of our EoE database. Patients diagnosed with EoE after Nissen were identified. Cases were defined according to recent consensus guidelines. Five patients underwent anti‐reflux surgery for refractory GERD, but were subsequently diagnosed with EoE. None had esophageal biopsies prior to surgery, and in all subjects, symptoms persisted afterward, with no evidence of wrap failure. The diagnosis of EoE was typically delayed (range: 3–14 years), and when made, there were high levels of esophageal eosinophilia (range: 30–170 eos/hpf). A proportion of patients undergoing fundoplication for incomplete resolution of GERD symptoms will be undiagnosed cases of EoE. Given the rising prevalence of EoE, we recommend obtaining proximal and distal esophageal biopsies in such patients prior to performing anti‐reflux surgery.     

Mannitol and AMP do not induce bronchoconstriction in eosinophilic bronchitis: Further evidence for dissociation between airway inflammation and bronchial hyperresponsiveness

Background and objective: Eosinophilic bronchitis (EB) shares many pathological features with asthma. However, patients with EB do not develop the characteristic physiological abnormalities of asthma: variable airflow obstruction and bronchial hyperresponsiveness (BHR) to a direct bronchial challenge with methacholine. Indirect bronchial challenges with AMP and mannitol are dependent on the presence of airway inflammation, and positive in 10% of asthmatic subjects who have a negative response to methacholine. We have therefore investigated whether subjects with EB are responsive to indirect airway challenge with AMP and mannitol. Methods: Subjects with asthma, EB and healthy controls attended on up to four occasions. After screening, subjects performed bronchial provocation tests to methacholine and then either AMP or mannitol. Each challenge was followed immediately by sputum induction for the measurement of airway inflammation and mast cell‐derived histamine. Results: No subjects with EB responded to either AMP (n = 5) or mannitol (n = 7) while 4/8 and 7/10 subjects with asthma responded to the respective challenges (P = 0.057 for AMP, P = 0.004 for mannitol). There was no difference in induced sputum concentrations of histamine or eosinophil cell counts following methacholine challenge compared with AMP or mannitol. Conclusions: The airways of patients with EB are not responsive to either direct or indirect bronchial challenge. This supports the view that it is the presence of functionally abnormal airway smooth muscle that is the key determinant of BHR in asthma, and that while this may be aggravated by the presence of mucosal airway inflammation, it is not caused by it.     

3起老人院诺如病毒胃肠炎暴发疫情分析

目的分析3起发生在老人院内的诺如病毒胃肠炎局部暴发疫情的流行特征,为今后预防类似事件的发生提供参考依据。方法收集2007年佛山市老人院诺如病毒胃肠炎暴发疫情现场流行病学调查报告．采用描述性流行病学方法对疫情调查处理情况进行分析。结果2007年佛山市共报告3起老人院诺如病毒胃肠炎暴发疫情,共发病56例,无死亡病例;疫情集中发生在2～3月份;每起疫情均从部分患者粪便标本中检测诺如病毒Ⅱ型核酸;3起疫情主要以人-人密切接触的途径传播。结论早发现、早报告、早处理疫情．以及日常加强院内卫生,强化护工的规范操作,是预防和控制诺如病毒胃肠炎在老人院发生的关键。     

我国诺如病毒感染性腹泻流行现状及防制措施建议

目的为加强我国诺如病毒感染性腹泻监测与防控工作,更新相关技术指南,提出技术关键点的措施建议。方法收集2006—2013年在全国突发公共卫生事件报告系统所报告的其他感染性腹泻暴发数据、全国病毒性腹泻监测网络2006—2012年数据以及国内外诺如病毒感染监测和控制技术指南及有关文献,分析我国诺如病毒发病情况、病原分型和暴发危险因素,监测及防控工作中存在的问题,比较国内外相关防控技术指南。结果2006—2013年全国诺如病毒腹泻暴发疫情报告数逐年上升,共报告56起,发病4979例,平均每起暴发89例病例,主要病原类型包括GⅠ型、GⅡ型。在病毒性腹泻监测哨点医院住院的5岁以下儿童腹泻病例中,诺如病毒检出率从2007年的11.2%上升至2011年20.3%,2012年为15.3%。结论我国诺如病毒感染性腹泻暴发和住院病例呈上升趋势,暴发规模较大,暴发监测的敏感性有待改进。本研究提出诺如病毒感染性腹泻防控主要技术措施建议,对指导开展我国诺如病毒腹泻防控工作,更新技术指南有重要参考价值。