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Xu Ren Chun-Lan Zhu Xu-Fu Qin Hong Jiang Tian Xia Yong-Ping Qu 《World Journal of Clinical Cases》2019,7(1):102-108
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. 相似文献
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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, 相似文献
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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 相似文献
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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]. 相似文献
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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. 相似文献
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Jun-Hui Guo Yuan-Yuan Wang Jiang-Wei Zhang Pei-Min Liu Yan-Jun Hao Hai-Rui Duan 《World Journal of Clinical Cases》2020,8(7):1326-1336
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. 相似文献
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目的了解护士职业倦怠、工作特征与工作压力的现状并评估三者的关系。方法采用一般情况调查表、中文版护士职业倦怠量表(maslach burnout inventory,MBI)、护士压力源量表、工作特征量表(job characteristics inventory)对423名护士进行调查。采用Pearson相关分析探讨护士工作特征、工作压力与职业倦怠三者的关系,根据Pearson相关分析,建立路径关系模型,对护士职业倦怠、工作特征与工作压力三者之间的关系进行路径分析。结果职业倦怠量表中护士情感耗竭维度的得分(26.04±11.64)分、工作冷漠感维度(7.39±2.14)分、个人无成就感维度(33.87±8.64)分,三者高度倦怠感分别占50.83%、39.01%、49.41%;护士工作特征总分(104.52±15.51)分;工作压力总分(109.32±18.93)分。工作压力在工作特征与职业倦怠之间有部分中介作用,中介效应占总效应的54.40%。结论护士职业倦怠较严重。护理管理者应采取有效的措施降低护士的工作压力感,从多个维度改善护士的工作特征,从而降低护士职业倦怠水平。 相似文献
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护理人员工作特征与工作满意度的调查研究 总被引:3,自引:0,他引:3
目的了解分析护士工作特征,明确工作架构与工作满意度的关系,为开发实用、确切的工作设计方案,有效提升工作满意度提供实证依据。方法抽取7所综合性医院的430名护士,运用工作诊断调查表(短题本)和明尼苏达满意度问卷(短题本)进行横断面调查。结果各工作特征与内在满意度及一般满意度均成正相关,他人反馈及合作性与外在满意度成正相关(P<0.01)。内在满意度受任务重要性、工作自主性、他人反馈、年龄和轮班方式影响;外在满意度受他人反馈、职务和用工性质影响;一般满意度受他人反馈、工作自主性和任务重要性影响。结论工作特征对工作满意度具有积极影响,工作自主性、任务重要性和他人反馈是影响护士工作满意度的主要工作特征。科学的工作设计有助于促进护士与工作岗位的最佳匹配,提升工作满意度。 相似文献
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Karen Hoover 《Journal of neonatal nursing : JNN》2009,15(5):159-163
In 2006, my husband took up a contract for 3 years work in the small state of Qatar in the Middle East. I joined him with my 6 year old daughter. It meant me leaving my position as a neonatal nurse practitioner, a job I really enjoyed, and I knew from previous years working in the Middle East, it is very different for neonatal nurses there… 相似文献
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护士压力及工作满意度对护理工作的影响 总被引:65,自引:12,他引:53
护士压力与工作满意度对护理工作有一定的影响 ,护士压力增高和工作满意度下降会使护理工作效率降低、护理工作质量下降。因此 ,降低护士工作压力 ,提高护理工作满意度 ,积极开展护士心理咨询 ,鼓励护士积极参加心理学学习和心理辅导是当前值得重视的问题 相似文献
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护士职业倦怠与工作压力源的关系分析 总被引:5,自引:0,他引:5
目的探讨护士职业倦怠与工作压力源的关系。方法采用工作倦怠量表(MBI—GS)和中国护士工作压力源量表对105名护士进行调查与分析。结果105名护士的情绪衰竭、玩世不恭与护士工作压力源呈正相关(P0.01);成就感低落与护士工作压力源(除工作环境及仪器设备不足外)呈负相关(P0.05)。护士工作压力源评分前三位是护理工作的社会地位太低、经常倒班、工作量太大。不同科室护士的职业倦怠存在差异,急诊室及ICU的护士倦怠程度较重,外科护士的职业倦怠程度较轻。结论护士的职业倦怠与工作压力源存在相关性。 相似文献
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