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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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Barrett's adenocarcinoma 总被引:1,自引:0,他引:1
Mafune K 《Nihon rinsho. Japanese journal of clinical medicine》2005,63(8):1463-1469
Esophageal adenocarcinoma has seen a rapid increase in incidence throughout the Western world. Gastroesophageal reflux disease is an important risk factor for this cancer that develops in patients with Barrett's esophagus, but infection with Helicobacter pylori may reduce the risk. The diagnosis of Barrett's adenocarcinoma is often at an advanced stage and is generally associated with a poor prognosis. Several innovative techniques (eg, chromoendoscopy, magnifying endoscopy, and narrow-band imaging) have recently been developed to improve the accuracy of diagnosis. Although surgical resection has been a mainstream treatment for advanced cancer, endoscopic submucosal dissection is becoming a promising treatment procedure for mucosal cancer. Surveillance, endoscopic ablative therapies, chemoprevention, and anti-reflux surgery have been developed for cancer prevention, but are of unproven value. Further evaluation is warranted to define the optimal method and standardize the procedures for diagnosis and management of Barrett's esophagus. 相似文献
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目的 探讨基于CT影像组学预测肺腺癌中的原位癌(AIS)和微浸润腺癌(MIA)以及浸润性腺癌(IAC)的价值。方法 回顾性分析542例经手术病理确诊且病理亚型明确的肺腺癌患者,将AIS及MIA归为第1组,IAC为第2组。比较2组患者性别和年龄差异。采用特征提取软件提取病灶三维纹理特征参数,分析组间差异明显的影像组学特征,筛选最佳影像组学特征构建预测模型。按2:1比例将数据分为训练集和验证集,采用6种机器学习算法对5倍交叉验证数据集进行分类,选择最佳分类器;以之分析5倍交叉验证数据集、训练集和验证集,获得模型预测肺腺癌病理分型的ROC曲线及相应AUC、特异度、敏感度及准确率。结果 第1组235例,第2组307例,组间性别和年龄差异均无统计学意义(χ2=0.56、t=-0.19,P=0.63、0.98)。共提取病灶1 766个三维纹理特征参数,其中988个影像组学特征存在明显组间差异,最终以10个最佳影像组学特征构建预测模型。以Perceptron分类器为最佳分类器。模型预测验证集病理分型的AUC为0.95,准确率、特异度、敏感度分别为0.88、0.87、0.84。结论 基于CT影像组学模型能有效预测肺腺癌中的AIS及MIA与IAC。 相似文献
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GRIUNBERG AIu 《Klinicheskaia meditsina》1954,32(11):66-68
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Shazer RL Luthringer D Agus DB Gross ME 《Clinical advances in hematology & oncology : H&O》2004,2(6):393-5; discussion 396
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125 patients with renal adenocarcinoma treated at two departments of radiotherapy in Finland are presented. 82 (66%) of the patients had localized disease and 43 (34%) had distant metastases. The five year survival for all stages was 38% and for cases with local disease 56%. There were no essential differences among Stage I, II and III patients treated with surgery alone or treated with combined operation and postoperative radiotherapy. For tumours with infiltration to adjacent organs or metastases in the lymph nodes the survival was slightly higher after combined surgery and radiotherapy than after surgery alone. For patients with P4 tumours or regional lymph node dissemination postoperative radiotherapy is recommended. 相似文献