胰纤维化结石性糖尿病

胰纤维化结石性糖尿病(FCPD)是一种以胰腺内、外分泌同时受累的较少见的胰源性疾病。为提高对本病的认识,现结合文献浅述其有关问题。一、概况1788年Cawley最早发现胰腺钙化与糖尿病有     

慢性胰腺炎纤维化、胰腺结石伴糖尿病一例

患者女性，66岁。因上腹部隐痛3年，疼痛向腰背部放射，于2003年5月22日入院(住院号：201596)。4年前患糖尿病，一直服用优降糖等降糖药，空腹血糖控制欠佳，无酮症史，无烟酒嗜好。入院体检：神清合作，消瘦，皮肤巩膜无黄染，心肺未见异常，腹平软，左上腹轻压痛，无反跳痛，肝脾未扪及，Murphy’s征(-)，移浊(-)。实验室检查：空腹血糖为     

胰源性糖尿病1例报告

患者男,47岁。因反复腹痛30年,消瘦半年,于2011年7月15日来我院就诊。30年前,患者无明显诱因地出现中上腹持续疼痛,向腰背部放射,伴恶心、呕吐,经补液及支持治疗后好转。此后,腹痛每月发作1～2次。     

胰源性糖尿病

胰源性糖尿病是由于胰腺外分泌疾病导致的糖尿病,主要病因为慢性胰腺炎和胰腺癌。目前尚无肯定的诊断标准,容易被忽视和漏诊。胰源性糖尿病患者血糖波动大,胰岛素需要量小,不容易出现糖尿病酮症酸中毒,主要的治疗药物为胰岛素,部分早期患者可使用二甲双胍。     

胰腺纤维化结石性糖尿病(附8例报告)

本人在华西医科大学附一院内分泌科进修期间收集1994～1999年FCPD8例作一报导 男性5例,女性3例,年龄40～53岁,均无食用木薯史.8例患者均明显消瘦,BMI15～19Kg/m2,其中6例有慢性或阵发性腹痛史;有7例患者在院外诊断为2型糖尿病2～6年,平均3年,口服降糖药治疗效果不佳,其中有2例有酮症倾向,入院后经检查发现有胰管结石;1例患者以腹痛、黄疸、呕吐急诊入院,入院后经检查发现胰管结石,血糖明显增高而确诊为FCPD,8例患者均经B超或CT检查有典型胰管结石,胰腺纤维钙化表现,8例患者入院时血糖明显增高,在18.1～27.6mmol/L之间,做胰岛素释放试验提示胰岛素,C肽明显降低.8例患者入院后均用胰岛素治疗,有3例血糖控制稳定后转外科手术治疗,其中1例手术2次.     

胰性腹水的诊断与治疗(附一例报道)

胰性腹水是指含有胰酶的胰液渗漏进入腹腔，引起慢性炎症，导致大量液体在腹腔内聚集，多有某些胰腺基础病变，特别是慢性胰腺炎，但不包括急性胰腺炎时腹腔炎性渗出或胰腺癌腹腔转移所至的癌性腹水，临床较为罕见。我们近期诊断治疗1例，报告如下。     

转基因治疗在囊性纤维化胰功能不全的研究

转基因治疗在囊性纤维化胰功能不全的研究吴建新，徐家裕，江石湖，袁耀宗，吴云林囊性纤维化（ｃｙｓｔｉｃｆｉｂｒｏｓｉｓ，ＣＦ）胰损害所致的胰功能不全表现为胰原性消化不良（脂肪和氮质性腹泻）与胰原性糖尿病，长期替代治疗受效甚微。近几年，重组ＤＮＡ技术渗入...     

胰源性糖尿病与1型糖尿病酮症临床发生率比较

比较慢性胰腺炎所致胰源性糖尿病与1型糖尿病发生酮症或酮症酸中毒的机率；结果胰源性糖尿病发生酮症或酮症酸中毒的机率明显低于1型糖尿病病人；结论胰源性糖尿病患者较1型糖尿病患者体内缺乏胰高血糖素是导致其发生酮症或酮症酸中毒明显减少的主要原因。     

PANCREATIC TUBERCULOSIS AND ITS DIAGNOSIS BY ENDOSCOPIC ULTRASONOGRAPHY: REPORT OF TWO CASES AND REVIEW OF THE LITERATURE

Mass lesions in the head of the pancreas are generally malignant and it is difficult to diagnose benign lesions preoperatively. We describe two patients with pancreatic tuberculosis, who presented with abdominal pain, jaundice and a pancreatic head mass, mimicking cancer. The correct diagnosis could be made by endoscopic ultrasonography (EUS) and EUS‐guided fine‐needle aspiration (FNA) cytology in both patients, precluding the need for surgery. Both patients responded well to anti‐tuberculosis treatment. We conclude that EUS with guided FNA is a useful modality to diagnose pancreatic tuberculosis.     

SALMONELLOSIS AND SYSTEMIC LUPUS ERYTHEMATOSUS. REPORT OF TEN CASES

A retrospective study of Salmonella infection was carried outin 109 SLE patients followed over the last 15 yr at a rheumatologyunit. Ten cases of non-typhoid salmonellosis were identified.All patients had bacteraemia and two focal pyogenic complications.No cases of salmonellosis limited to the gastrointestinal tractwere found. Death occurred in three cases and was significantlyassociated with renal failure. A comparative analysis of thepatients with and without salmonellosis failed to detect riskfactors for infection other than an older age at SLE onset inpatients with salmonellosis. We suggest that a heterogeneousgroup of SLE patients can be at risk for Salmonella bacteraemia.Renal failure or severe pharmacologic immunosuppression mightlend an additional risk of complications to infection. It canbe speculated that the increased susceptibility to both severeSalmonella infection and SLE might be related to the same immunogeneticbackground. KEY WORDS: Salmonella infections, Systemic lupus erythematosus     

Autonomic Dysfunction in Non-insulin-dependent Diabetes Mellitus and Fibrocalculous Pancreatic Diabetes in South India

The prevalence of cardiovascular autonomic dysfunction in non-insulin-dependent (Type 2) diabetes mellitus (NIDDM) and fibrocalculous pancreatic diabetes (FCPD) was assessed by a standard battery of autonomic dysfunction tests involving heart rate responses and blood pressure responses. Three hundred and thirty-six patients with NIDDM and 40 patients with FCPD were studied. Logistic regression analysis was done to look for risk factors associated with autonomic dysfunction. Abnormalities of autonomic function tests were detected in 120 NIDDM patients (35.7 %) and 9 FCPD patients (22.5 %). There was no significant difference in severity of autonomic dysfunction between NIDDM and FCPD groups. There was an increase in prevalence of autonomic dysfunction with age and duration of diabetes both in NIDDM and FCPD. In the 0–5 years duration group, 28.2 % of NIDDM and 16.6 % of FCPD had evidence of disordered autonomic function and these figures increased to 56.2 % and 60 % respectively, after 16–20 years duration of diabetes. Logistic regression analysis showed that only peripheral dysfunction was associated with autonomic dysfunction in NIDDM patients (r = 0.66, p = 0.02).     

PANCREATIC PLEURAL EFFUSION SUCCESSFULLY TREATED BY ENDOSCOPIC PANCREATIC DUCT DRAINAGE COMBINED WITH EXTRACORPOREAL SHOCK‐WAVE LITHOTRIPSY: REPORT OF A CASE

A 52‐year‐old man was admitted with complaints of dyspnea. Physical examination revealed that the breath sounds were reduced at the left lung. The results of the abdominal examination were normal. Chest radiography showed massive left‐sided pleural effusion. His white blood cell count was 4600/mm ³ , serum amylase 666 IU/L, serum C‐reactive protein (CRP) 3.7 mg/dL. Thoracentesis yielded bloody fluid with a protein level of 3.7 g/dL and amylase level of 6250 IU/L. Computed tomography showed dilatation of the pancreatic duct with calcifications of the pancreas, mediastinal pancreatic pseudocysts and bilateral pleural effusion. Magnetic resonance cholangiopancreatography demonstrated dilated pancreatic duct with pancreatic calculi and pancreaticopleural fistula. Initial endoscopic retrograde cholangiopancreatography showed obstructing pancreatic calculi of the main pancreatic duct at the head; however, insertion of a naso‐pancreatic drain was unsuccessful. A naso‐pancreatic drain could be placed beyond the site of obstruction following three extracorporeal shock‐wave lithotripsy (ESWL) sessions. Pleural effusion was resolved and the chest tube was removed 5 days following placement of the drain. The naso‐pancreatic drain was replaced with a pancreatic stent 20 days later. Endoscopic retrograde cholangiopancreatography after a total of nine ESWL sessions showed a significant reduction of pancreatic calculi at the head. The pancreatic stent was removed 70 days following stent placement and there has been no recurrence during a follow‐up period of 2 years. We suggest that endoscopic treatment combined with ESWL is a first‐line treatment for pancreatic pleural effusion resulting from obstructing pancreatic calculi, and operation should be reserved as a second‐line treatment.     

Cardiac autonomic function in fibrocalculous pancreatic diabetes

Cardiac autonomic function was evaluated in 23 patients with fibrocalculous pancreatic diabetes (FCPD). Though none of the patients had any symptoms referable to autonomic dysfunction, 5 had abnormal heart rate responses. The variability in the heart rate in response to deep breathing was the earliest abnormality found in our patients. Four of the 5 patients had clinical evidence of neuropathy while all 5 had retinopathy and overt nephropathy. We therefore conclude that the autonomic nervous system can be involved in patients with FCDP even as early as 2 years after the onset of the disease, and thus that evaluation of the autonomic nervous system should be part of the routine evaluation of all patients with FCPD.     

Case-control study on risk factors associated with fibrocalculous pancreatic diabetes

We investigated the relation between fibrocalculous pancreatic diabetes and cassava consumption in a case-control study, in which 31 cases of pancreatic diabetes were compared with 45 non-diabetic control subjects who had no pancreatic calcification. Risk of diabetes was not related to cassava consumption. We also observed no increased risk of fibrocalculous pancreatic diabetes associated with alcohol consumption, history of gallbladder and biliary tract diseases, ascariasis, and family history of diabetes. Lower monthly income, farmer occupation, rural residence, and low BMI were significantly (p less than 0.05) related to pancreatic diabetes. Our data suggest that consumption of cassava may not be an important risk factor for pancreatic diabetes. With limited sample size, however, cassava consumption could not be excluded as one possible cause of fibrocalculous pancreatic diabetes.     

Two case reports of macrovascular complications in fibrocalculous pancreatic diabetes

Summary Fibrocalculous pancreatic diabetes (FCPD) is a form of diabetes secondary to chronic, non-alcoholic pancreatitis in tropical countries. Being a secondary form of diabetes, vascular complications are believed to be rare. In this paper we present two case reports of macrovascular complications (myocardial infarction and gangrene). This shows that large vessel disease does occur in FCPD.     

EFFECTIVENESS OF CYTODIAGNOSIS WITH PANCREATIC DUCT LAVAGE FLUID FOR PANCREATIC DUCTAL CARCINOMA: NEW SAMPLING TECHNIQUE

Background: Pancreatic carcinoma is one of the most lethal cancers. Because pancreatic carcinoma is still very difficult to diagnose in its early stage, many of these patients will be considered unsuitable for surgery. If a cytological diagnosis is obtained at initial endoscopic retrograde cholangiopancreatography (ERCP), suitable treatment will be initiated without delay. Methods: To increase the number of exfoliated cells from the pancreatic duct, we devised a new technique, pancreatic duct lavage fluid (PDLF), following bronchoalveolar lavage fluid. The present paper reports the effectiveness of cytological examination using PDLF in the diagnosis of pancreatic carcinoma. We examined 18 pancreatic carcinoma cases. After the endoscopic retrograde pancreatography (ERP), PDLF was collected from a double‐lumen catheter inserted into the main pancreatic duct. Saline injected from the lumen for the injection, and PDLF was aspirated from the other lumen for the guidewire at the same time. The cytological examination was performed using PDLF. Results: Exfoliated cells were more frequently found in PDLF from all patients. In 15 cases (83%), cytological examination of PDLF revealed positive cytological results as the diagnosis of pancreatic carcinoma. Conclusion: Cytological examination using PDLF has a high sensitivity for detection of pancreatic carcinoma. The new examination, PDLF, is simple, safe and effective, so we expect PDLF to become widely popular.     

ENDOSCOPIC MANAGEMENT OF BILIARY and PANCREATIC DUCTS STRICTURES

Endoscopic treatment is applied to a relatively large number of biliary and pancreatic duct strictures, and is a practical matter. It is essential to select the most appropriate treatment for each lesion. For instance, when treating malignant biliary stricture, accurate diagnosis of whether surgical treatment is required or not is vital; and in choosing a stent for an inoperable case, location of the stricture, with or without anticancer treatment, prognosis, and management of possible post‐stenting re‐stricture must be taken into consideration. For benign strictures, not only short‐term results in mobility and motality, but also decades of long‐term results must be cautiously questioned. Bearing these in mind, we need to accumulate the worldwide data of the treatments and establish a proper treatment guideline.