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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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唐祎 《中国组织工程研究与临床康复》2008,12(19):3799-3800
背景:MTA (Mineral trioxide aggregate)是一种新型的无机三氧化物聚合体,以往研究表明,它作为根尖倒充材料,相比银汞合金、氧化锌丁香油水门汀具有更好的边缘密合性.目的:实验拟观察金属桩钉以MTA粘固后的抗微渗透作用.设计:对比观察性实验.单位:湖北省荆州市中心医院.材料:搜集本院2004年的正畸治疗拔除牙,筛选出牙体完整、牙根粗壮无弯折、无折裂的下颌第一磨牙32颗:MTA(美国 Dentsply公司).用于对照的粘固剂分别为磷酸锌水门汀(上海齿科材料厂)、玻璃离子水门汀(上海青蒲齿科材料厂)、EB复合树脂(解放军第四军医大学口腔医院齿科材料厂).方法:取出保存的已切除牙冠的32颗离体单根恒牙行根管充填后,分别取模制作镍铬合金铸造桩钉.牙根随机分为磷酸锌水门汀组,玻璃离子水门汀组,EB复合树脂组,MTA组,每组8枚.分别按说明书要求调拌粘固剂,将桩钉粘固于相应的牙根根管内,室温下固化,刮除牙根断面上多余粘固剂.主要观察指标:用染料渗透法检测4种不同粘固剂作为铸造桩钉粘固剂的微渗透情况.结果:用MTA粘固铸造桩定时的微渗透最小,封闭效果最好;用磷酸锌水门汀粘固时的微渗透最大.微渗透深度由浅到深依次为MTA相似文献
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目的 研究拉米夫定治疗慢性乙型肝炎期间乙肝病毒YMDD变异的情况及其与临床的关系.方法 选择治疗前YMDD变异阴性者拉米夫定治疗18 mo的病例271例,测定ALT,YMDD变异,HBeAg及HBV-DNA定量,观察其YMDD变异发生的情况.结果 YMDD变异阳性组的HBV-DNA复制量和ALT明显高于YMDD变异阴性组,HBeAg 转阴率%则明显低于YMDD变异阴性组.结论 用拉米夫定治疗慢性乙型肝炎可能发生YMDD变异,YMDD变异可使患者的肝功能恶化,HBV病毒复制水平提高并影响拉米夫定对乙型肝炎的治疗效果. 相似文献
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Evaldo Favi Carmelo Puliatti Rajesh Sivaprakasam Mariano Ferraresso Federico Ambrogi Serena Delbue Federico Gervasi Ilaria Salzillo Nicholas Raison Roberto Cacciola 《World Journal of Clinical Cases》2019,7(3):270-290
BACKGROUND Polyomavirus-associated nephropathy is a leading cause of kidney allograft failure. Therapeutic options are limited and prompt reduction of the net state of immunosuppression represents the mainstay of treatment. More recent application of aggressive screening and management protocols for BK-virus infection after renal transplantation has shown encouraging results. Nevertheless,long-term outcome for patients with BK-viremia and nephropathy remains obscure. Risk factors for BK-virus infection are also unclear.AIM To investigate incidence, risk factors, and outcome of BK-virus infection after kidney transplantation.METHODS This single-centre observational study with a median follow up of 57(31-80) mo comprises 629 consecutive adult patients who underwent kidney transplantation between 2007 and 2013. Data were prospectively recorded and annually reviewed until 2016. Recipients were periodically screened for BK-virus by plasmaquantitative polymerized chain reaction. Patients with BK viral load ≥ 1000 copies/mL were diagnosed BK-viremia and underwent histological assessment to rule out nephropathy. In case of BK-viremia, immunosuppression was minimized according to a prespecified protocol. The following outcomes were evaluated: patient survival, overall graft survival, graft failure considering death as a competing risk, 30-d-event-censored graft failure, response to treatment,rejection, renal function, urologic complications, opportunistic infections, newonset diabetes after transplantation, and malignancies. We used a multivariable model to analyse risk factors for BK-viremia and nephropathy.RESULTS BK-viremia was detected in 9.5% recipients. Initial viral load was high(≥ 10000 copies/mL) in 66.7% and low(< 10000 copies/mL) in 33.3% of these patients.Polyomavirus-associated nephropathy was diagnosed in 6.5% of the study population. Patients with high initial viral load were more likely to experience sustained viremia(95% vs 25%, P < 0.00001), nephropathy(92.5% vs 15%, P <0.00001), and polyomavirus-related graft loss(27.5% vs 0%, P = 0.0108) than recipients with low initial viral load. Comparison between recipients with or without BK-viremia showed that the proportion of patients with Afro-Caribbean ethnicity(33.3% vs 16.5%, P = 0.0024), panel-reactive antibody ≥ 50%(30% vs14.6%, P = 0.0047), human leukocyte antigen(HLA) mismatching > 4(26.7% vs13.4%, P = 0.0110), and rejection within thirty days of transplant(21.7% vs 9.5%; P= 0.0073) was higher in the viremic group. Five-year patient and overall graft survival rates for patients with or without BK-viremia were similar. However,viremic recipients showed higher 5-year crude cumulative(22.5% vs 12.2%, P =0.0270) and 30-d-event-censored(22.5% vs 7.1%, P = 0.001) incidences of graft failure than control. In the viremic group we also observed higher proportions of recipients with 5-year estimated glomerular filtration rate < 30 mL/min than the group without viremia: 45% vs 27%(P = 0.0064). Urologic complications were comparable between the two groups. Response to treatment was complete in55%, partial in 26.7%, and absent in 18.3% patients. The nephropathy group showed higher 5-year crude cumulative and 30-d-event-censored incidences of graft failure than control: 29.1% vs 12.1%(P = 0.008) and 29.1% vs 7.2%(P <0.001), respectively. Our multivariable model demonstrated that Afro-Caribbean ethnicity, panel-reactive antibody > 50%, HLA mismatching > 4, and rejection were independent risk factors for BK-virus viremia whereas cytomegalovirus prophylaxis was protective.CONCLUSION Current treatment of BK-virus infection offers sub-optimal results. Initial viremia is a valuable parameter to detect patients at increased risk of nephropathy. Panelreactive antibody > 50% and Afro-Caribbean ethnicity are independent predictors of BK-virus infection whereas cytomegalovirus prophylaxis has a protective effect. 相似文献
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Henna K S?derstr?m Juha T Kauppi Niku Oksala Timo Paavonen Leena Krogerus Jari R?s?nen Tuomo Rantanen 《World Journal of Clinical Cases》2019,7(3):260-269
BACKGROUND Overexpression of heat shock proteins(HSPs) is associated with several malignancies and contributes to the development, progression, and metastasis of cancer, in addition to the inhibition of cellular death. In recent years, there has been active research into using HSP inhibitors in several malignancies. Due to the poor prognosis of esophageal adenocarcinoma(EAC), it would be valuable to find new biomarkers for the development of cancer treatments.AIM To evaluate the expressions of HSP27 and HSP70 and their effect on survival in EAC.METHODS Immunohistochemical analyses and evaluations of HSP27 and HSP70 expression were performed on all available samples from 93 patients diagnosed with EACbetween 1990 and 2007 at two university hospitals. Fifteen cases with Barrett's metaplasia and 5 control cases from the same patient population were included in the analysis. HSP expression was quantitatively assessed and classified as high or low. Kaplan-Meier analyses and Cox regression models adjusting for age and sex as well as tumor site, stage, and grade were used to evaluate the effect on survival.RESULTS Tumor stage and surgical treatment were the main prognostic factors. High HSP27 expression in cancer cases was a strong negative predictive factor, with a mean survival of 23 mo compared to the 49 mo in cases with a low expression(P= 0.018). The results were similar for HSP70, with a poorer survival of 17 mo in cases with high HSP70 expression, in contrast to 40 mo(P = 0.006) in cases with a low expression. A Cox regression survival analysis was performed, adjusting for possible confounding factors, and higher HSP27 and HSP70 expressions remained an independent negative prognostic factor. The HSPs' correlation with survival was not affected by cancer treatments. When the analysis was adjusted for all factors, the odds ratios for HSP27 and HSP70 were 3.3(CI: 1.6–6.6, P =0.001) and 2.2(CI: 1.2–3.9, P = 0.02), respectively.CONCLUSION HSP27 and HSP70 overexpression is associated with poor survival in EAC, which is, to the best of our knowledge, reported for the first time. 相似文献
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上海市2007年自杀患者的初步流行病学调查 总被引:3,自引:0,他引:3
目的 探讨上海市2007年自杀患者的流行病学特征.方法 以本市急救中心2007年记录完整且初步诊断为各种伤害的病例数据和同期全市人口数据为基础,对其中的自杀患者相关资料进行回顾分析.结果 一年中本市因各种伤害而需者共有32 484例,分别为创伤30 742例(94.64%)、中毒1208例(3.72%)、自杀347例(1.07%)、中暑117例(0.36%)、电击伤35例(0.11%)和溺水35例(0.11%).自杀患者男女比为3.96:1,老年和青年人自杀的比例显著高于中年人和少儿.自杀患者的高峰日期和时点分别为05-29和17:51.结论 上海市自杀患者有其自身的流行病学特点,应建立一个全市较为完善的自杀伤害监测网络. 相似文献
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Xi-Chen Zhao Li Zhao Xiao-Yun Sun Zeng-Shan Xu Bo Ju Fan-Jun Meng Hong-Guo Zhao 《World Journal of Clinical Cases》2020,8(2):425-435
BACKGROUND Cumulative evidence suggests that the aberrant immune responses in acquired aplastic anemia(AA) are sustained by active chronic infections in genetically susceptible individuals. Recently, the constant source to trigger and sustain the pathophysiology has been proposed to come from the altered gut microbiota and chronic intestinal inflammation. In this case, our serendipitous finding provides convincing evidence that the persistently dysregulated autoimmunity may be generated, at least in a significant proposition of AA patients, by the altered gut microbiota and compromised intestinal epithelium.CASE SUMMARY A 30-year-old Chinese male patient with refractory severe AA experienced a 3-month-long febrile episode, and his fever was refractory to many kinds of injected broad-spectrum antibiotics. When presenting with abdominal cramps, he was prescribed oral mannitol and gentamycin to get rid of the gut infection. This treatment resulted in a quick resolution of the fever. Unanticipatedly, it also produced an excellent hematological response. He had undergone three episodes of recurrence within the one-year treatment, with each recurrence occurring 7-8 wk from the gastrointestinal inflammation eliminating preparations. However,subsequent treatments were able to produce subsequent remissions and consecutive treatments were successful in achieving durative hematological improvements, strongly indicating an etiological association between chronic gut inflammation and the development of AA. Interestingly, comorbid diseases superimposed on this patient(namely, psychiatric disorders, hypertension,insulin resistance, and renal dysfunction) were ameliorated together with the hematological improvements.CONCLUSION Chronic gut inflammation may be responsible for AA pathogenesis. The comorbidities and AA may share a common etiological association. 相似文献
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Sung Yong Han Dong Uk Kim Moon Won Lee Young Joo Park Dong Hoon Baek Gwang Ha Kim Geun Am Song 《World Journal of Clinical Cases》2020,8(1):20-28
BACKGROUND Post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP)is a critical and poorly managed complication of ERCP.Endoscopists need to understand the risk factors for PEP.However,the majority of studies investigating ERCP-related risk factors have included well-trained endoscopists,with the issue of endoscopist experience on PEP incidence not having been systematically evaluated.AIM To explore the risk factors for PEP in beginner endoscopists without supervision.METHODS We performed a retrospective analysis of 293 patients,with naïve papilla and no history of pancreatitis,treated using bile duct cannulation.Patients were classified according to the endoscopist’s experience(beginner vs expert).The angle of the distal common bile duct(CBD)was measured as the angle between the lower wall of the bile duct and a vertical line extending to the lower wall of the bile duct on coronal view computed tomography.RESULTS After propensity matching,there were no differences between patients treated by the expert and beginner endoscopist with regard to age,sex,mean bile duct dilatation,and ratio of benign disease.The distal CBD angle was classified as acute(>30º)or obtuse(≤30º),based on the mean angle of 29.9ºfor the group.An acute distal CBD angle was a significant risk factor for PEP for beginner(P=0.049),but not expert.CONCLUSION For beginner endoscopists first performing unsupervised ERCP,cases with an obtuse distal CBD angle may be more appropriate to lower the risk of PEP. 相似文献
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Objective:To explore the clinical effect of perioperative nursing guided by the concept of enhanced recovery after surgery and summarize them.Methods:Pubmed,Chinese National Knowledge Infrastructure(CNKI),Chinese Biomedical Literature Database(CBM),Wanfang Database,and VIP Database were searched to obtain the relevant literature involving enhanced recovery after surgery(ERAS)guidance,obtain the effective clinical data,review the reports in literature,and obtain the effective scheme.Results:Compared with the traditional nursing program,perioperative nursing principles guided by the concept of ERAS provide more accurate nursing care to patients and reduce the occurrence of intraoperative stress events through comprehensive nursing measures such as preoperative pre-rehabilitation measures,intraoperative body temperature and fluid management,postoperative analgesia,prevention of nausea and vomiting,early mobilization,catheter nursing,and better out-of-hospital follow-up.Conclusions:Perioperative nursing principles guided by the concept of ERAS can significantly reduce the incidence of perioperative complications,shorten the hospital stay of patients,and promote postoperative rehabilitation of patients.The transformation and implementation of this concept can bring significant benefits to hospitals,medical care,and patients. 相似文献
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