双歧杆菌V9对便秘和腹泻患者的临床研究

目的研究益生菌双歧杆菌V9对便秘和腹泻患者的临床治疗效果,为该菌株的临床应用提供数据支持。方法以153例患有便秘或急慢性腹泻的患者为研究对象,对双歧杆菌V9菌粉进行为期3 w的临床试验验证,菌粉服用剂量为1.0×1010cfu/d。试验期间,每3天记录一次受试患者的排便频率和粪便形态,并在试验前和试验后采集粪便,测定受试患者体内主要肠道菌群的变化。结果试验结果证明,连续3 w服用双歧杆菌V9菌粉,对便秘、急性腹泻和慢性腹泻患者的治疗有效率分别为95.3%、95.4%和89.9%,与试验前相比,患者粪便中双歧杆菌数量显著增加(P<0.01),肠杆菌、肠球菌、拟杆菌和产气荚膜杆菌的数量也发生了不同程度的变化(P<0.01),接近健康人群肠道菌群结构。结论临床研究表明,双歧杆菌V9具有调节肠道菌群的作用,对便秘和急慢性腹泻患者治疗效果显著。     

益生菌颗粒对便秘和腹泻患者的临床研究

目的观察益生菌颗粒对便秘与腹泻患者的疗效和安全性。方法采用自身对照试验,77例便秘和87例慢性腹泻患者口服益生菌颗粒30d,记录并量化服用前、后患者的胃肠道症状和不良反应情况。结果口服益生菌颗粒30d后,便秘、腹泻患者有效率分别为为71.4%、77.0%,无不良反应。结论益生菌颗粒可明显改善腹泻和便秘的症状,且安全性高、耐受性好。     

Disease course, frequency of relapses and survival of patients with juvenile or adult dermatomyositis

INTRODUCTION: The idiopathic inflammatory myopathies are systemic autoimmune diseases characterized by chronic muscle inflammation resulting progressive weakness and frequent involvement of internal organs, mainly the pulmonary, gastrointestinal and cardiac systems. OBJECTIVE: To present clinical characteristics, disease course, frequency of relapses and survival of 79 patients with juvenile or adult dermatomyositis. METHODS: A national registry of patients with juvenile dermatomyositis was elaborated by the authors in Hungary. The authors summarize data of the register such as signs and symptoms, disease course, frequency of relapses and survival of patients with juvenile dermatomyositis. Analysis was performed using data of 44 patients diagnosed between 1976 and 2004 according to Bohan and Peter's criteria. Survival probability was calculated by Kaplan-Meier method. Data of patients with juvenile dermatomyositis were compared with data of 35 patients with adult dermatomyositis. RESULTS: In view of the disease course, the authors found that more than the half of patients have monophasic disease, while one third of them suffered from polycyclic disease. The risk of the relapse was found to be higher during the first year after the remission. None of the juvenile patients died. Among adult patients, 4 disease-specific deaths occurred. DISCUSSION: There was no correlation between relapse free survival and initial therapeutic regimen. Many of the patients had polycyclic or chronic disease. As relapses can occur after a prolonged disease-free interval, patients should be followed up for at least 2 years. Despite favourable survival probability, further investigations are needed to assess functional outcome.     

The course of Alzheimer's disease in a group of nursing home patients: epidemiology, (co)morbidity and mortality

One hundred medical charts of patients of a psychogeriatric nursing home with 'possible' (senile) dementia of the Alzheimer type were reviewed. Eighty-seven patients had died and 13 were alive at the time of analysis. The aim of the study was to obtain epidemiological information and to investigate (co)morbidity and mortality of these patients. All the data of this group of nursing home patients appeared to have a wide range. The process of dementia started at a mean age of about 75 years and patients remained in their homes for more than five years before admission. The average time spent in the nursing home was 3.0 years. These patients had a shorter life expectancy, counted from the time of admission, compared with the Dutch population. At admission a large percentage of patients suffered from circulatory system disease, musculoskeletal and connective tissue disease and/or sensory deprivation. During the stay the most frequent diseases were urinary and respiratory tract infections, constipation and chronic ulcers of the skin. Symptoms specific of Alzheimer's disease also occurred: feeding problems, disorders of gait and neurological symptoms such as paratonia. A large percentage of patients showed adverse effects of drugs or suffered from the consequences of trauma. Patients died of cachexia or bronchopneumonia. It is unclear whether the population studied is representative of the total population of Alzheimer patients.     

基于循证指南及诊疗路径的麦胶性肠病营养干预改善结局一例

麦胶性肠病系摄入含麸质食物引起的慢性自身免疫性肠道炎症疾病。以往认为其多发于欧美国家,近年我国报道的病例数逐渐增多,但其诊治现状在国内仍存诸多不足,包括缺乏循证基础,未遵循营养诊疗路径。本文结合国内外相关文献检索和复习,报告基于循证和诊疗路径的1例麦胶性肠病患者营养干预改善临床结局,以期为该病的规范化营养干预提供参考。     

自发性结肠破裂15例临床诊治探讨

目的：分析自发性结肠破裂的发病机制,临床特征及诊治方法。方法：对15例自发性结肠破裂患者病因、诊断、治疗方法、术后并发症进行回顾性分析。结果：便秘15例（100.0%）、糖尿病6例次（40.0%）、高血压8例次（53.3%）、高脂血症7例次（46.7%）是自发性结肠破裂的高危因子。15例均给予手术,治愈10例（66.7%）,死亡5例（33.3%）,死亡5例就诊时均超过36h。结论：自发性结肠破裂早期诊断和手术,纠正休克,积极加强对围手术期的监护和综合治疗是改善其预后,提高治愈率的关键。     

Dietary fiber and bowel function in tube-fed patients.

In tube-fed patients, dietary fiber is often used to manage constipation/diarrhea. Dietary fiber consists of water-soluble and insoluble plant compounds that are resistant to digestion by small-bowel enzymes but are fermented to varying degrees by colonic bacteria. Many physiologic effects of fiber may be related to the degree of fermentation. Few controlled studies of fiber-containing tube feedings have been performed. These studies have limitations and are nondefinitive as to whether fiber prevents or controls constipation/diarrhea. Constipation in tube-fed patients has not been shown to respond to mixed soluble/insoluble fiber in the few studies performed to date. Likewise, fiber may be of only limited benefit in controlling diarrhea in acute illness because of such factors as stress or medication. Fiber does play a role in maintaining gut integrity in all patients, whether they have diarrhea or not. Fiber may be recommended as part of a standard tube-feeding regimen to help assure gut mucosal integrity but not specifically to treat constipation/diarrhea. Further studies are necessary before the role of fiber in the management of constipation/diarrhea in tube-fed patients is determined.     

Chronic constipation in childhood. A report of 78 patients

AIM: To assess the aetiology and the clinical patterns of chronic constipation in children. METHODS: A total of 78 patients (62% boys, mean age: 4.6 years) were enrolled in this retrospective study. For each patient, we collected these data: clinical features, radiological data, rectal manometry and rectal biopsy results, treatment and follow up. RESULTS: Functional constipation was the most frequent cause of chronic constipation (49 cases, 62.8%) followed by Hirschsprung's disease (19 cases, 24.3%). Rectal manometry, performed in all suspected Hirschsprung's disease, concluded to the absence of inhibitory rectoanal reflex in 17 of them. Rectal biopsy concluded to segmental absence of parasympathetic ganglion cells in eleven of them. Therapeutic approach consists of treatment of functional constipation by laxatives, enemas and dietary fibers in respectively 22, 12 and 6 children. Two other patients had a biofeedback re-education. Treatment was successful in 9 patients and unsuccessful in 2 others. Seven children with Hirschsprung's disease underwent Soave's (n = 3), Swenson's (n = 3) and Duhamel's procedures (n = 1). Outcome was favourable in five of them and complicated by stenosis in 2 others. CONCLUSION: Our study suggests that functional constipation is the most frequent cause of chronic constipation in children and that Hirschsprung's disease is the first organic cause of chronic constipation indicating the need of rectal manometry for diagnostic confirmation.     

A 6-year follow-up study of chronic constipation and soiling in a specialist paediatric service

OBJECTIVE: Constipation and soiling is a relatively common condition in childhood and its course is often chronic. This study investigated long-term outcome of children with chronic constipation and soiling by following up a cohort of children 6 years after their presentation to a specialist paediatric gastroenterology clinic with chronic constipation and soiling. DESIGN: Retrospective postal survey. SETTING/SAMPLE: All children referred in 1991 to a specialist paediatric gastroenterology clinic accepting both secondary and tertiary referrals. MEASURES: A semi-structured postal questionnaire was sent to all families, and the Strengths and Difficulties Questionnaire (SDQ) was sent to a random sample. RESULTS: The response rate (of those who could be traced) was 89%. Of these, over a third (36%) still had a problem with constipation and soiling and 17% were using regular laxatives. Three people still having problems with constipation and soiling in the sample were aged over 18 years. No significant difference was found with regard to age, sex or age at referral between the group that improved and the group that did not. Both groups felt they had suffered a high degree of distress because of the problem, with parents highlighting their powerlessness to help their child and the child identifying the embarrassment caused by the problem. CONCLUSIONS: A significant number of children presenting to a specialist paediatric clinic continue to have problems for several years. Further research is needed to identify these cases and to identify which factors promote resolution of the problem.     

Effect of a gluten-free diet on gastrointestinal symptoms in celiac disease

BACKGROUND: Atypical presentations of celiac disease appear to be at least as common as is the classic presentation of steatorrhea, diarrhea, and weight loss. OBJECTIVE: We examined the effect of a gluten-free diet on gastrointestinal symptoms in a cohort of US patients with celiac disease. DESIGN: A follow-up survey was conducted in 215 patients who were evaluated at the University of Iowa from 1990 through 1997 as having biopsy-confirmed celiac disease. The systematic survey asked detailed questions regarding gastrointestinal symptoms before and after the institution of a gluten-free diet in the patients, all of whom had been given the same dietary advice. RESULTS: The group consisted of 160 female and 55 male patients. Although diarrhea was the most frequent symptom in untreated celiac disease, steatorrhea occurred in only one-fifth of patients. Other complaints were common, and most responded to gluten exclusion. The benefit of gluten exclusion was equally apparent in men and women. Diarrhea responded in most patients, usually within days, and the mean time to resolution was 4 wk. Many patients had alternating diarrhea and constipation, both of which were responsive to the gluten-free diet. Most patients had abdominal pain and bloating, which resolved with the diet. CONCLUSIONS: Celiac disease causes a wide range of gastrointestinal symptoms. Clinicians must have a high level of suspicion to detect the atypical forms of celiac disease. With a gluten-free diet, patients have substantial and rapid improvement of symptoms, including symptoms other than the typical ones of diarrhea, steatorrhea, and weight loss.     

Intractable diarrhea in infancy--whether infection, zinc deficiency, cholestasis and hemorrhage are causes or results?

Although there has been a marked decrease in the number of infants with intractable diarrhea in Japan, the difficulty in treating it still remains unchanged. Here we report two infants who suffered presumably from "chronic nonspecific enterocolitis" with resistance to the usual treatment. Besides prolonged diarrhea and weight loss, they showed manifestations such as infection, zinc deficiency, cholestasis, abnormal blood coagulation, etc. In this paper, we discuss whether they are causes, effects, results, or coincidences. In spite of the reduction of diarrhea after 3 months of age, both babies are even now being followed up by us because of their still poor weight gain.     

思密达和庆大霉素灌肠治疗婴幼儿慢性迁延性腹泻

目的:观察思密达和庆大霉素片联合保留灌肠治疗婴幼儿慢性迁延性腹泻病的疗效。方法:将104例患儿随机分为3组,均给予保留灌肠治疗:Ⅰ组联合用思密达和庆大霉素片、Ⅱ组仅用思密达、Ⅲ组仅用庆大霉素片。比较3组的疗效、止泻时间和总病程。结果:3组疗效无显著性差异(P>0.05),但3组用药后总病程和止泻时间却有差异。结论:思密达和庆大霉素片联合保留灌肠治疗婴幼儿慢性迁延性腹泻病能缩短止泻时间和总病程。     

Faecal incontinence: an unrecognised epidemic in rural North Queensland? Results of a hospital‐based outpatient study

OBJECTIVES: We explored the prevalence of faecal incontinence (FI) in a referral hospital outpatient population, to explore suspicions that FI is inadequately studied, underestimated and poorly appreciated in the rural North Queensland (NQ) community. DESIGN: Prospective cross-sectional study using a specifically designed questionnaire. SETTING: The Townsville Hospital, a referral centre serving rural NQ. SUBJECTS: A total of 435 consecutive patients attending the gynaecology (n = 261) and colorectal clinics (n = 174) between 31 January and 12 June 2003 were enrolled (participating proportion 96.5%). MAIN OUTCOME MEASURES: FI prevalence, severity, impact on patients' lives, and risk factors. RESULTS: The prevalence of FI in the study population (median age 53 years) was 20.7%. Amongst affected patients (n = 90) the median duration of FI was 2 years with more than half of those affected soiling themselves at least once a month. Many patients with FI (42%) reported feeling hopeless at least some of the time. Rectal prolapse, chronic constipation, psychiatric problems, colon disease, and urinary incontinence were all significantly associated with FI. A CART analysis revealed that many patients (45%) with urinary incontinence and chronic constipation also experienced FI. CONCLUSIONS: This FI prevalence in a clinical setting in NQ is, apart from nursing home studies, the highest reported in the literature. FI negatively impacted on affected persons' lives. In patients presenting with urinary incontinence and chronic constipation, physicians should specifically enquire whether FI is also present. Definitive community studies to determine the scale of this 'silent epidemic' in northern Australia are now required.     

Fulminant hepatitis A in patients with chronic liver disease

Fulminant hepatitis is a rare complication of acute hepatitis A virus (HAV) infection. We report three cases of fulminant hepatic failure with death due to HAV infection in patients with pre-existing chronic liver disease. Data from the literature also indicate a high case fatality rate during HAV superinfection in patients with chronic hepatitis B, particularly those with cirrhosis, and in patients with alcoholic cirrhosis. In patients with chronic hepatitis C, results are conflicting with some reports indicating a high fatality rate of HAV superinfection and others not, irrespective of the presence or absence of cirrhosis. Based on our observations and this review of the literature, we suggest that patients with chronic liver disease should be vaccinated against hepatitis A.     

Adrenal insufficiency: an uncommon cause of fatigue.

BACKGROUND: Adrenal insufficiency is a rare condition that can cause common and nonspecific symptoms. One such symptom, reported by all patients with adrenal insufficiency, is fatigue. On the other hand, up to 20% of patients seeking care from primary care physicians will have fatigue as a complaint. Only a small percentage of patients are found to have underlying medical disease. METHODS: A MEDLINE literature search was performed from 1966 to the present using the key words "fatigue," "adrenal insufficiency," and "polyglandular autoimmune endocrinopathy." Major endocrinology textbooks were also referenced. In addition, references were obtained from bibliographies of available articles. RESULTS AND CONCLUSIONS: This article describes a patient with adrenal insufficiency and fatigue as the primary complaint. A brief discussion of fatigue and clues to organic causes follows, along with a more detailed discussion of adrenal insufficiency. Important medical history or signs and symptoms of organic disease suggest the need for screening tests and more detailed evaluation to uncover the uncommon medical causes of fatigue.     

老年人群慢性病现状及对日常生活功能的影响

目的：为老年人群慢性病防治和生活质量的改善提供科学依据。方法：采用多级抽样调查和logistic回归分析方法对1109名老年人慢性病状况及对日常生活功能的影响进行研究。结果：（1）慢性病患病率为67.2%，大多患2种以上，前五位依次为高血压，心脏病，白内障，骨质疏松和胃肠疾病；（2）日常生活功能ADL和IADL损害率分别为8.0%和43.6%;（3）对ADL损害有显著意义的因素有高血压，脑血管病，精神病，白内障，泌尿系疾病和肿瘤，对IADL损害有显著意义的因素有年龄，脑血管病和肿瘤，ADL和IADL的影响因素有较大差别，而且其与患病率高低，患多少种病并无一致的对应关系。结论；老年人慢性病患病率高，不少疾病对日常生活功能造成明显损害，而疾病的性质可能所起作用较大，应采取适宜的策略和和措施防治慢性病。     

Chronic constipation in overweight children

BACKGROUND: Obesity and functional constipation seem to share a common biopsychosocial model of causation. Though chronic constipation can significantly affect the quality of life of an overweight child, this association has not been highlighted in the literature. The purpose of this study was to compare the proportion of overweight children among children with chronic constipation with a control group of children with normal bowel habits. METHODS: Retrospective chart review with a control population. One hundred one consecutive children 5-18 years of age referred to the Subspecialty Clinic for functional constipation were the study group. The control group consisted of 100 consecutive children from the general pediatric practice seen for physicals and minor illnesses. Children with a body mass index (BMI) of >85 percentile from the National Institutes of Health (NIH) 2000 chart were classified as overweight. RESULTS: The control and study groups were statistically comparable in mean age (10.97 +/- 3.83 years and 8.07 +/- 2.56 years, respectively) and gender ratio (58 males in each group). Thirty children in the control group and 44 in the study population were overweight (p < .05). Among children with chronic constipation, the group of overweight children was male predominant (70.45% vs 47.36%, p < .05), had increased incidence of psychological/behavioral problems (45.45% vs 22.8%, p < .05), and was more likely to fail treatment (40.9% vs 21.05%, p < .05). There was no significant difference in the clinical profile of constipation, such as mean duration of constipation before presentation, sex ratio, incidence of painful defecation, and soiling and frequency of defecation between these 2 groups. CONCLUSIONS: There appears to be an association between chronic severe constipation and being overweight. Children with constipation are more likely to be overweight when compared with controls. Among children with chronic constipation, overweight individuals seem to constitute a distinct clinical group. This group is male predominant, has increased incidence of psychological/behavioral disorders, and is more likely to fail treatment.     

Health-related needs of people with multiple chronic diseases: differences and underlying factors

Purpose

To examine the health-related needs of people with multiple chronic diseases in the Netherlands compared to people with one chronic disease, and to identify different subgroups of multimorbid patients based on differences in their health problems.

Methods

Participants were 1092 people with one or more chronic diseases of a nationwide prospective panel study on the consequences of chronic illness in the Netherlands. They completed the EQ-6D, a multi-dimensional questionnaire on health problems (October 2013). Chi-square tests and analyses of variance were performed to test for differences between multimorbid patients and patients with one chronic disease. To identify subgroups of multimorbid patients, cluster analysis was performed and differences in EQ-6D scores between clusters were tested with Chi-square tests.

Results

Multimorbid patients (51 % of the total sample) experience more problems in most health domains than patients with one chronic disease. Almost half (44 %) of the multimorbid people had many health problems in different domains. These people were more often female, had a smaller household size, had a lower health literacy, and suffered from more chronic diseases. Remarkably, a small subgroup of multimorbid patients (4 %, mostly elderly males) is characterized by all having cognitive problems.

Conclusions

Based on the problems they experience, we conclude that patients with multimorbidity have relatively many and diverse health-related needs. Extensive health-related needs among people with multimorbidity may relate not only to the number of chronic diseases they suffer from, but also to their patient characteristics. This should be taken into account, when identifying target groups for comprehensive support programmes.

     

Lipid profile in patients with systemic lupus erythematosus, with special focus on lipoprotein(a) in lupus nephritis

Systemic lupus erythematosus (SLE) is a multifactorial polysystemic autoimmune disorder. Although life expectance in SLE has been improved by adequate immune suppressive therapy, the importance of chronic renal failure has not been reduced. Among late complications of the disease accelerated atherosclerosis attempts increasing attention. Dyslipoproteinemia and increased concentration of lipoproteins are important risk factors of atherosclerotic cardiovascular complication in SLE. Serum lipid parameters of 50 patients with lupus were examined in the present work. Thirty patients had histologically proven lupus nephritis (LN+), while the other group did not have renal involvement (LN-). Serum triglyceride, total cholesterol, LDL-C and apolipoprotein B (apoB) concentrations were significantly higher in the lupus nephritis (LN+) group. On the other hand, HDL-C and apoAI levels were also elevated in patients with LN. As a consequence of that, LDL-C/HDL-C and the apoB/apoAI ratios did not differ between patients with or without kidney involvement. This concluded the authors to measure the concentration of lipoprotein (a) in SLE patients, as Lp(a) is known to be an independent risk factor of atherosclerosis. Results indicated a significantly increased Lp(a) concentration in patients with lupus nephritis as compared to the LN- group. All but 2 patients without kidney involvement had lower than 100 mg/L Lp(a) concentration, while 27% of patients with lupus nephritis has an Lp(a) level between 100-300 mg/L. Further more, Lp(a) concentration was higher than 300 mg/L in 13% of the LN+ group. In a good correlation of these observations patients with nephritis suffered more frequently from deep venous thrombosis and ischaemic heart disease. The frequencies of hypertension and non-insulin dependent diabetes mellitus were slightly elevated in patients with nephritis. Present results suggest the importance of elevated lipoprotein (a) concentration in patients with lupus nephritis, further increasing the risk of athero-thrombotic cardiovascular complications.     

肠易激综合征回盲部肥大细胞的实验观察

目的观察肠易激综合征(IBS)患者肠黏膜回盲部肥大细胞的分布及变化,探讨其在IBS中的可能作用。方法符合入选标准IBS患者30例,按临床症状分为腹泻型、便秘型。与15例正常人经结肠镜钳取回盲部结肠黏膜,检测肥大细胞及脱颗粒肥大细胞的数目,进行比较。结果IBS患者回盲部肥大细胞的数目增多,与正常对照组比较,有高度统计学意义,腹泻型与便秘型之间差异无统计学意义;腹泻型、便秘型患者回盲部脱颗粒肥大细胞数明显多于正常组,差异有统计学意义;便秘型与腹泻型之间比较P<0.01,有高度统计学意义。结论肠易激综合征患者回盲部肥大细胞增多,提示与IBS临床症状有相关性;腹泻型肠易激综合征回盲部脱颗粒肥大细胞增多,提示肥大细胞活化是产生IBS腹泻的原因。