大肠黑变病的临床及内镜特征分析

目的探讨大肠黑变病的临床特点、内镜表现、病理特征等。方法总结23 596例接受结肠镜检查的患者中发现大肠黑变病患者的病例资料,对患者的临床特点、内镜表现及病理特征等进行分析。结果共发现大肠黑变病715例,检出率3.03%,其中男性检出率2.86%,女性检出率3.17%,女性高于男性,差异有统计学意义(P0.05);其中老年组患者占67.1%,中青年组患者占32.9%,中年组明显高于青年组(P0.05);病变多累及1个或多个肠段,左半结肠和右半结肠发生率较高;193(27.0%)例伴有大肠腺瘤,68(9.51%)例伴有结肠癌;401(56.1%)例患者有便秘,358(50.1%)例有服用泻药史。结论大肠黑变病的发病率与文献报道基本一致,女性高于男性,病变多位于左半结肠和右半结肠;大肠黑变病与结肠腺瘤和结肠癌可能有相关性,其发病与便秘和服用蒽醌类泻药有关。     

86例结肠黑变病回顾分析

目的探讨结肠黑变病（MC）的发病特征、临床与内镜特点、发病原因及其与大肠腺瘤、大肠癌及溃疡性结肠炎的关系。方法选择2007年1月～2010年12月本院内镜室结肠镜检记录、相关病理记录及定期随访资料,进行数据分析。结果 2007年～2010年MC检出率呈逐年上升趋势;老年患者检出率高于中青年（P〈0.01）,男性患者多集中在老年（P〈0.01）,女性患者检出率无年龄差异,老年患者检出率无性别差异,中青年患者女性检出率高于男性（P〈0.01）;便秘为MC最常见症状,其次是腹痛;病变可累及各肠段;长期便秘及服用蒽醌类泻剂易患MC;MC与结肠腺瘤病发病密切相关（P=0.012）,与结肠癌和溃疡性结肠炎无明显相关性。停用蒽醌类泻药结肠黑变能治愈或明显减轻。结论 MC的检出率呈逐年增加的趋势;老年人及中青年女性易患本病;临床表现缺乏特异性;容易合并结肠腺瘤;便秘及服用蒽醌类泻剂与MC密切相关;MC预后良好。     

78例结肠黑变病临床分析

目的 分析结肠黑变病(MC)的病因及与其结肠肿瘤的关系.方法 对78例结肠黑变病患者的临床资料进行回顾性分析.结果 便秘患者56例(23.1%),其中长期服用泻药患者38例(48.7%),无明确服泻药史患者18例(23.1%);合并有腺瘤样息肉16例;合并结肠癌1例.结论 便秘及服用泻药是导致MC发生的重要因素;泻剂中多为蒽醌类.结肠黑变病与结肠肿瘤的关系值得进一步研究.     

结肠黑变病57例

目的:探讨结肠黑变病的病因、预后以及与肿瘤的关系.方法:回顾性2005-01/2008-12延边大学附属医院结肠镜检查发现的57例结肠黑变病患者临床特点.结果:2006-2008年结肠黑变病的发病率逐年增加(0.78%<0.92%<1.73%);57例患者中女性患者占52.6%, 但男性与女性无统计学差异,老年男性与中年女性发病率高(P <0.005);57例患者均有服用泻剂史,口服蒽醌类泻药(6年以上), 如潘泻叶、芦荟胶囊、麻仁润肠丸、排毒养颜胶囊43例, 果导片(6年以上)12例, 减肥茶(6-12 mo)2例;31例患者有便秘、每周<3次, 粪便干燥, 或呈块状;排便困难、排便不尽感21例;腹痛、腹胀2例;肛门坠胀不适者2例;腹泻、便血1例;有1例并发结肠癌;停用泻剂后随访3例6-12 mo, 2例黑变病减轻, 1例治愈, 预后良好.结论:结肠黑变病可能与便秘、长期服用泻药有关;好发于中年女性和老年男性;可能与结肠癌有关.     

老年人大肠黑变病的临床和内镜特点分析

目的探讨老年人大肠黑变病(Melanosis coli,MC)的病因及其临床和内镜特点。方法总结我院自2000年-2010年间电子结肠镜检查4 821例中发现60岁以上58例老年MC的临床资料,并进行回顾性分析。结果老年MC病变多累及1个或多个肠段,全结肠发病率较高,58例中25例伴有大肠息肉,其中大肠腺瘤23例,5例伴有结肠癌,便秘49例,服用泻药53例。结论老年MC的病因主要与便秘和长期服用蒽醌类泻药有关,其伴发大肠息肉和结肠癌几率增加。     

大肠黑变病35例临床分析

目的探讨大肠黑变病的致病因素和临床特点。方法回顾性分析我院2007年1月～2011年6月经结肠镜和病理检查确诊的35例大肠黑变病患者的临床资料、内镜及病理特点。结果 35例患者中,有慢性便秘症状者28例,服用泻药者32例,合并增生性息肉3例,合并管状腺瘤1例,合并直肠腺癌1例。结论大肠黑变病病因与长期服用泻药及慢性便秘有关,并与大肠腺瘤和大肠癌相关。     

结肠黑变病内镜检查临床分析

目的探讨结肠黑变病相关致病因素。方法做好肠道准备,观察结肠黏膜的改变从而做出明确的诊断。结果 60例中42例便秘,32例有服用泻药史,伴发结肠息肉24例,伴发结肠癌4例。结论便秘与滥用泻药为结肠黑变病的主要原因,结肠黑变病与结肠息肉,结肠癌伴发可能有关。     

结肠黑变病与年龄、性别关系的研究

本文报告2457例结肠镜检查中发现结肠黑变病58例(2.36%)。其中男性患者检出率,老年组明显高于青年和中年组(p 均<0.01),而青年与中年组之间无显著差别(p>0.05);女性患者检出率,不同年龄组之间无显著差别。在青年组中,女性患者检出率明显高于男性,而中、老年患者检出率不同性别之间无明显差别(p 均>0.05)。     

老年便秘331例服泻药与结肠黑变病关系的临床分析

目的：探讨传统的中西药泻剂以及服药时间和方法和老年人结肠黑变病的关系。方法：总结了我科近7年住院老年便秘并服用泻剂331例患者结肠镜检查结果，根据便秘的病程及服用泻药的时间和方法分成4组，采用卡方检验分析了服药方式，时间与结肠黑变病的关系。结果：331例患者中连续服药≥1年者，连续服药＜1年，年者，间断服药≥1年者和间断服药＜1年者结肠黑变病的发生率分别为81．06％，77．78％，11．25％和9．52％，显示连续服药者结肠黑变病发生率明显高于间断服药者（P＜0．01），而在连续服药者和间断服药者中，服药时间长短相差不显著（P＞0．05）。结论：表明长期服用泻药与老年结肠黑变病的发生有相关性，但结肠黑变病确切的病理变化及临床意义有待进一步研究。     

结肠黑变病临床特点和内镜诊断分析(附145例报告)

[目的]探讨结肠黑变病(MC)的临床和内镜特点.[方法]对2004年1月～2009年12月经结肠镜检出的145例MC患者的临床资料、内镜下表现及并发息肉、肿瘤的检查结果进行回顾性分析.[结果]6 841例肠镜检查患者中检出MC145例,检出率2.11%;不同性别的检出率差异无统计学意义(P>0.05);>60岁的患者检出率明显高于<60岁患者(P<0.05);多数有便秘和(或)服用泻药病史;MC病变程度与服用泻药时间呈明显正相关(P<0.05).MC较易合并直径<0.5 cm的山田Ⅰ型结肠息肉.[结论]老年人易患MC;MC的发生与便秘和长期服用泻药有关;MC与结肠息肉、肿瘤发生有一定相关性,定期的肠镜随访是非常必要的.     

Melanosis of the rectum in patients with chronic constipation

In patients with constipation the prevalence of melanosis in rectal biopsies was evaluated in an attempt to correlate its occurrence with laxative consumption and intestinal stasis. Melanosis was present in 58 percent of the patients and in none of a control group. Melanosis was present in 73.4 percent of patients consuming anthracene laxatives and in 26.6 percent of those not consuming anthracene laxatives (P<0.01). No correlation was found between the occurrence (and grading) of melanosis and pattern of transit through the large bowel, bowel movements, and duration of symptoms. Results of this study seem to indicate that intestinal stasis is not a cause of melanosis of the colon and rectum and confirm that melanosis may well be due only to the consumption of anthracene laxatives; melanosis coli does not appear to be a sensitive marker of impairment of motor function in the “cathartic colon.”     

Overestimation of ulcerative colitis due to melanosis coli

Melanosis coli is a benign pigment deposition in the colonic mucosa that can be seen at the time of colonoscopy especially in patients with history of laxative use. In conditions in which the endoscopic findings influence therapeutic decisions, melanosis coli can lead to overestimation of disease aggressiveness and unnecessary therapy. We describe a case in which the finding of melanosis coli affected the treatment of a patient with mild ulcerative colitis exacerbation.     

Melanosis coli

Melanosis coli was diagnosed histologically in colon biopsies of 45 patients with prolonged administration of anthraquinone laxatives. Colonoscopies performed for increased constipation, abdominal pains, or distention disclosed discoloration of the mucosa in only 14 patients. Radiographic studies revealed motility disorders of the colon. In several cases, a circular stenosis occurred at the junction of the colon and the sigmoid, simulating a tumor. Electron microscopy showed abnormalities of the absorptive epithelial cells. The lamina propria contained pigment-laden macrophages, plasma cells, and several nerve fibers in different stages of degeneration. The most striking changes of autonomic nerve elements occurred in patients with the most serious motility disorders.     

Retrospective study on melanosis coli as risk factor of colorectal neoplasm: a 3-year colonoscopic finding in Zhuhai Hospital,China

International Journal of Colorectal Disease - Melanosis coli (MC) is a colonoscopic finding in which the colonic mucosa appears darkly pigmented than usual and generally caused by extended...     

Melanosis of the ileum

Melanosis involving the small intestine is extremely rare though not uncommon in the colon and appendix. Light and electron microscopic studies of a rare case of melanosis of the ileum are described. Histochemical studies showed that the pigment in the ileum was similar to that reported in cases of melanosis coli and gave reactions for both melanin and lipofuscin. Electron microscopic study revealed this pigment to be in large mononuclear cells in the lamina propria. No pigment was found in epithelial or other cells. Despite the well-recognized ultrastructure and histochemical reactions of this pigment, its precise chemical structure and mode of formation need further elucidation. This study establishes the occurrence of pigmentation of the small bowel identical to that seen in the colon and designated melanosis coli.     

Bacteremias caused by Escherichia coli in cancer patients - analysis of 65 episodes.

OBJECTIVES: The aims of this study were to evaluate risk factors, clinical presentation, outcome and antimicrobial susceptibility in patients with Escherichia coli bacteremia occurring over seven years in a single cancer hospital. METHODS: Sixty five episodes of bacteremia from E. coli appearing over seven years from 12,301 admissions in a single cancer institution were retrospectively analyzed. RESULTS: The proportion of bacteremia caused by E. coli among Gram-negative bacteremia was 20.8% (the second most common organism after Pseudomonas aeruginosa), and infection-associated mortality was 17%. The incidence in 1989-1995 varied from 14.3 to 24.7%. The most common risk factors were: solid tumors as the underlying disease (70.7%); central venous catheter insertion (32.3%); prior surgery (46.2%), and prior chemotherapy within 48 h (44.4%). Neutropenia and urinary catheters did not place patients at high risk in any of the subgroups. When we compared the two subgroups of 61 cases of bacteremia - monomicrobial and polymicrobial (when E. coli was isolated from blood culture with another microorganism) - we found that acute leukemia and breakthrough (recurrence while receiving antibiotics) bacteremia were more frequently associated with polymicrobial E. coli bacteremia. There was also a difference in infection-associated mortality: monomicrobial bacteremia due to E. coli only had a significantly lower mortality in comparison with polymicrobial E. coli bacteremia (8.9 vs 35.0%, respectively; P<0.03). CONCLUSION: The susceptibility of 115 E. coli strains isolated from 65 episodes of bacteremia was stable. Only two episodes caused by quinolone-resistant strains occurred, both in 1995, after six years of using ofloxacin for prophylaxis in neutropenic patients in our hospital. We found that 85.2-91.3% of all strains were susceptible to aminoglycosides, 97.8% to quinolones, and 90-100% to third generation cephalosporins and imipenems. The patients most commonly infected had solid tumors and the mortality was only 17%.     

结肠黑变病色素性质和病因与泻剂关系的研究与问题

芦荟、大黄是两种作用特别,应用广泛的中药,大量的患者长期应用,但这两种药物长期使用的安全性一直存在着争议,并已引起医药界和社会的关注,目前临床上所报道的毒性反应主要集中在结肠黑变病上。对于结肠黑变病的病因,结肠黑变病与芦荟、大黄类泻剂的关系国内外作了不少的研究,但仍未得到公认的结果,本文结合在研究的课题对此进行了分析讨论并提出我们的一点思考。     

Examination of diarrheal stools in Hat Yai City, South Thailand, for Escherichia coli O157 and other diarrheagenic Escherichia coli using immunomagnetic separation and PCR method

A total of 493 stool samples from diarrheal patients in Songklanagarind Hospital, in southern Thailand, were examined for Escherichia coli O157 by the culture method combined with an immunomagnetic separation (IMS) technique. E. coli O157 was not found, although the IMS-based method could detect 10(2)-10(3) CFU of artificially inoculated O157/g of stool samples. Polymerase chain reaction was also used for the detection and identification of diarrheagenic E coli from 530 stool samples. The target genes were eae for enteropathogenic E. coli (EPEC), stx for enterohemorrhagic E. coli (EHEC), elt and est for enterotoxigenic E. coli (ETEC), ipaH for enteroinvasive E. coli (EIEC), and aggR for enteroaggregative E. coli (EAggEC). Fifty-eight diarrheagenic E. coli strains were detected in 55 stool samples (10%) from 32 children and 23 adults. These included 31 EAggEC strains (5.8%), 13 ETEC strains (2.5%), 13 EPEC strains (2.5%), and one EIEC strain (0.2%). EHEC was not detected. The diarrheagenic E. coli strains were found mainly in children under 2 years of age (24 of 32 children). EAggEC strains and ETEC strains were susceptible to several antibiotics whereas the EPEC strains exhibited resistance to these antibiotics.