Differential diagnosis between Crohn's disease and intestinal tuberculosis in China

To evaluate the values of clinical findings in differential diagnosis between Crohn's disease (CD) and intestinal tuberculosis (ITb), so that better diagnosis strategies could be found, we analysed the records of 30 patients with ITb and 30 patients with CD retrospectively. We reviewed the cardinal symptomatic and physical, radiological, colonoscopic, pathological findings in the patients. Some cardinal symptomatic and physical, radiographic and colonscopic features of CD and ITb were positive correlation. Its Pearson correlation coefficients were 0.976, 0.953 and 0.961, respectively (p = 0.000, 0.003 and 0.000). Some histological features of CD and ITb had no correlation. Its Pearson correlation coefficient was 0.140 (p = 0.765). It is difficult to differentiate CD from ITb in clinical practice. The differential diagnosis depends largely upon colonoscopy and histopathology.     

Analysis of colonoscopic findings in the differential diagnosis between intestinal tuberculosis and Crohn's disease

BACKGROUND AND STUDY AIMS: Intestinal tuberculosis and Crohn's disease are chronic inflammatory bowel disorders that are difficult to differentiate from one another. This study aimed to evaluate the diagnostic value of various colonoscopic findings in the differential diagnosis between intestinal tuberculosis and Crohn's disease. PATIENTS AND METHODS: Colonoscopic findings on initial work-up were prospectively recorded in patients with an initial diagnosis of either intestinal tuberculosis or Crohn's disease. These findings were analyzed after a final diagnosis of intestinal tuberculosis (n = 44) or Crohn's disease (n = 44) had been made after follow-up. RESULTS: Four parameters (anorectal lesions, longitudinal ulcers, aphthous ulcers, and cobblestone appearance) were significantly more common in patients with Crohn's disease than in patients with intestinal tuberculosis. Four other parameters (involvement of fewer than four segments, a patulous ileocecal valve, transverse ulcers, and scars or pseudopolyps) were observed more frequently in patients with intestinal tuberculosis than in patients with Crohn's disease. We hypothesized that a diagnosis of Crohn's disease could be made when the number of parameters characteristic of Crohn's disease was higher than the number of parameters characteristic of intestinal tuberculosis, and vice versa. Making these assumptions, we calculated that the diagnosis of either intestinal tuberculosis or Crohn's disease would have been made made correctly in 77 of our 88 patients (87.5 %), incorrectly in seven patients (8.0 %), and would not have been made in four patients (4.5 %). CONCLUSIONS: A systematic analysis of colonoscopic findings is very useful in the differential diagnosis between intestinal tuberculosis and Crohn's disease.     

肠结核与克罗恩病的临床、内镜及病理分析比较

目的对肠结核(IT)与克罗恩病(CD)进行临床及内镜分析和比较,以期找出对鉴别诊断有帮助的要点。方法采用回顾性方法,对既往确诊的肠结核30例与克罗恩病24例资料进行复习,分析其临床表现、放射影像学、内镜和组织病理学特征的异同之处。结果肠结核腹水形成更常见(53.3%)。B超或CT下IT肠系膜淋巴结肿大12/30例(40%),CD肠系膜淋巴结肿大2/24例(8.3%)。肠镜下表现及病理包括病变常见部位、节段性病变、横形溃疡、息肉形成情况、上皮样肉芽肿两组比较差异均无显著性。IT组肠镜下活检黏膜标本结核菌PCR阳性率22/30例(73.3%)。结论IT与CD的鉴别需要多方面综合判断,活检黏膜结核菌PCR有助于鉴别诊断。     

克罗恩病的鉴别诊断

临床上大多CD的肠镜不典型,与其他疾病的肠镜表现互相重叠,其鉴别诊断极为困难。其中CD与肠结核（ITB）的鉴别尤为困难又特别重要,因二者的治疗完全不同。CD与ITB有相同的好发部位和临床表现,有各自的典型肠镜表现,但不典型的病变内镜几乎无法区别时,则主要依靠病理和肠外表现等综合分析。另一个容易误诊为CD的是肠淋巴瘤,误诊最主要原因是一次活检病理往往不能发现淋巴瘤,这与活检取材及病理阅片经验有关。所以,多次多部位活检及仔细病理阅片（必要时免疫组织化学、基因重排或原位杂交）是避免淋巴瘤误诊漏诊的关键。此外,发现病变不符合典型CD表现时还应想到肠白塞病、非甾体类消炎药所致药物性肠病及其他少见原因肠病的可能,通过反复活检病理、结合各自的临床特点大都可以予以鉴别。     

肠型白塞病患儿消化道出血及穿孔的护理

总结1例肠型白塞病患儿消化道出血及穿孔的护理经验.护理要点包括:消化道出血的护理、引流管的护理、营养支持、用药护理、经外周静脉穿刺中心静脉置管护理、患儿及家长的心理护理等,经过积极治疗与精心护理,患儿病情得到控制,转至消化科继续治疗.     

Differential diagnosis of Parkinson's disease

The differential diagnosis of PD includes other neurodegenerative disorders; hereditary disorders; and symptomatic causes, such as structural lesions, infections, metabolic abnormalities, hydrocephalus, and drugs or toxins. A good history of symptom evaluation, drug use, and family illness is just as essential as a careful neurologic examination when evaluating a patient with parkinsonism. Although there is no definitive diagnostic test for PD at this time, tests to rule out other causes should be considered and then treatment started.     

Vascular symptoms of Behcet's disease

AIM: To characterize vascular symptoms of Behcet's disease (BD) in patients treated for the last 10 years in the Institute of Rheumatology. MATERIAL AND METHODS: Vascular symptoms of BD were studied in 151 patients with BD (mean age 33.5 +/- 9.5 years, duration of the disease 14.0 +/- 10.1 years, 104 males and 47 females, 67.4% carried HLA B51(5) antigen). Duplex vascular scanning was made to detect venous thrombosis. RESULTS: Thrombotic complications were found in 37 of 151 (24.5%) patients with BD (30 males and 7 females, mean age 37.1 +/- 9.1 years, mean duration of the disease 7.3 +/- 9.7 years). Venous thromboses prevailed (36 patients). Four males (2.6%) had arterial lesions: aneurysms of the iliac arteries (n = 1), thrombosis of the iliac artery (n = 1), pulmonary infarction and thrombosis of the pulmonary arteries (n = 2). Combination of venous and arterial manifestations occurred in 3 patients. One patient had thrombosis of the venous sinus, occlusion of the retinal vessels was diagnosed in 7 patients. CONCLUSION: Incidence of vascular disorders was observed in 1/4 of the patients. This corresponds to those observed worldwide and concerns venous thrombosis and other thromboses. Among the examinees, vascular disorders were associated with a young age, earlier development of thrombotic complications in males than in females.     

Crohn's disease. The problem of early diagnosis]

A retrospective analysis was made of the diagnostic period of Crohn's disease as well as of x-ray and endoscopic signs in 28 patients. Three forms of the disease were distinguished: acute (pseudoappendicular), stenosing with chronic intestinal obstruction syndrome and primary chronic characterized by the triad (pains in the stomach, diarrhea, fever) or by the syndrome of malabsorption with extraintestinal manifestations. In the stenosing and primary chronic forms of Crohn's disease, a correct diagnosis was established in the majority of the patients 3-5 years after appearance of the symptoms. To improve early diagnosis of Crohn's disease, it is recommended that indications for x-ray and endoscopic examinations be extended. These examinations are indicated in all the patients with recurrent pains in the right iliac area, fever of obscure genesis and chronic diarrhea.     

Differential diagnosis in GERD and cardiovascular disease

In substantial portion of patients referred to the coronary care unit (CCU) with a tentative diagnosis of acute coronary syndrome (ACS), gastro-esophageal diseases are the origins of their symptoms such as chest pain. The differential diagnosis is difficult and the coronary angiography (CAG) and the gastro-esophageal endoscopy are often required. We recently evaluated our 100 consecutive cases that underwent CAG as ACS. Among the 100 cases, 72 had significant organic coronary artery lesions, 5 had significant coronary vasospasms proved by the acetylcholine provocation, and the other 23 showed no detectable major coronary artery abnormality. Among the last 23 cases, gastro-esophageal endoscopy revealed the gastro-esophageal diseases such as reflux esophagitis in 7 cases. Those 7 cases with gastro-esophageal diseases had less coronary risk factors than the 77 cases with the coronary artery diseases. Gastro-esophageal diseases are the major differential diagnoses of ACS, especially in those with few coronary risk factors.     

克罗恩病的腹腔镜诊治策略

目的探讨克罗恩病的腹腔镜诊治策略,最大限度避免并发症和复发的发生。方法回顾性分析12例克罗恩病在腹腔镜下进行诊治策略。结果 12例均在腹腔镜下手术顺利完成,无中转开腹,术前确诊5例(41.7%),经腹腔镜探查术后明确为克罗恩病7例(58.3%),手术平均时间为(180.0±42.1)min,术中平均失血为(201.1±5.4)mL,手术后平均住院天数(12.1±4.5)d,切口感染2例(16.67%),吻合口瘘1例(8.33%),术后随访6个月～6年,4例复发,复发率(33.3%),再手术1例,取得与开腹手术相同的疗效。结论克罗恩病的腹腔镜诊治要有整体治疗的策略,需结合患者全身状况和临床病期把握手术指征、时机与术式选择,才能有效地避免并发症和复发的发生,提高患者生存质量,体现微创手术的优势。