Spontaneous improvement of persistent ulceration after carotid artery stenting

BACKGROUND AND PURPOSE: Because carotid plaque ulceration is associated with an increased risk of cerebral embolism, residual carotid plaque ulceration directly around a stent (persistent ulceration) after carotid angioplasty and stent placement (CAS) could still be a risk factor for a stroke. The purpose of this study is to understand the morphologic and clinical prognosis of persistent ulceration. PATIENTS AND TECHNIQUES: CAS was attempted on 91 consecutive stenotic lesions (80 patients). Of these, 54 lesions (48 patients) had ulceration before CAS. Angiograms were evaluated immediately after the procedure. Persistent ulceration was found in 34 lesions (30 patients). The mean depth and length of persistent ulcers were 2.1 mm (range, 1-4.7 mm) and 8.9 mm (range, 1.5-22 mm), respectively. All patients with persistent ulceration were followed with antiplatelet therapy. RESULTS: No ischemic event due to the lesions occurred during the mean follow-up period of 25.5 months (range, 3-48 months). Angiography on 25 lesions (21 patients) at a mean of 5.8 months (range, 1-21 months) after CAS showed that persistent ulceration disappeared in 12 lesions (48%), improved in 11 lesions (44%), and remained unchanged in 2 lesions (8%). Nine lesions (36%) showed restenosis, which were < or =30% and did not require any additional intervention. New ischemic lesions were not detected in any of the 14 patients (17 lesions) who underwent follow-up MR imaging at a mean of 9 months (range, 1-32 months) after CAS. CONCLUSION: We conclude that persistent ulceration after CAS improves spontaneously and is not a risk factor for cerebral embolism.     

鼻胃管与鼻肠管在伴应激性溃疡的重症神经外科患者的联合应用

目的总结在应用鼻胃管引流治疗重症神经外科患者的应激性溃疡同时应用鼻肠管早期恢复患者肠内营养的经验。方法 2011年1月—2011年6月神经外科重症监护病房(NICU)30名出现应激性溃疡患者行鼻胃管引流及同时置鼻肠管,第2天行胸腹部X线检查确认鼻肠管位置后早期行肠内营养。同时监测胃残量。结果 30例患者在鼻胃管引流治疗同时均一次性鼻肠管置管成功,置管后次日恢复早期肠内营养。结论鼻胃管与鼻肠管在伴应激性溃疡的重症神经外科患者的联合应用是治疗应激性溃疡同时早期恢复肠内营养的有效方式。     

Angiographically undetected ulceration of the carotid bifurcation as a cause of embolic stroke.

The accuracy of angiographic diagnosis of carotid artery ulceration was evaluated. Of those carotid bifurcations showing ulceration at surgery, 60% were diagnosed as having ulcers at angiography. Half of the remaining ulcers occurred in smooth, benign-appearing plaques and were too small to be seen at angiography. An incorrect angiographic diagnosis of ulceration was made in 17 of 50 carotid arteries; in most cases this was due to the presence of a subintimal hematoma in the wall of the artery.     

Gastric ulceration after fundoplication.

Gastric ulceration after fundoplication for gastroesophageal reflux is relatively uncommon, occurring in 1% to 3% of cases. During the period 1974 to 1979, approximately 100 modified Belsey fundoplications were performed at McMaster University Medical Centre. In four patients gastric ulceration developed after the surgery. In all cases the ulcers were located in the proximal stomach, an unusual site. Published reports of gastric ulceration after fundoplication were reviewed, special attention being given to the cause. The authors conclude that local ischemia and mechanical trauma are important in the development of ulceration, which can occur as early as one week after fundoplication. The detection of ulcers requires awareness of the condition and special attention to the symptoms. Because the gastric anatomy is altered by the fundal wrap, the area can be visualized more easily by double-contrast barium studies than by endoscopy.     

湿润烧伤膏治疗湿疹性溃疡的临床分析

目的:探讨湿润烧伤膏(MEBO)治疗下肢湿疹性溃疡的有效方法。方法:对15例湿疹性溃疡创面采用外涂MEBO治疗,渗出高峰期每日涂药2～3次,高峰期过后采用MEBO包扎治疗,每日换药一次。结果:溃疡创面愈合最短21d,最长42d。结论:MEBO治疗下肢湿疹性溃疡疗效显著。     

The UGI series in renal transplant candidates

We reviewed the charts of 115 renal transplant recipients who had pre-transplant upper gastrointestinal (UGI) barium examinations to assess this examination as a predictor of post-transplant ulceration and hemorrhage. In the past surgical therapy for peptic ulcers was recommended before transplantation because of the risk of life-threatening hemorrhage after transplantation. Peptic ulcer disease was found in 22 patients. Fifteen of these were treated with histamine H2-receptor antagonists and none had ulceration post-transplantation. Three of the seven not so treated had recurrent peptic ulceration. The other 93 examinations were normal. Twelve of the patients with normal examinations developed post-transplant peptic ulceration. We conclude that: (a) the pre-transplant UGI series may not distinguish those patients at risk of UGI ulceration post-transplantation and (b) treatment with H2-receptor antagonists obviates the need for surgical therapy of peptic ulcer disease in these patients before transplantation.     

The nodular duodenum in chronic renal failure

A retrospective study of barium meals in 120 patients with chronic renal failure demonstrated duodenal abnormalities in 38 cases (31%). Multiple nodular filling defects were shown in 28 patients (23%), while in 10 cases (8%) peptic ulceration was found on a background of smooth duodenal mucosa. There was no common cause for the renal failure in the group with nodules. The nodular changes were a direct consequence of the uraemia and were unrelated to dialysis, renal transplantation or drug therapy. They were found almost exclusively in males, and in the more severe degrees of uraemia. Associated dyspeptic symptoms were infrequent and there was no apparent relationship between the nodules and peptic ulceration. Radiologically the nodules were typical of Brunner's gland hyperplasia while endoscopic and histological assessment excluded ulceration, infection, duodenitis and malignancy. Hyperplasia of Brunner's glands is commonly associated with chronic uraemia.     

胃肠型白塞氏病的X线表现

本文报告了16例胃肠型白塞氏病。白塞氏病是一种少见的原因不明的全身性疾病,其主要临床特征为口腔溃疡,生殖器溃疡和眼部炎症三联征。文中介绍了胃肠型白塞氏病的临床诊断标准,分析了临床及胃肠道X线表现,并对鉴别诊断问题进行了讨论。     

Clinical Doppler ultrasound for the assessment of plaque ulceration in the stenosed carotid bifurcation by detection of distal turbulence intensity: a matched model study

The assessment of flow disturbances due to carotid plaque ulceration may provide added diagnostic information to Doppler ultrasound (DUS) of the carotid stenosis, and indicate whether the associated hemodynamics are a potential thromboembolic source. We evaluated the effect of ulceration in a moderately stenosed carotid bifurcation on distal turbulence intensity (TI) measured using clinical DUS in matched anthropomorphic models. Several physiologically relevant ulcer geometries (hemispherical, mushroom-shaped, and ellipsoidal pointing distally and proximally) and sizes (2-mm, 3-mm and 4-mm diameter hemispheres) were investigated. An offline analysis was performed to determine several velocity-based parameters from ensemble-averaged spectral data, including TI. Significant elevations in TI were observed in the post-stenotic flow field of the stenosed carotid bifurcation by the inclusion of ulceration (P < 0.001) in a region two common carotid artery diameters distal to the site of ulceration during the systolic peak and the diastolic phase of the cardiac cycle. Both the size and shape of ulceration had a significant effect on TI in the distal region (P < 0.001). Due to the use of a clinical system, this method provides the means to evaluate for plaque ulcerations in patients with carotid atherosclerosis using DUS.     

加味半夏泻心汤对大鼠胃粘膜损伤的影响

目的:观察加味半夏泻心汤(原方加元胡、丹参等)对动物胃粘膜损伤的影响;方法:采用大白鼠应激性溃疡模型,观察其溃疡指数;采用注射利血平同时口服0。02％氨冰的方法,模拟大白鼠脾虚型慢性胃炎,观察胃粘膜的病理改变;结果:加味半夏泻心汤可抗溃疡和减轻胃粘膜慢性炎症反应;结论:加味半夏泻心汤有保护胃粘膜屏障的功能。     

大面积烧伤并发应激性溃疡出血的临床分析

目的：探讨大面积烧伤并发应激性溃疡出血的病因、发病机制、诊断、治疗及预防措施。方法：对47例烧伤病例的临床资料进行回顾性分析及文献复习。结果：本组病例中，41例经保守治疗出血控制，其中13例反复出血；手术治疗6例；1例合并败血症死亡；1例术后再次发生严重出血休克并发DIC死亡；其余均获得痊愈。结论：大面积烧伤后积极防治休克，控制感染，早期进食，应用抑酸药物，是防治烧伤后应激性溃疡出血的有效方法；并发应激性溃疡出血以内科保守、内镜下或介入治疗为主，必要时辅以手术治疗。     

Penetrating atherosclerotic ulcers of the descending thoracic aorta: evaluation with CT and distinction from aortic dissection.

Penetrating atherosclerotic ulceration of the aorta is a poorly understood entity that clinically mimics classic aortic dissection but has imaging features that are distinctly different. In a review of 16 patients with penetrating atherosclerotic ulceration, patients were typically hypertensive (n = 14), and they experienced chest or back pain (n = 13). All patients had an abnormal chest radiograph, with diffuse (n = 14) or focal (n = 2) enlargement of the descending thoracic aorta. Features at contrast material-enhanced computed tomography (CT) included intramural hematoma (n = 16), focal ulcer (n = 15), displaced intimal calcification (n = 13), pleural and/or extrapleural fluid (n = 7), mediastinal fluid (n = 4), and a thick or enhancing aortic wall (n = 6). The chest radiograph and CT findings were compared in patients treated conservatively (n = 9) and surgically (n = 7). These findings did not correlate with the need for surgery. Eight of nine conservatively treated patients were asymptomatic after treatment with antihypertensive medication. Contiguous dynamic contrast-enhanced CT of the aorta enables distinction of ulceration from dissection, which is particularly important in the hemodynamically unstable patient because the surgical management of ulceration is more extensive than that for aortic dissection.     

Diverticulum formation in Crohn's disease of the colon.

Three patients are described with ulceration of the colon in whom the disease was complicated by the formation of diverticula. In one patient this took the form of pseudo-diverticulum formation, which is well recognised, but in the others diverticula were wide-necked, and in one patient followed deep ulceration, a finding which does not appear to have been described before. In the latter it is suggested the diverticula are projections of mucosa through the fibrous scar of the healed ulcers.     

CT特征预测胃肠道神经内分泌肿瘤病理及预后

目的 探讨胃肠道神经内分泌肿瘤(GE-NEN)CT影像特征与病理分级及患者临床预后之间的相关性.方法 45例经病理诊断为GE-NEN的患者纳入研究,回顾性分析GE-NEN的影像征象(肿瘤体积、形态、强化方式及TNM分期)对GE-NEN良恶性诊断的准确性.并采用Kaplan-Meier方法描绘患者生存曲线,用Cox回归进行多因素分析,用Log-rank法检验GE-NEN影像特征与患者生存时间之间的关系.结果 肿瘤体积、形态、有无坏死或溃疡、T分期及N分期与其病理类型之间具有相关性(P＜0.05).GE NEN患者的生存情况与患者的年龄及病理分级相关,增强CT下肿瘤的体积、是否有囊变、坏死或溃疡及肿瘤TNM分期与患者生存之间均存在相关性,其中年龄、肿瘤是否有囊变、坏死或溃疡及远处转移是影响预后的独立因素.结论 增强CT可以用于GE-NEN的分级诊断并可预测患者的生存时间.     

A comparative study of double contrast and single contrast barium meals with endoscopic arbitration in the diagnosis of peptic ulcer

The study compares the ability of a simple double contrast technique with our standard single contrast barium meal to diagnose peptic ulceration. Two hundred and six patients were randomly allocated to either examination. Endoscopy was used as the definitive diagnostic procedure. Deformity of the duodenal cap was more accurately detected by the double contrast technique (P less than 0.01). There was no significant difference in the detection rates for duodenal ulcer. False positive or false negative diagnoses of duodenal pathology were similar by both techniques. The incidence of gastric ulceration in the series was too low for statistical analysis.     

Aphthoid ulcers in Crohn's colitis

Aphthoid ulceration is a strong indication and the earliest radiographic sign of Crohn's colitis. These small discrete ulcers were found by double contrast barium enema examination in 40 out of 91 patients with Crohn's colitis. Seen en face each ulcer appears as a central fleck of barium surrounded by a translucent halo set amidst a patch of normal mucosa. Their detection gives a more accurate assessment of the extent of disease. This information is required in order to plan medical or surgical treatment and can only be provided by meticulous double contrast examination or colonoscopy. Aphthoid ulceration has been demonstrated prior to the onset of bowel symptoms, and several years before the advent of severe colonic disease. The appearance of aphthoid ulcers in established quiescent disease has been observed to herald a relapse. The radiographic demonstration of the evolution of ulceration, which is illustrated, closely reflects what is seen on macroscopic examination of excised specimens and explains the characteristic patchiness and discontinuity of disease.     

CT findings of necrotizing sialometaplasia

An otherwise healthy 56-year-old Caucasian female was referred to the radiology department because of an ulceration of her palatal mucosa. Clinically the lesion was suspected to be malignant and a multislice CT examination of the head and neck region was performed. This revealed an ulcer-like cavity with no tumour-like contrast enhancement. No relevant bone changes or suspicious lymph nodes of the neck were detected. Based on the multislice CT findings, necrotizing sialometaplasia was suspected and the diagnosis was verified histopathologically. This report describes the CT findings of necrotizing sialometaplasia at the ulceration stage.     

Efficacy and sensitivity of axial scans and different reconstruction methods in the study of the ulcerated carotid plaque using multidetector-row CT angiography: comparison with surgical results

BACKGROUND AND PURPOSE: Carotid plaque ulceration is an important risk factor for stroke, and its diagnosis may be very important to plan a correct therapeutic approach. We hypothesized that axial scans and various reconstruction methods could have different specificity and sensitivity in the study of plaque ulceration. The object of this study was to evaluate their role and diagnostic efficacy in patients with carotid plaque complicated by ulceration through the comparison with surgical results. Materials and METHODS: From January 2004 to November 2005, 109 patients who underwent a carotid endarterectomy were analyzed using CT angiography for a total of 218 carotid arteries. We assessed every carotid for the presence of ulcerations. For each patient axial image, maximum intensity projection (MIP), multiplanar reconstruction (MPR), shaded surface display (SSD), and volume rendering (VR) reconstructions were obtained. RESULTS: Multidetector row CT angiography (MDCT) found 32 ulcerations; surgical confirmation underlined an overall 93.9% sensitivity (95% confidence interval [CI] 0.858-1.021), and a 98.7% specificity (95% CI, 0.961-1.012). Axial scans and volume rendering images demonstrated the highest sensitivity (90.9% and 87.9%, respectively); SSD, on the contrary, showed the lowest sensitivity: 39.4% (95% CI sensitivity, 0.227-0.561). CONCLUSION: Axial scans plus VR reconstruction techniques offer superior depiction of carotid plaque ulceration compared with MIP, MPR, and SSD.     

Colonic aphthous ulcers in pseudomembranous colitis

Colonic aphthous ulceration is usually due to Crohn's disease. It has been described in other colitides but has not been reported in pseudomembranous colitis. We report a patient with pseudomembranous colitis with aphthous ulceration demonstrated by barium examination.     

消化道Behcet氏病的X线表现(附6例报告)

本文报告消化道双重造影有异常表现的Behcet氏病患者6例,其中2例为食管病变,4例为回盲部病变,6例均有反复发作口腔溃疡及皮肤关节损害病史,2例有阴部溃疡史。根据X线形态表现将消化道Behcet's病分为两型:(1)溃疡型:5例,病变表现典型,为圆形或类圆形龛影,单发或多发,边缘光滑锐利;(2)增生型:1例,病变表现不典型,除龛影外,可见息肉状或类圆形充盈缺损,管腔狭窄,一般为病变的后期。小血管炎为其病理特征。