异位胰腺误诊1例

1　病例报告女 ,42岁。上腹部隐痛 8a余。查体未见明显异常。胃肠钡餐造影见胃体与胃窦交界处后壁有一 4cm× 3cm椭圆形充盈缺损 ,边缘光整 ,粘膜皱襞略变平 ,未见破坏。诊断为粘膜下良性肿瘤。纤维内窥镜见胃体后壁有一 3.5 cm大小的隆起物 ,手术见胃体后壁近小弯侧可扪及一柔软、表面光滑 ,约 4cm× 3cm的肿物。位于粘膜下层 ,与粘膜层紧连。病理报告为异位胰腺。2　讨论迷走胰腺 (异位胰腺 )是发生在正常胰腺解剖部位以外的胰腺组织 ,为少见的先天异常。常见于 40～ 5 0岁 ,一般无明显症状。X线典型表现为较小的、宽基底的圆形或椭圆形…     

回肠平滑肌脂肪瘤合并异位胰腺组织误诊1例

1　病例报告女 45岁。因发作性脐周疼痛 ,偶有黑便 5 a,加重 1周 ,以腹痛待查于 2 0 0 1- 0 6 - 19收住消化内科。 5 a来 ,每遇秋末冬初即有脐周腹痛伴食欲不振。在当地医院按消化道炎症、痉挛等对症治疗 (用药不详 )渐好转。于 1周前无明显原因又感脐周腹疼难忍 ,为阵发性 ,恶心呕吐 ,即来我院诊治。查体 :t36 .5℃ ,BP12 0 /90 mm Hg,贫血貌 ,腹软 ,脐周压痛 ,无反跳痛 ,肠鸣音正常。化验检查 :血常规、尿常规、肝功、血生化均正常 ,大便潜血 ( )。辅助检查 :钡透示 :胃炎、食道炎。住院给予解痉止痛 ,保护胃肠粘膜等药物治疗无效后 ,行…     

异位胰腺20例误诊分析

异位胰腺因缺乏特异性的临床表现及特殊的检查手段,故常易误诊.本文收集我院近10年来,经手术后病理确诊的20例异位胰腺进行分析,旨在探讨误诊的原因,以减少误诊率.     

小儿回肠末端异位胰腺误诊为恶性肿瘤

小儿回肠末端异位胰腺误诊为恶性肿瘤武汉市湖北医科大学［４３００７１］朱润庆，邹先进，索朗多吉，陈辉华【病例】男，４岁。无明显诱因出现脐周阵发性疼痛并逐渐加剧一天，伴停止排便排气，恶心，呕吐胃内容物数次。当地医院，以＂粘连性肠梗阻＂收住外科。既往史：发...     

经内镜诊断治疗胃异位胰腺研究

经内镜诊断治疗胃异位胰腺研究韩兵，于皆平，沈志祥，罗和生，汪朱文，杨咏梅胃异位胰腺是一种发育异常性疾病，以胰腺组织迷走，出现于胃粘膜下或肌层为其组织学特征。而其临床表现无特征性，诊断困难。以往多因异位胰腺引起的急腹症样表现或因其他疾病行手术治疗后，在...     

总胆管末段异位胰腺误诊2例分析

异位胰腺临床少见 ,发生于总胆管末段更为罕见 ,我们近10 a收治 2例 ,术前均误诊为胆道恶性肿瘤。为提高对本病的认识 ,现将临床资料整理报告如下。1　临床资料本组 2例均为男性 ,年龄分别为 30、6 0岁。 1例间歇性黄疸4a,进行性加重 ,入院前伴畏寒发热 ,1例无痛性进行性黄染3wk入院。 2例均无肝炎史。 B超检查 2例均有肝增大 ,肝内胆管及总胆管扩张 ,总胆管末段显示实质性光团阻塞 ,大小分别为 2 .7cm× 1.0 cm和 2 .4cm× 1.6 cm,管腔迂曲 ,呈鼠尾状缩窄。 1例 CT示胆总管中下段闭塞 ,并见小点状高密度灶。 HB-s Ag 2例均阴性。术前胆…     

胃窦异位胰腺误诊为胃息肉

1病例资料女,61岁。因胃胀痛、厌食11 d入院。患者因胃胀痛、厌食1周到某社区医院就诊,胃镜检查诊断为胃窦息肉,医生建议行高频电切息肉手术治疗,患者未同意。4 d后来我院就诊,门诊医生根据社区医院胃镜报告,建议到我科复查胃镜,同时镜下行高频电切息肉手术。我科胃镜检查示：     

胃肠异位胰腺15例临床分析

消化道异位胰腺以胃肠者居多，可发生在任何年龄，但多见于３０－５０岁，本组１５例胃肠异位胰腺，在空肠、胃各４０％，十二指肠２０％，其直径在空肠者０．５－２．５ｃｍ，胃者４－６ｃｍ。胃肠异位胰腺的临床表现为无特异性，其症多与异位胰腺所在的部位、所致的并发症有关，故常易误诊、漏诊。胃镜下发现隆起物有“脐样凹陷”。可从凹陷处注促胰激素，如有胰液流出者有助于本病诊断。Ｘ线钡餐造影检查有充盈缺损，缺损中央有存     

胃胰腺异位伴异位导管成分癌变临床病理学观察

<正>胃胰腺异位(gastric heterotopic pancreas)是以胃黏膜下或肌层内出现胰腺组织为其特征,是一种少见病,临床一般无特征性症状,常在其他胃疾病手术中或尸检中偶然发现。或者因为异位胰腺组织肿块较大,被疑为肿瘤而手术切除后诊断。有时异位肿物中可见Brunner腺或胃黏膜同时出现,或异位的胰腺组织同时有新生平滑肌束混合存在,此时,又称作腺肌瘤。1 材料与方法1.1 材料患者男性,61岁,     

儿童异位胰腺1例

患儿男,12岁.因反复上腹痛1年,黑便5 d就诊.患儿1年前开始出现节律性上腹痛,进食后诱发,伴恶心、反酸、嗳气,无腹泻呕吐.     

上消化道异位胰腺的内镜及超声诊断与治疗

目的:探讨上消化道异位胰腺内镜及内镜超声检查(EUS)所见及治疗效果.方法:回顾性分析在我院行胃镜检查并经术后病理证实的上消化道异位胰腺35例(其中26例同时行Eus)的临床资料.结果:胃镜显示病变位于胃窦29例,胃体1例,十二指肠球部3例,十二指肠降部2例.外形呈单纯黏膜隆起21例,隆起伴脐样开口12例,隆起伴表面溃疡2例.EUS表现为高回声2例,混杂回声13例,低回声11例,其中4例内部出现特征性管状结构样回声;24例边界清晰,2例边界不清;位于黏膜层1例,黏膜下层23例,固有肌层2例.内镜下高频电凝电切治疗29例,均无出血、穿孔等并发症.结论:异位胰腺的镜下表现缺乏特异性,EUS对异位胰腺有重要的诊断价值,内镜下高频电凝电切是安全有效的治疗手段.     

Validity and Specificity of the Children’s Automatic Thoughts Scale in Clinically Anxious and Non-clinical Children

The present study is a preliminary examination of the internal, criterion, and convergent validity of the Children’s Automatic Thoughts Scale (CATS; Schniering and Rapee 2002), a developmentally sensitive measure of cognitions associated with childhood internalizing and externalizing disorders, among clinically anxious and non-clinical children. Participants included 40 children (ages 7–14) with a clinical anxiety disorder and 40 non-clinical children with no prior anxiety disorder diagnosis. Results supported the internal consistency and criterion validity of the measure. In addition, controlling for age, sex, and clinical status, convergent validity was largely supported, with the Physical Threat subscale correlating with self-report of generalized anxiety and separation anxiety, and the Social Threat and Personal Failure subscales correlating with self-report of social anxiety and major depression. Limitations and suggestions for further research on the utility of the CATS are discussed.     

89例儿童化脓性脑膜炎临床相关指标分析

目的探讨儿童化脓性脑膜炎的临床特点,为临床诊断与治疗提供科学依据。方法对本院小儿内科2008年9月²012年9月确诊为化脓性脑膜炎89例住院患儿临床资料进行回顾性分析。结果89例中≤3岁患儿占48.3%,全年散发,春、夏、秋、冬四季发病率无明显差异,多以发热(92.1%)、精神反应差(76.4%)、呕吐(61.8%)为首发症状就诊,65.2%患儿白细胞计数>10×109/L,80.9%患儿中性粒细胞比例>50%,所有患儿脑脊液常规检查白细胞大于10×106/L,≥500×106/L45例(50.6%),出现并发症22例(24.7%),治疗方案以静脉应用第三代头孢为主,抗生素疗程142012年9月确诊为化脓性脑膜炎89例住院患儿临床资料进行回顾性分析。结果89例中≤3岁患儿占48.3%,全年散发,春、夏、秋、冬四季发病率无明显差异,多以发热(92.1%)、精神反应差(76.4%)、呕吐(61.8%)为首发症状就诊,65.2%患儿白细胞计数>10×109/L,80.9%患儿中性粒细胞比例>50%,所有患儿脑脊液常规检查白细胞大于10×106/L,≥500×106/L45例(50.6%),出现并发症22例(24.7%),治疗方案以静脉应用第三代头孢为主,抗生素疗程14⁶0(平均34)d;临床转归:治愈或好转74例(83.1%),未愈11例(12.4%),死亡4例(4.5%)。结论化脓性脑膜炎仍以婴幼儿为主,临床表现多样,不同年龄段表现存在差异,可结合实验室检查分析,总结临床特点,为临床诊治和转归提供参考。     

Community‐acquired Acute Kidney Injury Among Children Seen in the Pediatric Emergency Department

Objectives

Acute kidney injury (AKI) is a significant risk factor for morbidity and mortality in children. Little is known about community‐acquired AKI (CA‐AKI) in the pediatric emergency department (PED). Early recognition of AKI allows for nephroprotective measures. The goal of this investigation was to determine the incidence of CA‐AKI and the frequency of clinician identified CA‐AKI to better inform future nephroprotective interventions.

Methods

This was a retrospective cross‐sectional study in the PED of a children's hospital. Children 1 month to 18 years of age seen in the PED from January 1 to December 31, 2015, and in whom at least one creatinine level was obtained were included. Patients with chronic kidney disease or end‐stage renal disease or who died in the PED were excluded. Patients had CA‐AKI based on modified Kidney Disease‐Improving Global Outcomes criteria using the creatinine obtained in the PED compared to age‐specific norms. Patients were considered identified if the PED clinician diagnosed AKI. The primary outcome was the incidence of CA‐AKI. Secondary outcomes included frequency of AKI identification, nephrotoxic medication use, hospital length of stay, renal replacement therapy, and death. Fisher exact test or Pearson's chi‐square test was used to calculate odds ratio (OR) with 95% confidence intervals (CIs); multivariable analyses were performed using logistic regression.

Results

In 2015 there were 119,151 PED visits; 15,486 met inclusion criteria. CA‐AKI was present in 239 of 15,486 (1.5%) encounters. AKI was identified by PED clinicians in 46 of 239 (19%) of encounters and by the inpatient team in 123 of 199 (62%) of the encounters admitted. AKI was never recognized by a PED or inpatient clinician in 74 of 199 (37%) encounters. Encounters with AKI correctly diagnosed were older (13 years old vs. 10 years old, p = 0.0114), had more severe (stage 2 or 3) AKI (OR = 5.5, 95% CI = 2.6–11.8), and were more likely to be admitted (OR = 10.3, 95% CI = 1.38–77.4) than encounters with missed AKI.

Conclusions

CA‐AKI remains an underrecognized entity in the PED. Better tools for early recognition of AKI in the busy PED environment are needed.

     

Thyrotropin-releasing Hormone in the Systemic Circulation of the Neonatal Rat Is Derived from the Pancreas and Other Extraneural Tissues

Thyrotropin-releasing hormone immunoreactivity (IR-TRH) has been detected in the circulation of the neonatal rat. This immunoreactivity was demonstrated in purified ethanol extracts of plasma, and was indistinguishable from synthetic TRH using radioimmunoassay and chromatographic criteria. To determine the source of the circulating IR-TRH, tissue concentrations of TRH were analyzed during maturation of the rat. These studies revealed that during the first 10 d of life, the pancreas contained the greatest concentration of IR-TRH of any organ (pancreas, 289±35 pg/mg; hypothalamus, 13±3 pg/mg, day 5). Thereafter, pancreatic IR-TRH concentrations declined progressively while hypothalamic concentrations gradually increased (pancreas, 1.2±0.2 pg/mg; hypothalamus, 365±54 pg/mg, adult rat). IR-TRH was also found throughout the gastrointestinal tract but was not detected in the liver, spleen, kidney, or heart. IR-TRH from the pancreas and gastrointestinal tract gave radio-immunoassay binding displacement curves that were parallel to a curve generated with synthetic TRH, and co-migrated with synthetic TRH on Sephadex G-10 and high performance liquid chromatography. In addition, IR-TRH from purified pancreatic extracts was biologically active in that it released thyrotropin and prolactin from rat adenohypophysial cells maintained in monolayer culture. When a total pancreatectomy was performed on the 5th d of life of the rat, mean plasma TRH concentrations were significantly decreased 3 h afterwards (84±9 vs. 63±7 pg/ml, P < 0.05). Neither the TRH concentrations in the brain, hypothalamus, or gastrointestinal tract, nor the pituitary-thyroid axis were affected by the pancreatectomy. However, mean plasma TRH concentrations remained unaltered 3 h after removal of the hypothalamus and extrahypothalamic brain.     

胰腺移植进展

近来 ,随着外科技术的提高、免疫抑制剂的发展 ,胰腺移植的存活率已有很大的提高。目前该手术成为 1型糖尿病终末期的标准治疗方法。现就胰腺移植的方法、适应证、外科技术、并发症以及治疗结果等方面加以综述。