Diffuse calcification in gastric cancer

The progressive expansion of calcification into the wall of the stomach and peritoneal metastatic foci was observed in a 31-year-old female with Borrmann type 4 calcified advanced gastric cancer. Despite treatment with systemic lentinan, uracil tegaful and mitomycin C, together with intraperitoneal injections of mitomycin C, OK-432 and prednisolone, the patient died 27 months after first presentation. The case provided a useful means of studying the mechanism of calcification.     

Fulminant type 1 diabetes mellitus with remarkable elevation of serum pancreatic enzymes

Fulminant type 1 diabetes mellitus progresses extremely rapidly and is accompanied by ketoacidosis. Patients with the disease present at emergency departments with non-specific symptoms, including fever, nausea, vomiting, and abdominal pain. Here, we present a case of fulminant type 1 diabetes mellitus where the patient was initially misdiagnosed with gastroenteritis and acute pancreatitis. A 50-year-old Japanese woman was referred to our hospital with coma and shock. She had presented with nausea, vomiting, abdominal pain and thirst from 5?days before admission, and had been misdiagnosed with gastroenteritis by her primary care physician. Upon examination, metabolic acidosis and remarkable elevation of pancreatic exocrine enzymes were found (amylase 4322?IU/L, lipase 1046?IU/L). Acute pancreatitis was initially suspected because of the high pancreatic enzyme levels and abdominal pain. However, her plasma glucose level was markedly elevated at 1357?mg/dL. The patient was diagnosed with fulminant type 1 diabetes mellitus. Computed tomography showed no radiological evidence of acute pancreatitis. In conclusion, fulminant type 1 diabetes mellitus is often referred to hospital with flu-like or gastrointestinal symptoms and elevation of serum pancreatic enzymes. Physicians must be sure not to misdiagnose it as gastroenteritis or acute pancreatitis.     

Diffuse calcification of a nonfunctioning kidney allograft

Diffuse calcification of nonfunctioning kidney graft may rarely occur in clinical practice, and it is generally benign and does not require transplant removal in most cases.     

1型糖尿病患者胰腺体积和胰腺脂肪含量的相关性研究

目的:探讨1型糖尿病(Type 1 diabetes mellitus,T1DM)患者胰腺体积(PV)和胰腺脂肪含量(PFC)的相关因素.方法:回顾性研究我院T1DM患者,将92例患者按照患病时间分为A、B、C3组.A组:＜60月,51例;B组:60～＜120月,20例;C组:≥120月,21例.分析各组患者PV、胰腺内脂肪体积(PFV)、PFC、腹部脂肪含量(TA)、腹腔脂肪含量(VA)、腹壁脂肪含量(SA)、VA/SA、体质量指数(BMI)、患病时间(月)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)、血压(收缩压和舒张压)、血糖(OGTT空腹、餐后2h)、胰岛素(空腹、1h、2h、3h),C肽(空腹、1h、2h、3h)和糖化血红蛋白(HbA1c)等相关实验室检查数据之间差异和相关性.结果:A～C三组间,年龄、TG、空腹C肽、1hC肽、PFV和PFC的均值差异具有显著性,P＜0.05.A组与B组间空腹C肽和PV,A组与C组间年龄、空腹C肽、1hC肽、TG、PFV、PFC和VA,B组与C组间TG、PFV和PFC两两比较均值差异有显著性,P＜0.05.相关性分析方面:PV与年龄、C肽和患病时间不相关.PFV与VA和HDL-C值呈正相关.PFC与VA和患病时间正相关.C肽与年龄负相关、与BMI正相关.结论:T1DM患者PV和PFC的变化有其自身特点,PV与胰腺外分泌功能不相关,患病5年以上PV减小,5～10年以后体积减小不明显,这与C肽值变化同步;随患病时间延长PFC逐渐增多,患病10年以上增多明显,这与TG变化同步;PFC与VA和HDL-C相关,PFC变化早于VA变化;C肽与年龄和BMI等相关.与2型糖尿病中PFC与胰岛素抵抗相关不同,推测T1DM中PFC增加可能与稳定胰岛细胞功能相关,这点需要进一步证实.     

1型糖尿病胰岛自身抗体与胰岛功能的关系

目的分析不同种类、不同数量胰岛自身抗体阳性的1型糖尿病(T1DM)患者临床特征及胰岛功能。方法收集患者一般信息,行标准馒头餐试验(MMTT)、酶联免疫吸附试验(ELISA)检测胰岛细胞抗体(ICA)、胰岛素抗体(IAA)、谷氨酸脱羧酶抗体(GADA)和蛋白酪氨酸磷酸酶抗体(IA-2A),用SPSS 22.0软件对不同胰岛自身抗体阳性患者的临床特征及胰岛功能进行分析。结果 (1)本试验共纳入T1DM患者572例(男322例,女250例),平均年龄36岁(4~84岁)。四种胰岛自身抗体的阳性率分别为GADA 57%(326/572),IA-2A 27.4%(157/572),ICA18.4%(105/572),IAA 23.3%(13/572),且GADA阳性率显著高于其他三种抗体(P<0.05)。(2)联合检测GADA、ICA、IA-2A三种抗体,抗体阳性数目越多,BMI越小,病程越短,糖化血红蛋白越高,空腹及餐后120 min C肽越低,C肽曲线下面积(AUC)越小,各组间差异均存在统计学意义(P<0.05)。(3)空腹C肽在单一IA-2A阳性组最低,餐后120 min C肽、AUC在单一ICA阳性组最低,但三个单一抗体阳性组间差异无统计学意义(P>0.05);病程、年龄及BMI在IA-2A阳性组最低,三个单一抗体阳性组差异无统计学意义(P>0.05)。(4)GADA+IA-2A双阳性组空腹及餐后120 min C肽、AUC均最低,年龄、病程、BMI较低,与抗体阴性组差异有统计学意义,但与GADA+ICA阳性及ICA+IA-2A阳性组差异无统计学意义(P>0.05)。结论抗体阳性数目越多,病程越短,胰岛功能越差;单独或合并不同抗体阳性的患者临床特征和胰岛功能分析对临床早期干预有指导意义。     

Serum trypsin concentration and pancreatic trypsin secretion in insulin-dependent diabetes mellitus

Fasting serum trypsin concentration and pancreatic trypsin output, stimulated by secretin and cholecystokinin-pancreozymin, were measured in 18 patients with insulin-dependent diabetes, to assess a possible correlation between these two indices of exocrine pancreatic function. Serum trypsin concentration was subnormal in 13, and pancreatic trypsin output was decreased in 14 patients, but there was no significant correlation between the two measurements. There was no correlation between serum trypsin and residual beta cell function measured by plasma C-peptide immunoreactivity (CPR). After an interval of four years serum trypsin measurements were repeated in 11 subjects. All individual trypsin levels were lower than the previous results, the difference being highly significant (t = 9.0; p < 0.001). Serum trypsin concentration therefore represents a qualitative index of reduced exocrine pancreatic function in diabetes, but has no value in quantitating the degree of deficiency.     

MSCT三维测量对2型糖尿病胰腺体积变化的研究

目的用多层螺旋CT(MSCT)薄层扫描三维测量方法观察2型糖尿病(T2DM)患者胰腺体积(PV)、胰体比(PVI)的变化,以期为T2DM的临床研究提供有价值的信息。方法采用回顾性研究方法,收集2017年5月至2018年6月在南京中医药大学附属医院住院并经临床诊断为T2DM患者96例为T2DM组,收集同期相同年龄段在消化内镜科、肛肠科及泌尿外科住院排除糖尿病和胰腺疾病且符合纳入、排除标准的患者167例作为正常对照组。采用MSCT腹部平扫+增强扫描,三维PV测量方法,薄层重建图像层厚取1 mm,测量两组对象的PV、计算PV与体表面积的比值即胰体比(PVI),并进行比较,以了解T2DM患者的PV、PVI变化情况。结果正常对照组中,男性的PV[(80. 85±15. 27) cm^3vs (64. 09±14. 43) cm^3,P=0. 000]和PVI[(42. 75±6. 90) cm^3/m^2vs (38. 23±7. 37) cm^3/m^2,P=0. 000]分别大于女性;T2DM组中,男性的PV大于女性[(65. 76±13. 50) cm^3vs (57. 61±16. 89) cm^3,P=0. 010],男性的PVI与女性相近[(34. 13±6. 50) cm^3/m^2vs(33. 34±8. 17) cm^3/m^2,P=0. 615];正常对照组男性和女性的PV、PVI均大于相同性别T2DM患者(P <0. 05,P <0. 01)。用PVI判别研究对象是否为T2DM,在男性,当阈值取39. 89 cm^3/m^2,其ROC曲线下面积(AUC)为0. 819,敏感度和特异度为65. 2%和88. 7%;在女性,当阈值取31. 87 cm^3/m^2,其AUC为0. 677,敏感度和特异度为84. 0%和48. 8%。结论用MSCT薄层扫描进行三维PV测量能很好应用于人体的PV评估;T2DM男、女性患者的PV、PVI均较同性别正常对照组明显下降,且T2DM患者男性的PVI下降幅度大于女性,提示当人体PVI下降到一定程度时,T2DM患病风险会显著增加。影像学检查能否在早期发现T2DM患者胰腺的病理变化、进而为T2DM的临床研究提供更多有效信息,有待进行更深入的探讨。     

The child with diabetes mellitus

Parents, other family members, and health care professionals play an important role in the life of a child who has diabetes. The parents especially are constantly called upon to help make judgments regarding a child's diabetes management. As a child gets older, parents do not make as many of these judgments directly but are available to help the child make his own judgments. Even when a child starts to gain more independence and take over more aspects of his diabetes management, the need for ever-present support is still there. It may not be apparent at times but parents, other family members, and health care professionals must remember that the support is always needed.