Co-occurrence of IPMN and malignant IPNB complicated by a pancreatobiliary fistula: A case report and review of the literature

BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB) is pathologically similar to intraductal papillary mucinous neoplasm(IPMN). However, there are several significant differences between them. The rate of IPMN associated with extrapancreatic malignancies has been reported to range from 10%-40%, and it may occasionally be complicated with the presence of fistulas. IPMN associated with malignant IPNB is extremely rare and only nine cases have been reported in the literature.CASE SUMMARY We report a 52-year-old man who presented with recurrent cholangitis for nine months. Computed tomography and magnetic resonance cholangiopancreatography showed the common bile duct stricture with dilated pancreatobiliary duct without other abnormal findings. The underlying pathogenesis could not be identified based on the radiologic images. Endoscopic retrograde cholangiopancreatography revealed a pancreatobiliary fistula with dilated main pancreatic duct, biliary stricture with dilated biliary tree, and mucus discharge from the enlarged orifice of the major papilla. The patient underwent SpyGlass cholangiopancreatoscopy due to a suspected mucin-producing biliary neoplasm and indeterminate main pancreatic duct dilatation. Multiple papillary growing neoplasms with vascular images, with the extent of lesions spreading in the biliopancreatic ductal lumens, were identified by SpyGlass. In addition, the presence of a pancreatobiliary fistula was also identified. The patient was diagnosed as having benign IPMN and malignant IPNB with focal invasion by postoperative pathology. Furthermore, varying histological subtypes were present in both IPMN and IPNB. Pylorus-preserving pancreaticoduodenectomy was performed on the patient with excellent results during the 52 month followup period.CONCLUSION We deemed that pancreatography and SpyGlass allowed for an efficient diagnosis of IPMN with pancreatobiliary fistula, whereas the etiology could not be identified by radiologic imaging.     

多功能病号服在临床中的应用

病人在医院接受治疗时,往往在需要暴露局部治疗部位时,必需脱去整件衣、裤,由于春季、秋季、冬季室内温度低于体温,使病人易着凉、感冒,诱发其他并发症等,引起身体的不适.局部肿瘤放疗病人,指导放疗病人和家属将放疗局部的内衣剪开,露出局部皮肤进行治疗,这样不影响治疗,还可保暖,但这一方法还有待改进.另外住院病人的病号服颜色单调,款式单一,功能缺乏,根本不能满足住院病人的身心及治疗的需要.因此,近几年,通过大量的研究和临床实践,设计出多功能病号服,获国家实用型专利.现将其介绍如下.     

手术室与供应室一体化运作中手术器械的管理

我院为一家拥有800张床位的综合性医院,年手术量1万多例,有一个现代化的供应室,由于手术器械从手术室到供应室环节多,很容易出现手术器械丢失或无菌手术器械不能及时供应而延误手术的现象.为达到资源共享,我院于2003年6月实行手术室与供应室一体化运作,经过4年尝试,在工作中不断总结经验,形成了一定的管理模式,取得满意结果.     

介绍一种眼科点眼药盘

眼科工作中给病人点眼药是主要治疗方法之一,一般是多种眼药水放在一个药盘或药框中,眼药水品种繁多,且眼药水瓶东倒西歪摆放没有规律,甚至会出现作用相反的眼药水(膏)拿错的现象,如缩瞳类和散瞳类就是两个作用完全相反的眼药.因此,使用时往往需要仔细寻找或凭经验才能快速找到所需的眼药,如果使用不当就会给病人造成严重的后果.为减少不良后果的发生,在临床实践中,我们制作了一种简易、方便使用的点眼药盘.现介绍如下.     

1例脐尿管漏合并妊娠的护理

脐尿管瘘是一种膀胱畸形疾病,男性多见.临床表现为脐部漏尿,漏尿程度视瘘管的大小而定,脐部漏口为皮肤或黏膜所覆盖.静脉注射靛胭脂或从尿道导管将亚甲蓝注入膀胱,可见染色尿液自脐部漏出,故可诊断[1].     

ICU护士了解自由基和抗氧化剂的重要性

对自由基和抗氧化剂的基本知识,自由基在ICU常见疾病发生发展中的作用以及抗氧剂的临床应用四方面内容进行综述,提示了ICU护士了解这四方面内容是临床实践的组成部分.     

类风湿关节炎、高热、黑便、血三系减少

1病例介绍患者女,67岁。因"发热半个月,黑便1d"于2006年6月9日入院。患者半个月前起发热,多次测得体温≥39.0℃,无寒战,无咳嗽、咳痰,无腹痛、腹泻,无尿急、尿痛,无腰痛、咽痛,当地医院予抗生素、激素治疗体温反复,昨日起解黑便,共2次,伴头晕,晕厥1次,无呕血,为进一步诊治转入本院。既往类风湿关节炎     

代谢综合征的疗养护理

代谢综合征又称代谢异常心血管综合征，它是一组心血管疾病危险因素的聚集和组合，包括高血压、高血脂（血脂异常）、高血糖（糖尿病、血糖调节受损、糖耐量异常）、肥胖、吸烟、炎症、血凝增强、纤溶降低等。心血管疾病是人类头号杀手，给社会和家庭带来了沉重的经济负担。对于心血管疾病这种新的流行病学表现，     

Clinical effects of apatinib mesylate for treatment of multiple brain micrometastases:Two case reports

BACKGROUND Apatinib is a small-molecule multitargeted tyrosine kinase inhibitor.Apatinib has demonstrated encouraging antitumor activities.This study aimed to observe the efficacy and safety of apatinib for the treatment of multiple brain micrometastases.CASE SUMMARY We report two patients with multiple brain micrometastases after failure of second-line treatment.Both patients had extracerebral metastases.When the patients took 250 mg/d apatinib orally,the intracerebral lesions disappeared.The extracerebral lesions were partially alleviated.Both patients had a progressionfree survival of more than 12 mo and were still stable.The safety was good.The main adverse events(AEs)were mild hypertension and proteinuria,which could be controlled.CONCLUSION Apatinib has clear efficacy and good tolerance in patients with multiple brain micrometastases after failure of second-line treatment.     

青霉素的发现及应用

青霉素能杀灭各种病菌,却对人体几乎没有毒性,因此是迄今为止在临床上应用最为广泛的抗生素.历史上,它的发现及应用与3个人密不可分.他们分别是亚历山大·弗莱明(Alexander Fleming)、霍华德·弗洛里(Howard Florey).恩斯特·钱恩(Ernst Chain).     

Renal colic: A diagnostic and therapeutic review

Renal colic is a common presenting problem in emergency departments where the focus of treatment is on prompt analgesia, limited supportive investigations and exclusion of other serious disorders. This review gives an overview of the pathophysiology of this condition and those aspects of its care that are specific to the emergency department. The role of narcotics and non-steroidal anti-inflammatory drugs in treatment is examined, and the available imaging techniques are described and evaluated. Alternative diagnoses and indications for hospital admission are discussed.     

慢性肾病的彩色多普勒研究

以彩色多普勒检测３８例慢性肾病患者（７６只肾）和３２例正常对照者（６４只肾）的肾门动脉，叶段动脉，叶间动脉的最大流速和最小流速以及阻力指数，结果发现肾门动脉、叶段动脉及叶间动脉最大流速（Ｖｍａｘ），最小流速（Ｖｍｉｎ），均低于正常对照组（Ｐ＜０．００１），肾门动脉、叶段动脉和叶间动脉阻力指数高于对照组（Ｐ＜０．００５）。同时用二维测量肾脏大小，发现肾脏大小和肾内各段动脉阻力指数呈负相关，与肾内各段动脉最大流速呈正相关。     

Spontaneous renal tract rupture from obstructing vesico‐ureteric junction calculus

Spontaneous or non‐traumatic rupture of the renal tract is an infrequent presentation, and it is most frequently caused by ureteric obstruction. Rupture could occur at any level of the upper urinary tract. However, it is most common at the renal calyces and complications that could arise include; urinoma, and or hematoma collection which could progress to abscess formation and sepsis. We report a 77‐year‐old male patient who attended the emergency department following referral from his general practitioner with a 6‐day history of progressively worsening left sided abdominal pain. Due to his co‐morbidities, presenting blood pressure and age, he was suspected of having an aortic dissection or ruptured abdominal aortic aneurysm and subsequently had a CT (computed tomography) Angiogram. This showed extravasation of contrast from the left kidney with a 12 mm obstructing vesico‐ureteric junction calculus necessitating urgent urology referral and prompt review. He was worked up for a ureteric double J stent insertion, however, the procedure was unsuccessful due to complex multiple urethral strictures. The patient subsequently had a nephrostomy inserted and was planned for optical urethrotomy, rigid cystoscopy, rigid/flexible ureteroscopy, and laser stone fragmentation of left obstructing vesico‐ureteric junction calculus.     

肾脏病理结合肾功能显像评价慢性肾病残余肾功能的临床意义

目的探讨肾脏病理结合肾功能显像综合评价慢性肾病(CKD)残余肾功能的临床意义。方法 105例临床初步诊断为慢性肾炎伴慢性肾功能不全患者,同时进行经皮肾穿刺活组织检查及99 Tcm-DTPA肾动态显像(ECT)检查,对CKD残余肾功能进行综合评价,并确定治疗方案,动态观察CKD进展情况,回顾性验证两种检查方法对CKD残余肾功能判断的可靠性。结果 105例CKD患者中,肾脏病理显示肾小球硬化及肾小管间质慢性化程度,多数情况下(92%)与ECT对于CKD残余肾功能的判断是相符的,但8%的患者二者并不相符。根据形态学及功能学检查结果,所有2～5期的CKD患者共105例进行相应的治疗,随访2～3年,共35例进入透析。结论 对于各种CKD的诊断除病因诊断外,肾组织病理形态学诊断及肾脏功能诊断两者间既不能相互替代,又密不可分。仅根据CKD肾脏组织病理形态学判断CKD残余肾功能具有局限性。结合肾功能显像进行综合评价,正确评估保护CKD残余肾功能的治疗价值,对CKD治疗方案的确定具有重要临床指导意义。     

Benign essential tremor

Exposure to air pollution or a case of the common cold, which means little to a person with normal lung function, can be very serious to a patient with chronic obstructive pulmonary disease. It is helpful for primary care and emergency department physicians to know how to assess the severity of acute exacerbations and how to arrest deterioration of respiratory function. Dr Hagedorn describes pharmacologic treatment as well as mechanical ventilation in these patients.     

High venous pressure in the main renal vein causing development of peritransplant venous collaterals in renal transplant patients: a rare finding

We will show the sonographic appearance of peritransplant venous collaterals in renal transplants with renal venous hypertension. Three cases of renal transplants with pericapsular vessels were identified at our institution. Two cases were related to renal vein thrombosis. The third case had pericapsular vessels secondary to venous hypertension from arterialization of the transplant renal vein by a preexisting right thigh arteriovenous graft. The development of high venous pressures in renal transplants leading to the collaterals' venous drainage has been rarely described. This finding should be recognized as a rare complication of renal transplants but does not necessarily lead to transplant failure.     

Sonographic mimics of renal calculi.

OBJECTIVES: To review sonographic findings that can mimic renal calculi. METHODS: We comment on a number of echoes that can mimic renal calculi. RESULTS: There are a number of sonographic renal artifacts, vascular and nonvascular, that may confound a correct diagnosis. CONCLUSIONS: Awareness of these potential artifacts will result in a more specific sonographic examination and will accurately guide the referring physician toward appropriate patient treatment. The importance of other imaging modalities is also emphasized to ensure that a correct diagnosis is obtained whenever the sonographic findings are inconclusive.     

Autosomic dominant polycystic kidney disease and metformin: Old knowledge and new insights on retarding progression of chronic kidney disease

Autosomal dominant polycystic kidney disease (ADPKD) is the most common congenital kidney disorder, generally caused by mutations in the PKD1 and PKD2 genes, coding for polycystins 1 and 2. Its pathogenesis is accompanied by alterations of the cAMP, mTOR, MAPK/ERK, and JAK/STAT pathways. ADPKD is clinically characterized by the formation of many growing cysts with kidney enlargement and a progressive damage to the parenchyma, up to its complete loss of function, and the onset of end-stage renal disease (ESRD). The current aim of ADPKD therapy is the inhibition of cyst development and retardation of chronic kidney disease progression. Several drugs have been recently included as potential therapies for ADPKD including metformin, the drug of choice for the treatment of type 2 diabetes mellitus, according to its potential inhibitory effects on cystogenesis. In this review, we summarize preclinical and clinical evidence endorsing or rejecting metformin administration in ADPKD evolution and pathological mechanisms. We explored the biology of APDKD and the role of metformin in slowing down cystogenesis searching PubMed and Clinical Trials to identify relevant data from the database inception to December 2020. From our research analysis, evidence for metformin as emerging cure for ADPKD mainly arise from preclinical studies. In fact, clinical studies are still scanty and stronger evidence is awaited. Its effects are likely mediated by inhibition of the ERK pathway and increase of AMPK levels, which are both linked to ADPKD pathogenesis.     

Challenges and Considerations When Using Shear Wave Elastography to Evaluate the Transplanted Kidney,With Pictorial Review

The gold standard in evaluating renal allograft dysfunction has traditionally been renal biopsy. However, not only does biopsy come with inherent risks, the time frame from biopsy to detecting renal dysfunction is often inefficient. It is therefore advantageous to have a noninvasive, low‐cost, time‐saving method, such as shear wave elastography (SWE), to detect fibrosis early, to maximize immunosuppressive care. It is important to consider factors that affect tissue stiffness in the kidney, as well as the challenges incurred when using SWE in this anisotropic organ, in order to select the most appropriate patients for this exam.     

移植肾动脉狭窄介入治疗的彩色多普勒超声评价

目的：探讨彩色多普勒血流显像技术（CDFI）评估移植肾动脉狭窄经皮血管成形术（PTRA）和支架植入术（PTRAS）疗效的应用价值。方法：对11例移植肾肾动脉狭窄者于介入治疗前、后行CDFI检查并每隔3－4个月随访复查,取多普勒参数肾内段动脉血流加速度（Ac)和主肾动脉峰速度（Vp)进行统计学分析。结果：介入治疗后Ac显著增加,Vp明显减低,治疗前后差异有显著性意义（P＜0．01）。植入的支架呈并行相间的线样回声,支架出、入口血流速度最高,依次大于支架内、大于支架外流速。术后并发症包括支架脱落、假性动脉瘤、静脉血栓和再狭窄,均经CDFI准确诊断从而得以及时处理。结论：CDFI检查是评价移植肾动脉狭窄介入治疗近、远期疗效和诊断并发症的理想、可靠方法。