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Xu Ren Chun-Lan Zhu Xu-Fu Qin Hong Jiang Tian Xia Yong-Ping Qu 《World Journal of Clinical Cases》2019,7(1):102-108
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. 相似文献
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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, 相似文献
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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 相似文献
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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]. 相似文献
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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. 相似文献
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Jun-Hui Guo Yuan-Yuan Wang Jiang-Wei Zhang Pei-Min Liu Yan-Jun Hao Hai-Rui Duan 《World Journal of Clinical Cases》2020,8(7):1326-1336
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. 相似文献
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目的分析非酒精性脂肪肝肝纤维化评分(NAFLDFS)与非酒精性脂肪肝(NAFLD)及胰岛素抵抗(瓜)的相关性。方法以来自江苏徐州地区的2622例健康体检人群为研究对象,检测受试者的血清谷丙转氨酶(“r),谷草转氨酶(AsT),血小板计数(PLT),血清白蛋白(ALB),空腹血糖(FBG),餐后2h血糖(PBG),空腹胰岛素(Fins)等相关生化指标,计算出NAFLDFS及胰岛素抵抗指数(HOMA2-IR),将研究对象按非酒精性脂肪肝纤维化评分的低诊断阈值(~1.455)及高诊断阈值(0.676)分成三组,A1组:NAFLDFS〈-1.455;A2组:0.676≥NAFLDFS≥-1.455和A3组NAFLDFS〉0.676。Pearson分析肝纤维化评分与各指标相关性;运用二元Logistic回归计算NAFLDFS与NAFLD、IR的风险性。结果随着NAFLDFS值增高,年龄(Age)、体重(Weight)、体重指数(BMI)、腰围(wc)、臀围(Hip)、糖化血红蛋白(HbAlc)、颈围(NC)、FBG、PBG、Fins、收缩压(SBP)、舒张压(DBP)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)水平逐渐增高,且三组问的差异有统计学意义;而ALT、AST、PLT、ALB、高密度脂蛋白(HDL.c)随着NAFLDFS值的增高而减小。Pearson分析显示Age、NC、WC、Hip、Weight、BMI、HbAlc、FBG、PBG、PLT与NAFLDFS正相关。随着NAFLDFS值的增加,NAFLD与取的患病风险(OR)也增加。NAFLD的患病风险由1.22(OR=1.22)增加到1.79(OR=1.79):IR的患病风险由1.13(OR=1.13)增加到1.91(OR=1.91);进一步校正性别及年龄后,NAFLD的患病风险由1.15(OR=1.15)增加到1.53(OR=1.53);IR的患病风险由1.15(OR=1.15)增加到2.02(OR=2.02)。结论NAFLDFS与NAFLDF及瓜密切相关,在临床上可将其作为简易评价NAFLD及IR的指标。 相似文献
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目的 通过观察应用终末期肝病模型 (MELD)对人工肝治疗终末期肝病预后的预测作用 ,探讨其在临床的应用价值及人工肝支持系统在终末期肝病治疗中的效果。方法 43例患者随机分为治疗组与对照组 ,对其进行MELD评分 ,并对治疗组进行人工肝后评分 ,观察 3个月后的死亡率。结果 治疗组中 4例治疗前MELD评分大于 40分者 ,3个月死亡率为 10 0 %,17例治疗前评分 30~ 40分者 3个月死亡率为 5 3%,对照组中 6例MELD评分大于 40分者 ,3个月死亡率为 10 0 %,16例治疗前评分 30~ 40分者 3个月死亡率为87%,与治疗组相比P <0 .0 5。结论 MELD评分可以引入临床推广应用 ,人工肝治疗MELD评分在 30~ 40分的终末期肝病是安全有效的。 相似文献
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Adrenal-exhaustion syndrome in patients with liver disease 总被引:2,自引:2,他引:0
Marik PE 《Intensive care medicine》2006,32(2):275-280
Objective Adrenal failure is emerging as an important cause of excess morbidity and mortality in critically ill patients. We have recently
reported the high incidence of adrenal failure in patients with liver disease, the so called “hepato-adrenal syndrome.” It
has been noted that patients who on initial testing may have “normal” adrenal function subsequently progress to overt adrenal
failure, the adrenal-exhaustion syndrome. The goal of this study was to further characterize this syndrome.
Design Retrospective review of the “Hepatic Cortisol Research and Adrenal Pathophysiology Study” database.
Setting Liver transplant ICU of a tertiary care university hospital.
Patients and methods Patients who on initial testing had “normal” adrenal function were followed, and adrenal function testing was repeated in
those who failed to improve. The patients were grouped as follows: (1) patients who developed adrenal failure on follow-up
testing; and (2) patients who had normal adrenal function during their ICU stay. The incidence and risk factors for the development
of adrenal-exhaustion syndrome were determined.
Measurements and results The study cohort consisted of 221 patients, of whom 120 (54%) were diagnosed with adrenal insufficiency on initial diagnostic
testing and were excluded from further analysis. The remaining 101 patients comprised those who made up the group of interest.
On follow-up, 16 (16%) of these developed adrenal failure a mean of 3 days after initial testing. The only factor that predicted
the development of adrenal-exhaustion syndrome was a low HDL level (p < 0.001).
Conclusion This study demonstrates that adrenal failure is a dynamic process and that repeat adrenal function testing is indicated in
patients who remain hemodynamically unstable or fail to improve with aggressive supportive treatment. Low HDL levels may be
pathogenetically linked to the development of adrenal failure.
The author has no financial interest in any of the products mentioned in this paper. 相似文献
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M Guslandi 《The Journal of international medical research》1990,18(6):497-505
Evidence is accumulating that ursodeoxycholic acid (UDCA), an agent widely employed for gallstone dissolution, exerts therapeutic effects in chronic liver disease. UDCA is thought to act mainly by reducing the detergent properties of bile, making it less toxic for the liver cells. Confirming the results of preliminary observations double-blind, placebo-controlled trials have shown that UDCA significantly decreased serum concentrations of liver enzymes such as alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and gamma-glutamyl transferase in primary biliary cirrhosis and other cholestatic conditions, as well as in chronic active hepatitis. A substantial improvement in liver histology has also been detected in UDCA-treated patients with primary biliary cirrhosis. The effect of UDCA in chronic hepatitis is currently a matter of investigation. 相似文献
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Surgery in the patient with liver disease 总被引:3,自引:0,他引:3
This article deals with the effects of anesthesia and surgery on the healthy and diseased liver and the preoperative assessment of patients with liver disease. Emphasis is placed on estimating surgical risk. Guidelines for optimal preoperative preparation are discussed. 相似文献
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Peptic ulcer disease complicated with liver cirrhosis 总被引:2,自引:0,他引:2
A microcirculatory disorder and alterations of humoral factor are important in gastric mucosal lesion formation with liver cirrhosis, and degradation of a defense factor is important in ex-ulceration in the gastric mucosa. In terms of H. pylori infection, the liver cirrhosis which I sanitized when I think about consequence may be to be good. It is important that degradation of a gastric mucosal defense by liver cirrhosis itself, gastric mucosal atrophy might greatly affect the ulcerogenic mechanism in the stomach. 相似文献