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.     

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，     

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     

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.     

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.     

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).     

褥疮局部治疗进展

对褥疮局部治疗的方法进行了综述。主要介绍了褥疮的物理治疗、中药治疗、西药治疗、综合治疗。     

Use of optical imaging to progress novel therapeutics to the clinic

There is an undisputed need for employment and improvement of robust technology for real-time analyses of therapeutic delivery and responses in clinical translation of gene and cell therapies. Over the past decade, optical imaging has become the in vivo imaging modality of choice for many preclinical laboratories due to its efficiency, practicality and affordability, while more recently, the clinical potential for this technology is becoming apparent. This review provides an update on the current state of the art in in vivo optical imaging and discusses this rapidly improving technology in the context of it representing a translation enabler or indeed a future clinical imaging modality in its own right.     

心血管系统常用药物对新型冠状病毒肺炎感染风险及不良预后的影响

心血管疾病是新型冠状病毒肺炎(新冠肺炎)最为常见的合并症,在新冠肺炎大流行期间降压、降脂、抗血小板、抗凝、降糖及抗心律失常等心血管系统常用药物的安全性和有效性尚未形成统一明确的认识,相关指南也有待进一步完善。随着全球新冠肺炎病例数量的增加和第二波感染的发生,更好地了解这些药物对新冠肺炎患者的影响是当务之急。本文旨在总结心血管系统常用药物对新冠肺炎感染风险以及不良预后的关联,并对合并心血管疾病的新冠肺炎患者用药提出建议。     

序贯疗法、四联疗法及标准三联疗法根除幽门螺杆菌的疗效对比分析

目的对比序贯疗法、四联疗法及标准三联疗法根除幽门螺杆菌(Hp)的疗效。方法选取本院门诊Hp阳性病例105例,随机分为3组,A组采用序贯疗法;B组采用四联疗法;C组采用标准三联疗法。停药4周后复查胃镜、快速尿素酶试验及14C呼气试验,观察慢性胃炎改善、溃疡愈合及Hp根除情况。结果四联疗法与序贯疗法,对Hp阳性的慢性胃炎及消化性溃疡患者的Hp根除率、慢性胃炎改善及溃疡愈合,以及Hp感染复发率方面均显示出良好的疗效,而标准三联疗法显著劣于其他2种方案。3种方案的不良反应发率均较低,且程度轻。结论含泌剂四联疗法与序贯疗法在根除Hp、改善慢性胃炎、促进溃疡愈合以及降低复发率的疗效优于标准三联疗法,且不增加不良反应发生率及程度,可作为Hp感染初治患者的首选方案。     

Pharmacologic therapy for nonvariceal upper gastrointestinal bleeding

There are many clinical outcome measures for evaluation of the effectiveness of a pharmacologic agent in the management of upper gastrointestinal bleeding (UGIB). As a preemptive treatment, it should reduce the need for emergency endoscopy and endoscopic intervention, facilitate the efficient identification of the bleeding source and, hence, shorten procedure time and reduce the risk of procedure-related complications. As an effective adjunctive therapy after endoscopic hemostasis, it should reduce the incidence of recurrent bleeding and the need to repeat endoscopic hemostasis. This article provides an overview of different pharmacologic agents that have been used in the management of UGIB.     

针刺治疗小儿痉挛型脑瘫

探讨针刺疗法对小儿痉挛型脑瘫运动功能恢复的影响。２１６例９个月～３岁痉挛型脑瘫患儿随机分为对照组９４例和治疗组１２２例,均接受功能训练。治疗组再予针刺治疗。２组于治疗前后进行Ｇｅｓｅｌｌ发育商评定。结果：治疗组总的发育商及动作 育商在治疗后显著提高（Ｐ〈０．００１）,与对照组比较,差异有显著性（Ｐ〈０．００１）。提示：针刺结合功能训练能有效的提高痉挛型脑瘫患儿的治疗效果。     

Bobath等疗法对脑瘫患儿的疗效研究

为了研究Bobath等疗法对脑性瘫痪（cerebralpalsy，CP）患儿的疗效，我们对接受上述治疗的95例4个月～5岁CP患儿治疗前、后及随访中的运动功能改变进行量化评价，并以同期年龄相对应的620例作对照。结果表明：CP患儿治疗前的运动功能严重落后，其总分平均为1．28±0．34分／月，治疗后其运动功能显著改善，总分平均为8分／月左右，较治疗前增加5～6倍，较正常儿童的运动发育率亦增加1倍左右，表明PT对CP治疗确实有效，其疗效与开始治疗年龄和病情程度有关。     

Atrial Flutter—Update on the Mechanism and Treatment

Atrial flutter is a common and usually benign but symptomatic supraventricular tachycardia. There is a striking similarity between patients with atrial flutter suggesting a common substrate despite the presence or absence of underlying heart disease. In man, the mechanism is a single reentrant circuit originating in the right atrium whose center appears to be functional within the anatomical constraints of the right atrium. The reentrant circuit of atrial flutter contains an area of slow conduction in the inferior right atrium but the size and exact location is uncertain. Drug therapy directed at terminating and preventing atrial flutter has been available for many years. The efficacy and safety of this therapy is not as well tested as is the same therapy for atrial fibrillation. The most effective way to terminate atrial flutter is a nonpharmacological approach. Several nonpharmacological methods provide new treatment options in the management of patients with drug resistant or hemodynamically unstable atrial flutter. The use of anticoagulation for this disorder is still evolving. There is a risk of clinically apparent thromboemboli in some patients with atrial flutter although the risk appears less than that for atrial fibrillation. In the future, refinements and improvements in therapy for atrial flutter will likely be derived from a better understanding of its mechanism.     

USE AND ABUSE OF NON-VOCAL COMMUNICATION AIDS

Non-vocal communication aids are increasingly popular for use with speechless patients. Unfortunately not all such patients can learn to use them. This paper reviews the types of non-vocal communication aids, describes selected criteria for deciding to provide a patient with an aid, and outlines the therapeutic uses of such aids.     

中医中药治疗不孕症临床体会

目的比较中医中药治疗不孕症的临床疗效并总结治疗体会。方法按照中医辨证和辨病理论对我院2005年1月至2009年7月的86例门诊不孕症患者进行温肾益精、舒肝解郁、燥湿化痰、活血祛瘀为主治疗。结果 86例患者,治愈70例,好转8例,有效率90.70%。不同中医分型的临床疗效差异具有统计学意义(P<0.05)。结论 中医辩证治疗不孕症具良好的临床疗效,具有一定的推广意义。