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.     

游泳治疗新生儿毒性红斑效果观察

[目的]探讨游泳对新生儿毒性红斑的治疗作用.[方法]将192例发生毒性红斑的新生儿随机分为观察组和对照组,各96例.两组新生儿每日常规用38℃～40℃温水沐浴1次,洗浴后用干净毛巾擦干,用75%乙醇消毒脐部,适当包裹.观察纽除此之外从发生毒性红斑第1天起由具有水疗资格的护士帮助新生儿游泳,严格控制室温在26℃～28℃,水温在37℃～38℃,在喂奶1h后进行,每天2次,每次10 min～15 rain.[结果]观察组新生儿毒性红斑消退明显早于对照组,脓疱疮发生率低于对照组.[结论]游泳可促进新生儿毒性红斑的消退.     

Complex liver retransplantation to treat graft loss due to long-term biliary tract complication after liver transplantation: A case report

BACKGROUND Loss of graft function after liver transplantation(LT) inevitably requires liver retransplant. Retransplantation of the liver(Re LT) remains controversial because of inferior outcomes compared with the primary orthotopic LT(OLT).Meanwhile, if accompanied by vascular complications such as arterial and portal vein(PV) stenosis or thrombosis, it will increase difficulties of surgery. We hereby introduce our center’s experience in Re LT through a complicated case of ReLT.CASE SUMMARY We report a patient who suffered from hepatitis B-associated cirrhosis and underwent LT in December 2012. Early postoperative recovery was uneventful.Four months after LT, the patient’s bilirubin increased significantly and he was diagnosed with an ischemic-type biliary lesion caused by hepatic artery occlusion. The patient underwent percutaneous transhepatic cholangial drainage and repeatedly replaced intrahepatic biliary drainage tube regularly for 5 years.The patient developed progressive deterioration of liver function and underwent liver re-transplant in January 2019. The operation was performed in a classic OLT manner without venous bypass. Both the hepatic artery and PV were occluded and could not be used for anastomosis. The donor PV was anastomosed with the recipient’s left renal vein. The donor hepatic artery was connected to the recipient’s abdominal aorta. The bile duct reconstruction was performed in an end-to-end manner. The postoperative process was very uneventful and the patient was discharged 1 mo after retransplantation.CONCLUSION With the development of surgical techniques, portal thrombosis and arterial occlusion are no longer contraindications for ReLT.     

Fear can be more harmful than the severe acute respiratory syndrome coronavirus 2 in controlling the corona virus disease 2019 epidemic

The current corona virus disease 2019 outbreak caused by severe acute respiratory syndrome coronavirus 2 started in Wuhan,China in December 2019 and has put the world on alert.To safeguard Chinese citizens and to strengthen global health security,China has made great efforts to control the epidemic.Many in the global community have joined China to limit the epidemic.However,discrimination and prejudice driven by fear or misinformation have been flowing globally,superseding evidence and jeopardizing the anti-severe acute respiratory syndrome coronavirus 2 efforts.We analyze this phenomenon and its underlying causes and suggest practical solutions.     

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     

2型糖尿病患者颈动脉粥样硬化程度与血清ADAM10水平的相关性

目的探讨2型糖尿病(T2DM)患者血清解整合素-金属蛋白酶10(ADAM10)水平与颈动脉粥样硬化分级的相关性,并探究T2DM并发动脉粥样硬化的危险因素。方法采用回顾性研究方法,选取昆明医科大学第一附属医院2017年9月至2018年6月收治的T2DM患者87例,根据颈部血管彩超检查结果分为3组,即无动脉粥样硬化组(n=25)、动脉内-中膜厚度(IMT)增厚组(n=14)、粥样斑块形成组(n=48),比较各组间血清ADAM10水平,采用Logistic回归分析动脉粥样硬化危险因素;根据颈部血管情况分为无动脉粥样硬化组(n=25)及动脉粥样硬化组(n=62),使用受试者工作特征曲线(ROC)分析血清ADAM10水平的诊断价值。结果依颈动脉粥样硬化程度进展(无动脉粥样硬化组→动脉IMT增厚组→粥样斑块形成组),血清ADAM10水平有递升趋势[(1676.12±736.42)pg/ml→(1835.00±798.79)pg/ml→(2016.77±787.63)pg/ml,但差异无统计学意义(P>0.05)。Logistic回归分析显示,糖尿病病程延长、增龄、收缩压升高、血清ADAM10水平增加是T2DM患者动脉粥样硬化加重的危险因素。血清ADAM10水平预测T2DM并发颈动脉粥样硬化的ROC曲线下面积(AUC)为0.612(95%CI:0.480,0.743),最佳截断值为1426.50 pg/ml,灵敏度为0.82,特异度为0.44。结论糖尿病病程延长、增龄、收缩压升高、血清ADAM10水平升高是T2DM颈动脉粥样硬化加重的危险因素。血清ADAM10升高对T2DM并发颈动脉粥样硬化可能具有警示作用。     

2型糖尿病患者IL-18基因启动子区-607C/A和-137G/C位点多态性与颈动脉粥样硬化的相关性研究

目的　探讨2型糖尿病(type 2 diabetes mellitus, T2DM)患者IL-18基因启动子区-607C/A和-137G/C位点多态性与颈动脉粥样硬化(carotid atherosclerosis, CAS)的相关性研究。方法　收集2018年1月~2019年12月宝鸡市中心医院收治的375例T2DM患者为研究对象并记为T2DM组,另选择同期该院体检健康的200例志愿者作为对照组,T2DM组患者再根据颈部血管超声结果分为颈动脉内-中膜厚度(carotid intima-media thickness, CIMT)正常组(n=122)和CIMT增厚组(n=253)。采用聚合酶链式反应(polymerase chain reaction, PCR)法检测IL-18基因启动子区-607C/A和-137G/C位点基因型。分别比较各组两位点基因型和等位基因型的分布频率。采用Logistic回归分析法分析T2DM患者CIMT增厚的独立危险因素。结果　对照组和T2DM组的BMI,CIMT和高血压差异具有统计学意义(t=5.270,Z=16.038,χ2=6.261,P＜0.05),两组吸烟和血脂异常的差异无统计学意义 (χ2=0.800,1.991,均P＞0.05)。CIMT正常组和CIMT增厚组在吸烟、CIMT,糖尿病病程方面的差异具有统计学意义 (χ2=5.302,Z=15.694,12.057,均P＜0.05),两组BMI,高血压和血脂异常的差异无统计学意义 (χ2=0.567,0.741,3.133,均P＞0.05)。对照组和T2DM组IL-18基因启动子区-607C/A和-137G/C位点基因型和等位基因型分布频率的差异无统计学意义(χ2=1.654,4.939,1.742,2.812,均P＞0.05)。CIMT正常组和CIMT增厚组IL-18基因启动子区-607C/A和-137G/C位点基因型和等位基因型分布频率的差异均具有统计学意义(χ2=11.410,11.957,均P＜0.05),两组-137G/C位点基因型和等位基因型分布频率的差异均无统计学意义(χ2=3.696,2.931,均P＞0.05)。采用Logistic回归分析法结果显示糖尿病病程和-607C/A(CC vs CA+AA)基因型是T2DM患者CIMT增厚的独立危险因素。结论　T2DM患者中IL-18基因启动子区-607C/A位点多态性与CAS密切相关。     

2型糖尿病患者糖化血红蛋白与颈动脉内-中膜层厚度的关系:Logistic及单核细胞中介效应检验

目的 研究2型糖尿病(T2DM)患者糖化血红蛋白(HbA1c)与颈动脉内-中膜层厚度(carotid inti-ma-media thickness,CIMT)的关系及单核细胞在HbA1c与CIMT间的中介作用.方法 选择2014年至2019年于华东疗养院体检的T2DM患者1 539例,根据CIMT的厚度分为正常组80...     

初诊2型糖尿病患者血清抵抗素与颈动脉内中膜厚度的关系

目的 探讨初诊2型糖尿病(T2DM)患者血清抵抗素水平与颈动脉内中膜厚度(CIMT)的关系.方法 选取新诊断的T2DM患者共122例,根据CIMT分为两组:CIMT正常组(CIMT<1.0 mm)70例和CIMT增厚组(CIMT≥1.0 mm,伴或不伴斑块)52例.采用酶联免疫吸附(ELISA)法检测血清抵抗素水平,并采用高频彩色多普勒超声测定CIMT.结果 与CIMT正常组相比,CIMT增厚组的血清抵抗素水平明显升高(P<0.05);Spearman相关性分析结果 显示,血清抵抗素水平与CIMT具有显著相关性(r=0.247,P=0.028),而且经校正性别、年龄、BMI后,血清抵抗素水平仍与CIMT显著相关(r=0.198,P=0.034);Logistic多因素回归分析结果 显示,血清抵抗素与CIMT增厚呈显著性关联(OR=1.39,95%CI:1.08～2.04,P=0.037).结论 血清抵抗素是T2DM患者CIMT增厚的独立相关因素.     

急性脑梗死伴颈动脉斑块患者同型半胱氨酸、D-二聚体和纤维蛋白原的变化

目的：探讨老年急性脑梗死（ACI）伴颈动脉粥样硬化（CAS）斑块患者的血浆同型半胱氨酸（Hcy）、D-二聚体及纤维蛋白原的变化规律及临床意义。方法100例确诊的老年ACI患者均接受颈动脉彩色多普勒超声检查,测量左右颈总动脉内-中膜厚度（IMT）,根据结果分组为有CAS斑块组（n=60）和无CAS斑块组（n=40）。分别采用循环酶法、免疫比浊法及Clauss法检测血浆Hcy、D-二聚体和纤维蛋白原浓度并记录。将2组的血浆Hcy、D-二聚体及纤维蛋白原浓度进行比较,分析它们的变化规律和意义。结果老年ACI患者有CAS斑块组血浆Hcy浓度[17.77（13.00～23.10）μmol/L]高于无CAS斑块组[12.64（9.88～15.85）μmol/L];D-二聚体浓度[237.68（157.00～354.25）μg/L]高于无CAS斑块组[169.48（115.25～250.00）μg/L];纤维蛋白原浓度[2.89（2.50～3.92）g/L]高于无CAS斑块组[2.58（2.23～3.48）g/L],差异均有统计学意义（P＜0.05）。结论血浆Hcy、D-二聚体及纤维蛋白原水平增高与老年ACI患者的CAS斑块的形成关系密切,临床应早期干预治疗。     

脂蛋白相关磷脂酶A2与中老年高血压患者颈动脉不稳定斑块的关系

目的 探讨血浆脂蛋白相关磷脂酶A2(lipoprotein-associated phospholipase A2,Lp-PLA2)活性水平与中老年高血压患者颈动脉不稳定斑块的关系及其临床意义.方法 选取高血压患者102例行双侧颈动脉超声检查,依据超声影像、斑块形态和回声特征综合评价分为两组:稳定斑块组50例、不稳定斑...     

老年人骨质疏松与动脉硬化的关系

目的通过对骨密度与冠状动脉钙化积分、颈动脉内中膜厚度及斑块关系的分析, 探讨骨质疏松与动脉硬化的关系.方法对66例老年冠心病、高血压或脑动脉硬化患者行双能X线骨密度仪测定腰椎、髋部、前臂的骨密度, 螺旋CT检测冠状动脉钙化积分及冠状动脉总钙化积分, 颈动脉超声检测颈动脉内中膜厚度及斑块,测定血甲状旁腺激素全段、骨钙素、血钙.据骨密度分骨质疏松组(A组),非骨质疏松组(B组).结果 A组患者的冠状动脉各分支钙化积分及冠状动脉总钙化积分、颈动脉内中膜厚度、颈动脉多发性硬斑发生率高于B组(P<0.01).冠状动脉钙化积分、颈动脉内中膜厚度与甲状旁腺激素呈正相关,与骨钙素、血钙呈负相关, 与各部位的骨密度呈负相关.结论骨质疏松症与动脉硬化有密切的关系, 骨质疏松时钙从骨中溶出增加,体循环中的钙可异常沉积在血管内膜中,造成血管壁动脉粥样硬化、钙化.     

阻塞性睡眠呼吸暂停综合征与颈动脉粥样硬化相关性的系统评价

目的系统评价阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)与颈动脉粥样硬化疾病的相关性。方法计算机检索PubMed、EMbase、CNKI、WanFang Data、CBM和VIP数据库,搜集OSAS与颈动脉粥样硬化疾病和颈动脉内膜中层厚度(carotid intima–media thickness,CIMT)相关性的研究,检索时限均从建库至2021年8月10日。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件和Stata 16.0软件进行Meta分析。结果共纳入32个研究,包括2915例患者。Meta分析结果显示:与对照组相比,OSAS患者颈动脉粥样硬化斑块发生率更高[OR=5.56,95%CI(0.27,8.38),P<0.00001]。亚组分析结果发现,男性[OR=5.38,95%CI(2.79,10.38),P<0.00001]、轻中度OSAS[OR=3.9,95%CI(1.66,9.15),P=0.002]、重度OSAS[OR=19.86,95%CI(6.49,60.82),P<0.00001]患者颈动脉粥样硬化斑块发生风险均高;此外,OSAS组与对照组相比CIMT明显升高[SMD=1.24,95%CI(0.97,1.51),P<0.00001]。OSAS患者AHI和CIMT间呈正相关[r=0.52,95%CI(0.44,0.60),P<0.0001],CIMT随OSAS严重程度的增加而升高。结论OSAS患者颈动脉粥样硬化斑块发生率更高,与CIMT呈正相关,且CIMT会随AHI的升高而升高。受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。     

代谢综合征患者颈动脉内中膜厚度与PAI-1的关系

目的观察代谢综合征(MS)患者颈动脉内中膜厚度(IMT)与血浆纤溶酶原激活物抑制物-1(PAI-1)的关系。方法根据NCEP-ATPⅢ的MS诊断标准,323例住院患者分为MS组(160例)和非MS组(163例),采用ELISA法测定血浆PAI-1水平,应用高频多普勒超声检测颈动脉IMT及颈动脉粥样硬化斑块。结果MS组的PAI-1水平为(30.52±11.02)ng/ml,颈动脉IMT为(0.92±0.21)mm,粥样斑块发生率为63.1%,而非MS组分别为(26.57±11.09)ng/ml、(0.86±0.20)mm和49.1%,两组间差异有显著性意义(P<0.05～0.01),其中颈动脉IMT及粥样斑块发生率随着MS诊断条件数的增加而逐渐增加,差异有显著性意义(P<0.05)。多元逐步回归分析显示,PAI-1与颈动脉IMT独立相关(标准化回归系数β=0.105,P<0.05)。结论MS患者易引起颈动脉粥样硬化,PAI-1可能与动脉粥样硬化密切相关。     

血液透析患者颈动脉内中膜厚度与血清高敏C反应蛋白、成纤维细胞生长因子23和klotho蛋白的相关性研究

目的 了解维持性血液透析（maintenance hemodialysis,MHD）患者颈动脉粥样硬化情况,分析该人群颈动脉内中膜厚度（carotid intima-media thickness,CIMT）与血清高敏C反应蛋白（HsCRP）、成纤维细胞生长因子23（fibroblast growth factor 23,FGF23）及Klotho蛋白水平之间的相关性.方法 选取2012年1月至6月期间在卫生部北京医院血液净化中心MHD患者共88例,根据颈动脉彩色多普勒超声检查结果分为CIMT增厚组和CIMT正常组.对CIMT增厚可能的危险因素进行分析,采用非条件Logistic回归分析进行CIMT影响因素的多因素分析.结果 88例MHD患者中CIMT增厚者共53例（60.2％）,CIMT正常者共35例（39.8％）,2组CIMT中位数分别为1.5mm和1.0mm,有统计学意义（P=0.000）.其中CIMT增厚组粥样硬化斑块发生率明显高于CIMT正常组（92.5％比65.7％,P=0.001）.CIMT增厚组平均年龄为66.64±10.61岁,CIMT正常组平均年龄为58.63±11.78岁,有统计学意义（t=3.320,P=0.001）;CIMT增厚组糖尿病患病率为37.7％,CIMT正常组糖尿病患病率为17.1％,有统计学意义（x2=4.294,P=0.038）;CIMT增厚组与正常组FGF23中位数分别为127.82 ng/L和86.74 ng/L有统计学意义（Z=-3.713,P=0.000）;2组HsCRP中位数分别为5.34mg/L和2.19mg/L,有统计学意义（Z=-3.547,P=0.000）.CIMT增厚组与正常组Klotho蛋白中位数分别为42.48 U/L和41.21U/L,2组无统计学意义（Z=-0.085,P=0.932）.非条件Logistic回归分析显示年龄、FGF23和HsCRP是CIMT增厚的独立危险因素.结论 MHD患者伴CIMT增厚者易形成动脉粥样硬化斑块.血清HsCRP、FGF23和年龄是MHD患者CIMT增厚的独立危险因素.