Ruptured duodenal varices arising from the main portal vein successfully treated with endoscopic injection sclerotherapy: a case report

Duodenal varices result from retroperitoneal portosystemic shunts that usually come from the pancreaticoduodenal vein and drain into the inferior vena cava. Because they are a rare but fatal cause of gastrointestinal bleeding, a prompt hemostatic intervention is mandatory. A 62-year-old man who had a history of excessive alcohol consumption presented with massive hematemesis and melena. Emergent endoscopy revealed ruptured varices with an adhering whitish fibrin clot on the postbulbar portion of the duodenum. Abdominal computed tomography demonstrated a cirrhotic liver with venous collaterals around the duodenum and extravasated contrast in the second and third portions. The collaterals originated from the main portal vein and drained via the right renal vein into the inferior vena cava. Endoscopic injection sclerotherapy with cyanoacrylate was successful in achieving hemostasis, and resulted in the near eradication of duodenal varices at a 6-month follow-up.     

内镜下等离子射频联合尼龙圈套扎治疗消化道广基息肉的临床研究

目的研究内镜下等离子射频联合尼龙圈套扎治疗消化道广基息肉的临床疗效。方法临床入选2008年3月至2010年9月期间在我科诊疗的下消化道广基息肉患者104例,按照随机数字方法分成2组,每组52例,对照组患者在内镜下单纯予以内镜下等离子射频治疗,而研究组患者予以内镜下等离子射频联合尼龙圈套扎治疗。对两组患者的相关临床资料进行分析比较。结果两组患者在一次性治疗成功率方面具有统计学差异（P〈0.05）,均出现了并发症,主要有穿孔、出血、电凝综合征等,其中对照组其并发症发生率为34.62%,研究组的并发症发生率为7.69%,两组相比较具有统计学差异（P〈0.05）。两组患者在单颗息肉内镜治疗时间、住院时间及愈合时间方面均没有统计学差异（P〉0.05）。结论内镜下等离子射频联合尼龙圈套扎治疗消化道广基扁平息肉与内镜下单纯等离子射频治疗相比较,不仅疗效显著,而且并发症的发生率明显降低。     

GDC栓塞治疗颅内动脉瘤的护理

目的 探讨电解可脱性微弹簧圈（GDC）栓塞术治疗颅内动脉痛的护理特点。方法选择近两年我科研E栓塞治疗的颅内动脉瘤的病人12例，探讨其围手术期护理方法。结果 经我们周到的术前、术后护理，包括术前心理护理，消除紧张情绪，认真宣教，精心的术前准备，术后详细的记录各种症状和体征的变化，针对GDC栓塞术的特点，术后易出现的问题和并发症制定特定的护理方案，12位患者均获得了较好的疗效。结论 针对GDC拴塞术的特点，实施特定的护理方法，配合医师治疗，有助于病人术后的恢复。     

Portal biliopathy treated with endoscopic biliary stenting

Portal biliopathy is defined as abnormalities in the extra- and intrahepatic ducts and gallbladder of patients with portal hypertension. This condition is associated with extrahepatic venous obstruction and dilatation of the venous plexus of the common bile duct, resulting in mural irregularities and compression of the biliary tree. Most patients with portal biliopathy remain asymptomatic, but approximately 10% of them advance to symptomatic abdominal pain, jaundice, and fever. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography are currently used as diagnostic tools because they are noninvasive and can be used to assess the regularity, length, and degree of bile duct narrowing. Management of portal biliopathy is aimed at biliary decompression and reducing the portal pressure. Portal biliopathy has rarely been reported in Korea. We present a symptomatic case of portal biliopathy that was complicated by cholangitis and successfully treated with biliary endoscopic procedures.     

First-degree atrioventricular block in a young duodenal ulcer patient treated with a standard oral dose of ranitidine

A 20-year-old male patient on oral treatment with ranitidine 300 mg/day in a single bedtime dose was admitted to hospital for a brief episode of syncope which had occurred 20 min earlier. All clinical, laboratory and instrumental examinations yielded negative findings, except for electrocardiographic evidence of first-degree atrioventricular block. Administration of atropine produced transient disappearance of the block, which disappeared altogether after discontinuing ranitidine treatment. Two separate rechallenges with ranitidine each produced recurrence of (asymptomatic) first-degree atrioventricular block at electrocardiographic examination, but oral treatment with cimetidine (400–800 mg/day) and famotidine (40–80 mg/day) induced no electrocardiographic abnormalities. The hypothesis that this patient may be abnormally susceptible to the cholinergic or cholinergic-like effect of ranitidine, a side effect unrelated to the drug's primary H₂-blocking action, would appear to be consistent with evidence of an increased vagal tone of the atrioventricular node as revealed by atrial pacing. However, the ability of ranitidine to release histamine in man and the potential dysrhythmia-inducing effect of histamine should also be taken into consideration.     

Peripheral blood T lymphocytes in patients with duodenal ulcers treated with cimetidine.

The influence of cimetidine on the numbers of circulating T lymphocytes was studied in 24 patients with duodenal ulcer treated with cimetidine. The patients were divided into two groups according to the way of cimetidine administration and T lymphocytes were measured during treatment. No significant difference in the numbers of T lymphocytes was found in both groups of patients suggesting that cimetidine given therapeutically has no effect on circulating T lymphocytes.     

Diagnosis of duodenal and ampullary epithelial neoplasms by endoscopic biopsy: a clinicopathologic and immunohistochemical study

A series of 19 duodenal and 16 ampullary neoplasms was studied to determine their pathologic features on endoscopic biopsy, to evaluate the diagnostic accuracy of this procedure, and to assess the usefulness of immunohistochemical staining for carcinoembryonic antigen (CEA) in these neoplasms. The 11 benign neoplasms (31 per cent) were adenomas, five of which had focal hyperplastic features; the 24 malignant neoplasms (69 per cent) included ten intestinal-type carcinomas (resembling colonic carcinoma), seven anaplastic carcinomas (resembling diffuse gastric carcinoma), two adenocarcinomas in situ, and five lesions of unoriented, cytologically malignant epithelium. Malignancy was suspected endoscopically in 19 of 24 carcinomas, and the majority of the benign neoplasms were described as polyps or plaques. Resections (performed in 20 cases) demonstrated the accuracy of the biopsy diagnoses in 17 cases (85 per cent). In the three discordant cases, diagnosed by biopsy as adenoma in two cases and carcinoma in situ in one, coexistent in situ or infiltrating carcinomas were identified in the resected specimens. Carcinoembryonic antigen (20 cases) was identified mostly along glycocalyceal borders in normal and adenomatous tissues, whereas the carcinomas also showed strong cytoplasmic staining for CEA. Endoscopic biopsy is a valuable procedure in the diagnosis of duodenal and ampullary neoplasms. Correlation of the pathologic features of biopsy specimens with endoscopic appearances may result in more accurate diagnoses.     

Needle knife-assisted endoscopic polypectomy for a large inflammatory fibroid colon polyp by making its stalk into an omega shape using an endoloop

Colonic inflammatory fibroid polyp (IFP) is an uncommon benign polypoid lesion, which is composed of fibroblasts, numerous small vessels and edematous connective tissue with marked eosinophilic inflammatory cell infiltration. This condition is frequently detected in the stomach and small intestine, but uncommon in the colon. Although IFP is a benign lesion, surgical resections are performed in most colonic cases because the polyps are usually too large to resect endoscopically. Only three patients underwent endoscopic polypectomy in our literature reviews. Here, we present a case of IFP in the descending colon successful endoscopically resected using a novel technique of trapping its stalk with an endoloop, forming the stalk into an omega shape, and then dissecting the stalk with a needle knife.     

Intrapancreatic lipoma: a rare mesenquimatous tumor with an uncertain physiopathogenesis

Intrapancreatic lipoma is a mesenquimal tumor that currently is still considered a strange entity. There are numerous hypotheses about its pathophysiology; however, none has been clarified. Diagnosis is usually incidental, and computed tomography has been performed for other indications, with high sensibility and specificity, making histopathology confirmation unnecessary, hence suggesting image-follow up solely.     

Spindle cell lipoma: a clinicopathological study with some original observations

Forty-one cases of spindle cell lipoma, an entity first described in 1975, are presented. Of these, 38 were identified in a systematic review of 2478 tumours of adipose tissue diagnosed and treated in one hospital over a 25 year period. This lesion, therefore, accounts for about 1.5% of adipocytic neoplasms and is outnumbered by conventional benign lipomas by approximately 60 to 1. The remaining three were referred cases. Seventy-five per cent of the lesions arose, as expected, on the back of the neck, upper back or shoulder, almost exclusively in males between 40 and 70 years of age. Ten lesions were identified at unusual sites: six in the limbs, three on the face and one on the trunk. One lesion arose within skeletal muscle, a previously unreported phenomenon, and this case showed both cartilaginous and osseous metaplasia. Only one of the 41 tumours has recurred locally. The range of histological features in spindle cell lipoma is described and the differential diagnosis is discussed.     

Iron pill-induced duodenitis: A distinct pattern of duodenal mucosal injury in a patient with a duodenal mass

Ferrous sulfate is an oral iron supplement commonly used to treat iron deficiency anemia. Upper gastrointestinal (GI) tract mucosal damage with associated tissue iron accumulation can sometimes occur with therapeutic dosages of oral iron-containing medications. A distinct histologic pattern of iron deposition with associated inflammatory and reactive changes caused by mucosal injury from oral iron-containing medications has been most commonly described within gastric biopsies and has been referred to as “iron-pill gastritis”. There have only been very rare reports of duodenal mucosa biopsies demonstrating predominantly extracellular crystalline iron deposits with surrounding tissue inflammation and injury analogous to the “iron-pill gastritis” pattern. Here we report a case of “iron pill-induced duodenitis”, an uncommon histologic pattern of duodenal iron deposition and mucosal injury seen in a female in her 50 s with clinical findings of a duodenal mass.     

Ring chromosome 4 in a child with duodenal atresia

We report on a 19-month-old girl with ring chromosome 4 and a multiple congenital anomaly syndrome. The clinical and cytogenetic findings are compared with those of previous cases in whom the breakpoints in ring chromosome 4 are known.     

Patients with high-grade atrioventricular block treated and not treated with a pacemaker

One-hundred and eighty-one patients with chronic and with intermittent high-grade atrioventricular block (AVB) were studied retrospectively. Seventy-one were treated with fixed-rate, 51 with demand-type pacemaker, 59 were treated conservatively. Observation time was three years minimum and 14.5 years maximum. The mean age was about seven years higher, and 8.7% more patients had chronic AVB in the conservatively treated than in the pacemaker-treated group. About 12% more patients had Adams-Stokes attacks in the pacemaker group than in the conservatively treated group. There were 7% more patients with coronary heart disease (CHD) in the pacemaker group, and 10% more with aortic valve disease among the conservatively treated. Totally 4.4% of the patients had a calcification of the mitral annulus fibrosus. The two groups were comparable as regards functional class (NYHA) and heart size. Survival showed 31% more sudden deaths in the conservatively treated than in the pacemaker group. Sudden deaths were not more frequent among the patients with CHD than in those without. Long-term survival showed the more favourable result for the patients with than without pacemaker treatment. There were eight (11.3%) unexplained sudden deaths among the patients treated with fixed-rate pacemaker, only three (5.9%) among those treated with a demand unit. The fixed-rate and the demand units showed a mean longevity of 37.2 and 34.6 months, respectively.     

善宁对食管静脉曲张套扎术后再出血的防治

目的探讨善宁对食管静脉曲张套扎术后再出血的防治作用。方法82例乙型病毒性肝炎后肝硬化并食管静脉曲张随机分为套扎组（A组）和套扎＋善宁组（B组）,比较两种治疗方法对食管静脉曲张的治疗效果。结果B组的再发出血率、静脉曲张复发率及并发症发生率明显低于A组。结论套扎联合善宁是治疗肝炎后肝硬化食管静脉曲张的较为理想的方法。