Congenital biliary dilatation may consist of 2 disease entities

Background/Purpose

This study aims to establish the possible mechanisms of pathogenesis of congenital biliary dilatation and to classify the disease accordingly.

Methods

Radiologic features of congenital biliary dilatation and pancreaticobiliary malunion in 107 affected children were examined and correlated with laboratory results. Relative lengths/diameters were calculated to provide comparison between children of different ages. Intraluminal pressures of common bile duct (CBD) were measured intraoperatively.

Results

The minimal relative diameters of distal CBD negatively correlated with the maximal relative diameters/lengths of dilated CBD, the maximal relative diameters of common hepatic duct, and left/right hepatic ducts. The intraluminal pressure in patients with a stenotic distal CBD (stenotic group) was significantly higher than that in patients with a nonstenotic distal CBD (nonstenotic group). The narrower the distal CBD, the more deranged the liver function. Conversely, serum/bile amylase levels were more elevated in the nonstenotic group. Common channel protein plugs were only found in the nonstenotic group, whereas common hepatic duct strictures, intrahepatic duct dilatations, and calculi were detected more frequently in the stenotic group.

Conclusion

We propose to categorize congenital biliary dilatation into 2 subgroups: (1) cystic type with stenotic distal CBD associated with deranged liver function and common hepatic duct stricture and (2) fusiform type with nonstenotic distal CBD associated with pancreatitis and common channel protein plugs. Different underlying pathologies of each group require different operative strategies.     

Pregnancy outcomes in women with type 1 diabetes in China during 2004 to 2014: A retrospective study (the CARNATION Study)

BackgroundWe aimed to report pregnancy outcomes of women with type 1 diabetes (T1D) in China, on which data were sparse.MethodsThis is a nationwide retrospective study conducted in 11 general medical centers in 8 cities across China. We investigated the clinical data of all women who attended these centers with a singleton pregnancy and whose pregnancy ended between 1 January 2004 and 31 December 2014. Pregnancies of women with pregestational T1D were ascertained and compared with those of women without T1D.ResultsFrom over 300 000 pregnancies over the 11‐year study period, we identified 265 singleton pregnancies of women with T1D. One maternal death was documented among 265 (0.37%) women with T1D and 83 among 318 486 (0.03%) women without T1D. Women with T1D suffered from higher rates of pregnancy loss (13.21% vs 2.92%, crude risk ratio [cRR] 5.08 [95% CI, 3.56‐7.26]) and preeclampsia (17.74% vs 4.20%, cRR 4.94 [95% CI, 3.60‐6.77]) compared with those without T1D. Infants of these women with T1D had elevated rates of neonatal death (5.65% vs 0.16%, cRR 37.36 [95% CI, 21.21‐65.82]) and congenital malformation(s) (8.26% vs 3.53%, cRR 2.46 [95% CI, 1.54‐3.93]) compared with those of women without T1D. No significant improvement in pregnancy outcomes in women with T1D was observed over the period 2004 to 2014.ConclusionsPregnancy outcomes were persistently poor in women with T1D during 2004 to 2014 in China. Pregnancy care needs to be improved to reduce adverse pregnancy outcomes among Chinese women with T1D.     

血液系统疾病合并嗜水气单胞菌血流感染4例报告

本文报道了昆明医科大学第二附属医院4例血液系统疾病合并嗜水气单胞菌血流感染患者的诊疗及转归,进一步明确血培养重要性以及加深临床对此病的认识。 选择2017—2021年昆明医科大学第二附属医院收治的血液系统疾病合并嗜水气单胞菌血流感染的4例患者,对患者临床表现、血培养采集及嗜水气单胞菌检出时间、实验室检查、治疗及预后等临床资料进行回顾性分析。本研究中4例病例均为男性血液系统疾病患者,处于化疗后骨髓抑制期粒细胞缺乏,出现发热后采集血培养并检出嗜水气单胞菌,4例患者血培养报阳时间4~11 h。药敏检测结果显示对二代、三代、四代头孢类抗生素、喹诺酮类抗生素、碳青霉烯类抗生素敏感性较高。4例患者早期均使用亚胺培南-西司他丁钠进行经验性抗感染治疗,1例患者经积极抗感染及升白细胞等治疗后痊愈。1例患者未完成化疗,患者要求出院,后续不详。2例患者迅速发展为坏死性筋膜炎,后患者死亡。研究表明,血液系统疾病合并嗜水气单胞菌血流感染罕见但死亡率高,对于反复发热考虑感染致病的患者需尽早进行血培养确认病原体并进行药敏试验,临床治疗时应结合患者情况及时调整治疗,除抗感染治疗外同时要提升患者免疫力,警惕发展为坏死性筋膜炎。     

自发性脑出血患者小肠黏膜及胃泌素变化的分析

目的观察自发性脑出血患者小肠黏膜变化及其与胃泌素水平动态变化的关系。方法 25例自发性脑出血患者发病后第7天胶囊内镜观察小肠黏膜改变并使用酶联免疫分析法检测发病后第1,3,7,14,21天血清胃泌素浓度,并与11例健康志愿者对照。结果急性自发性脑出血患者发病后血清胃泌素水平升高,峰值时间为第7天。其中,非丘脑出血者及无小肠黏膜病变者血清胃泌素水平在第21天降至正常水平,而丘脑出血者或伴明显小肠黏膜病变者,在第21天时血清胃泌素仍高于正常对照组(P<0.05)。25例患者中13例小肠黏膜有不同程度的充血水肿、糜烂或浅溃疡形成,1例合并有活动性出血,对照组1例见小肠黏膜节段性充血(P<0.05)。结论自发性脑出血与小肠黏膜改变及胃泌素动态变化有着密切相关性。     

快速循环型情感性精神病的随访

作者对1983年1月至1986年6月住我院诊断为躁狂抑郁症,并符合Dunner快速循环型情感性精神病(RCAD)的27例患者中,仅18例获得为期1年半至4年半的临床随访研究,结果表明,8例有躁郁发作,其中仅1例属快速循环型发作,10例无复发。抑郁发作者对锂盐或停用抗抑郁剂有效,而躁狂发作者对卡马西平反应良好。这些病例治疗反应的差异提示RCAD可能存在生物学的异源性。     

病人的两难：可否成为主治医师研究计划中的受试者

医疗科技的进步使疾病的治愈率大幅提高,增进了人类的健康。为发现与改良新的医疗技术,进行人体试验是必经的过程,而对受试者保护的重要性的议题也随之产生。为研究便利,有许多主治医师会将自己的病人列为研究的受试者,在病人欲成为主治医师的受试者过程里,隐含着许多伦理议题,故藉由病人的知情同意之自愿性,针对此议题做伦理分析,并指出可行与不可行之理据、可行之受限与保护病人之机制。     

脑卒中患者自我护理能力与健康状况调查分析

目的:调查了解脑卒中患者自我护理能力和身心健康状况,探讨两者间的关系,为促进患者康复提供干预依据。方法:采用自编一般情况问卷、自我护理能力测定量表(ESCA)、自测健康状况评定量表(SRHMS)对120例社区脑卒中患者进行评定,并进行相关性分析。结果:脑卒中患者中ESCA高等水平占有率为22.5%,中等水平占有率为68.33%,低等水平占有率为9.17%。不同ESCA水平的脑卒中患者SRHMS评分具有显著性差异(P<0.01)。SRHMS分值与ESCA分值呈显著正相关(P<0.05或P<0.01)。结论:脑卒中患者自我护理能力和健康状况不佳,自我护理能力是影响脑卒中患者身心健康的重要因素,提高自我护理能力有助于提高健康水平和生存质量。     

Is automatic CPAP titration as effective as manual CPAP titration in OSAHS patients? A meta-analysis

Purpose  

It is costly and time-consuming to conduct the standard manual titration to identify an effective pressure before continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA) patients. Automatic titration is cheaper and more easily available than manual titration. The purpose of this systematic review was to evaluate the effect of automatic titration in identifying a pressure and on the improvement of apnea/hyponea index (AHI) and somnolence, the change of sleep quality, and the acceptance and compliance of CPAP treatment, compared with the manual titration.     

俯卧位用于患儿催吐洗胃效果观察

目的 探讨俯卧位催吐在口服中毒患儿洗胃中的应用价值.方法 将30例误服药物患儿随机分为观察组和对照组各15例.观察组采用俯卧位进行反复催吐洗胃,对照组采用常规坐位反复催吐.比较两组催吐成功率、药物残留率、洗胃并发症发生率以及患儿合作情况.结果 除药物残留项外,另3项观察组显著优于对照组(均P＜0.01).结论 俯卧位催吐应用于患儿洗胃效果好,安全,易于被家长及患儿接受.