Whipple's disease without malabsorption: new atypical features

The diagnosis of Whipple's disease in the absence of intestinal involvement is difficult and often overlooked. We describe five patients aged 8-71 years with normal jejunal biopsies and disparate clinical features, previously unrecognized in Whipple's; all were investigated at a single institution over a period of 18 months. Routine histological examination for periodic acid-Schiff (PAS) positive macrophages and polymerase chain reaction (PCR) analysis for Tropheryma whippelii was performed on the small intestine in all patients. PCR analysis was also performed on various tissues including peripheral blood, lymph node, muscle, synovium and spleen in individual patients. Patients 1, 2, 4 and 5 had unusual presenting features not previously associated with Whipple's: intractable immune thrombocytopenic purpura (ITP), juvenile chronic arthritis, isolated muscle weakness and quadriparesis, respectively. Patient 3 presented with pyrexia of unknown origin. All patients had histologically normal small-bowel biopsies with no evidence of PAS positive macrophages. PCR for T. whippelii was positive in all patients in one or more tissues: peripheral blood, intestine, muscle, lymph node and synovium. PAS- positive macrophages were found in 4/5 patients in various sites: lymph node, muscle, spinal cord. Whipple's disease presents with protean clinical features and should be considered in granulomatous disorders of unknown aetiology even in the absence of gastrointestinal involvement.      

电动牙刷与手动牙刷对口腔卫生的效果比较

目的对电动牙刷和手动牙刷在去除菌斑、维护牙龈健康、对色素和牙结石的作用、可靠性、不良作用和成本等进行比较.方法计算机检索Cochrane口腔健康协作组临床试验资料库(截至2004年6月17日)、Cochran临床对照试验中心资料库(Cochrane图书馆2004第2期)、MEDLINE(1966～2004)、EMBASE(1980～2004第2周)和CINAHL(1982～2004第2周),并与制造商联系以获取更多资料.根据下列标准纳入随机对照试验:随机分配研究对象;参加者为手运动无障碍的普通人群;干预措施为无监督的手动或电动牙刷刷牙,至少4周;主要结局指标为试验期间菌斑和牙龈炎的变化.由6个作者独立评价并纳入研究资料.用随机效应模型进行Meta分析,用标准化均数差(SMD)及其95%CI测量效果.检查可能的异质性来源,并针对研究质量和发表偏倚进行敏感性分析.为便于讨论,将SMD转换为百分率.结果对包含3 855例研究对象的42个试验进行系统评价,结果显示,旋转振动型电动牙刷去除菌斑和减低牙龈炎的效果在短期内明显优于手动牙刷,并在3个月以上的研究中显示降低了牙龈炎指数.在1～3个月的研究中,菌斑SMD为-0.43 [95%CI (-0.72, 0.14)],牙龈炎SMD为-0.62 [95%CI (-0.90, 0.34)],Quigley Hein菌斑指数降低11%,Loe and Silness龈炎指数降低6%.在3个月以上的研究中,菌斑指数SMD为-1.29 [95%CI (-2.67, 0.08)], 龈炎指数为-0.51 [95%CI (-1.76, 0.25)],Ainamo Bay探诊出血指数降低17%.短期研究之间有异质性,敏感性分析显示当选择高质量的研究时结果是肯定的,没有证据表明有发表偏倚.采取其他设计的电动牙刷并不比手动牙刷更优.对成本、可靠性和不良作用的报道不一致,已报道的不良作用都是局限的、暂时的.结论旋转振动型电动牙刷去除牙菌斑、减少牙龈炎的效果优于手动牙刷.遵守方法学指南和更标准化的设计有益于将来的研究和Meta分析.     

自体阴茎皮瓣和口腔黏膜治疗尿道狭窄的疗效

目的探讨影响自体组织替代尿道成形术临床疗效的相关因素。方法2000年2月至2006年5月采用口腔黏膜替代尿道成形术82例,带蒂阴茎皮瓣(含包皮内板)替代尿道成形术34例。对尿道狭窄位置及长度、替代物类型及宽度、术前手术次数、支架管留置时间等与狭窄复发率进行单因素分析。结果对116例患者随访5～60个月,平均为(24±6)个月。术后初期排尿通畅95例(81．9%);尿道出现并发症或再狭窄21例,2例经数次尿道扩张、12例经再次手术后排尿通畅;总体成功率为94．0%。结论替代材料对术后短期狭窄复发率无明显影响;在0．8～2．0cm范围内,口腔黏膜条越宽,尿道狭窄复发率越低。     

绿激光汽化治疗浅表性膀胱肿瘤

目的：总结应用绿激光（KTP）治疗浅表性膀胱肿瘤的安全性,可靠性及有效性。方法：2004年2月～2006年4月,采用Laserscope公司的KTP激光,经尿道汽化治疗73例浅表性膀胱肿瘤,男66例,女7例,年龄34～87岁（平均70岁）。肿瘤单发55例,多发18例。病理分级G1～G2,分期T1～T2,肿瘤直径0.3～3.5cm。40例伴有心肺疾病。结果：所有患者均可耐受手术。手术平均时间25min,术中出血量少,无闭孔神经反射、继发出血等并发症,1例因膀胱憩室内肿瘤发生膀胱穿孔。术后均行膀胱内灌注化疗。术后随访3～24个月,平均15个月．复发5例,均在汽化以外部位,复发率7％。结论：经尿道绿激光汽化治疗膀胱肿瘤具有操作简单,疗效确切,术中、术后无严重并发症等优点,尤其适合伴有严重心肺功能异常的老年患者。     

Diagnosis of acute surgical abdomen – The best diagnostic tool to reach a final diagnosiscin

ObjectiveTo evaluate the best diagnostic tool (clinical, radiological, laboratory, or endoscopy) used to reach a final diagnosis of four most common presentations of acute abdomen to the surgical unit in the Limerick University Hospital, Limerick, Ireland.MethodsData was analyzed retrospectively of prospective collected data of all patients who had been admitted at a single academic institution from July 2011 till September 2011. Radiology, operating theatre and histopathology, haematology and endoscopy databases were searched from the Hospital Inpatient Enquiry (HIPE) department for patients who had presented with acute abdominal pain. Patients' charts were searched manually and final diagnosis of each patient was recorded.ResultsOut of 30 confirmed final diagnosis of appendicitis or appendicular mass, 9/30 (30.0%) were diagnosed with radiological (either on ultrasonography or CT scan). The remaining 21 cases (70.0%) were diagnosed clinically. Majority cases of diverticulitis 16/22 (72.7%) was diagnosed radiologically compared to only 6/22 (27.3%) of those confirmed by endoscopy. All diagnosis of gallstone-related diseases (cholecytitis, biliary colic, or cholelithiasis and/or choledocholithiasis) and bowel obstruction were confirmed by radiological investigation.ConclusionsAppendicitis can be accurately diagnosed clinically based on history and clinical examination alone. Diagnosis of diverticular disease, gallstone disease, and bowel obstruction further requires radiology intervention to confirm the provisional diagnosis.