Factors associated with reduced insertion depth at double balloon enteroscopy: A retrospective,multivariate analysis

Background

Deep small bowel insertion during double balloon enteroscopy can be difficult to achieve.

Aims

To determine the factors influencing depth of insertion during double balloon enteroscopy.

Methods

History of abdomino-pelvic surgery, route of insertion, type of enteroscope, age, sedation or general anaesthesia used and gender were considered as potential influencing factors; procedures were categorised accordingly and maximal depth of insertion calculated.

Results

At multivariate analysis, maximal depth of insertion was significantly associated with history of abdominal-pelvic surgery (P < 0.001), rectal approach (P = 0.011), gender (P = 0.02) and use of the therapeutic enteroscope (P = 0.047). Mean maximal depth of insertion was 266 ± 12 cm, 255 ± 9 cm (P = 0.50), 197 ± 10 cm (P < 0.0001), 160 ± 12 cm (P < 0.01) and 103 ± 33 cm (P < 0.15) when 0, 1, 2, 3 and 4 influencing factors were present, respectively.

Conclusion

Maximal depth of insertion was significantly influenced by history of abdomino-pelvic surgery, insertion route, gender and type of enteroscope used.     

CD4−CD8− T-cells in primary Sjögren's syndrome: Association with the extent of glandular involvement

ObjectivesGrowing evidence suggests that IL-17-producing T cells, lacking both CD4 and CD8 molecules and defined as double negative (DN) cells, play a pivotal role in the pathogenesis of a number of systemic autoimmune disorders. We recently demonstrated that this T-cell subset is expanded in the peripheral blood (PB) of patients with primary Sjögren's syndrome (pSS), produces IL-17 and accumulates in minor salivary glands (MSGs). We aimed to investigate glandular and PB DN T cells in early pSS in order to verify a possible correlation with MSGs histological patterns and clinical parameters.MethodsPaired samples of PB mononuclear cells and MSGs from pSS patients were evaluated at the diagnosis by flow cytometry and immunofluorescence staining respectively. Histological analysis to identify histological scores, B/T cell segregation and the presence of germinal center (GC)-like structures was also performed.ResultsIn early stages of pSS, circulating DN T cells appear to be not yet expanded and inversely correlated with circulating CD4⁺Th17 cells. The number of infiltrating DN T cells were associated with extent of glandular involvement, presence of GC-like structures and dryness symptoms and were inversely correlated with circulating DN T cells.ConclusionsOur findings suggest that DN T cells are actively involved in the pathogenic mechanisms leading to glandular dysfunction and damage in pSS and may play a role in ectopic lymphoneogenesis development occurring during the disease.     

Długotrwała odpowiedź na leczenie azacytydyną pacjentki z ostrą białaczką szpikową z niekorzystnym profilem cytogenetycznym – prezentacja przypadku

Acute myeloid leukemia (AML) is the most common type of leukaemia found in adults and the number of disease cases increases with age. Despite the advances in the AML treatment, the results in patients over the age of 60 remain unsatisfactory.In this study we present the case of a 73-year-old female patient with an unfavourable cytogenetic profile, in whom we observe long-term response to azacitidine, after previous failures of classic polychemotherapy.In February 2010, a 70-year-old patient was admitted to the Department of Haematology USK in Bialystok on suspicion of AML. The patient was qualified for intensive chemotherapy regimen of daunorubicin (DNR) and cytarabine (Ara-C).Cytogenetic examination revealed the presence of double minutes – acentric fragments of extrachromosomal DNA, which is associated with resistance to standard chemotherapy. Induction chemotherapy was complicated by febrile neutropenia, pneumonia and episodes of atrial fibrillation. Due to the lack of remission and severe after-induction period, a brief reinduction chemotherapy with DNR and Ara-C was applied to obtain complete remission with incomplete regeneration (CRi).Due to the recurrence in October 2010, reinduction chemotherapy was given followed by two cycles of maintenance chemotherapy. After another relapse in February 2011 (23,6% blasts in the bone marrow), a chemotherapy regimen designed for refractory and relapsed leukaemia was given, without any effect. In April 2011, the patient began azacitidine treatment. By the end of March 2013, the patient received twenty-one treatment cycles. The twelfth cycle of chemotherapy was complicated by pulmonary embolism which was treated successfully. The complete blood count remains at normal values.Recent reports indicate a clear relationship processes such as epigenetic regulation of DNA methylation with leukaemogenesis. The use of hypomethylating drugs in AML is yielding promising results.     

不明原因消化道出血患者行双气囊小肠镜检查的时机选择

目的探讨不明原因消化道出血（OGIB）患者行双气囊小肠镜检查（DBE）的最佳时机。方法回顾性分析盛京医院2009年1月至2013年11月间接受DBE检查的OGIB患者的临床资料,按检查时机的不同分为急诊DBE组和非急诊DBE组,整理两组患者的临床特征、DBE检查结果、检查时间和并发症,并进行统计学分析及比较。结果78例OGIB患者接受DBE检查,发现病变48例,病变总检出率为61．54％。急诊DBE组病变检出率为77．14％（27／35）,明显高于非急诊DBE组的病变检出率48．83％（21／43）（P=0．019）。在检查时间方面,急诊DBE组明显短于非急诊组,差异有统计学意义（P=0．031）。结论对于OGIB患者,急诊DBE的检查时间更短,病变检出率更高。条件允许时,对OGIB患者应尽早行DBE检查。     

Clinical definition of the axillary vein and experience with blind axillary puncture

The prevalence of congenital anomalies of the coronary arteries (CAAs) is reported to be approximately 0.2-1.4% of the general population. Of them, The double right coronary artery (RCA) is one of the rarest coronary anomalies. Nonetheless, there is no consensus of the definition of a double RCA until now. Several concepts have been proposed in order to define what is and is not a double RCA. So far, it was been reported 37 times and in 44 cases after a comprehensive literature search through the PubMed database, using the keywords “double right coronary artery,” “duplicated right coronary artery,” “dual right coronary artery” and “split right coronary artery.” Most of the published articles (28 of 37 articles) used the name “double right coronary artery.” Nevertheless, some investigators contended that a split RCA is anatomically the same anomaly as the improperly named “double right coronary artery”. The debate between those who favor “double RCA” and those who favor “split RCA” indicate the need for a consensus regarding the nomenclature as well diagnostic criteria of such coronary anomalies. It is the time we need to reach a consensus of the nomenclature of this congenital coronary anomaly.     

Double Common Bile Duct: A Case Report

The aim of our study is to present a case of double common bile duct. Specifically, we found a common bile duct that was divided into two distinct ducts, one the main and the other the accessory duct, during its course downwards. The two bile ducts had a parallel course emerging from the common bile duct after its formation and reuniting just above the head of the pancreas. Finally, they drained into the second portion of the duodenum at the site of major duodenal papilla. This anomaly is of great importance because the duplication of the common bile duct can lead to severe intraoperative injury to one of the two common bile ducts, which can be mistaken for the cystic duct and be ligated. Moreover, we present the relative international literature and the clinical significance of our finding.     

双丝弓个性化舌侧托槽的计算机辅助设计

目的实现一种个性化托槽的计算机辅助设计,以便在临床矫治中显著减小前牙控根力,并且能够应用于拔牙病例。方法在包括患者牙根的整合牙颌模型上进行虚拟排牙,在排牙后的模型上绘制直丝弓和设计双丝直丝弓托槽,托槽通过托槽体的厚度补偿来实现弓丝的直丝化,在托槽上设计双槽沟,主槽沟为方槽沟,辅槽沟为圆槽沟,在主槽沟用方丝虚拟定位托槽后,用计算机辅助设计和制作的个性化托槽,将托槽的虚拟位置转移到患者牙齿上的实际粘接位置进行矫治。结果与方丝控根相比,双丝控根矫治力显著减小;唇侧或舌侧矫治时可以使用直丝弓,简化了临床弓丝弯制;虚拟排牙基于3D整合牙颌模型,可以在虚拟排牙中避免牙根的骨开裂、骨开窗和明显不平行。结论本研究为双丝弓个性化托槽的临床应用奠定了基础。     

结肠气钡双重造影和结肠CT应用价值的对比分析

目的 探讨结肠气钡双重造影和结肠CT在结直肠疾病诊断中的应用价值,并对比分析两种检查方法的优缺点.方法 回顾性分析2005年6月至2013年8月我院213例结肠气钡双重造影和结肠CT检查结果,对比观察两种检查方法所检出的病种、结直肠肿瘤和息肉的大小、部位及并发症发生情况.结果 结肠气钡双重造影对溃疡性结肠炎、慢性阑尾炎、憩室等疾病和近端结肠及小病灶的诊断能力优于结肠CT;结肠CT对结直肠肿瘤及远端结肠的诊断能力则优于结肠气钡双重造影.结论 结肠气钡双重造影和结肠CT各具优势,在临床工作中应视具体情况加以选择或联合应用.     

颧骨双L形截骨联合颧弓截骨Z形接合术矫治颧骨、颧弓过高

目的 观察颧骨双L形截骨联合颧弓后端截骨Z形接合术,对颧骨、颧弓过高矫治的疗效与预后.方法 32例颧骨、颧弓均过高的患者,在全身麻醉下应用颧骨双L形截骨联合颧弓后端截骨Z形接合术进行矫治.术后6个月后对所有患者进行随访,观察颧骨愈合及面型变化情况并调查患者满意度.结果 32例患者截骨矫治后Ⅰ期愈合,所有患者面部消肿后颧骨、颧弓明显降低,面中份两侧颧弓间宽度明显减少.6个月后随访,骨愈合良好,所有患者均对治疗效果表示满意.结论 颧骨双L形截骨联合颧弓后端截骨Z形接合术,可有效地矫治颧骨、颧弓过高,使患者面型达到一个理想的美学标准.     

双Endobutton钢板与锁骨钩钢板内固定治疗Rockwood Ⅲ～Ⅴ型肩锁关节脱位的疗效比较

目的比较双Endobutton钢板技术与锁骨钩钢板内固定治疗RockwoodⅢ~Ⅴ型肩锁关节脱位的中期疗效。方法回顾性分析自2009-06—2014-05分别采用双Endobutton钢板与锁骨钩钢板内固定治疗的40例RockwoodⅢ~Ⅴ型肩锁关节脱位。比较2组术后3个月、1年的患肩疼痛视觉模拟评分(VAS)、Constant肩关节功能评分。结果 40例术后均随访满1年。Endobutton钢板组手术时间长于锁骨钩钢板组,差异有统计学意义(P0.05)。术后3个月Endobutton钢板组的Constant评分及VAS评分均优于锁骨钩钢板组,差异有统计学意义(P0.05);但2组术后1年Constant评分及VAS评分比较差异无统计学意义(P0.05)。2组术后1年Constant评分及VAS评分均优于术后3个月,差异有统计学意义(P0.05)。术后1年Endobutton钢板组1例出现复位丢失,1例出现肩部疼痛;锁骨钩钢板组未出现复位丢失,但5例肩部疼痛。结论双Endobutton钢板内固定治疗RockwoodⅢ~Ⅴ型肩锁关节脱位的中期效果与锁骨钩钢板内固定并无明显差异,但Endobutton钢板内固定对肩关节功能影响小、术后肩痛发生率低、内固定不必取出。