Case report: Primary aortosigmoid fistula − A rare cause of lower gastrointestinal bleeding

IntroductionA primary aortoenteric fistula (PAEF) is a communication between aorta and the gastrointestinal tract. It is a rare condition that is difficult to diagnose and therefore associated with a high mortality.Presentation of caseWe report a rare case of a 66-year old man with an unstable bleeding PAEF. A salvage procedure was performed with a covered stent. Later, a sigmoidectomy was performed with resection of the fistula. Postoperatively, the patient suffered an infection that was treated well with antibiotics and he was discharged two weeks later with complete resolution of the fistula.DiscussionAortoenteric fistulas are more common secondary to previous vascular surgery of aorta, however, PAEF’s involve the sigmoid in 2%. Seldom, fistulization can be due to diverticulitis that can be difficult to diagnose.ConclusionRetroperitoneal bleeding from the left iliac artery is more common due to a ruptured aneurysm. This case, however, demonstrates a special PAEF formation as a very rare complication of diverticulitis. The pathophysiology of the PAEF is very unique along with the anatomic localization in the sigmoid colon and left external iliac artery.     

Letter to the Editor

Meckel’s diverticulum is a common congenital anomaly of the small intestine, affecting 2% of the population. Neoplastic transformation is infrequent and gastrointestinal stromal tumours are exceptional in this location. We report a case of gastrointestinal bleeding caused by a gastrointestinal stromal tumour of Meckel’s diverticulum.     

有幽门螺杆菌感染家族史儿童胃部菌群的特点

目的:探究有幽门螺杆菌(Helicobacter pylori, H. pylori)感染家族史,发生和未发生H. pylori感染的儿童胃部菌群特点。方法:分别采集患儿胃体和胃窦的黏膜标本,通过标本DNA提取、16S核糖体DNA(ribosomal DNA,rDNA)V3-V4区域PCR扩增、高通量测序、数据处理等步骤后,得到胃部黏膜菌群分析结果,将结果中有H. pylori感染家族史的标本根据是否发生H. pylori感染分为感染组(n=18)和非感染组(n=24),比较两组间菌群的α和β多样性、菌群丰度变化等指标,找出差异菌群,并对菌群功能进行预测分析。结果:感染组与非感染组胃部菌群α多样性和β多样性之间差异有统计学意义(P<0.05), 感染组的菌群多样性要低于非感染组。菌群相对丰度方面,门水平占优势的主要有变形菌门(Proteobacteria)、厚壁菌门(Firmicutes)、拟杆菌门(Bacteroidetes)、放线菌门(Actinobacteria)和梭杆菌门(Fusobacteria);属水平上,非感染组中拟杆菌(Bacteroides)、普雷沃氏菌(Prevotella)、链球菌(Streptococcus)和奈瑟菌(Neisseria)为优势菌种。差异物种方面,通过LEfSe分析,发现非感染组中属水平的拟杆菌属等的相对丰度显著高于感染组。功能预测发现,拟杆菌属与一些氨基酸和维生素代谢、丝裂原活化蛋白激酶(mitogen-activated protein kinase,MAPK)、哺乳动物雷帕霉素靶蛋白(mammalian target of rapamycin, mTOR)信号通路、安沙霉素(ansamycin)的合成相关通路均呈显著正相关。结论:有H. pylori感染家族史的儿童中,发生H. pylori感染和未发生感染者的胃部菌群存在显著差异,拟杆菌可能与儿童是否发生H. pylori感染存在关联。     

Detection of contractions in adaptive transit time of the small bowel from wireless capsule endoscopy videos

Recognizing intestinal contractions from wireless capsule endoscopy (WCE) image sequences provides a non-invasive method of measurement, and suggests a solution to the problems of traditional techniques for assessing intestinal motility. Based on the characteristics of contractile patterns and information on their frequencies, the contractions can be investigated using essential image features extracted from WCE videos. In this study, we proposed a coherent three-stage procedure using temporal and spatial features. The possible contractions are recognized by changes in the edge structure of the intestinal folds in Stage 1 and evaluating similarity features in consecutive frames in Stage 2. In order to take account of the properties of contraction frequency, we consider that the possible contractions are located within windows including consecutive frames. The size of these contraction windows is adjusted according to the passage of the WCE. These procedures aim to exclude as many non-contractions as possible. True contractions are determined through spatial analysis of directional information in Stage 3. Using the proposed method, 81% of true contractions are detected with a 37% false alarm rate for evaluations in the experiments. The overall performance of this method is better than that of previous methods, in terms of both the quality and quantity indices. The results suggest feasible data for further clinical applications.     

胃肠道间质瘤30例的诊断及外科治疗

目的探讨胃肠道间质瘤(GIST)的诊断和外科治疗。方法对周口市中心医院2002年至2009年诊断明确的30例GIST患者的临床表现、辅助检查、手术治疗、病理结果及预后进行回顾性分析。结果本组病例酪氨酸激酶受体CD117阳性者29例,阳性率为96.67%;CD34阳性者21例,阳性率为70%,CD117、CD34均阳性者为21例,阳性率为70%。治疗以手术为主,全组无围手术期死亡,未出现严重并发症,均治愈或好转出院。30例患者中随访24例,随访率80%,随访时间6个月～7年。结论 GIST缺乏特征性的临床表现,术前确诊率较低,免疫组织化学检测对确诊本病至关重要,外科手术切除是目前最主要的治疗方法。     

云南红药胶囊与银杏叶片在治疗眼底出血性疾病中的应用

目的观察云南红药胶囊与银杏叶片联合治疗眼底出血性疾病的疗效。方法连续收集近年来门诊就诊患者56例(73眼)纳入临床观察,出血一周内应用云南红药胶囊口服,3粒/次,3次/d;1周后联用银杏叶片1片/次,3次/d,疗程均为14d,治疗前后分别行视力比较并复查眼底。结果治疗总有效率91.8%,治疗后视力明显提高,疗效显著,具有明显止血和促进积血吸收的作用。结论云南红药胶囊与银杏叶片联合治疗眼底出血性疾病效果好,给药方便,是一种有效和安全的方法。     

CCK as a modulator of cardiovascular function

The gut-brain peptide cholecystokinin (CCK) has been implicated in a wide range of physiological processes including digestion, satiety, anxiety, nociception and lordosis. In addition, it is becoming clear that CCK is involved in regulating certain aspects of cardiovascular function. This article reviews the cardiovascular effects elicited by CCK via its actions at both central and peripheral sites and considers the physiological role of the peptide with respect to the cardiovascular function in different physiological and pathophysiological states. In the periphery CCK released from entoeroendocrine cells in the gut wall in response to a meal triggers a local postprandial hyperaemia in the gut that could promote digestion by facilitating intestinal motility and secretory processes. In addition, activation of CCK receptors on abdominal vagal afferents elicits a reflexly evoked hyperaemia that potentiates these effects and is also gasroprotective. In the brain CCK appears to act as a neuromodulator rather than a direct mediator within cardiovascular control circuits. In particular, it facilitates activity in amygdalar, hypothalamic and midbrain circuits that are involved in mediating acute cardiovascular and behavioural responses to an extreme physical or psychologically stressful challenge. Whilst in the short term activation of the CCK system appears to be beneficial to the organism, chronic stimulation of the system may be maladaptive, laying the foundation for the development of pathophysiological conditions such as panic disorder and chronic pain, both of which are states characterised by significant autonomic activation.