Co-occurrence of IPMN and malignant IPNB complicated by a pancreatobiliary fistula: A case report and review of the literature

BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB) is pathologically similar to intraductal papillary mucinous neoplasm(IPMN). However, there are several significant differences between them. The rate of IPMN associated with extrapancreatic malignancies has been reported to range from 10%-40%, and it may occasionally be complicated with the presence of fistulas. IPMN associated with malignant IPNB is extremely rare and only nine cases have been reported in the literature.CASE SUMMARY We report a 52-year-old man who presented with recurrent cholangitis for nine months. Computed tomography and magnetic resonance cholangiopancreatography showed the common bile duct stricture with dilated pancreatobiliary duct without other abnormal findings. The underlying pathogenesis could not be identified based on the radiologic images. Endoscopic retrograde cholangiopancreatography revealed a pancreatobiliary fistula with dilated main pancreatic duct, biliary stricture with dilated biliary tree, and mucus discharge from the enlarged orifice of the major papilla. The patient underwent SpyGlass cholangiopancreatoscopy due to a suspected mucin-producing biliary neoplasm and indeterminate main pancreatic duct dilatation. Multiple papillary growing neoplasms with vascular images, with the extent of lesions spreading in the biliopancreatic ductal lumens, were identified by SpyGlass. In addition, the presence of a pancreatobiliary fistula was also identified. The patient was diagnosed as having benign IPMN and malignant IPNB with focal invasion by postoperative pathology. Furthermore, varying histological subtypes were present in both IPMN and IPNB. Pylorus-preserving pancreaticoduodenectomy was performed on the patient with excellent results during the 52 month followup period.CONCLUSION We deemed that pancreatography and SpyGlass allowed for an efficient diagnosis of IPMN with pancreatobiliary fistula, whereas the etiology could not be identified by radiologic imaging.     

多功能病号服在临床中的应用

病人在医院接受治疗时,往往在需要暴露局部治疗部位时,必需脱去整件衣、裤,由于春季、秋季、冬季室内温度低于体温,使病人易着凉、感冒,诱发其他并发症等,引起身体的不适.局部肿瘤放疗病人,指导放疗病人和家属将放疗局部的内衣剪开,露出局部皮肤进行治疗,这样不影响治疗,还可保暖,但这一方法还有待改进.另外住院病人的病号服颜色单调,款式单一,功能缺乏,根本不能满足住院病人的身心及治疗的需要.因此,近几年,通过大量的研究和临床实践,设计出多功能病号服,获国家实用型专利.现将其介绍如下.     

手术室与供应室一体化运作中手术器械的管理

我院为一家拥有800张床位的综合性医院,年手术量1万多例,有一个现代化的供应室,由于手术器械从手术室到供应室环节多,很容易出现手术器械丢失或无菌手术器械不能及时供应而延误手术的现象.为达到资源共享,我院于2003年6月实行手术室与供应室一体化运作,经过4年尝试,在工作中不断总结经验,形成了一定的管理模式,取得满意结果.     

介绍一种眼科点眼药盘

眼科工作中给病人点眼药是主要治疗方法之一,一般是多种眼药水放在一个药盘或药框中,眼药水品种繁多,且眼药水瓶东倒西歪摆放没有规律,甚至会出现作用相反的眼药水(膏)拿错的现象,如缩瞳类和散瞳类就是两个作用完全相反的眼药.因此,使用时往往需要仔细寻找或凭经验才能快速找到所需的眼药,如果使用不当就会给病人造成严重的后果.为减少不良后果的发生,在临床实践中,我们制作了一种简易、方便使用的点眼药盘.现介绍如下.     

1例脐尿管漏合并妊娠的护理

脐尿管瘘是一种膀胱畸形疾病,男性多见.临床表现为脐部漏尿,漏尿程度视瘘管的大小而定,脐部漏口为皮肤或黏膜所覆盖.静脉注射靛胭脂或从尿道导管将亚甲蓝注入膀胱,可见染色尿液自脐部漏出,故可诊断[1].     

ICU护士了解自由基和抗氧化剂的重要性

对自由基和抗氧化剂的基本知识,自由基在ICU常见疾病发生发展中的作用以及抗氧剂的临床应用四方面内容进行综述,提示了ICU护士了解这四方面内容是临床实践的组成部分.     

类风湿关节炎、高热、黑便、血三系减少

1病例介绍患者女,67岁。因"发热半个月,黑便1d"于2006年6月9日入院。患者半个月前起发热,多次测得体温≥39.0℃,无寒战,无咳嗽、咳痰,无腹痛、腹泻,无尿急、尿痛,无腰痛、咽痛,当地医院予抗生素、激素治疗体温反复,昨日起解黑便,共2次,伴头晕,晕厥1次,无呕血,为进一步诊治转入本院。既往类风湿关节炎     

代谢综合征的疗养护理

代谢综合征又称代谢异常心血管综合征，它是一组心血管疾病危险因素的聚集和组合，包括高血压、高血脂（血脂异常）、高血糖（糖尿病、血糖调节受损、糖耐量异常）、肥胖、吸烟、炎症、血凝增强、纤溶降低等。心血管疾病是人类头号杀手，给社会和家庭带来了沉重的经济负担。对于心血管疾病这种新的流行病学表现，     

Clinical effects of apatinib mesylate for treatment of multiple brain micrometastases:Two case reports

BACKGROUND Apatinib is a small-molecule multitargeted tyrosine kinase inhibitor.Apatinib has demonstrated encouraging antitumor activities.This study aimed to observe the efficacy and safety of apatinib for the treatment of multiple brain micrometastases.CASE SUMMARY We report two patients with multiple brain micrometastases after failure of second-line treatment.Both patients had extracerebral metastases.When the patients took 250 mg/d apatinib orally,the intracerebral lesions disappeared.The extracerebral lesions were partially alleviated.Both patients had a progressionfree survival of more than 12 mo and were still stable.The safety was good.The main adverse events(AEs)were mild hypertension and proteinuria,which could be controlled.CONCLUSION Apatinib has clear efficacy and good tolerance in patients with multiple brain micrometastases after failure of second-line treatment.     

青霉素的发现及应用

青霉素能杀灭各种病菌,却对人体几乎没有毒性,因此是迄今为止在临床上应用最为广泛的抗生素.历史上,它的发现及应用与3个人密不可分.他们分别是亚历山大·弗莱明(Alexander Fleming)、霍华德·弗洛里(Howard Florey).恩斯特·钱恩(Ernst Chain).     

乙型肝炎病毒YMDD变异与ALT,HBeAg及病毒载量的关系探讨

目的 研究拉米夫定治疗慢性乙型肝炎期间乙肝病毒YMDD变异的情况及其与临床的关系.方法 选择治疗前YMDD变异阴性者拉米夫定治疗18 mo的病例271例,测定ALT,YMDD变异,HBeAg及HBV-DNA定量,观察其YMDD变异发生的情况.结果 YMDD变异阳性组的HBV-DNA复制量和ALT明显高于YMDD变异阴性组,HBeAg 转阴率%则明显低于YMDD变异阴性组.结论 用拉米夫定治疗慢性乙型肝炎可能发生YMDD变异,YMDD变异可使患者的肝功能恶化,HBV病毒复制水平提高并影响拉米夫定对乙型肝炎的治疗效果.     

金属桩钉MTA粘固后的抗微渗透效果

背景:MTA (Mineral trioxide aggregate)是一种新型的无机三氧化物聚合体,以往研究表明,它作为根尖倒充材料,相比银汞合金、氧化锌丁香油水门汀具有更好的边缘密合性.目的:实验拟观察金属桩钉以MTA粘固后的抗微渗透作用.设计:对比观察性实验.单位:湖北省荆州市中心医院.材料:搜集本院2004年的正畸治疗拔除牙,筛选出牙体完整、牙根粗壮无弯折、无折裂的下颌第一磨牙32颗:MTA(美国 Dentsply公司).用于对照的粘固剂分别为磷酸锌水门汀(上海齿科材料厂)、玻璃离子水门汀(上海青蒲齿科材料厂)、EB复合树脂(解放军第四军医大学口腔医院齿科材料厂).方法:取出保存的已切除牙冠的32颗离体单根恒牙行根管充填后,分别取模制作镍铬合金铸造桩钉.牙根随机分为磷酸锌水门汀组,玻璃离子水门汀组,EB复合树脂组,MTA组,每组8枚.分别按说明书要求调拌粘固剂,将桩钉粘固于相应的牙根根管内,室温下固化,刮除牙根断面上多余粘固剂.主要观察指标:用染料渗透法检测4种不同粘固剂作为铸造桩钉粘固剂的微渗透情况.结果:用MTA粘固铸造桩定时的微渗透最小,封闭效果最好;用磷酸锌水门汀粘固时的微渗透最大.微渗透深度由浅到深依次为MTA相似文献   

Incidence,risk factors,and outcome of BK polyomavirus infection after kidney transplantation

BACKGROUND Polyomavirus-associated nephropathy is a leading cause of kidney allograft failure. Therapeutic options are limited and prompt reduction of the net state of immunosuppression represents the mainstay of treatment. More recent application of aggressive screening and management protocols for BK-virus infection after renal transplantation has shown encouraging results. Nevertheless,long-term outcome for patients with BK-viremia and nephropathy remains obscure. Risk factors for BK-virus infection are also unclear.AIM To investigate incidence, risk factors, and outcome of BK-virus infection after kidney transplantation.METHODS This single-centre observational study with a median follow up of 57(31-80) mo comprises 629 consecutive adult patients who underwent kidney transplantation between 2007 and 2013. Data were prospectively recorded and annually reviewed until 2016. Recipients were periodically screened for BK-virus by plasmaquantitative polymerized chain reaction. Patients with BK viral load ≥ 1000 copies/mL were diagnosed BK-viremia and underwent histological assessment to rule out nephropathy. In case of BK-viremia, immunosuppression was minimized according to a prespecified protocol. The following outcomes were evaluated: patient survival, overall graft survival, graft failure considering death as a competing risk, 30-d-event-censored graft failure, response to treatment,rejection, renal function, urologic complications, opportunistic infections, newonset diabetes after transplantation, and malignancies. We used a multivariable model to analyse risk factors for BK-viremia and nephropathy.RESULTS BK-viremia was detected in 9.5% recipients. Initial viral load was high(≥ 10000 copies/mL) in 66.7% and low(< 10000 copies/mL) in 33.3% of these patients.Polyomavirus-associated nephropathy was diagnosed in 6.5% of the study population. Patients with high initial viral load were more likely to experience sustained viremia(95% vs 25%, P < 0.00001), nephropathy(92.5% vs 15%, P <0.00001), and polyomavirus-related graft loss(27.5% vs 0%, P = 0.0108) than recipients with low initial viral load. Comparison between recipients with or without BK-viremia showed that the proportion of patients with Afro-Caribbean ethnicity(33.3% vs 16.5%, P = 0.0024), panel-reactive antibody ≥ 50%(30% vs14.6%, P = 0.0047), human leukocyte antigen(HLA) mismatching > 4(26.7% vs13.4%, P = 0.0110), and rejection within thirty days of transplant(21.7% vs 9.5%; P= 0.0073) was higher in the viremic group. Five-year patient and overall graft survival rates for patients with or without BK-viremia were similar. However,viremic recipients showed higher 5-year crude cumulative(22.5% vs 12.2%, P =0.0270) and 30-d-event-censored(22.5% vs 7.1%, P = 0.001) incidences of graft failure than control. In the viremic group we also observed higher proportions of recipients with 5-year estimated glomerular filtration rate < 30 mL/min than the group without viremia: 45% vs 27%(P = 0.0064). Urologic complications were comparable between the two groups. Response to treatment was complete in55%, partial in 26.7%, and absent in 18.3% patients. The nephropathy group showed higher 5-year crude cumulative and 30-d-event-censored incidences of graft failure than control: 29.1% vs 12.1%(P = 0.008) and 29.1% vs 7.2%(P <0.001), respectively. Our multivariable model demonstrated that Afro-Caribbean ethnicity, panel-reactive antibody > 50%, HLA mismatching > 4, and rejection were independent risk factors for BK-virus viremia whereas cytomegalovirus prophylaxis was protective.CONCLUSION Current treatment of BK-virus infection offers sub-optimal results. Initial viremia is a valuable parameter to detect patients at increased risk of nephropathy. Panelreactive antibody > 50% and Afro-Caribbean ethnicity are independent predictors of BK-virus infection whereas cytomegalovirus prophylaxis has a protective effect.     

Overexpression of HSP27 and HSP70 is associated with decreased survival among patients with esophageal adenocarcinoma

BACKGROUND Overexpression of heat shock proteins(HSPs) is associated with several malignancies and contributes to the development, progression, and metastasis of cancer, in addition to the inhibition of cellular death. In recent years, there has been active research into using HSP inhibitors in several malignancies. Due to the poor prognosis of esophageal adenocarcinoma(EAC), it would be valuable to find new biomarkers for the development of cancer treatments.AIM To evaluate the expressions of HSP27 and HSP70 and their effect on survival in EAC.METHODS Immunohistochemical analyses and evaluations of HSP27 and HSP70 expression were performed on all available samples from 93 patients diagnosed with EACbetween 1990 and 2007 at two university hospitals. Fifteen cases with Barrett's metaplasia and 5 control cases from the same patient population were included in the analysis. HSP expression was quantitatively assessed and classified as high or low. Kaplan-Meier analyses and Cox regression models adjusting for age and sex as well as tumor site, stage, and grade were used to evaluate the effect on survival.RESULTS Tumor stage and surgical treatment were the main prognostic factors. High HSP27 expression in cancer cases was a strong negative predictive factor, with a mean survival of 23 mo compared to the 49 mo in cases with a low expression(P= 0.018). The results were similar for HSP70, with a poorer survival of 17 mo in cases with high HSP70 expression, in contrast to 40 mo(P = 0.006) in cases with a low expression. A Cox regression survival analysis was performed, adjusting for possible confounding factors, and higher HSP27 and HSP70 expressions remained an independent negative prognostic factor. The HSPs' correlation with survival was not affected by cancer treatments. When the analysis was adjusted for all factors, the odds ratios for HSP27 and HSP70 were 3.3(CI: 1.6–6.6, P =0.001) and 2.2(CI: 1.2–3.9, P = 0.02), respectively.CONCLUSION HSP27 and HSP70 overexpression is associated with poor survival in EAC, which is, to the best of our knowledge, reported for the first time.     

中小型医院检验科队伍建设的探讨

检验科是医院的一个重要医技科室,国际上一般称为医学实验室.中国检验界的专家和教师们又把其称之为临床实验室.美国CLIA88明确指出:"临床实验室是指以诊断、预防或者治疗人类任何疾病和损伤,或者评价人类健康为目的,而对人体的标本进行生物学、微生物学、血清学、化学、血液免疫学、生物物理学、细胞学、病理学检查或其他检查的机构."     

上海市2007年自杀患者的初步流行病学调查

目的 探讨上海市2007年自杀患者的流行病学特征.方法 以本市急救中心2007年记录完整且初步诊断为各种伤害的病例数据和同期全市人口数据为基础,对其中的自杀患者相关资料进行回顾分析.结果 一年中本市因各种伤害而需者共有32 484例,分别为创伤30 742例(94.64%)、中毒1208例(3.72%)、自杀347例(1.07%)、中暑117例(0.36%)、电击伤35例(0.11%)和溺水35例(0.11%).自杀患者男女比为3.96:1,老年和青年人自杀的比例显著高于中年人和少儿.自杀患者的高峰日期和时点分别为05-29和17:51.结论 上海市自杀患者有其自身的流行病学特点,应建立一个全市较为完善的自杀伤害监测网络.     

成功抢救中药中毒致持续性室速 室颤1例

1 病例介绍 患者,男性,57岁.2006-10-31因心律失常、心源性休克急诊入院.患者既往健康.入院当天10:00服用个体中医诊所配制治疗腰椎间盘脱出的中药(组成:乳香、 没药、川芎、桂枝、赤芍、当归、元胡、山参、忍冬藤、落石藤、青峰藤、海峰藤、王不留行、续断、桑继生、伸筋草、桑枝、 桑叶及滑石粉,量不详).患者大约在服药后1 h出现胸闷、心悸症状,继而恶心、呕吐、大汗、肢端麻木.     

小型节能头灯的制做与应用

医院(特别是儿童医院)在日常的诊断和治疗护理工作中,需要在小局部范围、短时间光源照明.目前市场上各种医用头灯存在着价格昂贵,使用不方便;我院医护人员在加05年10月至2007年3月使用我院自行研制的节能头灯,采用现代电子技术,在夜间给病人注射、换药和其他治疗以及查房巡视等小范围用光场合,取得了良好的效果.     

Excellent response of severe aplastic anemia to treatment of gut inflammation: A case report and review of the literature

BACKGROUND Cumulative evidence suggests that the aberrant immune responses in acquired aplastic anemia(AA) are sustained by active chronic infections in genetically susceptible individuals. Recently, the constant source to trigger and sustain the pathophysiology has been proposed to come from the altered gut microbiota and chronic intestinal inflammation. In this case, our serendipitous finding provides convincing evidence that the persistently dysregulated autoimmunity may be generated, at least in a significant proposition of AA patients, by the altered gut microbiota and compromised intestinal epithelium.CASE SUMMARY A 30-year-old Chinese male patient with refractory severe AA experienced a 3-month-long febrile episode, and his fever was refractory to many kinds of injected broad-spectrum antibiotics. When presenting with abdominal cramps, he was prescribed oral mannitol and gentamycin to get rid of the gut infection. This treatment resulted in a quick resolution of the fever. Unanticipatedly, it also produced an excellent hematological response. He had undergone three episodes of recurrence within the one-year treatment, with each recurrence occurring 7-8 wk from the gastrointestinal inflammation eliminating preparations. However,subsequent treatments were able to produce subsequent remissions and consecutive treatments were successful in achieving durative hematological improvements, strongly indicating an etiological association between chronic gut inflammation and the development of AA. Interestingly, comorbid diseases superimposed on this patient(namely, psychiatric disorders, hypertension,insulin resistance, and renal dysfunction) were ameliorated together with the hematological improvements.CONCLUSION Chronic gut inflammation may be responsible for AA pathogenesis. The comorbidities and AA may share a common etiological association.     

Acute distal common bile duct angle is risk factor for postendoscopic retrograde cholangiopancreatography pancreatitis in beginner endoscopist

BACKGROUND Post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP)is a critical and poorly managed complication of ERCP.Endoscopists need to understand the risk factors for PEP.However,the majority of studies investigating ERCP-related risk factors have included well-trained endoscopists,with the issue of endoscopist experience on PEP incidence not having been systematically evaluated.AIM To explore the risk factors for PEP in beginner endoscopists without supervision.METHODS We performed a retrospective analysis of 293 patients,with naïve papilla and no history of pancreatitis,treated using bile duct cannulation.Patients were classified according to the endoscopist’s experience(beginner vs expert).The angle of the distal common bile duct(CBD)was measured as the angle between the lower wall of the bile duct and a vertical line extending to the lower wall of the bile duct on coronal view computed tomography.RESULTS After propensity matching,there were no differences between patients treated by the expert and beginner endoscopist with regard to age,sex,mean bile duct dilatation,and ratio of benign disease.The distal CBD angle was classified as acute(>30º)or obtuse(≤30º),based on the mean angle of 29.9ºfor the group.An acute distal CBD angle was a significant risk factor for PEP for beginner(P=0.049),but not expert.CONCLUSION For beginner endoscopists first performing unsupervised ERCP,cases with an obtuse distal CBD angle may be more appropriate to lower the risk of PEP.