Splenic Injury Following Colonoscopy – An Underdiagnosed,But Soon to Increase,Phenomenon?

INTRODUCTION

We present a case of splenic rupture in a 71-year-old woman admitted 6 days following a diagnostic colonoscopy. She underwent an open splenectomy and made a delayed, but complete, recovery.We proceeded to perform a retrospective review of all relevant literature to assess the frequency of similar post-colonoscopy complications.

MATERIALS AND METHODS

Using relevant keywords, we identified 63 further PubMed reports of splenic injury associated with colonoscopy that were reported in English.

FINDINGS

We have described only the fourth report of splenic injury secondary to colonoscopy from a UK centre. Literature review reveals a mean age of 63 years and a female preponderance for this complication.Most patients present on the day of their colonoscopy with abdominal pain, anaemia, elevated white cell count and Kehr''s sign. CT is the investigation of choice and splenectomy the definitive management of choice. Most patients make a routine recovery, with mortality rates of approximately 8%.There is likely to be an under-reporting of this complication from UK-based centres,with the majority of reports originating from Europe and US.This points to a possible under-diagnosis or under-recognition of this potentially fatal complication. The incidence of such post-colonoscopic complications may increase with the forthcoming introduction of the National Bowel Cancer Screening Programme.     

主动脉夹层患者的心理社会因素分析

目的:探讨分析主动脉夹层患者的心理社会因素的特点。方法:应用临床心理测定工具分别评价62例主动脉夹层患者及62例正常对照人群的生活事件、人格特征、应付方式、社会支持、患病后的心身健康状况及其影响因素。结果:病例组患病前所经历的生活事件频数及紧张值,消极应付方式评分,抑郁及焦虑分值均显著高于对照组(P<0.05)。病例组积极应付评分、社会支持总分低于对照组(P<0.05)。生活事件负性紧张、焦虑和抑郁为主动脉夹层的危险因素,而积极应付方式和社会支持为疾病的保护因子。结论:本研究发现主动脉夹层患者具有特殊的心理社会特征和心身健康状况,除了常规治疗同时,应采取积极的社会心理干预措施。     

Cardiac abnormalities and facial anthropometric measurements in children from the Free State and Northern Cape provinces of South Africa with chromosome 22q11.2 microdeletion

Introduction

Microdeletions of chromosome 22 are common and have a prevalence of at least 1/4 000. Cardiac abnormalities, abnormal facial features and palatal abnormalities are frequently present in these patients.

Aim

To describe the cardiac lesions and selected measurable facial features in children from the Free State and Northern Cape presenting at the Cardiology Unit of the Universitas Academic Hospital complex in Bloemfontein.

Methods

This was a prospective study in which patients with abnormal facial characteristics were tested using a fluorescence in situ hybridisation (FISH) probe for the 22q11.2 microdeletion. Forty children tested positive for the microdeletion. All patients underwent an echocardiogram and where possible, facial anthropometric measurements were performed.

Results

The median age at diagnosis was 3.6 years (range 0.04 years, i.e. 2 weeks to 16.2 years). Tetralogy with or without pulmonary atresia was diagnosed in 43% (n = 17) of the children and truncus arteriosus in 20% (n = 8). A rightsided aortic arch was present in 43% (n = 17) of the patients. Mid-facial height was slightly longer (median z = 1.0; range –0.5 to 3.3) and width narrower (median z = –1.4; range –2.2 to 0.1) than normal. Ear height and width were notably small compared to normal, with median z-scores = –3.3 (range –4.8 to –2.6) and z = –2.4 (range –3.4 to –1.4), respectively.

Conclusions

Microdeletions of chromosome 22q11 are present in children from the Free State and Northern Cape. Conotruncal cyanotic heart lesions, especially tetralogy with or without pulmonary atresia and truncus arteriosus were the most frequent congenital cardiac diagnoses. A right-sided aortic arch was also commonly present in these children. Facial features varied and small ears were the most noteworthy anthropometric feature. A right-sided aortic arch with or without a congenital cardiac lesion, a long, narrow mid-face and small ears should alert the physician to the possibility of a microdeletion on the long arm of chromosome 22.     

抗红花花粉蛋白单克隆抗体的研制

目的：研究红花中过敏原性物质的检测和评价方法,为筛查红花制剂过敏原残留、优化红花制剂工艺、预防红花制剂过敏反应的发生提供新的研究思路和方法。方法：以水煮醇沉法提取红花花粉蛋白,用花粉蛋白免疫小鼠,筛选特异性细胞克隆,扩增、纯化制备抗红花蛋白单克隆抗体。采用酶联免疫吸附剂测定（ELISA）方法检测单克隆抗体对红花抗原的特异性识别情况。结果：3株单克隆抗体均能特异性识别红花抗原。结论：抗红花蛋白单克隆抗体对研究红花过敏反应的发生机理、优化红花制剂工艺及降低过敏反应发生具有重要意义。     

自体造血干细胞移植不同预处理方案治疗恶性淋巴瘤100例临床观察

本研究比较大剂量化疗联合或不联合大面积照射预处理方案对恶性淋巴瘤(ML)患者行自体造血干细胞移植(AHSCT)的疗效、预后及安全性的影响。回顾性分析1992年9月至2010年8月在解放军307医院行AHSCT的100例ML患者,根据AHSCT预处理方案不同,分为高剂量化疗组和高剂量放、化疗组,分析3、5、10年的总生存(OS)率、无进展生存(PFS)率和不良反应。结果表明,截止至2011年2月,中位随访时间33.5个月,所有患者造血功能均获重建。高剂量化疗组和高剂量放、化疗组患者白细胞计数恢复至1.0×109/L的中位时间为(6.0±0.4)d、(8.2±0.4)d,血小板恢复至20.0×109/L的中位时间为(7.1±0.8)d、(11.4±2.5)d,差异均具有统计学意义(P0.05)。高剂量化疗组和高剂量放、化疗组OS率分别为3年67.3%、68.9%,5年62.8%、60.6%,10年57.6%、56.2%;PFS率分别为3年63.6%、63.2%,5年59.4%、58.3%,10年50.8%、55.3%,差异均无统计学意义(P0.05);两组患者发热、感染、出血差异无统计学意义(P0.05)。结论:自体移植预处理方案中的高剂量放、化疗组较高剂量化疗组造血重建晚,但两组疗效及预后无统计学差异。     

Comparison of a Shortened Isosorbide Dinitrate-Potentiated Head-Up Tilt Testing with the Conventional Protocol: Tolerance and Diagnostic Accuracy

Background: The head-up tilt test (HUT) is widely used to investigate unexplained syncope; however, in clinical practice, it is long and sometimes not well tolerated. Objectives: To compare the sensitivity, specificity, accuracy, and patients' tolerance of a conventional and shortened HUT. Methods: Patients with a history of vasovagal syndrome (VVS) were randomized to a conventional HUT (group I) consisting of 20-minute passive tilt followed by 25 minutes after administration of sublingual isosorbide dinitrate (ISDN), or a shortened HUT (group II) where ISDN was given immediately after tilt and observed for 25 minutes. The control group consisted of age- and gender-matched subjects without VVS symptoms. A specific questionnaire to evaluate tolerance was applied. Results: Sixty patients (29 ± 10 years, 82% female) were included. In group I, 22/30 patients had a positive HUT compared to 21/30 in group II (73% vs 70%, P = 0.77). There was also no difference in the accuracy between the two protocols (63% vs 73%, P = 0.24). The time to positivity was shorter in group II (13.2 minutes vs 30 minutes, P < 0.001). Within the control group (n = 60), the frequency of false-positives was 47% and 23% for the conventional and shortened HUT, respectively (P = 0.058). After conventional HUT, 65.2% subjects reported that the test was too long compared to 25% subjects after the shortened HUT (P = 0.002). Conclusion: In this study, the HUT without passive phase was not inferior to the conventional HUT regarding sensitivity, specificity, and accuracy. Furthermore, the shortened ISDN-potentiated protocol allowed faster diagnosis and was better tolerated. (PACE 2012; 35:1005-1011).     

广西不同产地对叶百部的水溶性浸出物、水分及灰分测定

[目的]测定对叶百部的水溶性浸出物、水分、总灰分及酸不溶性灰分的含量.[方法]按《中华人民共和国药典》2010年版一部附录XA中的水溶性浸出物测定法、IX H中水分测定法(烘干法)和附录IX K中的灰分测定法测定.[结果]对叶百部水溶性浸出物含量为53.41％～80.48％,平均值69.61％;水分含量为6.17％～11.25％,平均值为8.41％;总灰分含量为3.61％～10.55％,平均值为6.19％;酸不溶性灰分含量为0.36％～1.85％,平均值为0.84％.[结论]所得结果可为制定该药材质量标准提供科学依据.     

YAP和Caspase在恶性肿瘤中的作用机制及其关联的研究进展

正常情况下细胞增殖与凋亡之间保持着动态平衡,维持着机体的生理状态,细胞异常增殖或凋亡抑制时细胞过度增殖组织异常生长导致肿瘤的发生。Hippo通路是最近发现的一条细胞信号传导通路,主要功能有调控器官体积、保持细胞增殖凋亡平衡、细胞接触性抑制的调节等。YAP是Hippo通路上的重要因子,YAP表达异常可导致Hippo通路不能正常发挥作用而细胞异常增殖导致肿瘤的发生。Caspase是与细胞凋亡密切相关的蛋白水解酶家族,一般以酶原形式存在,在凋亡信号的作用下激活启动型Caspase引发Caspase级联反应导致细胞凋亡,其功能异常导致各种相关疾病的发生。本文将介绍Hippo通路的主要组成及其作用机制,YAP和Caspase基因的作用机制及其与肿瘤发生发展的相关性。     

不同咽喉入路方式在声门上型喉癌手术中的应用

目的分析声门上型喉癌保留喉功能手术中进入咽喉腔的合理入路。方法对21例行声门上喉部分切除术的患者分别采用会厌谷入路、声带前连合上方入路及咽侧入路进入咽喉腔,完整切除肿瘤并行相应修复方式,保留喉功能。结果所有患者手术顺利,术中进入咽喉腔及肿瘤切除的过程中符合肿瘤切除的"无瘤"原则,术后病理未出现手术切缘阳性,无咽瘘。全部患者均于术后10～30 d拔除鼻饲管经口进食,20例患者于术后14～60 d拔除气管套管,所有患者均发音成功。结论声门上型喉癌行保留喉功能手术时,根据肿瘤原发部位及局部浸润情况,采取不同入路进入咽喉腔既获得了满意的手术视野及疗效,同时遵循了肿瘤切除的"无瘤"原则。     

Broadening the spectrum of controls for skin biopsy in painful neuropathies

Epidermal nerve fiber density (ENFD) is useful in the evaluation of small‐fiber neuropathies (SFSNs). A recent evidence‐based review highlighted the need to broaden the spectrum of ENFD controls to include lower limb pain states other than polyneuropathy. We studied epidermal innervation in multiple sclerosis (MS) and distal lower limb burning pain (DLLBP). Distal‐leg ENFD/morphology in MS DLLBP patients did not differ significantly from that of healthy controls. This study extends the range of ENFD controls and further supports use of ENFD assessment in SFSN. Muscle Nerve, 2010