乳糜泻治疗进展

乳糜泻是一种独特的自主免疫性疾病。目前认为可发生于各个年龄段,可以影响多个种族,临床表现也各不相同。乳糜泻的治疗以饮食营养治疗为主,例如去谷蛋白饮食治疗,但去谷蛋白治疗具有很大的局限性和弊端。随着对乳糜泻研究的深入,替代终生去谷蛋白饮食疗法和非饮食疗法等其他方法使乳糜泻患者的治疗有了新的进展。     

儿童乳糜泻的肝脏损害

乳糜泻(CD)是由遗传因素(易患基因)和环境因素(摄入麸质蛋白)共同作用而引发的自身免疫性肠病。其临床表现多样,可涉及多个器官和系统。而肝脏损害是儿童CD最常见的肠外表现之一。部分患儿缺乏胃肠道症状,仅表现为肝脏损害,且其表现可以从轻到重。大多数患儿坚持终身无麸质饮食可使病情得到有效缓解。然而延误诊治可使肝脏损害加重,严重时需要进行肝移植治疗。因此,未来对不明原因的肝脏损害患儿应常规进行CD的相关检测,这对早期诊断和改善CD相关的慢性和严重肝病的预后起重要作用。     

Prevalence of Celiac Disease in Children with Unexplained Failure to Thrive

Background

Gluten sensitive enteropathy or celiac disease (CD) is a disorder of small bowel that occurs upon exposure to gluten. A total of 67 children of either sex in the age group of 1–12 years with unexplained failure to thrive were studied for the prevalence of CD.

Methods

This was a cross-sectional study. It included detailed history, clinical assessment, estimation of anti gliadin (AGA), tissue transglutaminase antibodies (tTGA) and duodenal biopsy. Treatment with gluten free diet and follow-up of diagnosed cases was done for one year.

Result

Sixteen cases (23.88%) had villous atrophy and positive serology, essential criteria for the diagnosis of CD. Forty six (69%) children were between 4–12 years of age. Male to female ratio was 2.3:1. Main symptoms were irritability (63%), diarrhea (56%) and weight loss (56%). Thirty seven (56%) children had weight less than 3^rd percentile. tTGA was 100% sensitive and 90.2% specific. Duodenal biopsy showed decreased villious-crypt ratio in 81.25% and intra epithelial lymphocytosis in 81% children (p<0.000001). All the confirmed cases were advised strict gluten free diet for one year. On follow-up at six months, all children showed improvement in their symptoms and weight gain.

Conclusion

CD is an important cause of unexplained failure to thrive in children.Key Words: Failure to thrive, Celiac disease     

腹部开放伤并海水浸泡对腹腔内脏功能的影响

目的:了解腹部开放伤后海水浸泡对腹腔脏器影响。方法:实验动物致伤后随机分为对照组、生理盐水浸泡组和海水浸泡组。对照组为单纯腹外伤,后两组动物致伤后分别置入生理盐水或海水中,观察血淀粉酶、谷丙转氨酶及尿素水平的变化。结果:对照组、生理盐水浸泡组致伤前后血淀粉酶、谷丙转氨酶、尿素氮水平无明显变化(P>0.05);而海水浸泡组犬血淀粉酶、谷丙转氨酶及尿素氮水平随浸泡时间延长而升高。结论:腹部开放伤海水浸泡可引起机体内脏功能受损。     

腹腔脓肿的CT诊断

目的 分析腹腔脓肿的CT表现,提高腹腔脓肿的CT诊断水平.方法对28例患者37处腹腔脓肿的CT表现进行分析.结果 24处病灶均呈均匀强化的不规则厚壁,并见到少量气体影或气液平面;厚度约为0.1～0.9 cm.结论 CT对腹腔脓肿定位诊断准确,脓肿壁的强化和含气征象为其特征.     

血清-胸(腹)腔积液白蛋白梯度对胸(腹)腔积液性质的诊断价值

目的比较血清-胸(腹)腔积液白蛋白梯度法和传统的渗、漏出液分类法对胸(腹)腔积液性质判断的准确率。方法分别按照血清-胸(腹)腔积液白蛋白梯度法和传统的渗、漏出液的分类方法检测并判断胸(腹)腔积液的性质,对比两种方法的准确率。结果依据血清-胸(腹)腔积液白蛋白梯度法23例漏出液患者被正确诊断(23/25),17例渗出液患者被正确诊断(17/21),总准确率为87.0%。依据传统的渗、漏出液分类法,18例漏出液患者被正确诊断(18/25),13例渗出液患者被正确诊断(13/21),总准确率为67.4%。两种方法准确率间差别有显著性意义(P<0.05)。结论应用血清-胸(腹)腔积液白蛋白梯度法对胸(腹)腔积液性质的准确诊断率优于传统方法,具有重要的临床价值。     

Celiac disease presenting as severe osteopenia

The authors describe a unique presentation of celiac disease as multiple non-traumatic fractures in a young male without gastrointestinal complaints. A 29-year-old man presented with back pain and was found to have a non-traumatic compression fracture of the lumbar and thoracic spine on plain X-ray. Dual-energy x-ray absorptiometry (DXA) confirmed osteoporosis at the L3/L4 vertebral bodies. Parathyroid hormone (PTH), calcium, and vitamin D levels were normal. He had no gastrointestinal complaints, but serologic studies were positive to include an elevated gliadin IgA Ab, gliadin IgG Ab, and an elevated tissue transglutaminase IgA Ab. He was treated with a gluten-free diet, calcium, and vitamin D supplementation as well as teriparatide. Follow up bone density showed improvement and has no further fractures to date. Primary care physicians, gastroenterologists, and endocrinologists must have a high index of clinical suspicion for celiac disease in any patient who presents with low bone density regardless of the serum 25-OH vitamin D levels or presence of gastrointestinal complaints.     

选择性腹腔动脉造影的应用解剖学研究

为提供与选择性腹腔动脉造影插管有关的应用解剖学资料,在56例成人尸体标本上,观测了腹腔动脉起始部位、外径、干长度以及始端与椎骨的对应关系.测量了从腹股沟韧带下方20.0mm处经股动脉插管至腹腔动脉根部的长度和从颈静脉切迹至耻骨联合上缘间的前正中线,分别为301.6±38.7mm和501.6±37.5mm,插管长度与前正中线的自身比例近似于3/5,与前正中线的相关回归分析,相关系数(r)为.52,回归方程式为(?)=155.5 0.31x.     

Celiac disease presenting as acute colonic pseudo-obstruction

Acute colonic pseudo-obstruction rarely presents in children. Upon diagnosis, initiating conservative management and identification of an underlying etiology is mandatory. We describe the case of an 8-year-old girl who presented with signs of acute abdominal distention with no evident etiology. The diagnosis of celiac disease was suspected and confirmed by intestinal biopsy. Based on this case and other reported cases in the literature, we discuss this unusual mode of presentation of celiac disease, the underlying etiology and suggest management options to avoid unnecessary aggressive interventions.     

腹腔动脉的X线解剖学研究及临床意义

目的研究分析腹腔动脉的X线解剖,旨在指导介入治疗.方法对186例肿瘤病人在介入治疗前行腹腔动脉数字减影血管造影(digital subtraction angiography,DSA),其中行肠系膜上动脉DSA 21例.结果腹腔动脉开口位于第12胸椎与第1腰椎平面.由腹腔动脉干分为胃左、脾及肝总动脉三支者占92.4%,发现有47个分支有正常变异.肝固有动脉走行与肝总动脉呈钝角86.1%,肝固有动脉走行与肝总动脉呈锐角13.9%,胃十二指肠动脉与肝总动脉呈钝角67.5%,胃十二指肠动脉与肝总动脉呈锐角32.5%.脾动脉形态常见为上弧型、下弧型、水平、上升型、水平上升型等,少见为波浪型、回旋型.结论腹腔动脉及其分支的X线观察,对肝癌、胃癌等介入治疗具有很重要的意义.     

经腹主动脉腹腔神经丛阻滞术1例报告

经腹主动脉行腹腔神经丛阻滞术1例,成功进行了腹腔神经丛阻滞,并无任何并发症.腹腔神经丛阻滞术是治疗上腹部恶性肿瘤引起的顽固性疼痛的有效方法.特殊情况下可行经腹主动脉腹腔神经丛阻滞术.     

电子计算机断层扫描导向腹腔神经丛阻滞术18例临床应用

目的：应用电子计算机断层扫描（computed tomography,CT)导向下行腹腔神经丛阻滞术（celiac ganglion or plexus block,CGB或CPB）解除或减轻无法手术切除的上腹部恶性肿瘤所致的进行性癌性疼痛,方法：18例上腹部恶性肿瘤患者,在CT导向下行腹腔神经丛阻滞术,通过注射无水乙醇治疗癌性疼痛,结果：术后癌性疼痛消失或明显减轻,有效率达到100%。病人无严重不良反应,仅2例出现一过性低血压,有头晕,恶心的感觉,有1例出现较为剧烈的腹部烧灼感,短时缓解。结论：CPB术能有效地解除上腹部癌性疼痛,临床上又避免使用易成瘾的麻醉止痛药,适于临床推广使用。