反复水肿、蛋白尿,伴腹胀、腹痛、便血

青年男性,临床表现激素依赖、反复复发的肾病综合征,每次复发均合并腹痛、腹胀、腹泻及血便等消化道症状.治疗后消化道症状随肾脏疾病的缓解而好转,最终诊断为IgA肾病(微小病变型)合并缺血性肠病.     

反复黄疸、上腹痛伴肾病综合征

33岁男性患者,胰、胆管、胆囊、肺和肾脏等多系统受累,哮喘病史多年.消化系统有梗阻性黄疸,伴腹部疼痛,CT示胰腺炎,胰腺弥漫性肿大,胰腺病理示少量浸润细胞,但可见纤维化;胆囊活检病理示IgG4阳性浆细胞＞50个/HP.肾脏病以肾病综合征起病,肾功能正常,肾活检病理示肾小球膜性病变.血清IgG4水平明显升高,最终诊断为IgG4相关性疾病.     

Right upper quadrant abdominal pain not due to gallstones

Opinion statement Patients with typical biliary colic, ie, episodic pain in the right upper abdominal quadrant with radiation to the right shoulder or right subscapular region, commonly have gallbladder stones. When a good-quality transabdominal ultrasonography fails to find gallstones, the clinical diagnosis remains uncertain, but a large portion of these patients will be found to have subtle gallbladder disease (acalculous or microcalculous) or other pancreatobiliary disease.     

Factors relevant to persistent upper abdominal pain after cholecystectomy

Background

Cholecystectomy is a routine procedure for treatment of upper abdominal pain (UAP) and other atypical symptoms associated with gallstones. UAP, however, persists in some cases postoperatively. The present study was to identify the risk factors relevant to persistent UAP after cholecystectomy.

Back pain and spinal pathology in patients with functional upper abdominal pain

Thirty-nine hospital outpatients with upper abdominal pain without demonstrable organic abdominal abnormalities and 28 healthy controls were compared blindly with regard to back pain and back abnormalities when subjected to a standardized physical examination of the spine. Seventy-two per cent of the patients versus 17% of the controls were troubled with back pain (P less than 0.001). Seventy-five per cent of the patients with back pain actually had abnormalities revealed at the physical examination, indicating that some organic mechanisms are involved in back pain. Most of the findings were localized to the lower thoracic and thoracolumbar segments, the same segments that innervate the upper gastrointestinal tract. This suggests the existence of a connection between abdominal pain and back pain. Viscerosomatic or somatovisceral reflexes with trigger zones either in the viscera or in the skin, muscles, tendons, or ligaments could be part of the pathophysiology in this syndrome. Fifty-one per cent of the patients had symptoms of irritable bowel syndrome, and 41% had heartburn, which was significantly related to the experience of back pain.     

Predictors for the course of chronic non-organic upper abdominal pain

A group of outpatients with chronic non-organic upper abdominal pain was followed up 5-7 years after the index investigation, to evaluate the predictive value of several variables on the basis of a questionnaire and a laboratory pain study. Fifty-four per cent had symptoms of irritable bowel syndrome. A low pain tolerance measured with an ischemic pain technique significantly predicted a poor course of the disease (P = 0.03). So did a high score indicating psychic vulnerability (P = 0.02) and two social factors: poor school and vocational education (P less than 0.01). Without significant predictive value were level of abdominal pain rated on a visual analogue scale, length of dyspepsia history, bowel habits, relation of pain to meals and to life events, heartburn, headache, back pain, dysmenorrhea, paresthesias in fingers or feet, present occupation, sex, marital status, days absent from work because of the disease, and consumption of tranquilizers, cigarettes, and alcohol. The findings indicate that psychologic factors and a low pain tolerance may be elements in this poorly understood syndrome. This is supported by earlier findings of a decreased pain tolerance and an elevated psychologic score in this group compared with controls.     

临床病例讨论：腹胀、右上腹疼痛、肝内占位性病变

原发性肝淋巴瘤（primary hepatic lymphoma,PHL）临床十分少见,约占淋巴瘤的0.4%,仅占肝脏恶性肿瘤之0.1%。本病好发于HBV、HCV或人类疱疹病毒（EB）感染者,也易见于AIDS和其他原因如恶性肿瘤、器官移植术后、原发性胆汁性肝硬化（PBC）、干燥综合征、自身免疫性甲状腺炎等引起的免疫功能缺陷患者。PHL因临床症状、实验室检查及影像学检查均无特异性,难以凭临床资料明确诊断,误诊率极高,常误诊为原发性或转移性肝癌、肝血管瘤,甚至肝炎。PHL虽然十分少见,但其治疗方法及预后与其他肝肿瘤不尽相同。本文通过对1例PHL患者的病例讨论,期望加强临床医师对本病的认识。     

A diagnostic study of patients with upper abdominal pain.

197 consecutive, non-acute, medical patients who presented with upper abdominal pain were subjected to a standard programme of investigation. The investigation represents an attempt to supplement general clinical experience with exact data. In about half the patients no cause of the pain was found and a diagnosis of X-ray negative dyspepsia was made by elimination. It is concluded that a special research effort is needed to explain the complaint in this large group of patients. Duodenal ulcer was twice as common as gastric ulcer, and two patients suffered from gastric cancer. The diagnostic value of the symptomatology was analysed, but only the relation of pain to meals was found to be of diagnostic interest. In particular, the probability of duodenal ulcer was low and that of X-ray negative dyspepsia high, if the pain was provoked by eating. The age, sex, and acid production also had diagnostic value.     

Genotypes of Helicobacter pylori in children with upper abdominal pain

BACKGROUND: Studies related to genotypes of Helicobacter pylori infection and upper abdominal pain (UAP) in children are scarce all over the world. We prospectively analyzed the association between H. pylori infection and UAP in our study group of children and evaluated the vacA genotypes associated with this disorder. METHODS: We investigated 34 children with UAP (group I) and another 110 children as controls without UAP (group II) for H. pylori infection, using antral biopsies by culture, rapid urease tests, histopathology and ureA polymerase chain reaction (PCR). Genotyping was performed using specific cagA and vacA primers on 52 H. pylori strains (group I = 21; 18 boys, mean age 10.33 +/- 2.47 years; group II = 31; boys 21, mean age 9.63 +/- 2.51 years). RESULTS: A significant association between H. pylori infection and UAP was observed when compared to controls (21/34; 61.8%vs 31/110; 28.2%; P = 0.0004). cagA positive H. pylori strains were detected in 20 (95.2%) children with UAP and in 28 (90.3%) controls. Mixed infection was detected in 25% of children with no significant difference between the groups. On univariate regression analysis, s1a, m1 alleles and s1a/m1 genotype of vacA had significant associations with UAP (P = 0.018, 0.015 and 0.007, respectively), while s2 and m2 alleles and the s2/m2 genotype were significantly more frequent in controls (P = 0.034, 0.001 and 0.034, respectively). CONCLUSIONS: H. pylori infection is strongly associated with UAP in children and a significantly higher proportion have s1a, m1 alleles and s1a/m1 genotype. The negative associations of vacA s2, m2 alleles and s2/m2 genotype with UAP indicate that they are unlikely to have an important role in this disorder.     

内镜超声无水酒精注射腹腔神经丛治疗上腹部癌痛

目的探讨内镜超声(EUS)引导下腹腔神经丛注射无水酒精对癌痛的治疗作用.方法选择癌痛病例记录疼痛分数并随访,用纵轴式彩色EUS显示腹主动脉第一分支,在其两侧注射无水酒精.结果10例胰腺癌,1例胆囊癌,1例胃癌.全部病例均有转移征象.注射前疼痛分数(0～10分级)为:胰腺癌6.7 ± 0.3、胆囊癌5.9、胃癌6.0;注射后12周为胰腺癌1.2±1.0、胆囊癌1.3、胃癌1.5.并发症:8例注射后发生体位性低血压,6例出现腹泻,3例出现注射部位轻微渗血,用镜身压迫止血.全部病例无感染及穿孔发生.结论EUS引导下腹腔神经丛注射能够安全有效缓解腹腔内癌痛.