Recent Advances for Global Perspectives on Etiology, Pathophysiology, Clinical Presentations, and Management of Moyamoya Disease

Moyamoya disease (MMD) is a condition characterized by the gradual narrowing and blockage of blood vessels in the brain, specifically those in the circle of Willis and the arteries that supply it. This results in reduced blood flow and oxygen to the brain, leading to progressive symptoms and potential complications. The underlying pathophysiological mechanism remains elucidated. However, recent studies have highlighted numerous etiologic factors: abnormal immune complex responses, susceptibility genes, branched-chain amino acids, antibodies, heritable diseases, and acquired diseases, which may be the great potential triggers for the development of moyamoya disease. Its clinical presentation has varying degrees from transient asymptomatic events to significant neurological deficits. Moyamoya disease (MMD) shows different patterns in children and adults. Children with MMD are more susceptible to ischemic events due to decreased blood flow to the brain. Conversely, adults with MMD are more prone to hemorrhagic events involving brain bleeding. Children with MMD may experience a range of symptoms including motor impairments, sensory issues, seizures, headaches, dizziness, cognitive delays, or ongoing neurological problems. Although adults may present with similar clinical symptoms as children, they are more prone to experiencing sudden onset intraventricular, subarachnoid, or intracerebral hemorrhages. One of the challenges in moyamoya disease is the potential for misdiagnosis or delayed diagnosis, particularly when physicians fail to consider MMD as a possible cause in stroke patients. This review aims to provide a comprehensive overview of recent global studies on the pathophysiology of MMD, along with advancements in its management. Additionally, the review will delve into various surgical treatment options for MMD, as well as its rare occurrence alongside atrioventricular malformations. Exciting prospects include the use of autologous bone marrow transplant and the potential role of Connexin 43 protein treatment in the development of moyamoya disease.

Acute mechanical bowel obstruction: Clinical presentation, etiology, management and outcome

AIM: To identify and analyze the clinical presentation, management and outcome of patients with acute mechanical bowel obstruction along with the etiology of obstruction and the incidence and causes of bowel ischemia, necrosis, and perforation. METHODS: This is a prospective observational study of all adult patients admitted with acute mechanical bowel obstruction between 2001 and 2002. RESULTS: Of the 150 consecutive patients included in the study, 114 (76%) presented with small bowel and 36 (24%) with large bowel obstruction. Absence of passage of flatus (90%) and/or feces (80.6%) and abdominal distension (65.3%) were the most common symptoms and physical finding, respectively. Adhesions (64.8%), incarcerated hernias (14.8%), and large bowel cancer (13.4%) were the most frequent causes of obstruction. Eighty-eight patients (58.7%) were treated conservatively and 62 (41.3%) were operated (29 on the first day). Bowel ischemia was found in 21 cases (14%), necrosis in 14 (9.3%), and perforation in 8 (5.3%). Hernias, large bowel cancer, and adhesions were the most frequent causes of bowel ischemia (57.2%, 19.1%, 14.3%), necrosis (42.8%, 21.4%, 21.4%), and perforation (50%, 25%, 25%). A significantly higher risk of strangulation was noticed in incarcerated hernias than all the other obstruction causes. CONCLUSION: Absence of passage of flatus and/or feces and abdominal distension are the most common symptoms and physical finding of patients with acute mechanical bowel obstruction, respectively. Adhesions, hernias, and large bowel cancer are the most commoncauses of obstruction, as well as of bowel ischemia, necrosis, and perforation. Although an important proportion of these patients can be nonoperatively treated, a substantial portion requires immediate operation. Great caution should be taken for the treatment of these patients since the incidence of bowel ischemia, necrosis, and perforation is significantly high.

Analysis of Etiology and Clinical Characteristics of 1170 Patients with Symptomatic Epilepsy in Jianghan Plain

Objective: The etiology, clinical manifestations and treatment of 1170 patients with symptomatic epilepsy were retrospectively analyzed and provided guidance for further treatment of symptomatic epilepsy. Method: A retrospective analysis of 1170 cases of symptomatic epilepsy admitted to the First Affiliated Hospital of Yangtze University from January 2013 to June 2018 was conducted to analyze the etiology, clinical manifestations and treatment of different age groups. Results: Symptomatic epilepsy is high in the elderly, and men are more than women. Among the 1170 patients with symptomatic epilepsy, there were 81 (6.9%) cases of brain injury, 721 (61.6%) cases of cerebrovascular disease, 223 (19.0%) cases of tumor, 59 (5.0%) cases of central nervous system infection, 33 (2.8%) cases of immune metabolic disease, 11 (0.9%) cases of drugs, 6 (0.5%) cases of cortical dysplasia, 6 (0.5%) cases of neurodegenerative disease, 4 (0.3%) cases of parasites, 4 (0.3%) cases of poisons, and 22 (1.9%) cases of other diseases. Among them, central nervous system infection and cerebrovascular disease ranked first among the patients aged 0 - 18 years, followed by immune metabolic diseases;cerebrovascular disease ranked first among the patients aged 19 - 39 years, followed by tumors and brain trauma;cerebrovascular disease ranked first among the patients aged 40 - 65 years, followed by tumors and brain trauma;cerebrovascular disease ranked first among the patients aged over 65 years, followed by tumors, among the types of seizures, 74 (6.3%) cases of tonic seizures, 68 (5.8%) cases of clonic seizures, 856 (73.2%) cases of tonic-clonic seizures, 27 (2.3%) cases of myoclonic seizures, 12 (1.0%) cases of absence seizures, 116 (9.9%) cases of complicated partial seizures, and 17 (1.5%) cases of partial seizures, in addition to the etiology, 795 (67.9%) cases of sodium valproate, 152 (13.0%) cases of carbamazepine, 56 (4.8%) cases of topiramate, 117 (10.0%) cases of levetiracetam, 23 (2.0%) cases of lamotrigine, and 27 (2.3%) cases of others were taken. Conclusion: In symptomatic epilepsy, different age groups have different causes. Among them, cerebrovascular disease, central nervous system infection, brain trauma, and brain tumor are the main causes. The most common type of seizures is the occurrence of tonic-clonic seizures. The most common drugs are sodium valproate and carbamazepine.

Importance of etiologies of secondary diabetes:How often do we think off in clinical practice?

The article"Secondary diabetes due to different etiologies:Four case reports"by Song et al,published in the World Journal of Clinical Cases,delves into the identi-fication of rare causes of secondary diabetes and emphasizes the necessity for healthcare professionals to recognize these conditions.Failure to do so can result in treatment delays and compromised patient outcomes.The article discusses spe-cific types of diabetes,including maturity onset of diabetes in young,pancreas-related diseases,endocrinopathies,drug-induced diabetes,infections,and con-genital genetic syndromes associated with diabetes mellitus.Case summaries highlight how patients with secondary diabetes,stemming from conditions such as Williams-Beuren syndrome and pituitary adenoma,often exhibit distinct characteristics overlooked in clinical practice.The authors stress the importance of a holistic diagnostic approach and advocate for proactive management through early intervention,including genetic tests and antibody detection.Increased awa-reness and education are crucial for timely identification and proper management,ultimately improving patient well-being.These findings prompt a call to action for healthcare professionals to consider rare causes of secondary diabetes,facili-tating better glycemic control and overall patient care.

Etiology and clinical features of viral bronchiolitis in infancy

Background:Bronchiolitis is a common lower respiratory tract infection in infancy.The aim of this review is to present the clinical profile of viral bronchiolitis,the different culprit viruses and the disease severity in relation to the viral etiology.Data sources:Databases including PubMed and Google Scholar were searched for articles about the clinical features of bronchiolitis and its viral etiology.The most relevant articles to the scope of this review were analyzed.Results:Currently there are two main definitions for bronchiolitis which are not identical,the European definition and the American one.The most common viral pathogen that causes bronchiolitis is respiratory syncytiai virus which was identified in 1955;now many other viruses have been implicated in the etiology of bronchiolitis such as rhinovirus,adenovirus,metapneumovirus,and bocavirus.Several studies have attempted to investigate the correlation of bronchiolitis severity with the type of detected virus or viruses.However,the results were not consitent.Conclusions:For the time being,the diagnosis of bronchiolitis remains clinical.The isolation of the responsible respiratory pathogens does not seem to confer to the prognosis of the disease severity.

Epidemiological, Clinical and Etiological Aspects of Adult Hepatomegaly at the Gabriel Touré University Hospital of Bamako in 2023

Summary: Hepatomegaly is one of the clinical signs commonly encountered in chronic liver disease. The aim of our study was to study the epidemiological, clinical and etiological aspects of hepatomegaly in the hepato-gastroenterology department (HGE) of the Gabriel Touré university hospital. This was a cross-sectional study that took place from September 2021 to October 2022 in the department. All patients aged 18 years and older with hepatomegaly, hospitalized or examined by physicians were included. We collected 100 cases of hepatomegaly, representing 3.7% of 2661 patients examined or hospitalized in the HGE department during the study period. These patients had a mean age was 46.7 ± 16.10 years with extremes of 18 and 76 years. The sex ratio was 2.7. Jaundice was the most commonly reported history with a frequency of 26%. Pertaining to patients’ lifestyle, alcohol consumption was the most common feature with 6%. The most common associated clinical signs were jaundice, ascites, and edema of the lower limbs. Painful hepatomegaly (86%), with a sharp lower edge (74%), a firm consistency (69%), and an irregular surface (52%) was frequently observed. Cytolysis (75.5%), increased alphafetoprotein levels (70%), microcytic anemia (37%), hyperleukocytosis (54.3%), and biological hepatocellular insufficiency syndrome (low albumin with 30.4%, high bilirubinemia with 61.2% and low platelets with 33.9%) were the most common observed laboratory abnormalities. Hepatitis B virus markers (61%) were the most frequently found in the study patients. At ultrasound examination, heterogeneous hepatomegaly was observed in 87.3% of the patients. Esophageal varices (43.1%) were more commonly seen than other varices during upper gastrointestinal endoscopy. The dominant etiology was hepatocellular carcinoma on cirrhosis with 66% followed by cirrhosis. Conclusion: Painful hepatomegaly was quite frequently in our urban setting hospital with several etiologies. HCC was the most common etiology, therefore measures to prevent it in the community need to be established by the concerned stakeholders to improve adult population health in Bamako.

Classical clinical signs in rats experimemtally infected with Trypanosoma brucei

Objective:To investigate clinical signs in Trypanosoma brucei infection in albino rats.Methods:Fourteen rats grouped into 2 with 7 rats in each group were used to determine classical clinical manifestation of Trypanosoma brucei infection in rats.Group A rats were uninfected control and Group B rats were infected with Trypanosoma brucei.Results:Parasitaemia was recorded in Group B by(3.86±0.34)d and the peak of parasitaemia was observed at Day 5 post infection.Classical signs observed included squint eyes,raised whiskers,lethargy,no weight loss,pyrexia,isolation from the other rats,and starry hair coat.Conclusions:These signs could be diagnostic or aid in diagnosis of Trypanosoma brucei infection in rats.

Eyelid Wounds: Epidemiological, Clinical and Etiological Aspects

Purpose: The aim is to show epidemiological, clinical and etiological characteristics of palpebral wounds. Methodology: This was a retrospective study focusing on patients with an eyelid wound, over a 10-year period from 2012 to 2021. We collected and analyzed the data using Excel. Results: The frequency of eyelid wounds was 0.1%. The average age of our patients was 19.38 years with a range of 1 and 62 years. The sex ratio was 3.7. Eighty-one percent of patients lived in Dakar. Fifty-seven percent (57%) of patients consulted less than 24 hours after the trauma and 7% of patients on D1. The circumstances were brawls (11%), domestic accidents (9%), road accidents (6%), and work accidents (6%). We noted 1 case of dog bite. Thirteen patients presented with post-traumatic decreased visual acuity. Involvement of the isolated upper eyelid was noted in 40% of cases and both eyelids in 15% of cases. Involvement of the lacrimal ducts was noted in 17% of cases, and that of the free edge in 21% of cases. Eyelid wounds were associated with eyeball damage in 21% of cases. Various associated lesions were observed. Ninety-one percent of patients received surgical treatment. Three cases of superinfections, 1 case of conjunctival granuloma and 1 case of phthysis of the eyeball with postoperative retinal detachment were noted. Conclusion: Eyelid sores are relatively common in our context. They require rapid surgical treatment in order to preserve the functional and aesthetic prognosis. .

Clinical manifestations of patients with chronic pancreatitis

BACKGROUND: Recent advances in molecular and genomic technologies and pancreatic imaging techniques provided some insights into genetic, environmental, immunologic, and pathobiological factors for chronic pancreatitis (CP). This study was undertaken to investigate the clinical manifestations of patients with chronic pancreatitis at our hospital. METHODS: The data of the patients with CP who had been treated at our hospital between 1997 and 2004 were analyzed. RESULTS: The major symptoms of the patients with CP were abdominal pain, dyspepsia, loss of weight, diabetes mellitus, pancreatic pseudocyst, steatorrhea, and calcification. Biliary diseases were found to be the first cause of CP in this study; but alcohol abuse was the major cause of CP in men and biliary diseases were the first etiological factors for CP in women. The etiological difference of constituent ratio between men and women was related to alcohol comsumption (P<0.01). CONCLUSIONS: During the past 8 years, biliary diseases have been the major etiological factors for CP, but their constituent ratio is decreasing, and the constituent ratio of alcohol abuse is increasing gradually. Alcohol tends to replace biliary diseases as the primary etiological factor for CP.

Pituitary stalk interruption syndrome and liver changes:From clinical features to mechanisms

Pituitary stalk interruption syndrome(PSIS)is a rare congenital abnormality characterized by thinning or disappearance of the pituitary stalk,hypoplasia of the anterior pituitary and an ectopic posterior pituitary.Although the etiology of PSIS is still unclear,gene changes and perinatal adverse events such as breech delivery may play important roles in the pathogenesis of PSIS.PSIS can cause multiple hormone deficiencies,such as growth hormone,which then cause a series of changes in the human body.On the one hand,hormone changes affect growth and development,and on the other hand,they could affect human metabolism and subsequently the liver resulting in nonalcoholic fatty liver disease(NAFLD).Under the synergistic effect of multiple mechanisms,the progression of NAFLD caused by PSIS is faster than that due to other causes.Therefore,in addition to early identification of PSIS,timely hormone replacement therapy and monitoring of relevant hormone levels,clinicians should routinely assess the liver function while managing PSIS.

Primary biliary cirrhosis: Clinical and laboratory criteria for its diagnosis

Primary biliary cirrhosis(PBC) is a chronic progressive cholestatic granulomatous, and destructive inflammatory lesion of small intralobular and septal bile ducts, which is likely to be caused by an autoimmune mechanism with a the presence of serum antimitochondrial antibodies and a potential tendency to progress to cirrhosis. Despite the fact that the etiology of this disease has beenunknown so far, there has been a considerable body of scientific evidence that can reveal the clinical and laboratory signs of PBC and the individual components of its pathogenesis and elaborate diagnostic criteria for the disease and its symptomatic therapy. Deficiencies in autoimmune tolerance are critical factors for the initiation and perpetuation of the disease. The purpose of this review is to summarize the data available in the literature and the author's findings on clinical and laboratory criteria for the diagnosis of PBC. This review describes the major clinical manifestations of the disease and the mechanisms of its development. It presents the immunological, biochemical, and morphological signs of PBC and their significance for its diagnosis. A great deal of novel scientific evidence for the problem of PBC has been accumulated. However, the inadequate efficiency of therapy for the disease lends impetus to the quest for its etiological factors and to further investigations of its pathogenetic mechanisms and, on this basis, to searches for new methods for its early diagnosis.

Retrospective Study of clinical and hematological aspects associated with dogs naturally infected by Hepatozoon canis in Ludhiana,Punjab,India

Objective:To evaluate clinical and hematological aspects of dogs naturally infected with Hepatozoon canis(H.canis)presented at the Small Animal Clinics of Guru Angad Dev Veterinary and Animal Sciences University,Ludhiana.Methods:Blood films of 34 naturally infected dogs were examined for haematological alterations and parasitaemia.Signalment and clinical signs were recorded from the animals.Clinical histories were filled oul during the consultation.Results:Of the 34 positive dogs by Giemsa stained peripheral blood films.88.23%presented parasilaemia by H.canis only,while 11.77%had the combination of H.canis,Babesia sp.and Ehrlichia sp.Young male dogs less than oue-year-old,of nondescript breed,were the most commonly affected.And 26.47%were presented with anorexia/inappetence as the only clinical symptom.Other clinical symptoms were mild to moderate fever,pale mucosae and lethargy;a few were also showing the signs of vomiting and diarrhoea.Haematological alterations showed mainly normochromic-normocytic anaemia,leukocytosis and neutrophilia.Conclusions:The findings of this study substantiate that H.canis caused clinical and haematological alterations of the varied intensity in dogs,even with low parasilaemia.should he taken into consideration.

Symptoms and signs of acute alcoholic hepatitis

Although there is not one specific sign or symptom related to alcoholic hepatitis(AH),a constellation of symptoms and signs can help make the diagnosis of AH with reasonable accuracy.Documentation of chronic and active alcohol abuse is paramount in making a diagnosis of AH.Clinical presentation after abstinence for more than 3 m should raise doubts about the diagnosis of AH and dictate the need for considering other causes of liver disease,decompensation of alcoholic cirrhosis,sepsis and malignancy as the cause of patient's clinical profile.

Clinical and Epidemiological Evolution of Sheep Pox in Morocco

Sheep pox is an infectious viral disease that affects specifically sheep and it is caused by the Capripoxvirus genus.The clinical signs include fever,diarrhea,difficulty breathing,nodules,lung lesions and death.In Morocco,the 2010 epidemic of sheep pox was characterized by the emergence of a nodular form of the disease.The local strain was isolated and the analysis of affected animals was positively confirmed by virus isolation and real-time polymerase chain reaction(RT-PCR).The epidemiological analysis of 911 data records showed that the virus is endemic in the country;an average of 350 cases per year with an epizootic evolution was observed in 2010.The incidence varies depending on provinces and the disease appears confined to the central and the eastern regions of the country where a very intensive sheep breeding activity is taking place.The statistical analysis showed that there is a positive correlation between the endemicity and the significant factor of the rural market(p=0.006).The annual average morbidity and mortality rates were 2.96%(1.26%to 4.32%)and 0.71%(0.41%to 0.94%),respectively.The clinical findings associated to the epidemiological data analysis confirmed the presence of sheep pox in its nodular form and suggest that new pathogenic strains may have been introduced from Mauritania.The purpose of this work was to provide a better description of the spatiotemporal evolution of sheep pox disease based on some epidemiological indicators and to put forward plausible hypotheses regarding the emergence of the virus in order to implement an adequate control strategy.

Risk and benefit from clinical trials in minors:Making the case for transparent and consistent publications

Rationale, aim and objectives: The European (EU) regulation on medicinal products for pediatric use (EC 1901/2006), which became effective in 2007, aimed to stimulate the clinical testing of medications in minors in order to reduce off-label use. In consequence, the number of minors taking part in randomized controlled clinical trials (RCTs) is likely to increase. Clinical trials in minors require a complex methodological design, a careful consideration of risks and benefits and a high level of ethical reflection. Unfortunately, as to the quality of clinical trials and their publications in minors little is known. Therefore, we assessed published reports of randomized, controlled clinical trials in minors, focusing on a common disease (asthma) and a defined spectrum of lifethreatening diseases (malignant diseases). Method: In an exploratory design, we scanned the publications for methodological aspects as well as indicators of ethical soundness, e.g., statements that informed consent had been obtained before the start of the trial or that a Data and Safety Monitoring Board ensured the patients’ safety during the trial. We also looked for passages reflecting the debate on equipoise or other forms of weighing risks and benefits. Results: We found that many of these aspects, which according to the scientific literature and generally acknowledged guidelines are essential to ensure good-quality trials and trial reports, were not considered in the publications analyzed. Conclusion: Therefore, we call for a more transparent and consistent presentation of the trials, especially of safety aspects, relying on a more critical and transparent ethical reflection.

Epidemiological, Clinical and Etiological Aspects of Non-Traumatic Comas in Children at the Pediatric Teaching Hospital in Bangui

Background: Non-traumatic coma is the most common pediatric medical emergency. Its clinical diagnosis is easy. The difficulty lies in finding the etiology. Objective: To determine the prevalence and clinical profiles of non-traumatic Coma at the Centre Hospitalier Universitaire Pédiatrique de Bangui (CHUPB). Methodology: This was a descriptive and analytical cross-sectional study conducted between January 1 and June 31, 2021, at CHUPB. Children aged 1 month to 15 years, admitted to the emergency room with a Glasgow score less than or equal to 8 without any traumatism were included. The variables studied were sociodemographic, clinical and paraclinical. Data were entered and analyzed using SPSS 20.0 statistical software. The statistical test used was Pearson’s chi2, any p-value Results: Of 8551 children hospitalized during the study period, 370 were hospitalized for non-traumatic coma: 4.32%. They were divided into 57.5% (n = 213) boys and 42.44% (n = 157) girls, giving a sex ratio of 1.35. Their mean age was 35.95 ± 27.21 months. Children aged 1 to 24 months represented 54.59% (n = 202) of cases. The mean time to the consultation was 2.91 days ± 1.8. Fever 86.48% (n = 320) and convulsions 80% (n = 296) were the main reasons for consultation. Coma stages II - III and IV represented 52.44% (n = 194), 42.97% (n = 159) and 4.59% (n = 17) respectively. Neuromalaria (29.72%;n = 110), meningitis-meningoencephalitis-encephalitis (30%;n = 111), sepsis (19.72%;n = 73) and acidosis Coma (5.40%;n = 20) were the main etiologies. Conclusion: Non-traumatic coma is common at CHUPB. Infections were the main etiology, particularly cerebral malaria. The reduction of its frequency requires, among others, the strengthening of the national monitoring malaria program. The strengthening of the technical platform for a good etiological diagnosis constitutes the other axis of prevention.

甘肃省县(区)级结核病定点医院病原学阴性肺结核诊断质量调查分析

目的:分析甘肃省县(区)级结核病定点医院病原学阴性肺结核诊断质量,以进一步提高病原学阴性肺结核诊断质量。方法:采用现况调查方法,从“结核病信息管理系统”中收集2021年甘肃省登记的活动性肺结核患者,采用分层整群抽样方法,从甘肃省中部、西部和东部各抽取3个市(州),每个市(州)选择患者数前三位的3家县(区)级结核病定点医院作为调查点,由调查员通过“甘肃省病原学检测阴性肺结核患者现场调查表”现场收集各调查点登记的信息资料完整的病原学阴性肺结核(除外气管支气管结核和结核性胸膜炎)患者资料,从诊断流程、诊断依据、实验室检查、影像学诊断和诊断性抗感染治疗等5个方面进行病原学阴性肺结核诊断质量评价。结果:共收集到26家县(区)级定点医院符合调查标准的1187例病原学阴性肺结核患者作为调查对象。其中,诊断流程规范者941例(79.28%);诊断依据符合要求者699例(58.89%);病原学检查者1176例(99.07%),其中,行痰涂片镜检、分枝杆菌培养、分子生物学检查和结核病灶组织病理检查者分别为1169例(98.48%)、368例(31.00%)、900例(75.82%)和103例(8.68%),痰涂片质量合格者1084例(91.32%);至少选择1项结核病免疫学检查者958例(80.71%),其中,行结核菌素试验、抗结核抗体和γ-干扰素释放试验检查者分别为724例(60.99%)、574例(48.36%)和382例(32.18%),阳性者分别为572例(79.01%)、187例(32.58%)和329例(86.13%);行支气管镜和胸腔积液检查者分别为198例(16.68%)和29例(2.44%),均未检出阳性者;影像学检查者1187例(100.00%),其中,胸部X线摄影(简称“胸片”)检查率[73.21%(869/1187)]和合格率[85.04%(739/869)]均明显低于CT检查[分别为99.16%(1177/1187)和92.78%(1092/1177)],差异均有统计学意义(χ^(2)=335.585,P=0.000;χ^(2)=31.829,P=0.000)。诊断小组讨论1166例(98.23%)患者,建议进行诊断性抗结核治疗者626例,实际治疗者563例(89.94%)。结论:甘肃省县(区)级结核病定点医院对病原学阴性肺结核相关实验室检查以痰涂片和分子生物学检查为主,CT检查率和合格率均较高,但分子生物学检查率、诊断流程规范率和诊断依据符合率仍有较大提升空间,建议加强县(区)级结核病定点医院检测规范和技术人员培训,严格执行结核病相关检查流程,以进一步提升病原学阴性肺结核诊断质量。

消化道颗粒细胞瘤临床特征分析

目的分析消化道颗粒细胞瘤(GCT)的临床特征,提高对消化道GCT的认识及其临床诊治水平。方法回顾性分析经病理确诊为消化道GCT病人22例的临床资料。结果22例病人中男17例,女5例,平均年龄(49.36±8.45)岁;发病部位为食管17例(77.27%),回盲部2例(9.09%),结肠3例(13.64%)。17例病人表现为非特异性消化道症状,内镜下病灶最大径0.29~2.00 cm。22例行CT检查,6例食管壁略增厚,1例盲肠壁略增厚,余15例未见明显异常。1例行PET-CT检查,食管下段轻度增厚,结节状代谢增高,SUVmax约2.1。22例行内镜检查,病灶黄色15例(68.18%),白色7例(31.82%)。13例行超声内镜(EUS)检查,病变起源于黏膜下层7例(53.84%),黏膜肌层5例(38.46%),固有肌层1例(7.70%);病变低回声12例(92.30%),低回声混有少量高回声改变1例(7.70%),回声均匀10例(76.92%),回声欠均匀3例(23.08%)。免疫组化检查显示,所有病灶均表达S100,部分表达CD68、SOX10、Ki-67、SDHB、CD34。20例行内镜下治疗,1例行手术治疗,1例随访。病人随访7~69个月,中位随访时间为23个月,除1例病人化疗后失访,余均未见肿瘤复发及转移。结论消化道GCT以男性为主,临床症状无特异性,内镜、EUS检查相结合可提高对其诊断率,确诊需依据病理学及免疫组化检查,内镜下治疗是安全有效的方法。

洛阳市1例华支睾吸虫病误诊误治为弓形虫病的调查报告

华支睾吸虫病是由华支睾吸虫感染人和动物引起肝胆病变的一种食源性寄生虫病,多由于人和动物生食或半生食淡水鱼肉引起,在洛阳地区较为少见,临床表现以消化系统病变为主。本文报道了1例33岁男性华支睾吸虫病患者,发病前有食用生鱼片的流行病学史,临床症状和体征以腹部不适和肝胆系统损害为主,淋巴结肿大,实验室检查表现为肝功能异常,嗜酸细胞百分比、嗜酸细胞计数升高,C反应蛋白升高。采用肝吸虫抗体检查,但是因和弓形虫病、肺吸虫病存在抗体交叉反应,造成首次住院误诊误治。患者经吡喹酮片治疗后痊愈,出院38 d后复查,各项指标正常。建议对华支睾吸虫病患者采用诊断性治疗,吡喹酮片是治疗华支睾吸虫的特效药。借此病例报道提醒临床医生提高对华支睾吸虫病认识的敏感性,以减少漏诊和误诊。

新疆伊犁地区难治性反流性食管炎影响因素分析

目的分析新疆伊犁地区反流性食管炎(RE)病因特点,探讨难治性反流性食管炎(RRE)主要危险因素,为RRE诊治提供依据。方法回顾性收集2023年1月至12月新疆伊犁地区第四师医院、新疆伊犁哈萨克自治州友谊医院、新疆伊犁哈萨克自治州新华医院门诊及住院收治的RE患者713例,根据8周标准质子泵抑制剂治疗是否有效将患者分为普通组和难治组。比较两组一般资料,采用logistic回归分析RRE的影响因素。结果713例RE患者中RRE患者221例(31%)。两组性别,年龄,体重指数(BMI),吸烟,焦虑、抑郁状态,工作性质比较,差异有统计学意义(P<0.05)。多因素logistic回归分析显示:女性(OR=0.656,95%CI:0.455~0.945,P=0.024)是RRE的独立保护因素;年龄(OR=1.675,95%CI:1.255~2.236,P<0.001),BMI(OR=2.432,95%CI:1.875~3.131,P<0.001),焦虑、抑郁状态(OR=5.396,95%CI:3.115~9.347,P<0.001),脑力劳动(OR=12.663,95%CI:7.138~22.466,P<0.001)是RRE的独立危险因素。结论年龄,BMI,焦虑、抑郁状态,脑力劳动是RRE的主要危险因素,临床工作需要积极预防,同时加强医患沟通、确保患者依从性,帮助患者提高疗效及生活质量。