内镜逆行胰胆管造影术与腹腔镜胆总管探查术对胆总管结石的临床治疗特征比较

目的 比较内镜逆行胰胆管造影术(ERCP)与腹腔镜胆总管探查术(LCBDE)对胆总管结石(CBDS)的临床治疗特征。方法 回顾性纳入2017年1月至2020年12月中国人民解放军联勤保障部队第九〇四医院收治的200例CBDS病人,分析临床资料及随访资料,按照手术方式分为ERCP组(102例)与LCBDE组(98例),比较两组病人的基线资料、围术期相关指标、术后短期并发症及复发情况。结果 ERCP组的年龄[(68.13±7.22)岁比(61.20±5.59)岁]明显高于LCBDE组(P<0.05)。LCBDE组的结石长径[(13.76±2.89)mm比(7.58±2.34)mm]明显大于ERCP组(P<0.05)。ERCP组的手术时间[(105.60±18.29)min比(86.31±13.40)min]明显长于LCBDE组(P<0.05),术后3 d谷草转氨酶(GOT)水平高于LBCDE组(P<0.05)住院时间[(12.40±3.85)d比(17.56±4.28)d]明显短于LCBDE组(P<0.05)。ERCP组的手术成功率、复发率、术后短期并发症发生率分别为95.10%(97/102)、9.80%(10/102)、8.82%(9/102),与LCBDE组的97.96%(96/98)、13.27%(13/98)、9.18%(9/98)比较差异无统计学意义(P>0.05)。两组之间其他指标的比较差异无统计学意义(P>0.05)。结论 ERCP与LCBDE均是治疗CBDS的有效手段,高龄病人更倾向于选择ERCP,结石长径较大者更倾向于选择LCBDE,ERCP的住院时间更短。

不同年龄带状疱疹的临床特征及综合治疗研究

随机选取2010年3月-2013年4月期间我院收治的150例不同年龄带状疱疹患者,将他们分别分成青年组、中年组和老年组,给予不同的综合治疗方法,对他们的临床数据展开回顾性分析。结果青年组总有效率为96.0%,中年组总有效率为84.0%,老年组总有效率74.0%,青年组显著优于中年组、老年组,对比差异具有统计学意义（P〈0.05）。综合治疗有效缓解带状疱疹后遗神经痛发生,临床疗效显著,值得临床广泛推广。

320例手足口病患儿的临床特征及治疗

目的:探讨手足口病的临床特征及治疗。方法:对我院收治的手足口病患儿的临床表现、生化检查及治疗情况进行了回顾分析。结果:我市流行高峰在10至12月份,患儿多为幼托儿童,有群聚现象。<3岁患儿除手足典型疱疹外,在前臂、躯干、肘膝关节处可见红色斑丘疹。重症倾向患儿中2例有血糖升高,2周后复查正常。结论:手足口病发病时间可以延缓至冬季,早发现、早诊断、早隔离、早治疗,不仅可以降低发病率,同时可以降低重症发病率。<3岁患儿在诊断中应注意与其他出疹性疾病相鉴别。重症倾向患儿中疾病早期血糖升高,可能与应用糖皮质激素有关。

呼吸内科慢性咳嗽症状临床特征及治疗体会

慢性咳嗽属于呼吸内科常见病和多发病,权威文献研究表明,引起慢性咳嗽的病因较多,不同病因可表现出不同的临床症状。本研究主要对呼吸内科慢性咳嗽临床治疗情况进行分析,进而为临床诊疗活动提供更多科学依据,故选择2014-2015年12月收治的52例慢性咳嗽患者作为观察对象,并对其临床资料进行回顾性分析,总结如下。

CAR-T细胞免疫治疗相关的不良反应研究进展

CAR-T细胞治疗血液系统恶性肿瘤疗效显著,但是,同时观察到不良反应的发生,常见的非血液学不良反应有:细胞因子释放综合征、CAR-T治疗相关脑病综合征,血液学不良反应有:噬血细胞淋巴组织细胞增多症、弥散性血管内凝血、B细胞发育不良、造血功能恢复延迟。这些不良反应经积极治疗,多数可得到纠正,但是仍有部分不良反应加重后危及患者生命,如果能早期识别、对高危患者采取预防措施,避免严重不良反应的发生,那么该疗法就能使更多的患者获益。为此,本文就上述不良反应的临床特征、病理生理机制、处理措施及高风险患者的评估和预测作一综述。

苯丙胺类兴奋剂所致精神障碍临床特征及治疗分析

目的:总结苯丙胺类兴奋剂所致精神障碍的临床特征及治疗。方法:对120例符合CCMD-3诊断标准的苯丙胺类兴奋剂所致精神障碍患者进行临床特征及治疗的总结和分析。结果:滥用苯丙胺者以青少年居多,男女性别差异不大,文化素质普遍偏低,职业以无业和个体为主。常见临床表现为心慌烦躁、兴奋、发热、血压升高、抑制、消瘦、性欲亢进、食欲下降、抑郁、激越和精神病症状,部分病人有口腔和鼻粘膜溃疡、震颤、行走不稳和肌张力增高等类帕金森氏病样症状等。治疗以对症治疗为主,但类帕金森氏病样症状治疗效果不佳。结论:苯丙胺类兴奋剂是一类对生理和心理有显著伤害的中枢兴奋剂,治疗以对症治疗为主,并辅以心理治疗,总体疗效尚佳。

Clinical features and management of primary biliary cirrhosis

Primary biliary cirrhosis(PBC),which is characterised by progressive destruction of intrahepatic bile ducts,is not a rare disease since both prevalence and incidence are increasing during the last years mainly due to the improvement of case finding strategies.The prognosis of the disease has improved due to both the recognition of earlier and indolent cases,and to the wide use of ursodeoxycholic acid(UDCA).New indicators of prog-nosis are available that will be useful especially for the growing number of patients with less severe disease.Most patients are asymptomatic at presentation.Pruri-tus may represent the most distressing symptom and,when UDCA is ineffective,cholestyramine represents the mainstay of treatment.Complications of long-standing cholestasis may be clinically relevant only in very ad-vanced stages.Available data on the effects of UDCA on clinically relevant end points clearly indicate that the drug is able to slow but not to halt the progression of the disease while,in advanced stages,the only thera-peutic option remains liver transplantation.

Primary gastric mucosa associated lymphoid tissue lymphoma: Clinical data predicted treatment outcome

AIM: To determine clinical characteristics and treatment outcome of gastric lymphoma after chemotherapy and immuno-chemotherapy. METHODS: Thirty four patients with primary gastric mucosa associated lymphoid tissue (MALT) lymphoma (Ann Arbor stages Ⅰ to Ⅳ) were enrolled. All had upper gastric endoscopy, abdominal ultrasonography, CT and H pylori status assessment (histology and serology). After anti-H pylori treatment and initial chemotherapy, patients were re-examined every 4 mo. RESULTS: Histological regression of the lymphoma was complete in 22/34 (64.7%) and partial in 9 (26.5%) patients. Median follow up time for these 31 responders was 60 mo (range 48-120). No regression was noted in 3 patients. Among the 25 (73.5%) H pylori positive patients, the eradication rate was 100%.CONCLUSION: Using univariate analysis, predictive factors for overall survival were international prognostic index (IPI) score, hemoglobin level, erythrocyte sedimentation rate (ESR), and platelet numbers (P < 0.005). In addition to this, Cox proportion hazard model differentiate IPI score, ESR, and platelets as predictors of survival.

Laparoscopic hemicolectomy in a patient with situs inversustotalis

As among persons with normal anatomy, occasional patients with situs inversus develop malignant tumors. Recently, several laparoscopic operations have been reported in patients with situs inversus. We describe laparoscopic hemicolectomy with radical lymphadenectomy in such a patient. Careful consideration of the mirror-image anatomy permitted safe operation using techniques not otherwise differing from those in ordinary cases. Thus, curative laparoscopic surgery for colon cancer in the presence of situs inversus is feasible and safe.

Protective effects of ursodeoxycholic acid on chenodeoxycholic acid-induced liver injury in hamsters

AIM： TO investigate the effects of ursodeoxycholic acid （UDCA） on chenodeoxycholic acid （CDCA）-induced liver injury in hamsters, and to elucidate a correlation between liver injury and bile acid profiles in the liver.METHODS： Liver injury was induced in hamsters by administration of 0.5% （w/w） CDCA in their feed for 7 d. UDCA （50 mg/kg and 150 mg/kg） was administered for the last 3 d of the experiment.RESULTS： At the end of the experiment, serum alanine aminotransferase （ALl） increased more than 10 times and the presence of liver injury was confirmed histologically. Marked increase in bile acids was observed in the liver. The amount of total bile acids increased approximately three-fold and was accompanied by the increase in hydrophobic bile acids, CDCA and lithocholic acid （LCA）. UDCA （50 mg/kg and 150 mg/kg） improved liver histology, with a significant decrease （679.3 ±77.5 U/L vs 333.6 ± 50.4 U/L and 254.3 ±35.5 U/ L, respectively, P 〈 0.01） in serum ALT level. UDCA decreased the concentrations of the hydrophobic bile acids, and as a result, a decrease in the total bile acid level in the liver was achieved.CONCLUSION： The results show that UDCA improves oral CDCA-induced liver damage in hamsters. The protective effects of UDCA appear to result from a decrease in the concentration of hydrophobic bile acids, CDCA and LCA, which accumulate and show the cytotoxicity in the liver.

Role of alcohol in the regulation of iron metabolism

Patients with alcoholic liver disease frequently exhibit increased body iron stores, as reflected by elevated serum iron indices (transferrin saturation, ferritin) and hepatic iron concentration. Even mild to moderate alcohol consumption has been shown to increase the prevalence of iron overload. Moreover, increased hepatic iron content is associated with greater mortality from alcoholic cirrhosis, suggesting a pathogenic role for iron in alcoholic liver disease. Alcohol increases the severity of disease in patients with genetic hemochromatosis, an iron overload disorder common in the Caucasian population. Both iron and alcohol individually cause oxidative stress and lipid peroxidation, which culminates in liver injury. Despite these observations, the underlying mechanisms of iron accumulation and the source of the excess iron observed in alcoholic liver disease remain unclear. Over the last decade, several novel iron-regulatory proteins have been identified and these have greatly enhanced our understanding of iron metabolism. For example, hepcidin, a circulatory antimicrobial peptide synthesized by the hepatocytes of the liver is now known to play a central role in the regulation of iron homeostasis. This review attempts to describe the interaction of alcohol and iron-regulatory molecules. Understanding these molecular mechanisms is of considerable clinical importance because both alcoholic liver disease and genetic hemochromatosis are common diseases, in which alcohol and iron appear to act synergistically to cause liver injury.

ADENOSQUAMOUS LUNG CARCINOMA:CLINICAL CHARACTERISTICS,SURGICAL TREAMENT AND PROGNOSIS

Objective.The effectiveness of surgical resection of adenosquamous carcinoma of the lung remains poorly defined because of the histology’s relatively low frequency, the failure in most published series to separate adenosquamous carcinoma from the other variants of non-small cell lung carcinoma.To define the effectiveness of surgical treatment of adenosquamous carcinoma,we have retrospectively reviewed our hospital experience over a 12-year period. Methods.Retrospectively reviewed 22 cases of adenosquamous carcinoma who were surgically treated,except one patient,in the PUMCH from Jan.1985 to Aug.1997.This series constitutes the 19% of a total of 1 245 patients with all types of surgical treatment for the primary lung cancer during the same time. Results.The adenosquanous carcinoma was mostly presented in the old patients with a mean age of 60 years and mostly located in the peripheral of lung(n=20).The overall 5-year survival was 23%.Those with stage Ⅰ tumors survival was only 18%(n=13), stage Ⅱ 5%. The survival in stage Ⅲ tumors was not longer than 25 months and in stage Ⅳ survival was not longer than 12 months. Conclusion.Our results suggest that adenosquamous carcinoma of lung was a virulent tumor,which exhibited highly aggressive biological behavior with early lymph nodes metastasis(46%) and its prognosis was worse than that of both squamous cell carcinoma and adenocarcinoma.

ENDOMYOCARDIAL FIBROSIS IN CHINA

To introduce the epidemical, pathological, and clinical characteristics as well as the diagnostic and therapeutical experiences of endomyocardial fibrosis(EMF) in China. [WT5”BX] Data sources.[WT5”BZ]A CMBdisc search was done of the Chinese language literature published from January 1983 through June 1997 about EMF and/or restrictive cardiomyopathy. A manual search was then done for other contributions, including abstracts, between January 1965 and June 1997. [WT5”BX] Results. [WT5”BZ]Eighty seven Chinese cases of EMF were collected in this paper. There were 49 men and 38 women, with a mean age of 28±13 years(range, 8 to 68 years). The distribution of the cases is mainly in the south of China. Combined right and left ventricular disease occurs in 48 percent of cases, with pure right ventricular involvement occurring in 42 percent and pure left ventricular involvement in the remaining 10 percent of patients who are examined postmortem. The diagnosis of EMF was confirmed in 21 cases at autopsy, and in 66 cases by echocardiography, angiocardiography, and/or endomyocardial biopsy which showed the characteristic changes. Clinically, right sided disease is the commonest variety. Endocardiectomy and tricuspid(n=7) or mitral(n=1) valves replacement have been performed in 8 patients. There were 2 operative deaths. Six patients had a satisfactory recovery postoperatively and living well in the follow up duration. [WT5”BX] Conclusion.

Prognositic factors and clinicopathologic characteristics of small gastrointestinal stromal tumor of the stomach:a retrospective analysis of 31 cases in one center

Objective： To analyze the clinicopathologic characteristics and prognostic factors of small gastrointestinal stromal tumor （GIST） of the stomach. Methods： A total of 31 small gastric GIST patients, including 10 males and 21 females, with a median age of 58 years （37- 81 years）, who underwent surgery at any time from 1999 to 2012 were included in this study. The clinical records of the patients were analyzed retrospectively. Results： Abdominal discomfort and pain （10 cases, 32.3%, respectively） were the two most common complaints among the patients. All patients received surgery, 11 received gastric wedge resection, 11 received subtotal gastrectom）5 5 received laparoscopic gastric wedge resection, and 4 received endoscopic submucosal dissection. No severe adverse complication was observed. A total of 29 patients （93.5%） were followed up. During the follow-up, 2 patients were found to exhibit tumor recurrence, and 1 patient had liver metastases. One patient died of tumor progressionwhile another died of another malignant tumor. Median progression free survival （PFS） time was 120.3 months, and median overall survival （OS） time was 130.4 months. Conclusion： Small gastric GIST has better prognosis. Surgery is the best choice for therapy. Micro-invasive procedures are safe and effective for elective patients. Tumor necrosis, tumor bleeding, and muscle invasion are potential prognostic factors of small gastric GIST.

Clinical characteristics and type of antithrombotic treatment in a Spanish cohort of elderly patients with atrial fibrillation according to dependency, frailty and cognitive impairment

Background Available data regarding clinical profile and management of elderly patients with atrial fibrillation （AF） according to dependency, fragility and cognitive impairment are scarce. The objective of the study was to analyze the biodemographic data, clinical profile and antithrombotic treatment according to dependency, fragility and cognitive impairment in elderly AF patients. Methods Cross- sectional and multi-center study performed in consecutive AF patients ≥ 75 years treated with oral anticoagulants ≥ 3 months attended in Internal Medicine Departments in Spain. Results A total of 837 patients （83.0 ± 5.0 years; CHA2DS2-VASc： 5.0 ± 1.4; HAS-BLED： 2.1 ± 0.9） were included. 44.4% of patients had some degree of dependency, 43.3% were fragile, and 32.3% had cognitive impairment. Patients with any of these conditions were older, had a worse clinical profile, with more comorbidities and higher risks of thromboembolic and bleeding events. All these conditions were independently associated among them. Overall, 70.8% of patients were taking vitamin K antagonists, the remaining 29.2% direct oral anticoagulants and 9.7% oral antiplatelets. This distribution was independent of the presence of dependency or fragility, but there was a trend to a higher prescription of vitamin K antagonists in those patients with cognitive impairment （75.2% vs. 68.8%; P = 0.05）. Conclusions Approximately 32%-44% of elderly anticoagulated AF patients attended have some degree of dependency, fragility and/or cognitive impairment. Patients with any of these conditions are older and have a worse clinical profile. Ap？proximately 71% of patients are taking vitamin K antagonists, regardless dependency or frailty, but with a trend to higher prescription in patients with cognitive impairment.

DIAGNOSIS AND TREATMENT OF PULMONARY HAMARTOMA

From 1970 to 1997, 67 patients with pulmonary hamartoma were operated on in our hospital. There were 38 men and 29 women with a M/F ratio of 1. 3: 1. The mean age was 47 years (range 21 to 82 years). The peak incidence was 40 to 60 years. 39% Patients had pulmonary symptoms: hemoptysis, cough, phlegm and chest pain. All were solitary. 68. 7% tumors were located in right lung and 64. 2% in upper or middle lobe. 80. 6% hamartomas were less than 3 cm in transverse diameter. On chest films, the opacity was homogeneous in 79.1% cases, heterogeneous in 20.9% and calcifications in 9.0%. The vast majority of shadows were heterogeneous on CT films. Operation is the best treatment for hamartomas. Postoperative mortality was 1. 5%. There was none recurrences and canceration during the follow-up (mean 14 years).

Surgical management of gallbladder sarcomatoid carcinoma

AIM:To study the behavior as well as optimal treatment of gallbladder sarcomatoid carcinoma, we reviewed the results of treatment of gallbladder sarcomatoid carcinoma from Chang Gung Memorial Hospital. METHODS:From 1987 to 2005,six patients were diagnosed with gallbladder sarcomatoid carcinoma and treated at our institution.Tumor staging was based on 2002 revised tumor-node-metastasis(TNM)staging for gall bladder cancer from the American Joint Committee on Cancer.The clinical presentation,laboratory data and preoperative workup were reviewed retrospectively. RESULTS:Five patients were female and one was male.The age ranged from 51 to 66 years(median, 58 years).Surgical procedures included three curative resections,two palliative resections and one biopsy. There were two surgical complications(33.3%)and one case of surgical mortality(16.7%).The followup time ranged from 30 d to 5 mo.The median survival was 2.5 mo.The prognosis was extremely poor,even after curative resection and postoperative chemotherapy. CONCLUSION:The prognosis of gallbladder sarcomatoid carcinoma was not dependent on TNM stage and was always dismal.The clinicopathological features were different from those of gall bladder cancer.

肾综合征出血热诊治研究现状

肾综合征出血热（Hemorrhagic fever with Renal Syndrome，HFRS）在我国具有较高的发病率，为有益于对本病的深入探讨，本文拟对HFRS的临床特征与治疗、发病机理、早期诊断技术、预防等问题的主要方面进行扼要的阐述。

Tropheryma whipplei infection

Whipple's disease was initially described in 1907. Over the next century, the clinical and pathological features of this disorder have been better appreciated. Most often, weight loss, diarrhea, abdominal and joint pain occur. Occasionally, other sites of involvement have been documented, including isolated neurological disease, changes in the eyes and culture-negative endocarditis. In the past decade, the responsible organism Tropheryma whipplei has been cultivated, its genome sequenced and its antibiotic susceptibility defined. Although rare, it is a systemic infection that may mimic a wide spectrum of clinical disorders and may have a fatal outcome. If recognized, prolonged antibiotic therapy may be a very successful form of treatment.

Clinical Characters of Gastrointestinal Lesions in Intestinal Behcet's Disease

Objective To investigate the clinical features,diagnosis methods,therapeutic principles of intestinal Behcet's disease.Methods The clinical data of 45 patients with confirmed intestinal Behcet's disease admitted to Peking Union Medical College Hospital from August 1998 to April 2010 were retrospectively analyzed.Results The clinical courses of patients with intestinal Behcet's disease were from 26 days to 33 years,and the average duration was 6.32±1.01 years.The appearance of extra-gastrointestinal symptoms was significantly earlier than that of gastrointestinal symptoms(7.35±1.39 years vs.3.24±0.82 years,P<0.05).The predominant gastrointestinal manifestations were right lower quadrant pain(95.56%) and hematochezia or melena(40.00%).Misdiagnosis occurred in 17 cases.In patients without systemic medicine therapy before surgery,the incidence of postoperative infection of incision site and abdominal cavity was significantly higher than that in those undergoing systemic medicine therapy(80.00% vs.0%,P<0.05).Conclusions Because of the diversity of gastrointestinal manifestations,intestinal Behcet's disease is easily misdiagnosed.The systemic medical therapy before surgery could decrease the incidence of infection of incision and abdominal cavity.