儿科急性肠系膜巴结炎的临床治疗方法及效果分析

目的分析儿科急性肠系膜巴结炎的临床治疗方法以及治疗的效果。方法选取急性肠系膜巴结炎患儿100例作为研究对象,将这100例患儿进行随机分组,分别是对照组与实验组,各50例。对照组的患儿使用静脉滴注以及解痉退热的治疗,实验组的患儿使用常规的西药联合四逆理气汤进行治疗,对比2组患儿的治疗效果。结果实验组患儿的治疗效果明显优于对照组的患儿,2组对比差异具有统计学意义(P<0.05)。实验组的复发率明显少于对照组,2组对比差异具有统计学意义(P<0.05)。结论中西医结合治疗儿科急性肠系膜巴结炎,临床效果好,治愈率高,值得在临床治疗中推广使用。

高频超声对小儿急性肠系膜淋巴结炎的诊断价值

目的:评估高频超声在诊断小儿急性肠系膜淋巴结炎的价值和意义。方法:运用二维超声高频探头动态检查184例急性上呼吸道感染过程中及肠道炎症之后腹痛患儿。结果:小儿急性肠系膜淋巴结炎的声像图特征是腹部见多个大小不等椭圆型低回声结节(肿大淋巴结)。结论:高频超声诊断小儿急性肠系膜淋巴结炎有较高的准确率,对临床的诊断治疗有重要的指导意义。

坏死性淋巴结炎1例

1．病历摘要 患者，女，26岁，因畏寒、发热半个月于2006年3月6日入院。查体：T38．0℃右颌下、双侧颈部、可触及成群黄豆大小肿大的淋巴结，质硬，触痛，活动度可，表面皮肤不红，皮温不高。心肺腹无异常，四肢关节无红肿。

中医药治疗纵膈淋巴结慢性肉芽肿性炎1例报道

目的:探讨中医药治疗纵膈淋巴结慢性肉芽肿性炎的疗效。方法:对1例纵膈淋巴结慢性肉芽肿性炎患者进行中药治疗。结果:患者咳嗽,痰出不爽、咳血,气短、喑哑,烦躁易怒,口苦,纳差,胁肋胀痛,腹痛泄泻等症状明显好转。复查CT显示纵膈淋巴结明显缩小。结论:以抑肝扶脾泻肺为法,清肝降火,泻肺凉血,健脾补中,祛痰化瘀,并以辨证论治,治疗纵膈淋巴结慢性肉芽肿性炎取得较为满意的疗效。

分析儿科急性肠系膜巴结炎的临床治疗方法以及治疗的效果

分析儿科急性肠系膜巴结炎的临床治疗方法以及治疗的效果。方法 将本院儿科2015年4月到2016年5月期间收治的74例急性肠系膜巴结炎患儿作为研究对象,将患儿随机分为甲组与乙组,每组各37例患儿。甲组采用静脉滴注与解痉退热治疗方式,乙组在此基础上,联合应用四逆理气汤予以治疗,比较两组患儿的临床治疗效果以及复发率。结果 甲组与乙组患儿的临床治疗总有效率分别为86.49%(32/37)、97.3%(36/37),数据对比存在显著差异(p<0.05)。甲组患儿复发率为10.81%(4/37),乙组复发率为2.7%(1/37),差异比较存在统计学意义(p<0.05)。结论 联合用药治疗方式下,有助于快速缓解急性肠系膜巴结炎患儿的临床症状,提升临床治疗的总有效率,同时能够降低患儿的疾病复发率,临床治疗效果得以保障。

肺外结核之首——淋巴结核

肺外结核以淋巴系统结核病为多见,而颈部淋巴结核占全身淋巴系统结核的80％,腹股沟、腋下次之。 淋巴结核多见于儿童及青少年,女性较多,其传染途径除继发于肺结核及支气管结核外,更多的是结核菌由口腔(龋齿)、鼻咽部及扁桃体侵入牯膜下淋巴网,通过淋巴管抵达颈部淋巴结而发病的。因此,预防肺结核的发生及注意口腔卫生,是防止淋巴结核发生的重要环节。

Perioperative Cimetidine Administration Enhances Tumor Infiltration Lymphocytes and HLA-DR Expression in Colorectal Cancer~*

Objective： It has been shown in our previous study that cimetidine （CIM） can boost the hosts＇ cellular immunity in patients with gastrointestinal cancer. This study was conducted to evaluate CIM＇s effects on tumor infiltrating lymphocytes （TIL） and HLA-DR expression in tumor stroma in colorectal cancer （CRC）, so as to investigate its role in local immune response at the tumor site in CRC. Methods： Forty-nine CRC patients were randomized into treatment group of 25 patients who took CIM 7 days before curative surgery till the operation day, and control group of 24 patients who received similar treatment except for CIM intervention. TIL responses and HLA-DR expression were studied on tumor tissues taken before and after surgical resection. Results： The percentage of significant TIL response was increased from 32% （8/25） to 76% （19/25） （P〈0.005） in the CIM treatment group, whereas there were no significant changes in TIL response in the control group [25% （6/24） at recruitment vs. 33% （8/24） at operation, P〉0.50]. Moreover, the percentages of HLA-DR expression were increased from 36% （9/25） to 72% （18/25） in the CIM treatment group, but there were no significant differences in HLA-DR expression in the control group [41.7% （10/24） before resection vs 45.8% （11/24） after resection, P〉0.50]. Conclusion： CIM used before surgery might promote TIL responses and increase the HLA-DR expression in stroma cells in CRC patients, leading to enhanced host immunity against tumor.

Ischemic colitis during interferon-ribavirin therapy for chronic hepatitis C:A case report

Ischemic colitis is a rare complication of interferon administration.Only 9 cases in 6 reports have been described to-date.This report describes a case of ischemic colitis during pegylated interferon and ribavirin treatment for chronic hepatitis C,and includes a review of the relevant literature.A 48-year-old woman was treated with pegylated interferon-2a and ribavirin for chronic hepatitis C,genotype Ib.After 19 wk of treatment,the patient complained of severe afebrile abdominal pain with hematochezia.Vital signs were stable and serum white blood cell count was within the normal range.Abdominal computed tomography showed diffuse colonic wall thickening from the splenic flexure to the proximal sigmoid colon,which is the most vulnerable area for the development of ischemic colitis.Colonoscopy revealed an acute mucosal hyperemic change,with edema and ulcerations extending from the proximal descending colon to the sigmoid colon.Colonic mucosal biopsy revealed acute exudative colitis.Polymerase chain reaction and culture for Mycobacterium tuberculosis were negative and the cultures for cytomegalovirus,Salmonella and Shigella species were negative.After discontinuation of interferon and ribavirin therapy,abdominal pain and hematochezia subsided and,following colonoscopy showed improvement of the mucosal ulcerations.Ischemic colitis cases during interferon therapy in patients with chronic hepatitis C reported so far have all involved the descending colon.Ischemic colitis is a rarely encountered complication of interferon administration in patients with chronic hepatitis C and should be considered when a patient complains of abdominal pain and hematochezia.

Tuberculous lymphadenitis as a cause of obstructive jaundice:A case report and literature review

Obstructive jaundice secondary to tuberculosis (TB) is extremely rare. It can be caused by TB enlargement of the head of the pancreas, TB lymphadenitis, TB stricture of the biliary tree, or a TB mass of the retroperitoneum. A 29-year-old man with no previous history of TB presented with abdominal pain, obstructive jaundice, malaise and weight loss. Ultrasonography (US), computer tomography (CT) scan and endoscopic retrograde cholangiopancreatography (ERCP) were suggestive of a stenosis of the distal common bile duct (CBD) caused by a mass in the posterior head of the pancreas. Tumor markers, CEA and CA19-9 were within normal limits. At operation, an enlarged, centrally caseous lymph node of the posterior head of the pancreas was found, causing inflammatory stenosis and a fistula with the distal CBD. The lymph node was removed and the bile duct resected and anastomosed with the Roux-en Y jejunal limb. Histology and PCR based-assay confirmed tuberculous lymphadenitis. After an uneventful postoperative recovery, the patient was treated with anti-tuberculous medication and remained well 2.5 years later. Though obstructive jaundice secondary to tuberculous lymphadenitis is rare, abdominal TB should be considered as a differential diagnosis in immunocompromised patients and in TB endemic areas. Any stenosis or fistulation into the CBD should also be taken into consideration, and biliary bypass surgery be performed to both relieve jaundice and prevent further stricture.

Involvement of lymphocytes in dextran sulfate sodium-induced experimental colitis

AIM： To investigate the roles of lymphocytes in the development of dextran sulfate sodium-induced colitis. METHODS： Using various doses of dextran sulfate sodium （DSS）, we induced colitis in wild-type B6 control and Rag-1 knockout （H-2b haplotype） mice, and evaluated the colitis in terms of symptomatic and histologic parameters, such as weight loss, survival, severity of diarrhea, shortage of colon length and histological changes. Symptomatic parameters were checked daily and histological changes were scored. RESULTS： Although development of colitis in Rag-1 knockout mice treated with high dose （5%） of DSS was comparable to that in B6 control mice, colitis progression was much more tolerable in Rag-1 knockout mice compared to than in B6 mice treated with low dose （1.5%） DSS. Symptomatic parameters as well as histopathologic changes were improved in Rag-1 knockout mice. CONCLUSION： These results indicate that the presence of lymphoo/tes contributes to colitis progression at low dose of DSS stimulation. Lymphoo/tes may play roles as an aggravating factor in DSS-induced colitis.

Increased presence of effector lymphocytes during Helicobacter hepaticus-induced colitis

AIM： To identify and characterize drosophila mothers against decapentaplegic （SMAD）3-dependent changes in immune cell populations following infection with He- Iicobacter hepaticus （H. hepaticus）. METHODS： SMAD3/ （n = L9） and colitis-resistant SMAD3＋/ （n = 24） mice （8-10 wk of age） were in- fected with/-/, hepaticus and changes in immune cell populations [T lymphocytes, natural killer （NK） cells, T regulatory cells] were measured in the spleen and mesenteric lymph nodes （MsLNs） at 0 d, 3 d, 7 d and 28 d post-infection using flow cytometry. Genotype-dependent changes in T lymphocytes and granzyme B＋ cells were also assessed after 28 d in proximal colon tissue using immunohistochemistry. RESULTS： As previously observed, SMAD3＋, but not SMAD3＋/- mice, developed colitis, peaking at 4 wk post-infection. No significant changes in T cell subsets were observed in the spleen or in the MsLNs between genotypes at any time point. However, CD4＋ and CD8＋/ CD62L＋＋ cells, an effector T lymphocyte population, as well as NK cells （NKp46/DX5＋） were significantly higher in the MsLNs of SMAD3/ mice at 7 d and 28 d post-in- fection. In the colon, a higher number of CD3＋ cells were present in SMAD3＋ compared to SMAD3＋/- mice at base- line, which did not significantly change during infection. However, the number of granzyme B＋ cells, a marker of cytolytic lymphoo/tes, significantly increased in SMAD3＋ mice 28 d post-infection compared to both SMAD3＋/- mice and to baseline values. This was consistent with more severe colitis development in these animals. CONCLUSION： Data suggest that defects in SMAD3 signaling increase susceptibility to H. hepaticus-induced colitis through aberrant activation and/or dysregulation of effector lymphoo/tes.

Diagnostic approach using endosonography guided fine needle aspiration for lymphadenopathy in primary sclerosing cholangitis

We report a case of primary sclerosing cholangitis (PSC) with benign lyphadenopathy which was diagnosed with endosonography guided fine needle aspiration (EUS-FNA). A 65-year-old woman was admitted to Jikei University Hospital with severe jaundice. Although endoscopic retrograde cholangiography and liver biopsy revealed the findings consistent with PSC, abdominal computed tomography revealed numerous large perihepatic lymph nodes with a maximum diameter of more than 3 cm. Therefore, EUS-FNA was done in order to exclude malignant lymphadenopathy, and adequate specimens obtained by EUS-FNA showed reactive hyperplasia of lymphnode. The patients were scheduled to undergo liver transplantation.

Isolated lymphoid follicles in colon: Switch points between inflammation and colorectal cancer?

Gut-associated lymphoid tissue is supposed to play a central role in both the organization of colonic repair mechanisms and colorectal carcinogenesis. In inflammatory conditions, the number, diameter and density of isolated lymphoid follicles (ILFs) increases. They are not only involved in immune surveillance, but their presence is also indispensable in normal mucosal regeneration of the colon. In carcinogenesis, ILFs may play a dual role. On the one hand they may support tumor growth and the metastatic process by vascular endothelial growth factor receptor signaling and producing a specific cytokine and cellular milieu, but on the other hand their presence is sometimes associated with a better prognosis. The relation of ILFs to bone marrow derived stem cells, follicular dendritic cells, subepithelial myofibroblasts or crypt formation, which are all involved in mucosal repair and carcinogenesis, has not been directly studied. Data about the putative organizer role of ILFs is scattered in scientific literature.

Diagnosis by endoscopic ultrasound guided fine needle aspiration of tuberculous lymphadenitis involving the peripancreatic lymph nodes: A case report

Pancreatic tuberculosis is an extremely rare form of extrapulmonary disease. The diagnosis preoperatively is difficult because clinical, laboratory and radiologic findings are nonspecific. Published data indicate that these lesions mimic cystic neoplasms of the pancreas and the confirmation of clinical suspicion could only be obtained by an open surgical biopsy. Recently, fine needle aspiration cytology has been shown to be a safe, reliable and cost-effective alternative. We report a new case of a peripancreatic tuberculosis in a 52 year old woman and review the relevant literature, paying special attention to the usefulness of endoscopic ultrasound guided-fine needle aspiration in the diagnosis of abdominal tuberculosis.

B1a lymphocytes in the rectal mucosa of ulcerative colitis patients

AIM:To assess B1a cell expression in the rectal mucosa of ulcerative colitis (UC) patients in comparison with healthy controls.METHODS:Rectal mucosa biopsies were collected from 15 UC patients and 17 healthy controls.CD5 + B cells were analysed by three colour flow cytometry from rectal mucosal samples after mechanical disaggregation by Medimachine.Immunohistochemical analysis of B and T lymphocytes was also performed.Correlations between,on the one hand,rectal B1a cell concentrations and,on the other,erythrocyte sedimentation rate and C-reactive protein levels and clinical,endoscopic and histological disease activity indices were evaluated.RESULTS:Rectal B-lymphocyte (CD19 + /CD45 +) rate and concentration were higher in UC patients compared with those in healthy controls (47.85% ± 3.12% vs 26.10% ± 3.40%,P=0.001 and 501 ± 91 cells/mm 2 vs 117 ± 18 cells/mm 2,P < 0.001);Rectal B1a cell density (CD5 + CD19 +) was higher in UC patients than in healthy controls (85 ± 15 cells/mm 2 vs 31 ± 6.7 cells/mm 2,P=0.009).Rectal B1a cell (CD5/CD19 +) rate correlated inversely with endoscopic classification (Rs=-0.637,P < 0.05).CONCLUSION:B1a lymphocytes seem to be involved in the pathogenesis of UC,however,the role they play in its early phases and in disease activity,have yet to be defined.