AIM： To report the comprehensive diagnosis and treatment of acute rejection in the first case of living-related small bowel transplantation with a long-term survival in China. METHODS： A 18-year-old boy with short g...AIM： To report the comprehensive diagnosis and treatment of acute rejection in the first case of living-related small bowel transplantation with a long-term survival in China. METHODS： A 18-year-old boy with short gut syndrome underwent living-related small bowel transplantation, with the graft taken from his father （44-year old）. A segment of 150-cm distal small bowel was resected from the donor. The ileo-colic artery and vein from the donor were anastomosed to the infrarenal aorta and vena cava of the recipient respectively. The intestinal continuity was restored with an end-to-end anastomosis between the recipient jejunum and donor ileum, and the distal end was fistulized. FK506, MMF and prednisone were initially used for post-transplant immunosuppression. Endoscopic observation and mucosal biopsies of the graft were carried out through the terminal ileum enterostomy; serum was collected to detect the levels of IL-2R, IL-4, IL-6 and IL-8. The change of the graft secretion and absorption was observed. RESULTS： Acute rejection was diagnosed promptly and cured. The patient was in good health, 5 years after living- related small bowel transplantation. CONCLUSION： The correct diagnosis and treatment of acute rejection are the key to the long-term survival after living-related small bowel transplantation.展开更多
Acute appendicitis is a common surgical condition that is usually managed with early surgery, and is associated with low morbidity and mortality. However, some patients may have atypical symptoms and physical findings...Acute appendicitis is a common surgical condition that is usually managed with early surgery, and is associated with low morbidity and mortality. However, some patients may have atypical symptoms and physical findings that may lead to a delay in diagnosis and increased complications. Atypical presentation may be related to the position of the appendix. Ascending retrocecal appendicitis presenting with right upper abdominal pain may be clinically indistinguishable from acute pathology in the gallbladder, liver, biliaw tree, right kidney and right urinary tract. We report a series of four patients with retrocecal appendicitis who presented with acute right upper abdominal pain. The clinical diagnoses at presentation were acute cholecystitis in two patients, pyelonephritis in one, and ureteric colic in one. Ultrasound examination of the abdomen at presentation showed subhepatic collections in two patients and normal findings in the other two. Computed tomography （CT） identified correctly retrocecal appendicitis and inflammation in the retroperitoneum in all cases. In addition, abscesses in the retrocecal space （n = 2） and subhepatic collections （n = 2） were also demonstrated. Emergency appendectomy was performed in two patients, interval appendectomy in one, and hemicolectomy in another. Surgical findings confirmed the presence of appendicitis and its retroperitoneal extensions. Our case series illustrates the usefulness of CT in diagnosing ascending retrocecal appendicitis and its extension, and excluding other in- fiammatory conditions that mimic appendicitis.展开更多
AIM： To compare the features of biochemical metabolic changes detected by hepatic phosphorus-31 magnetic resonance spectroscopy （^31p MRS） with the liver damage score （LDS） and pathologic changes in rabbits and t...AIM： To compare the features of biochemical metabolic changes detected by hepatic phosphorus-31 magnetic resonance spectroscopy （^31p MRS） with the liver damage score （LDS） and pathologic changes in rabbits and to investigate the diagnostic value of ^31p MRS in acute hepatic radiation injury. METHODS： A total of 30 rabbits received different radiation doses （ranging 5-20 Gy） to establish acute hepatic injury models. Blood biochemical tests, ^31p MRS and pathological examinations were carried out 24 h after irradiation. The degree of injury was evaluated according to LD5 and pathology. Ten healthy rabbits served as controls. The MR examination was performed on a 1.5 T imager using a 1H/^31P surface coil by the 2D chemical shift imaging technique. The relative quantities of phosphomonoesters （PME）, phosphodiesters （PDE）, inorganic phosphate （Pi） and adenosine triphosphate （ATP） were measured. The data were statistically analyzed. RESULTS： （1） Relative quantification of phosphorus metabolites： （a） ATP： there were significant differences （P 〈 0.05） （LDS-groups：control group vs mild group vs moderate group vs severe group, 1.83±0.33 vs 1.55±0.24 vs 1.27±0.09 vs 0.98±0.18; pathological groups： control group vs mild group vs moderate group vs severe group, 1.83±0.33 vs 1.58±0.25 vs 1.32±0.07 vs 1.02±0.18） of ATP relative quantification among control group, mild injured group, moderate injured group, and severe injured group according to both LDS grading and pathological grading, respectively, and it decreased progressively with the increased degree of injury （r = -0.723, P = 0.000）. （b） PME and Pi; the relative quantification of PME and Pi decreased significantly in the severe injured group, and the difference between the control group and severe injured group was significant （P 〈 0.05） （PME： 1DS- control group vs LDS-severe group, 0.86±0.23 vs 0.58±0.22, P = 0.031; pathological control group vs pathological severe group, 0.86±0.23 vs 0.60±0.21, P = 0.037; Pi： LDS-control group vs LDS-severe group, 0.74±0.18 vs 0.43±0.14, P = 0.013; pathological control group vs pathological severe group, 0.74±0.18 vs 0.43±0.14, P = 0.005） according to LDS grading and pathological grading, respectively. （c） PDE; there were no significant differences among groups according to LDS grading, and no significant differences between the control group and experimental groups according to pathological grading. （2） The ratio of relative quantification of phosphorus metabolites： significant differences （P 〈 0.05） （LDS- moderate group and LDS-severe group vs LDS-control group and LDS-mild group, 1.94±0.50 and 1.96±0.72 vs 1.43±0.31 and 1.40±0.38） were only found in PDE/ATP between the moderate injured group, the severe injured group and the control group, the mild injured group. No significant difference was found in other ratios of relative quantification of phosphorus metabolites.CONCLUSION： ^31p MRS is a useful method to evaluate early acute hepatic radiation injury. The relative quantification of hepatic ATP levels, which can reflect the pathological severity of acute hepatic radiation injury, is correlated with LDS.展开更多
基金Supported by the National Natural Science Foundation of China, No. 30070742
文摘AIM： To report the comprehensive diagnosis and treatment of acute rejection in the first case of living-related small bowel transplantation with a long-term survival in China. METHODS： A 18-year-old boy with short gut syndrome underwent living-related small bowel transplantation, with the graft taken from his father （44-year old）. A segment of 150-cm distal small bowel was resected from the donor. The ileo-colic artery and vein from the donor were anastomosed to the infrarenal aorta and vena cava of the recipient respectively. The intestinal continuity was restored with an end-to-end anastomosis between the recipient jejunum and donor ileum, and the distal end was fistulized. FK506, MMF and prednisone were initially used for post-transplant immunosuppression. Endoscopic observation and mucosal biopsies of the graft were carried out through the terminal ileum enterostomy; serum was collected to detect the levels of IL-2R, IL-4, IL-6 and IL-8. The change of the graft secretion and absorption was observed. RESULTS： Acute rejection was diagnosed promptly and cured. The patient was in good health, 5 years after living- related small bowel transplantation. CONCLUSION： The correct diagnosis and treatment of acute rejection are the key to the long-term survival after living-related small bowel transplantation.
文摘Acute appendicitis is a common surgical condition that is usually managed with early surgery, and is associated with low morbidity and mortality. However, some patients may have atypical symptoms and physical findings that may lead to a delay in diagnosis and increased complications. Atypical presentation may be related to the position of the appendix. Ascending retrocecal appendicitis presenting with right upper abdominal pain may be clinically indistinguishable from acute pathology in the gallbladder, liver, biliaw tree, right kidney and right urinary tract. We report a series of four patients with retrocecal appendicitis who presented with acute right upper abdominal pain. The clinical diagnoses at presentation were acute cholecystitis in two patients, pyelonephritis in one, and ureteric colic in one. Ultrasound examination of the abdomen at presentation showed subhepatic collections in two patients and normal findings in the other two. Computed tomography （CT） identified correctly retrocecal appendicitis and inflammation in the retroperitoneum in all cases. In addition, abscesses in the retrocecal space （n = 2） and subhepatic collections （n = 2） were also demonstrated. Emergency appendectomy was performed in two patients, interval appendectomy in one, and hemicolectomy in another. Surgical findings confirmed the presence of appendicitis and its retroperitoneal extensions. Our case series illustrates the usefulness of CT in diagnosing ascending retrocecal appendicitis and its extension, and excluding other in- fiammatory conditions that mimic appendicitis.
基金Supported by The National Natural Science Foundation of China, No. 30770626the Great Transversal Science Foundation of Zhejiang Province, China, No. 491020I20857
文摘AIM： To compare the features of biochemical metabolic changes detected by hepatic phosphorus-31 magnetic resonance spectroscopy （^31p MRS） with the liver damage score （LDS） and pathologic changes in rabbits and to investigate the diagnostic value of ^31p MRS in acute hepatic radiation injury. METHODS： A total of 30 rabbits received different radiation doses （ranging 5-20 Gy） to establish acute hepatic injury models. Blood biochemical tests, ^31p MRS and pathological examinations were carried out 24 h after irradiation. The degree of injury was evaluated according to LD5 and pathology. Ten healthy rabbits served as controls. The MR examination was performed on a 1.5 T imager using a 1H/^31P surface coil by the 2D chemical shift imaging technique. The relative quantities of phosphomonoesters （PME）, phosphodiesters （PDE）, inorganic phosphate （Pi） and adenosine triphosphate （ATP） were measured. The data were statistically analyzed. RESULTS： （1） Relative quantification of phosphorus metabolites： （a） ATP： there were significant differences （P 〈 0.05） （LDS-groups：control group vs mild group vs moderate group vs severe group, 1.83±0.33 vs 1.55±0.24 vs 1.27±0.09 vs 0.98±0.18; pathological groups： control group vs mild group vs moderate group vs severe group, 1.83±0.33 vs 1.58±0.25 vs 1.32±0.07 vs 1.02±0.18） of ATP relative quantification among control group, mild injured group, moderate injured group, and severe injured group according to both LDS grading and pathological grading, respectively, and it decreased progressively with the increased degree of injury （r = -0.723, P = 0.000）. （b） PME and Pi; the relative quantification of PME and Pi decreased significantly in the severe injured group, and the difference between the control group and severe injured group was significant （P 〈 0.05） （PME： 1DS- control group vs LDS-severe group, 0.86±0.23 vs 0.58±0.22, P = 0.031; pathological control group vs pathological severe group, 0.86±0.23 vs 0.60±0.21, P = 0.037; Pi： LDS-control group vs LDS-severe group, 0.74±0.18 vs 0.43±0.14, P = 0.013; pathological control group vs pathological severe group, 0.74±0.18 vs 0.43±0.14, P = 0.005） according to LDS grading and pathological grading, respectively. （c） PDE; there were no significant differences among groups according to LDS grading, and no significant differences between the control group and experimental groups according to pathological grading. （2） The ratio of relative quantification of phosphorus metabolites： significant differences （P 〈 0.05） （LDS- moderate group and LDS-severe group vs LDS-control group and LDS-mild group, 1.94±0.50 and 1.96±0.72 vs 1.43±0.31 and 1.40±0.38） were only found in PDE/ATP between the moderate injured group, the severe injured group and the control group, the mild injured group. No significant difference was found in other ratios of relative quantification of phosphorus metabolites.CONCLUSION： ^31p MRS is a useful method to evaluate early acute hepatic radiation injury. The relative quantification of hepatic ATP levels, which can reflect the pathological severity of acute hepatic radiation injury, is correlated with LDS.
