犬耳螨病的诊治

河北省衡水市赵某饲养的20多条犬,两次发生耳螨病,死亡1只后,前来求诊,经化验诊断为犬耳螨病,现报告如下:1.症床症状病犬摇头,以耳朵摩擦笼子,不时用爪抓患部,造成耳根脱毛,发炎,耳道内可见红褐、色痂皮和耳后。

Bouveret's syndrome complicated by a distal gallstone ileus

AIM:Gastric outlet obstruction caused by duodenal impaction of a large gallstone migrated through a cholecystoduodenal fistula has been referred as Bouveret's syndrome.Endoscopic lithotomy is the first-step treatment, however,surgery is indicated in case of failure or complication during this procedure. METHODS:We report herein an 84-year-old woman presenting with features of gastric outlet obstruction due to impacted gallstone.She underwent an endoscopic retrieval which was unsuccessful and was further complicated by distal gallstone ileus.Physical examination was irrelevant. RESULTS:Endoscopy revealed multiple erosions around the cardia,a large stone in the second part of the duodenum causing complete obstruction,and wide ulceration in the duodenal wall where the stone was impacted.Several attempts of endoscopic extraction by using foreign body forceps failed and surgical intervention was mandatory.Preoperative ultrasound evidenced pneumobilia whilst computerized tomography showed a large stone,5 cm×4 cm×3 cm,logging at the proximal jejunum and another one,2.5 cm×2 cm×2 cm, in the duodenal bulb causing a closed-loop syndrome.She underwent laparotomy and the jejunal stone was removed by enterotomy.Another stone reported as located in the duodenum preoperatively was found to be present in the gallbladder by intraoperative ultrasound.Therefore, cholecystoduodenal fistula was broken down,the stone was retrieved and cholecystectomy with duodenal repair was carried out.She was discharged after an uneventful postoperative course.CONCLUSION: As the simplest and the least morbid procedure, endoscopic stone retrieval should be attempted in the treatment of patients with Bouveret's syndrome.When it fails, surgical lithotomy consisting of simple enterotomy may solve the problem. Although cholecystectomy and cholecystoduodenal fistula breakdown is unnecessary

Basic and clinical aspects of osteoporosis in inflammatory bowel disease

Low bone mineral density and the increased risk of fracture in gastrointestinal diseases have a multifactorial pathogenesis. Inflammatory bowel disease （IBD） has been associated with an increased risk of osteoporosis and osteopenia and epidemiologic studies have reported an increased prevalence of low bone mass in patients with IBD. Certainly, genetics play an important role, along with other factors such as systemic inflammation, malnutrition, hypogonadism, glucocorticoid therapy in IBD and other lifestyle factors. At a molecular level the proinflammatory cytokines that contribute to the intestinal immune response in IBD are known to enhance bone resorption. There are genes influencing osteoblast function and it is likely that LRP5 may be involved in the skeletal development. Also the identification of vitamin D receptors （VDRs） and some of its polymorphisms have led to consider the possible relationships between them and some autoimmune diseases and may be involved in the pathogenesis through the exertion of its immunomodulatory effects during inflammation. Trying to explain the physiopathology we have found that there is increasing evidence for the integration between systemic inflammation and bone loss likely mediated via receptor for activated nuclear factor kappa-B （RANK）, RANK-ligand, and osteoprotegerin, proteins that can affect both osteoclastogenesis and T-cell activation. Although glucocorticoids can reduce mucosal and systemic inflammation, they have intrinsic qualities that negatively impact on bone mass. It is still controversial if all IBD patients should be screened, especially in patients with preexisting risk factors for bone disease. Available methods to measure BMD include single energy x-ray absorptiometry, DXA, quantitative computed tomography （QCT）, radiographic absorptiometry, and ultrasound.DXA is the establish method to determine BMD, and routinely is measured in the hip and the lumbar spine. There are several treatments options that have proven their effectiveness, while new emergent therapies such as calcitonin and teriparatide among others remain to be assessed.

Is ERCP really necessary in case of suspected spontaneous passage of bile duct stones?

AIM:To investigate the usefulness of magnetic resonance cholangiopancreatography (MRCP) and the need for endoscopic retrograde cholangiopancreatography (ERCP) in cases of suspected spontaneous passage of stones into the common bile duct.METHODS:Thirty-six patients with gallbladder stones were clinically suspected of spontaneous passage of stones into the common bile duct because they presented with clinical symptoms such as abdominal pain and fever,and showed signs of inflammatory reaction and marked rise of hepatobiliary enzymes.These symptoms resolved and they showed normalized values of blood biochemical parameters after conservative treatment without evidence of stones in the common bile duct on MRCP.All these patients were subjected to ERCP within 3 d of MRCP to check for the presence of stones.RESULTS:No stones were detected by ERCP in any patient,confi rming the results of MRCP.CONCLUSION:When clinical symptoms improve,blood biochemical parameters have normalized,and MRCP shows there are no stones in the common bile duct,it can be considered the stone has spontaneously passed and thus ERCP is not necessary.

Dysentery caused by Balantidium coliin a patient with non-Hodgkin's lymphoma from Turkey

Balantidium coli is the only parasitic ciliate of man. It is a flattened oval organism covered with cilia, and a gullet at the anterior end. It is infrequently pathogenic for man,although epidemic buds in tropical zones have been described. The infection fundamentally affects the colon and causes variable clinic pictures, from asymptomatic to serious dysenteric forms. We present a case of parasitologically diagnosed as causes of diarrhea in a patient with non Hodgkin's lymphoma from Turkey.In order to find out the causative etiologic agent of diarrhea,stool samples were examined by native,lugol and flotation methods and we detected moving trophozoites, which were approximately 60μm long and 35μm wide.These bodies were diagnosed as Balantidium coli This case underlines that Balantidium coli should also be considered as a possible pathogen in immunocompromised patients with diarrhea.

Free radicals generation in an in vitro fertilization setting and how to minimize them

Several studies report an increase in both male and female factors in infertility worldwide. In recent years there has been a tremendous increase in couples seeking assisted reproductive technology(ART) procedures in order to have children. However, the success rates of these procedures still remain very low. One of the major contributing factors to the low success rate in ART has been the damage caused by free radicals to the gametes and the developing embryo. The manipulation of gametes and embryos in an in vitro environment when performing assisted reproductive techniques carries the risk of exposure of these cells to supraphysiological levels of free radicals; namely, reactive oxygen species(ROS) and reactive nitrogen species. Oxidative stress can originate from the early steps of ART involving the oocyte, sperm and embryo, as well as in the endometrial environment later on following embryo transfer. The common sources of free radicals in an in vitro fertilization setting include the developing embryo, spermatozoa and leukocytes, semen centrifugation, oxygen partial pressure, light, culture media and cryopreservation/thawing. These free radicals are measured using different techniques, such as the cytochrome C reduction method and chemiluminescence-based techniques. Different efforts are being employed to minimize theexcess generation of free radicals in the ART setting, with the aim of improving the success rate, and antioxidant supplementation has emerged as one of the viable routes. Moreover, it is very important to inform ART personnel about the sources of ROS in the laboratory so that they can stop the use of procedures that are deleterious and start to use safer procedures.

Management of nocturnal enuresis-myths and facts

Nocturnal enuresis often causes considerable distress or functional impairment to patient and their parents necessitating a multidisciplinary approach from paediatrician, paediatric nephrologist, urologists and psychiatrist. Mechanisms of monosymptomatic nocturnal enuresis are mainly nocturnal polyuria, bladder overactivity and failure to awaken from sleep in response to bladder sensations. Goal oriented and etiology wise treatment includes simple behavioral intervention, conditioning alarm regimen and pharmacotherapy with desmopressin, imipramine and anticholinergic drugs. Symptoms often recurs requiring change over or combination of different modes of treatment.

Recurrent inflammatory fibroid polyp of cardia:A case report

Inflammatory fibroid polyp is one of the chronic inflammatory diseases in the digestive tract, which often mimics the submucosal tumor. Precise diagnosis is possible after removal of the detected lesion. Endoscopic removal is recommended as a safe and efficient method of the treatment. In this report the authors present a case of inflammatory fibroid polyp located in the cardia, which has been removed endoscopically. Twelve months later, recurrence of the lesion was noted and the patient was referred to surgical resection.

Meckel's diverticulum masked by a long period of intermittent recurrent subocclusive episodes

Meckel's diverticulum(MD) is the most frequent congenital abnormality of the small bowel and it is often diff icult to diagnose.It is usually asymptomatic but approximately 4% are symptomatic with complications such as bleeding,intestinal obstruction,and inflammation.The authors report a case of a 7-year-old boy with a one-year history of recurrent periumbilical colicky pain with associated alimentary vomiting,symptoms erroneously related to a cyclic vomiting syndrome but not to MD.The clinical features and the differential diagnostic methods employed for diagnosis of MD are discussed.

COMPLICATION ANALYSIS OF INTRACRANIAL ANEURYSM EMBOLIZATION WITH CONTROLLABLE COILS

Objective To explore the causes, prevention, and management of the complications during intra-cranial aneurysm embolization with controllable coils (mechanical detachable spiral, MDS; and Guglielmi detachable coil, GDC). Methods Retrospective review of 120 cases with 125 intracranial aneurysms embolized with con-trollable coils from March 1995 to July 1999 was conducted. The 20 accidents(in 18 cases) including aneurysm rupture, over-embolization, protrusion of coil end into the parent artery, and thrombosis of the parent artery were analyzed. Results Among the 20 accidents, there were 6 aneurysm ruptures, 6 over-embolizations (in 5 cases), 6 coil protrusions, and 2 thromboses (one was secondary to coil protrusion). The embolization-related mortality was 3.33% (4/120), the permanent neurological deficit was 1.67% (2/120), and the transitory neurological deficit was 3.33%(4/120). The occurrence and outcome of the complications were related to the embolizing technique, the pattern of aneurysm and its parent artery, the imperfection of embolic materials, and the observation and management during embolization. Conclusion Skilled embolizing technique, better understanding of the angio-anatomy of an aneurysm and its parent artery, correct judgement and management during embolization, and improvement of embolic materials are beneficial to the reduction of complications and to the melioration of the outcome of complications.

Epidural fat distribution patterns in patients with lumbar intervertebral disc protrusion

Objective： To investigate epidural fat distribution patterns in patients with lumbar intervertebral disc protrusion. Methods： Medical records were selected randomly from 30 patients whose diagnoses were consistent with the inclusion criteria of the study. Thickness of bilateral fat, the longest length of posterior fat, thickness of bilateral yellow ligament and the hernial distance of lumbar discs were measured by MRI at L3/L4, L4/L5 and L5/S 1 levels. According to clinical symptoms of lumbar intervertebral disc protrusion, the patients were divided into two groups at all space levels. All data were analyzed by statistical software. Results： The longest length of posterior epidural fat at the symptomatic levels was shorter than that at the non-symptomatic levels in each disc space. The symptomatic levels had no effect on the whole thickness of the lateral fat and lateral yellow ligaments. Conclusion： Epidural fat distribution in patients with lumbar intcrvertebral disc protrusion is different from that in normal adults. It is affected by the hernial distance of lumbar discs. The diagnostic criteria for spinal epidural lipomatosis in normal adults may therefore prove to be inappropriate for patients with lumbar intervertebral disc protrusion.

Surgical Treatment of Intralobar Pulmonary Sequestration

Objective To evaluate the clinical features,diagnosis,treatment,and outcome of intralobar pulmonary sequestration (ILS). Methods Patients who were diagnosed with ILS in our hospital between January 1988 and January 2009 were retrospectively reviewed. We recorded the clinical symptoms,imaging findings,operative technique,complications,and outcome of these patients. Results Forty-seven patients (25 men and 22 women) with an average age of 32.3 years were enrolled. Forty-two patients had symptoms including cough and hemoptysis. Chest X-ray,computed tomography (CT),magnetic resonance imaging (MRI),and angiography were performed. Thoracotomy was performed in 45 patients,while thoracoscopy was performed in 2 patients. Lobectomy was the most common treatment procedure. Massive bleeding developed in 2 patients due to injury of aberrant supplying artery intraoperatively,1 patient had atrial fibrillation,1 patient had thrombosis of upper extremity postoperatively. All patients were confirmed the diagnosis pathologically,4 accompanied with bronchogenic cyst,15 with bronchiectasis,8 with infection,2 with aspergilloma,and 1 with carcinoid. No late complications occurred. Conclusions ILS is rare,surgery is recommended because some patients may have potential severe complications. Contrast enhanced CT and three-dimensional reconstruction is the best diagnostic method. Both thoracotomy and thoracoscopy are appropriate for the selected candidates.

Fifty Cases of Parkinson's Disease Treated by Acupuncture Combined with Madopar

Objective: To search for an effective therapy for treating motor disorder due to Parkinson's disease (PD). Methods: Fifty cases in a treatment group were treated by acupuncture combined with madopar, and 30 cases in a control group treated by madopar only. Results: A total effective rate of 92% was achieved with obvious alleviation of motor disorder in the treatment group, which was significantly higher than that in the control group (P<0.05). Conclusion: Acupuncture can enhance therapeutic effects of western medicine and lessen the dose of the medicine needed.

Improved symptoms following bumetanide treatment in children aged 3-6 years with autism spectrum disorder:a randomized,double-blind,placebo-controlled trial

With the current limited drug therapy for the core symptoms of autism spectrum disorder(ASD),we herein report a randomized,double-blind,placebo-controlled trial to investigate the efficacy,safety,and potential neural mechanism of bumetanide in children with ASD aged 3-6 years old.A total of 120 children were enrolled into the study and randomly assigned to either 0.5 mg bumetanide or placebo.In the final sample,119 children received at least one dose of bumetanide(59 children) or placebo(60 children) were included in the final analysis.The primary outcome was a reduction in the Childhood Autism Rating Scale(CARS) score,and the secondary outcomes were the Clinical Global Impressions Scale(CGI)-Global Improvement(CGI-I) score at 3 months and the change from baseline to 3-month in the Autism Diagnostic Observation Schedule(ADOS).Magnetic resonance spectroscopy(MRS) was used to measure y-aminobutyric acid(GABA) and glutamate neurotransmitter concentrations in the insular cortex(IC) before and after the treatment.As compared with the placebo,bumetanide treatment was significantly better in reducing the severity.No patient withdrew from the trial due to adverse events.The superiority of bumetanide to placebo in reducing insular GABA,measured using MRS,was demonstrated.The clinical improvement was associated with a decrease in insular GABA in the bumetanide group.In conclusion,this trial in a large group of young children with predominantly moderate and severe ASD demonstrated that bumetanide is safe and effective in improving the core symptoms of ASD.However,the clinical significance remains uncertain,and future multi-center clinical trials are required to replicate these findings and confirm the clinical significance using a variety of outcome measures.