经阴道彩色多普勒超声检查在诊断宫颈息肉样病变中的应用效果

目的 评价宫颈息肉样病变诊断中采用经阴道彩色多普勒超声检查的作用效果。方法 选取2021年6月—2022年7月临沂市妇幼保健院诊断的60例疑似宫颈息肉样病变患者,均接受经阴道彩色多普勒超声检查,以病理检查结果为金标准,比较两种诊断方式的检查结果及诊断效能。结果 病理诊断结果显示无宫颈息肉样病变40例、宫颈息肉样病变20例,经阴道彩色多普勒超声检查结果显示无宫颈息肉样病变30例,宫颈息肉样病变30例;经阴道彩色多普勒超声检查敏感度为100.00%,特异度为75.00%,准确性为83.33%,误诊率为25.00%,漏诊率为0,kappa值为0.667。结论 诊断宫颈息肉样病变中应用经阴道彩色多普勒超声检查,能够判断息肉状况,开展方式十分便捷,并且出结果快,更有利于基层宫颈息肉样病变诊断工作的开展。

中国大陆强震月季预测三步法和2010年实际预测检查

本文提出了强震成因的外核对流上升体顶托说,根据强震前时纬残差的大振幅摆动的观测结果,在一些假定之下,可估算得到外核上升流的速度可达到100 m/s,比板块运动要快8个量级,它可能是整个地球内部最快的一种运动,是震、旱、涝等天灾的肇因.强震三要素预测的先后顺序是:震级、震中、和发生月季.2010年两次强震预测的三要素有1～2项预测准确,看来此强震预测三步法可以继续试验.

DSP随机测试程序自动生成技术

提出了一种基于指令集结构,并可与硬件设计和测试环境相契合的自动随机测试生成方法ARTG(automatic random test program generation).它包含用于构造指令的指令树、动态生成策略、分支跳转指令生成算法、流水线冲突预测算法和一套自动结果检查机制.整个测试程序生成过程具有很高的自动化,验证遇到bug时能够减少调试时间迅速找出bug方位.ARTG已应用于自主研发的IME—Diamond数字信号处理器.实验结果表明,该方法产生的测试代码灵活高效,加速了验证过程,并且复杂度低.

基于双维度的环卫业务考核评价方法研究——以海淀环卫中心为例

以海淀环卫中心为例,从对环卫作业过程和结果的双维度检查考评入手,克服单一结果检查考核的片面性,对环卫业务考核程序进行完善创新,根据双维度的检查考评结果,汇总、量化、分析考核数据,找出科学的考核评价方法,对环卫中心各下属业务单位的管理和服务水平进行量化考核评估。

Utility of pancreatography for diagnosing autoimmune pancreatitis

AIM: To identify pancreatographic findings that facilitate differentiating between autoimmune pancreatitis (AIP) and pancreatic cancer (PC) on endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP). METHODS: ERCP findings of 48 AIP and 143 PC patients were compared. Diagnostic accuracies for AIP by ERCP and MRCP were compared in 30 AIP patients. RESULTS: The following ERCP findings suggested a diagnosis of AIP rather than PC. Obstruction of the main pancreatic duct (MPD) was more frequently detected in PC (P < 0.001). Skipped MPD lesions were detected only in AIP (P < 0.001). Side branch derivation from the narrowed MPD was more frequent in AIP (P < 0.001). The narrowed MPD was longer in AIP (P < 0.001), and a narrowed MPD longer than 3 cm was more frequent in AIP (P < 0.001). Maximal diameter of the upstream MPD was smaller in AIP (P < 0.001), and upstream dilatation of the MPD less than 5 mm was more frequent in AIP (P < 0.001). Stenosis of the lower bile duct was smooth in 87% of AIP and irregular in 65% of PC patients (P < 0.001). Stenosis of the intrahepatic or hilar bile duct was detected only in AIP (P = 0.001). On MRCP, diffuse narrowing of the MPD on ERCP was shown as a skipped non-visualized lesion in 50% and faint visualization in 19%, but segmental narrowing of the MPD was visualized faintly in only 14%. CONCLUSION: Several ERCP findings are useful for differentiating AIP from PC. Although MRCP cannot replace ERCP for the diagnostic evaluation of AIP, some MRCP findings support the diagnosis of AIP.

A case of eosinophilic cholangitis:Imaging findings ofcontrast-enhanced ultrasonography, cholangioscopy, andintraductal ultrasonography

A 38-year-old woman was referred to our institution due to epigastralgia. She presented with obstructive jaundice and eosinophilia. Endoscopic retrograde cholangiopancreatography showed diffuse narrowing from the distal common bile duct to the bifurcation of the hepatic ducts. An endoscopic plastic biliary stent was inserted; the specimen obtained from the common bile duct wall revealed dense infiltration by eosinophils. Treatment was started with prednisolone 60 mg daily. The patient's biliary stenosis and eosinophilia gradually improved. Eosinophilic infiltration in the lungs or stomach is relatively common, but it is rare in the common bile duct. Most of the reported cases of eosinophilic cholangitis presented with eosinophilia; our patient's eosinophil count was over 1000/mm3. Since our patient had allergies to pollen and house dust, a relationship between the allergies and the eosinophilic cholangitis was suspected, but no cause was identified.

Endoscopic ultrasonography findings in autoimmune pancreatitis

Endoscopic ultrasonography is an established diagnostic tool for pancreatic masses and chronic pancreatitis.In recent years there has been a growing interest in the worldwide medical community in autoimmune pancreatitis (AIP),a form of chronic pancreatitis caused by an autoimmune process.This paper reviews the current available literature about the endoscopic ultrasonographic findings of AIP and the role of this imaging technique in the management of this protean disease.

Evaluation of magnifying colonoscopy in the diagnosis of serrated polyps

AIM:To elucidate the colonoscopic features of serrated lesions of the colorectum using magnifying colonoscopy.METHODS:Broad division of serrated lesions of the colorectum into hyperplastic polyps(HPs),traditional serrated adenomas(TSAs),and sessile serrated adenomas/polyps(SSA/Ps) has been proposed on the basis of recent molecular biological studies.However,few reports have examined the colonoscopic features of these divisions,including magnified colonoscopic findings.This study examined 118 lesions excised in our hospital as suspected serrated lesions after magnified observation between January 2008 and September 2011.Patient characteristics(sex,age),conventional colonoscopic findings(location,size,morphology,color,mucin) and magnified colonoscopic findings(pit pattern diagnosis) were interpreted by five colonoscopists with experience in over 1000 colonoscopies,and were compared with histopathological diagnoses.The pit patterns were categorized according to Kudo's classification,but a more detailed investigation was also performed using the subclassification [type Ⅱ-Open(type Ⅱ-O),type Ⅱ-Long(type Ⅱ-L),or type Ⅳ-Serrated(type Ⅳ-S)] proposed by Kimura T and Yamano H.RESULTS:Lesions comprised 23 HPs(23/118:19.5%),39 TSAs(39/118:33.1%:with cancer in one case),50 SSA/Ps(50/118:42.4%:complicated with cancer in three cases),and six others(6/118:5.1%).We excluded six others,including three regular adenomas,one hamartoma,one inflammatory polyp,and one juvenile polyp for further analysis.Conventional colonoscopy showed that SSA/Ps were characterized as larger in diameter than TSAs and HPs(SSA/P vs HP,13.62 ± 8.62 mm vs 7.74 ± 3.24 mm,P < 0.001;SSA/Ps vs TSA,13.62 ± 8.62 mm vs 9.89 ± 5.73 mm,P < 0.01);common in the right side of the colon [HPs,30.4%(7/23):TSAs,20.5%(8/39):SSA/P,84.0%(42/50),P < 0.001];flat-elevated lesion [HPs,30.4%(7/23):TSAs,5.1%(2/39):SSA/Ps,90.0%(45/50),P < 0.001];normal-colored or pale imucosa [HPs,34.8%(8/23):TSAs,10.3%(4/39):SSA/Ps,80%(40/50),P < 0.001];and with large amounts of mucin [HPs,21.7%(5/23):TSAs,17.9%(7/39):SSA/Ps,72.0%(36/50),P < 0.001].In magnified colonoscopic findings,17 lesions showed either type Ⅱ pit pattern alone or partial type Ⅱ pit pattern as the basic architecture,with 14 HPs(14/17,70.0%) and 3 SSA/Ps.Magnified colonoscopy showed the type Ⅱ-O pit pattern as characteristic of SSA/Ps [sensitivity 83.7%(41/49),specificity 85.7%(54/63)].Cancer was also present in three lesions,in all of which a type Ⅵ pit pattern was also present within the same lesion.There were four HPs and four TSAs each.The type Ⅳ-S pit pattern was characteristic of TSAs [sensitivity 96.7%(30/31),specificity 89.9%(72/81)].Cancer was present in one lesion,in which a type Ⅵ pit pattern was also present within the same lesion.In our study,serrated lesions of the colorectum also possessed the features described in previous reports of conventional colonoscopic findings.The pit pattern diagnosis using magnifying colonoscopy,particularly magnified colonoscopic findings using subclassifications of surface architecture,reflected the pathological characteristics of SSA/Ps and TSAs,and will be useful for colonoscopic diagnosis.CONCLUSION:We suggest that this system could be a good diagnostic tool for SSA/Ps using magnifying colonoscopy.

Lymphogranuloma venereum proctosigmoiditis is a mimicker of inflammatory bowel disease

There has been an increasing prevalence of lymphogranuloma venereum(LGV) or Chlamydia trachomatis(C.trachomatis) cases among the men who have sex with men(MSM) population,particularly in Europe and North America.These cases may present with an incomplete or undisclosed history and proctosigmoiditis without characteristic adenopathy syndrome.During the initial evaluation and colonoscopy,there is a strong clinical and endoscopic suspicion of inflammatory bowel disease(IBD) by virtue of presentation and endoscopic and histological findings.The diagnosis of IBD is subsequently modified to LGV proctosigmoiditis when one or more of the following transpire:(1) there is failure of response to IBD therapy;(2) additional components of history(MSM/travel) may be identified;(3) return of initially performed Chlamydia antibody test is positive;and(4) response to antibiotics effective against Chlamydia.We describe three such cases initially suspectedto be an inflammatory bowel disease and subsequently identified as C.trachomatis proctosigmoiditis.

Distinct colonoscopy findings of microscopic colitis:Not so microscopic after all?

Microscopic colitis(MC) is considered an "umbrella term",comprising two subtypes,i.e.,collagenous colitis(CC) and lymphocytic colitis(LC).They are classically associated with normal or unremarkable colonoscopy.In the last few years,reports have been published revealing findings that are thought to be characteristic or pathognomonic of MC,especially CC.A systematic electronic and manual search of PubMed and EMBASE(to December 2010),for publications on distinct endoscopic findings in MC,resulted in 42 relevant reports for inclusion in this review.Eighty eight patients with collagenous colitis were presented.Only one publication describing a distinct endoscopic pattern in LC was found.Typical findings in CC are alteration of the vascular mucosal pattern,mucosal nodularity,a sequence of change from mucosal defects to mucosal cicatricial lesions,and perhaps(although of doubtful relevance) mucosal pseudomembranes.A causal connection of mucosal defects with the use of lansoprazole seems to exist.Adoption of the proposed lesion description herein is recommended in order to improve homogeneity of future reports.

Granular cell tumor of the common bile duct: A Japanese case

Granular cell tumor (GCT) of the biliary system is rare. It is reported that it occurs more commonly in young black women. We report here our seldom experience of a Japanese case in whom icterus was found as a first symptom just after a caesarean operation. A 36-year-old Japanese woman developed icterus after delivery by the Caesarean operation. A surgical operation was performed without can deny that there was a tumor-related change in a bile duct as a result of examination for various images. As a result of pathological evaluation, GCT was diagnosed. By the preoperative organization biomicroscopy result, it was not able to be attachd a right diagnosis. It was thought that this tumor, although rare, should be considered as one of the causes of biliary stenosis in the younger population.

Clinical usefulness of adherence to gastro-esophageal reflux disease guideline by Spanish gastroenterologists

AIM:To investigate usefulness of adherence to gastroesophageal reflux disease(GERD) guideline established by the Spanish Association of Gastroenterology.METHODS:Prospective,observational and multicentre study of 301 patients with typical symptoms of GERD who should be managed in accordance with guidelines and were attended by gastroenterologists in daily practice.Patients(aged > 18 years) were eligible for inclusion if they had typical symptoms of GERD(heartburn and/or acid regurgitation) as the major complaint in the presence or absence of accompanying atypical symptoms,such as dyspeptic symptoms and/or supraesophageal symptoms.Diagnostic and therapeutic decisions should be made based on specific recommendations of the Spanish clinical practice guideline for GERD which is a widely disseminated and well known instrument among Spanish in digestive disease specialists.RESULTS:Endoscopy was indicated in 123(41%) patients:50 with alarm symptoms,32 with age > 50 years without alarm symptom.Seventy-two patients(58.5%) had esophagitis(grade A,23,grade B,28,grade C,18,grade D,3).In the presence of alarm symptoms,endoscopy was indicated consistently with recommendations in 98% of cases.However,in the absence of alarm symptoms,endoscopy was indicated in 33% of patients > 50 years(not recommended by the guideline).Adherence for proton pump inhibitors(PPIs) therapy was 80%,but doses prescribed were lower(half) in 5% of cases and higher(double) in 15%.Adherence regarding duration of PPI therapy was 69%;duration was shorter than recommended in 1%(4 wk in esophagitis grades C-D) or longer in 30%(8 wk in esophagitis grades A-B or in patients without endoscopy).Treatment response was higher when PPI doses were consistent with guidelines,although differences were not significant(95% vs 85%).CONCLUSION:GERD guideline compliance was quite good although endoscopy was over indicated in patients > 50 years without alarm symptoms;PPIs were prescribed at higher doses and longer duration.

Synchronous double cancers of the common bile duct

We report an extremely rare case of synchronous double cancers of the common bile duct without pancreaticobiliary maljunction.Only two similar cases have been reported in the English literature.Endoscopic retrograde cholangiopancreatography showed a tuberous filling defect in the middle and superior parts of the common bile duct,and mild stenosis in the inferior duct.Computed tomography(CT) showed a well enhanced mass in the middle and superior parts of the common bile duct.A single cancer of the middle and superior bile duct was suspected and extra-hepatic bile duct resection was performed.CT eleven months after surgery revealed enhanced inferior bile duct wall and a slightly enhanced tumor within it.Retrospective review of the CT images taken before first surgery showed enhanced inferior bile duct wall without intrabiliary tumor only on the delayed phase.The inferior bile duct tumor was suspected to have originally co-existed with the middle and superior bile duct tumor.Pancreaticoduodenectomy was performed subsequently.Histopathological examination revealed that the middle and superior bile duct tumor was a moderately differentiated tubular adenocarcinoma while the inferior bile duct tumor was a papillary adenocarcinoma.The two tumors were separated and had different histological findings and growth patterns,further suggesting that they were two primary cancers.

Differences between diffuse and focal autoimmune pancreatitis

AIM:To investigate differences in clinical features between diffuse-and focal-type autoimmune pancreatitis(AIP).METHODS:Based on radiological findings by computed tomography and/or magnetic resonance imaging,we divided 67 AIP patients into diffuse type(D type) and focal type(F type).We further divided F type into head type(H type) and body and/or tail type(B/T type) according to the location of enlargement.Finally,we classified the 67 AIP patients into three groups:D type,H type and B/T type.We compared the three types of AIP in terms of clinical,laboratory,radiological,functional and histological findings and clinical course.RESULTS:There were 34 patients with D-type,19 with H-type and 14 with B/T-type AIP.Although obstructive jaundice was frequently detected in D-typepatients(88%) and H-type patients(68%),no B/T-type patients showed jaundice as an initial symptom(P < 0.001).There were no differences in frequency of abdominal pain,but acute pancreatitis was associated more frequently in B/T-type patients(36%) than in D-type patients(3%)(P = 0.017).Serum immunoglobulin G(IgG)4 levels were significantly higher in D-type patients(median 309 mg/dL) than in B/T-type patients(133.5 mg/dL)(P = 0.042).Serum amylase levels in B/T-type patients(median:114 IU/L) were significantly greater than in H-type patients(72 IU/L)(P = 0.049).Lymphoplasmacytic sclerosing pancreatitis(LPSP) was histologically confirmed in 6 D-type,7 H-type and 4 B/T-type patients;idiopathic duct-centric pancreatitis was observed in no patients.Marked fibrosis and abundant infiltration of CD20-positive B lymphocytes with few IgG4-positive plasma cells were detected in 2 B/T-type patients.Steroid therapy was effective in all 50 patients(31 D type,13 H type and 6 B/T type).Although AIP relapsed during tapering or after stopping steroids in 3 D-type and 3 H-type patients,no patients relapsed in B/T type.During follow-up,radiological features of 6 B/T-type patients were not changed and 1 B/T-type patient improved naturally.CONCLUSION:Clinical features of H-type AIP were similar to those of D-type,but B/T-type differed from D and H types.B/T-type may involve diseases other than LPSP.

Conscious or unconscious:The impact of sedation choice on colon adenoma detection

AIM: To determine if anesthesiologist-monitored useof propofol results in improved detection of adenomaswhen compared with routine conscious sedation. METHODS: This retrospective study was conductedat two separate hospital-based endoscopy units whereapproximately 12 000 endoscopic procedures are permed annually, with one endoscopy unit exclusivelyusing anesthesiologist-monitored propofol. Three thousand two hundred and fifty-two patients underwent initial screening or surveillance colonoscopies. Our primaryend point was the adenoma detection rate, def ined asthe number of patients in whom at least one adenomawas found, associated with the type of sedation. RESULTS: Three thousand two hundred and fi ftytwooutpatient colonoscopies were performed by fi ve selected endoscopists. At least one adenoma was detected in 27.6% of patients (95% CI = 26.0-29.1) with no difference in the detection rate between the anesthes-ologist propofol and group and the gastroenterologist-midazolam/fentanyl group (28.1% vs 27.1%, P = 0.53). CONCLUSION: The type of sedation used during colonoscopy does not affect the number of patients in whom adenomatous polyps are detected.

Signet-ring cell carcinoma of ampulla of Vater:Contrast-enhanced ultrasound findings

Signet-ring cell carcinoma(SRCC) of ampulla of Vater is extremely uncommon,and less than 15 cases have been reported so far in literature.It mainly occurs in elderly people(median age 57 years).We report a rare case of SRCC of the ampulla of Vater in a 38-year-old woman who presented with a small tumor at the Vater,discovered by the contrast-enhanced ultrasound(CEUS).Histopathological examination showed prominent signet-ring features.We also describe the imaging features of SRCC of ampulla of Vater in CEUS.

Hemorrhagic Fever with Renal Syndrome Associated with Acute Pancreatitis

Hemorrhagic fever with renal syndrome (HFRS) is a systemic infectious disease caused by Hantaviruses and characterized by fevers, bleeding tendencies, gastrointestinal symptoms and renal failure. It encompasses a broad spectrum of clinical presentations, ranging from unapparent or mild illnesses to fulminant hemorrhagic processes. Among the various complications of HFRS, acute pancreatitis is a rare find. In this report, based on clinical data, laboratory and radiologic examination findings, we describe a clinical case, with HFRS from Dobrava virus, associated with acute pancreatitis. The patient was successfully treated by supportive management. Clinicians should be alert to the possibility of HFRS when examining patients with epidemiological data and symptoms of acute pancreatitis.

Helical CT findings and clinicopathologic features in malignant gastrointestinal stromal tumors: the correlation between radiologic appearance and malignant potential

Objective： In this pictorial essay, we described the clinical, pathologic, and computed tomographic （CT） findings of malignant gastrointestinal stromal tumors （MGISTs） and attempt to establish the correlation between radiologic appearance and malignant potential. Methods： This retrospective analysis included 20 patients receiving treatment for MGIST between 2008 and 2010. The diagnosis was established by pathology and immunohistochemistry. All these patients underwent pre- operative CT. Clinical presentation, pathology and CT images were analyzed. Helical CT images were reviewed for morpho- logic features such as tumor size, number and location, tumor margins, necrosis, degree of enhancement and metastasis. Results： Gastrointestinal bleeding, abdominal pain and discomfort, and without clinical symptom were common findings and were observed in 9 （45%）, 6 （30%）, and 5 （25%） of the 20 patients. 8 （40%） tumors were located in stomach, and 10 （50%）, 1 （5%） and 1 （5%） were located in small intestine, mesentery and peritoneum, respectively. Male to female ratio was about 1：2. The size of MGIST ranged from 2.6 cm to 17.5 cm with a mean of 8.7 cm. All tumors density was inhomogeneous and heterogeneous enhancement. MGISTs with highly malignant located in small intestine were about 30% higher than stomach. The ＂satellite＂ turnouts were found in 6 cases with high malignant risk. 7 cases were suffered from liver metastasis, and 4 cases went with seeding into the abdominal cavity, 1 cases went with lymph node metastasis. Histologically, 19 cases （95%） were of spindle cell type. Immunohistochemical stains demonstrated a strong positivity for both c-kit （CDl17） and CD34s enhancement in 19 （95%）. Conclusion： Clinical expression is varied in MGIST patients. Female might be predominance in MGIST. The GISTs located in small intestine would tend to be more aggressive. The satellite tumours, necrosis and cystic degeneration were strongly benefit for MGIST diagnosis. Furthermore, intestinal obstruction doesn＇t support the diagnosis. Lymph node metastasis and calcification is rare.

A Primary Hepatobiliary Neoplasia in a Persian Cat

Biliary carcinoma was diagnosed in a 7-year female Persian cat. The presented clinical signs were not conclusive for hepatic neoplasms and shared many other common health problems in cats i.e. anorexia, vomiting and dehydration. Blood laboratory analysis showed marked elevation of liver enzymes. Ultrasonography revealed a mixed echogenic pattern with multiple hypoechoic cyst-like cavities. At necropsy, the liver showed diffuse multi-lobulated masses affecting the parenchyma of all the lobes of the liver. Histopathology confirmed the neoplastic nature of the hepatic parenchymatous masses.

Lower Extremity Arterial Occlusive Disease As a Rare Complication of Crohn’s Disease

Objective To investigate the clinical characteristics and treatment strategy of lower extremity arterial occlusive disease in patients with Crohn's disease (CD). Methods Clinical information of 9 cases suffering from lower extremity arterial occlusion and CD was investigated retrospectively. Results All the cases were less than 50 years old and the most were females (8/9). Arterial occlusions occurred in either active (5/9) or inactive (4/9) stage of CD. Besides the arteries of lower extremities, other arteries could also be involved such as aorta, iliac artery, renal artery or mesentery artery. Seven cases had atherosclerotic imaging findings (4 had aortic plaques and 6 had iliac artery stenoses). Embolectomy or thromboendarterectomy were mostly performed. Four (44.4%) cases had recurrent lower limb ischemia. Conclusions Arterial occlusive disease is a rare extraintestinal manifestation of CD. A thorough inspection of aorta is necessary. Embolectomy is mostly preferred. Anticoagulation treatment is highly recommended after the operation.