BACKGROUND Even in the immuno-oncology era,transcatheter arterial chemoembolisation(TACE)is the most effective way to treat intermediate stage hepatocellular carcinoma(HCC).Postembolisation syndrome(PES)is the most co...BACKGROUND Even in the immuno-oncology era,transcatheter arterial chemoembolisation(TACE)is the most effective way to treat intermediate stage hepatocellular carcinoma(HCC).Postembolisation syndrome(PES)is the most common side effect from TACE and there is still no standard prevention guideline.AIM To evaluate the efficacy of single dose intravenous dexamethasone regimen to prevent PES after TACE among patients with HCC.METHODS This study enrolled patients with HCC who had eligible indication for TACE without macrovascular invasion/extrahepatic metastasis.Patients were randomly assigned to either an intravenous single dose of dexamethasone 8 mg or placebo one hour before TACE.The primary outcome was a negative result of PES at 48 h after TACE,which was defined as score<2 of Southwest Oncology Group toxicity coding criteria using fever,nausea,vomiting and pain to calculated.And the secondary end point was duration of admission between two groups.RESULTS One hundred patients were randomly assigned 1:1.Under intention-to-treat analysis,49 patients were randomly assigned to the dexamethasone and 51 to the placebo groups.Both groups were similar for baseline characteristics.The negative PES rate was significantly higher in the dexamethasone group than in the placebo group(63.3%vs 29.4%;P=0.005).Mean Southwest Oncology Group toxicity coding PES was 2.14(95%CI:1.41-2.8)vs 3.71(95%CI:2.97-4.45)between the dexamethasone and placebo groups,respectively.Cumulative incidence of fever was significantly lower in dexamethasone group with P<0.001,pain,nausea and vomiting were also lower in the dexamethasone group compared with the placebo group(P=0.16,P=0.11,and P=0.49).The dexamethasone regimen was generally well tolerated by patients with HCC patients including those with hepatitis B virus infection and well-controlled diabetes mellitus.CONCLUSION Single dose dexamethasone was effective at preventing PES among patients with HCC treated with TACE.The study showed no adverse events of special interest related to dexamethasone.展开更多
·AIM:To report a successful osteo-odonto keratoprosthesis(OOKP) procedure in a case of end stage of corneal blindness due to Stevens-Johnson syndrome (SJS).·METHODS:An interventional case report.·RESULT...·AIM:To report a successful osteo-odonto keratoprosthesis(OOKP) procedure in a case of end stage of corneal blindness due to Stevens-Johnson syndrome (SJS).·METHODS:An interventional case report.·RESULTS:We describe a 35-year-old Indian woman,a known case of SJS with bilateral dry eyes and corneal blindness (failed corneal graft with vascularised total corneal opacity in the right eye and non-healing corneal ulcer in the left eye).Vision was hand movement only in both eyes.The corneal ulcer healed with medical treatment resulting in vascularised total corneal opacity with no improvement in vision.OOKP was performed in the right eye and the vision was improved from hand movement to 6/6.The same vision was maintained in the right eye at the last follow-up 5 years after surgery.·CONCLUSION:OOKP provides good visual rehabilitation with long-term anatomically stable prosthesis in patients with end-stage of ocular surface disorders and corneal blindness secondary to SJS.·展开更多
From its first description in antiquity, the place of cryptophthalmos in the history of medical genetics is briefly set out until, in the twentieth century, this rare constellation of multiple congenital malformations...From its first description in antiquity, the place of cryptophthalmos in the history of medical genetics is briefly set out until, in the twentieth century, this rare constellation of multiple congenital malformations of which cryptophthalmos is the most striking, even though not obligatory, component, was identified as an inherited autosomal recessive condition. It was given the name of Fraser syndrome and mutant alleles of the genes FRAS1, FREM2 and GRIP1 were identified as being responsible for a proportion of cases. In the remainder of cases, it may be supposed that mutant alleles of other genes, as yet unidentified, are responsible. In general, this association of multiple disparate malformations in an autosomal recessive condition may be expected to throw light on important aspects of gene action in embryogenesis. An aspect of medical genetics, which has become important with respect to the condition, is antenatal diagnosis with the prospect of abortion of affected fetuses.展开更多
BACKGROUND Candy cane syndrome(CCS)is a condition that occurs following gastrectomy or gastric bypass.CCS remains underrecognized,yet its prevalence is likely to rise due to the obesity epidemic and increased use of b...BACKGROUND Candy cane syndrome(CCS)is a condition that occurs following gastrectomy or gastric bypass.CCS remains underrecognized,yet its prevalence is likely to rise due to the obesity epidemic and increased use of bariatric surgery.No previous literature review on this subject has been published.AIM To collate the current knowledge on CCS.METHODS A literature search was conducted with PubMed and Google Scholar for studies from May 2007,until March 2023.The bibliographies of the retrieved articles were manually searched for additional relevant articles.RESULTS Twenty-one articles were identified(135 patients).Abdominal pain,nausea/vomiting,and reflux were the most reported symptoms.Upper gastrointestinal(GI)series and endoscopy were performed for diagnosis.Surgical resection of the blind limb was performed in 13 studies with resolution of symptoms in 73%-100%.In surgical series,9 complications were reported with no mortality.One study reported the surgical construction of a jejunal pouch with clinical success.Six studies described endoscopic approaches with 100%clinical success and no complications.In one case report,endoscopic dilation did not improve the patient’s symptoms.CONCLUSION CCS remains underrecognized due to lack of knowledge about this condition.The growth of the obesity epidemic worldwide and the increase in bariatric surgery are likely to increase its prevalence.CCS can be prevented if an elongated blind loop is avoided or if a jejunal pouch is constructed after total gastrectomy.Diagnosis should be based on symptoms,endoscopy,and upper GI series.Blind loop resection is curative but complex and associated with significant complications.Endoscopic management using different approaches to divert flow is effective and should be further explored.展开更多
Visual anosognosia or Anton-Babinski syndrome is a rare neurological condition related to cortical blindness. The patients deny their blindness and affirm adamantly that they are capable of seeing. The clinical presen...Visual anosognosia or Anton-Babinski syndrome is a rare neurological condition related to cortical blindness. The patients deny their blindness and affirm adamantly that they are capable of seeing. The clinical presentation includes confabulations and sometimes confusional states. In this article we report two patients with anosognosia related to ischemic stroke in two different sets of etiology and pathogenesis. We describe the major clinical manifestations of this syndrome and review the current medical literature. Two patients were identified, a 96-year-old male with visual anosognosia secondary to a right posterior cerebral artery thrombosis, and a 56-year-old female with the same syndrome but related to central nervous system angiitis in relation with multiple sclerosis and Hashimoto’s thyroiditis. Visual anosognosia or Anton-Babinski syndrome is a rare neurological condition, however the ischemic vascular cerebral disease is a frequent etiology. We believe that this is the first report of this syndrome in relation to angiitis with a clear autoimmune pathogenesis.展开更多
Blind loop syndrome after side-to-side ileocolonic anas-tomosis is a well-recognized entity even though its in-cidence and complication rates are not clearly defined. The inevitable dilation of the ileal cul-de-sac le...Blind loop syndrome after side-to-side ileocolonic anas-tomosis is a well-recognized entity even though its in-cidence and complication rates are not clearly defined. The inevitable dilation of the ileal cul-de-sac leads to stasis and bacterial overgrowth which eventually leads to mucosal ulceration and even full-thickness perfora-tion. Blind loop syndrome may be an underestimated complication in the setting of digestive surgery. It should always be taken into account in cases of acute abdomen in patients who previously underwent right hemicolectomy. We herein report 3 patients who were diagnosed with perforative blind loop syndrome a few years after standard right hemicolectomy followed by a side-to-side ileocolonic anastomosis.展开更多
目的:观察一清双解胶囊和片剂治疗急性上呼吸道感染(风温病热在肺卫证)的疗效,并对其安全性作出评价。方法:采用多中心随机对照双盲双模拟试验,对急性上呼吸道感染(风温病热在肺卫证)患者360例,按1∶1∶1比例随机分为一清双解胶囊组(治...目的:观察一清双解胶囊和片剂治疗急性上呼吸道感染(风温病热在肺卫证)的疗效,并对其安全性作出评价。方法:采用多中心随机对照双盲双模拟试验,对急性上呼吸道感染(风温病热在肺卫证)患者360例,按1∶1∶1比例随机分为一清双解胶囊组(治疗组A)120例,一清双解片剂组(治疗组B)120例及柴黄片组(对照组)120例。治疗组分别给予一清双解胶囊或片剂,每次3粒(片),每日3次;对照组给予柴黄片,每次3片,每日3次。疗程均为5d。观察治疗前后症状、体征变化和有无不良反应,并进行血、尿、大便常规,肝肾功能及心电图检查。结果:纳入患者360例,剔除3例,脱落18例,最终进入意向性(intention-to-treat,ITT)分析343例,符合方案集(per-protocol population set,PPS)分析339例。其中上呼吸道感染疗效:ITT显示,治疗组A总显效率84.96%,总有效率为96.46%;治疗组B分别为85.48%,97.45%;对照组分别为72.58%,99.12%。PPS显示,治疗组A总显效率87.27%,总有效率97.27%;治疗组B分别为86.20%,97.41%;对照组分别为72.58%,99.12%。试验组(胶囊、片剂)疾病疗效优于对照组(P<0.05),ITT与PPS结果一致。中医证候疗效:ITT显示,治疗组A愈显率84.07%,总有效率96.46%;治疗组B分别为88.89%,97.44%;对照组分别为72.58%,99.12%。PPS显示,治疗组A愈显率85.46%,总有效率97.27%;治疗组B分别为89.65%,97.41%;对照组分别为72.58%,99.12%。试验组(胶囊、片剂)中医证候疗效优于对照组(P<0.05),ITT与PPS结果一致。观察中未发现明显不良反应。结论:一清双解胶囊和片剂治疗急性上呼吸道感染热在肺卫证疗效确切,未发现明显毒副作用。展开更多
文摘BACKGROUND Even in the immuno-oncology era,transcatheter arterial chemoembolisation(TACE)is the most effective way to treat intermediate stage hepatocellular carcinoma(HCC).Postembolisation syndrome(PES)is the most common side effect from TACE and there is still no standard prevention guideline.AIM To evaluate the efficacy of single dose intravenous dexamethasone regimen to prevent PES after TACE among patients with HCC.METHODS This study enrolled patients with HCC who had eligible indication for TACE without macrovascular invasion/extrahepatic metastasis.Patients were randomly assigned to either an intravenous single dose of dexamethasone 8 mg or placebo one hour before TACE.The primary outcome was a negative result of PES at 48 h after TACE,which was defined as score<2 of Southwest Oncology Group toxicity coding criteria using fever,nausea,vomiting and pain to calculated.And the secondary end point was duration of admission between two groups.RESULTS One hundred patients were randomly assigned 1:1.Under intention-to-treat analysis,49 patients were randomly assigned to the dexamethasone and 51 to the placebo groups.Both groups were similar for baseline characteristics.The negative PES rate was significantly higher in the dexamethasone group than in the placebo group(63.3%vs 29.4%;P=0.005).Mean Southwest Oncology Group toxicity coding PES was 2.14(95%CI:1.41-2.8)vs 3.71(95%CI:2.97-4.45)between the dexamethasone and placebo groups,respectively.Cumulative incidence of fever was significantly lower in dexamethasone group with P<0.001,pain,nausea and vomiting were also lower in the dexamethasone group compared with the placebo group(P=0.16,P=0.11,and P=0.49).The dexamethasone regimen was generally well tolerated by patients with HCC patients including those with hepatitis B virus infection and well-controlled diabetes mellitus.CONCLUSION Single dose dexamethasone was effective at preventing PES among patients with HCC treated with TACE.The study showed no adverse events of special interest related to dexamethasone.
文摘·AIM:To report a successful osteo-odonto keratoprosthesis(OOKP) procedure in a case of end stage of corneal blindness due to Stevens-Johnson syndrome (SJS).·METHODS:An interventional case report.·RESULTS:We describe a 35-year-old Indian woman,a known case of SJS with bilateral dry eyes and corneal blindness (failed corneal graft with vascularised total corneal opacity in the right eye and non-healing corneal ulcer in the left eye).Vision was hand movement only in both eyes.The corneal ulcer healed with medical treatment resulting in vascularised total corneal opacity with no improvement in vision.OOKP was performed in the right eye and the vision was improved from hand movement to 6/6.The same vision was maintained in the right eye at the last follow-up 5 years after surgery.·CONCLUSION:OOKP provides good visual rehabilitation with long-term anatomically stable prosthesis in patients with end-stage of ocular surface disorders and corneal blindness secondary to SJS.·
文摘From its first description in antiquity, the place of cryptophthalmos in the history of medical genetics is briefly set out until, in the twentieth century, this rare constellation of multiple congenital malformations of which cryptophthalmos is the most striking, even though not obligatory, component, was identified as an inherited autosomal recessive condition. It was given the name of Fraser syndrome and mutant alleles of the genes FRAS1, FREM2 and GRIP1 were identified as being responsible for a proportion of cases. In the remainder of cases, it may be supposed that mutant alleles of other genes, as yet unidentified, are responsible. In general, this association of multiple disparate malformations in an autosomal recessive condition may be expected to throw light on important aspects of gene action in embryogenesis. An aspect of medical genetics, which has become important with respect to the condition, is antenatal diagnosis with the prospect of abortion of affected fetuses.
文摘BACKGROUND Candy cane syndrome(CCS)is a condition that occurs following gastrectomy or gastric bypass.CCS remains underrecognized,yet its prevalence is likely to rise due to the obesity epidemic and increased use of bariatric surgery.No previous literature review on this subject has been published.AIM To collate the current knowledge on CCS.METHODS A literature search was conducted with PubMed and Google Scholar for studies from May 2007,until March 2023.The bibliographies of the retrieved articles were manually searched for additional relevant articles.RESULTS Twenty-one articles were identified(135 patients).Abdominal pain,nausea/vomiting,and reflux were the most reported symptoms.Upper gastrointestinal(GI)series and endoscopy were performed for diagnosis.Surgical resection of the blind limb was performed in 13 studies with resolution of symptoms in 73%-100%.In surgical series,9 complications were reported with no mortality.One study reported the surgical construction of a jejunal pouch with clinical success.Six studies described endoscopic approaches with 100%clinical success and no complications.In one case report,endoscopic dilation did not improve the patient’s symptoms.CONCLUSION CCS remains underrecognized due to lack of knowledge about this condition.The growth of the obesity epidemic worldwide and the increase in bariatric surgery are likely to increase its prevalence.CCS can be prevented if an elongated blind loop is avoided or if a jejunal pouch is constructed after total gastrectomy.Diagnosis should be based on symptoms,endoscopy,and upper GI series.Blind loop resection is curative but complex and associated with significant complications.Endoscopic management using different approaches to divert flow is effective and should be further explored.
文摘Visual anosognosia or Anton-Babinski syndrome is a rare neurological condition related to cortical blindness. The patients deny their blindness and affirm adamantly that they are capable of seeing. The clinical presentation includes confabulations and sometimes confusional states. In this article we report two patients with anosognosia related to ischemic stroke in two different sets of etiology and pathogenesis. We describe the major clinical manifestations of this syndrome and review the current medical literature. Two patients were identified, a 96-year-old male with visual anosognosia secondary to a right posterior cerebral artery thrombosis, and a 56-year-old female with the same syndrome but related to central nervous system angiitis in relation with multiple sclerosis and Hashimoto’s thyroiditis. Visual anosognosia or Anton-Babinski syndrome is a rare neurological condition, however the ischemic vascular cerebral disease is a frequent etiology. We believe that this is the first report of this syndrome in relation to angiitis with a clear autoimmune pathogenesis.
文摘Blind loop syndrome after side-to-side ileocolonic anas-tomosis is a well-recognized entity even though its in-cidence and complication rates are not clearly defined. The inevitable dilation of the ileal cul-de-sac leads to stasis and bacterial overgrowth which eventually leads to mucosal ulceration and even full-thickness perfora-tion. Blind loop syndrome may be an underestimated complication in the setting of digestive surgery. It should always be taken into account in cases of acute abdomen in patients who previously underwent right hemicolectomy. We herein report 3 patients who were diagnosed with perforative blind loop syndrome a few years after standard right hemicolectomy followed by a side-to-side ileocolonic anastomosis.
文摘目的:观察一清双解胶囊和片剂治疗急性上呼吸道感染(风温病热在肺卫证)的疗效,并对其安全性作出评价。方法:采用多中心随机对照双盲双模拟试验,对急性上呼吸道感染(风温病热在肺卫证)患者360例,按1∶1∶1比例随机分为一清双解胶囊组(治疗组A)120例,一清双解片剂组(治疗组B)120例及柴黄片组(对照组)120例。治疗组分别给予一清双解胶囊或片剂,每次3粒(片),每日3次;对照组给予柴黄片,每次3片,每日3次。疗程均为5d。观察治疗前后症状、体征变化和有无不良反应,并进行血、尿、大便常规,肝肾功能及心电图检查。结果:纳入患者360例,剔除3例,脱落18例,最终进入意向性(intention-to-treat,ITT)分析343例,符合方案集(per-protocol population set,PPS)分析339例。其中上呼吸道感染疗效:ITT显示,治疗组A总显效率84.96%,总有效率为96.46%;治疗组B分别为85.48%,97.45%;对照组分别为72.58%,99.12%。PPS显示,治疗组A总显效率87.27%,总有效率97.27%;治疗组B分别为86.20%,97.41%;对照组分别为72.58%,99.12%。试验组(胶囊、片剂)疾病疗效优于对照组(P<0.05),ITT与PPS结果一致。中医证候疗效:ITT显示,治疗组A愈显率84.07%,总有效率96.46%;治疗组B分别为88.89%,97.44%;对照组分别为72.58%,99.12%。PPS显示,治疗组A愈显率85.46%,总有效率97.27%;治疗组B分别为89.65%,97.41%;对照组分别为72.58%,99.12%。试验组(胶囊、片剂)中医证候疗效优于对照组(P<0.05),ITT与PPS结果一致。观察中未发现明显不良反应。结论:一清双解胶囊和片剂治疗急性上呼吸道感染热在肺卫证疗效确切,未发现明显毒副作用。
