Carpal tunnel syndrome(CTS) is the most commonly diagnosed disabling condition of the upper extremities. It is the most commonly known and prevalent type of peripheral entrapment neuropathy that accounts for about 90%...Carpal tunnel syndrome(CTS) is the most commonly diagnosed disabling condition of the upper extremities. It is the most commonly known and prevalent type of peripheral entrapment neuropathy that accounts for about 90% of all entrapment neuropathies. This review aims to provide an outline of CTS by considering anat-omy, pathophysiology, clinical manifestation, diagnostic modalities and management of this common condition, with an emphasis on the diagnostic imaging evaluation.展开更多
Myofascial pain syndrome(MPS)is characterized by myofascial trigger points and fascial constrictions.At present,domestic and foreign scholars have not reached a consensus on the etiology and pathogenesis of MPS.Due to...Myofascial pain syndrome(MPS)is characterized by myofascial trigger points and fascial constrictions.At present,domestic and foreign scholars have not reached a consensus on the etiology and pathogenesis of MPS.Due to the lack of specific laboratory indicators and imaging evidence,there is no unified diagnostic criteria for MPS,making it easy to confuse with other diseases.The Chinese Association for the Study of Pain organized domestic experts to formulate this Chinese Pain Specialist Consensus on the diagnosis and treatment of MPS.This article reviews relevant domestic and foreign literature on the definition,epidemiology,pathogenesis,clinical manifestation,diagnostic criteria and treatments of MPS.The consensus is intended to normalize the diagnosis and treatment of MPS and be used by first-line doctors,including pain physicians to manage patients with MPS.展开更多
Dear Editor,I am Dr.Jia X from the Department of Ophthalmology,Second Xiangya Hospital,Central South University,Changsha,China.I write to present a rare case report of 9p deletion syndrome with congenital infantile gl...Dear Editor,I am Dr.Jia X from the Department of Ophthalmology,Second Xiangya Hospital,Central South University,Changsha,China.I write to present a rare case report of 9p deletion syndrome with congenital infantile glaucoma in an infant,accompanying with an effective method of both diagnosis and treatment.展开更多
The morbidity and mortality of acute coronary syndrome disease is extremely high and is the main cause of human death.As an important part of the wisdom of the Chinese nation,TCM plays an important role in treatment.B...The morbidity and mortality of acute coronary syndrome disease is extremely high and is the main cause of human death.As an important part of the wisdom of the Chinese nation,TCM plays an important role in treatment.By reviewing recent related research and reports on TCM theories,Chinese herbal formulas,Chinese and Western medicine treatment and other considerations,it aims to provide ideas and references for clinical treatment.展开更多
Irritable bowel syndrome (IBS) is a chronic and debilitating functional gastrointestinal disorder that affects 9%-23% of the population across the world. The percentage of patients seeking health care related to IBS a...Irritable bowel syndrome (IBS) is a chronic and debilitating functional gastrointestinal disorder that affects 9%-23% of the population across the world. The percentage of patients seeking health care related to IBS approaches 12% in primary care practices and is by far the largest subgroup seen in gastroenterology clinics. It has been well documented that these patients exhibit a poorer quality of life and utilize the health care system to a greater degree than patients without this diagnosis. The pathophysiology of IBS is not clear. Many theories have been put forward, but the exact cause of IBS is still uncertain. According to the updated ROME III criteria, IBS is a clinical diagnosis and presents as one of the three predominant subtypes: (1) IBS with constipation (IBS-C); (2) IBS with diarrhea (IBS-D); and (3) mixed IBS (IBS-M); former ROME definitions refer to IBS-M as alternating IBS (IBS-A). Across the IBS subtypes, the presentation of symptoms may vary among patients and change over time. Patients report the most distressing symptoms to be abdominal pain, straining, myalgias, urgency, bloating and feelings of serious illness. The complexity and diversity of IBS presentation makes treatment difficult. Although there are reviews and guidelines for treating IBS, they focus on the efficacy of medications for IBS symptoms using high-priority endpoints, leaving those of lower priority largely unreported. Therefore, the aim of this review is to provide a comprehensive evidence-based review of the diagnosis, pathogenesis and treatment to guide clinicians diagnosing and treating their patients.展开更多
Three patients with nutcracker syndrome(NCS) were enrolled in the study.Their clinical symptoms mainly included proteinuria and serious varicocele.Color Doppler ultrasound and computed tomography showed that the patie...Three patients with nutcracker syndrome(NCS) were enrolled in the study.Their clinical symptoms mainly included proteinuria and serious varicocele.Color Doppler ultrasound and computed tomography showed that the patients had constricted abdominal aortas,reduced superior mesenteric artery angles,and thinned left renal veins.Patients then underwent left spermatic vein ligation and iliac vein anastomosis.They were checked tliree months after their operation,and results showed that their sperms were improved and their proteinuria disappeared. The color Doppler ultrasound showed new cycle pathways.NCS clinical manifestations are complicated,and need combination diagnosis of symptoms and auxiliary examination to detennine surgical indications.Ligation of spermatic vein and vein anastomosis can be used to treat NCS.展开更多
Presented in this paper is our experience in the diagnosis and management of abdominal compartment syndrome during severe acute pancreatitis. On the basis of the history of severe acute pancreatitis, after effective ...Presented in this paper is our experience in the diagnosis and management of abdominal compartment syndrome during severe acute pancreatitis. On the basis of the history of severe acute pancreatitis, after effective fluid resuscitation, if patients developed renal, pulmonary and cardiac insufficiency after abdominal expansion and abdominal wall tension, ACS should be considered. Cystometry could be performed to confirm the diagnosis. Emergency decompressive celiotomy and temporary abdominal closure with a 3 liter sterile plastic bag must be performed. It is also critical to prevent reperfusion syndrome. In 23 cases of ACS, 18 cases received emergency decompressive celiotomy and 5 cases did not. In the former, 3 patients died (16.7 %) while in the later, 4 (80%) died. Total mortality rate was 33.3% (7/21). In 7 death cases, 4 patients developed acute obstructive suppurative cholangitis (AOSC). All the patients who received emergency decompressive celiotomy 5 h after confirmation of ACS survived. The definitive abdominal closure took place mostly 3 to 5 days after emergency decompressive celiotomy, with longest time being 8 days. 6 cases of ACS at infection stage were all attributed to infected necrosis in abdominal cavity and retroperitoneum. ACS could occur in SIRS stage and infection stage during SAP, and has different pathophysiological basis. Early diagnosis, emergency decompressive celiotomy and temporary abdominal closure with a 3L sterile plastic bag are the keys to the management of the condition.展开更多
Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disease, characterized by a combination of symptoms, clinical findings and histological abnormalities. Ulcers are only found in 40% of the patients; 20% of t...Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disease, characterized by a combination of symptoms, clinical findings and histological abnormalities. Ulcers are only found in 40% of the patients; 20% of the patients have a solitary ulcer, and the rest of the lesions vary in shape and size, from hyperemic mucosa to broad-based polypoid. Men and women are affected equally, with a small predominance in women. SRUS has also been described in children and in the geriatric population. Clinical features include rectal bleeding, copious mucus discharge, prolonged excessive straining, perineal and abdominal pain, feeling of incomplete defecation, constipation, and rarely, rectal prolapse. This disease has well-described histopathological features such as obliteration of the lamina propria by fibrosis and smooth muscle fibers extending from a thickened muscularis mucosa to the lumen. Diffuse collage deposition in the lamina propria and abnormal smooth muscle fiber extensions are sensitive markers for differ-entiating SRUS from other conditions. However, the etiology remains obscure, and the condition is frequently associated with pelvic floor disorders. SRUS is difficult to treat, and various treatment strategies have been advocated, ranging from conservative management to a variety of surgical procedures. The aim of the present review is to summarize the clinical features, pathophysiology, diagnostic methods and treatment strategies associated with SRUS. (C) 2014 Baishideng Publishing Group Co., Limited. All rights reserved.展开更多
Pneumonia and acute respiratory distress syndrome are common and important causes of respiratory failure in the intensive care unit with a significant impact on morbidity, mortality and health care utilization despite...Pneumonia and acute respiratory distress syndrome are common and important causes of respiratory failure in the intensive care unit with a significant impact on morbidity, mortality and health care utilization despite early antimicrobial therapy and lung protective mechanical ventilation. Both clinical entities are characterized by acute pulmonary inflammation in response to direct or indirect lung injury. Adjunct anti-inflammatory treatment with corticosteroids is increasingly used, although the evidence for benefit is limited. The treatment decisions are based on radiographic, clinical and physiological variables without regards to inflammatory state. Current evidence suggests a role of biomarkers for the assessment of severity, and distinguishing sub-phenotypes (hyperinflammatory versus hypo-inflammatory) with important prognostic and therapeutic implications. Although many inflammatory biomarkers have been studied the most common and of interest are C-reactive protein, procalcitonin, and pro-inflammatory cytokines including interleukin 6. While extensively studied as prognostic tools (prognostic enrichment), limited data are available for the role of biomarkers in determining appropriate initiation, timing and dosing of adjunct anti-inflammatory treatment (predictive enrichment)展开更多
Postural orthostatic tachycardia syndrome (POTS) has been recognized since at least 1940.A review of the literature identifies differences in the definition for this condition and wide variations in treatment and ou...Postural orthostatic tachycardia syndrome (POTS) has been recognized since at least 1940.A review of the literature identifies differences in the definition for this condition and wide variations in treatment and outcomes.This syndrome appears to describe a group of conditions with differing pathophysiology,which requires treatment tailored to the true underlying disorder.Patients need to be fully evaluated to guide treatment.Further research is required to effectively classify the range of underlying pathophysioiogy that can produce this syndrome and to guide optimal management.展开更多
Acute kidney injury(AKI) is a common complication in patients with end-stage liver disease and advanced cirrhosis regardless of the underlying cause. Hepatorenal syndrome(HRS), a functional form of kidney failure, is ...Acute kidney injury(AKI) is a common complication in patients with end-stage liver disease and advanced cirrhosis regardless of the underlying cause. Hepatorenal syndrome(HRS), a functional form of kidney failure, is one of the many possible causes of AKI. HRS is potentially reversible but involves highly complex pathogenetic mechanisms and equally complex clinical and therapeutic management. Once HRS has developed, it has a very poor prognosis. This review focuses on the diagnostic approach to HRS and discusses the therapeutic protocols currently adopted in clinical practice.展开更多
Kartagener's syndrome (KS) is an autosomal recessive genetic disease accounting for approximately 50% of the cases of primary ciliary dyskinesia (PCD). As it is accompanied by many complications, PCD/KS severely ...Kartagener's syndrome (KS) is an autosomal recessive genetic disease accounting for approximately 50% of the cases of primary ciliary dyskinesia (PCD). As it is accompanied by many complications, PCD/KS severely affects the patient's quality of life. Therapeutic approaches for PCD/KS aim to enhance prevention, facilitate rapid definitive diagnosis, avoid misdiagnosis, maintain active treatment, control infection and postpone the development of lesions. In male patients, sperm flagella may show impairment in or complete absence of the ability to swing, which ultimately results in male infertility. Assisted reproductive technology will certainly benefit such patients. For PCD/KS patients with completely immotile sperm, intracytoplasmic sperm injection may be very important and even indispensable. Considering the number of PCD/KS susceptibility genes and mutations that are being identified, more extensive genetic screening is indispensable in patients with these diseases. Moreover, further studies into the potential molecular mechanisms of these diseases are required. In this review, we summarize the available information on various aspects of this disease in order to delineate the therapeutic objectives more clearly, and clarify the efficacy of assisted reproductive technology as a means of treatment for patients with PCD/KS-associated infertility.展开更多
Abdominal cocoon syndrome(ACS) is a rare cause of intestinal obstruction due to total or partial encapsulation of the small intestine by a fibrocollagenous membrane. Idiopathic ACS with abdominal cryptorchidism and gr...Abdominal cocoon syndrome(ACS) is a rare cause of intestinal obstruction due to total or partial encapsulation of the small intestine by a fibrocollagenous membrane. Idiopathic ACS with abdominal cryptorchidism and greater omentum hypoplasia is even rarer clinically. We successfully treated a 26-year-old male case of small bowel obstruction with acute peritonitis. He was finally diagnosed with idiopathic ACS with unilateral abdominal cryptorchidism and greater omentum hypoplasia during exploratory laparotomy. He then underwent enterolysis, cryptorchidectomy, and appendectomy. He recovered gradually from the operations and early postoperative inflammatory ileus. There has been no recurrence of intestinal obstruction since the operation, and he is still in follow-up. We analyzed his clinical data and retrospectively reviewed the literature, and our findings may be helpful for the clinical diagnosis and treatment on ACS.展开更多
<strong>Background:</strong> Herlyn-Werner-Wunderlich syndrome (HWWS) is a rare type of female reproduction tract malformation, often accompanied by abnormal development of the ipsilateral urinary system, ...<strong>Background:</strong> Herlyn-Werner-Wunderlich syndrome (HWWS) is a rare type of female reproduction tract malformation, often accompanied by abnormal development of the ipsilateral urinary system, which shows mostly double uterus and the absence of the kidney on the oblique side. <strong>Case Report:</strong> An 11-year-old patient presented with lower abdominal distension and pain for 2 days and was suspected of vaginal haematoma. <strong>Conclusion:</strong> Ipsilateral renal agenesis was confirmed by ultrasound during hospitalization, and the diagnoses of obstructed hemivagina and ipsilateral renal anomaly syndrome were established. The aim of this study was to present the diagnostic and therapeutic approaches in HWWS, and to draw attention to the challenges in its diagnosis, which can coexist with multiple complications.展开更多
Intersection syndrome is a rare sports overuse injury occurring through friction at the intersection of the first and second compartment of the forearm. Differential diagnosis must be carefully made, especially from D...Intersection syndrome is a rare sports overuse injury occurring through friction at the intersection of the first and second compartment of the forearm. Differential diagnosis must be carefully made, especially from De Quervain tendonsynovitis. Clinical examination provides with the necessary information for diagnosis, still magnetic resonance imaging scans and ultrasonography may assist in diagnosis. Treatment consists mainly of rest, use of a thumb spica splint, analgetic and oral nonsteroidal anti-inflammatory drugs and after 2-3 wk progressive stretching and muscle strengthening. Should symptoms persist beyond this time, corticosteroid injections adjacent to the site of injury may be useful. In refractory cases, surgical intervention is warranted.展开更多
Syndrome stood for disease name and symptom in the ancient medical literature prior to the Tang Dynasty.With the development of pathogenesis theory,the meaning pathogenesis of syndrome came into being and the term dif...Syndrome stood for disease name and symptom in the ancient medical literature prior to the Tang Dynasty.With the development of pathogenesis theory,the meaning pathogenesis of syndrome came into being and the term differentiation of syndromes came into existence in the Song,Jin and Yuan Dynasties,hence differentiation of syndromes gradually became a diagnostics term of differentiating pathogenesis.展开更多
Cyclical vomiting syndrome(CVS) is a functional, debilitating disorder of childhood frequently leading to hospitalization. Affected children usually experience a stereotypical pattern of vomiting though it may vary be...Cyclical vomiting syndrome(CVS) is a functional, debilitating disorder of childhood frequently leading to hospitalization. Affected children usually experience a stereotypical pattern of vomiting though it may vary between different individuals. The vomiting is intense often bilious, and accompanied by disabling nausea. Identifiable precipitating factors for CVS include psychosocial stressors, infections, lack of sleep and occasionally even food triggers. Often, it may be difficult to distinguish episodes of CVS from other causes of acute abdomen and altered consciousness. Thus, the diagnosis of CVS remains largely one of exclusion. Investigations routinely done during the work-up of a child with suspected CVS include both blood and imaging modalities. Plasma lactate, ammonia, amino acid and acylcarnitine profiles as well as urine organic acid profile are indicated to exclude inborn errors of metabolism. The treatment remains challenging and targeted at prevention or shortening of the attacks and can be considered as abortive, supportive and prophylactic. Use of nonpharmacological therapy is also part of the management of CVS. The prognosis of CVS is variable. More insight into the pathogenesis of this disorder as well as role of non-pharmacological therapy is needed.展开更多
Objective:To compare the sex ratio,age distribution,severity of the illness,comorbidities,and the treatment of the patients with obstructive sleep apnea syndrome in China and Germany.Methods:A retrospective study of t...Objective:To compare the sex ratio,age distribution,severity of the illness,comorbidities,and the treatment of the patients with obstructive sleep apnea syndrome in China and Germany.Methods:A retrospective study of the data was conducted,and a total of 200 patients diagnosed with obstructive sleep apnea syndrome in Germany and China from March 2013 to October 2015 were analyzed.The sex ratio,age distribution,severity of the illness,comorbidities and treatment methods were analyzed.Results:There was no significant difference in the severity of disease,sex ratio,and age distribution between the patients with obstructive sleep apnea syndrome in China and Germany(P>0.05).In terms of comorbidities,the combination of moderate and severe patients in the German group,compared with the moderate and severe patients in the Chinese group,except for cerebrovascular disease,the comorbidities were less than those in the Chinese group(P<0.05),the difference was statistically significant.In terms of treatment,the patients in the German group were compared with the patients in the Chinese group with light,moderate,and severe patients.Except for the German patients who received oral appliances and surgical treatment,more patients were treated than Chinese patients(P<0.05),the difference is statistically significant.Conclusion:The two country(Germany and China)are basically the same in the diagnosis and treatment of obstructive sleep apnea syndrome,but Germany pays more attention to details and individualization in treatment.展开更多
Vanishing bone disease(Gorham-Stout syndrome) is a rare entity of unknown etiology, characterized by de struction of osseous matrix and proliferation of vascula structures, resulting in destruction and absorption o bo...Vanishing bone disease(Gorham-Stout syndrome) is a rare entity of unknown etiology, characterized by de struction of osseous matrix and proliferation of vascula structures, resulting in destruction and absorption o bone. Despite the extensive investigation of the patho genetic mechanisms of the disease, its etiology hasn'been clarified and several theories exist. The syndrome can affect one or multiple bones of the patient, includ ing the skull, the upper and lower extremities, the spine and pelvis. The clinical presentation of a patient suffer ing from vanishing bone disease includes, pain, func tional impairment and swelling of the affected region although asymptomatic cases have been reported, as well as cases in which the diagnosis was made after a pathologic fracture. In this short review we summarize the theories regarding the etiology as well as the clini cal presentation, the diagnostic approach and treat ment options of this rare disease.展开更多
文摘Carpal tunnel syndrome(CTS) is the most commonly diagnosed disabling condition of the upper extremities. It is the most commonly known and prevalent type of peripheral entrapment neuropathy that accounts for about 90% of all entrapment neuropathies. This review aims to provide an outline of CTS by considering anat-omy, pathophysiology, clinical manifestation, diagnostic modalities and management of this common condition, with an emphasis on the diagnostic imaging evaluation.
文摘Myofascial pain syndrome(MPS)is characterized by myofascial trigger points and fascial constrictions.At present,domestic and foreign scholars have not reached a consensus on the etiology and pathogenesis of MPS.Due to the lack of specific laboratory indicators and imaging evidence,there is no unified diagnostic criteria for MPS,making it easy to confuse with other diseases.The Chinese Association for the Study of Pain organized domestic experts to formulate this Chinese Pain Specialist Consensus on the diagnosis and treatment of MPS.This article reviews relevant domestic and foreign literature on the definition,epidemiology,pathogenesis,clinical manifestation,diagnostic criteria and treatments of MPS.The consensus is intended to normalize the diagnosis and treatment of MPS and be used by first-line doctors,including pain physicians to manage patients with MPS.
基金Supported by the Natural Science Foundation of China(No.81370913)
文摘Dear Editor,I am Dr.Jia X from the Department of Ophthalmology,Second Xiangya Hospital,Central South University,Changsha,China.I write to present a rare case report of 9p deletion syndrome with congenital infantile glaucoma in an infant,accompanying with an effective method of both diagnosis and treatment.
基金supported by National Natural Science Foundation of China(No.81360684)Guangxi Key Research and Development Plan Project(Gui Ke AB18221095)+3 种基金Teaching Teacher Training Project from Youjiang Medical University for Nationalities-National Teaching Teacher Training Project(You Hospital Zi[2018]No.98)High-level Talent Research Projects from Youjiang Medical University For Nationalities(No.01002018079)China National and Regional University Students Innovation and Entrepreneurship Training Scheme Funding(No.202010599022)China Regional University Students Innovation and Entrepreneurship Training Scheme Funding(No.202010599065).
文摘The morbidity and mortality of acute coronary syndrome disease is extremely high and is the main cause of human death.As an important part of the wisdom of the Chinese nation,TCM plays an important role in treatment.By reviewing recent related research and reports on TCM theories,Chinese herbal formulas,Chinese and Western medicine treatment and other considerations,it aims to provide ideas and references for clinical treatment.
文摘Irritable bowel syndrome (IBS) is a chronic and debilitating functional gastrointestinal disorder that affects 9%-23% of the population across the world. The percentage of patients seeking health care related to IBS approaches 12% in primary care practices and is by far the largest subgroup seen in gastroenterology clinics. It has been well documented that these patients exhibit a poorer quality of life and utilize the health care system to a greater degree than patients without this diagnosis. The pathophysiology of IBS is not clear. Many theories have been put forward, but the exact cause of IBS is still uncertain. According to the updated ROME III criteria, IBS is a clinical diagnosis and presents as one of the three predominant subtypes: (1) IBS with constipation (IBS-C); (2) IBS with diarrhea (IBS-D); and (3) mixed IBS (IBS-M); former ROME definitions refer to IBS-M as alternating IBS (IBS-A). Across the IBS subtypes, the presentation of symptoms may vary among patients and change over time. Patients report the most distressing symptoms to be abdominal pain, straining, myalgias, urgency, bloating and feelings of serious illness. The complexity and diversity of IBS presentation makes treatment difficult. Although there are reviews and guidelines for treating IBS, they focus on the efficacy of medications for IBS symptoms using high-priority endpoints, leaving those of lower priority largely unreported. Therefore, the aim of this review is to provide a comprehensive evidence-based review of the diagnosis, pathogenesis and treatment to guide clinicians diagnosing and treating their patients.
文摘Three patients with nutcracker syndrome(NCS) were enrolled in the study.Their clinical symptoms mainly included proteinuria and serious varicocele.Color Doppler ultrasound and computed tomography showed that the patients had constricted abdominal aortas,reduced superior mesenteric artery angles,and thinned left renal veins.Patients then underwent left spermatic vein ligation and iliac vein anastomosis.They were checked tliree months after their operation,and results showed that their sperms were improved and their proteinuria disappeared. The color Doppler ultrasound showed new cycle pathways.NCS clinical manifestations are complicated,and need combination diagnosis of symptoms and auxiliary examination to detennine surgical indications.Ligation of spermatic vein and vein anastomosis can be used to treat NCS.
文摘Presented in this paper is our experience in the diagnosis and management of abdominal compartment syndrome during severe acute pancreatitis. On the basis of the history of severe acute pancreatitis, after effective fluid resuscitation, if patients developed renal, pulmonary and cardiac insufficiency after abdominal expansion and abdominal wall tension, ACS should be considered. Cystometry could be performed to confirm the diagnosis. Emergency decompressive celiotomy and temporary abdominal closure with a 3 liter sterile plastic bag must be performed. It is also critical to prevent reperfusion syndrome. In 23 cases of ACS, 18 cases received emergency decompressive celiotomy and 5 cases did not. In the former, 3 patients died (16.7 %) while in the later, 4 (80%) died. Total mortality rate was 33.3% (7/21). In 7 death cases, 4 patients developed acute obstructive suppurative cholangitis (AOSC). All the patients who received emergency decompressive celiotomy 5 h after confirmation of ACS survived. The definitive abdominal closure took place mostly 3 to 5 days after emergency decompressive celiotomy, with longest time being 8 days. 6 cases of ACS at infection stage were all attributed to infected necrosis in abdominal cavity and retroperitoneum. ACS could occur in SIRS stage and infection stage during SAP, and has different pathophysiological basis. Early diagnosis, emergency decompressive celiotomy and temporary abdominal closure with a 3L sterile plastic bag are the keys to the management of the condition.
文摘Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disease, characterized by a combination of symptoms, clinical findings and histological abnormalities. Ulcers are only found in 40% of the patients; 20% of the patients have a solitary ulcer, and the rest of the lesions vary in shape and size, from hyperemic mucosa to broad-based polypoid. Men and women are affected equally, with a small predominance in women. SRUS has also been described in children and in the geriatric population. Clinical features include rectal bleeding, copious mucus discharge, prolonged excessive straining, perineal and abdominal pain, feeling of incomplete defecation, constipation, and rarely, rectal prolapse. This disease has well-described histopathological features such as obliteration of the lamina propria by fibrosis and smooth muscle fibers extending from a thickened muscularis mucosa to the lumen. Diffuse collage deposition in the lamina propria and abnormal smooth muscle fiber extensions are sensitive markers for differ-entiating SRUS from other conditions. However, the etiology remains obscure, and the condition is frequently associated with pelvic floor disorders. SRUS is difficult to treat, and various treatment strategies have been advocated, ranging from conservative management to a variety of surgical procedures. The aim of the present review is to summarize the clinical features, pathophysiology, diagnostic methods and treatment strategies associated with SRUS. (C) 2014 Baishideng Publishing Group Co., Limited. All rights reserved.
文摘Pneumonia and acute respiratory distress syndrome are common and important causes of respiratory failure in the intensive care unit with a significant impact on morbidity, mortality and health care utilization despite early antimicrobial therapy and lung protective mechanical ventilation. Both clinical entities are characterized by acute pulmonary inflammation in response to direct or indirect lung injury. Adjunct anti-inflammatory treatment with corticosteroids is increasingly used, although the evidence for benefit is limited. The treatment decisions are based on radiographic, clinical and physiological variables without regards to inflammatory state. Current evidence suggests a role of biomarkers for the assessment of severity, and distinguishing sub-phenotypes (hyperinflammatory versus hypo-inflammatory) with important prognostic and therapeutic implications. Although many inflammatory biomarkers have been studied the most common and of interest are C-reactive protein, procalcitonin, and pro-inflammatory cytokines including interleukin 6. While extensively studied as prognostic tools (prognostic enrichment), limited data are available for the role of biomarkers in determining appropriate initiation, timing and dosing of adjunct anti-inflammatory treatment (predictive enrichment)
文摘Postural orthostatic tachycardia syndrome (POTS) has been recognized since at least 1940.A review of the literature identifies differences in the definition for this condition and wide variations in treatment and outcomes.This syndrome appears to describe a group of conditions with differing pathophysiology,which requires treatment tailored to the true underlying disorder.Patients need to be fully evaluated to guide treatment.Further research is required to effectively classify the range of underlying pathophysioiogy that can produce this syndrome and to guide optimal management.
文摘Acute kidney injury(AKI) is a common complication in patients with end-stage liver disease and advanced cirrhosis regardless of the underlying cause. Hepatorenal syndrome(HRS), a functional form of kidney failure, is one of the many possible causes of AKI. HRS is potentially reversible but involves highly complex pathogenetic mechanisms and equally complex clinical and therapeutic management. Once HRS has developed, it has a very poor prognosis. This review focuses on the diagnostic approach to HRS and discusses the therapeutic protocols currently adopted in clinical practice.
文摘Kartagener's syndrome (KS) is an autosomal recessive genetic disease accounting for approximately 50% of the cases of primary ciliary dyskinesia (PCD). As it is accompanied by many complications, PCD/KS severely affects the patient's quality of life. Therapeutic approaches for PCD/KS aim to enhance prevention, facilitate rapid definitive diagnosis, avoid misdiagnosis, maintain active treatment, control infection and postpone the development of lesions. In male patients, sperm flagella may show impairment in or complete absence of the ability to swing, which ultimately results in male infertility. Assisted reproductive technology will certainly benefit such patients. For PCD/KS patients with completely immotile sperm, intracytoplasmic sperm injection may be very important and even indispensable. Considering the number of PCD/KS susceptibility genes and mutations that are being identified, more extensive genetic screening is indispensable in patients with these diseases. Moreover, further studies into the potential molecular mechanisms of these diseases are required. In this review, we summarize the available information on various aspects of this disease in order to delineate the therapeutic objectives more clearly, and clarify the efficacy of assisted reproductive technology as a means of treatment for patients with PCD/KS-associated infertility.
基金Supported by Major Projects of Chinese PLA"13~(th) Five-Year Plan" Logistics Research Subject,No.AKJ15J003
文摘Abdominal cocoon syndrome(ACS) is a rare cause of intestinal obstruction due to total or partial encapsulation of the small intestine by a fibrocollagenous membrane. Idiopathic ACS with abdominal cryptorchidism and greater omentum hypoplasia is even rarer clinically. We successfully treated a 26-year-old male case of small bowel obstruction with acute peritonitis. He was finally diagnosed with idiopathic ACS with unilateral abdominal cryptorchidism and greater omentum hypoplasia during exploratory laparotomy. He then underwent enterolysis, cryptorchidectomy, and appendectomy. He recovered gradually from the operations and early postoperative inflammatory ileus. There has been no recurrence of intestinal obstruction since the operation, and he is still in follow-up. We analyzed his clinical data and retrospectively reviewed the literature, and our findings may be helpful for the clinical diagnosis and treatment on ACS.
文摘<strong>Background:</strong> Herlyn-Werner-Wunderlich syndrome (HWWS) is a rare type of female reproduction tract malformation, often accompanied by abnormal development of the ipsilateral urinary system, which shows mostly double uterus and the absence of the kidney on the oblique side. <strong>Case Report:</strong> An 11-year-old patient presented with lower abdominal distension and pain for 2 days and was suspected of vaginal haematoma. <strong>Conclusion:</strong> Ipsilateral renal agenesis was confirmed by ultrasound during hospitalization, and the diagnoses of obstructed hemivagina and ipsilateral renal anomaly syndrome were established. The aim of this study was to present the diagnostic and therapeutic approaches in HWWS, and to draw attention to the challenges in its diagnosis, which can coexist with multiple complications.
文摘Intersection syndrome is a rare sports overuse injury occurring through friction at the intersection of the first and second compartment of the forearm. Differential diagnosis must be carefully made, especially from De Quervain tendonsynovitis. Clinical examination provides with the necessary information for diagnosis, still magnetic resonance imaging scans and ultrasonography may assist in diagnosis. Treatment consists mainly of rest, use of a thumb spica splint, analgetic and oral nonsteroidal anti-inflammatory drugs and after 2-3 wk progressive stretching and muscle strengthening. Should symptoms persist beyond this time, corticosteroid injections adjacent to the site of injury may be useful. In refractory cases, surgical intervention is warranted.
文摘Syndrome stood for disease name and symptom in the ancient medical literature prior to the Tang Dynasty.With the development of pathogenesis theory,the meaning pathogenesis of syndrome came into being and the term differentiation of syndromes came into existence in the Song,Jin and Yuan Dynasties,hence differentiation of syndromes gradually became a diagnostics term of differentiating pathogenesis.
文摘Cyclical vomiting syndrome(CVS) is a functional, debilitating disorder of childhood frequently leading to hospitalization. Affected children usually experience a stereotypical pattern of vomiting though it may vary between different individuals. The vomiting is intense often bilious, and accompanied by disabling nausea. Identifiable precipitating factors for CVS include psychosocial stressors, infections, lack of sleep and occasionally even food triggers. Often, it may be difficult to distinguish episodes of CVS from other causes of acute abdomen and altered consciousness. Thus, the diagnosis of CVS remains largely one of exclusion. Investigations routinely done during the work-up of a child with suspected CVS include both blood and imaging modalities. Plasma lactate, ammonia, amino acid and acylcarnitine profiles as well as urine organic acid profile are indicated to exclude inborn errors of metabolism. The treatment remains challenging and targeted at prevention or shortening of the attacks and can be considered as abortive, supportive and prophylactic. Use of nonpharmacological therapy is also part of the management of CVS. The prognosis of CVS is variable. More insight into the pathogenesis of this disorder as well as role of non-pharmacological therapy is needed.
基金Study on the Concept of Diagnosis and Treatment of Sleep Apnea in Foreign Country(Germany)to Improve the Diagnosis and Treatment Sleep Apnea and the Management Level of Sleep Center in China(NO:2013HH0025).
文摘Objective:To compare the sex ratio,age distribution,severity of the illness,comorbidities,and the treatment of the patients with obstructive sleep apnea syndrome in China and Germany.Methods:A retrospective study of the data was conducted,and a total of 200 patients diagnosed with obstructive sleep apnea syndrome in Germany and China from March 2013 to October 2015 were analyzed.The sex ratio,age distribution,severity of the illness,comorbidities and treatment methods were analyzed.Results:There was no significant difference in the severity of disease,sex ratio,and age distribution between the patients with obstructive sleep apnea syndrome in China and Germany(P>0.05).In terms of comorbidities,the combination of moderate and severe patients in the German group,compared with the moderate and severe patients in the Chinese group,except for cerebrovascular disease,the comorbidities were less than those in the Chinese group(P<0.05),the difference was statistically significant.In terms of treatment,the patients in the German group were compared with the patients in the Chinese group with light,moderate,and severe patients.Except for the German patients who received oral appliances and surgical treatment,more patients were treated than Chinese patients(P<0.05),the difference is statistically significant.Conclusion:The two country(Germany and China)are basically the same in the diagnosis and treatment of obstructive sleep apnea syndrome,but Germany pays more attention to details and individualization in treatment.
文摘Vanishing bone disease(Gorham-Stout syndrome) is a rare entity of unknown etiology, characterized by de struction of osseous matrix and proliferation of vascula structures, resulting in destruction and absorption o bone. Despite the extensive investigation of the patho genetic mechanisms of the disease, its etiology hasn'been clarified and several theories exist. The syndrome can affect one or multiple bones of the patient, includ ing the skull, the upper and lower extremities, the spine and pelvis. The clinical presentation of a patient suffer ing from vanishing bone disease includes, pain, func tional impairment and swelling of the affected region although asymptomatic cases have been reported, as well as cases in which the diagnosis was made after a pathologic fracture. In this short review we summarize the theories regarding the etiology as well as the clini cal presentation, the diagnostic approach and treat ment options of this rare disease.