Knowledge on pancreaticobiliary reflux in normal pancreaticobiliary junction and its pathologic implications has experienced tremendous progress during the last few years.This editorial reviews the current knowledge o...Knowledge on pancreaticobiliary reflux in normal pancreaticobiliary junction and its pathologic implications has experienced tremendous progress during the last few years.This editorial reviews the current knowledge on this condition and its pathological implications on gallbladder diseases.The following aspects were def ined appropriate for discussion:(1) Evidence of carcinogenesis associated with pancreaticobiliary reflux;(2) Evidence of pancreaticobiliary reflux in normal pancreaticobiliary junction;and(3) Evidence of sphincter of Oddi(SO) dysfunction as a cause of pancreaticobiliary reflux in normal pancreaticobiliary junction.The articles reviewed were selected and classif ied according to f ive levels of evidence:Level-this condition.Although an important body of research has been published regarding pancreaticobiliary reflux in normal pancreaticobiliary junction and its clinical significance,the current evidence does not fully support what has been suggested.Studies with evidence level Ι have not been undertaken.This is a fascinating subject of study,and if finally supported by evidence level Ι,the importance of this condition will constitute a major breakthrough in biliary pathology.展开更多
More than a century has elapsed since the identification of Clostridia neurotoxins as the cause of paralytic diseases. Clostridium botulinum is a heterogeneous group of Gram-positive, rod-shaped, spore-forming, obliga...More than a century has elapsed since the identification of Clostridia neurotoxins as the cause of paralytic diseases. Clostridium botulinum is a heterogeneous group of Gram-positive, rod-shaped, spore-forming, obligate anaerobic bacteria that produce a potent neurotoxin. Eight different Clostridium botulinum neurotoxins have been described(A-H) and 5 of those cause disease in humans. These toxins cause paralysis by blocking the presynaptic release of acetylcholine at the neuromuscular junction. Advantage can be taken of this blockade to alleviate muscle spams due to excessive neural activity of central origin or to weaken a muscle for treatment purposes. In therapeutic applications, minute quantities of botulinum neurotoxin type A are injected directly into selected muscles. The Food and Drug Administration first approved botulinum toxin(BT) type A in 1989 for the treatment of strabismus and blepharospasm associated with dystonia in patients 12 years of age or older. Ever since, therapeutic applications of BT have expanded to other systems, including the gastrointestinal tract. Although only a single fatality has been reported to our knowledge with use of BT for gastroenterological conditions, there are significant complications ranging from minor pain, rash and allergic reactions to pneumothorax, bowel perforation and significant paralysis of tissues surrounding the injection(including vocal cord paralysis and dysphagia). This editorial describes the clinical experience and evidence for the use BT in gastrointestinal motility disorders in children.展开更多
Chronic intestinal pseudo-obstruction(CIPO) is a rare disease due to a severe gastrointestinal motility disorder which may mimic,on both clinical and radiological grounds,mechanical obstruction.We report a case of a 2...Chronic intestinal pseudo-obstruction(CIPO) is a rare disease due to a severe gastrointestinal motility disorder which may mimic,on both clinical and radiological grounds,mechanical obstruction.We report a case of a 26-year-old woman who presented to our institution for plain abdominal radiography for referred long-lasting constipation with recurrent episodes of abdominal pain and distension.At X-ray,performed both in the upright and supine position,an isolated air-fluid level was depicted in the left flank,together with a number of radiological signs suggestive of pneumoperitoneum.First,subphrenic radiolucency could be observed in the upright film.Second,the intestinal wall of some jejunal loops appeared to be outlined in the right flank.Third,the inferior cardiac border was clearly depicted in the upright film.The patient however had no evidence ofperitoneal signs but only hypoactive bowel movements.Unenhanced multi-detector computed tomography(MDCT) of the abdomen and pelvis was therefore performed.MDCT revealed abnormal air-driven distension of the small and large bowel,without evidence of extraluminal air.All radiological signs of pneumoperitoneum turned out to be false-positive results.The patient was submitted to pan-colonoscopy and to anorectal manometry to rule out Hirshprung's disease,and was finally discharged with a diagnosis of CIPO.展开更多
文摘Knowledge on pancreaticobiliary reflux in normal pancreaticobiliary junction and its pathologic implications has experienced tremendous progress during the last few years.This editorial reviews the current knowledge on this condition and its pathological implications on gallbladder diseases.The following aspects were def ined appropriate for discussion:(1) Evidence of carcinogenesis associated with pancreaticobiliary reflux;(2) Evidence of pancreaticobiliary reflux in normal pancreaticobiliary junction;and(3) Evidence of sphincter of Oddi(SO) dysfunction as a cause of pancreaticobiliary reflux in normal pancreaticobiliary junction.The articles reviewed were selected and classif ied according to f ive levels of evidence:Level-this condition.Although an important body of research has been published regarding pancreaticobiliary reflux in normal pancreaticobiliary junction and its clinical significance,the current evidence does not fully support what has been suggested.Studies with evidence level Ι have not been undertaken.This is a fascinating subject of study,and if finally supported by evidence level Ι,the importance of this condition will constitute a major breakthrough in biliary pathology.
文摘More than a century has elapsed since the identification of Clostridia neurotoxins as the cause of paralytic diseases. Clostridium botulinum is a heterogeneous group of Gram-positive, rod-shaped, spore-forming, obligate anaerobic bacteria that produce a potent neurotoxin. Eight different Clostridium botulinum neurotoxins have been described(A-H) and 5 of those cause disease in humans. These toxins cause paralysis by blocking the presynaptic release of acetylcholine at the neuromuscular junction. Advantage can be taken of this blockade to alleviate muscle spams due to excessive neural activity of central origin or to weaken a muscle for treatment purposes. In therapeutic applications, minute quantities of botulinum neurotoxin type A are injected directly into selected muscles. The Food and Drug Administration first approved botulinum toxin(BT) type A in 1989 for the treatment of strabismus and blepharospasm associated with dystonia in patients 12 years of age or older. Ever since, therapeutic applications of BT have expanded to other systems, including the gastrointestinal tract. Although only a single fatality has been reported to our knowledge with use of BT for gastroenterological conditions, there are significant complications ranging from minor pain, rash and allergic reactions to pneumothorax, bowel perforation and significant paralysis of tissues surrounding the injection(including vocal cord paralysis and dysphagia). This editorial describes the clinical experience and evidence for the use BT in gastrointestinal motility disorders in children.
文摘Chronic intestinal pseudo-obstruction(CIPO) is a rare disease due to a severe gastrointestinal motility disorder which may mimic,on both clinical and radiological grounds,mechanical obstruction.We report a case of a 26-year-old woman who presented to our institution for plain abdominal radiography for referred long-lasting constipation with recurrent episodes of abdominal pain and distension.At X-ray,performed both in the upright and supine position,an isolated air-fluid level was depicted in the left flank,together with a number of radiological signs suggestive of pneumoperitoneum.First,subphrenic radiolucency could be observed in the upright film.Second,the intestinal wall of some jejunal loops appeared to be outlined in the right flank.Third,the inferior cardiac border was clearly depicted in the upright film.The patient however had no evidence ofperitoneal signs but only hypoactive bowel movements.Unenhanced multi-detector computed tomography(MDCT) of the abdomen and pelvis was therefore performed.MDCT revealed abnormal air-driven distension of the small and large bowel,without evidence of extraluminal air.All radiological signs of pneumoperitoneum turned out to be false-positive results.The patient was submitted to pan-colonoscopy and to anorectal manometry to rule out Hirshprung's disease,and was finally discharged with a diagnosis of CIPO.
