Endoscopic papillectomy of minor papillar adenoma associated with pancreas divisum

Tumors of the minor papilla of the duodenum are quite rare.We successfully and safely treated an 18-mm adenoma of the minor papilla associated with pancreas divisum using endoscopic papillectomy.A 64-year-old man was admitted to our hospital for treatment of an asymptomatic mass in the minor papilla detected by upper gastrointestinal endoscopy.Endscopic analysis showed an 18-mm,whitish,sessile mass,located in the duodenum proximal to a normal-appearing major papilla.Endoscopic retrograde pancreatography did not reveal the pancreatic duct.Magnetic resonance cholangiopancreatography showed a lack of the ventral pancreatic duct.We suspected this case was associated with pancreatic divisum;therefore,we performed endoscopic papillectomy of the minor papilla tumor.Subsequently,endoscopic pancreatic stent placement in the minor papilla was done to prevent drainage disturbance.The patient has been asymptomatic without recurrence of tumor or stenosis of the Santorini orifice upon endoscopic examination for the past 2 years.

Human papillomavirus-related squamous cell carcinoma of the anal canal with papillary features

Human papillomavirus(HPV)related squamous cell carcinoma(SCC)involving the anal canal is a well-known carcinoma associated with high-risk types of HPV.HPVrelated SCC with papillary morphology(papillary SCC)has been described in the oropharynx.We describe,for the first time,a case of anal HPV-related squamous carcinoma with papillary morphology.The tumor arose from the anal mucosa.The biopsies revealed a superficially invasive SCCwith prominent papillary features and associated in situ carcinoma.The tumor cells were positive for p16 and were also positive for high-risk types of HPV using chromogenic in situ hybridization.The findings are consistent with a HPV-related SCC of the anal canal with papillary features.This tumor shows histologic features similar to a papillary HPV-related SCC of the oropharynx.Additional studies are needed to characterize these lesions.

Tubercular Papillitis of Vater

A middle-aged man with no symptom or history visited our hospital due to duodenal abnormality and fecal occult blood detected by health screening. Upper gastrointestinal endoscopy showed marked enlargement of the papilla of Vater surrounded by nodules, and biopsy disclosed non-caseating granuloma. Colonoscopy yielded findings suggestive of intestinal tuberculosis such as annular ulcers. Examination of the biopsy samples failed to make a diagnosis of tuberculosis, and no pulmonary lesion was found, but whole-blood interferon gamma release assay was positive. The duodenal lesion was also suspected to be tubercular, so antitubercular drugs were administered. As this resulted in the resolution of both lesions, a definite diagnosis of tubercular papillitis of Vater was made. Duodenal tuberculosis is rare, and a localized lesion of the major duodenal papilla is extremely rare. However, this case suggests that tuberculosis must be considered in the differential diagnosis of lesions of the papilla of Vater.

瘤状软骨凹顶藻化学成分研究

采用硅胶柱色谱以及Sephadex LH-20凝胶色谱手段,对海洋红藻瘤状软骨凹顶藻(Chondrophycus papillous Garbaryet Harper)进行化学成分研究,分离得到5个化合物。通过MS、NMR等方法对得到的化合物进行结构确证,分别鉴定为邻苯二甲酸二丁酯(Ⅰ),邻苯二甲酸二异辛酯(Ⅱ),胆甾醇(Ⅲ),植醇(Ⅳ)和4-羟基苯甲醛(Ⅴ)。所有化合物均为首次从该种海藻中分离得到。通过MTT法对得到的单体化合物进行细胞毒活性筛选,结果显示所有化合物在10mg/L浓度下均无明显活性。

Optic Neuritis in Acute Neuroborreliosis (Lyme Disease) in the U.S.-Mexican Border: Case Report

Objective: We describe a patient diagnosed with acute neuroborreliosis presenting with anterior optic neuritis (papillitis) in a non-endemic region. Case Presentation: A 43-year-old previously healthy right handed man admitted due to an insidious onset of severe headache and spells of ascending paresthesias from his right foot into his right arm and face followed by speech arrest and clumsiness of his right hand. His neurologic exam was significant for somnolence, nuchal rigidity and Kernig and Brudzinski signs were present. MRI of the brain with gadolinium showed diffuse hyperintense signal involving the supra and infratentorial cortical sulci, with associated faint diffuse leptomeningeal enhancement, consistent most likely with diffuse leptomeningoencephalitis. EEG: normal. CSF VDRL was negative. Dilated fundus exam revealed mild optic nerve edema more significant to the left than to the right eye, confirmed and measured by spectral domain OCT (Optical Coherence Tomography). There was an evidence of posterior uveitis with an early vitreous hemorrhage superficial to the left optic nerve. Lyme disease serum antibody (IgM) Immunoblotting was positive in 2 bands confirming the diagnosis of neuroborreliosis. Conclusion: Optic nerve involvement in Lyme disease is an uncommon complication that should be confirmed by specific diagnostic criteria to establish its causal relation.

Ischemic optic neuropathies-update

This submission will briefly review the anatomy and physiology of the optic nerve,and highlight various ischemic optic neuropathies including anterior ischemic optic neuropathies(non-arteritis and arteritic),diabetic papillopathy,posterior ischemic optic neuropathies,and ischemic optic neuropathies in the setting of hemodynamic compromise.

儿童复发性呼吸道乳头状瘤的临床综合分析

本文就儿童复发性呼吸道乳头状瘤的发病机理、病理学、复发、综合治疗方案等方面进行综合分析。

早产儿脑室周围-脑室内出血(PIVH)的超声表现评价

探究早产儿脑室周围-脑室内出血(PIVH)的超声表现。方法 此次研究选取的研究对象为早产儿150例,研究时间为2019年12月-2021年6月,均行床边颅脑超声诊断,分析超声图像特征,采用Papile分级,分析不同等级情况,进行统计学分析。结果 150例早产儿中,诊断为PIVH者共40例,占比26.67%。轻度出血38例,占比95.00%;重度出血2例,占比5.00%。比对不同胎龄的PIVH发生率,胎龄为(27-31)周的明显高于胎龄为(32-35)周,组间差异呈P<0.05,表示统计学意义存在。比对不同体重早产儿的PIVH发生率,体重为<1500g的明显高于体重≥1500g,组间差异呈P<0.05,表示统计学意义存在。结论 使用颅脑超声诊断可有效确诊PIVH,以及Papile分级,且其发生率与病情严重程度受到早产儿的胎龄、出生体重的影响,需早期进行治疗并及时干预治疗。