ObjectiveTo sum up the diagnosis and treatment of adult ileal duplication with clinical cases from Peking Union Medical College Hospital (PUMCH). MethodsSix cases of adult ileal duplication admitted in our hospital from February 1996 to December 2010 were analyzed. Different assistant investigations were supposed to different patients due to the chief complaints including gastroscope, colonoscopy, abdominal CT scan, arteriography, 99Tcm radionuclide imaging, and double-balloon intestinal endoscope. None was made a definite diagnosis before operation with only one uncertain case. All cases received operation and pathological examination. Results All cases admitted were male. The chief complaints included intestinal bleeding, abdominalgia, intestinal obstruction, and abdominal mass. Five out of six patients received gastroscope, colonoscopy, and abdominal CT scan while three received mesenteric arteriography, but none was found any suggestion for ileal duplication. Even 99Tcm radionuclide imaging pointed out only two with abnormal abdominal bleeding. Three received doubleballoon intestinal endoscope, paying attention that only one discovered with ileal duplication. In a concluding, none was made a definite diagnosis before operation with only one uncertain case. All the cases received operation. The duplications of ileum in the length of 6-25 cm were found at the site of 11-100 cm proximal to ileocecum during the operation. Pathological report confirmed the clinical diagnosis of all cases with adult ileal duplications． Two cases were found with ectopic gastric mucosa, another two with diverticulum, and one with ectopic pancreas， in addition the remaining with inflammatory fibrous pseudotumor. Prognosis were good for all after operation. ConclusionsIleal duplications are rarely seen in adults, gender prefer male． Without specific clinical symptoms and inspections, definite diagnosis before operation is hard to make. But maybe doubleballoon intestinal endoscope and 99Tcm radionuclide imaging can give out positive result. Surgeons should be aware of this condition when performing abdominal exploration. Once discovered, resection is necessary.
In order to choose the appropriate antibiotics for treating secondary pancreatic infection, permeability of antibiotics to pancreatic tissue was investigated on experimental dogs with acute hemorrhagic necrotizing pancreatitis. The concentrations of 8 different antibiotics were determined in the blood and the pancreatic tissue using highperformance liquid chromatography. Pancreatic tissue permeability of Cefotaxime, Ofloxacin, Amikacin, Piperacllin, Cefoperazone, Ampicillin, Metronidazole and Ciprofloxacin was 12%, 19%, 20%, 46%, 55%, 63%, 71% and 132% respectively. The study shows that this eight antibiotics have different permeability to the pancreatic tissue. Such observations support the existence of a bloodpancreas barrier, which acts to restrict the permeation of antibiotics into the pancreas. The results suggest that antibiotics with high permeability rate be used to treat the patient with secondary pancreatic infection.
Chronic lymphocytic leukemia (CLL) / small lymphocytic lymphoma (SLL) is a malignancy of mature B cells characterized by progressive lymphocytosis, lymphadenopathy, and splenomegaly. On February 21st 2019, with the accumulating of new data, the National Comprehensive Cancer Network updated the guideline for CLL/SLL. This article aims at providing a reasonable interpretation of the most important messages conveyed in the guideline.
Objective To study the curative effect of operative and interventional treatment in 78 cases of BuddChiari syndrome (BCS). Methods Among these patients, percutaneous transinferior vena cava angioplasty (PTA) was performed in 18 cases, PTA and stent in 10 cases, splenopneumopexy plus pedicled omento-pneumopexy of the left lower lobe in 20 cases, combined transcardiac membranotomy and transfemoral venous ballon dilatation and stent in 15 cases, right atrium-inferior vena cava shunt in 10 cases, and radical operation plus stent in 5 cases. Results After the treatment, the descent of inferior vena cava (IVC) pressure from 2.50～3.95 kPa to 1.41～2.33 kPa, the descent of portal venous pressure from 3.63～5.00 kPa to 2.16～3.23 kPa were observed. Conclusion The authors consider that PTA is the first choice for localized lesions, the following method is the operation combined with interventional treatment.
Diabetic macular edema (DME) is the main cause of vision loss and even blindness in patients with diabetic retinopathy. Intravitreal anti-vascular endothelial factor therapy has become the gold standard management of DME. However, not all eyes response optimally to common management of DME, which could be due to the differences of individual factors. Increasing age could be the predictive factors for poor outcome. The influence of glycemic control, hypertension, dyslipidemia, chronic kidney disease and relative factors on treatment response require further investigation. Identifying the systemic factors that influence the treatment response of DME can provide the evidence to predict the prognosis of DME, and improve the efficacy of clinical treatment.
Objective To study the basic and clinical achievements in diagnosis and therapy of hereditary pancreatitis. Methods Related literatures of recent years were reviewed. Results Hereditary pancreatitis was a rare type of pancreatitis, with an estimated penetrance of 80%, and was believed to be caused by a mutation in the cationic trypsinogen gene. Patients with hereditary pancreatitis had a high frequency of pancreatic cancer.Conclusion The progress has been made on hereditary pancreatitis and has given us many useful suggestions for a better understanding about this difficult medical problem.
Abstract: Objective To investigate the clinical characteristics of thymoma and thymoma with myasthenia gravis(MG). Methods From Oct.1979 to July 2004,185 patients with thymoma were surgically treated. Among these patients, comparative analysis was made between 94 cases of thymoma (thymoma group) and 91 cases of thymus tumor with MG(thymoma with MG group).155 patients underwent radical operation (83.8%),16 patients underwent palliative operation (8.6%),and 14 patients underwent exploratory operation (7.6%). Clinical characteristics was analyzed in two groups. The factors affecting prognosis was analyzed by Masaoka’s stage system, with the lifttable method. Results Five patients died after operation, others had complete remission or symptomatic improvement. There was statistically difference of Masaoka’s stage system in two groups (χ2=53.14, P＜0.05). There were no statistically difference in pathological type of thymoma and clinical type of MG and pathologic period (χ2=8.21, P＞0.05). 57 cases of thymoma group were followed up, the duration of follow-up was 1 to 10 years, average follow-up was 40.7 months, and the patients with 1-, 3- and 5-year survival rates were 70.2% (40/57), 66.7% (22/33), 593% (16/27) respectively. 55 cases of thymoma with MG group were followed up. The patients’ survival rates were 98.2% (54/55), 86.4% (38/44), 81.6% (31/38) at 1-, 3-and 5-year respectively. There was no statistically difference of survival rates in two groups (χ2=0.83, P＞0.05). Totally, 112 patients were followed up in two groups, by Masaoka’s stage system, the 5-year survival rates were 93.7% for stage Ⅰ, 79.2% for stageⅡ, 51.4% for stage Ⅲ and 0% for stage Ⅳ respectively. Result of asaoka’s stage system evidence was statistically significant (χ25-year=51.62, P＜0.01). Conclusions Pathological type of thymoma isn’t related to modified Osserman’s classification, prognosis of thymoma is obviously related to Masaoka’s stage and isn’t related to MG. Generalized MG is the major type in MG patients accompanied by thymomas, and the major pathological type is lymphocytic. Chest CT can increase the accuracy early diagnosis of thymoma. The principal treatment is to resect the tumor as completely as possible, and proper administration of postoperative radiotherapy or chemotherapy according to the surgical status. Operative program and tumor stage are the most important prognostic factors.
ObjectiveTo understand the trend and problems of asthma treatment in different levels of hospitals in Chongqing, and to provide objective basis for more refined and standardized asthma management. MethodsThe outpatient and inpatient asthma diagnosis and treatment data of four hospitals of different grades in Chongqing from 2017 to 2021 were extracted by medical big data capture platform, and the trend of outpatient and prescription changes was analyzed retrospectively according to natural year. ResultsThere were 19514 outpatients asthma visits in the four hospitals, of whom 11816 (60.6%) were female. There were 1875 hospitalizations, of which 1117 (59.6%) were female. ① Changes of asthma visit mode: From 2017 to 2019, the number of outpatient asthma visits and the proportion of asthma in the total outpatient volume increased, decreased significantly in 2021, and basically recovered to the level of 2019 in 2022. Asthma hospitalizations in tertiary hospitals showed a decreasing trend, while those in secondary hospitals increased significantly. The proportion of asthma patients who chose outpatient treatment in the four hospitals increased year by year, among which the increase was more significant in non-tertiary teaching hospitals, and the proportion of asthma acute attack in outpatient and inpatient treatment increased. ② Changes of medication pattern: The rate of inhaled corticosteroids/long-acting β2-agonists (ICS/LABA) prescription in outpatient department increased year by year, the highest was 48.6%, but the rate of short-acting β2-agonists (SABA) prescription also increased year by year, especially in secondary hospitals, the rate of SABA prescription in secondary hospitals reached 39.7%. The proportion of hospitalized asthma patients treated with inhaled corticosteroids (85.1%) was higher than that of intravenous corticosteroids (50.9%), and the proportion of intravenous theophylline prescription was as high as 91.7%, while the proportion of nebulized SABA prescription was 71.4%. ConclusionsThe trend of asthma diagnosis and treatment is that the number of outpatients and the use of ICS/LABA is gradually increasing, while the number of inpatients is decreasing. However, there is still a large gap in the proportion of asthma maintenance medication used in different levels of hospitals, so it is necessary to continuously promote standardized diagnosis and treatment management of asthma in hospitals at all levels, especially primary hospitals.
Objective To investigate the diagnosis and treatment of pancreatic gastrinoma. Methods The clinical data of 13 patients with pancreatic gastrinoma who were admitted to Hainan Provincial People’s Hospital from Jan. 1990 to Dec. 2010 were retrospectively analyzed. Etiologic and localization diagnosis were preformed preoperatively according to the manifestation and the results of color Doppler ultrasound and computer tomography，respectively. All patients received chemoradiotherapy after operation according to the pathology results. Results All of the thirteen patients underwent operation. The location of pancreatic gastrinoma was found in the head of the pancreas in 9 cases，in the tail of the pancreas in 1 case，in the body of the pancreas in 2 cases， and 1 case with multiple pancreatic gastrinonma，respectively. The diameters of the pancreatic gastrinoma were 0.2-4.0cm and 11 patiens were above 2.0cm. One patient underwent resection of the body and tail of the pancreas and spleen，seven patients underwent tumor resection，two patients underwent resection of the choledocho-pancreatic junction， and three patients underwent pancreaticoduodenectomy. One patient complicated with pancreatic leakage and two with incision infection. Twelve patients were followed up for 16-120 months （mean 78 months）. Clinical symptoms such as diarrhea disappeared after operation in twelve patients. Results of electronic gastroscopy in 6 months after continuous treatment with proton pump inhibition agents showed that the gastric ulcer were healed，the 12 hour gastric juice volume and the level of the gastric acid were in the normal range. Ten patients were cured，but one patient died because of other disease in 1 year after operation，one patient died because of recurrence in 1.5 years after operation， and one patient died in 4 years after reoperation of liver metastases. Conclusion Surgical treatment is a effective method for pancreatic gastrinoma.
ObjectiveTo investigate the short-term curative efficacy of DC-CIK in comprehensive therapy of esophagus cancer.
MethodsWe randomly allocated 52 patients with esophagus cancer who had preoperatively confirmed by CT on stage Ⅱ-Ⅲ B into an observation group and a control group with 26 patients in each group. There were 14 male and 12 female patients in the observation group at median age of 60 years (range:49-67 years). There were 16 male and 10 female patients in the control group with median age of 62 years (range:48-65 years).The control group received postoperative chemotherapy, and the observation group received postoperative chemotherapy combined with DC-CIK biotherapy. The combination of paclitaxel and cisplatin for four cycles was choosen as the chemotherapy regimen. Patients in the observation group were treated with DC-CIK biotherapy for 2 weeks after operation. At the fifth week they received the first cycle of chemotherapy. There was a course of biotherapy between two cycles of chemotherapy. The clinical efficacy, lymphocyte subtypes, and intracellular cytokines in peripheral blood of the patients, performance status (KPS) and adverse reactions were compared.
ResultsAll patients completed the therapy regimen successfully. In the observation group, the ratios of CD3+, CD4+, CD4+/CD8+, CD56+, and CD19+ increased, and the ratio of CD8+ decreased with significant differences (P<0.05).The biotherapy significantly increased interleukin 2 (IL-2), IL-12, interferon gamma (IFN-γ) and tumor necrosis fator (TNF)-α level (P<0.05). However, in the control group, there was no significant difference between post and pre-therapy in the levels of lymphocytes and cytokines. The effective rate of KPS was 76.92% in the observation group and 46.15% in the control group with a significant difference (P=0.023). No other adverse reactions except 3 patients with fever in the observation group were found.
ConclusionThe short-term curative efficacy of DC-CIK in comprehensive therapy of esophagus cancer is distinct. DC-CIK biotherapy can improve patients' immune functions and elevate their life quality, so it is likely to be an effective adoptive immunotherapy for esophagus cancer.
