ObjectiveTo explore the pathogenesis, diagnosis and treatment of superior mesenteric artery syndrome (SMAS) complicated with Wernicke encephalopathy (WE). MethodsThe clinical data of 11 cases of SMAS patients complicated with WE were retrospectively analyzed. ResultsOf 9 SMAS patients complicated with WE, 8 patients were gradually awake and the time of consciousness recovery was from 7 d to 9 weeks (mean 5.2 weeks). Another 1 patient died of multiple organ failure attributed to severe condition. The symptoms of ophthalmopegia and ataxia in the rest 2 patients improved. All of symptoms such as ataxia, nystagmus, tinnitus, nausea, and sweating gradually disappeared. The nystagmus disappeared from 3 h to 4 d (mean 2.3 d) in five patients and the ataxia disappeared from 3 d to 12 weeks (mean 7.0 weeks) in 4 patients. The tinnitus, nausea, and sweating in 6 patients disappeared within 1 week. ConclusionImproving the understanding of SMAS complicated with WE is important during clinical practice and early diagnosis and intervention is the key point for a good prognosis.
ObjectiveTo explore the clinical significance of anterior median approach combined with lateral approach to the elbow joint in the treatment of terrible triad of the elbow.MethodsWe retrospectively collected the data of 63 cases who used the anterior median approach of the elbow joint combined with the lateral approach (group A, n=36) or the medial and lateral approach of the elbow (group B, n=27) in the treatment of terrible triad of the elbow between March 2014 and July 2019. The operation time, postoperative complications, and postoperative Mayo score of the elbow were compared between the two surgical approaches.ResultsThe operation time of group A and group B was (93.78±7.78) and (106.93±10.35) min, respectively, and the difference was statistically significant (P<0.05). The patients in both groups completed operations successfully, without vascular or nerve injury. All the wounds healed by first intention. No redislocation or reoperation occurred. Ten months after operation, there was no significant difference in the excellence rate of Mayo score of the elbow (83.3% vs. 85.2%) or postoperative complication rate (16.7% vs. 14.8%) between the two groups (P>0.05).ConclusionThe anterior median approach of the elbow joint combined with the lateral approach and the medial and lateral elbow approach for the treatment of terrible triad of the elbow are equivalent to the postoperative elbow function recovery. The operation time of the former is shorter than that of the latter, and the anterior approach reveals the coronal process intuitively and sufficiently. In the case that there is no medial ligament injury, the anterior median approach of the elbow joint combined with the lateral approach can be preferred.
Objective To evaluate the safety and efficacy of steroid withdrawal in modern triple immunosuppressant (Cycloproine/Tacrolimus, Mycophenolate Mofetil and Steroid) on renal transplantation recipients. Methods We searched MEDLINE (1966-Sep. 2005), OVID (1966-2004), EMBASE (1984-2004), The Cochrane Library (Issue 4, 2005), CBMdisc (1994-2005), and handsearched 7 Chinese Journals. Randomized controlled trials (RCTs) adopting modern triple immunosuppressant, and comparing steroid withdrawal (SW), group and steroid continuing group (SC) were selected. The quality of included studies was evaluated and graded according to Cochrane Reviewer’s Handbook 4.2.5, and meta-analysis was performed by using RevMan 4.2.7 software. Results Nine RCTs including 1 681 patients (845 in SW and 836 in SC) were identified. The average follow-up time was 6-12 months. No significant difference was found in using CsA or Tac in modern triple immunosuppressant. The results of our meta-analysis showed: ① the risk of acute rejection was two times higher in SW than SC (RR 2.05, 95% CI 1.54 to 2.72, P lt;0.000 01), mainly Banff grade I (mild) (RR 1.92, 95% CI 1.16 to 3.17, P =0.01); but no significant differences were found on Banff grade II and III between the two groups. ② the rate of graft and patient survival and chronic rejection were the same between two groups. ③ Steroid withdrawal decreased the incidence of opportunistic infection (mainly caused by simplex herpes virus and Candida) and urinary tract infection. While the incidence of CMV and sepsis infection has no significant difference between two groups. Conclusion Steroid withdrawal within 3 months in modern immunosuppressive regimen ① increases the risk of Banff Grade I rejection reaction, but the moderate and severe rejection are similar between the two groups; ② doesn’t affect the rate of graft, patient survival, and chronic rejection; ③ decreases the incidence of opportunistic and urinary tract infection, but doesn’t improve the CMV infection and sepsis. To prophylaxis serious infection, steroid withdrawal is worth considering under sufficient immunosuppressive regimen. The key point is to balance the benefit and harm for individual recipients.
ObjectiveTo systematically review the efficacy and safety of triple antiplatelet therapy (TAT:aspirin, clopidogrel and cilostazol) for patients with coronary heart diseases after percutaneous coronary intervention. MethodsSuch databases as The Cochrane Library (Issue 2, 2014), PubMed, EMbase, Web of Science, CBM, CNKI, VIP and WanFang Data were electronically searched for relevant randomized controlled trials (RCTs) on the efficacy and safety of TAT for patients with coronary heart diseases after percutaneous coronary intervention from inception to February 2014. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2 software. ResultsA total of 15 RCTs involved 6 980 patients were included. The results of meta-analysis showed that:a) the DAT group (DAT:aspirin and clopidogrel) and the TAT group were similar in non-fatal myocardial infarction (OR=0.72, 95%CI 0.47 to 1.10, P=0.05), stroke (OR=0.66, 95%CI 0.38 to 1.16, P=0.15), and hemorrhage (OR=1.03, 95%CI 0.74 to 1.44, P=0.85) with no significant difference; b) the TAT group was superior to the DAT group in reducing the incidences of the major cardiovascular and cerebrovascular events (MACCE) (OR=0.50, 95%CI 0.39 to 0.65, P < 0.000 01), cardiac death (OR=0.53, 95%CI 0.33 to 0.84, P=0.007), stent thrombosis (OR=0.52, 95% CI 0.27 to 0.99, P=0.05), target vessel revascularization (OR=0.63, 95%CI 0.51 to 0.76, P < 0.000 01), and target lesion revascularization (OR=0.44, 95%CI 0.28 to 0.70, P=0.000 6); and c) no significant difference was found between the two groups in the incidences of thrombocytopenia, leucopenia, and liver damage. The DAT group was superior to the TAT group in gastrointestinal reaction, palpitations, headache, and skin rashes between the two groups, with significant differences. ConclusionTAT therapy has good efficacy and safety in the treatment of patients with coronary heart diseases after percutaneous coronary intervention.
Carney triad is a rare tumor syndrome with few reports. This case showed the enhanced CT and MRI images of a rare young woman patient with Carney triad (containing gastric stromal tumor, renal cell carcinoma, adrenal pheochromocytoma, and pulmonary chondrosarcoma), which is intended to provide a reference for clinical diagnosis and differential diagnosis. This case reminds the radiologists and clinicians that the patients with a history of primary gastrointestinal stromal tumor and neoplastic lesions occurring at specific sites (pulmonary chondrosarcoma, adrenal pheochromocytoma, renal cell carcinoma, etc.) need to be alerted to the possibility of combining with Carney triad.
目的:观察两种常用一线根除幽门螺杆菌(H.pylori)三联方案在本地区(成都市)的疗效。方法:纳入70例诊断为消化性溃疡、慢性糜烂性胃炎、慢性萎缩性胃炎伴H.pylori感染的患者。随机分为A、B两组。A组采用埃索美拉唑(E)20 mg bid+克拉霉素(C)500 mg bid+甲硝唑(M)400 mg bid,B组采用E 20 mg bid+ C 500 mg bid+阿莫西林(A)1.0g bid治疗,疗程7天。H.pylori根除失败者以1周四联方案:E 20 mg bid+胶体次枸櫞酸铋(B)220 mg bid+呋喃唑酮100 mg bid+ A1.0g bid治疗,观察疗效。结果:64例完成实验。三联方案H.pylori根除率:A组62.5%,B组84.4%,有显著差异(Plt;0.05)。二线四联方案根除率94.1%。结论:ECA方案H.pylori根除率明显高于ECM方案,可能更适合于本地区根除H.pylori的一线治疗,EBFA方案作为二线治疗具有较高疗效。
Diagnosis and surgical procedures were studied in this paper. Twentyfive cases of insulinoma were treated surgically from 1970 to 1997, in which 10 patients had Whipple′s triad so that the early diagnosis could be made. The sites of tumours were found in 10 out of 12 undergoing. Selective celiac angiongraphy with the accuracy rate of 83%, but B-ultrasonography and CT gave only 10% (4 out of 25) and 40%(8 out of 20) respectively. In this series, 5 cases underwent bodytail pancreatectomy and 20 cases enucleation of insulinoma. Blood glucose levels were tested during operation in 15 cases, and they all reached the normal level one hour after the tumours were completely removed. The authors consider that Whipple′s triad is the main basis in diagnosis of insulinoma. The selective celiac angiongraphy play an important role in detecting and locating the tumour. If diagnosis is made, surgical operation should be taken. The blood glucose monitoring during operation is the hallmark for complete resection of insulinomas.