Giant bile duct dilatation in newborn: A case report.

BACKGROUND: Giant congenital biliary dilation (CBD) is a rare condition observed in clinical practice. Infants born with this condition often experience a poor overall health status, and the disease progresses rapidly, leading to severe biliary obstruction, infections, pressure exerted by the enlarged CBD on abdominal organs, disturbances in the internal environment, and multiple organ dysfunction. The treatment of giant CBD using laparoscopy is challenging due to the high degree of variation in the shape of the bile duct and other organs, making it difficult to separate the bile duct wall from adjacent tissues or to control bleeding. CASE SUMMARY: Herein, we present the details of an 11-d-old male newborn who was diagnosed with giant CBD. The patient was admitted to the neonatal surgery department of our hospital due to a history of common bile duct cyst that was detected more than 3 mo ago, and also because the patient had been experiencing yellowish skin for the past 9 d. The abnormal echo in the fetal abdomen was first noticed by the patient's mother during a routine ultrasound examination at a local hospital, when the patient was at 24 wk + 6 d of pregnancy. This finding raised concerns about the possibility of congenital biliary dilatation (22 mm × 21 mm). Subsequent ultrasound examinations at different hospitals consistently confirmed the presence of a congenital biliary dilatation. No specific treatment was administered for biliary dilatation during this period. A computed tomography scan conducted during the hospitalization revealed a large cystic mass in the right upper quadrant and pelvis, measuring approximately 9.2 cm × 7.4 cm × 11.3 cm. Based on the scan, it was classified as a type I biliary dilatation. CONCLUSION: The analysis reveals that prenatal imaging techniques, such as ultrasound and magnetic resonance imaging, play a crucial role in the early diagnosis, fetal prognosis, and treatment plan for giant CBD. Laparoscopic surgery for giant CBD presents certain challenges, including difficulties in separating the cyst wall, anastomosis, and hemostasis, as well as severe biliary system infection and ulceration. Consequently, there is a high likelihood of converting to laparotomy. The choice between surgical methods like hepaticojejunostomy (HJ) or hepaticoduodenostomy has not been standardized yet. However, we have achieved favorable outcomes using HJ. Preoperative management of inflammation, biliary drainage, liver function protection, and supportive treatment are particularly vital in improving children's prognosis. After discharge, it is essential to conduct timely reexamination and close follow-up to identify potential complications.

Correlations between drug resistance of Beijing/W lineage clinical isolates of Mycobacterium tuberculosis and sublineages: a 2009-2013 prospective study in Xinjiang province, China.

BACKGROUND: The prevalence of drug-resistant tuberculosis (TB) in Xinjiang is higher than in other regions of China, and Beijing/W lineage Mycobacterium tuberculosis (MTB) is the dominant strain of MTB in Xinjiang. However, information on multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB, particularly the correlation between MDR and the Beijing/W lineage and the correlation between drug resistance and the Beijing/W sublineage strains, is limited. MATERIAL/METHODS: We conducted a prospective study to describe the prevalence of MDR/XDR TB, Beijing/W lineage and sublineage strains in Xinjiang in China from 2009 to 2013. All MTB underwent drug susceptibility testing to the first- and second-line anti-tuberculosis drugs. The Beijing/W lineages and sublineages were detected by large-sequence polymorphisms with polymerase chain reaction. RESULTS: A total of 410 clinical isolates were identified. The overall percentage of MDR and XDR cases in Xinjiang was 13.2% (54/410) and 13.0% (7/54), respectively. Overall, 9.8% (14/143) of the Beijing lineage MTB were MDR patients, and 15.6% (40/257) of the Non-Beijing lineage MTB were MDR patients. In the 143 Beijing MTB lineages, 11.2% isolates were in sublineage 105, 15.4% isolates were in sublineage 207, 69.2% isolates were in sublineage 181, and 4.2% isolates were in sublineage 150. None of the isolates were detected in sublineage 142. Significant differences between the Beijing/W and non-Beijing/W strains were observed regarding INH and EMB resistance, respectively. CONCLUSIONS: The prevalence of the MDR TB in Xinjiang remains high and imposes challenges for TB control. Four Beijing/W sublineage isolates were observed in Xinjiang. There was no correlation between MDR and the Beijing/W lineage and no correlation between drug resistance and the Beijing/W sublineage strains. Surveillance of the clinical isolates of MTB is recommended to strengthen the identification of MDR/XDR TB and sublineages of the Beijing/W strains.

Elevated homocysteine and hypertension in Xinjiang Province, China.

BACKGROUND: Few data are available comparing homocysteine (Hcy) levels in patients with hypertension in different ethnic groups. OBJECTIVES: This study sought to determine whether there are associations of blood pressure and Hcy levels in patients with hypertension from Xinjiang Province, China. METHODS: We examined the serum total Hcy levels in a total of 451 Chinese of various ethnic groups (Han n=234 [51.9%], Uygur n=102 [22.6%], Kazak n=61 [13.5%], Hui n=54 [12.0%]) aged 18-78 years. Two groups of subjects were studied: 1) non-hypertensive, n=101; (2) hypertensive, n=350. We investigated the serum Hcy levels relationship with hypertension. RESULTS: Hcy levels of Kazak in no hypertension and hypertension patients were highest (11.9 +/- 9.8 vs 19.0 +/- 11.8 umol/L, respectively, unadjusted P=.004, adjusted P=.016). This pattern of higher Hcy values in hypertension patients was consistent across all ethnic groups even after adjustment (all P<0.05). The hypertension risks in the elevated Hcy (>13.9 umol/L) was 3.5 (95% CI, 2.2-5.4) times the normal Hcy (< or = 13.9 umol/L) (P<0.001). Even after adjustment for potential confounders, this difference remained 3.1 times higher (95% CI, 1.9-4.8) (P<.001). Bivariate correlation analysis revealed a statistically significant relationship of Hcy with systolic or diastolic blood pressure across all ethnic groups. CONCLUSION: This study confirms the existence of a significant association between hypertension and Hcy in Chinese population groups.