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Objective:To investigate the risk factors of Crohn′s disease (CD)-related gastrointestinal stenosis, and to summarize and analyze the corresponding treatments.Methods:From January 2010 to December 2018, 122 patients diagnosed with CD and hospitalized in the Seventh Medical Center, PLA General Hospital were selected including 72 patients in gastrointestinal stenosis group and 50 patients in non-gastrointestinal stenosis group. The gender, age of onset, course of disease, location of lesions involved (Montreal classification), disease activity, extraintestinal manifestations, application of therapeutic drugs, and complications were compared between the two groups. The treatment of CD patients with gastrointestinal stenosis was analyzed. Multivariate logistic regression was used to analyze the risk factors of CD patients with gastrointestinal stenosis. The independent sample t test, Mann-Whitney U test and chi-square test were used for statistical analysis. Results:The age of onset of patients in gastrointestinal stenosis group was older than that in non-gastrointestinal stenosis group ((37.6±15.1) years old vs. (30.8±14.7) years old), and course of disease was longer than that of non-gastrointestinal stenosis group (72 months, 11 to 492 months vs. 45 months, 3 to 240 months); and the differences were statistically significant ( t=-2.044, Z=-2.770; P=0.018, 0.006). The proportion of patients with ileum involvement of the gastrointestinal stenosis group was lower than that of the non-gastrointestinal stenosis group (69.4%, 50/72 vs. 86.0%, 43/50), and the proportion of severe patients was higher than that of the non-gastrointestinal stenosis group (15.3%, 11/72 vs. 4.0%, 2/50); and the differences were statistically significant ( χ2=4.463 and 3.942, P=0.035 and 0.047). There were no significant differences in gender, use of therapeutic drugs, extraintestinal manifestations, application of therapeutic drugs or the incidence of complications between the patients of two groups (all P>0.05). The results of multivariate logistic regression showed that the age of onset and course of disease were risk factors of CD-related gastrointestinal stenosis ( β=0.028, odds ratio ( OR)=1.028, 95% confidence interval ( CI) 1.000 to 1.056, P=0.046; β=0.008, OR=1.008, 95% CI 1.002 to 1.015, P=0.013). Further stratified analysis revealed that the incidence rates of CD-related gastrointestinal stenosis in patients with age of onset over 40 years old and course of disease more than five years were higher than those of patients with age of onset less than 40 years old and course of disease less than five years (76.3%, 29/38 vs. 51.2%, 43/84; 68.4%, 39/57 vs. 50.8%, 33/65), and the differences were statistically significant ( OR=3.072, 95% CI 1.298 to 7.272, P=0.009; OR=2.101, 95% CI 1.002 to 4.406, P=0.048). Among the 72 CD patients with gastrointestinal stenosis, 15 cases (20.8%) were treated with medicine and nutrition, without endoscopic or surgical treatment. Fifty-two patients (72.2%) underwent surgical treatment, among them six patients (11.5%) received twice surgery, the interval between the two operations was 46 months (1 to 204 months), and eight patients (15.4%) had postoperative complications. Twenty-one patients (29.2%) were treated with endoscopic dilatation, and no complications occurred after surgery. Five patients (23.8%) underwent surgical treatment during the follow-up period. Conclusions:The age of onset over 40 years old and the course of disease more than five years are the risk factors of CD-related gastrointestinal stenosis. Individualized medical treatment is the basis for the treatment of CD-related gastrointestinal stenosis. Surgery is still the main treatment. The endoscopic treatment is safety and can delay or avoid surgery to a certain extent.
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Objective@#To explore the valuable indicators for differential diagnosis by comparing the clinical features of Crohn′s disease (CD) with primary intestinal lymphoma (PIL).@*Methods@#From 2010 to 2017, at The Seventh Medical Center of PLA General Hospital, a total of 91 patients diagnosed with CD or PIL were enrolled, including 76 cases of CD, 14 cases of PIL and one case of CD with secondary lymphoma. The clinical data of enrolled patients were retrospectively analyzed. T-test, non-parametric test and chi-square test were used for statistical analysis.@*Results@#The average age at diagnosis of CD patients was (37.7±16.0) years, which was younger than that of PIL patients (52.6±19.6) years, and the difference was statistically significant (t=-3.085, P=0.003). The median duration of CD was 36.0 months, which was longer than that of PIL (3.5 months), and the difference was statistically significant (Z=-3.616, P<0.01). Abdominal pain and extra-intestinal manifestations (oral ulcers, joint injuries, erythema nodosum and perianal lesions) were more common in CD patients, and the differences were all statistically significant (χ2=9.427 and 5.173, both P<0.05). CD patients were not diagnosed by colonoscopic biopsy alone. Totally 13 of 14 patients were diagnosed by colonoscopic biopsy and immunohistochemisty and one patient was diagnosed after surgery. The diagnostic rate of pathological biopsy in PIL group was significantly higher than that in CD group (χ2=82.584, P<0.01). One patient was initially clinically diagnosed as CD, and then developed secondary lymphoma after five times of infliximab treatment.@*Conclusions@#The diagnosis of CD is generally supported by young age, long course of disease, abdominal pain and extra-intestinal manifestations. The diagnostic rate of colonoscopic biospsy in PIL patients is higher than that in CD patients.
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Objective To explore the valuable indicators for differential diagnosis by comparing the clinical features of Crohn′s disease (CD)with primary intestinal lymphoma (PIL). Methods From 2010 to 2017,at The Seventh Medical Center of PLA General Hospital,a total of 91 patients diagnosed with CD or PIL were enrolled, including 76 cases of CD,14 cases of PIL and one case of CD with secondary lymphoma. The clinical data of enrolled patients were retrospectively analyzed. T-test,non-parametric test and chi-square test were used for statistical analysis. Results The average age at diagnosis of CD patients was (37. 7 ± 16. 0)years,which was younger than that of PIL patients (52. 6 ± 19. 6)years,and the difference was statistically significant (t = - 3. 085,P = 0. 003). The median duration of CD was 36. 0 months,which was longer than that of PIL (3. 5 months),and the difference was statistically significant (Z = - 3. 616,P < 0. 01). Abdominal pain and extra-intestinal manifestations (oral ulcers,joint injuries,erythema nodosum and perianal lesions)were more common in CD patients,and the differences were all statistically significant (χ2 = 9. 427 and 5. 173,both P < 0. 05). CD patients were not diagnosed by colonoscopic biopsy alone. Totally 13 of 14 patients were diagnosed by colonoscopic biopsy and immunohistochemisty and one patient was diagnosed after surgery. The diagnostic rate of pathological biopsy in PIL group was significantly higher than that in CD group (χ2 = 82. 584,P < 0. 01). One patient was initially clinically diagnosed as CD,and then developed secondary lymphoma after five times of infliximab treatment. Conclusions The diagnosis of CD is generally supported by young age,long course of disease,abdominal pain and extra-intestinal manifestations. The diagnostic rate of colonoscopic biospsy in PIL patients is higher than that in CD patients.
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ObjectiveTo analyze the clinical characteristics of patients treated with multiple therapeutic endoscopic retrograde cholangiopancreatography (ERCP) procedures and to evaluate the causes, safety, and efficacy of repeated ERCP. MethodsAnalyses of therapeutic results, complications, and postoperative outcomes were performed on the clinical data of the patients who were admitted to Beijing Army General Hospital and received ERCP at least twice from July 2010 to December 2014. ResultsSeventy-seven patients underwent 187 times of ERCP procedures in total, among which 2 times were performed in 60 patients, 3 times in 6 patients, 4 times in 8 patients, 5 times in 2 patients, and 7 times in 1 patient. Postoperative events included hemorrhea after endoscopic sphincterotomy in 2 cases, post-ERCP pancreatitis in 2 cases, duodenal perforation in 1 case, and death within 3 weeks after ERCP in 2 cases due to chronic obstructive pulmonary disease. ConclusionRecurrent common bile duct stones, inflammatory stenosis of the bile duct, chronic pancreatitis, and prolonged survival of malignant tumor patients are the main reasons for repeated ERCP. The patients aged over 80 years are more likely to undergo multiple ERCP procedures. Repeated ERCP shows good overall safety and efficacy.
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ObjectiveTo analyze the clinical characteristics of patients treated with multiple therapeutic endoscopic retrograde cholangiopancreatography (ERCP) procedures and to evaluate the causes, safety, and efficacy of repeated ERCP. MethodsAnalyses of therapeutic results, complications, and postoperative outcomes were performed on the clinical data of the patients who were admitted to Beijing Army General Hospital and received ERCP at least twice from July 2010 to December 2014. ResultsSeventy-seven patients underwent 187 times of ERCP procedures in total, among which 2 times were performed in 60 patients, 3 times in 6 patients, 4 times in 8 patients, 5 times in 2 patients, and 7 times in 1 patient. Postoperative events included hemorrhea after endoscopic sphincterotomy in 2 cases, post-ERCP pancreatitis in 2 cases, duodenal perforation in 1 case, and death within 3 weeks after ERCP in 2 cases due to chronic obstructive pulmonary disease. ConclusionRecurrent common bile duct stones, inflammatory stenosis of the bile duct, chronic pancreatitis, and prolonged survival of malignant tumor patients are the main reasons for repeated ERCP. The patients aged over 80 years are more likely to undergo multiple ERCP procedures. Repeated ERCP shows good overall safety and efficacy.
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<p><b>OBJECTIVE</b>To study the clinical diagnosis and preoperative management of carotid body tumor.</p><p><b>METHODS</b>A total of 24 cases with carotid body tumors underwent surgery from 2003 to 2013 were reviewed. The clinical and imaging features, treatment and prognosis were retrospectively evaluated. Five of the 24 patients were males and 19 were females. Twenty-three cases were benign and one case was malignant. Seven of the 24 patients had bilateral tumors.</p><p><b>RESULTS</b>Nineteen of twenty-four patients underwent digital subtraction angiography (DSA) and temporary balloon occlusion (TBO) test, and one case of them was positive in the test. Twenty-three benign case were treated with operation. The malignant one treat with biopsy. Three cases underwent resection of tumors with both the internal and external carotid arteries without carotid reconstruction, and none of the three patients died or presented with hemiplegia after operation. Twenty-three benign cases were followed up for 6-122 months, the median was 75 months. The malignant patient died 6 months after operation.</p><p><b>CONCLUSION</b>TBO and DSA are reliable and practical methods to determine the safety of carotid ligation and can be used as routine preoperative examinations.</p>
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Female , Humans , Male , Angiography, Digital Subtraction , Carotid Artery, External , Carotid Body Tumor , Diagnosis , Pathology , Retrospective StudiesABSTRACT
Objective To establish the DNA fingerprint of microflora of some intestinal diseases such as ulcerative colitis (UC),acute gastroenteritis (AG) and irritable bowel syndrome (IBS),and analyze the structural characteristics of such fingerprints. Methods Thirty seven patients with intestinal diseases,definitely diagnosed by coloscopy as UC (20 cases),IBS (6 cases) and AG (11 cases),and 11 healthy people as control were involved in the present study. The total DNA was extracted from the fecal samples,and enterobacterial repetitive intergenic consensus sequence-polymerase chain reaction (ERIC-PCR) was used to set up the DNA fingerprint of intestinal microflora. The differences existed among the fingerprint profiles of intestinal microflora were compared. Results The numbers of DNA bands were obviously less in UC patients than in IBS and AG patients and healthy subjects,implying that significant differences existed in the intestinal microflora among UC and AG patients and healthy subjects. The principal band of DNA fingerprint in 17 UC patients appeared at 0.7kb,and 2 main DNA bands existed at 0.8kb and 1.1kb in AG patients,while no principal band was found in the DNA fingerprint of the IBS patients and healthy subjects. Conclusions It is likely that a single principal microflora is presented in the intestinal tissue of UC patients,which might be responsible for the morbidity of UC.